Obesity: the forgotten stigma
Sadly, prejudice and discrimination are still rife in the world today. Some of which regularly make the news and form large parts of political agendas. One form of discrimination is often unacknowledged however, and that is weight stigma.
“Weight stigma refers to the discriminatory acts and ideologies targeted towards individuals because of their weight and size. Weight stigma is a result of weight bias. Weight bias refers to the negative ideologies associated with obesity.” – definition from the World Obesity Federation.
A recent study published in The Lancet indicate that there are more than a billion people living with obesity worldwide, including approximately 880 million adults and 159 million children1. The obesity pandemic has been growing much like, for example, the rapid rise in dementia and although stigma does exist for people with dementia causing social isolation, it is nowhere near the level of that toward obesity. It is possibly the most stigmatized health condition which begs the question: why?
Obesity is clouded by misconceptions, with individuals frequently facing judgment and blame for what is erroneously perceived as a mere lifestyle choice. Other negative ideologies associated with obesity can be laziness, lack of will power, a lack of moral character, bad hygiene, low level of intelligence, and unattractiveness.
On the contrary, obesity is a complex condition with multifaceted origins, involving genetic, environmental, and behavioral/psychological factors. It is not solely a consequence of overeating and lack of exercise. According to the World Health Organization (WHO)2, the risk of comorbidities associated with obesity (BMI ≥ 30 kg/m2) increases with BMI. However, research has shown that the widespread stigma and discrimination experienced by those living with obesity is a stronger predictor of poor health outcomes than BMI3. People who experience weight discrimination are reported to have higher levels of stress hormones and inflammatory markers, higher long-term cardiometabolic risk, and increased mortality. It is also associated with poor mental health and increased risk of depression, anxiety, social isolation, low self-esteem, substance use, binge eating, emotional overeating, and unhealthy weight control behaviors.
The widespread culture of weight bias feeds into all aspects of life, including education, work, and personal relationships. A WHO report revealed that school-aged children with obesity experience a 63% higher chance of being bullied and 54% of adults with obesity reported being stigmatized by their co-workers4.
One area you may not suspect a disease-related bias is in the healthcare setting itself, but you would be wrong. The same report revealed that 69% of adults with obesity experienced stigma from healthcare professionals (HCPs). It has also been reported that HCPs spend less time in appointments, perform fewer medical interventions, and are more reluctant to perform certain screenings for people living with overweight or obesity compared to their healthy-weight counterparts5. In healthcare environments, weight stigma proves especially detrimental as it disrupts the very system intended to address the issue.
People struggling with obesity depend on healthcare support, and so if the bias is coming from those shaping and operating within these services it results in suboptimal care, a breakdown of patient–physician trust, and ultimately much worse outcomes for both the patient and the healthcare system. In the context of children or adolescents dealing with obesity, HCPs might not only demonstrate bias against the child but also toward the caregivers by placing blame on them for the child’s weight.
Shifting the narrative surrounding obesity from a lifestyle choice to a chronic disease is imperative for fostering a compassionate and effective approach to its management. Everyone needs to assess their personal weight bias and take steps to build a more inclusive and less judgmental environment for people battling obesity. Without this, the pandemic will only continue to grow.
Click here to watch two experts discuss the importance of overcoming weight bias and how to develop holistic and effective management plans for adolescents with overweight or obesity.