When researchers looked at news coverage of obesity in the United States and the United Kingdom a few years ago, they found that images in news articles often portrayed people with larger bodies “in a stigmatizing manner” — they emphasized people’s abdomens, for example, or showed them eating junk food, wearing tight clothes or lounging in front of a TV. 

When people with larger bodies were featured in photos and videos, nearly half were shown only from their necks down or with part of their heads missing, according to the analysis, published in November 2023. The researchers examined a total of 445 images posted to the websites of four U.S. news outlets and four U.K. news outlets between August 2018 and August 2019.

The findings underscore the need for dramatic changes in the way journalists report on obesity and people who weigh more than what medical authorities generally consider healthy, Rebecca Puhl, one of the paper’s authors, told The Journalist’s Resource in an email interview.

“Using images of ‘headless stomachs’ is dehumanizing and stigmatizing, as are images that depict people with larger bodies in stereotypical ways (e.g., eating junk food or being sedentary),” wrote Puhl, deputy director of the Rudd Center for Food Policy and Health at the University of Connecticut and a leading scholar on weight stigma.

She noted that news images influence how the public views and interacts with people with obesity, a complicated and often misunderstood condition that the American Medical Association considers a disease.

In the U.S., an estimated 42% of adults aged 20 years and older have obesity, a number researchers predict will rise to 50% over the next six years. While the disease isn’t as common in other parts of the planet, the World Obesity Federation projects that by 2035, more than half the global population will have obesity or overweight.

Several other studies Puhl has conducted demonstrate that biased new images can have damaging consequences for individuals affected by obesity.

“Our research has found that seeing the stigmatizing image worsens people’s attitudes and weight bias, leading them to attribute obesity to laziness, increasing their dislike of people with higher weight, and increasing desire for social distance from them,” Puhl explained.

Dozens of studies spotlight problems in news coverage of obesity in the U.S. and abroad. In addition to stigmatizing images, journalists use stigmatizing language, according to a 2022 research review in eClinicalMedicine, a journal published by The Lancet.

The research also suggests people with higher weights feel excluded and ridiculed by news outlets.

“Overt or covert discourses in news media, social media, and public health campaigns included depictions of people with overweight or obesity as being lazy, greedy, undisciplined, unhappy, unattractive, and stupid,” write the authors of the review, which examines 113 academic studies completed before Dec. 2, 2021.

To help journalists reflect on and improve their work, The Journalist’s Resource asked for advice from experts in obesity, weight stigma, health communication and sociolinguistics. They shared their thoughts and opinions, which we distilled into the six tips that appear below.

In addition to Puhl, we interviewed these six experts:

Jamy Ard, a professor of epidemiology and prevention at Wake Forest University School of Medicine and co-director of the Wake Forest Baptist Health Weight Management Center. He’s also president of The Obesity Society, a professional organization of researchers, health care providers and other obesity specialists.

Leslie Cofie, an assistant professor of health education and promotion at East Carolina University’s College of Health and Human Performance. He has studied obesity among immigrants and military veterans.

Leslie Heinberg, director of Enterprise Weight Management at the Cleveland Clinic, an academic medical center. She’s also vice chair for psychology in the Cleveland Clinic’s Center for Behavioral Health Department of Psychiatry and Psychology.

Monu Khanna, a physician in Missouri who is board certified in obesity medicine.

Jenn Lonzer, manager of the Cleveland Clinic Health Library and the co-author of several academic papers on health communication.

Cindi SturtzSreetharan, an anthropologist and professor at the Arizona State University School of Human Evolution and Social Change. She studies the language people of different cultures use to describe human bodies.

1. Familiarize yourself with recent research on what causes obesity and how obesity can affect a person’s health. Many long-held beliefs about the disease are wrong.

Journalists often report incorrect or misleading information about obesity, possibly because they’re unaware that research published in recent decades dispels many long-held beliefs about the disease, the experts say. Obesity isn’t simply the result of eating too many calories and doing too little exercise. A wide range of factors drive weight gain and prevent weight loss, many of which have nothing to do with willpower or personal choices.

Scholars have learned that stress, gut health, sleep duration and quality, genetics, medication, personal income, access to healthy foods and even climate can affect weight regulation. Prenatal and early life experiences also play a role. For example, childhood trauma such as child abuse can become “biologically embedded,” altering children’s brain structures and influencing their long-term physical and mental health, according to a 2020 research review published in the journal Physiology & Behavior.

“The causes of obesity are numerous and each individual with obesity will have a unique set of contributors to their excess weight gain,” Jamy Ard, president of The Obesity Society, wrote to The Journalist’s Resource.

The experts urge journalists to help dispel myths, correct misinformation and share new research findings. News outlets should examine their own work, which often “ignores the science and sets up situation blaming,” says Leslie Heinberg, director of Enterprise Weight Management at the Cleveland Clinic.

“So much of the media portrayal is simply ‘This is a person who eats too much and the cure is simply to eat less or cut out that food’ or something overly, overly simplistic,” Heinberg says.

Journalists need to build their knowledge of the problem before they can explain it to their audiences. Experts point out that educating policymakers, health care providers and the public about obesity is key to eliminating the stigma associated with having a larger body.

Weight stigma alone is so physically and emotionally damaging that 36 international experts issued a consensus statement in 2020 to raise awareness about it. The document, endorsed by dozens of medical and academic organizations, outlines 13 recommendations for eliminating weight bias and stigma.

Recommendation No. 5: “We call on the media to produce fair, accurate, and non-stigmatizing portrayals of obesity. A commitment from the media is needed to shift the narrative around obesity.”

2. Use person-first language — the standard among health and medical professionals for communicating about people with chronic diseases.

The experts we interviewed encourage journalists to ditch the adjectives “obese” and “overweight” because they are dehumanizing. Use person-first language, which avoids labeling people as their disease by putting the person before the disease.

Instead of saying “an obese teenager,” say “a teenager who has obesity” or “a teenager affected by obesity.” Instead of writing “overweight men,” write “men who have overweight.”

Jenn Lonzer, manager of the Cleveland Clinic Health Library, says using “overweight” as a noun might look and sound awkward at first. But it makes sense considering other diseases are treated as nouns, she notes. Journalists would not typically refer to someone in a news story as “a cancerous person,” for example. They would report that the individual has cancer.

It’s appropriate to refer to people with overweight or obesity using neutral weight terminology. Puhl wrote that she uses “people with higher body weight” or “people with high weight” and, sometimes, “people with larger bodies” in her own writing.

While the Associated Press stylebook offers no specific guidance on the use of terms such as “obese” or “overweight,” it advises against “general and often dehumanizing ‘the’ labels such as the poor, the mentally ill, the disabled, the college-educated.”

The Association of Health Care Journalists recommends person-first language when reporting on obesity. But it also advises journalists to ask sources how they would like to be characterized, provided their weight or body size is relevant to the news story.

Anthropologist Cindi SturtzSreetharan, who studies language and culture, says sources’ responses to that question should be part of the story. Some individuals might prefer to be called “fat,” “thick” or “plus-sized.”

“I would include that as a sentence in the article — to signal you’ve asked and that’s how they want to be referred to,” SturtzSreetharan says.

She encourages journalists to read how authors describe themselves in their own writing. Two books she recommends: Thick by Tressie McMillan Cottom and Heavy: An American Memoir by Kiese Laymon.

3. Carefully plan and choose the images that will accompany news stories about obesity.

Journalists need to educate themselves about stigma and screen for it when selecting images, Puhl noted. She shared these four questions that journalists should ask themselves when deciding how to show people with higher weights in photos and video.

• Does the image imply or reinforce negative stereotypes?
• Does it provide a respectful portrayal of the person?
• Who might be offended, and why?
• Can an alternative image convey the same message and eliminate possible bias?

“Even if your written piece is balanced, accurate, and respectful, a stigmatizing image can undermine your message and promote negative societal attitudes,” Puhl wrote via email.

Lonzer says newsrooms also need to do a better job incorporating images of people who have different careers, interests, education levels and lifestyles into their coverage of overweight and obesity.

“We are diverse,” says Lonzer, who has overweight. “We also have diversity in body shape and size. It’s good to have images that reflect what Americans look like.”

If you’re looking for images and b-roll videos that portray people with obesity in non-stigmatizing ways, check out the Rudd Center Media Gallery. It’s a collection of original images of people from various demographic groups that journalists can use for free in their coverage.

The Obesity Action Coalition, a nonprofit advocacy organization, also provides images. But journalists must sign up to use the OAC Bias-Free Image Gallery.

Other places to find free images: The World Obesity Image Bank, a project of the World Obesity Federation, and the Flickr account of Obesity Canada.

4. Make sure your story does not reinforce stereotypes or insinuate that overcoming obesity is simply a matter of cutting calories and doing more exercise.

“Think about the kinds of language used in the context of eating habits or physical activity, as some can reinforce shame or stereotypes,” Puhl wrote.

She suggested journalists avoid phrases such as “resisting temptations,” “cheating on a diet,” “making excuses,” “increasing self-discipline” and “lacking self-control” because they perpetuate the myth that individuals can control their weight and that the key to losing weight is eating less and moving more.

Lonzer offers this advice: As you work on stories about obesity or weight-related issues, ask yourself if you would use the same language and framing if you were reporting on someone you love.

Here are other questions for journalists to contemplate:

“Am I treating this as a complex medical condition or am I treating it as ‘Hey, lay off the French fries?’” Lonzer adds. “Am I treating someone with obesity differently than someone with another disease?”

It’s important to also keep in mind that having excess body fat does not, by itself, mean a person is unhealthy. And don’t assume everyone who has a higher weight is unhappy about it.

“Remember, not everyone with obesity is suffering,” physician Monu Khanna wrote to The Journalist’s Resource.

5. To help audiences understand how difficult it is to prevent and reduce obesity, explain that even the places people live can affect their waistlines.

When news outlets report on obesity, they often focus on weight-loss programs, surgical procedures and anti-obesity medications. But there are other important issues to cover. Experts stress the need to help the public understand how factors not ordinarily associated with weight gain or loss can influence body size.

For example, a paper published in 2018 in the American Journal of Preventive Medicine indicates adults who are regularly exposed to loud noise have a higher waist circumference than adults who are not. Research also finds that people who live in neighborhoods with sidewalks and parks are more active.

“One important suggestion I would offer to journalists is that they need to critically explore environmental factors (e.g., built environment, food deserts, neighborhood safety, etc.) that lead to disproportionately high rates of obesity among certain groups, such as low-income individuals and racial/ethnic minorities,” Leslie Cofie, an assistant professor at East Carolina University, wrote to The Journalist’s Resource.

Cofie added that moving to a new area can prompt weight changes.

“We know that immigrants generally have lower rates of obesity when they first migrate to the U.S.,” he wrote. “However, over time, their obesity rates resemble that of their U.S.-born counterparts. Hence, it is critical for journalists to learn about how the sociocultural experiences of immigrants change as they adapt to life in the U.S. For example, cultural perspectives about food, physical activities, gender roles, etc. may provide unique insights into how the pre- and post-migration experiences of immigrants ultimately contribute to the unfavorable trends in their excessive weight gain.”

Other community characteristics have been linked to larger body sizes for adults or children: air pollution, lower altitudes, higher temperatures, lower neighborhood socioeconomic status, perceived neighborhood safety, an absence of local parks and closer proximity to fast-food restaurants.

6. Forge relationships with organizations that study obesity and advocate on behalf of people living with the disease.

Several organizations are working to educate journalists about obesity and help them improve their coverage. Five of the most prominent ones collaborated on a 10-page guide book, “Guidelines for Media Portrayals of Individuals Affected by Obesity.”

• The Rudd Center for Food Policy and Health, based at the University of Connecticut, “promotes solutions to food insecurity, poor diet quality, and weight bias through research and policy,” according to its website. Research topics include food and beverage marketing, weight-related bullying and taxes on sugary drinks.
• The Obesity Society helps journalists arrange interviews with obesity specialists. It also offers journalists free access to its academic journal, Obesity, and free registration to ObesityWeek, an international conference of researchers and health care professionals held every fall. This year’s conference is Nov. 2-6 in San Antonio, Texas.
• The Obesity Medicine Association represents health care providers who specialize in obesity treatment and care. It also helps journalists connect with obesity experts and offers, on an individual basis, free access to its events, including conferences and Obesity Medicine Fundamentals courses.
• The Obesity Action Coalition offers free access to its magazine, Weight Matters, and guides on weight bias at work and in health care.
• The American Society for Metabolic and Bariatric Surgery represents surgeons and other health care professionals who work in the field of metabolic and bariatric surgery. It provides the public with resources such as fact sheets and brief explanations of procedures such as the Roux-en-Y Gastric Bypass.

For further reading

Weight Stigma in Online News Images: A Visual Content Analysis of Stigma Communication in the Depictions of Individuals with Obesity in U.S. and U.K. News
Aditi Rao, Rebecca Puhl and Kirstie Farrar. Journal of Health Communication, November 2023.

Influence and Effects of Weight Stigmatization in Media: A Systematic Review
James Kite; et al. eClinicalMedicine, June 2022.

Has the Prevalence of Overweight, Obesity and Central Obesity Leveled Off in the United States? Trends, Patterns, Disparities, and Future Projections for the Obesity Epidemic
Youfa Wang; et al. International Journal of Epidemiology, June 2020.

This article first appeared on The Journalist’s Resource and is republished here under a Creative Commons license.