Tag Archives: stigma

More Evidence that Fat Stigma is Killing Us

Today, I got an email pointing me towards some new research on fat stigma.  There has been an ever increasing pile of evidence indicating that weight stigma is making us miserable and sick.  We know that weight stigma makes us fatter,  increases inflammation, increases disease burden and decreases quality of life, increases the chances that we will engage in risky behaviors and may contribute significantly to diseases like diabetes and heart disease. We know that weight-based discrimination increases blood pressure and reduces our ability to think clearly. Now we have further proof that weight stigma is shortening our lives.

It has always been supremely frustrating to me that concern trolls are so ready to tell us that they beat us up about our weight because they are concerned for our health.  But as a person who has been on the end of concern trolling, I can tell  you that it doesn’t feel anything at all like genuine concern.  It feels like people relishing the fact they have an excuse to be a bully.  It feels like having a license that allows some people to spew hate under the micron-thick veneer of caring.  It feels like complete B.S.

And this new study indicates that the results of this hate can be profound and life-threatening.  The study states:

The ultimate cumulative effect of these hostile social interactions may be lower life expectancy. The present research examined whether the harmful effect of weight discrimination reached beyond morbidity to mortality and whether common comorbidities and health-risk behaviors accounted for this association. We also compared weight discrimination with other forms of discrimination (e.g., age, race, sex) to examine whether they share weight discrimination’s association with mortality risk. Finally, we examined whether the association between discrimination and mortality varied by sex, ethnicity, age, or body mass index (BMI). We tested these associations using data from two large longitudinal studies, the Health and Retirement Study (HRS) and Midlife in the United States (MIDUS).

After reviewing the data from both the HRS and the MIDUS, the study group came to some rather startling conclusions.  It appears that weight stigma can increase risk of mortality by a significant amount:

Weight discrimination was associated with an increase in mortality risk of nearly 60% in both HRS participants (hazard ratio = 1.57, 95% confidence interval = [1.34, 1.84]) and MIDUS participants (hazard ratio = 1.59, 95% confidence interval = [1.09, 2.31]). This increased risk was not accounted for by common physical and psychological risk factors. The association between mortality and weight discrimination was generally stronger than that between mortality and other attributions for discrimination. In addition to its association with poor health outcomes, weight discrimination may shorten life expectancy.

If people are truly worried about the health of fat people, they are going to have to give up on concern trolling.  Outside of the fact that you can’t hate someone for their own good (thank you Marilyn Wann), there is hard statistical evidence that it just may be your hate that is making fat people sick and giving them a shorter life.  Not to mention the horrible effect you have on their quality of life.  The study goes so far as to suggest that the harm of weight discrimination may be more harmful than any other effects of being overweight:

The present findings indicate that the harmful effect of unfair treatment that is attributable to body weight is not limited to psychological distress and morbidity: It also extends to risk of mortality. This association was apparent in two independent samples that covered different periods of the life span, and the association persisted after we accounted for behavioral and clinical risk factors. The effect of weight discrimination on mortality was generally stronger than that of other forms of discrimination but was comparable with that of other established risk factors, such as smoking history and disease burden. Moreover, the association between weight discrimination and mortality risk was in sharp contrast to the protective relation between some of the BMI categories and mortality risk. These findings suggest the possibility that the stigma associated with being overweight is more harmful than actually being overweight.

This type of research can have a profound effect on the lives of fat people around the world.  But just because it can doesn’t mean in necessarily will.  The media doesn’t jump to report these stories.  For many reasons, these articles aren’t popular with media outlets and are especially unpopular with advertisers.  If we want these studies to have an impact, we have to make sure that people in the world at large know about them.  We need activists.

That’s why I’m so excited that the Fat Activism Conference is starting tomorrow.  It’s not too late to get your tickets.  We have dozens of amazing speakers lined up ready to share ways that you can be an activist and an advocate for people of all sizes.  We’ve got speakers talking about activism and medicine and activism and art and activism and sex and many other topics.  I hope you’ll consider joining us for the conference.  This study indicates that activism against weight stigma may do more than just make us feel better and feel better about ourselves.  It just might help to save our lives.

Love,

Jeanette DePatie (AKA The Fat Chick)

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Diminishing Distress Dials Down Diabetes

First do no harm. Diabetes scare tactics just might kill you.

I recently ran across this article on Diabetes Hub which describes two important studies which correlate distress with poorer outcomes for people coping with diabetes.  The first of these studies involved a randomized trial of 150 women with uncontrolled diabetes.  What the study found is that those women in the study who were able to reduce their level of disease-related distress had significantly improved glycemic control.

Typical sources of disease related distress included fear of getting sicker and feelings of isolation or overwhelm in relation to disease management and treatment.  The EMPOWER study tested various forms of treatment interventions and found that regardless of treatment methodology, those people who were able to lower their distress were more compliant with treatment protocols:

HbA1c dropped much more substantially in those in whom distress was lowered, compared to those with whom distress was unchanged or increased,” Dr. Cummings said. “Medication adherence, self-care behaviors, and diabetes empowerment and self-efficacy were all substantially improved in the group with lower levels of distress at the end of the trial.

The doctors admit that they don’t quite know why lowering distress has such a significant effect on glycemic control among people with diabetes.  However it seems that working to lower distress among people with the disease is an important treatment goal.  According to Dr. Cummings:

We’re surprised at the number of these women caring for children, grandchildren, and other members of their families, often while working, and yet not finding time to care for themselves. It is clearly an important cultural phenomenon that we need to understand better.

The article went on to discuss data gathered from another important study: the national Reasons for Geographic And Racial Differences in Stroke (REGARDS) cohort study.  Dr. Cummings noted that in this study which included 4,000 black and white adults 45 years and older with diabetes and nearly 18,000 adults without diabetes, those subjects with diabetes were more likely to suffer from depression or distress (26.7% vs. 23.2%, P < .001) or both (10.1% vs. 6.2%, P < .001), compared with those without diabetes.  Those people who had diabetes and also symptoms of distress or depression had higher risks for stroke and CV death than people with diabetes without depression or distress.

What all of this seems to make clear to me is the deep need for compassionate, blame-free, stigma-free, evidence-based health care for people coping with diabetes.  The notion of scaring people straight or using dire warnings to fuel completely unrealistic weight loss goals may be more than counterproductive–they might prove especially medically dangerous for this population.  Many forums for people with diabetes are filled with horror stories about how members were stigmatized, told their conditions were their fault and told that if they didn’t get thin, they wouldn’t live to see their children or grandchildren grow up.

But maybe what really needs to grow up is our approach to helping people with diabetes live better, longer and happier lives.  Maybe we need to spend a little less time pointing fingers and a little more time holding hands as we help people make small, incremental, manageable and realistic changes in their lives.  It’s just possible that fear tactics are doing more to harm people with diabetes than to help them.

That’s one of the reasons I’m so excited to be giving a presentation at the upcoming Take Control Of Your Diabetes Conference on September 26 in San Diego, CA  The event focuses on helping people with diabetes take positive, small and sustainable steps to better health.

Newly Published Paper says Social Media Campaigns Balloon Up Stereotypes and Stigma associated with Fatness

Eric needs a new job–preferably one that doesn’t stigmatize an entire population.

I’m pleased to share with you that my colleague Lily O’ Hara has recently co-authored a paper in the journal Media and Culture.  The article offers a critique of two major anti-obesity media campaigns that ran in Australia.  These campaigns include “Measure Up” and “Swap It, Don’t Stop It”.  The Measure Up campaign promotes health management through body weight and waist circumference.  It included television advertising, posters, a community guide and a handy 12-week planning kit complete with, you guessed it, a tape measure.  Highlighted headlines included “The more you gain, the more you have to lose.” and “How do you measure up?”

Not surprisingly the images that accompanied these campaigns were troubling for many and triggering for some.  In the Measure Up campaign, there were video ads that showed a young man looking sadly at a waistline that expanded as he digitally aged.  Naturally dire warnings about disease accompanied the video.  In still images, both men and women were shown, head bowed, looking dejectedly at a tape measure slung around their waists.  These people were shown clad in their underwear (similar to the shorts/sports bra getup in The Biggest Loser) to add to the “public shaming” aspect of the campaign.

Ad copy for the Swap it Don’t Stop It campaign used fear and panic words, highlighting diseases and phrases like ballooning weight.  In fact the star of the campaign, Eric, is made of a balloon.  In the campaign he says,

over the years my belly has ballooned and ballooned. It’s come time to do something about it — the last thing I want is to end up with some cancers, type 2 diabetes and heart disease. That’s why I’ve become a Swapper! What’s a swapper? It’s simple really. It just means swapping some of the things I’m doing now for healthier choices. That way I can lose my belly, without losing all the things I love. It’s easy!

So aside from the panic inducing words and shame producing “balloon image” we have the assertion that swapping just a few foods in a person’s diet will significantly change weight, BMI and waist circumference, despite the fact that there is no concrete evidence that this result would indeed happen.

The paper concludes:

Through the use of textual, discursive and social practices, the social marketing campaigns analysed in this study perpetuate the following concepts: everyone should be alarmed about growing waistlines and ‘ballooning’ rates of ‘obesity’; individuals are to blame for excess body weight, due to ignorance and the practice of ‘unhealthy behaviours’; individuals have a moral, parental, familial and cultural responsibility to monitor their weight and adopt ‘healthy’ eating and physical activity behaviours; such behaviour changes are easy to make and will result in weight loss, which will reduce risk of disease. These paternalistic campaigns evoke feelings of personal and parental guilt and shame, resulting in coercion to ‘take action’. They simultaneously stigmatise fat people yet serve to invisibilise them. Public health agencies must consider the harmful consequences of social marketing campaigns focused on body weight.

So let’s take this apart for a moment, shall we?  I’ve spoken before, at great length, about how shame fails to make people healthier, happier or thinner.  In fact, I’ve spoken about how shame tends to make us, less happy, less happy and larger than before.  I’ve talked about how obesity levels are actually flattened out, and the obesipanic doesn’t really make sense in that context.  I’ve talked about how hard our bodies fight to maintain our weight and that in most cases, a few simple changes will not result in significant (if any) weight loss.  So everything about these campaigns are doomed.  They are much more likely to cause harm than to help.  But let’s look at one other aspect of this.  The taxpayers of Australia paid for these things.  They are government sponsored.

We’ve all  heard the argument that fat people can be fat as long as they don’t cost  you tax dollars.
And there are many reasons why this is a ridiculous argument.  But one eloquent comeback I see after reading this paper is this:

Your fat hatred is costing me far more tax dollars than any money you are supposedly losing caring for people of size.

We have ample evidence that these campaigns do no good.  We have ample evidence that these campaigns are actively causing harm to the people targeted by them.  And to me, the worst part is we are making people pay for the very media that is stigmatizing, brutalizing and depressing them.

The only thing ballooning here, is my rage over this particular state of affairs.

Love,

Jeanette DePatie (AKA The Fat Chick)

Radical Self Care

RASCAL

I am so excited to announce our new challenge on the Fit Fatties Forum called the RASCAL challenge.  This stands for Radical Activist for Self Care and Love.  In this challenge, we encourage you to think outside the box about what self-care means and we challenge you to prioritize self care in your life.  Given my current focus on healing, this challenge just could not have come at a better time.

One of the reasons I’m so excited about this challenge is that it helps us broaden our definition of what is included in the definition for “health”.  Some of us believe that being healthy means being thin.  If we are thin, we are healthy.  If we are not thin, we can’t be healthy.  I’ve talked quite a bit about this in the past.  There are lots of studies that indicate that simply isn’t true.  In particular, this study shows that healthy behavior is a better predictor of future health than BMI.  But this begs the question, what is healthy behavior?

Of course joyfully moving your body is a wonderful healthy behavior.  Of course eating in a way that is in tune with your body’s needs as well as your spiritual and emotional needs is a healthy behavior.  But is that all there is to wellness?  Eat an apple and go for a walk and you’ve got it covered?  I don’t think so.  To me health is nuanced and multidimensional.  And health involves self-care.  (Insert deep sigh here…) Why is it that so many of us are so good at taking care of other people and so lousy at taking care of ourselves?  Are we conditioned that way from birth?  I don’t know.  But I DO know that self care gives us the strength to help others.  Think about what the flight attendant says before you take off.  “First secure your own oxygen mask, then you can help small children and those around you.”  In other words, breathe.  Take a moment to care for yourself.

And that moment may involve eating something wonderful or going for a walk.  Or it may involve simply breathing.  Maybe your self-care moment is spending just a few seconds of your day simply being.  Maybe it means getting a little extra sleep.  Maybe it involves asking for help.  Maybe it involves doing a booty-shaking victory dance.  Maybe it means calling a friend and reconnecting.  Maybe it means writing a letter to someone who wronged you.  Maybe it just requires 5 minutes of quiet and a cup of tea.

Self-care is different for each of us.  But it is absolutely critical to our well being.  That’s why I’m so excited about the RASCAL challenge.  We’ve come up with over 100 official Radical Acts of Self Care and Love, and we’re challenging folks to do one of those acts every single day.  Aside from the intrinsic rewards that come from self love, we are ACTUALLY rewarding you with badges and encouragement and prizes for taking care of yourself.  Seriously.  How cool is that?

I hope you’ll join me in spending some time to take care of yourself this month, either by taking the challenge or simply choosing to do it on your own.  Because the world needs you to take care of you.

Love, Jeanette DePatie (AKA The Fat Chick)

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Talking to Kids About their Bodies

I am sad to say that September is Childhood Obesity Awareness Month.  I cannot see the need for this particular marker.  I don’t know a single adult who isn’t aware that there are fat children in the world.  And the vast majority of them are wringing their hands and worrying about what we should do about it.  Schools are still sending kids home with BMI report cards despite significant evidence that this practice is not only not helpful but is often actively harmful.  And most doctors still tell parents to put kids on a diet when kids vary even slightly from the statistical norms.

Infographic.034-001

And it’s not as if kids are unaware of “the childhood obesity crisis”.  Hospitalizations for eating disorders are up 119 percent among children under 12 years of age.  80 percent of all 10-year-olds are afraid of being fat and 42 percent of all 1st through third grade girls want to be thinner.  Just who is it that remains unaware of a societal desire for kids to be thin?  The whole thing is so deeply depressing I didn’t know how I was going to write about it.  That is until I came across an article somebody posted to Fit Fatties yesterday about a dance teacher working to change the language she uses to talk to kids about their bodies.

Worried about how her words as a dance teacher were affecting the body image of the girls taking ballet lessons, dance teacher Amanda Trusty took several weeks off to work on the language she used in her classes.  Trusty noted that many of the traditional commands from dance class like “tuck in” or “suck in your belly” or “pull in the butt” were not only imprecise, but tended to confirm a societal notion that kids bodies should be smaller and tummies and tushes should disappear.

In her article Amanda says,

I realize now where all my insecurities started. They started in first position at age seven at the barre.

 

And now here I am, 20 years later, catching myself doing the same things to my own seven year old students.

 

Oh, but I refuse. Nuh-uh. No way. I’m a body love advocate. How can I tell my ballerinas to suck it in and tuck it under, knowing how much that shaped my childhood?

So Amanda consciously and thoughtfully worked to change the language with her students.  The new language was not only more imaginative and precise, but also managed to remove body judgement from the equation.  Now rather than telling them to tuck the butt under, she asks the students to imagine they have beautiful tail feathers.  And she asks the students to send their tail feathers down rather than out.  Instead of asking kids to lift their chins, she tells them to imagine they are wearing a beautiful necklace and she asks them to display the necklace to everyone else.

Kids are perfectly well aware that many, many grownups are freaked out beyond all reason that their bodies are not thin enough.  We don’t need a month dedicated to getting adults more freaked out about childhood obesity.  And we don’t need a month dedicated to convincing fat kids that they should not exist, that there is a worldwide movement to eradicate them from the planet.  What we need is a month dedicated to thinking about how we talk to kids about their bodies.  We all need to take a time out like Amanda did, to figure out ways to communicate health and wellness to kids in a way that isn’t damaging to their body image and doesn’t send them charging down the road towards a life of eating disorders.  Now that’s a month I could get behind.

 

Love,

Jeanette DePatie (AKA The Fat Chick)

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Study Proves “Not all Fat People are Unhappy”–Follow up to indicate Papal Affiliation With Catholicism

PopeCatholicSo I got a notice in my inbox this week that a study has been announced that indicates “Not All Fat People are Unhappy.”  And honestly, my first thought was, “Duh.”  I mean it seems quite obvious to me that not all Fat people are miserable, much as it seems obvious that the Pope is Catholic.  But apparently the notion that not all fat people are sick, miserable, about to die and ready to throw in the towel is something we need to prove again and again.

But you know, before I cast to many aspersions on the study, I think maybe we really just need to look at the headline drawn from the study results.  Because there are actually quite a few interesting things indicated by this piece of research.  Let’s look at a few:

1.  Your happiness seems to have a lot more to do with homogeneity than body size.  If you are a fat person who lives in a town with lots of other fat people, you tend to be more happy than if you live somewhere with no other fatties.

2.  The study creators speculate that being fat does not in itself make people unhappy.  In the accompanying press release, study co-author Philip M. Pendergast states:

“In that light, obesity in and of itself, does not appear to be the main reason obese individuals tend to be less satisfied with their lives than their non-obese peers. Instead, it appears to be society’s response to or stigmatization of those that are different from what is seen as ‘normal’ that drives this relationship.”

3.  Women tend to pay a higher emotional price for being fat than men do.  The study creators speculate that this is because women face more social stigma based on body size then men do.  In the press release Pendergast also says,

“Think about the advertising we see on television or in magazines—we are bombarded by images of thin women, and we are told that is the ideal,”

So here is yet another study that seems to indicate that how we feel about our size may have a lot more to do with our actual health and wellness outcomes than what we weigh.  It follows on the heels of many other studies we’ve talked about on this blog regarding stigma and health outcomes like this one or this one.  And all of these studies lead me to ask one very important question.

Even if we knew how to make people permanently thin (which we do not) should we ask them to change their body size to fit in?  If being different leads to social stigma, and social stigma leads to poor health outcomes, should we encourage everybody to be the same for the sake of their health?

Even if we knew how to make people all be the same size (which we categorically do not) it seems to me that the answer is to deal with stigma rather than to make a completely homogeneous society to reduce stress on everyone involved.  What if we actively worked to fight stigma based on body size?  What if we actively worked to help people accept their own differences?  What if we could feel better about our bodies?  Might we be singing a song like this magnificent lady right here?

I mean just check these fabulous lyrics:

I looked in the mirror
What did I see a brand new image
Of the same old me ohhhh
But now I wonder why should I be surprised
I like the things about me that I once despised

There was a time
When I wished my hair was fine
And I can remember when
I wished my lips were thin

Makes no difference now y’all
How you may feel
I’ve done reached the point
Where I wanna be real
I’m tired of living living in disguise
I like the things about me that I once despised

Let’s face it, Mavis Staples has got it going ON!  But she leads me back to my original question.  Why can’t we take some of this time, money and energy that we are currently spending on stigma-inducing ineffective advertising that convinces people that they not only must be thin, but may easily obtain this state of grace by eating yogurt, and spend it on something that might actually help people feel better?  It will help them feel better emotionally, and it will help them feel better physically.  Why can’t we take some of the time, energy and money we are spending driving wedges into our society, by creating classes of otherness which we can blame for all our problems from the high cost of airplane tickets to soaring healthcare prices and spend it on something that teaches us to celebrate our differences.  It will bring us together.  It will help us live and breathe as a community rather than a simple pile of competitors in a winner-take-all, Victoria’s Secret model competition.  When will we reach the obvious conclusions?  Bears poo in the woods, stigma doesn’t help people, and yes, the Pope is indeed Catholic.

Call me captain obvious if you like.  I’ve stopped spending on diets and weight loss schemes and self hatred because I like the things about me that I once despised.

Love, Jeanette DePatie (AKA The Fat Chick)

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You know what’s fattening? News about the Obesity Crisis.

I wonder how many times studies will need to come out and people will need to talk about the damage caused by panic mongering over the obesity crisis before the media stops covering it.  I wonder if the media will ever stop sensationalizing fat.

Today I came across another article in U.S. News citing a small study that some women exposed to an article that appears to devalue fat people (how many of those do we see per day?)  seems to spur people to overeat.

The study was designed to determine if people who felt stigmatized for being overweight were likely to eat more, due to resulting anxiety or frustration, said study author Brenda Major. She is a professor in the department of psychological and brain sciences at the University of California, Santa Barbara…

Seeing media stories covering the so-called “obesity epidemic” and its potential impact on health care costs triggered Major’s interest in doing this study, she said. “There’s a frenzy about obesity in the media and there’s a negative, moralistic tone to the coverage,” she said.

Not surprising (to me at least) is that the results showed that presented with articles of how fat people were weak-willed or a high “cost to society” many of those studied turned to food for comfort.  The article cited other studies that indicate women placed in a situation where they felt devalued because of their weight had higher blood pressure and studies showing that discrimination based on weight can lead to weight gain.

And just this week, another study was released by the Rudd Center regarding the effect of weight stigma on cortisol reactivity.  What was truly fascinating about this study, is that perceived weight stigma affected the cortisol levels of all women, regardless of BMI.  So in other words, women of all sizes carried significantly greater levels of stress hormones after a single incident of weight stigma.  These stress hormones are related to many processes in the body including regulation of blood sugar and blood pressure.

All of which leads us to ask the question again.  Why oh why oh why does the world feel that it is okay to stigmatize fat people for their own good.  It doesn’t do fat people any good.  And in fact, there is ever increasing evidence that weight stigma makes people less healthy and probably makes them gain weight.

I think we have to start to wonder what various people and groups are getting out of wagging their finger at the fat folks.  Do they get a sense of superiority?  Do they get higher ratings?  Do I care why they do it?  Nope.  I just want them to stop.

Love, Jeanette (AKA The Fat Chick)