HAES in the LGBTQ+ community

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The LGBTQ+ community, much like the rest of our Western society, is rife with anti-fat bias and weight stigma.Through this discrimination, many individuals uphold unhealthy paradigms like diet culture and healthism. Health at Every Size (HAES), which is a weight-inclusive approach to healthcare, is a more inclusive view of wellness that should be adopted in queer and trans spaces as well.

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In this article

What is HAES and why is it important?

Typically, American doctors treat patients using a “weight-centric” approach, which means they consider weight to be the most important indicator of health, which is stigmatizing and harmful to people living in larger bodies. HAES takes an alternative approach to medical treatment, asserting that weight is not a major predictor of health outcomes and celebrating and respecting the diversity of body weights, sizes, and shapes. (1)

HAES doesn’t just refer to healthcare, though that is a major component—it also emphasizes intuitive eating and joyful movement. And it’s a movement that is actively challenging weight discrimination as well as medical and cultural assumptions about weight bias and weight stigma, centering the individual as the expert on their body. From a healthcare perspective, HAES condemns the weight-based approach that results in providers demanding that larger bodied people lose weight at every appointment. (1,2)

How HAES applies to the LGBTQ+ community

HAES has a place in the LGBTQ+ community as well, given the prevalence of healthism, diet culture, and fatphobia. Here are these three terms broken down:

  • Healthism: Healthism is the belief that personal health is the most important thing in life and that it is the responsibility of the individual person, typically equating well-being and health with thinness, which is not only inaccurate but harmful and stigmatizing. Healthism also ignores genetic and social determinants of health and promotes the myth that health is entirely controllable through individuals behaviors. 
  • Diet culture: Because healthism falsely equates health with thinness, it helps perpetuate diet culture, which values thinness and appearance over well-being and seeks to regulate what we eat, shaming us for eating foods we’ve been taught are “bad.” It is all around us, from TV and films to magazines and social media.
  • Fatphobia: Fatphobia is an extreme fear and hatred of fat people (a term higher-weight people have reclaimed).

Unfortunately, fatphobia causes many people to feel excluded from the LGBTQ+ community and also find it more difficult to date—especially given the immense discrimination on dating apps like Grindr, Tinder, and Bumble, which isn’t just limited to weight but also race and masculinity, with many Grindr profiles stating “no fats, no femmes.” While many queer people may claim that these are just “preferences,” they are far from harmless inclinations—rather, these declarations are prejudices embodying fatphobic, racist, and misogynistic attitudes that actively exclude and alienate members of their community.

One of the most common ways in which people, queer, trans, and cishet alike, justify weight discrimination and bias is out of “concern” for a fat person’s health. This is because of the widespread misconception that thin people are healthy and fat people are not. Not only is this assumption inaccurate, it also increases the hostility and stigma experienced by people in larger bodies which has been shown to decrease health outcomes. (7) Challenging these assumptions and creating community norms in which stigmatizing comments are unwelcome can help the LGBTQ+ community become a more inclusive and welcoming space for queer and trans people of all sizes and weights.

Fatphobia among gay men 

Fatphobia is particularly evident among gay men which the “ideal” body body is often equated with muscularity and low body fat. Research has found that over 33% of gay men reported experiencing fatphobia, including discrimination and rejection from potential romantic partners. (4)

Another study found that when compared to cisgender heterosexual fat men approaching women, gay men in larger bodies were more likely to be blatantly ignored, mocked, or treated poorly when approaching an attractive man. (4) 

Fatphobia amongst queer women

Though there is less research on fatphobia amongst queer women, there are plenty of examples of fatphobia in media depicting lesbians. Take the well-known lesbian show, The L Word, which premiered in 2004: all thin, mostly white women (with the exception of Max, a trans man character, who received his own transphobic treatment) dominated that show and contributed to a public image of what lesbians “should” look and act like, excluding fat women of color. When this image becomes the one associated with lesbians, it can inadvertantly become the type of queer women others are attracted to, leading to discrimination and prejudices. 

Fatphobia in the trans community

Just like cisgender people, transgender folks may feel immense pressure to conform to the “ideal” body and appearance standards of their gender. They may internalize societal messages about what “real” women and men should look like and weigh, which can negatively impact their self-esteem and body image.

For example, the stereotypical attractive female body is associated with thinness and a small waist. Many trans women experience feelings of distress and inadequacy if they don’t conform to this body type and may engage in disordered behaviors to attempt to achieve it. Likewise, trans men and transmasculine people may feel pressure to build muscle and have low body fat so they can conform with typical male beauty standards. While there is not a mainstream body ideal for nonbinary people, the most well known and celebrated nonbinary celebrities tend to be young, thin, white, and androgynous, and other nonbinary people often feel pressue to match this image to be regcognized as “nonbinary enough.” 

Additionally, those who may meet these stereotypically feminine or masculine standards may be more likely to “pass,” which means people perceive them as cisgender. Passing privilege allows transgender people to move through the world with relative safety compared to those who don’t pass, who may experience increased discrimination and violence.

Negative consequences of fatphobia and how HAES can help fight weight stigma

Fatphobia harms queer and trans people living in higher-weight bodies in a myriad of ways. It leads to fat-shaming, weight stigma, and weight bias, as well as: (5,6)

  • Poor body image
  • Low self-esteem
  • Psychological stress
  • Depression
  • Body dissatisfaction
  • Eating disorders

Fatphobia leads to negative stereotypes about people living in larger bodies, such as the fact that they are “lazy,” “undisciplined,” or “unhealthy,” and these attitudes extend to the LGBTQ+ community as well, with many people opting to call themselves “fit” people looking for other fit people. Although the term “fit” may be less overt than “no fats, no femmes,” it still comes with all sorts of implications about who is and is not welcome in the dating space.

Because weight stigma is so closely linked to healthism, understanding that people can be healthy at every size can help to combat weight bias and weight-based discrimination. HAES challenges many negative weight-based assumptions, such as: (2)

  • That weight loss will increase life expectancy
  • That weight can be sustainably manipulated through individual behaviors 
  • That weight loss is a practical and positive goal to have
  • That the only way for fat people to improve their health is to lose weight
  • That fat people have an increased risk of disease and death

As HAES was developed in a health-care context and is thought by some to not be radical enough to transform the myriad ways fat people experience discrimination and stigma, many fat activists advocate for a fat liberation approach to transforming both how the queer community and society in general views fatness and fat people. Because fatphobia and weight stigma in the LGBTQ+ community can increase the risk of eating disorders, embracing the goals and principles of fat liberation can be a powerful personal and political form of resistance and self-care. (8)

Fat liberation is a queer issue

Fat liberation involves deliberately dismantling the systems of oppression that deny fat people access to many aspects of life, including dating, quality healthcare, weight-inclusive transportation, clothing and apparel, and more. Fat people experience weight stigma from a variety of sources, including social media, TV, physicians, potential romantic partners, and doctors.

Fat liberation is different from movements like body positivity, body neutrality, and HAES, which various people may find helpful in their path toward body acceptance and happiness, because it turns the attention from the individual and holds systems of oppression accountable. 

And fat liberation is a queer issue, because of course, there are fat queer and trans people, but also because queer people know what it means to fight for liberation, to question and challenge the status quo, resist heternormative standards, and to create new paths of living. Queer people know what it’s like to once have been categorized as mentally ill for simply being queer or trans. There are complex forms of intersectional oppression that fat queer and trans people experience, including the additional barriers fat trans people face in getting gender affirming surgery and the marginalization of fat cisgender gay men in the highly image-centric gay dating scene. 

Fatness also cannot be separated from other intersections of identity, like queerness, transness, race, and class. While many queer and trans people are working to dismantle fatphobia, the LGBTQ+ community at large still hasn’t embraced fat liberation. There is still a lot of work to do to make fat people feel accepted amongst their queer and trans peers.

Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.

Resources

  1. The health at every size® (HAES®) principles. ASDAH. (2022, April 22). Retrieved November 1, 2022, from https://asdah.org/health-at-every-size-haes-approach/ 
  2. Penney, T. L., & Kirk, S. F. (2015). The Health at Every Size paradigm and obesity: missing empirical evidence may help push the reframing obesity debate forward. American journal of public health, 105(5), e38–e42. https://doi.org/10.2105/AJPH.2015.302552
  3. American Psychological Association. (n.d.). Apa PsycNet. American Psychological Association. Retrieved November 1, 2022, from https://psycnet.apa.org/doiLanding?doi=10.1037%2Fsgd0000159 
  4. Weight stigma. National Eating Disorders Association. (2019, June 27). Retrieved November 1, 2022, from https://www.nationaleatingdisorders.org/weight-stigma 
  5. Puhl, R. M., & Heuer, C. A. (2010). Obesity stigma: important considerations for public health. American journal of public health, 100(6), 1019–1028. https://doi.org/10.2105/AJPH.2009.159491
  6. Wu, Y. K., & Berry, D. C. (2018). Impact of weight stigma on physiological and psychological health outcomes for overweight and obese adults: A systematic review. Journal of advanced nursing, 74(5), 1030–1042. https://doi.org/10.1111/jan.13511
  7. Gibson, G. (n.d.). Health(ISM) at every size: The duties of the "good fatty". Taylor & Francis. Retrieved November 1, 2022, from https://www.tandfonline.com/doi/full/10.1080/21604851.2021.1906526

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