Reducing Stigma Toward Black Women Who Vary in Body Size

by Jessica Shropshire

Photo credit: Chiara Vercesi for Scientific American

Black women are at an increased risk for a variety of physical health outcomes. One out of four middle-aged Black women has diabetes and rates of death from heart disease and stroke are twice as high among Black people than White people.1 Obesity is a compounding problem to add to this list of health issues that disproportionately affect Black women. Eighty-two percent of Black women are classified as obese.2 And this disparity starts at an early age—21 percent of young girls are classified as obese compared to fifteen percent of White girls.3

Most efforts that address obesity focus on changing the individual’s behavior, such as through increased exercise and changes in diet.4,5 While these interventions can be empowering, they also implicate the individuals, and their body mass index (BMI), as the source of the issue. The perception of the individual as being at fault, increases weight stigma, i.e., harsh language and stereotypical portrayals of obese individuals.6 Both racial stigma and weight stigma put individuals at risk for a variety of health issues including weight gain, depression, and even death—obesity discrimination is associated with an increase in mortality risk of nearly 60 percent.7 Thus, Black women experience a compounding effect of stigma driven by both race and weight.

Despite the importance of stigma for a variety of mental and physical health outcomes, research in this domain has yet to test the connection between obesity- and race-based stigma. Moreover, existing efforts focus on the stigmatized individuals themselves. An untapped resource in reducing stigma and the associated mortality rates may lie in those who do the stigmatizing—termed perceivers. Previous research shows that interventions focused on stigma reduction are more effective for both mental and physical health improvement than interventions that focus on health alone.8

Weight stigma is mistakenly considered an acceptable weight loss tool:

Current lay theories and a majority of public health research on obesity tend to disregard the role of weight stigma in influencing the mental and physical health of obese individuals. However, previous research has found that obese individuals experience stigma associated with their appearance, including stereotypes that they are lazy, weak willed, and unintelligent, lack self-discipline, have poor willpower, and are non-compliant with weight loss treatments.9,10,11,12,13 Furthermore, this feedback tends to come from strangers, employers, coworkers, teachers, and even friends and family members. Indeed, stigma toward obese individuals continues to not only be socially acceptable but even considered necessary to hold obese individuals responsible for their weight.14 Individuals stigmatize others because they believe it motivates obese individuals to becomes skinny.15,16,17 However, stigma as a weight-loss tool is not effective at reducing obesity and leads to severe mental and physical health problems, even death.

Racial discrimination is associated with weight gain:

There are few studies that explicitly test the role of race in obesity stigma. And yet, for racial minorities, race-based discrimination plays a role in weight gain. Racial discrimination is associated with increased BMI and this association is strengthened with increased time spent in the United States.18 Black women who experience racial discrimination are more likely to become obese, particularly when the racism is expressed in the workplace and questions their intelligence.19 And, young Black girls in particular express more experiences with being labeled fat than young White girls, leading to greater odds of obesity later in life regardless of their initial body weight.20 Thus, racial minority status plays an important role in the effect of obesity stigma on health. However, rarely does work in this area of research address the source of the stigma.

Focusing on the source of the stigma—the perceiver:

Work in the domain of stigma has been incredibly useful in terms of exploring the relation between obesity stigma and health. However, interventions aimed at reducing obesity bias have proven difficult, and recent research suggests we need new solutions.21 One reason why this might be the case is that this work has focused largely on targets’ experiences of stigma. While understanding and addressing the impact of stigma is vital, methods aimed at addressing the source of the stigma and reducing the stigma itself can also be beneficial.

One way to measure perceiver stigma is by measuring bias in the visual cues they attend to in their environment. Individuals form important social impressions of others based on minimal information from visual cues in the body.22 Perceivers use shape and movement cues in the body to infer gender, sexual orientation, and affective states. 23,24,25,26 Furthermore, perceivers also attend to body cues to make evaluative judgments about others. In the context of obesity, people are considered undesirable if they are obese.27,28Perceivers make these evaluations rapidly and with minimal visual information. For obese individuals, these perceiver evaluations have significant mental and physical health consequences. As such, perceivers attendance to these visual cues play a critical role in understanding the relationship between obesity stigma and health.

Our research:

Previous research shows that, in the context of obesity, exposing perceivers to thin bodies (low BMI) shifts the categorization of what is considered obese to be smaller, and exposing perceivers to obese bodies (high BMI) shifts the categorization of what is considered obese to be larger.29 Our research will harness these methods that have proved successful at shifting perceivers categorization for what is considered obese and apply them to the domain of racial stigma. First, we will determine the role of perceiver stigma in evaluations of the average weight of Black vs. White men and women. We predict that, consistent with our preliminary data, perceivers will rate Black women as having the highest body weight relative to Black men, White men, and White women. Having established the role of perceiver stigma in driving obesity evaluations for Black individuals vs. White individuals, we will shift our focus from implicit stigma to explicit stigma. To explore explicit perceiver stigma, we will measure the extent to which perceivers ascribe negative traits associated with obesity stigma and race stigma to Black individuals vs. White individuals at varying levels of BMI. Here, we predict that perceivers will express greater stigma toward Black individuals relative to White individuals, especially Black women, and this stigma will increase as the BMI of Black individuals increases. Having clarified perceiver’s implicit and explicit stigma toward Black women, we plan to show that by reducing obesity stigma, we can reduce stigma toward Black individuals. We predict that when we expose perceivers to targets who have a large BMI, we will increase the point at which they rate Black individuals as being obese and this will subsequently reduce negative trait ratings associated with both obesity and race stigma.

In Conclusion:

We must cultivate a healthy social environment that includes and accepts Black women who vary in body size. Perceivers play an important role in creating a healthy social environment. Here we predict that perceivers are implementing obesity stigma, a socially accepted stigma, as a way of targeting Black women. By clarifying the nature of perceivers’ stigma toward Black women, we can inform interventions that address and reduce perceiver stigma toward Black women. Here, we propose visual processing as a tool by which we can both measure stigma as well as decrease stigma. A related area of unpublished research in our lab suggests that repeated exposure to a series of images in the media dramatically shifts later perception of the gendered representation of individuals. Thus, one actionable intervention consistent with our paradigm is one that increases exposure to Black women who vary in body size through various media outlets, so that we can change our concept of the “average” body type to actually include Black women of all shapes and sizes.

Jessica Shropshire is a PhD candidate in Social Psychology. Shropshire’s research investigates the role of visual cues in influencing a host of consequential judgments about individuals who vary along the dimensions of gender and race. She is a recipient of CSW’s 2020 Elizabeth Blackwell, MD, Graduate Award.

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