It’s Not About the Weight, It’s About the Weight Stigma

For decades, many health professionals have blamed individuals for their weight and recommended weight loss as a cure for all of their ailments. However, the latest research in weight science has revealed that body weight isn’t the concern it once was.

Researchers are finding that health behaviors are better predictors of mortality than body weight. In addition, researchers are discovering that weight stigma, more than weight itself, is harming health.

In honor of National Weight Stigma Awareness Week next week, let’s really dive into why we need to start reframing the “obesity epidemic” into the real culprit—a weight stigma epidemic.

In 2018, Tomiyama and her research team published an opinion piece titled "How and why weight stigma drives the obesity ‘epidemic’ and harms health." They made a strong case outlining specific mechanisms that explain why “weight stigma is harmful to health, over and above objective body mass index.”

With high levels of anti-fat bias in health care providers, patients at higher weights are receiving poorer care. And this fact just scratches the surface of why weight stigma is so bad for health. Here are five ways weight stigma harms health.

1. Weight bias worsens quality of care and is associated with health care avoidance

A health care provider communicates with a patient.

Source: CDC/Unsplash

Health care professionals often hold negative explicit and implicit biases about patients with higher weights. These negative attitudes are more socially acceptable than other forms of stigma and discrimination, as individuals at higher weights are often portrayed in the media as lazy, gluttonous, and undisciplined. Given the well-documented anti-fat attitudes within various health professions, it is no wonder that patients report receiving poor quality health care.

Alberga and her team looked at 21 different studies on patients’ perceptions of weight bias and how these experiences shape their engagement with their doctors. Overall, patients reported feeling that their providers were patronizing and disrespectful and that their providers often made false assumptions about causes of weight gain and attributed all health issues to excess weight. Patients noted poor communication from their providers and avoided or delayed their health care visits.

In fact, in other studies, weight stigma is associated with health care avoidance. Wetzel and colleagues found that for women, this association is strongest for those who report experiencing internalized weight bias, or the process of believing negative weight-related stereotypes.

Those who delay or avoid health care visits altogether can miss important screenings, diagnoses, and medical treatments.

2. Those experiencing weight stigma are less likely to engage in health-supporting behaviors

Weight stigma researchers have found that those who experience weight stigma have a poorer diet quality, more disordered eating behaviors, physical activity avoidance, sleep disturbances and higher rates of alcohol use, after controlling for BMI.

In fact, the frequency of weight stigma experiences seems to play a role. In 2018, Vartanian and colleagues followed 46 adults who reported prior stigma experiences for a two-week period and recorded their experiences with weight stigma along with their mood and their motivation to diet, exercise, and lose weight. On average, participants experienced weight stigma almost once per day, and the more frequently they experienced stigma, the less motivated they were to diet, exercise, and lose weight at the end of the day.

Across 54 different studies and 40,000 participants, those who experienced weight stigma were more likely to engage in unhealthy behaviors and less likely to engage in health-supporting behaviors.

3. Weight stigma causes a stress response

Weight stigma is stressful. Weight stigma researchers have explored biomarkers of stress, such as cortisol and C-reactive protein, and found that these levels are higher in those who report experiencing weight stigma. In fact, in a systematic review of 33 studies, weight stigma was positively associated with higher levels of cortisol, oxidative stress, and C-reactive protein. These stress signals can increase inflammation which may in part explain the negative physical health ramifications of weight stigma.

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4. Weight stigma is associated with higher rates of chronic disease

In a systematic review of 33 studies, weight stigma was positively associated with diabetes risk. In one study, higher weight women who had high blood pressure experienced elevated blood pressure in response to a stigmatizing experience, and this elevation persisted while they slept.

5. Weight stigma is associated with psychological distress and poor mental health

In a large meta-analysis of 105 studies, there was a tight link between weight stigma and poor mental health. In another meta-analysis with 30 studies, weight stigma was associated with higher rates of psychological distress, including depression and anxiety. How people cope with the weight stigma also seems to matter. Some people cope by turning to maladaptive eating, like dieting or bingeing. This response also links weight stigma to poorer mental health, including more depression and lower self-esteem.

If health care providers truly care about the health and well-being of their patients, they'll bypass the "just lose weight" messaging and instead just lose the weight bias.

To learn more, read Understanding and Combating Weight Stigma.