Weight stigma refers to the discriminatory acts and ideologies targeted towards individuals because of their weight and size. Weight stigma is a result of weight bias. Weight bias refers to the negative ideologies associated with obesity.
These can include laziness, lack of will power, a lack of moral character, bad hygiene, low level of intelligence and unattractiveness. Stigmatising beliefs and ideologies can lead to stigmatising acts. These acts can manifest themselves in various different ways. People with obesity may experience negative verbal commentaries, teasing, or physical assault. Additionally, subtle behavioural slights such as eye rolling and tutting frequently occur. The environment also plays a part - for example, seating in cinemas or airlines are not designed to accommodate people with obesity. This is commonly reported in medical settings in particular, where seating, gowns and examination tables are unable to accommodate people with obesity.
The school and education environment is renowned for bullying and weight is one of the primary reasons for victimisation. Weight bias in education settings can come from a variety of different sources - students are not just victimised by their peers. It has been documented that even their teachers (particularly, but not exclusively physical education teachers) can be common perpetrators of stigma.
Weight stigma can prevent students from progressing into higher education. Students with obesity are significantly less likely to be accepted to college or university and those that do are likely to receive less financial support than their healthy-weight peers.
There is consistent evidence of weight discrimination at every stage of employment including; career counselling, interviews and hiring processes, salary disparities, fewer promotions, harsher disciplinary actions and higher contract termination rates. People with obesity are also significantly less likely to be put into a sales or customer-facing position. It has also been shown that people with obesity can be paid less than their healthy-weight counterparts for the same work. This is more pronounced for women with obesity, who can receive up to 6% less for the same work, whilst men with obesity may tend to sort themselves into lower-paying jobs.
Close relationship partners, including spouses/partners, parents, siblings and children, are documented as being the most common source of stigmatising comments, and in some cases, generate the most harmful stigmatising encounters.
Weight bias persists into healthcare settings. Physicians, nutritionists, dietitians, fitness professionals and exercise science students have all shown a propensity to ascribe stereotypical characteristics such as lazy, weak- willed, and noncompliant. Physicians generally have lower levels of respect for patients with higher BMI and generally spend less time providing consultations to patients with obesity compared to their healthy-weight counterparts. Physicians can also be a direct source of stigmatising comments. In one study by Puhl and Brownell 53% of people with overweight and obesity reported to have received inappropriate comments from their doctor about their weight.
In addition to stigma arising from the physician-patient relationship, many people with obesity report a stigmatising physical environment. This can include gowns, chairs, and examination tables that cannot accommodate people with obesity.
Weight prejudice exists in almost all sections of the media, from children's shows where characters with obesity are stereotyped as clumsy, lazy, and without friends, through to news reports which have apportioned blame for global warming and rising fuel prices to people with obesity.
In terms of representation, underweight characters are significantly over-represented and overweight characters under-represented compared to the general population; something particularly true for women.
Marketing for weight loss products regimes is overwhelmingly focused on personal responsibility for weight, further perpetuating the belief that weight gain or loss is entirely in the hands of the individual. This framing of obesity as a purely personal-level responsibility can also be seen in public-health campaigns that solely focus on behaviour changes in their efforts to lower obesity levels.
Overtly discriminatory language is a predominant aspect of the obesity media narrative and will often be accompanied by equally stigmatising images that perpetuate the many false stereotypes attributed to people with obesity.
The consequences of stigma
Stigma can result in a variety of adverse emotional responses such as depression, low self-esteem and anxiety. Obesity itself is typically blamed for these potential consequences. However, it is weight stigma, rather than obesity, which has been proven to mediate the greater likelihood of depressive and anxiety disorders in individuals that have or have formally had obesity. Focus tends to be placed on the emotional effects of stigma. However, in addition to emotional health, weight stigma can also have social and physical effects.
Due to the numerous social contexts in which weight stigma can and does occur, the effects it can have on an individual’s social life can be extensive. It has been proven to weaken social relationships. In an effort to evade stigma, individuals have reported engaging in selective social isolation, which refers to avoiding social situations in an effort to remain unnoticed through fear of being stigmatised.
Stigma and the fear of stigma can affect physical health in a multitude of ways;
- Fear of stigma can lead to avoidance of seeking medical care which creates barriers to obesity prevention and treatment strategies.
- Weight stigma has been positively correlated with a variety of disordered eating patterns such as binge eating, emotional eating, restrictive eating, weight cycling and eating anxiety.
- There are many scientific studies associating obesity to a variety of serious medical conditions. However, more recently there have been studies with results which indicate that weight stigma plays a fundamental role in the development of some of these medical conditions. For example, it has been found that weight stigma, independent of adiposity positively correlates with increased stress hormone levels. Stress has been found to impact multiple areas of health such as, blood pressure, cardiac health, visceral fat levels and insulin resistance.
- Finally, in some cases weight stigmatisation is so severe that it has been directly associated with suicidal ideations and acts.
The drivers of stigma
The drivers of stigma are primarily based around a misunderstanding of the complex causes of obesity, with people attributing weight gain to personal responsibility, and failing to grasp the complex mix of genetics, environment, and biological factors that drive it. The focus on personal responsibility results in blaming people with obesity for their condition, and enables the stereotyping of people with obesity as lazy and lacking in willpower.
It is argued by some that stigmatisation of people with obesity will incentivise them to lose weight. However, evidence shows that this is a counterintuitive approach to weight loss motivation. Therefore, in addition to crossing moral boundaries, bias and stigma contribute considerably towards the globally rising obesity levels. Addressing weight stigma is essential in order to meet obesity reduction and prevention targets.
We are working in four distinct areas to tackle the stigma experienced by people with obesity, and encourage others to join us in this.
To tackle stigma in healthcare settings we are calling for better obesity education for healthcare professionals, as well as running our own e-learning platform SCOPE. Many healthcare professionals say they do not feel equipped to treat patients with obesity, and patients with obesity have self-reported their doctors as being a key source of stigmatising remarks. We believe that by providing and advocating for healthcare professional education on obesity we can reduce stigma amongst this group, leading to better treatment for people with obesity, as well as instilling a compassion for people with obesity that will trickle into the rest of our society.
Whilst changing attitudes for healthcare professionals is vital if we're going to reduce stigma, it's not enough to do only that. Wider societal attitudes need to be adjusted too. Our World Obesity Day 2018 Campaign aims to shed light on the ubiquity and seriousness of stigma. Improving awareness about obesity amongst the general public and challenging the assumption that obesity is purely an issue of personal responsibility is paramount to successfully reducing stigma.
Obesity is one of the last diseases where society has failed to implement people first language. People-first language puts the person before their disease, emphasising that an individual is not defined by their condition. For example, it is now very uncommon to see someone referred to as a disabled person; you'll more likely see reference to a person with a disability. The person comes first, and their disability is a characteristic rather than a defining feature. Unfortunately, this is not yet the norm with obesity, and the language used around the condition remains a major contributor towards stigmatisation. It is still usual to see obese people and a key part of our fight for people-first language is to change this to people with obesity. Language is integral to affording people with obesity the dignity they deserve.
Images used to accompany online or print news stories frequently depict people with obesity from unflattering angles, often inactive or consuming unhealthy food. This portrayal creates an environment where there is a lack of understanding and even a desire to shame individuals who have obesity. They invariably exploit the “shock value” of focusing on abdomens or lower bodies, and excluding heads from the frame of view. We are advocating for a fair portrayal of people with obesity in the media. We maintain a free to use image bank depicting people with obesity in various settings which we are encouraging media outlets to make use of.
Our image bank
One of the simplest ways to start fighting weight stigma is to use non stigmatising imagery. You can find a whole host of non stigmatising imaegery on our image bank, freely available using the link below.Image bank