Physiological mechanisms may also contribute to the relation between discrimination and unhealthy eating and weight gain. Psychological stress, particularly stress that involves heightened public awareness, engages the hypothalamic-pituitary-adrenal HPA axis and triggers cortisol release [35] , [36] , and experimental administration of glucocorticoids has been found to increase food intake [37].

Further, individuals with high cortisol reactivity tend to choose calorie-dense, high-fat foods following a social stress test [38]. In addition to the secretion of cortisol, activation of the HPA axis also stimulates the release of endogenous opioids, which serve to regulate HPA activity [39].

The release of such opioids stimulates intake of palatable foods, and palatable foods likewise encourage opioid release [40] ; a cycle may thus ensue that reinforces intake of high-fat, calorie-dense foods as a way to cope with stress.

The basic results were similar across analyses using either self-reported or measured weight and height. An interesting divergence emerged for the follow-up analyses on risk of becoming obese for participants who were normal weight at baseline.

For participants who fell in the normal weight range, there was a strong effect of discrimination on risk of self-reported obesity.

When obesity was derived from measured weight and height, however, none of the normal weight participants who reported discrimination became obese by follow-up. As with other factors, reliance on self-reported weight and height may exaggerate the effect of interest [41].

Of note, in contrast to normal weight participants, the effect of weight discrimination on risk of obesity for participants who were overweight at baseline was quite similar across reported and measured weight and height. Thus, weight discrimination has the greatest consequences for risk of obesity among those who are overweight or obese, which are the groups most likely to experience weight discrimination.

This study had several strengths, including a large and fairly diverse sample and a 4-year longitudinal interval. Future research could address some limitations. First, weight discrimination was assessed with a single-item measure.

Although previous research has successfully used single-item measures to examine health-related correlates of discrimination [26] and to document the correlates of weight bias [28] , a more detailed scale would provide more information on the relation between weight discrimination and the development of obesity.

In addition, the sample was drawn from an older population, which may have different experiences with weight discrimination than younger populations. It would be interesting to replicate these effects in young adults.

Finally, we did not test potential mechanisms that may lead from discrimination to obesity. Future research could test factors such as emotional eating and cortisol as mechanisms of this association. Given the complex etiology of obesity, creative approaches that span diverse disciplines are needed to combat its spread.

Weight discrimination, which is often justified because it is thought to help encourage obese individuals to lose weight [1] , can actually have the opposite effect: it is associated with the development and maintenance of obesity. Such discrimination is one social determinant of health that may contribute to inequities in employment, relationships, healthcare delivery, and body weight.

Conceived and designed the experiments: ARS AT. Performed the experiments: ARS AT. Analyzed the data: ARS. Wrote the paper: ARS. Browse Subject Areas?

Click through the PLOS taxonomy to find articles in your field. Article Authors Metrics Comments Media Coverage Reader Comments Figures. Abstract Weight discrimination is prevalent in American society. Newton, Pennington Biomedical Research Center, United States of America Received: November 20, ; Accepted: June 20, ; Published: July 24, Copyright: © Sutin, Terracciano.

Funding: The authors have no support or funding to report. Introduction There is a pervasive stereotype about obesity in American society: People who are obese are often perceived as lazy, unsuccessful, and weak-willed [1]. Methods Study Design Participants were drawn from the Health and Retirement Study HRS , a nationally representative longitudinal study of Americans ages 50 and older [23].

Discrimination Participants rated their experience of everyday discrimination [24] and then attributed those experiences to a number of personal characteristics, including weight [25].

Statistical Analysis We used logistic regression to test for the association between weight discrimination and change in obesity status. Results Weight discrimination was associated with becoming obese between baseline and follow-up: Among participants who were not obese at baseline, those who reported weight discrimination were approximately 2.

Download: PPT. Table 1. Discussion The mental health correlates of weight discrimination have been well documented; the present research indicates that there are also significant physical health correlates of such discrimination.

Author Contributions Conceived and designed the experiments: ARS AT. References 1. Puhl RM, Heuer CA Obesity stigma: Important considerations for public health.

Am J Public Health — View Article Google Scholar 2. Andreyeva T, Puhl RM, Brownell KD Changes in perceived weight discrimination among Americans, — through — Obesity — View Article Google Scholar 3.

Carr D, Friedman MA Is obesity stigmatizing? Body weight, perceived discrimination, and psychological well-being in the United States. J Health Soc Behav — View Article Google Scholar 4. Puhl RM, Luedicke J, Heuer C Weight-based victimization toward overweight adolescents: Observations and reactions of peers.

J School Health — View Article Google Scholar 5. Durso LE, Latner JD, White MA, Masheb RM, Blomquist KK, et al. Int J Eat Disord — View Article Google Scholar 6. Carels RA, Wott CB, Young KM, Gumble A, Koball A, et al. Eat Behav — View Article Google Scholar 7.

Vartanian LR, Novak SA Internalized societal attitudes moderate the impact of weight stigma on avoidance of exercise. View Article Google Scholar 8. Annis NM, Cash TF, Hrabosky JI Body image and psychosocial diffrences among stable average weight, currently overweight, and formerly overweight women: The role of stigmatizing experiences.

Body Image 1: — View Article Google Scholar 9. Roehling MV, Roehling PV, Pichler S The relationship between body weight and perceived weight-related employment discrimination: The role of sex and race. The stigma and prejudice towards obese persons significantly impact adverse physical and psychological outcomes.

The current belief is that labeling an individual obese will motivate weight loss. Weight stigma is also associated with an increased risk of depression, anxiety, suicidal thoughts, and low self-esteem. When obese patients experience weight bias in a medical setting, they are more likely to cancel appointments and avoid future preventative health care, ultimately increasing their medical risks and healthcare costs.

Weight stigma affects healthcare access and outcomes for obese individuals. Some studies have demonstrated elevated C-reactive protein levels indicating systemic inflammation in individuals with perceived weight stigmatization. These factors can lead to delayed cancer diagnoses, increasing morbidity and mortality.

Weight bias and stigma are troubling, influencing perceptions and resource allocation for crucial obesity-related research. This unfortunate reality has resulted in chronic underfunding, hindering the advancement of knowledge in this field. Even interventions like weight loss surgeries are not immune to societal bias.

One study revealed that individuals undergoing weight loss surgeries face more negative judgments compared to those who lose weight through diet and exercise alone. In the healthcare sector, it's crucial for professionals to confront weight stigma and acquire a comprehensive understanding of obesity.

When discussing the need for weight loss, healthcare providers should consider not only biological factors but also environmental influences. This involves effective communication and creating clinical settings that accommodate patients.

Healthcare providers must also be mindful of the language they use when interacting with patients. Research indicates that terms like obese , fat , and morbidly obese can have negative outcomes, whereas referring to patients as individuals with obesity or specifying the grade of obesity can yield more positive results.

To further improve interpersonal interactions and avoid embarrassment for obese patients, clinicians should ensure their physical environment includes office chairs that are armless and large enough to seat overweight patients and provide large gowns and medical equipment such as larger blood pressure cuffs and scales.

In primary care settings, the 5 As method ask, assess, advise, agree, and assist offers a nonjudgmental framework for obesity counseling. This approach involves asking patients for permission to discuss weight, assessing their readiness for change, evaluating key metrics like BMI, waist circumference, and obesity stage, providing advice on associated health risks, shifting the focus toward behavior rather than just weight, setting realistic weight-loss expectations and treatment plans, and assisting patients in identifying and addressing barriers.

It's essential to recognize obesity as a chronic, relapsing disease throughout this process. In addition to generating awareness, a pivotal strategy for combating weight bias involves advocating for the implementation of robust public policies.

These policies should span various domains, including education, employment, healthcare, and public spaces, ensuring protection against unjust treatment for individuals with obesity. Engaging in open dialogues is vital to garner support, dispel misconceptions, and highlight the detrimental impact of weight bias on individuals' mental and physical well-being.

To bring about meaningful change, we must take a 2-pronged approach: first, we need to increase awareness to reshape how society perceives obesity, and second, we must push for legislative reforms that provide concrete protections.

By adopting this approach, we can work towards creating a fairer and more inclusive society where individuals with obesity are treated with respect, receive support, and are empowered to succeed without the burden of unfair bias or discrimination.

Disclosure: Melody Fulton declares no relevant financial relationships with ineligible companies. Disclosure: Sriharsha Dadana declares no relevant financial relationships with ineligible companies. Disclosure: Vijay Srinivasan declares no relevant financial relationships with ineligible companies.

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Author Information and Affiliations Authors Melody Fulton 1 ; Sriharsha Dadana 2 ; Vijay N. Affiliations 1 West Virginia School of Medicine. Obesity Classification Table. Issues of Concern Understanding Weight Stigma Weight stigma refers to individuals' social devaluation and denigration due to their excess body weight, leading to negative attitudes, stereotypes, prejudice, and discrimination.

Clinical Significance The current belief is that labeling an individual obese will motivate weight loss. Nursing, Allied Health, and Interprofessional Team Interventions Addressing Weight Stigma in Healthcare Settings In the healthcare sector, it's crucial for professionals to confront weight stigma and acquire a comprehensive understanding of obesity.

Nursing, Allied Health, and Interprofessional Team Monitoring To bring about meaningful change, we must take a 2-pronged approach: first, we need to increase awareness to reshape how society perceives obesity, and second, we must push for legislative reforms that provide concrete protections.

Review Questions Access free multiple choice questions on this topic. Comment on this article. References 1. Hales CM, Fryar CD, Carroll MD, Freedman DS, Aoki Y, Ogden CL. Differences in Obesity Prevalence by Demographic Characteristics and Urbanization Level Among Adults in the United States, Ward ZJ, Bleich SN, Cradock AL, Barrett JL, Giles CM, Flax C, Long MW, Gortmaker SL.

Projected U. State-Level Prevalence of Adult Obesity and Severe Obesity. N Engl J Med. Li M, Gong W, Wang S, Li Z. Trends in body mass index, overweight and obesity among adults in the USA, the NHANES from to a repeat cross-sectional survey.

BMJ Open. Apovian CM. Obesity: definition, comorbidities, causes, and burden. Am J Manag Care. Cawley J, Biener A, Meyerhoefer C, Ding Y, Zvenyach T, Smolarz BG, Ramasamy A. Direct medical costs of obesity in the United States and the most populous states.

J Manag Care Spec Pharm. Nuttall FQ. Body Mass Index: Obesity, BMI, and Health: A Critical Review. Nutr Today. Ross R, Neeland IJ, Yamashita S, Shai I, Seidell J, Magni P, Santos RD, Arsenault B, Cuevas A, Hu FB, Griffin BA, Zambon A, Barter P, Fruchart JC, Eckel RH, Matsuzawa Y, Després JP.

Waist circumference as a vital sign in clinical practice: a Consensus Statement from the IAS and ICCR Working Group on Visceral Obesity. Nat Rev Endocrinol. Okorodudu DO, Jumean MF, Montori VM, Romero-Corral A, Somers VK, Erwin PJ, Lopez-Jimenez F. Diagnostic performance of body mass index to identify obesity as defined by body adiposity: a systematic review and meta-analysis.

Nearly two thirds of the most popular children's movies contain negative portrayals of fat people, stereotyping them to be unintelligent, lazy, and evil. In , another analysis sampled scenes featuring overweight individuals from popular television programs and movies are coded for anti-fat humor.

The majority of anti-fat humor found was verbal and directed at the individual in their presence. There is a great deal of empirical research to support the idea of thin ideal media, or the idea that the media tends to glorify and focus on thin actors and actresses, models, and other public figures while avoiding the use of overweight individuals.

Puhl et al. News reports have blamed individuals who are overweight and obese for various societal issues including prices of fuel, global temperature trends, and precipitating weight gain among their peers.

The University of California, Los Angeles , conducted a study that analyzed scientific research on weight and the news reports on such research. They looked for disparities in language, the cited causes of obesity, and proposed solution. News stories were more likely than the scientific articles to use dramatized language, words such as epidemic, crisis, war, and terrorism, and were more likely to cite individual behaviors as the causes and solutions to obesity, ignoring the systemic issues.

In September , prominent nationally syndicated columnist Michael Kinsley founding editor of Slate magazine wrote, "New Jersey Governor Chris Christie cannot be president: He is just too fat why should Christie's weight be more than we can bear in a president?

Why should it even be a legitimate issue if he runs? One reason is that a presidential candidate should be judged on behavior and character Perhaps Christie is the one to help us get our national appetites under control.

But it would help if he got his own under control first. To say that, because you're overweight, you are therefore undisciplined—you know, I don't think undisciplined people get to achieve great positions in our society, so that kind of stuff is just ignorant.

In , Haley Morris-Cafiero 's photography project "Wait Watchers", in which she photographed the reactions to her presence by random passers-by, went viral. New York magazine wrote, "The frequency with which Morris-Cafiero succeeds at documenting passersby's visible disdain for her body seems pretty depressing".

Research suggests that within the classroom teachers may perceive overweight individuals' work more poorly compared to average weight individuals. Puhl and colleagues concluded from their review of weight stigma in education that current trends indicate students with obesity face barriers to educational success at every level of education.

Several studies have evidenced that in environments such as these, students with obesity face greater educational disadvantages and are less likely to attend college, an effect that is particularly strong among women.

Studies suggest that obese individuals are less likely to be hired and once hired, have greater termination rates than average weight individuals. Weight stigma can lead to 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.

find that employees with obesity report their weight as the most influential factor contributing to losing their job. A study by Michigan State University researchers shows evidence that overweight political candidates tend to receive fewer votes than their thinner opponents.

Senate elections. Using a previously established scientific method, research assistants determined from color photos whether the candidates in primary and general elections were of normal weight, overweight, or obese.

Both obese men and women were often less likely to get on the ballot in the first place. When it came to merely being overweight, women were seen underrepresented on the ballot, though men were not.

This is consistent with previous research showing slightly overweight men tend not to experience the same discrimination as slightly overweight women. However, when it came to the voting, both male and female candidates, whether obese or simply overweight, tend to get a lower share of the vote total than their more slender opponents.

Some politicians have resorted to extreme weight loss measures, including surgery, to increase their elect-ability to political office. Medical professionals may be more likely to view obese individuals in negative terms such as annoying or undisciplined , have less patience with obese individuals, and assume non-compliance with their treatments.

Primary care physicians overstate the effects of being overweight on all-cause mortality, [63] describing being overweight as much more detrimental than clinical guidelines indicate.

In their 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 obesity, in particular ascribing to them culpability for their weight status.

Therefore, Puhl and colleagues concluded that research examining actual health outcomes is needed. Although a less studied topic than employment and healthcare, several studies reviewed by Puhl and colleagues provide evidence that overweight and obese women in particular face weight stigma from many interpersonal sources including family, friends, and romantic partners.

This external stigmatization and its internalized effects have been examined across different age groups. Overweight and obese children and adolescents experience stigmatization from parents, teachers, and peers.

Specifically, weight bias may become internalized and increases throughout childhood. It then decreases and levels-off during late adolescence and adulthood. Weight-based teasing in childhood and adolescence has been associated with a variety of damages to psychosocial health, including reduced self-esteem and lower self-concept , [72] [73] higher rates of depression and anxiety disorders , [74] [75] [76] and even greater likelihood of entertaining suicidal thoughts.

A survey of 7, children aged 11 to 16 conducted by the World Health Organization reported higher rates of physical victimization e. Additionally, these results showed relational victimization i.

Additionally, obese girls were more likely to be victims and perpetrators of bullying than their peers. Notably, overweight and obese adolescent girls also reported higher rates of smoking, drinking, and marijuana use relative to their normal-weight peers.

In adulthood, individuals who experience weight discrimination are more likely to identify themselves as overweight regardless of their actual weight status. People who expect to be fat-shamed by healthcare providers are less likely to seek care for medical issues or for weight loss, even if the weight gain is caused by medical problems.

In terms of psychological health, researchers found that obese individuals demonstrated a lower sense of well-being relative to non-obese individuals if they had perceived weight stigmatization even after controlling for other demographic factors such as age and sex.

In both adults and children with 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. Papadopoulos and Brennan recently found that across many reviewed studies of weight loss treatment-seeking adults, [91] relationships emerged between experiencing weight stigma and both BMI and difficulty losing weight.

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 issues.

Broadly speaking, experiencing weight stigma is associated with psychological distress. There are many negative effects connected to anti-fat bias, the most prominent being that societal bias against fat is ineffective at treating obesity, and leads to long-lasting body image issues, eating disorders, suicide, and depression.

Papadopoulos's review of the literature found that across several studies, this distress can manifest in anxiety , depression , lowered self-esteem , and substance use disorders , both in weight loss treatment-seeking individuals as well as community samples.

Over the past few decades, many scholars [ who? At the local level, only one state in the US Michigan has policy in place for prohibiting weight-related employment discrimination and very few local municipalities have human rights ordinances in place to protect individuals of large body size.

For example, the Americans with Disabilities Act is one such avenue, but as Puhl et al. The existing literature largely does not support the notion that weight stigma might encourage weight loss; as cited above, experiencing weight stigma both interpersonally as well as exposure to stigmatizing media campaigns is consistently related to a lack of motivation to exercise and a propensity to overeat.

With higher representation of black people being categorized as overweight by the BMI, the social stigma of obesity disproportionately affects black people. Sociologist Sabrina Strings writes, in her book Fearing the Black Body , about the historical ways in which fatphobia emerged out of an attempt by white people to distance themselves from black people.

In , Denis Diderot published the Encyclopédie , which was the first publications to claim that black people were "fond of gluttony. It was, moreover, racially inherited.

Black bodies are already stigmatized, which can result in violence when interacting with the social stigma of obesity. In a article published in the African American Review , one author cited the killing of Eric Garner as an example of this, as some excuses for using excessive force on Garner were his size, as he was an overweight man.

The findings of this publication demonstrated that there were no significant differences in weight stigma as a function of race or gender, having an overall equal representation across all racial groups analyzed.

Nonetheless, results additionally demonstrated that different racial groups had differing ways of internalizing and coping with weight and health-related stigmas, which as a result heightened health risks. Additionally, Hispanic women demonstrated to cope with weight stigma via disordered eating patterns more than black and white women.

The results of this research article highlighted the importance of needing to increase research and policy attention to addressing weight and health-related stigma as an issue regarding prevention and treatment for obesity in order to consequently decrease weight-driven inequalities in communities and differing groups, primarily focused on race and gender.

The fat acceptance social movement in the USA emerged in the s to highlight and counter social stigma and discrimination faced in a range of domains. Besides its political role, for example in the form of anti-discrimination NGOs and activism, the fat acceptance movement also constitutes a subculture which acts as a social group for its members.

The fat acceptance movement often uses the adjective "fat" as a reclaimed word. Preferences regarding terminology and descriptions vary, however, with common disagreements revolving around which words to use e. Person-first language , which emerged from some disability advocacy groups, has the ostensible goal of treating a person independently of a trait.

However, it also has the consequence of treating that trait as "toxic" abnormality which should be "fixed" to achieve normalcy, and which due to its inherent negativity must be talked about in a special, careful way, rather than used as a simple "benign" descriptor.

This may explain why person-first language is favored more often by those working in the obesity field and therefore seeking medical "fixes" than by other groups. Advocacy groups have criticized a top-down approach whereby proponents of person-first language claim to speak for all, whereas in reality it is not the preferred terminology of many in the fat-acceptance movement.

Various studies of overweight people seeking weight loss as well as a semantics study of terminology used to describe an overweight individual concluded that using the word fat elicits a negative reaction from people already critical of obesity.

Fat activist Aubrey Gordon argues that "disavowing the term fat reinforces its negative meanings. What We Don't Talk About When We Talk About Fat , Happy Fat , Things No One Tells Fat Girls , and Fat! Likewise, The National Association to Advance Fat Acceptance NAAFA was founded in , with the descriptor of the community being "fat.

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Download as PDF Printable version. In other projects. Wikimedia Commons. Type of discrimination based on weight. The examples and perspective in this article deal primarily with the United States and do not represent a worldwide view of the subject.

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Weight stigma refers to social stereotypes and misconceptions about obesity. These social stereotypes and misconceptions include beliefs that people with obesity are lazy, awkward, sloppy, non-compliant, unintelligent, unsuccessful and lacking self-discipline or self-control.

If you have ever been the victim of weight discrimination, you are not alone. Read on to learn more about what it is, how it can it can affect you and steps that you can take to eliminate this issue. Weight bias and stigma can lead to weight discrimination. This is when we enact our personal biases and the social stereotypes about obesity and treat people with obesity unfairly.

The unfair treatment that people with obesity face is called obesity stigmatization or weight discrimination. Obesity is a medical condition that can be caused by multiple factors. However, people often think that individuals living with obesity are personally responsible for their weight because they just eat too much or do not exercise enough.

This belief is a fundamental driver of weight bias, stigma and discrimination. Click here to open our weight bias infographic. Person First Language Briefing Note Weight Bias. Weight Bias Sample Member T Click here: Applying A Weight Bias Lens To Public Health Policies.

Studies have shown that physicians show strong anti-fat bias in health care situations. This bias results in reduced quality of care, and is yet another way in which weight stigma contributes to poor health in people with overweight and obesity.

Just as in everyday situations, there are many ways to address stigma in health care settings. Clinicians should of course follow the same recommendations as above, to acknowledge the existence of weight stigma and strive to use person-first language in their speech and medical documentation.

In addition, dispensing with the standard cookie-cutter advice to eat less and exercise more to lose weight would be of great benefit to patients. This type of advice doesn't take into account the many environmental, genetic, and physiologic causes of obesity, and puts blame on the patient as the sole cause and contributor of their obesity.

Clinicians should also take care not to assume a patient with obesity is automatically engaging in overeating behaviors, and should believe their patients' reports of dietary intake and physical activity.

The clinical visit should be focused on information gathering and understanding of a patient's particular situation. Copyright: © Sutin, Terracciano. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Competing interests: The authors have declared that no competing interests exist. There is a pervasive stereotype about obesity in American society: People who are obese are often perceived as lazy, unsuccessful, and weak-willed [1].

These beliefs about individuals with obesity are often translated into negative attitudes [2] , discrimination [3] , and verbal and physical assaults [4].

Such bias can have severe psychological consequences, including increased vulnerability to depression [5] , [6] and lower self-esteem [5] , [7] , self-acceptance [3] , and life satisfaction [8].

In addition, as with other forms of discrimination [16] , [17] , weight discrimination may have consequences for physical health [18] , [19].

Individuals cope with discriminatory experiences in a number of ways. A growing literature links weight bias with a number of coping behaviors, including problematic eating [6] , [20] and avoidance of physical activity [7] , [21].

For example, high school students who report feeling negative emotions due to weight-based victimization are more likely to cope by avoiding physical activity, including gym class, and are more likely to report increased food consumption [22].

This effect is not limited to high school students; adults who believe the negative stereotypes of obesity are true are more likely to refuse to diet and binge eat [20]. Thus, one coping mechanism for individuals who experience weight discrimination is to engage in the behaviors that are conducive to obesity.

As such, weight bias has been linked to factors that contribute to weight gain, but it has yet to be associated with actual changes in obesity over time. To that end, the present study tests whether reported weight discrimination is associated with becoming obese and remaining obese over a four-year period in a national sample of American adults.

We hypothesize that among participants who are not obese at baseline, those who experience weight discrimination will be at greater risk for becoming obese by follow-up. Likewise, we hypothesize that among participants who are obese at baseline, those who experience weight discrimination will be at greater risk of remaining obese at follow-up.

We also examine whether this effect generalizes to discrimination based on other characteristics e. Participants were drawn from the Health and Retirement Study HRS , a nationally representative longitudinal study of Americans ages 50 and older [23].

HRS participants are re-interviewed every two years. Starting in , participants in the enhanced face-to-face interview received a psychosocial questionnaire that they completed and returned by mail to the University of Michigan. Starting in , this questionnaire included items about the experience of different types of discrimination, including weight see below.

We used the assessment as the baseline, since discrimination was first measured in this assessment. We used the obesity data from the assessment as the follow-up to have the longest longitudinal interval between assessments. These participants were, on average, Human subjects approval for the HRS was obtained through the Institutional Review Board at the University of Michigan.

Of the 4, participants who were not obese at baseline, 5. When BMI was derived from measured weight and height, 2, participants were not obese at baseline, and of those, participants 5.

Of the participants who were obese at baseline, Participants rated their experience of everyday discrimination [24] and then attributed those experiences to a number of personal characteristics, including weight [25]. Although single-item measures are not ideal, they have been used successfully to examine the effect of race [26] and sex [27] discrimination on smoking, to track trends in weight discrimination over time [2] , and to document the correlates of weight bias [28].

We used logistic regression to test for the association between weight discrimination and change in obesity status. Weight discrimination was entered into a logistic regression to predict which participants, who were not initially obese at baseline, would become obese by follow-up and whether it would predict if obese participants at baseline would remain obese at follow-up.

All analyses controlled for age, age squared, sex, ethnicity, and education. We likewise used logistic regression to examine whether discrimination based on other characteristics race, ancestry, sex, age, physical disability, other aspects of physical appearance, sexual orientation was associated with becoming obese or remaining obese over the follow-up period, controlling for the same demographic characteristics.

We also reran all analyses controlling for baseline BMI. We did a number of follow-up analyses to examine the robustness of the initial findings. First, we repeated the logistic regressions using BMI derived from measured weight and height. Third, we tested for interactions between weight discrimination and age, sex, ethnicity, and education to test whether these demographic factors moderated the association between weight discrimination and obesity status.

We used SPSS 21 for all analyses. Weight discrimination was associated with becoming obese between baseline and follow-up: Among participants who were not obese at baseline, those who reported weight discrimination were approximately 2. This effect was specific to weight discrimination; the other types of discrimination were largely unrelated to reported obesity.

That is, none of the other types of discrimination assessed were associated with becoming obese between the two assessments. The one exception was age discrimination, which was associated with becoming obese, but this association was reduced to non-significant once baseline reported BMI was included in the analysis.

The findings were similar when we used BMI derived from measured weight and height. We next examined whether the effect of discrimination on risk of obesity was similar for normal weight versus overweight participants. Interestingly, a slightly different pattern emerged when the analyses were based on measured BMI.

In contrast, when this sample was limited to normal weight participants at baseline, there was not enough data for the analysis: of the 14 participants in the normal weight category who reported weight discrimination, none became obese. Similar to weight gain, weight discrimination was associated with remaining obese over the period between the two assessments see Table 1.

That is, those who experienced discrimination based on their weight were over three times more likely to remain obese at follow-up, rather than drop below the obesity threshold, than those who did not experience such discrimination.

The effect was similar when we used BMI derived from measured weight and height. Finally, none of these associations were moderated by any of the demographic factors, which indicated that the association between weight discrimination and risk of becoming and remaining obese did not vary by age, sex, ethnicity, or education.

The mental health correlates of weight discrimination have been well documented; the present research indicates that there are also significant physical health correlates of such discrimination.

These findings follow from the related literature on racial discrimination that shows that discrimination increases risk of hypertension [17] , severe coronary obstruction [29] , and elevated inflammatory markers, such as C-reactive protein [30].

Like other forms of discrimination, body weight is a highly visible, personal characteristic that can evoke strong stereotypes and strong reactions from others.

There are both behavioral and physiological mechanisms that may contribute to the relation between discrimination and obesity. Weight discrimination is associated with behaviors that increase risk of weight gain, including excessive food intake and physical inactivity.

There is robust evidence that internalizing weight-based stereotypes [20] , teasing [31] , and stigmatizing experiences [32] are associated with more frequent binge eating. Overeating is a common emotion-regulation strategy, and those who feel the stress of stigmatization report that they cope with it by eating more [22].

Individuals who endure stigmatizing experiences also perceive themselves as less competent to engage in physical activities [33] and are thus less willing to exercise and tend to avoid it [21]. Finally, heightened attention to body weight is associated with increased negative emotions and decreased cognitive control [34].

Increased motivation to regulate negative emotions coupled with decreased ability to regulate behavior may further contribute to unhealthy eating and behavioral patterns among those who are discriminated against. Physiological mechanisms may also contribute to the relation between discrimination and unhealthy eating and weight gain.

Psychological stress, particularly stress that involves heightened public awareness, engages the hypothalamic-pituitary-adrenal HPA axis and triggers cortisol release [35] , [36] , and experimental administration of glucocorticoids has been found to increase food intake [37].

Further, individuals with high cortisol reactivity tend to choose calorie-dense, high-fat foods following a social stress test [38]. In addition to the secretion of cortisol, activation of the HPA axis also stimulates the release of endogenous opioids, which serve to regulate HPA activity [39]. The release of such opioids stimulates intake of palatable foods, and palatable foods likewise encourage opioid release [40] ; a cycle may thus ensue that reinforces intake of high-fat, calorie-dense foods as a way to cope with stress.

The basic results were similar across analyses using either self-reported or measured weight and height.

An interesting divergence emerged for the follow-up analyses on risk of becoming obese for participants who were normal weight at baseline.