Humiliating Fat People Is Hazardous to Our Health

The War on Obesity Is Counterproductive. Why Not Focus On Better Eating and Living for Everyone?

Why is First Lady Michelle Obama supporting the humiliation of fat people? Ms. Obama, who has made fighting childhood obesity her signature issue, recently appeared for the second time on the television show The Biggest Loser. She was on as part of a campaign launched by the Partnership for a Healthier America to encourage people to drink more water. Encouraging children (and adults) to choose water over soda and other sugary drinks is a good thing. But Obama would have been better off conveying that message without endorsing a program that uses the fear and loathing of fat people to scare Americans into adopting these behavioral changes. The First Lady’s endorsement of this abusive show—and its enduring popularity as its 15th edition marks its mid-season finale—is indicative of all that is wrong about the broader “war on obesity.”

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The show’s premise is that anyone can be thin if they work hard at it. If some people are fat, it is because they don’t care enough to try to better themselves. Not only are they slothful and gluttonous, but—because obesity is a deadly and costly disease—they are risking their own health and the economic health of the nation for their self-indulgent ways. In one episode of an earlier season, a doctor tells a 20-year-old male contestant, “You have so much to live for. What are you doing?” to which the shamed contestant responds, “Throwing it away.” After being told that his death is imminent due to his weight, another contestant confesses to his doctor, “I realize how selfish I’ve been.” Later in the season, a physical trainer explains to viewers, “To get in shape and to change your life doesn’t come free; you’ve got to earn it. And if they want it bad enough, if they can change themselves mentally and emotionally right here, the rest will follow.” Over and over again, the show portrays being heavy as both a death sentence and a personal choice.

In fact, body weight is determined by a host of biological, genetic, and social factors, often beyond one’s personal control. According to one estimate, 70 percent of the variation in people’s weight can be accounted for by genetic inheritance. This helps explain why the weight loss produced by diets tends to be temporary. As geneticist Jeffrey Friedman has explained, “In trying to lose weight, the obese are fighting a difficult battle. It is a battle against biology, a battle that only the intrepid take on and one in which only a few prevail.” So it’s not surprising that The Biggest Loser does not follow up with contestants years after the show to see whether they have been able to keep the weight off or not.

The extent of shaming that takes place on The Biggest Loser is extreme, but the general attitude that anyone can—and should be able to—lose weight by applying themselves is pervasive. In researching my book What’s Wrong with Fat?, I analyzed hundreds of news reports on “obesity” published between 1995 and 2005, and discovered that the issue is treated as much a moral scourge upon the land as it is a health issue. News reports overwhelmingly emphasize individual blame and responsibility. A typical 2003 news article says, “The two prime culprits for this expanding obesity are inactivity and overeating, and TV watching is linked to both of them.” Making the moral implications clear, the article speaks of children spending “lazy hours in front of the TV.” Indeed, television is the preferred example of a sedentary activity, since it is widely regarded as morally suspect. Among the hundreds of articles I read, not one spoke about children becoming obese because they are spending too much time reading, playing board games, or engaging in other sedentary—but virtuous—activities, as this would have muddied the simple narrative of obesity as the product of bad individual choices or behavior.

There are health risks associated with higher body mass, the clearest being Type 2 diabetes, which becomes more likely with increased weight. Yet even here, it is unknown whether being heavy causes diabetes, whether diabetes causes weight gain, or whether both conditions are caused by a third factor, such as poor nutrition, stress, or genetic factors. Moreover, the association between weight and Type 2 diabetes is not perfect. Some thin people develop the disease, and many fat people never will.

A 2008 study showed that a person’s weight is not a perfect predictor of metabolic abnormalities in blood pressure, triglycerides, cholesterol, glucose, insulin resistance, and inflammation. Almost a quarter of normal-weight people had abnormal profiles, while more than half of overweight people and almost a third of obese people had normal profiles. In other words, treating weight as a proxy for health could result in the under-diagnosis of more than 16 million normal-weight Americans and the over-diagnosis of almost 56 million overweight and obese Americans.

While there is a lot of uncertainty about the health risks of weighing more than average, there is growing evidence that our widespread societal anti-fat bias takes a toll on public health in many ways. Afraid of public ridicule or abuse, some heavy women avoid exercising in public or even leaving their homes, depriving themselves of social interaction. Women categorized as obese are more likely than thinner women to report that they experience the doctor’s office as a hostile environment. Such women are also, on average, less likely to get Pap smears, contributing to higher rates of cervical cancer among women categorized as obese. And the fear of becoming fat can lead women of all sizes to develop eating disorders and body-image problems that diminish their lives and can be extremely dangerous to their health.

Yale researchers have shown that weight discrimination in the United States has increased dramatically in the past decade and is now comparable in prevalence to rates of reported racial discrimination, especially among women. Multiple studies have documented weight bias in employment, healthcare, education, and public spaces—unequal treatment based on stereotyping fat people as lazy, unmotivated, sloppy, and lacking in self-discipline and competence. Heavier women are not only less likely to be hired and less likely to earn a higher salary compared to their similarly qualified thinner peers, but they are also less likely to marry or to marry a high-earning spouse. Unlike thinner women, who can more easily climb the social and economic ladder, heavy women face the prospect of downward social mobility.

My colleagues and I have conducted research that suggests that exposure to moralizing messages promoted on shows like The Biggest Loser worsen anti-fat prejudice. We found that people who read a news report discussing an alleged obesity health crisis were more likely to agree—compared to those who read an article on a topic not related to weight—with stereotypes of fat people as unlikable, untrustworthy, and less intelligent than thinner people. Other studies have shown that individuals who think people can control their weight are more likely to believe that weight-based discrimination is justified. By aligning herself with The Biggest Loser, Michelle Obama further legitimizes anti-fat attitudes, and the ills they spread.

Moreover, discussing physical activity and nutrition solely as weight matters, instead of contributors to one’s broader health, is counterproductive. Plenty of people make positive changes to their diet and increase their physical activity as part of an effort to lose weight. If they don’t lose weight or their weight plateaus, they become frustrated and revert to their old ways, even though the behavioral changes bring with them other positive health dividends. Given how difficult it is to lose weight, the First Lady should consider using her platform to promote a more constructive message: that people of all sizes can make positive nutritional and exercise changes.

  • Deah Schwartz

    What a wonderful article…like a walk into sanity! Thank you!
    Dr. Deah Schwartz

  • SKM

    Excellent points! I wish articles like that were more a part of the dominant public dialogue about obesity.

  • JC Reilly

    I wish my doctor would read articles like this one. I can’t even stand going to her if I have a sinus infection because I know I’ll get a lecture for 30 minutes about my weight. Her answer is bariatric surgery…for everything. (I know, I know, I need to get another doctor… but I have little hope of finding one who is sympathetic–or at least, a non-judgmental.)

    • Martin Flynn

      You are the only one who will have to pass judgment. And if you’re okay with the drugs, and the discomfort and watching life from the eventual electric wheelchair, then we’re all okay.
      But there are no “takebacks” when it comes to being fit. It’s your call. Why not “Make Health A Game”?

      • JC Reilly

        I’m sorry, I don’t know what you mean, “watching life from the eventual electric wheelchair”? That sounds to me like you assume I am sitting on my ass with my face in a gallon of Haagen-Dasz. I play tennis in 3 leagues, have a personal trainer, and do water aerobics or walk 2 or 3 times a week for at least an hour. I’m still fat, and I still get shit from my doctor. It doesn’t matter to her that I have a relatively active lifestyle. What matters to her, only, is the number on the scale. Please check your fatphobic comments at the door, and STFU if you don’t have anything helpful to contribute.

    • Jinpa Heyer

      keep trying to find a doctor. They are not all like that. Even some of the ones who subscribe to the party line on weight can still be convinced to treat you as a person and not just your weight. I managed to find a service in which the doctors may not be happy with my weight, but they are still willing to actually treat my symptoms and refrain from lecturing me about it. (I made a point of telling them I eat healthy, giving a description of my habits and they still recommended a diet – I went to the nurse-supervisor and complained about it. Dunno if that helped, but at least it was an option.)

  • For a proper role model and attitude on body image, look no further than Jennifer Lawrence’s outspoken views. Just Google her and you see hundred of articles bashing Photoshopped magazine covers, her refusal to succumb to Hollywood ideals and slamming Joan Rivers’ Fashion Police.

    Her insistance on her character, Katniss Everdeen from the Hunger Games (a role model for young girls and women worldwide) be fit and strong rather than thin and underfed is wonderful.

  • Amber

    A person doesn’t get to 500 lbs because of “genetic inheritance” alone. Something else is going on there. Obviously no one chooses to be obese, but a combination of a poor diet, no work out regimen and genetic ingeritance is to blame. This show teaches discipline, good working out habits, and a healthy diet. There is nothing wrong with that.

    • Jinpa Heyer

      working out until one vomits is “good working out habits”?

  • Lynn

    Please keep writing these articles. Not only do I love reading them, I bring them to work (public health dept), and they have raised eyebrows, and resulted in opening minds, and thoughtful commentary. This side of the issue cannot be heard enough.

  • newgirl111

    Why does nobody talk about how sedentary jobs also contribute to obesity? I am sitting at my computer right now for my job. It sucks. 🙁

  • Taneesha Culture Clash Thomas

    if you work out & eat right…you’ll lose weight & or maintain weight loss…it’s definitely healthier to drink water than soda…it’s not rocket science