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Fat-Shaming or Fact-Sharing?

Controversy rages over UK obesity and cancer awareness initiative

As a response to decades of impossibly, unhealthily thin role models, the body-positivity movement was refreshing. It was a much-needed counterpoint to the media message that the “perfect” body—or at least the perfect female body—was thin to the point of emaciation. The goal was to underscore the fact that normal, healthy bodies come in a variety of shapes and sizes and that what media presented as ideal was often dangerously underweight.

A recent controversy in the UK, however, might make us question whether the pendulum has swung too far in the other direction. Have we reached a point where feelings trump facts? Is publicizing the very real health risks of obesity “fat-shaming” as some complain, or is it simply fact-sharing?

 

The controversy

Cancer Research UK is a London-based charity focused, not surprisingly, on cancer research. They’re an important source of funds for many research projects into treatment, diagnosis, and prevention. They are currently running a public-awareness campaign highlighting the link between obesity and cancer—and body-positivity activists want them to stop.

The campaign uses posters and billboards like the one on the right strategically placed in public spaces. They consist of a plain white background on which black letters say, “OB_S__Y is a cause of cancer.” The viewer is left to fill in the missing letters to spell “obesity.” At the bottom of the page is a black rectangle enclosing the words, “Guess what is the biggest preventable cause of cancer after smoking.” (If you’re a healthcare provider or other person in the health sector and you’d like your own copy, you can download it here.) Another poster shows a cigarette package filled with French fries, with the words “Obesity. Guess what is the biggest preventable cause of cancer after smoking.”

The message is short, to the point, compelling, and a simple statement of fact. It’s intended to raise public awareness of the link between obesity and cancer, and to hopefully inspire those who are overweight or obese to discuss the topic with their doctors.

But body-positivity activists are up in arms. They say the posters—intended to highlight a very real health risk—are nothing more than fat-shaming and they’re calling for an end to the campaign. One of the most outspoken, comedienne Sofie Hagen, started a social media firestorm when she wrote on Twitter:

“Right, is anyone currently working on getting this piece of [snip] CancerResearchUK advert removed from everywhere? Is there something I can sign? How the [effing eff] is this okay?” (profanity removed).

She continued:

“What your campaign is doing is so incredibly damaging, that I can’t even begin to describe it in only 280 characters … there is no excuse for you to have this campaign up.”

Other voices joined in with equally vitriolic complaints. Cancer Research UK has been forced to publicly defend the campaign, saying, “The aim of the charity’s campaign is to raise awareness of the fact that obesity is the biggest preventable cause of cancer after smoking. This is not about fat shaming. It is based on scientific evidence and designed to give important information to the public. Only 15% of people are aware that obesity is a cause of cancer. Cancer Research UK has a duty to put that message in the public domain.”

But the argument didn’t end there. Weeks later, cries of fat-shaming are still flooding social media and activists are still pressuring the charity to end the campaign.

And that should give us pause.

 

The science

Studies in recent years have shown that obesity increases the risk of at least thirteen different kinds of cancer. And though the science is still far from clear, it may increase the risk of several other types of cancer too. At the moment, there is a known link between obesity and:

  • Breast cancer in post-menopausal women – 7% – 15% risk increase.
  • Bowel cancer – 11 – 14% of all cases caused by obesity.
  • Uterine cancer – obese women are three times more likely to develop uterine cancer than those who are not obese.
  • Esophageal adenocarcinoma – overweight people are 80% more likely than healthy-weight people to develop this cancer, and the number is even higher among obese people.
  • Pancreatic cancer – 10-14% risk increase. It’s estimated that 1 in 10 cases of pancreatic cancer is caused by being overweight or obese.
  • Kidney cancer – studies consistently show that higher BMI is linked to kidney cancer, and it’s estimated that one-quarter of all cases may be caused by obesity.
  • Liver cancer – both overweight and obesity increase the risk of liver cancer.
  • Gallbladder cancer – risk of this cancer increases by 25% with each five-unit increase in BMI.
  • Ovarian cancer – obesity increases the risk of several types of ovarian cancer, though hormone replacement therapy seems to nullify the additional risk.
  • Thyroid cancer – obesity increases the risk of some, but not all, types of thyroid cancer.
  • Multiple myeloma (a type of blood cancer) – obesity not only increases the risk of this type of cancer, it increases the likelihood of death from it.
  • Meningioma (a type of brain cancer) – the link between obesity and this type of cancer(which makes up about one-quarter of all brain cancers) for women is clear, though the evidence for a link in obese men is less clear.
  • Some types of stomach cancer – obese people have nearly double the rate of gastric cardia (the upper part of the stomach connected to the esophagus) cancer. Risk increases roughly 23% with each 5 kg (about 11 pounds) of weight gained.

If you were unaware of these statistics, you’re not alone. Only a small percentage of the general public knows about the links between obesity and cancer, which is why Cancer Research UK mounted the campaign in the first place.

 

Feelings don’t trump facts when it comes to medicine

For all the public-health focus on obesity and the medical dangers of excessive weight, we’re in a perilous situation as a society. Few, if any doctors dispute the dangers of overweight and obesity, including their links to cancer, heart disease, type 2 diabetes, and more. Yet we’re at a point where many doctors are afraid to bring up the topic of weight with patients for fear of causing offense. Why? Because in the real world, where most people are connected through social media, a single patient like Ms. Hagen who feels she or he has been “fat-shamed” can seriously damage a doctor’s reputation and practice. It doesn’t take a global stage like Hagen’s to ruin a reputation, after all. All it takes is a wide circle of social media contacts in one’s own community. So instead of speaking up, many doctors simply keep their mouths shut.

And that’s a bad thing for all concerned. In cases like this, doctors effectively have their hands tied when it comes to some of the most effective treatments (like weight loss and type 2 diabetes) and patients never get the education and support they need—even if they might have been receptive to it.

A complicating factor is that many people who are significantly overweight may not even realize it. Over the past several decades, society’s waistline has expanded dramatically. With nearly 40% of American adults and almost 20% of children now obese, what was once unusual has become commonplace. The push to de-stigmatize obesity—a worthy goal, in the beginning—has had the effect of almost normalizing it, so that many people may not realize the size of the issue unless and until their doctor brings it up with them.

But in the eyes of activists like Ms. Hagen, this isn’t patient care—it’s a personal attack aimed at obese people. And pointing out that obesity may cause cancer isn’t an effort to save lives that might otherwise be lost through a painful and costly disease—it’s fat-shaming.

By this logic, advising people to stop smoking is smoker-shaming (but smoker-shaming is ok). Telling overweight type 2 diabetics that losing weight may bring their blood sugar under control is fat-shaming. Educating teenagers about the risks of unprotected sex is sex-shaming. Prohibiting driving while intoxicated or warning drinkers about cirrhosis of the liver are alcoholic-shaming. The logic simply doesn’t hold up. If we fail to warn people of the health consequences of their actions, lifestyle, or behaviors, we are failing in our public duty. Facts are facts, and just because a vocal minority may feel threatened by them doesn’t release us from that duty.

To be clear: fat-shaming does happen. And when it does, it’s reprehensible. It shouldn’t happen, and certainly never in a medical or public-health setting. But pointing out that obesity is a cause of preventable cancers is simply not fat-shaming. It’s an attempt to save lives, based on science and facts.

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Controversy over UK obesity and cancer awareness initiative
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Controversy over UK obesity and cancer awareness initiative
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Controversy over UK obesity and cancer awareness initiative should make Americans think more. As a response to decades of impossibly, unhealthily thin role models, the body-positivity movement was refreshing.
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