Just Another Four-Letter Word

Bias is one of those words that we may think we know the meaning of, like having a preference for something, but there is more to it than that. “Bias” hints that perhaps the judgment behind the relevant opinion is ill-informed, unfair, or just plain ignorant.

When people, including many professionals in medicine and psychology, use the term, they do not always seem aware that such prejudice is unfair and unjustified. And yet, we occasionally find writers who feel compelled to go to a great deal of trouble to explain the difference between informed opinion and ugly bias.

One of the major figures in this area has been Aubrey Gordon, a book author, podcaster, and advocate of fat acceptance, who for the first few years of her writing career used the pseudonym Your Fat Friend. A documentary film has been made about her.

Your Fat Friend zeroes in and names names

Early in 2020, Gordon published an article that severely criticized a popular TV series, “The Biggest Loser,” calling it one of the most harmful reality shows on the air. The host, Jillian Michaels (characterized as a celebrity fitness trainer), seemed to want to have things both ways, by insisting that her own attitude toward overweight people was “inclusive,” while at the same time accusing the popular entertainer Lizzo of glorifying obesity.

Gordon pointed out that the show actually popularized a logic of abuse, blaming the hopeful weight losers for their own sad situations. Michaels, she wrote, had a “lengthy history of publicly shaming, humiliating, and even publicly abusing fat people, and went on to say that,

The show promoted its trainers as providing “tough love” motivation, but many former contestants describe their experiences differently. In 2016, the Guardian compiled a list of Michaels’ most infamous insults, which range from demeaning to outright violent toward contestants… In the world of The Biggest Loser, its fat contestants were abject failures, wretched people who could be saved only by the trainers who humiliated them.

It was strongly suggested that rather than having good intentions, the TV series actually specialized in promoting the dirty four-letter word, bias. As an example of societal bias, in another essay Gordon brought up an unbelievably callous custom practiced by a Cornell University fraternity, the “pig roast, a contest that awarded points to fraternity members for sleeping with fat women.” With such a disgusting custom finding acceptance at one of the nation’s top providers of higher education, what hope could there ever be for the eradication of bias and the dawn of acceptance?

From Hastings Bioethics Forum

A couple of years back, endocrinologist Jody Dushay called out a seemingly harmless article about concerns in the ethical, policy, and public health areas, throughout which she nevertheless detected a strong undercurrent of bias.

Some experts claim that weight-loss meds should be prescribed sparingly because their use may divert patients from utilizing “good lifestyle choices” — an argument found inadequate by this medical weight management professional. To her ear, it sounded like unwarranted prejudice against people who live with obesity, eliciting the response,

When we elevate the bar for using pharmacotherapy to treat high body weight, we do so because, consciously or not, we are labeling obesity a disease of choice. My clinical experience informs my understanding that obesity is almost never entirely preventable, but bias against those with obesity certainly is.

It seems, in fact, entirely possible that the only truly reliably preventable aspects of obesity are personal bias and systemic bias.

Source: “Your Fat Friend,” IMDb.com, 2023
Source: “’The Biggest Loser’ Is One of the Most Harmful Reality Shows on Television,” Medium.com, 01/12/20
Source: “Why can’t we recognize fat anger?,” Medium.com, 02/26/18
Source: “What Is Preventable About Obesity?,” TheHastingsCenter.org, 09/16/24
Image by jobinscaria/Pixabay

Italy’s Childhood Obesity Crisis

For decades, Italy has been celebrated as the birthplace of the Mediterranean diet — a lifestyle centered on vegetables, legumes, whole grains, olive oil, fish, and fresh ingredients that has long been associated with good health and longevity. Today, however, many health experts say that image no longer reflects reality.

Italy is now facing a growing childhood obesity crisis, particularly in the country’s southern regions. The World Health Organization (WHO) reports that Italian children are among the most overweight in Europe, and communities around Naples have some of the highest childhood overweight rates in the country.

In a recent BBC article, 17-year-old Salvatore knows firsthand how devastating severe obesity can be. Weighing approximately 170 kilograms (375 pounds), even simple daily activities have become difficult. Walking is a struggle, tying his shoes is nearly impossible, and his scooter has repeatedly broken under the strain of his weight.

Doctors say his condition has become so severe that he cannot yet undergo bariatric surgery because the procedure would be too risky. Instead, physicians have prescribed a GLP-1 medication to help reduce his appetite and lower his weight enough to safely undergo surgery in the future.

His story reflects a larger trend that obesity specialists across Italy say they are seeing with increasing frequency. According to bariatric surgeon Dr. Sonja Chiappetta, the age of patients seeking treatment has dropped dramatically over the past decade.

Where severe obesity once primarily affected middle-aged adults, many patients are now teenagers, some as young as 16 years old. The increase has led to greater demand for bariatric procedures, which reduce stomach size and help patients eat less food.

For many young people, however, surgery is only one piece of treatment. Doctors often recommend weight-loss medications, nutrition counseling, and long-term lifestyle changes before surgery becomes an option.

So, what happened to the much-touted Mediterranean Diet? Researchers say Italy’s eating habits have changed substantially over the past several decades.

The traditional Mediterranean diet that once emphasized fresh produce, beans, seafood, whole grains, and olive oil has increasingly been replaced by highly processed foods, oversized portions, sugary drinks, and calorie-dense convenience meals.

Longevity researcher Dr. Valter Longo estimates that only a small percentage of Italians still consistently follow the traditional Mediterranean eating pattern.

Instead, he describes today’s diet as revolving around what he calls the “five Ps” — pizza, pasta, potatoes, protein, and pane, the Italian word for bread.

Even familiar foods have changed. Pizza, once relatively simple, is now commonly topped with fries, sausage, fried foods, and other calorie-rich ingredients that significantly increase its nutritional impact.

Pediatric obesity specialists say one of the biggest challenges is that many parents don’t realize their child has obesity. Children often arrive at medical appointments because of symptoms such as stomach pain, digestive problems, or chronic coughing, while excess weight goes largely unnoticed by their families.

Doctors explain that obesity usually develops gradually through everyday habits rather than one unhealthy meal. Frequent snacking, sugary beverages, highly processed foods, limited fruit and vegetable intake, and oversized portions can slowly contribute to unhealthy weight gain over time.

Many parents believe their children are active enough because they participate in sports or recreational activities. While physical activity is important, experts emphasize that exercise alone often cannot offset poor dietary habits.

Health professionals say cultural attitudes toward body weight can also delay intervention. In some Italian families, a child with rosy cheeks or extra weight may still be viewed as healthy rather than at risk for future medical problems.

Teachers have noticed this disconnect as well. Some educators report concerns about students whose weight may affect their health, yet conversations with families do not always lead to concern or action.

Experts believe schools can play an important role by teaching children about nutrition, hoping those lessons eventually influence family habits at home. Several regions of Italy have launched educational programs aimed at improving children’s nutrition knowledge.

One initiative in Naples will reach more than 17,000 students across dozens of schools while also providing resources for parents. The goal is to encourage healthier eating habits throughout the household rather than focusing solely on the child.

Not every student believes education alone will change behavior. Some teenagers acknowledge they already understand what foods are healthy but continue choosing junk food because it is convenient, appealing, and widely available.

Others believe nutrition education can still make a meaningful difference by helping young people understand the long-term consequences of their choices. Recognizing the complexity of obesity, Italy became the first country in 2025 to pass national legislation officially recognizing obesity as a chronic, progressive, and relapsing disease.

The law reflects a growing understanding that obesity is influenced by many factors beyond willpower, including genetics, biology, environment, food availability, culture, and socioeconomic conditions. This shift encourages healthcare providers to treat obesity as a medical condition requiring comprehensive care instead of simply blaming individuals for their weight.

For teenagers like Salvatore, these interventions represent more than weight loss; they offer the possibility of improved mobility, better health, and the opportunity to participate more fully in everyday life.

As Italy works to reclaim the healthy traditions that once defined its cuisine, healthcare professionals hope a renewed focus on nutrition, education, and comprehensive medical care can help reverse the growing childhood obesity epidemic before another generation is affected.

Your responses and feedback are welcome!

Source: “Pizza, pasta, potatoes, protein — how Italian children became so overweight,” BBC, 7/25/26
Source: “The country that inspired the Mediterranean diet is now battling a childhood obesity crisis. What went wrong?,” The Times of India, 7/26/26
Source: “Italy Faces Childhood Obesity Crisis Amidst Declining Mediterranean Diet,” Ratorarti.com, 7/27/26
Image by Klaus Nielsen/Pexels

You Like Po-tay-toe and I Like Po-tah-toe

Any person with no memory of that corny old song is not to be blamed in the least. The point that needs making is whether you call a belief system by the name of body acceptance, fat acceptance, body positivity, healthy at every size, or use some other terminology, it’s still the same old starchy vegetable.

Apparently, the whole subject kind of took a backseat with the arrival of weight-loss drugs on the open market. This is the conclusion offered by an AI source that was consulted just for fun, but it sounds about right. When asked how it formed that impression, AI referred us to a perfectly respectable publication, Psychology Today.

As journalist Mia Barnes reported,

The movement isn’t gone, but it’s not the cultural force it once was.

Many former adherents of the body positive philosophy have disappointed their fellow rebels by turning to the popular and increasingly affordable GLP-1 drugs, in the hope of cultivating a different sort of body to accept and feel positive about. Sadly, many true believers feel double-crossed just because some former comrades have reordered their priorities. The amount of mental energy used to express those emotions could be better employed elsewhere. Barnes goes on to say,

For some, it feels like a betrayal of the movement’s core values, while others argue that body positivity should include supporting people in making choices that align with their well-being — whatever that looks like for them.

She suggests that a healthy response to the debate is to adopt a philosophy of body neutrality, which includes protecting your sanity and emotional health by abandoning the destructive habits of self-criticism and comparison with others. Appreciation for one’s organs and limbs when they perform their jobs correctly, without causing pain, is an attitude that many disabled people would love the opportunity to experience just once in their lives.

But they are unable to escape; while at the same time, morbidly obese people, individuals who theoretically could transform themselves just by deciding to, roam the earth.

Some spiritual and mental-health schools of thought promote the idea that gratitude for the good we receive is a prerequisite for acquiring more psychological benefits. A “Sixties” quotation has probably stuck with a lot of people as they aged — “Praise all that you see, and more will appear.”

Ugly truths emerge

As previously mentioned, American landlords and employers are allowed to discriminate on the basis of weight — and this holds true in all but one state. But the ignominy worsens, because an organization that looks into these matters, the Council on Size and Weight Discrimination, has done enough research to state that “Fat people are even more prejudiced against fat people.”

Your responses and feedback are welcome!

Source: “So, Is the Body Positivity Movement Still a Thing?,” PsychologyToday.com, 01/23/25
Source: “Insight: America’s hatred of fat hurts obesity fight,” Reuters.com, 05/11/12
Image by RobinHiggins/Pixabay

One Woman’s Very Definitive Viewpoint

Who is Five Hundred Pound Peep? We may never know, but in 2001 she published an article about a major life change, then in 2010 followed it up with “Goodbye NAAFA and the rest: Why I left Size Acceptance.”

To assess the movement’s condition after an interval of almost a decade, she closely studied its “websites, publications, organizations and spokespeople” and concluded that it had noticeably shrunk. Yes, many if not most of its goals were praiseworthy — equal rights; no discrimination; plain old human decency (among other things) — but somehow it just wasn’t able to hang in there.

Two major organizations had formed — the National Association to Advance Fat Acceptance (NAAFA) and the International Size Acceptance Association (ISAA). There were also smaller groups with specialized aims like socialization and dance, but by 2010, the membership numbers had fallen off and the foundations were no longer just weakened, but at the stage that could justifiably be called “crumbling.” The author made some observations:

— Americans have gotten even fatter and corpulence is becoming even more reviled…
— The first reason Size Acceptance has not grown is it promotes fat rather then just dealing with it as a physical characteristic.
— Fat people can indeed be healthier and in better shape via exercise and better food, but some reality checks are in order.
— Physical realities come crashing through for those who suffer with obesity in its most severe forms.

The slogan “Health at any size” did not really catch on, because even the most zealous fat-acceptance enthusiasts were unable to maintain the notion that truly healthy health is possible once a person gets north of 400 pounds or so. Trying to maintain the ideal of good health at any size is a losing battle.

For a writer, the great advantage of having a place online where people can not only find you, but can also talk back, is a real boon — because it gives you even more to write about. And also, of course, it allows the writer to receive feedback from regular people, who say things like:

I cannot, with a clear conscience, advocate or agree with any movement that does not address the reality of the negative health consequences of severe obesity.

“Five Hundred Pound Peep” noted the absence of solid, serious medical studies focused on “supersized” individuals such as herself, and consistently made such solid points as,

— Imagine a kidney disease foundation telling those with kidney disease they must accept their condition. Fat people are told this is “your lot in life you must accept it”.
— “Fat” for most fat people is not their preferred way of being… for many it hurts, and makes everything harder to do.
— Obesity is seen like something like tallness, a normal part of person’s makeup.
— Repeating mantras of “Fat People are healthy,” even amid oxygen and wheelchair dependent people, very few are buying into the lie.

The author made the very painful point that, outside of the Size Acceptance clan, many obese people are not buying into the positive angle at all, but perceive SA as a population of “extremists who have given up.” She accused the size acceptance crowd of walling itself off to an inappropriate degree, and wondered out loud where the academic researchers might be who are “willing to face honestly the complexities of obesity.”

And according to the personal opinion of at least one public voice, namely “Five Hundred Pound Peep,” this sort of activity should have no place in the movement:

Some “size acceptance” websites, you will find obese women selling videos and nude photographs of themselves to the proverbial “FA” [or fat admirer]. Odd that objectification of fat women, has been one of the results of the “acceptance message.”

Increasing numbers of obese women came to see that the fat admirer (crudely known as the chubby chaser) really should have no place in this discussion. Technically, that extreme degree of fat admiration is what is known as a sexual fetish. But wait, it gets even worse.

One other debauched world is the one of “feeders” who seek to make their significant partner fatter and “feedees” who want to be fatter.

In other words, there are excellent reasons for the parents of overweight children to reject complacency or acceptance. Not wishing their daughters to grow up and star in sexual fetish porn is one of the strongest of those reasons.

Your responses and feedback are welcome!

Source: “Goodbye NAAFA and the rest: Why I left Size Acceptance,” Archive.is, 07/04/10
Images by Kyra_Starr/Pixabay

Yes to Prevention, But Also Access to Care

In her opinion piece in El Paso Matters, Dr. Lourdes Asiain, a pediatrician with more than 20 years of experience, makes a case for insurance coverage for treatment of obesity. We’ve also emphasized multiple times the importance of access to the best tools possible, not just to treat already-existing obesity but also to prevent it.

Fat-shaming and creating stigma around childhood obesity helps no one, and is likely coming from misguided notions and ignorance. We don’t know that person’s struggle, or their family’s. It might be an unfortunate side effect of a medical condition, or a side effect of the medication a person is taking for that condition. It might be caused by the situation in the family, or at school, or anywhere.

For years, childhood obesity has often been viewed as a problem that can be solved simply by eating less and exercising more. However, pediatric obesity specialists say that understanding has changed dramatically. Today, obesity is recognized as a complex chronic disease influenced by genetics, biology, hormones, environmental factors, and lifestyle — not a lack of willpower.

Despite significant advances in treatment, many families still struggle to access effective medical care because insurance coverage remains limited. As a result, children who could benefit from evidence-based therapies are often left without the support they need until serious health complications develop.

Childhood obesity continues to affect millions of young people across the United States. In Texas alone (where the author of the opinion piece lives), approximately one in four children between the ages of 6 and 17 is living with obesity, placing the state among those with the highest childhood obesity rates in the country.

We might sound like a broken record, but it’s worth repeating. Obesity can have lifelong consequences, such as an increased risk of developing diabetes, high blood pressure, sleep apnea, and more.

The effects extend beyond physical health. Many children also experience bullying, social isolation, anxiety, depression, and lower self-esteem, which can affect academic performance and overall quality of life.

Medical organizations increasingly emphasize that obesity should be treated like other chronic diseases. Instead of assigning blame, physicians encourage families to understand the biological factors that contribute to weight gain.

Dr. Asiain writes:

We would never tell a child with asthma, diabetes or cancer to simply “try harder” to overcome their condition. Yet, children living with obesity routinely face blame, stigma and judgment rather than receiving medical care. This stigma is uniquely destructive for young people still developing their sense of identity, confidence and self-worth.

Recognizing obesity as a disease rather than a personal failure can be transformative for families. It shifts the conversation away from guilt and toward treatment, allowing children and parents to focus on managing a medical condition instead of carrying unnecessary shame.

Today’s approach to pediatric obesity, Dr. Asiain points out, is far more comprehensive than it was just a decade ago. She writes:

Fortunately, medical science has advanced. Comprehensive obesity care includes nutrition counseling, behavioral interventions, physical activity support, FDA-approved medications, and, when clinically appropriate, metabolic and bariatric surgery — supported by telehealth to reach our rural communities. These treatments are not shortcuts. They are evidence-based medical interventions for a serious, costly chronic disease.

When patients in my practice have coverage for modern obesity treatments, the results are remarkable. I see significant weight loss, normalized lipid profiles and reversal of prediabetes.

While effective treatments exist, affordability remains one of the biggest obstacles for many families. Critics argue that insurance policies often cover illnesses caused by obesity, such as diabetes or heart disease, while refusing to pay for treatments that could help prevent those conditions in the first place. This creates a frustrating situation where families may be forced to wait until a child’s health worsens before coverage becomes available.

According to Dr. Asiain:

As physicians, we should never have to tell a suffering family that an effective treatment exists but is denied to them by an insurance loophole.

Experts agree that prevention remains essential. Access to healthy foods, regular physical activity, safe neighborhoods, and nutrition education all play important roles in reducing childhood obesity rates. However, prevention alone cannot help children who are already living with obesity. Those children often require individualized medical care, just as they would for asthma, diabetes, or other chronic conditions.

In another opinion piece, Dr. Barry Ramo drives this point home (which is something we’ve been doing as well). Research shows that family-based weight management programs can improve children’s weight and body mass index (BMI). To support healthier lifestyles, the American Academy of Pediatrics recommends the “5-2-1-0” approach: eat at least five servings of fruits and vegetables daily, limit recreational screen time to two hours, get one hour of physical activity each day, and avoid sugary drinks. Together, these simple guidelines encourage better nutrition, more exercise, and healthier routines for the entire family.

Treating obesity early may reduce the risk of serious health complications later in life while helping children develop greater confidence, improved mental health, and a better overall quality of life.

Your responses and feedback are welcome!

Source: “Opinion: Children with obesity deserve access to treatment, not stigma,” El Paso Matters, 7/15/26
Source: “Family-focused plan offers simple steps to address childhood obesity,” KOAT.com, 7/15/26
Image by Yan Krukau/Pexels