The War on Obesity vs the War on Obese People

The Western world’s rising levels of the overweight and obese are matched by steep increases in weight stigma: negative bias and discrimination towards those carrying excess body weight. The problem of weight stigma is, for lack of a better word, huge.

Implicit in the concept of weight stigma is the idea that an individual’s weight is the fault and responsibility solely of the individual. Perhaps there is some soothing appeal to this explanation. With so much about one’s future health being uncertain and out of control, there may be comfort in the idea that becoming overweight or obese is a choice you make.

If you haven’t previously stopped to consider your own beliefs about the cause of being overweight or obese, this could be a bias you implicitly hold, and right now you might be thinking, “If weight management is not an individual’s responsibility, then whose responsibility is it?”

It’s a good question, and an important one. I’m glad you asked it. There are two dominant, and opposing, views. The first, the personal responsibility perspective, places the weight (I’m so sorry but it’s truly difficult not to fill this article with puns) of responsibility for the social problem of overweight and obesity on the personal deficiencies of each individual affected by the problem. This explanation generates solutions that focus on changing an individual’s ‘problematic’ behaviours.

When these solutions aren’t effective, and they most often are not, weight stigma increases. It turns out that shame and discrimination are not useful motivators of behaviour. In fact, there is overwhelming evidence that the ‘personal responsibility’ perspective makes the problem worse.

In both children and adults, the experience of weight stigma actually increases unhealthy eating behaviours, reduces levels of physical activity, increases the likelihood of engaging in binge-eating or extreme weight-control practices, and can lead to the development of depressive symptoms and/or bulimia nervosa.

So, how is weight stigma experienced? For children and adolescents, primarily through weight-based teasing by other children. There is also evidence that overweight youths are subject to weight-based discrimination by teachers, particularly during physical education. In line with this, a survey of PE teachers showed that teachers had lower expectations of overweight students, compared to non-overweight students, particularly if those students were girls. Nice one.

For adults, weight stigma and discrimination is evident in the workplace, interpersonal relationships and even in the health care system. In employment settings, overweight and obese individuals are more likely to report being overlooked for a position or promotion, and wrongful termination. The likelihood of discrimination increases with body weight, and one study found women were 16 times more likely to report weight-related employment discrimination compared to men.

In relationships, overweight and obese individuals are more likely to report romantic relationship dissatisfaction, be rated by their partners as less skilled, warm and responsive, and be teased about their weight by parents and siblings.

Finally, there is overwhelming evidence that health care professionals, from GPs to dietitians, discriminate against overweight and obese patients. One study showed that as patient BMI increased, physicians reported corresponding decreases in job satisfaction, patience, and desire to help the patient.

I know — I still haven’t answered your very good question, that if weight management is not an individual’s responsibility, whose responsibility is it? The alternative perspective to the personal responsibility point of view is that, as a social problem, weight management exists within a network of social, environmental and political conditions. These can include distribution of wealth and resources, access to green space, unsafe environments, and unethical business practices. These conditions include the role of advanced workplace technology, reductions in the need for manual labour, and neighbourhood safety and walkability.

Never-mind the co-existing changes in food environments, including increased density and location of food stores and restaurants, increased accessibility of inexpensive and calorie-rich foods, and increased marketing and advertising of these foods.

It is likely that the most helpful explanation for rising rates of overweight and obesity lies somewhere between the two perspectives presented above. Indeed, the World Health Organisation recognises that behavioural interventions for weight management are only able to be effective in environments that promote healthy lifestyles, and that are supported by policy and legislation that manage the structural elements of these environments. Next time you find yourself tuning in to shame-porn like The Biggest Loser; remember you’re a part of the system that put those people there.

Dr Jessica L Paterson, Senior Research Fellow, CQUniversity, Appleton Institute

X