Restricted accessResearch articleFirst published online 2019-7
Perceived Weight Discrimination Mediates the Prospective Association Between Obesity and Physiological Dysregulation: Evidence From a Population-Based Cohort
Obesity is thought to cause ill health because of the biological strain that excess fat has on physiological function. We tested an alternative explanation in a population-based sample of 3,609 older English adults—that the pervasive discrimination experienced by individuals with excess weight may in part explain why obesity is associated with subsequent multisystem physiological dysregulation, measured via clinical indicators of cardiovascular, metabolic, and immune function. We found that both obesity and perceived weight discrimination predicted an increase in physiological dysregulation from baseline to follow-up 4 years later. Perceived discrimination because of body weight experienced by individuals with obesity explained more than one quarter of the prospective association between obesity and a deterioration in biomarkers of health status. These findings highlight the possibility that the stigma experienced by individuals with obesity may play an important role in explaining the obesity-related disease burden.
AndreyevaT.PuhlR. M.BrownellK. D. (2008). Changes in perceived weight discrimination among Americans, 1995–1996 through 2004–2006. Obesity, 16, 1129–1134.
2.
CraigR.DeverillC.PickeringK. (2006). Quality control of blood, saliva and urine analytes. In SprostonK.MindellJ. (Eds.), Health survey for England 2004: Methodology and documentation (pp. 34–41). Leeds, England: The Information Centre.
3.
DalyM.RobinsonE.SutinA. R. (2017). Does knowing hurt? Perceiving oneself as overweight predicts future physical health and well-being. Psychological Science, 28, 872–881.
4.
EpelE.LapidusR.McEwenB.BrownellK. (2001). Stress may add bite to appetite in women: A laboratory study of stress-induced cortisol and eating behavior. Psychoneuroendocrinology, 26, 37–49.
5.
GBD 2015 Obesity Collaborators. (2017). Health effects of overweight and obesity in 195 countries over 25 years. The New England Journal of Medicine, 377, 13–27.
6.
GuhD. P.ZhangW.BansbackN.AmarsiZ.BirminghamC. L.AnisA. H. (2009). The incidence of co-morbidities related to obesity and overweight: A systematic review and meta-analysis. BMC Public Health, 9, Article 88. doi:10.1186/1471-2458-9-88
7.
HampsonS. E.GoldbergL. R.VogtT. M.HillierT. A.DubanoskiJ. P. (2009). Using physiological dysregulation to assess global health status: Associations with self-rated health and health behaviors. Journal of Health Psychology, 14, 232–241.
8.
HatzenbuehlerM. L.KeyesK. M.HasinD. S. (2009). Associations between perceived weight discrimination and the prevalence of psychiatric disorders in the general population. Obesity, 17, 2033–2039.
9.
HeblM. R.RuggsE. N.SingletaryS. L.BealD. J. (2008). Perceptions of obesity across the lifespan. Obesity, 16(Suppl. 2), S46–S52.
10.
HimmelsteinM. S.Incollingo BelskyA. C.TomiyamaA. J. (2015). The weight of stigma: Cortisol reactivity to manipulated weight stigma. Obesity, 23, 368–374.
11.
HungerJ. M.MajorB. (2015). Weight stigma mediates the association between BMI and self-reported health. Health Psychology, 34, 172–175.
12.
JacksonS. E.BeekenR. J.WardleJ. (2015). Obesity, perceived weight discrimination, and psychological well-being in older adults in England. Obesity, 23, 1105–1111.
13.
JacksonS. E.KirschbaumC.SteptoeA. (2016). Perceived weight discrimination and chronic biochemical stress: A population-based study using cortisol in scalp hair. Obesity, 24, 2515–2521.
14.
JusterR. P.McEwenB. S.LupienS. J. (2010). Allostatic load biomarkers of chronic stress and impact on health and cognition. Neuroscience & Biobehavioral Reviews, 35, 2–16.
15.
KahnS. E.HullR. L.UtzschneiderK. M. (2006). Mechanisms linking obesity to insulin resistance and Type 2 diabetes. Nature, 444, 840–846.
16.
MajorB.EliezerD.RieckH. (2012). The psychological weight of weight stigma. Social Psychological and Personality Science, 3, 651–658.
17.
PascoeE. A.Smart RichmanL. (2009). Perceived discrimination and health: A meta-analytic review. Psychological Bulletin, 135, 531–554.
18.
PearlR. L. (2018). Weight bias and stigma: Public health implications and structural solutions. Social Issues and Policy Review, 12, 146–182.
19.
PearlR. L.WaddenT. A.HopkinsC. M.ShawJ. A.HayesM. R.BakizadaZ. M.. . . AlamuddinN. (2017). Association between weight bias internalization and metabolic syndrome among treatment-seeking individuals with obesity. Obesity, 25, 317–322.
20.
PotterL.WallstonK.TriefP.UlbrechtJ.JuthV.SmythJ. (2015). Attributing discrimination to weight: Associations with well-being, self-care, and disease status in patients with Type 2 diabetes mellitus. Journal of Behavioral Medicine, 38, 863–875.
21.
PuhlR. M.HeuerC. A. (2009). The stigma of obesity: A review and update. Obesity, 17, 941–964.
22.
RobinsonE.SutinA.DalyM. (2017). Perceived weight discrimination mediates the prospective relation between obesity and depressive symptoms in U.S. and U.K. adults. Health Psychology, 36, 112–121.
23.
SchaferM. H.FerraroK. F. (2011). The stigma of obesity: Does perceived weight discrimination affect identity and physical health?Social Psychology Quarterly, 74, 76–97.
24.
SchveyN. A.PuhlR. M.BrownellK. D. (2014). The stress of stigma: Exploring the effect of weight stigma on cortisol reactivity. Psychosomatic Medicine, 76, 156–162.
25.
SeemanT. E.McEwenB. S.RoweJ. W.SingerB. H. (2001). Allostatic load as a marker of cumulative biological risk: MacArthur studies of successful aging. Proceedings of the National Academy of Sciences, USA, 98, 4770–4775.
26.
SeplakiC. L.GoldmanN.GleiD.WeinsteinM. (2005). A comparative analysis of measurement approaches for physiological dysregulation in an older population. Experimental Gerontology, 40, 439–439.
27.
SteptoeA.BreezeE.BanksJ.NazrooJ. (2012). Cohort profile: The English Longitudinal Study of Ageing. International Journal of Epidemiology, 42, 1640–1648.
28.
StreinerD. L. (2003). Being inconsistent about consistency: When coefficient alpha does and doesn’t matter. Journal of Personality Assessment, 80, 217–222.
SutinA. R.StephanY.TerraccianoA. (2015). Weight discrimination and risk of mortality. Psychological Science, 26, 1803–1811.
33.
TomiyamaA. J. (2014). Weight stigma is stressful. A review of evidence for the cyclic obesity/weight-based stigma model. Appetite, 8, 8–15.
34.
TomiyamaA. J.CarrD.GranbergE. M.MajorB.RobinsonE.SutinA. R.BrewisA. (2018). How and why weight stigma drives the obesity ‘epidemic’ and harms health. BMC Medicine, 16, Article 123. doi:10.1186/s12916-018-1116-5
35.
TurveyC. L.WallaceR. B.HerzogR. (1999). A revised CES-D measure of depressive symptoms and a DSM-based measure of major depressive episodes in the elderly. International Psychogeriatrics, 11, 139–148.
36.
VadivelooM.MatteiJ. (2017). Perceived weight discrimination and 10-year risk of allostatic load among US adults. Annals of Behavioral Medicine, 51, 94–104.
37.
Van GaalL. F.MertensI. L.De BlockC. E. (2006). Mechanisms linking obesity with cardiovascular disease. Nature, 444, 875–880.
38.
VartanianL. R.PorterA. M. (2016). Weight stigma and eating behavior: A review of the literature. Appetite, 102, 3–14.
39.
VartanianL. R.ShaprowJ. G. (2008). Effects of weight stigma on exercise motivation and behavior: A preliminary investigation among college-aged females. Journal of Health Psychology, 13, 131–138.
40.
WilliamsD. R.YuY.JacksonJ. S.AndersonN. B. (1997). Racial differences in physical and mental health: Socio-economic status, stress and discrimination. Journal of Health Psychology, 2, 335–351.
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