Curr Obes Rep

DOI 10.1007/s13679-015-0153-z

OBESITY PREVENTION (A MUST, SECTION EDITOR)

Health Consequences of Weight Stigma: Implications

for Obesity Prevention and Treatment
Rebecca Puhl 1 & Young Suh 1

# Springer Science+Business Media New York 2015

Abstract Despite decades of research documenting con- Introduction

sistent stigma and discrimination against individuals
with obesity, weight stigma is rarely considered in obe- Stigma and discrimination are common experiences reported
sity prevention and treatment efforts. In recent years, by individuals with overweight and obesity. National esti-
evidence has examined weight stigmatization as a mates indicate that weight discrimination is among the most
unique contributor to negative health outcomes and be- frequent forms of discrimination reported by adults and is
haviors that can promote and exacerbate obesity. This comparable to rates of racial discrimination among women
review summarizes findings from published studies [1]. Among youths, weight stigma is experienced as pervasive
within the past 4 years examining the relationship be- bullying and victimization and is reported by youths, teachers,
tween weight stigma and maladaptive eating behaviors and parents to be one of the most prevalent forms of bullying
(binge eating and increased food consumption), physical that youths face at school [2–5]. In addition to numerous so-
activity, weight status (weight gain and loss and devel- cial consequences, economic inequalities, and psychological
opment of obesity), and physiological stress responses. consequences imposed by weight stigma [6], those who expe-
Research evaluating the effects of weight stigma present rience weight bias or discrimination may be additionally vul-
in obesity-related public health campaigns is also nerable to health risk behaviors and outcomes that can exac-
highlighted. Evidence collectively demonstrates negative erbate poor health and obesity. Increasing evidence has docu-
implications of stigmatization for weight-related health mented links between perceived weight stigmatization and
correlates and behaviors and suggests that addressing adverse health consequences such as binge eating, increased
weight stigma in obesity prevention and treatment is food consumption, avoidance of physical activity, physiolog-
warranted. Key questions for future research to further ical stress, weight gain, and impaired weight loss outcomes.
delineate the health effects of weight stigmatization are Taken together, this evidence suggests that weight stigma may
summarized. interfere with efforts to improve health and well-being and
potentially increase risk of behaviors that reinforce obesity.
The aims of this review are to summarize recent evidence
Keywords Obesity . Stigma . Discrimination . Health . documenting health consequences associated with weight
Health behaviors stigma and discuss implications for future research and stigma
reduction efforts in obesity prevention and treatment.

This article is part of the Topical Collection on Obesity Prevention Methods

* Rebecca Puhl A systematic literature search of studies published between

[email protected] 2010 through September 2014 was conducted using online
Young Suh libraries of psychological, medical, social science, and educa-
[email protected] tion research including PsycINFO, PubMed, SCOPUS, and
1
Rudd Center for Food Policy and Obesity, University of Connecticut, ERIC. The following search terms were used to identify stud-
One Constitution Plaza, Suite 600, Hartford, CT 06103, USA ies addressing weight stigma: bias, discrimination,
 Curr Obes Rep

discriminatory, discriminate, stigma, prejudice, prejudicial, [10] and significant associations between overt weight stigma
stereotype, stereotypical, stereotyping, victimization, and greater binge eating among overweight and obese adults
victimize, blame, blaming, shame, shaming, teasing, tease, (N=55) [11]. Research with community samples (N=415) has
unfair, bully, bullying, harassment, weight, obese, obesity, similarly found that perceived weight discrimination contrib-
overweight, BMI, fat, and fatness. As the aim of this paper is utes significantly and independently to the variance in emo-
to review the literature on weight stigma specifically in the tional eating and binge eating [12].
context of its associated health consequences and implications For youths, similar findings have emerged. Among boys
for obesity prevention and intervention, the following search and girls enrolled in weight loss camps (N=361), those who
terms were additionally used in different combinations with reported experiencing weight-based teasing had an increased
the aforementioned list of terms above: eat, overeat, diet, likelihood of engaging in unhealthy eating behaviors [13] and
consumption, intake, caloric, calorie, physical activity, binge eating compared to peers who were not teased [14]. A
exercise, weight gain, weight change, weight trajectory, study of 1491 adolescents found that reports of weight-based
physiological, cortisol, stress, biochemical, hormone, blood teasing were consistently associated with disordered eating for
pressure, campaign, and health promotion. Finally, manual both boys and girls across weight strata [15]. These patterns
searches were conducted with reference lists of retrieved arti- also appear to be present in minority samples of youths. In a
cles and in databases for authors with published work in this study of 57,997 Spanish adolescents, weight-related teasing
field. Unpublished manuscripts, dissertations, commentaries, was significantly related to abnormal eating in girls and with
and non-English publications were excluded. The initial body dissatisfaction in both boys and girls [16]. Among His-
search step identified 2366 articles. Upon removal of panic and African American girls (N=141), weight-related
duplicates (N = 712), titles and abstracts were further teasing from peers and parents correlated with emotional eat-
screened to exclude articles based on study design ing, and parent-specific teasing was associated with binge
(e.g., qualitative, case studies), involving animal sam- eating [17]. In a study of African American girls seeking treat-
ples, examining implications of weight stigma outside ment for obesity (N=92), weight-based teasing was signifi-
the scope of this review (e.g., employment discrimina- cantly correlated with eating pathology [18]. Retrospective
tion), or studies that used non-weight-specific measures research with young adult women (N=1533) also found that
of stigma (N=1581). Of the 73 remaining articles, full- those who experienced childhood weight teasing were signif-
text versions of 20 articles were further reviewed for icantly more likely to engage in maladaptive eating behaviors
clarification, and 13 articles were excluded due to use than non-weight-teased peers, and as the variety of weight
of composite health measures lacking differentiation be- teasing insults increased, so did disordered eating patterns
tween physical and emotional health, evaluations of out- and current body weight status [19].
comes uninformative for this review’s aims (e.g., emo- Internalization of weight bias (the extent to which a
tional eating), and sampling of clinical population af- person engages in self-stigma, attributing negative
fected with diseases unrelated to weight (e.g., schizo- weight-based stereotypes toward oneself) may have par-
phrenia). In total, 60 published articles were eligible ticularly important implications for binge eating behav-
for inclusion in this review. iors. Weight bias internalization is positively associated
with binge eating in obese adults seeking weight loss
treatment [20, 21] and is endorsed at higher levels in
Weight Stigma and Associated Health Consequences weight-loss treatment samples compared to controls
[22•]. In a sample of treatment-seeking obese patients
Binge Eating with BED (N=100), internalization of weight bias made
significant independent contributions to the variance of
Individuals who report experiences of weight stigmatization eating disorder pathology even after controlling for de-
have an increased likelihood of engaging in binge eating. In pression, self-esteem, and personal anti-fat attitudes
light of research documenting a high lifetime prevalence of [22•] and also correlates with poorer self-reported health
obesity among individuals with binge eating disorder (BED) among overweight patients seeking treatment for BED
[7] and that many individuals with BED have a history of (N=255) [23]. Recent evidence additionally found that
childhood obesity [8], it is important to examine the relation- implicit self-stigma predicted individuals’ (N=78) eating
ship of binge eating behaviors and experiences of weight stig- disorder psychopathology over and above their reported
matization. Evidence indicates that weight stigmatization is a experiences of weight stigmatization and regardless of
meaningful and unique predictor of binge eating beyond other whether they had obesity or BED [24]. In community
established risk factors [9•]. In clinical samples of adults, ev- samples, weight bias internalization has also been found
idence has documented higher exposure to weight stigma to partially mediate the relationship between perceived
among individuals with BED compared to controls (N=78) weight discrimination and eating pathology [12].
Curr Obes Rep

Increased Food Consumption (N=56), participants were randomly assigned to a shame or

no-shame (control) condition. It was found that compared to a
The influence of weight stigmatization on food consumption control group experiencing no shame, participants experienc-
patterns is an area of emerging research. Although previous ing shame rated a buffet meal more desirable and had an
work has documented that as much as 79 % of overweight and increased likelihood of binge eating. In a second experiment
obese women (N=2449) reported eating more food in re- (N=102), participants experiencing shame ate more food than
sponse to experiences of weight stigmatization, only recently controls in a comparative taste test. Findings remained consis-
has this topic been experimentally investigated [25]. Recently, tent after controlling for levels of hunger, time since last meal,
four experimental studies have tested the impact of exposure and negative emotions reported by participants.
to weight stigmatization on immediate food consumption. In a Taken together, although this topic of study has received
first study, researchers randomly assigned overweight (N=34) limited research attention, the recent available evidence sug-
and non-overweight (N=39) women to view one of two brief gests that exposure to weight-related stigma and shame leads
videos, depicting either weight stigmatizing media content or to overeating and increased desire for food. More work is
neutral content, after which participants were invited to con- needed to clarify mechanisms that may be at play and to better
sume (pre-weighed) snacks ad libitum [26]. Overweight wom- identify how energy intake is affected by personal experiences
en who watched the stigmatizing video ate more than three of weight stigma compared to internalization of stigma or
times as many kilocalories as overweight women who exposure to weight stigmatizing content in other forms
watched the neutral video (302.82 vs. 89.00 kcal) and con- (e.g., media).
sumed significantly more calories than the normal-weight
individuals who watched either the stigmatizing or the Physical Activity
neutral video.
In a second study, women (N=93) were randomly assigned Increasing research has begun to examine implications of
to read a news article about weight stigma experienced by weight stigma for engagement in physical activity, especially
overweight persons in the employment setting or a control for youths. Weight-based teasing during physical activities in
article [27•]. They were then asked to talk about the content the school setting is reported to be both commonly observed
and implications of the article in front of a video camera, and experienced by students. In a survey study of 1555 ado-
followed by a Bbreak^ period during which they watched a lescents, 85 % reported that they had witnessed overweight
neutral video and were invited to eat (pre-weighed) snack peers being teased about their weight during physical activi-
foods provided for them. Women in the weight stigma threat ties at school [2]. Another study of 361 adolescents enrolled in
condition who perceived themselves to be overweight (but not weight loss camps found that 73 % reported that they had been
women who did not perceive themselves as overweight) ate teased or bullied about their weight in a physical activity set-
more calories and felt less able to control their eating com- ting, such as their school gym glass or sports practice. Of
pared to women in the control condition. concern, 42 % also reported being teased or bullied about their
Third, two experiments by Brochu and Dovidio (2014) weight by physical education teachers and/or sports coaches
tested the effect of weight-based stereotype threat on food [30]. This finding may be partially explained by recent evi-
choice, as a function of body mass index (BMI) [28]. In the dence demonstrating that teacher attitudes about students may
first study, participants (N=176) were randomly assigned to a be negatively influenced by students’ body weight. For exam-
weight stereotype threat or control condition and asked to ple, an experimental study of 162 physical educators found
make dinner selections from a restaurant menu. Participants that participants expressed lower ability expectations for over-
in the stereotype threat condition ordered food containing weight students than non-overweight students, especially for
more calories from a conventional menu (that did not present girls [31], and variable responses to intervene in situations
calorie information) as their BMI increased, but no association where they became aware of students being teased about their
between participants’ BMI and calories was found in the con- weight [32]. Trainees in sport exercise and PE-related pro-
trol condition. In the second experiment (N=367), participants grams (N=167) have similarly expressed negative perceptions
in the stereotype threat condition again ordered more calories of overweight children [33].
from a conventional menu as their BMI increased, but no Not surprisingly, weight-based teasing at school and/or
association between BMI and calories was observed for par- during physical activity has negative implications for exercise
ticipants who ordered from a menu where calorie information motivation and behavior in youths. In a study of 1419 middle
was present, indicating that calorie labeling removed the effect school students, after controlling for demographic character-
of stereotype threat. istics, students who reported being teased about their weight
Finally, a fourth study by Chao and colleagues (2012) con- (N=245) had lower physical self-concept, lower physical ac-
ducted two experiments to assess whether weight-related tivity self-efficacy, and lower levels of physical fitness com-
shame induces a desire for food [29]. In a first experiment pared to peers who were not teased [34]. An experimental
 Curr Obes Rep

study of 140 overweight youths found that those who were Weight Gain, Obesity, and Weight Loss
randomly assigned to a stereotype-threat condition performed
worse on an exercise-based game than those who were not Given the harmful implications of weight stigma for weight-
exposed to stereotype threat [35]. related health behaviors, research has begun to examine obe-
Several studies have further demonstrated strong associa- sity as a potential outcome of stigma. Among adults, longitu-
tions between student reports of more frequent weight-based dinal evidence demonstrates a clear link between weight dis-
teasing and decreased physical activity [34, 36, 37]. Some crimination and obesity [43, 44•] and weight gain [43, 45].
evidence suggests that girls experience higher levels of teasing One nationally representative study of 6157 adults from the
experiences during physical activities and decreased physical Health and Retirement Study evaluated the association be-
activity compared to boys [37], where as one study has dem- tween experiences of everyday discrimination and obesity
onstrated this association in boys only [36]. Other research over 4 years [44•]. Regardless of baseline BMI, compared to
found that among 394 adolescents who had reported being adults without experiences of weight discrimination, those
teased about their weight during the past year, both boys and who reported experiences of weight discrimination (but not
girls who reported more negative affect in response to teasing other forms of discrimination such as race, appearance, or
experiences were more likely to cope with teasing through sexual orientation) were 2.5–3 times more likely to become
avoidance of school activities, including avoiding participat- obese or remain obese, respectively. In a second longitudinal
ing in physical activities and going to gym class [14]. Al- study of 2944 adults from the English Longitudinal Study of
though little longitudinal work has been done in this area, a Ageing, independent of baseline BMI, people reporting per-
recent study of preadolescents (N=108) found that children ceived weight discrimination similarly experienced greater
with overweight and obesity who experienced teasing during odds of becoming obese (odds ratio (OR)=6.67) and experi-
physical activity were more likely to report poorer subsequent enced significant increases in weight and waist circumference
health-related quality of life 1 year later. Teasing during phys- [43]. However, this study did not observe significance for the
ical activity also negatively influenced physical activity levels relationship between weight discrimination and likelihood of
in youths who were not overweight [38]. remaining obese. Given measurement differences between the
Taken together, this evidence suggests that youths are high- two longitudinal studies, more methodologically comparable
ly vulnerable to weight-based victimization in physical activ- research with overweight and obese samples is needed. Nota-
ity settings and that this may in turn negatively impact their bly, one nationally representative study in Sweden asked par-
attitudes toward and engagement in physical activity. These ticipants (N=2628) about their experiences in health care; rel-
findings have led to calls for re-examination of curricula and ative to individuals of comparable BMI who did not report
physical activity education to ensure that students are not mar- any weight discrimination, those who perceived discrimina-
ginalized because of their weight [39]. tion experienced an increased change in BMI [45].
Less research has addressed weight stigma and physical Among youths, compared to girls without experiences of
activity in adults, but recent findings suggest that internalized weight stigmatization, those reporting previous experiences of
weight stigma may play a particularly important role in phys- weight stigma face a 64–66 % increased risk of becoming
ical activity among adults. In a study of 76 adults enrolled in a overweight and obese [46–48]. During adolescence, teasing
weight management program, awareness and internalization and hurtful labels from family members may be especially
of weight stigma, regardless of objective weight status, were harmful. One study (N=2379) of a diverse sample of girls
found to negatively affect individuals’ willingness to partici- reports greater odds of obesity as a result of stigmatization
pate in physical activity and perceived competence in physical from family members, rather than friends and teachers
activity [40]. Vartanian and Novak (2011) illustrated that (OR=1.62 vs. 1.40) [48]. For boys, evidence is less clear.
weight stigma negatively influenced motivation to exercise Two studies suggest that weight-related teasing is not a signif-
among overweight and obese adults (N=111), particularly icant predictor of overweight and obesity for boys [46, 47].
for those who internalized societal attitudes about weight However, one study (N=1643) evaluated changes in teasing
[41]. Similarly, a study of 177 overweight and obese women over 10 years and observed that increases in weight-related
demonstrated that internalized weight stigma negatively influ- teasing from adolescence to adulthood were associated with
enced exercise motivation, self-efficacy, and reported levels of higher probability of being overweight for adult females
exercise and was a partial mediator between experiences (OR=2.43) and males (OR=1.67) [47]. As excess weight in
of weight stigma and exercise behavior [42]. However, childhood and adolescence increases the risk of obesity [49]
this study also found a positive association between and morbidity and premature mortality in adulthood [50], it is
stigma experiences and exercise behavior, indicating that important to continue examining the long-term effects of
more work in this area is needed to clarify how inter- weight stigma on obesity across the lifespan.
nalized versus experiences of stigma influence exercise Weight stigma may also pose challenges for achieving
motivation and behaviors among adults. weight loss. Among treatment-seeking patients, preliminary
Curr Obes Rep

evidence suggests that experiences of weight stigma may inter- procedures and larger sample sizes that include both men
fere with weight loss outcomes [11, 51•]. In a study of adults in and women are warranted. To date, only one experiment has
primary care (N=600), compared to patients who perceived examined cortisol reactivity (another index of physiological
respectful treatment from their primary care providers, those stress) in response to weight stigmatization within a laboratory
who felt judged by providers because of their weight were less setting [62]. In this study, exposure to weight-stigmatizing
likely to achieve a ≥10 % weight loss (OR=0.87) [51•]. Several stimuli elicited greater cortisol reactivity among both over-
studies have also begun to examine associations between im- weight and non-overweight women (N=123). Given that ex-
plicit weight bias among patients and percentage of weight loss, periences of weight stigma are reported by adults at different
with one study demonstrating that patients with greater weight body weight categories [63], the link between weight stigma
bias have poorer weight loss outcomes [52] and others showing and cortisol could be important to examine in samples across
either an opposite direction of association [53] or no significant the weight spectrum. Another study closely examined this link
association [21]. Furthermore, among adult patients with obe- among women with overweight and obesity (N=45) and sim-
sity in weight management clinics (N=115), those who experi- ilarly demonstrated that more frequent experiences of weight
enced weight discrimination selected potentially riskier weight discrimination were associated with greater blood pressure
loss interventions and expressed higher ideal weight loss and oxidative stress, independent of adiposity [64]. Recent
compared to patients of similar BMI without experi- work has also begun to examine links between weight stigma
ences of weight discrimination [54]. and C-reactive protein (CRP), a biomarker of systemic inflam-
More work in this area is clearly needed to identify the mation that may be independently predictive of type 2 diabe-
extent to which experiences of weight stigma influence weight tes and cardiovascular disease [65, 66]. In one nationally rep-
loss efforts and weight outcomes over time. Preliminary evi- resentative study of adults with overweight and obesity (N=
dence suggests that including components of treatment to ad- 7394), greater experiences of weight discrimination were as-
dress weight stigma with patients may facilitate positive treat- sociated with higher levels of circulating CRP, except for
ment outcomes [55] including weight loss [56]. In light of those with class III obesity [67]. Interestingly, these findings
documented associations between weight stigmatization and extended to experiences of discrimination related to physical
binge eating, increased food consumption, and reduced phys- disability, but not race or age. Additionally, within a subsam-
ical activity, all of which can reinforce weight gain and inter- ple of the national Midlife in the United States survey of non-
fere with weight loss, identifying that effects of stigma on diabetic adults (N=938), weight discrimination was identified
body weight seem particularly warranted. as a stressor that exacerbated the harmful effects of waist to hip
ratio on glycemic control (indexed by glycated hemoglobin
Physiological Stress Responses (HbA1c)) [68]. The observed interaction between waist to hip
ratio and weight stigmatization suggests that the psychosocial
Other forms of societal discrimination (e.g., inequities consequences of weight stigma and discrimination experienced
resulting from race/ethnicity) have been shown to induce neg- by individuals with overweight and obesity may be sources of
ative physiological reactivity in stigmatized individuals increased vulnerability that partly explains the manifestation of
[57–59]. Similarly, increasing research has begun to examine clinical diabetes. As research examining physiological re-
the ways in which weight discrimination may trigger physio- sponses to weight stigmatization remains in its infancy, more
logical stress responses that impair neuroendocrine control of studies are needed to clarify the effects of exposure to weight
health behaviors and contribute to increased adiposity and stigma on blood pressure, cortisol reactivity, CRPs, and HbA1c
elevated risk for cardiovascular and metabolic co-morbidities levels. Given the co-morbidities associated with obesity, it will
of obesity. In evaluating blood pressure, one experiment ex- be especially important to determine whether physiological re-
posed women (N=99) to weight stigmatization in which sponses to weight stigmatization exacerbate or contribute to
women were told that their body weight was either visible or obesity and its related adverse health outcomes.
not visible to others. Findings showed that higher BMI was
associated with greater increases in blood pressure only for Media Campaigns Addressing Obesity
participants who believed that their body weight was visible to
others, but not when they believed that their weight was not The above evidence documents a range of negative health
visible [60]. Among youths, one cross-sectional study (N= consequences that weight stigma can create for eating behav-
644) provided preliminary evidence demonstrating a direct iors, physical activity, and even weight status. In light of this
association of weight-related teasing and bullying with elevat- research, careful consideration should be given to messages
ed systolic and diastolic blood pressure [61]. As a well- communicated in public health media campaigns targeting
documented marker of hypertension and other cardiovascular obesity prevention, to ensure that messages intended to pro-
diseases prevalent among individuals with obesity and over- mote optimal weight-related health behaviors do not simulta-
weight, additional experiments with standardized test neously stigmatize or shame individuals with obesity.
 Curr Obes Rep

Despite hundreds of public health media campaigns content. Furthermore, messages that were perceived to be
targeting obesity that have been disseminated across the most positive and motivating made no mention of the word
USA, very little assessment or evaluation of media campaigns Bobesity^ at all and, instead, focused on making healthy be-
has occurred. However, several recent studies have begun to havioral changes without reference to body weight. In a
examine stigmatizing content in obesity-related media cam- follow-up experimental study, the same researchers randomly
paigns and its impact on the public. In a national study of 1014 assigned a national sample of 1085 adults to view either ten
adults, participants viewed a random selection of 10 (from a obesity-related campaigns that were stigmatizing or ten cam-
total of 30) messages from major obesity public health cam- paigns that contained more neutral content [70•]. Again, stig-
paigns, evaluating each according to positive and negative matizing campaigns were no more likely to instill motivation
descriptors [69]. Campaign messages that were publicly crit- for improving lifestyle behaviors than campaigns that were
icized for their stigmatizing content received the most nega- more neutral, and stigmatizing campaigns were also rated as
tive ratings and the lowest intentions to comply with message inducing less self-efficacy for health behavior change and

Table 1 Key research questions for future study on the health consequences of weight stigma

Topic Research questions

Eating behaviors • How does exposure to weight-based bullying and teasing affect binge eating and food
consumption in youths?
• How does weight stigmatization affect food consumption across individual characteristics
such as race/ethnicity, gender, age, and weight status?
• How does internalization of weight stigma affect binge eating and/or increased food intake?
• Can efforts to help patients cope with weight stigma lead to reductions in binge eating,
food consumption, or improve treatment outcomes for binge eating disorder?
Physical activity • To what extent does weight stigmatization affect exercise behaviors? Are there differences
across sociodemographic factors or weight status?
• Among adults, how prevalent and consequential are experiences of weight stigma and
discrimination in physical activity settings (e.g., fitness centers and group sports)?
• How does internalization of weight stigma affect levels of physical activity in youths and
adults?
• Can efforts to help individuals cope with weight stigma lead to improvements in physical
activity?
Weight gain, obesity, and weight loss • How do experiences of weight-related teasing and bullying in youths affect the development
and continuation of obesity in adulthood?
• Are there differential effects of experiences of weight discrimination versus internalization
of weight bias on weight status?
• Does weight stigma influence weight gain or weight loss differently across gender, race/
ethnicity, age, or body weight status?
• To what extent does weight stigma influence weight loss maintenance?
• Can helping patients address weight stigma improve weight loss treatment outcomes?
Physiological responses • How do negative physiological responses associated with weight stigmatization contribute
to eating behaviors, health outcomes, and obesity?
• Are there differential effects of experiences of weight discrimination versus internalization
of weight bias on physiological responses?
• Does weight stigmatization affect physiological responses similarly or differently across
individual characteristics such as race/ethnicity, gender, age, and weight status?
• What other neuroendocrine markers (e.g., ghrelin and leptin) and physiological responses
(e.g., heart rate) associated with obesity and related diseases respond to weight stigma
and discrimination?
• Do perceptions of psychological stress influence the association between weight stigma
and negative physiological reactivity?
• Can interventions addressing internalization of weight stigma reduce physiological stress
responses among individuals experiencing or anticipating weight stigma?
Media campaigns • Do stigmatizing obesity-related media campaigns influence health behavior outcomes
for adults and youths with obesity? How do these outcomes compare with exposure
to non-stigmatizing campaigns?
• How do different segments of the population (e.g., ethnic minorities, parents, youths)
respond to obesity-related media campaigns that are stigmatizing versus non-stigmatizing?
• What types of non-stigmatizing health campaign messages can effectively increase
awareness of obesity and improve health behaviors?
Curr Obes Rep

having less-appropriate visual content compared to more neu- and advocates working on obesity prevention and treatment.
tral campaigns. These findings remained consistent regardless Some medical schools and many bariatric centers across the
of participants’ body weight and across most country have already begun to implement sensitivity training
sociodemographic predictors. A more recent experimental to reduce weight stigma. With recognition that stigma is a
study examined the effect of a controversial media campaign legitimate and prevalent problem experienced by children
on perceptions of childhood obesity. A national sample of and adults with obesity, these fields will be better prepared
adults (N=1699) was randomly assigned to view one of three to respond through increased diligence to ensure that existing
publicized media messages featured in a controversial child- and future obesity prevention, intervention, and treatment ap-
hood obesity awareness campaign intended to increase aware- proaches provide support and empowerment to persons with
ness of the seriousness of childhood obesity or a control (no obesity rather than reinforce stigma, shame, or blame. There
exposure) group [71]. Messages tested specifically highlight- have been increasing calls for obesity prevention efforts to
ed health consequences of obesity (e.g., hypertension), psy- include strategies to prevent weight stigma [73, 74] and to
chosocial consequences (e.g., bullying), or parental contribu- ensure that health messages targeting individuals with obesity
tions to childhood obesity. The media messages had no effect first and foremost do no harm [72]. This may involve shifting
on participants’ attributions of responsibility to parents, sup- the emphasis of prevention efforts to encourage and support
port for obesity prevention policies, or perceived importance health behavior change in individuals across diverse body
and seriousness of childhood obesity, nor did they increase weight categories rather than disseminating messages that fo-
weight-based stigma. Although much work remains to be cus specifically on obesity or weight loss [69].
done in this area, this preliminary evidence indicates that some Finally, professionals in health-related fields can advocate
highly disseminated media campaigns targeting obesity may for and support broader systemic and policy efforts that aim to
not have their intended effects and, in some cases, may back- reduce weight stigmatization in our society. With weight bias
fire by instead leading to perceptions of stigma and lower and discrimination present in many domains of living including
motivation and intentions to engage in healthy behaviors. This employment settings, educational institutions, and the mass
underscores the importance of ensuring that obesity-related media [6], societal-level remedies may be needed to change
media campaigns are adequately tested and grounded in evi- this otherwise widespread form of bias. Thus, as policy reme-
dence and that steps are taken to avoid content that may fur- dies are increasingly discussed and considered as strategies to
ther stigmatize individuals with obesity [72]. offer protection against discrimination for people with obesity
[75], professionals in health-related fields can inform these ini-
tiatives and advocate for improving quality of life for individ-
Conclusions and Implications for Obesity Prevention uals affected by weight stigma and discrimination.

Collectively, recent research examining weight stigma illus-

trates a range of potential adverse health consequences that Acknowledgments The authors gratefully acknowledge support for
this research from the Rudd Foundation.
can reduce quality of life for individuals with obesity and
may ultimately interfere with efforts to improve their health, Compliance with Ethics Guidelines
lose weight, or prevent weight gain. Despite national attention
to obesity as a public health priority and strategies to identify its Conflict of Interest Rebecca Puhl and Young Suh declare that they
effective prevention and treatment, weight stigma and its asso- have no conflict of interest.
ciated health consequences are often absent in national dis-
Human and Animal Rights and Informed Consent This article does
course, decision-making, and policy efforts. Although more not contain any studies with human or animal subjects performed by any
research is needed to obtain a comprehensive picture of the of the authors.
ways in which weight stigma may influence different health
indices (see Table 1 for a summary of key research questions
that need to be addressed to advance this field of study), impli- References
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stigma can interfere with weight-related health behaviors. In-
Papers of particular interest, published recently, have been
creasing efforts should consider strategies to reduce weight
highlighted as:
stigma as part of broader initiatives to prevent and treat obesity.
• Of importance
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achieved through provision of education and sensitivity train- ination: prevalence and comparison to race and gender discrimina-
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 Curr Obes Rep

2. Puhl RM, Luedicke J, Heuer C. Weight-based victimization toward 22.• Durso LE, Latner JD, White MA, Masheb RM, Blomquist KK,
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