We all know the drill here: not only is obesity mocked, ridiculted and treated as if it is the visible sign of the sloth, laziness, and gluttony of people who don't bother to "take care of themselves".  This open stigma against fat people actually often results in further weight gain and increased shame.  The results are twofold: obese people hide in their homes, ashamed to be seen, and thus feel too ashamed to get exercise, whether it is jogging, walking, or working out at the gym.  We also know that obesity is on the rise and that the health problems fat and obese people often experience places their lives in danger and will result in far higher costs for health care.

Well...not so fast.  It seems that much of the evidence fails to support our assumptions, and where it does (like secondary disease such as type II diabeties), some surprising evidence is occuring.  Let me be clear that fat and obese people can suffer self-starvation, bingeing and purging, and binge eating disorder, just as other people with eating disorders can experience the same.  Eating disorders do not discriminate based on weight and shape; it is the thoughts and subsequent maladaptive behaviours that make eating disorders at any weight and shape prone to catastrophic medical events.

The first thing I always do when there is a disconnect between the hype and the reality is "follow the money", and it turns out that fat and obesity are huge revenue generators to the pharmaceutical, medical industry (think, bariatric surgery), diet, nutrition and fitness industries, fashion and entertainment industries, and the health sector, where money is usually more avaiable for prevention rather than management (the URL for this quote is no longer live, so I cannot cite source or author):

Cynics may point out that the reason for this is rather simple — irrespective of whether your industry is part of the problem or part of the solution, obesity can be good for business.

On the causal side, whether you are selling products or services that ultimately increase calorie intake or help decrease energy expenditure, countless large and small businesses directly profit from an increasingly obese and sedentary population that needs more calories and even more labour-saving gadgets.

On the solution side, we have a multibillion dollar industry that promises weight loss, be it through the latest fad diets, supplements or “super foods.” For those hoping to simply burn off excess calories, an entire “sports-industrial complex” offers its products and services, from fashionable wrist-band activity monitors to the latest in customized personal training in Pilates, yoga, Zumba or any other fitness craze that optimistically promises to help you shed pounds from problem zones forever. The insatiable voyeuristic appeal of weight-loss “success stories” continues to sell magazines and TV shows, as well.

In the health sector, the obesity epidemic promises almost limitless opportunity for growth. Whether you are selling the latest in diabetes medications, hip prosthetics or cancer treatments, any real solution to obesity will only cut into your business. What we lack in treatments for obesity we make up for in treatments for obesity related health problems.

Even the health promotion arena is not immune — the obesity epidemic creates and secures countless jobs at public health organizations. And obesity researchers (I add myself to this lot) are secretly grateful for the epidemic, too – after all, why would anyone fund our pet projects if not for the promise of solutions that they offer?

This one is the real kicker in my books: 

A team led by Katherine Flegal, an epidemiologist at the National Center for Health Statistics in Hyattsville, Maryland, reported that people deemed 'overweight' by international standards were 6% less likely to die than were those of 'normal' weight over the same time period.

The report on which this astonishing proposition was based was a meta-analysis, ultimately encompassing 2.88 million people, a finding so startling that it led to serious attack by clinicials, doctors and health agencies across the board.  The report led credibility to those who saw fat and obesity as a "paradox", rather than a looming health crisis about to drown us surrounded by fat people who are getting in the way of providing "real"care to "real" people with "real" health care problems.

This is a long read, so make some delicious buttery popcorn, kick off your shoes, and get ready to read some apple-cart upsetting perspectives about fat and obesity at "The big fat truth".

Another interesting article to check out that looks at weight stigma in healthcare: "The Weight-Inclusive versus Weight-Normative Approach to Health: Evaluating the Evidence for Prioritizing Well-Being over Weight Loss"