How common is weight stigmatization in health care?
Weight Bias: Hating Their Guts
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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
Intro: This video and the next discuss weight bias and discrimination, which may be a sensitive topic for many people. How does this play out in healthcare? Watch to find out more about this important topic.
Described as the last “acceptable” form of bias, weight stigma is the rampant discrimination and stereotyping of overweight individuals. Fifty overweight women were asked to keep a diary of all the times they felt they were being stigmatized for their weight. Over a single week, more than a thousand instances were recorded. An overweight woman may expect to be harassed (such as called names or insulted), run into physical barriers (like unable to fit into public seats), or discriminated against (such as perceived poorer service at restaurants or stores) on average about three times a day. Obese men report three times less discrimination than women of the same size; so, maybe it’s only a daily occurrence for them.
They’re not just being paranoid. Studies using professional actors presenting as job applicants made up to appear overweight with the Hollywood magic of theatrical prostheses were significantly more likely to be discriminated against than when appearing as their normal weight selves. This employment bias was found to be especially prejudiced against overweight women compared to men.
Attitudes can also be explored in surveys. In a comparison of 16 stigmatized social groups, such as homosexuals and homeless people, only drug addicts and smokers were regarded with higher levels of disgust than obese individuals. The researchers did note, however, there was effectively a tie: obese people were “rated just as disgusting as politicians.”
This weight stigma starts surprisingly young. Children as young as three years old describe overweight peers as “mean,” “stupid,” “lazy,” and “ugly.” Then, there was that famous study published back in 1961.
Children in summer camps and schools across a swath of different social, cultural, and ethnic backgrounds in California, Montana, and New York were asked to rank the following images as to who they liked best, including a child with crutches with a brace on their leg, a child in a wheelchair, a child with one of their hands missing, a facially disfigured child, or an obese child. In every population of kids they tested, there was “remarkable uniformity.” The obese child always came in dead last.
That was ages ago, though. In 2003, researchers published the 40-year follow-up. The study was repeated and…the title of the study gives it away: “Getting Worse: The Stigmatization of Obese Children.” The obese child was liked even less! This parallels trends throughout society, with nearly a 70 percent jump in perceived weight discrimination recorded in national surveys since the mid-nineties.
Attitudes among teachers may not be helping. More than a quarter of teachers and other school staff surveyed felt that becoming obese is “one of the worst things that could happen to a person.” Even parents can be biased, providing less support for college for their overweight daughters compared to thinner siblings. As two prominent obesity researchers commented, “It is a strong prejudice indeed when parents discriminate against their own children.”
What about doctors? One representative national survey found that more than half of physicians viewed obese patients as “awkward, unattractive, ugly, and noncompliant.” About a quarter of nurses agreed or strongly agreed to the statement: “Caring for an obese patient usually repulses me.”
This antagonism can have serious health consequences for those who may need it the most. For example, obese women are at higher risk for developing cervical, endometrial, and ovarian cancers. Yet they are less likely to be screened. Morbidly obese patients only have about half the odds of getting their recommended pelvic exams. Part of this may be avoidance on the part of the patient, but some doctors just turn obese patients away. The Sun Sentinel polled OB/GYN practices in Florida, and found that as many as one in seven refused to see heavier women––for example, setting weight cut-offs for new patients starting at 200 pounds.
Even doctors who welcome obese patients have been found to give them short shrift. Physicians randomized to receive a medical chart of a migraine patient who was either presented as average weight, overweight, or obese said they would give the obese patient about 28 percent less of their time. And it’s less quality time. Recorded doctor’s visits found physicians tend to build less emotional rapport with overweight patients.
Even obesity specialists profess increasingly explicit anti-fat attitudes. Worsening in surveys taken between 2001 and 2013, obesity specialists described fat people as significantly more “lazy, stupid, and worthless.” Even in the medical literature, you’ll find lines like this, an example from Annals of Internal Medicine: “obesity is an aesthetic crime: it is ugly.”
The good news is that they appear able to hide their disdain. In a study entitled “Obese patients overestimate physicians’ attitudes of respect,” despite the negative attitudes doctors harbored towards their obese patients, the same patients expressed their satisfaction with their providers. The researchers concluded, “While physicians may be successfully playing the part, the lack of true respect suggests…the authenticity of the patient–physician relationship should be questioned.”
Please consider volunteering to help out on the site.
- Puhl R, Brownell KD. Bias, discrimination, and obesity. Obes Res. 2001;9(12):788-805.
- Seacat JD, Dougal SC, Roy D. A daily diary assessment of female weight stigmatization. J Health Psychol. 2016;21(2):228-40.
- Puhl RM, Andreyeva T, Brownell KD. Perceptions of weight discrimination: prevalence and comparison to race and gender discrimination in America. Int J Obes (Lond). 2008;32(6):992-1000.
- Pingitore R, Dugoni BL, Tindale RS, Spring B. Bias against overweight job applicants in a simulated employment interview. J Appl Psychol. 1994;79(6):909-17.
- Vartanian LR. Disgust and perceived control in attitudes toward obese people. Int J Obes (Lond). 2010;34(8):1302-7.
- Cramer P, Steinwert T. Thin is good, fat is bad: How early does it begin? J Appl Dev Psychol. 1998;19(3):429-51.
- Richardson SA, Goodman N, Hastorf AH, Dornbusch SM. Cultural uniformity in reaction to physical disabilities. Am Sociol Rev. 1961;26(2):241-7.
- Latner JD, Stunkard AJ. Getting worse: the stigmatization of obese children. Obes Res. 2003;11(3):452-6.
- Andreyeva T, Puhl RM, Brownell KD. Changes in perceived weight discrimination among Americans, 1995-1996 through 2004-2006. Obesity (Silver Spring). 2008;16(5):1129-34.
- Neumark-Sztainer D, Story M, Harris T, Beliefs and attitudes about obesity among teachers and school health care providers working with adolescents. J Nutr Educ Behav. 1999;31(1):3-9.
- Crandall CS. Do parents discriminate against their heavyweight daughters? Pers Soc Psychol Bull. 1995;21(7):724-35.
- Foster GD, Wadden TA, Makris AP, et al. Primary care physicians’ attitudes about obesity and its treatment. Obes Res. 2003;11(10):1168-77.
- Bagley CR, Conklin DN, Isherwood RT, Pechiulis DR, Watson LA. Attitudes of nurses toward obesity and obese patients. Percept Mot Skills. 1989;68(3 Pt 1):954.
- Poorolajal J, Jenabi E. The association between BMI and cervical cancer risk: a meta-analysis. Eur J Cancer Prev. 2016;25(3):232-8.
- Adams CH, Smith NJ, Wilbur DC, Grady KE. The relationship of obesity to the frequency of pelvic examinations: do physician and patient attitudes make a difference? Women Health. 1993;20(2):45-57.
- Hernandez-Boussard T, Ahmed SM, Morton JM. Obesity disparities in preventive care: findings from the National Ambulatory Medical Care Survey, 2005-2007. Obesity (Silver Spring). 2012;20(8):1639-44.
- LaMendola B. Some ob-gyns in South Florida turn away overweight women. South Florida Sun-Sentinel Health. May 16, 2011.
- Hebl MR, Xu J. Weighing the care: physicians’ reactions to the size of a patient. Int J Obes Relat Metab Disord. 2001;25(8):1246-52.
- Gudzune KA, Beach MC, Roter DL, Cooper LA. Physicians build less rapport with obese patients. Obesity (Silver Spring). 2013;21(10):2146-52.
- Tomiyama AJ, Finch LE, Belsky ACI, et al. Weight bias in 2001 versus 2013: contradictory attitudes among obesity researchers and health professionals. Obesity (Silver Spring). 2015;23(1):46-53.
- Wadden TA, Stunkard AJ. Social and psychological consequences of obesity. Ann Intern Med. 1985;103(6 ( Pt 2)):1062-7.
- Gudzune KA, Huizinga MM, Beach MC, Cooper LA. Obese patients overestimate physicians’ attitudes of respect. Patient Educ Couns. 2012;88(1):23-8.
Motion graphics by Avo Media
Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
Intro: This video and the next discuss weight bias and discrimination, which may be a sensitive topic for many people. How does this play out in healthcare? Watch to find out more about this important topic.
Described as the last “acceptable” form of bias, weight stigma is the rampant discrimination and stereotyping of overweight individuals. Fifty overweight women were asked to keep a diary of all the times they felt they were being stigmatized for their weight. Over a single week, more than a thousand instances were recorded. An overweight woman may expect to be harassed (such as called names or insulted), run into physical barriers (like unable to fit into public seats), or discriminated against (such as perceived poorer service at restaurants or stores) on average about three times a day. Obese men report three times less discrimination than women of the same size; so, maybe it’s only a daily occurrence for them.
They’re not just being paranoid. Studies using professional actors presenting as job applicants made up to appear overweight with the Hollywood magic of theatrical prostheses were significantly more likely to be discriminated against than when appearing as their normal weight selves. This employment bias was found to be especially prejudiced against overweight women compared to men.
Attitudes can also be explored in surveys. In a comparison of 16 stigmatized social groups, such as homosexuals and homeless people, only drug addicts and smokers were regarded with higher levels of disgust than obese individuals. The researchers did note, however, there was effectively a tie: obese people were “rated just as disgusting as politicians.”
This weight stigma starts surprisingly young. Children as young as three years old describe overweight peers as “mean,” “stupid,” “lazy,” and “ugly.” Then, there was that famous study published back in 1961.
Children in summer camps and schools across a swath of different social, cultural, and ethnic backgrounds in California, Montana, and New York were asked to rank the following images as to who they liked best, including a child with crutches with a brace on their leg, a child in a wheelchair, a child with one of their hands missing, a facially disfigured child, or an obese child. In every population of kids they tested, there was “remarkable uniformity.” The obese child always came in dead last.
That was ages ago, though. In 2003, researchers published the 40-year follow-up. The study was repeated and…the title of the study gives it away: “Getting Worse: The Stigmatization of Obese Children.” The obese child was liked even less! This parallels trends throughout society, with nearly a 70 percent jump in perceived weight discrimination recorded in national surveys since the mid-nineties.
Attitudes among teachers may not be helping. More than a quarter of teachers and other school staff surveyed felt that becoming obese is “one of the worst things that could happen to a person.” Even parents can be biased, providing less support for college for their overweight daughters compared to thinner siblings. As two prominent obesity researchers commented, “It is a strong prejudice indeed when parents discriminate against their own children.”
What about doctors? One representative national survey found that more than half of physicians viewed obese patients as “awkward, unattractive, ugly, and noncompliant.” About a quarter of nurses agreed or strongly agreed to the statement: “Caring for an obese patient usually repulses me.”
This antagonism can have serious health consequences for those who may need it the most. For example, obese women are at higher risk for developing cervical, endometrial, and ovarian cancers. Yet they are less likely to be screened. Morbidly obese patients only have about half the odds of getting their recommended pelvic exams. Part of this may be avoidance on the part of the patient, but some doctors just turn obese patients away. The Sun Sentinel polled OB/GYN practices in Florida, and found that as many as one in seven refused to see heavier women––for example, setting weight cut-offs for new patients starting at 200 pounds.
Even doctors who welcome obese patients have been found to give them short shrift. Physicians randomized to receive a medical chart of a migraine patient who was either presented as average weight, overweight, or obese said they would give the obese patient about 28 percent less of their time. And it’s less quality time. Recorded doctor’s visits found physicians tend to build less emotional rapport with overweight patients.
Even obesity specialists profess increasingly explicit anti-fat attitudes. Worsening in surveys taken between 2001 and 2013, obesity specialists described fat people as significantly more “lazy, stupid, and worthless.” Even in the medical literature, you’ll find lines like this, an example from Annals of Internal Medicine: “obesity is an aesthetic crime: it is ugly.”
The good news is that they appear able to hide their disdain. In a study entitled “Obese patients overestimate physicians’ attitudes of respect,” despite the negative attitudes doctors harbored towards their obese patients, the same patients expressed their satisfaction with their providers. The researchers concluded, “While physicians may be successfully playing the part, the lack of true respect suggests…the authenticity of the patient–physician relationship should be questioned.”
Please consider volunteering to help out on the site.
- Puhl R, Brownell KD. Bias, discrimination, and obesity. Obes Res. 2001;9(12):788-805.
- Seacat JD, Dougal SC, Roy D. A daily diary assessment of female weight stigmatization. J Health Psychol. 2016;21(2):228-40.
- Puhl RM, Andreyeva T, Brownell KD. Perceptions of weight discrimination: prevalence and comparison to race and gender discrimination in America. Int J Obes (Lond). 2008;32(6):992-1000.
- Pingitore R, Dugoni BL, Tindale RS, Spring B. Bias against overweight job applicants in a simulated employment interview. J Appl Psychol. 1994;79(6):909-17.
- Vartanian LR. Disgust and perceived control in attitudes toward obese people. Int J Obes (Lond). 2010;34(8):1302-7.
- Cramer P, Steinwert T. Thin is good, fat is bad: How early does it begin? J Appl Dev Psychol. 1998;19(3):429-51.
- Richardson SA, Goodman N, Hastorf AH, Dornbusch SM. Cultural uniformity in reaction to physical disabilities. Am Sociol Rev. 1961;26(2):241-7.
- Latner JD, Stunkard AJ. Getting worse: the stigmatization of obese children. Obes Res. 2003;11(3):452-6.
- Andreyeva T, Puhl RM, Brownell KD. Changes in perceived weight discrimination among Americans, 1995-1996 through 2004-2006. Obesity (Silver Spring). 2008;16(5):1129-34.
- Neumark-Sztainer D, Story M, Harris T, Beliefs and attitudes about obesity among teachers and school health care providers working with adolescents. J Nutr Educ Behav. 1999;31(1):3-9.
- Crandall CS. Do parents discriminate against their heavyweight daughters? Pers Soc Psychol Bull. 1995;21(7):724-35.
- Foster GD, Wadden TA, Makris AP, et al. Primary care physicians’ attitudes about obesity and its treatment. Obes Res. 2003;11(10):1168-77.
- Bagley CR, Conklin DN, Isherwood RT, Pechiulis DR, Watson LA. Attitudes of nurses toward obesity and obese patients. Percept Mot Skills. 1989;68(3 Pt 1):954.
- Poorolajal J, Jenabi E. The association between BMI and cervical cancer risk: a meta-analysis. Eur J Cancer Prev. 2016;25(3):232-8.
- Adams CH, Smith NJ, Wilbur DC, Grady KE. The relationship of obesity to the frequency of pelvic examinations: do physician and patient attitudes make a difference? Women Health. 1993;20(2):45-57.
- Hernandez-Boussard T, Ahmed SM, Morton JM. Obesity disparities in preventive care: findings from the National Ambulatory Medical Care Survey, 2005-2007. Obesity (Silver Spring). 2012;20(8):1639-44.
- LaMendola B. Some ob-gyns in South Florida turn away overweight women. South Florida Sun-Sentinel Health. May 16, 2011.
- Hebl MR, Xu J. Weighing the care: physicians’ reactions to the size of a patient. Int J Obes Relat Metab Disord. 2001;25(8):1246-52.
- Gudzune KA, Beach MC, Roter DL, Cooper LA. Physicians build less rapport with obese patients. Obesity (Silver Spring). 2013;21(10):2146-52.
- Tomiyama AJ, Finch LE, Belsky ACI, et al. Weight bias in 2001 versus 2013: contradictory attitudes among obesity researchers and health professionals. Obesity (Silver Spring). 2015;23(1):46-53.
- Wadden TA, Stunkard AJ. Social and psychological consequences of obesity. Ann Intern Med. 1985;103(6 ( Pt 2)):1062-7.
- Gudzune KA, Huizinga MM, Beach MC, Cooper LA. Obese patients overestimate physicians’ attitudes of respect. Patient Educ Couns. 2012;88(1):23-8.
Motion graphics by Avo Media
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Title
Weight Bias: Hating Their Guts
LicenseCreative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)
Content URLDoctor's Note
This video and the next one discuss the important and troubling issue of weight bias and discrimination, which may be a sensitive topic for some viewers.
The next video in this two-part series is The Impacts of Weight Bias in Health Care.
Both videos in the series are drawn from my book How Not to Diet.
If you haven’t yet, you can subscribe to my videos for free by clicking here. Read our important information about translations here.
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