OBJECTIVE: To create inventories of stigmatizing situations faced by obese people and ways of coping with stigmatization, and to examine how stigma and coping are related to psychological distress in an obese patient population. DESIGN: Study 1: Items were generated by asking obese people to list stigmatizing situations they had encountered and their ways of coping. Study 2: Obese patients were surveyed about the frequency with which they encountered each form of stigmatization and employed each form of coping. Cross-sectional data on current psychological adjustment were obtained. SUBJECTS: Study 1: 63 obese patients (body mass index, BMI b 40 kgam 2 ); 38 obese non-patients, seven professionals who work with obese patients and 32 obese female authors from the print media. Study 2: 112 gastric bypass patients (BMI 33.9 ± 80.9 kgam 2 ) and 34 less obese patients (BMI 27.1 ± 57.2 kgam 2 ). MEASUREMENT: Study 1: Collection of stigmatizing situations and coping responses. Study 2: Frequency of stigmatizing experiences and coping responses, psychological symptoms, body image, and self esteem measures. RESULTS: Study 1 resulted in two objective questionnaires, consisting of 50 situations and 99 responses. Study 2 found that stigmatization is a common experience, and that obese subjects frequently engage in some effort to cope with stigma. More frequent exposure to stigmatization was associated with greater psychological distress, more attempts to cope, and more severe obesity. Certain coping strategies are associated with greater distress.Keywords: obesity stigma; coping; gastric bypass IntroductionIndividuals who share the stigma of obesity quickly ®nd that stigmatization affects nearly every aspect of their lives. Obese people report job discrimination, social exclusion, exploitation by the diet and ®tness industry, denial of health bene®ts, trouble ®nding clothing, mistreatment by doctors, and public ridicule. 1 ± 3 Additionally, obese people are less likely to be admitted to college 4 or to have their education funded. 5 Obese people are more likely to be of lower socioeconomic status 6 and to decrease in socioeconomic status over time. 7 Unlike racial prejudice, society freely expresses prejudicial attitudes towards obese people, justifying these attitudes on the grounds that weight is controllable. 5 Thus, obese people may be more likely than other minority groups to encounter overt hostility and discrimination. Negative stereotypes of obese people include the views that they are ugly, morally and emotionally impaired, asexual, discontented, weakwilled and unlikable. 5 Ironically, obese people are just as likely as non-obese people to hold these prejudiced attitudes. 5 Some recent studies have attempted to quantify different types of stigmatizing experiences faced by obese people. For example, a survey of 445 members of the National Association to Advance Fat Acceptance (NAAFA) found that 98% reported verbal harassment, criticism, or teasing from family and friends. 3 On the job, 75% reported criticism or teasi...

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Body dysmorphic disorder (BDD) is a distressing body image disorder that involves excessive preoccupation with physical appearance in a normal appearing person. Prior case reports of behavior therapy were encouraging, but no controlled evaluation of behavior therapy or any other type of treatment had been conducted. In the present study, 54 BDD subjects were randomly assigned to cognitive behavior therapy or no treatment. Patients were treated in small groups for eight 2-hour sessions. Therapy involved modification of intrusive thoughts of body dissatisfaction and overvalued beliefs about physical appearance, exposure to avoided body image situations, and elimination of body checking. Body dysmorphic disorder symptoms were significantly decreased in therapy subjects and the disorder was eliminated in 82% of cases at posttreatment and 77% at follow-up. Overall psychological symptoms and self-esteem also improved in therapy subjects.

This is a survey of the prevalence of weight reducing and weight gaining in high school children. Our sample of 1,373 high school girls and boys was geographically, racially, and economically diverse. On the day of the survey, 63% of the girls and 16.2% of the boys reported being on weight reducing regimens; 9.1% of the girls and 28.4% of the boys were trying to gain weight. Most female reducers and male gainers were already normal weight. Compared to other racial groups, whites and Hispanics were more likely to be reducing, whereas blacks were more likely to be gaining. Exercise and moderate caloric reduction were most popular for weight reducing, and a small but significant number were regularly using fasting, vomiting, laxatives, and appetite suppressants. The direction of weight modification for girls and boys conformed to stereotyped physical ideals. The rate of weight reducing in female high school adolescents has increased significantly since similar surveys of American youths 20 years ago.

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