Fat Shaming Won’t Stop Obesity; Respect and Science Will

Authored by: Nicole Loy

Art by: Ponthea Shojaian

It is well known that America is suffering from a nationwide obesity epidemic. Over 40% of US citizens are obese, increasing American medical costs by an estimated $147 billion every year [1]. Being overweight or obese is known to increase risks for heart disease, stroke, hypertension, and early mortality, leaving a large population of America susceptible to these issues [2]. Addressing the issue of obesity is tied heavily into social, environmental, and medical factors that complicate attempts to solve it. 

Before we can solve obesity, however, it’s important to address the distinction between exposing the harms of obesity and attacking those that are obese. Attacking a person with obesity, also known as fat shaming, is weight-based discrimination. It often presents itself as bullying in young children, backhanded comments in adults, or even discrimination in healthcare. In fact, physicians “have been found to spend less time with obese patients, perform less preventive health screenings, and even deny service to obese patients” [3]. Mistreatment by physicians may cause obese patients to avoid doctors, increasing their susceptibility to chronic diseases that may be mitigated by regular check-ins and health interventions. 

Some claim that fat shaming is “tough-love” that will motivate obese people to change their behaviors. Television host Bill Maher exemplified this belief when he said, “Fat shaming doesn’t need to end, it needs to make a comeback... We shamed them out of littering and most of them out of racism. Shame is the first step in reform” [4]. While Maher is a comedian and is not an authority on societal weight reform, his point of view is consciously or unconsciously shared by a large population of America. The belief that obesity is a choice caused by laziness is a harmful and incorrect assertion, but its pervasiveness permeates much of our culture and society. 

However, while some believe that weight-focused criticism would be motivating for losing weight, fat shaming has the opposite effect. Fat shaming has been shown to trigger obesogenic processes, increasing the likelihood of gaining weight and associated complications. When an obese individual is exposed to weight bias, they experience stress that increases cortisol, decreases self-control, and increases the risk of binge eating [5]. Thin individuals exposed to this same messaging showed a similar response, making them more likely to gain weight and become obese. 

In addition to affecting the weight of an individual, weight discrimination has been shown to severely harm mental health. Individuals who have experienced weight-based discrimination are “roughly 2.5 times as likely to experience mood or anxiety disorders” [6]. It can also severely affect self-esteem and increases risks for disordered eating. In conclusion, between increasing chances of mental health issues and universally increasing risks for obesity, fat-shaming is not a viable solution to the obesity epidemic. 

So what methods actually work to change our treatment of those with obesity? Change can start in the medical field. Doctors need to mitigate weight stigmatization during visits. Studies from the American Academy of Pediatrics offered suggestions such as to “[recognize] and [acknowledge] the complex etiology of obesity” and “use appropriate, sensitive, and non-stigmatizing language in communication about weight” [7]. When patients believe they are safe and listened to by healthcare professionals, they will be more likely to return for visits and re-evaluate their lifestyle choices. 

Changes also need to occur in our conversations about obesity. People with obesity are heavily stigmatized because weight gain is thought of as a failure of self control. This perception has been shown to cause “social distance and rejection” from peers [8]. While it is true that exercise and nutrition contribute to obesity, genetics, environment, wealth, and education are large contributors to obesity that can make it difficult to lose weight. Changing attitudes and acknowledging the real difficulty of maintaining a healthy weight can help to divert the burden of responsibility away from those with obesity and towards societal change that makes healthier choices easier for everyone. 

There is no reason to treat people with obesity with any less love and respect than others. Criticizing the weight of those with obesity will only harm them mentally and physically as there is no medical justification for fat shaming. Instead, we must shift the focus towards systemic change through healthcare, government programs, and education of youth to decrease obesity rates in America.

References:

1. Centers for Disease Control and Prevention. (2023, October 18). Adult obesity causes & consequences. U.S. Department of Health & Human Services. https://www.cdc.gov/obesity/adult/causes.html

2. National Institute of Diabetes and Digestive and Kidney Diseases. (2021, August). Health risks of being overweight. U.S. Department of Health & Human Services. https://www.niddk.nih.gov/health-information/weight-management/adult-overweight-obesity/health-risks

3. Stigma Experienced by Children and Adolescents With Obesity. (2018). In American Academy of Pediatrics, Pediatric Clinical Practice Guidelines & Policies (18th ed., pp. 1303–1303). American Academy of Pediatrics. https://doi.org/10.1542/9781610021494-part05-stigma_experienced

4. Lee, B. Y. (2019, September 15). Bill Maher asks people to fat-shame more: Here is the response. Forbes. https://www.forbes.com/sites/brucelee/2019/09/15/bill-maher-asks-people-to-fat-shame-more-here-is-the-response/?sh=4f6af98c6c7e

5. Vogel, L. (2019). Fat shaming is making people sicker and heavier. Canadian Medical Association Journal, 191(23), E649–E649. https://doi.org/10.1503/cmaj.109-5758

6. Tomiyama, A. J., Carr, D., Granberg, E. M., Major, B., Robinson, E., Sutin, A. R., & Brewis, A. (2018). How and why weight stigma drives the obesity “epidemic” and harms health. BMC Medicine, 16(1), 123. https://doi.org/10.1186/s12916-018-1116-5

7. Puhl, R. M., & Himmelstein, M. S. (2018). Adolescent preferences for weight terminology used by health care providers. Pediatric Obesity, 13(9), 533–540. https://doi.org/10.1111/ijpo.12275

8. Puhl, R. M., & Heuer, C. A. (2010). Obesity Stigma: Important Considerations for Public Health. American Journal of Public Health, 100(6), 1019–1028. https://doi.org/10.2105/AJPH.2009.159491