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Two international studies explore the impact of weight stigma. Jasmin Merdan/Getty Images
  • Two international studies have revealed the effects of internalized weight stigma, as well as its implications for healthcare.
  • The participants reported experiencing high occurrences of weight stigma from family members and healthcare professionals.
  • A reluctance to pursue adequate healthcare can potentially add adverse health effects to those already resulting from having excess body weight.

As obesity rates have increased over the past few years, research has shown a parallel increase in weight stigma and bias.

Public health authorities now recognize weight stigma, which includes negative stereotypes, prejudice, and unfair treatment based on a person’s weight, as a global health issue.

However, international comparative studies on weight bias have been lacking. To remedy this, researchers at the University of Connecticut in Mansfield have recently conducted two studies that found that study participants across six Western countries have experienced weight stigma and its associated negative social issues.

One of the studies appears in the journal PLOS ONE, and the other one is in the International Journal of Obesity.

The international studies systematically compared weight stigma reports from nearly 14,000 participants enrolled in WW International (formerly Weight Watchers) in Australia, Canada, France, Germany, the United Kingdom, and the United States.

Surveys assessed each participant’s history of weight stigma and the type of stigma they experienced, including teasing and discrimination. It also looked at the links between internalized weight bias, perceptions of bias from others, and people’s healthcare-seeking behaviors.

The results from the studies showed that:

  • More than half of the participants (56–61%) across all six countries reported having experienced weight stigma.
  • Family members were the most common source of weight stigma across each country, with more than 75% of participants reporting that they had experienced weight stigma from their relatives.
  • Approximately two-thirds of all participants reported perceived negative weight bias from doctors.
  • Participants with higher internalized weight bias reported greater healthcare avoidance and increased perceived judgment from doctors due to obesity.

Internalized weight bias is a common issue among people with a higher body weight. When people apply a negative stereotype to themselves and engage in self-devaluation based on their weight, this can result in negative psychological consequences. In addition, it can potentially seriously affect the individual’s physical health.

Body-related shame and guilt, along with a reluctance to pursue adequate healthcare measures, are often the results of this internalized bias.

Participants with higher internalized weight bias admitted greater healthcare avoidance, increased perceived judgment from healthcare providers, and lower quality of healthcare. They also reported feeling less heard and respected by doctors. These incidences led to participants across all six countries avoiding routine checkups.

The researchers acknowledge some limitations to these studies. For example, the data that they collected relied on self-reported recall of stigma and healthcare experiences.

Also, the results could include an element of self-report bias in the results, as participants may be more likely to interpret appraisal cues negatively.

Another possible limitation was the fact that the data collection took place during the COVID-19 pandemic — a time when general positivity across the world was lower than usual.

Conversely, there were multiple strengths associated with these studies. The researchers noted that the large sample size and consistent multinational comparisons contributed unique insights to previously scant cross-cultural research regarding weight stigma.

In their conclusion, the study authors recognize the need for a two-fold focus for the future. The first area of focus is a need to address weight stigma among families.

Rebecca Puhl, the lead author of the study, says, “The fact that family members are such common sources of weight stigma across these countries indicates a collective need to address weight stigma within the family environment and to help families engage in more supportive communication with their loved ones.”

“For many people, these experiences begin in youth from parents and close family members, and they can last for many years and have long-term negative consequences.”

The authors say that the second area of focus should revolve around the improvement in communication between healthcare professionals and people with obesity. They note that the medical community needs to develop and facilitate methods to certify knowledge of weight stigma and its harmful side effects. Education and training are critical to these efforts, and all countries should implement them.

“Our results also provide a compelling reason to step up international efforts to reduce weight biases held by medical professionals. We must prioritize efforts to establish a healthcare culture free of weight stigma, and we also need to work collaboratively to develop supportive interventions to help people when they do experience this stigma.”

– Rebecca Puhl