I cannot get behind fat acceptance, or better stated in medical lingo as “normalizing obesity.” As a physician and as someone who has been obese or morbidly obese my adult life, I know first hand what it’s like to hate my body and feel ashamed of it. I still do this very moment as I type this, that’s something I have to work on.

Funny thing is, I am much more understanding of my obese patients than myself, and I think my own struggles make me more empathetic. There is a place in which you can encourage people to lose weight without being cruel and judgmental.

I would never tell myself or any patient to accept that their body is destined to be obese and to just make the best of it. Just as I would never tell a drug or alcohol abuser to give up on sobriety. Obesity in this country, at its core, is caused by addiction to foods — to processed sugary foods and to lifestyles that are less and less active and more sedentary. There’s a reason we are now using naltrexone to treat obesity just as we treat our heroin addicts; it curbs the cravings. We are still learning more about why some people are more susceptible to obesity, and I hope in years to come research will continue to shine more light on the subject. In the meantime, the vast majority of us obese people need to find our version of the winning formula that works: fewer calories in, more calories out.

I think the bigger problem is the bias against obese patients. As I’ve said before, that’s a real thing and a huge problem. It makes me sad to see how obese people are treated in this country; we are treated the same way that we treat drug abusers, alcoholics, smokers, and the mentally ill. No one chooses these problems.

But I hate myself for being obese, so I can understand why other people would hate me for it, too. As everyone has seen the last two years, with a healthy calorie-counting diet and daily exercise an obese person can transform to one of (nearly) normal and healthy weight. But I harbor a dark passenger inside me that triggers me to binge eat and eat to the point of sickness.

Do I consider that to be a personal failing and sign of weakness? Yes, I do. That’s the bias I bring against myself. Are there genetic factors that predispose me to these behaviors, I’m sure there are. In the end, I feel like it’s up to me, and to my patients, to overcome what genetic factors we may have. And the good news is that if diet and exercise alone don’t help enough, there are medications and surgery that can.

I want myself and my patients to feel healthy, strong, and capable. Being fat doesn’t make me a worse person, but it does make me less capable of living a long, full, healthy, and active life. So I won’t sign off on fat acceptance; I won’t normalize obesity. I will keep doing everything in my power to help myself and every one of my patients live our best, healthiest lives.

This essay is cited in the KevinMD record on diabetes and obesity.

Jenny Hartsock is a hospitalist.

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