You’re on your way to the doctor’s office for a routine, yearly physical, and you’re dreading it more than you would a root canal. You check in, take a seat in the waiting room, and wait for your name to be called. When it is, the nurse looks you up and down before greeting you cooly and leading you back to the scale. Your heart begins beating faster as you hesitate to step up on the scale and hold your breath.
“Oh no,” you think, “it went up. I’m going to hear about this.” Your stomach drops, and you feel a wave of shame come over you. Your doctor enters the room, asks you a few questions while looking at your chart, and then gets a serious look in their eye.
“You need to lose weight, this is really serious. Eat more fruits and vegetables, and stay away from Burger King. Drink less soda, exercise more.” You nod your head slowly, eyes focused downward in humiliation and guilt, as your doctor continues delivering nutritional advice and education that you already know and you have already tried.
You don’t bother telling them about all the different diets you have been on and the amount of exercise you already do on a daily basis. It doesn’t feel worth arguing about, and you already feel embarrassed enough.
Your doctor dismisses you, and you head home feeling defeated, degraded, and disrespected. One year later when it’s time for your next physical, you decide not to go because you haven’t lost any weight, and you don’t have it in you to listen to those lectures again.
As a person in a smaller body, I have never had this experience at the doctor. I have almost always felt listened to and respected, which might just mean I have great doctors, but it could also be due to my weight status. I have never been given “the talk” doctors deliver to their patients regularly about their weight, and I have never been told all my medical problems stem from my BMI status.
Healthcare professionals are becoming more and more aware of weight stigma, but it still exists in medicine and it lurks in every corner of our country’s perceptions and policies. Today, we will be discussing what weight stigma is and how we can start to phase it out of our own lives to create a healthier environment for everyone.
Disease stigma is a term used to describe the notion that someone has a disease or condition due to their own actions. Obesity is far from the first time a group of people have been ridiculed and told they are the ones to blame for their situation.
One example I hadn’t know much about comes from 200 or so years ago, when Irish immigrants were viewed as less than or second class citizens. Irish immigrants largely settled in poor neighborhoods in America, and they were blamed for epidemics like cholera because they were supposedly “filthy and unmindful of public hygiene.”
Eventually, it was discovered that cholera was contracted from contaminated food and water sources, and cities began working toward eradicating it so it wouldn’t impact the rich as much. The Irish were blamed for cholera, but since they were considered undesirables, little help was sent until it started spreading to the more elite neighborhoods.1 Classic.
This is just one of the many instances where a group of people were blamed for a condition they live with and don’t have as much control over it as people might think. I suppose I get it- it’s easier to blame the group suffering than step in and help. But, to quote The Fray, “sometimes the hardest thing and the right thing are the same.”
What is Weight Stigma?
Weight stigmas are thoughts and beliefs about people in larger bodies. People in larger bodies are often viewed as are lazy, unintelligent, lacking in willpower and self-discipline, having poor hygiene, and being noncompliant with weight loss treatment. The list goes on and on, and it’s heart-breaking, especially if you or one of your loved ones lives in a larger body. These stereotypes negatively affect nearly every aspect of a person’s life at school, work, and in interpersonal relationships.
Obesity is seen as a condition that is completely within a person’s control; therefore, we think it is the individual’s fault if they have a larger body. These beliefs continue further by thinking that if people with obesity would just put in more effort into exercising and eating right, they wouldn’t have obesity. Simple as that, right?
Often, people think that others won’t lose weight because they aren’t working hard enough. Diet culture wants us to think we are the only ones responsible for our weight, so that we will buy diet products and the blame will be put on us when they don’t work. Then, we will spend more money and time trying other products and diets.
You cannot accurately judge someone’s personality or work ethic based only on how their body looks. But we sure try. We value work ethic and the constant pursuit of making ourselves better, which are fine on their own. When we perceive someone as not living up to these ideals, however, we judge. Hard. When it comes to body size, very little empathy is given.
What if an individual many perceive as lazy has actually tried incredibly hard to change their body by doing every diet and trying every rigorous exercise routine, but nothing as worked? What if their body is actually in starvation mode, so it holds onto everything it possibly can in the name of survival?
In previous weeks, I talked about the Minnesota Starvation Experiment. In this study, young men were put into semi-starvation mode for 6 months to lose 25% of their ideal body weight. After months of rehabilitation, many men ended up weighing more than they had before semi-starvation, and they had a higher percentage of body fat. Weighing more and having more body fat than before isn’t necessarily a bad thing, but it’s the opposite of what people want when they diet or purposely starve themselves.
Imagine going about your life, minding your own business, trying your best to lose weight, only to have people view you and treat you in such a negative, harsh way. Even health professionals, the people that are supposed to be there to help you, engage in these behaviors. One study showed that, on average, doctors spend less time with patients with obesity verses those of normal weight.3
It is known too, that many individuals with obesity skip cancer screenings and preventative health checks due to past disrespectful treatment, embarrassment about being weighed, unsolicited weight loss advice, and improperly fitting medical equipment and gowns.
Many people in America, and all over the world, don’t have to imagine these scenarios. They live them out day-after-day, and it has to be exhausting. You may not think you have these biases about people with obesity, but a lot of us have them buried in our subconscious. I was sick to my stomach when I took the Harvard Implicit Bias Test on weight and found out about my negative bias toward fat people.
It was a real eye-opener, as I like to think of myself as a good person. But I now know that being good doesn’t mean being stigma-free; it means doing the work to unravel the stigmas you carry. I would encourage everyone to take the weight bias test themselves (try a few or all of them!) because learning about your own subconscious biases is the first step in working on them.
How is Weight Stigma Harmful?
Weight stigma, like any biases a person deals with, are damaging psychologically, which can become damaging biologically and physiologically. Those who experience weight stigma have increased risk for anxiety, depression, and disordered eating behaviors.2
In addition, studies have shown that children who are considered overweight and are teased because of their weight (weight bias at work in the young) are more likely to engage in binge eating and other unhealthy behaviors than children who are considered overweight but are not teased.4
Binge eating and food restriction can mess with our hormones and metabolisms in ways that encourage our bodies hang on to as much energy as possible from each calorie consumed, like they saw in the Minnesota Starvation Experiment. This results in an increase in fat stores upon leaving the semi-starvation phase that most diets call for.
As soon as a person leaves the semi-starvation phase, they will likely start to regain the weight they lost, and perhaps some extra, due to increased hunger cues and other biological factors, prompting them to begin restricting again. This can result in a steady, gradual weight gain over the years if they cycle continues, or it can result in full blown disordered eating. Dieting definitely isn’t the solution, and in many cases, it may be the cause.
On top of this, people who experience weight stigma are less likely to exercise.5 Can you blame them? It’s difficult to find exercise clothes that fit larger bodies well, and gyms are intimidating places. Plus, not everyone has the means to afford gym memberships, and plenty of people live in unsafe neighborhoods, meaning outdoor walks aren’t always an option. Additionally, people in larger bodies have to deal with judgmental looks or harsh comments from others while they try to exercise.
In the book Health at Every Size by Lindo Bacon (anti-diet bada$$ alert), they discuss that Americans started seeing steady increases in body weight in the 1970’s. What also increased in the 1970’s? Dieting. Interesting timing, right?
Aside from rigorous food restriction, these fat-saving hormones can also become triggered from the chronic stress one is likely to experience from being stigmatized 24/7. In other words, weight stigma can exacerbate the exact condition it stigmatizes by being destructive to mental health.
Consider the following scenario:
You’re just a kid in grade school, and you happen to be in a slightly larger body than average. You love to play outside all day, and you eat your fruits and veggies, but your build is just a bit different than the other kids. By all measures, you’re a bright, healthy kid!
But, then the teasing occurs once you hit the age where kids become cruel. Other kids start calling you fat, and you begin to feel ostracized from the rest of your class. You start avoiding sports and participating in physical education class because you don’t want to be laughed at by the more athletic kids.
Less physical activity and the stress of bullying and living with weight stigma is enough to make your hormones go haywire, prompting your body to slow down your metabolism and hold onto every tiny bit of energy it can get from food.
So, you start learning about how to lose weight in hopes that you can fit in again someday. You look around you and notice all of the adults in your life who constantly restrict their intake and exercise to earn their food. You might read magazine covers at the grocery store and try the detox drink recipes inside that promise rapid weight loss.
Despite all the effort your putting in and all diets you’re trying as a kid or young adult, you aren’t losing weight, and your doctor gives you the talk from the opening scenario of this post. You can’t help but feel utterly defeated and totally responsible for all of it. Perhaps this cycle continues and/or creates major food anxiety and shame, prompting more weight gain and more stigma.
Weight-based bullying doesn’t always come from other kids, either. A close friend told me that her basketball coach would yell at her for not running faster, despite going as fast as she possibly could in practice. She could overhear her coaches saying how lazy she was behind her back, which permanently damaged her relationship with the coaches and the sport. She was only 10 at the time, and it made her feel too embarrassed to want to play sports anymore. My heart aches for the young version of her, as well as the adult version that still carries this with her.
When I think back to my own youth sports experiences, I realize how differently children in larger bodies were treated by coaches, teachers, and other adults. They were often talked down to, as if they couldn’t grasp what was going on. It was much like the experience adults in larger bodies can have at the gym when others say “good for you, you’ll feel so much better” in a well-meaning, yet condescending tone, even if that person has been going to the gym for years.
I firmly believe that sports can help kids learn persistence, resilience, teamwork, respect, and plenty of other positive attributes. That’s why it’s so important for coaches, especially those coaching children, to be inclusive. Some kids naturally have larger bodies, and it doesn’t mean they’re lazy, out of shape, or unhealthy in any way. But telling them that they are, based only on their appearance, may make them avoid sports and physical activity for years or even a lifetime, negatively impacting their health more than being in a larger body ever could.
Combating Weight Bias With Education
I am not saying that getting rid of bullying and weight stigma would completely “cure” obesity. Bullying seems completely impossible to eradicate, and in my personal experience, being teased a tiny bit helped thicken my skin a little anyway. Of course, I’m also not advocating for bullying, especially the relentless kind many kids in larger bodies experience. I am saying that one way to combat weight bias is to empower kids, and adults, that deal with it all the time.
As a huge fan of education, both formal and informal, I see it as one major way to significantly reduce weight stigma and bias in our country. For example, one study conducted a 1-day program that taught individuals about mindfulness and body acceptance.
The participants showed improvement in BMI, psychological stress, perceived weight stigma, and overall quality of life verses the control at the 3-month follow-up.6 Weight-specific acceptance and coping training, even from just a 1-day program, improved the lives of individuals living with obesity tremendously. This is just one example of hundreds or thousands of interventions that could help people deal with the ugliness of weight bias in healthy, wholesome ways.
Working with weight bias and stigma victims is super important, and so is educating the general public on these issues. Discussing the weight bias cycle that I outlined above can help people in smaller bodies, and those with biases, realize that obesity isn’t the result of laziness and not working hard enough. It’s complex, and it’s the result of so many factors, like a major lack of resources or any number of other things.
The more I have learned about weight stigma, the more empathy I feel for people in larger bodies because of all the bull crap they deal with. Feeling more empathy has personally meant fewer snap judgements toward people with obesity in my own life.
I don’t believe we should ever be too content and comfortable in our thoughts and perceptions. We should always strive to challenge ourselves and find common ground, especially when we have automatic assumptions based on another’s appearance. What we think, or say, about others often tells us more about ourselves than the other person.
The main thesis, if you will, of this blog post is that weight stigma and diet culture are actually partially, or mostly, responsible for obesity itself. Encouraging people to lose weight and diet often makes people gain weight in the long run, prompting them to “work harder” at the weight loss game.
Then, once they have hit a certain point, they began experiencing weight stigmas, which adds even more barriers to achieving the look and “health” that diet culture drills into our heads. When it comes down to it, people are people, regardless of their size, and they deserve to be treated as such no matter what.
As Always, A Book Recommendation
Re-reading Health at Every Size by Lindo Bacon made me really start to think about how crappy and systematic weight bias is in everyday life and healthcare. This book did an excellent job of opening my eyes to the idea that weight, in terms of actual health, might not matter as much as we think it does. Our habits, like exercise and eating them fruits and veggies, matter more than the number on the scale.
Check this book out as soon as you can! It’s one dank read.
You can also get this audiobook (or any other available audiobooks) for FREE if you sign up for a free 30-day trial of Audible! If you already have Amazon Prime, you get TWO FREE audiobooks with this offer.
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- Cholera In Ninteenth Century New York
- Obesity Stigma and Bias
- Obesity Stigma: Important Considerations for Public Health
- Experiences of Weight Teasing in Adolescence and Weight-Related Outcomes in Adulthood: a 15-Year Longitudinal Study
- Internalized Societal Attitudes Moderate the Impact of Weight Stigma on Avoidance of Exercise
- Teaching Acceptance and Mindfulness to Improve the Lives of the Obese: A Preliminary Test of a Theoretical Model
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