In June of 2013, the American Medical Association made a controversial decision –to classify obesity as a disease. This announcement was met with mixed reactions from Americans all over the country, inciting a national public debate on the issue.
Many healthcare professionals celebrated the AMA’s finding, citing obesity as a major health crisis in the United States, one that requires a new treatment approach. Others expressed feelings that the decision was extreme, and that obesity is more indicative of a condition, rather than a disease with lifelong implications.
It was perhaps comments from the average American, however; that sparked the most controversy. When reporters hit the streets with video cams looking for insight from passersby, most scoffed at AMA’s decision; insisting that overweight Americans do not have a disease, but are, actually, lazy and gluttonous.
For clinical psychologist Dr. Rebecca M. Puhl, remarks like these are nothing new. In fact, Puhl says such comments are indicative of the stigma attached to obesity in the United States, one that has become both pervasive and highly destructive.
As deputy director of the Rudd Center for Food Policy & Obesity at Yale University, Puhl conducted a study on the subject and published her findings in the Hastings Center Report in an article entitled, “Obesity Stigma: A Failed and Ethically Dubious Strategy.”
“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 this had on their quality of life,” Puhl said. “When I realized how much work needed to be done in this area, but how little attention it was getting, it became an area I wanted to immerse myself in.”
Puhl’s research shows that when individuals are stigmatized about their weight, this leads to numerous inequities in many different settings, including the workplace, schools, healthcare facilities, the media, and in interpersonal relationships.
“Stigmatism can manifest as being teased, bullied, treated unfairly, or discriminated against. Among children, being bullied about weight is among the most common reason students are bullied at school,” said Puhl. “Among adults, weight discrimination is one of the most frequent forms of discrimination experienced.”
According to Puhl, these experiences can lead to negative emotional and social consequences, which have a profound impact on the individual. From an emotional standpoint, depression, anxiety and suicidal thoughts often result from weight stigma. Socially, weights stigma can cause isolation, exclusion from activities, poor academic functioning and physical health consequences like increased food consumption, avoidance of physical activity, and avoidance of health care.
“Not only do these consequences impair a person’s quality of life, they can also contribute to increased weight gain and actually reinforce obesity,” Puhl reports. “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 challenges this notion, and the evidence shows the opposite is true. Weight stigma impairs health, lowers motivation for health behavior change, and reduces quality of life.”
Puhl’s findings also show there is a critical need to challenge weight-based stereotypes in American society to ensure that individuals are treated equally, regardless of their body size.
“Using stigma as an approach to motivate individuals to lose weight or become healthier is neither appropriate nor effective, and strategies to improve public health should instead support people in their efforts to obtain a healthy weight, rather than shame or stigmatize,” she says.
Puhl’s research also indicates that young people are very vulnerable to being bullied about their weight –an issue that is not being adequately addressed in the school setting.
“This means we need to improve the efforts in schools to ensure that children who are overweight or obese are protected from bullying,” she said.
Given that weight bias is so prevalent in many domains of society, Puhl says there is a need to increase awareness in multiple settings. These include focusing 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.
To be effective in these efforts, Puhl recommends several solutions:
- Schools and educators must be aware of weight-based bullying and have effective strategies to address this problem among students.
- Examples of weight bias in the media need to be highlighted.
- Educating employers about weight discrimination in the workplace and how this affects their employees is necessary, as well as implementing workplace policies to prohibit weight discrimination.
- Students in health fields and health care providers need to receive training and education to reduce weight bias toward their patients in clinical care.
Puhl has already had some success in these areas.
“Our work examining weight bias in the media led to the creation of a media repository containing hundreds of images and videos that portray people with obesity in non-stigmatizing ways,” Puhl said. “Our images have been used by numerous media outlets in their news reporting, which help to combat stigmatizing portrayals of obesity in the media.”
She also reports that her research in health care has 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,” said Puhl. “Our research has also been used to inform policy and legislation related to weight bias. In fact, Massachusetts recently held a state hearing on whether a law should be introduced to prohibit weight discrimination.”
Puhl recognizes that 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,” she said.