By Jori Hamilton
We’ve all read the hysterical headlines warning us of the “growing threat” of the “obesity epidemic.” We’ve all seen the hyperbolic ads for fad diets such as Code Red or even intermittent fasting and miracle products splashed across social media, promising to end the scourge of “obesity-related diseases.” People are even claiming that those with higher BMI’s are at special risk of dying from the coronavirus.
“Obesity” has become the buzzword for everything in modern society that is bad, dangerous, or repugnant about our bodies. In fact, studies show that women perceived to be “overweight” or “obese” are more likely to face felony conviction in a jury trial than are leaner defendants, both male and female.
But what are the meanings — the intentions — behind the words? And what are the effects, especially now that “obesity” has been transformed into a diagnosis? Is obesity truly a pathology, or is it simply a means to excuse discrimination, to conceal prejudice behind a medical label and, in the process, to legitimize such prejudice?
Why It Matters
It’s time to take a long, hard look at the way terms like “obesity” are bandied about in our society, because words matter. They are the truly weighty things because they shape not only our discourse but our thoughts. They inform what we believe and how we feel. Even more importantly, they exert their greatest influence at the subconscious level, shaping our values in ways we rarely understand or even recognize.
Consider the recent Washington Post essay written by an emergency room physician in which the author describes his patient as “a mountain of flesh” and blithely describes the judgmental and often cruel remarks of the patient’s supposedly “compassionate caregivers.” It is as if such scornful remarks were the only natural response to a man of the patient’s size.
But the language used to describe the patient isn’t just vicious and shaming. It’s also profoundly dehumanizing. The patient is no longer a thinking, feeling human being, a man sick, in pain, and in need of care.
No, the man is pathologically “obese.” The man is his diagnosis, his disease, and with this diagnosis comes a host of profoundly negative connotations, invoking a shocking pattern of assumptions that shape not only how the patient is perceived, but how he is treated.
Look again at the way the treating physician describes his hurting patient. He is, according to the doctor, a middle-aged man who spends his days on his sofa, drawing “disability checks” for back pain. In other words, he’s not only “lazy,” but a mooch. A drain on society’s resources. A vampire sucking away the care and help that other, worthier, people need. Basically, if he’s sick and in pain, he deserves it. Not only is this fatphobic, it’s ableist and classist. In a vicious circle of discrimination, the patient is being devalued because he is obese. He is obese because he is in pain. He is in pain because he cannot afford care. He cannot afford care because he cannot work. He cannot work because he is obese — and so on.
“Obesity” as an Ideological Category
As powerful as the term “obesity” has become in our society, the simple fact is it has no basis in empirical, biological reality. There are no definitive boundary lines to objectively differentiate between the lean, the overweight, and the obese. This can be seen in how airlines create policies to define who is obese and who is not when requiring people to buy extra seats for flights. Which definition of obese should be used to require someone to purchase more airplane real estate? Is there one?
In 2015, Samoa Air announced it would start charging its passengers by weight. As airplane seat space shrinks, policies continually change. Furthermore, during the current Covid-19 pandemic, misinformation spreads easily and quickly. Some have even said that obesity can make people more susceptible to the virus, which is clearly false. Although obesity can cause complications to the recovery process, these complications are present in any situation and have nothing to do with Covid-19, specifically. This misinformation only fuels the fire of obesity discrimination.
Above all, there is no scientific evidence to demonstrate a clear, causal link between an elevated BMI and the risk of so-called “obesity-related” diseases. The simple fact is, “obesity” is not a biological category. It is a moral and ideological one. It is used to separate the active, fit, healthy, and “hard-working” from the supposedly weak, self-indulgent, sick, and lazy. It’s used to separate society’s “good” and “worthy” people from its “bad” and “unworthy” ones. Once again, as exemplified by our patient from the Washington Post essay, he is seen as unworthy because he cannot “productively” contribute to our capitalist society. According to the essay writer, he takes from it in the form of his disability checks, reinforcing all the stereotypes of fatphobia, ableism, and classism. Yet morally, the US form of capitalism is set up to help people like him. How then, is it fair to call him unproductive in this capitalist society?
What It Means
The first responsibility of the healthcare provider is to provide just, equitable, comprehensive, and compassionate care to all those in need, no matter who they are. The principles of beneficence and nonmaleficence are the cornerstone of ethical medical practice. These principles instruct the caregiver to strive to their utmost to prevent suffering and protect the patient from harm, both physical and psychological.
Unfortunately, the “obesity” paradigm is having the exact opposite effect. Studies show that patients clinically diagnosed as obese are far more likely to be denied proper medical care. Their symptoms are immediately — and without evidence — dismissed as being related to their size. The robust attention and viable treatment plans suffering patients deserve, and that are the physicians’ responsibility to provide, are denied in lieu of recommendations to lose weight, eat better, and exercise more. Thus, the blame for the illness and the burden of recovery is dropped squarely on the patients’ shoulders alone.
The modern obsession with health, youth, and beauty is nothing new in our culture. For centuries, men and women have been chasing the eternal carrot of perfect health, while women, in particular, have labored under immense social pressure to conform to some largely unattainable ideal of the female body. In today’s society, however, the medicalization of the term “obesity” has increasingly come to serve as a weapon against those who do not meet the cultural ideal. The label has come to legitimize, perpetuate, and conceal discrimination under the guise of a medical “diagnosis.” It hides cruelty beneath the veil of kindness, and it misrepresents overt discrimination as a well-meaning form of “tough love.”