The society doesn’t exactly make things easy for people who are deemed overweight. Fat, obese, whatever. Every day in schools, colleges, workplaces and often even in their own homes, fat people are called names and are shamed – sometimes with casual nonchalance, at other times with studied cruelty. People who are overweight are sometimes (often?) labelled ‘fat and useless,’ get looked at with disgust, are sniggered at, are excluded, left out, laughed at, spoken to in a condescending manner and made to feel bad about themselves. It’s as if every thin person on the planet has an automatic, God-given right to talk down to those who are overweight. And since ‘fat shaming’ is a global, universal phenomenon, those who are overweight quickly learn to acquiesce, compromising any dignity or self-respect they might happen to be left with. Crack jokes and laugh at a fat person’s weight and they will usually pretend to laugh along with you. Because, hey, aren’t those jokes really funny?
While they are constantly, relentlessly judged in every social situation, fat people also get unsolicited advice all the time. Eat less. Join a gym. Go for a run. Don’t eat carbs. Go on a diet. Try bariatric surgery. This advice doesn’t necessarily come from doctors or other medically-qualified professionals, but from anyone and everyone who only accomplishment in life is that they happen to be thin. For people who are overweight, the world can be a constant barrage of barbs, half-baked and often misguided advice, unfair judgement, societal exclusion and all-around derision. The vast majority of fat people keep quiet – they learn to suffer in stoic silence, perhaps in the interest of keeping the peace, or maybe simply because they are deeply tired of dealing with the crap that’s dished out to them all the time. There is often immense anger, a deep-seated rage, a burning desire to hit back, but more often than not these feelings remain bottled up, get brushed under the carpet. Emotional and psychological distress? If you’re fat, who cares?The thing is, being fat isn’t necessarily as simple as 2+2=4. Every fat person isn’t fat simply because they’re eating too much and getting insufficient exercise. Being overweight can be due to a variety of physiological reasons – often compounded by psychological factors – that can only be understood by those with medical qualifications; others are not qualified to comment or offer advice. Fat people aren’t necessarily lazy, inefficient, dumb or bad at what they do. And they certainly do not owe the world an apology for being the way they are. You’d expect medical professionals to understand and offer empathy, but even that isn’t the case. Dr Rajeev Kurapati’s book, The Book of Body Positivity, highlights the fact that when it comes to fat shaming and discrimination, most healthcare professionals are actually part of the problem. ‘We assume doctors and medical professionals know it all, and that policymakers in public health have the best interests of society in mind. Unfortunately, many of these assumptions are incorrect. The Book of Body Positivity explains why the measures to control the so-called obesity epidemic have failed. With a penetrating critique of the current practice of medicine, this book is an astute guide to contemporary fragmented science centred around weight and health,’ says the publisher’s note.
Here are some excerpts from the book:
The stigma surrounding plus-sized patients is pervasive and is regrettably exacerbated by medical professionals. In a study entitled ‘Primary Care Physicians’ Attitudes about Obesity and Its Treatment’, researchers analysed 620 physicians’ responses to a questionnaire. They concluded that ‘physicians view obesity largely as a behavioural problem and share the broader society’s negative stereotypes about their attributes of obese persons’. Simply put, despite their medical training, healthcare professionals judge and stigmatize obese individuals as much as the general public does.
Numerous studies analysed overweight and obese individuals in their respective healthcare settings to understand more about existing biases towards weight. It was found that healthcare settings are, in fact, a significant source of discrimination. In a 2006 survey, heavy individuals were asked to rank the possible sources of obesity bias in order of frequency. It turned out that physicians were rated the second most common, with family members topping the list. Younger obese women reported more stigma compared to their older counterparts. The same study reported that half of the women received inappropriate comments from their physicians regarding their weight.
Research also shows that discrimination touches all disciplines in the field. Weight stigmatization has been documented among dieticians and even mental health specialists. This stigma significantly deters obese patients from seeking and receiving the medical care they need and deserve. In another study, obese participants reported that they avoid booking a future appointment with the clinic because they fear that their physician will reproach them if they have gained weight recently. Sadly, this bias developed even before the medical professionals stepped into their official roles. Both self-reported and experimental research showed that obese and overweight patients were labelled, stereotyped and discriminated against by medical students, including the views that obese patients are lazy, unmotivated, dishonest, ignorant and non-compliant with suggested treatment.
In a 2009 study published in the Journal of Clinical Nursing, groups of nursing students and registered nurses perceived obesity negatively. The majority of nursing staff found obese individuals ‘shapeless, slow and unattractive’. Half of the questionnaire’s participants felt that obese adults should be put on a diet while in the hospital. More alarmingly, registered nurses displayed more of such negative biases than students. This indicates that negative stereotypes were internalized from a young age when the students were still undergoing medical training and continued throughout their professional careers. In addition, research also revealed that healthcare providers assign less time to obese or overweight patients, build less of a rapport with them and offer fewer educational resources compared to patients of average weight. Studies have shown that even doctors, nurses and nutritionists often overestimate the actual food intake of heavy people.
Due to the gross disrespect these patients feel, along with the feelings of inadequacy and a sense that their health concerns are deliberately neglected, many patients harbour resentment and distrust towards healthcare professionals. Needless to say, this makes patients hesitant or even unwilling to discuss their weight with any medical professional. They might just avoid healthcare settings altogether. Unfortunately, many healthcare professionals are oblivious to their own deep-rooted biases towards heavier patients. Until we address this implicit bias directly within the medical community, educate healthcare professionals and encourage them to question their preconceptions towards their obese patients, the cycle of stigma from healthcare professionals and their mistreatment of patients will continue.
Psychologist Janet Tomiyama observed in a 2018 study that obesity stigma is now ‘more socially acceptable, severe and sometimes more prevalent than racism, sexism, and other forms of bias’. This finding illustrates that today, we judge people based on weight and social status. It also illustrates the emphasis on appearance in our modern society and its impact on a person’s overall well-being when they don’t fit within the supposed ‘average’. Studies show that people subjected to persistent negative stereotypes have a higher risk of developing heart disease and diabetes. When such weight-based stigma gets under their skin, they internalize the pain, profoundly affecting themselves mentally and psychologically. The prejudice these individuals experience increases their likelihood of developing obesity-related illnesses in the future.
In a Brazilian survey of 3621 people with obesity, 72 per cent of respondents reported that family environment is the most hostile environment when it comes to shaming linked to their weight. Stigma at home can be more traumatic than in any other setting. Home is meant to be a haven, a safe space where one can retreat from the harshness and challenges of the external world. The pain of being labelled and degraded by your closest family members can erode someone’s self-esteem and their view of themselves.
For a child or adolescent who lives in a morally damaging home environment, school often becomes their refuge. Or does it? Sadly, for overweight children, school is not a relief from stigma as well. It might begin with taunts on the school bus and continue into the classroom or extracurricular activities. Undoubtedly, these behaviours are incredibly harmful. As they grow older, the perpetrators of these acts continue to stigmatize heavier people, where they will most likely be just as biased. Meanwhile, the affected children will grow into adulthood with the same trauma.
Note: Dr Rajeev Kurapati practices hospital medicine and holds the position of assistant professor of medicine at the University of Kentucky, USA. Triple-board certified, and specializing in obesity and lifestyle medicine, Dr Kurapati is also an award-winning author. His book, The Book of Body Positivity is available on Amazon
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