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Obesity, Stigma And Discrimination


Obesity, Stigma And Discrimination

Article Author:
Melody Fulton
Article Editor:
Vijay Srinivasan
Updated:
5/5/2020 11:34:19 AM
For CME on this topic:
Obesity, Stigma And Discrimination CME
PubMed Link:
Obesity, Stigma And Discrimination

Definition/Introduction

Obesity is a complex medical disease and a significant public health issue in the United States as it has become a worsening epidemic. Obesity is defined by the body mass index (BMI), which is calculated using one’s weight (in kilograms) by the square of one’s height (in meters). According to the BMI classification, a BMI equal to or greater than 25 is overweight, and a value equal or greater than 30 is obese.[1] As obesity rates have increased, so have stereotypes and biases about obese individuals.[2] Modern society has adopted negative beliefs that obese individuals are lazy, irresponsible, and lack self-discipline even though genetic, socioeconomic, and environmental factors play a role in the development of obesity.[1] These negative attitudes towards obese individuals have created a negative stigma that leads to prejudice and discrimination. The weight stigma is a growing concern as it has increased by two thirds in the last decade.[3] The current societal belief is that labeling an individual as “obese” will be a motivator for weight loss.[4] On the contrary, research has shown that weight stigma leads to adverse physical and psychological health consequences for this population.[5][2][6][7][8]

Issues of Concern

Disease stigmas result from misconceptions and biases that exacerbate suffering on individuals with diseases, such as HIV and AIDs. The weight stigma is prevalent among the media, schools, workplaces, and even in health care settings.[3] The media highlights these attitudes by depicting thin actors as popular and kind, while overweight actors are often rude, aggressive, and unpopular.[9] Obesity is the most common cause of youth to experience bullying and teasing at school.[5][10][11] Medical professionals, including physicians, dietitians, nurses, and medical students, have been found to display both explicit and implicit bias towards overweight and obese individuals.[12] Research has shown primary care providers spend less time during office visits with obese individuals as they view them as non-compliant patients.[13] Health care professionals’ weight bias impairs their ability to offer support and empathy to these patients, which compromises their overall health care.[12] To reduce weight discrimination, multiple domains, including the media, educators, health professionals, need to be informed and properly educated about the negative implications of the weight stigma.

Clinical Significance

The stigma and prejudice towards obese persons have significant implications for adverse physical and psychological outcomes.[5] Studies have shown that people internalize the stigma and are less confident in their inability to lose weight.[3] Thus, obese individuals partake in binge eating and engage in less activity.[7][8] Resultingly, obese individuals are at risk for increased comorbidities such as cardiovascular disease, diabetes, and stroke.[14] Additionally, weight stigma leads to a greater risk of depression, suicidal ideation, and low self-esteem.[15] When obese patients experience weight bias in a medical setting, they are more likely to cancel appointments and avoid future preventative health care, increasing their risk of medical problems and health care costs.[12][10]

Nursing, Allied Health, and Interprofessional Team Interventions

Healthcare professionals need to address the weight stigma and need to be adequately educated about obesity, ensuring biological and environmental factors are evaluated as factors hindering an individual's weight loss.[10] Instead of concentrating on weight loss, professionals should focus patient education on healthy lifestyle changes which include, a well-balanced diet, exercise, adequate sleep, and decreased stress.[3] Additionally, health care professionals should improve the physical and social environment to enhance patient care through proper communication and an accommodating clinical setting.[16] Healthcare professionals need to be sensitive and carefully consider the language they use with overweight patients as studies have found words such as "obese" and "fat" have much worse implications than "unhealthy weight" or "body mass index." [3] To further improve interpersonal interactions and avoid the embarrassment of obese patients, clinicians should ensure their physical environment includes office chairs that are armless and large enough to seat overweight patients and provide large gowns and medical equipment such as blood pressure cuffs and scales.[16]

In conclusion, it is essential the obesity stigma is addressed by all domains of society, but particularly by health care professionals, to ensure the health care of obese individuals is not negatively impacted by weight discrimination.   


References

[1] Hruby A,Hu FB, The Epidemiology of Obesity: A Big Picture. PharmacoEconomics. 2015 Jul     [PubMed PMID: 25471927]
[2] Brewis AA, Stigma and the perpetuation of obesity. Social science & medicine (1982). 2014 Oct     [PubMed PMID: 25124079]
[3] Puhl RM,Heuer CA, Obesity stigma: important considerations for public health. American journal of public health. 2010 Jun     [PubMed PMID: 20075322]
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[14]     [PubMed PMID: 30805277]
[15]     [PubMed PMID: 26627213]
[16]     [PubMed PMID: 18978766]