CPPNJ - The Center for Psychoanalysis and Psychotherapy of New Jersey

Saturday, April 9, 2011

Fat Stigma: What It Is, How It Hurts

Researchers call it "fat stigma." The disapproving glances from complete strangers. The prospective employer who suddenly loses interest when he meets you face to face, or the person who squeezes into the seat next to you at the movies with evident disgust. And of course: "You would look so nice if you just lost some weight."

According to a recent article in the New York Times, the Western prejudice against fat people is now spreading to developing countries. The article quoted a Mexico City man who groused about riding the city's crowded buses.

"The fatties," he said, "take up a lot of space."

Imagine what it's like to be on the receiving end of that kind prejudice every day. As a person who lost 50 pounds a few years ago, I have some understanding of what it's like to be heavy in a society where you can never be too rich or too thin. The sense of shame a fat person feels when they look in the mirror is only intensified by the negative reaction of others.

As our society continues to get heavier, our fashion models -- and our tolerance -- keep growing thinner. Tabloids drool over the weight fluctuations of the Kardashians and other celebrities with relish (excuse the food pun). TVs "Biggest Loser" and its many copycats exploit the obese for ratings while women's magazine covers trumpet "the last diet you will ever need" next to photos of luscious chocolate cake. Love yourself as you are; now lose 30 pounds.

Why do we live in such a fat phobic society? When people respond to the obese with disdain ("Why don't they just exercise?"), it is likely because they themselves feel threatened. Many people look at the overweight and see laziness, poor self-control, and weakness. We all have sides that feel out of control and shameful, self-defeating habits we cannot tame. We may look at fat people and see unpalatable aspects of ourselves. And so we project our fears onto them. I'm not the one who is lazy or out of control, you are. I am not insecure about my looks. By binging on sanctimony, some people get to (temporarily) feel better about themselves -- precisely the kind of solace other folks find it in food.

Body image issues often begin in childhood, with parents who criticize their children's weight and appearance while sometimes giving conflicting messages about food. ("You're not leaving this table until you eat everything on your plate!") Frequently, parents project their own insecurities around body image onto their children, calling them fat and lazy even as they overfeed them.

Because these self-images are so deeply ingrained, all the diets in the world may not be helpful. Physiological and other practical factors are also crucially important, but many people avoid the psychological component because of the fear that lies under the fat. Better to stuff down insecurity than stir up what they fear could be a lot of pain. And so the pain -- and the pounds -- remain.

In therapy, the patient will need to trust the therapist. Particularly if the clinician is thin and appearance-conscious, the person struggling with weight issues may worry about being judged. After all, many overweight people stop seeing doctors because they are lectured and condescended to. In a Yale University study, more than half of the primary care doctors questioned described obese patients as “awkward, unattractive, ugly, and unlikely to comply with treatment.” And these were the sentiments they were willing to share openly.

In order to help the patient feel safe and understood, the therapist must be willing to examine her prejudices and her own issues with weight and body image. She must be attuned to the patient's fears and shame, and any experience of being judged in the treatment.

As the patient continues to feel trusting and supported, the work deepens. The psychoanalytic therapist helps the patient understand and work through his or her feelings of shame and fear. Many people learn early on to find comfort and self-soothing food, the very things they may have needed but didn't get from their parents. In many households, feeding is the only way children feel loved.

One of the goals of therapy is not simply a healthier lifestyle, but helping each person feel good about themselves no matter what the scale says. As a person who has dealt with weight and self-esteem issues, I can proudly say that I've been fat and and I've been thin. And happy is better.

-- Eric Sherman, LCSW