Bias comes in many different forms such as racism, sexism, and ageism just to name a few.
One that is now being talked about to a larger degree is weight stigma, otherwise known as weight bias, fatphobia, or weight discrimination.
In this article, you will learn the types of weight stigma and how weight stigma can cause you psychological and physical harm.
What is Weight Stigma?
You’ve heard of (and likely have experienced) weight stigma.
Weight stigma is defined as oppressive and discriminatory treatment of someone based on their body size, shape, or weight.
There are actually 3 different types: internalized, interpersonal, and institutional.
This is when a person applies negative thoughts and stereotypes about higher weight or size to themselves.
Try this activity: write down 10 words you would use to describe someone’s character if they were in a larger body.
Most people would use words like lack of self-control, lazy, ugly, unhealthy, or unattractive.
This is stereotyping.
The media industry is quick to tell us how to think and feel about higher-weight people. Fat actors/actresses are made out to be clumsy, ugly, stupid, un-loveable, lazy, and unhygienic (think of the character Kevin from the TV series The Office, or Fat Amy from the movie Pitch Perfect).
When weight stigma is internalized, a person may believe the only way to “fix” themselves or avoid being stereotyped is by losing weight or changing their body which research shows is not sustainable.
Interpersonal weight stigma is when a person is treated poorly by another person solely based on their weight or size.
Consider a fat person who is laughed at by thin gym-goers. Or the woman who was fat-shaming the airplane passengers she was seated between.
This is still culturally acceptable to many people. Simply put, it is bullying. It is dehumanizing.
Institutional or Systemic
This type of weight bias is society-wide. The world is not catered to fat bodies.
Think of small airplane seats or restaurant booths.
Think inability to find well-made, cute clothes that fit in the store.
Even being denied a job, a raise, or equal pay all because of your size.
Unlike racism or sexism, weight bias is not a protected form of discrimination.
Let’s face it: fat people are treated unfairly because of their size.
How is Weight Stigma Hurting You
The First Way
In all areas of life, fat people are told that their body is wrong. From strangers to peers to parents to friends to doctors.
“Just go on a diet.” “You could lose the weight if you really tried.” “If you don’t lose weight you’ll probably die before your kids are grown.”
The pressure couldn’t be higher.
So they diet.
Some people can lose weight for a while, but research shows that more than 95% of the time, the weight is regained within 2-5 years. Two-thirds of dieters will regain more weight than they started with.
Then it’s back to dieting – and the cycle repeats.
This is the first way weight stigma harms you.
This weight roller-coaster is known as weight cycling. Research has found that weight cycling seems to be more dangerous than if a person stayed at a higher weight their whole life.
Weight cycling is associated with:
- Type two diabetes and insulin resistance
- High cholesterol
- High blood pressure
- Heart disease
- Bone fractures
- Psychological disorders such as anxiety and depression
- Eating disorders and disordered eating
- Weight gain
- and a higher incidence of death
A sidebar: “weight management” research concludes that being fat is going to lead to disease. However, very, VERY few of these studies exclude people who have experienced weight cycling. How are we to know then if it was being fat or weight cycling that was associated with a disease?
The Second Way
Weight stigma also harms you by increasing your stress levels and blunting the cortisol response.
Cortisol is your main stress hormone, but what do I mean when I say blunted?
In a study conducted by McCleary-Gaddy et al, researchers wanted to know how weight stigma affected the stress hormone response in higher-weight individuals.
They first needed to induce some stress that would be equal for both groups. Participants had to videotape themselves giving a speech about what made them a good candidate for a job at a company.
In the first group, they induced weight stigma by sharing that the company had a weight-discriminatory health insurance benefit. The second group, for comparison, was not told about the company’s health insurance benefits.
The researchers then measured the participant’s cortisol response.
Thin individuals in the stigmatized group had a normal spike of cortisol (a job interview is stressful, even if it is a simulation!) and then cortisol levels returned to normal in a timely manner.
However, the higher-weight participants in the stigmatized group did not have the same response. Their cortisol levels did not return to normal (blunted) when they perceived a weight-based identity threat.
The findings are consistent with previous research (such as with other minority groups experiencing stigma that is non-weight related) showing that people who experience chronic stress, including stigma-related stress, have an irregular cortisol response to acute stress.
Stress hormones stay higher for longer which wreaks all kinds of havoc on body systems and puts you at a higher risk for chronic disease.
A 2017 study found that people with higher levels of weight stigma had more than twice the risk of high allostatic load—a measure of cumulative stress on all body systems—that puts people at greater risk of type 2 diabetes, cardiovascular disease, and early death.
The “Weight Talk”
So if weight cycling and weight stigma are so bad for health, why do doctors still prescribe weight loss or diets?
Your answer is as good as mine. Some doctors are starting to get more familiar with the research that diets don’t work, but a good majority of them still believe that weight is the cause of major health problems.
People who work in the medical field are still people who live in our society and are exposed to the same weight stigmatizing messages.
Research conducted on healthcare providers showed that doctors spend less time on average with a fat patient. When asked why, the reason they gave was that the doctors considered higher-weight patients to lack self-control and not care about their health – a prime example of weight bias.
Doctors (and other healthcare providers) have been known to:
- Spend entire appointments talking to the patient about the patient’s weight (without asking for permission to discuss this topic might I add)
- Dismiss the patient’s reported symptoms or chalk them up to their weight
- Refuse to run tests or do blood work to rule out or confirm a diagnosis
- Recommend weight loss as the only treatment option and refuse to discuss other options
- Shame the patient because of their weight or body size
The “weight talk” is useless.
You tune out, stop listening to the list of “healthy” suggestions, and are feeling the stress of being stigmatized for an abnormal period of time after the appointment.
This blatant weight stigma causes people to not go to the doctor. Fat people are less likely to go in for preventative testing like mammograms or colonoscopies. Health outcomes get worse as chronic disease(s) goes longer without proper treatment.
What Can We Do to Combat Weight Stigma?
The biggest step you can take is to realize that weight is something you have very little control over and to stop dieting in order to halt weight cycling (check out better ways to assess health).
Your genetics play a large role in determining your weight, just like they do your height, eye color, and shoe size. By working through your internalized weight stigma, you can reduce your negative response to experienced stigma.
On a societal level, there are big changes that need to occur:
- Stop classifying “obesity” as a disease. When we pathologize fatness, we create stigma. Weight should be considered a symptom of what is going on in the body, not the cause of diseases (which has more to do with genetics, socioeconomic, and environmental factors than food, exercise, and body size ever will).
- Ensure we give equal opportunities to those in larger bodies. (Did you know fat people make less money and have few job opportunities?)
- Revamp the physical structure of our society to accommodate larger bodies: appropriate seats on common modes of transportation, bigger MRI machines and other medical equipment, clothing stores being more size-inclusive, and so on.
In an attempt to control weight or body size, one is at higher risk for disordered eating, poor mental health, and chronic disease. Let’s drop the stigma, work on unlearning diet culture, and adopt a Health At Every Size mindset.
Want to know if you have fallen prey to disordered eating? Take the quiz on my home page.
Are you wondering if you should work with an anti-diet dietitian? Read How does an Anti-Diet Dietitian Compare to a Traditional DIetitian