Obesity: Education vs fat-shaming, where is the line?

By now many people have seen this PSA by Children’s Healthcare of Atlanta, depicting a 300 lb, 32-year-old man in the ER with a heart attack.  In it, one of the doctors asks, “How in the hell does that happen?”, at which point you see a graphic rewind of many of the unhealthy choices the man has made- and his parents (mostly his mother) made in raising him.  It’s a powerful video- as it was meant to be, but there is some debate about it.  If you haven’t seen it, I urge you to watch it before reading this.

So, does the video represent education, or is it just another way to shame people who are overweight?

Today, when it comes to obesity, there seems to be a fine line between educating people and “fat-shaming”.  To start with, I absolutely believe there are many different kinds of bodies out there, many of which are healthy.  The ultra-skinny female or the ripped, athletic male as ideal are products of media, and for most people represent unrealistic benchmarks to aim for.  You need not look like that to be healthy or beautiful.  I believe that if we are happy with yourselves and truly like what we see, then that is the most important thing.

However, obesity- especially in America, is a real problem.  As a healthcare professional I acknowledge this and strive to help people through education or working with them on their goals for change.  Yes, some people have medical issues which can affect their weight (e.g. hypothyroidism) or ability to be physically active (e.g. diabetes, muscle or bone issues)- but the changes in the average American’s body compared to 20, 30, or 50 years ago can largely be attributed to changes in lifestyle.  Fast food, larger portions, snacking, more people working in less active jobs, stress, less physical activity…and so on.  Today’s lifestyles are just different than they used to be, and that is no one’s fault.  As a society, though, we are paying for it- in part through the increase in obesity and related conditions.  My point is that this is a real issue and not one we should ignore.  As a psychologist I know that we have a tendency to ignore that which is uncomfortable and that it is VERY hard to face it, let alone do something about it.  On the other hand, I do not believe in shaming those who are overweight or obese.  It’s not kind and not likely to be effective.  I do believe, however, that more education is needed for all of us, and that education and fat-shaming are not necessarily the same thing.

This is not news to most people, and I am not writing this to start any kind of debate.  However, I want to highlight some of the factors and phenomena that I believe help fuel this issue.

1) A need for more education:

Unless you are a dietician, personal trainer, or a physician, you probably do not know all there is to know about healthy eating, the right amount or type of exercise for you, or what contributes to obesity and medical conditions.  And if you are not a mental health professional, you probably do not know some of the psychological factors that contribute.  We could all stand to know more about health-related topics, so we should strive to be open to new information.

2) False advertising by food and beverage companies:

Like all businesses, in particular corporations, food and beverage companies exist to make money.  Some may care more about your health or well-being than others, but that’s just not why they do what they do.  You can’t believe everything that you hear- especially from someone whose goal is to get you to buy a product they’re selling.  And it’s well-known that companies use shady tactics to boost sales.  Some “junk food” companies, like Doritos, have even been accused of designing their foods to be addictive, adding ingredients that will make it difficult to put their product down or will keep you coming back for more.  I don’t doubt that that is true.

3) Doing what’s easy:

We all take the easy way out sometimes, and I wrote a recent post about change (such as weight loss) requiring us to do the hard things that we really just don’t want to do.  But I think this speaks to some of the changes in our society over the years.  Working more hours, more dual-earner households, being involved in more activities… These things have contributed to more stress, feeling more tired at night, having fewer family dinners, and so on.  As a result, we’re eating on the run (McDonald’s, Chick-Fil-A, Wawa, or other easy choices), or we’re exercising less- perhaps in favor of sleep or down time watching TV.  This is not anyone’s fault, per se.  We’re busier and more stressed, making it even harder to make good choices or to do the things that will be more beneficial.  Couple that with the fact that there is a fast food restaurant or convenience store on every corner, vending machines, or a snack bar at the ball fields.  And healthy choices there are pretty much nonexistent.  It’s a tough battle to fight, and surely finding time to exercise and making better food choices isn’t easy.  But we have to be dedicated to doing this if we want the results that come along with it.

4) The “quick fix” mentality: 

We live in a time where we want what we want when we  want it.  How many infomercials have you seen where someone is guaranteeing great abs in 8 minutes, or a perfect booty in just 10 minutes a day?  Or if you take the right vitamins or drink a daily shake the weight will just come off?  The idea, essentially, is that you can get what you want without doing the work, or with a minimal amount of effort.  The fact that these are billion dollar industries illustrates this perfectly.  Who wouldn’t want that?  But the reality is that there are no quick fixes, and the goals we want to achieve (if they are even realistic) are hard!  If you decide to eat better or exercise more regularly, you need to be willing to commit  for a number of weeks or months.  Sure, that depends on your situation or goals, but you just won’t see results in 1 or 2 days.  The problem for many of us is that we get quickly discouraged and give up or start cheating (eating sweets, skipping workouts, and so forth), which puts us back where we started- probably feeling even more discouraged.  The quick fix is a myth, and we all need to understand that.

5) Reinforcement:

In Introduction to Psychology you learn about positive and negative reinforcement.  I have to admit that even as a psychologist I continued to confuse the two well into my master’s program.  But here are some definitions and examples of how they work:

Positive reinforcement: Doing something brings a reward, so you do it again.

A) You eat something sweet and it tastes good, so you eat it again.

B) You come home from a hard day at work and you drink a few beers.  You feel less stressed and more relaxed, so you do it again.

C) Your children beg you to pick them up McDonald’s for dinner.  You do it and they enjoy it, and are then full as well as happier.  They will beg you for this or something similar again because they know it will satisfy them.

Negative reinforcement: By doing an action, something unpleasant is taken away, so we do it again.

A) Eating when we are hungry takes away that hungry feeling, so we know that eating works and we do it again (obviously, we need to do this to survive!).

B) We learn that a few drinks after work takes away that stressed or “blah” feeling, so we do it again.

C) We learn that giving our children what they want will stop their whining or begging, so we give them what they want.

The bottom line is that patterns are created, which often are not healthy or beneficial in the long run.  We have to learn this and dedicate ourselves to changing it.  It can be done, but it often gets worse before it gets better.

6) Cognitive dissonance:

This phenomenon states that when we have two conflicting beliefs, it creates discomfort in us.  To reduce this, we need to either A) change our behavior, or B) change our beliefs.  Here are a few examples:

A) We smoke cigarettes but believe in leading a healthy lifestyle (or maybe we’re a doctor or nurse).  We feel discomfort because we know smoking isn’t healthy (and surely medical professionals should be models for good health).  So we either try to quit smoking, or we decide that smoking really isn’t that bad.  Maybe we’ll focus our efforts on eating better or exercising more- something we can do more easily.

B) We believe our kids should eat healthy, but our reality is that we lead a busy life with sports or activities on most nights.  We could either plan ahead and pack a healthy dinner, or we can take the kids for fast food, but try to pick the healthiest option for them, choosing to believe the restaurant’s claims that their food is healthy, even though we know that it’s not.

I hope that my bringing up these phenomena can give people a better understanding of some of the things that we’re up against and can highlight the need for more public education- not just about obesity, depression, or anything else- but about the factors that contribute to these issues.  To be clear, I do believe that “fat shaming” is a real thing and that it’s not at all an effective tactic to combat obesity.  BUT, I also believe that some people are too quick to write off education as that, due to the exact reasons I just discussed.  Change is hard, and talking about things we may need to change is uncomfortable.  Surely it’s easier to deny that something is a problem or to minimize it than it is to acknowledge it and do the work necessary to do something about it.  Education should be presented in a sensitive way, but I also believe that it’s powerful messages that get the attention necessary to make people think.

Dr. Jesse Matthews is a licensed psychologist in private practice in Chester Springs, PA.  He helps people of all ages to address many kinds of issues.  You can view his Psychology Today profile here.  For any questions or to arrange an appointment, please contact him at 610-482-4496 or drmatthewspsych@gmail.com. 

Published by Dr. Jesse Matthews

I'm a practicing psychologist and director of Matthews Counseling & Coaching, a private practice in Chester Springs, PA. I work with clients 18 and older, and my specialties include: depression; addiction/substance abuse; relationships; anxiety; ADHD and behavioral issues; and Autism/Asperger's. Our group works with individuals from tween through older adult, helping them with a variety of life issues. Check out the practice website for information on other clinicians and their services: http://matthewscounselingcoaching.com .

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