Stigma of obesity 'lingers after weight loss'

“No matter how much weight you’ve lost, your friends still think of you as fat,” according to the Daily Mail. The newspaper has reported new research showing that overweight women and women who have slimmed down are seen as less attractive than those who had always been slim.

The research analysed the views of 273 student volunteers who were asked to judge different descriptions of the same fictional 31-year-old woman whose weight details had been subtly altered in each one. These descriptions were designed to assess attitudes to both current weight and past weight, to see whether individuals who lose a large amount of weight are regarded negatively. The researchers found that slim people who had lost weight in the past attracted higher ratings of stigma than those who were currently slim but had maintained a stable weight in their lifetime.

The study highlights that obesity-related stigma may not just be based on current weight (obese vs. lean) and may be affected by previous weight history (stable body weight vs. weight loss). However, the study has many limitations and only found relatively small differences in the stigma directed towards the women. Furthermore, as the descriptions only assessed a single woman in a controlled setting, the research may not reflect attitudes towards a wider range of people in real life.

Where did the story come from?

The study was carried out by researchers from universities in Hawaii, Australia and England. No funding sources were mentioned within the research paper but the authors declared no conflict of interest.

The study was published in the peer-reviewed medical journal Obesity.

The Daily Mail reported that participants were "shown pictures of five 31-year-old women and told to read notes about them" before being asked to "rate each woman's attractiveness". This is not the case. The participants were deliberately not shown any such images to avoid biasing their opinions, and were only asked to read five different weight histories of just one fictional 31-year-old woman.

Furthermore, the assertion that friends and family will “always regard people as fat” even after slimming goes beyond the findings of the research. The researchers only asked strangers to judge a description of a fictional person in an artificial setting, not someone they actually knew.

What kind of research was this?

This was a cross-sectional study looking at individual attitudes towards other people’s weight and how these are affected by descriptions of their weight histories. For example, whether knowing a thin person used to be obese made people regard them differently from those they thought had been thin all their life (“residual stigma”). The weight may have come off but did the stigma remain?

The researchers reported that stigma associated with obesity is widespread and increasing. They pointed out that obesity is associated with poorer psychological functioning as well as academic, employment and relationship problems. They also said that the media implies that people can easily control their body weight, which may fuel some of the stigma directed at those who are overweight.

This study design was broadly appropriate to answer this research question.

What did the research involve?

This study investigated stigma directed at formerly obese people who lost weight and became lean (through behavioural or surgical methods) or lost weight but remained obese, compared with weight-stable obese and weight-stable lean people. The study also monitored the type of stigma directed at obese people after student volunteers were given descriptions of people who lost weight and remained at a stable weight.

The study assessed the attitudes of a group of 273 psychology students with an average age of 20.7 years. They had mixed ethnic backgrounds and 68% of participants were female.

The participants were randomly assigned to read one of five summaries describing a 31-year-old female “target” individual. All the biographical details that weren’t weight-related were identical across the five summaries. The weight-related details differed as follows:

The target had been overweight all her life and never lost weight (termed “weight-stable obese”). Her height and weight were provided to equal a BMI score of 35.44.
The target was a normal weight and had never been overweight (“weight-stable lean”; BMI = 23.24).
The target had previously been overweight but lost weight through bariatric surgery and is no longer overweight (“weight-loss surgery”; prior BMI = 35.44, current BMI = 23.24).
The target had previously been overweight but had lost weight through diet and exercise (“weight-loss-behavioural”; prior BMI = 35.44, current BMI = 23.24).
The target was currently overweight but had lost weight from a higher weight (“unspeciﬁed weight-loss method”; prior BMI = 47.63, current BMI = 35.44).

The summaries involving weight loss all described a loss of 31.78kg (70lbs). The summaries were designed to present the reader with information on two key dimensions that could influence their judgement of another person:

weight stability – whether they were weight-stable or had lost weight
current weight – obese or lean

Stigma towards any of the descriptions was measured using a Universal Measure of Bias (UMB) scale. This is a 20-item questionnaire that included questions such as “I find people like [target’s name] pleasing to look at,” and asked participants to rate how strongly they agreed with each statement ranging from a score of 1 (strongly agree) to 7 (strongly disagree). This assessment scale has subgroups of questions assessing attractiveness and negative judgements. Total scores were added up across the questions to create an overall stigma rating.

The participants’ attitudes toward obese people in general was also assessed using a 13-item questionnaire, which included statements such as “I don’t like fat people much,” and again asked participants to what extent they agreed with this statement. The researchers described how higher scores indicated higher “anti-fat” attitudes. This scale was split into subgroups assessing dislike and willpower for analysis.

The stigma towards all five target groups was analysed to evaluate which group attracted the most stigma. This included analysing subgroups of the UMB score, such as attractiveness ratings and negative judgement ratings.

What were the basic results?

The summary of the main findings are as follows:

In both the weight-stable and weight-loss groups, currently obese targets were more stigmatised than currently lean targets, although the actual differences in UMB score seemed relatively small. For example, in the weight-stable group the average total UMB score was 3.29 for currently obese people compared with 2.94 for the currently lean – higher scores denoting more stigmatisation.
People who had maintained a stable weight and were currently lean were rated more attractive (UMB attraction score 3.24) than those who had maintained a stable weight but were currently obese (UMB attraction score 4.51).
Targets depicted as ever having been obese, either currently or previously, were subject to increased stigmatisation compared with those who had never been obese, although again the actual differences were small.
Currently lean people who had lost weight were significantly more stigmatised (UMB total score 3.20) than currently lean people who were weight stable (UMB total score 2.94).
Those who were currently lean but had lost weight in the past had more stigma attached to their attractiveness (UMB attractive scale stigma score of 3.83) compared with those who were currently-lean but who had a stable weight (UMB attractive scale stigma score of 3.24)
There was greater obesity stigma after participants read summaries describing weight loss compared with weight-stable descriptions. For example, those who were currently lean who had lost weight were disliked more (average score 2.92) than those who were currently lean but had always been so (average score 2.58). A similar difference was seen between those who were currently obese and lean individuals with stable weight.

How did the researchers interpret the results?

The researchers concluded that currently lean individuals with a history of obesity “are judged less attractive than weight-stable lean individuals.” Additionally, “The ﬁnding that weight loss does not erase the stigma of obesity is consistent with prospective long-term studies showing lower earnings and occupational attainment in women who were previously overweight.”

The authors also highlighted the finding that “participants exposed to descriptions of weight loss also demonstrated greater dislike of obese people in general”. They suggested that people given the impression that body weight was easily altered (through reading about significant weight loss) were more likely to stigmatise obese people than those reading about stable body weight.

Conclusion

This cross-sectional study highlights small (yet statistically significant) differences in the stigma ratings given by psychology student volunteers after reading descriptions of a fictional woman with different weights and weight histories. It showed that obesity-related stigma may not just be based on an individual’s current weight (obese vs. lean) and may actually be affected by previous weight history (stable body weight vs. weight loss).

While this conclusion is interesting and should not be discounted, the study does have significant limitations.

For example, the participants assessing the descriptions were all young psychology students and the majority (68%) were female. It is yet to be demonstrated whether the same stigma ratings would be seen if the experiment was repeated using different groups such as more men or older adults or people from different cultural backgrounds.

The study also used a scale-scoring system to assess stigma. It is not obvious or tangible whether the seemingly small differences in the UMB stigma scores (although statistically significant in some cases) actually reflect real-world prejudices or behaviour towards obese people. The extent to which these differences in perception are felt and result in an impact on lives is unclear and should be carefully considered.

Finally, the summaries were all based on the description of a single fictional 31-year-old woman rather than a real person or group of people. Therefore, the results may have reflected a dislike of this particular character, and not obese people in general.

From this study alone it would be misleading to conclude that all lean people who have previously lost weight are more stigmatised by society than individuals who have always been lean. This is yet to be established and may differ significantly across different ages, genders and ethnic backgrounds.

However, stigma and the associated discrimination and negative attitudes towards people who are overweight or obese is reported to be an increasing problem and research such as this may help people to understand its causes better.