There's a dark side to obesity that's only recently getting attention; millions of people from all walks of life are often stigmatized and even shamed based on their weight –and it's one of the most pervasive and acceptable forms of bias and discrimination. For Weight Stigma Awareness Week (September 21-25), I'm discussing the causes and consequences of weight stigma.
What is weight stigma?
Weight stigma is negative bias and prejudice toward people with overweight and obesity, and it is a serious societal problem that has been on the rise. In the U.S. alone, the prevalence of weight-based discrimination rose 66 percent between 1995 and 2005, and has become comparable to rates of racial discrimination–particularly among women, for whom it is more common than age or sex discrimination. Weight stigma can also lead to weight-based victimization or bullying, and given that 2 in 3 U.S. adults are overweight or obese, it can affect millions. Weight has also become the most common reason for bullying among children.
What are the effects of weight stigma?
Discrimination and prejudice are wrong. Yet, individuals with obesity of all ages face discrimination and unfair treatment in virtually all aspects of life: Women with obesity report having fewer friends, and less success in finding romantic relationships, than their peers. And recently, a provocative experiment by Dr. Natasha Schvey and colleagues showed that weight stigma may even influence jurors' determination of guilt. Those with obesity are less likely to be hired or promoted, and they earn less than equally qualified peers. Notably, while U.S. federal law protects citizens from discrimination on the basis of race, there are no comparable protections surrounding weight; it does not violate federal law to fire someone solely on the basis of weight.
Does weight stigma or "fat shaming" help motivate people to lose weight?
No, the opposite is true. If weight stigma helped people lose weight, there would be no obesity epidemic. In a study of over 2000 adults with obesity, 79 percent of those surveyed managed the stress of weight stigma by eating. People with obesity who experience weight stigma are also more likely to experience anxiety, depression, and even suicidality, and they avoid situations where they might face further stigma.
Unfortunately, more than 2 out of 3 overweight people report experiencing weight stigmatization from health care providers. Patients with obesity also report instances of physicians missing important diagnoses because their symptoms were misattributed to obesity, and they were told to simply eat less. Patients respond to such weight stigmatization by avoiding future visits with that clinician, or sometimes, any health provider at all, which hardly helps obesity or general health.
Additionally, the stress of weight stigma has been shown to increase the reactivity of cortisol, the "stress hormone," in both thin and overweight women. This is particularly troubling given that heightened cortisol reactivity stimulates appetite, dampens satiety cues, prepares the body to store fat, and heightens preference for highly palatable foods.
What causes weight stigma?
Weight stigma largely stems from the cultural ideal of thinness and misperceptions about obesity. There is a commonly held stereotype that people with obesity are lazy, sloppy, undisciplined, and incompetent – and therefore solely responsible for their weight.
The role of personal responsibility in obesity is often overstated. Obesity is not a lifestyle choice; body weight involves a complex interplay of environmental, genetic, biological, and behavioral factors. In fact, obesity is considered a disease by the American Medical Association. The research is very clear that obesity is a chronic condition not easily amenable to lifestyle modification. Of the people with obesity who do manage to lose weight through diet and exercise, 97 percent regain the lost weight (and sometimes more).
Are there any encouraging signs in the fight against weight stigma?
Thanks in part to events like Weight Stigma Awareness Week, there is greater awareness around weight stigma than ever before. Weight stigma has also been a primary agenda item for the non-profit Rudd Center in recent years, and they have produced some of the most influential research and policy recommendations on this issue.
In addition, the National Science Foundation recently funded an exciting five-year study to examine the scope and consequences of weight stigma. This study will gather real-time data using mobile texting to test the theory that there is a vicious cycle: people with obesity cope with the stress of weight stigma by eating, which causes them to gain more weight, which then leads them to experience even greater weight stigma.
As the world faces an unprecedented obesity epidemic, weight stigma remains one of the most pervasive and socially acceptable forms of bias and discrimination. Society needs to attack the problem of obesity, not the people with obesity.
Stacey C. Cahn, Ph.D. is associate professor of clinical psychology at the Philadelphia College of Osteopathic Medicine. Dr. Cahn specializes in obesity, eating disorders, cognitive-behavioral therapy.