everyone they interact with that their size is nothing to apologize for. “When you pity someone, you think they’re less effective, less competent, more hurt,” he says. “You don’t see them as capable. The only way to get rid of stigma is from power.”

Your conscious mind is busy the whole day with how many calories is in everything, what you can eat and who’s watching,” she says. After a few intrusive comments over the years—should you be eating that?—she has learned to be careful, to perform the role of the impeccable fat person.

Erin Harrop, a researcher at the University of Washington, studies higher-weight women with anorexia, who, contrary to the size-zero stereotype of most media depictions, are twice as likely to report vomiting, using laxatives and abusing diet pills. Thin women, Harrop discovered, take around three years to get into treatment, while her participants spent an average of 13 and a half years waiting for their disorders to be addressed

And so, working within a system that neither trains nor encourages them to meaningfully engage with their higher-weight patients, doctors fall back on recommending fad diets and delivering bland motivational platitu

Many of the financial and administrative structures doctors work within help reinforce this bad behavior.

In a 2013 journal article, bioethicist Daniel Callahan argued for more stigma against fat people

No matter what you go in for or how much you’re hurting, the first thing you will be told is that it would all get better if you could just put down the Cheetos

If you looked at anything other than my weight,” Enneking says now, “I had an eating disorder. And my doctor was congratulating me.”

weight and health are not perfect synonyms

The first is that diets do not work. Not just paleo or Atkins or Weight Watchers or Goop, but all diets. Since 1959, research has shown that 95 to 98 percent of attempts to lose weight fail and that two-thirds of dieters gain back more than they lost.

“Baby Beluga” as she boarded the school bus, another said she has tried diets so extreme she has passed out and yet another described the elaborate measures he takes to keep his spouse from seeing him naked in the light. A medical technician I’ll call Sam (he asked me to change his name so his wife wouldn’t find out he spoke to me) said that one glimpse of himself in a mirror can destroy his mood for days.

Obesity, we are told, is a personal failing that strains our health care system, shrinks our GDP and saps our military strength. I

People’s Institute for Survival and Beyond, Race Forward, Western States Cen-ter, the Haas Institute for a Fair and Inclusive Society,

A clearer understanding of what we know, and what we don't know, is a better path to ensuring that our investments in social factors truly pay off.

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