“You’d be pretty if you lost weight.”
“Should you really be eating that?”
“Are you sure that dress is right for you?”
“For a bigger girl, you carry it well.”
“Have you tried dieting?”
These comments are bruising – not just to the ego but to overall health and wellbeing. In fact, they can leave indelible marks.
The link between obesity and health problems like type 2 diabetes and heart disease is well known, but few people know that people with obesity experience elevated levels of depression, anxiety, low self-esteem, poor body image, substance abuse, and even suicidality — in large part due to the stigma and discrimination they face in society.
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The Prevalence of Weight Bias
Sadly, people with obesity are vulnerable to unfair treatment almost everywhere they go, from the workplace (where they might experience hiring bias, lower wages, and fewer advancement opportunities) to the doctor’s office (where medical professionals with weight bias can deny them proper healthcare). Mass and social media further normalize weight bias by casting actors with obesity as the losers or stooges, and idealizing skinny models in advertisements.
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The Root Cause of Weight Bias
What’s typically behind society’s bias toward people with obesity is the false belief that obesity is a choice – and not a complex disease – and that people with obesity are lazy and undisciplined. If they only had the willpower to eat less and exercise more, the thinking goes, they could be thinner. Obviously, it’s not that simple. While GLP-1 medications might someday help lessen the problem of weight stigma and discrimination in society, the impact of body shaming and weight bias remains strong and severe.
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Bias Can Cause Weight Gain
Because maladaptive eating habits like binge eating and loss of control eating can be triggered by stress, weight stigma can paradoxically lead to weight gain in people with obesity. Stress can also elevate cortisol levels in the body, which can lead to abdominal fat accumulation, making stress-related weight gain even more of a risk.
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Poor Mental Health
The anxiety and depression that come from experiencing weight bias are well documented. People with obesity report being made to feel lazy, weak-willed, unintelligent, and unsuccessful by others. Once these feelings are internalized, people can start believing that they’re worthless because of their weight.
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Neglected Physical Health
Studies show that some people with obesity avoid seeing their doctor for fear of feeling shamed, judged, or humiliated by them during visits. But avoiding checkups and important follow-up appointments can result in worsening health. Physicians can be part of the problem, too, with studies showing that doctors with weight bias spend less time in appointments, provide less education about health, and are more reluctant to perform certain screenings with patients who have obesity compared to thinner patients. These doctors also view patients with obesity as less adherent to medications.
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Inadequate Fitness
For the same reason people with overweight avoid medical appointments, they may also forgo trips to the gym. If they are anxious or depressed in addition to feeling insecure and self-conscious about their bodies, a person’s motivation to work out can wane even more. Unfortunately, inactivity can lead to weight gain and worsening health problems.
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Increased Mortality Risk
Combine these issues together — chronic stress, reduced healthcare access, exercise avoidance, and maladaptive coping behaviors — and it’s no surprise, sadly, that studies link weight discrimination and its resulting health risks with early death in people with obesity.
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How to Change the Narrative
Everyone harbors biases of some kind, whether they are conscious of them or not. Play it safe by keeping your own personal opinions and judgements about people with obesity to yourself, even if you think your comments are well-meaning. Here are more bias-busting strategies to consider and share:
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Don’t Make Assumptions
Remember, you can’t judge a person’s health by the way they look. People who appear to have overweight can be healthy, with HDL and other numbers in the normal range, while people who appear thin could be suffering from any number of health conditions like high cholesterol or fatty liver disease.
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Watch Your Words
Even individuals with good intentions can offend people with obesity by making condescending comments like “good for you” when they see that person eating a salad, for example, or hitting the gym. Unless that person asks you to be their cheerleader, it’s better to stay mum and assume their weight is none of your business.
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Question Your Own Bias
Be frank with yourself: Do you tend to assume that, when someone can’t lose weight, it’s their fault? We all know thin people who eat everything in sight and never gain a pound, while others diligently limit calories and never see a change on the scale. Remember that — and this, too: Obesity is a complex issue that is caused by a wide range of issues. It is never a person’s choice.
