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Social stigma of obesity
Social stigma of obesity
Social stigma of obesity
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Social stigma of obesity is bias or discriminatory behaviors targeted at overweight and obese individuals because of their weight and high body fat percentage.[1][2] Such social stigmas can span one's entire life as long as excess weight is present, starting from a young age and lasting into adulthood.[3] Studies also indicate overweight and obese individuals experience rates of stigma near prevalent to that of racial discrimination.[4] Stigmatization of obesity is usually associated with increased health risks (morbidity) of being overweight or obese and the possibility of a shorter lifespan (mortality).

Obese people marry less often, experience fewer educational and career opportunities, and on average earn a lesser income than normal weight individuals.[3] Although public support regarding disability services, civil rights, and anti-workplace discrimination laws for obese individuals have gained support across the years, overweight and obese individuals still experience discrimination, which may have detrimental implications in relation to both physiological[5] and psychological health. These issues are compounded by the significant negative physiological effects that are already associated with obesity,[6] which some have proposed may be caused in part by stress from the social stigma of obesity (or which may be made more pronounced as a result of that stress).[5]

Anti-fat bias refers to prejudicial assumptions that are based on an assessment of a person as being overweight or obese. It is also known as "fat shaming" or "fatphobia". Anti-fat bias can be found in many facets of society,[7] and fat activists commonly cite examples of mass media and popular culture that pervade this phenomenon.[8][9]

Characteristics

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Studies have indicated that experiencing weight stigma reinforces lifestyle behaviors that contribute to obesity.[10] Individuals who are overweight or obese tend to devalue their own in-group and prefer the out-group (i.e. thinner individuals).[11]

Prevalence

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Individuals who are subjected to weight-related stigma are shown to be admired less in the public eye[12] when compared with other groups, such as sexual minorities and those with mental illness.[13] In the US, self-reported incidents of weight-based discrimination increased from 1995 to 2006.[14]

Anti-fat bias has been observed in groups hoping to become physical education instructors. In a study published in 2007, a group of 344 psychology or physical education majors at a New Zealand University were compared, and it was found that the prospective physical education teachers were more likely to display implicit anti-fat attitudes than the psychology majors.[15]

A number of studies have found that health care providers frequently have explicit and/or implicit biases against overweight people, and it has been found that overweight patients may receive lower quality care as a result of their weight.[16] Medical professionals who specialize in the treatment of obesity have been found to have strong negative associations toward obese individuals.[17] The stress from obesity-related stigma may also cause negative health outcomes.[5]

A 2004 study in preschool-aged children reported a preference for average-sized children over overweight children as friends.[18] Overweight individuals often found themselves suffering repercussions in many facets of society, including legal and employment issues later in their life.[7]

According to a 2010 review of published studies, interventions seeking to reduce prejudice and social stigma against fat and obesity are largely ineffective.[19]

Theoretical explanations

[edit]

In order to understand weight-biased attitudes, theories have been proposed to explain these biases and the subsequent discrimination they cause. Christian S. Crandall discusses the "Justification of Stigmatization".[20] Also his Social Ideology Perspective draws on traditional North American values of self-determination, individualism, and self-discipline. Based on these values, anti-fat attitudes may derive from directing blame for being overweight towards individuals who are overweight.[21] Similarly, the attribution theory suggests that attitudes towards obese individuals are dependent on how much control they are perceived to have over their weight.[2] Throughout the literature, numerous studies have shown support for this theory. One study conducted a multinational examination of weight bias across four countries (Canada, United States, Iceland, and Australia) with comparable obesity rates.[22] The study found that attributions of behavioral causes of obesity were associated with greater weight bias. Similarly, viewing obesity as being caused by a lack of willpower was also associated with greater weight bias. There appears to be a decrease in weight bias when weight is attributed to factors that are less within the individual's control, or when individuals are perceived as trying to lose weight.[23] However, evidence also exists showing that biases against obese individuals also include disgust towards them, which can persist regardless of if one knows that obesity is not caused by obese individuals' actions.[24]

Fatphobia does not generally refer to a fear of obese people, but rather a socially constructed phenomenon of particular prevalence in the western world.[25] People, often said to be living in the west, value healthy and strong bodies that prioritize agility, endurance and fertility[25] - with focus on achievement and individual responsibility.[26] Not only do such bodies associate the western world with similar ideals, but Lloyd deMause suggests the 'fitness/toughness craze' may also reflect preparations for war.[27] The overabundance of calorically high, nutrient- and other essential vitamin and mineral-depleted food options more common in the western hemisphere is often associated with people who are against fat phobia. The 'fattening huts' of young girls in Nigeria however, represent beauty, marriageability and money – a direct reflection of the value of economic resource and food.[28] There, fatness is a welcome sign of health, prosperity and maternity: linked to self-worth and sexuality also.[28]

Fatphobia does not fear 'fat' but prejudice, discrimination, exclusion and preventable disease too: fears directly attributable to the myriad of social, political, historical, economic and cultural processes at work (that do not similarly exist in other cultures).[28] In this way, fatphobia is a culturally derived phenomenon influencing relationships to food as well to the female form. Trends in 'blame, shame and stigma'[26] have contributed to fat positivity and 'health at every size' movements, that create digital 'safe spaces' for activism and radical fat acceptance that seek to resist/shift such powerful cultural perspectives.[29]

Trait attribution

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Anti-fat bias leads people to associate individuals who are overweight or obese with negative personality traits such as "lacking willpower",[30] "lazy", "gluttonous", "stupid", "incompetent", or "unmotivated".[31] This bias is not restricted to clinically obese individuals. It also encompasses those whose body shape is found to be unacceptable when compared to modern society's perception of the ideal body type (although still within the normal or overweight body mass index (BMI) range).[32] Fat-shaming is fairly common in the United States, even though most adult Americans are overweight. Huffington Post wrote "two-thirds of American adults are overweight or obese. Yet overweight and obese individuals are subject to discrimination from employers, healthcare professionals, and potential romantic partners".[33][34][35]

Anti-fat bias can be moderated by giving a mitigating context to the individual's appearance of obesity.[36] For example, when told an individual was obese because of "overeating" and "lack of exercise", a higher implicit bias was found among study participants than those not provided with context. When the group was told that "genetics" was to blame, they did not exhibit a lowered implicit bias after the explanation.

Anti-fat bias is not a strictly Western cultural phenomenon. Instances of implicit anti-fat bias have been found across several cultures.[37]

Additionally, recent work around physical appearance issues, body image, and anti-fat or obesity prejudice suggests that feelings about one's own appearance may stimulate downward physical comparisons with obese individuals in order to make one feel better about one's own physical appearance.[38][39]

Weight discrimination

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Weight stigma is present in multiple settings including healthcare, education, interpersonal situations, multiple media forms and outlets, and across many levels of employment.[2]

In the media

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See also: Obesity social stigma in television

Media, in general, overrepresents underweight individuals and underrepresents overweight individuals. One-third of women in television are classified as underweight, while only 5% of the general population falls into that category.[40] Conversely, a study on over a thousand major television characters from 2003 identified 14% of female characters and 24% of male characters to be overweight, despite the real-world percentages being more than double those reported numbers.[41][42]

Even when overweight people are included in television, they often play minor, stereotyped roles. Nearly two thirds of the most popular children's movies contain negative portrayals of fat people, stereotyping them to be unintelligent, lazy, and evil.[41] Fat television characters are more commonly seen eating and are less likely to be involved in romantic relationships compared to average weight television characters.[40] Male characters are less commonly portrayed as having close friendships.[41]

In 2007, another analysis sampled 135 scenes featuring overweight individuals from popular television programs and movies are coded for anti-fat humor. The majority of anti-fat humor found was verbal and directed at the individual in their presence.[40] Additionally, a relationship was found between audience laughter and a male character poking fun at a female character's body, but that same relationship wasn't there when it was a female character ridiculing a fat male.[40]

There is a great deal of empirical research to support the idea of thin ideal media, or the idea that the media tends to glorify and focus on thin actors and actresses, models, and other public figures while avoiding the use of overweight individuals.

Puhl et al. (2009) also reviewed how in entertainment, news reporting, and advertising, media is a particularly potent source of weight stigma. News reports have blamed individuals who are overweight and obese for various societal issues including prices of fuel, global temperature trends, and precipitating weight gain among their peers.[2] The news media repeatedly engages in the "Headless Fatties" phenomenon, coined by Charlotte Cooper, in which images and videos only depict overweight individuals as bodies by cropping out their heads. This objectification happens in 72% of all news reports on obesity.[41]

The University of California, Los Angeles, conducted a study that analyzed scientific research on weight and the news reports on such research. They looked for disparities in language, the cited causes of obesity, and proposed solution. News stories were more likely than the scientific articles to use dramatized language, words such as epidemic, crisis, war, and terrorism, and were more likely to cite individual behaviors as the causes and solutions to obesity, ignoring the systemic issues.[43]

In September 2011, prominent nationally syndicated columnist Michael Kinsley (founding editor of Slate magazine) wrote, "New Jersey Governor Chris Christie cannot be president: He is just too fat ... why should Christie's weight be more than we can bear in a president? Why should it even be a legitimate issue if he runs? One reason is that a presidential candidate should be judged on behavior and character ... Perhaps Christie is the one to help us get our national appetites under control. But it would help if he got his own under control first."[44] Governor Christie responded on October 4, 2011, stating "The people who pretend to be serious commentators who wrote about this are among the most ignorant I've ever heard in my life. To say that, because you're overweight, you are therefore undisciplined—you know, I don't think undisciplined people get to achieve great positions in our society, so that kind of stuff is just ignorant."[45]

In 2013, Haley Morris-Cafiero's photography project "Wait Watchers", in which she photographed the reactions to her presence by random passers-by, went viral. New York magazine wrote, "The frequency with which Morris-Cafiero succeeds at documenting passersby's visible disdain for her body seems pretty depressing".[46]

In education

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In regards to more direct weight bias, obese individuals were 40–50% more likely to report a perception of major discrimination compared to those of average weight across a multitude of settings.[47][48] In the educational setting, those who are overweight as youth often face peer rejection[49] and are bullied more.[50] Overweight children have poorer school performance if they experience weight-based teasing.[51] Between fifth and eighth grade, a child's increase in BMI results in a decrease in their teacher's perception of that student's ability,[41] and 50% of principals believe fatness is just a result of lacking self control.[41] Teachers, particularly those teaching physical education classes, sometimes express negative attitudes towards overweight individuals.[2]

Research suggests that within the classroom teachers may perceive overweight individuals' work more poorly compared to average weight individuals.[52] Students also perceive overweight individuals as being likely to have lower GPAs, and students are less likely to want to do groupwork with overweight individuals compared to average weight individuals.[53] Research has also found that overweight females receive less financial support for education from their families than average weight females, after controlling for ethnicity, family size, income, and education.[2][13] As individuals grow older they may be less likely to be admitted to college than individuals of an average weight, and in some cases, people were admitted to academic institutions then dismissed due to their weight.[2][13]

Puhl and colleagues (2009) concluded from their review of weight stigma in education that current trends indicate students with obesity face barriers to educational success at every level of education.[2] Reviewed research demonstrates that educators, particularly physical education teachers, report antifat attitudes toward their students with obesity, which may undermine educational achievement.[2] Importantly, the education disparities for students with obesity appear to be strongest for students attending schools where obesity is not the norm. Several studies have evidenced that in environments such as these, students with obesity face greater educational disadvantages and are less likely to attend college, an effect that is particularly strong among women.[2] Moreover, weight stigma in educational settings also affects interpersonal relationships (see "Interpersonal situations" below).[54]

In employment

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Studies suggest that obese individuals are less likely to be hired and once hired, have greater termination rates than average weight individuals.[2][13] Specifically, a national survey found that obese individuals were 26% more likely not to be hired, not receive a promotion, or to be fired compared to average weight persons.[47] Such outcomes may be a result of employers viewing them as less agreeable, less competent and lazier than average weight individuals.[2][13]

Weight stigma can lead to difficulty obtaining a job, worse job placement, lower wages and compensation, unjustified denial of promotions, harsher discipline, unfair job termination, and commonplace derogatory jokes and comments from coworkers and supervisors.[2] In their review, Rebecca M. Puhl et al. find that employees with obesity report their weight as the most influential factor contributing to losing their job.[2] Another review by Giel and colleagues (2010) found that certain stereotypes about employees with obesity are highly endorsed by employers and supervisors, in particular that they have poorer job performance and that they lack interpersonal skills, motivation, and self-control.[55]

In politics

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New Jersey Governor Chris Christie is a politician who was subjected to weight-related discrimination during his political career.[44]

A study by Michigan State University researchers shows evidence that overweight political candidates tend to receive fewer votes than their thinner opponents.[56] The researchers analyzed data from the 2008 and 2012 U.S. Senate elections. Using a previously established scientific method, research assistants determined from color photos whether the candidates in 126 primary and general elections were of normal weight, overweight, or obese.

Both obese men and women were often less likely to get on the ballot in the first place. When it came to merely being overweight, women were seen underrepresented on the ballot, though men were not. This is consistent with previous research showing slightly overweight men tend not to experience the same discrimination as slightly overweight women.

However, when it came to the voting, both male and female candidates, whether obese or simply overweight, tend to get a lower share of the vote total than their more slender opponents. Some politicians have resorted to extreme weight loss measures, including surgery, to increase their electability to political office.[57]

In healthcare

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Medical professionals may be more likely to view obese individuals in negative terms (such as annoying or undisciplined), have less patience with obese individuals, and assume non-compliance with their treatments.[58] As such, these individuals may receive poorer care compared to average weight people. Primary care physicians overstate the effects of being overweight on all-cause mortality,[59] describing being overweight as much more detrimental than clinical guidelines indicate.[60] Additionally, nurses have reported a reluctance to touch obese persons during treatment.[13] A national survey of the United States found that individuals who were overweight reported a three times higher likelihood to be denied medical care than average weight people.[47] In the UK, 25 out of 91 primary care trusts have bans for the treatment of obese individuals in addition to weight loss requirements.[61] Additionally, a 2012 survey revealed that 54% of doctor respondents believe the National Health Service should have the ability to withhold non-emergency treatment from obese individuals.[61] Further, health professionals who specialize in obesity showed strong implicit and explicit anti-fat bias as measured by self-report and the Implicit Associations Test (IAT).[62] However, such biases were mixed amongst dietitians and nutritionists.[63]

In their 2009 review, Puhl and colleagues found that many studies provide evidence supporting the notion that health professionals (including doctors, nurses, medical students, fitness professional, and dietitians) consistently endorse negative stereotypes about patients with obesity, in particular ascribing to them culpability for their weight status.[2] Weight stigma in the healthcare settings leads to impaired patient-provider communication, poorer doctor-patient relationships, poorer medical care and treatment (for example doctors spending less time with patients), and avoidance of the healthcare system all together on the part of the patient.[2] However, it is important to point out that the evidence that has been reviewed thus far comes primarily from self-report studies. Therefore, Puhl and colleagues concluded that research examining actual health outcomes is needed.[2] Overall, the impact of weight stigma in healthcare has become so problematic that many scholars have suggested that obesity-prevention programs should make minimizing stigma a priority.[2][64]

Interpersonal situations

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Although a less studied topic than employment and healthcare, several studies reviewed by Puhl and colleagues (2009) provide evidence that overweight and obese women in particular face weight stigma from many interpersonal sources including family, friends, and romantic partners.[2] Another recent review by Puhl and Suh (2015) also documented that in school settings weight-based bullying is one of the most prevalent types of harassment reported by parents, teachers, and students.[65] Experiencing interpersonal weight stigma is related to myriad negative physical and mental health consequences (see "Mental health and psychological consequences" below).

In a 2017 study, results showed that 89% of obese adults had been bullied by romantic partners.[66][67]

In early development

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This external stigmatization and its internalized effects have been examined across different age groups. Overweight and obese children and adolescents experience stigmatization from parents, teachers, and peers.[68] Peer stigmatization, especially, may be difficult for overweight adolescents considering the role of peer support in promoting identity development and self-esteem.[65] Some research suggests that negative attitudes about being overweight are even held by overweight and obese children themselves. Specifically, weight bias may become internalized and increases throughout childhood. It then decreases and levels-off during late adolescence and adulthood.[68]

Weight-based teasing in childhood and adolescence has been associated with a variety of damages to psychosocial health, including reduced self-esteem and lower self-concept,[68][69] higher rates of depression and anxiety disorders,[70][71][72] and even greater likelihood of entertaining suicidal thoughts.[68] Further, weight-based teasing has been associated with higher rates of binge eating and unhealthy weight control (e.g., fasting, self-induced vomiting, laxatives, diet pills, skipped meals and smoking).[68][73][74] Overweight adolescents who were bullied were also more likely to meet criteria for bulimia.[75]

A survey of 7,266 children aged 11 to 16 conducted by the World Health Organization reported higher rates of physical victimization (e.g., being shoved) with increasing body mass index (BMI) among girls. Additionally, these results showed relational victimization (i.e., being excluded or having rumors spread about you) was reported more often at increasing BMI by both girls and boys.[65] A separate survey of 7,825 students aged 11 to 17 also noted that, compared to average-weight peers, obese boys and overweight girls were more likely to be victims of bullying. Additionally, obese girls were more likely to be victims and perpetrators of bullying than their peers. Notably, overweight and obese adolescent girls also reported higher rates of smoking, drinking, and marijuana use relative to their normal-weight peers.[76]

[edit]

Stigmatization of obesity is associated with increased risk of obesity and increased mortality and morbidity.[34] In adulthood, individuals who experience weight discrimination are more likely to identify themselves as overweight regardless of their actual weight status.[77] The experience of weight stigma can function as motivation to avoid stigmatizing environments, and although it may motivate one to escape stigma through weight loss, it undermines one's capacity to do so.[78] Researchers have linked weight stigma to decreases in physical activity,[77][79][31] decreases in seeking health care[31] and increases in maladaptive eating patterns such as binge eating.[78][31] In addition, those who have experienced weight stigma have shown altered cardiovascular reactivity, increased cortisol level, oxidative stress, and inflammation.[80][78]

People who expect to be fat-shamed by healthcare providers are less likely to seek care for medical issues or for weight loss, even if the weight gain is caused by medical problems.[81]

In terms of psychological health, researchers found that obese individuals demonstrated a lower sense of well-being relative to non-obese individuals if they had perceived weight stigmatization even after controlling for other demographic factors such as age and sex.[82] Overweight and obese individuals report experiencing forms of internalized stigma such as body dissatisfaction as well as decreased social support and feelings of loneliness.[83][84] In addition, similar to findings in adolescence, weight stigma in adulthood is associated with lower self-esteem, higher rates of depression, anxiety, and substance abuse.[78][31][83]

In both adults and children with obesity, several reviews of the literature have found that across a variety of studies, there is a consistent relationship between experiencing weight stigma and many negative mental and physical health outcomes.[2][21][85][54][86] These will be discussed separately in the sections below, although physical and mental health consequences are often intertwined, in particular those related to eating disorders.

Papadopoulos and Brennan (2015) recently found that across many reviewed studies of weight loss treatment-seeking adults,[85] relationships emerged between experiencing weight stigma and both BMI and difficulty losing weight. However the findings are somewhat mixed. They also report evidence that experiencing weight stigma is related to poor medication adherence. Among weight loss treatment-seeking adults, experiencing weight stigma might exacerbate weight- and health-related quality of life issues.[85] This review along with reviews by Vartanian and Smyth (2013) and Puhl and Suh (2015) have also found that across several studies and in both adults and children, experiencing weight stigma is related to decreased exercise behavior overall, as well as decreased motivation to exercise, decreased exercise self-efficacy, and increased food craving and tendency to overeat.[21][85][65] These effects of weight stigma on exercise and physical activity emerge independent of body mass index, suggesting that weight stigma becomes a unique barrier to physical activity outside of barriers that may be associated with obesity in particular. Finally, across many studies, Puhl and Suh (2015) also found that experiencing weight stigma is related to many physiological consequences as well, including increased blood pressure, augmented cortisol reactivity, elevated oxidative stress, impaired glycemic control/elevated HbA1c, and increased systemic inflammation,[65][86] all of which have notable consequences for physical health and disease.

Mental health and psychological consequences

[edit]

Broadly speaking, experiencing weight stigma is associated with psychological distress. There are many negative effects connected to anti-fat bias, the most prominent being that societal bias against fat is ineffective at treating obesity, and leads to long-lasting body image issues, eating disorders, suicide, and depression.[87]

Papadopoulos's 2015 review of the literature found that across several studies, this distress can manifest in anxiety, depression, lowered self-esteem, and substance use disorders, both in weight loss treatment-seeking individuals as well as community samples.[85] Many empirical reviews have found that weight stigma has clear consequences for individuals suffering from eating and weight disorders (including anorexia nervosa, bulimia nervosa, and binge eating disorder), as it plays a unique role, over and above other risk factors, in perpetuating disordered eating psychopathology.[85][65][86] These results have emerged in both adult and adolescent, as well as in male and female samples.

The study shows an interesting table that demonstrates how fast food consumption due to social and cultural pressures leads to body image shame and guilt, which, in many cases, leads people to search for comfort, creating a cycle of binge eating.[88]  This article makes it evident that shaming and forcing people into guilt for their actions does not help or solve the issue of obesity. Better alternatives include teaching people the mental and physical benefits of eating healthily versus eating unhealthily, but without resorting to shaming unhealthy eating habits.[88]

Treatments

[edit]

Lifestyle Changes are the most effective long-term Health Solution when treating overweight and obese people.[89] Fully implementing dietary restrictions is proven to be most successful, with cutting calorie intake by 500 to 1000 calories a day. Along with this, increasing physical activity, such as walking, is recommended at a rate of 2 miles a day.[89] Therapy is essential in reshaping overweight people's relationship with food, setting goals, and avoiding shaming, which only increases weight gain.[90] Fat removal surgery is effective in removing large chunks of fat. It is recommended to be coupled with therapy and lifestyle changes to prevent the fat from returning and to avoid weight gain.[89]

Policy

[edit]

Over the past few decades, many scholars[91] have identified weight stigma as a long-standing form of social stigma and one of the last remaining socially acceptable forms of prejudice.[91] It follows then that individuals who are targets because of overweight and obesity, still face uniquely socially acceptable discrimination.[7][92] Civil rights legislation such as Title VII of the Civil Rights Act of 1964 prohibits discrimination based on race and several other domains, but weight is not included in this act. At the local level, only one state in the US (Michigan) has policy in place for prohibiting weight-related employment discrimination and very few local municipalities have human rights ordinances in place to protect individuals of large body size.[2][93] Specifically, localities that have passed legislation explicitly prohibiting weight-based discrimination include the state of Michigan; San Francisco and Santa Cruz in California; Washington, DC; Urbana, Illinois; Binghamton, New York; New York City, New York (in employment, housing, and public accommodations),[94] and Madison, Wisconsin. Typically, the only of type of legislation that overweight and obese individuals can cite in lawsuits is related to disability. For example, the Americans with Disabilities Act is one such avenue, but as Puhl et al. (2009) report, it is difficult for many individuals with obesity to qualify as disabled according to the criteria included in this statute.[2] Few cases have been successful and most of these successes have occurred since 2009, after Congress passed the ADA Amendments Act of 2008, which expanded the definitions of disability to include "severe obesity" (but not moderate obesity, overweight or underweight) as an impairment. However, in 2012, the US Equal Employment Opportunity Commission (EEOC) successfully settled 2 cases for employees who were terminated from their jobs because their employers regarded them to be disabled based on their obesity and their severe obesity was now a covered disability under the new amendment. Despite these few recent successes, not all weight discrimination occurs in the context of disability or perceived disability, and legal remedies that can directly address weight discrimination as a legitimate social injustice remain absent.[95]

Public health

[edit]

The existing literature largely does not support the notion that weight stigma might encourage weight loss; as cited above, experiencing weight stigma (both interpersonally as well as exposure to stigmatizing media campaigns) is consistently related to a lack of motivation to exercise and a propensity to overeat.[21][85][65] In a 2010 review examining whether weight stigma is an appropriate public health tool for treating and preventing overweight and obesi ty, Puhl and Heuer concluded that stigmatizing individuals with obesity is detrimental in three important ways: (1) it threatens actual physical health, (2) it perpetuates health disparities, and (3) it actually undermines obesity treatment and intervention initiatives.[4] In line with this, another recent review of the consequences of experiencing weight stigma, this one conducted by Puhl and Suh (2015), concluded that considering the myriad negative physical and mental health consequences associated with experiencing weight stigma, it should be a target, instead of a tool, in obesity prevention and treatment.[65] These authors further recommend that a necessary first step in reducing weight stigma is raising broader awareness of its negative consequences.[65]

Race

[edit]

With higher representation of black people being categorized as overweight by the BMI, the social stigma of obesity disproportionately affects black people.[96] More than 80% of African American women are categorized as overweight using the Body Mass Index.[97]

Sociologist Sabrina Strings writes, in her book Fearing the Black Body, about the historical ways in which fatphobia emerged out of an attempt by white people to distance themselves from black people. In 1751, Denis Diderot published the Encyclopédie, which was the first publications to claim that black people were "fond of gluttony."[98] In 1853, French aristocrat Arthur de Gobineau claimed, about black people, that their "gluttonous nature to be one of their more base characteristics."[99] In 1910, Charles Davenport founded the Eugenic Record Office, and he claimed that "obesity was a vile condition to be avoided. It was, moreover, racially inherited."[99] Eugenics sentiment toward black people regarding their size was prevalent.

Black bodies are already stigmatized, which can result in violence when interacting with the social stigma of obesity. In a 2017 article published in the African American Review, one author cited the killing of Eric Garner as an example of this, as some excuses for using excessive force on Garner were his size, as he was an overweight man.[100] The article explains how ableism, fatphobia, and racism interact to form a "double bind" in which violence is excused because fatness is already causing inherent injury, but necessary because the size of a large black person is a threat.

A paper published by the American Journal of Preventive Medicine titled "Intersectionality: An Understudied Framework for Addressing Weight Stigma"[101] focused on highlighting the intersectionality between weight stigma and health-related coping responses across several non-white racial and gendered groups. The findings of this publication demonstrated that there were no significant differences in weight stigma as a function of race or gender, having an overall equal representation across all racial groups analyzed. Nonetheless, results additionally demonstrated that different racial groups had differing ways of internalizing and coping with weight and health-related stigmas, which as a result heightened health risks.[101] Results revealed that white women and men reported higher weight bias internalization in comparison to black women and men. Additionally, Hispanic women demonstrated to cope with weight stigma via disordered eating patterns more than black and white women. Along with this black women are less likely to deal with weight related stigma by developing eating disorders in comparison to white women.[101] The results of this research article highlighted the importance of needing to increase research and policy attention to addressing weight and health-related stigma as an issue regarding prevention and treatment for obesity in order to consequently decrease weight-driven inequalities in communities and differing groups, primarily focused on race and gender.[101]

Responses

[edit]

Fat acceptance movement and organizations

[edit]
Main article: Fat acceptance movement

The fat acceptance social movement in the USA emerged in the 1960s to highlight and counter social stigma and discrimination faced in a range of domains. Besides its political role, for example in the form of anti-discrimination NGOs and activism, the fat acceptance movement also constitutes a subculture which acts as a social group for its members.[102]

Language and identity

[edit]

The fat acceptance movement often uses the adjective "fat" and neologisms like "infinifat" as a reclaimed word.[103] Preferences regarding terminology and descriptions vary, however, with common disagreements revolving around which words to use (e.g. "fat", "overweight", "obese"/"obesity", "of size"), the use of person-first language (e.g. "a person with obesity"), the use of medicalized terminology, and the avoidance of stigma.

Person-first language

[edit]

Person-first language, which emerged from some disability advocacy groups, has the ostensible goal of treating a person independently of a trait. However, it also has the consequence of treating that trait as "toxic" abnormality which should be "fixed" to achieve normalcy, and which due to its inherent negativity must be talked about in a special, careful way, rather than used as a simple "benign" descriptor.[104] Critics believe that because such a formulation necessarily begins from the assumption that there is something wrong with being overweight, it contributes to further stigma.[104] Furthermore, person-first language can contribute to the medicalization of obesity, as this is the language commonly used when referring to disease. This may explain why person-first language is favored more often by those working in the obesity field (and therefore seeking medical "fixes") than by other groups. Advocacy groups have criticized a top-down approach whereby proponents of person-first language claim to speak for all, whereas in reality it is not the preferred terminology of many in the fat-acceptance movement.[104][105]

Descriptions and terminology

[edit]

Various studies of overweight people seeking weight loss as well as a semantics study of terminology used to describe an overweight individual concluded that using the word fat elicits a negative reaction from people already critical of obesity.[106][107] However, "obesity" was found in one study to be equally as undesirable as "fat" when considering language preferences of overweight individuals.[104]

"Fat" is the preferred term within the fat acceptance movement.[108] Fat activists have reclaimed the term as a neutral descriptor in order to work against the stigma typically associated with the term.[104] In fact, many fat activists will censor the word "obesity" when tweeting or citing it as "ob*sity" due to its pathologizing nature.[109] The word "obesity" directly stems from the Latin word "obesus" which means "that has eaten itself fat".[109] Fat activists will also use this Latin definition to show stigma in the word "obese" itself, as it places blame on the individual for their state.[110]

See also

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References

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Further reading

[edit]
Revisions and contributorsEdit on WikipediaRead on Wikipedia

Social stigma of obesity

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The social stigma of obesity refers to the discriminatory attitudes, stereotypes, and behaviors directed at individuals with excess body weight, including explicit prejudices such as viewing them as lazy or undisciplined, and implicit biases that influence social interactions and judgments. This form of bias is pervasive, with empirical surveys showing that approximately 42% of U.S. adults have encountered weight-based stigma, such as teasing or unfair treatment, and internalized weight bias affects a significant subset of those with overweight or obesity. Manifestations of this stigma span personal, professional, and institutional domains, often attributing to personal failings like poor rather than multifaceted causes including , environment, and socioeconomic factors, leading to phenomena such as workplace and provider in medical settings. From a causal perspective, such attitudes may stem from perceptual associations between body size and character traits, reinforced by cultural norms equating thinness with virtue and success, though evolutionary accounts link anti-fat to adaptive aversions toward cues of ill or reduced fitness. The consequences include heightened risks for psychological distress, with meta-analyses confirming associations between experienced weight stigma and elevated depression, anxiety, and behaviors independent of . Physiologically, stigma correlates with stress-induced responses, avoidance of due to , and delayed healthcare seeking, potentially exacerbating obesity-related comorbidities, though debates persist on whether stigma motivates efforts or primarily induces counterproductive physiological adaptations like increased caloric intake. Efforts to mitigate stigma, such as campaigns, face contention over balancing anti-discrimination goals with incentives for health improvement, given obesity's established links to morbidity and mortality.

Definition and Characteristics

Core Elements of Stigma

Social stigma of obesity fundamentally comprises negative stereotypes, prejudicial attitudes, and discriminatory behaviors directed toward individuals with elevated body weight. Stereotypes commonly portray obese people as lazy, undisciplined, lacking willpower, gluttonous, and less competent or conscientious in professional settings. These views often stem from attributions of obesity to personal failings rather than uncontrollable factors, reinforcing perceptions of moral or character defects. Prejudicial attitudes manifest as explicit or implicit biases, including emotional responses such as , , or of , which underpin desires for from obese individuals. Empirical assessments, such as the Fat Scale, quantify these through measures of negative reactions and avoidance tendencies, revealing widespread endorsement across demographics. Discriminatory behaviors include verbal teasing, bullying, exclusion from social activities, and tangible disadvantages in domains like employment, where obese candidates face hiring biases or lower evaluations independent of qualifications. Studies document these acts as overt (e.g., derogatory comments) or subtle (e.g., unequal resource allocation), with prevalence rates indicating that weight-based discrimination rivals or exceeds other forms of bias in some populations. A critical internalized component involves individuals adopting societal stereotypes about themselves, leading to self-stigma characterized by diminished , , and endorsement of negative self-beliefs tied to weight. This internalization amplifies psychological distress, as evidenced by validated scales like the Weight Bias Internalization Scale, which correlate higher scores with avoidance of health-seeking behaviors and exacerbated issues. Together, these elements form a multifaceted stigma framework, where public perceptions interact with personal experiences to perpetuate cycles of bias.

Distinctions from Weight Bias and Discrimination

Social stigma of encompasses the broader societal processes of labeling, stereotyping, and devaluing individuals based on their body weight, often resulting in or reduced status, distinct from narrower attitudinal or behavioral components. This stigma operates as a cultural mechanism that attributes inherent negative traits—such as or lack of —to , fostering a disapproval that permeates norms and expectations. In contrast, weight refers specifically to the prejudiced attitudes, , and implicit or explicit negative evaluations held by individuals or groups toward those with higher body weight, serving as the cognitive and affective foundation that sustains stigma without necessarily manifesting in action. Weight , meanwhile, denotes the tangible, observable behaviors and practices arising from and stigma, such as denying opportunities, providing substandard healthcare, or imposing unequal explicitly due to . Empirical studies indicate that while may be widespread—evident in surveys showing over 90% of adults endorsing anti-fat — requires enactment, with self-reported experiences rising from 7% in 1995-1996 to 12% in 2004-2006 among U.S. adults with . These distinctions highlight that stigma is not merely (an internal disposition) nor (an external act), but the interplay of both within social structures, where internalized stigma can exacerbate health outcomes independently of BMI, such as through responses. Scholars note overlaps in terminology, with "weight stigma" sometimes broadly including and , yet precise differentiation aids in addressing root causes: stigma targets cultural narratives, requires attitudinal interventions like , and demands policy remedies such as anti-discrimination laws, though evidence on their efficacy remains mixed due to enforcement challenges. This framework underscores that while interconnected, conflating them overlooks how societal stigma can persist even amid reduced overt , perpetuating cycles of devaluation through subtle norms rather than explicit acts.

Evolutionary and Biological Underpinnings

Adaptive Functions in

In ancestral human environments characterized by intermittent food scarcity and high physical demands, social stigma toward likely functioned adaptively by promoting individual and group fitness through avoidance of perceived risks and unreliable cooperators. Evolutionary psychologists propose that anti-fat emerged as part of the behavioral , where cues of bodily abnormality—such as excessive fat accumulation—signaled potential infectious , prompting responses to minimize contact and transmission risks. Empirical studies demonstrate that individuals with heightened pathogen avoidance motivations exhibit stronger negative attitudes toward obese people, associating with disease-relevant concepts like , even when itself is not contagious. This false-positive , favoring over-detection of threats in uncertain ancestral settings, enhanced survival by erring on the side of caution against visible deviations from lean, functional body norms prevalent in populations. Beyond pathogen cues, obesity stigma served to enforce cooperative norms by inferring substandard character traits, such as laziness or lack of , which could indicate free-riding on group resources during foraging or defense efforts. In small-scale societies reliant on shared and gathering, where physical vigor determined resource acquisition and predator evasion, stigmatizing visible signs of reduced mobility pressured individuals to maintain fitness and contribute reliably, thereby sustaining group productivity. Research in links this to cheater-detection mechanisms, where obesity cues trigger moral disgust akin to responses toward other exploitative behaviors, reducing willingness to form alliances or share with those perceived as burdensome. Anthropological evidence from pre-agricultural groups, where obesity was exceedingly rare due to caloric constraints, supports that such bias reinforced selection for traits enabling endurance and efficiency, with leaner physiques correlating to higher status and . In mate selection, anti-fat attitudes adaptively signaled reproductive viability, as excess fat in resource-poor environments often denoted underlying metabolic inefficiencies, chronic illness, or inability to withstand , lowering perceived genetic quality. Studies show disgust sensitivity, particularly sexual disgust, predicts aversion to obese partners, with men exhibiting stronger biases reflecting ancestral pressures for partners capable of , , and child-rearing under physical strain. This mechanism aligned with dynamics, where preferences for athletic builds maximized offspring survival odds in nomadic bands facing migration and conflict, as evidenced by cross-cultural patterns tying waist-to-hip ratios indicative of to attractiveness ratings. Overall, these stigma functions, rooted in causal linkages between and survival demands, fostered populations better equipped for Pleistocene challenges, though their persistence today reflects mismatched adaptations to abundance.

Contemporary Biological Realities of Obesity

Obesity in contemporary environments represents an evolutionary mismatch, where human physiology, shaped by millennia of caloric scarcity, encounters chronic abundance of energy-dense foods and sedentary lifestyles, promoting excessive fat accumulation. Twin and adoption studies estimate obesity heritability at 40-70%, indicating substantial genetic influence on body mass index (BMI) and fat distribution, independent of shared environments. This genetic predisposition interacts with modern obesogenic factors, such as processed foods high in refined sugars and fats, which exploit reward pathways evolved for infrequent high-energy rewards, leading to overconsumption. Central to obesity's persistence are disruptions in hormonal signaling, particularly leptin resistance and . , secreted by adipocytes to signal to the , reaches elevated circulating levels in obese individuals—often exceeding 50 ng/mL compared to 5-15 ng/mL in lean states—yet fails to suppress due to impaired hypothalamic transport and intracellular signaling, mimicking despite ample stores. Concurrently, obesity induces insulin resistance via ectopic lipid deposition in muscle and liver, elevating free fatty acids and inflammatory cytokines like TNF-α, which impair and promote further fat storage in a vicious cycle. These mechanisms underscore as a multifactorial chronic disease, with over 200-500 genetic variants identified contributing to polygenic risk, rather than a simple behavioral deficit. Biologically, obesity confers heightened morbidity and mortality risks across organ systems. Meta-analyses link class II-III obesity (BMI ≥35 kg/m²) to 1.5-2.5-fold increased all-cause mortality, driven by (e.g., 2-3 times higher coronary heart disease risk), (7-fold prevalence increase), and at least 13 cancer types via chronic inflammation and . In 2020s data, accounts for 4-8% of global deaths, exacerbating conditions like non-alcoholic fatty liver disease and through mechanical overload and metabolic dysregulation. These realities highlight obesity's maladaptive burden in post-industrial societies, where preventive interventions must address both genetic vulnerabilities and environmental triggers.

Prevalence and Demographic Patterns

Weight stigma manifests globally, with surveys indicating that 19–42% of adults with report experiences of weight discrimination, rates that are elevated among women and individuals with higher . , over 40% of adults across body sizes have encountered weight stigma, including teasing or unfair treatment. reveal variations in intensity, but stigma correlates strongly with lower education levels worldwide, independent of , age, or personal status. Traditionally, some non-Western societies exhibited lower stigma, associating larger bodies with prosperity or status, yet and influence have diffused thin-ideal norms, elevating stigma in regions like , , the , and . In low- and middle-income countries, adolescents with or face notable stigma, such as 53.8% of affected males in reporting bias. Temporally, perceived weight discrimination in the United States increased substantially from 7% of adults in 1995–1996 to 12% in 2004–2006, representing a 66% rise amid growing public awareness of as a issue. This uptick paralleled the launch of national anti-obesity campaigns, which emphasized personal responsibility and may have amplified blame attributions. However, nationally representative longitudinal surveys from 2012 to 2021 show weight-based bias stabilizing thereafter, with only minor cohort-specific shifts among women in certain domains, unrelated to aging effects. Globally, while prevalence tripled between 1975 and 2016—reaching 16% of adults by 2022—stigma has not declined despite anti-bias initiatives, persisting as a psychosocial stressor even in developing contexts where rates are surging.

Variations by Race, Gender, and Socioeconomics

Women experience higher levels of associated with than men, with research consistently showing that females report more frequent encounters with weight-based and internalization of negative . For example, in a study of over 2,900 U.S. adults, women were significantly more likely to endorse experiences of weight stigma, which mediated associations with and body dissatisfaction more strongly than in men. This gender disparity persists even at comparable body weights, as women face amplified scrutiny in domains like appearance and social desirability, contributing to greater psychological distress from stigma. Racial and ethnic differences in obesity stigma reveal lower endorsement of negative attitudes among Black individuals compared to Whites, particularly among women. Across multiple studies involving U.S. samples, Black women demonstrated reduced stigmatization of obese body sizes, attributing less negativity to overweight figures than White women did, potentially reflecting cultural norms that tolerate larger body ideals within Black communities. Non-Hispanic White patients also report higher avoidance of healthcare due to anticipated weight bias, whereas racial minorities may perceive stigma differently, with less internalization linking it to mental health outcomes in some analyses. These patterns hold after controlling for obesity prevalence, which is higher among Blacks, suggesting cultural rather than purely epidemiological drivers. Socioeconomic status (SES) influences both the prevalence of stigmatizing attitudes toward and the impact of experienced stigma. Lower-SES individuals exhibit stronger public endorsement of stigma, including beliefs in personal controllability and reduced social acceptance, as evidenced in a German survey of over 1,000 respondents where low-SES participants scored higher on multiple stigma dimensions. Conversely, the psychological toll of weight —such as elevated depression and anxiety—is amplified among those with lower , where stigma compounds existing deprivations like limited resources for coping. Higher-SES groups, benefiting from greater access to buffering factors like and networks, internalize stigma less detrimentally, though they may perpetuate it through institutional biases in and . These intersections highlight how SES modulates stigma's expression and consequences, independent of rates that inversely correlate with income in developed nations.

Manifestations Across Domains

Media portrayals of frequently reinforce by depicting individuals with higher body weight as objects of ridicule, moral failing, or , rather than multifaceted characters. A of popular television programs from the to , including Growing Pains, The Golden Girls, Friends, and King of the Queens, found that characters were often subjected to , insults, or exclusion, with characters particularly likely to be mocked by male counterparts for their size. In a study of over 1,000 major characters on commercial television, only 14% of and 24% of male characters were portrayed as or obese—rates lower than their in the U.S. —while those who were were disproportionately associated with negative traits such as , , or unattractiveness, limiting their roles to peripheral or humorous figures. In film, obese characters similarly serve as comedic sidekicks or foils, rarely achieving romantic or heroic arcs, which perpetuates stereotypes of incompetence or undesirability. Systematic reviews confirm that such depictions across media genres foster negative attitudes toward people with obesity, with overweight individuals shown as isolated, freakish, or in need of transformation, as exemplified by reality programs like The Biggest Loser (2004–2016), where contestants' pre-weight-loss bodies were framed as shameful burdens requiring extreme intervention. News media exacerbates this through dehumanizing visuals, such as close-ups of isolated body parts or anonymous obese figures symbolizing an "epidemic," appearing in 87% of analyzed segments with unflattering, non-contextual imagery that strips individuals of agency or dignity. Popular culture's emphasis on thin ideals in and further entrenches stigma, though direct fat-shaming in ads has drawn scrutiny; for instance, campaigns historically implied or lack of in consumers, aligning with broader narratives of personal responsibility for body size. These patterns persist despite counter-movements, as evidenced by ongoing analyses showing obese characters confined to "funny fat friend" tropes in contemporary shows, underscoring media's role in normalizing bias over empathetic representation.

In Employment and Economic Opportunities

Obese individuals encounter barriers in employment due to weight-based stigma, including reduced hiring probabilities and wage disparities. Field experiments have shown that or obese job applicants receive fewer interview callbacks compared to thinner candidates with identical qualifications, with biases particularly pronounced for women. In simulated employment interviews, moderately obese applicants, especially women, receive lower performance ratings and are less likely to be recommended for hiring, attributed to of reduced competence and . Wage penalties associated with exhibit gender differences. Among women, correlates with a 6-12% reduction in hourly wages after controlling for factors like and , with penalties increasing over time and across the wage distribution. For men, evidence is mixed, with some studies finding no penalty or even wage premiums for mildly obese white and men, potentially linked to perceptions of in certain roles, though severe may impose costs in customer-facing occupations. These disparities persist even after accounting for productivity measures like health status, suggesting a role for stigmatizing biases rather than solely observable performance deficits. Beyond initial hiring and pay, weight stigma affects promotions and advancement. employees report higher rates of , with a 2007 survey of over 2,800 indicating that obese adults were 12 times more likely than thinner peers to experience employment-related , including denial of promotions. Recent qualitative and quantitative data link weight to increased burnout, lower , and heightened state-dependent self-perceptions of marginalization, exacerbating turnover in stigmatizing environments. In jurisdictions without explicit legal protections— is not a protected characteristic under U.S. or in many countries—such biases remain unchecked, contributing to broader economic disadvantages like reduced lifetime earnings.

In Healthcare Delivery

Healthcare providers frequently exhibit weight bias toward obese patients, encompassing both explicit negative stereotypes—such as viewing them as lazy or non-compliant—and implicit biases measured via tools like the , with systematic reviews confirming moderate to high prevalence among physicians, nurses, and other professionals. This bias contributes to suboptimal care delivery, including shorter consultation times; for example, a study of visits found physicians allocated approximately 28% less time to obese patients than to those of normal weight, potentially limiting thorough assessments. Manifestations of stigma in clinical settings include derogatory comments, reluctance to perform physical exams due to discomfort with body size, and assumptions that underlies all health issues without exploring comorbidities. with report frequent experiences of for their condition, public weighing without adequate privacy, and dismissive attitudes toward symptoms unrelated to weight, as synthesized in qualitative analyses from multiple studies involving over 1,000 participants. Such practices erode trust in providers, with surveys indicating that 40-70% of obese individuals perceive healthcare encounters as stigmatizing, leading to avoidance of follow-up care or preventive screenings like mammograms and colonoscopies. The downstream effects include delayed diagnoses and poorer health outcomes; for instance, weight-stigmatized patients show lower adherence to treatment recommendations and increased reliance over routine visits. Interventions to mitigate , such as perspective-taking exercises or on obesity's multifactorial , have demonstrated short-term reductions in explicit attitudes among providers, though sustained changes remain limited without systemic reforms like mandates. Despite obesity's established links to conditions like and —warranting clinical attention—unaddressed stigma exacerbates disparities by conflating medical urgency with prejudicial judgment, independent of .

In Education and Youth Development

Children and adolescents with experience heightened peer victimization in educational settings, with weight-based being the most frequently reported form of , surpassing targets such as or . Studies indicate that obese have significantly greater odds of involvement compared to normal-weight peers, even after controlling for sociodemographic and academic factors. This victimization often manifests as teasing, exclusion, and physical aggression, contributing to during formative developmental stages. Weight stigma correlates with diminished academic performance among affected youth, mediated by psychosocial stressors like reduced and from bullying-related distress. Longitudinal analyses show obese children achieving lower grades and scores, with stigma exacerbating disengagement from learning activities. For instance, kindergarteners with demonstrate poorer early academic outcomes, partly attributable to weight influencing cognitive and motivational processes. Educators exhibit implicit weight biases, perceiving obese students as lazier or less capable, which can perpetuate unequal treatment in classrooms and physical education. Pre-service and in-service teachers often endorse negative stereotypes, leading to lower expectations for obese pupils' scholastic success and reduced supportive interventions against peer harassment. Such attitudes hinder youth development by discouraging participation in extracurriculars and fostering internalized shame, with long-term implications for educational attainment and social competence. In youth development contexts, obesity stigma disrupts relational skills and , as adolescents report higher rates of rejection sensitivity and avoidance of group activities. links this to broader declines, including anxiety that impairs focus and peer bonding essential for adolescent maturation. Despite calls for anti-stigma programs, persistent biases in environments underscore the need for evidence-based policies addressing root behavioral contributors alongside victimization.

In Politics and Public Life

Obesity stigma in politics manifests through voter biases that disadvantage and candidates in elections and perceptions of fitness. A 2014 study analyzing U.S. congressional elections from 1996 to 2006 found that candidates were largely absent from primary and pools, while women but not men received fewer votes than thinner counterparts, indicating gender-specific . Experimental research has shown that voters exposed to weight-stigmatizing messages rate candidates lower on competence compared to non-stigmatizing conditions. Media coverage often amplifies this stigma by framing politicians' weight in derogatory terms that imply personal failings or incompetence. For instance, during Governor Chris Christie's 2016 presidential candidacy considerations, a of online news media revealed that over 80% of 1,490 comments on his size involved stigmatizing references, predominantly negative attributions linking his weight to or lack of . Political news metaphors portraying Christie's as a "" or peril further communicated stigma, associating his body size with threats to effective . Weight-stigmatizing attitudes correlate with conservative political values, including greater endorsement of personal responsibility for and authoritarian orientations, as evidenced by surveys linking such views to right-wing ideologies. This ideological alignment may reflect broader societal debates on obesity causation, where stigma reinforces perceptions of willful behavioral choice over systemic factors, influencing discussions on initiatives. Despite calls from organizations like the Obesity Society to avoid weight-based in candidate evaluations, empirical patterns suggest persistent barriers for heavier politicians in achieving electoral success.

In Interpersonal Relationships

Obesity stigma influences romantic partner selection, with showing preferences against individuals in and sexual contexts. In a study of preferences for sexual partners, participants ranked non-obese figures higher, indicating persistent stigma in intimate evaluations. Systematic reviews document that weight bias disrupts early stages of attraction, as fat-phobic attitudes reduce initiation of romantic pursuits toward persons. Longitudinal analyses reveal that young s classified as at baseline were significantly less likely to marry by age 23-30 compared to non-fat peers, even after controlling for socioeconomic factors. Within romantic relationships, partners frequently perpetrate weight stigma, ranking as the second most common source after mothers. This stigma correlates with maladaptive , lower sexual intimacy, heightened relational conflict, and reduced overall satisfaction, particularly when one partner is obese. For obese men, marital discord is elevated relative to non-obese counterparts, while obese women report paradoxically higher satisfaction, potentially due to lower expectations or selection effects in partnering. In family dynamics, weight stigma often emerges from close relatives, with mothers identified as the predominant source in qualitative accounts from women with . Family-based stigma extends to domains, associating with poorer outcomes and internalized among recipients in weight-management cohorts. Communication patterns within families, such as critical discussions of weight, reinforce stigma and shape attitudes toward body size across generations. Friendships among individuals with obesity involve elevated interpersonal adversity, including perceived rejection and fewer social ties, as meta-analyses of self-reported experiences confirm greater difficulties in forming and maintaining non-romantic bonds. Weight in these contexts contributes to , with obese adolescents and adults reporting lower peer acceptance and integration compared to normal-weight peers. Overall, such stigma perpetuates inequities in private social spheres, limiting access to supportive networks.

Theoretical Explanations

Psychological Mechanisms

Psychological mechanisms underlying the social stigma of primarily involve cognitive attributions, implicit biases, and emotional responses such as , which collectively frame obese individuals as personally responsible for their condition and possessing undesirable character traits. Attribution theory posits that observers tend to ascribe to internal, controllable factors like laziness or lack of willpower rather than external influences such as or environment, fostering blame and . This aligns with the , wherein situational and environmental contributors to —such as food availability or metabolic factors—are underemphasized in favor of dispositional explanations, amplifying negative judgments. Explicit stereotypes reinforce these attributions, portraying obese people as undisciplined, incompetent, and sloppy, with empirical reviews documenting consistent associations between perceived lack of and anti-fat attitudes across diverse samples. Implicit biases operate automatically and unconsciously, as evidenced by Implicit Association Tests (IATs) showing spontaneous preferences for thinness over fatness, independent of deliberate processing goals, which manifest in nonverbal behaviors like averted or avoidance. These biases contribute to character inferences, where signals moral or psychological deficiencies, such as reduced or emotional instability, beyond mere aesthetic aversion. Disgust sensitivity, particularly pathogen-avoidance , further drives stigmatization by eliciting visceral aversion to obese bodies as potential indicators of poor or contagion , with studies linking higher propensity to stronger negative attitudes, especially among women. This emotional mechanism intersects with perceptions, where viewing obesity as a of self-regulation heightens and condemnation, rendering anti-fat resistant to interventions that solely target without addressing these core appraisals. Overall, these processes sustain stigma by integrating cognitive shortcuts, associations, and innate emotional systems that prioritize signals of fitness and .

Sociological and Cultural Drivers

Sociological theories posit that stigma arises from attributions of personal agency and moral failing, wherein excess weight is interpreted as evidence of inadequate , , or , despite multifactorial etiologies including and environment. This perspective aligns with broader cultural norms in individualistic societies that valorize and , framing thinness as a marker of and success. Empirical from implicit association tests across 71 nations indicate widespread negative associations between fatness and traits like incompetence, with stigma levels correlating to societal emphasis on personal responsibility over systemic factors. Culturally, stigma is perpetuated through entrenched beauty standards prioritizing slim physiques, historically shifting in Western contexts from the early onward, when abundance decoupled fatness from elite status and linked it instead to vice. Media representations exacerbate this, with characters underrepresented (e.g., 72-86% below population prevalence in U.S. television) and often stereotyped as undesirable or , reinforcing normative thin ideals. messaging, such as campaigns emphasizing lifestyle modification, inadvertently amplifies blame by portraying as volitional, as seen in like the U.S. Personal Responsibility in Food Consumption Act of 2005. Cross-cultural analyses reveal variations, with higher explicit anti-fat bias in middle- and low-income countries like and compared to traditional fat-positive norms in parts of the Global South, driven by globalization's diffusion of Western slim-body ideals via media and . For instance, a 2024 comparative study of and found greater aversion to in Egypt (higher Antifat Attitudes Scale scores), attributed to differing societal values on body norms, though both nations report internalized bias rising with BMI in specific subgroups. These patterns underscore how stigma intensifies in transitioning economies adopting globalized health discourses, where fatness symbolizes deviation from aspirational thinness amid rising rates (e.g., from 4% global prevalence in 1975 to 13% in 2016).

Economic and Resource Allocation Perspectives

Obesity imposes substantial economic burdens on societies, including elevated healthcare expenditures and losses, which may underpin stigma as a form of rational to safeguard . , obesity-related medical costs reached approximately $173 billion annually as of 2019, with obese individuals incurring about $1,900 higher annual medical expenses than those of normal weight, straining public and private insurance systems. Productivity reductions further compound these costs; obese workers experience higher rates of and , leading to estimated annual losses of up to $6472 per affected employee when combining medical and . Such fiscal externalities incentivize employers and insurers to favor non-obese individuals, manifesting as stigma to minimize long-term resource drains on collective pools. From a standpoint, stigma serves as a social for signaling unfitness in competitive environments where traits correlating with future costs—such as or low inferred from excess weight—are deprioritized. posits that in contexts, deviates from norms of metabolic , signaling poor self-regulation akin to other costly behaviors, prompting avoidance in and markets to optimize resource investment in higher-yield partners or hires. supports this: adolescents who are face diminished economic attainment in adulthood, with reduced family incomes and higher risks, reinforcing societal mechanisms to allocate opportunities toward those less likely to impose intergenerational costs. In welfare systems, analogous stigmatization of obesity-related dependency arises from perceptions of controllable causation, prioritizing finite public resources for conditions viewed as less volitional. Critics of anti-stigma interventions argue that downplaying these economic realities may exacerbate resource misallocation by reducing incentives for behavioral change, as evidenced by stagnant rates despite efforts to normalize higher weights. Instead, stigma's persistence reflects causal realism: 's links to comorbidities like and drive 8-10% of total healthcare spending in developed nations, justifying discriminatory practices in actuarial and hiring decisions to preserve . This perspective contrasts with narratives framing stigma solely as bias, emphasizing instead its role in aligning individual choices with societal cost-benefit imperatives.

Consequences for Individuals and Society

Direct Health Risks of Obesity Itself

Obesity, defined clinically as a (BMI) of 30 kg/m² or higher, imposes direct physiological burdens through excess adiposity, leading to metabolic dysregulation, chronic inflammation, and mechanical stress on organs and tissues. These effects arise from hypertrophy and dysfunction, which promote , elevated free fatty acids, and pro-inflammatory release, independent of caloric intake or activity levels. Such mechanisms contribute to a cascade of comorbidities, including endothelial damage and altered , elevating overall mortality risk by 20-50% in affected individuals compared to those of normal weight. A primary direct risk is type 2 diabetes mellitus, where drives pancreatic beta-cell exhaustion via and glucotoxicity, with meta-analyses indicating a sevenfold relative risk for obese adults versus those with BMI under 25 kg/m². Cardiovascular complications follow closely, as visceral fat accumulation fosters through sympathetic overactivation and sodium retention, while and atherogenic inflammation increase coronary heart disease risk by nearly twofold. incidence rises due to similar vascular impairments, with accounting for up to 20% of attributable cases in population studies. Neoplastic risks stem from hyperinsulinemia, elevated insulin-like growth factor-1, and adipokine imbalances that stimulate cell proliferation and inhibit apoptosis, linking obesity to at least 13 cancer types including endometrial, postmenopausal breast, colorectal, and kidney cancers, with relative risks ranging from 1.2- to 3-fold depending on site and severity. Hepatic steatosis progresses to non-alcoholic fatty liver disease in 70-90% of obese individuals via intrahepatic triglyceride overload, often evolving to fibrosis or cirrhosis. Musculoskeletal strain manifests as osteoarthritis, where excess weight amplifies joint loading and synovial inflammation, doubling knee osteoarthritis risk per 5-unit BMI increment. Respiratory compromise occurs through pharyngeal fat deposition causing obstructive sleep apnea, affecting 50-70% of severely obese persons and impairing oxygenation. These direct risks compound, with contributing to 4-8% of all cancers and over 40% of BMI-attributable deaths from cardiovascular causes globally, underscoring its causal role in premature mortality exceeding 2.8 million annual deaths.

Attributed Effects of Stigma on and Behaviors

Weight stigma has been associated with elevated symptoms of depression and anxiety among individuals with , with meta-analyses of over 100 studies involving nearly 60,000 participants indicating consistent correlations between experiences of weight bias and poorer outcomes, including increased depressive symptoms and heightened anxiety. These associations strengthen with higher , suggesting a dose-response relationship where greater perceived stigma correlates with more pronounced impairments. In youth populations, systematic reviews report a moderate linking weight stigma to diminished and exacerbated internalizing disorders, such as anxiety and depression. Perceived weight discrimination is further linked to physiological stress responses, including elevated cortisol levels as measured in scalp hair samples, which serve as biomarkers of exposure over months. This chronic activation of the hypothalamic-pituitary-adrenal axis is attributed to contributing to deterioration, with internalized weight bias mediating associations between stigma experiences and symptoms of psychological distress. Studies also attribute weight stigma to increased risk of symptomatology, including and disordered eating patterns, particularly through pathways involving emotion dysregulation and . Regarding behaviors, weight stigma correlates with reduced engagement in and avoidance of exercise settings due to anticipated , as evidenced in systematic reviews of behavioral outcomes. Meta-analytic evidence indicates positive associations with unhealthy eating behaviors, such as and consumption of high-calorie foods, often posited as stress-induced coping mechanisms that perpetuate . These patterns extend to broader behaviors, including lower adherence to preventive care and increased , where stigma experiences are linked to yo-yo dieting and subsequent metabolic disruptions. Longitudinal data, though limited, support temporal precedence in some cohorts, with baseline weight stigma predicting subsequent declines in healthy behaviors over follow-up periods.

Empirical Debates on Stigma's Net Impact

Empirical research on the net impact of stigma presents conflicting findings, with much of the literature emphasizing detrimental effects on health behaviors and outcomes, while a smaller body of work highlights potential motivational benefits offset by avoidance mechanisms. A 2022 of 54 studies involving over 18,000 participants found weight stigma positively associated with unhealthy eating behaviors (r = 0.16) and (r = 0.22), and negatively associated with healthy eating (r = -0.11) and (r = -0.10), suggesting stigma exacerbates rather than alleviates obesity-related risks. Experimental manipulations of stigma, such as exposure to negative weight comments, have induced acute increases in and caloric intake in settings, supporting causal links to stress-induced independent of baseline weight. Longitudinal data reinforce these patterns, showing experienced weight stigma prospectively predicts greater over periods of 1–4 years, with effect sizes indicating 0.5–2 kg increases attributable to stigma-driven physiological and behavioral responses like reduced for changes. Population-level analyses, including those from the in America study (n=1,122), link perceived stigma to lower fruit/vegetable consumption and higher sedentary time, contributing to a cycle where stigma hinders access to care and sustains prevalence. These findings challenge assumptions that stigma serves as a tool, as no robust demonstrates reduced rates in high-stigma environments; instead, historical rises in obesity coincide with shifting norms, but correlational data do not isolate stigma's role amid factors like food availability. Counterarguments posit that stigma may yield net benefits by fostering motivation, though empirical support is limited and mixed. A 2020 experimental study (n=149) exposed participants to stigma scenarios and observed heightened intrinsic motivation for weight loss (β=0.24) alongside anticipated shame, yet this was countervailed by increased avoidance of exercise facilities (β=-0.19), resulting in no net behavioral gain. Proponents, including clinicians noting anecdotal successes, argue mild social pressure mirrors effective disapproval of behaviors like smoking, potentially curbing obesity if not excessive; a 2021 BMJ commentary asserted that eliminating stigma entirely risks higher obesity incidence, as complete acceptance removes accountability incentives, though this lacks quantitative backing. Critiques of dominant anti-stigma research highlight reliance on self-reported experiences prone to recall bias and overrepresentation of psychological outcomes from fields with progressive leanings, potentially underemphasizing adaptive responses in resilient individuals or population deterrence effects.00138-9/fulltext) Overall, the preponderance of peer-reviewed evidence tilts toward net harm, with stigma correlating to 2.5-fold higher of and diminished treatment adherence, outweighing unproven motivational upsides. However, remains debated due to ethical limits on randomized stigma exposure and failure to account for endogeneity, where itself invites stigma, complicating attribution. Rigorous trials isolating stigma's societal role are absent, leaving open whether calibrated disapproval could yield benefits in contexts prioritizing over psychological distress.

Responses and Counter-Movements

Fat Acceptance and Body Positivity Initiatives

The emerged in the United States in the late 1960s as a response to perceived against individuals, with the National Association to Advance Fat Acceptance (NAAFA) founded in 1969 by engineer Bill Fabrey—initially under the name National Association to Aid Fat Americans—to advocate for civil rights protections and end workplace and social biases based on body size. NAAFA's early efforts focused on legal challenges to weight-based and promoting , drawing parallels to civil rights activism, though it emphasized non-medicalized views of fatness as a neutral trait rather than a condition. By the 1970s, more radical offshoots like the Fat Underground formed, issuing manifestos that framed fatness as a form of identity deserving liberation from societal , rejecting as coercive. Body positivity initiatives built on these foundations but expanded in the 1990s and 2010s, originating partly from Black feminist fat activism in the 1960s that resisted mainstream beauty standards intertwined with racial and size biases. The term gained institutional form in 1996 with the establishment of The Body Positive organization by psychotherapist Elizabeth Scott and writer Connie Sobczak, which promoted self-care practices emphasizing emotional awareness over weight reduction. The movement proliferated via social media platforms in the early 2010s, amplified by influencers such as model Tess Holliday, who in 2015 became the first size-22 cover model for People magazine, and campaigns like #BodyPositivity, which amassed millions of posts on Instagram by 2018, encouraging users to reject "fat-shaming" and celebrate diverse body sizes. Associated paradigms include Health at Every Size (HAES), developed in the 2000s by researchers like , which prioritizes behaviors like and for well-being without targeting , arguing that scale-focused interventions fail long-term and exacerbate stigma. Proponents claim these initiatives reduce psychological distress, with qualitative reports from fat activists indicating improved and reduced behaviors among participants. However, empirical analyses link HAES-aligned approaches to minimal changes in objective health markers, such as or , while obesity—defined by the as excessive fat accumulation impairing health—increases risks of , , and reduced life expectancy by up to 10 years in severe cases, independent of stigma. Critics, including clinicians reviewing longitudinal data, contend that fat acceptance and may inadvertently discourage evidence-based obesity treatments like caloric restriction or , as messaging framing fatness as immutable or non-pathological correlates with lower motivation for in surveys of adherents. For instance, a 2023 analysis found that exposure to content on was associated with higher body appreciation but no corresponding uptake in health-promoting behaviors among individuals, potentially contributing to sustained or worsening adiposity amid rising global prevalence from 4% in 1975 to 13% in 2016. Peer-reviewed commentaries highlight that while stigma can hinder care-seeking, the net causal impact of itself on morbidity outweighs secondary psychological effects, with acceptance movements risking normalization of modifiable risk factors under the guise of empowerment.

Linguistic Reforms and Identity Politics

Advocates within the have promoted linguistic reforms to reframe discussions of body weight, emphasizing "person-first" language such as "individuals with " over "obese individuals" to mitigate perceived stigma and improve engagement with healthcare. Organizations like the European Association for the Study of Obesity (EASO) and the World Obesity Federation endorse avoiding terms like "" or "" in derogatory contexts, favoring "higher-weight" or "weight-inclusive" phrasing to foster positive and reduce barriers to treatment adherence. These guidelines, disseminated since the early , argue that stigmatizing contributes to avoidance of medical care, with surveys indicating patients respond better to non-judgmental terms. Such reforms intersect with , positioning fatness as a protected characteristic akin to other marginalized identities, as advanced by groups like the National Association to Advance Fat Acceptance (NAAFA), founded in 1969 to challenge societal generalizations linking obesity to moral failing. Fat activism draws parallels to and , reclaiming "fat" as an empowering identity and critiquing "thin privilege" in cultural narratives, with roots in 1967 "fat-in" protests against bias. This framing seeks societal acceptance without emphasis on weight reduction, promoting Health at Every Size (HAES) paradigms that prioritize over caloric restriction. Empirical studies on these reforms yield mixed results; while disease-framing can amplify anti-fat , rights-based may normalize larger bodies but does not consistently correlate with improved behaviors, such as increased or sustained . Internalized weight stigma has been associated with and elevation, yet longitudinal data suggest external stigma motivates attempts in some cohorts, implying that diluting motivational could inadvertently sustain by diminishing personal accountability. Critics, including analyses of media , contend that identity-driven reforms risk glorifying and fostering backlash, as evidenced by public perceptions of fat as seeking "special treatment" without addressing modifiable risk factors like diet and exercise.

Critiques and Evidence-Based Alternatives

Critics of fat acceptance and movements argue that these initiatives risk normalizing by decoupling body weight from its established physiological consequences, potentially discouraging preventive behaviors and efforts. For example, the Health at Every Size (HAES) paradigm, often aligned with fat acceptance, promotes and body acceptance without prioritizing weight reduction, yet a 2014 analysis contends that it underemphasizes the long-term regulatory effects of chronic caloric surplus on adiposity and metabolic dysfunction, which first-principles physiology links causally to , , and organ strain. Empirical evaluations of HAES interventions, including a 2024 of randomized trials, reveal no significant advantages over conventional weight-normative programs in reducing or improving cardiometabolic markers like and lipid profiles over 12-24 months. While proponents cite weight stigma's associations with stress-induced cortisol elevation and avoidance of physical activity—contributing to a meta-analytic with increased unhealthy eating and reduced exercise—countervailing evidence suggests stigma can enhance for behavioral change in some contexts, such as prompting avoidance of future through weight loss attempts. A 2020 experimental study found that exposure to weight-based disapproval simultaneously boosts short-term intentions to diet or exercise while eliciting compensatory , indicating mixed net effects rather than uniform harm. These findings challenge the dominant narrative in stigma research, much of which emanates from and fields prone to emphasizing harms over biomedical causality, potentially overlooking how social disapproval historically reinforced adaptive norms against excess adiposity in resource-scarce environments. Evidence-based alternatives prioritize causal interventions targeting obesity's drivers—energy imbalance and sedentary behavior—while integrating motivational framing without outright denial of risks. Behavioral programs emphasizing , goal-setting, and achieve average weight losses of 5-10% sustained at one year in meta-analyses of over 100 trials, outperforming acceptance-focused approaches in reducing incidence by up to 58% among high-risk participants. Public surveys, such as a 2020 German study of 1,000 adults, affirm widespread attribution of dietary health to individual agency, supporting strategies that foster personal accountability through incentives like financial rewards for adherence or community-based challenges. These methods align with causal realism by addressing modifiable factors like portion control and habitual movement, as validated in longitudinal cohorts tracking reduced all-cause mortality with modest BMI declines. Unlike stigma reduction campaigns, which a 2011 review deemed ineffective for population-level control, such alternatives leverage empirical data on human volition and habit formation to promote durable health gains.

Policy and Public Health Approaches

Anti-Stigma Legislation and Interventions

In the United States, no federal legislation prohibits discrimination based on weight or body size, despite surveys indicating that up to 40% of Americans have experienced such discrimination. Michigan's Elliott-Larsen Civil Rights Act of 1976 provides the primary state-level protection, explicitly including weight as a protected characteristic in employment, housing, and public accommodations, making it the only state with such a comprehensive ban. Local ordinances in cities like San Francisco (since 2013), Urbana-Champaign, Illinois, and Madison, Wisconsin, extend similar prohibitions to employment and sometimes housing, though enforcement remains limited and varies by jurisdiction. Proposals for broader protections, such as New York City's 2023 bill to ban weight discrimination in employment, housing, and public spaces, and Massachusetts' consideration of adding height and weight to anti-discrimination laws, have faced opposition over concerns that they could undermine public health incentives for weight management. Internationally, protections are sparse; for instance, some European countries like Iceland have explored BMI-related hiring restrictions, but no widespread laws exist, with global calls for policy reform emphasizing stigma's role in healthcare access disparities rather than causal links to obesity outcomes. Anti-stigma interventions primarily involve educational programs, healthcare provider training, and public campaigns aimed at challenging stereotypes and reducing implicit bias. Systematic reviews indicate that multifaceted educational strategies, such as combining exercises with evidence-based information on 's multifactorial causes, yield the most consistent short-term reductions in explicit weight bias among participants, though effects often diminish over time without reinforcement. Cognitive-behavioral techniques in targeted psychological interventions have shown promise in alleviating internalized weight stigma, with 23 out of 24 studies reporting reductions, particularly among individuals with , by addressing self-deprecating thoughts linked to stigma experiences. However, on broader impacts is mixed; Health at Every Size (HAES) campaigns effectively lower stigma but fail to enhance motivation for or in weight-related behaviors, suggesting they may not translate to improved health outcomes. Public health campaigns against stigma, including those avoiding stereotypical imagery, have demonstrated limited efficacy in altering long-term attitudes or behaviors, with some analyses finding no motivational advantage over neutral messaging and potential unintended reinforcement of stigma through overemphasis on victimhood narratives. Healthcare-specific interventions, like training for providers, reduce discriminatory practices in simulated settings but show inconsistent real-world effects on care quality or obesity treatment adherence, partly due to persistent implicit biases resistant to brief exposures. Critics, drawing from longitudinal data, argue that destigmatization efforts risk diminishing social pressures that correlate with attempts, as evidenced by studies where reduced stigma coincides with lower engagement in lifestyle interventions, though causal directions remain debated amid factors like . Overall, while interventions mitigate reported psychological distress, rigorous trials indicate they do not reliably curb prevalence or enhance metabolic health metrics, highlighting the need for evaluations prioritizing causal realism over attitudinal shifts alone.

Strategies Emphasizing Personal Accountability and Incentives

Strategies promoting personal accountability frame obesity primarily as a consequence of modifiable behaviors such as excessive caloric intake and insufficient , rather than inevitable or solely environmental factors, thereby encouraging individuals to take ownership of . These approaches contrast with stigma-reduction efforts by avoiding normalization of and instead leveraging social norms, education, and to foster self-control and habit change. For instance, messaging that highlights personal agency in dietary choices has been shown to increase motivation for without necessarily heightening when paired with actionable advice. Incentive-based interventions operationalize through tangible rewards or penalties tied to measurable outcomes like weight reduction or sustained healthy behaviors. Randomized controlled trials demonstrate that financial incentives, such as cash payments scaled to percentage of body weight lost, yield greater short-term compared to education alone; one study found participants receiving $14 per lost an average of 4.7 pounds over three months versus minimal loss in controls. Goal-directed incentives, where rewards are granted for meeting specific targets like BMI thresholds, have proven effective in low-income populations, with outcome-based variants outperforming resource-only programs by achieving clinically significant reductions (e.g., 5-10% body weight ). Deposit contracts, where individuals stake personal funds refundable upon success, further reinforce commitment by combining self-imposed with . Employer-sponsored wellness programs exemplify integrated accountability measures, offering premium discounts or bonuses for participation in , which correlate with higher adherence rates and modest long-term weight maintenance when incentives persist beyond initial phases. A 2020 study in obese cohorts reported that cash rewards of €150-300 increased the probability of meaningful by 20-30% and prompted behavioral shifts like increased vegetable consumption, though effects waned without ongoing reinforcement. Critics note that while these strategies align with causal evidence linking to voluntary and inactivity, their scalability depends on addressing barriers like socioeconomic constraints, yet empirical data affirm superior outcomes over non-incentivized alternatives.

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