Hi. I’m fat. The has-to-shop-online-to-find-her-size kinda fat. The oh-no-will-this-flimsy-plastic-chair-break-at-any-moment kinda fat. I’m also a researcher, a DIY queen, a house plant enthusiast, and, and, and. You couldn’t possibly know those things just by looking at me, but you can see that I’m fat. Unfortunately, this has meant that fatphobia (or, the fear and disgust of fat) has infiltrated most corners of my life. From romantic relationships to my education to the doctors office, institutional weight stigma has played a large role in my experiences. After years of learning about fatphobia on my own, I moved this work into a formal education setting to study ‘fat’. Pushback in my work is always commonplace, something par for the course when attempting to dismantle institutional inequality. Most of the time I am armed and ready to fight the good fat fight.
Yes, fat people deserve health care regardless of their health status.
No, ‘fat’ is not bad, fatphobia is.
Never has this fight taken more out of me than after losing Shelby.
We met in grad school where we worked together in the same office as graduate assistants. She was always calm and level-headed where I am loud and dramatic. She loved to hike in the mountains, and I love to paint in the air conditioning, but somehow it worked, and we quickly became inseparable.
Shelby was incredibly health conscious. Her favorite way to think was on walks. She would always drag me out of the office to walk around campus as we tried to solve the world’s problems. Our friends used to tease her for being so granola in all she did. Shelby kept coconut oil in an old mustard jar on top of her desk to solve everything from bruises to cuts to chapped lips.
She adored clothes, but she loved a deal even more. Secondhand shopping was her specialty. For her 27th birthday, we drove four hours round trip in pursuit of an outlet clothing sale. Not long into the trip I was already searching for a place to stop for coffee and a snack. As always, Shelby was prepared with a granola bar and her travel mug filled with coffee from home. The only time she would eat “junk” food was at the end of our Costco trips. She’d have a whipped coffee and a hot dog. I opted for a Diet Coke and a slice of pepperoni pizza.
Shelby didn’t really drink, she didn’t smoke. She was the healthiest person I knew.
And then, unexpectedly and suddenly, she died.
I will never forget the call. Shelby had left town for a job interview. I hadn’t heard from her in over a day, which was extremely unusual for us, but I chalked it up to her being busy with the trip. I was on campus studying in the library with a few friends. Her father called.
“She collapsed and there was nothing they could do to save her. Could you please let others know? Don’t post anything online. We are still making calls.” I couldn’t get anything out except “I’m so sorry. I’m so sorry. I’m so sorry.” The library is such a strange place to learn your best friend has died. I never went back after that night.
I began the phone tree to share the news no one wanted to hear. Over and over I was met with the same disbelief from our coworkers and her friends that had consumed me. Her death didn’t make sense. She hadn’t had an accident, nothing had happened. She just collapsed. She was the healthiest person we knew, and now she was dead.
Two weeks after Shelby died, I had to give a presentation. I was so consumed with grief that I could barely pull myself out of bed but this presentation was a required milestone for my masters degree. My master’s thesis exposed the numerous tolls medical fatphobia takes on fat women seeking medical care. I interviewed fat women about their experiences to better understand how weight stigmas and fatphobia affect the level of care given to fat women in medical situations.
You see, we know doctors don’t like fat people. Countless medical journals have published study after study that show doctors spend less time with fat patients, trust them less, and don’t want to touch them (Drury & Louis, 2002, Pantenburg et al., 2012, Brochu, 2012, Persky & Eccleston, 2010, to name a few). These weight biases and their effects are compounded by and intertwined with racism (Strings, 2019), sexism (Drury & Louis, 2002), and ableism (Mollow, 2017). Systems of oppressions don’t like to work alone.
So, there I was two weeks after losing my very thin, seemingly healthy best friend, presenting on weight discrimination in medical spaces. The evening was set up so that onlookers could approach the presenters to discuss the projects at hand and ask questions. As a fat woman studying fat women while pursuing a master’s degree in women’s and gender studies, I was no stranger to people questioning my work but this time was different. This time I was still trying to understand what had happened to Shelby. We had no answers, and my grief was raw.
I shared my findings with attendees: my participants had been ignored, mistreated, and misdiagnosed. Their stories were serious and powerful. Their narratives painted a grave picture of what it meant to be a fat woman seeking health care. These stories were backed by the extensive literature I had read that came from the medical industrial complex itself. And yet, of course, I was met with people who just knew that my work was wrong.
Their mother was a nurse and told them how dangerous fat was.
They had recently lost twenty pounds and felt so much better now.
They brought their anecdotes to fight toe to toe with my research. They felt qualified to challenge my work based on their own experiences with weight and doctors.
I wanted to scream. The point of my research is not to understand whether or not being fat is healthy or unhealthy. Frankly, I don’t care. There are healthy thin people and unhealthy thin people, just as there are healthy fat people and unhealthy fat people. My work focused on how a person’s weight impacts the level of care they receive based on the provider’s own fatphobic biases. My work joins conversations already taking place (yes, even in the medical field) about the likelihood that negative health outcomes for fat people are connected to medical fatphobia and the medicalization of fat (Muenning, 2008). Simply put, medicalization is the process through which a phenomenon becomes a medical problem. By medicalizing fat into “overweight” and “obesity”, every fat person becomes automatically, universally unhealthy. “Obesity” has become the only acceptable lens through which to understand a complex lived experience.
What fat is, and who is fat shifts based on race, age, gender, socioeconomic status, place, and time. Several fat studies scholars have used a social constructionist framework to unpack the ‘objective’ dominant narrative of fat as ‘obesity’ (Rich & Evans, 2005; Warin, et. al, 2011). As fatness is socially, historically, and culturally constructed, the way we decide who is fat and who is thin changes: sometimes as quickly as overnight. In 1998, the National Institutes of Health (NIH) lowered the Body Mass Index (BMI) thresholds and who was fat changed in an instant (Gordon, 2019). People didn’t physically change because of this new NIH policy, but the slippery nature of socially constructed phenomena meant they were now catapulted into an ‘unhealthy’ category. Without uncovering the many ways fatness is socially constructed, is it any surprise that we frame fatness as the “obesity epidemic”? I have always taken major issue with this particular framing of fatness, but our new hyper awareness of pandemic level transmission makes it easier for people to understand that “obesity” isn’t (and never was) an epidemic. Unlike COVID-19, you can’t ‘catch’ fatness by touching a fat person.
After the attendees left, I rolled up my poster presentation and went home. Six months after the phone call I learned what had happened to Shelby; she had suffered an aneurysm. Had she been fat, her doctors would have called her death an unfortunate self-inflicted consequence of weight rather than a tragic loss.
Just over a year into the COVID-19 pandemic, sickness and death is around us all of the time. We learn more and more every day about this virus- how it affects us, and who is most at risk for severe disease, but science is a slow process. In our understandable fear of this unknown, we are quick to search for blame, for a reason one person gets sicker than another, why some die and others don’t. Entire populations of people have become quickly expendable. Were they old? Did they have a chronic health condition? Were they fat? I can’t attempt to tackle the insurmountable ageism, racism, classism, ableism, and sexism spewing from COVID-19 discourse in two thousand words or less. I will not pretend to understand how this virus affects different populations on a medical or epidemiological level. What I do understand, however, is how, in our panic to understand this virus, we have yet again found a scapegoat in fatness.
Fat folks face innumerable barriers under the most normal of circumstances. Fat people are paid less than their thin counterparts (Cawley, 2004). Fat young women are less likely to go to college after high school than thin young women or young men of any weight, even when controlling for other factors (Crosnoe, 2007). And, as I have mentioned, fat people are less likely to receive unbiased, quality medical care than thin people (Forhan & Salas, 2013).
I am not surprised, then, that in the wake of COVID 19 fatphobia is having a field day. Early studies on the link between weight and COVID often did not control for other factors like age, gender, or race placing the blame solely on their weight (Byrne, 2020). When fat people die of COVID-19, society shrugs it off because ‘if the fatty had only lost some weight they’d have lived’. Messages from the Center for Disease Control on COVID-19 and “obesity” urge individual behavior changes, like sleeping more and reducing stress to lose weight because fatties are worsening the pandemic for everyone (Obesity, Race/Ethnicity, and COVID-19, 2021). Unfortunately, this inaccurate narrative is the one that stuck. In the time of COVID-19, we fat people have become even more dangerous to those around us and ourselves.
So why am I writing about this story now? What does losing my best friend have to do with COVID-19 when I lost her long before this new tragedy? I am telling you this story now because Shelby was not fat, but we still lost her. You see, thin people die all the time for a million different reasons. The assumption that thinness can protect us from disease and death is pervasive and began long before COVID-19 made its way into our lives. This assumption most severely affects fat people seeking care, and specifically in regards to pandemic care. Sun et. al (2016) found that during the H1N1 pandemic of 2009 to 2011, after accounting for early intervention in care, weight discrepancies disappear in outcomes. Fat people were offered antiviral treatment later than thin people which led to more severe disease and death rates in fat patients. Sun et. al (2016) cautioned against ignoring this in claims about severity of disease and “obesity” with the H1N1 virus.
Time and time again, health care providers tell us to lose weight, refuse to provide testing or treatment, and send us on our way without attempting to locate the source of our symptoms or health questions. Losing weight is seen as the cure all, leaving thin people also underdiagnosed. Their thinness is a visible marker of assumed health.
Shelby died three and a half years ago, and though we probably never would have been able to save her, there are things we can do to save others and ensure they are receiving access to quality health care.
I fear for the fat people who need health care right now. The barriers to adequate care are already so high that they seem almost insurmountable in the time of COVID-19. Every person, regardless of their health status, deserves unbiased care. This level of care isn’t happening, and it is leading to unnecessary deaths. Even in writing this piece, I know some will lean harder into fatphobic narratives of individual failure, thinking I’m just a fatty with an agenda. My credibility as a researcher is impacted by fatphobia. The truth is I do have an agenda. I want fat people, Black fat people, queer disabled fat people, to be able to walk into a doctor’s office and receive unbiased, compassionate care.
The funny thing about Shelby was that she never once doubted me and my work. She understood that health and dismantling fatphobia went hand in hand. She cared about this work. She recognized that denying weight stigma as a system of inequality only exacerbates inequality, shame, and pushes fat people away from seeking treatment in the first place (Lee & Pause, 2016). The medicalization of fat into “obesity” is covering up disparity. It is exhausting.
For Shelby, for the fat people you know, the fat people you don’t know, and for yourself, I challenge you to think twice about the messages that pin the blame on fatties and reconsider this notion of an ‘obesity epidemic’. Quarantine weight jokes are more than they appear at first glance. Ask yourself, “why is there so little discussion on the harm of weight stigma when we know how dangerous it is?” Fatphobia kills, but we can change that.
Brochu, P. M., & Esses, V. M. (2011). What’s in a name? The effects of the labels “fat” versus “overweight” on weight bias. Journal of Applied Social Psychology, 41(8), 1981–2008. doi.org/10.1111/j.1559-1816.2011.00786.x
Byrne, C. (2020). Weight Isn’t The Problem With COVID-19. How We Talk About It Is. HuffPost. www.huffpost.com/entry/fat-covid-19-pandemic-obesity_l_5f736f60c5b6e99dc3336e3e.
Cawley, J. (2004). The Impact of Obesity on Wages. The Journal of Human Resources, 39(2), 451-474. doi:10.2307/3559022
Centers for Disease Control and Prevention. (2021, January 8). Obesity, Race/Ethnicity, and COVID-19. Centers for Disease Control and Prevention. www.cdc.gov/obesity/data/obesity-and-covid-19.html.
Crosnoe, R. (2007). Gender, Obesity, and Education. Sociology of Education, 80(3), 241–260. doi.org/10.1177/003804070708000303
Drury, C. A., & Louis, M. (2002). Exploring the association between body weight, stigma of obesity, and health care avoidance. Journal of the American Academy of Nurse Practitioners, 14(12), 554-561. doi:10.1111/j.1745-7599.2002.tb00089.x
Forhan M., Salas X. R. (2013). Inequities in healthcare: a review of bias and discrimination in obesity treatment. Can. J. Diabetes 37, 205–209. 10.1016/j.jcjd.2013.03.362
Gordon, A. (2019). The Bizarre and Racist History of the BMI. Medium. elemental.medium.com/the-bizarre-and-racist-history-of-the-bmi-7d8dc2aa33bb.
Koenig, D. (2020, October 29). The pandemic diet: How to lose the ‘quarantine 15’. https://www.webmd.com/lung/news/20201029/pandemic-diet-how-to-lose-the-quarantine-15.
Lee, J. A., & Pausé, C. J. (2016). Stigma in Practice: Barriers to Health for Fat Women. Frontiers in psychology, 7, 2063. doi.org/10.3389/fpsyg.2016.02063
Mollow, A. (2017). Unvictimizable: toward a fat black disability studies. African American Review, 50(2), 105–121.
Muenning P. (2008). The relationship between stigma and obesity-associated disease. BMC Public Health 8, 1–10. 10.1186/1471-2458-8-128
Pantenburg, B., Sikorski, C., Luppa, M., Schomerus, G., König, H., Werner, P., & Riedel-Heller, S. G. (2012). Medical students’ attitudes towards overweight and obesity. PLoS ONE, 7(11), 1-8. doi:10.1371/journal.pone.0048113
Persky, S., & Eccleston, C. P. (2010). Medical student bias and care recommendations for an obese versus non-obese virtual patient. International Journal of Obesity, 35(5), 728-735. doi:10.1038/ijo.2010.173
Strings, S. (2019). Fearing the black body : the racial origins of fat phobia. New York University Press.
Lyla Byers is a feminist fat studies scholar doing work in family systems, fat parenting, and gender. She is a doctoral candidate in sociology and women’s and gender studies at Virginia Tech. Lyla is particularly fond of crafts, cats, popular culture, and fat liberation.