In the weeks following the horrible and needless murder of George Floyd, many are weary and bleary eyed from the vast amount of reading, learning (and unlearning), Instagram posts and re-shares, TikToks, memes and tweets… but that doesn’t mean our anti-racist education and work are done. While taking care of our health—mental and physical—is important (remember: we are still in the middle of a historic global pandemic—oh yeah, that thing. 2020, you are certainly one for the books), we must stay vigilant and active, as putting an end to racism is a collective effort. We must not fall back asleep.
The murders and violence against BIPOC in the United States is one piece of a vast and deeply embedded system of racism that spans 400 years of our country’s history. Our capitalist society was built on the free labor of people from the Western Coast of Africa—people whose culture, names, language and way-of-life (including food preferences) were stripped from them. The Civil Rights movement began in 1954 and ended in 1968, but 50 years is a very short amount of time in our country’s timeline (particularly when you consider that my great-great grandparents on my mom’s side were slaves), and we did not eradicate racism with the signing of the Civil Rights Act of 1968 by President Johnson.
Most of the racism that occurs today is not overt, such as the physically violent acts being captured on phones. It is found in our health care system, food deserts, housing inequality, and daily microaggressions. Even “diet culture”– a term that is used by many dietitians, doctors, therapists, fitness trainers, and influencers who work in the anti-diet, HAES, and body positive/body liberation spaces–has racist roots.
This is something that became apparent to me when, a couple of years ago, a Nutrition professor gave my class an extra credit assignment—to read an article on obesity and write a reflection on it. It was the first time I had been exposed to a different perspective on the obesity epidemic—through the lens of what life is like for people who live in a larger body and experience weight shaming and stigma, which follows them wherever they go.
Weight stigma and shaming is pervasive in our healthcare system and can have a very negative impact on a person’s body image and overall health. I learned that many people in larger bodies suffer from eating disorders, but these disorders either go unnoticed or are congratulated due to their body size (and perceptions about what behaviors are “acceptable” or “unacceptable” due to someone’s size). My reading and research eventually led me to learn about the racist roots of diet culture and the rise of the European thin ideal, which I continue to deepen my understanding and knowledge of.
I connected with a well-respected and experienced dietitian, Kim Rose (RDN, CDCES, CNSC, LD), who is a Diabetes Educator and inclusive Dietitian working in South-Central Florida, to talk about racial social justice issues in healthcare—something she sees all too much of in her clinical work.
Disclaimer: The topics discussed in this interview are not meant to be medical advice. Please speak to your personal doctor or nutritionist for medical advice.
Can you elaborate upon the history of fearing the black body?
One of my earliest memories of how society has not only feared the black body, but bodies of color in general, has to be the story of Sarah Baartman, a 19th century African women who was also known as ‘Hottentot Venus’ (disclaimer: this term may not be acceptable in some circles). I am pretty sure this discrimination goes back before the 19th century, but this account “took the icing off the cake” for me. For those who do not know the story of Sarah, she was one of two African women who was put on display in a human zoo in Europe because of her physique. Yes, like she was some kind of circus freak.
As a dietitian and diabetes educator this is significant for me because a lot of the patients and clients I see are Sarah Baartmans in their own respect. They have voluptuous, curvy bodies that don’t fit into the “normal” range for the height-to-weight proportion better known as the body mass index (BMI).
As a result, when I am consulted to provide diabetes management I am nine times out of ten also told to do some form of weight management in addition to preventing blood sugar spikes. For some people, this may not be appropriate or even realistic. Being thin and having a “normal” BMI is not the goal, nor is it the defining characteristics of health.
In my 9+ years of being a Registered Dietitian Nutritionist, I can tell you I have seen “thin” people and “overweight” people suffer from the same illnesses. Getting wacky blood sugar level readings is the sign! Wacky blood sugar levels can be caused by a variety of factors including, but not limited to poor sleep, hormones, infection, illness, and inactivity to name a few. Weight is not always to blame, but our weight based health system sees things in a different light.
What’s the difference between thin privilege and fat phobia ?
Skinny privilege—also called thin privilege—is an ideology that people have special rights or immunity when they are thin. Thin privilege is very dominant in our society and people are rewarded for their height-to-weight ratio, or BMI.
Just to give an example of the prevalence of thin privilege in society: I used to have quarterly health check-ups with my former employer and they were always concerned about my BMI. They would always tell me ‘for your height, your weight should be XYZ,’ and I would actually get a monetary discount from my health insurance for keeping my BMI within a “normal” range. On the other hand, a colleague of mine was not given the same discount because she was considered to be overweight. Why should she not receive the same discount? The problem with the BMI is manifold, but in weight-based healthcare it does not take into consideration your muscle mass. For example, have you seen Dwayne “The Rock” Johnson? He’s a pretty muscular guy, but according to the BMI he is overweight.
Is fat phobia really about health and wellness?
The very term “fat phobia” elicits fear in the mind of some healthcare professionals. To be honest, people need a certain degree of fat for the protection of their vital organs and normal functioning of their bodies. Fat phobia, when thought of in terms of describing the physique of someone’s body, is more harmful than good.
Fat phobia, in my opinion, may not be about health and wellness at all. Some practitioners may think of weight as a matter of choice and people who are heavier have attributes revolving around being ugly, lazy, and an undisciplined glutton. Health practitioners do not live in an isolated bubble and are impacted by conscious and implicit bias. When a blood pressure, lipid panel, blood glucose comes back elevated, weight may be the focus; but stress, finances, sleep, and other modifiable and non-modifiable lifestyle factors may be the actual culprit.
What are some ways thin privilege and fat phobia are pervasive in society?
A colleague once came to me in despair. For over ten years she refused to fly on an airplane because the airplane company always made her buy two seats because of her girth. She said “Kim, can you help me lose weight?” I was floored…FLOORED! I wanted to cry. I didn’t realize fat shaming was so pervasive, but as I looked a bit closer in society I could see it everywhere.
Clothing, coffins, and health insurance are some of the places where people are fat shamed. Simultaneously, the converse is true for thin people. Clothing, coffins, and health insurance does not come with an extra charge.
What are some tools we can use to see if we have an implicit or unconscious bias towards certain body types?
One tool I love, love, love is Project Implicit. It measures the attitudes and beliefs one has towards various topics, one of which is weight. Being aware of your unconscious or implicit bias allows you a chance to break away from this way of thinking.
Another great source is a book called Fearing the Black Body by Sabrina Strings. She gives an eye-opening historical view of why fat phobia came into existence and can be used as an empowerment tool by health professionals to look at weight in an entirely new light.
As a diabetes educator, how do you help someone manage their blood sugar levels while working in a setting that is so weight focused?
A lot of my patients and clients with diabetes think the way they are going to achieve acceptable blood sugar levels is by skipping meals, avoiding the foods they love, and going on a diet. I teach my clients not to focus on the scale, that it’s not the goal, and it is a distraction. Rather, let’s start by not skipping meals and eating at least three square meals a day which consists of a macronutrients and micronutrients, incorporating the foods you love by switching around carbohydrates, and not going on a diet because I don’t want to start the vicious cycle of yo-yo dieting, which is more harmful than helpful.
Once this criteria is met, next comes the deep-dive education into macronutrients and micronutrients, or in other words: carbohydrates, fats, protein and fruits and vegetables. I allow my patients and clients to make health conscious decisions by educating and empowering them on food composition. Yes, you can have the cookie and be satisfied. Just switch around your carbs and be mindful. As a result, I have seen two things happen: 1) patients and clients lose weight while lowering their blood sugar levels and 2) patients and clients who want to gain weight actually do so while lowering blood sugar levels.
To connect with Kim or learn more about nutrition from the many resources she provides, visit her website, her YouTube channel, or her Instagram. You can also subscribe to her podcast, Nutrition Lifestyles with Kim & Johane.