**8.3 Social media**

*Cardiac Diseases - Novel Aspects of Cardiac Risk, Cardiorenal Pathology and Cardiac Interventions*

health and vitality. There is a size threshold, albeit non-discrete, over which a person crosses over into a state of increased risk of, or overt illness. Established comorbidities and sequelae frequently accompany sustained obesity, despite practicing intuitive eating, that reduce quality of life, not the least of which include increased risk of musculoskeletal pathology [81], arthritis/joint pain, respiratory conditions/ diseases (e.g., sleep apnea, asthma), depression/anxiety, inability to participate in certain activities, and physical disability [1]. Additionally, the association between intuitive eating and diet quality remains unclear in epidemiologic literature. Nevertheless, HAES® holds value in its deemphasis on restrictive dieting, which has been associated with increased psychological stress, increased cortisol levels,

Despite years of empirical medical and comprehensive epidemiological research, many fat activists take pride in maintaining higher BMI and embracing their size, all while holding in contempt any efforts to increase health and wellness. Permeating through activism, academia, fashion, and even sports, the HAES® approach appears to promote not only acceptance, but pride in the esthetic of the fat body. Members of this movement seek to bring people of larger size back from the margins of society, fiercely labeling those who oppose their ideas as "body-shamers"

While the OW/obese may find intuitive eating and HAES® approaches successful, there still remains a tremendous (mental) health care cost of obesity-related illnesses. These costs are a real economic impact to society. Years of medical and scientific research has provided irrefutable evidence of the deadly cost of condoning preventable OW/obesity and unhealthy lifestyles of over 650 million OW/obese worldwide. Simultaneously, the medical and public health community must not use the campaign to reduce fat as justification for prejudice and oppression. OW/ obese individuals have a right to make their own choices; but health literacy and knowledge of the correct information and use of that information to make informed

At the primary level of prevention, modifying health behaviors, such as incorporating healthy eating and fitness habits into everyday lifestyles, can reduce metabolic risk factors (e.g., cholesterol levels, blood sugar levels, and BP) [25, 82]. The benefits of both reducing sedentary behavior together with increasing physical activity, especially in the elderly, is associated with a reduced risk for type 2 diabetes, compared with those physically inactive [82]. Lowering body fat, even if from obesity to overweight, can result in a reduction in metabolic abnormalities and lower levels of systemic inflammation, and lower BP [25]. The Look AHEAD study examined the effects of an intensive lifestyle intervention and found that lifestyle interventions can produce long term weight loss and improvement in fitness and

While self-acceptance and positive self-perception are certainly noble attributes, scientific knowledge of well-established risks of clinical obesity, particularly excess central body fat, cannot go unheeded. Health literacy, in combination with body positivity, may prevent reversal of the strides made in the reduction of CVD.

and subsequent weight gain [65].

and "fat phobic" perpetuators of societal norms.

health decisions is of utmost public health concern.

sustained beneficial effects on CVD risk factors [83].

**8.1 Health behaviors**

**8.2 Health literacy**

**8. Preventing the reversal of progress made in CVD research**

**90**

Social media is a crowded space that is filled with competing health messages. These platforms play a principal role in attempting to change health behavior and prevent or improve CVD health outcomes. Social media messages have influenced the health care decision making among patients, not all of whom always check the authenticity of information received. For example, in a study exploring the impact of health-related information sharing and the influence of social media on people's online health information-seeking behavior, the authors found that social media users received health information (80–90%), and admitted to starting (47%), and stopping medication (42%) after reading messages received on a social media platform [86]. Taking this into account, public health practitioners must focus their resources on platforms to counter sociological agendas. For example, most tenets of fat acceptance, body positivity (independent of weight status), and HAES® openly contradict health guidelines that are based on years of medical research. They must increase the amount of available information on CVD health, reinforce its salience

#### **Figure 6.**

*Adverse health risks for patients with low health literacy (source: Centers for Disease Control and Prevention (CDC), Center for Preparedness and Response. Available from: https://www.cdc.gov/cpr/infographics/ healthliteracy.htm [Accessed: 03 August 2020]).*

as a CVD risk factor and public health problem, attract the attention of the OW/ obese population, and offer practical solutions [87].

Medical advice must be translated into lay terms, adjusting for multiple levels of health literacy. Messages must include health incentives that are relatable to their audience. A successful public health campaign will include communication that is sensitive to the body positivity movement, one that encourages self-acceptance, and supports the mental health of this population. Incorporating elements from the social, biomedical, and functional models of health may elucidate why reducing body fat is beneficial for cardiometabolic health.

### **8.4 Clinical settings**

In clinical settings, it is imperative that medical professionals, including physician assistants [71] and exercise and nutrition professionals [72], increase their awareness of their own weight bias, as well as that of their colleagues. Creating a welcoming setting where the OW/obese do not feel stigmatized will open more opportunities for doctor-patient educational discourse on the health benefits of reducing body weight, restructure how they are clinically monitored, and reduce bias while profiling their CVD risk.

The biomedical model has been the dominant approach in medicine. However, in its organ-oriented approach and its failing to take psychosocial aspects of disease into account, its efficacy in the advent of chronic disease prevalence has become questionable [50]. There is an increasing recognition of the influential role of culture and society in our perception of health and healthy behaviors. Rather than medical practitioners taking the historic biomedical model approach to obesity in clinical settings, a more effective approach will be to incorporate ideas from the social model (e.g., screening for social and environmental contributors to obesity), together with concepts from the functional model (e.g., examining functional health of the OW/obese). Building bridges across models will advance our prevention efforts and holistic treatment in this population.

## **9. Chapter conclusion**

Obesity is still a pervasive problem, confirming its intractability. Obesity is a well-known risk factor for CVD, which is still a leading cause of morbidity and mortality in the U.S. and most developed countries. Yet, strides have been made in reducing CVD mortality rates. Over the last 40 years, we have seen a decline in mortality from CVD in the U.S. and many regions of the world. In response, there have been major setbacks to this progress, namely the fat acceptance and body positivity movements. Principally rooted within sociological frameworks, these movements appear inattentive to the established adverse health risks of maintaining an OW/ obese status; nor do they promote efforts to modify health behaviors that reduce obesity and thus decrease risk of type 2 diabetes and CVD. Yet these emerging views are gaining momentum, revealing key changes in trends in fat identity and fat acceptance. These trends have key public health implications with a direct impact on a generation who daily engages with social media influencers who promote such messages. The parallel trend of the body positivity movement, in the absence of weight status consideration, threatens to reverse decades of progress made toward reducing coronary heart disease and its comorbidities.

The urgency of reducing obesity as a public health message continues. The body positivity and fat activism communities must reconcile with medical and public health professionals to equally address both the mental health benefits of

**93**

**Author details**

Ketrell L. McWhorter

Wilmore, Kentucky, United States

provided the original work is properly cited.

School of Science, Health and Mathematics, Asbury University,

\*Address all correspondence to: ketrell.mcwhorter@asbury.edu

© 2020 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

*Obesity Acceptance: Body Positivity and Clinical Risk Factors*

cardiovascular health relies upon this collaboration.

self-acceptance and positive body image, while also bearing in mind the short- and long-term health advantages of preventing or treating obesity. Both groups must weigh in and not compete to win on framing the narrative of obesity. The future of

*DOI: http://dx.doi.org/10.5772/intechopen.93540*

*Obesity Acceptance: Body Positivity and Clinical Risk Factors DOI: http://dx.doi.org/10.5772/intechopen.93540*

*Cardiac Diseases - Novel Aspects of Cardiac Risk, Cardiorenal Pathology and Cardiac Interventions*

as a CVD risk factor and public health problem, attract the attention of the OW/

Medical advice must be translated into lay terms, adjusting for multiple levels of health literacy. Messages must include health incentives that are relatable to their audience. A successful public health campaign will include communication that is sensitive to the body positivity movement, one that encourages self-acceptance, and supports the mental health of this population. Incorporating elements from the social, biomedical, and functional models of health may elucidate why reducing

In clinical settings, it is imperative that medical professionals, including physician assistants [71] and exercise and nutrition professionals [72], increase their awareness of their own weight bias, as well as that of their colleagues. Creating a welcoming setting where the OW/obese do not feel stigmatized will open more opportunities for doctor-patient educational discourse on the health benefits of reducing body weight, restructure how they are clinically monitored, and reduce bias while profiling their

The biomedical model has been the dominant approach in medicine. However,

Obesity is still a pervasive problem, confirming its intractability. Obesity is a well-known risk factor for CVD, which is still a leading cause of morbidity and mortality in the U.S. and most developed countries. Yet, strides have been made in reducing CVD mortality rates. Over the last 40 years, we have seen a decline in mortality from CVD in the U.S. and many regions of the world. In response, there have been major setbacks to this progress, namely the fat acceptance and body positivity movements. Principally rooted within sociological frameworks, these movements appear inattentive to the established adverse health risks of maintaining an OW/ obese status; nor do they promote efforts to modify health behaviors that reduce obesity and thus decrease risk of type 2 diabetes and CVD. Yet these emerging views are gaining momentum, revealing key changes in trends in fat identity and fat acceptance. These trends have key public health implications with a direct impact on a generation who daily engages with social media influencers who promote such messages. The parallel trend of the body positivity movement, in the absence of weight status consideration, threatens to reverse decades of progress made toward

The urgency of reducing obesity as a public health message continues. The body positivity and fat activism communities must reconcile with medical and public health professionals to equally address both the mental health benefits of

in its organ-oriented approach and its failing to take psychosocial aspects of disease into account, its efficacy in the advent of chronic disease prevalence has become questionable [50]. There is an increasing recognition of the influential role of culture and society in our perception of health and healthy behaviors. Rather than medical practitioners taking the historic biomedical model approach to obesity in clinical settings, a more effective approach will be to incorporate ideas from the social model (e.g., screening for social and environmental contributors to obesity), together with concepts from the functional model (e.g., examining functional health of the OW/obese). Building bridges across models will advance

our prevention efforts and holistic treatment in this population.

reducing coronary heart disease and its comorbidities.

obese population, and offer practical solutions [87].

body fat is beneficial for cardiometabolic health.

**8.4 Clinical settings**

**9. Chapter conclusion**

CVD risk.

**92**

self-acceptance and positive body image, while also bearing in mind the short- and long-term health advantages of preventing or treating obesity. Both groups must weigh in and not compete to win on framing the narrative of obesity. The future of cardiovascular health relies upon this collaboration.
