G&S Blog Post – Weight Stigma, Gender & Medicine: A Tale of Two Times

By Natalie Ingraham

Recently, New York Times science journalist Gina Kolata wrote two stories about stigma related to fatness, often called weight stigma. These articles address that way fat people, and fat women in particular, are treated poorly by society because of body size. In her September 25th article, Kolata considers weight stigma specific to medical settings and the emotional and physical consequences of this stigma for fat patients. However, it’s important to note that she doesn’t  describe cases of medical neglect or mistreatment as a weight stigma. However, less than a week later on October 1st, she devotes and entire pieces to the “shame” of weight stigma and its negative outcomes for individuals who experience it. Here, she focuses heavily on the work of the Rudd Center, which works extensively on weight stigma and its impacts.

Weight Stigma & Medicine

Photo by Parker Knight (CC) 

Kolata reviews important evidence by social scientists and public health professionals (Drury and Louis 2002; Puhl, Peterson, and Luedicke 2012; Teachman and Brownell 2001; Teixeira and Budd 2010) about the various types of discrimination fat patient’s face. Such discrimination includes hostile language about a lack of willpower to lose weight, shaming from medical staff about weight gain, or increased costs for medical services based on BMI. The stigma becomes medical neglect when misdiagnosis of a problem or medical equipment is unsafe or inaccurate for larger patients (e.g. a small blood pressure cuff causing both pain to the patient and an inaccurate higher blood pressure). The stories from patients in this article reflect both empirical work and personal narratives about weight-based medical mistreatment.

Weight Stigma & Women

Kolata interviews fat women patients about their experiences. All medical providers interviewed for the article are men. This pattern of male medical providers dictating the problems with women’s bodies mirrors larger social patterns of women’s bodies, and fat women’s bodies, being the site of intense social control (Bartky 2003; Braziel and LeBesco 2001). Women face intense social pressures related to their bodies and weight. This is reflected in public health issues like restrictive eating disorder rates in men vs. woman as well as voluminous participation in the diet industry.

Weight Stigma & The Two Times

I was inspired to write this piece based on my research on weight stigma, health and gender. Some of my previous work at ANSIRH revealed how women at the highest weights experience weight stigma in accessing family planning care and reported having to pay more for the same reproductive health care procedures than thin patients (Ingraham, Roberts, and Weitz 2014). Additionally, it struck me that a reporter would write two stories about weight stigma without explicitly naming it. There is often this disconnect with mainstream media and public health reporting when it comes to weight stigma. My work relies on the use of the heavily critiqued Body Mass Index (BMI) to speak in the same “language” about fat bodies across disciplines, despite data suggesting BMI is a terrible measure of bodies or health outcomes (Burkhauser and Cawley 2008; Satinsky and Ingraham 2014). Statistics about the ever-growing rate of obesity support shame-based or scare tactic-based public health that attempt, and generally fail, at getting individuals to lose weight in the long term. Instead, weight stigma is reinforced and worsened.

Weight Stigma: What should we do?

In a perfect world, weight stigma would simply vanish as we accept that diversity of bodies including diversity not just in characteristics like height but also in shape and size. This stigma-free world would promote body acceptance rather than body hatred and shame and include fat liberation and equal civil and medical rights and access for fat patients. But what can we do now? One place to start are organizations committed to fighting weight stigma such as the Association for Size Diversity and Health and the Rudd Center, which provides a fair-use set of images of fat individuals engaging in daily life (without cutting their head off to perpetuate the notion that you would not want to be identified with a fat body) for use in media and research reporting. Organizations that focus on reducing weight stigma from a more radical, social justice and civil rights perspective include the National Association to Advance Fat Acceptance, NOLOSE, an intersectional LGBTQ and fat focused organization and FQDUP, a direct action group in the San Francisco Bay Area that centers people of color, queer, disabled and fat folks.

Natalie Ingraham, PhD, MPH is a faculty lecturer at CSU East Bay in Hayward, CA. She is also a research associate at UCSF’s Advancing New Standards in Reproductive Health (ANSIRH) and UC Berkeley’s SHARE program.  Her work on body size, health and sexuality has been published in Health Promotion & Practice, Women’s Health Issues, LGBT Health, Transgender Studies Quarterly, Journal of Fat Studies, and the International Journal of Multiple Research Approaches.

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