In literature, fat hasn't always been thought of as shameful. In Ivanhoe, for example, Walter Scott sympathetically portrays Friar Tuck as a virtuous outlaw with a girth that "spoke rather of sirloins and haunches, than of pease and pulse".
More recently, however, the novel, Blubber, by Judy Blume, equates fatness with tragedy and has been described by overweight adolescents as a challenging read.
Fat-shaming, fat stigmatisation and fat bias have increased as overweight/obesity becomes more prevalent. Ireland has one of the highest obesity rates in Europe – one in four adults are obese and one in four children are overweight or obese. Alongside an appropriate interest in trying to reduce obesity for health reasons, an unfortunate stigmatisation of individuals with overweight and obesity occurs in healthcare.
During the summer, Cancer Research UK launched a campaign pointing out the link between obesity and cancer. A series of advertisements had obesity warnings on what looked like cigarette packets, highlighting the fact that both smoking and obesity are risk factors for cancer.
Accusations of fat shaming quickly followed, with academics decrying the campaign's proposition that obesity caused cancer. Correlation, not causation, was the true relationship, they pointed out. A spokeswoman for the British Dietetic Association said "accusing people of causing their own cancers through being obese could be perceived as judgemental and unhelpful to those people who are already tackling their own complex issues around food and diet".
Researchers at the University of Liverpool, meanwhile, have found that people with obesity are not only stigmatised, but are blatantly dehumanised. More than 1,500 participants from the UK, USA and India completed online surveys to indicate how evolved they consider different groups of people to be.
Dehumanisation of obesity
The researchers also recorded the BMI of those completing the survey to find out whether dehumanisation of obesity was more common among thinner people. Overall, respondents rated people with obesity as “less evolved” and less human than people without obesity. While blatant dehumanisation was most common among thinner participants, it was also observed among participants who were themselves overweight or obese. And worryingly, people who blatantly dehumanised those with obesity were more likely to support health policies that discriminate against people because of their weight.
Co- author Eric Robinson said: "Obesity is a complex problem driven by poverty and with significant genetic, psychological and environmental components. Blatant or subtle dehumanisation of any group is morally wrong."
There is no reason to believe that doctors and nurses do not share the same views as the general population. So a piece of research published last month in the journal BMJ Open, looking at how medical students can be made more aware of their personal anti-fat prejudices, is interesting.
In simulated patient encounters between medical students and actors in fat suits who played obese diabetes patients struggling to maintain healthy habits, the students got a taste of what real medical practice could be like, and what biases they might bring with them into the consultation.
The 207 students, 22 faculty members and 13 actors who participated in the simulation at the University of Tuebingen in Germany later took a 47-item Anti-Fat Attitudes Test, which focuses on weight control and blame.
In general, participants disagreed with anti-fat statements in the attitude test. However, students were mostly neutral toward the statement: “Fat people could lose weight if they really wanted to.” Lecturers were more likely to disagree strongly with the statement “Most fat people are lazy” than were the students or actors.
Overall, it seems that while explicit fat bias against people with obesity is reducing slightly, implicit fat stigmatisation is on the increase. It’s an issue that not just health professionals but society as a whole must respond to.