Recognizing Weight Stigma in Social Work

Transcript:

Amanda Moore McBride:

Welcome to Episode 10 of the Brave Ideas for Social Change Podcast series, produced by the University of Denver Graduate School of Social Work. The series draws on GSSW faculty expertise for fast-moving discussions on emerging research, practice, and policy innovations that will spur social change. Today’s guest is Assistant Professor Erin Harrop, who uses art, storytelling and mixed-methods research to tell patient-centered stories about health care experiences, particularly the experiences of people with marginalized identities. A focus of Professor Harrop’s research is to increase awareness of weight stigma and acknowledge weight as an important aspect of diversity. Erin, thank you so much for being here, for sharing about this important work. Recognition of weight stigma in social work, I will say, (laughs) after learning from you is long overdue. Please tell us more.

Erin Harrop:

Thank you so much Amanda. You know, one of the things that drew me to the University of Denver and to the field of social work in general when I was a struggling psych student was this centrality of social justice. I can remember reading the NASW Code of Ethics and its emphasis on social justice and that line that talks about “the dignity and worth of every person” and kind of knowing that this field could be my academic home because of that emphasis. Unfortunately though, often in our social work circles, many people are unaware of how weight stigma fits into that social work/social justice lens. And so in my experience, weight stigma is not really discussed as frequently in our MSW- or even our PhD-level courses when we talk about issues of power, privilege and oppression.

And I think in general, we just have a little less comfort talking about body weight and size diversity. You know, it is a skill to talk about that, and it’s not currently a skill that we teach in the majority of our clinical classes. Body size isn’t frequently identified as a salient aspect of a person’s identity, even though body size results in so many defining experiences of privilege and discrimination. In social work education, we frequently have conversations about the impact of racism and sexism and homophobia. And in recent years, we’re even seeing increases in how much we talk about things like transphobia and ableism, but I think in general our field has been relatively silent around issues of weight stigma and body size.

And oftentimes, unfortunately, I think sometimes in our field we might actually inadvertently promote weight stigma attitudes. And often this comes in kind of, like, our health emphasis and usually in a very well-meaning way that is focused on trying to help higher weight people kind of be healthier. And so kind of in this—in that system, size-related microaggressions are frequent, and I think most people don’t even realize how those experiences or those comments can profoundly impact people who are in higher weight bodies.

Amanda Moore McBride:

Erin, thank you so much for your critical perspective and your constructive perspective. I so agree with everything that you’ve just said. I’d love for you to just reflect a little bit more, maybe, and take us a little further in our thinking here. Why haven’t social workers been more attuned to this issue?

Erin Harrop:

You know, so I’m gonna put on my researcher hat (laughs) for a minute. But when we study stigma, one really important aspect about different types of stigma is how socially acceptable a particular kind of stigma is. And I think this is really important for weight stigma because weight stigma for the most part is still seen as largely socially acceptable. Weight stigma is even seen as something that helps people become healthier. There’s a lot of kind of social rhetoric that, you know, if fat people … when I’m using the term fat right now, I’m using this term in line with fat liberation, in that reclaimed sense of the word. With society, there’s this worry that if fat people were to feel happy with their bodies that they would be, you know, glorifying obesity or promoting unhealthiness, contributing to the downfall of society. But one thing that should be very clear to social workers is that stigma is never good for health, not individually, not at a population level. Shame is never good for health, so we really need to move away from relying on weight stigmatizing strategies and assuming that telling someone that their body is unacceptable or overweight or obese or unhealthy is helpful or good for their health.

You know, I think many of our students in social work and students in other disciplines, especially those related to health, we’re taught that weight is the mutable aspect of health that is largely the result of, you know, calories in and calories out, um, that is a gross oversimplification of some very complex biological processes. Larger people are blamed for their fatness. It’s assumed that they lack the health knowledge or health behaviors needed to achieve a thinner, healthy weight, and it’s assumed that anyone in a larger body is inherently unhealthy. But, you know, the reality is that weight science is so much more complicated than that. People can be metabolically healthy, so things like good blood sugars, good blood pressure, good heart health. They can be metabolically healthy at a variety of weights, even weights that are considered overweight or obese according to current BMI standards. And just because a person is thin doesn’t mean that they have good health behaviors, and just because a person is fat doesn’t mean that they have poor health behaviors. So things like socioeconomic status, genetics, historical trauma, epigenetics, prenatal environments, even things like ZIP code, those are hugely influential in determining a person’s body size and their health.

But, you know, in general, most of our social work classes don’t address a critical perspective on weight and health. Even in our health social work classes, weight is generally treated as, like, a risk factor to be changed or managed or controlled, as opposed to explored as a neutral aspect of a person’s Identity or, you know, what I would promote, as an aspect of individual diversity. By focusing on trying to change a person’s body, and oftentimes we do this at any cost, we’re causing significant harm to patients — especially to our children who are learning those beliefs and attitudes — and to those vulnerable to eating disorders. You know, and in addition to doing that harm, we’re missing major opportunities to do good and actually help improve people’s health and health behaviors.

Amanda Moore McBride:

I'm just so grateful for [your] scholarship and how you are opening up opportunities to do just that by teaching us. And speaking of teaching, it’s pretty clear that the profession’s got a long way to go, and that starts with how we train future social workers. I’m just so excited about the course you’re teaching here at the University of Denver. Why don’t you tell us more about it?

Erin Harrop:

This is such a delight to teach this course. It’s called “Embodied Practice,” and I developed it a couple years ago. And it focuses around issues of weight stigma and how weight stigma intersects with other forms of discrimination. And I did that because I wanted to make it really clear to social work students how weight stigma fits into our social work wheelhouse. So each week, we examine a different intersection within weight stigma. We start with indigeneity and racism, and then we move to healthism, enableism, and then we start tackling other intersections, like gender, sexuality, spirituality and eating disorders. One of my favorite parts of the class is that students also get to tell a body story about their body. One of the primary tools that I use in teaching is an adapted version of Photovoice, which is usually used in research but I’m using it in teaching. And it involves, like, having students take pictures of where they see weight stigma in their daily lives. And so it’s my hope that by using this exercise we can actually teach students to see the world in a different way with this new lens of weight stigma and body liberation. My second favorite part of the class is that students also get to tell a body story about their body. And they can tell any story that they have that needs telling, That, for me, is always the highlight of the class, to be able to see students take ownership of their stories and then tell their stories in all of their diversity while demonstrating their new understandings of their bodies and what they mean in society.

Amanda Moore McBride:

That’s so powerful. I can see how that would be liberating for our students, but also a basis of liberation practice for them.

Erin Harrop:

Mm-hmm.

Amanda Moore McBride:

How do we translate some of that self-awareness into the practice setting and our way of just being in the world as individuals? You know, I often say that social work is always. You’re never not a social worker. So help us think through some of that.

Erin Harrop:

This is where the rubber meets the road, right? I think so much of undoing weight stigma starts with recognizing when it’s occurring. Most of us don’t even maybe have awareness of when it’s happening and how it might be harming people. I often start by having people, like, think about your own assumptions. So when I see a larger person, what am I assuming about them because of their body size? Like, how much do I think they exercise? What foods do I think they eat? How healthy are they? And then kind of back up and say like, “Wait, do I actually know anything about what (laughs) they eat or how much they exercise or what their health is, so how are my assumptions right now being influenced by my own bias, my own attitudes that I’ve inherited from this society that I’m living in?”

And it’s also really important to think about power differentials, and I think about this especially in a clinical context, although we could also apply this to teaching—so, thinking about how powerful it is when we can recognize and acknowledge your own thin privilege, if that is something that you have, if you are a person with thin privilege, and as well as helping our clients who might not have thin privileged to understand that the blame for the discrimination that they face because of their weight is not their fault. It’s not their body’s fault, the blame goes back to discrimination and to society. So really, you know, I think the crux of that is that we need to help our patients develop a critical consciousness around weight, just like we help our patients develop critical consciousness around other aspects of their identity.

And I think that critical consciousness is really essential in helping clients heal from the harms of weight stigma. And then kind of in general I would say this, you know, just in terms of, like, applying, steering clear of some of these really common weight-related microaggressions that happen, like, every single day. So things like, don’t compliment someone on their weight loss. Like, literally pick anything else ’cause you could be accidentally commenting on an ongoing health issue, you could be complimenting their eating disorder, you know, you could be complimenting, you know, a negative mindset that’s really harmful for them. So instead, just don’t (laughs) comment on it.

You know, similarly, don’t comment on someone’s food choices or complement their exercise. Instead, focus our food conversations on things, like, how food tastes, the social connection of eating together, the cultural meaning. And when talking about exercise, focus on the experience, on how it feels to move your body in enjoyable ways, or sometimes less enjoyable (laughs) ways. And then be aware of how you talk about your body and other people’s bodies, and be aware that even if you’re just disparaging your own body or your own weight, others hear that. And if they look like you or if they’re larger than you or they have a similar build, they can take that onto themselves as well.

Amanda Moore McBride:

I so appreciate your changeable examples, not only from your research but your teaching and then how you help us think about it in practice. Let’s talk a little bit about the field-building work you’re doing. You founded the Body Liberation Imagination Project, which has the best acronym (laughs) since it goes by BLIMP. Tell me about how you’re fostering collaborative weight justice work nationwide.

Erin Harrop:

I love that because I’m kind of reclaiming that, you know, fat insult of calling someone a blimp (laughs) so people are engaged in weight stigma. People right now who are engaged in weight stigma work, to me they seem really hungry for collaboration probably because we’re facing so many uphill battles when engaging with the dominant health paradigm, which is very loud and very certain about their knowledge. But in BLIMP right now, we have a group of about 30 researchers, and we’re actually worldwide at this point. So we now have collaborators in New Zealand, Australia and Canada and they are all these researchers are at kind of different points in their career, lots of early career folks, and some people who are more established in the field, and we’re all trying to work together to accomplish this body liberation work.

We currently have a lot of projects that BLIMP members are engaged in. To highlight a few, there is what we’re calling “We Deserve Space Collaboration,” which is actually kind of centered at DU with GSSW and the DU counseling psych department and working in collaboration with Denver Health. And we are developing an intervention to fight weight stigma in a free, therapeutic support group setting for people in primary health care clinics. So we’ve piloted this group online with eating disorder patients, and we’re actually running our first in-person, multilanguage groups at a Medicaid clinic here in Denver. We also have an R01 under review that would be addressing how to bring weight-inclusive practices to primary health care systems. We have colleagues doing work on biofeedback interventions, and biofeedback interventions help increase awareness of people’s internal body cues, which is really important for people whose cues have been disrupted by things like trauma or disordered eating or weight stigma. And then lastly, we also have people working in the field of eating disorders to increase awareness and screening, especially for people in larger bodies with eating disorders, and then to highlight how weight stigma is impacting those treatment experiences for people in larger bodies.

Amanda Moore McBride:

I can't believe that weight stigma is still considered an emerging area of social work practice. I mean, it’s really staggering because what I’ve learned from you and the work that you’re doing is that truly the stakes are so high. This is a matter truly of physical life and death, and I don’t think we think of it in those terms.

Erin Harrop:

Yeah. Weight stigma is absolutely an issue of life or death. People are literally dying from the abysmal medical care that they experience, and much of that is because of how that medical care is influenced by fat phobia. You know, we know in the research that fat people are less likely to get high quality care, they’re less likely to be touched by nurses in a clinical encounter, they’re less likely to have as much time as their thinner counterparts when meeting with a doctor, and that is the reality that I hear from patients every day when they’re telling you their stories. The medical stories (laughs) I’ve heard, that have happened to people personally or happened to their loved ones are horrifying.

You know, and on other the side when we think outside of medical care, that weight-based bullying — whether it’s from, you know, kids at school, family members is one of the most common areas and and physicians is one of the next most common areas — that weight-based bullying is one of the leading causes of youth suicide right now. And to me, this really isn’t surprising. In a world where so much of our public health rhetoric is focused on ending childhood obesity, you know, how does it feel to be a that child [in a] world that is trying to eradicate fat children?

Amanda Moore McBride:

Erin, what recommendations do you have for us? I mean, as social workers, as educators, for the profession, this is urgent, this is critical, and we need to act now.

Erin Harrop:

You know, I think first and foremost, like, and this is long overdue, ensuring that weight stigma is integrated into our existing PPO [power, privilege and oppression] curricula is so important. We need to teach our students what weight stigma is and how it harms people and how to interrupt it. What is the alternative framework? And then in terms of things like our social work work environments and our cultures, we can do super basic things like entering accessible seating in our classroom, in our offices, in our clinics. We can also help the field disentangle weight rhetoric from health. Since our field is so focused on health, we need to help show social work that our focus is on health and not on weight. They are not the same thing. We can make sure that things like employee wellness programs focus on health behavior rather than on things like weight loss goals or weight management.

And then other things like, you know, and this might be a little controversial, (laughs) but, really carefully and critically examining how our social work programs are interacting with obesity medicine I think is another really important place to start. You know, for instance, do we have practicum placement focus on weight management or weight loss? And if so, how are we ensuring that those students are well prepared to engage in those placements while not recreating the harms of weight stigma?

Amanda Moore McBride:

Erin, you’re just simply brilliant. I am so grateful for your comprehensive perspective. I also appreciate just critical analysis but also constructive analysis. Why don’t you add it all up for us as we end this podcast? What is the future that you envision?

Erin Harrop:

I love this question. You know, and for a long time, I think I just wanted a world in which weight didn’t matter, where weight was this neutral concept. And now, you know, I’m starting to dream of a world in which instead of focusing on making weight a non-issue, we focus on making a weight inclusive world for everybody, where we proactively facilitate connection and resources for people of all weights, where weight doesn’t have to be a deciding factor in your access to clothing or travel or fertility treatment or equitable pay or recreational activities or medical care or surgeries, dating app profiles, social connections. And right now, all of those things are more expensive or less accessible or not accessible at all for people in larger bodies.

You know, I recently sat through a conference presentation about lived experiences of obesity, and the entire presentation painted the lives of morbidly obese people, of which I am one, as dismal, hopeless lives where people have no friends, where they struggle to find meaningful work and they spend all day hating themselves and engaging in unhealthy coping behaviors. It was so frustrating listening to this presentation because those are all the lies of weight stigma. And the reality is that fat joy exists. Fat people can and do live meaningful, enjoyable, active, connected lives. I do this every day (laughs). There were moments in my life where I believed that lie from society, that if I were ever to become morbidly obese, like, my life would be over. But the reality is that’s not the case. I’m still an athlete, I’m still an artist, an academic, a parent, an employee, and I’m just fat while doing (laughs) those things. You know, when we get all caught up in the rhetoric about the dangers of obesity, we paint a really bleak, shameful, depressing, hopeless future to fat people, and this presumed hopelessness severely impacts our health. But the reality is that fat people, they have friends, they have partners, they get married, they sometimes have children, they work at jobs that change the world, they hike, and kayak, and go camping, and there’s fat-bodies-only yoga, they rock climb, they're Olympic athletes. They craft and cook, sew and garden. So I think when you were asking me what I, like, envision or what I’m hoping for, I think I’m envisioning a world where we really focus on fat joy and joy across the whole body weight spectrum, where we can embody and experience our bodies for all that they are and they can do, where inclusion and accessibility are prioritized so that joy and activity or not being gate caps by size limits.

And I’m also envisioning a world where people build community with each other, where fat people find joy with other fat people—those groups like, you know, Denver Fatties and Fat Girls Hiking and Fat Babes in the Wild. So there are places where this is happening, but I would love for it to not just be, you know, a couple people who know about those resources. And then, you know, lastly, I also think about representation. Like, I envision a world where kids, no matter what their body size, they see themselves reflected in, not just in the world around them, but also a media where they can be the main character and not just the fat, funny friend. And I, you know, I’m really hoping for a world where children don’t automatically discount themselves from joy and success just because of the uniqueness of their body and their inheritance from their ancestors.

Amanda Moore McBride:

Mm. Yes, yes, yes, I completely share that vision. Erin, thank you so much for sharing your knowledge and inspiring us today.

Erin Harrop:

Thanks so much for having me.

Amanda Moore McBride:

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