Body Image, Weight Stigma and Discrimination

Because of pervasive attitudes about what constitutes female attractiveness, particularly those which predominate in the mass media, women are more likely to experience more pressure than men to have the “correct appearance”.  The social requirement that women achieve an “ideal weight” is also based on the misconception that we can completely control our body size. Socially constructed standards for size and appearance for women in the public domain are much more restrictive than those for men.Poor body image is prevalent among teenage girls and negatively impacts young people’s health and wellbeing.  A 2012 Aotearoa New Zealand study of college students found over 30% of young women were unhappy or very unhappy with weight compared to just over 10% of young men. Research has shown that young people with poor body image or who report body dissatisfaction are at higher risk of depression and other mental health effects, bullying, eating disorders, reduced physical activity, poorer sexual health, diminished sexual negotiation, and risk taking behaviours including increased drinking and smoking, and lower self-esteem.¹  Women’s Health Victoria (2009) note in their issues paper on body image, ‘the many negative health impacts of body image dissatisfaction have meant that the issue is increasingly being recognised as an important target for public health action’.  Feminist psychology researchers have found that many girls and young women are justifying their health harming weight loss practices in order to achieve ‘correct appearance’ as pursuing a ‘healthy weight’.² These researchers warn that the focus on weight as a health issue in society is actually contributing to poor health in girls and young women.

Weight, size and stigma

Weight bias and stigma is prevalent in Western countries and has a negative impact on the health and wellbeing of larger people, particularly larger women.³ Weight stigma involves the attribution of negative characteristics to larger people including that they are lazy, lacking in will-power, incompetent, unclean and undisciplined.⁴Weight stigma has been shown to result in multiple forms of prejudice and discrimination against people with high body weight, including negative interpersonal experiences such as bullying and harassment, and inequities in employment, health care, and education. The consequences of weight bias and stigma include lower income and educational attainment, psychological effects such as increased vulnerability to depression, poor body image and decreased self-acceptance, as well as negative implications for physical health including decreased participation in recreational or physical activities, eating difficulties such as weight cycling, and avoidance of health care out of fear of negative interactions with health care professionals.  Weight bias research in the United States has identified a high and growing prevalence of weight discrimination, with much higher levels of discrimination reported among individuals in the heaviest weight category and with young people and women much more likely to report such experiences.⁵Prolonged exposure to stigmatisation due to having a large body not only threatens the health of individuals, it produces health disparities and may contribute to the failure of health care interventions.  This has particular implications for the health of women and girls. For example, while the incidence of “obesity” is not higher in women, the uptake of bariatric surgery certainly is, women currently constitute the large majority of those undergoing bariatric surgery suggesting that fat stigma and a slenderness ideal may be overly influential in some people’s decision to undergo the procedure.

• References

  ¹ Commonwealth Office of the Status of Women. Looking Risky: Body Image and Risk Taking Behaviours. Focus on Women. Barton ACT: Department of Prime Minister and Cabinet; 2003; 6 [cited 2009 February 4]. Available from  http://www.ofw.facs.gov.au/downloads/pdfs/focus_women_issue6.pdf.

  Larson, B. K., Clark, T. C., Robinson, E. M., & Utter, J. (2012). Body satisfaction and sexual health behaviors among New Zealand secondary school students. Sex Education, 12(2), 187-198.

  Neumark-Sztainer, D., Paxton, S. J., Hannan, P. J., Haines, J., & Story, M. (2006). Does body satisfaction matter? Five-year longitudinal associations between body satisfaction and health behaviors in adolescent females and males. Journal of Adolescent Health, 39(2), 244-251.

  Women’s Health Victoria. Gender Impact Assessment No. 8: Women and Body Image, February 2009.Available here »

  ² Burns, M., & Gavey, N. (2004). ‘Healthy weight’ at what cost?  ‘Bulimia’ and a discourse of weight control. Journal of Health Psychology (9), 549-565.

  ³ Brownell, K. D., Puhl, R., Schwartz, M., & Rudd, L. (2005). Weight bias: nature, causes, consequences. New York; London: The Guilford Press.

  Ding, V., & Stillman, J. (2005). An emperical investigation of discrimination against overweight female job applicants in New Zealand. New Zealand Journal of Psychology, 34(3), 139-148.

  ⁴ Puhl, R., Moss-Racusin, C. A., Schwartz, M. B., & Brownell, K. D. (2008). Weight stigmatization and bias reduction: Perspectives of overweight and obese adults. Health Education Research, 23(2), 347-358.

  ⁵ Puhl, R. M., Andreyeva, T., & Brownell, K. D. (2008). Perceptions of weight discrimination: prevalence and comparison to race and gender discrimination in America. Int J Obes, 32(6), 992-1000.  

• Articles and research

  Shrinking away: what does publically funded bariatric surgery mean for women’s health?-June 2010 Women’s Health Update.

  The end of the skinny runway model?- December 2006 Women’s Health WatchRead More »

  Puhl, R. M., & Heuer, C. A. (2010). Obesity stigma: important considerations for public health. [Research Support, Non-U S Gov’t]. Am J Public Health, 100(6), 1019-1028.

  Puhl, R.M., Moss-Racusin, C., & Schwartz, M.B. (2007). Internalization of weight bias: implications for binge eating and emotional wellbeing. Obesity, 15, 19-23

  O’Reilly, C., & Sixsmith, J. (2012). From Theory to Policy: Reducing Harms Associated with the Weight-Centered Health Paradigm. Fat Studies, 1(1), 97-113.

Promoting health

There is evidence that size and shape are based on a multiplicity of factors and that good health cannot be necessarily related to a one size fits all measurement such as body mass index (BMI). Many of the studies we have reviewed suggest that a shift away from a weight centred health paradigm is required and that the pervasive discourse of blame around size and weight may be having negative effects on health. The current focus on weight as a health issue contributes to weight bias, stigma and discrimination which disproportionately effects women and is detrimental to health and wellbeing, particularly for women of size.  More attention needs to be given to the social determinants of both weight and health including: food security, pricing and labelling, limitations on advertising of low quality foods; provision of accessible indoor and outdoor recreational areas that are safe and affordable for people of all ages. Some governments (e.g. Victoria, Australia) are developing standards to try and improve the portrayal of women in advertising in particular.¹

• References

  ¹ Commonwealth Office on the Status of Women.2003

Useful Links

Body Image Leaders in Schools »Learn more about Women’s Health Action’s programme working in schoolsNourish »Learn more about Women’s Health Action’s workshops for professionals working with young peopleEDANZ »Is an incorporated society established to provide support and education for parents and caregivers of people with eating disordersThe Mental Health Foundation »Works to counter discrimination, promote positive mental health and wellbeing and influence individuals, whānau, organisations and communities to improve and sustain their mental health and reach their full potentialCentral region eating disorders services »ADHB Eating disorders service »Ministry of Health »