People are bombarded by messages about how to be healthy and why—namely that good health contributes to a happy life. At the same time, messages about what it means to be unhealthy can be even more powerful and negative.

Some health conditions, such as obesity, substance abuse, or mental health issues, impose another burden on patients: shame, which comes from feeling that somehow they are at fault for being ill and do not have enough character, strength, or willpower to get better.

“There’s a worry that others are seeing us, judging us, and finding us so wanting that they will reject us,” writes Kate Virant, MSW, JD, LCSW, in Psychology Today. “When we’re ashamed of being ill, we don’t talk about our illness to others. We may try to ‘pass’ as healthy, constantly monitoring appearance, speech, and behavior so that we can keep shame at bay.”1

And that practice does not benefit anyone’s health.

The Prejudice That Won’t Go Away

A common example of health stigma centers around obesity. Advertisers and marketers are embracing more body types, but prejudice around weight still exists, and it starts early. Researchers have found that children as young as three years old have negative attitudes towards their overweight peers, and those views are often accompanied by discrimination and bullying.2 Another study found that children’s implicit bias towards overweight people is at about the same level as racial bias in adults.3

“Although modern societies approach prejudices as inherently evil, weight stigma largely escapes this view,” writes Scott Kahan, MD, medical director of the STOP Obesity Alliance. “Indeed, obesity has been called the last socially acceptable form of prejudice.”4

Addressing the issue requires an extra level of sensitivity. “Health issues around obesity can be truly difficult,” says Stacy Byers, CMA (AAMA), of Statesville, North Carolina. “Many patients are sensitive about not being at a healthy weight, which can lead to many comorbidities that affect their overall health. Addressing those topics can help them understand how making better choices that reduce those concerns can impact their weight as well.”

Health care professionals need to take extra caution to avoid stigma, which can cause patients to adopt unhealthy behaviors and gain weight.4 To achieve this, health care professionals should be mindful of their language, develop a better understanding of obesity, be a patient advocate, and care for the whole person.4

Silent Sufferers

Infertility is another common source of stigma. More than 10% of women ages 15–44 and 27% of women ages 35–44 experience fertility issues.5 Likewise, 12% of men ages 25–44 have impaired fertility.5

“Men see infertility as a condition that questions their masculinity and their virility,” says Barrett Cowan, MD, chief medical officer of Posterity Health and assistant clinical professor at the University of Colorado School of Medicine. “But … it is a medical issue that can be diagnosed and treated.”

Psychological consequences regardless of sex or gender may include guilt or shame, which is further exacerbated by social stigma.5 That stigma may prevent patients from seeking out support systems that can help reduce their stress.5

Two Stigmas for Two Eras

Martina Clark, the author of a memoir about COVID-19 and HIV, remembers how virulent the stigma around an HIV diagnosis was in 1992.

“I was certain that I was the only woman with HIV, and I felt a lot of shame,” she says. She experienced insensitive treatment by her physician and even her own family. “The broad stigma has diminished, to be sure, but it still lingers even today.”

“I have been astonished that several people have said something to the effect of, ‘I’m sure you didn’t have as much fun getting COVID-19 as you did HIV,’ which is such a weird and inappropriate thing to say,” she recalls. “It reminds me that the stigma around HIV is still there, even if it’s less frequently mentioned.”

And, new forms of insensitivity exist around COVID-19.

A quarter of Americans associate COVID-19 with shame, which stops people from accessing health services and measures needed to control the disease.6 The recent arrival of COVID-19 is part of the reason that stigma has been attached to it, writes Laura Murray for the Johns Hopkins Bloomberg School of Public Health.

“COVID-19 is a new virus that experts have learned more about over time with the science constantly evolving,” she writes. “This leads to changes in recommendations with new understandings, which can create confusion, frustration, and mistrust.”7

Put Stigma to Shame

Stigma can start a patient on a bad path that goes beyond their health issue.

“Shame promotes more shame, as we become ashamed of the fact that we are feeling shame,” explains Virant. “This shame spiral is characteristic of the experience of shame and intensifies the painful nature of the emotion.”1 In turn, this can affect patients’ willingness to seek out necessary health resources.

Health care professionals can take a stand against stigma by taking key actions8:

  • Maintain the privacy of patients
  • Correct false language that contributes to stigma by offering accurate information
  • Speak out against negative language or behaviors
  • Suggest useful resources and support services to those who may be experiencing stigma
  • Promote diversity in communication that avoids stereotypes

The best medicine of all can simply be empathy. “Acknowledge to patients that there is more to taking care of themselves than just taking their medicine,” recommends Clark. “Ask them how they are doing overall. Acknowledge that showing up to fight any stigmatized health issue is a full-time job and praise them for rising to the challenge.

“I never want to be babied,” she continues. “But I do appreciate it when any caregiver acknowledges that taking care of myself is a lot and that it involves so much more than swallowing pills.”