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Public Health Messages and Fat Acceptance — is there a conflict?

We can turn anything into an argument, but it doesn’t mean we should.

By Tiffany Bailey from New Orleans, USA (Flickr/photos/xshamethestrongx IMG_1588) [CC BY 2.0], via Wikimedia Commons

Both the UK and the US have high levels of obesity. In the UK 62% of the population is overweight or obese, and in the US it’s 74%. There is a wealth of advice from government and the medical profession encouraging us to slim down, to avoid the risk of serious illnesses and early death. However, as we become larger on average, there’s a corresponding desire to make society more accepting of bigger bodies. You might think that these two aspirations are in conflict with one another, but they don’t have to be.

Recently the Guardian published an op-ed in which the author attempted to join the dots between these two problems — and it didn’t go well. Here is the offending article:

It’s not fine to be fat. Celebrating obesity is irresponsible |Lizzie Cernik | Opinion | The Guardian

I suppose I should start by declaring any conflicts of interest. I’m not fat — far from it, I’m a UK size 6 — but I’m still acutely aware of the ways that society discriminates against those who are, and it’s not right. The ideal body type in today’s media is something that most people cannot achieve, and the disparity between that and the physique of most consumers is designed to create angst so that we feel compelled to buy a product to make us feel better. If fashion models were more ordinary-looking, their use in advertising wouldn’t be as effective — there has to be a manufactured need that we can fulfil through buying ourselves some small indulgence.

The article begins by praising the body-positivity movement for celebrating “unconventional”, i.e. normal, body types, but then makes the leap to suggesting that the fat acceptance movement is “actively encouraging unhealthy lifestyle choices and denying health risks”. The conflation of fat acceptance and encouraging a complete about-turn of our society’s ingrained beauty standards continues throughout the piece, but it is not supported by the fact that we continue to portray thin bodies as the norm in advertising. Even most “plus-size” models have bodies slimmer and more polished than real plus-sized people.

Public health campaigns are an important and necessary method of educating the public and creating change to support and improve the health of the nation. But they are not the same thing as a movement aimed at fostering respect and acceptance for all bodies. Some people are fat, and everyone else needs to just deal with that instead of playing Armchair Doctors. Fat people have their own, real, doctors and they don’t need unsolicited advice or disapproval any more than the rest of us. So zip it — it’s the polite and normal thing to do.

The blending of these two concepts assumes that fat people aren’t aware of the health risks of obesity, or that the fat acceptance movement works in direct opposition to public health messages. That is incredibly patronising, as well as being untrue. Both campaigns can exist at the same time without one cancelling the other out, or the two positions being pitted against one another. This supposed conflict has been manufactured, and while it may have originated in good intentions, it’s unhelpful and does nothing to support either cause.

Public health campaigns are accessible to all, and do sometimes tell us things we don’t want to hear. But their job is different to that of campaigns aimed at supporting marginalised groups. The fat acceptance movement will provide the most benefit to fat people (surprise!), not by encouraging people to eat more cake, but by making it unacceptable to bully and shame people because of their physical size. That’s a worthy aim that can run alongside whatever public health campaign you choose.

There is evidence that body-shaming is counter-productive when addressing obesity, and can actually make matters worse by creating barriers to accessing healthcare — both psychologically and practically. There are numerous examples of medical staff seeing the patient’s weight as the primary problem when there’s another, more pressing, concern that needs treatment in itself. Patients are less likely to seek help if they feel they’ll receive inadequate care, or be shamed by providers.

“Disrespectful treatment and medical fat shaming, in an attempt to motivate people to change their behavior, is stressful and can cause patients to delay health care seeking or avoid interacting with providers” — Joan Chrisler, PhD

I’m not sure why the Guardian article was necessary. Did we really need an opinion piece validating the opinions of those who disapprove of fat people? In what way has this enriched our culture? The concern over the nation’s health does not seem genuine and comes across as smug and judgemental, perhaps proving the fat acceptance movement’s point. I do understand the concept that influencing what society perceives as “normal” is instrumental in maintaining good health in the population, but the correct way to do this isn’t by bullying people into submission. We should also remember that not everybody is “normal”, and we shouldn’t necessarily strive to be.

Increased obesity rates are the result of many interrelated factors, some within our control, and some less so. It’s a complicated picture, and we must also balance this against other health issues and the need to strengthen society’s respect and concern for all bodies. We don’t need to present this as a problem of taking sides — we need to be conscious of the complex and pluralistic nature of the matter, and handle it with sensitivity and understanding.