Stop serving ridicule to the overweight

``Post your favorite fat photo on your refrigerator.''

This weight loss tip from a bodybuilding Web site reflects the widespread belief that making people feel bad about themselves is an acceptable -- and effective -- form of motivation to lose weight. It isn't. In fact, the effect of this sort of thing -- we call it weight stigma -- is likely to be just the opposite.

If the misconception were limited to a few Web sites, it wouldn't be much of a problem. But in late September a sensitive and intelligent professional asked one of us, ``Isn't there a danger that in fighting weight stigma you are glorifying obesity, actually discouraging people from a healthy lifestyle?''

The research says no. With colleagues, we recently completed a study of more than 2,000 people enrolled in a weight-loss program. (It's in the October issue of the journal Obesity.) Participants told us that when they are stigmatized because of their weight they respond by eating more or just giving up on dieting. Eating more in response to discriminatory treatment was reported by 79 percent of the participants, and 75 percent refused to diet. A smaller number, 63 percent, said they had at one time or another used dieting to cope with such discrimination, but it rarely works.

Other studies have shown that children who are teased because of their weight are more likely to engage in unhealthy weight control and binge eating than overweight youths who are not teased. It has also been shown that overweight young people avoid physical activities in which peer victimization frequently occurs.

The data are clear: Stigmatizing overweight people contributes to unhealthy behavior that adds to the problem of obesity. With two-thirds of American adults now overweight or obese, obesity is recognized as a pressing public health issue. Schools, health professionals and communities nationwide are beginning to talk about what must be done to improve eating habits and encourage more physical activity. But these efforts must expand to include the topic of weight stigma.

Weight stigma is more than indirect experiences -- for example, feeling inadequate compared with the size-zero celebrities who are everywhere in our culture. Study participants all reported derogatory comments, job discrimination and even physical aggression.

The personal stories we've collected in our studies are heartbreaking: a mother joking in a crowded room that she takes her child to a tentmaker to buy back-to-school clothes, a doctor telling a patient that she is too fat to interest her husband sexually, a teacher announcing to a classroom that an absent child ``probably stayed home to eat.''

These stories reflect a viciousness long ago shunned in matters of race or gender. Here, though, is a perverse twist: People inflicting the stigma are often convinced they are helping the victim.

The sources of weight stigmatization reported in the study were surprising, with family members being the most frequent perpetrators at 72 percent and physicians following closely at 69 percent. Doctors were not the only health care professionals on the list: 46 percent of respondents reported being stigmatized by nurses, 37 percent by dietitians or nutritionists, and 21 percent by mental health professionals. If even the health care system is unwelcoming, where can the obese turn for help?

We all need to change, and the first step is simple. We must recognize that weight stigma is harmful, that it may well be contributing to obesity and that it is not legitimate. Obesity rates are increasing everywhere in the world, driven by worsening diets and declining physical activity (intersecting with human biology, which has evolved to crave foods high in sugar and fat). Time and effort spent ridiculing overweight people would be better used in advocating for a society in which better eating and more physical activity are encouraged, rather than one in which certain people are denigrated and discouraged.

It's hard to change attitudes, perhaps even harder than it is to lose weight. But public health, not to mention fairness and humanity, demands nothing less. the center's director, is a psychology professor at Yale. They wrote this article for the Washington Post.