”Stigma affects us all! All the time! We cannot avoid it. It has a direct connection to our appearance, to our perceptions about our character and to the groups we want to belong to. So we learn to accept all these feelings of being worthless and not ’fitting in’. To help a person with obesity, the first thing is to help her (or him) regain her self-confidence. Otherwise, all the years of suffering under stigma and feeling worthless because of her weight will come in the way of her recovery.” – Christina Fleetwood
What is Stigma?
Weight bias is defined as negative attitudes toward and beliefs about others because of their weight.
Weight stigma refers to social stereotypes and misconceptions about people with obesity. Weight stigmatization or weight-based discrimination occurs when we treat individuals unfairly because of their weight or size.
Weight stigmatization is pervasive in our society. Studies conducted by the Rudd Centre for Food Policy and Obesity found that 63% of children with obesity who attend elementary schools face higher risk of being bullied by peers, while 54% of adults with obesity report being stigmatized in their workplace. Adults with obesity (64%) also report experiencing weight bias from health care professionals.
There are four classic traits that indicate social status — gender, class, race and age. To these, we can add size and weight. Every person can be categorized by each of these traits at the first meeting. Gender, race, weight and age are all immediately visible, sometimes also class, solely by the presence of the body. How the person is categorized by each observer influences his or her social status.
There is extensive research on the consequences of weight stigma.11 Health professionals often have biased attitudes towards patients with obesity. This can lead to their spending less time with patients living with obesity, for example. Stigma impacts health system policies, limiting access to evidence-based obesity
management and rehabilitation support.12
For you as a person with obesity, weight stigma can also have negative effects on friends and family, in schools and other educational settings, when seeking employment or housing. We explore these effects below in the section “The social implications of obesity”.
Social stereotypes about thinness and overweight combined with risk of weight gain due to various factors can stir up discomfort and sometimes even hostility that in turn might openly be directed towards individuals who have overweight. Social pressures to have a thin body continue to intensify and equate thinness with “happiness” and “success”. Consider, for example, how there is a multi-billion-dollar weight loss industry promoting unrealistic weight loss and promising a happier self and increased life opportunities and success.
As a person with obesity, no matter where you go or who you meet, obesity stereotypes and misconceptions are always there, sometimes openly, sometimes in the background. This recurring confrontation with stigma in your environment can lead to negative self-perception and “internalised weight bias”. You begin to believe that you are lazy or have a weak character, are unattractive, or whatever the stigma is telling you.6,14 This results in:
- Blame and shame
- Pressure from public opinion
Internalised weight stigma can lead to a variety of responses:
- Feelings of not “fitting in” and not being “normal”;
- Feelings of not being accepted and respected as a human being;
- Negative thoughts and self-talk;
- Feelings of shame and blame;
- Vulnerability, which can cause stress, anxiety, depression, suicidal thoughts and eating disorders.
- Feeling helpless and unable to engage in health promoting behaviours;
- Unhealthy coping methods such as binge eating or reduced physical activity;
- Suicidal acts.
- Increased chronic stress can activate physiological mechanisms that in turn can lead to increased weight.
- Avoidance of interactions with health professionals for fear of blame and shame; • Fear of being excluded.
Obesity occurs in a social context and causes inequalities. Aspects of our physical health have consequences for our social situations, which means that our social situations affect our health and, for persons with obesity, can lead to more weight gain.15
A combination of social factors can lead to a downward spiral in which your quality of life becomes progressively worse:
Many people with obesity have experienced stigma in the intimacy of their own family. Teasing by friends and family is common and often goes uncontested.
The person with obesity might not be considered attractive. Normal relationships may be hindered if other people fear being tainted by social contacts. This can restrict the choice of partner and limit the number of close friends.
Many children and young persons are bullied in school, sometimes brutally, because of their weight. Weight stigma can limit admission to college or university, especially if an interview is required.
Stereotyping persons with obesity as lazy and lacking discipline fuels discrimination in the workplace. Many employers avoid hiring people with obesity, however competent the person might be.
Some persons with obesity are unemployed or have lower-paying jobs, which leads to lower incomes and financial difficulties.
Landlords may avoid renting to persons with obesity.