If We Cancel Obesity, Will Weight Stigma Fade?

Public health should stop talking about obesity, says a policy brief from University of Illinois Chicago School of Public Health. “Replace assignments connecting ‘obesity’ and health,” suggests the brief. Cancel the word obesity and weight stigma will fade. That seems to be the thinking there.

At the other extreme, we have folks who love to catastrophize obesity. “Fast-food addiction fuels nation’s obesity disaster,” says the Daily Express. Restauranteur Jamie Oliver is telling members of the UK Parliament that child obesity is a “catastrophe” requiring urgent action.

It’s hard to imagine a more extreme – and false – dichotomy.

Let’s Talk About It

We have a tough time accepting the idea that a school of public health should not talk about obesity. Of course, it’s true enough that, like many other medical conditions, obesity can be stigmatizing. At one time breast cancer was something that polite people simply did not discuss. Before the ADA, serious diseases and disabilities were an excuse to exclude people from the joys of life and work.

These things change not by staying silent but by talking about the problem. And indeed, fat phobia and weight bias are real problems that easily do as much or more harm than obesity itself.

But silencing all talk about obesity will not alleviate weight stigma – no more than silence about health disparities would serve to reduce the burden of racism.

Misunderstanding Obesity

We do have a problem with the way many people talk about obesity, though. The presumption is that a person’s size defines this condition. You’ll find that presumption in the UIC brief, where they suggest eliminating the word obesity and replacing it with people in larger bodies.

Obesity often does correlate with body size and weight, but it is abnormal adiposity harming health that defines it. BMI can be a useful sign of possible obesity, but the essential characteristic is an impact on health. In fact, normal weight obesity is a very real phenomenon. So BMI doesn’t tell the whole story.

Catastrophizing Doesn’t Help

At the other extreme, nixperts catastrophizing obesity are a real problem. These are people who like to talk confidently about obesity but have no real expertise in the matter. Jamie Oliver bloviates about obesity though his real professional expertise is all about recipes like Beef and Guinness Pie. Tasty stuff, but it doesn’t make a person into an expert on obesity. Such nixperts come in many flavors, but the common thread is that their proclamations about obesity are dire and moralistic.

Sometimes they treat people living with obesity as objects of pity. Sometimes as self-destructive and irresponsible. But seldom do they show any regard for real people with real lives that matter. They equate obesity with the consumption of fast food, ultra-processed food, HFSS food, soda, or whatever bad food they currently think is the baddest. These nixperts seem to have no interest in the biological basis of obesity or the complex systems that promote it.

Respect for People and Facts

So no, we don’t need to catastrophize obesity, nor do we need to ban the word. What we do need is more respect for the people who live with it and may experience it in many different ways. This includes the experiences of folks who embrace a philosophy of fat acceptance, people who are informed and engaged in overcoming the real health effects they’re experiencing from it, and everything in between. A little more respect for facts and science would be nice, too.

Spare us from the false dichotomy of catastrophizing versus canceling obesity.

Click here for more on the UIC brief, here for more on misinterpretations of obesity, and here for more on fat phobia in healthcare.

This Flower Wishes to Fade, painting by Paul Klee / WikiArt

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May 29, 2022