The Negative and Bidirectional Effects of Weight Stigma on Health

Abstract

This chapter introduces a model describing the mechanisms by which weight stigma can lead to poorer health outcomes among people who are or who perceive themselves to be overweight. It is proposed that enacted weight stigma (discrimination) directly impairs the health of heavier weight individuals by changing the social and material aspects of their lives in ways that are detrimental to health. It is also proposed that perceived weight stigma can lead to social identity threat, which in turn can indirectly impair health by increasing stress and negative emotions, physiological reactivity, calorie intake, and stigma-avoidance behaviors. Finally, it is proposed that weight stigma is bidirectional, in that experiencing weight stigma leads to weight gain or inhibits weight loss through increased eating and other biobehavioral mechanisms, which in turn lead to further stigmatization. Implications for health and recommendations for future research are discussed.

Stress and Obesity

“…Another theoretical perspective is that of Hunger and colleagues (2015), who use the term weight-based social identity threat to capture the psychological experience of holding a socially devalued identity. This type of threat, they theorize, triggers emotional, physiological, and behavioral consequences, many of which cause weight gain (Hunger et al 2015, Major et al 2018.…”

“…In addition to the social self-preservation model (Dickerson & Kemeny 2004) and weightbased social identity threat perspectives (Hunger et al 2015) discussed above, another interesting theoretical aspect of weight stigma is that it need not even be consciously perceived to trigger obesogenic processes (Brewis 2011, Major et al 2018. Through discrimination in employment and education, heavier individuals can be tracked into lower socioeconomic status (SES) positions.…”

The role of psychological attribution in responses to weight stigma

“…5,7 Over time, repeated experiences with weight discrimination, coupled with an awareness of negative stereotypes and the socially devalued nature of people with obesity, can lead some individuals to internalize weight bias (ie, engage in self-devaluation and chronically fear being stigmatized for their weight). [8][9][10] Being the target of weight discrimination is associated with a range of negative consequences for psychological and physical health. 9,11,12 Perceived weight discrimination is correlated with higher risk of low self-esteem, poor body image and depression, 11 as well as worse self-reported health, 13 poorer diabetes management, 14 increased risk of dementia 15,16 and increased mortality risk.…”

“…[8][9][10] Being the target of weight discrimination is associated with a range of negative consequences for psychological and physical health. 9,11,12 Perceived weight discrimination is correlated with higher risk of low self-esteem, poor body image and depression, 11 as well as worse self-reported health, 13 poorer diabetes management, 14 increased risk of dementia 15,16 and increased mortality risk. 17 Moreover, perceived weight discrimination is associated with increased risk for the development and maintenance of obesity.…”

“…17,20 Weight discrimination is believed to contribute to poor health and obesity maintenance via cognitive (eg, impaired self-regulation and executive functioning), emotional (eg, psychological distress), physiological (eg, secretion of cortisol as triggered by activation of the hypothalamic-pituitaryadrenal axis) and behavioural (eg, increased eating) pathways that are activated in response to the psychological stress of being stigmatized. 9,13,[21][22][23][24][25][26][27][28] Compared with the long-term health consequences of weight stigma, 9,11,12 less is known about early-stage psychological mechanisms that underlie people's reactions to weight discrimination. The current study investigated whether people's responses to weight stigma are linked with biased patterns of psychological attribution.…”