Weight-based stigma is defined as negative attitudes and discrimination against an individual based on their weight, and tends to be rooted in the belief that those suffering from obesity lack self-discipline and personal responsibility. To mark World Obesity Day 2020, a group of leading obesity experts have issued a statement condemning biases and social stigma of the disease. Weight stigma leads to poorer health outcomes, including depression and anxiety, and contributes to increased weight gain due to psychological and social stress. The pressure of weight stigma impacts an individual’s personal and social relationships, employment prospects, and even their right to receive respectful and appropriate medical care due to weight stigma by health providers. There’s even a wage gap for overweight individuals: overweight men make about 3% less than their counterparts, and overweight women lose out on 6% of their income due to weight stigma baked into the workplace. Battling stigma is only possible through spreading knowledge, so here are a couple stigma-busting facts that can make us all better allies to ourselves and our friends and neighbors.
1. Diets don’t work.
One of the most pervasive myths underlying weight-based stigma is that the solution is simple: eat less. However, the reality is not quite that simple, and has a lot to do with the hormones that dictate whether we are hungry or sated – the hormones leptin and ghrelin.
Ghrelin is a hormone produced primarily by the stomach and its immediate effects are obvious: this hormone stimulates your appetite and promotes food intake. Ghrelin is responsible for a lot of physiological processes: it regulates our metabolism, affects the breakdown of glucose, regulates heat loss and production, and even affects your circadian rhythms, learning, memory, and taste sensation. On the other hand, leptin is the hunger repressor hormone released primarily by fat cells (adipocytes). Leptin reduces appetite and fat storage. Ghrelin peaks before your meal, and leptin levels creep up as you become full.
Weight-loss focused diets disrupt our homeostatic ghrelin and leptin levels, and these changes can last. One study tracking contestants on the weight-loss reality TV show The Biggest Loser found that the rapid weight loss contestants achieved on the show caused a lasting reduction in leptin levels and overall slowing of their metabolism. Though The Biggest Loser contestants are on the extreme end of the spectrum of weight loss diets, these results reveal that the human body has a dynamic mechanism that regulates body weight in the long term and tends to resist drastic changes in weight. Body weight regulatory mechanisms are built into our biology, and are part of the reason why dieting is considered an ineffective treatment for obesity by researchers in the field. In fact, studies show that the majority of those who undertake dieting for weight control gain back all the weight they lost—or more – within two years.
2. Weight and health are not the same.
Does skinnier = healthier? Studies show that obesity is associated with an increased risk of cardiovascular disease — a set of diseases which affect how well our heart and circulatory system works. However, more research is showing us that sedentary thin people carrying extra visceral fat (fat wrapping around the organs) can have the same cardiovascular risks as larger individuals. Distributions and ratios of fat and muscle mass are better prognosticators of health than weight itself.
Long-term diet studies can also help us understand how diet-based weight loss affects the body. Researchers at the University of Minnesota analyzed data from 21 long-term diet studies to assess the relationship between weight loss and several markers of overall health, such as cholesterol levels, triglyceride levels, blood pressure levels, and fasting blood glucose. Strikingly, the investigators found that diet-induced weight loss resulted in little change in these levels, and found no clear relationship between the amount of weight loss maintained and changes in these measures of health. Instead, the authors propose that positive health benefits that are wrongly conflated with weight loss may instead come from exercise independently of weight loss, healthy foods, preventative care and having healthy social support networks.
It’s clear that you cannot tell how healthy someone is simply by looking at them. Leading researchers blame the obesity epidemic on cheap, calorie-dense, highly processed food that makes up an increasing portion of our diets in the modern world. Quitting our modern diet requires a certain level of privilege that further stacks the odds against low-income individuals and people who live in food deserts. It’s time to adjust our worldview to reflect what science tells us about obesity and shed weight-based stigma — for good.
Peer edited by Matthew Tsilimigras