Four Ways Bias Blocks Progress in Obesity

Bias blocks progress toward evidence-based approaches to addressing obesity in a number of ways highlighted by recent publications. One is a commentary by Rebecca Puhl and Ted Kyle published by the Institute of Medicine (IOM). Another is a study of 2,944 British adults over the age of 50 and their experiences with fat shaming.

Here are some of the effects of weight bias on the pursuit of evidence-based solutions for obesity.

  1. Health of People with Obesity. The current study of British adults by Sarah Jackson and colleagues in Obesity suggests that weight discrimination promotes weight gain and the onset of obesity. Yet another study published in Obesity shows that weight discrimination is associated with higher levels of C-reactive protein. CRP is an indication of systemic inflammation linked to obesity and many of its complications, such as heart disease. These new findings build upon substantial evidence that experiencing discrimination leads people with obesity to avoid needed healthcare and develop further complications of obesity.
  2. Prevention. The prevailing bias that obesity is nothing more than the result of individual bad choices fosters little curiosity about what works for prevention. As a result, IOM recently concluded that the U.S. “lags behind international efforts in providing the leadership, guidance, support, and necessary infrastructure to support evaluation efforts” for preventing obesity. So we keep pursuing the same old strategies with little direct evidence for what works and what doesn’t.
  3. Policymaking. Conflicting agendas arise because of prevailing bias against people with obesity. The shame and blame implicit in some responses to obesity elicits an angry counter-agenda from some people with obesity that goes so far as to deny health effects of obesity. The net effect is to block straightforward pursuit of obesity as a health concern. Instead we have an expensive sick-care system to treat the chronic diseases that arise from obesity, rather than treating obesity itself.
  4. Research. Bias even affects research agendas and the scientific literature for obesity. Observational studies, short-term endpoints, surrogate endpoints, publication bias, and repetitive studies that build a bias of familiarity are all too common. The appetite and funding for ambitious, innovative research in obesity has not yet reached the scale that will be needed to solve this problem.

Reversing the harm of obesity to American health will require first that we reduce the bias against people with this complex, chronic disease.

Click here for the IOM commentary on bias by Puhl and Kyle, here for the study by Jackson et al, and here for the study of CRP and weight discrimination.

Blocks, photograph © Matthias Rhomberg / flickr

Subscribe by email to follow the accumulating evidence and observations that shape our view of health, obesity, and policy.