Structural Weight Stigma


Structural stigma includes societal conditions, cultural norms, or institutional pol- icies and practices that create disadvantages and adversely affect the well-being of stigmatized individuals.12


Popular media portrayals and news coverage of obesity


are examples of contributors to a stigmatizing culture. Television shows and movies for children and adults are rife with examples of weight bias and stigma, including presentations of characters with a higher weight as villains or “comic relief” rather than as protagonists; these higher weight characters often are portrayed with stereo- typical traits or behaviors (eg, eating all the time).13


News stories that frame obesity


as a simple problem of poor diet and inactivity perpetuate the narrative of personal responsibility, and images that accompany such news stories often display persons with obesity in a dehumanizing manner (eg, their heads are often not visible in videos or photos, or images zoom in on their specific body parts in an unflattering manner).14-16


to negative public attitudes toward individuals with a higher weight.16,17


Studies show that stereotypical media depictions of obesity contribute In addition,


social media outlets such as X (formerly known as Twitter), Facebook, Instagram, and YouTube are filled with weight-stigmatizing content that mocks or disparages people with overweight or obesity, in addition to providing forums for cyberbullying and promotion of dangerous disordered eating practices.18-20


This is of particular


concern for young people, who have high exposure to social media content and may be especially vulnerable to internalizing harmful messages about weight.21 Laws and policies (or lack thereof) can also perpetuate stigma or fail to


prevent it. In the United States and abroad, very few laws exist to protect against weight discrimination.22,23


For example, Michigan is the only state that prohibits


discrimination based on weight, and only a handful of US cities have such protec- tions in their employment laws.24


Similarly, despite the fact that every US state is


required to have an antibullying law, only one state (Maine) enumerates weight as a protected characteristic (three additional states include physical appearance or attributes).25


This lack of legal protection against weight-based discrimination and


bullying enables mistreatment without repercussions. In health care, institutional policies often facilitate discrimination based on weight in provision of care. For example, BMI cutoffs are commonly used to determine eligibility for certain pro- cedures, including fertility treatments and orthopedic surgeries.26-30


The rationale


for such policies is presented as attempting to mitigate health and safety risks; however, the BMI cutoffs are often made without consideration of other health factors, with the result of denied or delayed access to care that could substantially enhance health and quality of life for people with a higher weight.24,31


Another


form of health care discrimination is the lack of insurance coverage for most evidence-based obesity treatments, including lifestyle modification counseling, medications, and surgery.32,33


This may be due in large part to weight bias and the


continued conceptualization of obesity as a problem of personal responsibility that could be solved with simple diet and exercise rather than a complex disease that requires comprehensive medical care.


Interpersonal Weight Stigma


Individuals with obesity may experience weight stigma from a variety of interper- sonal sources, including family members, peers, educators, coworkers, employers, community members, service workers, fitness professionals, and health care pro- viders (the latter is discussed in more detail later).34


Examples of interpersonal


stigma may include microaggressions, such as offhanded comments about a CHAPTER 3: Weight Bias and Stigma 45


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