The stigmatization of obesity — the idea that obese people have only themselves to blame for being fat — is not just “the nation’s last, accepted form of prejudice,” it’s also a major barrier to getting the obesity epidemic under control, writes science reporter Sharon Begley, now with Reuters, in a provocative article published last Friday.
“As long as we have this belief that obese people are lazy and lacking in discipline, it will be hard to get support for policies that change the environment, which are likely to have a much larger impact than trying to change individuals,” psychologist Rebecca Puhl of the Rudd Center for Food Policy & Obesity at Yale University in New Haven, Connecticut, told Begley.
Blaming individuals also makes it less likely that people who are obese will seek treatment for their obesity and related illnesses. “Targets of stigma often fall into depression or withdraw socially,” writes Begley. “Both make overeating, binge eating and a sedentary existence more likely, studies show.”
Studies have also shown that health-care professionals hold more negative attitudes toward their patients who are obese and, as a result, often spend less time with them during office visits and tend to not counsel them about a healthy lifestyle. These negative attitudes may keep obese individuals from seeking treatment for diabetes, research has found.
Delaying care to avoid lectures
“Patients are afraid of hearing, ‘you’re fat,’ or ‘just lose weight,’ as if it were that easy,” Elizabeth Teixeira, a nurse practitioner at Drexel University who specializes in diabetes, told Begley. “I’ve had patients tell me they delay seeking care, even having their blood pressure or glucose checked, because they don’t want to be lectured.”
A Reuters/Ipsos poll taken earlier this month found that 61 percent of Americans believe that the main cause of the obesity epidemic is “personal choices about eating and exercising,” and 49 percent believed that it was OK for insurers to charge obese people more for health insurance, Begley reports. Only 19 percent of the poll’s respondents pointed to food manufacturers and the fast-food industry as the key source of the epidemic.
Yet, as Begley also points out, the more we blame individuals for their weight problems, the more our girths expand. Some 36 percent of Americans (73 million adults and 12 million children) are currently obese in the United States. As a government report noted last week, that percentage is projected to rise to a stunning 42 percent by 2030.
Current efforts are failing
Obviously, our current anti-obesity efforts, which focus on changing the habits of individuals rather than of society, are not working — something the public health community, if not the public itself, has come to realize. Writes Begley:
The belief that obesity reflects personal decisions implies that the solution, too, should be personal: Eat less, move more. But as the Institute of Medicine argued [last] week, the most effective way to combat obesity is to change the environment.
For average American adults, willpower is no match for “an environment in which we are constantly bombarded by food and food cues,” said David Kessler, former head of the Food and Drug Administration and author of the 2009 book, “The End of Overeating: Taking Control of the Insatiable American Appetite.” “Lecturing people doesn’t work.”
The IOM recommended building sidewalks to make it easier for people to walk, banning sugary drinks from schools and requiring 60 minutes of daily exercise in grades K-12, reducing portion sizes in schools and restaurants, and making low-cal choices widely available and as affordable as super-sized ice cream cones. Most important, it concluded, was changing the “messaging,” including the ubiquitous marketing of calorie-dense food.*
Fat stigma makes those ideas ripe for attack by an industry that says how much to eat and move reflects individual choice. The restaurant- and food-industry-funded Center for Consumer Freedom called the IOM “arrogant and absurd” for suggesting “that Americans are too stupid to make their own food choices.” By proposing to keep unhealthy, calorie-dense food out of school lunch programs, it said, “food nannies” like the IOM are “flatly arguing against consumers having any choice in their snacks and meals.”
Interestingly, research suggests that the stigma against people who are obese is often driven by political ideology. Writes Begley:
Psychologist Chris Crandall of the University of Kansas has found that young adults who stigmatize obesity tend to be more ideologically conservative, favoring traditional sex roles and capital punishment, his studies found.
“Particularly in America, self-determination and individual choice is a fundamental value,” he said. “We blame people for everything that happens to them — being poor, being obese. It’s the ‘just world’ idea that people get what they deserve.”
The stigma is less pronounced in countries such as India, Mexico and Turkey, whose cultures assign more collective responsibility for personal outcomes, Crandall found. His studies, going back to the 1990s, surveyed hundreds of people worldwide about how closely they associate obesity with adjectives such as lazy and stupid.
Americans also stand out in their conviction that hard work and determination lead to success, while failure is due to lack of effort.
“Being thin has come to symbolize such important values as being disciplined and in control,” said Yale’s Puhl. The converse: If someone is not thin, he must be lacking in those virtues.
* As science reporter Gary Taubes and others have noted, reducing calories alone may not be enough. Research suggests that not all calories are alike when it comes to creating new fat cells and that calories from sugars and other carbohydrates may be the most important factor behind the obesity epidemic.