News stories parrot assumptions about ‘body positivity’ health risks — and ignore conflicting evidence

A study published in the journal Obesity made headlines this week for suggesting that body positivity — a social movement encouraging acceptance of all body types — is putting people at risk of poor health outcomes.

It’s the kind of counter-intuitive claim that is likely to generate clicks. Could a movement meant to lift people up be causing them harm instead?

What exactly is body positivity?

Let’s hear from some proponents about the definition of body positivity; these quotes were collected by the website Bustle:

Body positivity is the conscious decision to be confident, bold, and proud of who you are holistically, despite not meeting what society deems as attractive or normal.

Body positivity is learning to accept bodies in all sizes, shapes, and forms.

The body positivity movement is about health (at any size), identity, and self-respect.

Over time, the term has come to include differently abled and gender-nonconforming bodies, but most agree that its initial use was about acceptance of people who have overweight or obesity, which is an ever-growing proportion of Americans.

Two news stories that covered the study used headlines full of body positivity buzzwords and emphasized a cause-and-effect relationship:

Study: Normalization of Plus-Size Culture Carries Health Risk (US News & World Report)

Body-Positive Movement Causes People To Think They Aren’t Obese, Study Says (Newsweek)

The first problem? The study did not measure “plus-size culture” or the “body-positive movement” in any way. Not at all. Therefore, the study did not show any relationship between this social movement and, well, anything else.

The scientific study

The study relied on data from a national health survey in England. For those respondents who had overweight or obesity by their numbers (their body mass index, or BMI, was at least 25), the study author tallied how many described themselves as “about the right weight” or “too light,” and called that “weight misperception” — saying those people “underestimated” their weight. The author also tallied how many said that they were currently trying to lose weight. The study analyzed various demographic factors and concluded that people with less education, lower income, and those belonging to minority ethnic groups were more likely to underestimate their weight. The underestimators also were less likely to try losing weight.

So where did the body positivity connection come in? It actually came from the journal article — just not from the study’s methods or results. The author, Dr. Raya Muttarak of the University of East Anglia, set the framework for her controversial view with the title, “Normalization of Plus Size and the Danger of Unseen Overweight and Obesity in England.”

Her introduction went on to describe the latest plus-size women’s clothing line from the UK retailer Marks & Spencer. But it did not provide any evidence that body positivity had anything to do with the responses reported in the survey. Nor did it provide evidence that body positivity is linked to any health “danger,” or that a different perception of one’s weight would reduce that so-called danger.

It’s unusual to see such overreach in framing a journal article, says Yoni Freedhoff, MD, medical director of the Bariatric Medical Institute at the University of Ottawa and a contributor. “It’s striking example of stretching the data to fit a presupposed opinion,” he says. “It’s a controversial paper — and it will get clicks.” 

Muttarak’s article makes several unsupported assumptions, dissected in an accompanying commentary, Why Thinking We’re Fat Won’t Help Us Improve Our Health: Finding a Middle Ground, written by Tiffany Stewart, PhD, an obesity researcher at Louisiana State University. Muttarak implies that if people knew they were overweight, they would be more likely to take action to lose weight. Stewart cites evidence that shows just the opposite, that people who perceive themselves as overweight are at “an increased risk of future weight gain.”

At the very least, the relationship between weight perception and healthy behaviors is complex.

Back to the news

The news stories made no mention of the commentary, much less of alternative views. Both stories relied heavily on the university news release, which if anything amplified the supposed association between the body positivity movement and underestimating one’s weight status.

We can’t know why these stories parroted the study author’s assertions rather than focus on the actual results. But we can advise readers to look for outside voices in health reporting. News stories should consult independent experts to comment on the claims made by a study author or a news release. In this case, calling upon an obesity doctor or researcher would have been an obvious first step.

What’s more, Newsweek’s story was illustrated with the all-too-familiar headless bodies. We’ve written about how this adds to the stigmatization of people with overweight and obesity:

Not showing a person’s face implies there is something shameful about what they are doing or who they are–yet that’s often what we see in news coverage about obesity.

A bathroom scale doesn’t measure health

Having overweight or obesity is associated with risk for many diseases, including diabetes and cardiovascular disease. But that doesn’t mean people who weigh more are unhealthy — and yet this assumption is made all the time.

To presume that someone with a BMI of 25 or greater is in “danger” (to use the word from the study title) because they’re not actively trying to lose weight shows bias, Freedhoff says.

“There are plenty of people with obesity who aren’t trying to lose weight — because they’re healthy and they feel well. And that’s fine!” What people do or don’t do is actually up to them. “We get to decide what priorities we take in our lives,” he says. “There are plenty of people whose weight is okay, but their lifestyle is terrible — they make poor dietary and exercise choices.”

Freedhoff says that 70-80% of all chronic, non-communicable diseases can be modified with lifestyle changes, such as diet and exercise. And yet, he says, “The only one we moralize about is obesity.”

Stewart, in her commentary, argues for turning the focus to health behaviors and not size or its numerical proxy, BMI:

There is evidence that taking a functional approach to the body, or focusing on health behaviors for the benefits, promotes greater adherence than an appearance‐based focus.

In other words, everyone should be exercising and eating nutritious foods for their health — not just those with certain BMIs.

Why this is important

The way we talk about obesity matters, and journalists have an opportunity and responsibility to shape that conversation. It starts with adopting a critical lens, differentiating assumptions from established fact, and demanding evidence to support claims. Consulting an independent expert is often essential to distinguishing data-based conclusions from well-crafted spin.

For their part, body positivity advocates are unlikely to be swayed by this study’s biased narrative or the assumptions that drove related news coverage. Here’s one more definition of body positivity from Bustle that wraps things up neatly:

I’m positive I don’t give a damn what you think about my body.

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Comments (2)

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Barbara Taylor

July 2, 2018 at 12:55 pm

I think that this sentence from the article sums it up: “There is evidence that taking a functional approach to the body, or focusing on health behaviors for the benefits, promotes greater adherence than an appearance‐based focus.” Body shaming for overweight people does NOT help.

Paul Ernsberger

July 6, 2018 at 3:01 pm

The original article is remarkably unscientific. There is no evidence for the phenomenon they discuss –lack of awareness of obesity. A small number of people with BMI values over 25 or over 30 do not perceive their BMI to be a problem. This is an honest and reasonable difference of opinion that the public has with health guidelines. Certain investigators have labeled this difference of opinion over BMI as a “lack of awareness” or “denial” or even “delusion”. This is an example of the logical fallacy of begging the question, whereby one asserts an answer to the question at hand without any evidence.