the HAES files: Why I Don’t Care about Health

Cat Pausé in this blog post reflects upon her experiences and the conversations around health and fat stigma.

As a Fat Studies scholar and fat activist, the issue of health is forever looming around me. In the background; in the foreground; off in the wings; waiting to pounce. Much of my scholarship has focused on fat identity and how it is managed in social media; much of my activism has focused on securing equal rights protection for fat individuals. And yet, when speaking to the media about weight discrimination in the workplace, or submitting an academic manuscript to a humanities journal, it is almost a guarantee that a reviewer or reporter will ask questions about fatness and health. “What about their health?” they’ll query, as though it has any relevance on whether fat people should be paid the same as non-fat people for work of equal value. “But isn’t fat unhealthy”, they’ll ask, as though someone’s health status has any bearing on whether they deserve to have a Facebook or Tumblr account.

Questions around health are always present in my work on/for fatness. Because health is one of the few lenses through which we, as a society, are capable of viewing fatness.

I spent much of my doctorate degree waging yet another war against my body. Even though I had been fat my whole life, and had a sneaking suspicion that there wasn’t anything wrong with me, I still went to war with my body regularly. I had all the tools – the scales, the points, the counting, the gym membership, the calendar on which I would check each day where I achieved at least 30 minutes of exercise. At the same time I was waging this latest battle, I was researching how very fat women constructed, maintained, and revised their weight identity. All of the women in my work had similar stories to my own; lifelong fatness, lifelong dieting; lives spent chasing that elusive fantasy of being thin. One of the women I interviewed was different from the rest; she wasn’t ashamed, wasn’t afraid, and didn’t believe that her weight was holding her back from anything, including health. At the end of our interview, she casually suggested I read Paul Campos’ The Obesity Myth. It was my first exposure to work that was critical of obesity studies. And from there it began; like many scholars, I fell down this new rabbit hole and read everything I could.

Friend of Marilyn v2.2

When I began, I was most drawn to understanding how tenable the links between weight and health really were. I spent a great deal of time reading empirical studies that disproved that weight was a reliable predictor of health, or that permanent weight loss was possible, even while concluding that weight loss should still be pursued by those who fell outside the desirable range. (This was before Health at Every Size; before scholars like Bacon, Aphramor, and Burgard, began revolutionising understandings of health and illuminating that keeping the definition of health as thin as it was ensured that many people of all sizes were excluded). This science, that never seemed to be at the fore of people’s minds when they casually dismissed fat politics, seemed to me to be the answer.

If I could just convince enough people that being fat isn’t automatically unhealthy, then things would change! They wouldn’t make assumptions about people based on their body sizes. They wouldn’t judge a fat person for eating at McDonalds while they themselves consumed the same food themselves. They would acknowledge that fat people deserved the same rights and dignity as non-fat people! I set to work doing just that: I facilitated workshops for healthcare providers, I wrote about the relationship between weight and health, I shared evidence through social media.

In 2012, I agreed to do a segment for 20/20 in New Zealand. By this time, my understanding of health as a social construct and a social contract had developed. When the interviewer asked me whether I was healthy, I first spoke to the varying definitions of health. Who’s health? Who gets to define health?  Who is excluded from these definitions? Then I moved into speaking specifically about my personal health. Was I metabolically healthy? Yes. Did I engage in health seeking behaviours? Yes. Did my BMI fall within what was believed to be healthy range? No. I then went on to speak on whether it should matter – did my worth of being a person with dignity and respect depend on my health status? Most of my response was edited down, and I cringed when the Me on TV began talking about my health behaviours. In my earlier work as a fat activist, I was willing to speak about my health, and the relationship between weight and health as demonstrated in the literature as I understood it. I kept thinking, one more time for the camera, and things will change. (I probably don’t have to tell you that they never have).

fat studies

I no longer participate in this form of respectability politics, a term coined by Evelyn Brooks Higginbotham to explain the efforts made by black women to demonstrate they were good enough for white society to overlook their flaw of being black (and women). In fat activism, respectability politics is often expressed in the performance of the good fatty; the fat person who apologises for their body, who demonstrates their efforts to seek health despite their size, who performs their fatness in ways that are most tolerable for the fat hating world they live in.

As a scholar and an activist, I’ve come to recognise that any conversation about health and fatness will be centred on physical health, and the ways that fatness impedes the achievement of health. And while increasingly conversations will include acknowledgement of the role of environments on health acquisition (the dreaded obesogenic environment), rarely does the conversation include a consideration of the impact of fat stigma and hate on the health and well-being of fat people. And for me, that’s the only interest of health that lives on in my scholarship and activism.

I am incredibly fat; death fat, as we like to say in the Fatosphere. In this way, I may have learned earlier than others that engaging in respectability politics wasn’t going to get me anywhere. It doesn’t matter how much I exercise or am seen eating a salad, the world will perceive me as incredibly unhealthy and incredibly unworthy. It doesn’t matter what my health status is, everyone, including healthcare providers, will treat me like a ticking time bomb that will, one day, implode and double-stomachedly take down public health care systems.

Health is the latest form of respectability politics for fat people. And I want no part of it.

More details about the authors:

Cat Pausé (Institute of Education, Massey University, New Zealand)

Causing stigma by highlighting stigma? A lesson from Twitter

Russell Delderfield in the following blog post explores and problematises the issue of stigma and eating disorders, within the context of exchanges he had on the social media site Twitter. 

Russell D pic

Image by frankieleon (Creative Commons License) 

I have recently had the wind knocked out of my post-PhD prideful sails. I studied male eating disorders using qualitative approaches for my doctorate.

The issue of stigma arises constantly in the research I read and conduct. It feels as if there is no avoiding it. It is pervasive and un-ignorable. I cannot possibly ‘choose’ to set it aside and not engage with it. Yet, when it appears in psychological publications, the treatment of it (within my field, at least) is dissatisfying. The inferences seem to start from a hefty assumption: that ‘stigma’ is a coherent, unified ‘thing’. And more importantly, that it either exists – or doesn’t. In addition, there is a kind of unwritten imperative that I experience. This asserts that mining the data for its evidence about stigma and presenting this to the world is a good thing; it helps to hold it up to the light for further keen observation. And this is where our dilemma begins.

Let me backtrack and fill in some gaps at this point. Whilst I qualitatively explore  men’s experiences with eating disorder, I’m not entirely alone. There are other clinicians, psychologists and psychiatrists who investigate  male disordered eating. A small number of studies have been published that try to improve our understanding using qualitative methods (I count 6 in my collection, thus far). Although I do not profess to specifically examine stigma in male eating disorders (my interest is broader than this alone), some of my participants share stigma they encounter.

During my PhD, I wanted to address the cursory and superficial coverage of stigma that I perceived in other work. So, I did something that no other person has done (at least to my knowledge) within my field. I did not simply report on the existence of stigma and select some careful quotes from the data to illuminate what men had been through, I took the study of a couple of men’s experiences back to its ‘roots’, with a Bordo-esque exploration of what this stigma meant to these men. I explored stigma through the lens of spoiled identity. I asked, ‘What does it mean to the man to live with stigma?’, ‘What does the experience of stigma mean for a man’s masculine identity?’, and ‘What does the avoidance of stigma mean for a man’s masculine identity?’

This, for me, emulated the ethos of feminist eating disorder work where there is an established history of women and researchers sharing their stories of ‘spoiled’ identity, objectified womanhood and the meanings of what it is to be an anorexic, bulimic or binge-eating woman. I formulated a useful exposition of what spoiled masculinities mean and feel like for men living with an eating disorder. This went beyond simply saying ‘men report they experience stigma and here’s an example of the stigma they had to deal with.’ Finally, I was satisfied. This laudable and novel achievement was a source of pride. Job done (at least for now, I’m not naïve enough to believe that qualitative work is finite).

Well that was then, and this is now. Over the summer a fellow researcher tweeted about a BBC News report that asked why men who have eating disorders keep it a secret. I was straight on the case. I retweeted with my usual ‘awareness-raising-challenge-the-stigma’ gusto. In a painfully cropped 140 words, I said that stigma is one reason that men do not speak out. I tweeted that I knew this due to my qualitative research with the men themselves. I encouraged others to face-down this stigma that can be so debilitating.

And I was challenged in turn. One of the men who has an eating disorder, who follows my research on Twitter, contacted me to raise something that I had not thought of before. In my positively proselytising mission to campaign against the damaging effects of stigma (important as I still believe it is), I had overlooked something. One tweet was all it took:

twitter“I sometimes wonder if (only) talking about how men with EDs feel stigmatised teaches men with EDs that they should feel stigmatised…”

I was floored – both as a man with an eating disorder and a researcher.

I wonder how many men feel similarly? I wonder if it is true that holding a mirror to the nature and effects of stigma simply serves to perpetuate it? In my empowered role as researcher I had overlooked something that, once said, seems so obvious. How could I not have thought about this before? Am I part of the problem, instead of being one among many cogs of the solution?

I didn’t despair for long. My interlocutor and I had a thought-provoking exchange of views. I learnt something extremely valuable. This is the very substance of what critical psychology embraces: it acknowledges the fallibility of research because it is carried out by humans about humans for humans. It challenges the monadic perspective of psychology and the monolithic nature of published research studies.   In many ways, the fact that people actually respond to my research on Twitter, rather than just passively consuming it, means that my work finds meaning somewhere. Talking about my research findings with the public leads to dialogue and a shared understanding of my single researcher experience.

However, I’m still left with a dilemma. I accept the proposition in the tweet but I do not have an answer as to how do we erode the deleterious effects of stigma, if we do not highlight the concept and the role it purportedly plays in preventing men from getting help. As a researcher, I must make sense of the potential consequences of my findings. Is uncomplicated campaigning for improvement unequivocally beneficent? I thought so, but I don’t anymore. I set out to redress the lack of complexity in male eating disorders research when it comes to stigma (amongst many other things). In turn, this bred further complexity because it created an unforeseen conversation.

Unforeseen, but not unwelcome: it’s a lesson that I appreciated learning.

Dr Russell Delderfield
University of Bradford
@MaleEDResearch