Findings from a meta-analysis recently published in the journal Obesity Reviews indicate that about half of adults with obesity in the United States report lifetime discrimination, and women with extreme obesity face more evident effects. The article is titled “Obesity and discrimination – a systematic review and meta-analysis of observational studies.”
Jenny Spahlholz , MSc at the Leipzig University Medical Center in Germany, and co-workers reviewed the published literature concerning the prevalence and nature of the perceived weight discrimination in obese individuals. The selection criteria included observational studies reporting on the prevalence and manifestations of perceived weight discrimination among individuals who are classified as obese. The exclusion criteria included research studies focusing on bullying and its relationship with body weight, as well as studies focusing on socioeconomic disparities in obesity.
Of the 4,393 citations retrieved for the meta-analysis, nine studies met the inclusion criteria. Eight of these studies were conducted in the U.S. and one in Europe, and their sample sizes ranged from 93 to 22,231 adults.
The results revealed that the pooled prevalence of perceived weight discrimination was of 19.2% for individuals with class I obesity (body mass index, or BMI = 30–35 kg/m2], and of 41.8% for individuals tending toward extreme obesity (BMI > 35 kg/m2). Overall, results from U.S. nationwide representative samples showed a higher prevalence of discrimination in individuals with higher BMI values (BMI > 35 kg m2), as well as in women.
In fact, some studies revealed significant differences according to sex. One longitudinal study, as part of the National Survey of Midlife Development in the United States (MIDUS) subgroup, revealed that the prevalence of weight discrimination varied from 20.6% for women with class I obesity and 45.4% for women with class II or class III obesity, in comparison with 6.1% for men with class I obesity and 28.1% for men with class II and class III obesity.
Both women and men experienced discrimination in the workplace and in healthcare settings, with women reporting more perceived discrimination compared with men. “Women reported more lifetime discrimination, work-related discrimination and health care-related discrimination than men, and women with more extreme obesity reported an even higher degree of perceived weight discrimination than women and men with class I obesity, thus underlying the ‘gendered nature of weight-related discrimination,’” wrote the research team according to a news release. “The lower prevalence in perceived weight discrimination among men might reflect a higher acceptance of obesity among men.”
According to the team, many of the reviewed studies did not provide a clear definition of “perceived weight discrimination.” As an umbrella term, “weight stigmatization” was often used across studies.
“While some still argue over the accuracy of self-reported discrimination, its relevance in general and its linkage to negative outcomes on mental and physical health have been demonstrated by many studies,” noted the research team.
The review documented the occurrence of perceived weight discrimination in several life domains, such as employment/school, healthcare and interpersonal relationships. However, it offers no firm conclusion about particularly vulnerable life domains.
The researchers concluded that there is a need for non-structural intervention strategies to reduce stigma, and that these should focus on multiple components, including interpersonal (e.g., interventions to improve social interactions between the stigmatized and non-stigmatized) and intrapersonal interventions (e.g., interventions to alter and to cope with stigma).