Maybe Fat People Are Poor And Sick Because Our Culture Treats Them Like Garbage

New research looks at the connections between obesity and economics, and big surprise, it turns out things are more complicated than just "personal responsibility" and "eating too much."
Publish date:
January 17, 2014
money, fat, health, body politics, healthcare, obesity panic

This week The Atlantic offered some refreshingly nuanced coverage of new research looking at how obesity and economics interact.

Typically, public discourse on fatness and money gets boiled down to oversimplified flailing over how much fat is costing us in terms of medical expenditures -- I have personally had strangers from the internet instruct me many times that I am greedily taking money from the pockets of earnest, hard-working, morally upright Americans (with my fat, fat hands, no doubt) by driving insurance premiums up with my continued existence at a certain weight. This is a popular sentiment, especially considering it gives folks looking to rail against the tyranny of the obese an opportunity to demonstrate how they personally are being affected by the percevied stubbornness of fat strangers -- a handy defense against anyone who might argue that the other people’s bodies are none of their damn business.

But obesity and economics are actually way, WAY more entangled than that, turns out. And class plays a major role:

…[T]here is copious evidence around the world that obesity is a peculiar condition for poor people in rich countries. Less-developed countries have lower obesity, but in richer countries, there tends to be an inverse relationship between waistlines and bank accounts. It's what researchers have called the "health-wealth" effect: Wealthier people tend to be healthier people. In the U.S., rich white women and poor black men have the lowest obesity rates (followed by rich white guys). America's highest obesity rates by far are among poor minority women. [...]So poverty might make some people obese, but obesity definitely makes many people poorer, through two broad channels: (a) it reduces take-home pay, particularly for women; and (b) it's related to health conditions that reduce discretionary income, too.

Quite the self-fulfilling prophecy, that. A really depressing self-fulfilling prophecy. On an economic level, being fat has effects much further reaching and arguably more damaging than the specter of individual health problems.

To understand, we need to look at the effects of weight stigma not simply as they run like toxic threads through our culture, but also as they reach across individual lifetimes. For example, sometimes medical costs for fat people can be higher because not all medical equipment is made to accommodate larger bodies -- even a necessary diagnostic MRI can be become a challenge to get if your body is too heavy for the machine at the facility your health insurance will cover.

In the past couple of years, some doctors have even taken to flat-out refusing to provide care to fat patients, which can pose a serious problem given the current shortage of primary care physicians in general.

Costs may also be higher because fat people, especially fat women, are less likely to have preventative care -- or even regular cancer screenings for gynecological and colon cancers -- that may catch life-threatening issues before they become, well, life-threatening. The tangible result of this reluctance is that by the time many fat women do get treatment, what might have been a simple thing six months ago is now a much more serious matter to correct.

With cancer in particular, this might even mean that fat women are more likely to die from their disease, not because of any medical intervention by their weight, but because they tend to go longer without having illnesses addressed, and so treatment of more advanced disease can be less effective (not to mention more costly).

Why on earth would fat women in particular delay going to the doctor, you ask? Probably because they are unsure of whether the doctor will have equipment to support them, because they have had negative experiences with doctors in the past, and because of fat stigma. One study of doctor attitudes toward their obese patients found that 17 percent were “reluctant” to perform a pelvic exam on an obese patient, and a mind-blowing 83 percent hesitated to do so if their patient seemed uncomfortable or reluctant to go forward with this basic, potentially life-saving procedure. (And REALLY now, doesn’t that describe MOST PATIENTS getting a pap smear?)

Add to this the growing body of research that has found that discrimination has measureable detrimental effects to the health of marginalized people. Much of the research on this subject has focused specifically on racism -- and understandably so -- but it’s not a huge leap to suggest that the experience of continuous and persistent discrimination for any reason is going to have similar health consequences, in the same way that people living under sustained stress are at higher risk of certain problems and diseases.

It is therefore hardly surprising that the group with the greatest health risks are often poor Black women, women living within a vast matrix of social marginalization.

Because if you also live in a less affluent area? You’re probably getting a lower quality of care than your wealthier neighbors, so even if you DO go to the doctor, you may be less likely to be diagonsed and treated in a timely manner.

Still, to look at the public perception of obesity, the solution many people seem to prefer is to pile on more stigma, and more shame, the very things that may cause -- or at least exacerbate -- these expensive problems in the first place.

The Atlantic’s coverage of this new fat economic research is refreshing to me because, instead of relying on the same old assumptions, it allows space to talk about obesity as a damned complicated thing. Because it is. No matter how much we as a culture want it to be very simple and personal-responsbility driven, a matter of individuals with no self-control, an issue of some people just eating too much food like stupid animals, and refusing to engage in physical activity. Fatness is not a straightforward problem with a straightforward solution. Indeed, for all the obesity panic we see in media coverage practically on a daily basis, nobody seems to acknowledge that, even IF fattery were a manner of solitary individuals making bad decisions, we still have no permanent, safe solution for weight loss that reliably works for everyone. Diets have massive failure rates. The riskiest and most dramatic weight-loss surgeries rarely render obese folks indelibly “thin” by even the most flexible standards of the term.

Fat people have always existed, and always will -- there is no benefit to talking about obesity as though it is something we can virtually eradicate on the order of smallpox or polio. And shaming people into weight loss doesn’t work. All that the current atmosphere around fatness does is reinforce the social issues that keep fat people poor and sick. That’s not a solution. It is rather the real, unrecognized public health disaster of a so-called “obesity epidemic.”