Health at Every Size


You know what, maybe it's just me but I see many many more skinny old people than I do fat old people. When was the last time you seen someone over 85 years old who was really fat? Now compare that with someone over 85 who was slender.
Oh, man, her name was BACON? That's rich.
Linda Bacon?
@2: HEY.


@1 Actually, when I think about the size progression of family members, it seems like they were all heavier in their 50's and 60's than they were in their 70's and 80's. I always chalked it up to the fact that old people shrink.
I don't think that fat people are pushing much of anything with "vigor". Isn't that why they're fat?
A modest proposal: mandate that it is illegal for insurance companies to fully cover treatments for chronic diseases that affect over x% of the population. Force insurers to charge significant copays for Statins and high blood pressure meds. Stop forcing the rest of us to pay for what is more or less a routine living expense by virtue of living in a country where health coverage is provided through nearly unregulated local monopolies.
Hernandez is right - old people do "shrink," largely due to a loss of appetite.
I'm gonna start a "Slob Pride" movement. Sure there are advantages to bathing and cleaning up. Yes there are disease links to having a house filled with rotting garbage. But people die every day in clean homes. In fact, a pile of dirty towels on the floor may save your life if you slip and fall in the bathroom!

Think of all the water saved by all those missed showers and laundry days. And it will help fight overpopulation because filthy people with terrible B.O. probably won't get laid.
"fat pride community"

Saw that coming, along with the others.
Another modest proposal: Stop the federal corn subsidies that have created a glut of corn products in our food supply. (Hello corn syrup!) Use the money to support small farms, instead. Lots of small farms = greater food security, better quality food and less dependency of fossil fuel for production.

Less corn = less obesity = lower costs for health care.

See Michael Pollan's Ominvore's Dilemma for details.
Health used to be measured by some basic standards: Being able to do a modest number of push-ups or sit-ups, touching your toes, being able to jog on a track or treadmill for 10 minutes without being heavily winded. Nothing crazy, just basic fitness. If you aren't fit enough to do 5 push-ups, are you really healthy? If you can't touch (or see) your toes, is that health? I'm all for adjusting our standards when necessary, but…
Healthy at Every Size? Seriously? I guess "every" includes dangerously thin people too, then, right?

@9 - I lol'd.
not thin =/= obese
Maybe if our government would stop the BS propaganda in favor of low-fat, high-carb diets, people would have a chance to drop some of those excess pounds. Worked for me and a few dozen people I know. They don't have to tax anything sugary, just get the truth out there.
I'm going to laugh till I cry when these "fat acceptance" gastropods start dropping dead from coronaries or are forced to get their legs amputated.
@15 yeah, its the governments fault. Maybe they should have a campaign that says "Stop eating so much unhealthy shit you fat fucks". Would that make you happy?
The NYT article ends with a comment from Ms. Bacon saying "We’re all in this life raft together." Do you think that a life raft filled with people is really a good image for a plus size person to bring up? Let's take this life raft metaphor a step further. If I'm in a life raft with a bunch of people am I going to let one person chow down a bunch of those rations? No, everyone's going to get the same amount of food to eat. If someone's eating 2x a much as the next person they use up the supplies and if one person's too big the whole thing will get unbalanced and we could all go down! Let Ms. Bacon eat what I do in the same amounts for a few years (and exercise as much as I do). I'll bet we're pretty much the same size at the end of that time...
I feel so confused by exactly what their goal is, some of it I kind of understand although completely disagree with e.g. forcing airlines to install loveseats to offer them at no additional cost but others are kind of like WTF?

The negative health effects of being obese are well-known, scientifically proven and even very logical in nature. A few of them are kind of abstract like cancer but most of them are kind of like, uh, duh, of course weighing 300 pounds is bad for your knees.

Except for some circumstances like airplanes I really don't care if they eat a vat of macaroni soup every night but to act like being fat isn't inherently unhealthy and that society doesn't have good reasons to discourage it is so staggeringly delusional that it hurts my head to think about it.

Here is a fattie making Macaroni Salad:…
uh... there is something wrong with being fat. We should be sending that message. It's unhealthy, just like smoking and health care penalizes people for being smokers.
Clearly, you folks need to buy my mega-dose fish oil supplement. You can have 30 orgasms a day and lose weight too. Oh, and buy my book.
@21, bwahaha.
If you have a decent diet, get at least the suggested minimum of exercise, and your doctor feels that you're doing an adequate job of maintaining your health, but are still not particularly thin, then that should be okay. I don't think we should judge people who put in the effort to be healthy, because it can be long process for some people and we should encourage the right behaviors.

The problem is that these "fat acceptance" folks find fault with the very idea of pushing and strongly encouraging people to pursue healthy behaviors. That is wrong. You can be reasonably healthy without being skinny, but only up to a point.
So people are getting upset that health care reform is including some tough measures to actually include public health according to the best epidemiological data we have... but no one seems to be up in arms over the fact that the House bill would require providers to cover Christian Scientist prayer "treatment" as a legitimate medical expense.

Freedom of Calories is the new Freedom of Religion. Somebody get in there and revise the Constitution.
The fat shaming in these comments is pathetic. NOT BEING THIN DOESN'T MEAN YOU'RE OBESE. How big are you guys? Do you fit the aesthetic standards of the multi billion dollar diet industry?

I used to live with a girl who was stick thin. Ate candy and ramen and smoked pot all day. People called her beautiful, said she should be a model, men fell over her. I also am part of a triathlon team. I compete with people who do not fit the skinny mold in the slightest, and they kick my 105lb ass. Their size prompts "fat," "ugly," and "gross."

Just like the first article says, being skinny should not be our goal, being HEALTHY should be. But we don't give a shit about that, and neither do the commenters in this thread - it's about fitting a standard of beauty, not being appropriately healthy.

It depends on who they are, but most don't have a problem with encouraging people to exercise and eat reasonably well. What they have a problem with is pushing crash diets (which the government does promote. 1200 calories/day is what the government recommends, and that definitely qualifies.) and losing weight at all costs.

What most of the judgmental fucks here, including Dan most of all, don't know or pretend not to know is that any fat person has been struggling with their weight all their life. The advice that the government and the medical establishment give out does more harm than good. Most people don't have the discipline, time, or resources to be thin, but they may be able to make small changes for the better. It's called harm reduction, and all you assholes (especially you, DAN) who insult teh fattiez for not being fuckable are part of the problem.
"Puff piece." Was that deliberate? If so, checkmate, sir.
26, the government recommendations are as follows

2500 calories a day for men

2000 calories a day for women (2,500 in third trimester of pregnancy)

1800 calories a day for children aged 5-10
28, the problem is many people will take in 2000 calories in a single meal without even realizing it because most people don't put much thought into what they are eating.
I can't take my eyes off this video. I want to throw up, but then I'd have to stop watching.

Brilliant sample.
@17, the government actively contributes to the lies being told re: carbohydrates being the solution, cutting fat being the cure. I believed the lie for a long fucking time and struggled with my weight as a result. I ate less than my skinny friends and worked my ass off with exercise and couldn't lose weight because I thought I was doing it right, the way they recommended.

Got the truth, lost the weight. The implication that "fat" people are just lazy is wrong and unfair. A lot of them don't know what the hell else to do because they follow the guidelines they've been told to trust and it still doesn't work. I eat more now and don't have to exercise as hard to maintain because I don't believe the BS anymore.

It may not be the solution for everyone, but it worked for me and a lot of people that I know, so I'm sure it can help many others. Jumping to the conclusion that fat people = lazy fuckers who do nothing for their health is not really going to help.

And you wouldn't laugh if it was someone you loved. It's a lifelong struggle for many good people, and it's not for lack of trying to "fix" it. Of course, you may not deign to love someone so imperfect, so perhaps you'll never get it.
@ 25 and 26 I don't think anyone is saying to have to be stick thin to be healthy, of course moderately "overweight" people can be very fit and healthy. But obese is a different thing. We shouldn't be telling people it's ok to be 50 lbs overweight, it's just not. My dad and all of his brothers have diabetes now, they're all fat too. I see that and it helps me choose to exercise and choose healthier food. I've seen enough of what fat people eat, if "struggling with your weight" includes struggling with the big mac you just ordered - give me a break. Come back when you made some attempt to walk 20 minutes a day and eat a little bit healthy. You can still be fat and do that, but you really can't get THAT fat.
31, Actually the government recommends avoiding both fats and sugars.
I've always considered obesity a self-inflicted condition, you know, barring that infinitesimal percentage of fatties that have a gland problem and make actual efforts to be healthy. But I don;t get the feeling that Mrs. Bacon is advocating for them so much as trying to assure herself.
@19: That video is awesomely terrible.
The solution is simple: Fat for Gold!
@32. Of course, and we should tackle obesity, but not by fat shaming. Not by mocking "healthy at any size."
as a stick thin high school kid that suddenly ballooned out to over 220 in his late 20's I can say, you may be proud of being fat, but you're sure as fuck not comfortable.

trying to tackle the san francisco hills with an extra 60 pounds was not fun. oh and the sweat... christ the sweat.

I'm a lazy bastard, and don't like rigorous excercise, so i took the slow path and just walked around for at least 2 hours a day. On my work lunch break and after work. took me the better part of a year but i lost it.

i can tell you which of the two states i enjoyed being better. This isn't a Hollywood beauty versus reality thing, this is just plain reality. Nature didn't evolve fat humans, we invented them.
Of course one reason this sort of story is coming up right now is because the Insurance Industry is fighting a last-ditch effort in the Senate to kill health care reform. The argument that costs will spiral out of control because all the fat fat fatties refuse to stop eating is one of many talking points that are being played up by those who wish to kill any sort of universal coverage. Because Americans have shown themselves to be willing to demonize the overweight, the "personal responsibility" angle here is likely to find some traction.

It doesn't mean that there is no substance to it -- Americans are as a group far more likely to have weight problems and other health problems associated with poor diet and limited physical activity. But it is certainly no coincidence that articles like this that blame increasing health care costs on unattractive people are hitting the pages of the NYT today.

I love watching BBC's "You Are What You Eat" on bbc america.
38, Losing weight slowly is the way to do it if you want to keep it off. People who lose weight too quickly almost always gain it back. One problem is so many people give up on improved exercise and dietary habits when they haven't lost 20 pounds in 2 weeks. People should aim to lose about 4-6 pounds a month until they reach their goal. Good for you for sticking with it.
Sorry, it's a Channel 4 production. Not BBC
39, I'm against rationing health care to obese people. A better solution is to tax unhealthy foods, and apply those funds to caring for obese people.
@28: Those government recomendations, though, are for maintaining a healthy weight if you are already physically active on a regular basis and of average height and body type. You have to realize that for the average person, who doesn't get all that much exercise, 1800 calories is MORE than enough. I don't think people realize just how little food is necessary to sustain a healthy life. I believe very few people choose to actually eat that little and those that do generally just do so by habit and not out of conscious decision.

Obviously the solution to getting healthier is more exercise and quality food in moderated proportions, but not everyone lives a life that allows that. For desk jockies, the standard 2000 calories is actually too much.
Obese means a BMI of greater than 30. No one is healthy if they are obese. This is coming from someone who topped out at a BMI of 32 and has lost 40lbs this year because it was starting to effect my health.
We could just let insurance companies charge people according to their risk. Obese people would pay more in proportion to their higher costs.

Or we could demand that everyone pay the same, create a massive new entitlement that allows many more people to get their health care on somebody else's dime, and paper over the perverse incentives in such a system with a few entirely symbolic, ineffective public service campaigns that waste a few more tax dollars.

At least the rise in obesity will give progressives a useful excuse when Obamacare explodes the budget: "It was the fat people that did it."
All this business about some kind of diabolical food making people fat is an out an out crock. All that matters is energy balance. Calories in versus calories out. Nothing magical happens in your body. It's all governed by the laws of thermodynamics.

Wanna lose weight? Eat less. Exercise more. Or both. Don't want to do either? I could care less - just STFU, make peace with your fat, and don't expect the rest of us to give any credence to your claims that the sky is green and the grass is blue when the subject of the health effects of obesity come up.

I'm not particularly skinny or thin, but I exercise vigorously three hours a week and I've stopped buying junk food. I've lost five pounds in four months. My BMI is 22.0 and I feel great.

Exercise also helps fight depression. For me, it's less about demonizing fat people and more about the benefits of eating well and exercising- which lead to being a healthy weight.

Nobody here has argued that obesity is the same thing as "not being thin." Yes, some people are healthy with a little extra padding, some are healthy with a six-pack, etc etc. Nobody, however, is healthy if they're full-blown obese. Acknowledging that isn't "anti-fat;" it's just realistic. The health effects of obesity are real whether it hurts anyone's feelings or not.

Take smoking, for instance. My belief that smoking causes lung cancer isn't based on a hatred of smokers. It's based on the fact that there is a traceable and statistically significant link between smoking and the occurrence of lung cancer. No matter how awesome and wonderful my smoking friends are, that isn't going to become untrue.

Advertising agencies may be guilty of being unfairly biased against larger people; the medical community, however, is not. It's their responsibility to report facts as they discover them. When they find evidence that obesity leads to diabetes, or heart disease, or skeletomuscular problems, they can't just bury their heads in the sand because the fat acceptance movement won't like those facts. It's the fat acceptance movement's job, rather, to adjust their worldview to accommodate facts. Maybe focus on the idea that there's nothing wrong with being large and HEALTHY (when that's the case) rather than trying to insist that there's no such thing as large and unhealthy. The latter is dishonest and irresponsible.
@26: I am literally unable to get the meal planner on to recommend a 1200 calorie diet for a 24-year old woman, even by making her 2 feet tall, completely sedentary, overweight, and trying to move toward a healthier weight. The closest I could come was 1400 calories (seems to be an absolute lower floor) for a 4 foot tall overweight woman who's trying to lose some pounds. At 5 feet tall, overweight and trying to fix that, it recommends 1800 calories. Meanwhile for me, as an overweight 24-year old 6'1" male, it recommends 3000. Where are you getting your numbers?
@38: Good for you, but please bear in mind that if you weren't fat as a kid or a teenager, you're at a distinct advantage for taking and keeping the weight off. Those who get fat when their bodies are creating new fat cells (as opposed to just filling up the existing ones with fat) will struggle a lot more than you have in taking the weight off. They'll lose the weight but still have those fat cells, and their bodies will want to fill 'em back up.

I only mention this because there's a real tendency for those who've lost weight to be smug assholes about it. There's usually more to the story than moral superiority.
46: When you take taxes, bills, and premiums into account, our health care system is one of the most expensive per capita on the planet, as it is right now (look it up). There is a long list of countries where nobody is denied health care, yet the cost per person is less. In other words, denying people health care (or rationing health care based on wealth) doesn't save money. Just because you're paying money through something called "premiums" or "bills" rather than something called "taxes" doesn't mean that you're magically not paying real money. You're already paying for someone else's health care. The difference is that, right now, you're also paying for someone else's corporate salary and heftier administrative costs.

That whole paragraph in my last post about "accommodating reality" in your beliefs? It doesn't just apply to the fat acceptance movement. It applies to anti-health teabaggers also.
"We could just let insurance companies charge people according to their risk. Obese people would pay more in proportion to their higher costs."

So, David, considering that women are responsible for 85% of the health-care costs in this country (and yes, that includes pregnancies), would you similarly espouse charging them higher rates?
@50 Really? Then why is Slog posting one article advocating being healthy at any size over "being thin" and then obesity statistics as the next? If they're not calling people who don't advocate thinness at obese, then why are they being placed side by side? What is the connection?

@45 BMI isn't an accurate indicator of healthy size and that's why doctors don't use it - they use growth charts instead. Everyone has a different body size and what's important is that they stay in a healthy range for THEIR SHAPE, not fit a skinny mold.
55: The first article is a fat acceptance person accusing the medical community of being anti-fat. The second is an article about the health care costs (which can serve as a measurement of health problems) caused by obesity. It's pointing out the tendency of the fat acceptance movement to defend actual unhealthy obesity rather than defending the notion that being heavy is okay AS LONG AS YOU'RE HEALTHY. They're forgetting the "healthy" part.

This does nothing to counter the actual belief that being heavy and healthy is okay.
@56 "It's pointing out the tendency of the fat acceptance movement to defend actual unhealthy obesity rather than defending the notion that being heavy is okay AS LONG AS YOU'RE HEALTHY."

What the fuck are you talking about?

"Heavier Americans are pushing back now with newfound vigor in the policy debate, lobbying legislators and trying to move public opinion to recognize their point of view: that thin does not necessarily equal fit, and that people can be healthy at any size...."

Right. They're totally advocating unhealthy obesity.

From the wikipedia entry on "Health at Every Size"…

"Health at Every Size (HAES) is an approach to health that focuses on intuitive eating and pleasurable physical activity rather than dieting and weight loss.


An increasing number of health professionals are adopting a HAES perspective[2]. HAES advocates generally do not believe that the same narrow weight range (or BMI range) is maximally healthy for every individual. Rather, the HAES approach is that as individuals include physical activity in their lives, and eat in response to physical cues rather than emotional cues, they will settle towards their own, personal ideal weights. These weights, however, can be higher or lower than those described by standard medical guidelines."

Where are they forgetting the healthy part?

oh and btw, they're not protesting medical professionals, they're pushing back at public opinion and public health care policy. You know, the people who blame an inability to stop eating on being fat, that subsidizes HFCS, has an out of date food pyramid, pays billions of dollars to quick fix diets and pills, pays pennies for shitty fatty food in public schools, calls Jordan Sparks fat, etc.
Oh come on, Dan. Leave the fatties alone. Seriously, they don't get enough of this bullshit on the schoolyard? Fat isn't always a sign of poor health; I personally know fat people healthier than myself. The fact is that our culture brands fat people as somehow immoral, and for people who don't have the fortune of being able to lose the weight, the discrimination, the foul looks, they're not really fair, are they?

For example, the message in our culture is that you're not just a target for mockery and self congratulatory judgmentalism if you don't toe the waistline, you're a bad person.

But there is no "Fat Agenda." No group of people is going around trying to get people to eat at McD's every day. There is no big Fat Conspiracy driving people's waistlines outward.

There are bad people out there. People who think it's okay to bomb abortion clinics and cut women's health care. People who pray for the President's death. Fat hate is just a big waste of time, as far as I'm concerned.

Some people should probably consider working to lose weight and everyone should try to be their best, but isn't that their own fucking business?
Would you like to know what is causing obesity in america? It's not laziness, lack of intelligence or self control on the part of those who are overweight.

Fact: by 6th grade, kids no longer have recess, or even a lunch period that takes place outside.

Fact: High schools require only one semester of gym class in the four years spent there.

Also speaking of schools, school lunches are not only packed with calories, but lunch periods last, at best, 20 minutes or so. Studies have shown that rushing meals leads to weight gain.

Kids are, further, under more pressure than ever before, academically speaking, often coming home with hours of homework a night.

Is it any fucking wonder people are overweight? If our KIDS don't have time to go play outside, how the hell are most working adults going to manage it?
I swear to god I just don't get it. I mean fat people look like s%@t. I don't think that is hard to refute. Fat people should be ashamed of themselves period. It doesn't take too much effort to look in the mirror and say you know what this weight is getting out of control. Maybe I should either stop eating so much or excersise. There is a guy I work with that wheezes whenever he talks because he's so fat. I once bought him a bag of oversize marshmallows one day hoping he would choke on them. I wish it was okay to throw rotten tomatoes and cabbage at fat people.
I'm fat. I'm five feet and weigh 175 pounds. Whoa, unhealthy right? Wrong. My cholestrol level is normal, my hear rate is within healthy range and I show no sign of diabetes. Why? Because I'm healthy. I use a bike or walk everywhere, I do aikido twice a week. I do physical labor. I'm tired of people going on about the dangers of being overweight like it's a threat to humanity.

Not everyone is supposed to look like a model and everyone comes in different sizes and shapes. I'm not in the mood to be lectured because I don't look like I take care of myself. I do, a lot of this genetics too. Ever see a Samoan? How about them lithe Norwegians?

There is a british athletic (I forgot his name) who is morbidly obese at over 280 pounds but has a resting pulse of a runner and competes in triathalons. Not everyone you sneer at as fat is unhealthy. There are plenty of thin people suffering from health problems too.

Now excuse me while I go bicycle a mile to the store.

@59 Where are you getting your info?

At my high school lunch lasts 30 minutes, and you are required to take four half-year courses of health and fitness to graduate.

Three of those courses can be replaced by either participation in an official school sports team or in an outside activity approved by the H&F department.

But, yeah. The lunches do have an insane amount of calories
@31 You want a cookie because you lost weight? Here ya go..nomnomnomnom.

I was stick-thin growing up, but by the end of college i was borderline over-weight. When i tried to eat less, I gained weight. Then I learned how to LINDY-HOP and after a year of my social life revolving around fun that also happens to be great exercise, I lost ~23 pounds. GO FIGURE!

the problem with many of the posts on this site about this subject, especially from Dan, is the lack of knowledge. simplification of the problem results in your simplistic solutions and of course, the bonus of mocking the overweight.

obesity is connected with cash. bad food is cheaper. areas in the US have what are called "food deserts" which severely limit the abilities of low-income people to even purchase reasonably priced healthy foods. for these people, the hip urban market with overpriced organic vegetables is not around (if they could even afford it).

yes, it's ironic that lack of access to food helps to cause obesity. check it out.……

don't worry, you can go on and keep hating on the fat people after you finish reading.
Aside from the question of how much obesity has increased, the BMI is an utterly horrendous tool to be using with such alleged precision.
The problem with BMI is it WAS NEVER INTENDED TO BE USED ON INDIVIDUALS, and now it is. First, off, it was designed as a relative measure for means of sedentary populations. As in, people who get zero exercise, which is already an unhealthy state. Applying it to people who actually exercise(and are carrying extra pounds of muscle) has little value.

Secondly, the measure is fatally flawed in that it uses the square of height, while human beings are three dimensional. That means it allows short people to be proportionately much heavier than tall people. So if you're five feet tall, you can be downright chubby before it says you're overweight, and if you're 6'4" you have to be gaunt or you are considered obese(unless you have an exceptionally narrow frame). So what, I should stop playing sports so I can qualify for cheaper health insurance? What kind of perverse incentive is that?
@21- Nonsense. You just need to clench and relax your anal sphincter enough times a day and you'll be fine.
As one of those rare chubby chicks who has an actual glandular issue, takes meds, whole ball of wax, I'll tel you this. Dan is both right, & not right.

Dan is right: *usually* fat = unhealthy, or at the very least, obesity = unhealthy. We Americans are the most obese country going. It's a massive problem. (It's also clearly one of Dan's phobias.)

Dan is wrong: it's not *always* the case. Fat isn't always unhealthy, nor is every fat person you see on their way to a Kentucky Fried Chicken.

There's a whole slew of reasons Americans (or fat Americans) are fat, some of which are mentioned above by other posters. There's the rare bunch of us w/ a medical issue. There's our increasingly sedentary lifestyle. We fuel ourselves with increasingly processed/salty/fried foods. Unhealthy foods are cheaper & easier to access; we're not encouraged either by most schools or most jobs to make time to take walks/get fit; & we've gotten lazy. Our favorite forms of entertainment involve going out somewhere & watching things; going out & eating; or staying in & doing both. We don't get enough sleep. Most of us are stressed out & can't afford our lifestyles. I'd be surprised as hell if at least one of these didn't apply to most of us reading this, especially those of us w/ weight issues.

& if you're in that slender majority (pun intended) for whom none of that is true, I'm not talking about you. Enjoy your healthy lifestyle.

I just got back from Belgium & Germany. Lotsa folks over there don't have cars. They walk & bike everywhere. Anytime I went out, the distance was measured by how long it took to walk there.

I lost 20 pounds before going on my 2-week trip (sadly, much more to go). When in the home of so many delicious things, I relaxed & did a sweet backstroke up a river of Belgian chocolate, spaetzle, schnitzel & beer. I felt fat coming home & figured I'd gained about half of it back. No. I only gained three pounds. Because I walked everywhere.

So the new diet? It's the shut yer fat mouth & move yer fat ass diet. & it's working for me, I'm on the way back down. (Mind you, I'd already started a lot of other healthy habits, with the water, veggies, etc.) I throw a lot more walking into my day than I did before the trip overseas.

(Lastly, not trying to have the weight loss smug tone! Just trying to share what's working so far. Burroughs said that being addicted to food was worse than drugs, because food you can't just quit cold turkey.. I'm worried about backsliding, all the time. But you can change your habits.)
Hi Dan,
It's your fat fanbase "weighing in" here.

You juxtapose these two ideas as though they are in conflict -- Health at Every Size and Efforts to Improve the Health of the Population.
They are not.

(FYI - Linda Bacon, PhD, is not herself fat. I think if you interviewed her, Dan, you would see you have quite a bit in common in terms of long-term goals -- it's just how to get there that differs).

Health at Every Size doesn't mean that everyone of every size is healthy. What it means is that pursuing health, rather than a particular size or weight, is a vastly better (more sustainable, more achievable, science-based) approach. Talk to any physician who is an expert in treating obese people, and they will tell you that long-term weight loss, even with medications (of which there are very few safe ones, and they would need to be taken forever, with their side effects, to work) and surgery rarely results in anything more than 20% of a person's initial weight in the long term.

Eating better, eating fewer calories, being more active -- these are things that most human beings in industrialized need to do to to maintain health long-term. It's not "calories in, calories out" so much as a combination of a genome designed to survive hard physical labor and times of famine and plenty living in an environment where movement is limited and it's "good n' plenty" 24/7. Relying on willpower or self-restraint or internal motivation isn't going to improve health -- it's going to take changes to our food and physical enviroment. I am all for these things, and I'm also all for a "Health at Every Size" approach -- focusing on what people need in order to be healthy -- so people who have the sky spitting on them 6 months out of the year but don't have the money to join a gym (and who barely have money to eat -- a "famine" and "plenty" cycle practically guaranteed to lead the body to store whatever it can get it's fat cells on) can afford one, and that the food people can afford contains more essential nutrition and fewer empty calories.
We're on the same side.
Talk to Linda Bacon.

it strikes me that PART of the problem here (one of many, lest i be accused of over-simplifying) is that the entertainment industry/media/cultural millieu whatever that holds up TOO thin as the only acceptible aesthetic, has over-sensitized people who do not look thin to any criticism the very real obesity epidemic in our country. As many have pointed out, being healthy does NOT mean you have to look like a super-model, but if you are morbidly obese then you are probably not healthy. just to set the record straight, i don't think the healthcare industry is saying that you need to look like tyra banks- what they're saying is that if you are several HUNDRED pounds overweight you are probably going to end up w/ heart disease, diabetes, and or knee problems. the definition of "morbid" in medicine, by the way, is essentially any condition that really fucks up a person's quality of life. you can't have a proper debate about any of the rest of it, until the bigger people in the convo-some of whome probably ARE healthy and just get on the top shelf whenever anyone says the word fat-at least give up the "you just hate me because im not a twig" argument.
You probably see more thin people aged over 70 because they grew up in an age when obesity was rare, there were no fast food restaurants, processed food and unhealthy snack items. Many more people lived on farms, had fresh food they grew themselves or purchased locally, they walked more, engaged in more labor and physical activities. Few people had the money to overeat, which is why in media then rich people are portrayed as fat.

The 1950s probably marked the end of this period in American history. After that you start seeing more obese people, and in the 1990s, obese children - previously virtually unknown.

That said, it is possible for a somewhat overweight person to be generally healthier and fitter than a given thin person who doesn't exercise or eat right. But mostly more and more Americans are too fat physically and between the ears.
Also, it's entirely possible for the not-fat elderly person you see today used to be heavier -- and that's what allowed them to withstand what illnesses they've encountered. The "obesity paradox" seems to indicate that having a BMI greater than 25 confers survival benefits. But as people have bouts with serious things, their bodies do what they are supposed to and release the stored energy when they need it. Heavier people tend to have better bone density, too -- so being overweight and fit for some is the best bet.
Being as physically fit and eating a healthy diet, avoiding harmful behaviors like smoking, drinking to excess, not wearing a seat belt, etc. -- those are things we can all do regardless of what size we end up.
So, unless you're going to do a thorough risk assessment and prove you're healthier than I am -- stop judging my fat ass.