The fat jokes and body shaming have officially gone too far. What may feel well intentioned, or maybe flat out aimed to criticize, has far greater ramifications than the “sticks and stones” variety. Those words won’t break bones, but they can damage hearts.

A new study out of the University of Pennsylvania found that there is a significant relationship between weight bias internalization, applying negative weight stereotypes to oneself, and a diagnosis of metabolic syndrome.

When someone hears that they are fat, overweight,  or other statements that make them feel shame about their body, they identify as lazy, unattractive, or completely at fault for their excess weight. “When people feel shamed because of their weight, they are more likely to avoid exercise and consume more calories to cope with this stress,” said lead researcher Rebecca Pearl, PhD.

The study included 159 adults. Those with high internalization were three times more likely to have metabolic syndrome, which is a group of risk factors for heart disease, diabetes, and stroke. They were six times more likely to have high triglycerides.

Similar studies have found other negative health effects when participants are exposed to weight bias, like physiological stress that increases inflammation and cortisol, overeating, and avoidance of physical activity.

When you know better, you have to do better. Blaming and shaming is not effective for promoting weight loss, whether it’s an exchange with a friend or loved one, messages from a marketing campaign, or from a physician. These prejudicial messages are, in fact, contributing to poorer health in those who can’t afford any more hits, said study co-author Tom Wadden, PhD.

Study researchers recommend a few ways to engage that might actually help these individuals:

• Respect
• Sensitivity
• No Judgement
• Support
• Encouragement

So basically: Treating them however you would like to be treated. 

They specifically note the importance of healthcare providers extending these principles to their patients. Imagine how damaging it can be when the one person who is supposed to be helping you seems to only contribute to the problem.

It seems like the kind of thing we learned under the golden rule at our earliest ages, but maybe seem to forget or lose sight up. Speak with kindness to one another, especially those who need our help the most. Obese individuals come into their weight for myriad reasons — some of which they can control, some they can’t. On the surface you can’t know the difference, and at the end of the day, it shouldn’t matter.