COMMENTARY

Stigma as a (Dis)incentive for Weight Loss and Healthy Lifestyle Behaviors

Rebecca M. Puhl, PhD

Disclosures

May 07, 2014

In This Article

Stigma: A Frequent Form of Prejudice

Stigma is a known enemy to health. Throughout history, stigmatization has imposed suffering on groups vulnerable to disease and has impaired prevention and treatment efforts for a range of public health issues, such as cholera, tuberculosis, syphilis, HIV/AIDS, substance abuse, and smoking.[1,2,3] There is broad recognition in the fields of medicine and public health that disease stigma creates significant obstacles, interferes with collective responses to disease, and undermines public health.[4,5]

With respect to obesity, now classified as a disease by the American Medical Association[6] and recognized as a significant public health priority for both adults and children, the issue of stigmatization also warrants attention. Several decades of research have consistently demonstrated that individuals with obesity are vulnerable to pervasive stigma and discrimination because of their excess weight.[7,8]

This form of prejudice has been documented in many domains of living, including the workplace, educational institutions, the mass media, and even healthcare.[7,8,9] Recent estimates show that the prevalence of weight discrimination among adults has increased and is now comparable to racial discrimination.[10,11] Among youth, weight-based victimization and bullying are the most common forms of harassment that they face in the school setting.[12,13,14]

From Blame to Shame

Despite substantial science on this issue, the social acceptability of weight stigmatization is rarely challenged. Instead, prevailing societal views about obesity often serve to reinforce biases. These views frequently stem from assumptions that individuals with obesity are personally responsible and at fault for their body weight, and lack the willpower, discipline, and treatment compliance necessary to lose weight. These stereotypes have been documented in multiple segments of the general population, and among healthcare professionals.[7,8]

In turn, a culture of blame has been cultivated -- with common perceptions that weight stigma is justifiable,[15] and perhaps even necessary, to motivate people with obesity to become healthier and lose weight. To this end, some scholars have proposed that stigmatization is an appropriate strategy to address obesity.[16]

Obesity stigmatization raises legitimate ethical concerns pertaining to social justice, inequitable treatment, and disparities. However, the issue of whether stigma might serve as a tool to facilitate improved health and weight-loss outcomes is an empirical question and one that, until the past decade, had not really been tested. There is already considerable evidence on the adverse psychological, social, and economic outcomes of weight stigmatization,[8,17,18] but now a new and growing knowledge base of evidence has examined implications of obesity stigma specifically for health behaviors, health indices, and weight loss.

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