Thin privilege in disability contexts plays a major role in how our public disclosures of impairment will be heard by the ableist, and sizist, world we live in. From doctors to store clerks to busybodies in parking lots who take it upon themselves to judge who looks disabled enough to use the disabled parking spots, fat people with disabilities face denial, discrimination, and detest. I’m not going to define thin and fat by a specific BMI number because the actual cut off from good treatment to bad falls at different weights on different bodies and can vary by race, age, and visible disability.
In a medical context, fat patients are diagnosed as fat. While thin people are considered victims of our ailments, fat people are blamed for causing any and all symptomatology they complain of. “I have constant joint pain” in a thin person may result in medical tests to determine the cause and probably some medication to manage the pain. “I have constant joint pain” from a fat person will be met with a diet and exercise plan, and they’ll be told the problem is their fault. “I get tired easily” in a thin person is more likely to raise concern and questions about the cause. “I get tired easily” from a fat person will more likely be met with chastisement and blame.
In social situations, fat disabled people are often disbelieved. Where a thin person might be indulged for using the motorized chair cart at a store, a fat person will be despised as lazy. The only possible reason we grant fat people for having mobility problems is their fat. Cultural myths about fatness correlating with sloth result in hiring and wage discrimination by size, especially for women. A fat, disabled woman in my country is virtually unemployable, based more on her size than her work ability.
Disability impacts people of every size, and people of every body type become disabled. Yet a fat patient with a family history of diabetes is more likely to be blamed for his pre diabetes than a rock climber whose daring led to a fall and broken bones. What’s more, many disability symptoms and medications lend themselves toward weight gain and fat retention. If your depression medication causes some weight gain but makes life worth living, I don’t want anyone telling you that you’d be better off unmedicated and on a diet.
We really don’t know how to do long term weight loss. While restrictive diets and intense workouts can lead to short term weight loss in some, that weight almost always returns. It becomes more work for a formerly fat person to maintain a thin body than it takes a lifelong thin person, and the historically thin one can eat far more calories without gaining weight than they can. Some of the health consequences of obesity are beginning to be attributed to the effects of yo-yo dieting, of repeated weight loss and gain. Some are probably the result of size. None are proof of the moral failings of fat people, and none suggest that fat patients are somehow less deserving disabled.
Being in good health should never be the totality of how we judge someone, especially in disability circles where so many of us are not well. In fighting for disability with dignity, we thin disabled must remember our heavier siblings and the extra burdens they face. We must fight against size stigma in medicine and the world at large, for them and for our own sakes because it cannot be separated from disability stigma. Consider that the number one justification for mistreating fat people is that obesity leads to poor health, and poor health leads to medical expenditures. Now think about what that implies about the rest of us in poor health or with costly medical needs.