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Abstract

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods and Procedures
  5. Results
  6. Discussion
  7. ACKNOWLEDGEMENT
  8. DISCLOSURE
  9. References

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.


Introduction

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods and Procedures
  5. Results
  6. Discussion
  7. ACKNOWLEDGEMENT
  8. DISCLOSURE
  9. References

Weight-based discrimination is a widespread societal problem that reduces quality of life for obese Americans and generates health disparities (1,2). Stigma and discrimination toward obese persons have been well documented in areas of employment, education, health care, the media, and interpersonal relationships (1,3). Recent national estimates indicate that the prevalence of weight discrimination has increased by 66% over the past decade (4), and is now comparable to rates of racial discrimination in the United States, especially among women (5). Numerous studies have demonstrated that obese persons are stereotyped as being lazy, unintelligent, unsuccessful, and lacking in self-discipline (1,3,6). These negative assumptions translate into pervasive stigmatization, which leaves obese persons vulnerable to prejudice and unequal treatment because of their body weight.

Social inequalities resulting from weight discrimination are especially apparent in employment settings. Several decades of research demonstrate that obese individuals are consistently denigrated in the workplace (1,7,8). Obese employees are less likely to be hired, less likely to be promoted, and paid less than thinner employees, even with identical qualifications, education, credentials, and job performance (1,7,8). Studies examining weight discrimination in employment settings using nationally representative samples of adults have demonstrated that reports of discrimination in the workplace increase as individuals become heavier (4,9,10). These findings indicate that overweight adults are 12 times more likely, obese adults are 37 times more likely, and severely obese adults are 100 times more likely to report employment discrimination compared to normal-weight respondents (10).

Obesity wage penalties have also been documented in large population-based studies (e.g., using the National Longitudinal Survey of Youth) demonstrating that obese employees are paid lower wages for the same work performed by thinner employees, even after controlling for numerous sociodemographic variables and health limitations (11,12,13). Recent estimates suggest that for white females, an increase of 64 pounds above average weight is associated with a 9% decrease in wages, which is approximately equal to the difference of 1.5 years of education or 3 years of work experience (12). Other work has found that obese white women experience a decrease in wages ranging from 5.8% to as much as 24%, and that obese white men experience as much as a 19.6% wage penalty (13).

A recent meta-analysis of experimental studies investigating weight-based employment discrimination confirms that, across studies, overweight individuals are consistently denigrated, and have worse employment outcomes compared to their nonoverweight co-workers (8). This is especially true in hiring practices, where overweight and obese individuals are less likely to be hired compared to nonoverweight individuals despite equal qualifications (8). In some cases, obese applicants receive more negative evaluations even when compared to less qualified thinner individuals (14).

In addition to these social and economic inequalities apparent in the workplace, weight discrimination poses numerous consequences for individuals' psychological and physical health. Overweight and obese individuals who experience weight stigma are more likely to engage in unhealthy behaviors, including more frequent binge eating (15,16,17), maladaptive eating behaviors (18,19,20), lower levels of physical activity (21), and avoidance of preventive health-care services compared to overweight peers who do not report stigmatizing experiences (22). Research also demonstrates that experiencing weight stigma may interfere with weight-loss attempts and potentially contribute to obesity (20,23,24). The emotional toll of weight discrimination is equally concerning, as weight stigmatization is a significant risk factor for psychological stress, including depression (25,26,27,28,29,30), low self-esteem (9,15), body dissatisfaction (31,32,33), and suicidal behaviors (34,35,36). It is important to note that these findings persist despite controlling for BMI, indicating that negative psychological outcomes result from stigmatizing experiences, rather than body weight itself (28,30,37,38). Current scientific evidence also suggests that the increased vulnerability to psychological stress caused by weight-based discrimination contributes to the poor physical health suffered by many obese Americans (2,39,40).

Despite the occurrence of weight discrimination and the clear implications for employment inequality and reduced quality of life, it is not illegal to discriminate on the basis of weight under the Constitution or federal law (41,42). Only one state (Michigan) and few localities (for example, the cities of San Francisco and Santa Cruz, and the District of Columbia) have enacted legislation to prohibit weight discrimination. Thus, most employers have the right to discriminate against job applicants and employees on the basis of weight, and the majority of obese Americans who experience weight discrimination in the workplace have no viable means for seeking legal recourse. Although some individuals have filed lawsuits under the Americans with Disabilities Act (ADA), few of these cases have been successful (41,42,43).

Given the prevalence of overweight and obesity in the United States, meaningful legal remedies are needed to protect against weight discrimination. Public support is necessary to enact antidiscrimination legislation; however, the level of public support for such measures is unknown. Few studies have examined public attitudes toward laws to prohibit weight discrimination (44,45). In these studies, support for antidiscrimination measures ranged from 33.1 to 48%. However, these studies typically asked only one or two fairly vague questions about antidiscrimination measures (e.g., “The government should play a more active role in protecting overweight people from discrimination”), and did not assess support for specific or different types of laws. These studies also presented participants with other information about the causes of obesity that may have influenced participants' responses.

Despite the lack of research in this area, there has been increasing discussion in recent years about potential legislative measures to prohibit weight discrimination. For example, some have proposed extending protections to obese individuals under the ADA under the premise that morbid obesity should be considered a disability, or adding body weight as a protected category in existing civil laws that protect individuals from discrimination based on sex, age, ethnicity, and other characteristics (41,42,43). Others have suggested modeling legislation after the Age Discrimination in Employment Act (ADEA) and creating the “Weight Discrimination in Employment Act” (WDEA), which would include identical prohibitions as the ADEA with respect to weight instead of age (41).

In order to determine potential legal remedies to address weight discrimination, it is important to understand public attitudes toward proposed legislative measures. Thus, this study aimed to examine public opinions toward a variety of potential laws to prohibit weight discrimination in a nationally representative sample of American adults. This study also assessed whether certain demographic characteristics (e.g., sex, age, body weight, race, political ideology) are related to participants' support for antidiscrimination legislation, and whether greater support is expressed among individuals who have themselves previously experienced weight-based stigmatization or discrimination.

Methods and Procedures

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods and Procedures
  5. Results
  6. Discussion
  7. ACKNOWLEDGEMENT
  8. DISCLOSURE
  9. References

Data source

An online survey was developed to assess levels of support for various types of legislation to prohibit weight discrimination. The sample was recruited through a survey panel administered by Survey Sampling International (SSI). Participants are recruited through thousands of Web sites to maximize the representativeness of the panel to the online population, with data aggregators that reach millions of users. SSI provides a variety of incentives (including information (research feedback), charitable donations, and monetary and points rewards) for overall program participation that is entirely voluntary. Individuals who chose to participate were directed to the online survey for completion. Our aim was to obtain ∼1,000 participants whose demographic makeup was representative of the US population. Of those participants who began the online survey, 95% completed the study, yielding a final sample of 1,059 participants.

Measures

Demographic and weight information. Participants were asked to report their age, sex, ethnicity, highest level of education completed, annual household income, height, and weight. Height and weight information was collected to determine the BMI of participants, and to determine whether support for weight-based legislation varied among individuals within different weight categories. Participants were also asked to indicate their political ideology and party affiliation. These questions were included because political ideology has been demonstrated to be correlated with antifat attitudes (46,47), and may be important in understanding support for legislation to prohibit weight discrimination.

Assessing support for measures to prohibit weight discrimination. Following completion of demographic information, participants were asked to read a brief paragraph introducing the topic of weight discrimination. This paragraph stated the following information:

Research shows that overweight and obese people are discriminated against in the workplace. Qualified people are less likely to be hired, less likely to be promoted, more likely to be fired, and paid less if they are overweight. Currently, there are no laws to protect overweight or obese people from discrimination based on their body weight. Thus, different types of laws are being considered to protect people from discrimination based on weight. We are interested in your opinions about these proposed laws.”

After reading this paragraph, participants were asked to respond to six questions, indicating their level of support for various legislative measures to prohibit weight discrimination. These questions were presented in a random order. The content and wording for each question was guided by previous research on legal and public health perspectives of weight discrimination (2,41,45), and included legal measures related to civil rights, protections for people with disabilities, and laws specifically pertaining to workplace discrimination (see Table 1). Questions 2 and 3 have been used in two previous studies (44,45), and question 6 was tested in recent research by the present authors (R.M. Puhl and C.A. Heuer, unpublished data). The remaining three questions were developed from scholarly and legal discussions pertaining to proposed legislation to prohibit weight discrimination (41). Participants indicated their level of agreement to each statement on a 5-point Likert scale (including “strongly disagree”, “disagree”, “neither agree nor disagree”, “agree”, and “strongly agree”). Prior to data collection, each item was piloted in an online sample of 100 individuals from the general population to ascertain participants' ability to clearly understand and respond to the questions. No difficulties were detected in participants' comprehension of the questions.

Table 1.  Wording of statements to assess support for legal measures to prohibit weight discrimination
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To examine whether sociodemographic characteristics affect the level of support endorsed by participants for each of the six laws (using available information on participants' sex, race, age, BMI categories, political party affiliation, education, income, and history of teasing or being treated unfairly), ordinal logistic regression (proportional odds model) was used for each law separately. Each regression was designed to test agreement with each of the six laws as a function of demographic characteristics. Age was divided into three categories (18–34 years, 35–49 years, and 50+ years), as was level of education completed (high school, some college/vocational technical school, and college degree or postgraduate education). The model with main effects was used to obtain the odds ratios for each demographic variable (controlling for all other variables), with the main objective of examining general patterns of predictors of support across laws rather than specifying any particular model.

Personal history of weight-based teasing and victimization. Finally, participants were asked seven questions about their personal experiences with weight-based teasing and discrimination. Specifically, questions were asked whether participants had ever been teased, treated unfairly, discriminated against, and discriminated against in the workplace because of their body weight. Participants were also asked whether their family members, friends, or children had ever been teased, treated unfairly, or discriminated against because of their weight. Each question was asked in a forced-choice format of “yes” or “no.”

Results

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods and Procedures
  5. Results
  6. Discussion
  7. ACKNOWLEDGEMENT
  8. DISCLOSURE
  9. References

The initial total sample comprised 1,059 adults. Participants were excluded from data analyses if they did not provide responses regarding their opinions about the six proposed laws, or if they had missing data on two or more demographic variables. Fifty-eight participants were excluded for these reasons, yielding a final sample of 1,001 participants.

Our sample closely reflected the sociodemographic characteristics for the current US population for sex and race, and varied only slightly from national averages for age, education, and income (48). Table 2 presents sociodemographic characteristics of the sample. The final sample consisted of 508 (51%) women and 493 (49%) men. The average age of participants was 43.67 years (s.d. = 14.72), and the mean BMI of participants was 28.53 (6.33). There were no significant gender differences in race, BMI, or age. BMI of participants was stratified using the clinical guidelines for the classification of overweight and obesity in adults by the National Heart, Lung, and Blood Institute of the National Institutes of Health (49). This stratification showed 32% of the sample to be normal weight (BMI 18.5–24.9), 33% overweight (BMI 25.0–25.9), and 35% obese (BMI of 30+). This distribution of body weight is representative of the general population (50). χ2 analyses revealed that women were more likely than men to report that they had been teased about their weight (47% vs. 38%, χ2 (1,999) = 7.67, P < 0.01), treated unfairly because of their weight (25% vs. 16%, χ2 (1,999) = 13.46, P < 0.001), discriminated because of their weight (19% vs. 12%, χ2 (1,999) = 11.33, P < 0.01), and discriminated against in the workplace because of their weight (11% vs. 7%, χ2 (1,999) = 5.61, P < 0.05). In addition, more women (26%) than men (17%) identified themselves as having a Liberal political affiliation, and more men (37%) than women (25%) identified themselves as Conservatives (χ2 (1,999) = 19.17, P < 0.001).

Table 2.  Sample characteristics (n = 1,001)
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Table 3 summarizes the extent of agreement for each of the six proposed antidiscrimination laws across demographic variables including sex, race, age, BMI, education, income, political affiliation, and history of weight-based teasing. Each of the six laws were significantly intercorrelated with each other (bivariate correlation coefficients ranged from 0.38 to 0.77, all significant at the level of 0.01), indicating that regardless of what order the laws were presented to participants, those who expressed agreement with one law were more likely to agree with the others or vice versa.

Table 3.  Agreement for antidiscrimination laws across sociodemographic variables of the total sample (N = 1,001)
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However, there was considerable variation in the extent of agreement for different laws and across various participant characteristics. In general, agreement was stronger for laws that would prohibit employers from discriminating against obese persons in the workplace than for laws that would consider obesity as a disability under the ADA or offer the same protections to obese persons as people with physical disabilities. Agreement was also stronger for laws that were stated in more specific terms (Laws 4, 5, and 6), than measures that were stated more generally (Laws 2 and 3). In general, women endorsed more agreement for each of the laws compared to men. Independent t-tests revealed that women endorsed stronger agreement than men with Law 4 (My state should include weight in civil rights law to protect people from weight discrimination) (t (999) = 5.34, P < 0.01), Law 5 (Congress should pass the WDEA to protect people from weight discrimination in the workplace) (t (999) = 5.77, P < 0.001), and Law 6 (It should be illegal for employers to refuse to hire, fire, or deny promotion based on weight) (t (999) = 5.91, P < 0.001). However, both women (81%) and men (65%) expressed the most agreement for Law 6 and the least agreement (32% of women, 27% of men) for Law 1 (which would include obesity as a disability under the ADA). There was also a consistent relationship between participant body weight and level of agreement with each of the laws, where obese adults endorsed more agreement for laws than normal-weight individuals.

Table 4 presents all significant odds ratios from the logistic regression analyses for each of the six laws. Results revealed a very similar pattern of relationships across all regressions.

Table 4.  Significant predictors of support for six proposed laws to address weight discrimination (N = 1,001)
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Regression results showed that several demographic characteristics, including body weight, political attitudes, and experiences of weight-based victimization were related to participants' support across the six laws. A general pattern emerged indicating that likelihood of agreement with antidiscrimination laws was higher among individuals who were obese, 35–49 years of age, with a political ideology identified as Liberal or Moderate (or who identified themselves as Democrats), and those with lower education (high school vs. college or graduate degrees) and lower annual income (<$25,000). In addition, although only 9% of the sample reported having experienced weight-based discrimination in the workplace, these individuals were 2–4 times more likely to endorse agreement with laws than individuals who had not reported workplace discrimination. Similarly, participants who reported that their family members had been targets of weight-based victimization were more likely to express agreement for laws compared to participants who did not report victimization toward family members. Race of participants did not predict likelihood of support for any of the laws, nor did participants' personal experiences of weight-based teasing, victimization, or general experiences of discrimination (not specific to the workplace).

Discussion

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods and Procedures
  5. Results
  6. Discussion
  7. ACKNOWLEDGEMENT
  8. DISCLOSURE
  9. References

This study is the first to examine public support for different types of legislative measures to prohibit weight discrimination in the United States. In general, there was moderate agreement, and in some cases, high agreement, for the proposed laws to prohibit weight discrimination. At least 1/4 of men, and approximately 1/3 of women, expressed agreement for each of the six laws. There was a clear distinction in levels of agreement for legislative measures that would prohibit employers from discriminating against obese persons in the workplace, which received the highest agreement, compared to laws that would consider obesity as a disability under the ADA or offer the same protections to obese persons as people with physical disabilities, which received the lowest support among both men and women. Despite increasing media attention and discussion about the disabling effects of obesity (51), our findings suggest that most Americans may not be in favor of considering obesity as a disability. Interestingly, the ADA is currently the only potential outlet for obese persons to seek legal recourse if they have experienced weight discrimination, but very few cases have been successful through this avenue (41,42,43). With little public support for laws that treat obesity as a disability and the existing obstacles for obese persons seeking legal redress through the ADA, it seems that other legislative measures are warranted. To this end, it is promising to note that 65% of men and 81% of women expressed favorable views toward laws that would prohibit employers from refusing to hire, firing, or denying promotions to qualified obese employees. This suggests that efforts to enact antidiscrimination legislation may receive considerable public support if there are specific provisions to prohibit weight discrimination in the workplace.

Several important gender differences were observed in agreement with the antidiscrimination laws. Women expressed more agreement than men with all six laws, although significant differences emerged only for Laws 4, 5, and 6 (which emphasized civil rights protections and specific provisions to address weight discrimination in the workplace), and not for Laws 1, 2, and 3 (which propose considering obesity a disability and extending the same protections to obese persons as people with physical disabilities). There was no difference in BMI between women and men in the present sample; however, women were more likely than men to report previous experiences of weight-based teasing, unfair treatment, and discrimination. This finding is consistent with previous research documenting gender differences in perceived weight discrimination and a heightened vulnerability of women to weight stigmatization (5), which may have contributed to women's stronger agreement with antidiscrimination laws in the present study.

Higher support among women for antidiscrimination laws may also be related to their political ideology, as women were more likely to report having a Liberal political affiliation. Men, on the other hand, were more likely to report a Conservative political ideology that has been associated with antifat attitudes in previous research (46,47). A series of experimental studies by Crandall and colleagues have demonstrated that negative attitudes toward obese persons are often linked to a specific social ideology, characterized by traditional American values of individualism, self-determination, and political conservatism. These values emphasize that people are responsible for their life situation and get what they deserve (46,47,52,53). These attributions tend to attribute others' failures to inadequate effort, reinforcing beliefs that obese people deserve to be stigmatized because they are to blame for their weight (46,54). The findings of the present study support these ideas, in that Liberals (including both men and women) were more likely to agree with antidiscrimination laws than Conservatives.

Given previous research demonstrating that obese individuals tend to express lower levels of weight bias and antifat attitudes than thinner individuals (55), it is not surprising that heavier participants were more likely to support antidiscrimination laws than thinner participants in the present study. However, it is important to note that considerable percentages of “normal-weight” participants also reported agreement with the laws, especially for Laws 4 (48%), 5 (50%), and 6 (69%). Thus, it appears that there is broad recognition of weight discrimination and the need for legal remedies across individuals with varying body weights.

Several puzzling findings emerged in the present study. First, the likelihood of agreement with antidiscrimination laws was higher among individuals aged 35–49 years than younger or older participants. There were no differences in gender, BMI, or reported weight-based teasing and discrimination across different age categories, and the political affiliation in this age-group was slightly more conservative than younger individuals. Thus, it is unclear why this group expressed higher agreement with the laws.

Second, it is interesting to note that participants with lower income and education were more likely to support antidiscrimination laws than individuals with higher income and education. The most likely explanation for this finding is that BMI was negatively associated with education (r = −0.10, P < 0.01) and income (r = −0.09, P < 0.01), indicating that individuals with lower education and income tended to have higher body weight than individuals with higher income/education. However, previous research has indicated that obese individuals in professional jobs are more likely than obese nonprofessionals to report employment discrimination (9), suggesting that it would be plausible to expect support for antidiscrimination laws among individuals with higher education and income. These findings indicate the need for additional research to better understand and clarify potential age and demographic differences related to support for weight-based antidiscrimination policies.

There are several limitations of the present study. Although the sample in the present study represents the demographics of the United States, sample bias may limit generalizability to individuals who have access to the Internet and the time and resources to participate in online surveys. In addition, more work is needed to examine support for weight-based antidiscrimination laws in larger samples of ethnic minorities, who may be vulnerable to both weight discrimination and racial discrimination, and who may also have different cultural attitudes toward weight (56). Finally, data obtained for height and weight of participants relied on self-report. There is a general tendency for individuals to underestimate their own weight and to overestimate height; however, these self-report inaccuracies are modest and self-reported weight and height data are typically correlated above 0.90 (57).

It is within the legal rights of most employers to discriminate against their employees on the basis of weight, and those who experience weight discrimination have no means for legal recourse. The accumulation of research documenting the negative personal and social consequences of weight stigma and discrimination justifies the need for legal action to protect overweight people. History has demonstrated the power of legislation to reduce institutionalized bias against stigmatized groups (41). Thus, legal measures to prohibit weight discrimination can help rectify employment inequalities, facilitate public health efforts to improve the health and well-being of obese Americans, and reduce the social acceptability of weight bias. At a time when the topic of obesity is prevalent in the media and a priority in the nation's public health agenda, we must recognize that weight discrimination is both a social injustice and a public health issue. Reducing weight stigma and improving the lives of overweight and obese individuals requires significant shifts in societal attitudes. Public support is fundamental in efforts to enact legislation to protect obese individuals from discrimination. Our findings are the first to examine public support for various legislative measures to prohibit weight discrimination in the United States, which can be used to inform policy makers and steer advocacy groups toward the most workable legislative opportunities.

ACKNOWLEDGEMENT

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods and Procedures
  5. Results
  6. Discussion
  7. ACKNOWLEDGEMENT
  8. DISCLOSURE
  9. References

This research was funded by the Rudd Center for Food Policy and Obesity at Yale University.

References

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods and Procedures
  5. Results
  6. Discussion
  7. ACKNOWLEDGEMENT
  8. DISCLOSURE
  9. References