To coincide with the wrapping up of Weight Stigma Awareness Week (Sept 28 – Oct 2), I’d like to keep the conversation going about weight stigma – specifically what it is, how it affects folks and why we need to talk about it.
(CW: discusses weight stigma experiences and mentions the word “ob***ty”).
Even though I would have liked to put this blog out earlier, I have been pouring over the detail to make sure it is not harmful nor distressing to those who have experienced weight stigma.
What is weight stigma?
Weight stigma is a societally driven construct that commonly excludes folks with higher weight bodies from many areas of our society. Weight stigma is derived from weight bias, which is a collection of beliefs, attitudes, and judgments held about people in a higher weight body.
If we were to officially define weight stigma, we could use a definition from a renowned weight stigma researcher Janet Tomiyama who defines it as: “the social devaluation and denigration of people perceived to carry excess weight, which leads to prejudice, negative stereotyping, and discrimination toward those people”.
Put simply, weight stigma is harmful, distressing and upsetting for those experience it.
A person can be impacted by weight stigma physically, socially, financially, and emotionally, and in ways that are overtly obvious and other ways that are a little more subtle.
Some examples of weight stigma include:
- Teasing and bullying
- Not seeking healthcare because of negative comments from health professionals
- Receiving comments from people about needing to lose weight
- Not being able to fit into chairs in public spaces, plane seats or bathroom stalls
- Missing out on employment opportunities and promotions
- Not finding clothes in required sizes
- Being ignored while in public
- Being stared at while in public
- Feeling socially isolated
- Receiving compliments for weight loss, which actually perpetuates the idea that lower body weights are better than higher body weights.
The sad reality is that weight stigma is not often challenged and it leaves folks in higher weight bodies vulnerable to social injustice, inequality, and unfair treatment (1).
How weight stigma impacts health
Weight stigma can lead to poor self-esteem, anxiety, depression, disordered eating behaviour, and body dissatisfaction (2). Research has also found a strong correlation between experiencing stigma and phobic anxiety which is feeling self-conscious around others, feeling uncomfortable in crowds, avoiding certain places, and being afraid to travel (2). This may be due to repeatedly experiencing stigma in specific situations and locations and now fear those situations.
Weight stigma can also lead to weight gain as it can promote disordered eating, less healthy food choices, reduced physical activity, and not seeking healthcare (3). It can also lead to other poor health outcomes (4).
Research has found that people who experience weight stigma are twice as likely to have a high allostatic load, which measures the amount of stress placed on multiple systems in the body, and therefore places them at greater risk of developing chronic disease and mortality (5).
We need to talk more about these findings because they fly in the face of what is normally assumed about the link between chronic disease and higher weight! The (misguided) assumption is that a higher weight causes chronic disease and early mortality, but in fact, this research shows that weight stigma is an independent risk factor for those same health outcomes.
With such poor health outcomes, it begs the question why do we see stigmatising public health campaigns that are aimed at curbing the “ob***ty epidemic” when weight stigma is clearly putting people in higher weight bodies at greater risk. In fact, research shows that targeted “anti- ob***ty” health campaigns increase public prejudice against people with higher body weight (6).
What we can do
We need to talk more about this topic, but in a thoughtful way that does not do harm.
Let’s start by acknowledging that all bodies are different. In the same way genetics determines if we are short or tall, bodies can be large or small. Body diversity is normal, beautiful and something to be accepted and appreciated.
If you are someone who experiences weight stigma, reading about this topic can be extremely difficult. If you are on social media, consider who you follow and if those accounts are helpful or harmful for you? It might be worth creating certain boundaries to ensure that the online spaces you engage with are safe ones.
As a dietitian who is deeply committed to weight inclusive practice and stamping out weight discrimination, I will continue to elevate this issue to raise awareness.
I will also continue to work on dismantling weight stigma to help those who sadly experience it on a regular basis.
References:
- Puhl, R., & Heuer, C. (2009). The Stigma of Obesity: A Review and Update. Obesity, 17(5), 941-964. doi: 10.1038/oby.2008.636
- Friedman, K., Ashmore, J., & Applegate, K. (2008). Recent Experiences of Weight-based Stigmatization in a Weight Loss Surgery Population: Psychological and Behavioral Correlates. Obesity, 16(S2), S69-S74. doi: 10.1038/oby.2008.457
- Phelan, S., Burgess, D., Yeazel, M., Hellerstedt, W., Griffin, J., & van Ryn, M. (2015). Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obesity Reviews, 16(4), 319-326. doi: 10.1111/obr.12266.
- Hunger, J., Smith, J., & Tomiyama, A. (2020). An Evidence‐Based Rationale for Adopting Weight‐Inclusive Health Policy. Social Issues And Policy Review, 14(1), 73-107. doi: 10.1111/sipr.12062
- Vadiveloo, M., & Mattei, J. (2016). Erratum to: Perceived Weight Discrimination and 10-year Risk of Allostatic Load Among US Adults. Annals Of Behavioral Medicine, 51(1), 105-105. doi: 10.1007/s12160-016-9870-0
- Pearl, R., & Lebowitz, M. (2014). Beyond personal responsibility: Effects of causal attributions for overweight and obesity on weight-related beliefs, stigma, and policy support. Psychology & Health, 29(10), 1176-1191. doi: 10.1080/08870446.2014.916807
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