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Content warning: discussion of fatphobia, weight stigma, disordered eating, bullying Originally published in Therapy Today, June 2021 edition (Volume 32, Issue 5) and on the BACP website. Please note, this article was published some time ago and some of my ideas may have changed or developed, and language may be outdated. I have added asterisks in to the word ob*sity to reflect the harm caused by medicalised language.  As a child in the early 1990s, I had free school dinners. As I clutched my special token, waiting for my slab of pizza and green custard for dessert, I knew for the first time that I was different. People thought I was poor, but – even worse – they thought I was fat. I was told to ignore the people who bullied me (the old ‘sticks and stones will break my bones’ motto) but my worst fears were confirmed by the school nurse. I was not normal. The BMI (Body Mass Index) chart showed that I was too fat and I had to lose weight to get to the ‘normal’ category as soon as possible. The BMI chart, I was later surprised to find out, was designed in the 1830s by a mathematician and it wasn’t intended as a measure of health for individuals. It was also largely based on white, male, European body shapes, and made no provision for sex or cultural difference.1 It’s shaming and dangerous, according a recent report from the Government’s Women and Equalities Committee.2 The school nurse suggested I start exercising and try to eat healthily. She’d made a common assumption, based on the myth that fat people don’t eat well or exercise. I was doing dance classes twice a week, plus step aerobics and Mr Motivator (the coolest way to exercise in the 1990s). Unfortunately, these assumptions about fat people didn’t stay in the 1990s. Today the same simplistic assumptions are made and many hold the view that fat people should simply eat less and take more exercise. This even includes our Government, whose ‘war on ob*sity’ campaigns are not only ineffective but potentially dangerous. Fat equals stupid? Ob*sity is a complex issue, influenced by many factors, including genetics, environment, culture and trauma, with poverty being a prominent predictor. I’ve noticed a wave of seemingly compassionate people making this connection and blaming cheap, processed food. This suggests that, if healthy food were cheaper, ob*sity would just disappear. The first problem with this approach is that it’s too simplistic – fruit and vegetables are already cheap from many greengrocers and it doesn’t make people want to munch on a carrot instead of a chocolate bar. Second, it’s based on the patronising belief that working-class people simply need educating, implying that we’re so stupid that we don’t know how to feed ourselves correctly. As a child, I spent every weekend cooking with my Italian grandmother, mainly because I had no friends (because of being fat) but also because I loved food and cooking. Everything we ate was fresh from my grandfather’s garden – homemade, unprocessed, hearty goodness. Ironically, I was eating less healthily when I ate diet bars and shakes, which I thought I needed in an attempt to compensate for the large Italian meals. It took many years to recognise these as restrictive and compensatory behaviours, and to realise the amount of anxiety I felt around food. I was always either ravenously hungry to the point of feeling faint, or stuffed full to the brim with stomach cramps. I was in a binge and restrict cycle without even knowing it, starting from about six years old. I thought all of this was completely normal. I also knew that being fat was the very worst thing I could be and that I’d need to do anything and everything to avoid it. I tried to override my hunger signals and told myself that I would be so ‘good’ and ‘strong’ if I hardly ate. Isn’t it strange that we don’t trust our bodies to tell us when we’re hungry? Yet we’d never ignore the signals that tell us we’re cold or that we need to go to the toilet. As babies, we cry, we get fed, then we stop crying when we’re full. Then, as we grow, we’re told to finish everything on our plate even if we’re full, and we’re introduced to ‘good’ and ‘bad’ foods. We’re taught to override our natural instincts. And then there are the beauty standards – women in the media, films and TV who are not too thin but not too curvy, sexy but still innocent, beautiful but unthreatening, confident but submissive. Fixing the problem The problem isn’t for fat people to fix – it’s much bigger than that. It’s about inequalities, austerity, discrimination, trauma and a hugely underfunded mental health system. It’s the family cycles of behaviour and trauma that can create difficult relationships with food. It’s the difficult home life and family experiences (such as domestic violence, addiction and abuse) that are more likely to affect the poorest children. It’s also a society that tells fat children that their bodies are wrong and that it’s their fault, or blames their parents, and encourages anything to get rid of the weight, however dangerous – diets, pills, barbaric bariatric surgery. It’s about a society that would rather blame fat people than look at what is really going on. The food industry spends millions encouraging us to eat more processed food than ever, while the diet and fitness industry tells us to lose weight. This push/pull keeps many people stuck in cycles of guilt and shame, while their weight fluctuates, with the anxieties and health implications that may come with that. Despite Government campaigns, ob*sity rates are not decreasing. The solutions so far have been short term, encouraging increased fear and anxiety around food and increasing stigma towards fat people. Shaming people into losing weight simply doesn’t work. In fact, it’s more likely to exacerbate difficult relationships with food as they search for further comfort, coping mechanisms and control. The recent report from the House of Commons Women and Equalities Committee concluded that the Government’s ob*sity strategy has failed to ‘promote healthy behaviours’ and could be ‘contributing to body image pressures’.2 It identified that the use of BMI as a measure of healthy weight has become a kind of proxy or justification for weight shaming, and called for the Government to immediately scrap its plans for calorie labels on food in restaurants, cafés, and takeaways, and to urgently commission an independent review of its Ob*sity Strategy and ensure its policies are evidence-based. Fatphobia In Love’s Executioner, Irvin Yalom is explicitly honest about his disgust at his fat client, Betty. I was both shocked and impressed by his honesty but ultimately was disappointed that the success of the client was measured by her weight loss. He recognises his weight bias but does nothing to challenge or change his own views – Betty loses weight and he puts his arms around her, seemingly delighted that his hands can reach. Even in Susie Orbach’s Fat is a Feminist Issue, fat is something that is pathologised – women especially are seen as psychologically unhealthy if they’re fat. There are strong links between trauma and disordered eating, but working on the trauma does not guarantee a client will lose weight. When I started to explore my relationship with food and unpack my trauma, I became happier and healthier, but not thinner. I worked on finding acceptance for myself as a happy, healthy, fat person, which is still seen as a radical act in our society. My body image problems were just the surface level of my deep-rooted low self-worth. My body image issues were part of a lifelong self-esteem deficit that affected my mental health, my relationships and my career choices. Growing up, I capped my ambitions to protect myself from more hurt, convinced that a short, fat girl from the Midlands couldn’t make anything of herself. That’s now incredibly sad to write. I just want to reach out and hug that young me who thought she was worthless. Weight stigma and fatphobia are prevalent in our culture and it’s arguably more harmful to health than actually being fat. If counsellors are compliant with the pursuit of happiness presented as thinness, we’re only reinforcing the myth that clients would feel better if they just lost a bit of weight. We need to delve into the unconscious biases we all hold towards fat people, question where they come from and then actively work to challenge them. Fat counsellors aren’t immune to this – in fact, internalised fatphobia might mean these biases are even stronger. If counsellors collude with the view that weight loss is always a virtuous pursuit, they’re complicit with a cycle of harm that keeps clients from finding their true self-worth beyond how they look. References 1. Gordon A. The bizarre and racist history of the BMI. Medium 2019: 15 October. http://bit.ly/2ZhiroN 2. Women and Equalities Committee. Changing the perfect picture: an inquiry into body image. Sixth report of session 2019–21. London: House of Commons; 2021. https://publications.parliament.uk/pa/cm5801/cmselect/cmwomeq/274/274.pdf
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