Anti-Fat Bias At Work: Should It Be Banned By Law?

Will The Supremes Kill The Health Law?

Dr. W. Scott Butsch, an obesity medicine specialist at Massachusetts General Hospital, keeps hearing deeply disturbing stories from patients who have lost lots of weight.

They tell him that within a few months of slimming down, they find themselves suddenly enjoying new recognition and promotions at work. Which is wonderful — until it hits them that their newfound success suggests that they were being discriminated against when they were heavier.

“They come to this moment where they’re excited that so many things have been positive in their life over the past several months,” Dr. Butsch said. “And then they realize that they have been almost cheated, throughout their business relationship, and it puts a bad taste in their mouth about how they’ve been treated.”

Their weight stemmed from what medical science increasingly understands as a disease, not a character flaw.

A growing body of research bears out those accounts of weight-based bias. Forty-three percent of overweight and obese people say they’ve experienced bias against them by their bosses, one study found. Another calculated that severely obese white women tend to earn 24 percent less than their normal-weight co-workers.

Dr. Butsch saw injustice compounded. His patients had been judged based on their weight, and their weight stemmed from what medical science increasingly understands as a disease, not a character flaw. He felt compelled to speak out: Earlier this year, he testified on behalf of a bill in the Massachusetts Legislature that would ban workplace discrimination based on weight.

Obesity specialist Dr. W. Scott Butsch (courtesy)

Obesity specialist Dr. W. Scott Butsch (courtesy)

It was a somewhat quixotic move. The bill had been proposed every session for the last 15 years, and never gone anywhere.

But this year is different. Last month, the weight discrimination bill sailed through the committee that considered it, gaining easy approval in a 7-to-1 vote.

What changed?

“I think the key to this shift was research,” said Rep. Byron Rushing, the Democrat and now House majority whip who has sponsored the bill for the last 15 years. “It was having academics who’ve been working in the field of obesity, having testimony from a medical doctor. To be able to say that in recent studies of discrimination against women, that a higher number of women report seeing discrimination based on their body shape than you have of women being discriminated against because of race. Those kinds of studies are giving people pause.”

Dr. Butsch notes that there’s also a far bigger scientific shift under way: from the old medical concept of obesity as a failure of willpower to the new understanding that it is a disease — a chronic and complex disease.

The old school portrays obesity as a psychological problem, a simple matter of self-discipline. “Just eat less and exercise more.”

The new understanding of obesity sees it as a “dysregulation of energy,” he says. It’s affected by genes and the environment; by the brain and the gut; by hormones with names like leptin and ghrelin and other physiology still to be discovered.

The American Medical Association officially recognized obesity as a disease in June, following the World Health Organization and other medical authorities. And as many millions of people know, it can be a very tough disease to beat.

“We think of obesity as one problem,” said Dr. Butsch, an instructor of Harvard Medical School, “but I would challenge you to think that it’s a number of different types of obesity, much like we have in cancer.”

“The treatment has to match the complexity of the disease. Just like in chemotherapy, where you have multiple regimens that somebody has to go on to cure cancer, the same thing is going to happen with obesity. It’s not going to be the one diet, it’s not going to be the one drug. It may not even be surgery. You see people who get surgery and it doesn’t cure their obesity.”

He makes one more striking cancer comparison: For you to tell a friend struggling with weight, “You should try my diet — it worked for me,” could be as irrelevant as a patient with one type of cancer telling a patient with another type, “You should try my chemotherapy — it worked for me.”

At the legislative hearing where Dr. Butsch testified, so did Melinda Watman, founder of the “The F WORD FAT,” a company that offers training and advocacy to combat “fat shaming” and weight bias.

She is 5’1″ and before she had weight-loss surgery, she used to weigh 225 pounds.

Melinda Joy Watman (Courtesy)

Melinda Joy Watman (Courtesy)

“I remember being in New York on a subway and sitting down,” she recalled in an interview, “and it’s tight, everybody’s squishing in, and just dirty looks. You know, ‘Who’s this fat person sitting next to me?’ With just utter contempt and disgust.”

That kind of thing, she says, “happens all the time.” She calls body-weight bias “the last bastion of public humiliation, public discrimination. Nobody would call you on the table for doing it, subtly or grossly. It’s like, ‘Have at it. It’s good clean fun.’”

At one point before she lost weight, Watman, a certified nurse-midwife, was a contender to be the director of a large nurse-midwifery practice, and didn’t get the job, despite strong credentials and endorsements from her peers.

“Can I absolutely, positively say it was because I had obesity? I can’t,” she says. “What I can tell you is they brought in a woman who was a stranger to the organization, had half the experience I did, and was thin.”

She has a one-word response to the stereotype of people with obesity as slovenly or lacking self-control:

“Oprah.”

“Now, this is a woman who has every resource known to mankind at her disposal,” Watman said. And yet, “she’s not winning the battle against the disease of obesity. Does that make her any of the [negative] things that people think about? No, it does not.”

With two-thirds of Americans now considered overweight, you might think the bias would diminish. But in fact, surveys suggest it is on the rise.

(Courtesy of the Rudd Center for Food Policy and Obesity at Yale University)

(Courtesy of the Rudd Center for Food Policy and Obesity at Yale University)

Researchers have not just documented the extent of body-weight bias; they’ve also looked at the argument that negative attitudes towards obese people can be helpful, because they add incentive to lose weight.

They’ve found the opposite. In a study that came out this summer, experiencing weight-based discrimination made obese people three times likelier to stay that way.

As Rep. Rushing says, such research seems to be affecting the political climate — that helps explain the 7-to-1 vote by the Massachusetts legislature’s Labor and Workforce Development Committee in early October.

Keiko Orrall, a Republican from Lakeville, Mass., was the lone vote against it; another member expressed concern about whether weight gain could keep employees from performing their work, the State House News Service reported.

No one was arguing that bias is acceptable. But Orrall says the focus needs to be on helping employers expand jobs, and adding new “protected classes” of employees could add to their fears of lawsuits, which can inhibit hiring.

“I understand the complexities of dealing with people of all different shapes and sizes, smokers and non-smokers, obese and very thin,” she said. “You could likewise make the argument for anorexics and whether or not that’s going to be a health cost, an additional health cost. And so mostly, we need to give employers the freedom to employ those whom they think will benefit their company and will be able to do the work that they’re wanting them to do, and that’s where the focus needs to be.”

When similar anti-discrimination bills have come up in other states, business groups have often opposed them, warning that they could bring a barrage of lawsuits, and arguing, like Keiko Orrall, that employers need a free hand in hiring and firing. Some also raise concerns that obese employees will incur higher health costs.

Michigan is the only state to have passed one of the bills — a full 25 years ago — but several cities have passed similar measures in recent years, including Washington DC, San Francisco and Madison, Wisconsin.

‘What we’re trying to eradicate here is a pervasive societal stigma.’

At the federal level, a new bipartisan bill called the Treat and Reduce Obesity Act is pending in Congress. It would not address bias, but it would expand Medicare coverage for obesity treatments, including counseling and drugs.

Dr. Rebecca Puhl, deputy director of the Rudd Center for Food Policy and Obesity at Yale University, says anti-bias bills are helpful but only a first step to tackling a bigger problem.

“What we’re trying to eradicate here is a pervasive societal stigma,” she said. “So that requires multiple efforts on many different fronts. Law is absolutely a critical piece of this, but it’s not the only piece. We need more than that. We need changing media portrayals; we need better protection for children who are being bullied; we need better coverage and quality of care in health care.”

Rushing, the Massachusetts bill’s sponsor, says he has about a year left to decide whether to bring the bill before the legislature for a vote. Similar bills are pending in three other states, he said.

“The one thing we, of course, don’t want to happen is we don’t want to lose,” he said. “When we feel we have a significant amount of support, then we’ll bring it to the next stage which will bring it to the floor.

Readers, thoughts? Opinions? Experiences?

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  • guest

    It appears that Doctors want obesity listed as a disease SO THEY MAKE MORE money. Have you ever watched obese people eating? They load up with French fries, as they slurp away on an enormous soda while shoving a Big Mac in their mouths.

    On the other side, people use blenders or juicers, if they need to lose weight. Go look up Joe Cross’ work. He weighed well over 250lbs, maybe 350lbs, and started a regiment that has enlightened so many. His work can be found on Hulu…Fat. Sick and Nearly Dead.

    This is not a disease but horrible eating habits. I’ll bet that I can take anyone for one month and they will have lost weight at the end of that month. They will not be hungry, although, they might act like spoiled brats or be GRATEFUL. Obesity is ignorance wrapped up in laziness. DON”T EAT any fast-foods ever and count all carbohydrates.

  • Thorsten

    There was no causal connection between the subject feeling discriminated against and staying fat. One could as easily say that a mental propensity to overeat makes you more likely to perceive “fat bias”

  • SMStauffer

    Do we need another law? Isn’t it illegal to discriminate on any basis other than the ability to do the job in question?

    • Born2lbfat

      No, it’s not. There are many groups that are discriminated against and not protected, such as gays. EEOC has in some cases has considered morbid obesity to be covered as a disability under the ADA.

      • SMStauffer

        I just discovered that yesterday in a discussion on another board about “at-will employment.” I had absolutely no idea that all employment in this country (except in Montana) is “at will” unless there is a contract that states otherwise or it is specifically forbidden by law. We have so far to go as a country!

  • fun bobby

    somehow I am not too worried about them taking to the streets for any sort of a march

  • fun bobby

    I feel like Dr Obesity Specialist has to make the claim that obesity is a disease because if it were not then we could not have doctors who are obesity specialists

  • Phil Varlese

    Well, let’s start with my feeling that ANY bias in the workplace should be banned.

    With regard to those who want to voice that fat shaming works in causing weight loss, or that fat people can’t be healthy, or that obesity is the cause of heart disease, diabetes and/or cancer, I think you may want to do a bit more research, and contemporary studies are showing that none of it is true.
    A good start might be to look over this article from Time online, which cites a research study saying that you can be both fat & fit.
    http://healthland.time.com/2012/09/05/can-you-be-fat-and-fit-or-thin-and-unhealthy/
    I think the problem centers around a bias that somehow fat people are not as good as their average sized and slimmer counterparts. Fat people are essentially told that on a daily basis, which has given rise to the fat acceptance movement. The fact is, there’s a significant amount of work bigotry in the US workplace, and if legislation is what’s needed to curb that (until the rest of America understands that fat people are not < than others), then so be it.

    • fun bobby

      does it not make sense that people world have more energy after losing weight and thus perform better at work resulting in promotion?

      • SMStauffer

        You might want to look up the words “stereotype,” “prejudice” and “bias.”

        • fun bobby

          Stereotypically people have more energy and a positive outlook after losing weight. It sounds like you are prejudice against people who improve themselves and have some sort of pro-fat bias.
          really you have never heard someone say after losing weight that they have more energy and feel better? you don’t think someone with more energy and a better attitude would get promoted?

          • SMStauffer

            As I said, look up the word “stereotype.” Admitting that you are prejudiced does not change the fact that you are a bigot.

            Please provide a link to a documented study that has found that fat people are lazy and lack energy and have a negative outlook. Also, that they need to be “improved.”

            You sound like you think that people who do not meet your standard of acceptable physical condition are lazy and have a “bad attitude.”

            Is it possible for you to not judge people solely on the basis of their weight?

          • fun bobby

            I never said any of those things. Do you have any evidence that any of the things I actually said are untrue? I have not judged anyone. Perhaps you have some studies that link obesity to long life or reduced medical costs?

          • SMStauffer

            You made the claims; it is your responsibility to back them up. You yourself used the word “stereotypically.” Either you are promoting stereotypes, or you are using words which you do not understand.

            I said nothing about life expectancy or medical costs.

            You said that losing weight would result in more energy — that most definitely implies that before losing weight, they would be lacking in energy.

            You said that losing weight would result in a positive outlook — that most definitely implies that, before losing weight, they had a negative outlook.

            You said that they would perform better at work after losing weight and thus earn a promotion, which most definitely implies that they their work before they lose weight is substandard.

            You said that by losing weight, they would be improving themselves.

          • fun bobby

            that’s a funny way to turn everything around without actually addressing the truth of everything I said. I have been in shape and been fat and its much better to be in shape. Seems like an odd fact to dispute. I can’t imagine you cannot find an article or study about how losing weight improves mood or increases energy. maybe you are just lazy. here you go

            http://www.qualityhealth.com/depression-articles/weight-loss-improves-mood-depression
            http://www.webmd.com/diet/news/20061103/exercise-fights-fatigue-boosts-energy

          • SMStauffer

            And that’s a funny way to try to deny what you said, by providing links to articles that, in fact, prove that you did say what you said. Why are you denying what you said, since you clearly believe it? Seems odd to dispute it and then say it again. If you don’t want to own the attitudes, then change them.

          • fun bobby

            I can’t change the facts.

  • fun bobby

    does it not make sense that people world have more energy after losing weight and thus perform better at work resulting in promotion?

  • fun bobby

    but if we protect the fatties won’t we need to go further and do something for ugly people and short men?

  • RHLauren

    Fat or thin. Humans need to get exercise every day.

  • MeghanJG

    Earlier this year I watched a movie called “A Place at the Table,” about food security in America. One doctor plainly states that obesity is not the opposite of starvation; in fact, obesity and poverty often go hand-in-hand, because people who are food insecure will buy the highest-calorie food in order to stretch their minimal food dollars. This isn’t comparing the cost of Doritos to a pound of apples. The people in the documentary were buying the off-brand stuff because when you have $5.00 to feed yourself for a week, you are going to buy as many things as possible at the lowest price points.

  • Stein

    Fine, so it’s a disease… but the cure *is* less food, more exercise!

    Few obese are *unable* to exercise, even quite vigorously. It actually helps cure a number of the “disease” symptoms (regulatory hormones, insulin resistance). But I think you’ll find that most of them don’t. And everyone else is paying the bill for the extra healthcare costs.

    Offer them an extra month’s wages to eat only what they *should* eat for a week, most will manage. Not saying it’s a walk in the park, but it’s not an *irresistible* urge.

    And yeah, alcoholism & smoking, other addictions are diseases in the same fashion, and the cure is to stop. Of course, many will need help to do so, but it’s not the lack of help that’s stopping most.

    • MeghanJG

      I had a friend who had a sister she was very close to. The sister was just naturally thinner, and it was easier for her to lose weight. Once the two of them decided to stop drinking sodas. The sister lost 5 pounds in two weeks; the other sister didn’t. They both did some fad 3-day diet, like the cabbage soup diet or something; the sister lost 9 pounds, my friend lost 2. They decided to do some variation of Atkins. The sister lost 15 pounds, my friend didn’t lose any. On the same diet. They both worked as servers and hostesses in a hotel restaurant, and they both lived with their dad, so their environments were very similar, and as sisters their genetics were similar too. But obviously, for them, it wasn’t as easy as “calories in/calories out.” There was something about my friend’s body that retained weight differently than her sister’s, and science can’t really say at this point what exactly that is. So until we know more about why our bodies store weight so differently from each other, and what about us drives us to eat in such a way that we store more and not less, we should probably replace judgment with compassion.

      • Stein

        Some people have a higher natural metabolism than others. Some people’s bodies respond to “starvation” by quite efficiently lowering the metabolism. Unfortunately for them, that means they’ll need to work harder (truly) than others. And there are oher differences as well. Science can tell – no witchcraft involved. And the equation still stands: energy in – energy out. Nobody creates calories spontaneously, and no wonderdrug can’t make fat pour from your fat cells out of your body.

        By the way.. a three day diet? Setiously? Did the Atkins diet last about as long, might I ask? And are you trying to say that one of these sisters just *can’t* lose weight? Well, just plain wrong. And while compassion is a good thing, misplaced compassion in matters of obesity can kill

        And siblings are not as similar, genetically, as people might think. In fact, apart from their mitochondrial DNA, they might have *no* shared “genes” (in that their genetic material came from different copies of each chromosome). Oops, forgot e X and Y chromosomes: boys *must* have the same Y-chromosome, and one of two X-chromosomes must be identical in sisters.

        • Charles

          Siblings share 50% of their genetic material. No more, no less.

          • Nope

            This is just incorrect. Siblings share ON AVERAGE 50% of genetic material, and the statistical distribution is such that most of the actual percentages end up somewhere near 50%, but it is very much possible for full biological siblings to share significantly more or less.

    • SMStauffer

      What are you qualifications for making these statements?

  • Al Paradise

    Had some good points, especially regarding how bias sucks and is relatively prevalent when it comes to looks vs. ability.

    Lost all credibility once they started comparing cancer to fat-gain.

  • Bill

    Doesn’t obesity bias fall under the bigger bias against un-attractive people. Is this any different than the fact that taller people earn more or that bald menay get skipped over for promotion?

    • fun bobby

      I was thinking short men and uggos would need a bill to protect them also. to be fair short men can’t do anything to get taller

  • Born2lbfat

    My weight is due to a medical condition called Lipedema. However, I am just seen as “fat”, and I was told in my annual review that my ability to advance within the company would be based on my appearance. All other skills and knowledge areas of the review I received meets or exceeds expectations. After being passed over for a promotion I stood up for myself and was eventually fired. http://born2lbfat.com/june-is-lipedema-awareness-month/

    • fun bobby

      where do you work?

      • Born2lbfat

        No where, now. I was fired.

        • fun bobby

          you are better off, that place sounded terrible. If you live in MA and want a job let me know. Have you tried cutting out wheat products?

  • Weighing In

    I have worked extremely hard to lose 50 pounds over the last year. But this 50 pounds has been on and off of me several times in the last 10 years. Yes there is definitely will power involved. I make a constant daily effort to make the right food choices and stay active. I also read articles and helpful tips on maintaining the proper mindset of a healthy lifestyle. I also face daily pitfalls. Thin people who constantly offer advice on the ‘right’ way to lose weight. People with backhanded compliments like ‘wow 50 lbs is great…what’s your goal weight?’ People who offer unhealthy food and say stuff like ‘come on, live a little!’. My husband is a recovering alcoholic. He said that the pitfalls I face sound an awful lot like the ones he faces. Sounds like obesity is a complex disease not unlike alcoholism.
    That being said, legislation is not going to help. People have always felt superior to those who are overweight. Just reading the comments on this page is enough evidence that no legislation will change this bias… it will only make it worse. I just hope that medical advances will help those like me win the fight against obesity.

    • SMStauffer

      Actually, it’s only in the past century or so that being thin has been worshiped. In previous generations, being fat was associated with being healthy and with being rich. The women who were admired were “pleasingly plump,” or “Rubenesque” or “voluptuous.” The thin people were the poor and the sick, the ones who were dying.

      And consider that this generation thinks that Marilyn Monroe was fat.

      • fun bobby

        not really

  • TheEmperorIsStarkers

    In other news, water is wet.

  • AaronWP

    This article brings up several valid points regarding overweight/obesity bias, and I’m sure it occurs on a regular basis.
    Let’s face it…obesity is just that…too much fat content in a person’s body for the height/body type. Calling it a disease is not going to change what it is. Calling it a disease will, however, ensure those “all-knowing” medical doctors will be able to “treat” it with a much more robust variety of “treatment” options.
    I agree that there is a pervasive “fat bias” in Western culture, and discriminating solely on whether a person is obese or not is certainly ethically wrong, so I respect the researchers’ views and findings on the numerous studies that have been conducted regarding so-called “fat bias”.
    What I do not respect is a business (e.g., medical field) doing their own research, miraculously discovering a result that ensures their Christmases will be a little better, their pocketbooks fuller, and their cars quite a bit nicer. Granted, strictly from a business perspective, this is absolutely genius. (If I could do all my own research, put out the results in established journals, and in so doing, ensure I make a few more dollars, why wouldn’t I?) Frankly though, I just don’t buy the opinion of the medical doctor who says, “Yep, obesity is a disease, and now I can treat it like a disease. I don’t have to treat it with pesky little things like healthy diet and exercise, because let’s face it…there’s no money in that for me. If I treat it like a disease, especially one that does not have a cure…well, not one that I’m going to tell them about anyway…I can drag this out for the rest of my career. I never have to address the root cause of obesity because that’s not my job. My job is to make people feel better, not necessarily to heal them, because we all know – if people aren’t sick, I lose business.”

  • PanTardovski

    Definition of disease according to Merriam-Webster: “a condition of the living animal or plant body or of one of its parts that impairs normal functioning and is typically manifested by distinguishing signs and symptoms.” It doesn’t say anything about how that condition is caused, or that it can’t be corrected behaviorally, simply that it is a definable state of poor health. Obesity fits the definition to a T.

    That being said, NPR: cut it with this shoddy science writing already. “[I]t’s a number of different types of obesity, much like we have in cancer”? Somebody should have their credentials pulled for giving a platform to this sort of junk science. The pathological behavior that leads to obesity has any number of roots but excess body fat has a single origin — energy intake. Aside from rare cases like extreme Cushing’s Syndrome where weight lost would predominantly be lean rather than fat mass the solution in *all* cases is to create a caloric deficit — eat less and/or move more. Contrary to popular wisdom metabolism varies relatively little between individuals (http://examine.com/faq/does-metabolism-vary-between-two-people.html), and when looking into changes in metabolism post-weight loss we find the majority of that variation attributable to activity (http://weightology.net/weightologyweekly/?page_id=415) rather than mysterious “metabolic” effects. “Non-responders” to dietary intervention have universally been found, when placed in a controlled environment where caloric intake and activity can be precisely measured, to misestimate their consumption and activity levels (http://www.nejm.org/doi/pdf/10.1056/NEJM199212313272701). There’s no significant mystery: Americans no very little about their diets, their showered with fads and bad pop science, and then they pay very little attention to what they eat anyway. Dietary education (grossly lacking in our basic curriculum these days) and behavioral intervention (measured portions, moderate exercise) are all it takes. Not necessarily easy, but simple.

    • SMStauffer

      And your qualifications for saying this are?

      • PanTardovski

        Literacy is a pretty good start.

  • ChicagoRunner

    I have a hard time with the idea that obese citizens are a protected class. We can not legislate everything (For the record, I am a Liberal). Who else should be protected? What about unattractive people (which studies show experience widespread bias–in hiring, service, housing, etc.)

    I understand that the AMA has classified obesity as a disease–and this is helpful so that obese Americans can have better access to medical support to help them lose weight (whether that is nutritional counseling, surgery, physical therapy, etc). But I also fear that normalizing obesity by making it a protected class, only serves to make obesity ok.

    Being obese is not healthy (I don’t look like a model, but I am a healthy weight–run 30 miles a week and attend 2-3 yoga classes). We have stigmatized smoking in the name of public health (and the AMA considers addiction a disease!). Why would we treat obesity differently?

    • Charles

      Really? So making disability a protected class has made disability OK?

    • Charles

      There’s a distinction between stigmatizing smoking, and stigmatizing smokers. That distinction is also applicable to obesity.

      • ChicagoRunner

        Charles, I’m interested in this difference between stigmatizing smoking and stigmatizing smokers. How does that distinction play out in the way we treat smoking/smokers. In Illinois, you can not smoke indoors or within 15 feet of the entrance to a public place. Thus forcing smokers to huddle in groups on small patches of sidewalk that meet the requirements.

        Being a smoker is not a protected class–so employers are free to discriminate against them in hiring decisions. In fact, a company I used to work for had a no-smoking clause in our contracts (admittedly, I never saw them enforce it). To you, how do you distinguish the act of becoming obese (I’m intentionally trying to stay away from the word lifestyle here) from actually being obese. Which would you stigmatize and how do you separate them?

        • Charles

          Well, “stigmatize” is your word, and I’m not sure it’s the best word to use in this argument. Making smokers go outside to smoke, away from the entrances, is intended to protect non-smokers’ rights. (Yes, smokers have a right to smoke, but everyone else’s right to clean air supersedes that). Smokers might *feel* stigmatized or discriminated against, but that is incidental. The intent is not to discriminate against certain *people* – they’re welcome to come back in once they’ve finished their cigarette. On the other hand, not hiring a smoker is discriminatory against a person and, in my opinion, wrong.

          • SMStauffer

            It’s because of the effect on health insurance rates.

        • SMStauffer

          It plays out in that I am more than willing to associate with smokers — and do so on a daily basis — as long as they are not putting me at risk for cancer. What they do in their personal time and space is not my concern. It is their smoking behavior I object to, not them as human beings.

          On the other hand, I did lose a valued colleague three years ago to stage 4 lung cancer and worry that I will lose another in the near future; I also am concerned about the young, extremely overweight women in our office.

      • J__o__h__n

        Stigmatizing smoking without stigmatizing the smokers is a distinction without a difference. I’m sick of smelling their smoke and seeing cigarette butts everywhere. And yet another careless idiot just burned down a multifamily house with a discarded cigarette. Bring on the stigma!

        • fun bobby

          yeah and I am sick of airplane seat overflow!

      • fun bobby

        smokers are always stigmatized have you seen the sign up for obamacare?

    • atheologist

      The only thing you can tell by a person’s size is your own level of bias. Many fat people are just as healthy as their thin counterparts – they eat healthy, they lead active lives, and they do not have any of the diseases often (and falsely) blamed on weight, such as type 2 diabetes and heart disease, both of which are far more attributable to genetics, environment, and lifestyle than weight alone.

      Certainly some people are fat because they are sedentary and eat too much for their bodies or do not eat healthful foods. Many are fat for other reasons. But really, being fat or “obese” IS okay and perfectly healthy for any number of people and blanket statements like “being obese is not healthy” have been disproven in multiple studies, despite the ongoing ignorance of people like you.

      • Charles

        Obesity is, by definition, unhealthy. That’s why the AMA considers it a disease.

        • Born2lbfat

          Actually under the AMA definition I would not be considered obese since I do not have any of the other co-morbidies such as heart disease and diabetes. The problem is the diagnosis of obesity and morbid obesity has always relied on weight only. If you are in a certain BMI you are obese, period, and no other health factors are considered. They defined obesity as a disease because they found it was a more complex condition and included more factors and than just weight.

          • SMStauffer

            Which the article is pretty clear about, but it seems that most of those commenting either didn’t read the article or are unable to see past their own preconceptions.

            BMI is widely recognized as a flawed measure, in any case.

    • SMStauffer

      We have also classified alcoholism as a disease — and I don’t see anyone saying that alcoholism is ok.

      As for why we would treat obesity any differently from smoking, that is because of the effects of smoking on non-smokers. If an obese person eats while standing next to me, that does not put me at risk of second-hand food and of becoming obese myself.

      • fun bobby

        unless what they are eating is so appealing that you just have to go get one yourself

  • teacher

    What will be the cut off for weight ratio? 5 lbs, 10 lbs over ideal weight? What if weight, clothing choices, how much a worker can move or what he/she smells like becomes a hindrance to performance, how will that be disproved? How can a law change what people think? I agree people are judged on their weight, but many times employers find non weight related performance markers(even ones that are usually over looked because we all are not perfect) to use instead of discussing weight. As someone who struggles with body image I am sensitive to weight discrimination, but I don’t see this playing out well either.

    • SMStauffer

      It isn’t about weight — it’s about health. There is no “cut off.” If you are healthy, then your weight is healthy for you. If you are unhealthy due to your weight, then your weight is unhealthy for you.

  • Kevin

    I agree upon the principle of non-discrimination, but this is somewhat ridiculous in the fact that this is only compensating for a larger problem which has been exacerbated by turning a blind eye to the real problem at hand: the fact that so many americans are obese.
    They need to be passing legislation that will educate people from a young age about healthy diets in order to prevent obesity. It starts in cafeterias where healthy foods are served and not pizza and burgers everyday. Healthy foods need to become more accessible to more people, and completely processed, unnatural, foods need to be taxed and labeled as disease-causing products. If obesity is a disease like cancer, than there should be a list of foods, just like there is a list of carcinogens, that contribute to obesity.
    Obviously it is not as white and black as I’m portraying it, because you can still become obese even by eating way too much healthy food, but lets face it, the majority of obese people did not become obese by snacking on fruits all day. Lets solve the problem from the root of it and stop trying to patch up holes like everything else this government is doing.

    • Charles

      Bad argument. Making disabled people a protected class didn’t imply that disability shouldn’t be treated, nor did it stop anybody from looking for cures or improving treatments for various disabilities.

    • SMStauffer

      You’re right — it isn’t as simple or simplistic as you are trying to make it. Have you studied the eating habits of “the majority of obese people” in order to know any of this?

  • Sarah

    Just because obesity has a biological component doesn’t make it a disease. My husband has lost over 50 pounds in the past year+ by watching what he eats and going to the gym … even when he doesn’t feel like it. He is constantly battling keeping the weight off, but he is doing it. He comes from a family of overweight people. I have no doubt that his struggle with weight is genetic. But I don’t consider it a disease. I am very thin by nature. I have struggled in the past not to be underweight. I don’t consider that a disease, either. It’s the just the way I am. Exercising has helped me not be underweight by building muscle. Not everything that we have to work to control is automatically a disease. Sometimes it is about disciplining yourself to work with what you were given by nature. Obesity is on the rise because of sedentary lifestyles and crap food, not because suddenly more people are falling victim to disease.

    • SMStauffer

      So you accept that you are genetically thin and are fine with it — but not with your husband being genetically fat and not with insisting that he spend the rest of his life battling his own genes.

      • Sarah

        No, as I said … I have struggled with being underweight and have had to work to overcome that. I go to the gym and make dietary decisions based on the fact that I don’t want to weigh 97 pounds (my body’s default, which is underweight for my height) just like my husband goes to the gym and makes dietary decisions so that he isn’t 240 pounds (his body’s default, which is obese for his height). I said we work with what we are given and don’t call it a disease.

        • SMStauffer

          Why do you need to “work to overcome that?” Is your health in danger? Has a physician or other health care provider told you that you need to “work to overcome that?”

          Has a physician told your husband that he must lose weight or his health will be in danger?

          • jannieho

            Why do dye your hair? Why to you wear makeup? Why do you choose to wear what you do?

            We all like to feel good about ourselves and we all do that in different ways. So what if her husband whats to weigh less and so what if she wants to weigh more. The bottom line is we should tend to our own gardens and not worry so much about what our neighbors are doing next door.

          • SMStauffer

            I don’t die my hair. Never have. Never will. Other than special occasions when I want to dress up, I don’t wear make-up. I choose to wear clothing that is comfortable and appropriate to the situation so that I can do what I need to do without worrying about how I’m dressed.

            The things that I do to feel good about myself are not related to my physical appearance. In fact, some of the things that I do to feel good about myself involve wearing old clothes and getting downright grubby.

            You might want to take your own advice about recognize that not all of us base our self-esteem on how we meet some arbitrary social standard of attraction — and about not being worried about what others are doing.

            Ironic, isn’t it, that you feel justified in telling someone else to mind their own business, but don’t take the advice yourself?

            She invited us all into her garden. She made it our business.

          • Sarah

            Yes, and yes.

          • SMStauffer

            Your (plural) healths are at risk, you are under a doctor’s care, yet you refuse to consider it a disease? Why?

            Would you consider your different weight-related health issues congenital or idiopathic disorders?

          • Sarah

            There are lots of things people can do to improve their health that aren’t based on them being diseased, merely based on them wanting to optimize their health. It is, in my husband’s case, well-known that abdominal fat contributes to the development of certain cancers, and, as my father-in-law died of one of those kinds, my husband and the doctor discussed his weight in relation to that. He’s not “under a doctor’s care” for his weight. He sees the doctor once a year for a physical. Perhaps I misinterpreted your previous comment. He was not told he “must” lose weight. He was told he’d be healthier if he did, which of course my husband already knew. He’s working out and eating well because he doesn’t want to be fat. I talk to my doctor about a lot of things that are health-related but aren’t diseases. Sometimes I follow his advice. Sometimes I don’t. He had some good ideas for increasing my muscle mass and overall weight, and I followed them. I wasn’t diseased. I was underweight.

          • SMStauffer

            Yes, you did misinterpret my question. I was asking whether your issues with weight were related to health or to a desire to meet some arbitrary social standard of attraction.

            You’ve answered it.

  • Pete

    I am 6’0″, 270 lbs. I am in the restaurant business. I certainly consider appearance when hiring servers. Very detailed studies have shown that a guest will believe they had better service from an attractive person. As director of many locations, I’m not on the floor and my appearance is not a factor. Why are obese people so shocked to hear of workplace discrimination? Get into the restaurant biz, where your gut is a badge of honor.

    • TheEmperorIsStarkers

      So, you proudly discriminate against fat servers, yet wear your own “gut” as a badge of honor. Got it.

  • ttllrr

    The viciousness of the comments here underscores all of the points in the article, so thank you tiny people, with tiny minds and no compassion, for that.

    I was fired 6 months ago by a newly hired manager who engaged in workplace bullying and discriminated against me based on weight, despite my excellent job performance and the support of colleagues at all levels of the organization. She came in gunning for me and eventually got her way. Consequently, I have gone through all of my savings, borrowed what funds I could from family and just applied for food stamps yesterday because I cannot find another job even though I possess far more skills and experience than peers in my field. Anti-fat bias is pervasive in our culture and has very real, and in my case dire, consequences.

    Things MUST change! We obese are now the majority in the USA so watch out: we will be heard.

    • fun bobby

      and how do you know its because you are fat? you seem to have an attitude problem that could be holding you back. I don’t think anyone has to worry about fatties taking to the streets anytime soon

      • SMStauffer

        And you seem to be have an attitude problem that you are entitled to judge others.

        You’re a lot of things, bobby, but fun ain’t one of them.

        • fun bobby

          looks like you have the same issue

          • SMStauffer

            I certainly have issues with your use of terms such as “fatties” and “uggos” and your characterization of the overweight as lacking in energy, performing poorly at work, and having poor attitudes. None of that leads me to believe that you are “fun.”

          • fun bobby

            What is the politically correct term for the ugly? have they got an organization to lobby on behalf of them yet? Should short men be protected as a class? they are frequently and consistently discriminated against in many ways. They can’t work out and get taller.
            If you fat people don’t like being fat then they should lose weight. It everyone’s decision.

    • SMStauffer

      Have you contacted EEOC or even the ACLU? If you were fired for something other than inability to do the job, you may have a case.

  • DavidL

    Obesity-bias certainly exists in the work place. It is prevalant in all aspects of society. And I agree it should be banned. But for heaven’s sake, what is the bigger problem here; a promotion or a life wrought with health problems. Obesity is an epidemic in this over-fed, under-exercised, poorly informed country. If we do more to cure obesity, “Anti-Fat Bias at Work” will go away without legal action.

  • Rose

    Looks like we should examine the American diet too. Medical coverage for those who need it is good for when it’s actually applicable, ignorace shouldn’ t count.

  • PaulD

    Can someone tell me exactly what a disease is? Are there any other diseases than can be cured through sheer force of will on the part of the afflicted? Also, why has obesity become so much more prevalent in the last ~20 years? Finally, if the job requires certain physical attributes (like say a house framer), will the employer be exempt from this bill?

    • RealityCheck

      You think obesity can be cured through sheer force of will on the part of the afflicted? Do you think the same about alcoholism and drug addiction? I think you may need a reality check.

      • PaulD

        Some people certainly accomplish becoming not obese anymore by a combination of diet and exercise. Is that not willpower? Are you denying that some people go from being obese to being physically fit without drugs or surgery?

        • Bob

          The doctored mentioned that there were many types of obesity, each with their own prescriptive treatment. She didn’t deny that there were obese people that were obese simply because they liked to eat, but rather that there were many (most?) that are obese because they have a disease.

          Anecdote time.
          Both my brother and father were skinny most of their young lives. However, once they got a little older they were both about 40 – 50 lbs overweight for quite some time. They’ve both lost weight simply by eating healthy and exercising. My dad’s had no problem keeping it off, but my brother likes to eat so he fluctuates. Whenever he gets back to not stuffing his face and exercising, he loses it. I’d say this is a case of simple willpower.

          In contrast, my best friend has been obese his entire life. Even when we were 4 – 5 years old, he was far overweight. Unlike my family, he eats well and exercises and he can’t keep it off. He lost close to 100 lbs a few years back after going on an incredibly rigorous, but impractical diet. He has since gained all of that weight back. I’d say this is a case disease.

          Completely unrelated, but my dad also managed to stop smoking cold turkey. He’s pretty good at using willpower to stop bad habits/addictions. I’d say he is an exception to the rule though.

          • atheologist

            Frankly, though, saying that someone whose weight places them in the “obese” BMI category despite healthy habits has a disease seems misleading, too. Why should we label someone diseased when they eat healthy, lead active lives, and are (based on those habits) no more at risk for developing heart disease or other illnesses than thinner people? Weight alone should never be enough to diagnose someone with a disease, though it might be a symptom of some underlying condition.

          • SMStauffer

            Maybe they shouldn’t be labeled obese.

      • Charles

        Alcoholism is managed through sheer force of will. Not medication, not surgery. There are helpful strategies a recovered alcoholic uses, programs, and help through others, but the bottom line is, the only thing keeping a recovered alcoholic from drinking is will.

      • fun bobby
    • Yaya

      1) It’s definitely a good idea to look at how the culture has changed in the last 20+ years, as there is definitely a relationship. There are more cheap processed foods around us than ever before. Those added chemicals are not good for us. Those processed foods with refined sugars and grains are not good for us. It’s difficult to find even supposedly healthy brands of food that don’t have added sugar. Beyond even videogames, we’re surrounded by all kinds of screens that keep us on our butts. When I was a kid, we had one TV, and you had to get up to change its channels. Now, living alone, I’ve got at least four devices with screens that it feels necessary for me to have my face planted in front of. The number of well-paying physical jobs are on the decline. Parents are less comfortable with kids playing outside due to violence and kidnappings. On and on.

      2) The ADA has never said that any person regardless of disability can do any job. Otherwise, we’d already have people with limited mobility winning lawsuits because they can’t be construction workers or professional basketball players. Plus, I’ve seen plenty of overweight house framers. Being big doesn’t mean you can’t also be strong and healthy.

      3) There is no question that choices that I made had a significant role in my weight, regardless of the family history of obesity. HOWEVER, I now have adrenal fatigue (stress induced) that messes with a whole slew of hormones. Of all the effects, the one I find the most terrifying is that my body can no longer convert stored energy (i.e., fat) into blood sugar, and I go into hypoglycemic episodes if I try to burn more energy than I consume. When my cortisol is low, my body literally can’t convert stored energy into sugar. This is heartbreaking because I can’t lose weight if my body can’t perform that chemical reaction. It’s more heartbreaking that then constant fatigue, body aches, brain fog, and other symptoms because as a woman isn’t my weight the most important thing about me?

      4) I’ve been thin and heavy and thin and heavy again. And do people treat me differently? YES, they do. I suspect people look at me, see my weight, and think I’m not terribly smart. And then I realized, OMG, I’ve done that.

    • Rika

      That is a good question – “health” and “disease” is a pretty ambiguous concept and doesn’t have a clear cut definition. Usually disease is defined as any deviation/interruption of the normal body function/structure. Based on this vague definition, I can see how people can argue obesity as a disease/nondisease. Being obese definitely deviates/interrupts normal body function like insulin sensitivity etc, but you can also say some people can be obese & still be healthy.
      Why obesity became so much prevalent is also a difficult question to answer. People try to link it with rise of high fructose corn syrup, trans fat, GMO, what have you, but it’s all correlation. It’s not ever going to be ethical to do a randomized control study and feed one group of people what we think is the cause of obesity. Also, with anything food related, it’s mix of everything. Genetics, environment, food intake, physical activity… all are so intermingled that I don’t think any one thing can be blamed for rise of obesity.

      • fun bobby

        it would be better to do the diet study on mice for many reasons.

    • Born2lbfat
      • SMStauffer

        Great article!

        I think the most important sentence in this paper is “In our definition of obesity, excess of body fat denotes an amount sufficiently large to cause reduced health or longevity.”

        In other words, you cannot tell just by looking at someone whether that person is obese — BMI doesn’t work — and neither do any other weight/height ratios. Only a doctor, after a full physical work-up, can determine whether a person is truly obese.

        And it’s a disease because it reduces health or longevity.

    • DovSherman

      I think you skipped over parts of this article. Fat, like cancer, isn’t just a single disease. There are many different forms of fatness with many different causes. While it is possible for one form of fatness to be cured through, as you say, “sheer force of will”, it doesn’t work for other forms of fatness.

      I would say that qualifications for a job should be based on merit. If someone is fat, they can still be healthy and strong, so it doesn’t prevent them from being a house framer. If someone happens be both fat AND weak, then really it’s just the part about being weak that would disqualify them. The important thing is to judge a person on what they can do instead of what you have guessed they can’t do just from looking at them without giving them a chance.

      • PaulD

        I didn’t skip over any parts. It is unequivocal that people become fat because they take in more calories than they burn. That equation may not be totally linear across all people, but it’s always true, period. Now maybe some people will have a much harder time changing that but that’s a different argument. Further, if there are different forms of fatness, what’s the distribution of those forms? Sure, some people have hormone imbalances but do most fat people have such a hurdle? It seems unlikely given the increase in obesity over a relatively short period and within a limited geography, but I suppose it’s possible (and if so, probably driven by changes in the food supply).

        Yes, an overweight person can be healthy and strong. However, at a certain point, yes, being too fat will prevent the person from doing certain jobs. Fireman climbing a ladder? Being overweight is a hinderance, period. The employer needs to be able to consider what kind of hinderance the condition will be based on that employer’s experience as not all performance situations can be tested for.

        • SMStauffer

          Perhaps if you knew as much as the researchers and scientists quoted above you wouldn’t have so many questions or have to “suppose” anything.

        • LogicCheck

          Not really. You understand how the amount of work you put in brought you success. There’s nothing saying that someone else couldn’t put in double that effort and not see success. Example of 1 (especially yourself) is a bad sample size.

          • PaulD

            It was still more physical work than most adults in this country put in, period. Yes, for some the amount of work needed may be more, or less, but in absolute terms, it was still a lot of work (force * distance) and was measurable in energy (calories) expended. It’s unequivocal that exercise is good unless there is some physical condition that would create a risk.

          • SMStauffer

            And why is it good? What are the benefits of exercise?

          • PaulD

            You seem to be supposing that it’s not proven that it is good and ignoring what all those scientists and researchers know. Anyway, I’ll humor you: http://lmgtfy.com/?q=benefits+of+exercise

          • SMStauffer

            And you are making a huge assumption based on a simple question. Maybe it’s time to stop assuming. Isn’t that the problem here — that so many assume that they know so much about others based solely on physical appearance? Or in this case, assuming that their individual experience is going to be true for every other person out there — worse, that your experience with asthma is in any way the equivalent of dealing with weight-related issues.

  • guest

    What an excuse! Obesity is not a disease unless overeating is a disease. Anyone who eats TOO MANY CARBS will become obese unless they exercise more than they eat. I suppose the medical community wants to make more MONEY and call obesity a disease.

    To all the obese people who want to lose weight, go see a nutritionist and learn about metabolism: acids, alkaline and carbohydrates. That’s ALL you need.

    • Linda

      This comment is a wonderful example of the ignorance of some thin people who enjoy feeling superior to those who suffer from obesity. If you can lose weight, fine. That means you were eating too much. But many people’s bodies resist weight loss or the maintenance of weight loss. Some bodies make less muscle than others and metabolize food differently. Of course, not having obese people to feel superior to and make fun of, well that will be a loss for some of the narrow minded.

      • Thorsten

        No, your body doesn’t your mind just makes you eat too much. Next to no-one has that much of a metabolic difference. Way to stay ignorant though.

        • fun bobby

          fat and ignorant

        • SMStauffer

          Could you possibly provide any valid evidence for what you claim?

    • Rika

      I do think calling obesity a disease seem rather ridiculous and I’m sure some medical community will benefit financially for it. But classifying obesity as a disease can also enable those to access & be reimbursed for visiting a dietitian for weight loss help