Public Opinion About Laws to Prohibit Weight Discrimination in the United States

Weight discrimination is pervasive in American society and impairs quality of life for obese persons. With approximately two‐thirds of Americans now overweight or obese, vast numbers of people are vulnerable to weight prejudice and its consequences. Currently, no laws exist to prohibit weight discrimination. This study conducted an online survey with a national sample of 1,001 adults (representing demographics of the United States) to examine public support for six potential legislative measures to prohibit weight discrimination in the United States. Results indicated substantial support (65% of men, 81% of women) for laws to prohibit weight discrimination in the workplace, especially for legal measures that would prohibit employers from refusing to hire, terminate, or deny promotion based on a person's body weight. Laws that proposed extending the same protections to obese persons as people with physical disabilities received the least support, suggesting that Americans may not be in favor of considering obesity as a disability. Findings also highlight specific predictors of support (related to sex, age, education, income, body weight, and political ideology). These findings can be used to inform policy makers in efforts to develop antidiscrimination laws. Such measures will rectify health disparities for overweight Americans and facilitate public health efforts to address obesity.     

Changes in perceived weight discrimination among Americans, 1995-1996 through 2004-2006

Objective: Little is known about the prevalence and patterns of weight discrimination in the United States. This study examined the trends in perceived weight/height discrimination among a nationally representative sample of adults aged 35–74 years, comparing experiences of discrimination based on race, age, and gender. Methods and Procedures: Data were from the two waves of the National Survey of Midlife Developmentin the United States (MIDUS), a survey of community‐based English‐speaking adults initially in 1995–1996 and a follow‐up in 2004– 2006. Reported experiences of weight/height discrimination included a variety of settings in major lifetime events and interpersonal relationships. Results: The prevalence of weight/height discrimination increased from 7% in 1995–1996 to 12% in 2004–2006, affecting all population groups but the elderly. This growth is unlikely to be explained by changes in obesity rates. Discussion: Weight/height discrimination is highly prevalent in American society and increasing at disturbing rates. Its prevalence is relatively close to reported rates of race and age discrimination, but virtually no legal or social sanctions against weight discrimination exist.     

The Case for Medical Management of Obesity: A Call for Increased Physician Involvement

The United States is in the midst of an escalating epidemic of obesity. Over one-third of the adult population in the United States is currently obese and the prevalence of obesity is growing rapidly. By any criteria, obesity represents a chronic disease which is associated with a wide range of comorbidities, including coronary heart disease (CHD), Type 2 diabetes, hypertension and dyslipidemias. The comorbidities of obesity are common, occurring in over 70% of individuals with a BMI of ≥ 27. In addition to obesity itself, excessive accumulation of visceral abdominal fat and significant adult weight gain also represent health risks. Physicians have an important role to play in the treatment of obesity. Unfortunately, the medical community has not been involved actively enough to help stem the major epidemic of obesity occurring in the United States. This article puts forth a proposed model for the treatment of obesity in clinical practice, including obtaining the “vital signs” of obesity, recommending lifestyle measures, and instituting pharmacologic therapy when appropriate. By utilizing a chronic disease treatment model, physicians can join other health care professionals to effectively treat the chronic disease of obesity. Relatively modest weight loss, on the order of 510% of initial body weight can result in significant health improvements for many patients and represent an achievable goal for most obese patients.     

Respect of law or respect through law?

What is the role of law and legality in social resilience? This review essay highlights how a sociology of law, culture, and institutions underwrites many of the findings of Getting Respect: Responding to Stigma and Discrimination in the United States, Brazil &; Israel. The book provides a trenchant analysis of group boundaries, stigma, and destigmatization across three cities worldwide. I suggest that in addition to the role of formal law and legal constraints that the book identifies, we can attend to how legality offers a repertoire for resilience on which people draw when faced with stigma, discrimination, or contentious situations, even when formal law falls short. In this way, combining a sociology of law with a sociology of culture can provide us with an understanding of how societies offer social resilience, and how this resource varies across social, national, and legal contexts.     

Willingness to pay for obesity pharmacotherapy

Several treatments for obesity have received regulatory approval, but health insurers and other payers typically refuse to support access to them. Thus, patients are left to bear significant out-of-pocket costs for obesity pharmacotherapy. This study aimed to assess preferences and willingness to pay (WTP) for obesity medications among people seeking weight loss in the United States and United Kingdom. An online survey was developed based on literature review, clinician interviews, and profiles of available therapies. Participants indicated their preference for hypothetical treatments which varied by seven attributes: percentage of weight loss, long-term health risk reduction, time to noticeable weight loss, delivery mode, side effects, lifestyle modification, and cost; 502 obese participants completed the survey (mean BMI 37.12 kg/m(2) (±4.63); 73.5% female; 47.7 (±12.9) years of age). The participants deemed weight loss of >21 kg (United Kingdom) and >28 kg (United State) as "acceptable". All treatment attributes were important (P < 0.001) except "time to noticeable weight loss." The survey found that percentage weight loss was the most important factor for patients and a reduction in long-term health risk was relatively less important. Patients were willing to pay ￡6.51/$10.49 per month per percentage point of weight loss that a pharmacotherapy could provide. Participants also highly valued therapies that did not require substantial lifestyle modifications and were willing to pay ￡17.78/$30.77 more per month for a one-pill-per-day treatment vs. a weekly injectable. Participants placed a high value on weight loss and avoiding changes to their lifestyle, and less value on reducing long-term risks to health.     

Ostracism and the law of defamation

This article compares the classical political institution of ostracism with the modern law of the United States concerning defamation. The classical institution of ostracism was a political tool of very limited scope. In modern society the term “ostracize” generally means to exclude a person from all or some of the benefits of a group. The law of defamation is a rather limited means of protecting an individual's reputation, consequently protecting individuals from being ostracized. The article concludes that United States law concerning defamation is generally inadequate as a means of protection from certain social consequences that resemble ostracism, such as job and educational discrimination. In addition, the article concludes that “the law seems to foster an unarticulated public policy that drifts in accordance with the preferences of individuals who have a great deal of personal or institutional power.”     

New developments in the law for obesity discrimination protection

Background:

Obese individuals are frequent targets of weight‐based discrimination, particularly in the employment setting. Victims of weight discrimination have sought legal restitution like others who have suffered from different forms of discrimination. However, in the vast majority of the United States, body weight is not a protected class and weight‐based employment discrimination does not provide a basis for a legal claim. Some have attempted to seek legal recourse under the Rehabilitation Act of 1973 or the Americans with Disabilities Act of 1990 (collectively, the ADA), which protect against discrimination based on mental or physical disabilities in a variety of settings. Until recently, claims of weight discrimination under the ADA have also been largely unsuccessful. However, Congress recently passed the ADA Amendments Act, expanding the definition of what constitutes a disability and incorporating a broad view of ADA's coverage.

Objective:

This short communication provides an update of the law as it relates to employment based discrimination of obese people. The authors propose a legislative direction for future legal recourse.

Design and Methods:

The authors conducted legal research into the ADA Amendments Act, and synthesized this work relating to discrimination against weight in the employment context.

Results:

In light of the ADA Amendments Act, courts and the Equal Employment Opportunity Commission have provided protection for severely obese people from discrimination based on actual or perceived disability in the employment context.

Conclusion:

The authors discuss this positive legal development and additionally propose a targeted solution to address weight discrimination in the employment setting. National polling suggests there is considerable public support for such a measure. The authors thus recommend the implementation of a “Weight Discrimination in Employment Act” modeled after the Age Discrimination in Employment Act to adequately address this pervasive and damaging injustice toward individuals who are affected by obesity.     

From “Overweight” to “About Right”: Evidence of a Generational Shift in Body Weight Norms

In this article, we describe differences in the self‐perception of weight status in the United States between the two most recent National Health and Nutrition Examination Survey (NHANES) periods (1988–1994 and 1999–2004), and test the hypothesis that secular increases in adult mean BMI, adult obesity, and childhood obesity contributed to changes over time in weight perceptions. We find that the probability of self‐classifying as overweight is significantly lower on average in the more recent survey, for both women and men, controlling for objective weight status and other factors. Among women, the decline in the tendency to self‐classify as overweight is concentrated in the 17–35 age range, and is more pronounced among women with normal BMI than those with overweight BMI. Among men, the shift away from feeling overweight is roughly equal across age groups. Overweight men exhibit a sharper decline in feeling overweight than normal weight men. Despite the declines in feeling overweight between surveys, weight misperception did not increase significantly for men and decreased by a sizable margin among women. We interpret the findings as evidence of a generational shift in social norms related to body weight. As a result, people may be less likely to desire weight loss than previously, limiting the effectiveness of public health campaigns aimed at weight reduction. On the other hand, there may be health benefits associated with improved body image.     

Iron and Obesity in Females in the United States

Since the late 1980s, the United States has witnessed a dramatic increase in average BMI levels and the proportion of individuals categorized as obese. Obesity is a major risk factor for a variety of illnesses, and an increase in obesity is, therefore, implicated in increased health‐care costs in the United States. These ultimately translate to a major health and economic problem for the United States. The present analysis examines a pathway to increased levels of obesity as of yet almost entirely unexplored. Specifically, we examine the relationship between obesity and iron deficiency via analyses of blood samples. The current analysis employs public‐use data files from the continuous National Health and Nutrition Examination Survey (NHANES) (1999–2006) survey to determine the relationship between obesity and an individual's iron blood content. Results suggest a negative relationship between levels of iron blood content and individual BMI after controlling for other individual characteristics. These results hold for nearly all eight panels tested in the ordinary least squares (OLS) regressions.     

A historical analysis of public health, the law, and stigmatized social groups: the need for both obesity and weight bias legislation

History teaches that discrimination against socially undesirable groups leads to societal and governmental neglect of the stigmatized group's health problem. By placing weight discrimination in a historical context, this article demonstrates that legislation specifically aimed at rectifying obesity is less likely while weight bias is socially acceptable. Beyond obesity legislation, public health professionals may consider advocating for legislation directly targeting discrimination based on weight. This article reviews the history of discrimination against distinct groups and provides statutory solutions for discrimination based on weight. In addition to revising current statutes and regulatory rules, a unique statute targeting weight bias in the employment context is considered.     

The Bias in Self‐reported Obesity From 1976 to 2005: A Canada–US Comparison

The objective of this study was to determine whether the bias in self‐reported estimates of obesity has changed over time and followed different patterns in Canada and the United States. Using age‐standardized data from three waves of the National Health and Nutrition Examination Survey (NHANES) in the United States and the Canadian Community Health Survey (CCHS) and the Canadian Heart Health Survey (CHHS) in Canada, discrepancies were compared between reported and measured estimates of height, weight, and obesity (based on the BMI) from 1976 to 2005. Results indicated that obesity increased in both countries, but rates were higher in the United States. The discrepancy between self‐reported and measured obesity was small in the United States with reported data underestimating measured prevalence by about 3%; this stayed relatively constant over time. In Canada, the discrepancy was large and doubled in the past decade (from 4 to 8%). In the United States, self‐reported data may be more accurate in monitoring changes in obesity over time, as the estimates have consistently remained about 3% below the measured estimates, whereas in Canada, monitoring obesity based solely on self‐reported height and weight may produce inaccurate estimates because of the increasing discrepancy between self‐reported and measured data.     

Examining the temporal relationships between childhood obesity and asthma

Childhood obesity has become an issue of increasing concern to health researchers and policymakers in the United States. One important chronic health condition linked to obesity is pediatric asthma. Although researchers have speculated that both conditions may have common origins, the majority of research in this area has focused on a unidirectional relationship between obesity and later asthma. However, much of the literature is limited by its reliance on cross-sectional data and its failure to examine the possibility that asthma may influence weight fluctuations through changes in physical and sedentary activity. Using data from the Early Childhood Longitudinal Study-Kindergarten Cohort (ECLS-K), I explore the bidirectional relationships between childhood obesity and asthma. The results in this paper suggest that past asthma levels are positively correlated with changes in BMI and the onset of obesity. However, only new onset asthma is positively correlated with subsequent changes in BMI. The potential mechanisms are unclear, as I find little evidence that asthma is structurally related to changes in physical or sedentary activity over time. When testing the prevailing hypothesis that obesity is related to subsequent asthma, I find that lagged weight status is strongly related to asthma prevalence levels but that the onset of overweight or obesity is not associated with the subsequent onset of asthma. These results suggest that the onset of asthma may be related to subsequent weight gain over time.     

The power of respect in (and for) the study of stigma and discrimination

This review essay of Getting Respect: Responding to Stigma and Discrimination in the United States, Brazil, and Israel explores how the politics of respectability is employed in vastly different ways as a response to encounters with stigma and discrimination. For such victimized people, the manner and timing of its employment rests in the particular nature of the social and political contexts circumscribing their lives. Differences remain in whether people interpret certain interactions as validating responses as well as in the kinds of responses they ultimately produce. Taking these and other factors into account, the employment of the politics of respectability should not be regarded solely as the self-affirmation of the moral legitimacy of the victimized. Rather, that form of response is predicated on the recognition of the kinds of agency that may (or may not) be available given the large-scale social power dynamics that circumscribe micro-level acts of discrimination and stigmatization.     

And How Are We Supposed to Pay for Health Care? Views of the Poor and the Near Poor on Welfare Reform

The welfare reform debate focuses on the characteristics of who gets government benefits and who pays for them. People perceive the welfare reform debate as the white middle class denying benefits to poor people of color. But larger questions regarding the U.S. lack of comprehensive social policy for health care, education, and child care lurk behind these concerns. Drawing on research with public assistance recipients and working- and middle-class people, in this paper I explore the ways that people interact with and perceive government social programs. I argue that both attitudes and proposed solutions toward welfare reflect different access to government programs and resources such as jobs, savings, and social supports among people who have and have not accessed welfare. Since economic disparity in the United States correlates highly with race, the debate over welfare reform also involves racial attitudes. Changing both the welfare debate and poverty in the United States must start by providing universal benefits, [ public policy, poverty, welfare reform, race, United States ]     

The obesity penalty in the labor market using longitudinal Canadian data

A Canadian study of weight discrimination also known as the obesity wage-penalty. This paper adds to the limited Canadian literature while also introducing a causal model, which can be applied to future Canadian studies. A general working-class sample group is utilized with personal income, which removes many biases introduced in other studies. The evidence suggests that a 1-unit increase in lagged BMI is associated with a 0.7% decrease in personal for obese Canadian females. Similar to other studies, the male results are inconsistent. The evidence brought forward in this study can provide an effective financial incentive for health promotion among Canadians for law and policy makers. Beyond health reasons, these results can also be applied as empirical evidence of gender discrimination based on body image perception. The evidence suggests that male physique is not a contributing factor in income, but larger female physique is associated with lower personal income.     

Excess weight and sleep-disordered breathing.

Excess weight is a well-established predictor of sleep-disordered breathing (SDB). Clinical observations and population studies throughout the United States, Europe, Asia, and Australia have consistently shown a graded increase in the prevalence of SDB as body mass index, neck girth, or other measures of body habitus increases. Clinical studies of weight loss and longitudinal population studies provide strong support for a causal association. The role of excess body weight, a modifiable risk factor, with SDB raises many questions relevant to clinical practice and public health. The topic takes on added importance with the alarming rate of weight gain in children as well as adults in industrialized nations. Among adults ages 30-69 yr, averaging over the estimated United States 2003 age, sex, and BMI distributions, we estimate that approximately 17% of adults have mild or worse SDB (apnea-hypopnea index > or = 5) and that 41% of those adults have SDB "attributable" to having a body mass index of > or =25 kg/m(2). Similarly, we estimate that approximately 5.7% of adults have moderate or worse SDB (apnea-hypopnea index > or = 15) and that 58% of those adults have SDB attributable to excess weight. Clearly, if the expanding epidemic of obesity seen in the United States continues, the prevalence of SDB will almost certainly increase, along with the proportion of SDB attributable to obesity.     

Obesity increases cerebrocortical reactive oxygen species and impairs brainfunction

Nearly two-thirds of the population in the United States is overweight or obese, and this unprecedented level of obesity will undoubtedly have a profound impact on overall health, although little is currently known about the effects of obesity on the brain. The objective of this study was to investigate cerebral oxidative stress and cognitive decline in the context of diet-induced obesity (DIO). We demonstrate for the first time that DIO induces higher levels of reactive oxygen species (ROS) in the brain and promotes cognitive impairment. Importantly, we also demonstrate for the first time in these studies that both body weight and adiposity are tightly correlated with the level of ROS. Interestingly, ROS were not correlated with cognitive decline in this model. Alterations in the antioxidant/detoxification Nrf2 pathway, superoxide dismutase, and catalase activity levels were not significantly altered in response to DIO. However, a significant impairment in glutathione peroxidase was observed in response to DIO. Taken together, these data demonstrate for the first time that DIO increases the levels of total and individual ROS in the brain and highlight a direct relationship between the amount of adiposity and the level of oxidative stress within the brain. These data have important implications for understanding the negative effects of obesity on the brain and are vital to understanding the role of oxidative stress in mediating the effects of obesity on thebrain.     

Socioeconomic status, height, and obesity in children

The substantial increase in the prevalence of child obesity over recent decades and its association with a number of negative health and economic outcomes suggests its strong potential as an influence on the lifecourse development of health and productivity. This paper evaluates interactive effects between family socioeconomic status (SES) and height on child obesity in the United States. Using the 1999-2006 National Health and Nutrition Examination Surveys (NHANES), the results of this paper confirm previous findings that taller children exhibit greater propensity towards obesity as measured by body mass index (BMI) and that obesity is inversely related to family SES as measured by poverty status. The analysis adds to the existing literature by showing that the magnitude of the SES-obesity association is larger in taller children. Age and sex patterns are evaluated that suggest the SES-height interaction persists through childhood and adolescence in males but is only evident in females during adolescence. Interaction effects are also shown to be most evident in white males and Hispanic females. Policy implications are discussed and directions for future work are suggested.     

The effect of rising obesity on eligibility to serve in the U.S. public health service commissioned corps

This study investigates how rising obesity has affected eligibility to serve in the United States Public Health Service Commissioned Corps (PHSCC), the uniformed service charged with protecting and promoting public health in the U.S. Data are drawn from the National Health and Nutrition Examination Surveys. Between 1959 and 2010, the percentage of eligible civilians who exceed the weight-for-height and body fat standards of the PHSCC rose from 9.05% to 18.24% among men, and from 6.13% to 23.10% among women. Simulations indicate that a further 1% increase in population body weight will result in an additional 3.42% of men and 5.08% of women exceeding PHSCC accession standards.This study documents an under appreciated consequence of the rise in obesity: fewer Americans eligible to develop and implement a public health response to obesity through the PHSCC. This illustrates how a public health problem can undermine the public health labor force, compromising a response and risking a self-reinforcing trend. These findings are timely as the Patient Protection and Affordable Care Act (ACA) calls for a major expansion of the PHSCC.     

Geographic Variation in the Prevalence of Obesity,Diabetes, and Obesity‐Related Behaviors**

Objective: To examine the variation in the prevalences of obesity and type 2 diabetes in weight loss counseling by health providers and in other potential obesity‐related determinants in 100 metropolitan statistical areas in the United States. Research Methods and Procedures: We performed a cross‐sectional study using data from the 2000 Behavioral Risk Factor Surveillance System, the largest telephone survey of health behaviors in the United States, of age‐adjusted prevalence of obesity, type 2 diabetes, intake of ≥five servings of fruits and vegetables per day, participation in 150 minutes of leisure‐time physical activity per week, receipt of weight management advice, and reports of trying to lose or maintain weight among men and women more than 18 years old. Results: The age‐adjusted prevalence of obesity ranged from 13.1% to 30.0% and that of type 2 diabetes from 3.3% to 9.2%. Among participants who had visited a physician for a routine checkup in the previous 12 months, 13.1% to 27.1% of all participants recalled receiving advice from a health professional about their weight, and 11.7% to 34.6% of overweight or obese participants recalled receiving advice to maintain or lose weight. Discussion: Significant differences in the prevalence of obesity and self‐reported type 2 diabetes and in medical practice patterns regarding weight management advice exist among metropolitan statistical areas. These results suggest important opportunities to investigate reasons for these variations that could potentially be used to mitigate the current epidemic of obesity and to identify areas where obesity and diabetes prevention efforts may need to be targeted.