Although the Brazilian Institute of Geography and Statistics (IBGE) estimates that 61.7% of Brazilians are overweight, the individual with obesity is still the target of jokes and prejudice on the part of society. They are the majority, but public spaces — cinemas, buses, planes, schools and even hospitals — are not prepared to receive them, causing constant embarrassment and discomfort.
Obesity is considered a chronic disease, but a large part of the population (including health professionals) believes that the situation is resolved only with willpower. The classification is frequently extrapolated, and many overweight individuals are classified as sick even before undergoing any examination. Pointing out solutions under the guise of a health concern and offering unsolicited advice is just one more way to put the person down.
The aversion and prejudice towards the fat body is called gordophobia. Discrimination takes place at home, among family members, in the workplace, on public transport, in the clothing trade and even in the doctor’s office.
“Any kind of prejudice is an act based on ignorance about a subject. In the case of gordophobia, it is something that is done to make the person with obesity feel bad and inadequate. A body-related joke ultimately leads to feeling left out. The fatphobic act is an act of exclusion”, says psychologist Andrea Levy, specialist in obesity and president of the NGO Obesidade Brasil.
She recalls that, unlike other types of prejudice, such as gender or race, for example, people with obesity are forced to “join in the fun” at the risk of being seen as boring and without a sense of humor. Sometimes, the person does not feel entitled to react, since their body is seen almost as a public good, something that everyone has the right to comment and opine.
“A person with obesity always has to be accountable. Have you done such a diet? Have you been to Doctor X? If you do nothing, you are judged. If you say you’re doing it, someone suggests a remedy. If the person takes medicine, they will say that it is bad for health. If you need to undergo a bariatric procedure, someone will say that it is a mutilation, that it is not necessary, that it is just a diet and exercise. There’s no way to get it right. The patient is always condemned, as if he had committed a crime”, warns the psychologist.
She points out that not every thin person is healthy and that the treatment for obesity is not “completed”, or only “worked”, when the patient is visually slim – if he has lost 10% of his weight and is managing to maintain it, the treatment is already considered successful. Obesity is a chronic disease, with no cure, and treatment involves control for the rest of your life, mainly to prevent the development of other conditions and physical limitations.
“Fatphobia generates exclusion in the lives of all fat people. They lose basic rights, such as moving around, finding work, finding clothes that fit their size. It is a prejudice that we are not always able to detect, because it is disguised as love, care and health”, says researcher Malu Jimenez, philosopher, doctor in Contemporary Culture and fat activist.
Patient x health professional
In 2019, the largest behavioral study ever done on the treatment of obesity was published. The ACTION IO survey was conducted through a partnership with universities in 11 countries, and funded by Novo Nordisk — the company that makes Ozempic. Scientists analyzed responses from 14,500 patients and 2,800 health professionals.
Research shows that 81% of people with obesity have already made an effort to lose weight and, on average, the patient spends six years trying to lose weight alone before looking for a doctor. In Brazil, the percentage is similar: according to a survey by the Brazilian Association for the Study of Obesity and Metabolic Syndrome (Abeso), 93.7% of people with obesity have tried to lose weight at some point, and 31.3% have done so by own account.
According to the international study, upon arriving at the office, 68% of patients would like health professionals to start a conversation about how to control weight. In contrast, 71% of health professionals think that people with obesity are not interested in losing weight — a very wrong analogy that is made between the accumulation of weight and laziness. Obesity is a multifactorial chronic disease and, most of the time, the resolution goes beyond the individual’s willpower.
“This fantasy is unfortunately not only ingrained in the population, but also in many people in the health field. This means that today there is mistreatment at the level of relationship with the obese patient. It’s something we try to demystify”, explains psychiatrist Adriano Segal, coordinator of Abeso’s Commission on Psychiatry and Eating Disorders.
The Obesity and Fatphobia — Perceptions 2022 survey, carried out by Abeso and the Brazilian Society of Metabology and Endocrinology (SBEM), shows that 85.3% of obese people in Brazil have already experienced situations of fatphobia.
Among the 3,621 interviewees, 61.5% said they felt discomfort and lack of acceptance when being treated at the public health service. Many units, for example, are not even prepared to receive the obese patient at a basic level — there are no wheelchairs, stretchers, devices to measure pressure or appropriate scales for the individual.
This is also fatphobia. Andrea explains that when someone stops going to the movies because they don’t fit in the chair or don’t have an exam because they are too heavy for the stretcher, they are being excluded from social life. “It’s something that affects an individual’s physical and mental health,” she says.
And the situation is no better in private care — the percentage of patients who feel uncomfortable looking for a health service, in this scenario, where the person is paying for the service, is 44%.
A survey carried out in Canada, by Concordia University, shows that 18% of health professionals even say that they feel disgusted when treating fat patients, and 33.3% feel frustrated when dealing with this type of person.
The problem also happens in Brazil: a survey carried out in the final work of nutritionist Katleen Marques, graduated from the Federal University of Santa Maria (UFSM), in Rio Grande do Sul, shows that prejudice against fat patients is widespread among Nutrition students, for example.
Among those interviewed by her, 38% said that if the person wanted to lose weight, they would succeed; 23% said that the patient clings to any excuse; and 16% opined that “there is no excuse for being fat”.
Doctor Fábio Moura, director of the Brazilian Society of Endocrinology and Metabology (SBEM), says that in medical schools, the subject of obesity is almost never addressed. “In my time, there was only one class on this in the entire formation. Today I teach at a public university, and there are two theoretical subjects. Training is very late, it is a disease relegated to the third plan”, he warns.
For Andrea, from the NGO Obesidade Brasil, one of the main focuses of action against fatphobia should be the medical field. Not every professional needs to be an obesity specialist, but it is essential to know how to approach and refer the patient to a specific service.
“We think it’s normal to go to the doctor, he’ll look at a mole, say he didn’t like the appearance of the lesion and refer it to a specialist. There was no embarrassment or offense. With obesity, the same thing should happen. You are not a specialist, but do you see that being overweight hinders the patient? Ask if the person would like to be referred to a qualified professional”, says the psychologist.
According to her, the subject of obesity is still considered a taboo, and many times the doctor pretends that he is not seeing the problem or speaks in a pejorative way, suggesting that the patient stop being lazy and exercise, or make healthy choices in meals — as if the treatment was that simple –, making the individual feel bad and not follow the recommendations.
Source: Obesity and Fatphobia – Perceptions 2022Art/Metropolises
data-3Source: Obesity and Fatphobia – Perceptions 2022Art/Metropolises
dice-4Source: Obesity and Fatphobia – Perceptions 2022Art/Metropolises
data-1Source: Obesity and Fatphobia – Perceptions 2022Art/Metropolises
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Is obesity a disease?
Despite being recognized as a chronic disease by the World Health Organization (WHO) for many years, the diagnosis of obesity is still based on an outdated marker, the Body Mass Index (BMI). The account, which takes into account the patient’s weight and height, is not considered accurate, as it does not analyze other important information, such as the individual’s muscle volume and general health.
Today, a person overweight recommended for their height (based on the controversial BMI) is not necessarily sick, and has health problems developed due to the extra fat in the body. The opposite is also true, as many thin people have illnesses.
For this reason, part of the researchers argues that obesity loses its ICD and is no longer considered a disease. The idea is that the doctor and society stop looking at the patient as a sick person even before taking the first exam, but as another individual seeking care.
“From a calculation, every fat person is considered sick. With this association, it is only stated that they are individuals who need treatment, and fatphobia is based on that. People don’t understand that fat people don’t choose to be fat: they think it’s the individual’s fault for not having space in society”, explains Malu.
She says that the conception of obesity as a disease began with doctors who were associated with pharmaceuticals and the slimming industry. The association of fat with a health condition, according to the researcher, has violent consequences that even guide the way society sees, reacts and understands the fat body.
“When we dissociate the fat body from a sick body, we can discuss fatphobia and how we see this body”, he says.
Andrea, in turn, believes that unlabeling obesity as a disease could end up stigmatizing the patient even more, because it would reinforce the misconception that it is a lack of willpower. “Each one can have the body they want, nobody has anything to do with it. It is not a question of preventing people from having the body they have, the treatment has to do with access, with the patient being able to treat himself. To fight fatphobia, we need to understand obesity as a disease”, says the psychologist.
How to solve?
As a society, the best way to resolve the issue of fatphobia, according to the president of the NGO Obesidade Brasil, is through education. She explains that it is essential to bet on offering quality information to health professionals and the population about what obesity is, how it is triggered, what treatments are available and ways to avoid it.
Education is important even for people with obesity, who need to know what their rights are in order to claim them.
Researcher Malu is categorical: to solve fatphobia, we need to talk about it. “When we know and understand, we begin to realize how important it is to fight stigma, prejudice”, she guarantees.
“But, we are human beings, we work based on punishment, on success and error. We see this in court cases about racism and gender violence, for example. I wish we didn’t have to get to that point, but depending on the degree of violence that the person suffers, it is necessary to take legal measures, yes”, says psychologist Andrea.
Malu believes that one of the solutions, combined with education, is criminalization. According to her, as seen in other struggles, such as racism and homophobia, criminalization is almost pedagogical, as it forces the individual to think before speaking. “Fatphobia is structural, and if there is no punishment and education, people will not stop being violent towards fat people”, she says.
For now, fatphobia is not considered a crime, but some bills are being processed in the National Congress to change this reality. The general idea is that the offending individual is criminally prosecuted, serving time in jail. In the Senate, a PL is moving to oblige health establishments to provide adequate equipment for obese patients.
In the next article, understand how public policies can interfere in obesogenic environments, favoring healthier choices.
