Dealing with the stigma and 'lived experience' of obesity

Andrea E. Bombak of the University of Manitoba carried out repeated in-depth interviews with obese or formerly obese people to see how dealing with their excess weight -- whether trying to lose it or coming to accept it -- affected their identities over time.

Key to Bombak's work was understanding the 'lived experience of obesity' among her participants in a world where weight-loss messages are omnipresent. To do so she constructed four different types of 'obesities' based on her participants' experiences. Each type reflected a particular approach to weight and weight loss, how the individuals may have been stigmatised, and their hopes and fears.

The first 'Hopeful Ideal Type' included individuals who attempted to lose weight through diet and exercise and were hopeful of making a permanent change through willpower. These individuals were able to minimise the stigma they experienced and were the most publicly accepted.

Second came the 'Despairing Ideal Type'. These individuals knew they didn't conform to society's norms regarding weight and blamed themselves for their size; they also viewed weight loss as a remote possibility for other, more disciplined people.

Individuals of the third, 'Resigned Ideal Type', abandoned the goal of losing weight in favour of other health goals; they were also stigmatised, but were more indignant about it.

The fourth and final type was the 'Acceptor Ideal'. These individuals didn't accept the notion of obesity as unhealthy, and instead adopted the 'Health-at-Every-Size' position.

Through her extensive interviews, Bombak discovered that her participants' views about their bodies were intricately linked to their lived experiences. She writes: 'They had lived most of their lives in bodies treated as abject, stigmatised, and contemptible by a "healthist," "sizist" community. Therefore, while some developed self-acceptance and opposed discrimination; for some, their lived experiences made it difficult to "simply chang[e] [their] mind[s] about [their] bod[ies]." '

Bombak's work broadens the traditional view of obesity from a 'static, self-imposed, and pathological condition' to a fluid state that can change over time. It demonstrates how obese individuals must negotiate their own identities constantly, based on society's 'pervasive fat phobia' and their current weight status.

Through her typologies and detailed examples, Bombak's work will help clinicians and policymakers understand and compare the experiences of obese or formerly obese individuals as well as treat them more effectively. It may also help create a less stigmatising approach to obesity that takes better account of individuals' own knowledge, struggles and priorities.