Baroness Bull: We need to take action to reduce weight stigma and bias to support general health and mental wellbeing
Despite this growing body of public support, there have been relatively few social policy and legislative approaches to address weight bias and there is still no particular provision in UK law that protects against discrimination on the grounds of weight, says Baroness Bull.
At some point in our lives, many of us will experience teasing, criticism or bullying about the way we look and, in particular, about our weight.
Sometimes it’s aimed to hurt, but oftentimes it’s careless rather than malicious: a throwaway comment that meant nothing to the person who said it and everything to the person to whom it was directed. Occasionally it’s intended (or at least justified) as a spur to action – a short, sharp shock that will precipitate a carefree life in which well-balanced eating and exercise play nothing more than a bit part.
Unfortunately, the evidence shows that weight- related teasing is more likely to be a precursor to disordered eating, unhealthy dietary restrictions and longer-term obesity. Weight bias and weight stigma are the terms used by the research and medical professions to refer to discriminatory attitudes and behaviours towards people on the basis of their body mass index (or BMI) – how much they weigh in relation to their height.
Weight bias is one of the few forms of discrimination increasing over time and researchers in the US have found that it’s not just reserved for the ill-educated or uninformed: a literature review from 2018 confirmed that weight bias is prevalent among health professionals and exercise, obesity and nutrition specialists, too.
The negative consequences of weight bias are far reaching and include an increased risk of depression, anxiety, low self-esteem, substance abuse and suicidality. People who suffer discrimination on the basis of weight are also less likely to seek medical advice, for fear of being further stigmatised by healthcare professionals.
In terms of obesity and eating disorders, the impact of weight bias is clear and the evidence compelling. Far from spurring overweight individuals into action, research shows that weight-related teasing actually contributes to obesity by increasing isolation, discouraging any social engagement with exercise (to avoid the risk of further shaming) and driving disordered eating. Longitudinal studies in both the US and the UK have demonstrated that weight discrimination increases the risk of becoming – and remaining – obese. And weight-related teasing is proven to be a powerful trigger for eating disorders, leading to emotional eating (a coping mechanism), binge eating and unhealthy weight control measures, including bulimia.
Compared to their healthy peers, people with eating disorders are two to three times more likely to have been teased and bullied about their appearance prior to the onset of their condition.
All of these studies point to the need to take action to reduce weight stigma and bias – not just as a factor in obesity and eating disorders, but to support general health and mental wellbeing. Across the US, Australia, Iceland, Germany and Canada there is broad support from the public, from parents and from educators for increased social policy initiatives to address weight bias.
These might include, for example, strengthening school-based anti-bullying strategies or tightening media regulations to reduce the over-representation of idealised (and often unattainable) bodies. At least two thirds of the people questioned by researchers were supportive of policies that would make it illegal for employers to refuse to hire, to assign lower wages, to deny promotions, or to terminate the contracts of qualified employees on the basis of their body weight.
And yet despite this growing body of public support, there have been relatively few social policy and legislative approaches to address weight bias and there is still no particular provision in UK law that protects against discrimination on the grounds of weight.
But perhaps the biggest challenge is that weight bias, like so many of our biases, is often unconscious. Recent research studies from Sheffield Hallam University, the University of Exeter and the University of Pennsylvania are the latest to show that deep-seated stereotypes persist about the relationship between character, capability and weight. If we are going to reduce weight stigma more broadly, we might need first to deal with our own prejudices.
Baroness Bull is a Crossbench member of the House of Lords.