At a recent obesity medicine conference, Fatima Cody Stanford was approached by a colleague who said she’d always been standoffish around Stanford and wanted to explain why.
When they were five years old, she said, taking a dance class together, Stanford had told her she was fat.
“Part of me died inside. I see myself as an ally for those with overweight and obesity, and I influenced her whole life by my comment,” said Stanford, the keynote speaker on weight bias and health at the third annual Breaking the Silence symposium, held March 29 on the Boston Health Sciences campus.
“We don’t realize what we’re saying can have huge implications for how people carry out their lives,” said Stanford, an obesity medicine physician at the Massachusetts General Hospital’s Weight Center. That lesson informed her talk, using the terms “people with overweight” and “people with obesity” instead of “overweight people” or “obese people.” “Stating ‘obese person’ sets up a stigma before you begin the conversation,” she said.
Stanford listed the many factors that contribute to a person’s body weight—from the gut microbiome and the hunger response to the quality of available food, weight gain-inducing drugs, and environmental toxins. “We spend all our time focusing on the biological factor, but there are others,” Stanford said.
We don’t realize what we’re saying can have huge implications for how people carry out their lives.
Weight bias is pervasive in our society, she said, citing an article saying that people associate the image of an obese person with adjectives such as “lazy,” “undisciplined,” and “careless.” She also told the audience about a young female patient with severe obesity—her BMI was 56—who applied for a job at a Boston retailer and was immediately rejected; a few years later, after she had gotten her BMI down to 27, and she applied again. “She had no additional training or schooling, and she was hired within twenty seconds of starting the interview,” Stanford said.
Examining when and how weight bias develops, Stanford pointed to a study revealing that infants whose mothers prefer images of leaner people versus people with overweight pick up that preference themselves. She also discussed how weight bias leads to negative health outcomes, citing a study that followed a group of boys ages seven to eleven who developed conduct and emotional problems and restrained eating behaviors after being teased about their weight. Another study showed that those who experience weight stigma suffer higher rates of stress, depression, low self-esteem, and substance abuse.
Turning her focus to the health-care field, she said weight bias is less common among health-care practitioners than the general public, but is still pervasive. Studies have shown that although implicit (or unintentional) weight bias has been going down among students at forty-nine medical schools surveyed in recent years, explicit weight bias has been going up. “We aren’t doing as well as we’d like to think we’re doing,” she said.