Weight Bias: Moving from Loud to Quiet

Head of a Shouting ManWeight bias is a moving target. It is moving from a shout to a quiet murmur, from explicit shaming to implicit insults. In 2015, a peer-reviewed medical journal would publish advice to tell patients bluntly that obesity is their fault. With an AJM editorial then, Robert Doroghazi wrote that he thought it best to confront patients, telling them:

“It’s not OK. Obesity is bad. You are overweight because you eat too much. You also need to exercise more.”

Today, there’s a broad recognition that this is bad form. Fat shaming brings shame on the shamers.

Yet a steady stream of publications makes it clear that weight bias remains strong and prevalent.

Deep Wounds from Family

Family members inflict some of the greatest harm with both loud and quiet expressions of weight bias. It has important implications for mental and physical health.

For example, a new study by Samantha Lawrence and colleagues explores accounts of painful experiences with weight stigma. These accounts come from a sample of 410 adult women in a weight management program. Stigmatizing experience came in different forms – critical remarks and teasing were the most common. It didn’t have to be harsh to have as lasting effect, as one 65-year-old woman described:

“When I think about the gentle teasing from my father when I was young, I realize that he
never intended the effect it had on me. Nevertheless, it has affected me throughout my

In fact, the notion of a life-long effect was a resounding theme, expressed by this participant in the study:

“It has played a major role in my 72-year development and started in infancy. I was an
only child, but older family members (especially my paternal grandmother and her 5
sisters) teased me about and pinched my chubby face, arms, and legs as far back as I can

A Slow Shift Away from Shame and Blame

Implicit and Explicit Bias PatternsData from Project Implicit provide support for our belief that explicit weight bias is declining, but the quiet part – implicit bias – keeps getting stronger.

A new study of 30 years of weight bias in the language of reporting on obesity in Australia also supports the notion that change is coming very slowly. Sharon Grant and colleagues found a “slow-paced shift” away from individual blame for obesity to a more structural view of the problem.

This is progress, but it is slow. It is also a reminder to examine the implicit assumptions that each of us carry with us about health, weight, and obesity.

Click here for the study by Lawrence et al. For the new paper by Grant et al, click here.

Head of a Shouting Man, painting by Matthias Grünewald / WikiArt

Subscribe by email to follow the accumulating evidence and observations that shape our view of health, obesity, and policy.


March 27, 2022