Weight stigma isn't just cruel — it makes losing weight harder

CNN

6 days ago

Maybe you have decided that the voice inside your head judging yourself or others for body size can be pretty mean, but at least it's encouraging weight loss, right?
No, it's not, experts say.
'There has long been a misunderstanding … that if you shame people about their weight, then that will lead them to eat less or to eat more healthfully or to exercise more in order to lose weight,' said Dr. Rebecca Pearl, associate professor of clinical and health psychology at the University of Florida.
'What the research, though, has shown over and over again is that that is not true,' Pearl said. 'It actually has the opposite effect.'
Stigma around weight and body size is everywhere: in US culture, messages from people around you and even at your doctor's office, Pearl said.
One study found that after bariatric surgery, experiencing continued weight stigma was associated with higher risks of depression, anxiety and disordered eating such as binge eating. Those who experienced less weight stigma were more likely to continue losing weight and maintain weight loss, according to the study published Thursday in the journal Health Psychology.
And not only are biases around weight damaging to mental health, they also are counterproductive if people want to lose weight or engage in more health-promoting behaviors, said first study author Dr. Larissa McGarrity, clinical psychologist in physical medicine and rehabilitation at University of Utah Health.
Weight stigma centers around a pervasive public misconception: that what a person weighs is entirely within a person's control.
'As a result of that, people should just be able to eat healthy on their own, to lose weight on their own, to be physically active –– that's their personal responsibility to do that,' said Pearl, who was not involved in the study.
When a person doesn't lose weight or comes up against barriers to that thin body ideal –– such as lack of access to nutritious and affordable foods, no place for physical activity, or their genetics –– the misconception says their body shape is a sign of a moral failing, said Dr. Alexis Conason, a psychologist and certified eating disorder specialist in New York City who also did not participate in the new research.
Messages saying that a person has a responsibility to lose weight and is a worse person if they do not can come from images or storylines in television and social media, direct comments from people you know, and bullying or discrimination, Pearl said.
It gets worse when a person absorbs those derogatory remarks from others about their body weight and applies it to themselves.
'Experiencing stigma from other people is harmful,' Pearl said. 'But for the individuals who really internalize that, that seems to be a really strong predictor of these negative eating and physical activity outcomes, but also kind of broader mental and physical health outcomes.'
Physical activity is so important to many aspects of health, including healthy aging, management of depression, better sleep and lower cancer risk.
People often have a hard time going to the gym or getting outside for exercise, because it can feel intimidating or overwhelming, said Dr. A. Janet Tomiyama, professor of psychology at the University of California Los Angeles who was not involved in the study.
It is particularly hard if you know you will get comments, judgment or even just extra attention because of your weight, Conason added.
Research has linked experiencing and internalizing weight stigma to less motivation and enjoyment of physical activity, less confidence about exercising, and less time spent exercising, Pearl said.
'A gym is a location where a lot of weight stigma and fat shaming can happen,' said Tomiyama. 'If you've been stigmatized for the way you look, the last thing you want to do is put on some tight clothes and go to a gym.'
Being judged for your body can be distressing, which can impact food choices.
'When someone is teased or criticized, or even just feels like they're getting negative looks from other people around them, that is stressful,' Pearl said. 'We know that one of the very common ways that everybody copes with stress is by eating more and eating more unhealthy kinds of foods.'
Stress eating isn't a behavior we need to shake our finger and shame people out of either, Tomiyama said. It is in our own biology as well as that of other animals, she added.
Physical or psychological stress signals your body to release the hormone cortisol, Tomiyama said.
'One of the things that cortisol does, is it works on our brain to really activate reward processes that make high-sugar, high-salt, high-calorie food taste really, really good,' she added. 'And so, at a brain level, it's making these potentially health harming foods way harder to resist.'
Cortisol also blocks the parts of your brain that help you make decisions that benefit you in the long term, Tomiyama said.
Research has linked exposure to weight stigma and unhealthy, disordered eating behaviors such as binge eating, purging and unhealthy restriction –– all of which undermine health, Pearl said.
Eating Disorder ResourcesThe NEDA has a confidential, toll free helpline at 800-931-2237 as well as an online click-to-chat service. For 24/7 crisis support, text 'NEDA' to 741-741.
The NEDA also has a list of recommended websites and free or low-cost resources.
ANAD runs a helpline at 888-375-7767 from 9 a.m. to 9 p.m. CT and provides links to support groups and treatment providers.
A call center at 800-334-673 and online chat run by the Butterfly Foundation is open 8 a.m. to midnight AET every day except public holidays.
Helplines for England, Scotland, Wales and Northern Ireland are open 9 a.m. to midnight weekdays and 4 p.m. to midnight weekends, every day of the year. Unfortunately, weight stigma is pervasive, and it isn't something you can snap your fingers and rid yourself of, Conason said.
One step the medical field can take is to de-emphasize body mass index, or BMI, as an important marker of health, especially because it often classifies healthy people as unhealthy and those with health issues as falling into a healthy weight class, Tomiyama said.
When working with clients, Conason also focuses on creating resiliency, she said.
'We may not be able to change the entire culture, but we can try to understand that the problem is the culture, not our bodies,' Conason said. 'That can provide resiliency around moving through the world and experiencing weight stigma and trying not to internalize the stigma.'
Conason does this by helping clients build greater self-compassion, educating them on the ways in which a culture of weight stigma has influenced them, and encouraging the practice of acceptance.
If you notice an internalized weight stigma is affecting your behavior, contacting a disordered eating mental health counselor or a weight-inclusive dietitian may be a helpful first step.