Eat a Salad

OCW2020: Weight Bias at the Core

Today for Obesity Care Week, the focus is weight bias, which lies at the core of our problems with making progress against obesity. It’s the core problem because it frustrates us in two ways. First of all, intellectual bias about obesity itself leads some very smart people to think (and say) some very dumb things about obesity. And then second, those dumb ideas about obesity fuel prejudice against the people who live with this chronic disease.

Even worse, people with obesity begin to internalize the bias and double the damage. Allow us to explain.

Intellectual Bias

The fundamental bias about obesity is that it is merely a behavioral problem. People eat too much and move too little. If we had a nickel for every person who lectures us on this false belief, we’d be rich.

But often, they dress their bias in fancy prose and bigger narratives. For example, David Katz tells us that three out of four of us have overweight or obesity because we eat a lousy diet. His bottom line is simple: “Eat a salad.”

The formula here is simple. Poor diet causes obesity. Obesity causes other diseases and an early death. If only we could get people to eat more healthy food, then all would be well and the problem would be solved. Easy peasy. With that line of thinking, the only argument is whether to blame the people with obesity for eating such a poor diet or the food industry for marketing it to us.

But Not So Simple

However, it’s not that simple. While obesity has been rising, the food industry has been marketing ever more food with compelling health claims. “Eat these plant-based burgers! They’ll be good for you and for the planet.” Who doesn’t want a two for one deal like that?

Simplistic narratives get in the way. They dull our curiosity about the real roots of obesity. Exactly how is the food supply promoting obesity? In what ways does our physical environment add to the problem? What about chemicals, drugs, and stressors that contribute to the problem? Why are some people genetically susceptible and others resistant?

From Bias to Blame That Compounds the Problem

If you believe that obesity is a simple behavioral problem, then inevitably, blame does land on the people who live with obesity. That adds to the problems we face. A new paper in the American Psychologist by Rebecca Puhl, Mary Himmelstein, and Rebecca Pearl explains this quite well. They describe how stigma contributes to the burden of obesity and undermines people who are seeking care.

Fortunately, people are paying attention this issue. Thea Werkhoven, for example, demonstrates the potential for education of health professionals to reduce the bias against people with obesity in another new paper. Hers and other research serve as a starting point.

This is why we must find more and better ways to reduce weight bias at the core of our difficulties in addressing the health impact of obesity.

Click here for the paper by Puhl et al and here for the paper by Werkhoven.

Eat a Salad, photograph © Alexa Clark / flickr

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March 2, 2020