Feeding Bias: Rethinking the Weight of People with IDD and Social Determinants of Health

Posted on September 2, 2025

By Carli Friedman, CQL Director of Research

A lot of attention is paid to the fact that people with intellectual and developmental disabilities (IDD) are more likely to be fat[1] than people without disabilities and trying to reduce their weight. Professionals almost exclusively recommend changing diet and increasing exercise as the only intervention (Cobbaert & Rose, 2023). However, changing eating patterns and exercise result in little to no weight loss for most people (Zhu et al., 2022). In addition, most people that lose weight gain it back, often gaining more than their original weight (Cobbaert & Rose, 2023; Pearl, 2018; Zhu et al., 2022). Shaming people to lose weight can also result in people gaining more weight and participating in fewer healthy behaviors (Brewis et al., 2018; Pausé, 2017; Puhl et al., 2020; Zhu et al., 2022).

It is important to recognize that the cause of people’s weight is not actually based on lifestyle alone or a lack of will power (Daníelsdóttir et al., 2010; Singh et al., 2019; Sorensen & Krings, 2023). Instead, how much we weigh is largely outside of our control because the cause of weight is multidimensional, with a wide variety of biological, genetic, developmental, environmental, and social factors contributing to our weight (Daníelsdóttir et al., 2010; Pearl, 2018; Singh et al., 2019; Zhu et al., 2022). In fact, social determinants of health play a very significant role in our weight (Cobbaert & Rose, 2023; Magaña et al., 2023; Puhl et al., 2020; Singh et al., 2019; Zhu et al., 2022). For example, poverty, employment, housing, accessibility, and many other factors contribute to our weight. One social determinant that plays a significant role in our weight is weight bias (Ata et al., 2018; Puhl et al., 2015; Puhl et al., 2021; Siqueira et al., 2021; Sorensen & Krings, 2023; Zhu et al., 2022). Weight bias is discrimination based on weight, including stereotypes about fat people being lazy, lacking self-control, and being incompetent, among others.

Despite research indicating the role of social determinants of health, including weight bias, in people’s weight, little to no research has focused on the impact on people with IDD specifically. For these reasons, the aim of this study was to examine how weight bias impacts the social determinants of health of people with IDD. To do so, I analyzed Personal Outcome Measures^® social determinants of health-related outcome data from 4,384 people with IDD, in combination with data about implicit weight bias in the states they lived, that came from 2 million people.

I found when people with IDD live in states that with more implicit weight bias – that are more biased against fat people – people with IDD have fewer social determinants of health (SDOH)-related outcomes present, regardless of their sociodemographics. This includes things like rights, choice, health, and community integration. For example, a person with IDD who lives in a state with an implicit weight bias of 0.40 is expected to have 8.12 out of 11 SDOH-related outcomes present (73.8%). In contrast, a person with IDD who lives in a state with an implicit weight bias of 0.50 is expected to have 1.82 out of 11 SDOH-related outcomes present (16.6%).

The Relationship Between Weight Bias and Outcomes of People with IDD

Not only does research indicate that social determinants of health play a significant role in people’s weight (Cobbaert & Rose, 2023; Magaña et al., 2023; Puhl et al., 2020; Singh et al., 2019; Zhu et al., 2022), but the findings of this study also suggest that increased weight bias is associated with people with IDD having fewer social determinants of health-related outcomes present. Thus, there is likely a cyclical relationship in that our lack of attention to social determinants of weight, as well as the ways we stigmatize weight and reinforce weight bias, not only causes people with IDD to gain more weight and participate in less healthy behaviors (Brewis et al., 2018; Puhl et al., 2020; Puhl et al., 2021; Siqueira et al., 2021), but also negatively hinders their social determinant-related outcomes; then the lack of social determinant-related outcomes likely also impact their weight. As such, we believe there needs to be a reframing of how people with IDD’s weight and bodies are thought about and ‘intervened.’ We should move away from exclusively focusing on people with IDD losing weight, towards a more holistic conceptualization of weight and health, including one that recognizes and attends to social determinants, including by reducing weight bias.

This article is a summary of the following journal manuscript: Friedman, C. (2025). Reconceptualizing weight of people with intellectual and developmental disabilities in the context of social determinants of health. Fat Studies: An International Journal of Body Weight and Society, 14(2), 197-210. https://doi.org/10.1080/21604851.2025.2550794

References

• Ata, R. N., Thompson, J. K., Boepple, L., Marek, R. J., & Heinberg, L. J. (2018). Obesity as a disease: Effects on weight-biased attitudes and beliefs. Stigma and Health, 3(4), 406. https://doi.org/10.1037/sah0000087
• Brewis, A., SturtzSreetharan, C., & Wutich, A. (2018). Obesity stigma as a globalizing health challenge. Globalization and health, 14(20), 1-6. https://doi.org/10.1186/s12992-018-0337-x
• Cobbaert, L., & Rose, A. (2023). Eating disorders and neurodivergence: A stepped care approach. Eating Disorders Neurodiversity Australia. https://nedc.com.au/assets/NEDC-Publications/Eating-Disorders-and-Neurodivergence-A-Stepped-Care-Approach.pdf
• Daníelsdóttir, S., O’Brien, K. S., & Ciao, A. (2010). Anti-fat prejudice reduction: A review of published studies. Obesity facts, 3(1), 47-58. https://doi.org/10.1159/000277067
• Friedman, C. (2025). Reconceptualizing weight of people with intellectual and developmental disabilities in the context of social determinants of health. Fat Studies: An International Journal of Body Weight and Society.
• Magaña, S., Eliasziw, M., Bowling, A., & Must, A. (2023). Racial and ethnic disparities in obesity and contributions of social determinants of health among boys with autism spectrum disorder. Frontiers in pediatrics, 11. https://doi.org/10.3389/fped.2023.1198073
• Pausé, C. (2017). Borderline: The ethics of fat stigma in public health. The Journal of Law, Medicine & Ethics, 45(4), 510-517. https://doi.org/10.1177/1073110517750585
• Pearl, R. L. (2018). Weight bias and stigma: Public health implications and structural solutions. Social Issues and Policy Review, 12(1), 146-182. https://doi.org/10.1111/sipr.12043
• Pickett, A. C., & Cunningham, G. B. (2017). Physical activity for every body: A model for managing weight stigma and creating body-inclusive spaces. Quest, 69(1), 19-36. https://doi.org/10.1080/00336297.2016.1145129
• Puhl, R., Latner, J., O’brien, K., Luedicke, J., Danielsdottir, S., & Forhan, M. (2015). A multinational examination of weight bias: Predictors of anti-fat attitudes across four countries. International journal of obesity, 39(7), 1166-1173. https://doi.org/10.1038/ijo.2015.32
• Puhl, R. M., Himmelstein, M. S., & Pearl, R. L. (2020). Weight stigma as a psychosocial contributor to obesity. American Psychologist, 75(2), 274. https://doi.org/10.1037/amp0000538
• Puhl, R. M., Lessard, L. M., Himmelstein, M. S., & Foster, G. D. (2021). The roles of experienced and internalized weight stigma in healthcare experiences: Perspectives of adults engaged in weight management across six countries. PloS one, 16(6), e0251566. https://doi.org/10.1371/journal.pone.0251566
• Singh, K., Russell-Mayhew, S., von Ranson, K., & McLaren, L. (2019). Is there more to the equation? Weight bias and the costs of obesity. Canadian Journal of Public Health, 110, 17-20. https://doi.org/10.17269/s41997-018-0146-2
• Siqueira, B. B., Assumpção, M. C., Barroso, S. M., Japur, C. C., & Penaforte, F. R. d. O. (2021). Weight stigma and health–Repercussions on the health of adolescents and adults: Integrative review of the literature. Jornal Brasileiro de Psiquiatria, 70, 162-178. https://doi.org/10.1590/0047-2085000000324
• Sorensen, B. L., & Krings, A. (2023). Fat liberation: How social workers can incorporate fat activism to promote care and justice. Affilia, 38(4), 724-731. https://doi.org/10.1177/08861099231183672
• Zhu, X., Smith, R. A., & Buteau, E. (2022). A meta-analysis of weight stigma and health behaviors. Stigma and Health, 7(1), 1-13. https://doi.org/10.1037/sah0000352

[1] The use of the term ‘fat’ rather than ‘obese’ or ‘overweight’ is intentional because the latter terms set up normative standards, which fat people do not meet, pathologize people’s bodies, and are also more stigmatizing, while ‘fat’ is descriptive (Picket et al., 2017). It is also important to note that BMI is not a good predictor of health and was originally created to advance eugenics (Picket et al., 2017).