Available online 26 November 2022

Author links open overlay panelAbstract

Weight stigma and weight bias are pervasive in our society and are based on wrong assumption that obesity derives basically from a lack self-discipline and personal responsibility, obviating recent evidence showing that obesity is a prevalent, complex, progressive, and relapsing chronic disease that results from the interaction between behavioural, environmental, genetic, and metabolic factors. This narrative review provides an overview of recent research on this problem, mainly focused on the negative impact of weigh stigma on health. Overall, recent evidence shows that weight stigma can contribute to worsening obesity-related problems and creating additional barriers to effective obesity care and prevention. In addition, a brief description of some of the most important international initiatives to address the weight stigma is provided.

Resumen

El estigma de la obesidad está generalizado en nuestra sociedad y se basa en la suposición errónea de que la obesidad se deriva principalmente de una falta de autodisciplina y responsabilidad personal, obviando la evidencia reciente que muestra que la obesidad es una enfermedad crónica prevalente, compleja, progresiva y recidivante, que resulta de la interacción entre factores conductuales, medioambientales, genéticos y metabólicos. Esta revisión narrativa proporciona una visión general de la investigación reciente sobre este problema, situando el énfasis en su impacto negativo en la salud. En general, las evidencias recientes muestran que el estigma de la obesidad puede contribuir a empeorar los problemas asociados a la obesidad y a crear barreras adicionales para un tratamiento y prevención efectivos. Además, se facilita una breve descripción de algunas de las iniciativas internacionales más importantes para abordar el problema del estigma de la obesidad.

Section snippetsIntroduction to obesity stigma

Obesity is a complex, chronic disease characterised by abnormal excess body fat that negatively affects physical1 and mental2 health. It has also been associated with significant financial burdens in developed and developing countries.3 According to the World Health Organization (WHO), obesity is rising worldwide, and its global prevalence almost doubled between 1980 and 2014. In 2014, 11% of men and 15% of women over 18 years of age were living with obesity, and more than 42 million children

Method

To provide a general overview of this issue, a narrative literature review of obesity stigma and its impact on health was performed, following the recommendations of Green et al.,15 one of the most widely cited and used guidelines for this type of review. According to the classification of these authors, this is a narrative overview. A literature search in the ISI Web of Science and PsychINFO databases focused on articles published between January 2010 and June 2021. However, earlier articles

Prevalence of obesity stigma

Obesity stigma is extremely relevant in our society and has become a global health challenge.18 Despite the increased prevalence of obesity in recent years, obesity stigma seems to have increased.19 A significant proportion of obesity-related costs could be due to obesity stigma.20 A recent report published by the WHO revealed that school-aged children with obesity experience a 63% higher chance of being bullied, 54% of adults with obesity reported being stigmatised by their co-workers, and 69%

Settings where obesity stigma occurs

Obesity stigma is prevalent in many areas of people’s lives, including health, work, education, family, the media, public health and society in general.

Many healthcare professionals manifest bias and negative attitudes towards patients with obesity.25 A report published by the WHO stating that almost 70% of adults living with obesity have reported experiencing stigmatisation from healthcare professionals has already been alluded to above.21 The multinational study conducted in six countries

The impact of obesity stigma and weight bias internalisation on health

Weight bias internalisation and the stigmatisation of people living with obesity have spread throughout society based on the belief that the stigma and blame will motivate them to lose weight.42 Yet research has shown that this approach is counterproductive, as these biases and stigmatisation, especially when internalised by the individual, rather than acting as a driver for change, could harm the physical and psychosocial health of sufferers and worsen their quality of life. Several recent

International initiatives to address the problem of obesity stigma

In the field of public health, the stigma associated with diseases such as HIV/AIDS, various types of cancer, alcoholism and drug use has been an important barrier to treatment and prevention. Significant efforts by healthcare professionals were required to break down this barrier that had a negative impact on intervention efficacy.85

In contrast, obesity stigma has not yet received sufficient attention from those responsible for health and public policy. However, as has been shown, its effects

Limitations

This review has a series of limitations. Firstly, it is a narrative literature review, not a systematic review that would be less biassed. However, systematic reviews focus on research aims and questions that are much more specific than the aim of this review, which would be very difficult to tackle by systematic review. Despite following guidelines and recommendations to reduce bias associated with narrative literature reviews,15 the inclusion of studies and reports selected based on the

Conclusions1

Obesity stigma is widespread in our society and occurs in many different settings, including health, education, work, family, the media and public health.

2

Obesity stigma has a very negative impact on the health and health-related behaviours of people with obesity.

3

Obesity stigma can exacerbate obesity-associated problems and create additional barriers to effective treatment and prevention.

4

Obesity stigma is based on the typically erroneous assumption that obesity derives primarily from a lack of

Funding

This study benefited from the support of the Project funded by the Ministry of Science, Innovation and Universities [Ministerio de Ciencia, Innovación y Universidades] RTI2018-099293-B-I00.

Conflicts of interest

The authors declare that they have no conflicts of interest.

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© 2022 The Author(s). Published by Elsevier España, S.L.U. on behalf of SEEN and SED.