By Valerie Douglas
Often, when one thinks of the words “discrimination” or “stigmatization” our mind will wander to identity groups who when we hear in the news about the systematic and overt discrimination they face makes us want to tweet, “What century do we live in, again???”. Western society has, overall, come to agree that the discrimination against those of varying skin colors, nationalities, religions, genders, ages, sexualities, etc. is abhorrent. One group usually seems to be forgotten, however: Those in higher weight or larger bodies. Weight stigmatization is an umbrella term that encompasses the discrimination and negative experiences a person encounters due to negative societal biases or stereotypes against those who are in bigger bodies . It runs rampant in Western society, with a 66% rise in discrimination based upon weight between 1995 and 2006  and implicit attitudes against those in larger bodies increasing by 40% between 2004 and 2010 . Anecdotally, it appears hard to escape the stigmatization online, such as with the relatively recent article in the UK’s Telegraph which mocked the inclusion of a plus-size mannequin in the Nike store (I won’t link to the original, dreadful article but a response which discusses it ).
Although it is a newer area of research, so far weight stigma has been linked to a whole host of negative consequences such as depression , lower self-esteem [5, 6], higher body dissatisfaction6, and disordered eating . Weight stigma is being linked to some increasingly disturbing outcomes. For example, one study found that those who experience weight-based discrimination have a 60% increased mortality risk compared to those who are discriminated against based on other identities, even when statistically controlling for possible health consequences one may have due to weighing more . The authors thought this difference may be due to the lack of support a person gets from family and friends when stigmatized for their weight compared to if they were stigmatized for other identities . For example, if you are yelled at in public based upon your skin color, others are much more likely to be horrified and support you whereas if you are yelled at in public based on your weight, others may be more likely to say “well, you could stand to lose a few pounds!”.
Physical health consequences linked to enduring weight stigma may not be the only link weight stigma has to mortality, however. A growing body of literature has begun probing the links between weight stigma, suicidal thoughts, suicidal behaviors, and suicide risk. One study of adolescents examined the source of their weight teasing and how that affected both suicidal ideation and suicide attempts . More than half of adolescents who were teased both at school and at home by a family member had suicidal ideation compared to a quarter of adolescents who were not teased . A quarter of teased adolescents had attempted suicide in comparison to the 8.5% who were not teased . For boys, being teased by their family seemed to be especially damaging as these adolescents were three times more likely to attempt suicide .
For adults, women who were seeking weight loss surgery and had experienced weight stigma had increased suicidal ideation and suicidal behaviors . A study that compared those who met the body mass index criteria for being in the “overweight” category currently, individuals who previously met the criteria and had lost weight to meet the “average” category, and those who had always been in the “average” category found that those who had lost weight were more likely to attempt suicide, and it appeared that perceived weight discrimination was related to this . This finding shows that moving out of the stigmatized group does not erase the damage of weight stigma. A recent study found that in two community samples, weight-based discrimination was associated with suicidal ideation, even when statistically controlling for body mass index . In my own work, we also found similar results in a university sample where weight stigmatization was associated with suicide risk .
So, what should we take away from this growing body of literature when thinking about the world of suicide prevention? Obviously, eliminating weight stigma would be a huge benefit for society’s physical and mental health, but save a magic wand which could instantly fix this, what could we do now? First, for researchers, consider expanding upon the current research base to investigate how and why weight stigma is associated with suicidal thoughts and behaviors and what we can do to help individuals cope with the stigma they have experienced in the past or are experiencing now. For clinicians, consider integrating body shape and size into your conceptualization of diversity and think about how your client’s body shape and size (and how it has changed throughout their life span) may affect their mental health and suicide risk. For anyone, consider examining your views on body shape and size and how that affects your behaviors and the support you extend to others. Keep an eye out for those you know who experience suicidal thoughts or urges and may have experienced a stigmatizing event recently.
- Puhl, R., & Brownell, K. D. (2001). Bias, discrimination, and obesity. Obesity Review, 9(12), 788-805.
- Andreyeva, T., Puhl, R. M., & Brownell, K. D. (2008). Changes in perceived weight discrimination among Americans, 1995-1996 through 2004-2006. Obesity, 16(5), 1129-1134.
- Charlesworth, T. E. S., & Banaji, M. R. (2019). Patterns of implicit and explicit attitudes: I. Long-term change and stability from 2007 to 2016. Psychological Science, 30(2), 174-192.
- Stamp, N. (2019). Berating Nike for plus-size mannequins is no war on obesity – it’s just war on bigger bodies. The Guardian. Retrieved from https://www.theguardian.com/commentisfree/2019/jun/12/berating-nike-for-plus-size-mannequins-is-no-war-on-obesity-its-just-war-on-bigger-bodies
- Durso, L. E., Latner, J. D., White, M. A., Masheb, R. M., Blomquist, K. K., Morgan, P. T., & Grio, C. M. (2012). Internalized weight bias in obese patients with binge eating disorder: Associations with eating disturbances and psychological functioning. International Journal of Eating Disorders, 45(3), 423-427.63.
- Vartanian, L. R., & Novak, S. A. (2011). Internalized societal attitudes moderate the impact of weight stigma on avoidance of exercise. Obesity, 19(4), 757-762.
- Douglas, V. J. & Varnado-Sullivan, P. (2016). Weight stigmatization, internalization, and eating disorder symptoms: The role of emotion dysregulation. Stigma and Health, 1(3), 166-175.
- Sutin, A. R., Stephan, Y., & Terracciano, A. (2015). Weight discrimination and risk of mortality. Psychological Science, 26(11), 1803-1811.
- Eisenberg, M. E., Neumark-Sztainer, D., & Story, M. (2003). Associations of weight-based teasing and emotional well-being among adolescents. Archives of Pediatrics and Adolescent Medicine, 157, 733-738. doi:10.1001/archpedi.157.8.733
- Chen, E. Y., Fettich, K. C., & McCloskey, M. S. (2012). Correlates of suicidal ideation and/or behavior in bariatric-surgery seeking individuals with severe obesity. Crisis, 33(3). 137-143. doi: 10.1027/0227-5910/a000115
- Levy, B. R., & Pilver, C. E. (2012). Residual stigma: Psychological distress among the formerly overweight. Social Science & Medicine, 75, 297-299. doi:10.1016/j.socscimed.2012.03.007
- Hunger, J. M., Dodd, D. R., & Smith, A. R. (In Press). Weight-based discrimination, interpersonal needs, and suicidal ideation. Stigma and Health.
- Douglas, V. J., Kwan, M. Y., & Gordon, K. H. (2019, January 12). The Dark Effects of Weight Stigma: Weight Stigma, Suicide Risk, and the Interpersonal Theory of Suicide. https://doi.org/10.31219/osf.io/bwhzq
Valerie Douglas (@ValerieJDougla1) is a clinical psychologist and current clinical postdoctoral fellow at the Alliance for Eating Disorders Awareness’ Psychological Services (firstname.lastname@example.org).