July 27, 2013

'Fat shaming' actually increases risk of becoming or staying obese, new study says

Making overweight or obese people feel bad about their bodies doesn’t do anything to motivate them to lose weight – actually, a new study finds it does just the opposite.
People who felt discriminated against because of their weight were more likely to either become or stay obese, finds a new report published this week in the journal PLoS ONE.
“Weight discrimination, in addition to being hurtful and demeaning, has real consequences for the individual’s physical health,” says study author Angelina Sutin, a psychologist and assistant professor at the Florida State University College of Medicine in Tallahassee, Fla.

It’s a funny cultural paradox: Most American adults – around 70 percent -- are overweight, and more than a third are obese. And yet research – not to mention popular culture – shows that we perceive obese Americans to be lazy, unsuccessful schlubs with no will power.

In a real-life example, just last month, evolutionary psychologist Geoffrey Miller tweeted, “Dear obese PhD applicants: if you didn’t have the willpower to stop eating carbs, you won’t have the willpower to do a dissertation #truth.”

Miller, an associate professor of psychology at the University of New Mexico, quickly deleted the tweet and apologized, but many don’t feel they need to be sorry for saying cruel things to overweight people – they’re just concerned about the person’s health,that’s all! A 2011 public health campaign in Georgia used that idea in a series of ads designed to fight childhood obesity, featuring chubby, sad-looking kids with slogans like “Big bones didn’t make me this way. Big meals did.”
"It’s almost like obesity is the last of the acceptable groups to be teasing," says Madelyn Fernstrom, NBC News health and diet editor. Being biased about the overweight or obese, she says, is still very socially acceptable.

Research has already shown that stigmatizing overweight people leads to psychological factors that are likely to contribute to weight gain – things like depression or binge eating. This new paper takes that a step further, linking what the Internet likes to call “fat-shaming” to weight gain and suggesting that you can’t scare people skinny.
“Stigma and discrimination are really stressors, and, unfortunately, for many people, they’re chronic stressors,” says Rebecca Puhl, deputy director of the Rudd Center for Food Policy and Obesity at Yale University. Puhl has studied weight bias and discrimination for 13 years. “And we know that eating is a common reaction to stress and anxiety -- that people often engage in more food consumption or more binge eating in response to stressors, so there is a logical connection here in terms of some of the maladaptive coping strategies to try to deal with the stress of being stigmatized.”

Researchers assessed the body mass index (a way of measuring body fat based on height and weight) of 6,157 people, all Americans ages 50 and older, in 2006 and 2010. The people they studied were a mix of sizes -- normal weight, overweight and obese. But they found that the overweight people who reported experiencing weight discrimination were more than twice as likely to become obese by the next check-in in 2010. And people who were already obese in 2006 were three times more likely to remain obese by 2010 if they had experienced weight discrimination.
“Many people, from your sister-in-law to ethics professors, think that the road to weight control runs directly through shame and humiliation,” bioethicist Art Caplan, the head of the Division of Medical Ethics at NYU Langone Medical Center and an NBC News contributor, said in an email. “Common sense says that this is not likely to be true. Now this important study demonstrates that discriminating and shunning those who are fat does nothing to help them lose weight.”
One of those ethics professors Caplan is talking about is Daniel Callahan, who in January wrote an editorial arguing that one way to fight obesity in America might be to increase social pressure on the very heavy. He says this new study adds to what is a “very confused situation.”

“I suspect that in our society people who are seriously overweight -- not mildly, but seriously -- do feel at a disadvantage, do feel that they’re open to discrimination, do feel that people look down on them,” Callahan says. He wonders if some obese people are internalizing those feelings, and then acting accordingly, making a kind of self-fulfilling prophecy. “I’m 83 years old, and I’ve heard for years (about) age discrimination and bias against aging. I haven’t seen that at all. But an awful lot of old people basically lose self-confidence, and it begins to interact with what they think the rest of the world is saying about them.”

If stigmatizing isn’t the way to fight obesity, what about the effect of naming obesity a “disease,” as the American Medical Association did last month? It’s too early to tell, Puhl says, but she has a good feeling about it. “I think time will tell. I think that there is reason to think it will be helpful -- that this could potentially reduce stigma because it may help remove blame that is so often put on people,” Puhl says. “But I think we need to observe this over time to see what happens.”
Moving forward, she hopes that research like this can help public health campaigns “shift focus from just a number on the scale” to a conversation focusing more on individual health. “We want people to engage healthy behaviors, regardless of their body size.”

“Obesity remains a complex problem—part choice and free will mixed in with a smidgen of genetics, sedentary lifestyles and a whole lot of promotion and advertising of fast food, sugary food, high-caloric food and junk food,” Caplan said via email. “It would be nice if guilt was the magic bullet to weight control. It isn't. Nothing is. It took a long time and a lot of bad habits to get the way we are in terms of size and, short of a pharmaceutical miracle, it will take public and heath policy attacking a lot of variables for a long time to slim us back down.”

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