Weight Stigma and Social Pressure

Being obese in the US is frequently accompanied by exposure to weight-related pressure and prejudice from a variety of sources, ranging from negative portrayals of obese individuals in the media to interpersonal difficulties with family members and co-workers. This can lead to negative physical and physiological health outcomes and is also associated with increased weight gain.

Fat bias or weight stigma is a pervasive and increasingly prevalent form of social discrimination involving negative weight-based stereotyping. Research indicates that the majority of overweight and obese individuals in the US have experienced some form of weight stigmatization. Furthermore, individuals who have not directly faced discrimination can still be negatively affected by weight stigma by internalizing negative social messages about obesity and overweight.

Weight Bias as Discrimination

It is not clear why weight stigma is on the increase in the US when other forms of discrimination such as racism and homophobia are considered socially unacceptable. Whilst the tendency to discriminate based on stereotypes is not a recent phenomenon, weight stigma is a relatively new form of prejudice, and is not universal; some cultures still view excess body weight as a sign of prosperity or high social status. It has been theorized that the high values placed upon individualism and self-determinism in the US may be at least partially responsible, with the current trend towards stereotypical representations of overweight and obese people in the media potentially having an exacerbating effect.

Disease stigma arises when the disease is perceived to be within the individual’s control. Similarly, weight stigma occurs when an individual is seen as being responsible for their own overweight or obesity. According to the psychological theory of attribution, people have a tendency to ascribe particular personality traits to individuals in order to explain aspects of their behavior or life situation. This can lead some people to view obese individuals as greedy, unintelligent, unattractive, lazy or lacking in self-control, rather than acknowledge the fact that obesity is a highly complex issue involving a range of genetic, biological, environmental and social factors.

Another issue that may contribute towards the prevalence of weight stigma is the widespread belief that social pressure can be effective in motivating someone to lose weight. There is currently no evidence to support this being the case. In fact, attempts to shame, embarrass or otherwise pressure people into losing weight frequently have the opposite effect, and exposure to weight stigmatization places obese individuals at increased risk of developing a range of serious physical and psychological health problems.

Social Exclusion and Negative Portrayals of Obesity

Weight stigma can take various forms including social exclusion, disrespectful, inappropriate or cruel remarks and teasing, practical issues such as seats, doorways or medical equipment being too small and negative portrayals of obese individuals in the media. It can lead to diminished employment prospects and educational opportunities, discrimination from educators and healthcare professionals and difficulties with interpersonal relationships. These factors can in turn contribute towards increased levels of stress, anxiety and an overall reduction in quality of life.

Experiencing weight stigmatization is positively associated with increased likelihood of being diagnosed with binge eating disorder, with many overweight and obese individuals displaying a tendency to overeat as a means of coping with weight stigma. Individuals who encounter weight stigma are also less likely to participate in regular exercise, even after controlling for factors such as BMI and body dissatisfaction.

Being subject to prejudice can affect physical and psychological health by promoting stress, which is associated with weight gain alongside numerous other negative health consequences. Those who internalize negative weight-related stereotypes are particularly susceptible to depression, anxiety, low self-esteem and body image concerns.

Obese individuals may experience various forms of relational victimization including social exclusion, being ignored, rejected or the subject of unpleasant gossip. This can result in isolation, loneliness and lack of social support, which are known risk factors for depression.

Fat Talk and Negative Dialog About Obesity

Fat talk is the phenomenon of engaging in negative dialog about body size or shape. It can occur within social groups, between individuals or internally. Whilst some individuals feel that expressing dissatisfaction about their own weight or body shape to others can have a positive impact as it provides an opportunity to receive empathetic responses, research indicates that both overhearing and actively participating in fat talk are associated with increased levels of body dissatisfaction, guilt and sadness independently of BMI. Additionally, participating in negative talk about weight and body shape in the presence of children and young people can have an adverse influence on how they view themselves and others.

Weight Bias Among Family and Friends

Whilst some individuals receive positive encouragement to lose weight from friends and family, others may find themselves subject to weight bias within the home, or even experience pressure to maintain unhealthy eating habits or deliberate attempts to confound their efforts to sustain positive lifestyle changes. Weight loss following bariatric surgery can rapidly lead to shifts in social status, improved self-confidence and physical function, all of which can alter the dynamic of existing relationships. This can cause envy or insecurity in others, who may try to sabotage healthy eating and exercise programs by suggesting that the amount of weight loss is too extreme, being critical of food choices, deliberately serving excessively large portions or preparing unhealthy food at family meals.

Some people may find their friends and family monitor and attempt to regulate what they eat, motivated by the desire to help. However, it is important to establish individual patterns of healthy eating without the need for intervention from others. Such interventions can undermine confidence in one’s own ability to cope around food.

Coping Strategies for Weight-Related Social Pressure

Research indicates that the psychological impact of weight-related social pressure is unrelated to the nature of the specific situation encountered, and it has been hypothesized that individual coping strategies may be at least partially responsible for this apparent incongruity.

Challenging Negative Beliefs

There is evidence to suggest that overweight and obese individuals tend to subscribe to the same stigmatizing beliefs about weight as non-obese individuals. Those who internalize negative stereotypes are significantly more likely to experience psychological distress as a result of weight stigma. High levels of body dissatisfaction are also associated with a tendency to adopt maladaptive coping strategies such as overeating, engaging in negative self-talk or socially isolating oneself to deal with weight stigma. Addressing personal attitudes and beliefs about weight, body image and obesity and seeking to replace internal acceptance of negative weight-related stereotypes with an understanding of the diverse factors involved in obesity may help to reduce the negative impact of weight stigma.

Whilst weight loss can ameliorate body image distress and improve self-esteem, making it easier to cope with discrimination and social pressure, research indicates that those issues can be successfully addressed without BMI reduction. Talking therapies such as Cognitive Behavioral Therapy (CBT) can be particularly beneficial to individuals with binge eating disorder or who are experiencing high levels of body image distress.

Social Support May Protect Against Weight Stigma

Individuals who experience high levels of social support tend to be less negatively affected by exposure to weight stigma and lose greater amounts of weight following bariatric surgery. Confiding in friends and family can mitigate the effects of discrimination, reduce stress and improve psychological wellbeing. When family and friends are unsupportive, discussing any concerns or misconceptions they may have about obesity, weight loss or bariatric surgery may help, as negative attitudes frequently stem from ignorance of the facts or misplaced concern. However, it is also important to remember that other sources of support are available. Attending a bariatric support group is associated with increased weight loss, and can be a source of practical advice and emotional support. Online groups and forums can also provide access to information and advice, as well as facilitating contact with individuals facing similar challenges.

Whilst certain relationships may change or become challenging to maintain following post-bariatric weight loss, it is typical to experience improvements in psychosocial functioning following bariatric surgery, leading to increased social activity and improved interpersonal relationships generally. In cases of severe relationship difficulties, it may be appropriate to seek professional intervention in the form of counseling, mediation or family therapy.

Positive Self-Talk as a Cognitive Technique

Positive self-talk (PST) is a cognitive technique used to manage negative thoughts that can cause or exacerbate problems such as anxiety, stress and depression. The technique is widely used by athletes to enhance performance across a range of sporting disciplines but has also been validated within healthcare settings and is associated with improved ability to maintain weight loss and cope with weight-stigma.

One approach to practicing positive self-talk involves identifying negative thoughts as they arise and replacing them with positive statements. For instance, if a negative thought such as “I fail at everything” arises, consider whether this is accurate or realistic. Think about times when you have succeeded at something and create positive statements based upon those experiences. You can write them down, say them out loud or just repeat them in your head. Some people also like to compile a list of specific positive self-talk statements to help them deal with particular challenges or difficult situations or to boost their confidence generally. This could involve identifying a number of honest positive statements about yourself that you can use as needed, focusing on your positive qualities, achievements and goals.

Medical Condition: 
Morbid Obesity
Medical Procedure: 
Bariatric Surgery
Speciality Classification: 
PublicHealth
Medical Entity Classification: 
Social Problems
MeSH Identifier: 
I01.880.735
National Library of Medicine: 
MeSH
Medical Audience: 
Patient