The pain of being the target of fat shaming may take a significant toll on one’s health, according to a new study led by researchers from the Perelman School of Medicine at the University of Pennsylvania. The findings show that people with high levels of weight bias internalization are much more likely to develop cardiovascular and metabolic disease.
Weight bias internalization occurs when people apply negative weight stereotypes to themselves — such as believing they are lazy or unattractive — and devalue themselves because of their weight.
“There is a common misconception that stigma might help motivate individuals with obesity to lose weight and improve their health,” said Rebecca Pearl, Ph.D., an assistant professor of Psychology in Psychiatry.
“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.”
For the study, the researchers examined 159 adults with obesity who were enrolled in a larger clinical trial testing the effects of a weight loss medication. Before any intervention was given, the participants completed baseline questionnaires measuring depression and weight bias internalization. A majority of the participants were African American women, a group typically underrepresented in weight bias research.
Participants were also given a medical exam to determine whether they had metabolic syndrome, a cluster of risk factors — such as high triglycerides, blood pressure, and waist circumference — which are linked to heart disease, type II diabetes, and other obesity-related health problems.
Initially, no link was found between weight bias internalization and metabolic syndrome when controlling for participant demographics, such as age, gender, and race. However, when patients were separated into two groups, “high” and “low” levels of weight bias internalization, 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.
“Health care providers, the media, and the general public should be aware that blaming and shaming patients with obesity is not an effective tool for promoting weight loss, and it may in fact contribute to poor health if patients internalize these prejudicial messages,” said co-author Tom Wadden, Ph.D., a professor of Psychology in Psychiatry and director of Penn’s Center for Weight and Eating Disorders.
“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.”
Previous research has shown that exposure to weight bias and stigma negatively affects mental and physical health, demonstrating that these experiences can lead to a physiological stress response such as increased inflammation and cortisol levels and can increase unhealthy habits such as overeating and avoiding physical activity.
Larger, longer-term studies are needed to explore which biological responses are responsible for putting a person with weight bias internalization at greater risk for cardio-metabolic disease.
“Disparagement of others due to their weight and messages that perpetuate blame and shame, if internalized, can cause harm to the physical and mental health of individuals with obesity,” added Pearl.
“As health care practitioners, we can help 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.”
The findings are published in the journal Obesity.