On screen and in real life, we pathologize fatness, even as we pretend to accept it

Few people actually enjoy going to the doctor, but there's a special kind of dread that comes when you know there's a good chance the physician won't take your pain seriously.

For some, fearing the doctor is not an irrational response, but a learned behaviour borne from years of humiliation.

That humiliation was brought to the attention of the wider Canadian public this summer because of an obituary published for Ellen Maud Bennett, a 64-year-old B.C. woman who died of cancer in May. Bennett asked her family to use her final farewell to call out the too-common phenomenon of fat-shaming in the medical community.

"Over the past few years of feeling unwell she sought out medical intervention and no one offered any support or suggestions beyond weight loss," her obituary read. "Ellen's dying wish was that women of size make her death matter by advocating strongly for their health and not accepting that fat is the only relevant health issue."

Her story should be novel, but it's not. From Roxane Gay's searing memoir Hunger, to analysis in the British Medical Journal, there are all sorts of stories of doctors telling bigger patients whatever ails them will disappear along with a few pounds.

For fat patients, it means their symptoms are often dismissed, they become less willing to go to the doctor and they often get less care when they do. 

That means serious medical issues can be missed. Take the story of Rebecca Hiles, a young American woman who spent years coughing so hard she often drew blood, only to have doctors tell her she needed to lose weight. In fact, Hiles had cancer, and thanks to five years of misdiagnoses, she ended up losing her entire left lung.

Weight loss as a panacea

I once had a walk-in doctor tell me that a searing pain in my side would disappear if I lost some weight and stretched more. Days of agony later, my GP told me I had passed a kidney stone without medication.

This is not to say big bodies are the only ones whose pain is lessened; study after study shows doctors often fail to take women's pain seriously — an issue that's often compounded for black and brown women. Nor is it to denigrate all doctors; my family doctor is lovely and one of the few physicians I've seen who has always treated me as a whole person, not a number on a scale.

Instead, this is to highlight how deeply our society has come to believe that weight loss is a panacea — and not just for physical ailments, but for social and emotional problems, too.

It plays out in an inexhaustible stream of tired pop culture offerings: get small, get the guy. Or some variation thereof: get small, get revenge — as seems to be the message of one forthcoming Netflix show that's already prompted a social media firestorm.

• Woman uses obituary to advocate against fat shaming in medical profession

• Good Fat Care: Website aims to reduce weight discrimination in health care

The show, Insatiable, is billed as binge-worthy romp about a teen girl who is relentlessly mocked by her peers for being overweight. The character suffers an injury early on and needs to get her jaw wired shut, which results in her getting thin, and thus, finding the confidence to get even with the classmates who tortured her bigger self. The glossy trailer was enough for many cultural critics to decry its dangerous trope, spawning petitions and calls for Netflix to halt the show's release.

Its creators responded by saying people should give it a shot: that its message is actually body-positive, despite the fact its main character has to literally stop eating to become a self-assured person.

But hey, I guess they could surprise us with something that actually embraces self love at all sizes: a world where the heroine gains all the weight back and ends up happier and bigger than ever.

I suspect not, however, because there are two ways fat bodies are usually portrayed in Hollywood: as something to be shed in the process of becoming something better, or as a punchline. The former category includes characters such as fat-suit Monica on Friends, or much-lauded books such as 13 Ways of Looking at a Fat Girl — both of which imply that fatness must be overcome to find joy.

In the latter category: average-sized women such as Amy Schumer and Lena Dunham are considered "Hollywood fat" and used for gross-out jokes, and larger women such as Rebel Wilson are used almost entirely for comedic relief. When they are written into love stories, as was Wilson's character in Pitch Perfect 2, the situation is treated as so absurd that it's a source of laughter. 

Even a film touted as Netflix's antidote to Insatiable, a flick called Sierra Burgess is a Loser, hangs off the character's weight, though it purports to be body positive. It's as if writers are incapable of imagining a wholly formed character who isn't defined solely by her size. 

But fatness doesn't work that way. Yet even in 2018, when it seems like every other week another brand is announcing "extended" sizing and advertisers start regularly positioning happy, smiling, curvy-but-not-quite-fat bodies in ads, we pathologize fatness in our culture even as we pretend to accept it. That attitude then creeps into everything: from teen romps to doctors' offices.

Our insatiable appetite for stories where characters are transformed when the weight falls off doesn't just fuel bullying and eating disorders: it creates a culture where fatness itself is the disease, blinding doctors to what lies beneath. The medical culture is a symptom of a larger societal rot, and one that shouldn't require obituaries to solve. Instead, all it takes is a little imagination and the ability to see fat bodies as whole people. To celebrate characters, not caricatures. 

This column is part of CBC's Opinion section. For more information about this section, please read this editor's blog and our FAQ.