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Undertstanding Obesity Stigma

Understanding
Obesity
Stigma
An educational
resource provided by the
Obesity Action Coalition
Understanding Obesity Stigma
“The alarming rates of obesity have brought
widespread attention to the medical consequences
of this public health problem. Often
ignored, however, are the social and personal
obstacles that overweight and obese individuals
face. Bias, stigma, and discrimination due to
weight are frequent experiences for many
obese individuals, which have serious consequences
for their personal and social well
being and overall health. Given that at least
half of the American population is overweight,
the number of people potentially faced with
discrimination and stigmatization is immense.”
– Rebecca Puhl, PhD, Coordinator for
Community and Weight Stigma Initiatives at
the Rudd Center for Food Policy and Obesity
at Yale University.
eight stigma plays a role in everyday life,
including work, school and healthcare
settings. It remains a socially
acceptable form of prejudice
in American society, and is
rarely challenged. One of
the goals of the Obesity
Action Coalition (OAC) is
to eliminate the negative
stigma associated with
obesity. To do this, we
must be able to define and
recognize obesity stigma in
all aspects of life. Once we
are able to identify the nature and
extent of this problem, we can increase education
and awareness about the damaging and lasting
effects of negative stigma.
Throughout this brochure, we will discuss the
many forms of stigma and provide readers with
options for dealing with stigma and ways to
educate others.
W
Causes of Obesity:
Perceptions May Perpetuate
Negative Stigma
Perceptions about the causes of obesity may
contribute to weight stigma and bias.
Assumptions that obesity can be prevented by
self-control, that individual non-compliance
explains failure at weight-loss, and that obesity
is caused by emotional problems, are all
examples of attitudes that contribute to
negative bias.
Research suggests that beliefs about the causality
and stability of obesity are also important factors
contributing to negative attitudes. For example,
studies show that obese individuals are more
likely to be stigmatized if their overweight
condition is perceived to be caused by controllable
factors compared to uncontrollable factors (e.g.,
overeating versus a thyroid condition), and if
obesity is perceived to be a condition of personal
choice versus a serious health condition.
Bias in Employment Settings
At Work
There is clear evidence of weight stigma and
bias in multiple aspects of daily life for obese individuals.
Negative perceptions of obese persons exist
in employment settings where obese employees are
viewed as less competent, lazy and lacking in selfdiscipline
by their co-workers and employers. These
attitudes can have a negative impact on wages,
promotions and decisions about employment status
for obese employees.
Experimental studies also show that obese
applicants are less likely to be hired than
thinner applicants, despite having identical
job qualifications. There are also increasing
legal cases emerging where obese employees
have been fired or suspended because of their
weight, despite demonstrating good job performance
and even though their body weight was
unrelated to their job responsibilities.
Bias in employment settings has been identified
in the following areas:
• Hiring preferences
• Promotions
• Wage inequities
• Employment termination
Hiring Preferences:
Obese job applicants are rated as having:
• Poor self-discipline
• Low supervisory potential
• Poor personal hygiene
• Less ambition & productivity
• Higher likelihood of being hired for a
job requiring little face-to-face contact
Promotions:
Obese applicants are rated as having:
• Lower promotion prospects compared
to non-overweight counterparts
• Harder time being recommended by
managers for promotion, as compared
to other candidates
• Less of a chance to get hired in highlevel
positions
Wage Inequities:
The following are true in regards to wage
inequities for obese individuals:
• Obese women earn as much as 12
percent less than non-obese females
• Obese women are more likely to be
in low-paying jobs than thinner women
• Obese men are under-represented
and are paid less than non-obese
men in managerial and professional
positions
Employment Termination:
Obese employees are affected more often in
the following examples than non-obese
employees:
• Fired due to prejudiced employers
and arbitrary weight standards
• Fired despite good to excellent
employment records for occupations
such as: teachers, pilots, office managers,
state troopers and city laborers
Bias in Education
In School
Multiple forms of weight stigmatization also occur
in educational settings. Obese students face
numerous obstacles, ranging from harassment
and rejection from peers at school, to biased
attitudes from teachers, lower college acceptances
and wrongful dismissals from college.
The severity of this problem is highlighted by
research showing that stigma toward overweight
students begins very
early. For example,
negative attitudes
have been reported
among
pre-school
children
(ages three
to five) who
associated
overweight
peers with
characteristics
of being mean,
stupid, ugly and
having few friends.
Bias in education is expressed through extensive
peer victimization at school, and negative
attitudes by teachers, administrators and
academic institutions.
Weight Bias
by Peers:
• Negative
attitudes
begin as
early as
preschool.
• Obese children are
teased by kids and chosen less as
playmates.
• Stigmatization continues through high
school and college, where obese
students are viewed as self-indulgent,
lazy and are excluded from social
activities.
Peer Victimization:
• At least 30 percent of overweight girls
and 24 percent of overweight boys
report being teased by peers at school.
• Adolescents at the heaviest weight are
most likely to be teased because of their
weight.
• Overall, as many as 63 percent of girls
and 58 percent of boys report peer
victimization.
• Being overweight predicts future peer
victimization.
Bias by Educators:
Teachers report that obese students are
perceived as:
• Untidy
• More emotional
• Less likely to succeed at school
• More likely to have family problems
Educational Institutions:
• Obese children are less likely to be
accepted to college, despite equivalent
application rates and academic
achievement.
• Obese students are sometimes dismissed
from college because of their weight.
Weight Bias in Healthcare
In Healthcare Settings
Unfortunately, weight stigma also exists in healthcare
settings. Negative attitudes about overweight
individuals have been reported by physicians,
nurses, dietitians, psychologists and medical
students. Research shows that even healthcare
professionals who specialize in the treatment of
obesity hold negative attitudes.
Bias may have a negative impact on quality of
healthcare for obese individuals. Some studies
have indicated that obese individuals are reluctant
to seek medical care, and may be more likely to
delay important preventative healthcare services and
cancel medical appointments. Weight bias has been
reported as one reason for these negative
experiences.
In a recent study, 46 percent of obese women
reported that small gowns, narrow exam tables and
inappropriately sized medical equipment were
barriers to receiving healthcare. In addition, 35
percent reported embarrassment about being
weighed as a barrier to care.
(source: Amy NK, Aalborg A, Lyons P, & Keranen L. Barriers to routine
gynecological cancer screening for White and African-American obese
women. Int J Obesity & Related Metabolic Disorders. 2006; 30: 147-155.)
Physicians:
Self-report studies show that physicians often view
obese individuals as described below more often
than they do non-obese individuals:
• Non-compliant
• Dishonest
• Lazy
• Lacking in self-control
• Weak-willed
• Unintelligent
• Unsuccessful
Physicians are common sources of stigma. In
a study that surveyed over 2,400 adult women
about their experiences of weight bias, 69
percent of respondents reported that physicians
were a source of weight bias, and 52 percent
reported they had been stigmatized
by a doctor on
multiple occasions.
Doctors were the second
most frequent source of
bias reported, out of
a list of more than 20
possible sources of
weight stigma.
(source: Puhl, R., & Brownell,
K.D. (2006). Confronting and
coping with weight stigma: An
investigation of overweight and obese
individuals. Obesity, 14, 1802-1815.)
Nurses:
Self-report studies show that nurses view obese
individuals as non-compliant, overindulgent,
lazy and unsuccessful.
Studies of self-reported attitudes among nurses
indicate that:
• 31 percent “would prefer not to care for
obese individuals”
• 24 percent agreed that obese individuals
“repulsed them”
• 12 percent “would prefer not to touch
obese individuals”
Psychologists:
In studies comparing beliefs about obese versus
“average” weight individuals, psychologists
ascribe the following attributes to obese clients:
• More pathology
• More severe psychological symptoms
• More negative attributes
• Worse prognosis in treatment
Quality of Care:
Obese individuals are also more likely to have
the following challenges with quality of care:
• Fewer preventive health services and exams
• Less access to cancer screening tests,
such as pelvic exams and mammograms
• More frequent cancellation or delay of
appointments
• Less time spent with the physician, less
intervention and less discussion with the
physician
Consequences of Weight Bias
Taken together, the consequences of being
denied jobs, rejected by peers and treated
inappropriately by healthcare professionals
because of one’s weight can have a serious
and negative impact on quality of life. Obese
individuals suffer terribly from this, both from
direct discrimination and from more subtle
forms of bias that are frequently encountered.
Weight bias can have psychological, social and
physical health consequences on those affected
by this disease.
Psychological outcomes can include:
• Depression
• Anxiety
• Low self-esteem
• Poor body image
The social effects can include:
• Social rejection by peers
• Poor quality of interpersonal relationships
• Potential negative impact on academic
outcomes
The physical health outcomes can include:
• Unhealthy weight control practices
• Binge-eating
• Avoidance of physical activity
What Can Be Done to Eradicate the
Problem of Weight Bias?
Given how acceptable weight stigma is in our
society, transforming societal attitudes and
enacting laws that prohibit discrimination based
on weight are needed in order to eliminate the
problem of stigma toward obese individuals.
Although this requires enormous efforts, there
are other important steps that can be taken by
both individuals and their healthcare providers
to help improve the daily functioning and
well-being of obese individuals.
Individuals as Advocates
Individuals who are struggling with weight
stigma can begin to approach this problem by
becoming advocates for themselves. This
includes identifying situations in which they
have been stigmatized because of their weight
and deciding how best to handle the situation
to achieve positive emotional health and to
help prevent additional stigma from occurring.
Specific strategies for dealing with weight
stigma are highlighted below.
Individual Strategies to Deal with
Weight Stigma
• Educate others about the stigma of obesity
to help challenge negative attitudes.
• Obtain social support from others who are
struggling with weight stigma, or from
friends and family members who are
supportive.
• Instead of avoiding enjoyable activities
because of negative feelings about your
weight, set goals to ease these restrictions
and participate more fully in these experiences.
• Rather than feeling inferior, practice
positive self-talk strategies that emphasize
self-acceptance and positive self-esteem.
• Be vocal about individual needs and
positively assert these to appropriate individuals
(e.g., requesting larger-sized medical
gowns from a healthcare provider).
• Communicate to the perpetrator of bias
that his or her comments were inappropriate
and hurtful, and that nobody deserves
such unkind remarks, regardless of their
weight.
• Talk to a therapist to help identify effective
ways to cope with stigma and to replace
self-defeating thoughts or self-blame with
healthier ways of coping.
It is important to note that there are many different strategies of
coping with weight stigma and some strategies may be more
or less effective with different types of stigmatizing situations.
An Important Role for Healthcare Professionals
Healthcare can easily become a negative and
shaming experience for obese individuals
because of weight stigma. Therefore, healthcare
professionals have an extremely important role to
play in addressing the problem of weight bias.
Encouraging individuals to share their experiences
of stigma and to help them feel less isolated
in these experiences is an important first step.
Clinicians can also help individuals identify ways
to effectively cope with stigma, such as using
positive “self-talk,” obtaining social support from
others and participating in activities that they may
have restricted due to feelings of shame about
their weight.
These tools can help reduce the tendency of obese
individuals to internalize negative stereotypes of
obesity and blame themselves, both of which can
negatively impact emotional well-being.
A second role for healthcare professionals is to
address the issue of weight bias within
themselves, their medical staff and colleagues.
In order to be effective and empathic with obese
individuals, this requires honest self-examination
of one’s own attitudes and weight bias. Education
can help increase awareness among healthcare
professionals about the pervasiveness and
consequences of weight bias and can also
encourage providers to adopt a more accurate
and empathic understanding of
their obese individuals.
Finally, healthcare
professionals can
do a great service
to their obese
individuals by
improving the
physical and social
environment of healthcare
settings. This means
having bathrooms that are
easily negotiated by heavier individuals, sturdy
armless chairs in waiting rooms, offices with
large exam tables, gowns and blood pressure
cuffs in appropriate sizes and reading materials
for individuals that are appropriate and “weightfriendly”
(rather than fashion magazines with thin
supermodels). The following checklist provides
suggested guidelines to improve the healthcare
environment for obese individuals:
Exam Room • Stepstool with handle for exam table access
• Large sized gowns
• Large and extra large adult and thigh
blood pressure cuffs
• Long vaginal specula
• Wide examination tables, bolted to the
floor
• Hydraulic tilt tables, if possible
• Sturdy armless chairs
Waiting Room • Open arm chairs that can support more
than 300 pounds
• Firm sofas that can support more than
300 pounds
• Ensure 6-8 inches of space between
chairs
• Weight-sensitive reading materials
• Doors and hallways accommodating
large size wheelchairs, walkers and
scooters
• Bathrooms with split lavatory seat with
handled urine specimen collector
• Bathrooms with properly mounted grab
bars and floor-mounted toilets
Scale • Wide based scale that measures greater
than 350 pounds
• Meets established accuracy requirements
• Accessible for individuals with disabilities
• Situated in a physical location that offers
privacy and confidentiality
• Wide platform with handles for support
during weighing
Healthcare professionals can also improve their
interpersonal interactions with obese individuals
by being sensitive to situations of embarrassment
for individuals, such as weighing
individuals in a private and sensitive manner,
without judgmental commentary. Asking
individuals for their permission to be weighed
at each visit is an easy and sensitive way to
begin the weighing procedure. Providers can
also help by emphasizing goals of health and
fitness behaviors (rather than only the number
on the scale) and celebrating positive health
behavior changes made by individuals.
Where to Turn for Help
The OAC, a non profit patient-based organization,
offers those affected by obesity many
valuable resources to begin educating
themselves about the disease and the negative
stigma often associated with it, in addition to
advocating for access to safe and effective
treatment. From information about the
emotional, social and physical
effects of all forms of
obesity, to the most
current information
on the disease and
its treatments, the
OAC provides
individuals with
the tools needed
to take a proactive
approach in the
fight against obesity.
The OAC encourages
all those affected by negative
stigma to contact the OAC for more information
on obesity stigma and to share their story
of stigmatization.
For more resources on weight bias, including
educational materials, resources for providers,
research papers, assessment tools and
PowerPoint presentations, please visit the Rudd
Center for Food Policy & Obesity at Yale
University at www.yaleruddcenter.org.
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OAC Resources
The OAC produces well-rounded and comprehensive
education and advocacy materials. All OAC resources
are free-of-charge and may be requested by contacting
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You may also make a request online by visiting our
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Brochures/Guides
• Are you living with Obesity?
• Understanding Obesity Series
- Understanding Obesity Brochure
- Understanding Obesity Poster
- Understanding Morbid Obesity Brochure
- Understanding Childhood Obesity Brochure
- Understanding Childhood Obesity Poster
• Advocacy Primer: Your Voice Makes a Difference
• OAC Insurance Guide: Working with Your
Insurance Provider
• State-Specific Advocacy Guides
• BMI Chart
Newsletters
• Obesity Action Alert - the OAC’s free monthly
electronic newsletter
• OAC News - OAC’s quarterly education and
advocacy newsletter
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Suite 250
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(800) 717-3117
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Fax: (813) 873-7838
www.obesityaction.org
info@obesityaction.org

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