BMI should no longer be used in medical settings, as the metric is known to be a flawed system of measuring health and wellness based in racist ideals. The American Medical Association states, “AMA recognizes issues with using BMI as a measurement due to its historical harm, its use for racist exclusion, and because BMI is based primarily on data collected from previous generations of non-Hispanic white populations.” The AMA has questioned its ethical usage given that BMI was adopted into medical systems through eugenics which sought to cultivate qualities and eradicate deficiencies of the human race during the late 19th and early 20th centuries.

Providers must understand the myriad ways the medical establishment propagates anti-fat biases and encourages disordered eating. By ignoring fat patients’/clients’ lived experiences and dismissing their medical concerns as purely weight-related, providers trigger a dangerous cycle of self-blame for patients/clients who may then engage in further disordered eating.  

Healthcare providers must listen to their patients/clients and be willing to see the people they treat as experts on their own bodies. It is crucial that providers work in partnership with patients/clients. Patients/clients must feel empowered to advocate for their needs in healthcare settings. 

There needs to be a greater emphasis on utilizing lived-experience as credible data to develop clinical recommendations and treatment plans. The medical community must respect personal anecdotes and stories from patients/clients as equally, if not more important, than the information they glean from medical textbooks and quantitative research studies. 

Often, patients/clients lack the verbiage to push back against providers who exhibit anti-fat bias, and advocate for themselves. Thus, patients/clients experiencing medical fatphobia may not only feel shamed by providers who are referencing “obesity treatments,” they may not know or know how to ask for a different approach that does not include intentional weight loss. When patients/clients aren’t equipped with the necessary tools to articulate their needs and confront providers who aren’t treating them with respect, patients/clients may choose to forgo care altogether. Even when individuals do have the tools to self-advocate, implicit and explicit weight bias may prevent practitioners from treating their self-advocacy seriously. Additionally, larger-bodied individuals who are also from demographic groups that have been systematically maltreated and stigmatized in healthcare are often met with even more resistance to their self-advocacy.

Both patients/clients and providers need to be educated on the negative impacts of diet-culture, as well as the way weight-based stigma intersects with other systems of oppression such as anti-Blackness, ableism, and colonialism. Diet-culture intersects with the desire to gain proximity to privilege; in order to fully understand a patient’s/client’s motivation for weight loss or reluctance to get care that may result in weight gain, providers must have a strong knowledge of how thinness enables access to resources for survival in a white supremacist society. 

Providers must understand the myriad ways the medical establishment propagates anti-fat biases and encourages disordered eating. By ignoring fat patients’/clients’ lived experiences and dismissing their medical concerns as purely weight-related, providers trigger a dangerous cycle of self-blame for patients/clients who may then engage in further disordered eating. 

Providers should know that prescribing dieting as a treatment method is rarely an effective weight loss method, as it more often results in weight cycling, which can have severe negative health impacts. Providers also should adjust treatment plans and discussions to account for the fact that Body Mass Index (BMI) is an inaccurate measurement of health that reinforces medical racism. 

The medical community has done significant damage by promoting the idea that “obesity” is a greater risk to individual and public health than weight stigma and anti-fatness are. We need greater investment in treatments to combat disordered eating, as well as clinical education that will eradicate anti-fat bias from our healthcare systems, rather than funding for weight loss. At the same time, the recognition of “obesity” as a disease and the addition of binge eating disorder  to the Diagnostic and Statistical Manual of Mental Disorders have served to frame both as healthcare conditions that are deserving of care, rather than choices people should be held morally accountable for. Some members of our roundtable discussion noted the tension here — between the potential need to legitimize “obesity” in medical terms so that legal protections against discrimination might be more easily established along a disability framework, and the concern that doing so codifies into law that fatness is a disease that needs a cure or chronic care. 

Many people with eating disorders have been overlooked for treatment by medical providers, because their eating disorder does not fit common stereotypes. The popular image of eating disorders has typically centered anorexia in cisgender white women who are visibly thin or emaciated. This has created obstacles for care and insurance coverage for Black and Indigenous people and other communities of color, people with binge eating disorder, men and LGBTQ+ populations, and those who are technically within a “healthy” BMI range, as well as people in larger bodies. People of all sizes can have eating disorders, but preconceived notions about what constitutes an eating disorder prevents many from being correctly diagnosed or receiving the necessary care. Removing weight and BMI as criteria for diagnosis is a crucial first step to ensuring greater access to care. 

News media and film play a major role in normalizing weight stigma. With education and tools, we can tip the bias away from weight stigma and toward weight neutrality.” 

Journalists, editors, and the publications that employ them need to be educated on the value of reporting on weight stigma and the fat community, whether that be stories about new products that improve access and quality of life for people in larger bodies, or company policies that fight against diet-culture. Rather than dismissing press releases about these innovations, journalists can help fight weight stigma by increasing visibility through widespread coverage of these topics. 

Journalists and the publications that employ them need to be educated on best practices for language when writing about weight discrimination and fatness. A standard style guide may be helpful here; The American Foundation for Suicide Prevention and the Trans Journalists Association offer potential templates for creating such a resource. Providing journalists with the correct language to navigate these topics is a crucial step toward incentivizing greater coverage, and ensuring journalists aren’t avoiding these topics out of fear of getting it wrong. 

“The obesity epidemic” has turned weight gain and weight loss into an opportunity for profit. The diet industry — companies such as those that sell weight loss drugs, supplements and teas, structured weight loss programs, and calorie-tracking apps — directly benefits from a fatphobic culture that rewards thinness and punishes fatness. 

Marketing campaigns that co-opt language around weight stigma developed by fat activists to sell products that still promote diet-culture and anti-fat bias, such as Weight Watchers. During our discussion, several people drew parallels to the way the diet-industry has co-opted this language and the way the anti-choice movement has cloaked its messaging under the guise of women’s health. 

Corporations must be made to understand that weight discrimination is one of many forms of workplace discrimination, and a topic to be addressed through Diversity, Equity, and Inclusion practices — which many companies are already investing in.

4. The frequency with which GLP-1 antagonists and other weight loss drugs are being prescribed by general practitioners rather than specialists like endocrinologists, has made these pharmacological approaches seem like a casual solution for those looking to lose weight. However, as we’ve seen with the Opioid Crisis, pharma companies prioritize the opportunity to make money through prescription drugs, often at patients’/clients’ expense. For-profit weight loss and weight management programs also do damage, while profiting off of these drugs. Weight loss drugs cannot be viewed as a lifestyle trend, and clinical recommendations about these drugs should not be influenced by industries that stand to profit. Rather, these drugs must be treated as a serious medical intervention that requires pre-screenings, doctor monitoring, and long-term investment in patient/client health above financial gain. 

Many companies have relied on marketing strategies that draw a parallel between weight loss and success in love, career, and overall life. Very few marketing campaigns treat people of all sizes as worthy of happiness and success, as they are right now. This is in part because corporate America tends to view fatness as an obstacle rather than a neutral characteristic of an important potential demographic. Profit often plays a role here as well. For example, in addition to the weight bias that prevents brands from thinking about larger-bodied people as their ideal customers, traditional fashion manufacturing restrictions can make it more costly for brands to produce expanded sizes. Brands need to be willing to consider the earnings they may win back from reaching new audiences, and work together to challenge outdated standards in their industry that disincentivize this kind of expansion.

While bills to counteract weight-based discrimination have been passed on a city and state-level, there is currently no federal legislation prohibiting weight-based discrimination. 

The onus to create accessible spaces, products, and policies should not fall on those asking for accommodations, nor should these requests be met with skepticism or refusal. Navigating physical spaces such as medical offices, workplaces, schools, and public transport is already emotionally and physically taxing for many people without having to battle weight discrimination in the process. Often, the pain that results from navigating these situations is not recognized by people who don’t experience it, making the effort to receive reasonable accommodations all the more demoralizing. 

Lawmakers often respond to requests for legislation that would effectively outlaw weight discrimination with the demand that those with larger bodies lose weight, or the fear that cases pertaining to weight discrimination would clog the justice system. There is significant anti-fat bias among lawmakers, in part because fatness is often viewed as a choice. However, weight loss is neither an immediate nor appropriate solution to inequity and injustice, for the myriad reasons discussed in the healthcare section above. Some members of our discussions suggested a cultural shift might be necessary in order to spur legal action; others noted that, while legislation cannot eliminate weight bias on its own, shifts in law can help to create those cultural shifts. Media narratives that humanize fat people and size-inclusive company policies (such as Pinterest’s choice to ban weight loss and dieting ads on their platform) may help put pressure on legislators to enact change more quickly. 

Federal law protects workplace wellness programs, many of which incentivize weight loss without acknowledging the existence of eating disorders or how these programs can trigger those in recovery. This incentivization confirms the stigmatizing view that weight is something that can be controlled by all people, and that being in a larger body is a negative outcome that can be punished in the workplace. These sorts of programs turn weight loss into a team activity and typically offer tangible rewards such as gift cards or fitness equipment to keep participants motivated. Even worse, such workplace wellness problems often create a compensation disparity by offering health insurance discounts for weight loss or lower BMI, thus discriminating against employees who cannot or choose not to lose weight and must pay higher insurance premiums. While these programs are often touted as a way to increase productivity, reduce sick days, and boost morale, the campaigns typically further weight-based bias and villainize those who opt out of participating as failing to be “team players.” It is worth advocating for legislation that would effectively eliminate a company’s ability to run this kind of program, as it contributes to weight discrimination in the workplace.