What is Weight Stigma? How Does This Impact Eating Disorder Recovery?
CW: Use of the words “obesity” and “overweight”
Weight stigma is discrimination and oppression of an individual or group of people on the basis of their weight and/or body size. It has devastating effects on individual’s mental, physical and psychological well being.
Just like ageism, sexism, and ableism are all forms of discrimination, weight stigma is another form of discrimination that harms those who live in bodies that deviate from cultural standards around thinness, namely those in larger or fat bodies*. Weight stigma is also known as weight bias, weight-based discrimination, anti-fatness and fat phobia.
Janet Tomiyama, one of the leading weight-stigma researchers, describes weight stigma is “the social devaluation and denigration of people perceived to carry excess weight, which leads to prejudice, negative stereotyping, and discrimination toward those people”
Who experiences weight stigma?
From children to the elderly, anyone of any age and gender can experience weight-based oppression and discrimination. Individuals who reside in larger bodies are subject to weight bias and weight-based discrimination, regardless of age. (This isn’t to say that people in thinner bodies don’t experience weight-shaming. While those in thinner bodies can experience thin-shaming, thin-shaming is not a form of oppression. Weight stigma is rooted in anti-fatness, and anti-fatness goes far beyond name calling or romantic rejection. )
In fact, research shows that weight bias for children can begin as early as ages 3-5 years old. Additionally, every “1 in 3 girls and 1 in 4 boys report being teased by their peers at school” because of their weight (1). Weight stigma is so deeply ingrained in our society that young children discriminate against their peers for their appearance.
Another piece of research shows that more than 50% of people studied exhibited weight bias, with one particular study concluding that, “Most people hold weight stigma and it is prevalent in individuals of all body sizes” (2).
It’s important to note that there are three different ways that you can experience weight stigma and the degree and frequency to which you experience each layer can add to the harm caused to an individual. The three ways are: intrapersonal (internalized beliefs about fat bodies and fat), interpersonal (between you and another individual re: the weight stigma they hold about you) and societal (the systems that discriminate and hold stigma against fat bodies such as medical, employment, insurance, government laws, etc.).
What are the harms of weight stigma?
Weight stigma, like many other forms of oppression, takes a toll on the affected individual’s physical and mental health. In order to escape weight-based oppression, people in bodies of size may avoid seeking healthcare for fear of harm being caused to their physical and/or mental wellbeing; this is called health care avoidance. Weight bias also has a strong impact on the mental health of people in larger bodies. These individuals are at high risk due to weight stigma for developing or worsening:
Anxiety
Depression
Social isolation
Social rejection
Low self-esteem
Internalized anti-fatness
Mood disorders
Where does weight stigma exist?
Weight stigma can take on many different forms and can occur anywhere, especially in the following places and spaces:
Weight stigma in workplace settings
Discrimination in the workplace is rampant, especially regarding weight-based discrimination. Although the U.S. Equal Employment Opportunity Commission (EEOC) has federal laws that protect employees from various forms of discrimination in the workplace (like age, sex, color, religion, etc.), weight is not included in this list (except in NY city which just passed a law in 2023 banning weight based discrimination.)
People residing in larger bodies are unprotected from weight bias at their own jobs. This weight bias presents itself in situations of promotion and hiring decisions, termination, wage inequities, and compensation. People in larger bodies are less likely to be hired for jobs, considered for promotions, and typically receive lower wages than their coworkers.
Weight-based oppression in the workplace has significant impacts on both the individual and the company. The negative psychological impacts of experiencing weight bias can lead individuals to have poor self-efficacy, self-esteem, and motivation, which in turn can decrease job performance and retention rates.
Weight stigma in the fitness industry
Society portrays people in larger bodies getting to be in their body as a result of “laziness” (and example of harmful weight stigma) when in reality body diversity is a normal, natural part of being human. The fitness industry often presents an oversimplified and false promise that with some “dedication and commitment”, individuals in larger bodies can lose weight and “be healthy”. Although weight is determined by a variety of variable factors, like genetics, socioeconomic status, race, ethnicity, etc. the fitness industry promises you that thinness and weight loss can override all of these determinants. Weight bias in the fitness industry often prevents individuals from achieving their exercise-related goals and exploring physical activity.
Additionally, the fitness industry, and by proxy the fitness instructors, personal trainers and fitness influencers that make up the industry, often focus on weight loss and equate it with worthiness, health and attractiveness. This is seen in gym-marketing of only thin bodies with sharp-cut abs, making fun of new-comers in the gym, and “before and after” photos as a source of “motivation”.
Weight stigma in the fitness industry prevents people in large bodies from going into spaces where movement is possible, such as gyms, classes and studios.
Weight stigma in educational settings
Weight-based oppression heavily impacts students of all ages and reduces their ability to thrive within education. One study found that adolescents in larger bodies are “ likely to experience threats, physical victimization, and social exclusion” along with teasing based on weight (3). The burden of such intense social isolation and targeting creates an unsafe and stressful environment for children solely based on their weight or body size.
Education systems also typically involve physical education classes, which can be a source of intense anxiety for adolescents residing in larger bodies. These classes often include public weighing and physical measurements that can induce weight-based teasing or bullying among students. Additionally, research has shown that physical education teachers, as well as other teachers, exhibit implicit and explicit weight bias towards children. One study examined the connection between teacher perceptions of students’ academic ability and student weight. Researchers found that teachers were more likely to perceive a student to be high-achieving if the student was of “normal” weight, whereas larger-bodied students were perceived as academically challenged (3).
Weight stigma in the media
Despite recent body positive movements and size inclusivity efforts, the media still remains a major source of perpetuation of weight bias in society. Weight-based discrimination, as well as who is chosen to represent characters in films and tv shows, the media reinforces this idea that to be thin is to be “better, more successful, more beautiful and more intelligent.”
You can see this in reality television, weight-loss programs, magazines, comedy shows, news coverage, books, and more! Characters and actors in larger bodies are negatively depicted, whereas characters in thinner bodies are idolized and respected. For example, some actors such as Aidy Bryant, have spoken out about their personal experience with Hollywood and the challenges of weight bias.
Weight stigma in healthcare
The most particularly alarming instances of weight stigma happen in the healthcare system. Anti-fat bias within the healthcare industry is real, causes a lot of harm and is baked into most doctors' and other health clinician’s education. Implicit weight bias in the medical field severely impacts a person’s ability to receive proper care and weakens the relationship between patients and providers.
Physicians, nurses, and dietitians have demonstrated evidence of implicit and explicit weight bias. A study completed by the American Academy of Orthopaedic Surgeons found that 53% of participating “overweight and obese” patients reported inappropriate comments about their weight from physicians(4). This is present in the form of unsolicited weight loss recommendations, often a result of providers automatically assuming that weight status is an indicator of health and leads to doctors ignoring issues, not listening to their patients, not offering life saving surgery or medication, and much more. Medical students have also reported that residents and physicians initiate demeaning jokes targeted towards patients in larger bodies, labeling these individuals as “noncompliant” and “annoying” (4).
Such weight stigmatization puts individuals in larger bodies at a much greater health risk than the perceived health consequences of being fat.
In fact, research has shown that patients who have experienced weight stigma or have gained weight are less likely to seek healthcare because of their experience with doctors, and are more likely to neglect health concerns. This causes other health issues to remain undiagnosed and poses immense harm to those residing in larger bodies.
Additionally, one study showed that “obese and overweight” patients report the negligence of provider’s to listen to health concerns and the providers’ tendencies to “attribute all of their other health issues to weight” as a contributor to low trust in doctors, health care avoidance, and low patient engagement (5).
Most medical education provides students with little-to-no training on body diversity and addressing medical weight bias. One study indicated that only 10% of medical students believe they were prepared to treat patients with “obesity” (6). This hinders their ability to properly treat and diagnose patients, and causes harm.
How is weight bias and weight stigmatization related to eating disorders?
The negative impacts of weight bias on physical and mental health put all people, and especially those in larger bodies, at a greater risk for developing eating disorders, and at greater risk for having an eating disorder go untreated and undiagnosed.
In fact, those who have experienced weight bias often develop a fixation on body appearance, a factor that’s a well-known precursor for eating disorders. Additionally, these individuals tend to develop maladaptive behaviors in an attempt to cope with these feelings of discrimination leading to bodily dissatisfaction, including binge eating, anorexia, and bulimia.
For those with pre-existing eating disorders, weight stigma makes the recovery from eating disorders even more difficult. Not to mention, many doctors and other health clinicians assume that people in larger bodies cannot have eating disorders and often prescribe diets and weight loss, further worsening the eating disorder and behaviors associated.
Additionally, many physicians underestimate the dangers of eating disorders, especially in individuals residing in larger bodies. Physicians fail to recognize the signs and symptoms of eating disorders in larger-bodied patients, and as a result eating disorders are often overlooked, undiagnosed, and untreated. This reinforces the misconception that body weight or body appearance accurately reflects the severity of an eating disorder.
One of the greatest flaws in the treatment of eating disorders lies in the use of body mass index (BMI) as a measurement of severity for eating disorders. In addition to physicians utilizing weight as the sole indicator of eating disorders, insurance companies often use BMI to determine eligibility for treatment.
This means that those with higher body weights have restricted access to eating disorder treatment and this reinforces ideas like “weight dictates deservedness” and you must be “sick enough” to receive help.
This also means that for those who have received insurance coverage for treatment, as soon as they reach what insurance deems “adequate weight”, treatment is no longer covered. Although there is no established timeline for how long treatment is supposed to last, providers who specialize in eating disorders have articulated that treatment is necessary long past weight restoration.
In addition to insurance issues, weight stigma presents another challenge to those with eating disorders. An important part of eating disorder recovery is bodily acceptance and dismantling fat phobia. Despite this, eating disorder treatment approaches very rarely acknowledge or address internal and external weight bias. Without the acknowledgement of anti-fat prejudice, it becomes nearly impossible for those in treatment to develop the coping skills to fully recover.
The over-emphasis of weight as a progress marker in recovery also presents great risk for those in treatment. One study indicates that although anorexia nervosa requires weight restoration “there is no empirical consensus in the field for setting target weights” (7). The use of weight as a measure of progress in recovery ignores differences of body composition, genetics, and malnourishment. Someone can be at a “normal” weight, yet still experience mental distress and require treatment. Although weight restoration is a necessary part of treatment for some in recovery, using weight as a sole progress marker ignores the psychiatric complexity of eating disorders. Remember that eating disorder are a mental illness.
Weight stigma is complex and presents many challenges for those existing in larger bodies. The first step to fight weight stigma is to acknowledge weight bias and internalized fat phobia, and to learn more about how and in what ways it shows up for you and/or has impacted you.
Although confronting your own weight bias (or internalized weight bias) can be intimidating, it is necessary to repair your relationship with your body and food.
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Curious about how you’ve been impacted by weight stigma? Wondering how to address your own weight stigma?
It’s hard to exist in this culture and not have weight bias which often makes recovery from eating disorders and disordered eating extra difficult. Consider meeting with our weight-inclusive and eating disorder dietitians at Bravespace Nutrition in Seattle, WA if you’ve been impacted by weight stigma, weight bias or weight-based discrimation especially when it comes to eating disorder and disordered eating recovery. Our eating disorder dietitians have resources to help you challenge your own weight bias, recover from the eating disorder and tools to help support you in navigate weight stigma. Schedule a discovery call today!