Weight stigma

By now, you may have heard about the National Obesity Forum¹ calling for all children to be weighed upon return to school in September, and then again in the spring, to encourage them to lose lockdown weight gain². It’s safe to say that whilst there has been a mixed response, the idea certainly invited a lot of criticism³, even gaining attention from BEAT, a UK eating disorder charity⁴.

WhatsApp Image 2020-08-24 at 13.10.22.jpeg — Obesity is associated with many chronic diseases, such as type 2 diabetes and heart disease⁵, and mental health issues such as depression⁶. According to the World Health Organization (WHO), overweight and obese children are more likely to remain obese into adulthood and are therefore at higher risk of developing associated chronic diseases⁷.

WhatsApp Image 2020-08-24 at 13.10.22 (2).jpeg — Weight stigma

The worry with this initiative is that it may encourage weight stigma by unintentionally shifting the attention away from health, intensifying the negative social preoccupation with appearance⁸,⁹. Many people hold negative attitudes towards people with excess weight¹⁰,¹¹, which can result in weight stigma¹²,¹³. Weight stigma is the discrimination or exclusion of individuals based on their weight¹⁴. It is present in many aspects of society including education, employment and healthcare¹⁵ and has been shown to increase harmful health behaviours such as; binge eating, social isolation, decreased physical activity and weight gain¹⁶,¹⁷.

Weight Stigma (1).png — One of the most common sources of weight stigma is doctors, with research finding 53% of study participants experiencing weight stigma from them¹⁸. Weight stigma in the healthcare setting can result in healthcare avoidance and the possibility of chronic disorders being poorly controlled in the long term¹⁹.
Weight stigma has also been used to apply pressure to encourage weight loss²⁰. However, experts suggest that it often has the opposite effect, frequently resulting in weight gain²⁰. There are a huge number of negative health outcomes associated with experienced weight stigma, both physical and psychological¹⁶,¹⁹.

WhatsApp Image 2020-08-24 at 13.39.59.jpeg — What can we do?

Shifting the attention away from weight and instead onto health, by increasing healthy lifestyle habits such as regular physical activity and having a diet rich in fruit and vegetables, has been shown to significantly decrease the risk of mortality regardless of body mass index (BMI)²¹. Additionally, obesity public health campaigns that did not mention the word ‘obesity’, but rather focussed on making healthy behaviour changes, were found to be the most motivating²².
The recent Canadian guidelines for obesity in clinical practice acknowledge the need to remove the focus from solely weight loss in treating obesity and instead focus on “patient-centred health outcomes”²³. This concept is reflected in the Health at Every Size approach which highlights that losing weight does not necessarily mean getting healthier²⁴.

WhatsApp Image 2020-08-24 at 13.10.22 (1).jpeg — In an effort to prevent and reduce weight stigma, greater education is needed on obesity and the complexities of the condition²⁵. The common view that obesity relates solely to diet and exercise is an oversimplification which results in continued weight stigma²⁶. Obesity is a multifactorial disease and therefore many other aspects must be considered along with diet and exercise including; genetics, environment, behaviour, metabolism and medications²³.
The use of language regarding weight and obesity is extremely important and can negatively affect overweight or obese people²⁷. A conscious effort should be made to use non judgemental or stigmatising language. One example of this is to use People-First Language²⁸. Instead of describing a person as “obese”, referring to them as “having obesity”.

WhatsApp Image 2020-08-24 at 13.45.18.jpeg — To summarise…

Overall, the most important consideration in this debate is the health and wellbeing of the population. A careful balance is required to maintain both physical and mental wellbeing²⁹, ³⁰. Promoting healthy lifestyle behaviours (e.g. balanced eating and physical activity)³¹,³², denoting less importance to body weight, size and appearance³³ and including specialists (i.e. dietitians and nutritionists) in the discussion and implementation³⁴, ³⁵, ³⁶, may lead to a more positive experience and outcome for people.

Resources

- Become aware of your own weight bias by taking the Harvard Implicit Association Test. Follow the link and select the Weight IAT.
- Use the appropriate language when speaking about obesity.
- Educate yourself
- Obesity Action - Understanding Obesity Stigma
- Health At Every Size

References:

Lina BenjellounSeptember 4, 2020Comment