All About That Bass

This piece was originally written in September 2015. I’ve decided to publish it here because I believe that, a few months on, the issues described are still relevant.

There’s a lot about fat shaming on social media at the moment. A quick look at my current Facebook feed reveals that Nina from The Bachelor has been fat shamed by intruder Rachel and YouTube has shut down the ‘fat shaming comedian’ Nicole Arbour. A couple of weeks ago it was all about Project Harpoon’s photoshopping and #Thinner Beauty hashtag, and a pregnant Kim Kardashian being mocked about her size following her appearance at the VMAs.

My opinion on fat shaming is this: it’s not nice. People should not be ridiculed because of their weight, just like they should not be judged because of their race, gender or sexuality. Fat shaming is also ineffective, with a study published in the journal Obesity in 2014 by researchers at University College London showing that weight discrimination does not lead to weight loss and may in fact exacerbate weight gain. Whenever I hear or read fat shamers two quotes come to mind: the old adage ‘if you don’t have anything nice to say, don’t say anything at all’, and the fabulous ‘I just wish we could all get along like we used to in middle school’ from Mean Girls (although perhaps a cake filled with rainbows and smiles isn’t the best analogy when discussing obesity).

While I’m completely against fat shaming, I admit that I’m conflicted when it comes to the acceptance (or even celebration) of obesity. There’s been quite a bit of this in social media too: over the past year Facebook has presented me with a Daily Life article entitled ‘Why It’s Time for Radical Fat Acceptance’ about author and fat activist Sarai Walker, pictures of actress Rebel Wilson and plus-sized model Tess Munster accompanied by body positive and ‘fat pride’ messages, and Meghan Trainor’s irritatingly catchy ‘All About that Bass’ (to name but a few). While having body confidence is undoubtedly better than not having it, I’m worried that social media fodder such as that described above goes some way to trivialising the harms of obesity and ‘normalising pathology’. To me, it is reminiscent of the modeling world, which traditionally used very underweight models and paraded these as body types to aspire to.

While ‘normal’ bodies do come in many different shapes and sizes, obese (just like severely underweight) is not one of these. I have just finished my Rural General Practice placement in Western Australia’s Goldfields, and was astounded to learn that over three quarters of the population are overweight or obese. Diabetes, osteoarthritis, sleep apnoea, heart disease and cancer are just a few of the many dangerous and debilitating health conditions stemming from obesity that I saw on a daily basis, conditions that cost the Australian government billions of dollars per year. This is hardly new information, but it is information that is important and at risk of being sidelined or minimised by the fat acceptance movement.

I stated earlier that I was conflicted about fat acceptance, and the source of my conflict is that I can sympathise with people’s desire for autonomy. In theory, it makes sense to me that people have the right to be obese if they choose: it is their body, they pay taxes that help fund public healthcare, and unlike smoking or excessive alcohol consumption the risks to others are relatively minor. Additionally, I appreciate that it can be very difficult to lose weight and the reasons why a person may be obese are complicated and various.

However, as a future doctor I do not believe it is responsible (or ethical) to promote this outlook over that of health promotion. While respecting a patient’s opinion is always important, telling them that it is ‘okay to be obese if they want to’ has the potential to jeopardise their future well being, and I for one do not feel comfortable putting my future patients at risk of disease unnecessarily. Even in my short time in the medical field, I have seen too many obese people crippled by osteoarthritis and people with amputated limbs and failing vision from diabetes. I have spoken to countless heart attack victims (the youngest of whom was in his early thirties) and have seen people die from obesity-related cancer. I do not want my future patients to not be able to breathe or sleep properly, or to not be allowed to drive because their severe sleep apnoea makes them a risk to others. When it comes to controlling obesity, I am in the compulsory seatbelt / smoking and alcohol restrictions / bike helmets camp: while they curtail personal liberties, the benefits far outweigh the negatives.

People who have problems with their weight do not need shaming, but nor do they need denial. If they choose to lose weight, what they need is support, education and practical ways of implementing this knowledge.

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