the HAES files: Stereotype Management Skills for HBO Viewers

by Health At Every Size® Blog

by Deb Burgard, PhD

I don’t know what HBO’s series, The Weight of the Nation*, is going to say, but if the previews are representative, you might want to use this handy “viewers’ guide” to conserving sanity points.

Critical Thinking Skills 101

The main flaw in the traditional view is to think that if an event happens in the life of fat people, it is because they are fat.  All of us are trained to think this way, but there are some questions to ask that can help reverse the brainwashing:

“Does this happen to thin people too?

  • I eat too much.
  • My doctor tells me I have diabetes.
  • That person I was attracted to rejected me.
  • I can’t get down on the floor and play with my grandchildren.

Fat is blamed for almost anything negative that happens in life.  But thin people don’t have their fatness to blame, so when those same things happen to them, they have a whole universe of possible solutions.  Those same solutions should be available to fat people – why would we think the only solution is to turn them into thin people?

There is a version of blaming fat where the very presence of fat people in society is enough to blame them for the society’s problem.  The question to ask here is,

“If everyone was thin, would we still have this social problem?

  • There are problems with the way we produce food, and inequities in how we distribute food.
  • We are living in an environmentally unsustainable way.
  • We don’t have a functional healthcare system.
  • The baby boomers are a big demographic group who are living longer and will cost more in their final phase of life.
  • Our schools are struggling to feed, educate, and exercise our children with too few resources.
  • The demands of making a living leave little time for caring for ourselves and each other.

Blaming fatness keeps us from addressing the root causes of our problems, and is clearly unfair to fat people.  Many powerful people understand this, but find it expedient to frame a problem in terms of fat in order to bring attention to it.  They don’t think people will just attend to the real issue unless they whip up the fat panic.  Whether it is being pessimistic that people will exercise if it is not in the context of a weight-loss effort, or being pessimistic that people will care about our food environment if it is not in the context of a moral panic about fatness, the justification for whipping up the fat hatred is the same.  I say, have the courage to make your argument about the real issues and stop doing it on the backs of fat people.

Arm Yourself with the Facts

Here are some other key facts to keep in mind while you are watching:

  • The “epidemic” refers to a rise of 10-15 pounds in the average weight of US adults between 1980 and 1999.  The rise was over before most of the “obesity epidemic” rhetoric began.
  • The pictures illustrating “two-thirds of US adults are overweight or obese” are almost universally of people who represent less than 1% of the population.  People at a BMI over 50 are so rare that the CDC cannot estimate their actual prevalence in the population.  The photo that would actually represent the headline would be of someone the size of Will Smith or Tom Cruise.
  • We can re-cast public health authorities’ notion that we are “in denial” about our fat as their complaint that we are not buying into the BMI categories, which is actually a triumph of common sense, since BMI is such a lousy proxy for health, appearance, and even degree of actual fatness.  There is a fog of confusion around BMI—supposedly educated people seem to think that squaring, dividing, and converting to metric units adds more information than the height and weight data you started with.
  • The range of weights considered problematic in children was tripled in 2007 for no scientific reason, from the 95th percentile and up, to the 85th percentile and up.  This allows for dramatic statements like, “1 in 3 children in Georgia are overweight or obese,” even though pediatricians agree that even the 95th percentile and higher does not necessarily signify ill health.
  • Despite the alarm, Type II diabetes in children is so rare that the CDC has not been able to accurately estimate prevalence.  We need to focus on the lack of access to good medical care for many of these children and their families, rather than using them as poster children for public hate campaigns.

Challenging the Untested Assumption

The entire health argument for weight loss is based on a single untested assumption:

A weight-suppressed fat person has
the medical risk profile of a thin person.

Think about it.  There are no data for this, because there are so few weight-suppressed fat people who maintain weight suppression long enough to find out.  Instead, we have the illusion from medical data 6 months or a year into weight loss (which reverses with weight regain) that temporarily shows improved risk factors, like lower cholesterol or better fasting glucose levels.  If research was required to be at least 2-5 years in length, we would lose our illusion that weight loss is a solution, because neither weight loss nor health benefits last.

Fortunately, we have a more reliable way to obtain those improved medical outcomes for people who lose no weight but increase their movement levels or nutritional quality, and the physiological improvements last with the ongoing practices.

And if fat tissue loss was the key solution, why do we see no medical improvements with liposuction?

Follow the Money

When you are evaluating the claims made in the series, remember to follow the money.  Historically, every time the public appears to be getting hip to the fact that “diets don’t work,” there are massive responses from the weight cycling industry.  Their target this year is clearly communities of color and men, and their campaigns seek to shame people who are “in denial” about their weight.  One can picture the marketing execs around the table: “We got white women to hate their bodies – but we saturated that market long ago!”

Big pharma is constantly trying to create new markets, so making people who are not sick need treatment for “pre-diabetes” and “pre-hypertension” is a great money-maker.  The health insurance industry has always gotten away with discriminating against fat people and will politically get away with flouting the new healthcare law – should it survive – by charging higher premiums for the two-thirds of the country who are “overweight.”  My own profession of psychology is seeking to enshrine the current ineffective weight change interventions to make ourselves the “weight loss experts” who get the Medicare reimbursements.

All of these interests stand to lose billions of dollars if they tell the truth.  So remember, people are getting paid to hate you.

Stereotype/Stigma Management Skills

A worksheet for cultivating Stereotype Management Skills. (Please click on link at right for entire document.)

Critical thinking skills are all well and good, but there is another difficult aspect of public hate campaigns, which is of course, these are real people being obnoxious and mean to us.  We can be armed with all the facts in the world but the social reality is that it really sucks being the target of hate and bullying.  This handout provides a worksheet for cultivating Stereotype Management Skills.

When people are mean, we have to be especially careful not to blame our bodies. There is nothing about us or our bodies that deserves scorn or derision.  Take special care to honor your body and its wondrous capacities and gifts.  The problem lies outside of you and your body, with the bullies and the forces that benefit from fat hatred.

One of the most important things we can do when we are experiencing discrimination is to seek out our tribe.  This is the time to talk about what you are experiencing—in person, or on the listservs.  Also, ASDAH is preparing materials designed to help viewers understand and critique the rhetoric of WOTN documentary—to be posted soon. [Update: ASDAH's response has now been posted: www.debatetheweight.com]

Time for a Party!

It looks like WOTN plans to hit all the major “obesity” memes, like, “this generation of children’s lifespans will be shorter than their parents,” “obesity will bankrupt our healthcare system,” and “by 2050 our entire country will be obese.”  We could not have a better opportunity to plan big parties and play Fat Hate Bingo!  HBO says we have to lose to win, but we say, all you have to lose is your hate.

* The Weight of the Nation (WOTN) is scheduled to air on HBO on May 14 & 15, 2012.

31 Responses to “the HAES files: Stereotype Management Skills for HBO Viewers”

  1. Thanks, Deb, for the sanity points! I won’t be watching this special but I am sure to hear about it from family and friends. I will be forwarding a link to this post to a few people this month I am sure. I also really like the concept of “stereotype management skills”!

  2. Thank you for this breath of sanity. I needed it today.

  3. Great article. I was just wondering if, for the sake of reference, you could link to where you’ve found this info! I’m not doubting you, but it’d be nice to be able to see it and point people towards when they try to convince me that their bad unscience is true!

    • Hi Meg, Are there specific questions you would like refs for? I am happy to try. Keep in mind that part of the argument here is that people who make these assertions do not have evidence for them, and are not asked to produce evidence. There isn’t a reference for that, since the evidence does not exist. But some of what I talked about does have specific refs that people have cited before and I am happy to give them. – Deb

      • Sure, I can be more specific!

        I was wondering about this statement: “People at a BMI over 50 are so rare that the CDC cannot estimate their actual prevalence in the population”. Has the CDC said this somewhere?

        And also this: “The “epidemic” refers to a rise of 10-15 pounds in the average weight of US adults between 1980 and 1999. The rise was over before most of the “obesity epidemic” rhetoric began.”

        I’ve heard that, but I’m wondering where that information is so I can point people to it when they come at with obesity “epidemic” scaremongering. These seem like important facts and stats to know!

    • Hi Meg,

      Apologies for replying up here but WordPress isn’t letting me reply to your reply (below).

      OK, first the documentation of the increased in weight in the 1980-2000 years is at http://jama.ama-assn.org/content/288/14/1723.full.pdf+html.

      The key article for subsequent years’ data is at
      http://jama.ama-assn.org/content/303/3/235.full

      This talks about the changes in the NHANES data over the waves from 1976 to 2008. “Over the [last] 10-year period, obesity showed no significant trend among women (adjusted odds ratio [AOR] for 2007-2008 vs 1999-2000, 1.12 [95% CI, 0.89-1.32]). For men, there was a significant linear trend (AOR for 2007-2008 vs 1999-2000, 1.32 [95% CI, 1.12-1.58]); however, the 3 most recent data points did not differ significantly from each other.” So the men slowed down after the women but everyone seems to have stabilized in the last 5-10 years.

      In that same article, the authors show in the “e-figures” some curves showing BMI vs frequency. I looked at those figures and thought, wow, there are hardly any people who are at the BMI that are typically pictured in the news articles. So I asked the authors about the prevalence of people at the far right tail of the distribution who have a BMI=50 (for a 5′ 4″ woman, about 290 pounds). They answered back in a personal communication that, “We really can’t estimate such a tiny percentage accurately. We would need a much much larger sample size. Any estimate would be statistically unreliable so far out in the tails of the distribution.”

      So you see how the photos accompanying the “obesity” articles in the media are creating a very distorted sense of the actual situation. The claims of the rates of obesity “soaring” or “exploding” or predictions that everyone will be obese by 20xx are also clearly hyperbole.

  4. Brilliant as usual!

  5. Thanks Deb, reading this blog and talking to you is always so enlightening and exciting. This is exactly the type of information we need. I really appreciate your comments about critical thinking skills and managing the stereotypes and stigmas. It is great to have facts and figures, yet this really is a social justice issue. If someone hates you, facts seem to take a back seat. Next week will be challenging, however you have prepared us as usual. I send you the wave of gratitude Dr. D!

  6. That’s not really an accurate portrayal of the CDC’s position on Type II diabetes in kids.
    http://www.cdc.gov/diabetes/projects/cda2.htm

    The problem isn’t just that it’s so rare, but that it’s hard to distinguish from Type I and symptoms are often mild. But there is evidence that it’s growing, especially in some vulnerable populations such as Native American groups.

    Yes, it is rare, but even those small numbers appear to be a symptom of more widespread problems with diet and exercise patterns among youth.

    The same for all of these kinds of “obesity epidemic” stories. The issue isn’t so much that we have an obesity epidemic is that we have an epidemic of people, overweight and not overweight, not taking very good care of their health. The BMI numbers are a symptom or a marker of that more serious problem, not a direct picture of the problem.

    Yes, BMI isn’t a very accurate proxy for health. The people who do this research know that. Not everyone who writes about it does. BMI is an easy and useful way to track population trends. It’s just not a very good way to evaluate an individual.

    • Thanks, Reed, for your thoughtful criticism. If what you mean is that the CDC’s “position” is more alarmed about Type iI diabetes than the data they report, I would agree with you – but here is what they say about the data on the page you referenced (thank you):

      “A statistically significant increase in the prevalence of type 2 diabetes among children and adolescents was found only for American Indians.” and “Population-based prevalence estimates for other ethnic groups were not available.”

      When I have read this page before, I have noted that it includes statements not based on the data, like, “Type 2 diabetes in children and adolescents already appears to be a sizable and growing problem among U.S. children and adolescents.”

      So we have the lack of data for most groups, but the willingness to frame it as “a sizable problem.” Because we were not looking for T2 diabetes in children before, and because we are still rarely looking for it in thin kids, I would contend that there is no way to know if it is a growing problem until we have tried to measure it over time.

      Please understand that I am fully in favor of making sure the social justice issues affecting the health disparities are addressed, and that the teens and their families who are struggling with diabetes have access to good medical care and effective treatments, but that is not the thrust of the discussion I see about the issue.

      Instead, the explosion of stories about T2D in children, in nearly every story about “childhood obesity” reflects the willingness to alarm the public with anecdotal data that makes it sound like 1 in 3 children are getting diabetes. This is poor science and poor public health policy.

      Finally, I would love to hear more from you about your thoughts that we have “an epidemic of people, overweight and not overweight, not taking very good care of their health.” Do you think this is different from the past? Why do you think we are suddenly alarmed – why now, when there are fewer smokers, fewer 3-martini lunches, lower rates of heart disease and some cancers, and longer longevity? I am not necessarily disagreeing with you that many people are not prioritizing their health, or that we have environments and life stressors that make it very difficulty to be as healthy as we could, but why are we so obsessed about it at this moment in history?

      • “an epidemic of people, overweight and not overweight, not taking very good care of their health.”
        Maybe Reed is referring to the technology spin we have on our lives today? That’s a big issue when it comes to children, of course. Video games, tv, etc that people are always whining about. But with the convenience and distractions that we face with technology like ipads and smart phones, people aren’t out doing as much? I don’t know and I don’t really buy it either. There’s no reason for people to not take care of themselves just because they can be online and in touch 24/7.
        I think it’s just the first time in our history that people are actually starting to pay attention to these things. And since we didn’t look at these things under a microscope x number of years ago, there isn’t *actually* any real data to compare exact studies to, so they make assumptions about what was like x number of years ago compared to today. And we all know how well assumptions are taken by the media and public–like proven fact. How do we know that people aren’t taking as good care of themselves as they did years and years ago? By the BMI, of course! What’s that tell you?

  7. Of course almost the whole population will be obese by 2050, Deb! That’s because the qualifying BMI for “obesity” will be 17. If it’s good enough for the entertainment business, it’s good enough for everyone else, right?

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