D is for Discrimination; The Rhetoric of Obesity.

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Obesogenic: limited access to fresh fruit and vegetables

Obesity is a threat to global health – the World Health Organisation reports that 2.8 million die each year as a result of obesity. 65% of the world’s population live in a country where overweight kills more than underweight.

According to the Trust for American Health, today’s generation will be the first in US history to live shorter and sicker lives than their parents.

The environment for many is “obesogenic,” by it’s very nature it contributes to obesity as a consequence of it being built up, urban, and offering only limited access to nutrient food and recreational space, yet an abundance of junk food.

In many ways, there is an element of powerlessness for the individual. This has been highlighted in the UK Gov Foresight report; “Tackling Obesities – Future Choices Project”, a UK Government Office of Science study into obesity. One of the main findings by the study is that obesity can no longer be prevented by individual action alone.

Major findings of the Foresight report  include –

  • Modern living ensures that each generation is heavier than the one before
  • The obesity epidemic cannot be prevented by individual action alone
  • Preventing obesity requires a societal challenge, similar to climate change

Despite the research, the modern obesogenic environment that has been created is often ignored — blame set squarely on the lap of the overweight individual for being overweight. Disapproval for obesity is prolific; evident in media, society and individual opinion.

Images of obese individuals are prerequisite of  articles on weight and obesity. The cliché of the typical overweight image in media made number 7 in the Independent Top Ten Visual Clichés, sharing the list of tired clichés along with wedding cake decorations for gay marriage, (number 1) and gas cooker flames for gas bill price hikes, (number 4).

Clichés are easy, and useful. The trouble with a cliché (excuse the one coming….) is that when a cliché is an image, it can speak a thousand words — most of them discriminative when compounding negative views held against a vulnerable group. A study published in PLOS One  found that most people considered overweight people as “lazy, unsuccessful, weak-willed” – an image of a large person at a fast food outlet will only cement the idea of the overweight as defective, less than.

D is for Discrimination

Women and children of low-income or low social economic status have been proven to be consistently more at risk of obesity than any other group, according to research by the Food Research and Action Center (FRAC).

Adult Poverty and Obesity, The Relationship Based on General Trends (excerpt) –

  • Based on a large national study, body mass index (or BMI, an indicator of excess body fat) was higher every year between 1986 and 2002 among adults in the lowest income group and the lowest education group than among those in the highest income and education groups, respectively (Truong & Sturm, 2005).
  • Wages were inversely related to BMI and obesity in a nationally representative sample of more than 6,000 adults – meaning, those with low wages had increased BMI as well as increased chance of being obese (Kim & Leigh, 2010)

With obesity proven to be the shackle of a specific group — low income, uneducated women and children, it is outdated to condemn the individual, to trivialize, or question the validity of obesity as a disease.

Yet, it happens, frequently and publicly. Obesity has made recent headlines in national media and the world has seen the best and the worst of  journalist puns on weight; “The Big Fat Lie,” “The Big Fat Truth,” “Fat Profits,” “Heavy Burden,” and even “F is for Fat,” — the title of an official study into obesity by the Robert Wood Johnston Foundation.

Obesity can cause obesity related cancers, Type 2 diabetes, cardiovascular disease. It is difficult to imagine any other disease so open to puns and play on words.

Is obesity, the last form of socially acceptable discrimination? Joseph Nadglowski of the President of the Obesity Action Coalition, thinks yes –

Obesity carries with it one of the last forms of socially acceptable discrimination. We, as a society, need to make every possible effort to eradicate it from our culture.” Joseph Nadglowski, President and CEO,  Obesity Action Coalition

The Consequence of Weight Bias

In a study by Florida State University College of Medicine, researchers proved that perceived weight discrimination leads to longitudinal changes in obesity.

Published on PLOS One, “Perceived Weight Discrimination and Obesity,” researched by Angelina R. Sutin Ph.D.,  and Antonio Terracciano Ph.D studied  6157 patients over a 4 year period, tracking BMI’s and individual experiences of  perceived weight discrimination.

Participants rated  experiences of everyday discrimination in a psychosocial survey,   attributing perceived discrimination to weight, ancestry, sex, race, age, physical disability, any other aspects of their physical appearance, and/or their sexual orientation.

4,193 of the 6157 were at baseline BMI at the beginning of the study — 1,964 were clinically obese.

Of the 4,193 participants who were not obese at baseline, 357 (5.8%) became obese by follow-up, and of the 1,964 participants who were obese at baseline, 1,618 (26.3%) remained obese at follow-up.

Participants who reported experiencing a perceived weight discrimination were 2.5 times more likely to become obese, and obese participants 3 times more likely to remain obese than those who had did not report experience weight discrimination.

These effects held even when BMIs were used as  a variable to predict outcomes, and despite ethnic and other bias affecting results.

Why Weight Bias?

According to a Rudd Center for Food Policy and Obesity report, weight bias exists because as a society, we share a belief that individuals are responsible for their own weight and refuse to consider the environmental conditions that cause obesity. Culturally, we value thinness, and, anything that strays from the acceptable idea of body image is considered a flaw, a failure even, belonging to the individual. Negative views are further compounded by negative portrayal of obese individuals, coupled with a media obsession with the body and its appearance.

According to researchers, discrimination against obese Americans is pervasive in society. Such biased and negative attitudes are thought to lead to depression,  a negative effect on employment opportunities, salary disparities, healthcare access.

The Rudd Center found in a recent study that even mental health workers working specifically with patients with eating disorders were “not immune to weight bias.”

At its worst, discrimination against people with excess weight can lead to the very behaviors that exasperate obesity; avoiding physical exercise and binge eating, and, as the study by the Florida State University College of Medicine proves, a longitudinal weight increase.

The measure of a society has long been judged by how it treats its weakest –

Any society, any nation, is judged on the basis of how it treats its weakest members — the last, the least, the littlest.” ~Cardinal Roger Mahony, In a 1998 letter, Creating a Culture of Life

An inability for us to foster compassion for those who suffer the consequence of health and economic inequity, makes us all small.

Notes:

The Independent, Top Ten: Visual cliches
http://www.independent.co.uk/news/media/tv-radio/the-top-ten-visual-clichs-8665467.html

Foresight Report – Tackling Obesities – Future Choices (2007)
http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Publichealth/Healthimprovement/Obesity/DH_079713

FRAC: Relationship between Poverty and Obesity
http://frac.org/initiatives/hunger-and-obesity/are-low-income-people-at-greater-risk-for-overweight-or-obesity/

Perceived Weight Discrimination
http://www.plosone.org/article/info:doi/10.1371/journal.pone.0070048

Consequences of Obesity (FRAC)
http://frac.org/initiatives/hunger-and-obesity/what-are-the-consequences-of-adult-overweight-and-obesity/

Rudd Center for Food Policy & Obesity
http://www.yaleruddcenter.org/mental-health-professionals-treating-eating-disorders-are-not-immune-to-weight-bias

Image credit: RGB Free Stock
Thanks to photographer tacluda

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