We all know how to lose weight. It is simple: eat less, move more. This sounds logical enough on the surface. The problem is, within this “calories in, calories out” message there is an implied meaning: if you can’t follow these instructions, you must be lazy or lacking self-discipline. Of course, this doesn’t reflect reality. There is plenty of evidence showing that losing weight isn’t easy and that it is rarely sustained in the long term. How heavy we are isn’t solely under personal control, as our genetics and environment have a huge impact.

And yet weight stigma, which describes the negative attitudes, discrimination and harmful stereotypes directed towards people with larger bodies, is mainly predicated on this personal control narrative. That narrative, say researchers, has an insidious effect on the well-being and health of people labelled as “obese”.

There is a view that this stigma motivates people to improve health. But for those who experience it, the opposite can be the case. They have increased risks of depression and suicidality and report poorer self-esteem. It is also linked to higher levels of the inflammatory C-reactive protein, which is associated with stress and can raise the risk of cardiovascular disease and diabetes.

Shaming people for their size can even lead to weight gain. Such stigma is linked to overeating, as it may activate a threat response: increased anxiety and stress because of feeling judged and devalued by others. People who feel less capable of controlling their intake may turn to comfort eating when they sense threat, says Erin Standen, who studies weight stigma at the University of Minnesota. That isn’t all. She also explains that people with larger bodies often try to defend themselves against this threat in a way that once again risks their health—they might stop exercising in public due to negative comments.

Another consequence of weight stigma is healthcare avoidance. A weight-centric approach by doctors can create mistrust between patient and physician and even lead to delays in cancer screenings. A survey found those who felt bad about their own weight believed doctors didn’t respect them or listen carefully enough to their health concerns. “Too often, patients feel blamed for their weight by healthcare providers,” says Rebecca Puhl at the Rudd Center for Food Policy and Health at the University of Connecticut. To change this, rather than making it all about weight loss, doctors can emphasise other positive changes, such as mobility improvements, to help healthcare become more weight-inclusive, says Puhl. This will help people feel empowered, not stigmatised.

Such stigma is in all parts of society, and healthcare won’t become weight-neutral until public attitudes also change. Ending the view that “obesity” is a personal failure of willpower is difficult. But we need to recognise that focusing so much time, energy and money on the “war against obesity” in the way we have has inadvertently created a new public health problem.

According to Erin Standen, in the face of negative judgements, people with larger bodies tend to__________.