Today’s profile comes from Dr. Ximena Ramos Salas, Ph.D., Director Research & Policy at Obesity Canada
Why I became an obesity advocate
My Name is Ximena Ramos Salas and I am Director of Research and Policy at Obesity Canada. Obesity is important to me for several reasons. On a personal level, I have many family members who live with obesity and I have seen the many challenges the face on a daily basis. On a professional level, I am a public health researcher working in the area of weight bias and obesity stigma. Allow me to share my story about how I became an advocate for obesity and why I decided to focus my entire professional career to ending weight bias and obesity stigma.
I was first trained as a nurse assistant, then as a kinesiologist where I learned about the importance of healthy living to prevent diseases. My academic training took me down the road of promoting healthy lifestyles. As a kinesiologist I was specifically trained on the importance of physical activity for obesity prevention. After graduating, I started working for the Canadian Institutes of Health Research – Institute of Nutrition, Metabolism and Diabetes which focused its strategic research funding in the area of obesity and healthy body weights. Working at CIHR-INMD I travelled across the country and met scientists working in nutrition, physical activity, basic science, clinical research, and public health. I learned very quickly that obesity is a very complex condition.
In 2004, I completed a masters’ degree in health promotion under the supervision of Dr. Kim Raine at the University of Alberta and there I learned a lot more about the factors that influence individual behaviours. I learned that the context in which we live matters for individual behaviours. It is not a matter of just educating people about healthy eating and exercise, we also need policies to make these behaviours accessible to everyone in an equitable way. Using a health promotion lens, I realized that although health is a basic human right, it is not accessible to all.
In 2008, I started working with Obesity Canada and this experience opened up a whole new reality – the reality of people living with obesity who are stigmatized in our society. In 2009, the board of directors of Obesity Canada concluded that weight bias and stigma was a major barrier to improving health equity for people living with obesity. Since, then eliminating weight bias and stigma is our primary priority.
My doctoral research opened my eyes to the reality that my family members, friends, and colleagues who live with obesity face. For five years, I lived along people living with obesity and listened to their stories. Together we explored how their experiences had influenced how they perceived themselves and how these experiences influenced their mental health, health promoting behaviours and obesity treatment. This experience made me confront my own personal biases that I had about obesity. I quickly realized that throughout my entire academic education, I had operated under the lens of obesity being preventable through individual behaviours. Even when I was using a health promotion, socio-ecological, and gender lenses, I was still thinking that we need to make policies to change the environment in order to make it easier for people to make the “healthy choice”.
This “healthy choice” narrative ultimately puts the responsibility on the individual to choose to eat healthy and to choose to exercise more as a way to prevent obesity. I started to think about my role in contributing towards a narrative that promoted individual responsibility for obesity. I reflected on my interactions with my nephew who had lived with obesity all his life and who had experienced bullying throughout this childhood and how I had encouraged him to lose weight by eating healthy and exercising more.
My doctoral research was a transformative experience that made me question my understanding of obesity and my professional practice. Since then, I have become very outspoken about changing the public health narrative from “eat less and move more” towards a more person-centred approach that promotes health for all.
I owe the shift in my focus to all the individuals living with obesity who have shared their stories with me. If they had not opened up to me to show me and to take me down the path of their realities, I would not have been able to change my perspective and approach.
Through my research I heard from many people living with obesity that they felt that obesity was their fault because society, meaning their friends, family, healthcare providers, public health policy makers, and the media tell them that obesity can be prevented by eating less and moving more. They told me that they believed this themselves and that since they were not able to lose weight, obesity was their fault. That they had failed. That they are a burden to society. This led them to continue to try diets and exercise programs to try to lose weight and spent years in endless yo-yo dieting cycles that made them feel ashamed, embarrassed and disappointed in themselves.
They told me that the judgemental looks, the fat jokes, the critical comments from friends, family, healthcare professionals left them feeling alone and isolated. Like they did not belong in this world. These experiences of weight bias are like mini traumas that people living with obesity experience on a daily basis. These experiences do not help people lose weight or to change their behaviour. In fact, the opposite is true. People who experience shame and blame for their weight will put on more weight because of the body’s response to stress.
I heard stories from people living with obesity that after experiencing weight bias and stigma all their lives, they had nothing left in them to give. My own nephew who experienced weight-based bullying throughout his life reached the point where he felt he could not live in this world anymore and attempted suicide. This personal experience compelled me even more to use my professional voice to eliminate weight bias and to promote equity for people living with obesity.
From a public health perspective, our role as health professionals is to “do no harm” and to promote “health for all”. This is why I think it is important for public health professionals and all health care professionals to critically reflect on their understanding of obesity and to question how this understanding influences their professional practice as well as their personal actions.
In public health, we can also move beyond awareness about the impact of weight bias and obesity stigma and create laws, policies, and regulations to prevent weight bias and stigma. Through my research I developed tools to help public health professionals to use a weight bias lens to their work. Through Obesity Canada we have engaged the Human Rights Commission of Canada to help us understand how existing laws and regulations can be leveraged to prevent weight-based discrimination in Canada.
Through my personal life, I make the effort to challenge weight bias, especially in my family. When I hear fat jokes, for example, I immediately point out to my son that this is not acceptable. I also explain to him the consequences of these fat jokes can have on the lives of people living with obesity.
I hope that my story helps you reflect on how you as an individual can do something about eliminating weight stigma in your personal and professional lives.
If you are a person living with obesity or if you have a loved one who is living with obesity, consider how you can take action to improve their lives by eliminating weight bias.
Learn more: Kirk, SFL, Ramos Salas X, Alberga AS, Russell-Mayhew S. Canadian Adult Obesity Clinical Practice Guidelines: Reducing Weight Bias, Stigma and Discrimination in Obesity Management, Practice and Policy.