When there are TV news reports about obesity, they invariably feature shots of big butts and jiggly bellies but you can almost guarantee there will be no faces visible. The same is true of newspapers, though they may also squeeze in an ice cream cone or burger at chin level, still keeping the focus of the photo squarely on the anonymous bulging midsection.
"The headless stomach" is how Rebecca Puhl, the director of research at the Rudd Center for Food Policy and Obesity at Yale University in New Haven, Conn., describes the phenomenon.
There is no doubt that the media portrayal of people who are obese - it ranges from sneering to pitying in everything from TV sitcoms to daily newspapers - is quite negative.
The implicit message in the cutting-off-the-heads approach is that obesity is shameful. So too is the condescending language, such as that used above (deliberately) like "big butts."
Weight bias is one of the last bastions of discrimination. Fat jokes are still de rigueur when an overweight/obese person comes into view. We allow ourselves to use language and images that would never be acceptable when speaking of people with disabilities, visible minorities or other identifiable groups.
These visual and linguistic shortcuts are not necessarily used maliciously but they fuel common stereotypes - namely people who are overweight/obese are lazy, slovenly and weak-willed.
These stereotypes, in turn, influence public policy and private gestures.
While we talk a lot about the medical consequences of obesity - reduced life expectancy, higher rates of chronic illnesses like diabetes, cardiovascular disease and cancer, etc. - we rarely delve into the social and economic consequences of having a significant body mass index.
That was the subject of a the 1st Canadian Summit on Weight Bias and Discrimination, held last week in Toronto.
Dr. Puhl, who has studied the question extensively, noted that increased attention on the health impacts of obesity has, paradoxically, resulted in increased weight-related discrimination.
But her research shows that there is a vicious cycle created: The more a person is singled out for weight-related ridicule, the more difficult it becomes to lose weight.
Part of the problem is that a common reaction to stress is to eat and drink - and our comfort foods don't tend to be carrots and broccoli. Bias and discrimination can lead to self-loathing and isolation.
People who are obese don't relish their predicament but they tend to avoid seeking professional help - from physicians, dieticians, personal trainers, etc. - because they are often stigmatized and hectored, not supported.
"There is a perception that stigma may be a good thing, that it will encourage weight loss," Dr. Puhl said. "In fact, the opposite is true."
The stigma begins at a young age. About one-third of overweight girls and one-quarter of overweight boys report being bullied because of their weight.
"Weight bias is a form of bullying," said Wendy Craig, a professor of psychology at Queen's University and scientific co-director of PrevNet (Promoting Relationships and Eliminating Violence). The focus, she said, should be on changing relationships so that people who are overweight/obese are not singled out and shunned.
Bullying the fat guy is not limited to the schoolyard; it happens in the workplace and the home. And one of the most common protective mechanisms is for overweight people to be self-deprecating, but it is humour tinged in pain.
People who are overweight/obese pay a financial and social penalty for the way they look. A study in the journal Health Economics that followed participants for 15 years found that the wages for obese females were on average 6.1 per cent lower and for obese males 3.4 per cent lower among people doing identical work.
The bigger your pant size, the harder it is to be taken seriously - in school, at work and in love. And, again, when you are unloved and isolated, succor is found more easily in food than in fitness.
There is, of course, an important underlying socio-economic issue: Obesity is more prevalent among the poor. But it is a classic chicken-and-egg question: Are people obese because they are poor or poor because they are obese?
Regardless of social circumstance, family members are one of the most common sources of teasing and put-downs, again on the mistaken belief that people can be shamed into thinness and good health.
The Protestant work ethic - the notion that individuals can achieve anything through hard work and discipline - is pervasive in Canadian society and it colours our attitudes toward people who are overweight/obese. It leads us to behave - often to the point of cruelty - as if all those who are heavy need to do is pull up their socks or, more to the point, push away from the table.
If only it were that simple.
Losing weight can be tremendously difficult for individuals for a host of reasons - genetics, environment, work demands, and illness - to name a few.
Similarly, tackling obesity is enormously complex on a societal level. We can't tax and shame our way out of this public health problem like we did with smoking.
We live in a society that is essentially crafted to facilitate weight gain. We have engineered activity out of our daily lives; built cities that are designed for cars not people; made food - particularly unhealthy food - available in abundance and relatively cheaply; placed the greatest value on work and play that is sedentary not active and; put all our health dollars into sickness care rather than prevention, and then wrapped thinness in a veneer of moral superiority.
"We need to move beyond 'eat less' and 'exercise more' to more comprehensive social policies that make it easier to be healthy," said Dr. Puhl.
That is not readily achievable. But one baby step would be to shift our social attitudes about those who are overweight/obese by changing media portrayals, challenging stereotypes, educating the public about weight bias and banning weight-based discrimination.
We need to fight obesity, not obese individuals.