What is Weight Bias?

Weight bias refers to negative beliefs and attitudes about a person due to their weight.

Bias against people living with obesity can be subtle or obvious, and can occur verbally and physically.

What is Weight Bias?

Weight bias refers to negative beliefs and attitudes about a person due to their weight.

Example: Negative beliefs that people with obesity are lazy, unmotivated, less intelligent, and lacking willpower.

Bias against people living with obesity can be subtle or obvious, and can occur verbally and physically.

Open/Explicit Bias: Open (overt) negative attitudes towards people with obesity can include judgmental comments and words such as: “you are fat and lazy” or “you are fat and unhealthy” or “you are morbidly obese”.

Unconscious/Implicit Bias: Believing that controlling your weight is simple and that people should take responsibility for their own weight and health, that obesity is a personal lifestyle choice, or that obesity treatments are unnecessary and ineffective.

Self-Bias/Internalized Bias: Thinking that obesity is our own fault. Feeling anxious about our weight, that we are less capable than others because we have excess weight or obesity, or that the disrespectful or unfair treatment from others is deserved because we should be able to manage our own weight.

Biased/Stigmatizing Practices: Harmful social stereotypes about people with obesity can lead to stigmatizing actions. For example, healthcare professionals may not refer patients with obesity to evidence-based obesity treatment programs because they believe that patients with obesity will not adhere to treatments (because they believe people with obesity are unmotivated and lack willpower).

Discriminatory Experiences: Weight bias can result in discrimination, which is the unfair treatment of people because of their weight. For example, when healthcare providers deny healthcare services to patients because of their weight (e.g., denial of fertility treatment or cancer screening tests).

Why does weight bias matter to people living with obesity?

Individuals with obesity from all walks of life face weight bias in all corners of society, such as healthcare, education, employment, in the media, within families, and in public spaces.

  • 71% of adolescents reported being bullied about their weight in the past year, and more than one-third indicated that the bullying had lasted for >5 years
  • 66% of adults in a weight management program reported experiencing weight stigma from doctors across Australia, Canada, France, Germany, UK and USA
  • 54% of women reported weight stigma from their coworkers and 25% reported experiencing job discrimination because of their weight

Living with Multiple Stigmas

Current research tells us that multiple social identities can interact with one another and influence our experiences with stigma. Weight stigma can intersect with gender, race, disability, sexual orientation, and socioeconomic status – and the effect of being stigmatized snowballs with each label that is applied to you. 

Consequences of Weight Bias

  • It is important to know that some healthcare professionals hold biased beliefs and attitudes about obesity, and this can lead to stigmatizing clinical interactions, practices, and decision-making with individuals who have obesity.
  • Experiencing weight stigma can impact health and wellbeing, independently of weight or BMI. Here’s how:
    • Weight stigma causes psychological stress that produces chemical, physical, mental and behavioral changes that can increase risk for diabetes and obesity.
      • Examples include cortisol release, which can cause weight gain, diabetes, hypertension and other problems; reward sensitization, which increases cravings and reduces the sensation of feeling full or satisfied; decreases in the ability to plan and set goals, focus, and maintain self-care strategies; and can lead to unhealthy behaviours such as avoiding healthcare professionals or health services such as medical screening tests.
    • Experiencing weight stigma can increase your risk for mental health outcomes such as internalising weight stigma (blaming yourself), depression and anxiety, unhealthy stress management and coping mechanisms, and body image dissatisfaction.
    • Weight bias can impact the quality of health care services individuals with obesity receive (e.g. healthcare professionals spend less time), as well being a barrier to accessing healthcare services (e.g. decreased screening for diseases such as breast cancer).
  • Experiencing weight stigma can also impact education (e.g. lower expectations by teachers can lead to fewer learning opportunities resulting in poor education outcomes) and employment outcomes (e.g. lower wages and fewer promotions).
  • Weight discrimination and internalized weight bias can significantly reduce quality of life for individuals living with obesity.
    • Children and adolescents with obesity report more than 5 times lower quality of life — in terms of physical, mental, emotional, social, and school functioning — compared with children and adolescents without health conditions. They also report similar quality of life as children or adolescents diagnosed with cancer.

Consequences of Weight Bias in Obesity Care

  • Many healthcare professionals lack training on treating obesity as a chronic disease. The combination of this lack of training and weight bias can result in healthcare professionals believing that weight can be controlled solely through individual health behaviours (e.g., eating less and moving more), and that obesity is not a chronic disease requiring or deserving of evidence-based treatments.
  • Some healthcare professionals who hold biased beliefs about weight management may think that shaming (stigmatizing) individuals for their weight can motivate people with obesity to change their health behaviours and lose weight.
  • It is important to remember that obesity is a complex chronic disease driven by interconnecting factors such as genetics, individual health behaviors, psychological, and environmental factors.
  • It is also critical to remember that weight is not a behavior. Our weight may or may not change in response to our individual health behaviors such as eating healthier or exercising more.
  • What is also key to understand is that shaming a person for their weight does not motivate them to change their health behaviors. In fact, the opposite is true. Individuals who are shamed for their weight may avoid health promoting behaviors for fear of being blamed and shamed for their weight.

Internalized Weight Stigma / Self-Stigma

  • Shaming or stigmatizing an individual for their weight can cause weight bias internalization.
  • Weight bias internalization or self-stigma refers to when an individual believes that the shaming they experience from others is deserved because obesity is their sole responsibility and they should be able to manage their own weight and/or obesity.
  • Self-stigma is harmful. It reduces overall health related quality of life. This means that individuals who have self-stigma perceive their physical and mental health status (including health risks, medical conditions, functional abilities, social support, and social and economic wellbeing) as poorer compared with those who do not have self-stigma.
  • Individuals with self-stigma are more likely to believe that obesity is caused mainly by their own health behaviour decisions (e.g., unhealthy decisions about exercise and diet), rather than a combination of factors including genetics, physical/hormonal issues, social and family pressures, and environmental factors (e.g., access to healthy foods within the local food environment).
  • Individuals who attribute obesity primarily to behavioral factors may not seek medical obesity care because they feel obesity is their responsibility to manage on their own.

What Can You Do to Eliminate Weight Bias and Stigma?

Now that you know that weight bias and stigma are common and impact the health and social wellbeing of individuals who experience it independently from their weight or obesity, what can you do to eliminate stigma?

  • The first step is to become aware of your own beliefs and attitudes about weight and obesity. This can be done in different ways, but one way is to do an implicit association test (https://implicit.harvard.edu/implicit/takeatest.html)
  • The second step is to critically reflect on how your own beliefs and attitudes about weight and obesity impact your interactions, behaviors, and communications with people who have obesity. You may also consider how your weight biased beliefs and attitudes impact your own self-care. Here are some examples of questions you may ask yourself to critically reflect on your own beliefs and attitudes about weight and obesity.
    • Do you assume that a person’s health, characteristics, behaviors, and/or abilities are based on their body weight, size, or shape?
      • Remember: People come in different body sizes and shapes and they live with different health conditions including obesity. A person’s body size, shape or weight is not directly associated with their health, work ethic, willpower, intelligence, or skills.
    • Do you think that everyone with a larger body size or a higher weight has obesity?
      • Remember: Obesity cannot be diagnosed solely through weight of body mass index (BMI). Obesity needs to be diagnosed by a qualified healthcare professional using medical assessment tools that go beyond weight and body size.
    • Do you believe that people with obesity are personally responsible for their disease?
      • Remember: Obesity is a complex, chronic, relapsing disease caused by many intersecting factors such as genetics, physiological, psychological, environmental factors. Many of these factors are beyond an individual’s control. This does not mean that obesity management does not require any individual responsibility. Like all chronic diseases, management strategies include medical interventions in conjunction with self-care.
  • Once you have considered if and how your own weight biased attitudes and beliefs influence your interactions, behaviors, communications, and self-care, you can move on to the next step which is changing your own attitudes, beliefs and behaviours.
    • Educating yourself about how weight control works (i.e. weight cannot just be controlled through individual health behavior changes) can reduce weight biased beliefs and attitudes.
    • Educating yourself about the many complex and interacting causes of obesity can also impact your weight biased attitudes and beliefs.
    • Understanding that obesity is a heterogeneous disease (meaning that different people develop obesity for different reasons) and that different people need different obesity treatments can also help change biased beliefs and attitudes about obesity.
    • Adopting standard chronic disease communications strategies such as person-first language when referring to or discussing obesity.
    • If you are living with obesity, seeking evidence-based obesity management, using approaches that are stigma free, empowering, and focused on improving health and well-being rather than weight loss alone can also help reduce the impact of weight stigma on your disease management strategy.
    • If you are a healthcare professional, approaching obesity as any other chronic disease, using evidence-based, unbiased, and person-centered approaches (e.g. clinical practice guidelines), can also reduce weight stigma and discrimination in healthcare settings.

Advocating to Eliminate Weight Bias

Eliminating weight stigma in our society will take combined efforts from all of us. We can intervene at many different levels.

Clinical Institutions
Public Health Policies
Schools and workplaces
  • Educate yourself about weight bias and obesity
  • Understand that weight is not a behavior or a personal choice
  • Get familiar with the science of weight regulation
  • Ensure your discussions around weight and obesity are respectful and non-stigmatising (non-judgmental)
  • Develop and implement evidence-based clinical practice guidelines and standards of care
  • Institute obesity education for all personnel
  • Provide weight bias sensitivity training for all personnel
  • Include weight-based discrimination in institutional policies
  • Adopt weight inclusive clinical communications, practices, policies and spaces
  • Avoid using BMI as a diagnostic tool for obesity or as a criteria for healthcare services (e.g. use clinical practice guidelines to assess and diagnose obesity)
  • Avoid framing obesity as behavior or lifestyle choice
  • Avoid focusing solely on individual responsibility for weight and obesity
  • Move beyond “eat healthy and exercise more” approaches for obesity prevention and universal health promotion strategies
  • Define population health outcomes based on health parameters rather than body size (e.g. BMI)
  • Use person-first language and non-stigmatizing images in public health communications
  • Use weight inclusive health promotion strategies in schools, workplaces, and healthcare spaces
  • Avoid using war metaphors (e.g. “war against obesity, fight against obesity”) and stigmatizing narratives in public facing campaigns (e.g. “unhealthy weight”, “burden of obesity”, “morbidly obese people” or stereotypical images of people with obesity)
  • Engage people living with obesity in policy development
  • Develop weight-based discrimination policies to protect people with higher weights and those living with obesity
  • Include weight, body size, and obesity in anti-bullying policies
  • Avoid using obesity as a hook for health promotion programs
  • Use weight inclusive health promotion strategies
  • Provide weight bias training for all personnel
  • Promote body positivity and diversity (e.g. physical education classes should allow for all students regarding of body size or illness to participate; avoid singling out children with obesity)
  • Educate the public about weight bias and obesity
  • Provide weight bias training for all personnel
  • Change the negative portrayal of obesity and people with obesity
  • Use non-stigmatising images
  • Use person-first language

Advocating for yourself and loved ones

  • Self-bias is common and may affect outcomes. Your healthcare provider may be able to assess for internalized weight bias (e.g. self-stigma) and aid with finding support and resources to address it. Cognitive behavioral therapy (e.g. acceptance and commitment therapy) can help mitigate against internalized weight stigma.
  • Experiences of weight stigma can harm your health and wellbeing. Unequal treatment because of your size, weight, or obesity is not acceptable. Talk to your healthcare provider about your experiences with weight stigma and discrimination. Speak up and support action to stop weight stigma and discrimination.

Additional Resources


A Note on Stigmatising Language

There are many conflicting opinions when it comes to personal preferences about terms and language relating to obesity. There may be no consensus on some of the ways to respectfully discuss obesity, body size etc., and that’s ok – the goal should be to be as respectful as possible. Using person-first language can help!

Here are some common terms and concepts that we’ve come across:

The word “obesity” – Some people feel the word itself is stigmatising, although today it is the term most commonly used when discussing the disease (particularly by researchers, healthcare professionals and health policy makers). Some people prefer terms such as “fat,” while others feel that term is inappropriate as it is commonly used as a derogatory comment – and note that “fat” does not capture the scientific definition of obesity, but rather tends only to focus on body size.

“Anti-obesity medications” – This term can be viewed as stigmatising, as if obesity and by extension people living with it are a problem to be combatted. The term “anti-” is common in healthcare practice and research when it comes to medicines and other treatments (e.g., “anti-cancer drugs”, “anti-hypertension treatments”), and so you still may hear the term even during a respectful conversation with your healthcare team.

Interpreting person-first language outside of English use – Saying that someone “lives with obesity” or “has obesity” is preferable to saying they “are obese.” This is what person-first language is all about – being identified as a person and not being defined by the conditions you live with. However, that concept does not necessarily readily translate into other languages and cultures, and so you may experience more stigmatizing wording outside of English (or in English translations). Be aware that culturally some individuals may or may not identify themselves by their disease or condition.

A note on Artificial Intelligence – AI is growing in popularity as a tool to understand and communicate complicated ideas, but note that any AI platform is only as good as the information it’s built upon. That means it is likely to draw upon language and concepts that are stigmatising. The more we all practice good language habits around obesity, the more AI will catch up to us!