Fat Prejudice and Our Well-Being
by Barbara Altman Bruno, Ph.D.

Recently, there have been the beginnings of a shift in the wind about fatness and health. Books have begun to appear, followed by magazine and newspaper stories, that being fat does not necessarily equal being unhealthy. Glenn Gaesser's excellent book, Big Fat Lies, is making a positive difference in this direction. As I mentioned in my last column, it appears that being an inactive "couch potato" is unhealthy at any weight, while exercising improves the health of people of any size.

In my opinion, prejudice has been a bigger detriment to fat people's health than has any other single factor. I believe that we're seeing this shift because so many Americans are now being considered fat. When "they" become "us," everything changes. And when "we" exercise our discretion about who gets our money, people and businesses listen to us.

Prejudice tends to be due to ignorance. By being informed, though, we fat people and allies can counteract many of its ill effects. But how many of us or our partners gave up on exercise when, for the millionth time, someone told us that if we just ate less and exercised more, we would stop being fat? So we dieted our weight up, exercised until it hurt, and stayed fat. One of the ignorant assumptions behind fat prejudice is that all fat people are alike-eating too much and not moving, except to get more food. To the contrary, much research has shown that, as a group, fat people eat no more than thin people. The proliferation of recent research into the causes of obesity is indicating that there are numerous contributors to being fat-whether it's due to a block in Leptin or insulin receptivity, a dearth of heat-producing fat cells, hypothyroidism or other glandular conditions, or untold many other possibilities. Some fat people are above their natural weight while others are at or even below it. Some fat people eat much more than other people, and some eat much less.

What Gaesser found was that "men and women medically classified as overweight who exercise regularly and are physically fit, yet remain above the ranges recommended by the height-weight tables, have lower death rates than thin men and women who do not exercise and are unfit, and have death rates comparable to thin and average-weight men and women who do exercise and are fit-proving that fitness, not thinness, is what really matters in terms of health." So we do need to move. Yet prejudice has affected our freedom of movement, even when we ourselves have been motivated. How many of us have faced ridicule at the gym or in the streets when we have tried to exercise? My mother, nearing 80, still remembers being taunted as a child, riding her bicycle. Whether the taunts come from others or are inside our own heads, though, we can make them irrelevant. Dee Hakala, a fat woman who developed a fat-friendly exercise program called "The New Face of Fitness," did just that. And since manufacturers are discovering that some fat people want and need exercise clothing, it is finally being produced in larger sizes. Again, exercising our purchasing power in fat-positive ways is changing the opportunities available to us. And if we should find ourselves in an exercise class with an instructor who does not adapt the exercises to larger bodies, we need to adapt them ourselves and/or educate the instructor (both are easier to do, by the way, if we have a friend with us.).

Much of the ill health attributed to fatness seems rather to be the fault of weight cycling (yo-yo dieting). Another quote from Gaesser: "Dieters, especially yo-yo dieters, who make up about 90 percent of the dieters in this country and whose weight is in constant fluctuation, have a risk for type II diabetes (the most common kind) and for cardiovascular disease that is up to twice that of 'overweight' people who remain fat." Many readers can identify with getting fatter (especially in the abdomen) after each diet/regain cycle. It is possible to raise animals' blood pressure by having their weight cycle. It is also likely to lower people's spirits (mood, energy, self-esteem, self-confidence, motivation) by having them yo-yo diet. If that were not enough, dieting leads to eating disorders, which do damage people's physical and mental health.

It is only recently that the ignorance about dieting's dangers has begun to be dispelled. Yet unscrupulous purveyors of diets and diet products are couching the same old thing (weight-loss diets) in new terminology. It's not a "diet," but an "eating plan." Or they are calling harmful products "all natural," so that we will assume they are therefore safe (for example, ma huang, or ephedra, an herbal product used for weight loss, has caused several deaths). And consumers continue to spend millions of dollars on weight-loss products which promise instant, effortless, overnight weight loss. The product names change, the purveyors occasionally get indicted, but as long as people continue to pour money into such frauds, they persist.

More frightening is the complicity of diet-drug companies and even the government in permitting unsafe and ineffective weight-loss drugs to appear on the marketplace, despite inadequate testing or tests which show these drugs' harm.

And then-Dr. Moe being the exception-there are physicians and other health-care providers whose own ignorance and prejudice harm their patients. They may be perfectly good, well intentioned doctors who share the belief that being fat is the unhealthiest of conditions, and that therefore anything (even diet drugs like Redux or fen/phen) is better than fatness. Or who are desperate to offer help to their even-more-desperate patients. Like Oprah, they may be such exceptionally self-disciplined people that they have succeeded in suppressing their own weight and therefore expect that everybody else can. Or they may feel the economic crunch of managed health care and fear that unless they treat an unpopular body size as a morbid medical condition, they will no longer be able to pay the rent.

Or, worse, they might share the disgust of those lipophobic people who blame people's body size on sloth and gluttony. They may be among those health-care providers who have attacked their fat patients so savagely that the patients subsequently stopped seeking medical attention for all but the most dire emergencies. I am aware of three studies which have shown that fat people have avoided medical care due to lipophobic doctors; one study suggested that the higher rates of certain "female" cancers in fat women may be due to these women not getting adequate preventive care, due to medical prejudice.

It is a shame that we who are or love fat people have to be the ones to educate health-care providers and others who ought to know better. But for now, that is our job. Fortunately, NAAFA (the National Association to Advance Fat Acceptance) offers several brochures which we can get, read, and distribute among those whose ignorance should end. They include guidelines for health-care providers and psychotherapists who treat fat patients, a brochure for people who wonder whether or not they have an eating disorder, information about weight and about weight-loss diets, information for fat children and their parents and for others who would like to help spread information and size acceptance. For less than the cost of one phony, harmful weight-loss diet, book, or other product, you can order a packet of NAAFA brochures and improve not only your own health, but that of many others. You can reach the NAAFA office at 916/558-6880 or P.O. Box 188620, Sacramento, CA 95818.

You can make a big difference.

Well Being