PHOTO: Jade Destiny
Text: Nicoleta Casangiu and Alejandra Misiolek
Notions of overweight and weight loss for health were almost non-existent in the population before the 20th century. With the advent of scales to measure body weight, the body mass index (BMI) within public and clinical healthcare began its ascent and with it the stigma of body weight.
What does weight stigma mean?
Weight stigma refers to the denigration and devaluation of weight-related experiences. Between 50% and 60% of adults experience weight stigma at least once in their lifetime.
Obese people are highly stigmatized in society and face many forms of discrimination because of their weight.
Recent studies provide findings that overweight adolescents who are victims of body or fat shaming are more likely to suffer from low self-esteem, social isolation, and anxiety. Overweight high school students are more likely to suffer from depression and suicidal thoughts than their normal weight peers.
In adults, the stigma surrounding obesity increases the risk of depression and suicide and further entrenches disordered eating behaviors. Fat shaming is also linked to low self-esteem and the development of eating disorders.
Studies show that exposure to weight bias triggers physiological and behavioral changes related to poor metabolic health and increased weight gain. A form of stress is experienced, cortisol spikes, self-control decreases and increases and the risk of binge eating increases.
There is increasing evidence that obesity and eating disorders can co-exist in individuals and share risk factors, such as body dissatisfaction and dieting. The more people are exposed to prejudice, the more likely they are to gain weight and become obese, even if they were initially thin.
This weight bias translates more globally into inequalities in health care, employment and education.
In the healthcare setting, negative attitudes from healthcare professionals make patients feel stigmatized and reluctant to access healthcare services, further damaging their long-term health.
Stigmatizing comments from healthcare professionals can perpetuate the negative thoughts a person has about their weight or shape, which are factors in eating disorders.
The social stigma faced by overweight healthcare professionals will also impact their own confidence and ability to offer health advice.
“Obesity stigma can damage people’s health and is even more damaging when it comes from healthcare professionals” is a statement from a sixth-year medical student.
What could medical schools do?
A U.S. study showed that an educational intervention focusing on the multifactorial causes of obesity, empathy induction, and role-playing improved medical students’ attitudes toward obese people.
Environmental, genetic, lifestyle, and other factors interact to cause obesity. Educating medical students about the multifactorial causes of obesity may help reduce stigma and blame. Obesity is not solely due to patients being “lazy,” “lacking in self-discipline,” or “noncompliant,” as many stereotypes suggest.
It could be helpful in reducing weight stigma:
- teach medical students to critically analyze the use of body mass index (BMI) as an indicator of health.
- look more closely at other measures of health, such as waist circumference, blood pressure and blood glucose.
- using a more neutral approach that focuses on the overall health and well-being of the individual rather than the number on the scale.
- a zero tolerance policy for discriminatory or derogatory behavior.
It is important to realize that body shaming attitudes, which many people use towards overweight or obese people, actually cause vicious circles. By generating shame and feelings of inferiority, they cause isolation of obese people, low self-esteem, difficulties in leaving the house and exposing themselves to the outside world. As a consequence, this leads to feeling many unpleasant emotions that are sometimes “regulated with food” when other resources fail us (or when we know the regulation of emotions with food from childhood). It is a fish that bites its own tail. However, there are people, including doctors and nutritionists, who still think that telling someone that they have to lose weight is a way to motivate them. Whereas really, and depending on how and in what context it is said, it is a way of shaming the person with obesity instead of first understanding their difficulties and jointly seeking solutions.