The stigma of obesity: Time for a hard look in the mirror

“Overweight and obesity have reached epidemic proportions in Ireland and other European countries, with the problem compounded by the Covid-19 pandemic, according to a new report from the World Health Organisation.”

So read the opening paragraph of a news story published in The Irish Times early last month. It went on to say that almost six out of every 10 adults are overweight or obese in the WHO European region.

However, the WHO referring to obesity as an epidemic is questionable. The issue doesn’t meet the true definition of an epidemic: there has never been exponential growth in the number of people with a body mass index (BMI) over some stated cut-off point. This mislabelling is yet another brick in the ever-growing wall of obesity-related stigma.

The problem with calling obesity an epidemic is that it frames larger people as inherently diseased and even a menace to society. Obesity stigma and weight bias – defined as prejudice towards people with higher body weight – are worsening.

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Psychologists found that children in New Zealand had developed a preference for thinner or “average-sized” bodies even before they turned three years old. And in one US study, nearly 60 per cent of adults reported experiencing stigma as a result of their body size.

Just what it’s like for Irish people to experience obesity stigma and bias when seeking healthcare is captured by a nice piece of research carried out in the school of public health, physiotherapy and sports science at UCD. Published in the journal PLOS One last November, the study explored the experience of individuals with obesity, when interacting with the Irish healthcare system. It examined whether participants encountered weight bias and stigma, and how it impacted them.

Participants identified interpersonal communication, both verbal and non-verbal, as a major issue. Communication problems were particularly evident in primary care and obstetric clinics. These included facial micro-expressions of disgust and contempt, accusatory judgmental comments and a generalised use of derogatory language that invoked feelings of shame, guilt and embarrassment. Here are some actual experiences:

“No one is completely rude, it is much subtler than that, it’s the facial expressions when you walk into the room first – no eye contact at all.”

“I didn’t realise you were so fat, we can’t possibly move someone as heavy as you” (in obstetrics)

“I even had a GP look me up and down and say to me, you’d be a very pretty girl if you’d lose some of that weight.”

The impact of bias and stigma on participants health and wellbeing was marked. A number reported a heightened level of sensitivity and negative pre-conceptions in advance of future healthcare appointments. They associated these feelings with their previous experiences of weight bias in these settings. Here are actual experiences:

“Since I have changed GP, I don’t mind going to the doctor. She is lovely and doesn’t judge me as soon as she sets eyes on me. Before this GP, I had a doctor that dismissed my weight concerns but at the same time attributed everything to my weight. He never took me seriously. So, no matter what was wrong, I avoided going back to him.”

“They made me feel so bad about my weight and you can imagine how emotional I already was, I never ever wanted to feel that way again. I never ever wanted to be pregnant again and never wanted to see those doctors again” (obstetrics).

“I wish my doctor would see me as a person first, who has feelings. Not just as fat. If only he would… try to understand how I got here. It’s not just black and white, it is way more complex than that”

The study is a major wake-up call for Irish healthcare. We need to look deep and hard inside ourselves and ask: what are we doing that’s perpetuating the stigma of obesity?

mhouston@irishtimes.com