3 Ways Public Health Professionals Can Combat Weight Stigma

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Kendrin Sonneville and Katherine Bauer

Assistant Professors, Nutritional Sciences

October 10, 2018


Stigma against people with larger bodies is omnipresent. At every turn, we hear comments or see images equating larger bodies with laziness, lack of willpower, and low intelligence.

There is a perverse fear that if our society accepts larger bodies, the health of our population will plummet. Meanwhile, over a decade of research demonstrates that weight stigma harms individual and the public's health.

 Even in the most conscientious circles, where jokes based on gender or race would never be tolerated, making disparaging comments about someone's weight or shape is still acceptable. People with larger bodies are teased, bullied, harassed, and excluded, with many believing that these individuals deserve such treatment because they chose to be this way.

Some of this stigmatizing behavior is driven by the belief that individuals of higher weights need to experience shame in order to "get healthy." There is a perverse fear that if our society accepts larger bodies, the health of our population will plummet. Meanwhile, over a decade of research demonstrates that weight stigma harms individual and the public's health.1 Being made to feel bad about yourself does not motivate healthful behavior change. Instead, it often leads to disordered eating, less physical activity, depression, and weight gain.2

While public health professionals frequently take pride in their commitment to social justice and equity, weight bias and size diversity are rarely discussed in schools of public health. Further, public health campaigns commonly perpetuate weight stigma, and public health researchers and practitioners often hold—and communicate—anti-fat attitudes.3

If we are truly committed to diversity, equity, and inclusion, all public health professionals have a responsibility to do better and work toward eliminating weight stigma. We can do this in a variety of ways:

1. Choose appropriate images to communicate weight and health. People with larger bodies are more likely than smaller-bodied people to be portrayed in a stereotypical or unflattering way: headless, with an emphasis on isolated body parts, engaging in sedentary behavior, and dressed in inappropriately fitting clothing.4 This portrayal, derisively referred to as the "headless fatty" among fat activists, dehumanizes individuals with larger bodies, spreads false assumptions, and contributes to negative attitudes toward people with larger bodies.5 Best practices for respectful representation include portraying individuals with larger bodies in the following manner:

  • Engaging in diverse activities, roles, careers, and lifestyle behaviors
  • Wearing appropriate-fitting clothing and portrayed with a well-kept appearance
  • Depicted in a neutral manner, free of additional characteristics that might otherwise perpetuate weight-based stereotypes6

The University of Connecticut Rudd Center for Food Policy and Obesity and the World Obesity Image Bank offer free image libraries that meet these best practice guidelines.

2. Use respectful language when talking about weight. Although differences in preferred terminology exist among individuals with higher body weights, terms like "high weight" or "large bodied" are generally considered acceptable and suitable in general and scientific communication. In an effort to reduce bias associated with obesity, many weight-focused journals now require the use of people-first language ("person with obesity" rather than "obese person"), the standard for respectfully addressing people with chronic diseases, rather than labeling individuals by their illness.7 However, it is important to note that fat activists and fat studies scholars denounce the use of person-first language, arguing that the term "obesity" implies disease and illness, thereby pathologizing and stigmatizing larger bodies.8 Within the fat acceptance movement, the term "fat" is the preferred term and is used as a reclaimed neutral descriptor.

3. Challenge the idea that weight is synonymous with health and that well-being is only possible at a specific weight. Someone's body size tells you nothing about their health behaviors. An individual of lower weight may be just as likely to have a poor quality diet and be sedentary as an individual of higher weight. Public health professionals can combat weight stigma by avoiding making assumptions or generalizations about people's health or health habits based on their weight. Further, our public health messages, campaigns, and interventions can adopt a weight-inclusive framework that supports practices that enhance people's health regardless of where they fall on the weight spectrum.1

References

  1. Tylka TL, Annunziato RA, Burgard D, et al. The weight-inclusive versus weight-normative approach to health: evaluating the evidence for prioritizing well-being over weight loss. Journal of obesity. 2014;2014:983495.
  2. Puhl R, Suh Y. Health Consequences of Weight Stigma: Implications for Obesity Prevention and Treatment. Current obesity reports. 2015;4(2):182-190.
  3. Tomiyama AJ, Finch LE, Belsky AC, et al. Weight bias in 2001 versus 2013: contradictory attitudes among obesity researchers and health professionals. Obesity (Silver Spring). 2015;23(1):46-53.
  4. Puhl RM, Peterson JL, DePierre JA, Luedicke J. Headless, hungry, and unhealthy: a video content analysis of obese persons portrayed in online news. Journal of health communication. 2013;18(6):686-702.
  5. McClure KJ, Puhl RM, Heuer CA. Obesity in the news: do photographic images of obese persons influence antifat attitudes? Journal of health communication. 2011;16(4):359-371.
  6. The Rudd Center for Food Policy and Obesity, The Obesity Society (TOS), Obesity Action Coalition (OAC), Obesity Medicine Association (OMA), and American Society for Metabolic and Bariatric Surgery (ASMBS). Guidelines for Media Portrayals of Individuals Affected by Obesity. 2016.
  7. Kyle TK, Puhl RM. Putting people first in obesity. Obesity (Silver Spring, Md.). 2014;22(5):1211.
  8. Meadows A, Danielsdottir S. What's in a Word? On Weight Stigma and Terminology. Frontiers in psychology. 2016;7:1527.They

About the Authors

Kendrin SonnevilleKendrin Sonneville is an assistant professor of Nutritional Sciences at the University of Michigan School of Public Health and research faculty with the university's Center for Human Growth and Development. Sonneville is a registered dietitian and behavioral scientist whose research focuses on eating disorders prevention and weight-inclusive health promotion among children, adolescents, and young adults.

Katherine BauerKatherine Bauer is an assistant professor of Nutritional Sciences at the University of Michigan School of Public Health and research faculty with the university's Center for Human Growth and Development. Trained as a behavioral epidemiologist, Bauer's research focuses on understanding social and behavioral influences on children's healthy eating, activity, and weight, and translating these findings into innovative, effective obesity prevention programs.

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