Weight Stigma and Eating Disorders: How Diet Culture Plays a Role

A mom boasts about her daughter’s weight loss with a before and after image on Facebook. Thumbs up emojis and “Congrats to her!” comments fill the mom’s feed. While she may have meant no harm, both her post and others’ reactions to it perpetuate weight stigma, also known as weight bias.

“Commenting on someone’s body size and shape and appearance in the world reinforces the message that people are only as much as their body, and that they are being judged by how they appear in the world,” says Dr. Elizabeth Wassenaar, MS, MD, CEDS-S, DFAPA, regional medical director at Eating Recovery Center. "It is an inescapable pressure from society that your body size and shape are not good enough and that you need to change it to be acceptable."

Our weight-biased culture can create fear and anxiety when outside of the perceived norm. Weight stigma is focused on shame, body hatred and judgment.

How diet culture perpetuates weight stigma

Before and after photos are a long-used advertising gimmick for weight loss and fitness programs. Attention given to weight control has skyrocketed in recent years, infusing words like "BMI," "obesity epidemic" and "diet" into our national vocabulary. 

Marketing for weight loss products is overwhelmingly focused on personal responsibility for weight. And a lot of people are buying. In 2019, diet and weight loss grew to a $78 billion industry. It slowed during the height of the pandemic in 2020 but is on the rise again.

"It is woven into the media as advertisement and advertisement’s job is to make you feel like something isn't good enough and that you need to buy something to fix it,” Dr. Wassenaar says. “Media can be really the loudest voice that people hear about what people should look like."

Sitcom characters in larger bodies are less likely than their thinner counterparts to be judged as attractive and tend to have fewer interactions with friends or romantic partners. Children’s movies and books also send body image-related messages that associate beauty and success with thinness.

And then there are the digital images we hold in our hands, swiping left and right, up and down. In mere seconds, individuals can experience joy, jealousy, love and loathing by what is posted. Social media channels are fertile ground for weight stigma.

How social media perpetuates weight stigma

Throughout the first year of the COVID-19 pandemic in which we were more sedentary and had limited access to food variety, 53% of adolescents reported increased exposure to at least one form of weight stigmatizing social media content. 

All too often people feel justified when they target others who are in larger bodies – memes and comments come from a belief that weight is something others can control but are choosing not to.

"It's so important for our society that we check ourselves around making comments on people's bodies,” says Dr. Wassenaar.

She stressed the importance for adults, and children and adolescents raised in a social media-saturated environment, to recognize that they are more than just their external appearance.

5 consequences of weight stigma

Those who experience weight stigma report physicians and family members as the most common source of weight bias, more so than social influences. But no matter who is doing the shaming, there is a significant threat to psychological and physical health.

1. Mental Health

According to a study published in 2023, people who have experienced external and internalized weight stigma are at an increased risk of developing eating disorder symptoms, depression, and anxiety. Weight stigma is also associated with increased risk of suicidal ideation, plans, and attempts.

2. Physical Health

Weight bias can negatively affect our ability or willingness to engage regularly in primary health care. This is often because of barriers to health care access for those in larger bodies, expecting to be treated differently in health care settings due to body weight or size, and unhelpful or biased provider communication leading to a lack of patient trust. All of these real or perceived obstacles can cause those in larger bodies to avoid, or delay seeking preventative or lifesaving health care services.

3. Poor Body Image

People of all sizes can internalize weight stigma. People in smaller or lower weight bodies may not be affected by the same systemic discrimination resulting from weight bias (like higher health insurance premiums, travel restrictions, or limited clothing options based on weight) – but, people of all sizes can experience poor body image as a result of cultural and environmental conversations influenced by weight stigma.  Those who have had weight-related stigmatization experiences are at a greater risk of lower self-esteem, body image dissatisfaction and more negative beliefs about themselves.

4. Personal Attacks

People in larger bodies may experience negative verbal commentaries, teasing or physical assault. Derogatory remarks directed at individuals with a higher body weight are (sadly) often seen as socially acceptable. Our culture has developed a normalcy around commenting on other people’s bodies, and assuming that the ability to change our bodies comes down to simply willpower (when we know is not true) –leading to more socially acceptable yet unhelpful and harmful social circumstances.  

5. Environmental Discrimination

Seating and equipment in many places are often not designed to accommodate people in larger bodies, including in theaters, sports arenas, airlines, restaurants and even medical offices. This can make it, very understandably, isolating to those who live in larger bodies and face this discrimination – furthering concerns, and lessening support.

Weight Discrimination in Healthcare

“Medicine does not acknowledge how impactful weight stigma has been on access to care,” says Dr. Wassenaar. Research into weight stigma has consistently shown that healthcare professionals are biased against people labeled as “having overweight” or “obesity.” This causes them to behave in discriminatory ways, such as blaming serious health issues on weight and sometimes ignoring other possible causes.

Patients who experience weight bias from providers may cancel or delay appointments as well as avoid preventative health care and screenings. In a study regarding weight stigma and bias, the percentage of women who reported having delayed seeking health care increased as the BMI increased. 

“Can you imagine going to a doctor and having them say their scale won't weigh you?” says Dr. Wassenaar. “These sorts of things make you never ever want to go back. It’s very, very traumatic.”

Providers can help to reduce weight stigma toward patients by:

• Acknowledging that some patients may have had negative experiences with other health professionals regarding their weight and approach all patients with sensitivity
• Recognizing the complex determinates of body size (and health, which is not synonymous to body size), and communicate this to colleagues and patients to avoid misconceptions that weight is a matter of personal willpower
• Creating a supportive environment with large, armless chairs in waiting rooms, appropriately sized medical equipment, and an appropriate range of patient gown sizes

How weight stigma can lead to eating disorders

Weight stigma can increase body dissatisfaction, a leading risk factor in the development of eating disorders.

“If you are in a body that you don't see represented on screen or in print then you might have a special vulnerability to feeling like you need to change your body to reflect what you see in media,” says Dr. Wassenaar. "For people who are vulnerable to dieting or working out, once they start that cycle of ‘if I change my body, I'll feel better,’ they get stuck in it and they can't actually get out of it, and that can influence eating disorders.”

Even body compliments such as “you look good” or “great job losing weight” can be a triggering experience that reinforces disordered eating and body dysmorphia. "It can trigger those old eating disordered thoughts that you have to have your body look a certain way in order to be acceptable and that your self-worth is really tied to how your body looks and how people perceive your body," she says.

Among family members, weight-based teasing and diet talk are linked to binge eating, weight gain and extreme weight control behaviors. Research has shown that overemphasizing weight can encourage disordered eating and have counterproductive effects.

Weight inclusivity in healthcare

"I think that we are in the midst of a real revolution around noticing and naming things that have previously been invisible,” says Dr. Wassenaar. “I think that weight stigma is one of those things. We're creating a space to recognize that people are worth much more than just a number on the scale or the size of their jeans.”

Here at Eating Recovery Center, we bring a weight-inclusive approach to health care. A weight-inclusive approach, as defined by the Association for Size Diversity and Health, is one that accepts and respects the inherent diversity of body shapes and sizes, and rejects the idealizing or pathologizing of specific weights. 

A few other popular movements have risen alongside social media to help turn the tide of weight stigma. 

• Body Positivity focuses on the acceptance of all bodies, regardless of size, shape, skin tone, gender and physical abilities, while challenging societal beauty standards. 
• Body Neutrality fosters messaging that a person does not have to love everything about their body -- and that it is okay to feel neutral or indifferent.

Eating Recovery Center has numerous resources to help people affected by weight stigma, including the art-based program Love Your Tree. The program is focused on cultivating self-compassion, body acceptance and positive mental well-being through creativity, community connection and self-reflection.

Read These Next:

• Bringing Weight-Inclusive Care to Health Care
• Why Weight Inclusivity in Health Care Is So Important (and How You Can Fight Weight Bias)
• 5 Self-Advocacy Tips for Fat Folks in Eating Disorder Recovery
• Our Response to the American Academy of Pediatrics Guidelines on Care for Kids in Larger Bodies

Free Download: Our Kids Deserve Weight-Inclusive Care

This page was updated following clinical review by Katie Bendel, LMSW, community outreach liaison for Eating Recovery Center and Pathlight Mood & Anxiety Center on June 22, 2023.