Weight bias has no place in society, much less in medicine. 

This week, an obesity management physician fat-shamed two scholars in obesity research and called into question their expert status in the field in part due to their physicality. At an obesity research conference. If you haven’t seen it, an excellent recap of the events and an even more excellent rebuttal by Dr. Yoni Freedhoff can be found here.

If you think this kind of talk is uncommon, the reality is that our society is saturated with body negative, weight-biased messages. Most of it is so normalized (like asking “do I look fat in this?” or “you can afford to eat that, you’re thin”) that we don’t bat an eye. It is unsurprising, then, that despite a growing wealth of knowledge of the myriad factors contributing to obesity  – primarily our food environment, social determinants of health, and genetics- 75% of Americans still believe that obesity is due to a lack of willpower; essentially, the vast majority of adults believe that individuals of size are wholly responsible for their health outcomes. A person’s weight and size are unfairly equated with morality and competence, value judgements no longer (acceptably) made about other physical attributes. These messages and phrases are discriminatory and full of blame, and, knowingly or not, intended to make individuals feel bad simply for living in their bodies.

On a population level, weight and BMI can tell us about risk for developing chronic disease but as I’ve said before, weight is only one small factor in determining an individual’s health risks; BMI for individuals tells us even less. What do we really know by someone’s weight or size? How much the earth’s gravity pulls on them, and that’s about it. What *should* a person weigh? There are calculations and tables out there, but the answer is far from that simple. The most accurate answer includes factors like what type of lifestyle is fulfilling mental and physically for them, and what is their genetic background; I’ve never seen and ideal weight chart even hint at that. Does obesity always need to be “treated” (i.e. should large people always be trying to become smaller)? Unless a person is ill or impaired, no. Bodies come in all shapes and sizes, all equally deserving of love, caring, and respect.

I say all this as a thin, white, middle class person who works in obesity management, including surgery. I enjoy a tremendous privilege when it comes to body type, and I know that this privilege comes at the cost of the value and self-worth of others.

 

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