Tag Archives: anti-fat bias

Fat and Fit: The Mountain Fat Athletes Have to Climb

naked fat woman lifting a heavy weight with another woman spotting
Copyright (c) 1994, Laurie Toby Edison.

Debbie says:

My friend Stef sent me Kelsey Miller’s article in Self, “The Relentless Reality of Anti-Fatness in Fitness,” a thoughtful and intelligent examination of how hard it is for fat people to become fit, be fit, and be recognized as fit. Miller starts with Sarah Jaffe, a 32-year-old endurance athlete who joined a gym when she’d just returned from a 550-mile bike ride. Jaffe, disappointingly but unsurprisingly, could not convince her new personal trainer that she wasn’t there to lose weight, or that she understood her own body’s metabolism. Tellingly, as Jaffe tried to get her point across, the trainer reportedly said ““So you did those things you wrote on your form?” Jaffe, at the time, was a size 16, what we would call “culturally fat” or “mid-size.” Miller says, eloquently and accurately:

The widespread consensus on fat people is that they are lazy, ignorant gluttons who simply will not get off the couch and get on the treadmill. The lesser-known reality is that treadmills typically have weight limits between 200 and 300 pounds (as do many bikes, stair-climbers, and other common gym types of equipment). Then there’s the dearth of activewear, the majority of which is not produced in plus sizes (Nike, for example, started adding plus items in 2017). Fitness is already a practice of the privileged; it requires time, money, and access that many people don’t have. Fat people have to jump those hurdles and more just to get to the gym. And when they do, they’re often met with judgment, discrimination, and calorie lectures they didn’t ask for. The problem keeping fat people out of the gym is not their fatness. The problem is fatphobia.

Laurie and I understand not just these obstacles but the driving urge to overcome them. The picture above, from Women En Large: Images of Fat Nudes, was taken in response to one of the most common requests we got when we were designing the book: show us fat women being active, being athletic, moving. The urge to move is present in most of us; stifling it is a form of dehumanization.

Miller’s analysis of the history of fatphobia is notable for its focus on the relationship to fitness. One particularly useful insight comes from Danielle Friedman, author of Let’s Get Physical [How Women Discovered Exercise and Reshaped the World], a study of modern fitness culture. As life got more sedentary in the 1950s and 1960s, and the Cold War stoked fears that could comfortably be channeled into body anxiety,

fitness became thin, hard, and estimable—a sign of moral and mental fortitude—and softness became its opposite. (Friedman cites the enduring issue of “flabphobia,” the insidious sidekick of fatphobia, that underpins concepts like “spot training” and “skinny fat.”) Back then, as now, Friedman says, fitness came to mean fat-less: “It’s [not] enough to just be small and thin. You have to be totally devoid of fat.”

… Half a century later, this novel idea—that fitness is something lean, virtuous, and measured by the scale—has settled into our cultural consciousness. Fitness has gone from a niche subculture to a vast, global industry valued at nearly $100 billion in 2019,

The article goes on to discuss the rise of BMI (body mass index or, as Laurie and I call it, Braindead, Meaningless, Insidious) as an indefensible but completely accepted metric, and the difficult role of fat fitness champions,

who are often called out, not for advocating an active lifestyle, but rather for “promoting obesity.”

“That’s the biggest one,” Latoya Shauntay Snell, a marathoner and fitness influencer known to many online as the Running Fat Chef, tells SELF. “It gets under my skin,” she says of the phrase that routinely appears in her Instagram comments. “Just living and breathing and thriving in the space, as myself, is ‘promoting obesity.’”

Snell has been running and blogging since 2013—a time when mainstream culture was suddenly interested in body positivity, but mostly as it applied to thin, white people. Snell, who is neither, hasn’t seen the needle move all that much since then. Over 200 races in, she still gets heckled from the sidelines, or “encouraged” by those who see her as a struggling newbie: Keep going! Don’t quit! Don’t worry girl, if you keep that up, you’ll lose some weight!

Miller repeatedly points to the dearth of plus-size exercise wear, especially above 3X. And then she highlights a remarkable exception:

[I]n 2020, one brand—Superfit Hero—made the bold pivot to plus-only clothing. Why? Because plus-size exercisers were their best customers.

Micki Krimmel founded Superfit Hero in 2015 with a line that ran from XS-5X. In 2019, while reviewing sales data, Krimmel realized that most of their repeat customers were in the plus range—“something like 95%,” she says. …. Plus shoppers broke down crying, saying how grateful they were to be able to play their sport or do their workout in comfortable, appropriate clothing. For them, “it’s life-changing,” Krimmel says, “It’s access.” Superfit Hero was serving a vast and virtually untapped market. Krimmel and her team decided to drop the smaller sizes and produce their line only in sizes 12-42. … Early this year, Superfit Hero is launching a partnership with Kohl’s—a milestone for the brand and its customers. “This is going to be the very first time that people can go in-store, in a major retailer, and try on size 6X and 7X in activewear,” Krimmel says.

The article closes with a persuasive and detailed case for legislation against fat discrimination, not just in the fitness arena, and a final aspirational rallying cry:

In a world where size is not used as a measurement of intelligence, competence, or mental stability, it might be possible to stop using it as a measurement of fitness too. If fat children and adults were valued and welcomed in workplaces and schools, they might feel safer (and more capable) walking into workout class or entering a race. If anti-fatness rather than fatness itself were deemed shameful and ignorant, the fitness industry would very likely be a different place—one accessible and beneficial to many more people than it is today.

Say it, sister! We’re all working for that world.

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Doctors Agree: No Fat Patients Need Apply

Lynne Murray says:

Debbie pointed out this New York Times article by Tara Parker Pope, where transcripts of doctor patient appointments showed the doctors’ comparative lack of engagement with fat patients when compared with their interaction with normal weight patients:

In conversations with patients of normal weight, the doctors offered simple comments to show concern — for example, “I’m glad you’re feeling better” to a woman who had experienced hot flashes. When a normal-weight patient had trouble getting an appointment with a specialist, her doctor shared her concerns. “I agree with you,” the doctor said. “That gets extremely frustrating when that happens.” …

While such expressions of concern and empathy are not remarkable on their own, what was surprising was how absent they were in conversations with overweight and obese patients.

And statements like these are no small thing. Studies show that patients are far more likely to follow a doctor’s advice and to have a better health outcome when they believe their doctor empathizes with their plight.

I have always been the patient doctors don’t want to see. Even before I open my mouth, my body size marks me as “noncompliant.” Once I started to resist weight loss advice, I became “the patient doctors avoid if at all possible.”

My first experience in requesting non-diet-oriented medical care came back when I had insurance in the 1990s. I brought The NAAFA Healthcare Bill of Rights (from the National Association to Advance Fat Acceptance) to an appointment. The first mistake I made was not giving it to the doctor before the appointment. When she started her diet spiel, I realized the flyer was in my purse and started to get off of the table, clad only in the flimsy paper covering. The doctor, a petite woman, literally stepped back in fear of being assaulted by a large, mostly naked, noncompliant patient. I gave her the flyer and she abandoned the diet talk. After that she managed not to ever to see me again.

She also took a certain kind of revenge for my having frightened her. When I developed extreme pain in my hands, arms and back at my job, which was all-keyboarding in a word processing center, she recommended only one week of leave. The specialist she referred me to intervened and I managed to get six weeks of disability to recuperate.

Fast forward 15 years, during which time I was self-employed and uninsured. The next doctor I saw at a local free clinic refused to accept that my maintaining a stable weight for 15 years was a good thing. She suggested that losing weight was the only solution to my arthritis, particularly my knee problems, even after I told her that decades of attempting weight loss had inevitably been followed by gaining back more than I had lost. So how did she propose to drastically reduce my already minimal food intake? Her view was that I was either mistaken or lying about what I eat. Essentially she stated that I must be doing something wrong or I wouldn’t be so fat.

She said “If what you say is true about what you are eating, you need to look into portion size and break it into several small meals.” She didn’t address, or maybe didn’t believe what I said about always regaining weight. This doctor wanted to share her eating disorder with me in the guise of treatment. The only reason I continued to see her was that I needed the clinic’s help. For my next appointment with her I both mailed in advance and brought in the Health At Every Size® manifesto, recommended by Linda Bacon, complete with citations to studies supporting the HAES approach.

She avoided seeing me at all during the appointment. Nurses at the clinic conveyed the necessary information to her and prescriptions to me. Mercifully she went on maternity leave and didn’t return. At my next appointment I actually saw another doctor. I could see the HAES materials in my file on the counter, but we didn’t discuss the subject. She simply said, “Aside from mobility problems and blood pressure you seem to be pretty healthy.” And we let it go at that.

I also have personal experience with the doctors described in the New York Times article, doctors who have been proven to provide sympathetic care for lower weight patients behaving very differently toward fatter patients. One friend had a doctor who had treated her with such sensitivity and concern that she felt he had saved her life. She wanted me to be able to have the same experience and even offered to pay the “concierge doctor” fees for his services. As it turned out money was not the problem. He simply refused to see me. Based simply on my friend’s description of me, including my weight, he recommended gastric bypass surgery.

In the New York Times article quoted above, Dr. David L. Katz, director of the Yale-Griffin University Prevention Research Center, notes:

In dealing with patients who are overweight … doctors often show the same biases and prejudices as the culture at large. The problem may be compounded by the fact that doctors are trained to deal with immediate medical problems that have specific solutions, like a pill to lower blood pressure or emergency treatment for a heart attack. But obesity is a far more complex problem that isn’t easy to solve, and that can be frustrating to doctors.

“When we can’t fix what is broken we tend to behave badly,” he said.…

Dr. Katz said his grandmother, who was obese, was so tired of physicians’ negative comments about her weight that she stopped going to the doctor altogether, even when she developed a breast tumor. When she finally sought treatment, she had advanced-stage breast cancer and died in her 50s.

“Every time she went to the doctor for any reason, they wagged a finger at her and talked about her weight,” Dr. Katz said. “We need to understand that the stakes are very high.”

The solution, he said, is better training so that medical students and doctors understand the complex nature of obesity as well as their own (perhaps subconscious) biases. Yale, for one, offers a continuing education program for doctors on compassionate and effective lifestyle counseling for patients.

“I think a lot of them are compassionate and don’t realize this is going on,” Dr. Katz said. “The antipathy for obesity is really rooted in our culture. We should expect better from doctors and train them better.

Even a small weight gain can put a patient “over the line” as far as doctor empathy is concerned.

At Fierce Fatties, bronwenofhindscroft writes about her husband’s first encounter with one doctor. Bronwen’s husband had gained 20 pounds in three years after a knee injury slightly curtailed his still impressive physical activities:

Those 20 pounds were enough to bring his BMI up three points and put him into “OMG YOU’RE GOING TO DIE TOMORROW!” range.

The doctor came in and, right off the bat, told him that he was “obese,” and needed to lose weight, first and foremost. If he didn’t, dire things would happen….

This leads many fat people to to mistrust the medical establishment and dread doctor visits. The physician bias against fat patients has been shown to exist as early as medical school.

The problem goes beyond doctors. The NAAFA newsletter points out:

A study by the Yale Rudd Center now shows that bias can be a two-way street, with patients being biased against physicians who are viewed as carrying excess weight.

Respondents reported more mistrust of physicians who are overweight or obese, were less inclined to follow their medical advice, and were more likely to change providers if the physician was perceived to be overweight or obese, compared to normal-weight physicians who elicited significantly more favorable reactions. These weight biases remained present regardless of participants’ own body weight.

In a post entitled “What to Say at the Doctor’s Office,” Ragen Chastain at Dances with Fat offers some wonderful boiled-down-to the essence Doctor Cards containing an explanation of Health at Every Size and a request for “shame free health care”–I love this phrase! The cards also offer some useful phrases to use at during office visits and citations to research to clearly make the point that science backs up the HAES approach.

I love her credo:

I believe that everybody of every size should be treated with respect.

I believe that it’s impossible to tell somebody’s health based on their weight.

I believe in giving people correct information and affordable options for eating and movement.

Doctors seem to share fatphobia with the rest of the world; this results in an unhealthy habit of discounting whatever fat people have to say, and thus translates into fat people getting treated at least as badly in the medical system as anywhere else.