Fatal Fat Shaming? How Weight Discrimination May Lead To Premature Death

As soon as the chair broke under the weight of his 533 pounds, Jeff Newell knew he wouldn't get the job.

With a background in customer service and a culinary arts degree, Newell, of Taunton, Massachusetts, had been searching fruitlessly for work for several years. Finally, a great job near his home opened up that seemed a perfect fit with his credentials. But then came the chair-breaking incident. Humiliating, yes, but even more infuriating because the interviewer, offering neither help nor an apology, simply shook her head and made a face.

"I knew what she was thinking: 'This person is overweight and he's going to be lazy and why should I hire him?' " Newell said. The situation was mortifying emotionally, but also took a physical toll. Newell broke out in a sweat, his heart racing.

The sort of weight-based discrimination that he says he experienced is not just unpleasant and stressful; it may actually lead to premature death, a recent study finds.

While earlier research has shown that weight discrimination is associated with poor health outcomes for a variety of reasons, the new study, led by researchers at Florida State University, concludes that in addition, "weight discrimination may shorten life expectancy."

The new analysis found an association only, and no causal link between discrimination and life expectancy. Still, researchers in the field say the paper, published in the journal Psychological Science, adds to a growing body of literature pointing to the deep, long-term impact of weight bias and discrimination.

"I think this is one of the most important papers to come out in the research of weight stigma," said A. Janet Tomiyama, Ph.D., assistant professor in the Psychology Department at the University of California, Los Angeles, where she studies weight stigma and directs UCLA's Dieting, Stress, and Health Laboratory. "The finding itself is astonishing, but even more significant is that they were able to replicate the finding across two very high quality cohort studies. The crucial implication here is that the stigma alone of being heavy can be harmful to health — and we know that weight stigma is rampant in this country."

The findings emerged after researchers analyzed data from two separate national studies: the Health and Retirement Study (HRS), with more than 13,000 participants, and the Midlife in the United States Study (MIDUS), with more than 5,000 participants. The two studies (conducted about 10 years apart) both included reports on perceived discrimination, including weight discrimination.

The new analysis found that weight discrimination was associated with an increase in mortality risk of nearly 60 percent among both HRS and MIDUS participants and also that the increased risk "was not accounted for by common physical and psychological risk factors." In other words, the health effects of the discrimination were teased out from the health effects of the weight itself.

In an interview, Angelina Sutin, the study's lead researcher and an assistant professor in the Department of Behavioral Sciences and Social Medicine at Florida State University College of Medicine in Tallahassee, said the big surprise was that even after statistically controlling for other factors such as body-mass index, level of disease, depression and smoking, among others, the experience of weight discrimination was linked with people dying earlier than expected.

"What was really surprising was that the association was there not just in one sample but in two, and the associations were almost identical," Sutin said.

Weight discrimination and bias are widespread, according to an overview on the stigma of obesity, and that translates into inequities in employment, health care and education

And that stigma appears to contribute to a “vicious cycle,” according to Tomiyama, of UCLA, who writes about "a positive feedback loop wherein weight stigma begets weight gain."

Indeed, in an earlier study, Tomiyama found that children labeled as "too fat" had an increased risk of having an obese body mass index nearly a decade later.

So why might stigma be causing such problems, and possibly contributing to premature death?

That question wasn't addressed in the recent study, but Sutin offered some informed speculation.

"Part of it might be stress that people are carrying around with them," she said. But sometimes it's where the discrimination comes from that's meaningful. For instance, she said: "Families are often the source of weight discrimination," and that can be particularly painful, since "families are supposed to be a support."

Also, several studies find that weight bias is rampant among medical students and other health care providers. Even eating disorder specialists are not immune to negative stereotypes about obese patients, according to a 2014 study. This attitude among health care professionals can lead to delays in care and treatment, and also misdiagnoses, experts say.

Much of the research on weight stigma and discrimination is led by Rebecca Puhl, Ph.D., deputy director of the Rudd Center for Food Policy & Obesity and a professor in the Department of Human Development & Family Studies at the University of Connecticut. She said there are several possible mechanisms at work that could contribute to premature mortality for people subject to weight discrimination.

"Other studies have found that when people are exposed to weight stigma or discrimination, that they actually experience elevated physiological stress responses (e.g., cortisol reactivity, blood pressure) which could contribute to poor health outcomes," Puhl wrote in an email. "In addition, studies show that exposure to weight stigma can also lead to increased calorie intake, food consumption, and binge eating, which could play roles as well. The idea here is that weight stigma can induce emotional distress, which in turn becomes a trigger for turning to some of these maladaptive eating patterns as temporary coping strategies to alleviate those negative feelings."

Sarah Bramblette, who has a master's degree in health law, says even though she suffers from a medical condition called Lipedema that contributed to her current weight of over 400 pounds, she has been subjected to weight discrimination throughout her life. While she says some of the nasty comments hurt her feelings, it's the bias from health professionals that has the greatest impact.

Here's how Bramblette opened her recent TedxNSU talk at Nova Southeastern University in Fort Lauderdale:

When I first appeared on stage, what was your perception of me? Lazy, disgusting, perhaps depressed, unmotivated, unhealthy? Based on my appearance it's usually assumed... that my weight and my condition in life are self-induced. That's not true, but often I don't get a second chance to make a first impression....Weight bias that I've experienced in health care has hurt me physically. When doctors and nurses have the perception that I'm lazy and unmotivated and noncompliant, that influences the care they provide and it has a negative impact on my health.

Angela Meadows, a doctoral researcher in the school of psychology at the University of Birmingham in the U.K., who convenes an annual weight stigma conference, said in an email that weight bias is far-reaching and insidious:

In the case of weight stigma, it's not just about people being outright discriminatory to you, although that happens; it's about comments from friends and loved ones; it's about turning on the TV and seeing people who look like you the butt of jokes, or worse; it's about opening a newspaper or a magazine and seeing another story about how fat people are the cause of all problems in society, usually accompanied by what Dr. Charlotte Cooper called a "headless fatty" picture — a dehumanised photo of a fat person who is reduced to nothing more than their fat...

It has also been consistently demonstrated that health professionals - doctors, nurses, fitness trainers, dietitian - have very negative views towards fat people. This results in a lot of people either not accessing the care they need, including preventive health care such as breast exams and pap smears, or, if they do go and see a doctor, having diagnoses missed and illnesses from broken bones to cancer being blamed on their weight and sent away with a diet sheet.

Finally, weight stigma affects educational outcomes - fat people do worse at all stages of education, despite doing equally well on tests of intelligence, and are less likely to go on to higher education or get in to graduate school than thinner peers. They're also less likely to be employed, get paid less, and are more likely to be disciplined or fired than equally qualified thin people. All of these things affect life outcomes and there is a strong link between high weight and low socioeconomic status...Addressing inequality and the social determinants of health cannot be achieved by telling people to lose a few pounds.

Experts say incremental changes have occurred in the two years since the American Medical Association recognized obesity to be a disease, rather than a chosen lifestyle marked by poor eating habits and inactivity. New collaborations among national health organizations to revise clinical guidelines for obesity treatment have been launched, says Puhl, of the Rudd Center, as well as increased efforts to improve medical education on obesity and some policy measures passed by the AMA. In some states, like Massachusetts, efforts are underway to pass laws that would ban workplace discrimination based on a person's weight.

But, Puhl says, "there is still a long way to go, and a need for broader-reaching changes to take place." Sutin, the Florida researcher, adds that the entrenched habit of "blaming the individual hasn't faded as much as we'd like it to."

Indeed, a just-released analysis of 73,000 adults surveyed between 2013 and 2015 by the Obesity Action Coalition and the Rudd Center found weight bias continues to persist. While "the public increasingly recognizes that obesity is more complicated than a simple problem of personal responsibility," the release says, "this awareness has not translated into improved social acceptance of people with obesity, which instead declined in settings such as the workplace, education, and other areas of life."

As for Newell (who underwent gastric bypass surgery last December and now weighs 294 pounds) he finally did get a job: the interviewer was a large, heavyset woman, he said.

"It was the first person of size who interviewed me and as soon as she walked into the room I got a huge smile on my face," he said. "I knew she wouldn't judge me based on my weight."