Our national "obesity epidemic" is spawning disease, shortening life spans and bankrupting our health care system. Or is it? Could our negative attitudes about fatness -- a disease that people bring upon themselves through sloth and gluttony -- be more hazardous to our mental and physical well being than excess weight?
This viewpoint is getting more attention since Jennifer Livingston, a television news anchor in Wisconsin, responded on the air to a hateful letter from a viewer who criticized her obesity and challenged her position as a role model for young people in the community. The writer called obesity a "choice" and a "dangerous habit."
The viewers' comments were unremarkable. In analyses of hundreds of news media reports, I found that the main way fatness is discussed is as a disease that people bring upon themselves through bad food and exercise choices. Indeed, much hurtful talk goes unchallenged on the grounds that it is a discussion about health practices and economic responsibility.
Of course there are some health risks associated with higher body mass. The strongest association is between higher body mass and Type II diabetes. However, even in this case, it is unclear whether obesity causes Type II diabetes, whether Type II diabetes cause obesity, or whether both are caused by a third factor (e.g., poor nutrition, stress, or genetic factors). Moreover, sometimes obesity is associated with a lower rate of disease, as in the case of breast cancer among postmenopausal women (1). There are also health risks associated with "normal weight," that are rarely discussed. For instance, people who are in the "normal weight" range are more likely than those who are overweight or obese to die of respiratory disease(2).
In her public response to the letter, Livingston encouraged children not to let their self worth be defined by bullies and urged parents to teach their children to be kind, not critical. However, weight-based bullying often extends into adulthood, and many of those perpetuating it occupy more powerful social positions than the popular table in the middle school cafeteria.
Adult women are routinely insulted in public simply because they are heavy. In my research, women described having food thrown at them and being scolded for eating -- or eating certain foods -- in public. Complete strangers feel entitled to comment on what heavier women put in their shopping carts. Some young men sexually prey on heavy women and then humiliate them during or after the sex act, in a practice known as hogging. This kind of behavior takes a devastating toll on mental health. When women avoid exercising in public or socializing out of fear of public ridicule, it harms their physical health as well.
For many women, the place where they feel their dignity most crushed is in the doctor's office. In fact, scores of studies show that "obese" women are less likely to get Pap smears and other medical screens because they experience the doctor's office to be a hostile environment(3). And they are not delusional. Study after study shows that medical professionals -- in the United States and abroad -- believe that their heavier patients are weak-willed and non-compliant(4). Other women and men are denied health care coverage because they are "morbidly obese." When lack of screening contributes to higher rates of cervical cancer among "obese" women, we can say that our attitudes about fatness are literally making us sick.
Public health campaigns may be worsening these problems. Just this month, L.A. County launched a new obesity awareness campaign titled "Choose Less, Weigh Less." News reports on the initiative included photos of headless torsos with overflowing guts. The efficacy of such programs remains unproven. However, there is growing evidence -- including from experiments I have conducted with psychologist David Frederick and UCLA sociology graduate student Kjerstin Gruys -- that such messages worsen weight-based stigma(5). In our experiments, people who read news reports that discuss obesity as a public health crisis were more likely to agree with negative stereotypes of fat people as unlikeable, untrustworthy and less intelligent than thinner people, compared to people not having read such articles.
The Patient Protection and Affordable Care Act -- signed into law by President Obama in March 2010 and to take effect in several years tocome -- will help overcome barriers to health care access by prohibiting insurers from charging higher rates for people based on pre-existing medical conditions. (Mitt Romney promises to dismantle this law, including this provision, if elected.)
But access to health care is not enough. We also need to address weight-based stigma and bullying. At a minimum, this means ceasing to reproduce and legitimate negative stereotypes via public health messages about fatness as inherently pathological and the product of sloth and gluttony. Ideally, we would design policies to combat weight-based stigma in society at large and within the medical professions specifically.
Abigail Saguy is Associate Professor and Vice Chair of Sociology and Associate Professor of Gender Studies at UCLA. She is the author of "What's Wrong with Fat?" (2013, Oxford University Press).
(3) Geraldine M. Budd et al., "Health care professionals' attitudes about obesity: An integrative review," Applied Nursing Research 24(2011).
Christina C. Wee et al., "Screening for cervical and breast cancer: Is obesity an unrecognized barrier to preventive care?," Annals of Internal Medicine 132, no. 9 (2000).
N. K. Amy et al., "Barriers to routine gynecological cancer screening for White and African-American obese women," International Journal of Obesity 30(2006).
Jeanne M. Ferrante et al., "Colorectal cancer screening among obese versus non-obese patients in primary care practices," Cancer Detection and Prevention Journal 30, no. 5 (2006).
(4) Jane Ogden et al., "General practitioners' and patients' models of obesity: whose problem is it?," Patient Education and Counseling 44, no. 3 (2001).
E. L. Harvey and A. J. Hill, "Health professionals' views of overweight people and smokers," International Journal of Obesity 25(2001).
Aurélie Bocquier et al., "Overweight and obesity: Knowledge, attitudes, and practices of general practitioners in France," Obesity Research 13(2005).
David A. Frederick, Abigail C. Saguy and Kjerstin Gruys. 2011. "Does this article make me look fat? How anti-fat attitudes are shaped by exposure to specific newsrepresentations of fat bodies." Presented at the Annual Meetings of the American Sociological Association, August 17, Las Vegas, NV.
Chris S. Crandall, "Prejudice against fat people: Ideology and self-interest," Journal of Personality and Social Psychology 66(1994).
Christian Crandall and Rebecca Martinez, "Culture, Ideology, and Antifat Attitudes," Personality and Social Psychology Bulletin 22(1996);
Chris S. Crandall and Amy Eshleman, "A justification-suppression model of the expression and experience of predudice," Psychological Bulletin 129, no. 3 (2003).
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