Around a year ago, I wrote about my reaction to Irvin Yalom's essay, "Fat Lady". At that time, I wrote:
How is a fat person, who, no matter the reasons for being fat, certainly has a whole host of emotional issues about her size and her body -- how is such a person to find the courage to talk about those feelings in the presence of someone who finds her as disgusting as she herself often does? How can she roar her anger at the prejudice she encounters? How is she to arrive at being able to care about her body and for herself lovingly rather than with contempt and hatred? And supposing she doesn't want to devote herself to losing all that weight? Supposing she wants to get off the diet merry-go-round and concentrate on being healthy and fat (and yes, that is possible)?
The operative assumption is that in a room with a normal weight therapist and a fat patient, that only the patient has a problem is, it seems to me, a very weak one.
I have remained interested in this issue, both personally and professionally and will be writing a series of posts about fatism, fat bias, fat acceptance and related issues -- not to the exclusion of all else, but in addition to my thoughts about therapy.
In a long review article in Nature, Rebecca Puhl and Chelsea Heur of Rudd Center for Food Policy & Obesity at Yale. Their research showed:
Obese individuals are highly stigmatized and face multiple forms of prejudice and discrimination because of their weight (1,2). The prevalence of weight discrimination in the United States has increased by 66% over the past decade (3), and is comparable to rates of racial discrimination, especially among women (4). Weight bias translates into inequities in employment settings, health-care facilities, and educational institutions, often due to widespread negative stereotypes that overweight and obese persons are lazy, unmotivated, lacking in self-discipline, less competent, noncompliant, and sloppy (2,5,6,7). These stereotypes are prevalent and are rarely challenged in Western society, leaving overweight and obese persons vulnerable to social injustice, unfair treatment, and impaired quality of life as a result of substantial disadvantages and stigma.
However, the realities of the effects of this bias and how it poses barriers to all kinds of care are little discussed as we focus on the "War on Obesity".
As I have been doing my own research and reading, I was surprised to find that the APA Monitor actually published a brief set of guidelines for therapists interested in being "size friendly" -- it's a short piece and seems to have been little noticed, though it was published in January 2004. Here are the guidelines:
Don't make assumptions about overweight clients, such as about whether they have an eating disorder or are working toward acceptance of their weight.
Display size-friendly artwork or magazines--such as BBW Magazine--in your office or lounge.
Have seating in your office that can accommodate larger people. An example is armless chairs.
Raise your colleagues' and students' awareness by addressing these issues in formal and informal ways, such as during clinical supervision or in workshops.
Ask larger clients about eating behaviors in the same way you would ask a thin or average-sized person.
Through self-questioning and introspection, become aware of your own level of prejudice toward overweight people.
Educate yourself on issues that affect overweight people, such as the genetic influences of size and the effects of dieting on physical and mental health.
Understand that an overweight person's problems are not always a result of their weight and that therapy does not bring thinness. Be aware that resolving life issues also does not necessarily result in weight loss.
How do you or therapists you know measure up against these guidelines?