WILL PEOPLE please stop talking about obesity as if it is just about eating too much and being lazy? This is unhelpful and amounts to fattism, or prejudice against those who have weight problems. Weight bias is as real as sexism and racism.
Studies show that almost two-thirds of fatter people are bullied, made fun of, and discriminated against because of their size. In Ireland, almost one million people are overweight or obese, which means that weight bias is widespread.
Fattism is not new. In 1968, WJ Cahnman's The Stigma of Obesityargued that being fatter is seen as morally reprehensible and a social disgrace. Almost five decades later, weight bias is one of the last forms of socially acceptable prejudices and even seen as necessary. The bias exists because of the incorrect belief that obesity is due to poor self-discipline, and that stigma and shame will motivate people to diet.
Fattism is based on stereotypical views of people with weight problems. Fatter adults are seen as stupid, lazy, ugly, weak willed, incompetent and out of control. Weight bias begins in childhood. Fatter children are bullied, ignored, and excluded from sport and play. A 2011 study of nearly 2,000 teenagers who completed a fat phobia scale, found that a majority agreed or strongly agreed that fatter children are lazy, slow and unattractive. David Cameron, the UK prime minister, recently accused those who “eat too much” of being complicit in creating a culture that lacks self-discipline. Stereotypical views are used to justify treating others with distain, contempt and physical revulsion.
Weight bias has serious medical and psychological consequences. There is strong evidence that, in healthcare settings, doctors and nurses have negative attitudes towards fatter patients who are seen as non-compliant, awkward and unmotivated. Attitudes are particularly judgmental in the obstetrics and gynaecology setting. More than two- thirds of nurses think that personal choices are to blame for a patient’s weight problems. Even dietitians, who should know better, see overweight patients as lazy and able to lose weight if they really want to. This prejudice means that fatter people are less likely to attend for screening and prevention programmes.
The media is extremely negative towards fatter people. Over the past several years, news coverage on obesity has increased dramatically and is invariably framed in terms of personal responsibility. An analysis of 751 articles in the New York Timesshowed that obesity is presented as a moral panic where blame is placed on the individual. A 2011 study on news stories about obesity showed that almost three-quarters were stigmatising. Overweight and obese people were 23 times more likely to have their heads cut out of photographs and significantly more likely to be portrayed showing only their abdomens and lower bodies. They were also more likely to be photographed in skimpy clothing and from the side or rear to ensure the viewer sees the rolls of fat. Normal weight people were never shown in this way.
Stigma is a known enemy of public health and occurs when people are blamed for their illness. The social construct of any disease incorporates moral judgments about the way it is contracted. In the case of TB and Aids/HIV, the effects of stigma are included as part of an effective public health response. Despite five decades of weight stigma, no attention is paid to it as a public health issue.
Weight bias is not an effective tool for changing health behaviour. Contrary to popular belief, it does not motivate people to eat less and exercise more. There is strong evidence that weight bias leads to binge eating and a refusal to diet. It also reduces motivation and participation in physical activity. One study of 2,400 fatter women found that 80 per cent coped with weight stigma by eating more food.
Over the past 50 years or so, we have created a biology-environment mismatch, where human weight regulation has not evolved fast enough to keep pace with environmental change. This is the reality, yet the media depicts weight as being easily modifiable and a matter of personal choice. Average long-term weight loss with existing dietary programmes is about 6 per cent of overall body weight. Most people regain all the lost weight within five years because of environmental influences. It is unfair to pretend otherwise.
The way obesity is talked about now is not helping anyone. The only effective public health response is to eliminate weight bias as a matter of social justice.
Dr Jacky Jones is a former regional manager of health promotion with the HSE