Monday May 12 2014
Being ‘fattist’ could be more harmful than being racist or sexist
“Fat shaming can have a much worse impact on mental and physical health than racism or sexism,” the Mail Online reports, describing “fat shaming” as discrimination against those who are overweight.
In fact, the science behind the headline suggests that all forms of discrimination have a negative impact, although some more so than others.
This was a large study, where older adults reported their health and everyday experiences of discrimination at two time periods, four years apart.
Their responses suggested that the experience of discrimination on the grounds of age, weight, physical disability or appearance was linked to worse self-reported physical or emotional health. Discrimination based on race, sex, ancestry and sexual orientation, on the other hand, appeared to have less of an effect on physical and emotional health.
Although the study was large, it had limitations. One was that it only studied older people, meaning that results may not necessarily be applicable to younger generations.
The study did not investigate how discrimination might lead to poorer physical or emotional outcomes, nor did it detail the type, severity, context and frequency of the perceived discrimination. These unanswered questions could be useful topics for future research.
Where did the story come from?
The study was carried out by researchers from Florida State University College of Medicine. No sources of funding have been reported, and the authors declare that they have no disclosures (conflict of interests).
The study was published in the peer-reviewed American Journal of Geriatric Psychiatry.
The Mail Online’s reporting was broadly accurate, but consistently spun the story to focus on weight discrimination, even though the research covered seven other types.
It is somewhat ironic that the Mail Online – a news site infamous for its “Sidebar of Shame,” in which it discusses celebrities’ body sizes in obsessive detail – should run a story about the negative impact of “fat shaming”.
What kind of research was this?
This was a longitudinal study aiming to see whether perceived discrimination affected physical, emotional and cognitive health in older adults. It did this by looking at self-reported questionnaire responses completed at two time points, four years apart. It looked at the impact that perceived discrimination had on a person’s health at the time of assessment (in the first questionnaire) and then again four years later (in the second questionnaire). The study, therefore, included both cross-sectional and longitudinal elements.
The questionnaires asked the same group of people about their experiences, which is a useful way of following this specific group and identifying possible links. However, this study type cannot prove cause and effect.
What did the research involve?
The study included people who were taking part in the Health and Retirement Study (HRS) in the US: a nationally representative longitudinal study of US citizens aged 50 years and older. It included 7,622 people who completed a “Leave-Behind” Questionnaire as part of the 2006 HRS assessment (with a mean age of 67 years) and 6,450 who completed the same health questionnaire again in 2010.
Using the questionnaires, participants rated their everyday experience of discrimination and attributed those experiences to eight personal characteristics:
- race (such as African American or Hispanic)
- ancestry (largely based on nationality, such as Filipino-American or Ukrainian-American)
- physical disability
- sexual orientation
At both the 2006 and 2010 assessments, participants completed measures of physical health (subjective health, disease burden), emotional health (life satisfaction, loneliness) and cognitive health (memory, mental status).
The study performed many analyses. The main analysis looked for links between the different categories of discrimination and poorer physical, emotional or cognitive health. A secondary analysis adjusted the statistics for the effects of body mass index (BMI) and smoking prevalence – which are both known to reduce physical health.
What were the basic results?
In this sample, perceived discrimination based on age was the most prevalent (30.1%), with perceived discrimination based on sexual orientation the least prevalent (1.7%).
Across the entire sample, physical and cognitive health generally declined, while emotional health saw an improvement.
The main findings were that discrimination based on age, weight, physical disability and appearance were associated with worse subjective health, greater disease burden, lower life satisfaction and greater loneliness at both assessments (2006 and 2010), with declines in health seen across the four-year period.
Discrimination based on race, ancestry, sex and sexual orientation was associated with greater loneliness at both time periods, but was not linked to a change over time. Discrimination appeared mostly unrelated to cognitive health.
To view the full impact of discrimination, the study’s authors calculated the added disease burden of experiencing it. For example, out of the 2,294 participants reporting age discrimination over the four-year period, the link between age discrimination and the change in disease translated into approximately 130 additional diseases. As such, at the four-year follow-up, participants who experienced age discrimination had almost 450 more diseases than participants who had not experienced such discrimination.
How did the researchers interpret the results?
The researchers conclude that, despite limitations, “the present research suggests that discrimination based on a number of personal characteristics is associated with declines in physical and mental health in older adulthood. This research suggests that the effects of discrimination are not limited to the young; older adults are vulnerable to its harmful effects. In older adulthood, discrimination based on age and other personal characteristics that change with age may have particularly adverse consequences on health and wellbeing.”
The research indicated that “discrimination based on race, sex, ancestry and sexual orientation was largely unrelated to the indices of health. In contrast, perceived discrimination based on age, weight, physical disability or appearance had consistent associations with poor physical and emotional health”.
The researchers indicated that “although seemingly modest, the effect of discrimination on health is clinically meaningful at the population level.”
This study suggests that perceived discrimination among older adults on the grounds of age, weight, physical disability or appearance is linked to worse self-reported physical and emotional health. It also indicated that discrimination based on race, sex, ancestry and sexual orientation is largely unrelated to physical and emotional health. Very few links were found between discrimination and cognitive ability, which was the third dimension tested in the study.
The study was large, giving it greater reliability than a smaller study of this type. However, there were still many limitations that should be considered when interpreting the findings, most of which were acknowledged by the study’s authors.
The measure of discrimination used was limited to just one item per characteristic (e.g. age, weight, race, etc) and did not capture whether the discrimination was ongoing, a specific event or whether it was context-specific – such as discrimination at work or if it was more widespread. This meant that detail on the type, severity, context and frequency of discrimination linked to the poorer health and emotional outcomes was missing.
The study did not examine how discrimination might lead to poorer physical or emotional health, although there may be many plausible ideas. Ideally, the mechanism by which discrimination can damage lives would be tested in further research to see if any are amenable to intervention or change.
Though this was a large study sample, it comprised mainly older adults (with an average age of 67) and limited ethnic diversity. This makes it unclear whether the findings can be generalised to younger groups or ethnic minorities in the US or UK.
Finally, the study used subjective measures of physical and emotional health, so may not give a wholly accurate picture of objective health.
The cognitive assessment involved tests that are more objective and, interestingly, was the only domain where very few links were found.
Similarly, the perception of discrimination in this study is unavoidably a subjective measure, and as already mentioned, we don’t have any more information on the context of the perceived discrimination.
With the limited contextual information available from this study (for example, there was no further exploration of the discrimination and medical verification of the reported health problems), it is difficult to exclude the possibility that other factors were influencing the apparent relationship between discrimination and health.
For example, a person with mental health issues may have low self-esteem or feel worthless. Because of this, they may have an altered perception of how other people view them.
Overall, these factors make it very difficult to prove cause and effect in this particular study.
If you are worried about your weight, then joining a weight-loss group, where you are encouraged to lose weight in a supportive environment with like-minded people, may help.
Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.