How the public-image becomes the self-image

Social devaluation makes obese people sick

The majority of the German population has a negative opinion of severely overweight (obese) people. The persuasion prevails, that they are lazy, stupid, undisciplined and obesity is their own fault. How does this affect the persons concerned, who have to acquiesce into these negative opinions, prejudices, bitter remarks and refusing behaviour? A study of Prof. Anja Hilbert et al, recently published in the professional journal Obesity, revealed that accepting this stigmatization by obese individuals leads to a strong reduction of self esteem and self confidence and thereby entails anxieties and depressions.

The representative survey (1) of the Department of Medical Psychology and Sociology of the University Leipzig and the Integrated Research and Treatment Center (IFB) AdiposityDiseases used special questionnaires to investigate in 1158 overweight and obese study participants aged 14 and older, how far they embrace negative weight-related opinions and prejudices (stereotypes) for themselves, self-stigmatize and thus have an increased risk for health impairments. This is especially the case, when the self-stigma reduces the self-esteem. “If the negative public-image becomes a self-image, these people need psychotherapeutic help to overcome the harmful self-stigma. Also in the treatment of obesity is it important to pay attention and not to deepen it”, underlines Prof. Hilbert. At the AdiposityClinics of the IFB AdiposityDiseases at the University Hospital of Leipzig this has already been implemented into practice by a psychological co-care of patients.

Unlike previously assumed, this study showed that obese people do not go less often to the doctor due to the self-stigma, but rather more often. This seems to be attributed to the perceived poorer health and the assumption, that they can not really change anything by themselves (diminished self-efficacy). However, there are also studies that show that the health care for obese people is worse than of the normal-weight population. E. g. obese men and women visit less often medical prevention examinations, because they fear refusal or depreciation in the doctor’s office due to their weight.

Further research will need to show if self-stigma, in the sense of a ‘self-fulfilling prophecy’, leads to disadvantages in other areas of life, e.g. in the job. Hence if  someone has only little self-esteem, she or he may pursue her or his goals less powerful. Thus, stigmatization would have a double negative effect: through social refusal and discrimination and through the lower motivation and diffidence of the people concerned. Yet, it is already proven that stigmatization of adiposity does not lead to a better weight-reduction in obese people.

(1) Hilbert A, Braehler E, Haeuser W, Zenger M. Weight bias internalization, core self-evaluation, and health in overweight and obese persons. Obesity (Silver Spring). 2013 Jul 9. doi: 10.1002/oby.20561. [Epub ahead of print]

Keywords: Psyche, IFB-reserach, stigmatization