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Let’s Talk About Weight Bias & Stigma

TW: This post uses the word “obesity” in the context of describing the current discourse on weight. Studies linked may contain stigmatizing language.

The idea of weight as a social justice issue has become a growing concern over the past few years. While most of us can grasp the idea of treating everyone with kindness and respect, regardless of size, that is just one teeny-tiny part of fighting weight bias and stigma.

What more can be done? How is weight bias and stigma still being perpetuated? Why is it important to be fighting weight bias and stigma? I don’t claim to have the answers, especially as a person with thin privilege, but I hope my exploration of some of these questions will help spark more discussion and potential solutions.

Let’s Start with Some Definitions

Weight bias and stigma are often used interchangeably, but they are not really the same thing. While both describe negative attitudes, beliefs and stereotypes about people of a larger size, bias tends to describe individual beliefs, whereas stigma applies to societal labels and stereotypes.

Can Thin People Experience Weight Bias and Stigma? Technically, yes, but bias and stigma against thin people is not as widespread, nor as impactful as it is for larger people. I would even go so far as to argue that stigma against thin people doesn’t exist, as thin people are generally viewed positively in society. So despite being termed “weight” bias and stigma, it is really referring to “fat” bias and stigma. In fact, in this episode of the Don’t Salt My Game podcast, fat activist Dr. Charlotte Cooper argues that weight bias and weight stigma are really just euphemisms for fatphobia.

According to fat activist Virgie Tovar, fatphobia can be broken down into three levels: intrapersonal, interpersonal and institutional.

Intrapersonal fatphobia, also termed “internalized weight stigma”, is when a person starts to apply (internalize) the negative thoughts and stereotypes about weight/size on themselves, and believe that the only way to “fix” these negative thoughts and feelings is by losing weight/changing their body. This level of fatphobia can impact anyone, regardless of size and shape.

Interpersonal fatphobia is what most people think of when they think of weight bias, stigma and fatphobia – when a person is treated poorly or unfairly by another based solely on weight/size.

Institutional fatphobia, or “systemic weight stigma” describes the societal and cultural norms that reinforce societal body ideals, and marginalize larger bodies. Examples range from airplane seats and the relative lack of plus-sized clothing, to assuming that all larger people are unhealthy or assuming that someone who is struggling to lose weight is “just not trying hard enough” or “hasn’t found the right diet”.

As you can probably imagine, the different levels of fatphobia often intertwine and overlap with each other. While thin people and others who meet societal body ideals generally don’t experience the interpersonal and institutional levels of fatphobia, amongst fat people, individual experiences and impacts of weight bias and stigma can vary greatly.

The Health Impacts of Weight Bias & Weight Stigma

Why weight bias and stigma is doubly important to me as a dietitian is because it’s not just a social justice issue; it is a health issue. There is a growing body of research looking at the independent impact of stigma on mental and physical health. I’ve previously shared this study, which found that people with perceived weight discrimination were twice as likely to develop multiple chronic conditions over 10 years, even after adjusting for body mass index (BMI). Another study “found that perceived discrimination and stigma concerns mediated the negative relationship between BMI and self-reported health, reducing this frequently observed relationship to non-significance.” (Emphasis mine)

Of course, correlation does not equal causation, so I don’t think that we can say that weight stigma alone is causing poor health, or that eliminating weight bias and stigma will lead to improved health. However, these studies confirm that the relationship between weight and health isn’t as strong as we’ve been led to believe. They also call to question all the studies looking at weight and health that don’t consider weight stigma as a possible confounding factor.

#Weightbias and #weightstigma is not just a social justice issue, it is a #health issue. Click To Tweet

A Note on Weight Bias/Stigma and “Obesity”

Given the documented health impacts of weight bias and stigma, it’s no surprise that health professionals who specialize in obesity care are starting to pay attention. Some of the larger professional groups have included reducing weight stigma as part of their organizational goals… sorta. There’s been a trend in these groups to use the phrase “obesity stigma”. The cynic in me believes that this is likely to legitimize the idea that obesity is a disease (thus aligning “obesity stigma” with say, mental health stigma), and/or response to pushback from fat activists who argue that the construct of obesity perpetuates weight stigma. (“Well, we’re fighting obesity stigma, not weight stigma.”)

I have written in the past about why the idea of obesity, and obesity as a disease is stigmatizing, and I continue to stand by the argument that it is not possible to eradicate weight bias and stigma while viewing obesity as a disease or problem that needs to be managed/treated. You can have all the high weight capacity chairs in the world, and discourage fad dieting until you’re blue in the face, but as long as a person’s health is being blamed on their weight, size or fatness, as long as the treatment is to “manage” their weight, as long as weight loss is seen as a positive (even as a “side benefit”), as long as weight gain is seen as a negative, and so on, this continues to uphold the idea that smaller bodies are better than larger bodies, thus perpetuating weight bias and stigma.

What More Can I Do to Fight Against Weight Bias and Stigma?

As mentioned earlier, treating all people with respect and kindness is a good place to start, but it’s not enough. We need to consider all the ways that we may be continuing to uphold, or even actively perpetuating fatphobia.

Intrapersonal

Confronting and working on your own body concerns can be uncomfortable, but can help you to recognize the impact of weight bias and stigma on your own life, and perhaps areas where you didn’t realize that you were still holding bias and stigma. Some questions to explore:

  • How would I describe my relationship with my body?
  • How has my relationship with my body changed over time, if at all?
  • What would my life be like if I woke up and found that I gained or lost X lb? (Feel free to experiment with different weights) How would my relationship with my body change then?
  • What thoughts and feelings come up when weight comes up as a topic in conversation?

After considering these questions, I invite you to take some time to consider your answers. Where do some of these attitudes and beliefs come from? Are they absolutely true? How might some of these attitudes and beliefs you have about yourself show up to others around you? What might change in how you show up if some of these attitudes and beliefs changed?

Interpersonal

Many of us may have already done some work in this area, and it never hurts to review. Here are some questions to explore:

  • What thoughts, emotions and beliefs come up when I see someone in a larger body, versus someone in a smaller body? (You may want to keep track of your reactions in real-time over a few days, or look at pictures of people on the Internet. If you try the latter, consider looking at different portrayals of fat people, like the stereotypical headless photos versus photos from plus-sized fashion blogs or fat positive Instagram accounts.)
  • How do I interact with people in larger bodies, versus people in smaller bodies?
  • How do I react when someone says, “I feel fat” or “I am fat”? Does their size influence my response? If so, how?

This may also be a good place to explore the concept of implicit, or subconscious, bias. There is a quick and simple test as part of Harvard’s Project Implicit. Please note that if the test comes back and says you have a preference for thin people, that does not make you a bad person. I think it just goes to show the power of diet culture and societal ideals in impacting our beliefs.

Institutional

When it comes to institutional fatphobia/systemic weight stigma, many people focus on physical accessibility, such as whether doors or chairs are wide enough. Here are some questions that might help you see some of the sneaky ways that weight bias and stigma exist in our culture:

  • Do you consider certain foods better/healthier based mainly on portion size/calorie content?
  • Do you compliment someone when they have lost weight?
  • What’s the largest clothing size that your favourite stores carry?
  • If you are a fat person, have you ever been told to lose weight for a condition that’s not weight related? If you’re a thin person, have your health concerns ever been brushed off, or have health professionals assumed a clean bill of health without a thorough assessment?
What are some ways that you have been impacted by weight bias and stigma? If you feel comfortable sharing, please do so in the comments below.

2 Comments

  • Beva Dudiak on Jun 14, 2018 Reply

    I fell getting on the bus and unbeknownst to me broke my kneecap. I’m pretty good at sucking up pain so I walked away from it and didn’t go to the doctors for about a week. Because time had passed since the accident the doctor told me it was pain from arthritis due to my obesity. It wasn’t until over a year later that I sprained my foot and saw an orthopedic surgeon for that and he decided to take an x-ray of my knee. Surprise surprise. I’d been walking around with a broken kneecap for over a year with never an apology from my doctor. I’ve since had surgery to repair it but it will never be good. I use a walker now. People think I use a walker because I’m fat. It’s very stigmatizing.

    • Vincci Tsui on Jun 14, 2018 Reply

      Thank you so much for sharing that experience, Beva. I’m so sorry that happened to you.

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