Weight Bias and Stigma

In the discussion of obesity, weight management and BMI it is also important to discuss the effects of weight bias and stigma experienced by individuals who are classified as overweight or having obesity.

In modern society, people who are classified as having obesity face discrimination regularly in the form of weight bias and stigma. Weight bias refers to the negative weight-related judgements, perceptions, and attitudes people have towards individuals classified as being overweight or having obesity. On the other hand, weight stigma refers to the social devaluation or ostracization of individuals due to their body weight or size.^[1] Weight-based discrimination exists in a wide variety of realms, which include healthcare, educational, and occupational settings. The increased prevalence of weight-based discrimination is particularly problematic because it can have several negative consequences on one’s physical and mental health and contribute to social and health inequalities.^[2]

Weight bias and stigma are extremely prevalent in clinical settings. Research studies have shown that healthcare professionals are the second most common source of weight stigma.^[3] Many healthcare professionals associate obesity with laziness, noncompliance, and low discipline and willpower. This is important to consider because these implicit biases can interfere with the clinician-patient relationship, resulting in poorer delivery of care for patients dealing with obesity. When patients feel stigmatized because of their weight, they are more likely to engage in high-risk maladaptive eating behaviours while living sedentary or physically inactive lifestyles. These patients are also more susceptible to experiencing mood disorders and poor health outcomes, including an increased risk of mortality.^[4] Due to the harmful effects of weight bias and stigma in healthcare settings, it is imperative to equip healthcare professionals with the education and resources to provide quality, respectful, and compassionate care to all patients. The Rudd Center’s Supportive Obesity Care is a great educational resource that can be used for more information on this.

Despite the growing pervasiveness of obesity, Western society struggles to recognize obesity as a disease. Instead, obesity bias is often considered a socially acceptable form of bias because obesity is perceived as a lifestyle choice. Weight is often thought of as something that is completely under personal control, which is why obesity is attributed to lifestyle choices such as physical inactivity and poor dietary choices. However, these perceptions severely undermine the complex nature of obesity and fail to take into account environmental, social, genetic, and cultural factors. For example, researchers established a negative relationship between socioeconomic status (SES) and obesity; a lower SES is linked to higher rates of obesity.^[5] The inverse relationship between SES and obesity may be explained by numerous factors such as reduced physical activity opportunities, poor health-related education, and limited access to higher-cost and nutrient-dense foods due to lower incomes. Research studies have also established the link between genetic and epigenetic factors and obesity. For example, maternal exposure to harmful chemicals and toxins such as cigarette smoking (≥ 15 cigarettes per day) can produce chemical modifications in the GFI1 gene, which resultantly increases the risk of offspring obesity ^[6]. These two examples explaining the role of socioeconomic and genetic influences on obesity are enough to disrupt the misconception that weight is the result of someone’s personal lifestyle choices alone.

Therefore, while it is very easy to make suggestions to confront the obesity epidemic, it is important to remember that obesity is a complex and multifactorial disease influenced by genetic, environmental, behavioural/psychological factors that will be further discussed later in this chapter.