The Hidden Weight We Carry: How Internalised Stigma Harms Our Health and Wellbeing.

Internalised weight stigma not body size is a powerful, often invisible force harming mental and physical health across all body types

In today’s society, the pressure to achieve the “perfect” body is everywhere from social media feeds to advertising to healthcare messages. But what if the real threat to your health isn’t your weight at all? Increasing evidence shows that internalised weight stigma the shame and self-criticism we adopt from society can quietly erode both mental and physical health. Even people with a “healthy” BMI can suffer, often without realising it. This hidden burden affects mood, stress levels, quality of life, and long-term wellbeing.

Q1: What is internalised weight stigma?

Internalised weight stigma occurs when people adopt society’s negative beliefs about body weight and apply them to themselves. Instead of simply noticing societal pressure, individuals start judging and blaming themselves for their body size. This is increasingly recognised as a serious threat to both mental and physical health (Zagaria et al., 2023) [1].

Q2: Can weight stigma affect people with normal weight?

Research shows that even individuals with a “healthy” BMI can experience the negative effects of internalised stigma. Zagaria et al. (2023) found that higher levels of self-directed weight bias were linked to lower physical and mental health-related quality of life, independent of actual body weight [1]. This means the real danger isn’t just size, it’s the shame and self-criticism that people carry.

Q3: How does weight stigma impact mental health?

The psychological effects are significant and often precede physical consequences. Internalised stigma is strongly associated with depression, anxiety, low self-worth, and disordered eating (Pearl & Puhl, 2016; Durso & Latner, 2008; Himmelstein & Puhl, 2017) [2–4]. For men and gender-diverse individuals, stigma can be compounded by societal silence around body dissatisfaction, making it harder to seek help or even talk about the issue (Griffiths et al., 2016) [5].

Q4: Can stigma affect physical health?

Chronic self-criticism and stress trigger cortisol surges, which over time can compromise immune function, cardiovascular health, and metabolic outcomes (Tomiyama, 2014) [6]. Zagaria et al. (2023) highlighted that while mental health is more immediately affected, prolonged internalised stigma can contribute to long-term physical health risks [1].

Q5: Is weight stigma problem only relevant for women?

While the study by Zagaria et al. (2023) focused on adult women, research shows that all genders can be affected by internalised weight stigma. Men and gender-diverse individuals face unique forms of stigma due to cultural expectations and silence around body image issues (Griffiths et al., 2016) [5].

Q6: What contributes to weight stigma?

Internalised stigma is fuelled by cultural ideals, media messaging, and even healthcare practices where individuals may be judged based solely on weight. This can create a vicious cycle of shame, self-blame, and avoidance, further harming both mental and physical health (Puhl & Suh, 2015) [8].

Q7: How should we approach Health at Every Size (HAES)?

Health at Every Size (HAES) and other person-centred approaches focus on behaviours rather than weight. This includes promoting physical activity, balanced nutrition, emotional wellbeing, and respect for body diversity. The goal is to improve quality of life without relying on weight as the primary outcome (Bacon & Aphramor, 2011) [7].

Q8: What can be done to reduce weight stigma?

Solutions involve systemic and personal changes:

• Inclusive education and public health messaging that prioritises behaviours and wellbeing

• Respectful, non-judgmental healthcare practices

• Raising awareness about the harmful effects of weight stigma

By addressing both societal and individual factors, people can release the “weight of shame,” which is often more damaging than body weight itself (Zagaria et al., 2023) [1].

Q9: Why is addressing weight stigma so important?

Because the harm is real and often invisible. Internalised stigma silently undermines mental and physical health, decreases quality of life, and discourages people from seeking help. Recognising it as a legitimate health risk is essential for both individual and public health (Puhl & Suh, 2015) [8].

Q10: Can weight stigma affect overall health even if someone with normal weight?

Internalised weight stigma impacts mental and physical health independently of body size. Chronic stress from self-criticism and shame can trigger hormonal imbalances, elevate blood pressure, disrupt sleep, and impair immune function (Tomiyama, 2014) [6]. Over time, these stress-related effects increase the risk of cardiovascular issues, metabolic problems, and lowered quality of life, even in individuals who are considered a “healthy” weight (Zagaria et al., 2023) [1]. In other words, it’s the psychological burden of stigma, not the number on the scale, that can silently harm health.

References:

1. Zagaria A, Cerolini S, Mocini E, Lombardo C. The relationship between internalized weight stigma and physical and mental health-related quality of life in a large sample of women: a structural equation modeling analysis. Eat Weight Disord. 2023 Jun 21;28(1):52. doi: 10.1007/s40519-023-01582-z. PMID: 37341775; PMCID: PMC10284938.

2. Pearl RL, Puhl RM. The distinct effects of internalizing weight bias: An experimental study. Body Image. 2016 Sep;17:38-42. doi:10.1016/j.bodyim.2016.02.002.

3. Durso LE, Latner JD. Understanding self-directed stigma: Development of the Weight Bias Internalization Scale. Obesity (Silver Spring). 2008 Nov;16(S2):S80-6. doi:10.1038/oby.2008.448.

4 Himmelstein MS, Puhl RM, Quinn DM. Intersectionality: An understudied framework for addressing weight stigma. Am J Prev Med. 2017 Oct;53(4):421–31. doi:10.1016/j.amepre.2017.04.003  

5. Griffiths S, Hay P, Mitchison D, Mond J, McLean SA, Rodgers B. Sex differences in the relationships between body dissatisfaction, quality of life, and psychological distress. Aust N Z J Public Health. 2016 Oct;40(5):518-22. doi:10.1111/1753-6405.12538.

6. Tomiyama AJ. Weight stigma is stressful: A review of evidence for the Cyclic Obesity/Weight-Based Stigma model. Appetite. 2014 Nov;82:8-15. doi:10.1016/j.appet.2014.06.108.

7. Bacon L, Aphramor L. Weight science: evaluating the evidence for a paradigm shift. Nutr J. 2011 Jan 24;10:9. doi:10.1186/1475-2891-10-9.

8. Puhl RM, Suh Y. Health consequences of weight stigma: implications for obesity prevention and treatment. Curr Obes Rep. 2015 Mar;4(2):182-90. doi:10.1007/s13679-015-0153-z.