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.