Primum Non Nocere: Obesity Stigma and Public Health

School of Psychology, The University of New South Wales, Sydney, NSW, 2052, Australia, .
Journal of Bioethical Inquiry (Impact Factor: 0.75). 01/2013; 10(1). DOI: 10.1007/s11673-012-9412-9
Source: PubMed


Several recent anti-obesity campaigns appear to embrace stigmatization of obese individuals as a public health strategy. These approaches seem to be based on the fundamental assumptions that (1) obesity is largely under an individual's control and (2) stigmatizing obese individuals will motivate them to change their behavior and will also result in successful behavior change. The empirical evidence does not support these assumptions: Although body weight is, to some degree, under individuals' personal control, there are a range of biopsychosocial barriers that make weight regulation difficult. Furthermore, there is accumulating evidence that stigmatizing obese individuals decreases their motivation to diet, exercise, and lose weight. Public health campaigns should focus on facilitating behavioral change, rather than stigmatizing obese people, and should be grounded in the available empirical evidence. Fundamentally, these campaigns should, first, do no harm.

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Available from: Lenny R Vartanian, Jan 20, 2015
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    • "Less emphasis on the individual as having sole responsibility for weight status may be beneficial (although externalizing all accountability may also be counterproductive). There should be focus on facilitation of behavioral change rather than stigmatization (Vartanian & Smyth, 2013). Allon (1979) suggested a middle ground based on observing more weight loss success among youth who understood their overweight status to be due to their own actions as well as an illness requiring collaboration with others. "
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    ABSTRACT: Because body weight is largely seen as controllable, weight stigma—the social devaluation of those who are overweight—is not subject to the social norms that condemn open expression of racism and sexism. Indeed, rejection of peers based on perceptions of excess weight is normative. Since weight stigma is internalized, popular views (and often the views of physicians) have suggested that increasing the salience of weight stigma might produce a reduction in overeating and/or an increase in physical activity. However, that perspective is not rooted in scientific evidence. Recent randomized controlled designs demonstrate that stigma may promote overeating. Correlational evidence suggests that self-reported stigma experience is associated with risk for binge eating and decreased interest in physical exercise and dieting, for children and adults. In addition to reviewing these research studies, this paper examines the potential for intersectionality of stigma across multiple social identities and considers alternatives to stigmatizing weight loss interventions.
    Full-text · Article · Jan 2016 · Appetite
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    • "In fact, recent work showed that reduced diabetes-related distress was related to enhanced health-related behaviors such as medication adherence, diet, and physical activity recommendations (Wagner et al., 2015). Further facilitating healthy lifestyle changes (e.g., improved diet, increased exercise) rather than solely focusing on changing actual weight status may benefit patients for whom weight discrimination is a barrier to disease management (Vartanian & Smyth, 2013). Importantly, our findings may bring awareness to highly prevalent health disparities among members of stigmatized groups that may be considered in clinical practice, future research, and interventions aimed at improving the health status of individuals with type 2 diabetes and, perhaps, other chronic diseases. "
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    ABSTRACT: This study examined the association between attributing self-reported discrimination to weight and diabetes outcomes (glycemic control, diabetes-related distress, and diabetes self-care). A community dwelling sample of 185 adults (mean age 55.4; 80 % White/Caucasian 65 % female) with poorly controlled type 2 diabetes (HbA1c level ≥7.5 %) provided demographic and several self-report measures (including diabetes-related distress, diabetes self-care activities, discrimination, and attributions of discrimination), and had height, weight, and glycated hemoglobin (HbA1c) assessed by trained research staff as part of a larger research study. Individuals who attributed self-reported discrimination to weight had significantly higher HbA1c levels, higher levels of diabetes-related distress, and worse diabetes-related self-care behaviors (general diet, exercise, and glucose testing). These relationships persisted even when controlling for BMI, overall discrimination, depressive symptoms, and demographic characteristics. Results indicate that the perception of weight stigma among individuals with type 2 diabetes is strongly associated with a range of poor diabetes outcomes. Efforts to reduce exposure to and/or teach adaptive coping for weight stigma may benefit patients with type 2 diabetes.
    Full-text · Article · Jul 2015 · Journal of Behavioral Medicine
    • "" This assumption, however, stands in stark contrast to the growing literature on the effects of weight stigma. Little evidence exists to indicate that stigmatizing experiences will lead to weight loss among overweight individuals (Vartanian & Smyth, 2013; but see Latner, Wilson, Jackson, & Stunkard, 2009). Rather, there is growing evidence that weight stigmatizing experiences promote weight gain over time (Hunger & Tomiyama, 2014; Jackson, Beeken, & Wardle, 2014; Sutin & Terracciano, 2013). "
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    ABSTRACT: Weight stigma is pervasive, and a number of scholars argue that this profound stigma contributes to the negative effects of weight on psychological and physical health. Some lay individuals and health professionals assume that stigmatizing weight can actually motivate healthier behaviors and promote weight loss. However, as we review, weight stigma is consistently associated with poorer mental and physical health outcomes. In this article, we propose a social identity threat model elucidating how weight stigma contributes to weight gain and poorer mental and physical health among overweight individuals. We propose that weight-based social identity threat increases physiological stress, undermines self-regulation, compromises psychological health, and increases the motivation to avoid stigmatizing domains (e.g., the gym) and escape the stigma by engaging in unhealthy weight loss behaviors. Given the prevalence of overweight and obesity in the US, weight stigma thus has the potential to undermine the health and wellbeing of millions of Americans.
    No preview · Article · Jun 2015 · Social and Personality Psychology Compass
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