Obesity Stigma: a Failed and Ethically Dubious Strategy

PuhlDr. Rebecca M. Puhl is the Deputy Director at the Rudd Center for Food Policy & Obesity at Yale University. Dr. Puhl received her doctorate in clinical psychology from Yale University and has been researching weight bias for over 13 years. Her focus has been on weight-based bullying in youth, weight bias in health care and the media, interventions to reduce weight bias, and the impact of weight stigma on emotional and physical health. Her recent publications address the prevalence and origins of weight stigma, interventions to reduce weight bias, and the impact of weight stigma on emotional and physical health. Her paper titled “Obesity stigma: a failed and ethically dubious strategy” was published in The Hastings Center Report.

Research Background

In my clinical training, I worked with many patients who struggled with their weight, and saw first-hand how frequently they were stigmatized because of their weight, and the devastating effects that this had on their quality of life. I also had several research opportunities to begin studying weight bias, which I didn’t know much about early in my training, and this introduced me to the scientific study of this topic. When I realized how much work needed to be done in this area, but how little attention it was getting, it became an area that I wanted to immerse myself in.

Research Findings

Our research shows that when individuals are stigmatized about their weight (e.g., being teased, bullied, treated unfairly, or discriminated against), that this leads to numerous inequities in many different settings, including the workplace, schools, health care facilities, the media, and in interpersonal relationships. Among children, being bullied about weight is among the most common reason that students are bullied at school, and among adults, weight discrimination is one of the most frequent forms of discrimination that people experience.

These experiences lead to a range of negative consequences, including negative emotional consequences (e.g., depression, anxiety, suicidal thoughts), social consequences (e.g., social isolation, exclusion from activities, poorer academic functioning), and physical health consequences (e.g., unhealthy eating behaviors, increased food consumption, avoidance of physical activity, and avoidance of health care). Not only do these consequences impair quality of life, but they can contribute to increased weight gain and reinforce obesity.

Our research has also found that there is considerable public support for laws to prohibit weight discrimination, and that the public is more likely to be motivated to improve their health behaviors when they are supported in those efforts, rather than made to feel ashamed or stigmatized because of their weight. There seems to be a public perception that stigmatizing or shaming people who are obese will motivate them to lose weight and provide them with the incentive to do so. However, research by our center and many others challenges this notion, and instead the evidence shows that the opposite is true – that weight stigma impair health, lowers motivation for health behavior change, and reduces quality of life.

(Editor’s note: click here for a video of Dr. Puhl discussing these findings in greater detail: http://www.scivee.tv/node/59123 )

Implications

First, our findings show that we need to challenge weight-based stereotypes in our society, to ensure that individuals are treated equally, regardless of their body size.

Second, using stigma as an approach to motivate individuals to lose weight or become healthier is neither appropriate or effective, and that strategies to improve public health should instead support people in their efforts to obtain a healthy weight, rather than shame or stigmatize.

Finally, our findings indicate that youth are very vulnerable to being bullied about their weight, but that this is not being adequately addressed in the school setting. This means that we need to improve the efforts in schools to ensure that children who are overweight or obese are protected from bullying.

Creating impact

Our research has been used to help create resources and approaches to reduce weight bias in different settings.

  • In media. Our work examining weight bias in the media led to the creation of a media repository containing hundreds of images and videos that portray persons with obesity in non-stigmatizing ways. Our images have been used by numerous media outlets in their news reporting, which help to combat stigmatizing portrayals of obesity in the media.
  • In healthcare. Our research in health care has also led to the creation of several educational resources for health providers to increase awareness of weight bias and strategies to reduce bias in their clinical practice. These resources include toolkits, videos, and online courses; and are all free.
  • In policy. Our research has also been used to inform policy and legislation related to weight bias. Massachusetts recently held a state hearing on whether a law should be introduced to prohibit weight discrimination. Our research evidence was used to educate policy makers about this issue, including the extent of public support for such legal measures. (Click here to view the policy brief that was distributed to educate policy makers about weight bias) 

The road ahead

Given that weight bias is so prevalent in many domains of society, we need to continue to increase awareness in multiple settings, including the following examples:

  1. Ensuring that schools and educators are aware of weight-based bullying and have effective strategies to address this problem among students.
  2. Bringing attention to examples of weight bias in the media.
  3. Educating employers about weight discrimination in the workplace and how this effects their employees, as well as implementing workplace policies to prohibit weight discrimination.
  4. Providing students in health fields (and health care providers) with training and education to reduce weight bias toward their patients in clinical care.

Thoughts from the field

Weight bias is a complex issue, and needs to be studied and addressed from multiple disciplines. Fields ranging from psychology and sociology to public health, law, economics, and civil rights, can all be very useful in efforts to address this social injustice and public health issue.

About the Rudd Center

The Rudd Center seeks to improve the world’s food environment and reduce weight stigma by establishing creative connections between science and public policy, developing targeted research, encouraging frank dialogue among key constituents, and expressing a dedicated commitment to real change. The Rudd Center assesses, critiques, and strives to improve practices and policies related to nutrition and obesity so as to inform and empower the public, to promote objective, science-based approaches to policy, and to maximize the impact on public health. You can see more about our center at www.yaleruddcenter.org