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Patient safety

Fat shaming stigma threatens obesity agenda

shame upset obese
shame upset obese

Lesley McCormack

CEO of national charity Helping Overcome Obesity Problems (HOOP)

Science documents weight stigma as a strong risk to public health promotion and interventions. Despite this, a national mindset of justifying fat blaming and shaming, as a way of motivating individuals to lose weight, is the biggest hurdle in combating obesity that we face.

It is shameful that, decades on from extensive scientific evidence showing that weight stigmatisation fails to act as a beneficial incentive for healthier lifestyle choices and is in fact harmful to psychological and physical health, we live in a society where bias based on weight and body image is not only prevalent, but it is still widely considered acceptable.

Studies have also shown that children who experience weight-based teasing are more likely to engage in binge-eating and unhealthy weight control behaviours compared with overweight peers who are not teased.

There is a link between weight-based victimisation and eating disorders.

Other research has consistently documented a positive association between weight-based victimisation and eating disorders such as binge-eating disorders or bulimia. The empirical evidence available cannot be understated.

Harmful stereotyping

Yet, not a day goes by without one or more of our HOOP members reporting incidents of weight stigma. They face regular anti-fat messages and bullying with the common misperception that they are the architects of their own ill health and personally responsible for their weight problems because of harmful stereotyping such as they are lazy, overeat, lack self-discipline, have poor willpower, are unintelligent and are unsuccessful.

We see posts in our online support groups about experiences in the workplace, in a health or care setting, at school or college, while attempting physical activity, out shopping or enjoying leisure time. Prejudice even occurs at home from family and friends.

A spiral of shame and stigma

As a direct consequence of weight stigma, many members get stuck in a spiral of shame and guilt, followed by binge eating, reduced exercise take-up and yo-yo dieting. Such a negative cycle can derail those who are already making positive changes to their lifestyle, perhaps with the help of specialists offering costly obesity interventions. It can also destroy the confidence to take up exercise and, worryingly, to attend medical appointments or take up NHS screening such as for cervical, testicular, bowel or breast cancers. This is especially true with our more vulnerable members with higher BMI and/or comorbid mental health illness.

It’s important to understand the potential long-term harm from weight stigma. It creates a significant barrier to change, which needs specialist psychological services alongside obesity interventions and treatments to overcome. With a lack of such resources, obesity policies and interventions are not only failing to get traction but they fall far short of what’s needed for most of our members.

Weight bias should and cannot exist in health settings, if we are to ensure overweight and obese individuals receive effective and timely medical care. To reduce health disparities, the NHS needs to make it a priority to challenge and address weight stigmatisation and discrimination among its workforce. Simple steps like having gowns to fit and beds, equipment and examination tables functional to obese sizes are also necessary and appropriate. All patients, irrespective of weight, should be treated with dignity and respect.

It is vital, too, that the media examine its role in helping to shape societal beliefs around obesity. Anti-fat messages fail where tolerance, understanding and positive change in lifestyle narrative can succeed.

We must put a stop to weight stigma across the board if we are to alleviate the heavy burden of obesity in the UK.

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