FATPHOBIA
You are are fatphobic.
Bit abrupt, apologies, I’m aware that your ignorance on the matter may have been blissful, and I do hear your gasps and shouts and cries in protest, ‘I’m not anti-fat people, I love LIZZO!’, but alas, dear friend, ’tis the truth.
It’s not your fault; you have been drip-fed fat phobic ideas every single day of your life: Fat is grotesque. Fat is disgusting. Fat is undesirable. Fat is unloveable. Fat is something that no one in the fucking world should ever want to be. This is what we’re all told to think; including those who live in fat bodies themselves. Fat phobia doesn’t just come in the form of Instagram comments telling anyone over a size 14 to “STOP PROMOTING OBESITY”; our fat phobic ideas are usually tucked safely away, at the back of our minds with all our other inadmissible thoughts. You probably don’t even notice the fat phobia woven into your psyche, but every single one of us has an immutable, unconscious understanding that fat is bad, fat is unhealthy and fat is scary. Very scary.
In fact, at this very moment, the fight against fat is raging. Our government plans to “launch an emergency drive to slim down the nation”. A drive that has been billed as a “War on obesity”, pushing to “get peoples’ BMIs down”, in preparation for a second wave of Covid-19. Obesity has nothing to do with Coronavirus; this theory has been debunked time and time again, so government scapegoating larger bodied people isn’t going to reduce infections at all. And, seeing as No. 10 say they want to encourage everyone to “lose weight rapidly”, I sure hope they plan to pump a shit load of money into Eating Disorder services, because otherwise they are going to get a nasty shock when patient numbers spike as a result of endorsing disordered behaviours. (Eating disorder awareness week)
Situations like this happen again and again in the medical world. The “Obesity Epidemic” (which is a made up and inaccurate term), is blamed for the strain on the healthcare system to cover up the government’s failure to fund it. It’s a clever escape route; because we all believe it.
But, what if the vilification of higher weights altogether is just a big...fat lie?…(no pun intended)
In 2013, the Journal of the American Medical Association published results of a study that unveiled the links between mortality rates and BMI (Bullshit Made-up Invention). 97 studies of mortality rates and BMI were analysed, which, in total, covered over 3 million peoples’ deaths. The results created a ‘U-Shaped Curve’. At the top ends of the curve, where death rates were the highest, are people whose BMIs were extreme, either deemed as severely underweight, or severely obese. At the very bottom of the curve, where death rates were lowest, were the people in the BMI category of ‘overweight’. I know - shock fucking horror - fat can be good?! Yes, statistically speaking, people who are classified as ‘overweight’ have a lower risk of death than those who are classified as ‘normal’. Furthermore - the death rates of those categorised as ‘mildly obese’ were shown to be equal to the death rates of those categorised as ‘normal’.
Clearly not the original, but the results formed a graph like this. (With less pink and more decimal places)In short: the common belief that being ‘fat’ damages our health, is false.
It's tough to be fat in a world like ours: fat people are othered on a daily basis, and live in a society that refuses to accommodate or respect them. Without the saving grace of an ‘after’ picture to justify their existence, they are seen as ‘before photos’: as unfinished projects. They struggle to find fashionable clothes in their sizes (An XL in both Bershka and Urban Outfitters is equivalent to a size UK 14: the average size of women in the UK). They are the punch-line of cheap jokes and memes. They are desexualised in every inch of our media. They are seen as a burden on our healthcare system. They are shamed through the endless articles about the weight loss, or gain of C-List celebrities. They are even paid less than their thinner colleagues. Fat people are stained with so many fucking stereotypes: laziness, bad hygiene, lack of control, gluttony, poor health, loneliness, desperation…it’s no wonder we’re scared of becoming fat - it’s a social survival mechanism that we are all armoured with, regardless of our size.
To make matters worse, the toxic mind-games that our buddy ol’ pal Diet Culture loves to play, reinforce these stereotypes. They spread the ideology that Fat is a curse to be driven away, and convince us that if we don’t take appropriate precautions, Fatness will creep its way into our lives. They whip us up into an anti-fat frenzy, ensuring their precious products keep flying off the shelves. We are given a false visual standard of “health” that is physically impossible for 95% of the population to achieve, warping everyone’s perspective of a ‘healthy’ lifestyle.
Now, you’re probably thinking - but what does any of this have to do with me? Well, you my friend, have been cunningly co-opted into upholding and promoting diet culture’s rhetoric, by internalising the fat phobia they feed you, and using it as a weapon against your own body. Through forensically scrutinising ourselves for so long; we have adopted the tools to forensically scrutinise other peoples’ bodies too. This is perfect for the diet industry: we can now do their hard work for them. DIY diet culture. We are walking, talking advertisements for weight-management: we ogle before and after pictures, we praise weight-loss as if it was equivalent to finding world-peace, we scold ourselves for growing out of jeans we bought a year ago, we make fat jokes, we use fat as an insult against ourselves and we constantly compare our bodies to those around us… Exactly how diet culture likes it.
The entire empire of dieting and weight-loss has been built on a carefully orchestrated fear of fatness, making our fat phobia instrumental to the success and profitability of the weight-management industry. No one would buy insect repellent every summer if mosquito bites weren’t the bane of everyone’s lives: it’s the fear that drives the consumption. This means companies profiting from the diet industry REALLY want us all to stay as fatphobic as possible, so that we remain driven to consume what they sell to us.
Because the payback to their bank accounts is so huge, companies go to great lengths in order to maintain the fatphobic status quo. They go beyond their own advertising, managing to worm their way into the forefront of our minds via a multitude of disguises…Take the charity Cancer Research for example; they form corporate partnerships with companies who promise regular (large) donations in turn for promotion and advertising. Anyone remember the “Obesity Causes Cancer Too” campaign that was plastered across every billboard and tube poster going? Well, I think you’ll find it was funded by Slimming World, the company worth £15.5 million as a result of flaunting bullshit weight loss and diet programmes, and one of Cancer Research’s biggest donors. ‘wHaT…uS…BiAsEd? nEvEr!…’.
Another example is the NHS Type 2 Diabetes Prevention Programme, marketed as: ‘A journey to a healthier YOU’, AKA, ‘Lose weight, you lazy bastard’. This translation is evident in the fact that programme participants have to weigh themselves each week and send a picture of their weekly weight into a group hub for other people to analyse. They also gain ‘Smart points’ for losing weight, eating lower calorie foods and exercising, with their scores shared and compared on the group hub too. I don’t know about you, but this all sounds very Weight Watchers-esque to me. You know why it feels very Weight Watchers-esque? Because it’s Weight Watchers in a mask. Not some special NHS X Weight Watchers collab: it is a mere front for the bog-standard weight-loss scheme that Weight Watchers rolls out to any fat fucker (plz hear the irony). The group hub is really just the Weight Watchers ‘Wellness App’, that tracks calories and tallies up points. This is a perfect situation for both organisations: Weight Watchers take on ‘burdensome’ patients and make more money, whilst precious NHS resources are saved: it’s a game of give and take that perpetuates the circulation of fat phobic rhetoric.
Now, if you’re thinking… ‘Obesity DOES cause cancer and diabetes!!!’ I ask you to think back to the U-Shaped curve. I appreciate it may still be hard to believe, so, to help you out, I’ll address this controversy head on; the argument that is the talk of the town and the star of the show: health.
It is a widely shared belief that fat people are unhealthy: ‘Fat causes cardiovascular disease!’ ‘Fat causes diabetes!’ ‘Fat people don’t exercise!’ ‘The Obesity epidemic is killing us all!’. ‘Fat people are selfish, greedy bastards who scoff up all the NHS’ resources just like they scoff up their McDonalds!!!’…Again, I sound like a broken record, but it is what we have been taught.
As I previously mentioned, our culture conflates health with weight loss and restriction, meaning our perceived image of a ‘healthy’ person, is thin, toned and fatless, and our idea of a ‘healthy’ lifestyle, is often disordered and unsustainable. Nowadays, getting ‘healthier’ essentially just means getting thinner. We accept that people can stay thin despite living solely off ‘junk’ food and never exercising. We accept that their bodies are simply genetically designed to be thin, and were we to see them in the street, we would most likely assume that they were healthy. Whereas a fat person, who stays fat despite eating nourishing food, exercising everyday and having the blood pressure levels of an Olympian athlete, is immediately deemed lazy, unhealthy, and a burden on society. Just a tad fucked up don’t you think?
Don’t get me wrong, it is true that a correlation exists between higher weight and unhealthy outcomes such as diabetes, heart disease and some cancers - but the question we need to ask is WHY. Because diet culture leads us astray by telling us that it is the fat itself that causes these unhealthy outcomes. This, my friends, is not the case at all…
Remember what I said earlier about corporations benefitting from fat phobia? Well, unfortunately, it is not only commercial enterprises that benefit; but the NHS too. Yes, I’m afraid the lack of funding from the Tories has left the NHS in a stranglehold, meaning they have to rely on big Pharma to invest in their research. Endorsement deals are drawn up at the top level between companies and hospitals, ensuring that exclusive (and expensive) drugs owned by said Pharma companies are promoted as ‘preferable’ treatment to patients.
This is perfect for Pharma, as it keeps the money rolling in. It is also pretty essential for the NHS: as it’s how they stay afloat. You may be wondering what this has to do with fat phobia, but when much of Pharma’s profits comes from weight loss drugs and procedures, and bariatric surgery made £9.5 billion in 2016-17 alone, (just a minor operation, where they hack away your stomach and then tie the remaining shreds together with an elastic band so that the stomach shrinks, and you are thus fuller, faster. All for a mere £15,000 a pop), I think fat phobia has a rather big part to play. Weight loss sells, and what sells, naturally makes money. Pharma relies on the diet industry to maintain their financial power, the NHS relies on Pharma to prevent crashing and burning. It really isn’t a very big leap to say that the NHS needs fat phobia; especially when there is so much entrenched fat phobia within it.
When looking at healthcare, the rhetoric that ‘fat is bad’ is everywhere. Weight management programmes such as the ’100 calorie snack’ campaign for primary school kids and the Change4Life campaign, that teaches young children how to read the calorie and nutritional information on food packets, both reek of disordered behaviour. Even as an Anorexia Nervosa patient, I was constantly told by health professionals that they would make sure I didn’t gain back “too much” weight. They said that if I went over the minimum ‘healthy’ BMI, they would help me lose weight again to get me back to the minimum. “No one wants you to be fat!” They would say... (The damage of diet culture) We literally trust our doctors with our lives, so we just assume their total authority and neutrality. But when the world is so infected with fat phobia, there is no such thing as neutral. To be clear, this is not the fault of the doctors themselves, they aren’t born anatomical geniuses and then whisked away to be sheltered from the influences of the world. They grew up with the same diet culture as the rest of us, as did their teachers and their teachers’ teachers. This means that going to the doctor can be hellish for fat people. No matter what is wrong with you, or what symptoms you may be experiencing, your diagnosis is fat. Cure? Ha. Silly question.
The blog ‘First Do No Harm: Real Stories of Fat Prejudice in Health Care’ shares stories of larger bodied people receiving poor healthcare treatment and misdiagnosis. One example is Rebecca Hiles, a woman who went to the doctors with extreme breathlessness and was told to lose weight, (because of course her breathing issues were due to the fact she was fat). For 5 years, Rebecca continually returned to the doctor to seek help for new symptoms, but every single time, she was given a different diagnosis and told to lose more weight, despite the weight loss clearly not improving her condition. At the end of the 5 years, Rebecca finally managed to get a scan of her lungs done and was told her lung had to be removed because she had extremely severe lung cancer, and had done the entire time.
The examples are pretty endless: Another woman, after already being prescribed a Weight Watchers diet at her last appointment, was told again that her weakness and shortness of breath was a result of her ‘overweight’ BMI. After expressing to the doctor she had already been told this, she was finally given a blood test, which revealed that she had a low haemoglobin count in her blood, causing fatigue and low oxygen. Another went into her GP to address her worsening depression, only for the GP to interrupt her and remind her of the fact that she was overweight, which, “was probably why she felt so down”, and go on to prescribe her the weight-loss drug ‘Alli’. Even a lady going to the doctor to get antibiotics for an infected insect bite was told by her doctor to lose weight first, and was recommended bariatric surgery.
But come on now, suuurely these are just extreme, one-off examples of individual experiences?
Well, I sure wish that was so, I really do, but surveys show that over 54% of NHS doctors believe that they hold the right to withhold any treatment from an ‘overweight’ patient until they lose weight. And a U.S. study revealed that over half of physicians described their larger bodied patients as “awkward, unattractive, ugly and non-compliant”, and over a third also described them as “sloppy and lazy”, regardless of the length of time they had known them.
As a result of this deeply fat phobic practice, larger bodied people are far less likely to show up for GP check-ups, and fat women are less likely to attend for breast and cervical cancer screenings because of the “disrespectful treatment and unsolicited advice to lose weight”. There’s something pretty unhealthy: not turning up to the doctor in fear of discrimination, and the misdiagnosis of serious illness.
But look, even if you think I’m talking out of my arse, and you don’t buy the argument that fat phobia within the healthcare system contributes to the correlation between weight and ill health, let me show you how fat phobia across our wider society most certainly does…
It is extremely stressful to be stigmatised for your weight, it places a whole lot of anxiety on the body, and as my fellow Biology students would know, anxiety takes a physical toll on the cardiovascular system, and increases the likelihood of cardiovascular disease. Stress also damages the sympathetic and parasympathetic nervous systems, and metabolism. The fancy term for this pressure on the body is ‘allostatic load’. A study that followed 1,000 participants for 10 years, found that those who reported having experienced weight stigma, either internalised, or externalised from others, were twice as likely to have a dangerously high allostatic load than those who didn’t experience weight stigma. There is no question that those with larger bodies are far more likely to have experienced external weight stigma, but these results were found regardless of the individual’s BMI: fat isn’t the issue here at all, it is the fear of fat. The same study also concluded that the health risks posed by weight stigma are greater than any health risk caused by ‘poor dietary patterns’ - eg the foods that diet culture brandishes as ‘bad’.Can we actually just absorb that information - weight stigma has been shown to have a worse impact on your health than what you eat…Well it’s safe to say my life has been a lie.Another blatant lie we have been fed, is that losing weight will benefit health…when really, it damages it. Weight cycling, where weight dramatically fluctuates up and down, occurs as a result of dieting (because they don’t work), and leads to fluctuations in blood pressure, heart rate, nervous-system activity, kidney filtration rate, blood sugar and blood lipids - all of which are cardiovascular risk factors. A study of more than 12,400 people, found that weight-cycling and short-term weight loss were strong predictors for the development of high blood pressure for those with ‘obese’ BMIs. In a world where fat is evil, it’s no question that those in larger bodies are going to be shamed into taking weight loss pills and trying diets, (not least because, as we have seen, doctors fucking prescribe them), meaning they are far more likely to experience weight cycling, and thus far more likely to cause damage on their cardiovascular system.
So, fat’s the problem is it? Cos right now it’s looking like the discrimination against fat people is what’s causing all the health issues that the fat itself is blamed for…If things could possibly get any more infuriating, a study in 2008 looked at over 170,000 people of all races, all levels of education, all genders and all ages, to see how their individual body image impacted on their health. What was found, was that the larger the difference between the participants’ current body weight and their perceived ‘ideal’ weight, the more physical health problems they experienced over the course of a month. This was again regardless of their BMI, meaning that someone in the ‘overweight’ BMI category, who was happy with their body, was less likely to suffer from physical health issues than someone who was within the ‘healthy’ BMI range, but unhappy with their body.
Hating your body worsens physical health…okay… so who, I ask, WHO is subjected to relentless body shame and judgement, and quite literally taught to hate their bodies from the age of 3?…FAT PEOPLE. Eu-fucking-reka. It actually boils my blood that women and girls have been forced to endure lifetimes of self-loathing and competition in the name of health and prosperity, when all it has done is damage our mental and physical health, waste our time, and take up too much precious headspace.
I’m aware that you are probably questioning the legitimacy of a lot of what I have bombarded you with. This is okay, it’s fair enough if you’re like ‘she’s lying’; fat phobia is woven into almost every aspect of society, including our own belief systems. I couldn’t possibly expect you to forget a lifetime of conditioning. It is extremely difficult to not be scared of fatness - I’m scared shitless of it. Who wouldn’t be when it is vilified in healthcare, the media, in our supermarkets, by our parents, our friends and ourselves, for so long. It’s hard to recognise it all as money-making bullshit; but that is exactly what it is.
I would never claim that fatness was the key to health, happiness and success, because you would think that was a stupid lie, and you would be right. But the world around us claims that thinness is the key to health, happiness and success, which is similarly: a stupid lie, yet we all believe it. The truth is that fat is a bloody body type. The world just needs to do its fucking research.
References:
2) Flegal, KM et al. “Association of all-cause mortality with overweight and obesity using standard BMI categories: A systemic review and meta-analysis” (JAMA, 2013)
3) National Association of Anorexia Nervosa and Eating Disorders (ANAD). “Eating Disorder Statistics”
4) https://www.montenido.com/pdf/montenido_statistics.pdf
6) https://www.urbanoutfitters.com
7) Megan Jaynne Crabbe, “Body Positive Power”, Penguin Random House, 2017, page 194
8) T.A. Judge, D.M. Cable, “When It Comes to Pay, Do the Thin Win? The Effect of Weight on Pay for Men and Women”, (Journal of Applied Psychology, 2010)
9) www.dosomething.org/us/facts/11-facts-about-body-image
11) https://www.weightwatchers.com/uk/healthieryou
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15) https://www.nhs.uk/conditions/weight-loss-surgery/who-can-have-it/
16) https://www.nhs.uk/change4life/food-facts/food-labels
17) Maya Dusenbery, “Doctors Told Her She Was Just Fat, She Actually Had Cancer", Cosmopolitan, April 17, 2018, https://www.cosmopolitan.com/health-fitness/a19608429/medical-fatshaming/.
18) https://fathealth.wordpress.com
19) www.theguardian.com/society/2012/apr/28/doctors-treatment-denial-smokers-obese
20) Rebecca Puhl, Chelsea A. Heuer, “The Stigma of Obesity: A Review and Update”, (Obesity, 2009)
21) N. K. Amy et al., “Barriers to Routine Gynecological Cancer Screening for White and African-American Obese Women”, (International Journal of Obesity, 2006)
22) Christy Harrison, MPH, RD, “Anti-Diet”, Hachette Book Group, 2019, page 137
23) Maya Vadiveloo and Josiemer Mattei, “Perceived Weight Discrimination and 10-Year Risk of Allostatic Load Among US Adults”, Annuals of Behavioural Medicine51, no.1, (2017): 94-104
24) J. Montani et al., “Weight Cycling and Cardiometabolic Risks”, Obesity Reviews 16 (February 2015), Suppl 1: 7-18.
25) M. Schulz et al., “Associations of Short-Term Weight Changes and Weight Cycling with Incidence of Essential Hypertension in the EPIC-Potsdam Study”, Journal of Human Hypertension 19 (January 2005): 61-67.
26) P. Muennig et al., “I Think Therefore I Am: Perceived Ideal Weight as a Determination of Health”, American Journal of Public Health, 98, no.3 (March 2008): 501-6
