Last weekend I holed up with top scholars who study weight stigma — in lovely B and B in central Vancouver where O’Canada was penned, amid glorious spring weather. The happy group consisted of two sociologists (Ellen Granberg, Deborah Carr), four psychologists (Janet Tomiyama, Brenda Major, Gina Sutin, and Eric Robinson) and me (the lone anthropologist). We use a wide array of different types of research — from ethnography, to experiments, to analyzing huge longitudinal datasets. But we have all converged independently in our research on a single idea: that weight-stigma is different than other stigmas, because it is the one stigma that seems to directly recreate itself. That is, feeling judged for being “fat” makes people more likely to gain weight and less likely to lose it. All the science tends to point in this direction, but we agree the evidence on this point is as scientifically solid yet as it needs to be. But the collective intuition of so many people who have worked on this problem with very open minds – that we are heading toward identifying something important and real – was reassuring to us all.
This weekend in Canada, alongside some recent work we have done in a different country (Guatemala), has set me thinking about the basic parameters of how we have defined the problem of weight-stigma generally. In US and UK-based research, which was the focus of the weekend retreat, we have assumed that weight-stigma and fat-stigma are much the same thing. People who are large feel judged, and this damages them. Accordingly, smaller people are considered basically exempt because they approximate the prevailing body ideals of slimness. But, maybe this is not a standard pattern for much of the world.
In a paper written with ASU colleagues Jonathan Maupin and graduate student Joe Hackman, we are able to demonstrate that in Guatemala that weight-stigma is not just affecting people who are larger than culturally expected. Using national data from a large maternal-child health study, we have found that being teased because of weight contributed to women’s depression as much as the effects of food insecurity or domestic violence (both major known triggers). But it wasn’t just overweight women who were being teased about their bodies. It was underweight ones as well. And both groups of women found it highly, highly distressing. While this study is analyzing secondary data, Jonathan has been on the ground in Guatemala for decades (where he runs a fantastic summer field school in medical anthropology). From his expert ethnographic perspective, he believes we are observing something real.
So this preliminary evidence from Guatemala suggests are more complex picture of what weight stigma is — people struggling to meet body norms at both ends of the size spectrum. And are being damaged psychologically when they cant meet them. Weight stigma in Guatemala is apparently not just about being fat – it is about not being “normal”. The negative moral messages attached to thinness make some sense, in a place where undernutrition remains widespread and associated with severe poverty. On the ground in Guatemala, both undernutrition and over nutrition are the focus of public health efforts. The military has actually been leading the new “war on obesity,” so to speak (see Emily Yates-Doerr’s new book on obesity in Guatemala for more on this). We have also previously published a field-based study, based on data Jonathan collected, showing that kids in one rural village attach a lot of negative words to thin bodies, just as they do to fat.
This all necessarily expands our scientific conversations about weight stigma, and tweaks how it matters to global health. Weight stigma isn’t always just about fat. We need to talk about weight stigma in global health in a more sophisticated, expansive way that is open to the possible damage of stigma at both ends of the body spectrum. We need to consider that weight-stigma might affect the billion people who are underweight, not just the millions who are very high BMI, and what happens in places like Guatemala where both often co-occur in the same household. From a global health perspective, this also suggests we need to not only examine anti-obesity efforts to see if they might seed stigma, but anti-hunger ones as well. And, we need more studies of how thin-stigma and fat-stigma relate to psychological distress and to each other. This also seeds the tantalizing possibility that the stress related to the stigma of being underweight might also have negative possible physiological outcomes for growth and development. I have no idea if that is the case, but if so it certainly would change the way the field of weight stigma research is oriented right now. Which is where the fun, cutting-edge part of doing science begins.