weight stigma

How To Make Fat Bodies Unhealthy

A Recipe For Poor Health

People in higher-weight bodies are not inherently unhealthy. Any research that shows a correlation between weight and poor health is just that, correlational. Is it that higher weights result in poorer health outcomes? Or is it that those in bigger bodies face weight stigma – pathologizing, oppression, and inadequate medical care?  A lot of evidence points to the latter, as it seems that a number of our systems come together to threaten the health of fat folks. Here’s how that happens.

Weight Stigma In Action

In 2013, the American Medication Association, after years of discussion, first recognized “obesity” as a disease.  This was in defiance of an earlier committee paper just that year that specifically suggested that the AMA not medicalize body size. 2013 marked the first time that the medical profession was able to refer officially to fat bodies as diseased. The move was highly financial. Labeling higher-weight bodies as inherently sick benefits a number of industries, including Big Pharma and the medical weight-loss industry.

Pathologizing bodies of certain weights, particularly under the guise of concerns about their health, allows us to more openly stigmatize and oppress fat bodies. Weight stigma and bias is condoned and reinforced in multiple arenas, now authorized by the medical establishment. Fat folks might have trouble finding seating in public spaces, finding clothing that fits, and finding jobs, despite their qualifications. Folks in larger bodies often receive harmful and ineffective medical care (more on that below), simply as a result of their weight. Socially, they are bullied and assigned a host of negative personality characteristics. And they are often met with concern from family, friends, acquaintances, and strangers about their health, even in the absence of any information about their actual physical functioning. It turns out that pathologizing body size allows for more open and socially acceptable weight stigma and oppression. If the doctors say fat is bad, then your family and friends, your community, the public, and the trolls can too.

Being oppressed as a result of one’s weight takes its toll on people’s minds and bodies. Whether it’s academic or employment discrimination, medical bias, or stigma in interpersonal relationships, the result is that  those in higher-weight bodies often suffer a reduced quality of life, impacting both physical and mental health. 

So when we talk about health outcomes related to weight, it’s critical that we include the damage to minds and bodies that are borne out of stigma and oppression. When we see correlations between weight and health problems – such as high blood pressure, heart disease, high cholesterol, and type 2 diabetes – it’s important to note that these are conditions also highly associated with stress. So does weight cause these conditions, or is the stress related to living in a larger body more to blame?

Additionally, exposure to weight stigma also tends to result in increased weight gain over time. For women who perceive themselves to be “overweight” for instance, exposure to weight stigma paradoxically causes them to consume more calories and feel less capable of controlling their food intake. Another study found that those who experienced discrimination based on their size gained more weight over time than those who did not.

The healthcare industry then adds insult to injury by responding to fat bodies in a way that causes them more harm. Fat people are consistently prescribed restrictive diets by medical doctors, dietitians, therapists, personal trainers, etc. that don’t adequately nourish them and can actually result in disordered eating. Moreover, prescriptions for reduced intake can set off a dangerous experience of weight cycling, associated with a number of significant health consequences.

When folks in higher-weight bodies try to access medical care, their experiences contribute to further shaming and stigma. In a study of 620 primary care providers, more than 50% of the physicians viewed “obese” patients in a negative light.

Doctors often blame all of their fat patients’ maladies on their weight, overlooking problems that require attention. One prominent case illuminated this devastating truth. Canadian Ellen Maud Bennett died in May of 2018 from inoperable cancer, which had been missed due to her doctors’ focus on her weight.  For years, Bennett had sought out crucial medical care, only to be told she needed to shrink her body. Bennett used her obituary to address fat shaming in medicine. She pressed those in higher-weight bodies (really, a call to everyone) to fight against medicine’s notion “that fat is the only relevant health issue.”

Focusing on someone’s weight at the expense of actual health measures can have fatal outcomes and is highly unethical. “The assumption that weight is responsible for, or related to, almost any presenting complaint has resulted in misdiagnosis. Recommending different treatments for patients with the same condition based on their weight (e.g., weight loss for fat patients; CAT scans, blood work, or physical therapy for other patients) is unethical and a form of malpractice,” Chrisler and Barney write, in their 2016 article, “Sizeism Is a Health Hazard.” 

Moreover, healthcare professionals often don’t have appropriate medical equipment or gowns to make a visit comfortable or effective, all of which can reduce the likelihood that those is larger bodies will continue to seek out medical care.

In one study that examined barriers to routine gynecological cancer screenings, “68% reported that they delayed seeking health care because of their weight, and 83% reported that their weight was a barrier to getting appropriate health care.” The authors asked women about specific reasons for delay of care and noted, “These barriers include disrespectful treatment, embarrassment at being weighed, negative attitudes of providers, unsolicited advice to lose weight, and medical equipment that was too small to be functional. The percentage of women who reported these barriers increased as the women’s BMI increased.”

What To Do Instead

There are a number of things laypeople and professionals can do to avoid participating in the type of harm described above.

  1. Don’t refer to body size as a disease. Remove words like “overweight” and “obesity” from your vocabulary. Instead, use words like “fat,” “higher weight,” or “in bigger bodies.”
  2. Uncouple weight and health. At the very least, acknowledge the physical and mental health impact of bullying, shaming, stigma, and oppression based on size.
  3. Create safe physical and emotional spaces for fat folks. Is your home or office, notably your healthcare office, accessible for fat bodies? Does your furniture, layout, attitude, language, equipment, etc. communicate that you accept and value bodies across the weight spectrum?
  4. Identify biases (even implicit ones) based on weight (and based on intersections with other marginalized identities). Challenge these biases in yourself and others.
  5. Adopt a Health at Every Size approach and advocate for more training in this approach among healthcare professionals.

*original terms are preserved in quotes but aren’t supported as valid descriptors in this space

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