Bias, discrimination, and obesity.

This article reviews information on discriminatory attitudes and behaviors against obese individuals, integrates this to show whether systematic discrimination occurs and why, and discusses needed work in the field. Clear and consistent stigmatization, and in some cases discrimination, can be documented in three important areas of living: employment, education, and health care. Among the findings are that 28% of teachers in one study said that becoming obese is the worst thing that can happen to a person; 24% of nurses said that they are "repulsed" by obese persons; and, controlling for income and grades, parents provide less college support for their overweight than for their thin children. There are also suggestions but not yet documentation of discrimination occurring in adoption proceedings, jury selection, housing, and other areas. Given the vast numbers of people potentially affected, it is important to consider the research-related, educational, and social policy implications of these findings.

[1]  A. Myers,et al.  Obesity stigmatization and coping: Relation to mental health symptoms, body image, and self-esteem , 1999, International Journal of Obesity.

[2]  H. A. Pines,et al.  No Fat Persons Need Apply , 1979 .

[3]  L. Helms,et al.  Responsibilities of nursing education: the lessons of Russell v Salve Regina. , 1993, Journal of professional nursing : official journal of the American Association of Colleges of Nursing.

[4]  Cynthia R. Jasper,et al.  Perceptions of Salespersons' Appearance and Evaluation of Job Performance , 1990 .

[5]  Carol T. Miller,et al.  Social interactions of obese and nonobese women. , 1990, Journal of personality.

[6]  H. Wedel,et al.  Sick leave and disability pension before and after treatment for obesity: A report from the Swedish Obese Subjects (SOS) study , 1999, International Journal of Obesity.

[7]  J. Rippe.  The obesity epidemic: challenges and opportunities. , 1998, Journal of the American Dietetic Association.

[8]  C. Frame,et al.  The Perception of obesity by normal-weight versus obese school-age children , 1986, Child psychiatry and human development.

[9]  E. Rothblum,et al.  Gender differences in social consequences of perceived overweight in the United States and Australia , 1988 .

[10]  Tim S. Ayers,et al.  Weight criticism during physical activity, coping skills, and reported physical activity in children. , 2002, Pediatrics.

[11]  T. Wadden,et al.  Social and psychological consequences of obesity. , 1985, Annals of internal medicine.

[12]  K. Fontaine,et al.  Access and use of medical care among obese persons. , 2000, Obesity research.

[13]  S. Desmond,et al.  Family practice physicians' beliefs, attitudes, and practices regarding obesity. , 1987, American journal of preventive medicine.

[14]  Cynthia R. Jasper,et al.  The role of physical appearance in managerial decisions , 1993 .

[15]  J. Ross,et al.  Attitudes of registered dietitians toward personal overweight and overweight clients. , 1997, Journal of the American Dietetic Association.

[16]  D. Allison,et al.  Body weight and health care among women in the general population. , 1998, Archives of family medicine.

[17]  L. Lissner,et al.  Reduction in incidence of diabetes, hypertension and lipid disturbances after intentional weight loss induced by bariatric surgery: the SOS Intervention Study. , 1999, Obesity research.

[18]  P. Regan.  Sexual Outcasts: The Perceived Impact of Body Weight and Gender on Sexuality1 , 1996 .

[19]  R. J. Paul,et al.  Shape up or ship out? Employment discrimination against the overweight , 1995 .

[20]  J. Wardle,et al.  Cause and effect beliefs and self-esteem of overweight children. , 1997, Journal of child psychology and psychiatry, and allied disciplines.

[21]  K. Brownell,et al.  Teasing, body image, and self-esteem in a clinical sample of obese women. , 1994, Addictive behaviors.

[22]  Carol M Kelley.  National Public Radio , 2001 .

[23]  J. Ziviani,et al.  Stereotypes, stigma, and mental illness: learning from fieldwork experiences. , 1995, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[24]  Louis F. Martin,et al.  Cost-benefit Analysis for the Treatment of Severe Obesity , 1998, World Journal of Surgery.

[25]  J. Wardle,et al.  Social variation in attitudes to obesity in children. , 1995, International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity.

[26]  D. Williamson,et al.  The 25-year health care costs of women who remain overweight after 40 years of age. , 1996, American journal of preventive medicine.

[27]  R. Klesges,et al.  Relationship between psychosocial functioning and body fat in preschool children: a longitudinal investigation. , 1992, Journal of consulting and clinical psychology.

[28]  R. Phillips,et al.  Fat, plain, but not friendless: self-esteem and peer acceptance of obese pre-adolescent girls , 1998, International Journal of Obesity.

[29]  JoAnn E. Manson,et al.  Design of the Women's Health Initiative clinical trial and observational study. The Women's Health Initiative Study Group. , 1998, Controlled clinical trials.

[30]  D. Neumark-Sztainer,et al.  Beliefs and Attitudes about Obesity among Teachers and School Health Care Providers Working with Adolescents , 1999 .

[31]  J Ogden,et al.  Practice nurses’ beliefs about obesity and weight related interventions in primary care , 1997, International Journal of Obesity.

[32]  W H Dietz,et al.  Social and economic consequences of overweight in adolescence and young adulthood. , 1993, The New England journal of medicine.

[33]  J. Thompson,et al.  A cross-cultural examination of weight-related teasing, body image, and eating disturbance in Swedish and Australian samples. , 2000, The International journal of eating disorders.

[34]  J. Bordieri,et al.  Work Life for Employees with Disabilities: Recommendations for Promotion. , 1997 .

[35]  B. Cardinal,et al.  Are Overweight Physical Educators At a Disadvantage in the Labor Market? A Random Survey of Hiring Personnel. , 1997 .

[36]  D. Neumark-Sztainer,et al.  Mistreatment due to weight: prevalence and sources of perceived mistreatment in women and men. , 1999, Obesity research.

[37]  R. Walker,et al.  Attitude of dietetics students and registered dietitians toward obesity. , 1995, Journal of the American Dietetic Association.

[38]  P. Cramer,et al.  Thin is good, fat is bad: How early does it begin? , 1998 .

[39]  Carol T. Miller,et al.  The relationship between obesity, employment discrimination, and employment-related victimization , 1990 .

[40]  G. Maddox,et al.  Overweight as a social disability with medical implications. , 1969, Journal of medical education.

[41]  R. Hoerr,et al.  Physician attitudes toward managing obesity: differences among six specialty groups. , 1997, Preventive medicine.

[42]  J Finlay,et al.  Attitudes toward obesity and the obese among professionals. , 1979, Journal of the American Dietetic Association.

[43]  J. Pagán,et al.  Obesity, occupational attainment, and earnings : Consequences of obesity , 1997 .

[44]  S. Golub,et al.  Nurses' Attitudes toward Obese Persons and Certain Ethnic Groups 1 , 1992, Perceptual and motor skills.

[45]  Lambros Karris.  Prejudice against Obese Renters , 1977 .

[46]  J. Wilson,et al.  Obesity stigma reduction in medical students. , 1992, International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity.

[47]  C. Braet,et al.  Psychological aspects of childhood obesity: a controlled study in a clinical and nonclinical sample. , 1997, Journal of pediatric psychology.

[48]  Yawn Bp,et al.  Overweight women delay medical care. , 1994 .

[49]  Phyllis Blumberg,et al.  Medical students' attitudes toward the obese and the morbidly obese , 1985 .

[50]  G A Colditz,et al.  Current estimates of the economic cost of obesity in the United States. , 1998, Obesity research.

[51]  S. Morgan,et al.  Children's attitudes and behavioral intentions toward a peer presented as obese: does a medical explanation for the obesity make a difference? , 2000, Journal of pediatric psychology.

[52]  T. Wadden,et al.  Obese women's perceptions of their physicians' weight management attitudes and practices. , 2000, Archives of family medicine.

[53]  R. Sargent,et al.  Ideal body size beliefs and weight concerns of fourth-grade children. , 1997, The International journal of eating disorders.

[54]  M. Tiggemann,et al.  An attempt to reduce negative stereotyping of obesity in children by changing controllability beliefs. , 2000, Health education research.

[55]  Carol T. Miller,et al.  Stereotypes of obese female job applicants , 1988 .

[56]  A. Tershakovec,et al.  Insurance reimbursement for the treatment of obesity in children. , 1999, The Journal of pediatrics.

[57]  E. Rothblum.  The Stigma of Women's Weight: Social and Economic Realities , 1992 .

[58]  J. Waltz,et al.  Awareness and prevention of bias against fat clients in psychotherapy. , 2000 .

[59]  C. Perry,et al.  Weight-teasing among adolescents: correlations with weight status and disordered eating behaviors , 2002, International Journal of Obesity.

[60]  A. Frank,et al.  Futility and avoidance. Medical professionals in the treatment of obesity. , 1993, JAMA.

[61]  M. Harris,et al.  Gender and Ethnic Differences in Obesity‐Related Behaviors and Attitudes In a College Sample , 1991 .

[62]  A. Timperio,et al.  Obesity management: Australian general practitioners' attitudes and practices. , 2000, Obesity research.

[63]  M. Crossley.  The Disability Kaleidoscope , 1999 .

[64]  S. Solovay.  Tipping the Scales of Justice: Fighting Weight-Based Discrimination , 2000 .

[65]  K. Peace,et al.  Psychobiological effects of gastric restriction surgery for morbid obesity. , 1989, The New Zealand medical journal.

[66]  A. Stunkard,et al.  Stigmatization of obesity in medieval times: Asia and Europe , 1998, International Journal of Obesity.

[67]  Christian S. Crandall,et al.  Do Heavy-Weight Students Have more Difficulty Paying for College? , 1991 .

[68]  C. Rand,et al.  Morbidly Obese Patients' Perceptions of Social Discrimination Before and After Surgery for Obesity , 1990, Southern medical journal.

[69]  K. Brownell,et al.  Psychological correlates of obesity: moving to the next research generation. , 1995, Psychological bulletin.

[70]  David R. Williams,et al.  The prevalence, distribution, and mental health correlates of perceived discrimination in the United States. , 1999, Journal of health and social behavior.

[71]  D R Black,et al.  Extremes in body mass index: probability of healthcare expenditures. , 1994, Preventive medicine.

[72]  T. Sørensen,et al.  Obesity and socioeconomic status--a complex relation. , 1993, The New England journal of medicine.

[73]  R. Tindale,et al.  Bias against overweight job applicants in a simulated employment interview. , 1994, The Journal of applied psychology.

[74]  D. Neumark-Sztainer,et al.  Perceived stigmatization among overweight African-American and Caucasian adolescent girls. , 1998, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[75]  J. Rood,et al.  Pharmaceutical cost savings of treating obesity with weight loss medications. , 1999, Obesity research.

[76]  Yanovski Sz.  A practical approach to treatment of the obese patient. , 1993 .

[77]  C. Crandall.  Prejudice against fat people: ideology and self-interest. , 1994, Journal of personality and social psychology.

[78]  S. Dornbusch,et al.  Cultural uniformity in reaction to physical disabilities. , 1961 .

[79]  W. H. Decker.  Attributions Based on Managers' Self-Presentation, Sex, and Weight , 1987 .

[80]  E. Bixler,et al.  Comparison of the costs associated with medical and surgical treatment of obesity. , 1995, Surgery.

[81]  M. Wiederman,et al.  The relationship between obesity and medical utilization among women in a primary care setting. , 1998, The International journal of eating disorders.

[82]  OBESITY, FITNESS AND HEALTH CARE COSTS , 1999 .

[83]  G. Oster,et al.  Lifetime health and economic benefits of weight loss among obese persons. , 1999, American journal of public health.

[84]  C. Bagley,et al.  Attitudes of Nurses toward Obesity and Obese Patients , 1989, Perceptual and motor skills.

[85]  C. Crandall.  Do Parents Discriminate Against their Heavyweight Daughters? , 1995 .

[86]  M. Harris,et al.  Feeling Fat: Motivations, Knowledge, and Attitudes of Overweight Women and Men , 1990, Psychological reports.

[87]  A. Stunkard.  The Pain of Obesity , 1976 .

[88]  M. Tiggemann,et al.  Negative Stereotyping of Obesity in Children: The Role of Controllability Beliefs , 2000 .

[89]  Thomas A. Schweitzer.  'Academic Challenge' Cases: Should Judicial Review Extend to Academic Evaluations of Students? , 1992 .

[90]  R. Keane.  Contemporary beliefs about mental illness among medical students: implications for education and practice. , 1990 .

[91]  J. Baxter.  Obesity surgery—another unmet need , 2000, BMJ : British Medical Journal.

[92]  L. Young,et al.  The effects of obesity on the clinical judgments of mental health professionals. , 1985, Journal of health and social behavior.

[93]  B. Teachman,et al.  Implicit anti-fat bias among health professionals: is anyone immune? , 2001, International Journal of Obesity.

[94]  C. Quesenberry,et al.  Obesity, health services use, and health care costs among members of a health maintenance organization. , 1998, Archives of internal medicine.

[95]  J. Ernst,et al.  The effects of applicant's health status and qualifications on simulated hiring decisions. , 1990, International journal of obesity.

[96]  M. Roehling.  WEIGHT‐BASED DISCRIMINATION IN EMPLOYMENT: PSYCHOLOGICAL AND LEGAL ASPECTS , 1999 .

[97]  Goldstein Dj.  Beneficial health effects of modest weight loss , 1992 .

[98]  K. Brownell.  Dieting and the search for the perfect body: Where physiology and culture collide , 1991 .

[99]  D. Wilbur,et al.  The relationship of obesity to the frequency of pelvic examinations: do physician and patient attitudes make a difference? , 1993, Women & health.

[100]  T. Brink.  Obesity and Job Discrimination: Mediation via Personality Stereotypes? , 1988, Perceptual and motor skills.

[101]  J. Najman,et al.  Patient characteristics that elicit negative responses from family physicians. , 1982, The Journal of family practice.

[102]  M. Katzman,et al.  Feminist perspectives on eating disorders , 1994 .

[103]  J. Kilbourne.  Still killing us softly: Advertising and the obsession with thinness. , 1994 .

[104]  W. DeJong,et al.  The stigma of obesity: the consequences of naive assumptions concerning the causes of physical deviance. , 1980, Journal of health and social behavior.

[105]  J. Mayer,et al.  Obesity — Its Possible Effect on College Acceptance , 1966 .

[106]  Elizabeth M. Adamitis.  Appearance Matters: A Proposal to Prohibit Appearance Discrimination in Employment , 2000 .

[107]  L. Nordholm.  Beautiful patients are good patients: evidence for the physical attractiveness stereotype in first impressions of patients. , 1980, Social science & medicine.

[108]  L. M. Irving.  Promoting Size Acceptance in Elementary School Children: The EDAP Puppet Program , 2000 .

[109]  M. B. Harris,et al.  Altering attitudes and knowledge about obesity. , 1991, The Journal of social psychology.

[110]  Charlotte A. Pratt,et al.  Michigan Physicians' Perceptions of Their Role in Managing Obesity , 1997, Perceptual and motor skills.