Assuming that being overweight automatically means being unhealthy. Alternatively, assuming that thinness means being healthy.
It Gets Fatter Project primarily serves self-identifying fat people of colour, including queer, trans, and disabled fat people. We offer workshops, trainings, peer support and mentorship, clothing swaps and speaking engagements to all of us who identify as fat and/or thick, large, abundant, succulent, supersize, etc. We provide an online forum and community @ itgetsfatter.tumblr.com for people to share their stories and find each other. We also provide workshops and trainings for the general public, with topics ranging from fat phobia and health, to desire and desirability, to deconstructing health, and body autonomy.
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Fat bodies are often viewed as public fodder for conversations about ‘moral good’ while our health, as a burden to taxpayers and our health care system. How we frame the idea of an “obesity epidemic” constructs fat bodies as always “unhealthy” and in need of interventions, sometimes in the form of dieting and exercise and sometimes in the form of medical surgery. In this context, fat people’s health is often detrimentally impacted when our health care providers focus solely on weight loss as the solution to health concerns that may be completely unrelated to an individual’s weight and/or size. This is why it is fundamental that fat people are a part of this conversation about assessing and improving our relationships with health care providers.
Despite the constant use of “fat” as a metaphor for gluttony and excess, statistics show that the majority of fat people in North America are both poor and racialized. This means that fat people’s health is often impacted by the lack of adequate access to health care, as well as access to wholesome and nutritious food. That is in addition to impact of the stress that can come from dealing with discrimination, racism, fatphobia, anxiety or depression, or from the lack of time and resources that may be associated with low-wage jobs where people of color are overrepresented. While we are entitled to quality care, doctors and health care practitioners can sometimes exhibit the same kinds of biases that fat people experience outside the health clinic, which jeopardizes these really important relationships. Fear of being stigmatized, shamed, or lectured on weight loss can cause many fat people to delay or forgo a visit to the health clinic altogether.
What is fatphobia?!
As with any system designed to exclude, shame or oppress people on the basis of shared characteristics or identities, it can be easy to assume that something like fatphobia, the fear and dislike of fat people paired with the stigma of individuals with bigger bodies, only exists on an individual level. In reality, it is layers of complex beliefs and systems that end up shaming, silencing and “correcting” fat people. It feeds the bias, discrimination, disregard and sometimes even hatred that all fat people have to contend with on a daily basis.
It can play out on a personal level. This means personal interactions, conversations or hurtful remarks that, regardless of intentions, enforce certain views about what bodies are good vs bad. For example, policing what someone is eating, telling them about their own health as if they wouldn’t know better, or giving unsolicited advice on weight loss, etc.
It certainly pops up in all of our media or, generally, in what we present as valuable in our culture. It is about our norms, values and practices devaluing fat people, and showcasing thin people as the standard to be measured up against and as what is ‘beautiful’ and ‘desirable’.
Institutional fatphobia is what frames it all and entrenches these harmful attitudes. It looks like institutions and/or policies excluding, oppressing or mistreating fat people. It looks like ever changing BMI standards used as thresholds for different things, company guidelines, prices or availabilities of certain items, etc.
This last one is especially of concern when we consider the intersection of race and fatphobia as the enforcement of what body deserves praise or punishment means different things for racialized people. For instance, talking BMI to Indigenous, Black and other racialized bodies means imposing a European and Anglo-Saxon arbiter of health on bodies that are vastly different in terms of their fat/muscle ratio, where they carry fat on their bodies (hips, butt) and in terms of how and what they eat as well. It also erases the context and history of why we eat a certain way and how our bodies process certain foods while still subjecting us to punishment that can often be made harsher due to racism.
Fatphobia certainly shows up in the doctor’s office. This may look like weight being recommended by doctors regardless of the person’s actual health or if weight loss has any bearing on their health needs. It can also look like assuming that being fat is the cause of any number of health problems, including sexual and reproductive health problems, whether or not any correlation exists between weight and the health concern an individual is seeking care for. This matters!
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Most of our members do not report positive interactions with their health care provider. In studies conducted by Rebecca Puhl, a researcher at Yale University, 25% of nurses said they are “repulsed” by fat people, and more than half of the 620 primary care doctors questioned described obese patients as “awkward, unattractive, ugly, and unlikely to comply with treatment”. (Heuer & Puhl, ‘The Stigma of Obesity’, 2012). This points to how most fat people have negative experiences when seeking health care. Doctors and other health care workers often give voice or credit to stigmatic assumptions when it comes to fatness and health, which then impacts how welcome we are in health care services, what kind of treatment we get, or how seriously our health and our needs are taken.
Treating being fat as something to be shamed for, reprimanded for, or be corrected is common practice in the context of health care. People who are fat tend to avoid going to see the doctor because they know they will most likely be scrutinized, or received negatively because of their weight. It is important for health care professionals to critically reflect on their assumptions around fat bodies and question the popular cultural narrative that equates fatness with unhealthiness. Until fat people feel safe enough to see a doctor for their health concerns and are not demonized because of their weight at the doctor’s office, the ways that they (we) access health and seek professional help, or avoid to do it altogether, will have adverse impacts and implications on our health and wellbeing.
The intersection of size, health and weight loss are far more complicated than we’ve been led to believe and this misunderstanding fuels fatphobia and discrimination based on size. Widespread anti-fat prejudice comes from misconceptions about health, weight and body positivity, and it impacts our health and our ability to access health care.
Health care practices informed by assumptions can certainly get in the way of building good and therapeutic relationships between people and their health care providers. The consequences can range from mistrust, to being misdiagnosed, to avoiding going to the doctor, to dealing with the stress of getting mistreated and belittled when we do seek help.
Assuming everyone wants to lose weight or, on the other hand, that only thin people struggle with eating disorders.
Assuming that fat people have low willpower, are out of control or are not compliant and therefore will not follow through with treatment or should not be trusted with taking care of their health.
Assuming that fat people have poor eating and exercise habits, or that they don’t care about their health, and so, that it is the first line of intervention for any kind of health issue brought forward. Alternatively, ignoring how mental health can play a role in how people relate to food or eating.
Assuming fat people are lazy, less intelligent, unmotivated, lacking in self-discipline, less competent, noncompliant, and sloppy.
Assuming fat people are not attractive, sexually active, desirable, desired or in relationships.
Assuming that if someone is fat, that it is “their fault” or “their own doing”. That no other factors may determine someone’s shape, or someone’s access to certain foods, etc.
Intervention tips and tricks
Everyone’s body is a GOOD body!
To start from there might help lay the foundation for more trusting relationships with your patients who are fat. This is important because, while we are continually told we should lose weight for our health, many things contribute to an atmosphere where we are afraid to or turned off of participating in health care.
Here are some possible interventions that can help interrupt discrimination based on size and mitigate its impact on our health and on our ability to access health care.
Treat your patients with dignity and respect regardless of their body size. If you make your patient feel like they’re in a safe, caring space — one where they’re free to talk about anything, even their weight, it will lead to being able to share more information, access preventative care, nurture trusting therapeutic relationships and getting the care we need and deserve to stay in good health.
Gently encourage folks to have a healthy attitude towards their own bodies. Ask individuals what a healthy body looks and feels like to them, leave the answer up to them. Do not impose your definition of health on bodies that are not your own.
Leave the diet talk out of the exam room. If your patient wants help losing weight, they will ask.
Examine your own biases. Do not measure a person’s worth on their weight or size. Researchers at Harvard ran a study called Project Implicit to gain insight into our implicit biases, including those against fat people. It has shown that doctors have as strong of a negative bias against fat people as the general public, and that many of them view fat patients as unattractive and difficult to work with, and that obese women get inappropriate comments about their weight from their doctor. These attitudes impact clinical practices and that, obviously not in a good way.
Remember that there are systemic causes outside of a person’s control that can cause some people to be fat so do not suggest lifestyle ‘solutions’ to something that may have to do with access to resources, genetics, social determinants of health, mental health, etc.
Help nurture access to fresh organic fruits and veggies for folks with limited financial resources. For example, inform your patients about programs like the Special Diet Allowance and support them in accessing them.
Read more about health and weight! Inform yourself about ‘Healthy At Every Size’! Educate yourself and your colleagues about fat people. Seek out resources and books like “Rethinking Obesity: An Alternative View of Its Health Implications” by Dr. Paul Ernsberger to help you start thinking more critically about “what we know” when it comes to fatness, dieting, health at different weight, etc.
Ask yourself if a patient’s weight is truly affecting their health or contributing to a health issue. If it is, have an honest and respectful discussion about why and how. If not, just focus on what the patient brought to you and treat the issue like you would for patients of any size. Relatedly, do inform yourself about when and how someone’s weight can impact what resources, treatment or devices are available to them. For example, emergency contraception is less effective for people with higher body weights.
Instead of focusing on a specific goal for weight loss, address the positive benefits of working out and eating differently. Aiming for a specific number on a scale can induce stress and anxiety.
Be mindful of your language. Don’t explicitly or implicitly blame people for their weight. It further disempowers, marginalizes and effectively shames people simply for being fat. It does not promote any kind of positive change if that is the intention of such intervention (if such change is also desirable to the patient).
Assist people in accessing sound nutritional info, resources on how to make good food choices while living on a budget. That information should be presented in a way that is not shaming of different sizes and bodies.
Do not assume weight loss is always a sign of good/improving health. Sometimes, extreme weight loss is the result of depression, complications from illness or disease, an eating disorder or other acute stresses in one’s life.
Make sure you focus on the needs and issues your patients are bringing forward rather than focusing on someone’s weight or size. Adopt a holistic approach to understanding health challenges someone is facing.
Do not make assumptions about what kinds of tests, intake questions or information is relevant to your patients, including when it comes to their sexual and reproductive health.
Do not make assumptions about people being sexually active or not, about people’s sexual orientation, about sexual preferences, their relationships, etc. Ask open ended questions in a non-judgmental and professional manner. Make it clear that sexual health matters are a part of routine care.
Do not devalue fat folks or make them feel like their body is wrong simply because it is fat. Assume that we already face a lot of stigma and don’t need you to be further marginalized or stigmatized. In some settings, health care providers are refusing care to fat people unless they lose weight, make derogatory remarks or jokes about us, treat us like we don’t deserve good health care, etc. Speak up if you see colleagues acting this way.
Build a list of health care providers, services, therapists, etc. who are body-positive so you can ensure referrals that are beneficial to your patients’ health and wellbeing.
Advocate for better access to healthy food options in poor neighborhoods, including in schools.
Quick tips for a welcoming and inclusive practice!
Add to your stack of waiting room magazines and make sure some of the reading material features body-positive content.
Feature posters and positive imagery of people of various sizes (races, ethnicities, etc.) who are healthy, happy and smiling.
Offer a snack and cell-phone friendly space.
Make sure your office or clinic has differently sized chairs / chairs with no arms rest, equipment that can accommodate bodies of different sizes and weight, gowns that fit differently sized bodies, large size blood pressure cuffs, etc.
Unless absolutely crucial to the appointment, do not weigh someone if an individual doesn’t feel comfortable. If a patient chooses to not be weighed, consider adding a note to their files that says “do not weigh” so they don’t have to go through the same conversation every time.
Offer individuals the option of being weighed privately.
Have a same-gender nurse be in the room if the patient desires
Always ask first when it comes to how an individual wants to be labelled. As a rule of thumb, use “fat,” or “of size” instead of obese or overweight, terms which imply there is a standard for a normal body that most people will never fit into.
Do not compliment people on losing weight.
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