Language disclaimer: This webpage discusses topics related to weight stigma and its intersection with “obesity” and eating disorders. The content addresses language and societal attitudes that have historically medicalized and pathologized larger bodies. As such, we have placed the terms “obese” and “overweight” in quotation marks to acknowledge the harms and stigma in using these terms. In line with critical weight and fat studies, we also use the term “fat” as a neutral descriptor of size and in reclamation of the term that has historically carried harmful negative connotations. For more information on this topic, you can visit this NEDIC webpage.
Weight bias refers to harmful weight-related attitudes, beliefs, and assumptions about people based on their weight. Weight bias manifests in society through weight stigma, or the harmful social stereotyping of people based on their weight. Weight bias and stigma can lead to weight discrimination, or the inequitable and unjust treatment of people due to their weight within settings such as the workplace, healthcare facilities, educational institutions, and the media. Weight bias and stigma can also lead to internalized weight bias, which is when negative weight-related attitudes, beliefs, and assumptions become internalized and applied to oneself.
Internalized weight bias can be an independent contributor to negative physical and psychosocial outcomes, such as weight cycling, depression, and disordered eating (Prunty et al., 2022; Pearl & Puhl, 2018;Puhl & Heuer, 2010; Quinn et al., 2020). Additionally, weight bias, stigma, and discrimination can all threaten access to, as well as the quality of, healthcare, which can also have negative consequences on physical and psychosocial health (Kirk et al., 2020; Puhl & Huer, 2010)
“Obesity” and eating disorders are often discussed and addressed separately in public health practice and policy. For instance, many health promotion campaigns revolve around “anti-obesity” initiatives, and the conversations about the causes of weight gain often leave out a multitude of factors beyond individuals’ knowledge and behaviours. In reality, “obesity” and eating disorders share similar factors, which can span from individual-level influences (e.g., negative body image, disordered eating behaviours) to broader societal influences (e.g., weight stigma).
Focusing on weight within conversations about health perpetuates misconceptions about weight being a reflection of one's health status and lifestyle choices. “Obesity” and eating disorders are often addressed as unrelated concepts. While they are distinct from each other, discussions that do not consider how they are related can lead to unintended harms, like the stereotype that only people with (very) thin bodies can have eating disorders, and that those in larger bodies do not or cannot experience these conditions. At the same time, "obesity" is often mentioned in the same breath as eating disorders, implying that "obesity" is a type or reflection of disordered eating. This can lead to false assumptions about individuals in larger bodies – they must not know how to eat "normally" or must have binge eating disorder, which has led them to become the size that they are.
Understanding that it is not constructive to continue tethering weight to conversations about health is a necessary step towards breaking down these harmful stereotypes and promoting inclusivity of people of all shapes and sizes. Weight inclusivity involves respecting the diversity of body shapes and sizes that naturally exists, and rejecting the idealizing or pathologizing of specific weights. Weight-inclusive approaches to health, therefore, emphasize that there are many components to wellbeing, and support people to achieve health without focusing on weight. Weight-inclusive approaches also employ intersectional and trauma- and violence-informed lenses to acknowledge how weight bias, stigma, and discrimination overlap with other systems of oppression.
This table contains some examples of ways in which weight-inclusive approaches can be applied to messages around eating, physical activity, and body image (NEDC; Rodgers et al., 2023; Tylka et al., 2014).
Within society, there are various levels in which weight stigma can perpetuate itself, ranging from individual-level factors to broader sociocultural influences. Some examples are outlined below. Within each level, there are different opportunities for action or self-reflection that people can take to begin to challenge weight stigma and create more weight-inclusive environments.
We present broader sociocultural influences, as well as individual-level factors, to emphasize how “no amount of change in attitudes will compensate for a health care environment that is made only for thin(ner) bodies" (Hardy, 2023)
Positioning “obesity” as a “disease” can perpetuate oppressive and stigmatizing notions about fat bodies requiring medical treatment that reduces their fatness. In healthcare settings, weight-related biases among care providers can lead them to cause harm to patients at an individual level, and more broadly to communities. Shifting away from the focus on weight and weight loss in discussions about health and wellbeing is a crucial step towards eliminating weight stigma and creating weight-inclusive healthcare settings.
Untethering weight from health can look and be defined differently for different people. Take a look at some approaches below:
- Ask patients how they want their body to be described. Make a habit of asking people about the language they use to describe their own body. Try to mirror their language.