Advocating for Fat Activism in a Therapeutic Context

Abstract

Sizeism has a negative impact on women and perpetuates fat shaming. Conventional therapeutic suggestions for addressing weight concerns focuses on self-discipline rather than on the larger social, cultural, or political contexts of weight stigma. Feminist scholars, therapists, and activists have encouraged social activism to promote psychological well-being and challenge systemic weight prejudice. Results of research on health prevention and promotion efforts have begun to shift thinking away from weight loss and toward deconstructing and changing anti-fat attitudes. We highlight some individual and community-based fat activists to illustrate how their strategies and ideas challenge sizeism in a variety of areas including: the rhetoric of fat; body positivity; photography/art; nutrition/exercise; and diversity/intersectionality. Fat activism has utility within a therapeutic context especially for those who have been recipients of sizeism. We strongly encourage therapists to work closely with clients on finding sources and types of fat activism that represent their unique identities which may be more difficult for those with marginalized identities.

Anti-fat prejudice and weight stigma commonly affect women in the United States (Fikkan & Rothblum, 2011; Puhl, Andreyeva, & Brownell, 2008) and largely contribute to body dissatisfaction, chronic dieting, and eating pathology (Almeida, Savoy, & Boxer, 2011; Simone & Lockhart, 2016). Anti-fat prejudice is described as a negative attitude toward, belief about, or behavior against people perceived as fat (Fikkan & Rothblum, 2011), and it may be experienced from various sources, such as family, friends, medical professionals, strangers, and employers. Western cultures tend to idealize an extremely thin and often unattainable figure for women (Swami et al., 2010), which increases the sociocultural pressures against fatness. These pressures to conform to the thin-ideal are perpetuated by media images, which have been shown to increase body dissatisfaction (Myers & Crowther, 2007; Groesz, Levine, & Murnen, 2002) and risk of eating pathology (Stice, 2002); the images also reinforce fat shaming and weight stigma.

Typical suggestions for addressing weight concerns follow conventional wisdom, which focuses on self-responsibility and suggest that change happens from the “inside out” (Hesse-Biber, 2007). Most psychotherapists do not include attention to the larger social, cultural, or political contexts of sizeism, which leaves individual clients primarily responsible to “get better.” A review of physician attitudes toward obese patients showed that many viewed overweight individuals as lazy and regarded the inability to lose weight as lack of personal motivation and compliance (Dixon, Hayden, O’Brien, & Piterman, 2008). Mainstream media and mobile technology also take this personal responsibility approach to weight loss, primarily suggesting exercise and reduced caloric intake (Willis & Knobloch-Westerwick, 2014) and providing apps that track one’s exercise and diet-related behaviors (Breton, Fuemmeler, & Abroms, 2011).

However, solutions can also come from the “outside in,” where strategies such as activism are focused on the deeply entrenched patriarchal structures that promote and maintain weight concern in women (Hesse-Biber, 2007). Feminism espouses issues of social justice (Yoder, 1999), which includes pushing back against sizeism. Fat activism has been advocated by feminist scholars and activists who seek to challenge systemic weight prejudice and promote psychological well-being among women (Cooper, 2016a; Maine, 2000; Hesse-Biber, 2007; Solovay & Rothblum, 2009; Wann, 2009). Historically, feminist counseling and therapy has espoused “the personal is the political” acknowledging the connection between individual and social change (Enns, 1993; Evans, Kindale, & Seem, 2011) and supporting activism as a therapeutic tool (Enns, 1997; Worell & Remer, 2003). Ali and Lees (2013) caution that not all clients are ready for activism and therapists should work closely with them to determine if such engagement will be beneficial for their psychological well-being.

In this article, we suggest that social activism, especially fat activism, can be an important avenue for clinicians to consider in a therapeutic context. Research on the relationship between social activism and feminist therapeutic efficacy is still needed (Israeli & Santor, 2000). However, there is evidence that activism is related to psychological well-being in college students and a community sample (Klar & Kasser, 2009), a neighborhood sample (Gilster, 2012) and in racialized immigrant women (MacDonnell, Dastjerdi, Khanlou, Bokore, & Tharao, 2017). We also review eating disorder prevention and health promotion efforts that have been shown to deconstruct anti-fat attitudes. Finally, we highlight individual and community-based fat activists whose ideas may help guide therapists with clients struggling with sizeism. Suggestions for how therapists might use research and activism are integrated throughout the paper.

Fat Attitudes, Prevention, Health Promotion, and Therapy

Anti-fat attitudes significantly impact women’s psychological and physical health (Cassone, Lewis, & Crisp, 2016), and often predict eating disorders (Almeida, Savoy, & Boxer, 2011; Stice, 2002) and low self-esteem (Bacon & Aphramor, 2011). Therefore, many eating disorder prevention efforts, as well as physical and psychological health programs, have shifted to promote body acceptance (Berman et al., 2016a; Berman et al., 2016b), remove focus on weight (Bacon & Aphramor, 2011), and aim to deconstruct the internalization of societal pressures to attain the thin ideal (Stice, Becker, & Yokum, 2013).

The internalization of the thin-ideal occurs when women assimilate the thin-ideal into their self-assessment and believe that women must be thin to be attractive or be valued in society (Myers & Crowther, 2007). Eating disorder prevention efforts, such as The Body Project (e.g., Stice et al., 2013), directly target the internalization of the thin-ideal. The Body Project engages participants in activities designed to decrease the internalization of the thin ideal among at-risk women by asking participants to engage in verbal, written, and behavioral exercises to critique the thin-ideal and develop anti-thin-ideal speech. The Body Project has been implemented across over 100 universities in North America and has consistently demonstrated that women who participate in the intervention report significant reductions in drive to attain a thin ideal, eating disorder symptoms, and psychosocial impairment among other eating disorder risk factors (e.g., Stice et. al., 2013). The Body Project directly aims to deconstruct fat prejudices among its participants and has consistently shown that by doing so, the psychosocial health of the participants greatly improves.

Similarly, a cognitive-behavioral group program titled Positive Bodies (Cassone, Lewis, & Crisp, 2016) was developed to promote positive body image. Participants reported higher self-esteem and body satisfaction, better quality of life, and less body shame and self-surveillance. These findings suggest that, by reducing the overvaluation of weight and the impact of sociocultural pressures to attain a thin-ideal, women report significantly better psychological health and well-being.

Further, programs designed to support physical health have shifted to promote and enhance health without encouraging weight loss (e.g., Health at Every Size; Bacon, 2008). Health at Every Size (HAES®) is a trademark of the Association of Size Diversity and Health, which offers a different process for defining health rather than weight or Body Mass Index (BMI; Bacon & Aphramor, 2011). The HAES® model was developed as a community effort by groups fighting size discrimination and anti-fat attitudes among nutritionists, therapists, and researchers (Bacon, 2008). To this end, HAES® promotes improvements in physiological health and psychosocial outcomes (Bacon & Aphramor, 2011) by focusing on size self-acceptance, weight diversity, reliance on internal cues of hunger and satiety rather than dieting, and embracing the joy of movement rather than prescribing a routine of regimented exercise (Kratina, 2003). The HAES® paradigm has been applied in various settings, including general education (Humphrey, Clifford, & Morris, 2015) and various therapeutic contexts (Berman, Morton, & Hegel, 2016a; Herb, 2006). Across settings, women enrolled in HAES®-informed interventions reported significant reductions in dieting behavior, anti-fat attitudes, energy expenditure, metabolic fitness (e.g., blood pressure), cardiorespiratory fitness, and significant improvements in body-esteem and psychological health (Berman, Morton, & Hegel, 2016b; Penney & Kirk, 2015; Humphrey et al., 2015).

Recently, a treatment program known as Accept Yourself! was developed to integrate tenants of HAES® and Acceptance and Commitment Therapy (ACT; Berman et al., 2016a; Berman et al., 2016b). Because women who are classified as obese are more likely to experience depression than women who are not (Berman et al., 2016a), Accept Yourself! was created to integrate both psychological and physical health of women classified as obese and depressed (Berman et al., 2016a). The treatment was designed to better assist women to: (1) trust their bodies natural internal cues (e.g., the experience of hunger); (2) move towards personal values that were previously blocked by negative thoughts, feelings, or experiences with weight, shape, eating, and moods; and (3) defuse cultural rules and programming to attain the thin-ideal to promote size acceptance (Berman et al., 2016a). The results from a pilot study on the Accept Yourself! program suggested the treatment significantly improved depression symptoms, quality of life, and health outcomes among women with depression and obesity (Berman, Moron, & Hegel, 2016b). While the Accept Yourself! treatment program was designed for group-based therapy, the program can be adapted for individual therapy approaches (see Berman, et. al., 2016a for a complete list of content covered throughout each treatment session).

Feminist psychologists have written that working on weight loss with women clients in therapy supports the thin-ideal and reinforces anti-fat attitudes (Brown, 1989; Chrisler, 1989; McHugh & Kasardo, 2012). To this end, therapists are encouraged to seek alternative approaches to working with fat clients that do not perpetuate anti-fat bias or celebrate weight loss (Brown, 1989; McHugh & Kasardo, 2012), such as the Accept Yourself! treatment program which incorporates the HAES® model. Not only are there psychological benefits associated with body acceptance (e.g., Cassone et al., 2016), but it may be considered unethical for clinicians to perpetuate bias and advocate for weight loss among their clients. While including approaches that break down anti-fat attitudes in therapeutic settings may not be seen as a direct form of fat activism, it has been suggested that clinicians may aim to bridge the gap between therapeutic work and activism by resisting the structures of injustice that influence peoples’ suffering (Reynolds & Hammoud-Beckett, 2012). Certainly part of feminist therapy and counseling asks clients to examine the relationship between their own distress and larger systems of oppression, in this case, sizeism. Several components of feminist therapy that have been shown to be effective--consciousness raising, social and gender-role analysis, and resocialization--are a pre-requisite to activism (Israeli & Santor, 2000). Some examples include connecting one’s lived experiences to sizeism (consciousness raising), becoming aware of how the thin-ideal has negatively affected one’s life (social and gender-role analysis), and/or restructuring one’s cognitive structure in regard to body size/weight (resocialization). Therapists must work closely with their clients when introducing various forms of fat activism to ensure that such action would be beneficial.

Fat Activism

Baumgardner and Richards (2005) define activism as creating a more just world and working together toward a collective good. Activists “view the social structure as a target of intervention not a framework within which to work (Gilster, 2012, p. 770). This idea that activism addresses systemic change is echoed by fat activist Cooper (2016a), who said that activist strategies can vary from “micro activism” (e.g., pointing out problematic language and behavior) to community building efforts to involvement in political processes. She noted the contradictions that are inherent in any social movement within a capitalist society. For example, Cooper (2016a) has drawn attention to the gentrification of radical fat activism that is a result of “fatshion,” or efforts to campaign for chic clothing for fat women as a result of the body positivity movement. This work has produced more clothing options for fat women and has turned the movement into a consumer activity in which only those with purchasing power can participate. Similar to Brown’s (1995) claim that feminist therapy has historically failed to be multicultural in its theory, research, and practice, Cooper argued that the gentrification of fat activism has removed itself from understanding the larger structures of oppression and primarily benefitted middle-class White women. In the words of one of her interviewees, “I don’t want, you know, fatties to just be on Vogue magazine, or whatever, I want it to be much more broad than that … Like, not a piece of the pie, the pie is rotten, let’s get rid of the pie, or something” (p. 59). This quote reflects a feminist call for action to challenge the deeper patriarchal structure that maintains and promotes fat prejudice. Thus, the fat activists and groups that we highlight take up this feminist call by addressing systemic sizeism in a variety of areas.

Social media platforms have given activists an easy way to connect to each other and engage in collective action (Obar, Zube, & Lampe, 2012; Obar, 2014), and many fat activist spaces can be found online in what is known as the fatosphere. In fact, social media has provided fat activists a new platform to challenge the mainstream, medicalized discourse of body image and beauty. A content analysis of the narratives of four fat activist bloggers showed that their strategies appeared to assimilate into the mainstream body positivity movements (e.g., taking and posting selfies), yet their language was anything but conventional (Afful & Ricciardelli, 2015). For example, one blogger “avoids assimilationist rhetoric, in that she declares she is not interested in creating positive or even normative images, but the opposite. She hopes to highlight how non-normative fat bodies appear to most people because of anti-fat discourses perpetuated in part by media” (p. 463). Fat activist bloggers have purposefully used strategies from the feminist, LGBTQ, and civil rights movements to talk about body diversity. For example, two fat activist bloggers used the phrase “coming out” in order to inhabit online and offline public spaces that challenge mainstream fat narratives.

Therapists might want to encourage clients to seek out and read work by bloggers in the fatosphere. Exposing clients to ways of thinking and talking about their bodies using new language may be a powerful way to reconstruct their own self-narratives and create community. Gerbner and Gross (1976) introduced the term “symbolic annihilation” to describe the underrepresentation of certain people based on group membership (e.g., race, class, gender, age, sexual orientation). Feminist and queer scholars have further argued that the lack of diversity in media portrayals of women and members of the LGBTQ community maintains social inequality. By extension, we argue that the lack of body size diversity, in terms of phenotype and the kind of language used to describe them, serves to eradicate the experience of those who are struggling with sizeism. The inclusion of diverse images and alternatives discourses could help to empower clients. The nature of grass-roots, civic engagement often happens at a local community level, so we encourage therapists and clients to seek out activist voices in their communities that represent their particular social identities.

Although some fat activists like Cooper are academics, much activist work appears outside the academy. We spend the remainder of this article introducing some fat activists and activist groups whose efforts challenge systemic sizeism despite superficial appearances that they have assimilated into the dominant framework. Their ideas do not fit neatly into “traditional” activist strategies such as speaking on behalf of a group, joining an organization, letter-writing, boycotts, organizing campaigns, protesting, and petitioning. However, these strategies can be used in any of the spaces where sizeism is challenged: the rhetoric of fat; body positivity; photography/art; nutrition/exercise; and diversity/intersectionality. Most fat activists’ work confronts sizeism within several of these areas, but we try and highlight their major focus. Where relevant, we include some of our own activist work on college campuses.

Fat Activists and Strategies

Challenging the rhetoric of fat.

We begin with Marilynn Wann, author of a zine and book titled Fat!So (Wann, 1998) because she was one of the first fat activists to write about sizeism. Wann challenged the healthcare, insurance, and diet industries, size discrimination laws, and the language used to refer to fat people. As she stated, “correct people when they use euphemisms for size. Say, ‘I prefer the word fat. It’s more polite’” (Wann, 1998, p. 11). Wann’s activism can also be seen through her art. She created the Yay! Scale, which shows compliments (e.g., gorgeous, sexy, yummy) instead of numbers (Gard, 2006). Wann’s and other body-positive artists’ work can be found on VoluptuArt (voluptuart.com), a site founded by psychotherapist Nomi Dekel. Wann (1998) suggested “154 ways to be a fatso” (p. 9), and we urge therapists and clients to read about some of these ideas, including the use of art as a therapeutic tool. Wann’s website (www.fatso.com) contains a blog where readers can submit their own stories and space where readers can submit photos of weight prejudice.

Like Wann, we view scales as powerful physical and symbolic tools of weight judgment, and we have used them in some of our own activist work on campus. We were inspired by Simone’s (2012) Project Weightless (www.facebook.com/ProjectWeightless/) work to combat mandatory BMI weigh-ins by holding a scale-smashing event where students and community members were invited to bring their bathroom scales to destroy in the middle of the campus green. As they brought a sledgehammer down onto the scale, we urged them to say, “My weight does not define me, I am…[a non-weight related self description].” There are several clips of this event on YouTube, including the one we suggest here: (youtube.com/watch?v=Vh46JdstrLo).

In one hour, over 30 people eagerly took a turn smashing a scale and we had countless onlookers including local media. Responses to the event were overwhelmingly positive and many of the participants expressed how enlightening and surprisingly freeing it made them feel. Even though she did not participate, one onlooker who felt ashamed of her weight later wrote to us expressing her gratitude. She was in tears and thanked us for demonstrating the possibility that she could someday relate differently to her weight. We also received an email in support of the event from a local a community member who recently lost a child as a result of complications related to anorexia nervosa. We are planning to repeat this event again.

We discuss Marianne Kirby and Lesley Kinzel together for their work on Fatcast (fatcast.twowholecakes.com), one of the first podcasts about body politics. Fatcast ran from 2010-2011, but all conversations can still be heard online. Fat activist podcasts consistently challenge the dominant discourse around fat may serve as a model for clients trying to reclaim the language of fat. Each activist has her own outlets for writing about body politics, social justice, and fat activism: Marianne Kirby (mariannekirby.com), Two whole cakes (blog.twowholecakes.com), and Lesley was here (lesleykinzel.com). Some other fat activism and feminist podcasts are introduced in an article published by Bustle (http://bustle.com/articles/173804-11-feminist-body-positive-podcasts-that-will-inspire-your-politics).

Reclaiming words, like “fat”, that have been used pejoratively is an activist strategy that can be explored in a therapeutic context. Cooper (2016b) said “in calling myself fat I am drawing on a feminist practice of naming things in order to bring them into being” (para. 1). Her zine entitled “Fat Activist Vernacular” (http://charlottecooper.bigcartel.com/product/fat-activist-vernacular) is a collection of words that subvert power from the medicalized language used to talk about fat people.

Body positivity.

In 1996, Connie Sobczak and Elizabeth Scott founded The Body Positive whose mission is to teach “people how to reconnect to their innate body wisdom so they can have more balanced, joyful self-care, and a relationship with their whole selves that is guided by love, forgiveness, and humor” (thebodypositive.org). From a list of 13 body positive bloggers labeled “fatshionistas” (Ospina, 2015), we recommend Jes Baker because her activism is representative of those who are critical of the body positivity movement. Baker (2017) dismissed what she calls the “shallow, exclusive, and uncritical” body positive movement for not being intersectional, only showing thin bodies, and refusing “to dig into the deep and critical political issues around comprehensive body liberation” (para. 7). Her website (themilitantbaker.com) has an extensive resource list regarding mental health, sexual assault, anti-online harassment, and intersectionality.

Like Cooper, Baker has reclaimed and uses “fat” to describe herself. Her “fatshion” (another clever term in language use) blog is popular and although not typically seen as an activist strategy, wearing clothes deemed unsuitable for fat women is certainly a way to challenge sizeism. Feminist therapist and activist Maine (2000) reminds us that even loving one’s body can be a revolutionary act.

Photography/art.

Photo activism is the use of photography to raise awareness; pictures can be shocking, confrontational, or symbolic (Bogre, 2012). In support of “artivism” Nossel (2016) said “to move an individual makes social change possible. We should not shy away from the aeffect [sic] of art but embrace and harness it” (p. 105). Activists have used powerful photo campaigns to combat issues such as transgender visibility(facebook.com/VisibleBodies), disabilities (Frank, 2014), gender-based street harassment (tlynnfaz.com/Stop-Telling-Women-to-Smile), marriage and gender equality (noh8campaign.com/), and sexual assault, domestic violence, and child abuse (projectunbreakable.tumblr.com/). Baker, mentioned above, is also a photographer and founder of Body Image(s) “a series of photographs of women with diverse” body sizes, shapes, and shades of beauty” (jesbaker.wixsite.com/the-body-images).

In a sizeist culture, fat people are symbolically annihilated and the use of photography is as an activist strategy is fairly available. Baker recommends “culture jamming” which is creating alternative images not seen in the mainstream media (Kronengold, n.d.). Letter writing is a well-documented strategy that can be used to request more diversity of images. For example, Baker wrote an open letter to Linda Heasly, President and CEO of Lane Bryant, regarding their #ImNoAngel campaign for lack of diverse images of women. In addition, Baker created a counter-campaign called #EmpowerALLBodies inclusive of body diversity including disability, race, sexuality, and age. We suggest that therapists can guide clients to not only look at images critically, but to take their own unaltered pictures, share them on social media, with other like-minded groups, and join in creating inclusive photo projects.

Photo activism have been very popular and successful with students. For example, Project Weightless (facebook.com/ProjectWeightless/), which was part of our scale smashing event, and Project Woman Defined (facebook.com/Project-Woman-Defined-1441101556121911) served to deconstruct weight and image rhetoric. Demauro’s (2014) Project Woman Defined challenged those who identify as women to define themselves beyond the male gaze. She was able to collect over 100 photos and stories from women-identified individuals from across the United States. College-based groups doing feminist and activist work like ours may serve as excellent resources for therapists and clients seeking to get involved in local efforts.

Natalie Perkins is a disabled, fat activist from Australia who designs, sews, and alters clothing patterns to fit fat women (definatalie.com). She rejects the size charts that suggest that she does not “exist,” and she focuses her politics on accessibility and taking up space. Speaking about activism, she wrote, “I never stopped my personal activism, and I never stopped experiencing fat stigma. It is a perpetual work, and it IS work. Many people don’t think they are doing labour when they are resisting and questioning systemic abuse and neglect” (Perkins, 2016). She also created “Girth Guides” for other fat activists as a sort of merit badge they could wear to validate and reward their work. These and other artwork can be found on her Etsy site: etsy.com/au/shop/fancyladyindustries. One of the benefits of engaging in “artivism” can be a sense of support, purpose and connection to others and organizations.

Nutrition and exercise.

Michelle Allison, who calls herself “the fat nutritionist” is a registered dietician from Canada who approaches eating and weight in an unconventional way (fatnutritionist.com). Using the “How to Eat” protocol from the HAES® model, her site lists what she does not do: tell clients what to eat, keep a food diary, and judge weight. Her blog also provides information on normal eating and debunks the myth that there is a connection between fat and being unhealthy. She also provides an excellent list of peer-reviewed scientific articles that address some of the controversies concerning dieting, weight, and eating.

Ragen Chastain is a fierce proponent of the HAES® model and in 2011 she left her job to become a full-time size diversity activist. She has been blogging since 2005 (danceswithfat.wordpress.com/blog) and calls herself a “fathlete,” who challenges the stereotypes that fat women cannot be physically agile. She was a varsity athlete, won three national dance championships, and ran a marathon. Clients and therapists who are seeking alternative ways to engage with eating and/or exercise may use these two blogs, as they both confront the mainstream strategies.

These and other fat activists certainly embrace two of the components of the HAES® model-- embracing the joy of movement and relying on internal cues of hunger and satiety. Fundamentally relating to other ways of eating and moving that are not tied to body weight, size, and caloric intake challenges the core and economic stability of the diet industry. Boycotting diet, health, and technology products that target weight loss could be empowering for clients.

Diversity/intersectionality.

Here we highlight two groups of activists whose mission is include issues of diversity and intersectionality that weight has with other social identities. In February, 2011, Sonya Renee Taylor’s fat activism began when she posted a profile picture on her Facebook page that went viral (thebodyisnotanapology.com). She said, “I was clear that my big, brown, queer body was not supposed to be seen or sexy, but I posted it anyway. This terribly frightening act was birthed from the outlandishly simple idea that no human being should be ashamed of being in a human body” (Taylor, n.d.). The body is not an apology: Radical self love for everybody and every body (thebodyisnotanapology.com) contains articles on the intersections of embodiment with race, disability, sexuality, gender identity, mental health, and other identities/issues. One author, a self-identified mixed-race U.S. citizen and child of immigrants, recently wrote about moving away from Eurocentric beauty standards (Gittelman, 2017). Her suggestions to achieve radical self-love include questioning, redefining, and identifying toxic beauty standards, including how the beauty industry equates beauty with being White. The site contains “bad picture Monday,” which challenges body terrorism, refuses “the politics of invisibility, and” refutes the rhetoric that a body can be “bad.” Clients can follow this group on Instagram where they post messages and images that regarding a variety of social identities.

Another fat activist group, It gets fatter! (itgetsfatter.tumblr.com) was created by fat, queer people of color. The founders’ goal was to create a space for self-identified fat people with intersecting identities (specifically, race, sex, gender, and ability) to talk about fat phobia and fat positivity. They noted, since we know people of color are socialized in entirely different ways from white folks when it comes to our bodies and the ways we relate to them, we want to create a space for us to really discuss what that looks like, to talk about what works and what doesn’t, and to share the ways we are surviving (It get fatter!, 2012).

This is one of the only activist groups created by people of color with diverse social identities, and it may an important online space for clients and therapists who seek fat positivity for those who with marginalized identities.

Feminist scholars have called for a more multicultural approach to both theory and practice (e.g., Brown, 1995) and noted the gentrification within fat activist history (Cooper, 2016a). In our search for fat activists online, White voices predominated (there was some variation in ability status and sexual orientation identities). Brown (1995) urged therapists and scholars do the hard work of ensuring that the experience of women of color are represented. Thus, what we know about fat activist strategies may be primarily used by Whites and not representative of people of color, the LGBTQ community, or those with other marginalized identities. We observed that the fat activists in this section involved community contributions rather than an individual’s. Therefore, we strongly encourage therapists to work closely with clients to find sources of activism that represent their unique identities and issues.

Conclusion

Conventional American wisdom suggests that body size and weight are under the control of the individual. However, feminist theories view women’s psychological distress over weight issues as embedded in the larger social systems that value the thin-ideal. Feminist therapies recognize that an individual woman’s distress cannot be improved in therapy unless there are also structural changes to those factors that maintain fat oppression. They thereby acknowledge that activism is part of the therapeutic process (Israeli & Santor, 2000). We suggest that therapists incorporate activist strategies with their clients who have been affected by sizeism such as reclaiming language, writing letters, boycotting organizations or products, creating clothing and fat positive images, and joining groups, campaigns, and movements.

Recent shifts in prevention efforts and health interventions (i.e., The Body Project and Accept Yourself!) have aimed to deconstruct sociocultural pressures to attain the thin ideal. These programs have shown that by deconstructing the thin ideal and moving away from a focus on weight results in improvements in psychology and physical health (Cassone, et. al., 2016; Humphrey, et al., 2015; Stice et al., 2013). Thus, we encourage therapists to seek out such interventions like the Accept Yourself! Program which is based on the HAES® model. These findings also suggest that activist work that also deconstructs the thin ideal may result in improved psychological and physical health.

While little research has examined the impact of fat activism in the context of therapy (Israeli & Santor, 2000) activism itself has been correlated to well-being, personal mastery, empowerment, and social ties (Gilster, 2012). For fat activists in particular, collective action through social media shows promise (Obar et. al., 2012). Connecting to others can raise consciousness, provide a sense of purpose, learn about and engage in fat activist ideas, and be exposed to fat affirming images. Such depictions may serve to empower those who do not see themselves represented in the culture, especially those with marginalized intersecting identities (Gerbner & Gross, 1976). Fat activism may also serve to empower individuals in therapy, particularly in what Brown (2010) identified as “interpersonal/social-contextual power.”

As academics, campus activists and size diversity advocates, we recognize that fundamental change must address these deeper social, cultural, and political structures that underlie fat oppression. We are encouraged by the presence of fat activists and several health promotion/prevention programs that challenge these structures in the areas language, body positivity, photography/art, nutrition/exercise, and diversity/intersectionality. Their thoughts, research, experiences, and strategies may be useful in a therapeutic context by offering new opinions and resources, aiding clients in deconstructing the thin ideal, and challenging the sociocultural structures that support sizeism.