In a recent comment piece in Nature Reviews Endocrinology, Professor Rachel Batterham highlights the indisputable evidence of the detrimental impact of weight-stigma on health and calls for action to eradicate weight stigma. This post summarises the piece and links to the full article.
Current scientific understanding
“Obesity is a highly prevalent, complex medical condition, characterised by excess body adiposity that impairs health and leads to premature mortality.”
Key empirical findings:
- The drivers of weight gain are complex.
- The human body is hard-wired to resist weight loss.
Popular misconceptions, weight stigma and discrimination
Despite advances in scientific understanding of obesity, it is still commonly held that:
- A person’s body weight is purely within their control.
- Obesity is a choice that can be easily reversed by eating less and exercising more.
These unfounded beliefs underpin and perpetuate negative stereotypes of people with larger bodies as lazy, gluttonous and lacking in willpower and intelligence, thus driving weight stigma and discrimination.
The impact of weight stigma on health
“There is now indisputable evidence that weight stigma has a detrimental impact on health.”
Research has shown that weight stigma has a negative impact on health behaviours, physiological biomarkers and psychological wellbeing:
- Weight stigma is associated with disordered eating, sleep disturbance and exercise avoidance.
- Exposure to weight stigma leads to increased cortisol levels and increased energy intake, through energy dense foods.
- Individuals with overweight and obesity who experience weight-based discrimination have higher circulating levels of C-reactive protein and greater likelihood of adverse systemic health conditions such as type 2 diabetes mellitus and metabolic syndrome compared to those who do not.
- Weight stigma increases the risk of mental ill-health.
Most concerningly, a 58% increase in all-cause mortality (meaning deaths) in people with overweight and obesity who experience weight-based discrimination compared with those who do not.
Weight bias amongst health care professionals
Over a decade of research has shown that healthcare professionals are some of the most common perpetrators of weight stigma and weight-based discrimination is commonly experienced in health settings. Experiences include experiencing lack of respect, insulting and judgemental comments, suboptimal treatment, unsuitable medical equipment, ‘therapeutic inertia’ (the failure of a healthcare provider to intensify therapy when therapeutic goals are not reached), over attribution of medical symptoms to a patients’ weight and poorer treatment outcomes.
Ending weight stigma in healthcare settings
Formal recommendations were made in 2020 to healthcare institutions for ending weight-based stigma which include incorporating formal teaching on causes, mechanisms and treatments of obesity into standard curricula for all HCPs, the accreditation by professional bodies of training in stigma-free practice for HCPS, and the provision of appropriate weight-inclusive infrastructure and equipment. However, despite the evidence of the existence of weight stigma in health settings and the harm it causes, these recommendations are not being implemented.
How then to eradicate weight-based stigma and discrimination in health settings?
Action must be taken
Professor Batterham argues that weight-stigma is everyone’s responsibility in healthcare, “weight stigma is a social justice issue that needs to be acknowledged not only by the recipient but also by witnesses, otherwise they become complicit bystanders.”
“Is the solution to adopt a policy of zero tolerance to weight stigma?”
Pointing out that, “To continue to ignore the evidence and do nothing is unethical. Action must be taken to eradicate weight stigma from all healthcare settings.”
Professor Rachel Batterham is Head of the Centre for Obesity Research, Department of Medicine, University College London and Special Advisor on Obesity to the Royal College of Physicians. Professor Batterham is one of the founding members, and Chair, of Obesity Empowerment Network UK.
OEN UK is committed to ending weight stigma and eliminating health inequalities.