Pathologizing Fat
We’ve been pathologizing Fat for so long that we’re no longer able to see the wood from the trees. Take a journey with me through the timelines, and you’ll soon realise it’s not at all what we think it is.
Why Are We Pathologizing Fat?
The more I think about the multiple issues Fat people experience trying to access healthcare, the one idea I keep returning to is that despite our complex conversations about fat and body image, many of us hold a very simplistic belief that fat is bad. This belief is deeply ingrained from an early age, which is why it is an almost childlike belief.
“Bad” can mean a lot of different things, but it tends to evoke a similar emotional response. Bad is the opposite of good. And we want to be good, which means we don’t want to be bad.
And if being Fat is bad, then becoming thin must be good.
So, if I’m thin I’m good, and if I’m fat, I’m bad.
But Why Though?
Even though many of us are starting to challenge this belief, this binary, black-and-white thinking persists. Because we were kids when we learned it, and we’ve been receiving the same messages ever since.
There are many reasons why people think fat is bad, and many of these reasons are not related to health. If you haven’t already read “Fearing the Black Body” by Sabrina Strings or “Belly of the Beast” by Da’Shaun Harrison, I highly recommend these books. They cover the multitude of reasons that society has deemed fat is bad.
Spoiler alert: they are all rooted in colonialism, white supremacy, and anti-Black racism.
The Origin Story
Today I want to talk about how the medical profession has and is pathologizing fat. It started with eugenics. Adolphe Quetelet, a Belgian statistician and social scientist, was a key figure in this movement.
Eugenicists believed that one could improve the white race through scientific means (such as controlled breeding). Their main aim was to promote desired traits and eliminate perceived undesirable traits through scientific means.
Gross, right? But hardly surprising that this is where the pathologization of fat started.
The Average Man
Quetelet’s work focused on the “average man” and established ideals based on height and weight. He only studied white European men, because women and non-whites could never be ideal.
As far as Quetelet was concerned, deviation from the average was seen as less ideal. I personally believe that average is boring and difference is essential for the human race to survive. But what would I know?
Quetelet wasn’t the only eugenicist to hold strong beliefs about weight and desirability.
The Cereal Guy
In the late 19th century, Dr. John Harvey Kellogg, whom you might recognize from Kellogg’s cereals, founded the Battle Creek Sanitarium. He was a Seventh-day Adventist and part of the temperance movement. He believed that food, alcohol, and even masturbation were sinful and bad for health.
Kellogg was responsible for pathologizing a lot of things. He combined his religious and eugenics beliefs into medical propaganda, promoting the idea that reforming the nation’s women was essential for preserving the superior Anglo-Saxon race in his book “A Lady’s Guide in Health and Disease”. This book advocated for temperance and warned women against being fat.
Side note: Kellogg also organized the first National Conference on Race Betterment in 1913.
Health and Morality
This history of eugenics, race science, and Christian hegemony has significantly influenced the pathologizing of fat. The closer you look, the more you realise just how much these historical beliefs continue to impact our perceptions of fat and health.
Dr. Lulu Hunt Peters was another doctor who influenced the pathologizing of Fat. She had a newspaper column called “Diet and Health,” which she followed up with her best-selling book, “Diet and Health: with Key to the Calories.”
She’s the reason we continue to obsess over calories today.
From what I can tell, Peters was a Fat child. She believed thinness was a sign of self-esteem as well as physical health, and that fatness was morally suspect. She explained her theories through the language of sin, punishment, and redemption.
Her beliefs were also influenced by the time of the First World War, claiming that denying yourself food was patriotic and helping the war effort;
“Every pang of hunger we feel we can have a double joy, that of knowing we are saving worse pangs in some little children, and that of knowing that for every pang we feel we lose a pound”.
How Money Shaped Our Beliefs
So, we started with eugenics, then brought in religion, patriotism, white nationalism, and other ideologies. At the turn of the 20th century, along came a man named Louis Israel Dublin. He was a well-respected public health pioneer, and played an important role in the growth of the American Public Health Association.
According to his obituary published in Journal of Public Health; “In the field of life insurance, Louis Dublin made major contributions to broadened and socially useful underwriting practices”.
Did I mention that Louis Dublin worked for the Metropolitan Life Insurance Company?
In 1930, he published “The Money Value of a Man,” during which he stressed that being Fat was a threat to longevity. It doesn’t get more pathologizing than that. Alongside his team at the MLIC, he provided measures and dimensions that could predict the length of life and the potential for chronic disease.
Money, Money, Money
Insurance companies flourish when they can charge higher premiums to people with a poorer outlook. Dublin had an illustrious career, working for the Metropolitan Life Insurance Company while also being considered an expert in public health. I would argue that this was a serious conflict of interest. However, this was 1930, and no one cared.
From its inception, public health and the private sector were very much intertwined. The Metropolitan Life Insurance Company, alongside Louis Dublin and his team, developed standardized height/weight tables.
And until the mid-1980s, medical professionals depended on these tables.
Height/Weight Tables
The first set of standardized tables was published in 1942, providing the “ideal weight.” In 1959, they published the second set of tables, entitled the “desirable weight.” Note that the concept had evolved from ‘ideal’ to ‘desirable’ weight, moving one step further in defining societal standards.
By the early 1980s, it was simply “height and weight.” Forget ideal or desirable, just height and weight.
So, for decades, doctors and healthcare professionals relied on tables produced by the Metropolitan Life Insurance Company, which used these tables to charge higher insurance premiums. We doctors adopted these tables without much questioning.
We Are Pathologizing Fat With BMI
Then along came Ancel Keys, who thoroughly disliked fat people. He made a name for himself with the the Minnesota Semi-Starvation Experiment.
In 1972, in the Journal of Chronic Diseases, he published a paper introducing the term “body mass index” (BMI). He acknowledged that it wasn’t particularly accurate, but argued that it was as good as any other measure out there, so let’s use it.
He emphasized it was for population studies only. This was not to be used for individual assessment. Them in 1975, he published a book with his wife on the Mediterranean diet, showcasing his dietary theories.
BMI Becomes The Standard
Despite Key’s disclaimer about BMI and individual assessment, the Dietary Guidelines for Americans were published in 1985. And they incorporated BMI for individual assessments. Less than 15 years later, in 1995, the World Health Organization (WHO) decided to classify different BMI levels and set cutoff points at 25, 30, and 40.
The WHO used “arbitrary methods” to associate BMI with mortality, essentially drawing a graph and picking numbers. It was basic, arguably bad science.
In 1999, the National Institutes of Health (NIH) followed suit, despite opposition from many experts. Millions of Americans were suddenly classified as “ov*rweight” or “ob*se” overnight, leading to widespread disagreement regarding the scientific validity of these classifications.
BMI is Dangerous
In summary, in 1972, Ancel Keys introduced BMI for population studies only. By 1985 it became part of individual assessments, and by 1995, was used to predict health status.
Let’s be clear – the chances that the BMI cutoff points of 25, 30, and 40 are perfect numbers are highly unlikely. It’s unrealistic to assume that these numbers, being multiples of 5, hold any particular significance in terms of health. The difference between being classified as ov*rweight at 25.3 and normal at 24.9 is minuscule and arbitrary.
The problem with BMI goes beyond just its numerical values. And it affects both fat and thin individuals. Fat individuals face barriers to accessing healthcare and treatments simply due to their BMI, while some thin individuals are falsely assumed to be healthy despite having underlying cardiometabolic issues.
Thinness Sells
Moreover, the introduction of terms like “pre-diabetes” in 2001 by the PR department of the American Diabetes Association has further perpetuated the focus on weight as a marker of health. This term has been used to market diabetes drugs to a broader population, despite lacking scientific validity.
Pharmaceutical companies like Novo Nordisk and Eli Lilly have capitalized on this narrative, heavily funding organizations like the American Diabetes Association while simultaneously developing weight loss drugs like Ozempic, Wegovy, and Mounjaro.
We Need To Stop Pathologizing Fat
The FDA’s approval of such weight loss drugs, like Semaglutide, without sufficient long-term data to support their benefits or risks, further emphasizes the pathologization of fat and the glorification of thinness.
The narrative has become oversimplified: being thin is equated with being healthy, and weight loss is seen as a panacea for health issues, despite the lack of evidence to support this notion.
Ultimately, the societal conditioning that “fat is bad” has led to a dangerous oversimplification of health discussions.
There’s More to Health
We need to shift the focus away from weight when addressing health conditions. But how can we do that when there is such a pervasive belief that thinness is inherently good? Especially since this has become deeply ingrained in society?
For those of you reading this that are still stuck on the idea that fat is bad and weight loss is essential in improving and maintaining health, I wonder if you might consider suspending your reality for a moment and ask yourself this;
Despite all the efforts to prove the benefits of weight loss, why isn’t there any real evidence supporting its long-term health benefits?
Let me know what you think in the comments below 👇
Thank you for writing this. I was familiar with the ideas described, and have read FTBB once, but I appreciated getting a visual timeline and run through of the key events and people that were instrumental in tightening the straightjacket of thinness society finds itself in today.
I love me a timeline! I’m so glad it helped X
Just finished FTBB. Really interesting. This timeline really helps. Thank you for this and everything you do.
Hope you enjoyed the book and I’m glad the timeline helps.