Not Blaming Fat People For Failed Weight Loss Isn't Enough
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Healthcare practitioners have a long history of blaming and shaming fat patients for the failure of intentional weight loss. In Stigma in Practice: Barriers to Health for Fat Women Lee and Pausé point to the following research:
Huizinga et al. (2009) found that fat patients were less respected by physicians than non-fat patients, and many doctors report that they prefer not to provide care for fat people (Maroney and Golub, 1992; Foster et al., 2003; Hebl et al., 2003; Persky and Eccleston, 2011; Stone and Werner, 2012). The primary care physicians in a study from Hebl and Xu (2001) reported an inverse relationship between patient BMI and the PCP's patience, job satisfaction, and willingness to assist the patient. Dieticians in Stone and Werner (2012) research expressed feelings of frustrations with their fat clients; “and this situation repeats itself, this frustration of people coming and not losing any weight. This frustration of knowing that I did my best, and I kept my end of the deal, and now it's your turn [the patient's]”(p. 771). Similarly, general practitioners in Australia reported working with fat patients as “professionally unrewarding,” due to the “limited efficacy in weight management” (Campbell et al., 2000, p. 459). Frank (1993) and Foster et al. (2003) found physicians to perceive treatment of ob*sity as futile.
This practitioner perspective ignores the fact that fat patients who “fail” at intentional weight loss are having the experience that the vast majority of people have had for the last hundred years of diet industry research. Blaming fat people for having the outcome that we know occurs about 95% of the time ignores the basic truth that fat people don’t fail at intentional weight loss attempts, intentional weight loss fails fat people. Moreover, it reflects a greater medical culture that is built on weight stigma and supports practitioners in feeling this way and expressing it – an environment where complaining about fat patients existing, making fat jokes, engaging in weight stigma out loud and in front of the patients is far too common. This means that instead of being on a team with their patients against a healthcare system that isn’t built for those patients, too many practitioners become another barrier to receiving ethical, evidence-based, compassionate care.
While fat activists and weight-neutral healthcare practitioners have been talking about this for literally decades, we are starting to hear pushback against this from, what seems at the outset, an unlikely source – the weight loss industry.
Suddenly they seem to be falling all over themselves to admit the failure of intentional weight loss.
While that seems like a step in the right direction, it’s their next step that is so dangerous and insidious. Behavior-based intentional weight loss almost always fails they say. (Yes!) So what we need are more people getting dangerous (and mega profitable) weight loss drugs and risky surgeries. (No!).
To be clear, the failure of behavioral weight loss interventions is not benign, with weight cycling (by far the most common outcome of these attempts) linked to most of the health issues that get blamed on body size, and to overall higher mortality. Still the risks of drugs and surgeries are even higher (and, they, too, often fail at creating significant long-term weight loss.)
Unfortunately, healthcare practitioners who are getting their anti-weight-stigma information from the weight loss industry and its paid champions are being told not to blame fat people for not being able to lose weight using diet and exercise (yes!), but rather to risk their lives with drugs and surgeries (no!). And for the patients who choose to opt out of these treatments? The practitioners’ blame, shame, and frustration toward their fat patients remain.
Practitioners not blaming higher-weight people for existing is a good step, but not if their next move is to push those patients to risk their lives and quality of life in unnecessary (but highly profitable) attempts to be thinner.
What we actually need is a healthcare system that respects and affirms the humanity of higher-weight people and seeks to support their health, rather than profiting from their attempted eradication and prevention.
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More research and resources:
https://haeshealthsheets.com/resources/
*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 Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.
Thank you for this...I'm so so tired already of seeing articles about Ozempic, op-eds looking at it from every angle EXCEPT ones that don't think fat people should be required to seek these 'miracles' in the first place. With all the mainstream news I consume treating risky drug and surgical interventions as worth it, it really weighs on me not to see a counternarrative pushing back. Your work is such a service in that respect. Makes me feel less like I'm the delusional one among all these 'experts,' screaming into the void.
The growing attitude of "it's not your fault you're fat (but you still need to fix it)" is a predictable outcome of the ADA in 2013 deciding that large bodies are a disease. In the US at least, we treat people with chronic diseases *terribly*. We make very few accommodations and those only grudgingly. They're either faking it (if it's invisible) or a burden (if it's not). The whole point of a disease is to *get over it* and get back to normal. Normal meaning the rest of us can ignore it--regardless of whether it still affects you.
It also pushes forward a false narrative that the default body is a thin one. The only reason people are fat is that they have a disease. Disease must be cured. Disease must be caught early and treated aggressively in its early stages. Again, predictably, leading to recommending weight-loss drugs and surgery to fat kids before they have a chance to become fat adults suffering from chronic fat. Which, of course, isn't their *fault,* but they still need to fix it.
Even with the "no-fault" attitude, society still views fat people as disgusting, lazy, sloppy, and stupid. Only the explanation has changed. Not the way fat people are treated. Because we have these wonderful drugs and surgeries now so only the bad fatties are left.
Given what we know about epigenetics, I have to wonder how much of the increase in average body size is due to three generations or so of people weight-cycling for most of their lives. In addition to social stressors, better nutrition (compared to the early 1900s when the tables were made), and the changing definition of who counts as too fat.
People aren't made in factories (...yet). There is no default body. The sooner we acknowledge this truth, the better off we'll be, individually and as a society.