It's not news that  overweight folks know what it's like to be on the receiving end of shaming or taunting messages.

These messages often hit hardest during childhood and adolescence. Most young people are dreadfully insecure themselves and always on the lookout for someone to dump their anxiety on, usually in the form of shaming.

But adults, too, are anxious and insecure, and shaming comments don’t stop just because you’re out of school and have your own apartment.

“Fat people today are still on the receiving end of vitriol once reserved for 17th-century witches,” author Natalie Kusz tells us from first-hand experience.

Once, while idling her car at a traffic light, a driver alongside her shouted, “Get out and walk, fat-ass!” She’s repeatedly had grocery cashiers hold up her purchases and loudly say, “I guess you didn’t notice the low-calorie version.”

Kusz writes with forceful candor about her decision to abandon the weight-loss life. She is no Pollyanna on the risks of obesity, but she’s clear about what the unsuccessful fight against fat has cost her, and where she now stands.

(Her motto: “They don’t put your weight on your tombstone.”)

For Kusz, like for many clients I see in therapy, the #1 most shaming of all admonitions is the well-intentioned disapproval of a friend—the one who leans a narrow hand on your arm and murmurs, “I hope this doesn’t hurt your feelings, but I love you and I’m concerned about your weight.”

One can flee the stranger who yells “fat-ass” and never see him again, Kusz observes. But with friends we feel safe and relaxed, and therefore more vulnerable to feeling betrayed.

“Why?” is the question that Kusz finds unfathomable. Not why people say what they do—but why they think their efforts might be effective. She writes:

Is it likely that in 38 years of living I have never once noticed my own corpulence? Or that I have somehow missed those alarmist hourly news reports on obesity (“Americans are fatter than ever!”), weight-loss studies, and the mortal (and, some believe, moral) risks of overweight? Perhaps they think I am having so much fun living the fat life (what with all those swanky clothes, adoring fans and male model escorts) that I’ve neglected subtle details such as creaky knees and a pendulous, unfashionable belly. Last possibility: that to weigh in (so to speak) on a fat person’s self-style is compulsory, a form of intervention similar to that imposed on alcoholics, drug addicts, gamblers—on anyone, in short, without the strength of will to make good choices on her own.

Kusz notes that doctors have an especially difficult time restraining themselves from repeated lectures on the health risks of obesity. “Doctors admonish me at every visit,” she writes, “until I mention the fat ladies I know who, afraid of being shamed, never brave a medical office until they are too sick to be helped much at all.”

Shame, even more than fear, keeps people from showing up. Of course, a doctor is responsible for putting forth the facts about risky and unhealthy behavior. But that is different from admonishing, lecturing, or hammering in the point after it has already clearly been made.

Stories I tell in The Dance of Fear, illustrate how frequently we make shaming comments in our misguided attempts to be helpful. My work with women confirms Kusz’s observations. The fear of being shamed by a doctor is greater than the fear of avoiding the doctor—and thereby risking disability or death.

Sometimes the most helpful thing you can do is to stop trying to be helpful. Unless, of course, the other person is asking for your help.

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