When bias and obesity collide

Nov. 8, 2012, 1:47 p.m.

Weight discrimination is a "very real problem," says Rebecca Puhl of the Yale Rudd Center for Food Policy & Obesity, and in the world of health care, it's become a "clinical concern." (Chris/Flickr Creative Commons)

In the mid-2000s, about 12 percent of American adults reported facing some form of discrimination based not on their ethnicity, gender, religion or political stance – but on their weight.

According to the 2012 Rudd Report, which comes out of the Yale Rudd Center for Food Policy & Obesity, that marked a 66 percent-increase in reports of weight bias since the mid-nineties.

And one can only imagine what that looks like now. California is on track to have an adult obesity rate of 47 percent by 2030, and the latest county statistics show Los Angeles' rate has shot up 74 percent over the past 14 years.

The weight situation in South Los Angeles is especially dire: Nearly 33 percent of adults are obese, marking a 36-percent rate increase since 1997.

Which all goes to show there are plenty of potential victims of weight bias – which, says the Rudd Center's Director of Research and Weight Bias Initiatives Rebecca Puhl, is a "very real problem."

"Unfortunately it has become really prevalent and widespread," said Puhl, who co-authored 2012's Rudd Report. She added that among women, the problem is "more common than racial discrimination."

Puhl attributes weight bias to three key causes: First, the notion that preventing obesity is rooted in personal responsibility. That's the primary approach the U.S. has taken to addressing the problem, she said – but it's problematic.

"That kind of approach, unfortunately, really creates a lot of blame on people who are obese," she said. "And that blame translates to pervasive stigma."

The second major reason, Puhl said, is the media portrayal of the overweight and obese.

"What we see is obese individuals are portrayed in very stigmatizing ways in both entertainment and news media," she said. "When we consider how much media we consume as a culture, it's really not surprising that public attitudes are so negative."

What this often means, Puhl explained, is that obese characters in the media are portrayed targets of humor and ridicule – the "butt of fat jokes." They're "very rarely shown having positive social interactions," and when it comes to kid shows, "they're never the hero of the story.

And finally: "We have no laws that prohibit weight discrimination," said Puhl.

The Rudd Report says that federal law only addresses weight bias when it's associated with a disability, thus putting it within the jurisdiction of the Americans with Disabilities and/or Rehabilitation acts. The Civil Rights Act of 1964 doesn't include weight as a protected class, and at the state level, Michigan is the only place that prohibits discrimination against people based on their weight.

As for Los Angeles, it's not one of the six cities and municipalities where local laws ban weight discrimination.

"There really is no legal outlet, and what that communicates to people in our country is that this a very socially acceptable form of bias," she said.

Weight bias at the doctor's

The Rudd Report's authors write that weight bias can affect obese people's prospects of employment, education and health care. The latter can be especially unsettling. A recent study appearing in PLOS One tested the "anti-fat biases" of nearly 400,000 people, including 2,000 medical doctors. Researchers found that those medical doctors tended to be as biased against obesity as the general public.

The study's authors wrote that it remains to be seen "how MDs' anti-fat attitudes affect clinical behavior," as well as "whether implicit weight bias is related to how overweight patients experience health care interactions." But Puhl cites other studies that already indicate the answer to that question.

"One thing we see is patients in the health care setting frequently report feeling stigmatized by health care providers," she said. Conversely, doctors admit to spending less time in their appointments with obese patients, having less discussion with them and not intervening in their lifestyle "as much as they think they should."

Not only that, but as a patient's body mass index increases, providers report having less respect and patience for them, said Puhl.

"We also see this has a potential impact on health care utilization," she said. "When obese patients feel stigmatized in the health care setting, they sometimes will avoid future medical appointments because of those stigmatizing experiences."

Examples are listed in the Rudd Report: being denied medical services because of your weight; being the target of derogatory jokes by health providers; not being provided appropriately-sized medical equipment; having unrelated medical problems attributed to your weight.

Something as simple the use of the word "fat," said Puhl, could play a role in someone's giving up on going to the doctor's.

Avoiding medical appointments is bad news, though – especially for obese patients, who are at increased risk for chronic conditions like diabetes and deadly conditions like heart disease. Skipping the doctor's could mean an early death.

"This is a real clinical concern," said Puhl. "It's one that we cannot ignore."

Have you ever experienced discrimination because of your weight? Let us know below, or email us and tell us your story.

Photo by Chris via Flickr Creative Commons.

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