NYT Ethicist’s Weight Stigma Problem

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Wow, did a lot of you write to me about this one. Someone wrote in to the New York Times column “The Ethicist” to ask if they should “intervene” because their friend, who specifically asked them not to talk to her about her weight, is fat and, in their perception, has health issues (which of course the letter writer blamed on her weight.)

So obviously the answer was “you should stop monitoring your friend’s body size and thinking and writing about her in shame-drenched ways, respect her wishes, and work on your own weight stigma.” Right?

Wrong.

What followed was a master class in what happens when someone using a title of authority (like “ethicist”) is coming from a place of unexamined weight stigma. I’m sure that “The Ethicist” didn’t intend to do harm, and likely does excellent work in other areas, but he is in a position of incredible influence and my concern for those who may be harmed by this has to come first.

I know that I often give content warnings for pieces like this, but I want to be extra clear on the content warning here. For reference, I’ve been writing about weight stigma for over a decade and have developed a robust toolbox of coping and self-care skills and support to deal with what it takes to dig into situations that are personally dehumanizing and break them down, and this article was still difficult for me to read and write about. The letter (which I’m not reprinting) is awful and the answer (at least for me) was worse in many ways, since it gives weight stigma power and a platform.

The text from the column itself is indented throughout so you can skip that and miss the worst of it, but it can all be very disturbing so please take care of yourself and feel free to skip this one.

The headline was:

My Friend Has Become Ob*se*. Should I Intervene?

The magazine’s Ethicist columnist on respecting a loved one’s boundaries when concerned about their health.

I’m not reprinting the letter. The language is steeped in weight stigma and paternalism and the word choices around her weight and health seems to me to be purposefully inflammatory and hyperbolic. The person who wrote the letter is guessing about their “friend’s” weight and blaming it for any health issues she may have (it’s impossible to say if the health issues listed are accurate, exaggerated, or simply in the letter writer’s head.) It’s also entirely possible that any weight gain and any other health issues this woman may be experiencing are caused by another factor that the “friend” writing the letter is not aware of.  Apparently, in addition to monitoring and judging her size, this letter writer has also been monitoring and judging her food intake and relationship with food as well, and thinks it is their business how she talks to her family and her doctor.

The letter says “I have thought about approaching her children about this. But if that doesn’t work, and the children tell my friend I tried to intervene, I am sure that would be the end of our friendship. She has told me, “Don’t talk to me about this.”

At this point I want to say that I think it’s possible and even likely that the original letter was written by an internet troll. The language used is very consistent with what you see in troll forums and troll attacks on fat people online and if this is the case, The Ethicist fell headlong into this trap and if not, it’s still a horrific letter.

Let’s break down the The Ethicist’s answer:

Your description suggests that your friend has Class III ob*sity* (“morbid ob*sity” is no longer the clinical term), a chronic, complex condition that is impairing her ability to carry out certain ordinary functions of daily life, and putting her at serious risk of debilitating disease and premature death. Of course you’re concerned; any friend would be.

Whoa - why is The Ethicist starting out by pseudo diagnosing someone who is not involved in the conversation, rather than being deeply concerned that the person writing to them has ignored the clear boundary created by their “friend” and instead publicly derided this person’s size, food choices, and how they choose to communicate with their family and their doctor and wants to know if they should enlist family members in this effort. Also, The Ethicist’s arm-chair “diagnosis” is based on the letter writer saying that their friend “must be [x] pounds plus overweight.” A trained medical doctor shouldn’t attempt to make a “diagnosis” based on that, let alone someone whose training is as a philosopher. (And note that “ob*sity” is a term that was made up to pathologize bodies based on shared size, with “classes” of “ob*sity” being even less credible if that’s possible.) The Ethicist also failed to mention that the same health issues that are correlated with being higher-weight are also correlated to weight cycling and weight stigma, which is what is on display here. Further, the language The Ethicist used is straight out of weight loss industry jargon, so I’m wondering if they got their information from an astroturf organization or diet industry propaganda.

But you’re not telling her anything she doesn’t know. The cost of the promising new weight-loss drugs is perhaps something of a red herring on her part. Insurers, public and private, will generally cover medically necessary bariatric surgery, which is substantially more effective than the drugs are. (With surgery comes a risk of major complications, but the perils of living with Class III ob*sity are greater.) There are forms of therapy that address eating disorders, including binge eating, associated with severe ob*sity. In any event, a competent primary-care provider will already have informed her of her medical options.

The correct answer is “You’re not telling her anything she doesn’t know, and she has asked you not to talk to her about it, so we’re done here.” The correct answer is not to suggest that someone who, again, has not asked to be diagnosed or discussed in this way, is being dishonest about their financial situation. Even worse, recommending a dangerous surgery and claiming that the “perils” of existing while fat are greater than those of mutilating a healthy digestive system to create a permanent disease state is absolutely not based in evidence and is massively out of scope for an ethicist whose training is as a philosopher. The idea that if you can’t afford (or don’t want) dangerous diet drugs then you should instead have part of your digestive system amputated because insurance will foot the bill for that is ethically questionable at best. Finally, The Ethicist’s categorization of eating disorders being associated with “severe ob*sity” is pretty questionable (since people of all sizes get all eating disorders) and the least he could have done is said “if she is dealing with an eating disorder…” Again, none of this is within the area of expertise of philosophy and all that was really needed here was the first and final sentence, if anything.

As for the risk of approaching her children? If you think they have a good chance of succeeding where you have failed, that’s a risk that a friend should take. Yet they can surely see that she is suffering because of her ob*sity, so a safe assumption is that they have already tried to get her to seek medical help — and that she’s told them what she’s told you.

The woman being discussed here (again, without her consent) is not a project for others to succeed or fail at. Being fat does not mean that she loses her agency or her humanity or that her life and choices become subject to the rule of others or that her boundaries should be violated. Here we see how the ultimate end of weight stigma is dehumanization. Also, do we really think, ethically, that a friend, when told “don’t talk to me about this” should hear “go behind my back and talk to my children.” I do not believe that The Ethicist’s advice here is morally justifiable in any way.

Unlike her primary-care provider, you have no special knowledge of complex conditions. (One such complexity: the vicious cycle that can arise between depression and ob*sity.) You may not be the right person to make a difference here. She has explicitly asked you not to raise the issue with her. As someone who cares about her, you obviously have reason to want her to get healthier. But you can’t insist on it.

While The Ethicist also has no special knowledge about this either (though that certainly hasn’t stopped him so far) note that he is still coming from the position that this woman  is a problem to be solved, making assumptions about her weight and health and life based on a letter written by someone else. Note that he mentions the idea of a supposed “vicious cycle” (not a medical term, and offered without evidence) between depression and existing while fat, without mentioning the correlation between depression and weight stigma, which he is actively perpetuating through the pathologization and subsequent dehumanization of fatness.

If the time comes when she cracks the door open to a conversation about her health, there’s plenty of good advice out there (including from the federal site Health.gov) about how to get into it.

If you have to go to a website to get health advice for someone, then you have no business giving them health advice, especially in this situation, you also lack the expertise to understand the ways that weight stigma might be impacting that advice or how it might apply to your friend. Also, since she has been clear that she has no interest in hearing from you on this, instead of pouncing on whatever the writer perceives to be a “cracked door” perhaps wait for a full-blown invitation.

 — keeping your focus on her well-being, not her eating habits; avoiding fault finding, judgment and shame; talking with her, not at her.

Nope. If you are giving someone (especially unsolicited )health advice, then you are already engaged in fault finding, judgment (and likely shame.) You have made the determination that they aren’t making the “right” choices/taking the “right” actions for their health, that you know better than this person how they should conduct their life, and that you should impart your “better” ideas upon them.

I’m glad you’ve made it clear that you’re concerned about her welfare and want to be helpful however you can. I wish she’d listen to you.

Note that despite a letter dripping in weight stigma, The Ethicist has cast the letter writer as the hero in this story, fully accepted their (dubious) premise, taken everything they said as the truth without any sense of perspective of how this person’s bias might have impacted their letter and then The Ethicist even puts himself and the letter writer on the same side against the subject of the letter for her unwillingness to subject herself to this person’s weight stigma or comply with what they think is best for her.

As long as we’re making guesses, it sounds to me like this person likely berated and badgered someone who has asked them to stop, and instead of telling this person that they need to stop monitoring their “friend’s” body, health, and conversations with family and doctor and respect their boundaries, The Ethicist laments that the subject of the letter won’t submit to her “friend’s” diatribes which, if they are remotely like the letter, would border on abusive.

But as her friend, you also have to listen to her — and take notice of the boundaries she has set.

This is the last line of “The Ethicist’s” column it should have been the entire column, with a few revisions “Whether or not you are her friend, you should listen to her and respect her boundaries.”

If you are thinking about talking to a loved one (or, hey, a total stranger) about their weight and/or health, I have a handy guide here.

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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’s Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.