How and why weight stigma drives the obesity ‘epidemic’ and harms health

Abstract

BackgroundIn an era when obesity prevalence is high throughout much of the world, there is a correspondingly pervasive and strong culture of weight stigma. For example, representative studies show that some forms of weight discrimination are more prevalent even than discrimination based on race or ethnicity.DiscussionIn this Opinion article, we review compelling evidence that weight stigma is harmful to health, over and above objective body mass index. Weight stigma is prospectively related to heightened mortality and other chronic diseases and conditions. Most ironically, it actually begets heightened risk of obesity through multiple obesogenic pathways. Weight stigma is particularly prevalent and detrimental in healthcare settings, with documented high levels of ‘anti-fat’ bias in healthcare providers, patients with obesity receiving poorer care and having worse outcomes, and medical students with obesity reporting high levels of alcohol and substance use to cope with internalized weight stigma. In terms of solutions, the most effective and ethical approaches should be aimed at changing the behaviors and attitudes of those who stigmatize, rather than towards the targets of weight stigma. Medical training must address weight bias, training healthcare professionals about how it is perpetuated and on its potentially harmful effects on their patients.ConclusionWeight stigma is likely to drive weight gain and poor health and thus should be eradicated. This effort can begin by training compassionate and knowledgeable healthcare providers who will deliver better care and ultimately lessen the negative effects of weight stigma.

Understanding and effectively addressing disparities in obesity: A systematic review of the psychological determinants of emotional eating behaviours among Black women

“…Factors associated with increased risk of emotional eating among women with overweight and obesity include negative emotions from weight‐based discriminatory practices in health care and other social settings . These discriminatory practices may be driven by weight stigma, defined as “social rejection and devaluation that accrues to those who do not comply with prevailing social norms of adequate body weight and shape.” Tomiyama et al argue, based on laboratory experiments, that weight stigma contributes to emotional eating by triggering increased cortisol production, increased eating, and weight gain. The authors further note that the current medical strategy to encourage patients to eat less and exercise more may induce patient shame and self‐blame, which perpetuates weight stigma.…”

“…These differences in weight loss response to behavioural treatment among non‐Hispanic Black women may be due to chronic stressors (eg, weight stigma and structural racism) that cause metabolic disturbances that are independent of lifestyle behaviours . These metabolic disturbances may increase adipose tissue accumulation preventing meaningful weight loss . Thus, it is plausible that non‐Hispanic Black women experience social and environmental stressors that may influence behavioural responses that impact weight control.…”

The challenge for global health systems in preventing and managing obesity

“…Weight‐based discrimination and stigmatisation can increase the risk of depression, anxiety, poor body image, and suicidal ideation . Furthermore, negative attitudes by clinicians can result in the avoidance of health care settings by people with obesity, delays in seeking prevention services such as cancer screening, and the patient perception of suboptimal health care provision by health care professionals . Additionally, public perceptions of adiposity have shifted to excess weight gain becoming more normalised, with rates of overweight and obesity continuing to increase, the majority of individuals in some countries .…”

“…29 Furthermore, negative attitudes by clinicians can result in the avoidance of health care settings by people with obesity, delays in seeking prevention services such as cancer screening, and the patient perception of suboptimal health care provision by health care professionals. 30,31 Additionally, public perceptions of adiposity have shifted to excess weight gain becoming more normalised, with rates of overweight and obesity continuing to increase, the majority of individuals in some countries. 32 Misperception of underweight has been found among adults, 33 adolescents, 34 and parents of their children.…”

Young adults’ BMI and changes in romantic relationship status during the first semester of college

“…While college student (and other young adult) weight status has been shown to be associated with relationship initiation, it remains less clear if weight status also influences relationship termination. This matters, because if weight influences relationship termination, it suggests an additional possible mechanism of weight stigma and discrimination faced by young adults [2,15], and there is a growing body of evidence that shows the experience of stigma-related rejection around weight is extremely stressful and can have profound negative effects on health [16].…”