"Whatever I said didn't register with her": medical fatphobia and interactional and relational disconnect in healthcare encounters.

Introduction: This article focuses on medical fatphobia as a specific phenomenon structuring interactions between patients and healthcare practitioners. Throughout the article, we use 'fat' and 'fatphobia' as the preferred terms in the body positivity and fat acceptance communities. It is well documented that 'fat' people frequently experience negative and highly stigmatising healthcare encounters where weight is disproportionately centred and over-attributed as a cause of ill-health. This can compound and worsen disordered eating, trigger mental health problems, and lead to healthcare avoidance. Although the regularity and risks of these weight-focused encounters are well established, there does not yet exist a coherent theoretical framework for understanding such discriminatory practises. Methods: In this article, we draw on the experiences of 15 fat women who are members of the Health at Every Size (HAES) online community to explore how they perceive their fatness impacting medical encounters. Results and discussion: Through these data and specifically drawing on the framework of 'cultural health capital,' we suggest that given the deep purchase of cultural tropes surrounding it, fatness is perceived to embody and therefore confer on patients' assumptions of low cultural health capital. We argue that ubiquitously characteristic of medical fatphobia is what we call an 'interactional and relational disconnect' between fat patients and healthcare practitioners. We suggest that this disconnect structures fatphobic interactions by over-attributing fatness as the underlying cause of medical problems, which entrenches patient and practitioner ambivalence because of a lack of joint decision-making. We argue that interactional and relational disconnect is produced by, sustained by, and reproduces asymmetric power relations between patients and practitioners. While we demonstrate that patients develop tactics to mitigate and manage fatphobia in healthcare encounters, the persistent interactional asymmetry between doctors and patients means these attempts often fail. We conclude with a plea for sociology to take medical fatphobia seriously as a form of intersectional systemic discrimination. While movements like HAES, fat positivity, and body acceptance create kinship and support fat patients with self-advocacy in healthcare interactions, we suggest that systemic rather than individual change is necessary for effective healthcare inclusion and interaction.

Compreendendo o termo gordofobia médica a partir da perspectiva de pessoas gordas / Understanding the term medical fatphobia from the perspective of fat people

Resumo O ativismo gordo tem como objetivo unir e mobilizar pessoas gordas, a fim de romper com a inviabilização de seus corpos e denunciar a gordofobia. Há algum tempo, o ativismo vem impulsionando a expressão "gordofobia médica" para denunciar a opressão vivenciada dentro dos serviços de saúde. Este artigo tem como objetivo compreender o termo, a partir da percepção de pessoas gordas. É uma pesquisa qualitativa, com dados coletados por meio de um questionário virtual direcionado a pessoas gordas ou ex-gordas, que alcançou 515 respondentes de todas as regiões do Brasil. Os dados foram analisados utilizando a análise temática, com a criação de seis categorias. Entre os principais resultados, pode-se compreender que a gordofobia médica envolve: despreparo, desrespeito e autoritarismo; reprodução de estereótipos, repulsa e preconceito, desumanização da pessoa gorda, diagnóstico superficial e generalizante, desprezo da queixa, foco no peso e negligência, e precarização do acesso e dos cuidados em saúde. Conclui-se que o estudo auxilia na compreensão do termo gordofobia médica, o que facilita o seu reconhecimento e prevenção na área da saúde.

Abstract Fat activism aims to unite and mobilize fat people to break with the impracticability of these bodies and denounce fatphobia. For some time now, activism has been pushing the expression "medical fatphobia" to denounce the oppression experienced by fat people within health services. This article aims to understand the term, from the perspective of fat people. This is a qualitative research, with data were collected via a virtual questionnaire aimed at fat or formerly fat people, which reached 515 respondents from all regions of Brazil. Data were analyzed using thematic analysis, with the creation of six categories. Among the main results, it can be understood that medical fatphobia involves: unpreparedness, disrespect and authoritarianism; reproduction of stereotypes, disgust and prejudice; dehumanization of the fat person; superficial and generalizing diagnosis; dismissal of the complaint, focus on weight and negligence; and precarious access to the health care. In conclusion, the work helps in understanding the term medical fatphobia, which facilitates its recognition and prevention in the health field.

The prevalence and practice impact of weight bias among New Zealand registered dietitians.

AIM: This study explored demographics and three characteristics of registered dietitians-optimism, perfectionism, and weight bias and whether they affect three components of dietetics practice-dietetics assessment, dietetics recommendations, and dietitian's perception of the client's success. METHODS: A self-administered questionnaire was completed by 92 registered dietitians and student dietitians in New Zealand to assess explicit weight bias. [Correction added on 27 January 2023, after first online publication: in the preceding sentence, '109 registered dietitians' has been updated to '92 registered dietitians'.] Participants were randomised to receive a case study for a condition unrelated to weight accompanied by a photo of a woman with either a smaller or a larger body. Participants then assessed the client based on data provided, provided recommendations, and rated their perception of the client. RESULTS: Mean (±SD) scores indicated mild fatphobia (2.63±0.39) in participating dietitians. Dietitians presented with the photo of a larger client assessed the client to have lower health and were more likely to provide unsolicited weight management recommendations. Additionally, dietitians rated the larger client as less receptive and motivated, and less likely to understand the recommendations adequately, with a lower ability to comply with and maintain these recommendations. CONCLUSIONS: Dietitians and student dietitians in New Zealand may practise in a manner that could be perceived as influenced by negative implicit weight bias, despite the explicit fatphobia scale scores assessing only mild fatphobia. Further research examining the extent of the problem in New Zealand, how it impacts client outcomes, and possible solutions are required.

"I'm coming out!": An autoethnographic situation of sel/f/ves within queer fat chronically Ill identity.

In this article, we (two fat, white, queer, nonbinary, chronically ill critical social work scholars) explore the parallel processes of coming out as fat and coming out as other identities (queer, femme, neurodivergent, nonbinary, chronically ill, disabled). We begin by reviewing literature from queer theories, crip theory, and fat studies, addressing concepts of "coming out" and identity. Next, taking an identity-centered autoethnographic and autoarchaeological approach, we explore how the processes in coming out as fat-growing critical consciousness, positive social identity reclamation, community belonging-mirrored other coming out processes, fostering resilience in our lives. We perform this reflection on sense(s) of self within a queer critical intersectional approach, as we individually and collectively examine how our fat identities are situated within our gender, racial, class, ability, health, and sexual orientation contexts. We interrogate how these identities of fatness and beyond, both privileged and oppressed, interplay in our personal, professional, and health-related experiences, and interactions with others. Finally, building off of the theoretical work proposed by Hunger, Major, and Blodorn (2015), we integrate concepts of critical consciousness, positive social identity, and community connectedness into the social identity threat model (as applied to weight stigma), hypothesizing how these potential positive outcomes of "coming out" may moderate the relationship between the psychological stress associated with marginalized identity and the adverse physical and mental health outcomes commonly associated with oppression and minority stress.

Under the 'weight' of norms: Social representations of overweight and obesity among Brazilian, French and Spanish dietitians and laywomen.

Most contemporary Western cultures are characterized by fatphobia. The fat body is seen as morally incorrect, a sign of disease, loss of control and weakness. People with obesity and overweight, especially women, are discriminated against and stigmatized for their body size, including by health professionals like dietitians. This study sought to understand and compare social representations of obesity and overweight among dietitians and laywomen from three nationalities: Brazilian, French and Spanish. A qualitative and comparative methodology was established based on 131 semi-structured individual interviews. The analysis revealed that the categories of overweight and obesity were negatively perceived by laywomen and dietitians from all three nationalities. Moral discourses linking these conditions with lack of discipline and a lack of emotional control were frequently used. Fatness was associated with irrationality, putting individuals who were overweight and obese in a position of social and moral inferiority. In the case of obesity, these ideas were more discriminatory and stigmatizing. Although environmental, genetic, hereditary or metabolic causes were mentioned as factors causing obesity, behavioural aspects occupied a central place in the discourses. Differences were also observed among the three nationalities. Cultural factors related to the relationship with body and food seemed to influence the interviewees' social representations. Brazilian laywomen and dietitians put more emphasis on moral and individual aspects. Spanish, French and informants who were overweight were more likely to cite physiological and environmental determinants. French informants also mentioned the role of food education given by parents. In conclusion, the discourses of professionals and laywomen had more similarities than differences, were based on moral and normative judgements and influenced by sociocultural norms. Fatphobic attitudes may impact dietitians' perception of patients with obesity and the eating education process.

Anti-Fat Biases of Occupational and Physical Therapy Assistants.

Fat people are highly stigmatized, and anti-fat bias is pervasive resulting in stigma, prejudice, and discrimination, including in health care. The aim of this study was to explore occupational and physical therapy assistants' anti-fat biases. We analyzed secondary weight implicit association tests from 5,671 occupational/physical therapy assistants. The overwhelming majority (82%) of occupational/physical therapy assistants were implicitly prejudiced against fat people. Interventions for occupational/physical therapy assistants' anti-fat biases are critical, especially with increasing prevalence and responsibilities of occupational/physical therapy assistants in the provision of rehabilitation services.

Expressões da violência associada ao corpo gordo: uma revisão bibliográfica qualitativa / Expressions of violence associated with the fat body: a qualitative literature review / Expresiones de violência asociadas al cuerpograso: una revisión bibliográfica cualitativa

Buscando entender quais são as contribuições dos estudos em ciências humanas e sociais sobre violência associada à obesidade/sobrepeso, foi realizada uma pesquisa bibliográfica de cunho qualitativo nas bases de dados Scielo, PubMed, Lilacs, PepSic durante os meses de dezembro de 2020 a janeiro de 2021, seguida de uma análise temática. Como resultados, tem-se a identificação de seis temas ­trabalho, educação, saúde, social, corpo e mídia ­que possuem núcleos de sentido que permitem compreender o fenômeno de estudo. Conclui-se que a violência associada a obesidade sofre uma forte influência dos padrões estéticos hegemonicamente aceitos, encontrando no discurso médico e de saúde pública argumentos para que pessoas obesas ou com excesso de peso sintam-se marginalizadas e culpabilizadas por suas condições. Entre crianças e jovens, o bullying foi identificado como uma marca nas suas trajetórias de vida, que engendra uma relação intra e interpessoal atravessada por sentimentos de raiva e medo. Entre adultos, a violência produz impactos nas esferas profissionais, familiares e sociais.

Seeking to understand the contributions of studiesin the humanities and social sciences on violence associated with obesity/overweight, a qualitative bibliographic research was conducted in the Scielo, PubMed, Lilacs, and PepSic databases between December 2020 and January 2021, followed by a thematic analysis. As a result, six themes were identified -work, education, health, social, body, and media -which have nuclei of meaning that allow us to understand the phenomenon under study. The conclusion is that the violence associated with obesity is strongly influenced by egemonically accepted aesthetic standards, finding in the medical and public health discourse arguments so that obese or overweight people feel marginalized and blamed for their conditions. Among children and young people, bullying was identified as a mark in their life trajectories, which engenders an intra and interpersonal relationship crossed by feelings of anger and fear. Among adults, violence produces impacts in the professional, family, and social spheres. (AU)

Buscando conocer las contribuciones de los estudios en ciencias humanas y sociales sobre la violencia asociada a la obesidad/sobrepeso, se realizó una investigación bibliográfica cualitativa en las bases de datos Scielo, PubMed, Lilacs y PepSic durante los meses de diciembre de 2020 a enero de 2021, seguida de un análisis temático. Como resultado, se identificaron seis temas -trabajo, educación, salud, social, cuerpo y medios de comunicación-que tienen núcleos de significado que permiten comprender el fenómeno estudiado. Se concluye que la violencia asociada a la obesidad está fuertemente influenciada por los estándares estéticos hegemónicamente aceptados, encontrando en el discurso médico y de salud pública argumentos para que las personas obesas o con sobrepeso se sientan marginadas y culpabilizadas por sus condiciones. Entre los niños y jóvenes, el acoso se identificó como una marca en sus trayectorias vitales, que engendra una relación intra e interpersonal atravesada por sentimientos de ira y miedo. Entre los adultos, la violencia tiene repercusiones en las esferas profesional, familiar y social. (AU)

Dieta para emagrecer o preconceito contra gordos: discursos anti-gordofobia no YouTube / Slimming down prejudice against fat people: anti-fatphobia discourses on YouTube / Para adelgazar el prejuicio contra gordos: discursos anti-gordofobia en YouTube

Este artigo analisa os discursos contra a gordofobia veiculados em três vídeos brasileiros publicados no YouTube em 2018 com grande visualização. O objetivo é explorar como plataformas digitais tais como YouTube podem dar visibilidade a discursos contra-hegemônicos acerca dos corpos gordos, colaborando na disseminação de informações e estratégias de mobilização e combate às formas de discriminação e preconceito. Os vídeos foram submetidos à análise temática e discutidos à luz de uma literatura crítica sobre a produção da identidade e diferença. A análise identifica três temas principais: "gordura como falha física e moral", "normatização do corpo e discriminação contra gordos" e "afirmação da identidade gorda, autoestima e autoaceitação". As situações apresentadas nos vídeos criticam os processos rotineiros de exclusão dos indivíduos gordos. Concluímos que os vídeos analisados, mediante paródia, ironia e uso de câmera oculta, ajudam a circular narrativas alternativas que suspendem certas verdades naturalizadas sobre os gordos e seus corpos.

This article analyses discourses against fatphobia (discrimination towards fat people) based in three Brazilian videos posted on YouTube in 2018 which had numerous viewers. The aim is to explore how digital platforms like YouTube provide visibility to counter-hegemonic discourses about fat bodies, helping to spread information and strategies to mobilize and combat forms of discrimination and prejudice. The videos underwent thematic analysis and were discussed on the basis of a critical literature on the production of identity and difference. The analysis identified three main themes: "fat as physical and moral failure", "normatization of body and discrimination against fat people", "affirmation of fat identity, self-esteem and self- acceptance". The situations presented on the videos criticize common processes of exclusion of fat people. We conclude that these videos, by use of parody, irony and candid camera, help to circulate alternative narratives that suspend certain naturalized truths about fat people and their bodies.

En este artículo se analizanlos discursos contra lagordofobia(discriminaciónde las personas gordas) emitidos entres vídeos brasileños publicados enYouTube (2018) com granvisualización. Exploramos cómolas plataformas digitalescómoYouTubepueden dar visibilidad a los discursos contrahegemónicos sobre loscuerposgrasos y difundir informaciones y estrategias para movilizar y combatirlas formas de discriminación y prejuicio. Los vídeos recibieronanálisis temático y discusiónbasadaen una literatura crítica sobre laproducción de identidad y diferencia. Identificamos los temas "lagrasa como fracaso físico y moral", "normalizacióndelcuerpo y ladiscriminación contra gordos" y "laafirmación de laidentidad gorda, la autoestima y laautoaceptación". Los videoscriticanlosprocesosordinarios de exclusión de losindividuos gordos. Concluimos que estosvideos, a través de parodia, ironía y cámara oculta, ayudan a circular narrativas alternativas que suspendenciertas verdades naturalizadas sobre las personas gordas y sus cuerpos.

"Anorexia? Não, olha seu tamanho": anorexia nervosa "atípica" em mulheres gordas / "Anorexia? No, take a look at your size": "atypical" anorexia nervosa on fat women

O objetivo da presente dissertação é refletir sobre que é considerado atipicidade na anorexia nervosa, especialmente os casos entendidos como atípicos pelo peso corporal. Nas imagens que circulam entre diferentes veículos de mídia e alimentam o imaginário social, o corpo anoréxico é feminino, branco, jovem e extremamente emagrecido; tem costelas ressaltadas e o corpo esguio. Essa percepção acaba inferindo erroneamente sobre o reconhecimento da presença e da gravidade do transtorno alimentar: pessoas podem ser naturalmente magras sem dietas e pessoas consideradas "acima do peso" podem desenvolver relações conturbadas de restrição alimentar. Para a pesquisa, quatro mulheres autodenominadas gordas e duas profissionais de saúde foram ouvidas em entrevistas presenciais. Acredito que a experiência da anorexia nervosa em pessoas que não se encaixam no critério diagnóstico de "peso corporal significativamente baixo" nos auxilia a pensar as fronteiras entre típico e atípico, entre peso normal e anormal, entre saudável e doente. O critério de peso corporal pode distanciar de um tratamento qualificado pessoas em notável sofrimento psíquico, mas que não necessariamente possuem o Índice de Massa Corporal em um valor considerado baixo o suficiente para receberem tal diagnóstico.

The goal of the present dissertation is to reflect upon what is considered "atypical" in anorexia nervosa, particularly in cases determined as atypical because of body weight. In the images disseminated by various media platforms that feed social repertoire, the anorexic body is feminine, white, young and extremely thinned: they have their ribs emphasized and their waist is very slim. This perception ends up inferring erroneously on the detection of the presence or the gravity of eating disorders: people can be naturally thin without diets and people considered "overweight" can develop problematic patterns of eating restrictions. This research consists of presential interviews with four women that self-identify as fat as well as two health professionals. I believe that the experience of anorexia nervosa by people that don't "fit" the diagnostic's criteria of "significantly lowered body weight" helps bringing our attention to the frontiers between typical and atypical, over and underweight, healthy and unhealthy. A body weight criteria can distance people in high levels of suffering ­ but that don't necessarily have what's considered a "low" BMI ­ from qualified treatment.