You’ve already heard of racism, sexism, homophobia, and other forms of discrimination. But what about weight-based discrimination? A study in Obesity says anti-fat bias has increased by a whopping 66 percent, and it’s the only form of oppression that’s still considered socially acceptable (though it shouldn’t be).

This type of oppression—which may also be referred to as “weight bias”—basically refers to the stigmatization, bullying, prejudice, and discrimination against people in larger bodies. And like race, gender, and sexual orientation, it’s not in someone’s control. While diet culture pushes the idea that people in larger bodies are unhealthy and morally “bad,” that simply isn’t the case. Yet, those people are still treated as if they don’t deserve to exist or have the same opportunities and support.

Weight is not a sole and direct deciding factor of health. According to the World Health Organization, the determinants of health are endless, from income to genetics to where you live and more—many of which can be affected by other systems of oppression at play, such as racism and classism.

Anti-fat bias is not only unhelpful and based in fiction, but it’s straight-up harmful, too. A study in Clinical Diabetes found that people who experience weight bias are less likely to exercise, as well as more likely to binge eat, experience high blood pressure, distrust their doctor, feel stressed, and more. But that’s just the beginning.

How anti-fat bias hurts fat people

The negative impacts of anti-fat bias are far-reaching, to say the least. Here are some of the main ways in which fat people are impacted by the stigma:

Physical health

One of the main places we see harm is, perhaps ironically, at the doctor’s office. “I have worked with clients who have gone to the doctor and been entirely dismissed, being told that they just need to lose some weight, and are prescribed diet and exercise,” says Gabriella Giachin, LMSW, a therapist at New York City Psychotherapy Collective. “Meanwhile, they have physical underlying health issues that are being entirely ignored, their pain being ignored, or their symptoms not being taken seriously.”

This form of fat shaming can also lead to stress (and the host of health issues that come from that), delayed medical visits, and undiagnosed medical conditions.

Worried you will have or have had this experience? A few red flags that may indicate your doctor holds weight bias include assuming how much you eat or exercise, ignoring a history of disordered eating, and encouraging weight loss.

Livelihoods and careers

In short, anti-fat bias is everywhere. “Anti-fat bias is implicit in today’s culture,” says Maya Feller, MS, RD, CDN, a registered dietitian nutritionist of Brooklyn-based Maya Feller Nutrition and author of Eating from Our Roots: 80+ Healthy Home-Cooked Favorites from Cultures Around the World. “Society normalizes, prioritizes, and rewards thinness.” We see this from small seats on airplanes and rollercoasters, to Wii Fit’s weight limit of 330 pounds, to the difficulty of finding clothing above a size 12 (though the average American woman is a size 16 to 18), and much more.

Commercials, TV shows, and other types of content illustrate this narrative, too. “Media shows us thin bodies laughing, eating bowls of salad, visiting the beach, and hanging out,” Feller adds. “Are these activities that are reserved for thin bodies?”

Anti-fat bias is also present in the workplace. According to a study in Economics and Human Biology, for every six pounds an American woman gains, her hourly pay drops by two percent. “Unfortunately, there are no laws explicitly citing how unethical and irrelevant a judgment call like this is, which means employers can continue to mistreat employees in larger bodies,” says Cara Bohon, PhD, the senior vice president of clinical programs at Equip and clinical associate professor at Stanford University.

People in larger bodies have to jump through extra hoops, and they shouldn’t have to. “You are getting the not-so-subtle message that your body is not welcome and needs modification,” Feller adds. “There isn’t one instance that comes to mind where thinness is not at the center of interpersonal interactions.”

Mental health

Given their life is filled with barriers and harsh judgments, it’s no wonder that many people in larger bodies struggle emotionally. “A culture that says that if you are of a certain size, it means that you must be lazy, or bad, or that you don’t try hard enough or don’t care about yourself or your health, leads to poor self-image, self-hatred, and a completely inaccurate self-image,” says Kate Hanselman, PMHNP, a psychiatric mental health nurse practitioner with Thriveworks in West Hartford, Conn. who specializes in depression, coping skills, relationships, and life transitions. As a result, you may also isolate yourself, feel intense shame, not be able to fully experience and enjoy your relationships, and more, she adds.

Additionally, weight bias can hurt your relationship with food and exercise, even turning into an eating disorder. While a myriad of factors contribute to the development of an eating disorder, we would be remiss to not note the weight component. “Many of the people we serve have eating disorders rooted at least in part in trying desperately to not be seen as fat by the culture,” says Jillian Lampert, PhD, MPH, RD, LD, FAED, chief strategy officer of Accanto Health.

People with eating disorders aren’t always thin, either. “People with large bodies often go undiagnosed for an eating disorder because they don’t ‘look the part,’ while some may be struggling with binge eating disorder or anorexia nervosa,” Dr. Bohon adds.

Anti-fat bias hurts people in smaller bodies, too

The benefits that come with being thin—and the fear surrounding becoming fat—are something we can all sense and be affected by. While fat people directly experience the most oppression, people in bodies of all sizes are affected by our weight-obsessed culture.

“If you think that someone is healthy just because they are thin, especially in a medical setting, that means you’re ignoring the fact that they may be starving themselves or overexercising to maintain that weight,” Giachin says. “You’re also not considering how much time and energy that person is spending thinking about their food, their body, their weight, etc.”

Those behaviors can lead to a laundry list of health problems. “Restrictive eating, excessive exercise, shame, anxiety, depression, and more become the mainstay,” Feller says.

How we can address the dangers of anti-fat bias

While it’s easy to feel powerless to all of these systemic issues, we’re not. In fact, there are many ways we can make a change—on a micro and macro level—when it comes to size-based discrimination.

Think critically about our views and words

First, we have to be mindful of our thoughts and opinions about food, bodies, and people. Where do they come from? Who are they serving (and not serving)?

Dr. Bohon says intentionally seeking out different viewpoints and experiences can help with this. Don’t only learn from those individuals, but fight with and for them, too. “It’s also vital to support fat-positive initiatives and advocate for fat acceptance,” she says. “During this process, people may identify challenges in their own body image concerns, and addressing those can be important to reduce anti-fat bias.”

Then, what can an outward expression look like? “We can also be really aware of how we speak about others, their bodies, and the messaging we reinforce in our daily lives,” Giachin says. She gives the example of not commenting on someone’s appearance.

Neutralize the topic of weight

Further, body neutrality (which differs from body positivity) has helped many people have a healthier and happier relationship with their body. It’s a more productive and effective way to view bodies, which are vessels that help us do things and not reflections of morals or habits.

Hanselman shares an example statement you can say to yourself—“I have a body and it does things for me”—which she says has felt attainable and helpful for her clients. “Not only can this be an easier shift from the narrative of hating one’s body, which this culture perpetuates at any size, but it can provide more of a mindful focus on partnering with our bodies that support us all day long,” she says.

It’s important to do this without being ableist, however, as some people’s bodies can’t do as much. So again, remember to take out any morality related aspects. “A triathlete is not better than someone who walks with a cane because of a knee injury—they’re just different,” Hanselman adds.

Make spaces for these conversations

If we don’t talk about these harms on a large scale, we won’t be able to get anywhere as a society. “We must raise awareness about the harms of anti-fat bias, the complexities of weight, and the negative impacts of weight stigma,” Dr. Bohon says.

Our work doesn’t end there. “We also need to enact laws that protect people from weight bias in the workplace, health care, and everywhere else,” she adds. This is one of many reasons why voting and being involved in politics—at the local and national level—is so important. And it’s happening, slowly but surely: New York recently passed legislation to stop height and weight discrimination in employment, housing, and public accommodation spaces.

Call people in

Holding each other accountable is a crucial piece, too. “Urge others to consider the harm they are doing to others and themselves when they engage in anti-fat bias behaviors,” Lampert says, listing name calling, snide comments and looks, criticism on social media, dismissing fat people, making jokes, and dieting as examples. In a gentle, clear, and kind manner, she encourages doing this in front of children, especially, who learn from our behaviors.

Embrace a Health at Every Size (HAES) model

While HAES isn’t a perfect framework—you may have heard about the controversies related to Lindo Bacon, who wrote a book on the topic—it’s probably the best and most mainstream one we have at the moment. In a nutshell, it promotes health equity, supports ending weight discrimination, and works to improve access to quality health care regardless of size.

It’s time to implemet HAES on a larger scale. “This goes for health-care settings, school settings, and within the diet/health/fitness industry,” Giachin says.

Give to creators and supporters of this cause

Diet culture thrives, in part, due to capitalism—but we can flip the script. “We can also support, with our dollars and voices, retailers, authors, influencers, [and] other creators that are addressing anti-fat bias, [using] our efforts toward broader change,” Lampert says.

Know your role

While we can all address these pieces, most of the work is reserved for those who have the most privilege (and are therefore most likely to be listened to). “It is the duty of thin people to check their privilege by calling out anti-fat bias where they see it, and to practice enough self-love and self-knowledge to ensure they are not contributing to it,” Hanselman says.

Ultimately, our words and behaviors should boil down to one thing: respect. “Bodies come in all shapes and sizes, and our bodies each have different needs in terms of fuel, energy and exercise,” Giachin says. “Regardless of the size of your body, people deserve proper health-care treatment and opportunities in all areas of their lives.”