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A line of young women party on the beach during the 1920s.

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It’s summer, which means swimsuit season, which means we should be on high alert for fatphobia. Dr. Melissa A. Fabello is a body-positive mental-health advocate and expert in the intersection of body politics and social justice. Through her PhD in human sexuality studies, she researches how the onset of eating disorders affects psycho-sexual development, and she believes that thin privilege, weight stigma and the “phony concern” for fat people’s health has got to stop. Social environments that place an importance on weight control or endorse thinness lead to body dissatisfaction, low self esteem, sexual dysfunction, poor mental health, even depression.

I spoke with Fabello about the rampant anti-fat bias woven into medicine, why understanding and dismantling fatphobia has reached a crisis level of importance, and what it really means to believe that “all bodies are good bodies.”

Let’s start with unpacking one statement you made in your newsletter, about the way the medical establishment treats and is failing fat people: “Sometime in the future … we are going to look back on how we treated fat people today as a human rights violation.”

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To a lot of people, that is a radical, wild thing to say. But one of the places it comes from is that obviously there’s been a huge shift in where we place our faith in society. Religion has died, overarchingly, I mean, and science became the thing people put their faith in. So when you suggest to people that science is wrong, they can’t handle it. What it all comes down to is that we culturally think of doctors as holding power and being pillars of science. Science is also something we put on a pedestal. Often the general public doesn’t understand that it’s ever-changing and subjective. Doctors aren’t infallible – they’re just people and people have biases and prejudices. Doctors are just as racist, sexist and fatphobic as anybody else. A lot of the research shows that doctors, nurses and those who work in medical fields actually have incredibly high rates of fatphobic thoughts, and think of those patients as less worthy of care.

I’m still learning all the facets of it, but I think of fatphobia as insidious and extended gaslighting.

That whole health concern trolling thing is basically gaslighting. The idea of anyone saying you don’t really know what’s happening in your own body. And now that, instead of religion, people think of health as a virtue and as a value, saying that fat people aren’t healthy, telling people in their life what they should do with their bodies, people believe they’re doing a great, virtuous thing. Even something like The Biggest Loser: People loved that show but what they put those people through is dangerous. It’s mind-blowing to me that people didn’t see that it was harmful.

There are dozens of great books with nuance that tackle the subject of fat acceptance – you often recommend body acceptance advocate Dr. Linda Bacon’s Body Respect and Health at Every Size, for example – but how does this issue get more attention? Are there any mainstream pop-cultural products aside from books that you consider good places to start a conversation?

A really good documentary called Fattitude [about fat shaming and fat hatred] has finally gone out in the world with screenings in different cities. I think that it is a start. Mostly, I think about books. It’s unfortunately really hard: Even documentaries in the past couple years about health don’t really address fatness in the way I think they should (if they address it at all) and that’s part of the problem. Dietland [AMC’s new series, based on the 2015 Sarai Walker novel] might be helpful.

Despite the surreal revenge-fantasy aspects, the show seems to critique and explore pretty much every aspect I’ve ever read around fatphobia: from body hunger and internalized self-loathing to mainstream medicine and hollow body positivity. One character even calls women’s magazines “the dissatisfaction industrial complex.” Do you think it’s possible to opt out of the toxic messaging from fashion and beauty advertising?

It’s not a media problem. It’s a social problem. The medium – whatever it is – reflects what’s going on in the world, in a feedback loop that’s constant. Not reading women’s magazines off the newsstand doesn’t mean you’re not bombarded with those same images and messages everywhere you go, and by the people are who are influencers on Instagram, and billboards. You can’t really escape it. I think it’s good that we can create our own media, and that has an effect for sure, and that we’re diversifying the way we take in media, but I think the people who get the most attention are still going to be thin, white and pretty because that’s how we place value on people.

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We’re now back in “beach body” season. Looking back at the recent coverage, there’s still plenty of blatant weight-loss pressure, but the buzzwords now seem to be “healthy” and “strong” – a dedication to health and fitness instead of narrow ideas of beauty and thinness.

But that is just as damaging. It is still wrapped up in a beauty ideal. You can call it health all you want, but if you’re defining health as someone who is thin then that’s just another aesthetic. You haven’t actually changed anything by saying “Let’s be healthy.” I get what people are going for, to teach people to have healthy relationships with their body, with food, with fitness and so on – that is a positive thing. But when you look at the staggering numbers of gym memberships over the past 10 years, it’s very clear that you’re just creating a new way for industries to make money.

If the problem is not in us but in a culture that assigns value to certain ways of being (slim) and less value to others (fat), how do you centre fat back into body politics? What’s your strategy?

Whether or not you define [yourself] as a feminist or an activist, I am a fan of taking an inside-out approach to these things. Working on your own stuff, the stuff you’ve internalized is important. To think about the ways I’ve been taught to think about fat or race and work on that. Not that that work is ever done – it’s a continual thing. We can’t lose sight of the fact that the reasons we feel bad about our bodies are socio-political. That perspective is necessary. It’s a domino effect.

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