Everybody hates us, and why that’s a good thing
I have just spent a thoroughly depressing few days reading through a spate of new studies on anti-fat stigma in healthcare, education, sports, employment, and the law. Anti-fat stigma is so widespread that you’d be hard-pushed to find anybody who actually likes us. Trigger warning: I’m now going to talk about this!!!
None of this is news; researchers have been collecting data for decades on the extent of anti-fat bias, but the papers seem to be coming thick and fast these days. A handful of recent examples for you from the healthcare arena:
- In an online study of over 2,000 doctors, high rates of anti-fat bias were found across the weight range, even in fat MDs. This included tests that were supposed to assess unconscious bias, as well as the ones where they were asked outright what they thought of fat people. On a scale of 1 (I strongly prefer thin people to fat people) to 7 (I strongly prefer fat people to thin people), the average was 1.36. Nice.
- A US study of physicians’ assistants (PAs) sent out 1,000 questionnaires to PAs registered in New York. Only 122 bothered to return them, and out of this lot, only 2.5% had a neutral or better view of us fatties. Or in real numbers, that’s three people.
- But maybe things are improving? Ha! A recently published UK study from a very good university asked 1,130 trainee doctors, nurses, dietitians and nutritionists their views on fat people. Over 98% were negative. In other words, 1,114 healthcare students couldn’t even manage a neutral score.
And just in the last couple of weeks, we’ve seen:
- Male jurors are biased against female defendants, but only if they’re fat.
- “Obese” students do significantly worse at university, and “overweight” and “obese” students do worse at school, despite absolutely no difference in tests of academic skill.
- Junior, middle, and high school PE teachers, as well as high school sports coaches, have just as low an opinion of us as do everyone else.
And there’s a handful more in press.
So why is this a good thing?
Well, obviously, it’s not. It’s awful and disheartening. But there is a growing body of researchers who are now looking at the topic of weight stigma. What used to be a bit of a niche subject is branching out.
And it’s not because weight stigma is getting worse. It’s because the existence, extent, and seriousness of the problem are starting to be recognised, at least within the scientific community. The medical community have a ways to go yet — they are so brainwashed by the OMGDeathFat paradigm that a bit of stigma can only be seen as a good thing. Right? Someone really needs to tell them that stigma (of any kind) is bad for health. It’s associated with heart disease, hypertension, and diabetes, amongst other things — all usually associated with obesity itself. Interestingly, in cultures where fat isn’t stigmatised (although it’s getting harder and harder to find any), the relationship between weight and health is much weaker.
So, yes, the problem is being recognised. Question: is it helping?
A few studies have tried to reduce anti-fat bias in certain groups of people, including medical students, with mixed results. A recent randomised study reported small improvements for students who received a tutorial about genetic and environmental factors, and an increase in anti-fat attitudes in those who were taught about diet and exercise. Whether this will find its way into med school curriculums, or translate into better treatment of fat patients remains to be seen.
Another approach has been to try and teach fat people psychological techniques to help them deal with their negative thoughts about themselves. This actually worked reasonably well, at least in the short-term, but kind of shifts the problem back on to us: the victims need to fix themselves.
There is an alternative. It’s just an inkling of an alternative at the moment. This is what I’m hoping to study over the next few years. Two studies from the same research team found that (1) female college students who had experienced weight stigma were less likely to exercise, even after controlling for BMI and poor body image and (2) it only seemed to matter in people with a high degree of internalised anti-fat bias and higher general anti-fat attitudes. In other words, they believed all the crap they were being fed about fat people.
Which brings us nicely to Health At Every Size®. The first tenet of the HAES approach to health is acceptance of size diversity. Stop beating yourself up people. Don’t let them convince you that you are any less because of what you look like. Start looking at yourself and other people with kinder eyes. It’s good for both of you.
The kinds of prejudice currently being directed at fat people can take generations to change, and in some circles, they probably never will. History shows us that with progress, knowledge, and the advancement of humanity, change is possible. But in the meantime, remember, you don’t have to take it!