World Obesity Day: Understanding the social consequences of obesity

11 October is World Obesity Day. Obesity has reached epidemic proportions globally, with at least 2.8 million people dying each year as a result of being overweight or obese. In the WHO European Region, an estimated 23% of women and 20% of men have obesity. Overweight and obesity are major risk factors for a number of chronic diseases, including diabetes, cardiovascular diseases and cancer. They can also lead to overweight bias and obesity stigma, as outlined in a new brief from WHO/Europe.

Obesity stigma is ubiquitous, with one recent study from a country in western Europe showing that 18.7% of people with obesity experienced stigma. For people with severe obesity, the figure was much higher – 38%. Individuals with obesity experience stigma from educators, employers, health professionals, the media and even from friends and family.

Stigma is a fundamental cause of health inequalities, and obesity stigma is associated with significant physiological and psychological consequences, including increased depression, anxiety and decreased self-esteem. It can also lead to disordered eating, avoidance of physical activity and avoidance of medical care.

Obesity stigma hits children especially hard

The effects of weight bias and obesity stigma can be particularly severe for children. Studies indicate that school-aged children with obesity experience a 63% higher chance of being bullied. When children and youth are bullied or victimized because of their weight by peers, family and friends, it can trigger feelings of shame and lead to depression, low self-esteem, poor body image and even suicide.

Weight-biased attitudes from teachers can involve lower expectations from students, which can lead to low education outcomes for children and youth with obesity. This can, in turn, affect children’s life chances and opportunities, and ultimately lead to social and health inequities. Policies are needed to prevent weight-victimization in schools, and parents can advocate for their children with teachers and principals by expressing concerns and promoting awareness of weight bias in schools.

Ethical considerations and the importance of social environments

Over-simplifying the causes of obesity and implying that easy solutions will lead to quick and sustainable results – for example, “eat less, be more active” – contribute to weight bias and can set unrealistic expectations, masking the challenges people with obesity can face in changing behaviour. Additionally, this often focuses discussion around individual behaviours and perceived failures, while neglecting to take into consideration important social and environmental factors.

It is important to understand the causes of obesity and for governments to invest in prevention and early intervention measures to halt its worrying rise. But, at the same time, it is vital to recognize that government and society have ethical obligations to act – particularly on behalf of children – to reduce not only the health but also the social consequences of obesity. Failure to do so will impact the social and health capital of future generations and increase inequities in Europe and beyond.

WHO/Europe aims to work with countries in many different ways and through several policy frameworks to ensure that weight bias and obesity stigma among children and adults are addressed appropriately in national public health activities, notably through:

• further research;
• knowledge exchange at national and local levels;
• prioritizing concerns around weight bias and obesity stigma in public policy, notably education and health care.

The new brief from WHO/Europe outlines specific actions that countries can consider taking to address the issues of weight bias and obesity stigma.