Weight Discrimination In The United States

We all know that in society it is wrong to discriminate against people. There are protections against this common practice for age, gender, sexual orientation, race, disability, and religion. However, there are no rules or standards in place for the size of certain people, small or large. Weight discrimination is often referred to as the only form of acceptable discrimination left. Now, why is that? Weight bias is something that has been around for a long time and has long flown under the radar. With more than 2/3 of the population in the United States being considered overweight or obese, it is important for this topic to be addressed

What exactly is weight bias? The most basic definition is negative attitudes toward people who we view as

either overweight, obese, and even underweight. The way we view people, of course, differs from person to person. People who are victims of weight bias often receive unfair treatment and can suffer long-term psychological, emotional, and physical problems. Weight bias is not just something that people experience from friends and family, it can come from health care practitioners, teachers, coaches, and even complete strangers.
When it comes to recognizing weight bias, language can be a good indicator. Weight labels and bias have a bigger correlation than one might think. In a study of the effects of the difference between the labels ‘fat’ and ‘overweight’, interesting results were found. Participants were asked to view pictures of people who were labeled ‘fat’ or ‘overweight’, it was shown that the people who were labeled as ‘fat’ were viewed in a significantly more negative way than people who were labeled ‘overweight’. People labeled as fat were viewed with more negative attitudes and stereotypes They also found that people in the study who were overweight or obese themselves had the same negative attitudes towards ‘fat’ people as the non-overweight participants. 1 This study provides evidence that the words ‘fat’ and ‘overweight’ are not synonymous. Avoiding pejorative language can help us avoid weight bias in conversation.
Overall, does weight bias really have an impact on people?

Many of the consequences of weight bias include depression, anxiety, binge eating disorder, using food as a coping mechanism, social exclusion, socioeconomic impact, and an overall lowered quality of life. Some people may ask, well why don’t they just lose weight? Although studies are limited, there is proof that weight bias can actually lower engagement in physical activity. In a study where participants who had a BMI greater than 27, with the mean being BMI of 36.6, began an eighteen-week behavioral weight loss program where they participated in self monitored caloric intake physical activity, and energy expenditure. People who had more positive attitudes towards obese people to begin with were associated with more frequent self-monitoring, lower daily caloric intake, and greater amounts of daily exercise. Those who had negative attitudes toward obese people had the complete opposite of all the above mentioned. People who were more positive were also less likely to drop out of the program. Implicit bias or, attitudes that are unconscious automatic behaviors learned from repeated messages in the environment were also taken into account. These specific biases are deeply rooted within in a person. Those with greater implicit bias also showed more negative attitudes.

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This study shows that bias can have an effect on the amount of weight a person is able to lose! It also shows that our culture and environment around us can affect our implicit biases.
Weight bias can have an effect on the way that we actually gain weight. The more weight bias in your life the more likely it is to negatively affect you. This can have an impact on you becoming obese, and maintaining a heavy weight if you are already considered obese. A study showed that people who experienced bias were 2.5 times more likely to become obese at a follow-up, and those who were already considered obese were three times more likely to remain obese at the time of follow-up than those who had not experienced weight discrimination. It also showed that these numbers were only specific to weight discrimination and that other forms of discrimination, such as sex, gender, and race were unrelated to the risk of obesity at follow-up. People may think that weight discrimination can motivate people to lose weight when in fact the exact opposite is true. 4
It is important to realize that discrimination is not a form of motivation and often has the opposite effect.
It has been said that people who are overweight or obese are a burden to our healthcare costs. Have we ever considered that maybe overweight and obese people are not getting the care that they need from out healthcare system until their condition has become severe? It is possible. People who are overweight and obese do receive a lower quality of care, and health professionals often think that their weight is the cause or has some effect on the conditions they are coming in for. Even people who are training to become registered dietitians, and are supposed to be trained to treat people who are overweight or obese are not immune to the effects of weight bias. A study of undergraduate dietetic students from didactic programs of fourteen different colleges in the United States showed some troubling results. Students were given profiles of a normal weight or overweight person, male or female, and were asked to give input on treatment. Despite health information being equivalent for both the overweight and normal groups in the male and female profiles diet quality and health status were still rated lower in the overweight group. After rating adjectives describing overweight people on the fat phobia scale, there was a mean score of 3.7 meaning there was moderate weight bias since the neutral zone for weight bias is 2.5. Overweight patients were also rated as having lower self-esteem, being slower, insecure, inactive, and less likely to comply with treatment. 3
If people who are entering the field to help people with weight problems can’t put aside there bias then we have a major problem on our hands. Proper education on weight bias implications on practice can help to reduce the weight bias that we see in this particular field.
The question you may be wondering at this point is what we can do to stop this?

Education is key! Those who are educated to recognize weight bias are less likely to engage in it. A study of pre-health students separated them into three groups, each of which received different levels of educations. The intervention group received a lecture on obesity, weight bias, and the multiple determinants of weight. The comparison group received a lecture on obesity and the behavioral determinants of weight. The control group received no lecture at all. The students then had their beliefs about the controllability of weight and attitudes towards overweight and obese people analyzed. This occurred one week pre-intervention, immediately post-intervention, and three weeks post-intervention. Participants who were in the intervention group were less likely to believe that weight is all about an individual’s control, and held less negative attitudes toward obese and overweight people three weeks post-intervention. There were no such changes in the other two groups. Negative attitudes toward obese and overweight people actually increased over time in the control group, but did not change in the comparison and intervention groups.

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Weight bias can be reduced with targeted education even if it is brief. Public health education of weight bias can greatly reduce the amount of bias that we see in our society.