What is Weight Stigma?

May 2

written by Sara Parsons

Content Warning: To provide a comprehensive exploration of weight bias and weight stigma, this post utilizes stigmatizing language such as “obesity”, “obese”, and “overweight”. While WIND does not subscribe to these offensive and stigmatizing terms, it is utilized in the existing research.

Within the last forty years, the U.S. has declared war on folks in larger bodies by labeling ob*sity as a disease (1,2). In the name of preserving and/or regaining health, the fight against "overweight" and "obese" people has been deemed a necessary and morally-just fight. The foundation this argument stands on is rocky at best and has led to many harmful consequences, including rising rates of weight stigma (3).

What is weight stigma and how does it differ from weight bias?

Weight bias refers to negative judgements, assumptions, or stereotypes against folks in larger bodies. Weight bias can include verbal or physical abuse and is prevalent in our physical environments (e.g., airplane seats or medical equipment not designed to accommodate larger bodies) as well as social environments. Weight stigma, on the other hand, describes how a person’s personality or behavioral characteristics are defined by their perceived body size. These folks may be labeled as lazy, amoral or unattractive, and devalued because their bodies do not match what has been deemed socially acceptable (3). Weight stigma leads to weight-based discrimination, criticism, microaggressions, abuse, and explicit inequitable treatment.

Weight bias says, “I think being fat is bad” while weight stigma says, “You’re fat, therefore you’re bad and you deserve to be treated poorly until you lose weight” (4).

Sources of Weight Stigma

Weight stigma is pervasive and shows up in a variety of circumstances and environments. Top sources of weight stigma include family members, doctors, nurses and dietitians . In healthcare settings this can mean doctors and medical professionals mistreating, misdiagnosing, or refusing to provide care to their fat patients. Weight stigma is also prevalent in education, employment, on-screen and in media including social media platforms (3).

Effects of Weight Stigma

The effects of weight stigma are profound. Weight stigma is embedded in the education and practical training that many medical students receive in the healthcare system, laying the path for implicit and explicit weight bias as future practitioners. This ultimately prevents compassionate, patient-centered care. Fat patients are often perceived by their providers as lazy, non compliant with medical advice, and unmotivated. Both outward and implied weight bias leads many fat patients to avoid healthcare appointments such as preventative care and screening (3).

Those who receive and internalize weight stigma have been shown to exhibit higher rates of binge eating and other disordered eating behaviors and are less likely to engage in physical activity. On top of that, stigmatized folks experience greater levels of stress and have been shown to have greater levels of cortisol (a stress hormone) and inflammation. Healthcare facilities and equipment are also not built to accommodate larger bodies and many procedures require patients to lose weight first (3). All these factors contribute to overall healthcare avoidance which puts folks at greater risk of preventable chronic diseases, psycho-emotional stress and poor-quality healthcare (3,5).

Weight stigma exists in the media as well, often portraying folks in larger bodies as messy, unorganized, undesirable, and lacking personality (3). Additionally, those in larger bodies are frequently the target of crude or offensive jokes normalizing the unfair treatment of fat people. Each of these unflattering and false portrayals of fat bodies influence public perception and perpetuate weight bias. Social media presents a whole new avenue in which folks experience weight stigma. The anonymity of the internet has paved the way for significant online bullying (3).

In educational spaces, particularly from peers and teachers, weight-based bullying is more prevalent than any other form of characteristic-based bullying such as sexual orientation or disability. Fat students tend to receive lower grades than thin students and teachers often view fat students as needing more tutoring than thin students (3). In the employment sector, folks in larger bodies are often overlooked for jobs, face greater rates of discrimination, receive lower pay, get fewer promotions, and have greater rates of termination compared to their thin counterparts. To make matters worse, there are no federal protections for employees who experience weight stigma because weight is not a protected class under the Civil Rights Act in the US or under federal law in most other nations (3).

The harmful effects of weight stigma extends well beyond the above, with day-to-day impacts in relationships, social situations, or the words and actions of strangers, politicians, public figures, and more.

Conclusion

Weight stigma is insidious and pervasive in our society. Research has explored several methods for reducing weight stigma in healthcare including better education, increasing understanding of the complexity of “ob*sity”, increasing understanding of the effects of weight stigma, building empathy towards fat patients, and fostering a weight-inclusive approach to healthcare (6). Educational programs, medical residencies, and teaching hospitals could put such strategies in place to prevent weight bias and weight stigma from influencing future healthcare providers. It is important to address weight stigma in healthcare so that we can shift away from a weight-centric approach to healthcare toward one that is health-focused and weight-inclusive (6). Dismantling weight stigma in healthcare can also extend to other spaces including education, employment, research, media, and social environments. Increasing public understanding and acceptance of Health At Every Size (HAES®), intuitive eating principles, and body diversity could pave a new path toward a more accepting, safe, and compassionate society (7); one that celebrates bodies of all shapes, sizes, and capabilities.

Looking to learn more about eliminating weight stigma and shifting away from weight centric care? Check out our Foundations of Weight Inclusive Care Workshop and follow WIND on Instagram.

What is Weight Stigma?

Weight bias says, “I think being fat is bad” while weight stigma says, “You’re fat, therefore you’re bad and you deserve to be treated poorly until you lose weight” (4).

Health at Every Size® (HAES®) + the Body Liberation Movement

WHAT IS WEIGHT INCLUSIVE NUTRITION AND DIETETICS (WIND)?

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