Weight stigma and redefining healthy
Kendrin Sonneville
Associate Professor, Nutritional Sciences
I started my career as a registered dietitian before entering the field of public health, and I saw a lot of weight stigma in my clinical practice, even though I didn't have the language to describe it at the time. Working in an eating disorder clinic, I noticed how differently we treated people in thin bodies who had weight concerns compared to those in larger bodies. This cognitive dissonance brought me to public health.
Initially, I thought I would study eating disorders prevention, but the more I worked in that space, the more I saw weight stigma and anti-fat attitudes as the real drivers of eating disorders at a population level. My passion grew to recognize not just the role of weight stigma in eating disorders, but its holistic impact across public health domains.
The focus on weight as an indicator of health has a complicated history. It's important to note that concerns about weight or fatness preceded any concerns about the relationship between weight and health. By the early 19th century, fatness was deemed evidence of immorality and racial inferiority. This racist history of body surveillance in our country shows we didn't start talking about bodies and categorizing them for the sake of health.
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When we rely on body mass index, or BMI, as an indicator of health, we often miss the mark. In one study, approximately 75 million Americans were misclassified, leading to incorrect assumptions about their health based solely on body size. This oversimplification can be problematic. For instance, if someone's weight increases because they are no longer engaging in eating disorder behaviors or chronic dieting, this is a positive change. On the other hand, if someone's weight decreases due to food insecurity or trauma, it's not something to celebrate.
Public health often places an excessive focus on weight and health, while failing to fully recognize the profound impact of weight stigma. People in larger bodies face discrimination in almost every domain of their life. They receive lower-quality healthcare because doctors spend less time with them and provide fewer interventions.
My recent research with college students found that weight stigma was consistently associated with poor mental health, including increased symptoms of eating disorders, anxiety, and depression. Even subtle forms of stigma, like people acting as though they're better than others because of body weight, were strongly associated with negative health outcomes.
What I advocate for is a weight-inclusive framework – an approach that emphasizes health and well-being as multifaceted. We must center the experiences of fat people in our research; they know best about their lives, behaviors, and experiences. As Tracey Tylka eloquently stated, a weight-inclusive approach "challenges the belief that a particular BMI reflects a particular set of health practices, health status, or moral character."
We know nothing about people by just looking at the size of their body. It's time we move beyond this narrow definition of health and work to reduce weight stigma as a way to improve health across the weight spectrum.
About the author
Kendrin Sonneville is a registered dietitian, behavioral scientist, and public health researcher whose research focuses on the prevention of eating disorders among children, adolescents, and young adults. She uses a weight-inclusive framework to study how to promote health and well-being without inadvertently increasing body dissatisfaction, disordered eating, and weight stigma.