Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
6 Jun

The Stigma of Obesity

ingroupoutgroupOne of the things I love about positive-focused healthy lifestyle communities (like but not limited to MDA) is the genuine support that exists for people to take charge of their well-being. It’s the collective excitement when others transform their bodies and health. It’s the willingness to offer help and advice, personal anecdotes and perspective to those beginning their journeys or struggling with the process. In the bigger framework of society, and even occasionally in these positive communities, however, weight-related stigma still holds sway. In these more subtle demonstrations, it becomes a sort of “if you’d only do X” assumption, a looking down one’s nose at someone else’s grocery cart or an unconscious judging that faintly influences impressions and interactions.

We live, of course, in a culture, obsessed by body image and weight. Celebrities are skewered on the covers of magazines for gaining (or losing) weight. Advertisements for diet products, often designed with questionable taste, are at every street corner and commercial break. For weekly entertainment, we watch obese people battle their weight on T.V., ominous music and trainers screaming in the background. Within this swirl of society jokes, cultural judgment, and media images, the obesity/overweight stigma is ubiquitous. Far beyond the intention to help, the function becomes to exploit. Outside any interest in being supportive, the focus becomes voyeuristic and, at times, self-congratulatory.

Some say the obesity/overweight stigma is the last allowable prejudice. Although I think there’s enough animosity and judgmentalism in the world to debate the statement itself, I understand the central point. Researchers have time and again measured the “anti-fat bias” (effects ranging from outright discrimination to unconscious stereotyping) at work in everything from employment to health care. Obesity/overweight stigma figures into the collective consciousness far more than we often give it credit for – lurking in places and people we’d assume would be immune to its effects.

Physicians themselves, numerous studies show, demonstrate a significant anti-fat bias. Just a few weeks ago, a published study reported 40% of medical students demonstrated an unconscious weight bias. Research has illuminated anti-fat bias in therapists and even health professionals within obesity related specialties.

With all this, research shows primary physicians are offering less weight loss counseling to their patients – particularly those with high blood pressure or diabetes. Karen Hitchcock, a physician who works in an obesity clinic with a bariatric surgeon’s group, offers a candid and surprisingly personal glimpse at the discomfort of a physician who struggles with counseling her patients: “The emotion in the room thickens; I am acutely aware of the shame my patients feel.” As critical as the need is for honest consultation, her perspective is hard to dismiss.

Finally, the kicker. Research shows that the social bias remains even after people lose weight – and can be as strong against those who were obese and lost their excess weight as as it for people who are currently obese. As someone in the health and weight loss business, this is the hardest to hear. I can’t quite imagine what it’s like for a person who actually experiences that bias.

I think it’s clear I believe in people taking personal responsibility for their health and well-being. That said, I also understand the reasons for obesity are varied and complicated. Genetics do play a role, and for some people it simply takes more effort. Thyroid, other hormonal issues, and even toxin exposure can throw a wrench in the best weight management endeavors. On a cultural level, too many people have little access to fresh food and even fewer to real nutrition education. Too many grow up with the unchallenged influence of incessant junk food marketing and perhaps poor familial modeling at home and school. As Karen Hitchcock suggests, “We live in a society that judges people for being fat, yet has in place every possible means for making them so.”

Physiology is physiology. The biological facts behind obesity are constant, yes. The personal picture of one’s weight – not to mention each person’s experience of it – however, is much more complex than any stereotype or momentary judgment can begin to tell.

When we simplify other people’s stories, I think the person we end up diminishing is ourselves. My mother used to constantly say “Worry about yourself.” Sure, it was generally in response to sibling quarrels or school yard gossip, but it gained dimension as I grew older. To this day, it’s one of the most abiding pieces of wisdom I’ve ever come across. It doesn’t mean of course, don’t appreciate other people or help where and when you can. After all, life is about connection. Happiness and health are about connection. That said, we miss the point when we bring a self-grandiosity or condescension to that engagement. We do better when our support for others comes from a place of personal humility.

If we’ve been successful in losing or managing our weight, that’s a great accomplishment. If we’re working on it, we’re worthy of respect and genuine support in our efforts. If we’re not to that point yet, we’re still worthy of the same respect. It’s been my observation people are more inclined to invest in themselves – and believe in the support of others – when they believe in their own worthiness. When we choose to question the obesity stigma, whether we’ve ever personally fit that category or not, we value – for ourselves and others – living as healthy but also “whole” people. That’s, to me, the best endeavor for thriving.

Thanks for reading today, everyone. I hope you’ll share your thoughts and comments on the obesity/overweight stigma. Have a great end to the week.

You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. You are displaying the very attitude outlined in this article. Why on earth would you presume to give (unsolicited) “advice” to this poster about her mother? You know NOTHING about the situation! I found your post incredibly arrogant.

    Sahara wrote on June 6th, 2013
  2. I agree with Sahara: it also reflects the dogmatic insistence that key to losing weight is just simply lowering calories, and fat people just need to eat less. As Taubes and many others have pointed out, that’s not the real story, and it’s based in ignorance and arrogance.

    Louise wrote on June 6th, 2013
  3. Or it could be that she is not eating enough. I began my journey through/towards menopause and found that I could eat very little and still gain weight.
    Migraines are at times a result in changing hormones that occur in women several times in our lives. With those changes in hormones come weight gain even with smaller portions or fewer meals. What helped me is eating more food along with upping my protein and fat intake. It’s been about 20 years since I started on that journey and I’ve been able to finally lose the 35 pounds I gained during those years bit by bit. Yay, I weigh now what I did when I got married 35 years ago.

    2Rae wrote on June 6th, 2013
  4. After menopause, I could eat as little as 1,000 calories a day and not lose weight, because I was eating the wrong foods. The old conventional wisdom about “smaller portions” was insanity. I had “dieted” (Weight Watchers etc) for years, doing the things Mark rails against – chronic cardio, eating low-fat and high-carb, and at most I lost 1.5 pounds and then gained it back. Even with a six-month “blast” of still more cardio and less food, nothing changed. Up and down by 1 or two pounds.
    Instead, I changed to primal/paleo eating, and I eat much MORE while losing weight! It’s astonishing!
    IT’S NOT HOW MUCH YOU EAT, IT’S WHAT YOU EAT.

    In addition, there ARE many medications that make people gain weight. Making them feel worse is not a kind thing to do.

    Celestia wrote on June 7th, 2013
  5. Let me qualify “it’s not how much you eat, it’s what you eat.” Obviously you won’t lose weight eating pounds of bacon every day. The thing about the primal way, though, is that you are not as hungry. I used to have to eat every three hours or I literally felt sick, like I was going to faint. I woke up starved. Eating primal, my body seems to know what it needs. (And as an aside, fasting is pretty easy now!).

    Celestia wrote on June 7th, 2013
  6. Celestia- actually, yes, you would lose pounds from eating bacon if you cut out carbs. It’s called ketosis and occurs when you consume moderate amounts of protein with high amounts of fat and low or no carbs at all. Bacon is especially preferable for this since it has a great fat to protein ratio. Obviously you would be malnourished if you didn’t include organs and even greens or occasional vegetables, but you certainly would lose weight and the amount would be significant. It would be fat loss and not muscle loss.

    Christina wrote on June 8th, 2013
  7. Actually, it’s not that simple. The Law of Thermodynamics does not apply to metabolism and weight gain/loss. A calorie is not a calorie (see http://www.huffingtonpost.com/robert-lustig-md/sugar-toxic_b_2759564.html). Please give up trying to justify your earlier comment and apologize to PotAsh.

    ARB wrote on June 6th, 2013
  8. I find this response a bit simplistic in nature.

    Focusing on the first statement only, I can safely tell you that not all calories are equal. I lost weight ingesting the same number of calories, instead changing what I ate.

    Mark had a great article on here illustrating that not all calories are the same.

    Converting calories from carbs to protein resulted in a 63 pound weight loss with no additional exercise (meaning I went from no exercise to no exercise), yet I was still eating around 3k calories a day.

    If you have not experienced the carb cycle to oblivion and how it impacts you on a physical and emotional level, I’m not sure you can relate. Carb addiction is brutal, especially when CW tells you, you are doing the right thing. How can you “change” if you don’t even know what you are supposed to change? At that point, then your statement on change from within becomes more relevant. The common theme in most of Mark’s success stories is the journey involving failed attempts at change. The cards were stacked against them.

    I didn’t even realize what I needed to change until I read a book that focused on the effects of your diet on your liver and that affects you all the way down to your metabolism, since I had fatty infiltration of the liver. At that point I finally knew what I needed to do, the recommendations made some much sense. It was paleo and primal on so many levels without even making a direct connection.

    Doug wrote on June 6th, 2013
  9. Physics may be inescapable, but we’re not just dealing with physics when it comes to an individual’s weight. We’re also dealing with biochemistry, genetics, hormones, and a few other things tossed in that all interact. Portion/calorie restriction coupled with increased exercise just does not yield anything close to consistent results under scientific research. If it did, there would not be as much debate in the medical and scientific communities as there is.

    b2curious wrote on June 6th, 2013
  10. “People who consume copious pounds of food relative to their energy needs become overweight.”

    Actually, I did the math on my weight issues, and if you use the over simplified calories in, calories out paradigm, I “over consumed” 32 extra calories a day for years, which amounted to 3 to 4 pounds a year of weight gain.

    Felix, do you actually know when you eat 32 calories more or less than you should? You must be a computer and weigh every single bite you put in your mouth. (And if I wasn’t nicer, I would now add a few of those names that you were objecting to earlier.)

    MDrake wrote on June 6th, 2013
  11. Oh well, now it’s all better. I will just change the way I feel and… nope my lungs still don’t work.

    Darn. I was so sure that would work. After all no one has ever ever told me it was all my attitude before. That was a fresh and new insight.

    Gracie wrote on June 6th, 2013
  12. No

    John wrote on June 6th, 2013
  13. Yes!

    patrick wrote on June 7th, 2013
  14. Yes. But if I judge Hitler to be a monster, is this a-holey of me to do? Judging does not equal being a jerk. But one can be a jerk by how one judges, who one chooses to be hard on.

    Joy Beer wrote on June 11th, 2013
  15. Yes.

    oxide wrote on June 6th, 2013
  16. Felix,
    I agree with you that name calling isn’t supportive, much less corrective. It is my hope that people will learn to disagree without the use of personal attacks. It makes for an open and respectful place for the exchange of ideas, opinions, and debate.

    Great article Mark. I appreciate the insight. I have been thin (by thin i mean I was “straight size.” No curves, and could have continued as a model if I were a bit taller) almost all of my life. When I turned 25, it became apparent that I could no longer survive on Doritos and Coke products and look relatively healthy. I understand the bias that one experiences in going from thin to thicker (I’m not overweight by my doctor’s charts, but I don’t carry weight well). I did not understand the psychological effects of the reverse process. I was once told that I was getting fat when I gained up to a total body weight of 100 lbs at a height of 5’4. You could see my hips and ribs sticking out for goodness sake! There wasn’t anything wrong with my weight, just my lack of muscle mass. Now I know the difference.
    Either way, I hope and pray for emotional and spiritual healing for those that have experienced the fear and pain of being ostracized for their physical appearance.

    My motto: You are separate, unique, and whole. You are never required to fit into someone else’s ideal. Even those people don’t fit into their own ideals. Realize that you are Separate – not created from the same mold as another person, Unique – different, with wonderful qualities that were meant for you and that would not be ‘right’ on anyone else, and Whole – you are complete as you are, you don’t need to model your personality, hopes, or body type after someone else to be acceptable.

    Ginny wrote on June 6th, 2013
  17. Edited:

    “Yep. I realized recently that there is no one magic community where everyone is perfectly open and nice to each other all the time. Some people are going to [needlessly belittle other people and/or their actions to somehow make themselves feel better about themselves] no matter what community they are in.”

    cTo wrote on June 6th, 2013
  18. ya know what, Felix? you’re making a lot of fuss by taking something out of context. Gracie wrote above that people treat her badly because she’s overweight due to a medical condition. those people are assholes. i replied to her comment when this article had four comments only….

    if you construed that to mean i called anyone HERE an asshole, i wonder why?

    in my second comment, not in reply to anyone else’s, i noted that EVEN HERE– where the tone is generally considerate and supportive — people who struggle with their weight are sometimes looked-down-upon. considering the size of Mark’s community, it’s a tribute to his (and his staff’s) characters that the number of unpleasant commenters is so very small.

    tess wrote on June 7th, 2013
  19. @Taco I’m obese and agree with you. Food is my drug of choice and unfortunately it’s not something I can stop cold turkey, unlike cocaine or alcohol food is needed daily.

    As far as paying more insurance for high risk behavior I also agree with you and would like to include risky sexual behavior along with the fatties, drunks & druggies.

    Lucylu wrote on June 6th, 2013
  20. Well, that’s actually not true. Does that fat 4 year old have to blame themselves, or their parents? There are many issues such as hormones or medications that affect your weight regardless of calorie balance.

    Also, once you have been fat, ESPECIALLY if you were fat as a child or teen when most of your fat cells are created, it is especially hard to lose the weight. In “Refuse to Regain” by Dr. Barbara Berkeley, she notes that people who are “formerly overweight” have a much more difficult time maintaining weight than those who are “never overweight”. This is primarily due to insulin and how the body processes carbs (also why low carb works well for people who were overweight). Meaning, we can permanently damage our bodies with what we eat.

    But I go back to the start – so if we know a fat 25 year old who was fat at age four, it’s all their fault?

    Marcia wrote on June 6th, 2013
  21. Taco, once I would have agreed with every word you wrote, and I still agree with some of it. I don’t like the rationalizing and excuse-making that’s so common among obese people, or that some of them pretend to be satisfied with their obesity. On the other hand, I’ve learned that there are many reasons for being fat and just as many reasons for why it’s sometimes very hard to lose that fat. I also realized that being judgmental and feeling smug about my thinness spoke volumes about my own flaws. I have since developed considerably more compassion regarding the difficulties fat people face.

    Shary wrote on June 6th, 2013
  22. Hey Taco,
    It always used to irk me to have to pay medical insurance premiums month after month and never use any benefits from it. But actually, what better blessing is there? Be glad you aren’t fat.

    By your logic people with genetic diseases or just the genes for such diseases should have to pay more. Or go one further, if you partake in any risky behavior like drinking on an occassional night out, you should have to pay more because you might get in an accident.

    That said, I agree obesity is a cause of great cost to society. And education is the key. What works (from my experience is Paleo and low-carb) is not what is preached. What people are taught is exercise more, eat less. Until society changes that, you can’t blame fat people for being fat.

    You obviously pride yourself on your health and fitness. Why not take complete charge of your life and skip insurance all together?

    Suzie_B wrote on June 7th, 2013
  23. “Overweight people should have to pay more for insurance.”

    The problem with this logic is that there are a million things you can do that will wreck your health at least as much as obesity and nobody seems to suggest that they pay more. So it comes off as more ‘i hate fat people’ shaming. Not to mention that an obese 25 year old is almost ALWAYS costing less than the 60 yo, but they are forced to pay a similar premium. If you are going to start charging people because of their personal health, then go all the way and charge everyone based on their health issues. I am overweight and I guarantee my insurance company makes boatloads of money off me, whereas I have thin colleagues that cost them a bundle.

    It is surprising to me that on this site you might not have some sympathy for the fact that many people have been ill advised on what to eat for their entire lives and this is the cause of much of the obesity problem in this country.

    Lea wrote on June 10th, 2013
  24. You sound like an incredibly cruel person, and I hope I never meet you. You clearly don’t understand anything about the complexity of being a human being. We are not just machines that can adjust input and output to create the “perfect” slim body. There’s a huge mental and emotional side to all of this, and many, many people aren’t privileged enough to have a firm standing there. A lot of the emotional trauma that has contributed to me being an obese adult is related to the abuse I received from being a slightly pudgy child.

    You also have no grasp of the complexity of cause and effect. So, somebody is fat and has a medical problem–which came first? Unless you know that person’s personal health history, you have no right to judge them. In fact, that disgusting, lazy fat person you see may have recently lost 100 lbs. from months and months of hard work–physical work, mental work, emotional work. You have NO IDEA how hard it is to change your body from what you’re used to and what your body seems to want to be.

    Your attitude is toxic and cruel and only contributes to fat people staying fat, and I sincerely hope you keep it to yourself in the future.

    Elizabeth wrote on June 13th, 2013
  25. Becoming fat does create metabolism sensitives. It *is* harder to lose weight and keep it off. But the 25 year old is responsible for themselves in a way that a 4 year old is not.

    Obesity is a medical problem but like so many other issues, it just is. My parents gave me the genes that cause my dairy allergy. I can blame them or be happy to be alive and accept that a part of my life is harder because I have to deal with stuff that others don’t.

    Amy wrote on June 6th, 2013
  26. At the age of 25, I would say yes it is their fault. True their parents set them up for a harder path when the 4 year old relied solely on what their parents fed them, but there comes a point in time when you must be accountable for your own problems…25 is well past that point.

    What ChocoTaco has said has merit…albeit a bit blunt in the delivery (but I respect him for it ;) ). Obesity, by and large, is a problem based on lifestyle. There are things that make certain people more pre-disposed to be obese (genetics, stress, medications, etc), but at the end of the day, you make the choice of what you put in your body and what you do with your body (except under extreme circumstances).

    However, that doesn’t mean we should condemn or look down upon anyone that is obese (not suggesting ChocoTaco or anyone else here does that). Obesity, in my view, is just another problem that people must battle with like any other struggle. Why there’s so much stigma with this issue baffles me…and I’m guilty of it sometimes too. Human nature I suppose.

    Jacob wrote on June 7th, 2013
  27. Well Chocotaco, although you have some noteworthy points, your stance is too simplistic. Medications, injuries, hormonal imbalances also have a huge effect, and to suggest that people need to be more educated, well what’s out there? Low fat, chronic cardio, whole grain goodness and eating all day?
    My father had narcolepsy, and cataplexy possible caused by polio as a child. One of the nasty effects of this debilitating disorder is the destruction of a small, but vital part of the brain that deals with leptin. The result? Obesity, front and centre. We didn’t find this out until he was long dead, and I only found it by trawling through Jack Kruses fascinating blogs, where all the tragic puzzle pieces finally came together. Nothing is black and white, like that racey book, there are many shades of grey :)

    Heather wrote on June 10th, 2013
  28. The point is that people who feel that “people only have to blame themselves” are the same idiots who think “a calorie is a calorie” (LOT of new research that disproves this, BTW).

    It’s easy to be judgmental when you have no idea what you are talking about, or have never experienced it.

    “Just eat less”. You know, the first time I lost weight, I thought “I eat healthy, this Weight Watchers thing isn’t going to work, and IT DID.”

    After I had the baby, I went back to Weight Watchers, it worked AGAIN.

    7 years later after a second baby – now over 40 – dang, IT DOESN’T WORK ANYMORE. Now I have to try this and try that and see if anything will work. Hormonally, however, this may be it. I may be eating healthfully and getting regular exercise and just be overweight.

    “Taking responsibility for your health” doesn’t mean you’ll be thin.

    Marcia wrote on June 7th, 2013
  29. The problem with using the first law of thermodynamics as an explanation of excess body fat is that it is stating the obvious without addressing the real problem.

    I am fat. I have consumed more calories than I have expended. No, duh. Obviously my excess 100 pounds had to come from somewhere. But WHY have I consistently over-consumed? Do I love junk food more than I love life? Am I morally inferior (gluttony and sloth are deadly sins, after all)? Am I just too stupid to be allowed to leave the house unattended? Possibly all of the above are true, but that has nothing to do with my girth.

    I have gone on various diets, including “sensible,” doctor-supervised CW diets, where I consumed between 800 – 1200 calories of “healthy, low fat foods” chock full of “nutritious whole grains” to provide fiber and “appetite control” and was RAVENOUS. Why, if I was eating an amount of food that many people on the planet would be grateful to get? Yes, I lost weight, but I couldn’t maintain it because I could not cope with the incessant hunger. There was no way a healthy person in a first-world country should be that obsessed with hunger and yet there I was.

    As research has shown (and this isn’t new research, this goes back over 50 years), the cause for being overfat is not overeating and inactivity; rather, the cause of overeating and inactivity is being overfat. As Taubes puts it in /Why We Get Fat (and What to do About it)/, when the regulation of fat becomes disordered then the fat has its own agenda. Instead of food being first used for immediate energy needs, then maintenance of body tissue, and finally fat storage for future use (if any is left over), the order becomes 1. Filling fat cells 2. Building more fat cells 3. Immediate energy needs and 4. Maintaining body tissue (if any is left over). Thus the increase in appetite and reduction in energy – lean mass is starving even as fat increases. Then I need to build more lean mass to tote around the extra fat, driving me to consume more. There is more going on than thermodynamics.

    Now that I am eating foods that do not trigger a rampant insulin response I am finally losing fat consistently. It is not coming off quickly or easily, but it is coming off. I generally eat about 1200 to 1500 calories daily of fat, protein and a few veggies and keep my carb intake around 20-30 grams a day.

    The best part of eating this way isn’t even the fat loss, it is the loss of appetite. I simply do not get as hungry as I did following CW diets. Many would say that is because I am eating more nutrient-dense foods and so I don’t need to eat as much to satisfy my body’s needs. However, I do not believe that is the case. I believe it is because my body is no longer in insulin-induced fat-hoarding mode, and so the food I do eat is going to energy and lean tissue maintenance first. As it should be.

    Now, all this typing has made me hungry, so please excuse me while I go scramble a couple of eggs with a side of spinach!

    Badger wrote on June 8th, 2013
  30. Comment winner of the day:

    “Taking responsibility for your health” doesn’t mean you’ll be thin.

    Your body shape and size isn’t itself an indicator of health.

    Stephanie wrote on June 13th, 2013
  31. Exactly. I have many thin colleagues (my age or not much older) who have battled diabetes, cancer, osteoporosis, high cholesterol, etc., but I, who have always been at least a little overweight, have had no life-threatening problems, have never had major surgery, and have never been in the hospital (knock wood). I’m on thyroid medication, and that’s it. I eat paleo/low carb and work out regularly, but can’t lose the last 30 lbs. If you saw me in line at the pharmacy or had to sit next to me on an airplane, what assumptions would you make about me based on my size alone?

    Mary Mac wrote on June 13th, 2013

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