Fitness and Fatness: The Conflation of Weight with Health, and the Consequences of Fat-Shaming

Abstract

"By definition, of course, we believe the person with the stigma is not quite human. On this assumption we exercise varieties of discrimination, through which we effectively, if often unthinkingly, reduce his life chances." -Erving Goffman, Stigma: Notes on the Management of Spoiled Identity, 1963 FITNESS AND FATNESS 3 Research QuestionWhat is the relationship between fat-shaming/obesity stigma and health behaviors of overweight and obese people, specifically their disposition to physical activity and exercise? AbstractObesity is widely accepted as one of the major health crises facing the United States, and increasingly, the world. Labeled a disease by the American Medical Association, and frequently characterized as an epidemic, obesity is the target of high profile national health interventions, media campaigns, and a multi-billion dollar self-help industry. The message produced by public health agencies is that obesity is a killer, and that reducing weight is a beneficial and achievable goal generating many positive health outcomes. This paper presents two primary arguments that counter the prevailing attitudes towards obesity: that as a stand-alone measure, Body Mass Index (BMI) is a poor metric for gauging health status of individuals; and that current public health messaging, with its implication that being fat is an inherently unhealthy and undesirable state, is counterproductive to the intended goal of motivating the public to engage in exercise and healthy dietary habits. Via a literature review and a survey, I demonstrate that obesity stigma and fat-shaming create an environment that stimulates and perpetuates poor lifestyle choices, and subjects fat people to dangerous psychological and physiologic stress.I also provide data demonstrating that cardiovascular fitness is a more meaningful health measure than is BMI. It is my contention that public health messaging should stop focusing on weight, drop references to weight reduction as a meaningful health goal, and instead FITNESS AND FATNESS 4 focus on goals of increased cardiovascular health and the development of healthy dietary habits.Keywords: BMI, body mass index, obesity, stigma, fat-shaming, weight-bias, exercise, stress FITNESS AND FATNESS 5 The Case for StigmaAt the time of its 2010 publication Vital Signs, the Centers for Disease Control and Prevention estimated that over 72 million Americans were obese (Centers for Disease Control and Prevention, 2010). The CDC reported strong associations between obesity and the leading causes of death worldwide, including diabetes, cardiovascular diseases, and some cancers. They further cite poor mental health outcomes and reduced quality of life as additional potential consequences of obesity (Centers for Disease Control and Prevention, n.d.). Given disease status by a controversial vote of the American Medical Association in 2013 (AMA, 2013; Pollack, 2013), obesity is the target of high profile national public health interventions, media campaigns, and a 60 billion dollar U.S. weight loss industry (Th...