大象传媒

The United States鈥� obsession with  has resulted in what 大象传媒 Magazine Executive Editor Evette Dionne calls a 鈥渃ulture that hates fat people and [that] uses institutions, including media, medicine, and marriage, to reinforce that repulsion.鈥�

In her new book , Dionne takes readers on a personal and political journey that begins with her own health issues and her resultant encounters with fatphobia in the medical establishment. 

Although the medical industry has, for decades, warned about an 鈥�,鈥� the real health hazard, as Dionne points out, is systemic fat shaming that can have deadly consequences for children and adults. 

But there is a shift, as a growing fat liberation movement has begun pushing government, medical, and cultural institutions to begin dismantling biases against fat people.

Dionne spoke with 大象传媒 Racial Justice Editor Sonali Kolhatkar about her story, how the support of her family has helped her thrive, and which system-wide changes are needed to counter fatphobia.

This interview has been edited for clarity and length.

Sonali Kolhatkar: Can you begin by telling me your personal story about how you received a frightening health diagnosis while you were in the process of writing this book鈥攁 diagnosis that helped set the stage for your critique of the medical industry?

Evette Dionne: Yes. So, I was diagnosed with heart failure when I was 29 and then subsequently diagnosed with pulmonary hypertension, which is a rare progressive lung condition, when I was 30. And, I鈥檝e been experiencing these symptoms for many years, at least three years, possibly more than that. And I was going to different doctors and trying to figure out what was happening with my body and constantly being dismissed. 

And so, it finally came to a head when one day I thought I was having an asthma attack鈥擨 had childhood asthma, really bad asthma, actually鈥攁nd so I thought I was having an asthma attack. I went to my local clinic to have professional albuterol treatment to open my lungs, and my lungs wouldn鈥檛 open. And thankfully, I got a doctor who recognized that something was wrong and that it could possibly be either my heart, or possibly a blood clot because I just had surgery, maybe two months before that. And so, she referred me to a cardiologist who discovered the problem. But from the first symptom to diagnosis, it was about three years. 

Kolhatkar: So, this journey around your interactions with doctors鈥攏ot just with this health issue, but others that you detail in the book鈥攚hat has that confirmed for you about how the medical establishment treats people who are considered 鈥渙verweight鈥� and how that affects their diagnoses?

Dionne: It is a really troubling issue. Once I鈥檇 been diagnosed and started going toward the path of trying to recover from heart failure, I realized that my story was not unique, which is the sad part of it all. Yeah, I was 29, and you鈥檙e really at the prime of your life, as they say, and I鈥檓 experiencing a chronic illness. But unfortunately, my experience is very common, because what happens is doctors, particularly family physicians, are trained to think about weight. They鈥檙e trained to think about BMI [Body Mass Index]. They鈥檙e trained to treat 鈥渙besity鈥� as an illness. And because of that, when they get a patient who they consider obese, they don鈥檛 actually treat the symptoms of whatever issue it is that they鈥檙e experiencing; they treat the obesity itself. 

So, I include examples in my book. There鈥檚 one woman in particular who had been experiencing lung issues for a long time. Come to find out, she had a tumor in her lung and ultimately had to have half of her lung removed. But they didn鈥檛 catch it for many years because they kept saying that if she lost weight she would feel better. 

And so, what happens with that, with the shame and the stigma that accompanies that, is that many people stop going to the doctor. 

So, there鈥檚 a  in the book about fat women in particular who stopped going to the doctor for gynecological screenings. So, if they do develop uterine cancer, by the time it is discovered, it鈥檚 more advanced. And that鈥檚 across illnesses, because people just stop going, because they fear the shaming that happens because of the size of their bodies.

Kolhatkar: So basically, when you go to see a doctor, they tend to diagnose or link any symptoms you might be having to your weight, rather than actually trying to find out what is happening? And in your instance, you were struggling with fibroids, you had a history of fibroids, and it took you almost a year to convince your doctor to have the surgery, right? It was infuriating and heartbreaking to read about your experience.

Dionne: It is infuriating, and it鈥檚 so common. That is what鈥檚 infuriating about it. It鈥檚 regardless of a woman鈥檚 size. We know that Black people, in particular, when they go to the doctor, they鈥檙e assumed to be able to handle more pain than other people.

Kolhatkar: Right, there are intersectional biases there.

Dionne: Right! Women are thought to be hysterical if they鈥檙e experiencing pain. So, they don鈥檛 take care of them. I think my greatest example of this is . I mean, it鈥檚 Serena Williams! And if Serena Williams can go, after giving birth, and say to her nurse, 鈥淚 think I鈥檓 redeveloping blood clots,鈥� and she鈥檚 not believed, many of us don鈥檛 stand a chance. That鈥檚 the reality of what we鈥檙e living with.

Kolhatkar: Is the medical establishment changing? I know there鈥檚 more and more research, and more writers like yourself are calling out the medical industry. There have already been studies showing that the supposed correlation between weight and disease is probably correlational rather than causal. Is there a change taking place within the industry? Or is it a matter of individuals having to find the doctors they know they can trust?

Dionne: It鈥檚 the latter. A lot of it is having to search for doctors that you can trust. So, I include information in the book about the  movement. So, there are doctors who are trained through that theoretical lens, that think that no matter what size your body [is], you鈥檙e deserving of good care. It鈥檚 a matter of searching and finding that doctor, but I don鈥檛 think a lot of change yet is happening at the systemic level in terms of retraining doctors. 

I think so much of this has to happen at the residency level, at the educational level, of training them to recognize an unconscious bias toward fat patients and to change that鈥攖o recognize and change it in the moment. That hasn鈥檛 happened yet, but I鈥檓 optimistic that it can, because so many people, particularly during the pandemic, so many people were criticizing the medical establishment and how it handled the pandemic. I think more people鈥檚 eyes are open, and if we continue to move in that direction, there can be change at some point.

Kolhatkar: Let鈥檚 talk about the reasons why there is this bias that is all around us. It鈥檚 in the culture. It鈥檚 in the water here in the U.S. and even in many parts of the world. You write about pop culture鈥攁nd, of course, things are changing now, especially with the advent of social media and a lot of especially Black women influencers proudly speaking out鈥攂ut there鈥檚 been decades of fat shaming in Hollywood, right?

Dionne: Our society treats fatness as a choice. So, when we think about race in the United States, if you鈥檙e an out-and-out racist, there are consequences for that, typically. If you are fatphobic, there are no consequences. You can fat shame people at the gym. You can fat shame them at the airport. You can take photos of them and post them online and humiliate them. There are no consequences for that. There is no social shaming attached to that.

And so, in pop culture, there鈥檚 a reflection of that, where we get characters who are fat, which on the surface seems to be revolutionary. I鈥檓 thinking about a company that recently released a short with their very first plus-size character, but that character was dealing with body dysmorphia. That is what fat people are encountering in pop culture. 

We really fit into one of three archetypes, which I outline in the book. And because of that, that mirrors the way fat people are treated in our society, where we鈥檙e treated as if we were not capable of having good partnerships, romantic or familial partnerships. We鈥檙e treated as if we should be comedic relief. We鈥檙e treated as if we are defiant against our thin social order, is how I frame it in the book. And therefore, we need to be shamed into assimilating. All of that is happening in our real life, and it mirrors what we see on screen.

Kolhatkar: One of the changes that we are now seeing is that there are a few shows here and there that are quite popular, that are trying to challenge fatphobia on screen. One of the earliest ones that you write about is Ugly Betty. It鈥檚 one of my favorite shows as well. Tell me why that was a revelation to you when you started seeing on screen this young woman who didn鈥檛 fit into the world of the fashion industry in New York, but made her own mark anyway.

Dionne: I loved Ugly Betty. I really, really did. I think I saw a lot of myself in that character. I鈥檓 also a girl from Queens. I also, at the time, really loved fashion. Clearly, I love magazines, because I鈥檓 now a magazine editor. 

But with that particular character, we saw [Betty] constantly really running uphill to try to be accepted by a society that said she couldn鈥檛 be who she actually naturally is. She couldn鈥檛 dress the way she wanted to dress. She just couldn鈥檛 exist the way that she existed. And so, I saw a lot of myself in that. 

And I think what that show really showed us [was that] in the end, she was able to step into her destiny, into her fate, and she was able to retain her dignity at the same time. And I saw it as a possibility model for me, of something that I could also do; that I didn鈥檛 have to become thin to live my life; that I could start right now, in the size that I鈥檓 in, the way that I look. My life is dictated by how I want to shape it. 

Kolhatkar: And it mattered that the protagonist is a woman of color, right? 

Dionne: Absolutely. Absolutely. I also outlined other women of color characters in the book, such as Queen Latifah, [who鈥檚] one of my favorite actors. Many of the characters that she has portrayed, including Khadijah James on Living Single, which was a show in the 鈥�90s. The fact that these are plus-size women of color who are not allowing fatphobia to get them down, I think there鈥檚 a lot of lessons in that for people who are watching it. And it really does imbue you with a sense of hope that it doesn鈥檛 have to be the way that it is right now. 

Kolhatkar: There are lots of well-meaning campaigns around the country to try to address fatness, but end up going down the wrong path and pathologizing obesity. One of the campaigns that you outline in your book is Michelle Obama鈥檚 campaign, which started out being centered on eating healthier. How did it end up feeding into the same culture that shames fat people? 

Dionne: Right. Ultimately, that鈥檚 what it ended up doing. And I don鈥檛 want to pick on Michelle Obama, of course, but the  campaign was really designed to end childhood obesity. So, the way that it was framed is that childhood obesity is the biggest crisis facing the United States. The numbers are skyrocketing, and that on a federal systemic level, something needed to be done, to ensure that our children, the next generation that鈥檚 inheriting this country, are 鈥渉ealthy,鈥� but what it actually does is put a target on the back of children who are already being demonized and ostracized and constantly told that the size of their body is a problem. 

It just further entrenched that, without addressing the larger systemic causes of 鈥渃hildhood obesity,鈥� such as that a lot of parents are impoverished. (We just watched a presidential administration attempt to end childhood hunger or reduce childhood hunger in the United States, because that is a systemic issue.) Or living in a food desert, or being at a school that doesn鈥檛 prioritize, at all, the humanities. So, all you鈥檙e doing is learning; there is no physical education, there aren鈥檛 music classes, there aren鈥檛 theater classes. All of that leads to children not being able to [move their bodies and] eat the way in which the Let鈥檚 Move campaign wanted them to eat. But it doesn鈥檛 actually address those issues. It just demonizes the children themselves without addressing those systemic challenges. 

Kolhatkar: And Michelle Obama talked publicly about the worries that she had watching her own very young daughters start to get a little chubby and how she began changing their diet. This seemed to be heartbreakingly typical of how some parents may mean well but end up shaming their children and actually triggering eating disorders where there might not be any.

Dionne: Right! The shaming doesn鈥檛 actually cause people to lose weight. All of the statistics show that when you shame fat people, when you ostracize them, isolate them, target their weight, it just causes them to gain more weight. 

So, while people are well-meaning, including parents, [who] are well-meaning, trying to police what their children are eating, watching what their children are eating鈥攚hich is the parents鈥� responsibility, right, to ensure that their children are eating 鈥渂alanced meals鈥濃�攖hat鈥檚 a community鈥檚 responsibility to ensure that children have food. 

At the same time, if you focus solely on their weight and what they can do to lose weight, you鈥檙e just doubling down on the idea that they should not be comfortable in the skin that they are currently [in], which just causes them to gain more weight. It becomes a cause-and-effect problem. 

Kolhatkar: So, let鈥檚 cycle back to what we started our conversation with, which is around health and the medical industry. Often, you have folks saying, of course we don鈥檛 want to be fat shaming, but in the end, you hear a lot of folks couch their fat shaming in concerns about health. But is it really true that obesity is the root cause of the epidemics of heart disease, cancer, hypertension, diabetes, etc.?

Dionne: The short answer is no. What I always say is that every disease seen in a fat person is seen in a straight-size or thin person. Every single disease. It鈥檚 not just that heart disease impacts fat people. It impacts thin people as well. It鈥檚 not just that any of these diseases impacts just one subset of people. 

What is happening is that because the medical industry is so hyperfocused on obesity, they literally surveil fat people. So, you cannot go to the doctor as a fat person for a cold without them testing your blood sugar or asking you if you want to be referred to the metabolic weight loss center. That is happening over and over and over again. So, it seems as if the statistics [of disease correlation with obesity] are really high, when in actuality, every single disease seen in a fat person is seen in a thin person. Nobody escapes that. 

Everyone is pre-susceptible to cancer. Everyone is pre-susceptible to diabetes. It really is about genetic makeup. So, a lot of what we鈥檙e seeing in this movement around shifting the medical industry鈥檚 relationship to obesity is disavowing them from the BMI, or the Body Mass Index, which just looks at weight and height and doesn鈥檛 think about fat adiposity, for instance, or doesn鈥檛 think about medical history, or doesn鈥檛 consider that if you鈥檙e a shorter person, your BMI may be naturally higher than if you鈥檙e a taller person, no matter what size you are.

So, [we need to be] thinking about new metrics for measuring weight and whether or not somebody is healthy, thinking about new ways in which to approach that. So, if we are going to treat obesity as an illness, that doesn鈥檛 mean we treat it as the almighty illness, and don鈥檛 treat anything else. But, rather, that we treat obesity alongside any other illness that may arise.

Kolhatkar: How do we change our culture to not just embrace every single one of us, but also allow people of different sizes to feel comfortable in their skin? The story you tell in your book about your parents and how they have supported you is such an instructive one and can be such a model for parenting. I鈥檓 wondering if you can share a little bit about that?

Dionne: I will say that I鈥檓 very fortunate to have been born into the family that I鈥檓 born in. It鈥檚 not only that my parents are really supportive. But I鈥檓 fortunate that my best friend is a plus-size woman. My grandmother is a plus-size woman. My aunt is a plus-size woman. And outside of me鈥攚ho happened to be struck with heart failure and pulmonary hypertension鈥攅very woman in my family is healthy. 

So, the narrative that I grew up with is, just because you鈥檙e fat doesn鈥檛 mean you鈥檙e automatically unhealthy. And that was said over and over and over again from my grandmother on down. And so, I was able to really be born into a paradigm that thought about fatness differently from the onset. And I think that that is something that we can apply, firstly in our interpersonal relationships. 

The thing that I always say is that it鈥檚 never acceptable to make a comment about the size of someone鈥檚 body. You never know the reason they鈥檝e gained weight or the reason they鈥檝e lost weight, and by implying that, particularly if they鈥檝e lost weight, that it鈥檚 a good thing鈥攍ike, 鈥淲ow, you look good, wow you look amazing鈥濃�攚hile that is well-meaning and it鈥檚 not intended to be malicious, the way in which it comes off is that you鈥檝e lost weight intentionally and that鈥檚 always a good thing, no matter how it鈥檚 been earned. 

So, it鈥檚 really showing up for one another on an interpersonal level, if you鈥檙e going to befriend or be in a just relationship with a fat person, never making your interactions about the size of their bodies鈥攖hat鈥檚 crucial and really a good step. And that goes from parent to child, that鈥檚 friends, that鈥檚 romantic partnerships, etc. That鈥檚 an easy thing to do on an interpersonal level. 

On the systemic level, I think a lot of it, it鈥檚 going to take all of us. And when I say all of us, I mean all of us who care about body politics, all of us who care about fat acceptance, to come together to really push these industries to think differently about what they are putting out into the world.

It鈥檚 very shocking to me and sad to me that even right now,  is the only state in the United States that has prohibited that discrimination in the workplace. It鈥檚 one state out of 50 states. And so, that requires all of us to organize, to lobby, to come together, to say, 鈥淭his is something that cannot stand, and these are the things that we can do together. These are our political priorities as a fat acceptance movement to ensure that Hollywood includes fat characters who don鈥檛 just think about their weight.鈥�

I think a lot about the . Is there a test that can be implemented for Hollywood about fat characters, that you have a fat character who doesn鈥檛 just care about their weight, you have a fat character who is three-dimensional, has relationships, is navigating their life? Can that be implemented? Can we get the Federal Communications Commission to outlaw dieting ads? 

Those are the sorts of priorities that we can come together and rally around and lobby around. And I think if at some point that happens, all of this will shift, both on the systemic level and the interpersonal level.