Public support for anti-weight stigma and eating disorder policies: new study

Since I have to read a lot of published papers for my studies, and since some of them are quite interesting, I think I’ll use some of my daily blogs to write about them. I hope you find them interesting too.

The one I’m writing about today was just published and is freely available, so if you want to read the whole thing, you can get it here. What the researchers did was to ask over 900 US adults and over 1400 members of organisations specialising in eating disorders, how much they supported a list of 23 possible policy initiatives designed either to address weight stigma or eating disorders. The differences between public and professional answers for both, and the differences between support for eating disorder initiatives and weight stigma initiatives, which are not usually looked at together, is kind of interesting.

First, the professionals had higher levels of support than the general public for just about every policy initiative looked at. The only exception was for school weighing. Measuring students’ height and weight and sending ‘BMI report cards’ home to parents is becoming more popular and is highly controversial. Only 22% of ED specialists support weighing in schools, possibly because they have seen the after effects of this approach. While higher, support for BMI cards among the general public was still under 50%.  Yet support for ED initiatives in schools is much higher among the general public. On the plus side, at least the message that eating disorders are bad has gotten through. Many people, and some health professionals, still believe that EDs are simply a matter of fussy eating and attention seeking, so high levels of support for ED-prevention interventions is encouraging. But there seems to be a disconnect in the minds of the general public between the focus on weight in kids and the increasing prevalence of EDs. We are bombarded with messages about the travails of childhood obesity but few people are aware of what is happening in the world of EDs – prevalence is on the rise, and ever younger children are being admitted to hospital in ever greater numbers with life threatening conditions. And these are likely just the tip of the iceberg. It is estimated that only about 1 in 10 people with an ED receive treatment for it. In contrast, despite all the hysteria, childhood diabetes is so uncommon as to be almost impossible to estimate reliably – less that 0.001% in under 10s, 0.02% in 10 to 19 year olds.  

Few ‘healthy eating intervention’ studies in schools look at the potential effect of driving an increase in disordered eating, and few people who promote these initiatives consider the impact of weight-focused judgments on weight-based bullying. But case studies have certainly been reported of the link between the two.

The good news is that 83% of the general public and 96% of ED professionals support anti-weight stigma bullying policies. One has to wonder about the people who don’t support this. Perhaps they still cling to the idea that bullying, or stigma, will motivate children to lose weight. We know this really doesn’t work in adults, but what about in young people? For a good review of the prevalence and effects of weight-based bullying, check out this review. But here are some ‘highlights’. In a study of 1555 teenagers, weight was the most common reason for bullying. 92% reported their fatter peers being bullied about their size; over half reported seeing verbal threats, and the numbers were similar for physical harassment. Fat elementary school children have fewer friends and lower peer acceptance. One study of grades 3 to 6 found the likelihood of being bullied was 63% higher for obese kids. US national data also relate increased weight with higher levels of psychological distress, suicidal ideation and suicide attempts.  

On the other hand, over one third of the general public in this study did not support restriction on sales of muscle enhancing products to minors. A similar number didn’t think there should be restrictions on the sale of over-the-counter diet pills and laxatives to minors. And nearly half thought it was ok for teen magazines to advertise weight-loss products. Astonishingly, while ED specialists favoured more restriction in all of these cases, some nevertheless did not think such policies were a good idea.

We are living in an incredibly fat-phobic society, yet many people cannot join the dots between this body policing, weight stigma, body image problems, disordered eating, and psychological and physical harm. There is a lot more work to do here.

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