Wednesday, February 13, 2013

Weight Bias and Obesity Discrimination Can We Shake Weight-Based Stereotypes?

As if the medical risks alone weren't bad enough......Alzheimer's disease and dementia are devastating diseases without effective treatments; as the population ages these conditions are becoming epidemic. Meanwhile, a second epidemic, obesity—driven by overabundance of calorie-rich but nutrient-poor food and sedentary lifestyles—is already evident in Western and Westernizing cultures. Researchers have begun to explore the possibility that overweight and obesity may affect the brain and play a role in age-related diseases. On December 4, 2012, epidemiologists, clinicians, and researchers met at the New York Academy of Sciences for The Paradox of Overnutrition in Aging and Cognition, a conference presented by the Sackler Institute for Nutrition Science to elucidate the intersection between aging, cognition, obesity, and nutrition.

Overweight individuals are often viewed as lazy, less competent, and sloppier in the workplace, classroom, doctor’s office, and at home. Here, suggestions for what can be done to squash these negative stereotypes

by Hollis Templeton 

From in-your-face public health campaigns to trendy diet foods, tremendous effort goes into fighting America’s obesity epidemic. Still, in our rush to slim down society at large, we’ve failed to make an important observation: Millions of Americans are living their lives in bigger bodies, and not all can, will, or even want to slim down.

The irony of it all:

While overweight and obese individuals face stigmas in the doctor’s office, workplace, classroom, family dinner table, and on the big screen, research suggests that negative stereotypes in these settings reduce quality of life and hinder rather than promote weight loss.

“When a person is stigmatized or discriminated against because of weight, he or she is more likely to experience depression, anxiety, low self-esteem, and also is more likely to engage in unhealthy eating behavior, like binge eating, extreme dieting, or staying away from physical activity, which all come back to obesity,” says Rebecca Puhl, PhD, director of research at Yale University’s Rudd Center for Food Policy and Obesity.

So what’s the solution?

Experts in the field of fat acceptance agree that reducing weight bias must come from a shift in societal attitudes, including changing media portrayals, fixing public education programs geared toward explaining the causes of and solutions to obesity, and promoting legislation that would put weight bias on par with discrimination based on race, gender, and sexual orientation.

On a smaller scale, sticking up for yourself and not holding yourself responsible for another person’s attitudes and misperceptions are key, says Jennifer Copeland, a member of the Association for Size Diversity and Health’s Education Committee. “Do not feel compelled to shatter the stereotypes someone else holds by behaving a certain way,” she says. “Instead, work to change those perceptions—not yourself.”

Here, we’ll walk you through weight biases that exist in four settings and give you tips for helping your doctor, employer, professor, or spouse see beyond your weight.

Teasing and bullying are concepts we think we leave behind once we grow up and step off the playground, but for many overweight adults, being picked on at work is a real concern. In a survey of 2,249 overweight and obese women published in the journal Obesity, 25% reported that they had experienced weight-based discrimination, like derogatory humor, denial of promotion, or firing—in the workplace.

Of these women, 54% stated that they had been stigmatized by colleagues and 43% by their supervisors.

Weighing more can also mean taking home less. A study of more than 12,000 adults published in Health Economics revealed that obese men took home between 0.7 and 3.4% less than their normal-weight counterparts, while the wage penalty for obese women was 2.3 to 6.1%, even after controlling for socioeconomic and family status. Research conducted at Marquette University reveals a similar trend: In a survey of 6,600 white and African American adults ages 23 to 30, severely obese women and men received lower wages—24% less for white women, 14.6% less for African American women, 19.6% less for white men, and 3.5% less for African American men.

Obese individuals are much less likely to get hired for a position, even when they are equally or more credentialed than their thinner competition, says Puhl. Research suggests that during interviews overweight or obese individuals are disadvantaged by common stereotypes—views that heavier employees are less conscientious, less agreeable, less emotionally stable, and more introverted compared with normal-weight workers. However, when researchers at Michigan State University and Hope College examined the validity of these stereotypes, they found that demographic variables such as age and gender were better predictors of personality traits than BMI.

What Your Employer Can Do

While antibullying policies exist in many workplaces, they can be vague in terms of the type of bullying they prohibit, notes Puhl, adding that obesity discrimination in the workplace needs to be put on par with discrimination based on race, gender, and sexual orientation. “Companies need to ensure that human resources personnel and hiring managers are provided with training to make sure weight-based discrimination is not taking place before a person is even hired,” she says.

Change Perceptions by…

Practicing good self-care. “Taking care of yourself physically improves your ability to handle these situations,” says Copeland. “This can be anything, from getting a good night’s sleep to participating in enjoyable physical activity to making sure your body is getting the fuel it needs from your nutrition.” Also participate in stress-busting activities, like deep breathing exercises, journaling, art, dancing, or listening to music, she suggests.

Keeping records and speaking up.

Monitor or record situations during which you are treated unfairly, and then report the occurrences to your hiring manager or HR contact, advises Puhl, who also suggests checking out the following resources for antibullying in the workplace.

The Workplace Bullying Institute
No Workplace Bullies
Bully Busters

At the Doctor’s Office

Your doctor, dietitian, or personal trainer is there to help you maintain a healthy body, but that doesn’t mean that each of them will always make you feel great. “Health care providers are not immune to weight bias and may express judgmental or negative attitudes toward obese patients,” says Puhl. In fact, when she and her colleagues examined the health care experiences of more than 2,000 overweight or obese women, they found that the women reported receiving inappropriate comments about their weight from doctors (53%), nurses (46%), dietitians (37%), and mental health professionals (21%).

The concern is that obese patients who experience weight stigma in medical settings will delay or forgo essential screenings, like those for breast, cervical, or colorectal cancers. But stigmatization isn’t just in patients’ heads—doctors admit to it, too. More than 50% of physicians view obese patients as awkward, unattractive, and noncompliant, according to a study of 620 primary care physicians published in the journal Obesity Research. A third of the doctors surveyed characterized heavier patients as weak-willed, sloppy, and lazy. Nurses, medical students, fitness professionals, and dietitians express similar attitudes toward the overweight. In a Journal of the American Dietetic Association study on dietetics students’ perceptions of obesity, a majority of students agreed with stereotypes that overweight people frequently overeat, don’t exercise, are slow and insecure, lack endurance, and have low self-esteem and poor self-control.

The good news is that there’s also evidence that suggests your physicians’ perceptions are misguided.

Researchers at the University of Kansas Medical Center found that patients’ self-reported levels of weight loss motivation were significantly higher than the levels of motivation that their doctors perceived. Thirty percent of female and 21% of male patients reported a motivation score of 10 or “completely motivated,” while their doctors estimated that only 2.5% of female and 3.1% of male patients were that motivated.

What Your Health Care Provider Can Do

Health care providers should to be mindful of the language used when discussing the health risks associated with a patient’s weight, asking the patient what word or words they feel comfortable with—“weight” versus “obesity,” for example, says Puhl.

Health care providers should also focus treatment on lifestyle and behavioral changes instead of emphasizing weight loss, gaining a better understanding of the biological factors that work against one’s body weight as well as the difficulties associated with losing weight and maintaining weight loss.

Change Perceptions by…

Putting your concerns in writing. If you feel as though a health care professional is treating you unfairly because of your weight, Puhl suggests jotting down a list of your concerns and contacting your health center’s medical advocate.

In her book Health at Every Size, Linda Bacon, PhD, provides readers with letters that they can take with them to their next doctor’s appointment as a way of opening up a dialogue with a health care provider about weight bias.

In the Classroom or Admissions Office

Although they probably aren’t aware of it, children can become targets of weight-based discrimination before they can even spell the word obesity. Weight bias in educational settings starts in preschool as early as age 3 and continues through elementary school, high school, college, and into adulthood, says Puhl.

Biases are not just exercised among peers; discrimination comes from educators, too. Teachers may not have negative intentions, but generally have lower expectations for overweight students, says Puhl.

In a study of 2,249 overweight or obese women published in the journal Obesity, 32% reported having experienced weight bias from a teacher or a professor while additional research reveals that overweight and obese individuals are less likely to attend college compared with their normal-weight peers.

What Educators Can Do

Teachers should model tolerance for different body sizes and intervene when they see weight-based teasing,” says Puhl, stressing the importance of providing classroom examples that challenge weight-based stereotypes, like highlighting the achievements of an overweight but successful public figure.

Change Perceptions by…

Educating yourself. “Stereotypes are not based on fact, and information is one of the most important components of changing them,” says Copeland. “Not only will you be more prepared to respond the next time someone treats you in such a way, but you will feel stronger with the facts on your side.” She suggests the following resources and reading materials:

Association for Size Diversity and Health
National Association to Advance Fat Acceptance

Big Fat Lies: The Truth About Your Weight and Your Health, by Glenn Gaesser, PhD

Health at Every Size: The Surprising Truth About Your Weight, by Linda Bacon, PhD

Keeping your kids safe. Parents should reassure children that weight-based discrimination—coming from an educator or a peer—is not their fault, says Puhl, adding that if a student feels stigmatized, he or she should speak with a guidance counselor or report the incident to a trusted educator or adult.

With Friends, Family, and Significant Others

Home is supposed to be a safe haven, but it doesn’t always feel that way. “For overweight and obese individuals, family members tend to be the most frequent sources of weight bias in their lives,” says Puhl, whose research reveals that 72% of overweight or obese women have been stigmatized by family members.Friends and family members often have positive intentions, but these positive intentions can come off in very critical, biased, and judgmental ways,” she says.

In fact, obese women report that they are generally more dissatisfied with the relationships they have with family members and significant others compared with thinner women, according to a study published in the journal Obesity Research.

What Your Loved Ones Can Do

Puhl stresses the importance of being mindful of language used in discussions about body weight and also recognizing that a friend or loved one may not want help but rather support. She urges parents, like teachers, to model weight tolerance. Mothers should be especially careful when speaking to—or in front of—their children about weight, bringing attention to what Puhl calls “fat talk,” mothers talking negatively about their own body shapes or those of strangers.

Communicating more effectively.

“Conversations about your weight and health can easily become heated and unproductive, and that’s okay,” says Copeland. “There is often a lot at stake in these moments, especially if the person talking to you feels as if your life is in danger.”

If conversations with your friends, family, or significant other turn into shouting matches or end with the silent treatment, Copeland advises trying another communication strategy: Start by taking turns speaking.

Break down your thoughts into small, easy-to-understand points. Share one point at a time and have your loved one repeat back in his or her own words what he or she thought you said, and correct as necessary. After you’ve shared one major idea, give that person a chance to respond. “This can be an awkward, but useful, process,” she says.

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