"Obesity is the biggest threat to the health of our nation,” proclaims the chief of epidemiology at a major medical school on the Scientific American Observations blog. This all too common suggestion does far greater damage to public health than fat tissue itself. When the focus is on weight and body size, it’s not “obesity” that damages people. It’s fearmongering about their bodies that puts them at risk for diabetes, heart disease, discrimination, bullying, eating disorders, sedentariness, lifelong discomfort in their bodies, and even early death.
Anti-obesity campaigns are so common and normalized these days that some readers might consider our claim as the outrageous one. Yet, consider this: stigmatizing and imposing shame on bodies, whether individually or as a group of people, is hurtful both to the vilified fat people and to the thinner people who are taught size prejudice and instilled with a fear of becoming fat. (“Fat” is used here as a descriptive term stripped of pejorative connotations, reclaimed by a growing fat acceptance movement.)
When the culture and the medical world are constantly pushing the idea that “obesity” needs to be eliminated, it’s not the fat cells that are feeling that stigma—it’s the fat people. This hierarchy of bodies is nothing new, with roots in racism, slavery and every other attempt to rank bodies. We can no longer pretend that being less likely to be hired or get promotions, being paid less, receiving biased medical treatment, being socially excluded and bullied are attempts to help people “be healthier.” These are the direct consequences of living in a culture that vilifies and fears fat bodies and that treats the people living in them as morally lesser beings.
From my (Linda) decades of challenging the pervasive “fat is bad” rhetoric, I know that every time I assert that the problem for fat people isn’t their bodies, but abuse from society, bigotry fights back. It’s not just the outright haters who populate the comments section, but worse, the self-righteous who see their stance as caring. It’s all about health, their argument goes, not bias.
No, it’s not. Intent does not negate impact. You cannot wage war on obesity without waging war on the people who live in those “obese” bodies. Moreover, the dignity of a group should not be contingent on whether its members are deemed healthy, eating “right,” or exercising regularly. It should be obvious, but weight stigma does not reduce “obesity”—and health care should be about self-care and promoting the health of the person in all its forms.
“Obesity”—the word itself is a problem, pathologizing the size of a body. It is a category based on the body mass index (BMI), which is simply a mathematical equation based on height and weight. It measures physical appearance, not health. It was never intended to be used for individual health concerns, but rather for statistical analysis of a group. When the American Medical Association declared obesity a disease, it overrode a recommendation by its own expert panel, which stated that correlations between “obesity” and morbidity and mortality rates did not establish causality and there was concern that medicalizing “obesity” would lead to further stigmatization and unnecessary treatment.
Even a quick glance at the weight research shows that, despite decades of trying, there is no evidence that efforts to prevent or reverse “obesity” are successful. In fact, there’s much evidence to suggest that the prescription for weight loss is more likely to result in physical harm and weight gain. The data also refute other longstanding, widespread—and incorrect—notions about health and weight. Like the “fact” that fat is a primary driver in metabolic disease. Or that weight loss prolongs life or improves health. None of this is true. Dogma, myths, and prejudices about fatness have trumped actual evidence in our view of weight and health.
It is true that many diseases are more commonly found in heavier people. However, that doesn’t mean that weight itself causes disease. Blaming fatness for heart disease is similar to blaming yellow teeth for lung cancer, rather than considering that smoking might play a role in both. And telling people they need to lose weight is a lot like telling someone with a cold to stop sneezing so much—it may not be possible and won’t make the cold go away.
Focusing on weight—or health behaviors—puts the burden on the individual, deflecting attention from the more pernicious problem: systemic injustice. Conditions in the places where people live, work, and play affect health outcomes to a much larger degree than health behaviors, which, all told (including eating, activity and other behaviors), account for less than 25 percent of differences in health outcomes. While health behavior change is valuable, to truly improve public health, we can work harder to create an inclusive society where everyone feels valued and has the opportunity to create a good life for themselves. Combating fat-phobia needs to be part of that agenda.
Ethical and effective public health intervention challenges fat bias and fosters self-care behaviors rooted in respect and nurture, not shame. I’ve seen it in my (Linda) research examining the Health at Every Size®1 (HAES) paradigm, as have many others. HAES practices have been shown in controlled trials to improve health habits, self-esteem and psychological well-being as well as metabolic health—all without weight loss or introducing weight bias. The HAES movement takes the focus off of weight change and supports people of all sizes in finding compassionate ways to take care of themselves, helping to advance social justice as it improves health outcomes.
For the HAES naysayers and those fighting to end obesity, we urge you to examine why these beliefs are so deeply held and what about challenging them is challenging you.
For those who feel the stigma of a fat body or fear of a fat body, we want you to know this isn’t your personal failing, it’s our culture that is failing you. It’s not easy to appreciate your body in a culture where your body is vilified. Oppression, by removing us from belonging, is writ large upon our bodies and literally killing us.
But places of refuge do exist and healing is possible. We urge you to look for an accepting and appreciative community. We are heartened to know the possibilities grow stronger by the day. Finding ways to belong to each other and create refuge for each other can help shift the world around us—until one day, all bodies are valued and all of us feel a sense of belonging.
The authors thank members of the ShowMeTheData listserv for critical review.
1Health at Every Size and HAES are registered trademarks of the Association for Size Diversity and Health and used with permission.