What Do Fat Women Want?

University of Massachusetts Amherst ScholarWorks@UMass Amherst Doctoral Dissertations 1896 - February 2014 1-1-2001 What do fat women want? : An exploratory investigation of the influences of psychotherapy on the process by which fat women work toward acceptance of their size and weight. Anne M. Downes University of Massachusetts Amherst Follow this and additional works at: https://scholarworks.umass.edu/dissertations_1 Recommended Citation Downes, Anne M., "What do fat women want? : An exploratory investigation of the influences of psychotherapy on the process by which fat women work toward acceptance of their size and weight." (2001). Doctoral Dissertations 1896 - February 2014. 5561. https://scholarworks.umass.edu/dissertations_1/5561 This Open Access Dissertation is brought to you for free and open access by ScholarWorks@UMass Amherst. It has been accepted for inclusion in Doctoral Dissertations 1896 - February 2014 by an authorized administrator of ScholarWorks@UMass Amherst. For more information, please contact [email protected]. 31S0tb 0510 117b 0 five college depository WHAT DO FAT WOMEN WANT? AN EXPLORATORY INVESTIGATION OF THE INFLUENCES OF PSYCHOTHERAPY ON THE PROCESS BY WHICH FAT WOMEN WORK TOWARD ACCEPTANCE OF THEIR SIZE AND WEIGHT A Dissertation Presented by ANNE M. DOWNES Submitted to the Graduate School of the University of Massachusetts Amherst in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY September 2001 School of Education © Copyright by Anne M. Downes 2001 All Rights Reserved WHAT DO FAT WOMEN WANT? AN EXPLORATORY INVESTIGATION OF THE INFLUENCES OF PSYCHOTHERAPY ON THE PROCESS BY WHICH FAT WOMEN WORK TOWARD ACCEPTANCE OF THEIR SIZE AND WEIGHT A Dissertation Presented by ANNE M. DOWNES Approved as to style and content by: 7K /Q, Marion Rhodes, Member DEDICATION This dissertation is dedicated to my mother, Beatrice Convey Downes, an unwavering source of support and inspiration whose wisdom and love have allowed me to learn patience and perseverance. At 93, her light her continues to shine. ACKNOWLEDGEMENTS Completion of a project of this scope reflects the support and encouragement of many people. I feel blessed to have been surrounded by people whose interest in the topic and belief in me sustained me as a writer, a > researcher, a therapist and a feminist. I thank Mary Horan, who has sustained me in ways only a caring older sister can. I thank the members of the fat women's support group of which I was a member, without whom I would not have articulated the idea for this dissertation. I thank the members of my dissertation committee. Jay Carey, Pat Griffin and Marion Rhodes, whose interest and support have been unequivocal from the start. I thank the study participants who so generously gave of their time in order to tell their stories. Their stories form the heart and soul of the dissertation. I thank the following individuals who each played an important role in ensuring that I brought this study to completion: Rene Andersen, Pat Beck, Julia Demmin, Kate Finnegan, Sharon Kipetz, Ned Norris, Kami Oliver, Charmaine Wijeyesinghe and Anne Wiley. It is difficult to adequately express the gratitude I hold for Anne's friendship, wisdom, practical commentary and tireless encouragement. All were invaluable in helping me bring this project from possibility to actuality. v ABSTRACT WHAT DO FAT WOMEN WANT? AN EXPLORATORY INVESTIGATION OF THE INFLUENCES OF PSYCHOTHERAPY ON THE PROCESS BY WHICH FAT WOMEN WORK TOWARD ACCEPTANCE OF THEIR SIZE AND WEIGHT SEPTEMBER 2001 ANNE M. DOWNES, B.A., LEMOYNE COLLEGE M.A., TEACHERS COLLEGE, COLUMBIA UNIVERSITY M.Ed., UNIVERSITY OF MASSACHUSETTS AMHERST Ph.D., UNIVERSITY OF MASSACHUSETTS AMHERST Directed by: John C. Carey This study explores the process by which a selected group of fat women work toward a positive acceptance of their size and weight and on the experiences and perspectives of these women as participants in psychotherapy. Research questions focused on participants' childhood, adolescent and adult experiences as large women prior to choosing to emphasize accepting, rather than changing their bodies; on the factors that influenced their decision to make that choice; and on participants' experiences as clients in psychotherapy. Psychotherapy experiences were examined to determine what role they may play in a woman’s process of working toward acceptance of size and weight. Participants were asked to describe therapist characteristics necessary to their being effective with clients who are fat women. v 1 In-depth phenomenological interviewing served as the primary method of data collection. Each participant was interviewed twice individually in sessions lasting from ninety minutes to two hours each. The study employed reflective and interactive components. Participants were given copies of the transcriptions of their individual interviews for review and comment and invited to take part in a focus group interview. The data are organized into four areas: childhood and family of origin, adulthood and independence, working toward acceptance of size and weight, and experiences in therapy. Findings indicate that the negative sequalae of participants a) being shamed for their size and b) blamed for not controlling their size, continued well into adulthood. Adult experiences of prejudice and discrimination based on size confirmed and recapitulated attributions of unattractiveness and inadequacy. The journey toward acceptance of size and weight is life-long, non¬ linear and involves embracing an alternative paradigm of assumptions concerning the origins of fatness, prevailing cultural standards of beauty, and the tendency to regard fatness as an indicator of compromised physical and mental health. In order to conduct effective therapy with fat women, psychotherapists need to understand the biological bases of fatness and the exacerbating effects of dieting; examine their own biases concerning size and weight; educate themselves regarding issues that fat women face; and remain aware of dynamic considerations specific to conducting therapy with fat women as clients. Vll TABLE OF CONTENTS Page ACKNOWLEDGEMENTS.. ABSTRACT.vi CHAPTER I. INTRODUCTION.’.1 Description of the Study.1 Statement of the Problem.5 Purpose of the Study.9 Research Questions.10 Definitions Used in Establishing the Research Questions.11 Significance and Rationale for the Study.14 II. REVIEW OF SIGNIFICANT LITERATURE.17 Physiological Aspects of Size.17 Traditional Paradigm of the Physiology of Size.18 The Emerging Paradigm of the Physiology of Fatness.20 The Biological Bases of Weight and the Heritability of Body Size.20 Body Weight, Morbidity and Mortality, Weight Loss and Mortality.25 The Weight Loss Paradox and Health Risks Associated with Dieting.29 The Health Risks of Weight Cycling.32 Improved Health and Reduced Mortality Independent of Weight Loss.35 Section Summary.38 Psychological, Social and Cultural Aspects of Size.40 How the Stigma of Obesity Manifests Itself.40 How the Stigma of Obesity is Maintained.45 viii Cultural Beliefs, Political Pressures and the Influence of Media.46 The Diet Industry and Its Ties to Physicians, Obesity Researchers, Pharmaceutical Companies and Academia.52 Prejudice and Discrimination Fostered by the Stigma of Obesity.57 Discrimination in Education, Employment and Health Care Settings.57 Legal Action Against the Parents of Fat Children.61 The Negative Sequelae of Stigma, Prejudice and Discrimination Against Fat People.66 Beginnings of Resistance to the Old Paradigm and Emergence of a New Paradigm Concerning Size and Weight.73 The Fat Acceptance/Fat Liberation Movement.74 Fat Culture and the Difficulty of Building Community Among Fat People.75 Personal Stories of Transformation.77 Fat Acceptance Literature.79 Use of the Legal System by Fat People to Further Their Interests.81 Legal Action Against Manufacturers of Diet Drugs.82 Legal Action in Cases Involving Employment Discrimination.83 Should Fatness Be Construed as a Disability?.84 Can Anti-Fat Bias Be Regarded as a Hate Crime?...86 Psychotherapy.86 Traditional Paradigm Concerning Body Size.87 Emerging Paradigm Concerning Body Size. 89 Section Summary.92 III. METHODOLOGY.93 Setting the Boundaries.93 Research Methods.94 IX In-depth Phenomenological Interviewing.96 Sampling Strategy.98 Design of the Study.99 Selection of Participants.99 Pilot Activities.101 Development of the Interview Guide.103 Data Collection. 104 Analysis of Data.107 Role of the Researcher.108 Trustworthiness.110 IV. PRESENTATION OF THE DATA.112 Childhood and Family of Origin.113 Participants' Recollections of Being Labeled Fat as Children.113 Participants' Reflections on the Attitudes and Actions of Their Families of Origin.115 Participants' Recollections of Feeling Shamed and Blamed.119 The "Protective Presence" of a Positive Role Model.121 Adulthood and Independence.123 Continuing Effects of Family Members' Negative Attitudes on Current Relationships with Family of Origin.124 Participants’ Experiences of Prejudice and Discrimination Based on Size.125 Health Care.126 Employment.130 Prejudice in Situations Other Than Health Care and Employment.133 Participants’ Recollections of Being Rewarded for Weight Loss.136 Participants' Reflections on Sexuality and Size.140 Partners’ Attitudes Concerning Participants' Size.143 Transgenerational Issues Concerning Size.146 x Having a Child Who is Fat, Having a Parent Who is Fat.147 Food, Eating, Weight, Size Oppression - Interrupting the Generational Cycle.149 Working

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