Let's reconsider this position using some other example:

Healthy on Heroin. HOH

HOH is not BS. Here's the deal. For lots and lots of people, being not addicted to heroin is very very hard. So hard, that even though there is enormous social pressure that they've had basically from ~18 years old to however old they are, they still haven't managed to become clean for any significant length of time.

HOH is a reaction that says "What if we accepted that some people are just going to be heroin addicts, and then tried to come up with ways of being as healthy as possible given the circumstances". You may not like the packaging that HOH comes wrapped up in, and the most vocal proponents of it are often the least interested in making it palatable to you. But it's not BS.

Consider that there is essentially nothing that medical science has for people who are chronically addicted to heroin except a detox. Shit is hard, yo.

You chose a pretty poor example.

Have you ever heard of methadone? Its literally accepting that someone will be addicted to opiates for a long time or life and then giving them a healthier alternative that doesnt try to change that.

https://www.crchealth.com/addiction/heroin-addiction-treatme...

Yeah, see, no one is bothered by that because no one is saying:

Be proud of your true heroin addicted self. Show it to the world. IF they don't accept your heroin addiction THEY ARE wrong.

See. If any movement said that, I'd be against it. Because they are trying to remove stigma from something that SHOULD HAVE IT.

Unsure if you're trying for a parody here, but HOH isn't actually that absurd. Numerous public health policies - methadone clinics, needle-exchange programs, Narcan syringes on every EMT - are based on the assumption that addicts are gonna be addicts, and until they are in a place in their life where they can do the work needed to kick the addiction, they might as well not be spreading HIV, committing petty crimes to support their habit, living on the street, or dying. All of these interventions make it more likely that they will eventually get to a place in their life where they will be able to do the work to actually kick the habit.

You are stretching VERY far.

There is a segment of the population that is addicted to a substance that is illegal. They die because they hide to satiate their addiction.

If fast food were illegal, and fat people sat under bridges eating fast food and occupationally chocked on an illegal KFC chicken bone, I'd advocate for fatty eating centers.

Comparing saving lives to removing stigma is... beyond absurd.

I don't know what you think you are proving here. I accept everything you just wrote and agree with it 100 percent (except for detox. I think I would say for heroin we now have buprenorphine which might be useful way to manage this specific addiction, but I'm not claiming to be an expert on heroin addiction).

Expect fat people can eat KFC in the open.

Fat people aren't being sent to jail for being fat.

Heroin addicts are being judged and looked down on. No one is fighting that.

No one is saying 'be proud ye heroin addicts'.

I have hear fat people basically say 'be proud of ye 'curves'"

Let's reconsider this position using some other example:

Such a shame that the "healthy at any genetic condition" BS is so popular these days. Literally killing people.

Genetic conditions cannot (currently) be changed, so not trying to change them is a reasonable approach.

Addiction to opioids is also partly genetic. Should being a heroin addict be fine?

The healthy while fat movement specifically tries to remove a stigma that IMO should not be removed.

>HAES is a reaction that says "What if we accepted that some people are just going to be fat, and then tried to come up with ways of being as healthy as possible given the circumstances". You may not like the packaging that HAES comes wrapped up in, and the most vocal proponents of it are often the least interested in making it palatable to you. But it's not BS.

If that was all it was saying, I'd be onboard.

But it also says things like "losing weight is literally impossible!", and "there is no evidence that obesity is unhealthy!" and then cherry-picks and misconstrues research so that it seems to give scientific backing to those conclusions, which are deeply harmful lies.

No, people say these things. This is cherry-picking as well. Again, lots of fat-acceptance people aren't stupid, they have just decided to pick their battles.

Most people in history were _not_ fat. It used to be _hard_ to be fat. Modern society and sedentary jobs make it harder to not be fat, so it takes discipline and hobbies like hiking and working out to actually get physical activity, and healthy diet is the key element. When everyone is eating processed food and doing very little during a typical day, it is hard to not be fat, but that doesn't mean we should accept that, we should push for a healthier society. There are things about lifespan, but also quality of life, ability to think, dealing with stress, _huge_ mental health effects, etc. Our entire society would improve if we decided to change things instead of giving up.

Obviously we should push for a healthier society, but that doesn't necessarily mean we should shame those who do not have a fit body size.

Don't forget that in many circumstances cooking and hobbies like working out and hiking and such can be privileged.

Someone working two jobs to get by probably doesn't have the funds for a gym membership or to go out hiking, and might not even have the mental energy to.

And then cooking healthy food is surprisingly expensive and time consuming when compared to processed foods.

So yes, absolutely, we should push for a healthier society, but at the same time we should accept that there are valid reasons someone might not be fit, and we shouldn't shame them for that. Instead, we should try to improve the situations that cause it as much as we can within our abilities.

Not shaming, but that is a false dichotomy. I don't want to go around condemning people; I just don't think telling them everything is okay and letting them die young is a good idea. There are many other options to take; better education on the topic, better culture around work, better pay, better childhood involvement in activity, less videogames, etc. It isn't just a poverty issue and it is getting worse in all levels of society.

How well is your strategy of "blaming individuals" working out? Should we blame them even harder to see if that works more often?

So it's the same logic as, "Well, we should let them do heroin -- just try to make it as safe as possible"?

Seems like a meme we should minimize the transmission of, to me.

> Consider that there is essentially nothing that medical science has for people who are chronically fat except a gastric sleeve.

It also yields ridiculous statements like this. Medical science has some very clear advice for fat people: eat less and exercise more.

They're making an entire movement to justify why they're lazy and undisciplined.

Portugal legalized drugs and made them safer to use and... people were generally healthier and better off.[1]

People have unhealthy habits because of issues in their life. Poverty, abuse, mental health issues, lack of access to healthcare and healthy foods.

If you want people to get better you need to stop vilifying them, e.g fat shaming or war on drugs, and start accepting and helping them. Same for drugs, same for weight, hell, I’d say it’s the same for many “criminals” too.

[1] https://en.m.wikipedia.org/wiki/Drug_policy_of_Portugal

Tying together legalizing drugs and fat shaming is a huge reach..

The drug vilification issue becomes a problem when the state gets involved in enforcing that moral compass -- the danger of drugs predominately derived from its users/product existing solely on a black market, with no regulation, and no verification of the product you're purchasing. It's not that hard to avoid overdose when you have pure heroin, it's much harder when you have heroin cut with unknown quantities of unknown alternatives. It's much harder to seek legal help, when it requires you to admit to criminal activity.

It's not the vilification at issue for drugs, it's the criminalization. Presumably portugal still does not have a positive outlook on drug usage (it's still vilified).

And afaik, being fat is no crime.

> The new law maintained the status of illegality for using or possessing any drug for personal use without authorization. However, the offense was changed from a criminal one, with prison a possible punishment, to an administrative one if the amount possessed was no more than a ten-day supply of that substance.

You seem to be mistaken about how their policy operates.

You're also working from a different premise than me: I believe people fundamentally have agency, and so they're influenced by their circumstances, but their problems are not causal from them -- they made a choice to adopt that habit as a coping strategy.

And frankly, I disagree with you about how to confront that: I think we should be accepting of how they got there, but I absolutely disagree with things like HAES which suggest that their choice isn't a problematic one.

To borrow a phrase from a friend, and use it somewhat out of context: I can love a sinner without enabling or accepting the sin.

Here’s what I don’t get about people from the “personal responsibility” camp: food companies spend billions of dollars on marketing research and ads to sell their products. The products they seem to be most easy at selling are any form of junk food. The easiest to target are the poor and people who don’t know better.

I think they have a huge responsibility for unhealthiness and fat shaming doesn’t address that cause. Saying “oh people just need to make better choices” seems pretty shallow.

I'm confused by what you're confused by -- you seem to be attacking a strawman rather than anything I said.

You're also confusing several issues:

- There's no reason that people can't be responsible for their choices and it be unethical for junk food companies to do what they do. Your entire premise is hinged on that being the case.

- I've never met a fat person that wasn't aware that junk food was bad. I'm sure they exist, but talking about the bulk of people, the 95% in the middle, they're aware that their diet impacts their health. They're simply choosing a self-destructive coping behavior of drugging themselves with food. I'm sympathetic to that, but I don't see any reason to pretend it's anything but what it is. Addiction and substance abuse, in a self-destructive behavior.

- I don't believe that ads are causal, just influential. Again, they're making a choice to act this way, even in the presence of ads. What bothers me about people in your camp is that you treat other humans like some kind of animal you own, can decide what's best for, and manipulate or control. You refuse to accept them in their capacity as human persons, who have agency and the capacity to self-direct, then have the gall to turn around and talk about me being the shallow one.

> "Well, we should let them do heroin -- just try to make it as safe as possible"?

That's the goal of "Safe Injection Sites" that are being build in a few cities.

The HUGE difference is that one is asking to use resources in a smarter way (safe injection sites). They are not destigmatizing drugs.

I've been to countries where there are 'tolerance' zones. But that doesn't mean there isn't stigma to doing it.

Stigma is a strong social disincentive.

The Healthy as fat is trying to remove stigma for something that is unhealthy. But it is not trying to re-assign social resources in a logical way.

> They're making an entire movement to justify why they're lazy and undisciplined.

Congratulations. You are literally the reason why this movement exists.

What do you think Safe Injection sites are, if not exactly that?

Yes -- that's the logic I was referring to.

However "safe injection sites" are anything but safe to the surrounding community, and may increase usage rates while only mildly decreasing fatality rates.

By keeping the sickly ones around, we're actually making the whole herd less healthy -- particularly when we enable them spreading their illness.

I think the medical professionals involved in "safe injection sites" should be seriously questioned about their medical ethics: they're failing to quarantine sick patients, and in treating them without that buffer, spreading the disease to the healthy population.

It's quack "medicine", just like HAES/HAMS.

Every bit of research I've seen contradicts this. I'm talking about NHI in the UK and several peer reviewed papers which seem to support safe injection sites as being a cost effective way of dealing with social addiction issues (we already know the war on drugs hasn't worked)

Care to share any sources on the ineffectiveness of these sites?

I came across most of my sources while studying for proposals to open another one, and don't have them convenient anymore.

However, looking through NIH reports --

The site in Vancouver appears to lower the fatalities marginally (1-10 less fatalities per year). Several other studies indicate that fatalities related to opioid overdose, ambulance calls, etc decrease in the immediate area of various sites.

I can't find anything on the Vancouver site in the last decade, it's all circa 2006 or 2007 -- and seem to recall in my earlier research that the initial results looked good, but later studies basically reported that we saw a decrease in fatalities that was offset by an increase in usage, and the whole thing came out as sort of a wash.

RAND seems to suggest that supervised consumption is not settled in terms of scientific study, even now. [0]

> We conducted our own assessment of the individual studies and found that the evidence base concerning the overall effects of SCSs is limited in quality and location. Although we identified 65 outcome-related articles (as opposed to commentaries or studies that gauge opinions), none involved an RCT, and just nine employed a quasi-experimental design with control groups. These nine studies were based on just four SCSs in three cities: Sydney (five studies), Vancouver (two studies), and Barcelona (two studies). There was considerable overlap in the design, methods, authorship, and data employed, so that four of the nine are arguably superseded by later studies using better methods or longer time series, in some sense reducing the effective number of quasi-experimental studies to five.

Worth noting, however, that many of these seem to indicate reduced petty crime in the area immediately around the site. Indicative I might be wrong, but not conclusive because of problems in the methods used, samples chosen, etc.

Looking at a compilation by Brookings, broadly on the topic [1] --

> New work by Packham and Wells (2018) suggests that syringe exchange programs—a staple of harm-reduction efforts—reduce HIV rates as intended but unintentionally increase opioid-related mortality by making it easier, cheaper, and safer to use heroin.

> Another popular harm-reduction effort is distributing naloxone, a drug that can save someone’s life if administered during an opioid overdose. Recent work by Doleac and Mukherjee (2018) finds that broadening naloxone access had mixed results. While some states saw beneficial effects of these policy changes, broad naloxone access increased opioid-related mortality by 14 percent in the Midwest, the region hardest-hit by the opioid epidemic.

So reports that I do find seem to suggest that this is a concern that is valid, at least in some contexts, and that the studies purporting to show outcomes are a) very narrowly done, b) often don't measure what I'd consider to be the complete set of externalities, and c) aren't particularly scientific.

It certainly seems reasonable that narrow focus on improving the outcomes of the addicts, particularly a narrowly defined set of metrics, actually lowers the group outcome.

Sorry I can't provide better sources to support that, though.

[0] -- https://www.rand.org/pubs/research_reports/RR2693.html

[1] -- https://www.brookings.edu/blog/up-front/2018/12/07/research-...

I can provide at least a half dozen studies that prove it does work.

You can't provide any that prove it doesn't. Even the few that you posted seem to be at the least, pointing to a possibly effective situation. Mentioning increased ODs in the immediate surrounding area is... I'd say kinda expected. That's kinda the whole idea, get all the ODs in the same place.

I mean, your own data shows that it reduces HIV rates (not possibly, it does)... and 'POSSIBLY' has unintended consequences.

Despite the data, you won't change your mind.

At least admit that like the anti climate change people, you just don't want to believe. It has nothing to do with data.

I'm glad you are willing to come out and state your positions clearly. For that I thank you.

I disagree with essentially everything you have said. While SIS may not be a panacea, they are definitely on the right track.

Are you implying we kill/let die the "sickly"?

Seems extreme...

> Are you implying we kill/let die the "sickly"?

What's the choice? Make other people ill and have the original sick people die anyways?

That's all slowing mortality down in heroin abuses does, and it's definitely not how we treat other kinds of diseases, particularly those which have reached epidemic proportions, where the prime objective is arresting transmission.

So, yes -- I think we should follow standard medical practices, and it's unfortunate that strong measures are needed to confront an epidemic level problem. Just like it always is when you have to make medical triage decisions.

But we have to prioritize maintaining the healthy population ahead of the comfort or longevity of the already ill, in broad strokes.

What you're suggesting is not standard medical practice, to be clear. Treatment for heroin addiction is to get that person off of heroin, not let them die.

And no, we don't have to prioritize maintaining a healthy population, not to the degree that treating the ill is excluded. That implies a limitation of resources that simply does not exist. We can and do both.

It's the entire Republican plan for healthcare: http://www.slate.com/articles/news_and_politics/the_big_idea...

>Blitzer pressed the point. "But, Congressman, are you saying the society should just let him die?" At that point, the rabble erupted in cheers and whoops of "Yeah!"

Safe injection sites are a socially responsible way of using resources.

It costs society money for ambulances to be running around to OD people.

Safe injection makes sense.

It doesn't promote heroin.

No one is saying: Heroin in a Healthy Manner.

They are simply saying: Let's spend a stitch in time. You don't even have to think of it as being kind, just rational.

It is an opportunity to say "Ok, we can't stop these people from doing heroin. But we can make it as safe as possible, and we can provide a vector for additional health care interventions". It also means that you aren't psychologically torturing addicts by telling them that if they were only 'strong enough' they could cure their addiction.

You might not like the way HAES or fat acceptance is packaged, but this is exactly the same thing.

The key difference: Social stigma. HAES seeks to remove stigma.

Safe injection sites don't.

Both being fat, smoking cigarettes or being a heroin addict are things to be, at the least, slightly ashamed of.

*exceptions go out to anyone with thyroid or other such medical conditions, just as to people who are opioid dependent due to pain management.

It's complicated. On one hand you don't want to foster mental health issues by constantly reinforcing to people that their weight is wrong and bad. On the other hand, you probably don't want to excuse a physiologically unhealthy condition by calling it "healthy".

I don't have an answer. I was fit until I hit university and now I'm struggling with my weight constantly. I'm committed to trying. Losing weight. Getting in a healthy habit. Relapsing. Dozens of times in a decade. But what I don't ever want to do is declare that I'm just healthy at any size and therefore throw in the towel.

The grim reaper doesn't give a crap what I think healthy means.

I think you are seeing what I'm trying to say. It's not like most fat people are not aware that they're fat, and not aware that that is a problem. They are just exhausted with trying to change it. Particularly for people who have "always" been fat.

Consider that being fat might be better for you than alternating between eating disorders and being fat, which is the choice that a non-trivial number of fat people are faced with.

Sometimes I see comments like this and it's like someone is posting from another galaxy.

I've literally never heard of a movement that says that can be healthy. How did that even happen?

Edit: link for HAES https://en.wikipedia.org/wiki/Health_at_Every_Size

On the internet, there is a supportive community for every possible opinion humans can have.

Plenty. I'm very fit all my life, but as I have gotten older, metabolism slowed down, less time and energy, I am still exactly as fit as I was, and still eat w/o a diet, often before bed.

What's changed: every morning I wear an ab belt while getting ready for work. With every greasy mean I pop an orlistat. I wear a couple of electrodes on my chest/back/arms under my shirt while at work, instead of a workout most days. 5'11, 170lb, 6% bodyfat, bench 300 20 times.

This is 100% because of medical science, because I'm a lazy 40yo slob. Just a really fit one despite the daily cake and pizza before bed.

You can be fit and still be fat though. I've been working out with a personal trainer for a couple of years now and I'm significantly healthier and stronger than I was before I started but I haven't lost the gut (yet).

If HAES is just an excuse to not try and be fit, it is going to kill people.

Some people will use it for that. Others won't.

I don't see what else the "movement" would be used for. If you are obese than you are unhealthy. It might be hard to be hard to maybe impossible to improve that but it doesn't suddenly become "healthy" because of that.

It's impossible to create matter out of nothing. Dieting works and will always work. Not saying it's easy, but waving off obesity as incurable is crazy.

> being not fat is very very hard

Irrelevant. It is not more healthy to be fat than it is to be not-fat because it's hard. Acceptance is not going to change a damn thing about the health risks inherent with being fat.

You have all my sympathy. One of my closest friends is a very large guy, and I want him to be around when we get old, but the stats tell me that's less and less likely every year he stays obese. Me accepting him (and I do) won't keep him on this planet. :(

Why do you think I'm fat? I'm not

> Irrelevant. It is not more healthy to be fat than it is to be not-fat because it's hard. Acceptance is not going to change a damn thing about the health risks inherent with being fat.

You are entirely missing the point. The issue is "given that I'm going to be fat, perhaps I should work with what I have, rather than beating myself up over the fact that I'm fat". Once you do that, you can start to look at what else you might change about your life that would improve your health.

"You" here being a stand-in for anyone reading this who is fat. It's not really relevant if you're fat.

And I'm not missing the point, you're making up some kind of generalization that doesn't A) fit the facts as we know them, and B) doesn't actually address the issue.

You're saying, "What else can I do to be healthy?" but you can/should do those things as well as work on losing weight. Giving up on losing weight doesn't lower your risk at all.

You can stop beating yourself up about being fat and keep trying to lose weight, as well. I think we can agree the moralizations aren't helping here, but you can't wish away the unhealthiness of obesity, like this stupid movement tries to do.

Damage control might be a smart way to improve health.

The data doesn't say it is. Sure you can improve on other axes, but weight is a leading indicator of mortality.

I wish you were right, it'd be great to be able to be obese and healthy, but that just isn't how it is.

That's not what damage control is. I am not claiming that there is a way to be fat and absolutely healthy. I am saying that there are ways to be healthier while being fat. That is damage control, like the ones applied to drug addiction. And that is proved to be a good decision in some cases.

> And that is proved to be a good decision in some cases.

No it hasn't, because it doesn't exist as you describe. It exists as I've described. Everything you can do, while obese, you can also do while not-obese.