Weight Stigma and Well-being

A guest blog by dietetic intern, Faith Aronowitz

Our diet culture’s moralistic paradigm and cultural obsession of thin = healthy and good, while fat = unhealthy and bad has led to the assumption that those who live in larger bodies have negative connotations associated with them. Even commonly used language, such as the ‘war on obesity’  and the ‘obesity epidemic’ pathologizes natural body size diversity, demeaning and denigrating those in higher-weight bodies.

As someone who very much benefits from thin privilege (i.e. never having to worry about fitting into a chair, being fat shamed at the gym, or being told by my doctor that weight loss would solve all of my medical issues), I wanted to explore how I could work toward becoming a more educated, compassionate practitioner to all people with all kinds of bodies. I started by delving into the research, and in the process, began to unpack my own implicit weight stigma.

What I’ve discovered is this: weight stigma is actually more harmful than weight, itself.

Research has shown that weight stigma has a direct impact on psychological and physical health. Weight stigma is associated with higher body dissatisfaction, lower self-esteem, depression, anxiety, higher levels of perceived stress, antisocial behavior, substance abuse, and poorer psychological well-being, overall. (1-3)

In fact, it can be said that the last form of socially acceptable discrimination is fatphobia. One study determined that weight stigma, defined as negative thoughts and attitudes directed toward someone based solely on their body shape and size, has increased by 66% from 1995 to 2006. (4) In the workforce, it is unacceptable and (mostly) illegal to discriminate against someone based on their race, religion, sex, gender, national origin, age, or genetic information. So why is body shape and size any different?

Perhaps the effect of weight stigma on mental health is not so surprising: it makes sense that constant individual and systemic discrimination and devaluation of your worth would negatively affect your mental health. However, weight stigma not only leads to poorer mental health, but also leads to poorer physical health. This occurs through the avoidance of healthcare, the avoidance of health-promoting behaviors, and through a direct, negative effect on physiological health markers. Studies show that those who experience weight stigma are less motivated to participate in physical activity. (5,6) In addition, research shows that individuals living in higher-weight bodies delay visits to their doctors and much needed medical care due to the discomfort of being stigmatized. (7,8) One study showed that physicians, along with family members, were the number one sources of weight stigma in a sample of overweight and obese adults. (9) Even when individuals in higher-weight bodies do seek healthcare, they report that physicians spend less time with them and engage in less health education during their appointment, in comparison to patients in smaller bodies. (7)

Beyond avoidance of healthcare, avoidance of health-promoting behaviors, and potential misdiagnoses from biased care, weight stigma has a very direct impact on physical health, as it is associated with a nearly 60% increase in mortality risk. (10) Weight stigma is not just harmful to health. It can literally kill.

People who experience weight stigma can experience something called high allostatic load, which is essentially the ‘wear and tear’ on the body. This ‘wear and tear’ accumulates as an individual is exposed to chronic stress (weight stigma), exacerbating disease processes over time. Research has shown that individuals who experienced weight stigma had more than twice the risk of high allostatic load compared with those who did not experience weight stigma. (11)

The research is clear that weight stigma leads to an increased risk of poorer mental and physical health. To truly do no harm as healthcare providers and humans, it is imperative that we listen to and learn from those with lived experiences of weight stigma and continue to challenge ourselves to unpack our own implicit biases.

References

1. Friedman KE, Reichman SK, Costanzo PR, Zelli A, Ashmore JA and Musante GJ. Weight stigmatization and ideological beliefs: relation to psychological functioning in obese adults. Obes Res. 2005;13:907–916. DOI: 10.1038/oby.2005.105

2. Papadopoulos S and Brennan L. Correlates of weight stigma in adults with overweight and obesity: a systematic literature review. Obesity. 2015;23: 1743-1760. DOI: 10.1002/oby.21187

3. Sikorski C, Luppa M, Luck T, Riedel-Heller SG. Weight stigma “gets under the skin”—evidence for an adapted psychological mediation framework—a systematic review. Obesity. 2015;23:266–276. DOI: 10.1002/oby.20952

4. Andreyeva T, Puhl RM, Brownell KD. Changes in perceived weight discrimination among americans, 1995-1996 through 2004-2006. Obesity. 2008;16(5):1129-34. DOI: 10.1038/oby.2008.35..

5. Vartanian LR and Novak SA. Internalized societal attitudes moderate the impact of weight stigma on avoidance of exercise. Obesity. 2011;19: 757–762. DOI: 10.1038/oby.2010.234

6. Schmalz DL.’I feel fat’: weight-related stigma, body esteem, and BMI as predictors of perceived competence in physical activity. Obes Facts. 2010;3:15–21. DOI: 10.1159/000273210

7. Tomiyama AJ, Carr D, Granberg EM, Major E, Robinson E, Sutin AR and Brewis A. How and why weight stigma drives the obesity ‘epidemic’ and harms health. BMC Medicine. 2018;16:123. https://doi.org/10.1186/s12916-018-1116-5

8. Olson CL, Schumaker HD, Yawn, BP. Overweight women delay medical care. Arch Fam Med. 1994;3:888-892. DOI: 10.1001/archfami.3.10.888

9. Puhl RM and Brownell KD. Confronting and coping with weight stigma: an investigation of overweight and obese adults. Obesity. 2006;14(10):1802–1815. DOI: 10.1038/oby.2006.208

10. Sutin A, Stephan Y, Terracciano A. Weight discrimination and risk of mortality. Psychol Sci. 2015:26(11):1803-1811. DOI: 10.1177/0956797615601103

11. Vadiveloo M and Mattei J. Perceived weight discrimination and 10-year risk of allostatic load among US adults. Ann Behav Med. 2017;51(1):94–104. https://doi.org/10.1007/s12160-016-9870-0