Being overweight is not a disease.

Society has a bias against people who weigh more than “normal,” a bias with attached stigma called fatphobia.

image: the verbal thing

Doctors are not immune. It’s not that doctors are unaware of fatphobia; it’s just that their biases are deeply engrained. In an attempt to tackle the problem, the Canadian Medical Association Journal recently published guidelines to counter prejudices that treat obesity as a disease.

The CMAJ calls their guidelines a “paradigm shift” but the guidelines don’t go far enough.

One problem is the use of euphemisms. Instead of calling people “fat,” medical practitioners prefer terms like “persons living with obesity.” This people-first language is supposed to humanize fat people.

Professors Michael Orsini of the Institute of Feminist and Gender Studies at the University of Ottawa and Deborah McPhail of community health sciences at the University of Manitoba disagree:

“But were fat people not quite human in the first place? People-first language is not somehow instantly empowering. Some communities reject it because it distances the person from their identity. For instance, saying ‘disabled person’ can be seen as less pathologizing than ‘person with a disability’ (Globe and Mail, August 21, 2020).”

Let’s reclaim the word “fat” and talk about fat people in the same way we do disabled persons –namely, fat people. The phrase “persons living with obesity” obscures what we are trying to say and it pathologizes people in the same way as “persons with a disability” does.

Another problem with the CMAJ suggestions is that while they promote “healthy living” and seek to sensitize others to the dangers of fatphobia, medical practitioners still cling to a model that pathologizes obesity as a disease.

They do so by recommending “treatments” such as weight loss or bariatric surgery. Medical practitioners still see obesity as a disease that can be managed medically.

The term “fat” has been deliberately used to harm people. Fat people are made the victims of hatred and discrimination in a way that is linked to other forms of oppression rooted in race, gender and ability.

Sabrina Strings, author of Fearing the Black Body: The Racial Origins of Fat Phobia, makes the connection between fatphobia and white supremacy. She argues that “the slender ideal and fat phobia are not distinct developments… The fear of the imagined ‘fat black woman’ was created by racial and religious ideologies that have been used to both degrade black women and discipline white women.”

Health care for fat people is still delivered in a system with a firm hierarchy between patient and doctor. Patients are hardly in a position to push back against a doctor who has outdated ideas about “normal” bodies. In our health care system, there is little opportunity to shop around for a more enlightened doctor. Fat people have to endure the lectures from doctors who suggest they should know better than to let their weight spiral out of control.

I have felt the sting and humiliation of fatphobia. As a fat kid, when my last name was Smith, kids would taunt me with: “Smit, Smit, the big fat sh*t.”

It’s time we recognize fat people as normal people.

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