Body Positivity vs. Fat Acceptance: Why It Matters

Body image is a hot topic nowadays. It seems to be talked about just about everywhere, from social media to TV.

Society’s evolving standards around beauty have shaped so many of us, many for the worst, so it is refreshing to see people finally standing up. Over the last decade or so, trends have shifted away from enduring beauty standards of thinness, with greater talk about “body positivity” and “fat acceptance."

This made me wonder how much the makeup of our bodies (our weight, for instance) matter to our health. Does it matter a little, a lot, or not at all? In my quest to uncover the answer, I did some research on the subject matter and came away quite shocked.

Highlights

Body standards in the US have always been trend-based and Eurocentric, with little regard for different ethnicities and body types.

Body positivity and fat acceptance are not synonymous with each other; fat acceptance aims to fight discrimination against larger bodies, while body positivity extends to attributes such as cellulite, scars, disabilities, disfigurements, stretch marks, and height.

Body weight isn't the only determinant of health, nor is it the most relevant one, and there is evidence-based research to support being healthy and technically overweight at the same time.

Body Standards in America: A Blast From The Past

Before we get into the surprising truth about how much weight matters and its relevance to our health, it’s helpful to briefly highlight how body standards have shifted in the U.S. over the last hundred years or so. Without understanding our history with body image as a country, it’s impossible to understand why we are where we are today.

The sad fact is that what is deemed a “desirable” body type has always been trend-based. Although historically the pressures have always been largely directed at women to be beautiful, thin, etc., men are also shaped by body image standards, though their standards are fairly consistent throughout history, with the exception of hair and other style changes.

The male body standard in the West has always looked something like this: tall, muscular, v-shaped torso, narrow-hipped, chiseled face and jaw, deep voice, and preferably with tan or darker skin.

Picture Michelangelo's David statue and you have the “ideal” male physique that so many men strive endlessly for.

It’s also important to keep in mind that many of the beauty standards that shape us are based largely on Eurocentric features and beauty standards with little regard for different ethnicities and body types.

For females, I have depicted those evolving trends with a timeline [1]:

Body Positivity Vs. Fat Acceptance

In an effort to challenge long-enduring standards of thinness that have arguably lasted from the 1960s to the mid-2010s, there has been an upsurge in voices promoting body positivity and fat acceptance in the media.

There have also been more fat-accepting role models like Tess Holiday and Lizzo that show us bigger bodies can be beautiful–not just thin ones.

In an effort to better understand these movements and the impact they are having on societal body image, I researched both body positivity and fat acceptance and was surprised to learn they are not synonymous with one another.

So what makes them different and why does this difference even matter?

Fat acceptance is focused more on preventing discrimination against overweight people specifically [2]. It deems larger bodies inherently worthy with no need to change and aims to fight discrimination against larger bodies in various industries such as the workplace, healthcare, transportation (for example, having to buy two seats on an airplane), and fashion.

Even though fat acceptance seems to be all the talk now, the movement actually began alongside the prominent civil rights movement in the 1960s.

The fat acceptance movement is more politically driven and more about exposing the barriers larger bodies face against society and using legal action to fight anti-fat bias. The term “body positivity” is a lot more general and does not pertain exclusively to larger-bodied individuals.

In addition to empowering all people to love and accept their bodies, the emphasis goes beyond weight, extending to attributes such as cellulite, scars, disabilities, disfigurements, stretch marks, height, and other traits not necessarily tied to weight.

Body positivity has also been criticized for being overly commercialized and a PR gimmick for businesses. It seems like just about everywhere you can find the hashtag #Bopo (Body Positivity), especially on social media when fashion and beauty companies are promoting their brands.

Can You Be Healthy and Overweight?

It's good that society is trending in a more body-positive direction, but I have often wondered what science says. Is there any evidence-based research to support being healthy and technically overweight at the same time?

The reality is that body weight isn’t the only determinant of health, nor is it the most relevant one for many reasons we will explore.

First, when you look at the true definition of weight it is more of a physics term. Weight is the amount of force acting on an object due to gravity. That’s it! That is all the scale can show us.

The other issue is that we tend to think of fat as all being the same, but in reality, there are different types of fat, and the type of fat you have is more important than how much of it you have. The main fat types are subcutaneous and visceral fat. Subcutaneous fat is found just under the skin. It's the kind you can pinch and the kind most people are concerned about losing.

The Type and Location of Fat Matters More Than the Amount

Visceral fat is the fat you can’t see. It’s located deep behind your abdominal muscles and surrounds and protects organs in your torso such as your heart, kidneys, and intestines.

As it turns out, the fat just under your skin is pretty benign. Fat is meant to be stored in fat cells. The fat that is actually dangerous and associated with obesity-related metabolic ailments we tend to think of like heart disease and type two diabetes is visceral fat, or the fat surrounding our organs, or yet a third kind of fat that accumulates within our organs like the liver, muscles, and pancreas called ectopic fat.

That is because this internal fat is metabolically active and more likely to produce inflammatory chemicals that can precipitate metabolic dysfunction like insulin resistance–a precursor to type two diabetes. So if your fat jiggles, it’s probably fine. In fact, some research even shows that this kind of fat might even be protective, and the more subcutaneous fat you have, the healthier you are [3].

So the type/location of fat you have matters more than the amount you have. This likely explains why as many as 22% of obese people show no evidence of metabolic dysfunction [4]. In fact, being skinny-fat is far more dangerous for your health or “thin on the outside, fat on the inside” (TOFI), even though these people often appear outwardly slender [5].

And other studies show that cardiorespiratory fitness and exercise can significantly reduce or even eliminate much of the increased mortality associated with being overweight or obese. In simpler words, you could very well be healthy and overweight if you’re active [6].

Impact of Weight on the Body Depends on Genetics and Race

We also must remember that the impact of weight on the body depends highly on genetics, but most lab ranges and medical research, in general, are based on white, male populations–not women of color, for example. This can be deeply skewing.

For example, African Americans tend to have a higher bone density and muscle mass compared to whites, which increases our overall body weight. For that reason, most African Americans do not start showing signs of metabolic distress until a BMI of around 35, but because Caucasians start seeing signs of illness at a BMI of only 30, the overweight BMI cap is set to 30 [7].

Asians start seeing signs of metabolic distress at a much lower BMI of 25, and for this reason, African American women can carry about 27 more pounds than an Asian woman of the same height before the extra weight causes any sort of negative health impact. We will go more into BMI and its implications in the next section, but now you can see just a few reasons why body weight alone is not as important as you think it is.

Is BMI A Good Indicator of Health?

BMI or Body Mass Index is a measure of a person’s weight divided by their height that doctors used to determine what weight range a person falls in. A weight of 18.5-24.9 is considered “healthy” but BMI has undergone much scrutiny in recent years, and for good reason.

For example, did you know that people in the 25-29.9 or “overweight” BMI live longer than people who stay in either the normal or obese BMI range all their lives [8]? That was not a typo.

Here are some of BMI’s other major flaws:

BMI cut-offs are based solely on the Caucasian population
Ethnic differences not considered
No distinction between the sexes
No distinction between body types or frame size
No distinction in body composition (muscle vs bone vs fat, etc) so thicker-boned and muscular people have an elevated BMI
No distinction between body fat percentage or more importantly visceral fat
No distinction of body fat distribution (i.e - fat stored in the abdominal area vs. thighs)
A healthy BMI does not automatically indicate good health and a higher BMI does not automatically indicate poorer health
Personal genetics not accounted for

This is not to say weight and BMI have zero relevance to your health, but weight must be taken in the context with the other markers of your health such as your cardiorespiratory fitness level, fat type and distribution (visceral vs. subcutaneous), ethnicity, age, gender, lab work results, and personal genetics.

So since BMI is overall a pretty lousy indicator of health, this begs the question, what are some better tools for evaluating our health? Here is a couple:

Work with your healthcare provider to assess labs/stats for metabolic health like blood pressure, markers for insulin resistance like HOMA-IR, blood sugar, liver enzymes, blood lipids, CRP, and visceral fat. If these markers are in good shape, it’s unlikely your weight is much of a concern.
Since visceral fat is the real fat we should be concerned about, assessing this kind of fat is usually more meaningful than your BMI. You can estimate visceral fat with things like waist circumference and waist-to-height ratio calculators or do the “squeeze” test. If you store fat in your abdomen and most of it can be easily squeezed, it's mostly subcutaneous, but if your belly is large but firm, you likely have elevated visceral fat. A bioelectrical impedance scale can also be used to estimate visceral fat since it measures your body composition. CT scans are sometimes used but they are more invasive and less accessible, but you could ask your doctor if you're interested in trying this method.

Here’s the good news if you do have elevated visceral fat: you only need to lose about 5% of your body weight to be metabolically healthy again. That’s because your body prioritizes shedding this type of fat first. That’s only about 12 pounds if you are 250 pounds, a far cry from the 100 pounds you would be advised to lose in order to reach a “normal” BMI.

And even if you don’t lose any weight but focus on a high fiber, low sugar diet (sugar promotes visceral fat storage) you may be able to shift the type of fat your body stores to a healthier ratio, meaning your body favors subcutaneous over visceral fat storage [9,10]. Now, that’s power.

Conclusion

We all struggle with body image, but understanding the role society plays in shaping how we feel about ourselves is very empowering. It's amazing how far a little dose of truth goes.

By applying the Ancestral Wisdom model and its compassionate focus on loving our bodies, I have helped many people not only become healthier but build a much greater appreciation for their bodies regardless of their weight. That’s one more reason to book a session with me today and ensure a healthier future for yourself.

References:

Edwards V. Beauty Standards: See How Body Types Change Through History. Science of People. Published January 27, 2015. Accessed January 5, 2023.

https://www.scienceofpeople.com/beauty-standards/#roaring-twenties-c-1920s

Nittle N, Seide M, Johnson A. What Is Fat Acceptance? Verywell Mind. Updated August 20, 2021. Accessed January 5, 2023. https://www.verywellmind.com/what-is-fat-acceptance-5186913
Porter SA, Massaro JM, Hoffmann U, Vasan RS, O'Donnel CJ, Fox CS. Abdominal subcutaneous adipose tissue: a protective fat depot? Diabetes Care. 2009 Jun;32(6):1068-75. doi: 10.2337/dc08-2280. Epub 2009 Feb 24. PMID: 19244087; PMCID: PMC2681034. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2681034/#:~:text=In%20addition%20to%20the%20detrimental,of%20abdominal%20fat%20(9).
Hamer M, Stamatakis E. Metabolically healthy obesity and risk of all-cause and cardiovascular disease mortality. J Clin Endocrinol Metab. 2012 Jul;97(7):2482-8. doi: 10.1210/jc.2011-3475. Epub 2012 Apr 16. PMID: 22508708; PMCID: PMC3387408.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3387408/

E.L. Thomas et al., “The Missing Risk: MRI and MRS Phenotyping of Abdominal Adiposity and Ectopic Fat,” Obesity 20 (2012): 76-87
Study Finds Exercise Is More Important than Weight Loss for a Longer Life. Men’s Health. Published October 4, 2021. Accessed January 5, 2023. Menshealth.com
Y.W. Park et al.,”The Metabolic Syndrome: Prevalence and Associated Risk Factor Findings in the US Population from the Third National Health and Nutrition Examination Survey, 1988-1994,” Arch. Intern. Med. 163 (2003): 427-36.
Ohio State University. Survival tip: Start at a normal weight and slowly add pounds: Study finds those who gradually get overweight live the longest. ScienceDaily. Published February 2, 2021. Accessed January 6, 2023. https://www.sciencedaily.com/releases/2021/02/210202085451.htm#:~:text=Summary%3A,normal%20range%20throughout%20their%20life.
American Heart Association. Sugar-sweetened drinks are linked to increased visceral fat. ScienceDaily. January 12, 2016. Accessed January 6, 2023. https://www.sciencedaily.com/releases/2016/01/160111162752.htm

Plain, C. Excess sugar linked to dangerous heart and abdominal fat. University of Minnesota School of Public Health. Published July 15, 2020. Accessed January 6, 2023. https://www.sph.umn.edu/news/excess-sugar-linked-to-dangerous-heart-and-abdominal-fat/

Body Positivity vs. Fat Acceptance: What's the Difference and Why Does it Matter?

Body Standards in America: A Blast From The Past

Body Positivity Vs. Fat Acceptance

Can You Be Healthy and Overweight?

The Type and Location of Fat Matters More Than the Amount

Impact of Weight on the Body Depends on Genetics and Race

Is BMI A Good Indicator of Health?

Conclusion

Related Questions:

How have body standards evolved in the US over the past 100 years?

What is the difference between body positivity and fat acceptance?

When did the fat acceptance movement begin?

Is there evidence-based research to support being healthy and technically overweight at the same time?

What are some criticisms of body positivity?

References:

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