Fat shaming, in which overweight individuals are stereotyped as unattractive, lazy, incompetent, and to blame for their condition, may take it’s toll on health. It could actually increase the risk of cardiovascular and metabolic disease, according to a new study led by a research team at the University of Pennsylvania.

Team leader Rebecca Pearl, PhD, an assistant professor of Psychology in Psychiatry and colleagues from Penn’s Center for Weight and Eating Disorders, said:

“There is a common misconception that stigma might help motivate individuals with obesity to lose weight and improve their health. We are finding it has quite the opposite effect.

When people feel shamed because of their weight, they are more likely to avoid exercise and consume more calories to cope with this stress. In this study, we identified a significant relationship between the internalization of weight bias and having a diagnosis of metabolic syndrome, which is a marker of poor health."

Weight Bias Internalization

The research involved 159 adults aged between 21 and 65 who had a body mass index (BMI) of 33 or higher, which is classed as obese. Most of the participants were African American women, a group typically underrepresented in weight bias research.

The women completed completed the Patient Health Questionnaire, which measured depression and weight bias internalization, before any intervention was given. Weight bias internalization occurs when people apply negative weight stereotypes to themselves, such as believing they are lazy or unattractive, and devalue themselves because of their weight.

Participants also underwent medical examinations, to assess whether they had a diagnosis of metabolic syndrome, a cluster of risk factors, such as high triglycerides, blood pressure, and waist circumference, which are associated with heart disease, type 2 diabetes, and other obesity-related health problems.

51 subjects (32.1 percent) met the criteria for metabolic syndrome, the team reports.

Metabolic Syndrome Risk

Compared to participants with lower levels of weight bias internalization, those with high levels were found to be at a three times higher risk of metabolic syndrome.

In addition, those with high weight bias internalization were six times more likely to have high triglyceride levels. High triglyceride levels can lead to atherosclerosis, a buildup of fatty substances in the wall of the arteries that can raise the risk of heart attack and stroke.

Co-author Tom Wadden, PhD, a professor of Psychology in Psychiatry and director of Penn’s Center for Weight and Eating Disorders, commented:

“Health care providers, the media, and the general public should be aware that blaming and shaming patients with obesity is not an effective tool for promoting weight loss, and it may in fact contribute to poor health if patients internalize these prejudicial messages.

Providers can play a critical role in decreasing this internalization by treating patients with respect, discussing weight with sensitivity and without judgment, and giving support and encouragement to patients who struggle with weight management – behaviors everyone should display when interacting with people with obesity."

Unhealthy Behavior

Although the study does not identify why participants with high internalized weight bias were more likely to have metabolic syndrome, the authors point to previous research that suggests such bias is likely to prompt unhealthful behaviors.

“Disparagement of others due to their weight and messages that perpetuate blame and shame, if internalized, can cause harm to the physical and mental health of individuals with obesity,” added Pearl. “As health care practitioners, we can help challenge negative, internalized stereotypes by educating patients about the complex biological and environmental factors that contribute to obesity, while providing concrete strategies to help patients manage their weight and improve their health."

The findings could help overturn the popular belief that body shaming motivates improvements in the lifestyle of people who are overweight or obese.

Rebecca L. Pearl, Thomas A. Wadden, Christina M. Hopkins, Jena A. Shaw, Matthew R. Hayes, Zayna M. Bakizada, Nasreen Alfaris, Ariana M. Chao, Emilie Pinkasavage, Robert I. Berkowitz, Naji Alamuddin Association between weight bias internalization and metabolic syndrome among treatment-seeking individuals with obesity Obesity, 2017; 25 (2): 317 DOI: 10.1002/oby.21716

Image: Anne-Katrin Purkiss, Wellcome Images

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