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Challenging Sizism: Health and Weight Don’t Always Equate

Close up on clothing size labels

By Brandy Smith, PhD (Diversity Coordinator and Interim Training Coordinator at Auburn University Student Counseling Services) 

Have you or someone you know gone to the doctor and heard comments about your health without the provider ever talking about your genetics or your specific eating and physical activity habits? Unfortunately, many people, answer “yes” to that question. I have too often read about and heard people in my personal and professional life recount how a doctor told them they were not healthy because of being large bodied. This was without the doctor ever talking to them about their family history related to size, eating habits, or physical activity levels even when the diagnostic tests run at the appointment did not indicate anything physically unhealthy.

This type of experience can fit within the concept of sizism, a form of prejudice against people because of their size. While this particular experience may never have happened to you, it does happen frequently enough to raise concern. Perhaps a different example of sizism may be more relatable to you.

Take for instance comments (or even thoughts) that occur when simply seeing someone—about a big person not being able to control what they eat or that they must never exercise or that a petite person must be so healthy. All of these thoughts or comments occur without us actually knowing anything about the person or their behaviors.

Sizism implies that a person can be deemed healthy or not by a few factors that only represent part of the picture. It reflects the myth that the current state of our health can be determined by weight, and, far too often a person’s weight becomes the primary and sometimes sole gauge of health within our society.

Part of the problem is the frequency with which those types of connections are made and how the pairing of size and health is so pervasively, sometimes subtly and other times more overtly, reinforced. Writers such as Bacon (2008), Abakoui & Simmons (2010), Berg & Rosencrans (2000), and Farrell (2011) have addressed concepts paired with size and the impact. Examples have included lazy/active, civilized/uncivilized, weak/strong, sexual/asexual, which lead people to view the size of their body and the number on a scale as THE focal points.

We perpetuate sizism in our individual conversations and in our news stories. Even medical personnel who may be well-intentioned often send the message that if you are a certain size, then that alone implies you are healthy/unhealthy.

Health is not directly related to a specific size; it is related to healthy behaviors. As part of the newly created Task Force on Feminist Perspectives on Sizism from APA’s Society for the Psychology of Women, my colleagues and I are concerned that sizism has a negative impact on physical health along with emotional and psychological well-being.

Health at Every Size (HAES; Bacon, 2008) presents a more useful way to attend to health and offers a way to improve our culture on individual and systemic levels. HAES:

  1. Includes a set point concept of weight, that is, the range at which the body comfortably maintains its weight (10-20 pound range)

  2. Highlights research about the body’s response to eating and exercise as genetically impacted rather than within complete personal control

  3. Educates about the ills of dieting and how it is different from healthy eating

  4. Encourages activity regardless of weight/size because of the overall health impact rather than focusing on weight loss

  5. Emphasizes stress management because of the negative impact of high cortisol levels

  6. Recommends an internal gauge of hunger (hunger/fullness cues) rather than an external gauge (eating what is on the plate)

  7. Notes the importance of challenging negative self-talk

  8. Asks people to live for the present instead of waiting until a certain size to do things

One criticism I and others who express concerns about sizism regularly encounter is that not focusing on weight equals not caring about what one eats or does activity-wise. Critics imply that we are encouraging a free-for-all approach that does not take into consideration a person’s actions. Please know that is not the case, which I hope is evident from the HAES information presented above. The goals are:

  1. to improve everyone’s overall health with attention on actual health behaviors rather than an erroneous perception of health, and

  2. to facilitate our ability to disconnect worth from size since that pairing is damaging on a multitude of levels.

We encourage physical and mental health care providers to include as part of their routine health assessments questions about eating habits, as well as physical activity and other health behaviors. Here is to making progress toward those goals!


Abakoui, R., & Simmons, R. E. (2010). Sizeism: An unrecognized prejudice. In J. E. Cornish, B. A. Schreier, L. I. Nadkarni, L. H. Metzger, E. R. Rodolfa (Eds.) , Handbook of multicultural counseling competencies (pp. 317-349). Hoboken, NJ: John Wiley & Sons Inc.

Bacon, L. (2008). Health at every size: The surprising truth about your weight. Dallas, TX, US: BenBella Books.

Berg, F. M., & Rosencrans, K. (2000). Women afraid to eat: Breaking free in today’s weight-obsessed world. Hettinger, ND: Healthy Weight Network.

Farrell, A. E. (2011). Fat shame: Stigma and the fat body in American culture. New York, NY: New York University Press.


Brandy Smith, PhD, is a licensed psychologist at Auburn University Student Counseling Services. She began working on topics of diversity during her undergraduate career at Mississippi University for Women then continued her diversity focus into her Masters and Doctorate programs at University of Memphis. Much of Brandy’s work has focused on sexual orientation and gender identity, but she is committed to diversity broadly defined and makes efforts to use her feminist approach to create safe, empowering spaces for all.

Image source: Flickr user Ralph Alchinger via Creative Commons

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