I was in the grocery store when I felt a tug on my lab coat. I looked down to find a very young kid. He said, “Hi My name is Aiden. What’s your name?” I said Billi. Then he said, “My mamma say you are so fat you don’t got no neck. How come you don’t got no neck? What happened to your neck? Did you eat it?”
If you are enduring obesity, or if you’ve ever loved someone who is, you’re familiar with how badly overweight people, especially those who are considerably over weight, are treated. This is probably because people who are not overweight have brain repletion (I’ve had enough to eat) mechanisms that work. So, they don’t understand why other people just can’t be more “disciplined” about eating. Hence, the malfunctioning of a complex network of homeostatic mechanisms gets dismissed as a character flaw. If it stopped with that false preconception, it wouldn’t be so bad, but it doesn’t stop there.
Overweight people are the only minority that is totally without legal protection from discrimination. It is completely acceptable for on-air personalities and comedians to treat us derogatorily. Weight bigotry has even spawned a cottage industry with “no fat chicks” T-shirts, bumper stickers, mugs, mud-flaps etc. While the Federal Trade Commission continually fines companies for marketing fraudulent weight loss cures, television networks continually sell air time to the next “Exercise In A Bottle.” What if you turned on your television and you saw a commercial for “Lump Away Spray” claiming a spritz a day would cure breast cancer? What if you saw a bumper sticker that said, “no crippled dudes” or “no cancer chicks”?
The medical profession is equally insensitive. An obese person goes into an ER with a gunshot wound to the head, and they say, “lose some weight, and you’ll stop bleeding”. Hospitals are rarely equipped to adequately accommodate metabolically challenged obese patients. If negligent hospitals aren’t injurious enough, they have the audacity to treat the obese patient as if it is his or her fault that the hospital isn’t prepared to provide the service they bill for. The list is endless: restaurants, airports, schools, theaters, shopping centers you name it—accommodating the obese community is rarely a consideration. You get it. We get it. This is earth, there’s no giant mouse holding a sign that says “Happiest Place in the Universe.” It’s a rough gig for everybody.
That is true. Certainly, the obese community can intellectually process weight-based discrimination. However, can their brains effectively process the constant micro-stressors from continually experiencing weight-based discrimination? Being able to intellectualize weight bigotry is fine, but the stress response doesn’t occur in the thinking part of the brain. It occurs in the subcortical non-thinking “emotional” structures whose mission statement is: “survive now ask questions later.”
There’s a practical reason evolution put the stress-response here. Say you’re a wildebeest and you hear a rustle in the distance. If you stop to think, “is that a lion, or is it tumbleweed,” as opposed to making a mad dash, if it’s a lion—the gig is up. If it’s tumbleweed, it’s just a few more steps on your already dusty hoofs. That is why the subcortical structures, responsible for stress regulation, cannot distinguish between actual and perceived threat. Their purpose is to prepare the body for the eventuality of fight-or-flight.
The first order of business is increasing the heart rate and sending extra blood to the muscles and organs, dilating the bronchial tubes in the lungs facilitating more oxygen to the brain and subsequently triggering fibrinogen, which accelerates blood clotting (a further defense against blood loss e.g., from the infliction of wounds). When this physiology evolved, this response was appropriate because the ancients faced threats like trying to escape a pack of hungry jackals, or find shelter in a sudden severe storm. My dealing with an indelicate (although adorable) child, like Aiden, is not the same thing. Nor, is my daily dealing with the constant barrage of minor weight-discriminatory events (micro-stressors). However, it doesn’t work that way. 
Unfortunately, because the stress response is located in the non-thinking old mammal brain, threat is threat. Aiden’s disturbing remarks are just the howl of another jackal to the amygdala and the hippocampus, which jointly initiate the stress response, which activates the physiological sequelae in preparation for fight-or-flight. When this happens constantly, in response to the micro-stressors of persistent weight-related discriminatory events, allostasis becomes over-used.
Allostasis, sounds like an obscure pope, or small dinosaur, but it’s not. Everything in the universe is driven by the need to maintain homeostasis or balance. Allostasis is the process restoring the balance (homeostasis) when an organism is out of balance. There are many allostatic mechanisms.
Allostatic Load occurs when your body’s allostatic mechanisms go from keeping you healthy to making you sick. It’s like riding your brakes until the pads are worn down. Suddenly, your brakes, which were a safety feature, now become a hazard because of overuse. For example, a sudden surge in blood pressure is good, when trying to fight or run from something. But when it happens constantly it becomes hypertension. This type of overuse happens because of excessive exposure to stress.
Obese populations constantly experience weight-related discriminatory events, which cause micro-stressors that contribute to negative health outcomes. The constant activation of the stress response requires taking long-term energy stores and making them available for immediate usage. So, basically it’s like making a withdrawal from your IRA for quick emergency cash. If there’s a catastrophic event, making a withdrawal from your IRA is understandable. But you don’t go to the bank several times a day and take money out of this account every time you experience a glitch in cash flow. Unfortunately, the old mammal brain doesn’t know the difference between needing money for a life-saving surgery, and your kid wanting a second X-Box. So in essence, the constant processing of micro-stressors from weight-based, discriminatory events physiologically bankrupts obese individuals.
To further add to this, regional brain alterations, often resulting from early life trauma, cause obese individuals to perceive stressors more intensely and take longer to habituate. The constant up-regulation of stress hormones (e.g. cortisol), also takes a physiological toll. In primate studies, psychological stress has been known to speed up the rate at which fat is deposited in the body.
So all things considered, a part of the problem is the metabolic condition. It’s complex, multifaceted and incorporates multiple brain regions, as well as receptors, neuropeptides and hormones throughout the body. This means there are many opportunities and scenarios for dysfunction to occur. But another part of the problem is the constant weight-related discriminatory that create micro-stressors that overburden stress regulation in overweight people.
So, what did I say to Aiden? I said, “Aiden, I have a neck, it’s just hard to see. Then I showed him my neck and asked him to take me to his mother, who was mortified. We spoke privately. I said, “you don’t want my life, nor I yours. But wouldn’t it be nice if we could pass by each other without being unkind. I suspect, like me, you’ve had more than your fair share of unkindness. Please, don’t punish Aiden for repeating what he heard you say. He didn’t understand what he was doing, any more than you understood what you were saying. You take good care. And if this is the worst thing that happens to us in our lives, we are totally good to go.” I shook her hand with both my hands, smiled genuinely, and looked directly into her eyes to let her know, it was okay. Then I left.
Weight-based bigotry is insensitivity and unawareness. The only viable response is being sensitive and increasing awareness. Stevie Wonder said, “We believe in things, we don’t understand, and so we suffer”. Isn’t it funny how the blind can see things so much clearer than the sighted sometimes?