Same Anti-Fatness, Different Look: An Analysis of the "Ob*sity Bill of Rights"

Upon first learning of the existence of the “Ob*sity Bill of Rights,” it may be tempting to look upon it as a tool for addressing anti-fatness in healthcare settings. While the packaging is pretty, though, what’s inside isn’t nearly as appealing. I’ve put together an analysis of the contents of the bill, and though this isn’t a complete list, it will hopefully draw attention to some of the document’s glaring issues.

It is very important for me to acknowledge my thin privilege - the ways I do not and never will understand the impact of this bill on fat folks. 

1. It’s Pathologizing

The use of the O-word in the title indicates, right away, that fatness and fat bodies are viewed as a problem to be eradicated. At this point in time, we have mountains of data to support the fact that the correlation between fatness and health problems is overwhelmingly due to the real-life impacts of anti-fat oppression, rather than fat itself as something inherently harmful. With all the research and data available, it is irresponsible at best – and, in many cases, medically negligent – to pathologize fatness as a problem that needs to be solved. This only perpetuates the very anti-fat narratives that threaten the well-being of fat patients in the first place. 

Fat people have insisted, for quite a while, that the word “ob*sity” is a slur that pathologizes and problematizes plus-size bodies. A movement that claims to respect and care for fat patients while using a word identified as a slur by fat communities is obviously not listening to the very people it purports to advocate for.

Additionally, the preamble dangerously perpetuates the idea of fatness being unequivocally harmful, stating that “400,000 people are estimated to die every year from ob*sity.” This language is misleading and entirely inaccurate: a tired assumption that if deaths from conditions such as diabetes and heart disease occur in patients who happen to be fat, their fatness must be the cause. Such assumptions do nothing but further the very narratives about fatness that are so often used to discredit and dehumanize fat people.

2. It Doesn’t Challenge Assumptions Rooted in Anti-Fatness, Instead Passing Them Off as “Information”

The bill states that patients have the right to  “accurate, trusted information in culturally appropriate and easily understandable language that explains obesity as a complex chronic disease requiring personalized treatment” (emphasis added). While it’s indisputable that patients should absolutely have the right to information, what happens when the information they are given – information being taken for granted as tried-and-true fact – is deeply rooted in anti-fatness and, by extension, eugenics, ableism, and white supremacy? Under the guise of informing patients, this item encourages healthcare professionals to coerce fat patients into problematizing their own bodies–a coercion that can be so strong, it can lead patients to agree to certain treatments under duress. Claiming that fatness is a disease requiring treatment leaves fat patients without a voice with which to refuse the pathologization of their bodies. 

3. It Makes False Claims About “Safe & Effective” Weight Loss Treatments

We know by now that intentional weight loss methods simply do not work; the vast majority of those who pursue intentional weight loss regain this weight, and then some, within a few years. Thus, the “safe and effective” treatments mentioned in the bill do not actually exist. This is misleading at best.

It’s important to note that many fat people have spent much of their lives engaging with diets, exercise regimens, and various forms of restriction/starvation in an attempt to make their bodies smaller. For some, these attempts began as early as childhood. We know, though, that when the body is exhausted and depleted in pursuit of the thin ideal, the opposite happens over time. I once worked with a fat adult patient who had engaged in food restriction patterns since elementary school, leading to decades of weight cycling that resulted in a higher weight set point with each cycle. When she realized this, she had an outburst during one of our sessions, exclaiming, “So I anorexiced myself to ob*sity?!” Her experience is not at all uncommon, and it points to the flaws of the claims of “safe and effective” weight loss treatments made by the bill of rights.

4. It Insists On Using Person-First Language “As a Sign of Respect”

While many are taught that person-first language is the most respectful way to talk about marginalized identities, an overwhelming amount of people with those identities, including fat people, caution against its use. A colleague and fat liberation advocate explains it as such:

“For me, person-first language inappropriately distances my fat identity from the reality of my day-to-day life. Referring to me as a 'person with fatness' gives the inaccurate idea that the size of my body isn’t a major part of my identity. It wouldn’t have to be, in a world that didn’t actively hate fat people, but unfortunately that’s not the world we live in. I identify myself as a ‘fat person’ because my fatness is always the first thing people notice about me, and because anti-fat oppression is unequivocally the thing that makes my life the hardest.”

5. It Perpetuates the Eugenicist Notion that Fat People Should Not Exist

We all know what the authors of this bill mean when they refer to “ob*sity treatment:” the eradication of fat bodies. It is this mentality that contributes to poor body image and eating disorders: when we identify certain bodies as “wrong,” people will go to great lengths to avoid looking like them, causing themselves great harm, and sometimes even dying, in the process.

Additionally, it maintains a false binary between ”good fat people” (that is, fat people who spend their lives trying not to be fat) and “bad fat people” (those who do not “obey” societal standards by constantly trying to take up less space). The fat patients described in the bill are all the former: the ones who accept their ob*sity diagnosis and obediently seek “treatment” for the alleged wrongness of their body in an attempt to make it smaller. Perpetuation of this binary unequivocally causes harm – particularly to the "bad" fat people who choose not to pursue intentional weight loss – making anti-fat discrimination in healthcare settings far more likely for these patients, who are often slapped with labels such as "non-compliant" that can cause insurance companies to restrict their access to many different types of care.  

6. It Entirely Misses the Real Problem with Anti-Fatness in Healthcare

Nowhere in this bill are any conditions mentioned that aren’t correlated with fatness; yet, this is what so many people in large bodies struggle with. I hear horror stories from people about going to the doctor for an earache and being lectured about weight loss. The same colleague who I quoted about person-first language spent decades of their life with chronic pain that was blamed on their fatness. It wasn’t until age 38 that they were finally diagnosed with a progressive disability – a disability that, due to lack of treatment, has severely impacted their ability to stand and walk. Their diagnosis could have come so much sooner, and their mobility could have been preserved, if doctors had been able to look beyond their fatness and actually evaluate their symptoms, the way they would for a thin patient.

These problems are so common, nearly every fat patient can tell you a similar story–yet the bill of rights doesn’t even mention them. Instead, everything it advocates for has to do with fat people receiving treatment so that they can somehow magically not be fat anymore. It doesn’t address anti-fatness within healthcare – instead, it perpetuates it.

Make no mistake: while the Ob*sity Bill of Rights may appear to have the interests of fat patients in mind, it essentially only functions as yet another tool of anti-fat oppression. Rather than attempting to pathologize fatness and “treat” fat people out of existence, those whose care practices are truly rooted in freedom from oppression would do well to take the bill with a heaping tablespoon of salt and treat their patients like diverse human beings instead of walking, talking diagnoses.

The Whale, Brendan Fraser, and Fat Representation: How Tired, Uncreative, and Harmful Tropes Perpetuate Eating Disorders

Several weeks ago, I happened to see the speech Brendan Fraser gave after winning an Academy Award for his latest film, The Whale. Having heard some concerning reports about the film itself, I’d decided against seeing it, but even Fraser’s acceptance speech was peppered with whale references. I was outraged, and as it turns out, I wasn’t the only one: Ragen Chastain of Dances With Fat tweeted that “Brendan Fraser making whale metaphors (jokes, really) while accepting an Oscar for cosplaying a fatter person in a film written and directed by thin people that rests on grotesque weight stigma, ableism, homophobia, and stereotypes is the end of my support for him.” Regardless of your feelings about the actor himself, there’s little doubt that The Whale leans on a stereotypical – and incredibly harmful – trope: that fat is the worst thing a person can be.

It is, of course, entirely possible for a person to exist in a fat body and still experience love, happiness, joy, fulfillment, health, and connection. Yet, looking at movies like The Whale, is it any wonder that so few people realize this is true? Representation of fat folks, particularly those on the larger end of the spectrum, is almost always limited to narratives like this, with fat people being portrayed as sad stories, wells of unrealized potential, or cautionary tales. Where are the movies about fat people experiencing elation, being promoted, falling in love, or living long and happy lives? 

This lack of representation only feeds into the idea that fatness is inherently bad–a paradigm which drives body dysmorphia and harmful patterns of disordered eating. For all the patients I’ve been able to help in my practice, there are others who make the choice to cease treatment, due solely to a fear of their body becoming larger as a result of recovery. These are people who are fully aware that their eating disorder is on the path to killing them, and do not pursue healing out of a fear of becoming fat. And yet their fear is real and their feared consequences are a reality. These moments are heartbreaking. There is pain in their voices: deep sadness, utter weariness. They know the decision they are making, the position they are putting their health in, and the dangerous consequences. But oppressive systems are insidious and oh-so-strong, and fatphobia is no exception. Patients tell me time and time again that our eating disorders clinic is the only space that supports their right for food liberation and nourishment and a weight restored body.

We won’t see an end, or even a reduction, in disordered eating behaviors until we, as a society, stop demonizing and dehumanizing fat people. In many ways, fatphobic discrimination and weight bias are still entirely socially accepted, even in a culture which is (far too slowly) moving toward curbing discrimination for other marginalized groups. For example, it is legal in 49 states to fire a person for being fat. Despite the very real consequences of, and casualties resulting from, fatphobia and weight stigma, body size is not considered a protected class, the way race, gender, and sexual orientation are, to name a few. The very fact that this is the case points to how socially, and even legally, sanctioned fatphobia is–and why so many people are so afraid of gaining weight.

The movement toward fat liberation is full of incredible people offering a wealth of resources for unpacking and untangling our own internalized fatphobia. Check out the following folks for (much, much) more information! 

Da’Shaun Harrison

• Website: https://dashaunharrison.com 
• Book: Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness

Aubrey Gordon

• Book: “You Just Need to Lose Weight” and 19 Other Myths About Fat People
• Podcast: Maintenance Phase

Sonya Renee Taylor

• Website: https://www.sonyareneetaylor.com 
• Book: The Body is Not an Apology

Ragen Chastain

• Website: https://danceswithfat.org
• Twitter: @danceswithfat

Lindley Ashline

• Website: https://bodyliberationphotos.com
• Twitter: @lindleyashline

Sonalee Rashatwar

• Website: https://www.sonaleer.com
• Instagram: @thefatsextherapist

Asher Larmie

• Website: https://www.fatdoctor.co.uk
• Podcast: The Fat Doctor

How Weight Stigma is Leading to a Less Kind World: Breaking Down the Myths Around Weight

They’re just lazy, unmotivated and they lack discipline. They must really not care about themselves. If they don’t care, why should I care about them?

These are some of the thoughts going through our minds when we come across someone in a large body. 

And yet, we don’t know this person at all. As Marilyn Wann says “ When you see a fat person, the only thing you know is your level of weight stigma”. Also isn’t it also none of your business why a person has the body they have?

Weight Stigma is Rampant

Weight Stigma is ​​prejudice or discrimination on the grounds of a person's size or weight. It’s a widespread problem leading to discrimination, violence, bullying, high stress levels, and unhealthy, disordered eating. Just like any other form of prejudice, it causes harm to those it impacts. 

Weight stigma plagues our world. Over 40% of US adults report weight stigma and body shaming, across all body types and weights. 

Weight Stigma also impacts children. Adolescents are bullied for many reasons. Tack on body shaming due to weight and it’s a rough ride. 71% of adolescents reported some form of weight shaming abuse over the last year alone. 

It leads to eating disorders and other self-harm behaviors. Because there’s such a stigma and bias towards folx in large bodies, they are bullied, mistreated, and harmed. It leads to increased stress levels and suicide. The impact is huge and it’s disheartening. 

Even their doctors assume the worst….assuming patients are unhealthy due to their weight without even assessing health behaviors. This type of shaming leads them to believe they are failing. They avoid return visits to the doctor. They feel ashamed and don’t want to be seen. 

Avoiding doctor visits leads to even worse health outcomes including death. This is not an ethical way of helping individuals. 

There has to be a better way. We need to unpack and rethink how we view bodies. Weight isn’t an indicator of health. Nor is it a holistic way of viewing health. 

Let’s start by debunking some myths about weight.

Myth One: Weight is an Accurate Measure of Health

alone, it’s only one number to be considered when evaluating a patient.

Researchers found “no clear relationship between weight loss and health outcomes.” Shedding weight doesn’t meaningfully lower blood pressure, diabetes risk, or cholesterol.

Instead of obsessing about one number, weight, we should be encouraging nourishing and connecting behaviors instead. 

Encouraging patients, friends, and loved ones to be in community, eat and produce foods together, get good sleep, and have a balance of self-care and collective care is more valuable. 

Let’s create welcoming spaces for all bodies. 

Let’s retool our culture and society to value holistic health. Not one metric….that doesn’t accurately measure health.

Myth Two: Fat People Aren’t Fit

I train in martial arts. In 2019, I presented with one of my training partners at a martial arts teachers’ conference on weight stigma in martial arts. We interviewed numerous people in large bodies sharing their experience of weight stigma in martial arts. Many of the people interviewed have advanced belts, some even more than one black belt. All people discussed having experiences where training partners, teachers, and tournament judges assumed they lacked skills due to their size. They also expressed being told that martial arts could lead to weight loss as opposed to skill and confidence development. Lastly, many expressed that they assumed they could take more physical contact due to their large body.

How sad and upsetting that we continue to focus on weight loss instead of the intrinsic and community benefits of physical activity and movement.

Researchers have found that losing pounds doesn’t always lead to healthy gains. 
Hunger points to a meta-analysis that found that even after dieters lost weight, their blood pressure, glucose, and other blood markers weren’t significantly better when they were reevaluated two years later.

A New View: Redefining how we hold Health

I am including this piece from ASDAH- Association of Size Diversity and Health as it articulates so powerfully how we need to hold weight, health and inclusivity
https://asdah.org/health-at-every-size-haes-approach/

“The Association for Size Diversity and Health (ASDAH) affirms a holistic definition of health, which cannot be characterized as the absence of physical or mental illness, limitation, or disease. Rather, health exists on a continuum that varies with time and circumstance for each individual. Health should be conceived as a resource or capacity available to all regardless of health condition or ability level, and not as an outcome or objective of living. Pursuing health is neither a moral imperative nor an individual obligation, and health status should never be used to judge, oppress, or determine the value of an individual.”

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