Public Health Without Weight Stigma

Public HealthIt’s become popular in recent years to act as if “public health” means making fat people’s health the public’s business, or at least that most public health messaging should include some kind of fat=bad element. Many people insist that it’s impossible to talk about public health without talking about body size.  I disagree.  I think that we can have a complete discussion of public health without ever discussing weight, and I think it would be far superior to what we are doing now.

There are times when a discussion about weight might be indicated – like if there are large fluctuations in weight without explanation, or if a prescription is dosed by weight.  I don’t think there is any need to discuss weight in general public health messaging at all, but I get a lot of push-back on this.

Before I get too far into this, the usual disclaimers about health and size acceptance. and about health in general, apply.

The first argument that I typically get is that weight loss makes people healthier and we need to get the word out.  Since public health messaging needs to be evidence-based, there are a couple of problems with this.  The first is that, based on the evidence that exists, there isn’t any reason to believe that more than a tiny fraction of people can achieve long term weight loss.  And the fact that some people survive jumping out of a plane without a working parachute does not make “Don’t use a parachute” a responsible public health message.  In fact, by far the most likely outcome of a weight loss attempt is weight gain so even if someone believes that being thinner will make people healthier, the fact that we don’t know how to get that done means that “lose weight” is not an appropriate public health message.

Then there’s the discussion of fat people and our knees. In this instance prescribing weight loss is like prescribing levitation. Even if levitating would be help people with knee issues (since floating will likely take the pressure right off the knees) suggesting that people jump off their roof and flap their arms really hard isn’t an appropriate public health message because – much like weight loss – we have no evidence to suggest that it will work, and there’s a significant downside if it doesn’t. And let’s remember that there’s only about a 5% greater chance of losing weight than of successfully levitating. Also, there is no study that shows that those who maintain weight loss long term are healthier than they would have been if they had stayed fat and simply practiced healthy habits – the idea that losing weight makes you healthier long term is a hypothesis, not a conclusion.

Another common argument  I get is that companies are specifically manufacturing processed food that manipulates our brains into always wanting more food and never being satisfied without giving us nutrition, and that it’s important  to let people know that those foods exist and may make people fat.

I think that you talk about foods without tagging on the “fat bogey man” message, and that it would be both more ethical and more effective.  Suggesting that part of the population should make choices in an effort not to look like another part of the population is highly problematic and creates an environment where people are encouraged to stereotype and shame others for how they look, which isn’t healthy for anyone. The concept of “healthy” foods is complicated and fluid (it varies based on many individual circumstances) But even if someone believes that there are clear cut “healthy and “unhealthy” foods it does not follow that there are separate healthy and unhealthy foods for fat people and thin people.  It’s not as if some foods are healthier for people who can eat tons of it and not gain weight.  I think that an effective public health message would be to let people know that companies are trying to manipulate their brain chemistry to make them buy more food, and let them decide if that’s ok with them, not tell them not to eat this food because it might put them into a class of people who are being actively stigmatized and oppressed, thereby reinforcing that stigma and oppression.

Finally is the notion that fat people aren’t aware that they are fat and/or aren’t concerned enough about being fat so we have to tell people to worry about their weight.

To this I can only ask “What in the hell are these people talking about?”  All of this FAT IS BAD EVERYBODY PANIC public health messaging has done one thing well – it has successfully stigmatized fat bodies.  Not only isn’t this supported by the evidence, it’s actually contraindicated by it.  Peter Muennig from Columbia has found that “The difference between actual and desired body weight was a stronger predictor than was body mass index (BMI) of mental and physical health.”  The truth is that we will never know how much healthier fat people could be if we weren’t constantly shamed and stigmatized, until society stops shaming and stigmatizing us.  So how about we roll the OMGDEATHFAT messaging back and try making public health about giving people information and access to options and resources, and then respecting their decisions and their bodies.

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13 thoughts on “Public Health Without Weight Stigma

  1. I think I got a very mild version of the “fat people with bad knees” thing a couple of weeks ago. I was seeing the doctor for an absolutely non-weight-related work injury, and even though he didn’t mention weight directly, he did keep asking about the “pre-existing arthritis” in my knee, and hadn’t it been bothering me before the injury. (It hadn’t.) He eventually let it go and never mentioned weight loss to me, so I have no problem going back at this point. But it’s enough to make you wonder if that’s what he was thinking.

  2. I haven’t mentioned my untreated (because not diagnosed until decades after the fact) Osgood-Schlatter to my current doctor because I’m worried about her interpreting something that happened to me when I was thin as a consequence of my now being fat. There may be ameliorative measures, even now. But I’ve gone this long with my knees hurting every single day and managed to build a life, and do I really want to risk having her get little fat signs in her eyes?

    1. If she’s not fat-shaming in general, then it’s probably safe to bring it up, especially prefaced with the fact that you kept it a secret out of fear of being fat-shamed.

      If she shows signs of fat-shaming, though, I’m with you. You’ve lived with it this long, and she probably wouldn’t be very helpful, if she gets all fat-shamey on you.

      I think it depends on the doctor, really. It IS worth finding a good, non-fat-shaming doctor, to see if your condition can be helped. Good luck!

  3. when i weighed about 135 pounds i broke my ankle, badly, by falling off a too-big, poorly-balanced pair of platform shoes [70s vintage, converse type, huge soles, at least two sizes too big]. YES, i was an idiot. after i’d begged+begged+begged+begged my [e’er retired] father to take me to emergency, the doctor put my leg in a cast all the way up, i believe, to my crotch— oh i was terrified, claustrophobic, everything. i mean, this was a bad break, right across the malleolus. i really liked the doctor who set my leg too.

    i really liked him UNTIL he told me my knees were gonna fall apart if i didnt lose weight. i’m not making this up &, if i’m wrong about my weight, it’s not by much. this is los angeles, mind, so the obsession is even worse….. not to mention that i was decades mostly anorexic [i took ‘breaks’ sometimes; this used to be called bulimarexia]. not to mention that my father started laughing & laughing, ie: ‘dont tell her that, she’ll go crazy!” he got off on this—oh he was a nightmare, this is minor—especially since he was way larger than i was, way larger than i’ve ever been.

    at this point if someone ever mentions weight [invariably on a message board, since christina hendricks they bother me less], i say: ‘if you are so concerned about the public’s health, you can pay for my dental work. i have a paypal account…..’ just so you know, not ONE person has volunteered yet.

    1. If you really do need help, send your PayPal information to Ragen and tell her to forward it Jenna. Alternately, you can contact me through Google’s email system – the user name is damianatheraven. (Take that, spambots!)

  4. One thing I’ve always wondered about the harsh opposition programs like the one you’re suggesting meet:

    If they’re so sure healthy behaviors lead to weight loss for everybody (or “most” everybody) who adopts them, why are they so opposed to programs that focus on those behaviors without talking up weight loss? Don’t they believe the participants would lose weight regardless?

    1. As near as I can figure out, such programs don’t have any basis in reality, logic,fact, or common sense. They are so wrapped up in Obesipanic and OMGALLFATIZDEATHFATZ that critical thinking is impossible.

  5. My idea of healthy vs. unhealthy food (and I am no expert, so this is not gospel) is that real food tends to be healthier than fake food.

    For example, sugar doesn’t give me migraines and intestinal issues, whereas sugar substitutes do. Don’t even get me started on fat substitutes, and the number they do on me. Naturally reduced fat (such as using skim milk to make cheese, rather than whole milk) is a completely different thing. I might not like the taste as much, but it won’t make me sick.

    That said, I won’t jump on the All fresh, unprocessed, raw foods bandwagon, because for some people, their food MUST be processed, or they can’t it, depending on the person, and the food, and the process used.

    Individuals have ALWAYS had individual dietary needs, before dieting was even a thing. Therefore, individuals need the right to make their own food choices, based on their experiences of what works best for their own bodies.

    1. Right. There are plenty of non-factory-made, unadulterated foods that are wonderfully healthy for some people while making others vilely ill–without even considering allergies. Cow’s milk and wheat are classic examples. And I know somebody who can eat refined fortified white flour in moderation, but a bite of whole-grain anything will cancel her entire day.

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