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.

7 Comments to “the HAES® files: Judgment Day”

  1. Great essay right up until the end. You leap from the quote to a different conclusion. The paper suggests that messages about health and weight should be decoupled because weight stigma hurts the obese population. That’s a different thing from saying that there is no relationship between weight and health, or that fat has no bearing on the reasons that people get sick. The paper does not conclude that at all.

    In fact, if you read through it carefully, you can see that the authors are very careful not to make that claim. They are suggesting that there is another dimension to the poor health outcomes experienced by the obese, and one that’s worth further study.

    • Annabelle – Thanks for reading. I am always glad to be reminded to read a study more carefully. However, I would in turn ask you to re-read my reaction to the final quote. I find it revealing that you read “no relationship between weight and health” into my common-sense suggestion that not every instance of a fat person getting sick is due to his or her fatness.

      In providing the final quote above, I was primarily interested in deconstructing and critiquing the authors’ underlying assumptions about our public health efforts on obesity. They suggest that decoupling health from weight is “counter-intuitive.” Because I reject the weight-based paradigm, I don’t find such a decoupling counter-intuitive at all. To me, their tentative insight that maybe, just maybe, we should separate health out from weight is nothing more than, as the ever-brilliant Ragen Chastain would say, a “big flaming sack of duh.”(see, e.g., http://danceswithfat.wordpress.com/2012/05/18/big-fat-faulty-assumptions/)

      The authors seem to find the idea that public health messages focused on “obesity” are stigmatizing to be paradoxical. If you start from an evidence-based, HAES® approach, then there is nothing paradoxical here. This is what we have been saying all along: you can’t “make” people healthier by trying to convince them that their bodies are “bad” or “wrong” or “flawed” or “abnormal” etc.

  2. The other paradox is saying how horrible stigmatizing fat people is because it interferes with eradicating fat people! What a great post Fall!

  3. It’s funny how when a long-stigmatized group begins to achieve something closer to social parity, the ‘health consequences’ of belonging to that group do tend to fall dramatically.

    Like you, Fall, I’m eager to see the day when doctors don’t use the word ‘paradox’ to describe every instance where a fat person doesn’t keel over dead.

  4. I’ve noticed an increasing number of people who agree with Rudd, that it may be “counterproductive” to fight obesity by shaming them. Other than the fact that the “war on obesity” is a terrible insult to the diversity of people, I guess I’m glad to get support from any quarter if it results in arguments being made against bullying and stigmatizing larger human beings. Similarly, some government initiatives in the misguided war around the globe will be cut back not because they are wrong or inherently misguided, but because a large expense will be shown to be not cost effective–especially when the world is in recession.

  5. No surprise here, but conflating health and appearance is plentiful in the realm of online dating. If you haven’t dipped your toes into these waters, online dating profiles are full of shaming comments, often revealing cultural bias and ignorance. A few comments I have seen: “I don’t expect anyone to have a perfect body (who does?), but I won’t date anyone who cares so little about their health that they are visibly overweight.” “You don’t have to be a super model, but you do have to take care of yourself.” “You don’t have to be Barbie, but you have to be cute.” The most common comments concern fitness, such as “I am active, and I need you to be too.” No consideration that you need to look beyond appearances to discern health.

    • Very good point, Alex! Actually, I was active in plus-size online dating for a year, 2-3 years ago, until I met my fiance that way. You mentioned some of the comments aimed at the women by some men (or women, if it was a LGBT site). From my male perspective, the plus size women’s comments on the sites I joined were too often revealing of a negative mindset which, sadly, is understandable considering the prevailing judgmental attitude against fat. I saw comments that women made about themselves, such as “I have more than a few pounds to lose, but I’m working on it” or “I’ve joined a gym to get into better shape” or “don’t let my size fool you–I’m actually a lot of fun.” This, despite the fact they were on dating sites for plus size people and their admirers (there are several sites like that) and the kind of man who is likely to seek a match on such a site is one who is neutral about weight, or more frequently, prefers the larger woman. Needless to say, my fiance is someone who got an A+ on her “essay questions” and did not display a negative mindset about her size…

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