What Is Weight Stigma?

Weight stigma is also known as weight bias, weight-based discrimination, fat stigma, or fatphobia. At its most basic level, it’s consistent, systemic oppression against larger-bodied people, which makes it difficult or impossible to find clothes and spaces that fit, healthcare that’s effective and non-discriminatory, equal access to employment, and other basic human rights that we all deserve.  

As Janet Tomiyama, one of the leading weight-stigma researchers, put it in 2014, weight stigma is “the social devaluation and denigration of people perceived to carry excess weight, which leads to prejudice, negative stereotyping, and discrimination toward those people” (Tomiyama 2014; CW for weight-stigmatizing language).

Researcher Rebecca Pearl further defines weight stigma as “a broad range of experiences from minor, everyday instances of differential treatment, or ‘microaggressions’ (e.g., being treated with less respect than others in subtle ways), to being treated unjustly in specific contexts (e.g., being denied employment)” (Pearl 2018; CW for weight-stigmatizing language).

In other words, weight stigma can be incredibly subtle or huge and overt. 

Here are just a few of the ways that weight stigma shows up in the world:

• Being bullied by peers at school for your size and shape 

• People stereotyping you and doubting your capabilities because of your weight

• Doctors commenting on your weight at every visit

• Not being able to fit into airplane seats, restaurant booths, or other public spaces

• Not being able to find clothes in your size at many/most clothing stores 

• Having loved ones express shame about your size

• Being ignored in public spaces

• Being stared at in public spaces (sometimes by the very same people who were previously ignoring you!)

• Being denied jobs, promotions, and equal pay

• Being physically or verbally assaulted

• Feeling pressured to lose weight 

• Being complimented on weight loss—which might not seem like stigma, but the subtle message of these compliments is that higher weights are bad and lower weights are good

• Reports about the so-called “obesity epidemic” (see Frederick et al. 2016; CW for weight-stigmatizing language)

Weight stigma clearly has a deep emotional impact, and that can affect people’s health in many ways. 

In fact, a large and growing body of research shows that weight stigma is an independent health risk factor, even when controlling for BMI. For example, a 2017 study found that people with higher levels of weight stigma have more than twice the risk of high allostatic load—a measure of cumulative stress on all body systems—that puts people at greater risk of type 2 diabetes, cardiovascular disease, and mortality. 

And that’s important, because those health outcomes often get blamed on weight, as though weight were the cause; in fact, the data show that weight stigma is an independent risk factor for those outcomes, and may explain much of the excess risk we see in larger-bodied people.  

This study also found that weight stigma was a greater risk factor than what people ate—and that’s important for anyone in the business of nutrition, because if we’re delivering nutrition messages with a side order of weight stigma, we’re actually cancelling out any benefit of the nutrition information and putting people’s health at greater risk.

One mechanism by which weight stigma confers these health risks is by putting stress on the body. Numerous studies have shown that exposure to weight stigma changes people’s physiological stress responses in a way that indicates chronic stress, and the same is true for exposure to racism and other forms of discrimination (McCleary-Gaddy et al. 2019; CW for weight-stigmatizing language).

Another mechanism by which weight stigma affects health is through disparities in healthcare. Weight stigma from healthcare providers is very real, at both the implicit and explicit levels, and patients pick up on it. 

Research has found that doctors are the most frequent source of weight stigma cited by women and the second most frequent source cited by men (Puhl & Brownell 2006; CW for weight-stigmatizing language)—and that list includes sources of stigma from ALL areas of life, not just from healthcare providers.

Because of healthcare providers’ bias, they’re likely to misdiagnose larger-bodied patients and misattribute their symptoms to their body size, which leads to a greater likelihood that the patient will be prescribed weight management instead of being given real, evidence-based medicine for what ails them. 

An example of this is my friend and colleague Ragen Chastain, who went to the doctor for strep throat and was told to lose weight instead of getting a throat swab and antibiotics like she should have. Luckily she was able to advocate for herself and get the proper diagnosis and treatment, but not everyone is able to do that. 

In fact, a significant number of people in larger bodies just opt NOT to go to the doctor so they don’t have to deal with the stigma.  

And so both because of stigma-related misdiagnosis and because of healthcare avoidance, high-weight people often end up with more advanced disease states and worse health outcomes when they finally do seek out care (Phelan et al. 2015; CW for weight-stigmatizing language).

The final mechanism by which weight stigma can affect overall health is through impacts on mental health and health behaviors, again independent of BMI. 

Weight stigma is associated with greater body dissatisfaction; an increased risk of disordered eating; increased risks of depression, anxiety, and low self-esteem; lower rates of physical activity; and greater eating in response to stigma in controlled trials—so stigma is the opposite of “motivation” to diet and exercise, the way some people may think (Wu & Berry 2017; Jackson & Steptoe 2017; CW for weight-stigmatizing language).

What’s more, even people in the “normal” BMI range with high levels of internalized weight stigma have been shown to experience more frequent illness (Muennig et al. 2008; CW for weight-stigmatizing language). So weight stigma is a risk factor across the BMI spectrum—although of course it disproportionately impacts people at the highest end of the spectrum. 

In short, weight stigma is profoundly harmful to people’s well-being, and eradicating it needs to be a top public-health priority.

To learn lots more about weight stigma and how it harms our health, check out my book, Anti-Diet: Reclaim Your Time, Money, Well-Being, and Happiness Through Intuitive Eating, and my podcast, Food Psych.