How Weight Stigma Impacts Body Image
What is weight stigma?
Weight stigma is defined as the discrimination or exclusion of individuals based on their weight (1). It is present in many aspects of society including education, employment, and healthcare, and has been shown to increase harmful health behaviours such as binge eating, social isolation, decreased physical activity and weight gain (2,3,4). Many people hold negative perceptions and attitudes towards individuals with excess weight, which can result in weight stigma (5,6,7,8).
Weight stigma amongst doctors is alarmingly prevalent, according to a study that found that their rate of stigmatisation towards people with excess weight was around 69% (9). Weight stigma in the healthcare setting can result in healthcare avoidance and the possibility of chronic disorders being poorly controlled in the long term (10). Weight stigma has also been used as a tactic to encourage weight loss. However, experts suggest that it often has the opposite effect, leading to weight gain (11). With negative impacts on self-esteem and long-term body weight, weight stigma has various consequences on physical and psychological health (9).
Weight fluctuations & the pandemic’s contribution
In the UK, approximately two-thirds of adults struggle with weight (12). Similarly to how being underweight may contribute to potential health consequences, holding excess weight is also a factor, excluding many other influences, that may increase risk of developing chronic diseases such as type 2 diabetes and heart disease, and mental health issues such as depression and anxiety (13,14). With COVID-19 came chaos, and from the underlying stress of lockdown, uncertainty and fear of the unknown, some people adopted behaviours that marked a significant increase in emotional eating, as a coping strategy. With a rise in disordered eating and eating disorders, such as binge eating disorder, this could have then led to heightened levels of weight fluctuations. This may have also been contributed towards by lockdowns, quarantining, and reduced access to gyms or social spaces (15,16).
How do we combat weight stigma?
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 fruits and vegetables, has been shown to significantly decrease the risk of mortality regardless of body mass index (BMI) (17). Additionally, public health campaigns on obesity that did not mention the word ‘obesity’, but rather focussed on making healthy behavioural changes, were found to be the most motivating (18).
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” (19). This concept is reflected in the Health at Every Size approach which highlights that losing weight does not necessarily mean gaining health (20).
To drive the prevention and reduction in weight stigma, greater education on obesity and the complexity of the condition is needed (21). The generalised view that obesity relates solely to nutrition and exercise is an oversimplification which contributes to continued weight stigma (22). Obesity is a multifactorial disease and therefore, many other aspects must be taken into consideration along with food and activity such as genetics, environment, behaviour, metabolism, and medication (19).
The use of language regarding weight and obesity is extremely important and can negatively affect overweight and obese people (23). A conscious effort should be made to avoid the use of judgemental or stigmatising language. One example of this is to use the People-First Language; instead of describing people as obese, refer to them as “having obesity” (24).
The take-away…
Overall, the most important consideration in this discussion is the health and wellbeing of the population. A careful balance is required to maintain both physical and mental wellbeing (25,26). It is extremely important to note that behaviour change should be the main priority of any type of weight altering journey. Understanding the internal “stuff” that may have driven you to overeat in the first place and forming healthier habits based on that, helps you to maintain your progress, and makes you a happier person both mentally and physically. Promoting healthy lifestyle behaviours (e.g., balanced eating and adequate physical activity), denoting less importance to body weight, size, and appearance as well as including specialists (i.e., dieticians and nutritionists) in the discussion and implementation, may lead to a more positive experience and outcome for people (27,28,29,30,31,32,33). Weight stigma is a problem that needs to be addressed, the effects it has can be long-term and severely detrimental to someone’s physical and psychological well being, so be wise with the words you choose, including the dialogue directed at yourself (34)!
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.
References:
https://www.thelancet.com/action/showPdf?pii=S2468-2667%2819%2930045-3
https://pediatrics.aappublications.org/content/140/6/e20173034
https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-018-1116-5
https://onlinelibrary.wiley.com/doi/full/10.1038/oby.2006.208
https://www.euro.who.int/__data/assets/pdf_file/0017/351026/WeightBias.pdf
https://www.health.harvard.edu/blog/addressing-weight-bias-in-medicine-2019040316319
https://www.worldobesity.org/what-we-do/our-policy-priorities/weight-stigma
https://www.bupa.co.uk/health-information/nutrition-diet/obesity-in-adults
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/210608
https://www.sciencedirect.com/science/article/pii/S1054139X20306790?dgcid=rss_sd_all
https://cdn.easo.org/wp-content/uploads/2020/07/31073423/Obesity-Language-Matters-_FINAL.pdf
https://www.obesityaction.org/action-through-advocacy/weight-bias/people-first-language/
https://www.nhs.uk/live-well/healthy-weight/healthy-weight-children-advice-for-parents/