(University of Connecticut)
What is obesity stigma?
This is expressed by attitudes and stereotypes that discriminate against people living with overweight or obesity. It is the preconceived idea that people living with obesity are lazy, clumsy, less intelligent, incompetent and lacking in willpower and discipline. This stigma negatively influences our interactions with these people. It is important to talk about it since there is a sharp increase in the prevalence of weight stigma (Puhl, RM and Heuer CA., 2010).
This can be caused by the media, popular culture, health messages and industry discrimination. The biases and prejudices we have about obesity are almost inevitable.
Consequences:
Psychological health: increased vulnerability to depression, anxiety, low self-esteem, negative body image and depression.
Physical health: decreased physical activity, unhealthy eating habits, high blood pressure, drug and alcohol use.
Cost: on the health system = avoiding health care use and rescheduling appointments. Economic plan: decline in school results or the quality of one's work, socio-economic status, etc.
(Public Health Dietitians of Ontario, 2019)
How can the stigma of obesity be reduced?
1 Recognize that we may have prejudices:
Do I have implicit biases about obesity? Take the test here: https://implicit.harvard.edu/implicit/langchoice/canada.html
Vocabulary and what to say:
To be avoided: obese person, an obese, you are obese, overweight person.
To use: person living with obesity (it's more humane and respectful than saying obese), you are obese, fat person, fat mass.
Instead of saying: You need to lose weight, we can say that it would be beneficial to work on our lifestyle habits (nutrition, physical activity, stress management, etc.). We must stop saying that someone must reach a certain weight or BMI to be healthy.
Think about it :
If you are a health professional and weight is a factor influencing other diseases (example: diabetes): ask permission to talk about weight.
Do not assume that a fat person wants to lose weight.
Do not assume unhealthy behaviors. For weight management, it should not be assumed from the outset that the person is not doing physical activity or eating poorly.
Focus: change lifestyle habits to feel good about your body and reduce comorbidities and not for weight loss as the ultimate goal.
New guidelines from Obesity Canada (5 A: ask, assess, advise, agree & assess):
1- “Recognition of obesity as a chronic disease by health professionals, who should ask their patients for permission to advise and help them treat this disease impartially.
2- Assessment of the person living with obesity according to the appropriate parameters and identification of the underlying causes of the problem, its complications and the barriers to treatment.
3- Discussion of the main therapeutic options (nutritional therapy, physical activity) and adjunctive treatments as needed, including psychotherapeutic, pharmacological and surgical approaches.
4- Agreement with the person living with obesity about treatment goals, focusing on the value of health-focused interventions.
5- Commitment of healthcare professionals to perform periodic follow-up and reassessments and to promote the treatment of this chronic disease” (CMAJ, 2020)
For more information on the new obesity guidelines, see: https://www.cmaj.ca/content/192/49/E1757#sec-5
Karine Drouin RD, registered dietitian
References
Cmaj. (2020). L’obésité chez l’adulte : ligne directrice de pratique clinique. Retrouvé le 6 mai 2021 au https://www.cmaj.ca/content/192/49/E1757#sec-5
Harvard. (n.d.). Implicit Association Test. Retrouvé le 26 mai 2021 au https://implicit.harvard.edu/implicit/langchoice/canada.html
L’hôpital d’Ottawa (n.d.). Sachez reconnaître et réduire la stigmatisation de l’obésité – une maladie impossible à cacher. Retrouvé le 2 mars 2022 en ligne au
https://www.ottawahospital.on.ca/fr/sachez-reconnaitre-et-reduire-la-stigmatisation-de-lobesite-une-maladie-impossible-a-cacher/
Puhl, RM and Heuer CA. Obesity Stigma: Important Considerations for Public Health Am J Public Health.2010 June; 100(6): 1019–1028.doi: 10.2105/AJPH.2009.159491
Rubino F., Puhl RM, Cummings DE, Eckel RH, Ryan DH, Mechanick JI, et al. Joint international consensus statement for ending stigma of obesity. Nat Med. 2020;26(4):485-97
University of Connecticut. (n.d.). UConn Rudd Center for Food Policy & Obesity. Retrouvé le 27 Avril 2021 au https://uconnruddcenter.org/media-gallery/page/2/
Wharton S. et al. (2020). L’obésité chez l’adulte : ligne directrice de pratique clinique. CMAJ. Retrouvé le 27 Avril 2021 au https://www.cmaj.ca/content/192/49/E1757#sec-5