We’re dietitians but we may not weigh you. Here’s why…
Obesity has been firmly positioned in the public eye as a worldwide public health issue. The links between overweight and obesity to all cause mortality and chronic disease are frequently cited and publicised. Whilst the intention may be well-meaning to improve public health outcomes, the associated stigma that has developed continues to see responsibility and blame being placed on individuals for assumed poor dietary and lifestyle choices. Weight bias, or weight stigma, refers to this associated stereotyping, discrimination and social exclusion based on an individual’s body weight, which, in turn, can lead to poorer health outcomes for our population .
Stigmatisation of any trait, regardless of whether internalised or driven externally, can lead to experiences of low self-esteem, depression, reduced quality of life and discrimination [2-9]. Representative studies have shown that some forms of weight discrimination are even more prevalent than discrimination based on race or ethnicity . Weight stigma has been associated with an increased risk of mortality, chronic diseases and health conditions, including an increased risk of obesity, beyond the risk associated with an elevated body mass index (BMI) [1,10,11]. This presents an interesting juxtaposition to the well-publicised links between overweight and obesity to all cause mortality and chronic disease. It’s an alarming irony that weight stigma can exacerbate the original health concerns that are linked with overweight and obesity in the first place. Elevated caloric consumption, disordered eating and diet cycling are all more common when weight discrimination exists . Perhaps public health policy would be more effectively directed at addressing the stigma associated with obesity and cultivating attitudes conducive to positive health outcomes more broadly.
Weight bias remains particularly prevalent in the medical and healthcare industry. High levels of stigma and bias have been reported amongst health professionals, often resulting in poorer care or reduced health outcomes for individuals of larger size [1,11]. Further, where stigmatisation is internalised, coping mechanisms, including intake of alcohol and substance use, have been reported help manage the associated negative psychology .
The field of dietetics is not immune to weight bias. A study of 400 Australian dietitians highlighted clinician reports of frustration with lack of perceived compliance, commitment, motivation and unrealistic expectations with their overweight or obese clients . Similar attitudes were displayed by dietitians in the UK where obese people were considered more responsible for their excess weight than overweight individuals . Studies in dietetic students have shown the majority of student cohorts agreeing with stereotypes that overweight people lack self control, overeat, are inactive or lazy, suffer from poor self esteem and are insecure [15,16].
In order for the culture of weight bias to change, these finding stress the need for education to be included in dietetic and health curriculums. Further education and understanding is required amongst current and emerging health professionals around the detrimental impact of weight stigma, and the evidence regarding the inaccurate assumptions that overweight or obesity shortens lifespans or that reduction in weight will necessarily reverse risk factors of chronic disease.
Training of all health professionals must address weight bias front on, exploring how this pervasive stigma sustains and accelerates the condition and worsens health outcomes for their clients, patients and the population. Public health policy and promotion needs to address weight stigma directly, campaigning widespread awareness as a starting point. Whilst the value of compassion can not always be taught, the strength of evidence of the inefficacy of traditional weight loss interventions can be.
T A I L O R Y O U R P L A T E | B U I L D Y O U R B E S T Y O U
Accredited Practising Dietitian
- The Lancet Public Health. Addressing weight stigma. The Lancet Editorial. 2019 April; 4(4):168.
- Link BG, Struening EL, Neese-Todd S, Asmussen S, Phelan JC. Stigma as a barrier to recovery: the consequences of stigma for the self-esteem of people with mental illnesses. Psychiatr Serv. 2001;52:1621–1626.
- Phelan SM, Griffin JM, Jackson GL, et al. Stigma, perceived blame, self-blame, and depressive symptoms in men with colorectal cancer. Psychooncology. 2013;22:65–73.
- Phelan SM, Griffin JM, Hellerstedt WL, et al. Perceived stigma, strain, and mental health among caregivers of veterans with traumatic brain injury. Disabil Health J. 2011;4:177–184.
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- Link BG, Phelan JC. Stigma and its public health implications. Lancet. 2006;367:528–529.
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- Tomiyama J, Carr D, Granberg EM, Major B, Robinson E, Sutin AR et al. How and why weight stigma drives the obesity ‘epidemic’ and harms health. BMC Med. 2018; 16: 123.
- Phelan SM, Burgess DJ, Yeazel MW, Hellerstedt WL, Griffin JM, van Ryn M. Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obes Rev. 2015 Apr; 16(4): 319–326.
- Phelan SM, Burgess DJ, Puhl RM et al. The adverse effect of weight stigma on the well-being of medical students with overweight or obesity: findings from a national survey. J Gen Intern Med. 2015;30(9):1251–8.
- Campbell K, Crawford D. Management of obesity: attitudes and practices of Australian dietitians. Int J Obes 2000; 24: 701– 710.
- Harvey, EL, Summerbell, CD, Kirk, SFL, Hill, AJ. Dietitians’ views of overweight and obese people and reported management practices. J Hum Nutr Diet 2002; 15: 331– 347.
- Berryman, D, Dubale, G, Manchester, D, Mittelstaedt, R. Dietetic students possess negative attitudes toward obesity similar to nondietetic students. J Am Diet Assoc 2006; 106: 1678– 1682.
- Puhl, RM, Wharton, C, Heuer, CA. Weight bias among dietetics students: implications for treatment practices. J Am Diet Assoc. 2009 Mar;109(3):438-44.
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