Weight bias and stigma, which results in people being treated differently because of their body size, can get under your skin—literally. A 2018 report found that experiencing weight bias and stigma can be as harmful to a person as the effects of obesity itself. Here’s how to spot it (the signs can be subtle) and ways to combat it at every level.
What is weight bias and stigma?
The two concepts are closely linked, but aren’t quite the same thing. Weight bias is defined as negative weight-related attitudes, beliefs, assumptions and judgements towards individuals who are overweight and obese. While weight stigma refers to the social devaluation and criticising of people with higher weight/larger bodies that occur because of those negative thoughts or attitudes. Like other forms of discrimination, weight stigma can happen on both a personal level, like being bullied or excluded, as well as in a larger systemic or institutionalised way.
Where does weight bias and stigma occur?
Weight stigma can emerge in almost any setting—including schools, workplaces, doctors offices, public transportation and even in close interpersonal relationships.
Weight bias from healthcare providers
Public healthcare settings are places where you’re supposed to feel safe and supported on your health journey, but it often doesn’t feel that way. This can lead to poorer quality of care and communication between providers and patients and can even prevent people from attending weight management services and healthcare. Medical professionals have been found to spend less time in consultations with obesity patients, and perform fewer medical interventions. This might lead to a doctor not fully investigating a medical complaint—instead just insisting that the patient lose weight or telling them to diet to fix what ails them. Reports also show that negative comments have been made by healthcare professionals along the lines that heavier patients have a lack of ‘willpower’,are ‘lazy’ and ‘noncompliant’. Even things like the size of blood pressure cuffs, chairs in the waiting room, and hospital gowns can be stigmatising for people with larger bodies.
Weight bias at work
In the workplace, people can face prejudice and discrimination because of their weight. Research shows that those who are overweight or obese are less likely to be hired or promoted, and also report that they have been subjected to derogatory comments from coworkers. Those living with obesity also tend to have lower incomes, something researchers say is partly due to stigma. But many times, weight bias at work can be hard to spot, or hidden behind giggles.
Weight bias in relationships
Even relationships with family and friends are not immune. “Family members are one of the most common sources of weight teasing and judgemental comments about weight,” says Rebecca Puhl, Ph.D., clinical psychologist. Have you ever had a relative make a pointed remark when you’re serving yourself or say yes to dessert? That‘s weight bias. This can be especially hard on teens, with one study showing that adolescents felt more insecure, embarrassed, and hurt when parents brought up their weight in critical ways.
Weight bias throughout the day
In buildings and on public transport, the most basic of things—the size of chairs or aeroplane seats, for example—are not always sized adequately to easily accommodate people in bigger bodies. Even just the subtle side-eye or audible sighs from passengers when someone larger sized is seated next to them can be harmful—and obvious.
What part does the media play in weight bias?
It can be hard to say exactly where someone’s weight bias comes from, but popular media definitely reinforces the idea that people in larger bodies are somehow less worthy. “We see negative weight-based stereotypes and stigmatising portrayals of people with higher weight in television, film, news, social media, and advertising,” says Puhl. “As an example, my research team found that about two-thirds of news reports about obesity contain images that portray people in ways that reinforce negative weight stereotypes.” Think of pictures showing heavier people as lazy, sloppy, or undisciplined.
Body shaming and weight bias remains a constant in television and film, whether it’s reality TV shows, sitcoms, or cartoons. Ever notice “how in TV shows the stars and popular people are often thin, while the funny sidekicks or less desirable people are heavier,” says Kate W. Bauer, Ph.D., associate professor of nutritional sciences at University of Michigan’s School of Public Health in the United States. And it starts young: Researchers have studied top-grossing children’s movies and found that over 80% contain content that promotes weight stigma, and that more than half of youth-targeted TV shows contain negative comments about the appearance of a character with a larger body, says Puhl. When you’re continually exposed to these sorts of characterisations from a young age, it can’t help but burrow deep into your value system and psyche. Without even realising it, you see larger bodies negatively and internalise that being heavy is bad (both when thinking about other people’s bodies and your own).
What are the effects of weight bias on wellbeing?
There are still people who believe that “encouraging” someone to lose weight through stigmatising comments can be a powerful motivator and ultimately help someone improve their health, but the truth is quite the opposite. “There seems to be a belief that heavier people don‘t know they're heavier, and if someone just told them then they‘d ‘wake up’ and change, but that is absolutely not true,” says Bauer. Being shamed or stigmatised about weight can be harmful in multiple aspects of a person’s life. These include:
- Emotional wellbeing: Weight stigma can contribute to increased depression, anxiety, lower self-esteem, and poorer body image. “It is exhausting and upsetting to walk through life constantly being reminded that your body, and you, do not belong and are less worthy of happiness and health than someone who is thinner,” says Bauer. “Heavier people are always on guard, worried they will be insulted or dismissed or just ‘take up too much space.’”
- Physical health: This constant stress of feeling stigmatised against can raise your risk of health problems such as high blood pressure, type 2 diabetes, and cardiovascular disease. The chronically higher levels of cortisol can make it harder for your body to regulate inflammation and can increase visceral fat levels, two things that are linked to many chronic health conditions. Weight stigma can even lead to weight gain and ultimately increase the risk of mortality. It doesn’t help that, as Puhl notes, weight stigma leads people to avoid physical activity due to a fear of being judged.
- Level of healthcare: “People with higher weights go to the doctor and are told losing weight will solve all their health problems; they are denied evidence-based treatments because doctors don‘t think that they have the willpower to be compliant,” says Bauer. There may be medical equipment that’s not sized correctly for bigger bodies and doctors may also spend less time with people with higher weights. As a result, those who have larger bodies and experience stigma are less likely to go to see a healthcare provider in the future.
"It is exhausting and upsetting to walk through life constantly being reminded that your body, and you, do not belong and are less worthy of happiness and health than someone who is thinner"— Kate W. Bauer, Ph.D.
How can you identify if weight stigma is happening to you?
For the more obvious types of weight stigma, many people with higher weight are already aware that they’re being treated in a way that doesn’t make them feel good. “People know that mainstream stores don‘t often carry their size, or that they get stared at when they‘re eating or exercising,” says Bauer.
But the more subtle forms of weight stigma might be harder to pinpoint. According to Puhl, if you feel you are being treated unfairly by others because of your body weight or size, and the mistreatment can’t be explained by something else, such as being passed over for a job you were clearly the most qualified for or being told that a medical issue is simply a weight problem, that is weight stigma.
“If you are being verbally teased about your weight or size, that is weight stigma. If someone is blaming or shaming you for your weight, or applying stereotypes to you because of your body size, that is weight stigma,” says Puhl. “It can look different across different situations, but at the core of these experiences are themes of being devalued, rejected, judged, blamed, or dismissed because of one’s body.”
How can you advocate for yourself?
Removing yourself from situations and relationships where you feel stigmatised against is an important step in avoiding many of the negative impacts of weight bias and stigma. Here’s what else you can do:
- Take stock of your mindset. “It’s vital that you know that you deserve good things and proper treatment, regardless of your weight,” says Bauer. “For some people it might require a really strong social support system or working on the issue with a mental health professional to get there. But once you believe that, it becomes easier to stand up for yourself in difficult situations.”
- Talk to advocates. In workplaces, schools, and medical offices, there are people whose job it is to help you fight stigma. Talk to your HR department about adding obesity to your company’s anti-harassment policy or meet with a patient advocate within your healthcare group to talk about ways that providers have talked to you about your weight.
- Find a different doctor. This is a big one: You want to see medical providers you feel comfortable with, especially ones that don‘t always turn to weight as the source of problems. Remember: You want a provider who focuses on your weight health (the impact your weight is having on your health and wellbeing), not on the number on the scale.
The bottom line
Weight bias and stigma can negatively impact people in so many ways, from raising their risk for serious health conditions and reducing the quality of their healthcare to making it harder to have a successful career or simply travel on an aeroplane. Being a strong self-advocate and well-informed about where weight bias can occur can help you feel prepared to fight back and reduce the risk that comes from being stigmatised against.