Weight Stigma and Bias
Weight stigma and weight bias refer to the prejudice, discrimination, and stigma experienced by individuals based on that individual’s weight. This discrimination can happen in every facet of life including employment, education, healthcare, relationships, and the media (Lee & Pausé, 2016; Puhl & King, 2013; Phelan et al., 2015; Washington, 2011; Puhl & Brownell, 2001; Blodorn, Major, Hunger, & Miller, 2016; Carr & Friedman, 2005). Individuals can experience stigma and bias through bullying, shaming, and discrimination. According to the Binge Eating Disorder Association, “Weight stigma depends upon three basic suppositions: thin is always preferable, thin is always possible, and thin people are better people,” (Pershing, 2013). This is known as the thin ideal and it is socially and culturally validated by the media, clothing stores, furniture and architectural design, etc.
The media promotes the thin ideal on extreme weight loss television such as The Biggest Loser and Extreme Weight Loss where contestants are put on unhealthy extreme diets and exercise routines to lose drastic amounts of weight in short time spans. In the case of The Biggest Loser, contestants are shamed for their weight through forcing contestants to wear barely-there outfits to weigh-ins and yelling at contestants throughout the competition, especially during workout scenes, to “inspire” them to exercise and lose weight. This idea that shame can promote weight loss is especially present in the show despite research showing stigma and shame result in the opposite effect including weight gain, ill health effects, and negative psychological consequences (Pearl, Puhl, & Dovidio, 2014; Nolan & Eshleman, 2016). Additionally, following the show, most contestants regain a significant amount of the weight lost and show signs of metabolic slowing with those contestants with more long-term weight loss showing greater metabolic slowing (Fothergill et al., 2016). This is because of the dangerous, unhealthy, and unrealistic tactics used in the show to promote weight loss.
The thin ideal is also promoted in the media using ultra-thin models in magazines and runways. The average American women is a size 16-18 (Christel & Dunn, 2016) while the average fashion model is much smaller and growing even smaller over time from weighing 8% less than the average women twenty years ago to weighing 23% less in 2012 (Jones, 2012). Even the size of plus fashion models is decreasing from averaging between a size 12-18 ten years ago to a size 6-14 in 2012 (Jones, 2012). The average size of a fashion model has decreased in size despite research suggesting that average-size models are more effective and do not have the same negative effect on body dissatisfaction (Diedrichs & Lee, 2010; Diedrichs & Lee, 2011; Bartlett, Vowels, & Saucier, 2008; Dittmar & Howard, 2004). These differences can be seen when comparing models in older magazines to those today.
Research suggests that the thin ideal and the media negatively impacts individuals. In a study of adult women by Grabe, Ward, and Hyde (2008) on body image concerns and the media, the study found a correlation between exposure to the media and the thin ideal and body image concerns. These results were similar in study by Field et al. (1999), who studied this effect in girls. In the Field et al. (1999) study, “The frequency of reading fashion magazines was positively associated with the prevalence of having dieted to lose weight, having gone on a diet because of a magazine article, exercising to lose weight or improve body shape, and deciding to exercise because of a magazine article,” (p. 3). The negative effects of the media were also present in a study by Barlett, Vowels, and Saucier (2008) who studied the media’s effect on men and found the men in the study felt pressure from the media and this pressure correlated with negative body image. These studies support the idea that the media and the thin ideal have a deleterious effect on viewers.
The thin ideal in the media is also present in social media. In a study conducted by Mingoia, Hutchinson, Wilson, and Gleaves (2017) on the relationship of social media and the thin ideal found a positive correlation between social media use and internalization of the thin ideal. Mabe, Forney, and Keel (2014) in their study of Facebook use and disordered eating found that increased Facebook use was correlated with greater disordered eating. Both studies show the negative effect of social media on its users with correlations between the use of social media and body image.
Fashion further reinforces that thinness is the ideal through clothing retailers. In the US, clothing sizes in the average women’s clothing retailer range from 0-12/14 (straight size) with plus size starting at 14/16. The average women’s clothing retailer does not make clothes for the average woman. The average woman instead must shop at retailers who carry plus size clothing, which can be hit or miss. Simply because a retailer carries plus-size options does not mean that those options are fashionable, stocked, or priced the same as straight size even within the same store (Banjo, 2016; Bellafante, 2010; Cheng, 2017; Hanbury, 2017; Reagan, 2015). However, there is reason for hope. The plus size market is continuing to see a growth in annual sales and the growth is larger than that of straight sizes (Banjo, 2016; Hanbury, 2017; Reagan, 2015). While there may be a growth in sales, a widespread change in the industry has yet to happen.
This sizing for smaller bodies is also present in furniture design. The design of seating, for example, is not always created to accommodate larger bodies (MacVean, 2010; Park, 2012). This is present in restaurant booths, chairs with arms, and airplane seats where larger bodies may or may not fit. This reinforces and promotes the idea that all bodies must fit a certain size. Though there is change occurring in the industry with increasing options for accommodating furniture (MacVean, 2010; Park, 2012), the industry still has a long way to go, especially in regards to airplane seats, which are shrinking in size rather than increasing (Associated Press, 2017; White, 2017).
This culture of thinness and shame creates even more shame and stigma. From 1995-1996 to 2004-2006, discrimination based on weight increased the most when comparing weight/height, race, age, gender, and ethnicity discrimination rates (Andreyeva, Puhl, & Brownell, 2008). In that study, weight-based discrimination increased the most over that time span. There were comparable results in a study by Latner and Stunkard (2003), who studied the stigma of childhood obesity. The study showed children various drawings of children from healthy to disabled to obese and compared the reactions from 1961 and 2002. The results of the study were that children in both 1961 and 2002 liked the drawing of the obese child the least and the bias against the obese image increased from 1961 to 2002 (Latner & Stunkard, 2003).
And yet people are not getting any thinner. The weight of adults and children has increased from the 1980s to the 2000s (Flagel et al., 2002; Ogden et al., 2006). People are subscribing to this thin ideal and turning to things like the weight loss market to avoid the stigma and shame with being overweight (“U.S. Weight Loss Market To Reach $58 Billion in 2007”, 2007). The more people weigh, the more weight stigma there is. The more weight stigma there is, the more people weigh. In a study done by Stevens et al. (2016), “…an increase in BMI was associated with a significant increase in lifetime weight stigmatization,” with “…weight status directly affect[ing] psychological outcomes.” Weight stigma begets weight stigma.
In a study by Ashmore, Friedman, Reichmann, and Mustante (2008) on the correlations between weight stigma, psychological distress, and binge eating behavior, the results suggested that weight stigma predicts psychological distress and binge eating behavior. Comparable results are found in O’Brien et al. (2016) who studied the relationship between weight stigma and eating behavior. The O’Brien et al. study found, “…weight stigma was significantly associated with all measures of disordered eating, and with weight bias internalization and psychological distress,” (p. 70). These results of weight stigma correlating with psychological distress and eating disturbances are consistent throughout the literature (Stevens et al., 2017; Nolan & Eshlemann, 2016; Vartanian & Porter, 2016; Puhl & King, 2013; Thompson et al., 1995; Stice, Marti, & Durant, 2011). The consensus from these studies is that weight stigma has negative consequences.
The negative psychological consequences of weight stigma and bias include body image dissatisfaction, depression, anxiety, suicide ideation, and other psychological issues (Puhl & King, 2013; Durso & Latner, 2008; Ashmore, Friedman, Reichmann, & Mustante, 2008; O’Brien et al., 2016; Vartanian & Porter, 2016). These negative psychological effects can result in internalization of the stigma and declines in physiological health including causing unhealthy eating habits and eating disorders (Culbert, Racine, & Klump, 2015; Durso et al., 2011; Durso & Latner, 2008; O’Brien et al, 2016; Webb & Hardin, 2016).
Weight stigma’s negative impact on body image and eating behaviors are supported by eating disorder research, which suggests a correlation between weight stigma and body image dissatisfaction and eating disorders (Culbert, Racine, & Klump, 2015; Stice, Gau, Rohde, & Shaw, 2017; Stice, Marti, & Durant, 2011; Thompson et al., 1995). In a study done by Stice, Marti, and Durant (2011), “…body image dissatisfaction was the strongest predictor of risk of onset of any eating disorder,” (p. 7). Though the research suggests a correlation, none of the studies referenced found any causation.
Weight stigma and bias exist because of the thin ideal. The thin ideal is socially and culturally validated, which reinforces weight stigma and perpetuates the negative physical and psychological effects of this unattainable ideal. Men, women, and children all face negative consequences because of the thin ideal and weight stigma. Perhaps if the thin ideal was debunked and denounced, individuals would no longer suffer from the negative effects and one risk factor of eating disorders would be eliminated.
References
Andreyeva, T., Puhl, R. M. and Brownell, K. D. (2008), Changes in Perceived Weight Discrimination Among Americans, 1995–1996 Through 2004–2006. Obesity, 16: 1129–1134. doi:10.1038/oby.2008.35
Ashmore, Friedman, Reichmann, & Musante. (2008). Weight-based stigmatization, psychological distress, & binge eating behavior among obese treatment-seeking adults. Eating Behaviors, 9(2), 203-209.
Associated Press. (2017, July 29). ‘Incredible shrinking airline seat’: US court says seat size a safety issue. The Guardian. Retrieved from https://www.theguardian.com/business/2017/jul/29/incredible-shrinking-airline-seat-us-court-says-seat-size-a-safety-issue.
Banjo, S. (2016, May 10). Retailers Ignore Most of America’s Women. Retrieved December 13, 2017, from https://www.bloomberg.com/gadfly/articles/2016-05-10/plus-size-could-save-retailers
Barlett, C. P., Vowels, C. L., & Saucier, D. A. (2008). Meta-Analyses of the Effects of Media Images on Mens Body-image Concerns. Journal of Social and Clinical Psychology, 27(3), 279-310. doi:10.1521/jscp.2008.27.3.279
Bellafante, G. (2010, July 28). Plus-Size Wars. Retrieved December 13, 2017, from http://www.nytimes.com/2010/08/01/magazine/01plussize-t.html
Blodorn, Major, Hunger, & Miller. (2016). Unpacking the psychological weight of weight stigma: A rejection-expectation pathway. Journal of Experimental Social Psychology, 63, 69-76.
Carr, D., & Friedman, M. A. (2005). Is Obesity Stigmatizing? Body Weight, Perceived Discrimination, and Psychological Well-Being in the United States. Journal of Health and Social Behavior, 46(3), 244-259. doi:10.1177/002214650504600303
Cheng, A. (2017, May 1). A Bright Spot for Fashion? Plus Size. Retrieved November 28, 2017, from https://retail.emarketer.com/article/bright-spot-fashion-plus-size/5908fd49ebd400097ccd5f85
Christel, D. A., & Dunn, S. C. (2016). Average American women’s clothing size: comparing National Health and Nutritional Examination Surveys (1988–2010) to ASTM International Misses & Women’s Plus Size clothing. International Journal of Fashion Design, Technology and Education, 10(2), 129-136. doi:10.1080/17543266.2016.1214291
Culbert, K. M., Racine, S. E. and Klump, K. L. (2015), Research Review: What we have learned about the causes of eating disorders – a synthesis of sociocultural, psychological, and biological research. J Child Psychol Psychiatr, 56: 1141–1164. doi:10.1111/jcpp.12441
Diedrichs, & Lee. (2010). GI Joe or Average Joe? The impact of average-size and muscular male fashion models on men’s and women’s body image and advertisement effectiveness. Body Image, 7(3), 218-226.
Diedrichs, P., & Lee, C. (2011). Waif goodbye! Average-size female models promote positive body image and appeal to consumers. Psychology & Health, 26(10), 1273-1291.
Dittmar, H., & Howard, S. (2004). Thin-Ideal Internalization and Social Comparison Tendency as Moderators of Media Models Impact on Womens Body-Focused Anxiety. Journal of Social and Clinical Psychology, 23(6), 768-791. doi:10.1521/jscp.23.6.768.54799
Durso, L. E. and Latner, J. D. (2008), Understanding Self-directed Stigma: Development of the Weight Bias Internalization Scale. Obesity, 16: S80–S86. doi:10.1038/oby.2008.448
Durso, L. E., Latner, J. D., White, M. A., Masheb, R. M., Blomquist, K. K., Morgan, P. T. and Grilo, C. M. (2012), Internalized weight bias in obese patients with binge eating disorder: Associations with eating disturbances and psychological functioning. Int. J. Eat. Disord., 45: 423–427. doi:10.1002/eat.20933
Field, A., Cheung, L., Wolf, A., Herzog, D., Gortmaker, S., & Colditz, G. (1999). Exposure to the Mass Media and Weight Concerns Among Girls. Pediatrics, 103(3)e36. doi:10.1542/peds.103.3.e36
Flegal KM, Carroll MD, Ogden CL, Johnson CL. Prevalence and Trends in Obesity Among US Adults, 1999-2000. JAMA. 2002;288(14):1723–1727. doi:10.1001/jama.288.14.1723
Fothergill, E., Guo, J., Howard, L., Kerns, J. C., Knuth, N. D., Brychta, R., Chen, K. Y., Skarulis, M. C., Walter, M., Walter, P. J. and Hall, K. D. (2016), Persistent metabolic adaptation 6 years after “The Biggest Loser” competition. Obesity, 24: 1612–1619.
Grabe, S., Ward, L. M., & Hyde, J. S. (2008). The role of the media in body image concerns among women: A meta-analysis of experimental and correlational studies. Psychological Bulletin, 134(3), 460-476. http://dx.doi.org/10.1037/0033-2909.134.3.460
Hanbury, M. (2017, March 05). Retailers like J. Crew are ignoring a $20 billion opportunity – and it’s infuriating shoppers. Retrieved December 13, 2017, from http://www.businessinsider.com/plus-size-clothing-big-opportunity-retailers-2017-2
Jones, M. (2015, August 25). Plus Size Bodies, What Is Wrong With Them Anyway? Retrieved October 24, 2017, from https://www.plus-model-mag.com/2012/01/plus-size-bodies-what-is-wrong-with-them-anyway/
Latner, J. D. and Stunkard, A. J. (2003), Getting Worse: The Stigmatization of Obese Children. Obesity Research, 11: 452–456. doi:10.1038/oby.2003.61
Lee, J. A., & Pausé, C. J. (2016). Stigma in Practice: Barriers to Health for Fat Women. Frontiers in Psychology, 7, 2063. http://doi.org/10.3389/fpsyg.2016.02063
MacVean, M. (2010, March 11). Plus size furniture for plus size people. Retrieved December 13, 2017, from https://www.seattletimes.com/life/lifestyle/plus-size-furniture-for-plus-size-people/
Mingoia, J., Hutchinson, A. D., Wilson, C., & Gleaves, D. H. (2017). The Relationship between Social Networking Site Use and the Internalization of a Thin Ideal in Females: A Meta-Analytic Review. Frontiers in Psychology, 8, 1351. http://doi.org/10.3389/fpsyg.2017.01351
Nolan, & Eshleman. (2016). Paved with good intentions: Paradoxical eating responses to weight stigma. Appetite, 102, 15-24.
O’Brien, Kerry S., Latner, Janet D., Puhl, Rebecca M., Vartanian, Lenny R., Giles, Claudia, Konstadina, Griva, Carter, Adrian. (2016). The relationship between weight stigma and eating behavior is explained by weight bias internalization and psychological distress. Appetite, 102, 70-76.
Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of Overweight and Obesity in the United States, 1999-2004. JAMA. 2006;295(13):1549–1555. doi:10.1001/jama.295.13.1549
Park, M. (2012, February 15). Obese children outgrowing kids’ clothing and furniture. Retrieved December 13, 2017, from http://www.cnn.com/2012/02/15/health/bigger-kids-bigger-sizes/index.html
Pearl, R. L., Puhl, R. M., & Dovidio, J. F. (2014). Differential effects of weight bias experiences and internalization on exercise among women with overweight and obesity. Journal of Health Psychology, 20(12), 1626-1632. doi:10.1177/1359105313520338
Pershing, A. (n.d.). Toolkits for Providers. Retrieved October 17, 2017, from https://bedaonline.com/weight-stigma-awareness-week-toolkits/toolkit-providers/
Phelan, S., Burgess, D., Yeazel, M., Hellerstedt, W., Griffin, J., & van Ryn, M. (2015). Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obesity Reviews, 16(4), 319–326. http://doi.org/10.1111/obr.12266
Puhl, R. and Brownell, K. D. (2001), Bias, Discrimination, and Obesity. Obesity Research, 9: 788–805. doi:10.1038/oby.2001.108
Puhl, R. M., & King, K. M. (2013). Weight discrimination and bullying. Best Practice & Research Clinical Endocrinology & Metabolism, 27(2), 117-127. http://doi:10.1016/j.beem.2012.12.002
Reagan, C. (2015, April 10). Missed opportunity? Retail’s plus-size problem. Retrieved December 13, 2017, from https://www.cnbc.com/2015/04/08/retails-plus-size-problem-designing-for-larger-sizes.html
Stevens, S., Herbozo, S., Morrell, H., Schaefer, L., & Thompson, J. (2017). Adult and childhood weight influence body image and depression through weight stigmatization. Journal of Health Psychology, 22(8), 1084-1093.
Stice, E., Gau, J. M., Rohde, P., & Shaw, H. (2017). Risk factors that predict future onset of each DSM–5 eating disorder: Predictive specificity in high-risk adolescent females. Journal of Abnormal Psychology, 126(1), 38-51. doi:10.1037/abn0000219
Stice, E., Marti, C. N., & Durant, S. (2011). Risk Factors for Onset of Eating Disorders: Evidence of Multiple Risk Pathways from an 8-Year Prospective Study. Behaviour Research and Therapy, 49(10), 622–627. http://doi.org/10.1016/j.brat.2011.06.009
Thompson, J. K., Coovert, M. D., Richards, K. J., Johnson, S. and Cattarin, J. (1995), Development of body image, eating disturbance, and general psychological functioning in female adolescents: Covariance structure modeling and longitudinal investigations. Int. J. Eat. Disord., 18: 221–236. doi:10.1002/1098-108X(199511)18:3<221::AID-EAT2260180304>3.0.CO;2-D
Thompson, K. A., Kelly, N. R., Schvey, N. A., Brady, S. M., Courville, A. B., Tanofsky-Kraff, M., . . . Shomaker, L. B. (2017). Internalization of appearance ideals mediates the relationship between appearance-related pressures from peers and emotional eating among adolescent boys and girls. Eating Behaviors, 24, 66-73. doi:10.1016/j.eatbeh.2016.12.008
U.S. Weight Loss Market To Reach $58 Billion in 2007. (2007, April 19). Retrieved October 17, 2017, from http://www.prweb.com/releases/2007/04/prweb520127.htm
Vartanian, & Porter. (2016). Weight stigma and eating behavior: A review of the literature. Appetite, 102, 3-14.
Washington RL. Childhood obesity: issues of weight bias. Preventing Chronic Disease 2011;8(5):A94. http://www.cdc.gov/pcd/issues/2011/sep/10_0281.htm
Webb, J. B., & Hardin, A. S. (2016). An integrative affect regulation process model of internalized weight bias and intuitive eating in college women. Appetite, 102, 60-69. doi:10.1016/j.appet.2016.02.024
White, M. (2017, November 6). Air Travelers Resisting the ‘Incredible Shrinking Airline Seat’. The New York Times. Retrieved December 13, 2017, from https://www.nytimes.com/2017/11/06/business/airline-seat.html
Yufe, S., Taube-Schiff, M., Fergus, K., & Sockalingam, S. (2017). Weight-based bullying and compromised peer relationships in young adult bariatric patients. Journal of Health Psychology, 22(8), 1046-1055.
kristin bulzomi 