Archive for June 5th, 2012

June 5, 2012

the HAES® files: Judgment Day

by Health At Every Size® Blog

by Fall Ferguson, JD, MA

We live in a culture of judgment.  Is this point even debatable?  Many of us revel in judging each others’ work, family life, relationships, wealth, education, political beliefs, religious beliefs and practices, consumption habits, “taste” (a concept that implies judgment on multiple levels!), and behavior of all sorts.

Indeed, reality TV has elevated judgment to an art form, or pseudo-art, perhaps.  How many of us thrill to the guilty pleasure of raining down judgments upon certain wealthy and outrageous housewives misbehaving for our viewing pleasure?  MTV has a show devoted to the “Ridiculousness” of other people’s behavior as captured on videotape.  Viewers relish the moment that “the tribe has spoken” or when the contestant they love to hate hears those immortal words “You’re fired” from the Donald.  I could keep going, but do I really need to?

One of our favorite ways to judge each other and ourselves is, of course, body size and appearance.  Again, do I really need to elaborate?  If only a Google search for the phrase “celebrity bikini bodies” (in quotes) didn’t return 4,710,000 results—but alas, it did.

In this culture, body shame is not limited to one group or one demographic.  Body shame is ubiquitous, and experienced by people of all sizes, genders, ethnicities, sexualities, religions, and any other characteristic you can think of.

When I teach about body image in my course on The Collective Body, I have the students read “Ideal” by Rebecca Popenoe from the anthology, Fat: The Anthropology of an Obsession.  Popenoe writes about her experiences, first as a Peace Corps volunteer, then as an anthropologist, living amongst a people she describes as “desert Arabs in Niger,” in the Southern Sahara.  Nigerien Arabs, according to Popenoe, value a “fat female ideal” and find stretch marks and rolls of fat to be beautiful.  These women pitied Popenoe for her scrawny, underdeveloped (in their eyes) physique.  In mid-childhood (well before adolescence), families who can afford to do so begin to restrict girls’ movements and force them to consume large amounts of food.  Surprise, surprise—some women are able to become fatter than others.  It turns out that just as in our culture, body ideals and body realities among Nigerien Arab women demonstrate the complex inter-relationship of biology, culture, and economics.

Some of the students struggle with the cognitive dissonance created by the descriptions of Nigerien Arab women’s attitudes toward fat.  Others gleefully embrace this evidence that our thin ideal is culturally driven—that there is nothing inevitable or inherently desirable about thin bodies.  I have taught this essay for four years now, and my favorite moment always seems to happen about 15 minutes into the discussion.  One of the students says, voice laced with outrage:

But isn’t it just as wrong to force women to be fat as it is to force them to be thin?

And they’re off—I don’t have to say another word.  A rich discussion ensues in which the students explore the injustice of expecting people of any size, any gender, any shape, any color of skin, to be what they are not or to modify their bodies to conform to a cultural norm.  My work is done.

In a 2010 article in the American Journal of Public Health, the authors looked at the effects of weight stigma and concluded that “stigmatization of obese individuals poses serious risks to their psychological and physical health” and “generates health disparities.”  While these authors (from Yale’s Rudd Center) also bemoan how weight stigma “interferes with implementation of effective obesity prevention efforts,” I don’t think we should let this problematic framing detract from their key finding that weight stigma is bad for our collective health.  It is morally reprehensible to stigmatize even one person for how s/he looks or what s/he weighs.  We all know the numbers: stigmatizing “obese individuals” means a whole lot of stigma goin’ round.  As the authors of the study point out, this is “a social justice issue.”

Self-judgment matters for our health too.  The psycho-spiritual effects of holding one’s own body in contempt should never be underestimated.  One study examined the effect of individuals’ opinions about their own weight and found that these opinions affect both psychological and biological health:

Our finding that percentage of desired weight loss was a much stronger predictor of unhealthy days than was BMI further suggests that percentage of desired weight loss plays a greater role in generating disease than adiposity itself.

This finding has broad implications for the prevailing public health approaches to “obesity.”  To the authors of the study, “the policy implications may be counterintuitive”:

[I]f more of the association between BMI and poor health is perceptual, some public health messages that advocate idealized body types may be harming their target audience. Concerted efforts to disassociate health messages, such as encouragement of exercise, from obesity stigmatization may circumvent the paradox.

I don’t know about you, but I am tired of hearing about “paradoxes” whenever a health researcher is shocked that there is some reason other than adiposity that a fat person gets sick.  (For a great series on the so-called “obesity paradox,” see the archives of the Junkfood Science blog.)  There is nothing “counter-intuitive” for me about the idea that if we really care about people’s health, and not their appearance, then public health messages directed at individuals need to focus on self-acceptance and self-care, not on losing weight or presenting one body size or shape as “normal.”  But then again, I am starting from a Health At Every Size® perspective

Judging people—all people—is harmful to their health.  It harms them psychologically, and it harms them physically.  There is a growing body of work on health disparities that examines the increasing evidence that, as the U.S. Centers for Disease Control and Prevention (CDC) puts it, “[c]urrent information about the biologic and genetic characteristics of minority and underserved populations does not explain the health disparities experienced by these groups.”  It’s time for the public health and medical communities to recognize that fat people are one of the populations that experience such health disparities.

Bottom line: When we let go of negative judgments about ourselves and others—including but not limited to judgments about body size and shape—everyone’s lives and health improve immeasurably.

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