OCW2022: Putting an End to Weight Bias

For OCW2022 today, Rebecca Puhl and Ted Kyle take on a tough question: can we put an end to weight bias? In answer to that question, there’s both good news and bad news, highlighted in a new video release today.

First the Good News

Without a doubt, awareness of weight bias has grown over the last decade. Data from the Project Implicit documents a downward trend in explicit weight bias. Puhl explains:

“Awareness of weight bias is certainly improving. It’s much more on the radar – much more in social consciousness than it has been in the past.

“I also think there’s been an increased recognition of the complexity of obesity. This is not just an issue of needing to eat less or be more active. I think that understanding is helping to raise awareness.”

Now the Challenge

But as you’ll note from the chart on the right, implicit weight bias isn’t really improving. In fact, the data from Project Implicit suggests it’s getting worse. This reflects the unconscious judgments people make when they see a bigger, heavier person. To the extent that media and even public health campaigns depict people with obesity as pathetic victims, it serves to add to that implicit bias.

Even in healthcare, people with obesity encounter bias, as Puhl explains:

“I think we need to remember that being a medical professional doesn’t make you immune to weight bias. We all live in the same society where weight bias is really ingrained in the societal culture.

“It’s also important to recognize that medical training on nutrition and obesity is often inadequate. Weight bias has rarely been included. That gap in education can contribute to the presence of weight bias in healthcare.”

When Stigma Becomes a Complication of Obesity

One might be tempted to think this is a special side issue – not really a central concern for health. But that would be a mistake. A new paper in Clinical Diabetes by Puhl, Mary Himmelstein, and Jan Speight makes this quite clear. Because experiences of stigma and bias for someone with obesity and diabetes can become internalized. People start to believe the harsh judgments they face.

When this happens, Puhl et al found that health deteriorates. People become less active, eat more to cope with negative emotions, and even become more likely to develop symptoms of binge eating disorder.

So when people internalize the stigma they experience, self-stigma becomes a complication of obesity that further erodes a person’s health. This is precisely why it’s imperative to end weight bias – to challenge it wherever we find it. Especially in ourselves.

Click here for the full OCW2022 weight bias discussion with Puhl and Kyle. For the new study from Puhl et al, click here.

Obesity Care Week graphics and resources available at obesitycareweek.org

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March 2, 2022