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Clinical Social Work Journal

, Volume 34, Issue 4, pp 595–597 | Cite as

BOOK REVIEW

  • Esther Howe
Book Reviews
  • 60 Downloads

WEIGHT BIAS: NATURE, CONSEQUENCES, and REMEDIES. Kelly D. Brownell, Marlene B. Schwartz, Rebecca M. Puhl, Leslie Rudd, (Eds.), New York: Guilford Press, 2005, 320 pp., $35.00.

This book brings comprehensive research to bear on a societal conundrum: Americans are becoming heavier while prejudice and discrimination against heavy individuals continues unabated. Weight bias, particularly against women, has a negative impact on major domains of external functioning, e.g., education, employment and health care, as well as on personal relationships and psychosocial functioning. To explore why this is so, the book is divided into four parts: the nature and extent of weight bias; its origins, explanation, and measurement; the stigmatizing consequences of weight bias; and, possible remedies.

The first section of the book contains chapters that document the negative outcomes experienced by overweight people in the workforce, in school, and in the health care system. Because of the sensibilities involved, the authors explain their use of the terms “obese” and “fat” as interchangeable while acknowledging that there is not uniform consensus on the definitions. They differentiate among “prejudice, bias, stigma, and discrimination.” For purposes of this review, I will use the authors’ terminology.

Not only do the overweight have less chance of being hired, they also earn less money and are more severely disciplined for infractions. While there is clear evidence for a differential treatment of fat people in employment, the effects are mediated by race, gender, and type/level of employment. Overweight white women suffer the most negative consequences. Overweight has less negative impact on employment outcomes for Hispanic women and African American women. Men are adversely affected only when they are morbidly obese (100% overweight). Even when white women are only moderately obese (20% overweight), the negative effects are greater than for black men who are morbidly obese. The income penalty for fat women is most evident for highly educated women: they earn 30% less than normal weight women. There is no measurable income difference based on weight for the lowest educational group, and overweight women who are self-employed actually earn more than their normal weight counterparts.

As the authors note, weight bias begins in early childhood as children begin to absorb cultural values. Not only do children prefer their normal weight peers and find them more attractive, children also assign more negative characteristics that are unrelated to appearance to overweight classmates, and they evaluate the actual work of overweight classmates more negatively than similar work by normal weight peers. Research on teachers’ attitudes and reactions to overweight children and their performance shows similar outcomes. Such prejudice and discrimination takes a toll on children. They are more likely to exhibit psychosocial problems, particularly depression. And they do less well in school. More of these consequences stem from the negative reactions of others rather than from the obesity itself.

While most discrimination occurs in schools, overweight children also experience discrimination from close family members and health care professionals. Obesity is documented to have severe adverse health risks. Obese patients do access health care services more frequently than their normal weight counterparts; however, they do not access preventive services such as mammograms and Pap smears with the same regularity as those with normal weight. In addition, obese patients frequently change physicians. Both these behaviors can be attributed to two factors: the patients are embarrassed by their weight and thus avoid preventive procedures, and they feel the disapprobation of the physician and thus seek out other medical practitioners, looking for a more sympathetic practitioner. Using attitude measurements, the authors confirmed that health care professionals frequently do have negative attitudes toward obese patients.

The conclusion to be drawn from this section of the book is that negative outcomes for obesity are pervasive in three major life domains: children, particularly girls, suffer from discrimination and its attendant consequences in school; this adverse impact continues in their occupational endeavors; and, even in the arena of health care, there is evidence that obese patients are not receiving optimal care in part because of the attitude of health care professionals, in part because the medical equipment is not suitable for people of this size, and in part due to their own internalization of the stigma of obesity.

If obesity and the concomitant experience of discrimination and prejudice affect the external life realms of obese individuals, what then are the social effects of weight bias? As the section dealing with these ramifications makes clear, the evidence here is less quantifiable, more diffuse, than in the arenas of education, work, and medical treatment. Yet, weight bias affects the informal, personal arenas such as familial and marital relationships, friendships, and encounters with strangers. And these arenas are vital to the quality of life as experienced by obese individuals.

The evidence suggests that obese people have less opportunity to marry, but when they do, the quality and durability of their relationships approximate that of their normal weight counterparts. While there is conflicting research about whether or not obese individuals experience difficulties in making and sustaining friendships, there is more research documenting their lack of social support in terms of social networks. The stigmatization of overweight makes it more difficult for obese people to be included in the desirable “ingroups.” This, in turn, leads to less and lower quality social support.

What then are the consequences of discrimination and prejudice on the internal self perception of obese people, on their self esteem? Obese people, again women more so than men, share the weight bias found in the rest of the population, leading to an internalized stigma. Yet not all obese people have diminished self-esteem. One chapter explores which factors buffer against weight bias while others increase vulnerability. The findings are that “self-blame for weight, associated with beliefs about controllability, not recognizing weight prejudice (of others), and belief in the Protestant Ethic contribute to low self-esteem in the overweight” (Crocker & Garcia, 2005, p.169.) The authors suggest that the optimal means of protecting oneself from the adverse effects of weight bias is to not focus on weight-related issues. Rather, obese people should focus on other significant elements in their lives—getting jobs, finding friends.

The final section deals with possible remedies. These vary from developing and utilizing medical equipment in medical offices and hospitals that are appropriate for overweight patients to legal recourse against weight discrimination. The problem with the latter is that that the law protects only against discrimination in specific arenas such as race, gender, and handicap. While morbid obesity successfully has been portrayed as a handicapping condition protected by the law, simple overweight is not. Also, there is disagreement within the obese community about having obesity labeled as handicap. The concern is that by doing so, there will be an even greater inclination to label obese individuals as “sick.”

Other chapters argue that more research is needed to respond to this growing epidemic. One of the means to obtain funding for such research is to have obesity identified as a disease, as has already occurred within the Social Security Administration. This could have the dual effect of increasing needed research into both the etiology of the disease and possible treatments and changing the focus from stigma-inducing personal responsibility to possible genetic and other physical factors. Several of the authors posit that obesity should be viewed as a chronic disease based on genetic predisposition, environmental factors, and failure to take self-protective measures. They think this approach will help free obese people from the stigma that adheres to the condition, encourage them to seek better medical care, and support further research.

This book brings together the current research on the problems encountered by the obese due to the weight bias prevalent throughout our culture. Using attribution theory, stigma theory, as well as other theories from the field of social psychology, the book will be a significant resource for anyone interested in understanding weight bias. There is a great deal of ambiguity and ambivalence surrounding this issue, on the part of the public and the obese themselves. Reading the book suggests how difficult it is to launch a public health campaign to get people to lose weight and exercise more while, at the same time, try to reduce the stigma of obesity. Weight Bias is a welcome addition to the literature on the topic and will be particularly useful for practitioners to enhance their sensitivity to the issues their obese clients endure.

Reference

  1. Crocker, J., & Garcia, J.A. (2005). Self-esteem and the stigma of obesity. In K.D. Brownell, M.B. Schwartz, R.M. Puhl, & L. Rudd (Eds.), Weight bias: Nature, consequences, and remedies (pp. 165–174). New York: Guilford Press.Google Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  1. 1.Department of Social WorkSouthern CT State UniversityNew HavenUSA

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