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Microaggression in Obesity

This week, it’s becoming apparent that obesity is fraught with risks for microaggression. When we write about weight bias and discrimination, we find that there’s a good chance of stepping on toes by mixing in any mention of health issues related to obesity.

After writing about wellness programs opening the door to discrimination against people with obesity, we found the story being shared along with a warning: “This website allies with anti-‘obesity’ yuck.” In sharing another story about weight bias on Twitter this week, someone cautioned parenthetically: “includes obesity as disease language.”

Experience tells us that both fat activists and scholars in the growing field of fat studies share the deep concern that clinicians and researchers in obesity have about weight bias and discrimination. But despite this common ground, conversations can be quite difficult because of strong and divergent views about the health effects of obesity.

In fat activism and fat studies, “obesity” is regarded as a term used to pathologize normal weight diversity. That term is offensive because it is used as a label to promote weight discrimination in medical care. This perspective is so strongly held that the very word “obesity” could fairly be described as a trigger word in that community.

For obesity researchers and clinicians, this perspective is quite challenging. These are, by and large, thoughtful people who respect size diversity and understand the the tremendous harms done by weight bias. They understand the serious problems with BMI. But they also know that obesity, defined by the accumulation of adipose tissue harming health, is a legitimate health concern. A normal function of the body — the regulation of energy balance and storage — is not working properly. It’s not defined by BMI or weight. It’s defined by metabolic dysfunction.

Sometimes words get in the way. But writing the word “obesity” out of our vocabularies will neither make weight bias go away, nor will it make the health implications of excess adiposity go away.

What’s needed is deeper understanding and meaningful dialogue. Weight bias is the highest priority because it causes so much harm. But a deeper understanding of the physiology of adipose tissue is essential as well. That understanding must be translated into common knowledge.

We must stop dealing with obesity as a voluntary condition of size and appearance. Respect for human dignity and health must come first.

Click here for more on fat studies and here for more on microaggression and trigger words.

Bomb, photograph © Apionid / flickr

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February 27, 2016

6 Responses to “Microaggression in Obesity”

  1. February 27, 2016 at 10:51 am, Joan Ifland said:

    In my opinion, it’s not about fat tissue except to the extent that the accumulation of fat tissue points to the possibility of active addiction to processed food. In my reading of the research, I am relying on the correlation between processed food addiction and obesity to learn more about food addiction. By focusing the discussion on fat tissue, I fear that we are missing the opportunity to address food addiction.

  2. February 27, 2016 at 11:26 am, Al Lewis said:

    What bothers me is that “microaggression” against obesity in the workplace is equated with the (far more legitimate) microaggression against smokers. The two are NOT the same in any way, but wellness vendors equate them, and overweight/obese employees are ostracized and stigmatized like smokers.

    Wellness vendors have no clinical training, no licensing requirements, no oversight…and so they can promulgate their wacky ideas that all employees need to do to lose weight is eat more broccoli. And they should be fined if they don’t.

  3. February 27, 2016 at 12:29 pm, Angela Meadows said:

    Thank you for citing my tweet, Ted!

    In a previous exchange, we have discussed the definition of obesity. You claim that is it not based on BMI but on a constellation of metabolic risk factors. I would actually agree with you that the presence of those risk factors has serious implications for health and must be addressed.

    However, first, while these risk factors are definitely more common in higher weight individuals, they are nevertheless also not uncommon in more normative-weight individuals, where their presence is often missed due to the widespread notion among both lay people and healthcare professions that metabolic ill health is associated with higher weight, i.e. obesity. Additionally, many higher weight individuals, who are obese by BMI standards, do not have this constellation of symptoms, and the current dialogue on the subject lumps everyone together, pathologising their bodies in the absence of actual disease (unless you consider the weight itself to be a disease, which you claim not to do, but maybe you could have a word with the AMA on that topic).

    Further, while you claim that obesity is not defined by BMI, this is a specious argument. You and I both know what you mean; but read any single scientific paper or national or professional guideline on the subject, or even the WHO’s own page, and the first line you will see is that obesity is an increasingly prevalent condition defined by having a BMI of 30 or higher. Just because *you* are talking about metabolic health, when you use the word ‘obesity’, you are talking, in most people’s eyes, about having a high BMI.

    Interestingly enough, you and I agree on just about everything except the appropriate treatment for obesity. We all agree that it is not simply about poor behaviour and lack of willpower, and that because of biological adaptation, dieting is not the answer to weight loss. Based on evidence from non-weight-focussed health promotion interventions, I would argue that many of the risk factors we are talking about can be improved by behaviour *in the absence of weight loss*. You do not. Thus, you promote the use of surgery to achieve weight loss. This in itself indicates that you believe the high weight to be the problem, and that the health issues can be solved by removing the weight. So again, your argument that it is not about weight doesn’t really stand up.

    And finally, as you say, the size acceptance movement considers the words ‘obesity’ and ‘overweight’ to medicalise body diversity and suggest that one size is best for all. I am a member of that community with a scientific and health background, and people look to me for information and expertise. As I said, I agree with very much of what you write and often want to share your posts. However, as I am known as a size acceptance activist, people do not expect me to share content that originates within the current ‘weight-is-the-problem’ paradigm. Thus, if I think a piece is suitably useful or important or insightful, I will share it with my followers, but always include content warnings (I do this for talk around eating disorders and all sorts of other things that may trigger some people) so they can choose whether or not to read it. Most will read it anyway but will not be blindsided by a HAES(r) and size acceptance activist sharing content that tells them that their body size is a disease. I do hope you understand.

    • February 27, 2016 at 2:56 pm, Ted said:

      I do understand, Angela, and I agree with most everything you have said here. The exception would be your assertion that I don’t believe health can be improved in the absence of weight loss. I actually agree that it can and I think every single person has to make the best choices they can for themselves. Body size, shape, and weight is not something that people choose. You take what you get and do the best you can with it.

  4. February 27, 2016 at 7:46 pm, Carolyn said:

    “But they also know that obesity, defined by the accumulation of adipose tissue harming health, is a legitimate health concern – See more at: https://conscienhealth.org/2016/02/microaggression-in-obesity/#sthash.75BwxEo8.dpuf”

    This is a completely tautological statement on the face of it. Of course something that harms health is by definition a legitimate health concern. But the issues are more to what extent obesity or overweight do actually harm health and secondarily how these terms should be defined. Clearly WHO, CDC and NHLBI define obesity as a BMI of 30 or more.