Almost three months ago, millions of people of diverse ethnicities, religions, gender identities, and sexual orientations took to the streets to rally for the rights of women and marginalized groups. Those human rights that people championed for are as relevant today as they were on Jan. 21, the day of the Women’s March on Washington and more than 600 sister marches across the globe.
The recent collapse of the Republican’s health care plan was a victory for Obamacare supporters, particularly for the needy, the elderly and the disabled, who gained insurance under the bill’s major expansion of Medicaid. Impoverished, disabled and elderly women have often been excluded from women’s movements. However, applying an intersectional approach to human rights and feminism recognizes the way poverty, disability and old age intersect with gender and race to create unique experiences of discrimination for women.
Intersectionality does not end at studying how race, age, disability and class oppression create inequalities for women. With the eruption of the body-positive movement in mainstream fashion, which has improved clothing options for plus-size bodies, more people are becoming aware of how fat women are at the intersection of various forms of discrimination—including, but not limited to, racism, weight discrimination, sexism, ageism, classism, ableism, homophobia, transphobia, xenophobia and belief-based bigotry.
Advocates of Health At Every Size® (HAES), a social justice movement that celebrates body diversity and challenges cultural assumptions about health, have been more vocal than ever about size diversity as an issue of social justice and feminism, which are critical facets of the HAES movement. Erica Ormanovich, a Houston-based mom, photographer and podcaster, came across HAES after years of battling bulimia and disordered eating.
“For the majority of my adult life I was trying to live in a body that didn’t belong to me, chasing after this thin ideal,” Ormanovich said. “Once I learned that true recovery from my eating disorder was possible, and that I could accept and love myself exactly as I was, it opened endless doors for me.”
Guided by a desire to improve body positivity among women in Houston, Ormanovich created The Way You Are Project, which is a body positive photography project, blog and podcast. Ormanovich selected a diverse group of women who identified with the messages of self-acceptance that are central to HAES in order to highlight the damage that “fatphobic” messages can have on individuals. Fatphobia is, in simplest terms, a dislike or fear of fat people.
With almost perfect timing, Ormanovich released her photography project on Jan. 21, right after a conservative Facebook page (which has since been removed from the social network) shared a meme that featured a photo of hundreds of protestors with the caption, “In one day, Trump got more fat women walking than Michelle Obama did in eight years.”
This meme angered thousands of HAES activists around the globe, including Sarah Vance, a self-love coach and the host of The Reclaiming You podcast, who said that this meme played into the erroneous stereotype that fat women are inactive. In addition to employing sexist language, this meme exploited “ableist” language. Not all women, fat or not, have the physical ability to go out and march.
“It’s so easy to forget about fat acceptance as a feminist issue. Dieting is one of the major ways that the patriarchy keeps us literally smaller, underfed, under-energized, and unable to speak up and fight for what we deserve,” Ormanovich said. “We would not be triggering people who are already predisposed to eating disorders if our culture accepted all bodies, regardless of size, gender, orientation, race, ethnicity, or ability.”
One of the obstacles to producing a culture that believes in equality for all, including fat people, is that current health guidelines unceasingly warn against the dangers of the “obesity epidemic.”
Every day, public health officials and doctors encourage fat individuals to lose weight via weight loss surgeries and lifestyle modifications. Fat is so menacing that six months after the terrorist attack against the World Trade Center, the former surgeon general described obesity as “the terror within, a threat that is every bit as real to America as the weapons of mass destruction.”
Dr. Linda Bacon, who is a professor, researcher and the author of Health at Every Size: The Surprising Truth About your Weight and Body Respect: What Conventional Health Books Get Wrong, Leave Out, or Just Plain Fail to Understand about Weight, states that because fat is a physical characteristic, the current war against fat has actually become “a war against people and bodies.”
HAES advocates—which include scientists, doctors, fitness professionals, therapists, dietitians, writers and even photographers, like Ormanovich—utilize peer-reviewed research to destroy the myths and misinformation that fuel the war against fat, ultimately striving to create a paradigm shift in which weight, size and BMI cease to determine the health and value of an individual.
Kathleen Bishop, a therapist who utilizes HAES principles when working with clients who have eating disorders and body image issues, likens weight discrimination to the unjust and prejudicial discrimination between people of different racial groups. Certain populations, including fat people, are treated as “subhuman.” Bishop believes that if people want to accept their own bodies and gain body autonomy, they must look at the social contexts their bodies live in.
“How do I heal the relationship with my own body if I never take into account the bigger context from which this problem started?” Bishop said. “As a ‘small fat’ woman, I fit in an airline seat. People don’t throw things at me when I walk out the door. I have a responsibility to fight for people who don’t have privilege even if I have it.”
The National Association to Advance Fat Acceptance (NAAFA), a civil rights organization dedicated to protecting the rights of fat people and promoting equality at every size, aims to redefine the term “fat” as a descriptive term, stripped of its pejorative connotations. Peggy Howell, the Vice Chairman and Public Relations Director of NAAFA, said that the organization believes that fat is a form of body diversity that deserves to be respected like forms of diversity based on skin color or sexual preference.
“Fat is not a four-letter word,” Howell said. “Regarding the term ‘overweight,’ activists say, ‘over what weight?’ There should not be arbitrary limits on what weight is acceptable or not.”
HAES advocates actually challenge the idea that BMI is an accurate health measure. In Body Respect, Bacon reveals that the World Health Organization (WHO) relied on the International Obesity Task Force (IOTF) to create the international BMI standards. During the time the recommendations were created, IOTF was funded by two major pharmaceutical companies that sold the only weight-loss drugs on the market.
According to Bacon, no scientific evidence supports any theory for long-term, permanent weight loss. There is, however, a multitude of accessible research that demonstrates the danger and ineffectiveness of weight loss. A longitudinal study, which investigated the relationship between weight loss from maximum body weight and mortality, indicates that weight loss of 15 percent or more from maximum body weight is associated with increased mortality—an unsettling fact, considering that multiple studies show that dieting is a strong predictor of future weight gain.
Bacon compares the weight loss-regain cycle to the legend of Sisyphus, who ceaselessly rolls a large stone to the top of a hill, only for it to roll down and force him to roll it uphill again. Dieting actually interferes with the body’s natural weight regulation system, which explains why the vast majority of dieters return to their pre-dieting weight, plus bonus pounds. After an extended period of calorie restriction, the human body, which cannot differentiate between starving and dieting, slows metabolism and increases appetite in an effort to escape death by starvation.
Moreover, research shows that “excess” fat is benign. A 2014 study, published in Progress in Cardiovascular Diseases, shows that the mortality rate for individuals who are thin but unfit is twice as high as the mortality rate for “obese” individuals who are fit. It turns out that exercise can improve health outcomes, regardless of weight.
Another study, which examined the differences between adults’ actual weights and what they perceived as their ideal weights, found that this gap was a stronger indicator of mental and physical health than BMI. In other words, simply thinking one is fat appears to be more harmful than actually being fat.
“We have this $65 billion industry that is vested in keeping the paradigm that the person is the failure and that they failed the diet,” Bishop said. “If diets worked, we’d only need one. There’d be one diet, you’d go on it, you’d lose your weight, you’d keep it off forever, and you’d be cool, but in people of really high weights, you can often track back a dieting history. We shouldn’t be treating them badly because they live in a culture that convinces them that dieting works.”
Fat individuals are vulnerable to prejudice and discrimination in a myriad of settings, including the workplace, healthcare facilities and educational institutions. An article published in Pediatric Obesity shows that weight-based bullying is more prevalent than any other form of stigmatized bullying and is the prevailing reason for peer harassment among youth.
At present, federal laws prohibit discrimination on the basis of race, gender, national origin, age, religion, pregnancy status and disability. Even though empirical studies demonstrate that discrimination based on weight is as prevalent as discrimination based on race or gender, only one state and six cities have laws that protect fat people against discrimination.
“The attitude is that we are the size we are because of the choices we make and as a result of making those choices, we have to suffer whatever consequences come along,” Howell said. “We hear stories about people ramming their grocery carts into other people at the store and making remarks like, ‘Do you really need all that food?’”
A 2010 article published in the American Journal of Public Health found that weight discrimination remains socially acceptable in North American culture and as a result, thousands of fat individuals face unfair treatment on a daily basis and have minimal outlets for protection.
For instance, fat women earn less money than average-weight women and all men across varying lines of work, and they are more likely to work in lower-paying and more physically demanding jobs, according to a 2014 Vanderbilt study. The study controlled for education levels, which not only challenges the stereotype that the “real” reason fat women earn less is due to lack of education, but also points to cultural bias against them. The study also showed that every pound gained decreases a woman’s likelihood of working in higher paying jobs that involve forms of personal interaction. Contrary to the stereotype that fat people are inactive, a woman is actually more likely to work in a physically demanding occupation as she becomes heavier.
Another study, published in the Journal of Applied Psychology, analyzed pay discrepancies among people of different sizes. The study broke down women’s body sizes into categories of “very thin,” “thin,” “average,” “heavy” and “very heavy.” It found that “very thin” women earned $22,283 more than and “very heavy” women earned $18,902 less than women of average weight.
“Everybody will admit that women get paid less than men for doing the same job, but a fat women gets paid even less than the women sitting next to her doing the same job,” Howell said. “How is that not a social justice issue? Where is there any justice in paying this woman less based solely on her body size?”
In addition to impacting an individual’s paycheck, an accumulation of public health research shows that like racial discrimination, weight discrimination is a significant risk factor for depression, low self-esteem and body dissatisfaction. These studies have controlled for variables such as age, gender and BMI, suggesting that these issues are not a consequence of “excess” body weight itself.
Of particular concern is the fact that “evidence-based” studies that support weight loss for health are funded by weight loss companies and the pharmaceutical industry. This means that private industry is writing public health policy.
“The diet industry is vested on the myth that weight is a simple function of calories in versus calories out and that anyone can achieve this perfect body if they just do the correct thing,” said Isabel Foxen Duke, a certified health coach who teaches women to improve their relationships with food and stop dieting. “We need to come to terms with the fact that we’ve been lied to and that the diet industry is really about creating a capitalistic hamster wheel around convincing you to buy a particular weight loss supplement, pill or program.”
Weight discrimination undermines fat patients’ opportunities to receive medical care. Several studies have established that fat people are less likely to undergo preventive cancer screenings and delay seeking health care due to disrespectful treatment from providers and the experience of medical equipment that is impractical for their body size. Self-report and experimental research shows that health care providers and fitness professionals not only spend less time in appointments with fat patients compared with thinner patients, but these professionals also report that they perceive fat patients as lazy, lacking in self-discipline and noncompliant with treatment. It doesn’t matter what symptoms a patient presents with; healthcare providers often tout weight loss as the end-all solution.
“We are handed diets even though weight cycling, which is taking weight off and putting it back on again, is much more harmful to our bodies than just staying at a higher weight,” said Kristy Fassio, a certified personal trainer and a counseling student who is currently working through the Body Trust® Certification program through the Be Nourished Training Institute, which teaches the tenets of Intuitive Eating and HAES. “Doctors are humans who have the exact same biases that we have. They don’t get weight management training and they don’t get any more nutrition training than people do just as human beings.”
Because health care practitioners demonstrate intense weight bias and often advise patients that their health problems can be solved by weight loss, the appendix of Bacon’s book, Health at Every Size: The Surprising Truth About your Weight, comes armed with a HAES manifesto and a cover letter that people can share with their doctors. The manifesto uses peer-reviewed articles to discuss and disprove the most common assumptions that underlie the war against fat. The appendix also includes cover letters for friends and family, along with messages for legislators and politicians, school administrators and teachers, journalists and people in the media, and therapists, among others.
“A big part of HAES is advocacy, self-advocacy, and advocating for the rights of people at higher weights, and demanding that we be treated like normal human beings and not sub-human beings,” Bishop said. “There are people who would rather die than be fat because fat people are not treated well. HAES advocates would say that’s what needs to change in our culture.”
According to the Association for Size Diversity and Health (ASDAH), an international professional organization composed of HAES practitioners, an individual’s health status should never be used to “judge, oppress, or determine” his or her value. who reject the myth that weight is an accurate proxy for health. Community leaders should take the HAES model into account when crafting policies, to stimulate policy, institutional and individual changes that improve the lives of all people and increase the safe and affordable access to healthcare.
Because the movement is grounded in a social justice framework, HAES is a compassionate and inclusive alternative to the current-weight based paradigm. It rejects the idea of pathologizing specific body types and advocates that health should be available to individuals of all sizes, colors, ethnicities, sexual orientations, gender identities, socioeconomic statuses, ages and ability levels. The HAES approach has empowered people to sustain long-term behavior changes that improve metabolic fitness, energy expenditure, eating behavior and mental health.
Because there are currently only one or two HAES-informed professionals in Houston, according to ASDAH’s Find HAES® Expert database, Ormanovich and other Houstonians are advocating to change this by increasing awareness about size diversity and justice for all. Ormanovich said that she would have saved herself “time, pain and turmoil” if she had gained access to a HAES-informed treatment team earlier in her recovery from bulimia. One of her friends, a fat woman who suffers with anorexia, has never been given a formal diagnosis even though she meets all the DSM-V criteria for anorexia nervosa—except for the “significantly low body weight in the context of age, sex, developmental trajectory, and physical health.” When people think of eating disorders, they usually picture a white, emaciated woman. But eating disorders do not discriminate.
Eating disorders affect both men and women of all races, ages and ability levels. And yes, they affect fat people too.
“My friend has suffered a very long and drawn out recovery process. She fears going to support groups or seeking help,” Ormanovich said. “I think we all agree that the DSM-V needs to rework its eating disorder category.”
Ormanovich does not only advocate for women, but also for the future of her children. She fears that her daughter will internalize the “fatphobic” messages that are rampant in Western culture and develop an eating disorder like she did, as eating disorders are often biologically inherited. Ormanovich strives to teach her daughter that “thin” does not amount to health, success or beauty, and that fat does not amount to laziness, carelessness or a lack of health.
“We have to start by accepting fat bodies, so all bodies can be accepted,” Ormanovich said. “I fight this fight and spread these messages in hopes of raising my children in a world that accepts them for all the things that they are, so they are not put into boxes.”
For more information about HAES, check out its professional organization, ASDAH, along with Linda Bacon’s website, lindabacon.org. Ormanovich’s body positive photography project can be found at www.thewayyouareproject.com.