on nutrition
When I was getting my master’s degree in public health a decade ago, I saw a certain level of what might be considered hypocrisy. On the one hand, our eyes were opened to the social determinants of health, which the The Centers for Disease Control and Prevention define as “conditions in the places where people live, learn, work and play that affect a wide range of risks and outcomes for health and quality of life”. On the other hand, we were given a lecture on the “obesity epidemic” and how encouraging fat people to eat less and move more would make them slimmer and healthier. (I’m using fat as a neutral descriptor, like short, tall, or skinny.)
Never mind that this form of “personal responsibility” rhetoric is dubious at best. For example, In 1992, a panel of experts convened by the National Institutes of Health found that when people intentionally lose weight, “one-third to two-thirds of the weight is regained within a year, and almost all of it is regained within five years.” A 2007 review from UCLA researchers found that between one-third and two-thirds of dieters regain more weight than they lost, and that “there is little support for the notion that diets lead to lasting weight loss or health benefits.”
I’ve heard more than one public health expert acknowledge all of this and then say something like, “Well, we still have to encourage people to keep trying.” Perhaps darker is the case of CDC researcher Katherine Flegal, who found herself on the receiving end of an aggressive smear campaign by a prestigious school of public health after she published research in 2005 that concluded that having ” overweight” was associated with fewer excess deaths than being “normal weight.” She detailed these attacks in her 2021 article, “The Obesity Wars and a Researcher’s Education: A Personal Account.”
For years, governments and public health departments have created “anti-obesity” task forces and public health campaigns. Unfortunately, these efforts have done more harm than good, as the stigmatizing messages used in many of these campaigns have fueled anti-fat bias, or weight stigma, in all corners of society.
In his 2018 article, “What’s wrong with the ‘War on Obesity’?Public health researchers Lily O’Hara and Jane Taylor wrote: “In a bitter twist of irony, there is evidence of a direct causal pathway from weight stigma to weight gain, with or without changes in eating behavior such as mediator, proving that…a fat-hating environment makes people fat.”
Experiencing an anti-fat bias increases levels of the stress hormone cortisol, which contributes to weight gain but also directly harms your health. While the “war on obesity” may affect everyone by fostering shame about being fat or afraid of becoming fat people, the greatest harm goes to people who are already fat and experience hostility, discrimination, and oppression while navigating a physical environment designed for thin people. If you identify as female, low-income, disabled, or as a member of any other marginalized group, these effects are amplified, resulting in greater health inequalities.
Fortunately, there are signs of change. One is a policy brief titled “Public health needs to decouple weight and health” from the University of Illinois Chicago School of Public Health Collaborative for Health Justice, which stated: “If the goal is to find the most ethical and effective strategies to achieve optimal public health, there must be an alternative to ‘obesity’ and weight. focused approaches and a shift in understanding of weight stigma as a social justice issue.”
That’s how it is. Weight stigma, or anti-fatness, is a social justice issue. Final point.
