Thursday, July 05, 2018

Guest Post Highlighting How The Fat Acceptance Movement Isn't Always All That Accepting

Source: Obesity Canada Image Bank
Today's guest post is from my good friend and colleague Dr. Ximena Ramos-Salas, and she penned it at my request after I saw her being attacked on social media by fat acceptance advocates. Why? Certainly not because she doesn't support fat acceptance, but rather because she also believes that if a person with obesity wants medical help to try to reduce weight that for them may be having a detrimental impact on their health or their quality of life, they should have access to it. And herein she writes about a strange dichotomy, whereby it would seem that for at least some of the more vocal members of the fat acceptance community, one cannot be simultaneously supportive of fat acceptance, and also of the promotion of the treatment of obesity. Ximena (and I) would disagree
The Dichotomy of Obesity and Fat Acceptance Narratives

The field of weight bias is diverse, and there are scholars working in medical, social, and political sciences and across disciplines such as psychology, obesity, eating disorders, health care, and policy (1).  Although, we might expect a common goal (i.e. eliminate weight bias and stigma) between these fields of research, their narratives can be quite dichotomized.

While working on my doctoral dissertation I had the opportunity to learn from many of these research areas and disciplines. In my opinion, these areas and disciplines are not mutually exclusive and there is room for constructive collaborations.  In a recent commentary, my colleagues and I deconstructed these dichotomized narratives to help us understand the tensions between them (2).  We argue, that while we should always remain critical of our own academic and personal perspectives, practices, and beliefs, a basic tenet of scholarship is to be able to have a respectful dialogue with other scholars.

Unfortunately, based on my recent experiences working between these narratives, I have decided that I am no longer willing to engage in what I consider disrespectful personal attacks.

It all started when I participated in a panel discussion regarding the use of person-first-language (to which I was invited by the organizers to advocate for). The panel discussion quickly escalated into a broadside against the medical establishment labeling obesity as a chronic disease. Rather than debating the pros and cons of people-first language, the panelists launched head on into ad hominem attacks on obesity scholars, questioning both our morality and ethics.

While I argued that using person-first-language was a widely accepted approach in the chronic disease world to accommodate and support individuals in the health system, fat-acceptance advocates argued that calling obesity a chronic disease is a major social injustice because it implies that all fat people are ill and need to lose weight.  This, in their minds, actually increased weight bias and stigma.

Never mind that in my view (and that of an increasing number of obesity experts) obesity needs to be diagnosed and treated as a chronic disease only when weight affects a person’s health.

Never mind that as a life-long feminist, I am a strong believer in promoting body diversity and inclusivity.

Never mind that my own engagement and research is entirely dedicated to fighting weight bias and discrimination in health, education, and policy setting (3, 4, 5, 6, 7).

None of this seemed relevant – there was simply no room for respectful discussion or thoughtful exchange of perspectives.

To be fair, I fully understand and support the notion that people who identify as fat deserve to be treated with respect and should not be pressured into seeking medical help that they don’t want or need. On the other hand, I also fully understand and support people with obesity, who have made the personal decision to reach out for help and strongly feel that they should have access to adequate and respectful health care, including access to evidence-based obesity treatments.

Last year, I watched the same type of attacks on Obesity Canada’s (formerly known as Canadian Obesity Network) Facebook page. In response to a post about bariatric surgery, I witnessed how very quickly, a discussion of the pros- and cons- about bariatric surgery turned into a moral and dogmatic shouting match.  While individuals, who had chosen to undergo bariatric surgery asked to be respected for their decision, the fat acceptance proponents accused them of having internalized weight bias and, by supporting bariatric surgery, being guilty of supporting “eugenics” against fat individuals. Once again, the argument was made the framing obesity as a chronic disease increases weight bias.

However, findings from a recent Canadian study indicate that understanding obesity as a chronic disease has a positive impact on emotions which can in turn reduce negative attitudes against people with obesity.  Hence, framing obesity as a chronic disease and using person-first-language may be a way to reduce weight bias.

Despite growing evidence that framing obesity as a chronic disease may reduce weight bias, personal attacks towards my research on obesity has continued. In response to an article about my research on the University of Alberta’s School of Public Health website, I was once again personally attacked. This time, the attacks related to me being a thin person doing fat research. Apparently, as a thin person I “cannot be trusted to do work on fatness or fat people”.  Once again, I was accused of trying to eliminate fat people and contributing to medical eugenics.

Whether or not the modest overlap between the narratives allows for finding a common ground that can lead to a constructive discussion remains to be seen.  But the way forward cannot lie in resorting to disrespectful personal attacks and questioning the opponents’ intentions and morality.  Clearly, we all want the same thing, which is for all people to be treated with dignity and respect, regardless of their size or weight.

1. Nutter S, Russell-Mayhew S, Arthur N, Ellard JH. Weight Bias as a Social Justice Issue: A Call for Dialogue. Canadian Psychology. 2018;59(1):89-99.
2. Ramos Salas XF, M.; Caulfield, T.; Sharma, A.M.; Raine, K. Authors' response to Invited Commentary by Brady and Beausoleil. CanJPublic Health. 2017;108(5-6):e646-e647.
3. Ramos Salas X. The ineffectiveness and unintended consequences of the public health war on obesity. Canadian Journal of Public Health. 2015(1):79.
4. Ramos Salas X, Fohan, M., Caulfield, T., Sharma, A.M., Raine, K. A critical analysis of obesity prevention policies and strategies. Canadian Journal of Public Health. 2017;108(5-6):e598-e608.
5. Ramos Salas X, Forhan M, Sharma AM. Diffusing obesity myths. Clinical Obesity. 2014(3):189.
6. Forhan M, Ramos Salas X. Inequities in Healthcare: A Review of Bias and Discrimination in Obesity Treatment. Canadian Journal of Diabetes. 2013;37(3):205-209.
7. Puhl RM, Latner JD, O'Brien KS, Luedicke J, Danielsdottir S, Ramos Salas X. Potential Policies and Laws to Prohibit Weight Discrimination: Public Views from 4 Countries. Milbank Quarterly. 2015;93(4):731 741p.

Ximena Ramos Salas has a PhD in Health Promotion and Sociobehavioural Sciences from the School of Public Health at the University of Alberta. She is Managing Director of Obesity Canada (formerly the Canadian Obesity Network), and technical consultant with the World Health Organization Regional Office for Europe. As a population health researcher, she is exploring the unintended consequences of obesity prevention policies for people with obesity. Her research goal is to spark solutions that will prevent the perpetuation of weight bias and obesity stigma and create more effective population health approaches.