This piece, the second of two written by our Council member Lucy Aphramor, is part of our new series of articles offering diverse perspectives which challenge and seek to expand the debate on current research, narratives and ways of thinking.
“Anti-fatness cannot exist as a coherent ideology without anti-Blackness”
In its food strategy for England, the UK government aims for ‘a generational change in our relationship to food’ using ‘a new approach’ that is grounded in place, concerned with inter-connectedness, and responsive to complexity, including a meaningful recognition of nonhuman nature. Although biomedical thinking still prevails, naming relational variables signals openness to a paradigm shift. More recently, EAT-Lancet likewise recommends a significant shift in how readers configure food and sustainability and has been widely acclaimed for its rhetorical focus on justice. A new parliamentary inquiry intended to ‘tackle the ob*sity epidemic’ was also enthusiastically received, and the same goes for Scotland’s recently published Good Food Nation.
These and other initiatives purportedly seek real change. As do I. But I don’t think the policies can take us there. My experience as a dietitian working with marginalised communities has led me to believe that the food system transformation we seek is sabotaged by our collective failure to critically examine the oppressive ideologies and values that shape our policy and practice. For example, I’ve outlined some ways in which the value system of coloniality is used as a template for EAT-Lancet. Despite this, EAT-Lancet is discussed as neutral ‘objective’ science serving the common good. This ‘innocence-based’ stance embeds habits of thought and action that stabilise the status quo. Our lack of criticality continually steers us away from engaging with colonialism, racism, and inequity in food systems.
In this blog I extend consideration of coloniality and food system thinking to explore some deep assumptions in the ‘tackling ob*sity’ agenda.
Lowering population Body Mass Index (‘BMI’) is a centrifugal force in UK food policy. It is presented as universally beneficial, ethical and harm-free, based on incontestable scientific evidence. I share a contrasting perspective that finds a BMI-based model to be inequitable and shaped by coloniality.
Building Knowledge for Transformation
My starting point is that we cannot build for liberatory public health and food systems transformation by thinking with ob*sity. The concept ‘ob*sity’ is brought into being through particular colonial constructs of the body, health, food, that are not grounded in place, that ignore inter-connectedness and complexity, and that assume domination of nonhuman nature. These ideas echo and expand research in Food Matter’s Sankofa report which highlights the legacy of damage wrought by the ‘positional superiority of European knowledge’, including the erasure of diverse ways of knowing and being in relation to land, food, and nature.
I am suggesting that the generational change envisioned in the government’s Food Strategy needs a new paradigm, one (or more) that animates an anti-racist, decolonising agenda, meaning public health services and food systems are not organised around BMI. In these new paradigm/s what we now refer to as ‘health’, an individualistic and atomistic colonial construct, would be rendered obsolete and we would reconceptualise personal, collective, and planetary vitality as relationally entangled.
Learning from Existing Alternatives
Valorising Eurocentric ideas and ideals, colonialism aims to wipe out diverse ways of knowing (epistemicide), a goal twinned with the historic and contemporary genocide of Indigenous peoples and one that continues to shape food systems and racialised climate crisis. However, it is also true that oppressed people (the land/entities) have met threats of knowledge capture and erasure with resistance, marronage, fugitivity (forms of flight from racial violence and dehumanization), and further responses beyond my ken. The colonial story protects European supremacy by casting subaltern approaches ‘in the past’ or lesser. (Subaltern refers to colonised populations denied agency). When we step outside this story we find ways of making sense of wellbeing collectively through reciprocity and kinship, for example, already exist outside of western medicine. Here, a relational approach to wellbeing can mean that languages have no equivalent to colonial ‘health’ and gives rise to framings, such as Kaupapa Maori,that locate fatness outside of a medical model.
Likewise, in Food Security & Nutrition (FSN) the stand-alone concept of ‘nutrition’ is redundant as food ways, food knowledge, cultural integrity and community are inextricably inter-linked and food discourse meaningfully engages gender-equity.
Liberatory work is also ongoing in parallel with mainstreamed healthcare – as disability justice, tenants’ rights, public health abolition, and mutual aid movements, to list a few examples.
A movement whose scholarship is crucial to transforming public health and food justice is fat activism, giving rise to the discipline of Fat Studies. The Fat Liberation Manifesto 1973, a pivotal document in fat politics, frames fat activism as allied with the struggles of other oppressed groups against classism, racism, sexism, ageism, financial exploitation, imperialism and the like. Note that fat scholar-activists, reclaiming the term fat, make clear that a goal of ‘tackling obesity’ is a goal of eliminating fat people.
Internationally, a large number of critical health academics and practitioners have responded to fat activist perspectives on language (see this for children) and built on early fat activist insights on flaws in weight science. This includes healthcare and fitness professionals including dietitians and nutritionists, GPs and other medics , midwives, coaches, psychologists, and others who have dropped the weight-centric (BMI-based) paradigm and adopted a weight-inclusive/ non-diet/ HAES (or its more recent rebrand ‘anti-diet’), health gain, or a ‘healthy weight’ approach. Though some of this work engages fat-and disability-politics, a weight-inclusive approach isn’t inherently anti-colonial or abolitionist. While it can be informed by and aligned with fat liberation, it too often adopts a reformist assimilationist position which protects privilege even as it argues for equity.
What’s Wrong with Our Current Knowledge Creation Norms Around Fatness?
To reiterate, when we’re not listening for difference, we’re likely to believe the dominant narrative lies beyond scrutiny. After all, it is ubiquitously presented as derived from rigorous scholarship and the only possible, reasonable, way of making sense of fatness.
In biomedical circles, challenging a prevailing medical narrative can seem preposterous and spark allegations of bias, scientific incompetence, shady ulterior motives, of not caring about people’s health and ‘giving up’ on yourself if you are a fat person. The implication of a vast compass-error causing collective lack of rigour can seem far-fetched.
Within decolonial scholarship, suggesting that dominant narratives exist outside of the violence of colonialism seems preposterous.
The colonial story that centres BMI-based, or weight-centric, public health routinely excludes inconvenient knowledge through overlapping strategies such as:
A Weight-Centric Narrative Excludes Relevant Scholarship
The reports I opened with cast fat scholarship as irrelevant. There is nothing unusual about this othering. Fat scholarship is routinely ignored across food and public health policy. It is absent from equity and inclusion agendas in health, food justice, sustainable diets spaces even though fatness and thinness are hugely relevant to intersectional experiences of power and privilege.
Saying that fat scholarship is ignored is not the same as saying people living in larger bodies are never invited to share an opinion, as in citizen panels, for instance.
Fat scholarship refers to a rigorous, community- and praxis-based scholarship built by fat activists, scholars, and creatives, grounded in fat politics. These voices are not represented in UK food strategies, notwithstanding citizen panels.
Fat activism grew out of the US civil rights movement. To reiterate, The Fat Liberation Manifesto (1973) is a blueprint for solidarity linking struggles ‘against classism, racism, sexism, ageism, financial exploitation, imperialism and the like’. Contemporary work in this tradition, notably that by Black, queer and disabled fat scholars (including Da’ Shaun Harrison and Mikey Mercedes), shows how anti-fatness, anti-blackness and anti-queerness are co-constituted. Scholars call for a radical re-imagining of public health. All this is neglected in mainstream work across food system change and public health nutrition. This is an example of epistemic and testimonial injustice being used to cement the dominant, colonial logic.
When we repeat the so-called o-words, ob*sity and overweight, we are ignoring over four decades of sociopolitically aware, equity-driven research by fat scholars working to end systemic fat hatred. Instead of using pathologising terms, we can talk about fat people, and people living in a larger body. Instead of talking about ‘tackling ob*sity’, we need a radical reframe such that public health is not predicated on anti-fatness. The point is not to find substitute words and keep things the same, but to cultivate new framings that serve transformation. Here, transformation involves utterly changing the world as we know it, and becoming utterly changed ourselves as part of this process.
As a group, those of us working for food systems change seek to listen to marginalised voices and integrate data from diverse sources. The question arises, how did we miss an activist take on respectful language – for over fifty years?
Knowledge creation across food systems transformation would be richer for implementing decolonial scholarship and more-than-abstract engagement with critical, activist, and abolitionist perspectives.
Misrepresenting Data
Soon into my first dietetic post I realised that ‘weight management’ didn’t give textbook results and caused distress. It was an inadequate offering. I sensed I was missing something, so I read the research behind the guidelines, then ‘SIGN 1996’ (Scottish Intercollegiate Guidelines Network) , looking for answers. Not one of the claims for treatment effectiveness in the guidelines was supported by the primary data. In other words, the guidelines misrepresented the research findings.
Here’s some of the research that first re-routed my thinking. An updated SIGN guideline (2011) reiterates the harms I first read about 20 years ago:
“Weight cycling is a common condition as only a minority of people who lose weight through weight management interventions are able to maintain their weight loss.115,116. Weight cycling is a risk factor for all-cause mortality and cardiovascular mortality (hazard ratio (HR) approximately 1.8 for both).118,119″
This is what the British Nutrition Foundation were saying back in 1999:
“a positive association has consistently been observed between body weight fluctuation and all-cause mortality and usually… with coronary mortality in particular. This finding is very robust, further confirmation is found in the British Regional Heart Study (Wannamethee & Shaper, 1990), in the Seven Nations Study (Peters et al., 1995) and in the Iowa Women’s Health Study (French et al., 1997) (p 137).”
A 2005 BMJ article found “Although these were the best studies available according to the principles of evidence based medicine, many did not fulfil its requirements…. These flaws bias the results and can exaggerate the effects….. Rather than showing what does work for preventing and treating obesity (sic), research to date shows us clearly what does not.”
The next article is especially interesting. Here’s why. Clinicians are taught to use a protocol called evidence-based practice (EBP) to make decisions. EBP ranks evidence. Data from a randomized controlled trial (RCT) is considered highest quality. (In an RCT with 100 people, 50 would be randomly assigned to receive the treatment and the other 50 would receive a substitute or delayed treatment. Researchers compare outcomes from both groups to understand the impact of treatment). The best available ‘gold-standard’ evidence in EBP is when results from RCTs are synthesized in a systematic review.
Within EBP, gold-standard evidence is provided by this systematic review of randomized controlled trials of intentional weight management that finds “ the studies do not provide consistent evidence that dieting results in significant health improvements, regardless of weight change…The benefits of dieting are simply too small and the potential harms of dieting are too large for it to be recommended as a safe and effective treatment ...
This mirrors data cited in the Fat Liberation Manifesto in 1973.
As abolitionist sahibzada mayed (صاحبزادہ مائد) writes :The politics of violence doesn’t begin with the act itself, but with what reaches our bodies as shock and what/ who is deemed worthy of collective grief and moral outrage. . . What shocks us, then, is not violence itself, but the collapse of the perceived distance that once protected those in the heart of empire from feeling implicated.
Several papers compile data for a weight-inclusive approach. (I critique my early work that side-stepped coloniality). These biomedical analyses can be useful for learning, being mindful where it gives a free-pass to coloniality, and even though HAES has since been reconfigured as a framework of care.
Active Repression of Critical Voices
As I read through SIGN I learnt about harm caused by treatment known as iatrogenic outcomes. This was news: these harms were overlooked in the final guidelines, by senior colleagues, and in the curriculum. To understand the local picture, I turned to audit data: department weight management interventions had a 97% failure rate over the last four years. The findings, and silence, felt very wrong. Not least because inaction meant we were ignoring Healthcare and Professions Council and British Dietetic Association protocol. As I shared my concerns and mapped an alternative in meetings and conversation, no-one contested the integrity of my argument. The issue was that these were inconvenient Truths: as one dietitian commented after my presentation I get what you’re saying Lucy. But it’s too big. The Chief Dietitian didn’t question my analysis or dispute my concerns about harm, unethical practice, failure to take informed consent or note any clinical downside in the paradigm shift I proposed. When I asked why she wasn’t taking the data seriously, she answered ‘because you’ll never be successful.’
I was being socialised to dispense with care, ethics, critical appraisal, EBP, moral concern. The message was that a good professional protected the status quo so that here, in the heart of empire, we would decide whose suffering counted and whose did not, without ever feeling accountable for or implicated in violence.
Similar blocking responses from other professional leaders prompted me to seek like-minded colleagues overseas and together we established World Critical Dietetics (WCD). Now in its sixteenth year, World Critical Dietetics is a vibrant forum, a collective indebted to the impassioned praxis of Canadian dietitian Jacqui Gingras. Her commitment to professional change helped those of us deeply troubled by dietetic norms to find each other and re-imagine our scholarship and practice.
We shared personal experiences of silencing and reprisal and recognised the deliberate and covert operation of systemic power abuses in manufacturing dominant narratives, also surfacing our own complicity.
I am grateful that researcher Katherine Flegal, whose work was highly significant in developing collective criticality around weight science, published her experiences of vitriol, harassment, and threats once she retired . . .
Her research became the target of an aggressive campaign that included insults, errors, misinformation, social media posts, behind-the-scenes gossip and manoeuvres, and complaints to her employer. The goal appeared to be to undermine and discredit her work. The controversy was something deliberately manufactured, and the attacks primarily consisted of repeated assertions of preconceived opinions. She learned first-hand the antagonism that could be provoked by inconvenient scientific findings.
The role of this form of power abuse in shaping narratives is too often hidden and Katherine’s descriptive article is valuable for naming Walter Willett’s and others’ attempts to manipulate agendas.
It’s also important that we remember how positionality, including thin privilege, mitigates some of the grimness and threat of our experience as critical professionals. For fat people there is no such protection: fat people advocating for fat dignity receive death threats.
Ignoring Injustice and Other Harm
Colonial thinking builds knowledge by extraction. We are primed to re-cognise ideas that fall within our existing frames of sense-making and respond to them as potentially useful and valuable. In this way, we accumulate material that aligns with the story we know and skip over material that the story is designed to obscure. This means it can be easy to miss the significance of my earlier statement that work led by Black, fat, Indigenous, trans and queer scholars demonstrates the inextricable links between anti-Blackness, anti-fatness, ableism, cis- heteronormativity, and/or scientific racism.
Food systems transformation requires that we seek out and meaningfully engage with this knowledge. Da’ Shaun Harrison’s book The Belly of the Beast is a powerful read, sharing knowledge that was never meant to be accommodated by Big Nutrition. ‘Big Nutrition’ alerts us to the ways that ostensibly neutral healthy eating messages in fact reproduce a particular set of values and political ideology, and these are the same neoliberal values and capitalist logic driving Big Food and Big Ag.
For deep change we should contest BMI as an organising principle for public health not because it is empirically unsound, but because it stabilises oppressive ideologies. The task is not to make BMI inclusive but to create systems (of thought, practice, affect) that oust its colonial logic. In the meantime, it is important that we do better providing equitable care for fat people right now: this is not about abandonment but transformation.
Questioning Everything – Action for Food Systems Transformation
If we accept that dominant stories about food, ‘health’, and fatness rely on colonial norms that camouflage, protect, and reproduce oppressive practice, then isn’t our task learning to notice and interrogate these norms. This means turning over taken-for-granted assumptions – our own, and those of esteemed scientific organisations – with curiosity and compassion. How will we educate ourselves personally and collectively to engage with new ideas through a liberatory pedagogy? The links throughout the blog provide some pointers to resources. Sustain and Eating Better provide guidance on using an anti-/decolonial approach which if/when implemented would lead to the collapse of Big Nutrition and its colonial, anti-fat logic and nurture an emplaced and life-affirming alternative story.
We need to be serious about the harm caused in and beyond food systems by our complicity and ignorance, however much this was unintended and unavoidable. How can we be accountable as we develop collective capacity for learning and healing? What does an ethics of reckoning, care, and repair entail?
“Three simple behaviours with potential for profound ramifications are
(1) drop the ‘o’ words
(2) reject BMI as an organising metric for public health
(3) prepare for, and have, conversations about why you’ve made these changes.
Do you feel any relief, confusion, resistance, grief, clarity or other responses reading this?”
Three simple behaviours with potential for profound ramifications are (1) drop the o words (2) reject BMI as an organising metric for public health (3) prepare for, and have, conversations about why you’ve made these changes. Do you feel any relief, confusion, resistance, grief, clarity or other responses reading this?
What do you anticipate will happen? What happens in your body when you imagine taking action about colonialism? How can you prepare for transformation at an embodied and collective level?