A Black Feminist's Critique of the Crooked Room of Medicine (CRoM): Innovation of Thick Studies and the Gender, Race, Weight (GRW) Matrix

First described by physician William Dietz in 1995, the "Food Insecurity-Obesity Paradox" (FIOP) attempts to explain the biology and behaviors of people who are simultaneously overweight and food-insecure. I was introduced to this theory as a Behavioral Health graduate student and, in that context, was taught to understand it as a fact. My personal experiences as a Black woman, however, alongside ongoing engagement with Black feminist thought and critical medical sociology, have taught me otherwise. This disssertation takes Dietz's theory as a starting point in order to argue that Black women in the US experience fatphobic and racial discrimination while being "cared for" by western institutional medicine. I argue that discourses like the FIOP, though framed as benevolent clinical theories, do more harm than good: not only do they multiply pathologize so-called "fat" Black women by drawing on disparaging stereotypes, but they simultaneously ignore the specific health and wellness needs that emerge at the intersection of weight, size, skin color, gender, ability, and economic class.

My broader dissertation project is an interdisciplinary critique of pathologizing discourses about Black women, including medically "legitimate" ones like the FIOP. Via critical analysis of these discourses, and employing Black feminist and medical sociological perspectives, I explore how stereotypes of Black women correlate with how these women are perceived and treated by physicians and other health professionals. These racialized perceptions and forms of discriminatory medical treatment are instances of what has been labeled, variously, as a racial formation (Omi and Winant, 1997), a matrix of domination (Patricia Hill Collins, 1990) and a racial ideology (Feagin, 2006). These processes are further extended by physicians who use these pathologizing discourses and practices to advance their own careers. Black feminist theorists have described the multiple marginalizations experienced by contemporary Black women in the US and my project places weight and body size within this marginalizing dynamic. After tracing the long history of medical "othering" of Black women by science, I show the persistence of these ideologies in contemporary medical practice. My interviews with Black women investigate their lived experiences of these ideologies and practices, and allow women to speak for themselves in a space that so often speaks for them.