Junkfood Science: Food for thought: Status has its rewards

January 21, 2007

Food for thought: Status has its rewards

What do these recent news stories have in common — A judge advises a defendant to call someone a “fat bastard;” trendy restaurant diners are seated according to their color, age and fatness; fat kids tell what their life is like at school; and Nobel prize winners are found to live longer?

Medpundit shared this UK article concerning an Exeter Crown Court Judge accused of making light of a racist remark. The Times reported:

A man who called a police surgeon a “f***ing Paki” was advised yesterday by a judge: “Next time call him a fat bastard and don’t say anything about his colour.” The judge gave the unusual advice after describing the decision by the Crown Prosecution Service to prosecute the man for a racially aggravated offence as “a nonsense.”

The judge said last night that his comments were “not intended to make light of racist remarks.”

But no mention was ever made, and the press reported no concern, over the judge’s remarks about fat people. As Dr. Smith said: “The judge has a point. These days fat people (and smokers) are more offensive than racists, or at least more criminal. Offenders against the public health.”


Readers have been writing to the blog of San Francisco Chronicle editor Michael Bauer about the discrimination they experience in the city’s trendiest restaurants. It appears that where one is seated is determined by if one is judged as worthy to be seen. Minority diners are reporting that they’re being ushered to the rear of the restaurant, near the kitchen, or in a separate dining room where others of their kind are seated. Bauer writes: “I’m not sure how much of where people are seated is actually some subtle form of discrimination (too old, too gay, too fat, too dark) or just an oblivious insensitivity to what the diner might be feeling.”


And the current issue of Teaching Tolerance Magazine reports on the harassment and prejudice that fat children face, “sometimes unrelenting from peers and teachers, because they are heavier than others.” The medical news incessantly reporting the dangers of childhood obesity and that being fat is bad have frightened many into hating their bodies and being afraid they are going to have a heart attack, the issue reports. Students also told the magazine that all these efforts to get or keep them thin — “eliminating vending machines, serving salads for lunch, increasing their gym time — have increased their fear rather than reduced their weight.”

These kids are also feeling low self-esteem, serving as the butt of jokes — the stereotypical funny fat kid. “It is amazing that so many fat children survive adolescence, given the hatred and meanness directed at them,” said Michael Loewy, associate professor and chair of the University of North Dakota Department of Counseling. Victims of size discrimination often suffer from depression, anxiety and loneliness...The Tolerance issue reports that many students say teachers or other adults rarely speak up about size bias because they think thin is better than fat, too.


Lastly, economists at the University of Warwick, UK, released an intriguing study, “Mortality and Immortality,” which looked at half a century of Nobel prize winners and nominees and found that winning the Nobel prize added two years to the recipients’ lives as compared to the nominees. More importantly, they found the life-extending benefits had nothing to do with the actual money or socioeconomic status of the recipients, but it was the status boost and recognition. In their lengthy paper, they made a careful review of the research on the effects of social status and health. While socioeconomic status correlates with better health and longer life, on closer examination they found that within similar occupations and incomes, the research had clearly demonstrated that it was the status of a position that most accounted for health disparities, not just the person’s income or educational level.

Since status is beneficial for those at the top of the prestige rank, they weren’t surprised to find evidence that those at the bottom were worse off. For example, they described multiple studies that had documented that deaths from heart disease are nearly four times higher among those in the lower end of each civil service job grade, even after accounting for the traditional risk factors such as smoking, weight, blood pressure, blood cholesterols, etc. The status effect was found even within the uppermost grades where everyone in that group was well-educated and high-income. Perceived social status and its psychobiological consequences, including social support and stress levels, appear to account for the causal process from socioecomic status to mortality, they showed. Their study examined the body of research on other explanations for this phenomenon, but social status held as the critical factor. Even among extraordinarily successful scientists, those who had the added status recognition of winning the Nobel prize lived longer than their peers.


While these news stories may have been taken by many readers as passing minor interests, they illustrate something much bigger. Something often overlooked or dismissed among healthcare providers and public health officials when examining the health disparities found among fat people, minorities and the poor.

Just as prestige and status is healthy, stigma is unhealthy. In fact, it may be one of the most omitted and significant considerations for health disparities.

As these news stories showed, many people in our society experience stigma and the resulting discrimination — in court rooms, social settings to schools. These are the same populations afflicted with a disproportionate number of health problems. Could there be reasons for their health problems that go beyond what is popularly assumed?

The Mood Disorders Society of Canada, a nonprofit caregiver charitable organization, began a multi-year research project last October looking at stigma and discrimination. Stigma is based on stereotypes about certain people and they found it results in serious economic, health and social consequences. Their research on stigmatized people with mental health issues, shares a surprising similarity to the research that’s been shown on other stigmatized groups such as fat people, ethnic/racial minorities, disabled and elders:

• They are reluctant to seek medical care early, making treatment more complicated and less effective resulting in greater disability.

• They hold the same negative attitudes and blame about themselves that society at large inflicts upon them.

• They expect to be rejected by the community, which interferes with their sense of belonging, something more acutely felt by those with fewer social supports.

• Stigma and the resulting social withdraw has been shown to have a greater impact on the quality of life than the actual symptoms of any illness.

• Those with health problems are less likely to be treated for medical conditions and to not be treated as equitably.

• Although they are willing and able to work, stigmatized people are underemployed and unemployed in higher numbers.

• They experience loss of human rights including forced treatment, finding or keeping housing, the right to parent, access to loans, immigration and denial of insurance coverage.

Being the target of hostility, mockery and shunning serves to traumatize and marginalize people, adding to the oppression they experience. As studies in a recent Obesity Research found, the stigma of obesity, which was already significant in 1960, has significantly increased over the past four decades.

Discrimination is much stronger as a predictor (odds ratio of 2.6) of hardening of the arteries than BMI or any of the classic risk factors like blood pressure or cholesterol, said obesity researcher Paul Ernsberger, Ph.D., Department of Nutrition, Case Western University, Cleveland, Ohio.

The recent results of the multi-medical center SWAN Heart Study, examining the calcifications of coronary arteries of 181 middle-aged African American women, concurred. The researchers found that experiencing chronic daily disrespect, mistreatment and prejudice was the most significant factor for the buildup of calcium deposits in the women’s coronary arteries. The development of this early sign of heart disease was 2.5 times higher among the women experiencing chronic discrimination, even after accounting for all other traditional risk factors for heart disease, such as smoking, high blood pressure, high cholesterol, older age and body weight.

Agency for Healthcare Research and Quality research examining disparities of diabetes among minorities found that 10.8 percent of African Americans, 10.6 percent of Mexican Americans, and 9.0 percent of American Indians have diabetes, compared with 6.2 percent of whites. And complications and deaths ran as much as 50% higher among minorities. Even when other risk factors for diabetes are controlled for, such as obesity, Blacks are more than twice as likely as whites to be diagnosed with diabetes, according to the most recent Boston Public Health Commission study.

The Centers for Disease Control and Prevention analyzed data from the National Center for Health Statistics' National Vital Statistics System and found that the incidences and deaths from cancers were higher among minorities. Prostate cancer deaths, for example, were twice as high for blacks as whites and while death rates from lung and bronchus cancers decreased among other groups it increased about 2% a year among American Indians/Alaska Natives. In a 2005 analysis of disparities for heart disease and stroke, the CDC reported that minorities were much more likely to have risk factors such as high cholesterols, high blood pressures and diabetes than Caucasions. But a closer examination of the risks found it was a lower level of education and annual income, possible correlations with stigma and status, that was associated with a doubling of their risks over those with higher education and economic status.

Health problems clearly have many causes and contributing factors, but stereotypes about certain populations color our interpretations of them and their health problems. “Those people” are often perceived as stupid, lazy and lacking self control, and assumed to not be taking responsibility to eat right, etc....

When that stigma itself might just be their greatest health risk factor.

© 2007 Sandy Szwarc

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