Weight stigma, also known as weight bias or fatphobia, is the stereotyping, discrimination, or assumption-making about someone based on their weight. Much of this phenomenon is attributed to the cultural idealization of thinness and the subsequent undervaluing of larger bodies. Weight stigma is ingrained in our culture, including within the healthcare and eating disorder treatment world. As you can imagine, the presence of weight stigma in eating disorder treatment can have incredibly harmful effects physically, mentally, and psychologically.
The Birth of Weight Stigma: Profiting off Body Image
First, let’s look deeper into weight stigma, how it started, how it evolved and why it is still prevalent today.
Weight stigma is not a new phenomenon. In fact, it has been shaped and reinforced throughout history, largely based on media representations. In a study conducted in the 1950’s, 10-11 year old children were shown six images of children of varying heights, weights and abilities. They were asked to rank them in order of ‘which child they would like, from the best to the least.’ Across all socioeconomic, racial and ethnic backgrounds surveyed, the image of the child with obesity was ranked last. Skipping ahead to the 1990’s ‘waif era,’ thinness was both the ideal and the norm in terms of media portrayal, which underrepresented and still under-represents much of the population. For decades, thinness has been culturally ingrained in us to be “good”.
Underneath all of this is the belief that thinness means that you have “self control” and are therefore morally “good”. On the other hand, if you are in a larger body, then you are perceived as “lazy” or inherently “bad.”
Weight stigma causes self-loathing or feelings of unworthiness in those whose bodies are considered “larger”. It also causes those in bodies that are considered “normal” or “small” to fear weight gain, otherwise known as fatphobia. Weight stigma affects our relationships with our bodies, our perceptions of food, and our understanding of our place in society.
Weight-based discrimination happens in almost every sector of society. Women especially have been found to be rejected from jobs, educational opportunities and romantic relationships based on their weight. Many social settings, such as restaurants and airplanes, are designed for a certain body type, therefore excluding those who ‘do not fit’ in these spaces that were simply not designed with everybody in mind. A whole dissertation could be drafted on weight stigma in the clothing and fashion industry: read more about it here.
Who benefits from weight stigma? Mostly the weight loss industry, which is worth $72 billion in the U.S. alone (as of 2020). The diet industry perpetuates the ideas that:
- You cannot be fit and fat at the same time.
- All larger people must lose weight to become more healthy and fit
- All fat people are in poor health.
- Everyone can lose weight if they just stick to [insert costly diet and exercise program, plan, pill, DVD set, etc. here]
- The reason that people do not lose weight when dieting is because of their own failure to comply with the diet’s guidelines
- Failure to comply with a diet is a show of weakness or lack of commitment
Within diet culture certain things are demonized. An famous example being the “cheat day,” a day where you “allow yourself” to eat whatever “bad foods” you want. “Bad foods” typically contain higher amounts of carbohydrates, fats or sugar – all of which your body NEEDS TO SURVIVE.
Weight Stigma in Healthcare: “The Obesity Epidemic”
Healthcare workers actually have the highest rates of weight bias out of just about any industry. This is likely because obesity has been portrayed as going hand-in-hand with several harmful or life-threatening conditions such as diabetes, high blood pressure, and heart failure. Because of this association, those in larger bodies often receive vastly different care than those in smaller ones.
Many patients in larger bodies have described their treatment as weight-central, as if weight is always a problem. This has consequences such as:
- Patients putting off going to the doctor due to their fear of fat shaming, and letting potential health problems grow
- Doctors not thoroughly testing for health problems that could be unrelated to weight at all
- The reinforcement of the idea that fat is bad and dangerous, and that you must diet
Weight Stigma in Eating Disorder Diagnosis
You might assume that eating disorder specialists would be immune to weight stigma, but unfortunately, this is not so. There are shifts happening, but weight stigma does also exist in eating disorder diagnosis, treatment, and regarding insurance coverage.
The DSM-V, which is essentially the textbook of mental health disorders, includes weight-based criteria for the diagnosis of certain eating disorders, especially anorexia, which has the highest rate of mortality out of every mental illness. This learned association between weight and eating disorder diagnosis often leads health professionals to overlook key eating disorder symptoms, or not even consider bringing up the idea of eating disorders in general. Individuals who approach the subject can even be dismissed by their healthcare provider, and not offered needed treatment. We have heard many accounts of healthcare professionals praising weight loss, despite the unhealthy, often disordered ways of achieving it.
We know that eating disorders DO NOT DISCRIMINATE and can be experienced by anyone at any size. There can be significant health consequences, such as malnutrition and heart problems, even in those who are considered to be “normal” or “overweight” based on typical BMI measures. Relying on weight-based criteria may cause a disorder to be overlooked for long periods or never be treated.
Many eating disorder sufferers do not immediately seek help due to the idea that they will not be perceived as having a serious illness by their peers. This is known as imposter syndrome, and is a common occurrence in eating disorder treatment facilities.
Insurance Coverage for Eating Disorders
Insurance companies can be difficult in general, but especially when trying to receive treatment for an eating disorder. Your level of care – which may be inpatient, residential, day programming, or outpatient – is governed by your severity of symptoms. Too frequently however, it can also be largely determined by your weight. Those in larger bodies are often not offered as much time in treatment (especially higher levels of treatment) because their disorders are perceived as “less of a threat” by insurance companies. Meanwhile, in actuality, harmful eating disorder behaviors can take months of intensive treatment to mitigate and cease.
Related: How to Pay for Eating Disorder Treatment, because you deserve it.
Hope for the Future
Finally, some good has come out of social media in terms of eating disorders: the Health at Every Size (HAES) movement. This movement is based on the notion that you can be healthy at any size, because our bodies are inherently diverse. Once these principles have been realized and integrated, the moral implications of weight can be lifted, but this will take significant time and effort.
Equally important is the integration of holistic, wellness based healthcare. This mode of healthcare recognizes that weight is only one of many health indicators, and that more is needed to create a full picture of one’s health.
If you or someone you love is suffering from an eating disorder, take the first step today and talk to talk to someone about recovery or simply learn more about the eating disorder recovery programs we offer.
