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Weight and Self-Esteem

Andrew MartinIn our society, living in a larger body can come with unfair discrimination and stigma. That stigma can be internalized as poor self-esteem, because we are frequently told, or think ourselves, that our weight is totally our fault, or a sign of laziness or mental weakness, all of which is untrue. If weight were easily under our control, there would be no multi-billion-dollar weight loss industry.

Eating is a basic, survival-related activity, and it is strongly influenced by unconscious, and emotional forces. It’s also influenced by external forces, like difficulty accessing healthy food, the expense of healthy food, and the relatively easy availability and persistent advertising of high-calorie, high-fat-and-sugar foods. In many countries, advertising unhealthy foods is not allowed, and sometimes even selling the food is not allowed. Those countries’ citizens tend to weigh less.

Thinking that our weight is all our fault can damage self-esteem, create negative emotions, and make it more difficult to control what we eat (e.g., we may turn more to comfort food when emotionally upset).

Even healthcare professionals sometimes judge us unfairly about our weight. Several studies identify weight bias and stigma in medical providers, including derogatory humor about larger patients, spending less time with larger patients, and over-focusing on weight and weight-loss.¹²³,4,5,6 The danger of over-focusing on weight is that healthcare providers may miss diseases and injuries that need to be treated.  Even mental health professionals can be biased against larger patients, over-focusing on weight-management, when help is needed more for depression, anxiety, or trauma.7,8

Helpful mental health professionals focus on weight-related self-esteem problems. They help people identify unfair judgments, and accept that weight is not totally under our personal control. They also help patients recognize external sources of stigma – such as comments in the workplace, biased treatment by healthcare providers, and social bullying and teasing. Even some public health programs incorrectly imply that weight is totally under our control, or they reinforce the idea that there is something wrong with people living in larger bodies.

We can learn to focus on health instead of weight, which research shows leads to better overall health outcomes. In focusing on what is under our control, we become more aware of our bodies’ needs – nourishment, exercise, and sleep. Mental health professionals can also help patients learn to advocate for themselves, for instance searching for healthcare providers who are unbiased regarding weight and body shape. They may also introduce patients to social media resources such as Jessamyn Stanley and Regan Chastain, who help patients connect with one another for social support, and actively promote self-acceptance.9

Dealing with weight stigma is an important treatment target, and can be an important step toward changing weight. Understanding and relieving emotional distress related to weight helps us think more clearly about the problem, and begin controlling a little more of what we can control.

 

1Lawrence, B. J., Kerr, D., Pollard, C. M., Theophilus, M., Alexander, E., Haywood, D., & O’Connor, M. (2021). Weight bias among health care professionals: a systematic review and metaanalysis. Obesity, 29(11), 1802-1812.

2Phelan, S. M., Burgess, D. J., Yeazel, M. W., Hellerstedt, W. L., Griffin, J. M., & van Ryn, M. (2015). Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obesity Reviews, 16(4), 319-326.

3Wear, D., Aultman, J. M., Varley, J. D., & Zarconi, J. (2006). Making fun of patients: medical students’ perceptions and use of derogatory and cynical humor in clinical settings. Academic Medicine,81(5), 454-462.

4Ferrante, J. M., Ohman-Strickland, P., Hudson, S. V., Hahn, K. A., Scott, J. G., & Crabtree, B. F. (2006). Colorectal cancer screening among obese versus non-obese patients in primary care practices. Cancer Detection and Prevention, 30(5), 459-465.

5Puhl, R. M., & Heuer, C. A. (2009). The stigma of obesity: a review and update. Obesity, 17(5), 941.

6Rathbone, J. A., Cruwys, T., Jetten, J., & Barlow, F. K. (2023). When stigma is the norm: How weight and social norms influence the healthcare we receive. Journal of Applied Social Psychology,53(3), 185-201.

7Puhl, R. M., Latner, J. D., King, K. M., & Luedicke, J. (2014). Weight bias among professionals treating eating disorders: attitudes about treatment and perceived patient outcomes. International Journal of Eating Disorders, 47(1), 65-75.

8Brochu, P. M., Pearl, R. L., & Simontacchi, L. A. (2018). Weight stigma and related social factors in psychological care. Psychological care in severe obesity: A practical and integrated approach, 42-60.

9Ehrich, L. (2024, April 12). From Shame to Acceptance: Helping patients manage internalized weight stigma in clinical practice [Conference Presentation].

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