Why our fat-hatred is making us sick.
Susie sits in my office with glassy eyes stretched open wide as she looks up towards the ceiling, trying to call back the tears that have already started rolling down her face. Her mascara gathers in thick wet clumps on her lashes before leaving delicate black trails down her ruddy cheeks. She grabs a tissue and dabs at her eyes, as if the tissue would somehow soak up her pain. Her voice quivered as she recounted her experience yesterday at the doctor’s office when, sitting in a flimsy gown exposed on the hard examining table, her doctor scolded her saying she needed to lose weight. “He didn’t ask me anything about my life, he didn’t care what I eat or that I’m training for a 10k race. He just saw my disgusting body. I feel so bad, I wish that I could lose weight but I’ve tried everything and I just can’t do it. I don’t know what is wrong with me.”
Alexis Conason Psy.D. is a clinical psychologist in practice in New York City and a researcher at the New York Obesity Nutrition Research Center at St. Luke's-Roosevelt Hospital. She specializes in the treatment of overeating, body image, and psychological issues related to bariatric surgery. Her most recent research examines substance use in bariatric surgery patients.
Editor: Nadeem Noor
Susie’s experience is not unique. In fact, it is a story that I’ve heard countless times from patients who meet BMI criteria for “obesity.” We blame fat people for our broken healthsystem and see them as blight on our country. Medical professionals tell us that obesity causes practically every imaginable medical condition, from cancer to erectile dysfunction. It is not uncommon for a patient to visit the doctor complaining of an ear infection and be prescribed weight loss. Anti-obesity campaigns on television try to shame fat people into thinness. Trust me: if shame led to weight loss, we would be a country with an epidemic of emaciation.
What all of this fat-hatred has led to is pervasive weight stigma for people at higher weights. And new research suggests that it is this stigma—more so than being “obese” on its own—that is really making us sick.
A study by Pearl et al (2017) published in Obesity examined the role of internalized weight stigma (the phenomenon in which fat people take all of the awful things that society attributes to them—lazy, ugly, worthless, unmotivated, etc–and actually start to believe these things about themselves) in the relationship between BMI and metabolic syndrome. Metabolic syndrome is a cluster of risk factors for cardiometabolic disease and Type 2 diabetes that is commonly associated with obesity. They found that, after controlling for the effect of BMI and other psychosocial and demographic variables, participants who scored high on a measure of weight bias internalization had 3 times greater odds of meeting criteria for metabolic syndrome and 6 times greater odds of having high triglycerides and/or taking medication for dyslipidemia than participants who had low weight bias internalization. One explanation for these findings may be the role of chronic stress, a natural outcome of weight bias internalization which leads to oxidative stress and cortisol secretion, both implicated in metabolic syndrome.
These findings should also be viewed in tandem with the growing body of research revealing the dangerous consequences of weight stigma. Past studies have concluded that weight stigma is associated with an increased risk for depression, anxiety, body dissatisfaction, low self-esteem, and medical consequences including increased risk of death. Yet, very few of the articles touting the dangers of obesity account for weight stigma. In fact, most research studies concluding that obesity is associated with the familiar endless list of medical problems don’t even account for lifestyle factors such as physical fitness and nutrition. When studies do account for these factors, the relationship between weight and health often disappears.
When patients like Susie go to the doctor, their physicians are often singularly focused on the numbers on the scale. They encourage people to lose weight by any means possible—even when those weight loss tactics compromise their health. It is not uncommon for patients struggling with anorexia to have their weight loss cheered on by physicians when they are at higher weights. Weight-stigma has infiltrated our medical system; the people who are supposed to be our healers are actually making us sicker. This is the broken healthcare system—it is not the fat people who are a burden on the system, but rather the system that teaches doctors to shame them.