When discussing health, you’ll notice a trend between two approaches – weight normative and weight inclusive.
Screenshot from American Heart Association, 1/25/2015
The weight-normative approach includes the many principles and practices that emphasize achieving a “normal” weight when defining health and well-being. This approach rests on the assumption that weight and disease are related in a linear fashion, with disease and weight increasing in tandem. Under the weight-normative approach, personal responsibility to make “healthy lifestyle choices” and maintain “healthy weights” are emphasized. The approach prioritizes weight as a main determinant of health and as such, weight management (calories in/calories out) as a central component of health improvement and health care recommendations.
Instead of imagining that well-being is only possible at a specific weight, a weight-inclusive approach includes research-informed practices that enhance people’s health regardless of where they fall on the weight spectrum. Under this paradigm, weight is not a focal point of treatment or intervention. Instead the weight-inclusive approach focuses on health behaviors that can be made more accessible to all people. These are behaviors such as exercising for pleasure, eating when hungry and stopping when full.
So is one better than the other? We’ll look at three questions to figure that out:
This week is weight stigma awareness week. Last week, I attended UNC’s Smash TALK, an open discussion with leading eating disorder experts, and I was shocked to learn that weight stigma is much more than the brief sting of hearing the words “you’re fat.”
Imagine that you were sitting at Lenoir or Starbucks with some friends, looking at the photo below in a magazine or online. What are people saying?
“Models photo shoot” by David Yu, Flickr Creative Commons
Now, imagine ya’ll are looking at this photo. What are people saying?
“It’s been awhile” by Amber Karnes, Flickr Creative Commons
We did a similar exercise at the Smash TALK event, and it really illustrated the assumptions we make around body size. The thin-framed woman drew words like hot, confident, disciplined, healthy, social, popular, and vain. The large-framed woman was described as both happy and unhappy, weak-willed, lazy, lonely, not-as-popular.
Wow. That’s a lot of assumptions based on one photo and NO interaction.
Where do these assumptions come from?
These assumptions are clear examples of weight bias. The Binge Eating Disorder Association defines weight bias as “negative judgment based on weight, shape, and/or size.” It can be both explicit and implicit, and it leads to weight stigma, or internalized shame resulting from weight bias.
Weight bias stems from a culture that inaccurately equates thinness with health, happiness, and success. Add to that the growing “war on obesity” which has become a war on obese people, and it is clear that weight bias is increasingly pervasive.
Unfortunately, it also starts young and often in the home: in one study, 47% of overweight girls and 34% of overweight boys were teased about their weight by family members. Many parents who struggle with their body image subconsciously pass this on to their kids, while others try intentionally not to.
What about weight stigma for the skinny folks?
I have written a few blogs about body image, and I try to veer away from promoting one body type over another, because thin people face assumptions that they are stuck up or vain or that they have an eating disorder. Songs like “All About That Bass” and campaigns like “Real Women Have Curves” send a negative message to thin women, and I’m not okay with that.
But…
When it comes to weight stigma, people with large bodies have it worse. And here’s why:
People with large bodies don’t just face stigma from fat jokes, they also face discrimination. Weight discrimination has increased 66% over the past decade, making it comparable to rates of racial discrimination, especially among women.
Here are some of the inequities:
Education—compared to nonobese children, obese children are
Perceived as less likely to succeed by teachers and principals
Less likely to be admitted to college with comparable academic performance
Less likely to attend college
Subject to teasing and bullying which leads to increased absences and depression
Employment—compared to nonobese adults, obese individuals face
Lower employment with comparable qualifications and skills
Lower wages (1% to 6% less than nonobese employees)
Negative bias in performance evaluations
Health—compared to nonobese patients, obese patients experience
Negative stereotypes among health care professionals
Less time with their physicians
Increased depression, lower self esteem, and negative body image
In an earlier blog, I talked about how body shame hurts us all. And it does. However, the shame associated with larger bodies comes with a large dose of discrimination that affects people’s ability to get into college, get a job and get paid fairly, and get the medical attention they need. And that’s the real shame.
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