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Weight Stigma

Definition

Weight stigma has been broadly defined as bias (prejudicial and negative attitudes, beliefs, and/or stereotypes) or discriminatory behaviors targeted at individuals with overweight or obesity or who are perceived to carry excess body weight.[1][2] Weight stigma is present in multiple domains, such as healthcare, education, media, and interpersonal settings, and is perpetrated by friends, family, and the individual him- or herself.[2]

Prevalence of Weight Stigma

Researchers have found that over previous decades, the prevalence of reports of weight-based discrimination has increased 66%, rising from 7% in the 1990s to 12% in the 2000s.[3] Newer prevalence estimates, however, are needed. Comparatively, individuals with overweight and obesity as a group are rated more negatively than many other stigmatized groups, including sexual minorities and persons with mental illnesses.[4] Additionally, weight-based discrimination has been found to be comparable to race-based discrimination, and among women, weigh-based discrimination is the third most commonly reported source of discrimination, more prevalent than race-based discrimination.[5]

Uniqueness of Weight Stigma

Weight stigma is a unique source of stigma, for many reasons including the following:

  1. Many studies have evidenced that experiencing weight stigma may actually perpetuate behaviors associated with obesity, such as unhealthy eating behavior and lack of exercise,[4][6] suggesting that experiencing weight stigma may exacerbate the condition eliciting stigma in the first place. This is not the case with other forms of stigma such as race stigma.
  2. Individuals with overweight and obesity are blamed for their obesity. However the literature broadly supports that sustained weight loss is extremely difficult and unattainable for most. Moreover, obesity is actually related to several inheritable genetic factors.[4]
  3. While many targets of bias and stigma are minorities, overweight and obesity actually comprise a numerical majority in the United States and many other parts of the world.
  4. Unlike other forms of discrimination, weight-based discrimination is not only legal (see “Policy” section below), but some government agencies and health policy scholars actually recommend promoting weight stigma as a treatment and intervention tactic for reducing obesity (see “Weight Stigma and Public Health: A Tool or a Threat?” below).
  5. Individuals with overweight and obesity do not receive in-group protection; in fact increased BMI is not associated with decreased weight bias,[7] and research has found that individuals with overweight and obesity actually show devaluation of their own in-group and prefer the out-group (i.e., thin people).
  6. An individual does not have to be obese to experience weight stigma, as even individuals who are normal weight by BMI standards can attribute discrimination or mistreatment to their body weight.[8]

Domains of Weight Stigma

A 2009 review of the weight stigma literature by Puhl and colleagues identified that weight stigma is present in multiple settings including healthcare, education, interpersonal situations, multiple media forms and outlets, and across many levels of employment.[2] Weight stigma's presence in these domains will be elaborated upon in the following sections with evidence from several empirical review papers:

Employment

A recent review of weight stigma in employment settings revealed that individuals with overweight and obesity face bias and discrimination in virtually all aspects of employment.[9] This weight stigma manifests in multiple forms of employment discrimination including difficulty obtaining a job, worse job placement, lower wages and compensation, unjustified denial of promotions, harsher discipline, unfair job termination, and commonplace derogatory jokes and comments from coworkers and supervisors.[2][9] In fact, employees with overweight and obesity report their weight as the most influential factor contributing to losing their job.[2] Another review found that certain stereotypes about employees with overweight and obesity are highly endorsed by employers and supervisors, in particular that they have poorer job performance and that they lack interpersonal skills, motivation, and self-control.[10] 

Healthcare

Many studies provide evidence supporting the notion that health professionals (including doctors, nurses, medical students, fitness professional, and dietitians) consistently endorse negative stereotypes about patients with overweight and obesity, in particular ascribing to them culpability for their weight status.[2] Weight stigma in the healthcare settings leads to impaired patient-provider communication, poorer doctor-patient relationships, poorer medical care and treatment (for example doctors spending less time with patients), and avoidance of the healthcare system all together on the part of the patient.[2] However, it is important to point out that the evidence that has been reviewed thus far comes primarily from self-report studies. Therefore, research examining actual health outcomes is needed.[2] Overall, the impact of weight stigma in healthcare has become so problematic that many scholars have suggested that obesity-prevention programs should make minimizing stigma a priority.[2][11]

Interpersonal Situations

Although a less studied topic than employment and healthcare, several studies provide evidence that women with overweight and obesity, in particular, face weight stigma from many interpersonal sources including family, friends, and romantic partners.[2]

Media

In entertainment, news reporting, and advertising, media is a particularly potent source of weight stigma. News reports have blamed individuals with overweight and obesity for various societal issues including prices of fuel, global temperature trends, and precipitating weight gain among their peers.[2] The literature also documents how in television programs, actors with overweight and obesity are often cast in minor roles, if at all. Programs also often depict them as the targets of teasing and derogation and are often portray them as displaying eating behaviors stereotypical to overweight and obesity.[2] This relatively low social status of assigned to characters with overweight and obesity in television is also evidenced in children’s television, a tendency that has been found to perpetuate antifat attitudes among viewers.[2]    

Physical and Mental Health Consequences of Experiencing Weight Stigma

Physical Health and Physiological Consequences

In both adults and children with overweight and obesity, several reviews of the literature have found that across a variety of studies, there is a consistent relationship between experiencing weight stigma and many negative mental and physical health outcomes.[2][4][6] which will be discussed below (Papadopoulos & Brennan, 2015; Puhl & Heuer, 2009; Puhl & Suh, 2015a, 2015b; Vartanian & Smyth, 2013).

Mental Health and Psychological Consequences

Policy

Weight Stigma and Public Health: A Tool or a Threat?

References

  1. ^ Puhl, R. M.; Brownell, K. D. (2003-11-01). "Psychosocial origins of obesity stigma: toward changing a powerful and pervasive bias". Obesity Reviews. 4 (4): 213–227. doi:10.1046/j.1467-789X.2003.00122.x. ISSN 1467-789X.
  2. ^ a b c d e f g h i j k l m n Puhl, Rebecca M.; Heuer, Chelsea A. (2009-05-01). "The Stigma of Obesity: A Review and Update". Obesity. 17 (5): 941–964. doi:10.1038/oby.2008.636. ISSN 1930-739X.
  3. ^ Andreyeva, Tatiana; Puhl, Rebecca M.; Brownell, Kelly D. (2008-05-01). "Changes in Perceived Weight Discrimination Among Americans, 1995–1996 Through 2004–2006". Obesity. 16 (5): 1129–1134. doi:10.1038/oby.2008.35. ISSN 1930-739X.
  4. ^ a b c d Vartanian, Lenny R.; Smyth, Joshua M. (2013-01-04). "Primum Non Nocere: Obesity Stigma and Public Health". Journal of Bioethical Inquiry. 10 (1): 49–57. doi:10.1007/s11673-012-9412-9. ISSN 1176-7529.
  5. ^ Puhl, R. M.; Andreyeva, T.; Brownell, K. D. (2008-03-04). "Perceptions of weight discrimination: prevalence and comparison to race and gender discrimination in America". International Journal of Obesity. 32 (6): 992–1000. doi:10.1038/ijo.2008.22. ISSN 0307-0565.
  6. ^ a b Papadopoulos, Stephanie; Brennan, Leah (2015-09-01). "Correlates of weight stigma in adults with overweight and obesity: A systematic literature review". Obesity. 23 (9): 1743–1760. doi:10.1002/oby.21187. ISSN 1930-739X.
  7. ^ Latner, J. D.; O'Brien, K. S.; Durso, L. E.; Brinkman, L. A.; MacDonald, T. (2008-04-15). "Weighing obesity stigma: the relative strength of different forms of bias". International Journal of Obesity. 32 (7): 1145–1152. doi:10.1038/ijo.2008.53. ISSN 0307-0565.
  8. ^ Carr, Deborah; Friedman, Michael A. (2005-09-01). "Is Obesity Stigmatizing? Body Weight, Perceived Discrimination, and Psychological Well-Being in the United States". Journal of Health and Social Behavior. 46 (3): 244–259. doi:10.1177/002214650504600303. ISSN 0022-1465. PMID 16259147.
  9. ^ a b Nowrouzi, Behdin. "Weight Bias in the Workplace: A Literature Review". Occupational Medicine & Health Affairs. 03 (03). doi:10.4172/2329-6879.1000206.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  10. ^ Giel, Katrin Elisabeth; Thiel, Ansgar; Teufel, Martin; Mayer, Jochen; Zipfel, Stephan. "Weight Bias in Work Settings – a Qualitative Review". Obesity Facts. 3 (1): 33–40. doi:10.1159/000276992.
  11. ^ MacLean, Lynne; Edwards, Nancy; Garrard, Michael; Sims-Jones, Nicki; Clinton, Kathryn; Ashley, Lisa (2009-03-01). "Obesity, stigma and public health planning". Health Promotion International. 24 (1): 88–93. doi:10.1093/heapro/dan041. ISSN 0957-4824. PMID 19131400.
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