Stereotypes and weight stigma contribute to poor health outcomes

Focusing on weight loss and “healthy weight” contributes to poor physical and emotional wellbeing.

Health professionals are obligated to contribute to optimal health for patients and communities— and first and foremost to “do no harm.” An article featured in the Journal of Obesity examines how the common practice of focusing on weight, body mass index (BMI), weight loss and weight management by doctors, nurses, dietitians and nutrition educators contributes to poor physical, mental and emotional wellbeing in people.

In the article titled The Weight-Inclusive versus Weight-Normative Approach to Health: Evaluating the Evidence for Prioritizing Well-Being over Weight Loss, researchers emphasize that while extensive evidence shows that a focus on dieting leads to short term weight loss, weight regain and problematic eating behaviors, many practitioners and educators continue to focus on weight management. Data shows that the “weight-normative” approach which presumes an ideal or “healthy weight” is not sustainable long-term for most people. This approach also contributes to eating disorders and weight cycling which is also called “yo-yo dieting” (repeated cycles of weight loss and weight gain, usually resulting in overall higher weight). The weight-normative approach is also linked to several poor physical and emotional health outcomes.

The authors emphasize that the weight-normative approach reinforces negative stereotypes and stigma toward higher-weight people promoting the view that “higher weight individuals are unhealthy and a burden to society.” This approach also promotes the perspective that weight can be controlled through “will power” and individual lifestyle choices and largely ignores the complexity of body size determination including the influence of genetics, environmental factors and health inequities. Environmental factors include root causes such as limited access in low-income communities to affordable, nutritious foods, stable jobs and safe and available opportunities for physical activity and exercise.

According to Peggy Crum, MA, RD, nutritionist with Michigan State University’s Health4U program, one of the worst things health professionals can do is to focus attention on people’s size and weight. “When we emphasize weight management with people, we are doing more harm than good,” Crum says. “Shifting away from dieting and weight loss interventions and toward relaxing and enjoying food shows more promise for positive overall health and wellbeing.”

According to the article featured in the Journal of Obesity, a weight-normative approach leads to weight cycling which contributes to greater emotional distress—especially when people believe that their personal and social success is tied to being thin (for example, “I will be more successful, loved, desired and healthy once I am thin/lean.”) When the health care community intentionally or unintentionally emphasizes “healthy weight,” they imply that there is a “normal” weight that everyone should be striving to attain. This medical endorsement of normal weight “gives credibility to cultural messages prizing thinness (for women), leanness (for men) and weight loss.” When people internalize these messages, it contributes to body shame and eating disorders (for women) and potentially harmful muscle-enhancing and disordered eating behaviors (in men). A focus on weight and weight loss also perpetuates weight stigma and negative weight-related attitudes including stereotypes, prejudice, discrimination, bullying and social rejection of children, youth and adults of higher weights.

The “weight-inclusive” approach accepts and supports human diversity – including size diversity. Practicing the weight-inclusive attitudes and behaviors also stops the stigmatizing of health problems as weight problems—and offers a more accurate, research-based understanding of positive health and wellbeing for all people.

Michigan State University Extension provides resources for addressing bullying, bias and harassment by fostering an acceptance of human diversity, nurturing social and emotional health and wellbeing and by creating inclusive, supportive climates with and on behalf of young people. Check out a new initiative called Be SAFE: Safe, Affirming and Fair Environments for more information.

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