Modern expectations for women’s bodies are rooted in centuries of racism, according to Sabrina Strings, PhD, Professor and North Hall Chair of Black Studies at UC Santa Barbara. In a recent free event hosted by Penn Medicine Princeton Center for Eating Disorders, Dr. Strings described the evolution of fatphobia and its impact on weight expectations during a webinar entitled “Fatphobia as Misogynoir: Gender, Race, and Weight Stigma.”Recalling when her grandmother first pointed out an actress who .was “dying to be thin,” the relevance of the statement didn’t sink in .for Dr. Strings until years later during her research work at an HIV adherence clinic. Two women – one Black and one Latina – chose to forego HIV medication for fear of gaining weight. The realization that women were risking death to maintain their figures was one of the reasons Dr. Strings returned to graduate school to study the disturbing phenomenon of fatphobia, particularly as it relates to race and gender.
“I quickly recognized the reality that for centuries, a focus on slenderness has been expressed in racially coded ways,” says Dr. Strings. “During the Renaissance, voluptuous and curvaceous physiques were prized – until race science began to impact these views in the late .17th century. Race science was largely used to justify inequality and serve as a rationale for slavery.”
Throughout her presentation, Dr. Strings showed examples of how 18th and 19th century artists, authors, and scientists created inaccurate portrayals of body size and characteristics of Black people while promoting the notion of slenderness as something to be prized among White people. By the 1910s, physicians were becoming interested in the relationship between race and weight. Then, by the 1920s, obesity science began to take hold.
Dr. Strings explained that Charles Davenport, a biologist and eugenicist who held racist views, advocated the use of an index developed by a Belgian statistician named Adolphe Quetelet to survey weight across populations. Ancel Keys, lead investigator for the Minnesota Starvation Experiment, later popularized this tool as body mass index, or BMI.
“This tool was created with data almost exclusively from White men across a population, rather than a representative sample,” says Dr. Strings. “BMI was never meant for individualized assessments, but it became a deeply flawed measurement of obesity and health.”
Lifting the Veil on BMI
According to Dr. Strings, the overreliance on BMI has contributed to the stigmatization of fat people, potentially leading to worse health outcomes. These may stem from a lack of ongoing health care if patients avoid returning to the doctor, negative health consequences that can result from weight cycling or yo-yo dieting, and even missed underlying issues due to too strong a focus on BMI.
“The good news is that we’re in a moment where change is taking place,” says .Dr. Strings, whose research shows that racial disparities in diabetes cannot be explained by BMI. “We need to advocate ending the use of BMI, and there’s no need to replace this tool with anything else.”
Instead, Dr. Strings recommends a focus on holistic measures of health, access to nutritious foods and walkable neighborhoods, joyous movement, adequate sleep, and resources to support the study of upstream causes of health issues.
“By sharing knowledge, we can help people undo what we have all internalized,” adds Dr. Strings. “It can start with something as simple as organizing a reading group and grow from there. Where you are is where you begin.”
Reframing the Approach“Having Dr. Strings’ insightful historical and sociological perspectives can help us reframe body image interventions. This work can empower people to think more about how body image concerns can be embedded in social systems instead of something wrong with them. Helping people challenge internalized beliefs and adding social considerations .to medical models in eating disorders treatment provides a .richer biopsychosocial picture to better serve our patients." – Rebecca Boswell, PhD, Supervising Psychologist, Princeton Center for Eating Disorders |