The Impact of Weight Stigma on Children
By Lesley Williams, MD, CEDS
Children come in all shapes and sizes, and they are not immune to the impact of weight stigma and the development of eating disorders. Even young elementary school kids are spending their playground time talking about size and shape instead of swinging on the swings or playing on the slides. Weight stigma and fatphobia are everywhere. Children in larger bodies often feel alienated by the bullying and overt “sizeism” they experience. Schools, homes, and health care settings have been identified as common places where weight stigma exists. Strides have been made to address stigma in other areas. Despite this, weight stigma typically remains uncharted waters. In fact, it was only a few years ago that some schools in this country were weighing students and sending “golden tickets” home with children above a certain BMI. The alleged goal was to improve health and address the “childhood obesity epidemic” by informing children and their parents that something needed to be done re: their weight. The primary outcome was that children felt humiliated and helpless. Few options are available for young children being told that their size is unacceptable. They didn’t make their genetics, and they rarely make their own meals. Many begin engaging in restriction in an effort to make their bodies smaller. Others begin to eat more as a way to reduce the negative feelings they have about themselves. Weight stigma is not harmless. It can serve as a catalyst for years of disordered eating and body dissatisfaction. If the health and happiness of our youth is the goal, we need to work together to reduce weight stigma and support happy and healthy living for children of all sizes.
What is weight stigma?
Also known as: weight bias or weight discrimination
Discrimination or stereotyping based on size
Weight stigma can also manifest as fatphobia, which is the dislike of or fear of becoming fat.
Weight stigma is both a public health and social justice issue.
How does weight-based victimization show up?
- Cyberbullying/negative comments on social media
- Physical aggression
- Relational victimization: being ignored, excluded, or the target of rumors
The trend of increasing pediatric body sizes is indisputable. As of 2016, 13.7 million children in the U.S. were classified as overweight or obese. This number is nearly triple what it was in 1963. Although we recognize that the number is increasing, the plan regarding what to do about it is up for debate. In fact, some question whether anything needs to be done at all. Singularly focusing on decreasing the number of individuals who meet this weight criteria feels like a misguided quest. We could also recognize that the number of LGBTQ youth has increased over that same period of time. This fact is regarded as a trend that reflects our evolving world and something that we need to be more sensitive and attuned to. It is not regarded as something that needs to be eradicated. When it comes to increasing size, health care professionals should take a similar approach. Instead, many have elected to address the issue by waging a war on “childhood obesity,” citing a quest to improve the health of our youth as their motivation. Improving the health of our youth is something we can all agree on. However, if health is our goal, we can’t address the potential health issues associated with higher body weights while at the same time ignoring the equally deleterious impact of weight stigma on health. We cannot profess our concern for health while ignoring the negative impact that weight stigma also has on health. According to a 2020 American Psychologist report, weight stigma has been linked to depression, maladaptive eating behaviors, decreased engagement in physical activity, and psychological stress, as well as body dissatisfaction and weight gain. None of that sounds very healthy to me. Is it possible to help children feel accepted just the way they are while simultaneously encouraging healthy lifestyle habits that could benefit children of all sizes?
All too often health care providers tell children in larger bodies they simply need to “eat less, exercise more.” This basic prescription is ineffective and does not take into account how multifactorial weight and shape are. Children are given the impression that their size is somehow their fault. They are told that the blame for their size rests solely with them. It is rarely acknowledged that even if every child in America ate the same thing every day and did the same amount of activity, sizes would vary greatly. If we want to promote health, we need to start by recognizing that efforts to blame and shame children into weighing less are causing harm. These tactics have been used by some health care professionals because they believe it will help motivate the child or their parents to make necessary dietary and lifestyle changes. I can assure you, this is not the case. A child who is fat-shamed by a doctor or someone else whom they hold in high regard does not go home and eat a salad and join a sports team. They go home filled with humiliation and self-loathing. The experience has a negative impact on them. If we want our youth to lead happy, healthy lives, we must eliminate weight stigma and make them feel valued and capable of greatness, no matter their size.
Navigating overlapping stigmas is especially challenging for children of color in larger bodies. Given the current racial climate in our country, it is imperative that we understand how impactful dealing with cumulative stigmas can be. If we are advocating for the reduction of weight stigma, we need to simultaneously advocate for reducing racial stigma as well. Some old studies have suggested that children of color are immune to body image dissatisfaction and disordered eating. This is not the case. It is evident that children of color are less likely to be diagnosed and treated. They also struggle to find mental health professionals that understand the negative psychological impact of living in a society that rejects you based on your skin color as well as your size. All children should be given an opportunity to grow up in a world that supports their strengths and successes regardless of their size or color.
How can we combat diet culture, racism, and weight stigma while cultivating a new generation of children who love and accept one another and all of the unique sizes, shapes, and colors that they come in? That’s a big task. One proposed step in that direction is having an open dialogue with children about the true meaning of health. The World Health Organization defines health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” We should be teaching our children that it is possible to achieve this globally accepted definition of health regardless of what size you are. Physical, mental, and social well-being are available to all of us. Imagine a new world where children of all sizes feel free to engage in the good things that life has to offer without the fear of stigma or discrimination. Wouldn’t that be a happier, healthier world for all of us?
Goals for reducing weight stigma in pediatrics:
- Assess internalized weight bias in adults
- Educate children that their bodies come in all shapes and sizes
- Tell children that promoting health and happiness is important
- Encourage all children to love and support one another
- Discuss what weight stigma is and the variety of ways it can show up
- Brainstorm ways to reduce weight stigma
About the author:
Lesley Williams, MD, CEDS
Dr. Lesley Williams is a board certified Family Medicine physician and Eating Disorder Specialist. She received her Doctor of Medicine degree from the University of Kentucky College of Medicine and completed her Family Medicine residency training at Mayo Clinic Arizona. Dr. Williams has been providing medical care for patients with eating disorders and other mental health issues for over 16 years. She currently serves at the Medical Team Lead for Banner Behavioral Health Hospital in Scottsdale, AZ. In addition to her clinical work, Dr. Williams is a passionate advocate for diversity, equity and inclusion in healthcare. She serves on the Academy of Eating Disorders’ DEI Committee and is an executive co-sponsor for Banner Health’s DEI Multicultural Team Resource Group. Dr. Williams recently authored a children’s book that celebrates body diversity, Free To Be Me: self love for all sizes. Her areas of special interest include: Health Equity and Health at Every Size advocacy.