Pennsylvania: Body shaming is a pervasive form of prejudice, found in cyber bullying, critiques of celebrities' appearances, at work and school, and in public places for everyday Americans. People who are battling obesity face being stereotyped as lazy, incompetent, unattractive, lacking willpower, and to blame for their excess weight. The pain of these messages may take a toll on health and increase risk of cardiovascular and metabolic disease, according to a new study published in Obesity, the journal of The Obesity Society, led by a research team from the Perelman School of Medicine at the University of Pennsylvania.
The team led by Rebecca Pearl, PhD, an assistant professor of
Psychology in Psychiatry and colleagues from Penn's Center for Weight
and Eating Disorders found that, above and beyond the effects of body
mass index (BMI) and depression, higher levels of weight bias
internalization were associated with increased risk for cardiovascular
and metabolic disease.
"There is a common misconception that stigma might help motivate
individuals with obesity to lose weight and improve their health," Pearl
said. "We are finding it has quite the opposite effect. When people
feel shamed because of their weight, they are more likely to avoid
exercise and consume more calories to cope with this stress. In this
study, we identified a significant relationship between the
internalization of weight bias and having a diagnosis of metabolic
syndrome, which is a marker of poor health."
The team examined 159 adults with obesity who were enrolled in a
larger clinical trial testing the effects of weight loss medication,
funded by Eisai Pharmaceutical Co. - the majority of whom were African
American women, a group typically underrepresented in weight bias
research - and completed baseline questionnaires measuring depression
and weight bias internalization before any intervention was given.
Weight bias internalization occurs when people apply negative weight
stereotypes to themselves, such as believing they are lazy or
unattractive, and devalue themselves because of their weight.
Participants also underwent medical examinations, which determined
whether they had a diagnosis of metabolic syndrome, a cluster of risk
factors, such as high triglycerides, blood pressure, and waist
circumference, which are associated with heart disease, type 2 diabetes,
and other obesity-related health problems. Initially, no relationship
was observed between weight bias internalization and metabolic syndrome
when controlling for participant demographics, such as age, gender and
race. However, when patients were stratified into two groups, "high" and
"low" levels of weight bias internalization, those with high
internalization were three times more likely to have metabolic syndrome,
and six times more likely to have high triglycerides as compared to
participants with low internalization.
"Health care providers, the media, and the general public should be
aware that blaming and shaming patients with obesity is not an effective
tool for promoting weight loss, and it may in fact contribute to poor
health if patients internalize these prejudicial messages," said
co-author Tom Wadden, PhD, a professor of Psychology in Psychiatry and
director of Penn's Center for Weight and Eating Disorders. "Providers
can play a critical role in decreasing this internalization by treating
patients with respect, discussing weight with sensitivity and without
judgment, and giving support and encouragement to patients who struggle
with weight management - behaviors everyone should display when
interacting with people with obesity."
Researchers note that previous studies have shown that exposure to
weight bias and stigma negatively affects mental and physical health,
specifically demonstrating that these experiences can lead to a
physiological stress response such as increased inflammation and
cortisol levels, and can escalate unhealthy behaviors such as overeating
and avoiding physical activity. Additional research, specifically
larger, longer-term studies, are needed to further explore the possible
biological responses and behaviors that may explain why individuals with
obesity who internalize weight bias might be at greater risk for
"Disparagement of others due to their weight and messages that
perpetuate blame and shame, if internalized, can cause harm to the
physical and mental health of individuals with obesity," added Pearl.
"As health care practitioners, we can help challenge negative,
internalized stereotypes by educating patients about the complex
biological and environmental factors that contribute to obesity, while
providing concrete strategies to help patients manage their weight and
improve their health."
This study was supported by an investigator-initiated grant from Eisai Pharmaceutical Co.