“That’s the Hollywood secret! Don’t put food in your dumb mouth!” That’s how Amy Schumer, a 34-year-old comedian, mocks the tyranny of thinness in Hollywood and American society. As Schumer recounted on the television show Ellen, as she prepared for her film “Trainwreck,” movie executives hired a personal trainer to try to help her slim down. They gave her a meal plan that consisted of “a smoothie for breakfast, and then like for lunch you journal about that smoothie…like, there’s no food!”

At 5’7” and 160 pounds, Schumer’s Body Mass Index is 25.1, just barely over the current cut-off between “normal weight” and “overweight” and slightly below average for the current U.S. population. But she counts as heavy in Hollywood, where weight-based discrimination prevails and bigger bodies are devalued and rendered invisible in the contemporary United States. Unlike most women performers, Schumer has defiantly refused to resemble an “undernourished bird.” Her normal weight has not hurt her romantic life or her career. On its opening weekend, “Trainwreck,” the movie Schumer wrote and starred in, grossed $30 million.

Weight-Based Discrimination is Widespread

Although few other industries have equally rigid body-size standards, weight-based discrimination is not limited to Hollywood, as I learned doing research for my book What’s Wrong with Fat? Studies have shown that women categorized as “obese” (with a Body Mass Index of 30 or higher) are less likely to marry or to marry a high-earning spouse. They are also less likely to get jobs and earn less on average than similarly qualified thinner women. Weight bias has been documented in employment, health care, education, and public spaces. In all these spheres, heavier people are stereotyped as lazy, unmotivated, sloppy, and lacking in self-discipline and competence.

Weight-based stereotyping can violate principles of equal opportunity, especially because this kind of discrimination reinforces other forms of discrimination. Very heavy men can face discrimination but, overall, women are judged more on appearance and are thus more likely than men to suffer this form of discrimination, especially in employment. The ill effects kick in at lower weights for women than for men. Heft in women is not only seen as unattractive but also as a violation of social expectations that females take up less space than males. Furthermore, weight-based discrimination reinforces prejudice against the poor and minorities, because low-income women, Mexican Americans, and African American women tend to weigh more on average than wealthier whites.Weight-based stereotyping can violate principles of equal opportunity, especially because this kind of discrimination reinforces other forms of discrimination.

Health Debates

Of course, there are some health risks associated with higher body mass. The clearest case is Type 2 diabetes, which becomes more likely as weight goes up. Yet as many medical researchers have pointed out, it is not clear whether obesity causes diabetes, diabetes causes obesity, or both conditions are caused by another factor such as poor nutrition, stress or genetics. Moreover, the association between weight and Type 2 diabetes is not perfect. Some thin people develop the disease, and many fat people never will.

For some people, moreover, being overweight or obese seems to protect health, as discussed in the “obesity paradox” literature. Among patients with heart disease, those labeled obese are less likely to die than those considered to be of normal weight.

Although the extent to which higher weight harms health is debated, there is considerable evidence that weight-based discrimination negatively affects health. Because heavier women are more likely than thinner women to experience hostility at the doctor’s office, they are less likely on average to get Pap smears – which means that obese women suffer from cervical cancer at higher rates. Many heavy women respond to fears of public ridicule or abuse by not exercising in public or even leaving their homes. And their desire to be unrealistically thin drives thousands of girls and women to develop eating disorders and body-image problems. Lives are diminished and sometimes lost. All of these ill-effects from weight discrimination make it a public health problem, as well as a civil rights issue.The extent to which higher weight harms health is debated, but there is considerable evidence that weight-based discrimination negatively affects health.

Missing Legal Protections and Unintended Stigmas

The U.S. federal government provides no specific protections against weight-based discrimination and only one state – Michigan – plus a few local jurisdictions such as San Francisco have statutes outlawing weight-based discrimination. In 2013, laughter greeted consideration of a height and weight discrimination bill by the Utah legislature, which ultimately defeated the proposal by a broad margin.

In fact, public health authorities may be reinforcing weight-based stigmas by pouring money into education campaigns about the health risks of obesity. First Lady Michelle Obama has made eliminating childhood obesity the biggest issue on her agenda. In 2011, Children’s Healthcare of Atlanta ran an aggressive ad campaign that included billboards with fat children blankly staring at viewers, accompanied by captions such as “Chubby kids may not outlive their parents” and “big bones didn’t make me this way. Big meals did.”

Messages like this, which place blame on fat people or on the parents of heavy children, can worsen weight-based stigma and discrimination. People who think that weight is easy to control (as opposed to beyond ready personal control) are more likely to see discrimination as justified. My own research documents that U.S. news media outlets regularly portray weight as a matter of personal responsibility, even though some geneticists say that weight, like height, is largely biologically programmed.

Remarkably, experiments I conducted with psychologist David Frederick revealed that simply having people read a news article about the supposed “obesity crisis” made them more likely to agree with stereotypical statements portraying fat people as unlikable, untrustworthy and less intelligent than thinner people. This alarming result should alert us to the need to recognize weight-based discrimination for what it is – a serious public health problem in its own right and an important civil rights issue.Simply having people read a news article about the supposed “obesity crisis” made them more likely to agree with stereotypical statements portraying fat people as unlikable, untrustworthy and less intelligent than thinner people.