Social Psychology Quarterly 74(1) 76–97 The Stigma of Obesity: Ó American Sociological Association 2011 DOI: 10.1177/0190272511398197 Does Perceived Weight http://spq.sagepub.com Discrimination Affect Identity and Physical Health? Markus H. Schafer1 and Kenneth F. Ferraro1 Abstract Obesity is widely recognized as a health risk, but it also represents a disadvantaged social position. Viewing body weight within the framework of stigma and its effects on life chances, we examine how perceived weight-based discrimination influences identity and physical health. Using national survey data with a 10-year longitudinal follow-up, we consider whether perceptions of weight discrimination shape weight perceptions, whether perceived weight discrimination exacerbates the health risks of obesity, and whether weight perceptions are the mechanism explaining why perceived weight discrimination is damaging to health. Perceived weight discrimination is found to be harmful, increasing the health risks of obesity associated with functional disability and, to a lesser degree, self-rated health. Findings also reveal that weight-based stigma shapes weight perceptions, which mediate the relationship between perceived discrimination and health. Keywords obesity, stigma, discrimination, health The sense that one has been treated weight discrimination). Though less unfairly at work or in public places frequently studied, social reactions to can have negative consequences for body weight may be linked to opportu- sentiment and health. When discrimi- nity structures and personal well- nation is perceived to be related to being, but the mechanisms for how race or ethnicity (an ascribed status), this occurs are a matter of ongoing it is often viewed as an overt form of debate (Muennig 2008; Puhl and racism, initiating a stress process Brownell 2001). that may compromise physical and mental health (Gee 2002; Williams, Neighbors, and Jackson 2003; Taylor 1Purdue University and Turner 2002). Other forms of per- ceived discrimination, however, may Corresponding Author: Markus Schafer, Center on Aging and the Life be linked to attributes or conditions Course, Purdue University, Young Hall, 155 S. that are developed over time, such as Grant St, West Lafayette, IN 47907-2114 the case with excess body weight (i.e., Email: [email protected] Downloaded from spq.sagepub.com at ASA - American Sociological Association on March 4, 2011 The Stigma of Obesity 77 There is some evidence from studies affects health, this study examines of perceived ethnic discrimination that body weight, self-perceptions of weight positive ethnic identity plays a protective status, perceived weight discrimination, role on mental health (Mossakowski and changes in health observed over 10 2003; Sellers et al. 2003), but it is years. We posit that the social processes unlikely that a parallel effect would be involved in identity formation and revi- widely observed from weight-based dis- sion are critical to assessing how physi- crimination. Despite social movements ological factors such as excess body for self-acceptance among overweight weight influence health. Missing from people, relatively few people favorably much of the previous literature is a con- identify themselves as overweight or sideration of how interpretive processes obese. Rather, many feel that being fat associated with body weight shape is a stigmatizing experience, one that health outcomes. We therefore draw limits social and economic opportunities from studies of stigma to examine the and operates as the ‘‘last acceptable antecedents and health consequences basis of discrimination’’ (Puhl and of identity as an overweight person.2 Brownell 2001:788). As a basis of One expects that excess body weight stigma, heavy body weight constrains is related to identification as an over- or harms occupational chances, delivery weight person, but we ask whether per- of health services, educational attain- ceived weight discrimination heightens ment, family relations, self-concept, identity as an overweight person. The and various indicators of well-being analysis aims not only to document (Carr and Friedman 2005; Carr how discrimination may get ‘‘under and Friedman 2006; Crosnoe 2007; the skin’’ in a medical sense (McEwen Crosnoe, Frank, and Mueller 2008; 1998), but also to examine whether Puhl and Brownell 2001). perceived discrimination shapes the Increasingly, even medical resea- way people evaluate themselves in rchers are acknowledging that excess relation to a stigmatized condition. body weight is harmful for health not We anticipate that people do not inter- solely on a physiological basis, but in pret their body weight status on the part because of the stress associated basis of mere physiology, but rather with enduring an unfavorable social through interaction with others. trait (Muennig 2008).1 Implicit in Thus, we approach the analysis from this proposition are core sociological a sociological understanding of stigma. themes, including the internalization of stigma and interpretive self- identity processes borne out of social interactions. To more clearly understand how 2Throughout the paper, we use the term ‘‘over- perceived weight-based discrimination weight’’ when referring to identities, but speak of ‘‘obesity’’ only in terms of its official classification, which is a body mass index of 30 or more. A main 1The reasons for perceived discrimination’s reason that we do not mention ‘‘obese’’ identities deleterious effects on health are many, including owes to the wording of the survey questions stress of repeated contact with antagonistic that refer to ‘‘very overweight’’ and ‘‘somewhat others, rejection or avoidance in social settings, overweight.’’ Moreover, in colloquial discourse, negative self perceptions, and differential alloca- people more commonly refer to being somewhat tion of resources via social segregation or very ‘‘overweight,’’ rather than making (Campbell and Troyer 2007; Carr and Friedman refined, diagnostic categorizations of themselves 2005; Krieger 1999; Muennig et al. 2008). and others. Downloaded from spq.sagepub.com at ASA - American Sociological Association on March 4, 2011 78 Social Psychology Quarterly 74(1) STIGMA AND BODY WEIGHT Most studies on stigmatization in sociology focus on ‘‘unusual condi- In discussing distinctive features of the tions,’’ such as severe mental illness self, Goffman (1963) developed a nuanced (e.g., Schulze and Angermeyer 2003) depiction of stigma and articulated how or HIV/AIDS (e.g., Parker and it plays out in everyday social life. Aggleton 2003). This interest in the Stigmatized traits, or ‘‘deeply discredit- ‘‘unusual’’ has been noted as an ing’’ characteristics, make people appear arbitrary boundary mechanism that dangerous or unacceptable in the eyes of sets apart stigma scholarship from its others, reduce their life chances, and iso- close intellectual cousins—prejudice late them (Goffman 1963:3). In his clas- and discrimination—which focus on sic statement on the subject, Goffman usual traits such as race, gender, or (1963:3) argued that people are rejected religion (Stuber, Meyer, and Link and classified as undesirable on three 2008). Indeed, some scholars assert accounts: (1) ‘‘tribal stigmata,’’ (2) that prejudice and stigma stem from ‘‘abominations of the body,’’ and (3) a singular theme, leading Phelan ‘‘blemishes of individual character.’’ Not and colleagues (2008) to suggest the only do outsiders look down upon the latter term be used as the unifying stigmatized individual, but the victim concept from which flow attitudinal him- or herself absorbs the discomfort and behavioral responses (i.e., preju- and unease from social interaction into dice and discrimination, respectively). his or her own self-concept. Therefore, the experience of perceived Soon after Goffman’s book, other weight discrimination will be treated sociologists began to show that body in this paper as an indication of weight—obesity in particular—is an stigma. attribute related to embarrassment and ultimately to life chances (Cahnman 1968; Maddox, Back, and OBESITY’S EFFECT ON HEALTH Liederman 1968). Several classic studies showed that not only was corpulence Though we are mainly interested in seen as a physical blight, but also that how issues related to stigma are associ- body weight is thought to be under peo- ated with health declines, it is useful ple’s control; thus, obese people were fre- from the outset to anticipate that the quently considered lazy, self-indul- physiology of heavy weight will have gent, and gluttonous (DeJong 1980; its own direct effect on health problems. Maddox et al. 1968). These findings The general effects of excess weight on demonstrated the prejudiced manner health have been enumerated at in which obese people are treated, but length (Andreyeva, Sturm, and Ringel as Carr and Friedman (2005) note, it 2004; Ferraro and Kelley-Moore is important to also consider whether 2003), and thorough reviews of the lit- obese people perceive that they have erature can be foundelsewhere(e.g., been mistreated. This subjective attri- Houston, Nicklas, and Zizza 2009; bution of discrimination to one’s Kopelman 2007). In brief, excess weight is a key component of the stig- weight has a pervasive effect on matization process and helps explain a host of bodily systems, affecting why a stigmatized trait would affect metabolism, endocrinology, respira- someone’s life chances (Carr and tion, and musculoskeletal integrity, Friedman 2005). among other aspects of health. Downloaded