Addressing Weight Stigma

Editorial
Addressing weight stigma

2019 will be marked by a new Lancet initiative on self-reported weight-based discrimination was as For more on The Lancet
initiative on Nutrition see
nutrition. Nutrition is a vast subject that needs a prevalent in those with underweight as it was in those Editorial Lancet 2019; published
multisectoral approach, hence throughout this year, it with obesity class II. online Jan 16. https://www.
thelancet.com/journals/lancet/
will be a special focus at The Lancet family of journals. Disappointingly, the health-care settings are not article/
It started with two excellent Commissions published exempt of prejudice against people with overweight PIIS0140-6736(19)30080-7/
fulltext
in January—one on healthy diets and sustainable food and obesity, with patients with obesity reporting
For Tomiyama and colleagues’
systems and one on the global syndemic of obesity, receiving poorer care and having worse outcomes, and article see https://www.ncbi.
which put obesity into a much wider context. An also medical students with obesity having internalised nlm.nih.gov/pmc/articles/
PMC6092785/pdf/12916_2018_
important aspect that has received very little attention is weight stigma. Article_1116.pdf
stigma. While obesity is now recognised as a worldwide Whereas most people will now concede that weight For Sikorski and colleagues’
article see https://www.nature.
public health issue, it can still too often be regarded by stigma is a reality, health-care professionals, public com/articles/ijo2015165
some as an individual responsibility resulting from poor health experts, and policy makers need to take this
choices and motivations. Weight stigma, also known issue much more seriously. It is not an unavoidable
as weight bias, is the discrimination, stereotyping, and consequence of overweight and obesity or a deterrent
social exclusion based on a person’s weight. Although for those heading in that direction. Weight stigma not
obesity has become, unfortunately, more common, only compounds the consequences of overweight and
discrimination has not subsided. Whereas we now obesity, but also contributes to disordered eating and
understand that an obesogenic environment has a increased calorie consumption, suggest that addressing
substantial role in the development of obesity, the and mitigating discrimination could be an effective
stereotypical perception that people with overweight public health intervention to combat obesity. Policy
and obesity are somehow responsible for their weight makers should actively seek out the ways in which
remains pervasive. their policies could be stigmatising. Researchers could
Tomiyama and colleagues recently discussed how systematically search and account for the influence of
weight stigma can drive the obesogenic processes and weight stigma when studying overweight and obesity.
harm health. A growing body of evidence shows the More research on the consequences of weight stigma
psychological, physiological, and social consequences is also needed in lower income settings, as much of the
of weight stigma. People who have obesity face existing body of literature is in high-income settings, in
inequity and prejudice in employment, education, and particular from the USA.
stigmatisation in interpersonal relationships and in Weight stigma is a complex and multifaceted subject
the media. Adults who experience weight stigma have that requires multiple perspectives. As part of the 2019
increased psychological stress, depression, and anxiety. Lancet initiative on nutrition and obesity, The Lancet
Experiencing weight stigma increases physiological Public Health is calling for papers that will contribute
stress, as marked by elevated concentrations of to the evidence base needed to lessen and ultimately
cortisol, oxidative stress, and C-reactive protein. Weight eradicate weight stigma. Effective approaches to change
stigma is also linked to increased calorie consumption, behaviours and attitudes, including in the health-care
maladaptive eating behaviour, and binge eating, and settings, the role of the primary care level, and the need
preliminary evidence suggests weight stigma could be for medical training that addresses weight bias, are some
associated with poorer weight loss treatment outcomes. of the most pressing issues. But more importantly, it is
Weight stigma is also often internalised—the person time for patients with obesity to be treated with the
blames themselves for their perceived overweight. This same consideration and compassion that is extended to
can also have harmful consequences, as this has been other diseases. Like with any form of stigma, the path
associated with binge eating, reduced physical exercise, towards inclusion starts with widespread awareness.
and social isolation. Interestingly, the perception of ■ The Lancet Public Health
weight stigma is not limited to those with overweight Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open
and obesity. Sikorski and colleagues showed that Access article under the CC BY 4.0 license.
www.thelancet.com/public-health Vol 4 April 2019 e168

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Editorial

Addressing weight stigma

www.thelancet.com/public-health Vol 4 April 2019 e168

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