Does Weight Bias Promote Obesity?

There is now an overwhelming body of literature that documents the substantial bias and discrimination that overweight and obese people face in all important domains of living, including employment, health care and education. The well-documented negative portrayal of overweight and obese people in the media as lazy, poor-willed, over-indulgent does much to reinforce and promote this bias.

I have previously suggested, that perhaps even well-meant public health messaging, promotes simplistic (and therefore?) ineffective solutions (diet and exercise), may well reinforce the prevailing public notion that obesity is simply the self-inflicted consequence of eating too much and not moving enough.

Why is weight bias important?

From my own daily interactions with health professionals and decision makers it is often blatantly evident that weight bias is a root cause of the health system’s failure to take responsibility for and ensure equitable access to evidence-based obesity treatments.

Additionally, however, as discussed in a comprehensive review of this topic published in last month’s issue of OBESITY, Rebecca Puhl and Chelsea Heuer from Yale University’s Rudd Centre for Food Policy and Obesity (New Haven, CT, USA), point out that weight bias may have a direct negative impact on the psychological and physical health of people challenged by overweight and obesity.

As stated in their article:

“The emerging data thus far suggests that weight bias increases vulnerability to depression, low self-esteem, poor body-image, maladaptive eating behaviours and exercise avoidance.

These negative consequences challenge societal notions that stigma may serve a positive function of motivating healthy eating behaviours, and instead suggest that bias may impair efforts to engage in healthy lifestyle behaviours through negative emotional distress and unhealthy eating patterns.”

Thus, in the prevailing climate of weight-bias and stigmatization, I fear that well-meant public health efforts to promote healthy active living are likely to remain ineffective in helping people with excess weight achieve weight control.

In fact, in my own practice, I am all too keenly aware of the frustration, distress, anger, despair, and devastating sense of hopelessness that patients often report every time they encounter simplistic and naïve (and as we now know entirely ineffective and futile) suggestions to simply eat less and move more.

Unfortunately, as also pointed out in the article by Puhl and Heuer, there is virtually no research on strategies to reduce weight bias:

“Of the few studies that exist, weight bias appears to be a challenging stigma to reverse, and may be resistant to interventions that have successfully improved attitudes towards other stigmatized groups. It is likely that multiple stigma-reduction strategies will be needed to shift negative societal attitudes about obese persons.”

“This may require education about the complex causes of obesity and the harmful consequences of stigma, recognition of the difficulties of obtaining significant sustainable weight loss, efforts to challenge weight-based stereotypes, promotion of weight tolerance in multiple settings where bias is present, and legislation to prohibit inequities based on body weight”.

I fully concur with the authors’ conclusion that without sufficient attention to this issue, weight bias will remain both a social injustice and a public health issue, negatively affecting the lives of both present and future generations of people struggling with excess weight.

Edmonton, Alberta