OPINION: When Science Falls Short: Anti-Fat Bias in Research
Lucille Whittier ‘24
**Content Warning: This article contains topics some readers may find upsetting or triggering, referencing discussions of slavery, anti-fat bias, and eating disorders.
Fatness and its association with greed and laziness has a long history. A history which informs our current treatment of fat.
It is crucial to our understanding of how society goes about the science of fatness that we acknowledge that fat people are marginalized. This ostracism is everywhere, look at airplanes, look at the doctor’s office, look at the workplace. Fields that we typically trust as a society, particularly in left-leaning communities, are subject to this bias. Scientific Research is one of those fields.
While this will be an aspect of the following discussion, the point here is not to prove that fat people are marginalized, but that anti-fat bias exists in and impacts scientific research and how we interact with it. For more information regarding the marginalization of fat people, I highly suggest looking into the writing of fat activists such as Aubrey Gordon and Virgie Tovar.
As University of California Irvine Professor Sabrina Strings discusses in her book Fearing the Black Body, the origin of anti-fat ideals, like everything else in our society, is inextricably tied with racism and colonialism.
Strings writes that, in the seventeenth century, upper-class and educated men began to support the idea that intellect was associated with restraint. It is this puritanical logic that even the most basic pleasure is sinful, simply transferred from religion to elitism.
Thinness was a sign of self-control; starving meant not overindulging, it meant willpower.
Thus, in Strings words, “fatness for English intellectuals was progressively linked to irrationality; thinness was seen as more befitting the intelligent, self-possessed white male”
However, prior to the seventeenth century, Strings asserts, white women were meant to be shapely while “black women and men [were] unnatractive, hypersexual, and diminutive in both size and social standing.”
As the prevalence of slavery increased, Black people became “aesthetic counterpoints within the budding culture of taste,” according to Strings. Black women were increasingly represented as small and foul, while white women were seen as stately and beautiful.
That said, white people demeaned Black people and justified their enslavement by characterizing them as “mindless, self-gratifying automatons,” Strings writes, thus unfit to rule themselves or their resources. They were irrational, the opposite of the intelligent, self-possessed European elite.
By the logic of the time, if Black people were over-indulgent and irrational then they must be fat, but this clashes with the standard for women’s beauty which emphasized plumpness.
This dichotomy between the increasing association of thinness with intelligence but plumpness with beauty comes to a head in 1615, Strings writes, in renowned painter Peter Paul Reubens’ depiction of an Ethiopian nymph in The Four Rivers of Paradise as having the same desirable body as the white nymphs, and equal social status. To be clear, this depiction is in no way concurrent with Reubens’ other depictions of Black women.
The Four Rivers of Paradise (Peter Paul Reubens) via Gallerix
“Reubens’ work throws into relief the moment the distinction between African and European women came into increasingly rely on the physical body,” Strings writes.
It was after this association of fatness with Black people, according to Strings, that doctors began to prescribe weight loss treatments to the white elite, sometimes as extreme as purging – which, no, is not healthy.
Strings writes, “the phobia for fatness and preference for thinness have not, principally or historically, been about health. Instead, they have been one way the body has been used to craft and legitimate race, sex and class hierarchies.”
This recollection of anti-fat values permeating culture is condensed, to say the least. However, it demonstrates that the association of fat with immorality, low-intellect and affliction has existed long prior to any scientific findings or technology that would prove those assumptions to be fact.
It is bizarre that society takes so much of anti-fat science at face value without taking into consideration the biases of the society, scientists and researchers that found those claims.
As a society we tend to view science and data as existing in a separate realm, untouched by our human flaws and prejudices: science is science, science is fact.
We know, though, that science is an evolving field prone to human error. For the majority of human existence, we believed that the Earth was the center of the universe, until we realized that it isn’t.
We also know that there are many past instances of societal biases found in scientific research. At one point in time, not too long ago, “female hysteria” was an accepted medical diagnosis. Science might not be human, but scientists are.
Yet here I am, providing hard evidence.
A 2012 study regarding anti-fat bias, demonstrated a group of 398 obesity researchers and scientists all exhibited significant implicit and explicit anti-fat bias.
Another 2012 study examining several forms of bias in the medical field, found that a pool of 2284 medical doctors showed strong anti-fat attitudes.
In a 2017 review of 42 studies regarding bias in health care, significant implicit anti-fat, racist, sexist etc. sentiment was found in the results of thirty-five studies.
Something to note is that any data regarding biases will be at least partially self-reported, which is notoriously untrustworthy – these studies also rely on Implicit Attitude Tests, though, which have been tested thoroughly and shown to be accurate.
The self-reported data is, admittedly, a bump in the road. My way of thinking about this is that people do not typically admit that they are prejudiced – particularly not people who are lauded for their objectivity, as scientists are. Still, these studies are revealing bias against fat people.
I will also turn you once again to fat activist writers, as well as the many stories of, frankly, medical malpractice surrounding doctors’ treatment of fat patients.
Science journalist and professor Regina Nuzzo, in a 2015 article regarding unconscious bias in science, wrote “even an honest person is a master of self deception.” This can happen countless ways in science: hypothesis myopia, asymmetric attention and just-so storytelling, to name a few.
To be clear, this is not an argument for anti-science movements, like the anti-vaccination movement or climate denial. In both cases, the “science” has been discredited as under-researched and false data.
In the case of anti-fat science, though, what we are looking at is a bias existing only to later be backed up science. What evidence there is that our cultural assumptions regarding fatness and fat people are incorrect, is largely ignored.
That said, it is only fair to examine some of the counter arguments.
According to a 1995 study, weight gain threatens a higher risk for type two diabetes mellitus in women and could be seen as a predictor of a diagnosis.
What is baffling to me about this study, is that it fails to consider other factors that may contribute to weight gain and type two diabetes separately and in tandem. Type two diabetes is known to be strongly genetic, yet these researchers immediately jump to the conclusion that weight is the cause of type two diabetes, when it could easily be the other way around.
A 2016 analysis of 239 obesity-related studies found there are consistent associations between fatness and all-cause mortality. This study is also based on self-reported data, which, again, is unreliable, especially in cases regarding weight and diet.
It is unclear how the participants in this study actually died – it would be ridiculous to associate non-medical issues, such as car-related death (which falls under the umbrella of all-cause mortality), with fatness. However, there is no evidence to suggest that this is not the case here.
This study also does not take into consideration that fat people consistently report being denied health care or are told to lose weight as a cure for any ailment. I don’t think I need to explain how being turned away by your doctor or being medically prescribed an eating disorder might have negative health impacts.
These kinds of studies are typical. They find data and, based on held societal assumptions, jump to conclusions about what the data means rather than doing an in-depth analysis of the possibilities. The data has shown a correlation, but that correlation is being presented as a definitive answer rather than being explored.
There are also numerous studies finding contradictory results. Regardless of what any studies say, conflicting evidence in a scientific field should be a red flag.
For example, a 2013 review associates a medium to high BMI with lower mortality and better outlook in cases of chronic diseases or other health circumstances.
In 2016, a study demonstrated little to no association between grade one obesity and elevated risk of all-cause mortality. In fact, overweight BMI was associated with significantly decreased risk of all-cause mortality.
A 2004 legal review argued that as obesity rates have increased in the United States, incidence of heart disease is falling. This review also presents research showing that fat and active people tend to be healthier than thin and inactive people.
This evidence, and other evidence like it, has been labeled the “obesity paradox,” which is to say that the findings are contradictory to truth, that it is the truth that fat people are unhealthy.
It is a strange phenomenon that when data is presented indicating that fatness is not unhealthy, it is taken as an enigma rather than what it is: evidence.
One thing to note about the aforementioned studies, is they all utilize the BMI, which confuses the data – for example, bodybuilder Lou Ferrigno was 6’5” and weighed 275 lbs at the 1993 olympics, which would have categorized him as obese according to the BMI, however we would never, socially, treat Ferrigno as if he were fat.
On one hand, the use of BMI could indicate that the healthy people categorized as obese are simply body builders. On the other hand, it could indicate that the deaths associated with obesity were not just fat people, but could include people such as body builders. The science behind fatness is nearly indecipherable while BMI remains in use.
This is partially because the BMI was not even created to be used as it currently is.
According to a 2009 NPR article regarding the history of the BMI, Belgian mathematician Lambert Adolphe Jacques Quetelet produced the BMI to assist the Belgian government in allocating resources. The calculation does not consider varying proportions of bone, muscle or fat in a body. It was created based on a small community of Europeans 200 years ago and is not applicable to a diverse and modern population.
This is an instance that necessitates common sense. Not only to understand that there are more fat people than bodybuilders in the world, but that scientists studying the impacts of fatness would most likely be using visibly fat people in their experiments.
Still, the science surrounding fatness is almost rendered useless by the amount of dubious tools used to collect data. These tools are so pervasive that they have become a commonplace way to discuss diet, exercise and health outside of science.
For instance, Tamara Duker Freuman, MS, RD, CDN writes in a 2016 US News article, “the diet of 2000 calories per day is more likely an exception to the norm, not the norm.”
According to Freuman, the 2000 calorie suggestion from the FDA is based on an average of self-reported caloric intake data from a 1990 survey.
Say it with me: self-reported data is not reliable. This especially applies to caloric intake; if you know the exact amount of calories you are consuming, it is because you are actively counting them and measuring your food, which I will tell you from experience, is not a fun and casual thing to do.
Besides the fact that exact calorie counting is nearly impossible, the science behind calories – our most basic unit of measurement here – has been brought into question.
As Giles Yeo MBE writes in a 2021 article, what we understand about calories comes mainly from the research of Wilbur Atwater in the 1880s, using a bomb calorometer – “a highly pressurised sealed container that is filled with pure oxygen for burning” – to calculate a food’s caloric content.
This method, according to Yeo, does not take into consideration the energy released during metabolism – a significant amount of energy.
Yeo puts it best when he writes, “humans are not bomb calorometers.”
As humans, our one purpose is not to ingest and burn calories, so why do we consistently treat ourselves as if it is?
This is all to say nothing about the involvement of weight-loss drug companies in obesity research. Nor does it touch upon the studies linking weight to genetics, indicating that our weight is not totally in our control.
The science around fatness is still uncertain and it is hasty to put into action policies that target fatness, which is to say, fat people.
Still, it should not take pro-fat science to treat fat people with dignity.
What all of the above studies fail to observe is that they are discussing real humans, who are facing the consequences of whatever scientists and researchers are publishing as scientific fact with zero caveats.
I am certainly not arguing that science should not be trusted or that you should entirely ignore the advice of medical professionals. What I am arguing is that we remain open minded to a diversity of evidence and research, and not use any science to justify persecuting a person for existing in their bodies.
Vaccinations and climate change are both fields that have been researched extensively, with clear evidence and little valid scientific debate. Yet, there are those people who refuse vaccines and deny climate change. When it comes to the science of fatness, though, a field which consistently finds contradictory data, we accept anti-fat results unreservedly.
When we talk about trusting science, which science are we talking about?