Weight stimga and bias - what is known? Rapid review of evidence

Abstract

Weight stigma is pervasive in mass media, including news, movies and television, as well as social media. Mass media perpetuate weight stigma through overrepresentation of thin and underweight individuals, underrepresentation of individuals with obesity, and the portrayal of characters with obesity in a stigmatizing or negative light. This cumulative evidence indicates that the media is an influential source that can reinforce bias against people with obesity. Despite having a goal to promote healthy behavior and reduce obesity, and in contrast to the argument that stigma motivates engagement in health behaviours, obesity-related media campaigns perpetuating messages of blame and stigma against individuals with obesity can instead reduce motivation to engage in weight-related health behaviours. Stigmatizing visual portrayals of obesity elicit less self-efficacy to engage in health behaviours among individuals of diverse weight status. Children and adults who experience weight stigma are vulnerable to numerous consequences affecting their psychological and physical health. Psychological consequences include increased risk of depression, anxiety, low self-esteem, poor body image, substance abuse, and suicidal thoughts and behaviours. Many of these outcomes persist even after accounting for factors such as BMI, obesity onset, gender, and age, indicating that negative psychological consequences emerge from stigmatizing experiences rather than from obesity per se. Adverse health outcomes which result from peoples experience of weight stigma can reduce quality of life and pose major obstacles to efforts to prevent and treat obesity effectively. This combined evidence suggests that weight stigma and discrimination represent a public health issue and should be prioritized alongside efforts to address this problem as a societal injustice. The evidence on prevention and reduction of weight stigma is at an emergent stage and the quality overall is weak but the seriousness of the probable consequences is such that there is an ethical imperative to take precautionary action now, even as more research is underway or about to commence. Common themes across studies include the following points: i) weight bias is common and has adverse health consequences; ii) shaming individuals for their body weight does not motivate positive behaviour change; iii) internalized weight bias is particularly problematic; iv) public health interventions, if not carefully thought out, can perpetuate weight bias; v) weight bias is a manifestation of social inequity; vi) action on weight bias requires an upstream, population-level approach; and vii) to achieve sustainable reductions in weight bias at a population level, substantive modifications and collaborative efforts in multiple settings are required. The body of evidence on prevention indicates that multilevel efforts to implement stigma reduction strategies may be required. This will entail downstream stigma reduction interventions targeted to different settings (e.g., education and training of medical professionals to reduce weight-based stigma in health care), but broader upstream policy initiatives are likely required to eradicate systemic societal weight-based discrimination and prejudice that otherwise remain pervasive and impair the health and quality of life for many people who are so affected. On message framing, the evidence suggests that neutral terminology (e.g., “weight” or “unhealthy weight”) is preferred and that words like “obese” and “fat” are least acceptable, particularly in provider patient conversations about weight. Individual variation in language preferences is evident across demographic characteristics like race/ethnicity, gender, and weight status. Research to improve upon the limited diversity of the existing evidence, both with respect to sample diversity and the use of culturally relevant weight-related terminology (which is currently lacking in measurement) is urgently needed. In public health media campaigns targeting obesity prevention, careful consideration should be given to messages communicated to ensure that messages intended to promote optimal weight-related health behaviours do not simultaneously stigmatize or shame individuals with obesity.