Stigma Of Obesity Not Easy To Shed

Obese people often feel discriminated against and misunderstood by both the public and their physicians, according to a new study from Australia.

"Being overweight has consequences," says Paul Komesaroff, MD, PhD, a professor of medicine at Monash University in Melbourne. Komesaroff led the study and presented his findings this week at ENDO 08, the 90th annual meeting of The Endocrine Society in San Francisco.

His team interviewed 76 people about their life experiences associated with their excess weight . "They feel they are regarded as lazy, self-indulgent, and blamed for the fact they are overweight, despite the fact they may have to struggle to overcome it," he tells WebMD.

Stigma of Obesity

The researchers recruited obese people using newspaper advertisements and interviewed them one-on-one for an hour or longer. They talked to 76 men and women, aged 16 to 72, with an average BMI (body mass index) of 34. (A person who weighs 220 and is 5-foot-7 has a BMI of 34.5; a BMI of 30 and above is considered obese.)

Among the findings:

• Being obese carries a social stigma. Nearly all of the participants, 72 of 76, reported they had experienced humiliation and discrimination related to their weight, whether in childhood or later. "In many cases, people who are overweight feel strongly stigmatized and experience discrimination at various levels," Komesaroff says. It may begin during school years - when overweight persons may not be chosen readily for school teams - and extend into adult life. "It may be difficult to establish personal relationships," he says. "It may be difficult for them to obtain employment."
  
• Beingobese affects their personal identity. "The fact they are overweight has become a key part of how they see themselves, part of their personal identity, something they have struggled against all their lives," Komesaroff says. Nearly half of the study participants report poor mental and emotional health, including depression, related to their weight.


• Obese persons say they feel misunderstood by health care providers. "People who are overweight have heard the message," Komesaroff says. "They know they are overweight. They've tried many diets and they have not worked." More than 25% of the participants report they have gone to great (and unhealthy) lengths to lose weight by trying to go long periods without food, essentially "starving" themselves. The key, he says, is for physicians to hone in on cultural differences about weight issues and to dig deeper to find the underlying reason why an individual is having trouble losing weight. Overweight people feel "they are being judged and victimized for a condition that they feel is out of their control," he says. "And they need sympathy, support, and help tailored to their specific circumstances."

In the course of the interviews, Komesaroff says he heard some stories that disturbed him. "In a train, one person reported she overheard two people talking within earshot of her, saying, 'That is the trouble with obese people, they take up so much space.'"

Another participant reported that in the supermarket, someone said to her, "Get out of my way, Fatso."

Stigma of Being Obese Increasing

The study findings "add to the accumulation of research documenting stigma and bias toward overweight and obese persons," says Rebecca Puhl, PhD, a Yale University research scientist who co-authored a study published earlier this year in the journal Obesity finding that discrimination against overweight persons is prevalent and increasing.

With colleagues from Yale University, Puhl evaluated data from two national surveys, looking for experiences of "weight-height" discrimination in variety of settings and comparing them to discrimination based on race, age, and gender. From the first survey in 1995-1996 to the second in 2004-2006, the prevalence of U.S. adults reporting such "weight-height" discrimination rose from 7% to 12%, affecting all groups but the elderly. The researchers don't think the increase is explained by changes in obesity rates. The rates are close to the reported rates of race and age discrimination, they say.

"We need to challenge weight-based stereotypes and recognize the difficulties that obese persons face and act with compassion instead of with contempt," Puhl tells WebMD.

Peggy Howell, spokeswoman for The National Association to Advance Fat Acceptance, says, "Discrimination against people of size is increasing at an alarming rate and discrimination is wrong."

By Kathleen Doheny
Reviewed by Louise Chang
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