Researcher Sarah Nutter is fighting weight stigma

What are you working on right now?

A lot of the work I've been doing recently is advocating for researchers and healthcare professionals to think differently about body weight. Specifically, to consider the relationship between weight and health as a nuanced conversation rather than weight as an indicator of health or risk of mortality. When we look at research that has been done well, it’s clear that the relationship between weight and health is far more complex than we have been taught to believe. I am particularly interested in the ways that society’s beliefs and inaccurate assumptions about health and weight contribute to healthcare inequity for people of higher weight.

How does weight bias show up in the healthcare industry?

Researchers who have looked at weight bias and stigma among healthcare professionals have found that it manifests in many ways that contribute to an overall negative and potentially shaming experience for patients. For example, healthcare providers might hold negative stereotypes or attitudes towards higher-weight patients, believing that they are lazy or lacking in willpower. That can translate into assumptions that they make about a person's eating habits and lifestyle. It also can translate into the use of negative language or verbal communication such as tone of voice, which leaves patients feeling patronized, talked down to and insulted.

Research shows that healthcare providers spend less time with higher-weight patients, offer them fewer treatment options and ask fewer questions to better understand a patient's presenting concern. All of this translates into a poorer healthcare experience. And when people feel shamed by their healthcare provider, they are more likely to delay or avoid healthcare in the future and they are less likely to shop around for healthcare providers.

Is weight really tied to health? Are there any common misconceptions?

My answer is no, weight is not tied to health. I think there are a lot of misconceptions partly because of the discussion of our culture in and around health care and public health. The messages we get from healthcare authorities can reinforce incorrect ideas about health and weight. So, it's common in our culture to believe that we can look at a person's body weight and determine whether they are healthy or unhealthy.

We also associate higher body weights with an increased risk of death. There's a lot of messaging in our culture that we can see around the war on obesity. These include ‘obesity being an epidemic’ or ‘obesity needing to be eradicated. All of this language is alarming and easily strikes fear in the people who read it. We get this idea that to be fat is to be unhealthy and this leads to a shorter lifespan. It makes us fear the outcome of being fat.

In reality, research that has looked at the connection between weight and health has found that it's a significantly imperfect connection. For example, researchers that have looked at BMI (Body Mass Index) have found that BMI, overwhelmingly, is not a good indicator of health. People who would be classified as having a ‘healthy BMI’ could still be deemed metabolically unhealthy. With folks who would fall within the categories of “overweight” or “obese”, a significant number of them would be metabolically categorized as healthy. Researchers have found that the number of chronic health conditions a person has is a better predictor of mortality than their body weight. People across the weight experience high, medium, and low levels of risk. Therefore, the level of risk is not correlated with body weight.

Why do you think society sees weight as an issue?

Many feminist scholars have talked about the way gender roles, beauty standards and the policing of women's bodies have changed over time. I think there are a number of forces at play that influence why society thinks about weight.

From the time of Victorian corsets that kept women close to home to the introduction of very thin models into the fashion industry and clothing sizes becoming smaller and smaller, there have always been these influences at play. As a result, the diet industry became more popular and more powerful as a different way for society and the patriarchy to control women's bodies. In the 70’s, a researcher coined the term ‘Health-ism’, and since then, we have seen an increasing focus on individual responsibility for health. This idea of weight as an indicator of health is viewed as personal, controllable and an individual's own moral responsibility.

Now, we live in a society where all of these forces have come together. We are told that to be healthy means to be beautiful and attractive. To fit these beauty and attractiveness ideals means to be healthy and, by extension, means to be thin. These social ideas come together to create a message that people who have higher body weights are not doing their moral and civil responsibility to be thin and healthy. As a result, the immediate emotional response is negative, like disgust, followed by shame, blame and weight stigma. All of that is wrapped up in cultural ideals of what beauty and health look like.

What are some of the root causes of body shaming in society and how can we counter them?

I think the root causes of body shame are our ideas about health, weight, and attractiveness. If we believe that weight is controllable, it makes sense that people jump to shame and blame. I think if this idea that weight is controllable is so prevalent, it leads people to think that shaming and blaming is okay. ‘Oh, I'm just helping that person’, ‘I'm going to motivate that person to lose weight’. None of that is true. First of all, weight isn't controllable. And second of all, shame is not a good motivator for behaviour change. 

I want to change social discourses to be more accurate around weight and health and to be more respectful and accepting of all bodies regardless of whether or not somebody is healthy or unhealthy. Shaming someone for what their body looks like, or what their body can or can't do, isn't appropriate. The goal should be to be able to provide room for all people, no matter what they look like, to be able to be respected and accepted in society. I'm not sure exactly how we do that.

How does language use factor into weight stigma? 

Language is really important when talking about body weight. The use of the term ‘obesity’ has been really prevalent over the years and a lot of people think about the word obesity as being a pejorative word for the way that they look. This is because obesity is applied to all people that have higher body weights and is paired with the implication that they are unhealthy simply due to their body weight.

There has been a change in some research and professional circles to try to change the way the word obesity is used so that it's not just applied to everybody who has a higher body weight. But in a lot of ways, the damage is already done. When we hear the word obesity, we immediately think about specific body weights, not the potential intersection of body weight and health status. This has led me as a researcher to move away from using the word obesity and to start using words that might be perceived as more neutral, like ‘higher body weight’ or ‘larger body’. 

In the same way, there's been a shift in obesity research and practices to use ‘person-first’ language in the way that we do with other health conditions. So, for example, using the term ‘person with obesity’. But that's wrapped up in this redefinition of obesity as only applying to somebody when their body fat is negatively impairing their health. That updated definition is gaining popularity in certain circles and in certain health professions.

How does weight bias relate to social justice?

When considering equity regarding power, opportunity and resources in a society, weight stigma is a social justice issue. People with higher body weights experience weight stigma across their lifespans and across social contexts. For example, across all levels of education, in health care and in the workplace, weight stigma can be a barrier. In the workplace, it can be a barrier to gaining employment as well as gaining promotions. It can be associated with a wage gap between higher and lower-weight people.

We also see weight stigma is significantly impacting all kinds of interpersonal relationships. These include peer relationships, like bullying and social exclusion. This also includes family relationships. For example, parents can place their children on diets or have negative weight-based conversations with their children. It can also impact romantic relationships in situations where a partner in a relationship has a higher weight. Their significant other might say that their partner is less attractive than their ideal partner. As a result, weight-based beliefs might contribute to poor relationship satisfaction. All of this contributes to significant inequity in the lives of people with higher body weights to varying degrees.

So absolutely, I think it's a social justice issue that ought to be taken seriously and ought to be incorporated into equity and inclusion policies and anti-discrimination legislation. If you think about the incidence of higher body weights in Canada, there's a massive proportion of the Canadian population that isn't being protected by a form of discrimination that is, in a way, largely socially acceptable. I think protections should exist the way they do for other forms of discrimination, which aren't perfect. Somebody should be legally protected from being discriminated against because of personal identity. Of course, passing discrimination legislation doesn't mean that discrimination has gone away, but it’s a way to hold people accountable.

What motivates you to continue your research in this area?

I think the way researchers have explained where weight stigma has come from in the past is based on a variety of different perspectives that don't necessarily account for one another. I want to integrate these perspectives to try to get a more complete and nuanced understanding. In Canada, there's very little research that has examined weight stigma among healthcare providers. I want to change that.

I'm also interested in better understanding the ways weight stigma is experienced differently for people from an intersectional and social justice perspective. I want to conduct research on people with higher body weights who hold other oppressed identities. That would include talking to people of varying gender, sexuality, racial identity, age and socioeconomic status, and trying to better understand their experiences with weight bias based on other identities that a person holds and other ways that they might experience oppression in their lives.