Addressing weight bias in public health

• Author / Creator

  Ramos Salas, Ruth Marjorie Ximena

• Obesity is a highly stigmatized condition due to pervasive personal, professional, institutional and cultural weight bias. Public health policies have been criticized for promoting a simplistic narrative that may contribute to weight bias. Individuals with obesity experience internal and external stigma, which can affect their life chances and significantly impact their health and social outcomes. Despite decades of research indicating that obesity stigma significantly affects individual and population health outcomes, very few interventions have been implemented and evaluated to reduce it. ObjectiveThe objective of this study is to explore how obesity narratives are constructed and enacted among public health policy makers and individuals living with obesity. By developing a deeper understanding of the lived experiences of public health policy makers and people with obesity, we aimed to understand how obesity narratives relate to each other, what tensions might exist between them, and how we can begin to dislodge potential tensions between them.MethodsThe study was implemented in four interrelated components: Part 1 included a narrative inquiry with people living with obesity. Part 2 involved a critical analysis of obesity prevention public health policies and strategies. Part 3 engaged public health policy makers in individual interviews to understand dominant obesity discourses in public health practice and policy. Part 4 used a modified brokered dialogue method to move towards consensus on key messages and strategies that can be used to address weight bias in education, health care and policy sectors. ResultsThe narrative inquiry findings demonstrated that individuals with obesity experience damaged identifies due to internal and external weight bias. We present ten counterstories developed in collaboration with persons living with obesity as a way to address some of these damaged personal and social identities. The critical review of obesity prevention policies and strategies revealed five prevailing narratives about obesity: 1) childhood obesity threatens the health of future generations and must be prevented; 2) obesity can be prevented mainly through healthy eating and physical activity; 3) obesity is an individual behaviour problem; 4) achieving a healthy body weight should be a population health target; and 5) obesity is risk factor for other chronic diseases not a disease in itself. The individual interviews with public health policy makers revealed that although the prevailing obesity discourse in public health is that obesity is a complex problem, policy makers face personal, institutional, and political barriers operationalizing this understanding. Findings also demonstrated the emergence of a paradigm shift in Canada towards health and wellness as opposed to weight-centric population health approaches. Through the modified brokered dialogue, participants agreed on the following key messages to reduce weight bias in education, health and policy sectors: 1) weight bias and obesity discrimination should not be tolerated in education, health care, and public policy sectors; 2) obesity should be recognized and treated as chronic disease in health care and policy sectors; and 3) in the education sector, weight and health need to be decoupled. There was also consensus on the following strategies to reduce weight bias: 1) creating resources to support policy makers; 2) using personal narratives from people living with obesity to engage audiences and communicate anti-discrimination messages, and 3) developing a better clinical definition for obesity.Conclusions and RecommendationsPublic health obesity narratives about obesity being preventable mainly through healthy eating and physical activity contributes to weight bias by oversimplifying the causes of obesity. Operationalizing the complexity of obesity in public health obesity policies using person-centered and non-weight centric chronic disease frameworks, may help mitigate tensions between public health obesity prevention discourses, clinical practice and the experiences of persons living with obesity. Future research should: a) explore how we can support emerging health focused paradigm shifts in obesity prevention and clinical practice; b) implement and evaluate weight bias reduction messages and strategies; and c) engage individuals living with obesity to change stigmatizing narratives, practices, and policies.

• Subjects / Keywords

  • obesity stigma
  • weight bias
  • public health

• Graduation date

  Spring 2018

• Type of Item

  Thesis

• Degree

  Doctor of Philosophy

• DOI

  https://doi.org/10.7939/R3TB0Z95S

• License

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