Addressing Weight Stigma and Anti-Obesity Rhetoric in Policy Changes to Prevent Eating Disorders

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The Lancet


Weight stigma diminishes wellbeing and contributes to inequities across multiple domains. A 2020 report by the UK eating disorder charity Beat highlighted several ways that obesity prevention public health campaigns can unintentionally amplify risk of eating disorders and exacerbate symptoms. This report made useful recommendations to minimise these harms and identified specific risk pathways—eg, promotion of dieting (an ineffective strategy for long-term weight loss, which also heightens risk for binge-eating behaviour), prioritising thinness in a way that falsely equates thinness with health (and correspondingly, higher weight with poor health), and engagement in weight-stigmatising actions, such as the use of body-mass index (BMI) report cards and problematic discourse in public health programming. Beat has also flagged problems with other well intentioned efforts such as calorie labelling on menus and food labels, which can exacerbate eating disorder thoughts, behaviours, and distress, and a weight-loss app introduced by the UK National Health Service, which emphasises dietary restriction with insufficient safeguards by age, BMI, and medical considerations. We agree and contend that in certain ways anti-obesity campaigns could fundamentally be at odds with efforts to prevent eating disorders. Indeed, some have argued that to reduce the risk of eating disorders, the world needs to be made safe in terms of reducing stigma and discrimination for higher-weight individuals and that the programmatic goals of eating disorder prevention and obesity prevention campaigns are incompatible, given that the underlying premise of anti-obesity campaigns is that higher weight is harmful. However, greater attention to shared experiences of weight stigma, epidemiology, genetic features, and environmental factors could serve to reduce this seeming incompatibility and benefit public health.


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