Obesity and stigma

No discussion of overweight individuals would be complete without mentioning the problem of “social stigma.”  Social stigma is negative bias toward someone because of their 1) external appearance, 2) presumed deviations in personal traits, or 3) membership in a race, nation, or religion that is considered by the dominant culture to be deviant.  The first two parts of this definition apply to people who are “overweight.”

People are stigmatized because they are considered unattractive, even repulsive, by the trendsetters in a culture. This form of stigma is independent of the presumed cause of the deviancy, and therefore doesn’t take into consideration whether the condition is an affliction (e.g., leprosy or cleft palate) or brought on by the person’s own behavior (e.g., dressing like a “nerd” or neglecting dental care). Obese people are devalued in our culture because they do not match the current “ideal” of a person who appears youthful and fit (people we now call “obese” would be considered sexy in some cultures today, and would have been envied at some other points in history).

In addition, because of our growing fear of overpopulation (global warming, etc.) and the reduction in available physical environment and natural resources, there is even more pressure on people to not over-consume, take up too much space, or leave too large a “carbon footprint.” Overweight people, of necessity, use more food and energy and take up more space than thinner people.

People are also stigmatized if the larger society blames them for their own predicament. To the extent that we believe obesity is brought on by lack of self-discipline, this belief adds to the stigma, and presents a problem for scientists and health practitioners who treat obesity as a health problem that can be alleviated (at least in part) through behavioral interventions.

There is evidence that some degree of stigma is actually helpful in reversing the public health problem of childhood obesity. A controversial program in  Singapore required overweight school children to participate in exercise classes and special dietary programs, thus stigmatizing them in the eyes of their normal-weight peers [although successful, the program was ended after fifteen years because of concern about stigma; see here].  The program had been successful and may be a model for what could work in other cultures, and many of the children grew up to be adults who are grateful they were in such a rigorous program. Still, many feel they were psychologically harmed by the stigma they experienced as children. There are no easy answers.

This book, to the extent that it focuses on what individuals can do to control their own weight, adds to the perception that self-discipline plays a part in what we weigh. As a physician and researcher, I am troubled by this dilemma and do not wish to become part of the stigma problem. However, I strongly believe that honesty and a search for what is true or valid are more important in the long run than being “politically correct” in the short run.

Some scientists studying obesity bend over backwards (it seems) to claim that people have no control over what they weigh, and congratulate themselves for their role in fighting stigma. I sometimes wonder whether they are being truly objective or are biased in their own way against looking carefully at all potential factors which influence weight. The rush is on to find a gene or hormone to explain obesity, and to find a pill to “cure” it. There is comparatively little basic research going on to discover how self-control works in the brain and what factors affect “willpower.”  In part, this bias in favor of biological, rather than behavioral, research approaches is related to the way we fund research – increasingly through large academic/corporate complexes (looking for a quick answer that can be patented and commercialized) and in part through the Federal Government, which has its own corporate ties and political agendas.

I can only hope that my discussion of weight management is comprehensive and balanced, and reflects the genuine feelings of compassion, tolerance, and respect I have for people who are not considered “perfect” in our culture. My belief is that none of us is perfect, and that we all need encouragement to work on improving our health and happiness. I also believe that we have much to learn about how our brains, minds, and social networks affect our ability to exercise free will.

[above excerpted from Weight Management for Your Life]

One Response to “Obesity and stigma”

  1. Do you know a fat person? « Happy-Well Health and Fitness Blog Says:

    […] them obese, huge or fat — the stigma won’t go away. And I’m not sure it should.  Obesity is bad for a person’s […]

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