What is Weight Stigma? (April 2018)
Sadly, we live in a culture that is obsessed with the thin ideal, idealizes our bodies looking a certain way, and judges people on how they look.
According to the National Eating Disorder Association (NEDA) website, Wendy Oliver Pyatt, MD, FAES, CEDS Co-Founder and Executive of Oliver-Pyatt Centers wrote a wonderful article about weight stigma. In it, she defines it as: “weight stigma reflects internalized attitudes towards body size that affects how those are the targets of bias are treated.”
Did you know that weight stigma is also known as weight-ism, weight bias, and weight based discrimination? Simply put, all of these terms are used to describe discrimination and stereotyping based on an individual’s weight, especially in people in larger bodies.
It is important for our society and all health care clinicians to work on their own belief system regarding weight stigma. Research has shown that physicians are the #2 source of weight stigma and it has been seen among dietitians, RN’s, psychologists and fitness professionals. Unfortunately, it seems that clinicians sometimes make judgments based on appearance too quickly, just like our culture does. It is important that all people remember that an individual’s size is not going to tell you if the person has an eating disorder. Just because we work in a health-mind-body related field, doesn’t mean that we are immune to not being judgmental about one’s body based on their size. If we are going to work with this population, it is necessary to have healed our relationship with food and our own bodies so that we have no judgment. Our clients come to us with shame to begin with and it takes a lot of courage to see any one of us. The last thing they need to encounter is negativity and a critical voice once they take that brave leap.
According to Harriet Brown in Body of Truth:
“This obsession is bigger than all of us. It’s become epidemic, endemic and pandemic. It comes from all around us, but it’s dug its way deep under our skins, and it festers there. It’s a pain that involves our deepest sense of who we are in the world. We experience the world through our bodies, our skin and neurons and nerves. Other people see us only and always in the context of our flesh and bone and blood.”
She hits the nail directly on the head when she states: “we automatically conflate fat with being unhealthy, & praise thinness as a model of health. People naturally come in a range of shapes and sizes”
When we have weight stigma it can lead to the development of eating disorders, psychological distress (the individual has shame to eat in public or believes that he/she is being judged for food options), dysfunctional attitudes about weight and shape, body dissatisfaction, and thin ideal internalization. These thoughts are often times what our clients spend most of their time and energy thinking about. They are not able to function in day-to-day life without these thoughts consuming their mind.
Weight stigma is the essential ingredient in body shame. When a person has been made fun of at school, at home, or the workplace (to name a few locations) negative internalized beliefs develop. Such comments and judgment lead to a lack of self esteem and the individual begins to believe that his/her body size/shape is their primary “fault,” IE: the “one thing about me that is bad.” This internalized weight stigma leads to the individual thinking that changing his/her body weight/size/shape is the way to make all things “right,” to fix what is wrong, and to make themselves worthy of love and self-love. It is this negative connection between weight stigma and internalized beliefs about appearance and worth that lead to individuals changing his/her relationship to food and exercise in unhealthy ways, such as dieting or, even worse, developing an eating disorder.
Weight stigma can also be masked as atypical anorexia nervosa. Atypical anorexia nervosa is when the individual has all the symptoms of anorexia with their weight being just above the diagnostic threshold for anorexia nervosa. As a result of their weight, individuals with atypical anorexia may go under the radar, with no one noticing there is a problem because of his/her physical appearance of “health.”
It is important to be aware that the statements dietitians make to clients, friends or loved ones can perpetuate weight stigma. Examples would be when you see a person at the grocery store and in their cart it contains ice cream and chips. We tend to make favorable assumptions if the person is relatively lean or with a “normal” BMI as opposed to the negative assumptions given if the person is in a larger body. What about not assuming anything and accepting that people with normal relationships to food have a variety of foods in their diet, including fun foods?
Another example would be telling someone that they are over their “ideal body weight.” For what purpose does this serve? First, these charts are outdated and do not accurately reflect an “ideal body weight.” Second, and more importantly, this gets the individual to become fixated on their body, what will and will not be consumed, etc. It’s best NOT to comment on any body as their shape and size does not matter.
Our society is too focused on this topic. As a way to help without harming, eating disorder professionals could begin by have conversations with clients regarding what they associate the word “fat” with. Another helpful exercise would be to ask an individual that may be living in a larger body what feelings and thoughts they have that may be considered internalized fat-phobia.
It is crucial that clinicians and dietitians take inventory of their own food and body image issues and process them so that they don’t cause harm to those around them, especially their clients. Work hard to dispel any pre-conceived and negative body image beliefs you may have, avoid making comments about any person’s body, no matter the size or shape, and spread the message of self-love and body positivity to everyone you encounter.
References:
- Brown, Harriet, Body of Truth,(Boston, MA: Da Capo Press, 2015),xxiv,xxv,xxvi Introduction
- Baker, Jes, “Things No One Will Tell Fat Girls”, (Berkeley, CA: Seal Press 2015), 27, 156
- Vartanian, Lenny, Porter, Alexis. “Weight Stigma and Eating Behavior”: A review of the literature, Appetite xxx (2016) 1-12.
- Nolan, Laurence, Eshleman, Amy. “Paved with good intentions: Paradoxical eating responses to weight stigma”: Appetite xxx (2016) 1-10.
- Farrell, Amy Erdman. “Fat Shame, Stigma and the Fat Body in American Culture”, (New York University Press, 2011).
