Thank you to the authors for their commentary. Our perspective remains that fat and obesity studies, although currently deeply segregated, are not mutually exclusive. Although there are many points of disagreement, there are also points of convergence. The fundamental disagreement lies in the framing of obesity as a chronic disease. We would like to reiterate that in our view obesity needs to be identified and treated as a chronic disease only when weight affects a person's health. We also believe in the need to promote body diversity and inclusivity. Our engagement and research in this field is entirely dedicated to fighting weight bias and discrimination in health, education, and policy settings. (1) We fully understand and support the notion that people who identify as fat deserve to be treated with respect and not be pressured into seeking unwanted medical help. On the other hand, we also fully understand and support people with obesity who have made the personal decision to reach out for help, and strongly feel that they should have access to adequate and respectful health care, including access to evidence-based obesity treatments.

We have reflected on the opposing narratives, which may help understand the tensions between them (Table 1). Whether the modest overlap between the narratives (as shown in bold in the table) allows for finding a common ground that can lead to a constructive debate remains to be seen. Both perspectives clearly call for all people to be treated with dignity and respect, regardless of their size or weight. While we should always remain critical of our own academic and personal perspectives, practices, and beliefs, a basic tenet of scholarship is to be able to have a respectful dialogue with others. (2)

doi: 10.17269/CJPH.108.6559

REFERENCES

(1.) Ramos Salas X, Alberga A, Cameron E, Estey L, Forhan M, Kirk SFL, et al. Addressing weight bias and discrimination: Moving beyond raising awareness to creating change. Obes Rev 2017; 18:1323-35. PMID: 28994243. doi: 10. 1111/obr.12592.

(2.) Alberga AS, Russell-Mayhew S, von Ranson KM, McLaren L, Ramos Salas X, Sharma AM. Future research in weight bias: What next? Obesity 2016; 24(6):1207-9. PMID: 27129601. doi: 10.1002/oby.21480.

(3.) Bray GA, Kim KK, Wilding JPH. Obesity: A chronic relapsing progressive disease process. A position statement of the World Obesity Federation. Obes Rev 2017; 18(7):715-23. PMID: 28489290. doi: 10.1111/obr.12551.

(4.) Bacon L, Aphramor L. Weight science: Evaluating the evidence for a paradigm shift. NutrJ 2011; 10(1):9. PMID: 21261939. doi: 10.1186/1475-2891-10-9.

(5.) Campos P, Saguy A, Ernsberger P, Oliver E, Gaesser G. The epidemiology of overweight and obesity: Public health crisis or moral panic? Int J Epidemiol 2006; 35(1):55-60. PMID: 16339599. doi: 10.1093/ije/dyi254.

(6.) Sharma AM, Campbell-Scherer D. Redefining obesity: Beyond the numbers. Obesity 2017; 25(4):660-61. PMID: 28349662. doi: 10.1002/oby.21801.

(7.) World Health Organization. Obesity: Preventing and Managing the Global Epidemic. Geneva, Switzerland: WHO, 2000.

(8.) Beausoleil N, Ward P. Fat panic in Canadian public health policy: Obesity as different and unhealthy. Radical Psychol J Psychol Polit Radicalism 2009; 8(1):5.

(9.) Kyle T. Reducing Weight Bias: Identifying Obesity as a Chronic Disease Helps, 2017. Available at: http://conscienhealth.org/2017/04/reducing-weight-biasheres- pretty-strong-clue/ (Accessed June 2, 2017).

(10.) Boswell J. 'Hoisted with our own petard': Evidence and democratic deliberation on obesity. Policy Sci 2014; 47(4):345-65. doi: 10.1007/s11077014- 9195-4.

(11.) Harjunen H. Neoliberal Bodies and the Gendered Fat Body. Abingdon, UK: Routledge, 2016.

(12.) Kirk SFL, Penney TL, McHugh TLF, Sharma AM. Effective weight management practice: A review of the lifestyle intervention evidence. Int J Obes 2012; 36(2):178-85. PMID: 21487396. doi: 10.1038/ijo.2011.80.

(13.) CON-RCO. Report Card on Access to Obesity Treatment for Adults in Canada 2017. Canadian Obesity Network, 2017. Available at: http://www. obesitynetwork.ca/reportcard (Accessed December 12, 2017).

(14.) O'Hara L, Gregg J. The war on obesity: A social determinant of health. Health Promot J Austr 2006; 17(3):260-63. PMID: 17176244.

(15.) Kuk JL, Ardern CI, Church TS, Sharma AM, Padwal R, Sui X, et al. Edmonton Obesity Staging System: Association with weight history and mortality risk. Appl Physiol Nutr Metab 2011; 36(4):570-76. PMID: 21838602. doi: 10.1139/ h11-058.

(16.) Puhl R, Suh Y. Health consequences of weight stigma: Implications for obesity prevention and treatment. Curr Obes Rep 2015; 4(2):182-90. PMID: 26627213. doi: 10.1007/s13679-015-0153-z.

(17.) Kirk SFL, Price SL, Penney TL, Rehman L, Lyons RF, Piccinini-Vallis H, et al. Blame, shame, and lack of support: A multilevel study on obesity management. Qual Health Res 2014; 24(6):790-800. PMID: 24728109. doi: 10. 1177/1049732314529667.

(18.) Forhan M, Ramos Salas X. Inequities in healthcare: A review of bias and discrimination in obesity treatment. Can J Diabetes 2013; 37(3):205-9. PMID: 24070845. doi: 10.1016/j.jcjd.2013.03.362.

(19.) Crandall CS. Prejudice against fat people: Ideology and self-interest. J Pers Soc Psychol 1994; 66(5):882-94. PMID: 8014833. doi: 10.1037/0022-3514.66.5. 882.

(20.) Saguy AC, Riley KW. Weighing both sides: Morality, mortality, and framing contests over obesity. J Health Polit Policy Law 2005; 30(5):869-923. PMID: 16477791. doi: 10.1215/03616878-30-5-869.

(21.) O'Hara L, Gregg J. Human rights casualties from the "war on obesity": Why focusing on body weight is inconsistent with a human rights approach to health. Fat Stud 2012; 1(1):32-46. doi: 10.1080/21604851.2012.627790.

(22.) Eller GM. On fat oppression. Kennedy Inst Ethics J 2014; 24(3):219-45. PMID: 25423849. doi: 10.1353/ken.2014.0026.

(23.) Puhl RM, Kyle TK. Pervasive Bias: An Obstacle to Obesity Solutions. Commentary. Institute of Medicine Roundtable on Obesity Solutions, National Academy of Sciences, 2014.

(24.) Muennig P. The body politic: The relationship between stigma and obesity-associated disease. BMC Public Health 2008; 8(1):128-37. PMID: 18426601. doi: 10.1186/1471-2458-8-128.

(25.) Carels RA, Young KM, Wott CB, Harper J, Gumble A, Hobbs MW, et al. Internalized weight stigma and its ideological correlates among weight loss treatment seeking adults. Eat Weight Disord 2009; 14(2-3):e92-97. PMID: 19934642. doi: 10.1007/BF03327805.

(26.) Durso LE, Latner JD, Ciao AC. Weight bias internalization in treatment-seeking overweight adults: Psychometric validation and associations with self-esteem, body image, and mood symptoms. Eat Behav 2016; 21:104-8. PMID: 26826975. doi: 10.1016/j.eatbeh.2016.01.011.

(27.) CON-RCO. 5As of Obesity Management Framework and Resources. Vol. 2013. Canadian Obesity Network, 2013.

(28.) Cameron E. Toward a fat pedagogy: A study of pedagogical approaches aimed at challenging obesity discourse in post-secondary education. Fat Stud 2015; 4(1):28-45. doi: 10.1080/21604851.2015.979336.

(29.) Robinson J. Health at every size: Time to shift the paradigm. Health at Every Size 2004; 18(1):5-7.

(30.) Ellison J. Weighing in: The "evidence of experience" and Canadian fat women's activism. Can Bull Med Hist 2013; 30(1):55-75. PMID: 28155520. doi: 10.3138/cbmh.30.1.55.

(31.) CON-RCO. EveryBODY Matters Collaborative, 2016. Available at: http://www. obesitynetwork.ca/pg.aspx?pg=452 (Accessed December 12, 2017).

Table 1. Fat and obesity studies dichotomized narratives

Statement/principle

Obesity studies

* In some people, excess adiposity can pose significant morbidity
and mortality risk. (3)

* Once established, obesity (defined as adiposity affecting a
person's health) is often a progressive chronic disease. (3, 6, 7)

* People-first language is widely accepted in the chronic disease
world as a way to promote respectful and people-centred care. (9)

* People who have obesity (the disease) need access to safe,
effective, and evidence-based weight management approaches. (12, 13)

* Not everyone who is fat has obesity. (1, 15) *#

* People with obesity are stigmatized in health care systems
because of their weight and size. (16-18)#

* People with obesity seeking treatment support have the right to
receive evidence-based obesity management services. (13, 23)

* Obesity management is not about weight loss. It is about
improving health. (27)

* Health is not measured on the scale. (27)#

* Body positivity and acceptance is a core principle of obesity
management. (27)#

* Obesity health professionals, educators, and policy makers should
embrace body positivity and promote body diversity. (1, 2, 31)#

* Obesity management approaches need to be tailored to individuals'
needs and situations. There is no single approach that will work
for everyone. (27)

Statement/principle

Fat studies

* Excess adiposity does not pose a significant morbidity and
mortality risk. (4, 5)

* Obesity is a social construct developed by the medical
establishment to pathologize fat bodies and perpetuate a social
injustice. (8)

* The obesity discourse vilifies fat bodies and is based on
phenomena such as neoliberalism, healthism, and medicalization of
society. (10, 11)

* Weight management approaches are never effective and cause more
harm than good. (14)

* People who identify as fat do not have a disease. (5)#

* Fat people are stigmatized in health care because of their weight
and size. (19-22)

* Fat people who believe their weight is affecting their health
have internalized weight bias. (24-26)#

* Obesity management is weight loss centric. (14)

* Health is not measured on the scale. (4, 28, 29)#

* Fat acceptance movement emerged in Canada and the US in the early
1950s. (30)#

* Fat studies embrace body diversity and promote body positivity.
(20)#

* Obesity management approaches are unnecessary. (5)

* Bold type signifies an overlap between the narratives.

Note: Overlapping narratives are indicated with #.