There’s a dangerous narrative that I’ve been watching unfold for the last handful of years, although I’m sure it started before then. I really noticed an amping up shortly after Christy Harrison’s book “Anti-Diet: Reclaim Your Time, Money, Well-Being, and Happiness Through Intuitive Eating.”

“Ahhh,” I thought. “The diet industry feels threatened, and they’re pushing back.”

This narrative has several facets, but the predominant storylines are that:

  1. Medical and surgical weight loss are ways to combat weight stigma
  2. Better access to “ob*sity care” = non-stigmatizing healthcare
  3. People who push back against encouraging bariatric surgery or the new weight loss medications are in fact stigmatizing fat* people

Number 3 really came about after the release of the American Academy of Pediatrics weight loss guidelines for children and adolescents came out, followed quickly by pushback from fat activists, eating disorder professionals, and anyone who know the weaknesses of weight science.

*(I use “fat” as a neutral descriptor, such as “thin” or “short” or “tall.”)

Medical and surgical weight loss are ways to combat weight stigma

That first storyline is the oldest, and it shows up in a LOT of “ob*sity” research, which blames “ob*sity” for increased risk of depression and a lot of other things that are likely caused by the stigma of being in a larger body (weight stigma, or anti-fat bias), not being in a larger body itself.

In fact, this is a big problem with a lot of weight stigma research, which makes it sound like the worst thing about weight stigma is that it provides an obstacle to fat people becoming less fat, and that we need to reduce weight stigma so fat people feel better enough about their bodies to try to lose weight.

This is particularly virulent in research on weight stigma in healthcare, which repeatedly makes it sound like the main reasons that doctors should be nicer to their fat patients is so those patients will be amenable to trying to lose weight via “intensive lifestyle interventions” (read: restrictive diets and exercise), medication or bariatric surgery.

They also make it sound like all it takes for doctors to be less stigmatizing is to “talk nice” and use “person-first language.” For example, saying “people with ob*sity” instead of “ob*se people.” I touched on this nonsense in a 2019 article for The Washington Post and in an article for Today’s Dietitian (which was weirdly edited by someone who rewrote some of my sentences in really stiff and stilted ways, but the info is good).

(To be fair, I know from some weight stigma researchers that it’s hard to get their research funded if they don’t somehow wrap around to “this is how we can make fat people less fat” thanks to the outsized focus on “The Ob*sity Epidemic.” The issue of how diet culture and weight stigma show up in weight stigma research was addressed wonderfully by one of my favorite weight stigma researchers, Jeffrey Hunger, in Episode #192 of the Food Psych Podcast, “Why we can’t fight weight stigma while also advocating for weight loss.”)

Better access to “ob*sity care” = non-stigmatizing healthcare Part 1

The idea that better access to “ob*sity care” = non-stigmatizing healthcare morphed out of the first storyline, but became more strident when the new generation of weight loss drugs was approved by the FDA, and pharmaceutical companies started expressing their deep commitment to ending weight stigma at the same time they rubbed their hands together and jumped up and down with glee in anticipation of massive profits.

In fall 2021, Novo Nordisk, creator of the latest weight loss drug du jour, launched the “It’s Bigger Than Me” Campaign, which claimed to be about destigmatizing “ob*sity” but was really about trying to turn fat people into unpaid shills for Novo Nordisk in the hopes that they would pressure insurance companies to pay for this “ob*sity care.” (Read more about that campaign in a piece that Ragen Chastain wrote for The Mighty.)

Marquisele (Mikey) Mercedes, a fat liberationist writer, educator and doctoral student at Brown University School of Public Health shared via her Patreon newsletter how in March 2022 she was approached by Vox Media about doing an explainer video on the history of fatphobia and its origins in anti-Blackness, as part of an overall series on the history, science and impact of “ob*sity” stigma. Guess who was paying for the series? Novo Nordisk. She very politely said she would not participate and provided an in-depth explanation as to why, and never heard back.

That’s OK, because Novo Nordisk managed to get a PSA on “Gray’s Anatomy.

Better access to “ob*sity care” = non-stigmatizing healthcare Part 2

Ragen Chastain also wrote a great piece for her “Weight and Healthcare” Substack newsletter in May 2022 (“Is it anti-weight stigma or diet industry propaganda—a handy guide”). Here’s a brief quote:

“Activists, both within and outside the healthcare industry, have been pushing back against this pathologization of body size for decades and have been making headway. In an attempt to nullify that work and progress, the diet industry has developed a marketing and PR plan in which they co-opt the language of anti-weight stigma activists in order to repackage and continue to sell the same old dangerous and futile interventions.”

“So this huge PR campaign includes publishing similar articles in multiple major media outlets, along with a major social media push. These articles push the narrative that healthcare professionals need to work on their weight bias in order to….wait for it… treat “ob*sity.” They are being dutifully published without any kind of examination or critique by the media.”

In the wake of the APP guideline release, I’ve noticed a lot of articles in major media outlets that read more like Novo Nordisk promotional pieces. It’s disturbing, but perhaps not surprising that journalists are humans who live in an anti-fat society, may have their own anti-fat biases, and have bought into the idea of “The Ob*sity Epidemic.”

Fat activists are perpetuating weight stigma? What??

As mentioned, it was shortly after the pushback on the APP weight loss guidelines began that the third storyline emerged.

I’ve primarily noticed it pushed by a very vocal longtime mouthpiece for the medical and surgical weight loss industries, who I will not name because I don’t want to give him more oxygen. Suffice to say that I’ve subscribed to his daily emails for a long time, and often want to stop but I don’t because I feel like it’s important to keep an eye on this sh*t.

Here’s a direct quote from one email:

“There is great irony when someone who recognizes the harm of stigma attached to a high body weight and obesity is using heated rhetoric to stigmatize medical care for obesity….It seems that an addiction to outrage permits even advocates against stigma to promote stigma for the sake of their fat acceptance agenda. This is a mistake.”

“Attaching stigma to medical care for obesity is simply wrong. People who are pumping out overheated rhetoric need to look in the mirror and get a grip.”

He deploys a few different tones. Angry Mouthpiece uses a combination of barely restrained anger and righteous indignation, as demonstrated above. Disappointed Mouthpiece comes across as if he’s shaking his head sadly and a bit bemusedly at the silly people who are suggesting that there’s something wrong with pushing weight loss.

Just for fun, let’s add some sexism

This mouthpiece, shill, whatever you want to call him, is also an older white man, and because most people pushing back against the medical and surgical weight loss industries are women, there’s a slightly sexist, and very condescending, edge to his rhetoric.

For example, after Virginia Sole-Smith wrote her excellent opinion piece for the New York Times about the APP guidelines, he put on his Disappointed Mouthpiece voice when he mentioned her the next day, referring to her as a “HAES activist.” While there’s nothing wrong with primarily being an activist, considering that Virginia is also a journalist, author and a mother with a robust following on social media and her Substack newsletter, only calling her an activist was extremely dismissive. And not accidental. I should also mention that he lobs personal attacks against Christy Harrison a lot.

To say this co-opting of the work and words of fat activists (along with attacks on them) makes me mad and sad is an understatement, in part because of the hard work at the roots of this activism, as I wrote about in an article for Today’s Dietitian Magazine on “Body Positivity in Dietetics Practice“:

“Body positivity” is a buzzy catchphrase popular with Instagram influencers, advertisers, and diet companies. But the origins of the body positive movement run much deeper than its current commercialized manifestations. Body positivity has its roots in late 1960s social justice movements created by and for people in marginalized bodies — particularly fat, Black, queer, and disabled bodies — to talk about the oppression they experience in society and fight back against discrimination in the workplace, doctor’s offices, and other public settings.

Most of these “people” were women. And they deserve better.

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Carrie Dennett, MPH, RDN, is a Pacific Northwest-based registered dietitian nutritionist, freelance writer, intuitive eating counselor, author, and speaker. Her superpowers include busting nutrition myths and empowering women to feel better in their bodies and make food choices that support pleasure, nutrition and health. This post is for informational purposes only and does not constitute individualized nutrition or medical advice.

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