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Weight Loss Is Not the Answer: A Well-being Solution to the “Obesity Problem”

December 2015
Social and Personality Psychology Compass 9(12):678-695

DOI:10.1111/spc3.12223

Authors:

Danu Anthony Stinson

University of Victoria

Paula M. Brochu

Nova Southeastern University

Americans have been gaining weight in recent decades, prompting widespread concern about the health implications of this change. Governments, health practitioners, and the general public all want to know: What is the best way to reduce the health risks associated with higher body weight? The dominant weightloss solution to this “obesity problem” encourages individuals to lose weight through behavior change. This solution rests on the assumptions that higher body weight causes health problems, that permanent weight loss is attainable, and that weight loss improves health. But comprehensive reviews of the scientific evidence find mixed, weak, and sometimes contradictory evidence for these premises.We suggest that a different solution to the “obesity problem” is needed – a solution that acknowledges both the multifaceted nature of health and the complex interaction between person and situation that characterizes the connection between weight and health. Thus, we use the lens of social psychological science to propose an alternative, well-being solution to the “obesity problem”. This solution has the potential to improve health by encouraging eating and exercising for optimal health rather than weight loss, by developing interventions to reduce weight stigma and discrimination, and by helping higher body-weight people cope with the stress of stigma and discrimination.

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Social and Personality Psychology Compass 9/11 (2015): 678–695, 10.1111/spc3.12223

Weight Loss Is Not the Answer: A Well-being Solution to the

“Obesity Problem”

Christine Logel

*, Danu Anthony Stinson

and Paula M. Brochu

Renison University College, University of Waterloo

University of Victoria

Nova Southeastern University

Abstract

Americans have been gaining weight in recent decades, prompting widespread concern about the health

implications of this change. Governments, health practitioners, and the general public all want to know:

What is the best way to reduce the health risks associated with higher body weight? The dominant weight-

loss solution to this “obesity problem”encourages individuals to lose weight through behavior change.

This solution rests on the assumptions that higher body weight causes health problems, that permanent

weight loss is attainable, and that weight loss improves health. But comprehensive reviews of the scientific

evidence find mixed, weak, and sometimes contradictory evidence for these premises. We suggest that a

different solution to the “obesity problem”is needed –a solution that acknowledges both the multifac-

eted nature of health and the complex interaction between person and situation that characterizes the

connection between weight and health. Thus, we use the lens of social psychological science to propose

an alternative, well-being solution to the “obesity problem”. This solution has the potential to improve

health by encouraging eating and exercising for optimal health rather than weight loss, by developing in-

terventions to reduce weight stigma and discrimination, and by helping higher body-weight people cope

with the stress of stigma and discrimination.

…obesity is one of today’s most blatantly visible –yet most neglected –public health problems…If immediate action

is not taken,millions will suffer from an array of serious health disorders.

–World Health Organization (2015

)

Body weight is indeed “blatantly visible”, as noted by the World Health Organization

(WHO, 2015a) above. With a single glance, people can size up one another and categorize each

other as thinner or fatter. More than ever, people are categorizing each other as fatter. In the

United States, the focus of the present review, the majority of adults now weigh more than

health authorities agree is optimal for health (Centers for Disease Control and Prevention

[CDC], 2014b, September 9; WHO, 2015b). Indeed, the prevalence of weights that are con-

sidered “obese”according to medical classification systems –and thus are considered to pose

a significant health risk –has increased from 13% to 32% over the past 50years (e.g., Wang &

Beydoun, 2007).

However, the extent to which higher body weight is actually a “neglected public health

problem”that has not yet been targeted with “immediate action”in the United States is debat-

able. The American government has taken action. They have created a dedicated division of the

CDC with an annual budget of $49.5 million (The State of Obesity, 2015) and made higher

body weight among children the priority issue of the First Lady’s office (see www.letsmove.

gov). Individuals are also taking action. The most common New Years’resolution is to lose

weight (Norcross, Mrykolo, & Blagys, 2002), and Americans spend $50 billion annually on

weight-loss products (Weiss, Galuska, Khan, & Serdula, 2006). Despite these and other actions,

as the WHO notes above, most people still weigh more than what is considered optimal for

health by health authorities.

So it may not be lack of action that makes higher body weight a neglected public health

problem, but a lack of effective action. Yet the dominant response to the ineffectiveness of past

efforts has been to take the same actions, but just try harder: Governments increase funding

for weight-loss initiatives (The State of Obesity, 2015); encourage employers to monitor their

employees’weight and implement weight-loss programs in the workplace (CDC, 2014a,

November 2012); and introduce taxes on foods thought to contribute to higher body weight

(Mandaro, 2014). Individuals, for their part, attempt one diet after another (Montani, Schutz,

& Dulloo, 2015). Yet body weights remain high.

Rather than continuing to pour money and energy into actions that have not been effective,

we suggest that researchers, health practitioners, and lay people pause to ask themselves a tough

question: What is the best way to reduce the health risks that are associated with higher body

weight? We call this the “obesity problem”, and in this paper, we use the lens of social psycho-

logical science to evaluate the currently dominant solution, and then to propose an alternative.

With its focus on the complex interactions between the person and the social situation, and its

emphasis on experimental methods to determine causality, social psychological science is

uniquely suited to tackle the “obesity problem”.

Throughout this paper, we use the colloquial term body weight to refer to a person’srelative

fatness or leanness. Higher body-weight people are those who would be deemed “overweight”

or “obese”according to the common medical classification system for weight, or by themselves

or important others. We use quotation marks around these weight terms because they reflect

arbitrary classifications and many higher body-weight people find them stigmatizing. Beyond

the scope of this article are issues pertaining to the one in 200 people who are classified as “ex-

tremely obese”(Sturm & Hattori, 2013), to children’s weight, or to clinically significant eating

disorders.

Evaluating the Weight-loss Solution

Obesity is a national epidemic,causing higher medical costs and a lower quality of life.

–CDC (2010)

This quote from a CDC pamphlet exemplifies a common belief: That a high volume of ad-

ipose tissue causes costly and debilitating health problems. This belief about the “obesity prob-

lem”leads logically to what we term the weight-loss solution: If higher body weight causes serious

health problems, the appropriate solution is to encourage weight loss. Implicit to this solution is

the assumption that permanent weight loss is attainable with individual efforts, and that it will

improve health. Does the evidence support these premises?

Evidence that higher body weight causes health problems

Evidence is strong that higher body weight predicts health problems over time. Studies in high-

caliber epidemiological and biomedical journals identify higher body weight as a risk factor for

type 2 diabetes, cardiovascular disease, osteoarthritis, and several types of cancer (e.g., Calle,

Thun, Petrelli, Rodriguez, & Heath, 1999; Mokdad, Marks, Stroup, & Gerberding, 2004).

Large-scale longitudinal studies demonstrate moderate correlations between higher body

A Well-being Solution to the “Obesity Problem”679

weight and both disease and all-cause risk of mortality (e.g., Flegal, Graubard, Williamson, &

Gail, 2005; Hedley et al., 2004). If body fat actually causes these outcomes, then the United

States is experiencing a true public health crisis.

However, articles in many of the same high-caliber epidemiological and biomedical journals

call for caution in concluding that this link is causal. Virtually all research linking higher body

weight to longer-term negative health consequences is, necessarily, correlational, and many

studies fail to adequately control for third variables known to predict, and sometimes cause, both

higher body weight and poor health. One such third variable is socioeconomic status (SES;

e.g., Kassirer & Angell, 1998). People who are of lower SES are higher in body weight and also

experience worse health outcomes than their higher SES counterparts. Another is physical ac-

tivity (e.g., LaMonte & Blair, 2006). Studies that distinguish between physical activity and body

weight reveal that fitness, not fatness, is the strongest predictor of health (e.g., Farrell, Braun,

Barlow, Cheng, & Blair, 2002; Grundy et al., 1999; Lee, Blair, & Jackson, 1999; Wie et al.,

1999). Additional and potentially important third variables include powerful social determinants

of health (Wilkinson & Marmot, 2003) such as social rejection, poor social support, and stress,

each of which can lead to weight gain and poor health (e.g., Björntorp, 2001; Cohen, 2004;

Cohen, Tyrrell, & Smith, 1991; Dallman, 2010; Logel et al., 2014; Stinson et al., 2008). These

confounding variables may explain the so-called obesity paradox, the finding in many large-scale,

multi-country epidemiological studies that body fat predicts lower mortality risk (Flegal, Kit,

Orpana, & Graubard, 2013; Grabowski & Ellis, 2001; Orpana et al., 2010; Stessman, Jacobs,

Ein-Mor, & Bursztyn, 2009; Tamakoshi et al., 2010), and better outcomes following pneumo-

nia infection (Corrales-Medina, Valayam, Serpa, Rueda, & Musher, 2011), kidney disease

(Kopple, 2005), and cardiovascular disease (Lavie, Milani, & Ventura, 2009).

When taken together, evidence suggests that it is premature to conclude that higher body

weight causes health problems. What are the implications of this uncertain causality for the

weight-loss solution to the “obesity problem”? If a given public health action has potential to

benefit health, is easy to implement, and carries few costs, then it make sense to implement it

while scientists continue to seek causal evidence. This appears to be the perspective adopted

by public health and governmental organizations like the WHO and CDC, whose scientists

have surely been aware of the problem of inferring causal associations from correlational

evidence, and who support ongoing research in this area. Some of this research has investigated

the degree to which weight loss is easy to attain and has costs. Does this research support

continued implementation of the weight-loss solution?

Evidence that weight loss is attainable

So here I stand,40 pounds heavier than I was in 2006….I’m mad at myself.I’m embarrassed.Ican’t believe that after

all these years,all the things I know how to do,I’m still talking about my weight…How did I let this happen again?

–Oprah Winfrey (2009)

Oprah Winfrey conquered childhood poverty and prejudice to become one of Time

Magazine’s“100 Most Inf luential People in the World”and win the Presidential Medal of

Freedom (Turner, 2011). But as she poignantly describes, she has been unable to consistently

maintain a body weight in the range considered optimal by health authorities. Her failure is

not for want of trying. Ms Winfrey has famously lost and then regained weight numerous times

during her long tenure in the public eye.

How can a highly successful philanthropist and business woman have so much difficulty

maintaining a lower body weight? The formula for weight loss seems simple –consume less

680 A Well-being Solution to the “Obesity Problem”

energy than you burn, creating an energy deficit, and forcing your body to use stored fat for

fuel. Ms Winfrey’s website includes tips to create such an energy deficit by consuming

1300–1500kilocalories per day (Oz, 2012), an amount consistent with public health recom-

mendations for weight loss (American Heart Association, 2014) and much less than the 2500ki-

localories necessary to be “well-nourished”according to the Food and Agricultural

Organization of the United Nations (FAO, 2000). Ms Winfrey’s guidelines are less extreme

than popular commercial diet plans like Nutrisystem (1250 to 1500 kilocalories) and Jenny

Craig (1200 kilocalories).

Public health communications typically recommend attaining this reduced energy intake by

eating smaller portions that include more fruits and vegetables and exercising to burn additional

fat stores (e.g., American Heart Association, 2014; CDC, 2014). However, this behavioral for-

mula for weight loss can only work if body weight is a predominantly controllable characteristic

(Friedman, 2003, 2004; O’Rahilly & Farooqi, 2008). It is not. Large-scale studies of families,

including twins who have been reared apart, reveal that fully 70% of individual variance in body

weight can be explained by genetics (Stunkard, Harris, Pedersen, & McClearn, 1990; see also

Sørensen, Price, Stunkard, & Schulsinger, 1989; Stunkard et al., 1986), a degree of heritability

commensurate with traits like height (e.g., O’Rahilly & Farooqi, 2008). This means that most of

the population’s variance in body weight is determined by individual differences in genetic

heritage, not individual differences in behavior. Furthermore, although environmental factors

like greater availability of calorie-dense foods (e.g., Kessler, 2010), increasing portion sizes

(Wansink & Chandon, 2014), and less active work lives (Prentice & Jebb 1995; but see

Westerterp & Speakman, 2008) may explain recent weight gains across the entire American

population, the same large-scale studies of families we just reviewed reveal that some people

are genetically more susceptible to such environmental factors, and this susceptibility is generally

uncontrollable by the individual. Thus, many experts conclude that weight is a largely genetic

trait that is highly responsive to the environment (e.g., Friedman, 2003, 2004).

Once genes and the environment interact to settle a person at a given body weight,

automatic, homeostatic biological processes work to maintain it as a minimum body weight –

or more specifically, a minimum fat volume –that only varies within a relatively narrow range

(e.g., Keesey & Powley, 2008). Thus, decreases in energy intake, such as those proscribed by

weight loss plans, prompt a cascade of biological changes that resist weight loss. These include

shifts in appetite-regulatory hormones that increase subjective appetite (Sumithran et al.,

2011) and changes in metabolism that reduce energy expenditure (Brownell, 1991; Leibel,

Rosenbaum, & Hirsch, 1995), which can persist up to a year after weight loss occurs.

Moreover, the level of energy intake recommended by many popular diets (i.e., 1200 to

1500 kilocalories per day) is comparable to that of the most undernourished global regions,

where severe hunger interferes with individuals’ability to thrive and make meaningful contri-

butions to society (FAO, 2000). It is no wonder, then, that dieting for weight loss is psycholog-

ically and physiologically stressful (Tomiyama et al., 2010). This stress further undermines

weight loss by prompting increased caloric consumption (see Torres & Nowson, 2007) and

physiological changes that facilitate weight gain (see Björntorp, 2001; Dallman, 2010).

Pitted against these genetic, environmental, biological, and psychosocial factors, how well do

people fare in their efforts to lose weight? Independent comprehensive reviews of behavioral

weight-loss interventions all reach the same conclusions: In the short term, some weight loss

is possible on any diet program, but nearly every dieter regains the weight they lost within three

to five years, and as many as two-thirds of dieters regain more weight than they initially lost

(Katz, 2005; Mann et al., 2007; see also Aphramor, 2010; Bacon, 2008; Bacon & Aphramor,

2014; Garner & Wooley, 1991; Kassirer & Angell, 1998). Permanent weight loss, at least via

individual behavioral efforts, is exceptionally rare.

A Well-being Solution to the “Obesity Problem”681

But can those rare individuals who do maintain significant weight losses over time serve as

exemplars for the potential success of the weight-loss solution? Perhaps. But such individuals

might also be counted as statistical outliers. Moreover, in a sample drawn from the National

Weight Control Registry, participants reported that they maintained their 30-pound weight

losses for five years or more by continuing, against biological, environmental, and psychosocial

pressures, to follow a starvation-level diet –1685 kilocalories daily for men; 1300kilocalories daily

for women (Shick et al., 1998). And even then, on average the women’s weights were barely

into “healthy weight”classification, and the men were still classified as “overweight”.

Proponents of the weight-loss solution to the “obesity problem”might argue that the

weight-loss solution should not be abandoned, but merely adjusted –that new methods of

weight loss should be sought for the sake of people’shealth.Butdoesweightlossimprovehealth?

Evidence that weight loss improves health

Researchers have documented some modest, short-term health benefits of weight loss. A re-

view of 21 randomized-controlled trials of weight-loss interventions concluded that participants

in the weight-loss conditions enjoyed small decreases in coronary morbidity and mortality risk,

as well as slight improvements in blood pressure, use of diabetes medication, fasting blood glu-

cose, levels of cholesterol and triglycerides, and incidence of diabetes and stroke compared to

the control participants (Tomiyama, Ahlstrom, & Mann, 2013). However, none of these effects

were correlated with the amount of weight that participants lost, meaning that participants in

the intervention conditions enjoyed these health benefits regardless of their level of weight loss,

which varied widely across participants. Given that most interventions increased exercise, social

support, healthcare access, and consumption of fruits and vegetables in addition to manipulating

calorie intake, the authors of the review could find little convincing evidence that weight loss

itself played any causal role in the (mostly small) positive health outcomes observed in the treat-

ment conditions. Indeed, health interventions that include all of these beneficial factors but do

not limit caloric intake demonstrate equally positive health outcomes in the absence of weight

loss (Bacon & Aphramor, 2011).

Not only does evidence that weight loss directly improves health appear to be weak, but ev-

idence that weight-loss efforts can be harmful appears to be stronger, and includes correlational

but also experimental evidence. Dieting requires sustained acts of willpower which can

eventually break down, resulting in overeating and a lack of self-regulatory capacity needed

for other tasks (Kahan, Polivy, & Herman, 2003; Vohs & Heatherton, 2000). The stress of

dieting increases the stress hormone cortisol, potentially compromising dieters’immune func-

tioning (Tomiyama et al., 2010). Dieting also predicts elevated rates of depression and negative

self-image (Markowitz, Friedman, & Arent, 2008), and in adolescents, predicts future weight

gain and binge eating (Field et al., 2003). And it appears that the more often people attempt

weight loss, the more their health is at risk –frequency of dieting predicts decreased markers

of immune functioning among higher-weight, currently-healthy women (Shade et al., 2004).

The costs of the weight-loss solution are not borne by higher body-weight people exclu-

sively. Theportrayal of higher weight as unhealthy and weight loss asboth desired and attainable

has likely contributed to the fear of fat that extends across the weight spectrum. In one study,

nearly 60% of participants classified as “non-overweight”agreed that they would give up at least

one year of their lives rather than be “obese”, and 15% agreed that they would give up ten years

or more (Schwartz, Vartanian, Nosek, & Brownell, 2006). Weight dissatisfaction is so pervasive

among women that it is referred to as a “normative discontent”(Rodin, Silberstein, & Striegel-

Moore, 1983). Among young people, body dissatisfaction prospectively predicts a host of

682 A Well-being Solution to the “Obesity Problem”

unhealthy behaviors for both higher- and lower-weight people, including extreme dieting,

binge eating, smoking, lower fruit and vegetable intake, and lower rates of exercise

(Neumark-Sztainer, Paxton, Hannan, Haines, & Story, 2006). The difference between a per-

son’s actual and ideal weight is a stronger predictor of physically and mentally unhealthy days

than is actual body weight (Muennig, Jia, Lee, & Lubetkin, 2008), and the negative health con-

sequences of weight loss followed by weight regain (i.e., weight cycling) are most severe for

lower body-weight people (Montani et al., 2015). Moreover, negative body image predicts

weight gain over time independent of body weight (van den Berg & Neumark-Sztainer, 2007).

The research evidence regarding body weight and health is perhaps best summed up by the

editors of the New England Journal of Medicine:“Unfortunately, the data linking overweight and

death, as well as the data showing the beneficial effects of weight loss, are limited, fragmentary,

and often ambiguous”(1998, p. 52). Our own reading of the empirical literature supports that

conclusion and adds that evidence suggests that long-term weight loss is extremely rare, and that

efforts to attain long-term weight loss can be harmful to health and well-being.

And when viewed through a social psychological lens, this research points to another ques-

tion that must be asked of the weight-loss solution: Could it be helping to maintain stigma

and discrimination against higher body-weight individuals?

Weight stigma and discrimination

In 2008, Representative W. T. Mayhall Jr proposed legislation requiring restaurants to weigh

prospective diners and refuse service if their weight met Mississippi’scriteriafor“obesity”

( Junkfood Science, 2008). This bill did not pass, but its very proposal offers a stark reminder

of the pervasive –and socially acceptable –weight stigma that dominates American culture

(Puhl & Brownell, 2001; Puhl & Heuer, 2009).

Higher body-weight people are commonly stereotyped as unhealthy, unhappy, lazy, unat-

tractive, and slow, and they are perceived to have poor eating habits, to lack physical fitness,

and to lack self-control or willpower (e.g., Brochu & Esses, 2011). At three years of age, children

describe their “chubby”peers as mean, stupid, lazy, and ugly (Cramer & Steinwert, 1998), and

5th and 6th grade students like “obese”children less than any other stigmatized group (Latner &

Stunkard, 2003). As potential marriage partners, higher body-weight people are deemed less

desirable than embezzlers, cocaine users, and shoplifters (Venes, Krupka, & Gerard, 1982).

Physicians report that “obese”patients are awkward, unattractive, ugly, and noncompliant

(Foster et al., 2003) and display less warmth in their interaction with higher body-weight

patients (Gudzune, Beach, Roter, & Cooper, 2013). Sadly, higher body-weight people cannot

always rely on their family members or close friends for support in the face of such negativity,

because such close relationships are often a major source of weight stigmatization in people’s

lives (Puhl & Brownell, 2006).

In an age where blatant bias or discrimination is becoming less and less acceptable, weight bias

remains one of the last socially acceptable forms of discrimination (Puhl & Brownell, 2001).

Higher body-weight people face discrimination in employment, health care, education, media,

and interpersonal relationships (Puhl & Heuer, 2009). Higher body-weight job candidates are eval-

uated less favorably than lower body-weight job candidates who are unqualified for the position

(Sartore & Cunningham, 2007), and such discrimination continues throughout hiring, promotion,

earning, disciplinary decisions, and f iring (Roehling, 1999; Roehling, Pichler, & Bruce, 2013).

Higher body-weight people are also underrepresented in college and are less likely to receive

post-interview offers of admission to psychology graduate programs, despite high standardized test

scores, strong recommendation letters, and aspirations to attend college (Burmeister, Kiefner,

A Well-being Solution to the “Obesity Problem”683

Carels, & Musher-Eizenman, 2013). It is no surprise, then, that they earn approximately 90 cents

for every dollar earned by their lower body-weight counterparts (Baum & Ford, 2004).

Thus, the negative stereotyping, prejudice, and discrimination experienced by higher body-

weight people in America permeate their daily lives. And evidence suggests that the weight-loss

solution to the “obesity problem”serves to perpetuate this discrimination. Of course, weight

stigma and discrimination existed long before the recent upsurge in “anti-obesity”actions

carried out as part of the weight-loss solution. Yet stigmatizing comments and discriminating

behavior are commonly framed as concern about the target’s health, a tactic termed concern

trolling (e.g., warn a friend they’re fat day; Connelly, 2015). Size-acceptance activists devote

considerable attention to helping higher body-weight people protect themselves from this

subtle, yet damaging, form of aggression (e.g., Harding & Kirby, 2009). Representative

Mayhall’s proposed bill banning higher body-weight people from restaurants, putatively to help

them avoid temptation to overeat, is one example of this type of discrimination. Thus, the

weight-loss solution to the “obesity problem”works together with existing weight biases to

foster the belief that higher body weight is a personal moral failure.

This likely-unintended cost of the weight-loss solution undermines its goal of helping higher

body-weight people prevent health problems. Cultural weight bias exposes higher body-

weight people to both acute and chronic stressors, taxing their ability to cope and negatively

impacting the cardiovascular system, the neuroendocrine system, and the body’s restorative

processes (Major, Mendes, & Dovidio, 2013). For example, the frequency of weight stigma that

people experience and their awareness of weight stigma in their daily lives each predict

biological markers of stress (cortisol) and cellular aging (F

-isoprostane), suggesting that weight

stigma “may contribute to the development of chronic disease”(Tomiyama et al., 2014, p. 862).

Because financial security, access to healthcare, education, and social support all cause better

health (Wilkinson & Marmot, 2003), discrimination against higher body-weight people in these

domains likely undermines health. Indeed, higher body-weight people who experience weight

stigma are more likely to avoid preventive healthcare screenings and cancel medical appoint-

ments (Amy, Aalborg, Lyons, & Keranen, 2006).

Weight stigma also triggers social identity threat, a concern that one is being judged in light of

negative group stereotypes (Hunger, Major, Blodorn, & Miller, 2015; Steele, Spencer, &

Aronson, 2002). In such situations, higher body-weight people show reduced executive control,

increased blood pressure, cortisol reactivity, and subjective stress (Major, Eliezer, & Rieck, 2012;

Schvey, Puhl, & Brownell, 2011), resulting in increased calorie consumption and feelings of loss

of self-control (Brochu & Dovidio, 2013; Major, Hunger, Bunyan, & Miller, 2014; Schvey et al.,

2011). Indeed, perceived weight stigma explains why higher body-weight people report worse

health outcomes than lower body-weight people (Hunger & Major, 2015; Jackson, Beeken, &

Wardle, 2015), and perceived weight discrimination predicts weight gain over time in nationally

representative samples ( Jackson, Beeken, & Wardle, 2014; Sutin & Terracciano, 2013).

If weight loss was attainable and improved health, then weight loss would be the solution to

this problem of stigma and discrimination. But as the evidence reviewed in the previous section

demonstrates, weight loss efforts tend to be ineffective and harmful. Clearly, a different answer

to the “obesity problem”is needed –a solution that draws on social psychological science.

Proposing a Well-being Solution

Fat people already are ashamed…No further manpower needed on the shame front…My question is,what if they

try and try and try [to lose weight]and still fail?What if they are still fat?What if they are fat forever?What do you

do with them then?Do you really want millions of teenage girls to feel like they’re trapped in unsightly lard prisons

684 A Well-being Solution to the “Obesity Problem”

that are ruining their lives,and on top of that it’s because of their own moral failure,and on top of that they are

ruining America with the terribly expensive diabetes that they don’t even have yet?

–Lindy West (2011)

In the above quote, Lindy West, an award-winning journalist and self-identified fat person,

gives voice to the urgent need for a solution to the “obesity problem”that acknowledges the

toll of weight stigma and the elusiveness of permanent weight loss. Scientists, health practi-

tioners, and activists from diverse backgrounds share Ms West’s concerns and have rallied to

propose alternative, weight-inclusive models of health (see Tylka et al., 2014). Perhaps the best-

known and most influential of these alternatives is the Health at Every Size

™

approach

(HAES

™

; www.haescommunity.org; Bacon, 2008), which emerged from the feminist and

size-acceptance movements in the 1970s and has grown in scope and inf luence in the interven-

ing decades (see Bruno, 2013). HAES

™

promotes a model of health care that honors the prin-

ciples of accepting and respecting all bodies, engaging in compassionate self-care by listening to

the body’s hunger and satiation cues and engaging in joyful activity, and critically challenging

scientific and cultural assumptions about weight and health.

We draw upon this weight-inclusive health movement as well as social psychological theory

and research to propose a well-being solution to the “obesity problem”. This solution uses an

evidence-based approach to improve overall health and to reduce the negative health outcomes

associated with higher body weight. Importantly, a well-being solution defines health as “… a

state of complete physical, mental and social well-being and not merely the absenceof disease or

infirmity”(WHO, 2003, para. 1). Hence, actions that might positively affect physical health but

might negatively affect mental or social health are not supported. Moreover, a well-being solu-

tion evolves as new evidence supports or fails to support its key elements. Currently, some pro-

posed elements are supported directly by weight and health research, and others are suggested

based on research in other literatures.

Promote healthful –and weight-neutral –approaches to eating and exercise

Proponents of the weight-loss solution may fear that any focus away from weight loss might en-

courage malnutrition, extreme weight gain, and inactivity. But a well-being solution includes

attention to nutrition, weight stability, and physical activity and does so in a publically appealing

way –people perceive health-focused public health campaigns to be more motivating, less stig-

matizing, and more promoting of self-efficacy for health behavior change than weight-loss fo-

cused campaigns (Puhl, Luedicke, & Peterson, 2013; Puhl, Peterson, & Luedicke, 2013).

Indeed, a recent review of six randomized and controlled HAES

™

interventions concluded that

weight-inclusive approaches to health can decrease blood pressure and cholesterol, reduce in-

stances of binge eating, increase physical activity, and improve psychological well-being across

a range of dimensions, all without dieting or weight loss (Bacon & Aphramor, 2011). But what

does a weight-inclusive approach to eating and exercise look like?

Encourage eating for health, not weight loss. Evidence suggests that longevity and vitality can be sup-

ported by eating fewer processed foods and more plants, according to a comprehensive review

(Katz & Meller, 2014). None of the popular, specific recommendations for proportioning mac-

ronutrients (e.g., low carb, low fat, “Paleolithic”) have been consistently found superior to the

others, nor has an ideal intake amount been identified, perhaps because ideal food intake should

vary according to the needs of the individual in each situation.

One evidence-based strategy for healthful nutrition intake is intuitive eating, which emphasizes

attention to internal cues of hunger and fullness and an attitude of body acceptance (in contrast

A Well-being Solution to the “Obesity Problem”685

with dieting, which directs attention away from hunger and satiety cues onto external rules;

e.g., Orbach, 2006). A review of 20 interventions found that intuitive eating decreased reports

of disordered eating behaviors like binge eating and dietary restraint, increased physical activity,

body satisfaction, self-esteem, and quality of life and reduced depression and anxiety (Schaefer

& Magnuson, 2014). Furthermore, intuitive eating can lead to better nutrition, such as reduced

fat intake and increased consumption of fruits and vegetables. Many of these improvements in

health lasted longer than the temporary weight loss resulting from traditional diets.

Encourage exercising for health, not weight loss. The evidence is strong that regular physical activity is

effective in preventing chronic diseases and premature death (Warburton, Nicol, & Bredin,

2006). Exercise also appears to have psychological benefits, predicting decreased symptoms of

anxiety and depression (Jayakody, Gunadasa, & Hosker, 2014; Penedo & Dahn, 2005; Scully,

Kremer, Meade, Graham, & Dudgeon, 1998) and improved body image (Hausenblas & Fallon,

2006). However, much of this research concerning psychological health is correlational. The

experimental studies, although promising, have not yet clarified the precise mechanisms

through which exercise benefits psychological well-being (some theorized causal paths include

increasing endorphins and providing a “time out”from stressors; Scully et al., 1998); nor have

they established what type, duration, and frequency of activity is optimal for psychological

health. However, it seems plausible that exercising for immediate and long-term improvements

in well-being may be more rewarding than exercising –while hungry –in the hopes of achiev-

ing a potential, future weight loss. This shift in purpose could potentially result in higher levels

of exercise participation and improved population health. Indeed, there is some experimental

evidence that people who exercise for health, but not weight loss, are more likely to maintain

their new exercise regime than people who exercise for weight loss (Bacon, Stern, Van Loan, &

Keim, 2005). Furthermore, research suggests that framing physical activity as fun and enjoyable

(e.g., “ascenicwalk”) reduces the compensatory hedonic eating that typically follows physical

activity when it is framed as “exercise”(Werle, Wansink, & Payne, 2014).

Reduce weight stigma and discrimination

If weight stigma impairs health, then one action in the well-being solution to the “obesity

problem”must be to reduce the stigma. Doing so is no easy task. The social acceptability,

pervasiveness, and cognitive and affective underpinnings of anti-fat prejudice –such as beliefs

about weight’s controllability, and disgust towards fat –make it particularly intractable

(e.g., Daníelsdóttir, O’Brien, & Ciao, 2010). Still, social psychological science suggests some

promising strategies.

Develop and implement social psychological interventions. A meta-analysis concludes that social psy-

chological interventions that address controllability beliefs, foster empathy, or use social consen-

sus and informational social inf luence can produce a small, positive effect on negative beliefs and

attitudes towards higher body-weight people (Lee, Ata, & Brannick, 2014). Such prejudice-

reduction efforts may be especially worthwhile when aimed at healthcare professionals, because

their biases can constrain higher body-weight people’s access to healthcare (Puhl & Heuer,

2010). Especially promising are psychoeducational interventions that emphasize the uncontrol-

lable aspects of body weight, which have been shown to reduce implicit and explicit anti-fat

prejudice among healthcare students (O’Brien, Puhl, Latner, Mir, & Hunter, 2010).

Promote non-stigmatizing media portrayals of higher body-weight people. Higher body-weight people

are rarely seen in the media, and when they are seen, they are stigmatized (Greenberg, Eastin,

Hofschire, Lachlan, & Brownell, 2003; Hilbert & Ried, 2009). One content analysis of online

686 A Well-being Solution to the “Obesity Problem”

news stories about “obesity”observed that72% of news images depict higher body-weight peo-

ple in stigmatizing ways, by focusing on their stomachs, portraying them eating or drinking, or

cutting their heads from the frame (Heuer, McClure, & Puhl, 2011). Reducing stigmatizing

portrayals and introducing positive portrayals could help to reduce weight bias. Non-

stigmatizing media portrayals of higher body-weight people improve weight attitudes and re-

duce support for discriminatory weight-based medical policy (Brochu, Pearl, Puhl, & Brownell,

2014; Pearl, Puhl, & Brownell, 2012).

Include weight as a protected category in federal legislation. Inclusion of weight as a protected category

has potential not only to reduce systematic weight-based discrimination and establish nondis-

criminatory social norms but also to reduce weight-based health disparities and improve the ef-

fectiveness of public health efforts. Civil rights legislation in the 1950s and 1960s is at least

partially credited with increasing awareness of racism, reducing tolerance for overt discrimina-

tion, improving racial attitudes, and spawning interest in intergroup relations research (Bobo,

2001; Dovidio, Newheiser, & Leyens, 2011). Furthermore, in the 12months after the legaliza-

tion of same-sex marriage in Massachusetts, sexual minority men had fewer medical care visits,

mental healthcare visits, and mental healthcare costs compared to the 12 months before the law

change (Hatzenbuehler et al., 2012). However, there is currently no federal legislation that pro-

tects people from discrimination based on their body weight (Pomeranz & Puhl, 2013). Among

states, only Michigan prohibits weight discrimination, and among cities, only six (Washington,

DC; San Francisco, CA; Santa Cruz, CA; Binghamton, NY; Urbana, IL; and Madison, WI)

include weight and/or physical characteristics as protected categories in their human rights

law or municipal code (National Association to Advance Fat Acceptance, n.d.). It is encourag-

ing, however, that public opinion polls demonstrate overwhelming support for legislation that

prohibits weight discrimination, particularly in employment decisions (Puhl & Heuer, 2010;

Puhl, Heuer, & Sarda, 2011; Suh, Puhl, Liu, & Fleming Milici, 2014).

Promote strategies for coping with weight stigma

Stigma is highly stressful (Miller & Major, 2000), and stress damages health. Social psychological

science has identified numerous strategies that can reduce the pernicious effects of the stress of

stigma. Not only could these strategies support higher body-weight people’s health, they could

also benefit lower body-weight people, whose well-being is compromised by fear of fat and

body dissatisfaction.

Theory-driven psychological interventions. Positive psychology interventions are treatment methods

or intentional activities that cultivate positive feelings, behaviors, or cognitions. A review sug-

gests they can enhance well-being and reduce depression symptoms (Sin & Lyubomirsky,

2009). Mindfulness interventions, which can be effectively carried out in therapy, groups, or in-

dividually with workbooks and computer programs (Cavanagh, Strauss, Forder, & Jones, 2014),

teach people to intentionally focus their attention, in an accepting and non-judgmental way, on

the emotions, thoughts, and sensations of the present moment. Mindfulness increases subjective

well-being, reduces psychological symptoms and emotional reactivity, and improves behavioral

regulation (Keng, Smoski, & Robins, 2011). A review of 14 interventions showed that mind-

fulness decreases binge eating and emotional eating among populations engaging in these be-

haviors (Katterman, Kleinman, Hood, Nackers, & Corsica, 2014).

A related intervention fosters self-compassion, which entails treating the self with kindness

during emotional setbacks, recognizing the shared humanity of one’s f laws and negative

experiences, and adopting a mindful, non-judgmental perspective towards the self (Neff, 2011).

A Well-being Solution to the “Obesity Problem”687

Self-compassion reduces guilt after overeating among chronic dieters (Adams & Leary, 2007) and

buffers young women against body shaming from family (Daye, Webb, & Jafari, 2014), benefits

that may explain why self-compassion is already a mainstay of the size-acceptance community

(e.g., Baker, 2015). Thus, self-compassion may be a potential antidote to the negative self-

evaluations that higher body-weight individuals often experience as a result of weight stigma

(i.e., Crocker, Cornwell, & Major, 1993; Puhl, Moss-Racusin, & Schwartz, 2007).

Finally, self-affirmation is a guided-writing task in which individuals contemplate a cherished

personal value, such as relationships, creativity, or education (e.g., Sherman & Cohen, 2006).

Such contemplation affirms people’s sense of personal worth and self-integrity and allows them

to more effortlessly cope with both mundane stressors and experiences of discrimination. These

benefits can persist for months and even years after the initial intervention, because immediate

changes in self-integrity positively inf luence behavior and experiences over time, which further

reinforce self-worth. Thus, self-affirmation may be an effective tool to buffer higher body-

weight people against the stress of weight stigma.

Changing attributions. Higher body-weight people may be able to improve their well-being by

(accurately) attributing their weight status to factors that are primarily out of their control, such

as genes. Similarly, higher body-weight people may benefit from learning to attribute their neg-

ative experiences to the offending party’s discrimination and prejudice, rather than their own

personal and moral shortcomings. Higher body-weight people typically attribute negative ex-

perience to their weight, and most importantly, they do not blame an offending party for his

or her transgression (Crocker et al., 1993). As a consequence of this attribution style, higher

body-weight people experience heightened negative mood, depression, and anxiety. In con-

trast, members of stigmatized groups who attribute their negative experiences to discrimination

and prejudice are buffered from many of the negative psychological consequences of discrimi-

nation (Crocker & Major, 1989). Thus, higher body-weight people who learn to embrace the

size-acceptance mantra “my body is fine, it’s the world that is messed up”may also come to

benefit from these self-protective aspects of stigma.

Identifying with the “stigmatized majority”.Because most higher body-weight people do not want

to identify with “fat people”and have internalized the premises of the weight-loss solution,

higher body-weight people do not currently enjoy the stigma-buffering effects of group mem-

bership (Crocker & Major, 1989; Wang, Brownell, & Wadden, 2004). Thus, another strategy

for coping with weight stigma is to build social networks with other in-group members and

allies from the outgroup. The online size-acceptance community is doing just that in blogs

(see The Militant Baker, militantbaker.com; Dances with Fat, danceswithfat.wordpress.com;

and The Body is Not an Apology, thebodyisnotanapology.com). Research is needed to

examine the degree to which participation in the size-acceptance community supports higher

body-weight people’s well-being by encouraging them to reject the premise that thinness is a

prerequisite for beauty or self-acceptance and reduce the importance of body shape and size

for self-worth. The size-acceptance community also may help people to reaffirm their worth,

for example, by reappropriating the term “fat”(e.g., Galinsky et al., 2013; Wann, 1998) and cel-

ebrating the positive aspects of higher body weight, like softness and strength. By encouraging

social activism and confronting prejudice in daily life, these communities may increase feelings

of empowerment and self-confidence.

One aspect of group identification that is particularly applicable to higher body-weight peo-

ple is that of satisfaction –one’s positive attitudes about the group and one’s membership in it

(Leach et al., 2008). This type of weight satisfaction confers numerous benefits, including pos-

itive health behaviors (e.g., less likely to diet and more physically active) and physical health

688 A Well-being Solution to the “Obesity Problem”

outcomes (e.g., lower rates of hypertension, diabetes, and hypercholesterolemia), regardless of

body weight (Blake et al., 2013). Preliminary research suggests that, as a component of group

identity, weight satisfaction buffers the negative consequences of discrimination and increases

perceptions of injustice (Brochu & Jones, 2014).

Conclusion

People are tired of diets,tired of feeling like failures,and tired of being scared of food.They are excited to ﬁnd a par-

adigm that respects the diversity of human bodies and starts from the very basic premise that they can trust themselves,

a paradigm that respects pleasure rather than denial.

–Linda Bacon (n. d.)

Nutrition professor and HAES

™

pioneer Linda Bacon, quoted above, describes an approach

towards weight and health that has, thus far, been uncommon in North America. As population

weights have risen, and the association between higher body weight and health problems has

been identified, researchers, health practitioners, and individuals have been striving to solve this

“obesity problem”. The approach so far has been to pursue weight loss. But this approach has

generally failed to produce lasting weight loss or health improvements and appears to contribute

to weight gain, weight cycling, weight bias, and body image dissatisfaction and preoccupation –

ultimately undermining health and well-being. These costs are especially lamentable given that

research has not convincingly shown that higher body weight is the key cause of its associated

health problems.

We conclude that it is time to abandon the weight-loss solution. It is time for researchers,

health practitioners, and individuals to stop trying to find the “right”diet, and instead focus

on supporting health, broadly defined, by encouraging eating and exercising for well-being

rather than weight loss, by reducing weight bias and stigma, and by protecting higher body-

weight people from the damaging effects of discrimination.

Acknowledgements

This work was completed with the support of research grants awarded to Drs Logel and Stinson

by the Social Sciences and Humanities Research Council of Canada (SSHRC). We thank our

research assistants, Steven Hallman and Christopher Lok, for their help.

Short Biographies

Christine Logel’s research seeks to understand and address social-psychological barriers to

health, well-being, and educational success. She has authored or coauthored papers in Psycholo-

gical Science, Educational Psychologist, Journal of Educational Psychology, Journal or Personality and

Social Psychology, Journal of Experimental Psychology, and others. She is currently an assistant pro-

fessor in the Department of Social Development Studies at Renison University College, affili-

ated with the University of Waterloo in Ontario, Canada. She holds a BA in Psychology and

PhD in Social Psychology from the University of Waterloo and previously held postdoctoral

fellowships at the University of Colorado Boulder, Stanford University, and the University of

Waterloo. Her research is funded by SSHRC, HEQCO, and the University of Waterloo’s

Centre for Teaching Excellence.

Danu Anthony Stinson’s research seeks to identify the consequences of different regulatory

strategies for people’s psychological, social, and physical well-being. Her recent publications ex-

amine the role of self-esteem and social relationships in health and well-being. Dr Stinson’s

A Well-being Solution to the “Obesity Problem”689

SSHRC-funded work is published in Journal of Personality and Social Psychology, Psychological Sci-

ence, Social Psychology and Personality Science, Personal Relationships,andSelf and Identity.DrStinson

is an associate professor in the Psychology Department at the University of Victoria. She did her

undergraduate degree at the University of British Columbia and her PhD in Social Psychology

at the University of Waterloo, both in Canada, and a postdoctoral fellowship at State University

of New York, Buffalo.

Paula M. Brochu’s research examines the processes underlying the expression of prejudice, as

well as the consequences of stigma on human functioning. With obesity levels high and weight

bias rampant, she finds weight bias to be an informative domain to test, extend, and formulate

psychological theories of prejudice and stigma. Her research has been published in Social Psycho-

logical and Personality Science, Health Psychology, Personality and Social Psychology Bulletin, Journal of

Applied Social Psychology,andGroup Processes and Intergroup Relations, among others. Dr Brochu

earned a BA in Psychology at the University of Saskatchewan and a PhD in Social Psychology

at the University of Western Ontario, both in Canada. She completed a postdoctoral fellowship

at Yale University, before accepting a position as an assistant professor at Southeastern Nova

University in Florida.

Note

*Correspondence: Department of Social Development Studies, Renison University College, University of Waterloo,

Waterloo, Ontario, Canada N2L 3G4. Email: clogel@uwaterloo.ca

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It’s interpersonal: Internalized weight bias and suicidality are associated indirectly via perceived burdensomeness and thwarted belongingness.

Article

Oct 2020

Let's Talk about Sex: Females with Obesity Dissertation Manuscript

Thesis

Apr 2020

Jason Jones

Couples losing kinship: A systematic review of weight stigma in romantic relationships

Article

Aug 2022

Romantic relationship quality is a robust predictor of health and well‐being. With increasing awareness of the pervasiveness and harm of weight stigma, it is important to understand the role of weight stigma within romantic relationships. This systematic review sought to synthesize the findings of research examining the association between weight stigma and relationship functioning. Following PRISMA guidelines, 32 relevant articles were identified. Only nine assessed or manipulated weight stigma directly; most measured body mass index (BMI) and examined associations with relationship outcomes. Although, the association between BMI and relationship functioning was inconsistent across studies, weight stigma, most notably in the form of weight criticism between partners, was consistently associated with poorer relationship functioning, including lower relationship satisfaction, sexual intimacy, relationship stability, and constructive communication during conflict. The existing literature is limited by convenience samples of primarily White, heterosexual adults in individualistic countries. Several studies reinforced and expressed weight stigmatizing beliefs due to reliance on weight‐normative perspectives on health to interpret findings. Future research is encouraged to examine the association between weight stigma and relationship functioning and underlying mechanisms using dyadic, longitudinal designs that incorporate weight‐inclusive approaches. The development of couples‐based interventions to address weight stigma in relationships is sorely needed.

Does Body Mass Index Confer Risk for Future Suicidal Thoughts and Behaviors? A Meta-analysis of Longitudinal Studies

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Jun 2022

Purpose of Review Body mass index (BMI) outside of the “normal” range is commonly cited as a predictor of adverse health outcomes and has been identified as a potential risk factor for suicidal thoughts and behaviors (STBs). This meta-analysis provides a descriptive and quantitative summary of the literature evaluating the longitudinal relationship between BMI/weight status and STBs. Recent Findings The longitudinal literature examining the relationship between BMI/weight status and STBs is small and methodologically constrained. Within the existing literature, BMI and weight status are generally weak or nonsignificant risk factors for STBs. It is possible that body weight has a complex relationship with physical and mental health, including STBs, which may not be possible to accurately capture with a singular metric such as BMI. Summary BMI and weight status do not appear to robustly predict STBs, at least within the methodological constraints of the existing literature.

Exploring the association between parental anti-fat attitudes and restrictive feeding practices in a British and Irish sample

Article

Oct 2021
APPETITE

Parental restriction of food intake has been associated with heightened eating disorder psychopathology in some longitudinal research. Yet, relatively little is known about the determinants of restrictive feeding practices. This cross-sectional study explored the association between parents' anti-fat attitudes and their use of restrictive feeding practices in a mixed British (41.10% England, 39.90% Scotland, 4.20% Other) and Irish (14.80%) sample. Parents and caregivers (N = 472; 94.10% female; 70.90% university level education) of children between the ages of 4-8 (48.20% female; 91.10% rated as "normal weight" by their parents) completed self-report questionnaires assessing their anti-fat attitudes (dislike, fear, and blame subscales), use of restrictive feeding practices (for weight control, health purposes, and covert restriction), and how influential their child's body-weight and -shape is for their perception of themselves as parents. Overall, our hypothesis that parental anti-fat attitudes would be significantly associated with restrictive feeding practices was supported. Anti-fat attitudes related to disliking higher body-weight people and blaming parents for their child's weight were significant predictors of all forms of restrictive feeding (all ps < .05). However, anti-fat attitudes related to fearing being a higher body-weight were not significant predictors of restrictive feeding for the purposes of health nor for covert restriction (ps > .05). Additionally, our hypothesis that the associations between anti-fat attitudes and restrictive feeding practices would be stronger for parents for whom their child's body-weight and -shape more strongly influenced how they judged themselves as parents was not supported (the interaction term was not significant in two out of three analyses). Future research is needed to investigate these associations across time and in samples of higher body-weight children.

The ups and downs of lifestyle modification: An existential journey among persons with severe obesity

Article

Full-text available

May 2021
SCAND J CARING SCI

Background: Maintaining a healthy living after the end of a lifestyle intervention is a challenge for persons with severe obesity. Measurable outcomes are often emphasised, but there is a need for understanding the process of lifestyle change and the long-term perspectives among persons with severe obesity. Aim and objective: To describe and deepen the understanding of how persons with severe obesity experience making and maintaining lifestyle changes in everyday life three years after lifestyle intervention. Methodology and methods: The study used a hermeneutic phenomenological approach. A purposive sample of seven adults with BMI ≥ 40 was recruited from a lifestyle intervention programme. Data were generated through individual follow-up interviews. The analysis was based on theoretical framework on dwelling and mobility. Ethical approvals were received from the Danish Data Protection Agency and the ethical principles of the Declaration of Helsinki were followed. Results: One overarching theme emerged: ‘The journey of ups and downs’. Three sub-themes were: ‘Living with and tackling the demands of life's hassles’, ‘Deliberating the fight for weight loss’ and ‘Needing a trusted person to feel met as a human being’. Conclusions: Everyday life among persons with severe obesity is experienced as a dynamic process of shifting experiences of dwelling and mobility. Sustained lifestyle changes require ongoing adjustments of action, which healthcare providers can influence in ways that either support or obstruct. Collaboration and a humanised approach across disciplines and sectors are suggested to promote sustained healthy living.

Compassion Focused Therapy to Reduce Body Weight Shame for Individuals with Obesity: A Randomized Controlled Trial

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Feb 2023
BEHAV THER

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Jan 2022

Psychology of Prejudice and Discrimination

Book

May 2022

A primer with purpose: Research implications of the objectification of weight in the workplace

Article

Dec 2021

We offer a primer for researchers who seek to carry out studies that evaluate the lived experience of larger‐bodied workers. We use objectification theory to describe the process by which intraculturally‐determined body size preferences impact how observers think about and react to larger‐bodied colleagues, and how these larger‐bodied colleagues internalize and cope with these judgements. Arguing that exploration of the objectification of larger‐bodied professionals is incomplete without the use of multidisciplinary lenses, we describe mechanisms that reinforce weight stigma, including the role of healthism‐based value systems, intersectionality, and body image. We conclude the primer by outlining areas for new research that highlights burgeoning applied demand for more nuanced, evidence‐based discussions of weight at work. In professional spaces, many workers feel comfortable “objectifying” their colleagues who occupy larger (i.e., “overweight”/”obese”) bodies. This means that workers (a) constantly compare their colleagues’ bodies to a “thin” standard, (b) feel a certain comfort in remarking on their larger‐bodied colleagues’ size, and (c) this judgment feeds into a cycle of self‐consciousness and self‐dislike that many larger‐bodied workers feel about themselves. This objectification process can be doubly harmful to the well‐being of larger‐bodied workers when they, too, occupy a secondary marginalized identity/ies, such as being female or of a minority ethnicity. The motivation for objectification comes from broader Western culture, which views the pursuit of health as a value that all people should pursue. Workers often assume their larger‐bodied colleagues are not pursuing health simply because of their size and can feel punitive toward them as a result. Organizational remedies for this objectification process include educational programming and training to talk about the myriad ways “health” may be realized; more precise information about the complex origin’s of one’s body size; education around how marginalization of larger‐bodied colleagues does not stimulate effective action, but instead harms these colleague’s mental health (and beyond).

Psychological stress in humans and susceptibility to the common cold.

Article

Full-text available

Sep 1991

It is not known whether psychological stress suppresses host resistance to infection. To investigate this issue, we prospectively studied the relation between psychological stress and the frequency of documented clinical colds among subjects intentionally exposed to respiratory viruses. After completing questionnaires assessing degrees of psychological stress, 394 healthy subjects were given nasal drops containing one of five respiratory viruses (rhinovirus type 2, 9, or 14, respiratory syncytial virus, or coronavirus type 229E), and an additional 26 were given saline nasal drops. The subjects were then quarantined and monitored for the development of evidence of infection and symptoms. Clinical colds were defined as clinical symptoms in the presence of an infection verified by the isolation of virus or by an increase in the virus-specific antibody titer. The rates of both respiratory infection (P less than 0.005) and clinical colds (P less than 0.02) increased in a dose-response manner with increases in the degree of psychological stress. Infection rates ranged from approximately 74 percent to approximately 90 percent, according to levels of psychological stress, and the incidence of clinical colds ranged from approximately 27 percent to 47 percent. These effects were not altered when we controlled for age, sex, education, allergic status, weight, the season, the number of subjects housed together, the infectious status of subjects sharing the same housing, and virus-specific antibody status at base line (before challenge). Moreover, the associations observed were similar for all five challenge viruses. Several potential stress-illness mediators, including smoking, alcohol consumption, exercise, diet, quality of sleep, white-cell counts, and total immunoglobulin levels, did not explain the association between stress and illness. Similarly, controls for personality variables (self-esteem, personal control, and introversion-extraversion) failed to alter our findings. Psychological stress was associated in a dose-response manner with an increased risk of acute infectious respiratory illness, and this risk was attributable to increased rates of infection rather than to an increased frequency of symptoms after infection.

Weight Discrimination, Hiring Recommendations, Person–Job Fit, and Attributions: Fitness-Industry Implications

Article

Full-text available

Apr 2007

The purpose of this study was to examine the impact of weight discrimination on perceived attributions, person-job fit, and hiring recommendations. Three experiments were undertaken to investigate these issues with people applying for positions in fitness organizations (i.e., aerobics instructor and personal trainer). In all three studies qualified people who were overweight, relative to their qualified and sometimes unqualified thin counterparts, were perceived to have less desirable attributes (e.g., lazy), were thought to be a poorer fit for the position, and were less likely to receive a hiring recommendation. These relationships were influenced by applicant expertise and applicant sex in some cases. Implications for the fitness industry are discussed.

Psychological stress and susceptibility to the common cold

Chapter

Full-text available

Jan 1997
NEW ENGL J MED

The Stigma of Overweight: Affective Consequences of Attributional Ambiguity

Article

Jan 1993

Attributing negative outcomes to prejudice and discrimination may protect the mood and self-esteem of some stigmatized groups. Thus, the overweight may be low in self-esteem because they blame their weight, but not the attitudes of others, for negative outcomes based on their weight. In an experiment, 27 overweight and 31 normal weight college women received either positive or negative social feedback from a male evaluator. Relative to other groups, overweight women who received negative feedback attributed the feedback to their weight but did not blame the evaluator for his reaction. This attributional pattern resulted in more negative mood for these overweight women in comparison with other groups. Dimensions of stigma that may account for differences in the tendency to attribute negative outcomes to prejudice, and implications of these findings for weight loss programs and psychotherapy for the overweight, are discussed.

Long-Term Persistence of Hormonal Adaptations to Weight Loss

Article

Feb 2012
OBSTET GYNECOL SURV

BMI and all-cause mortality among Japanese older adults: Findings from the Japan Collaborative Cohort Study

Article

Jan 2009

Bias, discrimination, and obesity

Article

Jan 2014

Perceived weight discrimination and changes in weight, waist circumference, and weight status

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Sep 2014

Objective: To examine associations between perceived weight discrimination and changes in weight, waist circumference, and weight status. Methods: Data were from 2944 men and women aged ≥50 years participating in the English Longitudinal Study of Ageing. Experiences of weight discrimination were reported in 2010-2011 and weight and waist circumference were objectively measured in 2008-2009 and 2012-2013. ANCOVAs were used to test associations between perceived weight discrimination and changes in weight and waist circumference. Logistic regression was used to test associations with changes in weight status. All analyses adjusted for baseline BMI, age, sex, and wealth. Results: Perceived weight discrimination was associated with relative increases in weight (+1.66 kg, P < 0.001) and waist circumference (+1.12 cm, P = 0.046). There was also a significant association with odds of becoming obese over the follow-up period (OR = 6.67, 95% CI 1.85-24.04) but odds of remaining obese did not differ according to experiences of weight discrimination (OR = 1.09, 95% CI 0.46-2.59). Conclusions: Our results indicate that rather than encouraging people to lose weight, weight discrimination promotes weight gain and the onset of obesity. Implementing effective interventions to combat weight stigma and discrimination at the population level could reduce the burden of obesity.

Actual causes of death in the United States

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Jan 2004

Ali Mokdad

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Jan 1992

Weight Loss Is Not the Answer: A Well-being Solution to the “Obesity Problem”

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