Weight stigma, also known as weight bias, refers to negative attitudes, stereotypes, or discrimination based on larger body size. When people are perceived as “overweight” or “obese,” they are also often perceived as lazy, unattractive, and lacking willpower. Weight stigma is not just about overt insults; it is embedded in all areas of our culture, including healthcare and workplaces. It is an invisible and largely unexamined bias with the explicit and implicit message of thin = better. To better understand implicit weight bias, take the Implicit Association Test.
Weight Stigma Hurts People in Larger Bodies
Most obviously, weight stigma hurts fat people. (Note: The word “fat” is used here as a reclaimed descriptor. It is not used as an insult.) One study demonstrated that fat people are discriminated against as job applicants, as compared to their thinner counterparts. Other serious consequences can result from weight stigma, such as during court proceedings.
Arguably, there are no consequences more serious than one’s life. Unfortunately, weight bias in the healthcare field harms patient care. Despite years of training, physicians have been found to have as much bias towards people in larger bodies as does the general public. There are very real results from weight stigma. First, it is linked to increased mortality, as well as to diseases and medical conditions. This health risk goes beyond any risk due to a patient’s actual weight. In other words, weight stigma itself increases disease risk, independent of how much a patient weighs.
Second, weight bias by healthcare professionals results in poorer care. It is not uncommon for a fat person to visit
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their doctor for a straightforward issue, such as a sore throat, and to be sent away with a referral to a bariatric surgeon. Even worse, patients in larger bodies are often denied the testing, therapies, and surgeries provided to thinner patients with the same health conditions. Twitter users have coined #diagnosisfat to tell about their own negative lived experiences with the healthcare system.
With all the external sources telling fat people that their bodies are wrong, it is no wonder that many turn to dieting. Internalized weight bias results from repeated cultural messaging, and leads people to believe they are in total control of their body size. This typically leads to years of dieting, and repeated cycles of weight loss and regain.
Weight Stigma Hurts People in Smaller Bodies
Internalized weight bias is not limited to larger people. The unfair stereotypes and cultural maligning of fat people spill over to everyone, regardless of size. It is no wonder that the weight loss industry is still strong, at $72 billion per year. Even when phrased as “wellness,” “detoxing,” or “clean eating,” the underlying goal is usually to lose weight. Internalized weight bias in smaller individuals is connected to the development of eating disorders.
Weight Stigma Hurts Men
Although the pressure to be thin would seem to fall mostly on women, men are not immune. A recent study of over 1700 men found that both external and internalized weight bias were linked to worse health. This included increased dieting, depressive symptoms, and binge eating. These results were independent of body mass index, race, and socioeconomic status. The results of this study indicate that more research focusing on men is warranted.
Weight Stigma Hurts Children and Teens
As with adults, weight stigma against children and teens harms their body image. Even if they have not experienced weight stigma first hand, children absorb the larger cultural beliefs about body size and act accordingly. Early on, children learn that thin is in; and for boys, large muscles are desirable. For six- to eight-year old children, over half of girls and a third of boys believe their ideal body size is thinner than their actual size. Moreover, 80% of 10-year-old American girls have dieted. Another study discovered that for adolescent males, body dissatisfaction is relatively common, centering around muscularity. Greater concern about physique was found to be linked to binge drinking and drug use.
This desire to meet a culturally acceptable body size and shape is understandable. Since fat people are stereotyped as lazy and unattractive, children learn that being a certain body size is protective. Larger children have approximately twice the risk of being bullied than “normal” weight children, with girls at greater risk than boys.
It is crucial that the dangers of weight stigma be more widely understood. To that end, the National Eating Disorders Association hosts the annual Weight Stigma Awareness Week September 23-27, 2019. Use hashtags #WSAW2019 and #ComeAsYouAre to encourage an understanding of why weight stigma matters to all people, in all size bodies, when it comes to eating disorders.
About the Author
Barbara Spanjers, MS MFT is a therapist and wellness coach who helps people feel more attuned with food and in their body.