What is Weight Stigma?
A mom boasts about her daughter’s weight loss with a before and after image on Facebook: on the left is a junior high photo that emphasizes her daughter’s double chin; on the right is a recent college snapshot that highlights her now prominent jaw line. Thumbs up emojis and “Congrats to her!” comments fill the mom’s feed. While she may have meant no harm, both her post and others’ reactions to it perpetuate weight stigma, also known as weight bias.
“Commenting on someone’s body size and shape and appearance in the world reinforces the message that people are only as much as their body, and that they are being judged by how they appear in the world,” says Dr. Elizabeth Wassenaar, Regional Medical Director at Eating Recovery Center.
Our weight-biased culture can create fear and anxiety when outside of the perceived norm. The National Eating Disorder Association (NEDA) states that weight stigma is focused on shame, body hatred and judgment. Dr. Wassenaar adds, "It is an inescapable pressure from society that your body size and shape are not good enough and that you need to change it to be acceptable."
Weight Stigma and the Media
Before and after photos are a long-used advertising gimmick for weight loss and fitness programs. According to NEDA, however, attention given to weight control has skyrocketed in recent years, infusing words like "BMI," "obesity epidemic" and "diet" into our national vocabulary. The rise of national obesity prevention campaigns has led to a 66% increase in the incidence of weight stigma.
Marketing for weight loss products is overwhelmingly focused on personal responsibility for weight. "It is woven into the media as advertisement and advertisement’s job is to make you feel like something isn't good enough and that you need to buy something to fix it,” Dr. Wassenaar says. And a lot of people are buying. In 2019, diet and weight loss grew to a $78 billion industry. It slowed during the height of the pandemic in 2020 but is on the rise again.
“Media can be really the loudest voice that people hear about what people should look like,” says Dr. Wassenaar. Sitcom characters with obesity are less likely than their thinner counterparts to be judged as attractive and tend to have fewer interactions with friends or romantic partners. Children’s movies and books also send body image-related messages that associate beauty and success with thinness.
And then there are the digital images we hold in our hands, swiping left and right, up and down. In mere seconds, individuals can experience joy, jealousy, love and loathing by what is posted. Social media channels are fertile ground for weight stigma. During the pandemic, 53% of adolescents reported increased exposure to at least one form of weight stigmatizing social media content. All too often people feel justified when they target persons with obesity in memes and comments because of a belief that weight is something they can control -- but are choosing not to.
"It's so important for our society that we check ourselves around making comments on people's bodies,” says Dr. Wassenaar. She stressed the importance for adults, and children and adolescents raised in a social media-saturated environment, to recognize that they are more than just their external appearance.
Impacts of Weight Stigma
Victims of weight stigma report physicians and family members as the most common source of weight bias, more so than social influences. But no matter who is doing the shaming, there is a significant threat to psychological and physical health.
One study showed that individuals who perceive they have been discriminated against because of weight are roughly 2.5 times as likely to experience mood or anxiety disorders. The World Obesity Federation reports that in some cases, weight stigmatization is so severe that it has been directly associated with suicidal ideations and acts.
Because experiencing bias and stigma is a form of trauma, this can lead to an increase in overall inflammatory load and a higher risk of negative health outcomes. This ultimately increases the odds of all-cause mortality.
Poor Body Image
People who simply perceive themselves as overweight will experience the negative effects of the fear of discrimination, just like those in the overweight or obese category.
People with obesity may experience negative verbal commentaries, teasing or physical assault. On social media, derogatory remarks directed at individuals with a higher body weight are more socially acceptable than stigma directed toward other marginalized groups.
Seating and equipment in many places are not designed to accommodate people with obesity, including theaters, sports arenas, airlines, restaurants and even medical offices.
Weight Stigma and Healthcare
“Medicine does not acknowledge how impactful weight stigma has been on access to care,” says Dr. Wassenaar. Research into weight stigma has consistently shown that healthcare professionals are biased against people deemed as having overweight or obesity. This causes them to behave in discriminatory ways, such as blaming serious health issues on weight and sometimes ignoring other possible causes.
Patients who experience obesity bias from providers may cancel or delay appointments as well as avoid preventative health care and screenings. In a study regarding obesity stigma and bias, the percentage of women who reported having delayed seeking health care increased as the BMI increased. “Can you imagine going to a doctor and having them say their scale won't weigh you?” says Dr. Wassenaar. “These sorts of things make you never ever want to go back. It’s very, very traumatic.”
Providers could reduce weight stigma toward patients by acknowledging that some patients may have had negative experiences with other health professionals regarding their weight and approach all patients with sensitivity; recognizing the complex etiology of obesity and communicate this to colleagues and patients to avoid misconceptions that obesity is a matter of personal willpower; and creating a supportive environment with large, armless chairs in waiting rooms and appropriately sized medical equipment and patient gowns.
How Weight Stigma Can Lead to Eating Disorders
Weight stigma can increase body dissatisfaction, a leading risk factor in the development of eating disorders. “If you are in a body that you don't see represented on screen or in print then you might have a special vulnerability to feeling like you need to change your body to reflect what you see in media,” says Dr. Wassenaar. "For people who are vulnerable to dieting or working out, once they start that cycle of ‘if I change my body, I'll feel better,’ they get stuck in it and they can't actually get out of it, and that can influence eating disorders.”
Even body compliments such as “you look good” or “great job losing weight” can be a triggering experience that reinforces disordered eating and disordered body images. "It can trigger those old eating disordered thoughts that you have to have your body look a certain way in order to be acceptable and that your self-worth is really tied to how your body looks and how people perceive your body," she says.
Among family members, weight-based teasing and diet talk are linked to binge eating, weight gain and extreme weight control behaviors. Research has shown that overemphasizing weight can encourage disordered eating and have counterproductive effects.
Movements that Tackle Weight Stigma
"I think that we are in the midst of a real revolution around noticing and naming things that have previously been invisible,” says Dr. Wassenaar. “I think that weight stigma is one of those things. We're creating a space to recognize that people are worth much more than just a number on the scale or the size of their jeans.”
The Health at Every Size® (HAES®) Approach is a continuously evolving alternative to the weight-centered approach to treating clients and patients of all sizes. The movement also works to promote size acceptance, end weight discrimination and stigma and lessen the cultural obsession with weight loss and thinness.
A few other popular movements have risen alongside social media to help turn the tide of weight stigma. Body Positivity focuses on the acceptance of all bodies, regardless of size, shape, skin tone, gender and physical abilities, while challenging societal beauty standards. Body Neutrality fosters messaging that a person does not have to love everything about their body -- and that it is okay to feel neutral or indifferent.
Eating Recovery Center has numerous resources to help people affected by weight stigma, including the art-based program Love Your Tree. The program is focused on cultivating self-compassion, body acceptance and positive mental well-being through creativity, community connection and self-reflection.