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

Abstract

Background Discrimination promotes multisystem physiological dysregulation termed allostatic load, which predicts morbidity and mortality. It remains unclear whether weight-related discrimination influences allostatic load. Purpose The aim of this study was to prospectively examine 10-year associations between weight discrimination, allostatic load, and its components among adults 25–75 years in the Midlife Development in the US Biomarker Substudy. Methods Participants with information on weight discrimination were analyzed (n=986). At both timepoints, participants self-reported the frequency of perceived weight discrimination across nine scenarios as “never/rarely” (scored as 0), “sometimes” (1), or “often” (2). The two scores were averaged and then dichotomized as “experienced” versus “not experienced” discrimination. High allostatic load was defined as having ≥3 out of 7 dysregulated systems (cardiovascular, sympathetic/ parasympathetic nervous systems, hypothalamic pituitary axis, inflammatory, lipid/metabolic, and glucose metabolism), which collectively included 24 biomarkers. Relative risks (RR) were estimated from multivariate models adjusted for sociodemographic and health characteristics, other forms of discrimination, and BMI. Results Over 41% of the sample had obesity, and 6% reported weight discrimination at follow-up. In multivariable-adjusted analyses, individuals who experienced (versus did not experience) weight discrimination had twice the risk of high allostatic load (RR, 2.07; 95 % CI, 1.21; 3.55 for baseline discrimination; 2.16, 95 % CI, 1.39; 3.36 for long-term discrimination). Weight discrimination was associated with lipid/ metabolic dysregulation (1.56; 95 % CI 1.02, 2.40), glucose metabolism (1.99; 95 % CI 1.34, 2.95), and inflammation (1.76; 95 % CI 1.22, 2.54), but no other systems. Conclusions Perceived weight discrimination doubles the 10-year risk of high allostatic load. Eliminating weight stigma may reduce physiological dysregulation, improving obesity-related morbidity and mortality.

Joint international consensus statement for ending stigma of obesity

“…Individuals with overweight and obesity who experience weight discrimination show higher levels of circulating C-reactive protein 36 , cortisol 37 , long-term cardio-metabolic risk 38 , and increased mortality 39 compared with those who do not experienced weight discrimination.…”

Cardiovascular Health in African Americans: A Scientific Statement From the American Heart Association

“…Common sources of stress, job stress and strain, neighborhood-related safety concerns, socioeconomic concerns, and major life events combine with salient sources of stress for African Americans such as perceived discrimination. [270][271][272][273] Perceived racial discrimination is known to be associated with all aspects of health, including hypertension, 274 weight gain and obesity, 275 persistent inflammation and other subclinical processes, 276,277 and incident CVD events. 278 The potential for interventions that promote positive psychological health (eg, mindfulness, resiliency) to reduce stress levels may be relevant in improving the health behaviors and ultimately health outcomes of African Americans.…”

An Evidence‐Based Rationale for Adopting Weight‐Inclusive Health Policy

“…Nationally representative data from the United States shows that weight discrimination predicts 2.48 times the risk of having a mood disorder and 2.62 times the risk of having an anxiety disorder (Hatzenbuehler, Keyes, & Hasin, ). Weight discrimination also prospectively predicts elevated levels of allostatic load, a marker of cardiometabolic dysregulation (Vadiveloo & Mattei, ). High allostatic load is a robust predictor of mortality (Juster, McEwen, & Lupien, ) and thus may partially explain the findings from Sutin et al.…”