Like the headline says, I want to unpack internalized weight stigma, but first, let’s all get on the same page about weight bias, weight stigma (generally) and weight discrimination.

Weight bias — negative, prejudiced attitudes and beliefs about individuals due to their weight — can have a profound impact on health. This bias, also known as anti-fat bias, may take the form of stereotypes, such as laziness, lack of motivation or lack of self-discipline.

When someone directs their weight bias prejudice towards individuals by labeling them with stereotypes, it becomes weight stigma. While people in fat bodies (I use fat as a neutral descriptor of body size) are the most common targets of weight stigma, it can happen at lower weights, too. For example, someone with a BMI in the “normal” range could be subjected to stigma if their family or peer group idealizes a very thin frame. This can also happen in so-called weight-dependent sports such as gymnastics, wrestling and figure skating, or in running if a coach believes that “lighter is faster.”

When someone is overtly discriminated against because of weight bias, then that becomes weight discrimination. For example:

• Derogatory humor or receiving unsolicited advice and inappropriate comments about weight.
• Being turned down for a job or job promotion because of weight-based stereotypes.
• Being denied an effective treatment for a health condition by their doctor, and instead told to “lose weight.”

Sources of stigma

When weight stigma is embedded in institutions — including healthcare — and the broader society, this is known as structural or institutional stigma.

When it’s perpetuated by others, including friends, family, co-workers, individual healthcare providers, or strangers, it’s known as externalized stigma.

Stigma can also be vicariously experienced through knowledge of others' experiences with stigma, such as hearing about stigma or discrimination in the media or the witnessing the direct experiences of friends and family.

Weight stigma does not motivate people to “get healthy” or lose weight, regardless of what people who engage in concern trolling (“I’m concerned about your weight,” “But what about your weight?”) like to think — assuming that their intentions are even good in the first place.

Rather, what research overwhelmingly shows is that weight stigma has negative effects on both psychological and physical health, contributing directly to anxiety, depression, poor body image and self-esteem, increased stress, disordered eating behaviors, avoidance of physical activity, high blood pressure, high cortisol levels and systemic inflammation.

Weight stigma is a form of oppression, and a unique one at that. Whey someone experiences stigma based on gender, race or disability, they’re likely to identify with others of the same “group,” which may help protect against some of the effects of stigma.

However, when people on the receiving end of weight stigma hold those same stigmatizing views about themselves (in other words, they’ve internalized the stigma), they often don't want to identify with others of their “group," and therefore have no group protection.

Also, because weight bias and stigma are socially acceptable, it's common for people in larger bodies to express "anti-fat" attitudes.

Internalized weight stigma and it’s physical effects

Research suggests that internalized weight stigma — again, when someone accepts weight-based stereotypes to be true about themselves — has the greatest impact on physical and mental health.

When people internalize weight stigma, they:

• Feel less confident in their ability to engage in health-supporting behaviors such as physical activity and eating a nutritious diet — and so are less likely to try.
• Become more prone to binge eating as well as restrictive eating disorders such as anorexia.
• Are more likely to delay or avoid preventive and follow-up healthcare

Many people try to escape weight stigma by losing weight. But when people try to lose weight and “fail,” especially if they place an extremely high value on weight and body shape, this may worsen internalized stigma. Also, research has found that even “successful” weight loss may not reduce internalized weight stigma.

What’s notable is that even after adjusting for body mass index (yes, I know, BMI is a stupid measure of anything) and sociodemographic risk factors for poorer health, the experience of weight stigma is associated with multiple chronic medical conditions. For example, weight dissatisfaction is a major driver of unhealthy dieting behaviors, such as yo-yo dieting and weight cycling, that are themselves associated with negative health outcomes such as type 2 diabetes, hypertension and mortality.

Psychological effects of weight stigma

Weight stigma is associated with increased risk of mood disturbances and disordered eating, and these associations happen regardless of BMI. This may be because the more that individuals experience and internalize weight stigma, the more likely they are to use maladaptive instead of adaptive coping mechanisms when dealing with that stigma.

Examples of maladaptive coping mechanisms include:

• Refusing to spend time with friends (social isolation)
• Use of alcohol, drugs or tobacco
• Self-harm (cutting, engaging in unsafe sex)
• Disordered eating (including binge eating and emotional eating — note that emotional eating is not always maladaptive, but if it is causing physical distress, then it probably is)
• Trying to “fix” the problem by dieting
• Engaging in self-critical or self-shaming talk
• Engaging in “fat talk” with others

Examples of adaptive coping mechanisms include:

• Talking with supportive friends or family
• Talking to a therapist or counselor
• Engaging in meaningful activities or hobbies (which can help you get out of your head)
• Engaging in enjoyable physical activity (which can clear your head and help you get into your body)
• Journaling to help process your experience
• Mindfulness meditation or other practices
• Self-compassion practices

Because maladaptive coping is strongly associated with poorer psychological well-being, people who experience more frequent weight stigma and don’t have adaptive coping mechanisms at the ready may be more vulnerable to psychological distress. For example:

• Increased risk of depression and anxiety
• Poor body image and lower self-esteem
• Increased stress

OK, now let’s get REAL real

While anyone of any body size can internalize weight stigma, and the harmful effects of that are real, I also want to make it clear that all bodies are not in the same boat.

That’s because some bodies are being subjected to both internalized AND external weight stigma. They’re getting it from ALL directions.

Also, if you are in a fat body and you’ve done “the work” (i.e., body image or embodiment work) and you are at peace with your body, however that looks for you (body neutrality, body acceptance, body respect body love, body liberation), you still have a target on you whenever you leave your house. You may have a target on you IN your house, if your parents, partner or spouse directs stigma at you.

Accepting your body doesn’t mean that airplane, theater, café and waiting room seats magically fit your body. It doesn’t magically expand the range of clothing that fits your body. You don’t magically see bodies like yours suddenly represented in a positive or even a totally normal and average light in media. You unfortunately don’t get to both live your best, fullest life in the body you have and opt out of society’s B.S. That sucks, and it SHOULD NOT BE THAT WAY!

So if you are in a thin body or even an almost-thin body, and you feel bad about your body and that’s doing a number on your mental health and even physical health, I have utmost compassion for you, because your suffering is real. And I encourage not making the mistake of thinking that your experience is the same as that of someone in a visibly, undeniably fat body.

Again, weight stigma harms EVERYBODY , but not everyone experiences the same amount of stigma. But we all have a role to play in dismantling weight stigma, even if it starts with examining our own feelings about our body, and other people’s bodies.

Disclaimer: All information provided here is of a general nature and is furnished only for educational purposes. This information is not to be taken as medical or other health advice pertaining to an individual’s specific health or medical condition. You agree that the use of this information is at your own risk.

Until next time,