This article argues that public health campaigns have an ethical obligation to combat fat stigma, not mobilize it in the “war on obesity.” Fat stigma is conceptualized, and a review is undertaken of how pervasive fat stigma is across the world and across the lifespan. By reviewing the negative impacts of fat stigma on physical health, mental health, and health seeking behaviors, fat stigma is clearly identified as a social determinant of health. Considering the role of fat stigma in public health, and the arguments made for using stigmatisation in public health campaigns to promote population health, it is concluded that it is a violation of public health ethics to use stigma as a tool in combatting fatness. The article concludes by making recommendations of how public health in New Zealand can combat, rather than reinforce, fat stigma.
Get full access to this article
View all access options for this article.
References
1.
C.J.Pausé, “Live to Tell: Coming Out as Fat,”Somatechnics2, no. 1 (2012): 42-56; C.J.Pausé, “Die Another Day: The Obstacles Facing Fat People in Accessing Shame-Free and Evidenced-Based Healthcare,”Narrative Inquiry in Bioethics4, no. 3 (2014): 135-141.
2.
E.Goffman, Stigma: Notes on the Management of Spoiled Identity (New York, NY: Simon and Schuster, 2009), at 3.
3.
A.C.Saguy and A.Ward, “Coming Out as Fat: Rethinking Stigma,”Social Psychology Quarterly74, no. 1 (2011): 53-75.
A.Jutel, “Weighing Health: The Moral Burden of Obesity,”Social Semiotics15, no. 2 (2005): 113-125.
6.
Pausé, supra note 4.
7.
W.DeJong, “The Stigma of Obesity: The Consequence of Naïve Assumptions Concerning the Causes of Physical Deviance,”Journal of Health and Social Behavior21, no. 1 (1980): 75-87.
C.Sikorski, M.Luppa, M.Kaiser, H.Glaesmer, G.Schomerus, H.H.König, and S.G.Riedel-Heller, “The Stigma of Obesity in the General Public and its Implications for Public Health-A Systematic Review,”BMC Public Health11, no 1 (2011): 1.
10.
M.M.Rogge, M.Greenwald, and A.Golden, “Obesity, Stigma, and Civilized Oppression,”Advances in Nursing Science27, no. 4 (2004): 301-315.
11.
Pausé, supra note 4; Sikorski et al., supra note 9.
12.
J.C.Chrisler and A.Barney, “Sizeism is a Health Hazard,”Fat Studies6, no. 1 (2017): 38-53; R.Crawford, “Healthism and the Medicalization of Everyday Life,”International Journal of Health Services10, no. 3 (1980): 365-388; J.A.Lee and C.J.Pausé, “Stigma in Practice: Barriers to Health for Fat Women,”Frontiers in Psychology7 (2016): 2063.
13.
D.Carr and M.A.Friedman, “Is Obesity Stigmatizing? Body Weight, Perceived Discrimination, and Psychological Well-Being in the United States,”Journal of Health and Social Behavior46, no. 3 (2005): 244-259.
14.
Goffman, supra note 2.
15.
B.G.Link and J.C.Phelan, “Conceptualizing Stigma,”Annual Review of Sociology27, no. 1 (2001): 363-385.
16.
A.A.Brewis, A.Wutich, A.Falletta-Cowden, and I.Rodriguez-Soto, “Body Norms and Fat Stigma in Global Perspective,”Current Anthropology52, no. 2 (2011): 269-276, at 270; S.K.Council and C.Placek, “Cultural Change and Explicit Anti-Fat Attitudes in a Developing Nation: A Case Study in Rural Dominica,”Social Medicine6, no. 9 (2014): 11-21; O.Dedeli, S.A.Bursalioglu, and A.Deveci, “Validity and Reliability of the Turkish Version of the Attitudes Toward Obese Persons Scale and the Beliefs About Obese Persons Scale,”Clinical Nursing Studies8, no. 2 (2014):105.
17.
E.Barlösius and A.Philipps, “Felt Stigma and Obesity: Introducing the Generalized Other,”Social Science & Medicine130 (2015): 9-15; S.J.Eriksen and B.Manke, “‘Because Being Fat Means Being Sick’: Children at Risk of Type 2 Diabetes,”Sociological Inquiry81, no. 4 (2011): 549-569; J.D.Latner and A.J.Stunkard, “Getting Worse: The Stigmatization of Obese Children,”Obesity Research11, no. 3 (2003): 452–456; R.M.Puhl and J.D.Latner, “Stigma, Obesity, and the Health of the Nation’s Children,”Psychological Bulletin133, no. 4 (2007): 557; W.Su, “Preschool Children’s Perceptions of Overweight Peers,”Journal of Early Childhood Research10, no. 1 (2012): 19-31.
18.
Barlösius and Philipps, supra note 17; Puhl and Latner, supra note 17; W.Wills, K.Backett-Milburn, S.Gregory and J.Lawton, “Young Teenagers’ Perceptions of Their Own and Others’ Bodies: A Qualitative Study of Obese, Overweight and ‘Normal’ Weight Young People in Scotland,”Social Science & Medicine62, no. 2 (2006): 396-406.
19.
S.Ambwani, K.M.Thomas, C.J.Hopwood, S.A.Moss, and C.M.Grilo, “Obesity Stigmatization as the Status Quo: Structural Considerations and Prevalence Among Young Adults in the US,”Eating Behaviors31, no. 3 (2014):366-370.
20.
J.Greener, F.Douglas, and E.van Teijlingen, “More of the Same? Conflicting Perspectives of Obesity Causation and Intervention Amongst Overweight People, Health Professionals and Policy Makers,”Social Science & Medicine70, no. 7 (2010): 1042-1049.
21.
Ambwani et al., supra note 19, at 368.
22.
Greener, Douglas, and van Teijlingen, supra note 20; A.Hilbert, E.Braehler, W.Haeuser, and M.Zenger, “Weight Bias Internalization, Core Self-Evaluation, and Health in Over-weight and Obese Persons,”Obesity22, no. 1 (2014): 79-85; S.Lewis, S.L.Thomas, R.W.Blood, D.J.Castle, J.Hyde, and P.A.Komesaroff, “How do Obese Individuals Perceive and Respond to the Different Types of Obesity Stigma that They Encounter in their Daily Lives? A Qualitative Study,”Social Science & Medicine73, no. 9 (2011): 1349-1356.; Rogge et al., supra note 10.
23.
R.M.Puhl and K.D.Brownell, “Confronting and Coping with Weight Stigma: An Investigation of Overweight and Obese Adults,”Obesity14, no. 10 (2006): 1802-1815; Puhl and Latner, supra note 17.
24.
J.Ogden and C.Clementi, “The Experience of Being Obese and the Many Consequences of Stigma,”Journal of Obesity2010 (2010): 2010; Puhl and Brownell, supra note 23; Puhl and Latner, supra note 17.
25.
Puhl and Brownell, supra note 23; A.K.Sadati, F.Rahnavard, N.Ebrahimzadeh, and A.Rezaei, “Obesity, Lived Experience, and the Self: A Qualitative Study of Overweight People in Southern Iran,”Women’s Health Bulletin3, no. 3 (2016): e31127; Su, supra note 17.
26.
Puhl and Brownell, supra note 23; Sadati et al., supra note 25.
27.
D.Abu-Odeh, “Fat Stigma and Public Health: A Theoretical Framework and Ethical Analysis,”Kennedy Institute of Ethics Journal24, no. 3 (2014): 247-265.
28.
Puhl and Brownell, supra note 23; Puhl and Latner, supra note 17.
29.
I.Brown and A.McClimens, “Ambivalence and Obesity Stigma in Decisions about Weight Management: A Qualitative Study,”Science Research4, no. 12A (2012): 1562-1569; Cooper, supra note 8; C.A.Heuer, K.J.McClure, and R.M.Puhl, “Obesity Stigma in Online News: A Visual Content Analysis,”Journal of Health Communication16, no. 9 (2011): 976-987; S.M.Himes and J.K.Thompson, “Fat Stigmatization in Television Shows and Movies: A Content Analysis,”Obesity15, no. 3 (2007): 712-718; E.Rich, “‘I See Her Being Obesed!’ Public Pedagogy, Reality Media, and the Obesity Crisis,”Health15, no. 3 (2011): 3e21.
30.
K.Friedman, S.Reichmann, P.Costanzo, A.Zelli, J.Ash-more, and G.Musante, “Weight Stigmatization and Ideological Beliefs: Relation to Psychological Functioning in Obese Adults,”Obesity Research13 (2005): 907–916; A.Myers and J.C.Rosen, “Obesity Stigmatization and Coping: Relation to Mental Health Symptoms, Body Image, and Self-Esteem,”International Journal of Obesity23 (1999): 221–230.
31.
Lewis et al., supra note 22.
32.
S.Kwan, “Navigating Public Spaces: Gender, Race, and Body Privilege in Everyday Life,”Feminist Formations22, no. 2 (2010): 144-166.
33.
Kwan, supra note 32; Rogge et al., supra note 10.
34.
Kwan, supra note 32.
35.
A.A.Brewis, “Stigma and the Perpetuation of Obesity,”Social Science & Medicine118 (2014): 152-158.
36.
T.Andreyeva, R.M.Puhl, and K.D.Brownell, “Changes in Perceived Weight Discrimination Among Americans, 1995–1996 through 2004–2006,”Obesity16, no. 5 (2008): 1129-1134.
37.
Carr and Friedman, supra note 12; K.Malterud and K.Ulriksen, “Obesity, Stigma, and Responsibility in Health Care: A Synthesis of Qualitative Studies,”International Journal of Qualitative Studies on Health and Well-Being6, no. 4 (2011); S.M.Phelan, D.J.Burgess, M.W.Yeazel, W.L.Hellerstedt, J.M.Griffin, and M.Ryn, “Impact of Weight Bias and Stigma on Quality of Care and Outcomes for Patients with Obesity,”Obesity Reviews16, no. 4 (2015): 319-326; Puhl and Brownell, supra note 23; R.M.Puhl and C.A.Heuer, “Obesity Stigma: Important Considerations for Public Health,”American Journal of Public Health100, no. 6 (2010): 1019-1028, at 1019; Rogge et al., supra note 10; C.W.Rudolph, C.L.Wells, M.D.Weller, and B.B.Baltes, “A Meta-Analysis of Empirical Studies of Weight-Based Bias in the Workplace,”Journal of Vocational Behavior74, no. 1 (2009): 1-10; J.D.Seacat, S.C.Dougal, and D.Roy, “A Daily Diary Assessment of Female Weight Stigmatization,”Journal of Health Psychology21, no. 2 (2016): 228-240.
38.
C.L.Baum and W.F.Ford, “The Wage Effects of Obesity: A Longitudinal Study,”Health Economics13, no. 9 (2004): 885-899; J.Cawley, “The Impact of Obesity on Wages,”Journal of Human Resources39, no. 2 (2004): 451-474.
39.
Lewis et al., supra note 22; Puhl and Brownell, supra note 23; Rogge et al., supra note 10.
40.
K.Crenshaw, “Mapping the Margins: Intersectionality, Identity Politics, and Violence against Women of Color,”Stanford Law Review43, no. 6 (1991): 1241-1299.
41.
C.J.Pausé, “X-static Process: Intersectionality within the Field of Fat Studies,”Fat Studies3, no. 2 (2014): 80-85.
42.
Kwan, supra note 32; S.Stoneman, “Ending Fat Stigma: Precious, Visual Culture, and Anti-Obesity in the ‘Fat Moment,’”Review of Education, Pedagogy, and Cultural Studies34, no. 3-4 (2012): 197-207.
43.
P.Muennig, “The Body Politic: The Relationship Between Stigma and Obesity-Associated Disease,”BMC Public Health8, no. 1 (2008): 128.
44.
M.S.Himmelstein, A.C. IncollingoBelsky, and A.J.Tomiyama, “The Weight of Stigma: Cortisol Reactivity to Manipulated Weight Stigma,”Obesity23, no. 2 (2015): 368-374; N.A.Schvey, R.M.Puhl, and K.D.Brownell, “The Stress of Stigma: Exploring the Effect of Weight Stigma on Cortisol Reactivity,”Psychosomatic Medicine76, no. 2 (2014): 156-162; A.J.Tomiyama, E.S.Epel, T.M.McClatchey, G.Poelke, M.E.Kemeny, S.K.McCoy, and J.Daubenmier, “Associations of Weight Stigma with Cortisol and Oxidative Stress Independent of Adiposity,”Health Psychology33, no. 8 (2014): 862; A.J.Tomiyama, “Weight Stigma is Stressful: A Review of Evidence for the Cyclic Obesity/Weight-Based Stigma Model,”Appetite82 (2014): 8-15.
45.
B.Major, D.Eliezer, and H.Rieck, “The Psychological Weight of Weight Stigma,”Social Psychological and Personality Science3, no. 6 (2012): 651-658; K.A.Matthews, K.Salomon, K.Kenyon, and F.Zhou, “Unfair Treatment, Discrimination, and Ambulatory Blood Pressure in Black and White Adolescents,”Health Psychology24, no. 3 (2005): 258.
46.
A.R.Sutin, Y.Stephan, M.Luchetti, and A.Terracciano, “Perceived Weight Discrimination and C-Reactive Protein,”Obesity22, no. 9 (2014): 1959-1961.
47.
Major et al., supra note 45.
48.
Sutin et al., supra note 46.
49.
Carr and Friedman, supra note 13; Friedman et al., supra note 30; Hilbert et al., supra note 22; Lewis et al., supra note 22; Myers and Rosen, supra note 30; Puhl and Brownell, supra note 23; Puhl and Latner, supra note 17; Sadati et al., supra note 25; S.J.Salvy, J.C.Bowker, L.A.Nitecki, M.A.Kluczynski, L.J.Germeroth, and J.N.Roemmich, “Impact of Simulated Ostracism on Overweight and Normal-Weight Youths’ Motivation to Eat and Food Intake,”Appetite56, no. 1 (2011): 39-45; Schvey et al., supra note 44; Seacat and Mickelson, supra note 37; L.R.Vartanian and J.G.Shaprow, “Effects of Weight Stigma on Exercise Motivation and Behavior: A Preliminary Investigation Among College-Aged Females,”Journal of Health Psychology13, no. 1 (2008): 131-138.
50.
R.A.Carels, C.B.Wott, K.M.Young, A.Gumble, A.Koball, and M.W.Oehlhof, “Implicit, Explicit, and Internalized Weight Bias and Psychosocial Maladjustment Among Treatment-Seeking Adults,”Eating Behaviors11, no. 3 (2010): 180-185; Friedman et al., supra note 30; Myers and Rosen, supra note 30; Sadati et al., supra note 25.
51.
Carels et al., supra note 51; Friedman et al., supra note 30; Hilbert et al., supra note 22; Puhl and Brownell, supra note 23; Puhl and Latner, supra note 17; C.B.Wott and R.A.Carels, “Overt Weight Stigma, Psychological Distress and Weight Loss,”Journal of Health Psychology15, no. 4 (2010): 608-614.
52.
Lewis et al., supra note 22; Puhl and Latner, supra note 17; Rogge et al., supra note 10.
53.
Puhl and Latner, supra note 17.
54.
J.M.Hunger and B.Major, “Weight Stigma Mediates the Association Between BMI and Self-Reported Health,”Health Psychology34, no. 2 (2015): 172-175, at 174.
55.
J.Lillis, M.E.Levin, and S.Hayes, “Exploring the Relationship Between BMI and Health-Related Quality of Life: A Pilot Study of the Impact of Weight Self-Stigma and Experiential Avoidance,”Journal of Health Psychology16, no. 2 (2005): 498.
56.
Carr and Friedman, supra note 13; Friedman et al., supra note 30; Lewis et al., supra note 22; Seacat et al., supra note 37; S.S.Wang, K.D.Brownell, and T.A.Wadden, “The Influence of the Stigma of Obesity on Overweight Individuals,”International Journal of Obesity28, no. 10 (2004): 1333–1337.
57.
A.Drury, C.Aramburu, and M.Louis, “Exploring the Association Between Body Weight, Stigma of Obesity, and Health Care Avoidance,”Journal of the American Academy of Nurse Practitioners14, no. 12 (2002): 554-561; Rogge et al., supra note 10.
58.
M.L.Hatzenbuehler, K.M.Keyes, and D.S.Hasin, “Associations Between Perceived Weight Discrimination and the Prevalence of Psychiatric Disorders in the General Population,”Obesity17, no. 11 (2009):2033-2039.
59.
A.R.Sutin and A.Terracciano, “Perceived Weight Discrimination and Obesity,”PLoS One8, no. 7 (2013): e70048.
60.
Hunger and Major, supra note 54, at 172; Major et al., supra note 45.
61.
J.D.Seacat and K.D.Mickelson, “Stereotype Threat and the Exercise/Dietary Health Intentions of Overweight Women,”Journal of Health Psychology14, no. 4 (2009): 556-567.
62.
M.H.Schafer and K.F.Ferraro, “The Stigma of Obesity: Does Perceived Weight Discrimination Affect Identity and Physical Health?,”Social Psychology Quarterly74, no. 1 (2011): 76-97, at 79.
63.
C.C.Gravlee, “How Race Becomes Biology: Embodiment of Social Inequality,”American Journal of Physical Anthropology139, no. 1 (2009): 47-57; Schafer and Ferraro, supra note 62; R.M.Sellers, C.H.Caldwell, K.H.Schmeelk-Cone, and M.A.Zimmerman, “Racial Identity, Racial Discrimination, Perceived Stress, and Psychological Distress Among African American Young Adults,”Journal of Health and Social Behavior (2003): 302-317; J.Stuber, I.Meyer, and B.Link, “Stigma, Prejudice, Discrimination and Health,”Social Science & Medicine67, no. 3 (2008): 351-357; D.R.Williams and S.A.Mohammed, “Discrimination and Racial Disparities in Health: Evidence and Needed Research,”Journal of Behavioral Medicine32, no. 1 (2009): 20-47.
64.
L.Almeida, S.Savoy, and P.Boxer, “The Role of Weight Stigmatization in Cumulative Risk for Binge Eating,”Journal of Clinical Psychology67, no. 3 (2011): 278-292; Carels et al., supra note 50; Friedman et al., supra note 30; B.Major, J.M.Hunger, D.P.Bunyan, and C.T.Miller, “The Ironic Effects of Weight Stigma,”Journal of Experimental Social Psychology51 (2014): 74-80; S.E.Jackson, C.Kirschbaum, and A.Steptoe, “Perceived Weight Discrimination and Chronic Biochemical Stress: A Population-Based Study using Cortisol in Scalp Hair,”Obesity24, no. 12 (2016): 2515-2521; S.J. Salvy et al., supra note 49; Schvey et al., supra note 44; L.R.Vartanian and A.M.Porter, “Weight Stigma and Eating Behavior: A Review of the Literature,”Appetite102 (2016): 3-14; Wott and Carels, supra note 51.
65.
Puhl and Brownell, supra note 42.
66.
S.E.Jackson and A.Steptoe, “Association Between Perceived Weight Discrimination and Physical Activity: A Population-Based Study among English Middle-Aged and Older Adults,”BMJ7, no.3 (2017): e014592; Lewis et al., supra note 12; R.L.Pearl, R.M.Puhl, and J.F.Dovidio, “Differential Effects of Weight Bias Experiences and Internalization on Exercise Among Women with Overweight and Obesity,”Journal of Health Psychology20, no. 12 (2015): 1626-1632; Puhl and Latner, supra note 36; D.L.Schmalz, “‘I Feel Fat’: Weight-Related Stigma, Body Esteem, and BMI as Predictors of Perceived Competence in Physical Activity,”Obesity Facts3, no. 1 (2010): 15-21; Seacat and Mickelson, supra note 56; Vartanian and Smyth, supra note 4; Wott and Carels, supra note 51.
67.
N.K.Amy, A.Aalborg, P.Lyons, and L.Keranen, “Barriers to Routine Gynaecological Cancer Screening for White and African-American Obese Women,”International Journal of Obesity30, no. 1 (2005): 147-155; Drury et al., supra note 57; K. Malterud and Ulriksen, supra note 37; C.L.Olson, H.D.Schumaker, and B.P.Yawn, “Overweight Women Delay Medical Care,”Archives of Family Medicine3, no. 10 (1994): 888; Pausé, supra note 26; Puhl and Heuer, supra note 13.
68.
Pausé, supra note 1.
69.
J.L.Pomeranz, “A Historical Analysis of Public Health, the Law, and Stigmatized Social Groups: The Need for Both Obesity and Weight Bias Legislation,”Obesity16, no. S2 (2008): S93-S103.
70.
J.D.Fortenberry, M.McFarlane, A.Bleakley, S.Bull, M.Fishbein, D.M.Grimley, C.K.Malotte, and B.P.Stoner, “Relationships of Stigma and Shame to Gonorrhea and HIV Screening,”American Journal of Public Health92, no. 3 (2002): 378-381.
71.
G.M.Herek, J.P.Capitanio, and K.F.Widaman, “Stigma, Social Risk, and Health Policy: Public Attitudes Toward HIV Surveillance Policies and the Social Construction of Illness,”Health Psychology22, no. 5 (2003): 533-540, at 38.
72.
L.R.Vartanian, and J.M.Smyth, “Primum non Nocere: Obesity Stigma and Public Health,”Journal of Bioethical Inquiry, 10, no. 1 (2013): 49-57; S.J.Wimalawansa, “Stigma of Obesity: A Major Barrier to Overcome,”Journal of Clinical & Translational Endocrinology1, no. 3 (2014): 73-76.
73.
Abu-Odeh, supra note 27.
74.
D.Couch, A.Fried, and P.Komesaroff, “Public Health and Obesity Prevention Campaigns – A Case Study and Critical Discussion,”Communication Research and Practice (2017): 1-18; J.M.Hunger, B.Major, A.Blodorn, and C.T.Miller, “Weighed Down by Stigma: How Weight-Based Social Identity Threat Contributes to Weight Gain and Poor Health,”Social and Personality Psychology Compass9, no. 6 (2015): 255-268; R.Puhl, J.Luedicke, and J.L.Peterson, “Public Reactions to Obesity-Related Health Campaigns: A Randomized Controlled Trial,”American Journal of Preventive Medicine45, no.1 (2013): 36-48.
75.
Couch et al., supra note 74; C.C.Simpson, B.J.Griffin, and S.E.Mazzeo, “Psychological and Behavioral Effects of Obesity Prevention Campaigns,”Journal of Health Psychology (2017).
76.
Couch et al., supra note 74, at 12.
77.
R.Bayer, “Stigma and the Ethics of Public Health: Not Can We But Should We,”Social Science & Medicine67, no. 3 (2008): 463-472.
78.
D.Callahan, “Obesity: Chasing an Elusive Epidemic,”Hastings Center Report43, no. 1 (2013): 34-40.
79.
P.Campos, A.Saguy, P.Ernsberger, E.Oliver, and G.Gaesser, “The Epidemiology of Overweight and Obesity: Public Health Crisis or Moral Panic?,”International Journal of Epidemiology35, no.1 (2005): 55-60; L.Bacon and L.Aphramor, “Weight Science: Evaluating the Evidence for a Paradigm Shift,”Nutrition Journal10, no.1 (2011): 9.
80.
M.Hartlev, “Stigmatisation as a Public Health Tool against Obesity — A Health and Human Rights Perspective,”European Journal of Health Law21, no. 4 (2014): 365-386, at 386.
81.
Vartanian and Smyth, supra note 72.
82.
X.R.Salas, “The Ineffectiveness and Unintended Consequences of the Public Health War on Obesity,”Canadian Journal of Public Health106, no. 2 (2015): e79-81, at e79.
83.
T.Mann, A.J.Tomiyama, and A.Ward, “Promoting Public Health in the Context of the “Obesity Epidemic” False Starts and Promising New Directions,”Perspectives on Psychological Science10, no. 6 (2015): 706-710; Simpson et al., supra note 75.
84.
R.Young, R.Subramanian, and A.Hinnant, “Stigmatizing Images in Obesity Health Campaign Messages and Healthy Behavioral Intentions,”Health Education & Behavior43, no. 4 (2016): 412-419.
85.
Puhl et al., supra note 74.
86.
D.S.Goldberg, “The Implications of Fundamental Cause Theory for Priority Setting,”American Journal of Public Health104, no. 10 (2014): 1839-1843, at 1841.
87.
Greener et al., supra note 20; Lewis et al., supra note 22.
88.
Puhl and Heuer, supra note 37.
89.
M.L.Hatzenbuehler, J.C.Phelan, and B.G.Link, “Stigma as a Fundamental Cause of Population Health Inequalities,”American Journal of Public Health103, no. 5 (2013): 813-821; Hunger et. al, supra note 54; Stuber et al, supra note 63.
90.
See, for example, the Like Mine National Plan Ministry of Health and Health Promotion Agency, “Like Minds, Like Mine National Plan 2014–2019: Programme to Increase Social Inclusion and Reduce Stigma and Discrimination for People with Experience of Mental Illness,” (Wellington, New Zealand: Ministry of Health, 2014).
91.
L.S.Hung, D.K.Tidwell, M.E.Hall, M.L.Lee, C.A.Briley, and B.P.Hunt, “A Meta-Analysis of School-Based Obesity Prevention Programs Demonstrates Limited Efficacy of Decreasing Childhood Obesity,”Nutrition Research35, no. 3 (2015): 229-240; Puhl and Heuer, supra note 37.
92.
The connection of love to food is a cultural one, meant to address the indigenous population.
L.R.Vartarian, “‘Obese People’ vs ‘Fat People’: Impact of Group Label on Weight Bias,”Eating and Weight Disorders15, no. 3 (2010): 195-198.
97.
C.O’Reilly and J.Sixsmith, “From Theory to Policy: Reducing Harms Associated with the Weight-Centered Health Paradigm,”Fat Studies1, no. 1 (2012): 97-113.
98.
J.E.Cook, V.Purdie-Vaughns, I.H.Meyer, and J.T. A.Busch, “Intervening Within and Across Levels: A Multilevel Approach to Stigma and Public Health,”Social Science & Medicine103 (2014): 101-109.
