Weight Bias & Stigma
Have you ever noticed whenever there is media coverage on the topic of obesity, they always show obese people from the neck down? They also show obese people just milling around, sitting down (implying their sedentary lifestyle) or even just eating? I often wonder, do these people know they are being filmed? And that their image (at least below neck level) is shown to portray the issue of the increasing obesity “crisis” (their term not mine!). This is fat shaming, also known as weight bias and stigma. Something, not only the media is guilty of doing.
However, slim people do not experience stigma or bias about their weight and are not fat shamed. Negative assumptions about obese people are so entrenched in society, that even some obese people themselves hold these assumptions. For example, have you ever seen an obese person eat in a public place, and assume, that they must’ve been eating all day long?
Or perhaps, you’re carrying a few extra pounds yourself and pass someone larger in the street thinking “well, at least I’m not as big as HER!” Other assumptions are that they are actually slim people who are getting fatter, whereas that person may actually be losing weight at a steady recommended pace of 2lbs a week, therefore becoming slimmer. Or that they are out of control in many if not all the areas of their life and that this is evident by their size.
Fat shaming can also occur in intimate and familial relationship settings. Where a loved one attempts to help their obese beloved lose weight by verbal bullying. It doesn’t work, and in fact can make the situation worse. Worse for the relationships, and worse for weight loss motivation.
What about being considered “fat and stupid”? Although, various earlier research findings showed a link between obesity and intelligence, a more recent study found that contrary to earlier research conclusions, it is more likely that low intelligence from childhood leads to obesity and weight gain in adulthood, as opposed to obesity causing a reduction in intelligence. ((http://personal.lse.ac.uk/kanazawa/pdfs/COEDO2014.pdf Intelligence and Obesity: Which Way Does the Causal Direction Go?). But is it reversible after weight loss?
A small study with 171 participants, found that most had a mild cognitive impairment (MCI) regardless of age. Their results also showed a decrease in the MCI of most of the patients after having bariatric surgery (Rochette et al 2016 Mild cognitive impairment is prevalent in persons with severe obesity. Obesity, 24: 1427–1429. doi: 10.1002/oby.21514).
Weight stigma could be a factor in the increase in the super morbid obese group with a BMI>50 who are becoming housebound. Unfortunately. we only hear of the cases where a super obese person needs medical care, and had to have a wall taken down by the local fire service in order to get taken to hospital. Or even have part of their home demolished and airlifted out of their home. Such as in the case of Khalid Mohsin Shaer who at 20 years old weighed 1344lbs/610ks/96stone. As an humanitarian gesture, he was ordered to be taken to hospital in 2013 by King Abdullah. A special bed was made for him in the US, so he can be transported safely. He went on to lose half his body weight by 2014 after having bariatric surgery at King Fadh Medical City in Riyadh. But even in a healthcare environment, the overweight or obese patient may still experience weight stigma.
Dr Sean Phelan from the College of Medicine, Mayo Clinic lectures and has also conducted research on the topic of weight stigma. He found that in the field of healthcare, not only are obese patients’ victim to discriminatory comments by healthcare staff, but overweight and obese medical students also experience perceived and internalized weight stigma, which may contribute to worsen their well-being. In a survey conducted with his colleagues, Dr Phelan suggested that this may be due to the healthcare culture is which obesity is considered preventable (http://bit.ly/2dqdHD2). Unfortunately, as a result, this bias may impact the interaction you have with a healthcare professional.
Whether from nurses, doctors or consultants, it results in the obese patient feeling that they are judged as being lazy, undisciplined and responsible for their predicament. Unfortunately, this may act as a deterrent in obese people seeking medical help whether for obesity or other health problems. The resulting shame felt when obese, then often becomes a factor in increasing poor eating behaviours.
The awareness that this is a sensitive topic, has resulted in some doctors changing their approach in discussing obesity with their patients.
Dr. Arya M. Sharma, MD, DSc (hc), FRCPC is Professor of Medicine & Chair in Obesity Research and Management at the University of Alberta, Edmonton, Canada. He is also the Clinical Co-Chair of the Alberta Health Services Obesity Program. He teaches doctors a new approach which he calls the 5 A’s of Obesity Management:
- Ask patient for permission to discuss excess weight.
- Assess patient completely before offering any advice
- Advise by focusing on behavioural goals, not on weight loss.
- Agree a treatment plan with the patient
- Assist the patient in accessing treatment options e.g. Professional (psychological, bariatric etc.), community resources etc.
Give them a chance to help you before a treatable health issue becomes a bigger problem. Alternatively, you may want to approach someone in the weight loss industry who can support you on your weight loss journey.
In my personal experience, I did believe in the past that I was considered ‘fat and stupid’ by many others, including health professionals. Even, if my belief was accurate, it was something I had to change in myself in order to take the first steps in reducing my weight. This along with other self-directed negative beliefs led to my feeling depressed. My depression fed my hunger for food, and the resulting extra weight gain ‘fed’ my depression. I decided to educate myself on the topic of diet and nutrition and also anatomy & physiology. This self education, led to my having a fuller understanding of what I was doing to my body. And at that point, I was able to start a weight loss journey which was successful, long term, for the first time in my life.
My cognition and indeed my IQ did change after my weight loss. This happened primarily because my confidence and self-esteem improved, enabling me to enrol at university and do a psychology degree. During my studies, I had to learn study skills, exam revision skills, critical thinking, research skills and much more. Although, I had done many qualified courses before while obese, losing weight enabled me to release all of my negative self-directed fat thoughts I held about myself and my level of intelligence. My anxiety about being a fat (and ‘stupid’) student also lifted in the absence of my obesity. Allowing me to feel that I at last, rightfully belonged in the classroom environment along with the rest of my mature student peers.
In addition, my exercise routine, enabled me to release stress from my body and mind leaving me to focus on other things. Also, my limitation of brain dulling foods and alcohol, was replaced with water, water rich foods, fruits and vegetables, which left me with a clear mind and body. I found that eating better, actually made me feel better physically and mentally. Through my job working with clients wanting to lose weight, they also found these benefits.
But, don’t just listen to me, you should be your own judge on this. I know you’re smart and ready to make a decision about your life. Get smart about what you eat, and why you are eating it. You can change your mind and change your behaviour as a result. Weight Stigma exists, Yes. But it’s easier to change your mind about how you feel about yourself, than it would be to change a mass of ignorant people!
In other words, what other people think of you is none of your business, what matters is what YOU think of YOU Don’t let your excess weight stop you exercising, changing your life or leading an active full life.
Do you feel fat shamed in your personal or professional life?
Have you ever experienced it in a healthcare setting?
Let me know your thoughts.
Antoinette Niles Bsc (Hons) Psychology