Fat-shaming in India is, perhaps, as commonplace as aloo paratha at a breakfast buffet. One encounters it in families, workplaces, friend circles, educational institutions, and popular culture. If you have been fat-shamed or been called out for fat shaming others, please get yourself a copy of Dr Rajeev Kurapati’s informative and affirming book titled The Book of Body Positivity: How We Got It All Wrong and What We Can Do about It (Penguin, 2023).
“Obesity stigma is a global phenomenon, with differences based on geography and culture. It is experienced by 19-42 per cent of adults,” says Dr Kurapati, based on findings published in the World Obesity Report. There are research studies about the prevalence of obesity stigma in various parts of the world, including North America, France, the United Kingdom, Germany, Australia, Argentina, Mexico, Qatar, Tanzania, Paraguay, and Puerto Rico.
People who engage in fat-shaming are often defensive about their behaviour, so the author, who is an assistant professor of medicine at the University of Kentucky, the US, has a comprehensive definition to offer. He writes, “Fat shaming is the act of making fun of someone for being overweight or implying or stating that an overweight person is worthless, useless, lazy or even disgusting due to their size.” In addition, he mentions that fat-shaming often involves comments that are disguised as seemingly harmless jokes about what people eat and how they eat but usually carry “implicit judgemental and insensitive overtones”.
This book needs to be read widely because the author reveals that many people who crack such jokes actually believe that humour motivates obese people to lose weight by eating less and exercising more. They do not understand how their words can erode self-esteem. He speaks from his experience as a hospital doctor specialising in obesity and lifestyle medicine.
The author must be commended for holding up a mirror to his own profession. He points out that most medical professionals, who are expected to be experts on issues related to health, make the grave mistake of equating larger body sizes with adiposopathy, which is also called sick fat disease. This claim is backed up with anecdotes from patients who have faced stigma, discrimination and inappropriate remarks from doctors, nurses as well as medical students.
It would serve as an excellent resource for pre-service and in-service training of healthcare providers because the author highlights the variety of ways in which these people perpetuate harm. The author points towards research studies on how healthcare providers overestimate the actual food intake of patients, assign less time to obese people, do not make the effort to build a rapport, and also offer fewer educational resources. This kind of behaviour is counter-productive. When obese patients feel discouraged and humiliated, they look for ways to avoid seeing a doctor to seek and receive the medical care that they actually need and deserve.
Dr Kurapati writes, “While fat is naturally occurring and crucial to the metabolism of the body, sick fat is the product of abnormal conditions. It begins when fat cells expand superfluously and interfere with normal fat metabolism.” When the fat cells in a person’s body grow in size and increase in number, the inflammatory effect within the tissues multiplies. This affects organs throughout the body. The condition is labelled as adiposopathy.
Read this book to find out answers to questions such as: Where does the body store excess energy when we consume more food than we require? What does food addiction really mean? Why can’t people stop eating even when they feel guilty? How do preservatives, colouring agents, taste-enhancing additives, environmental pollutants, plastic packaging, and pesticides affect fat cells? What is the link between fat accumulation, metabolism, and inflammation?
The author cautions against using Body Mass Index, which is “the ratio of a person’s mass (kilograms) to his/her height squared (metres squared)”, as a one-size-fits-all metric since it fails to account for differences based on sex, ethnicity, age and lifestyle. These factors play an important role in weight gain. There is a whole chapter on how loss of muscle mass, hormonal changes, lifestyle changes, prescribed medications, social and psychological changes, and changes in diet and sleep cycle – all related to ageing – can lead to weight gain.
Instead of paying lip-service to the power of self-discipline in staying healthy, the author offers concrete tips such as eliminating artificial sweeteners, reducing the consumption of highly processed foods, increasing the intake of wholefoods that are organic and plant-based and have a high fibre content, using a water filtration system that reduces exposure to chlorine, switching from plastic water bottles to stainless steel and glass water bottles, replacing non-stick cookware with stainless steel or cast iron, and limiting the use of cosmetics such as perfumes and deodorants that expose users to endocrine disruptors.
This book uses an empowering tone, assuring readers that obesity should not be reduced to a personal failure. It is caused by multiple factors. The author looks at why people regain the weight they had managed to lose with a diet, why individuals who eat the same quantity of food and have similar lifestyles may have bodies of different shapes, and why some continue to gain weight despite regular exercise. It examines how advertising targets vulnerable children and teenagers, how people who employ make-up artists and personal trainers influence beauty standards, and how government policies to remove fast-food vending machines from campuses can reshape dietary choices. It is undoubtedly worth reading.
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