The first two recommendations from the Senate’s “Select Committee into the Obesity Epidemic in Australia” final report addressed weight stigma. But you wouldn’t know it. Since its release in December last year, most publicity has highlighted recommendations for a tax on sugar sweetened drinks, advertising restrictions, and mandatory Health Star Ratings. So far, the recommendations regarding weight stigma have been overlooked.

The committee expressed support for “a move away from using the term ‘obesity’ in all prevention and intervention programs and public information campaigns, and move the focus from weight on to health.” (p. xv). Specifically, recommendations were made to avoid stigma and blame in all aspects of public health campaigns, and to increase understanding and awareness of stigma and blame among health professionals.

What is weight stigma?

Weight stigma refers to negative judgements made about a person on the basis of their body weight, shape, or size, and affects people across the weight spectrum. Weight stigma is a common experience, especially for people with larger bodies, but often goes unrecognised and unchallenged.

Weight stigma may be overt, such as being stared at, teased, or bullied, or less obvious, such as people making unsolicited comments about a person’s health or eating habits. People may share negative social attitudes about body weight and apply it to themselves; this is known as internalised weight stigma.

What causes weight stigma?

While there is no one cause of weight stigma, research shows that widely held social attitudes and beliefs about body weight, and its relationship to one’s health and self-worth, create a bias where thin = good and fat = bad. Family, friends, co-workers, classmates, teachers, and even health providers may share this bias, which influences their behaviour towards people with larger bodies.

Weight stigma is also often unintentionally reinforced in public health campaigns, the media, and through social media discourses, which oversimplify the relationships between weight and health through associating certain body shapes and sizes with risk and disease, while idealising others. In addition, emphasising an individual’s responsibility to maintain a “healthy” weight causes fear of weight gain, fuels body dissatisfaction and encourages blame, while ignoring the broader social, cultural, environmental, and commercial determinants of health.

What are the consequences of weight stigma?

There is a common belief that weight stigma is necessary to motivate people to lose weight. Research, however, shows that the opposite is true. Longitudinal studies show that weight-based teasing is associated with disordered eating behaviours, such as yo-yo dieting or binge eating, which can lead to further weight gain, poor body image, and eating disorders. A recent systematic review found that weight stigma is a chronic stressor that is independently associated with increased risk of cardiovascular disease and diabetes, as well as anxiety and depression.

Discrimination based on a person’s body weight, shape or size is common across work, education, leisure, and health care settings. Past experiences and fears of weight stigma can lead people to avoid social situations, such as eating and exercising in public, and delay seeking health care.

In health care settings, focusing on the appearance of people’s bodies, rather than their overall health, can have serious consequences. For instance, a person with an eating disorder may not be diagnosed because of their body size, or may receive inappropriate lifestyle and treatment recommendations that compromises their recovery.

What can be done to reduce weight stigma?

Too often, weight and weight stigma are seen as individual problems, with weight-loss, through diet and exercise, medication, or even bariatric surgery, offered as solutions. However, being a higher weight is not inherently unhealthy nor disabling. Rather, stereotypes, social attitudes, and physical environments create barriers to participation or actively exclude people with larger bodies.

Weight stigma is a social justice issue. Therefore, reducing stigma is a societal responsibility requiring education and cultural change. Choosing appropriate language is an important first step. The terms “obese” and “overweight”, for example, are unhelpful. While some researchers and organisations have argued for person-first language (e.g. person with obesity), fat activists prefer the term “fat”, which they have reclaimed as a neutral descriptor of their body size. A useful compromise is to recognise and respect the wishes of the person.

But, as the Senate Select Committee acknowledged, addressing weight stigma “goes far beyond a simple language issue” (p. 16). Like other complex public health challenges, addressing weight stigma requires a community-based, multi-strategy approach. We all have a role to play in addressing weight stigma. Here are a few practical ideas:

· Family members, friends, and colleagues can avoid making unsolicited comments about people’s bodies, eating habits, or exercise routines;

· Health professionals can avoid making assumptions about a person’s health based on their weight and focus treatment on the person and their identified concerns and priorities;

· Public health practitioners can empower people through campaigns that encourage sustainable health behaviours and address upstream determinants of health;

· Journalists and media can challenge negative stereotypes by featuring positive stories about people with larger bodies that do not focus on weight or weight-loss, and choosing images that preserve people’s humanity and dignity;

· Designers can employ the principles of universal design to create clothing, seating, and equipment for people of all body shapes and sizes that is both stylish and affordable; and

· Policy makers can include physical features (height, weight, size, shape) as a protected characteristic under human rights legislation (as is the case in some Australian states and Territories, including Victoria and ACT).

By listening to people’s lived experiences and recognising body weight as one aspect of human diversity, we can promote inclusion and acceptance of all people, regardless of their body weight, shape or size, and support their health, well-being and participation throughout life.

Written by Dr Carolynne White and Dr Natalie Jovanovski, Swinburne University of Technology.

The practical ideas shared in this article are informed by a research project conducted by Mikaela Foy that investigated community members’ experiences of weight stigma. We would like to acknowledge the participants who shared their experiences and ideas about how to address weight stigma.

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Image credit: representationmatters.me

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Registered occupational therapist and health promotion lecturer. Promoting health, well-being and participation for all people. Twitter: @Carolynne_OT

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