Shriver writes that her older brother is "a sadly good test case for the claim that one can be 'healthy at every size.'" He weighs 330 pounds, and suffers from compressed vertebrae, diabetes, emphysema, and heart problems. Shriver says he received serious injuries that left him unable to exercise, but that "he also eats too much." And while she has "buckets of sympathy for the obese" and "respect [...] for their feelings, for their humanity," she also writes,

I won't simply accept that my brother is fat. And his only chance at a future is to refuse to accept himself that his weight gain is irrevocable. [...] My brother is only 55, and without drastic intervention – gastric bypass surgery or a sudden resolve on his part that I fear is unlikely – I doubt he'll see 60. My brother is eating himself to death. I love him dearly, and I can't support any political movement that would have him believe he can be "healthy at any size."

Shriver's piece is heart-wrenching to read in light of its coda — her brother died of cardiac arrest soon after it was written. Even without this information, Shriver's concern for her brother's well-being is palpable — she's not that family member who says "I'm just worried about your health," but really wants you to fit into a size 4 dress. Not all fat people are healthy, and it's possible that losing weight would have improved Shriver's brother's life.

But. Health At Every Size did not kill him. First of all, fat acceptance doesn't mean believing every fat person is in perfect health — fat people with cancer obviously still have cancer, no matter how you feel about their weight. Being fat does seem to raise the risk of some health conditions — but so does being thin. Ultimately, the message of Health At Every Size isn't that fat people suffer no health problems, it's that the way to combat health problems (usually) isn't major weight loss — because most of the time it doesn't work. Would weight-loss surgery have extended Shriver's brother's life? Maybe, but the surgery carries risks too. And whether or not he might have benefited from some sort of drastic intervention, the message of Health at Every Size isn't that he was healthy, or that he should have simply ignored his diabetes or heart issues. In fact, it's possible to believe in fat acceptance and have weight-loss surgery. What's not possible: that a movement that teaches that you can be healthy and fat made a man unhealthy.

The trailer for Fat Girls Float, currently seeking funding on Kickstarter, is a good place to get the truth about fat acceptance. (Thanks to the tipster who sent it in this morning.) The film, by self-described "300lb. filmmaker" Kira Nerusskaya (pictured) lets "fat women from four countries (England, France, Russia, and the United States) tell their tales of sorrow and success, wow and woe; discussing size discrimination, political activism (fat and size acceptance), and social networking communities." Interviewees include Velvet D'Amour, who points out that fat characters in Disney films are always evil, and asks, "when is fat Cinderella?" But the real show-stealer of the trailer is a woman named Colleen (pictured above), who says,

If anyone thinks that they are so important and so special that I will give them the power to change my life, to change my attitude, my smile, my frown, if you think you are going to have any effect on that whatsoever, you're mistaken. You have no power. You have no power over me.

Shriver's essay is more moving and personal than the mainstream media's typical anti-fat screeds, but at bottom, its message is an old one — that if we don't keep harping on the idea that fat itself is unhealthy, fat people are going to keep dying. Unfortunately, this is true. Fat people are going to keep dying no matter what we say to them. So are thin people. Everyone dies. While Shriver's brother's death is tragic, stigma definitely wouldn't have saved him. When Shriver calls HAES a "political movement that would have him believe he can be 'healthy at any size,'" she misses the point — nobody could truthfully call her brother healthy when he wasn't. All HAES and fat acceptance aim to do is to decouple health from fat discrimination, and to help fat people protect the self-respect that society tries to take away. Shriver says she has "buckets of sympathy for the obese," but Colleen doesn't need her sympathy. She's secure enough in herself that stigma can no longer hurt her — and she is the real face of fat acceptance, not some notional fatty feeding a sick man lies.

Lionel Shriver: My Brother Is Eating Himself To Death [Guardian]
Get In The Pool! With Fat Girls Float [Kickstarter]

Johnna's doctor, Alan Wittgrove, is infuriated by this decision. "And all this is, is discrimination," Wittgrove tells ABC. "What they want her to do is to submit to a process that is known to fail, that is diets for morbidly obese individuals in lieu of having something that is known to be successful in a very high percentage of the population. No other place in medicine would they do that."

Johnna's husband does painting and drywall work, and her father is a school custodian. The only solution the family could come up with is for Johnna's dad, Skip Dove, to put the 30K surgery on a credit card that had a 22% interest rate, effectively delaying his retirement for the foreseeable future. Elizabeth Edwards says that the deplorable state of the health insurance industry and the plight of women like Johnna is to blame for the current economic crisis. This afternoon, the AP reports that "Elizabeth Edwards said during a conference call Tuesday that medical bills often lead to foreclosure, a primary factor in the lagging housing market that's led to the demise of several Wall Street firms."

What's more, Edwards pointed out earlier this year that under John McCain's aggressively deregulated, market-driven health care plan, both she and McCain would have trouble getting insured because of their pre-existing conditions (Edwards's cancer and McCain's melanoma). It's hard to believe that under a McCain regime, Johnna's situation would be any better, and it would likely be far worse, as a new study shows that women who pay for health insurance on the individual market pay up to 45% more than men on the individual market, depending on age.

Going Into Debt To Save A Life [ABC News]
Elizabeth Edwards Ties Health Care To Economy [AP]
Federal Money In Health Care Plan From McCain [NYT]
COVERAGE: I Am Woman... Hear Me Pay More [New Health Dialogue Blog]

Earlier: Weight Discrimination Is Rampant The World Over