Social stigma of obesity

The social stigma of obesity has created negative psychosocial impacts and has caused disadvantages for overweight and obese people. The social stigma can span one’s entire life, as long as the excess weight is present, starting from a young age and lasting into adulthood.^[1] Several studies from across the world (e.g., United States, University of Marburg, University of Leipzig) indicate overweight and obese individuals experience higher levels of stigma relative to their thinner counterparts. In addition, they marry less often, experience fewer educational and opportunities, and on average earn a lesser income than normal weight individuals.^[1] Although public support regarding disability services, civil rights and anti-workplace discrimination laws for obese individuals have gained support across the years,^[1] overweight and obese individuals still experience discrimination, which may have implications to physiological and psychological health.

Obesity stigma stands to be one of the few acceptable forms of discrimination in Western society. Media, in general, under represents overweight individuals and when these roles are present, they are often minor, stereotyped roles. They are more commonly seen eating, and are less likely to be involved in a romantic relationship compared to the average weight television character.^[2]

Theoretical explanations for weight-stigma

In order to understand weight-biased attitudes, theories have been proposed to explain the discrimination. Crandall’s Social Ideology Perspective draws on traditional North American values of self-determination, individualism and self-discipline. Based on these values, anti-fat attitudes may derive from directing blame towards individuals who are overweight.^[3] Similarly, the attribution theory suggests that attitudes towards obese individuals are dependent on how much control they are perceived to have over their weight.^[2] Throughout the literature, numerous studies have shown support for this theory. One study conducted a multinational examination of weight bias across four countries (Canada, United States, Iceland, and Australia) with comparable obesity rates.^[4] The study found that attributions of behavioral causes of obesity were associated with greater weight bias. Further, these individuals were more likely to view obesity as being due to lack of willpower. There appears to be decreased weight bias when weight was attributed to factors that were less within the individual’s control, or when individuals are perceived as trying to lose weight.^[5]

Weight discrimination in education

In regards to more direct weight bias, obese individuals were 40-50% more likely to report major discrimination compared to those of average weight across a multitude of settings.^[6] More specifically, studies have shown that those who are overweight face discrimination throughout the educational and employment systems. In the educational setting, those who are overweight as youth often face peer rejection.^[7] As individuals grow older they may be less likely to be admitted into a college compared to average weight persons, and in some cases, individuals were admitted to academic institutions and dismissed due to weight.^[2][3] Research suggests that within the classroom teachers may perceive overweight individuals’ work more poorly compared to average weight individuals, and the attention the teacher provides to these two groups may differ.^[2] Research has also found that overweight females receive less financial support for education from their families than average weight females, after controlling for ethnicity, family size, income, and education.^[2][3]

Weight discrimination in the workplace

Studies suggest that obese individuals are less likely to be hired and once hired, have greater termination rates than average weight individuals.^[2][3] Specifically, a national survey found that obese individuals were 26% more likely not to be hired, not receive a promotion, or to be fired compared to average weight persons.^[6] Such outcomes may be a result of employers viewing them as less agreeable, less competent and lazier than average weight individuals.^[2][3]

Weight discrimination in politics

New Jersey Governor Chris Christie is a politician who may have suffered from weight related discrimination at times during his political career.

A study, by Michigan State University researchers, shows evidence overweight political candidates tend to receive fewer votes than their thinner opponents. The researchers analyzed data from the 2008 and 2012 U.S. Senate elections. Using a previously established scientific method, research assistants determined from color photos whether the candidates in 126 primary and general elections were normal weight, overweight or obese.

Both obese men and women were often less likely to get on the ballot in the first place. When it came to merely being overweight, women were seen underrepresented on the ballot, though men were not. This is consistent with previous research showing men who are slightly heavy tend not to experience the same discrimination of a slightly overweight women.

However, when it came to the voting, both male and female candidates, whether obese or simply overweight, tend to get a lower share of the vote total than their more slender opponents. Some politicians have resorted to extreme weight loss measures, including surgery, to increase their elect-ability to political office. ^[8]

Weight discrimination in health care

Medical professionals may be more likely to view obese individuals in negative terms such as weak willed, unsuccessful, hopeless, and non-compliant with their treatments. As such, these individuals may receive poorer care compared to average weight people. Doctors have reported less intervention and an avoidance of weight-related discussion with obese patients. Additionally, nurses have reported a reluctance to touch obese persons during treatment.^[3] A national survey found that individuals who were overweight reported a 3xs more likely to be denied medical care than average weight people.^[6] Further, health professionals who specialize in obesity showed strong implicit and explicit anti-fat bias as measured by self-report and the Implicit Associations Test (IAT).^[9] However, such biases were mixed amongst dietitians and nutritionists.^[10]

Weight discrimination in early development

This external stigmatization and its internalized effects have been examined across different age groups. Overweight and obese children and adolescents experience stigmatization from parents, teachers, and peers.^[11] Peer stigmatization, especially, may be difficult for overweight adolescents considering the role of peer support in promoting identity development and self-esteem.^[12] Some research suggests that negative attitudes about being overweight are even held by overweight and obese children themselves. Specifically, weight bias may become internalized and increase throughout childhood, then decrease and level-off during late adolescence and adulthood.^[11]

Weight-based teasing in childhood and adolescence has been associated with a handful of costs to psychosocial health, including reduced self-esteem and lower self-concept,^[11][13] higher rates of depression and anxiety disorders,^[14][15][16] and even greater likelihood of endorsing suicidal thoughts.^[11] Further, weight-based teasing has been associated with higher rates of binge eating and unhealthy weight control (e.g., fasting, self-induced vomiting, laxatives, diet pills, skipped meals, smoking).^[11][17][18] Overweight adolescents who were bullied were also more likely to meet criteria for bulimia.^[19]

A survey of 7,266 children aged 11 to 16 conducted by the World Health Organization reported higher rates of physical victimization (e.g., being shoved) with increasing body mass index among girls. Additionally, these results showed relational victimization (i.e., being excluded or having rumors spread about you) was reported more often at increasing body mass index by both girls and boys.^[12] A separate survey of 7,825 students aged 11 to 17 also noted that, compared to average-weight peers, obese boys and overweight girls were more likely to be victims of bullying. Additionally, obese girls were more likely to be victims and perpetrators of bullying than their peers. Notably, overweight and obese adolescent girls also reported higher rates of smoking, drinking, and marijuana use relative to their normal-weight peers.^[20]

Health-related outcomes associated with weight discrimination

In adulthood, individuals who experience weight discrimination are more likely to identify themselves as overweight regardless of their actual weight status.^[21] The experience of weight stigma can function as motivation to avoid stigmatizing environments, and although it may motivate one to escape stigma through weight loss, it undermines one’s capacity to do so.^[22] Researchers have linked weight stigma to decreases in physical activity,^[21][23][24] decreases in seeking health care^[24] and increases in maladaptive eating patterns such as binge eating.^[22][24] In addition, those who have experienced weight stigma have shown altered cardiovascular reactivity, increased cortisol level, oxidative stress, and inflammation.^[22]

In terms of psychological health, researchers demonstrated that obese individuals demonstrated lower sense of well-being relative to non-obese individuals if they had perceived weight stigmatization even after controlling for other demographic factors such as age and sex.^[25] Overweight and obese individuals report experiencing forms of internalized stigma such as body dissatisfaction as well as decreased social support and feelings of loneliness.^[26][27] In addition, similar to findings in adolescence, weight stigma in adulthood is associated with lower self-esteem, higher rates of depression, anxiety, and substance use.^[22][24][26]

References