March 23, 2016

How Weight Stigma Hurts People of All Sizes - Dr. Ashley Solomon

young woman with girl

Ask most children today what they most fear being called on the playground, and they will quickly answer, “Fat.” In fact, being of a higher weight is the most common reason that kids today are bullied, far surpassing issues of race, gender, or sexual orientation.

Meanwhile, the adults in these children’s lives, saddled with our own weight stigma, don’t take these issues seriously enough. Most states’ anti-bullying laws don’t include weight-based bullying, which means that higher weight children are left without the same protections afforded to others.

This problem doesn’t stop at the schoolyard. Fat shaming and weight stigma affect adults in almost all realms of life. Higher weight adults are less likely to get a fair trial in court, less likely to be hired for a job for which they are equally qualified, and less likely to be accepted to college.

And sadly, weight stigma is all too prevalent in medical settings as well. Medical providers of all kinds – from nurses to clinicians to medical students to dietitians – all experience weight bias that can subtly and more directly impact their work. Perhaps the most unfortunate result of this issue is that higher-weight patients avoid medical facilities and treatment due to histories of discrimination in those settings.

Meanwhile, it’s important to recognize that weight stigma impacts individuals of all shapes, weights, and sizes.

In fact, a recent study by Major and colleagues (2014) showed that the effects of weight stigma are associated with one’s self-perception of their weight, not one’s actual weight. This means that someone who simply perceives themselves as overweight will experience the negative effects of the fear of discrimination, just like someone in the overweight or obese category.

Our weight-biased culture creates fear and anxiety regarding being outside of the accepted norm.

We know, of course, that many individuals’ natural body shape and size will not conform to the cultural ideal. In fact, if we look to the media and models for the cultural standard, almost no one will conform!

The fear of not conforming is ultimately the fear of not being accepted in our communities. There is almost no greater pain than feeling ostracized and not being part of the tribe.

So, for many individuals who struggle with eating disorders and maintain a fear of weight gain, there is an underlying anxiety of being rejected or even maligned. When we live in a culture where higher weights become incorrectly associated with attributes like “lazy,” “overindulgent,” and “unintelligent,” it makes sense why this fear exists.

I believe that we cannot rest our efforts at telling patients to ignore the culture. We can, instead, do the following:

  • Empower them with skills and tools to challenge these cultural messages
  • Support them in building their lives in accordance with their values — versus society’s values
  • Help them create their own communities that support their personal well-being

But we also have to address the weight stigma that perpetuates every corner of our culture. We need to support medical providers in getting training in weight bias awareness. We need to call out signs of size discrimination. We need to advocate for the depiction of body diversity in media.

And for providers and families, that includes examining our own weight bias and how that shows up in our various activities. Like other forms of bias, weight bias can be subtle, but powerful. We have to recognize that as members of our culture, we are not immune.
 

Ashley Solomon, PsyD, CEDS is the Executive Clinical Director at Eating Recovery Center, Ohio.

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