Obesity as a Stigma Or a Threat to Health

The social consequences of being overweight and obese are serious and pervasive. Person who are over-weight or obese, they will being targeted of stigma. Then, they also being exposed negative impression in their life such as at employment setting, at university, at medical facilities, at mass media, and also personal things.

What is weight stigma?

In Ancient Greece, a stigma was a brand burned into a slave or a criminal's skin to symbolize disgrace. In the 1500s, the word stigmatize meant literally "to brand or tattoo." Nowadays, to stigmatization is to embarrassment or label a person in a more symbolic way. However, stigmatization of obesity is things that are not new more because it is foreshadowed centuries ago by behavior obtain from then still existing theories of the emergence of obesity.

Stigmatization generally mention to bad behavior that influences the interpersonal interactions and activities in not reliable way. Then, stigma also can come in any form, such as verbal types of stigma for example, touching, teasing, insults, stereotypes, names calling or others. Another form of stigma is physical stigma which is, touching, grabbing, or other antagonist behavior, or other barrier and obstacles due to weight such as medical equipment that to small for obese patients, chairs or seats in public area which do not accommodate obese person, or stores which do not carry clothing in large sizes. In an supreme form, stigma can show in smooth or rough of discrimination, such as in employment setting discrimination where an obese employee is repudiate a position or qualification due the appearance, despite being appropriately qualified.

Where does weight stigma occur? Employment Weight stigma occurs in multiple settings by a range of individuals. For example, in employment settings, overweight people may face bias from several sources. Studies have found that weight stigma manifests in multiple forms of employment discrimination towards employees with overweight and obesity. These include difficulty obtaining a job, worse job placement, lower wages and compensation, unjustified denial of promotions, harsher discipline, unfair job termination, and commonplace derogatory jokes and comments from coworkers and supervisors.

In review by Puhl et al. found that employees with overweight and obesity report their weight as the most things that effected factor contributing to losing their job. Another review found that certain oversimplified about employees with overweight and obesity are highly approval by employers and supervisors, in particu-lar that they have poorer job performance and that they lack interpersonal skills, motivation, and self-control. Giel and colleagues (2010). Other research shows that overweight employees are ascribed multiple bad oversimplified comprise being lazy, sloppy, and less competent, lack of discipline, disagreeable, less vice, and poor role models. In addition, overweight employees may suffer wage penalties, as they tend to be paid less for the same jobs, are more likely to have lower paying jobs, and are less likely to get promoted than thin people with the same qualifications.

Healthcare

In their 2009 review, Puhl and colleagues found that many studies provide evidence supporting the notion that health professionals (including doctors, nurses, medical students, fitness professional, and dietitians) consistently endorse negative stereotypes about patients with overweight and obesity, in particular ascribing to them culpability for their weight status. Weight stigma in the healthcare settings leads to impaired patient-provider communication, poorer doctor-patient relationships, poorer medical care and treatment (for exam-ple doctors spending less time with patients), and avoidance of the healthcare system all together on the part ofthe patient. However, it is important to point out that the evidence that has been reviewed thus far comes primarily from self-report studies. Therefore, Puhl and colleagues concluded that research examining actual health outcomes is needed. Overall, the impact of weight stigma in healthcare has become so prob-lematic that many scholars have suggested that obesity-prevention programs should make minimizing stigma a priority.

Education

Puhl and colleagues (2009) concluded from their review of weight stigma in education that this area still warrants further investigation, but that current trends indicate that students with overweight and obesity face barriers to educational success at every level of education. Reviewed research demonstrates that educators, particularly Physical Education teachers, report artifact attitudes toward their students with overweight and obesity, which may undermine educational achievement. Importantly, the education disparities for students with overweight and obesity appear to bestrongest for students attending schools where obesity is not the norm. Several studies have evidenced that in environments such as these, students with overweight and obesity face greater educational disadvantages and are less likely to attend college, an effect that is particularly strong among women. Moreover, weight stigma in educational settings also affects interpersonal relationships (see "Interpersonal situations" below). In school settings, students who are overweight or obese can face harassment and ridicule from peers, as well as negative attitudes from teachers and other educators. At the college level, some research shows that qualified overweight students, particularly females, are less likely to be accepted to college than their normal weight peers.

Interpersonal situations

Although a less studied topic than employment and healthcare, several studies reviewed by Puhl and col-leagues (2009) provide evidence that women with overweight and obesity, in particular, face weight stigma from many interpersonal sources including family, friends, and romantic partners. Another recent review by Puhl and Suh (2015) also documented that in school settings weight-based bullying is one of the most prevalent types of harassment reported by parents, teachers, and students. Experiencing interpersonal weight stigma is related to myriad negative physics and mental health consequences (see "Physical and Mental Health Consequences of Experiencing Weight Stigma" below).

Media

Puhl et al. (2009) also reviewed how in entertainment, news reporting, and advertising, media is a particular-ly potent source of weight stigma. News reports have blamed individuals with overweight and obesity for various societal issues including prices of fuel, global temperature trends, and precipitating weight gain among their peers. The literature also documents how in television programs, actors with overweight and obesity are often cast in minor roles, if at all. Programs also often depict them as the targets of teasing and derogation and often portray heavy characters displaying eating behaviors stereotypical to overweight and obesity. This elatively low social status assigned to characters with overweight and obesity in television is also evidenced in children’s television, a tendency that perpetuates artifact attitudes among viewers. In terms of media attention for obesity itself, a recent review by Puhl and Suh (2015) revealed that obesity-related media campaigns that used stigmatizing messages in fact undermine motivations and intentions to pursue healthy eating and exercise behaviors.

What are the consequences of weight stigma?

Despite decades of research documenting consistent stigma and discrimination against individuals with obesity, weight stigma is rarely considered in obesity prevention and treatment efforts. In recent years, evidence has examined weight stigmatization as a unique contributor to negative health outcomes and behaviors that can promote and exacerbate obesity. This review summarizes findings from published studies within the past 4 years examining threlationship between weight stigma and maladaptive eating behaviors (binge eating and increased food consumption), physical activity, weight status (weight gain and loss and development of obesity), and physiological stress responses. Re-search evaluating the effects of weight stigma present in obesity-related public health campaigns is also highlighted.

Evidence collectively demonstrates negative implications of stigmatization for weight-related health correlates and behaviors and suggests that addressing weight stigma in obesity prevention and treatment is war-ranted. For obese adults, research has documented that individuals who experience weight stigmatization have higher rates of depression, anxiety, social isolation, and poorer psychological adjustment. Some obese adults may react to weight stigma by internalizing and accepting negative attitudes against them, which may in turn increase their vulnerability to low self-esteem. Because societal messages often perpetuate beliefs that weight is under personal control, obese persons may be less likely to challenge stereotypes because they can attempt to escape stigma by losing weight. Stigma may also have negative consequences for eating behaviors by interfering with weight loss attempts and leading some adults to eat more food in response to stigmatizing encounters. Stigma also has implications for physical health in the context of avoidance of health care services due to bias in medical settings. It is not known whether, or to what degree, stigma exacerbates poor self-care behaviors or contributes to additional complications and co-morbidities of obesity.

Physical and mental health consequences

In both adults and children with overweight and obesity, several reviews of the literature have found that across a variety of studies, there is a consistent relationship between experiencing weight stigma and many negative mental and physical health outcomes. These will be discussed separately in the sections below, although it should be noted that oftentimes physical and mental health consequences are intertwined, in particular those related to eating disorders.

Physical health and physiological consequences

Papadopoulos and Brennan (2015)recently found that across many reviewed studies, relationships emerged between experiencing weight stigma and both BMI and difficulty losing weight in weight loss treatment seek-ing adults. However the findings are somewhat mixed. They also report evidence that experiencing weight stigma is related to poor medication adherence. Among weight loss treatment-seeking adults, experiencing weight stigma might exacerbate weight- and health-related quality of life.

This review along with reviews by Vartanian and Smyth (2013) and Puhl and Suh (2015) have also found that across several studies and in both adults and children, experiencing weight stigma is related to decreased exercise behavior overall, as well as decreased motivation to exercise, decreased exercise self-efficacy, and increased food craving and tendency to overeat. It is important to note that these effects of weight stigma on exercise and physical activity emerge independent of Body Mass Index, suggesting that weight stigma becomes a unique barrier to physical activity outside of barriers that may be associated with over-weight and obesity in particular.

Finally, across many studies, Puhl and Suh (2015) also found that experiencing weight stigma is related to many physiological consequences as well, including increased blood pressure, augmented cortisol reactivi-ty, elevated oxidative stress, impaired glycemic control/elevated HbA1c, and increased systemic inflamma-tion, all of which have notable consequences for physical health and disease.

Mental health and psychological consequences

Broadly speaking, experiencing weight stigma is associated with psychological distress. Papadopoulos's 2015 review of the literature found that across several studies, this distress can manifest in anxiety, depres-sion, lowered self-esteem, and substance use disorders, both in weight loss treatment seeking individuals as well as community samples. Many empirical reviews have found that weight stigma has clear conse-quences for individuals suffering from eating and weight disorders (including Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder), as it plays a unique role, over and above other risk factors, in perpet-uating disordered eating psychopathology.

These results have emerged in both adult and adolescent samples and among both men and women. No-tably, the studies included in these reviews reported their results emerging over and above the degree of overweight/obesity in their respective subjects, suggesting that weight stigma, in particular, and not just being overweight or obese, precipitates these negative outcomes.

How are children affected by weight stigma?

Children who are overweight and obese are also targets of stigma and may be especially vulnerable to the consequences of bias. Negative attitudes towards obese youth develop in children as young as three years old, and children attribute multiple negative characteristics to overweight peers including being mean, stupid, ugly, unhappy, lazy, and having few friends. Peers are common perpetrators of weight-related teasing and derogatory names, and school is a frequent venue where stigma occurs. Bias and stigma have negative implications for emotional well-being in children. Research shows that children who are targets of weight stigma internalize negative attitudes and engage in self-blame for the negative social experiences that they confront. Research on adolescents has documented that weight-based teasing is associated with low self-esteem and depression, and that overweight teens are more likely to be socially isolated. Most alarming are recent studies demonstrating a positive association between obesity and suicidal attempts among youth. Stigmatization happen because of obesity.

What is obesity? Obesity is a condition where a person has accumulated so much body fat that it might have a negative effect on their health. If a person's bodyweight is at least 20% higher than it should be, he or she is considered obese. If your Body Mass Index (BMI) is between 25 and 29.9 you are considered overweight. If your BMI is 30 or over you are considered obese.

What is Body Mass Index (BMI)? The body mass index (BMI) is a statistical measurement derived from your height and weight. Although it is considered to be a useful way to estimate healthy body weight, it does not measure the percentage of body fat. The BMI measurement can sometimes be misleading - a muscleman may have a high BMI but have much less fat than an unfit person whose BMI is lower. However, in general, the BMI measurement can be a useful indicator for the 'average person'.

Why do people become obese?

People can become obese for many different reasons. This some of the most common ones:

Consuming too many calories.

These days’ people are eating much more food than in previous generations. This used to be the case just in developed nations. However, the trend has spread worldwide. Despite billions of dollars being spent on public awareness campaigns that attempt to encourage people to eat healthily, the majority of us continue to overeat. In 1980 14% of the adult population of the USA was obese; by 2000 the figure reached 31% (The Obesity Society). In the USA, the consumption of calories increased from 1,542 per day for women in 1971 to 1,877 per day in 2004. The figures for men were 2,450 in 1971 and 2,618 in 2004. Most people would ex-pect this increase in calories to consist of fat - not so! Most of the increased food consumption has con-sisted of carbohydrates (sugars). Increased consumption of sweetened drinks has contributed significantly to the raised carbohydrate intake of most young American adults over the last three decades. The consump-tion of fast-foods has tripled over the same period. Various other factors are also said to have contributed to America's increased calorie and carbohydrate intake.

In 1984 the Reagan administration freed up advertising on sweets and fast foods for children - regulations had previously set limits. Agricultural policies in most of the developed world have led to much cheaper foods. The US Farm Bill meant that the source of processed foods came from subsidized wheat, corn and rice. Corn, wheat and rice became much cheaper than fruit and vegetables.

Leading a sedentary lifestyle

With the arrival of televisions, computers, video games, remote controls, washing machines, dish washers and other modern convenience devices, people are commonly are leading a much more sedentary lifestyle compared to their parents and grandparent Some decades ago shopping consisted of walking down the road to the high street where one could find the grocers, bakers, banks, etc. As large out-of-town supermar-kets and shopping malls started to appear, people moved from using their feet to driving their cars to get their provisions. In some countries, such as the USA, dependence on the car has become so strong that many people will drive even if their destination is only half-a-mile away. The less you move around the fewer calories you burn. However, this is not only a question of calories. Physical activity has an effect on how your hormones work, and hormones have an effect on how your body deals with food. Several studies have shown that physical activity has a beneficial effect on your insulin levels - keeping them stable. Unstable insulin levels are closely associated with weight gain.

Not sleeping enough

Research has suggested that if you do not sleep enough your risk of becoming obese doubles. Research was carried out at Warwick Medical School at the University of Warwick. The risk applies to both adults and children. Professor Francesco Cappuccio and team reviewed evidence in over 28,000 children and 15,000 adults. Their evidence clearly showed that sleep deprivation significantly in-creased obesity risk in both groups. Professor Cappuccio said: "The 'epidemic' of obesity is paralleled by a 'silent epidemic' of reduced sleep duration with short sleep duration linked to increased risk of obesity both in adults and in children. These trends are detectable in adults as well as in children as young as 5 years." Professor Cappuccio explains that sleep deprivation may lead to obesity through increased appetite as a result of hormonal changes. If you do not sleep enough you produce Ghrelin, a hormone that stimulates appetite. Lack of sleep also results in your body producing less Leptin, a hormone that suppresses appe-tite.

Obesity gene

A faulty gene, called FTO, makes 1 in every 6 people overeat, a team of scientists from University College London reported in the Journal of Clinical Investigation (July 2013 issue). Lead researcher, Racher Batter-ham, explained that people who carry the FTO gene variant tend to eat too much, prefer high-energy, fatty foods, and are usually obese. They also appear to take much longer to reach satiety (feeling of being full).

How can weight stigma be reduced? Professionals in the obesity field, both researchers and clinicians, can employ a variety of strategies to help reduce weight stigma and improve attitudes. Health professionals can make a difference by becoming aware of their own biases, developing empathy, and working to address the needs and concerns of obese patients.

Some specific strategies for health professionals are outlined below:

1. Consider that patients may have had negative experiences with other health professionals regarding their weight, and approach patients with sensitivity
2.  Recognize the complex etiology of obesity and communicate this to colleagues and patients to avoid stereotypes that obesity is attributable to personal willpower
3.  Explore all causes of presenting problems, not just weight
4. Recognize that many patients have tried to lose weight repeatedly
5. Emphasize behavior changes rather than just the number on the scale
6. Offer concrete advice, e.g., start an exercise program, eat at home, etc., rather than simply saying, “You need to lose weight.”
7. Acknowledge the difficulty of lifestyle changes
8.  Recognize that small weight losses can result in significant health gains
9. Create a supportive health care environment with large, armless chairs in waiting rooms, appropriately-sized medical equipment and patient gowns, and friendly patient reading material.

Public health: a tool or a threat?

Although many health policy scholars and public health initiatives have suggested that weight stigma might motivate weight loss, the evidence from the existing literature largely does not support this notion. As cited above, experiencing weight stigma (both interpersonally as well as exposure to stigmatizing media cam-paigns) is consistently related to a lack of motivation to exercise and a propensity to overeat.

In review, examining whether weight stigma is an appropriate public health tool for treating and preventing overweight and obesity, Puhl and Heuer concluded that stigmatizing individuals with overweight and obesity is actually detrimental in three important ways: it threatens actual physical health, it perpetuates health dis-parities, and it actually undermines obesity treatment and intervention initiatives. In line with this, another recent review of the consequences of experiencing weight stigma, this one conducted by Puhl and Suh (2015), concluded that, considering the myriad negative physical and mental health consequences associated with experiencing of weight stigma, it should in fact be a target, instead of a tool, in obesity prevention and treatment. These authors further recommend that a necessary first step in reducing weight stigma is raising a broader awareness of its negative consequences.

Conclusion

For the conclusion, stigmatization of obesity is not new. It was foreshadowed centuries ago by attitudes deriving from then extent theories of the origins of obesity. However, weight stigma is associated with ad-verse physiological and psychological outcomes. This conclusion highlights the need to increase public and professional awareness about the issue of weight stigma and the importance of the further development of assessment and prevention strategies of weight stigma.