A theoretical paper has explored the dual understandings of fatness and health from Kaupapa Māori and fat studies perspectives. Māori understandings of bodies and fatness that reflect whakapapa and culture are often excluded from health contexts and discourses. Fat studies have highlighted the cultural constraints against fat people and fat bodies and the structural oppression that prevents fat people from accessing public services, including evidence-based healthcare. The authors suggest a shift away from public health approaches to fatness that can often be oppressive and perpetuate healthism, in favour of Kaupapa Māori and fat studies pathways that promote self-determination and agency, supporting the community and collective, and body sovereignty.