Sizeism Is Harming Too Many of Us: Fat Shaming Must Stop

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We all know that being overweight can carry a stigma that results in demoralizing feelings of shame. All too often, onlookers judge or bully someone with a higher BMI as being stereotypically lazy, gluttonous, or lacking willpower simply based on his or her size. For example, a 2014 survey of weight bias and anti-fat attitudes reported that 85 percent of adolescents had observed overweight classmates being fat-shamed or teased in gym class.

Medical fat-shaming

Surprisingly, new research suggests that fat-shaming and sizeism (discriminating against someone based on his or her size) are also commonplace occurrences in doctor’s offices. Medical fat-shaming—in an attempt to motivate patients to change obesogenic behaviors—is clinically proven to be mentally and physically harmful.

The good news is that a review of recent research addressing this topic, “Weapons of Mass Distraction—Confronting Sizeism,” was presented in a symposium today, August 3, at the 125th Annual Convention of the American Psychological Association in Washington, D.C. (Aug. 3-6, 2017). Also, there is a growing trend among educators to curb weight bias amongst health care practitioners and medical students.

"Disrespectful treatment and medical fat shaming, in an attempt to motivate people to change their behavior, is stressful and can cause patients to delay health care seeking or avoid interacting with providers," presenter Joan Chrisler, professor of psychology at Connecticut College, said in a statement prior to the APA symposium.

Chrisler added, "Implicit attitudes might be experienced by patients as microaggressions—for example, a provider's apparent reluctance to touch a fat patient, or a headshake, wince or 'tsk' while noting the patient's weight in the chart. Microaggressions are stressful over time and can contribute to the felt experience of stigmatization."

The weight-centric model of health

Maureen McHugh, professor of psychology at the Indiana University of Pennsylvania, co-presented this research on fat-shaming and sizeism at the APA symposium. She believes that a strictly medicalized view of someone's weight can overemphasize 'fatness as a disease' and 'weight loss as a cure.' McHugh said, "A weight-centric model of health assumes that weight is within an individual's control, equates higher weight with poor health habits, and believes weight loss will result in improved health."

The researchers drive home the point that there isn't specific empirical evidence that can clinically prove exactly how much weight is too much for any given person. "Other predictors of illness, such as genetics, diet, stress, and poverty, also play a role, yet being fat often leads to the assumption that a person is unhealthy," Chrisler stated.

Stigmatization increases health risks

The bottom line is that fat-shaming is not an effective approach to reducing obesity or improving someone's health. McHugh concluded, "Rather, stigmatization of obese individuals poses serious risks to their psychological health. Research demonstrates that weight stigma leads to psychological stress, which can lead to poor physical and psychological health outcomes for obese people."

Addressing weight stigma

Chrisler and McHugh posit that it's imperative for weight stigma to be addressed in psychology and medical training, theory, and research. When working with patients, prescriptive interventions should focus on overall psychological and physical well-being (not just weight loss) as the ultimate desired outcome.

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In the past few decades, skyrocketing rates of obesity have created a public health conundrum. Despite a massive push to reduce obesogenic behaviors by putting the obesity epidemic in the spotlight, statistics show that the general population continues to gain weight at an unprecedented pace; i.e., over the past two decades, the percentage of Americans who are classified as "obese" has gone from about 15 percent in the late 1990s to roughly 37 percent in 2016. Clearly, whatever health care practitioners are doing to curb obesity, isn't working. Most experts agree: It's time for a fresh start and readjustment of our weight-loss mindsets, which includes putting an end to medical fat shaming.

As part of the growing trend to address doctors' conscious and subconscious weight bias, there is a pilot program amongst osteopathic educators geared towards shifting the mindset of medical students’ negative attitudes toward people with obesity. This educational initiative at Touro University began in 2012 and is currently being featured in the August 2017 issue of The Journal of the American Osteopathic Association.

The Touro curriculum begins by measuring each medical student's attitudes on the Fat Phobia Scale, which is designed to improve self-awareness of stereotypical weight bias, such as perceiving obese or fat people as being "lazy," "self-indulgent," or having "poor self-control." Then, students are educated on the wide range of causes and treatments for obesity. Follow-up testing on their knowledge and attitudes toward obesity are subsequently conducted during each year of medical school.

Touro University's four-year obesity education curriculum focuses on the complexities of obesity: Diet and exercise are viewed as just two contributing factors to the multi-faceted obesity epidemic. As another example of obesity's psychosocial complexity, a recent Duke University study reported that on days when at-risk adolescents were exposed to violence (either at home, school or in the neighborhood) they displayed significantly higher same-day obesogenic behaviors. These findings were published online on July 31 in the journal Social Science & Medicine.

In a statement, Michael Clearfield, Dean of Touro University's College of Osteopathic Medicine, said, "It's not unlike the way we treated depression 40 years ago. Only, instead of telling people to 'get over it,' we say, 'just eat right and exercise.' We know there are economic, cultural, political, and environmental elements causing this problem, yet our approach to treatment puts sole responsibility on the patient's behavior."

Clearfield is optimistic that proactively confronting physicians' weight biases can change the dynamics between doctors and patients. Based on the promising results of the four-year study, Touro University plans to expand its weight bias curriculum to an online platform. And make it available to other medical schools and residency programs. Future research will also explore the impact of shifting physicians' attitudes about obesity and patient outcomes. Stay tuned.