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The Stigma of Obesity

Posted By Mark Sisson On June 6, 2013 @ 8:00 am In Weight Loss | 195 Comments

One 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 [7]. It’s the willingness to offer help and advice [8], personal anecdotes [9] and perspective to those beginning their journeys [10] or struggling with the process [11]. 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 [12] 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 [13] reported 40% of medical students demonstrated an unconscious weight bias. Research has illuminated anti-fat bias in therapists [14] and even health professionals within obesity related specialties [15].

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 [16] 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 [17] 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.


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[12] measured: http://onlinelibrary.wiley.com/doi/10.1038/oby.2008.636/full

[13] study: http://journals.lww.com/academicmedicine/Abstract/publishahead/Are_Medical_Students_Aware_of_Their_Anti_obesity.99382.aspx%5C

[14] anti-fat bias in therapists: http://www.apa.org/monitor/jan04/weighing.aspx

[15] health professionals within obesity related specialties: http://onlinelibrary.wiley.com/doi/10.1038/oby.2003.142/abstract

[16] offers: http://www.themonthly.com.au/issue/2013/march/1361848247/karen-hitchcock/fat-city

[17] shows: http://www.ncbi.nlm.nih.gov/pubmed/22395810

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