摘要：Stigma and discrimination toward obese persons are pervasive and pose numerous consequences for their psychological and physical health. Despite decades of science documenting weight stigma, its public health implications are widely ignored. Instead, obese persons are blamed for their weight, with common perceptions that weight stigmatization is justifiable and may motivate individuals to adopt healthier behaviors. We examine evidence to address these assumptions and discuss their public health implications. On the basis of current findings, we propose that weight stigma is not a beneficial public health tool for reducing obesity. Rather, stigmatization of obese individuals threatens health, generates health disparities, and interferes with effective obesity intervention efforts. These findings highlight weight stigma as both a social justice issue and a priority for public health. Negative attitudes toward obese persons are pervasive in North American society. Numerous studies have documented harmful weight-based stereotypes that overweight and obese individuals are lazy, weak-willed, unsuccessful, unintelligent, lack self-discipline, have poor willpower, and are noncompliant with weight-loss treatment. 1 – 3 These stereotypes give way to stigma, prejudice, and discrimination against obese persons in multiple domains of living, including the workplace, health care facilities, educational institutions, the mass media, and even in close interpersonal relationships. 1 – 3 Perhaps because weight stigma remains a socially acceptable form of bias, negative attitudes and stereotypes toward obese persons have been frequently reported by employers, coworkers, teachers, physicians, nurses, medical students, dietitians, psychologists, peers, friends, family members, 1 – 4 and even among children aged as young as 3 years. 5 Recent estimates suggest that the prevalence of weight discrimination has increased by 66% over the past decade, 6 and is now comparable to prevalence rates of racial discrimination in America. 7 Despite several decades of literature documenting weight stigma as a compelling social problem, 1 , 2 , 8 , 9 this form of stigma is rarely challenged in North American society and its public health implications have been primarily ignored. Instead, prevailing societal attributions place blame on obese individuals for their excess weight, with common perceptions that weight stigmatization is justifiable (and perhaps necessary) because obese individuals are personally responsible for their weight, 10 and that stigma might even serve as a useful tool to motivate obese persons to adopt healthier lifestyle behaviors. 11 – 13 We have examined existing evidence to address these assumptions about weight stigma and discuss their public health implications. Documentation of the stigma of obesity has been extensively reviewed elsewhere, 1 , 2 , 4 thus, our aim was to highlight relevant evidence from this body of work to examine public health implications of weight stigma, an issue that has received little attention in the obesity field. We obtained articles cited in this paper through comprehensive literature searches in computerized medical and social science databases, including PubMed, PsycINFO, and SCOPUS. Search terms were limited to various keyword combinations pertaining specifically to body weight and stigma descriptors to identify studies examining the relationship between weight stigma and public health, and emotional and physical health consequences of obesity stigma. (For examples of descriptor search terms, please refer to Puhl and Heuer. 2 ) We also conducted manual searches for specific authors and journals that have published relevant research on these topics. In addition, we retrieved references from a recent comprehensive systematic review of peer-reviewed research studies documenting bias and stigma toward obese individuals that we recently published. 2 The vast majority (87%) of studies we included were published in the past decade, with the exception of several studies published earlier that are cited when relevant to the historical context of the discussion or to provide 7 examples of landmark studies. On the basis of the current evidence, we conclude that weight stigma is not a beneficial public health tool for reducing obesity or improving health. Rather, stigmatization of obese individuals poses serious risks to their psychological and physical health, generates health disparities, and interferes with implementation of effective obesity prevention efforts. This evidence highlights the importance of addressing weight stigma as both a social justice issue and a priority in public health interventions to address obesity.
