This chapter outlines duelling narratives that surround perspectives on body shape and size, and their meaning more broadly in medicine and society. The authors acknowledge the historical and global roots of these discourses, but focus this chapter on the United States from the second half of the twentieth century through to the beginning of the 2020s. In the first section, we explore the rise of ‘obesity’ as a construction and a ‘problem’ that requires intervention. We then examine scholarly and activist critiques of mainstream ‘obesity’ rhetoric in the second section, before ending by discussing examples of intersections and ongoing debates within fat activism and politics.

For this chapter it is important to note we have chosen to use the words ‘fat’ and ‘larger bodies’. To date, the bulk of academic work has used the words ‘overweight’ and ‘obese’ to refer to people in larger bodies, despite many self-identified fat people finding such language stigmatizing and pathologizing. We use the word ‘obesity’ in single quotation marks throughout the chapter to refer to the use of this rhetorical construction by the medical community and others, and to highlight that the categorization of ‘obesity’ as a health condition is a social construction. We recognize that this language can be harmful, especially for people living in larger bodies, whether or not they identify as fat. ‘Obesity’ is often considered a ‘health condition’ in mainstream constructions, but we examine the context and appropriateness of that categorization, especially as this chapter appears in the ‘Critical Health Conditions: Debates and Histories’ section of this volume.

The Rise of ‘Obesity’ as a Perceived Problem and the Modern Medicalization of Fatness

To understand the rise of narratives surrounding the modern ‘obesity epidemic’, it is important to review the history of perceptions of fatness in the United States and globally. Perspectives on fat bodies have varied widely by time and place, within and beyond medicine, but for millennia these discourses have been intertwined with notions of class, race, morality and fertility.

Celebrations of fatness can be found throughout recorded history. From BCE to the Middle Ages and through the Renaissance, early depictions of women of status were portrayed as prosperous beauties with large breasts, a rotund stomach and thick thighs – unmistakably fat and symbols of fertility and desire. Negative critiques of fat bodies can also be traced to ancient times.