I think, therefore I am: Part Four

Can one be said to be against discrimination and an advocate of discriminated peoples, while furthering the very stereotypes and prejudices behind their discrimination? During the Civil Rights Movement, the answer would have been obvious: of course not. Today, however, advocacy is used as a marketing tactic to promote products, services and various agendas by taking advantage of false stereotypes and prejudicial beliefs.

As the Civil Rights Movement understood, prejudices and social stigma have to be changed, as those are what lead to the action of discrimination. There’s no more essential place to begin to raise awareness, educate and fight those prejudices than among those being discriminated against. It’s the key to erasing the internalization of the negative stereotypes that can most adversely affect health. As is increasingly being shown, it is the internalization of prejudices and negative social stigma directed at oppressed people that is most often related to health problems.

According to Teaching Tolerance, the educational project of the Southern Poverty Law Center in Montgomery, Alabama: “During the Civil Rights Movement, black children would get picked on at school and when they got home they were told ‘black is beautiful and you’re fine just the way you are.’”

It would have been unacceptable to reinforce the prejudicial beliefs of that era — which sought to stigmatize them as being of lower intellect, lazy, psychologically unstable with criminal tendencies, and physically undesirable and diseased — by proposing solutions to the “black problem” like special screening of black children for low IQs and mental problems, segregating black children to special exercise camps and boarding schools; and alleviating their discrimination through the use of skin whiteners, hair straighteners and surgeries to make them more white and socially acceptable.

Yet that is exactly what is being done to fat children and adults.

Teaching prejudice

Fat children get teased at school and when they come home they hear they should watch their weight, eat healthier and exercise more, and need continual disease monitoring, noted Teaching Tolerance. Or worse, they’re whisked away to fat camps or teens to bariatric surgeons.

As Teaching Tolerance Magazine reported, fat children not only face unrelenting prejudice and harassment from peers and teachers, their school days are filled with health messages on the dangers of obesity and need for healthy eating and exercise to prevent obesity and chronic diseases of aging. The message sent to fat children and adults is that they are damaged and need to change to be acceptable, said Dr. Michael Loewy, Ph.D., assistant professor at San Diego State University. According to Teaching Tolerance, childhood obesity programs have led many heavier children to hate their bodies and say they’re afraid they’re going to have a heart attack. Students reported that efforts “eliminating vending machines, serving salads for lunch, and increasing their gym time have increased their fear.”

It’s unpopular today to publicly promote the idea that fat is beautiful, let alone that body shapes and sizes are primarily natural diversities and not a measure of health or behavior. Larger children and adults never hear, as was known among the abundant Rosetans and through most of human history, that larger people can be as healthy and happy as anyone else. We can learn from the experiences of other discriminated groups to help children of all diversities feel accepted.

Prejudices are learned, and at very young ages, and education can bring awareness of the false beliefs behind stereotypes of groups of people. The first step to ending any prejudice, said Teaching Tolerance, is education and confronting the misinformation that supports and perpetuates it. That means teaching the soundest science and facts of fat and health, exposing the myths and stereotypes about fat people, and confronting weight prejudices. Silence and failing to challenge fat prejudice only condones and reinforces it.

Prejudices, it is well known, are most difficult to eradicate from the heart whose soil has never been loosened or fertilized by education; they grow there, firm as weeds among rocks. — Charlotte Bronte (1816-1855)

There is literally no safe refuge for a fat child or adult from fat prejudice, nor little true advocacy for them. “Unfortunately, weight prejudice continues to be culturally condoned in our society,” said doctors at Toronto General Hospital University Health Network examining body weight and body image for the Women’s Health Surveillance Report. “Weight prejudice must be made unacceptable and positive body image should be encouraged and diversity valued,” they said. “Body image disparagement, chronic dieting and exercise to improve appearance need to be acknowledged as vehicles of oppression.”

But over recent decades, health has become the main vehicle of oppression, with an “emergence of health-consciousness as an ethical principle,” wrote Dr. Roberta Pollack Seid, Ph.D. in Never Too Thin. The emphasis has shifted from focus with appearance and weight loss, to longevity and well-being. Each younger generation increasingly had no collective memory of a time when plumpness was equated with robust health, she explains. As they grew up surrounded by indictments of being fat and the belief that fat was unhealthy grew, so did the belief that fatness was brought on by overeating and lack of exercise.

“To a generation that had grown up hearing [falsely] how America’s culinary abundance was dangerous because it causes obesity and so heart disease, it was easy to make the logical leap that food caused health or disease and that American habits were unhealthy,” she said. Fat phobia took on a new slant: the idea of a ‘healthy’ diet and exercise. “The official campaign against overweight became much more potent and pervasive in the seventies because it was embedded in a larger philosophical and social change: the development of the health ethic.” Today, even young children and healthy adults fear for their health and believe they’re going to die of their fat if they don’t lose weight or if they don’t rigorously eat ‘healthy’ and exercise, and diligently monitor their health risks.

They have internalized fat prejudicial beliefs.

Predatory advocacy

Fat people have become especially lucrative targets for interests eager to take advantage of fat prejudice and heighten beliefs of obesity as a disease, a crisis, an epidemic, and caused by bad behavior and poor eating. Obesity is big business and big politics. But marketing is often couched as advocacy, of being accepting of fat people and against discrimination. According to Teaching Tolerance, discrimination is the actions that result from prejudices — beliefs about certain people, born from lack of knowledge and sound information. It is impossible to advocate for people and promote acceptance, while simultaneously fostering the very prejudices that lead to their discrimination.

Still, while marketing disguised as advocacy is nothing new, it isn’t always easy to recognize. The fact that stakeholders use patient advocacy groups to disease monger has been widely documented in the medical literature for decades. Convincing people that ordinary symptoms and variations, that are part of the normal human condition, are medical issues that need intervention — and increasingly redefining them as diseases — is enormously profitable. The point is to try and make ordinary people feel sick, said Ray Moynihan, author of Selling Disease. Inflating the numbers afflicted, exaggerating the dangers and making people feel anxious brings more customers to whatever program, diet or intervention they’re selling. But, of course, it’s not healthful or helpful for healthy people to be continually told that they are sick, he said.

Today, fat advocacy is couched as being about health, and “help” is made to appear reasonable and necessary, and in their best interests. Marketers know that people who’ve internalized fat prejudices are more fearful and anxious about their health and food; and are more ready to buy whatever remedy they promise brings hope. But, as Teaching Tolerance explains, treating people differently based on prejudicial beliefs about them, regardless of how reasonable and necessary it may seem, is discrimination.

The test of pseudo-advocacy is if it leaves people feeling anxious about an inherent physical characteristic. If the messages begin by describing an obesity health crisis and need to eradicate obesity and change unhealthy diets and lifestyles, you’re into disease mongering-ville. Listen closely to these advocacy messages and you’ll find them based on prejudices; and their solutions, themselves, are vehicles of discrimination that reinforce prejudices. Language and doublespeak cannot disguise the prejudice.

They want people to believe that working to eradicate “obesity” — and address the obesity crisis through proactive health policies towards weight reduction or healthy diets and lifestyles — are compatible with fighting discrimination, and are fat advocacy. Understanding the facts, substitute the word “obesity” with black, aged, Jewish or GLT and the fallacy of this belief becomes apparent.

In recognizing fat advocacy that isn’t, proposed obesity solutions that are specifically marketed to fat people often provide clues to what’s really being sold, by taking advantage of their internalized prejudices and anxieties. Think about these examples:

· preventive health and wellness programs, and intensified risk factor screenings (What’s the link to fat? The “fat people are unhealthy, diseased (see Obesity Paradox series) and heading for a premature grave” myth.)

· admonitions for a need to eat ‘healthy’ and eat their fruits and vegetables, and programs to tell poor fat people how to eat (What’s the link to fat? The “fat people eat junk and are too stupid to understand nutrition” myth. This one sometimes follows the co-opting of “diets don’t work” by claiming their suggestion isn’t a diet, but “healthy eating.”)

· programs addressing the “obesogenic” environment to make ‘healthy’ eating and activity compulsory, and restrict access to bad food and sedentary activities (What’s the link to fat? The “fat people are irresponsible and gluttons and sloths” myth. This one is sometimes followed by feigned understanding that obesity isn’t their fault — “fat people can’t help but have unhealthy diets and lifestyles in today’s environment.”)

· psychological help for overeating “issues” and “food addictions,” and the promotion of long-standing diet techniques that attempt to restrict eating, such as filling up on low-calorie foods, intuitive/mindful eating, or counting grams and calories (What’s the link to fat? The “fat people have psychological problems and all overeat” myths.)

· and of course, weight loss interventions, from diets, pills to surgeries (see sidebar) — to “help them feel better about themselves and spare them from further weight discrimination and stigma” (The message is clear: You are not acceptable as you are. Rather than acceptance and promoting positive, healthful body images, this uses fat hatred against themselves. It’s the “obesity is a choice” myth, as well as diets work myth.)

True advocacy, as Teaching Tolerance and the lessons of the past have taught, works to dispel prejudices through education. It empowers discriminated people with sound facts, positive health messages and a supportive, accepting community. Big Liberty wrote a thought-provoking article earlier this year examining fat prejudice and oppression amidst veiled health messages:

Fat people are in a semi-unique situation, when one undergoes the study of historically oppressed groups. No matter how ‘hard’ he works, a black cannot become non-black, a Jew not a non-Jew, a gay not a non-gay, a woman not a non-woman (all of these have qualifying arguments that I’d be happy to supply at request...). So we’re facing an opposition that claims if we don’t bear our cross-by-birth, dieting, we are bad, ugly, and immoral. The scarlet letter is bright, and apparent to all: they know us for who we are. How we got there is irrelevant...

[T]here are some out there who are more honest about it than most. Instead of insidiously suggesting that we should just cut out the soda and get out butts off the couches for a 10-minute daily walk, they say things like, “Yeah, we should just ship all the fatties to a concentration camp,” or “he/she could use a little anorexia.” We should listen very carefully to these people, because they’re merely the extreme product of a culture which shoulders some of us with a diet cross, and not others.

Weight discrimination continues to increase, despite the facts that people have never been healthier and are living longer than at any time in our history, our diets and food supply have never been better, and claims of an obesity epidemic are greatly exaggerated. But prejudices are beliefs based on misinformation, not facts, and discrimination is acting on those beliefs.

A study in the current issue of the journal Obesity examined experiences of size discrimination reported in the National Survey of Midlife Development in the US. A full 12% of Americans reported experiencing size discrimination (up from 7% in 1995, even while there’s been no notable change in weights or obesity rates over the past decade, according to CDC National Center for Health Statistics data). The National Slimming Survey in Britain reported that 90% of fat women reported feeling like second class citizens. The director of the report said: “Overweight people receive a constant barrage of criticism and abuse and have never been more persecuted.” Discrimination, based on nothing more than prejudices, pervades every facet of daily life, including social and public settings, employment, education, housing and healthcare.

As history has taught, discrimination will never end as long as the underlying prejudices are allowed to continue. We can start with some actual science.

© 2008 Sandy Szwarc