When Bill Maher blames the high numbers of Covid deaths on the overweight, he errs on at least two counts. First, pandemics kill plenty of non-obese people and have clearly done so in the past when obesity levels were much lower. Second, discrimination against the overweight is real and has been shown to contribute directly to their health woes. Fat shaming does not need to be increased.
Fat shaming aids no one. If it did, obesity wouldn't exist at all, as shame is something society reliably overdelivers to the overweight. Shaming makes things worse and leads - not to weight loss as Maher suggests - but to additional weight gain. In fact, more shame, more gain.
While weight bias is common, concerted efforts to stem it are scarce. Incredibly, healthcare professionals hold weight bias at depressingly high levels. Following negative experiences within healthcare settings, many of the overweight develop reluctance to interact with their providers. They are less likely to seek care for any condition. And when care is sought, it trends toward the substandard: The obese receive fewer preventive health screenings, less health education, and decreased time in appointments.
Assess your own implicit weight bias by taking Harvard's Implicit Association Test for Weight Bias.
Fat shaming produces harmful health effects on its own and certainly worsens other risks associated with obesity. Weight stigma increases depression, anxiety, low self-esteem, poor body image, substance abuse, suicidality, unhealthy eating behaviors, exercise avoidance, and decreased motivation to exercise. Because racial discrimination, sexism, and homophobia also increase many of the same negative health outcomes, weight stigma may be viewed as another eisk factor that intersects with the other hate-based health threats.
Treatments with lasting effects for reducing obesity have been elusive.
Those most prone to fat shaming usually fail to consider that obesity, like every other chronic disease, does not result by conscious choice. While lifestyle certainly affects our weight, it affects all chronic diseases. But we moralize about obesity. It's important to understand that other disease lifestyle levers are not governed by the thousands of genes and dozens of hormones that impact obesity. The overweight must swim against strong physiological rip currents that influence our most important survival drive: eating. You likely won’t "lifestyle" your way out of obesity. Medical interventions, including diets, offer very limited success in reducing obesity in the long term. Even surgical procedures like lap banding result in weight rebound for many.
On a grander scale and more positive note, some countries have made headway in repairing problems wrought by weight bias. In Brazil, for example, a committed fight against gordofobia - the Portuguese term for weight-based discrimination - has begun in earnest. Laws now ensure that appropriate seating is available in schools for obese youth. An annual day promoting the rights of people with obesity has been established. Preferential seating for the overweight is provided on mass transit, and fines have even been levied against at least one comedian for making fat jokes. These systemic interventions are based on the idea that government has a duty to protect minorities and the vulnerable.
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