*Geek Box: Weight Bias & Weight Stigma
Part of the impetus for the emergence of the ‘non-diet’ or ‘weight-normative’ paradigm was not simply the lack of robust evidence for long-term weight loss maintenance and long-term health outcomes related to weight loss, but particularly the negative consequences of weight bias experienced by persons with obesity in healthcare.
We can distinguish weight bias as the negative behaviours, attitudes, and assumptions, toward individuals who have overweight or obesity. Weight stigma is the negative psychosocial and physiological effects of experiencing weight bias. Weight bias is pervasive in wider society and in healthcare, as body image ideals are propagated through the popular media and marketing, while in healthcare negative assumptions that an individual with obesity must not be personally responsible for, or care about, their health, must eat a poor diet, overeat, is lazy, etc. The presence of this bias among healthcare professionals represents a major barrier to accessing healthcare for persons with obesity.
One reason for this, beyond wanting to avoid stigmatising treatment, is the problem of internalised weight bias and stigma, where an individual comes to believe they are deserving of stigmatising treatment due to their size. This correlates with high levels of disordered eating and eating disorders, binge eating in particular. It is important to note that the effects of weight stigma are not confined to adverse psychosocial effects, although stress, depression, anxiety, low self-esteem, and negative body image have all been identified as consequences of weight stigma. However, there are physiological responses to stress associated with weight stigma, in particular cortisol reactivity. These adverse consequences are crucial to understand as measurable and documented outcomes, given that “tough love” type thinking still abounds in the medical, nutritional, and fitness industries.
For a thorough discussion of the evidence in relation to adverse consequences of weight bias and weight stigma, check out this episode of Sigma Nutrition Radio which Danny and myself recorded earlier in the year.