Weight Stigma in American Medical Professionals

Unpacking anti-fat attitudes in healthcare settings is key to dismantling them.

Reviewed by Michelle Quirk

Key points

• Negative attitudes about people who are overweight are rampant in the United States.
• Health professionals often hold anti-fat attitudes.
• Directly confronting perceived weight-based discrimination in healthcare settings is important.

Stupid. Ugly. Sloppy. Lazy. Undisciplined. Fat. All words frequently used to describe people who are overweight or obese.

Commonplace in the United States, weight stigma refers to negative beliefs associated with being obese or overweight that emerge in a culture that is sizeist (McHugh & Chrisler, 2019; Kinavey & Cool, 2019). For example, overweight and obese individuals are frequently described using a slew of negative attributes (from smelly and unstylish to lacking in moral integrity). Such negative beliefs about overweight individuals often result in weight-based discrimination (Puhl & Heuer, 2009) or the maltreatment or disenfranchisement of individuals due to their body size.

Weight Stigma in Health Professionals

One might think that mental health professionals wouldn't hold anti-fat attitudes or negative weight bias. Psychologists and mental health professionals are, in fact, ethically responsible for the health of our patients and for creating a nonjudgmental therapy environment that is free from societally based bias (Kinavey & Cool, 2019). Yet, that is not the case.

Weight stigma research consistently finds that healthcare professionals (including physicians, nurses, and dietitians) hold biased attitudes and beliefs about obese patients (Budd et al., 2011; Mold & Forbes, 2013; Puhl & Heuer, 2009). Healthcare providers often characterize obese individuals as unmotivated and noncompliant (Brown, Stride, Psarou, Brewins, & Thompson, 2007), blame them for their weight (Foster et al., 2003), and demonstrate implicit anti-fat attitudes (Vroman & Cote, 2010). Strikingly, patients themselves rank healthcare professionals as among the most common sources of weight-based stigma (Puhl & Brownell, 2006).

Although few mental health providers are likely to endorse holding anti-fat attitudes and discriminatory weight-based behavior, they may communicate negative messages to patients indirectly through microaggressive behavior. Microaggressions are subtle, often unintentional expressions of negativity toward individuals due to their membership in a marginalized group (Sue et al., 2007). In a recent study from my lab (Akoury, Shafer, & Warren, 2019) we conducted semi-structured interviews with 15 obese women to explore their experiences with weight-based microaggressions in psychotherapy (mean BMI = 41.52). We found that common microaggressions included therapists who overly focused on their clients' weight, therapists who appeared to be less interested in clients because of their weight, and dissatisfaction with waiting room seating options.

Confronting Weight Stigma

Weight-based teasing and discrimination are associated with poor psychological health outcomes, including depression, poor self-esteem, and eating pathology (Friedman et al., 2005). If you notice that you or your healthcare professional seems to be holding anti-fat attitudes, some suggestions for how to address it include the following:

• Talk openly about your own experience of your body weight and shape.
• Actively explore any anti-fat attitudes and biases you may have internalized or believe because of your family, cultural, and social interactions over the course of your life.
• Acknowledge that weight dissatisfaction and body image struggles are normal in mainstream American culture.
• Directly talk to your doctor if you think they are engaging in discriminatory weight-based behavior.

The Naked Truth Is This: Weight-based stigma and discrimination are rampant in the United States. Learning to appreciate our physical bodies, focus on health, and accept some of the features we may not like as much is key to fighting anti-fat attitudes we take out on ourselves and others.

Copyright Cortney S. Warren, Ph.D., ABPP

Note: This content is only for informational and educational purposes and should not be considered therapy or any form of treatment. I cannot respond to personal requests for advice over the internet. Best on your continued journey.