Obese individuals are highly stigmatized and face multiple forms of prejudice and discrimination because of their weight (1,2). The prevalence of weight discrimination in the United States has increased by 66% over the past decade (3), and is comparable to rates of racial discrimination, especially among women (4). Weight bias translates into inequities in employment settings, health-care facilities, and educational institutions, often due to widespread negative stereotypes that overweight and obese persons are lazy, unmotivated, lacking in selfdiscipline, less competent, noncompliant, and sloppy (2,5–7). These stereotypes are prevalent and are rarely challenged in Western society, leaving overweight and obese persons vulnerable to social injustice, unfair treatment, and impaired quality of life as a result of substantial disadvantages and stigma. In 2001, Puhl and Brownell published the first comprehensive review of several decades of research documenting bias and stigma toward overweight and obese persons (2). This review summarized weight stigma in domains of employment, health care, and education, demonstrating the vulnerability of obese persons to many forms of unfair treatment. Despite evidence of weight bias in important areas of living, the authors noted many gaps in research regarding the nature and extent of weight stigma in various settings, the lack of science on emotional and physical health consequences of weight bias, and the paucity of interventions to reduce negative stigma. In recent years, attention to weight bias has increased, with a growing recognition of the pervasiveness of weight bias and stigma, and its potential harmful consequences for obese persons. The aim of this article is to provide an update of scientific evidence on weight bias toward overweight and obese adults through a systematic review of published literature since the 2001 article by Puhl and Brownell. This review expands upon previous findings of weight bias in major domains of living, documents new areas where weight bias has been studied, and highlights ongoing research questions that need to be addressed to advance this field of study. A systematic literature search of studies published between January 2000 and May 2008 was undertaken on computerized psychological, medical, social science, sport, and education databases including PsycINFO, PubMed, SCOPUS, ERIC, and SPORTDiscus. The following keyword combinations were used: weight, obese, obesity, overweight, BMI, fat, fatness, size, heavy, large, appearance, big, heavyweight, bias, biased, discrimination, discriminatory, discriminate, stigma, stigmatized, stigmatization, prejudice, prejudicial, stereotype(s), stereotypical, stereotyping, victimization, victimize(d), blame(d), blaming, shame(d), shaming, teasing, tease(d), unfair, bully, bullying, harassment, assumptions, attributions, education, health, health care, sales, employment, wages, promotion, adoption, jury, customer service, housing, media, television. Reference lists of retrieved articles and books were also reviewed, and manual searches were conducted in the databases and journals for authors who had published in this field. Most studies retrieved for this review were published in the United States. Any articles published internationally are noted with their country of origin. Research on weight stigma in adolescents and children was excluded from this review, as this literature was recently reviewed elsewhere (8). Unpublished manuscripts and dissertations were also excluded. In addition, issues pertaining to measurement of weight stigmatization, and demographic variables affecting vulnerability to weight bias such as gender, age, race, and body weight are not addressed in this review. This article instead primarily reviews the evidence of specific areas where weight bias occurs toward adults and its consequences for those affected. This article is organized similarly to the first review published by Puhl and Brownell (2), with sections on weight bias in settings of employment, health care, and education. New sections have been added including weight bias in interpersonal relationships and the media, as well as psychological and physical health consequences of weight bias, and the status of stigma-reduction research. As with the 2001 article, this review also provides an update on legal initiatives to combat weight discrimination, and outlines specific questions for future research.

https://www.sochob.cl/pdf/obesidad_adulto/The%20Stigma%20of%20Obesity%20%20A%20Review%20and%20Update.pdf

The stigma of obesity: a review and update.

Bodies of research pertaining to specific stigmatized statuses have typically developed in separate domains and have focused on single outcomes at 1 level of analysis, thereby obscuring the full significance of stigma as a fundamental driver of population health. Here we provide illustrative evidence on the health consequences of stigma and present a conceptual framework describing the psychological and structural pathways through which stigma influences health. Because of its pervasiveness, its disruption of multiple life domains (e.g., resources, social relationships, and coping behaviors), and its corrosive impact on the health of populations, stigma should be considered alongside the other major organizing concepts for research on social determinants of population health.

/pdf/stigma-as-a-fundamental-cause-of-population-health-4zm46wls6r.pdf

Stigma as a fundamental cause of population health inequalities.

Stigma and discrimination toward obese persons are pervasive and pose numerous consequences for their psychological and physical health. Despite decades of science documenting weight stigma, its public health implications are widely ignored. Instead, obese persons are blamed for their weight, with common perceptions that weight stigmatization is justifiable and may motivate individuals to adopt healthier behaviors. We examine evidence to address these assumptions and discuss their public health implications. On the basis of current findings, we propose that weight stigma is not a beneficial public health tool for reducing obesity. Rather, stigmatization of obese individuals threatens health, generates health disparities, and interferes with effective obesity intervention efforts. These findings highlight weight stigma as both a social justice issue and a priority for public health.

https://ajph.aphapublications.org/doi/pdfplus/10.2105/AJPH.2009.159491

Obesity Stigma: Important Considerations for Public Health

Background/Aims: Increasing public awareness of obesity genetics could have beneficial or harmful effects on overweight individuals. This study examined the impact of genetic information on weight-related cognitions as well as interest in personalized genetic information about obesity among overweight individuals. Methods: Online survey respondents (n = 655) were randomly assigned to read either genetic, gene-environment, or nongenetic obesity causal information. Fifty-two percent of the participants were female, 82.4% were White, 45% had an annual income of USD Results: Participants in the genetic and gene-environment conditions were more likely to believe genetics increase obesity risk than participants in the nongenetic condition (both p Conclusion: Dissemination of information about obesity genetics may have neither a beneficial nor a harmful impact on how overweight individuals perceive themselves. Some overweight individuals may be interested in receiving personalized genetic information. The actual effects of obesity genetic information being incorporated into public health messages and of personalized genetic information on obesity prevention and treatment interventions remain to be seen.

/pdf/impact-of-informing-overweight-individuals-about-the-role-of-1ikao5lufj.pdf

Impact of Informing Overweight Individuals about the Role of Genetics in Obesity: An Online Experimental Study

The objective of this study was to critically review the empirical evidence from all relevant disciplines regarding obesity stigma in order to (i) determine the implications of obesity stigma for healthcare providers and their patients with obesity and (ii) identify strategies to improve care for patients with obesity. We conducted a search of Medline and PsychInfo for all peer-reviewed papers presenting original empirical data relevant to stigma, bias, discrimination, prejudice and medical care. We then performed a narrative review of the existing empirical evidence regarding the impact of obesity stigma and weight bias for healthcare quality and outcomes. Many healthcare providers hold strong negative attitudes and stereotypes about people with obesity. There is considerable evidence that such attitudes influence person-perceptions, judgment, interpersonal behaviour and decision-making. These attitudes may impact the care they provide. Experiences of or expectations for poor treatment may cause stress and avoidance of care, mistrust of doctors and poor adherence among patients with obesity. Stigma can reduce the quality of care for patients with obesity despite the best intentions of healthcare providers to provide high-quality care. There are several potential intervention strategies that may reduce the impact of obesity stigma on quality of care.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/obr.12266

Impact of weight bias and stigma on quality of care and outcomes for patients with obesity

This study conducted a content analysis to examine the types of images that accompany online news stories about obesity and to determine how obese people are portrayed in news photographs. Images were selected from news articles about obesity obtained from 5 major news Web sites, during a 2-week period in September of 2009. Images accompanying news stories about obesity (N = 549) were systematically coded. Of 441 individuals identified in news photographs, 65% were overweight/obese and 27% were nonoverweight. Overall, 72% of images that depicted an overweight or obese person were portrayed in a negative, stigmatizing manner. Overweight/obese individuals were significantly more likely to have their heads cut out of the photos, to be portrayed showing only their abdomens or lower bodies, and to be shown eating or drinking than were nonoverweight individuals. Overweight/obese individuals were significantly less likely to be shown fully clothed, wearing professional clothing, or exercising than were nonoverweight individuals. Obese individuals are frequently stigmatized in online news photographs; this phenomenon has important implications for public perceptions of obese persons and may reinforce pervasive prejudice and discrimination.

http://www.uconnruddcenter.org/resources/upload/docs/what/bias/ObesityStigmaOnlineNews_JHC_5.11.pdf

Obesity Stigma in Online News: A Visual Content Analysis

News coverage of obesity has increased dramatically in recent years, and research shows that media content may contribute to negative public attitudes toward obese people. However, no work has assessed whether photographic portrayals of obese people that accompany news stories affect attitudes. In the present study, the authors used a randomized experimental design to test whether viewing photographic portrayals of an obese person in a stereotypical or unflattering way (versus a nonstereotypical or flattering portrayal) could increase negative attitudes about obesity, even when the content of an accompanying news story is neutral. The authors randomly assigned 188 adult participants to read a neutral news story about the prevalence of obesity that was paired with 1 of 4 photographic portrayals of an obese adult (or no photograph). The authors subsequently assessed attitudes toward obese people using the Fat Phobia Scale. Participants in all conditions expressed a moderate level of fat phobia (M = 3.83, SD = 0.58). Results indicated that participants who viewed the negative photographs expressed more negative attitudes toward obese people than did those who viewed the positive photographs. Implications of these findings for the media are discussed, with emphasis on increasing awareness of weight bias in health communication and journalistic news reporting.

Obesity in the News: Do Photographic Images of Obese Persons Influence Antifat Attitudes?

Background Several studies have examined attitudes about obesity among food and nutrition professionals, yielding mixed results, and no experimental research has tested the impact of dietitians' attitudes on their treatment practices or health evaluations with obese patients. Objective This study investigated attitudes of dietetics students toward obese persons and tested whether a patient's body weight influences students' treatment decisions and health evaluations within a randomized experiment. Design Between the months of September and December 2007, a convenience sample of 182 dietetics undergraduate students (92% women; mean age 23.1±5.4 years) from colleges throughout the United States completed online self-report surveys to assess weight bias (using the Fat Phobia Scale). Participants were also randomly assigned to read one of four mock health profiles of patients who varied only by weight-related characteristics (eg, obese or average weight) and sex (male or female), and asked to make judgments about the patient's health status and participation in treatment. Statistical analyses performed To compare group data, multiple analysis of variance was used to test for an effect of the patient's body mass index on participants' health evaluations and their perceptions of patients in each of the four experimental conditions. Correlations were calculated between mean fat phobia scores and perceptions of patients. Results Participants in all conditions expressed a moderate amount of fat phobia (mean=3.7), and students rated obese patients as being less likely to comply with treatment recommendations compared with nonobese patients ( P Conclusion Implications of these findings for education and intervention in dietetics training are discussed, with emphasis on increasing awareness of weight bias in existing dietetics curricula.

Chelsea A. Heuer

Papers

The stigma of obesity: a review and update.

Obesity Stigma: Important Considerations for Public Health

Obesity Stigma in Online News: A Visual Content Analysis

Obesity in the News: Do Photographic Images of Obese Persons Influence Antifat Attitudes?

Weight Bias among Dietetics Students: Implications for Treatment Practices