Fat shaming – the process of insulting, bullying or stigmatizing a person for their weight — is an American pastime.
"[Weight stigma] remains a socially acceptable form of prejudice in American society, and is rarely challenged," the Obesity Action Coalition states on its website. So much in American culture — rhetoric, entertainment and media — insists fat people are inferior. And, surprising or not, people who are overweight or obese are treated as inferior by the law. It's legal to discriminate based on someone's weight in every state except Michigan, suggesting that a person's weight can determine their value in the boardroom.
Seemingly well intentioned instances of fat shaming — like discouraging someone from eating dessert or telling them they need to be more active — are socially acceptable because they're framed as concern for someone's health. But in a sick twist, fat shaming is proven to be counterproductive. The language we use to talk about weight and the assumptions we make based on a person's size can contribute to more weight gain and less self care, like seeking medical attention. Here are a few insidious ways fat shaming thwarts Americans' best efforts to be healthy:
Fat shaming can spike stress hormones that can increase weight gain.
The shame people feel about their weight doesn't work as inspiration for dropping pounds. In fact, the stress associated with being overweight could potentially have the opposite effect. Numerous studies show weight stigma and discrimination can lead to elevated levels of cortisol, a stress hormone that's been linked to overeating, binge eating and weight gain.
Research published in the journal Obesity revealed college-aged women who perceived a weight bias against them experienced an greater levels of cortisol compared to a control group of women who did not perceive weight bias. Another study reiterated the idea that weight stigma is stressful, finding women who watched videos showing weight stigmatization (e.g. actors struggling to exercise) had higher cortisol levels than women who watched a neutral video.
Some neuroscientists argue that dieting is also inherently stressful and can lead to weight gain, not weight loss because weight anxiety is linked to binge eating, NPR noted.
Shame stems from the insinuation that overweight people lack control, but losing weight isn't as simple as having willpower.
There's a misguided confidence in the belief that weight loss is as simple as summoning willpower — that people who fail to lose weight just aren't trying hard enough.
Weight loss-focused shows like The Biggest Loser, suggest getting thin is about working hard and really wanting it, but they don't tell the full story. Several former contestants of The Biggest Loser struggled to maintain their weight loss, the New York Times reported, noting the contestants' metabolisms slowed during their weight loss — meaning, they had to eat less and exercise more than peers who did not lose weight. This kind of not-so-happy ending doesn't make for good TV, and it certainly doesn't fit in with the idea that losing weight is a self-discipline thing.
And, this kind of entertainment, it turns out, perpetuates the myth: Research revealed people who weren't trying to lose weight who watched weight loss-focused reality TV more likely to believe that weight can be controlled by self-discipline.
The belief is both reductive and false. Weight gain and obesity stems from a whole host of factors including genetics and environment, a report from Harvard Medical School noted. Roughly 400 genes, childhood habits and many features of modern life (e.g. inflated portion sizes, sedentary jobs, lack of sleep) can increase the likelihood someone is overweight or obese.
Even doctors are prejudiced, which can be harmful to their overweight patients.
Perhaps most startling of all, medical professionals hold weight biases which can prevent them from providing the best possible care. A study in the journal Obesity Society found that health professionals specializing in obesity held "anti-fat bias," which led them to buy into stereotypes that obese people are more lazy, stupid and worthless compared to thin people.
"Unfortunately I'm unaware of any population of health care providers who when studied, were not found to possess weight biases," Yoni Freedhoff, assistant professor at the University of Ottawa and founder of Ottawa's Bariatric Medical Institute, said in an email. Freedhoff explained these biases can affect the patient care (the treatment providers recommend) and can even prompt patients to be less likely to seek care if they had a negative experience in the past.
Doctors often treat overweight patients differently than slender ones and delay preventative care (like pap smears and breast exams) for obese women, Stat, a health news site, reported.
For example, Rebecca Hiles, a woman interviewed by Stat, said doctors repeatedly advised her to lose weight to combat a persistent cough they attributed to her body size. In fact, cancer in one of her lungs had been causing the respiratory symptoms and she eventually had the lung surgically removed.
"This is not about somebody's feelings being hurt," Dr. Michelle May, a medical physician and member of the advocacy group Health at Every Size, told Stat. "This is about people receiving inadequate health care, and preventative advice, and counseling, and support and treatment — because the focus is on weight instead of managing risk factors."
But some doctors just can't see past a heavy frame. For example, a doctor named Jason Fung implied two keynote speakers (who were both high-level professionals) at a conference called "Obesity Week" should not be considered obesity experts because of their bodyweight, Vox reported. Fung tweeted a photo of two keynote speakers and used scare quotes to imply they weren't "experts." (The tweet has since been deleted.) When Vox reporter Julia Belluz asked Fung about his tweet, he responded, "Would you take financial advice from a homeless man?"
While already facing health consequences, obese patients risk facing even more dangers if their doctors don't support them or if they feel so discouraged that they stop seeking professional care. One patient told Belluz she avoided going to the doctor entirely because appointments for illnesses like the flu would sometimes devolve into weight loss interventions.
Doctors shouldn't be "erroneously using weight as a measure of the presence or absence of health" - Yoni Freedhoff, obesity doctor
Health care providers shouldn't think of obesity any differently than other medical conditions that cary degrees of risk, Freedhoff said. "Providers need to assess the individual in front of them by taking comprehensive medical and social histories as well as ordering and evaluating appropriate testing," he said, explaining providers shouldn't be "erroneously using weight as a measure of the presence or absence of health."
Perhaps rather than resolving to lose weight every New Year, like so many Americans do, it'd be wiser to resolve to remember that body size is not directly correlated with a person's work ethic or worth. If there's any laziness associated with fat shaming, it's that the laziness of failing to correct our own flawed beliefs about weight and health.