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19 April 2016

Only yourself to blame: how stigma is making us fatter

Interacting with health-care professionals has been a long-standing problem for obese people. It's time to tackle the question of weight without prejudice.

By Michael Brooks

This month, researchers from across the world convened at the O2 Arena in London to dodge the F-word: fat. Most focused on medical and nutritional interventions but a few wanted to name the elephant in the room: discussions of obesity, they said, even among scientists, are tinged with disapproval and sly disgust.

One man who raised the issue was Stuart Flint of Sheffield Hallam University. His presentation at the Obesity Summit focused on what some call “the last acceptable prejudice”. Scientific research has shown that the causes of obesity are at least 70 per cent genetic. Modern environmental conditions such as the wide availability of high-calorie food, convenience-oriented lifestyles and changes in the way we build houses and offices have transformed a common predisposition into an alarming epidemic.

Social attitudes have yet to catch up with the science. Flint’s studies show that those attitudes are born out of what he terms “Protestant ethic values”. Obese people are considered “immoral, slothful and gluttonous”, akin to deviants, particularly in media reports where obesity is portrayed as a controllable condition that is easy to remedy. Witness the popularity of redemption stories (“Obese woman who was too fat to fit in a plane seat reveals how she slimmed to a slinky size 10”) or the preference for illustrating with photos that show dehumanised pariah figures that are headless or swaddled in ill-fitting clothes.

This is hardly helped by the rhetoric used by politicians, as exemplified by David Cameron, quoted here in the Times: “Some people who are poor, fat or addicted to alcohol or drugs have only themselves to blame.” Classing the obese with addicts and alcoholics isn’t helpful, Flint suggests.

Weight stigma has now become a significant problem in the workplace. Employers and employees alike will openly admit to discriminating against those who are obese. Efforts to reduce discrimination have been largely ineffective.

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Perhaps the most shocking workplace in which you might hear anti-fat rhetoric, though, is among obesity researchers. Flint reports attending a conference during which a “renowned speaker” referred to a successful campaign as having “provided more space for commuters on the London Tube”. Another commented that if obese people lost weight, “they would have a lot of sex, which is probably good as they won’t have had it for a while”.

Lesley Gray, who also presented results at the O2 conference, has shown that health-care professionals have difficulty dealing with obese people. Gray’s research, carried out at the University of Otago in New Zealand, shows that many doctors and nurses are embarrassed and awkward when faced with obesity because there is no vocabulary considered free from stigma.

Interacting with health-care professionals has been a long-standing problem for obese people. A 2006 study showed that doctors are the most frequent source of stigma, more problematic even than family members and classmates. The same study showed a positive correlation between the frequency of expressed prejudice and two factors: higher BMI and more attempts to deal with it. In other words, the more that obese people want and need to attend gyms, exercise classes and doctors’ surgeries, the more abuse they suffer.

It’s especially problematic because the greater burden is borne by those with the least power. According to research published this month by the University of Georgia, “obesity inequality” is growing in the US. If you live in a socioeconomic group or subculture that has had higher-than-average obesity in the past, your chances of becoming obese are getting bigger all the time. Top of the table is black America. It’s a problem, the authors note, not only because of the social stigma, depression and workplace discrimination that are likely to ensue. Other studies show that living within a group where obesity is prevalent makes it more acceptable – and thus more likely – for the next generation to become fat. In other words, this is a vicious circle.

Our problem with facing up to such issues will affect everyone. In the developed world, the fastest-growing category of obesity is the most desperate – morbid obesity. A significant proportion of these people are not yet problematic: they are well, and not using health-care services, Gray says. But that will change, unless the tone of our conversation changes first. Fat is not a pejorative; fat is a fact of modern life, and a civilised society has to tackle the matter without prejudice.

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This article appears in the 13 Apr 2016 issue of the New Statesman, The making of a monster