Study finds obesity stigma erodes will to exercise, socialise

Study participant Bri King and daughter Ruby. People interviewed in the study reported having their parenting abilities questioned because of their weight. Bri King

Shaming obese people commonly leads to self-blame and a reduced desire to engage in healthy activities like swimming, socialising or exercise, a new study has found.

Australia’s obesity rates have been rising faster than any other country in the OECD in the last 20 years. Obesity is associated with an increased the risk of heart disease, diabetes and other chronic diseases but making overweight people feel bad about themselves doesn’t help, according to a new paper published in the journal Social Science and Medicine.

For the study, researchers from Monash University, the University of Canberra, the University of Melbourne, Melbourne, Deakin University and Australian Health News Research Collaboration interviewed 141 obese people to find out what sorts of stigma they commonly experienced and how it affected their lives.

Between half and three quarters of those interviewed reported experiencing stigma directly from strangers, family members or partners, school peers, health professionals, friends, employers and colleagues.

“Most direct stigma was based on ‘moral’ judgements about the reasons why the participant was overweight - in particular laziness, gluttony and overconsumption,” the paper said.

Parenting abilities questioned

Some female participants reported having their parenting abilities questioned, with one interviewee recalling being told ‘it was probably all for the best’ after she had experienced a miscarriage.

“And I said, ‘Why?’ And they said, ‘Well you wouldn’t want to have a child when you’re that weight.’ I was just devastated,” the paper quoted the interviewee as saying.

Several reported being denied promotions based on their weight, with one participant who worked as a website developer recalling that a manager had asked her to lose weight because it affected her work.

“My weight is completely irrelevant. I was so stunned that she thought she could call me on that,” the 29-year-old study participant said.

Participants also commonly reported experiencing indirect stigma such as people staring at them when they were eating or gazing at the contents of their supermarket trolley, the study said, while forms of environmental stigma included plane seats that were too small or workplace chairs that were unsuitable.

“Participants described how the combination of direct, indirect and environmental stigma prevented them engaging in exercise in public spaces,” the paper said.

“Some stated they were unwilling to participate in exercise because they "expected” that people would “laugh at”, “ridicule” “stare at” or “abuse” them. One participant (a 34 year old female) said that she rarely participated in physical activity, because she felt constantly “on display”.

Anti-fat stigma prevented many people from pursuing ambitions such as going to university, applying for a new job, or engaging in new relationships. It also led to decreased socialising and feelings of loneliness.

“Furthermore, anti-obesity messages and strategies may have little effect while we continue to publicly commit to perpetuating an anti-fat rhetoric through campaigns and policy,” the study said.

One of the researchers involved in the study, Dr Samantha Thomas from Monash University’s Department of Marketing, said health authorities need to design public messages that aimed to reduce obesity without encouraging fat-hating.

“We don’t deny that obesity is an important public health problem. But current efforts are pushing people away from the very things we want them to engage in,” she said.

Involving obese people in policy design and research, in the same way that other stigmatised groups such as people with mental illness or HIV are involved in policy design, could help, said Dr Thomas.

“We need to start talking to obese people about their experiences and involve them in designing interventions. Obese people are remarkably absent from policy design.”

Blame doesn’t work

Professor Lauren Williams, Head of Discipline of Nutrition and Dietetics at the University of Canberra and an expert on obesity stigma said the study showed that some obese people had internalised feelings of self-blame but that stigma clearly did not help.

“The finding that it’s a barrier to them participating in health promoting activities is good evidence to quash the idea that shame and guilt can be a good thing,” said Professor Williams, who was not involved in the study.

Instead of focusing anti-obesity messages on individual responsibility, public health authorities should look to see what systemic changes could be made to stop Australian society getting fatter, she said.

“When you have a society where junk foods are marketed to children in their TV viewing time, intensifying work hours and such high energy density food, you have a perfect storm of factors,” said Professor Williams.

“It’s all very well for the government to throw money at the problem but we need them to take a tougher stand on things like high energy density food. There are products out there more fattening than butter. How does the food tech industry do that? That’s where the real effort needs to be in terms of regulation,” she said.