Weight Stigma and Ethical Care for Obesity

Obesity is stigmatized and many heath care providers, like the general public, hold explicit and implicit negative attitudes about higher weight individuals. We will discuss ways that weight stigma may affect the quality of care for people with obesity and contribute to size disparities in health and health care outcomes, as well as some strategies to improve interpersonal care for higher weight people.

Evidence has been accumulating for some time indicating that perceived racial discrimination is a major contributor to the health disparities that exist between Blacks and Whites in the US. The current climate in our country suggests there is reason to expect this relation may become even more of a health issue in the future. My research has examined this relation and factors that mediate and moderate it. This research includes both experimental (laboratory) work in which discrimination has been manipulated, and survey studies. Most of the latter have come from the Family and Community Health Study (FACHS), a 20-year multi-wave study of 900 African American families with a focus on environmental, economic and especially interpersonal (i.e., perceived discrimination) stressors and their effects on physical health and health behavior. Current and future directions of the FACHS project will be discussed.

America’s war on the “obesity epidemic” is intensifying stigmatization of people with heavy and obese bodies. Many lay individuals and health professionals believe that “a little stigma is a good thing’ – i.e. that stigmatizing carrying excess weight motivates people to engage in healthier eating habits and promotes weight loss. I will review a growing body of research showing that this strategy is not only ineffective, but is backfiring. Experiencing or anticipating being stigmatized based on one’s weight increases physiological stress, undermines self-regulation, compromises psychological health, and increases motivations to avoid stigma and escape stigma that have negative health implications. Furthermore, experiencing weight-based stigma leads to weight gain and poorer physical health outcomes, controlling for actual body weight.

Persistent racial disparities in health represent a significant social and moral dilemma, as well as a serious public health concern. Racism is a fundamental cause of disease, and is physically embodied through social and psychobiological mechanisms. A social toxin, racism can be experienced environmentally at the area-level, as well as interpersonally through inter-personal experiences of racism, which impact biological processes underlying multiple disease pathways including via accelerated aging at the cellular level.

Exposure to racial and ethnic discrimination has been associated with negative outcomes including mental health symptoms, problematic health behavior and heart disease risk factors among other health impairments. How could discrimination have effects on such a wide range of outcomes? One possibility is that discrimination operates by changing social cognition – the structures and processes that influence the way we engage with the social world. Discrimination at all levels (i.e., cultural, institutional, and interpersonal) may have effects on building blocks of social cognition including schemas and on the underlying cognitive control processes that support social cognition. Through effects on social cognition, discrimination can shape self-regulation, exacerbate stress reactivity, and undermine the relationships vital for health promotion. In this talk, I will describe a model of the social cognitive pathways linking discrimination to health, and present evidence from our lab and others in support of this model.

In this talk, Rodolfo Mendoza-Denton offers a perspective in which within-group variability—namely, the individual differences that differentiate group members from one another— is as important a component to understanding the relationship between stigma and health outcomes as is between-group variability, or comparisons of relevant health outcomes among population groups. Drawing from his lab’s work on status-based rejection sensitivity, he offers a framework through which to understand such individual differences in relation to culture and cultural experience. The broad goal is to reconcile individual variability with the fact that group level differences exist in the frequency, type, and severity of discrimination that groups are exposed to, and the cultural environments they navigate.

Interpersonal discrimination contributes to health inequalities for disadvantaged groups across numerous stigmatized identities. In this talk, I will discuss a theoretical framework for understanding the effects of discrimination on health and will present some recent empirical findings in support of our model. I will then discuss aspirations for the field including innovations in study design that incorporate multiple levels of discrimination, consider multiple identities, and measure a wider range of objective physical health outcomes.