Note: this article uses possibly triggering words in this article in reference to the history and studies about body size.
We need a more expansive definition of “health.” Research continues to show that BMI is a poor indicator for health.¹ “...what we think of as health risks associated with being fat may in fact be health risks of experiencing discrimination and internalizing stigma.”² As a society, we need to develop new definitions of “health” that don’t bias against fat bodies. Ragen Chastain, a Health at Every Size leader and author of the “Weight and Healthcare” newsletter, writes, “So one last time - health is an amorphous, multi-factorial concept that is not an obligation, barometer of worthiness, entirely within our control, or guaranteed under any circumstance. We should keep our focus on removing barriers, providing access, and respecting individual’s priorities.”³
The use of Body Mass Index (BMI) has flawed origins. Based on ideas influenced by social Darwinism and eugenics, Belgian mathematician Lambert Adolphe Jacques Quetelet invented this outdated formula to reflect the “ideal” body size of average, white, European men. Life insurance companies in the late 19th and early 20th centuries then used this concept to create height and weight tables in order to show “ideal” body weights, based on data with inaccurate reporting and no standardization. The use of the term “Body-Mass Index” didn’t arrive until the 1970’s and 80’s, and since then the cut-off for “obese” has shifted over time, leading some to be labeled as “overweight” overnight.
No one should be discriminated against. Weight stigma is pervasive across healthcare, and is linked to an increase in anxiety and mood disorders. Some believe that the increased stress levels from weight stigma could be linked to other long term health effects, like heart disease and stroke. Research has also shown that fear of weight stigma has prevented people from accessing necessary cancer screenings.⁴ Even when people in larger bodies get healthcare, they may experience cancer at a higher rate due to lower quality medical care due to stigma.5 Weight stigma can be so harmful that it has even been shown to increase the likelihood of death.6 We are aware that weight stigma can be especially prevalent during pregnancy and postpartum, when changes in weight are common. People in larger bodies often experience more negative interactions with healthcare providers.7
Aubry Gordon again–“We deserve a new paradigm of health: one that acknowledges its multifaceted nature and holds t-cell counts and blood pressure alongside mental health and chronic illness management. We deserve a paradigm of personhood that does not make size or health a prerequisite for dignity and respect.”²
At Embrace Pelvic Health, we believe that everyone deserves access to safe and empowering healthcare services. No one should be discriminated against due to the size of their body. We have worked to make our office accessible to all people by making sure that we have armless chairs and equipment that can support people in larger bodies. Embrace’s therapists take into account size inclusivity and your feelings about exercise when recommending a home program.
We will use whatever terms you like to use for your body. Embrace firmly believes in respectful care for people of all body shapes and sizes.
Tomiyama, A. J., Hunger, J. M., Nguyen-Cuu, J., & Wells, C. (2016). Misclassification of cardiometabolic health when using body mass index categories in NHANES 2005–2012. International journal of obesity, 40(5), 883-886.
Gordon, A. (2020). What We Don't Talk About When We Talk About Fat. United States: Beacon Press.
Phelan, S. M., Burgess, D. J., Yeazel, M. W., Hellerstedt, W. L., Griffin, J. M., & van Ryn, M. (2015). Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obesity reviews : an official journal of the International Association for the Study of Obesity, 16(4), 319–326. https://doi.org/10.1111/obr.12266
Pearl, R. L., Wadden, T. A., Hopkins, C. M., Shaw, J. A., Hayes, M. R., Bakizada, Z. M., Alfaris, N., Chao, A. M., Pinkasavage, E., Berkowitz, R. I., & Alamuddin, N. (2017). Association between weight bias internalization and metabolic syndrome among treatment-seeking individuals with obesity. Obesity (Silver Spring, Md.), 25(2), 317–322. https://doi.org/10.1002/oby.21716
Sutin AR, Stephan Y, Terracciano A. Weight discrimination and mortality. Psychol Sci. 2015;26(11):1803–11.
Mulherin, K., Miller, Y.D., Barlow, F.K., Diedrichs, P.C., Thompson, R., 2013. Weight stigma in maternity care: women’s experiences and care providers’ attitudes. BMC Pregnancy Childbirth 13, 19. https://doi.org/10.1186/1471-2393-13-19