Image Description: An illustration showing a brain, an eye, bottled water, an avocado, a scale, and a medical book.

Combatting Weight and Appearance Bias II: Changing the way we think about health

Disclaimer: In this post, I’ll be using the term “fat.” Fat is a neutral descriptor, similar to tall or short; it’s the stigma we attach to the word that is harmful. Fat individuals have reclaimed the word, similar to how LGBTQIA+ individuals have reclaimed the word “queer.” While fat is something people should be able to choose to identify as, rather than be labelled as, for the purpose of this discussion I use the term generally to refer to people in the “overweight,” “obese,” and “very obese” BMI bands. I understand that BMI is a problematic tool for categorization, as will be discussed in this article, but it’s one of the most commonly used metrics in studies on this topic.

I am queer, White, and thin. As such, I benefit from a lot of privilege. I don’t pretend to speak to the experiences of fat individuals but instead hope to share academic and community knowledge and start a conversation.

Close your eyes for a moment and try to picture a “healthy” person. What do they look like? What foods do they eat? What physical activities do they engage in?

Over the past century, thinness has evolved into a beauty standard and achieving and maintaining it through a “healthy diet” and exercise has become a moral imperative and a health obligation, especially in the US and Canada. As I discussed in my last post, these beliefs lead to weight and appearance discrimination, which can have profound negative effects on people’s lives and careers.

This obsession with thinness was not always a given. Articles shaming people for fatness first emerged in the1890s, for complex social and historical reasons. But our preoccupation with weight loss really picked up momentum in the 1960s, when medical studies implicated fat as a major risk factor for heart disease. These bases for the “war on fat”, both on weight and the nutrient, were faulty, filled with bias and cherry-picked data. However, because these early studies went largely unchallenged and were accepted as gospel truth by the majority of the population, the US government recommended a low-fat diet to all Americans in 1977.

But health is more nuanced than that. In fact recent studies indicate that it may be entirely idiosyncratic, with certain nutritional profiles, including high fat diets in some instances, working for one body or type of person and not another.

Regardless of current research though (45), the media continues to condemn fatness, promoting misleading quick-fix products and methods to lose weight. From Whole 30 to detox cleanses, it’s easy to find new diets, exercises, and “lifestyle changes” that promise to keep you thin, happy, and healthy. But in reality, many of these are overly restrictive, ineffective in the long term, and even dangerous.

In this article, I invite you to challenge popular assumptions about health and consider how they feed into weight and appearance bias.

Size does not determine health

When you go to the doctor, one of the first things they do is weigh you. Have you ever wondered why that is?

Unless your doctor is trying to determine dosage for a narrow range of medicines, they are almost certainly weighing you solely to calculate your Body Mass Index (BMI). This common health metric is simply your weight to height ratio. It was devised in the 1830s to measure the degree of obesity in the general population, and is still used today as a quick measure of health.

BMI divides people into the following categories: “underweight,” “normal weight” (otherwise referred to as “healthy” or “ideal” weight), “overweight,” “obese,” and “very obese.” Note that by defining one category as “normal,” “healthy,” and “ideal,” it’s implied that other categories are not.

You’re likely familiar with BMI. However, most people are unfamiliar with the serious criticisms of this metric, which is now viewed by many health researchers as a wildly inaccurate health indicator.

For starters, BMI does not account for the varied proportions of bone, muscle, and fat, all of which have different densities, across bodies. For example, many professional athletes, whose bodies are low on fat but high on dense muscle content, would be categorized as “overweight” or “obese” on the BMI scale.

Recent studies also indicate that the things many might assume about those in “overweight” and “obese” BMI bands — that they eat poorly and to excess and will die earlier than their “healthy” peers — are unfounded.

About the same ratio of people in each BMI band eat a quality, nutritious diet (30). People in higher BMI bands do not eat more on average than those in lower bands (32). And people in “overweight” and “obese” BMI bands appear to live longer than their “healthy” peers (29, 31, 33).

To top it all off, BMI categories have been redefined for (at best) dubious reasons. In 1997, the National Institutes of Health lowered the BMI cutoff for “overweight” from 27 (28 for men) to 25, ostensibly because this was an easier number for people to remember. This was somehow supposed to make them more aware of their health. However, reporters have noted that this shift financially benefitted healthcare and insurance companies, by making millions of people newly “overweight”, and thus treatable and billable, overnight.

So why do we still use BMI as a predictor of health? Largely because alternatives that might be more accurate indicators of wellbeing take more time and money to calculate than BMI.

Just as BMI is not an accurate indicator of health, neither is a person’s physical appearance — especially their weight.

A person’s appearance tells you nothing about the quality of their diet, how physically active they are, what diseases they currently or may one day experience, what risk factors may lie in their DNA, how they sleep, whether they smoke, or what sociodemographic background they come from. All of these are more accurate, and largely invisible, measures of health.

Size, health, and “choice”

Many people view wellness and body size as “choices.” As such, our culture often blames fat individuals for “choosing” not to be thin and “healthy”. But “choice” is a concept born of privilege; few actually have the ability to control the circumstances surrounding their weight and wellness. The idea that we can all “choose” our circumstances equally and easily has frequently been used against marginalized groups (e.g. LGBTQIA+ people “choose” their sexuality or gender identity) to legitimize bias and discrimination against them.

Recent studies suggest that body size and shape, height, and weight are largely determined by genetics and specific medical conditions. As such, there is no standard “healthy” body everyone could and should try to achieve.

Even in the areas where people can exercise control over their body and wellness, not everyone has access to the tools necessary to do so — respectful healthcare, health insurance, physical activity, and fresh, nutritious food (34, 35, 36). For example, many individuals cannot access or afford fresh, nutritious foods (35). Many others with physical impairments may not be able to access or prepare these foods as well.

Harmful effects of dieting

While fatness is not harmful, diets often are. They teach us to ignore and mistrust our hunger and incorrectly demonize nutrients like salt, sugar, and carbs, all of which have suffered the same dubious crusades as fat.

Many people believe that without the rules of diets we will “lose control,” and become unable to stop ourselves from eating endless amounts of “junk” food. In truth, every one of us is born with the innate ability to sense and eat when we’re hungry, stop when we’re full, and choose the foods that are right for us (48). Every time we go on another diet that asks us to ignore these signals, we begin to lose those abilities.

We often assume that we should gravitate towards foods that diet culture tells us are “good” or “healthy.” But the idiosyncrasies of our bodies make it impossible to say that any one food is “healthy” or “unhealthy” in general. Someone whose body is burning through nutrients quickly for whatever reason, for example, may need the the easily digested, calorie-dense content of a McDonald’s meal.

Contrary to public opinion, research shows that long-term weight loss is virtually impossible for most people and does not improve health or help you live longer. Fluctuations in weight have been proven to damage your health and weight cycling causes chronic inflammation (46, 47).

The mindsets that drive dieting can be harmful too. They can lead to a preoccupation with food and the body, distract from self-care, lower self-esteem, and cause eating disorders. Studies show that 75 percent of women report eating disorders or similar symptoms, which have the highest mortality rates of any mental illness.

Everyone would benefit from less diet culture, whether they realize it or not. Recent studies prove that the shaming associated with this culture actually worsens people’s wellbeing, increasing your risk of heart disease, stroke, and diabetes (3, 14, 15).

Health is complicated. It is not easily measured or defined, especially by someone’s weight or appearance. The idea that we should strive for a common ideal body or live one unified “healthy” lifestyle is built on the oversimplification of wellness, whether misguided or malicious. Challenging these overly simple and blatantly flawed narratives can be beneficial for all of us. But it is vital to combatting the bias and discrimination many face due to their weight and appearance.

However shifting society’s understandings of weight and wellness will likely be a slow, gradual process. As we wait for that cultural change to set in, though, there are actions we can take to mitigate the harm caused by our social misconceptions in the immediate future. We will discuss these potential steps and actions in next week’s post.

Edit: Due to the need to create some time-sensitive content, the next post will be published in July. Stay tuned!

Did you like this article? We’d love to hear from you on Twitter, or you can email us.

✌️ Versett is a product design and engineering studio. If you like this post, you’d love working with us. See where you’d fit in at https://versett.com/

Sources

(1) Roehling, Mark V, et al. “The Relationship between Body Weight and Perceived Weight-Related Employment Discrimination: The Role of Sex and Race.”

(2) Flint, Stuart W, et al. “Obesity Discrimination in the Recruitment Process: ‘You’re Not Hired!’”

(3) Pearl, Rebecca L, et al. “Association between Weight Bias Internalization and Metabolic Syndrome among Treatment‐Seeking Individuals with Obesity.”

(4) Durso LE, Latner JD. “Understanding self-directed stigma: Development of the weight bias Internalization scale.”

(5) Puhl RM, Schwartz M, Brownell KD. “Impact of perceived consensus on stereotypes about obese people: A new approach for reducing bias.”

(6) Cramer P, Steinwert T. “This is good, fat is bad: How early does it begin?”

(7) Crandall CS. “Prejudice against fat people: Ideology and self-interest.”

(8) Klesges RC, Klem ML, Hansoon CL, Eck LH, Ernst J, et al. “The effects of applicant’s health status and qualifications on simulated hiring decisions.”

(9) Teachman BA, Brownell KD. “Implicit anti-fat bias among health professionals: Is anyone immune?”

(10) Puhl, R., Brownell, K. D. (2003). “Ways of coping with obesity stigma: Review and conceptual Analysis.”

(11) John M. Kang, “Deconstructing the Ideology of White Aesthetics”

(12) Askegaard, Søren. “Moralities in Food and Health Research.”

(13) Oliver-Pyatt W. “Fed Up!”

(14) O’Hara, Lily, Taylor, Jane. “What’s Wrong With the ‘War on Obesity?’ A Narrative Review of the Weight-Centered Health Paradigm and Development of the 3C Framework to Build Critical Competency for a Paradigm Shift.”

(15) Hunger, Jeffrey M, et al. “Weighed down by Stigma: How Weight-Based Social Identity Threat Contributes to Weight Gain and Poor Health.”

(16) Fikkan, Janna L, Rothblum, Esther D . “Is Fat a Feminist Issue? Exploring the Gendered Nature of Weight Bias.”

(17) Grossman, R. F. “Countering a weight crisis.”

(18) Cossrow, N. H., Jeffrey, R. W., & McGuire, M. T. “Understanding Weight stigmatization: A focus group study.”

(19) Hebl, M. R., Mannix, L. M. “The weight of obesity in evaluating others: A mere proximity effect.”

(20) Roehling, M. V. “Weight-based discrimination in employment: Psychological and legal aspects.”

(21) Wade, T. J., DiMaria, C. “Weight halo effects: Individual differences in perceived life success as a function of women’s race and weight.”

(22) Theran, E. E. “Free to be arbitrary and capricious: Weight-based discrimination and the logic of American anti-discrimination law.”

(23) Drogosz, Lisa M., Levy, Paul E. “Another Look at the Effects of Appearance, Gender, and Job Type on Performance-Based Decisions.”

(24) Riniolo, Todd C. et al., “Hot or Not: Do Professors Perceived as Physically Attractive Receive Higher Student Evaluations?”

(25) Cash, Thomas F., Kilcullen, Robert N. , “The Aye of the Beholder: Susceptibility to Sexism and Beautyism in the Evaluation of Managerial Applicants.”

(26) Alan Feingold, “Good-Looking People Are Not What We Think.”

(27) Toledano, Enbar, et al. “The Looking-Glass Ceiling: Appearance- Based Discrimination in the Workplace.”

(28) Spettigue, Wendy, and Katherine A Henderson. “Eating Disorders and the Role of the Media.”

(29) Bacon, Linda, and Lucy Aphramor. “Weight Science: Evaluating the Evidence for a Paradigm Shift.”

(30) X, Guo. “Healthy Eating Index and Obesity.”

(31) Corrada, M M. “Association of Body Mass Index and Weight Change with All-Cause Mortality in the Elderly.”

(32) Drenowatz, C. “Differences in Correlates of Energy Balance in Normal Weight, Overweight and Obese Adults.”

(33) McGee DL. “Body Mass Index and Mortality: a Meta-Analysis Based on Person-Level Data from Twenty-Six Observational Studies.”

(34) Mays, Vickie M., Cochran, Susan D., Barnes, Namdi W. “Race, Race-Based Discrimination, and Health Outcomes Among African Americans.”

(35) Woolf, Steven H, et al. “How are Income and Wealth Linked to Health and Longevity?”

(36) Lee, Jennifer A, Pause, Cat J. “Stigma in Practice: Barriers to Health for Fat Women.”

(37) Rudolph, Cort W., et al. “A meta-analysis of empirical studies of weight-based bias in the workplace.”

(38) Phelan, Julie E., Moss-Racusin, Corinne A. , Rudman, Laurie A. “Competent Yet Out in the Cold: Shifting Criteria for Hiring Reflect Backlash Toward Agentic Women.”

(39) Rogge, M. M., Greenwald, M., Golden, A. “Obesity, Stigma, and Civilized Oppression.”

(40) Zakrzewski, Karen. “Lookism in Hiring Decisions: How Federal Law should be Amended to Prevent Appearance Discrimination in the Workplace.”

(41) Cavico, Frank J, Muffler, Stephen C, Mujtaba, Bahaudin G. “Appearance Discrimination, “Lookism” And “Lookphobia” In The Workplace.”

(42) Bartlett, Katharine T. “Only Girls Wear Barrettes: Dress and Appearance Standards, Community Norms, and Workplace Equality.”

(43) Carels, Robert A., Musher-Eizenman, Dara R. “Individual differences and weight bias: Do people with an anti-fat bias have a pro-thin bias?”

(44) Lelwica, Michelle M. “The Religion of Thinness: Satisfying the Spiritual Hungers Behind Women’s Obsession with Food and Weight”

(45) Penney, Tarra L., Kirk, Sara F. L. “The Health at Every Size Paradigm and Obesity: Missing Empirical Evidence May Help Push the Reframing Obesity Debate Forward”

(46) Lissner, L. et al. “Variability of body weight and health outcomes in the Framingham population.”

(47) Strohacker, K., McFarlin, B. K. “Influence of obesity, physical inactivity, and weight cycling on chronic inflammation.”

(48) Sairanen, Essi, et al. “Psychological Flexibility and Mindfulness Explain Intuitive Eating in Overweight Adults.”