Episode 14: Dr. Joan Chrisler- Sizeism and Fat Shaming

Therese Markow: Welcome to this week's episode of Critically Speaking, where we explore issues at the intersection of science and society, issues central to individual and societal health and wellbeing. I'm your host, Therese Markow.

There's been increasing attention in the media to what's referred to as the obesity epidemic or crisis in the United States and other Western countries. On the other side of the coin, considerable evidence exists that something called fat shaming or the denigration of fat people can be very damaging. The same is true of against fat people. A number of movements which collectively could be called fat acceptance movements have emerged to bring these attitudes and practices to light and to support fat people who feel their effects. Today's guest, Dr. Joan Chrisler, Professor Emeritus of Psychology at Connecticut College, and Editor of the academic journal, Women's Reproductive Health, has written extensively about women's reproductive rights as well as issues confronting fat people. Dr Chrisler's expertise will provide us with the perspectives of the . Dr Chrisler, welcome to Critically Speaking.

Dr.Joan Chrisler: Thanks for inviting me.

Therese Markow: Dr. Chrisler, can you tell us exactly what sizeism is?

Dr.Joan Chrisler: Sizeism refers to or discrimination against individuals based on their body size or shape. So, it could refer to making fun of people who are considered to be too tall or too short or too thin. But given our society's aesthetic preference for thinness and our against heavy weight, it's almost always directed against people who are considered to be too fat. So anytime someone assumes that a heavyweight person is lazy or unmotivated or lacks self-discipline, or anytime someone declines to hire a fat person because they're not attractive enough for a front office job, that's sizeism.

Therese Markow: Okay, and the origins of sizeism, is it recent, or has it always been around?

Dr.Joan Chrisler: Well, it's probably always been with us in some way or another, but the [inaudible 00:02:12] size and shape considered beautiful or ideal changes over time. If you think about the women that Rubens painted, we consider them fat today, but in his time they were exemplars of feminine beauty. So the [inaudible 00:02:27] and bulimia nervosa dates from around when the thin ideal was firmly established. Girls and women then began to try to lose, and those who succeeded were admired, and those who did not were criticized for not trying hard enough. The National Association to Advance Fat Acceptance, known as NAAFA, was founded in 1969. The feminist movement started in the 1970s. The fat underground are best known for their fat liberation manifesto, which

included the phrase, "Fat people of the world unite. You have nothing to lose." That's a great line, isn't it? I think it's important to think about the intersection of sizeism with other forms of prejudice and discrimination. First of all, we could say that although men also suffer from the effects of sizeism, they tend not to experience it at their very high body weight.

Therese Markow: Yeah. You know, it's interesting because when I was in high school ... I'll date myself, it was back in the 60s, I had friends that were larger and they would shop at Lane Bryant, which had a good selection of clothes for people that were a little bit bigger. But honestly, I can't remember anyone making fun of them or denigrating them. It's just kind of how it was. And some had boyfriends and some thin girls didn't. Do you think this has changed, or was I just oblivious?

Dr.Joan Chrisler: Well, you might have been oblivious, but the 1960s was the time of change and the change to the thin ideal might've happened sooner in some parts of the country than in others. So the phrase pleasingly plump was still in use in the 1960s.

Therese Markow: True.

Dr.Joan Chrisler: And I can remember my mother commenting children's too skinny and she said that with an implied criticism of their parents for not taking good enough care of them. But my parents, and yours, lived through the Great Depression, when many Americans did not have enough to eat, so the thought of discarding food rather than eating it or vomiting it up after having eaten it was an anathema to many at that time.

Therese Markow: Right. Okay. No, that makes a lot of sense. I spend a lot of time in Mexico, and many people in Mexico are fat. I think they've actually surpassed the United States, and, you know, the number of people considered to have obesity. But it seems to me that in Mexico there's really truly social acceptance because the word in Spanish for a fat person is 'gorda,' and they affectionately refer to fat people as 'gordito' or 'gordita.' It's like calling somebody sweetie or darling, you know? And so, it's not the same in the U.S. Maybe that's a cultural thing. As you say, different parts of the country or maybe it's related to history, but it's interesting because I don't see it in Mexico. I don't see it as the same type of discrimination.

Dr.JoanChrisler: Well, we are talking about cultural ideals here and studies in the U.S. show that there are differences by ethnic groups in terms of what people think the ideal body size and shape are. For example, most African Americans think that heavyweight women can be beautiful and sexy, whereas most European Americans don't agree with that. Immigrants to the U.S., and their children, often retain traditional ideas about body weight, but those who are well socialized, that is, who eagerly adopt mainstream culture and want to fit in to American society, adopt size views and engage in disordered eating in attempt to lose weight.

Therese Markow: Right. If you weigh more, it means that you're not poverty-stricken. It means that you are doing well, right?

Dr.Joan Chrisler: Yeah.

Therese Markow: Interesting. Do you think fat shaming is a way that some people can just feel better about themselves? Like with , you know, you pick on somebody who's different?

Dr.Joan Chrisler: Yes, I agree. Some people are just naturally thin, but they like to think that they're self-disciplined and motivated to look good and be healthy, so they feel superior to others. They don't try to lose weight or don't care how they look. And of course sizeism can interact with or cover for other forms of prejudice because of the I mentioned earlier.

Therese Markow: Right.

Dr.Joan Chrisler: Sizeism is a more acceptable prejudice than racism or .

Therese Markow: Yeah, that makes sense. It doesn't sound as awful. It doesn't sound as awful as racism or ... or that. So, you know, for me, I wasn't aware about fat people feeling discriminated against when they sought healthcare until I read some of your papers and other literature on websites of the fat support groups. Do you think this can prevent people from seeking medical help for serious conditions?

Dr.Joan Chrisler: Oh yes, unfortunately. Studies show that patients who have experienced what scholars call medical fat shaming are often reluctant to return to their doctors. They know they're going to be weighed and if, as is likely to be the case, they haven't lost weight or they've even gained some, they're going to be in for another unpleasant lecture. There are many testimonials from fat people about having been told by their doctors that whatever is wrong with them, whether it's the flu, or a broken toe, or strep throat might not have happened if they weren't so fat.

Therese Markow: So that's fat shaming, right-

Dr.JoanChrisler: Oh, yeah.

Therese Markow: To tell them that. The National Health and Nutrition Examination Survey, that's called NHANES, is a program of studies designed to assess the health and nutritional status of adults and children to show that what they call overweight has pretty much stayed the same level in the population since 1962, but that obesity, or morbid obesity, has gone from 13% of the population to 40%. How do you think this increase can be explained?

Dr.Joan Chrisler: Well, I think that changes in our society and culture are probably to blame for this. So much of our work is done sitting down at a computer keyboard. People

are just less active than they used to be. Many schools have cut out Phys Ed classes due to reduced budgets, and children's games and leisure activities today are more sedentary. Adults have longer commutes and both parents work than most families, so they have less time to cook healthy foods.

Therese Markow: Yeah, so a combination of less physical activity and changes in the food itself.

Dr.Joan Chrisler: Because portion sizes are bigger, and the standard size of dinner plates and china sets has gotten larger since the 1960s.

Therese Markow: Oh, is that right? ... I didn't realize that.

Dr.Joan Chrisler: Yeah.

Therese Markow: The plates themselves have gotten bigger?

Dr.Joan Chrisler: Go and look at some antique china.

Therese Markow: Wow, got to go look at my grandmother's plates and compare them to the ones I recently bought.

Dr.Joan Chrisler: Exactly, yeah.

Therese Markow: I knew that portion sizes had increased. There's a lot of literature about that. But the plates themselves ... I guess then if if the portion size didn't increase then it would look like there's less on the plate.

Dr.Joan Chrisler: Right.

Therese Markow: Do you think that medical professionals actually are concerned about the risks for diseases in the very obese patients and they're well-intentioned, but their approach in dealing with the patients is not so great?

Dr.Joan Chrisler: I do think so. They are also affected, though, by their aesthetic preference for the thin ideal. And I think that busy practitioners, you know, GPs, internists, pediatricians, probably know little about the research on weight gain and loss. So they may think that 90% of diets fail because patients are unmotivated and lack self-discipline, and thus they just keep telling their patients to eat less and exercise more. But there are both physiological and socio-cultural factors that work against that simplistic advice. It's also worth mentioning that some of the advice that people are given by healthcare professionals mimics the symptoms of the eating disorders. So if thin people restricted their intake to the extent of very low calorie diets, they'd be diagnosed with anorexia and hospitalized. So yeah, bad advice doesn't result in weight loss and fat shaming is never helpful.

Therese Markow: So how might physicians or other healthcare providers make the patients feel more welcome and accepted and listen to them and not just denigrated or told, "Okay, you have to lose weight?"

Dr.Joan Chrisler: Well, first of all, it's possible to encourage people to adopt healthy behaviors without making weight loss the end goal. If people get adequate exercise, nutrition, sleep, relaxation, and social support, they're going to be healthier regardless of their weight. So, I would start there and direct people to the Health at Every Size Movement, which is a good place to learn more about this approach. But, providers could also make sure that they have chairs in their waiting room and examination tables, gowns and instruments and other materials in their practice that can accommodate people of all sizes. And I would say doctors should ask themselves whether it's really necessary to weigh a patient at every visit. If someone comes in for a flu shot, does she need to be weighed? Because fat patients may avoid office visits so they won't see the number on the scale and the doctor or nurse's look of disapproval.

Therese Markow: Ah, okay. Yeah, that makes sense. But I've also heard that the incidents of depression might be higher in fat people, and I wonder if that's possible because of the shaming and the being made to feel uncomfortable because of their size.

Dr.Joan Chrisler: Well, I doubt that fat people have a higher rate of clinical depression than the general public. But let's face it, it's stressful to be subject to sizeism. Heavyweight women are especially alert to how others see them and judge their appearance. Fat children are among the groups most likely to be bullied. Internalized sizeism, where you accept those attitudes and apply them to yourself, lowers self-esteem and can cause people to feel they deserve to be treated badly. So yeah, there are mental health effects of sizeism for sure, such as social anxiety and sadness or even mild depression due to social rejection. And by the way, psychotherapists and counselors are as as likely as doctors and nurses to advise their patients to lose weight and to attribute problems to body size and shape. So you know, a client might be told if you lose weight, you'll make friends more easily. If you lose weight, your marriage might improve. But in these examples, sizeism, not the patient's weight is probably to blame.

Therese Markow: Yeah, right, so there's a different way that they could treat those seeking any kind of psychological assistance without focusing on that, because then they probably won't go back to that therapist either.

Dr.Joan Chrisler: Exactly, yeah.

Therese Markow: We had just mentioned this a minute ago, because I've heard people say that the fat acceptance movement itself could lead to even very, very fat people feeling like they're okay and thus not seek help for some truly dangerous excess weight. What do you think?

Dr.Joan Chrisler: Well, obviously if people are hundreds of pounds overweight and find it difficult even to move around, they're in a dangerous situation, given that every time people diet and lose weight and gain it back, they're likely to end up heavier than they were initially.

Therese Markow: Dr Chrisler, what's the answer here to keep people of all sizes healthy while not causing psychological or emotional harm?

Dr.Joan Chrisler: Well, if people accept themselves as they are and learn to feel more positive about their bodies, they're then in a better place psychologically to engage in self-care.

Therese Markow: So it sounds like a first step is in self acceptance and with that, that a person would be more disposed to self care.

Dr.Joan Chrisler: Right, I mean if you like yourself, then you feel that you deserve to be healthy, that you deserve to take good care of yourself, as opposed to people with internalized sizeism who believe that they are bad, that they are ... something is wrong with them. That they don't deserve to be loved and cared for and that they don't like their bodies. If you hate your body, you're probably not going to take good care of it.

Therese Markow: It's such an interesting point. I hadn't thought about the fact that sizeism ... you think about sizeism as something external, that it's something that other people do to you, but you could internalize the sizeism about yourself. That's so interesting. What an interesting take-home message. It's really been interesting chatting with you. Thank you so much for being with us, Dr Chrisler.

Dr.Joan Chrisler: I enjoyed it.

Speaker 3: Critically Speaking, hosted by Dr. Therese Markow, is produced by Turnkey Podcast Productions. Music by Matthew Mc Gaughey. Look for more episodes of Critically Speaking at iTunes, Google or your favorite podcast app. And don't forget to follow us on Twitter @CritiSpeak