The Struggles with Weight Bias
The prevalence of overweight and obesity continues to rise. Nearly one in three adults are overweight and nearly two in five are living with obesity in the U.S. Correspondingly, weight stigma is increasingly strong. Its pervasiveness and impact can be as harmful as other forms of discrimination, such as those based on race or ethnicity. Weight bias has serious adverse physical and psychological repercussions, including inadequate healthcare and depression.
Definitions. The World Obesity Federation defines weight bias as the negative ideologies associated with obesity, and weight stigma as the discriminatory acts and ideologies targeting someone because of their weight and size. Though mostly referring to people with overweight and obesity, there is also evidence that people categorized as underweight, including those with eating disorders, have experienced weight bias. This discrimination can occur in any environment—school, employment, healthcare, home, media—and may be written, verbal, physical, and unspoken. “Society is quick to judge someone in a larger body, says Andrea Mathis, MA, RDN, owner of Beautiful Eats and Things and author of The Complete Book of Smoothies: 115 Recipes to Nourish, Heal, & Energize. “They are automatically labeled as lazy, unmotivated, sedentary, unhealthy, etc., and because of these labels, these individuals are treated differently and discriminated against for not partaking in society’s obsession with thinness.”
Negative Impacts. The results of weight bias and weight stigma can lead to low self-esteem, depression, anxiety, disordered eating patterns, and more, according to Mathis, who says, “It’s a huge issue in our society that’s often overlooked, and because of this, individuals residing in larger bodies are not receiving adequate health care.” Due to their size, their health concerns are frequently not taken seriously and are often initially blamed on their weight, Mathis explains. Studies have shown that even nutritionists and nutrition students display negative attitudes and biases toward patients with obesity. One study reported that a patient’s weight influenced consultation time and nutrition students’ perceptions and treatment approaches and strategies, revealing biases and negative evaluations toward obese patients, particularly obese women. The experience of weight bias has been associated with avoidance of preventive health care and lack of engagement in primary health care settings.
In addition to the negative medical conditions associated with obesity itself, research suggests the stigma associated with weight may also be the cause of its own set of medical conditions. Independent of body fat, weight stigma has been linked with increased stress hormone levels, which can lead to several health issues, such as those involving blood pressure, heart and organ health, and insulin resistance. In severe cases, weight stigma has led to increased mortality risk, including suicidal thoughts and acts.
Though there is the belief that weight stigma will motivate people with obesity to lose weight, the opposite seems to be more accurate. Evidence suggests shaming people for their body weight and size doesn’t motivate positive change. As a dietitian, Mathis says she has seen this with several clients dealing with weight stigma. “In most cases,” she explains, these biases become barriers which hinder their progression.” Studies show that weight stigma in persons with obesity often triggers unhealthy eating, disordered eating, such as binge eating, emotional eating, as well as extreme fasting and compulsive exercising. Research suggests weight bias and stigma actually contribute to the globally rising obesity levels.
The culture of weight bias is based on misunderstanding. People don’t understand the causes of obesity, which are complex. They involve genetic, physiological, psychosocial, and environmental factors. Incorporate the changes to the food system with modern agriculture and food production and patterns, and the complexity deepens. Because weight is widely thought of as a matter of personal responsibility, it is viewed as a choice, a choice that is often ridiculed. “Just because someone resides in a larger body doesn’t mean they despise working out or choose to eat excessive amounts of food,” says Mathis. “There are several individuals in larger bodies that live an active lifestyle and enjoy incorporating a variety of nutrient-dense foods into their diets, but may choose to prioritize a positive well-being instead of rapid weight loss—and that’s okay.”
Moving Forward. Awareness through education to improve the knowledge and understanding behind obesity and the negative impact of weight bias is necessary for change to occur. In addition to better obesity education to reduce weight stigma in areas like healthcare and the media, it’s a collective societal responsibility. “As a society, we often steer away from or have the tendency to judge something that’s unfamiliar,” says Mathis, who encourages people who are unfamiliar with weight stigma or have never experienced it, to try asking questions or do a little research to learn more about it. “Practice using respectful language when talking about weight and challenge the idea that a healthy well-being is only possible at a specific weight,” she says. “Become a part of the solution.”
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