COMMENTARY

Stigma as a (Dis)incentive for Weight Loss and Healthy Lifestyle Behaviors

Rebecca M. Puhl, PhD

Disclosures

May 07, 2014

In This Article

The Truth About Stigmatization

With respect to weight-related health behaviors, research consistently demonstrates that children and adults who experience weight stigmatization are more likely to engage in unhealthy behaviors that interfere with weight loss efforts. Specifically, individuals who are made to feel ashamed, blamed, teased, stigmatized, or treated unfairly because of their weight are more likely to engage in maladaptive eating patterns, binge-eating behaviors, avoidance of physical activity, and increased calorie consumption.[19,20,21,22,23,24] Experimental research indicates that exposure to weight stigmatization significantly increases calories consumed[25] and unhealthy food choices,[26] which parallels survey research showing that as many as 79% of adults report that they turn to food as a way of coping with the distress of being stigmatized about their weight.[27]

Research has also begun to examine the implications of weight stigmatization on physiologic health indices, which exacerbate mean arterial pressure[28] and nondiabetic glycemic control.[29] Most recently, experimental evidence demonstrates that exposure to weight stigmatization significantly increases cortisol reactivity.[30]

Given that other forms of discrimination have been shown to induce similar physiologic outcomes,[31,32] it is not necessarily surprising to observe this with obesity stigma. Of importance, however, the increased health risks associated with these physiologic indices, such as hypertension, dyslipidemia, and insulin resistance, are already of heightened concern with obesity and indicate that weight discrimination can exacerbate the harmful effects of excess body weight.

With respect to weight-loss efforts, recent evidence demonstrates that among individuals in behavioral weight-loss treatment, weight bias is associated with lower energy expenditure, higher program attrition, and a smaller percentage of weight loss.[33,34] Other work indicates that perceived negative judgments about weight from health providers negatively influences weight loss among patients with excess weight and obesity.[35] Furthermore, recent longitudinal research with a nationally representative sample of over 6000 adults found that individuals who experienced weight discrimination were 2.5 times more likely to become obese than those who had not experienced weight-specific discrimination, even after demographic characteristics were controlled for and body mass index was included as a covariate.[36] Other forms of discrimination were unrelated to risk for obesity.

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