Weight Stigma: Health Implications

[Guest guest]

From Medscape Public Health <goog_1201158543> > Hot Topics in Public

Health Yale

Rudd Center for Food Policy & Obesity: Weight Stigma: Health ImplicationsWeight

Stigma and Stereotypes

Stigma and prejudice toward obese persons occur frequently in our society.

Several decades of research have identified many negative weight-based

stereotypes, including opinions that obese individuals are lazy,

unintelligent, unsuccessful, lacking in willpower and self-discipline, and

noncompliant with treatment.[1] Unfortunately, these pervasive stereotypes

contribute to prejudice and discrimination in many areas of daily life, such

as employment, healthcare, education, and the media.[2] Unlike other forms

of social bias, weight-based stigmatization is largely acceptable in our

culture, and no federal law prohibits weight discrimination. Thus, perhaps

not surprisingly, reports of weight discrimination are increasing. Recent

estimates show that the prevalence of weight discrimination has increased by

66% over the past decade[3] and is now on par with prevalence rates of

racial discrimination in the United States.[4]

Although weight discrimination is often framed and discussed as an issue of

social injustice, it is equally important to understand and address this

form of discrimination as a public health problem.[5] Unfortunately, despite

consensus that disease stigma undermines public health, this principle has

not been applied to the obesity epidemic, and instead the stigma of obesity

has been largely ignored in the context of public health. There is even a

public perception that stigma might serve as an incentive to motivate obese

persons to adopt healthier lifestyle behaviors. This is concerning, given

evidence that stigmatization of obese individuals poses serious risks to

their psychological and physical health, generates health disparities, and

interferes with implementation of effective strategies to address obesity.

Let's look at these issues more closely.

Weight Stigma Compromises Psychological Well-Being

Evidence consistently demonstrates that weight stigma increases risk for

psychological stress and impaired emotional well-being in the targeted

individuals. In obese children and adults, the experience of weight

stigmatization has been documented as a significant risk factor for

depression, anxiety, low self-esteem, and body dissatisfaction,[7-9] even

after accounting for variables such as age, sex, obesity onset, and body

mass index (BMI).[10] Consequently, negative psychological outcomes are

arising from these experiences, rather than from body weight per se. The

psychological toll of weight stigmatization can be devastating, particularly

for children who are vulnerable to teasing and bullying. Some research

indicates that overweight youth who are teased about their weight are 2-3

times more likely to engage in suicidal thoughts and behaviors compared with

their overweight peers who are not teased.[11] Among adults, perceived

weight discrimination is associated with a current diagnosis of mood and

anxiety disorders and use of mental health services, even after controlling

for sociodemographic characteristics and perceived stress.[12] Given that

many children and adults are confronting multiple forms of weight

stigmatization in their daily lives, it is not surprising that psychological

well-being is compromised. For many, confronting weight stigmatization

becomes a chronic stressor, impairing their quality of life.

Weight Stigma Is Not an Effective Motivator for Lifestyle Changes

Despite a common public perception that stigmatizing obese individuals might

provide necessary incentive to engage in healthier lifestyle behaviors, the

science suggests that the opposite is true. If weight stigma were effective

in promoting healthier lifestyle behaviors and weight loss, then the

increased weight stigmatization witnessed over the past several decades

should be accompanied by a reduction in obesity rates. Not only are more

people in the United States now obese, but more obese people are also

reporting discrimination on the basis of their weight.

Recent research demonstrates that obese children and adults who experience

weight stigma have a higher likelihood of engaging in unhealthy eating

behaviors and lower levels of physical activity, both of which exacerbate

obesity and weight gain. For example, overweight children who experience

body weight-related teasing are more likely to engage in binge-eating and

unhealthy weight control behaviors compared with overweight peers who are

not teased, even after controlling for BMI and socioeconomic

status.[11,13]In addition, weight-based victimization is associated

with lower levels of

physical activity, negative attitudes about sports, and lower participation

in physical activity by overweight students.[14] This is perhaps not

surprising because overweight and obese youth are frequently teased during

gym class and physical activities.[15]

Similar findings exist for overweight and obese adults, who engage in more

frequent binge-eating, are at increased risk for maladaptive eating

patterns, and report lower motivation and participation in exercise if they

have been stigmatized about their weight.[6,16,17] In fact, some research

shows that adults report coping with experiences of weight stigma by eating.

In 1 study of more than 2400 overweight and obese women, 79% reported coping

with weight stigmatization by eating more food, and 75% reported coping by

refusing to diet.[18] Individuals who internalize weight stigma and blame

themselves also report more frequent binge-eating compared with adults who

did not internalize stigma.[19]

Finally, evidence suggests that weight stigma interferes with weight loss

behavior. In more than 1000 overweight and obese women participating in a

weight-loss support program, experiences and internalization of stigma did

not predict adoption of weight-loss strategies.[19] Weight stigmatization is

also associated with greater caloric intake, higher program attrition, lower

energy expenditure, less exercise, and less weight loss in treatment-seeking

overweight and obese adults.[20]

Weight Stigma Affects Healthcare

The healthcare setting is a typical backdrop for weight stigmatization.

Numerous studies have demonstrated that a range of healthcare providers

(physicians, nurses, psychologists, dieticians, medical students) hold

negative stereotypes and attitudes toward obese patients. Opinions that

obese patients are lazy, lacking in self-discipline, dishonest,

unintelligent, annoying, and noncompliant with treatment are

typical.[1,2]Moreover, research shows that providers spend less time

during appointments

and provide less health education with obese patients compared with thinner

patients. Obese patients frequently report experiences of weight bias in

healthcare, and being disrespected by providers.[2]

Weight stigma also can influence healthcare utilization. Obese persons are

less likely to undergo age-appropriate preventive cancer

screenings,[21]even when accounting for factors such as education,

income, health

insurance, and illness burden.[22] Weight stigma may be a specific

contributor to these outcomes. For example, in a survey of 498 overweight

and obese women (who had health insurance and high access to healthcare),

weight stigma was a significant barrier to routine cancer

screenings.[23]Women reported delaying and avoiding medical

appointments because of

disrespectful treatment and negative attitudes from providers, and

embarrassment about being weighed, receiving unsolicited advice to lose

weight, and being forced to use medical equipment that is too small to be

functional for their body size. The percentage of women reporting these

barriers increased with the women's BMIs.

Weight Stigma Interferes With Effective Obesity Intervention

Societal views about obesity and obese persons play an important role in

influencing policy responses to address obesity. Because obesity is often

viewed as a personal failing, policy efforts to address obesity have

primarily focused on nutrition education to promote personal responsibility

for body weight, rather than more comprehensive strategies that address the

underlying societal and environmental causes of obesity. Until recently,

with the comprehensive strategies to address obesity in First Lady

Obama's Let's Move! campaign, federal and state legislative initiatives have

primarily avoided addressing the societal and environmental causes of the

disease, and instead spent significant time considering laws to protect the

food and restaurant industry from potential civil injury claims. Arguing in

favor of the " Personal Responsibility in Food Consumption Act, " a

Congressman stated, " This bill is about self-responsibility. If you eat too

much, you get fat. It is your fault. Don't try to blame somebody

else. " [24]In 2008, a Mississippi State House bill was proposed to

prohibit restaurants

from serving food to any person who is obese. Most recently, Arizona

Governor Jan Brewer proposed imposing financial penalties on Medicaid

recipients who are obese.

These examples of discrimination highlight the general acceptability of

weight stigmatization, even by elected leaders. Stigmatization related to

obesity may also influence research funding decisions made by federal grant

agencies. For example, in 2009, the budgets proposed by the National

Institutes of Health for cancer, HIV/AIDS, and digestive diseases were $5.6

billion, $2.9 billion, and $1.2 billion, respectively. In contrast, the

budget for obesity was $658 million[25] even though obesity threatens the

health of a major proportion of Americans across every age, sex, racial, and

socioeconomic group.

Moving Forward: Eliminating Weight Stigma

Taken together, the evidence indicates the importance of recognizing the

damaging effects of weight stigma on psychological health, lifestyle

behaviors, quality of healthcare, and obesity interventions, all of which

affect public health. To improve quality of life of obese persons and

optimize efforts to address obesity, we must challenge common societal

stereotypes and misperceptions that perpetuate weight stigma, and prioritize

weight stigma in the national discourse on obesity. It will be critical to

increase awareness of the harmful impact of weight stigma on quality of

life, and to ensure that efforts to prevent and treat obesity include

strategies to reduce weight-based stigma and discrimination.

Possible strategies to achieve this goal include the following:

- Incorporate antistigma messages into obesity prevention/intervention

campaigns;

- Increase the focus of intervention on health *behaviors* -- not just

body weight;

- Provide sensitivity/stigma-reduction training for health providers and

educators;

- Implement policies to prohibit weight-based bullying in schools and the

workplace;

- Move beyond " education " and " individual " strategies to address obesity,

and implement comprehensive strategies that address societal, environmental,

and economic contributors to obesity; and

- Propose legislation to prohibit weight-based discrimination.

www.medscape.com

--

Ortiz, MS, RD

*The FRUGAL Dietitian* <http://www.thefrugaldietitian.com>

Check out my blog: mixture of deals and nutrition

Join me on Facebook <http://www.facebook.com/TheFrugalDietitian?ref=ts>

The Frugal Dietitian Giveaway: One tube of ROC RETINOL CORREXION® Deep

Wrinkle Night Cream <http://thefrugaldietitian.com/?p=21714>Polo Shirt with

your logo: $2.95 shipped Great Father’s Day

Gift<http://thefrugaldietitian.com/?p=20750>

* " Nutrition is a Science, Not an Opinion Survey " *