Reader Poll Update :: The "F" Word

by Ashley Solomon

Did you get a chance to “weigh-in” (pun intended!) in on the debate about the “f” word? If not, check it out here.

I was totally in love with all of the comments offered in the debate. It’s what I love about the world of social media – it opens us up to enriching discussions where we can learn so much from disparate views.

So, as promised, I wanted to offer my own thoughts on this topic. Like many of you, my reactions and opinions shifted somewhat as I thought about the various aspects of this argument. However, the psychologist training in me won out and my opinion came down to answering the question, “What works?”

The problem with providers using the term “fat” to scare people into losing weight to me isn’t as much of an issue of the word, though I’ll get to that in a moment. What it ultimately boils down to for me is that using this word is an attempt to shame individual into losing weight, and we know that shame-based interventions do not work. Unfortunately, the idea of shaming people into action appears on the surface to be fairly easy and effective. However, major behavioral changes, whether individual or cultural, do not develop due to shame. As some of you pointed out, shaming others often leads them to further into a behavior – because shame generates fear and fear makes us retract in the behaviors that we know. Just look at how ineffective scare tactics are at reducing things like teen pregnancy or drug use, for instance. So if shame techniques don’t work, there’s no reason for a medical provider to use them.

Now on to the more heartfelt part of my argument. I believe that words have incredible power. While some argue that a word is just a word, I think that most of us can acknowledge that words have immense influence over our thoughts, our feelings, and our conceptualizations of the world. In fact, research on various therapies (there goes my empiricism again, damnit.), such as Acceptance and Commitment Therapy and Narrative Therapy, show us that words help shape our realities. Further, words cannot easily be separated from one another – they are inextricably linked by the connotations in our minds. Regardless of your own lack of biases, the word “fat” has taken on the connotation of “lazy”, “indulgent”, and even “stupid” in our culture. As hard as we may try, we cannot separate the word from the meaning that resonates in our minds. And thus when a provider calls a patient “fat”, (s)he also calls the patient all of these other things. Which is unprofessional, hurtful, and once again, not useful in accomplishing the ultimate goal of pushing the patient toward health.

One more point: A patient may be over what is considered his or her ideal body weight, but that does not necessarily mean the person is unhealthy. A (small) percentage of individuals considered “obese” can be considered metabolically healthy. While it’s likely that someone who is overweight does face medical issues, it’s important to consider the individual in providing care. If the person does face increased risk, then providers should bring up those health concerns. Focusing on weight, rather than health, often leads to “dieting” rather than lifestyle changes, and we know DIETING DOESN’T WORK!

So those are my thoughts. Thanks to everyone for weighing in, and please continue to do so below. Disagree with me, please! I’d love to hear more on this…

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9 Comments to “Reader Poll Update :: The "F" Word”

  1. I agree with you for the most part. I wouldn’t want to say “you’re fat” as a label or category for the person. However, I wouldn’t want to stigmatize the word “fat” as a no-no word, because “fat” is a legitimate word. I’m thinking of a sentence like…”x% of your body weight is fat”, and referencing fat cells, fat deposits, etc. Being overweight is because of excess fat, right? I guess what I’m saying… the person is not fat, the person has fat. I just can’t imagine a physician saying to me “this amount of pudgy-wudgy, doughyness, gushyness,spare tires, love handles, muffin top, around your midsection is a risk factor for your health”. But yes, please don’t call me “fat” as a description of me as a person.

  2. Actually I agree with you, lol.

    But April brings up a good point, about “fat” vs. fat. In fact, I quite like how she put it. Maybe instead of calling *people* fat, doctors could point out that their excess fat is a health risk. Do you think that would make a difference, if it were worded correctly?

  3. The comments thus far are interesting. I agree that we need to separate “fat” as a word describing a person’s identity from “fat” describing something our bodies have (and need, to a certain extent!).

    I am wondering if the solution is perhaps not to stop using the word “fat” entirely, but rather attempt to reclaim it, or de-stigmatize it if you will. In other words, make the word no longer shameful. I think this might be useful because think about how many women don’t get enough dietary fat in their diet, solely b/c they assume eating fat will make them fat, and being fat is a “bad” thing. If we take the stigma out of the word “fat,” we then can open up a dialogue about the ways that fat – in our diets and on our bodies – isn’t always bad, and sometimes is necessary!

    Easier said than done, of course.

  4. I’m loving these thoughts. I like the idea of working to de-stigmatize the concept of “fat”, as, like you all point out, “fat” (as a noun) is a necessary and normal part of being alive. In terms of the adjective, I think that some of what we’re talking about here relates to the work that the Fat Acceptance movement is doing. If you’re interested, you can check out one naafaonline.com for some information.

  5. Ashley, I looked at the NAAFA website. Interesting, and so so wrong in my opinion. I do not agree that being overweight should ever be considered the norm, it’s unhealthy and diminishes people’s quality of life. I’m not talking about those extra 20 baby lbs, but more in the obese category. Current statistics on diabetes and obesity say that this generation will have a shorter life span that our parents. That’s just so crazy to me!

    • While I’m not a member (and actually fairly new in my knowledge of NAAFA), I support the mission of this organization in terms of its focus on acceptance of all people, regardless of size. I will give you that NAAFA may be extreme in some of its views and tactics – but the overall message of inclusiveness and considering the individual circumstances of the person (rather than simply size) is something I agree with. I also agree with you that the rate at which obesity-related health issues are rising is really alarming for all of us, because we’re all affected (as you pointed out yesterday). I think the difficulty comes in when we have to walk the line between acceptance and change. As I said in a post a while back, I don’t think “fat acceptance” has to occur to the exclusion of change. It just gets a bit more complex.

  6. Definitely interesting comments! I just wanted to add that being a certain size is not inherently unhealthy. I think people often forget that you can’t judge someone by their appearance. For instance, someone who looks fit and lean may be very unhealthy. They might have a fast metabolism and lead a very sedentary lifestyle, without giving their body important nutrients. Or they may suffer from an eating disorder. On the other hand, someone who’s considered overweight may lead a very healthy and active lifestyle. But genetically they’re predisposed to a certain weight and shape. I get upset when people assume that someone’s weight or shape is indicative of their lifestyle. This contributes to a lot of stigma, which is very unfortunate. To me, the focus should be on engaging in healthy habits.

    OK, sorry, end rant. 🙂

    And I totally agree with you on how the word “fat” has so many negative connotations, which is also really unfortunate.

    Great post!

  7. Ashley, to note on your point of “overall message of inclusiveness and considering the individual circumstances of the person” – that applies to everything, religion, sex, national origin, skin color, etc. I think that’s a message we should all keep in mind no matter what differentiates the person from us (except for politics – no acceptance there!!!! kidding. maybe).

    Margarita – yes, size is not an indication of health, just a very strong correlation.

    On a slightly related note, one of the issues I’m very passionate is availability of nutritious foods and eradication of so-called food desserts. In DC, where I live, the difference between neighborhoods is tremendous. Where I live, there are 2 supermarkets within walking distance of me, and the ratio is one supermarket per 7 500 residents. Once you get to very poor neighborhoods, the ratio can go up to 75 000 per supermarket. The only food available to those people is fried chicken and 711. Pretty much your definition of a food dessert if there ever was one. Add to that school lunches full of fat and sodium, and you get a population with tremendous obesity rates and health problems. Those people didn’t even have a chance. It breaks my heart, and I hope Michelle Obama’s programs will change some of that. So when I see an organization like NAAFA with their ra-ra about “hey, come to San Fran on your expensive airline ticket and celebrate being overweight/fat/obese/whatever” it just really turns me off. Rant is over.

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