Addressing Structural Racism, Bias, and Health Communication as Foundational Drivers of Obesity Proceedings of a Workshop Series (2022) / Chapter Skim
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4 The Intersection of Biased Mental Models, Stigma, Weight Bias, and Obesity
4 The Intersection of Biased Mental Models, Stigma, Weight Bias, and Obesity
Pages 25-34
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From page 25... ...
• Well-intentioned workplace health promotion programs with a nutrition, exercise, or weight management component may inadvertently reinforce obesity stigma and make people with obesity reluctant to participate. (Bevan)
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He elaborated on two specific challenges -- the obesity "wage penalty" for women, and the sometimes inadvertent internalization of weight stigma in worksite health promotion efforts. He also offered suggestions for ways in which employers and health care providers could improve work outcomes for people with obesity.
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Bevan then turned to discussing the obesity wage penalty, the first of two specific challenges he would address. He reported that a 2016 review conducted by the UK government identified a 10 percent wage gap between people with obesity and those with average weight.
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The conclusion from some of this evidence, Bevan summarized, is that the multiple employment disadvantages already experienced by women with obesity in the labor market are being compounded by a pervasive wage penalty in a tangible way, established for many in adolescence and continuing throughout adulthood. He reviewed the projected effect of the wage penalty at the national level in the United Kingdom on annual earnings per woman, based on average earnings and a prevalence of obesity of 30 percent: a 2 percent wage penalty = a 500-GBP (Great British pound)
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He added that employers could modify their human resources processes to reduce the risk of stigma and discrimination by including obesity more explicitly in the design, implementation, and evaluation of diversity and inclusion programs and policies. He reiterated the call for workplace health promotion programs to avoid reinforcing stigma and to involve employees in their design.
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To a patient, he pointed out, these narratives make weight loss and management sound simple, but they may also convey that health professionals believe obesity is self-imposed, so they have no obligation to help the patient find evidencebased treatments. In reality, Norris suggested, the journey for many patients has been anything but simple; he urged mindfulness of the challenges faced by people living with obesity.
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. He explained that experiences of weight-based discrimination amplify psychosocial stress, which in turn triggers a reallocation of neuronal activity in the brain that leads to poor cognitive processing.
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He encouraged clinical settings to treat patients as individuals and with empathy, care, and respect instead of relegating them to particular categories to which labels and personal attributes are automatically assigned. To unravel the institutionalization of bias, Norris urged examining and revising health system policies and practices that perpetuate structural biases.
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From page 33... ...
Patients have a sense of the barriers to change they may encounter, he elaborated, and sharing those barriers helps clinicians tailor recommendations and determine when to refer patients to other colleagues or specialists who can help them pursue the goals. Norris also posited that a common health care perspective is to overestimate the ability of clinical recommendations on lifestyle changes to impact weight loss.
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From page 34... ...
For example, employers may conduct health risk assessments and collect biometric measures, which he argued can reinforce stigma if not messaged carefully. In the United Kingdom, he said, worksite health promotions tend to fall into two categories: those that help the employer compete in the labor market by offering a benefit to employees but are rarely evaluated in terms of health outcomes, and those that aim to reduce psychosocial risk and musculoskeletal strain through a more methodological approach that assesses and mitigates workplace risks, and measures such outcomes as serious absenteeism, presenteeism, and labor productivity.
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