'I was fat and healthy, so why was I contemplating weight loss surgery?'

For as long as she can remember, Kate Manne has wanted to be smaller. As a feminist philosopher, she wanted to believe that she was exempt from the cultural gaslighting that compels so many of us to ignore our hunger. Here she shares why she was not.

Kate Manne is learning to accept her body size, after years of shame and dieting.

There was a moment early on in the pandemic when I was contemplating weight loss surgery. My BMI put me in the “severely obese” category, and I had tried every diet under the sun—low carb, low GI, low fat, low calorie, and so on. I exercised intensely. Although I’d once been able to lose weight by sticking to a rigorous diet, the weight always came back before long. And diets were no longer working for me at all—my body remained defiantly fat in spite of them.

And so I wondered: should I do something drastic? Should I have bariatric surgery? Should I go under the knife, for the sake of finally losing weight permanently? In a fit of desperation, I left a voicemail with a local weight loss surgery clinic, and started researching different procedures.

What I discovered in the process of doing that research was confronting and edifying. Bariatric surgery typically induces rapid weight loss; but, far from being a magic bullet, about a third of patients regain a significant amount of the weight back afterward. Moreover, these procedures, which shrink or even amputate a large portion of people’s stomachs, lead to serious health repercussions in many cases: nutritional deficiencies (including anemia and scurvy), gallstones, hernias, intestinal leakage, bowel obstructions, and serious bone loss. Disturbingly, they also seem to increase the risk of suicide. And that’s even before we get to some of the shortcuts that are being taken to churn through bariatric surgery patients, at least in the US context.

But what many people do know, and what gave me as much pause as these issues, is the fact that bariatric surgery makes eating hugely uncomfortable for the vast majority of patients. Eating more than a very small amount of food in one sitting comes to induce nausea, vomiting, stomach pain, bloating, diarrhea, and an effect aptly called dumping, where sugars rush into the small intestine and induce these effects and more, such as light-headedness and fainting and heart palpitations. Some patients even have trouble stomaching sips of water after their operation.

The thought that made me rebel against the idea of weight loss surgery was, in essence, this: my body is a comfortable place to be. I suffered from very little pain—beyond the psychological pain of simply having a fat body in a fatphobic world—and enjoyed good health and excellent bloodwork. I found no particular difficulty in being physically active or withstanding the physical challenges of pregnancy and caring for my infant daughter. When I wasn’t thinking about my appearance, or worrying about health risks that were more speculative than actual, I felt good in my body.

I want to be clear here: the body liberation movement, of which I now consider myself a card-carrying member, is inclusive of all bodies, whatever their size, shape, health conditions, and disabilities. There is no limit on size acceptance, and you do not have to be healthy in order to be valid, regardless of the fatness of your body. (“Fat” is now a word I regard not as a pejorative, but as a merely neutral description of some bodies—much like “short,” “tall,” and so on.) The point I am making here is one of simple possibility: some fat people are healthy and happy in their bodies, or at least would be but for the world that relentlessly demands that we shrink ourselves.

By the time the weight loss surgery clinic had eagerly returned my phone call, I had found in myself a source of deep resistance to the idea of bariatric surgery. 

I would be going from a body that served me well and supported my needs and wants and interests to one that would likely rebel against my nourishing myself, let alone eating pleasurably. And I would argue that such pleasures, as well as nourishment, matter.

Another thing to be clear about: people have all sorts of reasons to seek out bariatric surgery, and I don’t judge anyone’s choice to do so for a moment. People have the right to do what they want with their bodies, by and large, and in a world which makes life virtually unlivable for people over a certain size, it may well even be rational for some people to seek drastic solutions in order to be smaller. What worries me is the strong possibility that many of these people feel not only entitled but obligated to lose weight, by whatever means are available, and whatever the costs of doing so. If we lived in a world that was more accepting of people’s natural variations in size and shape, and was appropriately accommodating of all of our different bodies, many people might opt to live more comfortably in their fat bodies without trying desperately to shrink themselves.

The fat activist Da’Shaun L. Harrison writes that ours is “a culture designed to punish fat people at the behest of ‘health’ itself.” There’s a deep truth to their words. Although the topic of the relationship between health and fatness is a complicated one, which I tackle in my book on fatphobia, it’s vital to recognize the ways every weight loss solution proffered has enormous costs to health and well-being at the moment. (Or is not a solution at all; exercise, while terrific for our health in most cases, doesn’t tend to lead to weight loss on its own.) Dieting, even when it does induce weight loss in the short term, leads to weight regain in the long term in the vast majority of cases. And when people subsequently go up and down in weight, which is known as weight cycling, there are independent health harms—including cardiovascular, immune, and metabolic problems, which increase the risk of type 2 diabetes.

Weight loss drugs, which have a long and storied history of terrible risks and side effects, are another much-hyped option at the moment, with the advent of semaglutides such as Ozempic and Wegovy (used as appetite suppressants, rather than their original purpose in treating type 2 diabetes). But even aside from the uncertain effects of being on these drugs in the long term—which will be required in order to maintain weight loss—they induce nausea, vomiting, diarrhea, constipation, and stomach pain in most people who take them. And that’s even before we get to potentially life-threatening side effects, such as gastroparesis (stomach paralysis) and bowel obstructions.

What you do with and to your body is, of course, ultimately up to you. But, when it comes to trying to lose weight, it’s worth considering whether the side effects and costs are worth it in making our bodies far less comfortable places to be. Our body is our home, as the slogan has it. Even if mine is softer and rounder than it is meant to be, according to the beauty norms and standards of which I’ve come to be highly critical, it has ultimately served me well. Although I’m smaller now than I once was—for less than salutary reasons—I am also quite prepared to get heavier again as I get older. For now, my body readily lets me eat and sleep and write and move and love and be, in ways for which I have learned—and am still learning—to be grateful.

• Kate Manne is a philosopher, writer and associate professor at Cornell University. Her research is primarily in moral, social and feminist philosophy and she has written on moral and political topics for The New York Times, The Boston Review, the Huffington Post, the Chronicle of Higher Education and the Times Literary Supplement. The author of the acclaimed books Entitled and Down Girl, she was named one of the ‘World's Top 10 Thinkers’ by Prospect magazine.
• UNSHRINKING: How to Fight Fatphobia by Kate Manne (Allen Lane, €24.99) publishes on 9 January.