It’s safe to say that, as a year, 2020 has sucked. At the same time, though, and perhaps partly because of it, many Americans have begun reexamining our roles in the treatment of people of other races, genders, classes, and so on. But some types of discrimination receive more attention than others.
Fat-shaming pervades every aspect of our culture. If you’re fat, there are few, if any, aspects of your life that it will not impact. It will shape your social relationships, affect your ability to find employment, and alter the quality of the healthcare you receive.
“This is a cultural problem and the more we can identify that the problem is in the culture and not in our bodies, the closer we get to changing it,” said Lindo Bacon, author of “Health at Every Size: The Surprising Truth about Your Weight.”
Fat phobia is such a part of our everyday lives, most people don’t recognize it when they’re actively perpetuating it. If anything, they think they’re helping. Instead, the blame for size discrimination is placed on its recipients, who tend to be perceived as too lazy or unwilling to change their lives to improve their situations.
The intersectionality of fatnessHailey Otis is a Ph.D. candidate at Colorado State University who experienced fat phobia throughout her life. After becoming aware of body positivity and fat activism in college, she decided to make it the focus of her academic career.
“This movement has done a lot for me and made me sort of more able to live in this world and survive and thrive. And so I felt like it was kind of my responsibility to give back to the movement by researching it and uplifting it and sort of bringing those voices into my own work,” she said.
For Otis, fat acceptance intersects on a basic level with most forms of social justice.
“Our cultural understandings about fatness and fat bodies are rooted in so many other forms of marginalization,” she said. “Our cultural hatred towards fat bodies has a lot to do with the fact that fatness was read as a property of blackness or minority identities for a really long time within our history. White people tended to be thin, or at least that was kind of the common perception, and people of color were larger and therefore less civilized.”
In other words, the bias against fat people is inherently racist, and questioning assumptions about body size also means recognizing how they’re connected to race. It shouldn’t come as a surprise, though, that fat-shaming is a feminist issue as well.
“Fatness is often linked with the inability to perform femininity. Women are supposed to be thin and dainty and all these things, and when they’re not, that’s a problem that gets in the way of these gender roles that we’re so invested in,” she said. “And with sexuality, fatness is kind of this refusal to perform sexual desirability in the way that people want them to.”
But that’s certainly not where the cross-connections end.
“Anti-fatness is also super connected to capitalism and how we understand bodies that can perform the labor that needs to happen to keep capitalism going. ... Our assumptions about body size are never just about body size, or about all these other things, and all these other ways that people get marginalized,” she said.
What fat phobia looks likeMany forms of fat discrimination, such as bullying and harassment, are obvious. On a more subtle level, studies show fat people are less likely to be chosen as friends and romantic partners. They’re more likely to have lower levels of education, live in poverty, be unemployed, and experience lower standards of living. People perceived as fat, particularly women, are less likely to be hired or promoted within workplaces and tend to be paid less than their thin counterparts.
Anti-fat bias is particularly dangerous within medical settings.
Obesity (a problematic word in and of itself because it pathologizes a body type), is defined medically as a category on the body mass index, calculated based on height and weight. Obesity is the result of several factors, including genetics and environment. But studies show that healthcare professionals, including those who specialize in treating obesity, often treat it as a character defect and associate fatness with stereotypes of laziness, lack of intelligence, and less personal worth. In practice, medical professionals spend less time with fat patients, develop less of a rapport with them, and leave them feeling dehumanized.
As a consequence, fat patients are less likely to seek care for ailments or get medical screenings to, for instance, detect cancers that are easier to treat and less deadly when you catch them early.
It’s also worth noting that the “obesity epidemic” the pop culture likes to warn us about is based on a bad Centers for Disease Control and Prevention study published in the Journal of the American Medical Association in 2004. The article reported that more than 400,000 Americans die as a result of being overweight or obese every year — and the news media publicized the heck out of it. Much less popular was the correction JAMA published the next year in which better methodology and proper computation placed the number around 26,000 — less than guns, alcohol, and car crashes, according to Otis’ white paper, “Improving Healthcare Professionals’ Communication to Reduce Fat Stigma.”
This is all compounded by the fact that stigmatization isn’t great for your health in the first place — it has both psychological and physiological effects, Bacon points out.
“We tell people that they’re not worthy of respect, and it’s bound to make them feel bad and increase levels of depression and anxiety and fear going out into the world,” he said. “It’s also pretty well documented that when people feel bad about themselves, they’re less able to take care of their bodies. And we also know that regardless of what somebody’s self-care behaviors are, when people are treated poorly it affects their stress levels, which in turn has a major impact on health — things like diabetes and heart disease and irritable bowel syndrome.”
And it’s not just fat people who suffer from the stigmatization. Thinner people often live their lives in fear of fat, which leads them to adopt bad behaviors and to be scared of food, he said.
Colorado’s subtle health obsessionThin people tend to engage unknowingly in another form of fat-shaming, Otis said, when they talk about their own bodies.
“People think that when they’re talking about their own body, they’re not implicating other people. People talk about wanting to lose weight or not feeling good because they’re feeling fat. The idea of feeling fat is really problematic,” she said. “When people talk about their own bodies in a disparaging way, because of their perceived proximity to fatness, I think that’s one way that comes through. I’ve had a lot of family members and friends who are thin, but any moment that they think they’re getting fat or gaining weight, they talk about it a lot and how upset they are. ... They’re not trying to apply that to me, but it always will because the way we talk about our own bodies automatically implicates other people’s bodies.”
Similarly, congratulating people on weight loss, let alone chastising them for not achieving it, can be a very negative thing.
“When we congratulate people on weight loss, we’re automatically affirming this idea that losing weight is good and being fat is bad — often without knowing anything about why somebody lost weight.”
People lose weight for many reasons — eating disorders, losing a loved one, fighting an illness — but we’re culturally ingrained to assume that any kind of weight loss is a positive thing.
“When somebody congratulates somebody else on weight loss that sort of sends a message to everybody else in the room about what types of bodies are valued and what kinds aren’t,” she said.
These more subtle forms of anti-fatness are especially common in places like Colorado, which is consistently rated as one of the “fittest” states in the country (often based on little more the arbitrary measurement of average BMI). Colorado has an affinity toward fitness culture, but likes to pretend that outdoor exercise activities are part of the lifestyle of Coloradans and not what people choose to do to stay fit or thin, Otis said. Hiking, mountain biking, rock climbing, kayaking, and the like are activities that are not accessible to a lot of fat or disabled people.
“That obsession with healthiness is super interesting in Colorado because for the most part people aren’t calling out fat bodies for being problematic, but there’s a lot of judgment toward people that aren’t perceived as healthy — which tend to be fat people. Fitness-and-health culture is a super interesting, coded way of still excluding fat people and enforcing stigma against them,” Otis said.
COVID-19 and fatnessFat stigma goes hand in hand with healthism — the idea that only healthy bodies have value. This was already a widespread problem, but the discourse about the coronavirus epidemic has brought it right out into the open.
“Especially at the beginning of the pandemic, it was like, ‘Oh, this thing is only going to hurt or kill people with underlying conditions. Therefore, we don’t all have to worry about it.’ Which was always sort of a very ableist argument — that disabled people and people with health conditions don’t matter and that we can happily sacrifice them if it means that we all get to live our life the way that we want to,” Otis said.
That ableism quickly overlapped with anti-fatness when people began pointing at obesity as a risk factor for COVID-19. Studies suggested that weight was not a factor, and some even suggested that being overweight was protective against the coronavirus (something true about a lot of illnesses), she said. Many studies that now include weight as a risk factor don’t account for race or socioeconomic status, two forms of marginalization linked with health disparities.
“We have all this sort of problematic data that wants to blame fat people and say that they’re going to die or get sick and it’s their fault, when we actually don’t have the data to support that because we aren’t accounting for all these other factors, and we’re not accounting for the fact that things like medical bias and not treating comorbidities — specifically not treating fat people’s comorbidities — all of that leads to poor health outcomes,” she said.
In medicine, comorbidity is the presence of additional conditions that co-occur with a patient’s primary condition. And it became a hot topic at the end of August when a CDC statistic — indicating that 6% of people who have died of COVID-19 have only the virus listed as the diagnosis on the death certificate — became popular on social media. Conspiracy theorists, including President Trump, shared the stat, suggesting that it was the CDC sheepishly admitting it had wildly inflated the virus’ death toll by lumping in people who were killed by conditions unrelated to the virus.
That’s not what the statistic actually means.
“Death certificates list any causes or conditions that contributed to the death,” the CDC/NCHS Mortality Statistics Branch told Health.com in a statement. For instance, over 30% of that remaining 94% also have “respiratory failure” listed as a cause of death. They stopped breathing ... probably because of the coronavirus. (That “SARS” in “SARS-CoV-2,” the name of the virus, stands for “severe acute respiratory syndrome” — it makes your respiratory system fail.) Even when the comorbidity is something like diabetes or cardiovascular disease, both linked to obesity, in the vast majority of COVID-19 deaths, the virus has been determined to be the trigger for mortality.
“I think any moment that public health comes into question, people automatically want to turn and blame fat people. And they also want to make sure that resources don’t go to fat people because, you know, we are to blame for not being healthy, whatever that means,” Otis said.
The entire situation is also aggravated by the fact that many people lost their usual means of self-care during COVID-19 shutdowns and turned to food instead, resulting in weight gain, Bacon said. At the same time, others are taking advantage of the situation to sell more diets, all while the government promotes bad assumptions about the relationship between health and weight.
Where to go from hereWhat can people do to fight fat stigma and fat phobia?
For one, listen to the people who are most affected by it and take them seriously, Otis said. A ton of information is already out there through organizations such as the National Association to Advance Fat Acceptance. Bloggers such as the anonymous Your Fat Friend are useful resources to follow on social media.
“That way you don’t have to bombard your fat friends with all these questions and put that emotional labor on them,” she said.
Making a commitment to questioning your own internalized fat phobia — sitting down and thinking about your beliefs about bodies and what those are rooted in and what experiences led to them — is also important, she said. You can also see if there’s any kind of fat activism going on in your region, repost activist content on social media, and bring up arguments against fat phobia in conversations with friends and family.
“Most of the work that people can do to help the cause of fat activism and be an ally honestly happens at that interpersonal level — just tweaking those conversations and disrupting them when fat phobia kind of rears its ugly head,” she said.