2024 Equity Challenge Day 15: Weight Bias & Anti-Fatness in Health Care

Note on anti-fat language: At United Way we encourage dialogue and centering the voices of folks most connected to the language we use. Our Diversity, Equity and Inclusion team is using anti-fat and fatphobia to describe the system of oppression that impacts people in bigger bodies in this piece and in the challenge because of our own internal dialogues, where our staff and community expressed the importance of honoring the multiple ways each individual person has their own language to express themselves.

Anti-Fatness is deeply rooted in our culture, and therefore, rooted inside all of us, regardless of the size of the body we are living in or what our profession is. These internalized beliefs are called bias, and you can learn more about it here from last year’s challenge.

According to the Boston Medical Center, “Fatphobia, also known as anti-fat, is the implicit and explicit bias of overweight individuals that is rooted in a sense of blame and presumed moral failing. Being overweight and/or fat is highly stigmatized in Western culture. Anti-fatness is intrinsically linked to anti-Blackness, racism, classism, misogyny and many other systems of oppression.”

Weight discrimination in health care is reported at rates comparable to racism and is one of the last types of discrimination still condoned and carried out by public health and medical experts. In fact, discrimination against larger bodies is rooted in racism. Historically, larger bodies were celebrated as a representation of one’s status – having a larger body meant you were wealthy enough to afford the privileges of fine food. However, this began to change with the rise of eugenics and scientists that focused on the differences between races. This system of valuing some bodies over other bodies to justify oppressive behaviors is called Body Terrorism and you can learn more about it here from last year’s Equity Challenge.

During the period of enslavement in America and with access to new food resources, including sugar, Black bodies began to look like the voluptuous white bodies that had been depicted in art and culture for years. Because of this, race scientists began to draw direct ties between gluttony, stupidity, and the characteristics of Africans, which began drastically changing the way large bodies were viewed in society.

Anti-fatness also impacts an individual’s access to adequate health care for several reasons, including:

• The assumption that if someone is overweight, they cannot be healthy.

• Clinical care teams that typically lack experience in treating diverse body sizes.

• Weight-related structural barriers, e.g., size of exam tables, gowns, blood pressure cuffs and scale limits.

Today, we encourage you to learn more about the history of anti-fatness, how it shows up in health care and what biases you have toward people living in bodies different from yours.