Shame, shame on anyone who embarrasses an individual struggling with obesity. We now know that obesity is a very complicated disease with many causes and health implications. Recent findings also indicate just how hard it is for the average person to maintain significant weight loss, long-term.
Our society still hasn’t caught up to the realities surrounding a diagnosis of obesity, and unfortunately fat bias and fat-shaming is quite pervasive. A January 2017 study suggests that if you feel persistently vulnerable to fat bias and fat-shaming, you may be at higher risk of developing health issues like heart disease and diabetes.
Body shaming seems to have escalated in recent years, mostly because its reach has extended. Beyond work, school, and home, you can now use social media and cyber-bully to weight shame someone you know or even a stranger. There is a stereotype associated with obesity, and it often includes common descriptive words like: lazy, sloth-like, unattractive, lacking willpower, unkempt, and sloppy, among others. There is incredible pain associated with this type of stereotyping, and it’s easy to feel embarrassed, inadequate, and incompetent. Weight bias internalization occurs when you apply these negative comments and perceptions to yourself. If you struggle with self-esteem issues and internalize the pain, this study suggests that there can be a significant negative impact on your metabolic and cardiac health.
The study published in Obesity, the journal of The Obesity Society, looked at weight bias internalization as a separate issue from the direct effects of body mass index (BMI) on risk of depression, a well-recognized association. The research team looked at 159 adults with obesity, already enrolled in a larger clinical trial that was testing a weight loss medication. Most of the subjects were African-American (a group often under-represented in weight and weight bias research). The subjects were given a questionnaire to evaluate levels of depression or perceived weight bias, to serve as baseline information. They also had a series of physical assessments to see if they met the criteria for metabolic syndrome.
Metabolic syndrome is a cluster of risk factors including high triglycerides, high blood pressure, a larger than normal waist measurement, and elevated BMI, all of which are associated with risk of developing a number of chronic health conditions including heart disease and type 2 diabetes.
Initially, the researchers didn’t find a correlation between internalizing weight bias and risk of disease. But when the researchers divided the subjects into “high” and “low” levels of “weight bias internalization” groups, they noted that individuals in the “high” group were three times more likely to have metabolic syndrome, and six times more likely to have elevated triglyceride levels, compared to the “low” group.
Prior studies on weight bias seem to indicate that the mental health impact may actually provoke a psychological stress response involving elevated levels of cortisol and increased general inflammation, which can clearly instigate conditions like heart disease and type 2 diabetes. Weight bias was also shown to further escalate unhealthy eating patterns (emotional eating) and induce a reluctance to exercise because the person feels that everyone is watching them or because they feel inadequate or especially large next to normal gym attendees. Weight bias can literally “make the person fatter.”
The researchers suggest that based on the results of this small observational study, there are some powerful lessons:
If you routinely embarrass and shame people with obesity, it is unlikely to motivate them to lose weight and it may actually further complicate their health situation.
We could all benefit from learning empathic ways to express concern over someone’s weight issue, and appropriate times to engage in conversation.
Obesity is a disease and should not be handled as a failure of willpower condition. We need to be supportive and not judgmental.
Health care providers need to realize that how they communicate with the patient is crucial to the health of the patient. Treating the patient with respect, discussing weight matters with sensitivity, and refraining from judgement, as well as providing care and support, can help to minimize further health consequences.
We, as a society, need to look at weight stigma as a serious and chronic stressor. The individual struggling with excess weight is already vulnerable to self-stigmatization. When they look in the mirror, or try buying new clothes, or try to get on a ride at an amusement park, they likely berate themselves with messages of inadequacy. Offering unkind and unsolicited comments or opinions on someone’s weight will likely not help the situation and may actually make it worse, in terms of their mental and physical health. So how do you express concern? You do it with empathy and without judgement. You offer support respectfully.
I’m of the belief that you can “be real” and honest when the health stakes are high. An individual with obesity may need to hear truths from their friends or loved ones. But there is a big difference between shaming someone into weight loss and encouraging habit changes to improve their health and quality of life. The question is — do you know the difference?
Amy Hendel, also known as The HealthGal, is a Physician Assistant, nutritionist and fitness expert. As a health media personality, she's been reporting and blogging on lifestyle issues and health news for over 20 years. Author of The 4 Habits of Healthy Families, her website offers daily health reports, links to her blogs, and a library of lifestyle video segments.