Backgrounds/fields: Rachel is a social scientist who started in the hard sciences and always expected to go to medical school. Kelly found herself deciding on medical school after several years conducting analytical chemistry research.
Current research: A series of workshops for medical students and fat participants, designed to combat fat stigma. NB: this is about fat stigma and health education, not fat and health!
Methods: The workshops bring together fat participants from the local community with medical students for five sessions in which they close-read a text (of a different style each week) together, quick write to a prompt provided by Rachel and Kelly, and then discuss the writing as a group. All participants are also given a longitudinal prompt: write the story of a time when you encountered fat stigma in the clinic, and rewrite it in the style of each week’s reading. The last part of every workshop is devoted to sharing these longitudinal writings in pairs or triads. Assessment of the effects involved mixed methods: Fat Phobia rating scale, focus group interviews in two groups (medical students and community participants), and an unsupervised concluding group discussion.
Analysis: The study involved mixed-methods analysis. The quantitative measure was Bacon et al.’s Fat Phobia Scale, administered before and after the workshops.
(Bacon, J. G., Scheltema, K. E., & Robinson, B. E. (2001). Fat phobia scale revisited: the short form. International journal of obesity, 25(2), 252. Open-access full text here.)
Qualitative analysis included coding focus group transcripts and participant writings and letting themes emerge from close textual analysis.
Findings: Though results were not statistically significant given the small sample size, there was a reduction in overall Fat Phobia scores across almost all measured items. The attitudes that underwent the most transformation were those related to physical presence and movement which could only have occurred through direct contact.
Themes that emerged from focus group interviews were more intriguing. First, the workshops allowed fat bodies to be educators, teaching medical students about lived experiences for fat bodies who must navigate unaccommodating built environments. Second, trauma was a recurring theme in the workshops and in participant writings. In the act of writing and rewriting troubling experiences in the company of peers, members of both groups gave each other permission to heal from trauma.
Observations/hypotheses about participants:
- Being facilitators with different personal and academic perspectives helped in recruitment from different communities.
- During the sessions, participants were nervous at offending others, and found it difficult accepting that ‘fat’ needn’t be a pejorative.
- It seemed crucial to involve both fat participants and at least one fat facilitator; otherwise the physiological and phenomenological aspects of fat stigma (the way we’re all trained to respond to fat with physical aversion) would not be tackled.
Observations/hypotheses about texts:
- It was important for the texts to be about fatness (to validate the genre), but also not to be just first-person narratives like blog posts (there should be textual interest beyond the content).
- The reading and writing were also crucial in making this not just group therapy, but a way of coming at things obliquely and creatively.
Observations/hypotheses about mechanisms:
- The longitudinal prompt helped achieve an iterative transformation of the past.
- Coming at things obliquely (via texts) created a different kind of efficacy than found in, for example, group therapy without use of texts.
What was surprising?
How well it all worked! In particular, Rachel and Kelly realised that the workshops didn’t actually operate on a model of stigma reduction. Despite initially framing the project as an intervention to combat weight stigma among medical students, it ended up becoming much more. Their participants helped them understand that fat phobia is violence committed by the medical industrial complex against providers and patients. They therefore concluded that stigma reduction programs are not adequate for addressing fat phobia and embodied prejudice because they depend on a one-sided correction that does not break down the fundamental power imbalance between provider and patient. Instead, they now feel it is more useful to use the trauma-informed care model that respects the autonomy and agency of community members rather than merely exploiting them for knowledge.
- Working out how much the format can be standardised and rolled out on a larger scale, or how much it depends on context-sensitive tailoring.
- Pursuing additional funding sources that will permit greater diversity among participants.
- Modifying the method to retain the medically accessible concept of stigma reduction, but make it more equitable by incorporating it into trauma frameworks.
Making the case: Being fat is typically viewed as abnormal and pathological, but it is also extremely common. Fat phobia runs obviously counter to the aim of medicine to help not harm: fat people are subjected to the ugly paradox of being told that being fat is unhealthy and at the same time confronted with the phobia and stigma that prevent them accessing and benefiting from treatment. Enhancing empathy through storytelling is a hot topic, but it’s often done so superficially that medical students dismiss it. We need to do these things carefully and thoroughly, especially when tackling such ingrained beliefs.
Find out more:
- Kelly can be reached at email@example.com
- Rachel’s UC San Diego webpage is http://communication.ucsd.edu/people/phd-students/rachel-fox.html, and her personal site is http://rachelefox.com/
- You can also find the handout Rachel and Kelly created for their conference presentation here. It includes details of the workshop texts and further reading on fat and health, dieting and weight loss, and public health perspectives on obesity and weight stigma.
- Rachel’s 2018 Fat Studies article, ‘Against progress: Understanding and resisting the temporality of transformational weight loss narratives’, is here
And thanks to Aussens@iter for the intro/outro music:
Between Worlds (Instrumental) by Aussens@iter (c) copyright 2017.
Licensed under a Creative Commons Attribution (3.0) license. http://dig.ccmixter.org/files/tobias_weber/56664 Ft: (Smiling Cynic)