Weight stigma comes in so many forms, from so many sources. It’s prevalent in media and entertainment, at school and work, and even in health care, where providers fat-shame patients in the name of “health.”
But more and more evidence shows that fat-shaming people is not only emotionally damaging, it may cause people to gain even more weight. And women may be particularly susceptible.
A small new study, recently presented at an annual American Heart Association conference, found that women were more likely than men to say they feel stigmatized about their abdominal fat, no matter what they actually weigh. That internalized weight stigma was linked to additional weight gain.
“Some people who struggle with managing their weight may devalue themselves based on external messages from society telling them they are unattractive, self-indulgent or weak-willed because they weigh more,” lead study author Natalie Keirns, a doctoral candidate in clinical psychology at Oklahoma State University, said in a statement. “When these ‘anti-fat’ messages are internalized, people often feel shame, which in turn, may make them vulnerable to weight gain.”
The pitfalls of fat-shaming
The new research has limitations, including its small size (only 70 participants) and the fact that it was a cross-sectional study, so it relied on data from one point in time and could not establish cause and effect.
Still, the researchers believe it raises a lot of interesting questions about how exactly weight stigma and weight gain are linked. One hypothesis is that people who have been shamed for what they weigh might be less likely to seek out medical care — particularly if they’ve had health care providers make them feel bad about their weight before. They might also be more likely to turn to unhealthy behaviors to cope with that kind of stigmatization.
There may also be an underlying physiological connection between weight stigma and weight gain.
“Shame, specifically as an emotion, is related to human stress response,” Keirns said. “When we feel shame, our production of cortisol increases, which can lead to the accumulation of visceral fat.”
Rethinking weight as a measure of health
Keirns and her co-researchers believe their study is the first to draw a connection between internalized weight stigma and visceral fat specifically. Visceral fat is a particular type of deeper abdominal fat that surrounds a person’s organs, and has been linked to serious health outcomes, like diabetes, heart disease and high blood pressure. For years, many experts have warned that this type of belly fat is particularly “dangerous.”
But at the same time, doctors and researchers are reexamining the relationship between weight and health, or at least arguing that it’s a whole lot more nuanced than many of us have been led to believe.
Using a person’s body mass index, or BMI, as a measure of health has been criticized not just for being overly simplistic, but also for being inherently racist and sexist. Research also shows that focusing too much on weight really misses the point.
One recent scientific review found that physical activity is much more important in predicting whether a person will live a long and healthy life than what they weigh. As one of the researchers behind that study said: “We would like people to know that fat can be fit, and that fit and healthy bodies come in all shapes and sizes.”
The researchers behind the new study say they really hope doctors will take note of their findings and focus much more on promoting healthy behaviors than harping on weight. “Healthy” behaviors can include getting more physical activity (things like yardwork, brisk walking and yoga all definitely count), eating more fruits and vegetables, or even just establishing a heart-healthy bedtime.
“Among health care professionals, we need to be more aware of our assumptions and how weight bias can negatively affect our patients,” Keirns said.