The University of Illinois Chicago’s School of Public Health advocated for the change in a recent brief, titled: “Addressing weight stigma and fatphobia in public health,” in which it acknowledges the negative impacts of weight discrmination, as well as the notion that the “focus on body size is rooted in racism”.
The brief begins by addressing the increase in “weight stigma and negative attitudes towards people in larger bodies” that has occurred as a result of a focus on “obesity” prevention over the last few decades, and claims weight discrimination remains “one of the only forms of discrimination actively condoned by society”.
It also alleges that this discrimination is rooted in racism, as the idea that larger bodies are “less civilised” began with Charles Darwin and other race scientists, who “created a hierarchy of civilisation” in which white individuals were placed on top, while people of colour, specifically Black people, were placed at the bottom, and in which fatness was used “as a marker of ‘uncivilised behaviour’”.
“This ideology has perpetuated Desirability Politics – where thinness and whiteness are given more access to social, political and cultural capital,” the brief states.
The brief also acknowledges the issues with using BMI [body mass index], a measure of body fat based on height and weight, as it claims it does not consider health behaviours or body composition, and as result, does not give an accurate picture of health, and the issues with weight-loss research in the US, which it claims is largely “funded by weight loss and drug companies”.
The university’s school of public health then acknowledges some of the effects experiencing weight stigma can have on an individual, with the brief highlighting research that has found experiencing this stigma can increase the risk of “diabetes, heart disease, discrimination, bullying, eating disorders, sedentariness, lifelong discomfort in one’s body and even early death”.
According to the brief, public health approaches focused on obesity prevention can also be harmful because they are typically based on “limited or poor quality evidence” and focus on the “narrative that weight is controllable and a personal responsibility”.
“If the goal is to find the most ethical and effective strategies to achieve optimal public health, there needs to be an alternative to ‘obesity’ and weight-focused approaches and a shift in understanding of weight stigma as a social justice issue,” the school states.
— UIC School of Public Health (@uicpublichealth) March 30, 2022
To achieve the goals, the university notes that one of the first steps is recognising examples of weight bias and weight stigma in public health settings, as well as the adverse consequences these stigmas can have on a patient, and then developing public health strategies that are inclusive of all body types.
According to the brief, by implementing a weight-inclusive approach to public health, it will allow bodies of all sizes and shapes to be appreciated, and reinforces the idea that “fat people can be just as healthy as thin people”.
“Remember, you cannot tell someone’s health on the inside by looking at their size on the outside,” the brief states. “It is the responsibility of those in public health to create environments for every person to thrive in whatever body they live in.”
The brief also acknowledges the importance of those in public health focusing on behaviours that impact health, such as eating, exercise or movement, sleep and smoking cessation, and on improving health access, autonomy and social justice for all individuals.
“Trust that people move toward greater health when given access to stigma-free health care and opportunities,” the university continues, referencing examples of gyms with equipment for people of all sizes or medical facilities that do not weigh patients.
In an effort to fight the stigma, the brief suggests avoiding the term obesity, which it described as “extremely stigmatising,” and instead using terms such as “people in larger bodies”. The university also encourages professors teaching public health to replace assignments that connect obesity and health, or that focus on weight loss, and to avoid referencing research that is “rooted in fatphobia”.
Individuals are also encouraged to explore their own “internalised fatphobia,” such as the biases that they have towards those who have larger bodies, and to consider whether they “prioritise” thinness.
The university is not the first to address the stigma associated with weight, and the racism rooted in the stigma, as the University of Texas’s Institute for Bioethics & Health Humanities recently hosted a lecture on “Fatphobia as Misogynoir: Gender, Race, and Weight Stigma,” during which Dr Sabrina Strings, an associate professor of sociology at the University of California, Irvine, highlighted the “troubled past of fat stigma,” and the “centrality of slavery and race science in its perpetuation throughout the western world”.