There are many assumptions made about weight and health in the dominant framing of “obesity.” Two key assumptions are that high weight causes ill health, and that body weight can be easily reduced through dieting or lifestyle changes.
There is a large body of evidence that refutes these two assumptions. Critical weight researchers suggest that while there is a correlational relationship between BMI and certain health outcomes (e.g., diabetes, heart disease, etc.), the evidence doesn’t support higher amounts of body fat as the cause of these outcomes (Mensinger et al., 2016; Tylka et al., 2014). There are many confounding variables that can help to explain this correlational relationship, including weight cycling (e.g., yo-yo dieting) and weight stigma (more on that in the next section; Hunger, 2015).
Additionally, there is research going back to the 1950s suggesting that intentional weight loss (or dieting) most often leads to weight cycling, where the weight that was lost, and often more, is regained (e.g., Fildes et al., 2015; Stunkard & McLaren-Hume, 1959). Thus, intentional weight loss is ineffective at best, and often leads to harmful outcomes such as an increased risk for eating disorders and/or disordered eating (e.g., Neumark-Sztainer et al., 2006). For people who try and “fail” over and over to lose “excess” weight, it is not their fault, despite what dominant rhetoric suggests.
Video: My Mi’kmaw Body by Margaret Robinson
Margaret Robinson’s story, My Mi’kmaw Body, from the Through Thick and Thin project takes some of the dominant notions, assumptions, and beliefs about fatness discussed in this sub-module and subverts them. Margaret stories her family’s fatness and ability to store fat as a survival mechanism, rather than as something harmful or damaging. Margaret reframes getting fat as something that her ancestors were good at, rather than as something pathological.
Reflection Questions
- What have you learned about weight and health, either through formal education or from friends and family or in other social spaces?
- How do your own experiences related to bodies and weight align, or not, with the messages you’ve been exposed to throughout your life?
- How might stories work to intervene in what is “known” about fatness in health care?
Activity: Critical Appraisal
Even studies that purport to show the benefits of weight loss or intensive lifestyle interventions need to be read with a critical eye. For example, the Look AHEAD research study (Look AHEAD Research Group, 2014) is often used as “proof” that long-term weight loss is indeed possible and beneficial to health, specifically for people with type 2 diabetes. However, take a read through Look AHEAD’s 2014 research article, and assess whether they actually prove this point.
- Do you think that the weight loss presented as “clinically meaningful” in this article would be meaningful in someone’s life?
- Are the behaviours that are presented as important to weight loss in this study sustainable or health-promoting in the long-term? You can think about your own life here, or for others you know.
- Does this study adequately assess the risk of disordered eating or any other known risks of dieting?
- The Look AHEAD study was halted early due to the intensive lifestyle intervention not having significant positive impacts on cardiovascular risk (the trial’s primary outcome measure). What does this suggest for this and other weight-centric interventions?
- Is there anything else you notice about this study that challenges what you thought you knew about weight loss and health?
Fatness and COVID-19
One current example of the real-world impacts of normative weight science on fat people is the treatment of fatness in the context of the continuing COVID-19 pandemic.
From the beginning of the pandemic, reporting suggested that “obesity” was a key risk factor in severe COVID-19 illness and death. As Pausé and colleagues (2021) pointed out, this reporting shifted focus and responsibility away from health system change onto fat individuals, who were encouraged to pursue weight loss to reduce their risk. Challenging the framing of COVID risk as determined by personal health behaviours, Pausé et al. (2021) instead framed this issue as one of health justice and equity.
Building on this argument, Bessey and Brady (2021) highlighted how Canadian media coverage of COVID-19 and “obesity” reinforced individual responsibility for poor outcomes following infection with the virus, and emphasized medicalizing and moralizing messages about fatness. Further, media coverage discursively constructed “obesity” as a result of health behaviours, leading body weight to be considered a “modifiable” risk factor for COVID-19. These findings point to the need for policies and guidelines around anti-fat bias in media reporting.
Example
One early example of activist responses to this stigmatizing rhetoric around fatness and COVID-19, and the accompanying mistreatment of fat people, is the #NoBodyIsDisposable (2020b) campaign, which originated as resistance to triage discrimination against fat people, disabled people, chronically ill people, elderly people, and others, early in the COVID-19 pandemic.
In her article Even During a Pandemic, Fatphobia Won’t Take a Day Off, Claudia Cortese (2020) outlined the pervasive fatphobia occurring in the midst of (and prior to) the COVID-19 pandemic and highlights the #NoBodyisDisposable campaign in response.
#NoBodyIsDisposable also put together a toolkit for surviving triage discrimination (2020a), including advocacy strategies, sample letters to give health care providers, and resources.
Reflection Questions
- What have you been led to believe about the relationship about fatness and COVID-19?
- How have these messages impacted your own relationship to your body during the COVID-19 pandemic?
- What role have eugenics-based ideologies of anti-fatness, ableism, and racism played in the social construction of the supposed “end” of the pandemic, despite the continued high rate of spread of the virus and its accompanying negative impacts on health and mortality (John Snow Project Editorial Group, 2023)?
A line drawing by Allison Tunis of community member and writer, Phillip Barragán, his partner, and friends at an accessibility conference. Phillip is using a power chair, two friends are using mobility scooters, and two are standing. The image shows disabled and able-bodied people living their lives and engaging in everyday fun.
