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The U.S. has a problem with its weight鈥攂ut not in the way you might think. According to the Centers for Disease Control and Prevention, more than 70% of Americans are either , but there鈥檚 another side to the 鈥渙besity epidemic鈥� that isn鈥檛 spoken about enough: fat bias.

Americans who aren鈥檛 fat live in fear of becoming so. An estimated 45 million are on . According to a Gallup poll, 45% of Americans , and in one study, almost half of girls ages 3 to 6 said they .

This is not new.

The 20th century opened with a rip-roaring debate about corsets. Should women continue to wear them to look slender? What about the intestine-constricting health risks that come with cinching one鈥檚 waist for hours? Fainting became so common that wealthy women had , where they could recover from swooning episodes. Women, under extreme societal pressure, wore corsets despite medical advisories.

In 1921, a man named G.B. Pulfer wrote in 鈥淐orsets and Lingerie鈥� that 鈥渇ear of sagging bodies, fear of lost figure, fear of shiftless appearance鈥� kept women in corsets. He was tapping into a fear that had begun to haunt America鈥檚 cultural ethos: the fear of fat. 

In the 1800s, being fat signified wealth, while thinness signified poverty. A century later, that belief reversed. Professor Peter Stearns, author of Fat History, says that first, patterns of food availability changed. A system of processed abundance replaced scarcity. Then, work patterns changed, and capitalism meant less time for cooking: On average, Americans work the longest hours in the industrial world. 

By the late 19th century,  to persuade the public that thin people lived longer, and were more stable and attractive than their fat counterparts. Some doctors 鈥渉appily exploited the commercial opportunities of more weight-aware and weight-anxious populations in the middle 1800s,鈥� writes Jayne Raisborough in Fat Bodies, Health and the Media. For the first time, the market flooded with diet products such as Kellogg鈥檚 Safe Fat Reducer and Dr. Vincent鈥檚 Anti-Stout Pills.

After World War II, the fear of fat coalesced into a phobia, Stearns says. By the 1950s, psychologists began to argue that being fat was symptomatic of 鈥渕aladjustment and insecurity,鈥� and that fat people were 鈥渕iserable, self-indulgent and lacking in self-control,鈥� according to Stearns鈥� Fat History. 鈥淕irls get fat because they鈥檙e emotionally disturbed,鈥� was one example of post-WWII pseudoscience quoted in Stearns鈥� book.

Fatphobia, 聽the 鈥渋rrational fear of, aversion to, or discrimination against, obesity or people with obesity,鈥� isn鈥檛 just a matter of interpersonal bias.

These fears were also tied to White supremacy, says Sabrina Strings, author of Fearing the Black Body: The Racial Origins of Fat Phobia. Faulty race science created the stereotype of 鈥渢he big Black woman,鈥� and associated fatness with being African. 鈥淭hinness became a form of American exceptionalism,鈥� Strings says. It was a sign White people were supposedly more disciplined than the Africans who were brought to North America through the slave trade. This grim history exemplifies how fatphobia was used to bolster racist propaganda.

Fatphobia,  the 鈥渋rrational fear of, aversion to, or discrimination against, obesity or people with obesity,鈥� isn鈥檛 just a matter of interpersonal bias. It is a structural issue that affects every aspect of our lives, from economics to psychology. Mary Himmelstein, a researcher who focuses on the consequences of fat-shaming, says, 鈥淲hen you think about weight stigma, essentially you see it everywhere,鈥� from educational settings, to the media, to personal relationships. And this stigma can have many harmful effects.

The last accepted form of bias

The stress of weight stigma affects psychological and physical health, as well as , Himmelstein says. The mental health effects of this stigma have been correlated with suicidal ideation, depression, anxiety, and eating disorders. In a 2019 study, researchers found that larger-sized children were so anxious about confirming the  that the ability of their working memory was actually reduced.

Researchers Paula Brochu and Victoria Esses say fatphobia is our last culturally . Fat characters often exist onscreen to be mocked in , and their weight is used as a narrative shortcut to explain that the character is lazy or unintelligent (see Pitch Perfect鈥檚 Fat Amy.) In Netflix鈥檚 Insatiable, the main character dons a 鈥攚hich implies that using offensive tropes is preferable to hiring an actual fat person.

To this day, fat jokes are still a standby for comedians, and it is still socially acceptable for fat people to be mocked publicly. Researchers Rebecca Puhl and Chelsea Heuer say people justify it 鈥渂ecause obese individuals are personally responsible for their weight鈥� and that shame could motivate them into .

But embarrassing people into losing weight doesn鈥檛 work. In a landmark study of 2,600 adolescents, researcher Janet Tomiyama discovered that being told 鈥測ou鈥檙e too fat鈥�  over time, as well as disordered eating.

The economics of being overweight

The internet abounds with forums designed to help people with the dilemma of shopping while fat, a task that often can only be done online. Then people have to contend with the , a phenomenon where fat people pay more for items such as clothing and furniture. Many airlines require fat people to buy two seats, and mattresses, bikes, and even caskets for plus-sized people cost more.

Some argue that fat people should pay a premium for these items because they use more material. But the clothing industry doesn鈥檛 set its costs based on the amount of fabric used鈥攃osts are calculated by supply and demand. For example, tall people don鈥檛 pay more for . And if the clothing industry was simply charging for quantity of fabric, baby clothes would be the cheapest purchase around.

Another way fat people are economically disenfranchised is professionally. Studies show that  get , than their thinner peers. One survey indicates only 15% of  would even hire an overweight woman, and weight discrimination is actually legal .

Insurance companies can legally  for people whose Body Mass Index is over 25, despite the fact that has a complicated, medically contested history. Even prescribed medications like Plan B, birth control, and antibiotics are often ineffective for fat people.

The medical costs of being fat

Being overweight means receiving . Doctors spend  and show them less empathy.When fat people go to the doctor, they are often just told to go on a diet, regardless of what other medical issues they may have. Half of the women in a 2013 study said they delayed going to the doctor until they .

鈥淭here鈥檚 no way to tell how healthy someone is, just based on their appearance,鈥� Himmelstein says. While obesity can increase the risk of heart attacks and diabetes, it is possible to be . In some cases, obesity can even when it comes to certain diseases.

But our $72 billion dollar doesn鈥檛 work. Scientist Traci Mann has spent most of her career proving that diets are better indicators of  than they are of anything else. And the term 鈥渄iet,鈥� with its now negative connotations, has been replaced with 鈥渉ealth,鈥� thanks to the rise of pseudoscience outlets like Gwyneth Paltrow鈥檚 goop and a slew of Instagram 鈥渉ealth鈥� influencers. But according to Himmelstein, it鈥檚 really the same thing: 鈥淧eople say 鈥業 want you to be healthy,鈥� which is code for 鈥業 want you to lose weight.鈥欌��

Because of a sexist, racist history of anti-fatness, and a for-profit 鈥渉ealth鈥� industry, we have a pervasive and 鈥渁cceptable鈥� bias that harms people every day. But we鈥檙e not stuck with it. 鈥淭o start, one of the most important things that individuals can do is examine their own biases,鈥� Himmelstein says. 鈥淏eing aware of these biases can help reduce discrimination, just like it would for any other stigmatized identity.鈥�