Obesity and Stigma

"The alarming rates of obesity have brought widespread attention to the medical consequences of this public health problem. Often ignored, however, are the social and personal obstacles that overweight and obese individuals face. Bias, stigma, and discrimination due to weight are frequent experiences for many obese individuals, which have serious consequences for their personal and social well being and emotional health. Given that at least half of the American population is overweight, the number of people potentially faced with discrimination and stigmatization is immense," Rebecca Puhl, PhD Coordinator for Community and Weight Stigma Initiatives at the Rudd Center for Food Policy and Obesity at Yale University.

The above paragraphed originally appeared in the April 2006 issue of OAC News. To view the full story, titled "Understanding the Negative Stigma of Obesity and its Consequences," please click here.

UPDATE!
Recently, the Rudd Center for Food Policy and Obesity at Yale University released a new report detailing weight bias. The report covers the consequences of bias in employment, health care and education; provides citations for important studies; suggests responses to common arguments against the need for weight bias; and discusses current law, and policy recommendations. Please click here to download the report.

Bias in employment settings has been identified in the following areas:

Hiring Preferences
Promotions
Wage Inequities
Employment Termination

Hiring Preferences

• Obese job applicants rated as having:

Poor self-discipline
Low supervisory potential
Poor personal hygiene
Less ambition & productivity

• Thin applicants preferred over obese applicants

• Obese applicants are more appropriate for jobs requiring little face-to-face contact

Promotions

• Lower promotion prospects compared to non-overweight counterparts

• Managers less likely to recommend obese employee for promotion than other candidates

• Less likely to get hired in high-level positions

Wage Inequities

• Obese women earn 12 percent less than non-obese females
  

• Obese women more likely to be in low-paying jobs than thinner women
  

• Obese men under-represented and paid less than non-obese men in managerial and professional positions

Employment Termination

• Fired due to prejudiced employers and arbitrary weight standards

• Fired despite good to excellent employment records in occupations like: teachers, pilots, office managers, state troopers, city laborers

Bias in health care settings has been identified in the following areas:

Physicians
Nurses
Psychologists
Quality of Care

Physicians

Self-report studies show that Physicians view obese patients as:

• non-compliant

• dishonest

• lazy

• lacking in self-control

• weak-willed

• unintelligent

• unsuccessful

Doctors are common sources of stigma:

Study:  2449 adult women provided with list of 22 different individuals (family members, employers, doctors, educators, strangers) and asked how often they were sources of weight stigmatization.

Doctors were the second most frequent source reported, with more than 50 percent stating that doctors had stigmatized them on more than one occasion.

Nurses

Self-report studies show that Nurses view obese patients as:

• non-compliant, overindulgent, lazy, unsuccessful

• 31 percent “would prefer not to care for obese patients”

• 24 percent agreed that obese patients “repulsed them”

• 12 percent “would prefer not to touch obese patients”

Psychologists

In studies comparing beliefs about obese vs. ‘average’ weight patients, psychologists ascribe obese clients to have:

• more pathology

• more severe psychological symptoms

• more negative attributes

• worse prognosis in treatment

Quality of Care

Obese patients less likely to obtain:

Preventive health services & exams
Cancer screening tests, pelvic exams, mammograms

• More likely to cancel or delay appointments

• Physicians: less time spent, less intervention, less discussion with obese patients

Bias in education is expressed through extensive peer victimization at school, bias by teachers and administrators and institutional level weight bias.

Weight Bias by Peers

• Negative attitudes begin as early as preschool

• Obese kids viewed as ugly, stupid, mean, lazy, unhappy, having few friends, undesirable playmates

• Teased by kids & chosen less as playmates

• Continues through high school & college, where obese students are viewed as self-indulgent, lazy and are excluded from peer activities

Peer Victimization

30 percent of overweight girls and 24 percent of overweight boys are teased by peers at school

Adolescents at the heaviest weight are most likely to be teased because of their weight. Overall, 63 percent of girls and 58 percent of boys reported peer victimization.

Being overweight predicts future peer victimization

Bias by Educators

• Teachers report that obese students are
              - untidy
              - more emotional
              - less likely to succeed at work
              - more likely to have family problems

• Obese students receive poorer evaluations

• Physical Education teachers criticize athletic abilities of students

Educational Institutions

• Less like to be accepted to college, despite equivalent application rates and academic achievement

• Students dismissed from college because of their weight

Taken together, the consequences of being denied jobs, rejected by peers, or treated inappropriately by healthcare professionals because of one’s weight can have a serious and negative impact on quality of life. Obese individuals suffer terribly from this, both from direct discrimination and from more subtle forms of bias and stigma that are frequently encountered.

Weight bias can have psychological, social and physical health consequences on those affected by this disease. Psychological outcomes can include depression, anxiety, low self-esteem, poor body image and much more. The social effects can be social rejection by peers, poor quality of interpersonal relationships and potential negative impact on academic outcomes. The physical health outcomes can include binge-eating and unhealthy weight-control practices.

How do we reduce weight bias?

Given how pervasive and acceptable weight stigma is in our society, transforming societal attitudes and enacting laws that prohibit discrimination based on weight are needed in order to eliminate the problem of stigma toward obese individuals. Although this requires enormous efforts, there are other important steps that can be taken by both patients and their healthcare providers to help improve the daily functioning and well-being of obese individuals.

Patients who are struggling with weight stigma can begin to approach this problem by becoming advocates for themselves. This includes identifying situations in which they have been stigmatized because of their weight and deciding how best to handle the situation to achieve positive emotional health to help prevent additional stigma from occurring.

Education about obesity and its causes:

• Educate participants about the biological, genetic, and external causes of obesity

• Provide explanations for obesity outside of one’s personal control

Perceptions of other's beliefs:

Learning that others hold more favorable attitudes towards obese people leads to:

• more positive attitudes toward obese persons
  

• fewer negative stereotypes about obese persons
  

• increased beliefs that causes of obesity are not within personal control
  

• attitudes improve more if information comes from a valued peer group

Strategies:

• Educate others about the stigma of obesity to help challenge negative attitudes.

• Obtain social support from others who are struggling with weight stigma, or from friends and family members who are supportive.

• Instead of avoiding enjoyable activities because of negative feelings about your weight, set goals to ease these restrictions and participate more fully in these experiences.

• Rather than feeling inferior, practice positive self-talk strategies that emphasize self-acceptance and positive self-esteem.

• Be vocal about individual needs and positively assert these to appropriate individuals (e.g., requesting larger-sized medical gowns from a healthcare provider).

• Communicate to the perpetrator of bias that his or her comments were inappropriate and hurtful, and that nobody deserves such unkind remarks, regardless of their weight.

• Participate in public groups to protest weight stigmatization. The National Association for the Advancement of Fat Acceptance (NAAFA) is one such advocacy group which promotes size acceptance, fights weight discrimination, and publicly campaigns to challenge stigma.

• Talk to a therapist to help identify effective ways to cope with stigma and to replace self-defeating thoughts or self-blame with healthier ways of coping

For more information on the negative stigma and weight bias associated with obesity, please view the April 2006 "OAC News" article, titled "Understanding the Negative Stigma of Obesity and its Consequences."

The above information was provided by Rebecca Puhl, Ph.D., the Coordinator for Community and Weight Stigma Initiatives at the Rudd Center for Food Policy and Obesity at Yale University. The original information can be found in Dr. Puhl's presentation, titled "Weight Bias." For more information or to contact Dr. Puhl, please visit the Rudd Center for Food Policy and Obesity at www.yaleruddcenter.org/home.aspx.