Laken Brooks, 27, thinks weight bias might be why no one noticed her depression. At one point in college, the PhD student and freelance health writer couldn’t sleep. She’d forget to eat. Then she dropped nearly 30 pounds in a single semester.
Fast, unexplained weight loss is often a sign of another health problem, but her slimdown didn’t raise any red flags. “My friends and professors would remark that I looked great because of my weight loss,” she says, “but I felt like I was at the weakest – mentally and physically – point of my entire life.”
She reached out to her doctor for mental health help. The advice: “You’ll probably feel better soon if you keep losing weight.” Months later, Brooks says, she survived a suicide attempt.
Now she’s regained her weight and is in treatment for her depression. She feels good in her body. But she’s left wondering if people would’ve spotted warning signs, or taken her seriously, if she’d been thinner.
“But because I was fat, people only saw that I had lost weight,” Brooks says. “And they assumed that weight loss meant that I must be healthier.”
Rebecca Puhl, PhD, studies weight-based bullying, bias, and discrimination. She’s a professor in the Department of Human Development and Family Sciences and deputy director for the Rudd Center for Food Policy and Obesity at the University of Connecticut.
She says these terms are often thought to mean the same thing, but they don’t.
- Weight stigma generally refers to the “societal devaluation” of people who have a larger body size.
- Weight bias includes beliefs or negative attitudes and stereotypes that “give way to prejudice and unfair treatment and even overt forms of discrimination.”
Weight bias and stigma can come from anyone: employers, teachers, loved ones, or health providers. Some examples include views that people with obesity are “lazy, lacking in willpower or discipline, or they’re sloppy or noncompliant with medical treatment,” Puhl says.
When you turn that judgment on yourself, it’s called internalized weight stigma.
Self-blame happens across diverse body sizes, Puhl says, but it’s higher among people with obesity and those trying to lose weight. More research is needed, but it also seems to be more likely in white women, compared to those who identify as Black or Latina, she says.
They can seep into your daily life. “We may struggle to find affordable and flattering clothing. We may be judged when we eat in public,” Brooks says. “We may have trouble fitting into seats in planes or buses.”
Conscious and unconscious weight bias can also affect your medical care. People with higher weights often report doctors as one of their biggest sources of stigma, Puhl says.
If you have a larger body mass index (BMI), health providers may:
- Spend less time with you
- Give you less health education
- Seem less respectful
- Use harsh language to describe your body
- Blame other health problems on your weight
Sean Phelan, PhD, is a Mayo Clinic researcher who studies how weight discrimination and stereotyping affect medical care. He says people with larger bodies who experience stigma are more likely to “doctor shop” or delay needed care.
Brooks says she usually doesn’t go to the doctor unless she’s “very sick.” In the past, she put off recommended health screenings until her heavy periods and chronic menstrual pain became too troublesome to ignore.
“Going to the OB/GYN is already an incredibly vulnerable experience,” Brooks says. “So it can feel scary to worry if a doctor will refuse to treat you with the dignity you deserve just because you’re fat.”
There’s growing evidence that weight stigma – no matter where it comes from or in what setting – is a form of stress that can harm your physical and emotional well-being, Puhl says.
“When people are made to feel shame about their weight, they experience low self-esteem, anxiety, higher levels of depressive symptoms, and worse body image,” Puhl says. “There are links with higher levels of substance use and suicidality.”
People who experience weight bias are also more likely to turn to unhealthy eating behaviors, less likely to get physical activity, and have higher levels of physiological stress.
“That underscores that weight stigma is not only a social justice issue,” Puhl says, “but is a public health issue as well.”
It can be a challenge to confront weight bias, but it’s OK to speak up when it happens to you. Start by telling someone if they’ve said something out of line or unwanted about your weight.
“That’s easier said than done,” Puhl says. “But this is a situation where you have to advocate for yourself. That’s true for the doctor as well.”
When it comes to weight bias and medical care, here are some expert tips:
Make a plan. Write down some key questions before your visit. “And if the conversation turns to weight, and weight is not what you’re there for, say that to the doctor,” Puhl says.
Take a moment. Weight-based comments can boost your anxiety and throw you off balance. It can be helpful to give yourself an internal pep talk and “take a deep breath and reengage in the encounter,” Phelan says.
Bring a support person. Puhl suggests briefing a friend or loved one on what your goals are for the appointment. “Let them advocate for you if you feel this is something that’s too hard for you to talk about.”
Educate your provider. Have a conversation about weight bias. Your doctor might rethink or soften their approach if they know you’ve been stigmatized in the past. “There are a lot of helpful providers out there who will respond in ways that are supportive,” Puhl says.
Many people say they’ve experienced weight stigma in a health care setting. Maybe they feel shame about their weight when they step on that scale at the doctor’s office or get a lecture that’s unwelcome and maybe not even accurate.
Compared to a decade ago, many more health care providers know that weight bias is a problem. And some may signal that they’re a weight-inclusive space, Phelan says. For example, you might see signs that say weight loss won’t come up unless you want to talk about it.
“I think that can be a really powerful message to see that in writing,” he says.
You can also ask a provider if they use the Health at Every Size (HAES) approach. “It’s this general philosophy that me being your doctor and getting you the best care possible is not contingent on you losing weight,” Phelan says.
Brooks suggests making friends with people who have larger bodies and asking them where they get their medical care. She’s found a psychiatrist she likes, but she’s still searching for a “fat-friendly” doctor that takes her health insurance.
“I’m not giving up because fat people are our own best advocates,” she says. “But it can be exhausting to spend years – literally, years – trying to find a doctor you can really trust.”
It can be hard to unlearn internalized stigma, Puhl says, but cognitive behavioral strategies can help. Ask your doctor to refer you to a therapist who works with people who have larger bodies. They can help you challenge and replace automatic negative thoughts with helpful ones.
“Sometimes that can be as cliche as writing down positive self-statements and having them available to you on your phone or on sticky notes,” Puhl says. “You can go and look at them when you start to go down that self-defeating thought pattern.”
Brooks supports body neutrality, or the mindset that “your body doesn’t have to be magical and beautiful.” But she takes a body-positive approach in her own life, which includes “feeling super cute in crop tops, feeling strong in your body when you exercise, and celebrating your body and all that it can do.”
Body positivity doesn’t mean ignoring your health, Puhl says. “But you don’t have to hate your body if you don’t look like the thin ideal.”
Search social media for like-minded folks. There are a growing number of spaces dedicated to body positivity, body neutrality, and Health at Every Size. “You can gain a lot of strength from those communities,” Phelan says.
It’s key to have a support network of “fat folks” who can offer reassurance and advice, Brooks says, especially when it comes to health care.
“Your thinner friends may be allies and may be sympathetic to your experiences,” Brooks says. “But it’s been very empowering for me to be able to talk about my medical struggles with other people who have been through a similar situation.”
