The Weight of Stigma

How Attitudes and Stereotypes About Weight Affect Us All

More than two in three adults in the United States are living with overweight or obesity (1). Even as overweight and obesity have become increasingly common worldwide, harmful attitudes about weight and shape remain pervasive. These negative weight-related stereotypes and the resulting discrimination against those who are overweight are known as weight stigma (2).

What is weight stigma?

Weight stigma places the blame for overweight and obesity on the individual, rather than the biological and cultural forces that contribute to the global rise of obesity (3). For example, a common stereotype about people who are overweight is that they are lazy, suggesting that being overweight is their fault for not exercising enough. In reality, many people who are overweight live active lifestyles, and their weight is more a reflection of genetics than their activity level. Another common weight-related stereotype attributes obesity to consuming high-fat, high-sugar, processed foods. While choosing to eat these foods can certainly contribute to weight gain, it is also important to consider the role the fast food industry plays by engineering and advertising these super-tasty foods.

Weight stigma is a combination of three factors: stigma beliefs, stigma experiences, and internalized stigma.

Stigma beliefs are the widespread negative attitudes about weight and shape. Although not everyone accepts the widespread negative attitudes about people who are overweight, most of us are aware that these beliefs are prevalent in our culture. All of us are subjected to media messages telling us that it is good to be thin and bad to be "fat." Some of these media messages are overt and obvious, such as in advertisements for fad diets that celebrate extreme weight loss, or when a character's weight is portrayed comedically (such as "Fat Amy" in the Pitch Perfect movie series). Other media messages are more implicit and subtle, like when villainous movie characters are depicted as overweight (such as Ursula from Disney's The Little Mermaid). In addition to anti-overweight bias in the media, many of us encounter weight stigma in the way our loved ones talk about health, even when good-intentioned. For instance, parents might tell their children that they need to avoid eating junk food, or else they will gain weight. This sends the message that gaining weight is something they should be afraid of, and teaches them that people who are overweight made unhealthy choices.

Stigma experiences encompass weight-related harassment and discrimination. Due to stigma beliefs about weight and shape, individuals who are overweight often experience criticism from family and friends, public shaming, and even maltreatment from medical professionals due to their weight (2). Children and teens who are overweight are often bullied at school, resulting in social isolation (4). These experiences can shape a person's future behavior, as they try to avoid further stigmatization.

Internalized stigma occurs when a person accepts a stigmatizing belief about weight and applies it to their own self-image (5). Internalized weight stigma is more than just poor body image; it involves attributing one's own weight or shape to personality traits like laziness or impulsivity. For example, someone who internalizes the stereotype that people who are overweight are lazy might start to thing, "I'm overweight because I'm lazy." Since all of us are exposed to weight stigma beliefs, it is possible for anyone of any weight or shape to internalize weight stigma if they believe themselves to be overweight -- regardless of whether anyone else would consider them overweight.

Weight Stigma and Health

There is a widespread misconception that weight stigma is "good for us" -- that a fear of being overweight encourages people to live healthy lifestyles. On the contrary, research has consistently demonstrated that weight-related stigmatizing experiences and internalized weight stigma are associated with poor mental and physical health outcomes (6-9). Weight-related teasing and harassment leave individuals at higher risk for depression, anxiety, and poor self-esteem (10). Additionally, weight stigma is a risk factor for disordered eating behaviors such as binge eating (6,7). And despite the belief that weight stigma might motivate someone to be more physically active, weight stigma is associated with exercise avoidance (11,12), likely due to embarrassment about one's physical abilities or the way one looks while they are working out. Individuals who have experienced stigmatizing comments or treatment from medical professionals may be reluctant to seek medical care when they need it, for fear of being ridiculed for their weight or being blamed for their health problems (2).

What Can We Do About Weight Stigma?

Shifting societal attitudes about weight stigma starts with changing the way we talk about weight with our own family and friends. Weight can be a sensitive topic for many people, and it is important to be aware of the words we use and the implicit messages we convey when we talk about weight (13). Labeling people as "fat" or "chubby" is hurtful, and suggests to everyone who is listening that you believe people who are overweight deserve to be described in pejorative terms. Avoid commenting on other people's weight, and if you have to, use neutral terms such as "above average weight."

You might be wondering how you can encourage a loved one to make healthy lifestyle choices without focusing on weight or how you can make a difference in tackling such an insidious and pervasive problem such as weight stigma. Here are a few thoughts, but we welcome comments on things you have done that you feel have made a difference.

  1. Start with you. Children and adolescents need role models to envision what self-acceptance looks like. Walk tall and walk proud. Embody beauty: in your words, actions, and spirit.
  2. Don’t participate in the tendency of media forums to analyze and criticize the appearance of others. Help your child be an activist: stop buying publications or visiting blog spaces where this is the tone, write to editors to request respectful treatment of others, and praise media outlets that promulgate respect for all persons.
  3. Practice a vital lifestyle: savor food, savor nature, rejoice in what your body can do, take pride in getting stronger. Lead by example and you will find your vibrancy is contagious.
  4. Marvel in what a body’s history can tell you about how complex and interesting each individual’s story is. We wear our history: every scar, skin fold, blemish. It is who we are and a notation of what we have been through.  Help your children be curious about other people’s lives.

By Julia Nicholas

References

1. Fryar, C. D., Carroll, M. D., & Ogden, C. L. (2016). Prevalence of overweight, obesity, and extreme obesity among adults aged 20 and over: United States, 1960-1962 through 2013-2014, 6.

2. Puhl, R. M., & Brownell, K. D. (2001). Bias, discrimination, and obesity. Obesity Research, 9(12), 788-805.

3. Theories of weight stigma. (2019). Retrieved from http://www.uconnruddcenter.org/weight-bias-stigma-theories-of-weight-bias.

4. Pont, S. J., Puhl, R., Cook, S. R., & Slusser, W. (2017). Stigma experienced by children and adolescentes with obesity. Pediatrics, 140(6), e20173034.

5. Durso, L. E., & Latner, J. D. (2008). Understanding self-directed stigma: Development of the Weight Bias Internalization Scale. Obesity, 16(S2), S80-6.

6. Almeida, L., Savoy, S., & Boxer, P. (2010). The role of weight stigmatization in cumulative risk for binge eating. Journal of Clinical Psychology, 67(3), 278-292.

7. Ashmore, J. A., Friedman, K. E., Reichmann, S. K., & Musante, G. J. (2008). Weight-based stigmatization, psychological distress, & binge eating behavior among obese treatment-seeking adults. Eating Behaviors, 9(2), 203-209.

8. Pearl, R. L., & Puhl, R. M. (2014). Measuring internalized weight attitudes across body weight categories: Validation of the Modified Weight Bias Internalization Scale. Body Image, 11(1), 89-92.

9. Puhl, R. M., & Suh, Y. (2015). Stigma and eating and weight disorders. Current Psychiatry Reports, 17(3), 1-10.

10. Puhl, R. M., & Heuer, C. A. (2009). The Stigma of Obesity: A Review and Update. Obesity, 17(5), 941-964.

11. Vartanian, L. R., & Shaprow, J. G. (2008). Effects of weight stigma on exercise motivation and behavior: A preliminary investigation among college-aged females. Journal of Health Psychology, 13(1), 131-138.

12. Vartanian, L. R., & Novak, S. A. (2011). Internalized societal attitudes moderate the impact of weight stigma on avoidance of exercise. Obesity, 19(4), 757-762.

13. Parents: Talking to your kids about weight. (2019). Retrieved from http://www.uconnruddcenter.org/files/Pdfs/Update%20for%20main%20site_Talking%20to%20your%20child%20about%20weightPDF.pdf.