Sneaky Pigeon

Obesity Care Week: Sneaky Stigma Stalks Us

Implicit-and-Explicit-Bias-Patterns Through 2020Today, we are putting a bow on Obesity Care Week by coming back to a root problem that gets in the way of reducing the harm of obesity – stigma. It causes psychological distress for the people living with this disease and leads them to avoid medical care. Explicit weight bias has become less acceptable in recent years. But implicit bias appears to be as high as it has ever been for the last two decades.

Implicit bias sneaks up on people with obesity because it takes so many forms in so many aspects of life. Rebecca Puhl summarized the problem recently in Gastroenterology Clinics of North America:

“Weight stigma is prevalent and has negative consequences for health and well-being. This problem is present in health care, with stigmatizing attitudes toward patients with obesity expressed by medical professionals across diverse specialties and patient care settings. Weight stigma creates barriers to effective care, including poor patient–provider communication, reduced quality of care, and health-care avoidance.”

Embedded in Imagery and Discourse

Aditi Rao, Rebecca Puhl, and Kirstie Farrar recently published a visual content analysis of weight stigma in imagery used to depict persons with obesity in U.S. and U.K. online news.  They found:

“Overall, 70% of persons of higher weight in these news images were depicted in a stigmatizing manner. Further, 46% of individuals with higher weight were depicted with their head partially or fully removed from the image, compared to 25% of individuals with lower weight. Additionally, U.K. news were 2.5 times more likely to contain stigmatizing images than U.S. news.”

Ted Kyle, Scott Kahan, and Joe Nadglowski recently explained how language has framed a biased understanding of obesity and the people who live with it:

“Language is essential for framing the public and professional understanding of obesity. Historically, the understanding of this complex chronic disease has been inaccurate, dominated by the characterization of it as a simple problem of excess weight caused by poor personal choices and unhealthy behaviors.”

Spotlight on Healthcare

Clearly, stigma is deeply entrenched in attitudes about obesity all over the world. So its elimination is a challenge. But Andrew Steptoe and Philipp Frank point out that healthcare is the right place to start. Promotion of stigma is easy to find and should be hard to tolerate there.

Obesity Care Week has been all about changing the way we care. We can begin with zero tolerance for weight stigma in healthcare.

Sneaky Pigeon, photograph by Adarsh Patel, licensed under CC BY-SA 4.0

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


March 8, 2024