Definition and Background
Fat acceptance, also known as size acceptance, is a social movement that fights discrimination based on weight. Fat acceptance challenges the aesthetic, legal, and medical spheres that are biased towards fat people by working to improving the self-esteem of fat people, countering negative media stereotypes, and promoting care models focused on health rather than weight (Berg & Keller, 2008, p. 263).
Fat people often face discrimination and prejudice in several areas, including institutional, physical, and social settings. In the workplace, fat people are often “subject to harassment by their employers, kept in jobs beneath their abilities, and are often demoted or fired” (Berg & Keller, 2008, p. 263). Many employers refuse to hire fat people, particularly in jobs that involve physical strength or social interaction. Fat people are frequently rejected as applicants to educational institutions, and are “systematically denied health and life insurance or forced to pay higher premiums” (Berg & Keller, 2008, p. 263). They constantly deal with problems of inaccessibility to public facilities and transportation such as narrow armchairs, small bathrooms, and turnstiles that are unable to accommodate a larger person. Airplanes, trains and buses often have constricted seating that is uncomfortably tight for plus-size people. Moreover, fat people constantly suffer bullying, harassment, derision, insults, and criticism from peers and strangers, as well as subtler forms of disrespect from friends and family (Berg & Keller, 2008, p. 263).
The fat acceptance movement strives to change societal attitudes regarding body image and attractiveness by creating a “subculture” that acts as a social support group encouraging fat people to accept and stand up for themselves. Values of fat acceptance include the celebration of size diversity and the noting of the “ideal body type as a concept that changes over time and across cultures” (Berg & Keller, 2008, p. 264). Fat acceptance helps fat people to improve their self-esteem through “support, education, and camaraderie with other self-accepting people” (Berg & Keller, 2008, p. 264). Fat acceptance also has an online social presence with various internet support groups, such as Big Beautiful Woman (BBW) dating services (Berg & Keller, 2008, p. 264).
Advocates of fat acceptance work toward protecting fat people from discrimination and “treatment as second-class citizens” based on weight to make the point that “worthy people come in all sizes” (Berg & Keller, 2008, p. 264). Several organizations that represent the goals of the fat acceptance movement include the National Association for the Advancement of Fat Acceptance (NAAFA), International Size Acceptance Association (ISAA), and Council on Size & Weight Discrimination (CSWD). Professionals who use the size acceptance and non-diet approach are represented by Association for Size Diversity and Health (ASDH). Activist groups and individuals protest unfair treatment and policies against fat people through the use of books, videos, letter-writing campaigns, email lists, and websites.
Scientifically, fat acceptance questions the conception of being fat as equivalent to being unhealthy. They dispute the premise that weight loss makes one healthier with arguments such as the long-term ineffectiveness of currently known weight loss methods that commonly result in dieters regaining the weight, so the “diet is failing not the people following the diet” (Berg & Keller, 2008, p. 264). Instead, fat acceptance endorses a holistic approach to healthcare that upholds “health improvement without focusing on weight loss” (Berg & Keller, 2008, p. 264). They also point to the health problems of overweight individuals as being exacerbated by medical infrastructure itself, such as “biased attitudes on the part of healthcare practitioners” that cause “plus-size people to delay care for their medical problems out of fear of diet lectures and judgment” (Berg & Keller, 2008, p. 264). Moreover, medical offices and facilities often lack necessary equipment that fit larger bodies or higher weights, causing plus-size patients to often be unable to obtain diagnostic tests that would prevent or ameliorate potential medical problems.
Historical Context
Beginning in the mid-1990s, the popularization of the use of weight scales, statistical standards, and computer power helped to introduce a new diagnostic standard focused solely on body weight (Bombak, 2015, p. 256). This diagnostic standard is the Body Mass Index, or BMI. The BMI is a measure of body fat based on height and weight, and categorizes bodies as underweight, normal weight, overweight, or obese (NIH, 2018). The BMI has become “the way governments, drug manufacturers, physicians, and would-be dieters measure obesity, or the lack thereof” (Hobson, 2016). In current biomedical discourse, fatness that is deemed to the point of excessive is termed “obesity” (Bombak, 2015, p. 256). Intensified medicalization of the problem of fatness has resulted in the “routine definition of excess weight as a disease” (Greenhalgh, 2012, p. 471). Fat and obese individuals are labeled as “at risk of disease” and “in need of medical treatment”, and are constantly urged to lose weight in order to improve their health.
The rising concern about the health of fat bodies has prompted a large expansion of social forces to intervene, including political, economic, and cultural, and in turn has triggered an explosion of “fat talk” (Greenhalgh, 20120, p. 471). Fat talk can be described as “public and private discourse that increasingly targets weight as a subject of concern, lament, ridicule, and much more” (Greenhalgh, 20120, p. 472). By the late 1990s, news reporting on Americans’ increasing weights “spiked dramatically” and tended to “dramatize, moralize, and individualize body weight” (Kirkland, 2008, p. 398). The U.S. is the epicenter of what the World Health Organization (WHO) calls a “global epidemic of obesity”, in which rising proportions of the public are becoming obese or overweight (Greenhalgh, 2012, p. 472). According to Greenhalgh (2012), currently 68% of adults and 32% of children and adolescents in the United States are obese or overweight. Although the rate of increase in overweightness and obesity has slowed in recent years, narratives articulated by government, public health, and media sources announce that the “heavy burden of fat” is “eroding the nation’s health” (Greenhalgh, 20120, p. 471). In 2001, the U.S. surgeon general launched a nationwide public-health campaign to “eat more healthfully and to be more active in an effort to achieve a “normal” Body Mass Index (BMI)” (Greenhalgh, 2012, p. 471). The latest initiative of the nation’s approach to remedying the obesity problem is First Lady Michelle Obama’s “Let’s Move!” campaign in 2010 (Greenhalgh, 2012, p. 471). In other words, the U.S. can be said to have declared war on fat.
Perspectives and Controversies
In opposition to the war on fat, fat acceptance activists have called for less public awareness and intervention regarding obesity (Saguy & Riley, 2005, p. 870). In 1969, the National Association for the Advancement of Fat Acceptance (NAAFA) was founded (www.naafa.org/). NAAFA calls itself a “human rights organization dedicated to improving the quality of life for fat people”, and is founded upon the idea that “fatness is a form of body diversity that should be tolerated and respected, much like diversity based on race, ethnicity, or sexual preference” (Saguy & Riley, 2005, p. 872). NAAFA has five primary purposes, as stated on its website: to fight discrimination and work for equal opportunity for fat people; to disseminate information about the consequences of being fat, including the psychological, sociological, legal, medical and physiological aspects; to sponsor research; to encourage obese people to accept themselves and to promote their acceptance in society; and to serve as a forum to address the issues of fat people” (Boslaugh & Keller, 2008, p. 485). While NAAFA is based in principles of identity, it has met strong opposition by medical arguments about health risk (Saguy & Riley, 2005, p. 872).
Antiobesity proponents and fat acceptance supporters are at the forefront of the public discussions of the obesity controversy, and apply disparate frames over the “nature and consequences of excess body weight” (Saguy & Riley, 2005, p. 870). Members of fat acceptance group embrace a “body diversity frame”, which presents “fatness as a natural and inevitable form of diversity” (Saguy & Riley, 2005, p. 870). On the other hand, members of the antiobesity group utilize a “risky behavior frame”, which likens higher weights as “risky behavior akin to smoking”, implying that body weight is “under personal control and that people have a moral and medical responsibility to manage their weight” (Saguy & Riley, 2005, p. 870). Both groups sometimes use the “disease frame” by equating obesity to illness, which lifts blame by “suggesting that weight is biologically or genetically determined”, but also “simultaneously stigmatizes fat bodies as diseased” (Saguy & Riley, 2005, p. 870).
Antiobesity researchers strongly believe that obesity is an “urgent health crisis” (Saguy & Riley, 2005, p. 875). They not only study body weight, but are also committed to the principle that obesity is an “important health problem that needs to be fought” (Saguy & Riley, 2005, p. 875). Antiobesity researchers include scientists and clinicians from a variety of academic backgrounds such as epidemiology, psychology, nutrition, and neuroscience, and they dominate expert panels at the National Institutes of Health (NIH), Federal Drug Administration (FDA) and the World Health Organization (WHO) (Saguy & Riley, 2005, p. 875). They argue that overweightness and obesity have serious health consequences, and advocate for “increased public investment in obesity research, public policy initiatives, and personal responsibility for maintaining healthy body weight” (Saguy & Riley, 2005, p. 875). As shown in Figure 1, medical research on obesity has rose since 1995, and correlate with the increase in mass media reports that draw heavily on antiobesity research. Antiobesity activists draw on antiobesity research to argue that obesity is a health threat that requires public intervention, research funding, and personal action on behalf of the obese individual (Saguy & Riley, 2005, p. 877).
Figure 1: Articles about Obesity in Medical Research (Pubmed) and the Mass Media (Lexis Nexis), 1980-2004 (Saguy & Riley, 2005)
Fat acceptance activists reject the term “obese” with the reason that this term “pathologizes heavier weights”, and argue that weight should be a political rather than medical issue (Saguy & Riley, 2005, p. 877). NAAFA is the only existing nationwide fat acceptance organization, and speaks out against body size discrimination in areas such as “airline polices that require people who cannot fit into one airplane seat to purchase two at full price, the weight-loss industry, offensive advertising, and negative media representation” (Saguy & Riley, 2005, p. 877). NAAFA works to attain legal protection for fat people by educating lawmakers and serving as a “national clearinghouse for attorneys challenging size discrimination” (Saguy & Riley, 2005, p. 877). NAAFA also provides emotional support to fat people by creating workshops and support groups during their annual national convention, as well as holding local chapter meetings (Saguy & Riley, 2005, p. 877). Researchers who support fat acceptance disagree with the orthodox notion that overweightness and obesity cause ill health, and they include neurobiologists, exercise physiologists, nutritionists, and social workers (Saguy & Riley, 2005, p. 879). Fat acceptance researchers spread this alternative message about weight and health through both scientific publications and mass media. Some researchers in support of this perspective refer to their approach as the Health At Every Size (HAES) paradigm (https://haescommunity.com/). As stated on its website, Health At Every size “supports people of all sizes in addressing health directly by adopting healthy behaviors” through the components of “respect, critical awareness, and compassionate self-care” (Bacon, 2018). HAES often creates campaigns based on inclusivity (shown in Fig. 2) that “challenge the structural and systemic forces that impinge on living well” (Bacon, 2018).
Figure 2: “I STAND against weight bullying” campaign shares positive images of people who are comfortable and happy in their bodies (Health At Every Size®, 2012)
The body diversity frame draws on U.S. traditions of antidiscrimination and civil rights by speaking of “fat phobia” to describe fear and hatred of fat people (Saguy & Riley, 2005, p. 873). By asserting fatness as a “natural and inevitable” form of diversity, fat acceptance activists compare fatness to a form of identity such as race, gender or sexual orientation (Saguy & Riley, 2005, p. 882). This frame bases obesity in genetics and biology, and cites studies showing that long-term weight loss is unattainable for subjects in order to demonstrate that weight is outside of personal control. In this case, it is implied that rather than trying to resolve health risks associated with obesity that have “little remedial function”, society needs “diversity training, social tolerance, and less discrimination on the basis of size” (Saguy & Riley, 2005, p. 873).
The risky behavior frame uses proven patterns of public health interventions against risky health behaviors to emphasize that body weight can be controlled by personal intervention (Saguy & Riley, 2005, p. 870). It ties obesity to established and well-known behaviors that heighten health risks, such as smoking. This situates fatness as a “preventable health risk” that needs “less tolerance and more public vigilance” (Saguy & Riley, 2005, p. 870). However, this frame does not take into consideration the people who are fat but lead healthy lifestyles, or people who are thin despite having unhealthy diets and sedentary lifestyles. In response to fat acceptance researchers who present the view that weight-loss diets are ineffective and therefore irrelevant in the conversation of health improvement, antiobesity researchers express the opinion that those people are simply not trying hard enough and are not “truly committed to [losing weight]” (Saguy & Riley, 2005, p. 884).
Another argument of fat acceptance activists is that concerns over obesity are actually counterproductive and can diminish attention to real problems. Many state that the war on fat can encourage dangerous weight-loss methods and hazardous obsessions with weight that ultimately cause more harm to health. Additionally, some point out that approved body fat measurements such as BMI are not reliable indicators of overall healthiness as it can “incorrectly flag the athletic or particularly muscular as overweight” (Hobson, 2016). A growing body of research reveal that “taken alone as an indicator of health, the BMI is misleading” (Hobson, 2016). A study by UCLA researchers looked at 40,420 adults and assessed their health by six accepted metrics, including blood pressure, cholesterol, and C-reactive protein. It found that 46% of people classified as overweight by BMI and 29% of those who qualified as obese were healthy as measured by at least five of those other metrics, while 31% of normal weight people were unhealthy by two or more of the same measures (Hobson, 2016). Based on the study, the researchers believe that using BMI alone as a measure of health would “misclassify almost 75 million adults in the U.S.” (see Fig. 3).
Figure 3: Estimated share of U.S. adult population that is healthy and unhealthy, according to other health metrics, in each BMI category (International Journal of Obesity, 2016)
The presumed goal of obesity indicators is to “identify people with excess fat, since that fat has been associated with bad health outcomes” (Hobson, 2016). However, because the BMI is a function of a person’s height and weight, and weight includes not only fat but also “bones, muscles, fluids and everything else in the body”, it can miss the category of people who are normal weight according to their BMI, but “have too much fat in a particularly dangerous place” (Hobson, 2016). If they use the BMI as a singular measurement of obesity, these people may “walk around thinking they’re perfectly healthy when they’re at higher risk of heart disease, diabetes, and premature death” (Hobson, 2016). The researchers propose using instead the waist-to-hip ratio that would better indicate dangerous excess fat that is associated with dire health outcomes (Hobson, 2016).
Relation to Politics of Health
Fat acceptance has several intersections in relation to concepts we have learned in Politics of Health, including the definition of “health”, normality, medicalization, the social model of disability, historical trauma, biological citizenship, and structural violence.
Fatness as a determinant of health emulates a “prescribed state and an ideological position” that “allows for a set of moral assumptions” (Metzl & Kirkland, 2010, p. 2). Health is the idea of “ongoing moral self-transformation”, and public health policies regarding obesity promote definitions of health that represent “moral imperatives” in the regulating of one’s body (Metzl & Kirkland, 2010, p. 6). The notions of morality plays a central role in the controversy of obesity and fat acceptance, as the risky behavior frame attributes fat bodies to evidence of immorality such as gluttony and sloth.
While the classification of obesity as having a BMI of over 30 is supposedly an objective and purely clinical categorization of bodies, it is also a “highly ideological construction” (Bombak, 2015, p. 256). Davis defines the concept of the norm as an ideal average that “implies the majority of the population must or should somehow be part of”, and that all normative bodies fall under the standard bell-shaped curve (Davis, 3013, p. 3). The BMI as the standard measurement for body fat is exemplary of the concept of bodily norms, as overweight and obese bodies that do not fit into the normal weight category are seen as “deviations or extremes” that are both socially and medically unacceptable (Davis, 2013, p. 3).
According to Conrad, the “medical profession and the expansion of medical jurisdiction is a prime mover for medicalization” (Conrad, 2005, p. 4). The extreme medicalization of fatness and obesity largely renders fat acceptance activists’ arguments as erroneous, because many antiobesity proponents are represented by experts in the medical field who are respected and seen as having more authority and credibility. The rejection of fat acceptance is exacerbated by the moral implications of health when fat acceptance activists are portrayed as making excuses for their weight. This is further amplified by fat acceptance activists’ refusal to being medically labeled as ill, which could give them scientific and political claims, and hence the benefits of biological citizenship that many groups who identify with disease categories are given. According to Petryna, the “damaged biology of a population becomes grounds for social membership and citizenship claims”, and a person “categorized as disabled is far better compensated than a mere sufferer” (Petryna, 2013, p. 5). Consequently, when fat acceptance activists demand for antidiscrimination policies, they are easily shot down and ridiculed because they are seen as morally, scientifically, and politically undeserving of civil rights and legal protection from the state.
Fat acceptance highlights reasons why certain identity groups embrace medical models, whereas others reject them. According to Mollow, the disabled reject the label of being ill because this entails that they are flawed, when it is in fact “society which disables physically impaired people” (Mollow, 2006, p. 287). This is similar to many fat acceptance activists’ criticism regarding accommodation problems in public and medical facilities that restrict them from “full participation in society”, much like the disabled (Mollow, 2006, p. 287). It could be said that in some ways, the fat acceptance movement prefers utilizing the social model of disability to frame claims surrounding fat discrimination by focusing on the social oppression of fat people rather than the physical impairments of bodily fatness.
Overweight and obese individuals are victims of historical trauma, which is defined as a “complex and collective trauma experienced over time and across generations of people who share an identity, affiliation, or circumstance” (Mohatt, Thompson, Thai, & Tebes, 2014, p. 128). Historical trauma functions as a narrative with personal and public representations, and fat acceptance members publicly share transformative narratives that illustrate the positive growth in accepting one’s fatness. Historical trauma can result in resiliency and higher levels of well-being, and fat acceptance has responded with saliency in the face of the trauma associated with fat discrimination and stigma by creating a large support group that fosters self-acceptance.
It is important to note that most of the people who comprise the overweight and obese population are minorities and of low socioeconomic status (NIH, 2018). In that the risky behavior frame takes personal responsibility and an unhealthy lifestyle hand-in-hand, this perspective blames overweight individuals for their fatness, and parallels the view that the poor are to blame for their disadvantaged socioeconomic position. The risky behavior frame is concerning as this ignores the structural factors such as poverty and inaccessibility to healthcare that propagate obesity, and instead uses self-discipline as the solution to obesity. This denotes the obligation of the sick person to get well, which mirrors the concepts of bodily control and the capacity of bodies. Given that minorities such as black and Hispanic populations are especially likely to be categorized as obese as well as impoverished, it can be said that blaming fat people for their weight may further reinforce existing racial inequalities.
References
Bacon, L. (2018). Health at Every Size®. Retrieved April 13, 2018, from https://haescommunity.com/
Berg, M. (2008). Fat Acceptance (K. Keller, Ed.). Encyclopedia of Obesity,264-265. doi:10.4135/9781412963862.n165
Bombak, A. E. (2015). “Obesities”: Experiences and perspectives across weight trajectories. Health Sociology Review,24(3), 256-269. doi:10.1080/14461242.20151045919
Boslaugh, S. (2008). National Association to Advance Fat Acceptance (K. Keller, Ed.). Encyclopedia of Obesity,486-488. doi:10.4135/9781412963862.n308
Conrad, P. (2005). The Shifting Engines of Medicalization. Journal of Health and Social Behavior, 46(1), 3-14. doi:10.1177/002214650504600102
Davis, L. J. (2013). The Disability Studies Reader. London: Routledge.
Greenhalgh, S. (2012). Weighty subjects: The biopolitics of the U.S. war on fat. American Ethnologist,39(3), 471-487. doi:10.1111/j.1548-1425.2012.01375.x
Hobson, K. (2016, February 25). BMI Is A Terrible Measure Of Health. Retrieved April 13, 2018, from https://fivethirtyeight.com/features/bmi-is-a-terrible-measure-of-health/
Metzl, J., & Kirkland, A. (2010). Against Health: How Health Became the New Morality. New York, New York: New York University Press.
Mohatt, N. V., Thompson, A. B., Thai, N. D., & Tebes, J. K. (2014). Historical Trauma as Public Narrative: A conceptual review of how history impacts present-day health. Social Science & Medicine,106, 128-136. doi:10.1016/j.socscimed.2014.01.043
Mollow, A. (2006). “When Black Women Start Going on Prozac…” The Politics of Race, Gender, and Emotional Distress in Meri Nana-Ama Danquah’s Willow Weep for Me. MELUS: Multi-Ethnic Literature of the United States,31(3), 67-99. doi:10.1093/melus/31.3.67
Petryna, A. (2013). Life Exposed: Biological Citizens After Chernobyl. Princeton, New Jersey: Princeton University Press.
Saguy, A. C., & Riley, K. W. (2005). Weighing Both Sides: Morality, Mortality, and Framing Contests over Obesity. Journal of Health Politics, Policy and Law,30(5), 869-923. doi:10.1215/03616878-30-5-869
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