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September 2022, Volume 72, Issue 9


Baro-Bullying: An ignored comorbidity of living with obesity

Sanjay Kalra  ( Department of Endocrinology, Bharti Hospital, Karnal, India. )
Saurabh Arora  ( Department of Endocrinology, Dayanand Medical College and Hospital, Ludhiana, India. )
Nitin Kapoor  ( Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore (TN) -632004, India, and Non Communicable Disease Unit, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia. )


Obesity is no longer considered as a result of simplistic voluntary inequality of excessive intake of calories and inability to expend the same by physical activity. Though the calorie imbalance occurs, it is said to be biologically driven by underlying genetic mechanisms and associated with alterations in the orexigenic and anorexic hormones in the hypothalamus. However, despite recognising obesity as a disease the stigma associated with obesity is still a big problem in the society. In this manuscript we propose the term Baro-Bullying which provides a holistic overview of this stigma encompassing its different aspects and its downstream effect on the individual and the disease process. We also propose different methods to reduce barobullying across the spectrum of this disease process.


Keywords: Body shaming, Psychological impact, Obesity bias, Stigma, Gender disparity, Depression






Obesity is now recognised as a disease which is biologically driven by changes in hormones in the neuronal circuits secondary to the genetic predisposition and modified by environmental factors.1 However, despite its global recognition as a disease, still a lot of stigma is associated with people living with obesity. This further increases the already high psychological burden on these patients.2  Body shaming is defined as the act of criticizing or disparaging a person’s body habitus or physical appearance. People living with obesity are often at the receiving end of body shaming, though the same experience, at times, is reported by thin persons as well.


The concept of Baro-Bullying


Body shaming is part of a wider phenomenon of weight stigma, or stigma against people living with obesity. Weight stigma implies bias or discriminatory behaviours targeted at individuals because of them being overweight or having obesity. This in part, is based upon “sizeism”, which is the attitude that persons are prejudged based upon their weight or size.

Recent years have witnessed a dramatic change in the way we communicate with each other. Social media have made it possible to share opinions and thoughts with multiple people, and amplify noise. While such e-communication certainly has its advantages, there is a dark side to it as well. At times, social media can be a vehicle for propagation of incorrect ideas, and for cyber bullying.3 Very few platforms are properly policed and often weight shaming or sizeism-based comments and images have a free run of the ground. The misinformation regarding obesity, its causative factors, clinical features, comorbidities, complications and control, is difficult to quantify. Along with this, a negative stereotype of persons living with overweight or obesity is reinforced.

This situation creates a fertile ground for cyberbullying of such persons. Cyberbullying is defined as bullying that takes place using digital technology. Hateful or discouraging remarks shared over instant messaging, social media, online forums and e-mail all come under the ambit of cyberbullying. Many such posts look down upon obese persons, and lead to a social ostracization of sorts.4

Bullying is not limited to the e-world as well. Bullying is an aggressive behaviour, repeated over time, with a hostile intent, to hurt a person physically, mentally or emotionally, by a person with real, or perceived, power over the victim. Bullying occurs in multiple settings, including at home, school, work, and in recreation facilities especially during eating and meal timings.5 Children and adults living with obesity are more prone to bullying by parents, playmates, peers and partners.

Bullying in the scientific community, was also a problem but has been successfully curbed by vigilant editors and reviewers of various journals. Guidelines have been published on how to refer people living with obesity as a “person first” approach, for example rather than writing “obese people” to mention “people living with obesity”.6 We propose the term baro-bullying to include all these challenging situations. Baro-bullying can be defined as aggressive verbal and/or physical acts, in person or through digital channels, designed to physically, mentally or emotionally hurt a person living with overweight or obesity, which may lead to impairment of biomedical, psychological or social functioning of the individual, and/or the community at large.

Baro-bullying includes, and is more inclusive than the concept of body shaming. While body shaming is obvious, and is usually limited to verbal comments on bodily attributes of the victim, baro-bullying includes non-verbal and physical hurt as well. (Table-1) Baro-bullying incorporates the concept of sizeism, and helps pin the responsibility on the culprit, or bully, rather than blaming society at large. Baro-bullying incorporates hostile messages shared through digital technology as well as in person. Our definition includes the possible implications of such hostility, and brings both clinical and public health concerns in its ambit. Table-2 mentions the key methods of preventing Baro-Bullying across different levels of prevention. This needs to be identified and incorporated in the person centric model of managing obesity.7,8







Baro-Bullying is a novel concept encompassing different aspects of stigma associated with obesity. This framework provides a comprehensive method of assessing the impact of stigma associated with obesity and its downstream effect on the individual and the disease process. This manuscript also provides methods of preventing Baro-Bullying across the spectrum of obesity from primordial prevention to quinary prevention.




1.       Kalra S, Kapoor N, Bhattacharya S, Aydin H, Coetzee A. Barocrinology: The Endocrinology of Obesity from Bench to Bedside. Med Sci (Basel). 2020;8:51 doi: 10.3390/medsci8040051.

2.       Jiwanmall SA, Kattula D, Nandyal MB, Devika S, Kapoor N, Joseph M, et al. Psychiatric Burden in the Morbidly Obese in Multidisciplinary Bariatric Clinic in South India. Indian J Psychol Med. 2018;40:129-33.

3.       Kalra S, Kumar A. Quinary prevention: Defined and conceptualized. J Pak Med Assoc. 2019;69:1765-11766.

4.       Sergentanis TN, Bampalitsa SD, Theofilou P, Panagouli E, Vlachopapadopoulou E, Michalacos S, et al. Cyberbullying and Obesity in Adolescents: Prevalence and Associations in Seven European Countries of the EU NET ADB Survey. Children (Basel). 2021;8:235 doi: 10.3390/children8030235.

5.       Kapoor N, Sahay R, Kalra S, Bajaj S, Dasgupta A, Shrestha D, et al.Consensus on Medical Nutrition Therapy for Diabesity (CoMeND) in Adults: A South Asian Perspective. Diabetes Metab Syndr Obes.2021;14:1703-28.

6.       Kyle TK, Puhl RM. Putting people first in obesity. Obesity (Silver Spring). 2014;22:1211.

7.       Kalra S, Kapoor N, Kota S, Das S. Person-centred Obesity Care - Techniques, Thresholds, Tools and Targets. Eur Endocrinol. 2020;16:11-3.

8.       Kapoor N, Kalra S, Kota S, Das S, Jiwanmall S, Sahay R. The SECURE model: A comprehensive approach for obesity management. J Pak Med Assoc. 2020;70:1468-9s.

Journal of the Pakistan Medical Association has agreed to receive and publish manuscripts in accordance with the principles of the following committees: