Who knew that free donuts would provide such a perfect example of weight discrimination in healthcare? (JK, many of us could have guessed.)
Krispy Kreme announced on 3/22 that anyone with a COVID-19 vaccination card can get a free glazed donut. It should come as great news! Except of course, plenty of people expressed concern. Here’s a preview of what that looked like: (Don’t get too caught up in it. I’ll go into all the reasons why it’s harmful and inaccurate below.)
First of all, I recognize that this person is a physician. More than likely, she’s really trying to help people with this messaging. Her intentions are good! But they’re misguided. Let’s pick apart the issues, one by one.
A donut a day won’t make you gain 15 pounds by the end of 2021
(I typically stay away from concrete weight numbers, but she tweeted this!)
The claim that you’ll gain X amount of weight by eating X amount of food is incredibly outdated. First of all, countless peer-reviewed articles have thoroughly debunked the old “3500 calories per pound of weight loss/weight gain” rule. A 2013 study explains the “most serious” failure of this rule. It doesn’t “account for dynamic changes in energy balance that occur during an intervention.” The “interventions” they’re referring to are the low-calorie diets that researchers put people on in order to measure their weight loss. In a nutshell, what they’re saying is that how many calories “equal” one pound can change based on all sorts of things. Eat less and your body may learn to use fewer calories. Eat more and your body may use more. Things like your genetics, metabolism, stress, and mass also affect how efficiently your body uses calories.
The idea that someone might eat a donut a day and “change no other aspects of their diet/exercise” is also flawed. Think about it. You might occasionally add a donut to whatever your “normal” eating routine is without eliminating anything else. But, it seems highly unlikely that you’d do this EVERY DAY FOR A YEAR. That donut would probably replace your regular breakfast (or part of it), or your regular mid-morning/afternoon/evening/late-night/whenever snack.
(Pssst… If you want more body-positive, shame-free nutrition information, sign up to get my free newsletter every week!)
You eat and move differently every day, anyway!
I’ll get to talking about weight discrimination in healthcare and elsewhere in a moment. But first I want to dig in even further on this idea that eating a donut a day will make you gain a certain amount of weight, or any weight at all.
Yes, I referenced a “normal” eating routine in the previous section, but I’ll be honest: I’m not sure exactly what my “normal” eating routine is. I eat differently every day. And I choose different foods in different amounts. Also, I have a different number of meals and snacks, and at different times. Some days I feel particularly hungry, other days I fill up on much less.
The same goes for exercise. Some days I’m really feeling it, and I’ll go for a run or lift some weights. Other days I just want to go for a walk. Occasionally, I’ll feel drained and I won’t do anything at all. There’s no “normal” exercise routine. And honestly, I think that’s normal.
Saying that you’ll gain weight if you “changed no other aspects of their diet/exercise” is silly. It ignores the fact that you change many aspects of your diet/exercise daily! And, villainizing donuts (or any other food) just leads people to fear them, restrict them, then feel out of control and guilty around them.
Public health experts need to stop furthering weight discrimination in healthcare!
And don’t get me started on this statement. “As a public health expert, I can’t endorse a diet of daily donuts.” As public health experts, it’s not our job to police people’s behavior. It’s our job to make health-promoting choices AN OPTION for people. We do this by improving access to healthcare and nutritious food. By making health messages more culturally inclusive. Our goal as public health experts is to combat health-harming stigma and shame, not enforce it. Weight discrimination in healthcare and public health only worsen health outcomes, after all.
The pushback against Krispy Kreme free donuts is incredibly fatphobic.
Let’s just get right to it. This “concern” that free Krispy Kreme donuts will ruin people’s health isn’t about health. It’s about weight. And it’s not “concern,” it’s fatphobia, the extreme fear of fatness.
See the above tweet from Jeff Hunger, social psychology professor at Miami University of Ohio who researches weight stigma. The article he cites is a 2003 review about justification-suppression and the expression of prejudice. People claim that their concern is actually about health, in order to justify their prejudice towards fat bodies by. (That’s the “justification” side of the justification-suppression model.) And I think he’s right.
Let’s not forget: This whole Krispy Kreme free donut promotion is meant to encourage people to get the COVID-19 vaccine. Undoubtedly, vaccinating as many people as possible is good for public health. If the concern were really about health, wouldn’t people see the bigger picture? Of course they would. Except, It’s. Not. About. Health.
Being at a higher weight isn’t inherently bad!
Implicit in Dr. Wen’s tweets is the assumption that weight gain and larger bodies are bad. (I don’t mean to pick only on her. Thousands of people have tweeted similar ideas.) First of all, that’s not true. There’s no denying that higher weights are associated with some diseases. But that doesn’t mean that someone at a higher weight is automatically unhealthy. A 2019 analysis of data from 8,721 adults found that many people at higher weights were perfectly healthy. A 2015 study of over 100,000 Danish adults found that those in the “overweight” category actually lived the longest. It’s complicated, for sure. That said, there’s just no evidence-based justification for this idea that being at a higher weight is inherently bad.
And, I’ll also point out that weight gain is NOT an inherently bad thing. People gain weight for all sorts of reasons. Weight gain happens naturally as you age. People who are recovering from eating disorders or stopping restrictive behaviors often gain weight as a healthy part of this process. And, our weight naturally fluctuates slightly depending on lifestyle changes, stress, sleep, etc.
Weight discrimination in healthcare is a huge problem.
Here’s the kicker: All of this fear mongering (“You’ll gain weight if you eat Krispy Kreme ahhhhh!”) is just perpetuating weight stigma. The National Eating Disorders Association defines weight stigma as “discrimination or stereotyping based on a person’s weight.” The assumption that weight gain is BAD, that being at a higher weight is BAD, perpetuates weight stigma. Hell, it is weight stigma.
And there’s evidence that weight stigma is harmful to health. (Of note: There’s no concrete evidence that free Krispy Kreme donuts are harmful to health.) A 2018 review found an association between the experience of weight stigma and poor metabolic health, increased stress hormones, poor mental health, and exercise avoidance. Weight stigma is bad for health, and yet healthcare providers (like Dr. Wen) are particularly guilty of perpetuating it.
Healthcare providers tend to be even more biased against fat people than the general public.
According to this 2012 article, weight discrimination in healthcare runs rampant. That’s a huge problem. A 2015 review found an association between doctors’ weight bias, lower-quality care, and poorer health outcomes. And, as this 2018 review outlines, if a patient feels that their doctor is stigmatizing them for their weight (which happens often), they’re likely to start avoiding healthcare.
Also, these Krispy Kreme donuts are an OPTION, not a requirement. No one has to eat them. And just because you could get a free one every day doesn’t mean that you will.
All of this to say: there’s nothing wrong with Krispy Kreme free donuts. Will they incentivize people to get the COVID-19 vaccine who otherwise wouldn’t have. Eh, I don’t know, but they won’t have any measurable negative impact on public health.
I encourage you to join me in taking a photo of your Krispy Kreme free donut(s). Post it to Instagram, and tag it #itsjustadonut. Because it really is. It’s just a donut. A single donut won’t make or break your health.
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