Trigger Warning: This #OTalk may not be suitable to attend for anyone currently struggling with disordered eating. If you need help and support with this at this time do check out BEAT – https://www.beateatingdisorders.org.uk/.
Watch this video about Ytisebo
In some respects I see this as an expansion to the diversity in OT series but also fatphobia as an issue impacts so much on people in society and within healthcare in particular. In this chat, Sarah, Alice and I hope to expand your awareness on one of the last great “socially acceptable” forms of discrimination.
Alice Hortop is an OT lecturer at UWE who has keen interests in the therapeutic use of humour, hygge and occupation and infertility. @laughingot
Sarah Merton is a Social Sciences student at LSBU exploring the body positive movement on instagram. @sociology_sarah
Kirsty Stanley is an Independent OT who is passionate about ALL OF THE THINGS – but sadly not her own body. She once lost 5 stone with Slimming World but because – funnily enough – losing weight didn’t fix all her life problems has put it all back on and more!
She has recently been diagnosed with ADHD and is just learning more about the food = dopamine connection. @occ4lifeltd
Scenarios
Consider this discussion between friends:
“It’s because I’m fat.”
“Oh no you aren’t, you are beautiful. I don’t like to hear you so down, where’s your cheerful self?”
And this within a healthcare situation:
Person: “I dropped my laptop on my toe and I think it’s broken.”
Dr: “There’s not much we can do about that but have you thought about losing weight?’
“Oh I have lost a stone over the last couple of weeks”
“I thought you looked thinner. Well done.”
Or this scenario:
Walks by a colleague and is eating a biscuit that was brought to a team meeting.
“Be careful, I don’t want to have to buy you a bigger uniform again.”
In the first scenario:
Fat identity is not legitimised.
Thinness is equated with beauty.
Looks are associated with ‘being worthy’.
The ‘cheerful’ fat friend narrative is continued.
In the second there is a danger of alienating people we work with. If all they ever hear is about their weight they they may disengage with services. This may also lead to them actually putting on more weight. It also risks health issues being missed, e.g. rapid weight loss and cancer. Or recognising that bodies change over time. Alice and I have both written about fertility, to access support with fertility issues women are often made to lose weight in order to ‘try and conceive naturally’ and investigations into other medical issues are delayed – creating a vicious cycle with subsequent mood disorders and unhealthy eating patterns. Also BMI has been criticised no end but it is still being used widely within healthcare.
Fat is not a moral failing.
Fat is a feminist issue.
It will have taken that person A LOT to ask for a bigger uniform, to belittle that is traumatic. You never truly know the struggles people have around food.
A summary of Sarah Merton’s research on Body Positivity
My name is Sarah Merton and I am a second year PhD student from the Social Sciences department at London South Bank University. During spring 2020, my online survey went live as part of postgraduate study into the body positive movement on Instagram. It was a tense time. The study was unveiled following 18 months of preparation just as large proportions of the global population entered into state induced lockdown. However, the research experience was one of community and camaraderie. Not words always readily applied in conversations about ‘toxic’ social media spaces.
I received over 500 survey responses submitted by Instagrammers who had used a #BodyPositive hashtag, or as they are more colloquially known, ‘BoPo Warriors.’ Originally, the study aimed to understand whether the Instagram platform could be conceptualised as a ‘protest site.’ Yet it soon became apparent that, although to some the app signalled an arena for hashtag activism and/or feminism, an overwhelming majority regarded Instagram as a therapy space. 71.2% (n=351) of Instagrammers described the platform as a site of solidarity with other women.

The summer was spent reviewing the hundreds of emotive first-hand testimonies generously shared by BoPo Warriors and it made for a heart-breaking experience:
‘After suffering with Bulimia and hating my body for years and dieting over and over again I wanted to find a better way.’
‘I struggled with eating disorders my whole life. I was on instagram telling my weightloss story for 3 years or so before I ran across the hashtag Body Positive and read some of the posts.’
Though the body positive movement is borderless and networked in constitution, the impact of fatphobia, sizeism and weight stigma united dispersed but substantial populations. Diet culture permeated a diversity of cultures. When looking at the most common precursors to joining the body positive movement, eating disorder recovery presented the highest ranked reason for women seeking out connectivity.

In fact, 85.8% (n=429) of body positive Instagrammers said they used social media to share stories of struggle against narrow beauty standards. Beyond the filters, the jiggle and the wiggle, there was another underbelly of brutal biographies. There was shame, blame and weighing scales. The fatphobia that put the fire in those bellies.
The fat female body is endlessly prodded and policed by external agencies from media to medicine. This often prompts an alienation from your own sense of bodily autonomy because it feels like everybody else’s property rather than your own. The summer I spent reading the stories behind the Instagram Stories, belonging to body positive hashtivists, alerted me to the shared struggle beneath the selfies. I had thought that I understood BoPo Warriors, but I only knew the half of it, up until then I never fully comprehended the body battles preceding the Insta-ready performances. The real-life reasons underlying the rallying cries of, ‘Riots not Diets!’
Alice’s poem from We Are OT (available here: https://occupation4life.co.uk/books-by-occupation4life/)
Wearing Grief Alice Hortop
It surrounds me, inches pad my broken body,
As the fruitless years pass, the padding grows,
A physical barrier, consciously and uncomfortably worn.
Visible grief, heavy on my bones,
Heavy with judgement,
And the irony?
The unwanted padding of grief,
Traps you into the childlessness that caused it,
Fat people aren’t allowed to be mothers.
Sea Swimming and Body Positivity – Alice Hortop
A miracle happened after years of fat shaming and desperately trying to shed pounds but actually making myself very ill. I gained weight through the grief of involuntary childlessness. I was refused IVF for being a size 16 at 5’11, I tried for 2 years to lose the weight, only managing to gain a few stone in desperate fad diets and developing IBS. I went on to be fat shamed by social workers when I tried to adopt for increasing to a size 18. I am curvy, voluptuous with a big bust, bum and hips. I was conflicted and outraged that my whole humanity, my human right to have a family, to be a mother recognised by international laws, was reduced to the numbers on the weighing scale. My body abandoned me in my greatest desire to have a family but further left me open to endless cruel and humiliating judgments from strangers in health and social care. It is hard to love yourself, love your body, when you are treated as if you are lazy, weak willed, greedy and undeserving of a family as a result. Everyone should be told they are attractive, it’s really not hard to compliment the warmth in a smile, a sparkle in a pair of eyes, the colour of an item of clothing that flatters or an engaging body language. I found except from my partner and a handful of friends that compliments were rare, especially as I gained weight. Family praised weight loss but in my yoyo weight loss and gain cycle those were few and far between especially when they finished with the deflating encouragement to lose more. I had been a triathlete and surfer in my twenties but stopped due to back and hip issues. I have lived by the sea for most of my life, including now. I have always loved the sea and swimming but never felt body confident, whether a size 10 or 18. A friend up north was raving about wild swimming for about a year, she is inspirational and brave to my mind, but I could not imagine doing it. The previous summer I had been in the sea with my dog as it was boiling, I wore a dress to avoid exposure. I have dozens of bathing suits, always bought in the sale in bigger and bigger sizes but always looked awful. This summer was boiling and I failed to fit into any of my swimsuits. I had a sudden thought, I wondered if they did tall swimsuits. They did! I bought a tall polka dot swimsuit and it actually fit, smaller than the bigger ones that did not! The first day I went to the sea I had an argument with my partner, one of those ones where you disguise the row by arguing through a grimace of closed teeth. In summary I wanted to get as close to the sea as humanly possible before revealing my swimsuit body. In the water I had a wonderful time, laughing out loud and splashing in the waves. The next few times I became less self-conscious and dare I say it brave! Now, I am a fully-fledged mermaid! I recorded my World OT Day 30 sec film on the life affirming occupation of wild swimming, with no makeup and in my polka dot bathing suit in the sea! It’s November and I still go in most days, happily strutting around in my bathing suits… I have many tall ones now! I do not care who sees me having an epic time, often enjoying boisterous camaraderie with the rest of my sea-swimming pals. It is interesting that many of us were body shy but not anymore. Who knew that wearing far less would give us the armour of body confidence we needed. My body feels so gorgeous in the water, how could I continue to hate it? I honestly feel I could teach a lecture in my bathing suit now, my body didn’t let me down, society did.
Recommendations/Key Discussion Points for OT
Activity related rather than weight related (or BMI) goals. A target weight is often never enough – there is always that extra couple of pounds to go.
Support people with access to food, time, routine and skills for food preparation, help them balance alternatives, e.g. is it better to eat 3 moderately nutritious meals, than to eat a ‘perfectly balanced’ salad and binge late at night.
Do not shame or bully people into weight loss – it doesn’t work!
Please don’t buy into the lockdown or post Christmas weight loss narrative – or the shame associated with it.
Consider this for people of ALL genders.
No Body (Type) can be wrong – this is an ableist narrative. Health does not have a look or aesthetic. It can’t be beat into submission, it is not a machine.
No food is naughty.
Be aware of the societal focus on individualistic responsibility. What about the mantra ‘wealth over health’.
What whole society changes could we support, e.g. governmental responsibility vs Marcus Rashford – MacDonald’s offering free meals. Deprivation and Gluttony dichotomy. Conflicting messages.
Don’t assume that people are using instagram passively – when they are actively engaging in social justice issues around Body Positivity.
The joy of movement – joyful movement. Exercise for the fun of it and not to burn off calories. Dance like nobody is watching. If you do exercise that you don’t enjoy it stresses the body. (https://www.theactivetimes.com/fitness/why-hate-working-out-science).
Recognise people’s lived experience.
Consider all of this when working with “bariatric” clients.
Obesity related conditions often related to the stigma rather than the weight itself (https://onlinelibrary.wiley.com/doi/abs/10.1111/spc3.12172?fbclid=IwAR1sc3zgtdwojzg64n04KyMUMEqF3tUzwQR3-2cF0qd8kLRkOxu-A6J4_AA)
Questions for the chat
- Share an image of the “perfect” body type? Why? How does that make you feel about your own body?
- Fatphobia and Body Positive Occupational Therapy #BoPoOT – what do they mean to you?
- After the Prime Minister’s ‘War on fat’ what steps will you take to be ‘fair on fat’?
- How can we support people to live their lives in a body positive way, love their bodies, and step back from the need to strive for the stereotype, whilst also promoting health and wellbeing?
- Can instagram/social media be reclaimed as a protest space and a therapy/recovery space?
We would love to start a #BoPoOT Movement. Share your thoughts and reflections (and images if comfortable to) using the hashtag.
Resources
Embrace by Taryn Bumfritt
https://bodyimagemovement.com/embrace/
Hope Virgo petition – stop calories being listed
https://www.change.org/p/eating-disorders-are-not-just-about-weight-dumpthescales
Fat chat podcast
https://twitter.com/FatChatPodcast
Fattily Ever After – Stephanie Yeboah
https://www.goodreads.com/book/show/50693537-fattily-ever-after?ac=1&from_search=true&qid=6mpXwY5Z0b&rank=1
Happy Fat – Sofie Hagen
https://www.goodreads.com/book/show/42653524-happy-fat?ac=1&from_search=true&qid=iOsQXXcKh1&rank=1
Shame, Blame & Weighing Scales – Sarah Merton
https://atcconference.wordpress.com/p29-sarah-merton/
Fat Shaming and RSD
“Social distancing is something I am good at…” Bjarne was isolated living with obesity.
https://www.truthaboutweight.global/global/en/people/bjarnes-tips-on-obesity-and-covid-19.html?cid=ps-tw-dp-img-obe
An Evidence-Based Rationale for Adopting Weight Inclusive Health Policy (Hunger et al)
https://spssi.onlinelibrary.wiley.com/doi/abs/10.1111/sipr.12062
Weight Stigma 101 by Dr Carolynne White
https://t.co/RTY3q5Gy1qhttps://t.co/RTY3q5Gy1q
A few Body Positive Companies – Share your favourites in the comments below
Snag Tights
Dove
Simply Be
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