Although research has consistently documented the prevalence and negative health implications of weight stigma, little is known about the stigma associated with eating disorders. Given that weight stigma is a risk factor associated with disordered eating, it is important to address stigma across the spectrum of eating and weight disorders. The aim of this review is to systematically review studies in the past 3 years evaluating stigma in the context of obesity and eating disorders (including binge eating disorder, bulimia nervosa, and anorexia nervosa). Physical and psychological health consequences of stigma for individuals with obesity and eating disorders are discussed. Recent studies on weight stigma substantiate the unique influence of stigma on psychological maladjustment, eating pathology, and physiological stress. Furthermore, research documents negative stereotypes and social rejection of individuals with eating disorder subtypes, while attributions to personal responsibility promote blame and further stigmatization of these individuals. Future research should examine the association of stigma related to eating disorders and physical and emotional health correlates, as well as its role in health-care utilization and treatment outcomes. Additional longitudinal studies assessing how weight stigma influences emotional health and eating disorders can help identify adaptive coping strategies and improve clinical care of individuals with obesity and eating disorders.
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Hayran OMD, Akan HMD, Özkan ADP, Kocaoglu BP. Fat phobia of university students: attitudes toward obesity. J Allied Health. 2013;42(3):147–50.
Sikorski C, Luppa M, Kaiser M, Glaesmer H, Schomerus G, König H-H, et al. The stigma of obesity in the general public and its implications for public health—a systematic review. BMC Public Health. 2011;11(1):661.
Brochu PM, Esses VM. What’s in a name? The effects of the labels “fat” versus “overweight” on weight bias. J Appl Soc Psychol. 2011;41(8):1981–2008.
Ambwani S, Thomas KM, Hopwood CJ, Moss SA, Grilo CM. Obesity stigmatization as the status quo: structural considerations and prevalence among young adults in the U.S. Eat Behav. 2014;15(3):366–70.
Brownell KD, Puhl RM, Schwartz MB, Rudd L, editors. Weight bias: nature, consequences, and remedies. New York: The Guilford Press; 2005.
Puhl H. The stigma of obesity: a review and update. Obesity. 2009;17(5):941–64.
Grucza RA, Przybeck TR, Cloninger CR. Prevalence and correlates of binge eating disorder in a community sample. Compr Psychiatry. 2007;48(2):124–31.
Hudson JI, Hiripi E, Pope Jr HG, Kessler RC. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry. 2007;61(3):348–58.
Villarejo C, Fernández‐Aranda F, Jiménez‐Murcia S, Peñas‐Lledó E, Granero R, Penelo E, et al. Lifetime obesity in patients with eating disorders: increasing prevalence, clinical and personality correlates. Eur Eat Disord Rev. 2012;20(3):250–4.
Kessler RC, Berglund PA, Chiu WT, Deitz AC, Hudson JI, Shahly V, et al. The prevalence and correlates of binge eating disorder in the World Health Organization World Mental Health Surveys. Biol Psychiatry. 2013;73(9):904–14.
Gueguen J, Godart N, Chambry J, Brun‐Eberentz A, Foulon C, Snezana M, et al. Severe anorexia nervosa in men: comparison with severe AN in women and analysis of mortality. Int J Eat Disord. 2012;45(4):537–45.
Hilbert A, Pike K, Goldschmidt A, Wilfley D, Fairburn C, Dohm FA, et al. Risk factors across the eating disorders. Psychiatry Res. 2014;220(1–2):500–6.
Sutin AR, Terracciano A. Perceived weight discrimination and obesity. PLoS ONE. 2013;8(7):e70048.
Olvera N, Dempsey A, Gonzalez E, Abrahamson C. Weight-related teasing, emotional eating, and weight control behaviors in Hispanic and African American girls. Eat Behav. 2013;14(4):513–7.
Krug I, Villarejo C, Jimenez-Murcia S, Perpina C, Vilarrasa N, Granero R, et al. Eating-related environmental factors in underweight eating disorders and obesity: are there common vulnerabilities during childhood and early adolescence? Eur Eat Disord Rev. 2013;21(3):202–8.
Almeida L, Savoy S, Boxer P. The role of weight stigmatization in cumulative risk for binge eating. J Clin Psychol. 2011;67(3):278–92.
Puhl R, Andreyeva T, Brownell K. Perceptions of weight discrimination: prevalence and comparison to race and gender discrimination in America. Int J Obes. 2008;32:992–1000.
Puhl RM, Luedicke J, Heuer C. Weight-based victimization toward overweight adolescents: observations and reactions of peers. J Sch Health. 2011;81(11):696–703.
Bucchianeri MM, Eisenberg ME, Neumark-Sztainer D. Weightism, racism, classism, and sexism: shared forms of harassment in adolescents. J Adolesc Health. 2013;53(1):47–53.
McCormack LA, Laska MN, Gray C, Veblen-Mortenson S, Barr-Anderson D, Story M. Weight-related teasing in a racially diverse sample of sixth-grade children. J Am Diet Assoc. 2011;111(3):431–6.
Bradshaw CP, Waasdorp TE, O’Brennan LM, Gulemetova M. Teachers’ and education support professionals’ perspectives on bullying and prevention: findings from a national education association study. Sch Psychol Rev. 2013;42(3):280–97.
Puhl RM, Luedicke J, DePierre JA. Parental concerns about weight-based victimization in youth. Child Obes. 2013;9(6):540–8.
Haines J, Hannan PJ, van den Berg P, Eisenberg ME, Neumark-Sztainer D. Weight-related teasing from adolescence to young adulthood: longitudinal and secular trends between 1999 and 2010. Obesity. 2013;21(9):E428–E34.
Gollust SE, Eboh I, Barry CL. Picturing obesity: analyzing the social epidemiology of obesity conveyed through US news media images. Soc Sci Med. 2012;74:1544–51.
Hussin M, Frazier S, Thompson JK. Fat stigmatization on YouTube: a content analysis. Body Image. 2011;8:90–2.
Yoo JH, Kim J. Obesity in the new media: a content analysis of obesity videos on YouTube. Health Commun. 2012;27(1):86–97.
Puhl RM, Peterson JL, DePierre JA, Luedicke J. Headless, hungry, and unhealthy: a video content analysis of obese persons portrayed in online news. J Health Commun. 2013;18(6):686–702.
Domoff SE, Hinman NG, Koball AM, Storfer‐Isser A, Carhart VL, Baik KD, et al. The effects of reality television on weight bias: an examination of the biggest loser. Obesity. 2012;20(5):993–8.
McClure K, Puhl RM, Heuer CA. Obesity in the news: do photographic images of obese persons influence anti-fat attitudes? J Health Commun. 2011;16(4):359–71.
Yoo JH. No clear winner: effects of the biggest loser on the stigmatization of obese persons. Health Commun. 2013;28(3):294–303.
Throop EM, Skinner AC, Perrin AJ, Steiner MJ, Odulana A, Perrin EM. Pass the popcorn: “obesogenic” behaviors and stigma in children’s movies. Obes (Silver Spring). 2013.
Meers MR, Koball AM, Oehlhof MW, Laurene KR, Musher-Eizenman DR. Assessing anti-fat bias in preschoolers: a comparison of a computer generated line-drawn figure array and photographic figure array. Body Image. 2011;8(3):293–6.
Fettich KC, Chen EY. Coping with obesity stigma affects depressed mood in African‐American and white candidates for bariatric surgery. Obesity. 2012;20(5):1118–21.
Koball A, Carels R. Coping responses as mediators in the relationship between perceived weight stigma and depression. Eat Weight Disord-Stud Anorexia, Bulimia Obes. 2011;16(1):17–23.
Vartanian LR, Novak SA. Internalized societal attitudes moderate the impact of weight stigma on avoidance of exercise. Obesity. 2011;19(4):757–62.
Puhl RM, King KM. Weight discrimination and bullying. Best Pract Res Clin Endocrinol Metab. 2013;27(2):117–27.
Major B, Eliezer D, Rieck H. The psychological weight of weight stigma. Soc Psychol Personal Sci. 2012;3(6):651–8.
Greenleaf C, Petrie TA, Martin SB. Relationship of weight‐based teasing and adolescents’ psychological well‐being and physical health. J Sch Health. 2014;84(1):49–55.
Bucchianeri MM, Eisenberg ME, Wall MM, Piran N, Neumark-Sztainer D. Multiple types of harassment: associations with emotional well-being and unhealthy behaviors in adolescents. J Adolesc Health. 2014;54(6):724–9.
Puhl RM, Luedicke J. Weight-based victimization among adolescents in the school setting: emotional reactions and coping behaviors. J Youth Adolesc. 2012;41:27–40.
Harriger JA, Thompson JK. Psychological consequences of obesity: weight bias and body image in overweight and obese youth. Int Rev Psychiatry. 2012;24(3):247–53.
Mustillo SA, Budd K, Hendrix K. Obesity, labeling, and psychological distress in late-childhood and adolescent black and white girls the distal effects of stigma. Soc Psychol Q. 2013;76(3):268–89.
Libbey HP, Story MT, Neumark-Sztainer DR, Boutelle KN. Teasing, disordered eating behaviors, and psychological morbidities among overweight adolescents. Obesity. 2008;16:S24–S9.
Major B, Hunger JM, Bunyan DP, Miller CT. The ironic effects of weight stigma. J Exp Soc Psychol. 2014;51:74–80.
Schvey NA, Puhl RM, Brownell KD. The impact of weight stigma on caloric consumption. Obesity. 2011;19(10):1957–62.
Pearl RL, White MA, Grilo CM. Weight bias internalization, depression, and self-reported health among overweight binge eating disorder patients. Obesity (Silver Spring). 2014;22(5):E142–8. This article evaluates the internalization of weight bias on several components of physical and mental health.
Durso LE, Latner JD, White MA, Masheb RM, Blomquist KK, Morgan PT, et al. Internalized weight bias in obese patients with binge eating disorder: associations with eating disturbances and psychological functioning. Int J Eat Disord. 2012;45(3):423–7.
Carels RA, Burmeister J, Oehlhof MW, Hinman N, LeRoy M, Bannon E, et al. Internalized weight bias: ratings of the self, normal weight, and obese individuals and psychological maladjustment. J Behav Med. 2013;36(1):86–94.
Durso LE, Latner JD, Hayashi K. Perceived discrimination is associated with binge eating in a community sample of non-overweight, overweight, and obese adults. Obes Facts. 2012;5(6):869–80.
Hilbert A, Braehler E, Haeuser W, Zenger M. Weight bias internalization, core self‐evaluation, and health in overweight and obese persons. Obesity. 2014;22(1):79–85.
Pearl RL, Puhl RM, Dovidio JF. Differential effects of weight bias experiences and internalization on exercise among women with overweight and obesity. J Health Psychol. 2014.
Roberto CA, Sysko R, Bush J, Pearl R, Puhl RM, Schvey NA, et al. Clinical correlates of the weight bias internalization scale in a sample of obese adolescents seeking bariatric surgery. Obesity. 2012;20(3):533–9.
Schvey NA, Puhl RM, Brownell KD. The stress of stigma: exploring the effect of weight stigma on cortisol reactivity. Psychosom Med. 2014;76(2):156–62.
Tomiyama AJ, Epel ES, McClatchey TM, Poelke G, Kemeny ME, McCoy SK, et al. Associations of weight stigma with cortisol and oxidative stress independent of adiposity. Health Psychol. 2014;33(8):862–7.
Tsenkova VK, Carr D, Schoeller DA, Ryff CD. Perceived weight discrimination amplifies the link between central adiposity and nondiabetic glycemic control (HbA1c). Ann Behav Med. 2011;41:243–51.
Sutin AR, Stephan Y, Luchetti M, Terracciano A. Perceived weight discrimination and C-reactive protein. Obesity. 2014;22(9):1959–61.
Wott CB, Carels RA. Overt weight stigma, psychological distress and weight loss treatment outcomes. J Health Psychol. 2010;15(4):608–14.
Carels RA, Young KM, Wott CB, Harper J, Gumble A, Wagner Oehlof M, et al. Weight bias and weight loss treatment outcomes in treatment-seeking adults. Ann Behav Med. 2009;37:350–5.
Hunger JM, Tomiyama A. Weight labeling and obesity: a longitudinal study of girls aged 10 to 19 years. JAMA Pediatr. 2014;168(6):579–80.
Tomiyama AJ. Weight stigma is stressful. A review of evidence for the cyclic obesity/weight-based stigma model. Appetite. 2014;82:8–15.
Quick V, Wall M, Larson N, Haines J, Neumark-Sztainer D. Personal, behavioral and socio-environmental predictors of overweight incidence in young adults: 10-yr longitudinal findings. Int J Behav Nutr Phys Act. 2013;10:37.
Lillis J, Hayes SC, Bunting K, Masuda A. Teaching acceptance and mindfulness to improve the lives of the obese: a preliminary test of a theoretical model. Ann Behav Med. 2009;37(1):58–69.
Panzer BM, Dhuper S. Designing a group therapy program for coping with childhood weight bias. Soc Work. 2014;59(2):141–7.
Ebneter DS, Latner JD. Stigmatizing attitudes differ across mental health disorders: a comparison of stigma across eating disorders, obesity, and major depressive disorder. J Nerv Ment Dis. 2013;201(4):281–5. This study uniquely compares the stigma associated with each of the eating disorder subtypes, obesity, and non-weight related mental disorder (MDD).
Ebneter DS, Latner JD, O’Brien KS. Just world beliefs, causal beliefs, and acquaintance: associations with stigma toward eating disorders and obesity. Personal Individ Differ. 2011;51(5):618–22. Findings suggest varying causal factors for each of the eating disorders and obesity, as well as the distinctiveness of stigma associated with anorexia nervosa.
Chao Y-H, Yang C-C, Chiou W-B. Food as ego-protective remedy for people experiencing shame. Experimental evidence for a new perspective on weight-related shame. Appetite. 2012;59(2):570–5.
Eisenberg ME, Berge JM, Fulkerson JA, Neumark-Sztainer D. Associations between hurtful weight-related comments by family and significant other and the development of disordered eating behaviors in young adults. J Behav Med. 2012;35(5):500–8.
Goldschmidt AB, Wall M, Loth KA, Le Grange D, Neumark-Sztainer D. Which dieters are at risk for the onset of binge eating? A prospective study of adolescents and young adults. J Adolesc Health. 2012;51(1):86–92.
Zeeck A, Stelzer N, Linster HW, Joos A, Hartmann A. Emotion and eating in binge eating disorder and obesity. Eur Eat Disord Rev. 2011;19(5):426–37.
Brauhardt A, Rudolph A, Hilbert A. Implicit cognitive processes in binge-eating disorder and obesity. J Behav Ther Exp Psychiatry. 2014;45(2):285–90.
Puhl RM, White MA, Paris M, Anez LM, Silva MA, Grilo CM. Negative weight-based attitudes in treatment-seeking obese monolingual Hispanic patients with and without binge eating disorder. Compr Psychiatry. 2011;52(6):737–43.
Barnes RD, Ivezaj V, Grilo CM. An examination of weight bias among treatment-seeking obese patients with and without binge eating disorder. Gen Hosp Psychiatry. 2014;36(2):177–80.
Pearl RL, White MA, Grilo CM. Overvaluation of shape and weight as a mediator between self-esteem and weight bias internalization among patients with binge eating disorder. Eat Behav. 2014;15(2):259–61. doi:10.1016/j.eatbeh.2014.03.005.
Burmeister JM, Carels RA. Television use and binge eating in adults seeking weight loss treatment. Eat Behav. 2014;15(1):83–6.
Wingfield N, Kelly N, Serdar K, Shivy VA, Mazzeo SE. College students’ perceptions of individuals with anorexia and bulimia nervosa. Int J Eat Disord. 2011;44(4):369–75.
Rousseau A, Callahan S, Chabrol H. Representations and beliefs about eating disorders in a sample of French adolescents. Int J Eat Disord. 2012;45(2):247–51.
Furnham A, Davidson L. Sex differences in beliefs about bulimia nervosa. Soc Psychiatry Psychiatr Epidemiol. 2012;47(1):67–77.
McLean SA, Paxton SJ, Massey R, Hay PJ, Mond JM, Rodgers B. Stigmatizing attitudes and beliefs about bulimia nervosa: gender, age, education and income variability in a community sample. Int J Eat Disord. 2014;47(4):353–61.
Angermeyer MC, Mnich E, Daubmann A, Herich L, Wegscheider K, Kofahl C, et al. Biogenetic explanations and public acceptance of people with eating disorders. Soc Psychiatry Psychiatr Epidemiol. 2013;48(10):1667–73. This survey of the general population provides information about the nature and extent of stigma associated with anorexia nervosa and bulimia nervosa.
von dem Knesebeck O, Mnich E, Kofahl C, Makowski AC, Lambert M, Karow A, et al. Estimated prevalence of mental disorders and the desire for social distance—results from population surveys in two large German cities. Psychiatry Res. 2013;209(3):670–4.
Mannarini S, Boffo M. Anxiety, bulimia, drug and alcohol addiction, depression, and schizophrenia: what do you think about their aetiology, dangerousness, social distance, and treatment? A latent class analysis approach. Soc Psychiatry Psychiatr Epidemiol. 2014;50(1):27–37.
Mond JM, Arrighi A. Perceived acceptability of anorexia and bulimia in women with and without eating disorder symptoms. Aust J Psychol. 2012;64(2):108–17.
Pearl RL, Lebowitz MS. Beyond personal responsibility: effects of causal attributions for overweight and obesity on weight-related beliefs, stigma, and policy support. Psychol Health. 2014;1–29.
Black MJ, Sokol N, Vartanian LR. The effect of effort and weight controllability on perceptions of obese individuals. J Soc Psychol. 2014;154(6):515–26. just-accepted.
Persky S, Eccleston CP. Impact of genetic causal information on medical students’ clinical encounters with an obese virtual patient: health promotion and social stigma. Ann Behav Med. 2011;41:363–72.
Diedrichs PC, Barlow FK. How to lose weight bias fast! Evaluating a brief anti-weight bias intervention. Br J Health Psychol. 2011;16:846–61.
Swift JA, Tischler V, Markham S, Gunning I, Glazebrook C, Beer C, et al. Are anti-stigma films a useful strategy for reducing weight bias among trainee healthcare professionals? Results of a pilot randomized control trial. Obes Facts. 2013;6(1):91–102.
Poustchi Y, Saks NS, Piasecki AK, Hahn KA, Ferrante JM. Brief intervention effective in reducing weight bias in medical students. Fam Med. 2013;45(5):345–8.
Lippa NC, Sanderson SC. Impact of informing overweight individuals about the role of genetics in obesity: an online experimental study. Hum Hered. 2013;75(2–4):186–203.
Lippa NC, Sanderson SC. Impact of information about obesity genomics on the stigmatization of overweight individuals: an experimental study. Obesity. 2012;20(12):2367–76.
Dryer R, Tyson GA, Kiernan MJ. Bulimia nervosa: professional and lay people’s beliefs about the causes. Aust Psychol. 2013;48(5):338–44.
Dryer R, Uesaka Y, Manalo E, Tyson G. Cross-cultural examination of beliefs about the causes of bulimia nervosa among Australian and Japanese females. Int J Eat Disord. 2014. doi:10.1002/eat.22269.
Jones WR, Saeidi S, Morgan JF. Knowledge and attitudes of psychiatrists towards eating disorders. Eur Eat Disord Rev. 2013;21(1):84–8. This study documents perspectives from psychiatrists about their attitudes towards and perceived competency for treating anorexia nervosa and bulimia nervosa.
Gonçalves SF, Machado BC, Martins C, Machado PP. Eating and weight/shape criticism as a specific life-event related to bulimia nervosa: a case control study. J Psychol. 2014;148(1):61–72.
Abraczinskas M, Fisak B, Barnes RD. The relation between parental influence, body image, and eating behaviors in a nonclinical female sample. Body Image. 2012;9(1):93–100.
Magallares A. Well-being and prejudice toward obese people in women at risk to develop eating disorders. Span J Psychol. 2012;15(3):1293–302.
Magallares A, Jauregui-Lobera I, Ruiz-Prieto I, Santed MA. Antifat attitudes in a sample of women with eating disorders. Nutr Hosp. 2013;28(3):649–53.
Griffiths S, Mond JM, Murray SB, Touyz S. Young peoples’ stigmatizing attitudes and beliefs about anorexia nervosa and muscle dysmorphia. Int J Eat Disord. 2014;47(2):189–95.
Bannatyne AJ, Abel LM. Can we fight stigma with science? The effect of aetiological framing on attitudes towards anorexia nervosa and the impact on volitional stigma. Aust J Psychol. Jun. 2014.
Darby AM, Hay PJ, Mond JM, Quirk F. Community recognition and beliefs about anorexia nervosa and its treatment. Int J Eat Disord. 2012;45(1):120–4.
Watters JE, Malouff JM. Perceived personality traits of individuals with anorexia nervosa. Clin Psychol. 2012;16(3):118–22.
Zwickert K, Rieger E. Stigmatizing attitudes towards individuals with anorexia nervosa: an investigation of attribution theory. J Eat Disord. 2013;1:5.
Maier A, Ernst JP, Müller S, Gross D, Zepf FD, Herpertz-Dahlmann B, et al. Self-perceived stigmatization in female patients with anorexia nervosa—results from an explorative retrospective pilot study of adolescents. Psychopathology. 2014;47(2):127–32. This study documents the perspectives from former adolescent patients.
Sabin JA, Marini M, Nosek BA. Implicit and explicit anti-fat bias among a large sample of medical doctors by BMI, race/ethnicity and gender. PLoS ONE. 2012;7(11):e48448.
Phelan SM, Dovidio JF, Puhl RM, Burgess DJ, Nelson DB, Yeazel MW, et al. Implicit and explicit weight bias in a national sample of 4,732 medical students: the Medical Student CHANGES Study. Obesity. 2014;22(4):1201–8.
Puhl RM, Luedicke J, Grilo CM. Obesity bias in training: attitudes, beliefs, and observations among advanced trainees in professional health disciplines. Obesity (Silver Spring). 2014;22(4):1008–15.
Puhl R, Peterson JL, Luedicke J. Motivating or stigmatizing? Public perceptions of weight-related language used by health providers. Int J Obes (Lond). 2013;37(4):612–9.
Volger S, Vetter ML, Dougherty M, Panigrahi E, Egner R, Webb V, et al. Patients’ preferred terms for describing their excess weight: discussing obesity in clinical practice. Obesity (Silver Spring). 2012;20(1):147–50.
Kushner RF, Zeiss DM, Feinglass JM, Yelen M. An obesity educational intervention for medical students addressing weight bias and communication skills using standardized patients. BMC Med Educ. 2014;14(1):53.
Puhl RM, Latner JD, King KM, Luedicke J. Weight bias among professionals treating eating disorders: attitudes about treatment and perceived patient outcomes. Int J Eat Disord. 2014;47(1):65–75.
Puhl RM, Neumark-Sztainer D, Austin SB, Luedicke J, King KM. Setting policy priorities to address eating disorders and weight stigma: views from the field of eating disorders and the US general public. BMC Public Health. 2014;14(1):524.
Karasu SR. Psychotherapy-lite: obesity and the role of the mental health practitioner. Am J Psychother. 2013;67(1):3–22.
McVey GL, Walker KS, Beyers J, Harrison HL, Simkins SW, Russell-Mayhew S. Integrating weight bias awareness and mental health promotion into obesity prevention delivery: a public health pilot study. Prev Chron Dis. 2013;10:E46.
The authors gratefully acknowledge support for this research from the Rudd Foundation.
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Rebecca Puhl and Young Suh declare that they have no conflict of interest.
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This article does not contain any studies with human or animal subjects performed by any of the authors.
This article is part of the Topical Collection on Eating Disorders
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Puhl, R., Suh, Y. Stigma and Eating and Weight Disorders. Curr Psychiatry Rep 17, 10 (2015). https://doi.org/10.1007/s11920-015-0552-6
- Eating disorders
- Physical health
- Psychological health