Stigma Loading: The Effects of Disease Classification & AMA’s Decision to Call Fat a Disease

*I wanted to publish this blog asap. Addenda may be added later this week.

I am a bit late on the American Medical Association’s decision to categorize obesity as a disease. But, ghurl, when the news hit I was in the middle of the woods at Harbin Hot Springs, naked, eating kale and tri-tip hash with seven other babes (and wishing you there, duh). And then I had to go to a pool party and a wedding and then dance to Taylor Swift in a barn. So, yeah, mama’s been busy. I’m literally writing this as a San Francisco Chronicle photographer is shooting me in my kitchen.

I’m sure that you can list 10 (100?) reasons that this decision is horrible. I’d like to put into words the biggest reason that this decision is problematic to me. I call it “stigma loading.”

Stigma Loading is the cumulative effects of dealing with multiple axes of discrimination/oppression. After some research I was unable to find literature that used this verbiage; please send me a citation if you know of any.

The AMA’s decision is not only a dangerously flippant dismissal of the complexity of body size (and body diversity) in the heterogeneous United States, but also a complete refusal to engage with the realities and dangers of stigma loading. A disease classification may lead to Health Related Stigma (HRS), which is considered both a “feature and a cause of many health problems.” (italics added). HRS would, of course, be on top of other stigma a fat person is likely already facing from peers, family, media, and, oh yeah, doctors.

Obesity (fatness) – as an identity or an experience - does not exist in a vacuum. One’s experience as a fat person is mediated by their gender, race, class standing, ability, and citizenship status; these realities overlap, intersect and complicate the way that a disease classification may be stacked onto other marginalized identities. Furthermore, because women, poor people and people of color are likelier to be classified/seen as fat in our culture, the AMA decision de facto upholds sexism, classism and racism.

Fat cannot be viewed with myopic unidimensionality, and that is exactly the lens that some members of the AMA have adopted (NB: not all members of the AMA supported the classification).

Though it’s difficult to gauge the effects of disease classification in our particularly germophobic/disease-concerned culture, I feel confident in my guess that the effects will lead to stress for some (many?) of the 79% of Americans who qualify as “obese.” In a 2011 CNN article, writer Alex Berezow called the United States a “nation of germophobes.” And we are uniquely globally positioned in our fear of contamination.  When you add something like a disease classification to an already pre-existing socially mandated stigma (fat) in a uniquely disease averse nation, you can be looking at stress levels that become dangerous – even though the daily effects of stigma loading may be imperceptible.  

I was just chatting with the SF Chronicle photographer and he asked me what I thought the day-to-day effects of this decision would be. His question was emblematic of most people’s concerns: the average person wants to know if this will affect their family, their income: the concrete, tangible elements of their life.

The problem with stigma is that it is not so simple. Not to get too drastic, but think of stigma as radiation… no, no that’s too intense. Think of stigma as a cavity. Cavities are not built in a day. Rather small amounts of cavity-causing elements build up over time and their effects are cumulative. It sometimes takes years for the enamel and then the tooth to erode, but it will if unabated. The stress of stigma works the same way. It is difficult to gauge because it manifests differently in different people and it builds up slowly over time. But its effects have been linked to things like low birth weights among Black Americans and shorter life spans among gay men.

You know I’m always talking about minority stress (and I’m going to talk about it ah-gain). It is a well-established body of theory in social psychology that convincingly posits that the daily stress of interpersonal discrimination – things like stares, micro-aggressions, as well as the perception or anticipation of these experiences – can lead to cardiovascular problems and shorter lives. If we know that stigma erodes at health and life, and that presumably more stigma causes greater harm, then one must call into question the AMA’s validity and reasoning in this matter.  

I see the AMA’s decision to classify obesity as a disease as adding to the stigma load of some of the United States’ already most marginalized populations.

Someone once told me that a nation must be judged by its treatment of the most vulnerable. Because I believe that the AMA has further endangered some of the US' most vulnerable, I oppose and refuse to recognize the AMA's disease classification.