Impact of Weight Stigma on Mental Health - with Shira Collings

Episode Transcript

Announcer: Welcome to "You First -- The Disability Rights Florida Podcast."

Keith Casebonne: Welcome to the You First Podcast. I'm Keith Casebonne. The topic of today's episode is weight stigma -- what it is, and its effect on mental health.

I happen to be no stranger to weight stigma and have felt some of its effects throughout most of my life. However, I'd never heard the term weight stigma and could never give what I experienced a proper name until after I researched and recorded this episode.

Sometimes I wasn't even sure it was there thinking maybe I was just paranoid and feeling things that weren't really there. It was, and now I can recognize it more definitively and even call it out.

I hope you can learn more about it too during this episode. We're also hosting a webinar to discuss this topic in even more detail, more about that after the interview.

I really quickly want to remind you to subscribe to the You First Podcast. Each month, we bring you a new episode. By subscribing, you won't miss any. We're on Apple Podcast, Stitcher, Google Podcast, and Amazon Podcast. Search for You First on your platform of choice and subscribe today. Plus, you can always find us at disabilityrightsflorida.org/podcast.

My guest today is Shira Collings. Shira is the vice-chair of the Disability Rights Florida PAIMI Advisory Council. PAIMI is a federal grant we receive and is an acronym for Protection and Advocacy for Individuals with Mental Illness.

Shira is a graduate student in clinical mental health counseling at Troy University, a mental health counseling intern at Gateway Therapy Center, and also provides training and consultation on disability self-advocacy, peer run mental health services, and more.

Thanks, Shira, for being our guest today. Tell us a little bit about what weight stigma is and how does it occur?

Shira Collings: Thanks so much for having me. Weight stigma is defined as bias, discrimination or stereotyping, that's based on a person's body size. It's also sometimes referred to as weight bias, sizeism, fat phobia, also fatmisia sometimes.

The ways it shows up that includes just everyday assumptions that we make about people's character, self-discipline, their eating and exercise habits, and their health status on the basis of body weight alone.

We tend to assume that those in larger bodies, they don't have healthy habits or that they're not as self-disciplined. We tend to assume that those in thinner bodies are more self-disciplined or automatically healthier. That's often false and not based on reality.

Weight stigma shows up as the idealization of thinness and pervasive promotion of weight loss in the media and in healthcare settings. In general, there's this idea that we should always be trying to lose weight, always be trying to be thinner. That's often not healthy or not necessarily what's best for us.

It also shows up as different types of discrimination, hiring discrimination against those in larger bodies, income disparities, workplace and school bullying, discrimination in adoption and custody that sometimes BMI can be used for criteria to deny someone adoption or custody.

Denial of healthcare, that there are certain surgeries sometimes, certain procedures that aren't done on people over certain weights. Instead of having legitimate medical issues addressed that have nothing to do with weight, they're told, "You need to lose weight, or you need to go on this diet," which may not address the serious concern.

Keith: I myself have been overweight, up and down, most of my life since from childhood on. I can certainly say that I've seen this once or twice. I have to admit, I never had a name for it.

I don't think I've ever heard the term weight stigma. Naming it helps giving an identity. From my own experiences, I'm sure this is very prevalent. How prevalent is this?

Shira: Extremely prevalent. I was going to say that's another way that weight stigma shows up, is that it's not given a name. When we talk about discrimination, when we talk about issues of diversity and social justice, we often don't name weight stigma.

That's partly because it's considered this is how things should be because being at a higher weight is automatically unhealthy. We do need to encourage people to lose weight. That's not necessarily true.

Even if that were true, studies and research shows that weight stigma doesn't lead to weight loss. Often, weight loss efforts ends up leading to increased weight gain. That's a very common form of weight stigma, is just not talking about it or the belief that it's a positive thing.

It's very prevalent. Just some statistics, at least 30 percent of higher-weight girls and 24 percent of higher-weight boys report being teased at school.

One in three children has experienced weight bias from a teacher. 69 percent of higher-weight women have experienced weight bias from a physician. The higher-weight women are paid 14.6 percent less than straight-sized women.

It's very prevalent. There is a chance that even though studies might be skewing low often. Research studies aren't taking into account the intersections of weight stigma with other forms of oppression, with discrimination that people of color and higher-weight bodies might experience, or trans people in higher-weight bodies. That all increases it.

Keith: There's a lot of interdimensional play there that I'm sure is not being...In fact, it's surprising when you mentioned about being bullying in school, those numbers seem low to me. In my own experience, I feel 100 percent of [laughs] kids who are overweight get bullied about it.

It's probably not 100 percent. I think you said 30 percent of females and 24 percent of males, like that's underreporting. People don't want to even admit it, maybe.

Shira: I think so. That feels very low.

Keith: What are some of the effects of weight stigma? How does it affect people's lives?

Shira: There're so many effects, mental health, physical health. Mental health, it can lead to depression, anxiety, suicidality. One study showed that as many as one in eight adults have experienced suicidal ideation due to body image issues. That's definitely a big effect.

Also, disordered eating and eating disorders. One effects of weight stigma is this idea that we're supposed to eat as little as possible. We're supposed to constantly be in pursuit of weight loss. That is a pretty disordered mindset to have around food and exercise, and can definitely adversely impact people's health.

Same with physical health, that all of this can lead to negative physical health consequences, cardiovascular issues, blood pressure, neurological issues due to the effects of stress, and due to the effects of having to constantly navigate a world that isn't accepting of your body size, or that's telling you that if you get to a certain body size, then you won't be worthy of respect.

A lot of researchers have often said that the effects of weight stigma are far more dangerous and far more harmful than any particular weight.

Keith: That is really interesting.

Shira: There's this idea with language like overweight and obesity, that these weights are automatically harmful, inherently unhealthy.

The reality is that a lot of that research, a lot of those correlations are not, maybe, accounting for the effects of weight stigma and the effects of [laughs] things like denial of healthcare, or avoiding health care, because of fears of being shamed at the doctor's office.

It's definitely, if we truly care about the health of people of all sizes, then combating weight stigma is super important for that.

Keith: Indeed. You mentioned eating disorders, and I want to get to that in a second. A couple of things you mentioned, I remember too, the idea of going to the doctor, I hated it. I knew I was going to get the obligatory, "Oh, you have to lose weight." It's not like I didn't already feel that in my own head from every other source.

The doctor says it. Honestly, it's more like you feel guilt. I had one doctor for several years that was overweight himself. He would roll his eyes when he said it and laugh and pat his own stomach.

I actually enjoyed going to that doctor. He approached it in a very different way. He said, "Hey, I'm in the same boat too, but I got to tell you. Anyway, moving on." That was the one doctor for years that I felt any comfort going to.

It's amazing how that once a year, or maybe once every six-month checkup, you can dread it, because you know those few words are going to be coming out, "You need to lose weight."

It doesn't have the effect that I think they think. I'm sure they're well-meaning when they say it. They don't know any better. It doesn't have the effect that people think it will.

Shira: No, it doesn't. Absolutely. I'm sorry you experienced that so much. It often has the effect of leading people to avoid seeking health care, which then may lead to some of the problems that we attribute to "overweight" and "obesity."

It can also lead to disordered eating. There's this idea that if you're in a larger body, you're eating too much, or you can't be exercising. When in reality, size isn't necessarily at all correlated with how much you eat. It's very genetic.

If you're telling somebody who's eating a pretty normal amount, "You need to be eating less. You need to be exercising more," that can very quickly lead to disordered eating.

Keith: Absolutely. I can see the vicious cycle of sorts that can happen, where you're eating unhealthy, and then you're getting the criticism about it, which makes you upset, which makes you eat unhealthy.

Not everyone's eating unhealthy, as you said, but if that's the issue that someone has, binge eating, let's say, or something like that, it's a loop. It becomes this cycle.

Shira: That's the case. For sure, with some people, that can happen. I also think what we don't talk about enough is that binge eating is often what happens if you restrict. Just like if you hold your breath for a super long time, you're going to gasp for air.

Keith: That's a good analogy.

Shira: If you try to diet for a while and restrict your calories severely, then you're going to binge. Often, what happens is that people are told to lose weight, so they go on a diet, and they try to restrict. That leads to your body desperately wanting food and feeling like it's deprived and starving.

It's important to look at how shaming people and the stress of being shamed can lead to binge eating. I also often think shaming people leads to restriction, which leads to binging. We skip that step and overlook the negative consequences of restriction itself.

Keith: That's a really interesting observation. I totally agree. I can say that I've been down that exact road, so I know exactly what you're talking about. That's really interesting. Binge eating probably could lead into the eating disorders you mentioned.

What are some of the eating disorders that come about when people experience weight stigma? How does weight stigma cause eating disorders, when you think it would be the reverse?

Shira: A lot of times, there's this pervasive idea that you need to be dieting. That almost no weight is thin enough. That I'm someone within privilege. Having experienced oppression or discrimination based on size, but I've still gotten the message a lot of times that you need to be thinner and thinner.

If you're not constantly pursuing weight loss or this idea of "eating healthy," which often means eating a low-calorie diet or not eating food groups that are high in calories. For me, that's definitely led to disordered eating. A lot of times, it leads to a preoccupation with weight and body size, which is at the root of many eating disorders.

Eating disorders can manifest as anorexia, high restriction. That mentality of no weight is thin enough. Bulimia, purging behaviors, binge eating disorder, which again, a lot of people have this misconception that binge eating disorder is about impulse control or that it means you're addicted to food.

The reality is binge eating disorder is a restrictive eating disorder, too. It starts with restricting, and then it's the body's response to that. Weight stigma isn't always at the root of all eating disorders, but it absolutely is a huge factor.

It's considered the biggest sociocultural contributor to eating disorders, because of this societal idea that you need to be a certain weight to be worthy of respect.

Keith: This is starting to change a little bit. I remember, especially in the '80s and '90s, all you saw on TV were people of what they considered ideal size and shape. So many young people would see that. They may have been totally healthy, absolutely, and wonderful, nothing to be concerned about, but if they felt, "Oh, gosh, these extra 10 pounds I have."

It's almost like another form of weight stigma, is the media's representation of what is appropriate or what is healthy. I know that leads to anorexia, bulimia, or things like that in a lot of young people. I'm glad to see that's changing a little bit, but probably not nearly enough yet.

Shira: Both the media's exclusion of people in larger bodies, just that they're not often portrayed. When people in larger bodies are represented in the media, it's often in a negative way or in a joking way, like with stereotypes of laziness or poor self-discipline.

A lot of the issue is this idea of controllability. That if someone is a certain weight, they did something to be that way, or they're eating a certain way, or not exercising enough. It convinces people, if they take the right steps and hyper control their eating and their exercise, then they too can be the perfect weight or the ideal weight that they're seeing portrayed on the media.

Keith: If you feel you encountered weight stigma, what can you do? I don't see signs up in front of building saying, "Weight stigma counseling," or anything like that. What do you do if you want help?

Shira: If it's something that you're encountering in your everyday life, and you want to challenge that, I would definitely recommend that to challenge weight stigma as much as possible, and combat some of the myths and share with people that this isn't something that's helpful. This isn't something positive for people's health.

Sharing that weight stigma is more harmful than any particular weight can be helpful. If people are saying different things about different food groups or stigmatizing different foods, is like, "This is unhealthy or this is healthy," sharing that, having that mindset of planning your food around weight loss is far less healthy than eating what your body wants.

If it's to the point where it's affecting someone's mental health, and where people are experiencing disordered eating, or symptoms of eating disorders, or body image dissatisfaction, that can be a good opportunity to seek counseling. A lot of eating disorder therapists and dietitians practice from a framework called Health at Every Size.

That's about promoting healthy behaviors, meaning non-low calorie diets [laughs] or frequent exercise but eating and moving in a way that your body wants, at all sizes and focusing on accepting your natural body size, rather than losing weight or using BMI to judge whether your body size is healthy.

Seeking help from HAES-aligned -- Health at Every Size-aligned --dietitian or therapist can be super helpful. Also, reading books, listening to podcasts on that topic of Health at Every Size, and intuitive eating can be incredibly helpful for countering some of that weight stigma that you might have heard or messages you might have gotten that aren't necessarily true or helpful.

I would highly recommend the "Food Psych Podcast." It's about intuitive eating and Health at Every Size, and how to have a healthy relationship with food and your body, accepting more of a normal balanced relationship with food.

Keith: As I mentioned in the introduction, there is a webinar coming up on this very topic, February 24th. Tell us a little bit why people listening to this should attend the webinar? What would they gain from getting a little more information on this?

Shira: Like we've discussed, weight stigma is not talked about a lot. It's not something that a lot of mental health professionals or mental health advocates are educated on. Unfortunately, that leads to weight stigma showing up in a lot of ways in the mental health field and in mental health advocacy, even.

Certain diets are recommended to improve mental health or exercise can sometimes be given as this blanket recommendation as a way to improve mental health, which it can but sometimes that can be harmful if it's not given with caution or an understanding that over-exercise or compulsive exercise can be an issue.

Sometimes, people in larger bodies are assumed to have food addiction, or they can't possibly be mentally healthy, because of their weight, things like that. It's important for people who work in mental health or people who do mental health advocacy, to learn about that and be able to combat weight stigma in their practice, or in their advocacy.

Right now, during this time, our society is learning a lot about how to be inclusive toward different groups, which is super important. There needs to be more attention to that, now more than ever, looking at how to fight for racial justice, how to fight for gender equality, things like that, within mental health.

At mental health, we're starting to see is not so separable from what's going on in the world and how you're treated due to different identities you might have. Weight stigma needs to be one of those things that needs to be brought to our attention of how we can improve mental health by bringing about size and quality as well.

Keith: Totally. I agree 100 percent. I'll definitely be attending. I'm looking forward to it. I definitely recommend to everyone listening to this, to sign up and attend. Thank you so much, Shira. This has been enlightening. I appreciate your time.

Shira: Thanks so much for having me.

Keith: Thanks again to Shira for being our guest, exploring weight stigma with us and giving us a preview of what to expect at the webinar. To learn more about and register for the Impact of Weight Stigma on Mental Health Webinar, visit disabilityrightsflorida.org/webinar.

I'll put the link in the show notes as well as links to other resources that Shira mentioned. We hope everyone listening can attend the webinar. If you're listening to this after the event occurs, use the same link to find and watch the recording or read the transcript.

Thank you for listening to the You First Podcast or reading the transcript online. Please email any feedback, questions or ideas about the show to podcast@disabilityrightsflorida.org.

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