In the body-image workshops I run as a trauma therapist, I teach the concept of understanding our bodies as heirlooms. If we think about the purpose of an heirloom, it is a symbolic representation of resilience. We do not criticize an heirloom. We do not devalue it for its flaws and imperfections. We see heirlooms as tangible evidence of the existence of our ancestors. I want fat folks of color to see our bodies as important and necessary in the context of survival. I want us to remember to write ourselves into existence at the expense of diet culture and fatphobia.
I’ve worked with clients fearful of going grocery shopping because strangers have pulled food out of their carts or made snide fat shaming comments about their body. I’ve met with clients who were denied sex and affection by their partners unless they lose weight. I had a client who was told by a fertility doctor that it was good she had a miscarriage because her baby would’ve been fat. In addition to the social stigma fat people face, they are also subject to medical fatphobia—the practice of discrimination by medical professionals of fat patients on the basis of metrics like body mass index (BMI). Fat patients can be denied insurance coverage for medical procedures like IVF, joint replacement surgery, and gender-affirming top surgery.
Health at Every Size aims to decouple thinness and health and help eradicate fatphobic bias by providing health care providers a weight-neutral set of principles to help guide them in their care for patients. HAES also highlights research that suggests weight loss is a faulty mass prescription. In a 2009 article published in the International Journal of Exercise Science, researchers cited evidence that within nine years of initial weight loss, 95% of women and 93% of men studied were unable to maintain their reduced body weight. If that many people can’t keep the weight off, why are so many of us consistently dieting—for medical reasons? In 2013, researchers from UCLA and the University of Minnesota reviewed health outcomes of long-term, randomized controlled diet studies and found that losing weight alone didn’t improve health biomarkers like blood pressure, fasting glucose, or triglyceride levels for most people. A paper published in Nutrition Journal in 2011 cited additional research suggesting that pressuring patients to lose weight can actually cause more psychological harm than physical good.
Research like this adds credence to what I’ve seen firsthand in my work. I’ve had clients tell me they’ve felt too ashamed to schedule follow-up appointments with a doctor because they had not lost the weight they’d been asked to lose and felt discouraged from seeking future medical attention until their conditions became too severe for early intervention. HAES empowers fat folks with the audacious idea that our bodies are allowed to exist and be taken care of just as they are without any regard to the scale. And this entitlement has saved my life.
As the child of immigrant parents, I’ve had to accept that their hopes for me to lose weight—though rooted in love and a desire to assimilate—is toxic. I was first encouraged to restrict my food intake at age 9. My childhood feels sad when I think back to how disobedient I felt as a fat kid who couldn’t stop eating. And I was placed on non-consensual diets until I was in college. Their efforts to pressure me into attending Jenny Craig meetings and try meal replacement foods only taught me to loathe myself and hide my food consumption out of shame. Part of coming back home to my body focused on learning to trust it. This means not using a scale to measure my health. Instead, I ask myself how I’m feeling. Have I moved my bladder or bowel? Am I experiencing hunger, thirst, libido, or sleep in ways that feel good to me? How is my pain? Are there things weighing on my mental health? I try to carry a more holistic understanding of what my body needs.
When it’s hard to find love for the body, I like to imagine that there must be a good reason for why I am fat. And so if I place my fatness into the context of my Indian mixed-caste lineage, then maybe my fat body would be more likely to survive another famine, genocide, or revolution. After all, there are evolutionary reasons why some of us are as large as Vikings or broad as Samoans, and valuing a single size of health does not respect or appreciate the ways we are meant to be different—and why we all deserve to exist. This understanding has been an important aspect of my fat acceptance journey. There’s been relief in this process, and grief, too. Having fat—and queer—role models like Lindy West, Samantha Irby, Caleb Luna, and Ashleigh Shackelford has been integral.
It has only been five years since I promised myself I would never go back to intentional weight loss. It was the second and final time I would be pressured to lose weight by my parents. This time, they had convinced me to consider weight-loss surgery, and I got pretty far into the process of insurance approval before I backed out. It was 2015, and the procedure would have removed healthy gut tissue from my body in order to induce permanent malnutrition. And for the rest of my life, I would have had to augment my diet with vitamins, supplements, and protein powder because there would be no comfortable way for me to consume the amount of nutrients my body would need without that gut tissue.
I wanted so badly to make my parents happy, to fulfill their dream of finally having a beautiful, brilliant daughter who was also thin. I still do. But in this metaphorical death was also my rebirth. In choosing myself five years ago, I was able to become The Fat Sex Therapist, an Instagram influencer with an almost 100K following who travels internationally to teach the world about the harms of dieting and fatphobia. I could never sign up for a life where every decision I made about my day would first come down to food. I needed all of that time and brain space to become the role model I was meant to be—to become the role model I needed when I was a teenager.
I’m uninterested in a narrative that questions the legitimacy of HAES by asking if it is really possible to be healthy at any size. To me, this is like asking if there is some loophole that in matters of health it’s still okay to fat shame your parent, partner, friend, or child. I am only interested in a conversation where we acknowledge that fat stigma deeply harms fat people, maybe even so much so that it can help explain the elevated negative health outcomes we see in fat people who have tried to lose weight by dieting. Those who write off HAES are often folks who don't have empathy for what fat individuals experience.
I’ve learned to make what Adrienne Marie Brown calls a “pleasure practice” for myself—this includes learning to cook for my body in a way that makes her, yes her, feel loved and considered. I enjoy weaving abundant food and sexual pleasure into my weekly routine. I enjoy the work of forgiving my past selves for feeling the pressure to diet, shrink, and self-betray. Along with many other health sustaining practices, these new habits come from a long-term investment in myself.
Understanding my body as an heirloom helps me to wonder why my fat body deserves to stay. If I trust my body and its genetic code, which is actually what determines my body shape, then maybe I would see my fat body as one of wisdom and survival. My ancestors survived British colonialism, partition, and migration for me to exist. And so I often think to myself what Lindy says in the first article of hers I ever read in 2011 titled, “Hello I am Fat.”
“Do you really want millions of teenage girls to feel like they're trapped in unsightly lard prisons that are ruining their lives, and on top of that it's because of their own moral failure, and on top of that they are ruining America with the terribly expensive diabetes that they don't even have yet? You know what's shameful? A complete lack of empathy.”
Sonalee Rashatwar (she/they) is an award-winning clinical social worker, sex therapist, and grassroots organizer. Based in Philadelphia, she is a superfat queer bisexual non-binary therapist and co-owner of Radical Therapy Center. Popularly known as The Fat Sex Therapist on instagram, Sonalee is specialized in treating sexual trauma, internalized fatphobia, immigrant kid guilt, and South Asian family systems, while offering fat positive sexual healthcare.