What’s the Problem?

From a young age, we were taught that skinnier people are healthier than fat people. This idea was the product of societal norms and systemic factors, most of which were unrelated to health, in a culture that idealized the thin, white individual. The idea then grew into internalized beliefs that thinner people are “better” and superior, more deserving of respect and approval, and fatter people- the contrary. Thus emerged both explicit and implicit biases against people living in larger bodies, which still exist to this day.

Why should doctors care?

Weight bias exists in medicine.

“Healthcare providers often view obesity as an avoidable risk factor that impedes their ability to treat and prevent disease.” They hold stereotypes that overweight patients are less adherent to treatment, lazier, or less disciplined than patients of normal weight, reducing the quality of care provided. (Phelan, 2015)

A study using a matched sample of 222 overweight adult men and women, revealed that doctors were one of the most frequent sources of weight stigma. Overweight participants cited encountering negative assumptions based on their weight, physical barriers to care, and inappropriate comments from doctors. (Puhl, 2006)

Weight stigma, as a form of discrimination, affects both physical and mental health.

Perceived discrimination, including weight bias, increases the levels of stress and cortisol experienced by individuals, which can lead to negative long term health effects, including HTN and cardiovascular disease. (Pascoe, 2009)

Psychiatric adverse effects of weight stigma include mood and anxiety disorders, increased suicidal ideation, poor academic performance, and development of maladaptive eating behaviors. (Puhl, 2013)

Our Response?

BMI (how we define “obesity”), is a flawed measure of health.

The BMI, calculated solely from an individual’s weight and height, was invented by a mathematician in 1830, to help the Belgian government allocate resources. (Devlin, 2009) It only became an “indicator of health” in the 1900’s, when life insurance companies decided to adopt it.

Watch: Poodle Science Illustration of why BMI is problematic.

Research has shown a higher BMI is not uniformly associated with higher mortality, & that physical activity can improve health, without changing weight.

Individuals in the mild obesity category (BMI 30-35) have a similar mortality rate to those in the normal weight category. (Flegal, 2005 and Flegal, 2009)

A meta-analysis of 10 articles demonstrated that overweight and obese individuals had similar mortality risks to those of normal weight, when matched for levels of cardiorespiratory fitness. (Barry, 2014)

Muscular fitness is associated with reduced risk of chronic disease and mortality, independent of BMI. (Correa-Rodriguez, 2018)

Cardiometabolic risk factors associated with being overweight, including hypertension, poor glycemic control, and hypercholesterolemia, can be improved with physical activity, independent of weight loss. (Gaesser, 2021)

Prescribing diets for weight loss isn’t harmless.

Because about 95% of dieters regain the weight they lost within 1 year, weight cycling (rapid weight gain after weight loss) is a common phenomenon among overweight individuals. Weight cycling has been associated with increased cardiovascular morbidity and mortality. (Strohacker, 2010)

Multiple longitudinal studies have shown that dieting and weight-control behaviors implemented during adolescence led to unhealthy eating behaviors and eating disorders later on in life. (Field, 2003), (Neumark-Sztainer, 2006 & 2011)

Learn about what we are doing to help.

*Disclaimer: This page is not an exhaustive list of resources or research studies related to these topics. To read more, please visit our resources page or email us at sizeinclusivemedicine@gmail.org.

MSSI is dedicated to using the most accurate and up-to-date research to inform our advocacy efforts. Have a journal article you’d like us to read?

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