'Fat-Shaming' Drops in US but UK Public Still Apportion Blame

Becky McCall

September 04, 2020

Weight-shaming, or explicit bias towards people with obesity, has significantly reduced in the United States over the past 3 years, suggesting wider acceptance of obesity as a medical problem, according to a new survey conducted in the United States and UK.

However, the US finding is in stark contrast to the UK, where the survey suggests the general public continues to attribute blame to people with obesity. 

Exploring attitudes towards weight was the topic addressed by the survey conducted in both countries over the last 3 years.

"This finding is important because it highlights that, in the United States at least, obesity is increasingly considered a medical condition and not a personal failure," said Ted Kyle, MBA, founder of ConscienHealth, an advocacy organization in Pittsburgh, Pennsylvania, who led the work.

He presented the findings as a poster at this year's virtual European and International Congress on Obesity (ECOICO 2020).

The survey shows nearly one in three UK adults blame people with obesity for their condition and do not believe obesity is a medical problem.

In contrast, over the past 3 years in the United States there has been a 12% increase in respondents who believe obesity is a medical problem. The difference between the two countries was statistically significant.

"There are multiple reasons for this change including that in the US, the fastest growing medical specialty is obesity medicine; the science of obesity has progressed; and culturally, the noise level about so-called 'fat-shaming' as being morally and socially wrong has increased," said Kyle.

"But by no means is the problem solved," he added. "There's still a lot of bias — and remember this refers to explicit bias — that expressed, which is very different to implicit bias that is internalized and influences a decision before you are aware of it."

Stuart Flint, PhD, associate professor of the psychology of obesity at the University of Leeds, UK, had this to say: "The decline in weight stigma in the US is much needed and encouraging."

But, he told Medscape Medical News, it is important to learn why these changes in attitudes have occurred in the United States to try to disseminate these positive opinions more widely.

"Considering that weight stigma is so perceptive, and in some instances encouraged, this study shows that greater efforts are needed to reduce weight stigma that is high in the UK," he asserted.

Previous research by Kyle (Obes Facts. 2018;11:1-364. Abstract S1.3) suggests that explicit weight bias is more common in the UK than in eight other countries including the United States, and that those harsh British attitudes to obesity are hampering efforts to tackle the obesity epidemic. "Reducing weight stigma has been identified as a key target by, for instance, the UK Obesity Policy Engagement Network and the All-Party Parliamentary Group on obesity," added Flint.

"Greater efforts are warranted and required at all levels including policy, health care, and within the community."

Blame and Stigma Reducing in US; UK Shows No Progress

The researchers analyzed the responses from a random sample of 6082 adults from the US and UK, half of whom completed an anonymous online Google survey in November 2017 and the other half in May 2020.

The survey asked participants for their opinion on one of three different statements using a five-point Likert scale (strongly agree to strongly disagree): 1) that obesity is the fault of the person with obesity; 2) that it is not their fault; or 3) that obesity is a major problem because people with obesity are blamed for the disease instead of receiving needed medical help. The results were adjusted for gender, age, country, and year.

In the United States, results showed a considerable drop in the proportion of respondents who agree that obesity is the fault of people with obesity, from 31% (115/372) in 2017 to 25% (93/377) in 2020 (P = .10). By comparison, UK respondents showed a smaller drop from 34% to 30% for the same question (P = .28).

Turning the question around — so asking if the respondent thought obesity was not the fault of the person with obesity — showed a rise in the proportion of US respondents agreeing with this statement from 11% to 16% (P = .17) between the two time points. But in the UK, there was an insignificant change from 16% to 15% (P = .31).

A significant change was also seen when American respondents were asked whether they agreed with a medical explanation for obesity. US respondents were much more likely to agree with this than those from the UK.

The percentage of US respondents in agreement rose from 30% to 42% between 2017 and 2020 (P = .002), but among UK respondents, that percentage remained unchanged at 31% (P = .8).

Weight Shaming Results in Worse Medical Outcomes

In 2018, the Royal College of Physicians in the UK called for obesity to be urgently recognized as a disease by government and the broader health sector, warning that until this happens its prevalence is unlikely to be reduced.

"There was some considerable backlash to this," noted Kyle.

"In the UK, for some people, there just seems to be a stronger impulse to blame people with obesity. It takes time for sentiment to shift on something that's so deeply held," he added.

"In the US where obesity is more common than in the UK it might make it harder to vilify obesity if over 40% of the population have it."

Kyle explained that by weight-shaming and implying people make bad choices or are somehow defective, "People turn in on themselves and they start believing the bad things people say about them. This is internalized stigma and this is known to predict worse medical outcomes."

Kyle also highlighted that obesity is genetic in origin but that the obesogenic environment plays a large part in people becoming obese.

"We can make a choice about how we are going to cope with a bad set of genes or a hostile environment, but we can't make a choice about susceptibility to obesity in our genes."

ECOICO 2020. Presented September 1, 2020. Abstract 1150/LBP-126.

Kyle is a board member for the Obesity Action Coalition. Flint has reported no relevant financial relationships.

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