Obesity stigma weighs more than pounds | Health weight

People with obesity, a condition that affects about 30% of the Spanish population, live with one of the existing diseases that has the greatest impact on physical and mental health. The health problems this entails are often coupled with social pressures that those suffering from other chronic diseases such as diabetes or hypertension do not suffer – an additional burden that leads to discriminatory attitudes that sometimes begin very early age.

The lack of information about the many factors influencing the development of obesity, the imposed Apollonian image model and the preconceived notions that many have about this pathology have turned it into one of the most commonplace and socially stigmatized health problems. experts note. What weighs more: the kilos or the stigma and the psychological impact it entails? “One of the things that patients repeat most is that they want to stop feeling judged or discriminated against,” explains Carmen Grau, psychologist and researcher at the Foundation for the Promotion of Health and Biomedical Research of the Valencian Community (Fisabio).

The National Bariatric Association Hispalis continues to receive reports of discrimination, some of which are traumatic. “Do you know what it means for a young person to be turned away from a nightclub because of your weight, or when you go skiing and they tell you that fat people don’t ski, that there are no clothes for them? President Victoria Buiza asks her.

Kilograms make you invisible

Federico Luis Moya faced this harsh social stigma many times. fatphobia which clearly shows disgust towards obese people. “For years I was invisible to some of my neighbors, they stopped saying hello to me and only started doing so again when I returned to my normal weight,” recalls the 41-year-old man from Santander. Coordination problems he had as a child led him to swim competitively, and at age 13 he was on the verge of competing in the national championships. He was two-tenths away from achieving this goal, and the disappointment he felt at the failure caused him to hang up his hat and swimsuit.

From that moment on, the calories he burned in the pool accumulated in his body. First there was overweight and then obesity, a process that intensified after the cancer that led to the death of his mother ten years later. Moya turned his anxiety into food, and overeating, common among obese people, became normal for him. Sometimes I would have lunch or dinner at work and do it again at home. “In my shelter, in my room, every night I ate 18 donuts and two liters of Coca-Cola. “So, from Monday to Sunday.” Result: 183 kilograms. At 183 centimeters tall, his body mass index (BMI) was 54. This index is used in diagnosing the disease and is obtained by dividing weight by height in meters squared. Over 30 is considered obese.

The alarm bell rang in his head six years later. “I got up to go to work and had to wake up my dad to tie his shoes.” In 2014, he underwent bariatric surgery at the Marqués de Valdecilla hospital in Santander and now weighs 90 kilograms when he steps on the scale. The end result is a success and it may seem that obesity is a thing of the past, but Moya is very clear that the disease he suffers from is a chronic condition with many factors involved and it will always be with him. “Yes, I have lost weight, but I can gain it back. I know, as doctors told me, that the stomach is the only organ that expands but does not contract.”

Resilience as therapy

Estefania Villanueva (Malaga, 1978) lived with obesity all her life. Her excess weight made her an easy target for bullies during her early years of school and high school. According to numerous studies, this happens to many children. Research from the Complutense University of Madrid (UCM) in 2023 shows that physical appearance, especially being overweight, is directly linked to bullying. 10% of obese students consider themselves victims of bullying.

Villanueva endured this random abuse until he was 15 years old, at which age everything changed due to a confluence of factors. She was influenced by messages of support from her parents and new friends who paid attention to everything but her pounds. And above all, he tuned into an inner strength that made him appreciate the many qualities he possessed. “I found success by developing social skills and abilities that people already felt, such as friendliness and the ease of making friends, and weight was no longer a barrier.”

Fatphobic comments and silences (looks, stares), as eloquent as words, have not gone away, but Villanueva has learned to live with them using resilience, the ability to confront something that bothers us without dragging us down emotionally. With the people she helps in her practice as a psychologist at the Vitaly Salud clinic and in Dvitas, she tries to increase their resilience with one goal: “that obesity is a physical health problem, but does not become a mental health problem.” At the same time, they are referred to a specialist who will help them lose weight.

Throughout her life, the rather tall Villanueva (173 centimeters) had periods of normal weight. He now weighs 113 kilograms and is again in the process of losing weight, motivated by the belief that “obesity is a health problem associated with pathologies such as diabetes or cancer, and therefore a normal weight is not something to please others ” He insists on a different message to his patients, based on his personal experience: “I have always avoided isolation, it is very important to have a quality social network to avoid loneliness, sadness and hopelessness.”

Psychological attention

Psychologist Carmen Grau confirms that the tools her professional colleague uses work for many people. He tests this every day at the Dr. Peseta Hospital in Valencia, where he is conducting research to evaluate how psychological support can help obese people change their habits – a process in which the social environment in which they operate is also important. especially. Researcher Fisabio notes that “although progress is being made in the right direction, the belief remains that the sole responsibility for weight lies with the patient himself. This is contrary to what the scientific evidence shows: obesity is a much more complex phenomenon.”

The environment can also make a decisive contribution to combating the stigmatizing clichés associated with this disease, which are reflected in numerous studies. A 2023 survey by the Spanish Society for the Study of Obesity (SEEDO) shows that unfounded platitudes about this pathology reach a wide variety of areas. “There are studies that show that 50% of obese people feel stigmatized in the workplace because they are viewed as lazy or lacking self-control,” explains Carmen Grau.

According to Victoria Buiza, the SEEDO survey shows that being overweight “continues to cause dissatisfaction in large sections of society.” The problem, he adds, is that “messages and attitudes that discriminate against someone based on their appearance go so deep that often the obese person believes them and ends up blaming themselves for being overweight.”

In such cases, Carmen Grau reminds her patients that “opinions reflect the person who expresses them, and do not speak about the person they intend to disqualify.” Downplaying comments is a good strategy, but sometimes more is required. “A person’s self-concept can be very damaged, and such a situation requires psychological help,” says the researcher.

The psychological distress caused by social stigma can lead those who suffer from it to become socially isolated. This is common, for example, in cases of bullying. This is why it is so important to consult a psychologist as soon as possible. “If we act early, we will significantly improve their emotional well-being and prevent their mental health from deteriorating and leading to depression, for example,” says Carmen Grau.

Humanized care

The clinical recommendations include the importance of having psychologists in multidisciplinary teams, a historic demand from patient associations that is part of the increasingly important humanization of care that is set to transform the health system, according to experts.

Report Humanizing social and medical care for people living with obesity (HASPO), unveiled last year, also includes this initiative, in addition to others aimed at eradicating stigma for good. One requires medical facilities and infrastructure tailored to patients with this condition, and the other requires something as basic as ensuring they have the appropriate size gown when they enter the center to maintain their privacy.

Victoria Buiza notes in this regard that “although these recommendations may seem obvious, they are very important because often in a consultation the patient is told to sit in a chair, but he cannot do this because he does not.” doesn’t fit into it.” Although such situations are common, they are unjustified, experts say and point to the need to implement protocols with specific measures that step by step change social and medical care for people with obesity.

Focusing on interventions to address the stigma of obesity is key to preventing, minimizing and better managing the emotional consequences it entails. It also has another effect, which Carmen Grau points out: “It facilitates adherence to disease treatment and improves the prognosis of many health problems associated with obesity (cardiovascular, metabolic, joint…).” The task of providing comprehensive care to people with obesity requires the involvement of health professionals, as well as changes in attitudes towards them. “We pay a lot of attention to society, but WHO conducted a study that showed that 70% of people felt stigmatized by health workers. It is important to recognize that this needs to change and go in a different direction,” concludes Carmen Grau.