The unbearable weight of fatphobia
By Katie Paulot
Master's student, Online MPH in Population and Health Sciences
This article was originally developed for PH510: Communication Fundamentals, in the Population Health Studies online MPH program. Learn more about the storytelling series from class instructor, William D. Lopez.
Trigger warning: eating disorder, weight stigma, mental health
Sometimes, I think breaking my leg saved my life. That may sound dramatic, but breaking my leg completely changed how I viewed myself and health.
I‘ve always been fat, or what doctors and public health professionals would refer to as “overweight” or “obese.” Growing up in the 2000s, the childhood “obesity epidemic” was a focal point of public health programs. Health messaging often targeted kids like me through commercials where movement was marketed as "fun" along with a reminder to "make healthy choices." I internalized messages about my body and therefore myself. I thought if I worked hard enough, I would be thinner and, therefore, happy. I tried to be healthy. I ate my vegetables and drank my milk. I went on numerous diets off and on. I played sports, albeit not really for fun, more so as a symbol of discipline and a way to actively pursue weight loss.
As I got older, I was more influenced by peer pressure and social media, promoting diet culture at every turn. But I was a young girl in a sea of eating disorder blogs filled with “thinspiration.” I secretly took up tactics I learned through those around me and the media on how to not eat. These new tactics were exacerbated by, at the time, undiagnosed mental health conditions. I started spending days counting calories neurotically, which only escalated as time went on.
It was a Wednesday in early May, toward the end of my sophomore year of high school. The ground was still soft from April showers that had flooded the campus. Despite playing softball my whole life, high school was different. I had to compete with peers who were thinner, faster, and had devoted their entire lives to the sport. For the last two years, I had been the designated benchwarmer. But that night, we had a doubleheader at home against the worst team in the division—it was my time to shine.
Bottom of the fourth inning, game one and I was at bat. I got on first base and eventually made it to third. Next thing I knew, the ball was in play and I was running down the line, my eyes fixed on home plate. As I sprinted, I saw the fluorescent ball fly past, and in that split second, I knew I had to slide.
Snap. Instant, overwhelming pain. Pain I had never felt before. Later, I would find out that somehow my metal cleat got stuck in the waterlogged gravel infield. All I remember is laying there in the dirt with the high school sports trainer and my parents hovering over me.
“It’s probably just a sprain,” the trainer said to my parents, before skeptically looking down at my ankle. Next I knew, I was being rushed off to the hospital.
It was a nasty break that has left me with a permanent scar, a plate, and several screws in my left ankle. Suddenly, my weight or running a mile before practice was not my focus. Counting calories was no longer my priority. After years of misery focusing on my weight, here I was in a cast, too dizzy from pain killers to navigate crutches and forced to hobble around with a walker.
For months, I relied heavily on others, focused only on learning to walk again. That’s when I started eating more regularly and getting help for my mental health. But the truth is, it took breaking my leg to break the cycle I’d been stuck in for years. I don’t know if I would still be chasing an unattainable ideal otherwise. While recovering, I was forced to prioritize some of the most basic aspects I took for granted and I realized despite what I had been told my entire life: my well-being could not be defined by the number on a scale. I was reminded that health meant more than weight loss, even for fat people like me.
No one ever suspected my behavior as disordered eating, nor was I ever diagnosed with an eating disorder. It would be years of learning structural, interpersonal, and internalized fatphobia until I would recognize the behavior that characterized my early teenage years as disordered eating. Instead, fatphobia had influenced my judgment and shaped what I, and those around me, considered appropriate behavior.
It was not only acceptable for me to be obsessed with losing weight any way possible, I was praised. And I’m not alone. Fatphobia directly informs ideas about health, and more specifically what someone with an eating disorder looks like despite numerous studies finding that those categorized as “overweight” or “obese” are often more likely to engage disordered eating behaviors such as those associated with anorexia, bulimia, and binge eating disorder. This bias also enables anorexia to go unnoticed in many normal or higher weight individuals.
I was among the millions of “obese” Americans more likely to hate our bodies. “Obesity” is often framed as something to be cured, brandishing one unhealthy otherwise. Yet according to medical research, “there is no strong evidence that diagnosis and following treatment result in clinical meaningful long-term weight loss nor improves health.” The promises that come with weight loss are not only misleading, but unrealistic, influencing unhealthy behaviors while also leaving patients feeling alienated, with some avoiding healthcare altogether.
Weight is normalized as an indicator of health, with higher weights seen as an individual flaw, signs of laziness, or lack of willpower. This influences all aspects of healthcare, and is perpetuated through discrimination and direct violence, most often directed at those over a certain weight. For example, refusing to provide care, discrediting patient experiences, and spending less time with certain patients. Overemphasis on weight also bolsters bias and arbitrary ideas in diagnosing diseases, particularly those associated with weight. As noted, eating disorders are less likely to be diagnosed in higher weight patients, but this impacts other areas of health, too. For example, fat people are less likely to be screened for cancer. At the same time, fatphobia perpetuates myths that impact those at the other end of the spectrum. For example: the assumption that lower weight individuals are not at risk for diseases such as diabetes.
I realize that breaking my leg wasn’t just a physical injury—it was a pivotal moment in understanding health beyond weight. I am, and will likely always be, fat. It has taken years of unlearning along with mental health treatment to see my health holistically and while the traditional biomedical approach would still signal alarms based on arbitrary, out-dated, and racist metrics such as the Body Mass Index, I know that my well-being is more than a number on a scale. Unfortunately, many remain in an ongoing battle in their own body in the pursuit of “health,” often resorting to dangerous, potentially life threatening avenues to shed pounds while being cheered on every step of the way.
Public health professionals must work through biases and acknowledge the harm that is caused assuming health based on weight. We must reframe health to embrace human diversity to provide equitable care. As we continue to navigate the complexities of fatphobia, especially with the increased marketing of GLP-1s as a "weight loss solution," it is important to recognize individuals' autonomy in accessing health care that respects their personal decisions.
It is also important to understand that the impacts of fatphobia are not felt evenly, as weight intersects with other identities related to race, class, ability, and so on. Our understanding of health should be shaped by the experiences of those historically excluded and most impacted. We can look to organizations such as the Association for Size Diversity and Health (ASDAH) that provides an alternative approach through the Health at Every Size (HAES) Framework and Principles, offering a more inclusive perspective on well-being. Key to the HAES framework is the belief that equitable healthcare is a human right and that health status should not dictate access to care, challenging anti-fat bias and scrutinizing power dynamics in health beliefs. Without this, public health professionals promote ideals of health that alienate patients above a certain weight and leave all individuals in an ongoing battle against their bodies.
About the author
Katie Paulot (she/they) is a master's student in the online MPH program in Population and Health Sciences at the University of Michigan School of Public Health. She holds a BA in Comparative
Cultures and Politics from Michigan State University and has experience working in
a number of nonprofits and community organizations. Katie is interested in to healthcare
access, barriers to care, and patient experiences.
