Understanding Size Bias

To learn more about the things educators and families should know about size discrimination, Teaching Tolerance turned to Rebecca Puhl, Ph.D., who serves as the coordinator of the Yale's Rudd Center for Food Policy and Obesity [1]'s Community and Weight Stigma Initiatives.

Teaching Tolerance: There is a lot of talk in the news about the "childhood obesity epidemic." Is there an "epidemic" or is the public panic exaggerated?
Rebecca: The fact is that obesity is a significant public health problem, and prevalence rates of obesity among children continue to rise. By 2010, it is expected that the number of overweight children will increase significantly worldwide, with almost 50% of children in North America and 38% of children in the European Union becoming overweight.

What should schools and families be doing to address the needs of children who are overweight or obese? How are current practices helping or hurting?
Schools need to create a healthy food environment for all students, regardless of their body weight. We need to make it easy for children to eat healthy foods and be physically active at school, and create many opportunities for kids to integrate nutrition and wellness into their daily lives. Teachers and parents also need to model healthy behaviors to children, and communicate the importance of achieving optimal health rather than focusing on appearance or thinness.

Regarding school practices such as BMI (body mass index) report cards, there is currently insufficient research evidence to determine what kind of impact this intervention will have. We need controlled research studies to examine this issue. But in the meantime, we need to be cautious and approach BMI report cards in a sensitive manner to avoid creating further bias against overweight students.

How does weight stigma and bias impact people who are overweight or obese?
Unfortunately, overweight and obese children are frequent targets of teasing, harassment, and victimization from peers, and school is the most common setting where this occurs. Weight bias can be expressed verbally by peers (e.g., teasing, derogatory comments, being made fun of), through physical aggression (e.g., bullying), or through social exclusion from peer activities.

Weight bias has a range of negative consequences for people who are overweight and obese. Emotional consequences of bias include increased vulnerability to depression and anxiety, lower self-esteem, and poor body image. In addition, research shows that obese youth who are victimized by their peers are more likely to engage in suicidal thoughts and behaviors than overweight children who are not victimized.

There are also physical health consequences of weight bias that occur in youth, such as unhealthy eating behaviors and avoidance of physical activity. For example, overweight children who are teased are more likely to engage in unhealthy weight control and binge eating behaviors than overweight youth who are not teased about their weight. There is also evidence to suggest that obese children are less likely to engage in physical activity because of weight stigma, most likely because these students are often teased when engaging in physical activities.

How does weight bias impact the broader community?
People who are not overweight have stronger weight bias and negative attitudes compared to individuals who are overweight. By believing and accepting common weight-based stereotypes (e.g., that obese people are lazy), we promote an environment of intolerance and prejudice, leading to unfair treatment of individuals who are overweight.

Negative attitudes are also linked to beliefs that the cause of obesity a result of personal willpower, which only places blame on the individual, and ignores important social and environmental causes of obesity that require intervention. For example, the significant rise in obesity has occurred largely within the past 30 years. What has changed during this time? Have our genes changed? Have people become lazier or less personally responsible? The answer to both of these questions is no. In fact, studies show that people have demonstrated improved personal responsibility for health behaviors during this time, rather than less responsibility.

The real change that has occurred is our environment -- we live in a society where high-fat and high-sugar foods are readily accessible and inexpensive, making it difficult to be healthy. A major focus of intervention that is needed is to create a healthier environment for our citizens, but this often gets ignored when people assume that obesity is the result of poor willpower. This assumption has done nothing to reduce rates of obesity.

Where does such bias come from?
There are several key origins of weight bias. One powerful source is our cultural value of thinness. Being thin has come to symbolize important values in our society [2]. In a culture that values self-control and hard work, having a thin body symbolizes control over impulses to eat, self-discipline, ambition and desire. Unfortunately the opposite of this thinking is that people who are overweight are wrongly assumed to be indulgent, lazy, and lacking in self-control.

Another important contributor to weight bias is the media. As an example, many television shows depict weight-based stereotypes of overweight characters. Research shows that overweight characters on television are primarily portrayed in stereotypical roles, they are often ridiculed and teased, and they are rarely shown as having positive social interactions and romantic relationships. And we’re starting to see the impact of this on children. There is now research showing that television exposure increases fat stereotyping among children, where children who watch more television are more likely to negatively stereotype an overweight target.

These attitudes lead to beliefs that the cause of obesity is within personal control, and that a person can lose weight through hard work and discipline. So, our perceptions of the causes of obesity also reinforce weight bias. If a person believes that obese people are responsible for their weight gain, he or she will blame and stigmatize them. There is a lot of research evidence to support this idea. For example, experimental studies show that people are less likely to stigmatize obese persons if they are told that an individual’s obesity is due to a medical condition outside of their personal control (e.g., a thyroid condition or genetic predisposition), whereas they express negative attitudes when they are not given an external explanation for the person’s weight.

We are constantly told by the media that if a person just works hard enough, he or she can have a "perfect" body. However, our physiology really makes it challenging to lose weight and we know from research that important contributors to body shape and weight are biology and genetics. Despite this, it remains very pervasive in our culture to have a diet mentality and to believe that body weight is simply an issue of working hard enough. This attitude reinforces weight bias.

What should schools and families be doing to address weight bias?
Schools need to enforce zero-tolerance policies when it comes to weight-based victimization and bullying. Educators and parents both need to model appropriate attitudes and weight tolerance, and intervene when they become aware of teasing towards overweight students. Adults need to make themselves available and approachable to students who are being victimized because of their weight, and to provide a safe environment for children to talk about their stigma experiences.

Teachers and parents also need to recognize that they are not immune to society’s negative attitudes toward obese persons. Research shows that family members and educators are frequent sources of weight bias. So, adults and caregivers need to be aware of their own attitudes toward weight, and be mindful of the language that they use about weight. It can be helpful to start by challenging personal assumptions about weight and obesity, and looking for examples of individuals who challenge weight-based stereotypes that can be shared with children.