the HAES® files: Murder at the Intersection of Fat and Black

by Health At Every Size® Blog

by David Spero, RN

When a fat person dies, many people say s/he died because s/he was fat. That’s the standard narrative, so we don’t need facts to support it in any particular case. Everyone knows it’s true because that’s the way the story is always told.

Another narrative that needs no facts to support it has to do with police violence. If the police beat or kill someone, especially someone Black, the victim must have brought it on him or herself. They must have done something wrong. Racism was not involved.

Those narratives come together in the case of Eric Garner. Eric Garner was fat and Black and now he’s dead. He was killed by police for selling cigarettes on a street corner. Five or six cops took him down with a chokehold and held him face down on the pavement while they pressed on his back. The whole crime was caught on a bystander’s video for the world to see. Even a White person like me; heck, even George W. Bush thought the cops had acted criminally.

Science, in the persons of the Medical Examiner’s Office, concluded that Garner died due to “the compression of his chest and prone positioning during physical restraint by police.”

But police supporters and apologists didn’t agree. One calling himself “Johnny Wishbone” tweeted, “Obese porker would have died soon anyway.” The New York Post headlined their article on the incident, “An obese man died of a heart ­attack Thursday after he was tackled by police officers on Staten ­Island.” Interestingly, the Post’s web site changed the headline since I wrote my first draft to drop the word “obese.” Wish I’d saved a screenshot.

Congressman Peter King said, “If [Garner] had not had asthma and a heart condition and was not so obese, almost definitely he would not have died from this.”

The Medical Examiner found a grain of truth in King’s view, listing “bronchial asthma, heart disease, obesity, and [hypertension] as “contributing factors” in Garner’s death. The police seized on these contributing factors as evidence their actions were not at fault. But as a conservative blogger on Red wrote, “When you have an arm around your neck and bodies on top of you, health problems are not to blame.”

Exactly. When you look at health statistics or death statistics for Black people, poor people, or for fat people, part of what you are seeing is the result of living “with an arm around your neck and bodies on top of you.” You are seeing the physical results of stress, trauma, and poverty, causing illness and death. Yet the blame falls on the people who live and die with those pressures.

Eric Garner had asthma and high blood pressure, but where did those come from? African-Americans are 50% more likely than Whites to have asthma. In a study in New York City, people from low income neighborhoods were up to 16 times more likely to be hospitalized for asthma than their counterparts from neighboring zip codes with higher incomes. African-Americans are also 50% more likely to have hypertension than are non-Hispanic Whites.

Those connections are mostly due to stress, although unhealthy environments – such as toxic chemicals and air pollution also contribute. Stress is the feeling of living “with an arm around your neck and bodies on top of you.” It’s facing threats that seem beyond your ability to control. In psychological studies, stress goes along with being discriminated against, stigmatized, and regarded with fear, distaste, or pity.

One of the addresses found at the intersection of Black and Fat is poverty. Poverty was likely the reason Garner was out there in the first place. According to a friend, asthma caused him to give up his job as a city horticulturalist. He was selling cigarettes to help feed his family.

Poverty and Blackness are both strongly linked with “obesity” and diabetes, my professional specialty. According to the Centers for Disease Control, non-Hispanic Blacks have a 90% higher diabetes rate than Whites.

These correlations are nearly always blamed on fat people and the communities they live in. Something about African-American or Hispanic genes, or their culture, or about poor people of any color’s eating habits must be causing their weight, their diabetes, and their poor health outcomes. They get fat, the fat gives them diabetes, and their own genes and behaviors doom them, according to the mainstream narrative.

But science shows otherwise. The connections are mainly about stress and inequality, although chemical exposure and the relative affordability of sugary, processed foods compared to more nutritious food also contribute.

Being poor, traumatized, and discriminated against are stressful. Worrying about money and your kids’ safety and their future, and/or fearing for your life on a regular basis will make you insulin resistant and worsen your asthma. Stress raises blood pressure to prepare bodies to fight or run away from danger, and the body perceives all of these oppressive life conditions to be dangerous.

Stress makes you gain weight through the effect of stress hormones, and chronic stress makes you sick. It’s not the gained weight that makes you sick, it’s the chronic stress and unhealthy environments that cause both changes.

In a Swedish study of 900 men, those with more self-reported stress had a 50% greater chance of getting diabetes. The famous Whitehall study in the UK found that men with more work stress had a 70% greater chance of being classed as “obese.” So is the fat causing the diabetes, or is the stress causing both?

Note: there is almost never one single cause for any chronic condition. Stress and environment are the primary factors for most people, but everyone has their own story and their own coping mechanisms for dealing with stress (some of which come with their own risks and consequences, like smoking or using alcohol or drugs).

And that’s just work stress. It doesn’t account for (metaphorically) “having an arm around your neck and bodies on top of you.” It doesn’t account for severe economic stress, struggling to keep your head above water, endemic among African-American, and increasingly widespread among many kinds of Americans.

Why Did Eric Garner Die?

On a visible level, the police killed Eric Garner. They held him down and squeezed the life out of him. His weight, asthma, hypertension, and color didn’t kill him. Neither did his poverty.

But at a deeper level, those things also contributed to Garner being killed. Do we really believe that five big cops would hold a thin White man face down while he gasped “I can’t breathe?” The police saw him as a danger because he was big and Black, the same way Darren Wilson saw Mike Brown in Ferguson as “Hulk Hogan” and as “a demon” before shooting him five times. He didn’t see Brown as a person; he saw Black and 285 pounds. And he fired.

When people tell you “fat kills,” recognize that it can be true, but not in the way they say it is. The stigma and oppression people live with are the real killers, the first causes of the heart disease, diabetes, asthma, and other conditions correlated with, but not primarily or necessarily caused by weight.

People in the size diversity and Health at Every Size® movements recognize the importance of the current protest against police violence. It’s time to get involved because this struggle is our struggle. All these forms of discrimination reinforce each other, and if we come together to fight back, good things will come of it. Then those who have died will not have died in vain.


David Spero RN is author of three books: Diabetes: Sugar-coated Crisis, Diabetes Heroes, and The Art of Getting Well. He blogs about diabetes, public health and self-care at Diabetes Self-Management and writes about spiritual and personal journeys at his blog Reasons to Live.

12 Responses to “the HAES® files: Murder at the Intersection of Fat and Black”

  1. Excellent article!

  2. Exceedingly Eloquent and Powerful piece David – I will make sure others have access to it as well – Jon

  3. Thank you for this. The mainstream media, as usual, wants to narrow things down to one cause, when rarely is it that simple. We need to cultivate a more holistic understanding.

  4. I am tired of seeing the fat community pile on with race baiting and propaganda. Gilbert died from consequences of his own actions: a long criminal history of 30 arrests for everything from assault to larsony and theft, then chosing to disobey the law and continue to resist arrest. The police did not murder him because of his skin color or weight, nor are the cops out of control with police violence and targeting black people. Look at facts and put them into perspective. There are over 228,000 arrests in NYC alone, with none of them resulting this ending.

    Socio-economic factors (stress and working in unappreciated jobs and hostile work environments, for example) are, indeed, contributing factors to health problems, including high blood pressure, diabetes and weight gain. As research by the NIOSH just published in the American Journal of Preventive Medicine found, people working in law enforcement had the highest rates of obesity because of the stress and hostile work environments of their jobs. Instead of condoning criminal behavior and looking only at skin color (which is the definition of racism) why not support all people of size and color?

  5. Why are racists and sexists always so poor at spelling and grammar?

    Spero’s article is excellent; the comment above applies to “Rene.” By the way, the definition of racism is NOT looking at skin color; racism = prejudice + POWER.

  6. Racism is prejudice. It is defined here:

    Prejudice is the same as ignorance and lack of understanding, and is never based on reasoned, rational thinking or facts. It is judging an individual or a group by some characteristic (weight, color, religion, dress, income, etc). Prejudice against fat people is the same as prejudging someone because they are white, black or brown, poor or rich, etc..

    Prejudices are allowed to grow and become hate in an environment of lies, pseudoscience and/or disinformation. It is never helpful to blame and excuse prejudice of any kind, but those who most often cry “racism” fail to recognize they often hold the most prejudices of all.

    Thomas Sowell warned about the tragic consequences of using race baiting and creating an us-versus-them divisiveness in his article this week:

    Victor Sharpe made an even stronger case against the “global tsunami of lies and hatred being spewed across America…”

  7. Thank you, David, for an excellent and insightful article. To your words, I say “Amen!”

    Rene, I appreciate your view, but find I respectfully disagree. Maintaining that

    “Prejudices are allowed to grow and become hate in an environment of lies, pseudoscience and/or disinformation. It is never helpful to blame and excuse prejudice of any kind, but those who most often cry “racism” fail to recognize they often hold the most prejudices of all.”

    only blames the victim. Moreover, changing the discourse from discussing unequal treatment—in whatever venue—to blaming the victim, does not move a conversation forward.

    When individuals are members of the dominant culture, it is excessively easy to claim that those who are like-minded are logical and rational, while those who recognize and expose discrimination “often hold the most prejudices of all.” Instead, it is the first clue that those of the dominant culture are the privileged and powerful, and do not see what they do not see.

    When one part of a society has created the rules and is winning the game, it seems hard to understand why the losers resent the whole game as unfair, yet have no choice but to remain in the game, playing for stakes of life and death. Their protestations of unfairness are met with cries of “Well, if you’d only play as well / earnestly / diligently as we do, you’d be winning too.” Never mind the game has been rigged from the beginning, with the playing field kept groomed and un-level by those who own the stadium. Blaming the victim seems to be the primary retort of those powerful, blind few who have created both the game and the rules by which everyone must play.

    There are some in the dominant culture in the United States who have the ability to recognize their good fortune as well as empathize with those not blessed to be born onto the “winning side” of American society. They are able to “see” that their success did not sprout in a vacuum due to their superior human diligence as an individual, but that their success was built on the shoulders of family, circumstances, and institutions that placed them squarely on the winning side.

    Are there some people who have overcome every conceivable disadvantage to rise to greatness? Sure. A few. But they, too, had a leg up from someone, and thank goodness for that! But holding the few exceptions to the rule as the norm—should others “work hard enough” to follow—does a disservice to every one of us, because it perpetuates as fact the fallacy that the playing field is, in fact, level.

    Inherent in the principles of the HAES® approach are access to accurate scientific information, personal assessment, self-knowledge, and the ongoing development of healthful practices that engage both internal and external aspects of living. Personal growth requires very hard work and humility. Effectively caring for self includes caring about others, and it means realizing that not one of us really succeeds while any of us is falling off the slanted game board.

  8. An excellent piece, Mr. Spero. Very perceptive.

  9. I am very happy to see ASDAH talking about how different oppressions intersect and impact health. This conversation is so important! I also have some thoughts about Rene’s comment. She said: “Gilbert died from consequences of his own actions: a long criminal history of 30 arrests for everything from assault to larsony and theft, then chosing to disobey the law and continue to resist arrest” First off the man’s name was GARNER, not Gilbert. Secondly, it doesn’t matter how many times Mr. Garner was arrested before the day he died. Even if he’d been arrested 300 times previously, the police are expected to follow certain procedures and rules about how to treat people, especially with regards to detaining or restraining people safely. When those procedures or rules aren’t followed, *and when there is a very clear, longstanding pattern of those procedures consistently being ignored* when it comes to certain groups of people it is important for a society to do whatever it takes to change this. Again, I’m glad ASDAH is joining in this work.

    It’s frustrating to me why someone who understands and sees how fat people get treated differently, get less respect, etc… in our culture and by our institutions would have such a difficult time seeing how People of Color also get treated differently. And of course this will have an effect on their health, and of course the evidence is just as clear. David, you’ve done a great job walking us through some of it. Thanks!

  10. Thanks for commenting, Lisa. For anyone who doesn’t think race is involved in these types of police interactions, take a look at more recent news:

    A 45-year-old white woman dressed in full body armour, randomly shot at vehicles, led police on a chase and pointed her gun at officers, but ended up arrested in police custody without incident or injury after her shooting spree.


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