In the Tavern

Obesity and Stigma: The War Inside Your Head

The “War on Obesity” has claimed many victims, but made little progress against the disease itself. This  approach to obesity has done a fine job of setting up a war inside our own heads – self-stigma. “Weight stigma is widespread, damaging and difficult to eradicate,” writes Rebecca Puhl in the Washington Post. In fact, the bogus war on obesity often serves to promote self-stigma with counterproductive messages about “personal responsibility.”

A new paper in Qualitative Health Research describes how “personal responsibility” sets up this war:

“Our study highlights novel findings in that PWO struggle to recognize obesity as a disease due to the perception that they should be able to control themselves as they have agency with regards to body weight regulation. With this narrative and lack of options to treat their disease it is unsurprising many end up feeling trapped with no hope of ever finding resolution and ‘always at war with yourself.’”

In-Depth, Semi-Structured Interviews

This new study comes from Andrew Grannell, Carel le Roux, and Deirdre McGillicuddy. They are building on prior work to understand the lived experience with obesity. So they interviewed 23 patients in a tertiary care obesity clinic. What they discovered is a jumble of ideas about obesity setting up a conflict inside their own heads. On one hand they found an overall agreement that obesity is a disease.

But at the same time, they found that:

“A sense of personal responsibility appears to be a barrier to fully accepting obesity as a disease
which may negatively impact on seeking treatments and thus health outcomes.”

Understanding Obesity and a Better Sense of Self

So the war on obesity has put us at war with ourselves, promoting self-stigma along the way. Our biology is colliding with a hostile environment that promotes obesity. But the understanding of that biology and all of the environmental factors triggering it is quite incomplete.

One thing is clear. The war metaphor, paired with tropes about personal responsibility, is not helping. It’s hurting us all by promoting self-stigma.

Click here for the paper by Grannell, le Roux, and McGillicuddy. For more on the global harm of weight bias and self-stigma, click here.

In the Tavern, painting by Laszlo Mednyanszky / WikiArt

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September 30, 2021

2 Responses to “Obesity and Stigma: The War Inside Your Head”

  1. September 30, 2021 at 10:06 pm, Chester Draws said:

    Moving it away from personal responsibility isn’t going to help though.

    The first rule of fixing something is that it has to be within your own control. If it isn’t, you can’t fix it.

    So moving responsibility for obesity somewhere else (where, exactly?) will just leave people feeling even more helpless.

    It is within a person’s control to lose weight. People do it frequently enough. What we have to accept is that it isn’t easy, and there’s no “just do this simple thing” for most people.

    But pretending obesity is caused by some mysterious influences outside one’s control, rather than an imbalance of calories in versus calories out is to defy biology.

    • October 01, 2021 at 4:42 am, Ted said:

      Thank you for illustrating how people misunderstand the dynamic systems of weight regulation. The body responds to fluctuations in energy consumption by changing the levels of energy use, which involves far more than voluntary physical activity. More than 37 trillion cells in a person’s body burn energy every minute and the body regulates this burn without asking permission.

      A person does have some opportunity to exert control, but that involves more than eating less and moving more. It involves seeking care when metabolic functions of the body are out of whack. Unfortunately, healthcare systems don’t make this easy and perfect solutions are often not available. So we do the best we can and get on with life.