The Great Judge

Does Weight Stigma Harm More Than Obesity?

An article of faith in the fat acceptance community is the idea that weight stigma causes more harm than obesity itself. In the extreme, there’s a belief that we should do away will any reference to obesity. People hold this belief because they think the health harm ascribed to obesity actually comes from weight stigma. A more moderate statement of this concern can be found in proposals for weight-inclusive health policy.

In fact, new research by Greg Pavela and colleagues in SSM – Population Health aimed to test the idea that stigma arising from having a higher BMI than population norms might account for some of the excess mortality associated with obesity. But these researchers did not find evidence to support their hypothesis:

“We hypothesized that the stigmatization of obesity might lead to an increased MR [mortality rate] after controlling for absolute BMI. Contrary to expectations, a higher relative BMI was not associated with an increased MR independent of absolute BMI.”

Absolute, Not Relative, BMI Predicts Mortality

This was a challenging analysis to undertake. So the authors are quite transparent about the challenges. They analyzed data from three different sources: NHANES, NHIS, and the Health and Retirement Study. In total, they analyzed data from more than 600,000 individuals. They examined the relationship between absolute BMI and mortality. In addition, they looked at BMI relative to social reference groups based on age, sex, and race.

They supposed that a person who is above the norm of BMI for their social reference group might experience more stigma and perhaps more harm from that stigma.

In the end, they did find a clear relationship between absolute BMI and mortality as BMI rose above 25. As BMI rose, so did mortality. But they could not find a relationship between relative BMI and mortality.

Not the Final Word

By no means is this analysis the final word on the contribution that stigma makes to the health harms of obesity. Many challenges are inherent to studying this question. Pavela et al discuss those challenges at length in their excellent paper.

But at the very least, these findings stand in the way of making the bold assertion that most or all of the harm of obesity comes from stigma. No, obesity is real and its pathophysiology does cause harm to the body. Stigma very likely adds to that harm, though it is not clear exactly how much it does.

So for now, we suggest that one does not have to choose between taking obesity seriously or taking weight stigma seriously. Both are important concerns for physical and mental health.

Click here for the new paper by Pavela et al. For further perspective on weight inclusive health policy and on addressing both obesity and weight stigma, click here and here.

The Great Judge, painting by James Ensor / WikiArt

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


August 16, 2022