By Dr. Katie E. Golden, MD

The majority of US adults have been labeled as overweight or obese according to the CDC guidelines. This is part of a larger health campaign to identify the drivers and outcomes of increasing rates of obesity across in the US and world. But this has generated a skewed perception that weight is an accurate indicator of health — and thus a harmful bias towards people in larger bodies. 

Many people in larger bodies are healthy, and their weight is not a problem. But almost half of US adults report experiencing weight bias and stigma. And research shows that this discrimination increases mortality risk by as much as 60%, regardless of weight. In other words, anti-fat bias may be a bigger risk to someone’s health than fat itself.

Whenever you need medical care, it is important that you feel safe and supported by your providers. And no one should hesitate to seek medical help to avoid weight discrimination. So here, I’ll explain what weight bias is, how it can be harmful, and what you can do if you experience it. 

What is weight bias?

Weight bias refers to any negative thoughts about someone based on their body size. It is rooted in a false mindset that someone is personally responsible for their weight. This mindset persists despite evidence that shows someone’s weight is mostly determined by genetics and environment, not lifestyle choices.  

There are several different terms used in reference to weight bias. Even though some of these terms have slightly different definitions, they all refer to negative ideas and actions directed towards people based on their weight: 

  • Weight stigma
  • Weight discrimination
  • Anti-fat bias
  • Fat shaming
  • Body shaming
  • Sizeism

Weight bias is pervasive and exists in many different places and forms. But healthcare settings are one of the more common offenders. And this is particularly troubling given weight bias discourages people from seeking the care they need, or finding the treatment they deserve.

Common weight bias thoughts are that people in larger bodies:

  • Are lazy.
  • Have a lack of will power or self-discipline.
  • Are unhappy with their life and/or body.
  • Don’t care about their health.
  • Have poor hygiene.
  • Have a higher weight because of lifestyle choices.
  • Are less likely to be successful.

These thoughts are particularly harmful when they come from a healthcare provider. Especially when they immediately assume someone is unhealthy because of their weight. Or believe that any medical conditions or symptoms stem from their weight. 

Why is weight bias harmful?

If you have experienced weight bias in a healthcare setting, you may have been made to feel like your weight is a problem. But this may not be true. In fact, studies show there may be a large percentage of people who fit the definition of obesity (BMI over 30) that do not have any markers of metabolic disease — like high blood pressure, high cholesterol, or diabetes.

For these people, weight bias may be more harmful that weight itself. Research shows that weight stigma can be source of chronic stress that is associated with the following negative health outcomes:

  • Weight gain. People who experience weight bias are more likely to gain weight or become obese, even if they started at a BMI considered normal. 
  • Mental health conditions. Weight stigma is associated with depression, anxiety, and poor self-esteem. Someone’s perceived weight status even increases someone’s risk of suicide, particularly among women and adolescents. 
  • Substance use. Regardless of BMI, research shows that weight stigma increases alcohol use among men and women at similar rates. 
  • Disordered eating. It probably comes as no surprise that a negative self-perception of one’s weight can lead to a spectrum of disordered eating. This includes anything from restrictive eating and anorexia, to bulimia and binge eating. 
  • Death. Two large studies showed that weight bias increased risk of mortality by 60%, even when the researchers controlled for other physical and mental risk factors.

And these are just the measurable health outcomes. Weight bias also discourages people from seeing a medical provider when they need one. It also means that some people do not get the health screening, diagnostic testing, or treatment they need when they do. 

But we can all be part of the movement that changes that. 

What can you do about weight bias?

Weight bias is a systemic problem in the healthcare environment. But that doesn’t mean it has to be part of your own individual experience. No matter what your weight, here are some reminders of the way you can advocate for yourself and your body:

  • Find a provider you trust. It is important that you feel your provider listens to your concerns and understands the importance of an individual approach to your health. Don’t be afraid to switch providers or practice if the experience does not feel safe and positive to you.
  • You can ask not to be weighed. A trip to the scale does not need to be part of every doctor’s appointment. If a recorded weight is absolutely necessary, you can provide a weight you took at home. Or ask to turn around on the scale, and not be told the number.
  • You can also ask that weight not be discussed. Your weight does not have to be a topic of discussion. You can control the conversation about weight by asking your provider that it not be discussed as a medical problem during your appointment.  
  • Be honest about your concerns. Don’t be afraid to lead the conversation about any concerns you do have about your weight or body. Especially if you feel like your weight is impacting your mental health. In many cases, this can stem from negative self-perceptions about your body size — even if your weight is not a problem. 

We know that a lot of these suggestions do not apply to visits to the emergency department. But even in the ER, it is still important to advocate for yourself if you feel you are being stigmatized by your weight — or any other reason. You should always report any form of discrimination you experience in a healthcare setting. Every person deserves to feel safe and supported by their environment and providers.