Letter To Med Students Doing a Weight-Stigma Capstone – Guest Post by Rachel Fox

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I don’t do a lot of guest posts here, but as I was reading Rachel Fox’s excellent piece “An Open Letter to the Well-Intentioned Medical Students Who Want to Do a Capstone Project on Weight Stigma and Email Me Asking For Advice” I knew I wanted to share it here. I reached out to Rachel who kindly agreed and here we are.

Rachel does all kinds of powerful and important work - I was actually just getting started on an analysis of an excellent study on ending weight stigma that she co-authored with Kelly Park and Rowan Hildebrand-Chupp when I came across this piece, which was originally published on Medium. You can also find her on on Twitter, and on her website.

Without further ado, here is Rachel’s piece:

 Dear Well-Intentioned Medical Students Who Want to Do a Capstone Project on Weight Stigma,

With appreciation for your enthusiasm, from the bottom of my fat activist heart, please pause, read this letter, and stop your project. Do something better. I’ve written you this guide to help.

Most of you who contact me have recently become aware that medical anti-fatness harms fat people. I’m so glad you’re learning!

Many of you are required, as part of your medical education (read: indoctrination into thin ideology[1]), to undertake an ill-conceived, short-term research project. Most of you are not, from my understanding, appropriately trained to do so. Very few of you would be qualified, in my opinion, to do weight stigma research.

But you’re medical students! The brightest of the bright, the hardest working of the hard workers. So you do a quick review of the literature, follow an Instagram account or two, listen to an anti-diet podcast, and decide you — so recently aware of the systemic force that fat activists have battled for decades — should take up the mantle.

The vast majority of weight stigma interventions go the same way. You gather a group of participants, usually students. You administer a “before” survey to measure anti-fat attitudes. Then you do your intervention, almost always a lecture/video/other presentation about how fat people aren’t fat just because we’re lazy!! Probably genetics has something to do with it!! Maybe we grew up in a food desert!! Plus weight stigma is bad because it makes people fatter!! There’s at least a 50% chance you’ll use materials provided by the Rudd Center.[2]

Afterward, you administer your survey again. Surprisingly to you, anti-fat attitudes didn’t change, or changed by only marginal amounts.[3] You write up an article anyway.

Let me be clear: you are not combating anti-fatness through this exercise.[4]

There’s no way for this to work.[5] Even if you did it well (which you probably didn’t) it wouldn’t work. Anti-fatness permeates your curriculum. Your institutions were built for thin people. Your rites of passage depend on mocking fat people instead of treating us.[6] How can one hour where you kindly instruct your peers to pity fat people instead of outright hating us do anything to make us more human to you?

Let me be clear again: if you are committed to dismantling the systemic oppression of fat people in healthcare, there are things you can do. You have access fat activists don’t have. You are the ones who can write an exposé. You are the ones whose voices the media will take seriously. Here are some recommendations about how to use your time and energy better:

1. Turn your lens back on your curriculum: You have access to your syllabi and textbooks! How many assigned modules or readings are perpetuating anti-fatness? How many of the bodies you practice on are fat? Are all the cadavers in your anatomy lab thin? How often do you read the words overweight, obese, and obesity? How often is stomach amputation[7] (bariatric surgery) recommended as a treatment?

2. Do an infrastructural audit: Can fat people sit in the chairs around you? Do your exam tables have a stated weight limit? Can fat people get onto them? Will your gowns cover our bodies?

3. Make literal, material change: BMI charts? Throw them away. Someone you know doing fat suit research? Go stop them. Advertisements for weight loss drugs? Cover them with information about how weight cycling increases risk for heart attacks.[8] Put up art with diverse bodies.[9] Stock the waiting rooms with Fat Studies books and articles.

4. Take a risk and go public: Your school is harming fat people. Let a journalist know. Publish a medium post. Make a fuss. Boycott a particularly vile professor. Go on strike. Put your reputation on the line. Anti-fatness is everywhere; make it visible. It’s scary, I know. Some of you will be better able to do this than others. Protect your most vulnerable (especially your fat classmates). You have an obligation to act.

I know these suggestions might not fulfill the requirements of your capstone project, so please use this letter to request an exemption to those requirements and do something that will actually help fat people instead. I have faith that you can convince at least one supervisory person that these projects are more worthwhile interventions than a milquetoast seminar.

If you need reassurance that this is the right direction, you’re welcome to email me.[10] I also think being able to point to the change you’re making — rather than being disappointed by what would be your minimally useful quantitative results — will be its own reward.

In Solidarity,

Rachel

[Ragen here: Again, this is such a great piece, huge thanks to Rachel for letting me share it here! One quick thing I’ll expand on that I notice when students in the middle of this process email me, is that often they’ve stumbled upon diet industry propaganda masquerading as anti-weight stigma research/education. This leads them to enthusiastically ask me to help them eradicate fat people (of which I am one) but, you know, in a non-stigmatizing way. You can’t effectively end weight stigma if you are invested in anti-fatness. To help clear up the confusion on this, I wrote a quick guide to understanding if something is anti weight-stigma or just diet industry propaganda. You can find it here!]

References

[1] Spinetta, C. M. (2013). Fat and fit: A culture-centered approach toward a new paradigm of health and the body (Doctoral dissertation, Purdue University).

[2] For an explanation of why the Rudd Center perpetuates anti-fatness, see: Mollow, A. (2015). Disability studies gets fat. Hypatia, 30(1), 199–216.

[3] Alberga, A. S., Pickering, B. J., Alix Hayden, K., Ball, G. D., Edwards, A., Jelinski, S., … & Russell‐Mayhew, S. (2016). Weight bias reduction in health professionals: a systematic review. Clinical Obesity, 6(3), 175–188.

[4] For a more thorough explanation of why most weight stigma interventions don’t work, see: Fox, R., Park, K., Hildebrand‐Chupp, R., & Vo, A. T. (2021). Working toward eradicating weight stigma by combating pathologization: A qualitative pilot study using direct contact and narrative medicine. Journal of Applied Social Psychology.

[5] Lindley Ashline makes a similar point here: https://bodyliberationphotos.com/2021/07/09/10-tips-for-making-your-weight-management-practice-more-weight-inclusive/

[6] Wear, D., Aultman, J. M., Varley, J. D., & Zarconi, J. (2006). Making fun of patients: medical students’ perceptions and use of derogatory and cynical humor in clinical settings. Academic Medicine, 81(5), 454–462.

[7] https://danceswithfat.org/2018/01/29/success-and-stomach-amputation/

[8] Bacon, L., & Aphramor, L. (2014). Body respect: What conventional health books get wrong, leave out, and just plain fail to understand about weight. Dallas, TX: BenBella Books.

[9] https://bodyliberationphotos.com/

[10] rafox@ucsd.edu

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More research and resources:
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*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings’ Fearing the Black Body – the Racial Origins of Fat Phobia and Da’Shaun Harrison’s Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.