What are we saying about being fat?

Tuesday 06 August was not only the 57th Anniversary of Jamaica’s political independence from the UK – with all that portends – but also my very first opportunity to review the newspapers on BBC Radio London with Vanessa Feltz. As fortune would have it, two headliners that day were just up my street: first, the treatment of dementia, highlighted by Dame Barbara Windsor’s open letter to PM Boris Johnson imploring him to “sort out” care for people with Alzheimer’s; second, the reporting on Michael Buerk’s piece in the Radio Times suggesting that fat people “are weak, not ill”, and their dying young saves the NHS money. Both topics raise important issues, but in this blog I focus on obesity and leave Alzheimer’s for the future (no pun intended!).

Inevitably, describing people as ‘fat’ opens up a host of emotive responses! The recent introduction of obese Nike manikins in retail stores created additional impetus to explore issues around “fatness”. We live in a society that sends mixed messages, often conflicting and derogatory, rarely complimentary, about what it means to be fat. Unlike other protected characteristics that are covered by the Equality Act (2010), being fat leaves many individuals open to discriminatory comments and practices.

We should recognize that what constitutes a picture of health and beauty differs between societies. We only need consider the different body shapes of starlets in Bollywood, Hollywood, and Nollywood to see this. In certain cultures where food scarcity is ever-present and thinness is an outward sign of poverty, to be called fat signifies the recognition of growing prosperity and health. Nevertheless, whilst in certain societies some individuals would wish to be described as fat and would admonish anyone for describing them otherwise, in the West being considered fat is often perceived as shameful – especially for women. It is significant to note here that although the health implications of obesity cuts across sexes, most, if not all of the public opprobrium/fat shaming seems to be reserved for women.

“‘Bikini bodies’ appear to be acceptable advertising descriptors to attract public attention to what is deemed beautiful.”

Conflicts in attitudes and behaviours arise constantly as society emphasizes and strives to respect individual choice, yet the mass media depicts a norm where fatness is either covertly or overtly negatively portrayed. For instance, the attack on Marion Bartolli’s alleged fatness by a BBC commentator in 2013 was a prime example of this negative portrayal and of thinness being a signifier of female beauty where even Wimbledon Champions are not exempt. Such is the negativity regarding fatness, it is often correlated with or attributed to unacceptable gluttony.

The medical literature adopts terminology related to fatness based on measures of BMI – with all of the inaccuracies and misinterpretations associated with this concept. Peymane Adap, professor of chronic disease epidemiology and public health, and co-writers in ‘Is BMI the best measure of obesity?’ warns of these dangers. Nevertheless, terms such as ‘overweight’, ‘obese’ and ‘morbidly obese’ continue to be adopted as acceptable descriptors of an individual’s weight.

The general message from the medical community is that to be fat or overweight is to be unhealthy and that the burgeoning obesity crisis in society needs to be addressed.

Georgina Lee and co researchers, in an experimental study of social influence on fat attitudes and prejudice in 2019, make the strong suggestion that expressions of anti-fat prejudice versus truth about people described as overweight are influenced by exposure to expert opinion. Thus the influence from the medical community is powerful. It needs to lead and send clear messages of how fat one has to be in order to be considered unhealthy. Currently, this is hazy.

Given all of the sensitivities and negativity associated with fatness, how should society approach the topic and clarify how it should be defined and judged? The answer is complex. Some of the issues that come into play stem from: who is doing the judging, what is being judged – physical and/or mental health, where is the judging taking place, and what are the contextual reasons for carrying out the judgement?

As a Chartered Physiotherapist with a cultural link to people experiencing and having a predisposition to health conditions strongly associated with obesity, I consider the dissemination of clear health messages such as publications from the Chartered Society of Physiotherapy to be an imperative. At the heart of the NHS’s current strategy is the drive to combat rising obesity. It is identified as a focus of activity in the recently-published NHS Long-Term Plan 2019. Obesity’s causal links to cancer, strokes, cardiovascular disease and other morbidities that are major killers in society are well-documented. These links raise further questions, including the extent to which individuals should be encouraged take ownership of managing their own weight. There is limited scope to explore complexities this issues raises here. However, I proffer the suggestion that in promoting achieving good health, to which most people aspire, conversations on the topic of fatness should begin with identification of individual’s goals and desires. Not only does this offer a space to explore personal priorities, but also it helps to set the scene for open and honest conversations.

It is interesting to note how often we read the following or similar written by fat people: ‘it’s other people’s problem, not mine’; ‘thinner and unhappy or fat and happy’; body positivity- if you can’t change it, love yourself and move on’; ‘everyone has things they need to work on’; ‘we want society to accept us as human beings whose worth is not defined by weight, appearance or health’; ‘fat has largely been weaponized by straight size people’, and so on. Despite this fat acceptance, it is also apparent that thinness is often viewed as an innate accomplishment held with pride by those who are thin. Such statements and perceptions highlight the battles that continue to rage around fatness. Therefore, should we be identifying more clearly obesity promoting environments, recognising the difficulty individuals have penetrating and examining intricate lifestyle patterns that are contributing to these environments, and that attempts to change behaviours and lifestyle patterns are resource intensive? The literature recognises an individual’s prerogative to make an informed choice to be obese – but it also recognises that obesity is a state that many wish to change.

Society needs to offer individuals scope to address the triad of health, obesity and fitness, and to explore them together when we talk about fatness. Contributory factors such as exercise and physical activity and nutrition must be paramount in the discussions.

There is little doubt about the strong association between fatness, fitness and levels of physical activity.

Healthy lifestyle guidance places physical activity at its heart and ‘exercise is medicine’ is a popular medical mantra to get people moving.

To conclude, what we are saying about being fat is that everyone has a responsibility to share positive messages and to address sensitivities surrounding it. Since enjoying good health is a priority for the majority of people and individual choice is normally geared around improving it, conversations centred on fatness could even begin with ‘what do you think about the supersized Nike manikins?’

© 2020 Melrose Stewart
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