Presented by Dr. Wendy Oliver-Pyatt
“Wellness” is a vague concept involving certain aspects of self-love and self-care, but the idea has also been co-opted by diet culture, often resulting in recommendations to lose weight or ascribe to certain body images.
The conflated ideas are responsible for spreading weight stigma, a harmful attitude around people in larger bodies.
With over 25 years of experience in the mental health field, Dr. Wendy Oliver-Pyatt has developed a number of well-informed views on the issues of wellness, weight stigma, shame, and eating disorders. And there are ways, she says, to combat these problems and for everyone to find the unique treatment they deserve.
Weight stigma is a common form of discrimination involving negative thoughts and behaviors toward people in larger bodies. This can include:
Though its effects can be devastating, the discrimination itself can be hard to see, as it’s generally socially sanctioned, Oliver-Pyatt explains. This has to do with prevailing ideas around “wellness” and fitness, including that people in larger bodies are automatically less healthy and people in fit or toned bodies are healthier, more motivated, or otherwise morally superior.
These ideas are often held by people in positions of authority, including healthcare professionals, researchers, educators, and government agency workers. When these people dispense advice about “wellness” from this point of view, it can act almost as a form of gaslighting, Oliver-Pyatt says, further fueling the problem.
Shame, as Oliver-Pyatt describes it, is an intensely negative emotion directed at the self as a consequence of failing to live up to some standard, ideal, or norm. This is at the heart of many mental health issues, including suicidality, addiction, and disordered eating behaviors. And it can also both drive and derive from weight stigma.
In one study quoted by Oliver-Pyatt, over 90% of participants experienced some form of body shame. This represented the closest thing to a universal experience recorded by the study.
Oliver-Pyatt notes that even more damage can be done when those who are supposed to be “helping” are spouting the same views that cause this type of shame. However, she adds that healthcare workers are often unaware of their own weight biases.
“Weight stigma is like a poison to our soul that damages the interpersonal connection between two parties or groups of people and leaves one person hurt or injured,” she says. “That person may avoid future interactions as much as they can and may also turn to other behaviors to get through the pain of weight stigma.”
Many people in larger bodies internalize ideas related to weight stigma, which can be intensely damaging.
As Oliver-Pyatt explains, our idea of ourselves is built by outside influences, including:
When these internalized ideas are mostly negative—such as when they’re informed by weight stigma—it can lead to a devalued self-identity, which is a form of trauma, Oliver-Pyatt says. Dealing with this type of trauma can potentially lead to:
This creates almost a type of self-fulfilled prophecy, where people experiencing weight stigma start acting in ways stereotypically associated with those in larger bodies, which can kick off a harmful cycle of shame, judgment, and disordered behavior.
Separating “wellness” from weight stigma can be difficult, especially at the doctor’s office. But
Oliver-Pyatt sees weight stigma as one of society's most dangerous prevailing attitudes today. The concept, she says, is similar to racism and on par with age and gender discrimination.
The negative effects of weight stigma can also, unfortunately, be seen across a number of settings.
Oliver-Pyatt has strong words for the recent guidelines on childhood obesity by the American Academy of Pediatrics. Among other recommendations, these guidelines advocate prescribing children as young as 12 weight loss medications if they reach a certain BMI.
“It basically teaches children they’re defective if they’re a certain weight,” Oliver-Pyatt says. “It’s a prime example of weight stigma coming in authoritative terms.”
As a result, many schools have come up with policies or programs in accordance with these guidelines. School-wide BMI screenings and the banning of certain “junk” foods are among the most harmful and, ultimately, ineffective, Oliver-Pyatt says.
Schools are not the only institutions that put high stock in BMI readings. The measure—a ratio of someone’s weight to height—is a key statistic in many healthcare practices.
Oliver-Pyatt says this is just as harmful to adults and misleading to boot. The BMI is increasingly seen as an ineffective measure of overall health, yet it’s still used as a benchmark for certain disease and health condition screenings.
And many guidelines around eating disorders specifically mention BMIs, both for determining “how sick” someone is and when someone can be considered “in recovery.” This is the case even when everyone’s “ideal” weight is extremely individual and based on several unique factors.
In society, one of the biggest dangers around weight stigma is how frequently it masquerades as “wellness.” This can include everything from self-care advice focused on body image alone to diet and exercise plans peddled as “good for everyone.”
In many cases, “wellness” gurus will prescribe restrictive diets to achieve a specific body type. This can be hugely harmful, possibly contributing to the development of disordered eating behaviors.
As Oliver-Pyatt explains, following a set diet can lead people to ignore their body’s natural hunger and satiety cues and bring on an internal battle between what people feel they “should” do and what they want to do.
To drown out the internal noise, shame, and other negative emotions involved in internalized weight stigma, people may turn to binge eating behavior, as the act can bring on a sense of dissociation that, while harmful in the long run, can feel in the immediate term like a sense of relief, Oliver-Pyatt says.
While many treatment providers struggle with their own weight biases, there are a growing number in the field working to educate themselves on these issues and develop more inclusive practices.
Oliver-Pyatt recommends looking for a practice or practitioner with a weight-inclusive approach, meaning one that:
She also points to the fat acceptance movement and Health at Every Size (HAES) movements as resources for additional information and tips on finding appropriate care.
Oliver-Pyatt warns against listening to those who prescribe any type of weight loss regimen or those who teach that the only kind of “good” movement is aggressive gym workouts. And for healthcare appointments specifically, she says, coming prepared can be a game-changer.
Using and insisting on the use of appropriate and comfortable language, emphasizing the desire to not focus on weight, and even bringing in resources and information from home can all be helpful, she says.
“You should think of your healthcare provider as a partner,” she says. “This should be a collaborative and beneficial relationship.”