Upon first learning of the existence of the “Ob*sity Bill of Rights,” it may be tempting to look upon it as a tool for addressing anti-fatness in healthcare settings. While the packaging is pretty, though, what’s inside isn’t nearly as appealing. I’ve put together an analysis of the contents of the bill, and though this isn’t a complete list, it will hopefully draw attention to some of the document’s glaring issues.
It is very important for me to acknowledge my thin privilege – the ways I do not and never will understand the impact of this bill on fat folks.
1. It’s Pathologizing
The use of the O-word in the title indicates, right away, that fatness and fat bodies are viewed as a problem to be eradicated. At this point in time, we have mountains of data to support the fact that the correlation between fatness and health problems is overwhelmingly due to the real-life impacts of anti-fat oppression, rather than fat itself as something inherently harmful. With all the research and data available, it is irresponsible at best – and, in many cases, medically negligent – to pathologize fatness as a problem that needs to be solved. This only perpetuates the very anti-fat narratives that threaten the well-being of fat patients in the first place.
Fat people have insisted, for quite a while, that the word “ob*sity” is a slur that pathologizes and problematizes plus-size bodies. A movement that claims to respect and care for fat patients while using a word identified as a slur by fat communities is obviously not listening to the very people it purports to advocate for.
Additionally, the preamble dangerously perpetuates the idea of fatness being unequivocally harmful, stating that “400,000 people are estimated to die every year from ob*sity.” This language is misleading and entirely inaccurate: a tired assumption that if deaths from conditions such as diabetes and heart disease occur in patients who happen to be fat, their fatness must be the cause. Such assumptions do nothing but further the very narratives about fatness that are so often used to discredit and dehumanize fat people.
2. It Doesn’t Challenge Assumptions Rooted in Anti-Fatness, Instead Passing Them Off as “Information”
The bill states that patients have the right to “accurate, trusted information in culturally appropriate and easily understandable language that explains obesity as a complex chronic disease requiring personalized treatment” (emphasis added). While it’s indisputable that patients should absolutely have the right to information, what happens when the information they are given – information being taken for granted as tried-and-true fact – is deeply rooted in anti-fatness and, by extension, eugenics, ableism, and white supremacy? Under the guise of informing patients, this item encourages healthcare professionals to coerce fat patients into problematizing their own bodies–a coercion that can be so strong, it can lead patients to agree to certain treatments under duress. Claiming that fatness is a disease requiring treatment leaves fat patients without a voice with which to refuse the pathologization of their bodies.
3. It Makes False Claims About “Safe & Effective” Weight Loss Treatments
We know by now that intentional weight loss methods simply do not work; the vast majority of those who pursue intentional weight loss regain this weight, and then some, within a few years. Thus, the “safe and effective” treatments mentioned in the bill do not actually exist. This is misleading at best.
It’s important to note that many fat people have spent much of their lives engaging with diets, exercise regimens, and various forms of restriction/starvation in an attempt to make their bodies smaller. For some, these attempts began as early as childhood. We know, though, that when the body is exhausted and depleted in pursuit of the thin ideal, the opposite happens over time. I once worked with a fat adult patient who had engaged in food restriction patterns since elementary school, leading to decades of weight cycling that resulted in a higher weight set point with each cycle. When she realized this, she had an outburst during one of our sessions, exclaiming, “So I anorexiced myself to ob*sity?!” Her experience is not at all uncommon, and it points to the flaws of the claims of “safe and effective” weight loss treatments made by the bill of rights.
4. It Insists On Using Person-First Language “As a Sign of Respect”
While many are taught that person-first language is the most respectful way to talk about marginalized identities, an overwhelming amount of people with those identities, including fat people, caution against its use. A colleague and fat liberation advocate explains it as such:
“For me, person-first language inappropriately distances my fat identity from the reality of my day-to-day life. Referring to me as a ‘person with fatness’ gives the inaccurate idea that the size of my body isn’t a major part of my identity. It wouldn’t have to be, in a world that didn’t actively hate fat people, but unfortunately that’s not the world we live in. I identify myself as a ‘fat person’ because my fatness is always the first thing people notice about me, and because anti-fat oppression is unequivocally the thing that makes my life the hardest.”
5. It Perpetuates the Eugenicist Notion that Fat People Should Not Exist
We all know what the authors of this bill mean when they refer to “ob*sity treatment:” the eradication of fat bodies. It is this mentality that contributes to poor body image and eating disorders: when we identify certain bodies as “wrong,” people will go to great lengths to avoid looking like them, causing themselves great harm, and sometimes even dying, in the process.
Additionally, it maintains a false binary between ”good fat people” (that is, fat people who spend their lives trying not to be fat) and “bad fat people” (those who do not “obey” societal standards by constantly trying to take up less space). The fat patients described in the bill are all the former: the ones who accept their ob*sity diagnosis and obediently seek “treatment” for the alleged wrongness of their body in an attempt to make it smaller. Perpetuation of this binary unequivocally causes harm – particularly to the “bad” fat people who choose not to pursue intentional weight loss – making anti-fat discrimination in healthcare settings far more likely for these patients, who are often slapped with labels such as “non-compliant” that can cause insurance companies to restrict their access to many different types of care.
6. It Entirely Misses the Real Problem with Anti-Fatness in Healthcare
Nowhere in this bill are any conditions mentioned that aren’t correlated with fatness; yet, this is what so many people in large bodies struggle with. I hear horror stories from people about going to the doctor for an earache and being lectured about weight loss. The same colleague who I quoted about person-first language spent decades of their life with chronic pain that was blamed on their fatness. It wasn’t until age 38 that they were finally diagnosed with a progressive disability – a disability that, due to lack of treatment, has severely impacted their ability to stand and walk. Their diagnosis could have come so much sooner, and their mobility could have been preserved, if doctors had been able to look beyond their fatness and actually evaluate their symptoms, the way they would for a thin patient.
These problems are so common, nearly every fat patient can tell you a similar story–yet the bill of rights doesn’t even mention them. Instead, everything it advocates for has to do with fat people receiving treatment so that they can somehow magically not be fat anymore. It doesn’t address anti-fatness within healthcare – instead, it perpetuates it.
Make no mistake: while the Ob*sity Bill of Rights may appear to have the interests of fat patients in mind, it essentially only functions as yet another tool of anti-fat oppression. Rather than attempting to pathologize fatness and “treat” fat people out of existence, those whose care practices are truly rooted in freedom from oppression would do well to take the bill with a heaping tablespoon of salt and treat their patients like diverse human beings instead of walking, talking diagnoses.