Discrimination is Dangerous to Fat People’s Mental Health- Why and What Mental Health Professionals Can Do to Help

June 06, 2024

The word “fat” isn’t supposed to be a dirty word, a joke, or a judgment. Instead, “fat” is a neutral word describing the type of body a person has, just like the descriptions of “thin,” “tall,” and “short.” “Fat” can be triggering for many people who have only been introduced to the word as a negative concept or way of being. But over the past decade, body positivity and fat liberation movements have been gaining traction in both online and physical spaces, spreading the message that we, as fat people, have the right to exist as much as straight-sized people (aka people who are not fat). 

While this growing activism is a step in the right direction toward global body acceptance, research shows that the prevalence of weight-based stigma – the social devaluation, denigration, and marginalization of fat bodies – continues to increase against fat people, with negative consequences. This increase in weight-based stigma is continuing to endanger fat people’s mental health.

The Problem of Weight-Based Stigma

Michael Hobbes, the author of the news article Everything You Know About Obesity is Wrong, writes “fat shaming is visible and invisible, public and private, hidden and everywhere at the same time.” Research has found that weight-based stigma is often found in both overt forms of prejudice and discrimination and in more subtle microaggressions. Weight-based stigma shows up as bullying, harassment, hostility, ostracism, derogatory humor, and violence. Unlike other discriminatory stereotypes, weight-based stigma and stereotypes against fat people remain socially acceptable in the U.S. and other countries. The world is constantly and unapologetically reminding fat people that we are not enough, we are unworthy, and that our fatness is a personal failing. 

Through weight-based stigma, “Fat” has become synonymous with the concepts of laziness, lack of motivation, lack of self-discipline, incompetence, moral bankruptcy, and morbidity and mortality. But studies have shown that fat people may experience medical and psychological distress not only due to their weight, but mostly to these stressful effects of weight-based stigma.

How Does Weight-Based Stigma Affect Mental Health?

Weight-based stigma easily becomes internalized and integrated into the fabric of fat peoples’ lives. To the detriment of our own self-worth and dignity, many fat people blame and shame ourselves – as well as others our same size and larger than ourselves – for having a fat body. Having negative thoughts about our body image has become a typical struggle for almost half the American population, with nearly 85 percent of cisgender women reporting they worry about their body size and body features.

Weight-based stigma leads to the inequitable treatment and marginalization of fat people in employment, school, health care, intimate relationships, and almost any form of media. It can result in poor academic performance, lower physical activity, maladaptive eating behaviors and eating disorders, avoidance of health care, anxiety, panic attacks, low self-esteem and/or confidence, body dissatisfaction, depression, and suicidal ideation (Puhl & King, 2013). It is often the experiences of weight-stigma that are detrimental to fat people’s mental health, not the physicality of being fat. As professionals, we must do more to create spaces for fat people to heal from these effects of weight-based stigma both in our therapy sessions, and out in the world.

Where do we go from here? 

Here are some starting points for professionals who want to ensure our fat clients are comfortable and welcome in our buildings, therapy rooms, and sessions.

  1. In our therapy sessions and the waiting room, we can ensure that the physical space has comfortable and appropriate seating, becoming aware of the placement of chairs and the design of the chairs in the session rooms and waiting rooms. For example, seating should not have arms attached, should have flat backs and seats and should be cushioned. Chairs and couches need to be comfortable enough that clients can sit in them up to an hour in length, without issue.
  2. We can also ensure that the building itself is accessible to fat people. Rooms, entrances, outside ramps, and inside doorways must be able to accommodate wheelchairs and other accessibility and adaptive devices. Inside the bathrooms, the toilet seats must also be a larger size and wheelchair accessible.
  3. Language is an important part of therapy work. Ask your client what language and terms they want to use for their body parts. Help reframe gently when clients are talking negatively about their bodies or when they are using blaming or shaming language about themselves or others – and do it without shaming the client for using that language. 
  4. We must begin to hold others in the psychotherapy, medical, social work, and other helping fields accountable for perpetuating weight-based stigma and urge them to educate themselves. A place to start for our own education would be looking for trainings on working with fat people in therapy. Here are just a few that do great work, are culturally sensitive, and view bodies of all types in a neutral or positive light: Ample + Rooted Foundations Training; The Body Positive Institute; Health at Every Size (HAES) Curriculum; The Center for Body Trust.

Are you a client or clinician and want to learn more? Click here for a curated list including books, podcasts, and social media resources about navigating weight-based stigma, fat liberation and body acceptance.

References for this post:

  1. Belle, K., Rieger, E. & Hirsch, J. K. (2019). Eating disorder symptoms and proneness in gay men, lesbian women, and transgender and gender non-conforming adults:Comparative levels and a proposed mediational model. Frontiers in Psychology, 9. doi:10.3389/fpsyg.2018.02692
  2. Berman, M. I., Morton, S. N., & Hegel, M. T. (2016). Health at every size and acceptance and commitment therapy for obese, depressed women: Treatment development and clinical application. Clinical Social Work Journal, 44, 265-278.  
  3. Calogero, R. M., Tylka, T. L., Mensinger, J. L., Meadows, A., & Daníelsdottir, S. (2018). Recognizing the fundamental right to be fat: A weight-inclusive approach to size acceptance and healing from sizeism. Women & Therapy. https://doi.org/10.1080/02703149.2018.1524067
  4. Christel, D. A. & Dunn, S. C. (2017). Average American women’s clothing size: Comparing national health and nutritional examination surveys (1988-2010) to ASTM international misses & women’s plus size clothing. International Journal of Fashion Design, Technology and Education, 10(2), 129-136.
  5. Ciciurkaite, g. & Perry, B. L. (2018). Body weight, perceived weight stigma and mental health among women at the intersection of race/ethnicity and socioeconomic status: Insights from the modified labeling approach. Sociology of Health & Illness, 40 (1), 18-37. Doi: 10.1111/1467-9566.12619
  6. Duba, J. D.,  Kindsvatter, A., & Priddy, C. J. (2010). Deconstructing the mirror’s reflection: Narrative therapy groups for women dissatisfied with their body. Adultspan Journal, 9(2), 103-116.
  7. Gillen, M. M. (2015). Associations between positive body image and indicators of men’s and women’s mental and physical health. Body Image, 13, 67-74. http://dx.doi.org/10.1016/j.bodyim.2015.01.002
  8. Gordon, A. R., Austin, S. B., Krieger, N., White Hughto, J. M. & Reisner, S. L. (2016). “I have to constantly prove to myself, to people, that I fit the bill”: Perspectives on weight and shape control behaviors among low-income, ethnically diverse young transgender women. Social Science & Medicine, 165, 141-149.
  9. Hobbes, M. (2018, September, 19). Everything you know about obesity is wrong. Highline by Huffpost. https://highline.huffingtonpost.com/articles/en/everything-you-know-about-obesity-is-wrong/
  10. Puhl, R. M. & King, K. M. (2013). Weight discrimination and bullying. Best Practice & Research Clinical Endocrinology & Metabolism, 27, 117-127. http://dx.doi.org/10.1016/j.beem.2012.12.002
  11. Wilkes, J. (2014, July, 25). Nearly half in U.S. remain worried about their weight. Gallup. https://news.gallup.com/poll/174089/nearly-half-remain-worried-weight.aspx?

Written By:
Beth Cortez-Neavel, LPC-Associate, LMFT-Associate, Supervised by Michelle Silva Segura, LMFT-S, LPC-S, SEP


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