What Bill Maher gets wrong about obesity, health, and behavior change
This past Friday the country — indeed the entire world — received some shocking news: after a lengthy hiatus, Fat Shaming was making its big, long-awaited comeback. That’s right, after spending some much-needed time out of the limelight, away from our schools, grocery stores, and gyms, Fat Shaming has finally returned and not a moment too soon.
When did this happen? How did I miss it? Were all our letters finally received? Well, like the Justin Timberlake of bullying we didn’t know we needed, Bill Maher has taken the heroic step of bringing Fat Shaming back. For that, we should all apparently be grateful.
This past Friday, Maher announced to his audience that Americans are too fat, that they are causing their own inflated healthcare expenses, and that it’s imperative that we shame them (preferably publicly and from an outsize cable television platform) into changing their behaviors for their own good.
“In August, 53 Americans died from mass shootings. Terrible right? Do you know how many died from obesity? Forty thousand,” Maher told his audience. “Fat shaming doesn’t need to end; it needs to make a comeback.”
There’s only one small problem with Fat Shaming’s big return to public life: it literally never left. Not for a second.
What is fat shaming?
Fat shaming continues to be pervasive in our society and is insidious in its ability to morph into a variety of forms that seep into many parts of our day to day lives, some of which you might not even expect.
Fat shaming isn’t just school bullies or comments about a co-worker’s lunch habits, though both are fairly obvious examples. It can be as overt as directly criticizing someone for how they look. Sometimes it’s unsolicited comments about eating less and exercising more, especially under the guise of care and concern. Often, though, it happens in ways that are easy to miss if they aren’t directed at you. It’s looks from other diners in a restaurant when a fat person dares to order something other than a salad. It’s complaining that you “feel fat” (clearly the worst thing one can actually be), especially around someone who actually is. It’s telling someone they’re not fat, they’re beautiful as though the two were mutually exclusive concepts.
These day-to-day microaggressions aside, fat people also experience all kinds of outright discrimination because of their bodies. Fat people are less likely to be hired for new jobs and are frequently passed up for promotions — and this is LEGAL in 49 states. They’re also significantly more likely to receive job reviews that include comments about their appearance being unprofessional, rather than focusing on their actual performance.
Worse still, fat people also experience discrimination in healthcare settings, where their symptoms are often ignored or chalked up to a side effect of their weight. As a result, fat people are frequently misdiagnosed or not diagnosed at all. Instead, they’re given potentially harmful dieting advice in lieu of the treatment they actually need.
But isn’t obesity killing 40,000 Americans a month?
Much of Maher’s information came from work cited in a recent opinion piece by Dariush Mozaffarian and Dan Glickman published in the NY Times last month. The article cites many statistics on diet and disease and notes that “poor diet” is responsible for nearly half a million deaths in the United States each year. Note that this explicitly says “poor diet” not “being fat.” It’s important that anyone making sweeping generalizations like Maher did on Friday be aware of that distinction. However, Maher, in his typically boorish and indelicate style, failed even to recognize the difference between fat and unhealthy. For him, they’re one and the same, and that very premise is what undermines his entire argument.
It would be intellectually dishonest to ignore the legitimate points that Maher did make on Friday — namely that obesity-related illnesses are on the rise and are responsible for numerous deaths in this country and around the world. Diabetes, heart disease, stroke, and some cancers can be caused or worsened by high body weight. The problem is particularly severe in children who will likely carry the literal weight of such risks, in addition to bullying and shaming, for most or all of their lives.
People often cite these points as reasons why we should, in fact, be encouraging people to go on diets and exercise more. This, however, is a fundamentally dishonest argument, and completely lacking in nuance and sensitivity.
For one thing, Maher should know that correlation does not equal causation. There might be a strong link between obesity and a variety of illnesses, but that doesn’t mean that it’s body size that’s causing them or that there aren’t underlying causes of obesity that are being missed or willfully ignored in this conversation. As noted above, it’s far more accurate to describe the illnesses that are causing Maher so much concern as diet-related diseases. After all, poor diet has negative health consequences for people of all sizes.
Additionally, and despite so many assumptions to the contrary, not all fat people are sick, and not all sick people are fat. You can do all the “right” things — eat all the grilled tofu and kale that the world has to offer and bookend your day with yoga and burpees — and STILL be fat. You can also eat fast food every day and never come close to clocking 10,000 steps on your Fitbit and still be skinny.
Say it with me: You can be fat and healthy; you can be slim and unhealthy.
And therein lies the biggest problem with Maher’s cheeky recommendation. If you can’t tell if someone is actually unhealthy just by looking at their size, then what right do you have to offer criticism, shame, or even well-meaning advice?
So, what should we be doing to reduce diet-related illnesses?
We should be having honest conversations informed by public health professionals about the health problems plaguing this country. But our aim should be addressing the causes of obesity and poor health outcomes, not just focusing on fatness as the cause of those problems. Drawing attention exclusively to fat bodies and placing blame and moral judgment about discipline and self-control on fat people only opens them up to additional discrimination.
And here’s the real kicker: shaming doesn’t even work!
In fact, research has repeatedly shown that fat shaming has the opposite of its intended effect. People who experience fat shaming tend to consume more, not fewer, calories after a shaming incident occurs. They’re also less likely to exercise because doing so opens them up to further ridicule. Additionally, they also experience lowered self-esteem, depression, and even suicidal ideation. So, if you’re genuinely trying to get people to improve their diet and exercise habits, this is the exact wrong way to go about it.
Maher, however, seems to believe that there’s a rich history of shame resulting in behavioral and social change in this country.
“Some amount of shame is good. We shamed people out of smoking and into wearing seat belts. We shamed them out of littering and most of them out of racism. Shame is the first step in reform,” Maher announced to his audience.
But shame didn’t get people to stop smoking or wear seat belts or throw out their trash, regulation and legislation did. We passed laws that required cigarette manufacturers to put warning labels on their products and stop advertising directly to children. We passed laws requiring people to use seat belts while they drove. We passed laws against littering and cities provided readily available public trash cans.
And there’s real room for the government to help in this case as well, by creating policies to improve nutrition education, access to healthy foods, and incentives and disincentives around particular food choices. If you want to make a real impact, you target the root of the problem, not the people impacted by it.
If you can’t tell someone is actually unhealthy just by looking at their size, then what right do you have to offer criticism, shame, or even well-meaning advice?
So, if you, like Maher, believe that “Americans eat shit and too much of it” and you’d like to help reduce poor health outcomes related to diet, where should you start? Well, in addition to the policy changes noted above, your anger and concerned social media posts would be far better directed toward fast food companies, soda companies, food lobbies, government subsidies for agriculture (especially corn), targeted food advertisements, cuts to public education and extracurricular activities, cuts to SNAP benefits and free lunch programs, lack of access to healthcare providers in many communities, food deserts in poor areas, shrinking public lands for recreational uses, ever-increasing student loan debt, slow wage growth, and longer workdays.
This is far from an exhaustive list, but all of these things are controllable factors driving increases in diet-related chronic illnesses in this country. Focusing on shaming fat people ignores the broader, more systemic issues that impact our ability to make the healthiest choices for our bodies. It also assumes that fat people aren’t taking responsibility for their individual health or trying to lose weight. In fact, we know this is false because the U.S. weight loss market is worth about $72 billion as of 2019, and all that profit isn’t being generated exclusively by skinny people.
If our real “concern” is health, then let’s spend time improving health behaviors. Maybe that will change the size of some people’s bodies, but maybe it won’t, and that has to be okay. And if our goal is to effect real change, let’s focus our attention and judgment on the things that are actually responsible for the health issues we claim to care so deeply about.