As we continue the conversation about Health At Every Size, two factors are important to look at. Last week, I talked about weight inclusivity. Weight inclusivity means looking at your weight bias, including your own body. The two factors I want to explore are health enhancement and respectful care. These are two important aspects of life that weight bias greatly exists in and being pushed to change.

The Association of Size and Diversity (ASDAH) defines health enhancement with HAES as supporting policies that improve and equal access to information and services. It looks at personal practices that enhance human well-being, including attention to individual physical, economic, social, spiritual, emotional, and other needs.

Respectful care is defined as acknowledging our biases and work to end weight discrimination, weight stigma, and bias. Provide information and services to understand that socio-economic status, race, gender, sexual orientation, age, and other identities impact weight stigma and support environments that address these inequalities.


These are two fundamental issues that impact those in a larger body, and they are inter-related with one another. If we look at the health policies in place, there is great attention to “obesity prevention.” But studies and statistics have shown that this has, in fact, backfired. Americans are trying to lose weight but have found themselves in a place where they are in a damaging cycle of weight loss and weight regain. They have experienced excessive preoccupation with food and their body, decreased self-esteem, feeling like a failure, and for some, developing life-threatening eating disorders.

This focus on healthcare is also looking at the discrimination that is found in health insurance, as well as in the healthcare field. It is sad when it is hard to find compassionate and unbiased health care providers. I can’t tell you how much struggle my clients face to find a weight-neutral doctor. My colleagues and I are constantly asking one another if we know of any primary care doctors that are unbiased. And when we find one, they become flooded with patients, that they become full and no longer take new patients. What does this say? There is such a desperate need to educate doctors and the health care system that the old ways are not working. People who live in a larger body avoid taking care of their medical needs because of the bias they experience.

This focus on weight has only moved people further away from health and has actually decreased quality of life, rather than improving it. It is the false belief system that people will change and, therefore, become healthier with the focus on weight. But the exact opposite is happening. There needs to be a shift directed towards the health of the body, not the weight. What are the behaviors that are being engaged in that are health-focused rather than body-focused?

The Bias

It is important to note that biases within subset groups exist within our society regarding weight. These include socioeconomic status, race, gender, sexual orientation, age, and other identities. In each of these subsets, there is bias.

There has been a lot of attention to the availability of nutritious food to lower socio-economic status. It is easier and even more costly to get a fast-food meal to feed a family. We have to look at the cost that is associated with eating more nutritiously. It becomes a privilege to afford nutritious food. This must change and take a real look at our food system.

Race, gender, and even sexual orientation all face bias; bias’ we might not even consider. For example, social media influencer, heydrsand, speaks very passionately about the alarming incidence of eating disorders in the trans community. They bring attention to the violence and transphobia and lack of safety, lack of agency, and control over access to gender-affirming care. That trans health care perpetuates eating disorders with BMI and surgical requirements. Our eyes need to be opened to what our society, in every subset group, experiences and truly see how pervasive our weight stigma and discrimination seeps into our culture.

Author, Sabrina Strings, brings to light the weight stigma in our culture, in her book, Fearing the Black Body. She speaks to fatphobia as being means to use the body to validate race, class, and gender prejudice. She explores the history of how this originated more than two hundred years ago.

What is Your Privilege?

I feel that it is important for me to acknowledge that I am fully aware of the privilege that I live in every day. I am a thin, white, middle-class woman. I know that I am not fully aware of others’ biases because I do not walk in their shoes. I will never fully understand what it is like for them because I am treated differently because of my body’s size and skin color. But I am committed to use my privilege responsibly and to help end the oppression that those face with bias. I encourage you to do the same if you find yourself in a place of privilege. You can be reflective on how you are treated, as well as how you treat others.

How would your life be different if you were in a larger body than you are now?

Think about your daily activities-meeting a new person, shopping for clothes, ordering a cheeseburger and fries, or even speaking about weight bias. Would others view or treat you differently?

Would you feel more or less self-conscious about others’ judgments?

More or less entitled in whatever it is that you are doing?

This allows you to realize where you sit.

When we look at the bias with weight, we must acknowledge that the harder it is for people who are in a larger body to be accepted and respected within our society, the more fear it promotes with becoming fat. There is an internalized fear that being thinner is better, promoting those living in a larger body to be preoccupied with being smaller and waiting for some aspects of life to start until they have lost weight and are deemed “acceptable.” We need to look at what we are valuing as a society as a whole. How is it that we value the size and shape of a body over the person as a whole?

So much of the change that needs to happen can shift with you. Becoming conscious of your bias and your stigma is the first step. Talking to your health care provider about weight neutrality and Health At Every Size can make a significant difference. It is going to take the collective to shift this issue. Are you willing to be a part of the change?



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