Body Shaming May Lead to Cardiovascular, Metabolic Diseases

Internalizing weight bias can lead to unhealthy behaviors and high levels of triglycerides.

The mental toll that body shaming takes on individuals may lead to an increase in cardiovascular and metabolic diseases, according to findings from a new study published by Obesity.

Body shaming is widespread form of bullying where individuals are criticized about their physical appearances in public and online. These comments characterize individuals with obesity as lazy, unattractive, and lacking the willpower to change their perceived unhealthy lifestyles.

The authors found that the emotional toll of these comments can lead to serious health problems. Besides health effects from higher body mass index and depression, body shaming comments that were internalized were seen to increase the risk of developing cardiovascular and metabolic diseases.

Weight bias internalization occurs when individuals apply negative thoughts to themselves, and then devalue themselves based on their weight.

"There is a common misconception that stigma might help motivate individuals with obesity to lose weight and improve their health," said lead researcher Rebecca Pearl, PhD. "We are finding it has quite the opposite effect. When people feel shamed because of their weight, they are more likely to avoid exercise and consume more calories to cope with this stress. In this study, we identified a significant relationship between the internalization of weight bias and having a diagnosis of metabolic syndrome, which is a marker of poor health."

Included in the study were 159 patients with obesity who were enrolled in a clinical trial for weight loss medication. The patients were typically African American women, and were asked to complete questionnaires that measure depression and weight bias internalization at baseline.

Patients underwent examinations that determined if they had a metabolic syndrome, or risk factors for heart disease or diabetes, such as high blood pressure, large waist circumference, and high triglyceride levels.

The researchers did not initially observe a relationship between weight bias internalization and metabolic syndrome, even when participant demographics were controlled for.

Once classified by level of weight bias internalization, patients with high internalization were 3 times more likely to develop a metabolic syndrome, and 6 times more likely to have high levels of triglycerides, compared with patients with low internalization, according to the study.

"Health care providers, the media, and the general public should be aware that blaming and shaming patients with obesity is not an effective tool for promoting weight loss, and it may in fact contribute to poor health if patients internalize these prejudicial messages," said study co-author Tom Wadden, PhD. "Providers can play a critical role in decreasing this internalization by treating patients with respect, discussing weight with sensitivity and without judgment, and giving support and encouragement to patients who struggle with weight management -- behaviors everyone should display when interacting with people with obesity."

Previous studies show that weight bias internalization negatively impacts mental and physical health, which can lead to physiological stress responses that lead to increased inflammation and cortisol levels. This can result in overeating and avoiding physical activity.

Further studies are needed to better understand why patients with obesity who internalize weight bias may be at a higher risk for developing cardiovascular and metabolic diseases, according to the study.

"Disparagement of others due to their weight and messages that perpetuate blame and shame, if internalized, can cause harm to the physical and mental health of individuals with obesity," Dr Pearl concluded. "As health care practitioners, we can help challenge negative, internalized stereotypes by educating patients about the complex biological and environmental factors that contribute to obesity, while providing concrete strategies to help patients manage their weight and improve their health."