by Emily Presseller and Natalie Papini
Emily Presseller (@EmilyPresseller) is a 2022 CEED Summer Fellow. Her research interests include understanding factors that influence the maintenance of and recovery from eating disorders.
Natalie Papini (@nataliep310) is a 2022 CEED Summer Fellow. One of her research interests includes the intersection of eating disorders, weight stigma, and internalized weight stigma.
Societal attitudes and beliefs can change throughout different cultures and different time periods. Research in the U.S. shows that societal attitudes around sexual orientation, race, and skin tone have become more accepting while other attitudes around age and disability have remained unchanged over the course of the past decade.1 Only one societal attitude seemed to worsen between the years of 2004 and 2016—attitudes toward body weight. Weight stigma is defined as mistreatment from others and societal disapproval based on weight.2,3 Weight stigma is communicated and expressed in several domains of life, including: the workplace, healthcare, education and schools, mass media, and interpersonal relationships.2-10 For example, weight stigma in the form of interpersonal relationships could be a relative suggesting weight loss to a family member in a larger body.11 In the job market, carrying excess weight could prevent a person from getting a job. In fact, Michigan is the only state in the U.S. that explicitly outlaws discrimination based on weight.12,13
What is Internalized Weight Stigma (IWS)?
Separate from the stigma people experience from others about their body shape and size, IWS involves how a person feels about themselves as a person as a result of believing negative attitudes about their size or shape.14 There are four steps to developing IWS: 1. A person becomes aware of overweight and obesity stereotypes; 2. The person believes those stereotypes; 3. They apply those stereotypes to themselves; and 4. They begin to devalue themselves as a result of identifying with the stereotypes.14 For example, a person may begin to think of themselves as “lazy” or lacking will power as a result of negative stereotypes associated with their size.
Impact of IWS
People who perceive themselves to have overweight or obesity report higher IWS than people who perceive themselves to be normal weight.15 People who experience or feel as if they are being stigmatized by others because of their weight are more likely to internalize that stigma, and this can lead to negative health outcomes (including disordered eating and body dissatisfaction16). IWS is associated with poor physical and mental health, including high blood pressure,17 increased stress responses,18,19 and inflammation (which can lead to even more health problems20). People with higher IWS may avoid healthcare services for fear of further stigmatization or traumatization, which can further contribute to poor health.3 IWS is also linked with poorer mental health, including depression,21-25 low self-esteem,21,22 body image concerns,22,25-28 psychological stress,29-30 and increased substance use.22
In Part 2 of this post (coming soon), read more about the impact of IWS on eating disorders and next steps we need to take to reduce weight stigma in our society.
1. Charlesworth TES, Banaji MR. Patterns of implicit and explicit attitudes: I. Long-term change and stability from 2007 to 2016. Psychol Sci. 2019;30(2):174-92.
2. Puhl R, Wharton C, Heuer C. Weight bias among dietetics students: implications for treatment practices. J Am Diet Assoc. 2009;109(3):438-44.
3. Puhl RM, Lessard LM, Himmelstein MS, Foster GD. The roles of experienced and internalized weight stigma in healthcare experiences: Perspectives of adults engaged in weight management across six countries. PLoS One. 2021;16(6):e0251566.
4. Batterham RL. Weight stigma in healthcare settings is detrimental to health and must be eradicated. Nat Rev Endocrinol. 2022;18(7):387-8.
5. Chen TT, Ching BHH, Li Y, He CC, Wan R. Weight stigma from media: Its association with coping responses and health outcomes. Curr Psychol. 2022:1-14.
6. Pearl RL. Weight bias and stigma: Public health implications and structural solutions. Social Issues Policy Rev. 2018;12(1):146-82.
7. Plummer RS, Alter Z, Lee RM, Gordon AR, Cory H, Brion-Meisels G, et al. “It’s not the stereotypical 80s movie bullying”: A qualitative study on the high school environment, body image, and weight stigma. J Sch Health. 2022.
8. Selensky JC, Carels RA. Weight stigma and media: An examination of the effect of advertising campaigns on weight bias, internalized weight bias, self-esteem, body image, and affect. Body Image. 2021;36:95-106.
9. Weight bias: Nature, consequences, and remedies. Brownell KD, Puhl RM, Schwartz MB, Eds: Guilford Publications; 2005.
10. Puhl R, Brownell KD. Bias, discrimination, and obesity. Obes Res. 2001;9(12):788-805.
11. Seacat JD, Dougal SC, Roy D. A daily diary assessment of female weight stigmatization. J Health Psychol. 2016;21(2):228-40.
12. Gaines R, Vincent V. Weight discrimination: Implications to the workplace. Strategic HR Review. 2022.
13. Giel KE, Thiel A, Teufel M, Mayer J, Zipfel S. Weight bias in work settings – a qualitative review. Obes Facts. 2010;3(1):33-40.
14. Durso LE, Latner JD. Understanding self-directed stigma: development of the weight bias internalization scale. Obesity (Silver Spring). 2008;16 Suppl 2:S80-6.
15. Schvey NA, White MA. The internalization of weight bias is associated with severe eating pathology among lean individuals. Eat Behav. 2015;17:1-5.
16. Bidstrup H, Brennan L, Kaufmann L, de la Piedad Garcia X. Internalised weight stigma as a mediator of the relationship between experienced/perceived weight stigma and biopsychosocial outcomes: a systematic review. Int J Obes (Lond). 2022;46(1):1-9.
17. Major B, Hunger JM, Bunyan DP, Miller CT. The ironic effects of weight stigma. J Exper Social Psychol. 2014;51:74-80.
18. Schvey NA, Puhl RM, Brownell KD. The stress of stigma: exploring the effect of weight stigma on cortisol reactivity. Psychosom Med. 2014;76(2):156-62.
19. Tomiyama AJ, Epel ES, McClatchey TM, Poelke G, Kemeny ME, McCoy SK, et al. Associations of weight stigma with cortisol and oxidative stress independent of adiposity. Health Psychol. 2014;33(8):862-7.
20. Sutin AR, Stephan Y, Luchetti M, Terracciano A. Perceived weight discrimination and C-reactive protein. Obesity (Silver Spring). 2014;22(9):1959-61.
21. Greenleaf C, Petrie TA, Martin SB. Relationship of weight-based teasing and adolescents’ psychological well-being and physical health. J Sch Health. 2014;84(1):49-55.
22. Bucchianeri MM, Eisenberg ME, Wall MM, Piran N, Neumark-Sztainer D. Multiple types of harassment: associations with emotional well-being and unhealthy behaviors in adolescents. J Adolesc Health. 2014;54(6):724-9.
23. Fettich KC, Chen EY. Coping with obesity stigma affects depressed mood in African-American and white candidates for bariatric surgery. Obesity (Silver Spring). 2012;20(5):1118-21.
24. Koball AM, Carels RA. Coping responses as mediators in the relationship between perceived weight stigma and depression. Eat Weight Disord. 2011;16(1):e17-23.
25. Puhl RM, Luedicke J. Weight-based victimization among adolescents in the school setting: emotional reactions and coping behaviors. J Youth Adolesc. 2012;41(1):27-40.
26. Harriger JA, Thompson JK. Psychological consequences of obesity: weight bias and body image in overweight and obese youth. Int Rev Psychiatry. 2012;24(3):247-53.
27. Puhl RM, King KM. Weight discrimination and bullying. Best Pract Res Clin Endocrinol Metab. 2013;27(2):117-27.
28. Vartanian LR, Novak SA. Internalized societal attitudes moderate the impact of weight stigma on avoidance of exercise. Obesity (Silver Spring). 2011;19(4):757-62.
29. Major B, Eliezer D, Rieck H. The psychological weight of weight stigma. Soc Psychol Personal Sci. 2012;3(6):651-8.
30. Mustillo SA, Budd K, Hendrix K. Obesity, labeling, and psychological distress in late-childhood and adolescent black and white girls: The distal effects of stigma. Soc Psychol Q. 2013;76(3):268-89.