Let’s stop fat shaming

 

The New York Times had a recent discussion about our culture of ‘fat shaming’ in which overweight people are made to feel bad about themselves1,2. Fat shaming is a serious problem and, whether or not it is ill-intentioned, it is clear that it has significant ill effects. For example, studies have shown that experiencing weight-related discrimination causes people to eat more3, exercise less4, and gain weight rather than lose it5. So if you think that fat shaming someone will somehow encourage them to take better care of themselves, think again.

There have been many reasonable attempts to make the case against fat shaming, but these efforts are often not as effective as they could be. Those who attempt to support overweight people often argue both that ‘people who are overweight shouldn’t be made to feel bad about themselves’ and that ‘there is nothing wrong with being overweight’. But these are very different statements and, while the first is plainly true, the second needs clarification.

Being overweight does not make you a bad person …

A good place to start is by establishing that being overweight does not make someone a bad person. A person’s weight is simply a product of their genes and the circumstances in which they live, with each of these factors making a significant contribution.

It is impossible to argue that someone should be judged based on their circumstances, which are, by definition, outside of their control. Imagine two identical twins who are separated at birth and sent to different families. If one twin grows up eating fresh foods and stays thin, while the other twin grows up eating processed foods and becomes overweight, is it reasonable to assert that the thin twin is a better person than the overweight twin? Obviously not.

If a person cannot be judged based on their circumstances, the only alternative is to judge them based on their genes (keeping in mind, of course, that actually making such a judgement is impossible; one cannot know whether any particular person is overweight because of their genes, or their circumstances, or some combination of the two). Therefore, to assert that someone who is overweight is a bad person is to assert that having genes that, in certain circumstances, lead you to take in more calories than you burn makes you a bad person.

While there is no obvious logical flaw in this assertion, the argument in support of it is not very compelling. For the last 99.99% of human history, food was scarce and, therefore, genes that encouraged the seeking and eating of food and the storage of body fat were a great advantage for survival. Now, all of the sudden, food is everywhere, and the same genes have become a disadvantage. Judging someone negatively for having genes that have been favored throughout the evolution of their species seems perverse.

And what basis is there for treating someone who is overweight differently than someone whose genes and circumstances cause them to overconsume in another way? Drug addicts, for example, are generally treated with sympathy rather than derision, presumably because of the recognition that their addiction is a product of unfortunate genes or circumstances. But the hard-wired brain circuits that drive the consumption of drugs are the same as those that drive people to overeat processed foods6, so anyone who is unlucky enough to be unable to control the cravings produced by these circuits in any form should be treated equivalently.

… but being overweight does make you unhealthy

So being overweight does not make you a bad person; however, that does not mean that there is nothing wrong with being overweight. This is the point where many arguments against fat shaming go wrong. Unfortunately, being overweight is clearly unhealthy. However, despite the overwhelming evidence linking overweight and obesity to increased risk of, for example, cardiovascular disease (CVD)7, those who attempt to support overweight people often downplay this risk.

Statements that downplay the health risks associated with being overweight are a problem not only because they are inaccurate, but also, more importantly, because including them among legitimate arguments in support of overweight people undermines those other arguments, and gives those who are inclined toward fat shaming, or don’t believe it to be a serious problem, an excuse to dismiss the issue altogether.

One source of confusion appears to be that some people can be overweight and still appear to be ‘metabolically healthy’8. The explanation for this is straightforward: the problem with being overweight is not excess body fat itself, but the chronic inflammation that excess body fat tends to cause.

Some people’s genes will protect them against the inflammatory effects of excess body fat, so it is indeed possible to be overweight without developing chronic inflammation and, therefore, it is possible to be overweight without metabolic dysfunction or increased risk of developing CVD. But the fact that some people can be overweight without significant inflammation does not that mean that the health risks associated with being overweight are overblown. It is also true that some people can smoke heavily and never develop lung cancer, while others can drink heavily and never develop cirrhosis. These people are lucky enough to have genes that protect them from the problems that would normally be caused by excess tobacco or alcohol consumption. But the existence of such people does not imply that the health risks associated with smoking or drinking are exaggerated.

The fact is that the amount of inflammation caused by a given amount of excess body fat is going to be different for everyone; however, on average, the amount of fat carried by a person who is classified as overweight or obese is enough to cause significant inflammation and increased health risks in the average person.

The right approach is to be supportive of overweight people while still encouraging them to improve their health

It is unfortunate that the arguments against fat shaming often attempt to minimize the health risks associated with being overweight. Some who argue in support of overweight people even go as far as to say that encouraging people to lose weight is doing them a disservice, suggesting that it is merely a veiled form of shaming. But the line between shaming and encouraging is not that fine, and most people, if they choose to, are able to stay on the right side of it.

The legitimate arguments against fat shaming will be enough to convince most reasonable people that it is not OK, and unreasonable people will never be convinced anyway. Pretending that being overweight doesn’t matter at all may be less harmful than fat shaming, but it is also less helpful than an honest approach that is supportive of the overweight people while still recognizing the associated risks and encouraging efforts to be more healthy.

 

1. http://www.nytimes.com/2016/02/07/opinion/sunday/yes-im-fat-its-ok-i-said-it.html

2. http://www.nytimes.com/2016/02/14/opinion/how-we-view-obesity.html

3. Durso LE, Latner JD, Hayashi K. Perceived discrimination is associated with binge eating in a community sample of non-overweight, overweight, and obese adults. Obes Facts. 2012.

4. Vartanian LR, Shaprow JG. Effects of weight stigma on exercise motivation and behavior: a preliminary investigation among college-aged females. J Health Psychol. 2008.

5. Jackson SE, Beeken RJ, Wardle J. Perceived weight discrimination and changes in weight, waist circumference, and weight status. 2014.

6. DiLeone RJ, Taylor JR, and Picciotto, MR. The drive to eat: comparisons and distinctions between mechanisms of food reward and drug addiction. Nature Neuroscience. 2012.

7. Wilson PF, D’Agostino RB, Sullivan L, Parise H, Kannel WB. Overweight and Obesity as Determinants of Cardiovascular Risk: The Framingham Experience. Arch Intern Med.2002.

8. Tomiyama AJ, Hunger JM, Nguyen-Cuu J, Wells C. Misclassification of cardiometabolic health when using body mass index categories in NHANES 2005–2012. Int J Obes. 2016.