Stigma & Weight Bias in the Media

By Gwenyth Brockman

Editor’s Note: In doing knowledge translation (KT) and engaging patients and the public in health research, we have to consider the language we use to talk about health conditions and the people living with them. The way we portray health and illness affects how our research and the people involved are perceived by stakeholders and the general public. Additionally, we need to consider that the way in which we frame our research can also have an impact on the bigger picture — that is, social determinants of health. Gwen Brockman breaks down how weight bias and associated stigma can be damaging, how the media often contributes to this stigma, and why this matters in health research.

Discrimination as Policy

Last year there were several stories in the media about experiences of weight discrimination in healthcare. One memorable story was about England’s National Health Service considering a ban on surgeries for non-life-threatening conditions, such as hip and knee surgeries, for patients who smoke or are clinically obese (i.e.: have a body mass index over 30). Patients who smoke or are obese have a higher risk of complications during these surgeries, which is why the policy was proposed as a cost-saving measure in the face of limited resources, thus reserving spots for more lower-risk patients.

The proposed policy however, was highly criticized. In an article published in The Guardian, one surgeon stated that a policy that restricted care based on weight bias was equivalent to “racial discrimination”.

We have heard obesity called an epidemic, as now approximately 1 in 4 Canadian adults are living with the condition, and its prevalence is increasing worldwide [1]. However, few are aware of the “shadow epidemic” of stigma and discrimination. Weight stigma or weight bias refers to the negative attitudes and feelings our society typically has towards someone who is overweight or obese [2]. For example, obesity is often associated with stereotypes of laziness and lack of willpower. The Canadian Obesity Network has described weight bias as the “last form of socially acceptable prejudice”.

Why the Stigma?

Obesity is not yet fully understood, and is often perceived to be completely within the control of individuals — based on their choice of what to eat, how much, and their levels of exercise. While personal choices are important, in no way are they able to explain obesity entirely. From what researchers understand so far, obesity is a complex condition likely resulting from overlapping and intersecting environmental and genetic factors including socioeconomic status [3], family history, and psychological factors, and even your gut microbiota [4] — to name a few — most of which are uncontrollable on an individual level.

Current conceptualizations of obesity range from recognizing it as a disease requiring intervention, to considering obesity as a social construct based on weight bias, stigma, and perceptions of society. For more on the on the historical, social and cultural context of obesity, check out Obesity in Canada: Critical Perspectives, co-authored by the University of Manitoba’s very own Dr. Deborah McPhail.

Regardless of where you think obesity fits on this spectrum, however, the fact remains that our society tends to shame and blame people for their weight. Why is that a problem, if high body mass index (BMI) has been identified as a risk factor for a growing list of chronic diseases [1]?

The problem is that mounting evidence indicates that weight bias internalization (WBI), which includes self-directed shaming, negative weight-related attitudes, and stereotypes about ones self, is a risk factor for chronic disease in and of itself [5]. That’s not to mention the highly damaging social and psychological effects of weight bias. We need to ensure that we treat people living with obesity as just that — people — without further contributing to weight bias and discrimination.

The Media and Weight Bias

The media can be particularly bad with perpetuating weight bias, even in articles that are about the problem of weight bias and discrimination. Often, this only further contributes to existing prejudices and stereotypes surrounding obesity and weight. For example, many news articles identify people by their condition first — an ‘obese person’, rather than someone living with obesity, who does not define themselves solely by their weight (e.g.: in The Guardian, BBC, and even our very own CBC).

Additionally, images used to portray obesity need to be more closely examined for their potential negative effects. Many of the photos used in news articles related to weight and obesity show only a stomach or parts of the body, without showing a person’s face — in The Telegraph, BBC, National Post, and again The Guardian. These kinds of images are dehumanizing and reinforce negative attitudes towards people who are overweight or obese. Similarly, images used in the media regarding obesity that show unhealthy food or people eating are not helpful in trying to change current stereotypes.

What Can We Do?

We need to find better ways to talk about obesity, and to portray people living with obesity, without resorting to shaming or common stereotypes. We may all have our own inherent biases (which you can explore with tools like Harvard’s Project Implicit tests), but it is necessary to find ways to overcome them in our work. Take the time to reflect on your own biases, try to educate yourself more on the condition, and consciously think about how the words you say and things you do may affect others. Two major things we can remember to do are: (1) Always use people first language when writing or speaking about people with obesity, and (2) use positive images when portraying people living with obesity.

People First Language

People first language literally means putting people first, before their condition. People first language avoids labeling people by the disease, condition, or disability they may have, recognizing these conditions are descriptors, and not identifiers. For examples of people first language, visit Carolyn’s post on Evidence Network.

Positive Images

A number of organizations have publicly available, open access galleries of positive images of people with obesity to help change perceptions, and to promote representation of people as more than just their condition. Galleries include those by the Obesity Action Coalition, the Canadian Obesity Network, the World Obesity Federation, and the European Association for the Study of Obesity.

Overall, putting people first, before their condition — whether it be obesity, cancer, or diabetes — is critical to ensuring our work is focused on helping patients and the public, and ensuring we understand their needs and priorities for health research.

References

1. The GBD Obesity Collaborators. Health Effects of Overweight and Obesity in 195 Countries over 25 Years. NEJM, 2017.
2. GermAnn et al. From Weight to Well-Being: Time for a Shift in Paradigms? PHSA, 2013: Vancouver, BC.
3. Newton et al. Socio-economic status over the life course and obesity: Systematic review and meta-analysis. PLoS One, 2017.
4. DiBaise et al. Impact of the Gut Microbiota on the Development of Obesity: Current Concepts. Am J Gastroenterol Suppl, 2012.
5. Kahan & Puhl. The damaging effects of weight bias internalization. Obesity, 2017.

About the Author

Gwenyth Brockman is a former Research Assistant with the George &Fay Yee Centre for Healthcare Innovation.