[Note: In accordance with National Association to Advance Fat Acceptance (NAAFA) recommendations, guidance from fat activists and liberationists, and the American Chemistry Society’s Inclusivity Style Guide, this story uses the term “fat” as a value-neutral descriptor. When the term “overweight” is used, it is a self-description.]
As fascism and far-right extremism rise, fat transgender people find themselves facing a culture that’s increasingly hostile to their bodies. Over the past decade, trans Americans have been catapulted into the zeitgeist, and that visibility has come at a cost. Much has been written about the harmful, reductive, and uninclusive media portrayals of trans people. Less discussed, though, is how this anti-trans animus coincided with a mainstream resurgence of fatphobia.
Media portrayals of fatness have been incredibly limited for years. A 2021 review of news coverage conducted by National Association to Advance Fat Acceptance (NAAFA) found 18,000 stories about intentional weight loss. They only found 48 that discussed anti-fatness, despite clear empirical evidence that fat people experience systemic oppression like difficulties being taken seriously in medical settings and being paid less at work than their thinner counterparts. More recently, the conservative culture has been signaled by an overt return to so-called “skinny culture” and rampant fatphobia. The popularization of GLP-1s has paved a new path for intentional weight loss, but it’s also reignited debates around medication stigma, virtuous suffering, and body positivity.
These factors have left experiences with the intersection of fat and trans identities underexplored. For Kody Hersh, a self-described “small-fat” nonbinary transmasc, the overlap of fat and trans liberation comes down to one question: “Are our bodies a test that we have to pass in order to deserve respect, or do we have inherent dignity and a right to self determination?”
When fatness is brought up in a trans spaces, it’s often only in reference to gender-affirming medical procedures.
World Professional Association for Transgender Health (WPATH) guidelines, the leading standards org for trans healthcare, sets no requirements for body mass index (BMI) cutoffs for trans surgeries, and the prevalence of BMI in healthcare settings has long faced scrutiny due to its flaws as a metric and potential harms to patient health. Still, BMI cutoffs for gender-affirming surgeries are incredibly common.
“A lot of girls despair when faced with BMI requirements,” said Vyria Durav, a demigirl living in Thailand, which has been called “a global hub for gender-affirming surgery.” Durav said her first choice for her recent vaginoplasty would’ve been the Suporn clinic, but their “restrictive BMI” requirement meant she instead saw Dr. Chettasak of WIH Hospital. While that clinic suggested she lose some weight before her surgery, Durav said, making her worry she might be denied care when she didn’t, she was still able to get the care she needed.
Durav isn’t the only one. While fat patients are often told the reason for their denial of surgery is due to potential complications, Dr. AJ Eckert, who’s spent over 12 years providing gender-affirming primary care, said that increasingly, medical literature shows “a lack of empirical evidence for BMI cutoffs and increasing evidence that it is safe.” Eckert emphasized that potential increased risks of complications for these high BMI patients is often outweighed by the negative consequences of denying care. “I saw too many patients turned away from this life-changing and potentially life-saving surgery due to BMI,” he said.
These barriers for fat trans people come on top of already salient barriers to gender-affirming surgeries, including bans and other government interference, the low number of surgeons with these specialties, and healthcare costs.
The impacts of weight stigma go beyond the medical field, though. When transitioning, fat people can experience new gendered expectations or a lack thereof. Hersh lives in New Mexico, and they’ve thought of themselves as fat since they were a kid, though they now think that that’s “absurd.” They traced that to a lot of the messaging they received about “that incredibly narrow definition of what’s an acceptable body,” which was especially focused on weight for those perceived as girls.
He also noted that it’s still hard for him to disentangle how much of his feelings about his body were internalized fatphobia or unrecognized gender dysphoria. They described having a “self-consciousness for as long as I could remember about not wanting to wear a two-piece bathing suit” and “doing a lot of work to hide my body.”
After their transition, Hersh’s relationship with their body changed. In part, it was gender euphoria, but some of it wasn’t. They noted they “didn’t feel the same pressure to thinness” they had back when they were presenting in a more feminine way. “… As someone who is perceived as gender nonconforming or male… I’m allowed to be fatter before I’m perceived as fat.”
Terra Field’s fatness offered her, as a trans woman, something like a “shield.” The same people who might’ve harassed her for her gender identity, she posited, overlooked her because being overweight lent her a kind of invisibility. Still, as she began taking estrogen, she felt increased societal pressure about her weight.
Field still considers herself fat, but she’s lost a significant amount of weight since starting a GLP-1 in 2022, to the point where she now qualifies for gender-affirming surgeries she thought were off the table. “One of the hardest things, in terms of having lost so much weight… is seeing all of the ways people treat me better,” Field said.
Both Field and Hersh drew parallels between their trans and fat experiences: the body policing, the fraught medical scenarios, and the open disgust they faced from others. Hersh admitted that before the interview, he’d been fearful about the repercussions of connecting fatness and transness, given how entrenched anti-fat bias is and his protectiveness of the trans community.
The idea that let him break through that fear to speak openly was a simple one: “There’s no liberation of one set of bodies without liberation of all bodies.”
Madisyn Parisi is a queer journalist from Maryland and the writer behind The Backbone, a newsletter dedicated to stories that hold power to account. They cover tech, culture, and trans topics.
