"No culture can live, if it attempts to be exclusive." -- Gandhi
Most people assume that the reason I write and research about fat stigma is because of a personal stake I have. I am, after all, fat. It certainly is a personal issue for me. That is understandable. Some decide that what I have to say is necessarily suspect because of my personal stake. Others recognize a kind of authority that comes with daily experience of such situations. All of this is true, of course. I am biased. I do have a personal stake. My bias should inform any assessment of my words. My personal experiences have authority from the subjective and offer valid information on the topic.
I know that most people think that being fat is a singularly tragic fact about a fat person. That it somehow defines everything about them. But it does not. In fact, one of the ways in which reclaiming the word "fat" helps is that unlike any other descriptor of my body size, this one is simply pointing out the size. It is an adjective. It is true. I am fat. I also have hazel brown eyes, light skin and a short stature. These things describe me but they do not define me.
Surviving losses, involvement in a long-term relationship, achieving educational and professional goals, writing well, teaching well, creating art, and having a desire to make a mark on the world around me are things that define me. Fat, like any other physical feature, does not define a person. It is always wrong to assume that any group of people who share physical traits are "all alike." Making such an assumption is called stereotyping. Judging and stigmatizing on such a basis is called bigotry.
I have remained interested in fat stigma for over 10 years now because I see how it dissects and deconstructs the American healthcare system. Fat people have become the canary in the mine of American public health. No matter what size body you have, you should be paying attention to the economic, political and cultural realities of fatness in America. It will tell you a lot about what is wrong with our medical systems.
A lot has been written about the economics and politics, so I want to address culture, since that is most in line with my area of training and expertise. Max Weber, one of the forefathers of sociology, described 19th century capitalism in terms of what he called the "Protestant Work Ethic." He posited that European capitalists wanted to amass wealth and European factory workers wanted to be diligent in their work because of the cultural baggage of John Calvin and predestination. Calvinism boiled down to a belief that material wealth demonstrated God's blessings. So having wealth, or at the very least, not being poor was equated with righteousness. This "spirit," as Weber called it, set up the mechanisms of capitalism. Wealth and hard work are not only the building blocks of strong economies, they were the basis for higher status, put on the level of entry into a heavenly afterlife.
In many ways, health is the new wealth. In the same way that the poor were suspected of sinfulness and a falling out of God's favor, ill-health has taken on the social meaning of marking someone as having failed in some manner. Health, like wealth, is now perceived almost exclusively as being under the control of the individual. Bad habits are perceived as the major reason for both poverty and illness. In the same way only the deserving poor were granted aid (widows, children, veterans, etc.), only the deserving sick are to be given assistance. Like all good lies, a grain of truth to this assertion - the fact that bad habits might indeed contribute to both poverty and illness - is seen as proof that no other factors could be involved. This new attitude about health and illness has come to be known as healthism, and fatness is at the center of many healthist practices.
I could write (and have written) all about the other factors that affect individual health and discuss how this stigma of the poor and sick contributes to their plight. I could point out, as many people in the recent economic collapse have discovered, that most human beings are vulnerable to both economic forces and physical forces that make almost everyone of us potential victims of poverty and illness. One of the lessons that should have been learned in the past few years is that we, meaning the entire planet, are in this together. We are interconnected. Given that much illness comes from germs and environmental factors, this connectivity and collectivity is equally true of health, if not more so.
But I want to point out a more fundamental aspect of this view of humanity, this Protestant Health Ethic (Clinical Calvinism?). We have become a culture that turns its back on the poor and the sick. We honor and esteem the wealthy, celebrities and "beautiful" people while we ridicule and oppress the poor, the down-trodden and the ill. As a human being, I point out that this is indecent. As a sociologist I point out that this is a defective way to build a robust society.
The basis for a strong social group lies, in part, in the ability of individuals to be able to empathize with others. By empathy, I mean, the ability to see the world through the eyes of another person and understand, at least in part, the way the world works from their point of view. It does not require agreement, but it does require comprehension. As humans we do this all the time. We would not be able to care for children or animals if we didn't realize that they are not mini-versions of ourselves, but rather see the world differently than we do. Few human beings are incapable of doing empathy, but it is harder without practice.
In our current medical culture, fat people are regarded as a single, monolithic group of people whose lives are defined by their body size. They are regarded as undeserving of care until they repent. Their health is defined by an aesthetic and a social status. When they, like all human beings, suffer an illness, that illness is seen as solely their own fault, no matter what the cause.
If you think that fat people deserve this withholding of services and demand for repentance, then consider what is happening throughout the medical system. More and more companies are demanding intrusive surveillance of the health of employees as a condition of insurance. Governments and schools are using weight as an excuse to invade the privacy of citizens. Lower diagnostic thresholds are marking more and more of us as sick or "pre-sick," often with little medical or scientific basis. Iatrogenic causes of injury and death are rising as more invasive and dangerous interventions are gaining approval on the basis of panic rather than evidence. Emergency rooms are filled with non-emergency patients who have no where else to turn, which is creating a national crisis. Oligopolistic pharmaceutical companies are creating artificial shortages in medications and slowly raising the prices of what were previously inexpensive treatments. Bullying and shaming are becoming acceptable methods to motivate children. Little is being done to fight epidemics while millions, if not billions, of our public health funds are being used on programs that do not work, but are politically popular.
Instead of good preventative practices (vaccinations, screenings, early disease interventions, regular check-ups, environmental, housing and food quality standards, addressing starvation and food insecurity), we are being told that we hold our own fate in our hands. It is much cheaper, more politically expedient and more profitable to the healthcare industry, if public health officials spend their time promoting diet and exercise. While diet and exercise affect health, lifestyle is only a small portion of the picture and many people still get sick with good habits. We have been lowering the threshold of what is considered "unhealthy" body size for some time now and as such, have defined the majority of us as the "undeserving" sick. This makes for a ready excuse for poor public health priorities.
Instead of resolutions, in some cultures, the new year is met with wishes. Here's my wish for the new year: a change in the culture of public health. I want a healthcare culture that puts people over profits. I want a healthcare culture that understands what bacteria and viruses understand: a human host can be from any socioeconomic level, ethnic background, gender or body-size. I want a healthcare culture that does not judge people on the basis of aesthetics but treats illness and provides prevention on the basis of solid evidence mixed with social empathy. In short, I want healthism replaced with compassion.
I wish good health for us all and a decent, caring provider when we face illness. I don't think that's too much to wish for.