Sizeism

THE "F"

WORD

FAT: Critical Questions

• Using the word "fat" vs. "obese." Pros and Cons.
• Do we have an objective definition of fat? What is it determined by?
• Does "fat" even matter?
• Perceptions of "ideals" have changed; isn't it possible that perceptions of "fat" change as well?
• What is "fat?" What is "obesity?"
• Is physical fat the same as being perceived as fat? Identifying as fat?
• Do we discriminate against people who are fat? If so, how? Why?
• Does fatness only result when we eat too much and move too little?

Let's start thinking of weight only in terms of physical health for a little while.

Background on Obesity

• Obesity affects about a third of adult Americans, and nearly 17% of children (CDC, 2012).
• Obesity is associated with heart disease, stroke, type 2 diabetes, and cancer (CDC, 2012).
• Obesity is a multi-dimensional, transdisciplinary issue that needs to be addressed from all sides. (Harrison et al., 2011)

According to American Medical Association, Obesity is now a disease, but this was decided after the association’s Council on Science and Public Health advised against the classification.

Are obesity and fatness the same thing?

Two Possible Answers (and a third if you're creative):

1) Yes. Fat is both a societally determined construct and a physical aspect of one's body.

2) No. Fatness invariably leads to health problems, even if they aren't present initially.

"Metabolic Syndrome?"

Physical

Activity

Mixed bag?

• Small weight loss (10% or more) is associated with substantially reduced health risk and health care cost, and increased lifetime expectany.
• Small increase in MVPA is also associated with reduced health risk and cost, in addition to increased life expectancy, independent of weight loss/gain.
• Small weight gain (5% or more) is associated with increased risk for CHD (Li et al., 2006) and metabolic syndrome (Bankoski et al., 2011).

Exercise and healthful eating, independent of weight change (loss/gain), reduce risk for cardiometabolic disease in obese and overweight individuals (Gaesser et al., 2011).

We can't say that obesity is the only significant factor related to health when present.

In what ways is weight irrelevant in our day to day lives? In what ways is it relevant?

Keep in mind:

• Weight does not affect whether you can learn something from your teacher.
• Weight does not affect how smart or funny someone is.
• Weight does not affect one's ability to do his or her job.*
• Weight does not affect a person's ability to interact socially.

Sizeism does.

What is Sizeism?

Prejudice or discrimination against a person or persons on the basis of physical size, esp. against those viewed as overweight or short (Oxford English Dictionary, 2012).

Take a minute:

Get in a small group, and brainstorm how sizeism (not obesity) could affect people in day to day activities.

“…anyway, yes, I think I’d be grossed out if I had to watch two characters with rolls and rolls of fat kissing each other … because I’d be grossed out if I had to watch them doing anything. To be brutally honest, even in real life, I find it aesthetically displeasing to watch a very, very fat person simply walk across a room — just like I’d find it distressing if I saw a very drunk person stumbling across a bar or a heroin addict slumping in a chair.”

Is sizeism a new phenomenon? Why or Why not?

Some may argue "yes," and point to ads like this

Clearly, there are some serious issues here. What are they?

Unfortunately, society has been yo-yo "dieting" its image for generations.

Sizeism is nothing new, but it is one of the "final fronteirs."

Is sizeism only directed toward people who are overweight?

Where are some other places that you've seen "reverse" sizeism, or confusing body image expections?

What is the issue here?

Fallon & Rozin, 1985

Not really. Perceptions of attractiveness are subjective, and we don't know what the others find attractive.

248 male & 227 female undergraduates rated a set of figure drawings based on:

• their current figure
• their ideal figure
• the figure that they felt would be most attractive to the opposite sex,
• and the opposite sex figure to which they would be most attracted.

How can we measure and test weight biases?

How do implicit associations affect health care?

We found that MDs’ implicit and explicit attitudes about weight follow the same general pattern seen in the very large public samples that hold strong implicit and explicit anti-fat bias. We conclude that implicit and explicit anti-fat bias is as pervasive among MDs as it is among most people in society. In socially sensitive areas such as race, sexuality, disability, and age, implicit attitudes are often stronger than self-reported attitudes. However, for weight bias, both implicit and explicit anti-fat attitudes are very strong, with self-reported attitudes slightly stronger. Strong explicit attitudes suggest that individuals, including medical doctors, may feel that it is socially acceptable to express negative attitudes about overweight people.

In light of the challenges that mental and physical health care providers confront when treating obese patients, what kind of strategies can they use to ensure sensitive, compassionate care that is free of weight bias?

• Review assessing weight-related biases
• In written descriptions of imaginary managers, college students were more likely to rate overweight managers harshly for certain negative behaviors, than normal-weight managers. (Decker, 1987)
• Written descriptions of applicants come to a similar result: "obese" applicants had more negative judgements than non-obese applicants. (Klassen et al., 1993).
• "Obese employees are also believed to think slower, have poorer attendance records, and be poor role models (Paul & Townsend, 1995). These stereotypes could affect wages, promotion, and termination." (Puhl et al., 2012).

This really bothers me; how does sizeism in the workplace affect other aspects of life?

• Teasing is more common in overweight children (Hayden-Wade et al., 2005)
• Overweight youth are considered: unhealthy, lazy, and socially inept by their peers. (Greenleaf et al., 2006).
• A study that compared children's preferences for obese peers compared to diabled peers has shown a consistent pattern of bias against obese children over the past 40 years. (Latner & Stunkard, 2001).
• Teachers do recognize biological factors as causative in obesity, but 20% believed that people who are obese are untidy, 19% believed that they were more emotional, less likely to succeed at work (17.5%), and more likely to have family problems (27%).

So, now we know that obesity affects your physical health, and sizeism affects your mental health. What are we (in the service sector; social work, public health, medicine, etc.) doing to combat this?

the good

• Evidence-based interventions available that:
• increase availability of healthy foods and beverages to at-risk populations
• demonstrate proper portion sizing
• increase walkability of neighborhoods with limited sidewalks, parks and public recreation.
• (Khan et al., 2009)

Identify a common theme here.

the "lets see where this goes"

• New York City XL Soda Ban
• Question: What happens when the government tries to take away freedom of choice from Americans, even for a good cause?
• Great idea, good implications; BUT...
• Will it be implemented?
• If so, how?
• Can it be translated to other cities?
• Will it be effective? Remember: Do No Harm.

the ugly

Challenge:

Three "pros" and three "cons"

about these ads

How can you respond to this as a part of the service industry?

What is the context?

How can we measure it?

This seems like a "modern" way to conceptualize negative feelings toward size.

Have you seen this rhetoric before?

What is going on in this meme?

Not necessarily.

- Marie Claire Magazine Blog, Maura Kelly on the show Mike and Molly

bias comes in all sizes.

How about to this?

What was the media reaction to these pictures?

IAT

Weight Bias in Medicine

Implicit Associations Test:

Weight Bias.

https://implicit.harvard.edu/implicit/demo/

Does size affect attractiveness?

"

- Sabin et al, 2012

How does this relate to social work?

What is it?

How does sizeism affect day-to-day life?

School

Puhl et al., 2012

Work

Puhl et al., 2012

So...

The "Stop Sugarcoating" Campaign in Georgia

The Community Guide

Isn't it possible to be healthy, and be "fat?"

Diagnosis:

• waist circumference greater than 102 cm in men and 88 cm in women
• serum triglycerides level of at least 150 mg/dL (1.69 mmol/L)
• high-density lipoprotein cholesterol level of less than 40 mg/dL (1.04 mmol/L) in men and 50 mg/dL (1.29 mmol/L) in women
• blood pressure of at least 130/85 mm Hg; or serum glucose level of at least 110 mg/dL (6.1 mmol/L).

Consider :

• School
• Work
• Mental Health

From Gronniger (2006)

In a population study in JAMA by Yong Woo et al. (2003) , it was found that: older age, postmenopausal status in women, Mexian-American ethnicity, current smoking, low household income, high carbohydrate intake, no alcohol consumption, and physical inactivity were associated with increased odds of metabolic syndrome.

After adjusting for body mass index, age, and socioeconomic status, race was still a strong, significant predictor for metabolic syndrome.

LaMonte et al. (2005) found that cardiorespiratory fitness was a stronger independent predictor of metabolic syndrome than weight in a large, prospective population study.

So, is fatness the same as obesity?

• Men who engaged in >3 hours of moderate to vigorous physical activity (MVPA) were half as likely as sedentary men to develop metabolic syndrome, after adjusting for age, BMI, smoking, alcohol, and SES. (Laakonsonen et al., 2002)
• Sedentary activity is associated with metabolic syndrome, independent of MVPA. (Bankoski et al., 2011)
• Obesity and sedentary activity are independently associated with coronary heart disease in women. (Li et al., 2006)

UConn Rudd Center on Food Policy and Obesity, Rudd Report on Weight Bias

How does it apply to us?

Sizeism: Balancing Sensitivity with Real Health Concern

Jaclyn Saltzman