Body size is medicalized and pathologized in our society, including within health care. Bodies above a certain weight are labelled “obese,” which is a term derived from the Latin word obesus meaning “that has eaten itself fat.” This term frames people as an affliction or a condition to be cured, rather than a human being; this has been further reinforced by the recent re-definition of “obesity” as a disease in many countries. Although “obesity” is still frequently measured based on BMI, there have been moves in the health care field to find “better” ways of measuring supposedly pathological fatness, such as the Edmonton Obesity Staging System (EOSS) (Swaleh et al., 2021). Advocates argue that the EOSS allows for more accurate assessment of “obesity”-related comorbidities, beyond someone’s body weight or BMI (e.g., Swaleh et al., 2021). However, these efforts ignore the fact that the main issue with diagnostic tools like BMI is not their inability to accurately diagnose “obesity,” but their eugenist and racist history (Your Fat Friend, 2019), and the idea of treating fatness as a disease in the first place (Mercedes, 2022). Letting go of the need to categorize bodies into “healthy” and “unhealthy” would be to the benefit of all.
Although many who work in the area of “obesity medicine” argue that medicalization helps to counter weight stigma by reframing high body weight as a disease rather than as some sort of individual failing, we can look to other “conditions” that have been medicalized to see that that is not the case. For example, hysteria was a discriminatory diagnostic label foisted on women who were deemed pathological or out-of-control, in an attempt to discipline their non-normative embodiments and to justify violent “treatment” plans (Blanchette, 2020). In a narrative analysis project from fat studies researcher Cat Pausé (2014), a participant recognizes that reconceptualizing “obesity” as a disease likely reinforces the shame and stigma attached to fat bodies:
Somehow the association between obesity and chronic medical conditions like heart disease and diabetes has only given people more ammunition to voice judgment. Now people think it is acceptable to comment on your weight because they are worried about your health. I don’t buy it. I think it is still about fat shame and judgment. People don’t look at me with sympathy and say things like “Poor thing, she must be sick.” They look at me with disgust and hatred (Pausé, 2014, p. 136).
Video: Wings by C. J.
Furthermore, the diagnosis of “obesity” has been used to justify the use of weight loss surgeries (sometimes called bariatric, metabolic, or “obesity” surgeries) to “treat” the pathology of “obesity.” “Treatments” for conditions like hysteria and “obesity” are framed as medical “solutions” to problems that are inherently social: misogyny, anti-fatness, and other forms of discrimination, as illustrated in C.J.’s story.
In C.J.’s story, Wings, from the Rolls and Race project, she describes her experience growing up as an Indigenous person in a predominantly white community. Although she did not notice that she was different as a child, her otherness became more obvious to her at nine-years-old when a white child told her she looked like a maid and wasn’t allowed to come to her house. This led C.J. to diet, to exercise punitively, to avoid sunbathing to keep her skin lighter, and to seek plastic surgery in an attempt to assimilate into the white, thin norm. C.J.’s story highlights the entanglements of white normativity, anti-fatness, and medical interventions to “correct” supposed flaws.
Reflection Questions
- How do classism and racism intersect in C.J.’s story? Does being upper-class impact the racism and exclusion that C.J. experiences?
- How does C.J.’s relationship with her body, her fatness, and her ethnicity evolve over time? Why do you think moving to Canada ultimately impacted this relationship positively?
- What do you think the painting C.J. is doing in her video represents? How do you interpret the image?
Medicalization also contributes to certain populations being framed as more “at risk” than others—for example, women, racialized and Indigenous people, trans and gender non-conforming people, and working class/poor people (Friedman et al., 2020). Framing these groups as “at risk” often adds to the stigma already faced by these marginalized peoples, as discussed by Friedman et al. (2020, p. 2):
Although the construction of risk populations in public health and medical research is intended to bring increased attention and resources to identified groups, such focus often reproduces essentialist stereotypes about the behaviours, knowledge, intelligence and embodiments of the populations targeted (McPhail, 2013; McPhail et al., 2016; Rail & Jette, 2015), thus subjecting already marginalised people to additional stigma when their bodies are also read as fat (LaMarre et al., 2020).
Weight stigma intersects with other social status markers to restrict fat people’s access to pregnancy and parenthood, often surfacing in reproductive care settings as individual blame for what are socially produced health outcomes (Ward & McPhail, 2019). Blaming the individual serves to “justif[y] the regulation and control of minority and low-income population groups as they are portrayed as the source of the ‘obesity epidemic’ and as deficient, unable, or ill-equipped to make the ‘right’ decisions in regard to their health” (Parsons et al., 2016, p. 603).
Reflection Questions
- Were you aware of the root word for “obese”? Does this change your perception of this term, or of what you’ve previously known about “obesity”?
- How do you see the relationship between medicalization and weight stigma or anti-fatness?
- How do you understand the concept of “risk” and who is defined as a “risky population” in the context of health care?
The Weight of Words by Allison Tunis. A line drawing of a fat person with short hair and a goatee, wearing a tank top and shorts. The person stands on a medical scale next to a speech bubble with the words “resistant, high risk, medicalization, BMI, stigma.” Language around fatness and weight in healthcare settings often reveals anti-fat bias. Judgment and pathologization have negative impacts on health, leading to poorer health outcomes overall.
