Exercising Power Over People with Obesity

It’s easy to lose sight of power dynamics in obesity. “Instruct the patient to lose weight.” For years, that was the standard prescription for dealing with obesity in primary care. It is worse than useless advice. People with obesity dread hearing a condescending lecture from health providers. That’s because power dynamics matter. We live in a culture that values thinness and demeans people living with obesity. And it may well serve to make obesity worse.

Coping with a Rigged System

Michelle Cardel and colleagues presented new research on subjective social status and eating behaviors at Nutrition 2019 earlier this month. They studied how eating behavior varied when Hispanic adolescents participated in a rigged game of Monopoly. Some of the subjects got a high status that helped them win. Others got a low status that made it difficult or impossible. After the game, researchers served a lunch and carefully measured how much each participant ate.

In combination with sex and food insecurity, social status had a significant effect on eating behaviors. In the low status groups, subjects felt more powerless. Males with low status ate less. But females with low status ate more. Food insecurity contributed a tendency to eat more, too.

In another study published in Appetite, many of the same investigators found a relationship between social status and eating behaviors after a large meal. For two weeks, female subjects ate a large lunch in the lab. It gave them 60% of the calories they needed. But the food these subjects chose to eat outside the lab varied with their subjective social status. Those with lower status ate significantly more. They didn’t compensate as well for getting that big meal at lunch.

Physical Activity

Likewise, Katja Rajala and colleagues found that social status of adolescents at school has a relationship with how active or sedentary they are. Low status individuals were less active all day and more sedentary at school.


All of this reinforces something we’ve known for some time. Social status matters for health and well-being. Demeaning people with obesity doesn’t help. It adds to the problem and has potential to turn a difficult problem into an impossible one.

Good health and well-being is an important aspiration. But it’s not merely a matter of choice. Dignity, respect, and good health go together.

Click here for the rigged Monopoly study, here for the study in Appetite, and here for the study of physical activity.

Go! photograph © Bill Selak / flickr

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June 21, 2019