WHY WEIGHT STIGMA IS A PUBLIC HEALTH ISSUE

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There’s more to weight stigma than just the emotional consequences. Dive deeper into the underlying issues that may be impacting our community’s health as a whole.


BY: VINCCI TSUI, RD

It’s well-documented that weight stigma and weight bias, or discrimination and stereotyping based on a person’s weight or size, is rampant in our society. This is not just in the general public, but also within health professionals, employers, teachers, and other figures of authority.

Although much of the focus has been placed on the mental and social consequences of weight stigma, fighting weight bias is not just about “making people feel good about themselves”.

Weight stigma does, in fact, impact physical health.

Higher weight people are often reluctant to seek necessary medical care, are outright denied medical care, or told to lose weight for concerns that have a tenuous link, if any, to their size. In fact, one study found that those who experienced weight discrimination were twice as likely to have multiple chronic medical concerns, even after adjusting for BMI.  This indicates that a weight-focused approach is more likely to have a negative impact on a person’s ability to manage cardiovascular disease, diabetes and other metabolic risks – the very chronic diseases that impact nearly half the U.S. population and has been declared a public health issue.

So where does weight currently stand in health care?

In recent years, obesity organizations have taken up fighting weight stigma as a cause, but seem to fail to acknowledge that the concept of “obesity” itself is stigmatizing. The word “obesity” itself comes from the Latin word obēsus, or “eaten itself fat”. Research has shown that “obesity” is considered stigmatizing, blaming, and undesirable to people when it comes to discussing weight. Despite this, the American Medical Association leaned harder into this idea by declaring “obesity” a chronic disease in 2013, against the advice of its Council on Science and Public Health.

While some have argued that calling obesity a disease would decrease stigma by shifting the focus away from personal responsibility and towards its more complex biology, emerging research is showing that has not been the case.  The term “obesity” still pathologizes larger bodies by implying that a body is automatically unhealthy when it’s above a certain size.

This may all seem like a matter of semantics, but if the goal of our current public health policies is to fight chronic disease, a concurrent “war on obesity” doesn’t make sense. Instead, we need to unlearn the beliefs and dismantle the systems that uphold weight stigma.

If we were truly concerned about chronic disease, then the focus should be on health, not the number on the scale.

While there is a correlation between higher weight and certain medical conditions like heart disease or diabetes, there is a lack of evidence to suggest the assertion that weight or body fat is the cause of these conditions.  After all, so-called “weight-related co-morbidities” are also present in thinner people – they also have heart disease, diabetes, arthritis, depression, and other chronic disease.

We are all aware of the multiple factors that can contribute to each of these conditions—genetics, aging, other medical conditions, lifestyle, just to name a few. So, why the focus on weight? Perhaps because it is easily measured and thought to be something that we can change. However, from a health standpoint, we know that attempts at intentional weight loss are actually correlated with emotional eating, disordered eating, weight cycling and weight gain. Furthermore, research has shown that chronic weight cycling is linked to higher risk of heart disease and diabetes.

Wouldn’t it make sense to stop prescribing a treatment that is associated with the opposite effect of what it’s supposed to do?

Rather than promising weight loss as the holy grail of health, let’s reshift the focus to eating nourishing foods, joyful movement, and other self-care practices that help an individual, regardless of their size. Let’s advocate for changes in our environment and other social determinants of health, which arguably have a larger effect on our overall wellbeing. Most of all, let’s begin to emphasize that adopting healthier habits is absolutely possible for everyone,

No matter what size they are right now.

Adapted from the original article.
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Vincci Tsui, RD is a former bariatric dietitian turned certified Intuitive Eating counselor and Health At Every Size(r) advocate. Based in Calgary, Canada, Vincci specializes in helping people untangle their messy relationships with food and their body, and works with individuals in-person and virtually through her private practice. Read more from Vincci at www.vinccitsui.com.

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