Attributing discrimination to weight: associations with well-being, self-care, and disease status in patients with type 2 diabetes mellitus

Abstract

This study examined the association between attributing self-reported discrimination to weight and diabetes outcomes (glycemic control, diabetes-related distress, and diabetes self-care). A community dwelling sample of 185 adults (mean age = 55.4; 80% White/Caucasian, 65% female) with poorly controlled Type 2 diabetes (HbA1c level ≥7.5%) provided demographic and several self-report measures (including diabetes-related distress, diabetes self-care activities, discrimination, and attributions of discrimination), and had height, weight, and glycated hemoglobin (HbA1c) assessed by trained research staff as part of a larger research study. Individuals who attributed self-reported discrimination to weight had significantly higher HbA1c levels, higher levels of diabetes-related distress, and worse diabetes-related self-care behaviors (general diet, exercise, and glucose testing). These relationships persisted even when controlling for BMI, overall discrimination, depressive symptoms, and demographic characteristics. Results indicate that the perception of weight stigma among individuals with type 2 diabetes is strongly associated with a range of poor diabetes outcomes. Efforts to reduce exposure to and/or teach adaptive coping for weight stigma may benefit patients with type 2 diabetes.

Perceived Weight Discrimination and 10-Year Risk of Allostatic Load Among US Adults

“…In MIDUS, Tsenkova and others [24] noted that experiencing weight discrimination amplified the adverse effects of elevated WHR on HbA1c. Among community-dwelling adults with diabetes, researchers found that participants experienced worse glycemic outcomes if they had experienced weight-based discrimination [11]. Similar to the present study, the changes in glycemic markers persisted even after accounting for body weight and other forms of discrimination [11].…”

“…By accounting for family relationships within the cohort, we reduced bias related to shared genetic or environmental factors that contribute to weight and metabolic dysregulation. The present study also builds upon existing evidence that self-reported weight discrimination adversely influences biochemical parameters beyond the effect of actual weight [11]. Given the established connection between personal responsibility campaigns and increased obesity stigma [5], the results from this study have important policy implications with respect to framing obesity prevention campaigns as well as treatment implications for clinicians working with clients with obesity.…”

“…Among community-dwelling adults with diabetes, researchers found that participants experienced worse glycemic outcomes if they had experienced weight-based discrimination [11]. Similar to the present study, the changes in glycemic markers persisted even after accounting for body weight and other forms of discrimination [11]. Moreover, the participants from the study conducted by Potter and others also reported worse diabetes self-care practices related to diet, exercise, and blood glucose monitoring, providing insight into the pathways by which weight discrimination adversely impacts physiologic parameters.…”

“…Between 1995 and 2006, the absolute prevalence of weight discrimination increased from 7 to 12 % in the USA, representing a 66 % increase in prevalence and exceeding the proportion that could be attributed to concomitant increases in obesity [9]. Despite the lay belief that weight stigma motivates positive behavioral change [10], most evidence demonstrates that weight shaming promotes poorer dietary and exercise practices and health care avoidance [11, 12], akin to how experienced racism correlates with negative health outcomes like cancer risk [13, 14]. As such, weight discrimination may contribute to obesity [3, 15] by discouraging individuals from seeking treatment, reducing engagement with social support, or promoting disordered eating patterns, less healthful food choices, and emotional dysregulation [12, 16–21].…”

Adolescents with Diet-Related Chronic Health Conditions (DRCHCs) and Unique Risk for Development of Eating Pathology

“…The stigma associated with both obesity and Type II Diabetes, particularly in childhood and adolescence, are posited to negatively affect the psychological functioning, coping, and positive self-care behaviors in this population [79]. In adults with Type II Diabetes, weight stigma was found to be strongly tied to poor care management such that individuals who strongly felt a weight stigma had poorer self-care behaviors [80].…”