International Study on Weight Stigma Reveals Similar Problems Worldwide

Over half of adults surveyed in six countries report that they are more likely to avoid checkups and perceive less respect from doctors due to stigma about their weight, according to new research.

Results published in the International Journal of Obesity included nearly 14,000 people enrolled in WW (formerly Weight Watchers) in Australia, Canada, France, Germany, the U.K., and the U.S. who completed identical online anonymous surveys.

They provided information on their experiences with weight stigma and associated distress from stigma in different time periods, including childhood and adolescence.

Between 55% and 61% of participants reported experiencing at least one episode of weight stigma, and people with higher body mass index were significantly more likely to report negative experiences compared to those with lower BMI.

Key Findings

In addition to weight stigma from doctors, participants in each country also experienced negative comments from family members, classmates, coworkers, and friends. In all countries, weight stigma episodes were most frequent for kids and teens.

Participants in Germany reported a higher frequency of weight stigma across their whole lives but had lower levels of distress as a result of those experiences.

In general, though, weight stigma was similar across all the countries, according to lead author Rebecca Puhl, PhD, deputy director at the Rudd Center for Food Policy and Obesity at the University of Connecticut.

She adds that weight bias and distress over these experiences can lead to issues like:

• Maladaptive eating
• Sedentary behavior
• Chronic stress
• Increased risk for depression and anxiety
• Low self-esteem
• Poor body image
• Substance abuse
• Suicidality

“The fact that family members are common sources of weight stigma, no matter which country you’re in, should prompt efforts to address weight stigma at home,” she says.

That’s particularly true since negative perceptions start in childhood, often from parents and close family members, and can linger long into adulthood even after weight loss.

Healthcare Ripple Effect

Just as much of a concern as family pressure is weight bias held by medical professionals, says Puhl. Another study she led about weight bias in the management of patients with diabetes and obesity, published in Clinical Diabetes, found that weight discrimination is reported by Americans at rates comparable to those of racial discrimination, especially in women.

This can lead to a range of potentially serious outcomes, she says, including:

• Poor treatment adherence
• Less trust of health providers
• Avoidance of follow-up care
• Delay in preventive health screenings
• Poor communication
• Less effective chronic disease self-management
• Lower quality of life

“Unfortunately, negative societal weight biases against people with obesity often are shared and expressed by health care providers,” says Puhl, adding that weight bias has been demonstrated among primary care providers but also among specialists like endocrinologists, cardiologists, nurses, and dietitians. “Some of these biases appear to have worsened rather than improved over time, even among professionals who specialize in obesity.”

A study of over 2,000 physicians, published in PLoS One, found that weight bias is as pervasive among medical doctors as it is in the general public. Puhl says other research has found that women with obesity view physicians as one of the most frequent sources of weight bias they encounter in their lives.

Many who experience this bias from health providers feel blamed for their weight, Puhl adds, and are reluctant to discuss weight concerns.

Evidence suggests that health care providers spend less time in appointments, provide less education about health, and are more reluctant to perform certain screenings with patients who are overweight or have obesity compared to lower-weight patients, she says.

Steps Forward

Addressing this issue is sometimes seen as a patient’s responsibility, but that puts more pressure and potential negativity into a healthcare interaction. Instead, it’s important that clinicians should take steps toward ending weight bias, according to Janet Tomiyama, PhD, associate professor in health psychology at the University of California Los Angeles.

Many standard anti-obesity efforts are unintentionally fueling weight bias, she adds, because they focus on strategies like willpower—and when patients falter, they are shamed for their “lack of motivation.”

Healthcare professionals and students should be educated about weight bias and the effect it has on patients, Tomiyama notes. Also, public health approaches are needed to stop blaming individuals since that condones discrimination.

Instead, she says the emphasis for both those in healthcare and public health should be on encouraging healthy behaviors in positive ways, such as getting better sleep, reducing stress, increasing physical activity, and eating fruits and vegetables.

“Without once mentioning weight or size, we can emphasize that modifiable behaviors would improve health for all, regardless of the number on the scale,” according to Tomiyama.