The existence of thin privilege and stigmatization of larger bodies is not much debated in our current culture, but what continues to be debated is what to do about it. One side of the debate is to push shaming tactics to motivate weight loss through insisting on personal responsibility and will power to “eat less and exercise more” in order to conform to thin ideals, or at least get as close as possible to it. Despite significant research on the lack of success in maintaining weight loss over time and the detrimental impacts on health from yo-yo dieting, restrictive dieting to meet weight loss goals continues to be a staple of advice within our medical communities; particularly for people of size. This is likely explained by the pervasiveness of weight stigma in healthcare settings which has been observed among physicians, nurses, medical students, and dietitians.
Weight stigma can be defined as the social rejection and devaluation of bodies that do not comply with social norms of ideal body weight and shape. This stigma then drives weight discrimination which has been found to be more prevalent than other forms of discrimination. Women are particularly stigmatized due to their weight across multiple sectors, including employment, education, media, healthcare, and romantic relationships.
So, what’s the big deal?
In short, it doesn’t work and causes harm to physical and psychological health. Stigmatizing large bodies does not lead to weight loss though it may do the opposite. Research has shown that being exposed to experiences of weight stigma triggers behavioral changes, increased food intake past fullness, decreased self-regulation, increased cortisol (stress hormone) levels, and avoidance of exercise.
Physiological responses have also been shown. People who reported high experiences of weight discrimination have more dysregulation in metabolic health and inflammation. The mere perception of oneself as being overweight, across body sizes, even among individuals at a “normal” BMI, has been associated with markers of poorer health, including unhealthy blood pressure, C-reactive protein, HDL cholesterol, triglycerides, glucose, and HbA1c levels
These impacts are magnified when weight stigma is internalized, which includes self directed beliefs of worth being equated to weight and body shape. Internalization of weight bias has an impact across body sizes and has consistent associations with psychological distress, eating disorder behaviors, low self esteem, and perceived poor quality of life.
So, what do we do about it?
On the other side of the debate in dealing with weight stigma is a shift towards celebrating body diversity and focusing on health regardless of body size or shape such as in Health at Every Size ® (HAES®) approaches. These interventions have been shown to increase long term positive eating attitudes, body image, self esteem, energy expenditure, cardiovascular health, and psychological well being with or without weight or body size changes.
We also must start considering body size as an area of our identity with equal importance as other areas of our identity which have clear delineations in marginalization or privilege status. People of size are marginalized by thin privilege, weight stigma, weight discrimination, and anti-fat bias. The unique aspect of weight stigma is that it also impacts those living with thin privilege if they have internalized weight stigma to their body. The most effective and ethical approaches should be aimed at changing the behaviors and attitudes of those who stigmatize and to help individuals to reduce internalized stigma as a shield against the impact of weight discrimination.
Where to start?
A personal starting point is to evaluate your own internalized weight bias and weight stigma beliefs. Try to look at this with curiosity and not judgement. Consider your own thoughts on weight and shape. What values do you put on body size? Do you correlate thinness with health, attractiveness, ability, or worth?
Examine your level of internalized weight bias by completing the Weight Bias Internalization Scale: https://www.researchgate.net/publication/262414648_WBIS-11-item
Gain insight into weight preference and potential weight stigma beliefs by completing the Weight Implicit Bias Test: https://implicit.harvard.edu/implicit/research/
We all have the power to shift the way we talk about our bodies on both a personal and community level. Focus on holding worth for other people based on their presence, their individuality, and their value in your life. Focus on holding gratitude for your own body. “I have gratitude that my heart beats, my lungs breathe, my muscles move my body, and my bones hold me up”. Try it out, then try it again, it takes daily attention and practice to improve your health through increasing body appreciation to decrease the impact of weight stigma.
References:
Durso, L. E., & Latner, J. D. (2008). Understanding self‐directed stigma: Development of the Weight Bias Internalization Scale. Obesity, 16, S80-S86. doi:10.1038/oby.2008.448
Lee, M. S., Gonzalez, B. D., Small, B. J., & Thompson, J. K. (2019). Internalized weight bias and psychological wellbeing: An exploratory investigation of a preliminary model. PloS one, 14(5), e0216324.
Tomiyama, A., Carr, D., Granberg, E. et al. How and why weight stigma drives the obesity ‘epidemic’ and harms health. BMC Med 16, 123 (2018).
Ulian, M. D., Aburad, L., da Silva Oliveira, M. S., Poppe, A. C. M., Sabatini, F., Perez, I., Gualano, B., Benatti, F. B., Pinto, A. J., Roble, O. J., Vessoni, A., de Morais Sato, P., Unsain, R. F., and Baeza Scagliusi, F. (2018) Effects of health at every size® interventions on health-related outcomes of people with overweight and obesity: a systematic review. Obesity Reviews, 19: 1659– 1666.