18.9 Weight Stigma

An overarching contributor to body dissatisfaction is the negative attitudes exhibited toward people with larger and thinner bodies and associated weight-related stigma, prejudices, and forms of discrimination across systems (Puhl & Brownell, 2001). Weight stigma includes both institutional and individual actions toward larger people and the reactions and feelings of those individuals who are devalued.

First and foremost, people are othered through categories of weight; in other words, weight is often categorized using medical terminology into underweight, normal, overweight, or obese. One problem with this is that it implies that anything outside of a narrow range is abnormal. Research shows that weight-related bias can be harmful in a number of ways (Puhl & Brownell, 2001; Puhl & Latner, 2007), including in:

• Workplace hiring, promotion, and termination decisions, performance evaluations, and compensation;
• Healthcare settings where weight-related prejudices have been documented in physicians, nurses, and medical school students and where weight can influence the focus of discussion and recommendations made during medical appointments; and
• Educational settings where educators’ weight bias can be seen to have an impact on students as early as elementary school, which in turn, can impact long-term educational attainment.

Bias is a result of our brains taking all of our experiences in life—even early experiences and experiences we don’t actively remember—and organizing these experiences into categories to decide what is good or bad, right or wrong, and positive or negative. People of all sizes, including those who are larger, can carry anti-fat biases, which removes the protective factor of having in-group support that may exist among members of other marginalized groups (Crandall, 1994).

Anti-fat bias is particularly strong because many believe that weight, unlike race or sex, is entirely controllable. Those who do not maintain an “acceptable” weight, according to societal expectations, are considered blameworthy and responsible for this perceived shortcoming. In other words, many believe both the cause of and solution to weight-related concerns rest solely on the individual, despite the fact that many genetic, biological, environmental, and economic factors are also at play in determining a person’s weight (Finkelstein, Ruhm, & Kosa, 2005; Frayling et al., 2007; Lee, 2009).

Addressing and Reversing Size-Based Bias

While most people are not overtly discriminatory against people based on shape, size, or other physical characteristics, bias exists in all of us, whether we overtly discriminate against others or not. Holding implicit bias against or toward a group of people is part of being human; it is considered to be problematic when it influences our behavior. The Kirwan Institute for the Study of Race and Ethnicity (2013) suggests that debiasing ourselves requires us to construct all new mental associations through changes in awareness and behaviors. One way to reduce bias toward a stigmatized group is to be aware of your own affinity bias—the tendency to surround yourself with and gravitate toward people who are more like you, sometimes unintentionally leaving others out.

Making generalizations about a person or population based on weight alone, and, in particular, making inferences between what a person’s size or shape might say about their health or abilities in general, dehumanizes them and disregards the reality of their wellbeing, something that cannot be assessed solely by appearance.