Does Weight Discrimination Affect Glucose Control?

Regular readers will recall previous posts on the very real negative health impacts of the weight-bias and discrimination that people with excess weight face everyday.

Now, a paper by Vera Tsenkova and colleagues from the University of Wisconsin-Madison, just published in the Annals of Behavioral Medicine, suggests that perceived weight discrimination may directly affect glycemic control.

The study included over 900 non-diabetic participants of the Midlife in the United States (MIDUS II) survey and found a clear relationship between measures of adiposity (BMI, waist circumference) and HbA1c levels (a marker of glycemic control).

Participants were also asked “how often on a day-to-day basis do you experience each of the following types of discrimination?”:

(1) “you are treated with less courtesy than other people”,
(2) “you are treated with less respect than other people”,
(3) “you receive poorer service than other people at restaurants or stores”,
(4) “people act as if they think you are not smart”,
(5) “people act as if they are afraid of you”,
(6) “people act as if they think you are dishonest”,
(7) “people act as if they think you are not as good as they are”,
(8) “you are called names or insulted”,
(9) “you are threatened or harassed.”

Respondents who indicated that they had ever experienced any such mistreatment were then asked “what was the main reason for the discrimination you experienced?” A dichotomous indicator was created based on whether one had ever (at least once) experienced due to weight or height.

Interestingly, the highest HbA1c levels were seen in people with high waist circumference levels who also reported having experienced weight discrimination. These negative effects of weight discrimination appeared independent of health behaviors, such as smoking, exercise, and fast-food consumption.

As the authors discuss,

Previous studies have documented that obese individuals might not seek timely healthcare or comply with proper healthcare regimens due to fear of mistreatment, teasing, and the demoralization that results from this mistreatment. Thus, perceptions of persistent mistreatment may exacerbate the already harmful consequences of central adiposity for a range of physical outcomes, including glycemic control.

In addition there may be physiological mechanisms that may account for this relationship. Thus, chronic psychosocial stress such as perceived discrimination might introduce the major stress hormones (norepinephrine, epinephrine, and cortisol), which may have adverse effects on lipid and glucose metabolism.

As the authors note,

“Understanding how biological and psychosocial factors interact to increase vulnerability could have important implications for public health and education strategies. Effective strategies may include targeting sources of discrimination rather than solely targeting the health behaviors and practices of overweight and obese persons.”

In this context, readers may be interested in attending a National Council on Weight Bias and Discrimination organised by the Canadian Obesity Network on January 17, 2011 in Toronto.

Edmonton, Alberta