“Sticks and stones may break my bones but words will never harm me!”
How many of us were told as children to use that as a comeback to the body bullies? And how many of us were harmed by those words, scarred by them – maybe far worse than the damage that sticks and stones may have caused?
My hand is raised. Those words that harmed came from body bullies in the form of classmates and family members, but also from doctors and nurses and gym teachers.
Before I go any farther, I want to acknowledge that I am a white, cis-gendered, straight female from an upper-middle-class family, and in a body that is, according to the current standards within our society, in the acceptable range to receive thin privilege.
But many do not have my privilege. Many adults still hear and feel the sting of those words every day from classmates and family members, doctors and teachers, and even strangers on the street and on the internet. As a person of privilege and a practitioner in the healthcare field, it is my responsibility to first do no harm. Therefore, as an ally and as an educated professional on the topic of weight stigma, I no longer use the terms “overweight” or “obese.”
I use the word “fat.”
I use the word “fat” because it is what the people in larger bodies who are at the forefront of the fat acceptance movement prefer. I use it because it is an accurate description of a body size, just as words like thin, tall, short, curvy and straight are body size descriptors.
The word fat has been co-opted by the body bullies, which have invaded our culture via the diet industry and mainstream media, and have found their way into the healthcare industry. In our culture, “fat” is synonymous with “lazy,” “sedentary,” “in a diseased state,” and “unhealthy.” This is not only stereotyping and pathologizing a body size, it is simply untrue. The word, “obese” in itself is a misnomer; “obese” comes from the Latin, “obesus,” which means something that has “eaten itself fat.” The use of this word perpetuates the untruth that all fat bodies are fat because of their own doing, rather than one of the diverse shapes found in our genome.
The Association of Size Diversity and Health, the organization that created the philosophy behind the Health At Every Size® movement, has a great video explaining how bodies come in all shapes and sizes, but due to societal pressures and changes to the norm, fat bodies, which were once a sign of wealth amongst aristocrats, are now vilified.
Opponents of the theory that a BMI in the “obesity” category is not a health risk nor is it something that can be controlled via diet and exercise proclaim that those with a BMI in the “overweight” and “obese” category are at a higher risk of disease and death. According to one study in the Journal of the American Medical Association, those in the “underweight” category were at a higher risk of death than those in the “overweight” category. The problem with categorizing people according to the BMI is one part of the problem. Correlation versus causation is the other part.
BMI is a calculation of weight and height squared that was originally created by an astronomer and statistician to draw conclusions about societies to measure the “average man.” Problem number one: This was created to measure men, yet it is used to make conclusions about the health of women and children. Problem number two: BMI was created as a tool to study populations, not individuals. The BMI assumes a person’s health by their height and weight alone. It doesn’t take into account blood pressure, cholesterol levels, blood glucose measurements, and it doesn’t take into account the makeup of one’s body. Many competitive athletes fall into the “obese” BMI category because they have a large muscle mass, and since height and weight are measured – not muscle mass or body fat percentage or bone density – they are considered “unhealthy” and may be subjected to some of the same inequities that people in fat bodies encounter, like obtaining affordable health insurance coverage, for example. This leads me to the other problem with BMI…
Correlation versus causation. Correlation is when two things happen at the same time which may or may not be a coincidence. Causation is when one thing is proven to cause another thing to happen. Many of the studies published in journals can prove correlation, but many of these same studies get dumbed down into a sound bite for mainstream media and reported as causation. For instance, a BMI in the “obese” category is correlated with a higher risk of death from cancer. One might report that the obese body causes cancer. Let me shed some light on this: Although there is a correlation between an “obese” BMI and cancer, the fat on the body is not what leads to a higher death rate. The higher death rate is caused by weight stigma. Health is an “inside” job, but for some, healthy habits don’t include regular medical care – either by choice or by lack of access. Vilifying a fat body as the cause of disease makes no sense. All bodies get diseases. There is not one disease that only fat people get (you can read more about my opinion on that here)
People in fat bodies are body shamed constantly. They are body shamed when they seek out medical care. Many people, even those who are not in the “obese” BMI category are told to lose weight and exercise (I’ll tackle that prescription in a minute). These people are told to lose weight and exercise every time they seek medical care – even if it’s to treat a sore throat! Once you are body shamed by a health professional, it’s likely that you won’t return for treatment or preventive care, knowing full well that your weight will be the diagnosis, regardless of your chief complaints. Self-preservation takes the place of seeking out care when you sense that something isn’t right with your body, and you might avoid seeing a health specialist until it’s too late. In the previous example, the “obesity” didn’t increase the risk of dying from cancer; weight stigma, which led to the avoidance of seeking out help or not receiving proper medical care after being diagnosed as “obese” was the cause. There are many other scenarios that people in fat bodies can share, and they can intersect with race, socioeconomic class, and gender identity.
As for the prescription of “lose weight and exercise” for anyone outside of the normal BMI, this is a neglectful healthcare practice. If we are tasked to first to do no harm, why would we prescribe something that, 1) we have no data proving its sustainability or efficacy (the vast majority of people who diet gain the weight back after going off the diet within 3-5 years and there are no studies proving otherwise), and 2) that we increasingly diagnose as an illness (ie eating disorders) in another group?
Here is why I use the word “fat” in my practice as opposed to “overweight” or “obese”: Fat is a body size. I do not use it as an insult but as a description. In fact, I find the word, “obese” to be offensive and correct my clients who use it. The word “overweight” is also nonsensical to me. Over what weight? And why don’t we do the same thing for height? After all, height is part of the BMI equation, but you rarely hear the explanation of someone’s BMI as being “under tall.”
As I mentioned earlier, I experience thin privilege, and as such, I am not treated like those in fat bodies are treated. My responsibility as a healthcare professional is to be an ally to those who are targeted by weight stigma. In my practice, I don’t focus on making bodies smaller; I focus on empowering my clients to care for their bodies to bring them to health in the body they have right now, and at every size. If you are a healthcare professional, it is time to change your way of practicing. If you are seeking healthcare, it is time to find a Health At Every Size® practitioner. The perpetuation of treating a body size rather than treating the patient within it is dangerous, negligent, and needs to stop. There is another way, and it is kinder, inclusive, and most of all, effective and data-driven.