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Stress of Fat-Shaming Raises Health Risks for Obese Patients

Mary Caffrey
The study found a strong link between measures of "weight bias internalization" and metabolic syndrome in a group of obese, mostly female patients.
Losing weight is hard enough for those who are obese. Add a culture of “fat shaming,” and for some patients the stress of being overweight raises cardiometabolic risk even higher, according to a new study from the University of Pennsylvania.

The study team found a strong connection between having self-stigma over weight gain and having metabolic syndrome, which is diagnosed by measuring waist circumference, blood pressure, fasting glucose, triglycerides, and high-density lipoprotein cholesterol. This cluster of indicators can show who is at risk for heart disease or stroke.

According to study, published in the journal Obesity, cultural messages that associate weight gain with laziness or lack of will power fuel self-stigma, or “weight bias internalization" (WBI). This self-loathing becomes a chronic stressor, which the Penn authors say has been shown in other studies to be just as harmful as comments or acts by others. White women in particular are at risk for this self-induced condition, which they say “can elicit a biochemical stress response,” resulting in higher levels of oxidative stress and inflammation. Several health problems, including diabetes, are linked to inflammation. One study cited by the authors tracked obese patients from 4 to 10 years and found that self-stigma could increase mortality rates by 57%.

For this study, researchers studied 178 adults with obesity who were enrolled in a weight loss trial. Of the group, 159 completed a 11-question assessment to gauge their WBI levels. They also completed the Patient Health Questionnaire, also called the PHQ-9, to screen for depression.

Those who answered the questions were overwhelming female (88.1%) and mostly African American (67.3%). The group had an average body mass index (BMI) of 41.1 kg/m2, above the level of Class III or morbid obesity. The assessment also checked if patients were taking medication for hypertension, dyslipidemia, or prediabetes.

VIDEO: Dr Fatima Cody Stanford on why helping obese patients change self-perception is key

Of the 159 assessed for WBI, 51 (32.1%) met the criteria for metabolic syndrome. The chance of meeting the criteria for metabolic syndrome increased among those with higher WBI, and the elevated risk remained when controlling for depression and BMI. A higher WBI also strongly predicted the odds of high triglycerides.

The study did not answer why there is a link between self-stigma and the greater health risks, but the authors pointed to other research for clues. Self-stigma increases among those who have had frequent episodes of bias because of their weight, and studies show that once this weight bias is internalized, it is a stronger predictor of psychological distress than bias expressed by others. WBI creates a vicious circle, prompting self-defeating behaviors like binge eating and avoiding exercise that, in turn, cause additional weight gain.

And, perceived bias may prevent those who are overweight from seeking help. “Individuals who perceive or experience weight stigma in health care settings are more likely to avoid or delay preventive care, thus increasing risk for disease progression,” theh authors wrote.

However, studies show that the bias is not all in patients’ heads. A recent survey found that physician training does not pay enough attention to treating obesity, and the result can be bias from doctors, who tell patients “lose weight,” often without effective advice on what to do. Bias from health plans may limit care that obese patients receive, when there are no such limits on other chronic conditions.


Pearl RL, Wadden TA, Hopkinsn CM, et al. Association between weight bias internalization and metabolic syndrome among treatment-seeking individuals with obesity [published January 26, 2017]. Obesity. 2017; DOI: 10.1002/oby.21716.

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