Running head: ANTI-FAT BIAS IN HEALTHCARE

Anti-Fat Bias: Medias Influence on Obesity Stigma

and its Impact on Healthcare for Women with Lipoedema
Catherine Seo
Fielding Graduate University

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Abstract

Medias influence is far reaching. Nowhere does it have more impact than on the
internalized and externalized images the culture projects about womens bodies. Perfect idealized
images of women, impossible to attain and maintain, are disempowering and lead to widespread
stigma and discrimination. Lipoedema, an inherited genetic Fat Disorder, affects 11% of women
of all sizes, from extremely thin to the morbidly obese, resulting in localized fat that is bilateral,
symmetrical and usually from the waist to just above the ankles. Unlike normal fat of obesity,
lipoedemic fat cannot be lost through diet and exercise.
Anti-fat bias is common and along with a lack of knowledge about lipoedema among
healthcare professionals generally results in misdiagnosis for women with the disorder. Despite
its medical vs. cosmetic nature, lipoedema is often confused with obesity and women are judged,
shamed and blamed by healthcare professionals, either implicitly or explicitly. Women learn a
sense of powerlessness in the face of anti-fat bias, and fail to advocate for themselves in
healthcare situations. Cognitive understanding about lipoedema and mindfulness meditation are
two interventions that can increase self-efficacy and self-caring, especially for women with
lipoedema, allowing them to advocate for themselves in receiving appropriate quality healthcare.
Keywords:
Obesity, body image, anti-fat bias, healthcare, stigma, lipoedema, fat disorders, learned
helplessness, self-efficacy, self-caring, mindfulness meditation

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Table of Contents

Abstract .......................................................................................................................................... 2
Anti-Fat Bias: Medias Influence on Obesity Stigma and its Impact on Healthcare for
Women with Lipoedema............................................................................................................... 4
Stigma............................................................................................................................................. 5
Obesity Stigma ............................................................................................................................ 5
Obesity: An Escalating Crisis ...................................................................................................... 6
Body Mass Index (BMI) ............................................................................................................. 6
Medias Influence in Obesity Stigma .......................................................................................... 7
Media Effects: Consequences of Obesity Bias ........................................................................... 8
Social Implications of Media Images ......................................................................................... 9
Social Stigma of Obesity .......................................................................................................... 10
Controllability ....................................................................................................................... 10
Anti-fat Bias in Healthcare ........................................................................................................ 12
Explicit and Implicit Anti-fat Bias in Healthcare ..................................................................... 12
Lipoedema: Genetic Inherited Fat Disorder ............................................................................. 14
Impact of Anti-fat Bias on Womens Health ............................................................................ 14
Survey Responses .................................................................................................................. 14
Anti-Fat Bias: Awareness, Resiliency and Tools for Healing ................................................. 15
Healthcare Awareness: Educating Healthcare Professionals.................................................... 16
Social Awareness: Social Support ............................................................................................ 17
Personal Awareness: Mindfulness, Compassion & Advocacy ................................................. 18
Conclusion: Words of Wisdom from Oprah Winfrey ............................................................. 19
References ..................................................................................................................................... 21

ANTI-FAT BIAS IN HEALTHCARE

Anti-Fat Bias: Medias Influence on Obesity Stigma

and its Impact on Healthcare for Women with Lipoedema
Perfect idealized images of women barrage us through the media. Slender, tall, flawless
creatures of desire that appear with a sense of glamor are used again and again to objectify
someone elses image of women and sexuality. These images certainly dont represent a true
image of reality. When most women look into the mirror, thats not at all what they see or
experience, or in truth, want to look like. This media proliferation influences and perhaps
contributes to the cause of many complex issues for girls and women including disordered
eating, body distortions, body and identity shame and numerous radical behaviors in an attempt
to fit into this idealized unrealistic expectation. Paramount to this visual assault is the stigma and
anti-fat bias that has become an integral part of our cultural meme.
Those struggling with body size and body image are internally affected as well as
stigmatized by many of those interacting with them, including and most especially their
healthcare providers. Anti-fat bias affects the general population and has significant impact on
patients by their healthcare providers who explicitly or implicitly carry that prejudice into their
interactions with those who are overweight or obese. The consequence for women with a genetic
hereditary fat disorder, lipoedema, can be particularly critical since misdiagnosis and lack of
treatment exacerbates the condition and as the disorder progresses can lead to dire complications
and for some immobility.
This paper first explores the definition and the causes of stigma and reviews the specifics
of the rising obesity crisis. Then it goes on to examine medias contribution briefly reviewing the
impact of media images, and medias influence in creating the narrative and contributing to a
culture of anti-fat bias, most especially in healthcare. In addition, the prevalence of anti-fat bias,

ANTI-FAT BIAS IN HEALTHCARE

both explicit and implicit, and its impact on womens health is explored. Current research is
reviewed on cognitive awareness in understanding the role of stigma, especially in relationship to
obesity and fat disorders. Raising awareness in the healthcare system, social support and
mindfulness meditation are reviewed as coping strategies and elements of change in dealing with
weight stigma.
Stigma
Stigma is defined as an extreme form of disapproval or rejection, deeply discrediting,
in essence, disgrace that separates someone from the norm. Social stigma, as defined by
Goffman, includes the concept of an aberration of social identity. For instance, there exists a
normative expectation that most people adhere to, but those outside that norm, possess an
attribute that makes them different from others, are considered deviants who are reduced in our
minds from a whole and usual person to a tainted, discounted one (1963, p. 2-3). There exists a
fundamental belief that the stigmatized person is not quite human (Goffman, 1963, p. 5).
Referring to Goffmans seminal work, Kurzban and Leary further detail stigma as a
process of global devaluation of an individual who possesses a deviant attribute. Stigma
arises during a social interaction when an individual's actual social identity (the attributes
he or she can be proved to possess) does not meet society's normative expectations of the
attributes the individual should possess (his or her virtual social identity). Thus, the
individual's social identity is spoiled, and he or she is assumed to be incapable of
fulfilling the role requirements of social interaction (2001, p. 187).
Obesity Stigma
Though prejudice and judgment continue to exist within many cultural conditions such as
race, gender orientation and class, there has been progress in identifying and abating the intensity

ANTI-FAT BIAS IN HEALTHCARE

of the stigma and prejudice within these categories. However, overweight and obesity, especially
in light of the rising epidemic, which has reached crisis proportions, still, remains the deviant
attribute to which a lack of compassion gets applied. In fact, it's probably the last stigma where
open ridicule and harassment are often supported.
As Puhl and Heuer from the Yale University Rudd Center for Food Policy & Obesity
reported, Obese individuals are highly stigmatized and face multiple forms of prejudice and
discrimination because of their weight. The prevalence of weight discrimination in the United
States has increased by 66% over the past decade (2009, p. 941).
Obesity: An Escalating Crisis
Overweight and obesity continue to escalate despite the rising diet industry and numerous
interventions offered to and attempted by those struggling with obesity. The Centers for Disease
Control (CDC) reported in the National Health and Nutrition Examination Survey (NHANES)
Data Brief that more that 70 % of adults and 33 % of youth in the U.S. are either overweight or
obese (2012). These numbers continue to rise. The Department of Health in the U.K. reported in
its Public Policy, classifying 61.3 % of adults and 30 % of children aged between 2 and 15 as
either overweight or obese in England (Soubry, 2013). Predictions continue to show an increase
in the U.K. and as Western eating habits become more widespread globally as well.
Body Mass Index (BMI)
Body Mass Index (BMI) measures body height and weight and is the measurement for
body size. Currently, underweight is defined as Body Mass Index (BMI) < 18.5, normal weight
is defined as (BMI) > 18.5, overweight is defined as (BMI) > 25, and obesity is defined as BMI
> 30. As the trends in obesity have continued to increase globally, additional obesity categories
have been needed to accommodate the rising incidence of morbid obesity and several have been

ANTI-FAT BIAS IN HEALTHCARE

added including severe obesity (Class II, BMI > 35), morbid obesity (Class III, BMI > 40), and
super obese (BMI > 50) (Strum, 2007).
Though issues of body size and obesity affect both genders, women are by far more
impacted, judged and shamed, and the focus of this paper is on those issues. Medias influence is
paramount in sculpting the story of thin/fat, and what and how a womens body should look like,
across cultures. Obesity is referred to in the media as a crisis. The graphic below from the
Centers for Disease Control (CDC) illustrates the degree of impact and increase of obesity in the
past 20 years.

Figure 1: Obesity Trends Among U.S. Adults Between 1985 and 2010, CDC
Medias Influence in Obesity Stigma
Media proliferates distortion and misrepresentation of womens bodies that have become
a cornerstone to our cultural story. Idealized images are based, in part, on extremes of thinness
and extremes of obesity significantly based on the cultural values we have adopted through

ANTI-FAT BIAS IN HEALTHCARE

consuming media. Media portrays thinness as the cultural ideal of femininity, while obesity is
affected directly from the onslaught of food advertising.
In When Fantasy Becomes Reality, Dill-Shackleford states, we are making our girls and
women sick by tolerating the pervasive misrepresentation of femininity in the mass media
(Kindle edition, 2009, 3332). Women are affected on a daily basis by the stigma attached to body
size and the explicit and implicit responses from others as well as by their own self-judgment,
self-shame and self-blame.
Media Effects: Consequences of Obesity Bias
The common cultural meme or narration tells a story of obese people, with attributes such
as out-of-control and lazy (Puhl & Brownell, 2001, p. 792). It is not yet politically incorrect to
vilify those who are obese, and along with that come significant consequences to the individual
and to the social environment within which it exists.
While Western culture has idealized thin womens bodies, this has not been true in many
other cultures around the world up until more recently. Many Latin and tribal based countries
have esteemed fuller and curvaceous bodies as a symbol of generosity, success, wealth, fertility
and beauty. The Western way of looking at obesity and the onslaught of media reinforcing these
values seem to be over-riding these traditional beliefs resulting in ever-increasing levels of antifat bias, stigma and discrimination globally.
Most cultures of the world for most of history have viewed fatness as a welcome sign of
health and prosperity (Brown & Konner, 1987). A recent study by Brewis, Wutich, FallettaCowden & Rodriguez-Soto (2011) suggested that there is a rapidly growing trend for
globalization of fat stigma. Overweight and obese people in societies previously unbiased
towards fat are being viewed as rejects, ugly, lazy, undesirable and lacking in self-control.

ANTI-FAT BIAS IN HEALTHCARE

While this story of fat has consequences for those struggling with obesity in many areas
such as employment and education, the most negatively impactful and potentially harmful is in
interactions with healthcare professionals. Anti-fat bias runs rampant with otherwise intelligent
and service-oriented healthcare providers. By attacking the victims of epidemic obesity, we single
it out from other threats to health for no justifiable reason, compound its harms, and divert resources
from attacking its causes (Katz, 2011).

Social Implications of Media Images

Media has played a prominent role in creating and growing the visual story about
womens bodies. Girls and women have learned that their body size, idealized by unrealistic
thinness, is socially more important than mostly any other attribute and have developed shame in
their perceptions of self-identity. Ahern, Bennett, Kelly & Hetherington (2011) reported that
girls and young women, ages 16 25 in their study, overtly expressed the negative influence of
social pressures. In reporting about their experience, girls openly revealed that viewing idealized
images in magazines and other media actually worsened their body dissatisfaction and often
prompted those even normal sized to begin to diet in order to lose weight striving for this
unrealistic ideal.
Contributing to the complex issues surrounding overweight and obesity, Herbozo,
Tantleff-Dunn, Gokee-Larose, and Kevin Thompson (2004) reported detailed studies that have
shown children overpoweringly associate traits considered negative with obese images of girls
and women while attributing positive traits with thin and average-sized images of girls and
women. Since there is such a high rate of media consumption, it is not unusual or surprising that
children, as young as preadolescent, express and act on body image concerns. A desire for
thinness and an aversion to obesity is widespread even in very young children. The narrative
goes deep and is instilled early.

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Since young children are frequently exposed to sociocultural ideal body shapes, it is
likely that they have internalized these ideals as well as the prejudice against obesity. In
fact45% of a sample of girls and boys in grades three through six had a desire to be thinner,
37% had tried to lose weight, and 6.9% scored within the anorexia nervosa range (Herbozo, et
al., 2004, p. 23).
Social Stigma of Obesity
In mainstream U.S. culture, obesity is socially stigmatized even to the point of
abhorrence (Brown & Konner, 1987, p. 39). Advertising and products for weight loss
proliferate in the media, and is a major industry in the U.S. with current analyses of the diet
industry putting the annual total at $58 billion spent on weight-loss products and services. This is
representative of how offensive obesity is perceived to be by the culture, and the level of
activities and diet that many engage in to change it.
Physical attractiveness stereotypes valued by adults are learned early and are also
prevalent in children (Dion, Berscheid, & Walster, 1972). Children ages 6-9 years old associated
positive traits with thin or normal sized body images but associated negative words such as
fights, cheats, gets teased, lazy, lies, mean, dirty, and stupid with overweight or
obese body images. Tiggemann and Wilson-Barrett (1998) reported stereotyping from both boys
and girls, regardless of age, judging the obese body images as being lazier, less happy, less
popular, and less attractive than the average-size figure.
Controllability
Contrary to theories of controllability, diet and exercise are not the primary factors
underlying the complex problem of obesity. Controllability offers the notion that one can
determine or have control over what a system does, how it behaves and ultimately the outcome.

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attributions of controllability stem from underlying beliefs about causality in the physical and
social world and are intricately related to social ideologies (Crandall, D'Anello, Sakalli,
Lazarus, Nejtardt, & Feather, 2001, p. 31). Simply put, obesity is blamed on internal,
controllable causes.
Its important to note that scientific evidence does not support the theory that overeating
and lack of exercise are the primary cause of overweight and obesity. Rather the majority of
research evidence supports the notion that body weight is the result of genetic and metabolic
factors and is only modestly related to dietary habits (Crandall, 1994).
Numerous studies support evidence that many physiological factors contribute to
making dieting both difficult and ineffectivethe belief that fat people got that way primarily
from overeating and a lack of self-control does not properly represent the scientific data
(Crandall, 1994, p. 884).
In essence, many people believe that people get what they deserve and that those who are
overweight or obese are such due to their own actions, or lack of actions, and therefore people
with negative characteristics such as fatness should be punished, avoided, and stigmatizedin
short, they deserve anger and prejudice (Crandall et al, 2001, p. 31). This pattern of belief has
broad implications for how we behave toward others If ideology leads a person to chronically
attribute controllable causality to others, he or she will tend to blame fat people for their weight
and stigmatize them for it (Crandall, 1994, p. 884).
While weight stigma influences many aspects of overweight and obese peoples lives, it
is most impactful in the area of healthcare, where understanding, acceptance and support are
critical for diagnosis, treatment, and ongoing healthcare.

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Anti-fat Bias in Healthcare

Anti-fat bias has significant consequences but nowhere is it more impactful than in the
healthcare system, a place where solutions should be forthcoming and health supported. It is all
too common for the obese person to be shamed, blamed and told by healthcare professionals,
either implicitly or explicitly, that whatever the presenting problem, the underlying cause it that
you are too fat, go away and lose weight and then come back and see me (Teachman &
Brownell, 2001).
Explicit and Implicit Anti-fat Bias in Healthcare
There is a multitude of social consequences that are significant and pervasive as a result
of the obesity epidemic and the rising anti-fat bias of those interacting with the obese population.
Weight-based stigmatization shows up in multiple areas, including in work settings where
overweight and obese people have been treated poorly by coworkers and employees and
denied jobs and promotions; educational settings in which obese students have been
ridiculed by peers, viewed negatively by educators, and even dismissed from college
because of their weight; and healthcare environments, where obese patients confront bias
from health care professionals including doctors, nurses, dieticians, and mental health
professionals (Puhl & Brownell, 2006, p. 1802).
In a study of 400 doctors, one of every three listed obesity as a condition to which they
respond negatively. They ranked it behind only drug addiction, alcoholism, and mental illness.
Attributes that they associated with obesity included: noncompliance, hostility, dishonesty, and
poor hygiene (Friedman & Puhl, 2012).
A study by Puhl and Brownell reported that physicians and family members were the
most frequent sources of weight bias (2006). Techman and Brownell indicated that health

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care specialists have strong negative associations toward obese persons, indicating the
pervasiveness of the stigma toward obesity (2001, p. 1525). The tendency to make appearancerelated comparisons appears to play a central role in anti-fat attitudes, which is consistent with
other group-based prejudice research (OBrien, Hunter, Halberstadt & Anderson, 2007).
Though there is widespread anti-fat bias in the culture, it is especially salient in
healthcare settings and with the healthcare providers, doctors, nurses, medical technicians,
physical therapists and other staff who directly care for the patient. A study by Sabin, Marini and
Nosek (2012) indicated that MDs, on average, also showed strong implicit anti-fat
biasreported a strong preference for thin people rather than fat people or a strong explicit antifat bias (p. 1). They concluded that strong implicit and explicit anti-fat bias is as pervasive
among MDs as it is among the general public.
Eenfeldt, MD reported an incident that is representative of many patient/doctor
interactions.
a patient asked her doctor about possible medical causes for her weight gain. The
doctor told her not to worry about such things. Weight gain was just a matter of how
much food she ate. Then the doctor asked her if she had seen pictures from the
concentration camp Auschwitz, and if she had seen any fat prisoners there (2013).
Since body size and weight have significant impact, even in those cases where there
might be underlying medical conditions, there is still the tendency to judge and respond from
these explicit and implicit anti-fat biases when interacting with a patient appearing either
overweight or obese. One such medically based condition is a common but little recognized fat
disorder, lipoedema. Medical professionals on the whole do not know about lipoedema,
generally failing to recognize the signs and symptoms leading to misdiagnose as obesity. There

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is some progress in Europe, but an evident lack of knowledge more so in the United States.
There is research available mostly in Germany and somewhat in the U.K.
Lipoedema: Genetic Inherited Fat Disorder
Obesity stigma has significant impact for women with lipoedema, a little known and
oftentimes misdiagnosed inherited genetic fat disorder that affects 11% of women of all sizes,
from the extremely thin to the morbidly obese. Lipoedema is characterized by localized fat that is
bilateral, symmetrical and usually from the waist to just above the ankles. Unlike the normal
fat of obesity, lipoedemic fat cannot be lost through diet and exercise (Herbst, 2012).
Medias influence represents and reinforces overweight and obesity as the result of poor
life-style choices such as diet and exercise and exacerbates the stigma and discrimination thats
likely to occur when treatment is sought, even though lipoedema is a medical condition and not
necessarily a result of inappropriate food choices. Body size and weight matter, judgment and the
resultant stigma can be present, whatever the cause might be.
Impact of Anti-fat Bias on Womens Health
Overweight and obese women report being treated disrespectfully by health professionals
because of their weight. One study found that 53% of overweight and obese women reported
receiving inappropriate comments about weight from their doctors (Puhl & Brownell, 2006).
Obese patients who report perceptions of weight discrimination avoid seeking routine preventive
care such as cancer screenings (Sabin, Marini & Nosek, 2012). This is most problematic for
those with lipoedema, since the appearance of obesity is from a medically based condition.
Survey Responses
I am in the midst of administering a survey about healthcare experiences to women with
lipoedema. Their responses offer evidence to this perspective with many indicating significant to

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severe impact from lack of diagnosis, unclear treatment options, and interactions with healthcare
professionals ladened with anti-fat bias. In many cases they reported explicit anti-fat bias from
their healthcare professionals.
In one such case, a woman with both lipoedema and obesity reported, I repeated myself
over and over, and was told I am fat and need to lose weight without any regard for my whole
well being and the shape of my legs. I am still experiencing this. And in another instance, I
have been denied other treatment in the past - left in chronic pain for 15 years by a gynecologist
who refused to treat me due to my size. And a third woman reported, The journey to get a
diagnosis was frustrating and demeaning. I was blamed and shamed and made to feel I was
cheating and the weight was my own fault. I thought things would be a lot better after the
diagnosis but I quickly found having Lipoedema as opposed to lymphoedema precluded me from
lots of treatment and it was difficult to get advice, information and treatment. Unfortunately, in
many instances, lack of diagnosis and treatment leads to further complications.
Teachman and Brownell (2001) reported that healthcare professionals are exposed to the
same social messages about obese persons as is the general population and are even more aware
of the negative health consequences of obesity. The evidence suggested that negative attitudes
expressed by medical professionals are directed not just toward obesity as a health condition, but
also against people who are obese (p. 1525). This corroborates the underlying discomfort, shame
and blame reported by patients in interacting with their medical professionals.
Anti-Fat Bias: Awareness, Resiliency and Tools for Healing
As detailed above, the obesity crisis is on the rise. Various research into interventions is
being conducted as solution building for dealing with anti-fat bias and stigma associated with
obesity and body size. Since stigma and anti-fat bias is a multi-dimensional problem, a multi-

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dimensional approach to changing it is needed. Components suggested and being researched as

viable options include education for healthcare professionals, social awareness and social support
on a relational level, and personal individual awareness raising and mindfulness meditation.
Healthcare Awareness: Educating Healthcare Professionals
A study recently conducted in the U.K. by Swift, Tischler, Markham, Gunning,
Glazebrook, Beer and Puhl (2013) at the University of Nottingham suggested that education by
way of film helped to improve awareness in medical students and nutrition counselors in
training. Two 17-min films were shown to the intervention group in a controlled study; Weight
Prejudice: Myths and Facts' and Weight Bias in Healthcare'. Both films have been developed
by the Rudd Center for Food Policy and Obesity at Yale University, New Haven, CT, USA.
Both films employ several different strategies to promote stigma reduction, including
i)

attributions of weight controllability

a. (e.g. communicating the complex etiology of obesity, of which individual
behaviour is only one contributing factor);

ii)

empathy induction
a. (e.g. showing viewers personal experiences of weight stigmatization and how
it affects individuals), and

iii)

debunking weight-based stereotypes

a. (e.g. directly challenging common weight-based stereotypes with scientific
evidence and examples of obese persons whose behaviours are nonstereotypical).
(Swift, Tischler, Markham, Gunning, Glazebrook, Beer & Puhl, 2013, p. 93).

ANTI-FAT BIAS IN HEALTHCARE

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Their study confirmed the existence of weight bias among trainee healthcare
professionals, on both implicit and explicit attitude measures. Additionally, there were strong
beliefs of controllability that obesity is under a person's control. Explicit attitudes and beliefs
about obese persons significantly improved after viewing the films. Participants evaluations
were positive.
The researchers concluded that the brief, educational films did indeed improve trainee
healthcare professionals' attitudes toward obesity. Weight bias is an issue of critical importance
that the educators of tomorrow's healthcare professionals cannot afford to ignore.
Social Awareness: Social Support
According to Puhl and Brownell (2006), when someone believes that obese people are
responsible for their fatness, he or she will blame and stigmatize them. The effect of dealing with
or trying to avoid dealing with these kinds of day-to-day interactions often results in isolation for
obese people. Social interaction and social support, often in like-minded communities, can help
in mitigating the consequences of anti-fat bias and weight stigma.
Several coping strategies have been reported to be frequently used to alleviate stigma
included heading off negative comments, using positive self-talk, and seeking social support
from others. Coping strategies to deal with stigma have important implications for emotional
functioning. Among women, positive coping strategies, including positive self-talk and obtaining
social support, were related to healthier psychological adjustment and increased self-esteem
(Puhl & Brownell, 2003).
Members of stigmatized groups may cope with identity threat by approaching, or
identifying more closely with, their group. Groups can provide emotional, informational,
and instrumental support, social validation for ones perceptions, social consensus for

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ones attributions, and a sense of belonging. Group identification is positively correlated

with self-esteem among stigmatized groups (Major & OBrien, 2005, p. 405).
Face to face support groups have proven successful for many years, most especially noted
are the 12-Step programs of Alcoholics Anonymous and Overeaters Anonymous. Social media
and online support groups have made connection and support more easily accessible globally and
many exist today. Specialized groups attending to specific populations have grown such as
several particular to those with lipoedema. Participation and results for self-esteem, selfcompassion, and social support can be further studied to evaluate for successful intervention in
developing health coping strategies in response to weight stigma.
Personal Awareness: Mindfulness, Compassion & Advocacy
Many obese people hold negative weight attitudes towards themselves and others. They
react to external bias by applying these same negative stereotypes to themselves. Puhl and
Brownell (2003) reported that weight bias occurs irrespective of an individuals own body
weight, and that overweight people themselves tend to express bias (p. 215). Mindfulness
meditation research has demonstrated such conditions as self-awareness, self-regulation, selfcompassion and overall positive emotional well-being as a result of mediation practice.
Mindfulness refers to a process of self-regulation of attention to the present moment.
According to Eberth and Sedlmeier mindfulness meditation entails sitting quietly and is mainly
characterized by just observing ones experiences, not creating or modifying them (2012, p.
174). Someone engaged in mindfulness meditation focuses their conscious awareness of their
immediate experience with an attitude of curiosity, openness, and acceptance.
Jon Kabat-Zinn established one of the first Centers for Stress Reduction using
mindfulness meditation at the University of Massachusetts Medical School. His research

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reported that the most direct evidence for the benefits of mindful awareness and attention has
come from research demonstrating that mindfulness training is related to positive psychological
and physical outcomes (1990).
There are questions still to be addressed about whether, and to what extent, coping efforts
influence emotional well-being and are helpful in offsetting the impact of stigmatizing
experiences (Brown & Ryan, 2003). Mindfulness meditation can be one of several coping
strategies to deal with bias and increasing emotional well-being for those obese people
experiencing weight stigma. Additional research is needed to address the relationship between
weight stigma and mindfulness meditation, and how both of these experiences influence
psychological and behavioral outcomes.
Conclusion: Words of Wisdom from Oprah Winfrey
As detailed in this paper and other seminal work cited, obesity is a complex and multilayered issue necessitating continued research delving into core causes of the depth of prejudice
and stigma that exists towards obese people. Growth, understanding and self-advocacy stand
firmly in light of the barrage of negativity, none so apparent than with the media personality,
Oprah Winfrey.
Perhaps as one of the most noticeable media personalities caught in the limelight of body
image is Oprah Winfrey who has generated ongoing buzz in the media. All forms of media have
documented her various body size ups and downs with numerous diet and exercise programs
over the years. Despite her undeniable presence and position of power in the public discourse,
she too has had to deal with stigma and anti-fat bias.
Rather than be victim to the medias barrage of judgment on her body, Oprahs process
reflects one of growth, acceptance and courage and are demonstrated in her own words.

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Are you ready to stop colluding with a culture that makes so many of us feel physically
inadequate? Say goodbye to your inner critic, and take this pledge to be kinder to yourself
and others. This is a call to arms. A call to be gentle, to be forgiving, to be generous with
yourself. The next time you look into the mirror, try to let go of the story line that says
you're too fat or too sallow, too ashy or too old, your eyes are too small or your nose too
big; just look into the mirror and see your face. When the criticism drops away, what you
will see then is just you, without judgment, and that is the first step toward transforming
your experience of the world (2013).
While the stigma of obesity has serious impact, there is recourse in learning to raise
awareness as to medias influence. Change can happen by educating healthcare professionals
about the impact that stigma causes and about various medical conditions such as fat disorders,
making visible the ways in which acting on anti-fat bias hurts both patients and those attempting
to treat them and by helpful coping strategies such as mindfulness meditation and self-efficacy.

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21
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Cognition, 18(1), 329-353
Brewis, A. A., Wutich, A. Falletta-Cowden, A., & Rodriguez-Soto, I. (2011). Body norms and
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