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The body politic: the relationship between stigma and obesity-associated disease

Peter Muennig email

Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, USA

author email corresponding author email

BMC Public Health 2008, 8:128doi:10.1186/1471-2458-8-128

Published: 21 April 2008



It is commonly believed that the pathophysiology of obesity arises from adiposity. In this paper, I forward a complementary explanation; this pathophysiology arises not from adiposity alone, but also from the psychological stress induced by the social stigma associated with being obese.


In this study, I pursue novel lines of evidence to explore the possibility that obesity-associated stigma produces obesity-associated medical conditions. I also entertain alternative hypotheses that might explain the observed relationships.


I forward four lines of evidence supporting the hypothesis that psychological stress plays a role in the adiposity-health association. First, body mass index (BMI) is a strong predictor of serological biomarkers of stress. Second, obesity and stress are linked to the same diseases. Third, body norms appear to be strong determinants of morbidity and mortality among obese persons; obese whites and women – the two groups most affected by weight-related stigma in surveys – disproportionately suffer from excess mortality. Finally, statistical models suggest that the desire to lose weight is an important driver of weight-related morbidity when BMI is held constant.


Obese persons experience a high degree of stress, and this stress plausibly explains a portion of the BMI-health association. Thus, the obesity epidemic may, in part, be driven by social constructs surrounding body image norms.



Obesity-associated stigma and physiological markers of stress: evidence from the Dominican Republic
Peter Muennig *, Kara Keating Bench
Department of Health Policy and Management, Columbia University, New York, NY, USA
email: Peter Muennig (pm124@...)

*Correspondence to Peter Muennig, Columbria University, Department of Health Policy and Management, 600 West 168th Street, 6th Floor, new York, NY 10032

obesity • Stress • Social Desirability • Hypertension
Social stigma is increasingly recognized as a cause of stress-induced pathophysiology. We tested the hypothesis that stigma is associated with obesity-related morbidity, using a cohort of subjects from the Dominican Republic who value fat bodies over thin ones. We surveyed 87 subjects from Batey Algodón - a small region in the Dominican Republic where obesity is not stigmatized. We obtained information on ideal body norms, perceptions of one's own body and self-rated health. We also measured height, weight, waist circumference and blood pressure. We then performed linear regression analyses to ascertain the extent to which body mass index (BMI) and body norm perceptions were related to self-rated health and blood pressure. Self-rated health was strongly associated with one's satisfaction with his or her physical appearance (p < 0.001) and weight (p < 0.001). As expected, self-rated health was not independently associated with BMI in this community, which does not stigmatize obesity. However, BMI was nevertheless associated with both systolic and diastolic blood pressure (p < 0.05). While de-stigmatizing obesity may improve perceptions of health, it might not significantly reduce the incidence of hypertension among heavier persons. Copyright © 2008 John Wiley & Sons, Ltd.




Muennig, Peter, Haomiao Jia, and Erica Lubetkin. 2008. "I think therefore I am: Perceived ideal weight as a determinant of health." American Journal of Public Health 98:501-506. 

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