Social stigma of obesity is broadly defined as
bias
Bias is a disproportionate weight ''in favor of'' or ''against'' an idea or thing, usually in a way that is closed-minded, prejudicial, or unfair. Biases can be innate or learned. People may develop biases for or against an individual, a group, ...
or
discriminatory
Discrimination is the act of making unjustified distinctions between people based on the groups, classes, or other categories to which they belong or are perceived to belong. People may be discriminated on the basis of race, gender, age, relig ...
behaviors targeted at overweight and obese individuals because of their weight.
Such
social stigma
Social stigma is the disapproval of, or discrimination against, an individual or group based on perceived characteristics that serve to distinguish them from other members of a society. Social stigmas are commonly related to culture, gender, rac ...
s can span one's entire life, as long as excess weight is present, starting from a young age and lasting into adulthood.
Several studies from across the world (e.g.,
United States
The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country primarily located in North America. It consists of 50 states, a federal district, five major unincorporated territorie ...
,
University of Marburg
The Philipps University of Marburg (german: Philipps-Universität Marburg) was founded in 1527 by Philip I, Landgrave of Hesse, which makes it one of Germany's oldest universities and the oldest still operating Protestant university in the wor ...
,
University of Leipzig
Leipzig University (german: Universität Leipzig), in Leipzig in Saxony, Germany, is one of the world's oldest universities and the second-oldest university (by consecutive years of existence) in Germany. The university was founded on 2 Decemb ...
) indicate
overweight
Being overweight or fat is having more body fat than is optimally healthy. Being overweight is especially common where food supplies are plentiful and lifestyles are sedentary.
, excess weight reached epidemic proportions globally, with mo ...
and
obese
Obesity is a medical condition, sometimes considered a disease, in which excess body fat has accumulated to such an extent that it may negatively affect health. People are classified as obese when their body mass index (BMI)—a person's we ...
individuals experience higher levels of stigma relative to their thinner counterparts. In addition, they marry less often, experience fewer educational and career opportunities, and on average earn a lesser income than
normal weight
Body mass index (BMI) is a value derived from the mass (weight) and height of a person. The BMI is defined as the body mass divided by the square of the body height, and is expressed in units of kg/m2, resulting from mass in kilograms and hei ...
individuals.
Although public support regarding disability services, civil rights, and anti-workplace discrimination laws for obese individuals have gained support across the years, overweight and obese individuals still experience discrimination, which may have detrimental implications in relation to both physiological
and psychological health. These issues are compounded by the significant negative physiological effects that are already associated with obesity,
which some have proposed may be caused by stress from the social stigma of obesity, rather than from obesity per se.
Anti-fat bias refers to
prejudicial
Prejudice can be an affective feeling towards a person based on their perceived group membership. The word is often used to refer to a preconceived (usually unfavourable) evaluation or classification of another person based on that person's per ...
assumptions that are based on an assessment of a person as being overweight or obese. It is also known as "fat shaming". Anti-fat bias can be found in many facets of society,
and
fat activists commonly blame popular media for the pervasiveness of this phenomenon.
Prevalence
Research indicates that self-reported incidents of weight-based
discrimination
Discrimination is the act of making unjustified distinctions between people based on the groups, classes, or other categories to which they belong or are perceived to belong. People may be discriminated on the basis of race, gender, age, relig ...
increased from 1995 to 2006. Individuals who are subjected to weight-related stigma appear to be rated more negatively when compared with other groups, such as
sexual minorities
A sexual minority is a group whose sexual identity, sexual orientation, orientation or practices differ from the majority of the surrounding society. Primarily used to refer to lesbian, gay, bisexual, or non-heterosexual individuals, it can als ...
and those with
mental illness
A mental disorder, also referred to as a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such features may be persistent, relapsing and remitti ...
.
Anti-fat bias has been observed in groups hoping to become physical education instructors. In a study published in 2007, a group of 344 psychology or
physical education
Physical education, often abbreviated to Phys Ed. or P.E., is a subject taught in schools around the world. It is usually taught during primary and secondary education, and encourages psychomotor learning by using a play and movement explorati ...
majors at a New Zealand University were compared, and it was found that the prospective physical education teachers were more likely to display implicit anti-fat attitudes than the psychology majors.
A number of studies have found that
health care providers
A health professional, healthcare professional, or healthcare worker (sometimes abbreviated HCW) is a provider of health care treatment and advice based on formal training and experience. The field includes those who work as a nurse, physician (suc ...
frequently have explicit and/or implicit biases against overweight people, and it has been found that overweight patients may receive lower quality care as a result of their weight. Medical professionals who
specialize in the treatment of obesity have been found to have strong negative associations toward obese individuals. The stress from obesity-related stigma may also cause negative health outcomes.
In one study,
preschool
A preschool, also known as nursery school, pre-primary school, or play school or creche, is an educational establishment or learning space offering early childhood education to children before they begin compulsory education at primary school ...
-aged children reported a preference for average-sized children over overweight children as friends. Overweight individuals often find themselves suffering repercussions in many facets of society, including legal and employment issues later in their life.
According to a 2010 review of published studies, interventions seeking to reduce prejudice and
social stigma
Social stigma is the disapproval of, or discrimination against, an individual or group based on perceived characteristics that serve to distinguish them from other members of a society. Social stigmas are commonly related to culture, gender, rac ...
against fat and
obesity
Obesity is a medical condition, sometimes considered a disease, in which excess body fat has accumulated to such an extent that it may negatively affect health. People are classified as obese when their body mass index (BMI)—a person's we ...
are largely ineffective.
Characteristics
Weight-related stigma can be characterized by the following aspects:
# An individual does not have to be overweight or obese to experience weight-related stigma.
# Studies have indicated that experiencing weight stigma reinforces lifestyle behaviors that contribute to obesity.
# Many groups who are subjected to stigmatisation tend to be minorities. Overweight and obese individuals make up the majority of the population in the United States and in other parts of the world.
# Individuals who are overweight or obese tend to devalue their own in-group and prefer the out-group (i.e. thinner individuals).
Theoretical explanations
In order to understand weight-biased attitudes, theories have been proposed to explain these biases and the subsequent discrimination they cause. Christian S. Crandall discusses the "Justification of Stigmatization". Also his Social Ideology Perspective draws on traditional North American values of self-determination, individualism, and self-discipline. Based on these values, anti-fat attitudes may derive from directing blame for being overweight towards individuals who are overweight.
Similarly, the
attribution theory
Attribution is a term used in psychology which deals with how individuals perceive the causes of everyday experience, as being either external or internal. Models to explain this process are called attribution theory. Psychological research into a ...
suggests that attitudes towards obese individuals are dependent on how much control they are perceived to have over their weight.
Throughout the literature, numerous studies have shown support for this theory. One study conducted a multinational examination of weight bias across four countries (Canada, United States, Iceland, and Australia) with comparable obesity rates. The study found that attributions of behavioral causes of obesity were associated with greater weight bias. Similarly, viewing obesity as being caused by a lack of willpower was also associated with greater weight bias. There appears to be a decrease in weight bias when weight is attributed to factors that are less within the individual's control, or when individuals are perceived as trying to lose weight. However, evidence also exists showing that biases against obese individuals also include disgust towards them, which can persist regardless of if one knows that obesity is not caused by obese individuals' actions.
Fatphobia is a socially constructed phenomenon of particular prevalence in the western world. Societies produce the sort of bodies they need. The west values healthy and strong bodies that prioritize agility, endurance and fertility - with focus on achievement and individual responsibility. Not only do such bodies associate the western world with similar ideals, but Lloyd deMause suggests the ‘fitness/toughness craze’ may also reflect preparations for war. The ’fattening huts’ of young girls in Nigeria however, represent beauty, marriageability and money – a direct reflection of the value of economic resource and food. Fatness is a welcome sign of health, prosperity and maternity - linked to self-worth and sexuality also.
Fatphobia does not fear ‘fat’ but prejudice, discrimination, exclusion and preventable disease too - fears directly attributable to the myriad of social, political, historical, economic and cultural processes at work (that do not similarly exist in other cultures). In this way, fatphobia is a culturally-derived phenomenon influencing relationships to food as well to the female form. Trends in ‘blame, shame and stigma' have contributed to fat positivity and ‘health at every size’ movements, that create digital ‘safe spaces’ for activism and radical fat acceptance that seek to resist/shift such powerful cultural perspectives.
Trait attribution
Anti-fat bias leads people to associate individuals who are overweight or obese with negative personality traits such as "lacking willpower", "lazy", "gluttonous", "stupid", "incompetent", or "unmotivated". This bias is not restricted to
clinically obese
Obesity is a medical condition, sometimes considered a disease, in which excess Adipose tissue, body fat has accumulated to such an extent that it may negatively affect health. People are classified as obese when their body mass index (BMI) ...
individuals. It also encompasses those whose
body shape
Human body shape is a complex phenomenon with sophisticated detail and function. The general shape or figure of a person is defined mainly by the molding of skeletal structures, as well as the distribution of muscles and fat. Skeletal structure ...
is found to be unacceptable when compared to modern society's perception of the ideal body type (although still within the normal or overweight
body mass index
Body mass index (BMI) is a value derived from the mass (weight) and height of a person. The BMI is defined as the body mass divided by the square of the body height, and is expressed in units of kg/m2, resulting from mass in kilograms and he ...
(BMI) range). Fat-shaming is fairly common in the United States, even though most adult Americans are overweight. ''Huffington Post'' wrote "two-thirds of American adults are overweight or obese. Yet
overweight
Being overweight or fat is having more body fat than is optimally healthy. Being overweight is especially common where food supplies are plentiful and lifestyles are sedentary.
, excess weight reached epidemic proportions globally, with mo ...
and obese individuals are subject to discrimination from employers, healthcare professionals, and potential romantic partners".
Anti-fat bias can be moderated by giving a mitigating context to the individual's appearance of obesity. For example, when told an individual was obese because of "
overeating
Overeating occurs when an individual consumes more calories in relation to the energy that is expended via physical activity or expelled via excretion, leading to weight gain and often obesity. Overeating is the defining characteristic of binge e ...
" and "
lack of exercise
Sedentary lifestyle is a lifestyle type, in which one is physically inactive and does little or no physical movement and or exercise. A person living a sedentary lifestyle is often sitting or lying down while engaged in an activity like socia ...
", a higher implicit bias was found among study participants than those not provided with context. When the group was told that "
genetics
Genetics is the study of genes, genetic variation, and heredity in organisms.Hartl D, Jones E (2005) It is an important branch in biology because heredity is vital to organisms' evolution. Gregor Mendel, a Moravian Augustinian friar wor ...
" was to blame, they did not exhibit a lowered implicit bias after the explanation.
Anti-fat bias is not a strictly Western cultural phenomenon. Instances of implicit anti-fat bias have been found across several cultures.
Additionally, recent work around physical appearance issues,
body image
Body image is a person's thoughts, feelings and perception of the aesthetics or sexual attractiveness of their own body. The concept of body image is used in a number of disciplines, including neuroscience, psychology, medicine, psychiatry, ps ...
, and anti-fat or obesity prejudice suggests that feelings about one's own appearance may stimulate downward physical comparisons with obese individuals in order to make one feel better about one's own physical appearance.
Weight discrimination
Weight stigma is present in multiple settings including healthcare, education, interpersonal situations, multiple media forms and outlets, and across many levels of employment.
In the media
Media, in general, overrepresents underweight individuals and underrepresents overweight individuals. One-third of women in television are classified as underweight, while only 5% of the general population falls into that category.
Conversely, a study on over a thousand major television characters from 2003 identified 14% of female characters and 24% of male characters to be overweight, despite the real-world percentages being more than double those reported numbers.
Even when overweight people are included in television, they often play minor, stereotyped roles. Nearly two thirds of the most popular children's movies contain negative portrayals of fat people, stereotyping them to be unintelligent, lazy, and evil.
Fat television characters are more commonly seen eating and are less likely to be involved in romantic relationships compared to average weight television characters.
Male characters are less commonly portrayed as having close friendships.
In 2007, another analysis sampled 135 scenes featuring overweight individuals from popular television programs and movies and coded for anti-fat humor. The majority of anti-fat humor found was verbal and directed at the individual in their presence.
Additionally, a relationship was found between audience laughter and a male character poking fun at a female character's body, but that same relationship wasn't there when it was a female character ridiculing a fat male.
There is a great deal of empirical research to support the idea of
Thin Ideal
The thin ideal is the concept of the ideally slim female body. The common perception of this ideal is a woman who possesses a slender, feminine physique with a small waist and little body fat. The size that the thin ideal woman should be is decrea ...
media, or the idea that the media tends to glorify and focus on thin actors and actresses, models, and other public figures while avoiding the use of overweight individuals.
Puhl et al. (2009) also reviewed how in entertainment, news reporting, and advertising, media is a particularly potent source of weight stigma. News reports have blamed individuals who are overweight and obese for various societal issues including prices of fuel, global temperature trends, and precipitating weight gain among their peers.
The news media repeatedly engages in the "Headless Fatties" phenomenon, coined by
Charlotte Cooper Charlotte Cooper may refer to:
* Charlotte Cooper (author) (born 1968), British author and LGBT activist
* Charlotte Cooper (tennis) (1870–1966), British tennis player
* Charlotte Cooper-Andrade, wife of Vernon Andrade
* Charlotte Cooper (born 19 ...
, in which images and videos only depict overweight individuals as bodies by cropping out their heads. This objectification happens in 72% of all news reports on obesity.
The
University of California, Los Angeles
The University of California, Los Angeles (UCLA) is a public land-grant research university in Los Angeles, California. UCLA's academic roots were established in 1881 as a teachers college then known as the southern branch of the California St ...
, conducted a study that analyzed scientific research on weight and the news reports on such research. They looked for disparities in language, the cited causes of obesity, and proposed solution. News stories were more likely than the scientific articles to dramatized language, words such as epidemic, crisis, war, and terrorism, and were more likely to cite individual behaviors as the causes and solutions to obesity, ignoring the systemic issues.
On September 29, 2011, prominent nationally syndicated columnist
Michael Kinsley
Michael E. Kinsley (born March 9, 1951) is an American political journalist and commentator. Primarily active in print media as both a writer and editor, he also became known to television audiences as a co-host on ''Crossfire''.
Early life and e ...
(founding editor of ''Slate'' magazine) wrote, "New Jersey Governor Chris Christie cannot be president: He is just too fat ... why should Christie's weight be more than we can bear in a president? Why should it even be a legitimate issue if he runs? One reason is that a presidential candidate should be judged on behavior and character ... Perhaps Christie is the one to help us get our national appetites under control. But it would help if he got his own under control first."
Governor Christie responded on October 4, 2011, stating "The people who pretend to be serious commentators who wrote about this are among the most ignorant I've ever heard in my life. To say that, because you're overweight, you are therefore undisciplined—you know, I don't think undisciplined people get to achieve great positions in our society, so that kind of stuff is just ignorant."
In 2013,
Haley Morris-Cafiero
Haley Morris-Cafiero (born 1976) is an American photographer, Associate Professor of Photography and Acting Vice President of Academic Affairs at the Memphis College of Art. Her series "Wait Watchers", in which she photographs the reactions of ...
's photography project "Wait Watchers", in which she photographed the reactions to her presence by random passers-by, went viral. ''New York'' magazine wrote, "The frequency with which Morris-Cafiero succeeds at documenting passersby's visible disdain for her body seems pretty depressing".
There is also evidence that especially young adults and adolescents experience weight stigma on social media. For example, a study suggests that adolescent patients with obesity experience derogatory comments about weight and visual self-presentation in their online social networks. The study found that this was particularly evident among girls and that they avoided sharing weight-related images on social media (such as close-up images of their bodies or pictures of food that they perceive as "unhealthy" or "fattening").
In education
In regards to more direct weight bias, obese individuals were 40–50% more likely to report a perception of major discrimination compared to those of average weight across a multitude of settings.
In the educational setting, those who are overweight as youth often face peer rejection and are bullied more. Overweight children have poorer school performance if they experience weight-based teasing. Between fifth and eighth grade, a child's increase in BMI results in a decrease in their teacher's perception of that student's ability,
and 50% of principals believe fatness is just a result of lacking self control.
Teachers, particularly those teaching physical education classes, sometimes express negative attitudes towards overweight individuals.
Research suggests that within the classroom teachers may perceive overweight individuals' work more poorly compared to average weight individuals.
Students also perceive overweight individuals as being likely to have lower GPAs, and students are less likely to want to do groupwork with overweight individuals compared to average weight individuals. Research has also found that overweight females receive less financial support for education from their families than average weight females, after controlling for ethnicity, family size, income, and education.
As individuals grow older they may be less likely to be admitted to college than individuals of an average weight, and in some cases, people were admitted to academic institutions then dismissed due to their weight.
Puhl and colleagues (2009) concluded from their review of weight stigma in education that current trends indicate students with obesity face barriers to educational success at every level of education.
Reviewed research demonstrates that educators, particularly physical education teachers, report antifat attitudes toward their students with obesity, which may undermine educational achievement.
Importantly, the education disparities for students with obesity appear to be strongest for students attending schools where obesity is not the norm. Several studies have evidenced that in environments such as these, students with obesity face greater educational disadvantages and are less likely to attend college, an effect that is particularly strong among women.
Moreover, weight stigma in educational settings also affects interpersonal relationships (see "Interpersonal situations" below).
In employment
Studies suggest that obese individuals are less likely to be hired and once hired, have greater termination rates than average weight individuals.
Specifically, a national survey found that obese individuals were 26% more likely not to be hired, not receive a promotion, or to be fired compared to average weight persons.
Such outcomes may be a result of employers viewing them as less agreeable, less competent and lazier than average weight individuals.
Weight stigma can lead to difficulty obtaining a job, worse job placement, lower wages and compensation, unjustified denial of promotions, harsher discipline, unfair job termination, and commonplace derogatory jokes and comments from coworkers and supervisors.
In their review, Rebecca M. Puhl et al. find that employees with obesity report their weight as the most influential factor contributing to losing their job.
Another review by Giel and colleagues (2010) found that certain stereotypes about employees with obesity are highly endorsed by employers and supervisors, in particular that they have poorer job performance and that they lack interpersonal skills, motivation, and self-control.
In politics
![Chris Christie by Gage Skidmore 5](https://upload.wikimedia.org/wikipedia/commons/a/a8/Chris_Christie_by_Gage_Skidmore_5.jpg)
A study by
Michigan State University
Michigan State University (Michigan State, MSU) is a public university, public Land-grant university, land-grant research university in East Lansing, Michigan. It was founded in 1855 as the Agricultural College of the State of Michigan, the fi ...
researchers shows evidence that overweight political candidates tend to receive fewer votes than their thinner opponents. The researchers analyzed data from the 2008 and 2012 U.S. Senate elections. Using a previously established scientific method, research assistants determined from color photos whether the candidates in 126 primary and general elections were of normal weight, overweight, or obese.
Both obese men and women were often less likely to get on the ballot in the first place. When it came to merely being overweight, women were seen underrepresented on the ballot, though men were not. This is consistent with previous research showing slightly overweight men tend not to experience the same discrimination as slightly overweight women.
However, when it came to the voting, both male and female candidates, whether obese or simply overweight, tend to get a lower share of the vote total than their more slender opponents. Some politicians have resorted to extreme weight loss measures, including surgery, to increase their elect-ability to political office.
In healthcare
Medical professionals may be more likely to view obese individuals in negative terms (such as annoying or undisciplined), have less patience with obese individuals, and assume non-compliance with their treatments. As such, these individuals may receive poorer care compared to average weight people. Doctors have reported less intervention and an avoidance of weight-related discussion with obese patients. Additionally, nurses have reported a reluctance to touch obese persons during treatment.
A national survey of the United States found that individuals who were overweight reported a three times higher likelihood to be denied medical care than average weight people.
In the UK, 25 out of 91 primary care trusts have bans for the treatment of obese individuals in addition to weight loss requirements.
Additionally, a 2012 survey revealed that 54% of doctor respondents believe the National Health Service should have the ability to withhold non-emergency treatment from obese individuals.
Further, health professionals who specialize in obesity showed strong implicit and explicit anti-fat bias as measured by self-report and the
Implicit Associations Test (IAT). However, such biases were mixed amongst dietitians and nutritionists.
In their 2009 review, Puhl and colleagues found that many studies provide evidence supporting the notion that health professionals (including doctors, nurses, medical students, fitness professional, and dietitians) consistently endorse negative stereotypes about patients with obesity, in particular ascribing to them culpability for their weight status.
Weight stigma in the healthcare settings leads to impaired patient-provider communication, poorer doctor-patient relationships, poorer medical care and treatment (for example doctors spending less time with patients), and avoidance of the healthcare system all together on the part of the patient.
However, it is important to point out that the evidence that has been reviewed thus far comes primarily from self-report studies. Therefore, Puhl and colleagues concluded that research examining actual health outcomes is needed.
Overall, the impact of weight stigma in healthcare has become so problematic that many scholars have suggested that obesity-prevention programs should make minimizing stigma a priority.
Interpersonal situations
Although a less studied topic than employment and healthcare, several studies reviewed by Puhl and colleagues (2009) provide evidence that overweight and obese women in particular face weight stigma from many interpersonal sources including family, friends, and romantic partners.
Another recent review by Puhl and Suh (2015) also documented that in school settings weight-based bullying is one of the most prevalent types of harassment reported by parents, teachers, and students.
Experiencing interpersonal weight stigma is related to myriad negative physical and mental health consequences (see "
Mental health and psychological consequences" below).
In a 2017 study, results showed that 89% of obese adults had been bullied by romantic partners.
In early development
This external stigmatization and its internalized effects have been examined across different age groups. Overweight and obese children and adolescents experience stigmatization from parents, teachers, and peers.
Peer stigmatization, especially, may be difficult for overweight adolescents considering the role of peer support in promoting identity development and self-esteem.
Some research suggests that negative attitudes about being overweight are even held by overweight and obese children themselves. Specifically, weight bias may become internalized and increases throughout childhood. It then decreases and levels-off during late adolescence and adulthood.
Weight-based teasing in childhood and adolescence has been associated with a variety of damages to psychosocial health, including reduced
self-esteem
Self-esteem is confidence in one's own worth or abilities. Self-esteem encompasses beliefs about oneself (for example, "I am loved", "I am worthy") as well as emotional states, such as triumph, despair, pride, and shame. Smith and Mackie (2007) d ...
and lower
self-concept
In the psychology of self, one's self-concept (also called self-construction, self-identity, self-perspective or self-structure) is a collection of beliefs about oneself. Generally, self-concept embodies the answer to the question ''"Who am I? ...
,
higher rates of
depression and
anxiety disorder
Anxiety disorders are a cluster of mental disorders characterized by significant and uncontrollable feelings of anxiety and fear such that a person's social, occupational, and personal function are significantly impaired. Anxiety may cause physi ...
s, and even greater likelihood of entertaining suicidal thoughts.
Further, weight-based teasing has been associated with higher rates of
binge eating
Binge eating is a pattern of disordered eating which consists of episodes of uncontrollable eating. It is a common symptom of eating disorders such as binge eating disorder and bulimia nervosa. During such binges, a person rapidly consumes an exc ...
and unhealthy weight control (e.g., fasting, self-induced vomiting, laxatives, diet pills, skipped meals and smoking).
Overweight adolescents who were bullied were also more likely to meet criteria for bulimia.
A survey of 7,266 children aged 11 to 16 conducted by the
World Health Organization
The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of h ...
reported higher rates of physical victimization (e.g., being shoved) with increasing
body mass index
Body mass index (BMI) is a value derived from the mass (weight) and height of a person. The BMI is defined as the body mass divided by the square of the body height, and is expressed in units of kg/m2, resulting from mass in kilograms and he ...
(BMI) among girls. Additionally, these results showed relational victimization (i.e., being excluded or having rumors spread about you) was reported more often at increasing BMI by both girls and boys.
A separate survey of 7,825 students aged 11 to 17 also noted that, compared to average-weight peers, obese boys and overweight girls were more likely to be victims of bullying. Additionally, obese girls were more likely to be victims and perpetrators of bullying than their peers. Notably, overweight and obese adolescent girls also reported higher rates of smoking, drinking, and marijuana use relative to their normal-weight peers.
Health-related outcomes associated with weight discrimination
In adulthood, individuals who experience weight discrimination are more likely to identify themselves as overweight regardless of their actual weight status.
The experience of weight stigma can function as motivation to avoid stigmatizing environments, and although it may motivate one to escape stigma through weight loss, it undermines one's capacity to do so.
Researchers have linked weight stigma to decreases in physical activity,
decreases in seeking health care
and increases in maladaptive eating patterns such as binge eating.
In addition, those who have experienced weight stigma have shown altered cardiovascular reactivity, increased cortisol level, oxidative stress, and inflammation.
People who expect to be fat-shamed by healthcare providers are less likely to seek care for medical issues or for weight loss, even if the weight gain is caused by medical problems.
In terms of psychological health, researchers found that obese individuals demonstrated a lower sense of well-being relative to non-obese individuals if they had perceived weight stigmatization even after controlling for other demographic factors such as age and sex. Overweight and obese individuals report experiencing forms of internalized stigma such as body dissatisfaction as well as decreased social support and feelings of loneliness.
In addition, similar to findings in adolescence, weight stigma in adulthood is associated with lower self-esteem, higher rates of depression, anxiety, and substance abuse.
In both adults and children with obesity, several reviews of the literature have found that across a variety of studies, there is a consistent relationship between experiencing weight stigma and many negative mental and physical health outcomes.
These will be discussed separately in the sections below, although physical and mental health consequences are often intertwined, in particular those related to eating disorders.
Papadopoulos and Brennan (2015) recently found that across many reviewed studies of weight loss treatment-seeking adults,
relationships emerged between experiencing weight stigma and both BMI and difficulty losing weight. However the findings are somewhat mixed. They also report evidence that experiencing weight stigma is related to poor medication adherence. Among weight loss treatment-seeking adults, experiencing weight stigma might exacerbate weight- and health-related quality of life issues.
This review along with reviews by Vartanian and Smyth (2013) and Puhl and Suh (2015) have also found that across several studies and in both adults and children, experiencing weight stigma is related to decreased exercise behavior overall, as well as decreased motivation to exercise, decreased exercise
self-efficacy
In psychology, self-efficacy is an individual's belief in their capacity to act in the ways necessary to reach specific goals. The concept was originally proposed by the psychologist Albert Bandura.
Self-efficacy affects every area of human endea ...
, and increased food craving and tendency to overeat.
It is important to note that these effects of weight stigma on exercise and physical activity emerge independent of body mass index, suggesting that weight stigma becomes a unique barrier to physical activity outside of barriers that may be associated with obesity in particular. Finally, across many studies, Puhl and Suh (2015) also found that experiencing weight stigma is related to many physiological consequences as well, including increased
blood pressure
Blood pressure (BP) is the pressure of circulating blood against the walls of blood vessels. Most of this pressure results from the heart pumping blood through the circulatory system. When used without qualification, the term "blood pressure" r ...
, augmented
cortisol
Cortisol is a steroid hormone, in the glucocorticoid class of hormones. When used as a medication, it is known as hydrocortisone.
It is produced in many animals, mainly by the ''zona fasciculata'' of the adrenal cortex in the adrenal gland ...
reactivity, elevated
oxidative stress
Oxidative stress reflects an imbalance between the systemic manifestation of reactive oxygen species and a biological system's ability to readily Detoxification, detoxify the reactive intermediates or to repair the resulting damage. Disturbances ...
, impaired glycemic control/elevated
HbA1c, and increased systemic
inflammation
Inflammation (from la, wikt:en:inflammatio#Latin, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or Irritation, irritants, and is a protective response involving im ...
,
all of which have notable consequences for physical health and disease.
Mental health and psychological consequences
Broadly speaking, experiencing weight stigma is associated with psychological distress. There are many negative effects connected to anti-fat bias, the most prominent being that societal bias against fat is ineffective at treating obesity, and leads to long-lasting body image issues, eating disorders, suicide, and depression.
Papadopoulos's 2015 review of the literature found that across several studies, this distress can manifest in
anxiety
Anxiety is an emotion which is characterized by an unpleasant state of inner turmoil and includes feelings of dread over anticipated events. Anxiety is different than fear in that the former is defined as the anticipation of a future threat wh ...
,
depression, lowered
self-esteem
Self-esteem is confidence in one's own worth or abilities. Self-esteem encompasses beliefs about oneself (for example, "I am loved", "I am worthy") as well as emotional states, such as triumph, despair, pride, and shame. Smith and Mackie (2007) d ...
, and
substance use disorder
Substance use disorder (SUD) is the persistent use of drugs (including alcohol) despite substantial harm and adverse consequences as a result of their use. Substance use disorders are characterized by an array of mental/emotional, physical, and ...
s, both in weight loss treatment-seeking individuals as well as community samples.
Many empirical reviews have found that weight stigma has clear consequences for individuals suffering from eating and weight disorders (including
anorexia nervosa
Anorexia nervosa, often referred to simply as anorexia, is an eating disorder characterized by low weight, food restriction, body image disturbance, fear of gaining weight, and an overpowering desire to be thin. ''Anorexia'' is a term of Gr ...
,
bulimia nervosa
Bulimia nervosa, also known as simply bulimia, is an eating disorder characterized by binge eating followed by purging or fasting, and excessive concern with body shape and weight. The aim of this activity is to expel the body of calories eate ...
, and
binge eating disorder
Binge eating disorder (BED) is an eating disorder characterized by frequent and recurrent binge eating episodes with associated negative psychological and social problems, but without the compensatory behaviors common to bulimia nervosa, OSFED, o ...
), as it plays a unique role, over and above other risk factors, in perpetuating disordered eating psychopathology.
These results have emerged in both adult and adolescent, as well as in male and female samples.
Policy
Over the past few decades, many scholars have identified weight stigma as a long-standing form of social stigma and one of the last remaining socially acceptable forms of prejudice.
It follows then that individuals who are targets because of overweight and obesity, still face uniquely socially acceptable discrimination. Civil rights legislation such as
Title VII of the Civil Rights Act of 1964
The Civil Rights Act of 1964 () is a landmark civil rights and labor law in the United States that outlaws discrimination based on race, color, religion, sex, and national origin. It prohibits unequal application of voter registration requir ...
prohibits discrimination based on race and several other domains, but weight is not included in this act. At the local level, only one state in the US (
Michigan
Michigan () is a state in the Great Lakes region of the upper Midwestern United States. With a population of nearly 10.12 million and an area of nearly , Michigan is the 10th-largest state by population, the 11th-largest by area, and the ...
) has policy in place for prohibiting weight-related employment discrimination and very few local municipalities have human rights ordinances in place to protect individuals of large body size.
Typically, the only type legislation that overweight and obese individuals can cite in lawsuits is related to disability. For example, the
Americans with Disabilities Act
The Americans with Disabilities Act of 1990 or ADA () is a civil rights law that prohibits discrimination based on disability. It affords similar protections against discrimination to Americans with disabilities as the Civil Rights Act of 1964 ...
is one such avenue, but as Puhl et al. (2009) report, it is difficult for many individuals with obesity to qualify as disabled according to the criteria included in this statute.
Public health
The existing literature largely does not support the notion that weight stigma might encourage weight loss; as cited above, experiencing weight stigma (both interpersonally as well as exposure to stigmatizing media campaigns) is consistently related to a lack of motivation to exercise and a propensity to overeat.
In a 2010 review examining whether weight stigma is an appropriate public health tool for treating and preventing overweight and obesity, Puhl and Heuer concluded that stigmatizing individuals with obesity is detrimental in three important ways: (1) it threatens actual physical health, (2) it perpetuates health disparities, and (3) it actually undermines obesity treatment and intervention initiatives.
In line with this, another recent review of the consequences of experiencing weight stigma, this one conducted by Puhl and Suh (2015), concluded that considering the myriad negative physical and mental health consequences associated with experiencing weight stigma, it should be a target, instead of a tool, in obesity prevention and treatment.
These authors further recommend that a necessary first step in reducing weight stigma is raising broader awareness of its negative consequences.
Race intersection
With higher representation of black people being categorized as overweight by the BMI, the social stigma of obesity disproportionately affects black people. More than 80% of African American women are categorized as overweight using the Body Mass Index. Yet, the BMI was created based on a group of European men and cutoffs have been altered in the US in a non-scientifically verified way, with no distinguishing between appropriate cutoffs for different races.
Sociologist Sabrina Strings writes, in her book ''Fearing the Black Body'', about the historical ways in which fatphobia emerged out of an attempt by white people to distance themselves from black people. In 1751,
Denis Diderot
Denis Diderot (; ; 5 October 171331 July 1784) was a French philosopher, art critic, and writer, best known for serving as co-founder, chief editor, and contributor to the ''Encyclopédie'' along with Jean le Rond d'Alembert. He was a promine ...
published the ''Encyclopédie'', which was the first publications to claim that black people were "fond of gluttony." In 1853, French aristocrat
Arthur de Gobineau
Joseph Arthur de Gobineau (; 14 July 1816 – 13 October 1882) was a French aristocrat who is best known for helping to legitimise racism by the use of scientific racist theory and "racial demography", and for developing the theory of the Aryan ...
claimed, about black people, that their "gluttonous nature to be one of their more base characteristics."
In 1910,
Charles Davenport
Charles Benedict Davenport (June 1, 1866 – February 18, 1944) was a biologist and eugenics, eugenicist influential in the Eugenics in the United States, American eugenics movement.
Early life and education
Davenport was born in Stamford, Co ...
founded the
Eugenic Record Office, and he claimed that "obesity was a vile condition to be avoided. It was, moreover, racially inherited."
Eugenics
Eugenics ( ; ) is a fringe set of beliefs and practices that aim to improve the genetic quality of a human population. Historically, eugenicists have attempted to alter human gene pools by excluding people and groups judged to be inferior or ...
sentiment toward black people regarding their size was prevalent.
Body standards differ between black and white communities, but whiteness, and therefore thinness, is seen as the cultural norm. Scholar Elizabeth Hughes discusses this in "I'm Supposed to be Thick:" Managing Body Anxieties Among Black American Women," citing the norm of a "thick" body type, in other words curvier bodies, in the black community.
Black bodies are already stigmatized, which can result in violence when interacting with the social stigma of obesity. In a 2017 article published in the
African American Review
''African American Review'' (''AAR'') is a scholarly aggregation of essays on African-American literature, theatre, film, the visual arts, and culture; interviews; poetry; fiction; and book reviews.
The journal has featured writers and cultural c ...
, one author cited the killing of
Eric Garner
On July 17, 2014, Eric Garner was killed in the New York City borough of Staten Island after Daniel Pantaleo, a New York City Police Department (NYPD) officer, put him in a prohibited chokehold while arresting him. Video footage of the inciden ...
as an example of this, as some excuses for using excessive force on Garner were his size, as he was an overweight man. The article explains how
ableism
Ableism (; also known as ablism, disablism (British English), anapirophobia, anapirism, and disability discrimination) is discrimination and social prejudice against people with Disability, disabilities or who are perceived to be disabled. Ableis ...
, fatphobia, and racism interact to form a "double bind" in which violence is excused because fatness is already causing inherent injury, but necessary because the size of a large black person is a threat.
A paper published by the
American Journal of Preventive Medicine
The ''American Journal of Preventive Medicine'' is a monthly peer-reviewed medical journal that publishes articles (in-print and online) in the areas of prevention research, teaching, practice and policy. Original research is published on intervent ...
titled “Intersectionality: An Understudied Framework for Addressing Weight Stigma” focused on highlighting the intersectionality between weight stigma and health-related coping responses across several non-white racial and gendered groups. The findings of this publication demonstrated that there were no significant differences in weight stigma as a function of race or gender, having an overall equal representation across all racial groups analyzed. Nonetheless, results additionally demonstrated that different racial groups had differing ways of internalizing and coping with weight and health-related stigmas, which as a result heightened health risks. Results revealed that white women and men reported higher weight bias internalization in comparison to black women and men. Additionally, Hispanic women demonstrated to cope with weight stigma via disordered eating patterns more than black and white women. The results of this research article highlighted the importance of needing to increase research and policy attention to addressing weight and health-related stigma as an issue regarding prevention and treatment for obesity in order to consequently decrease weight-driven inequalities in communities and differing groups, primarily focused on race and gender.
Language and identity
Preference regarding language varies widely amongst overweight individuals, though there is some consensus on generally unaccepted terms.
Person first language is not ubiquitous among
fat acceptance movement
The fat acceptance movement, also known as fat pride, fat empowerment, and fat activism, is a social movement which seeks to eliminate the social stigma of fatness from social attitudes by pointing out the social obstacles which are faced by ...
s, and in fact people view it as an “inherent adverse judgment.” Those who promote person-first language, i.e. using terminology such as a person with obesity, seem to have done so without consultation in fat activist groups.
Critics of person-first language cite problems with the desire to separate a person from that characteristic, as separating it implies that there is something wrong with being overweight, which contributes to further stigma.
Furthermore, person-first language contributes to the
medicalization
Medicalization is the process by which human conditions and problems come to be defined and treated as medical conditions, and thus become the subject of medical study, diagnosis, prevention, or treatment. Medicalization can be driven by new evid ...
of obesity, as the language is commonly used when referring to disease.
The term "fat" appears to result in more stigma and judgement from the broader community. Various studies of overweight people seeking
weight loss
Weight loss, in the context of medicine, health, or physical fitness, refers to a reduction of the total body mass, by a mean loss of fluid, body fat (adipose tissue), or lean mass (namely bone mineral deposits, muscle, tendon, and other conn ...
as well as a semantics study of varied terminology used to describe an overweight individual conclude that using the word fat elicits a negative reaction from people already critical of obesity. Regarding other terms, "
obesity
Obesity is a medical condition, sometimes considered a disease, in which excess body fat has accumulated to such an extent that it may negatively affect health. People are classified as obese when their body mass index (BMI)—a person's we ...
" was found in one study to be equally as undesirable as "fat" when considering language preferences of overweight individuals.
Yet, "fat" is the preferred term within the fat acceptance movement. Fat activists have reclaimed the term as a neutral descriptor in order to work against the stigma typically associated with the term.
In fact, many fat activists will censor the word "obesity" when tweeting or citing it as "ob*sity" due to its pathologizing nature. The word "obesity" directly stems from the latin word "obesus" which means "that has eaten itself fat".
Fat activists will also use this latin definition to show stigma in the word "obese" itself, as it places blame on the individual for their state.
Fat activist
Aubrey Gordon argues that "disavowing the term fat reinforces its negative meanings."
Although studies have not been conducted among fat activists on preferred terminology, books such as ''What We Don't Talk About When We Talk About Fat, Happy Fat,'' ''Things No One Tells Fat Girls,'' and ''Fat! So?'' all have the word Fat in the title in a non-derogatory sense. Likewise, The
National Association to Advance Fat Acceptance
The National Association to Advance Fat Acceptance (NAAFA) is a non-profit, fat acceptance civil-rights organization in the United States dedicated to improving the quality of life for fat people. . NAAFA works to eliminate discrimination base ...
(NAAFA) was founded in 1969, with the descriptor of the community being "fat."
See also
*
Fat acceptance movement
The fat acceptance movement, also known as fat pride, fat empowerment, and fat activism, is a social movement which seeks to eliminate the social stigma of fatness from social attitudes by pointing out the social obstacles which are faced by ...
* ''
Fattitude
''Fattitude'' is a documentary film by Lindsey Averill and Viridiana Lieberman. The movie is about fat discrimination and its main objective is to make the general public more aware of the prejudice that fat people experience. The movie propagates ...
''—2017 documentary on fat discrimination
*
Height discrimination
Height discrimination (also known as heightism) is prejudice or discrimination against individuals based on height. In principle, it refers to the discriminatory treatment against individuals whose height is not within the normal acceptable range ...
*
Reddit anti-fat communities
*
Sizeism
Sizeism or size discrimination is prejudice directed at people based on their size.
Discrimination
This type of discrimination can take a number of forms, ranging from refusing to hire someone because they are considered to be too short or too ...
References
Further reading
*
{{Discrimination
Obesity
Obesity
Obesity is a medical condition, sometimes considered a disease, in which excess body fat has accumulated to such an extent that it may negatively affect health. People are classified as obese when their body mass index (BMI)—a person's we ...
Stereotypes