Obesity has historically been regarded as a moral failing， and people with obesity describe being seen as deficient， lazy， and/or undeserving of respect， lacking willpower and self-discipline， and gluttonous1.
把肥胖看成品德问题由来已久，肥胖者称他们被指有缺陷、懒惰、不配受到尊重、意志薄弱、缺乏自律，还贪吃。
These views contribute to weight bias （negative ideologies2 associated with obesity）， which can lead to weight stigma3 （discriminatory acts and ideologies targeted toward individuals because of their weight and size）.
这些看法助长了体重偏见（涉及肥胖的负面思想），进而形成了体重污名（针对个体体重和身材的歧视性行为和观念）。
Paradoxically， research suggested an association between weight stigma and increased food intake， eating without being hungry， emotional eating， binge4 eating， and long-term weight gain.
矛盾的是，研究表明，体重污名与进食量增加、非饥饿性进食、情绪化进食、暴饮暴食和长期体重增长之间存在关联。
The medical community is working to address the problem， and there are practical steps physicians can take to make their practices weight inclusive.
医学界正在努力解决这个问题，也有了一些切实可行的办法，医生加以采用就可使其诊疗过程具有体重包容性。
Impact of weight stigma
体重污名的影响
Weight stigma in healthcare settings is communicated to patients verbally and nonverbally. Patients reported being “fat shamed，” as described in a recent article in Fortune magazine.
医疗场景中的体重污名是通过口头和非口头方式传达给患者的。正如《财富》杂志最近一篇文章所述，患者吐槽他们“因肥受辱”。
“I always go in [to medical appointments] with my guard up5，” one patient said in the article. That patient was told by an obstetrician/gynecologist that she was “too fat” and that the physician couldn’t treat people like her after the doctor tried and failed to insert an intrauterine device6.
文章中有位病人这样说：“我就诊时总是防备心很重。”曾有一位妇产科医生试图给这个病人放置宫内节育器，失败之后反倒怪她“太胖了”，说医生没法给这么胖的病人看病。
Nonverbal shaming can include looks of disgust or contempt， discussions that lack warmth， and a demonstrated unwillingness to touch the patient.
非言语性羞辱包括厌恶或轻蔑的神态、冷冰冰的问诊，以及明显不愿触碰病人。
Weight discrimination can have serious consequences for patient health. Patients who have experienced weight bias in a medical setting are more likely to cancel appointments and avoid preventive care， which increases their medical risk. For example， women with obesity are less likely to be up-to-date7 on Pap smears8 and screening mammograms9， often due to perceived weight stigma and lack of appropriately sized examination equipment.
体重歧视会严重影响患者的健康。在医疗服务中体验过体重偏见的患者更有可能取消预约并回避预防性治疗，其医疗风险也因此而增大。例如，肥胖妇女很少会接受宫颈涂片检查和乳腺X光筛查，通常都是因为感受到体重污名，以及缺少尺寸合适的检查设备。
“Weight stigma is a major concern that needs to be addressed in clinical practice and medical education，” Kathleen Robinson， MD， PhD， assistant professor of internal medicine-endocrinology and metabolism， Iowa Carver College of Medicine， Iowa City， Iowa， told Medscape Medical News10.
“体重污名是临床实践和医学教育中需要解决的重要问题。”艾奥瓦州艾奥瓦市卡佛医学院内科-内分泌与代谢学助理教授、医学博士、哲学博士凯瑟琳·鲁宾逊博士接受“医景网医疗新闻专栏”采访时说。
Robinson and colleagues surveyed 395 individuals who were asked about their experiences related to weight stigma and healthcare. Of these， 73 provided narrative responses， some of which included experiences of being shamed.
鲁宾逊及其同事调查了395人，问他们与体重污名和就诊相关的经历。受访者中，有73位提供了叙事性回复，其中就有遭受羞辱的切身经历。
“We found ongoing tension between the framing11 of weight as solely a result of personal responsibility vs weight as a multifactorial12 condition with an array of uncontrollable aspects，” Robinson reported.
“我们发现，有两种观点持续对立——一种观点把体重问题完全归因于个人责任，另一种则认为体重受多因素支配且很多因素难以控制。
