The Problem With Weight Stigma Research

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I spend a massive amount of time digging into weight stigma research and much of it is incredibly frustrating because of how often research around weight stigma still takes (and supports) views that are, in and of themselves, rooted in weight stigma.

The overarching problem is that much of this research is still predicated on the idea that fatness* is bad and should be eradicated. (I don’t think it’s a coincidence that much of this research is funded and/or conducted by people with a profit interest in selling weight loss, and that people who are working from a weight-neutral perspective can have a much more difficult time getting prestige and funding.) Commonly these studies use stigmatizing terms (like ob*se*, overw*ight, and associated person-first language) or describe fat people’s bodies using terms like “excess weight,” and describe fat people simply existing in the world as an “epidemic.”

One way weight stigma shows up in weight stigma research is the idea that weight stigma is bad because it may cause weight gain or make people less likely to participate in and “comply with” weight loss interventions which, again, bases so-called “anti-stigma” work firmly in anti-fatness.

Another is the suggestion that weight loss is a weight stigma intervention. Each fat person is of course allowed to make personal decisions about how they will deal with weight stigma. That said, it’s important to be clear that, regardless of what one believes about fat and health, suggesting that the solution to oppression is for oppressed people to change themselves to suit their oppressors is absolutely wrong. And while no two oppressions are completely comparable, as someone who is both fat and queer I definitely see the parallels between the message I get as a fat person that losing weight would solve weight stigma, and the messages I have received as a queer person that the best way to deal with homophobia is to become straight.

The message becomes “we don’t want to stigmatize fat people, but we do think they should be eradicated from the Earth and future fat people should be prevented from ever existing.” (Often with the fact that the organization generating the research is profiting from these anti-fat views left unspoken.) You cannot promote the idea that it would be better if current fat people were eliminated and future fat people were prevented from existing and also end weight stigma, these are mutually exclusive goals even though the weight loss industry has been working overtime to convince us otherwise.

For me one of the most frustrating examples of weight stigma in research is the ignoring/erasure of the experience of those at the highest weights. While weight stigma can harm people of all sizes, as people’s weights become higher, their experience of bias and structural stigma (including lack of accommodation) increase. (Again, this also becomes more pronounced for those with multiple marginalized identities.)

Within fat activism communities, the varying sizes are often defined as small fat, mid fat, large fat, super fat and infinifat. (There is an in-depth article about this here.) Within the medical community, categories are overw*ight, Class 1, Class 2, and Class 3 ob*sity. From a scientific/medical perspective this is questionable.  

For example, per the NIH calculator, at 5 foot 3 inches tall, I would be
“Overw*ight” from 140.5-169lbs (Range: 28.5lbs)
“Class 1” from 169.5 to 197lbs (Range: 27.5lbs)
“Class 2” From 197.5-225.5lbs (Range: 28lbs)
“Class 3” Anything over 226lbs (Range: Infinite)

Dividing people into classifications based on Body Mass index (a dubious concept in and of itself) and then just lumping everyone BMI of 40 or more in the same category does not have the ring of sound science, whether the research is about a pharmaceutical intervention, an anesthesia technique, or the experience of weight stigma.

Erasing the experiences of those at the highest weights in weight stigma research can be done implicitly by simply making a single category out of all higher-weight people and not making any distinction between the experiences of, for example, someone who weighs 180 pounds vs someone who weighs 580 pounds. In other research it is done explicitly when, for example, only “class 1” people are included, or when “class 2” and “class 3” people are compressed into a single category further diluting the experiences of those at the highest weights.

By not specifically capturing the experiences of the highest weight people, the research also erases experiences of those for whom treatment risk is predicated on weight, or treatment itself is denied. For example, a commonly referenced paper about utilizing dangerous weight loss surgeries as a “treatment” for Type 2 Diabetes suggests that the surgery be “considered” for those who are “class 1” who have “inadequate” glycemic control, but suggests that the surgery be “recommended” for anyone who is “class 3” regardless of glycemic control. People of lower weights are often shocked to find out how aggressively these surgeries are pushed on those of the highest weights and/or how much of their healthcare is held hostage for a weight loss ransom. And erasing the experience of weight stigma among the highest-weight people means also erasing the very real harm that stigma does. Harm that is often blamed on their bodies.

I have long wanted more weight stigma research that focuses on the experience of those who are at the highest weights and that is rooted in weight inclusion. Soooooo… I’m super excited to say that Dr. Lesleigh Owen and I have received IRB approval for a new study “Healthcare Experiences of Weight Stigma and Iatrogenic Harm in the Highest Weight Patients: A Qualitative Study.” We’re researching and writing a paper that centers the voices and experiences of the highest-weight people as they navigate healthcare settings to examine not just the stigma they experience, but also the the harm it inflicts. We will be interviewing superfat/infinifat/higher/highest weight people who have had negative healthcare experiences as a result of weight stigma. There is more information here  for those who might want to be interviewed (on zoom, email, DM, or phone).  

Overall, whenever we are reading and discussing weight stigma research we always have to ask ourselves: Is this research rooted in weight-inclusion or weight stigma, and who is being captured and who is being left out? It’s important to talk about what exists in the weight stigma research, it’s also important to talk about (and solve!) what isn’t there, including and especially for those with multiple marginalized identities.

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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.