Obesity prejudice is alive and well.
Obesity is often said to be the last acceptable form of social prejudice and most people with weight problems have experienced “fat prejudice” of one form or another. However, their complaints are often dismissed as exaggerated or unreliable and there is a general attitude that their weight problems are self-inflicted.
But it isn’t just that being overweight attracts negative comments; being obese has important societal effects well beyond unpleasant comments. Obese individuals not only have to endure stigma but also tend to avoid healthcare services such as check-ups and screening programmes.
Two recently published studies compared the experiences of overweight or obese adults in Australia, Canada, France, Germany, the UK and the US. The aim of this research was (1) to establish the frequency of weight stigma in different countries and (2) to see how this stigma affected the individual’s willingness to participate in healthcare services. These studies involved almost 14,000 adults, all of whom were involved in an internationally available weight-management programme (Weight-Watchers). All subjects completed an online assessment which assessed their own experience of weight prejudice (including from health professionals) and their utilisation of other health services. The key findings were:
- At least half (56-61%) of people in each country reported they had experienced weight stigma.
- High percentages of participants in each country experienced weight stigma from family members (76%-88%), classmates (72%-81%), doctors (63%-74%), co-workers (54%-62%), and friends (49%-66%).
- In all countries, weight stigma experiences were most frequent in childhood and adolescence, with associated anxiety and distress highest during these time periods.
- Across all six countries, those with higher levels of self-blame for their weight were more likely to avoid healthcare professionals, obtained less frequent check-ups, and perceived their healthcare quality to be lower.
These findings are stark and worrying, especially when one might think that family and friends would be the least likely to exhibit weight prejudice! The finding that doctors also show a high prevalence of negative attitudes towards overweight or obese patients is not surprising. It has been shown in numerous studies and is a shameful reflection on the profession.
It is also worrying that this highly damaging form of prejudice starts in childhood, persists throughout life and has extremely negative long-term consequences.
Despite a widespread belief to the contrary, obesity is not simply a self-inflicted problem caused by over-eating and a sedentary lifestyle. It is an extraordinarily complex problem of energy balance and appetite regulation, with prominent genetic, environmental, behavioural and cultural factors involved. Obesity has serious health and psychological consequences in its own right – without adding layers of entirely unjustified prejudice for the overweight to deal with.
Those with chronic weight problems need our help and understanding, not intolerance born of ignorance.