A chubby-cheeked young girl with a button nose is featured center-screen. Her name is Tina, and she tells Atlanta residents that going to school is tough because other kids pick on her. She doesn’t have to say it, but everyone knows: They pick on her because she’s fat.
The ad, produced by Strong4Life Georgia in 2011, is just one example of public health campaigns aimed at reducing obesity among adults and children. But a new study suggests many of these efforts, which show how hard it is to be overweight or obese in today’s society, might be ineffective from the start. Discriminating against overweight and obese people, also known as "fat shaming," not only fails to motivate people to live a healthier lifestyle — it may actually cause them to gain more weight. The research reminds us that obesity is more complex than the number on the scale, and that the route to good health involves taking into account psychological and emotional factors.
What’s the Deal?
Researchers recruited men and women over the age of 50 who had participated in another study on health after retirement, and followed them over the course of four years. After two years, they asked participants questions about how often they experienced different types of discrimination, including weight discrimination. Researchers also measured subjects’ body mass index (BMI) at different points throughout the study. Turns out overweight and obese participants who said they’d experienced weight discrimination were significantly more likely to become or remain obese by the end of the study. Interestingly, participants who started out at a normal weight and experienced discrimination were more likely to say they became obese by the end of the study, even if their BMI didn’t fall in the obese category.
While the researchers can’t say for sure exactly why weight discrimination predicted risk of obesity, they have a few hunches. First, those who feel others are judging them based on their weight might use unhealthy coping mechanisms, such as overeating or avoiding physical activity. Another possibility is that the stress of feeling stigmatized triggers the release of cortisol, which may motivate people to eat more Cortisol, hunger, and desire to binge eat following a cold stress test in obese women with binge eating disorder. Gluck, M.E., Geliebter, A., Hung, J., et al. New York Obesity Research Center, Department of Medicine, St. Luke’s/Roosevelt Hospital Center, New York, NY, USA. Psychosomatic Medicine 2004 Nov-Dec; 66(66):876-81. Effects of glucocorticoids on energy metabolism and food intake in humans. Tataranni, P.A., Larson, D.E., Snitker, S., et al. American Journal of Physiology, 1996 Aug;271(2 Pt 1):E317-25. .
Why It Matters
At the same time as rates of overweight and obesity are increasing (as of 2011, nearly 70 percent of Americans were overweight and more than a third were obese), weight discrimination is increasing rapidly across the U.S. Changes in perceived weight discrimination among Americans, 1995-1996 through 2004-2006. Andreyeva, T., Puhl, R.M., Brownell, K.D. Rudd Center for Food Policy and Obesity, Yale University, New Haven, Connecticut, USA. Obesity, 2008 May ;16(5):1129-34. . But this study isn’t the first to suggest making someone feel bad about his body isn’t doing him any favors. A similar study found women who see themselves as overweight and feel stigmatized based on their size tend to eat more than women who don't feel that way. Other research has found that weight stigmatization is linked to depression, anxiety, low self-esteem, and body dissatisfaction Weight discrimination and bullying. Puhl, R.M., King, K.M. Rudd Center for Food Policy and Obesity, Yale University, New Haven, CT, USA. Best Practice and Research. Clinical Endocrinology & Metabolism, 2013 Apr;27(2):117-27. . It’s also associated with poor physical health, such as lower physical activity and lower motivation to exercise, unhealthy eating behaviors, and avoiding seeking medical care Internalized societal attitudes moderate the impact of weight stigma on avoidance of exercise. Vartanian, L.R., Novak, S.A. School of Psychology, The University of New South Wales, Sydney, New South Wales, Australia. Obesity, 2011 Apr;19(4):757-62. Effects of weight stigma on exercise motivation and behavior: a preliminary investigation among college-aged females. Journal of Health Psychology, 2008 Jan;13(1):131-8. Weight discrimination and bullying. Puhl, R.M, King, K.M. Rudd Center for Food Policy and Obesity, Yale University, New Haven, CT, USA. Best Practice and Research. Clinical Endocrinology and Metabolism, 2013 Apr;27(2):117-27. .
And while this particular study looked at forms of interpersonal weight discrimination and not public policies, there’s reason to believe that stigmatization doesn’t work for public health campaigns either. In surveys, people tend to rate stigmatizing public health messages as less motivating than other types of advertisements Fighting obesity or obese persons? Public perceptions of obesity-related health messages. Pulh, R., Peterson, J.L., Luedicke, J. Rudd Center for Food Policy and Obesity, Yale University, New Haven, CT, USA. International Journal of Obesity, 2013 Jun;37(6):774-82. . Instead, they prefer messages that don’t mention body weight at all, and encourage people to practice a healthy lifestyle by eating more fruits and vegetables.
Still, some health experts advocate social pressure as the best way to lower obesity rates. In a controversial editorial, bioethicist Daniel Callahan argued that people will only lose weight if they strongly want to avoid being overweight and obese. In response, other health experts countered that obese people are already the most stigmatized people in American society and that shame is an ineffective way to help them lose weight.
The only thing that’s clear is that there’s no one reason behind or solution to the obesity epidemic. Moreover, the techniques that might motivate one person to develop healthier habits won’t necessarily work for another. What we can conclude is that any approach to helping someone work toward a healthier weight needs to acknowledge the psychological and emotional experiences that might be keeping that person at an unhealthy weight. Sometimes people might not even realize that there are such complicated reasons behind their unhealthy habits, and part of helping them to achieve their health goals needs to focus on their thoughts and feelings. As human beings, struggling to fit into our bodies is something we can all relate to.
This article originally posted July 2013. Updated December 2013.
Have you ever felt stigmatized because of your weight? Let us know in the comments below or get in touch with the author at @ShanaDLebowitz.