A Penn study of body shaming — a form of prejudice that can stereotype people with obesity as lazy, incompetent, unattractive, lacking willpower and to blame for their excess weight — found it may take a toll on health and even increase risk of cardiovascular and metabolic disease. The results of the study, led by a research team from the Perelman School of Medicine, are published in Obesity, the journal of The Obesity Society.

The team led by Rebecca Pearl, assistant professor of psychology in psychiatry and colleagues from Penn’s Center for Weight and Eating Disorders found that, in addition to the effects of body mass index (BMI) and depression, higher levels of weight bias internalization were associated with increased risk for cardiovascular and metabolic disease.

“There is a common misconception that stigma might help motivate individuals with obesity to lose weight and improve their health,” Dr. Pearl said. “We are finding it has quite the opposite effect. When people feel shamed because of their weight, they are more likely to avoid exercise and consume more calories to cope with this stress. In this study, we identified a significant relationship between the internalization of weight bias and having a diagnosis of metabolic syndrome, which is a marker of poor health.”

The team examined 159 adults with obesity who were enrolled in a larger clinical trial testing the effects of weight loss medication. The participants completed baseline questionnaires measuring depression and weight bias internalization — which occurs when people apply negative weight stereotypes to themselves, such as believing they are lazy or unattractive, and devalue themselves because of their weight — before any intervention was given. Participants also underwent medical examinations to determine any obesity-related health problems.

At first the research did not show a relationship between weight bias internalization and metabolic syndrome when controlling for participant demographics, such as age, gender and race; however, after patients were separated into groups of “high” or “low” levels of weight bias internalization, those with high internalization were shown to be three times more likely to have metabolic syndrome, and six times more likely to have high triglycerides as compared to participants with low internalization.

“Health care providers, the media, and the general public should be aware that blaming and shaming patients with obesity is not an effective tool for promoting weight loss, and it may in fact contribute to poor health if patients internalize these prejudicial messages,” said co-author Tom Wadden, professor of psychology in psychiatry and director of Penn’s Center for Weight and Eating Disorders. “Providers can play a critical role in decreasing this internalization by treating patients with respect, discussing weight with sensitivity and without judgment, and giving support and encouragement to patients who struggle with weight management — behaviors everyone should display when interacting with people with obesity.”