WE ALL know how to lose weight, it is simple: eat less, move more.
This sounds logical enough on the surface. The problem is, within this 鈥渃alories in, calories out鈥� message there is an implied meaning: if you can鈥檛 follow these instructions, you must be lazy or lacking self-discipline.
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Of course, this doesn鈥檛 reflect reality. There is plenty of evidence showing that losing weight isn鈥檛 easy and that it is rarely sustained . Even newer weight-loss drugs such as Wegovy can lead to weight gain when you . How heavy we are isn鈥檛 solely under personal control, as our genetics and environment have a huge impact.
And yet weight stigma, which describes the negative attitudes, discrimination and harmful stereotypes directed towards people with larger bodies, is mainly predicated on this personal control narrative. That narrative, say researchers, has an insidious effect on the well-being and health of people labelled as 鈥渙bese鈥�.
There is a view that this stigma motivates people to improve their health. But for those who experience it, the opposite can be the case. They have increased risks of depression and and . It is also , which is associated with stress and can raise the risk of cardiovascular disease and diabetes.
Sadly, weight stigma runs deep in many healthcare systems. As a researcher looking at how fertility treatment is rationed, I have been surprised by how embedded weight discrimination is in public health policies. For example, women categorised as 鈥渙bese鈥� are often excluded from IVF until they lose weight. But this doesn鈥檛 consider individual health circumstances, and it isn鈥檛 always .
Shaming people for their size can even lead to weight gain. Such stigma is linked to overeating, as it may activate a threat response: increased anxiety and stress because of feeling judged and devalued by others. People who feel less capable of controlling their intake may turn to comfort eating when they sense threat, says , who studies weight stigma at the University of Minnesota. That isn鈥檛 all. She also explains that people with larger bodies often try to mitigate against this threat in a way that once again risks their health 鈥� they might stop exercising in public due to negative comments.
Another consequence of weight stigma is healthcare avoidance. A weight-centric approach by doctors can create mistrust between patient and physician and even lead to delays in . A found those who felt bad about their own weight believed doctors didn鈥檛 respect them or listen carefully enough to their health concerns.
鈥淭oo often, patients feel blamed for their weight by healthcare providers,鈥� says at the Rudd Center for Food Policy and Health at the University of Connecticut. To change this, rather than making it all about weight loss, doctors can emphasise other positive changes, such as mobility improvements, to help healthcare become more weight-inclusive, says Puhl. This will help people feel empowered, not stigmatised.
Multiple and organisations have condemned weight stigma and committed to incorporating new knowledge on weight discrimination into their practices. This is a positive step, but such stigma is in all parts of society, and healthcare won鈥檛 become weight-neutral until public attitudes also change.
Ending the view that 鈥渙besity鈥� is a personal failure of willpower is difficult. But we need to recognise that focusing so much time, energy and money on the 鈥渨ar against obesity鈥� in the way we have has inadvertently created a new public health problem.
Becca Muir is a PhD candidate at Queen Mary University of London @beccalmuir
