Obesity Is in the Eye of the Beholder: BMI and Socioeconomic Outcomes across Cohorts

Abstract

Abstract:The biological and social costs of body mass cannot be conceptualized in the same way. Using semiparametric methods, we show that the association between body mass index (BMI) and socioeconomic outcomes such as wages, being married, and family income is distinctly shaped by gender, race, and cohort rather than being above a specific threshold of BMI. For white men, the correlation between BMI and outcomes is positive across the "normal" range of BMI and turns negative near the cusp of the overweight range, a pattern that persists across cohorts. For white women, thinner is nearly always better, a pattern that also persists across cohorts. For black men in the 1979 cohort, the association between BMI and wages is positive across the normal and overweight ranges for wages and family income and inverted U-shaped for marriage. For black women in the 1979 cohort, thinner is better for wages and marriage. By the 1997 cohort, however, the negative association between body mass and outcomes dissipates for black Americans but not for white Americans. In the social world, "too fat" is a subjective, contingent, and fluid judgment that differs depending on who is being judged, who does the judging, and the social domain.Keywords: obesity; BMI; gender; race; wages; marriage N UMEROUS studies link obesity to poorer socioeconomic outcomes, including lower wages, family income, education, marriage rates, and spousal earnings (Averett and Korenman 1996;Cawley 2004;Conley and Glauber 2007;Glass, Haas, and Reither 2010). But does the medical definition of "obese" apply to the social world? Obesity is a condition defined as having excessive body fat. Because body fat is difficult to measure directly, obesity is usually approximated by body weight adjusted for height using standard cutoffs along the body mass index (BMI) (Ogden et al. 2007). The continuous BMI scale is divided into four major intervals (underweight, normal, overweight, obese) with subclassifications of mild, moderate, and severe within these groupings. 1 Although more accurate measures of body fat exist (e.g., waist-to-hip ratio, waist circumference, body volume index), these are far less commonly used in the social science research literature.BMI is a flawed measure of actual body fat because it is not sensitive to differences in mass that are due to fat versus muscle or bone, and it misclassifies more African Americans as having excessive fat than white Americans (Burkhauser and Cawley 2008). However, it is a simple and standard measure that allows medical and public health studies to examine the biological links between this measure of corpulence and health-related outcomes. The BMI cutoff of 30 is used internationally as a standard medical definition of adult obesity. Once we move from biological to social outcomes, however, the definition of obesity becomes far more subjective. What counts as being excessively fat in the social world? A sizable literature demonstrates that the body is socially constructed and that our perceptions of fat bodies are tied...

Race/ethnicity, gender and the SES gradient in BMI: The diminishing returns of SES for racial/ethnic minorities

“…Specifically, black individuals tend to have greater body satisfaction and find heavier bodies more attractive (Ali et al, 2013, 2014). Notably, some evidence suggests that white individuals tend to suffer more severe income penalty for obesity relative to people of colour (Maralani & McKee, 2017). This set of findings may partially explain the stronger SES‐BMI gradient among white women and highlight the need to formally test these mechanisms.…”

“…Second, obesity is a modifiable chronic illness and a health risk factor that is highly dependent on transferable resources, and access to socioeconomic resources may be facilitated or obstructed depending on one's race/ethnicity and/or gender (Phelan et al, 2010). Finally, because individual body weight and appearance is one of the dimensions of social valuation, cultural meanings of body weight may transform the ways certain social groups utilize resources to maximize their health outcomes (Maralani & McKee, 2017). As an example, differences in perceptions about individual body weight between white and black women have been observed in several studies.…”

Coloring Weight Stigma: On Race, Colorism, Weight Stigma, and the Failure of Additive Intersectionality

“…The wage penalty, however, is not evenly distributed across social groups. White people, particularly white women, are penalized the most, while black Americans suffer the smallest penalty or none at all (Maralani and McKee 2017;Slade 2017). Slade (2017) examined the effect of BMI on wages across the wage distribution.…”

“…Conversely, the effect of body mass on wages remained mostly flat across the entire wage distribution for black women and was actually increasingly positive at higher wages for black men. Maralani and McKee (2017) use two different data sets to examine whether the effect of body size on wages had changed over time by comparing two different cohorts of people. They found the connection between body size and wages dissipated for the most recent cohort of black people, with data from 2010.…”

“…Black people also suffer less stigma and discrimination based solely on body size, and this apparent lack of stigma is reflected in the racial differences in the income penalty for black and white people. Whereas white people, especially white women, suffer a relatively severe income penalty for being obese, black people seem to suffer, at worst, a significantly diminished income penalty for obesity and, at best, no penalty at all (Maralani and McKee 2017; Slade 2017). Researchers generally explain this difference by arguing there are different racial standards for body size (Fletcher 2014), although some argue weight-based discrimination may be overshadowed by racial discrimination (Keith et al 2017).…”