Obese people who feel stigmatised about their size may be at increased risk for metabolic syndrome, a new study suggests.

Weight stigma is a chronic stressor that may increase cardiometabolic risk. Some individuals with obesity self-stigmatise, but no study to date has examined whether this might be associated with metabolic syndrome, the authors note in their online paper in Obesity.

For the study, they measured blood pressure, waist circumference, and fasting glucose, triglycerides, and high-density lipoprotein cholesterol at baseline in a group of adults with obesity enrolled in a weight-loss trial. Medication use for hypertension, dyslipidemia, and prediabetes was included in criteria for metabolic syndrome.

Altogether, 159 participants (88 per cent women) completed the Weight Bias Internaliation Scale and Patient Health Questionnaire (to assess depressive symptoms).

Overall, 51 people, or 32 per cent, had metabolic syndrome.

The researchers found that participants who internalised weight-related stigma were 41 per cent more likely to have metabolic syndrome than people who didn’t internalise stigma very much, after accounting for depression and the degree of obesity.

I would like people with obesity and their healthcare providers to see the number on the scale as an indicator of health

“Experiencing weight stigma can elicit a physiological stress response, marked by elevated blood pressure and inflammation, and it’s possible that self-directed weight stigma may be a form of chronic stress as well,” said lead study author Rebecca Pearl, a psychiatry researcher at the University of Pennsylvania in Philadelphia.

“Individuals who internalise weight bias may also engage in unhealthy behaviours to cope with this stress – such as eating high-caloric comfort foods – which could affect triglycerides and other cardiometabolic risk factors measured in this study,” Pearl added by e-mail.

“Additionally, when people apply negative weight stereotypes to themselves, such as being lazy or lacking willpower, they have less confidence in their ability to engage in healthy behaviours, such as physical activity.”

The study wasn’t an experiment designed to prove how different levels of weight stigma directly cause metabolic syndrome, the authors note. It’s also possible that the results based on a group of patients participating in an obesity treatment study might not necessarily reflect what would happen with obese people in real life.

Still, discrimination clearly can cause chronic stress, which can result in biochemical changes that contribute to weight gain and inflammation that lead to abnormalities in blood pressure, blood sugar and cholesterol, said Kimberly Gudzune of Johns Hopkins University in Baltimore.

“It can start you down a pathway that increases your risk for cardiovascular disease,” Gudzune, who wasn’t involved in the study, added by e-mail.

In part to avoid making feelings of discrimination and stress worse, doctors treating patients for obesity should choose their words carefully, said Anne McTiernan, a researcher at Fred Hutchinson Cancer Research Centre and the University of Washington in Seattle who wasn’t involved in the study.

“I would like people with obesity and their healthcare providers see the number on the scale as an indicator of health, just like their blood pressure,” McTiernan added by e-mail.

“The goal with excess blood pressure is to get the number down, not to subject the patient to shame. Similarly, let’s treat the number on the scale as a measure of health risk, and help the patient get the number down effectively and safely, and help them avoid gaining the weight back.”

Sign up to our free newsletters

Get the best updates straight to your inbox:
Please select at least one mailing list.

You can unsubscribe at any time by clicking the link in the footer of our emails. We use Mailchimp as our marketing platform. By subscribing, you acknowledge that your information will be transferred to Mailchimp for processing.