Pauline Sobelman, a 52-year-old employee benefits consultant in New York City, felt a squeezing sensation in her chest a few years ago. Worried it might signal a serious heart problem, she immediately sought out a doctor. The first issue Sobelman, who’s five feet, one inch tall, encountered was that none of the gowns in the exam room fit her 200-plus-pound, size 3XL frame. When the doctor entered, she says he looked at her body spilling out of the inadequate robe and, with his eyes wide and face contorted, registered his disgust. It’s a look Sobelman wouldn’t forget.
“I had an incredible feeling of shame, that my doctor is appalled by looking at my body,” she recalls.
Although the physician accurately diagnosed her condition—she had costochondritis, an inflammation of the chest cartilage—Sobelman never went back to see him and has largely avoided doctors since. Recently, when she needed help with a bladder problem, she called the new physician before her visit to check whether she was accepting of larger bodies. Sobelman is not alone in being weight shamed by a medical professional, as well as by people in all spheres of society.
Stigmatizing people for their weight is “the last acceptable form of bias,” says A. Janet Tomiyama, a professor of psychology at the University of California, Los Angeles, and a leading researcher in the field.
In recent years, scientists have documented what high-weight people have long understood: weight stigma is widespread and has a severe impact on its victims. It can lead to everything from depression, anxiety, eating disorders, and other mental-health effects to poor heart health and even death.
The issue has become more urgent since January, when the American Academy of Pediatrics published guidelines advocating aggressive treatment for high-weight children and teens. This encourages families to focus on their children’s body even though, critics charge, adolescents subject to weight-shaming have higher rates of obesity in their thirties. (A survey of 2,000 teens published last April found roughly half prefer never to discuss weight with their parents, even though many felt they primarily heard positive and accepting messages from them.)
Even people who are heavier frequently subject others to weight-shaming, says researcher Mary Himmelstein, assistant professor of psychological sciences at Kent State University. For example, some 42 percent of Americans have a body mass index that classifies them as having obesity, yet even some of these people feel comfortable mocking others with large bodies, she says.
In some cases, relatives and medical professionals believe chiding people about their weight can inspire them to lose it, says Rebecca Puhl, deputy director of the Rudd Center for Food Policy and Health at the University of Connecticut. But research shows the opposite to be true. “When people feel shamed about their weight, that actually increases their risk of weight gain over time,” Puhl says.
Others feel it’s OK to judge higher-weight individuals because they see them depicted in movies and television shows as being slovenly, unlikable, and out of control. And on social media, individuals are regularly targeted for their weight without blowback, Tomiyama says.
This is because weight is portrayed as being under an individual’s control, even though science has shown that numerous factors— genetics, the physical and cultural environment, bacteria in the gut—play a role and that dieting doesn’t successfully keep weight off long-term.
“There’s this idea that people are higher weight because of their own lazy behaviors,” Himmelstein says. It’s become a sign of a lack of willpower because people think others could lose weight if they wanted to, even though most high-weight people have tried for years without success, she says.
Depression and eating disorders
The most revered body type hasn’t always been model-thin, because a high-status shape generally reflects the lifestyles of people in power, Tomiyama says.
In earlier times, when food was scarce, larger bodies projected wealth. By the 20th century, with food abundant, the beauty ideal was reversed and people with larger body sizes were considered less desirable.
The stigma affects Black and Hispanic people as well as white people, and men along with women. Young adults who experienced a devalued body before the spread of COVID-19 were more likely to respond to stress during the pandemic by becoming depressed and binge eating than those who hadn’t been stigmatized, according to a 2020 survey by Puhl and her colleagues. Weight-shaming exists across many Western countries that glorify thinness. A survey published in 2021 in the medical journal PLOS One documented its widespread nature in 14,000 adults with a high body-mass index in France, Germany, the United Kingdom, Australia, and Canada, as well as the United States.
Importantly, many people who are subjected to weight abuse and come to feel personally ashamed don’t fit the medical definition of obesity. These thinner people nonetheless experience similar negative health impacts, including anxiety and eating disorders.
People subject to shaming often tend to avoid medical settings. The PLOS One study found two-thirds of those who’ve been stigmatized attribute bruising words to their physicians. But skipping routine checkups and delaying appointments causes people to experience worse health outcomes, Himmelstein says.
Even when people brave the indignity, doctors regularly blame symptoms of poor health on a person’s weight, even when other factors are more likely involved, Puhl says. This happened to Sobelman when eye pain forced a visit to her longtime optometrist in 2020. The doctor stated that because she was heavier than during her last visit, diabetes must be the root of her vision troubles. Anxious about the new diagnosis, Sobelman rushed to get a blood test, which came back negative. The problem turned out to be a poorly fitting contact lens, which the doctor hadn’t first considered.
Weight-shaming and stress hormones
Frequently, weight-shaming causes people to eat in ways they might not otherwise. When researchers caused higher-weight women to feel stigmatized in a one-day laboratory study, they found the women snacked more than those not subject to the abuse. And Puhl and Himmelstein found people with type 2 diabetes who are routinely stigmatized to the point they agree they should feel weight shame are more likely to binge eat.
They are also less likely to exercise, something other researchers have documented too. “A person who is made fun of because of their size is not going to want to put on some tight Lululemon outfit and go to the gym,” Tomiyama says.
In her view, weight-shaming triggers a viscous cycle: Feeling rejected causes a person’s brain to release the stress hormone cortisol, which is known to produce cravings for food, especially fatty and sugary fare, and it signals the body to deposit fat around the abdomen. “In ancestral times, this [response to a stressor] would let you run or fight,” Tomiyama says. Today, it just makes someone heavier, which then leads to the possibility of additional humiliation.
Researchers have so far been unsuccessful uncovering strategies that reduce weight bias in society. “It’s proving resistant to interventions that have worked with other stigmatized groups,” Puhl says. For example, educating teasers about the complex factors behind obesity helps for a time, she says, but the effect isn’t lasting. And while encouraging people of different races to get to know one another can help with racial bias, this doesn’t work with weight, likely because most people already know many high-weight individuals, Puhl notes.
Puhl is skeptical any magic bullets will be found until there are largescale shifts in social norms. “People are surrounded in their everyday lives by messages that reinforce [weight] stigma rather than challenge it,” she says. “If we truly want to reduce it, we need those bigger, broader systems to change.”
