Healthy Change

Fostering better lifestyle behaviors

The Stigma of Being Broken

The pervasiveness of obesity stigma

A small, but I think warranted, digression from the usual healthy change content for a subject near and dear to my heart. The world is a harsh place if you are obese. Despite all the talk about “fat and proud,” mountains of evidence keep pouring in suggesting that obese people are frequently targeted for derision, seen as lazy, weak, undesirable, and even unintelligent- attitudes that begin to develop as early as age 3- and are discriminated against at work, school, and even in the doctor’s office. A recent study in NeuroImage by researchers in Italy may shed some new light on what mechanisms play a role in allowing this culture to persist.

In the study, participants were asked to view brief videos of people being touched in their face by either a q-tip (neutral condition) or penetrated in their face by a syringe (pain condition). The videos depicted two non-overweight individuals and four obese individuals. Among the obese individuals, two were described as being obese due to “unknown causes” and the other two were described as being obese due to a disease that was out of their control (Cushing’s Disease). Researchers used an fMRI machine to track participant responses to the videos.

When viewing obese individuals, participants in the study showed reduced neural activity in key areas that are associated with sensory and emotional responses to pain in the brain. In other words, there was evidence of a possible “dampened” emotional response to seeing an obese person experience pain when compared to a non-overweight individual. That’s not great to hear, although certainly not unexpected. The next finding, however, was unexpected.

Participants showed a further “dampened” response to the pain video when viewing the obese people described as having uncontrollable weight gain due to a disease. In other words, if the obesity wasn’t their fault, there was less neural reactivity to the depiction of pain towards them. This flies in the face of similar research done on HIV and other conditions. When a person with HIV is described as contracting it from a blood transfusion as opposed to unprotected sex, for example, more empathy and emotional responding is elicited.

What could this possible mean? Of course, further research is warranted and it makes sense to be cautious when interpreting findings from one study. Having said that, I think it’s worth exploring how deeply stigmatized body-shape is in our society. There is an incredible amount of dehumanization occurring in all of us due to the massive exposure we’ve had to derogatory depictions of people with larger body shapes, countless fat jokes, horrible rants and memes on the internet, stereotypical TV show character depictions, media depictions (frequently highlighting overeating and lack of willpower as causes), and so on. We all have massive programming of “fat=broken.” That’s not to say we all act consistent with that programming, certainly not, but the exposure to those messages is part of us. And this study presents evidence that maybe this dehumanization is occurring somewhat at a neurobiological level. Maybe.

But again the shocking finding here is that, when obesity was described as uncontrollable, participants showed less reactivity to their pain. I wonder if part of what is going on is this. In studies, obese people are rated as less desirable than people with disabilities, amputations, and disfigurements. The pervasiveness of this lack of desirability is profound. What if, the fact that someone can’t change their weight puts them in a different classification. Now, instead of being broken, they are broken and they can’t be fixed.

One thing is for sure. We need to mount a culture change that is built on compassion and connecting with our common humanity in order to help mitigate our own programmed biases and ease the suffering of those around us. Change starts by saying, “I recognize I am a part of this culture and I want to do something about it.”

Study: R.T. Azevedo E. Macaluso, V. Viola, G. Sani, S.M. Aglioti (2014). Weighing the stigma of weight: An fMRI study of neural reactivity to the pain of obese individuals. NeuroImage 91, 109-119.



Jason Lillis, Ph.D., is assistant professor of research at the Alpert Medical School of Brown University.


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