Two studies highlight increased fat-shaming and its tie to healthcare avoidance

By Stephanie Stephens
Contributed by Karen Herbst MD PhD

Your patients here in the United States have something in common with patients in Australia, Canada, France, Germany, and the United Kingdom: weight stigma, or fat-shaming.

That’s the finding of a new study published in the International Journal of Obesity that also reported that out of nearly 14,000 adults—mostly White women—enrolled in WW International (formerly Weight Watchers), more than half (55.6 to 61.3 percent) reported the stigma, especially if they had a higher BMI compared to those whose BMI was lower.

The five authors, led by senior author Rebecca Puhl, PhD of the University of Connecticut, said their systematic comparison used “identical measures to assess experiences of weight stigma, including the types, time periods, and interpersonal sources of these stigmatizing experiences.” Those experiences, said the authors, “most commonly involve teasing but also mistreatment and discrimination.”

Puhl is also Deputy Director for the Rudd Center for Food Policy & Obesity.

Being Younger Brought More Stigma

Three yes/no questions asked participants if they’d “ever been teased, treated unfairly, or discriminated against because of their weight.”

The periods of childhood and adolescence were the worst for participants, who completed an online, anonymous survey from May 2020 to July 2020.

It’s easy to think “Ah, strangers can be so mean,” but this study found the accusers were much closer to home, and physicians were not excluded. Among those who fat-shamed: family members (76.0 to 87.8 percent), classmates (72.0 to 80.9 percent), doctors (62.6 to 73.5 percent), co-workers (54.1 to 61.7 percent), and friends (48.8 to 66.2 percent).

The authors recommended similar studies for Africa, Asia, and South America, “where body ideals and other relevant aspects of culture may differ.”

Weight Stigma Reduces Healthcare Quality

As if weight stigma isn’t serious enough, wait, there’s more, according to a second, “sister” study in PLOS ONE that looked at the connections between weight stigma and healthcare experiences. It noted that as obesity rates have increased, sadly, so have weight bias and stigma.

This study noted that two-thirds of participants in the first study said doctors conveyed weight stigma to them. Those with “higher internalized weight bias” said they felt more perceived judgment from doctors and felt they were listened to less and got less respect. As a result, they avoided healthcare more, and went for routine checkups less, and so their quality of healthcare was lower. All weight stigma “was indirectly associated with poorer healthcare experiences” in all countries.

The study found that, on average, almost a third of participants across countries avoided visiting their doctor even when they suspected they should, and that’s not good.

“Obtaining regular care, minimizing delays in healthcare, and promoting effective provider-patient communication are vital to early detection and effective treatment of a number of chronic diseases of which individuals with high weight may be at elevated risk,” the study authors said.

Going forward, they suggested collective and collaborative initiatives to address weight stigma.

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