April 18th, 2020

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Fat people have dealt with social distancing since the dawn of Western culture (photo: canweallgo.com)

Why is it even more important than ever to talk about fatphobia in the midst of the corona crisis? Because fatphobia is an oppressive structure in society. And oppressive structures always become even clearer and harder in times of crisis.

Not just modern day
I am a fat activist. I use the word fat about myself. Because fat is a neutral word. There is nothing wrong with being fat. It is just a variety of the human form. Fat people have always existed. Just think of the fat Venus figurines that are up to 30,000 years old – back when literally everyone was on the paleo diet.

Western culture is not as old as the fat Venus figurines. Western culture is a few thousand years old – and fatness has never been welcome in this culture. We have a fatphobic myth that in some kind of unspecified ‘old days’, fatness was accepted and even ideal.

But Western culture is full of corsets and fat jokes – from ancient Greece till today. Because fatness was never ideal. If you don’t believe me, try googling Peter Paul Rubens, for instance, and his painting ‘The Judgement of Paris’ from 1638/39 and look closely at the ‘rubenesque’ models we’ve been told are fat. Spoiler alert: they are not fat. They look like Kate Winslet and Drew Barrymore.

Fatphobia is the name of the structure that places fat people outside the norm and at the bottom of the hierarchies. The reason I want to talk about fatness and fatphobia right now, in the midst of a chaotic health crisis that seems to be bringing on a financial crisis too, is that every crisis in society always underlines the already existing hierarchies.

Workplace woes
Why was the financial crisis particularly hard on fat people? Because we are already less likely to get hired, more likely to get fired and will not make the same money as people who are not fat. An article from 2016 written by researchers from six different European universities, and edited by Saba Hinrichs-Krapels from Kings College London, found that all existing literature on the topic of the discrimination of fat people in the recruitment process shows that anti-fat bias plays a huge part in who gets hired.

A report from the US non-profit organisation Rudd Center tells us that 1) Fat people don’t get hired as much as people who are not fat, 2) Fat people don’t get promoted in work spaces as much as people who are not fat, 3) Fat people are likely to get fired for being fat and/or unable to lose weight, 4) Fat people are subjected to bullying and stigmatisation by non-fat colleagues and superiors, and 5) Fat people risk being punished for their fatness via rules and policies about dieting at the workplace.

The report also states there is no law to protect fat people in workplaces in the US. The states of Michigan and Washington are exceptions, even though they still don’t have explicit laws that make it illegal to discriminate against fat people in workplaces.

Odds stacked against fat
A US survey from 2017 revealed that only 15.6 percent will consider hiring a fat woman. That means 84.4 percent will not even consider looking into what qualifications she may have before discarding her. In Denmark, Fagforbundet Lederne carried out surveys amongst its members in 2011 and 2017 that showed that two-thirds would refuse or be reluctant to hire fat people.

Needless to say, a financial crisis with overwhelming unemployment rates will place fat people in an even harder situation than we already face in times of no crisis. For those of us fat people who survive this health crisis, the financial crisis looks unbelievably scary!

Stigmas can alter stats
I follow several doctors, dieticians and other healthcare professionals who advocate for equality for fat people in the healthcare system. One of them is Dr Lindo Bacon, an American physiologist who has written several books including ‘Health At Every Size: The Surprising Truth About Your Weight’ from 2008.

Bacon argues that fatness and health are in no way mutually exclusive – but that fatphobia manifested in, for instance, hate crimes and discrimination in workspaces leads to poor health that should not be confused with fatness causing health problems. In other words fat is not the problem, fat stigma is.

Bacon expressed concern on Twitter on March 19, retweeting these words from @biggirlsworkout: “High BMI is currently being used to exclude people from ventilator treatment due to the shortage … I predict that in a year, doctors point to higher death rate for fat people from COVID and say: ‘See? I told you so!’ BUT THEY ARE LITERALLY CAUSING IT NOW.”

High BMI no extra risk
Dr Joshua Wolrich, a British doctor who is active in debates and on social media trying to fight fatphobic discrimination, posted about BMI and corona on March 31. In the UK, in Denmark and elsewhere authorities have – as per usual – condemned high BMI to be a risk factor with COVID-19.

Wolrich wrote: “The latest report on COVID-19 from the Intensive Care National Audit & Research Centre in the UK is pretty conclusive. There is no evidence to suggest that BMI is a risk factor for admission to ICU with COVID-19.”

Looking at the data graphically you can see that the distribution of those admitted critically ill with COVID-19 follows the BMI distribution of the general population. BMI is not a risk factor.

Furthermore he writes about lung infections and high BMI: “Interestingly, a higher BMI even seems to be slightly protective against admission when looking at a previous data set from 2017-2019 of patients with non-COVID-19 viral pneumonia.”

Previous research has also suggested that patients with a higher BMI have a lower mortality risk when requiring mechanical ventilation for ARDS (PMID 22430246) – the type of respiratory failure seen in COVID-19.

Going back to the ICNARC report, there is also currently no significant difference between BMI cohorts and successful discharge once admitted to critical care. This is less conclusive at present, but there is currently a lot less data that we can analyse.

I hope this has given some of you some reassurance about what we know already: that BMI is a poor predictor of health at an individual level.

Healthcare has a role
There is obviously a fear that the healthcare system will let down fat people during this healthcare crisis – because fat people are let down all the time. A 2017 WHO report, ‘Weight Bias And Obesity Stigma: Consideration For The European Region’, concurs that fatphobia is everywhere, all the time.

People of size experience fatphobia from educators, employers, health professionals, the media, friends and family, contends the report, which urges action against fatphobia as its core message. It argues that health professionals must focus on health gain – as opposed to weight loss – and it advises health professionals to encourage body positivity with children, young people and adults of size.

“Obesity stigma can also affect the quality of care for patients with obesity, ultimately leading to poor health outcomes and an increasing risk of mortality,” it urges the healthcare profession.

“Consider that patients may have had negative experiences with health professionals, and approach patients with sensitivity and empathy. Explore all possible causes of a presenting problem, and avoid assuming it is a result of an individual’s weight status.”

I hope that fat people everywhere will get equal treatment during this pandemic.

And I hope that fat people everywhere will not have to suffer harder than everyone else during the financial crisis upon us. But given the gloomy statistics, I find it quite hard to be an optimist in these matters.