First things first: a person's size and weight is not an accurate indicator of an individual's health.
Have you seen posts on your social media accounts about gaining weight during isolation or during a holiday? Have your felt that your health care provider doesn't take your health concerns seriously or you've been ignored as a result of your body size or shape? These are common examples of weight bias or weight stigma.
Before we dive further into weight bias, let's talk about weight regulation. There is a belief that weight loss is as simple as calories in = calories out, which in a sense it is. However, the idea that our weight is only influenced by what we eat (calories in) and our physical activity (calories out) is oversimplified. Many other factors influence weight such as genetics, stress, hormones, environment, geographic location, sleep, history of dieting and restriction, medical conditions, medications and so on. Additionally, when our body senses weight loss, we have physiological processes to stop weight loss. So, the idea that a person's weight is entirely due to their lifestyle, their behaviours or their choices, that a person is lazy or constantly eating does not fit with the complexity of our bodies and experiences.
A second false belief is that you can determine someone's health based on their weight. In fact, you cannot determine a person's health by the size, weight or shape of their body. There are many pictures one social media with a small body and large body side-by-side comparing their health; saying the large body is unhealthy and the small body is healthy. The person in the small body could be healthy, yes, but they could also have cancer, diabetes, depression, suicidal thoughts, a genetic disorder, an eating disorder or any number of health concerns. The person in the large body could have any of those health concerns as well or they may have NO health concerns at all. We are unable to determine an individual's health concerns from the size, shape or weight of a person's body.
Now let's talk about weight bias and stigma a little more. Weight bias is the negative attitudes towards and beliefs about a person based on the size, shape or weight of their body1,2. Weight bias can occur internally (labelling or stereotyping of ourselves) or externally (from others or society at large). Weight stigma is the stereotyping, actions and discrimination towards individuals that often results from weight bias.
Healthcare may be a place people experience weight stigma. Why does this matter?
Stigma can lead to worse health outcomes by putting additional stress on our bodies which can increase our risk of chronic diseases (cardiovascular disease, eating disorders, anxiety, depression). This increased risk is independent of an individual's weight and therefore is not caused by weight but rather the bias they experience.
Weight stigma prevents people from seeking care. This is likely because a person is not feeling their concerns are heard or their weight is often blamed for those health concerns.
Weight bias results in reduced quality of care, often related to reduced quality of communication, health education, different treatment plans and less time spent with those patients.The health community is starting to recognize the harm that weight stigma and bias is having on their patients, clients and residents. You may not be in healthcare, but you can help to reduce weight bias and stigma. You've already made a step by reading this. Here are a few other steps you can take:
Compliment your friends and family on something other than their appearance. "I appreciate your kindness/honesty/drive" or "I enjoy spending time with you" instead of "you look so good!"
While we are at it, stop commenting on anyone's body, not just friends and family. Even if you have the best intentions, are concerned for their health, or complimenting them. Avoid comments such as: "You look so great! Are you losing weight?" or "Have you thought about losing weight to get healthier?"
If you feel ready to learn more about the impact of weight bias on health and reflect on your own bias, here are a few resources to check out:
Anti-diet by Christy Harrison
Body Respect by Linda Bacon and Lucy Aphramor
Health at Every Size by Linda Bacon
Her Body Can by Katie Crenshaw and Ady Meschke (Children's book)
Association for Size Diversity and Health https://www.sizediversityandhealth.org/
Obesity Canada https://obesitycanada.ca/
Implicit Association Test https://implicit.harvard.edu/implicit/takeatest.html. This site has multiple tests with one relating to weight.
Practice Based Evidence in Nutrition (2020). Weight Stigma Backgrounder.
Obesity Canada. Weight Bias. https://obesitycanada.ca/weight-bias/
Obesity Canada. Understanding Obesity. https://obesitycanada.ca/understanding-obesity/
Phelan SM et, al. Impact of weight bias and stigma on quality of care outcomes for patients with obesity. Obes Rev. 2015 Apr; 16(4): 319-326 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4381543/
Rathbone JA et, al. When stigma is the norm: How weight and social norms influence the healthcare we receive. L App Soc Psych. 2020 Jun. https://onlinelibrary.wiley.com/doi/abs/10.1111/jasp.12689