Why the issue of fatphobia is structural and systemic

Fatphobia is defined as the hatred, rejection and violence experienced by people because they are overweight. It can also be understood as the fear of being fat, both their own (internalized fatphobia) and that of others. It is characterized by negative attitudes, stereotypes and prejudices towards overweight people and may be accompanied by acts of physical, moral or verbal violence.

Fatphobia is structural and systemic. People with excess weight are confronted every day with situations that tell them that their body does not fit in, even putting their health at risk, for instance, with seat belts that do not accommodate them on public transport. They are constantly being scrutinized and their health, habits and personality are judged on the sole basis of the size of their bodies.

The system oppresses these individuals through access to transportation and public spaces, and limited possibilities for movement. They are labeled as unsporty and lazy, but there are few gyms or sports centers for overweight people to go to. In the scientific and healthcare field, it is more commonly referred to as “weight bias” or “weight stigma,” which is the inclination to make value judgments about a person purely because of their weight.

In addition, weight stigma breeds stereotypes, and assumes that people with larger bodies do not eat healthily, do not play sports, suffer from depression, are clumsy and careless, and have absolutely no willpower. In addition, any disease they suffer from is attributable to their weight, as if thin people do not get sick and being slim protects us from diseases, as if it were a vaccine.

A stigma associated with a group of people with similar characteristics becomes a social stigma. But what exactly is a social stigma? It is the disapproval of, or discrimination against, an individual or group based on perceived characteristics — such as a condition, attribute, trait or behaviors — that serve to distinguish them from other members of a society. Under the all-powerful mantle of stigma, social exclusion is achieved through mockery, insults, barriers and obstacles, thus creating a structural fatphobia that is applied individually and collectively. Stigma can be applied from one’s own family and friends and through education and health.

Fatphobia also leads people to be ashamed of their bodies. Aesthetic canons have made it so that there is only one possible body model. In such a way that, as we move away from it, the value of our body diminishes. Especially for us women; the pressure that a fat woman receives on her body is greater than that received by a fat man, and in turn, a fat white woman faces less pressure than a fat Black woman. And so on, depending on sexuality, ethnicity, etc.

In medicine and healthcare, in general, we have always worked with weight as a cut-off point. The BMI (body mass index) determines whether our weight is healthy or not. It is a totally obsolete parameter. It does not take into account anything more than the weight and height of the person and, to make matters worse, it is based on perimeters drawn from stats coming from mostly white men, so the measurements leave out women and people of color. It is not an intersectional measure, but it still applies to everyone the same.

It is precisely from this belief that weight equals health that medical fatphobia arises. It can manifest itself in many ways:

• Weight loss is prescribed for any ailment, even if it has nothing to do with it.
• Not having appropriate chairs in medical or nutritional consultations.
• Overweight people are not offered the same resources as thin people. In the end, this makes overweight people not want to go to the doctor, which in turn puts their health at risk.
• Denial of fertility treatments based on BMI.

This ends up violating fat people’s basic right to access quality health care.

On the other hand, fat people are not well represented in popular culture. How many fat actors do you know? And actresses? How many of them have leading roles? And if they do have leading roles, how many of the plots are centered around their weight? Normally, fat characters are secondary, funny, undesirable, and always spend their lives on a diet.

Fatphobia has great consequences in the lives of fat people: they suffer ridicule and harassment, they are more likely to suffer from eating disorders, dieting cycles and anxiety, they avoid physical activities, they deprive themselves of things they like to do to avoid exposing their body…. They put their lives on hold until they lose weight.

In the end being fat has become an identity that no one wants, as Enrique Aparicio, screenwriter and writer says: “Being a fat, gay kid had ravaged my mental health, and had convinced me that I didn’t deserve to be loved. Always anxious, always drowning in shame and guilt. I wouldn’t stop being gay for all the gold in the world, but I would pay to stop being fat.”

It is time to decouple weight from health and work on public health policies that do not address food problems from the private sphere, because this ends up being classist and unequal. On an individual level, we must become aware of our internalized fatphobia, work on it and correct it. And if we are health professionals or educators, we have a greater responsibility to start transmitting that all bodies are valid and that health is much more complex than pounds.

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