Source: UConn Rudd Center for Food Policy & Obesity.
No matter where you live, it is very likely you know someone who struggles with their weight. 70% of Americans have overweight or obesity. Weight bias is pervasive in many cultures, and it is defined by Dr. Reginald Washington from the University of Colorado as “negative weight-related attitudes, beliefs, assumptions, and judgments toward individuals who are overweight and obese.” I would make the amendment and say “towards individuals who have overweight or obesity”- one of the ways to combat weight bias is to use people-first language. As individuals, we are more than our diagnoses so that you may have noticed a shift in the medical field from diabetics to people with diabetes, and this too is happening regarding the topic of obesity.
Where does Weight Bias Show Up?
One of the champions of the importance of addressing and combatting weight bias has been Dr. Rebecca Puhl, Professor of Human Development and Family Studies at the University of Connecticut, and the Deputy Director of the Rudd Center for Food Policy and Obesity. Dr. Puhl has spent the last 15 years building the evidence base on the impacts of weight bias in children, adolescents, and adults. One of the foremost experts on the topic, I am fortunate also to call her a colleague.
What trends have emerged in the past decade? It is clear that discrimination facing those with obesity occurs in many settings, including workplace, healthcare, and education. Family and friends are also a significant source of bias in children and adults. Bias can be subtle or overt. The media is also a considerable driver; think about this next time you look at television reports on the topic of obesity – what images are being shown? Most commonly, it is the torso of a person with obesity – no face, no legs, just torso. In essence, it is de-humanizing.
The Rudd Center at Duke has been instrumental in shaping the narrative of having more body positive images; the picture at the top of this post comes from that library, and I have included the link to their image gallery below. Studies have shown women are at higher risk for being discriminated against due to their weight status. Law professor Jennifer Shinall from Vanderbilt University reported women earned on average $9000 less than their normal weight colleagues who were doing the same work. She also reflected that “No matter what the type of occupation, obese men seem to do just as well as average-size men. They make just as much as non-obese men and make just as much money in both personal interaction occupations and physical occupations. But we see the opposite pattern for women,” says Shinall*. Recent press coverage on the gender wage gap demonstrate women already earn less than men for the same labor; it would also appear that weight status also has an adverse effect on earnings.
Health Impacts of Weight Bias
The majority of studies that address weight loss have focused on middle-aged white women; studying the topic of obesity, in general, has also focused mainly on this population. In part, this makes sense, as women have reported higher rates of discrimination due to their weight. Dr. Jenny Spahlholz and colleagues from the University of Leipzig, Germany, released a meta-analysis (a study of studies) in Obesity Reviews which showed 19% of women with class I obesity (BMI 30-35) had experienced weight-related discrimination; this number jumped to 41.8% for women who have Class II obesity (BMI >35). The evidence is also clear that women delay health care due to the discrimination they have faced in receiving care. It has significant consequences for prevention if people delay routine screening to prevent cancer (Pap smear and mammography): and if a disease is present, it is discovered at a later stage. Death seems too high a price to pay for weight bias.
Data is also clear that in the context of health care, doctors, nurses, and psychologists have all been found to be a source of weight bias. While it may take time to change societal views, weight bias impacting the quality of care should be addressed as part of the training these professions receive. The Obesity Action Coalition has also been an important advocacy group to raise the critical issues impacting people living with obesity; they share the literature that shows attitudes of study participants toward those living with obesity view them as “lazy” and “weak-willed.” Bias may mean that any clinical issues the person is presenting with may be overly attributed to their weight status and that providers might spend less time on these visits, which seems counter-intuitive. Davis-Chelho and colleagues published in Professional Psychology Research and Practice on psychologists attitudes toward people with obesity- findings indicate that psychologists are likely to ascribe more pathology, negative attributes and severe symptoms compared to study participants with normal weight, even when presented with the same case study of life circumstances.
Weight Bias in Men?
The current issue of Obesity includes an article by Mary Himmelstein, Rebecca Puhl and Diane Quinn from the Rudd Center at Duke that looks at weight bias in men. They examined this phenomenon in three samples of men totaling 1,513 participants; one sample was at high risk for weight bias, the second was an online convenience panel, and the third a national survey sample of US adults. Results showed that 40% of those sampled reflected they had experienced weight-related discrimination. Interestingly, weight stigma was demonstrated in those with underweight as well as with obesity when compared to those with normal weight.
This study shows that men experience weight-related discrimination at similar levels to the published studies on women. Younger men, men who were never married, men with higher levels of income, and those at lower income levels currently obese or underweight, were most likely to experience discrimination in this mixed cohort. Men who had experienced weight bias were also more likely to have attempted weight loss as a result of this discrimination or were currently dieting. The authors point to some unique clinical intervention opportunities to support men in their weight loss efforts, as men tend to cope with weight bias by eating; it will be essential to assist men in developing alternative coping mechanisms to deal with the negative impact of weight bias.
Are You Biased?
The Implicit Association Test for weight bias is administered online by Harvard and can be accessed here https://implicit.harvard.edu/implicit/takeatest.html. What can you do if your score demonstrates bias? You have taken the first step by taking the test; being aware of your attitudes and recognizing how they may impact your interaction with people with obesity, is an essential step in the right direction. Notice where bias shows up in the media, and challenge it via social media and other channels at your disposal!
Thanks for reading- Trina
(Opinions are my own)
Childhood Obesity: Issues of Weight Bias
Prevalence of weight-related discrimination
Obesity Action Coalition
Harvard Implicit Association Test for Weight Bias
Psychologists and Weight Bias
Female Wage Penalty
*quote not altered to reflect people first language