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I See Fat People

Fat phobia is rampant and actually contributes to the problem of obesity.

All people are created equal—that is, unless they’re fat. Although overweight and obesity affect two-thirds of Americans, the public is as troubled by obese people as young Haley Joel Osment was when his character declared, “I see dead people” in the supernatural thriller Sixth Sense.

Overweight people are presumed lazy, undisciplined, dishonest and unintelligent. More than half of people (61 percent) see no harm in making negative remarks about a person’s weight.

Obesity is the last frontier in tolerable prejudices. Whereas discrimination based on age, race, religion, sex and other protected characteristics is illegal, federal law (and most state and local laws) does not make it illegal to discriminate against people based on their weight. This means that if an employer doesn’t want to hire overweight people or a landlord only rents property to the thin-bodied, there is no redress.

Research reveals that weight discrimination is hurled at people from all directions:

  • More than half of doctors described their overweight patients as ugly, awkward, and non-compliant with treatment.
  • Nearly one-quarter of nurses admitted to feeling repulsed by their obese patients.
  • Nearly 30 percent of teachers said that becoming obese was "the worst thing that can happen to someone."
  • Defendants in lawsuits who are overweight are more likely to get slapped with a guilty verdict.
  • More than 70 percent of obese people reported being ridiculed about their weight by a family member.
  • Fifty-two percent of obese individuals believe they’ve been discriminated against when seeking employment or a promotion.
  • Children as young as 4 are reluctant to make friends with an overweight child.

A Self-Perpetuating Problem

All of these manifestations of fat stigma not only hurt emotionally and psychologically—increasing the risk of depression, body dissatisfaction, and low self-esteem—but they also contribute to the problem of obesity itself.

Arguing “it’s for their own good,” some people use blame and shame in an attempt to motivate obese individuals to lose weight. We know this doesn’t work. If it did, as stigma increases obesity would decrease. Instead, as obesity rates have risen, weight discrimination has also increased by 66 percent in the past decade.

Rather than motivating people to lose weight, weight discrimination increases the risk of obesity by as much as 2.5 times. This, in turn, makes individuals more vulnerable to weight discrimination, perpetuating a cycle of weight gain.

Weight bias in health care is particularly troublesome because it discourages people at high risk of health problems from receiving medical care or discussing health concerns with their doctor. After visiting health care professionals, obese patients report feeling disrespected, not taken seriously, and having all of their medical problems attributed to their weight.

Thinness = Success and Other Misconceptions

Why are overweight people judged so harshly?

Our society views thinness as a symbol of hard work, self-discipline, and willpower—values we have come to revere above all else in the Western world. People who are overweight are presumed to be lacking these virtues. In one study, two in five women said they would trade three to five years of their lives to achieve their ideal weight.

The media may contribute to the problem. In stories about obesity, news outlets on the Web use negative images of overweight people bulging out of ill-fitting clothes or gobbling down fast food or worse, as dehumanized, isolated body parts.

The public holds widespread misconceptions that minimize the complexities of obesity and how difficult it is to reverse, including that it is a temporary condition that is within the individual’s control. In a Reuters online poll, 61 percent of respondents blamed obesity on “personal choices about eating and exercise.”

These misconceptions flourish in spite of five decades of scientific research documenting the negative consequences of weight stigma and the fact that many causes of obesity are beyond the individual’s control. For example, genetics, economic status, upbringing, and the way parents talk to their children about weight all have a bearing on obesity.

The obesity epidemic also can be explained, at least in part, by people’s response to changes in their environment. Reductions in manual labor, greater density of fast-food restaurants and accessibility of inexpensive foods, heavy advertising of processed foods by the food industry, and safety concerns that make neighborhoods less walkable are a few examples of environmental contributors.

If people are so bothered by the stigma of being obese, why don’t they just lose weight? As anyone with a history of dieting knows, it’s extremely difficult to lose weight and even more difficult to keep it off. Moreover, weight stigma is so pervasive that research shows it lingers even after an individual has lost a significant amount of weight.

A Better Approach

Stigma doesn’t motivate people to make healthier choices and poses a serious threat to physical and psychological health. So what can we do? As it turns out, the opposite approach — one grounded in acceptance — is more effective.

Rather than focusing solely on personal responsibility, let’s tackle the bigger issue and work on changing the obesity-promoting environment. Rather than lecturing people about exercise and weight loss, let’s emphasize more effective approaches such as Health at Every Size.

Blaming the victim frees everyone else of responsibility, but with an epidemic as complex as obesity, we all have a role to play in prevention and treatment — and that includes not discriminating against people based on their weight or any other factor.

More from Carolyn C. Ross M.D., M.P.H.
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