The impact of weight bias globally: how to shift the stigma
17 October 2023
The World Obesity Federation releases position statement by global obesity community addressing weight stigma and changing obesity narratives.
Titled ‘Changing the Global Obesity Narrative to Recognize and Reduce Weight Stigma’, the paper published in Obesity Reviews sheds light on the pervasive misconceptions and stereotypes associated with higher body weight. Thirty-nine patient and professional experts from multiple countries came together, hosted by the World Obesity Federation, to consider the ways that global obesity narratives and cultural biases may contribute to weight stigma. This included healthcare practitioners, obesity researchers, weight stigma researchers, health policymakers, youth advocates and individuals with lived experience of obesity representing different regions of the world, including Africa, Asia and the Americas.
Weight stigma has been identified as a significant social determinant of health that is a barrier to health equity. It leads to systemic disadvantages, inequities, numerous adverse health consequences and discrimination – which also makes it a human rights issue. It is imperative to consider how weight stigma may be impeding health promotion efforts on a global scale.
The overall goal of the working group - co-chaired by board leaders of the Healthy Caribbean Coalition and Obesity Canada - was to discuss weight stigma on a global scale, identify knowledge gaps, examine the impact of obesity-related narratives on weight stigma, propose recommendations applicable across different global regions, and increase the representativeness of research in different regions of the world. They looked closely at how overall obesity narratives, food and physical activity narratives, and scientific and public-facing language may contribute to stigma, while also considering its impact across the lifespan.
Overall obesity narrative
The prevailing narrative surrounding obesity plays a substantial role in fostering weight stigma. Individuals with higher body weights are often stereotyped by unflattering traits of behaviour, both in their day-to-day experiences and in various media platforms. However, this reinforces the incorrect notion that individuals with higher body weights or obesity have moral character flaws.
Food and physical activity narratives
Simplistic obesity prevention messages that concentrate solely on individual food consumption and physical activity contribute to weight stigma by overlooking the underlying factors of obesity. These encompass a multitude of interrelated biological, psychosocial, and environmental determinants of health. Nutrition and exercise-focused interventions have demonstrated a lack of effectiveness for long-term sustainable obesity treatment.
Another concern is that many healthcare providers lack specific training on obesity and weight stigma, and this can contribute to weight stigma and discrimination in healthcare encounters, which can have significant consequences for health. Weight stigma can often be internalised by people, which can negatively impact eating behaviours for individuals across the weight spectrum, increasing the risk of developing disruptive eating behaviours. And for youth, these effects often continue into adulthood.
Weight stigma throughout the lifespan
Weight stigma has an influence across all stages of life, from pregnancy to adulthood.
- Throughout pregnancy, women living with obesity are often stigmatised by the prenatal healthcare environment. Weight-stigmatising experiences are also associated with perinatal complications, including gestational diabetes, preeclampsia and postpartum depression.
- Weight-based stereotypes throughout childhood such as weight-based bullying have severe repercussions from as early as the age of five. Sources of weight stigma include family, peers, teachers, healthcare professionals and the media.
- For adolescents, a key source of weight stigma is social media which often devalues individuals with higher body weights. Experiencing weight stigma is associated with increased depression, anxiety, suicidality, disordered eating, and substance use.
- In adulthood, people with higher body weights may also be subjected to weight discrimination, including reduced job opportunities, limited healthcare access and quality, and poor interpersonal relationships.
Scientific, policy, and public-facing language
The language and imagery used to communicate about weight and obesity plays an important role in shaping social norms and narratives in research, education, policy, healthcare and media.
There is a general lack of clarity regarding the definition of obesity in research, policy, practice, and among the public. To prevent weight stigma, it is important to distinguish between body size or weight and the disease of obesity. Individuals can be healthy and unhealthy across the weight spectrum, therefore the clinical term ‘obesity’ should not be used to refer to a person’s body size, and should only be used when an individual has been appropriately medically diagnosed with obesity.
Many scientific articles on nutrition, weight, or obesity use sweeping generalisations, which detract from efforts to understand the complexity of weight and obesity in the context of health.
Recommendations for a global effort to reduce weight stigma
The working group has outlined nine recommendations to reduce weight stigma globally:
- Distinguish between body size and obesity
- Use person-first language
- Consider individual language preferences
- Use non-stigmatising language and imagery
- Engage in weight-neutral health promotion
- Engage in legislative and policy efforts to reduce weight stigma
- Promote human rights-based approaches to tackle weight stigma and discrimination
- Raise awareness of weight stigma
- Increase the global evidence base
Conclusion
Given the far-reaching and detrimental impacts of weight stigma, it is critical for the global community to address this significant social determinant of health and wellbeing. With increased efforts targeting weight stigma, we may accurately and equitably represent people of all sizes, support healthy bodies and minds, and promote societies that embrace body diversity and inclusion of all people.
"We firmly believe that addressing weight stigma is critical to fostering a more equitable and inclusive society. With collective efforts targeting weight stigma, we aim to promote healthy bodies and minds and support societies that embrace the well-being of all individuals,"
- Johanna Ralston, CEO of the World Obesity Federation.
Read the paper here
Read the full position statement including more detail on the nine recommendations in our journal, Obesity Reviews. This paper is freely available to all.
Read here