Ways We Might Be Unintentionally Participating In Weight Stigma and Diet Culture
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Living in a society with so much weight stigma means that, whether we are fat ourselves or someone who is thin and wants to work in solidarity to eradicate weight stigma, it’s an ongoing process. This can be particularly true for those who work in healthcare since the system itself is so steeped in weight stigma, but it can happen to anyone and everyone.
We have to keep fighting back against the negative messages that we receive, and we have to dig deep to find the things that we've been sold by diet culture and weight stigma that we are still hanging on to, and then we have to work to let them go. Here are some examples of ways that we can perpetuate diet culture and/or weight stigma, often without even realizing it.
Complimenting Weight Loss
If we compliment people on their weight loss we do a couple of things to support diet culture and weight stigma.
We confirm the mistaken and harmful belief that a thin(ner) body is better than a fat(ter)
We set up someone for a bigger fall. When (as almost everyone does) they gain their weight back, not only will they feel that they failed at weight loss (even though the truth is that the weight loss failed them,) but they'll have the memory of all the people (including you) who told them that they looked/were better thinner.
It can be difficult when someone who is still fully entrenched in diet culture is looking at us expectantly for our congratulations. There are weight-neutral ways to respond to weight loss, I blogged about some options here.
For healthcare practitioners specifically, I recommend reminding patients that, through no fault of their own, most people who lose weight will regain it, and that you’ll continue to focus on their health goals rather than focusing on their size.
Supporting Inequality
We can become conditioned to the idea that fat people shouldn't expect the same things/experiences/treatment that thin people get, but that doesn’t make it right.
This happens in healthcare discussions in ways that harm fat patients. One example would be someone saying “If you don’t fit in the MRI, then I recommend you lose some weight and we’ll schedule you for a scan then.” Even if significant long-term weight loss was possible for most people (and it’s not) delaying healthcare for weight loss causes harm. Beyond which, people shouldn’t have to change themselves for healthcare tools. Healthcare tools should be created to accommodate people of all sizes.
This type of argument is particularly troubling when it comes from someone who is fat themselves and believes that they, and other fat people, don’t deserve access to healthcare (or the world in general.) Internalized fatphobia is real and it can cause us to participate in our own oppression, as well as oppressing others. Fat people should have the right to decline equal access in healthcare for themselves, but not the right to suggest that other fat people shouldn’t be accommodated.
This Size But No Bigger
This can happen with individuals when we feel like we should be accommodated and treated well, but still hold onto stereotypes and bigotry about those bigger than us. Often this becomes sheer hypocrisy - like if we believe that we should have access to, say, a chair in the waiting room, or table in the operating room that accommodates us, but we don't think it's "reasonable" for someone however-many-pounds heavier than us to have access to the same thing. In truth if we’re not advocating for the fattest and most marginalized bodies, then we have some personal work to do.
In healthcare, this can look like a practitioner who is willing to practice weight-neutral health for patients up to a certain size, but after that they feel that intentional weight loss interventions (including and especially dangerous drugs and surgeries) become appropriate. The dangerous and harmful underlying belief here is that people’s lives and quality of life are less valuable and more risk-able at larger sizes.
Blaming Fat Bodies
This takes a couple of forms.
The first form is assuming fat bodies are to blame for any health issues, even though thin people get the same issues. I wrote about this in-depth here.
It can also look like blaming fat bodies for their lack of accommodation (in a simple example “you’re too big for this blood pressure cuff,” rather than “I’m sorry, we don’t have the correct blood pressure cuff to accommodate you.” The language you choose when you discuss accommodation failures with patients matters. Here are some options you can use if you can’t accommodate the patient/client in front of you.
Hanging Onto Healthism/Ableism
Even as we leave our own fatphobia behind, we can still hold onto healthism. This can sound like "It's ok to be fat as long as [you meet some definition for healthy or abled]” or it can sound like "I'm fat but not [unhealthily/disabled] fat." Anytime we suggest that health or physical ability is an obligation, barometer of worthiness, or a requirement to receive equal treatment or to be allowed to exist without shame/stigma/bullying/oppression, we are making a mistake and doing harm.
We live in a society that is full of weight-based inequality and oppression, built on a scaffolding of weight stigma which is rooted in racism and anti-Blackness* (and intersects with other oppressions including healthism, ableism, homophobia, transphobia and more). Reflecting on this may lead us to the conclusion that we have participated in that oppression and harmed people with our actions. We will likely feel some guilt and shame about that, which is reasonable since we harmed people, but the idea here isn't to become stuck in guilt, it's to recognize the issues so that we can fix them, stop doing harm moving forward, and atone, when possible and appropriate, for the harm we’ve already caused.
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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.