person’s weight or health behaviors (eg, criticism about food choices), as well as blatant mistreatment, including peer victimization and discrimination. Peer victimization due to weight is highly prevalent, especially among youth. Examples include teasing, systematic bullying (verbal or physical, in person or online), social exclusion, and other forms of harassment (such as being the target of rumors).35,36


Weight is the most common reason for victimization in adolescents—


as reported by students, parents, and teachers—above all other reasons, such as race or ethnicity and sexual orientation.37


lescents with obesity have over two times greater odds of experiencing peer victimization as youth with lower weight.38


Data suggest that children and ado- Weight-based victimization is more


commonly experienced by girls than boys, although weight-based victimization is also common among boys with lower weight, due in part to differences in body ideals for size and muscularity.35,36,39 Although weight-based victimization can be experienced throughout the life


span, most research on weight-related mistreatment in adults focuses on dis- crimination. Discrimination is a broad term that can refer to unequal treatment across interpersonal relationships, education, employment, health care, and public settings, among other domains. Meta-analytic estimates suggest that 20% to 45% of women with obesity and 6% to 28% of men†


with obesity report experiencing


weight-based discrimination, with higher rates for individuals with higher BMIs.40 Rates of weight discrimination for women† and race-based discrimination,41


are comparable to rates of gender-based and weight is one of the most strongly identified


reasons for mistreatment among diverse samples of adults with obesity who may experience discrimination for a variety of reasons.42


Workplace discrimination is


particularly prevalent, as it is reported in up to 28% of women with obesity and 12% of men†


with obesity.40 Self-reported perceptions of discriminatory experi-


ences are supported by economic studies of unemployment and wages that show considerable weight disparities (especially for women† for other sociodemographic and health factors,43-46


), even when controlling and by experimental studies


that document biases in hiring, promotion, and salary decisions by employers and human resource professionals.24,47,48


Workers with a higher weight are also ascribed


more negative character traits (eg, incompetence) than lower weight workers,47 further exemplifying how bias may contribute to unfair treatment and adverse social consequences.


Intrapersonal Weight Stigma


Stigma processes that occur within individuals with a higher body weight include anticipation of being judged or mistreated due to weight,49 tion of stigma (ie, self-stigma).50


as well as the internaliza- The threat or expectation of stigmatization may


be present in social situations, during employment, or in health care settings. This anticipation can impair performance (eg, in a job interview) and lead to avoidance of certain settings and activities, including seeking health care.49


The internaliza-


tion of weight stigma begins with awareness among people who identify as having a higher body weight that they are devalued by others in society.51


Negative attitudes


and stereotypes may be endorsed and applied to oneself; for instance, people with obesity may blame themselves for their weight and believe that they are lazy and lack self-control. As a result, this internalization can lead to lower self-esteem or self-worth (ie, self-devaluation), based solely on weight.51-53


† Study participants were described as women and men. Gender was not further specified.


46 SECTION 1: Foundations of Treatment: The Human Element


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