Nearly every time we publish a photo of a plus-size person in a Refinery29 article, we get a slew of comments — not about the actual content of the story, but about how we're supposedly doing our readers a disservice by "normalizing" obesity and unhealthy behaviors. And when we announced that we were recommitting to
the 67% of women who identify as a size 14 or above last week, this was especially true.
Sadly, no matter how many times we make it clear that
concern-trolling and fat-shaming are both misguided and harmful, these comments continue to surface. And the problem is, they shift the conversation from one about representation to one about fear-mongering assumptions about the health and safety of plus-size people.
Here's the thing: It's wrong to assume you know anything about an individual's health simply by the way they look. This is a
tired conversation, but clearly one that bears repeating. At Refinery29, we're committed to making sure that all people — including the 67% of us who are plus-sized — are represented and understood. So, ahead are three facts to keep in mind the next time a conversation around these issues turns toxic.
Size, weight, and body mass index (BMI) are not necessarily indicators of health. People are quick to judge someone's health because of the size of their body, but the reality is that there are many other factors that contribute to health besides BMI, says Rebecca Puhl, PhD, deputy director for the Rudd Center for Food Policy & Obesity and professor in the department of human development and family studies at UConn. "For example, there are people who have a thin body size who engage in unhealthy behaviors that aren’t visible from their physical appearance, such as unhealthy eating habits, smoking, or excessive alcohol or drug use," Dr. Puhl says. On that same note, there are certainly people with a BMI of 25 (which is considered "overweight") and higher who eat healthfully, exercise, and have good blood pressure and cholesterol, she says. (Wondering why many doctors still use the flawed BMI metric? So are we.) There's also a belief that people who are heavier or obese don't take care of themselves, which is based on blanket assumptions, rather than fact, explains Scott Kahan, MD, MPH, director of the National Center for Weight and Wellness, and faculty member at the the Johns Hopkins Bloomberg School of Public Health. "We don’t know where people are in their weight journeys, and we don’t know what behaviors they're doing or not," Dr. Kahan says. "We certainly don’t know how much attention they put into it simply by judging what they look like, or what their size is, or their weight is." And given that genetics account for at least 50% of the likelihood of gaining weight and developing obesity, there's at least a 50% chance that critics don't know what they're talking about. "With any other health concern, you can’t look at somebody and say, 'This person has cancer ,'" explains Ted Kyle, RPh, MBA, chairman of the Obesity Action Coalition. "Really, you have no business diagnosing based on what [a person] looks like."
Only your doctor can measure your health — and even they might be biased. So, if you can't measure a person's health just by looking at them, how can you? The only way you could get an accurate read on a person's health is by a careful clinical assessment by a healthcare professional who can "look at the whole person," and take many other factors into account, Dr. Kyle says. For example, factors like stress, sleep, sedentary lifestyle behaviors, and substance use are important factors that affect health, Dr. Puhl says. "Genetic and biological factors certainly affect our health and susceptibility to illness, which again, are not visible characteristics in our physical appearance," she says. And the only person who can make an informed judgment about someone's health is their medical provider who can evaluate all this information together. Unfortunately, there's a tremendous amount of bias and discrimination that comes from doctors themselves, when they're treating a patient who has a higher BMI or is obese, Dr. Kyle says. ("Obese" is a loaded term we don't normally use, but it's also a precise classification in the medical field.) Micro-aggressions from doctors can range from recommending different treatment s simply because they assume factors about a larger-bodied person's lifestyle, to tracing any sort of ailment back to the patient's weight, according to the American Psychological Association. Other research has shown that when people confront bias from their doctors, they're more likely to delay going to the doctor again. So, it's important to be an advocate for your own health, and you should feel empowered to speak up if anything (like getting weighed at the doctor's office) makes you feel uncomfortable or singled out.
What is detrimental to people's health? Concern-trolling. It’s not only inaccurate to judge and blame each other based on physical appearance, it’s counterproductive and harmful, Dr. Puhl says. "We should be promoting a culture of support and empowerment, rather than one of shame and stigma," she says. In a study that was published earlier this week, Dr. Puhl and her colleagues found that people living with obesity tend to internalize the bias against larger bodies, and assign stigma to themselves. "That's one of the biggest problems with this condition: that it leads to a lot of judgements, whether they're egregious, negative shaming or more subtle conclusions," Dr. Kahan says. Other 2017 research has shown that fat-shaming is linked with a greater risk of developing diseases like diabetes and heart disease. But it shouldn't take a scientific study to tell you that concern-trolling and fat-shaming are both harmful and wrong — or that, even if someone isn't healthy, that doesn't mean they have any less value as a person. So, the next time a conversation about bodies take a turn for the worse, just remember: You can't assess someone's health simply by looking at them. But you can help create a more tolerant, empathetic, and — yes — healthy world by embracing all bodies.