Do No Harm

Fatphobia & the Medical Industry

Hannah Hawkins

• Publisher: New Degree Press
• Year: 2020
• eBook ISBN: 9781636761374
• Edition: 1
• Topic: Medicine
• Subtopic: Health Care Delivery

After interviewing scores of patients and studying weight bias research, Hannah Hawkins has developed solutions for patients, and for providers, in removing weight discrimination from healthcare settings. Despite the fact that it has a 95% failure rate, weight loss is still the standard prescription for anyone in a bigger body, regardless of their medical complaints. Do No Harm: Fatphobia and the Medical Industry explores how fatphobia is harming patients of every size and age.

In this book, you'll learn:

• How and why patients are being discriminated against

• What patients in bigger bodies can do to advocate for themselves

• How to better your relationship with your health and medical providers in natural healthy ways

• Why weight loss is a myth

• How providers can remove weight bias from their practice

Filled with numerous studies and stories about people proving that weight loss doesn't improve health or work in the long term, Do No Harm will leave you with action steps to take your health into your own hands and educate the medical community on the harm of weight bias.

Part 1:

When and How Did Society Become So Fatphobic?

Chapter 1
Diet Culture’s Heavy Hand

Diet culture is hard to ignore. It’s all over our social media, on invasive ads, and on explore pages. You see it on billboards, in commercials, in doctors’ offices, and at restaurants. We are told that we need to watch our sugar because if we don’t, we’ll get diabetes. We’re told that sitting is the new smoking (which is ridiculous). We are sold cellulite creams, fat burners, and workout programs ridden with empty promises. “Clean eating” movements have demonized processed foods without regard for the fact that for many families in lower socioeconomic statuses, that’s the quickest, most affordable way to feed their children. Weight Watchers, now WW, rolled out Kurbo, a diet program for children, that has games for kids to rank foods as green, yellow, or red according to whether the food is a good food or a bad food. Does that sound healthy to you?

In this chapter, we’ll cover:

•What exactly diet culture is and how it causes harm

•Firsthand stories of how diet culture has negatively impacted people’s lives, inside and outside of the healthcare system

•And, when diet culture took off as well as how we got here

DIET CULTURE:

(n) a system of beliefs that worships thinness and equates it to health and moral virtue.8

(n) a system of beliefs rooted in patriarchal and colonialist ideals.

(n) will make you feel lesser for your entire life if you allow it, will call you a failure for not beating biology, or will at least make you feel morally “bad” for eating designated “bad” foods.

(n) has seeped into the medical industry and is causing harm to patients. Medical providers are human, too, and can fall victim to quack diet advice. See: Dr. Oz.

(n) has shape-shifting qualities that allows it to change over time to suit the palette of society’s current interests, such as wellness, which has recently made it extremely difficult to decipher real wellness from the fake. See: Weight Watchers rebranding to WW. The new buzzword “wellness” has also proved to be a new way for diet culture to sell diets and unhealthy exercise regimens as “healthful choices” that are really masked disordered, unsustainable behaviors.

Diet culture is present in homes, at schools, at your kid’s sports activities, and at weekly work lunches. It makes us feel responsible for our body’s size, despite the fact that our weight is largely determined by genetics and a host of other factors. It sends the message that in order to fit in, we must change X, Y, and Z about our bodies, our appearance, and our habits. Diet culture says that fatness has no place in society; it must be eradicated at all costs, or else you won’t be deemed good enough to succeed, thrive, and even find love in the world.

I believe it’s very helpful to look at how one person’s view of dieting or losing weight as a result of diet culture’s messaging can affect those around them. It’s important to recognize diet culture in our personal lives and see how it not only affects those around us, but how it also affects healthcare and how our culture practices medicine. The following are a few stories of women who’ve experienced diet culture and fatphobia in their lives, inside and outside the healthcare system. Although all of these women have gotten clinical help, they are still struggling today and dealing with the battle of wanting to nourish themselves properly without dealing with the repercussions of living in a fatphobic society in a bigger body. It’s the catch-22 of today: Be body positive, but don’t take up too much space.

The overarching message we receive from our culture is this: “We want you to be healthy, but if that involves weight gain, maybe diet just a little bit, so you’re more palatable to society.”

We live in a world today where people in bigger bodies can’t exist in peace without being constantly judged, given advice, discriminated against, and hated because of their bodies. We’re all told by the media, by our primary care doctors, and by our loved ones that “it’s just a matter of willpower” or “X diet worked for me, it’ll work for you too.” The reality is our bodies just aren’t built to be manipulated.

We aren’t born to hate our bodies; we learn to hate them through the messages we receive or hear from family, work, the media, and peers. This is diet culture through the eyes of N’kyla, Sarah, and Amita.

N’kyla

It’s important to point out before sharing N’kyla’s story that parents do their best to raise their children; I’m not here to blame or attribute anything to any family or caregiver’s behaviors. It is no one’s fault that we were brought into a world that tells us we need to shrink ourselves to be worthy of acceptance. In a lot of ways, these diet-culture-rooted beliefs protected many of us throughout our lives, served as a coping skill, and helped us feel accepted. In that case, it makes sense to want to pass down lifelong skills that allowed us to cope and feel accepted to our children.

N’kyla, Jade, Anna, and I danced together for almost a decade when we were younger. N’kyla’s mom “struggled” with her weight and went on several diets throughout N’kyla’s childhood. She had gone through a few minor plastic surgery operations, only bought organic, natural food at times, and would hide sweets in the house.

As a result, N’kyla would take full advantage of having access to “banned” foods at her house when she’d come over to mine.

“Oh my gosh Mrs. Hanks you have regular jelly? This is so good!”

You’d think peanut butter and jelly sandwiches were a delicacy.

“My mom served fennel as our dinner last night. I was so hungry I raided our pantry after.”

This wasn’t unusual at her home. My mom made a point to buy N’kyla regular Smucker’s jelly and would make sure we had cookies or some sort of treat when she’d come over. Anna, Jade, and I used to joke that N’kyla was always hungry and could always eat, because, well, she was. Her food preferences weren’t satisfied at home, so she’d make up for that elsewhere. One time she bought a cake at the grocery store for a sleepover and ended up eating it all herself.

You might think that this sort of behavior isn’t normal for a kid—and it isn’t. Nobody was really concerned with her behaviors at the time; on the surface, there was nothing to worry about yet.

Until one summer, that is. N’kyla had to undergo an invasive jaw surgery that left her on a liquid-only diet for weeks. We didn’t see her for almost two months, and when she came back to dance that fall, the difference in her appearance was stark.

“N’kyla, you’re so skinny! Are you okay?” Anna exclaimed with concern.

“Oh, yeah. Because of my surgery I kind of had to live off smoothies for a while. It just happened!”

Anna was suspicious. “But you’re eating now, right? You’ve never been a skinny person.”

“Yeah, I am. My appetite has just changed some.”

That was the end of the conversation. We thought something was off, but as fourteen- and fifteen-year-olds, we didn’t know what else to say.

As N’kyla’s disordered eating evolved and developed into something more serious, her body began to ...

Table of contents

• Acknowledgments
• Introduction
• Acknowledging My Privilege
• Inspiration Story
• Part 1: When and How Did Society Become So Fatphobic?
• Chapter 1 Diet Culture’s Heavy Hand
• Chapter 2 Racism, Fatphobia, and Its Impact on the “O Word” Epidemic
• Chapter 3 Why Weight Loss Isn’t Sustainable: Biggest Loser Study
• Part 2: How Fatphobia is Marginalizing People and Harming Society
• Chapter 4 Fatphobia and Health Care Avoidance
• Chapter 5 Fatphobia and Late Diagnoses
• Chapter 6 Employers, Insurance Coverage, and Fatphobia
• Chapter 7 Fatphobia and Quack Doctors
• Chapter 8 Children and Fatphobia
• Chapter 9 The Dangers of Gastric Bypass Surgery
• Part 3: Advocating for Yourself, Disrobing Your Own Fatphobia, and Practicing Weight-Inclusive Medicine
• Chapter 10 HAES and Why It Works
• Chapter 11 Why All Doctors Should Ditch “Weight Management” Methods and Adopt Intuitive Eating as Health Intervention
• Chapter 12 Weight Management Has No Place in Evidence-Based Care
• Chapter 13 Stories from the Doctor’s Office: How These Women Advocated for Themselves
• Conclusion
• Appendix