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This week, the health secretary has been heaping praise onto a proposed new generation of weight-loss drugs. Wes Streeting filed an opinion piece in The Telegraph stating obesity costs the NHS £11 billion a year.
This quick-fix drug could also get people back to work, he lauded. An injection or two and the unemployed could get jobs – given, obviously, these overweight people are all too fat and lazy to be bothered to try.
The Prime Minister responded that weight-loss jabs could be “very important” for a thriving economy, and it was time to “think differently”. On thinking differently, Sir Keir, we agree with you.
What if we reframed how we thought about fatness? What if we didn’t write away social problems by saying fat equals lazy and lazy equals fat? What if we knew the line between a public health crisis and moral panic?
Streeting spoke about “illness caused by obesity” causing people to take extra sick days, or being forced out of work altogether– but he failed to mention that plus-size candidates are less likely to be hired for a job, and of those currently employed, they’re also less likely to be promoted.
He failed to mention that even if hired for a job, people can experience weight discrimination: of 14,000 people participating in weight-management courses surveyed across three continents, 58% said they experienced weight stigma from colleagues.
This is unsurprising when politicians, pop culture, advertising, and your family all prescribe to the same line of thinking: thin is good, and fat is bad. Hollywood shows us life through the eyes of the unsustainably sculpted and never walks in the footprints of anyone heavy enough to leave them.
The money-making machine that is the diet industry inundates us annually with ‘new year new you’ messages, promising us this could be the best year of our lives if we could only be smaller.
News articles about the health secretary’s comments display the inevitable images of fat headless torsos. “The fact they always cut the heads off, it’s almost like we don’t get to have ownership over our bodies”, plus-sized author of Fattily Ever After, Stephanie Yeboah said on Media Storm.
“It completely dehumanises fat people,” agreed disability activist Essie Dennis. “When I was younger [these images] really affected my feelings towards my own body, because I didn’t really look at my own body like it was just a whole thing, I’d look at it in parts, and I’d look at all the parts that had to be changed.”
But what about health? This popular adage follows any attempt to point out that multiple body types exist. Yes, there are crucial connections between weight and health (as we’ll get onto), but their crude conflation has become a trojan horse for fat-shaming and thin-glorifying that is simultaneously unhealthy and nothing to do with health at all (rather control/ ‘sexiness’/ the patriarchy).
And no, health professionals are not immune to this culture. Many hold biases against fat people. Research has shown medical fat-shaming often deters people from seeking healthcare, plus-sized patients are underdosed, and doctors advise weight loss instead of running appropriate tests – leaving obese patients 1.65 times more likely than others to have significant undiagnosed medical conditions.
Helena Burton-Jones has endometriosis, a condition where tissue similar to the lining of the womb starts to grow outside the uterus. Ten percent of women worldwide have the condition, which is typically agonising, carries a risk of infertility, and can affect anyone with a uterus regardless of their weight.
But when Burton-Jones connected her symptoms to endometriosis, she told Media Storm her GP denied her: “’Well, it’s not that. You’ve got a bad period because you’re overweight’”.
Endometriosis is notoriously slow to diagnose – patients wait eight years on average from the onset of symptoms. But a survey Media Storm ran for plus-sized endometriosis sufferers returned an average diagnosis time of 11 years, with many respondents waiting over 20.
Still, medical fatphobia can be harsher and explicit. “When I gained weight, the way I was treated was so different,” remembered Burton-Jones. “Needles were being pushed in [to me] more roughly, or I was being handled more roughly, or with less respect or less kindness.”
Menstrual wellbeing coach Katherine Irene said her 17-year wait for an endometriosis diagnosis was delayed at every appointment by discussions of her BMI – “not an indicator of health in any way,” she told Media Storm.
BMI, a person’s weight in kilograms divided by their height in metres squared, is still used as a measure of health in medical settings. But BMI wasn’t designed by a medical professional, it was designed by an astronomer – in the early 19th century, for population studies, not individual healthcare. The sample data came from primarily white males: this has not changed despite gender, ethnicity and age massively affecting weight and fat distribution. This renders BMI both absurdly unhelpful and unacceptably discriminatory.
Before handing out weight-loss drugs we should train doctors to combat these harmful biases. Professor Rachel Batterham, a doctor specialising in care for – she uses the medical term – ‘severe obesity’, created a course titled ‘Raising the topic and discussing obesity with patients’ for The Royal College of Physicians.
“Our scientific understanding of the drivers of obesity, its impact upon health, and how to treat it, has so changed over the last 5 to 10 years,” she said on the podcast. “We need to get that knowledge across to healthcare professionals so that they understand obesity isn’t just somebody being greedy.”
So yes, it’s time to think differently. Headlines that equate weight with an individual being ‘unhealthy’, rather than a myriad of social, economic, and environmental factors, are part of what causes fatphobia to be – according to Yeboah – “one of the last acceptable forms of hate crime”.
And the proposed weight-loss jab plan falls into this – looking at people based on their economic value, rather than their needs. “I am unhealthy”, says Dennis, “I’m chronically ill, and I will be for the rest of my life. And does that mean I’m not a person? Does that mean I’m not a human being? Does that mean I’m not deserving of respect? Do you say that to people with cancer?”
“I don’t understand why me being unhealthy means that I’m not a person anymore.”
Media Storm’s episode ‘Fatphobia: Healthcare by size’ is available wherever you get your podcasts.