Perceived Weight Discrimination Amplifies the Link Between Central Adiposity and Nondiabetic Glycemic Control (HbA1c)

Abstract

Background While the preclinical development of type 2 diabetes is partly explained by obesity and central adiposity, psychosocial research has shown that chronic stressors such as discrimination have health consequences as well. Purpose We investigated the extent to which the well-established effects of obesity and central adiposity on nondiabetic glycemic control (indexed by HbA1c) were moderated by a targeted psychosocial stressor linked to weight: perceived weight discrimination. Methods Data came from the nondiabetic subsample (n=938) of the Midlife in the United States (MIDUS II) survey. Results Body mass index (BMI), waist-to-hip ratio, and waist circumference were linked to significantly higher HbA1c (p < .001). Multivariate-adjusted models showed that weight discrimination exacerbated the effects of waist-to-hip ratio on HbA1c ( p < .05), such that people who had higher WHR and reported weight discrimination had the highest HbA1c levels. Conclusions Understanding how biological and psychosocial factors interact at nondiabetic levels to increase vulnerability could have important implications for public health and education strategies. Effective strategies may include targeting sources of discrimination, rather than solely targeting health behaviors and practices of overweight and obese persons.

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].…”

“…Discrimination also affects chronic stress, which could subsequently promote adverse physiologic changes [3, 15, 22–24]. For example, weight stigma has been associated with higher glycemic parameters [24] and C-reactive protein (CRP) [15] in large, longitudinal studies.…”

“…For example, weight stigma has been associated with higher glycemic parameters [24] and C-reactive protein (CRP) [15] in large, longitudinal studies. In studies where weight stigma was experimentally manipulated, greater stigmatization resulted in sustained cortisol secretion [22, 25].…”

Health Consequences of Weight Stigma: Implications for Obesity Prevention and Treatment

“…Interestingly, these findings extended to experiences of discrimination related to physical disability, but not race or age. Additionally, within a subsample of the national Midlife in the United States survey of nondiabetic adults (N=938), weight discrimination was identified as a stressor that exacerbated the harmful effects of waist to hip ratio on glycemic control (indexed by glycated hemoglobin (HbA 1c )) [68]. The observed interaction between waist to hip ratio and weight stigmatization suggests that the psychosocial consequences of weight stigma and discrimination experienced by individuals with overweight and obesity may be sources of increased vulnerability that partly explains the manifestation of clinical diabetes.…”

Pressure To Be Thin and Insulin Sensitivity Among Adolescents

“…Extant research has indicated that, in addition to excess body fat, psychological factors may be associated with, and predictive of elevated insulin concentration and impaired insulin sensitivity, which themselves predict the onset of type II diabetes [2], and confer additional risk for hypertension, above and beyond the contribution of obesity [3]. For instance, weight-based stigmatization, a considerable source of psychological stress, is associated with biochemical stress [4] and has been shown to amplify the link between central adiposity and nondiabetic glycemic control among overweight adults [5]. Body dissatisfaction and weight-related concerns have also been implicated in the pathophysiology of obesity, above and beyond the effects of excess adiposity [6].…”