We all harbor antiobesity bias -- even those of us who are, ourselves, overweight or obese.
And we're so afraid of being fat that we'd make tremendous sacrifices to avoid it, find Marlene B. Schwartz, PhD, associate director of Yale University's Rudd Center for Food Policy and Obesity, and colleagues.
As part of her online study of antiobesity bias, Schwartz asked lean, normal weight, and heavy people what they'd be willing to give up if only it would keep them -- or make them -- not obese.
"A surprising number of people would make significant sacrifices," Schwartz tells WebMD. "That is an indication of how aversive being obese is."
'Desperate' to Avoid Obesity
Among the 4,283 people who participated in Schwartz's online survey, in order not to be obese:
--46 percent said they'd give up a year of life.
--15 percent said they'd give up 10 years of life.
--25 percent said they'd rather be unable to have children.
--15 percent said they'd rather be clinically depressed.
--14 percent said they'd rather be alcoholic.
--5 percent said they'd give up a limb.
--4 percent said they'd rather be blind.
Moreover, 10 percent of participants said they'd rather have an anorexic child than an obese child. Eight percent said they'd rather have a learning-disabled child than an obese child.
"It is easy to hypothetically say you would give something up, so I would take this with a grain of salt," Schwartz says. "But the fact they would even say it shows how desperate people are to avoid being obese."
Schwartz and colleagues report their findings in the current issue of the journal Obesity.
Obese People: Bias Inside
While obese people often said they'd make great sacrifices not to be obese, Schwartz found that underweight people were far more willing to endorse these sacrifices.
"The finding that the leaner people were willing to give up more was consistent with the finding that lean people have stronger antifat biases," Schwartz says. "But understanding why obese people had a lower level of being willing to give up those things is interesting."
The answer isn't the commonly held -- and erroneous -- notion that obese people aren't willing to make an effort.
"In our society, obese people already have sacrificed a lot -- all the time and energy and money spent on weight loss programs, all the opportunities closed to them because of stigma -- yet they are still overweight," Schwartz says. "It is important for us to realize that you can't just look at someone and understand the effort they are making to lose weight. People say, 'Oh, they just need to give up cheeseburgers.' That illustrates the weight bias we were trying to study."
Internalizing Negative Messages
In a test of unconscious weight bias, Schwartz found that obese people are just as likely as lean people to pair the words "lazy" and "fat." And they are just as likely to prefer thin people to fat people.
Morgan Downey, JD, executive director, of the American Obesity Association, says Schwartz's work goes to the root of the issue.
"When one is overweight or obese, one is always bombarded with news about fad diets, and fast and easy resolution of weight, and getting fast weight control," Downey tells WebMD. "Obese people take in the external message that it is easy to control their weight, and feel marked as a person who cannot take control. So they internalize the message there is something wrong with you if you can't control your weight."
This makes it even harder for an obese person to pursue a healthy lifestyle.
"Internalizing these negative things about yourself damages your ability to make healthy changes," Schwartz says. "The advice I give my obese patients is to really focus on the places in their lives where they are motivated and successful. They must keep reminding themselves of how much ability they have to make change."
Measure Behavior, Not Weight
Schwartz says America does not have an obesity epidemic because of what people weigh, but because of how people act.
"We need to pay more attention to what people are doing, not what they look like," she says. "Walking into a school and handing out high-fat, high-sugar foods is worse than walking into a school being obese. We need to focus on that rather than on the children who are gaining weight."
Obese people, Schwartz says, aren't the cause of the obesity epidemic.
"There is an epidemic of eating junk food, of kids eating sugared cereal and sugared soda and not eating enough fruits and vegetables and so on," she says. "There is also an epidemic of too much TV, too much computer and video-game time, and not enough time being active. We definitely have a huge societal problem that needs to be addressed. But we should measure behavior, not body weight."
Seen this way, the stigma of obesity is one more obstacle to health.
Weight Control 'Reality'
"We as a society have tried to simplify obesity and weight management. But it is a very complex issue," Downey says. "Weight regulation is a very, very complex body system. Normal weight regulation is exceedingly well balanced between energy intake and energy outflow. And we live in an environment that causes people to overconsume and underexpend calories."
It's simply not possible, Downey says, for obese people to become thin people. What is possible is for obese people to become healthy people.
"Most consumers want more than just maintaining weight -- they want to lose great amounts of weight," he says. "Short of surgery, we just cannot deliver that at this time. We have to reconcile our expectations with the reality of weight control, and get people to think more about long-term health issues. Weight control is a lifelong effort, and people need to test different tools to find the ones that help them. The end product is to reduce things like type 2 diabetes, and heart disease, and stroke -- things that steal a lot of years from the lives of people who are overweight and obese."
By Daniel J. DeNoon, reviewed by Louise Chang, MD
SOURCES: Schwartz, M.B. Obesity, March 2006; vol 14: pp 440-447. Marlene B. Schwartz, PhD, associate director, Rudd Center for Food Policy and Obesity, Yale University. Morgan Downey, JD, executive director, American Obesity Association, Washington.