On Weight Bias & Weight-Inclusive Care

I wrote in a recent blog post about some common myths related to eating disorders, the main myths being that eating disorders affect only young, thin, white women. This is also known as the SWAG stereotype (“skinny, white, affluent girls”). If you read the post, it’s clear that that is not the case. But the stereotype points to a much larger issue- the fact that people in larger bodies, those of color, or of lower socioeconomic backgrounds are less likely to receive an eating disorder diagnosis and less likely to get treatment.

Eating disorders are life-threatening mental illnesses that affect every major organ system in the body. Approximately 5% of people in the United States will suffer from an eating disorder in their lifetime, and only 1/3 of those ever receive treatment. Many studies have shown that eating disorders impact individuals of a wide range of weights, race/ethnicity, sex, and socioeconomic backgrounds. And yet the SWAG stereotype prevails. The fact is that people who fall into the category of underweight, female, and higher socioeconomic status are more likely to receive a diagnosis and treatment.(1)

And it’s not just in the field of eating disorders that people in larger bodies face discrimination. Weight bias and thin privilege exist within our culture.

What is thin privilege?

I want to share this excerpt from Lindo Bacon’s book, Health at Every Size: The Surprising Truth About Your Weight, because I think it does an incredible job at summarizing thin privilege.

“The word ‘privilege’ is used to describe receiving unjust advantages at the expense of others. These advantages are often largely invisible—especially to those who enjoy them. For instance, I have what is called ‘thin privilege,’ a consequence of weight discrimination.

Because I’m relatively thin, it’s been easier for me to meet and get approval from other people. This has helped me make friends, find a life partner, develop professional contacts, and secure jobs. It also means I am treated with greater respect when I shop or eat in a restaurant. It means I have a larger choice of fashions at less expensive prices and never have to pay for more than one airline seat, making travel and its accompanying opportunities more accessible. I could go on for days listing the ways in which I have benefited from others’ perception of my weight, but I believe these simple examples make the point. I can think of very little in my life that is untainted by ‘thin privilege.’”

What is weight bias and discrimination?

There is a very real belief in our culture that being fat is bad. Weight stigma, also known as weight bias or weight-based discrimination, is stereotyping based on a person’s weight. Some of the assumptions are that fat people are lazy, gluttonous, or inherently unhealthy; while thin people are seen as attractive, desirable, and healthy. These assumptions are not rooted in fact, but rather are a toxic message in our culture. To quote Bacon, “As long as it is more difficult to live in a fat body, everyone fears becoming fat”.(2) This drives diet culture and the overall obsession with the thin ideal.

Weight discrimination in healthcare

And as Bacon says above, thin privilege is a direct consequence of weight discrimination. People in larger bodies face discrimination at every turn: employment (including lower wages), media stereotypes, biased attitudes and negative judgments, and lower quality of care from health professionals. So many health conditions get blamed on weight and the individual’s ability to “take care of themselves” by controlling their food intake and weight- diabetes, heart disease, hypertension, PCOS, etc. In reality, genes play a larger role in the development of these diseases than weight does. It is worth remembering that dieting and sustained intentional weight loss efforts do not work. (3)

Weight bias is so powerful that even the fear of being “too fat” has harmful consequences and is associated with disordered eating. A recent study of adolescent girls showed that girls who were labeled as too fat by people close to them (family, friends, teachers) at age 14 reported greater unhealthy weight control behaviors, bulimic tendencies, drive for thinness, and body dissatisfaction at age 19. Weight discrimination has lifelong consequences. Even the potential for rejection or discrimination based on body size can undermine health.(4)

Taking a weight-inclusive approach

A weight-normative approach in healthcare means emphasizing “weight and weight loss when defining health and well-being”. A weight-inclusive approach emphasizes “viewing health and well-being as multifaceted and directing efforts toward improving health access and reducing weight stigma”. Research shows a weight-inclusive approach, including Health at Every Size, was associated with improved physical, behavioral, and psychological outcomes. A weight normative approach is not effective for most people due to its high rates of weight regain and cycling, which is linked to adverse health and well-being. A weight normative approach also further promotes weight stigma in healthcare and society.(5)

Our work

We at SD Nutrition Group are proud to offer weight-inclusive care. We firmly believe that every body, regardless of size, shape, gender, age, ability, or weight, is worthy of respect and compassionate care. We support body diversity and understand that each individual has unique needs. You are the only one who can know what it feels like to be in your body, and we are here to support you in your journey to authentic health.

For more information about Health at Every Size, thin privilege, and weight discrimination, we recommend reading Health at Every Size: The Surprising Truth About Your Weight by Lindo Bacon. You can also find a number of free articles and resources at the book’s website, lindobacon.com.

For HAES health sheets providing information on seeking weight-inclusive care for a variety of health conditions, visit haeshealthsheets.com.

References

1. K.R. Sonneville, et al. (2018). Disparities in eating disorder diagnosis and treatment according to weight status, race/ethnicity, socioeconomic background, and sex among college students. International Journal of Eating Disorders, 518-526.

2. Reflections on thin privilege and responsibility. (2010). In L. Bacon, Health at Every Size: The Surprising Truth About Your Weight (pp. 312-315). Dallas, Texas: BenBella Books.

3. Why Don't We Recommend Dieting? (2021). Retrieved from HAES Health Sheets: https://haeshealthsheets.com/why-we-dont-recommend-intentional-weight-loss/

4. Jeffrey M. Hunger, et al. (2017). Weight labeling and disordered eating among adolescent girls: longitudinal evidence from the National Heart, Lung, and Blood Institute Growth and Health Study. Journal of Adolescent Health, 360-362.

5. Tracy L. Tylka, et al. (2014). The weight-inclusive versus weight-normative approach to health: evaluating the evidence for prioritizing well-being over weight loss. Journal of Obesity, 1-18.