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Social stigma of obesity is
bias Bias is a disproportionate weight ''in favor of'' or ''against'' an idea or thing, usually in a way that is inaccurate, closed-minded, prejudicial, or unfair. Biases can be innate or learned. People may develop biases for or against an individ ...
or
discriminatory Discrimination is the process of making unfair or prejudicial distinctions between people based on the groups, classes, or other categories to which they belong or are perceived to belong, such as race, gender, age, class, religion, or sexu ...
behaviors targeted at
overweight Being overweight is having more body fat than is optimally healthy. Being overweight is especially common where food supplies are plentiful and lifestyles are sedentary. , excess weight reached epidemic proportions globally, with more than ...
and
obese Obesity is a medical condition, considered by multiple organizations to be a disease, in which excess body fat has accumulated to such an extent that it can potentially have negative effects on health. People are classified as obese when ...
individuals because of their weight and high
body fat percentage The body fat percentage of an organism is the total mass of its fat divided by its total body mass, multiplied by 100; body fat includes essential body fat and storage body fat. Essential body fat is necessary to maintain life and reproductive fu ...
. Such
social stigma Stigma, originally referring to the visible marking of people considered inferior, has evolved to mean a negative perception or sense of disapproval that a society places on a group or individual based on certain characteristics such as their ...
s can span one's entire life as long as excess weight is present, starting from a young age and lasting into adulthood. Studies also indicate overweight and obese individuals experience rates of stigma near prevalent to that of racial discrimination. Stigmatization of obesity is usually associated with increased health risks (morbidity) of being overweight or obese and the possibility of a shorter lifespan (mortality). Obese people marry less often, experience fewer educational and career opportunities, and on average earn a lesser income than
normal weight Normal(s) or The Normal(s) may refer to: Film and television * ''Normal'' (2003 film), starring Jessica Lange and Tom Wilkinson * ''Normal'' (2007 film), starring Carrie-Anne Moss, Kevin Zegers, Callum Keith Rennie, and Andrew Airlie * ''Norma ...
individuals. Although public support regarding disability services, civil rights, and anti-workplace discrimination laws for obese individuals have gained support across the years, overweight and obese individuals still experience discrimination, which may have detrimental implications in relation to both physiological and psychological health. These issues are compounded by the significant negative physiological effects that are already associated with obesity, which some have proposed may be caused in part by stress from the social stigma of obesity (or which may be made more pronounced as a result of that stress). Anti-fat bias refers to
prejudicial Prejudice can be an affective feeling towards a person based on their perceived social group membership. The word is often used to refer to a preconceived (usually unfavourable) evaluation or classification of another person based on that perso ...
assumptions that are based on an assessment of a person as being overweight or obese. It is also known as "fat shaming" or "fatphobia". Anti-fat bias can be found in many facets of society, and fat activists commonly cite examples of
mass media Mass media include the diverse arrays of media that reach a large audience via mass communication. Broadcast media transmit information electronically via media such as films, radio, recorded music, or television. Digital media comprises b ...
and
popular culture Popular culture (also called pop culture or mass culture) is generally recognized by members of a society as a set of cultural practice, practices, beliefs, artistic output (also known as popular art
f. pop art F is the sixth letter of the Latin alphabet. F may also refer to: Science and technology Mathematics * F or f, the number 15 (number), 15 in hexadecimal and higher positional systems * ''p'F'q'', the hypergeometric function * F-distributi ...
or mass art, sometimes contraste ...
that pervade this phenomenon.


Characteristics

Weight-related stigma can be characterized by the following aspects: * An individual does not have to be overweight or obese to experience weight-related stigma. * Studies have indicated that experiencing weight stigma reinforces lifestyle behaviors that contribute to obesity. * Individuals who are overweight or obese tend to devalue their own in-group and prefer the out-group (i.e. thinner individuals).


Prevalence

Individuals who are subjected to weight-related stigma appear to be rated more negatively when compared with other groups, such as
sexual minorities Sexual and gender minorities (SGM) comprise individuals whose sexual identity, sexual orientation, sexual behavior, or gender identity differ from the majority of the surrounding society. Sexual minorities include lesbians, gay men, bisexual peo ...
and those with
mental illness A mental disorder, also referred to as a mental illness, a mental health condition, or a psychiatric disability, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. A mental disorder is ...
. In the US, self-reported incidents of weight-based
discrimination Discrimination is the process of making unfair or prejudicial distinctions between people based on the groups, classes, or other categories to which they belong or are perceived to belong, such as race, gender, age, class, religion, or sex ...
increased from 1995 to 2006. Anti-fat bias has been observed in groups hoping to become physical education instructors. In a study published in 2007, a group of 344 psychology or
physical education Physical education is an academic subject taught in schools worldwide, encompassing Primary education, primary, Secondary education, secondary, and sometimes tertiary education. It is often referred to as Phys. Ed. or PE, and in the United Stat ...
majors at a New Zealand University were compared, and it was found that the prospective physical education teachers were more likely to display implicit anti-fat attitudes than the psychology majors. A number of studies have found that
health care providers A health professional, healthcare professional (HCP), or healthcare worker (sometimes abbreviated as HCW) is a provider of health care treatment and advice based on formal training and experience. The field includes those who work as a nurse, phys ...
frequently have explicit and/or implicit biases against overweight people, and it has been found that overweight patients may receive lower quality care as a result of their weight. Medical professionals who specialize in the treatment of obesity have been found to have strong negative associations toward obese individuals. The stress from obesity-related stigma may also cause negative health outcomes. A 2004 study in
preschool A preschool (sometimes spelled as pre school or pre-school), also known as nursery school, pre-primary school, play school, is an school, educational establishment or learning space offering early childhood education to children before they ...
-aged children reported a preference for average-sized children over overweight children as friends. Overweight individuals often found themselves suffering repercussions in many facets of society, including legal and employment issues later in their life. According to a 2010 review of published studies, interventions seeking to reduce prejudice and
social stigma Stigma, originally referring to the visible marking of people considered inferior, has evolved to mean a negative perception or sense of disapproval that a society places on a group or individual based on certain characteristics such as their ...
against fat and
obesity Obesity is a medical condition, considered by multiple organizations to be a disease, in which excess Adipose tissue, body fat has accumulated to such an extent that it can potentially have negative effects on health. People are classifi ...
are largely ineffective.


Theoretical explanations

In order to understand weight-biased attitudes, theories have been proposed to explain these biases and the subsequent discrimination they cause. Christian S. Crandall discusses the "Justification of Stigmatization". Also his Social Ideology Perspective draws on traditional North American values of
self-determination Self-determination refers to a people's right to form its own political entity, and internal self-determination is the right to representative government with full suffrage. Self-determination is a cardinal principle in modern international la ...
, individualism, and self-discipline. Based on these values, anti-fat attitudes may derive from directing blame for being overweight towards individuals who are overweight. Similarly, the
attribution theory Attribution is a term used in psychology which deals with how individuals perceive the causes of everyday experience, as being either external or internal. Models to explain this process are called Attribution theory. Psychological research into ...
suggests that attitudes towards obese individuals are dependent on how much control they are perceived to have over their weight. Throughout the literature, numerous studies have shown support for this theory. One study conducted a multinational examination of weight bias across four countries (Canada, United States, Iceland, and Australia) with comparable obesity rates. The study found that attributions of behavioral causes of obesity were associated with greater weight bias. Similarly, viewing obesity as being caused by a lack of willpower was also associated with greater weight bias. There appears to be a decrease in weight bias when weight is attributed to factors that are less within the individual's control, or when individuals are perceived as trying to lose weight. However, evidence also exists showing that biases against obese individuals also include disgust towards them, which can persist regardless of if one knows that obesity is not caused by obese individuals' actions. Fatphobia does not generally refer to a fear of obese people, but rather a socially constructed phenomenon of particular prevalence in the western world. People, often said to be living in the west, value healthy and strong bodies that prioritize agility, endurance and fertility - with focus on achievement and individual responsibility. Not only do such bodies associate the western world with similar ideals, but Lloyd deMause suggests the 'fitness/toughness craze' may also reflect preparations for war. The overabundace of high caloric, depleted of nutrients and other essential vitamins and minerals and food options more common in the western hemisphere is often associated with people who are against fat phobia. The 'fattening huts' of young girls in Nigeria however, represent beauty, marriageability and money – a direct reflection of the value of economic resource and food. There, fatness is a welcome sign of health, prosperity and maternity - linked to self-worth and sexuality also. Fatphobia does not fear 'fat' but prejudice, discrimination, exclusion and preventable disease too - fears directly attributable to the myriad of social, political, historical, economic and cultural processes at work (that do not similarly exist in other cultures). In this way, fatphobia is a culturally-derived phenomenon influencing relationships to food as well to the female form. Trends in 'blame, shame and stigma' have contributed to fat positivity and 'health at every size' movements, that create digital 'safe spaces' for activism and radical fat acceptance that seek to resist/shift such powerful cultural perspectives.


Trait attribution

Anti-fat bias leads people to associate individuals who are overweight or obese with negative personality traits such as "lacking willpower", "lazy", "gluttonous", "stupid", "incompetent", or "unmotivated". This bias is not restricted to
clinically obese Obesity is a medical condition, considered by multiple organizations to be a disease, in which excess Adipose tissue, body fat has accumulated to such an extent that it can potentially have negative effects on health. People are classifi ...
individuals. It also encompasses those whose
body shape Human body shape is a complex phenomenon with sophisticated detail and function. The general shape or figure of a person is defined mainly by the molding of skeletal structures, as well as the distribution of muscles and adipose tissue, fat. Ske ...
is found to be unacceptable when compared to modern society's perception of the ideal body type (although still within the normal or overweight
body mass index Body mass index (BMI) is a value derived from the mass (Mass versus weight, weight) and height of a person. The BMI is defined as the human body weight, body mass divided by the square (algebra), square of the human height, body height, and is ...
(BMI) range). Fat-shaming is fairly common in the United States, even though most adult Americans are overweight. ''Huffington Post'' wrote "two-thirds of American adults are overweight or obese. Yet
overweight Being overweight is having more body fat than is optimally healthy. Being overweight is especially common where food supplies are plentiful and lifestyles are sedentary. , excess weight reached epidemic proportions globally, with more than ...
and obese individuals are subject to discrimination from employers, healthcare professionals, and potential romantic partners". Anti-fat bias can be moderated by giving a mitigating context to the individual's appearance of obesity. For example, when told an individual was obese because of "
overeating Overeating occurs when an individual consumes more calories than the energy that is expended via physical activity or expelled via excretion, or when they consume food past the point of satiation, often leading to weight gain and often obesity. O ...
" and "
lack of exercise Sedentary lifestyle is a lifestyle type, in which one is physically inactive and does little or no physical movement and/or exercise. A person living a sedentary lifestyle is often sitting or lying down while engaged in an activity like soci ...
", a higher implicit bias was found among study participants than those not provided with context. When the group was told that "
genetics Genetics is the study of genes, genetic variation, and heredity in organisms.Hartl D, Jones E (2005) It is an important branch in biology because heredity is vital to organisms' evolution. Gregor Mendel, a Moravian Augustinians, Augustinian ...
" was to blame, they did not exhibit a lowered implicit bias after the explanation. Anti-fat bias is not a strictly Western cultural phenomenon. Instances of implicit anti-fat bias have been found across several cultures. Additionally, recent work around physical appearance issues,
body image Body image is a person's thoughts, feelings and perception of the aesthetics or sexual attractiveness of their own body. The concept of body image is used in several disciplines, including neuroscience, psychology, medicine, psychiatry, psycho ...
, and anti-fat or obesity prejudice suggests that feelings about one's own appearance may stimulate downward physical comparisons with obese individuals in order to make one feel better about one's own physical appearance.


Weight discrimination

Weight stigma is present in multiple settings including healthcare, education, interpersonal situations, multiple media forms and outlets, and across many levels of employment.


In the media

Media, in general, overrepresents underweight individuals and underrepresents overweight individuals. One-third of women in television are classified as underweight, while only 5% of the general population falls into that category. Conversely, a study on over a thousand major television characters from 2003 identified 14% of female characters and 24% of male characters to be overweight, despite the real-world percentages being more than double those reported numbers. Even when overweight people are included in television, they often play minor, stereotyped roles. Nearly two thirds of the most popular children's movies contain negative portrayals of fat people, stereotyping them to be unintelligent, lazy, and evil. Fat television characters are more commonly seen eating and are less likely to be involved in romantic relationships compared to average weight television characters. Male characters are less commonly portrayed as having close friendships. In 2007, another analysis sampled 135 scenes featuring overweight individuals from popular television programs and movies are coded for anti-fat humor. The majority of anti-fat humor found was verbal and directed at the individual in their presence. Additionally, a relationship was found between audience laughter and a male character poking fun at a female character's body, but that same relationship wasn't there when it was a female character ridiculing a fat male. There is a great deal of empirical research to support the idea of
thin ideal The thin ideal is the concept of the ideally slim female body. The common perception of this ideal is a woman who possesses a slender, feminine physique with a small waist and little body fat. The size that the thin ideal woman should be is decrea ...
media, or the idea that the media tends to glorify and focus on thin actors and actresses, models, and other public figures while avoiding the use of overweight individuals. Puhl et al. (2009) also reviewed how in entertainment, news reporting, and advertising, media is a particularly potent source of weight stigma. News reports have blamed individuals who are overweight and obese for various societal issues including prices of fuel, global temperature trends, and precipitating weight gain among their peers. The news media repeatedly engages in the "Headless Fatties" phenomenon, coined by Charlotte Cooper, in which images and videos only depict overweight individuals as bodies by cropping out their heads. This objectification happens in 72% of all news reports on obesity. The
University of California, Los Angeles The University of California, Los Angeles (UCLA) is a public university, public Land-grant university, land-grant research university in Los Angeles, California, United States. Its academic roots were established in 1881 as a normal school the ...
, conducted a study that analyzed scientific research on weight and the news reports on such research. They looked for disparities in language, the cited causes of obesity, and proposed solution. News stories were more likely than the scientific articles to use dramatized language, words such as epidemic, crisis, war, and terrorism, and were more likely to cite individual behaviors as the causes and solutions to obesity, ignoring the systemic issues. In September 2011, prominent nationally syndicated columnist
Michael Kinsley Michael E. Kinsley (born March 9, 1951) is an American political journalist and commentator. Primarily active in print media as both a writer and editor, he also became known to television audiences as a co-host on '' Crossfire''. Early life and ...
(founding editor of ''Slate'' magazine) wrote, "New Jersey Governor
Chris Christie Christopher James Christie (born September 6, 1962) is an American politician and former United States Attorney, federal prosecutor who served as the 55th governor of New Jersey from 2010 to 2018. A member of the Republican Party (United States) ...
cannot be president: He is just too fat ... why should Christie's weight be more than we can bear in a president? Why should it even be a legitimate issue if he runs? One reason is that a presidential candidate should be judged on behavior and character ... Perhaps Christie is the one to help us get our national appetites under control. But it would help if he got his own under control first." Governor Christie responded on October 4, 2011, stating "The people who pretend to be serious commentators who wrote about this are among the most ignorant I've ever heard in my life. To say that, because you're overweight, you are therefore undisciplined—you know, I don't think undisciplined people get to achieve great positions in our society, so that kind of stuff is just ignorant." In 2013, Haley Morris-Cafiero's photography project "Wait Watchers", in which she photographed the reactions to her presence by random passers-by, went viral. ''New York'' magazine wrote, "The frequency with which Morris-Cafiero succeeds at documenting passersby's visible disdain for her body seems pretty depressing".


In education

In regards to more direct weight bias, obese individuals were 40–50% more likely to report a perception of major discrimination compared to those of average weight across a multitude of settings. In the educational setting, those who are overweight as youth often face peer rejection and are bullied more. Overweight children have poorer school performance if they experience weight-based teasing. Between fifth and eighth grade, a child's increase in BMI results in a decrease in their teacher's perception of that student's ability, and 50% of principals believe fatness is just a result of lacking self control. Teachers, particularly those teaching physical education classes, sometimes express negative attitudes towards overweight individuals. Research suggests that within the classroom teachers may perceive overweight individuals' work more poorly compared to average weight individuals. Students also perceive overweight individuals as being likely to have lower GPAs, and students are less likely to want to do groupwork with overweight individuals compared to average weight individuals. Research has also found that overweight females receive less financial support for education from their families than average weight females, after controlling for ethnicity, family size, income, and education. As individuals grow older they may be less likely to be admitted to college than individuals of an average weight, and in some cases, people were admitted to academic institutions then dismissed due to their weight. Puhl and colleagues (2009) concluded from their review of weight stigma in education that current trends indicate students with obesity face barriers to educational success at every level of education. Reviewed research demonstrates that educators, particularly physical education teachers, report antifat attitudes toward their students with obesity, which may undermine educational achievement. Importantly, the education disparities for students with obesity appear to be strongest for students attending schools where obesity is not the norm. Several studies have evidenced that in environments such as these, students with obesity face greater educational disadvantages and are less likely to attend college, an effect that is particularly strong among women. Moreover, weight stigma in educational settings also affects interpersonal relationships (see "Interpersonal situations" below).


In employment

Studies suggest that obese individuals are less likely to be hired and once hired, have greater termination rates than average weight individuals. Specifically, a national survey found that obese individuals were 26% more likely not to be hired, not receive a promotion, or to be fired compared to average weight persons. Such outcomes may be a result of employers viewing them as less agreeable, less competent and lazier than average weight individuals. Weight stigma can lead to 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. In their review, Rebecca M. Puhl et al. find that employees with obesity report their weight as the most influential factor contributing to losing their job. Another review by Giel and colleagues (2010) found that certain stereotypes about employees with 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.


In politics

A study by
Michigan State University Michigan State University (Michigan State or MSU) is a public university, public Land-grant university, land-grant research university in East Lansing, Michigan, United States. It was founded in 1855 as the Agricultural College of the State o ...
researchers shows evidence that overweight political candidates tend to receive fewer votes than their thinner opponents. The researchers analyzed data from the 2008 and 2012 U.S. Senate elections. Using a previously established scientific method, research assistants determined from color photos whether the candidates in 126 primary and general elections were of normal weight, overweight, or obese. Both obese men and women were often less likely to get on the ballot in the first place. When it came to merely being overweight, women were seen underrepresented on the ballot, though men were not. This is consistent with previous research showing slightly overweight men tend not to experience the same discrimination as slightly overweight women. However, when it came to the voting, both male and female candidates, whether obese or simply overweight, tend to get a lower share of the vote total than their more slender opponents. Some politicians have resorted to extreme weight loss measures, including surgery, to increase their elect-ability to political office.


In healthcare

Medical professionals may be more likely to view obese individuals in negative terms (such as annoying or undisciplined), have less patience with obese individuals, and assume non-compliance with their treatments. As such, these individuals may receive poorer care compared to average weight people. Primary care physicians overstate the effects of being overweight on all-cause mortality, describing being overweight as much more detrimental than clinical guidelines indicate. Additionally, nurses have reported a reluctance to touch obese persons during treatment. A national survey of the United States found that individuals who were overweight reported a three times higher likelihood to be denied medical care than average weight people. In the UK, 25 out of 91 primary care trusts have bans for the treatment of obese individuals in addition to weight loss requirements. Additionally, a 2012 survey revealed that 54% of doctor respondents believe the National Health Service should have the ability to withhold non-emergency treatment from obese individuals. Further, health professionals who specialize in obesity showed strong implicit and explicit anti-fat bias as measured by self-report and the Implicit Associations Test (IAT). However, such biases were mixed amongst dietitians and nutritionists. In their 2009 review, Puhl and colleagues found that 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 obesity, in particular ascribing to them culpability for their weight status. 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. However, it is important to point out that the evidence that has been reviewed thus far comes primarily from self-report studies. Therefore, Puhl and colleagues concluded that research examining actual health outcomes is needed. 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.


Interpersonal situations

Although a less studied topic than employment and healthcare, several studies reviewed by Puhl and colleagues (2009) provide evidence that overweight and obese women in particular face weight stigma from many interpersonal sources including family, friends, and romantic partners. Another recent review by Puhl and Suh (2015) also documented that in school settings weight-based bullying is one of the most prevalent types of harassment reported by parents, teachers, and students. Experiencing interpersonal weight stigma is related to myriad negative physical and mental health consequences (see " Mental health and psychological consequences" below). In a 2017 study, results showed that 89% of obese adults had been bullied by romantic partners.


In early development

This external stigmatization and its internalized effects have been examined across different age groups. Overweight and obese children and adolescents experience stigmatization from parents, teachers, and peers. Peer stigmatization, especially, may be difficult for overweight adolescents considering the role of peer support in promoting identity development and self-esteem. Some research suggests that negative attitudes about being overweight are even held by overweight and obese children themselves. Specifically, weight bias may become internalized and increases throughout childhood. It then decreases and levels-off during late adolescence and adulthood. Weight-based teasing in childhood and adolescence has been associated with a variety of damages to psychosocial health, including reduced
self-esteem Self-esteem is confidence in one's own worth, abilities, or morals. Self-esteem encompasses beliefs about oneself (for example, "I am loved", "I am worthy") as well as emotional states, such as triumph, despair, pride, and shame. Smith and Macki ...
and lower
self-concept In the psychology of self, one's self-concept (also called self-construction, self-identity, self-perspective or self-structure) is a collection of beliefs about oneself. Generally, self-concept embodies the answer to the question ''"Who am I? ...
, higher rates of depression and
anxiety disorder Anxiety disorders are a group of mental disorders characterized by significant and uncontrollable feelings of anxiety and fear such that a person's social, occupational, and personal functions are significantly impaired. Anxiety may cause phys ...
s, and even greater likelihood of entertaining suicidal thoughts. Further, weight-based teasing has been associated with higher rates of
binge eating Binge eating is a pattern of disordered eating which consists of episodes of uncontrollable eating. It is a common symptom of eating disorders such as binge eating disorder and bulimia nervosa. During such binges, a person rapidly consumes an exc ...
and unhealthy weight control (e.g., fasting, self-induced vomiting, laxatives, diet pills, skipped meals and smoking). Overweight adolescents who were bullied were also more likely to meet criteria for bulimia. A survey of 7,266 children aged 11 to 16 conducted by the
World Health Organization The World Health Organization (WHO) is a list of specialized agencies of the United Nations, specialized agency of the United Nations which coordinates responses to international public health issues and emergencies. It is headquartered in Gen ...
reported higher rates of physical victimization (e.g., being shoved) with increasing
body mass index Body mass index (BMI) is a value derived from the mass (Mass versus weight, weight) and height of a person. The BMI is defined as the human body weight, body mass divided by the square (algebra), square of the human height, body height, and is ...
(BMI) among girls. Additionally, these results showed relational victimization (i.e., being excluded or having rumors spread about you) was reported more often at increasing BMI by both girls and boys. A separate survey of 7,825 students aged 11 to 17 also noted that, compared to average-weight peers, obese boys and overweight girls were more likely to be victims of bullying. Additionally, obese girls were more likely to be victims and perpetrators of bullying than their peers. Notably, overweight and obese adolescent girls also reported higher rates of smoking, drinking, and marijuana use relative to their normal-weight peers.


Health-related outcomes associated with weight discrimination

Stigmatization of obesity is associated with increased risk of obesity and increased mortality and morbidity. In adulthood, individuals who experience weight discrimination are more likely to identify themselves as overweight regardless of their actual weight status. The experience of weight stigma can function as motivation to avoid stigmatizing environments, and although it may motivate one to escape stigma through weight loss, it undermines one's capacity to do so. Researchers have linked weight stigma to decreases in physical activity, decreases in seeking health care and increases in maladaptive eating patterns such as binge eating. In addition, those who have experienced weight stigma have shown altered cardiovascular reactivity, increased cortisol level, oxidative stress, and inflammation. People who expect to be fat-shamed by healthcare providers are less likely to seek care for medical issues or for weight loss, even if the weight gain is caused by medical problems. In terms of psychological health, researchers found that obese individuals demonstrated a lower sense of well-being relative to non-obese individuals if they had perceived weight stigmatization even after controlling for other demographic factors such as age and sex. Overweight and obese individuals report experiencing forms of internalized stigma such as body dissatisfaction as well as decreased social support and feelings of loneliness. In addition, similar to findings in adolescence, weight stigma in adulthood is associated with lower self-esteem, higher rates of depression, anxiety, and substance abuse. In both adults and children with 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. These will be discussed separately in the sections below, although physical and mental health consequences are often intertwined, in particular those related to eating disorders. Papadopoulos and Brennan (2015) recently found that across many reviewed studies of weight loss treatment-seeking adults, relationships emerged between experiencing weight stigma and both BMI and difficulty losing weight. However the findings are somewhat mixed. They also report evidence that experiencing weight stigma is related to poor medication adherence. Among weight loss treatment-seeking adults, experiencing weight stigma might exacerbate weight- and health-related quality of life issues. This review along with reviews by Vartanian and Smyth (2013) and Puhl and Suh (2015) have also found that across several studies and in both adults and children, experiencing weight stigma is related to decreased exercise behavior overall, as well as decreased motivation to exercise, decreased exercise
self-efficacy In psychology, self-efficacy is an individual's belief in their capacity to act in the ways necessary to reach specific goals. The concept was originally proposed by the psychologist Albert Bandura in 1977. Self-efficacy affects every area of hum ...
, and increased food craving and tendency to overeat. These effects of weight stigma on exercise and physical activity emerge independent of body mass index, suggesting that weight stigma becomes a unique barrier to physical activity outside of barriers that may be associated with obesity in particular. Finally, across many studies, Puhl and Suh (2015) also found that experiencing weight stigma is related to many physiological consequences as well, including increased
blood pressure Blood pressure (BP) is the pressure of Circulatory system, circulating blood against the walls of blood vessels. Most of this pressure results from the heart pumping blood through the circulatory system. When used without qualification, the term ...
, augmented
cortisol Cortisol is a steroid hormone in the glucocorticoid class of hormones and a stress hormone. When used as medication, it is known as hydrocortisone. Cortisol is produced in many animals, mainly by the ''zona fasciculata'' of the adrenal corte ...
reactivity, elevated
oxidative stress Oxidative stress reflects an imbalance between the systemic manifestation of reactive oxygen species and a biological system's ability to readily detoxify the reactive intermediates or to repair the resulting damage. Disturbances in the normal ...
, impaired glycemic control/elevated HbA1c, and increased systemic
inflammation Inflammation (from ) is part of the biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. The five cardinal signs are heat, pain, redness, swelling, and loss of function (Latin ''calor'', '' ...
, all of which have notable consequences for physical health and disease.


Mental health and psychological consequences

Broadly speaking, experiencing weight stigma is associated with psychological distress. There are many negative effects connected to anti-fat bias, the most prominent being that societal bias against fat is ineffective at treating obesity, and leads to long-lasting body image issues, eating disorders, suicide, and depression. Papadopoulos's 2015 review of the literature found that across several studies, this distress can manifest in
anxiety Anxiety is an emotion characterised by an unpleasant state of inner wikt:turmoil, turmoil and includes feelings of dread over Anticipation, anticipated events. Anxiety is different from fear in that fear is defined as the emotional response ...
, depression, lowered
self-esteem Self-esteem is confidence in one's own worth, abilities, or morals. Self-esteem encompasses beliefs about oneself (for example, "I am loved", "I am worthy") as well as emotional states, such as triumph, despair, pride, and shame. Smith and Macki ...
, and
substance use disorder Substance use disorder (SUD) is the persistent use of drugs despite substantial harm and adverse consequences to self and others. Related terms include ''substance use problems'' and ''problematic drug or alcohol use''. Along with substance-ind ...
s, both in weight loss treatment-seeking individuals as well as community samples. Many empirical reviews have found that weight stigma has clear consequences for individuals suffering from eating and weight disorders (including
anorexia nervosa Anorexia nervosa (AN), often referred to simply as anorexia, is an eating disorder characterized by Calorie restriction, food restriction, body image disturbance, fear of gaining weight, and an overpowering desire to be thin. Individuals wit ...
,
bulimia nervosa Bulimia nervosa, also known simply as bulimia, is an eating disorder characterized by binge eating (eating large quantities of food in a short period of time, often feeling out of control) followed by compensatory behaviors, such as self-indu ...
, and
binge eating disorder Binge eating disorder (BED) is an eating disorder characterized by frequent and recurrent binge eating episodes with associated negative psychological and social problems, but without the compensatory behaviors common to bulimia nervosa, OSFE ...
), as it plays a unique role, over and above other risk factors, in perpetuating disordered eating psychopathology. These results have emerged in both adult and adolescent, as well as in male and female samples.


Policy

Over the past few decades, many scholars have identified weight stigma as a long-standing form of social stigma and one of the last remaining socially acceptable forms of prejudice. It follows then that individuals who are targets because of overweight and obesity, still face uniquely socially acceptable discrimination. Civil rights legislation such as
Title VII of the Civil Rights Act of 1964 The Civil Rights Act of 1964 () is a landmark civil rights and labor law in the United States that outlaws discrimination based on race, color, religion, sex, and national origin. It prohibits unequal application of voter registration requi ...
prohibits discrimination based on race and several other domains, but weight is not included in this act. At the local level, only one state in the US (
Michigan Michigan ( ) is a peninsular U.S. state, state in the Great Lakes region, Great Lakes region of the Upper Midwest, Upper Midwestern United States. It shares water and land boundaries with Minnesota to the northwest, Wisconsin to the west, ...
) has policy in place for prohibiting weight-related employment discrimination and very few local municipalities have human rights ordinances in place to protect individuals of large body size. Specifically, localities that have passed legislation explicitly prohibiting weight-based discrimination include the state of Michigan; San Francisco and Santa Cruz in California; Washington, DC; Urbana, Illinois; Binghamton, New York; New York City, New York (in employment, housing, and public accommodations), and Madison, Wisconsin. Typically, the only of type of legislation that overweight and obese individuals can cite in lawsuits is related to disability. For example, the
Americans with Disabilities Act The Americans with Disabilities Act of 1990 or ADA () is a civil rights law that prohibits discrimination based on disability. It affords similar protections against discrimination to Americans with disabilities as the Civil Rights Act of 1964, ...
is one such avenue, but as Puhl et al. (2009) report, it is difficult for many individuals with obesity to qualify as disabled according to the criteria included in this statute. Few cases have been successful and most of these successes have occurred since 2009, after Congress passed the
ADA Amendments Act of 2008 The ADA Amendments Act of 2008 (Public Law 110–325, ADAAA) is an Act of Congress, effective January 1, 2009, that amended the Americans with Disabilities Act of 1990 (ADA) and other disability nondiscrimination laws at the Federal level of th ...
, which expanded the definitions of disability to include "severe obesity" (but not moderate obesity, overweight or underweight) as an impairment. However, in 2012, the US
Equal Employment Opportunity Commission The U.S. Equal Employment Opportunity Commission (EEOC) is a federal agency that was established via the Civil Rights Act of 1964 to administer and enforce civil rights laws against workplace discrimination. The EEOC investigates discrimination ...
(EEOC) successfully settled 2 cases for employees who were terminated from their jobs because their employers regarded them to be disabled based on their obesity and their severe obesity was now a covered disability under the new amendment. Despite these few recent successes, not all weight discrimination occurs in the context of disability or perceived disability, and legal remedies that can directly address weight discrimination as a legitimate social injustice remain absent.


Public health

The existing literature largely does not support the notion that weight stigma might encourage weight loss; as cited above, experiencing weight stigma (both interpersonally as well as exposure to stigmatizing media campaigns) is consistently related to a lack of motivation to exercise and a propensity to overeat. In a 2010 review examining whether weight stigma is an appropriate public health tool for treating and preventing overweight and obesity, Puhl and Heuer concluded that stigmatizing individuals with obesity is detrimental in three important ways: (1) it threatens actual physical health, (2) it perpetuates health disparities, and (3) it actually undermines obesity treatment and intervention initiatives. In line with this, another recent review of the consequences of experiencing weight stigma, this one conducted by Puhl and Suh (2015), concluded that considering the myriad negative physical and mental health consequences associated with experiencing weight stigma, it should be a target, instead of a tool, in obesity prevention and treatment. These authors further recommend that a necessary first step in reducing weight stigma is raising broader awareness of its negative consequences.


Race

With higher representation of black people being categorized as overweight by the BMI, the social stigma of obesity disproportionately affects black people. More than 80% of African American women are categorized as overweight using the Body Mass Index. Sociologist Sabrina Strings writes, in her book '' Fearing the Black Body'', about the historical ways in which fatphobia emerged out of an attempt by white people to distance themselves from black people. In 1751,
Denis Diderot Denis Diderot (; ; 5 October 171331 July 1784) was a French philosopher, art critic, and writer, best known for serving as co-founder, chief editor, and contributor to the along with Jean le Rond d'Alembert. He was a prominent figure during th ...
published the ''Encyclopédie'', which was the first publications to claim that black people were "fond of gluttony." In 1853, French aristocrat
Arthur de Gobineau Joseph Arthur de Gobineau (; 14 July 1816 – 13 October 1882) was a French writer and diplomat who is best known for helping introduce scientific race theory and "racial demography", and for developing the theory of the Aryan master race and N ...
claimed, about black people, that their "gluttonous nature to be one of their more base characteristics." In 1910,
Charles Davenport Charles Benedict Davenport (June 1, 1866 – February 18, 1944) was a biologist and eugenicist influential in the American eugenics movement. Early life and education Davenport was born in Stamford, Connecticut on June 1, 1866, to Amzi Bened ...
founded the Eugenic Record Office, and he claimed that "obesity was a vile condition to be avoided. It was, moreover, racially inherited."
Eugenics Eugenics is a set of largely discredited beliefs and practices that aim to improve the genetic quality of a human population. Historically, eugenicists have attempted to alter the frequency of various human phenotypes by inhibiting the fer ...
sentiment toward black people regarding their size was prevalent. Black bodies are already stigmatized, which can result in violence when interacting with the social stigma of obesity. In a 2017 article published in the
African American Review ''African American Review'' is a scholarly aggregation of essays on African-American literature, theatre, film, the visual arts, and culture; interviews; poetry; fiction; and book reviews. It is the official publication of the Modern Language Ass ...
, one author cited the killing of
Eric Garner On July 17, 2014, Eric Garner, an African American man, was killed in the New York City borough of Staten Island by Daniel Pantaleo, a New York City Police Department (NYPD) officer, after the latter put him in a prohibited chokehold while a ...
as an example of this, as some excuses for using excessive force on Garner were his size, as he was an overweight man. The article explains how
ableism Ableism (; also known as ablism, disablism (British English), anapirophobia, anapirism, and disability discrimination) is discrimination and social prejudice against physically or mentally disabled people. Ableism characterizes people as they a ...
, fatphobia, and racism interact to form a "double bind" in which violence is excused because fatness is already causing inherent injury, but necessary because the size of a large black person is a threat. A paper published by the
American Journal of Preventive Medicine The ''American Journal of Preventive Medicine'' is a monthly peer-reviewed medical journal that publishes articles (in-print and online) in the areas of prevention research, teaching, practice and policy. Original research is published on intervent ...
titled “Intersectionality: An Understudied Framework for Addressing Weight Stigma” focused on highlighting the intersectionality between weight stigma and health-related coping responses across several non-white racial and gendered groups. The findings of this publication demonstrated that there were no significant differences in weight stigma as a function of race or gender, having an overall equal representation across all racial groups analyzed. Nonetheless, results additionally demonstrated that different racial groups had differing ways of internalizing and coping with weight and health-related stigmas, which as a result heightened health risks. Results revealed that white women and men reported higher weight bias internalization in comparison to black women and men. Additionally, Hispanic women demonstrated to cope with weight stigma via disordered eating patterns more than black and white women. The results of this research article highlighted the importance of needing to increase research and policy attention to addressing weight and health-related stigma as an issue regarding prevention and treatment for obesity in order to consequently decrease weight-driven inequalities in communities and differing groups, primarily focused on race and gender.


Responses


Fat acceptance movement and organizations

The fat acceptance social movement in the USA emerged in the 1960s to highlight and counter social stigma and discrimination faced in a range of domains. Besides its political role, for example in the form of anti-discrimination NGOs and activism, the fat acceptance movement also constitutes a subculture which acts as a social group for its members.


Language and identity

The fat acceptance movement often uses the adjective "fat" and neologisms like " infinifat" as a reclaimed word. Preferences regarding terminology and descriptions vary, however, with common disagreements revolving around which words to use (e.g. "fat", "overweight", "obese"/"obesity", "of size"), the use of
person-first language People-first language (PFL), also called person-first language, is a type of linguistic prescription which puts a person before a diagnosis, describing what condition a person "has" rather than asserting what a person "is". It is intended to av ...
(e.g. "a person with obesity"), the use of medicalized terminology, and the avoidance of stigma.


Person-first language

Person-first language People-first language (PFL), also called person-first language, is a type of linguistic prescription which puts a person before a diagnosis, describing what condition a person "has" rather than asserting what a person "is". It is intended to av ...
, which emerged from some disability advocacy groups, has the ostensible goal of treating a person independently of a trait. However, it also has the consequence of treating that trait as "toxic" abnormality which should be "fixed" to achieve normalcy, and which due to its inherent negativity must be talked about in a special, careful way, rather than used as a simple "benign" descriptor. Critics believe that because such a formulation necessarily begins from the assumption that there is something wrong with being overweight, it contributes to further stigma. Furthermore, person-first language can contribute to the
medicalization Medicalization is the process by which human conditions and problems come to be defined and treated as medical conditions, and thus become the subject of medical study, diagnosis, prevention, or treatment. Medicalization can be driven by new evi ...
of obesity, as this is the language commonly used when referring to disease. This may explain why person-first language is favored more often by those working in the obesity field (and therefore seeking medical "fixes") than by other groups. Advocacy groups have criticized a top-down approach whereby proponents of person-first language claim to speak for all, whereas in reality it is not the preferred terminology of many in the fat-acceptance movement.


Descriptions and terminology

Various studies of overweight people seeking
weight loss Weight loss, in the context of medicine, health, or physical fitness, refers to a reduction of the total body mass, by a mean loss of fluid, body fat (adipose tissue), or lean mass (namely bone mineral deposits, muscle, tendon, and other conn ...
as well as a semantics study of terminology used to describe an overweight individual concluded that using the word fat elicits a negative reaction from people already critical of obesity. However, "
obesity Obesity is a medical condition, considered by multiple organizations to be a disease, in which excess Adipose tissue, body fat has accumulated to such an extent that it can potentially have negative effects on health. People are classifi ...
" was found in one study to be equally as undesirable as "fat" when considering language preferences of overweight individuals. "Fat" is the preferred term within the fat acceptance movement. Fat activists have reclaimed the term as a neutral descriptor in order to work against the stigma typically associated with the term. In fact, many fat activists will censor the word "obesity" when tweeting or citing it as "ob*sity" due to its pathologizing nature. The word "obesity" directly stems from the Latin word "obesus" which means "that has eaten itself fat". Fat activists will also use this Latin definition to show stigma in the word "obese" itself, as it places blame on the individual for their state.


See also

*
Fat acceptance movement The fat acceptance movement (also known by various other names, such as fat pride, fat empowerment, fat liberation, and fat activism) is a social movement which seeks to eliminate the social stigma of obesity. Areas of contention include the aes ...
* ''
Fattitude ''Fattitude'' is a 2017 American documentary film by Lindsey Averill and Viridiana Lieberman. Summary The movie is about fat discrimination and its main objective is to make the general public more aware of the prejudice that fat people experienc ...
''—2017 documentary on fat discrimination * Height discrimination * Reddit anti-fat communities *
Sizeism Sizeism, weightism or size discrimination is unjust or prejudicial treatment directed at people based on their size. Discrimination This type of discrimination can take a number of forms, ranging from refusing to hire someone because they are c ...


References


Further reading

* {{Discrimination Obesity
Obesity Obesity is a medical condition, considered by multiple organizations to be a disease, in which excess Adipose tissue, body fat has accumulated to such an extent that it can potentially have negative effects on health. People are classifi ...
Stereotypes