Weight-related stigma is well established as a pervasive feature of societies in the global north, such as North America, Australasia, and Western Europe. Embedded in cultural valorization of personal effort and individual responsibility, fat bodies symbolize negative traits like laziness and lack of self-control . In such anti-fat contexts, people living with obesity report high attendant levels of systematic discrimination. This manifests directly as teasing, bullying, or being socially ignored or discounted. Indirectly, weight discrimination manifests as reduced education, career, and economic opportunities and success across the lifespan .
Based on studies published to date, weight stigma clearly matters for health . For one, it changes health-relevant behaviors for the worse. For example, feelings of weight stigma trigger disordered eating and exercise avoidance -- even when people are desperately trying to lose weight. Feelings of being judged as “fat” are highly emotionally distressing in themselves, and accordingly weight-related stigma predicts higher risk of depression, anxiety, and suicidality. The stress effects of the stigma also likely places people at greater risk of inflammation and chronic disease, as does living with other forms of overt discrimination.
Weight stigma embedded in medical and public health practice can also contribute to the health damage. Medical professionals consistently display high levels of anti-obesity bias, assume obesity suggests patient non-compliance, and admit they would prefer to avoid dealing with obese patients at all. Accordingly, larger patients receive lower quality care, and expecting or fearing negative judgments and mistreatment in clinical settings discourages larger patients from seeking further care.
Public health messages around obesity may also act to reinforce the cultural preoccupations of obesity as individual responsibility and the perpetuate weight stigma. Usually the shaming and blaming is inadvertent, but implied. For example, the Strong4Life campaign in the US emphasized that “fat prevention begins at home and the buffet line,” and in Australia “child obesity is child abuse” was deployed as a campaign message. Yet, some campaigns have been built explicitly on the idea that disproven idea that stigma is a tool that might help motivate weight loss. One proposed strategy in the UK, drawing from anti-smoking successes, was to place pictures of sick, obese bodies onto junk food to scare people away from buying and eating it.
From a public health perspective, also concerning is the growing evidence that all this pervasive weight stigma in itself promotes weight gain, especially for those who are already clinically-defined as obese. There are several different theorized pathways linking weight stigma to population level weight gain, including its influence on the proposed mediators of stress as physiologically damaging, discrimination as a barrier to accessing health care and health-relevant resources, and feeling of judgments leading to weight-positive behavior change. There is growing suggestion it may in fact act as significant, if basically unrecognized, driver of population level weight gain and the obesity epidemic itself.
Accordingly, there is a nascent but energetic push to raise awareness that public health messages around obesity prevention can inadvertently promote stigma and thus ultimately undermine anti-obesity efforts and inadvertently create other related health disparities. This includes recommendations to create anti-obesity campaign messages that do not aggravate weight stigma, and to address weight stigma reduction as part of anti-obesity efforts in the US, the UK, and several other advanced industrialized nations with high rates of obesity. Other anti-stigma efforts promoted by academics, medical experts, and activists include pushing back against negative stereotyping in mainstream media and efforts to include obesity as a class covered by anti-discrimination legislation.
In terms of weight stigma and global health, conventional wisdom suggests that weight stigma is essentially a “first world problem.” Anthropological cases are often cited as demonstrating that many or most human groups view large and fat bodies in positive terms, such as symbolic of goodness, beauty, care, and effort . This conclusion is based in decades of solid, high quality ethnographic enquiry. For example, an extended ethnography of Jamaican views of bodies, conducted in the 1980s, plump bodies are described as sexy, healthy, happy, and loved. Thinness, by contrast, is associated with meanness and social isolation. Another detailed study of a semi-nomadic Azawagh Arabs in Niger at around the same time describes the great lengths women – and their families – go to in order to develop the soft, rounded and very fat bodies that are seen as most godly, loved, and marriageable.
As yet, there has been almost no consideration of links between weight stigma and anti-obesity efforts in the global south. But many countries are right now moving forward with public health campaigns to address obesity, and the early signs are that messages appear to similarly link to notions of blame or shame as they have in many prior campaigns designed for and implemented in the global north. For example, in 2015 anti-obesity legislation in Puerto Rico proposed large fines that punished parents if their children did not lose weight.
As governments in the global south roll out large-scale and costly anti-obesity efforts, it is thus timely and important to ask two basic questions from an evidence-based position: Is there any evidence of weight-related stigma in middle and lower income countries? And, if so, does experiencing it similarly damage the wellbeing of individuals? Herein we draw together recent and disparate anthropological, linguistic, and other evidence to show there is growing reason to suspect that anti-fat ideas, and their negative health consequences, may be a rapidly emerging across the global south – including in cultural settings where fat-positivity was previously the norm.
If weight stigma is growing in the global south, recognition of this as a global health challenge is crucial. This is because obesity itself is now a truly global phenomenon: there are currently numerically more obese people in India and China than anywhere else, and many of the “fattest” nations by percentage are in the Middle East, South Pacific, or Africa. If weight stigma is evident and impacts people emotionally in such places, it suggests a much-needed research agenda on the implications of globalizing obesity stigma for obesity prevention and treatment in middle and lower income countries. And, it has significant potential practical implications for how global public health should understand and respond to obesity, including identifying vulnerabilities, formulating policy, intervention design, and the need to recognize and track weight-related stigma with a goal of making global anti-obesity efforts more effective.