Medical Examiner

Shame on People Who Fat-Shame

Obesity isn’t nearly as bad for your health as poverty is. Let’s extend the logic …

The solution is shame?

Photo by monkeybusinessimages/Thinkstock

Last week comedian Nicole Arbour posted a self-described “truth bomb” on YouTube, “Dear Fat People,” that quickly went viral. “If we offend you so much that you lose weight, I’m OK with that,” she said, and then did her best to offend, mocking an obese family for smelling “like sausage” and claiming that “fat-shaming” is “fucking brilliant.”

The subsequent outpouring of criticism left Arbour unfazed. “I’m not apologizing for this video,” she told Time. And why would she? Arbour isn’t some lone hate-spouting troll. Quite the contrary: Studies show that her rant, which blames obesity on lack of personal responsibility, actually reflects mainstream beliefs, even among health professionals.

There’s actually not much difference between Arbour’s stance and the public declarations of prestigious scholars. In an interview with University of California–Los Angeles sociologist Abigail Saguy, Harvard epidemiologist Walter Willett said that if people were “really serious about controlling their weight,” most would succeed. JoAnn Manson, another Harvard epidemiologist, asserted fat people “just don’t feel like” doing exercise, instead opting for “the Big Mac and french fries instead of a salad or roasted chicken.” And Daniel Callahan, co-director of the Yale-Hastings Program in Ethics and Health Policy, has suggested fighting obesity with “the force of being shamed and beat upon socially.” He calls it “stigmatization-lite.”

What’s strange is how all these well-meaning fat-shamers ignore a health condition far graver than obesity, one that is also presumably within people’s power to change. This condition results in shorter lifespan, high frequency of mental illness, and increased risk for diabetes, heart disease, and countless other problems associated with fat.

It’s called poverty. And by the logic of fat-shaming, we should be shaming poor people as well.

Let’s start with health. The Centers for Disease Control and Prevention says that health behaviors—that’s right, sitting around and snacking—account for less than 25 percent of the variation in people’s health. Biology and quality of medical care together account for another 25 percent. The remainder, more than 50 percent, comes down to “social determinants,” which include income, gender, and race. This is why life expectancy can vary by as much as 25 years between two neighborhoods in the same city.

It’s hard to disentangle these factors, but income is likely the most important. Research consistently shows that poverty is associated with psychosocial and physiological responses that wreak long-term mental and physical havoc, especially on children. In one Canadian study, researchers found that compared with women in the highest income bracket, those in the lowest bracket had triple the risk of developing Type 2 diabetes. After controlling for body mass index and physical activity, the risk was still double.  The Canadian National Population Health Survey backed up the conclusion—their data indicate that low income, not obesity, is the most accurate predictor of Type 2 diabetes.

Similarly, a study of black Americans (thus controlling for health differences associated with race) in Mississippi found that low income tripled the incidence of cardiovascular problems for people under the age of 50. The study’s author, Samson Y. Gebreab, emphasized that the findings shouldn’t be attributed solely to increased rates of obesity: “Another possible explanation is that African-American women of low socioeconomic status experience higher rates of psychosocial stressors such as chronic stress, depression, discrimination and are more likely to live and work in a worse physical and social environment.”

I spoke with East Carolina University bioethicist Daniel Goldberg, a specialist in social determinants of health, who confirmed the devastating effects of poverty. “We call it material deprivation,” he told me, “and I think most epidemiologists would agree it’s the single best predictor of negative health outcomes.”

So poverty is more of a threat to public health than obesity. Fortunately, there’s good news! Nicole Arbour—and the Harvard epidemiologists—emphasize that losing weight boils down to a simple formula: Eat less and exercise more. Well, if that’s true, then poverty also boils down to a simple formula: Spend less and work more. Calories in, calories out? Dollars in, dollars out. I mean, if you’re “really serious” about getting out of poverty, it’s not rocket science. Right?

Some might find the comparison between getting out of poverty and losing weight absurd. And it is—because losing weight is even harder than getting out of poverty. A recent study found that the annual odds of an obese person attaining a “normal” body weight was 1 in 210 for men and 1 in 124 for women. For severely obese men and women, the odds changed to 1 in 1,290 and 1 in 677, respectively.

Compare those numbers with the odds of getting out of poverty. According to the Pew Trust, people whose incomes are in the lowest fifth of the U.S. population have a 4 in 100 chance of reaching the highest fifth. That goes up to just 17 in 100 for reaching the middle fifth. (Pew’s figures are conservative: The Equality of Opportunity Project puts the odds of going from the lowest fifth to the highest at 9 in 100.)

To state that more clearly: Your chances are four to eight times better of going from extreme poverty to relative wealth than they are of going from obese to “normal” BMI. Did your friend work hard and lose weight? Did you? That’s great—but remember, unlikely success is even more common in the financial sector.

Poverty predicts poor health better than obesity does. It’s easier to get out of poverty than it is to lose weight. Why, then, are there no calls for shaming the poor among ethicists and epidemiologists? Why would Nicole Arbour never make a video called “Dear Poor People”?

I can only speculate. Maybe it’s because people recognize that poverty is an incredibly complicated problem, and reducing it to banal formulas like “dollars in, dollars out” or “work more, spend less” is ridiculous and offensive. Maybe it’s because when the media depicts poor people, we usually get to see their faces, while fat people appear most often as headless bodies or the butts of jokes. Or maybe it’s because we’ve realized that rags to riches stories are deceptive fairy tales, and Horatio Alger’s heroes have been replaced by contestants on The Biggest Loser.

Whatever the case, there are plenty of good reasons to stop fat-shaming. For one, it’s counterproductive. “When people are made to feel stigmatized or shamed, they are more likely to turn to food or avoid physical activity,” warns Rebecca Puhl, deputy director of the Rudd Center for Food Policy and Obesity.  “Individual choices and behavior are small pieces in a larger puzzle, and if we focus on them we’re ignoring everything else.”

Not only that, fat-shaming contributes to rampant weight discrimination by educators, employers, and peers. Such discrimination depresses wages, makes people more likely to lose jobs, and lowers self-esteem. For women, reported rates of weight discrimination are comparable to those of racial discrimination.

But the best reason not to fat-shame, or poor-shame, is the most obvious one. Fat and poor, like skinny and rich, are adjectives that describe people—people who live, work, love, struggle, fail, and triumph, real people whose worth far exceeds the size of their butts or their bank accounts, whose humanity can’t be measured with a blood pressure cuff. Endorsing Nicole Arbour’s call for fat-shaming means forgetting about other people’s humanity—and losing a little of our own.