How and why weight stigma drives the obesity ‘epidemic’ and harms health

TLDR

Weight stigma is pervasive worldwide, often more common than discrimination based on race or ethnicity, and is deeply embedded in society. The authors argue that effective solutions must target the attitudes and behaviors of those who stigmatize, especially through medical training, rather than focusing on the stigmatized. They propose that training compassionate, knowledgeable healthcare providers can reduce weight stigma and improve patient care. Weight stigma is prospectively associated with increased mortality, chronic disease, obesity risk, and poorer healthcare outcomes, including bias and reduced quality of care.

Abstract

In an era when obesity prevalence is high throughout much of the world, there is a correspondingly pervasive and strong culture of weight stigma. For example, representative studies show that some forms of weight discrimination are more prevalent even than discrimination based on race or ethnicity.In this Opinion article, we review compelling evidence that weight stigma is harmful to health, over and above objective body mass index. Weight stigma is prospectively related to heightened mortality and other chronic diseases and conditions. Most erroneously, it actually begets heightened risk of obesity through multiple obesogenic pathways. Weight stigma is particularly prevalent and detrimental in healthcare settings, with documented high levels of 'anti-fat' bias in healthcare providers, patients with obesity receiving poorer care and having worse outcomes, and medical students with obesity reporting high levels of alcohol and substance use to cope with internalized weight stigma. In terms of solutions, the most effective and ethical approaches should be aimed at changing the behaviors and attitudes of those who stigmatize, rather than towards the targets of weight stigma. Medical training must address weight bias, training healthcare professionals about how it is perpetuated and on its potentially harmful effects on their patients.Weight stigma is likely to drive weight gain and poor health and thus should be eradicated. This effort can begin by training compassionate and knowledgeable healthcare providers who will deliver better care and ultimately lessen the negative effects of weight stigma.