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Weighing in on anti-fat bias

By Sonya Hansen MD

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With three quarters of Americans struggling with weight, the stigma attached to being overweight must be addressed. Anti-fat bias is a negative implicit attitude and belief toward overweight persons who are perceived by others or themselves as unattractive, dull-witted and weak-willed.

How do you know if you have an anti-fat bias? Have you ever thought, “Heavy people are fat because they just don’t eat right” or “If they would only just take better care of themselves…”? Do you see a heavy person and think of them as lazy, dumber or less educated? If yes, to any of the above, you have an anti-fat bias. You’re not alone. Negative attitudes against overweight peers have been observed in children as young as age 3, and unfortunately, we don’t outgrow it. It shocked me to learn that the biggest source of such a bias came from the very people who are supposed to love, guide, help you and from the one that should love you unconditionally, yourself.
The bias came from spouses, family and friends and then teachers, nurses, doctors and therapists. But probably the most harm comes from the person’s own bias. I hear it everyday in my practice when I try to identify barriers to weight loss. “I’m lazy” “I never follow through” “I always end up quitting.” These words come from smart, driven, successful people. When asked, “are you lazy at work?” They laugh, “No, of course not. They wouldn’t know what to do without me at work.”
Let’s say you gain some weight due to puberty, pregnancy, depression, injury, menopause, medicines (anti-depressants, prednisone, diabetes drugs and many more) Weight gain raises your own body’s natural insulin levels. High insulin levels result in an altered metabolism. Calories from food are preferentially stored as fat and there’s little left for much else. Heavy people also don’t sleep well so they have less energy. Their joints may hurt, so it’s no fun to go jogging. Combine that, with an increase in hunger driven by the high insulin levels and you get a vicious cycle of less exercise, increased food intake, lower metabolism, weight gain that is truly hard to break out of. And it says absolutely nothing about your character that you can’t fight this disease with just your willpower.

Luckily, the new medicines that are available decrease insulin levels reversing this abnormality. You may run into one of my patients doing her 5 mile daily walk. See, now that’s she’s so much lighter, she too loves to exercise.
If you’re the parent, spouse, teacher, nurse, doctor, therapist, friend, or if you think poorly of yourself for being unable to shed the weight, I invite you to help end the bias. We can only abolish it if we can first accept that it exists. Then, we will abolish it, once we realize that it has no basis in fact.


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