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Is Anti-Fat Bias Making People Sick?

New research finds that experiencing weight-related stigma may cause ill health.

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Recent research published in Psychological Science asks us to consider a novel idea about how obesity might lead to negative health outcomes. For decades, researchers have assumed that obesity is linked to conditions like cardiovascular disease, diabetes, and high blood pressure because excess fat tissue puts a strain on the body’s biological processes. But what if obesity is associated with ill health effects at least partly because those who are obese face rampant discrimination and stigma in their everyday lives? After analyzing data from a four-year longitudinal study of several thousand older adults living in England, the authors concluded that the “psychosocial strain of weight stigma may account for a notable proportion of the obesity-related disease burden.”

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Anti-fat bias is well-documented. People who are obese face discrimination in both employment and educational settings. More directly relevant to health outcomes, researchers have provided overwhelming evidence that medical professionals show a great deal of bias when treating obese patients. (You can read numerous online accounts of obese individuals who have been misdiagnosed or otherwise mistreated by the medical establishment due to the assumption that any health problem they had was a direct result of their body weight and could be solved simply by dieting. In fact, many who are obese report avoiding medical care altogether because of how they have been treated by medical professionals.)

Despite the fact that around 40 percent of American adults are technically obese (using Centers for Disease Control guidelines), there is evidence that weight-based bias and discrimination are increasing. Facing any kind of chronic discrimination can have disastrous health outcomes, and weight-based discrimination is no exception. For example, discrimination and stigma can elevate cortisol (a stress hormone), which has numerous downstream negative health effects. Weight-based bias has also been linked via single time-point laboratory studies with metabolic dysfunction and inflammation.

The authors of this new research studied over 3000 participants from the English Longitudinal Study of Ageing. This sample of participants was collected using what’s called stratified random sampling. As a result, the participants in the study generally match England’s broader demographic patterns as determined by the national census.

Researchers had access to objective biomarkers like cardiovascular, immune, and metabolic system functioning for all participants. They used these health indicators to create an overall index of physiological dysregulation. Research participants also completed the “Everyday Experiences with Discrimination Scale.” This scale provides a list of discriminatory experiences (e.g., being threatened or harassed, being treated with less respect or courtesy, people acting as if you are not smart, people acting as if they are better than you). After marking how often they have had these experiences (ranging from almost every day to never), participants identified the reasons they were treated this way. The authors defined the group of participants who experienced weight discrimination as those who reported any form of discrimination and attributed it to their weight.

Consistent with other research, the authors found that obesity (defined for this study as having a body mass index greater than 30) was associated with more physiological dysregulation. However – and this is where things get interesting – experiencing weight discrimination also predicted physiological dysregulation. In fact, a significant amount of the link between obesity and physiological dysregulation (around 27 percent) was accounted for by experiences of discrimination. Results were similar for both men and women and held up when researchers tested several different ways to measure body size (BMI, obesity status, or waist circumference).

Some seem to believe that shaming people who are fat is a way to motivate weight loss. (It isn’t.) Others perpetuate weight-based stigma with the argument that they do so because they are “worried about people’s health.” The lesson of this research is clear: If you are concerned about the link between obesity and health, challenge your own stigmatization of fat bodies and fight weight-based discrimination. Work toward a world where people of all body shapes and sizes are treated fairly and with respect. Don’t let your own biases contribute to a climate that makes people sick.

* Note: I use the words obesity and obese in this post because those are the words the authors of this research used. However, many in the body positivity movement prefer to use the term fat instead of obese, arguing that the term “obesity” unnecessarily medicalizes and stigmatizes fat bodies and that the word “fat” can be reclaimed as a basic descriptor of a body (like “tall” or “short”) instead of as an emotionally loaded term often used as an insult.