Does Psychological Stress Explain the Harm of Obesity?

For some time, one of the tenets of the fat acceptance movement has been that the health harms of obesity have been grossly exaggerated. Rather, it is the psychological stress of fat phobia that explains the poor health outcomes associated with obesity. In selling her fat acceptance book, philosopher Kate Manne insists obesity itself is not especially harmful to health. Weight loss does not produce health benefits according to her. Instead, she argues that the psychological stress of fat phobia is the primary source of harm to mental and physical health in people living with obesity.

New research in the International Journal of Obesity suggests that this is a false dichotomy. Researchers found that both psychological well-being and obesity may independently and additively contribute to the development of non-communicable diseases. These NCDs include hypertension , heart disease, stroke, diabetes, arthritis, cancer, and dementia.

A Mediation Analysis

To reach this conclusion, the authors used longitudinal data from U.K. and U.S. studies in older adults. Specifically, they relied upon the English Longitudinal Study of Ageing and the U.S. Health and Retirement Study. Cox proportional hazard models, Poisson regression, and causal mediation analysis were their tools.

They found:

“Obesity was consistently associated with an increased prospective risk of hypertension, heart disease, diabetes, arthritis, and a cumulative number of NCDs in both ELSA and HRS. Worse overall psychological well-being (index measure) and some individual psychological well-being related measures were associated with an increased prospective risk of heart disease, stroke, arthritis, memory-related disease, and a cumulative number of NCDs across studies. Findings from mediation analyses showed that neither the index of overall psychological well-being nor any individual psychological well-being related measures explained (mediated) why obesity increased the risk of developing NCDs in both studies.”

A False Dichotomy

The point here is that the physiologic harm of obesity and the harm of psychological distress that accompanies it are additive. The false dichotomy suggesting we must choose between treating obesity and stopping weight bias is unhelpful. Obesity itself harms health. Weight stigma compounds the harm.

So we must deal with both sources of harm.

Click here for the new study in IJO, here for more of the false argument that treating obesity makes weight stigma worse.

A Sad Girl, painting by Carlos Saenz de Tejada / WikiArt

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June 10, 2024