Talk to Linda Bacon and Lucy Aphramor for an hour in a coffee shop, as I did a few weeks ago for my column in Sunday’s Seattle Times, and you walk away quite clear that the root causes of obesity go much deeper than individual choice and responsibility. Weight stigma and social disparities are profound contributors to the so-called obesity epidemic.
“If we’re serious about health, ultimately we need to build a better world. That’s it,” Aphramor said. “On the one hand, if you focus on health gain rather than weight, health gain means helping people with self-care, and also in tackling the things beyond individual health behavior change that make for poor health. What the health at every size model does is gives us a way to integrate them.”
She said that in the United Kingdom, malnutrition costs the National Health Service (NHS) much more than obesity costs, yet government agencies are telling the whole nation to get thin. “If you had a similar response to malnutrition, you would tell the whole nation to ‘eat up,’ which is ridiculous,” she said.
Aphramor also made the spot-on point that the government and media would also never show images of undernourished people the unflattering way they show images of obese people. “Our response to malnutrition is much more understanding,” she said. “It’s not that we call malnourished people selfish and they’re costing the NHS money and resources. The morality of it is very different as soon as you start talking about high weight.”
She called weight stigma a symptom of a political inequality and a political mood that promotes the notion that weight and health is all about personal responsibility. She said this “neoliberal paradigm” abdicates our responsibility to the society as a whole, and helps ensure that the haves continue to get more while the have-nots continue to get less.
“That form of stigma legitimizes inequalities, so it gets played out in the bodies of fat people as it does around race and age. It justifies the ideology ‘If you just try hard, you can have it all.’”
This ideology is one we might use against ourselves…and then against others.
“We have a binary hierarchy that splits things into good/bad, fat/thin and we’re using that to judge ourselves very harshly, but we’re also using it to construct a worldview,” Aphramor said. In that worldview, there is always inequality and points scoring (if you’ve ever body checked someone, that’s points scoring).
“In itself, that leads to stigma and stereotype,” she said. “If you’re serious about improving the health of fat people as a particular group, then you challenge size stigma. If you want to stop populating weight gain, stop dieting.”
Aphramor used type 2 diabetes, which is often described as a disease of lifestyle choices, as an example. “While diet and exercise can make a big difference in managing diabetes and somebody’s quality of life, if you look at the population level, fundamentally it’s a disease of disadvantage,” she said. “People who get diabetes are the people with insecure employment, living in poverty with stress and discrimination. So helping someone to look after themselves can make a big difference, but tackling the prevalence of diabetes needs social justice.”
“From a position of privilege, the best thing I can do for health is to advocate for social justice, not eat more veg.”
Tomorrow: HAES and the healthcare system
Photo source: Yale Rudd Center for Food Policy & Obesity