Fat-shaming by doctors, family, classmates is a global health problem

Weight stigma is so widespread and so detrimental to a person’s self-esteem and health care readiness that it has become a “social injustice and a major public health problem,” said Rebecca Puhl, who First author of two new studies on the subject.

The prevalence of weight stigma is particularly significant because the causes of obesity are complex and often beyond personal control, said Puhl, who has studied weight stigma for nearly two decades.

“We have certainly created an obesity-promoting society, with an emphasis on rapidly processed and highly processed foods and a lack of physical activity,” Puhl said. “And we ignore all the other pieces of the puzzle like genetics, environment, biology, agriculture, food prices, food deserts and accessibility.

“Instead, these oversimplified and imprecise societal beliefs remain that if you try hard enough, you can have any body you want – those are the beliefs that really fuel the societal weight stigma,” she added . “Basically, this topic is about respect and dignity and equal treatment of people of different heights and weights.”

Loved ones do permanent damage

Nearly 14,000 members of WW (formerly Weight Watchers) in six countries were surveyed between May and July 2020 about their experiences with weight stigma and how it affects their self-esteem and willingness to seek medical help.

Family members were most likely to be ashamed of being fat, according to one study published Tuesday in the International Journal of Obesity. Between 76% and 88% of the respondents had experienced weight loss from a parent, sibling or other family member, especially in childhood and adolescence.

You might suspect that the stigma was the unintended result of a parent or family member trying to help a child overcome their weight problems and improve their health, but the study did not find that.

“When we asked family members open questions about the experiences of people with weight stigmatization, it was often really harsh criticism, teased them and made fun of them,” said Puhl.

“These ranged from being labeled fat or ‘thunderbolts’ to saying that because of their weight they will never find someone to date them – really derogatory comments that have a long-term effect,” she added.

Fat shaming by family members did not end in childhood, the study found.

“About 22 to 30 percent of people said their first experiences with weight stigma occurred around the age of 10, but family weight stigma persists over time well into adulthood,” Puhl said.

“That really speaks to the need to address the family environment, which is often neglected when it comes to weight stigma,” she added. “We need to help families have supportive, less stigmatizing communication with their family members.”

School and work were important sources

Classmates ranked second on the fat shaming ladder, with 72% to 81% of respondents reporting being teased or bullied at school.

Between 54% and 62% of the respondents said that their colleagues had shamed them in the workplace.

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Finally, even friends were very likely to be critical of weight – between 49% and 66% had seen negative comments from friends.

“People experience weight stigma in several close interpersonal relationships and in different environments, be it in healthcare, at work, or at home,” said Puhl.

While the study was able to compare similar groups – people who felt they needed to be on a weight loss program – across countries, the study’s limitations included a lack of diversity (the majority were white women) and because they were on a weight management program Results not applicable to the entire population of adults with a higher body mass index (BMI). The study was supported by a grant from WW International Inc.

Doctors play a key role in burning fat

In what they call the first “multinational study of the association between weight stigma and health care experience,” Puhl and her colleagues used the same WW dataset in a second study to see if respondents felt that their doctors were them judged by their weight. The study was published on Tuesday in PLOS ONE magazine.

Previous studies had identified a stigma or bias in weight among medical professionals, but the research focused on the US, Puhl said.

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The study found that between 63% and 74% of people surveyed in Australia, Canada, France, Germany, the UK, and the US felt they were losing weight when they see a doctor for health care.

In all six countries, people who internalized this stigma or blamed themselves for their weight were more likely to avoid health care, the study found.

“They would be examined less by the doctor, they were more of the opinion that their doctors rated their weight negatively and that their doctor respected them less and did not listen to their needs,” said Puhl.

Those beliefs persisted even if the person wasn’t significantly overweight, the study found.

“I should note that body weight has not been associated with any of these healthcare experiences, so it was just internalizing that stigma.” said Puhl.

Previous research shows that when people experience and internalize weight stigma, it can itself predict weight gain.

“A common belief is that a little shame or stigma might motivate people to lose weight, but that’s not what we see in the research,” Puhl said. “In fact, people’s stigma contributes to unhealthy eating habits, less physical activity, and weight gain.”

This pattern was also evident in both studies across countries: the more people blamed themselves for their weight, the greater the weight gain over the past year – and the more they turned to diet to deal with stress.

“These results really give us a compelling reason not only to target the weight stigma of doctors or health care professionals, but also to find ways to help people reduce self-blame for stigma,” Puhl said.

Change starts at home

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Attitude change should start at home, Puhl said, with loving conversations about healthy behavior without “making the child feel completely ashamed or embarrassed or judged for their body looks”.

Our studies show that when parents shift the conversation to health Behaviors that tend to be far more effective, “she said.” The focus is not on the number on the scale, but on the whole family eating fruits and vegetables, replacing soda with water, and doing daily exercise.
Teens often prefer more neutral words like “BMI” or “weight” rather than “obese” or “fat” or “heavy”, but they can Change depending on individual preference and gender, said Puhl.

“One of the things we found out in girls in particular is that even when parents add weight in a more neutral way, they can feel emotionally troubled, so maybe it’s best not to mention the weight of everything,” Puhl said .

“I think we can significantly reduce the stigma of weight in the home environment by focusing conversations on health and health behaviors, rather than the number on the scale or looks.”

It is also a political problem

In addition to changing personal attitudes about obesity, its causes, and who to blame, Puhl said local, state, and federal governments should play a role in tackling weight stigma.

“In the United States it is legal to discriminate against people because of their weight,“, she said. “Only if you live in the state of Michigan, which passed law in the 1970s, are you protected from discrimination (based on weight).”

Some cities have local ordinances, and other states like Massachusetts are trying to enforce laws, but there is no federal mandate against weight discrimination, such as. B. not getting a job because of the weight, said Puhl.

Still research shows that there is “significant public support in the US to pass laws that would make weight discrimination illegal,” she added.
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“This is a clear political goal that could really change people’s lives and send the message that this is a legitimate form of stigma and abuse that we will not tolerate,” she said.

There must also be changes in medical facilities, emphasized Puhl. “We need to train medical professionals early on in medical school instead of waiting for them to be in clinical practice,” she said.

One positive note: A. Consensus Statement Last year’s co-author Puhl called for an end to weight stigma and has been signed by 100 international medical organizations.

Policy changes can also be implemented in schools by ensuring that children are protected from weight-based bullying, Puhl said.

“Many schools have diversity curricula and we need to make sure that weight is part of that diversity teaching,” she said. “We definitely need to talk about race and ethnicity, as well as sexual orientation and religion, but we also need to make sure that weight diversity is covered too.”

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