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Laurie Cooper Stoll, Fat Is a Social Justice Issue, Too, 43 Humanity & Society 421 (2019)

Abstract

Empirical evidence continues to show that like other historically marginalized groups, fat people experience discrimination in employment, education, the media, politics, interpersonal relationships, and especially health care. Yet, despite the fact that fatphobia in the United States has always been intimately connected to other systems of oppression like sexism, racism, and classism, those of us who identify as critical sociologists so often exclude it from our analyses. We fail to acknowledge that fat is a social justice issue, too. In this article, I argue that fatphobia is a system of oppression worthy of greater theoretical and empirical consideration in humanist sociology. I begin by providing a brief history of the ways fat has been pathologized and medicalized in the United States. I then discuss some of the ways fat is connected with gender, race, and class in particular. Finally, I offer some strategies for how critical sociologists can move forward, including suggestions for engaging in fat activism.

Personal Reflexive Statement

As a critical scholar, I am embarrassed to admit that my foray into fat studies happened only a few years ago. After coming across a reading on fat politics, I was convicted. Here I was a feminist, critical race scholar who had devoted my career to studying systems of oppression and advocating for historically marginalized bodies—but my activism never included fat bodies. I realized there were two reasons why. First, I had bought into the myths so often perpetuated in our society that pathologize and medicalize fat bodies. Second, as a fat person who first started learning to hate my body at the tender age of nine, I struggled at the time to even grasp concepts like body positivity or fat acceptance. Nevertheless, it was at that point that I started immersing myself in the field of fat studies and the online fatosphere. I quickly realized I could no longer teach and do research on social inequalities while ignoring the salience of fat as a social justice issue, and I could no longer engage in social justice work that did not also include fat activism.

When you’re overweight, your body becomes a matter of record in many respects. Your body is constantly and prominently on display. People project assumed narratives onto your body and are not at all interested in the truth of your body, whatever that truth may be. Fat, much like skin color, is something you cannot hide, no matter how dark the clothing you wear, or how diligently you avoid horizontal stripes…. Your body is subject to commentary when you gain weight, lose weight, or maintain your unacceptable weight. People are quick to offer you statistics and information about the dangers of obesity, as if you are not only fat but also incredibly stupid, unaware, delusional about the realities of your body and a world that is vigorously inhospitable to that body. This commentary is often couched as concern, as if people only have your best interests at heart. They forget that you are person. You are your body, nothing more, and your body should damn well become less.

From Hunger by Gay (2017:120, 121)

Prior to the late 1800s and early 1900s in the United States, fat1 was typically associated with wealth and prosperity. As Farrell (2011) points out, up until this time, fatness was attainable by only a small portion of the population:

One had to have both wealth (meaning one had sufficient food and physical leisure) and health (meaning one was free of diseases that wasted away bodily flesh) in order to maintain a healthy body. As such, fatness was often linked to a generalized sense of prosperity, distinction, and high status. (P. 27)

But as the economic structure and systems of food production and distribution evolved in the United States, it became possible for the first time for more people who were not in the upper class to become fat, and perhaps not surprisingly, the positive connotations previously associated with being fat were replaced (Fraser 2009).

This was not only due to an increasingly plentiful food supply but also the rise of Protestantism in the West. As Oliver (2006) points out:

It wasn’t just that a plentiful food supply made fatness widely available, but rather that a plentiful food supply made eating a new target for a Protestant, middle-class preoccupied with bodily control. With scarcity no longer a limiting factor of one’s diet, voluntary self-restraint was needed, as eating became seen as a decadent and dangerous yielding to appetite and passion. The ideal of fatness was thus replaced with a new conception of physicality that better suited the concerns of rationality, efficiency, and self discipline of an industrial age. (P. 68)

To be fat at the turn of the twentieth century was now correlated with being weak-willed, unrestrained, unproductive, and gluttonous. To be fat was to be of the lowest social order, which was associated with immigrants and other peoples of color believed to be so-called inferior races by scientists and prominent social thinkers of the day (Farrell 2011). Thus, thinness became a marker of social status in the United States and a proxy for fitness for citizenship and the capacity to be civilized (LeBesco 2004). By the 1910s and 1920s, antifat sentiment in the United States was widespread (Fraser 2009).

A century later, weight stigma and size discrimination remain pervasive. In fact, empirical evidence continues to show that like other historically marginalized groups, fat people experience discrimination in employment (Grant and Mizzi 2014; Swami et al. 2010), education (Swami and Monk 2013), the media (Afful and Ricciardelli 2015; Dickens et al. 2016; Domoff et al. 2012; McClure, Puhl, and Heuer 2011; Pearl, Puhl, and Brownell 2012; Puhl, Luedicke, and Heuer 2013), politics (Bresnahan et al. 2016; Elmore et al. 2015; Miller and Lundgren 2009), interpersonal relationships (Collisson et al. 2017), and especially health care (Gudzune, Huizinga, and Cooper 2011; Ip et al. 2013; Miller et al. 2013; Nazione 2015; Phelan et al. 2015; Poon and Tarrant 2009; Puhl, Leudicke, and Grilo 2014). Yet, despite the fact fatphobia has always been intimately connected with other systems of oppression like sexism, racism, and classism, those of us who identify as critical sociologists so often exclude it from our analyses. We fail to acknowledge that fat is a social justice issue, too.

In this article, I argue that fatphobia is a system of oppression worthy of greater theoretical and empirical consideration in humanist sociology. I begin by providing a brief history of the ways fat has been pathologized and medicalized in the United States. I then discuss some of the ways fat is connected with gender, race, and class in particular. Before concluding, I offer some strategies for how critical sociologists can move forward, including suggestions for engaging in fat activism in a health-obsessed culture that remains steeped in fat shaming despite increasing attention to fat-acceptance movements and body positivity (e.g., Baker 2015; Kinzel 2012; Thore 2015).

Situating Fat as a Social Justice Issue

Perhaps the biggest reason so few of us who are critical sociologists fail to situate fat as a social justice issue is because unlike other marginalized identities, we think of fat as a “choice” and, more to the point, we think of it as a bad choice (McHugh and Kasardo 2012; Puhl and Heuer 2010; Sender and Sullivan 2008). This is due in large part to the pervasiveness of several health myths that so often go unquestioned in our culture (Bacon 2008; Bacon and Aphramor 2014; Campos 2004; Greenhalgh 2015; Oliver 2006). Some examples include the following: (1) We are in the midst of an “obesity” epidemic in the United States; (2) people who are “overweight” have higher rates of mortality than people who are “normal” weight or thin; (3) “obesity” causes a host of other diseases and illnesses, many of which are life-threatening; (4) to lose weight, all people need to do is eat less and exercise more; and (5) anyone can lose weight and keep it off if they just try hard enough. Why do we as critical sociologists, like so many people in general, view these myths as unimpeachable truths? To answer this question requires a brief history of the ways fat has been pathologized and medicalized in the United States.

Having already established the origins of fatphobia in the United States at the turn of the previous century, we now turn to the 1940s when a statistician at the Metropolitan Life Insurance Company by the name of Louis Dublin began charting death rates using height-to-weight tables that could be utilized by underwriters to shore up profits for their employers. As Oliver (2006) points out, by the 1950s, these tables were the go-to for doctors, epidemiologists, and the federal government in determining who was “overweight.” This is when body mass index (BMI), even though it is an extremely poor measure of health (Bacon and Aphramor 2014; Campos 2004), was used for the first time as a proxy for health, primarily as a matter of convenience. For example, it is easier (and cheaper) to measure height and weight than more complex measures like fitness. But who determined where the BMI cutoffs should be? Who decided what constituted “normal” weight and “overweight”? How did we get to the war on “obesity?”

While efforts to pathologize and medicalize fat began decades earlier, it was in the early 1980s, when a small group of health professionals, government health officials, and lobbying groups, with ample support from the pharmaceutical and weight-loss industries, began diligently promoting the idea that “obesity” was a disease (Oliver 2006:37). Their efforts would start to pay off in the following decade, beginning in 1993 when a study by McGinnis and Foege titled, “Actual Causes of Death in the United States,” (emphasis added) was published in the Journal of the American Medical Association (JAMA). The McGinnis and Foege article suggested that a poor diet and a sedentary lifestyle were associated with 300,000 deaths per year in the United States. This study became a major justification for Surgeon General C. Everett Koop to launch the Shape Up America! Campaign (a campaign Weight Watchers, SlimFast, and Jenny Craig contributed over a million dollars to) and declare the war on “obesity” in 1995 (Fraser 1997; Greenhalgh 2015).

In the same year, the World Health Organization (WHO) issued a report recommending that “overweight” be established at a BMI of 25 (see Technical Report Series No. 894, 2000).2 The International Obesity Taskforce (IOTF) had a major hand in drafting this report (Oliver 2006; Saguy 2013). But as Oliver points out in Fat Politics, what most laypeople did not realize was that the IOTF was primarily funded by Hoffman-La Roche, makers of the diet drug Xenical, and Abbott Laboratories, makers of the diet drug Meridia (see also Campos 2004). In 1997, the National Institutes of Health convened a panel of experts who voted to adopt the WHO guidelines and lower BMI in the United States to 25 for “overweight” (the panel also thought 25 was a “round” number that would be easier for people to remember) (see NIH Publication No. 98-4083, 1998). This had the effect of making millions of Americans “overweight” overnight (Bacon 2008; Squires 1998). It also illustrates how BMI designations of “overweight,” “obese,” and other weight-related categories are socially constructed.

In 1998, William Dietz, a director at the Centers for Disease Control and Prevention (CDC) along with his colleague, Ali Mokdad, decided the best way to convince the public that “obesity” was not just a disease but an epidemic was to produce a series of PowerPoint slides with maps of the United States using alarming colors and graphics that made it appear as if “obesity” was rapidly spreading throughout the United States (Campos 2004; Oliver 2006). As Oliver points out, although the maps were misleading (i.e., the maps only show the percentage of people in each state with a BMI greater than 29, not the spread of the disease; and the maps exaggerate the extent of obesity by using state boundaries that do not relate to the size of a state’s population), they were powerful, and because Dietz made the maps publicly available on the CDC website, they quickly became cited over and over again in scholarly research and in the media (pp. 42, 43).

In 1999, JAMA published its first theme issue on “obesity”. Researcher David Allison and colleagues published additional analyses to reassert the conclusion that “obesity” caused 300,000 deaths per year, illuminating one of the major problems with the “obesity” research presented thus far. When it comes to research on “obesity” and mortality, correlation is often presented as causation, either by the researchers themselves or the media (Campos 2004; Oliver 2006; Saguy 2013). This happens with rates of morbidity as well (Bacon and Aphramor 2014; McHugh and Kasardo 2012). However, this is also not unusual when it comes to “obesity” research in the United States. As Saguy (2013) points out in What’s Wrong with Fat?, by the time JAMA published its second theme issue on “obesity” in 2003, it was widely accepted that “obesity” was a major public health concern in the United States.

Then, in 2004, another study appeared in JAMA that supported the thesis that “obesity” caused early mortality (Mokdad et al. 2004). This study was actually a replication of the 1999 study in JAMA by Allison and his colleagues. This time the researchers estimated that “obesity” caused 365,0003 deaths per year. Yet, like in the 1999 study, there were several flaws in the data analyses. As Saguy (2013) points out, not only did the researchers rely on a number of large-sample studies, many of which were not representative of the United States, but they assumed rather than tested that if people in the “overweight” and “obese” categories died sooner than those in the upper range of the “normal” weight category, it was due to poor diet and lack of physical activity (pp. 118, 119; see also Bacon 2008; Campos 2004; Oliver 2006). According to Saguy, despite these and other methodological concerns, this research provided justification for a government-sponsored “obesity” education campaign and more funding for “obesity” research and “obesity” prevention programs (p. 119).

However, in 2005, a study by researcher Katherine Flegal and some of her colleagues at the CDC reexamined the purported causal link between “obesity” and mortality (see Flegal et al. 2005). Using only nationally representative data and the full range of the “overweight” category, and controlling for gender, age, and smoking, something the other studies did not do, they found that people in the “overweight” category of BMI actually had lower mortality rates than people in the “normal” weight category. In other words, they found people who were “overweight” (but not “obese”) lived longer than people who were “normal” weight. Their research suggested that “obesity” and “overweight” combined may only be correlated with approximately 26,000 deaths per year, as opposed to 365,000 deaths per year. By comparison, people who were “underweight” had the highest rate of mortality in their study.

When this article was published, it sparked outrage on the part of a number of “obesity” researchers and public health officials who thought it would undermine the war on “obesity” (e.g., Hill 2005), but ultimately the CDC issued a public statement adopting the new lower numbers associated with “obesity”-related deaths in the United States. As Saguy (2013) and Bacon (2008) point out, the CDC did not mention the fewer deaths associated with being “overweight”, and they also made it a point to reiterate that “obesity” remained a health risk. In other words, they did not stray from the narrative that “obesity” was a major public health concern. In 2013, Flegal and her colleagues conducted a meta-analysis that corroborated their original findings (Flegal et al., 2013).

There is one final historical moment that is important to acknowledge before moving forward. In 2013, the American Medical Association (AMA) voted to recognize “obesity” as a disease. The AMA convened its own panel of experts to study the efficacy of labeling “obesity” a disease before members were set to vote on Resolution 420. As Brown (2015) describes in Body of Truth, the AMA’s own expert panel recommended that “obesity” not be labeled a disease citing that (1) “obesity” did not fit the definition of a medical disease, (2) correlations between “obesity” and rates of morbidity and mortality did not establish causality, and (3) there was concern that medicalizing “obesity” would lead to further stigmatization and unnecessary treatments (pp. 102, 103). The membership of the AMA, however, overwhelmingly voted in support of labeling “obesity” a disease, thus ensuring greater standardization for reimbursements and treatments (p. 104).

What happens when a condition is medicalized? First, it is brought under the purview of the medical establishment. Second, people come to believe the condition can only be treated within a biomedical model and only medical experts can speak authoritatively about the condition (Oliver 2006; Weitz 2007). Third, people come to believe those who are diagnosed with the condition have a moral obligation to seek treatment regardless of the risks involved (Saguy 2013). This is exactly what has happened with “obesity”. The medicalization of “obesity” has led to more treatments and more profits.

For example, bariatric medicine is one of the fastest growing and most lucrative areas in medicine today (Brown 2015; Herndon 2014; Oliver 2006). Bariatric procedures seek to surgically alter what is an otherwise healthy stomach and, in the case of gastric bypass, lower intestine as well. These procedures not only fail to guarantee weight loss, they are associated with a host of concerning complications including the likelihood of follow-up surgeries, nutritional deficiencies, and chronic side effects like “dumping syndrome” (Hartcollis 2012). As Herndon (2014) notes, dumping syndrome, which typically occurs after eating certain foods, is “a horrible process that can involve sweating, vomiting, dizziness, and diarrhea but is nonetheless actually touted as being helpful for controlling a patient’s eating” (p. 114). Further, while it is true that mortality rates from bariatric surgeries have been declining over the years, it is important to note that this is likely due at least in part to the fact that doctors are operating on increasingly younger patients and patients with increasingly lower BMIs (e.g., Brown and Inge 2009; Ingelfinger 2011; Inge, Xanthakos, and Zeller 2007; Michalsky et al. 2011).

Despite the concerns, I highlight in this very abbreviated history of the pathologization and medicalization of fat in the United States, there are a few conclusions we can draw with some confidence. First, the average American is heavier by about 20 pounds (and taller by about an inch) than they were in 1960 (Brown 2015:12). Scientists and intellectuals debate why this is (Saguy 2013). Some believe it is due to changes in the way food is produced, marketed, and distributed in the United States (Critser 2003; Nestle 2002; Pollan 2008; Schlosser 2001). Some believe it is a natural and inevitable biological response to our changing culture (Oliver 2006). Some believe it is due to environmental toxins (Brownell and Horgen 2003; Guthman 2011). Regardless, according to the CDC, the rates of “overweight” and “obesity” in the United States started leveling off around 2000. Further, during the same time our collective weight was rising, life expectancy was increasing dramatically (Bacon and Aphramor 2014; see also Gregg et al. 2005).

Second, weight is a poor indicator of health. Fitness level, on the other hand, has consistently been shown to be a strong indicator of health (Gaesser 2009). In fact, people who are fat but fit live longer on average than people who are thin but not fit (Bacon and Aphramor 2014; Blair et al. 1995; Blair et al. 1996; Blair and Church 2004; Chrisler and Barney 2017). Still it is important to note there is not a causal link between exercise and weight loss (Bacon 2008).

Third, despite declaring a war on “obesity”, neither the medical nor the public health establishment knows how to effectively treat “obesity” (Greenhalgh 2015; Oliver 2006). Dieting is commonly prescribed for weight loss, yet studies show time and again the majority of people who lose weight will gain back all the weight they lose within five years, usually with extra pounds to boot (National Institutes of Health Technology Assessment Conference Panel 1992). Indeed, diets fail 90–95 percent of the time and tend to have deleterious effects on the body (Bacon and Aphramor 2014; Gaesser 2009; McHugh and Kasardo 2012). For example, chronic dieting and weight cycling have been linked to higher blood pressure, depression, and eating disorders (e.g., Corwin, Avena, and Boggiano 2011; Lyons 2009; Neumark-Sztainer et al. 2006; Pietiläinen et al. 2012; Stice et al. 1999).

Fourth, the way our research system is set up in the United States, scientists have to rely on grant monies to provide a significant portion of their salaries and the salaries of their staff (Oliver 2006). Much of the research on “obesity” in the United States is funded by weight loss and drug companies; this influences the types of studies that get funded and has an impact on which studies get published (Bodenheimer 2000; Brown 2015; Moynihan and Cassels 2005). In sum, it is difficult to find any major “obesity” researcher in the United States who does not have financial ties to a weight loss or drug company (Campos 2004; Fauber and Gabler 2012; MacPherson and Silverman 1997).

Fifth, the war on “obesity” is fundamentally a war on fat people (Farrell 2011). By the 1970s, many feminist scholars, activists, and psychotherapists had declared fat a feminist issue (Fikkan and Rothblum 2012; Orbach 1978). To be clear, fat is a feminist issue, but it is also fundamentally a social justice issue that continues to intersect with other systems of inequality like gender, race, and class in very problematic ways (Bacon and Aphramor 2014; Chrisler 2012; Farrell 2011; Herndon 2014; Saguy 2013; van Amsterdam 2013).

For example, fat women are stigmatized more than fat men in U.S. society (Beren et al. 1996; Chrisler 2012; Cogan 1999; French et al. 1996; McHugh and Kasardo 2012; Roehling 2012; Snyder 2010), and the fattest women are penalized the most (Saguy and Ward 2011). As Fikkan and Rothblum (2012) found in their review, (1) fat women are less likely to be hired for jobs than their thinner counterparts and when hired are more likely to be paid less and treated worse, (2) fat women are less likely to be accepted into elite colleges and less likely to receive financial support from their families to go to college, (3) there are few positive role models in the media for fat women (and when they are portrayed they are oftentimes caricatured), and (4) fat women are less likely to marry and when they do they are more likely to marry down in terms of socioeconomic status.

Fat women are also particularly vulnerable to weight stigma in health care. As a case in point, fat women tend to have higher rates of certain types of gynecological cancers. One major reason for this is because fat women are less likely to get preventive screenings even when they have insurance due to the harassment they experience about their weight when they go to the doctor (Budd et al. 2011; Herndon 2014; Wee, Phillips, and McCarthy 2005). Some doctors will not even perform Pap tests on “obese” women (e.g., Amy et al. 2006). In general, when fat people go to the doctor, they are likely to be counseled first and foremost about their weight, have their presenting symptoms attributed to their weight without further investigation, and prescribed weight loss as the method of treatment regardless of condition (e.g., Drury and Lewis 2004; Ferrante et al. 2006; Mitchell et al. 2008; Rosen and Schneider 2004; Thompson and Thomas 2000; Wee et al. 2004).

When it comes to race, fatphobia, which has always been intimately connected with the historical development of whiteness in the United States (Farrell 2011), is often used as a way to mask overt racism in the name of “health” (Oliver 2006; Saguy 2013). As Herndon (2014) points out, “many of the same attitudes and actions toward women of color and/or poor women that would be called discriminatory in another situation can be couched as justified—or even helpful—when read through the lens of fatness because such claims are supposedly about health” (p. 45). For example, black and Latinx cultures are often admonished for promoting “obesity” because of their historic tendency to accept and value greater body size diversity as compared with white and Asian American communities, even though higher BMI is found among black and Latinx people (Greenhalgh 2015; Kelly, Bulik, and Mazzeo 2011; Nichter 2000; Wilson 2009). This does not mean, however, that fatphobia and eating disorders are nonexistent in black and Latinx communities (Allen, Mayo, and Michel 1993; Taylor 2015). In fact, as LeBesco (2004) points out, “When research on views of fatness in black communities actually includes the voices of black individuals, fatness tends to be described as a contradictory and discrimination-prompting state, rather than as some utopic mode of being” (p. 61).

In addition to gender and race, fat is connected with poverty, but perhaps not in the direction we might assume. Because of size discrimination and weight stigma, fatness tends to precede poverty, not the other way around (Sørensen 1995). As Ernsberger (2009) points out,

The typical assumption made by experts is that poverty is fattening. Living in poor neighborhoods with high levels of crime and pollution can limit the opportunities for leisure-time physical activity. Also, foods that are high in nutrients and relatively low in calories, such as fresh fruits and vegetables and lean meats, are difficult to come by in poor neighborhoods. Processed or fast foods may be the only alternative, especially because many of the working poor hold more than one job and have child-care duties. (P. 26)

Yet, in Ernsberger’s review, he found that a stronger case could be made that fatness is impoverishing because social stigma against fat people leads to discrimination in education, employment, health care, and downward social mobility in marriage (p. 31). In other words, this research suggests it is the discrimination fat people face for being fat that might better explain the association between fatness and lower socioeconomic status.

Finally, while it is important to understand the unique relationships between fatphobia, sexism, racism, and income inequality, as Collins (2000) reminds us, systems of oppression work together to produce injustice. The targeting of women and children in the war on “obesity” offers a salient example. As Herndon (2014) notes in Fat Blame, women and children are perhaps the two biggest casualties in the war on “obesity”, despite the fact that according to the National Health and Nutrition Examination Survey, in general, “obesity” levels in children have stayed about the same since 19994 (Bacon and Aphramor 2014). Nevertheless, when a child is fat, overwhelming, it is the mother who is blamed, especially if that mother is poor, working class, black, or Hispanic (Boero 2009; Greenhalgh 2015). According to Greenhalgh, “mothers, especially working mothers, and even more so those marginalized by race and class, are seen as the primary cause of childhood obesity, posing threats to the child, the community, and the nation” (p. 212).

Some pregnant women are now even counseled about the potential “dangers” of fetal overnutrition in the womb (e.g., Lawlor et al. 2007; Veena et al. 2013). As Herndon points out, “In the midst of the hysteria about obesity, the idea that women pass obesity on to children through their bodies nearly guarantees both surveillance of and interventions upon women’s bodies that may go far beyond recommendations about weight gain during pregnancy” (p. 42). But perhaps the most salient danger a mother faces is the threat of having her child taken from her because of the child’s weight. In fact, there are a number of cases in the United States where a child has been removed from the custody of their parents because the child was deemed too fat (Herndon 2014; LeBesco 2004; Saguy 2013). I know of no cases where the families in question were not poor or working class and/or families of color, highlighting once again the intersections of fatphobia and other systems of oppression. As Boero (2009) argues, “evaluating the fitness of mothers based on the size of their children obscures larger structural issues of racism, economic inequality, fat phobia, and sexism among others” (p. 113).

Indeed, it is impossible to evaluate the historical and contemporary significance of fat in our culture without taking into account the intersections of fatphobia and other systems of oppression like sexism, racism, and classism. Yet, while we view these other systems of oppression as worthy of great theoretical and empirical consideration in our discipline—and we should—when it comes to fatphobia, critical sociologists have been relatively silent by comparison. This is unacceptable given the theoretical and empirical tools we have at our disposal as critical sociologists to study and address systems of inequality and privilege—and our long history of doing so when it comes to other systems of oppression.

Discussion and Conclusion

Fatphobia not only remains pervasive in the United States (Fahs and Swank 2017; Hayran et al. 2013; Himmelstein and Tomiyama 2015; Puhl et al. 2015; Sutin, Terracciano, and Corrigan 2017), research indicates it is on the rise (Andreyeva, Puhl, and Brownell 2008; McHugh and Kasardo 2012). Some findings even suggest it is more prevalent now than other forms of oppression like racism (Latner et al. 2008; Puhl, Andreyeva, and Brownell 2008). I urge great caution in these kinds of interpretations of the data because, as has already been established, fatphobia is deeply rooted in these other systems of oppression. It does, however, differ in some important ways as well. For example, it remains socially acceptable in our culture to body-shame people for their weight. Indeed, in this age of healthism (Crawford 1980), many feel entitled to counsel people they know and strangers alike to lose weight for their own “good” (Brown 2015; Greenhalgh 2015).

Yet, while there have been some important and notable exceptions (e.g., Boero 2012; Davis in press; Kwan and Graves 2013; Lupton 2013; Saguy 2013; Strings 2019), there remains a dearth of critical weight studies or fat studies in sociology when compared with other disciplines like psychology or certain health-related fields, but also when compared with the rich bodies of scholarship that exist in our own discipline when it comes to other systems of oppression. This lack of theoretical and empirical attention is further witnessed by the fact that while there are dedicated sections of the American Sociological Association for inequality, poverty, and mobility; Latina/o sociology; race, gender, and class; racial and ethnic minorities; sociology of sex and gender; and sociology of sexualities, for example, there are no sections dedicated exclusively to fat studies or critical weight studies in sociology, including the section on sociology of body and embodiment (which was not even created until 2010). It also remains relatively rare to find fat studies courses in sociology and designated fat studies sessions at sociological conferences, especially compared with the number of classes and conference sessions offered related to race, class, gender, and sexuality, for example.

The bottom line is we need far more critical sociological theorizing and empirical research on fat and fatphobia in humanist sociology, especially work that utilizes an intersectional framework. In the same vein, we need critical sociologists who are otherwise engaged in intersectional work to take account of the important intersection of body size. As critical scholars, we need to interrogate our assumptions about fat and “obesity”, especially given the tendency in our culture to default to our prejudices rather than sound empirical evidence and sociological reasoning when it comes to these topics. Further, we need to be more self-reflexive about how we discuss fat and/or “obesity” in our work; even just utilizing quotes around medicalized terms like “obesity” is a powerful reminder of the socially constructed nature of weight-related categories in our culture. But in general, opting to use the word fat in our work as opposed to “overweight” and “obesity” helps undermine the continued pathologization and medicalization of fat.

In sum, we need to acknowledge that fat is a social justice issue, too. As such, we also need more critical sociologists to engage in fat activism. In Fat Activism (2016), Charlotte Cooper outlines five types of activism. I will briefly discuss two: political process activism and micro fat activism. According to Cooper, political process activism is associated with attempts to win rights for people and change policies and laws. The key to political process activism is mobilizing people in order to create structural-level change. One way we can engage in political process activism is by working to enact laws that protect fat people from discrimination. Currently, in the United States, it is legal for employers to discriminate against employees based on their weight in 49 states. Michigan is the only state in the United States where it is illegal to discriminate based on weight. There are a few cities that have passed legislation to prevent weight discrimination including San Francisco, California, Santa Cruz, California, Washington, District of Columbia, and Madison, Wisconsin, but there is no national law. Clearly, there is still much work to be done in terms of legally protecting fat people from discrimination.

While working to create institutional change at the national level is imperative, political process activism also requires taking a closer look at the institutions we interact with every day. For example, does the built environment we navigate accommodate fat people? I often teach in classrooms with individual desks I can barely fit in myself, so I am acutely aware these desks are not accommodating for all students, especially fat students. This is not just a matter of “comfort” as Hetrick and Attig (2009) point out:

The relationship between classroom desks and disciplinary practices that seek to form and control body “size and general configuration” is evident: the hard materials and unforgiving shapes of these desks punish student bodies that exceed their boundaries with pain and social shame. Some fat students are unable or unwilling to subject their bodies to the disciplinary powers of desks and must sit elsewhere. In these cases, desks can threaten fat students’ very identities as students; if their bodies cannot fit into structures that signify their intellectually receptive status, then they are, symbolically, at least, unable to learn. Homogenous thinness is rewarded with comfort and various privileges accorded to those granted identification as both students and normal. In these ways, classroom desks control body size and thereby produce the ideal thin student. (P. 199)

Similarly, on my campus faculty with fat bodies have pointed out that almost every chair in our offices and classrooms meant for instructor use have arms, which, again, is not accommodating for people with bodies that do not easily fit into these chairs.

We should also interrogate workplace policies that may have deleterious effects on fat people, such as employer wellness programs which typically focus on weight loss and weight management. According to Karen Powroznik (2017),

When a company chooses to implement one of these programs, it signals that the organization supports the values of healthism. This institutional endorsement makes health-based evaluations a more legitimate basis for discrimination in the workplace and allows individuals to more freely express anti-fat prejudice. Second, these programs make health-based judgments relevant criteria for evaluating others in the workplace. Finally, health promotion magnifies negative fat stereotypes that are linked to beliefs about poor health outcomes. This means that negative stereotypes about why an employee is fat, such as assumptions about their self-discipline, motivation, and competence, become more salient. This leads to more negative evaluations of that employee’s work ethic and competence, which in turn, increases the likelihood that they will experience workplace discrimination. (P. 147)

Powroznik’s research findings corroborate this; in fact, she found that just the mention of an employer wellness program, with no explicit discussion of weight, was enough to evoke negative fat stereotypes.

While political process activism focuses on macro-level structural changes, micro fat activism, according to Cooper (2016), takes place in everyday spaces, is generally performed by one person, sometimes two, but rarely more and happens in small understated moments (pp. 78, 79). Examples of micro fat activism might include refusing to weigh yourself or refusing to be weighed. It might also include refusing to engage in negative fat talk, diet talk, or body shaming. If you are unsure what these discursive practices look like in everyday life, let me take you through a typical scenario: Its one of your colleague’s birthdays, someone has brought a cake, and everyone is invited to have a slice. One coworker pipes up, “Oh, I really don’t think I should. I’m trying to be good.” Another says, “Well, maybe just a little slice. But I’m going to have to work that off later at the gym.” Another example might include having your partner or a friend ask, “How do I look in this? Does this make me look fat?” Another might include having your fitness instructor or personal trainer yell, “Tighten it up! We don’t want anything jiggling!” While refusing to entertain these kinds of conversations may seem like a small act, given that research has shown 75 percent of women in the United States engage in some form of disordering eating (University of North Carolina at Chapel Hill 2008), refusing to contribute to a climate that promotes these behaviors is an act of resistance. I invite all sociologists, especially my critical sociology colleagues, to join me in resisting.

Notes

Whenever possible, I use the term fat in this article as opposed to terms like “obese” or “overweight.” Among fat studies scholars, fat-acceptance activists, and Health at Every Size advocates, the word fat is preferable to terms like “obese” and “overweight” because these latter terms serve to pathologize and medicalize fatness (Bacon and Aphramor 2014; Baker 2015; Farrell 2011; Saguy 2013; Wann 2009). Taking my lead from these previous scholars, practitioners, and activists, I also include any terms commonly associated with the meidcalization and pathologization of weight in U.S. culture in quotation marks when possible.

This report was formally published in 2000.

In the original 2004 study, the authors actually estimated that “obesity” caused 385,000 deaths per year in the United States; however, in a 2005 correction in Journal of the American Medical Association, they acknowledged some computational errors in the data analyses (see Mokdad et al. 2005). Subsequently, they lowered the estimated annual rate of mortality in the United States due to obesity to approximately 365,000 deaths.

The exception is a small subset of the heaviest boys aged 6–19.

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