Impact of Obesity Stigma in Low to Middle-Income Countries

Overview of Obesity Stigma

Experts in the United States have recently examined the implications of obesity stigma in low to middle-income countries. Obesity is increasingly recognized as a significant global health issue. In wealthier nations like the United States, Western Europe, and Australia, being overweight is often associated with negative characteristics such as laziness and a lack of self-control. This stigma leads to high levels of discrimination and bullying among individuals who are overweight or obese. Furthermore, medical professionals and public health campaigns frequently perpetuate “anti-fat” messages, which adversely affect mental health, diet, and exercise habits. These factors can hinder the effectiveness of health interventions aimed at treating obesity, prompting a growing recognition of the need to combat stigma associated with being overweight.

Changing Perspectives on Obesity

Historically, obesity stigma was viewed as a “first-world problem,” with larger body sizes often being celebrated in low to middle-income regions. However, recent research indicates that these attitudes are evolving. A review of current evidence on obesity stigma in these regions was published in Globalization and Health.

Rising Obesity Stigma

Shifts in Attitudes

Anthropological studies have documented shifts in perceptions surrounding body size in low to middle-income countries. Research from Fiji conducted in the 1980s and 1990s showed a strong appreciation for well-cared-for, larger bodies. However, studies from the mid-2010s reveal a growing perception of larger bodies as undesirable. Similarly, Belize has witnessed a rapid transformation in attitudes; in the early 2000s, curvy women were deemed attractive, while by 2015, larger bodies began to be viewed as social and economic burdens.

A comprehensive study across various countries, including Samoa, Mexico, and Paraguay, identified a higher prevalence of “anti-fat” attitudes compared to those in the USA, UK, and New Zealand. In some lower-income nations, the situation is more complex, with individuals expressing both “anti-fat” and “pro-fat” sentiments. For instance, in Western Polynesia, while “anti-fat” anxieties exist, “pro-fat” attitudes are prevalent during social gatherings such as church events and feasts.

The Emergence of “Fat Talk”

There is growing evidence of evolving attitudes toward fatness being reflected in language. Searches on platforms like Yahoo Answers, such as “Am I Fat?” are increasingly common in low and middle-income countries, mirroring trends seen in wealthier nations. These inquiries often correlate with concerns about bullying. Additionally, the phenomenon of “fat talk”—conversations around body image, such as “Does this make me look fat?”—is emerging among young women in both low and high-income countries.

Evidence of “Anti-Fat” Bias

Psychological Assessments

Standardized psychological tools have been widely utilized in high-income nations to assess explicit and implicit anti-fat biases. The Attitudes to Obese People (ATOP) questionnaire measures explicit bias, while Implicit Association Tests (IATs) explore implicit bias. Small-scale studies using the ATOP questionnaire in countries like Dominica, Bolivia, and Paraguay have indicated alarmingly high levels of anti-fat attitudes. Furthermore, Project Implicit, a study involving 71 countries, demonstrated significant variability in implicit anti-fat attitudes, with notably high levels identified in both low and middle-income countries as well as in wealthier nations.

Health Consequences of Growing Obesity Stigma

Documented Negative Effects

In the United States, the detrimental health effects of obesity stigma are well-documented, and emerging evidence suggests that similar outcomes may arise in lower-income countries. A substantial study in Guatemala revealed that weight teasing is frequently reported among young women, leading to depressive symptoms comparable to those experienced due to domestic violence, food insecurity, or civil conflict. Instances of teasing for being underweight also resulted in similar depressive outcomes. Additional studies from Fiji, Belize, and the United Arab Emirates corroborate that obesity stigma contributes to disordered eating behaviors.

Conclusion

The limited research indicates that “anti-fat” attitudes are becoming more prevalent in low to middle-income countries, reflecting a recent shift in societal perceptions. Evidence shows that obesity stigma is distressing and may negatively impact health in these regions. The researchers advocate for the monitoring of weight-related stigma in diverse cultural contexts and emphasize the need to establish the detrimental effects of anti-fat attitudes on health. Furthermore, it is crucial to clarify how public health messages may inadvertently foster anti-fat sentiments. The definition of “weight stigma” should encompass both overweight and underweight individuals, particularly in regions still grappling with malnutrition. Insights gained from the experiences of high-income countries can inform efforts to avoid similar pitfalls in lower-income settings.

Written by Julie McShane, Medical Writer
Reference: Brewis A, SturtzSreetharan C, Wutich A. Obesity stigma as a globalizing health challenge. Globalization and Health (2018) 14:20. Doi:10/1186/s12992-028-337-x