Obesity: Combating both stigma and disease

Obesity can be seen as a social construction, because its representations vary in space and time. This is evidenced by the emergence of “fat activism”, which defends a more positive image of obese people. But on the other hand, obesity is also seen as a chronic disease against which it is advisable to fight.

The development of these divergences leads to a certain separatism within our societies, in particular between the social sciences and the health sciences. It would no doubt be advisable to take a more nuanced look at obesity, in order to adopt a conscious and reconciling position vis-à-vis these two types of approach.

From grossophobia to "fat activism"

The term "grossophobia" is increasingly present in our conversations. Directly translated from English "fat phobia", it designates "All the hostile attitudes and behaviors that stigmatize and discriminate against fat, overweight or obese people".

These attitudes, singled out in the late 1960s in the United States, quickly became the subject of social science research. In 2010, the Americans Rebecca Puhl and Chelsea Heuer do not fail to emphasize which

“The stigmatization of obese people is not a beneficial public health tool in the fight against obesity. Rather, (it) threatens health, generating health disparities and interfering with effective obesity intervention efforts ”.

It is also noted that such a stigmatization reinforces deleterious eating habits. Over time, however, the concept of "fat phobia" will no longer only be mobilized in the context of obesity prevention. It will also be a question of fighting the "fat phobia" by a "fat activism".

At the University of Wisconsin-La Crosse, sociologist Laurie Cooper Stoll defends the concept of "Fat positive", which advocates the interiorization of positive representations of corpulence through education - by putting the aesthetics of thin and fat bodies on an equal footing - to fight against the stigmatization of obese people. If it is a question of encouraging "fat" people to appreciate their bodies, the objective is also to proselytize, by insisting on the fact that representations of beauty depend on cultural variants.

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Therefore, the fight against obesity can very quickly be considered as a "Fat shaming", in other words the humiliation of people considered fat. Even if the initial intention is not to stigmatize them, their corpulence is identified with a pathology, they are placed in a category - "obese" - against which it is a question of "fighting".

“Fat activism” thus raises the question of the right for people judged to be “fat” to no longer be seen as pathological cases, as “sick” or sick people. It also leads to reconsider the inclusion of obese people in movies and TV entertainment, where they often embody an unattractive character, who is teased and does not make you want to identify with them. It will thus be a question of campaigning so that they can be represented in the same way as “thin” people and associated with a more positive image.

However, if the fight against the stigmatization of obese people seems quite legitimate in terms of ethics, this should not lead to neglect the dangers of obesity either.

Obesity, a chronic disease

For the World Health Organization, obesity matches to an "abnormal or excessive accumulation of body fat which represents a risk to health": a person is considered obese when their body mass index (i.e. their weight in kilograms divided by the square of their height in meters) is equivalent or greater than 30.

Obesity is also considered a chronic disease, which itself promotes the development of other pathologies : for example, it is held responsible for 41% of cancers, and 42% of cases of diabetes. Gold since the beginning of the XNUMXth century, cancers, asthma, cardiovascular diseases, type 2 diabetes, joint diseases and other intrinsically linked chronic diseases have seen their prevalence increase: they are now the cause of more than 73% of early deaths worldwide.

At the same time as this progression, social inequalities in health are hollowed out, these diseases - and in particular obesity - more affecting the most precarious populations.

Fight against the stigma of obese people and against obesity

To fight effectively against these risks while avoiding stigmatizing the people concerned, it seems essential to us to establish a distinction between “obese people” and “obesity”.

An obese person can indeed be the victim of discriminations and condemnable stigmatizations: they directly attack individuality and integrity, compromising their right to be considered and recognized as a human being whose dignity is on the same level as that of any individual.

In addition, as we have already mentioned, these discriminations and stigmatizations tend to push obese people to withdraw into themselves, by adopting unfavorable eating behaviors, resulting in increased exposure to the health risks of obesity.

However, it seems difficult to us to consider a chronic disease in a positive way, rather than to seek to prevent it. This seems all the more risky to us because obesity is linked to the development of many other chronic pathologies.

Finally, let us insist on the fact that obesity is more frequent among the most precarious populations, which are also the most affected by chronic diseases. Thus, in the long term, socially “positive” obesity could prove (at least) just as harmful as the stigmatization of obese people.

For a nuanced approach

While it is tempting to think of obesity only as socially constructed, it nevertheless represents a significant threat to health - particularly in our industrial societies where its rate has reached levels never seen before.

The industrialization of our societies has indeed exposed our health to a whole range of risks., which we are only beginning to realize today - especially in the face ofexplosion in the prevalence of chronic diseases. However, because of the different capacities of adaptation to the internalization of the representations and the knowledge necessary for the prevention of these diseases, but also inequalities in access to healthcare, the most precarious populations are the most exposed to dangers of which they are not always aware, including obesity.

It will therefore be necessary to fight both against the stigmatization of obese people and against obesity, hence our proposal for a nuanced approach, aware of both social and health issues. Such a look makes it possible in particular to reconcile the social sciences and the so-called "hard" sciences: either to take a balanced look at humans and society, whose living conditions depend as much on culture as on nature.

Louis Lebredonchel, PhD student in sociology, University of Caen Normandy et Anthony Fardet, Researcher, UMR 1019 - Human Nutrition Unit, University of Clermont-Auvergne, Inrae

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