Can we do good public health without fat-shaming?


By Catt Turney

Fat shaming, weight stigma – whatever you call it, it’s been a hot topic over the last couple of weeks. Geoffrey Miller, Professor of Evolutionary Psychology at NYU, recently tweeted the following:

Naturally, this caused a storm in the twitterverse, with calls for Miller to be fired, and the birth of a tumblr dedicated to trashing Miller’s claim. I found the uproar that followed reassuring, but also surprising, more so than the tweet itself. Miller’s claim was wildly offensive, but you only need to look at the comments on any obesity-related news story to see that he’s not alone in thinking this way.

As it was put on the Friend of Marilyn blog, “This is not about this one guy who tweeted this one hateful thing – it’s about our larger culture and how we are content to allow fat individuals to exist as second class citizens.” In many Western societies, fatness is treated as the ultimate evil. Overweight people are underrepresented and ridiculed in the media, and openly discriminated against in countless aspects of life.

Using stigma positively?

From a public health perspective, is this a problem? Not everyone thinks so. Daniel Callahan, a bioethicist based at the Hastings Center, has suggested that fat-shaming could even be used to address obesity. The idea of trying to harness stigma to shame people into changing their behaviour echoes a campaign last year in Georgia, which featured pictures of overweight children, overlaid with phrases including ‘Fat kids become fat adults’ and ‘Chubby kids may not outlive their parents’.

Unsurprisingly, this approach has been lambasted. Critics of Callahan have pointed out that weight stigma not only has negative consequences for the mental health of overweight and obese people, but is ineffective in improving physical health. In their response to Callahan, ‘If shaming reduced obesity, there would be no fat people’, Janet Tomiyama and Traci Mann point out that not only are most overweight and obese people fully aware of the negative connotations attached to being overweight, but shaming them further may encourage engagement in unhealthy behaviours. Elsewhere, it has been found that weight stigma, perpetuated even by medical professionals specialising in obesity, means healthcare avoidance increases in proportion to bodyweight.

Why should we care about fat-shaming?

Many will agree, then, that deliberately exacerbating weight stigma isn’t a great strategy. But is it realistic – or even desirable – to try and address the genuine health problems of obesity without further stigmatising fatness?

This takes a bit of unpicking. Much fat-shaming relies on two fundamental principles: being overweight is the fault of an individual, and being overweight is always unhealthy.

For public health, these views are of fundamental importance. The first, the individualistic, blame-laden attitude that pervades weight stigma, is regressive and ineffective, the antithesis to good public health. Perpetuating this view in relation to obesity and overweight undermines the efforts of public health more widely to encourage a focus on structural and environmental factors and stop blaming individuals.

Secondly, weight stigma thrives on the belief that all overweight is the same, and all is grossly unhealthy. Again, this view is damaging to public health. This isn’t to say we should ignore the health problems associated with being overweight or obese. But oversimplifying, conflating overweight and unhealthy, and valuing of being ‘normal weight’ above all else, can mean other aspects of health are neglected.

What does this mean?

This has implications for public health research. For a start, the socio-ecological model of health – which takes into account the social and environmental context of an individual’s health and health behaviour – is key. Happily, this approach is already popular within public health research, and underpins the work of many key research centres, including DECIPHer. In understanding obesity as a result of complex causal factors, public health research can better address the structures that lead individuals to become or remain obese. Additionally, developing and communicating this understanding can help undermine the individual-focused, blame-laden understanding of obesity that underpins much weight stigma.

Addressing the conflation of overweight, obese and unhealthy is more complicated. One approach is that taken by the American Medical Association, who today voted to classify obesity as a disease. There’s already been vehement disagreement about the implications of this – some believe it has the potential to better clarify the distinction between overweight and obese, but others point out that it further pathologises obese people and muddies the distinction between overweight and unhealthy.

To me, classifying obesity in this way seems a poor alternative to properly figuring out, and communicating, the facts about the relationships between weight and health.  These relationships are, however, fantastically complex, and our love of simplicity means that changing our understanding of these relationships is a slow task. The narrative of fat people as homogenous and fatness as bad fits tidily with our cultural standards, and is reproduced everywhere we look.

Any attempt to shift our relationship with obesity needs to be accompanied, then, by a move towards concentrating on improving health, not just getting people to weigh less. This is already happening to some extent. Many interventions focus on healthy behaviours – physical activity, eating well – as a goal in themselves, rather than part of an overarching struggle to lose weight.  Maybe this can help move away from the idea that being ‘normal weight’ is an ideal to be chased at the expense of all else.

We need complex interventions to address the health problems associated with overweight and obesity, which address both structural and individual factors. Ignoring the complexity of weight, and allowing this to simply become a fight against overweight people, doesn’t help anyone.

Do you think exacerbating stigma is an inevitable part of addressing public health problems? What do you think about the ACA’s decision to classify obesity as a disease? Leave your comments below.

Catt Turney (@CattTurney) is Research and Knowledge Exchange Assistant at DECIPHer.

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