What is fatphobia and weight stigma?
Fatphobia (fat phobia or fatphobic) is a deep-seated fear and hatred of fat bodies. It is prevalent throughout society and manifests in many different ways. Weight stigma is discrimination and stereotyping based on a person’s body weight and size.
Most people of low or average weight likely don’t even notice the rampant weight discrimination around them. And they certainly aren’t likely to be aware of how they perpetuate weight stigma in their daily lives and benefit from thin privilege. But, for fat (a term that has been reclaimed as a neutral descriptor by those living in larger bodies) people, weight stigma has devastating consequences, such as:1,2
- Psychological stress
- Poor self-esteem
- Poor body image
- Depression
- Body dissatisfaction
Weight stigma has a serious negative impact on physical well-being, too. Weight stigma can lead to chronic diseases, substance abuse, increased mortality rate, and, paradoxically, weight gain.3
Weight stigma
Weight stigma is present everywhere in Western culture, including:
- Social media, including Instagram and TikTok
- TV shows and movies
- Advertising and marketing
- Public transportation
- Healthcare settings
- Employment settings
- The diet industry
- Sports/athletics
Research has found weight-based shaming to be profoundly damaging when coming from family and friends. Plus, family members and friends often discriminate against larger people by discussing diets, teasing people about their weight, commenting on the shapes and sizes of others, and more.
Intense shame can result, which can lead to disordered eating behaviors and the psychological and physiological challenges mentioned above.
Sadly, doctors are some of the most common perpetuators of fatphobia and weight discrimination.
Is fatphobia rooted in racism?
According to Sabrina Strings, author of “Fearing the Black Body: The Racial Origins of Fat Phobia,” fatphobia has its roots in the transatlantic slave trade, in which colonists asserted that Black people were prone to gluttony and sexual excess and that their love of food caused them to be fat. European colonists claimed moral superiority, valuing moderation and self-control, which made them thin and, according to them, “the superior race.” By the early 1800s, fatness was considered a sign of immorality in the U.S., as well as racial inferiority.4,5
Ultimately, people used body size and shape to distinguish between those who were enslaved and those who were free since skin color wasn’t necessarily a reliable indicator (due to two hundred years of interracial sex, mostly rape, when enslavers bred their enslaved). Essentially, larger bodies were deemed undeserving of freedom. And these anti-fat, anti-Black attitudes persist well into current times due to modern medical practices.4,5
Doctors are some of the most common perpetrators of fatphobia and weight discrimination. Research shows that they spend less time with larger people on office visits, provide them with less medical information, and often hold biased, stigmatizing views of fat people, including that they are non-compliant or undisciplined.1
Is BMI racist and inaccurate?
You’ve likely heard of body mass index (BMI) as a measurement of healthy weight. It’s used everywhere, from doctors’ offices to schools to places of employment. It is even responsible for the infamous “fat letters” many schools sent home to parents of students.
But BMI isn’t actually an accurate indicator of health. It is simply a person’s weight-to-height ratio. It doesn’t take any other factors into account, such as muscularity, biological and environmental influences, bone density, and beyond. For example, someone with a lot of muscle mass may have a BMI that falls in the “obese” range.
Within Health’s co-founder, Wendy Oliver Pyatt, MD, has experienced the misuse of BMI firsthand.
“In 2006, at the Academy for Eating Disorder Conference in Seattle, Washington, I was becoming increasingly worried about the implications of weighing children at school as well as frightened by the rush to interpret BMI as an indicator of health. Because of this concern, I raised the point to the Academy, and out of it, we set out to create guidelines meant to stop weighing children in schools.
Later, in 2012, while having the opportunity to work on the Board of Directors of the Binge Eating Disorder Association, we started Weight Stigma Awareness Week.”
- Wendy Oliver-Pyatt, MD, FAED, CEDS
Generally speaking, proponents of BMI claim that a high BMI will lead to disease, negative health risks, and even premature death. However, research has shown that BMI alone is a poor measurement of health and mortality. The exact opposite is true.
Research by Katherine Flegal of the Centers for Disease Control and Prevention (CDC) has shown that being overweight is actually associated with a lower mortality rate.6
Research by Dr. Tomiyama, director of UCLA’s Dieting, Stress and Health Laboratory, has also debunked the accuracy of BMI. Her research, which involved measuring health according to glucose, cholesterol and triglyceride levels, and blood pressure, found that over 47% of U.S. adults who fall into the “overweight” range for BMI are healthy, as well as nearly 20 million people who are considered “obese.”7
Over 47% of U.S. adults who fall into the “overweight” range for BMI are healthy.
BMI was created to measure the “ideal” white man in the 19th century
Besides BMI being inaccurate and stigmatizing, BMI also has racist origins. Created by Adolphe Quetelet during the 19th century, BMI was never intended to be a measurement of obesity or health. Instead, he intended to categorize people (though not exactly a noble pursuit itself).
Instead, Quetelet’s intention was to determine the “average man,” whom he deemed (ridiculously) to be “ideal.” This really meant the ideal white, cisgender European man since that’s who he collected his data from. In his book, “A Treatise on Man and the Development of His Faculties,” Quetelet asserted that “Everything differing from his proportion or condition would constitute deformity or disease.” It’s not hard to see how his categorization of the “ideal” could quickly turn into a justification for racism, fatphobia, and more.
By the 20th century, Quetelet’s Index, as BMI was initially called, was adopted by life and health insurance companies as the main way to measure body fat, which they linked with an increased risk of heart disease. This practice still affects doctors today. However, correlation is not the same as causation, and the research is far more complex and nuanced than this simplified connection.
Additionally, Quetelet’s Index was used to justify eugenics,10 which involved selectively mating people who have “desirable” traits with the goal of eliminating disabilities, disease, and “undesirable” traits. This resulted in the mass sterilization of people of color, people with mental illnesses, immigrants, disabled people, and poor people.
Quetelet’s legacy lives on and is practiced by many doctors today. BMI is still the gold standard for measuring weight and health in the medical world.
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How the current medical system fails Black women and men
BMI was devised based on studies of European white cisgender men. For this, and many other medical reasons, its accuracy in measuring the weight and health of people who fall outside this category is inherently flawed.
“The implication of weight stigma and the traumatizing impact of the many aspects of stigmatizing experiences has become more obvious. Over the past decade, I have become more and more focused on the importance of calling out and addressing the painful, devastating impact of weight stigma on our society as a whole.
The even more painful reality is the racist origin of weight stigma and the disproportionate, and medically unsubstantiated, traumatic impact it has on our African-origin community.”
- Wendy Oliver-Pyatt, MD, FAED, CEDS
When it comes to applying BMI to Black women and men, it is particularly problematic and stigmatizing. There is a body of research proving that African American women are often healthier at heavier weights and with larger waist circumferences than white women.5,8 But the medical community doesn’t take this into account when advising patients, particularly Black women, to lose weight.
This advice is neither helpful nor in the patients’ best interest. Research has found the exact opposite to be true. Telling people to lose weight damages the mental health of people living in larger bodies who have internalized the message that their bodies are not perfectly fine the way they are. The patient doesn’t lose weight, which can lead to shame and many other negative effects.
So much medical focus is placed on weight loss and obesity prevention to no good end. However, Western medicine is slowly becoming aware of a weight-neutral paradigm that incorporates truly comprehensive, culturally responsive, and compassionate healthcare practices for all bodies.
Destigmatizing fatness in the Black community
At Within, we understand that the racist origins of fatphobia are sadly still evident in our society today, presented in how we approach food, health, and the treatment of eating disorders. Due to the racist origins and damage of fatphobia, we make sure always to include a trauma-informed approach to care for each of our patients. Our eating disorder treatment programs are designed to be inclusive and attuned to the needs of each individual patient.
Our clinical team at Within wants to continue working toward recognizing and removing our own biases as eating disorder treatment providers while further educating our community throughout the process. Part of this work includes listening to people who are active in this space. Below, you will find a list of a few of these incredible people who are working towards destigmatizing fatness within the Black community. We encourage you to continue your education.
Further learning
Further reading
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