Abstract. This article adds historical dimension to the developing literature on "obesity stigma': negative treatment and discrimination experienced as a consequence of the belief that overweight people are lazy and lacking willpower and basic knowledge about nutrition. Interviews with women who identified as fat suggest that medical and cultural concern about weight was conflated in their interactions with doctors, peers, and family. Stigma was a cause of frustration and despair for those deemed obese, who felt that unfair assumptions were made about their lifestyle and their abilities. In response, the women interviewed formed organizations, exercise classes, and social activities for "fat women only." Fat activists offer unique insight, because their work sheds light not only on the impact of obesity stigma but also on how some women responded to and resisted the medicalization and objectification of their bodies.
Keywords. obesity, fat, Health at Every Size (HAES), social movements
Resume. Cet article se propose d'ajouter une dimension historique a la litterature, en pleine expansion, sur << le stigmate de l'obesite >> (c'est-a-dire le fait de considerer les individus en surpoids comme des gens paresseux, manquant de volonte et/ou de connaissances de base sur la facon de << bien se nourrir >> et par consequent de porter des jugements negatifs sur eux, voire de les discriminer). A partir d'entrevues effectuees aupres de femmes identifiees comme etant << grosses >>, on suggere que les inquietudes, medicales comine culturelles, a l'endroit du poids jouent un role fondamental dans les relations de ces dernieres avec les medecins, leurs pairs ou encore leurs proches. Le stigmate qui les touche dans ces circonstances constituerait alors une source de frustration et de desespoir; ces femmes ressentiraient un sentiment d'injustice lie au regard porte sur leurs habitudes de vie et sur leurs capacites a << faire face >>. En reponse a ces representations, les interviewees ont forme des associations, se sont retrouvees dans des cours d'exercice physique et ont participe a des activites sociales reservees aux femmes obeses. Ces activistes nous offrent alors un point de vue unique en cela que leur investissement revele non seulement le poids social du stigmate de l'obesite mais egalement comment les femmes reagissent et resistent a la medicalisation et a l'objectivation de leur corps.
Mots-cles. obesite, surpoids, Health at Every Size (HAES), mouvements sociaux
In 2007 the federal government of Canada re-launched ParticipACTION, a physical fitness promotion campaign, to combat Canada's "inactivity and obesity crisis." In the press release announcing the re-launch of the social marketing campaign, then Health Minister Tony Clement justified the $3 million expense, noting that the "crisis" "will have a major impact on our health, our society, and our economy if Canadians don't get more active in the very near future." (1) Like its predecessor launched in 1973, the new ParticipACTION would use advertisements funded through private-sector partnerships to promote physical activity to Canadians. It departed from the original campaign, however, in that the specific goal was the reduction and prevention of obesity. ParticipACTION campaigns produced since 2007 have used both humour and fear to raise awareness among Canadians of the "obesity epidemic" facing their children. Images of children riding in motorized wheel chairs and talking about their heart problems were intended to be amusing reminders of the risks associated with extra weight and inactivity. Other ads were more direct and more menacing, featuring images of the torsos of obese adults and children to warn Canadians of the dire consequences of physical inactivity. These advertisements assume that obese people are physically inactive and that obesity is the cause of health problems.
Medical and cultural concerns about the risks associated with being obese, defined as having a body mass index (BMI) over 30, have increased in the last 15 years. BMI is calculated by dividing a person's weight in kilograms by the square of their height in metres (BMI = kg/[m.sup.2]). Health Canada, following the World Health Organization, has adopted the language of an obesity epidemic to describe what appears to be an overall increase in the number of citizens with a BMI between 25 and 29, which is currently categorized as overweight, as well as those with a BMI over 30. (2) These studies attribute the causes of obesity to "obesogenic environments'--poor food choices, lack of knowledge about nutrition, and lack of physical activity. (3) In addition to the health problems caused by obesity, researchers have estimated that in 2009 the direct costs of primary health care and lost productivity caused by obesity-related illness to be $1.98 billion dollars. (4) These statistics are presumed to tell the truth about the health and weight of Canadians, and efforts to "fight" obesity rely on these data as a measure of their success or failure.
Current approaches to obesity--quantitative and measurable--are the product of long-standing government and medical interventions aimed at improving the health of Canadians through physical fitness and improved nutrition. (5) Often absent in current policy approaches and the public discourse is a discussion of the personal and experiential dimensions of weight management. With this issue in mind, this article considers what qualitative analyses, and particularly the personal accounts of self-identified "fat" women, can add to our understanding of obesity in the recent past. I argue that qualitative evidence yields important insight into the way that people learn what it means to be healthy and the ways in which they understand their health.
Between 2005 and 2010, I completed 47 interviews with women who participated in the fat activist movement in Canada. My use of interviews as primary sources builds on feminist scholarship that has worked to incorporate women's experiences into the historical record. The question of how or when it is appropriate for historical actors to "weigh in" on their experiences is, however, contested. This debate, which followed out of feminist efforts to insert the voices of women into the academic study of the past, has taken several turns since the 1970s. In women's history, experiential accounts were initially highly valued. Women's stories about their lives helped scholars to better understand silences in the historical record and the unheralded and invisible lives of everyday women. (6) In the wake of the cultural turn of the 1990s, some scholars challenged established social historical paradigms and sought to understand representations, language, and the body rather than to pursue a "discernible, retrievable historical 'reality.'" (7) Most notably, historian Joan Scott called the value of experiential evidence into question because, first, she believed historians used experience unquestioningly as "truth" without consideration of subjectivity and, second, because experiential evidence was assumed to have universal application. (8)
Methodologically, I seek a middle path in the debates over the use of women's experiences by considering how historical actors come to know themselves in relation to broader social, cultural, and political discourses of a given time period. In collecting and analyzing this data, I draw on the work of Kathy Davis, who, examining aspects of the women's health movement in the United States, argued that "experience" is an epistemological framework in its own right. In concrete terms, this means that we should see experience as a lens used by women to understand their lives. (9) These experiential claims are truths, which are complementary, or help to add complexity to, other types of knowledge about gender, health, and medicine in the late twentieth century. At least 15 fat activist groups were organized in Canada between 1979 and 2000, and I talked with women about their participation in activities ranging from aerobics classes to fashion shows to public protests, as well as the experiences that led them to fat activism. My research indicates that fat women understood that they were perceived as being unhealthy but that they did not believe this assessment of their bodies was fair or accurate.
This article adds historical dimension to the developing literature on "obesity stigma': negative treatment and discrimination experienced as a consequence of the belief that "overweight and obese persons are lazy, unmotivated, lacking in self-discipline, less competent, non-compliant, and sloppy." (10) Such stigma has been documented in employment and education settings. (11) This research provides further evidence of the impact of negative stereotypes about fat people, and the ways in which family and social interactions, as well as public health messaging, contributed to obesity stigma in the recent past. Here I build on the work of scholars working in the field of Fat Studies, who argue that contemporary obesity rhetoric pathologizes natural variations in body size and shape. (12) Following that scholarship, I will use the terms "fat" as a description for body size and "obesity" when referring to medical perspectives on the subject. I do so to signal my participation in the scholarly project of deconstructing contemporary discourses about body size.
The article should be seen as a counterpoint to contemporary quantitative approaches to obesity in several important ways. It suggests that medical and cultural concerns about weight have been conflated. For this reason, stigma was a cause of frustration and despair for those deemed obese, who felt that unfair assumptions were made about their lifestyle and their abilities. Fat activists offer unique insight into this issue, because their work sheds light not only on the impact of obesity stigma but also on how some women responded to and resisted the medicalization and objectification of their bodies. Comparing the tricky and conflicting ways that obesity has been named and quantified in the recent past to the experiential accounts of self-identified fat people, suggests that it is important for medical and social scientific studies of this topic to speak to each other. People experience their health, fat or thin, not with discreet dividing lines between medical and social settings, but immersed in a culture that is fascinated with better managing the body.
OBESITY: SOCIO-HISTORICAL PERSPECTIVES
"Obesity stigma" is not a new phenomenon, in that evidence of ambivalence and outright negative perceptions of fatness can be found in texts dating back to the 5th century. Christian texts from 5th-century Augustine to 17th-century Martin Luther describe earthly bodies as bloated and sickly and heavenly bodies as light, speedy, and soaring. Fatness was believed to be the consequence of a phlegmatic character: lazy, inert, and apathetic. (13) Traces of this moral bodily economy linger in modern rationalist approaches to weight. As Elizabeth Grosz has argued, the Enlightenment ideal of mind over matter has led to the belief that human beings can and should have control over their bodies. A rational person should be able to control her or his will, and the body should be subservient to the mind. (14) This kind of thinking has been embedded in North American approaches to weight management, according to Peter Stearns. Modernity, particularly mass production and urbanization, resulted in the collapse of longer-standing modes of assessing character. The growth of cities in the 19th century, where people increasingly lived among strangers and mixed with members from different ethnic, class, and linguistic backgrounds, combined with scientific innovations in nutrition and germ theory, led to cultural shifts in the understanding of morality and regulation. The body offered a site for people to read and assess a person's character. Stearns described approaches to body size of this period, from the late 19th century until the 1970s as "weight morality," because slenderness was taken as "a sign of an ability to resist temptation and unwanted appetite, a guarantor of ... reliability." (15)
While historical studies suggest that "obesity stigma" could be directed toward men, there is considerable evidence that women were the particular targets of this phenomenon from the early 20th century. Amy Erdman Farrell's Fat Shame (2011) argued that in the early 20th century, thinness became a marker of those who were higher on the evolutionary scale. (16) In media representations, wealthy women were denigrated for being out of control and unable to manage their consumption, while immigrant and working-class women were represented as fat, coarse, dumb, and echoing the contemporary obesity epidemic debate, unable to properly care for their children. (17) In the mid-century and the postwar era, Canadian historians have also noted a rhetoric of mother-blame around obesity. Women, in their roles as wives and mothers, were deemed failures if their husbands and children grew obese. (18) Growing up in the 1950s, 1960s, and 1970s, the activists I interviewed believed that fat was a women's issue because they experienced it to be true. They believed that fat women were distinct from other women who did not experience real weight problems as well as from fat men, for whom the social and medical stigma of obesity was not as bad. (19)
Though they did not always frame their critique in such terms, fat activists' critique of stigma echoed late 20th-century feminist concerns about the commercialization of dieting and the emergence of a new normative femininity, emphasizing a slim and toned physique. (20) Proof of the development and negative impact of this norm can be found in the growing rates of eating disorders and plastic surgery in the 1980s and 1990s, the diminishing size of fashion models, and the growth of the cosmetics industry. (21) Canadian women's weight preoccupation was also documented in the 1981 Canada Fitness Survey, which indicated marked differences in male and female attitudes toward physical activity. Where girls (aged 10-19) and women (over 20) ranked physical activity sixth among factors that contributed to well-being, boys and men ranked physical activity first. Likewise, women listed weight as the main factor impacting their well-being, and 51% saw weight control as a very important reason for physical activity. (22) This data, coupled with growing awareness of dramatic weight control strategies taken up by young women, made eating disorders a priority of women's health advocates of the 1980s. (23) At that time, the problem of women's weight preoccupation was popularly attributed to the "beauty myth" and feminine norms of the late 20th century. (24) Where I expected my research participants to blame media images of slender women as the source of obesity stigma, they were more likely to point to family and social interactions, public health campaigns like ParticipACTION, and medical doctors as the source of negative social messages about fatness. As my discussion will further show, self-identified fat women did not distinguish between medical, government, and family messages about fatness. They felt that such messages were indistinguishable because they indicated a fundamental misunderstanding about what it meant to be fat.
In scholarly analyses of fat, Canadian and American scholars have documented changing attitudes toward fatness, as well as stigmatization of fat people. (25) Social scientists and historians have, however, been wary of taking on obesity science directly. Michael Gard has argued that social scientists and historians should be wary of challenging medical perspectives on obesity, for fear of falling into a debate about "good science" and "bad science." He distances himself from these researchers who argue that a lot of obesity science is "bad" and instead emphasizes that the scientific evidence is inconclusive. (26) Gard suggests scholars see themselves as "obesity sceptics" whose role is to use social scientific research to deconstruct and challenge obesity epidemic discourses. (27) Where I, too, think it is appropriate to approach medical literature on obesity with caution, I believe historians have more to add to this debate than a long view of medical attitudes toward the body or a critical interrogation of the rhetoric of obesity stigma. Qualitative approaches help scientists and social scientists to understand how "patients" take up health information in everyday life. As Patricia Huston and Margo Rowan have argued, qualitative research should also be of interest to health scientists because it is an "interpretive science that seeks to explain social and psychological phenomenon," and such studies yield important insights into how medical and social attitudes affect people's health. (28) For social historians of medicine, qualitative research is a valuable tool yielding insight into everyday life in the past. Textual documents from the past help us to see beyond numbers, to understand the dynamics of social, cultural, and political life.
THE "EVIDENCE OF EXPERIENCE:" FAT WOMEN WEIGH IN
It is within the context of growing cultural, government, and medical interest in women and weight in the 20th century that the fat activist movement emerged. The first fat activist event organized in Canada took place in September 1978, at a therapy workshop called "The Forgotten Woman: For Fat Women Only." Twenty women attended this workshop, a handful of whom went on to form Large as Life (LaL), a group whose motto was "stop postponing your life until you lose weight, and start living now." Several other groups followed, some with a connection to LaL, others inspired more directly by lesbian, feminist, and women's health organizing of the time period. Ideologically and epistemologically, then, there was considerable variation within the movement. I use the term "obesity stigma," but in the 1980s and 1990s activist groups variously named this problem fat oppression, discrimination, and weight preoccupation. Among the shared beliefs were that it was okay to be fat and that fat people could be healthy. This latter point was particularly important to activists who felt unfairly maligned by doctors, family members, and peers who failed to distinguish between looking well and being well. Activist groups became important sites to share these concerns about the mistreatment of fat people, as well as sites where women could talk about their experiences.
In Canada, activists were primarily white, working- and middle-class women born between 1940 and 1960. While there is some evidence that they were aware of different cultural perspectives on fatness, questions about race were often met with confusion or discomfort. Many of my participants saw fat as the central unifying characteristic of their groups and had not considered that most members were also white. (29) They believed that they shared common experiences with all women who identified as fat, regardless of their ethnic or class background. The question of whether or not fat is a white woman's issue is the matter of some debate. (30) While activists did not identify their work in such terms, the Canadian movement certainly suggests that the movement appealed most to white women. What the interviews offer is a rich source on the emotional impact, and the pleasure and pain, experienced by women who identified as fat. Other documentary material was a valuable tool to "jog" the memories of research participants, and it allowed me to focus our conversations on what it felt like to participate in activities for fat women exclusively and why someone would want to do so. (31)
The self-identified fat women who participated in this study came to know themselves as fat through social interactions, including contact with family, peers, jobs, and school. Below, I explore representative examples of several fat activists, as well as the work of the most popular Canadian fat activist group, LaL Vancouver (1981-1985), which had over 100 members. Together, these stories of individuals and groups help us to think about the impact of obesity stigma, and about how people learn about health and the sometimes-blurry boundaries between health and beauty. Experiential accounts also offer important insight into the ways people have taken up medical research, and used it to develop alternative health and weight management practices dedicated to fat women's needs.
The participants in this study remembered feeling embarrassed and ashamed by their bodies as young children, and experienced obesity stigma in a range of settings. Few remembered their weight problem being attached to health specifically, and as children they felt confused and angry when they were denied food. The message received was that they were "not okay." (32) Parents, and mothers in particular, figured prominently in participants' accounts of how they came to know themselves as fat. As children, these women were told implicitly and explicitly that they needed to reduce their body size. Sometimes these messages were well-intentioned reminders to avoid particular foods and eating between meals. At other time, the denial of food was a punishment which confused them, and they felt compelled to eat secretly or hide food to avoid having to "wait for dinner" or be denied dessert while their siblings and parents ate. (33) Helena Spring reported receiving mixed messages: her parents expressed concern about her weight while at the same time providing her with, and consuming themselves, rich weekend meals. (34) More common among my research participants was their mothers putting them on a diet. They encouraged their daughters to diet out of concern for how they were "seen by others." (35) Children under 12 years old were provided with diet aids, or prescribed diet pills by doctors with the consent and collusion of parents. (36) Less common, but troubling, were the women who reported their parents telling them that they were "too fat" and were punished or denied opportunities to participate in activities like dance classes because of their size. (37) The significant role that mothers played in the experiences of about one quarter of all of my participants, who grew up in the 1950s and 1960s in Canada, is evidence of the pressure put on mothers to ensure the well-being and normality of their children. As Deborah McPhail has noted of the "baby boom" era, "women were to be in the home at all times, ready, willing, and available to provide their domestic labour to their children and husbands." (38) Prevention of obesity was a critical part of this process, and international experts like Hilde Bruch and Doctor Benjamin Spock placed responsibility for raising a mentally and physically normal child on the shoulders of mothers. (39) In this light, we can see the role of mothers in these narratives as reflective of the social context of the 1950s and 1960s.
As young adults, some women found that their body weight was problematic in educational and social settings. Several American studies have documented employment discrimination and diminished educational opportunities as a consequence of being fat. This included being refused employment, denied insurance, being asked to lose weight, and receiving lower incomes. (40) Questions about employment discrimination were not central to my interviews, which focused on attitudes toward beauty and health among Canadian fat activists. Nonetheless, participants did report instances of being told to lose weight in educational and employment settings. Two women had to diet to get into or stay in nursing programs. (41) Both women succeeded in losing weight to stay in school, but regained the weight in subsequent years. Jody Sandler, who went on to become a fitness instructor for "large" adults, was asked to lose weight to join a dance company. (42) Janet Walker went on a diet after being told that she was "too fat to sit behind the counter" in a diner where she applied for a job. (43) As a teacher and at the time a size "12 or a 14" Sandy Friedman didn't think she was "particularly fat." Nonetheless, she was told in her annual employment physical that, despite the fact that she was healthy, she should lose weight. (44)
Negative messages received at home and at work were reinforced in self-identified fat women's interactions with doctors. Like participants in consciousness-raising groups and women's health workshops of the 1960s and 1970s, fat acceptance groups became places to share doctor stories, accounts of condescension, and sexism women encountered in medical settings. (45) A common complaint was that some doctors assumed that fat people did not, or did not know how, to care for themselves. (46) This included the assumption that they would have high blood pressure and cholesterol levels. (47) Other women expressed pride at surprising doctors who didn't expect their blood pressure and cholesterol measurements to be healthy. (48) Participants most feared doctors who appeared to be judgemental about their weight. Joan O'Brien recalled this was a common topic of conversation at LaL, where members frequently complained that doctors "would say diet, before they'd even look at you they would just tell you to diet." She recalled such experiences "sort of felt abusive." (49) Other research participants also reported feeling maligned by doctors. Joyce Cusack recalled being shamed by a doctor for her body weight and shape, and, while lying naked under a sheet on an examining table being told "you're so fat." (50) A doctor teased Sue Masterton when she asked if she should take off her shoes prior to getting on the scale. His reply was, "you can take your lipstick off if you think that will make any difference." (51) Masterton was open to the possibility of weight loss but she felt that doctors too often berated her and put her down. Even well-intentioned health interventions could result in feelings of embarrassment. Anne Zatylny was enrolled in an after-school nutrition and weight-loss program offered in her Manitoba hometown. Though the facilitator worked to make the children "feel special and to feel like they "were doing something really positive and exciting" she felt "totally ashamed" to be there. (52)
Members believed there was a disconnect between their experiences and medical approaches to weight, and this led them to push for new ways of seeing the body and new services for fat women. A common first step was to research and understand the relationship of fatness to health. Canadian activists, as well as their American counterparts, were quite savvy at finding medical research that helped to support the idea that people could be fat and healthy. (53) Groups sometimes relied on idiosyncratic distinctions. "Bad science" was that espoused by doctors who shamed fat people and by medical journals whose scientific "neutrality" belied the pain and suffering experienced by overweight patients. "Good science" was that which incorporated and reflected members' personal experiences. Other criteria that may have been important, including the scientific authors' qualifications, their philosophy on weight-loss dieting or even the number of articles that repeated a particular claim, were less important than finding research that did not take a moralizing or shaming approach toward fat people.
What is interesting from a historical perspective is not only the way that activists used experience as a baseline for assessing the validity of medical claims, but also their familiarity with contemporary research on the topic. The terms "BMI" and "obesity" were not used by my research participants to describe their bodies during our interviews, conducted between 2005 and 2010, and they appear infrequently in the newsletters and pamphlets produced by LaL and other groups. Part of the reason BMI did not matter that much was that it was not as commonly used in medical and public conversations about weight before the mid-1980s. Two major policy documents published in 1988, the "Promoting Healthy Weights" discussion paper, and the revised "Canadian Guidelines for Healthy Weights," illustrate how different the conversation about weight was in this time period from that in 2012.
"Promoting Healthy Weights," prepared for Health and Welfare Canada by weight-loss experts including Janet Polivy, John Hunt, and David Garner, suggests that there is "confusion" about whether or not excess weight is unhealthy. The risks associated with obesity are dependent on the location of fat on the body, the age of onset, and a person's genetic background. The authors suggest that obesity stigma may be as bad as the physical risks associated with extra weight, because overweight people are seen as lazy and lacking willpower. (54) Further, the "multimillion dollar dieting industry" is described as "frequently exploitive" of the 70% of Canadian women who want to lose weight. (55) The discussion paper ultimately recommended that the best way to promote health would be to "promote personal and societal acceptance of a range of healthy weights and variations in body size" and "to increase knowledge and understanding in both the general public and among professionals regarding healthy weights and factors affecting weight." (56)
The authors of the study known as the "Expert Group on Weight Standards" were behind a second document released by Health and Welfare Canada in 1988, the purpose of which was to "establish appropriate, realistic weights which relate to positive body image." (57) Included in this report was a BMI nomogram that looks quite different from the 2003 guidelines currently in use by Health Canada. Here, and in the "Promoting Healthy Weights" discussion paper, we can see a more relational approach to health than the quantitative measures that are currently in fashion. Table I is a reproduction of the "Canadian Guidelines for Healthy Weights" published in 1988. The table outlines four zones (A through D) that correspond with different BMI ranges. The table indicates that BMI is on a continuum. Rather than having firm lines and divisions, weight ranges are indicated by an arrow. Zone A, classified as a BMI under 20, "may be associated with health problems for some people," Zone B, BMI 20-25 represents a "Good weight for most people," Zone C "may lead to health problems in some people" and Zone D indicates an "increasing risk of developing health problems." (58) The language of the table is noteworthy because it allows for variations in weight.
The 2003 BMI Nomogram currently used by Health Canada reflects a change in the discourse around weight and health in Canada since the 1980s (See Table 2). This table makes firmer distinctions between the weight categories. Gone is the relativism of the 1988 chart--the language has now shifted to the more definitive categories of "Underweight," "Normal Weight," "Overweight" and "Obese" classes I through III. (59) The notion of risk remains intact, with the health consequences of each category framed in terms of the risk for developing health problems that ranges from increased to very high. As Bruce Curtis has argued for the census, the categorization of objects helps to make aspects of human experience that are otherwise abstract and difficult to grasp knowable and measurable. BMI is an example of a change in scientific knowledge that yielded new ways for understanding weight, by creating distinct categories to estimate a person's body fat. (60) While the Canadian BMI chart certainly did not create the category "obese," it made it tangible and knowable in different ways by the 2000s. We can look to this subtle shift to understand the changing preoccupations with health in the recent past. BMI might be seen as a "grid of social relations" that makes changing health norms observable. (61) Whereas the words "normal," "overweight," and "obese" appear nowhere in the 1988 guidelines, by 2003 they are established categories for knowing the body.
Many fat activists were familiar with the research cited in "Promoting Healthy Weights." Work by members of the expert group was featured in LaL's newsletters. Janet Polivy's 1983 book Breaking the Diet Habit, co-authored with Peter Herman, was also quoted extensively. In the late 1970s and early 1980s, in the wake of the rise of commercial dieting programs and the practice of "crash dieting," Polivy and Herman argued that weight, like height, is subject to natural variation. While most people's weight falls within an average range, there will always be those who are naturally fatter and thinner than the majority population. (62) According to Polivy and Herman, health problems usually attributed to being obese are actually the result of overeating and dieting. (63) They considered dieting particularly problematic because of the "yo-yo" cycle of starvation and overeating that could lead to a number of health problems including hypertension, fainting, fatigue, anemia, and gallstones. (64) They acknowledged that dieting might be a viable way to reduce body weight for about 60% of "overweight" people, but for about 30% of this population, "weight loss involved eluding the body's defenses of its natural weight, which seems to demand chronic semi starvation.... Few of the juvenile onset, 'naturally' overweight people are able to manage this constant vigilance and become dieting success statistics." (65) Polivy and Herman's research resonated with activists, because it suggested that people who were fat in childhood had "naturally" larger bodies that could not be transformed through diet and exercise.
Members of LaL also felt vindicated by Breaking the Diet Habit because it confirmed a critique that had long been a topic of LaL meetings: the ineffectiveness of dieting. Members noted that the outcome of dieting was usually regaining more weight than they had lost. Evelyn Booth felt that dieting probably made her gain weight, while Ingrid Laue felt that dieting had "wrecked" her metabolism and manipulated her immune system to the point her body no longer responded to a low-calorie diet. (66) LaL also published a booklet on this topic, "obesity: facts & fiction." Obesity, argued the pamphlet's author, LaL member Kate Partridge, was a complex problem, not easily controlled by the conscious will. (67) The greatest threat facing fat people was to their emotional well-being since there was an "extraordinary social distaste for fatness and general obsession with slimness in our culture." (68) The result of such social pressure was shame and fear of "social rejection and humiliation." Dieting, Partridge warned, could actually make you fatter because "[w] hen you deprive yourself of food during a crash diet, your metabolic rate slows down, resulting in a decrease in overall energy expenditure." The solution was to get off the binge cycle altogether, eat normally, and get regular exercise. (69)
What makes the interviews of the fat activist members of LaL particularly useful is that they allow us to understand both the individual impact of obesity stigma as well as collective responses to health norms of a given time period. LaL's medical research serves as a reminder of the initiative that interested "patients" take in learning about their health. LaL members sought out information in medical libraries with the specific goal of debunking common assumptions about weight. (70) They wanted this information because their experiences did not seem to reflect the truism that discipline and calorie counting would help them to control their weight. In this way, these groups add new dimension to the debates about the "evidence of experience" in that they help us to see that personal experience may be a baseline from which historical actors approached health information. Joan Sangster recently elaborated a similar analysis of women's responses to the Royal Commission on the Status of Women. Sangster argued that private letters, and by extension experiential knowledge, are valuable because they provide us with an understanding of how women situated themselves within the structural conditions of a given time period, and how they understood concepts like liberation in relation to their own lives. (71) Self-identified fat women found that their commitment to self-care was called into question from a very young age and in multiple social sites, and consequently, the aesthetic and health consequences of being fat blurred together in their memories. In the contemporary context obesity tends to be framed as a public health issue, even a crisis, but evidence from the recent past serves as a reminder that body size has never been only a health issue. It was difficult for women who identified as fat to distinguish between stigma experienced in different settings. These experiences inspired these women and led them to join fat activist groups later in life in an attempt to accept and find pleasure in their bodies. At this point, it was no longer the sense of shame or being different that irked these activities. Rather, they were frustrated because they felt they had made sincere efforts to follow the diet sheets and regimes given to them, to take the pills prescribed by doctors and dosed out by their mothers. It became a truism for them that diets didn't work and even more important, that diets had a negative long-term impact on their eating habits and body weight. Even before joining LaL, some women had begun to reject diets and the idea that they would lose weight at all, arguing that doctors simply did not know or accept the efforts their fat patients had already put into this method of weight reduction. This rejection of dieting was based on their previous experiences and the research like Polivy and Herman's that they had read-and it was all confirmed for them when they came into contact with other like-minded women at group meetings.
RESPONDING TO OBESITY STIGMA
Despite their belief that dieting was ineffective and long-term weight loss was unlikely, some LaL members felt empowered by the knowledge that they would stay fat. Through her interactions with other group members, Kate Partridge came to realize that her failure to permanently lose weight on diets wasn't a failure of her own "moral rectitude" but rather the physiological impact that some foods seemed to have on her body. (72) Personal accounts further reveal that members took LaL's catch phrase "stop postponing your life until you lose weight, and start living now!" to heart. Information gleaned at group meetings gave members permission to "start living" and to try to see weight as but one component of their overall well-being. Joan Dal Santo took the YWCA fitness leadership course to become an aerobics instructor for LaL. This helped her to put information she had learned at meetings into practice, and she stopped being bothered by her physical differences because she "was beginning to understand that" she "had a body that worked, and it was a good one." (73) Group interactions and exercise classes designed for fat women gave Janet Walker the "[f]reedom to live in extravagant ways that" she "had never thought about before ... [a]nd just be, just be. It was valuable, so very valuable." (74)
Physical fitness was an important component of the work of LaL, and the group spearheaded the organization of dozens of aerobics classes and swimming groups for large women in Vancouver and Calgary in the 1980s. For participants, aerobics classes became another way to collectively combat the stereotype that fat women were "lazy, stupid, underachievers, lacking in will power ... and out of control." (75) Barbara Berry reported, "I weigh 255 lbs ... and I am a borderline diabetic. But I challenge anyone, slim or not, to keep up with me for even one day!" (76) Ingrid Laue further chastised ParticipACTIONCanada for their "Fat is NOT where it's at!" ad campaign. In her February 1982 article, Laue charged:
Fitness has little to do with body size, although it may take more effort, initially, to move 2001bs around the Stanley Park seawall than it takes to move 1251bs ... your slim friend who does not believe in exercising the body beautiful may have trouble keeping up with you. (77)
Laue identified ParticipACTION's "fat is not where it is at" advertisements as particularly irksome because of their assumption that fat people were unfit and had poor habits. (78) Carla Rice similarly found that dangerous eating and exercise practices were influenced by public health messaging like ParticipACTION, as well as through health lessons at home and in schools. "Framing fat as unhealthy and unfit" led to the tendency to "avoid physical activities, to engage in secretive eating, and eventually to gain weight." (79)
By undertaking their own research on weight and health and creating spaces for fat women to exercise, LaL resisted obesity stigma. Their critique, and the critique of other Canadian fat activists, was not, however, aimed only at doctors. Fat activism was a multifaceted response to social, cultural, and medical discourses about weight. Beyond their medical research and exercise classes, LaL held fashion shows, clothing swaps, and personal style workshops for their members. Even though the group disbanded gradually between 1984 and 1985, their aerobics classes lasted well into the 1990s. Since that time one former instructor, Jody Sandler, has continued to offer fitness leadership for "size plus" women in the Vancouver area.
Other Canadian fat activist groups responded to obesity stigma in different ways. LG5 (lesbiennes grosse cinq, Montreal, 1984-1992) focused on "looksism," discrimination, and rejection experienced by fat women based on their looks. Hersize (Toronto, 1987-1992) worked to educate women about the negative impact of media images with the goal of reducing weight preoccupation. Pretty, Porky, and Pissed Off (Toronto, 1996-2005) held rallies in front of clothing stores to raise awareness about the limited size options in most retail chains, and performed burlesque in local cabarets. Even when their focus was not explicitly on health issues, fat activists were responding to obesity stigma experienced in different parts of their lives. They sought to develop social sites and services, public awareness campaigns, and rallies to communicate that it was okay to be fat and that fat people could be healthy.
The personal accounts of self-identified fat women yield important data about what it is like to be fat in a socio-cultural context where "thin is in." While my interviews focused on women who had been fat activists during the 1980s and 1990s, the information they provided is relevant to contemporary approaches to the "obesity epidemic." Experiential accounts of self-identified fat women illustrate the overwhelmingly negative impact of obesity stigma in the late 20th century and the ways in which health and aesthetic concerns about weight were conflated. Fat activists felt misunderstood and frustrated by the assumption that they must be out of shape or that they did not understand nutrition. Experiential accounts therefore suggest there are risks to singling out a population for health reform.
It is also worth noting that "health at every size" (HAES) approaches to weight management have gained increasing legitimacy in Canada since the 1980s, showing that fat activism and research conducted by LaL members were representative of important gaps in the literature on dieting and nutrition. Canadian physicians and dieticians have been at the forefront of HAES, a movement of health professionals who focus on "self-acceptance and healthy day-to-day practices, regardless of whether a person's weight changes." (80) Building on the earlier work of Janet Polivy and Peter Herman, Canadian studies of the 1990s and 2000s have continued to deconstruct taken-for-granted assumptions about the relationship between weight and health. Most recently, scholars working in the field of critical dietetics like Jacqui Gingras, have advocated for a more relational and interdisciplinary approach to weight management by dieticians. (81) In Edmonton, Dr. Arya Sharma has developed the Edmonton Obesity Scaling System, which assesses health based on risk behaviours rather than body weight specifically. Dr. Sharma's work indicates that blood pressure, cholesterol, and blood glucose levels are not necessarily tied to body size. (82)
Lastly, experiential accounts of self-identified fat women offer a case study of the ways that people without formal training interpreted medical information. Research on women's mental and physical health played an important role in every Canadian fat activist group. Looking at the way this information circulated within LaL reveals that the women judged the relevance and legitimacy of medical information based on their own embodied experience. The disjuncture between experience and evidence often resulted in hostility and frustration with the medical profession, further complicated by negative messages at home and at work. Nonetheless, they were motivated to find ways to be fat and healthy and many agreed that social contact through such activities as aerobics classes helped improve their mental and physical health. The knowledge and practices that developed out of these groups is a reflection of the impact of obesity stigma. Fat activism suggests the importance of finding alternative approaches to weight management that take an individual's personal history and account of their health into perspective.
Thank-you to Kathryn McPherson, Molly-Ladd Taylor and Susan Cahn for their comments on earlier drafts of this research, and to Shannon Stettner, Sarah Glassford, the Editors and the anonymous CBMH reviewers for their comments on this article. I also gratefully acknowledge the financial support of the Social Science and Humanities Research Council, York University, and Mount Allison University for their support of this work.
Jenny Ellison, Centre for Canadian Studies, Mount Allison University.
(1) National Post, "Ottawa Revives ParticipACTION Campaign to Promote Fitness," The National Post, 17 February 2007, A10; Participaction, "For Immediate Release: ParticipACTION Launches National Movement to Move," (Particlpaction, 15 October 2007).
(2) Charlotte Cooper, "Fat Studies: Mapping the Field," Sociology Compass, 4, 12 (2010): 1022; Sheena Starky, "The Obesity Epidemic in Canada," (Ottawa: Library of Parliament, Economics Division, 15 July 2005).
(3) See, for example, Peter N. Stearns, Fat History: Bodies and Beauty in the Modern West (New York: New York University Press, 1997); and Sander L. Gilman, Fat Boys: A Slim Book (Lincoln: University of Nebraska Press, 2004).
(4) Birmingham et al. (1999), Katzmarzyk et al. (2000), Katzmarzyk and Janssen (2004) as cited in Starky, "The Obesity Epidemic in Canada," p. 10.
(5) Numerous Canadian projects of the 20th century were aimed at improving the health of Canadians through fitness and nutrition. These are documented in works such as Colin D. Howell, Blood, Sweat, and Cheers: Sport and the Making of Modern Canada (Toronto: University of Toronto Press, 2001); J. Thomas West, "Physical Fitness, Sport, and the Federal Government 1909 to 19547 Canadian Journal of History of Sport & Physical Education, 4, 2 (1973): 26-42; Ian Mosby, "Eat Right to Work and Win: The Origins and Implications of Canada's First National Nutrition Education Campaign, 1937-1949," (MA Thesis, York University, 2005); and Aleck Samuel Ostry, Nutrition Policy in Canada, 1870-1939 (Vancouver: University of British Columbia Press, 2006).
(6) Kathleen Canning, Gender History in Practice: Historical Perspectives on Bodies, Class and Citizenship (Ithaca: Cornell University Press, 2006), p. 25. Scholars working in the tradition of E. IF?. Thompson also invoked experience as a valuable tool for understanding human agency, and specifically the development of shared class-consciousness. See Joan Sangster, "Invoking Experience as Evidence," The Canadian Historical Review, 92, 1 (2011): 140; and Joan Wallach Scott, "The Evidence of Experience," in Judith P. Butler and Joan Wallach Scott, eds., Feminists Theorize the Political (London: Routledge, 1999), p. 87.
(7) Canning, Gender History in Practice, p. 65.
(8) Michele Barrett and Anne Phillips, eds., Destabilizing Theory: Contemporary Feminist Debates (Cambridge: Polity Press, 1992), p. 4.
(9) Kathy Davis, How Feminism Travels across Borders: The Making of Our Bodies, Ourselves (Durham: Duke University Press, 2007), p. 125.
(10) Rebecca M. Puhl and Chelsea A. Heuer, "The Stigma of Obesity: A Review and Update," Obesity, 17 (2009): 941.
(11) Sandra Solovay, Tipping the Scales of Justice: Fighting Weight-Based Discrimination (Amherst, N.Y.: Prometheus Books, 2000); and Anna Kirkland, Fat Rights: Dilemmas of Difference and Personhood (New York: New York University Press, 2008).
(12) Marilyn Wann, "Foreward, Fat Studies: An Invitation to Revolution," in Sandra Solovay and Esther Rothblum, eds., The Fat Studies Reader (New York: New York University Press, 2009), p. ix-x.
(13) Gilman, Fat Boys: A Slim Book, p. 36-56 passim.
(14) Elizabeth Grosz, "Refiguring Bodies," in Mariam Fraser and Monica Greco, eds., The Body: A Reader (New York: Routledge, 2005), p. 50.
(15) Stearns, Fat History: Bodies and Beauty in the Modern West, p. 126.
(16) Amy Erdman Farrell, Fat Shame: Stigma and the Fat Body in American Culture (New York: New York University Press, 2011), p. 64.
(17) Farrell, Fat Shame, p. 68-80, passim.
(18) Deborah McPhail, "What to do with the 'Tubby Hubby'?: 'Obesity, the Crisis of Masculinity, and the Nuclear Family in Early Cold War Canada," Antipode, 41, 5 (2009): 1042.
(19) All interviews were conducted in person by the author, digitally recorded, and transcribed. Suzanne Bell interview, New Westminster, British Columbia: 4 October 2005; Kate Partridge interview, Crediton, Ontario: 20 September 2005; Evelyn Booth interview, North Vancouver, British Columbia: 11 October 2005.
(20) Estelle B. Freedman, No Turning Back: The History of Feminism and the future of Women, 1st ed. (New York: Ballantine, 2002), p. 226; Lois Banner, American Beauty (Chicago: The University of Chicago Press, 1983), p. 274; and Naomi Wolf, The Beauty Myth (Toronto: Random House, 1990), p. 4. This sort of critique has also been the basis for studies of fat women in the fields of Fat and Cultural studies. Works by Mary Russo, Angela Stukator, and Kathleen LeBesco liken fat women to the transgressive and "low" body described by Mikhail Bakhtin. These authors argue that fat offers a potentially resistant subjectivity from which women can challenge feminine and bodily norms. See Kathleen LeBesco, Revolting Bodies: The Struggle to Redefine Fat Identity (Amherst and Boston: University of Massachusetts Press, 2004), p. 124; Mary Russo, "Female Grotesques: Carnival and Theory," in Teresa de Lauretis, ed., Feminist Studies Critical Studies (Bloomington: Indiana University Press, 1986), p. 59; and Angela Stukator, "'It's Not Over until the Eat Lady Sings': Comedy, the Carnivalesque, and Body Politics," in Kathleen LeBesco and Jana Evans Braziel, eds., Bodies Out of Bounds: Fatness and Transgression (Berkeley: University of California Press, 2001), p. 201.
(21) Estelle B. Freedman, No Turning Back, p. 201 and 211; Roberta Pollack Seid, Never Too Thin: Why Women Are at War with Their Bodies (New York: Prentice Hall Press, 1989), p. 201-4; and Susan Bordo, 'Anorexia Nervosa: Psychopathology as the Crystallization of Culture," in Irene Diamond and Lee Quinby, eds., Feminism & Foucault: Reflections on Resistance (Boston: Northeastern University Press, 1988), p. 88.
(22) Canada Fitness Survey, Changing Times: Women and Physical Activity (Ottawa: Fitness and Amateur Sport Canada, 1984), p. 18-19.
(23) Georgina Feldberg, "Holism and History in Toronto's Women's Health Movements," in Robert D. Johnston, ed., The Politics of Healing: Histories of Alternative Medicine in Twentieth-Century North America (New York: Routledge, 2004), p. 185.
(24) Susan Bordo, "Material Girl': The Effacements of Postmodern Culture," in Donn Welton, ed., Body and Flesh: A Philosophical Reader (Oxford: Blackwell, 2001), p. 45-59; Patricia Bradley, Mass Media and the Shaping of American Feminism, 1963-1975 (Jackson: University Press of Mississippi, 2003), p. 3,12; Freedman, No Turning Back, p. 201,204; Jean Kilbourne, Deadly Persuasion (New York: Free Press, 1999), p. 18-19; Seid, Never Too Thin, p. 15-17; and Naomi Wolf, The Beauty Myth (Toronto: Random House, 1990), p. 2-6.
(25) Stearns, Fat History; Farrell, Fat Shame; Carla Rice, "Becoming the Fat Girl: Emergence of an Unfit Identity," Women's Studies International Forum, 30, 2 (2007): 158-72; Natalie Beausoleil and Pamela Ward, "Fat Panic in Canadian Public Health Policy: Obesity as Different and Unhealthy," Radical Psychology, 8,1 (2010): http://www.radicalpsychology .org/vol8-1/fatpanic.html. Accessed 10 October 2011.
(26) Michael Gard, "Friends, Enemies, and the Cultural Politics of Critical Obesity Research," in Jane Wright and Valerie Harwood, eds., Biopolitics and the "Obesity Epidemic': Governing Bodies (New York: Routledge, 2009), p. 32; Hillel Schwartz, Never Satisfied: A Cultural History of Diets, Fantasies and Fat (New York: Anchor Books, 1986); and Gilman, Fat Boys: A Slim Book.
(27) Gard, "Friends, Enemies and the Cultural Politics of Critical Obesity Research," 36, 42.
(28) Patricia Huston and Margo Rowan, "Qualitative Studies: Their Role in Medical Research," Canadian Family Physician, 44 (November 1996): 2455.
(29) Farrell, Fat Shame; Deborah McPhail, "Canada Weighs In: Gender, Race, and the Making of 'Obesity,' 1945-19707 PhD thesis, York University, 2009.
(30) Retha Powers, "Fat is a Black Woman's Issue," Essence Magazine (October 1989):75, 78, 134, 136; and Tamara Beauboeuf-Lafontant, "Strong and Large Black Women? Exploring Relationships between Deviant Womanhood and Weight," Gender & Society 17,1 (February 2003): 111-21.
(31) All but two of the women interviewed chose to use their real names for this study. In the footnotes I've included the names of informants as they appeared in the sources. My process for conducting interviews was informed by the debates about experience outlined in this article, as well as feminist research methodologies which seek to recover the social relations and lived realities of oppressed groups of people. See, for example, Penelope Ironstone-Catterall, "Feminist Research Methodology and Women's Health: A Review of the Literature," (Toronto: National Network on Environments and Women's Health, 1998), p. 7; Dorothy Smith, The Everyday World as Problematic: A Feminist Sociology (New York: Open University Press, 1987), p. 18; and Marjorie L. Devault, "Talking and Listening from Women's Standpoint: Feminist Strategies for Interviewing and Analysis," Social Problems, 37, 1 (February 1990): 104.
(32) Janet Walker interview, White Rock, British Columbia: 6 October 2005.
(33) Jan Mindlin interview, Burnaby, British Columbia: 20 August 2006; Anne Zatylny interview, Toronto, Ontario: 20 June 2006; Mary Frances Ellison interview, Toronto, Ontario: 15 December 2005. Ellison is not a relative of the author.
(34) Helena Spring interview, Toronto, Ontario: 5 January 2006.
(35) Susan White interview, Winnipeg, Manitoba: 11 July 2006.
(36) Walker interview; Laura Thaw interview, Surrey, British Columbia: 6 October 2005; Spring interview; Andria Siegler interview, Toronto, Ontario: 7 June 2006; Monica Seiben-Kuhn interview, Calgary, Alberta: 20 July 2006; Claudia Savage interview, Burnaby, British Columbia: 17 August 2006; Partridge interview; Joyce Cusack interview, Calgary, Alberta: 21 July 2006; Bell interview; Sarah King interview, North Vancouver, British Columbia: 12 October 2005.
(37) Trudy Norman interview, Victoria, British Columbia: 3 August 2006; Spring interview.
(38) McPhail, "Canada Weighs In," p. 123-24.
(39) McPhail, "Canada Weighs In," p. 128, 132.
(40) See for example Kirkland, Fat Rights: Dilemmas of Difference and Personhood; and Esther Rothblum, "The Stigma of Women's Weight: Social and Economic Realities," Feminism & Psychology, 2, 1 (1992): 61-73.
(41) Lynne Grauer interview, Burnaby, British Columbia: 8 August 2006; Spring interview.
(42) Jody Sandier interview, North Vancouver, British Columbia: 5 October 2005.
(43) Walker interview.
(44) Sandra Friedman interview, Sechelt, British Columbia: 7 October 2005.
(45) Davis, How Feminism Travels across Borders, p. 21.
(46) See, for example, works from the American "Fat Underground" from 1973-1979, such as Vivian [Aldebaran] Mayer, Compulsive Eating--In Sicks Easy Steps (Fat Underground: 1974); Mayer, The No-Cure "Cure" (Fat Underground: 1976); Health of Fat People: The Scare Story Your Doctor Won't Tell You (Fat Underground: 1974) found in the Mazer Lesbian Archives, Los Angeles, California.
(47) Terryl Atkins interview, Kamloops, British Columbia: 12 August 2006; Norman interview.
(48) Pat [Bulcock aka Nokomis] Donaldson interview, Empress, Alberta: 25 July 2006; Michele Charland and Louise Turcotte interview by author: Montr6al, Quebec, 22 October 2006; King interview.
(49) Joan Dal Santo O'Brien interview, Sechelt, British Columbia: 7 October 2005.
(50) Cusack interview.
(51) Evelyn Booth and Susan Masterton interview, North Vancouver, British Columbia: 11 October 2005.
(52) Zatylny interview.
(53) Sara Golda Bracha Fishman, "Life In The Fat Underground," Radiance, (Winter 1998): 32-35, 50.
(54) Health Services and Promotion Branch, "Promoting Healthy Weights: A Discussion Paper" (Ottawa: Health and Welfare Canada, 1988), p. 2, 3, 5.
(55) Health Services and Promotion Branch, "Promoting Healthy Weights," p. 1.
(56) Health Services and Promotion Branch, "Promoting Healthy Weights," p. 53.
(57) Canada, Canadian Guidelines for Healthy Weights: Report of an Expert Group Convened by Health Promotion Directorate, Health Services and Promotion Branch (Ottawa: Health and Welfare Canada, 1988), p. 5.
(58) Canada, Canadian Guidelines for Healthy Weights, p. 5.
(59) BMI Nomogram Health Canada, http://www.hc-sc.gc.ca/fn-an/nutrition/weightspoids/guide-ld-adult/bmi_ chart_java-graph_imc_java_eng.php. Accessed 12 December 2011.
(60) Bruce Curtis, The Politics of Population: State Formation, Statistics and the Census of Canada, 1840-1875 (Toronto: University of Toronto Press, 2001), p. 308.
(61) Curtis, The Politics of Population, p. 311.
(62) Janet Polivy and C. Peter Herman, Breaking the Diet Habit (New York: Basic Books, 1983), p, 191-92.
(63) Polivy and Herman, Breaking the Diet Habit, p. 191-92.
(64) Polivy and Herman, Breaking the Diet Habit, p. 80-81.
(65) Polivy and Herman, Breaking the Diet Habit, p. 196.
(66) Ingrid Laue interview, North Vancouver, British Columbia: 3 October 2005; Booth and Masterton interview.
(67) Kate Partridge, obesity: facts &fiction [no caps in original] (Vancouver: Large as Life Association, 1984), p. 3.
(68) Partridge, obesity: facts & fiction, p. 4.
(69) Kate Partridge, "The Fat-Promoting Metabolism," The Bolster (December 1981): 12.
(70) Barbara Berry, "Naturally the choice is up to you," The Bolster (January 1982): 11.
(71) Sangster, "Invoking Experience as Evidence," p. 148, 151.
(72) Partridge interview.
(73) Dal Santo interview.
(74) Walker interview.
(75) Suzanne Bell, "Fat and Fit: Classes for Women," Kinesis (May 1984): n.p.
(76) Barbara Berry, "'Naturally the Choice is up to You'," The Bolster (January 1982): 11.
(77) Ingrid Laue, "Editor's Sphere, The Bolster (February 1982): 1.
(78) Laue, Ingrid, "Editor's Sphere," The Bolster (February 1982): 1.
(79) Rice, "Becoming the Fat Girl," p. 171.
(80) Deb Burgard, "What Is 'Health at Every Size'?," in Sandra Solovay and Esther Rothblum, eds., The Fat Studies Reader (New York: New York University Press, 2009), p. 42.
(81) Jacqui Gingras, "Throwing Their Weight Around: Canadians' Take on Health at Every Size," Health at Every Size Journal, 19, 4 (2006): 203-4.
(82) Raj S. Padwal et al., "Using the Edmonton Obesity Staging System to Predict Mortality in a Population-Representative Cohort of People with Overweight And Obesity," Canadian Medical Association Journal, 183, 14 (4 October 2011): E1059-E1066.
Table 2 2003 BMI Guidelines Risk of developing Classification BMI Category (kg/m2) health problems Underweight < 18.5 Increased Normal Weight 18.5-24.9 Least Overweight 25.0-29.9 Increased Obese class I 30.0-34.9 High Obese class II 35.0-39.9 Very high Obese class III >= 40.0 Extremely high Source: Health Canada "BMI Nomogram." Published on http:/www/ hc-sc/gc/ca/fn-an/nutrition/weights-poids/guide-ld-adult/ bmi_chart_java-graph_imc_java-eng.php. Access date: 12 December 2011. Reproduced with permission from the Minister of Health, 2013.