Weight shaming appears to be declining more in the US than in the UK

Americans are less likely to blame people with obesity for their condition, and are more likely to believe that obesity has a medical explanation now than 3 years ago, suggest the results of two online surveys involving more than 6,000 UK and US adults, being presented at The European and International Congress on Obesity (ECOICO 2020), held online this year from 1-4 September.

In contrast, attitudes in the UK have remained largely unchanged with nearly one in three adults surveyed in both 2017 and 2020 believing that obesity is the fault of the person with the condition, and rejecting the idea that obesity is a medical problem rather than a matter of choice.

The findings highlight the importance of initiatives aimed at combating societal weight bias, researchers say.

"Weight bias causes both physical and psychological harm to people with obesity. It is an important barrier to progress in reducing its health impact", says Ted Kyle from ConscienHealth, an advocacy organisation in the U.S.. "While attitudes appear to be improving in the U.S., our study finds that blaming people for their weight is still commonplace in both countries."

Previous research suggests that explicit weight bias (overt, consciously held negative attitudes that can be measured by self-report) is more common in the UK than eight other countries including the U.S., and that harsh British attitudes to obesity are hampering efforts to tackle the obesity epidemic.

To explore this further, researchers analysed the responses from a random sample of 6,082 adults from the U.S. and UK who completed anonymous online Google surveys in November 2017 and May 2020 on the causes of obesity. Survey participants were asked their opinion on one of three different statements using a five-point scale (strongly agree to strongly disagree): that obesity is the fault of the person with obesity; that it is not their fault; or that obesity is a problem because people with obesity are blamed for the disease instead of receiving needed medical help. The results were adjusted for gender, age, country, and year.

The analyses found a significant increase in the proportion of US survey respondents agreeing that obesity is a problem because people are blamed for the condition instead of receiving the medical help they need—rising from 30% (108/360) in 2017 to 42% (164/389) in 2020 (see figure 2). But among UK respondents, agreement with the statement remained unchanged at 31% in both 2017 and 2020 (see figure 3). The results suggest that more people in the U.S. than in the UK may now view obesity as a medical problem.

The two countries also appear to be split on whether people with obesity are to blame for their condition. The proportion of US respondents who believe that obesity is the fault of the person with the condition fell from nearly one in three (31%; 115/372) in 2017 to one in four (25%; 93/377) in 2020. However, there was little change in attitude among UK respondents, with around one in three (34%; 144/426) agreeing in both 2017 and 2020 (30%; 110/372).

When asked whether obesity is not the fault of the people who have it, opinions were also divided in 2020, with more UK respondents (49%; 197/404) than US respondents (40%; 158/394) disagreeing, but similar proportions agreeing (16% vs 15%, figure 4). Overall, the responses reflect significantly less blame in the US than in the UK, researchers say.

"If someone has excess weight, there may be numerous factors at work, meaning it's not due to poor discipline or willpower", says Joe Nadglowski from the Obesity Action Coalition in the U.S. who co-authored the research. "We'd like to see public policy experts, health professionals, and the media look at these findings, step back and work on ways to challenge and change public perception of obesity. Maybe that's through public education campaigns or strong policies to prevent weight-based discrimination."

The authors note that the primary limitation of their study is that it measures explicit bias (self-reported), and not the implicit attitudes that people might not express.