This post was written by Jen Barney, MS, psychology resident, outpatient and eating disorder program therapist, Parkview Behavioral Health Institute.

Living in the United States today, it’s almost impossible to have a body and not be impacted by weight stigma, also referred to as weight bias. These terms are used to describe the negative beliefs, attitudes, stereotypes, and/or acts of discrimination directed toward a person because of their body weight or size. Weight stigma is happening whenever we consciously or unconsciously make assumptions about someone or attribute labels to them, such as “good” or “bad”; “healthy” or “unhealthy”; or “attractive” and “unattractive,” based on their weight or body size. These biased presumptions then influence the ways that we interact with or treat the person, even if we don’t know anything else about them.

According to the International Journal of Obesity, more than 40% of adults in the U.S. report experiencing overt forms of weight stigma at some point in their life. Weight has also been identified as the No. 1 reason children and adolescents report being bullied by their peers. 

How weight stigma causes harm

There is a common misconception that weight change is completely within an individual’s control and the direct result of their individual choice. Because of this thinking, some have argued that weight stigma might be helpful because it can motivate people to lose weight in the service of health. Such arguments ignore a significant amount of research showing that weight change is a far more complex process than just “energy in vs. energy out,” and is influenced by an array of biological, societal and environmental factors.

Experiences of weight-related stigma actually appear to be counterproductive to improving one’s health. Like other forms of discrimination, experiences of weight stigma are stressful for the mind and body. This stress has been found to predict long-term weight gain, and is associated with several negative impacts to one’s physical, emotional and behavioral health including:

• Increases in stress hormone levels (e.g., cortisol)
• Increased likelihood of disordered eating patterns such as binge eating, restrictive eating, purging and emotional eating
• Increased rates of depression and anxiety
• Social isolation/poor quality of social relationships
• Low self-esteem
• Decreased engagement with health-promoting behaviors (e.g., going to the doctor, exercising at a gym)

The places where weight stigma is prevalent

In Western society, cultural acceptance of the “thin ideal” and misconceptions about body weight and shape influence social rejection, devaluation and discrimination of individuals in higher weight bodies in both obvious and subtle ways. Here is a closer look at some of the spaces where we see this play out most often.

In the media

Across all forms of mass media, stigmatizing and biased presentations of different body sizes are abundant. Advertisements and images being used to promote beauty, fashion, fitness or health almost always include imagery of thin bodies that conform to the societal “ideal.”  Higher weight bodies are underrepresented within media broadly, and when they are depicted, they are cast as unpopular, undesirable or the focus of ridicule far more often than those whose bodies conform to the thin ideal. Weight is also more likely to become a central focus in the storyline for characters in larger bodies, which reinforces weight stigma by suggesting that primarily focusing on one’s weight – particularly if they are in a larger body - is socially appropriate and acceptable.

In healthcare settings

Research suggests that healthcare providers have some of the highest rates of “anti-fat” biases and these biases directly impact the quality of care they provide. Studies have found that many physicians, especially those who work in weight management roles, report seeing patients in higher weight bodies as “lazy,” “unmotivated,” or “lacking in self-control.” These biases correlate to data supporting that providers spend less time per session interacting with these patients and more reluctance to perform additional tests and rule out alternative explanations for a reported problem if they believe it is due to the person’s weight.

In employment settings

Unlike other forms of discrimination (e.g., gender, race or religion) which have at least some legal protections, weight-based discrimination by employers is still considered legal in almost every state. Many individuals in higher weight bodies report experiencing stigmatizing comments in the workplace made by colleagues and/or supervisors. Average hourly wages for people in larger bodies are consistently lower than those of people within the “normal” BMI range, even after controlling for other socioeconomic factors. This gap is also more pronounced among women, and the discrepancy in wage widens as an individual’s BMI increases. Finally, studies of employers and HR professionals show high rates of weight stigma and discrimination which decrease their likelihood of hiring or promoting people with higher weights compared to applicants or employees of “normal weight.”

In public spaces

Weight stigma is also present in more subtle environmental ways. Seating options in waiting rooms, theatres, on airplanes or in restaurants frequently don’t accommodate individuals in larger bodies. The availability of stores that carry accessible clothing for people of all body sizes is almost non-existent, which makes finding comfortable and enjoyable fashion options significantly harder and often more expensive for these individuals. Social comments classifying certain food choices as admirable or “good,” and the social acceptability of praising and congratulating someone for losing weight reinforce weight stigmatizing notion that people in smaller bodies are more valued and desirable.

Fighting weight stigma

Ending the widespread acceptance of weight stigma in the U.S. is essential as both a human rights and public health issue. To begin combatting weight stigma, consider taking some of these actions to make a difference within yourself and your community:

• Take a “be more than a body – see more than a body” approach.  Refrain from making comments on your body or someone else's, even if they’re meant to be a compliment.  Attend to other qualities of a person that are likely to be far more interesting than their weight!
• Recognize and challenge your automatic beliefs or assumptions about different body sizes.  Have conversations with others in your life about weight stigma and seek opportunities to educate yourself or others. 
• Challenge the idea that weight is synonymous with health. When making lifestyle decisions about food or exercise, try focusing on eating foods and moving in ways that you find help your individual body feel its best. If you feel comfortable doing so, ask your healthcare providers to consider taking a Health at Every Size approach to discussing your health, and only weigh you or discuss weight during appointments if it is truly necessary.

Resources

If you're interested in exploring your own experiences with weight stigma or other forms of implicit bias further, consider checking out Harvard's free Implicit Association tests here.

If you find that you or a loved one is struggling with disordered eating as a result of weight stigma, we can help. At Parkview Behavioral Health Institute, we specialize in IOP group therapy and outpatient levels of care. Our eating disorder program utilizes an interdisciplinary treatment approach, collaborating with dietitians, medical providers, psychiatrists and skills coaches at all levels of care. To get started, patients can call 260-481-2700 and request an assessment to begin eating disorder treatment. A physician referral is not needed for any of our programs, but IOP requires prior authorization from insurance, which is handled by Parkview’s team.