Obesity Stigma: Changes Are Slow
Over the years, the way society thinks about obesity has undergone a profound transformation. What was once viewed as a simple issue of personal responsibility has now evolved into a more nuanced understanding of a complex, chronic condition influenced by various factors beyond individual control. This shift in thinking has far-reaching implications for public health, healthcare, and the well-being of individuals living with obesity.
From personal failure to a complex condition
For much of recent history, obesity was seen as the result of poor lifestyle choices — too much food and too little exercise. It was commonly viewed as a moral or personal failing, with public health campaigns often focusing on slogans like the “war on obesity” or the “obesity epidemic.”
These messages reinforced harmful stereotypes of larger-bodied people as lazy or lacking self-control. As a result, many people with obesity experience stigma, discrimination, and shame, not only from society but also within the healthcare system. (We’ve written plenty about fat shaming alone over the years.)
This narrow view of obesity failed to consider the broader range of factors that contribute to weight gain. In recent years, research has increasingly shown that obesity is influenced by a variety of complex factors, including genetics, socioeconomic status, psychological well-being, medications, and the environment. While diet and physical activity remain important, they are only part of the puzzle.
Is the word “obesity” offensive?
A recent article for The Conversation, “How we think about ‘obesity’ and body weight is changing. Here’s why,” Executive Editor Stephen Khan used the word “obesity” with an asterisk (“ob*sity”) throughout his article, explaining,
Historical reflections on the word “obesity” reveal its offensive origins, with advocates suggesting the term ob*sity should be used with an asterisk to acknowledge this. To show our respect, we will adopt this language here.
He also noted that in 2014, the American Medical Association classified obesity as a chronic disease, sparking debate about whether this label pathologizes natural body changes and fuels discrimination.
Why we should fight stigma
A lengthy article by the American Psychological Association by Zara Abrams cites plenty of research to back up the notion that stigma can lead to serious consequences in the person’s physical and mental well-being, quoting a few experts, including Sarah Novak, Ph.D., an associate professor of psychology at Hofstra University in Hempstead, New York, who says,
There’s a perception that weight stigma might feel bad but [that] it’s tough love and it’s going to motivate people… But research shows that this isn’t true.
Citing this and this research on the subject, Abrams writes,
Like other forms of bias and discrimination, weight stigma, also called sizeism, leads to suffering and psychological distress. Sizeism increases a person’s risk for mental health problems such as substance use and suicidality.
Perception of sizeism has been difficult to change
Sizeism is one of the most deeply entrenched stigmas in today’s society, partly because of “sociocultural ideals tying thinness to core American values such as hard work and individualism.” Abrams also notes that “weight-based bullying is more common than bullying based on race, sexual orientation, or disability status” among children, according to some research results published in the Journal of Adolescence. Sadly, family members are “high on the list of perpetrators.”
Psychologists have tested various interventions to reduce sizeism, including empathy-building and education about body weight. However, these approaches have had little effect on anti-fat biases. Unlike racism and sexism, weight discrimination remains legal in most places, with only a few states and cities banning it. This lack of legal protection allows weight-based discrimination in hiring, promotions, and wages to persist. Though public support exists for stronger protections, policy changes have been slow.
Shifting public health approaches
As our understanding of obesity has grown, so too has the way public health professionals approach the issue. The previous weight-centric model — where weight loss was the primary health goal — has come under scrutiny. Many experts now believe that focusing solely on weight loss can lead to negative outcomes, including weight cycling (repeatedly losing and regaining weight), increased stigma, and negative mental and physical health effects.
In response, a new weight-inclusive approach to health has gained momentum. This perspective promotes healthy behaviors — such as balanced eating, regular physical activity, and mental well-being — regardless of whether they lead to weight loss. This approach aims to reduce the harm caused by weight stigma and support people in improving their overall health, rather than fixating on a number on the scale.
The role of healthcare providers
Healthcare providers play a critical role in how obesity is addressed in medical settings. Historically, larger-bodied patients often experienced weight bias, even from their doctors. This stigma can lead to worse health outcomes, as patients may avoid seeking care or feel blamed for their condition rather than supported.
Today, there is a growing recognition of the need for more compassionate and inclusive care. Health professionals are encouraged to use person-first language (e.g., “person living with obesity”) to avoid reducing individuals to their weight. Additionally, clinicians are urged to shift their focus from weight to health behaviors, helping patients set goals around physical activity, nutrition, and mental well-being without making weight loss the central objective.
Your responses and feedback are welcome!
Source: “How we think about ‘obesity’ and body weight is changing. Here’s why,” The Conversation, 9/18/24
Source: “The burden of weight stigma,” American Psychological Association, 3/1/22
Image by RDNE Stock project
