the HAES files: fat stigma – not fat – is the real enemy

by Health At Every Size® Blog

by Linda Bacon, PhD

 From bar stools to TV studios, Americans are far more reticent than we used to be about race-bashing and other slurs. In even the most politically correct circles, however, it’s still okay to put down “the obese.” So long as you don’t use the f-word (“F-A-T”), you can call “overweight” people couch potatoes and hold them accountable for everything from government spending to cramped airplane seats and even global warming. You can call them unattractive, saying you “just don’t find it attractive.” And, yeah, you can joke about them huffing their way up a staircase.

It’s all about health, this argument goes, not bias. Because obesity’s supposedly linked to disease and early mortality, it’s okay to vilify it. And vilify it we do, from labs and board rooms to dorm rooms and editorial desks. How better to symbolize morbid decrepitude, after all, than with rolls of flesh in those prosaic “headless fatty” photos and video every editor reaches for to accompany yet another story about the “Obesity Epidemic?”

More than dignity is at stake, though: Punishing fat people is increasingly entrenched in our health care system. In Michigan, fat Blue Cross subscribers must lose weight to keep the “enhanced” benefit. Their options are joining Weight Watchers or logging 5,000 steps a day on a pedometer, until their BMIs fall below 30. The alternative? A larger deductible and higher co-pays.  Arizona, meanwhile, is considering a $50 “fat tax” for obese people on Medicaid, which kicks in if they don’t follow a slimming plan.

Yes, many Americans eat unhealthy stuff and move too little, but that’s a problem for people of all body types. A recent Mayo clinic study on heart disease outcomes reinforced findings that, for fat and thin alike, fitness matters more than weight. And body mass tells you very little about individual lifestyle habits.

This demonization of fat flies in the face of not just psychology (calling people names never made anyone thin), but economics and medical science, too. Persuasive, peer-reviewed evidence abounds that – hold onto your stethoscope – fat is blown out of proportion as a health risk and may actually confer some protection against early death. Mortality analyses from the Centers for Disease Control and elsewhere show that “overweight” people actually outlive those in the government-defined “normal” range. Other research makes it evident that diet and activity habits wield far more impact than weight on individuals’ health status. And, since diets don’t work, our government is spending millions of health “care” dollars on programs doomed to failure.

Even the well-meaning talk about obesity isn’t doing any good. It hasn’t made people thinner – and is downright damaging. Eating disorders, poor body image, stress and discrimination are collateral damage in our war against fat. Few of us are at peace with our bodies, whether because we’re fat or afraid of getting that way. That very stress can initiate or aggravate some so-called “obesity-related” conditions, like diabetes and hypertension, helping to explain why they’re often associated with weight.

For those who try to reduce, whether freelance or under doctor’s orders, only a tiny minority keep it off more than a couple years.  Most regain the weight regardless of whether they maintain their diets or exercise programs. It is well-established that biological safeguards – some we understand and others we don’t – cause our bodies to resist long-term weight loss.

As for “try, try again,” that’s even worse: Weight-cycling has been found to cause some of the very conditions, like cardiovascular disease, weight losers seek to avoid. (Fat but stable-weight people log better outcomes.) Evidence is scarce, in any case, that losing weight prolongs life – the vast majority of studies show that weight losers have decreased longevity, even when the loss is intentional.

Yet, anti-obesity “health” talk persists and there’s growing evidence that it leads to hateful bias towards’ fat people. Our national discourse fixates not so much on tackling disease as on getting rid of “the obese.” While government and medical authorities claim they’re focused on health, the real-world takeaway message is about people: that fat people are bad, gross and ugly. And now it’s not just “made in America:” Researchers from Arizona State University recently revealed that stigmatization has spread even in societies, like Samoa’s, that traditionally honored rotund shapes. When they internalize this shame, we learn in study after study, fat people are less likely to be active and take other steps to improve their health, in an endlessly negative spiral.

The real enemy, then, is not weight, but weight stigma. Fear of fat is much more harmful than actual adiposity, distracting us from true threats to our health and well-being. Let’s stop the demonization and switch our emphasis to Health At Every Size®, encouraging health-promoting behaviors for all.

 

[Scientific support for much of the above can be found in Bacon, L., & Aphramor, L. Weight Science: Evaluating the Evidence for a Paradigm Shift, Nutrition Journal, 2011, 10(9) and Bacon, L., Health at Every Size: The Surprising Truth about Your Weight, BenBella Books, 2010.]

 

10 Comments to “the HAES files: fat stigma – not fat – is the real enemy”

  1. “It is well-established that biological safeguards – some we understand and others we don’t – cause our bodies to resist long-term weight loss.”

    This statement really captures a lot of the reasons that I have so much respect for your work. Not because you are willing to say something that isn’t mainstream and popular (although I love that about you), not even because I agree with your perspective (although I do), but because you’re willing to say “others we don’t [understand]”

    I see so many people from MDs to researchers to members of the news media willing to hyperbolize and obfuscate just to keep from saying those words. I think it takes incredible courage and integrity as a researcher to say “I don’t know”. Thank you for who you are and what you do!

    ~Ragen

  2. I love this.

    While i am considered obese, I think I’m the “healthiest” (by that, I mean more active than ever and probably eating better than before) I’ve ever been my entire life. But people would probably assume I was “healthier” when I was skinny (and I absolutely was not!) than now.

    I had taken an exercise class that also had a nutrition class included in it. In this program, they have people take DEXA scans instead of relying on BMI. The nutritionist told us about two women she gave a DEXA scan to: one woman that weighed around 150 lbs and a small woman that weighed only around 100 lbs. They both had the same amount of body fat (which was in the “overweight” range). I like that, because it shows that thin people, or those who don’t weigh much, can be “fat.”

  3. “The real enemy, then, is not weight, but weight stigma. Fear of fat is much more harmful than actual adiposity, distracting us from true threats to our health and well-being.”

    Yes! Great post, Linda.

  4. another great writing by Linda about Fat Stigma. Thank you Linda!

  5. Thank you. Just… thank you.

  6. I second everything that Ragen said. Thank you, Dr. Bacon!

  7. Is is really true that *everyone* who is fat is simply biologically engineered to be that way? I know people who were thin, and then became fat over the course of a few years. I wasn’t in close enough proximity to know if their lifestyles changed or not. And, it may be fairly unusual, but people DO lose weight, and keep it off. I’m more and more coming to understand how unhelpful the BMI is, and how overly simplistic, and vilifying, our current attitudes toward fat people are, but I still wonder if the view you profess might also be oversimplified?

    I say this with a great deal of respect for what you do; your blog is wonderful, informative, and positive. I don’t mean to suggest otherwise; I am only seeking more information than I currently have on this important issue.

  8. In response to Emily, there are many factors other than genetics that play a role in our weight; lifestyle choices are certainly part of the picture. It’s interesting to note that how our lifestyle choices affect us is in part genetically determined. So two people may eat a large number of calories; one will store some of that as bodyfat and for the other person, it might just bump up their metabolism and get burned up. So you can’t look at someone and make assumptions about their lifestyle habits. And no, I don’t think it is oversimplified to switch focus from weight to health. In response to your example, sure there are a small percentage of people who maintain weight loss over time, but that doesn’t mean that fighting fat or pursuing weight loss is the answer. I’d rather support people in adopting good health habits than having a goal of being one of those few – weight loss may be a side effect for some people (like the small percentage you refer to), but improved health habits will benefit all. Perhaps you want to follow up with some of the resources I listed to see more depth on these issues.

  9. Do you have a citation on that Samoan comment? My understanding of non-western traditional cultures is that they are lean and muscular prior to adopting a more western diet (i.e. the Pima and Hawaiians) and my initial searching on Samoans indicates the same. Good work on the rest, though.

  10. Re Somoa, this popular press article can help you find the original research: http://asunews.asu.edu/20110330_obesity.

Follow

Get every new post delivered to your Inbox.

Join 987 other followers

%d bloggers like this: