When I was 19 I worked at a grade school, where I served as both a kindergarten classroom assistant and a part-time administrative assistant, working the school’s front desk with the school’s sole full-time administrative assistant.
We both worked through lunch regularly, eating bites between acting as school nurse and answering the phone. Our office was surrounded by large windows, and its location at the school’s front entrance meant that the two of us, fat school secretaries eating for all to see, were a prime attraction for nearly anyone. Adults would leer, staring pointedly at our food, though comments were mercifully rare.
They were rare, that is, until my colleague announced that she was pregnant. The floodgates of unwanted judgment and unsolicited advice opened. I changed my schedule so that she could eat lunch in her car, but that didn’t spare her. As it turned out, most didn’t even need to see her eat in order to assert their own invasive judgments and prescriptions. One parent, just hearing my colleague mention sushi, snapped that she shouldn’t be eating fish while she was pregnant. Just the mention of a nonapproved pregnancy food had led this person to assume that my coworker was eating it while she was pregnant, and was therefore endangering the life of her child.
It’s a kind of misogyny and concern trolling that takes its aim at pregnant people regularly. But it wasn’t just that: others readily drew conclusions about the kind of person she was based solely on what they believed she ate, and whether they believed her behaviors were healthy and, by extension, morally acceptable. I didn’t know it at the time, but I was watching healthism in action.
Healthism was coined by Robert Crawford in a 1980 paper for the International Journal of Health Services. In the 1970s the U.S. had seen a wave of renewed interest in holistic health and wellness, and Crawford was wary of how that investment in health was curdling into a perceived responsibility to seem healthy to others. He defined healthism as “the preoccupation with personal health as a primary—often the primary—focus for the definition and achievement of well-being; a goal which is to be attained primarily through the modification of life styles.” That is, for Crawford, healthism flattened the health of whole populations from a dynamic and multifaceted issue with many and varied influences, to a simple matter of personal responsibility. Crawford saw health as inherently political, a reflection of systems that create and perpetuate poverty, racism, misogyny, and more. But under healthism, health was an individual matter, not a systemic one, which meant that the individual was primarily responsible for their own health. “For the healthiest, solution rests within the individual’s determination to resist culture, advertising, institutional and environmental constraints, disease agents, or, simply, lazy or poor personal habits.”
Crawford’s work on healthism was published before some major public health crises and panics in the U.S. It was published just before the AIDS crisis began, and queer and trans people watched one another die at astronomical rates, with a delayed government response that many LGBTQ+ people experienced as indifference to our very lives. It was published before obesity was declared an epidemic, and before we declared a “war on obesity,” often fighting that “war” by stigmatizing fat bodies. And it was published before health became, in a sense, a moral imperative—and one that nearly all of us feel compelled to enforce at one moment or another.
As a fat person, my health is one of the primary grounds offered by those who mock, harm, and reject me as a fat person. Cruel and judgmental behavior is often justified with an off-handed I’m just concerned about your health. As if my health were their responsibility. As if I owed it to them, a debt I’d never taken out and could never repay.
And often, as many fat people know, trolling often masquerades as genuine concern—that’s what makes it so insidious, and what can make it so cutting. But underneath its explicit message of caring concern, there’s a clear implicit judgment. You’re doing it wrong. You have failed. I have been monitoring your health. I know your body better than you.
And healthism isn’t just a problem for fat people—it’s a tool used to further anti-fat bias, yes, but also ableism, transphobia, misogyny, racism, and more. Healthism shows up when we joke about getting diabetes from a single dessert, or refer to a rich meal as a “heart attack on a plate”—implying that those health conditions are caused by failures of a perceived personal responsibility to be healthy, not by structural forces that disproportionately harm the health of people living on the down side of power. Healthism shows up when we suggest that trans people should be more worried about the side effects of long-term hormone therapy than their own lived experience of their gender.
Healthism isn’t just an individual problem, either—it’s present in many of our systems and institutions. Until the passage of the Affordable Care Act in 2010, U.S. insurers routinely (and legally) denied health insurance to people with “pre-existing conditions.” Paradoxically, we had a system where people were not healthy enough to qualify for health care coverage—and countless patients were unable to meet their most basic needs as a result. Healthism even shows up in the war on drugs, when we culturally and politically respond to drug dependency—strongly linked to environmental factors like poverty, stress, and trauma—as a personal responsibility to “just say no.” And it shows up in the worlds of fertility, pregnancy, and lactation, all of which pressure expecting parents to become pregnant, be pregnant, and give birth in one or two “right ways.”
To be clear, healthism isn’t the root cause of transphobia, ableism, racism, anti-fatness, or misogyny—but it can be a tool to enforce all of them. That’s in part because healthism assumes a playing field that simply isn’t there. And when it stubbornly attributes societal and community outcomes to “individual choices,” it reinforces the biases facing marginalized communities. If health is a personal responsibility, and so many marginalized communities have such bad health outcomes—well, they must just be less responsible. It’s an insidious and powerful kind of bias, and one that many of us perpetuate every day—even if we don’t know it, and even if we don’t mean to.
Perpetuating healthism is a learned behavior, yes, but it’s one that also often gives us a sense of mastery, control over our own bodies, and, sometimes, a sense of superiority over those whose health we’re so ready to judge and dismiss. So if you, like me, regularly find yourself falling into the trap of healthism, there’s a lot to unpack in our personal investment in upholding healthism. Here are some questions to reflect on:
Why do you want or expect to know about other people’s health?
If you’re discussing their health with them, have they asked for your input? Are you telling them something they haven’t already heard? (Spoiler alert: Every fat person has heard every diet tip you’re about to share.)
How do you feel when you assess or judge someone else’s health? How does it make you feel? And why do you keep doing it?
Does your perception of other people’s health usually determine how you treat them? Do you want it to?
We’ve all perpetuated healthism in some way or another because, after all, it is all around us. How could we help but learn it when it’s everywhere? But if we know better, we can do better. After all, our perception of someone else’s health shouldn’t determine how we treat them or what they can access.
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