Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
6 Jun

The Stigma of Obesity

In Group, Out GroupOne of the things I love about positive-focused healthy lifestyle communities (like but not limited to MDA) is the genuine support that exists for people to take charge of their well-being. It’s the collective excitement when others transform their bodies and health. It’s the willingness to offer help and advice, personal anecdotes and perspective to those beginning their journeys or struggling with the process. In the bigger framework of society, and even occasionally in these positive communities, however, weight-related stigma still holds sway. In these more subtle demonstrations, it becomes a sort of “if you’d only do X” assumption, a looking down one’s nose at someone else’s grocery cart or an unconscious judging that faintly influences impressions and interactions.

We live, of course, in a culture, obsessed by body image and weight. Celebrities are skewered on the covers of magazines for gaining (or losing) weight. Advertisements for diet products, often designed with questionable taste, are at every street corner and commercial break. For weekly entertainment, we watch obese people battle their weight on T.V., ominous music and trainers screaming in the background. Within this swirl of society jokes, cultural judgment, and media images, the obesity/overweight stigma is ubiquitous. Far beyond the intention to help, the function becomes to exploit. Outside any interest in being supportive, the focus becomes voyeuristic and, at times, self-congratulatory.

Some say the obesity/overweight stigma is the last allowable prejudice. Although I think there’s enough animosity and judgmentalism in the world to debate the statement itself, I understand the central point. Researchers have time and again measured the “anti-fat bias” (effects ranging from outright discrimination to unconscious stereotyping) at work in everything from employment to health care. Obesity/overweight stigma figures into the collective consciousness far more than we often give it credit for – lurking in places and people we’d assume would be immune to its effects.

Physicians themselves, numerous studies show, demonstrate a significant anti-fat bias. Just a few weeks ago, a published study reported 40% of medical students demonstrated an unconscious weight bias. Research has illuminated anti-fat bias in therapists and even health professionals within obesity related specialties.

With all this, research shows primary physicians are offering less weight loss counseling to their patients – particularly those with high blood pressure or diabetes. Karen Hitchcock, a physician who works in an obesity clinic with a bariatric surgeon’s group, offers a candid and surprisingly personal glimpse at the discomfort of a physician who struggles with counseling her patients: “The emotion in the room thickens; I am acutely aware of the shame my patients feel.” As critical as the need is for honest consultation, her perspective is hard to dismiss.

Finally, the kicker. Research shows that the social bias remains even after people lose weight – and can be as strong against those who were obese and lost their excess weight as as it for people who are currently obese. As someone in the health and weight loss business, this is the hardest to hear. I can’t quite imagine what it’s like for a person who actually experiences that bias.

I think it’s clear I believe in people taking personal responsibility for their health and well-being. That said, I also understand the reasons for obesity are varied and complicated. Genetics do play a role, and for some people it simply takes more effort. Thyroid, other hormonal issues, and even toxin exposure can throw a wrench in the best weight management endeavors. On a cultural level, too many people have little access to fresh food and even fewer to real nutrition education. Too many grow up with the unchallenged influence of incessant junk food marketing and perhaps poor familial modeling at home and school. As Karen Hitchcock suggests, “We live in a society that judges people for being fat, yet has in place every possible means for making them so.”

Physiology is physiology. The biological facts behind obesity are constant, yes. The personal picture of one’s weight – not to mention each person’s experience of it – however, is much more complex than any stereotype or momentary judgment can begin to tell.

When we simplify other people’s stories, I think the person we end up diminishing is ourselves. My mother used to constantly say “Worry about yourself.” Sure, it was generally in response to sibling quarrels or school yard gossip, but it gained dimension as I grew older. To this day, it’s one of the most abiding pieces of wisdom I’ve ever come across. It doesn’t mean of course, don’t appreciate other people or help where and when you can. After all, life is about connection. Happiness and health are about connection. That said, we miss the point when we bring a self-grandiosity or condescension to that engagement. We do better when our support for others comes from a place of personal humility.

If we’ve been successful in losing or managing our weight, that’s a great accomplishment. If we’re working on it, we’re worthy of respect and genuine support in our efforts. If we’re not to that point yet, we’re still worthy of the same respect. It’s been my observation people are more inclined to invest in themselves – and believe in the support of others – when they believe in their own worthiness. When we choose to question the obesity stigma, whether we’ve ever personally fit that category or not, we value – for ourselves and others – living as healthy but also “whole” people. That’s, to me, the best endeavor for thriving.

Thanks for reading today, everyone. I hope you’ll share your thoughts and comments on the obesity/overweight stigma. Have a great end to the week.

You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. As always from MDA, this article is superb. How Mark hits all these important angles, I have no idea, but I thank God for this website.

    I’m the guy who has been fat and thin his entire life. I’ve lost and regained over 200 pounds during my 42 years and I am so tired of it all. I’m 5’11” and weighed 286 pounds this morning. I suffer from it all: Low T, high blood pressure, lethargy, headaches, joint and muscle pain…I was at 250 last summer, losing weight, eating primal, and doing Crossfit. I just can’t stay with it because I suppose I no longer care. I’m done. I’m invisible to most of society now that I’m really fat again. People just look right through me or avert their glances quickly.

    Thin people do not understand. You can be the thinnest person in the world, even downright skinny, and there is a preconceived notion that a thin person is fit, which is totally wrong. When I am in the gym, I often outperform people much less obese than me. I know two physical education coaches who are in wonderful condition. During our lunches together, they talk and make fun of fat people incessantly. It’s all they talk about. It’s so elitist and judgmental that it has made me less likely to want to exercise or eat primal. They’ve even covertly snapped pictures of fat people in the gym and laughed about it while sharing them with one another, and these coaches are both adults. It doesn’t matter that the fat person is in the gym trying to improve. It doesn’t matter that the fat person has totally changed their diet. All that matters is that they’re fat.

    It’s astonishing how much differently I’m treated when I’m thin. A few years ago, I lost a lot of weight, hit the weight pile and gained some lean muscle mass, and had more attention from the ladies than I’d ever had in my life. My male friends all wanted to “know my secret.” There was no secret. I worked my ass off in the gym and swore off junk food and empty carbs. I resented the ladies who wouldn’t give me the time of day when I was fat and I resented my male friends who just the year before would call me “big boy” or “big fella” during conversations. Light-hearted fun, I know, but I didn’t need to be reminded that I was a porker. I already knew.

    C.C. Deville, the famous guitar player from Poison said it best, “When I was in Poison [80’s], I was a cocaine addict. When I left Poison [90’s], I quit cocaine and got fat. It was more socially acceptable for me to be a junkie than be fat.”

    C.C. Deville gets it.

    jbourneidentity wrote on June 16th, 2013
  2. This was a great post. As someone who is on her way down from 250lbs, I get people who congratulate me, but still roll their eyes when I take the bun off of my burger, or who just down right tell me I look sickly (at 5’3 and 180lbs, I don’t think so) to deter me from doing whatever crazy diet they think I’m doing. It’s frustrating, because I feel like I’ll never really shake the obesity stigma. My family and close friends and amazingly supportive, it’s the aunts and uncles and people who didn’t watch the transformation over time (I just showed up weighing 60 pounds less one day) who are the least supportive.

    I’ve also gone to the doctor for anything, you name it, and 9 times out of 10, they tell me to lose weight. To be fair, when I lose the weight, my aches and pains did get better, but how frustrating is it to hear a doctor’s condescending attitude when all you want is medical help. In the end, after years of complications, I finally ASKED to be tested for Celiac’s. I was literally told to put the fork down by one doctor.

    Anna wrote on June 16th, 2013
  3. These are all great comments. I am so glad America is finally talking about obesity from a place of compassion and understanding…. although we have a long way to go.

    To help bring attention to obesity stigma (and demonstrate how it is actually counterproductive to healthy eating behaviors), I thought I would share an article that would be of interest.

    Dr. Rebecca Puhl conducted a study on the subject and published her findings in the Hastings Center Report in an article entitled, “Obesity Stigma: A Failed and Ethically Dubious Strategy.” Here is a link to an article that summarizes her findings: .

    Shaming people to lose weight doesn’t work..plain and simple.

    Bethany_DugDug wrote on November 25th, 2013
  4. I was lean growing up. I didn’t get fat (and I got very fat, very fast) until my early 20’s. Seeing the difference in how people treat you is so profound there aren’t even sufficient words for it. Really this is something that you’d have to BE really fat to probably see. And since I didn’t grow up that way, I didn’t expect it; I was constantly confused, not understanding, and then eventually realizing what was going on with people’s behavior.

    Ironically, my family suffers a genetically inherited, currently incurable disorder called lipedema. (A few spellings on that.) ‘Inflammation cascade’ can create a lot of fat fast and it stores in the hips to ankles (and upper arms) and never-but-never goes away. Not by diet, not by exercise, not by anorexic starvation till organs fail, not by gastric bypass surgery, nothing budges the fat which just accumulates until eventually a person is pretty well immobilized. (For ‘tiny’ stage-1 amounts, liposuction can help a bit, though it’s controversial whether it returns.) I guess at that point a bullet is the only solution.

    By stats, 11% of women in USA have lipedema. Given its diagnoses is from symptoms based on observing the fat and its behavior, let’s say that if we take that % into the number of actually overweight women we get literally 40% of overweight women are probably lipedemic. That means cutting out their guts will not solve that, it means all the diet food in the world — or even paleo — won’t solve it. (Paleo will however make them feel better in the meantime and probably reduce some water/inflammation bloat.) Not like there’s much research on that because really now we’re competing with a huge entrenched combination of industries related to being fat.

    So what, I wear a sign? “I’m not a gluttonous pig, it’s a mystery incurable genetically inherited disease?” Please. Nobody cares. Fat is just the “icon” at this point that a whole society is delighted to pour their sneering opinions into. As if people who need to lose bikini weight are really dealing with the same metabolic issues as someone who is 300# overweight. As if really fat people would all be skinny if they would just quit eating bon-bons all day for godssakes.

    Dr. Sharma’s blog over time has had a number of articles explaining how even when someone loses weight, the body can compensate a shocking number of parameters to bring it back.

    I suspect that maybe our bodies think that whatever our high weight was, that was ‘fully grown,’ and anything less is something we must have lost through illness that needs recovering.

    Anyway. The bias against obesity, believe me on this, is pretty horrifying.

    I once told my cousin, who is half black, that I didn’t really see the bias he talked about, at least most of the time. He laughed and told me that nobody who isn’t black has any clue what it’s really like living it. I suspect the same goes for obesity, especially extreme obesity.

    PJ (RightNOW) wrote on June 2nd, 2014
  5. in 2008 I was in a farming accident and had a traumatic brain injury w pituitary trauma and went from 225 to 300. Now w meds down to 195. I was totally crushed by how I was treated and still am by friends. As a fat person I was treated like crap. Like I wasnt trying although I didnt and still cant eat anything. Id watch skinny ppl eat like hogs and never gain.
    Ive learned compassion for the broken and made me a better person I think.

    steve wrote on June 3rd, 2014
  6. In addition to the factors behind obesity that Sir Grok-Sisson mentions (yes, I had him knighted here in my personal kitchen kingdom),
    I’d like to add some psychosocial aspects.

    Basically, if i makes sense to you that an experience would make weight management difficult, odds are that you’re right. In this one study, and I encourage you to look for more, 69% of patients self-reported childhood maltreatment.

    Children die from lack of attachment and emotional nourishment. It happens in orphanages, and it happens in families. Other children survive socially and emotionally paltry environments through self-medication, such as over-eating. This creates a behavioral pattern, and a wariness of other people, that takes a lot of time and effort to change on a neuronal level.

    A lot of the obese people I meet are survivors of trauma of the drawn-out, horrific kind. I have come to view them as heroes. It is odd to me that a country that salutes its soldiers for participating in wars overseas, have so much scorn for the soldiers of childhood battle on home soil. Oftentimes, obesity is but the price a person had to pay for survival, and a heavy medal to bear for absorbing much violence and not paying it forward. In my mind, they should be saluted and supported, not isolated further.

    Obesity is lethal. I see it as a neuronal knot that takes a lot of love to untie.


    a soon-to-be licensed psychologist (yay!)


    Hanna wrote on June 4th, 2014
  7. I’m 44 and fat. Really fat. I weigh 280 pounds and I’m only 5’11”. Last year, my 38 year old wife was diagnosed with pancreatic cancer. We were blessed to be able to seek treatment at MD Anderson in Houston. Long sedentary hours there and eating in restaurants took their toll on me. I ballooned up to an unbelievable size. While my beautiful wife won her battle with her pancreatic tumor, I’ve lost my life-long battle with my weight.

    I have low T, high blood pressure, and extremely high estrogen. My very experienced endocrinologist called me an “anamoly.” Frankly, he doesn’t know what to do with me. My waistline has expanded from 36″ to 44″ and I’m now wearing 3XL shirts. I don’t recognize myself in the mirror. I know if I don’t lose weight, I’m dead in 10 years. There’s a part of me that doesn’t care. Low T has robbed me of good moods and vitality. Blood pressure meds have ruined by sex life and energy levels. How can you work out when you have no energy? I started eating Primal about 22 days ago and began Crossfit last week. It’s a minute to minute struggle. I’m a complete carb addict and I’ve been fat and thin all my life. I’ve lost and regained over 150 pounds in my 44 years.

    I’ll echo what has already been said, “When I’m thin, people flock to me. When I’m fat, no one notices me.” Truer words have never been said. I’ve watched women cast an interested glance in my direction while seating in my pickup, but when I exit the pickup, their eyes avert downward quickly and they flee as fast as possible. I’m happily married, so that isn’t important to me, but it’s the motivation behind the action that bothers me. I’m still a human being and for people who’ve never been fat, the pain is indescribable. I am in a constant state of embarrassment. I teach at a large college and sometimes, when my friends and co-workers talk to me, they say, “How are you, big ‘un?” or “What’s up, big man?” Really? Thanks for letting me know I’m fat. I had no idea until you told me.

    CC Deville, guitarist for the famous rock band Poison, put on weight after the band broke up in the mid-1990s. He said that it was more acceptable to be a junkie in LA than it was to be fat.

    Pray for me as I continue on this Primal journey and thanks for listening.

    chris wrote on June 4th, 2014

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