What Is Weight Discrimination & How Does It Affect Us? UCLA Researcher A. Janet Tomiyama Has Answers

A. Janet Tomiyama, Ph.D., is an associate professor at UCLA.  She studies health psychology and social psychology.

​Tovar: How did you end up researching weight discrimination?
Tomiyama: I first studied low calorie dieting and why it didn't work. The evidence was so overwhelming that restrictive dieting was counterproductive. The many non-academics I talked to all seemed to know that already, yet they kept starting new diets. The question for me was: Why?? Why would people do something that they found dreadful and that they knew would not contribute to long-term weight loss? The answer, it seemed to me, was the high levels of anti-fat bias and weight stigma that exists in our society. That was what pushed me into weight stigma research.

Tovar: What does weight discrimination look like?
Tomiyama: We are just wrapping up a study to answer exactly that question. In it, we had participants text us quick descriptions of weight stigma that they experienced as they went about their daily lives. I can tell you that weight stigma exists in all the domains of our lives: close relationships, the workplace, healthcare, education, from strangers, and the media. Sometimes it's blatant, like a physician discouraging a (fat) patient from getting pregnant because she is "too fat." Sometimes it's subtle, like not people not making eye contact with (fat) individuals.  
 
Tovar: What are the effects of weight stigma on individuals experiencing it? 
Tomiyama: It makes people feel bad and harms their mental health. Weight stigma is linked to depression, anxiety, and eating disorder symptoms.  Others' research has linked weight discrimination with inflammation and even mortality risk.
 
Tovar: People always ask me about how ending fatphobia is compatible with promoting health. What would your answer to this question be? 
Tomiyama: You can improve health -- for anyone -- without ever mentioning the "w" word (weight). People, whatever shape or size they are, can benefit from eating more fruits and veggies, moving around more, getting better sleep, and getting a handle on their stress. There is no need to know about weight, change weight, or certainly denigrate (fat) people in order to achieve health.
 
Tovar: What are the correlations between weight discrimination and education outcomes? 
Tomiyama: Research has shown that, for example, (fat) graduate school applicants receive fewer admissions offers than lower BMI applicants after the interview stage. We've found that (fat) individuals receive less financial support from their parents for their college education, and this was particularly true of daughters. There's a lot of work showing that weight-based bullying is extremely common, and you could see easily how being bullied leads to poorer educational outcomes.
 
Tovar: What could the potential (health, education, etc.) outcomes of ending weight discrimination be?  
Tomiyama: That would eliminate the negative mental and health outcomes that I mentioned earlier. As I'll go into later, I do not think the nation's hysteria about "obesity" is warranted. 
 
Tovar: You have written about the ineffectiveness of diets. Can you explain how you came to that conclusion? 
Tomiyama: I had read diet study after diet study that showed initial weight loss and then weight regain (oftentimes more weight gained back than lost on the original diet!). As a scientist, I couldn't understand why people would still advocate for the use of calorie-restricting diets given these kinds of studies. Traci Mann and my colleagues decided to gather every single weight loss study that followed participants for at least 2 years to definitely answer the question of: Do diets work? We found the answer was No, across many different kinds of studies, with the highest quality studies showing the least effectiveness of dieting for long-term weight loss. 
 
Tovar: In a 2016 article, you found that "Using BMI categories as the main indicator of health, an estimated 74,936,678 US adults are misclassified as cardiometabolically unhealthy or cardiometabolically healthy." Can you explain that? And what are the implications of this misclassification?
Tomiyama: There is a widespread assumption that absolutely everyone who has a BMI in the "overweight" or "obese" range is unhealthy. We thought that sounded weird, so we decided to actually look at the data. We looked at two things. First, whether there were any people who had an "overweight" or "obese" BMI but still looked healthy in terms of blood pressure, blood sugar, cholesterol levels, etc. There were lots of those people. Millions. Second, we looked at whether there were people in the "underweight" and "normal" weight BMI who looked UNhealthy according to those indicators. Again, there were lots! So, using BMI falsely accuses millions of high BMI people as being unhealthy, and gives a free pass to millions of people who have lower BMIs yet are actually unhealthy. At the time of my paper, the EEOC (Equal Employment Opportunity Commission) was considering whether to allow insurance companies to charge people with a higher BMI more for their health insurance. So there were big implications for many people's pocketbooks.
 
Tovar: Recently I was looking up the Wikipedia page for the Fat Acceptance Movement (which was clearly written with quite a bit of a bias). The author called it a "pseudo-scientific" movement. I think many people see the fight for fat people's human rights as divorced from science. What's your stance on this?
Tomiyama: I think the science of weight stigma is now undeniable. Both the National Institutes of Health and the National Science Foundation have funded work on weight stigma, showing that it is a worthy, scientific topic. 
 
Tovar: What do you see as the origins of weight stigma? 
Tomiyama: This is a sociological and anthropological question, which is out of my wheelhouse, but as with many forms of stigma, I think it comes down to who has power in a society. For a long time, those at the top of society's ladder had heavier bodies, because they had the resources to buy calories, which were in short supply. There was no weight stigma then. In the current food environment, the situation has flipped, where multiple forces (economic, political, environmental) conspire to make the bodies of those at the top thinner, and now we have widespread weight stigma. 
 
Tovar: Have you found any factors or interventions that offset the stress or effects of weight stigma?  
Tomiyama: This is the "bad news" part of the interview... there is no silver bullet that makes weight stigma disappear. We know from meta-analyses (a study of studies) that everything that's been tested appears to work a tiny bit but not enough to move the needle. We really need fresh ideas in this space.
 
Tovar: Do you feel that the medical field's or academia's stance on weight has shifted at all since you began your work? 
Tomiyama: Absolutely. Now medical departments are reaching out to me to learn about weight stigma. Last year I even gave a keynote address to the US Department of Health and Human Services. 
 
Tovar: Any good news we can otherwise cling to? 
​Tomiyama: Awareness about weight stigma has never been this high. I'm seeing a sea change where people are finally understanding that it's not ok to treat people differently because of the way they look. 

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