Wrong Way to Fight Fat

By Rebecca M. Puhl and Kelly Brownell
Thursday, November 2, 2006

"Post your favorite fat photo on your refrigerator."

This weight loss tip from a bodybuilding Web site reflects the widespread belief that making people feel bad about themselves is an acceptable -- and effective -- form of motivation to lose weight. It isn't. In fact, the effect of this sort of thing -- we call it weight stigma -- is likely to be just the opposite.

If the misconception were limited to a few Web sites it wouldn't be much of a problem. But in late September a sensitive and intelligent professional asked one of us, "Isn't there a danger that in fighting weight stigma you are glorifying obesity, actually discouraging people from a healthy lifestyle?"

The research says no. With colleagues, we recently completed a study of more than 2,000 people enrolled in a weight loss program. (It's in the October issue of the journal Obesity.) Participants told us that when they are stigmatized because of their weight they respond with such strategies as eating more food and just giving up on dieting. Eating more in response to discriminatory treatment was reported by 79 percent of the participants, and 75 percent refused to diet. A smaller number, 63 percent, said that they had at one time or another used dieting to cope with such discrimination, but dieting doesn't work very often.

Other studies have shown that overweight girls and boys who are teased because of their weight are more likely to engage in unhealthy weight control and binge eating than are overweight youth who are not teased. It has also been shown that overweight young people avoid physical activities in which peer victimization frequently occurs.

The data are quite clear: Stigmatizing overweight people contributes to unhealthy behavior that only adds to the problem of obesity. With two-thirds of American adults now overweight or obese, obesity is recognized as a pressing public health issue. Schools, health professionals and communities across the country are beginning to talk about what must be done to improve eating habits and encourage more physical activity. But these efforts, which are urgently needed, must expand to include the topic of weight stigma.

Weight stigma is more than indirect experiences -- for example, feeling inadequate compared with the size-zero celebrities who are everywhere in our culture. Derogatory comments, job discrimination and even physical aggression were all reported by study participants.

The personal stories that we have collected in years of studying this issue are heartbreaking: a mother joking in a crowded room that she takes her child to a tentmaker to buy back-to-school clothes. A doctor telling a patient that she is too fat to interest her husband sexually. A teacher announcing to a classroom that an absent child "probably stayed home to eat."

These stories reflect a viciousness long ago shunned in matters of race or gender. In the case of obesity, though, there is a perverse twist: The people inflicting the stigma are often convinced that they are actually helping the victim. Indelible harm is the more likely result.

The sources of weight stigmatization reported in the study were surprising, with family members being the most frequent perpetrators at 72 percent and physicians following closely at 69 percent. But doctors were not the only health-care professionals to make the list: 46 percent of respondents reported being stigmatized by nurses, 37 percent by dietitians or nutritionists, and 21 percent by mental health professionals.

The obvious question is: If even the health-care system is unwelcoming, where can an obese person turn for help? Health professionals are not biased more than others; they reflect society in general. We all need to change.

The first step is simple. We need to recognize that weight stigma is harmful, that it may well be contributing to obesity and that it is not legitimate. Obesity rates are increasing everywhere in the world, driven by worsening diets and declining physical activity (intersecting with human biology, which has evolved to crave foods high in sugar and fat). Time and effort spent ridiculing overweight people would be better used in advocating for a society in which better eating and more physical activity are encouraged, rather than one in which certain people are denigrated and discouraged.

It's hard to change attitudes, perhaps even harder than it is to lose weight. But the public health, not to mention fairness and humanity, demands nothing less.

Rebecca M. Puhl is coordinator of community and weight stigma initiatives at the Rudd Center for Food Policy and Obesity at Yale University. Kelly Brownell is director of the center and a psychology professor at Yale.

© 2006 The Washington Post Company