Sizeist Microaggressions You Shouldn’t Have to Put Up With

“Microaggression,” according to Wikipedia, is a term was coined by Chester M. Pierce in 1970. Columbia professor Derald Wing Sue, who literally wrote the book on them, defines microaggressions as “brief and commonplace daily verbal, behavioral, or environmental indignities, whether intentional or unintentional, that communicate hostile, derogatory, or negative racial slights and insults toward people of color.” Some examples of racial microaggressions include statements like “But you don’t act like a black person,” or any of these others mentioned in this Buzzfeed list, or this list from American Psychologist, and this Tumblr.

Microaggressions are definitely real things that impact the lives of marginalized people of all categories. Most discussion of microaggressions focus on race, but they play a big role in size politics too. But because size is a dynamic element for most people (i.e. it might change), sizeist microaggressions tend to impact people of all sizes – those who are fat, and those who are afraid that they are fat or afraid of becoming fat. I’m personally getting really damned sick of them.

“You look great! Have you lost weight?” 

“You look so skinny in that picture!”

“God, I am a disgusting pig at this weight.”  “…You weigh less than me….”   “I mean, just because I’m not usually this weight. It’s different.” 

“But you eat healthy. I’m talking about the fat people who eat McDonalds.”

“Wow, you look great! You lost like a million pounds!”

“Just so you know, I used real butter in that recipe.”

“I used to be overweight, but I’m happy with my body now. If I was ever a size 10 again, I’d shoot myself.”

“But I don’t think of you as a fat.”

The important thing to remember is that  these micgroaggressions are committed unintentionally. For many people, these microaggressions come from the practice of fat talk – a self-deprecating way of communicating that people use to try to assuage their guilt over their eating/exercise habits, or demonstrate their social humility. It’s really unfortunate because people who fat talk think they’re only talking about themselves, and therefore only affecting themselves with their statements. They fail to realize that every time they criticize their own body or eating/exercise habits in front of other people, their words have the same impact of a microaggression.

It’s also possible that the person doing it just really has no idea because they just don’t think about weight stuff that often. For example, laughing at a fat joke on a TV show. While sitting right next to a fat person, totally oblivious to the impact of their complicit laughter on their friend next to them.

Microaggressions can result from the environment we live in too, like when clothing brands only carry up to a size 12. They can be actions rather than words, like when someone gives out free t-shirts as prizes, but only in sizes XS-L. They can happen in academia/research, like when you’re reading a book on organizational change theory and all of the examples are compared to weight loss maxims (“Just tell your team to put down the cookie, or better yet, remove all the cookies from the office!” – the cookie here being a metaphor for whatever “bad behavior” you’re trying to change).

Do you have more examples of sizeist microagressions? Have you been committing them unintentionally? And if so, are you willing to make an effort to stop?

How to promote health without being healthist

Have you ever felt suffocated by the pressure to be healthy? To eat “clean food,” run 5ks, go vegan, lose weight, tone up, eat paleo, buy agave nectar, do Crossfit, meditate, track your steps, count calories, eat organic, go paraben-free, switch to coconut oil, try acupuncture, use a Himalayan Salt Lamp, or quit sugar?

Do you ever feel like a bad person for failing to meet this standard of health so clearly articulated on sites like Pinterest?

health on pinterestWhen it’s your job to promote health, it’s also your responsibility to be aware of the barrage of health messaging out there and of the way it can make people feel: confused, overwhelmed, frustrated, insufficient, lazy, incapable, flawed, ugly, less-than, defeated, worthless, or even hopeless.

I’m going to throw out a radical thought experiment. What if I chose to be unhealthy? What if I simply opted out our contemporary culture of wellness? What if I decided that I didn’t care about longevity or preventing disease? What if I wasn’t interested in athletic pursuits? What if I was happy with my life without any of that stuff?

Would that make me a “bad” person? Would that make me less deserving of civil rights and legal protections? Healthcare? Federal or state assistance? Education? Would it make me less deserving of respect? Kindness? Compassion?

What if rejecting the active pursuit of health and wellness was a valid choice? 

Believe it or not, I do think it’s a valid choice. This may be surprising coming from a public health professional. But I think it is especially an important perspective for health professionals to have. My job is to promote health and wellness as well as to prevent and alleviate illness, violence, and suffering in the community I serve. Convincing people to care about their health and wellness is part of my job, but it’s something that has to be done carefully and thoughtfully so that I do not fall into the trap of perpetuating an oppressive culture of “healthism.”

What is Healthism?

The term “healthism” can be traced back to a 1980 article by political economist Robert Crawford, “Healthism and the medicalization of everyday life”:

Healthism represents a particular way of viewing the health problem, and is characteristic of the new health consciousness and movements. It can best be understood as a form of medicalization, meaning that it still retains key medical notions. Like medicine, healthism situates the problem of health and disease at the level of the individual. Solutions are formulated at that level as well. To the extent that healthism shapes popular beliefs, we will continue to have a non-political, and therefore, ultimately ineffective conception and strategy of health promotion. Further, by elevating health to a super value, a metaphor for all that is good in life, healthism reinforces the privatization of the struggle for generalized well-being. –  Inlt J Health Serv

Implicit in healthism is morality, a driving force behind public health since the Civil War. The sanitation movement of the 1860s and 70s was largely led by the social (and moral) reformers of the Women’s Christian Temperance Union, who fought unsanitary living conditions and prostitution in the same breath.

Sylvester Graham (of Graham Crackers) and later Dr. John Harvey Kellogg (of Kellogg’s Cornflakes) were practicing healthists in the 1880s. They believed in a connection between immorality and disease, and prescribed bland foods and abstinence (from masturbation especially) as part of a healthy lifestyle that would produce a “higher. purer, and nobler type.”

Petr Skrabanek, whose 1994 book The Death of Humane Medicine and the Rise of Coercive Healthism explored this issue, wrote that healthism begins when all human activities are judged according to their health impact, and deemed either “healthy” or “unhealthy”, “responsible” or “irresponsible”, “acceptable” and “not acceptable” based on this measure. Skrabanek goes further to claim that “healthism either leads to, or is a symptom of, incipient totalitarianism … Healthism justifies racism, segregation, and eugenic control; for the healthist, what is ‘healthy’ is moral, patriotic, and pure; while what is ‘unhealthy’ is foreign, polluted, and impure.”

In his review of Skrabanek’s book, Bryan Appleyard wrote:

Skrabanek has two arguments against healthism. First he insists that this kind of pressure and coercion amounts to a fascistic imposition on the lives and freedom of individuals.

And, secondly, he points out that most of the healthist assumptions are either not proven, wrong or highly biased. For example, he says that screening – a central doctrine of healthism – has been found to have no health benefits, but that this finding has been suppressed. And he regards the caring of the healthists as a hypocritical cover for crude authoritarianism.

‘As healthism is driven by power,’ he writes, ‘rather than by concern for the welfare of fellow men, it is devoid of any moral principles.’

, calls healthism “the new Puritanism“:

Healthism is an avenue for subliminal narcissism. There is something seductively deterministic and morally appealing about eating like a cheese-fearing vegan rabbit and looking better, living longer and getting 50 % of the insurance premium back thanks to Affordable Care Act’s Zen-sounding Wellness provisions.

In short, healthism is the new puritanism. The old puritans worked for God’s glory with a famed work ethic which, according to Max Weber, might have been the chiefly responsible for the success of capitalism.

The righteous, mirthless, po-faced, lycra-clad new puritans are forever punching numbers in to risk calculators and obsessing over arbitrary thresholds of LDL-cholesterol whilst watching the Dr. Oz show with the fastidiousness with which the old puritans internalized Leviticus, lest they miss another opportunity for a miniscule relative risk reduction.

Fall Ferguson, Assistant Professor of Health Education at John F. Kennedy University and current President of the Association for Size Diversity in Health says:

Healthism includes the idea that anyone who isn’t healthy just isn’t trying hard enough or has some moral failing or sin to account for … More subtly, healthism represents the widespread ethic of individual responsibility for health in our culture. In the debate over U.S. health care reform, we obsess over the health of individuals, whether it’s reshaping individual behavior to our liking or finding ways to pay for the expensive treatment protocols that we see as being needed because of people’s personal “failure” to care for their own health.

At best, “healthism” refers to a cultural preoccupation with health. At worst, it describes an ethical paradigm in which certain health behaviors are considered moral imperatives and a person’s value and character is judged based on their adherence to those behaviors. A person might also be denied services, benefits, and rights based on their adherence to those behaviors. This is highly problematic.

People engaged in the work of health education/promotion, public health, medicine, nutrition and fitness, etc., must be aware of the pitfalls of healthism, and try to avoid them whenever possible.

Why is healthism bad for INDIVIDUAL HEALTH?

Obsession is not healthy, even if it’s an obsession with health. Encouraging or condoning this kind of preoccupation or obsession in others can be seriously detrimental to their mental, emotional, and physical health. It’s what leads to disordered eating and exercise behaviors, as well as what some are calling “orthorexia nervosa” – a rigid fixation on food quality and purity. It teaches people to ignore their body’s signals – to “push through the pain” – resulting in injury. It robs people of time and resources that they otherwise could put towards fostering social connections, creative hobbies, community service, and other worthwhile pursuits that foster well-being and happiness.

Healthism also creates and encourages stigma, particularly fat stigma. By promoting this idea that “fat = always unhealthy” (which is just not true), fat people are singled out as failing to uphold their “personal responsibility” to maintain their health. As a result, they are labeled as “lazy,” “ignorant,” “lacking willpower,” “gluttonous,” “greedy,” etc.

Whoever came up with the idea of making dieting about health is simply brilliant. Now, society can be prejudiced, but it is ok because it’s about health. Now, you are not shallow if you focus all your attention on dieting, you are righteous. And, whoa be to you who do not diet – for thou art sinning! – Lonie McMichael in Talking Fat

If fat people are automatically “sinners” by virtue of being fat, then it becomes socially acceptable to insult them or shame them. In some cases it can even be seen as a moral imperative to insult and shame them, especially if one believes that will cause them to lose weight. But being fat does not necessarily mean someone is unhealthy. And not only is insulting and shaming people a generally shitty thing to do, it DOES. NOT. HELP. PROMOTE. WEIGHT. LOSS. In fact, it can result in weight gain. So, not only is it cruel, it’s detrimental.

laci green quoteWhy is healthism bad for PUBLIC HEALTH?

Another major problem with healthism is that it tends to focus the attention and resources of public health work on fostering individual behavior change, when we know that social determinants of health influence our health more than individual behaviors do. Public health professionals and health educators pay a lot of lip service to the socio-ecological model intended to address these social determinants.

S-E-ModelYet, due to the influence of healthism, health professionals tend to concentrate most of their efforts at the individual level. Fall Ferguson writes:

In my own field of health education/health promotion, there is a disturbing disconnect between the evidence about the social determinants of health and the profession’s focus on changing individual health behaviors. Even “ecological” approaches to health education, which are inspired by systems perspectives that highlight the interconnected web of health causes, tend to focus on the end result of changing individual behavior rather than collective solutions to health issues. A 2012 article in Health Education and Behavior reviewed 20 years of reported ecological health education interventions; the article acknowledged the field’s shortcomings in this arena, and noted that in addition to certain structural barriers, we may need to move past our own training: “health educators may not have the training or resources to successfully plan and implement institutional-, community-, or policy-level programs.”

Maybe it’s more than just our training that holds us back. Maybe we need to acknowledge our basic healthism instilled by our cultural milieu as well as our professional training. And maybe we need to unpack the privilege that has allowed us to focus so much attention on the role of individual behavior in health.

Why is healthism bad for SOCIETY?

Today we often speak about eating and exercise in terms of morality, often to the point of absurdity. Amy Schumer did a great job of calling out the way we self-flagellate for eating dessert in her sketch, “I’m so bad!”

But this is one symptom of a much bigger problem. Healthism is a social justice issue. To focus on wellness requires resources, namely money, access, and time. This is a matter of privilege. Who has access to organic foods in their neighborhood and who does not? Who can afford childcare in order to exercise and who cannot? Who has healthcare benefits and who does not? Who can devote time to their meditation practice and who cannot? Fall Ferguson writes:

It seems to me that healthism is reflective of deep privilege; it is (in my opinion) a classic “first-world” problem. Healthism can only thrive in a culture where the dominant groups do not have to worry about such things as famine, infectious disease, war, poverty, and hatred as factors that affect their health. It’s privilege that allows us to make health a “project” that we can judge others for not taking up.

Those with lower socioeconomic status do not always have the luxury to focus on their wellness, especially if they are struggling with the basics of Maslow’s Hierarchy of Needs, like safety, housing, and hunger. We cannot talk health behaviors as “necessary” or “essential” or “mandatory,” (as in, “eating GMO-free is basically mandatory”) when they are often beyond the reach of lots of people. We must not judge people for failing to prioritize wellness based on our assumptions about their lives and our paternalistic ideas about what is best for them.

We also must remain vigilant and push back against legislation and policies that discriminate against people based on their health. As Ragen Chastain, educator, activist, and fitness enthusiast, frequently reminds us: “the rights to life, liberty and the pursuit of happiness are inalienable and not size, health, or healthy habit dependent.

The good news? There are things we can do to help avoid the pitfalls of healthism.

Here are some tips for health professionals:

  • Do not focus your work solely on individual behavior change. Make sure that you’re spending equal, if not more, time and resources on addressing social determinants through policy and environmental approaches. If your wellness program is focused solely on individual behavior change and there is no additional support for addressing social determinants in place, you need to rethink your program.
  • When sharing health promotion knowledge/tips/techniques/advice, always start with a disclaimer. For example, “Nobody has any obligation to participate in exercise, however for those who would like to participate – or just learn about the benefits of physical activity- I’m going to share the following info and tips.” Remind people that their heath habits have no bearing on their worth, their moral “goodness,” or their human and civil rights.
  • Be reasonable with your goals and expectations. Not everyone has to have the body of an athlete. Not everyone has to eat like a “health nut.” When you share guidelines, make them reasonable for the average person. Remember that for some people, the absence of illness and suffering is healthy enough, and that’s their choice and it’s valid.
  • Do not impose your beliefs about health and morality on your patient/client/student by automatically assuming they want to lose weight or devote time and other resources to fitness, nutrition, wellness, or weight loss. Use motivational interviewing techniques to find out what their motivations are for seeking help and work from there. Find out what they believe and respect their goals and value system.
  • Understand that shame and guilt are NEVER good motivators. Under any circumstance. Not only do they NOT WORK, they have a negative impact on a person’s mental and emotional well-being and can actually discourage them from participating in healthy behaviors.
  • Help every person cultivate a positive body image. It will not “promote obesity,” I promise.

Have you encountered healthism in your life or work? Have any other tips for how to avoid these pitfalls? Please share your thought and experiences in the comments!

The Thing About Being a Fat Health Educator

I am a college health educator and I am fat. I suspect that people do a mental double-take when I introduce myself as a health educator. My educated guess is based on the fact that fat stigma exists. In 2009, Salon published an article asking if Dr. Regina Benjamin, a renowned MD and recipient of the MacArthur genius award, was “too fat” to be Surgeon General. If folks are asking that about her, it’s not much of a stretch to imagine they’re wondering about me too. But here’s the thing. I don’t think my weight has any bearing on my qualifications as a health educator, and here’s a whole list of reasons why.

  1. Nutrition, fitness, and weight management are only one small part of a college health educator’s job. Depending on a college’s size and organization, they may not be in the job description at all. For example, my job description instructs me to spend at least 60% of my time on alcohol and drug abuse prevention, with a secondary focus on running our peer health education program. My next prescribed priorities are stress management, sexual health education, tobacco cessation, and sexual assault prevention. In my copious spare time (sarcasm alert) I attempt to cover the rest, including cold and flu prevention, cancer prevention, eating disorder prevention, and education around sleep, nutrition, and fitness.
  2. Not every health educator became a health educator because they’re a nutrition and fitness enthusiast. In fact, a lot of college health educators get into this field because of the badass health topics we get to cover: sex, drugs, and rock n’ roll. My academic interest in sexual health politics (the HIV epidemic, Roe v. Wade, etc.) are what led me to this field; learning more about other wellness topics in the process has been a bonus.
  3. You can’t accurately judge my health status based on my weight. Health does not equal thin. Plenty of thin people engage in unhealthy behaviors, and plenty of fat people engage in healthy behaviors. It is folly to assume that you know anything about a person’s health based on their appearance.
  4. Sometimes being a fat health educator can actually come in handy. Students struggling with weight, body image, or eating disorders sometimes feel more comfortable speaking with someone who they believe can relate to their experiences. Just as they might judge fat health educators as being able to relate to those experiences, they may judge thin health educators as being unable to understand their struggles. Clearly, you cannot tell by looking at a person whether or not they have struggled with weight, body image, or eating disorders, but it’s not far from the mark to assume that a visibly fat person has probably experienced fat stigma and can relate to what that feels like. The desire to receive help and support from someone who shares your experience or perspective is not unique to this issue. For example, many people struggling with substance addiction seek help from other recovering addicts. We see this in the sponsorship model in Alcoholics Anonymous and Narcotics Anonymous. It’s also not surprising that at any given time, 37%-57% of addiction counselors are in recovery themselves. I do not intend to equate the experiences of being fat and addiction because they are two completely different things. But sometimes it really helps to talk to someone who’s been there, you know what I mean?
  5. As a fat health educator, I know first-hand that nutrition, fitness, and weight management are not easy or simple – despite what some people would have you believe. I also know first-hand the unintended consequences of talking about weight management as if it were easy, simple, or even attainable for the majority of people. Those unintended consequences can range from frustration to self-hatred, from “fat talk” to dangerous disordered eating and exercise behaviors. As a result of this knowledge and experience, I am incredibly careful in my messaging around nutrition, fitness, and weight management. I avoid using calorie counts because those numbers can be triggering for people struggling with eating disorders. I stress Health at Every Size – a philosophy that promotes healthy eating and exercise behaviors for their own sake, regardless of whether or not they result in weight loss. I do not promote dieting, but I do promote making healthy dietary choices. I teach nutrition, fitness, and positive body image within a framework that supports an understanding of wellness as multi-dimensional – and I trust students to decide for themselves which dimensions they will prioritize.

It has been suggested to me that I should lose weight in order to be “taken seriously” as a health educator. This is so, so, so problematic on so many levels.

First of all, this is essentially saying that in order to escape the consequences of fat stigma, I should stop being fat. That’s a bit like suggesting a black person change their race in order to avoid the consequences of racism in the workplace, or that gay people stop being gay in order to avoid the effects of homophobia. With social stigma, the morally correct response is to fight to end the stigma, not eliminate the group of people who are stigmatized.

To be sure, being fat is different from being black or gay. I do not mean to equate these different experiences of oppression. Instead, I am suggesting that it’s not really helpful to think of being fat as something a person can necessarily change.

People do not always have control over the circumstances of their lives, especially in regards to health and disability, access to medical care, and financial security. Sometimes people may have medical reasons why they cannot lose weight. For others, the time, money, and energy it would require to lose weight may be more than they have to give. To assume that every fat person could lose weight if they chose to is a hugely reductive perspective, based in stigma, that denies fat people the right to their own individual stories, situations, and experiences.

To get more personal, I guess I could be classified as a person who “could” lose weight if I chose to. The thing is, I have made that choice in the past and it didn’t go so well for me. You can read all about in “My Breakup with Exercise.”

From my past experience, I know that In order to be a thin health educator, I would have to sacrifice to a degree that would have an overall negative impact on my life and personal wellness, as well as my job performance. For me, maintaining a low body weight is a mentally exhausting and extremely time intensive endeavor. It requires devoting nearly all of my free time to exercise and meal planning, to the extent that I do not have enough time or brainpower leftover to hang with friends, see shows, or work on creative projects like quilt-making, comedy writing and improv, and this blog.

The “decision fatigue” from focusing so much attention on food choices would also take its toll at work, leaving little decision-making power for my actual work. Plus, have you ever tried to go a whole work day on yogurt and salad? It’s not easy to keep that upbeat smile going when you’re hungry and irritable, and it’s definitely inconvenient when a serious one-on-one with an at-risk student is continually interrupted by your stomach growling.

However, with moderation, I can maintain a decent level of health without making those kinds of sacrifices. I may not be thin, but I can live a full life and perform my best at work.

For me, wellness continues to be a journey.

A Softer World

Each year I adopt new behaviors to improve different dimensions of my health and wellness. My priorities may change, but I will be continuing this journey for the rest of my life. My weight may or may not fluctuate as a result of my choices, but I refuse to think any less of myself for doing health education – or any work, for that matter – in a fat body.

So the next time you judge a health professional for being fat, take a step back and check your prejudice. It is up to all of us to create a future where professionals are judged not by their appearance, weight, race, ethnicity, religion, gender, sexuality, or gender expression, but by the quality of their work.

Your fat is not your fault

Your fat is not your fault.

tumblr_lqq3xmd7nw1qky3lio1_500

You are not lacking willpower.

You are not lacking willpower because you can’t stick to your diet. You are fine; it’s dieting that doesn’t work. No really. Diet and exercise DO NOT CURE BEING FAT. They may help you lose weight for a few months to a year to six years… but, according to a massive analysis of every long-term weight loss study, no one — statistically speaking NOT A ONE PERSON — has kept off a significant amount of weight (i.e. more than 15-20 lbs) permanently. There is a lot of emerging evidence that when a person goes on a diet, their chemistry changes so that they’re bodies will continue to fight against weight loss long after the dieting has stopped. As David Wong from Cracked put it, “It’s like being an addict where the withdrawal symptoms last for decades.”

You are not lazy.

You are not lazy because you choose to focus your time and energy on things other than losing weight. To quote David Wong again, “The people who successfully [lose weight and keep it off] are the ones who become psychologically obsessive about it, like that weird guy who built an Eiffel Tower out of toothpicks.” So congratulations, you aren’t spending every waking moment of your life focusing on your waistline. You are doing amazing things, whatever they are. Seriously! Whatever you are doing with your precious time and brainspace (reading, writing, working, creating, studying, caretaking, being nice–contributing to society in any small way) is worthwhile and meaningful and more important than spending it obsessing about your weight.

If you want to be more active, then cool. Go for it. Hopefully you’ll find some activities that will bring you pleasure and joy. But don’t think that being more active is going to make you lose weight. It’s not. (See above). So don’t force yourself into a lifestyle that doesn’t work for you–you’ll only end up making you feel worse.

tumblr_mab2gzHeHb1qm339ko1_500You are not unhealthy.

You are not unhealthy just because you happen to be fat, I mean. Isn’t that great? Your weight and your health are two different things. You can be healthy at any size.  Health is determined by your behaviors, luck, and genetics (more luck). Your behaviors are up to you. And they are NO ONE’S BUSINESS but yours. For whatever reason, being “healthy” has been equated to being moral or being “good” in our society. Let me blow your mind for just a second by throwing this nugget out there: You have a right to be unhealthy. For any reason. It’s YOUR body and you can treat it however you wish. But if you choose to be healthy, eat nutritious food and try to sleep for 8-10 hours a night. Find some active things to do that you enjoy and quit smoking. But don’t conflate your health with your weight. Losing weight probably wont improve your health, and improving your health often times doesn’t result in weight loss. This is okay.

You are not stupid.

You are not stupid for trying that juice cleanse or hoping that trying Weight Watchers or eating paleo or forcing yourself to go to the gym every day would “fix” your fat. Our society believes that diet and exercise cures fat. This is what our doctors tell us. This is what the medical and public health arms of our government advise. They are wrong. They have failed us.

Instead of focusing on fixing the real, structural, environmental problems that cause people to become overweight, like poverty or food deserts or lack of sleep or being overworked/overstressed, food advertising, agricultural subsidies, high fructose corn syrup and processed flour…. public health officials have spent millions of dollars and time and energy telling you to diet and exercise. Why? Because it’s easier. It’s much, much easier (politically) to tell individuals to diet and exercise than it would be to fight the lobbyists or make any real headway in regulating the food industry or addressing poverty or our tradition of overwork in America. As Gary Taubes wrote in The Daily Beast, “…the reason the anti-obesity efforts championed by the IOM, the CDC, and the NIH haven’t worked and won’t work is not because we’re not listening, and not because we just can’t say no, but because these efforts are not addressing the fundamental cause of the problem. Like trying to prevent lung cancer by getting smokers to eat less and run more, it won’t work because the intervention is wrong.”

You are not weak.

You are not weak. In fact, your strength is incredible. You are living in a world that does not make it easy for you. You are living in a world that tells you you have to look a certain way in order to be loved, and at the same tells us food is love. You are told to resist eating foods that are scientifically engineered to be literally irresistible — as in, they trick our senses in order to make us physically unable to resist eating them. You have struggled with stigma and shame and guilt and survived. You are alive and you are living.

So let me say this one more time: Your fat is not your fault.

it-s-not-your-fault-o

Give yourself permission to forgive yourself.

Go out and live your amazing life.