How should we talk about weight?

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Journalist Lindy West on her wedding day. Image from: https://www.theguardian.com/lifeandstyle/2015/jul/21/my-wedding-perfect-fat-woman#img-2

 

In a lot of ways, I’m reluctant to publish this blog post. It’s not a topic I’m an expert on, and academics are generally cautious about writing on something they haven’t researched, due to the fear of being shredded by someone with a PhD and 20 years’ experience in the field.

I’m also worried about making things worse, about saying the wrong thing and invoking the collective ire of the Internet #trolls.  This is also the kind of topic where it’s difficult not to take sides or to admit that you don’t have all the answers, because it’s so polarizing. But I’ve got a question I want to get it off my chest. How do we – as public health advocates, as a community, and as individuals – talk about weight?

This question has been bugging me for a while, but especially since I wrote an opinion piece (with Alexandra Jones) in the Medical Journal of Australia talking about the need for better nutrition policy in Australia. One of the readers of my article cautioned me about the need not to conflate nutrition and weight: people can be “overweight,” but eat well, feel good and live healthy lives.

Her comments immediately reminded me of a podcast that I’d listened to recently on This American Life, which discussed how people are starting to think differently and talk differently about body weight. Among the stories was one from Lindy West, a US journalist, feminist and fat acceptance activist on how she confronted her boss about his some of his reporting on the “obesity epidemic.” Other stories in the podcast described saddening and horrifying accounts of the discrimination, stigma, and sub-par medical care that people experience because of the way society perceives and treats people who fall outside what is considered a desirable weight range.

The reporting that Lindy West was concerned with seemed laced with personal prejudice. Yet it’s not uncommon for stigma to be considered as a tool to convince people to lose weight. The UK’s former public health minister once said that doctors should tell their patients that they are “fat” rather than “obese” to better motivate them to lose weight and to take “personal responsibility” for their lifestyles.

Stigmatizing language (and behavior) is never acceptable. A growing body of research shows that stigma tends to demotivate people to lose weight or change their eating habits. Stigma is also linked to negative health outcomes, including poor mental health and low self-esteem.

Even if it did result in public health gains, stigma can’t be justified given the negative impact it has on individuals’ health, wellbeing and self-perception.

However, the problem goes beyond stigmatizing, discriminatory, and shaming language. As Lindy West explains, it’s also about being constantly bombarded by apparently scientific or “objective” messages that obesity is a “crisis,” that having a high BMI is undesirable and unhealthy, and that people who are “fat” are a drain on the healthcare system. Many people will understand the pressure to achieve a “desirable” weight, and what it does to self-esteem, and the fat acceptance movement is, in part, a push back against this kind of messaging.

So should we talk about weight at all? Could the public health message simply be “eat well and move often?” (And when I talk about moving I mean dancing, going for a walk with friends, or whatever else takes your fancy, not boot camps and chin-ups). A lot of my research targets the food industry and focuses on how food is made and sold. I want to improve the food system, not tell people to eat less chocolate.

From a public health advocates’ perspective, the problem is that a certain amount of excess body weight is a risk factor for chronic disease, as well as being associated with a range of health conditions. One of the main reasons why we focus on promoting and facilitating healthy eating is because weight gain has effects on people’s health.

Public health advocates know that body weight isn’t simply a question of people cramming Tim Tams into their faces while simultaneously watching Netflix and drinking two litres of soft drink (or “soda” for the Americans out there). It has a lot to do with genetic and physiological make-up, as well as whether we have the kinds of social, cultural, and economic environments that make good food easy to access and affordable, where healthy eating is valued, and is possible. Public health shouldn’t be about fat shaming, but even what seems like a relatively neutral message may have that effect. The concern for public health advocates, however, is that we will lose one of the main health messages behind our work if we take the word “weight” out of the picture.

Yes, we can think about using language more carefully when we convey information about weight and health, but is that enough? Would it be more helpful if we stopped talking about weight altogether, or – as Lindy West suggests – we stop seeing it as a problem? We should keep in mind here that most people on diets fail to lose weight and keep it off, that there are difficulties in defining what a healthy weight actually is (and what tools are useful in categorizing weight), and that there are socioeconomic and ethnic differences in population weight distribution. Most of the time, fat shaming will also mean shaming poorer people and people of color (with the shaming being done by middle-class, white people).

Also, evidence of a connection between weight and increased mortality and morbidity is not all one way. We are still untangling the complex connections between body weight and health (remember, correlation is not necessarily causation). Even within the public health community there are debates about whether body weight is the crisis that we make it out to be.

So what’s the answer here? To be honest, I don’t know. I hope we haven’t lost the opportunity to have a constructive conversation about how we talk about weight (or if we should talk about it at all).  I can’t pretend to be an expert on the topic, and while I’ve had issues related to eating and my weight, I’ve never experienced the type of discrimination that Lindy West and others describe. But listening to her, and hearing from other people with similar experiences, makes me think we could – and should – do better.

Thanks to Alex Bayley for the comments and resources she provided for this post. All the opinions expressed here are mine, as are any mistakes or misconceptions.

83 thoughts on “How should we talk about weight?

  1. Very nice discussion. I think that we can still discuss weight but I really think that there should be more correlation to body type and ethnicity. Unfortunately we tend to stigmatize anything that is outside of norm and even though size 14 and up (US female sizes) are rather common place at this point larger individuals are still looked upon as an anomaly even a taboo. I am fat and that word is really a taboo. Here in the United states and in my culture fat individuals are called thick and fluffy. No matter how you dress it we are outside of the perceived norm.I recently went to a doctor about my allergies. I was nervous and my blood pressure was high. I was worried about seeing this doctor for the first time and what he may say to me about my weight. He immediately prescribed me pills for high blood pressure and I almost died. I understand norms and being healthy. In the past I would just need to workout and I could maintain a weight that was acceptable for me but now that I am older the old methods are not working.

    I said all that to say I think that we should still have discussions about healthy living. I also think that it is a good idea about look at our food industries. Here in the United States portions are way off. Even salads tend to be huge and as old as I am I still have an irrational need to clean my plate.

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  2. I think weight should be viewed as only one aspect of how healthy you are. How active your lifestyle is can also play a role in how much you might weight. Eating healthy and exercising regularly to keep healthy would be much better of course rather than sitting at home. As muscle does weigh more than fats, many bodybuilders might cross the border of being overweight. It should only be a concern(your weight) if it starts to hinder your daily activities in which case you should see a doctor.

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  3. I think that your wight is a very sensitive topic, that some like to talk about and some sont. I personally don’t have a problem with ,my weight so I don’t mind talking about it ,but some people do, so I think we needto think about
    Them too and I think that we need to be sensitive about that

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  4. I have been small most of my life. I was a chubby kids but lost it all by middle school and maintained a very small physique. When I became pregnant almost two years ago, I held onto a lot and the weight just kept piling on. I am now a mother of a toddler and I am still overweight. I constantly am made to feel shamed about it. People always asking when am I going to lose the weight. Not accepting me as I am now and instead holding on to what I used to be. Once at a family event, I was handed the tiniest sliver of cake and told “that’s all you get”. Very humiliating. To be honest, I don’t even have an issue with food. If anything, I don’t eat enough. When I do, it is healthy, i rarely eat junk. It’s important to me for my children to have a healthy diet, therefore I do too. I admit I could be more active, but it’s hard to do things with a demanding toddler and when it’s time for me to have my own space, I just want to relax. Things people have said to me about my weight and how I used to be skinny, has really had a negative effect on me. I feel like I shouldn’t feel comfortable and accept my body. If I do, I’ll never change. So everyday when I see myself in the mirror, I feel guilt. I personally don’t like talking about weight…because I am not comfortable with it. I don’t think it’s a bad thing to talk about, so long as it is respectful and all parties are comfortable talking about it.
    To me, it’s not appropriate to be having a nice outing out with friends or family and enjoying my day and life and then in the middle of the fun (say, at a beach while i’m uncomfortable in my bathing suit for the sake of my child having fun – not me) someone wants to start talking about weight. Not into it.

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  5. It’s always interesting to see the sensitive nature surrounding issues of weight. I think it should be boiled down to a simple statement “Are you healthy?” I know large guys and girls that at first glance one would probably say “Your fat, lose weight.” However, a medical check up would say “You’re perfectly healthy, keep doing what your doing.” That’s all that matters. Screw aesthetics. As long as your healthy its all that matters. People aren’t robots, we aren’t mass produced in a factory, we are unique pieces of art, walking sculptures. Some big, some small, as long as you’re healthy, should it really matter if your aesthetically pleasing to the general population? Someone, somewhere is gonna think your sexy. Just be healthy, the rest will fall into place.

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  6. Wonderful post! This is something I have struggled with for a while. Doing outreach can be difficult when we know that body image can affect mental health, but also knowing the risk of many devastating chronic diseases increases with the additional pounds or the particular place the fat is stored. I think we want to focus on the positives- you should love your body because you can walk and talk and see the world- but at the same time consider other risk factors for debilitating diseases. The individual needs to consider more than just weight when considering risk for disease.
    The discrimination against those who are morbidly obese is pretty awful. Daily conversations can have unintentionally ill-willed statements, such as “I love fried chicken so much I am secretly a fat girl.” The stigma against obese people would easily lead to poor mental health.

    In my opinion, if we can decrease the shame associated with “overweight” and “obese”, we can do a better job preventing disease by promoting a healthier life and a healthier mind.

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  7. Hi i am overweight but pretty healthy and loosing some wight .I think people see overweight people are fat pigs and they watch how much you eat. You get stared and spoken of. I turn it back onto people and tell them would you like to take a picture? make me famous? Are you staring at me? i’m no one famous but thank you so much for staring? It embarrasses them and i tell them “oh yes i know i’m fat ……. but thank you for looking anyways” and i smile and people don’t know what to do with that. They expect a fight which i’m glad to discuss. .i think people see overweight and automatically assume you eat too much or your lazy and it never occurs to them u can have an illness ,menopause etc. Stop judging and get to know us were human too.I work 12 hrs a day as a nanny with young kids and i am on the go all day long . Also look at the food industry all thos “diet” things make you fatter so you can keep buying….think about it. I eat healthy and yes i do have an ice cream once in a while . I am entitled to have some . Be kind to everyone and love one another. A person should be judge by their actions not their body.

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  8. Quite an enlightening context.It is true that there are many people out there who think about overweight people as fat pigs and what not as ladybellac17 said above thats what fasion magasines featuring young handsome men and beautiful women has done to us😄.It makes people think that ,that is how a man/woman is supposed to like like . Which is obviously utter bs.They don’t realise how much they hurt a person for being what they are and not striving to obtain a zero figure .I have many friens who are quite “healthy” but that has never gotten between our relation as friends.We do some healthy teasing once in a while just for giggles but have never even considered them as Fat or unhealthy or not appealing and what not .

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  9. Great read! I work in the retail industry and it’s very tricky to talk about. We are only allowed to say things a certain way and ask certain questions to be sensitive to every person that walks in our doors. I’ve had women of every size complain about what size they are when I’m trying to help them pick out outfits. The best part though, is when I have women tell me how grateful they are that we have their size and that our clothing in their sizes are actually beautiful. Everyone should feel beautiful so I always appreciate when someone feels better walking out our store than they did when they walked in!

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  10. This was my favorite, well-said article on viewing weight, because it speaks on all sides of the situation, and you wrote every word all victims of fat-shaming are thinking. Yet, again the stigma is very strong. I hope that I can witness it go away in my time.

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  11. This is precisely the reason I’ve started talking about my own weight myself…so that those around me won’t be so afraid to bring it up like it is some giant bombshell. Visit my blog for my journey.

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  12. I think the politically correct language you seem to be seeking won’t change the stigma or the sensitivity of others. I mean it won’t go very deep. The rise in obesity due to the processed food industry and added sugar in everything isn’t going away. Smaller packaging and labels is just a new marketing wrapper. People don’t want the easy access foods to go away. A wider acceptance of obesity as the new normal, is happening because 75% of americans are now considered obese. We tend to look like the people around us and eat like them. (This isn’t body shape due to ethnicity I’m talking about which isn’t “fat”…when a woman has hips etc.) this 75% is about lack of exercise and poor nutrition… which can only be addressed by getting rid of the “food deserts” and making access to real food and teaching about whole foods. Marketing campaigns are not concerned with that though because they don’t make enough money that way. There is shelf life to consider and transportation costs and it takes room to garden… as well as Marketing campaigns are capitalizing on the “all sizes are beautiful” to sell beauty products that mostly objectify the women. The make up, the underwear commercials… and everything to be sexy not healthy still preys on self esteem. The last cover of Sports Illustrated with a (“don’t say” plus size anymore) model is one example of how women are undermining themselves… She was gorgeous… but we are all looking at her to see “how” fat or how she carries it or how we champion her in a string bikini or talk sensitively about her while she is an object. The clothing designers mostly want models to look like hangers in order to show off their designs… and I think that will not really go away, either. There will be room made for marketing to the “commoners” to make them feel included and to keep buying… but people are prejudiced. People want to be thin. They don’t even care if they are fit.
    Anyhow, I was born skinny, and was “lucky” to stay skinny naturally, but skinny women get objectified and picked on too… and so it’s just a different end of the spectrum, not a “better” source of self esteem.
    I recommend walking for health to everyone It’s good. Thanks for allowing my comment.

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  13. I would agree wth the statement your posed concerning people associating weight gain with cramming food down their throats while watching television. Many believe this to be the case. I am constantly hitting the gym most weeks 6 times a week and I still am having a hard time losing weight. I workout hard and eat low-calorie foods. Genetics has a lot to play in this. I honestly believe due to my working out I am generally more healthy than many other people. I do not take medicine. I do not get sick except rarely. Weight loss is difficult, but being big is more difficult. When I first started exercising by walking in my town I had a full can of soda chucked at my head while they drove down the street and yelled fat a** get back inside. I am very familiar with these things, but it is ignorance rather than intelligence. While I work toward losing more weight I have learned to be happy with myself in whatever state I am in.

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  14. We should talk about weight. We need to in effort to consider the balances of weight and health. I think weight should be discussed from a medical perspective. And we should not spend our time discussing the images that we are taught as beauty. This is not ideal. Weight should be discussed but obesity should be addressed as much as anorexia.

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  15. We definitely should discuss weight. However, I think height, and cultural mores are left out too often, when weight and health are discussed. I feel like the media and Pop culturre are blurring the lines between health and weight.

    Then theres the class and racial distinctions that you made. Poorer areas of the country have worse food, and those areas tend to be overweight. Those areas tend to have more minorities, and some minority cultures value heftier people. Whereas the areas with more fit people tend to be richer, and be predominately white or asian. Those cultures tend to value thinner people. Great article.

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