Weight bias is hurting us. Here’s what we can do about it.

We are obsessed with weight, or more accurately—we are obsessed with weight loss. Every year, 45 million Americans go on a diet, and we spend $33 billion on weight loss products each year (Boston Medical Center, 2018). 

It would be reasonable to assume that our enthusiasm for weight loss translates into healthful dietary behaviors, but this is not the case.

• Most Americans exceed the recommendations for added sugars, saturated fats, and sodium, 
• Three-fourths of the population consume a diet that is low in fruits and vegetables, and
• More than half of the calories in the American diet come from processed foods (HHS, 2018). 
  

What about physical activity? Are the numbers any better? Not quite. A report from the Centers for Disease Control and Prevention revealed that only 23% of Americans are meeting the recommendations for physical activity (CDC, 2014).

How is this weight-loss obsessed –while undernourished and inactive –paradox even possible? Like most public health dilemmas, this one is multifaceted. We are all aware of overweight and obesity rates and the increased portion sizes now served at home and in restaurants. Furthermore, our over-scheduled lifestyles can make it hard to fit in regular exercise. All of these things are important pieces to the puzzle, but emerging research suggests that there is another piece that may be sabotaging our “move more” and “eat better” health promotion messages more than we realize. That piece is weight bias.

Weight bias is defined as negative weight-related attitudes, beliefs, assumptions, and judgements towards individuals who are overweight and obese” (Alberga et al., 2016). It is difficult to capture how often weight bias occurs, but the literature suggests that it is pervasive. It occurs in employment settings, schools, and even medical facilities (Obesity Society, 2018). A 2016 study published by the American Psychological Association followed 46 participants for 14 days. All participants were considered overweight based on BMI standards (mean BMI was 30.52). Participants were asked to track self-reported weight stigmatizing experiences for the full 14 days. On average, participants experienced 11 episodes of weight stigma over the two-week period. In this study, the more frequently weight stigma was experienced, the less motivated participants were to diet, exercise, and lose weight (Vartanian et al., 2018).

Unfortunately, health promotion campaigns that are weight-focused can unintentionally perpetuate these biases and stereotypes, especially when they conflate thinness and weight loss with health. The thin = healthy message that is embedded in so many of our fitness programs is problematic. Not only do these types of messages reinforce weight stigma, they do not promote long-term weight loss, and they often negatively impact self-esteem and body image (Pearl et al., 2015; Essayli et al., 2017).

So what works? A trans-disciplinary movement called Healthy at Every Size (HAES) uses a weight-neutral approach to health and fitness. The model has been shown to improve both psychological and physiological health metrics (ACSM, 2015). As health-fitness professionals and enthusiasts, we have the ability to help shift weight stigmatizing culture by adopting a HAES approach to movement and physical activity. The HAES model is rooted in principles that promote inclusion and that focus on process goals (e.g. physical activity) rather than outcome goals (e.g. weight loss). The Healthy at Every Size Principles are:

1. Weight Inclusivity: Accept and respect the inherent diversity of body shapes and sizes and reject the idealizing or pathologizing of specific weights.
   
2. Health Enhancement: Support health policies that improve and equalize access to information and services, and personal practices that improve human well-being, including attention to individual physical, economic, social, spiritual, emotional, and other needs.
   
3. Respectful Care: Acknowledge our biases, and work to end weight discrimination, weight stigma, and weight bias. Provide information and services from an understanding that socio-economic status, race, gender, sexual orientation, age, and other identities impact weight stigma, and support environments that address these inequities.
   
4. Eating for Well-being: Promote flexible, individualized eating based on hunger, satiety, nutritional needs, and pleasure, rather than any externally regulated eating plan focused on weight control.
   
5. Life-Enhancing Movement: Support physical activities that allow people of all sizes, abilities, and interests to engage in enjoyable movement, to the degree that they choose.    

Source: Association for Size Diversity and Health. 2018

As we move to spaces that truly promote the Healthy at Every Size message, we must remember to confront our own biases. Ask yourself, do I hold any biases related to weight and body size? Do I make assumptions about a person’s fitness and health based on outward appearances alone? Keep in mind that not all bias and prejudice exist at a conscious level. Researchers at Harvard have developed the Implicit Association Test (IAT), a tool that measures attitudes and feelings outside of our awareness and control. Implicit attitudes can impact our behaviors just as much as explicit attitudes. This means that our intention to treat all people equal regardless of body size or fitness level could be superseded by implicit attitudes. But here’s the good news –once we are aware of our own hidden biases, we can work to align both our attitudes and behaviors with our intentions. You can learn more and take the Weight IAT at: https://implicit.harvard.edu/implicit/selectatest.html.

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References

• Alberga, A.S., Russell-Mayhew, S., von Ranson, K.M., & McLaren, L. (2016). Weight bias: A call to action. Journal of Eating Disorders, 4(1), 34.
• Association for Size Diversity and Health (2018). Healthy at Every Size Principles. Retrieved from https://www.sizediversityandhealth.org/content.asp?id=76
• Boston Medical Center (2018). Weight Management. Retrieved from http://www.bmc.org/nutrition-and-weight-management
• Centers for Disease Control and Prevention (2014). State Indicator Report on Physical Activity. Retrieved from https://www.cdc.gov/physicalactivity/downloads/PA_State_Indicator_Report_2014.pdf
• Essayli, J.H., Murakami, J.M., Wilson, R.E., & Latner, J.D. (2017). The impact of weight labels on body image, internalized weight stigma, affect, perceived health, and intended weight loss behaviors in normal-weight and overweight college women. American Journal of Health Promotion, 31(6), 484–490.
• Obesity Society (2018). Obesity, Bias, and Stigmatization. Retrieved from http://tosconnect.obesity.org/obesity/resources/facts-about-obesity/bias-stigmatization
• Pearl, R.L., Dovidio, J.F., & Puhl, R.M. (2015). Visual portrayals of obesity in health media: Promoting exercise without perpetuating weight bias. Health Education Research, 30(4), 580–590.
• Souza., B. (2015). A weight neutral approach to health and fitness instruction. ACSM’s Health & Fitness Journal. 19 (2), 17-22.
• U.S. Departments of Health and Human Services and Agriculture (2018). Current Eating Patterns in the United States. Retrieved from https://health.gov/dietaryguidelines/2015/guidelines/chapter-2/current-eating-patterns-in-the-united-states/
• Vartanian, L.R., Pinkus, R.T., & Smyth, J.M. (2018). Experiences of weight stigma in everyday life: Implications for health motivation. Stigma and Health, 3(2), 85-92.

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Contributed By:

Jennifer Turpin Stanfield, M.A. (Exercise Science), is the Assistant Director for Fitness and Wellness at Wright State University in Dayton, Ohio, a fitness writer, and a national presenter for NETA. She has more than 15 years of experience in the health and fitness industry and is passionate about helping others live healthier lives through the adoption and maintenance of positive health behaviors.