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I applied to the Harvard T.H. Chan School of Public Health with no expectation of getting in — I just wanted to see if I could. My personal statement was honest about my intention to explore weight stigma as a public health problem. I had a hypothesis that the real epidemic was not of fat people, but of anti-fatness, and I planned to pursue this line of inquiry regardless of where I ended up. But Harvard, I knew, was the site of some of the most influential, most fatphobic work of the last century or so. Once I was admitted, it didn’t seem like an option not to go. 

Beatrice Adler-Bolton defines eugenics as “the belief that science must intervene at a population level lest the vulnerable overwhelm the strong leading to the destruction of society.” At Harvard,  pro-social justice rhetoric and eugenic approaches to public health coexisted in the same building, classroom, professor, syllabus — a tension few of my classmates seemed to see or feel. It became immediately apparent that public health  — or at least, the public health curriculum for my degree program — focuses on “prevention” without robust frameworks for grappling with what kinds of conditions can and should be considered “preventable.” 

Without those frameworks, even well-intentioned public health researchers and practitioners can and do enact significant harm, which is precisely what happens with fatness. It only took two weeks of classes to begin seeing my own harmful experiences with public health and healthcare in a whole new light. Weight stigma, like other forms of oppression, operates on interpersonal, institutional, and structural levels to create poor health outcomes for fat people. 

When it comes to medical settings, fat people are marked for iatrogenic harm: that is, harm caused specifically by the “care” we receive. This harm is repeated and cumulative. It is acute and chronic. It makes “care avoidance” both a trauma response and a completely logical reaction to the clinician’s expectation that you will fork over a $25 copay to be handled roughly or not examined at all, then given “medical advice” you could have gotten from Cosmo or Vogue: lose weight. In countless resources that fat people have assembled — from the First Do No Harm blog to the Twitter #DiagnosisFat hasthag to Ellen Maud Bennett’s striking obituary — we see that “weight loss counseling” constitutes a refusal on the healthcare provider’s part to engage a diagnostic mindset.

In other words, fat people are provided demonstrably subpar health care. We are constantly subjected to denigrating messages inside and outside the clinic. It’s an environmental exposure like pollution: the message that our bodies are incorrect, a plague, a contagion, is so ubiquitous in our interpersonal relationships, in media and advertising, and in the built environment that it might as well be in the air we breathe.

At the structural level, fat people are expected to contort ourselves, literally, to fit – to tense ourselves and squeeze into airplane and bus seats, in restaurants and classrooms. The wear-and-tear doctors ascribe to gravity is evident everywhere in the built environment, once you know how to look for it. If thin adults were expected to sit in child-sized chairs day in and day out, wouldn’t they have joint pain too?

The theories about race- and gender-based marginalization contributing to poor health outcomes — the ones you’ve definitely seen academic rockstars espouse in documentaries and TED talks about racism and health — treat fatness as a disease that occurs more often in poor people and racially oppressed communities as a consequence of injustice. Even though body size is not behavior. Even though discrimination against fat people is documented in virtually every aspect of modern life, from employment to housing to dating and our personal lives. Even though the claim that ob*sity is a disease is both novel and contested. Even though all the best contemporary evidence we have suggests that behavioral interventions for intentional weight loss are ineffective at best and harmful at worst. (For what other illness do we make a universal recommendation for an intervention with a success rate that maxes out at 20%?)  Even though the historical evidence makes it plain that anti-fatness preceded medical or public health concern about the health effects of ob*sity (and indeed, that “concern” is a mechanism by which anti-fatness operates). Even though we know anti-fatness travels with and from anti-Black racism, ableism, and misogyny. 

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I once asked a visiting lecturer in my “Obesity Epidemiology” class if, given what she’d presented, it could be argued that the relationship between ob*sity and poor health outcomes is confounded by weight stigma. (“Confounding” means that weight stigma is a third factor associated with both ob*sity and poor health outcomes that better explains the relationship, and I had learned it the same week I asked the question.)  I didn’t expect her to pause thoughtfully and then agree with me, but she did. And I really didn’t expect the degree of hostility it provoked in the senior lecturer. I swear he glared at me every time I raised my hand. I started referring to him as my nemesis. Eventually, he stopped showing up to class.(It only occurred to me after the fact that with functional pedagogy, graduate students wouldn’t think of professors as antagonists.)

A year later, in the final semester of my degree, I asked a professor in a different class about the ethics of weight-loss interventions given the known tendency toward weight regain. His answer didn’t make any sense to me; he emphasized the differences between “overweight” and “obesity,” didn’t talk about ethics at all, and moved back into his planned lecture as fast as he possibly could. It was only when a classmate two seats away texted me, “holy shit, are you okay?” that I understood what had happened: This renowned professor wrongly assumed that I, as a white student at the Harvard T.H. Chan School of Public Health, must be “overweight” rather than ob*se, never mind that my friend was two seats down because the desk attached to my chair wouldn’t lay flat enough over my stomach to use, so I was using the left-handed desk between us to take my right-handed notes. He assumed that I was unfamiliar with the literature and asking out of concern for my personal health. It was less threatening for him to “reassure” me with a word salad emphasizing the differences in health risks between those two arbitrary categories than to engage my legitimate inquiry about research ethics. 

If thin adults were expected to sit in child-sized chairs day in and day out, wouldn’t they have joint pain too? 

By responding to my body instead of my question, he made his ethics crystal clear.

Even more ironically, I was only in this class because of an incident the previous semester: a different professor thought it would illustrate something about behavioral economics or social contagion or what-the-fuck-ever to teach a fat suit study and laugh while he did it. The study,  which counted how many M&Ms participants ate when offered candy by an experimenter in a thin body versus one in a fat suit, was meant to illustrate how social influences inform behavior. Instead, it was a profound and shocking example of how weight stigma renders researchers unable to design ethical studies, read literature critically, and draw meaningful conclusions from data. When I complained to the DEI office, they helped me drop the fat-suit class without a penalty, telling me, confidentially, that anti-fatness was a known issue with this professor, and I was the first student who was willing to lodge a formal complaint. I was told the study would not be taught again. But I still needed to meet a curricular requirement, so I signed up for the other class.

Fat lot of good that did me.

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That’s not to say it’s hopeless. When the professor addressed my body instead of his ethics, two classmates immediately texted me to ask if I was OK, so I didn’t immediately start gaslighting myself about whether it had really happened. After class, a third offered me a hug. And a fourth said: “I know it can’t make up for what happened, but I was looking around the room, and I saw the lightbulb go off for, like, five people.” My cohort — who I trained by presenting to my classes on weight stigma every time a project about ob*sity was assigned  — cared for me as a person, a classmate, and a friend, not a manifestation of an imaginary illness. It is possible for public health practitioners, researchers, and scholars to learn and do better. They just have to want to see fat people as human enough to think critically about all that evidence.