By Alana Ireland
In recent posts, we have been talking about advocacy in healthcare. There is value in knowing that you can ask questions, request clarification, or speak up about a concern. But there is a risk in stopping there. If people are repeatedly having to advocate around the same kinds of barriers, assumptions, or dismissive experiences, then the problem is not simply whether an individual knows how to speak up. We also need to ask why those barriers are there, who is expected to work around them, and what responsibility healthcare professionals and systems have for changing them.
Weight stigma is one area where this becomes particularly clear. Research has documented weight-based bias and discrimination across healthcare, employment, education, media, and interpersonal settings, and has linked these experiences with both psychological and physical health consequences.1-4 When people in larger bodies are stereotyped, receive different treatment, encounter environments that do not accommodate them, or are excluded from decisions that affect them, we are no longer talking only about an interpersonal attitude. This is inequity. That is why weight stigma belongs within conversations about social justice.
A social justice approach is useful here because it changes where we locate the problem. It asks whether people have equitable access to care and resources, whether they are treated with dignity, whether their perspectives are included in decisions that affect them, and whether institutional practices create disadvantages for some groups. Applied to weight stigma, this means examining how body size can shape people’s access, participation, and experiences of disadvantage, including where weight-related inequities intersect with other forms of marginalization.2 In practical terms, that means we cannot reduce weight stigma to a matter of convincing individual people to be less biased. We also have to look at the conditions in which those biases are produced, reinforced, and translated into practice.
What Weight Stigma and Bias Looks Like in Healthcare
In healthcare, weight stigma is not limited to overt comments or clearly discriminatory encounters. It may involve a provider making assumptions about someone’s eating, movement, motivation, or adherence based on body size. It can involve bringing weight into a conversation when it is unrelated to the reason someone sought care, or failing to investigate a concern adequately because weight is treated as the most likely explanation. It can also be structural, such as chairs, gowns, examination tables, blood pressure cuffs, or other equipment that do not adequately accommodate a range of bodies. These examples have all been documented in the literature on weight stigma in healthcare.3
These examples point to different sources of weight stigma within healthcare. Some may be addressed through better training and greater awareness of provider assumptions, while others are built into the physical environment, clinical practices, or policies that shape care. Self-advocacy may help someone navigate a particular encounter, but it does not address those broader conditions, and it should not leave the person experiencing stigma responsible for correcting them.
There is also a broader issue in how body weight is interpreted. Weight is often treated as though it tells us far more than it actually does about a person’s behaviour, health, effort, or self-discipline. Across different areas of weight-bias research, beliefs about personal control have repeatedly been linked with greater blame and more negative judgments toward people in larger bodies.1,3 We need to stop treating body size as a simple proxy for behaviour, character, or health.
Weight Stigma in a Broader Cultural Context
The assumptions that appear in healthcare are reinforced well beyond healthcare settings. Media, public health campaigns, advertising, and everyday conversations all contribute to ideas about which bodies are considered healthy, disciplined, attractive, or acceptable. Research has shown that stigmatizing portrayals of people in larger bodies can increase negative attitudes, and some public health messages that emphasize personal responsibility for weight can also reinforce weight bias broadly.3,4
This is one reason it is not enough to tell people to feel better about their bodies or become more resilient in the face of stigma. Those approaches may be useful for some people, particularly when they are dealing with internalized weight stigma or shame, but they do not address the environments that continue to communicate that some bodies are less acceptable than others. If the cultural message remains unchanged, then the individual is being asked to adapt to a problem that is still being actively reproduced around them.
Weight stigma also does not operate separately from other forms of inequity. Experiences can differ depending on gender, race, socioeconomic circumstances, sexuality, disability, and other aspects of a person’s social position. Research using an intersectional lens has drawn attention to these differences and to the ways multiple forms of marginalization can shape both exposure to stigma and its consequences.2 For us, that means a social justice approach to bodies cannot be reduced to simply adding body size to a list of identities. It requires attention to how different systems of power and disadvantage overlap in people’s actual experiences.
Psychology’s Role in Addressing Weight Stigma
Psychology has traditionally been very good at locating problems within individuals. We assess thoughts, emotions, behaviour, coping, relationships, and symptoms, and those are all legitimate areas of psychological work. But there are limits to what we can understand if we focus too narrowly on the person in front of us.
Examining Psychology’s Own Approach to Weight
We also need to examine how this individual focus has shaped psychology’s own approaches to weight. Within parts of health psychology and behavioural medicine, body weight has often been treated as an outcome to be changed through interventions targeting eating, physical activity, and other health behaviours. In doing so, the distinction between behaviour and body size can become blurred. Weight is not itself a behaviour, and using weight loss as an indicator of behavioural success can reinforce the assumption that body size primarily reflects individual choices or effort.
The limits of an individual focus become particularly clear when someone is distressed because they have repeatedly been judged, dismissed, excluded, or treated differently because of their body. It would be incomplete to frame that distress only as a problem of self-esteem, body image, coping, or assertiveness. Therapy may still help with the emotional consequences of those experiences, including internalized stigma, shame, avoidance, or self-criticism. At the same time, psychology also needs to recognize when distress is being produced or intensified by social conditions.
This is where the social justice literature within counselling psychology is especially useful. It asks psychologists to work at more than one level: supporting individuals while also examining the assumptions, practices, and structures that shape their experiences. It also emphasizes reflexivity, including attention to our own biases and to whose knowledge is treated as credible in research, education, and practice.2
For psychologists, that can mean examining how we talk about weight in assessment and case conceptualization, whether we infer eating or movement behaviours from body size, what we teach trainees about weight and health, and whether our clinical environments are actually suitable for the people we serve. It also means listening carefully when clients describe discriminatory or stigmatizing experiences rather than automatically interpreting the problem as a distorted perception or an individual difficulty to be corrected.
Our role can extend beyond the therapy room as well. Psychologists teach, supervise, conduct research, work on interdisciplinary teams, provide professional education, and contribute to public conversations about health. Those are all opportunities to challenge assumptions that reproduce weight stigma and to support approaches that include the perspectives of people with lived experience in decisions about research, practice, and policy. Both the counselling psychology literature and more recent public health work identify this kind of participation as an important part of reducing weight-based inequity.2,4
Why Self-Advocacy is Not Enough to Address Weight Stigma
There is still a place for self-advocacy. People may want to ask questions, request that a concern be investigated more fully, decline an unnecessary weigh-in, or raise concerns about how they are being treated. Those are practical tools for navigating the healthcare system as it currently exists.
But self-advocacy should not become our solution to weight stigma. If the same types of barriers are occurring across healthcare settings, professional practices, public messaging, and policy, then responsibility for addressing them has to extend beyond the person experiencing them. The literature points to changes in professional education, healthcare environments, communication, policy, and legal protections, as well as greater involvement of people with lived experience in developing responses to weight stigma.3,4
There is still disagreement across medicine, obesity research, eating-disorder research, psychology, public health, and fat studies about how body weight should be conceptualized and what role it should have in healthcare. That disagreement is real, and it should not be glossed over. At the same time, there is substantial common ground that weight stigma causes harm and should not be accepted as an inevitable part of healthcare or public health practice.1,4
For us, this is where the social justice framing becomes most useful. It allows us to support people in advocating for themselves without suggesting that they should have to carry responsibility for fixing the systems they are navigating. It also asks more of those of us who work within those systems: to examine our own practice, to notice where inequities are being reproduced, and to contribute to changing the conditions that make individual advocacy necessary so often in the first place.
References
- Nutter, S., Russell-Mayhew, S., Alberga, A. S., Arthur, N., Kassan, A., Lund, D. E., Sesma-Vazquez, M., & Williams, E. (2016). Positioning of weight bias: Moving towards social justice. Journal of Obesity, 2016, Article 3753650. https://doi.org/10.1155/2016/3753650
- Nutter, S., Russell-Mayhew, S., Arthur, N., & Ellard, J. H. (2018). Weight bias as a social justice issue: A call for dialogue. Canadian Psychology/Psychologie canadienne, 59, 89–99. https://doi.org/10.1037/cap0000125
- Pearl, R. L. (2018). Weight bias and stigma: Public health implications and structural solutions. Social Issues and Policy Review, 12(1), 146–182.
- Puhl, R. M. (2025). Facing challenges for reducing weight stigma in public health policy and practice. Annual Review of Public Health, 46, 133–150. https://doi.org/10.1146/annurev-publhealth-060722-024519
