You’ve heard it said, probably in hushed whispers: Don’t call her fat, it’s rude. And largely we acquiesce, don’t we? But why? Why does a descriptor like “fat” carry such negative connotations? If it isn’t rude to say “that woman is blonde,” or “that man is tall,” why is it impolite to say they are also fat? The answer is stigma. In the United States, in particular, we have attached shame to weight, and it has blinded us to the real problems of our food and health industries.

In May of 2020, Charlotte Zoller of Teen Vogue wrote that the word “fat” makes people uncomfortable because it “has been hurled around as an insult for decades” but now, “it’s a term that plus-size individuals are reclaiming as a neutral descriptor for themselves.” Self magazine followed up with “‘Fat’ isn’t a Bad Word,” but explained that the word had been made so by others: “Some people use fat to mean unlovable, undesirable, slovenly, unintelligent, lazy.”

For proof, we need look no further than the nearest advertisement about weight loss: “Take back your life,” says a hospital YouTube; get your life “back on track” in a book about weight loss surgery — almost the same rhetoric used to describe kicking substance abuse. Then there are horror stories, such as British businesswoman and columnist Katie Hopkins who gained 43 pounds on purpose to “prove” that obesity is “just laziness.” Note: She is wrong, and I talk more about that in another essay. And yet, this kind of ugly, misguided thinking persists, leading us to treat weight as though it lives in another category from other physical descriptors.

Believe it or not, our stigmatizing of fat is a very modern convention. Historically, extra weight was deeply attractive. The Venus of Willendorf is one of the earliest images of the body made by humans — and she is plump and full-figured. PBS suggests that the people who made this statue, “lived in a harsh ice-age environment where features of fatness and fertility would have been highly desirable.” Christopher Forth, in his Fat: A Cultural History of the Stuff of Life,suggests that fatness has always had both good and bad connotations. But in the Middle Ages, writes Ken Mondschein, “body fat could also be seen as a sign of prosperity, social status, success, and even rulership” — think, for instance, of portly Henry VIII.

In some non-Western societies, the relationship between fat and affluence or power persists. Men from the Bodi tribe of Ethiopia compete to become the fattest during a new year festival. The winner proves the strength of his clan, and it is an honor. In fact, as reported by Stephen Nash, historian of science and an archaeologist at the Denver Museum of Nature & Science, until at least the 1990s, American Samoa, Puerto Rico, and Tanzania demonstrated a preference for plump bodies. They have since begun to lose their fat positivity, however, due mainly to the infiltration of Western ideas — and ideals.

The modern West has determined that fat is ugly and aligned it with undesirable characteristics. We are reaping shame and stigma, and seeing an increase in bullying and mistreatment. This is bad enough, but fat-shaming has also hidden a much wider, deeper problem. Our country’s food industry and its medical industry conspire in the obesity epidemic, one that makes it difficult to get proper nutrition at reasonable prices, and next to impossible to get human-centered medical care.

Not long ago, a friend of mine noticed that her hair had begun falling out. She had fatigue all the time, and brain fog. When she went to her general practitioner, he interrupted her narrative to suggest she try losing weight. She later sought out a specialist, and even a gynecologist (worried it might be hormonal). Both of them made weight loss the first suggestion. In the end, it turned out to be a combination of polycystic ovarian syndrome and long Covid, but it took her three visits at her expense to get that diagnosis. This is a common story, repeated again and again; weight bias among doctors means they can’t see beyond “fat” to the patient.

[I’ve just used the word again. How did it make you feel? Charlotte Zoller’s column asks interesting questions: Why are we uncomfortable? Is it because we have been shamed ourselves? Understandable. But, “if you’re not fat yourself, is it that you fear the stigma and discrimination that come along with being fat? Are you worried about losing the inherent privilege that comes along with thinness?”]

So the medical system has demonized obesity, calling it an epidemic, and offering numerous takes on the how and why we arrived at this moment. But they have simultaneously judged their patients, probably unintentionally, by refusing to hear about their health concerns and instead, making weight loss the primary topic. The message is clear: Whatever is wrong, it’s your fault. Lose weight, or I won’t treat anything else.

Except it isn’t your “fault.” First, being fat is highly subjective. Some people carry more weight and that has been true since humans were a thing. You can be fat and healthy. You can be skinny and sick. But for a moment, let us take a look at weight that does affect health. Obesity has been linked to higher rates of diabetes, for instance. There is a situation where the medical community is right in expressing the need for weight loss, as it can lengthen a person’s life. It’s still not your fault. Why? Because no one becomes unhealthy on their own — our health (or lack of it) is tied to socioeconomic, interpersonal, cultural, and systemic conditions.

If you live in the United States, it is cheaper and easier to locate high-sugar, high-fat food. There is an entire industry bent on making sure you prefer it, and they market to us incessantly. And guess what? There is intentional bias here, too. The Rudd Center for Food Policy and Obesity announced that the fast-food industry alone spent $5 billion in ads, and disproportionately targeted Black and Latino youth (75% more often, in fact), with $2 billion targeted at children. Now consider the ads for other types of processed food and drink, and couple that with the fact that in the U.S., fresh produce and meats are disproportionately expensive by comparison. I’ve written elsewhere about how the stress of racism and poverty also contribute to obesity, as well. Taken together, even if and when weight might be affecting your health, the system in which you live is much to blame.

Fat is not invariably unhealthy. Fat people can be healthy, sexy, productive, fun, active, and happy. Fat is part of your body, and should be, and is necessary and useful for all sorts of things. (I am, myself, very thin because I suffer from an autoimmune condition. I had someone once say “well, at least you are skinny.” Trust me. I would rather be healthy.) What unnerves me the most is how stigma against fat takes the very real problem of accessible nutrition and health care and turns it into discrimination. There is no reason to be phobic of fat. There is reason to hate the “rampant discrimination” fat people face in “employment, health care, education,” writes the author of that Self article, and “the ceaseless street harassment and sexual harassment that follow very fat people” wherever they go.

It’s time we put a spotlight on the real problems — of discrimination, of access, of nutrition, of bias — that undergird our health care systems. Fat is just a word, says Zoller, “not a value judgment.” We aren’t there yet, as a society, but I hope we are headed in the right direction. It’s okay to be fat. It’s not okay to have your personhood revoked or ignored by the medical establishment because of it.