It's time to rethink our attitude toward obesity, academic argues

Prejudice against fat people is endemic in our society and public health initiatives aimed at reducing obesity have only worsened the problem, according to a U.S. academic.

In her new book, "Why It's OK To Be Fat," Rekha Nath, an associate professor of philosophy at the University of Alabama, argues for a paradigm shift in how society approaches fatness.

According to Nath, society must stop approaching fatness as a trait to rid the population of, and instead fatness should be approached through the lens of social equality, attending to the systematic ways that society penalizes fat people for their body size.

Nath explains, "Being fat is seen as unattractive, as gross even. We view fat as a sign of weakness, of greediness, of laziness. And we have made the pursuit of thinness, bound up as it is with health, fitness, beauty, and discipline into a moralized endeavor: making the 'right' lifestyle choices to avoid being fat is seen as a duty we each must fulfill.

"Our collective aversion to fatness translates into an aversion to fat people. Fat people are bullied and harassed. They receive worse health care, frequently at the hands of doctors and nurses who endorse harmful anti-fat stereotypes. Fat students are ridiculed and teased by classmates and even teachers. In the workplace, fat people experience rampant discrimination, which is legal in most jurisdictions."

Health and weight

According to research cited in the book, global obesity rates have tripled during the past 50 years, while the World Health Organization has deemed childhood obesity "one of the most serious global public health challenges of the 21st century."

Nath explains why, from a public health standpoint, this is worrisome, as severe obesity is linked to lower life expectancy, and carrying "excess weight" (weight that places one above a "normal" BMI) is associated with a heightened risk of diabetes and heart disease.

However, Nath explores further into the science of weight and health beyond headline figures, revealing a more complex picture. Surveying a body of scientific research, Nath shows that diet and fitness may bear more on our health than weight alone. For instance, a 2010 systematic review of 36 studies found that fit, obese individuals were less likely to die prematurely than unfit normal-weight individuals.

Nath also points to evidence that advice dispensed to fat people to lose excess weight—eat less and move more—is ineffective and can even be harmful. According to one rigorous review, cited in the book, many people who try to lose weight through dieting end up heavier in the long run with 41% of dieters weighing more four to five years after dieting than they had before starting their diets.

Stigmatizing fatness

Nath shows how many public health campaigns that aim to help people lose weight can make the situation worse by inadvertently stigmatizing fatness.

"The consensus view in the literature on weight stigma is that it doesn't help. Actually, it's worse than that," she explains. "Not only does subjecting fat people to weight stigma seem to make it less likely that they will become thin, but, moreover, weight stigma appears to seriously harm their physical and mental health in many ways."

Nath cites research showing that people who feel stigmatized are less likely to lose weight. In one study that tracked more than 6,000 individuals for four years, those who reported experiencing weight discrimination were more likely to become obese or remain obese than those who did not.

"Numerous studies indicate that people who experience weight stigma are more likely to suffer depression and low self-esteem," she explains.

Looking forward

Nath writes that the prejudice experienced by fat people is stark and impacts their lives in tangible terms. She cites studies that reveal children as young as 3 show a preference for a playmate who "isn't chubby." And she says that a survey of more than 800 American college students found that one in three agree with the claim that becoming obese would be "one of the worst things that could happen to a person."

In the book, Nath imagines a world where fat people should enjoy equitable health care, equitable inclusion in the workforce, and the ability to appear in public without shame.

She says, "It is OK to be fat because there's nothing wrong with being fat. There's nothing wrong with being fat, of course, except for all that our society does to make it bad to be fat: oppressing fat people for their body size by imposing on them the gross injustice of sizeism."