Weight stigma, fat bias, or weight discrimination are terms you may have encountered through the media, and are part of an ongoing health and cultural debate over the stigma associated with being overweight. Fatphobia, a concept inclusive of these terms, identifies the implicit and explicit bias aimed at overweight and obese individuals that is often infused with an intense sense of blame or failure.
Fatphobia is a trending topic in television shows, healthcare circles, and is becoming a common discussion at the dinner table. While plus-size models like Ashley Graham and Tess Holliday have been changing dialogues about what it means to be beautiful, healthy, and larger than life, many barriers to better social and health outcomes still remain.
Obesity in America is an ongoing health crisis that impacts more than 100 million adults and just under 15 million children as of 2023. From a health promotion perspective, it demands attention, but effectively caring for people who are obese also requires inclusion and equity of care. Dispelling myths and misconceptions about fatphobia so that overweight individuals are comfortable seeking and participating in care is critical.
What is Fatphobia?
Any discussion of fatphobia must first start with knowing what it is and the impact it has on society. Knowing how to recognize and respond to fatphobia while understanding the downstream effects it can have on a person’s health and well-being is the perfect place to start.
Defining fatphobia may not be as straightforward as we think. On one hand, “phobia” implies an intense fear of something that can’t be controlled or is not intentional. On the other hand, fatphobia stems from a bias that implies feelings that are observed and learned through experiences resulting in a conscious or unconscious expression of stigmatization.
Fatphobia is threaded through our culture and societal infrastructure with small seats in movie theaters and airplanes that have even the leanest of individuals rubbing elbows.
In evaluating fatphobia, the definition of the concept does not give us the complete picture. Historically, there have been many times where being overweight was viewed as a positive trait. In the 17th and 18th centuries, for instance, a larger body type was indicative of affluence and privilege, and that body type ideal is reflected in the cherubic depictions of painters like Rubens and Carracci.
By the 20th century, a slender build became symbolic of physical superiority, emphasizing the values of self-control and discipline in America. This, unfortunately, created the sentiment that those who are overweight lack these values. The narrative shifted from weight and health to blame and shame.
Today, breakthroughs in psychology, genetics, nutrition, and medicine have confirmed that the issue is far more complex, and our cultural obsession with weight and weight stigma actually contributes to poorer health outcomes, not better ones.
Can You Be Overweight and Still Be Healthy?
The short answer is yes. Being overweight and being “unhealthy”—a very vague term—are not mutually exclusive.
“Health” relates to the presence of signs and symptoms of disease or debilitation, and is unique to the individual. Some people may be overweight and free of any signs of chronic disease or illness. While being overweight is a precursor to obesity, it doesn’t necessarily imply a deficit in health and wellness.
The Impact of Weight Bias
The dehumanizing impact of weight bias threatens the physical and mental health of those it victimizes. People who are overweight or obese experience marginalization and bias, and may make decisions in pursuit of a sense of safety and self-preservation that can have profound impacts for health and wellness down the line.
Dismissive Medical Care
Stigmatization of weight is, sadly, still a major problem in healthcare. Medical professionals who treat patients through the lens of weight stigma can actually harm the long-term health of patients they are trying to treat.
If people who seek medical care walk away from an encounter feeling worse about themselves than they did before, a vicious cycle of blame and avoidance perpetuates. They will be more reluctant to pursue care in the future, which can result in worse health outcomes.
Dangerous Behaviors Encouraged
Fatphobia implies a lack of understanding and nuance, which will undoubtedly be accompanied by a lack of support and teaching on how to achieve and maintain a healthy body weight. Without proper guidance on how to shed weight in a healthy way, patients may resort to unhealthy eating behaviors like food restrictions.
Food restriction in itself can bring on a whole new set of problems. Patients who take limiting their food intake to the extreme can put themselves at risk for deficiency in vital nutrients, or may possibly rebound to another extreme of disordered eating. Food restriction is not a healthy or sustainable method of losing weight.
Tess Holliday provides a particularly powerful example of the disconnect between body type and healthy eating in American culture. Although she is a plus size model, she was recently diagnosed with anorexia, which is typically associated with being extremely skinny. However, anorexia is fundamentally about control and an intense fear of weight gain, and is a deadly eating disorder that can affect anyone of any size.
The possibility that weight stigma may have played a role in Tess Holliday acquiring a dangerous eating disorder is a tragic reminder of the importance of addressing fatphobic thinking in modern culture.
Improving Health and Wellness Outcomes
The cultural debate over weight stigma isn’t going to be over anytime soon, but in the end, the most important thing is achieving better outcomes for everyone. The goal of each healthcare professional should be to optimize the health and wellbeing of the patient they work with, and that means first identifying their own implicit and explicit biases towards overweight and obesity. It’s critical to employ a non-judgmental approach with empathy and compassion while navigating the complex relationship between weight and health.
Courses like Implicit Bias: Weight Stigma in Healthcare by Premiere can help you navigate these challenging concepts. All courses by Premiere are developed by leading experts in their fields. Implicit Bias: Weight Stigma in Healthcare was created by Anne Cockerham, PhD, RN, CNM, WHNP-BC, CNE, and Professor, Frontier Nursing University.