Why Weight Stigma Persists (And What We Can Do About It)

Weight stigma is the thing I encounter as a dietitian that saddens me most. It is based on assumptions and lies that people of a larger size:

  • are lazy and gluttonous
  • lack willpower, self-control and self-respect
  • eat too much
  • don’t exercise
  • are unhealthy
  • need to lose weight

It seems like no matter the research, books, or professionals who speak against these presumptions, people still want to hold onto these beliefs. Why?

From my experience, most people pull the “health” card. They want people who are overweight or obese to be healthy, which somehow means that they should lose weight by whatever means possible. Liquid meals, starvation, cutting off part their stomach, being publicly shamed.

The irony is that these interventions for the sake of health promote anything but health. As I’ve discussed before on my podcast and in other posts, diets, restriction, rigid food rules and shame all create a perfect storm for deleterious health benefits of both mind and body.

The other sad irony is that many people with larger bodies exercise regularly, eat their fruits and veggies, and are healthy. Of course, we have to define health somehow, and how it usually is measured is by things like lab values and blood pressure. These numbers are often totally ignored by health professionals who have a weight bias when they see a high BMI on the chart or a fat patient in the treatment room.

At one point I worked at a clinic that served a population predominantly from the Asia Pacific region. The majority of my patients were of a normal weight, following the faulty BMI categorization. Many of them also had uncontrolled diabetes, hypertension and dyslipidemia, which is why their doctors referred them to me. I also had patients who fell into the overweight and obese categories who had healthy blood sugar, blood pressure and cholesterol. So why were they referred to me? Their weight, of course!

Weight is just one of many indicators of health, and it should be treated as such. Unfortunately, this isn’t so. Time after time, I see weight trumping all other evidence that points to the health of larger people.

Sometimes I wonder if the health card is a coverup. Some people (maybe without even recognizing it) just want everyone to have a certain sized and shaped body that they consider aesthetically pleasing. Fat is offensive to them. The assumptions that I listed at the beginning of this post have been subtly and not so subtly inserted into public health messages, the education of health professionals, and media. I think if we took at long, hard look, we would have to admit that fat people can be healthy and they can be unhealthy.

And if we really cared about them and their health, weight stigma would go away.

Do you care?

Weight Stigma Awareness Week  is September 26-30. The annual online event is hosted by the Binge Eating Disorder Association (BEDA). The 2016 theme—Teaching Kids the Truth—will revolve around kids’ perceptions of weight bias and body image, and include personal narratives from adults discussing why it’s important to model healthy behaviors around developing minds and bodies.

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There are 9 comments

  1. Chantal

    I care!!!

    Thank you for this!! So true!! I recently got my Zumba license and when we were there a few people shared their stories and this one girl was plus-sized (by societal standards) and she had actually already lost 52kgs and was still going strong. She was one of the fittest at the training and I thought how awful that certain people would look at her and judge and be so far off-base!!!

  2. Dee

    I’m a registered midwife and nurse and have seen many many complications related to obesity of young people with normal clinical values. Especially during pregnancy and childbirth. Also I’m currently overweight and its because I eat too much. I’ve lost weight by not eating packets of m&ms, tubs of icecream and packets of doritos and by walking everyday. I have been lazy and gluttonous in the past and clearly have lacked self respect when I feed my body such rubbish. My blood pressure, cholesterol and blood sugar have always been ‘normal’. And I dont feel healthy if I can barely do a brisk walk for 5 minutes without huffing and puffing. I dont think we should generalise that all obese people are the same but if we start accepting obesity as ok it will only serve to add to health problems not solve them.

    1. Michaela Ballmann, MS RD

      Thanks for sharing your experiences Dee! I am by no means saying that people who are obese never have health issues…but normal weight people and underweight people can have the same or similar issues (dyslipidemia, hypertension, pregnancy complications, etc.). There are absolutely people who are obese (going by BMI) that eat a lot of fast food and are sedentary. And there are also a lot of obese people who eat healthy and exercise regularly. Focusing on helping people to live healthy lives is important, not trying to get them to a particular weight/size. What I’m saying is there is a problem with looking at someone and making a judgement and assumptions about their lifestyle based on their size. As a dietitian, I work with a lot of heavy people who are “doing everything right” and are still heavy. I want to draw attention to this because there is so much shame and condemnation of fat people that is socially acceptable and I think it’s wrong.

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