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A dietitian at the University of Illinois Chicago is pushing for the word “obesity” to be removed from public health discourse.
An article published by the University of Illinois Chicago School of Public Health says that focusing on preventing obesity has led to an increase in “weight stigma” and negative health consequences for obese people. In the article, author Amanda Montgomery, a registered dietitian and a member of the “Collaboratory for Health Justice” at the School of Public Health, claims that instead of “focusing on the narrative that weight is controllable and a personal responsibility,” experts need to shift toward an “understanding of weight stigma as a social justice issue.”
Montgomery’s first complaint against the current “weight-based approaches to health” is that focusing on body size is rooted in racism. “Around 81 percent of societies historically have favored people in larger bodies,” she claims, citing research. “Larger bodies signified wealth and prosperity while thinness signified poverty and weakness. However, this began to change due to racism and eugenics. Charles Darwin and other race scientists created a hierarchy of civilization, placing white men on top and people of color, specifically black people, at the bottom, considering them to be ‘less civilized.’ Fatness and differing body characteristics were used to justify lack of civilization: fatness used as a marker of ‘uncivilized behavior’ while thinness was ‘more evolved.’ This idea was maintained throughout the United States in the 19th and 20th centuries, as a way to justify slavery, racism and classism, and control women through ‘temperance.’ This ideology has perpetuated Desirability Politics- where thinness and whiteness are given more access to social, political and cultural capital.”
In addition to this, Montgomery claims that the Body Mass Index (BMI) scale is a flawed metric of health, that focusing on weight under-diagnoses thin people and misdiagnoses larger people, and that weight loss research is also flawed.
Further along in the article, Montgomery assails the idea of dieting and weight loss itself. She writes that food restriction has harmful effects on our body, noting that oftentimes while dieting, the body will undergo changes in reaction to lower food intake. She also notes that people on diets experience weight cycling, or repeated gains and losses in weight, and that eating disorders and “disordered eating” are increasing. Montgomery also claims that there is not a cause-and-effect relationship between weight and health outcomes, that “weight stigma” is harmful to health.
Montgomery then claims that the focus on weight ignores systemic injustice. “Though lifestyle factors such as nutrition and exercise are important, it is essential to note the historical racism and injustices within our current food environment,” she writes. “The U.S. food system is built on stolen land using stolen labor from Black and Latinx indigenous people. Not only has this created a large scale food apartheid and trauma for people indigenous to this land, it has caused a disconnection of indigenous people from their cultural practices and identities.”
Montgomery then suggests that “public health needs a weight-inclusive approach.” Stating that “bodies come in all sizes,” she recommends a “Health at Every Size approach” that focuses on the “root causes” of health. She suggests that public health officials “work to increase health access, autonomy, and social justice for all individuals along the entire weight spectrum.” To accomplish this, she recommends that people change their everyday language from “obesity” to “people in larger bodies.” She also recommends replacing weight-based assignments in classrooms, analyzing “fatphobia” in clinical research and exploring “internalized fatphobia.”