Separating Self-Stigma from Self-Care

New research from Rebecca Pearl and colleagues on self-stigma raises important questions for self-care. In obesity, self-care is the most common approach. “I ought to be able to do this myself” is a common thought we hear. WW (formerly Weight Watchers) has many millions of members. Diet, exercise, and weight loss books top the charts of nonfiction best sellers all the time. And yet, with all this energy going into self-help, we see a whole lot of self-stigma among people using these tools.

Self-stigma is self-defeating. So this is a big problem.

Validated Measures in 18,789 WW Members

Pearl et al administered two validated measures to an impressive sample of WW members. In fact, WW provided a grant for this research, which would never have been possible without its help.

They found that many of the people in this program had internalized the stigma they experienced in life. In particular they found the strongest associations with stigma in the workplace, in routine community interactions, and in healthcare. Experiences of stigma in those settings were the most predictive of self-stigma being a problem.

Likewise, self-stigma was more often a problem for people with higher BMIs, without a partner, and a long history of weight stigma experiences. Black women and widows were less likely to internalize weight stigma.

Time for Self-Reflection

Knowledge is power. And self-care is the most common approach for obesity care. But these data tell us that self-stigma is an important barrier for better health through self-care. Internalized weight stigma leads to poor health, unhealthy behaviors, and avoidance of healthcare.

So everyone who is promoting self-care needs to ask themselves, “am I helping or hurting?”

Is the doctor who simply advises a patient to “lose some weight” really helping if they haven’t taken time to ask and listen to a patient’s concerns. Absent any dialogue with an empathetic provider, how helpful is that BMI screening sheet handed to us as we leave our annual visit?

Equally important would be a bit of self-reflection about employer wellness programs. Is your workplace wellness program promoting good health or is it serving to stigmatize people living with obesity? Is it integrated with health benefits that give people access to real, evidence-based obesity care – including skilled providers, pharmacotherapy, and surgery? If not, it might be doing more harm that good. This might explain why wellness programs often turn out to be ineffective for promoting health.

This glimpse of so much self-stigma in self-care is a strong signal to rethink our assumptions about health and weight.

Click here for the study. Here and here you can find more on the impact of self-stigma.

Self-Portrait, photograph © Lua Pramos / flickr

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July 15, 2019

One Response to “Separating Self-Stigma from Self-Care”

  1. July 20, 2019 at 9:43 am, Karen R. Koenig, LCSW, MEd said:

    I am a psychotherapist specializing in eating disorders for 30+ years and the author of 7 books. Although I agree that the self-care of higher weight people is impacted by weight stigma, I disagree with several aspects of your article. Reading self-help books is not necessarily self-care: It depends on what a person is reading. WW participants are not self-care oriented: They’re weight-loss, not health, focused.
    Poor self-care (which I am not correlating with higher weights) underlies much of dysfunctional eating. True self-care involves self-love, high self-value and acquiring skills to manage life effectively. Self-care is based on a set of positive values, beliefs and feelings that we have about ourselves.