The
experience of “being fat” is a demoralising, persistent predicament for
millions of people. Reasons for this
include the growing centrality of the physical body in the construction of
social identities, difficulty in masking one’s size, widespread negative
messages about excess weight and stigma-related maltreatment such as
bullying. Unlike race, gender and
sexuality, body size is not a legally protected characteristic covered by the
UK’s 2010 Equality Act, meaning there is nothing in law to prohibit someone
acting in a discriminating way against a fat individual (Moller & Booker, 2014). Indeed, it has been described as the last
“acceptable” form of bias, with social norms condoning the blatant expression
of weight-based prejudice and negative weight-related stereotypes (Nolan & Eshleman, 2016).
Before I
continue, it feels appropriate to comment on the terminology I will use in this
paper. Whilst the term ‘fat’ makes some
people uncomfortable, it is a term that has been reclaimed by the Fat
Acceptance Movement, whose perspectives feel most aligned with my values as a
trainee counselling psychologist. They
place terms more synonymous with medical discourse, such as “overweight” or
“obese”, in quotation marks and I will do the same, noting that these are levels
of fatness delineated by the Body Mass Index (BMI) (Moller & Booker, 2014), which is itself based on
a Caucasian body type and does not account for body composition.
This paper
will firstly consider the origins and impact of weight stigma, thus
legitimizing weight-based discrimination as a social justice issue. We will then examine the social, political
and economic factors surrounding weight-based prejudice.
Origins of weight stigma
People
who are deemed fat face discrimination and bias in a range of areas including
interpersonal relationships (Black, Sokol, & Vartanian, 2014), employment, education and
customer service (Ruggs, Hebl, & Williams, 2015). Fatness is infused with cultural meaning in
all cultures, significantly shaping and reflecting identities and the wider
social order (Brewis, Wutich, Falletta-Cowden, & Rodriguez-Soto, 2011). Understanding the issue
of being fat and the associated stigma is, however, complex, due to the
biopsychosocial and environmental nature of “obesity”.
Traditionally,
personal accountability for eating healthily and exercising regularly has been
emphasized as the main determinant of weight status, which has in turn
predicted strong beliefs that weight is controllable. This appears to be linked to the notion that
body size reproduces contemporary concerns and anxieties in society and has a
central meaning of control. From this
perspective, the fat body represents uncontained desire, uncontrolled impulse
and unrestrained hunger, whereas the thin body is seen to reflect psychological
stability and self-control over one’s inner state within the context of a
culture of consumerism (Ogden, 2010). These notions are highly
problematic, however, in that such beliefs are not only associated with
stigmatizing attitudes towards fat people, but also divert attention from other
causal factors such as biological elements and environmental influences such as
food prices, high availability of junk food, medication side effects, poor
health, conflicting messages about healthy eating and marketing that promotes
the consumption of unhealthy foods (Pearl & Lebowitz, 2014). Indeed, a 2007 government report presented
over 100 factors involved in obesity, many of which operate at the individual
level but are beyond individual control (Moller & Booker, 2014). This aligns with Weiner’s (1985) attribution theory of stigmas, which postulates that the perceived
causes and permanence of a stigmatizing condition will influence affective
responses and judgements toward specific people. In the context of weight stigma, a study by Fardouly and Vartanian (2012) found that individuals who
were previously “obese” and had lost weight through diet and exercise were
perceived more positively than those who had lost weight through surgery. This difference is reflective of the notion
that surgical patients are less responsible for their weight loss. When someone who is fat tries to lose weight
and fails, however, it reinforces the stereotype that they lack willpower (Foster-Gimbel & Engeln, 2016) even though numerous
studies have found sustained weight loss to be both difficult and rare.
Repeated
failed attempts to lose weight often elicit shame, a key emotional mechanism in
the cyclic obesity/ weight-based stigma (COBWEBS) model (Tomiyama, 2014). This model typifies weight
stigma as a vicious cycle, whereby the stress of weight stigma impacts the
targeted individual psychologically (e.g. lowered self-esteem), physiologically
(leading people to gain more weight through stress-induced cortisol secretion),
or behaviourally (engaging in efforts at coping that encourage eating and
weight gain). This finding is supported
by large longitudinal studies which have found that weight stigma actually
predicts weight gain over time (Hunger et al., 2015).
Despite
these findings, negative attitudes towards fat individuals have been observed
in the general population, amongst children, health care practitioners, fat
people themselves (Black et al., 2014) and even public health campaigns aimed at reducing obesity. These are based on the premise that if being “obese”
were sufficiently unpleasant, then “obese” people would be prompted to adjust
their lifestyle and lose weight, despite the absence of any supporting evidence
for this view (Vartanian, Pinkus, & Smyth, 2014). Unfortunately, this perspective
is reinforced by the dominant medical discourse which has suggested that
finding a ‘remedy’ for fatness is the optimal way of reducing weight stigma,
thus once again placing responsibility for reducing the issue on those
individuals who are fat (Dickins, Thomas, King, Lewis, & Holland, 2011). This is not the only area in which fat people
have been scapegoated; they have also been blamed for draining National Health
Service resources, global warming and the world food crisis (Edwards & Roberts, 2009). Being excessively fat can have negative
implications for health, but it seems the heightened level of concern goes way
beyond the risks involved and is more indicative of a cultural phenomenon.
Accompanying
these attitudes are a host of negative stereotypes; fat people are seen as
lacking motivation and self-discipline, have inferior personal hygiene,
symbolize poor health, have questionable moral values (Dickins et al., 2011) and are socially
irresponsible (Black et al., 2014). Fat people also face
discrimination in the form of unfair treatment in daily interactions with
others (e.g. being excluded, harassed or rejected) and as structural
constraints (e.g. fewer employment or educational opportunities, chairs that do
not fit and poorer treatment from healthcare professionals) (Brewis, 2014).
Impact of weight stigma
Whilst
excessive fatness is commonly understood as a serious public health challenge,
the stigma attached to it also creates considerable suffering. Weight stigma is now a critical social issue,
with body dissatisfaction so common that it is now normative and cultural norms
that assign individual responsibility, blame and failure to weight gain (Brewis et al., 2011). This is consistent with Crandall and
Eshleman’s (2003) Justification-Suppression model of prejudice, which proposes that
believing that a trait is negative and under personal control increases the
likelihood that people will convey prejudice against individuals with such traits.
Weight
stigmatization poses numerous consequences for the physical and emotional well-being
of targeted individuals, including risk of anxiety, depression, suicidality,
low self-esteem, avoidance of physical activity and health care services and
increased risk of weight gain (Gloor & Puhl, 2016). Weight-related societal pressures have been
found to predict extreme (sometimes ineffective or dangerous) weight loss
measures, future “overweight” status, binge eating and disordered eating (Foster-Gimbel & Engeln, 2016), body hatred and
self-stigma (Dickins et al., 2011). It has also been shown to lead to social
disconnection, not helped by the fact that there are limited places outside of diet
clubs for fat people to find support and engage in non-weight-related
discussions about their health and wellbeing.
Despite this, many “overweight” people report still attending diet clubs
even though they know they are ineffective, in order to meet the public
pressure to ‘do something’ about their weight.
Intersectionality
Intersectionality
can also increase the difficulties individuals face regarding their body
size. For example, gay men report more
pressure to be lean than heterosexual men and “overweight” gay men are often
seen as inviable romantic partners due to the importance of attractiveness
(signified by muscularity and low body fat) in the gay community (Foster-Gimbel & Engeln, 2016). Feminist scholars, meanwhile, argue that issues
surrounding women’s weight must be recognized within the context of a
patriarchal society (Rothblum, 2014). This argument is supported by studies indicating that fat women are
judged more negatively than fat men (Ogden, 2010) and those on lesbian (Share & Mintz, 2002) and bisexual (Taub, 1999) women, which suggest that a culture not invested in satisfying or attracting
men may possess a wider range of acceptable body shapes and sizes.
Sociopolitical and economic
influences on weight stigma
Despite
efforts by the Fat Acceptance Movement to provide an alternative discourse
around obesity, it seems that the stigma felt by fat people may be increasing
as the public and medical focus on obesity intensifies (Dickins et al., 2011). The media is a domain in which weight stigma
is particularly prevalent, portraying fat individuals as weak-willed, lazy and
self-indulgent (Moller & Booker, 2014). “Overweight” characters in films, comedies
and reality television shows are frequent targets of disparagement humour and
stigmatization (Pearl & Lebowitz, 2014). This aligns with the theory of downward
social comparison (Wills, 1981) which predicts that people are likely to compare themselves with those
in less respected social positions related to a specific attribute (e.g. body
weight), thus experiencing an increase in subjective well-being as a result. Magazines targeting children and adults of
all ages seldom have fat people on their covers, sending the message that being
fat is both undesirable and unacceptable.
Indeed, some authors have suggested that stigmatizing obesity may motivate
people to lose weight due to the notion that stigma can be a powerful source of
social control (Major, Hunger, Bunyan, & Miller, 2014). However, the growing rates of obesity in the
UK and globally demonstrate its resistance to current prevention and treatment
efforts, including stigmatization. A
2012 government report found that 57.2% of women and 66.6% of men in England
were “overweight” or “obese” and those figures appear to be rising (Moller & Booker, 2014).
On a
political level, statements such as that of former U.S Surgeon General, Richard
Carmona, who claimed that the “magnitude
of [obesity] will dwarf 9-11 or any other terrorist attempt” (Pace, 2006, p. 1) present obesity as a public health crisis and inevitably exacerbate the fear
of being fat. This is despite the fact
that no study has ever proven that losing weight prolongs life. On the contrary, what the research does show
is that those who fall into the “overweight” category actually live longer than
“normal” weight people (Bacon, 2008). Numerous anti-obesity initiatives
have been developed by governmental, nongovernmental and commercial
stakeholders, including regulation and social marketing initiatives implemented
nationwide alongside weight-loss interventions aimed at the individual. However, despite little evidence to suggest
the efficacy of any of these interventions on reducing obesity, few
alternatives aimed at improving the overall health of “obese” adults exist
outside of the weight-loss arena (Dickins et al., 2011). Indeed, even the British Psychological
Society’s publication, ‘Obesity in the
UK: A psychological perspective,’ (Waumsley, 2011) inadvertently reinforces this issue by emphasizing weight-centric
psychological interventions and omitting the issue of weight stigma on the
grounds of lack of space.
Economically,
there are both causes and consequences of obesity. The falling prices of high-calorie foods,
combined with individuals rationally accepting higher body weights in exchange
for other things that they value such as time and money, have certainly played
a part. An increase in sedentary
occupations and entertainment options are also factors. The consequences of obesity, meanwhile, are
often divided into direct costs such as increased health care, and indirect
costs such as decreased productivity, higher job absenteeism and lower wages
for “obese” individuals (particularly women) (Dickins et al., 2011). However, research illustrates that for those
who are “overweight”, exposure to stigmatizing messages about the impact of
obesity on a social and economic level not only increases their concerns about
being stigmatized, but can also paradoxically have the effect of increasing
their calorific food consumption and reduce feelings of self-control when it
comes to managing their diet (Major et al., 2014).
Previous
research has shown that whereas weight stigma may exacerbate weight gain among
those who are already “overweight”, it may deter weight gain amongst those who
are not. This may explain the
instinctive draw of stigma as a motivational tool; those who are not
“overweight” have difficulty understanding what it is like for those who are
and assume stigma will help to bolster other people’s resolve to control their
eating since it strengthens their own (Major et al., 2014). Professionals working in all
facets of healthcare should therefore avoid using weight-based stigma as a
motivational tool and instead focus on well-being and self-care. Education is required in order to spread
this message and promote public health initiatives such as HAES, thus focusing
on improving both psychological and physical well-being without focusing on
specific ‘ideal’ weights.
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