How to Decrease the Stigmatizing Effects of Fatness
Mental health professionals often see clients with problems related to body size, body image, and obesity. Some of these clients want to lose weight specifically and others have unrelated issues they want to focus on. Should these clients be encouraged to attempt weight loss even if they have a long history of failed diets that resulted in weight regain? Should clients be encouraged to focus on weight-related issues even if it is not their presenting problem?
Unfortunately, our society is obsessed with thinness and fitness. It is very common for people to diet and exercise to fit into the ideal body image. In this environment, people who are overweight are often prejudiced, shamed and treated negatively – this phenomenon is called fat phobia (Robinson, Bacon, & O’Reilly, 1993). Many mental health professionals are also affected by their own prejudices and misinformation about weight and health, as well. So it is important to create programs that can address body image issues, fat phobia, and fatness and health not only for all those affected by it but for the rest of society as well.
Misconceptions About Weight
1. Fat people eat too much – this idea has been accepted by mainstream culture as well as medical/psychological circles for way too long. The literature does not support the assumption that fat individuals consume more calories that their thin counterparts (Rothblum, 1990). Therefore, if fat people do not eat any more than thin people, the prescription of a diet to fix the problem may not be warranted either.
2. Dieting is an effective treatment for obesity – numerous studies have documented the difficulty of maintaining substantive weight loss (e.g.: Kirkland & Anderson, 1993). These studies show that even most of the people who manage to successfully lose weight during a diet, tend to regain the weight (or more weight) over time.
3. Dieting is a safe way to lose weight – severe dieting has been associated with the onset of bulimia for some people (Wadden & Stunkard, 1987), can lead to binge eating, and weight fluctuation as a result of dieting has severe physical consequences (Lissner et al., 1991).
4. Fat people have more psychological problems than others – research shows that emotional disturbance is not more common among fat individuals than among people with average weight (Wadden & Stunkard, 1987).
Bacon and Robinson (1996) have developed a treatment program aligned with the so-called “Antidieting Movement”. This standardized treatment model consists of a general psychological assessment of each individual in the program, 8 group therapy sessions and 2 individual therapy sessions. This program focuses on the following main domains:
Understanding Origins of Negative Attitudes
Clients learn to identify the source of their negative beliefs about their bodies by examining critical messages learned from society, culture, family, friends, medical professionals, dating partners and the media. They learn that society creates and reinforces many negative stereotypes about fatness and fat individuals. Once they understand the basis for their negative beliefs, clients find it easier to start challenging them both on an individual and societal level.
Most fat clients blame their lack of willpower and overconsumption of calories for their weight. They buy into the idea that a diet will work and resolve their weight issues forever. In the program, however, they are presented with evidence that “weight is determined by a complex array of variables, many of which are not under a person’s control” (Bacon & Robinson, 1996). They also learn about the dangers of dieting and draw their own conclusions about the ineffectiveness of yo-yo dieting while realizing the high failure rate of many diets and the vested interest of the diet industry promoting new diet plans.
Examining Eating Patterns Through Eating Diaries
Clients are asked to keep a food journal for 4-6 weeks. The treatment providers often find that fat clients almost always report eating fewer calories than theoretically necessary to maintain their weight. The most common issues are limitations on the variety of foods eaten, total absence of their favorite foods, and long time periods between meals, which increases the chances of overeating later in the day. Keeping a food diary and being faced with these tendencies, clients realize that all fat people do not eat like “glutton” and that their body size might be due to variables other than overeating and may not be in their control entirely.
Since the prevailing cultural standard for beauty in the US is that thinness equals attractiveness, fat individuals need to learn to expand their own definition of attractiveness. This is done by examining how the definition of beauty changes over time and across cultures and being exposed to images of attractive, stylish fat people. Most clients had been waiting to get thin before enhancing their appearance. Once they start to believe that fat can be attractive, they improve their appearance immediately, which leads to increased self-confidence and self-esteem. Cognitive restructuring is also used to help clients learn to describe fatness in more positive ways and repeat affirmations daily. Moreover, relaxation and guided imagery are used to help clients experience what their bodies can do and accomplish instead of only focusing on their appearance.
Decreasing Restricted Activities
One of the consequences of having negative feelings about one’s body is that these feelings may stop a person from engaging in important aspects of their life such as going to school, changing jobs, buying nice clothes, dating, enjoying their sexuality or even seeking medical care. Restriction of such activities is associated with higher levels of depression (Lewinsohn & Graf, 1973). Clients are asked to record their negative feelings and thoughts about their bodies that lead to avoidance behaviors and start challenging and disputing these beliefs as well as challenging themselves to be exposed to fear-inducing situations.
One specific area of avoidance is physical exercise, as many fat individuals are ridiculed or shamed when they engage in exercise. In the program, clients are encouraged to exercise for enjoyments and health reasons, not to modify their body size. The idea that it is possible to be fit and fat is foreign to most people and can provide motivation to engage in healthy exercise for cardiovascular health and fun.
Social Action and Assertion
Even when clients change their internal dialogue and learn to accept themselves, they are still confronted with prejudice from others. So it is an integral part of the program to teach and encourage clients to be assertive in situations that involve weight and body shape. One homework assignment is to assess the attitude of one’s primary care physician toward fat people, many of whom hold fat phobic attitudes (Robinson et al., 1995). Some client end up educating their doctors on the latest research, while others switch doctors altogether. Also, clients are encouraged to let others know about what it is like to live in a world that caters to thin people – having to worry about getting through a turnstile, sitting in subway or airplane seats, fitting into restaurant chairs, etc. Furthermore, clients are encouraged to take direct social action by writing letters to TV networks, advertisers, airline companies, clothing companies and the diet industry to express dissatisfaction and unfair treatment.
How to Reduce the Stigmatizing Effects of Fatness References
Robinson, B.E., & Bacon, J.G. (1996). The “If Only I Were Thin…” treatment program: Decreasing the stigmatizing effects of fatness. Professional Psychology: Research and Practice, 27, 175-183.
Robinson, B. E., Bacon, J. G., & O’Reilly, J. (1993). Fat phobia: Measuring, understanding and changing anti-fat attitudes. International Journal of Eating Disorders, 14, 467-480.
Rothblum, E. D. (1990). Women and weight: Fad and fiction. Journal of Psychology, 124, 5-24.
Kirkland, L., & Anderson, R. (1993). Achieving healthy weights. Canadian Family Physicians, 39, 157-162.
Wadden, T. A., & Stunkard, A. J. (1987). Psychopathology and obesity. Annals of the New York Academy of Science, 499, 55-65.
Lissner, L., Odell, P. M., D’Agostino, R. B., Stokes, J., Ill, Breger, B. E., Belanger, A. J., & Brownell, K. D. (1991). Variability of body weight and health outcomes in the Framingham population. New England Journal of Medicine, 324, 1839-1844.
Lewinsohn, P. M., & Graf, M. (1973). Pleasant activities and depression. Journal of Consulting and Clinical Psychology, 41,261-268.
Robinson, B. E., Gjerdingen, D. K., & Houge, D. (1995). Obesity: A move from traditional to more patient-oriented management. The Journal of the American Board of Family Practice, 8, 1-10.