The stigmas surrounding appearance, weight and body image are aspects of social prejudices that are all too common in the field of eating disorders. Breaking down societal stigma is a key focus of mental health and eating disorders sectors. Two areas that experience a heightened level of stigma is Binge Eating Disorder, and Obesity.
What we know
- Binge eating can be underpinned by feelings of shame and guilt
- Binge eating often occurs during times of stress, anger, boredom or distress
- Individuals often feel great deals of fear around what reactions they will face in speaking out about their concerns
Research shows that fear can stem from two major areas, these are; 1. Internalised weight bias and 2. Societal bias around Binge eating disorder.
What is internalised weight bias (IWB)?
Internalised weight bias, can be described as, self-directed weight bias deriving from self beliefs and attitudes, that are contributed to by societal and cultural factors (Pearl, White, & Grilo, 2014b). This wide spread bias, both internal and external, can lead to strong internalisation of negative messaging (Durso et al., 2012).
Multiple studies have shown that IWB is strongly linked to other mental health concerns such as depression, self-esteem issues and a variety of other psychological issues (Durso et al., 2012; Pearl, White, & Grilo, 2014a; Pearl et al., 2014b). There has been much literature that has explored to support the links between stigma and its impacts on those who are overweight and obese and found that weight gain due to binge eating or otherwise may heighten risk for poor psychosocial outcomes such as depression and anxiety, particularly among females (Anderson et al., 2007; Ball et al., 2008; Bjerkeset et al., 2008; Jorm et al., 2003).
Studies have shown that there is a direct link between BMI and overall health-related quality of life, however more research on relationships between health and self-stigma is minimal and there is a need for additional research to fully understand the impacts (Pearl et al., 2014b).
Societal weight bias and stigma
Anti-obesity messages are everywhere – in news, in entertainment, and in public health campaigns. We are constantly being told that fat is bad, and the only road to health and happiness is to lose weight. Obesity-reduction strategies in the form of community-based interventions and social marketing campaigns often emphasise the desirability of an idealised body weight or shape through dieting and physical exercise (Bombak 2014). However there is no evidence to show that these strategies prompt or result in weight loss. Instead, popular ideas about fatness and health may inadvertently stigmatise the individuals they intend to help, and may be a risk factor in the development of eating disorders, such as BED (Schwartz & Henderson, 2009; Waddie & Diddie 2003).
Our environment, societal views and opinions can have quite an impact on how we position ourselves within the world. Therefore the way that obesity and binge eating is perceived can have a substantial impact on the way in which treatment is approached. Current approaches by health practitioners and within health promotion/media have focused on weight, shape and size; this raises the question: Do our current methods for addressing obesity also address de-stigmatisation?
Studies have uncovered a deep rooted bias within society against individuals that are overweight or obese with many, including health care providers, being of the opinion that obese individuals are lazy, lacking will-power and are undisciplined (Puhl et al 2013; Teachman & Brownell, 2001, Schwartz et al., 2003;Foster et al., 2003).
Many public health campaigns aimed at reducing obesity employ social marketing tactics designed to arouse emotional responses including fear, shame, humiliation, concern about being unattractive or undesirable, and disgust (Lupton, 2013). Disgust is a shock tactic employed in anti-obesity campaigns by public health authorities in many countries including Australia (Lupton, 2013). Through the implementation of these tactics it has been shown that negative stigmas around obesity increase.
By focusing on weight as the problem and weight loss as the solution, messages intended to motivate individuals to be healthier can be more effective if framed in ways that foster confidence and self-efficiency to engage in healthy behaviours, rather than in ways that imply personal blame or require solitary effort. It is therefore important that weight-related public health messages consider the potential that these messages may have for promoting adverse or unintended consequences.
What are the potential implications to these biases/stigmas?
- Individuals my take a longer time to express concerns or worries about BED due to personal fears around being judge, unearthing feelings of shame and or guilt
- Later access to treatment could mean an increase of complexity and severity upon presentation
- Misperception could cause signs and symptom to be missed. Additional health issues could arise as a result of a missed diagnosis or action plan.
Anderson, S. E., Cohen, P., Naumova, E. N., Jacques, P. F., & Must, A. (2007). Adolescent obesity and risk for subsequent major depressive disorder and anxiety disorder: prospective evidence. Psychosomatic Medicine, 69(Mdd), 740–747.
Bjerkeset, O., Romundstad, P., Evans, J., & Gunnell, D. (2008). Association of adult body mass index and height with anxiety, depression, and suicide in the general population: The HUNT study. American Journal of Epidemiology, 167(2), 193–202.
Bombak, A. (2014). Obesity, health at every size, and public health policy. American Journal of Public Health, 104(2), 60–68.
Durso, L. E., Latner, J. D., White, M. a., Masheb, R. M., Blomquist, K. K., Morgan, P. T., & Grilo, C. M. (2012). Internalized weight bias in obese patients with binge eating disorder: Associations with eating disturbances and psychological functioning. International Journal of Eating Disorders, 45(3), 423–427.
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Lupton, D. (2013). Revolting Bodies : the Pedagogy of Disgust in Public Health Campaigns Sydney Health & Society Group Working Paper No . 4 Department of Sociology University of Sydney, (4).
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Schwartz, M. B., & Henderson, K. E. (2009). Does obesity prevention cause eating disorders? Journal of the American Academy of Child and Adolescent Psychiatry, 48(8), 784–786.
Teachman, B. a, & Brownell, K. D. (2001). Implicit anti-fat bias among health professionals: is anyone immune? International Journal of Obesity and Related Metabolic Disorders : Journal of the International Association for the Study of Obesity, 25(10), 1525–1531.
Jorm, A. F. (2003). Association of obesity with anxiety, depression and emotional well being:a community survey. Australian and New Zealand Journal of Public Health, 27(4), 434–440.
Wadden, T. a, & Didie, E. (2003). What’s in a name? Patients' preferred terms for describing obesity. Obesity Research, 11(9), 1140–1146.
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