Plan B and Fat-Shaming: How to Avoid Unnecessarily Judgmental Reporting on Weight

This week, Mother Jones released an important story about how the European version of Plan B emergency contraception will carry a warning telling women over 165 pounds that the drug is less effective for them and women over 176 pounds that it likely won’t work for them at all. The story was a success from a policy perspective, as the Food and Drug Administration (FDA) immediately responded by saying it will look into including similar warnings on American packaging.

Unfortunately, what could have been a clean victory for public health was sullied by the fact that many in the press have no idea how to handle a story about women and weight without bringing it back to fat-shaming. As reported at ThinkProgress, many headline writers around the country used the words “overweight” or “obese” in their headlines, even though the story is not actually about whether a woman weighs “too much,” nor is it about how much body fat she has. Because of this, the stories ended up delivering a pointless dose of shame alongside important health information, which may have made them less effective in getting the point across.

In response, I put together a quick guide on how reporters and editors can present stories about health care and weight that avoid fat-shaming. I’ve certainly failed at times to be as mindful as I can, but a little more diligence can help improve the quality of health-care reporting.

Make sure your facts are straight! One of the major problems with using “obese” or “overweight” in the headlines for the Plan B story is that the package warning isn’t about those issues. The warning is about women who weigh over 176 pounds. A woman who is over 6 feet tall can weigh that without coming close to the medical definition of “overweight.” Simply verifying that the story was about absolute body weight and not about other measures could have helped avoid this error. The word “heavier” is the better choice for headlines, because it is accurate.

Not every story about weight needs to come back to the “obesity epidemic.” Not every story about weight and health is about how Americans weigh too much and need to lose weight. Obesity’s effects on health are a common news item, but as this Plan B story shows, there are stories out there about how weight affects health care that aren’t about gaining or losing weight, or about dietary/exercise issues at all. Make sure your story focuses on the important issues—in this case, the limits of Plan B emergency contraception—and isn’t adding to the growing pile of stories chastising women about their weight.

Be mindful about what art you use. This story was about emergency contraception and package labeling. There was no need to use, as some outlets did, pictures of women standing on scales. (At least no stories I have seen used a picture of the headless fat person, something to be avoided at all costs because it’s so dehumanizing.) The illustrations insinuate the story is  about weight management, when in fact it’s a story about drug efficacy. Pictures of the pills in question, of pharmacies, or even of women looking worried because they (presumably) had unprotected intercourse are all better options.

Only use the terms “obese” and “overweight” in the scientific sense, and reference whose definition you’re using. People throw these words around as if they’re moral judgments or something you can determine just by looking at someone. Remind yourself that these are medical terms used by public health officials and should only be used in that context. To make sure your audience is clear about this, reference whose definition you’re using when describing what counts as “overweight” or “obese.” Is it the Centers for Disease Control and Prevention’s? The World Health Organization’s? There’s a lot of internal debate in the medical community about these terms, so make sure you’re clear which definition you’re using. If you’re not speaking in medical terms, avoid them completely.

BMI is better for measuring populations, and doesn’t work for individuals. The Plan B story had nothing to do with body mass index (BMI), and thankfully some reporters were careful to point that out. But overall, there’s a tendency in the media to treat BMI as if it’s a useful measure for assessing an individual’s body and health. It’s really not, in no small part because there’s so much individual variation regarding body type, genetic tendencies for certain nutrition-related disease, and muscle-to-fat ratio. The BMI might be a good way for public health officials to create understanding about what’s going on in a general population, but it’s not a useful way to render judgment about one person’s body. Avoid using it to talk about individuals altogether.

Do not marginalize people based on their weight. As Mother Jones reporter Molly Redden noted in her story, 166 pounds—the weight at which current formulations of emergency contraception start to lose effectiveness—is the average weight of the U.S. woman. Beyond the shaming and the inaccuracy, this points to why using terms like “obese” and “overweight” is such a bad idea. The implication is that the story only affects a small number of women when really the story has widespread public health implications. Instead, write it with the people whose bodies are being discussed in mind as your primary audience. After all, as the Plan B story shows, they’re the ones who have the most vested interest in your piece. Why wouldn’t you write directly to them?

Weight and health care are tricky subjects, because there’s no way to completely separate them, but there’s also so much shame built into the discourse about weight. It might feel overwhelming at times, but with these few simple suggestions, some of the major landmines can be stepped around. It’s important to do so, and not just because sensitivity is important in and of itself. It’s also because articles that come across as judgmental or shaming are unlikely to be read by people who need the information the most. And isn’t the whole point to get good health information into the hands of people who need it?

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  • Lauren Guy

    My understanding is that the weight recommendations had to do with body fat content, not just weight. Because fat absorbs hormones, and folks with higher fat content tend to have faster metabolisms, all hormonal contraceptives will be less effective for folks with more fat on their bods.

    • Amanda Marcotte

      That was a theory that was floated, but the research on hand does not support that hypothesis. Clearly, more research is needed, but right now the recommendations are based on body weight, NOT body fat.

  • Quis ut Deus

    I am 6′ tall and have weighed 165 in the past. It is by no means ‘obese’ especially for someone of my height

    • CJ99

      Nor should women be singled out. Nor should taller women be singled out either but since I’m 5’10 a lot of women are taller than me.

  • longreddress

    Kudos to the author of this awesome article! So great to see reproductive rights, body positivity and Health At Every Size converging.

  • Wonder

    Wait so EC only works properly for thin women ?

  • Amanda Levitt

    While I appreciate the sentiments of this article and I fully support reporting that isn’t stigmatizing toward fat people, I am incredibly hesitant to accept an argument that tries to say in any way it is acceptable to report about Plan B and use terms like “overweight/obesity” as long as it purely medical terminology. I’m pretty sure regardless of health status people have the right to reproductive health services and pathologizing a body type is pushing fat stigma, while having absolutely nothing to do with emergency contraceptives. Arguing to use those terms as medical terminology also ignores how they are socially constructed and are not based anymore more than a probability model that shows fat people have a higher likelihood of being unhealthy but are not inherently unhealthy. It’s a label with very little scientific meaning.

    Also, trying to reframe the discussion around how more people than just fat people are impacted by this trivialized the lack of access fat people have to reproductive health services in general. While a lot of the reporting was false or misleading it still allowed for a larger discussion about how fat people regularly face stigmatizing health services including access to drugs that actually work with their body type and care that is accessible / affordable / available to them. This issue overwhelmingly impacts fat people and should be part of a larger discussion around how most reproductive health services in general are not made with fat people in mind.

    • Amanda Marcotte

      I do think that’s true, and don’t begrudge anyone reporting this story. Overall, it was good that it took off and kudos to Mother Jones, who I think had excellent reporting and framing of the story from the get-go. My main complaint was with media outlets that reported on the Mother Jones story and weren’t as careful to keep the facts straight and immediately went to the cozy “FAT WILL KILL YOU” framing, without bothering to check if that was even what this story was about. (It’s not. )

  • Greg Laden

    I think the limitation is about body fat percentage, not weight, and weight is being used as an approximation even clumsier than BMI for individuals.

  • Greg Laden

    That is doubtful. When body mass has a strong effect on dosage dosages can be adjusted. I’ve not seen the original research but people involve in this work who have commented refer to BMI, suggesting that it is not weight but fat that matters here.

  • Amanda Marcotte

    That’s also not showing to be true in studies. To be completely clear, this is a way understudied issue, and more research will hopefully clear up if this is a dosage issue, a body fat issue, or something that we just have no way of fixing.

  • Mandy

    FtM transgender men exist fyi. We should not forget them. Many of them still have a uterues and need access to reproductive health care. Esp if they have penatrative sex with cismale partner.