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The Personal Costs of Obesity
People who are overweight and obese face many difficulties their normal weight peers do not. Frequent doctor visits are a fact of life for overweight and obese people, due to the development of weight-related disorders such as diabetes and osteoarthritis. Along with the daily difficulties associated with these diseases, the overweight or obese person may be personally affected financially as a result of weight-related expenses and reduced income.
The personal consequences and costs of obesity are serious, and the personal financial cost great. Multiple studies have shown that obesity significantly negatively affects personal and working relations, wages, and advancement, particularly for females.
While the health problems as the overweight/obese age may ravage savings, an overweight/obese person may have difficulty accumulating those savings in the first place. One of the earliest sociological studies of the overweight, in 1966, found that the heaviest students had a harder time getting into top colleges. The obese, particularly white women, are paid less. A study by Cornell University found that a weight increase of 64 pounds above the average for white women was associated with 9 percent lower wages.
I can personally attest to the ceiling placed on the obese; the jobs that are available to you based on your talents and abilities are often not received; there can be pattern of coming in second in interviews. This is particularly so when the job involves social context or a large amount of meet and greet.
Overweight people may or may not spend more than normal-size people on food, but their life insurance premiums are two to four times as large. They can expect higher medical expenses, and they tend to make less money and accumulate less wealth in their lifetimes. They can have a harder time being hired, and then a harder time earning promotions. People carrying as little as 30 to 40 pounds extra can be seriously affected.
In 2004, The Obesity Society created a Task Force on weight which found accumulating evidence of clear and consistent bias, stigmatization, and in some cases discrimination, against obese individuals in three areas of living: employment, education, and health care. They also reported that recent studies have documented automatic negative associations with obese people among health professionals and among obese individuals themselves.
In addition to the negative financial impact that excess weight carries, there is also impact on quality of life. People who are severely overweight may have difficulty performing simple daily tasks, such as tying shoes or walking up a flight of stairs. Many obese people have trouble sitting in, or can not trust the weight limit of, standard furniture. It becomes difficult to go to restaurants or theaters, or to utilize public transportation. Many bathroom facilities would be inaccessible to the obese were it not for the availability of the much larger handicap stall. While I was able to use the regular stalls when I weighted a little over 300 pounds, which is certainly obese but not gargantuan, there were many that were on the small size, and getting in and turning around to shut the door was awkward, if not difficult.
Think about all the places you might not go if you had to be worried about fitting in, or not breaking, the chairs; think of all the places that have booths, which have fixed distances from the table. Consider the size of the average subway turnstile. Go window shopping and mentally buy several stylish items; then go to one of the plus size departments or stores and try to replicate the satisfaction you had mock shopping in your size range. Tie a few gallon water jugs to yourself and see what it is like to sit in your own furniture.
If you are really looking to get an inkling of the reality, fill the jugs with water and carry in your groceries. Water weights about eight pounds a gallon, so you can see what it is like at 50 pounds overweight, 100, 150. I doubt many of us could handle carrying around enough jugs to bring our weight up to the 500, 600 or higher that some people live with; the obese put the weight on over time so tend not to realize just how much weight they are asking their backs and knees to support. There is no way to truly feel what it is like physically to be obese: things like raw inner thighs from chaffing and permanent raw indentations from bra straps can not be duplicated.
These problems may seem trivial to some, but they represent serious, multi-layered difficulties that can have both a cumulative and a rippling effect. If you are afraid you might not be able to use facilities, long shopping trips become less inviting. If your size affects your lung capacity, you may have trouble sleeping, which can affect your performance at work, which in turn may worsen the experience of day-to-day financial strains. So might the ability to keep up, literally.
Duke University Medical Center researchers reported in 2004 that obesity significantly impairs the sexual quality of life. Obese people report sexual problems such as lack of desire, lack of enjoyment, avoiding sex, and performance difficulty at a much higher rate than people of normal weight.
Overweight and obese people are frequently stereotyped as emotionally impaired, socially handicapped, and as possessing negative personality traits. Evidence of discrimination is found at virtually every stage of the employment cycle, including selection, placement, compensation, promotion, discipline and discharge, according to research presented by Western Michigan University. In addition, this bias extends to job assessments of overweight individuals in their various work related roles, both as subordinates and co-workers.
According to recent studies, wages of mildly obese white women were 5.9 lower than standard weight counterparts; morbidly obese white women were 24.1 percent lower. In contrast to females, the wages of mildly obese white and black men were higher than their standard weight counterparts. Men only experienced wage penalties at the very highest weight levels.
The potential effect of applicant weight, age, sex and race on ratings of job candidate acceptability in a laboratory setting was examined in 1988. Overweight candidates were rated significantly lower, but none of the other criteria manipulations had a significant effect. Michigan is the only state that prohibits employment discrimination on the basis of weight.
The Americans with Disabilities Act (ADA) is a federal statute that protects qualified individuals with disabilities from discrimination on the basis of disability in the workplace. Since the enactment of the ADA, the Equal Employment Opportunity Commission has taken the position that people who are morbidly obese (body weight more than 100 percent over the norm) are disabled and protected under the ADA. This leaves a huge number of obese, but not morbidly obese, unprotected in forty-nine of fifty states. It also puts those who do qualify under obligation to bring an ADA law suit to rectify a qualifying situation. And you still have to prove it was discrimination due to obesity.
Compared to normal weight people, morbidly obese and massively obese people are more likely to incur instances of institutional and day-to-day interpersonal discrimination. Morbidly obese and massively obese persons report lower levels of self-acceptance than normal weight persons, yet this relationship is fully mitigated by the perception that one has been discriminated against due to body weight or physical appearance: a more palatable reason psychologically than character or personality defect, or a job not well done.
Unflattering portrayals of obese people pervade popular culture, while multiple studies document that children, adults, and even health care professionals who work with obese patients hold negative attitudes toward overweight and obese persons. Twenty-eight percent of teachers in one study said that becoming obese is the worst thing that can happen to a person; twenty-four percent of nurses said that they are repulsed by obese people.
Obese people who believe that their health care providers look down upon them may avoid seeking care; this reaction is potentially dangerous given that obese individuals are at an elevated risk for many health conditions.
Research conducted over the past 40 years shows that obese people are viewed as physically unattractive and undesirable. Obese individuals also are viewed as responsible for their weight due to some character flaw such as laziness, gluttony, or a lack of self-control and self respect. Obese persons may form negative self-evaluations as a reaction to the pervasiveness of negative attitudes toward obese persons and real or perceived discriminatory treatment.
Interpersonal consequences of severe obesity are most acute for members of higher socioeconomic strata. A number of studies suggest that upper-middle class Americans are less likely to be obese, more likely to adopt negative views toward the obese, and more likely to view thinness as an ideal body type; the belief that obesity is a consequence of laziness may be particularly common among those with richer resources and opportunities. Physical appearance and putting forth a positive image of your employer also may be a more critical aspect of job success in professional occupations than in blue-collar or service occupations. In all of our surveys, the only striking difference in obesity statistics was a drop in the obesity percentages in the shopping playgrounds of the wealthy.
The Employment Law Alliance (ELA) released findings from its America at Work Opinion Poll portending a rise in lawsuits alleging employment related obesity discrimination. The survey found 47 percent of obese Americans believe they have suffered discrimination in the workplace, while 32 percent think obese employees less likely to be respected and taken seriously in the workplace. Nearly 40 percent of those who identified themselves either as obese or overweight contend they deserve special government protection against weight-based discrimination in the workplace, though only 26 percent of individuals of normal weight echoed that contention.
Studies show that overweight and obese students, especially girls, are less likely than the non-obese to be accepted by the more competitive colleges. This is true even if their grades, standardized test scores, and other variables are the same as for other boys and girls.
Overweight people are less likely to attend college even though they score high on standardized tests and are academically motivated. Also, overweight women are more likely than other men or women to pay their way through college.
Overweight students are more likely to be refused letters of recommendation from faculty members.
There has been some change in the practices regarding hiring of the obese, as so much more of the employment force has become obese there is not often an option. Look at the number of employees you see in stores and businesses in a day, and you will notice that there are more obese employees than there were when you were a child. But it does not remove the ceiling or reduce the promotion restrictions that shadow the obese.
A study of 1200 doctors revealed that, although physicians recognized the health risks of obesity and perceived many patients as overweight or obese, they did not intervene as much as they thought they should, were ambivalent about how to manage obese clients, and were unlikely to refer them to weight loss programs. Only 18 percent of physicians reported that they would discuss weight management with overweight patients, and only 42 percent of physicians would have this discussion with mildly obese patients. I have lived and worked in five states in my lifetime, and have had jobs in six different counties in California, so I have had many different primary physicians in my adult lifetime, and I can tell you that most never broached the subject of my weight, and the few who did merely remarked that I should lose some.
In a 1969 survey of physicians, obese patients were described as weak-willed, ugly, awkward, and self–indulgent. In a more recent physician survey, one of three doctors said they respond negatively to obesity, behind three other diagnostic/social categories: drug addiction, alcoholism, and mental illness. A survey of severely obese patients found that nearly 80 percent reported being treated disrespectfully by the medical profession.
Physicians are not immune to obesity. Ironically, physicians report fifty percent of their physician colleagues are obese. The Physicians’ Health Study reported that 44 percent of male physicians are overweight, and 6 percent are obese. Although there are no published data on obesity in female physicians, the Nurses’ Health Study demonstrated that 28 percent of female nurses in the United States are overweight, and 11 percent are obese.
Researchers at the Mayo Clinic recently released the results of a survey of more than 2,500 obese patients who went to their doctor for a regular checkup over the course of a year. They found that only one in five of those people were listed on their charts as obese.
Discussing weight becomes even more complicated with children. According to a 2005 study in the Journal of Pediatrics, doctors diagnosed obesity less than 1 percent of the time among 2 to 18 year olds, a figure far below the one-third of young Americans struggling with overweight and obesity.
Among physicians, 17 percent reported reluctance to provide pelvic exams to very obese women, and 83 percent indicated reluctance to provide a pelvic exam if the patient herself was hesitant. Given that overweight women may hesitate to obtain exams and that physicians are reluctant to perform exams on obese or reluctant women, many overweight women may not receive necessary medical attention or preventive care.
Overweight and obese people get waited on more slowly than normal weight customers. They often encounter more difficulty making returns or exchanges than their thinner counterparts. When I was obese, sales people rarely asked to assist, and I often felt I had to track someone down; I assumed this was a general condition of the loss of the ethics of service of the old days. One thing I noticed when I became a size 4 was that sales people began to come up to me and ask if they could be of help much more frequently.
Results of a study by the North American Association for the Study of Obesity revealed that obese children were liked less and rejected more often by peers. Obese boys encounter more overt victimization (verbalteasing or physical aggression) and obese girls reported more relational victimization (cruelty by friends and cliques) compared with their average-weight peers.
Obese girls were also less likely to date than their peers. Both obese boys and girls reported being more dissatisfied with their dating status compared with average-weight peers. The results suggest that obese adolescents are at greater risk for mistreatment by peers and may have fewer opportunities to develop intimate romantic relationships; this may contribute to the psychological and health difficulties frequently associated with obesity; during adolescence, a time of rapid change in body shape and size as well as dynamic interactions with peers and parents, weight control is a particularly sensitive issue.
Recently school nurses reported being more likely to label obese children as sad and lazy. They overwhelmingly agreed with the statement Childhood obesity is a significant cause of peer rejection. Another recent study found that children who are obese are absent from school more than other children, missing an average of two more days than their non-obese peers. Interestingly, obesity seems to predict absenteeism more than any other factor, including school performance and socioeconomic status, two of the top reasons cited in the past for poor attendance. As a former public school teacher (at both elementary and high school levels, and as an principal and superintendent of schools pre-K-12), I can tell you that the number of days of school missed severely effects a child’s learning, and can carry forward in terms of lesser jobs and less pay for the rest of the life of a child. That is a steep personal cost.
Social attitudes towards obesity are negative and usually result in the adolescent becoming withdrawn and isolated. Obese adolescents have feelings of low self-esteem, social isolation, feelings of rejection and depression and a strong sense of failure. Obese children are more likely to engage in high-risk behaviors such as smoking,or consuming alcohol. Obese adolescent girls are more likely to become sexually active at a younger age in an effort to achieve acceptance and attention.
The prejudice associated with obesity is intense. Fat teenagers are often disregarded and subjected to ridicule. Most comments about fatness have negative consequences. Young people are often humiliated and frequently suffer permanent emotional scars. Fat people become tired of being judged by weight first and personality second. Adolescent girls who are dissatisfied with their bodies frequently try to lose weight in unhealthy ways, including skipping meals, fasting, and smoking to ward off hunger. A smaller number of girls are even resorting to more extreme methods such as self-induced vomiting, diet pills, and laxative use. Strict food denial in an effort to lose weight often leads to late afternoon or evening binging episodes. More than one-third of obese individuals in weight-loss treatment programs report difficulties with binge eating. This type of eating behavior contributes to feelings of shame, loneliness, poor self-esteem, and depression, and these feelings in return can spur additional eating as a means of solace.
In a study by the University of California, San Diego, researchers were surprised to find that the scores of obese children on a quality of life survey were as bad as cancer patients in every domain of life.
One obesity study asked severely obese persons to take a forced-choice questionnaire; for each question, they had to make a choice between being at their present weight or having some other given illness. The results were astounding. Although there were some variations on some of the questions, every obese person said that they would rather be blind or have one leg amputated than be at their present heavy weight. Most interestingly, every person who participated in the study would rather be a poor thin person than a morbidly obese millionaire.
Little wonder that depression is commonly linked with obesity, and, having been overweight and obese from age 5 to 50, I can personally attest that this chapter understates the multitude and magnitude of the true personal costs of obesity.
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