COMMENTARY

'Fat Shaming Is Just Bullying'

Arghavan Salles, MD, PhD

Disclosures

September 27, 2019

"Fat shaming doesn't need to end. It needs to make a comeback."

In a 7-minute tirade on his show, Bill Maher recently used his immense platform to lambast people with overweight and obesity. He made some reasonable assertions, highlighting that obesity is associated with a number of other medical problems. But he also explicitly incorporated fat shaming, suggesting it as a way to stem the tide of the obesity epidemic.

What he may not know is that healthcare workers have been shaming people for their weight for decades. There are no data to suggest that this is an effective public health intervention. Rather, it is likely harmful.

Even though approximately one third of Americans have overweight or obesity, many people still incorrectly link the condition to lack of willpower, poor hygiene, and low competence. What is perhaps most perverse about this narrative is that when people with obesity internalize this societal weight bias, they have a harder time losing weight.

Damaging Messages Abound

It turns out that Bill Maher's call to action is unnecessary because mainstream media already reinforces weight bias and fat shaming in routine programming.

One example is a recent episode of the CBS series Blue Bloods, a show about police officers. After initially acknowledging that fat shaming is inappropriate, the show later devolves into a reification of many myths about bariatric surgery, with Tom Selleck's character and his colleague (played by Gregory Jbara) suggesting that bariatric surgery is cosmetic, an easy way out for patients with obesity. In reference to the choice to have bariatric surgery, Selleck says, "It's not like you even sweated off the extra weight, disciplined yourself, set an example." And Jbara responds, "You took the shortcut." 

This brief dialogue signals to the audience that bariatric surgery is a cosmetic procedure for those who have no willpower or discipline. This false narrative is harmful because it prevents people from seeking surgical treatment. Bariatric surgery is the most effective treatment for type 2 diabetes, and weight loss with bariatric surgery is more likely to be sustained than with diet and exercise. "Eat less, move more," in contrast, has failed millions of Americans.

Bill Maher and Blue Bloods are not the only mainstream influences with damaging messages about obesity. In the first season of This Is Us, when one of the main characters seeks consultation with a bariatric surgeon, her brother's concern about the procedure being dangerous propagates another myth. In reality, bariatric surgery is as safe as having an outpatient procedure to remove one's gallbladder, and those with obesity who have surgery live longer, on average, than those who do not.

The idea that bariatric surgery is an easy way out can only be believed by those who have never known anyone who went through the life-altering procedure. The relatively few insurance companies that cover bariatric surgery often mandate visits to a psychologist, dietitian, and even monthly weigh-ins before paying for the procedure. These monthly weigh-ins don't improve outcomes and only delay surgery.

Jumping through these hoops to qualify for surgery is a major feat. The adjustments that come after surgery, however, are perhaps even more challenging. After surgery, many people struggle to drink enough fluid to keep themselves hydrated and to take in enough protein to maintain healthy tissues. A year after having had the surgery, Roxane Gay eloquently described the changes as well as the psychological consequences: "[Food] was my comfort and my friend," she wrote. "And then, that comfort was gone. I've lost the best friend I never had the courage to acknowledge but who was my constant, loyal companion nonetheless."

Evidence-Based Care, Not Stigma

In contrast to the popular narratives about people with obesity, the patients I care for as a bariatric surgeon are tenacious, persistent, and diligent. I am constantly impressed by their commitment to health and a new lifestyle. Unfortunately, negative and inaccurate messages on popular TV shows hinder people from seeking the most effective treatment for their disease.

With the obesity epidemic growing, what we need now is promotion of evidence-based care, not stigma. Rather than rely on old stereotypes about how or why people gain weight, we must finally acknowledge the truth that obesity is multifactorial. Perhaps writers, networks, and celebrities can focus on sharing the benefits of surgical treatment for obesity, advocating for access to care for patients with obesity, and changing the narrative about the characteristics of those living with obesity. 

James Corden's response to Maher was a start, sharing his own long-standing struggles with obesity in an honest and touching commentary on his show. He directly confronted Maher, saying, "Let's be honest. Fat shaming is just bullying."

There is a lot we don't yet understand about obesity. What we do know is that people with obesity are as deserving of access to treatment as are those with heart disease, diabetes, or any other medical condition. No amount of fat shaming or ranting will change that fundamental truth.

Follow Arghavan Salles on Twitter: @arghavan_salles

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