**5. Weight stigmatization**

### **5.1 The role of culture and society**

Western societies, particularly those with affluence in the twenty-first century, have generally associated thinness with happiness, success, youthfulness, and social acceptance [56]. Most citizens of the Western world view fatness as a negative that is to be avoided. There has been a cultural prejudice and stigma toward those with overweight or obesity [60]. However, weight stigmatization has itself become a public health concern due to the associated psychological and physical health consequences to OW/obese individuals. The psychological and social stigmata associated with being OW/obese often makes this population vulnerable to discrimination in their personal and work lives [5]. Often blamed for their weight, the OW/obese are labeled as lazy, weak-willed, out of control, and lacking motivation [2, 56, 60]. The prevailing message in the media is that the cause and cure for obesity lies within the individual [60]. In a study examining obesity perception among policymakers from over 10 developed countries, over 90% saw lack of personal motivation as having a "strong" or "very strong" impact on obesity [23].

Nevertheless, weight stigmatization has been a long-standing approach to reducing obesity. However, it has not proven to be a motivator for weight loss [60]. There are studies that show stigmatizing weight is counterproductive. Individuals who experience weight stigma or perceived weight discrimination are at increased risk for anxiety, depression, bulimia, body dissatisfaction, low self-esteem and other psychological disorders [24]. Other findings have shown that even after controlling for key covariates such as BMI, age, and sex, these psychological outcomes remain, indicating that overweight perception rather than obesity is associated with psychological distress [63].

Weight stigma perpetuates unhealthy behaviors, including increased eating, reduced self-regulation, and avoidance of exercise [64]. Further, chronic stress resulting from weight stigma contributes to the development and/or pathophysiology of obesity, independent of adiposity [64]. Stress has been found to induce high levels of cortisol (an obesogenic hormone), leading to increased activity of the sympathetic nervous system (SNS) and release of corticotrophin-releasing hormone. Chronically elevated SNS activity could deregulate hypothalamic-pituitary-adrenal axis activity, thus further contributing to the etiology of obesity [65].

#### **5.2 Weight bias in clinical settings**

Reducing obesity rates has become a target for public health action, due to the link between obesity and a range of chronic diseases and premature mortality. However, critics of this view suggest that obesity has been primarily framed within a medical narrative, thus generating greater social anxiety and fears of "fatness" [66]. Some argue that dominant medical narratives are responsible for the discourse circulating around the idea of fatness as a pathology and a moral failing [66], further asserting that all the statistics on fat people being unhealthy are baseless due to the failure of society to delineate between fat and fat stigma [67]. The supposed bias of physicians has increasingly come under scrutiny. Physicians are said to notoriously view fat patients as noncompliant, or unwilling to follow their directions [67]. Some medical and allied health professionals have been overtly labeled "fat phobic" and showing weight bias. Weight bias is defined as having a widespread stereotypical and prejudicial attitude, assumption, belief, or judgment toward fat people [68, 69]. Studies show widespread weight bias among medical professionals [70], medical students and physician assistants [71], and exercise and nutrition professionals [72], with no

**87**

**Figure 4.**

*13 August 2020]).*

*Obesity Acceptance: Body Positivity and Clinical Risk Factors*

clearly defined approach to reduce these biases among students and professionals across various health disciplines [69]. There have even been reports of obese women avoiding routine gynecological exams, despite having higher rates of gynecological cancers than nonobese women, due to weight stigmatization and the corresponding negative attitudes of health care professionals toward overweight people [44]. The obesity problem we are facing is only exacerbated when participants express reluctance to address weight concerns with their health care providers for fear they will not be taken seriously [70], or avoid seeing their primary care physician or specialist

There has been a growing awareness of the psychosocial harms of weight stigmatization and fat shaming. Our culture is moving more toward body positivity, self-empowerment, inclusivity, and encouraging individuals to take pride in and accept their bodies, despite having BMI's that classify them as clinically OW/obese. Popularized through Instagram, with over 11 million posts tagged with #bodypositive, 4 million for #bodypositivity, and more than 1 million for #bopo [73]. Indeed, an internet search of body positivity will yield more than 112 million results [73]. Body positivity aims to challenge dominant body image ideals, promote acceptance and respect of all bodies, irrespective of shape, size, and features, focusing more on appreciating the functionality and health of the body rather than only its

Positive body image is indeed a key factor in determining one's ability to reach weight loss goals. However, setting positive weight loss goals is an assumption in traditional approaches to weight loss [74]. Other assumptions include 1) the notion that adiposity increases risk of morbidity and mortality, 2) maintaining weight loss can be achieved through proper diet and exercise, which will prolong life, 3) obese individuals can improve health only through weight loss, 4) and finally, the high

*A group of women at a fitness facility stretch to hold a child's pose with their hands all reaching in to form a circle. Body positivity promotes strength and fitness coming in many forms, no matter the body shape or size (photo by: Sarah Pflug. Available from: https://burst.shopify.com/photos/ladies-stretch-circle?c=yoga [Accessed:* 

*DOI: http://dx.doi.org/10.5772/intechopen.93540*

entirely.

**6. Body positivity**

appearance [73] (**Figure 4**).

*Obesity Acceptance: Body Positivity and Clinical Risk Factors DOI: http://dx.doi.org/10.5772/intechopen.93540*

clearly defined approach to reduce these biases among students and professionals across various health disciplines [69]. There have even been reports of obese women avoiding routine gynecological exams, despite having higher rates of gynecological cancers than nonobese women, due to weight stigmatization and the corresponding negative attitudes of health care professionals toward overweight people [44]. The obesity problem we are facing is only exacerbated when participants express reluctance to address weight concerns with their health care providers for fear they will not be taken seriously [70], or avoid seeing their primary care physician or specialist entirely.
