First do no harm? Weight stigma by the numbers

Decolonizing the food justice movement also requires us to examine the deeply held anti-fat biases that permeate many of these spaces. The Monitor Index details how deep this bias goes and how damaging it is.

September 2, 2021

5-minute read

Decolonizing the food justice movement also requires us to examine the deeply held anti-fat biases that permeate many of these spaces. At its core, anti-fat bias—often called fatphobia—is rooted in white supremacy and the idea that there is one ideal body type to which all people should aspire. 

For the September/October issue of the Monitor, the Index dove deep into the details of how pervasive anti-fat bias is and how damaging it is on the health and wellbeing of fat0 people who experience it.

1832: the year that Quetelet’s Index was created.1 This index was developed by Adolphe Quetelet to measure the averages (height, weight, birth and death rates) of an entire population. It was never intended to provide health information at an individual level. Quetelet was a mathematician, astronomer and sociologist who had no training in health sciences. 

Despite this limitation, Quetelet’s Index would be reinterpreted in 1972 by Ancel Keys as a mechanism for determining obesity.* Both Quetelet’s Index and Key’s subsequent Body Mass Index (BMI) were based predominantly on measurements of Western European white male bodies.2

25: The new cutoff for an “overweight” BMI, recommended by a 1995 report written by the World Health Organization (WHO) in collaboration with The International Obesity Taskforce (IOTF). This recommendation was made against the advice and findings of many WHO researchers. The IOTF received the majority of its funding from the pharmaceutical companies Hoffman-La Roche and Abbott Laboratories, both of which were set to release new diet drugs when the cutoffs were introduced. 

In their research, Paul Campos et al. observed, “although expert panels on obesity* are largely devoted to evaluating epidemiological evidence and claims, qualified epidemiologists are almost never included as members.”3 25 was chosen as the new cutoff, not for scientific reasons but because it was believed that it would be easy to remember.4

214: The number of articles published in the Journal of the American Medical Association (JAMA) between 1921 and 1940 that mentioned obesity.*5

2,998: The number of articles published between 2001 and 2020 in the JAMA that mention obesity.*

5,496: The number of additional articles mentioning obesity* published in that same timeframe by JAMA Network publications including JAMA Pediatrics, JAMA Dermatology, and JAMA Psychiatry.


Illustrations by Katie Sheedy
Illustrations by Katie Sheedy

>100: the number of factors that inform a person’s weight identified by a 2007 British study. The report further illustrates over 300 connections between these factors. Contrary to the popular adage that weight is determined by a simple formula of “calories in, calories out,” this report maps a complex web of factors including those related to food production, physical environment and social psychology.6

>50%: of 620 physicians, when surveyed, reported viewing obese* patients as awkward, unattractive, ugly, and noncompliant.7

49.5%: percentage of Canadian physicians surveyed in 2019 who said they believed that obese* people increase demand on the public health care system.8

18.5%: percentage of physicians in the same survey who agreed with the statement “I feel disgust when treating [an obese* patient].”9

1.65: times more likely deceased obese* patients in an autopsy study were to have a missed major diagnosis than their normal and underweight counterparts combined. Pulmonary thromboembolism was the most frequent significant missed clinical diagnosis. The study authors concluded “greater clinical vigilance” when treating obese* patients was warranted.10

0.94 kg: the average amount of weight loss maintained among participants in diet conditions from baseline to follow-up, across the 21 trials in a meta-analysis. 

The article authors noted that weight loss in all 21 trials did not correlate with improvements in participants’ diastolic and systolic blood pressure, fasting blood glucose, cholesterol, or triglyceride levels analysis. 

In addition to their finding that weight loss treatments did not improve health outcomes, the researchers also concluded that their findings “are in line with a recent meta-analysis that found that overweight and class I obesity* were not associated with higher all-cause mortality.”11

46.5%: percentage of obese* respondents to the 2002-2003 National Latino and Asian American Study who reported experiencing racial discrimination. Researchers found that experiences of racism among respondents “were associated with increased BMI and obesity* among Asian Americans, even after control for reports of weight discrimination and other factors.”12

21,357: number of American adults surveyed in the 2001-2002 and 2004-2005 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) who were classified by the BMI as either overweight* or obese*. Researchers found that participants’ experiences of weight discrimination significantly correlated with their likelihood of developing arteriosclerosis, diabetes, high cholesterol, heart conditions, and stomach ulcers.13

Illustrations by Katie Sheedy
Illustrations by Katie Sheedy

$192.2 billion: estimated global value of the weight loss industry in 2019. It is projected to be worth $295.3 billion by 2027.14

$189.4 billion: estimated gross domestic product (GDP) of Greece in 2020. Put another way, the weight loss industry in 2019 was worth the equivalent of the combined 2020 GDPs of Ecuador, Lithuania, Honduras and Madagascar.15


Notes

0 I use the term fat as a neutral descriptor for large-bodied people. This is a common practice among fat activists and scholars as the term fat should not be seen as inherently negative.

*This Index uses the terms obese and obesity to reflect the language of the scientific studies and articles that it cites and the classification system of the BMI upon which these studies rely. The Monitor recognizes that obesity is a socially constructed classification that, as this Index details, has caused a significant amount of damage to those who live with that label.

After completing my research for this Index, Aubrey Gordon and Michael Hobbes published their episode of Maintenance Phase on the Body Mass Index and I would be remiss to not mention this fantastic piece of journalism. If you haven't heard it yet, I highly recommend it.

References

1, 2 Strings, Sabrina (2019). Fearing the Black Body The Racial Origins of Fat Phobia. New York University Press.

3 Campos, P., Saguy, A., Ernsberger, P., Oliver, E., & Gaesser, G. (2005). The epidemiology of overweight and obesity: Public health crisis or moral panic? International Journal of Epidemiology, 35(1), 55–60. https://doi.org/10.1093/ije/dy...

4, 5 Strings, Sabrina (2019). Fearing the Black Body The Racial Origins of Fat Phobia. New York University Press.

6 Butland, B., Jebb, S. Kopelman, P. McPherson, K. Thomas, S. Mardell, J. & Parry, V. (2007). Foresight tackling obesities: Future choices – project report. https://assets.publishing.serv...

7 Foster, G.D., Wadden, T.A., Makris, A.P., Davidson, D., Sanderson, R.S., Allison, D.B. & Kessler, A. (2003), Primary care physicians’ attitudes about obesity and its treatment. Obesity Research, 11, 1168-1177. https://doi.org/10.1038/oby.2003.161.

8, 9 Alberga, A. S., Nutter, S., MacInnis, C., Ellard, J. H., & Russell-Mayhew, S. (2019). Examining weight bias among practicing Canadian family physicians. Obesity Facts, 12(6), 632–638. https://doi.org/10.1159/000503751.

10 Gabriel, S., Gracely, E.J., Fyfe, B.S. (2006). Impact of BMI on clinically significant unsuspected findings as determined at postmortem examination. American Journal of Clinical Pathology, 125(1), 127–131, https://doi.org/10.1309/NVVMPB3DTFRGW3VV.

11 Tomiyama, A.J., Ahlstrom, B. and Mann, T. (2013), Long-term effects of dieting: Is weight loss related to health? Social and Personality Psychology Compass, 7, 861-877. https://doi.org/10.1111/spc3.12076.

12 Gee, G. C., Ro, A., Gavin, A., & Takeuchi, D. T. (2008). Disentangling the effects of racial and weight discrimination on body mass index and obesity among Asian Americans. American journal of public health, 98(3), 493–500. https://doi.org/10.2105/AJPH.2...

13 Udo, T., Purcell, K., & Grilo, C. M. (2016). Perceived weight discrimination and chronic medical conditions in adults with overweight and obesity. International journal of clinical practice, 70(12), 1003–1011. https://doi.org/10.1111/ijcp.1...

14 Allied Market Research (2021 May). Weight loss and weight management diet market by product type (better-for-you, meal replacement, weight loss supplement, green tea, and low-calorie sweeteners) and sales channel (hypermarket/supermarket, specialty stores, pharmacies, online channels, and others): global opportunity analysis and industry forecast, 2021–2027  https://www.alliedmarketresear...

15 The World Bank (2021). GDP (current US$) All countries and economies. https://data.worldbank.org/ind...


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