Body Shaming Linked To Greater Health Risks

It's not hard to imagine that we have clear and defined references about what beauty is and how it should be presented.

Thin, beautiful models grace the covers of our magazines, star in the shows we watch and find their way into our internalizations of how we, ourselves, should look.

Often to our own detriment.

In a study led by Rebecca Pearl, PhD, an assistant professor of Psychology in Psychiatry and her colleagues from Penn's Center for Weight and Eating Disorders examined 159 adults with obesity who were enrolled in a larger clinical trial testing the effects of weight loss medication, the majority of whom were African American women, a group typically underrepresented in weight bias research. The partcipants completed baseline questionnaires measuring depression and weight bias internalization. Weight bias internalization is characterized by the application of negative weight stereotypes to oneself, such as believing you are lazy, unattractive, or unworthy because your weight. Participants also underwent medical examinations, which determined 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.

After stratifiying participants into two groups, "high" and "low" levels of weight bias internalization, the researchers found that those with high internalization were three times more likely to have metabolic syndrome, and six times more likely to have high triglycerides as compared to participants with low internalization. Further, above and beyond the effects of body mass index (BMI) and depression, higher levels of weight bias internalization were associated with increased risk for cardiovascular and metabolic disease (Pearl et al., 2017).

"There is a common misconception that stigma might help motivate individuals with obesity to lose weight and improve their health," notes Pearl. "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."

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

Tom Wadden, PhD, a professor of Psychology in Psychiatry and director of Penn's Center for Weight and Eating Disorders explains, "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."

As previous studies have shown that exposure to weight bias and stigma negatively affects mental and physical health, specifically demonstrating that these experiences can lead to a physiological stress response such as increased inflammation and cortisol levels, and can escalate unhealthy behaviors such as overeating and avoiding physical activity, this new research only adds strength to the message that shame can be harmful not only psychologically, but also physically.

The goal, notes Pearl, is to 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. For many, it is just one step toward a better way to manage obesity.

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