Obesity Stigma Depends on Where You Live

People living in areas where obesity is more common may experience less stigma, which could help reduce some of the social and health consequences of being overweight.

If people with obesity feel less conspicuous in those regions — the Midwest, South, and East Coast, for example — they may face fewer social, economic and medical issues, according to recent research published in the journal Psychological Science.

This suggests that some negative effects of obesity are caused by social attitudes and can be reduced, the researchers said.

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The Rise in Obesity

Why is the rate of obesity on the rise?

Those negative consequences “aren’t as inevitable as often thought,” said lead author Jana Berkessel, PhD, a postdoctoral research fellow at the University of Mannheim in Germany. “One way to change society’s views of obesity may be through a more true-to-life representation of different body sizes in the media.”

People with obesity experience higher rates of prejudice, discrimination, unemployment, poor physical health, and poor mental health, studies have found. Adult obesity doubled and adolescent obesity quadrupled between 1990 and 2022, according to the latest data from the World Health Organization.

Obesity “has severe consequences for those affected,” said Berkessel, who studies cross-cultural social and personality psychology. 

“It is quite easily imaginable that people with obesity in regions with low obesity rates stick out much more and have different social experiences on an everyday basis,” Berkessel said.

Different Places, Different Attitudes

Obesity rates vary from 5% to 50% in different parts of the United States. People with obesity often face the bias that they are “lazy, unmotivated, and undisciplined,” the paper noted.

In two studies, the researchers analyzed data across 2,500 U.S. counties and in 380 U.K. districts. Obesity rates (using a body mass index of 30 or higher) were above average in the Midwest, South and along the East Coast but below average in Florida, New England, and the West Coast. 

In the U.K., obesity rates were above average in the central and northern parts of the country, especially in southern Wales, but were lower in the southern region, including London.

Researchers assessed obesity’s effects in close relationships, economic outcomes, and health. Their analysis revealed that “the association between obesity and its adverse consequences is reduced (or absent) in high-obese regions,” the paper said. 

Likewise, people with obesity who live in low-obesity regions were significantly more likely to report worse outcomes — such as unemployment or poorer health — than those in high-obesity areas.

“These findings give way to social interventions, stress the importance of reducing weight bias, and may inform policymakers about the different challenges that obesity-related policies face in different regions,” Berkessel said.

In an additional analysis of 409,000 Americans across 2,900 counties, the research team looked at attitudes about others’ weight and found that obesity bias appeared to be lowest in high-obesity regions. This difference could partially explain why people with obesity may experience fewer social, economic, and health consequences in areas with less weight bias.

How a Change in Attitude Might Help 

Finding ways to reduce obesity bias requires “careful consideration,” said Robert Eckel, MD, an emeritus professor of medicine at the University of Colorado Anschutz Medical Campus in Aurora, Colorado. He wasn’t involved in the study.

In 2020, Eckel and three dozen colleagues worldwide issued a consensus statement calling for the end of obesity stigma, particularly in health care settings. 

“The next research steps relate to making health care professionals more comfortable in assessing and treating patients with obesity in areas where obesity is less prevalent,” said Eckel, who has previously served as president of the North American Association for the Study of Obesity. “This is a big effort, but expanding videoconferencing by thought leaders in obesity science and social workers would be important to consider.”

It’s a complicated field. Age, gender, race, and ethnicity play roles in the connections among obesity, weight bias, and negative consequences. So do socioeconomic status and mental or physical comorbidities. 

Moreover, obesity and mental health are intertwined, posing barriers to each other.

“While it’s clear that excess weight can take a toll on someone’s emotional well-being, it’s also true that mental health conditions may influence a person’s weight,” said Dorothea Vafiadis, senior director of the National Council on Aging’s Center for Healthy Aging.

Treatments can also create challenges, where antidepressants and mood stabilizers lead to weight gain. Also, many people may not be able to access weight-management therapies, whether through nutrition, physical activity, behavioral therapy, or medications, she said. Ongoing change requires greater awareness across the health care spectrum, including patients, primary care providers, specialists and health care policymakers.

“Good health and happiness are things we all deserve — at every age,” Vafiadis said. “A holistic treatment plan can help improve people’s mood and outlook while empowering them to achieve and maintain a healthy weight.”