Social concepts and applications

Obesity and Discrimination

Bias against overweight and obese individuals is perhaps the last form of acceptable discrimination. Overweight people are subject to both subtle and blatant forms of discrimination, from childhood to adulthood. Discrimination occurs in family, social and professional situations as well.

This paper takes an interdisciplinary approach to the issue of weight-based discrimination and harassment, drawing on diverse literature from fields including psychology, law, pediatrics and economics. The extent of discrimination is explored through a critical survey and integration of current research on the social and professional effects of obesity.

The first part of this paper looks at the varying definitions of the terms "overweight," "obesity" and "discrimination."

It highlights the limitations of these definitions and how these terms can be misapplied.

The next part looks at statistics regarding the growing number of overweight and obese people in the United States. Recent studies show an alarming rise in obesity and overweight adults and children. Currently, an estimated half the population of the United States is overweight. Of that number, an additional 18% are considered morbidly obese.

In the next section, the paper examines the effects of being obese or overweight on a person's social life and interactions with others. This section is divided into the following parts: (1) effects of being overweight on an individual's personal perceptions and self-esteem; (2) effects on family relationships; (3) effects on a person's social relationships; (4) effects of being overweight on an individual's work and professional life.

Since conventional wisdom holds that women are more subject to being judged based on appearance, this section then examines if the effects of weight-based discrimination are muted or enhanced by a person's gender and race.

The next part of the paper looks at the various misconceptions that give rise to discrimination against obese or overweight people. These reasons include real economic issues -overweight individuals will have higher healthcare premiums - to unfounded myths that people who weigh more are "lazy," "sloppy," "inefficient" or more prone to absenteeism.

Finally, the paper examines the various options available to people who experience weight-based discrimination. This includes the limited effectivity of various legal recourses under state and federal law, as well as the Americans with Disabilities Act. The work of grassroots advocacy groups to raise awareness and form support groups for the overweight and obese are also discussed.

The goal of this paper is to contribute to the body of literature that studies how bias against overweight and obese individuals is prevalent, particularly in western cultures such as the United States. By examining the false conceptions about the overweight and studying the complex interactions between weight, gender, race and class, this paper aims to promote a better understanding of the discrimination and lack of tolerance against people who do not or cannot conform to society's prevailing standard of acceptable weight.

Definition of terms

Body weight is an important dimension of physical attractiveness. Though no standard definition exists, the National Institutes of Health (NIH) measures weight using a person's Body Mass Index (BMI). The BMI is determined by dividing a person's weight in kilograms by their height in meters squared. Under the BMI formula, a value of 25 or higher is considered obese in people aged 34 and below. For people above 35, a BMI value of 27 indicates obesity. Under this definition, a person who is 5 feet, 4 inches tall should weigh less than 144 pounds. An individual would be considered overweight at 145 pounds. At 175 pounds or more, the same person would be considered obese (Stearns, Borna and Sundaram, 2001).

Several physicians, however, have criticized the BMI value of 25 as an inadequate definition of being overweight. Instead, physician Steven B. Halls proposes a disaggregated overweight BMI threshold of 27.3 for women and 27.8 for men (Halls 2002).

Other health experts point out how this height-to-weight formula is imposed on both male and female physiques. The BMI also does not take into account body frames, or whether the weight is from fat or muscle. Under the BMI standards, for example, many healthy professional athletes will be considered overweight (Cohen and McDermott, 1998).

Despite these limitations, the BMI index has emerged as the standard definition of determining who is overweight or obese. The NIH maintains that this standard is necessary, since studies have linked extra weight to significant health problems. The BMI index is the standard used by several health care providers and insurance companies in determining who presents additional risk factors due to weight.

Statistics on the Overweight and Obese

The number of overweight and obese people in the United States has been rising steadily for the past decade. In the year 2000, people with a BMI value of 30 or above was at 19.8% of the total population. By 2001, that percentage has risen to 20.9%. This translates to 44.3 million obese adults in the United States (Mokdad et al. 2002).

Since 1991 the percentage of those who were obese in the United States has increased by 74%. Among racial groups, African-Americans had the highest obesity rates. Mississippi ranked first among the states in number of obese people (Mokdad et al. 2002).

In addition to the obese, statistics from the National Center for Health Statistics shows that an estimated 64% of adults in the United States have BMI values about 25. More than half of the population is overweight and an estimated one-third is obese (NCHS Factsheet 2002).

The NHCS statistics additionally show that there are more adult women who are obese than men. The prevalence of overweightness and obesity was most prevalent among African-American women (NHCS Factsheet 2002).

The number of overweight children continues to increase. A 2002 survey found that an estimated 9 million children, 15% of the population, are overweight. This is triple the number of overweight children in 1980. Mexican-American children were more likely to be overweight than their peers. Another 15% of children and teenagers are at risk of becoming overweight (NCHS Factsheet 2002).

Effects of Weight-based Discrimination

The effects of weight-based discrimination are both hurtful and pervasive. Obese and overweight people face harassment and discriminatory behavior from strangers, employers and even loved ones. The effects are felt early in childhood and continue to affect many heavier people throughout their lives.

Personal

In a survey conducted by University of Florida researchers on formerly overweight people who lost weight through intestinal bypass surgery, virtually all respondents said that they would rather be blind or deaf or have a leg amputated than be fat again (cited in Kolata 1992).

This extreme reaction against being fat was spurred by a lifetime of teasing, harassment and discrimination. The pressure to be thin among teenage girls is disturbing, particularly because self-perceptions about weight are often distorted. For example, as early as ninth grade, an estimated 33.4% of girls think they are overweight, compared to the 7.7% who actually are. By 12th grade, the number of girls who falsely assume they are overweight is 35.9%, compared to the 6.3% who really are overweight (Kolata 1992).

Formerly obese people have an almost irrational fear of becoming fat again. Aside from blindness and amputation, every survey respondent said they would rather have dyslexia, diabetes, bad acne or heart disease than ever be obese again. As one respondent observed, "When you're blind, people want to help you. No one wants to help you when you're fat" (Kolata 1992).

Obese people who try to lose weight often have symptoms of chronic starvation. They tend to feel cold all the time, are always hungry and are obsessed with food. Many of the formerly obese feel an overwhelming compulsion to eat until they are fat once more. The few who manage to stay thin keep the weight off by fanatically monitoring every piece of food that they eat or by becoming weight counselors themselves (Kolata 1992).

Aside from drastic surgery, respondents reported spend their money on ineffective diet programs. Some even endanger their health by smoking cigarettes or taking amphetamines in an effort to lose weight (Kolata 1992).

In addition to these effects, many obese men and women believe in a "basic badness." Psychologists Lewis Engel and Tom Ferguson describe this as an internal belief that a person is worthless, that there is something deeply and fundamentally wrong with them. Such feelings of worthlessness and inadequacy make it even more difficult to lose weight and address the emotional and psychological problems connected with excess weight (Engel and Ferguson 1991).

In summary, being overweight and obese can take its toll on an individual's psychological, as well as physical well-being. People who are overweight often endanger their health through unsafe diets. They opt to undergo drastic surgical procedures. Many can harbor feelings of inadequacy and worthlessness, which affect their emotional health. Many who manage to lose weight live in fear of gaining it back and end up strictly monitoring their food intake to the point of obsession.

Family

Weight stigmatization starts in childhood. Overweight and obese children often reported being teased about their weight, being treated differently or nagged about their weight by family members. As children, they were given nicknames like "chubbo" and "tubby." Many overweight women reported being admonished by concerned parents and grandmothers, who worry that their being overweight will keep them from finding a husband (Crossrow, Jeffery and McGuire 2001).

Though hurtful, many overweight adults recognize such behavior as well-meaning, if misguided. However, other studies have found that parents can discriminate against their overweight children in more insidious ways. In a 1995 study, for example, Christian Crandall found that daughters were less likely to receive financial support for attending college if they were overweight. This effect was constant in female undergraduate students, regardless of socioeconomic status, ethnicity, family size and the number of children already attending college (Crandall 1995).

Many times, comments regarding the children's weight were a form of child abuse. One woman reported not feeling overweight as a child, until her father commenced a brutal regimen of verbal abuse. "He called me fat pat, fat cow and fat pig. He said he would tie me to the back of his truck so I could run around the block and lose weight. He wanted mom to lock me up and feed me bread and water" (cited in Berg, 1997, 85).

The negative reactions from family members continue to plague overweight adults. Overweight individuals report being treated badly by a spouse because of their size problems. Others say their own children are ashamed of them. One respondent said her daughter, fearing teasing from her peers, asked him to stay away from her school events (Crossrow, Jeffery and McGuire 2001).

Stigmatization from family members is an additional burden for many overweight people, since the teasing and stigmatization comes from people who are supposed to love them. This contributes to the low self-esteem and isolation already felt by many overweight children and adults.

Social Relationships

Aside from parents, overweight children and teenagers are often subjected to vicious forms of prejudice from classmates and even teachers. Often, these experiences have negative effects which last until adulthood.

The stigma is ingrained early. In one study, children as young as six years old characterized silhouettes of an overweight child as "lazy, dirty, stupid, ugly, cheats and lies." When shown drawings of an overweight child, a normal weight child and children with various handicaps, many children rated the overweight child as the least likeable. Many children felt this way, regardless of whether they were of normal weight or larger (Berg 1997).

Weight often affects the quality of education and peer interaction of overweight children and adolescents. A study found that 28% of teachers believe that becoming obese "is the worst thing" that can happen to a person, while 24% of school nurses reported being "repulsed" by obese students. The results imply that many obese students face latent forms of discrimination even from people in authority in school (Brownell 2001).

The effects of weight stigmatization during childhood and adolescence are often felt through adulthood, whether or not the individual loses weight. A study found that people who have been overweight had completed fewer years at school, were less likely to get married and had higher rates of poverty.

This study concluded that unlike other chronic conditions such as asthma and musculoskeletal abnormalities, being overweight during adolescence had greater social and economic impacts on a person's life. The study also found that discrimination against overweight and obese persons largely accounts for these discriminatory effects (Gortmaker et al. 1993).

The discriminatory treatment also pervades interactions with service providers. In school, this is felt with teachers and nurses. As adults, many overweight and obese people experience disparaging treatment from health care professionals. Studies found that many doctors assume that an overweight person's problems are always related to their weight, and that many doctors will avoid treating obese patients altogether. One woman reported that a doctor refused to operate on her cervical cancer unless she lost 100 pounds, even if the risks of surgery were dwarfed by the risk of ignoring the cancer (Kolata 1992).

Corollary to this, other studies found that obese people are less likely than their slim counterparts to seek or receive preventive health services. Many overweight people say it is difficult for them to establish positive rapport with their personal physicians (Crossrow, Jeffery and McGuire 2001).

While health care providers were the main group with which they were most frustrated, the discrimination and disparagement occurs in other situations as well. Some overweight patrons are criticized for their food choices by servers in restaurants. Salespeople would avoid them inside department stores. Others report being harassed in the gym, making them afraid or too ashamed to work out or join fitness classes (Crossrow, Jeffery and McGuire 2001).

Another study finds that dietitians also blamed overweight clients for being unable to set realistic goals for weight loss. Many of these diet and nutrition experts were ambivalent about weight reduction diets or an exercise program, making them less effective in addressing the needs of overweight or obese clients (McArthur and Ross 1997).

When it comes to social relationships between friends, potential spouses and even professional service providers, overweight people continue to experience discrimination in a myriad of forms. These range from dirty looks to verbal slurs in public settings. They are also excluded from private social affairs such as weddings and other celebrations.

For many overweight and obese people, this discriminatory behavior can be life-threatening, especially when healthcare professionals like physicians and nurses do not take their illnesses seriously. In addition, many overweight and obese individuals refrain from seeking help for their condition, either from doctors or professional trainers at the gym.

The effect is a self-perpetuating cycle.

The stigmatization they experience at the hands of people who should understand better prevents many heavier people from getting professional help to lose weight.

Employment

Discrimination against overweight and obese individuals is found at every stage of the employment cycle. This includes selection, interviews, placement, career advancement, salaries and discharges.

For many, simply getting through a job interview is an almost insurmountable hurdle. A 350 pound paralegal who was fired from her job found it difficult to get employment, despite a stellar resume and good recommendations. She reported getting numerous positive phone interviews, but was always turned away after prospective employers met her in person (Valenti 1999).

Similarly, many other applicants reported being denied further interviews. One even saw the interviewer write the words "too fat" on the evaluation sheet (Crossrow, Jeffery and McGuire 2001).

A report by Roehling (1999) finds this paralegal's example typical for overweight and obese job hunters. In this report, Roehling evaluated 29 other studies on weight-based discrimination and interviewed employees who felt they were victims of weight discrimination and the employers. He found that many employers did not even bother hiding their discrimination, stating simply that they would not hire "fat employees" (Roehling 1999).

Roehling additionally found that qualified overweight candidates were generally preferred over the unqualified candidates of normal weight. However, among clients with equal qualifications, the candidate who was not overweight almost always got the position. In addition, a laboratory study of social stigmas regarding hiring practices showed that participants displayed more negative attitudes towards overweight applicants than ex-convicts of former mental patients. (Roehling 1999).

One study (Pingitore et al. 1994) even found that weight played a much bigger role in hiring decisions compared to the applicant's gender.

Once on the job, many employees find it difficult to get promoted. For example, despite her success in negotiating multimillion-dollar deals for her firm, the paralegal mentioned earlier was repeatedly denied promotions because of her weight (Valenti 1999).

Other overweight and obese people report similar experiences of being passed over for promotions because they do not fit their company's "corporate image." One person was told by management that she would never be promoted until she lost weight. Her union took management's side and refused to fight for her case. (Crossrow, Jeffery and McGuire 2001).

The discriminatory behavior extends to salaries. The starting salaries of overweight people with MBAs, for example, are around $3,000 higher than their overweight counterparts. In addition, many overweight and obese employees say they are forced to forego benefits like health care coverage (Crossrow, Jeffery and McGuire 2001).

Still others reported being pressured to resign because of their weight (Roehling 1999).

The situation is worse for those who are morbidly obese, or who are 100% over their ideal recommended weight. Their salaries were an average 24.1% lower than those of their slimmer counterparts with equal qualifications (Roehling 1999).

Overweight and obese people also experience harsher disciplinary measures than their thin counterparts. Ideally, the severity of the disciplinary measure should be consistent with the nature of the employees' unacceptable behavior. However, in a study of sales managers, Bellizi and Hasty (2001) found that overweight salespeople were disciplined more severely than their colleagues who were of normal weight (Bellizi and Hasty 2001).

Finally, many overweight and obese professionals find themselves hampered from doing their jobs by the negative reactions of their prospective clients. A study of patient perceptions regarding their physicians, for example, shows that many patients ranked obese physicians lower in terms of patient thrust in specialties like laser surgery, spinal surgery and general surgery (Stearns, Borna and Sundaram 2001).

In summary, almost every stage and field of employment presents a challenge for the overweight and obese professional. They must deal with discriminatory attitudes from supervisors, colleagues and clients. They are generally paid less for the same position. Many do not have benefits and most face obstacles towards promotion. They were subject to harsher disciplinary actions. When their companies come under new management, many are simply terminated or laid off because they no longer fit their new firm's "corporate image."

Overweight and Obese Women

It is widely believed that Western society places a greater premium on a woman's physical appearance more than they do for men. Even overweight and obese men tend to agree that the range of acceptable weight for women was "narrower and leaner than the acceptable weight for men" (Crossrow, Jeffery and McGuire 2001).

Women consistently report that that other women "are more accepting and tolerant of weight and appearance in men than men are in their acceptance and tolerance of weight and appearance in women" (Crossrow, Jeffery and McGuire 2001).

This anecdotal evidence is borne out by studies showing that obese and overweight women have even lower salaries than overweight and obese men.

Both overweight and obese men and women were paid lower salaries. However, Roehling found that only the most obese men experienced this salary differential while all overweight women were affected regardless of how overweight they were (Roehling 1999).

In studies conducted in settings unrelated to employment, Roehling further found that overweight women were evaluated more negatively than overweight men. Though the findings were not consistent, Roehling stated that when an interaction was found, overweight women were consistently more denigrated by doctors, nurses, peers, small children and even their own family (Roehling 1999).

The same study that found overweight salespeople received harsher disciplinary measures also found that heavier women were punished more severely than obese men (Bellizi and Hasty 2001).

Other studies show that women who are or were overweight as adolescents are more likely to complete fewer years in college. They are less likely to be married and when they do, they are more likely to marry beneath their socioeconomic status than their thinner sisters. In addition, women who are or were overweight as adolescents posted higher rates of household poverty than women who have always been slim (Gortmaker et al. 1993).

In summary, while all overweight and obese individuals are targets of discriminatory behavior, the biases affect women much more negatively. Because Western society holds women to a leaner body standard, larger women therefore face more consequences of weight-based discrimination than their male counterparts.

Reasons behind the Discrimination

The prevailing negative attitudes towards overweight and obese individuals are rooted in several social misconceptions assigned to excess weight. This section evaluates the validity of common reasons why people express distaste over larger individuals.

Anticipated Lower Levels of Performance

There is a wide range of negative stereotypes relating to the performance related traits of overweight men and women. Employers and evaluators often perceive overweight applicants and workers as lazy or less conscientious, unable to get along with their co-workers and generally less intelligent. They are supposedly less effective in service-related fields because of problems relating to clients or customers (Roehling 2002).

However, no studies have found that a relationship between employees' bodyweight and an employee's actual work performance. No studies have shown that overweight employees in general make poorer or less conscious workers. The study of patient perceptions (Stearns, Borna and Sundaram 2001) also indicates that any perceptions regarding an overweight worker's performance are often based on prejudice or bias on the part of the client.

Reactions to Bias of Others

When terminating employees who no longer "fit the corporate image," many supervisors report that while they do not hold negative feelings regarding the overweight and obese, they perceive bias on the part of others, such as superiors or clients. Individuals who engage in this "rational bias" feel that while they personally treat people equally, engaging in this form of discrimination is unavoidable (Trentham and Larwood 1998).

Despite such justifications based on rational self-interest, such an argument hardly justifies discriminatory behavior against employees who are otherwise qualified. Such reasoning in fact borders on behavior that could be grounds for a lawsuit for weight-based discrimination.

Assigning Blame

Roehling (1999) believes that most weight-based discrimination stems from the fact that we "tend to blame overweight people for their condition." Discrimination based on weight is seen as more acceptable because, unlike race or gender, people see bodyweight as a choice, not an immutable characteristic (Roehling 2002).

This argument stems from the misconception that obesity is a voluntary condition, that overweight people could lose weight simply if they stopped eating and shored up their willpower (Solovay 2000). However, research has since shown that this is not true, and that obesity is caused by a variety of genetic, psychological, physiological and even environmental factors. These could include a deficiency in leptin hormones and the "thrifty gene." In fact, trying to lose weight is often accompanied by significant health risks (Roehling 2002).

To compound the difficulty, people who seek the help of dieticians, physicians and trainers often face discouragement and discrimination (McArthur and Ross 1997; Kolata 1992; Crossrow, Jeffery and McGuire 2001).

Although the causes of obesity are not yet fully understood, these studies indicate that being overweight is not simply an effect of laziness, lack of willpower or simply eating too much. Weight conditions are not immutable characteristics. It is therefore unethical to infer character traits from a person's weight, just as it is unfair to judge people by their gender or skin color.