Guest Post: Combating Weight Stigma

Today's guest post comes from Aubrey Toole, a recent graduate of the University of California, Berkeley who will begin a doctoral program in clinical psychology at Emory University in the Fall. 

I am willing to bet that most of you reading this don’t go a typical day without hearing a weight-related comment or conversation, or seeing body weight-related advertisements or media messages. It seems like I hear about another celebrity weight loss ‘success’ story or weight gain ‘fiasco’ every time I turn on the TV. Standing in line at the drug store means being surrounded by a smattering of tabloids fraught with photos of celebrity cellulite. And even on facebook, it’s hard to avoid sneaky before and after photos of some new miracle diet appearing out of the corner of my eye.

Interestingly, amidst our culture’s condemnation of fatness and idealization of thinness, most American waistlines have expanded over time, and thinness has become ever more illusive to many. This rise in the average American BMI has been accompanied by increasingly negative perceptions about overweight and obese individuals. Fear of fatness is so pervasive that it has become normative and acceptable to harbor and express negative attitudes toward overweight and obese individuals. In this post, I explore the origins of weight stigma, the reasons why it is harmful, and how we might reduce it in ourselves and others.

What is weight stigma? Weight stigma occurs when an individual is deemed overweight by society, and experiences the negative effects of prejudice and discrimination because of his/her weight. While research on weight stigma is still relatively new, the literature suggests that weight stigma is powerful and resistant to change. Weight stigma is a form of prejudice and stereotyping. It might involve, for example, a belief that overweight or obese individuals are lazy, incompetent, self-indulgent, or unmotivated.

Like other forms of prejudice, prejudiced beliefs about overweight individuals can lead to discrimination, or treating someone differently because of his/her weight, which could involve choosing not to hire someone (intentionally or unintentionally) because of his/her weight, excluding someone from a social group, or providing less financial support. Individuals may justify these behaviors by viewing weight as controllable.

Where is weight stigma? Research suggests that weight stigma is present in many aspects of life, including employment, education and health care settings. For example, obese individuals are less likely to be hired than thin people, despite identical qualifications. Furthermore, studies have shown that even very young children express weight bias and prejudice, revealing that weight stigma emerges early on in life. Even more disheartening is that overweight people themselves tend to express weight bias and may even apply negative stereotypes to themselves. And, no surprise here, the media plays a big role in the propagation of weight stigma and bias. Overweight characters are often portrayed in negative stereotypical ways, and are the objects of humor and ridicule. Even well-intentioned media campaigns designed to combat the obesity epidemic have perpetrated weight bias and stigma. For instance, the controversial Children's Healthcare of Atlanta Strong4Life childhood obesity ad campaign featured images of downcast-looking overweight kids staring mournfully at the camera with captions such as “WARNING: It’s hard to be a little girl if you’re not” and “Fat prevention begins at home, and in the buffet line,” or, “Big bones didn’t make me this way, big meals did.”

These types of images and captions may serve to increase shame and insecurity in children, placing undue blame on the children as well as the parents of overweight youngsters. In reality, it’s probably “hard to be a little girl” when you are exposed to images suggesting that your weight is all your fault (i.e., simply the result of overindulging), and that that your body weight determines your happiness. Research suggests that obesity is not so simple and is rather a complex interplay between biological and environmental influences. While the campaign may have been developed to motivate health behavior change, it may have inadvertently served to increase stigma and bias which research shows is not helpful, and is instead harmful for overweight and obese individuals. Ads like these may actually exacerbate the issue they hoped to remedy.

Why is weight stigma important? Counter to the popularly held belief that weight stigma can motivate individuals to lose weight, it may actually have the opposite effect, and may lead to other undesirable health outcomes. While research on this area is still in its infancy, researchers from the Yale Rudd Center for Food Policy and Obesity suggest that weight stigma may promote weight gain because it leads stigmatized individuals to withdraw or isolate themselves from social situations. This in turn can potentially exacerbate obesity via increased susceptibility to unhealthy coping mechanisms such as over-eating or seeking comfort in sedentary activity. Thus, weight based stigma could be contributing to the rise in the prevalence of obesity. Because weight stigma has been documented in health care settings, even among professionals specializing in the treatment of obesity, it is not surprising that many obese patients are reluctant to seek medical treatment. This suggests yet another way in which weight stigma impedes the improvement of the health of obese people.

Understanding and addressing weight stigma is essential because it negatively impacts vast numbers of American adults and children. Currently, the majority of adults in the United States are overweight, and the CDC estimates that over one-third of US adults are obese, along with approximately 17% of US children and adolescents. So whether or not you are overweight or obese, it’s likely that you interact with individuals that fall into either of these categories on a daily basis. It is also highly likely that you have a friend, a family member, or a loved one who is overweight or obese. As if the health concerns associated with obesity aren’t enough to deal with, overweight and obese individuals also have to face painful stereotypes, bias, and discrimination. And to make matters worse, this stigma may contribute to poorer health outcomes. No wonder obesity is also associated with increased likelihood of depression, suicide, and suicide attempts. If we can reduce weight stigma, perhaps we can improve the lives of great numbers of adults and children.

Why does weight stigma exist? A number of theories have attempted to explain weight stigma. Here is one example that has received empirical support in the weight stigma field:

Psychological attribution theory suggests that people try to figure out the cause of stigmatized conditions (e.g., obesity) and to use the information they gather to form opinions about the obese person. Some researchers have proposed that our social ideology uses negative attributions to explain negative life results. In other words, Americans tend to believe that people get what they deserve in life and are to blame for negative outcomes. Because being overweight and obese is thought to be controllable, those who fall into these categories are held completely responsible and are believed to be at fault for their excess weight. Therefore, at the crux of weight stigma and bias are perceptions of causality and controllability, and just world beliefs (i.e., blaming the victim). These attributions free individuals from experiencing guilt for prejudiced attitudes and discriminatory actions.

How can we reduce weight stigma? Clearly reducing weight stigma is no simple task. And again, research in this area is still very new. However, some strategies have achieved stigma reduction. 

Social consensus approaches have yielded the most promising results in the area of stigma reduction. Basically, social consensus theory asserts that stigma is a result of how one perceives the stigmatizing beliefs of others. So if you believe that your friends hold negative attitudes about overweight people, then you likely will also carry negative attitudes. This is exciting because it suggests that if we can change perceptions, we can change stigma. Studies have shown that stereotypes can be changed by manipulating participant perceptions of other people’s beliefs. The researchers at the Yale RUDD Center for Food Policy and Obesity have successfully decreased negative attitudes and increased positive attitudes toward obese people by providing individuals with consensus feedback indicating that others held more favorable beliefs about obese people. This feedback had a stronger influence if it came from an in-group member and was also as effective, or more effective, than educating participants about the uncontrollable causes of obesity, such as genetics and environmental influences.

In summary, weight stigma and bias affect vast numbers of Americans and can lead to negative mental and physical health outcomes for overweight and obese people. By changing our own attitudes and behaviors we can improve the lives of many individuals. This promising research suggests that simply endorsing positive attitudes towards overweight and obese individuals can have a strong impact on those around us.

More resources about how to reduce weight stigma and bias in your own life, and to promote size and weight acceptance, can be found at:

The Yale Rudd Center for Food Policy and Obesity: http://www.yaleruddcenter.org/what_we_do.aspx?id=10

Health at Every Size:

http://www.haescommunity.org/

Reference:

Puhl, R., & Brownell, K. (2003). Psychosocial origins of obesity stigma: toward changing a powerful and pervasive bias Obesity Reviews, 4 (4), 213-227 DOI: 10.1046/j.1467-789X.2003.00122.x

Aubrey Toole is a recent graduate of UC Berkeley and a soon-to-be graduate student in Emory University's clinical psychology doctoral program. At Emory, Aubrey looks forward to exploring mindfulness-based treatment approaches for disordered eating and weight concerns.