Out On The Couch
I am a fat, queer, able-bodied, neurotypical, white, and cisgender femme person (note: cisgender = my gender is congruent with the gender I was socially assigned). I’m well aware of societal expectations for the way my body should look, to express my gender consistent with white womanhood, and to engage in romantic and sexual relationships in a certain way. I also know that the bar for being seen, respected, and accepted for who I am would be sky high if I was a fat, autistic, disabled, polyamorous, transgender feminine person of color.
Most of the research conducted with people who are fat and/or trans has been with white, able-bodied humans, so any negative impact I discuss related to fat trans folks is likely even more detrimental for people of color and for those with chronic illness and/or disabilities. I write this as a person with privilege who aims to learn more, and educate others about systems of oppression and power, while also advocating for human rights and dignity. I am personally familiar with experiences of fatphobia and sexism, and I have a specialty in counseling trans and gender nonbinary (TGNB) people.
Weight Stigma, Fatphobia, & Microaggressions
When you see a slim person jogging down the road, do you think, “good for them!?” When a slim person walks along the beach in a bikini, do you think, “ugh, they shouldn’t be wearing that!?” When you notice that a slim friend has gained weight, do you say, “oh wow, you’ve gained weight? What are you doing?” I’m guessing most of us don’t, so why would it be OK for us to judge or comment on fat bodies? The short answer: it’s not OK. Basically never. Just like it’s never OK for us to comment on trans and gender non-conforming bodies.
The National Eating Disorders Association (NEDA, 2018) defines weight stigma as discrimination or stereotyping based on a person’s weight (also referred to as sizeism). Weight stigma is known to increase body dissatisfaction, which is a leading risk factor for disordered eating. NEDA clearly states, “the best-known environmental contributor to the development of eating disorders is the sociocultural idealization of thinness.” Many people who struggle with body image and disordered eating got messages along the way that shamed their bodies and/or food choices, suggesting they weren’t good enough just the way they were.
Fatphobia, the fear and/or hatred of fat bodies, is an extension of sizeism. Many of us have learned not only that thin is the ideal, but that being fat is to be avoided like the plague. We are constantly exposed to messages that thin = good and fat = bad (e.g., TV and movies, comments from our parents, health & wellness marketing, conversations with our friends, and health insurance companies offering wellness discounts). Brené Brown’s research found that a) appearance and body image and b) being stereotyped and labeled are two of the 12 most common triggers for shame (Brown, 2007). This hatred and fear of fatness becomes internalized and spreads like wildfire in the ways we talk about ourselves, evaluate ourselves compared to others, and judge others’ bodies and food choices. Three questions you might ask yourself to examine your weight bias are: 1) Do I engage in negative body talk? 2) How do I feel about bodies of different sizes? and 3) How do I feel about the concept of weight gain for myself? (Chastain, 2018).
We can’t talk about stigma and fatphobia without also talking about microaggressions, which Sue (2010) defined as “commonplace verbal, behavioral, or environmental indignities, whether intentional or unintentional, that communicate hostile, derogatory, or negative insults to a target person or group.” The very nature of microaggressions is that they are often unintentional and unacknowledged slights, leaving the recipient to process those thousands of tiny moments that invalidate that person’s very existence.
For example, when someone says to a friend who has lost weight, “wow, you look great,” it is thinly veiled as a compliment that covers up the deeper diet culture judgment, “your body is more desirable now that it is thinner.” When someone watching you eat X food says, “I don’t eat X – it’s bad for you,” what it really suggests is, “be careful eating that food – you wouldn’t want to become fat and/or unhealthy. In fact, the conflation of weight with health and “concern for health” is one of the more common ways that people (especially health providers) justify weight-related microaggressions. Sadly, what often gets in the way of health for fat folks is the very structural oppression they face by those who believe people are unhealthy because they are fat (Lee & Pausé, 2016).
At the Intersection of Fat & Trans
When we talk about the above concepts in relation to fatness, they also hold true for other identities that experience oppression, e.g., race, gender, ability, sexuality, etc. TGNB folks experience transphobia, cissexism, cis-heteronormative expectations, and pressures to fit into (white) binary understandings of gender, i.e., what it supposedly means to be a man or a woman. Because TGNB people are often valued based on how well their bodies “fit in” to these expectations, it follows that they would also be held to standards of body size, shape, and weight. Adding weight stigma to the other pressures that a TGNB person experiences along with their own struggles with their body is like a shaken soda bottle of oppression waiting to explode.
Here are several ways that a TGNB person might experience the cumulative and harmful effects of sizeism and fatphobia in the context of their transness:
- A trans masculine person eats as little as possible to shrink his body and appear more androgynous by reducing the width of his hips & the size of his chest
- A nonbinary person hesitates to go to the gynecologist for worsening pelvic pain, because when they initially brought it up, the doctor said the pain was weight-related.
- A transfeminine person fears going out on a date, because she can’t blend enough with her large belly.
- An agender person has to search endlessly for affordable clothing that both fits their large body and also feels congruent with their gender.
- A genderqueer person wants to fly without drawing attention to themself, but they face ridicule when going through the security body scanners and then are looked at with disgust while walking down the airplane aisle due to their body size.
- A trans woman’s doctor does not refer her to get treatment for her Anorexia, because he reasons that restriction might help her to lose weight.
- A trans adolescent is extremely uncomfortable in their body due to the compounded effects of going through puberty as a fat person.
- A pregnant trans man gets mistaken for being fat and doesn’t get the emergency medical care he needs (note: an article was recently published about this exact situation at usatoday.com).
- A trans person arrives for their consultation appointment for gender affirming surgery, but the armchairs in the waiting room are too small for them to fit, the exam room table cannot hold their weight, and they soon find out that the surgeon has a maximum BMI requirement.
- A trans college student gets the courage to go to the gym and build muscle for his upcoming top surgery, but then is fat shamed by other students at the fitness center.
It is so crucial to be mindful of the ways in which weight stigma and fatphobia intersect with the policing of trans and nonbinary bodies. Don’t trans folks already have enough to worry about with their internal struggles to find peace and affirmation with their bodies? Why do we pile on societal constructions of what they should and shouldn’t look like, that they should and shouldn’t eat, and pressures to modify their bodies to be more feminine (i.e., thin and curvy in the “right” places) or masculine (i.e., thin and muscular)? Why do we expect TBNB people to not only modify their bodies to societal standards, but to do it without developing an eating disorder or increasing hatred toward themselves? We need to do better in making space for TGNB folks of ALL sizes, shapes, expressions, and food preferences. Everybody and every body is worthy of respect and human dignity.
The Greater Impact
The impact of sizeism and fatphobia are pervasive and insidious. For example, adolescents who are teased for their weight are 2-3x more likely to consider and attempt suicide (Eisenburg et al. 2003). TGNB folks, especially transfeminine people and people of color, are significantly impacted by the pressure to fit into gender appearance ideals (i.e., white, light skinned, thin, & young with straight hair; Patton, 2006) that reflect the binary norms of femininity or masculinity.
Here are some ways that TGNB people are impacted by these pressures compared to cisgender people:
- Increased body dissatisfaction and frequent body checking
- Risk of dissociation from or hatred of certain parts of their bodies
- Increase in disordered eating or weight and shape control behaviors, including binge eating, fasting, vomiting, and laxative use
- Weight loss to suppress secondary sex characteristics and/or
- For transfeminine people, to achieve the thin ideal
- For transmasculine people, to slow or stop the menstrual cycle
- For TGNB people with a high BMI, even greater rates of body dissatisfaction and disordered eating
- For transfeminine people, increased experiences of sexual objectification
- Greater risk of mental health struggles due to the stigma of being trans and/or fat
- e.g., desire for weight change increases reported history of suicide attempts and self-injury
- Risk of negative social consequences, stigma, and safety concerns when physical features are not in line with societal expectations for their gender
(Algers et al., 2010, Algars et al., 2012; Diemer et al., 2015, Gordon et al., 2016, Hepp & Milos, 2002; Jones et al., 2016; McGuire et al., 2016, Peterson et al., 2017; Sevelius, 2013; Vocks et al., 2009; & Witcomb et al., 2015)
It’s not surprising that trans folks are afraid to seek medical care from providers who often invalidate them while also imposing guidelines and hoops for them to jump through in order to seek some semblance of gender affirmation/congruence. When you’re fat, that fear increases. And don’t get me started on providers who recommend weight loss as a treatment for anything, regardless of gender. Would you pay to participate in a treatment program that had a 95-98% failure rate and led to most people going back to pre-treatment symptoms within 3-5 years? I hate to be the bearer of bad news, but if you have ever joined a weight loss program or gone on a fancy diet to lose weight, that’s exactly what you’ve done.
Though many TGNB people experience disconnect and dissatisfaction with their bodies, some reconnect with themselves and improve body satisfaction by altering their body, for example, through gender affirming surgery and hormones, body art/tattoos, and/or exercise. Gender affirming treatment, increased body satisfaction, and perceived social support from family, school, and friends help to reduce the risk of disordered eating (McGuire et al., 2016; Testa et al., 2017; Watson et al., 2017). Some find ways to reject the cultural ideals by creating their own unique gender expression, and those who have a more integrated gender identity are more likely to report social awareness, social acceptance, and body satisfaction (McGuire et al., 2017).
So What Can I Do?
Munro (2017) explains, “we live in a world that resists the notion of fatness as a facet of body diversity; as such, fat bodies are rarely represented in a positive light. Fatness is labeled as a disease and the treatment is eradication.” Social change movements for fat acceptance and body liberation are working to challenge and change this cultural mindset, but the journey is long and difficult – like transness, many are afraid of those who are different, those who do not fit the social norms, and those whose bodies challenge our internalized beliefs and fears.
Here are some ways I believe we can work to support our fat TGNB friends and fellow humans:
- Don’t comment on someone’s body parts, body size, food choices, or changes in weight. Ever. Check in when you’re thinking of complimenting someone – is there any chance that the compliment is a veiled microaggression?
- Practice empathy and compassion for others. Many TGNB and fat folks may struggle to love and accept their bodies, which can be a source of significant pain. “Empathy is the antidote to shame.” (Brown, 2007).
- While you’re at it, why not practice self-compassion and be mindful of the way you talk to yourself? “The act of giving yourself some grace is the practice of loving the you that does not like your body.” (Taylor, 2018, p. 114)
- Don’t assume that a TGNB person wants their body to be in line with binary constructions of femininity & masculinity. People have every right to exist in their bodies in whatever way works (or doesn’t work) for them.
- Dig into fat positive movements and literature (note: while there are some body positive (bopo) spaces that address fatphobia, not all bopo spaces are as fat accepting as they should be). Recommendations include:
- Ragen Chastain, https://danceswithfat.org/ blog
- Sonya Renee Taylor, The Body is Not an Apology book
- Rachel Wiley, Nothing is Okay book
- Christy Harrison, Food Psych podcast
- Alison Rachel, Recipes for Self-Love book & instagram
- Some awesome humans on social media: bodyposipanda; mynameisjessamyn; jazzmynejay; alokvmenon; ihartericka; po.rodil; ashleighthelion, and tessholliday.
- Be critical of the way that mass media portrays TGNB people, fat people, and TGNB fat people. Then, “dump the junk” (Taylor, 2018).
- Read up on intersections of transness with various identities, including size, health, race, ability, spirituality, sexuality, etc. so that your TGNB friends don’t need to teach you about their experiences.
- Check the privilege you carry in the world, whether you are cis, white, straight, able-bodied, healthy, wealthy, Christian, slim, etc. or any of the various intersections of these.
- Seek out medical and mental health providers who are fat positive and work from a Size Acceptance and Health at Every Size (HAES) perspective (Bacon, 2008; Chastain, 2012).
A Final Note
To those who are trans and fat, I see you. You are worthy, even when society doesn’t always communicate that to you. Everyone deserves to have love and compassion for the vessel that gets them through this world, even when you don’t like all parts of that vessel. You deserve to dress and express in ways that make you feel good about yourself and in clothes that fit your body, no matter what size you are. You deserve to access gender affirming care from providers who view fatness as a descriptor rather than an epidemic. You deserve to be gentle to yourself on good days, on bad days, and on in between days. There are people out there who will love and accept you at all sizes, in all gender presentations, and for all of the beautiful intersections that make up your identity. You are worthy.
Algars, M. Santtila, P., & Sandnabba, N. K. (2010). Conflicted gender identity, body dissatisfaction and disordered eating in adult men and women. Sex Roles, 63, 118-125.
Algars, M., Alanko, K., Santtila, P., & Sandnabba, N. K. (2012). Disordered eating and gender identity disorder: A qualitative study. Eating Disorders, 20, 300–311. doi: 10.1080/10640266.2012.668482
Bacon, L. (2008). Health at Every Size: The Surprising Truth About Your Weight. Benbella Books, Inc: Dallas, TX.
Brown, B. (2007). I Thought it was Just Me [But it Isn’t]: Making the Journey from “What Will People Think?” to “I am Enough.” Avery/Penguin Random House: New York, NY.
Chastain, R. (2012). Are health at every size and size acceptance the same? Article retrieved on 6/10/19 from https://danceswithfat.org/2012/09/28/are-health-at-every-size-and-size-acceptance-the-same/
Chastain, R. (2018). Three questions to work on weight bias. Article retrieved on 6/10/19 from https://danceswithfat.org/2018/06/12/3-questions-to-work-on-weight-bias/
Diemer, E. W., Grant, J. D., Munn-Chernoff, M. A., Patterson, D. A., & Duncan, A. E. (2015). Gender identity, sexual orientation, and eating-related pathology in a national sample of college students. Journal of Adolescent Health, 57, 144-149.
Eisenberg, M. E., Neumark-Sztainer, D., & Story, M. (2003). Associations of weight-based teasing and emotional well-being among adolescents. Archives of Pediatrics & Adolescent Medicine, 157(8), 733-738.
Gordon, A. R., Austin, S. B., Krieger, N., White Hughto, J. M., & Reisner, S. L. (2016). “I have to constantly prove to myself, to people, that I fit the bill”: Perspectives on weight and shape control behaviors among low- income, ethnically diverse young transgender women. Social Science & Medicine, 165, 141-149. doi: 10.1016/j.socscimed.2016.07.038
Hepp, U., & Milos, G. (2002). Gender identity disorder and eating disorders. International Journal of Eating Disorders, 32, 473–478. doi: 10.1002/eat.10090
Jones, B. A., Haycraft, E., Murjan, S., & Arcelus, J. (2016). Body dissatisfaction and disordered eating in trans people: A systematic review of the literature. International Review of Psychiatry, 28, 81–94. doi: 10.3109/09540261.2015.1089217
Lee, J. A., & Pausé, C. J. (2016). Stigma in practice: Barriers to health for fat women. Frontiers in Psychology, 7: 2063.
Munro, L. (2017). Everyday indignities: Using the microaggressions framework to understand weight stigma. The Journal of Law, Medicine & Ethics, 45, 502-509. doi: 10.1177/1073110517750584
McGuire, J. K., Doty, J. L., Catalpa, J. M., & Ola, C. (2016). Body image in transgender young people: Findings from a qualitative, community based study. Body Image, 18, 96-107. doi: 10.1016/j.bodyim.2016.06.004
National Eating Disorders Association (NEDA) (2018). What is weight stigma? Definition retrieved on 5/20/19 from https://www.nationaleatingdisorders.org/weight-stigma.
Patton, T. O. (2006). Hey girl, am I more than my hair?: African American women and their struggles with beauty, body image, and hair. National Women’s Studies Association Journal, 18(2), 24-51.
Peterson, C. M., Matthews, A., Copps-Smith, E., & Conard, L. A. (2017). Suicidality, self-harm, and body dissatisfaction in transgender adolescents and emerging adults with gender dysphoria. Suicide and Life-Threatening Behavior, 47(4), 475-482. doi: 10.1111/sltb.12289
Sevelius, J. M. (2013). Gender affirmation: A framework for conceptualizing risk behavior among transgender women of color. Sex Roles, 68(11-12), 675-689. doi: 10.1007/s11199-012-0216-5
Sue, D. W. (2010). Microaggressions in Everyday Life: Race, Gender, and Sexual Orientation. John Wiley & Sons: Hoboken, NJ.
Taylor, S. R. (2018). The Body is not an Apology: The Power of Radical Self-Love. Berrett-Koehler Publishers, Inc: Oakland, CA.
Testa, R. J., Rider, G. N., Haug, N. A., & Balsam, K. F. (2017). Gender confirming medical interventions and eating disorder symptoms among transgender individuals. Health Psychology, 36(10), 927-936. doi: 10.1037/hea0000497
Watson, R. J., Veale, J. F., & Saewyc, E. M. (2017). Disordered eating behaviors among transgender youth: Probability profiles from risk and protective factors. International Journal of Eating Disorders, 50, 515-522. doi: 10.1002/eat.22627
Witcomb, G. L., Bouman, W. P., Brewin, N., Richards, C., Fernandez- Aranda, F., & Arcelus, J. (2015). Body image dissatisfaction and eating- related psychopathology in trans individuals: A matched control study. European Eating Disorders Review, 23, 287–293. doi: 10 .1002/erv.2362
Vocks, S., Stahn, C., Loenser, K., & Legenbauer, T. (2009). Eating and body image disturbances in male-to-female and female-to-male transsexuals. Archives of Sexual Behavior, 38, 364–377. doi:10 .1007/s10508-008-9424-z
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