Define “technology



CHAPTER 5

Fat Chances: Being Overweight in a Society that Prizes Thinness

Kelly Clarkson was a topic of conversation during Mike Gallagher’s nationally aired radio show on April 4, 2015. Gallagher asked his guest, Fox News anchor Chris Wallace, if he’d seen recent photos of the pop star because “holy cow, did she blow up.” Wallace agreed, commenting that Clarkson “could stay off the deep dish pizza for a little while.” In the rest of their conversation, the two men made no mention of the Grammy Award winner’s soothing voice, the mesmerizing soprano behind such hits as Love So Soft and Piece by Piece. This came on the heels of similar comments six weeks earlier by British newspaper columnist and TV personality Katie Hopkins when she tweeted: “Kelly Clarkson had a baby a year ago. That is no longer baby weight. That is carrot cake weight. Get over yourselves." Hopkins subsequently told Access Hollywood: “Jesus, what happened to Kelly Clarkson? Did she eat all of her backing singers? Clarkson is a chunky monkey…She's fat, she needs to get out, eat less, and move more." [i]

Figure 1: Kelly Clarkson performing during the American Idol competition in 2002 (left) and at the 2015 Billboard Music Awards (right)

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As journalists were shaming Kelly Clarkson, Toma Dobrasavljevic was on his way to winning Season 16 of The Biggest Loser, the NBC reality show where a group of obese individuals compete to see who can drop the most weight in 30 weeks. By losing 171 pounds through a combination of regimented dieting and vigorous exercise, Dobrasavljevic upheld the conventional wisdom that self-discipline can lead to dramatic weight reduction. The disparaging comments made about Clarkson equally characterized this individual perspective; these comments suggested that overweight people deserve blame for deviating from societal norms about physical appearance. Other pop stars in recent years – including Justin Bieber, Adele, Leonardo DiCaprio, and Kate Winslet – have also experienced fat shaming. During the 2016 presidential campaign, Donald Trump got lots of media coverage for calling former Miss Universe contestant Alicia Machado “Miss Piggy” after she gained a lot of weight. While many people condemned Trump’s mean words, they reflected the popular sentiment that individuals should make certain lifestyle choices in order to avoid being fat. [ii]

Figure 2: Toma Dobrasavljevic before (left) and after (right) becoming the biggest loser.

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It’s no coincidence that winners of The Biggest Loser gain fame while established stars who put on weight often receive criticism. Fat shaming reflects the premium our society puts on thinness. Most often, we hear about negative judgment directed at girls and women; however, it’s not uncommon for boys and men to be targets too. Can you think of people – either celebrities or individuals you know – who’ve experienced shaming because of the size of their bodies? [iii]

This topic is deeply personal, even for people who’ve never directly experienced criticism about their weight. A 2014 Gallup poll found that among Americans of varying Body Mass Index (BMI), 45 percent worry at least some of the time that they’re too heavy. That’s a 32 percent increase from 1990. Approximately 45 million people in the U.S. diet each year, spending about $33 billion on weight-loss products. A massive amount of marketing is directed at them. It particularly target girls and women, given the strong association in our society between feminine beauty and thinness. A common piece of advice is that dieters should get on the scale every day. [iv]

Figure 3: We’ve all seen ads like this. The message is clear: anyone has the power to lose weight.

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While weight is a topic that makes many people self-conscious, it’s not just personal. There’s been a dramatic increase during your lifetime in the percentage of overweight Americans. Figure 4 shows data about people with a BMI exceeding 30, the medical definition of obesity. In 1990, the obesity rate was below 15 percent in every single state. By 2000, about half the states had an obesity rate over 20 percent and by 2010 it exceeded 25 percent in the majority of states. One in three adults in the U.S. is obese. For children, it’s one in six. [v]

Figure 4 – Obesity rates in the United States rose dramatically between 1990 and 2010.

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(Source: Centers for Disease Control and Prevention)

There were a few years during my childhood when I was a bit overweight. I recall feeling inadequate whenever my brother called me fat. I knew this word wasn’t a neutral description of my body size, but assigned negative judgment to it. The obesity epidemic seems to have added an even greater stigma, or mark of humiliation, to being labeled “fat.” In this chapter, I will only use this word in a non-evaluative way, to describe people with BMIs above the healthy range.

Redefining this word highlights its typically negative meaning. You will see how this meaning fuels the sorts of fat shaming that often get publicity when directed at celebrities, and which countless ordinary Americans also frequently experience. As a result, size discrimination – the unequal treatment of people because they are overweight – runs rampant throughout our society. When we explore fat people’s lives from a sociological perspective, we discover that the choices they make about how to treat their bodies often reflect the economic, educational, and social opportunities available to them. Being fat isn’t simply a sign of personal irresponsibility. It’s a weight we all must bear.

SIZING UP SIZE DISCRIMINATION

When Leah went shopping for a new bra the summer after her sophomore year of college, the sales associate said the store had nothing in 38 DD “because boobs aren’t really supposed to be that big.” Patti once interviewed for a job at an optometrist’s office and as the conversation was wrapping up, the interviewer told her: “You know, we have VERY small hallways here.” When Serine was in high school and auditioned to be part of the cheering squad, as she did her routine the teacher evaluating her performance laughed at her large body. [vi]

Stories like these have become more common as obesity rates have risen. Whereas during the mid-1990s seven percent of adults of varying weights reported having experienced size discrimination, the figure grew to 12 percent by the mid-2000s. Indeed, fat adults often encounter size discrimination, and women more so than men. The fact that weight bias occurs across a range of setting highlights the multiple ways it negatively impacts people’s lives. [vii]

Let’s first look first at its effects in the labor market. In one study, 43 percent of overweight workers reported experiencing size discrimination from either their supervisors or other employees. Other research documents that for women a gain of 25 pounds equates with an average salary loss of $14,000 a year. This is due to bosses denying them a promotion or reassigning them to a lower-paying job. Previously thin women are more prone to such discrimination than women who’ve already been overweight. A third study highlights the significant effect size discrimination has on men too. Men of normal weight applied for jobs at retail stores. Then, while wearing overweight prosthetics they applied for jobs at different stores and also posed as customers in a third set of stores. In both of the contexts where they wore prosthetics, these men experienced bias. Employees displayed more avoidance toward them and were less likely to nod or smile while interacting with them.

Figure 5: Job recruiters are often biased against fat applicants, seeing them as lacking self-discipline and ambition.

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Weight bias is also common in school. Teachers often have low expectations of fat students – seeing them as untidy, overly emotional, and lazy. Being fat is, moreover, a leading cause of bullying. A survey of overweight sixth graders found that 24 percent of boys and 30 percent of girls have been bullied. Among overweight high school students, these figures increase to 58 and 63 percent respectively. [viii]

Figure 6: Body size is the most common reason kids are teased at school.

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(Source: Yale Rudd Center for Food Policy and Obesity)

Federal law doesn’t bar such mistreatment. Legislators have not defined weight as a protected category in the ways they’ve come to regard many other group identities including race, gender, and disability. Employers have successfully projected the view that showing a preference for hiring workers who look a certain way is a legitimate business strategy. Michigan is the only state that bars size discrimination. So do a handful of cities: Madison, Wisconsin; Urbana, Illinois; Washington, DC; San Francisco, and Santa Cruz, California. [ix]

The fragmented legal protections for overweight people reflect the conventional wisdom that being fat is one’s own fault. This individual perspective mirrors public sentiment toward smokers, who are generally seen as undeserving civil rights because they’ve made unhealthy lifestyle decisions. Since fat American have similarly behaved poorly, they too are unworthy of rights.

In the eyes of many, how people treat their bodies has powerful social meanings. A person’s weight is much more than a number on a scale or BMI chart. Our bodies are like walking resumes. They’re literally where we embody how strongly we embrace core values like hard work and perseverance. Being fat, therefore, symbolizes an unwillingness to discipline eating and exercise habits – a refusal to delay the present gratification of a milkshake for the future reward of conforming to societal beauty norms. Because large bodies reflect weak character, they pose a threat to these core values and fuel the sorts of malicious treatment so many fat people experience. [x]

Figure 7 – Many people in American society view being fat as a moral failure. Eating too much (gluttony) and exercising too little (sloth) are, after all, two of the seven deadly sins.

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Posted on Tumblr – December 28, 2013

THE ELEPHANT IN THE ROOM

We have been exploring the individual perspective – that fat people make poor lifestyle choices – and how this point of view condones size discrimination. The sociological perspective moves your thinking in a different direction by revealing how these lifestyle choices reflect unequal opportunities. Obesity is most prevalent among the least educated Americans and least prevalent among the most educated. Figure 8 presents data from the Centers for Disease Control and Prevention. Notice that boys who dropped out of high school were nearly twice as likely to be obese than boys who graduated from college – 21.1 percent v. 11.8 percent. Among girls, high school dropouts were nearly 2 ½ times as likely to be obese – 20.4 percent v. 8.3 percent. The less formal education a person has, the more likely that person is to be obese.

Figure 8 – Obesity rates in the United States reflect people’s level of educational attainment.

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Of course, college graduates typically earn significantly more than high school dropouts. This gap takes on significance when we consider the cost of eating well. Whole Foods is called “Whole Paycheck” for a reason. Since the cheapest foods are high in carbohydrates and saturated fats, lower-income people are inclined to make unhealthy choices. They simply can’t afford fresh fruits and vegetables or lean meats. There’s truth in the conventional wisdom: anyone can gain weight by eating poorly. Yet, people are not equally at risk of becoming fat.

Those least able to afford nutritious foods are the most likely to live in neighborhoods where these foods aren’t even available close to where people live. This is significant given that low-income people often don’t own cars and can’t easily get to supermarkets by public transportation. Poor communities across the U.S. are food deserts, where the only nearby places to shop are minimarts like 7-Eleven that stock mostly junk food. [xi]

Figure 9 – This is the scene in many low-income neighborhoods. The only restaurants are fast food joints.

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Given these obstacles to eating nutritiously, low-income people are ripe targets of junk food marketing. Journalist Michael Moss did an eye-opening, behind-the-scenes investigation of large food companies like Kraft and General Mills. He found that there were few restrictions on how they manufactured and marketed chips, soda, cookies, and other junk foods engineered with irresistible combinations of salt, sugar, and fat. [xii]

Limited opportunities for exercise present a further reason why low-income people are prone to being fat. Neighborhoods often lack green spaces for exercising, and joining a gym is expensive. Since crime in these places is typically high, fear is another factor that inhibits people from going outside. These income-related factors that foster a sedentary lifestyle are easily invisible to people of greater means, who may take for granted the availability of fitness opportunities. It’s no wonder that many who enjoy these opportunities are inclined to see fat people as lazy. [xiii]

There’s so much more to the story of America’s obesity epidemic than the lifestyle choices people make. This epidemic is a sign that at a time of unprecedented economic inequality, we’ve become a nation where prospects for low-income people to become upwardly mobile – and enjoy the opportunity to lead healthier lifestyles – have greatly diminished. A 2016 report by the Russell Sage Foundation documents that an astounding 60 percent of American kids born into families in the bottom fifth of the income distribution will still be in the bottom two-fifths at age 40. Over half of kids born into the bottom fifth who are Black or whose parents didn’t finish high school will remain in the bottom fifth as adults. (See Chapter 2 for a discussion of the growing opportunity divide). [xiv]

When it comes to obesity, economic inequality is the elephant in the room. Yet, news coverage seldom explores how poverty creates conditions that lead to poor eating and infrequent exercise. Journalists seamlessly incorporate the individual perspective into their stories about obesity. In a study of news coverage over a 10-year period, sociologists Abigail C. Saguy and Kirsten Gruys found that the reporting consistently emphasized bad lifestyle choices as the leading cause of the obesity epidemic. Consider how one article characterized a 40-something couple, Bruce and Lisa Smith:

Chips, fried chicken, canned fruit, sodas – they ate as much as they wanted, whenever they wanted. Exercise? Pretty much nonexistent, unless you count working the TV remote or the computer mouse. “We were out of control,” says Bruce, 42. And so was their son, Jarvae, who is 5 feet 4 and weighs 176 pounds.

The researchers noted that while the news sources they studied sometimes mentioned sociological causes of obesity, the articles presented these as secondary to individual causes. The same holds for videos posted on YouTube. In portraying people being teased for excessive eating, the underlying message these videos convey is that fat people are to blame for their size. Given the prominence of visual images online, they leave a much more significant impression on audiences than text. By reinforcing individual explanations for obesity, these images legitimize the public shaming of fat people and the discriminatory treatment they often experience. [xv]

LIVING ON A TREADMILL

As long as the inequalities at the root of obesity remain hidden, size discrimination will persist and there will be little outcry about its many adverse effects. These include poor self-esteem, depression, social rejection, low educational attainment, and anxiety. Even having a normal weight, or being underweight, doesn’t immunize a person from these problems. A 2014 Gallup poll found that nearly a third of Americans with an average BMI worry at least some of the time about their weight. [xvi]

A survey of college women found that over 90 percent described themselves to others as fat. Yet only nine percent had an above-average BMI. Men experience weight anxiety too. Twenty-five percent of college males reported in a study by psychologist Renee Engeln that they engaged in negative talk about their bodies. All of us, it seems, are at risk of experiencing the fallout of living in a society that places such a premium on disciplining one’s body. Despite this commonality, how might the sources of weight anxiety differ for women and men? [xvii]

Figure 10 – In American society, the body is a powerful symbol of one’s character, and it has different meanings for women and men.

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Might weight anxiety motivate people to embrace healthier lifestyle? That’s certainly the conventional wisdom. However, stigmatizing fat people often doesn’t produce behavior change. Shaming more commonly causes them to eat more, not less. Consider a study where the researchers randomly assigned one group of fat women to watch a video with discriminatory content and a second group of fat women to watch a video with no such content. After offering food to all of them, the researchers observed that the first group consumed over three times as many calories. That’s because weight bias creates anxiety, which activates the physiological urge to eat as a way of coping with the anxiety. [xviii]

Although other studies have reached this same conclusion, I won’t bore you with their details. Even if I did, you might still believe that when people are anxious about their bodies they become motivated to lower their weight. Certainly, The Biggest Loser demonstrates that in a society where fat people often experience shaming and discrimination, they can still slim down within a short timeframe. This TV show has been such a hit because it affirms the iconic American story that people have it in their power to triumph against great odds.

However, try to resist the temptation to become too wrapped up in this story. Given that the goal of weight loss is to keep the pounds off, the findings from a six-year study of The Biggest Loser contestants are revealing. The study tracked the weight of 14 people from the 2009 season and found that on average they regained 70 percent of what they’d lost. Dropping a significant amount of weight slowed their metabolism while diminishing their levels of the hormone that tells the body it’s satiated. The former contestants felt the need to increase their calories at the same time that they were burning them more slowly – a perfect storm for significant weight gain. [xix]

The broader takeaway is that the effects of diets often don’t last. This isn’t only true for obese people who aim to shed a significant number of pounds quickly, but for all of us – even if the aim is to become thinner over a more gradual period of time. To understand why, you just need to know some basics about the brain. It has a survival instinct that works to regulate a person’s weight and keep it within a certain range. If it dips lower, the body’s response is exactly what The Biggest Loser contestants experienced – a greater urge to eat combined with slower metabolism. Research shows, incredibly, that dieters are more likely to become obese than non-dieters – a finding that holds true through middle age, across ethnic groups, and for men and women alike. This effect is actually strongest among people who were at a normal weight before they started dieting. [xx]

Figure 11 – Diet ads play up how easy it is to lose pounds. They don’t mention how much harder it is to maintain weight loss.

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Because dieters often do not maintain weight loss, their inability to do so may make them even more anxious about their body size. Dieting fuels a vicious circle of failure and self-blame. Our society not only produces a lot of bodily insecurity, but also propels people onto a treadmill where they relentlessly feel they must push forward to lose weight. This isn’t the type of treadmill found at fitness centers. It’s one where people keep striving for – yet seldom attain – a greater sense of security about, and acceptance of, their own bodies.

BEYOND THE “F” WORD

”I’ve sat in meetings with colleagues who wouldn’t dream of disparaging anyone’s color, sex, economic status or general attractiveness,” wrote Syracuse University journalism professor Harriet Brown in the New York Times. Brown is obese and a leading expert on body image issues. “Yet [these colleagues] feel free to comment witheringly on a person’s weight.” We’ve seen in this chapter how the conventional wisdom that being fat is a problem of personal irresponsibility gives license to this sort of bias. [xxi]

Let’s return to the shaming of Kelly Clarkson, discussed at the very beginning of this chapter. Consider what the punitive response might have been if she had been thin and Black, and the attacks were about her race instead of her size. In 2007, after the nationally syndicated DJ Don Imus called the all-Black Rutgers women’s basketball team a bunch of "nappy-headed hos,” CBS suspended “Imus in the Morning” for several months. Yet, Chris Wallace – the FOX anchor who ridiculed Clarkson – got off with a mere apology. This double standard speaks volumes about the vastly different meanings we attach to race and weight bias. This is ironic given that size discrimination occurs more frequently than race – or even gender – discrimination. [xxii]

How can our society address the adverse medical consequences of the obesity epidemic while protecting the dignity of fat people? These consequences include rising rates of heart disease, Type-2 diabetes, hypertension, and high blood pressure. In treating overweight people who may suffer from these conditions, it’s not uncommon for doctors or nurses to regard them as lazy or lacking self-discipline, and to make jokes or derogatory comments about them. [xxiii]

Taking the stigma out of having a large body is the major aim of a fascinating group of people who self-identify as “fat acceptance activists.” These activists assert that no one should have to live with diminished self-worth due to body size. They use the slogan “health at every size” to distinguish between constructive public concerns about poor health and destructive public angst about large bodies. Fat acceptance activists refer to research indicating that one can be both overweight and healthy. For example, one study found that normal heart disease risks – based on factors like cholesterol level and blood pressure – were prevalent among a third of the obese people sampled. Subsequent research illustrated that the key determinant of health is not one’s weight, but level of physical activity. Whereas obese people who are fit account for two to three percent of deaths in the United States, inactivity across the board is responsible for 16 to 17 percent. [xxiv]

Figure 12: Lindy West, an outspoken fat acceptance activist, regards identifying as fat to be a comparably valuable way to assert self-worth in the face of stigma as coming out as gay or transgender.

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This chapter has exposed two adverse consequences of the conventional wisdom that being overweight is a problem of personal irresponsibility. First, this individual way of thinking legitimizes fat shaming and bias, since supposedly we choose our size. Second, the conventional wisdom about weight blinds us from recognizing the social forces that tip the scales toward some people having larger bodies than others. Given the stigma of being fat, the sociological perspective offers us the opportunity to redefine this word. From now on, we can see “fat” simply as a way to describe a person with a high BMI; as a characterization made without judgment. To not seize this opportunity would make us the biggest losers of all.

Notes

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[i] For news accounts of the fat shaming of Kelly Clarkson, see Stephanie Webber, “Chris Wallace Fat-Shames Kelly Clarkson: ‘She Could Stay Off the Deep Dish Pizza,’” Us, April 4, 2015, and Medeline Boardman, “Katie Hopkins Takes Kelly Clarkson Fat-Shaming Comments Even Further, Calls Singer a ‘Chunky Monkey,’" Us, March 6, 2015, .

[ii] For a list of celebrities who’ve been targets of fat shaming, see .

[iii] For discussion of evidence that boys and men are increasingly experiencing fat shaming, see Michael Andor Brodeur, Why male body shaming is on the rise in the media.” Boston Globe, March 9, 2015, .

[iv] Joy Wilke, “Nearly Half in U.S. Remain Worried About Their Weight.” Gallup, July 25, 2014, . Figures on dieting on money spent on weight loss comes from “Weight Loss.” Boston Medical Center, . A January 3, 2016 USA Today article sums up the popular view among experts that dieters should weigh themselves every day. See “New Advice for Weight Loss: Get on the Scale Every Day,” .

[v] Figures for adults come from the Department of Health & Human Services, . For kids, data come from the Centers for Disease Control, .

[vi] These stories of bias are part of a collection chronicled in “Fat Discrimination: 14 Women Open up about Their Experiences with Size Prejudice,” The Huffington Post, May 21, 2013, .

[vii] Data about the increase in size discrimination between the mid-1990s and mid-2000s come from Tatiana Andreyeva, Rebecca M. Puhl, and Kelly D. Brownell, “Changes in Perceived Weight Discrimination among Americans, 1995–1996 Through 2004–2006.” Obesity 2008 16(5): 1129-34.

[viii] With the exceptions noted below, data about size discrimination are from Roberta R. Friedman and Rebecca M. Puhl, “Weight Bias: A Social Justice Issue.” Rudd Center for Food Policy & Obesity, 2012, . Data equating a 25 pound weight gain for women with an annual salary loss of $14,000 come from Timothy A. Judge and Daniel M. Cable, “When It Comes to Pay, Do the Thin Win? The Effect of Weight on Pay for Men and Women.” Journal of Applied Psychology 2011 96(1): 95-112. The study of size bias toward men in retail stores was done by Enrica Ruggs, Michelle R. Hebl, and Amber Williams, “Weight Isn’t Selling: The Insidious Effects of Weight Stigmatization in Retail Settings.” Journal of Applied Psychology 2015 100(5): 1483-1496. The Obesity Action Coalition’s survey data linking weight and bullying can be found at .

[ix] Samantha Kwan and Mary Nell Trautner, “Weighty Concerns.” Contexts 2011 10(2): 52-57. Friedman and Puhl, 2012.

[x] Louise Townend, “The Moralizing of Obesity: A New Name for an Old Sin?” Critical Social Policy 2009 29(2): 171-190.

[xi] Data on education and income disparities come from the Bureau of Labor Statistics, . Alison Hope Alkon, Daniel Block, Kelly Moore, Catherine Gillis, Nicole DiNuccio, and Noel Chavez, “Foodways of the Urban Poor.” Geoforum 2013 48: 126-35; Cynthia Gordon, Marnie Purciel-Hill, Nirupa R. Ghai, Leslie Kaufman, Regina Graham, and Gretchen Van Wye, “Measuring Food Deserts in New York City's Low-income Neighborhoods.” Health and Place 2011 17(2): 696-700.

[xii] Michael Moss, “The Extraordinary Science of Addictive Junk Food.” New York Times Magazine, February 20, 2013.

[xiii] Amy M. Burdette and Terrence D. Hill, “An Examination of Processes Linking Perceived Neighborhood Disorder and Obesity." Social Science and Medicine 2008 67(1): 38-46.

[xiv] “Opportunity, Mobility, and Increased Inequality.” Russell Sage Foundation 2016, .

[xv] Abigail C. Saguy and Kjerstin Gruys, “Morality and Health: News Media Constructions of Overweight and Eating Disorders.” Social Problems 2010 57(2): 231-50. The article quoted in their study is Karen Springen, “Health: Battle of the Binge.” Newsweek, February 19, 2007. The YouTube study is Jina H. Yoo and Junghyun Kim, “Obesity in the New Media: A Content Analysis of Obesity Videos on YouTube.” Health Communication 2012 27(1): 86-97. Kimberly J. McClure, Rebecca M. Puhl, and Chelsea A. Heuer, “Obesity in the News: Do Photographic Images of Obese Persons Influence Antifat Attitudes?” Journal of Health Communication: International Perspectives 2011 16(4): 359-371.

[xvi] Friedman and Puhl, 2012. Wilke 2014.

[xvii] Rachel H. Salk and Renee Engeln-Madoxx, “’If You’re Fat, Then I’m Humongous!’ Frequency, Content, and Impact of Fat Talk among College Women.” Psychology of Women Quarterly 2011 35(1): 18-28. Renee Engeln, Michael R. Sladek, and Heather Waldron, “Body Talk among College Men: Content, Correlates, and Effects.” Body Image 2013 10(3): 300-308.

[xviii] Natasha Schvey, Rebecca Puhl, and Kelly Brownell, “The Impact of Weight Stigma on Caloric Consumption.” Obesity 2011 19(10): 1957-62. Janet Tomiyama, “Weight Stigma is Stressful. A Review of Evidence for the Cyclic Obesity/Weight-Based Stigma Model.” Appetite 2014 82: 8-15.

[xix] Erin Fothergill, Juen Guo, Lilian Howard, Jennifer C. Kerns, Nicolas D. Knuth, Robert Brychta, Kong Y. Chen, Monica C. Skarulis, Mary Walter, Peter J. Walter, and Kevin D. Hall, “Persistent Metabolic Adaptation 6 Years After ‘The Biggest Loser’ Competition.” Obesity May 2016.

[xx] Sandra Aamodt, “Why You Can’t Lose Weight on a Diet.” New York Times, May 6, 2016.

[xxi] Harriet Brown, “For Obese People, Prejudice in Plain Sight.” New York Times, March 15, 2010.

[xxii] Rebecca M. Puhl, Tatiana Andreyeva, and Kelly D. Brownell, “Perceptions of Weight Discrimination: Prevalence and Comparison to Race and Gender Discrimination in America.” International Journal of Obesity 2008 32: 992-1000.

[xxiii] For evidence linking obesity to adverse health outcomes, see Y Claire Wang et al. “Health and Economic Burden of the Projected Obesity Trends in the USA and the UK.” The Lancet 2011 378(9793): 815-25.815-25. For a discussion of derogatory comments made by doctors and nurses, see Friedman and Puhl 2012.

[xxiv] The handbook for this activism is Linda Bacon, Health at Every Size: The Surprising Truth about Your Weight. Dallas: Benbella Books, 2010. Rachel P. Wildman, Paul Muntner, Kristi Reynolds, Aileen P. McGinn, Swapnil Rajpathak, Judith Wylie-Rosett, and MaryFran R. Sowers, “The Obese Without Cardiometabolic Risk Factor Clustering and the Normal Weight With Cardiometabolic Risk Factor Clustering.” JAMA Internal Medicine 2008 168(15). Steven N. Blair, “Physical Inactivity: The Biggest Public Health Problem of the 21st Century.” British Journal of Sports Medicine 2009 43: 1-2.

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