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Before we start, I just want to acknowledge that this post has been written by me, someone who occupies a thin, white and able body. I don’t want to claim to be an expert in what it means to be living in a larger body as I have never experienced it. The purpose of this article is for individuals, including myself until more recently, who aren’t necessarily aware of our own weight stigma and the harms it may cause.

Weight Stigma

Weight stigma (also known as weight discrimination or weight based bias), is discrimination, negative judgements or stereotyping based solely on a person’s weight (1). It has been argued that weight stigma remains the last “socially acceptable” form of discrimination, meaning that stigma surrounding weight is commonplace and widespread (2). You don’t need to look further than the new Netflix TV series Emily in Paris to see what we mean!

Weight stigma is the fourth most prevalent form of discrimination after age, gender, and race-based discrimination (3). Weight stigma has been frequently reported by employers, co-workers, teachers, physicians, nurses, medical students, dietitians, psychologists, peers (4), and even among children as young as 3 years old (5). With the ever increasing emphasis on weight control or weight management, the rise of ob*sity prevention campaigns, talk of the “ob*sity epidemic” and now COVID and ob*sity, it’s hardly surprising that the incidence of weight stigma has increased by about 66% in recent years (1).

Equally, unsurprising, there are links between our society’s obsession with weight as an indicator of “health” (and beauty) which can encourage body dissatisfaction and disordered eating, leading risk factors in developing eating disorders (1).

Our culture has idealised thin bodies, seeing them as “good bodies”, whilst simultaneously negatively portraying larger bodies. Think The Little Mermaid’s Ariel and Ursula. Moreover, the idealisation of thinness is the best-known environmental contributor to the development of eating disorders (1).

Overemphasising weight can encourage disordered eating as weight stigma can increase body dissatisfaction, a leading risk factor in developing an eating disorder (1). Our culture has idealised thin bodies, seeing them as “good bodies” and has portrayed large bodies negatively and as objects of ridicule. This idealisation of thinness is the best-known environmental contributor to the development of eating disorders (1).

Weight stigma is fuelled by fat phobia, which is the dislike or fear of becoming fat. Social constructions of body weight are entrenched and ingrained in the way that our society perceives and reacts to high weight bodies. Important to note, the historical relationship between weight stigma, diet culture and racism are deeply intertwined. In her book “Fearing the Black Body: The Racial Origins of Fat Phobia”, author Sabrina Strings examines how in the 1800s thinness and fatness evolved as new means of separating superior from inferior, “free” from “slave”.

Research reveals that individuals who are categorised as o**ese by their BMI (more about problems with BMI here) are viewed negatively because of their weight. This is more than 4 out of 5 adults in the UK (6). Moreover, 62% of Britons think people are likely to discriminate against someone who is o**erweight (7).

Weight stigma impacts ALL bodies. However, it would be wrong to gloss over how it impacts individuals differently.

Co-author of Intuitive Eating Evelyn Tribole explores the challenges for different individuals in working on their relationship to food. In an individual with “thin-privilege”, the privilege that is afforded to someone who can buy clothes in a regular store, not worry about having to fit in a plane seat and have their medical concerns properly investigated and taken seriously without everything being put down to weight, they can make peace with food and when they go into the culture it’s like a waltz off into the sunset. For an individual in a larger body, they can do all the work, but when they go out into the culture, the culture is hostile. They are met with judgement and prejudice. As someone with a lot of thin privilege, I feel it’s really important to acknowledge this as why as part of this work, it is so important that we look to do more in dismantling these systems of oppression.

It is never acceptable to discriminate against someone based on their size, but shaming, blaming, and “concern trolling” happen everywhere – at work, school, in the home, and even at the doctor’s office (1).

Concern trolling is disingenuously expressing concern about an issue. Research shows that individuals with a high weight body experience stigma and discrimination across all aspects of their life. Nearly half of UK adults living with “ob*sity” have felt judged because of their weight in clothes shops or in social situations, 45% in healthcare settings and 32% in gyms (7).

The impact of weight stigma and discrimination is far-reaching. 25% of UK adults in the UK admitted that out of two equally qualified candidates they would appoint the one with a “healthy weight” over a candidate with “ob*sity” (7).

Weight stigma can affect people’s physical and mental health, as well as people’s social lives and relationships. Individuals who fear being stigmatised have been reported to avoid social situations (known as selective social isolation) in an effort to remain unnoticed (8). As discussed in a previous blog post (Why we need a weight inclusive approach to health: An open letter), research has also shown this kind of weight stigma may actually drive many of the conditions associated with high weight bodies including inflammation and pro-inflammatory markers, hypertension and type 2 diabetes - more about this later.

Weight stigma can also be internalised, known as internalised weight stigma, which is where individuals judge themselves through the lens of fat stereotypes e.g. believing that they are personally responsible for their weight or lazy, greedy, out of control or unhealthy (9).

What Can Weight Stigma Look Like?

The ways in which weight stigma may occur is nuanced, especially for those who live with thin privilege. Weight stigma can arise subconsciously or purposefully in any time and place.

Overt weight stigma includes abusive language, bullying, mocking, violence and threats, which are seen as socially unacceptable. Whereas covert weight stigma, is stigma that is often hidden, or not glaringly obvious to others and is often seen as socially “acceptable”. Examples of covert weight stigma include lack of clothing sizes to fit large body individuals, praising weight loss, offering unsolicited weight loss advice and assuming you can know how healthy someone is just by their weight.

The media is a major contributor to fuelling weight stigma by bombarding us with unrealistic ideals of thinness and telling us how our bodies “should” be. Just think about how one page of a glossy magazine will tell us to love ourselves, whilst the other trolls a celeb for their cellulite – a totally normal and humanly part of being a women.

Images used in the media frequently depict large body individuals from unflattering angles, often consuming fast food, which bolsters stigmatising perceptions that large body individuals are greedy and “unhealthy” (2). Images of isolated abdomens are used prominently in media, thus reducing the individuals to abdomens and weight, rather than as human beings (2).

Weight stigma is also rife in in clinical and research communities and especially in Eating Disorders (10). For example, many individuals seeking help are turned away as their BMI is not low enough to warrant treatment and at the same time treatment providers promote weight loss as a component of treatment for high weight individuals with an eating disorder, especially binge eating disorder (10).

Weighty Misperceptions

Weight stigma is rarely challenged as common perceptions are that it is justifiable and may even motive individuals to adopt “healthier” behaviours. Experimental research in psychology consistently demonstrates that people classified as “ob*se” according to BMI standards, are stigmatised because their weight is perceived to be caused by factors within personal control (i.e. “overeating”) (11).

Numerous studies have documented harmful weight-based stereotypes that individuals with large bodies are lazy, weak-willed, unsuccessful, unintelligent, lack self-discipline, and have poor willpower (12). The commonly used mantra of “eat less, move more” is overly simplistic and places the blame on the individual. However, this message does not accurately reflect the scientific evidence demonstrating that many significant contributors to body weight are beyond the control of individuals, including genetic and biological factors regulating body weight (13), and multiple social and economic factors (2).

Harmful Impact of Weight Stigma

Research has shown that adults who experience weight-based stigmatisation engage in more frequent binge-eating (14), and are at increased risk for maladaptive eating patterns and eating disorder symptoms (15).

Weight stigma has also been documented as a significant risk factor for depression and low self-esteem (16). There is now solid evidence demonstrating that weight stigma not only is psychologically damaging but is physiologically damaging too. Weight discrimination is a characterised stressor that triggers a downward cascade of unfavourable psychosocial and behavioural processes that ultimately result in poor biological outcomes across multiple systems (e.g. metabolic syndrome, cardiovascular disease)(17).

A study carried out on 986 adults looking at a 10 year association between weight discrimination and allostatic load (which is the “wear and tear” on the body that accumulates as an individual is exposed to repeated chronic stress), found that individuals who experienced (versus did not experience) weight discrimination had twice the risk of high allostatic load (17). Furthermore, compared to individuals reporting no weight-related discrimination, long-term weight discrimination was most strongly associated with metabolic/ lipid dysregulation, glucose metabolism, and markers of inflammation (17).

The very things that are so frequently blamed on large bodies, occur in direct in direct response to the mistreatment of those bodies. The detrimental effects of weight discrimination on allostatic load persisted following adjustment for BMI, suggesting that perceived weight-related discrimination adversely affects overall physiological regulation beyond what can be attributed to “excess weight” alone (17).

Despite the distorted belief that weight stigma may motivate some positive behavioural change, most evidence demonstrates that weight shaming promotes poorer dietary and exercise practices and health care avoidance (3). Individuals classified as having “ob*sity” frequently experience weight stigma in health care and report that they feel as though will not be taken seriously by medical professionals because of weight and often their weight is blamed for all of their medical problems (18).

A study carried out in 2006, looking at perceived barriers to routine gynaecological cancer screenings in women classified as “overweight” or “ob*se”, found that 68% reported that they delayed seeking health care because of their weight, and 83% reported that their weight was a barrier to getting appropriate health care (19). The women also reported feeling embarrassed about being weighed, received unsolicited weight loss advice, and also reported that gowns, examination tables, and other medical equipment were too small to be functional for their body size (19).

What Can I Do To Help?

Do learn about the experiences of fat individuals and seek to learn and unlearn. Follow a whole load of fat positive social media accounts and look to books and podcasts. You can find some recommendations here.
Don’t give unsolicited weight loss advice, it’s not helpful, it’s shaming individuals.

Don’t make weight-based comments (i.e. “you look so great, have you lost weight?”).

Don’t assume someone’s health based solely on their body size.
Be cautious about diluting the body positive movement. Yes, we may all experience challenging body image days, but more images on social media on individuals with thin privilege gripping one body roll and claiming to love their body is unhelpful.
Don’t post before and after pictures.

Think about the language we use when trying to combat weight stigma. Use person-first language and avoid using words such as “ob*se” as these can be offensive.

Challenge the negative stereotypes associated with large body individuals, acknowledge and educate others that weight does not determine health and that weight is determined by genetic and other factors that are outside of any individuals control.