Welcome to Office Hours with Fatty, MPH
Answering questions about weight stigma and size-inclusive care from students, practitioners, and providers in medicine, nursing, and public health
Hi, I’m Monica — known on the Internet as Fatty, MPH.
I’m a fat lady who went to public health school to study weight stigma. I had to reconcile what I knew about my inherent worth and value as a fat person with the health and medical news, studies, and guidance documents I was reading daily as a social media manager for a national health care providers’ association.
What I thought was an issue in how providers communicate with patients turned out to be much deeper: Weight stigma is an outgrowth of anti-Black racism. The proliferation of weight stigma predates medical concern with the purported health risks of fatness. (I cannot recommend Sabrina Strings’ Fearing the Black Body and Amy Farrell’s Fat Shame strongly enough for understanding this essential historical context.) This has profound implications for how public health and medicine are practiced, especially as an increasing proportion of providers and practitioners consider health equity to be foundational to their work.
Simply put, BMI is about as valid as phrenology when it comes to predicting health. While weight gain can sometimes be a symptom of a health problem (in the same way that weight loss can) — fatness is not, in and of itself, a health problem. Most “obesity care” does more harm than good, and is at odds with what we already know are best practices in medical care: being evidence-based, patient-centered, and trauma-informed. To the extent that fat people are “at risk” of poor health outcomes, the risk comes from the toxic social stress of anti-fat bias and structural discrimination, multiple marginalization, and the subpar medical care we often receive — not from inside our bodies.
I understand how challenging this is to take in because I also had to take it in. The gap between what the research says, when we look beyond the conclusions section and get into the actual data, and what clinicians and health systems are actually doing — is staggering.
I was lucky and privileged enough to make sense of this as part of a cohort of graduate students. My classmates were public health practitioners and communicators, like me, along with nurses, medical students, residents, and pre-med students, health attorneys and pre-law students. They proofread my papers, listened to my presentations, and joined me on group projects. They supported me in challenging the bias in our curricula and began finding ways to incorporate weight stigma into their own work. And throughout these processes, they asked me excellent questions — questions that forced me to interrogate my own assumptions and expand how I thought about issues, questions that invited me to try new approaches and helped me uncover connections between seemingly unrelated topics.
I loved answering my classmates’ questions. Now I want to help you work through yours.
Welcome to Office Hours.
WHAT THIS IS:
an advice column for people working in health care and public health who want to advance health equity and improve care for patients of all sizes
answering questions about weight stigma and size-inclusive care, helping writers resolve cognitive dissonance and solve concrete problems related to the practice of size-inclusive public health and medicine
drawing from my lived experience of medical fatphobia as a chubby kid and fat adult, and the academic expertise I gained by studying weight stigma as a public health problem for my Masters of Public Health degree
in the hopes that one day enough clinicians will be knowledgeable enough about weight stigma that hospitals and doctors’ offices won’t be so traumatic for fat people to visit
written in plain language for accessibility (as much as I can)
published twice monthly-ish; I am committed to answering at least two questions/month, but frequency and schedule may vary while I find my rhythm
always free to read, with comments open to paid subscribers to keep the trolls at bay; if cost is an issue, please reach out to me at FattyMPH [at] gmail [dot] com for a comp subscription
WHAT THIS IS NOT:
a persuasion-oriented space; I am here to support practitioners who understand that weight stigma is an integral issue to the cause of health equity, not debate my lived experience or defend my worthiness of care in the body I have now
advice for fat people facing medical discrimination; despite the ease with which I run my mouth online, I really struggle with self-advocacy within medical systems. (For information and resources about self-advocacy as a fat person in medical settings, I look to NAAFA, activists like Ragen Chastain and Marilyn Wann, and community forums like the official Health at Every Size (R) (HAES) Facebook Group.)
advice from a clinician; it bears repeating that I am drawing from lived experience and the academic expertise developed in grad school, but not any experience as a healthcare provider—which means I may miss things, or misunderstand them, or answer your questions with more questions
scholarly writing; I will do my best to credit the activists and writers whose work I draw from and offer references when available and appropriate, but I am an independent researcher working without institutional resources — if you have access, you may want to follow up with a medical librarian
set in stone; for me, this is an exercise in going with the flow and resisting the paralysis that comes from being overwhelmed by things I could be writing about
my only online home; follow me on Twitter and Instagram at @FattyMPH!
please email questions to FattyMPH [at] gmail [dot] com and include “Office Hours” in the subject line
keep questions brief to the extent that you are able; I recognize that more technical questions may take more words to ask, especially since I’m not a clinician, but I’d appreciate you capping it at 500 words if possible
by submitting a question, you consent to having it published in Office Hours with Fatty, MPH; light edits for brevity and/or clarity may be applied
if you’d like to use a pseudonymous sign-off, please include one!
In the meantime, tell your friends!