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Try out PMC Labs and tell us what you think. Learn More. Both authors reviewed the relevant literature, wrote ificant portions of the article, conceptualized ideas, interpreted findings, and reviewed drafts of the article. Stigma and discrimination toward obese persons are pervasive and pose numerous consequences for their psychological and physical health.
Despite decades of science documenting weight stigma, its public health implications are widely ignored. Instead, obese persons are blamed for their weight, with common perceptions that weight stigmatization is justifiable and may motivate individuals to adopt healthier behaviors. We examine evidence to address these assumptions and discuss their public health implications. On the basis of current findings, we propose that weight stigma is not a beneficial public health tool for reducing obesity.
Rather, stigmatization of obese individuals threatens health, generates health disparities, and interferes with effective obesity intervention efforts. These findings highlight weight stigma as both a social justice issue and a priority for public health. Negative attitudes toward obese persons are pervasive in North American society. Numerous studies have documented harmful weight-based stereotypes that overweight and obese individuals are lazy, weak-willed, unsuccessful, unintelligent, lack self-discipline, have poor willpower, and are noncompliant with weight-loss treatment.
Instead, prevailing societal attributions place blame on obese individuals for their excess weight, with common perceptions that weight stigmatization is justifiable and perhaps necessary because obese individuals are personally responsible for their weight, 10 and that stigma might even serve as a useful tool to motivate obese persons to adopt healthier lifestyle behaviors.
We have examined existing evidence to address these assumptions about weight stigma and discuss their public health implications. Documentation of the stigma of obesity has been extensively reviewed elsewhere, 124 thus, our aim was to highlight relevant evidence from this body of work to examine public health implications of weight stigma, an issue that has received little attention in the obesity field.
Search terms were limited to various keyword combinations pertaining specifically to body weight and stigma descriptors to identify studies examining the relationship between weight stigma and public health, and emotional and physical health consequences of obesity stigma.
For examples of descriptor search terms, please refer to Puhl and Heuer. In addition, we retrieved references from a recent comprehensive systematic review of peer-reviewed research studies documenting bias and stigma toward obese individuals that we recently published. On the basis of the current evidence, we conclude that weight stigma is not a beneficial public health tool for reducing obesity or improving health. Rather, stigmatization of obese individuals poses serious risks to their psychological and physical health, generates health disparities, and interferes with implementation of effective obesity prevention efforts.
This evidence highlights the importance of addressing weight stigma as both a social justice issue and a priority in public health interventions to address obesity. In the field of public health, stigma is a known enemy. Throughout history, stigma has imposed suffering on groups vulnerable to disease and impaired efforts to thwart the progression of those diseases. Disease stigma occurs when groups are blamed for their illnesses because they are viewed as immoral, unclean, or lazy. According to Herek et al. Historical examples abound of stigma interfering with collective responses to diseases ranging from cholera to syphilis.
In all of these cases, the social construction of illness incorporated moral judgments about the circumstances in which it was contracted as well as preexisting hostility toward the groups perceived to be most affected by it.
Recommendations from the report include providing funding and programming activities for multifaceted national approaches to the reduction of HIV stigma and discrimination. Thus, within current public health ideology there is clear recognition of the critical obstacles created by disease stigma. Bayer notes:.
In the closing decades of the 20th century, a broadly shared view took hold that the stigmatization of those who were already vulnerable provided the context within which diseases spread, exacerbating morbidity and mortality…. In this view, it was the responsibility of public health officials to counteract stigma if they were to fulfill their mission to protect the communal health.
In sharp contrast, the stigma of obesity has not been addressed as a legitimate concern that requires the attention of those working to combat obesity, and is Seeking younger slender high maintenance and Atlanta discussed in the context of public health. Obesity is hardly ever mentioned in the writings of sociologists, and not at all in the literature on social deviance.
This omission is amazing…. Clearly, in our kind of society, with its stress on affluence and upward mobility, being overweight is considered to be detrimental to health, a blemish to appearance, and a social disgrace. This omission remains almost 50 years later. Even as obesity rates have risen dramatically, weight stigma is rarely, if ever, afforded the same recognition or intervention as other disease stigmas. Although there is ificant consensus that stigma undermines public health, this principle has not been applied to the obesity epidemic. Common societal assumptions about obesity, including the notion that obese individuals are to blame for their weight, contribute to the disregard of weight stigma and its impact on emotional and physical health.
An examination of these assumptions in light of current scientific evidence reveals that obesity stigma creates ificant barriers in efforts to address obesity and deserves recognition in the public health agenda. Social constructions of body weight are ingrained in the way that our society perceives and reacts to obesity. Not only is weight stigma viewed as a beneficial incentive for weight loss, but it is also assumed that the condition of obesity is under personal control, 10283233 implying that the social influence of weight stigma will be sufficient to produce change.
Although these assumptions about obesity and weight stigma are prevalent in our national mindset, considerable scientific evidence has emerged to challenge them. To optimize obesity prevention and intervention efforts, these assumptions must be addressed within the sphere of public health, with recognition of the harmful impact of weight stigma on quality of life Seeking younger slender high maintenance and Atlanta the need to eliminate stigma from current and future public health approaches to the obesity epidemic.
We present scientific evidence relevant to these societal assumptions. Societal attributions about the causes of obesity contribute ificantly to expressions of weight stigma. Experimental research in psychology consistently demonstrates that obese persons are stigmatized because their weight is perceived to be caused by factors within personal control e. Research findings since that time have followed suit. In a study examining attitudes toward 66 different diseases and health conditions including obesitythe attributed degree of personal responsibility for the disease predicted social distance and rejection by participants.
The view that obesity is a matter of personal responsibility is the prevailing message in the media. However, this prevailing message does not accurately reflect the science. Many ificant contributors to obesity are beyond the control of individuals. In addition to the important Seeking younger slender high maintenance and Atlanta of genetic and biological factors regulating body weight, 48 — 50 multiple social and economic influences have ificantly altered the environment to promote and reinforce obesity.
We have created a biology—environment mismatch, as the human weight regulation is unable to evolve fast enough to keep pace with the environmental change. Advancements in workplace technology and reduction of manual labor have resulted in decreased energy expenditure. The built environment has decreased opportunities for healthy lifestyle behaviors through factors such as urban de, land use, public transportation availability, 5253 density and location of food stores and restaurants, 54 and neighborhood barriers such as safety and walkability.
ificant changes have taken place in the food environment with increased accessibility of inexpensive foods. Prices of calorie-dense foods and beverages have decreased considerably in contrast to increasing prices of fresh fruits, vegetables, fish, and dairy items, 51 contributing to increased consumption of unhealthy foods, especially as the portion sizes of these items have grown considerably larger. These complex societal and environmental conditions that have created obesity necessitate that we move beyond the narrow focus that targets the individual as both the culprit and the solution for obesity.
Public health efforts must address the multiple forces contributing to the development and maintenance of obesity and recognize that individual behaviors are powerfully shaped by the obesogenic environment. There is also considerable scientific consensus about the challenge of ificant long-term weight loss. The high rate of weight regain following weight loss is equally concerning. Most weight losses are not maintained and individuals regain weight after completing treatment. Dieters who manage to sustain a weight loss are the rare exception, rather than the rule.
Dieters who gain back more weight than they lost may very well be the norm, rather than an unlucky minority. It is also important to note increasing research documenting a considerable percentage of overweight and obese persons who are metabolically healthy and nonoverweight individuals who exhibit metabolic and cardiovascular risk factors. For those individuals without metabolic risk factors, losing weight may not be important for improving health.
The recognition that there are obese individuals who are metabolically healthy and nonoverweight individuals who are metabolically obese challenges weight-based stereotypes and reinforces the heterogeneous nature of obesity. Because weight-based stereotypes and prejudice so often emerge from attributions that obesity is caused and maintained by personal characteristics such as laziness or lack of willpower, 1047 there is a clear need for increased public awareness and education about the complex etiology of obesity and the ificant obstacles present in efforts to achieve sustainable weight loss.
The prevailing societal and media messages that reinforce blame on obese persons need to be replaced with messages that obesity is a chronic disease with a complex etiology, and a lifelong condition for most obese persons.
The idea that stigma may be a useful tool of social control to discourage unhealthy behaviors and improve the health of stigmatized individuals has been debated, with some theorizing that individuals will act to change their behaviors to avoid being out of step with social norms and the resulting stigmatization. However, several lines of evidence fail to demonstrate this relationship with obesity.
First, if weight stigma promoted healthier lifestyle behaviors and weight loss, then the documentation of increased weight stigmatization over the past several decades 84 should be accompanied by a reduction in obesity rates, rather than the alarming increase.
Second, a of studies have consistently demonstrated that experiencing weight stigma increases the likelihood of engaging in unhealthy eating behaviors and lower levels of physical activity, both of which exacerbate obesity and weight gain. Among youths, several studies have demonstrated that overweight children who experience weight-based teasing are more likely to engage in binge-eating and unhealthy weight control behaviors compared with overweight peers who are not teased, even after control for variables such as BMI and socioeconomic status.
Among overweight and obese adults, similar findings have emerged. In both clinical and nonclinical samples, adults who experience weight-based stigmatization engage in more frequent binge eating, 96 — 99 are at increased risk for maladaptive eating patterns and eating disorder symptoms, 90, and are more likely to have a diagnosis of binge eating disorder. Coping responses in reaction to weight stigma may also lead to unhealthy eating behaviors. Few studies have addressed the relationship between stigmatizing experiences and actual weight loss. In a study of more than overweight and obese women participating in a weight-loss support organization, it was found that stigma and internalization of weight-based stereotypes did not predict adoption of weight-loss strategies.
The atypical sample and concurrent assessment of variables raise uncertainty about these findings.
Rather than using stigma as an incentive to lose weight, it may be that supporting individuals with adaptive ways to cope with weight stigma can facilitate weight loss outcomes. A recent randomized treatment study found that, compared with wait-list controls, a brief 1-day intervention that taught patients acceptance-based strategies to cope with obesity-related stigma resulted in greater improvements in body mass, quality of life, perceived weight-related stigma, and psychological distress at 3-month follow-up.
Although more work is needed to examine the impact of weight stigma on weight loss outcomes, the available evidence challenges the assumption that weight stigma is a useful tool for changing health behaviors. Instead, research shows that weight stigmatization reinforces unhealthy lifestyle behaviors that contribute to obesity, and is an unlikely method of inducing successful weight loss. In addition to reinforcing unhealthy behaviors, weight stigma poses a ificant threat to psychological and physical health. An accumulation of evidence demonstrates that weight stigma invokes psychological stress and emerging research suggests that this stress le to poor physical health outcomes for obese individuals.
Among both clinical and nonclinical samples of obese adults, weight stigmatization has been documented as a ificant risk factor for depression, 9099— low self-esteem, 96and body dissatisfaction. In addition, a recent study examining a nationally representative sample of more than obese adults found that perceived weight discrimination was ificantly associated with a current diagnosis of mood and anxiety disorders and mental health services use after control for sociodemographic characteristics and perceived stress.
Meunnig argued that the high degree of psychological stress experienced by obese persons as a result of weight stigma contributes to the pathophysiology associated with obesity, and that many of the adverse biochemical changes that are associated with adiposity can also be caused by the psychological stress that accompanies the experience of frequent weight-based discrimination.
Social disadvantages may specifically affect obesity through chronic stress, anxiety, and negative mood, which are associated with abdominal obesity, and may increase risk for obesity by activating particular physiological mechanisms that can increase appetite and blunt the satiety system, increasing fat retention and food intake.
The belief that stigma-induced stress both exacerbates and triggers disease Seeking younger slender high maintenance and Atlanta frequently discussed in literature on the health effects of racial prejudice and discrimination. Research has demonstrated that African Americans who perceive racial discrimination or mistreatment have an increased risk of coronary events, breast cancer, coronary artery calcification, vascular reactivity, and elevated blood pressure, — and higher substance use.
Some evidence points directly to links between perceived racial discrimination and obesity-related outcomes, including weight gain and metabolic abnormalities. Irish, Jewish, Polish, and Italian Whites who perceived chronic discrimination were 2 to 6 times more likely to have a high-risk waist circumference than White individuals of the same ethnic descent who did not perceive chronic discrimination. There are distinctions between prejudices based on race and weight see Puhl and Latner for discussion 4but these findings have important implications for the impact of weight stigma on health outcomes for obese individuals.
Current evidence suggests that weight-based stigma and discrimination increase vulnerability to psychological distress that may contribute to poor physical health. Given the increased risk of adverse outcomes already present with obesity, the additional negative impact of weight stigmatization on health is concerning. As Link and Phelan concluded:. Not only are they at risk to develop other stress-related illnesses, but the clinical course of the stigmatized illness itself may be worsened and other outcomes affected, such as the ability to work or lead a normal social life.
Continued research in this area will help to clarify the relationship between weight stigma—induced stress and health. Both self-report and experimental research demonstrate negative stereotypes and attitudes toward obese patients by a range of health care providers and fitness professionals, including views that obese patients are lazy, lacking in self-discipline, dishonest, unintelligent, annoying, and noncompliant with treatment.
Health care utilization is also compromised by weight stigma. A of studies demonstrate that obese persons are less likely to undergo age-appropriate preventive cancer screenings. When asked about specific reasons for delay of care, women reported disrespectful treatment and negative attitudes from providers, embarrassment about being weighed, receiving unsolicited advice to lose weight, and also reported that gowns, examination tables, and other medical equipment were too small to be functional for their body size. The percentage of women reporting these barriers increased with BMI.
As obese individuals are at a high risk for weight-related comorbidities, quality health care is essential. Acknowledging the detrimental effects of weight stigma in health care is essential for a better understanding of the cumulative impacts of weight stigma on public health.Seeking younger slender high maintenance and Atlanta
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