Obesity Stigma

Understanding and Coping with Obesity Stigma

June 24, 2020

Obesity bias and obesity stigma are alive and well. As an obesity medicine provider, I have been facilitating obesity sensitivity training in healthcare settings for over a decade. My goal is for anyone struggling with obesity is to provide understanding and coping with this stigma. I also provide critical education to weight loss patients on ways to cope with obesity stigma in healthy ways. 

I begin all of my obesity sensitivity training with an exercise that explores common stereotypes. I take the time to have participants finish the sentence, "All fat people are....", I often hear the following responses:

DirtySlowTo Be Ignored

If you are a person affected by the disease of obesity, you are not surprised by these hurtful stereotypes. According to the Rudd Center for Food Policy and Obesity, obesity bias refers to negative stereotypes directed towards individuals affected by excess weight or obesity which often leads to prejudice and discrimination. 

Obesity Stigma by Definition

Obesity stigma is the social devaluation and denigration of people perceived to carry excess weight. It plays a role in everyday life, including work, school, and healthcare settings. It remains a socially acceptable form of prejudice in American society and is rarely challenged.

In this article, we will take the time to examine the many areas our patients experience obesity stigma. We will look at the impact of obesity stigma. Most importantly, I am eager to share with you healthy ways for you to cope with it.  

My patients often share with me they experience obesity stigma in every area of their life. “I can't escape it. It's everywhere” or “ It's still ok to always go to the fat joke”. 

These powerful statements are supported by sound research. Research notes that obesity stigma is present in family settings, employment settings, educational settings, health care settings, and of course, the media. 

Most recently, we have witnessed the obesity stigma in the COVID-19 crisis.   Sadly, I was not surprised to see hurtful obesity stigma on my social media feed during the COVID Crisis.  You know the ones that sound like this “ I need to socially distance myself from the refrigerator” or “Gaining weight in college with the freshman 15. This time it’ll be the quarantine 15.” And, of course, there are the “before and after quarantine”  illustrations. 

People affected by excess weight identify their own family as the number one area they experience obesity stigma. In my office, I hear countless painful stories about a parent who mocked their child's appearance or another family member who said that all too common “You have such a pretty face, dear, if you could only do something about your weight” comment. 

Obesity Bias Affects Employment Settings

Research shows that obesity stigma also affects employment settings. Bias in employment settings has been identified in the following areas: Hiring preferences, promotions, wage inequities, and employment termination.

“Negative perceptions of people affected by obesity exist in employment settings where employees affected by obesity are viewed as less competent, lazy, and lacking in self-discipline by their co-workers and employers.  These attitudes can have a negative impact on wages, promotions, and decisions about employment status for employees affected by obesity” [The Obesity Action Coalition) 

Obesity stigma is a common theme in the media. Whether it's on tv, in a movie, on YouTube, Facebook, or ads...persons affected by obesity are often ridiculed. 

“Fattertainment“ media is both immensely popular and a breeding ground for obesity stereotypes. Characters with obesity are often portrayed in “slapstick” humor scenes like getting stuck in small spaces because of their size. 

Characters with obesity are shown overindulging in junk food.  News reports on obesity often show the person “without a head” while zooming in on an unflattering part of their body (such as a large stomach or buttock).  The above media portrayals promote and perpetuate unhealthy stigma. 

The COVID Crisis

Finally, you may be wondering how is the obesity stigma showing up during the COVID Crisis? Social media posts are suggesting that gaining weight could be one of the worst outcomes of a global pandemic. These posts are using the bodies of people heavier than you as a punchline. 

A recent article in Psychology Today suggests “If you post about how awful it would be if you gained 20 pounds during a quarantine, what might that communicate to the person who weighs 20 pounds (or more) than you do?" 

Sadly,  people affected by obesity also experience stigma in the one place we would assume is safe: their doctor's office. As a public speaker, I have traveled the country teaching health care professionals how to help without harming. 

The Rudd Center research shows that health care professionals hold negative attitudes about individuals affected by obesity. This includes physicians, nurses, dieticians, psychologists, social workers, fitness professionals, and medical students.

As a patient's body mass index increases, doctors report less desire to help the patient, often report treating the patient is a waste of their time and express less overall respect for the patient. 

Self-report studies show that nurses view individuals affected by obesity as non-compliant, overindulgent, lazy, and unsuccessful. When psychologists work with patients affected by obesity they attribute more pathology, more negative attributes, and report the worst prognosis in treatment. In summary “Doctors, nurses, and other health professionals self-report bias and prejudice against patients affected by obesity."

The most common stereotypes expressed by health providers are: 

Weak-WilledLacking in Self-ControlUnintelligent
UnsuccessfulOverindulgent Blamed for their symptoms

Based on the above examples, you now know why you were not surprised at the answers I receive when I start each Obesity Sensitivity training with this stereotype exercise: “All fat people are…” 

Obesity Stigma is Real and Relevant

The obesity stigma is real and relevant. It is evidenced by the research. Most importantly, I have learned more about stigma and its effects from the patients that I serve.

It is crushing to hear painful childhood memories when they were bullied by their own family members because of their excess weight. I cringe when I hear a story about them attending a comedy club and the entire room laughing at the all too common acceptable fat joke. I grieve with them when they share unfair hiring and termination practices in their places of employment. 

I am devastated with them when I hear of the obesity stigma they have experienced time and time again in healthcare. No chair for them to fit in in the waiting room. Overhearing hushed inappropriate comments about their weight after they are weighed. Medical gowns that are too small for them to fit into. And of course, the all too common “I went to the doctor for an ear infection and the doctor blames everything on my weight." Finally, too many healthcare professionals have blamed their patients for their obesity instead of treating it as the legitimate disease it is.  

Taken together, the consequences of being denied jobs, rejected by peers, and treated inappropriately by healthcare professionals because of one’s weight can have a serious and negative impact on the quality of life. 

Individuals affected by obesity suffer terribly from this, both from direct discrimination and from more subtly forms of bias that are frequently encountered (Rudd Center).  More specifically individuals suffer adverse psychological, social, and physical outcomes.  Psychological outcomes include depression, anxiety, and low-self esteem. 

Social outcomes include social rejection by peers, poor quality of interpersonal relationships, and a negative impact on academic and/or employment outcomes.   

Sadly, I witness the physical outcomes of this stigma on my patients on a regular basis. These include but are not limited to emotional eating, binge eating, avoidance of physical activity and exercise, increased social isolation, and unhealthy weight control practices. 

Our society often believes that stigma and shame will serve as some “public service announcement” to help individuals with obesity to be healthier and exercise. Research and my experience with patients show the exact opposite. A recent study by the Rudd Center noted that internalized weight stigma significantly predicted poorer weight loss maintenance. This is why there has to be a better way. 

Healthy Ways to Cope With the Obesity Stigma

Now that you understand what obesity stigma is and its significant negative impact, it's time to discuss healthy ways to cope with the stigma you experience every day in so many areas of your life. 

Emotional eating, binge eating, avoidance of exercise, and increased isolation only hinders your overall weight loss success. It's time to consider a better way. 

First, it's important you obtain social support from ‘others who get it”. This can be in a bariatric surgery support group or a community like this one on ObesityHelp and my online community.

There is power in sharing your experiences of stigma with others who have experienced the same thing. You feel heard and validated. You learn you're not alone which leads to a sense of empowerment.  

I witness this happening on a regular basis in the support groups that I facilitate. It is inspiring to see a patient talking about their painful experiences with others instead of turning to food to numb stress and painful feelings.

Second, take time to work on improving your positive self-talk skills, self-acceptance skills, and self-esteem building skills. One of the best ways to do this is to engage in behavioral health therapy with a trained expert. 

Third, instead of avoiding enjoyable activities because of negative feelings about your weight, start with physical activities you feel more comfortable with. 

Advocacy is a Powerful Coping Skill

Finally, advocacy is a powerful coping skill. Be vocal and assertive about your needs. After a patient participated with me in both a group and individual therapy for a while, she reached the point of calling out to her healthcare provider that she too deserved a chair that she could sit in while in the waiting room. This experience was so empowering for her.

The next time you are in the doctor's office, and they do not have a gown for you, point it out and ask for a change. You can also advocate that your healthcare offices provide yearly obesity sensitivity training for their staff, which bariatric behaviors like me provide. 

There are many forms of this stigma and it can hinder your long-term weight loss success if you let it. It's my hope this article not only provided validation to your painful experiences of stigma but has provided you healthy coping skills to respond to it.

Please continue to stay involved with the ObesityHelp community and do not hesitate to reach out to me if I can help in any way. I am honored to be on your team and I promise I will never stop educating and advocating to end all obesity stigma.

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Lora Grabow, LMSW is a weight loss counselor that has partnered with individuals seeking to lose weight and keep it off. Holding a Masters in Social Work, Lora also equips medical providers & educational institutions to serve weight loss patients. She works with an obesity medicine practice located in Grand Rapids, MI, & is a member of the American Society for Metabolic and Bariatric Surgery and The Obesity Action Coalition. Lora teaches weight loss tools via her online community.
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