Weight stigma — or any of its synonyms: weight bias, weight discrimination, fat phobia, fat shaming, sizeism — are all the same thing.

Weight stigma impacts us all, but impacts people in larger bodies the most.
Weight stigma is so pervasive that it can almost feel invisible. And for those in smaller bodies, it IS invisible. But for people in fat bodies, weight stigma is something they have to face every single day.
weight stigma
We are a culture that equates “fat” with ill health, and judge a person’s character, personality, work ethic and lifestyle based on size alone.
How often do we hear fat people described as unintelligent, lazy or sloppy?
This perception actively harms a person’s health. This is why we need to be taking weight stigma seriously, and why those of us within the medical community need to be making changes about how we treat fat patients.
This week is Weight Stigma Awareness Week, sponsored by the National Eating Disorder Association (NEDA). Did you know that:

  1. Individuals who experience weight bias are at increased risk of eating disorder symptoms and engage more frequently in extreme weight control behaviors and subsequent binge eating.
  2. Victims of weight bias often report family members and physicians as the worst offenders.
  3. Studies show that health care professionals often provide individuals in large bodies with less health information and spend LESS time with them.
  4. Individuals in higher weight bodies often have eating disorders go unrecognized due to commonly held misperceptions of what an eating disorder “looks like.”

In summary, weight stigma causes those in larger bodies to avoid routine preventative care and when they do seek health services, they may receive compromised care.
Here is an article I wrote earlier this year about one of my clients’ experiences and it speaks to some of these assumptions. You can click here to read the article, A Story about the Fear of Fat for One Family on my website.

I want to take a moment and share some powerful words about weight stigma from real people who have experienced weight stigma themselves.

According to Ragen Chastain, an ambassador for the National Eating Disorder Association, and a large-bodied athlete (she identifies ‘fat’ as a neutral descriptor of her body size):

In the eating disorders community, we often hear the phrase “Not every diet leads to an eating disorder, but every eating disorder starts with a diet.” That’s true, but if we really want to prevent eating disorders and allow for full recovery, we can’t stop there. We have to ask ourselves the next logical question: Where do the diets come from?

And the answer to that question is clear—it’s weight stigma. Diets happen because people believe that a thinner body will be, in some way, a better body—more attractive, more desirable, healthier… better. Those beliefs aren’t just in people’s heads. They are created by a society that is rife with weight stigma.” (1)

According to Kimmie Singh, MS, RD, a registered dietitian and fat activist:

“Reducing weight stigma requires that you ask yourself difficult questions. Are you scared of being fat?? This fear of having a fat body wasn’t created in a vacuum. It was planted as a seed and nourished by messages you’ve internalized about health, beauty, and body diversity. Do you think this doesn’t affect the way you interact with fat people? Think again. We can tell when you aren’t comfortable in close proximity to fat bodies. In addition to doing the work by examining your privilege, this means exploring your own fear of having a fat body.” (2)

Similarly, weight stigma influences those in small bodies too.
Weight gain is essential for individuals recovering from anorexia nervosa and restrictive eating disorders. Fear of this weight gain can prevent full recovery. Many patients, families, health care practitioners and even eating disorder treatment centers set weight gain goals that are insufficient for full recovery.
In the words of Harriet Brown, a mother helping her daughter recover from anorexia nervosa:

My daughter’s recovery work required us to not just question the cultural norms around weight but to flip them. Sometimes the results were funny, like the looks we got one night in a grocery store as we searched for the highest-calorie ice cream when everyone else was looking for the low-cal brands. Sometimes they were not so funny, like the day I was clothes shopping with my daughter in tow. As I stood in front of a mirror considering an outfit, the salesclerk said to my daughter, “You’re lucky—you got the thin genes in the family!” I severed friendships with people who couldn’t or wouldn’t stop commenting snidely on weight in my presence. Even after I asked them not to, reminding them that the pursuit of thinness had nearly killed my daughter.” (3) 

Weight stigma can be seen in the total lack of accommodations for people in large bodies.
weight stigma
Have you noticed that there are none or very few chairs without arms in waiting rooms of doctor’s offices, emergency rooms, schools, restaurants?
How about having medical equipment that can accommodate all sizes with blood pressure cuffs that fit properly, gowns that are roomy enough for all bodies, medical devices that can accommodate ALL size bodies?
One of the best ways to manage weight bias is to first acknowledge that it exists. The next step is to examine your own internalized weight bias.
The Health at Every Size ® movement encourages acceptance of the natural diversity of bodies. If we accept that all bodies are deserving of kind and compassionate care, the world would indeed be a better place.

To learn more about Health at Every Size and weight stigma, you can register for one of two self-study programs I offer. They will get you on the road to Make Peace with Your Body and Food.
Intuitive Eating Essentials for Midlife, Menopause and Beyond: This is a self-paced program that explores your relationship with food, your dieting history, readiness to integrate intuitive eating into your life, and teaches you how to use your values to make peace with food. Click here for all the details!
Nutritional Guidance: This course helps you free yourself from food rules that keep you stuck in unhealthy patterns of eating and embrace intuitive eating. Click here to learn more. (Fee: $19)