Introduction
Weight bias and the resulting stigma and discrimination is a significant public health problem and social justice issue that leads to health inequities. Public health must not frame higher weights as a disease or epidemic as this contributes to weight discrimination. A weight-inclusive approach is necessary to reduce harm and promote health for individuals in larger bodies.
The purpose of this position statement is to raise public health professionals’ awareness of the systemic injustices and harm that results from weight bias, stigma, and discrimination. It also provides recommendations to mitigate harm through a weight-inclusive approach.
All public health professionals need to work together to support a weight-inclusive approach that improves health outcomes for all.
(note- the content on this page is taken from the Executive Summary – Download the full position statement (95 pages including checklist and appendices, using the Download PDF button on this page. Checklist and other materials are also available as separate documents on the Weight Bias Resources page)
Background
The prioritization of health from a Western viewpoint is evident in the World Health Organization’s (WHO) definition of health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity”. This definition can create unrealistic expectations and lead to feelings of inadequacy and self-blame, which can negatively impact individual health and well-being. It is important to note that health is dynamic and can vary depending on cultural, social, environmental, and historical contexts. As such, the notion of achieving “health” is not absolute and is subject to relativity and constant evolution.
The public health field often frames health as modifiable through individual behaviour change, thereby creating a moral imperative that a state of “good” health is attainable and should be desired or pursued by all. However, achieving health is subjective and different for everyone, as health is influenced by complex systemic, structural, physiological, psychological, environmental, economic, political, and social factors, referred to as the Social Determinants of Health (SDH).
Like health, weight is complex and multifactorial. Many healthcare professionals and researchers associate higher weights and Body Mass Index (BMI) with poorer health and increased mortality. Despite its widespread use, Body Mass Index (BMI) on its own is not, nor was it intended to be, a valid measure of an individual’s overall health. This oversimplified view results in weight focused recommendations that contribute to weight bias, stigma and discrimination while increasing health inequities and negatively impacting health outcomes.
Weight bias, stigma, and discrimination also intersect with other forms of discrimination and systems of oppression, including, but not limited to, colonialism, homophobia, transphobia, racism, classism, ableism, and sexism. Beauty and weight ideals in Western culture are rooted in anti-Black and anti- Indigenous racism, colonialism, classism, and sexism. Centuries of colonial policies have created a system of hierarchy that privileges Whiteness, resulting in racial discrimination and ongoing settler colonialism. This has worsened health outcomes for Black, Indigenous, and other racialized peoples. Public health professionals must seek to better understand how systemic racism and colonialism has influenced societal and medical beliefs about body size.
Weight bias, stigma, and discrimination impact individuals across the lifespan. Weight ideals and stereotypes about larger bodies are taught to young children by society, through family, peers, media, school, and other settings. Women experience weight stigma more frequently than men. As well, racialized groups and 2SLGBTQ+ communities experience higher rates of weight stigma than White and heterosexual individuals.
Widespread weight bias and stigma leads to discrimination for people in larger bodies in the following settings:
Healthcare: Negative attitudes across a range of health disciplines impacts quality of care. For example, patients are often blamed for their weight, prescribed weight loss for unrelated complaints, and restricted from accessing medical care.
Employment: Weight discrimination in employment occurs through hiring decisions, salaries, promotions, and termination decisions which results in restricted economic opportunities.
Education: Weight stigma can appear in schools through weight- based bullying, curriculum, and educator actions (or inactions), which can impact academic achievement.
Media: Through popular media, social media or health promotion campaigns, media perpetuates stereotypes about individuals in larger bodies while normalizing weight stigma.
Interpersonal Interactions: Family is the most frequent source of weight stigma, which can be especially harmful to children and youth. Experiencing weight-based teasing and inappropriate comments at any age is associated with feeling less satisfied in relationships with others. It can also occur with complete strangers and has been reported while grocery shopping, riding the bus, and out walking.
Mitigating Harm Through a Weight-Inclusive Approach
Weight normative and health/complication-centric approaches place blame on the individual for their health status and focus on weight and/or BMI as a health concern to be resolved. In contrast, the weight-inclusive approach is the only option that actively works to mitigate and eliminate harms caused by the weight- normative and health/complication-centric approaches. Public health must not frame higher weights as a disease or epidemic as this contributes to weight discrimination. A weight-inclusive approach is necessary to reduce harm and promote health for individuals in larger bodies.
The weight-normative approach regards larger bodies as having a disease requiring treatment rather than a normal variation of human body size. Assigning a disease label to larger bodies causes those in larger bodies to feel dehumanized and experience bias, stigmatization, and discrimination. The weight-inclusive approach opposes blame on the individual for their health status and highlights the impact of social, cultural, and environmental conditions on one’s health.
A weight-inclusive approach recognizes the importance of trauma-and- violence-informed care. Weight and weight loss are not elements of treatment or intervention, and this approach advocates for care for everybody by using research, tools, equipment, and best practices that include larger-bodied individuals in its development.
The Role of Public Health in Perpetuating Weight Bias
The public health sector has contributed to weight bias by framing “obesity” as a public health crisis, economic burden, and treating weight as a personal responsibility. Such campaigns and messaging do not increase motivation to improve health and well-being; rather, they decrease individuals’ feelings of control over their health status. They also contribute to increased weight bias, which leads to weight-related teasing, bullying, harassment, violence, hostility, ostracism, pressure to lose weight, and negative appearance commentary.
Impacts of Focusing on Weight Loss
There is no evidence of effective approaches to achieve long-term weight loss. When weight loss is pursued, there are often adverse consequences including increased mortality, disordered eating and eating disorders, emotional distress, poorer mental well-being, and weight cycling.
Impacts of Weight Bias, Stigma, and Discrimination on Health
The stigma and discrimination experienced by people in larger bodies are independent risk factors for mortality and morbidity. Additionally, weight stigma and discrimination result in mental, physical, social, and economic consequences. These outcomes exist even after controlling for BMI, suggesting that weight stigma and discrimination, rather than higher weights alone, increase the risk for mental and physical health concerns.
Recommendations for Public Health Practice
Weight bias, stigma, and discrimination dehumanize people and contribute to the oppression of people living in larger bodies. Differences in treatment create inequities, disregard individual needs, and cause harm on a physical, mental, and emotional level.
To improve population health, public health must apply an anti-racist, anti- oppressive, and trauma-and-violence-informed lens, and divest from a weight- centric lens when moving towards a weight-inclusive approach as a component of equity-informed practice.
The following recommendations outline how this position statement can be applied to public health practice. Recommendations are grouped into four primary categories: communications, supportive environments and policy, collaboration and partnership, and education and training/capacity building.
This list is not exhaustive; we recognize that much more can be done in public health practice to end weight bias, stigma, and discrimination. All public health professionals need to work together to support a weight-inclusive approach that improves health outcomes for all.
Collaboration and Partnership
- Foster partnership and collaboration among communities and individuals with lived experience (e.g., those living in larger bodies) and commit to amplifying their voices as experts. Ensure their work is compensated appropriately.
- Consult with local partners (e.g., schools, workplaces, health care providers) to raise awareness of weight bias, stigma, and discrimination. Support them in their efforts to reduce its perpetuation, such as through training and advocacy initiatives within their organization and the broader community.
- Encourage and support partners in discontinuing programs and resources that do not align with a weight-inclusive approach.
- Empower and support partners with updating policies and resources to reflect a weight-inclusive approach.
Communications
- Review, discontinue, or update resources and messages to ensure alignment with a weight-inclusive approach. Consider involving people with lived experience in co-creation and/or review of resources.
- Remove all references to “healthy weights”, “normal weight”, and BMI categories, and replace it with information on weight bias, stigma, and discrimination.
- Align with a weight-inclusive approach by using positive, non- stigmatizing images.
- Avoid using the terms “obesity” or “overweight” in messaging, and incorporate more inclusive language.
- Avoid listing “obesity” as a chronic disease and framing it as a public health crisis, as evidence suggests it may be harmful.
- Avoid referring to “overweight/obesity” as a health behaviour as there is strong evidence weight is not a behaviour and should not be treated as such.
- When developing messaging around health behaviours, ensure the impact of the SDH are also communicated.
- Avoid reporting on BMI information.
Supportive Environments and Policy
- Create a weight-inclusive environment throughout the space as well as including furniture and equipment (e.g., chairs, bathroom stalls) that are designed to accommodate people of diverse body sizes. When meeting with clients, ensure a quiet, private, and comfortable space is available. Ask clients how the space may be changed so that they feel safer and more comfortable.
- Develop and implement a checklist to support a weight-inclusive environment and review regularly.
- Remove images or materials (e.g., magazines, wall photos) that promote thin ideals and stigmatize larger bodies and replace them with ones that feature positive portrayals of a diverse group of individuals in different bodies (e.g., ability, race, gender, etc.).
- Develop and implement policies that promote a weight-inclusive approach. Incorporate continuous quality improvement and evaluation processes.
• This includes inclusive clinical and weight-based practices, such as how to obtain informed consent when weight measurement is necessary (e.g., medication and vaccine dosing), an option for taking a blind weight, ensuring privacy, and not making comments about a client’s weight.
• Amend policies related to equity, diversity, and inclusion to address discrimination based on appearance and weight.
• Amend accessibility policies to accommodate people in larger bodies.
• Acknowledge, utilize, and amplify the voices of folks with lived experience of living in a larger body and those who may have experienced weight bias. Seek informed consent and provide appropriate compensation for lived experience feedback.
• Ensure a transparent process for complaints and feedback takes a trauma-informed approach.
• Conduct regular reviews of policies, procedures, programs, spaces, and plans by engaging those with expertise in and lived experience of weight stigma .
• Refrain from using programs and activities that perpetuate weight stigma, such as weight loss programs, using weight or BMI as eligibility criteria, or measuring weight when not medically necessary.
• Staff are supported to complete training and continuing education opportunities on weight-inclusive care. - Encourage the use of trauma-and-violence-informed care to be sensitive to the experiences of all people who have been stigmatized or marginalized. For example, acknowledge the emotional and mental labour involved with seeking and accessing services.
- Promote the inclusion of weight as a protected characteristic in the Ontario Human Rights Code (OHRC) by advocating for its recognition and protection under the OHRC.
- Advocate for upstream programs and policies that address the SDH instead of focusing specifically on individual behaviour change.
Education and Training/Capacity Building
- Seek to understand the issue of weight bias through critical self- reflection and awareness of personal attitudes, biases, beliefs, cultural identity, power, and privilege.
- Provide training and discussion opportunities for reflecting on diet culture within the workplace, and practicing responses to diet talk in various settings. Recognize that disrupting diet culture in the workplace is important to help make safer spaces for people in all bodies.
- When reviewing evidence or conducting research, approach it with a weight-inclusive lens.
- Commit to unlearning colonial narratives of racial superiority and oppression, and how this intersects with weight-based discrimination.
- Provide training and resources on a weight-inclusive approach to improve the skills, knowledge, and attitudes of public health professionals, educators, community partners, and related provincial organizations.
- Commit to continue learning about tools and supports for people in larger bodies without focusing on weight loss (e.g., mobility supports, physical therapy, and skincare).
- Promote and distribute the position statement and its accompanying appendix across all teams in Public Health Units in Ontario to maintain consistency in messaging.
