Fat Shaming: Problem or Solution?

 by Sara Dalrymple, RSW MSW BA Psych., BANA Clinical Therapist

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Body shaming is the act of criticizing one’s overall body-appearance; more specifically, fat shaming is to criticize one’s weight/shape for being above-average, and for not meeting societal standards of a “beautiful weight”. Often this is done through passive aggressive comments, and attempts to mask fat-shaming as “just a joke” is a frequent defense.

There have been some who have argued that fat shaming is necessary to combat the “obesity epidemic” (now considered a “pandemic”) in North America and worldwide, suggesting that acceptance for all body types only allows the public to believe that being obese is “okay” and is not a health concern. These individuals and groups believe that showing compassion towards obesity will send the message that taking care of oneself and one’s body is not necessary or important. They argue that shaming obesity and fat is the way to motivate individuals to lose weight, eat well and be healthy.

Before we look at the research suggesting fat shaming is more harmful than helpful, we want to note that health and wellness is of course a top priority at BANA. We understand that being of above-average weight increases one’s health risks, but we argue that not everyone who is of above-average weight – even “obese” by BMI standards – is unhealthy, and many may never see those risks come to fruition. Weight does not equal health.

The perspective that “fat shaming is a solution” undermines not only a large body of research to argue the contrary, but it also makes vast generalizations about individuals of a certain weight. Moreover, it makes the assumption that obesity is solely the cause of personal factors – such as individual control (or lack thereof) – when there is a great body of evidence that has linked other factors to the development or maintenance of obesity that are not the individual (we will not be overviewing these causes in this article). This perspective also makes the assumption that BMI – the tool used to label obesity – is a reliable indicator of overall health. At BANA, we see many clients who have a BMI considered “obese” but are in outstanding health, exercise regularly, and have normalized their eating. These individuals’ health struggle is arguably more mental than physical – likely due to many years of being shamed for their weight and appearance. Examples like these beg the question: is fat shaming the solution, or does it perpetuate the problem?

THE RESEARCH

There is a significant body of research that has linked fat shaming to health consequences. It has been shown on numerous occasions that individuals who are the recipients of weight stigma are more likely to overeat and binge eat after being stigmatized, and experience lowered motivation to exercise: both of these outcomes could perpetuate weight gain. In fact, Schvey and his colleagues found that after research participants watched a weight-stigmatizing video, they consumed 3x as many calories (2011). Similarly, it was found by Sutin and Terraccino that individuals who had experienced weight stigma were 2.5-3.2x more likely to develop or maintain obesity than their counterparts who had not been stigmatized (2013).

Research has also shown that those who have experienced weight stigma may be more likely to turn to food to cope with negative emotions (like depression, anxiety, guilt, shame, humiliation, embarrassment, etc.) – emotions that could be triggered by fat shaming. Some research has even demonstrated that individuals who have been discriminated against based on weight have higher levels of cortisol – a stress hormone which has been linked to numerous health consequences. Furthermore, individuals who have been fat shamed and experienced weight stigma have higher rates of substance abuse, mental health problems, and suicidality/self-harm. These results were maintained even when weight/”fatness”, sex and age were controlled for; what this means is that the only common denominator between participants was that they had been shamed for their weight, whatever their weight was.

In a study conducted in developing nations where weight-stigma had previously been low, researchers monitored the outcomes of increasing weight stigma messages through anti-obesity initiatives (Brewis et al., 2018). What was found was as weight stigma went up within a country, so did health consequences – specifically depressive symptoms and disordered eating behaviours.

It is important to note that weight stigma and fat shaming messages are heard by everyone – not just individuals who are overweight or obese. The highest rate of mortality across any mental health diagnosis exists for clients with Anorexia Nervosa – not Binge Eating Disorder, where many individuals may be considered to be overweight. In other words, being of significant low weight can be more deadly in the realm of eating disorders than being overweight or obese. Troop and his colleagues wanted to identify how different types of shaming – whether internal from self-blame (likely adopted from a fat-phobic culture) or external from societal messages and weight stigma – impacted eating disorder behaviours in anorexic and bulimic individuals (2008). What they found was that anorexic symptoms increased more when external shame was experienced, whereas bulimic symptoms increased more with internal shame. What this means is that individuals with anorexia nervosa, who are typically of underweight status, are more symptomatically impacted by external shaming (such as weight stigma) than individuals who have bulimia, who are typically average-weight or overweight. Keep in mind, this study did not include individuals with Binge Eating Disorder, although these findings are still quite interesting: underweight individuals are also affected by body shaming messages, and experience more harmful symptoms and health consequences when exposed to weight stigma.

The bottom line across research is that weight stigma creates health consequences rather than solves them. And to further this point, it can be argued that fat shaming is more a cause of obesity than a resolve.

BODY MASS INDEX – FRIEND OR FOE

Many use BMI as a method of assessing whether or not someone is obese. The problem with BMI is that it was developed in the 1800’s and is therefore outdated (Walden Behavioral Care, 2019). Moreover, BMI overlooks variance in body mass and other factors that can contribute to “the number on the scale” (muscle-to-fat ratio, fluid retention, bone density, etc.). Most importantly, however, is that BMI is not an indicator of health, yet it is often used alone to facilitate applying pressure for weight loss and dieting.

BMI serves medical purposes that are still important and informative. However, it is highly recommended that BMI is used in collaboration with other medical indicators and treatments to ensure best practice and reduce the risks of “categorizing” individuals in a weight-stigmatizing way. To learn more about these recommendations, Balanced View offers a free online course about weight bias and stigma in healthcare settings. Visit https://balancedviewbc.ca/ to register!

MESSAGES OF WEIGHT STIGMA

By and large, one of the largest culprits of weight stigmatization are media platforms. Most media messages that focus on body argue the same points like a broken-record: “fat is bad, thin is ideal”. These repetitive messages often condone weight-discrimination by inadvertently (or sometimes directly) telling the public that being over-weight or obese is wrong, and that fat-shaming is okay.  The more the public sees these messages, the more “normal” fat-shaming becomes.

One major thing that is often overlooked by the media and those who fat-shame is this: individuals who are above-average weight, over-weight or obese KNOW they are. They’ve been reminded of this on a regular basis, by absorbing media messages, being lectured every time they visit their primary healthcare practitioners, and/or with self-shame and criticism whenever they experience their body (while looking in the mirror, getting dressed, etc.). They do not need to be reminded of their weight, because they are the ones who live in their body day-in and day-out. They’ve likely been shamed for their weight for most of their life, and many may desire to reach a more “ideal” body weight/shape rather than accept the body they currently live within. Imagine being diagnosed with a physical condition requiring a wheelchair, and every person you come across says “hey, did you know you’re in a wheel chair”? Imagine how silly that would sound. Those who argue that fat-shaming is a solution to obesity forget one key point: fat shaming has existed all over society for decades. If fat shaming worked, by now there would be no one of above-average weight left in our society. Yet the opposite is true; obesity has been identified as a global “pandemic” during the same generation that has seen a drastic increase in weight stigmatizing messages in the media and society at large. Coincidence? We think not.

POTENTIAL SOLUTIONS

There have been suggestions made by many professionals working with obesity who do recognize the consequences of weight stigma; these suggestions also mirror those discussed in much of the research. These solutions are aimed at engaging these clients/patients in healthcare settings in a non-stigmatizing way, increasing their overall health and wellbeing, and working to reduce weight-stigma in society.

  • Improve access to healthcare and physical activity (costs, transportation, time)
  • Make nutritious foods more affordable
  • Emphasize realistic and balanced long-term lifestyle changes directed at overall health and wellness, rather than focusing on weight loss and dieting
  • Encourage healthy behaviours without mentioning weight
  • Educate and problem-solve to reduce weight bias in healthcare settings
    (for a free educational course on weight bias and stigma in healthcare settings, please visit: https://balancedviewbc.ca/ )
  • Target media messages to be more representative of all body types
  • Educate and address attitudes and behaviours of those who are “doing” the stigmatizing
  • Introduce legal protection against weight-discrimination (especially given obesity is considered a “disease” in many nations, and discrimination of other diseases would not typically be tolerated)

OVERVIEW

Weight-stigma has been connected to an increase in health concerns throughout much of the research, in numerous cultures. Fat shaming, a form of weight-stigma, has been shown to cause individuals to develop or maintain obesity, as well as countless other health concerns. Those who argue that fat shaming is a solution to obesity overlook a great deal of evidence to the contrary.

Simply put… fat shaming is not a solution; rather it perpetuates the “problem”.

References:

Brewis, A., SturtzSreetharan, C., & Wutich, A. (2018). Obesity stigma as a globalizing health challenge. Globalization and health14(1), 20.

Goss, K., & Allan, S. (2009). Shame, pride and eating disorders. Clinical Psychology & Psychotherapy: An International Journal of Theory & Practice16(4), 303-316.

Gunnars, K. (2019). The Harmful Effects of Fat Shaming. Retrieved June 10, 2020, from https://www.healthline.com/nutrition/fat-shaming-makes-things-worse

Major, B., Hunger, J. M., Bunyan, D. P., & Miller, C. T. (2014). The ironic effects of weight stigma. Journal of Experimental Social Psychology51, 74-80.

National Association of Anorexia Nervosa and Associated Disorders. (2020). Body Shaming. Retrieved June 10, 2020, from https://anad.org/education-and-awareness/body-image/body-image-articles/body-shaming/

Schvey, N. A., Puhl, R. M., & Brownell, K. D. (2011). The impact of weight stigma on caloric consumption. Obesity19(10), 1957-1962.

Sharpe, H., Naumann, U., Treasure, J., & Schmidt, U. (2013). Is fat talking a causal risk factor for body dissatisfaction? A systematic review and meta‐analysis. International Journal of Eating Disorders46(7), 643-652.

Stanford, F. C., Tauqeer, Z., & Kyle, T. K. (2018). Media and its influence on obesity. Current obesity reports7(2), 186-192.

Sutin, A. R., & Terracciano, A. (2013). Perceived weight discrimination and obesity. PloS one8(7).

Tomiyama, A. J. (2014). Weight stigma is stressful. A review of evidence for the Cyclic Obesity/Weight-Based Stigma model. Appetite82, 8-15.

Tomiyama, A. J., Carr, D., Granberg, E. M., Major, B., Robinson, E., Sutin, A. R., & Brewis, A. (2018). How and why weight stigma drives the obesity ‘epidemic’ and harms health. BMC medicine16(1), 123.

Tomiyama, A. J., & Mann, T. (2013). If shaming reduced obesity, there would be no fat people. The Hastings Center Report43(3), 4-5.

Troop, N. A., Allan, S., Serpell, L., & Treasure, J. L. (2008). Shame in women with a history of eating disorders. European Eating Disorders Review: The Professional Journal of the Eating Disorders Association16(6), 480-488.

Walden Behavioral Care. (2019). Actually, Bill Maher, Fat Shaming Won’t Make Bodies Smaller. Retrieved June 10, 2020, from https://www.waldeneatingdisorders.com/blog/fat-shaming-wont-make-bodies-smaller/