If you're a reader living in the UK, you’ll have undoubtedly seen the headlines this week about new government plans to provide weight-loss injectables to ‘get people back to work’.
If by some miracle you missed it, here’s a link to the Guardian’s piece; although not the worst take I’ve seen, it’s still dire. It’s wild out there; do what you need to do to take care of yourself.
First of all, for any fat readers who have been affected by this, I’m sending care and solidarity your way. It’s not exactly a secret that in the era of weight-loss injectables and ‘ballerina bodies’, overt anti-fatness is stronger than ever. And while I’m sure many of you will just roll your eyes at this, I know for others it can make you feel vulnerable and unsafe. Remember that the comments are only available for paying subscribers so, no trolls. Feel free to use that space to vent/scream/cry if that feels like it would be cathartic.
At some point, I’ll do a deeper dive into ‘weight-loss jabs’; right now I’m less concerned about whether they work/don’t work/the possibility of side effects and so on. This is all important, but I think secondary to the politicisation of fatness and fat people being used as collateral damage to score political points.
The story is essentially this: Wes Streeting - our esteemed health secretary – has suggested that ‘widening waistbands’ are placing a burden on the NHS. And to ease costs on the NHS, they are going to administer ‘weight-loss jabs’, a class of drugs known as GLP-1 receptor agonists which you may know as Ozempic, Mounjaro, or Wegovy. This, in a gargantuan leap of logic, will apparently get more people back into work.
Oh and side note: Eli Lilly – one of the world’s most powerful pharmaceutical companies – has just cut the UK government a cheque for £280 million. And P.S., they make the weight-loss injectables Mounjaro and Zepbound.
Eli-Lilly are funding a trial in Manchester alongside Health Innovation Manchester – apparently a private company fronting for NHS services – to see if the weight-loss injectables can help reduce levels of ‘worklessness’. The study is set to last 5 years.
There are so many layers to this that it’s hard to know where to start. But first let's talk about the ways that news stories about weight – regardless of the content of the story – perpetuate harmful stereotypes that are detrimental for fat people’s health.
A content analysis of US and UK news stories, published in January this year in the Journal of Health Communication, found that UK online news outlets were ‘were 2.5 times more likely to contain stigmatising images than U.S. news’. It also found that 70% of the images of higher weight people depicted them in a stigmatising way: without a head/face, of them eating ‘junk food’, or sitting down being ‘lazy’. All of these tropes contribute to the deep dehumanisation of fat folks, which perpetuates more harm.
Secondly, as mentioned above, Streeting is frequently reported as using the phrase ‘widening waistbands’, placing blame for both the state of the economy and the state of the NHS on fat folks. The idea that the average weight of the population is climbing astronomically ubiquitously gets reported as fact.
But it is not true.
Population estimates of the number of people who are ‘overweight’ or ‘ob*se’ has been leveling off for at least 5 years. And because of the way that data are reported – i.e. with ‘overweight’, ‘ob*se’, and ‘severe ob*sity’ all lumped together – it distorts the picture. When we tease these categories out, the data suggest that levels of ‘overweight’ and ‘ob*sity’ increased mostly in the first half of the 20th century, and have been fairly steady since. It is the super and infinifat numbers that are increasing, albeit not at the sensationalised rate that Wes’ is suggesting. Regardless, Wes’ diatribe pushes these folks farther to the margins and centres their fatness as the problem.
I’m sceptical that he doesn’t know this information. But it’s easier to blame fat people for both the failing economy and a crumbling NHS, than to try to undo a decade and a half of Tory austerity (give or take 40 years of neoliberal responsibilisation of health).
And because fat folks have been scapegoated for government failings since at least the 90s, journalists and media pundits uncritically recapitulate violent narratives that beget cycles of pain and suffering. ‘Worklessness’ and ‘unemployed’ are closely related – in the public imagination – to ‘lazy’, ‘slothenly’, ‘indolent’. The articles don’t say these words, but they don’t have to.
CIHAS medical correspondent, Dr. Hammad (who we met in a previous rapid response), was one of the approximately 400 people who sent me this article (although, true to form, a day later than everyone else). Turns out he’s not a huge fan of Streeting, and makes a similar point: ‘he knows it’s populist and popular to scapegoat fat people as lazy and workshy’.
Streeting is quoted as saying, ‘Illness caused by ob*sity causes people to take an extra four sick days a year on average, while many others are forced out of work altogether.’
Here Streeting is blaming fatness for pushing people out of the workplace, and takes no account of two mass disabling events that we’ve lived through in recent history: the aforementioned austerity – estimated to have caused at least 335, 000 excess deaths between 2012 and 2019 – as well as the Covid-19 pandemic.
It also obscures the reality of work for fat people where workplace discrimination is rampant. Should they be offered a job at all, fat folks are less likely to get promotions and are more likely to experience harassment, bullying, and anti-fat bias at work. Workplaces can be full of toxic diet and wellness chat and body shaming too; why would fat folks subject themselves to that if they can call in sick?
But the thing that was most uncomfortable to me was the way that the value of fat folks has been tied to their economic productivity. The idea that we are only worthy of care or rest (or indeed access to the NHS) once we have ‘earned it’, usually through paid employment, is deeply problematic.
Dr. Hammad points me to a passage in the book Health Communism, by Beatrice Adler-Bolton and Artie Vierkant, that eloquently sums up the problems with linking human value to our capacity to produce for the ruling class. It’s long but I think it's worth including in full, especially since Hammad typed it all out for us:
‘It is crucial to recognise how we have deflected and diverted accountability for poverty and ill health away from the obvious culprit - the capitalist political economy - and toward a more individuated notion of isolated labor power - the worker-beneficiary - absolving our political imaginary of the need for radical redistribution of wealth and the expansion/socialization/communization of robust social safety net supports. Placing the blame for idleness, dependency, illness or vagrancy on the individual facilitates a push-and-pull system where an “afflicted individual” is solely responsible not only for their poverty and ill health but also transcending them. In this logic, society at large and the system of political control are therefore not materially or ethically liable for the care and welfare of those unable to meaningfully contribute to the economic worth of the nation. Those “unsound” burdens instead were a threat to the nation’s fitness and proposed for elimination to preserve the future of the capitalist state. Pathologizing and criminalizing dependency is a way of taking the blame for poverty and ill health away from capital and the state and roofing it onto the most afflicted.
The worker/surplus binary solidifies the idea that our lives under capitalism revolve around our work. Our selves, our worthiness, our entire being and right to live revolve around making our labor power available to the ruling class. The political economy demands that we maintain our health to make our labor power fully available, lest we be marked and doomed as surplus. The surplus is then turned into raw fuel to extract profits, through rehabilitation, medicalization and the financialization of health. This has not only justified organized state abandonment and enforced the poverty of the poor, sick, elderly, working class, and disabled; it has tied the fundamental idea of the safety and survival of humanity to exploitation.
We’ve been told that work will heal us. We’ve been tricked into trying the work cure. We are told that work is in our best interest, when the truth is that it only serves the need of capital and the ruling class at the expense of our health. Breaking the mirage of worker versus surplus provides a revolutionary opportunity to unite the surplus and worker class in recognition of a better truth: safety, survival, and care are best ensured outside of capitalism. This revolutionary potential has been divided, discouraged, and criminalized.’
While at first glance, the idea of increasing access to medication may seem like it’s shifting responsibility away from the individual and towards the state. But Streeting makes it clear that health is still an individual responsibility. From the Guardian: ‘However, Streeting said individuals would still need to remain responsible for taking “healthy living more seriously”, as the “NHS can’t be expected to always pick up the tab for unhealthy lifestyles”.’
‘Really he doesn’t care at all about the health of individual fat people, or public/population health’, Hammad reckons. ‘He wants to demonise people and punish them for ideological reasons, even if any scheme is going to be cruel, unworkable, and counterproductive. Because he’s a [bad word redacted for the sake of his BMA membership].’
Healthism is a structural bias against people who are sick and disabled. It insists that we distinguish sickness that is ‘within’ and ‘outside’ individual control, and further insists that the majority of ill health is within individual control. This paves the way for exploitative diet and wellness companies to make money from vulnerable people, but also shifts the blame away from the social and structural determinants of health.
Fatness is particularly susceptible to the impacts of healthism; we believe that fatness is the fault of individuals and are simultaneously unwilling to address the material conditions that make people fat, aside from a light nod to the ‘ob*sogenic’ food environment which also has a through-line of personal responsibility. Wes Streeting undoubtedly knows that there are over 100 different contributors to body weight. But by constantly centring a personal responsibility narrative, he can continue the legacy of privatisation and decimation of the NHS and brand it as novel and revolutionary. He is also reinforcing the damaging idea that all fat people are automatically sick; that fatness is a pathology. This again obscures the disabling effect that anti-fat bias engenders in fat folks.
There are also questions about what kind of work will be available, and where these jobs are going to materialise from? And a tacit implication that work will be better for people’s health than unemployment.
‘...the theorist Karl Marx also began to turn his attention to the psychic and relational injuries that result from the capitalist mode of production, in his theory of ‘alienation’. Marx observed that workers were estranged from their work, the things that they produced, from their co-workers and from themselves. Under the capitalist system, workers only produced because they would die if they didn’t, and the terms with which they engaged with work were determined by external forces – the boss, the boss’ boss, the board, and the markets. Workers therefore became fundamentally dissociated from the capacity for joy and connection, a psychic wound that accompanied each of the physical ones sustained during work. Although the last two centuries have seen conditions of production shift across time and space, it remains true that capitalist work harms our entire bodyminds through exploitation and the quest for profit.’
Indeed Dr. Hammad has the receipts to back up this assertion: ‘This study showed that several biomarkers were negatively affected by going from being unemployed to being in poor quality jobs; quality was measured by asking questions on things like autonomy, insecurity, pay etc…’
Work is not always compatible with health: zero hours contracts; the gig economy; workplace harassment; hustle culture; overwork; job precarity; the expectation to be always available to your boss or reply to emails outside of work hours; hazardous working conditions; burnout; micromanagement; inflexible working; the expectation to get back to the office; impossibly high workloads; lack of compassionate or sick leave and limited holidays; and toxic workplace dynamics all detract from any objective metric or subjective sense of wellbeing. If Streeting was serious about reducing health disparities, then removing the need to work for basic survival through universal basic income (pg 34-35) would be a better and more dignifying place to start.
I don’t really have anything to offer here; any tiny glimmer of hope that Labour would be anything other than Tory-lite was extinguished almost immediately after spineless Starmer took office and continued to aid and abet Israel’s genocide of the Palestinian people (and now Lebanese people too) and commit his own war crimes.
I don’t have hope that this health secretary will be anything less than a vile fatphobic troll, and I’m really worried about what the anti-ob*sity policies will be from this government. While I’m sure they won’t do anything to actually support the needs of fat folks, they will act discursively to inflame fatphobic rhetoric that continues to distract from the real issues: exploitation of workers; unfathomable treatment of immigrants; institutionalised hunger; the disposability of sick, disabled, fat, Black and Brown, trans, queer, neurodivergent and elderly people; poverty; wealth hoarding of the ruling class. His ‘health policy’ will no doubt continue to entrench health disparities while lining the pockets of Eli fucking Lilly’s shareholders.
All I can offer is a space for venting and grieving, for solidarity and rage, and a commitment to keep fighting back.
