The Weight of Inequity: A Critical Analysis of Fat Phobia in the Canadian Healthcare System.
By: Vanessa Greer
University of Victoria – School of Social Work
SOCW 400: Introduction to Social Work in the Healthcare Sector
Instructor: Leanne Stepp
July 25th, 2025
Author’s Note: The use of the word ‘fat’ and ‘fatphobia’ has been controversial and stigmatised throughout Western Euro-centric society. Due to this fact, our society has chosen to use terms like “overweight”, “obese”, “chubby”, “big”, or “well-rounded” among others. I choose to use the word fat in this research paper because many fat people prefer directness and ownership of the word instead of attaching shame to the term. It is time to remove the stigma and shame associated with this word.
Introduction
The current problem of fat phobia in Canadian healthcare is one that has caused significant harm within our healthcare system and continues to limit people’s access to necessary care and support. This problem has been exacerbated by the creation of clinical tools, like the Body Mass Index (BMI) system. The BMI further cemented this historical bias into our healthcare system by reducing complex human bodies down to a single metric. Originating from a history of colonisation and racism, fat phobia is now deeply ingrained within the Canadian healthcare system where it continues to cause measurable harms that fuel profound health inequity. Therefore, this paper argues that for healthcare professionals to dismantle this oppressive legacy, they must adopt activist frameworks like Fat liberation and Fat Activism (Sorensen & Krings, 2023), which offer a necessary decolonial and intersectional pathway toward body justice and health equity.
History and Racist Origins
The Body Mass Index (BMI) was not created by any healthcare professional. As the literature review by Pray and Riskin (2023) confirms, the formula was created by Belgian mathematician Lambert Adolphe Jacques Quetelet in the 1830s as a tool for population-level statistics, not for clinical diagnostics. The fundamental faults of the BMI stem directly from this origin. It was developed using data exclusively from white, European, cisgender male populations, and it inherently fails to account for crucial variables such as body composition, muscle mass, or fat distribution (Pray & Riskin, 2023) (Kelvas, 2024). In the 1970s, dietician Ancel Keys turned Quetelet’s Index into what we now know as the Body Mass Index (Truu, 2022). Despite its rebranding, these core flaws remain, rendering it an inaccurate predictor of an individual's health. Any athlete can have a high BMI number while being very healthy (Truu, 2022). Now, almost 200 years after its original creation, BMI continues to be used in everything from health tracking apps to surgical assessments. This reliance on the BMI is not merely theoretical; it has tangible and sometimes life-altering consequences, as many fat individuals are denied access to necessary surgeries based solely on this inaccurate number. Doctors continue to dismiss fat people’s health concerns due to the discriminatory belief that weight is an indicator of health. This can easily be disproven because otherwise people who are classified as thin would statistically have fewer health issues than fat individuals with a higher weight or larger waist circumference. According to an article in Within Health Magazine, “Weight, often, has little overall influence on someone's overall risk factor for specific health conditions” and “thinner-bodied people can still have significant health problems” (Kelvas, 2024). These points should help us to steer away from using metrics such as the BMI in healthcare, yet we continue to needlessly cling to this outdated metric which was not designed for this use. Although some physicians are starting to move away from using the BMI, many still won’t accept patients for necessary surgeries without them being below a specific BMI number (personal experience, 2025). If we look up to doctors as being some of the most educated people in our society, then why would they use a system as distorted as the BMI, or fail to understand that weight is not a reliable indicator of health?
The Harms of Fat Phobia and Body Discrimination
To understand the harms of fat phobia, we must also understand the concept of healthy equity. As López and Gadsden (2016) explain, health equity is not merely the absence of health disparities, but the “active assurance of optimal conditions for all people.” This requires “valuing everyone equally, rectifying historic inequities and distributing resources according to need” (López & Gadsden, 2016, p. 3). The fat phobia in the Canadian healthcare system is a systemic issue which fundamentally violates each of these tenets. When physicians and health care professionals dismiss the concerns of fat people, and use flawed clinical tools like the BMI, the system fails to treat everyone's bodies equally. Furthermore, by ignoring the colonial and racist origins of modern body standards (Strings, 2019, as cited by Sorensen & Krings, 2023) it fails to rectify historic inequities. As López and Gadsden argue, such inequities are not a "'natural' phenomenon but is the result of a toxic combination of poor social policies... and bad politics" (2016, p. 3). Fat phobia is the kind of toxic political arrangement that acts as a powerful social determinant of health while also actively preventing health equity from being achieved. This presents a direct challenge to the social work profession. While social work is mandated to address the social determinants of health, the article by Craig et al. (2013) suggests a significant gap between this mandate and frontline social work practice. In their study, "Making the invisible visible," Craig et al. (2013) found that health social workers often face systemic barriers that prevent them from consistently addressing the social determinants of health. This raises a critical question: if the profession already struggles with known determinants like poverty or housing, how can it effectively address a less visible, highly stigmatised determinant like fat phobia without a dedicated and critical framework?
Aside from many accounts that can be found online about discrimination of fat people in the healthcare system, I have personally witnessed several instances myself. One of my friends recently sought the help of a registered dietician due to severe health problems including kidney issues, type 2 diabetes, and malnutrition. The dietician not only ignored the person’s concerns but also told her to “just go eat more salads”. This dismissal of her symptoms just added insult to injury and, although it was reported and hopefully dealt with, the person who was seeking care was harmed at a time when she was vulnerable and asking for help. There are other stories of health issues being incorrectly attributed to fatness due to fat phobia and judgement from healthcare professionals, which have even led to the death of the patient (Kost et al., 2024). Fat phobia exists in many areas of our society, such as in schools, workplaces, and in healthcare. It is my opinion that when people are accessing healthcare, they can be extremely vulnerable and need more compassion and understanding.
Through adopting an intersectional lens (Crenshaw, 2016), we know that although a cisgender white man may experience fat phobia in a healthcare setting, someone who is female-identifying experiences more discrimination. In the article, “First People, Second Class Treatment” (Allan & Smylie, 2015), it is clear that Indigenous people already experience discrimination, especially in the healthcare system. If someone is fat as well, this discrimination would compound upon other identities of being female and indigenous.
Along with fat phobia often come judgements from others about how the person got there. This can be one of the most harmful rhetorics out there because it causes a lot of shame in people for being fat. Even in modern society with scientific information at our fingertips, people continue to subscribe to popular diet culture which continues to tote thinness as one of the only ways to achieve health (Kelvas, 2024). This is not true. In their article, Sorensen and Krings (2023) explain that “although fatness is typically interpreted as a moral failing that must be ‘cured’”, a person’s weight is “primarily a reflection of factors outside of one's control including social determinants of health like poverty, environmental health, discrimination, lack of access to quality health care, and sociocultural identity.”
Fat Liberation and Moving Forward
The concept of fat activism could be one of the best ways to move the Canadian healthcare system away from fat phobia and weight bias and toward health equity. As Sorensen and Krings (2023) state, “Fat activism draws upon critical feminist theory, fat studies, critical weight science, and disability studies to emphasize a new understanding of fatness.” Acknowledging the deep colonial roots of fat phobia is an important step, but analysis alone is not enough to create the necessary change. A true social-justice response requires the synthesis of critical reflection along with deliberate action. The framework of fat liberation (Sorensen & Krings, 2023) provides the necessary praxis for moving forward in a socially just way. This will help social workers and other healthcare practitioners to move from being compassionate observers of harm, to becoming co-conspirators in the fight for body justice and health equity for all. Adopting a fat liberationist stance is a fundamentally decolonial practice. As Eguchi et al. (2016) outline in their toolkit for decolonizing social work, this work needs to occur at the individual, workplace, and community levels. Fat liberation (Sorensen and Krings, 2023) provides a direct pathway for this multi-level engagement on the micro, mezzo, and macro levels.
At the micro-level, which Eguchi et al. (2016) describes as the individual level of practice, a social worker would embrace body sovereignty. This means actively challenging the colonial origins of the BMI in clinical practice as well as advocating for a patient’s right to self-determination regarding their health goals, free from the pressure to lose weight.
At the mezzo-level, or the workplace, the task is to dismantle the institutional structures that perpetuate harm. Guided by the principles of both fat liberation and decolonization, a social worker would advocate for changes like purchasing size-inclusive medical equipment, removing weight from routine intake forms, and developing anti-oppression training for all staff that explicitly addresses fat phobia.
Finally, at the macro-level, both frameworks call for engagement with the broader community and political systems. For social workers, this means moving beyond the clinic to challenge the systems that create health inequities. This would include advocating for policies that protect against weight-based discrimination and supporting community-led movements, such as Indigenous food sovereignty, that offer alternatives to colonial models of health and nutrition.
Social workers have a choice. We have a choice in how we treat fat people both in our practice and in our daily lives. We have a choice in how we integrate fat activism into our social work through a decolonial and ethical approach. Sorensen and Krings (2023) explains that although social workers may integrate principles of fat activism into their practice without calling it as such, “without critical analysis, they can act as ‘norm enforcers,’ who interpret intentional weight loss as a positive pro-health behavior”. This provides a caution that social workers can unintentionally cause harm if we do not address our own biases.
Conclusion and Final Thoughts
So, what is the way forward? How do we change our societal way of thinking and our continuous judgment of those who are fat? The media has continued to portray fatness or obesity as a global epidemic. Diet culture still causes people to believe that gaining weight is a moral failing and somehow only attributed to bad dietary choices. On top of this, people with other intersecting identities such as being Black, Indigenous, disabled, gender diverse, or otherwise marginalised can compound on this discrimination even further. As social workers, it is our responsibility to support people, no matter their body size. So how do we do this?
The racist and colonial origins of the BMI and body size discrimination are clear. We also know that the judgement of different bodies, especially in our healthcare system, continues to cause measurable harms that fuel profound health inequity. This paper set out to argue that for healthcare professionals to dismantle this oppressive legacy, they must adopt activist frameworks like fat liberation and fat activism (Sorensen & Krings, 2023), which offer a necessary decolonial and intersectional pathway toward body justice and health equity. Ultimately, the choice is clear for social workers and all health care providers. We can either continue to operate in a system that causes measurable harm where we inadvertently act as 'norm enforcers' by perpetuating weight stigma, or we can answer the call of the fat liberation movement. As the article by Sorensen and Krings (2023) warns, “when social workers fail to challenge belief systems relating to weight stigma and anti-fat bias, they risk causing harm.” This tells us that the way forward is not simply to be more kind and understanding, but to be actively anti-oppressive and decolonial in our approach. We can become active and willing co-conspirators in the fight for body justice and true health equity for everyone, regardless of their size.
References:
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