Paula Edwards-Gayfield, LCMHCS, LPC, CEDS-S, BC-TMH
While I was planning to write this blog on weight stigma, I had an experience that I believed to be timely. During a recent flight, I had a lovely conversation with a couple in my row, which I shared that I worked in mental health, specifically eating disorders. Whenever this occurs, people frequently begin to discuss food, diet related topics and weight. One of them shared a comment she made to her daughter to include something healthy with her breakfast; her intentions were good. Her daughter’s response was “are you fat-shaming me?” I was grateful to hear her 14/15-year-old daughter be assertive about the food she consumed and weight related topics. It’s vital that everyone address the harmful messages around weight stigma, victimization, and discrimination.
Weight stigma awareness is one of many social justice movements present today, and the eating disorder community has increased its focus on this topic. So, let’s begin with a few definitions:
Weight stigma – a form of discrimination based on whether someone fits the cultural ideal for body weight, size, or shape; unfortunately, this form of discrimination continues to be socially accepted.
Examples of weight stigma include (Montgomery, 2021):
- Negative comments or “health concerns” about your weight from anyone, including health care professionals.
- Complimenting someone on their weight loss
- Receiving poor treatment because of your size or being denied/required to lose weight because of your size to receive a medical treatment.
- Lack of comfortable chairs, airplane seats, etc.
Weightism – the biases, assumptions, stereotypes, and discriminatory behaviors we engage in based on someone’s body size.
Anti-fat bias – the attitudes, behaviors, and social systems that specifically marginalize, exclude, underserve, and oppress fat bodies, including individual beliefs and institutional policies.
In a diet obsessed culture, individuals that do not adhere to the westernized beliefs of “normal” weight or the thin ideal, are considered “fat”; in our society, fat is bad. Stereotypical beliefs about these individuals are that they are lazy, lacking in willpower, and undisciplined; as if your character is determined by size, shape, and weight. Our health industry is focused on making people thinner. We receive constant messages that we should lose weight and that it is under our control. Sabrina Strings (2019) reminds us that “Thinness is privileged, and fatness is stigmatized”.
Weight stigma is hurtful. People in larger bodies, at higher weights or identify as fat, should feel like they “fit in” and trust that they are not treated differently.
Weight stigma impacts eating disorder diagnoses and treatment. Despite education, eating disorders continue to be stereotyped by healthcare professionals and the general population as disorders that affect thin, white, young women. Individuals that do not fit into this category are frequently overlooked and their symptoms are undiagnosed but may be at greater risk of subthreshold clinical eating disorders. Disordered eating patterns and diet mentality may be prescribed to individuals at higher weights as weight management interventions.
Weight stigma is not new. However, the social justice movement around weight stigma is newer and intends to increase awareness around individuals who are denied opportunities or do not have the same rights as others because of their size. These individuals may experience different treatment at work, at school, and with medical providers. Let’s think about provider bias for a moment and how that might impact the type of care or treatment someone might receive. If an individual is experiencing weight discrimination or size bias, how willing do you think they are to seek treatment? How do they determine if something is medically wrong versus “needing better control” over their eating? What if they have an active eating disorder that is undiagnosed? The focus on weight and the various stereotypes that exist about those who live outside the “social body norm” can have a negative and harmful impact on those individuals. We want to empower you to advocate for yourself if you believe something is wrong. Seek out services and support. If you don’t feel like you are receiving adequate or helpful care, say something or seek out another recourse. You have the right to receive compassionate and helpful treatment in any body size.
Consider the following:
- How do you view individuals with a larger body?
- What stereotypes influence your work with clients?
- Do you consistently address weight stigma, size bias, anti-fat bias? Personally, and professionally?
- Are you willing to confront family and friends when they engage in discussions that reinforce weight stigma?
- Are you aware of the harmful language that you say to or about yourself, not just others?
Strategies that can assist in addressing weight stigma (Eisenberg et al., 2015):
- Be empathetic—toward yourself and others.
- Everyone deserves the right to be treated with respect and not be discriminated against
- Appreciate diversity and body sizes, shapes, and weight.
- Promote body inclusivity!
- Identify role models and utilize them to help foster resilience.
- Create resources for continued education and promote/support policy changes regarding bias and discrimination in research and healthcare (and other domains).
- Explore the impact of television, media, and social media. Are they representative of size diversity? Take a stance against images that reinforce stigma.
- Increase education in schools about weight stigma and remove teachings that reinforce we should all be thinner.
Paula Edwards-Gayfield, LCMHCS, LPC, CEDS-S, BC-TMH is a Regional Assistant Vice President and Diversity & Inclusion Co-Chair at The Renfrew Center. Ms. Edwards-Gayfield is an advocate for increasing awareness about eating disorders affecting Black, Indigenous and People of Color (BIPOC) and is passionate about access to culturally sensitive, inclusive, and equitable care; an experienced presenter addressing eating disorders and diversity, as well as a contributor to the book, Treating Black Women with Eating Disorders: A Clinician’s Guide. She is a certified member and approved supervisor (CEDS-S) of iaedpTM and a former Co-Chair of the African American Eating Disorder Professionals – Black, Indigenous and People of Color Committee (AAEDP-BIPOC). She serves on the National Eating Disorder Association’s (NEDA) Clinical Advisory Council and serves on the advisory board for Eating Disorder Recovery Support (EDRS).
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
Montgomery, Amanda; Collaboratory for Health Justice (2021). Public Health Needs to Decouple Weight and Health. University of Illinois at Chicago. Educational resource. https://doi.org/10.25417/uic.16823341.v1
Osa, M. L., Siegel, J., Meadows, A., Elbe, C., & Calogero, R. M. (2021). Stigmatizing effects of weight status on lay perceptions of eating disorder-related distress. Eating Disorders, 30(1), 99–109. https://doi.org/10.1080/10640266.2020.1855571
Sabrina Strings, Fearing the Black Body: The Racial Origins of Fat Phobia. New York: New York University Press, 2019. Pp. 304.