Bias comes in many different forms such as racism, sexism, ageism just to name a few. An age-old bias that is now being talked about to a larger degree is weight stigma. Weight stigma is the bias against people in larger bodies and when experienced and internalized, weight bias can cause psychological and physical harm.
What is Weight Stigma?
You’ve heard of (or maybe even experienced) fatphobia and weight stigma. Think of the fat person who is laughed at by the thin gym-goers or is moo’ed at while eating lunch in the cafeteria. The person who was fat-shaming the airplane passengers she was seated between. Face it: fat people are treated differently because of their size. That is weight bias.
In the culture we live in, we are told fat is bad and that fat people have inherently bad qualities. 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 characters Kevin from the TV series The Office, or Fat Amy from the movie Pitch Perfect). These biases unfortunately are internalized in us and then play out in the real world.
How is Weight Stigma Hurting You
Fat people are told by people in all areas of life that their body is wrong. From strangers to peers to parents to friends to doctors. “Just go on a diet.” “You have control over your body. 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 can lose weight for a while, but more than 95% of the time, the weight is regained in 2-5 years. Two-thirds of dieters 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
- and a higher incidence of death
The second way in which weight stigma harms you is 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 effected the stress hormone response in higher-weight individuals. They induced weight stigma in one group by having them videotape a speech about what made them a good candidate for a job at a company that was described as having a weight-discriminatory health insurance benefit. The non-stigmatized group, for comparison, made an audiotape speech for a company whose health insurance benefit was not described.
The researchers then measured the 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 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.
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 show that doctors spend less time on average with a fat patient. When asked why, the reason they gave was because doctors consider higher-weight patients to lack self control and not care about their health – a prime example of weight bias. Doctors (and other 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 have likely tuned out (and stopped 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 mamograms or colonoscopies. Health outcomes are worse as chronic disease(s) goes longer without proper treatment.
What Can We Do to Stop 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 releasing 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 being fat, we create stigma. Weight should be considered a symptom of what is going on in the body, not the cause of disease (which has more to do with 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 medial 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.
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Other References for this article (Content Warning for BMI numbers and stigmatizing language)
Feldes, Alison, Judith Charlton, Caroline Rudisill, Peter Littlejohns, A. Toby Prevost, and Martin C. Gulliford. 2015. “Probability of an Obese Person Attaining Normal Body Weight: Cohort Study Using Electronic Health Records.” Am J Public Health 105 (9): e54–59. https://doi.org/10.2105/AJPH.2015.302773.
Gaesser GA. Thinness and weight loss: beneficial or detrimental to longevity? Med Sci Sports Exerc. 1999 Aug;31(8):1118-28. doi: 10.1097/00005768-199908000-00007.
Dulloo, A. G., J. Jacquet, and J-P Montani. 2002. “Pathways from Weight Fluctuations to Metabolic Diseases: Focus on Maladaptive Thermogenesis during Catch-up Fat.” International Journal of Obesity, no. 26: S46–57. https://doi.org/10.1038/sj.ijo.0802127.
Montani, J-P, Y. Schutz, and A. G. Dulloo. 2015. “Dieting and Weight Cycling as Risk Factors for Cardiometabolic Diseases: Who Is Really at Risk?” Obesity Reviews 16 (S1): 7–18. https://doi.org/10.1111/obr.12251.
Jacquet, Philippe, Yves Schultz, Jean-Pierre Montani, and Abdul Dulloo. 2020. “How Dieting Might Make Some Fatter: Modeling Weight Cycling toward Obesity from a Perspective of Body Composition Autoregulation.” International Journey of Obesity, no. 44: 1243–53. https://doi.org/10.1038/s41366-020-0547-1.
Fruh SM, Nadglowski J, Hall HR, Davis SL, Crook ED, Zlomke K. Obesity Stigma and Bias. J Nurse Pract. 2016;12(7):425-432. doi:10.1016/j.nurpra.2016.05.013
Lee JA, Pausé CJ. Stigma in Practice: Barriers to Health for Fat Women. Front Psychol. 2016;7:2063. Published 2016 Dec 30. doi:10.3389/fpsyg.2016.02063