According to Rebecca Boswell, PhD, Supervising Psychologist at Penn Medicine Princeton Center for Eating Disorders, weight bias can be defined as certain social, cultural, and interpersonal beliefs about people based on body size. Internalized weight bias – combined with the macro- and microaggressions faced by people in larger bodies – can contribute to the development of health conditions such as anxiety, depression, post-traumatic stress disorder (PTSD), and eating disorders.
Below, Dr. Boswell provides three assumptions related to weight bias, and why they miss the mark.
Assumption #1: People in larger bodies are unhealthy.
Body mass index (BMI) is currently used to screen for weight categories that may lead to health problems, but its relationship with “health” is correlational – not causal – across populations. In fact, zip code is more strongly correlated with health than BMI. BMI fails to factor in heart function, muscle mass, labwork, medical history, and health behaviors, all of which are far better indicators of an individual’s overall health – and these markers are on point for people with all body sizes.
Assumption #2: Body size is controllable.
This belief can lead to the assumption that people in larger bodies don’t have “enough willpower.” Yet this misses the science of what influences body size, including the many genetic and biological processes that contribute to an individual’s natural weight, or set point, where the body is functioning exactly as it should. The body’s physiological adaptations to dieting defy weight loss efforts; despite the marketing, no weight-loss program has achieved clinically meaningful long-term health or weight outcomes.
Assumption #3: People in larger bodies couldn’t possibly have an eating disorder.
While the stereotype of someone with an eating disorder may be a thin, young, white female, eating disorders affect people of all sizes, ages, races/ethnicities, and genders. Many people in larger bodies are malnourished due to dangerous dieting behaviors, and an eating disorder is just as deadly.
“At any size, the body really needs two key things: a diverse array of nutrients to nourish it, and moderate, enjoyable activity to make it stronger,” says Dr. Boswell.
Dr. Boswell notes that body size has become acceptable to point out, including in comments about appearance and weight. But it can be more harmful than people realize, as it places undue focus on physical appearance, reduces attention on a person’s unique internal qualities, and contributes to weight bias in social environments.
"As providers, it’s important to examine our own perceptions about body size to ensure that we’re creating a safe, inclusive space and providing appropriate care for all of our patients,” says Dr. Boswell. “Everyone has one body that helps us experience the world, and isn’t that amazing? What would it be like if people were kind to their own and other peoples’ bodies?”
