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What is Sizeism and How to Fight It?

Have you ever been made to feel less than human based on your weight? Dr. Monica Johnson, the Savvy Psychologist, explains what sizeism is, and how you can deal with it in your everyday life.

By
Dr. Monica Johnson
7-minute read
Episode #358
The Quick And Dirty
  • Sizeism, or weight stigma, is prejudice or discrimination based on a person's size or weight.
  • If you're dealing with sizeism in your life, borrow strategies from other forms of discrimination and modify them for your fatness.
  • Size and weight is only one factor when it comes to health. Promote being healthy, not being thin.

I’ve been following the news around Lizzo, and the sizeist and racist comments she has endured. Keeping it real and honest here, I was a proud fat and black woman myself until about two years ago. I’d been obese since before I could walk, my weight topping out at 417 lbs. So this is a topic that I relate to both personally and professionally to this topic, as many of my patients struggle with weight and body image issues.

I’ve enjoyed seeing Lizzo being confident and happy in her body. I’m also disappointed that we live in a world where the truth of this self-love feels novel and the idea that someone could be fat and love themselves is still "controversial." I want to be abundantly clear that a human’s self-worth does not have an inverse relationship with a number on a scale. So today, we’re going to talk about the effects of sizeism, and how to deal with it in your personal life.

What is sizeism?

Let’s start by defining some terms.

I will be using the term "fat," as fat people have been working to reclaim the word and eliminate the stigma attached. I want to convey that "fat" is not a dirty word.

Sizeism, or weight stigma, is defined as prejudice or discrimination based on a person’s size or weight. The terms "overweight" and "obesity" are medical terms that are usually defined by your body mass index (BMI). You are categorized as overweight if your BMI is between 25-29.9 and obese at a BMI of 30 or higher. BMI is a flawed measurement, especially for people of color, but it is deeply ingrained in our medical system.

I'm not here to argue that morbid obesity doesn't have negative effects on physical health. What I am here to argue is that sizeism and its negative effects need to be equally addressed. One can't make assumptions about someone's health based solely on their size or BMI. An individual's health is determined by a myriad factors and is best explored between them and their (hopefully unbiased) health providers.

I will be using the term "fat," as fat people have been working to reclaim the word and eliminate the stigma attached. I want to convey that "fat" is not a dirty word.

What are the effects of sizeism?

Here's some of the latest research on sizeism that you may have missed because it doesn't get as much air time as diet culture or judgemental comments.

According to researchers, weight stigma can trigger physiological and behavioral changes. When study participants were manipulated to experience weight stigma, their food consumption increased, their ability to self-regulate decreased, and cortisol, a hormone related to weight gain, levels increased.

On the mental health side, those who had perceived weight stigma also experienced low self-esteem, poor psychosocial functioning, binge eating, depression, anxiety, and psychological distress. Researchers have also discovered a link between weight stigma and avoidance of exercise. 

Some people believe that we can shame people into losing weight, but the facts don't support that tactic. Instead, as the research I just outlined shows, all sizeism does is add additional psychological and physiological stress. This makes it difficult for stigmatized individuals to lose weight if they want or need to. 

Not only do fat people face discrimination in their everyday lives, but they also face sizeism from the medical community. Fat patients report weight discrimination in health care settings, which leads them to avoid routine preventative health care. Studies of doctors have also shown a strong explicit and implicit anti-fat bias. High levels of bias were even found in medical professionals specializing in obesity-related issues.

What did this bias look like? Medical professionals endorsed explicit anti-fat sentiments like "fat people are worthless," and endorsed negative stereotypes of patients with obesity like the terms "bad," "lazy," and "weak-willed." They also noted feeling less respect for obese patients and were more likely to report them as a "waste of time."

Sizeism has direct and observable consequences for the quality of care and nature of services provided to fat people, which only leads to higher rates of poor health in fat people.

In my review of the literature, one article hit home for me. It found that 1 in 6 physicians expressed reluctance to perform pelvic exams on obese women. When I was in grad school, I had an issue with dysfunctional uterine bleeding. I was reluctant to go to the doctor; even in my early 20s, I'd already had terrible experiences with medical professionals. I also came from a poor background and was on Medicaid, so my options were limited when it came to choosing my providers.

However, my problem was so severe that I went in for care. In the several months I saw a gynecologist, not once did he request to perform a pelvic exam. In fact, he did no physical exam whatsoever. Instead, he gave me a prescription that didn't solve the problem and provided no other treatment alternatives.

One fateful Wednesday morning, I went in to see him to review my symptoms, which were worsening. He sang me the same old song, despite the fact that I'd been bleeding heavily for about eight months on a daily basis. That afternoon, I went to stats class, and when I stood up to leave at the end of class, I felt a sensation. I looked down, and it was the hallway scene from The Shining. I am incredibly thankful for the friends who supported me that day, and for the hospital workers who examined me and finally provided me with care alternatives.

This is just one story, but I hope it illustrates that sizeism has real consequences.

How to deal with sizeism

Sizeism is another form of discrimination and should be treated as such. I recall sessions I’ve had with patients who, like Lizzo, are both BIPOC and fat. When I’ve made the comparison to racial discrimination, it’s blown their minds.

For instance, I have a proud black patient who is fat and readily uses coping skills to deal with racial trauma. Despite strong anti-black sentiments around her, she has a strong, unshakeable sense of racial identity. Where's the gap? Essentially, it comes down to the fact that she has a community of people who taught her how to be black in a hostile society, but no one ever taught her how to be fat, love herself, and cope with negative societal impact.

You are allowed to take up space and be seen. You're not too fat for that outfit. Your healthcare or employment should not be negatively influenced by your size.

Borrow strategies from other forms of discrimination

My best piece of advice for those dealing with sizeism is to borrow strategies used for other forms of discrimination (race, sexuality, gender, religion, etc.) and modify them for your fatness. You are allowed to take up space and be seen. You're not too fat for that outfit. Your healthcare or employment should not be negatively influenced by your size.

Surround yourself with supportive people. By supportive, I don't mean people who enable truly unhealthy behaviors. What I mean is communities of people who don't judge your self-worth based on your size, and instead, encourage you to be holistically healthy.

If you use social media, consider who you follow. Do you focus on pages that display classically thin people or ones that focus on diet and exercise with the sole goal of getting as thin as possible? Swap those out for pages of individuals of various sizes who engage in healthy activities and illustrate that you can have a fashion sense that matches your personality and not one that's deemed socially appropriate by traditional beauty standards. For me this included following the likes of Gabi Fresh or Jessamyn Stanley. 

If it is difficult for you to think of positive body affirmations on a daily basis (it's hard for all of us), focus on the function of your body. For example, I might thank my body for carrying me up three flights of stairs or for my ability to touch my toes. This is an alternative way to develop a sense of pride or acceptance of yourself. 

Promote being healthy, not being thin

If you’re a parent, friend, healthcare provider, or really, any person on the planet: openly teach messages that promote being healthy, and not ones that idealize thinness. Find healthcare professionals who include your weight as a single factor in your health, and work with you to create a truly comprehensive wellness plan to improve your mental and physical state. If your provider's go-to response to a medical condition is to tell you to lose weight, here’s a question I love to ask: “If I wasn’t fat, what would you recommend for me?” That doesn’t mean a healthy diet and exercise isn't a part of your plan, but it means you consider all the relevant factors to improve your health.

Regardless of whether you remain fat for the entirety of your life, or lose weight, you deserve to be treated with dignity in all aspects of your life. You’re allowed to seek happiness.

Sizeism is largely based on our perception of size, not our actual weight or health. For example, I have lost more than 200 lbs. I was obese when I started losing weight, and I’m still considered to be obese today based on my BMI. Despite the fact that I'm still an obese person by medical definition, most people do not perceive me as being overweight, and I don't experience the same kind of discrimination as I once did. 

If you want to see some of the ways I use my body to benefit my mental and physical fortitude, head over to my Instagram where I've posted pictures. Let me know your struggles with sizeism as well via my email psychologist@quickanddirtytips.com, or leave me a voicemail at (929) 256-2191‬.

Sources +
All content here is for informational purposes only. This content does not replace the professional judgment of your own mental health provider. Please consult a licensed mental health professional for all individual questions and issues.

About the Author

Dr. Monica Johnson

Dr. Monica Johnson is a clinical psychologist and owner of Kind Mind Psychology, a private practice in NYC that specializes in evidenced based approaches to treating a wide range of mental health issues (e.g. depression, anxiety, trauma, and personality disorders). Additionally, she has a focus on working with marginalized groups of people including BIPOC, LGBTQ+, and alternative lifestyles to manage minority stress. She is also dedicated to contributing to her field professionally through speaking, training, supervision, and writing. She routinely speaks at conferences, provides training and workshops at organizations, supervises mental health trainees, and co-authored a book for professionals on addressing race-based stress in therapy.

Dr. Johnson earned her bachelor's degree from the University of South Carolina, completed her Psy.D. at the Arizona School of Professional Psychology, and completed her postdoctoral training year at Cherokee Health Systems in Knoxville, TN. She currently lives in Manhattan where she indulges in horror movies, sarcasm, and intentional introversion. You can find her on Instagram and online at kindmindpsych.com

Got a question that you'd like Dr. Johnson to answer on Savvy Psychologist? You can send her an email at psychologist@quickanddirtytips.com or leave a voicemail for the Savvy Psychologist listener line by calling (929) 256-2191‬.