Doctors and scientists generally follow the narrative that larger people should be referred to as "people with obesity" and that obesity should be treated as a disease just like any other—but fat activists disagree.
Tigress Osborn, executive director of the National Association to Advance Fat Acceptance (NAAFA), prefers the term "fat people" and objects to "the medicalization of fat."
As a fat activist and fat liberationist herself, Osborn told Newsweek: "Our argument is that classifying all fat bodies as inherently diseased, regardless of other aspects of our health profile, actually has more to do with social bias and capitalism than it has to do with medicine and science."
Professor Carel Le Roux, Head of Pathology at University College Dublin, Ireland, holds a different view. He told Newsweek: "We advocate for obesity to be treated in a similar way to all other chronic diseases, as it is not more special or less special than any other chronic disease.
"If a patient does not think they have the disease of obesity, then nobody should force them to be treated."
Osborn said that many think treating obesity as a disease is kinder towards larger people, but that this was not true.
"In fact, what happens is, when our civil rights are violated, when we're treated badly socially, when we're denied access to things, we are told that it should help motivate us to seek medical treatment," she said.
Le Roux said: "The complications of the disease of obesity can be metabolic, mechanical and mental. The purpose of treating the disease of obesity is not weight loss but health gain."
Osborn said that fat activists' argument was not that body size did not relate to health, but that there were more questions to consider before classifying a larger person as diseased.
She said that health complications linked to "obesity" might be caused by weight bias in the medical establishment that led to fewer fat people seeking treatment, less accurate testing, and doctors dismissing fat people's symptoms as weight-related rather than investigating them fully.
"We know that there's medical avoidance for fat people," said Osborn. "There are access issues with medical facilities sometimes—especially for very large fat people—that makes the experience more frustrating and traumatizing."
And medical conditions linked to "obesity"—such as type 2 diabetes and heart disease—might be correlative rather than causative. In other words, larger people might be more likely to have these diseases, but that did not necessarily mean that these diseases were caused by weight.
"The danger of labeling everything that is related to health that can cause an increase in body size as being a problem because of the increase in body size, is that we underscore the idea that all the thin people who are doing the same behaviors are healthy," said Osborn. "I really believe that the obesity epidemic is more of a moral panic than it is a medical epidemic."
This moral panic, said Osborn, was fueled by companies who benefited from treating obesity as a disease.
"I'm sure there's someone out there who believes that pharmaceutical company executives' ultimate goal is to make people healthy," she said. "I am not one of those people.
"How much of what we believe about obesity is funded by people who develop drugs to treat obesity?"
That's not to say that Osborn was opposed to the idea of people losing weight.
"I don't see my job at all as to tell people whether they should or should not try to lose weight," she said. "My job is to critique the system and to make sure people are getting accurate information about what weight loss actually does.
"In some cases, weight loss—depending on how you pursue it—can be worse for your health than just carrying some extra weight."
However, Osborn said she objected to the public affirmation of weight loss at the expense of people in larger bodies—and to a system defined by "anti-fat" discrimination.
"The constant narrative from the mainstream media and from your own medical providers is everything about how fat you are is deadly to you, so anything you do to not be that fat is better than you being that fat," she said. "That's the flashing sign over our heads everywhere we go as fat people.
"If you want to dim the bulbs on that flashing sign by losing a little weight, or by losing a lot of weight, I can't be mad at you for that."
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