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Running Head: HEALTHISM AND WEIGHTISM

Social Problem: Healthism and Weightism

Kiki Kline

University of Denver
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Introduction

Healthism is a social issue experienced by shame for engaging in socially deemed non-

healthy behaviors. It’s an attitude of prejudice that remains to stay hidden behind more well-

known forms of discrimination. The ideology behind behavior and lifestyle decisions often

targets weight as a focal point. As such, the discrimination of weight called weightism blames

body size for disease and failure to achieve wellbeing. Healthism and weightism have become

social justice issues, as they not only marginalize groups of people, but contribute to serious

health consequences. Social work has an opportunity to unmask the socially acceptable form of

prejudice and respond to the task of fostering individual and societal wellbeing. We must

understand the historical context of such issues, how they appear individually and in the social

environment, why it is important for social work to address the problem, and then look towards

applications of interventions and preventions.

Historical Analysis

Medicalization of lifestyle behaviors and weight has shaped societal norms of wellbeing

for more than a century. The biomedical model of health appeared in practice in the late 1900s

with a focus on ridding diseases (Guttmacher, 1979). Public dissatisfaction of the definition in

the 20th century brought the World Health Organization (WHO) to redefine health in the 1940s as

“a state of complete physical, mental, and social wellbeing and not merely the absence of disease

or infirmity (WHO, 2005).” New approaches in medicine and public health were guided by a

moral ideology of health with the framework that an impure mind or body lead to disease

(Crawford, 1980). The term “healthism” was first used in a 1980 academic journal to describe

the development of self-help, self-care, and disease as an emerging political movement.

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A major tenant of healthism is focused around body size as causal to disease. From the

1970’s to 1990’s weight and height trends increased and The Centers for Disease Control and

Prevention (CDC) responded by classifying obesity as a disease. Lorie McMichael, a fat activist

and scholar argues that in 1997 William Deets, Director of the Division of Nutrition and Physical

Activity at the CDC publicly stated that the drastic increase in weight trends was an ‘epidemic’

(2013). Public health noted fat bodies as symptomatic for disease were to blame for threatening

the wellbeing of a society and its citizens (McMichael, 2013).

Problem Identification

Unrecognized cultural biases on health and weight creates stigma. Healthism is

experienced amongst Western culture and typically associated with weight. Weightism is

experienced by 5% of men and 10% of women in the general population, 24% of African

American women, and 40% for those with a BMI greater than 34 (Puhl, Andreveva, & Brownell,

2008). Weight discrimination is the third most prevalent cause of perceived discrimination

among women, only after gender and age, and fourth among all adults after gender, age, and race

(Puhl, Andreveva, & Brownell, 2008).

Assumed Causes

A major contribution to healthism is the medicalization of weight. The Body Mass Index

(BMI) scale is widely used by medical professionals to classify weight ranges and diagnosis a

disease of obesity based on body size. The initial intention of the BMI was to be used as an

instrument for population studies to measure body weight in relation to height (McMichael,

2013). Although the tool was not meant for individual evaluation, the BMI became popular for

insurance companies to use as a measurement of health and subsequent out-of-pocket expenses

(McMichael, 2013). Proponents of the BMI state that wellness can be predicted by staying within
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the mid BMI range of 18.5-24, where co-morbid disease probability increases with higher BMI

(Tylka et al., 2014). However, others criticize the generalizable health predictions without also

considering biological or behavioral factors (Sabin, Marini, & Nosek, 2012).

Stigma of poor health behaviors and large body size may be from cultural and systemic

contributions that puts the ownness of health onto the responsibility of an individual.

Neoliberalism is a cultural attitude that places individual responsibility on personal attributes.

Two central ideals to neoliberalism concern the consequence of choice and minimal government

intervention. Nike Ayo (2012) believes healthism from neoliberalist approaches starts through

the intention of health promotion. Public health interventions stem from the idea that individuals

are encouraged to take full responsibly of their health. This allows systems and institutions to

sidestep blame for faulty initiatives and continue to hold oppressive power.

Prejudice of health and body size are largely reinforced by systems of power through

messaging of industries motivated by financial incentives (Ayo, 2012). Corporations involved in

healthcare, food sourcing and regulation, and diet and weight loss benefit from business created

under the appearance of ‘health.’ Words like ‘healthy’, ‘organic’, natural’, and ‘wellbeing’ as

well as ‘skinny’, ‘light,’ and ‘thin’ are used to describe products, reiterating the importance of

health and a slender body type.

Consequences

Health trends over the last few decades show a rise in both eating disorders and obesity

(CDC, 2019), showing relationships between physical size and psychiatric concerns. Prevalence

rates for eating disorders vary by diagnosis, up to 6% of the population clinically diagnosed and

13% report subclinical status (Hudson, Hiripi, Pop, & Kessler, 2007; Touchette et al., 2011). In

the United States 40% of adults are diagnosed as obese, however, 30% of overweight individuals
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who seek treatment may be psychologically misdiagnosed engaging in disordered eating

symptoms of binge eating or compulsive overeating (CDC, 2019; Puhl & Suh, 2015).

Adolescents with a BMI at 85% above population averages are at increased risk for developing a

restrictive disorder later on (Lebow, Sim, & Kransdorf, 2015) and people with diagnosed eating

disorders have a greater than 30% chance of later becoming classified as obese (Puhl & Suh,

2015).

Even kids are subject to the effects of over half of the American population having issues

with relationships to food and their body (Ortega-Luvando et al., 2015; Reba-Harrelson et al.,

2009; Nagata, Garber, Tabler, Murray, & Bibbins-Domingo, 2018). A study by Meers, Koball,

Oehlhof, Laurene, & Musher-Eizenman (2011) found that preschoolers display fat-bias towards

others and internalized stigma towards themselves. Undertones of being ‘fat’ and ‘unhealthy’ as

wrong may come from implicit messaging made by adults in children’s’ movies with derogatory

depictions of large bodies and negative attitudes towards unhealthy foods, and well-intentioned

initiatives by former First-Lady Michelle Obama with a weight-loss motivated Healthy Kids

Campaign (Throop, Skinner, Perrin, Steiner, Odulana, & Perrin, 2013).

Ideal

Counter ideals to healthism and weight bias include neutral health attitudes and weight

inclusivity, including systemic support to health as a resource of wellbeing. Unfortunately, those

that impact systemic norms on health, food, and weight such as policymakers and large health

agencies argue that poor health behaviors place a fiscal and social burden on society, eating up

societal resources (Tylka et al., 2014; Tremmel, Gerdtham, Nilsson, & Saha, 2017). However,

Linda Bacon founder of Health at Every Size (HAES)®, an alternative approach to health

behaviors and weight, claims that body size is not to blame for the negative impacts on society,
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but instead we must focus on the health behaviors themselves as a more pressing contributor to

health (Bacon & Aphramore, 2011).

Interventions/Advocacy Steps at the Micro, Mezzo, and Macro Levels

Micro, mezzo, and macro initiatives may be employed to grow towards weight-inclusive

attitudes of health in the helping professions (see Table 1). Historically, social work has seen

obese clients from a medicalization of weight lens, with research stating the negative impact on

client relationships (Laurence, Hazlett, & Abel, 2012; Eliadis, 2006). Furthermore, medical

professionals often show implicit and explicit bias of weight and health, hindering larger-bodied

individuals from seeking all types of medical help (Sabin, Marini, & Nosek, 2014).

Health at Every Size Approach

Focusing on the utilization of health behaviors as a resource for quality of life may be

effective for future interventions. Health at Every Size (HAES)® is a trademarked approach to

physical and mental health and wellbeing claiming weight is not causal for disease and health

behaviors are resources that promote quality of life. HAES is claimed to be effective for overall

health improvement and is recommended to be used as the official health suggestion of

practitioners working with clients on body, food, or health concerns (Tylka et al., 2014). An

analysis of six research studies employing various types of HAES interventions showed positive

effects for physiologic, psychosocial, and health-related behaviors. Furthermore, in a 2018 meta-

analysis of interventions contributing to health-related variables, the HAES approach showed

significant improvements over weight-loss interventions on health practices, biological, and

psychological measures (Ulian et al.). Focusing on body acceptance, internal regulatory

processes, and active embodiment (consciously being in ones' body) improves overall biological,

psychological, and social wellbeing (Bacon & Aphramor, 2011).

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Systemic approaches for healthism and weight bias can also be carried out through the

framework of HAES. Micro-level change includes rejecting healthist behaviors and internalized

weight stigma for ourselves and our clients. On a mezzo-level, education on awareness and

advocacy efforts for large institutions allows a new understanding of the widely accepted

prejudice of health and weight present at schools and the workplace (Tremmel, Gerdtham,

Nilsson, & Saha, 2017). Macro initiatives may work towards creating legislation and

organizational best-practices to change systemic attitudes from engaging in harmful health habits

for weight-loss to practicing health behaviors for wellbeing.

Advocacy Organizations

The HAES approach has attracted grassroots organizing to mobilize the message of

evidence-based anti-diet approaches to quality of life. Organizations such as Health at Every

Size®, The Eating Disorders Coalition (EDC), Be Nourished, and Association for Size Diversity

and Health gather to develop educational curriculum, offer support, and advocate for policy

change. Interventions and educational efforts promoting anti-weight stigma have resulted in

greater awareness of the need to address weight bias and decreased prejudice towards individuals

of a larger body size (McVey, Walker Beyers, Harrison, Simkins, and Russel-Mayhew, 2013).

Table 1

Recommendations of social work interventions at micro, mezzo, and macro levels

Advocacy Prevention Intervention/Treatment

Micro  Awareness of self-biases
 Self-practice of HAES
(Association of Size Diversity
and Health [ASDAH], 2019)
Mezzo  Social media campaigns
 Assert education in  Medical professional
personal interactions individual client
 Preventative health interaction with HAES
attitudes yielding health lens (Tylka et al.,
as a resource (Puhl, 2011)
Neumark-Sztainer,
Austin, Luedicke, &
King, 2014)
 Healthism education for  Group therapy with
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promoting social justice for
relationship to food and bodies
(ASDAH, 2019)
Macro  Legislation to address factors
perpetuating healthism and
weight bias (EDC, 2019)
 Cost and accessibility of produce
 FDA regulations for addiction
prone food ingredients
 Media regulations of body size
(EDC, 2019)
 Media/advertising content
regulations (EDC, 2019)
medical professionals HAES approach
and schools (Puhl et al., (ASDAH, 2019)
2014)
 CDC and WHO  Insurance company
workgroups to adopt standards of coverage
policy and initiatives of relative to weight
health and weight neutral (EDC, 2019)
approaches to health  Research and
(ASDAH, 2019) interventions for eating
disorders and obesity
overlap

Summary

Healthism and weightism are social justice issues from biased attitudes and approaches to

health. With what emerged as an attempt to promote wellbeing and prevent disease (WHO, 2005;

McMichael, 2013), brought socially acceptable forms of discrimination of health and weight

through medicalization, neoliberal attitudes, and influences of large industries and policy

initiatives. A neutrality of health attitudes and weight inclusivity can be achieved with a HAES

 approach on the micro, mezzo, and macro levels. The field of social work has an opportunity

to foster health as a resource to wellbeing and promote health behaviors as a means to quality of

life regardless of body size.

Limitations of the Paper

Healthism is an uncommon term with a loaded definition and has not been studied as

often as weight bias. Weightism falls under healthism and can be found in academic journals

targeted towards eating disorders, obesity, public health and public policy, psychology, nutrition

and dietetics, social justice, and medicine. Social work has fallen behind in addressing healthism,

and as such small-scale and partial approaches to solve the social problem of biased attitudes and

misinformed views of wellbeing by health and body size have not been conducive to social
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change. This paper is only a starting point to a bigger discussion on social work interventions,

prevention efforts, and systemic change to healthism and weightism.

Recommendations for Future Research and Advocacy

Future research is needed from a multidimensional approach with issues of personal and

societal relationships with food and the body in lieu of health. Longitudinal research as well as

data on individual and societal comparisons of the Health at Every Size approach may increase

awareness and provide stronger evidence for a stigma-free approach to health. Subsequently,

fields addressing obesity and eating disorders need to work together on collaborative solutions

for systemic changes on health behaviors and body size. Social work has the ability to bring

together otherwise fragmented fields and institutions to organize long-term and permanent

solutions to healthism.

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