Weight Stigma
By Paula Edwards-Gayfield, MA, LCMHCS, LPC, NCC, CEDS-C
What is Weight Stigma?
Weight stigma, also known as weight bias or weight-based discrimination, refers to the negative attitudes, beliefs, stereotypes, and discriminatory behaviors directed towards individuals based on their body weight or size. This form of discrimination is prevalent everywhere and manifests in various settings and in social interactions.
Weight stigma often targets individuals who are deemed to be in higher weight bodies, but it can affect people of all body sizes. Weight bias can increase body dissatisfaction, a leading risk factor in the development of eating disorders. In fact, the best-known environmental contributor to the development of eating disorders is the sociocultural idealization of thinness.
What Causes Weight Stigma?
Weight-based stereotypes coexist with the notion that weight is controllable and that achieving weight loss is both desirable and attainable through sufficient effort. Weight stigma unfairly portrays individuals at higher weights as lazy, impulsive, unhealthy, unattractive, unintelligent, and lacking in willpower and self-discipline. Additionally, weight-based discrimination may arise more from preconceptions about an individual’s eating habits rather than simply their physical body size.1
Media messages also help shape societal and cultural norms about body weight and shape, which may create unhealthy expectations of body weight and contribute to teasing.2 Stigmatization sends a message to all people that no matter what their weight, their bodies are not good enough. In fact, researchers suggest that the disparity between men and women in experiencing weight stigma may be narrower than previously believed.3
It is never acceptable to discriminate against someone based on their size. Unfortunately, shaming, blaming, and “concern trolling” happen everywhere – at work, school, in the home, and even at the doctor’s office. Sadly, weight discrimination occurs more frequently than gender or age discrimination.2 Weight bias was cited as the fourth most common form of discrimination among US adults.4,5
The Impact of Weight Stigma
Despite its unfortunate prevalence, experienced and internalized weight-based discrimination is dangerous and can increase the risk for adverse psychological and behavioral issues, including depression, low self-esteem, poor body image and disordered eating behaviors. Weight stigma, uniquely, leads to negative effects on weight-related health by inducing stress, increasing consumption and reducing engagement in enjoyable activities.6
Verbally expressed comments directly to an individual represent a form of direct weight stigmatization. Such remarks can send a message about the normalization and acceptability of this behavior, as they are often openly presented and not perceived as shameful. Additionally, when laughter follows these comments, it can further support this behavior instead of indicating dissatisfaction or neutrality. When weight-based teasing and diet talk occurs within familial and social supports, individuals may engage in unhelpful behaviors (unhealthy dieting, binge eating, and purging behavior) to manage the resulting emotional distress of these experiences.7
Victims of weight stigma report physicians and family members are common sources of weight bias. Individuals who encounter weight-based mistreatment in healthcare settings often report engaging in negative eating behaviors and avoid seeking health care due to their anticipation of further weight related mistreatment.8 This behavior change is driven by a desire to avoid stigma. Weight bias in healthcare is a significant concern. Researchers emphasize that internalizing weight stigma can contribute to elevated emotional eating, uncontrolled eating, and engagement in restrictive dieting behaviors.8
Weight stigma and internalization of these messages are causally linked with increased caloric consumption and reduced belief in one’s ability to manage their diet or food intake.6 Unfortunately, research shows that healthcare providers when talking to patients in larger bodies tend to:
- Provide them with less health information
- Spend less time with them during appointments
- View them as undisciplined, annoying, and noncompliant with treatment.4
The Problems with Obesity Prevention Campaigns
Attention given to weight control has skyrocketed in recent years, ingraining words like “BMI,” “obesity epidemic,” and “diet” into our national vocabulary. Since the rise of national obesity prevention campaigns, the incidence of weight stigma has increased about 66% over the past 20 years.9 Regardless of body size, more than 40% of U.S. adults report experiencing weight stigma at some point in their life.10 While these programs were created with good intentions, public health campaigns are frequently criticized for being stigmatizing and promoting fear.11 The research is clear: overemphasizing weight can encourage disordered eating and have counterproductive effects.
Sources
[1] Hollett, K. B., & Carter, J. C. (2021). Separating binge-eating disorder stigma and weight stigma: A vignette study. The International journal of eating disorders, 54(5), 755–763. https://doi.org/10.1002/eat.23473
[2] Eisenberg, M. E., Carlson-McGuire, A., Gollust, S. E., & Neumark-Sztainer, D. (2015). A content analysis of weight stigmatization in popular television programming for adolescents. The International journal of eating disorders, 48(6), 759–766. https://doi.org/10.1002/eat.22348
[3] Jones, D. P. (2018). Men may experience weight stigma as much as women. UConn Today. https://today.uconn.edu/2018/04/men-may-experience-weight-stigma-much-women/
[4] Alberga, A. S., Edache, I. Y., Forhan, M., & Russell-Mayhew, S. (2019). Weight bias and health care utilization: a scoping review. Primary health care research & development, 20, e116. https://doi.org/10.1017/S1463423619000227
[5] Puhl, R. M., Andreyeva, T., & Brownell, K. D. (2008). Perceptions of weight discrimination: Prevalence and comparison to race and gender discrimination in America. International Journal of Obesity, 32(6), 992–1000. https://doi.org/10.1038/ijo.2008.22
[6] Himmelstein, M. S., Puhl, R. M., & Quinn, D. M. (2017). Intersectionality: An Understudied Framework for Addressing Weight Stigma. American journal of preventive medicine, 53(4), 421–431. https://doi.org/10.1016/j.amepre.2017.04.003
[7] Nitsch, M., Adamcik, T., Kuso, S., Zeiler, M., & Waldherr, K. (2019). Usability and Engagement Evaluation of an Unguided Online Program for Promoting a Healthy Lifestyle and Reducing the Risk for Eating Disorders and Obesity in the School Setting. Nutrients, 11(4), 713. https://doi.org/10.3390/nu11040713
[8] Wetzel, K. E., & Himmelstein, M. S. (2023). Health care avoidance as vigilance: A model of maladaptive eating behaviors due to weight stigma in health care, avoidance, and internalization among women. Stigma and Health. Advance online publication. https://doi.org/10.1037/sah0000470
[9] Puhl, R. M., & Heuer, C. A. (2010). Obesity stigma: important considerations for public health. American journal of public health, 100(6), 1019–1028. https://doi.org/10.2105/AJPH.2009.159491
[10] Abrams, Z. (2022). The burden of weight stigma. Monitor on Psychology, 53(2). https://www.apa.org/monitor/2022/03/news-weight-stigma
[11] Stewart, S.-J. F., & Ogden, J. (2021). Motivating or stigmatising? the public health and media messaging surrounding covid-19 and obesity: A qualitative think aloud study. Health Education, 122(4), 374–386. https://doi.org/10.1108/he-04-2021-0067
