About half of Americans would support laws against weight-based discrimination, with those who have personally experienced weight bias being about twice as likely to support the policy as people who have not, according to the findings, which were presented June 7 at the American Society for Metabolic and Bariatric Surgery Annual Meeting (ASMBS) in Dallas.
Can a Person Be Denied a Job or Fired Because of How Much They Weigh?
Weight bias is defined as negative attitudes, beliefs, judgments, stereotypes, and discriminatory acts aimed at people simply because of their weight, according to Obesity Action Coalition (OAC). This can be obvious or subtle, and can happen in any setting — work, healthcare, school, and even personal relationships. What exactly does weight bias look like in practice? Take the case of Taylor v. Burlington Northern Railroad Holdings, Inc. Casey Taylor was an ex-Marine who sued after the railway company made a conditional job offer but then revoked it when a medical exam found his BMI (body mass index) to be in the severely obese range. Taylor was 5 feet 6 inches tall and 256 pounds, which translates to a 41.3 BMI. A person with a BMI of 25 to 29.9 is considered overweight, and a person with a BMI of over 30 is considered obese. According to the National Heart, Lung, and Blood Institute, BMI is calculated on the basis of a person’s weight and height, and the same formula is used for both men and women. The railway company informed Taylor that it was their policy to not hire anyone who had a BMI over 35; to be able to start work for the railroad, he would need to provide proof of satisfactory health by undergoing several tests (that he would have to pay for out of his own pocket) including a sleep study and an exercise tolerance test, or lose 10 percent of his body weight and keep it off for six months. Taylor claimed this was a violation of Washington state’s Law Against Discrimination. The case made it all the way to the Washington Supreme Court, where the court ruled in favor of Taylor. The court held that obesity is an impairment, and therefore a protected disability. But statutes like the one in Washington are few and far between, says the senior author of the research, Fatima Cody Stanford, MD, MPH, an associate professor and obesity medicine physician scientist at Massachusetts General Hospital and Harvard Medical School in Boston. “There are no universal laws in the U.S. for weight discrimination. With the exception of Washington and Michigan and a few cities, it is legal to discriminate on the basis of weight,” she says.
People Are More Likely to Support Laws Prohibiting Weight Discrimination if They Have Been on the Receiving End of It
To find out more about people’s perceptions about obesity bias, researchers had a diverse group of 1,888 adults complete a 26-item online questionnaire; the participant makeup was as follows: 328 Asian or Pacific Islander, 404 Hispanic or Latinx, 395 Black, and 761 white. Questions explored issues such as whether or not obesity is a disease, what most Americans think about obesity, awareness of obesity advocacy organizations, and whether or not the participant supported laws against weight discrimination. About half of Americans overall would back such legislation, and the researchers found there were several major predictors of support — or lack thereof. “Controlling for other variables, if you personally experienced weight bias, you were twice as likely to support this policy. If you considered obesity to be a disease, you were 1.8 times as likely,” says Matt Townsend, MD, the lead author and a resident internal medicine doctor at Duke Health in Durham, North Carolina. “Interestingly, Black race and female gender were each associated with being 1.4 times as likely to support antidiscrimination laws. We can only conjecture that lived experience of stigma is a powerful motivator to make things more equitable,” he says. It makes sense that individuals who have had to navigate race and gender bias are more likely to support laws around weight bias, says Dr. Stanford. “These individuals probably face more weight-based discrimination just because of their intersectional identities of being part of a racial/ethnic group, being female, and then having the disease of obesity compounding that,” she says.
Obesity Was First Recognized as a Disease Nearly a Decade Ago
The American Medical Association (AMA) designated obesity a disease in 2013. Although it is influenced by behavioral factors, experts now recognize that genetics, environment, social determinants of health, and biological factors influenced by medications, illnesses, and hormones all play a role. Having too much body weight for your height is associated with an increased risk of heart disease, high blood pressure, type 2 diabetes, and even certain cancers. It’s estimated that more than two in three U.S. adults have overweight or obesity, according to the U.S. Department of Health and Human Services. When people have excess weight, other people make many assumptions. They may assume those individuals are lazy, passive, lack self-control, or make poor decisions, says Stanford. “We know these biases are not true, but they are widely held beliefs in our society,” she says.
Weight Bias Needs to Be Addressed in Several Ways
Dr. Townsend believes that a problem as culturally ingrained as weight bias needs to be addressed on multiple fronts — individual, institutional, and through societal or policy means. “At a personal level, it’s more awareness on the issue — how it creates disparities in attainment, socioeconomic status, and psychological harms,” he says. At the institutional level, organizations can take steps to root out the most common sources of weight stigma, says Townsend. “Our study found that the media was the most frequent source of weight bias, but high rates were also experienced in the employment and healthcare sectors,” he says. Townsend uses the entertainment industry as an example of how a bias could be recognized and corrected by avoiding the fat-lazy stereotype in movie characters. Action is also needed at the policy level, he says. The Civil Rights Act of 1964 does not identify weight as a protected condition, and as Stanford notes, laws that prevent weight-based discrimination are the exception, not the rule. “Legislation has the potential to create more equitable protection for people with obesity, and our study showed about half of Americans were supportive of the idea of laws against weight discrimination,” says Townsend. These findings could be used to build public support in these “natural allies” for antidiscrimination legislation, he adds.
Recognizing and Addressing Weight Bias
Wondering if you have negative assumptions around weight and may be part of the problem? One way to find out is to take the free Harvard implicit association test about weight bias, says Stanford. “This can help you discern where you are on the spectrum; if you have biases in this area, then you can begin work on improving that." Educating yourself can be a good start, she says. The Obesity Action Coalition offers information and resources to help people understand the issue, as well as ways that people can take action to foster positive change.
