Affecting 42% of adults in the U.S., obesity is not just a cosmetic concern, it’s a serious but treatable chronic disease. Although the prevalence of obesity in the older adult population is increasing, there’s still one topic that doesn’t get enough of the spotlight: the negative societal perceptions linked to excess body weight, or weight stigma, which serves as a barrier for older adults looking for ways to find help and address overweight and obesity.

What is weight stigma?

The World Obesity Federation defines weight stigma as “the discriminatory acts and ideologies targeted towards individuals because of their weight and size.”

Older adults face weight-related discrimination every day—at stores and restaurants, on public transportation, in the workplace, and in healthcare settings. Weight stigma even affects personal relationships. In fact, “fat shaming” is so ingrained in our modern society that people may not even notice it’s happening. And the problem is getting worse: one study found that as obesity rates rise, weight discrimination also increases.

The unfortunate truth is that in North America, bias against people living with obesity is still socially acceptable. This makes a large percentage of the population vulnerable to blatantly unfair treatment, with little recourse in terms of protection and support. There are currently no federal laws in place to prohibit weight-based discrimination. As a result, this type of behavior is rarely questioned or challenged. In fact, it’s often outright ignored.

What are some examples of weight stigma?

There are many misperceptions surrounding people living with obesity. They may include generalizations and beliefs such as:

• Men and women living with obesity are lazy and irresponsible. They lack willpower and self-discipline.
• People carry extra weight because of choices they’ve made—it’s “their fault” they’re struggling.
• A larger body size is unattractive and undesirable.
• Individuals who are overweight must not be very smart.
• People who carry excess weight have poor hygiene.
• Those with obesity are less capable of succeeding.

Stigmatization against individuals living with obesity is widely perpetuated by the media, which tends to focus on a thin body as the ideal. In commercials, movies, and TV shows, people living with excess weight are significantly underrepresented, particularly women. When they do appear on screen, they’re often portrayed as objects of ridicule or inferiority—the wisecracking sidekick instead of the hero, or the smart best friend instead of the love interest. Slim-figured actors are portrayed as popular and successful, while actors with obesity are depicted as unpopular, aggressive, or ill-mannered.

Older adults face more subtle forms of weight stigma in their daily environment. For example, in many doctor’s offices, examination tables and gowns do not accommodate people of larger size. This is also true on many commercial airplanes, where seats will not fit an individual who carries significant excess weight. In this case, the passenger is often required to purchase two seats to sit comfortably during their flight.

What are the consequences of weight stigma?

According to the Obesity Action Coalition (OAC), weight stigma can have serious social, psychological, and physical effects, such as:

• Low self-esteem and negative body image
• Depression and anxiety
• Rejection by peers and family members
• Poor quality of personal relationships
• Lower pay at work and fewer promotions
• Harmful weight control practices (e.g., eating disorders)
• Exercise avoidance / sedentary behaviors

While someone might assume that weight discrimination would motivate an individual to lose weight, the opposite is true. Research suggests that anti-obesity bias and fat shaming can actually drive weight gain. This is because exposure to weight bias triggers stress, which in turn inhibits self-control and leads to binge eating. In one study, people who internalized weight bias to a large degree were three times as likely to be at risk of heart disease and diabetes by having metabolic syndrome, that includes a cluster of three out of four health conditions such as  elevated blood sugar, high blood pressure, high body mass index and high cholesterol than those who did not.

Living with obesity can also stand in the way of getting high-quality healthcare. Some primary care providers view people with obesity as "non-compliant" and spend less time with them during visits. Bias against patients with weight issues can make a provider less kind, supportive, and compassionate—which compromises the level of care they deliver. In addition, perceived provider discrimination may make people living with obesity reluctant to seek medical help for health problems.

How do you fight obesity stigma?

Changing deeply embedded cultural attitudes about obesity and enacting laws that ban weight-based discrimination will take time and effort. However, if you’re an older adult living with obesity, there are steps you can take now to help battle weight stigma:

1. Educate others. Whether it’s family members or friends, many people simply don’t have a good understanding of obesity. Challenge common misconceptions by explaining that obesity is a chronic medical condition with numerous and complex causes. There’s also no easy, one-size-fits-all solution.
2. Make your voice heard. When meeting with a healthcare provider, tell them about any weight discrimination you’ve experienced in the medical setting, whether it was blatant or more insidious. When you see instances of weight bias on social media platforms or on TV, contact the OAC and let them know so that their task force can take action.
3. Speak to your government representatives. Reach out to your local or state legislator via letter or email. Ask them to initiate or support legislation that prohibits weight discrimination.
4. Seek support. Join support groups designed for people who are coping with obesity and weight stigma—or express your feelings to a trusted friend or relative. Consider speaking to a therapist about ways you can counter self-defeating thoughts that keep you in a negative spiral.
5. Leverage the Obesity Bill of Rights. Endorsed by nearly 50 national obesity and chronic disease organizations, these are 8 essential rights established so that people with obesity will be screened, diagnosed, counseled, and treated according to medical guidelines and no longer face widespread weight bias and ageism within the health care system or exclusionary coverage policies by insurers and government agencies. Find out more at right2obesitycare.org 

Above all, it’s important to be your own advocate. Practice being vocal about your needs—and don’t be afraid to “rock the boat.” You are entitled to the same comforts and conveniences as anyone else. For instance, if the patient gowns at your healthcare provider’s office don’t fit you, request that they stock a larger size.

Self-advocating also means asking your doctor about all of your options for shedding excess weight and lowering your risk of chronic disease. There’s a full range of treatments that one can  explore including lifestyle changes, bariatric surgery, and anti-obesity medications.

Now is a great time to have this conversation, since since March 4-8, 2024 Obesity Care Week, with World Obesity Day observed on March 4. These are public health and awareness campaign that respectively: 1) highlight five principles concerning obesity as a chronic yet treatable disease; and 2) encourage cross-cutting conversations about obesity and its connections to our individual health, its impact on youth (e.g., stigma, food marketing, schools), and the world (e.g., climate change, food systems, creating healthy environments). 

What are the health risks of being overweight? Can you be overweight and healthy? Learn more about obesity and how you can manage your weight after age 60.