obesity ethics and human rights perspective

public health

obesity + chronic diseases are health equity issues

also mental health issues

Strong evidence links weight stigma to increased vulnerability for many health outcomes

outcomes include: depression, anxiety, low self-esteem, poor
body image, substance use, and suicidality among youth

Unlike other forms of discrimination, such as gender, race/ethnicity, and age, there are few legal protections for weight-based stigma and discrimination

“Weight stigma is damaging to both emotional and physical health,
and it decreases quality of life,” said psychologist Dr. Rebecca Puhl,
University of Connecticut and deputy director of the university’s Rudd
Center for Food Policy and Health.

tells us that we need to address weight stigma not only as a social justice issue but also a public health issue

stigma vs discrimination

weight stigma or bias:

• Negative weight-related attitudes

• stereotypes

• ideas of laziness of lacking will power

• verbal teasing, aggression

• relational victimization

weight discrimination:

• unequal or unfair treatment due to weight

• obese individual is qualified for a job, but not hired due to weight

• denied a medical procedure

• denied scholarship / admission

• prevented from renting or buying a home

42% of adults in the US state that they have faced some type of weight related stigma

areas of predjucide and discrimination

Hiring prejudice
• workplace is one sphere where overweight people may be vulnerable to
discriminatory attitudes and weight bias.
• Inequity in Wages, Promotions, and Employment Termination
• Overweight employees are assumed to lack self-discipline, be lazy, less
conscientious, less competent, sloppy, disagreeable, and emotionally
unstable
• An analysis from the National Longitudinal Survey Youth Cohort examined
earnings in over 8,000 men and women 18 to 25 years old and reported that
obese women earned 12% less than non-obese women

impacts of weight stigma

• Perhaps ironically, weight stigma leads to a decrease in health-seeking
  behaviors—and an increase in weight—over time.
  • Regardless of their body mass index (BMI), people who face weight stigma
  are more likely to engage in disordered eating or unhealthy eating
  behaviors, such as binge eating
  • More likely to avoid exercising and to report feeling uncomfortable
  exercising in public

areas of predjudice and discrimination: health care

Health care and healthcare workers (HCW)
• Negative attitudes of HCW towards obese individuals
may affect quality of care
• Physicians were mailed anonymous questionnaires and
asked to specify five diagnostic categories and social
characteristics of patients to which they responded
negatively. Obesity fourth most common category listed
(among dozens of other categories), and ranked behind
only drug addiction, alcoholism, and mental illness.
• May deter obese individuals from seeking care
• Over 12% of women indicated that they delayed or
canceled physician appointments due to weight
concerns, and of the 33% of women who had
discussed weight with their physicians, discussions
were described as negative

insurance and health care cost obstacles

Treatment and prevention are seldom emphasized
by insurance providers.
• With more Americans overweight, obesity has
become a leading cause of preventable death.
• Beliefs that obesity treatment is unsuccessful and
too costly have been challenged.
• Weight losses as small as 10% are associated
with substantially reduced health care costs,
reduced incidence of obesity-related comorbid
conditions, and increased lifetime expectancy

Even with some evidence of cost-savings for some
weight-loss methods, medical coverage is
inconsistent. Surgical treatment is often not
reimbursed even though diseases with less
supported treatments are compensated
• In 1998, the IRS excluded weight loss programs as a
medical deduction, even when prescribed by a
doctor.
• In response, several organizations such as the
American Obesity Association filed petitions for a
ruling to allow the costs of obesity treatment to be
included as a medical deduction. As of 2000, the IRS
policy changed its criteria, allowing costs for
weight-loss treatments to be deducted by
taxpayers for certain treatment programs under a
physician’s direction to treat a specific disease
• Classification of obesity as a disability

key points: impact of weight stigma

Social and Psychological Impact: Weight stigma leads to negative mental health
outcomes, including increased anxiety, depression, and low self-esteem.
Individuals facing stigma often experience social isolation and discrimination.

• Health Misconceptions: Weight stigma perpetuates the misconception that body
weight is the sole determinant of health. This can lead to harmful behaviors, such
as disordered eating, as individuals may feel pressured to conform to societal
standards of thinness.

• Barriers to Healthcare: Stigmatization can create barriers to accessing
healthcare. Individuals with higher body weights may avoid seeking medical
attention due to fear of judgment or negative experiences, which can result in
untreated health issues