“I have always thought that it’s your own fault,” said Sergio Miranda, 35, who has a shoeshine stand in Mexico City. “People eat just things that make them fat, like bread and pizza.”
Mr. Miranda said he did not really notice whether his clients were fat or not. But he does when he is wedged in a crowded city bus.
“The fatties take up a lot of space,” he said. “People are annoyed. It’s uncomfortable.”
At a time when global health officials are stepping up efforts to treat obesity as a worrisome public health threat, some researchers are warning of a troubling side effect: growing stigma against fat people.
“Of all the things we could be exporting to help people around the world, really negative body image and low self-esteem are not what we hope is going out with public health messaging,” said Alexandra Brewis, executive director of the School of Human Evolution and Social Change at Arizona State University.
Dr. Brewis and her colleagues recently completed a multicountry study intended to give a snapshot of the international zeitgeist about weight and body image. The findings were troubling, suggesting that negative perceptions about people who are overweight may soon become the cultural norm in some countries, including places where plumper, larger bodies traditionally have been viewed as attractive, according to a new report in the journal Current Anthropology.
The researchers elicited answers of true or false to statements with varying degrees of fat stigmatization. The fat-stigma test included statements like, “People are overweight because they are lazy” and “Some people are fated to be obese.”
Using mostly in-person interviews, supplemented with questions posed over the Internet, they tested attitudes among 700 people in 10 countries, territories and cities, including American Samoa, Tanzania, Mexico, Puerto Rico, Paraguay, Argentina, New Zealand, Iceland, two sites in Arizona and London.
Dr. Brewis said she fully expected high levels of fat stigma to show up in the “Anglosphere” countries, including the United States, England and New Zealand, as well as in body-conscious Argentina. But what she did not expect was how strongly people in the rest of the testing sites expressed negative attitudes about weight. The results, Dr. Brewis said, suggest a surprisingly rapid “globalization of fat stigma.”
“The change has come very, very fast in all these places,” she said.
To be sure, jokes and negative perceptions about weight have been around for ages. In Mexico, for instance, a nickname like “gordo” which translates as “fatty,” raises no eyebrows.
But what appears to have changed is the level of criticism and blame leveled at people who are overweight. One reason may be that public health campaigns branding obesity as a disease are sometimes perceived as being critical of individuals rather than the environmental and social factors that lead to weight gain.
“A lot of the negative health messages have a lot of negative moral messages that go with them,” Dr. Brewis said.
Surprisingly, stigma scores were high in places that have historically held more positive views of larger bodies, including Puerto Rico and American Samoa.
Stephen McGarvey, a professor of community health at Brown Universitywho studies Samoan health issues, noted that 25 years ago, Samoan study subjects living in Samoa and New Zealand who viewed thin and large body silhouettes mostly had positive feelings about bigger bodies. (The exception was young, educated women, who showed a preference for slimmer silhouettes.)
Dr. McGarvey said that more extensive study was needed to determine just how much that had changed, and that it was important that public health campaigns intended to curb diabetes and high blood pressure did not end up creating negative images of overweight individuals.
“A public health focus on ‘You can change,’ or ‘This is your fault,’ can be very counterproductive,” he said. “Stigma is serious.”
What is not clear from the new research is how pervasive fat stigma has become. With only 700 people included, the study is not a representative sample of each country and reflects only a snapshot of cultural attitudes in the area studied. In addition, the research looked only at selected locales and did not include any Asian or Arab countries.
In India, for instance, being overweight or obese is associated with being middle class or wealthy, said Scott Lear, associate professor for health sciences at Simon Fraser University in Vancouver. Even so, Dr. Lear, who is studying rising childhood obesity in that country and in Canada, agrees the potential for stigmatization exists. “We know in developed countries that obese people are less successful, less likely to get married, less likely to get promoted,” he said.
Nisha Somaia, 38, who lives in New Delhi and pioneered the first plus-size women’s clothing stores in India, said criticism against people who are large was often direct and overt. In India, she said: “Fat equals lazy. Fat equals comedy relief.”
The fashion industry, Ms. Somaia said, seems to promote the ideal of beauty as having a body “like an adolescent boy.”
“I think all around the ideal of beauty is skinny thin,” she said. “I had a highly educated friend confess that she would prefer for her children to be anorexic rather than overweight.”
Marianne Kirby of Orlando, Fla., who writes the fat-acceptance blogTheRotund.com, said the apparent spread of fat stigma was not surprising, given the global push to brand obesity as a major health threat.
“The fundamental message we’re putting into the world is that fat people deserve shame for their own health,” said Ms. Kirby, co-author of the book “Lessons From the Fat-o-Sphere.” “We’ve been pushing this message for a long time. I don’t think anyone is immune to it.”
Dr. Brewis notes that far more study is needed to determine the extent of fat stigma and how it is affecting the lives of individuals. She noted that her study was designed only to detect cultural views of obesity and did not show whether people were experiencing more social or workplace discrimination as a result of the growing fat stigma.
“I think the next big question is whether it’s going to create a lot of new suffering where suffering didn’t exist before,” Dr. Brewis said. “I think it’s important that we think about designing health messages around obesity that don’t exacerbate the problem.”
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