Weight Bias and Stigma Have Power to Unite and Divide

Weight bias and stigma hold power over us. It can poison just about everything we might do about obesity. And yet today, it unites us. As we observe National Obesity Care Week, our focus today is squarely upon weight bias.

Two Ways to Express Bias

Two distinct types of bias work against us. First and most obvious is the bias against people with obesity. It surrounds us. But intellectual bias about obesity itself is both common and disruptive, too. All too often, bias guides the response to obesity more than facts. More than science. When that happens, policy is utterly ineffective.

Promoted by Health Professionals

For help with obesity, exercise and nutrition professionals could be a great source of help. However, it turns out that they are also a source of considerable bias. Gregory Panza and colleagues recently published a systematic review. They found clear and consistent evidence of both explicit and explicit bias in these professions.

More broadly, stigma is common in just about every aspect of healthcare. In BMC Medicine, Janet Tomiyama et al explained how it actually adds to obesity rates and harms health. In addition, Sean Phelan recently reviewed the research that shows stigma is a barrier to effective treatment. Specifically for obesity – specifically bariatric surgery.

The Power to Divide

Where weight holds power to divide us is in our thinking about obesity. Those biases run deep. Take, for example, the way we think about weight and BMI. The core issue in obesity is adiposity. The physiology of how the body stores energy has gone haywire when obesity takes off. The body works hard to store much more energy as fat than it needs.

But our thinking – and our conversations – about obesity break down into debates about weight and weight loss. We get stuck in silly arguments about BMI – as if the definition of obesity begins and ends with BMI.

On one side of this argument, you have people who think that obesity is easily solved through weight loss. In a galling display of bias, the American Heart Association lists a BMI less than 25 as “an ideal health behavior.”

On the other side, we hear fat acceptance advocates advancing a straw-man argument. Obesity is defined by weight, they say. Weight is not synonymous with health. Ipso facto, the thought that obesity is a disease state is simply wrong. We’re too hung up on catastrophizing obesity, according to this argument.

On WBUR recently, Michael Hobbes and Fatima Cody Stanford debated that straw man. Their discussion ranged widely. Hobbes and Stanford largely agreed on bias directed at people with obesity. But they sharply disagreed on the question of defining obesity as a disease.

The discussion between Hobbes and Stanford illustrates how weight bias and stigma can both unite and divide us. These two thoughtful people clearly agree on the destructive influence of stigma. But bias in thinking about obesity itself can get in the way of problem-solving.

Click here to listen to Hobbes and Stanford with Meghna Chakrabarti.

Coming Together, photograph © Obesity Action Coalition / OAC Image Gallery

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October 11, 2018