Fat acceptance as social justice

Abstract

CMAJ | SEPTEMBER 7, 2021 | VOLUME 193 | ISSUE 35 © 2021 CMA Joule Inc. or its licensors T he fat body has long been a site of medical surveillance, and this has not changed during the COVID-19 pandemic. Early research focused on linking fatness with more severe disease outcomes,1 yet many have questioned the strength of this association, including within the pages of this journal.2,3 F a t c o m m u n i t i e s , s u c h a s t h e National Association to Advance Fat Acceptance (NAAFA), have contested society’s stubborn generalizations that associate fatness with disease and poor health outcomes, and push back against the assumption that fat people have little regard for themselves or their own well-being. They argue that thinking about obesity as a disease or medical risk (such as for severe COVID-19) contributes to stigma because it positions larger bodies as drains on an alreadytaxed health care system. The NAAFA mobilizes the term “fat” in its fight against weight discrimination and fatphobia in all aspects of life, including in employment, health care and education. Similarly, as social scientists, we use the term “fat” rather than the deeply problematic medical term, “obesity,” which causes harm to people under the guise of benign objectivity. Categories can shape how individuals view themselves, as philosopher Ian Hacking has argued; they reinforce judgments about people who do not conform to a norm. Thus, “obesity” is not merely a statistical category, but is rather an evaluation about what constitutes an ideal weight. To “fatten” a category, Mollow and McRuer explain, “means examining it through the lenses of fat studies and the fat justice movement.”4 Scholars of fat studies understand fatness as a way of thinking about bodily diversity.5 This literature maintains that fatness should be uncoupled from pathology, as such framings attach fatness to a sense of moral weakness and failed citizenship, and can fuel stigma in various settings, even health care.6 Such an uncoupling is increasingly supported by medical and population health research, which suggests that people who are labelled obese are not necessarily unhealthy.7 Larger bodies have been associated with heightened health risks, chief among them rising rates of chronic illnesses such as diabetes, cardiovascular disease, hypertension, mental illness and some cancers.8 Early in the pandemic, research identified a link between largerbodied patients and higher mortality rates from COVID-19, as well as more severe COVID-19 that required mechanical ventilation.9 As the authors of a recent meta-analysis on obesity and COVID-19 have cautioned, however, body weight may not be an independent predictor of poor health outcomes.10 Such findings are echoed by the recently developed Canadian Adult Obesity Clinical Practice Guidelines, which acknowledge the complex relation between weight and health, and link a person’s overall health and well-being to health markers such as blood pressure and sugar levels, which can be normal in larger-bodied people.7 Thus, a fat person might be at risk of a particular health condition, but the move to think about a person whose body mass index categorizes them as obese, or worse, “morbidly obese,” as generally unhealthy does little to promote the health of the person sitting in the doctor’s office. Scholars of fat studies also point to the ways in which obesity is racialized, as higher levels of obesity are often associated with already marginalized communities. This is particularly important for the medical profession, given that physicians and other allied health professionals have recently engaged in efforts to challenge the HUMANITIES | MEDICINE AND SOCIETY