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‘Fat’ is the new ‘ugly’: Why fat shaming is harmful

Not long ago, the ultimate put-down among children was calling someone "ugly." Today, the most common reason kids are bullied is weight. And the consequences are no joke. Compared to their peers, children with obesity have lower academic performance and their parents spend less money on their higher education. Kids with obesity are also more likely to refuse to attend school all together. Can you blame them?

Yet, it's not just kids who fat-shame. Millions of adults are fat-shamed; some very publicly. While men are hardly immune, women are the most common targets: A high-profile film critic once referred to the talented Melissa McCarthy as "tractor-sized" and "a female hippo." Best-selling author and local treasure, Jennifer Weiner, has written poignantly about her personal experiences with fat-shaming growing up. Even pregnancy offers no refuge. Just ask Philadelphia meteorologist, Katie Fehlinger, who recently endured hundreds of fat-shaming comments and emails while she's been pregnant with twins!

I could go on, but where would I stop? Talented, successful, hard-working women — sisters, daughters, friends, wives, and mothers — all bullied about their weight. What message does this send our loved ones? What lesson does it teach our children?

While fat shaming is rampant, many minimize or sugarcoat the problem. Let's separate these so-called "facts" from fiction:

1.  Fat shaming is a wake-up call that helps people lose weight!

False. Adults of all sizes are generally well acquainted with 1) their appearance, 2) the health effects of obesity, and 3) the thin beauty ideal.

Fat shaming isn't helpful, it's the opposite of helpful. Fat shaming is more likely to increase obesity than improve it. Being shamed and belittled is stressful. Humans, like other animals, often eat in response to stress. This physiological response can increase the reactivity of cortisol, a "stress hormone," which, in turn, increases appetite and prepares the body to store fat, particularly if the stress is chronic.

2.  People wouldn't be obese if they just ate less and exercised more!

False. People don't wish to have obesity; it's not a fashion choice. The biology of body weight is complex and genetics plays an important role. In fact, some people with obesity may actually be eating fewer calories, and exercising more than some of their thin friends. This is particularly true for those trying to maintain significant weight loss as one's metabolism adapts to "defend" the higher baseline weight (see my Goal Getter article on this topic, here).

The truth is, substantial and sustained weight loss is both incredibly difficult and often improbable following non-surgical treatment of obesity. Our science has simply not kept pace with the magnitude of the obesity epidemic.

3.  It's just mean online commenters who fat shame.

False. Unfortunately, the biggest adult bullies aren't anonymous internet meanies: they're most often family members and even health care providers. Sadly, more than 2 in 3 people with obesity report being fat shamed by medical professionals.

I spoke with one woman who shared her own story of a particularly embarrassing visit to a new health care provider, many years ago, for a non-weight related appointment. As she described the scene, the clinician, before even introducing himself, looked her up and down and said, "Well, I see YOU don't miss any meals!" followed shortly thereafter by,

"You know, if you would just close your mouth and put down your fork, you wouldn't weigh so much."

The clinician had never met her before. He hadn't even looked at her chart.

This woman responded like most patients who've been fat shamed: by never going back. In these cases, many patients will never visit another provider, forgoing important screenings and ongoing medical care: just one of the many indirect costs of fat shaming.

To be clear, the vast majority of clinicians are compassionate and intelligent people, committed to sensitively and effectively addressing patients' health concerns, including obesity. And the medical community has made important strides. For example, Philadelphia College of Osteopathic Medicine (PCOM), has an interdisciplinary training program whereby clinical psychology graduate trainees collaborate with medical students and physicians in PCOM's community-based healthcare centers. The trainees work with patients on lifestyle modification for weight loss, as well as other behavioral issues. And at University of Pennsylvania, Dr. Thomas Wadden and his colleagues have shown that primary care treatment protocol can lead to meaningful, long-term weight loss for some patients.

Where does fat shaming come from?

Fat shaming results from weight bias, a negative bias or prejudice against those who are overweight or obese. Our biases influence our behavior, regardless of our awareness of them. Widespread weight bias helps explain why people with obesity are hired less, earn less, promoted less, and (unfairly) seen as lazier and less competent than their peers without obesity. Outside the workplace, they face increased social rejection and are even less likely to be rented an apartment.

Many of us are simply unaware of our own weight biases. The Rudd Center is an excellent resource for further information on weight bias and stigma. They also offer a free online toolkit for health care providers to help prevent their own negative weight biases.

Fat shaming isn't just unkind, it's physically, economically, and psychologically damaging. Yet it remains socially acceptable.

And that is both ugly and shameful.

Stacey C. Cahn, Ph.D. is associate professor of clinical psychology at the Philadelphia College of Osteopathic Medicine. Dr. Cahn specializes in obesity, eating disorders, cognitive-behavioral therapy. She wishes to acknowledge Dr. Jonathon Tomlinson's helpful contribution to this article.


Read more Goal Getter for healthy eating, weight loss and more.