Skip to main content

Advertisement

Log in

Health Consequences of Weight Stigma: Implications for Obesity Prevention and Treatment

  • Obesity Prevention (A Must, Section Editor)
  • Published:
Current Obesity Reports Aims and scope Submit manuscript

Abstract

Despite decades of research documenting consistent stigma and discrimination against individuals with obesity, weight stigma is rarely considered in obesity prevention and treatment efforts. In recent years, evidence has examined weight stigmatization as a unique contributor to negative health outcomes and behaviors that can promote and exacerbate obesity. This review summarizes findings from published studies within the past 4 years examining the relationship between weight stigma and maladaptive eating behaviors (binge eating and increased food consumption), physical activity, weight status (weight gain and loss and development of obesity), and physiological stress responses. Research evaluating the effects of weight stigma present in obesity-related public health campaigns is also highlighted. Evidence collectively demonstrates negative implications of stigmatization for weight-related health correlates and behaviors and suggests that addressing weight stigma in obesity prevention and treatment is warranted. Key questions for future research to further delineate the health effects of weight stigmatization are summarized.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Puhl R, Andreyeva T, Brownell K. Perceptions of weight discrimination: prevalence and comparison to race and gender discrimination in America. Int J Obes. 2008;32:992–1000.

    Article  CAS  Google Scholar 

  2. Puhl RM, Luedicke J, Heuer C. Weight-based victimization toward overweight adolescents: observations and reactions of peers. J Sch Health. 2011;81(11):696–703.

    Article  PubMed  Google Scholar 

  3. Bucchianeri MM, Eisenberg ME, Neumark-Sztainer D. Weightism, racism, classism, and sexism: shared forms of harassment in adolescents. J Adolesc Health. 2013;53(1):47–53.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Bradshaw CP, Waasdorp TE, O’Brennan LM, Gulemetova M. Teachers’ and education support professionals’ perspectives on bullying and prevention: findings from a national education association study. Sch Psychol Rev. 2013;42(3):280–97.

    Google Scholar 

  5. Puhl RM, Luedicke J, DePierre JA. Parental concerns about weight-based victimization in youth. Childhood Obes. 2013;9(6):540–8.

    Google Scholar 

  6. Puhl H. The stigma of obesity: a review and update. Obesity. 2009;17(5):941–64.

    Article  PubMed  Google Scholar 

  7. Villarejo C, Fernández‐Aranda F, Jiménez‐Murcia S, Peñas‐Lledó E, Granero R, Penelo E. Lifetime obesity in patients with eating disorders: increasing prevalence, clinical and personality correlates. Eur Eat Disord Rev. 2012;20(3):250–4.

    Article  PubMed Central  PubMed  Google Scholar 

  8. Hilbert A, Pike K, Goldschmidt A, Wilfley D, Fairburn C, Dohm F-A, et al. Risk factors across the eating disorders. Psychiatry Research. 2014.

  9. Almeida L, Savoy S, Boxer P. The role of weight stigmatization in cumulative risk for binge eating. J Clin Psychol. 2011;67(3):278–92. This study considers the influence of weight stigmatization on binge eating alongside other individual-level and environmental risk factors and presents clear evidence for weight stigmatization as a unique predictor of binge eating.

    Article  PubMed  Google Scholar 

  10. Brauhardt A, Rudolph A, Hilbert A. Implicit cognitive processes in binge-eating disorder and obesity. J Behav Ther Exp Psychiatry. 2014;45(2):285–90.

    Article  PubMed  Google Scholar 

  11. Wott CB, Carels RA. Overt weight stigma, psychological distress and weight loss treatment outcomes. J Health Psychol. 2010;15(4):608–14.

    Article  PubMed  Google Scholar 

  12. Durso LE, Latner JD, Hayashi K. Perceived discrimination is associated with binge eating in a community sample of non-overweight, overweight, and obese adults. Obes Facts. 2012;5(6):869–80.

    Article  PubMed  Google Scholar 

  13. King KM, Puhl RM, Luedicke J, Peterson JL. Eating behaviors, victimization, and desire for supportive intervention among adolescents in weight-loss camps. Eat Behav. 2013;14(4):484–7.

    Article  PubMed  Google Scholar 

  14. Puhl RM, Luedicke J. Weight-based victimization among adolescents in the school setting: emotional reactions and coping behaviors. J Youth Adolesc. 2012;41(1):27–40.

    Article  PubMed  Google Scholar 

  15. Goldfield G, Moore C, Henderson K, Buchholz A, Obeid N, Flament M. The relation between weight-based teasing and psychological adjustment in adolescents. Paediatr Child Health. 2010;15(5):283–8.

    PubMed Central  PubMed  Google Scholar 

  16. Rojo-Moreno L, Rubio T, Plumed J, Barberá M, Serrano M, Gimeno N, et al. Teasing and disordered eating behaviors in Spanish adolescents. Eat Disord. 2013;21(1):53–69.

    Article  PubMed  Google Scholar 

  17. Olvera N, Dempsey A, Gonzalez E, Abrahamson C. Weight-related teasing, emotional eating, and weight control behaviors in Hispanic and African American girls. Eat Behav. 2013;14(4):513–7.

    Article  PubMed  Google Scholar 

  18. Gerke CK, Mazzeo SE, Stern M, Palmberg AA, Evans RK, Wickham EP. The stress process and eating pathology among racially diverse adolescents seeking treatment for obesity. J Pediatr Psychol. 2013;38(7):785–93.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Quick VM, McWilliams R, Byrd-Bredbenner C. Fatty, fatty, two-by-four: weight-teasing history and disturbed eating in young adult women. Am J Public Health. 2013;103(3):508–15.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Burmeister JM, Carels RA. Television use and binge eating in adults seeking weight loss treatment. Eat Behav. 2014;15(1):83–6.

    Article  PubMed  Google Scholar 

  21. Carels RA, Wott CB, Young KM, Gumble A, Koball A, Oehlhof MW. Implicit, explicit, and internalized weight bias and psychosocial maladjustment among treatment-seeking adults. Eat Behav. 2010;11(3):180–5.

    Article  CAS  PubMed  Google Scholar 

  22. Durso LE, Latner JD, White MA, Masheb RM, Blomquist KK, Morgan PT, et al. Internalized weight bias in obese patients with binge eating disorder: associations with eating disturbances and psychological functioning. Int J Eat Disord. 2012;45(3):423–7. This study highlights the important role of internalization of weight bias as a contributor to maladaptive eating behaviors and emotional well-being.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Pearl RL, White MA, Grilo CM. Weight bias internalization, depression, and self-reported health among overweight binge eating disorder patients. Obesity. 2014;22(5):E142–E8.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Rudolph A, Hilbert A. A novel measure to assess self-discrimination in binge eating disorder and obesity. International Journal of Obesity. 2014.

  25. Puhl RM, Brownell KD. Confronting and coping with weight stigma: an investigation of overweight and obese adults. Obesity. 2006;14(10):1802–15.

    Article  PubMed  Google Scholar 

  26. Schvey NA, Puhl RM, Brownell KD. The impact of weight stigma on caloric consumption. Obesity (Silver Spring). 2011;19(10):1957–62.

    Article  Google Scholar 

  27. Major B, Hunger JM, Bunyan DP, Miller CT. The ironic effects of weight stigma. J Exp Soc Psychol. 2014;51:74–80. This is the most recent experiment conducted in a laboratory setting documenting the direct effects of weight stigma on greater caloric intake and poorer dietary control only among women with overweight.

    Article  Google Scholar 

  28. Brochu PM, Dovidio JF. Would you like fries (380 cal) with that? Menu labeling mitigates the impact of weight-based stereotype threat on food choice. Social Psychol Personal| Sci. 2013.

  29. Chao YH, Yang CC, Chiou WB. Food as ego-protective remedy for people experiencing shame. Experimental evidence for a new perspective on weight-related shame. Appetite. 2012;59(2):570–5.

    Article  PubMed  Google Scholar 

  30. Puhl RM, Peterson JL, Luedicke J. Weight-based victimization: bullying experiences of weight loss treatment-seeking youth. Pediatrics. 2013;131(1):e1–9.

    Article  PubMed  Google Scholar 

  31. Peterson JL, Puhl RM, Luedicke J. An experimental assessment of physical educators’ expectations and attitudes: the importance of student weight and gender. J Sch Health. 2012;82(9):432–40.

    Article  PubMed  Google Scholar 

  32. Peterson JL, Puhl RM, Luedicke J. An experimental investigation of physical education teachers’ and coaches’ reactions to weight-based victimization in youth. Psychol Sport Exercise. 2012;13(2):177–85.

    Article  Google Scholar 

  33. Peters DM, Jones RJA. Future sport, exercise and physical education professionals’ perceptions of the physical self of obese children. Kinesiology. 2010;42(1):36–43.

    Google Scholar 

  34. Greenleaf C, Petrie TA, Martin SB. Relationship of weight-based teasing and adolescents’ psychological well-being and physical health. J Sch Health. 2014;84(1):49–55.

    Article  PubMed  Google Scholar 

  35. Li BJ, Lwin MO, Jung Y. Wii, myself, and size: the influence of proteus effect and stereotype threat on overweight children’s exercise motivation and behavior in exergames. GAMES FOR HEALTH. Res, Deve, Clin Appl. 2014;3(1):40–8.

    Google Scholar 

  36. Losekam S, Goetzky B, Kraeling S, Rief W, Hilbert A. Physical activity in normal-weight and overweight youth: associations with weight teasing and self-efficacy. Obes Facts. 2010;3(4):239–44.

    Article  PubMed  Google Scholar 

  37. Slater A, Tiggemann M. Gender differences in adolescent sport participation, teasing, self-objectification and body image concerns. J Adolesc. 2011;34(3):455–63.

    Article  PubMed  Google Scholar 

  38. Jensen CD, Cushing CC, Elledge AR. Associations between teasing, quality of life, and physical activity among preadolescent children. J Pediatr Psychol. 2014;39(1):65–73.

    Article  PubMed  Google Scholar 

  39. Cardinal BJ, Whitney AR, Narimatsu M, Hubert N, Souza BJ. Obesity bias in the gym: an under-recognized social justice, diversity, and inclusivity issue. J Phys Educ, Recreat Dance. 2014;85(6):3–6.

    Article  Google Scholar 

  40. Schmalz DL. ‘I feel fat’: weight-related stigma, body esteem, and BMI as predictors of perceived competence in physical activity. Obes Facts. 2010;3(1):15–21.

    Article  PubMed  Google Scholar 

  41. Vartanian LR, Novak SA. Internalized societal attitudes moderate the impact of weight stigma on avoidance of exercise. Obesity (Silver Spring). 2011;19(4):757–62.

    Article  Google Scholar 

  42. Pearl RL, Puhl RM, Dovidio JF. Differential effects of weight bias experiences and internalization on exercise among women with overweight and obesity. J Health Psychol. 2014. doi:10.1177/1359105313520338

  43. Jackson SE, Beeken RJ, Wardle J. Perceived weight discrimination and changes in weight, waist circumference, and weight status. Obesity (Silver Spring). 2014;22:2485–8. doi:10.1002/oby.20891.

  44. Sutin AR, Terracciano A. Perceived weight discrimination and obesity. PLoS ONE Vol 8(7), Jul 2013, ArtID e70048. 2013;8(7). This four-year, longitudinal study provides strong support that experiences of weight discrimination (but not other forms of discrimination) greatly increases the risk for becoming and remaining obese among adults.

  45. Hansson L, Rasmussen F. Association between perceived health care stigmatization and BMI change. Obes Facts. 2014;7(3):211–20.

    Article  PubMed  Google Scholar 

  46. Haines J, Kleinman KP, Rifas-Shiman SL, Field AE, Bryn AS. Examination of shared risk and protective factors for overweight and disordered eating among adolescents. Arch Pediatr Adolesc Med. 2010;164(4):336–43.

    Article  PubMed Central  PubMed  Google Scholar 

  47. Quick V, Wall M, Larson N, Haines J, Neumark-Sztainer D. Personal, behavioral and socio-environmental predictors of overweight incidence in young adults: 10-yr longitudinal findings. Int J Behav Nutr Phys Act. 2013;10:37.

    Article  PubMed Central  PubMed  Google Scholar 

  48. Hunger JM, Tomiyama A. Weight labeling and obesity: a longitudinal study of girls aged 10 to 19 years. JAMA Pediatr. 2014;168(6):579–80. doi:10.1001/jamapediatrics.2014.122.

    Article  PubMed  Google Scholar 

  49. Singh AS, Mulder C, Twisk JW, Van Mechelen W, Chinapaw MJ. Tracking of childhood overweight into adulthood: a systematic review of the literature. Obes Rev. 2008;9(5):474–88.

    Article  CAS  PubMed  Google Scholar 

  50. Reilly JJ, Kelly J. Long-term impact of overweight and obesity in childhood and adolescence on morbidity and premature mortality in adulthood: systematic review. Int J Obes. 2011;35(7):891–8.

    Article  CAS  Google Scholar 

  51. Gudzune KA, Bennett WL, Cooper LA, Bleich SN. Perceived judgment about weight can negatively influence weight loss: a cross-sectional study of overweight and obese patients. Prev Med. 2014;62:103–7. This study is the first to document that experiences of weight stigma in health care may undermine patients’ efforts for weight loss.

    Article  PubMed Central  PubMed  Google Scholar 

  52. Carels RA, Hinman N, Koball A, Wagner Oehlhof M, Gumble A, Young KM. The self-protective nature of implicit identity and its relationship to weight bias and short-term weight loss. Obes Facts. 2011;4(4):278–83.

    Article  PubMed  Google Scholar 

  53. Carels RA, Hinman NG, Hoffmann DA, Burmeister JM, Borushok JE, Marx JM, et al. Implicit bias about weight and weight loss treatment outcomes. Eat Behav. 2014;15(4):648–53.

    Article  PubMed  Google Scholar 

  54. Sharma S, Wharton S, Forhan M, Kuk J. Influence of weight discrimination on weight loss goals and self-selected weight loss interventions. Clinical Obes. 2011;1(4–6):153–60.

    Article  CAS  Google Scholar 

  55. Carels RA, Burmeister JM, Koball AM, Oehlhof MW, Hinman N, LeRoy M, et al. A randomized trial comparing two approaches to weight loss: differences in weight loss maintenance. J Health Psychol. 2014;19(2):296–311.

    Article  PubMed Central  PubMed  Google Scholar 

  56. Lillis J, Hayes SC, Bunting K, Masuda A. Teaching acceptance and mindfulness to improve the lives of the obese: a preliminary test of a theoretical model. Ann Behav Med. 2009;37(1):58–69.

    Article  PubMed  Google Scholar 

  57. Wagner J, Lampert R, Tennen H, Feinn R. Exposure to discrimination and heart rate variability reactivity to acute stress among women with diabetes. Stress Health. 2013. doi:10.1002/smi.2542

  58. Dolezsar CM, McGrath JJ, Herzig AJ, Miller SB. Perceived racial discrimination and hypertension: a comprehensive systematic review. Health Psychol. 2014;33(1):20–34.

    Article  PubMed  Google Scholar 

  59. Jamieson JP, Koslov K, Nock MK, Mendes WB. Experiencing discrimination increases risk taking. Psychol Sci. 2013;24(2):131–9.

    Article  PubMed  Google Scholar 

  60. Major B, Eliezer D, Rieck H. The psychological weight of weight stigma. Soc Psychol Personal Sci. 2012;3(6):651–8.

    Article  Google Scholar 

  61. Rosenthal L, Earnshaw VA, Carroll-Scott A, Henderson KE, Peters SM, McCaslin C, et al. Weight- and race-based bullying: health associations among urban adolescents. J Health Psychol. 2013.

  62. Schvey NA, Puhl RM, Brownell KD. The stress of stigma: exploring the effect of weight stigma on cortisol reactivity. Psychosom Med. 2014;76(2):156–62.

    Article  CAS  PubMed  Google Scholar 

  63. Dutton GR, Lewis TT, Durant N, Halanych J, Kiefe CI, Sidney S, et al. Perceived weight discrimination in the CARDIA study: differences by race, sex, and weight status. Obesity. 2014;22(2):530–6.

    Article  PubMed Central  PubMed  Google Scholar 

  64. Tomiyama AJ, Epel ES, McClatchey TM, Poelke G, Kemeny ME, McCoy SK, et al. Associations of weight stigma with cortisol and oxidative stress independent of adiposity. Health Psychol. 2014;33(8):862–7.

    Article  PubMed  Google Scholar 

  65. Danesh J, Wheeler JG, Hirschfield GM, Eda S, Eiriksdottir G, Rumley A, et al. C-reactive protein and other circulating markers of inflammation in the prediction of coronary heart disease. N Engl J Med. 2004;350(14):1387–97.

    Article  CAS  PubMed  Google Scholar 

  66. Pradhan AD, Manson JE, Rifai N, Buring JE, Ridker PM. C-reactive protein, interleukin 6, and risk of developing type 2 diabetes mellitus. Jama. 2001;286(3):327–34.

    Article  CAS  PubMed  Google Scholar 

  67. Sutin AR, Stephan Y, Luchetti M, Terracciano A. Perceived weight discrimination and C-reactive protein. Obesity (Silver Spring). 2014;22(9):1959–61.

    Article  CAS  Google Scholar 

  68. Tsenkova VK, Carr D, Schoeller DA, Ryff CD. Perceived weight discrimination amplifies the link between central adiposity and nondiabetic glycemic control (HbA1c). Ann Behav Med. 2011;41(2):243–51.

    Article  PubMed Central  PubMed  Google Scholar 

  69. Puhl R, Peterson JL, Luedicke J. Fighting obesity or obese persons? Public perceptions of obesity-related health messages. Int J Obes (Lond). 2013;37(6):774–82.

    Article  CAS  Google Scholar 

  70. Puhl R, Luedicke J, Peterson JL. Public reactions to obesity-related health campaigns: a randomized controlled trial. Am J Prev Med. 2013;45(1):36–48. The counter-productive effect of weight stigma in obesity prevention media campaigns addresses the need for empirical testing of obesity health messages prior to public dissemination.

    Article  PubMed  Google Scholar 

  71. Barry CL, Gollust SE, McGinty EE, Niederdeppe J. Effects of messages from a media campaign to increase public awareness of childhood obesity. Obesity (Silver Spring). 2014;22(2):466–73.

    Article  Google Scholar 

  72. Vartanian LR, Smyth JM. Primum non nocere: obesity stigma and public health. J Bioeth Inq. 2013;10(1):49–57.

    Article  PubMed  Google Scholar 

  73. Bazyk S, Winne R. A multi-tiered approach to addressing the mental health issues surrounding obesity in children and youth. Occup Ther Health Care. 2013;27(2):84–98.

    PubMed  Google Scholar 

  74. Puhl RM, Heuer CA. Obesity stigma: important considerations for public health. Am J Public Health. 2010;100(6):1019–28.

    Article  PubMed Central  PubMed  Google Scholar 

  75. Suh Y, Puhl R, Liu S, Milici FF. Support for laws to prohibit weight discrimination in the united states: public attitudes from 2011 to 2013. Obesity (Silver Spring). 2014;22(8):1872–9.

    Article  Google Scholar 

Download references

Acknowledgments

The authors gratefully acknowledge support for this research from the Rudd Foundation.

Compliance with Ethics Guidelines

Conflict of Interest

Rebecca Puhl and Young Suh declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Rebecca Puhl.

Additional information

This article is part of the Topical Collection on Obesity Prevention

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Puhl, R., Suh, Y. Health Consequences of Weight Stigma: Implications for Obesity Prevention and Treatment. Curr Obes Rep 4, 182–190 (2015). https://doi.org/10.1007/s13679-015-0153-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13679-015-0153-z

Keywords

Navigation