Fat Is Not the Problem—Fat Stigma Is

"Obesity is the biggest threat to the health of our nation,” proclaims the chief of epidemiology at a major medical school on the Scientific American Observations blog. This all too common suggestion does far greater damage to public health than fat tissue itself. When the focus is on weight and body size, it’s not “obesity” that damages people. It’s fearmongering about their bodies that puts them at risk for diabetes, heart disease, discrimination, bullying, eating disorders, sedentariness, lifelong discomfort in their bodies, and even early death.

"Obesity is the biggest threat to the health of our nation,” proclaims the chief of epidemiology at a major medical school on the Scientific American Observations blog. This all too common suggestion does far greater damage to public health than fat tissue itself. When the focus is on weight and body size, it’s not “obesity” that damages people. It’s fearmongering about their bodies that puts them at risk for diabetes, heart disease, discrimination, bullying, eating disorders, sedentariness, lifelong discomfort in their bodies, and even early death.

When the culture and the medical world are constantly pushing the idea that “obesity” needs to be eliminated, it’s not the fat cells that are feeling that stigma—it’s the fat people. This hierarchy of bodies is nothing new, with roots in racism, slavery and every other attempt to rank bodies. We can no longer pretend that being less likely to be hired or get promotions, being paid less, receiving biased medical treatment, being socially excluded and bullied are attempts to help people “be healthier.” These are the direct consequences of living in a culture that vilifies and fears fat bodies and that treats the people living in them as morally lesser beings.
当文化和医学界不断提出“肥胖”需要消除的想法时，感觉到耻辱的不是脂肪细胞，而是肥胖人群。这种身体等级制度并不新鲜，其根源在于种族主义、奴隶制和任何其他试图对身体进行排名。我们不能再假装不太可能被录用或升迁，得到更少的报酬，接受有偏见的医疗，被社会排斥和欺凌，这些都是帮助人们“变得更健康”的尝试。这些都是生活在这样一种文化中的直接后果，这种文化污蔑和恐惧肥胖的身体，并将生活在其中的人视为道德上低人一等的人。

From my (Linda) decades of challenging the pervasive “fat is bad” rhetoric, I know that every time I assert that the problem for fat people isn’t their bodies, but abuse from society, bigotry fights back. It’s not just the outright haters who populate the comments section, but worse, the self-righteous who see their stance as caring. It’s all about health, their argument goes, not bias.
No, it’s not. It should be obvious, but weight stigma does not reduce “obesity”—and health care should be about self-care and promoting the health of the person in all its forms.
从我(琳达)几十年来面对对普遍存在的“脂肪是坏的”言论的挑战中，我知道每当我断言胖子的问题不是他们的身体，而是来自社会的虐待时，偏执者就会反击。不仅仅是那些公然的仇视者占据了评论部分，更糟糕的是，自以为是的人把自己的立场看作是关心他人的人。这一切都是关于健康的论点，而不是偏见

“Obesity”—the word itself is a problem, pathologizing the size of a body. It is a category based on the body mass index (BMI), which is simply a mathematical equation based on height and weight. It measures physical appearance, not health. It was never intended to be used for individual health concerns, but rather for statistical analysis of a group. When the American Medical
Association declared obesity a disease, it overrode a recommendation by its own expert panel, which stated that correlations between “obesity” and morbidity and mortality rates did not establish causality and there was concern that medicalizing “obesity” would lead to further stigmatization and unnecessary treatment.
过度肥胖这个词本身就有待商榷，它只不过是基于身高和体重，利用简单的数学公式将身形病理化而得出的结论，也就是所谓的“体质指数”（BMI）.它仅仅测量了人的外表，并不能从根本上判断其健康状况，事实上，这一指数从未被刻意应用于个人健康管理领域，但对于那些热衷于分析数据的群体来说情况却恰恰相反。美国医学会曾公开宣称肥胖是一种疾病，这意味着，一些专家组的建议被无视了，该专家小组指出，“肥胖”与发病率和死亡率之间的相关性并不能建立因果关系，人们担心，将“肥胖”医学化会导致进一步的误读和不必要的治疗。

Even a quick glance at the weight research shows that, despite decades of trying, there is no evidence that efforts to prevent or reverse “obesity” are successful. In fact, there’s much evidence to suggest that the prescription for weight loss is more likely to result in physical harm and weight gain. The data also refute other longstanding, widespread—and incorrect—notions about health and weight. Like the “fact” that fat is a primary driver in metabolic disease. Or that weight loss prolongs life or improves health. None of this is true. Dogma, myths, and prejudices about fatness have trumped actual evidence in our view of weight and health.

It is true that many diseases are more commonly found in heavier people. However, that doesn’t mean that weight itself causes disease. Blaming fatness for heart disease is similar to blaming yellow teeth for lung cancer, rather than considering that smoking might play a role in both.

Focusing on weight—or health behaviors—puts the burden on the individual, deflecting attention from the more pernicious problem: systemic injustice. Conditions in the places where people live, work, and play affect health outcomes to a much larger degree than health behaviors, which, all told (including eating, activity and other behaviors), account for less than 25 percent of differences in health outcomes. While health behavior change is valuable, to truly improve public health, we can work harder to create an inclusive society where everyone feels valued and has the opportunity to create a good life for themselves. Combating fat-phobia needs to be part of that agenda.