COMMENTARY

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

Rebecca M. Puhl, PhD

Disclosures

May 07, 2014

In This Article

Legitimizing Weight Bias Experiences

In addition to the evidence that obesity stigma interferes with weight-loss efforts, research indicates that weight-loss treatment approaches that acknowledge the negative impact and distress of weight bias, help patients to challenge weight-based stereotypes, and learn strategies to cope with experiences of weight bias have more favorable weight-loss treatment outcomes.[37,38] Thus, the approach of legitimizing patients' experiences of weight bias and helping them cope adaptively with these distressing experiences, rather than using stigma as an incentive to lose weight, is promising for facilitating weight loss.

Finally, if stigma were an effective incentive for weight loss, we would expect to see obesity rates decline as societal weight stigmatization increases. Instead, the opposite has occurred. Weight stigma and discrimination have worsened in the United States in the past several decades,[10,39] becoming some of the most common forms of discrimination and bullying -- but during this time, obesity rates have increased rather than decreased.

There is already widespread societal stigma toward persons with obesity. It is a stigma that is rarely challenged and often perpetuated by the mass media, and there are ample societal messages of shame, blame, and stigma targeting of people with obesity. Instead of providing motivation for improved health, societal stigmatization has promoted adverse consequences for health and well-being.

Reducing Obesity Stigma

Taken together, the emerging evidence indicates that obesity stigma contributes to unhealthy behaviors, interferes with weight-loss efforts, and reinforces obesity. There is no indication that obesity stigma would be effective as a public health tool to incentivize weight loss.

In recognition of the detrimental impact that disease stigma creates for vulnerable groups who are affected, it seems warranted to afford obesity the same recognition and interventions as other disease stigmas. To effectively prevent and treat obesity, the evidence points to the importance of recognizing the barriers that weight stigma creates in these efforts, and implementing strategies to reduce this harmful stigma.

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