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Everybody hates us, and why that’s a good thing

January 14, 2013

Change how you see

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:

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!

Never Diet Again Sigs
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14 Comments leave one →
  1. January 14, 2013 11:43 am

    Thanks – great round-up post. It’s good to have those links.

  2. January 14, 2013 11:49 am

    Fabulous post Angela! W00t!

  3. The Real Cie permalink
    January 14, 2013 12:37 pm

    When I was in nursing school, we were asked what kinds of patients we’d prefer not to work with. I said pediatric patients, not because I dislike kids, but because I tend to get too many freaked out “mommy” feelings when dealing with children. I’m far more able to stay calm and level when working with adults.
    At least five of my fellow students said they did not want to take care of obese people.
    I found myself disgusted.

    • violetyoshi permalink
      January 14, 2013 8:56 pm

      They need to teach if you have any strong bias against a group of people, do not go into the medical profession. That biased people are not wanted.

      • The Real Cie permalink
        January 15, 2013 9:58 am

        Believe me, the instructors were all biased as f**k too. I never in my life saw such a cadre of hateful. prejudiced witch-with-a b’s in my life.
        I trained as an EMT before I trained as a nurse. Emergency professionals tend to be much more forgiving of people’s various foibles, as a whole.
        My EMS gallows humor also did not go over well among the laced corset types in the nursing department at the school I attended. I cracked a joke about a manikin being dead one time. The instructor pulled me aside and hissed that one NEVER jokes about such things. In the EMT class, we did all the time.
        I hated that program, but from what I’ve heard, they’re all just about as bad. If anyone else has had a better experience in a nursing program, please share.

  4. Duckie Graham permalink
    January 14, 2013 12:44 pm

    yes, great post!

    “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.” – we could all stand to hear that a little more often!

  5. January 14, 2013 12:47 pm

    Very interested to read the last article you linked. Thank you! Also…whenever I take the Harvard implicit attitudes test about weight bias I am slightly biased in favour of fat people. It always makes me laugh.

  6. singpretty permalink
    January 14, 2013 10:21 pm

    I agree that HAES and self-esteem are important, but I’m still depressed that an innocent fat woman might find herself in prison solely due to bias or that doctors will continue to treat fat ppl poorly…

    • January 15, 2013 4:34 am

      I agree. Let’s hope she’s not black too – then she’ll really be in trouble.

      Prejudice is rampant and people are people. Some will change, although it does take years to alter a cultural paradigm. Some won’t. I think legislation is important but not many legislators agree, largely because of inherent weight stigma and the idea that fat people only have themselves to blame for their problems. But even if that were true, it is still illegal to discriminate against the teenage boy racer who is now in a wheelchair after crashing his bike at 150 mph. Attempts are made to improve access to healthcare etc etc for the disabled. Who was to blame for the disability is not the issue.

      Fat is one of the last bastions of legitimate bigotry and this needs to stop – I completely agree with you. But from the point of view of your own health, in the meantime, not buying into it will make a big positive difference, biochemically speaking, and you’ll feel a lot happier too. But even that is a battle sometimes.

      Ang :)

  7. January 15, 2013 10:12 am

    It’s like the whole gun control debate in the US. The NRA has deliberately blocked legislation what would allow the government to track gun violence because if you can’t quantify the problem, then nobody will know that the situation needs fixing. So, although the news of anti-fat bias is depressing, the fact that we’re tracking it is good. And I love the studies that show how simply explaining how obesity actually works eliminates the stigma almost entirely. Jeffrey Friedman did something similar in one of his lectures that really showed how education and enlightenment is the key in this fight.

    Peace,
    Shannon

    • January 15, 2013 10:26 am

      Yes, it helps. But not always. I’d have to look up the study, but one showed that despite a good understanding of the multifactorial causality of obesity, med students anti-fat bias was still high. :(

      I’m not familiar with Jeffrey Friedman. I’ll check him out.

      • January 15, 2013 10:34 am

        I wrote about him here a while back, but click the links in that post to go to the lecture series and watch his shit. He is, hands down, the best thing in obesity research today. You will love it.

        Peace,
        Shannon

  8. January 21, 2013 3:59 pm

    Great post! Well said.

    Periodically I speak to healthcare professionals about HAES and pregnancy in women of size and it always is so striking to me how few fat folk are in the room. Med school is not very representative of societal demographics, and I wonder how that affects healthcare.

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  1. Extent and Impact of Weight Bias and Stigmatizing in the society

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