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Study: Obesity
bias prevalent among professionals, public
(January
2006 Issue)
You see it on television, in cartoons or billboards. It shows a
woman with the donut around her middle because she eats sweets for
breakfast. There's a health club ad that insists fat people are
more likely to be eaten by aliens. Even in movies about being sensitive
to overweight people, most of the entertainment factor comes from
seeing a beloved thin actor walking around in a fat suit.
Making fun of overweight people - it's the last refuge of the anti-PC
crowd, the last allowable prejudice in the U.S. Heavy people are
lazy and stupid and have no self-control. They are unattractive
and sloppy, say their critics. It's amazing how much negative bias
is heaped on this one physical attribute, how much someone who is
overweight has to deal with on a day-to-day basis.
There's an attitude in America that a person must pull himself
up by his bootstraps. It's the pioneer mentality - "look how my
great-great-grandfather turned a dime in his pocket into a multi-million
dollar corporation." It's all about taking responsibility for one's
destiny and making it on one's own.
It's a great philosophy and one that has helped this country go
from being a backwoods outpost for the British Empire to being what
it is today.
But, it's a philosophy that can hurt us too. When turned around,
that sense of self-responsibility can become a way to heap blame
on anyone who fails and a reason not to make changes in our nutrition
policies. For overweight people, it's a mentality that has become
an excuse for some of the most serious prejudice in this country.
New England Psychologist's Catherine Robertson Souter spoke
with Marlene Schwartz, Ph.D., co-director of the Yale Center for
Eating and Weight Disorders and associate director of the new Rudd
Center for Food Policy and Obesity at Yale University about several
studies that the center has produced, including one that showed
that anti-fat prejudices are shared by many health care providers.
Q: You published a study in 2003 showing that even health care
providers have prejudices when it comes to dealing with overweight
people.
A: Our group at Yale was looking at the issue of obesity stigma
and one study was to see if health professionals who were studying
obesity had the same level of automatic negative attitudes as we
had seen in the general public. We did the test at the North American
Association for the Study of Obesity Conference and we found that
even this group of professionals exhibited a significant anti-fat
bias. It was less than we see in the general public but it still
was significant.
Q: How was this information received in the medical community?
A: The study got a lot of press at the time. Our hope was not
to make professionals feel badly but to raise people's awareness
that we live in a culture that reinforces the message that thin
is good and fat is bad and that we need to be aware of that when
working with our clients and patients who are overweight.
One of reasons this issue is so important is there is other research
that suggests that overweight women, in particular, may put off
preventive health screenings, such as pap smears or mammograms because
they do not want to go to a doctor's office and get weighed.
We are looking into that in more detail but it seems that the bias
that people experience with their health professional or in the
medical setting could be negatively influencing the health of these
individuals.
We are trying to get a study started to see if we can design an
intervention and improve the percentage of people who get those
screenings.
Q: How does this relate to mental health professionals?
A: There were psychologists in the test sample but we did not
pull out psychologists from surgeons or from other professionals.
One thing we did look at is that people who had more clinical contact
with overweight patients tended to have lower levels of bias. So
that was encouraging.
Q: It's important to challenge these beliefs on a population
level but how do we do this individually, in ourselves?
A: The first step is really just to notice assumptions you make
about people based on their physical appearance. The stereotypes
that tend to be associated with obesity are that the person is lazy,
that they are noncompliant, have no self-control and that they are
not as intelligent. For all of us who have patients, we can pay
attention to our own reactions to our patients and just note to
ourselves that there might be an assumption going along with that.
More importantly, a psychologist needs to recognize the fact that
overweight people in our society are stigmatized. The research shows
over and over the horrible ways that people are discriminated against
in terms of employment, education, housing and other social factors.
So if we have patients who are overweight, we need to keep that
in mind as we are interpreting and understanding their symptoms
and working with them in treatment.
Their experience of the world is different because they have this
physical characteristic that is so disparaged in our society. For
example, when patients come in to our center, there is an item on
the questionnaire that asks "are you afraid to eat in public?" or
"do you think people are looking at you?" But they are not being
paranoid and it is not an unreasonable reaction when you are obese
and you live in this society to feel self-conscious when you eat
in public, to feel that people are watching you.
Q: Because they are.
A: Right. It may also be something a patient may have a hard
time telling the therapist about, particularly if it's a thin therapist.
The patient might feel he wouldn't understand. Maybe there is a
way to bring this up to help the patient understand that you do
have a sense of what it must be like and want them to help you understand
their experiences.
There is so much shame that goes along with being obese that can
interfere with the therapeutic process. The more psychologists can
be aware of that, the better we can help our patients deal with
those feelings.
Q: Are we getting anywhere in the battle against obesity in
children?
A: I am optimistic by nature and I do think that there has been
progress. The fact that looking at junk food in schools is on the
legislative agenda in so many states is evidence that people care
about this issue.
That there is even a debate about policy versus personal responsibility
shows that we have made progress. In the past, people would have
said it's the parents' job, end of story. But, we are still so busy
blaming individuals that it has slowed us down in making the environmental
changes that are going to eventually really help.
Q: So, we need to look at the issue of obesity as more of an
environmental problem?
A: In the United Sates, we so strongly believe in personal responsibility
and taking care of yourself and your destiny that we are slower
than other countries [in making important policy changes]. Many
European countries have made radical changes like banning advertising
to children and taking soft drinks out of schools. In Europe, they
tend to think of things from more of a community perspective.
But, we are so ill equipped to deal with the environment we are
in. We have evolved to eat the high sugar/high fat food when it
is available and we have changed our culture so much that we are
completely maladaptive. I just don't think that nutrition education
alone is going to get us out of this.
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