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Obese women experience much more negative social stigma than previously thought, study finds

REUTERS/Rick Wilking
People who report weight-related stigmatization are more likely, for example, to become binge eaters and to avoid exercise and other healthful habits.

Women who are obese experience many more incidents of stigmatization because of their weight — an average of three incidents a day — than previous research has reported, according to a study published in the Feb. issue of the Journal of Health Psychology.

Past research has tended to suggest that people who are overweight or obese experience negative weight-related stigmatization only a few times during their entire lives.

Those studies relied, however, on asking people to recall any past experiences with weight-related stigmatization. This new study had women keep contemporaneous diaries. 

As background information in the current study explains, the stigmatization of overweight people has increased significantly over the past two decades. These negative attitudes have disproportionally been aimed at women, even though the rates of obesity are similar for both men and women.

Weight-related stigmatization can take many forms, such as interpersonal (being ridiculed or shamed for your size), institutional (not getting a job or promotion because of your size), or physical barriers (not being able to find clothes that fit or chairs in theaters or restaurants that can accommodate your body). Such stigmatization has been linked to low self-esteem and increased rates of depression, but it can also have physical and health consequences. People who report weight-related stigmatization are more likely, for example, to become binge eaters and to avoid exercise and other healthful habits.

For these reasons, say the current study’s authors, it’s important to get a better understanding of both the frequency and nature of this particular social stigma.

Study details

The study was led by Jason Seacat, an associate professor of psychology at Western New England University who researches social stigma. He and his colleagues recruited 50 overweight and obese women from weight-related websites. Their average age was 38, and their average body mass index was 42.5. (A BMI of 30 or higher falls under the category of "obese.") More than 40 percent of the participants were married, more than a third had a college education, and almost all (90 percent) were white.

The women were asked to make entries in a diary each night before going to bed for seven straight days. They recorded their daily activities, both within and outside of their home. They also recorded any experiences of weight-related stigmatization. 

A long list of possible stigmatizing experiences was provided, such as “a spouse or partner called you names because of your weight” or “strangers suggested a diet to you” or “you were not able to fit in seats at restaurants, theaters and other public places.” Space was also provided for the women to describe incidents of stigmatization that weren’t on the list, although these entries were not included in the study’s final statistical analysis.

Key findings

The 50 women cited a total of 1,077 stigmatizing experiences during that single week — an average of three a day for each woman. The most common experiences involved “physical barriers” (84%), “nasty comments from others” (74%), “being stared at” (72%) and “others making negative assumptions” (72%). Experiences least frequently reported included “job discrimination” (22%), “comments from doctors” (16%) and “being physically attacked”(12%).

The most frequent sources of the nasty comments, by the way, were spouses, friends and family members.

A further crunching of the data revealed that the higher a woman’s BMI, the more likely she was to report all forms of weight-related stigma. Women who were older or who had lower levels of education also tended to record more stigmatizing experiences.

Healthful behaviors were less common among the women who reported higher numbers of stigmatizing events, a finding that is consistent with other evidence linking weight-related stigmatization to avoidance of exercise and to unhealthful eating habits.

“Healthful activities such as maintaining a diet and exercise regimen are already challenging for most individuals, but when the additional burden of weight stigmatization is added to daily life, these goals may become unattainable,” write Seacat and his co-authors.

Insightful examples

The open-ended entries in the diary offer some insight into what daily life is often like for people who are obese: 

“With friends at a baby shower. Went to McDonald’s first so people wouldn’t look at me eating more than I should.” 

“Teenagers made animal sounds [moo] outside of a store I was in.”

“I was told what a bad mother I am because I can’t set limits as to what my son or his friends eat during sleepovers, because I can’t even control myself.”

“Boyfriend’s mother denied me access to food, also stated that I was so fat because I was lazy.”

Not all the entries were negative, however. Some provided examples of positive experiences — including the experience of being in the study: 

Positive thing today — just moved from Canada to the UK and found out that I fit into a standard size that many stores carry here — in North America, I always have to shop at specialized “plus sized” stores. I have a beautiful new red raincoat in a trendy style. Yay!

Thank you for allowing me to be a part of this research study. I hope that your research reveals answers that you were looking for. I am pleased to say that since 5/15, the start of my healthy lifestyle change; I have lost 2.5 lbs and with the exception of the last two days, am working out. I am taking my health more seriously. I feel your study has contributed to helping me make these changes.

A need for greater understanding

This study, like all studies, has several important limitations. Most notably, it involved a relatively small number of participants who were all women and almost all white. The study’s findings, therefore, may not reflect the experiences of other populations, particularly men and people from other ethnic and racial groups.

Still, Seacat and his colleagues say they hope that their findings will "help broaden the scientific understanding of factors that may serve to exacerbate and/or alleviate weight stigma."

“As the obesity epidemic intensifies and public attention to this issue increases, weight stigmatization will likely persist and may even intensify,” they add. “It is therefore important that researchers continue investigating all aspects of this important phenomenon. Future interventions to reduce stigma and better equip overweight/obese individuals for their encounters with stigmatization should be based upon solid empirical and ecologically valid research.”

FMI: You’ll find an abstract of the study on the website on the Journal of Health Psychology, but the full study is, unfortunately, behind a paywall. An online version of the study was published in 2014; this latest version is considered the "version of record."

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Comments (5)

Not to quibble, but the term "social stigma" seems incorrect.

I understand the term "stigma" to refer to a posture of being disgraced in the eyes of others. The most frequently cited "social stigma" in the study is "physical barriers." The fact that the typical chair in a public place is not designed comfortably to accommodate the obese doesn't implicate "stigma." It reflects that because of material costs and space considerations, typical chairs are designed for those of typical size.

Another fault of the study, it seems, is that incidents of "social stigma" are based on the subjects' perceptions. It seems likely that a person who is obese, who is self-conscious about her obesity, and who is participating in a study about how others respond to her in light of her obesity, is going to be somewhat more inclined to perceive "false positives" in the eye contact, comments, etc of others than "false negatives."

What the study seems more to be measuring is the self-stigmatization of those who are obese - i.e., how often, and in what respects, someone who is obese is negatively self-aware of that fact when in public.

"Social stigma" is exactly the right term

One of the things that helps perpetuate stigma and hold oppression in place is peoples’ tendency, when told about someone else’s experience of stigma, to immediately engage in an attempt to try to explain it away or justify it. Charles’ comment is (perhaps purposefully, or perhaps inadvertently) a master class in that technique. Let’s look at it bit by bit:

“I understand the term “stigma” to refer to a posture of being disgraced in the eyes of others. The most frequently cited “social stigma” in the study is “physical barriers.” The fact that the typical chair in a public place is not designed comfortably to accommodate the obese doesn’t implicate “stigma.” It reflects that because of material costs and space considerations, typical chairs are designed for those of typical size.”

For the purposes of this exercise, I’ll go ahead and use Charles’ definition of stigma. I’m also going to use the word “fat” rather than “obese” because I prefer it. First of all, does he honestly think that not being able to fit in a chair isn’t being disgraced in the eyes of others? Does he imagine fat people to be like “No, it’s cool, I’m not embarrassed at all. I mean obviously it’s just way too difficult to have some arm-less chairs in this restaurant, so I’ll just stand through this business lunch, it won’t be weird at all, it won’t feel stigmatizing in any way, it’s really my fault for existing.”? A (weak) justification for the stigmatizing experience does not erase the nature of the stigmatizing experience.

“Another fault of the study, it seems, is that incidents of “social stigma” are based on the subjects’ perceptions. It seems likely that a person who is obese, who is self-conscious about her obesity, and who is participating in a study about how others respond to her in light of her obesity, is going to be somewhat more inclined to perceive “false positives” in the eye contact, comments, etc of others than “false negatives.”

Nope. In a world where the diversity of body sizes was respected and there was no stigmatizing of fat bodies, there would be no self-consciousness about body size. That the self-consciousness exists (and as Charles illustrated is expected of fat people) is a pretty good indicator that fat people are living in a world where fat people are stigmatized (possibly to the tune of over 1,000 incidents a year based on this study and that doesn’t include all of the constant messages we get that “thin = good/fat=bad” from the media.)

Telling people who are experiencing stigma that you know better than they do what their experiences are isn’t new, and as long as it’s been around, it’s been a way to hold oppression in place, and it perpetuates the incorrect and dangerous message that “No I’m not.” is a complete and acceptable answer to “You’re hurting me.”

“What the study seems more to be measuring is the self-stigmatization of those who are obese – i.e., how often, and in what respects, someone who is obese is negatively self-aware of that fact when in public.”

Let’s examine the situation:

“Teenagers made animal sounds [moo] outside of a store I was in.”
“I was told what a bad mother I am because I can’t set limits as to what my son or his friends eat during sleepovers, because I can’t even control myself.”
“Boyfriend’s mother denied me access to food, also stated that I was so fat because I was lazy.”

Oh sure, these are all just examples of people being negatively-self aware, and not of other people directly engaging in stigmatizing behavior. I totally see it now! (Why isn’t there a font to indicate sarcasm? Can someone get on that please?)

But what about “With friends at a baby shower. Went to McDonald’s first so people wouldn’t look at me eating more than I should.” Surely that’s just in the fat person’s head right? Wrong. First of all, this person knows their friends and family better than we do, so if they tell us that their experience of stigma led them to avoid eating in public at an event where food was served, we should take their word for it. In general, ask yourself this – if this person hadn’t experienced stigma around eating in public as a fat person, where would they have gotten the idea to avoid eating in public as a way to avoid stigma?

Again - one of the things that helps perpetuate stigma and hold oppression in place is peoples’ tendency, when told about someone else’s experience of stigma, to immediately engage in an attempt to try to explain it away or justify it. We do more to work against oppression and stigma when our first thought upon being told that something is stigmatizing is “tell me more” (assuming the person is interested in doing so, nobody has an obligation to educate,) or “wow, let me think about that” rather than “no it’s not, and let me tell you why.”

Charles (and so many like him) are missing the point here. Fat people don’t just wake up and “self-stigmatize” out of the blue. Internalized oppression happens when fat people believe all of the stigmatizing messages that we get (from teenagers who moo at us, people who question our parenting, and boyfriend’s mothers who deny us food, the US Government which is waging war on us etc., all because of a physical characteristic that is easily identifiable by sight and thus easily stigmatized. )

The suggestion that the existence of internalized oppression somehow invalidates a fat person’s experience of stigma is an excellent example of oppression – the belief being that if people are able to convince some fat people of the idea that being fat makes them bad/ugly/unhealthy/immoral etc., then they can declare that fat people aren’t competent witnesses to their experience of stigma, because they “self-stigmatize,” is super messed up.

Fat people face real stigma, and it needs to stop right now, and a great place to start would be to stop pretending that it doesn’t happen.

Ragen Chastain
www.danceswithfat.org

Clearly you have strong and considered views on this.

Which may explain why you took the time to write a very lengthy response not to my comment, but to a straw argument. I didn't say anywhere that fat people aren't subject to stigma. My comment was that the attempt to "quantify" occasions of stigma is suspect, even more so when an occasion of "stigma" rests on the intent of the other person but the counting is done by the subject.

Your response supports my comment. Except for the three quotes from the article that you reproduce, you reply that when a subject reports an instance of stigma, it must be stigma because the subject has experienced stigma previously and/or feels embarrassed (i.e., self-stigma). Again, I didn't say there aren't many occasions of fat people being shamed by others. I said that a study "counting" instances of stigma so that they can be quantitatively compared over time is silly.

On the other hand, the article does raise what seems to be an important question about the internalization of stigma. After all, humans are a weak creature who are not any time within the next few centuries going to stop judging, shaming, ridiculing others as a way of making themselves feel better. Anybody who is a little bit different or who thinks for her/himself knows this, not just fat people. You can try to get humanity to stop doing this, but it's going to be more productive to focus on self-esteem and internalizing the fact that others' acts don't reflect on your virtue, worth and dignity as a person. In other words, keeping stigma from being converted into self-stigma. E.g., here, where you are holding me up as an "other" who is an oppressor and a fit object of sarcasm.

Agreed

Stigmatization requires intent from another. Embarrassment of a physical impediment as a result of otherwise practical considerations of others is not stigmatization, as there is no intended external judgement. On the other hand, where accommodations are made for those outside of the "average," stigmatization can be found in how it is implemented, such as the example of putting "plus sized" clothes in separate stores or separate sections of a store. While it is understandable that such clothing should be priced appropriately according to the cost of the materials, it does not make sense that larger women's clothing should be put in a separate part of the store, let alone be labeled "plus sized" while a similar situation for men is labeled "big and tall" if such clothing is separated out at all.

I agree that we all need to work on our own esteem, and make our own changes. But that can only go so far when you're looking for pants and you go to the pants section of the store only to find that the sizes stop below your size, and you must stand in a completely different section of the store where "your clothes" are. You have effectively been put in the "fat" part of the store, where clothes aren't conveniently separated by function, but rather segregated from the rest by the appearance of the person in need of them. This is compounded by the fact that women often enjoy shopping to a greater degree than men--and being stigmatized in this way seems to be a way to remove that enjoyment.

Thank you Charles!

"You can try to get humanity to stop doing this, but it's going to be more productive to focus on self-esteem and internalizing the fact that others' acts don't reflect on your virtue, worth and dignity as a person."

As someone who has gotten picked on a lot in the past, this part of your comment really spoke to me. I have been dealing with depression for years to the point where I have lost all sense of self worth. I really couldnt see a way out and it was affecting my behavior in a negative way. I have become bitter, isolated, mistrusting and sad.
Your comment helped me put that into perspective. Humanity is flawed and it would be easier to work on and accept myself rather than trying to force the world to accept a negative me. Maybe once I accomplish that, the world will see me differently as well. Thank you for the hope. :)