Best Practice & Research Clinical Endocrinology & Metabolism 27 (2013) 117–127

Contents lists available at SciVerse ScienceDirect

Best Practice & Research Clinical

Endocrinology & Metabolism
journal homepage: www.elsevier.com/locate/beem

Weight discrimination and bullying

Rebecca M. Puhl, PhD, Director of Research, Senior
Research Scientist *, Kelly M. King, MPH, Research Associate
Rudd Center for Food Policy and Obesity, Yale University, 309 Edwards Street, New Haven, CT 06511, USA

Keywords:
Despite significant attention to the medical impacts of obesity,
obesity often ignored are the negative outcomes that obese children and
bias adults experience as a result of stigma, bias, and discrimination.
stigma Obese individuals are frequently stigmatized because of their
social consequences weight in many domains of daily life. Research spanning several
victimization decades has documented consistent weight bias and stigmatiza-
youth tion in employment, health care, schools, the media, and inter-
personal relationships. For overweight and obese youth, weight
stigmatization translates into pervasive victimization, teasing, and
bullying. Multiple adverse outcomes are associated with exposure
to weight stigmatization, including depression, anxiety, low self-
esteem, body dissatisfaction, suicidal ideation, poor academic
performance, lower physical activity, maladaptive eating behav-
iors, and avoidance of health care. This review summarizes the
nature and extent of weight stigmatization against overweight and
obese individuals, as well as the resulting consequences that these
experiences create for social, psychological, and physical health for
children and adults who are targeted.
Ó 2013 Elsevier Ltd. All rights reserved.

Introduction

The health impacts of obesity have received significant attention by researchers, health profes-
sionals, and policy makers, leading to an increased recognition of the importance of focused prevention
and treatment of obesity and its related comorbidities. However, often absent in the national discourse
of obesity are the negative outcomes that obese children and adults experience as a result of bias,
stigma, and discrimination. Overweight and obese persons are highly stigmatized in our society, and
weight-based stereotypes remain widespread including perceptions that obese persons are lazy,
unmotivated, incompetent, noncompliant, sloppy, lacking in self-discipline, and lacking in willpower.1,2

* Corresponding author. Tel.: þ1 203 432 7354; Fax: þ1 203 432 9674.
E-mail address: rebecca.puhl@yale.edu (R.M. Puhl).

1521-690X/$ – see front matter Ó 2013 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.beem.2012.12.002
118 R.M. Puhl, K.M. King / Best Practice & Research Clinical Endocrinology & Metabolism 27 (2013) 117–127

The social acceptability of these stereotypes often lead to overt forms of prejudice and discrimination,
including inequities in employment settings, disparities in health care, and disadvantages in education,
see Ref.2 In the United States, the prevalence of weight discrimination has increased by 66% in the last
decade,3 and is now comparable to and in some cases exceeds racial discrimination.4 Given the
prevalence of overweight and obesity in the American population, the number of children and adults
potentially faced with stigmatization is immense. The consequences of being denied jobs, disadvan-
taged in education, marginalized by health care professionals, or victimized by peers because of one’s
weight can have a profound impact on quality of life, and may even lead to behaviors that reinforce
obesity. This review summarizes the nature and extent of weight stigmatization against overweight
and obese individuals, as well as the resulting consequences that these experiences create for social,
psychological, and physical health for children and adults who are targeted.

Documentation of weight stigmatization

Although negative stigmatization toward overweight and obese persons has been documented in
published research for over fifty years, this topic has only begun to receive focused attention in the
obesity field in the last decade.1 Findings from population-based studies, experimental research,
longitudinal and cross-sectional work all point to consistent stigma and discrimination against obese
persons in multiple domains of living. The continued social acceptability of weight stigmatization
leaves overweight and obese persons vulnerable to stigmatization in the workplace, health care
settings, educational institutions, the media, and even in interpersonal relationships with their family
members and friends.2 Of additional concern is the frequency and impact of bullying and victimization
toward obese youth, who are especially vulnerable to the negative consequences of weight-based
stigmatization.5 The evidence in each of these areas is summarized below.

Employment

Overweight and obese employees face frequent discrimination in the workplace. Considerable
experimental research shows that compared to thinner employees with identical qualifications, over-
weight and obese employees face discriminatory hiring practices, are denied promotions, face wrongful
termination, and are stigmatized by colleagues and supervisors because of their weight.6 Recent
research by Giel and colleagues (2012) found that individuals in charge of hiring underestimated the
occupational prestige of obese individuals and were more likely to disqualify them from being hired.7 In
some cases, hiring managers report more willingness to hire a less qualified thinner candidate, than
a more qualified overweight candidate.8 Disparate treatment likely stems from negative weight-based
stereotypes such as beliefs that obese employees are less conscientious, agreeable, emotionally stable,
and extraverted than normal-weight colleagues despite a lack of validity to these claims.9
Obese employees also receive lower wages than thinner individuals for the same work performed,10
with some research showing that obese women earn 6% less than healthy weight women, and obese
men earn 3% less than thinner men.11 This obesity wage penalty has been documented across all race and
gender groups, with the exception of African American men and women.12 It has been estimated that for
women, every one unit increase in Body Mass Index (BMI) is associated with a 1.83% drop in hourly wages.13
Reports of employment discrimination among obese persons parallel the above findings. In
a nationally representative sample of 2838 Americans, compared to non-overweight individuals,
overweight persons were 12 times more likely to report employment discrimination; obese persons
were 37 times more likely to report employment discrimination, and severely obese persons were 100
times more likely to report employment discrimination.14 Similar findings have been reported in other
national samples15 and among obese women who report high levels of weight stigmatization from
supervisors and co-workers.16

Health care

Weight bias also extends to the health care setting, where overweight and obese patients are
vulnerable to stigmatization from health providers. Studies have consistently documented that
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medical professionals (e.g., physicians, nurses, medical students, and other health professionals) hold
negative stereotypes about overweight patients, see Ref.17 including perceptions that obese patients
are lazy, noncompliant, undisciplined, and have low willpower.2 One study of over 620 primary care
physicians found that over half of doctors ascribed traits like, awkward, unattractive, ugly and non-
compliant to obese patients, while one-third categorized them as weak-willed, sloppy and lazy.18
Further, physicians exposed to patients with higher body mass index (BMI) reported having less
respect for their patients, having less ability or desire to help their patients, and reported treating
obesity was “more annoying” and a greater waste of their time.19,20 Such negative beliefs persist, even
for health professionals who specialize in the treatment of obesity.21
Despite evidence that physicians hold perceptions that obese patients are noncompliant with
medical advice, or lack the willpower to make lifestyle changes,22 recent research has challenged these
assumptions and shows that patients’ reported levels of motivation for weight loss are significantly
higher than physicians’ opinions.23 Ultimately, the mismatch between doctors’ perceptions and
patients’ lived experiences may compromise the patient–provider relationship and hamper commu-
nication around healthy behavior change.24 Obese patients additionally report feeling disrespected,
dismissed, and upset about comments made by heath providers because of their weight.25 In a self-
report study of 2449 overweight and obese women, 69% specifically reported being stigmatized
about their weight from a doctor, and 52% reported this occurring multiple times.
Thus, poor communication and perceived stigma in medical settings may impede access to
preventative care for obese patients.26 Weight stigma may also partially explain why many physicians
fail to counsel obese patients about their weight.27 Overweight and obese patients who do receive
medical counseling, however, have more realistic perceptions of their weight, increased desire to lose
weight and more recent attempts at weight loss, providing even further evidence as to why stigma
reduction in the health care sector is crucial to the health of overweight and obese persons.28

Education

Overweight and obese students experience weight stigmatization from peers and educators in
educational settings.2 Negative weight-based stereotypes toward obese students have been increasingly
reported by educators.29 Research demonstrates that teachers hold biased perceptions about overweight
youths’ abilities, viewing them to have poorer social, reasoning, physical, and cooperation skills than non-
overweight students, as well lower expectations for overweight students across a range of performance
areas.30 Such biases may limit the educational opportunities available for overweight students. A recent
study by Burmeister et al., 2012 found that students with higher BMIs were significantly less likely than
average weight peers to receive offers of admission to psychology graduate programs after completing the
interview process, despite receiving more positive letters of recommendation overall.31 Obese students
also report awareness of weight bias from educators,32 with previous work documenting that over a third
of overweight and obese women (N ¼ 2449) reported experiencing weight stigmatization from a teacher
or educator, with over 20% indicating that such experiences occurred on multiple occasions.16 Recent work
has further demonstrated that experiences of weight-based teasing mediate the relationship between
poor school performance and body mass index among school children.33 More work is needed in this area
to determine the nature and extent to which weight stigma contributes to disparate educational outcomes
among overweight students and their thinner peers.

Media

The social acceptability of weight stigma is readily apparent through the negative depiction of
overweight and obese persons in television and film, see Ref.34 Within both child and adult enter-
tainment, overweight individuals are more likely to be cast as minor characters, the targets of ridicule
and humor, depicted engaging in stereotypical behaviors (e.g., eating or bingeing on unhealthy foods),
and are less likely to be portrayed as having romantic partners or interactions with friends,35 while thin
characters take on central roles and are assigned positive characteristics. Content analyses of male and
female television characters have found that heavier women receive significantly more negative
comments from male characters, while heavier male characters are more likely to make negative
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references about their own weight, with both types of commentary often reinforced with audience
laughter. Similar findings exist in children’s media. A study of 1221 cartoons with over 4000 cartoon
characters revealed that overweight characters were more likely to be portrayed as having socially
undesirable traits compared to average weight or underweight characters who were portrayed posi-
tively.36 Specifically, overweight characters are often portrayed as more aggressive, anti-social, evil,
unattractive, unfriendly, disliked by others, and eating food compared to thinner characters who are
depicted as being sociable, kind, successful, popular, attractive, and happy.37
Obese individuals are also negatively stereotyped in news media, and have been implicated in
national stories as being responsible for increasing fuel prices,38 global warming39 and social contagion
of obesity.2,40 Research has documented that the news media often frames obesity as an issue of personal
responsibility, prioritizing overeating and lack of exercise as key explanations, over genetic, environ-
mental or socioeconomic factors that may contribute to overweight. An analysis of 751 obesity related
articles published in the New York Times between 1990 and 2001 revealed that the majority of news
stories blame individuals for obesity and resulting moral panic. Similar to entertainment media, over-
weight people in news media were characterized by negative traits such as “stupid,” “ugly,” “naïve,”
“irresponsible,” “lazy”, “greedy,” “without manners,” and “repugnant.”41 Moreover, a recent content
analysis of online news imagery revealed that 72% of images portrayed overweight and obese individuals
in a stigmatizing manner.42 Individuals who view negative photographs in news media display more
negative attitudes toward obese people,43 suggesting that using more positive media portrayals of obese
persons that challenge common stereotypes may help reduce negative societal stigma.

Interpersonal relationships

Weight bias is also present in close interpersonal relationships with friends, family and romantic
partners. Research suggests obese and overweight women have a more difficult time finding partners
and report less satisfying relationships when those relationships are established. Studies assessing
personal ads have found that women who describe themselves as obese receive more negative eval-
uations by both men and women, and received fewer responses from men compared to ads in which
women disclose having a history of drug abuse.44 Moreover, when college students (N ¼ 449) were
asked to rank photographs of six potential sexual partners including one obese partner, one healthy
partner and partners with various disabilities (e.g., missing a limb, diagnosed with a mental illness,
history of sexually transmitted infections), consistently the obese partner was rated as least desir-
able.45 Overall, obese women are perceived as being less sexually attractive, skilled, or responsive
compared to average weight peers.2,46 Among dating and married couples, heavier women had lower
quality relationships that they predicted were significantly more likely to end.
Family members are also frequent sources of interpersonal weight bias. Of particular concern, youth
may even experience weight-related victimization from their parents and siblings.47 In a study of 4746
adolescents, 29% of girls and 16% of boys reported weight-related teasing from a family member.48 Such
reports of weight stigmatization by family members continue through adulthood. A study of 2449 over-
weight and obese women found that 72% of participants rated family members as the most frequent source
of weight stigma, often in the form of weight-based teasing, name calling and inappropriate comments. The
majority of participants also named friends (60%) and spouses (47%) as perpetrators of weight bias.16
Perceptions of bias may place strain on close interpersonal relationships, especially for overweight
women. Research has found that obese women are more dissatisfied with family and partner rela-
tionships,49 and have fewer close friends,50 compared to thin women.2 Further, negative weight-
related commentary from family members and significant others has been associated with disor-
dered eating behaviors among male and female young adults.51 Although it is clear that obese persons
face stigma within their social, romantic and familial relationships, further work is necessary to
determine how weight bias differs by gender, ethnicity and BMI.

Youth

For youth who are overweight or obese, weight stigmatization translates into pervasive victimi-
zation, teasing, and bullying. These experiences may be explicit (e.g., verbal teasing, name calling,
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physical violence), or may take more subtle forms such as relational victimization (e.g., social exclusion,
avoidance, being the subject of rumors). Self-report, prospective, and experimental studies have
examined these experiences in overweight and obese youth (See review by Puhl & Latner, 2007), and
show that weight bias and negative stereotypes are established early in childhood.5 Among children as
young as age three, overweight peers are described as mean, ugly, stupid, lazy, and undesirable
playmates,52 and by age four children can identify excess weight as the reason for their negative
attitudes toward heavy peers.52 As children enter elementary school, stereotypes worsen, with
students reporting that overweight peers are ugly, selfish, lazy, and stupid, and that they lie, get teased,
and have few friends.53 Overweight and obese youth in elementary school face less peer acceptance,
have fewer friends, and experience higher rates of bullying than thinner peers, even after accounting
for gender, race, social skills, and grade level.33,54,55 In grades 3–6, the likelihood of being bullied is 63%
higher for an obese child compared to a healthy weight peer.54 By middle school, bullying is more
severe, frequent, and upsetting for overweight youth compared to non-overweight peers,56 and elicits
more negative emotional reactions compared to being teased for other reasons.57 This appears espe-
cially apparent among girls and the heaviest youth.58 A study of 4746 middle and high school students
found that 30% of girls and 24% of boys reported weight-based teasing from peers. For students at or
above the 95th BMI percentile, rates of victimization increased to 63% of girls and 58% of boys.59
Similarly, a prospective study of 8210 youth documented that 36% of obese boys and 34% of obese
girls reported being victims of weight-based teasing and various forms of bullying.60 Throughout
adolescence, weight-based bullying remains widespread. In recent research examining victimization in
adolescents aged 13–19 years (N ¼ 1555), students reported weight to be the most common reason that
their peers were teased and bullied at school, which was more frequent than other reasons for bullying
such as sexual orientation and race.61 This research additionally found that 92% of adolescents reported
witnessing their overweight and obese peers being teased at school, 85% observed this occurring
specifically during physical activities (e.g., gym glass), 67% observed them being excluded from social
activities, 57% witnessed them being verbally threatened, and 54% saw them being physically har-
assed.61 Furthermore, the National Education Association (2011) surveyed 5056 teachers across the
country regarding their perceptions of different forms of student bullying, and similarly found that
weight-based bullying was viewed to be the most problematic form of bullying in the school setting.62
Taken together, the research documenting weight-based teasing and bullying toward overweight and
obese youth is considerable, and indicates a clear need for intervention to identify youth most at risk
and to implement measures to help protect them from pervasive teasing and torment.

Consequences of weight stigmatization for adults

Given the pervasiveness of societal weight bias, it is important to consider the consequences of
being exposed to such stigmatization. Multiple adverse outcomes are associated with weight bias for
overweight and obese individuals, affecting their psychological functioning and physical health.

Psychological consequences

Exposure to weight stigmatization contributes to a range of negative psychological outcomes,

including poor body image, low self-esteem, social isolation and risk of depression and anxiety in both
clinical and non-clinical samples of obese adults, see Ref.2 For example, frequency of weight stigma-
tization is positively associated with depression among treatment-seeking obese adults, even after
controlling for effects of age, gender, BMI, and obesity onset.63 Previous experiences of appearance-
based teasing are also associated with depression in adult women with Binge Eating Disorder
(BED),64 and weight stigmatization has been found to contribute to depressed mood among obese
adults seeking weight loss surgery, over and above variables such as BMI, gender, obesity onset,
physical disability, and binge eating status.65 Similar findings have been demonstrated with respect to
self-esteem and body dissatisfaction.63,66 Among non-clinical samples of adults, Carr and colleagues
conducted a nationally representative study of 3354 American adults and found that reports of being
mistreated due to weight were significantly associated with impaired mood.67 Another nationally
representative study of over 9000 obese adults found that perceived weight discrimination was
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significantly associated with current diagnoses of mood disorders and substance abuse, as well as
utilization of mental health services, after controlling for sociodemographic characteristics and
perceived stress.68 Of importance, many of these studies suggest that weight stigmatization and
mistreatment, rather than excess weight alone, increase risk for emotional distress.

Consequences for eating behaviors and physical activity

Weight bias may also reinforce unhealthy behaviors that contribute to obesity. Adults who report
weight stigmatization engage in more frequent binge eating behaviors, are more likely to be diagnosed
with BED, and are more likely to engage in maladaptive eating patterns and eating disorder symp-
toms.69 Psychological distress emerging from stigmatization may contribute to binge eating patterns,
as those who internalize negative weight-based stigma are more vulnerable to binge eating.70 Stigma-
induced psychological stress may also lead to maladaptive coping strategies that reinforce unhealthy
eating behaviors. For example, in a study of 2449 overweight and obese women, 79% reported coping
with weight stigma on multiple occasions by eating more food, and 75% reported coping by refusing to
diet.16 Recent experimental research also demonstrated that overweight women who were exposed to
weight stigmatizing stimuli consumed more than three times as many calories post-manipulation as
overweight women who were exposed to neutral stimuli.71 In addition to maladaptive eating behav-
iors, research shows that adults who report experiences of weight stigmatization are more likely to
avoid exercise, and have less motivation for exercise, even after controlling for BMI and body dissat-
isfaction.72 It may be that overweight individuals feel heightened vulnerability to negative attitudes
and criticism in public settings where exercise occurs, and therefore make attempts to avoid potentially
embarrassing or stigmatizing situations.
These findings are important to highlight in face of commonly held perceptions that weight stig-
matization may be helpful in providing incentive and motivation to obese individuals to lose weight or
engage in healthier eating and exercise behaviors, see Refs.2,73 The existing research to date instead
suggests that weight stigmatization is an unlikely motivator for weight loss, and may instead lead to
unhealthy behaviors that reinforce obesity and impair weight loss efforts. Based on the present
evidence, weight stigmatization seems to pose considerable harm for emotional wellbeing and health
behaviors, and should not be considered an appropriate or effective tool to promote public health.73

Additional health consequences

Weight bias may have additional links to physiological health outcomes. Although very little
research has examined physiological effects of weight bias, some work found that adolescents who
reported unfair treatment because of their physical appearance (including body weight) had elevated
ambulatory blood pressure compared to those who did not report unfair treatment, even after
accounting for typical determinants of blood pressure, including BMI.74 A recent study additionally
demonstrated that experiences of weight-related stigma exacerbated the effects of waist-to-hip ratio
on non-diabetic glycemic control,75 a risk factor for cardiovascular disease. Experiences with
discrimination may also contribute to obesity itself, as some work has documented correlations
between perceived interpersonal discrimination and abdominal adiposity.76 This area of research
remains in its infancy but warrants additional research, given the potential for stigma to worsen health
outcomes among individuals whose weight may already pose increased health risks.
Experiencing weight bias may also have negative implications for health care utilization, and may
play a contributing role in avoidance and delay of health care among obese individuals. For example,
Amy and colleagues (2006) surveyed 498 overweight and obese women (with health insurance and
high access to health care) about their perceived barriers to routine gynecological cancer screenings,
and found that among the heaviest women, 68% reported delaying health care services because of their
weight.77 Women attributed their decisions to delay medical care to disrespectful treatment and
negative attitudes from providers because of their weight, embarrassment about being weighed by
medical staff, and that gowns, exam tables, and other medical equipment were too small to be func-
tional for their body size. The percentage of women who reported these bias-related barriers increased
with BMI.77 More recent research with nationally representative samples of adults (N ¼ 1064) and
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parents (N ¼ 455) show that 19% of adults and 24% of parents would avoid future medical appoint-
ments if they felt a doctor had stigmatized them (or their child) because of their weight.78,79

Consequences of weight-based victimization in youth

In light of the vulnerability of overweight and obese youth to pervasive weight-based teasing and
bullying, it is important to examine the impact that these experiences have specifically for children and
adolescents who are targeted. Thus far, the research to date indicates that weight-based victimization
can hinder emotional, social, academic, and physical wellbeing. Similar to research with adults,
evidence suggests that some of the consequences that youth experience from weight-based victimi-
zation may reinforce their excess weight and interfere with health behaviors.

Emotional consequences

Weight-based teasing may contribute to negative emotional consequences for overweight

and obese children and adolescents.48 Among both clinical and non-clinical samples of obese youth,
weight bias increases risk of depression, anxiety, low self-esteem, and body dissatisfaction.
Importantly, these findings remain even after controlling for BMI and other variables like age,
gender, and age of obesity onset,48,56,63 indicating that stigma, rather than body weight per se,
leads to these negative emotional outcomes. For example, weight-based teasing, rather than actual
body weight, has been found to be significantly related to poor body image among boys
and girls.48,80 Moreover, a study of 4746 adolescents found that weight-based victimization was
related to increased risk of depression, when in many cases weight status itself was not directly
related.48,81
Perhaps the most severe emotional consequence of stigma among youth is their increased risk
of suicidal behaviors. Obese adolescents exhibit more suicidal thoughts and attempts, with one
study finding that obese girls were almost two times more likely to report a suicide attempt in the
last year than average weight peers.82,83 Weight-based teasing is key in understanding this rela-
tionship; adolescents teased about their weight are 2–3 times more likely to report suicidal
ideation. Moreover, one study found that over half of girls who experience weight-based victimi-
zation by peers and family consider committing suicide. Among boys, 13% who were teased by
family members about their weight reported attempting suicide compared to 4% who were not
teased.48

Social and academic consequences

Weight-based teasing may also compromise adolescents’ abilities to form supportive social
relationships with peers. Foundational research documented that overweight and obese elemen-
tary school students are liked less and experience higher levels of rejection than average weight
students.84 More recent research using the National Longitudinal Study of Adolescent health
(N ¼ 90,118) found that among adolescents aged 13–18, overweight adolescents were significantly
more likely to experience social isolation and were less likely to be nominated as friends than lean
students.85 Other work with adolescents (N ¼ 9943) found that obese girls and boys spent less time
with friends and reported weaker social bonds than thinner peers, after controlling for variables
such as grade level, race, and socio-economic status (SES).83 Consistently, overweight youth are
cognizant that their weight status may impact their social relationships, with one study finding that
69% of overweight 9–11 year olds believed they would have more friends if they could lose
weight.86
Positive social bonds are especially important for children and adolescents, and may impact
academic performance. A study by Krukowski et al., 2009 (N ¼ 1071) found that when weight-based
teasing was controlled for, overweight children no longer exhibited poorer school performance
compared to their average weight peers.33 Weight-based teasing may also serve to disengage students
from their school environments. A recent study found that adolescents reported that their grades were
harmed and that they avoided going to school in response to experiences of weight-based teasing and
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bullying; the likelihood of students reporting these reactions increased by 5% per teasing incident, even
after accounting for gender, race, age, grades, and weight status.87

Physical health consequences

Physical health may also be impacted by weight stigma in direct and indirect ways. Overweight
adolescents who experience frequent weight-based teasing are more likely to engage in disordered
eating behaviors, such as binge eating, chronic dieting, vomiting and the unhealthy use of diet pills or
laxatives, even when controlling for BMI.88 Similarly, prospective research has demonstrated that
weight-based teasing predicted binge eating at 5 years of follow-up among both males and females,
even after controlling for other factors.89 These findings suggest that weight-based teasing, rather than
body weight alone, contributes to disordered eating. Weight-based victimization has also been asso-
ciated with reduced physical activity and increased cardiovascular risk.58,90,91 For example, overweight
youth who are victimized by their peers are less likely to participate in physical activity and physical
education classes.92 Given recent research suggesting that overweight and obese youth are frequently
teased in physical activities such as gym class,93 it is likely that youth avoid physical activity in order to
escape victimization. Overweight and obese adolescent girls may also be at increased risk for frequent
substance use, which has been documented as a coping strategy for stress associated with weight
stigma.94 Ultimately, distress resulting from weight-based victimization may increase youth and
adolescents’ risk for poor health outcomes such as hypertension and glucose intolerance.90,95 The
recognition that bullying contributes to health consequences for obese children is a concern that
parents are becoming increasingly aware of. Findings from a 2008 nationally representative household
survey of 2064 individuals regarding parental health concerns found that parents with an overweight
or obese child rated bullying as their top health concern for their child (from a list of 20 different health
concerns).96

Conclusions

The stigmatization, bullying, and discrimination of obese children and adults are pervasive and lead
to damaging consequences for individuals who are targeted. Given that weight stigmatization has been
consistently documented in major life domains such as employment, health care, and schools, millions
of individuals are vulnerable. Research to date shows that weight stigmatization can increase
vulnerability to a range of adverse outcomes for children and adults, including impaired psychological
wellbeing, social isolation, academic consequences, economic inequalities, and unhealthy eating and
exercise behaviors that can ultimately reinforce weight gain and impair weight loss efforts. Certainly
more work is needed to better understand the impact of weight stigmatization on physiological health
indices, but it is clear from existing research that quality of life is reduced for targets of weight stigma
and discrimination. Thus, although the medical comorbidities of obesity require continued and
immediate attention to improve the lives of obese persons, the adverse psychological, social, and
health consequences resulting from weight stigmatization must also be prioritized in efforts to prevent
and treat obesity.

Research agenda

 Increase longitudinal prospective studies to examine impact of weight bias over time
 Examine the extent to which weight stigma contributes to disparate educational outcomes
 Determine how weight bias within interpersonal relationships differs by gender, ethnicity
and BMI
 Identify the nature/extent and impact of weight bias in public health campaigns
 Examine longitudinally whether/how weight stigma contributes to physiological health
indices
 R.M. Puhl, K.M. King / Best Practice & Research Clinical Endocrinology & Metabolism 27 (2013) 117–127 125

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