Obesity: Social rejection promotes mental illness and further weight increase

Obese persons are often confronted with prejudices, depreciation, social isolation and discrimination. These are chronic stressors and the psychic strain through such stigmatizations can lead to depressions, anxiety disorders and even often to further weight increase.

Based on existing studies on stigmatization Dr. Claudia Sikorski has examined the mechanisms of this vicious circle for the Integrated Research and Treatment Center (IFB) AdiposityDiseases. The results were recently published in the professional journal Obesity. Since obesity still is on the rise and since there are only a few effective treatment options, it is important to understand which mechanisms undermine the success of obesity therapies.

Sikorski and her team analyzed 46 scientific studies that examined the coherence between stigmatization of severely overweight people with psychic strains and disorders. “We find many risk factors that are established in the field of mental disorders, strongly pronounced in people with obesity. These risk factors are not anything special for this group, but obese people seem to show these factors more often, also due to stigmatization.” Especially the decreased self-esteem described in all studies is considered as a major risk factor for mental illness such as depression and anxiety disorders.

Based on the explanatory approach of Mark Hatzenbuehler (Columbia University) about the effects of stigmatization in homosexual men Sikorski developed a process model that results in greater susceptibility of obese patients for mental illness. On the level of individual it comes to a decrease of self-esteem and the ability to solve problems (coping). There are also other risk factors such as negative self-perception, increased loneliness and lack of social support. Morbid overweight men and women also assume the negative public image conveyed via stigmatization as their self-image. Experts call this an internalized stigma or self-stigma. However, especially within a weight reduction program the confidence in one’s own capabilities and strengths is indispensable. An obesity therapy requires more than other treatments a lot of strength, engagement and motivation of the patient.

Obesity research showed that stigmatization and self-stigma support unhealthy eating behaviors and therefore lead to preservation or aggravation of obesity. A vicious circle of stigmatization due to obesity, more social withdrawal, increasing weight and hence even more stigmatization develops. Additionally, experiences of disadvantage and discrimination occur in social and work life.

Sikorski’s research may help finding therapeutic approaches to interrupt this vicious circle. “Our work is important for an improved obesity therapy, because we cannot trust in changing the public opinions on obesity any time soon. Thus, we should show people concerned ways to deal with stigmatization. Preferably, this should get an integral component of obesity therapy”, explains the 29-year-old scientists.

In a follow-up study Sikorski’s scientific team will survey about 1000 adults about their experiences with stigmatization. The scientists will cooperate with the Forsa opinion research center. This should help to better understand how stigmatization is experienced, how it affects obese people and how one can deal with it. Only the scientific evaluation of those phenomena allows developing guidelines for a more effective therapy lives up to the standards of evidence-based medicine.

Sikorski, C., Luppa, M., Luck, T. and Riedel-Heller, S. G. (2014), Weight stigma “gets under the skin”—evidence for an adapted psychological mediation framework—a systematic review. Obesity. doi:10.1002/oby.20952   (published online 31.12.2015)

Doris Gabel