Perceived Weight Discrimination and 10-Year Risk of Allostatic Load Among US Adults
- 516 Downloads
Discrimination promotes multisystem physiological dysregulation termed allostatic load, which predicts morbidity and mortality. It remains unclear whether weight-related discrimination influences allostatic load.
The aim of this study was to prospectively examine 10-year associations between weight discrimination, allostatic load, and its components among adults 25–75 years in the Midlife Development in the US Biomarker Substudy.
Participants with information on weight discrimination were analyzed (n=986). At both timepoints, participants self-reported the frequency of perceived weight discrimination across nine scenarios as “never/rarely” (scored as 0), “sometimes” (1), or “often” (2). The two scores were averaged and then dichotomized as “experienced” versus “not experienced” discrimination. High allostatic load was defined as having ≥3 out of 7 dysregulated systems (cardiovascular, sympathetic/parasympathetic nervous systems, hypothalamic pituitary axis, inflammatory, lipid/metabolic, and glucose metabolism), which collectively included 24 biomarkers. Relative risks (RR) were estimated from multivariate models adjusted for sociodemographic and health characteristics, other forms of discrimination, and BMI.
Over 41% of the sample had obesity, and 6% reported weight discrimination at follow-up. In multivariable-adjusted analyses, individuals who experienced (versus did not experience) weight discrimination had twice the risk of high allostatic load (RR, 2.07; 95 % CI, 1.21; 3.55 for baseline discrimination; 2.16, 95 % CI, 1.39; 3.36 for long-term discrimination). Weight discrimination was associated with lipid/metabolic dysregulation (1.56; 95 % CI 1.02, 2.40), glucose metabolism (1.99; 95 % CI 1.34, 2.95), and inflammation (1.76; 95 % CI 1.22, 2.54), but no other systems.
Perceived weight discrimination doubles the 10-year risk of high allostatic load. Eliminating weight stigma may reduce physiological dysregulation, improving obesity-related morbidity and mortality.
KeywordsObesity stigma Weight discrimination Allostatic load Allostasis Dysregulation Weight stigma
This work was supported by the NHLBI (grant numbers HL49086, HL60692). Funding was also provided by a Mentored Career Development Award to Promote Faculty Diversity in Biomedical Research from the NHLBI (J.M., grant number K01-HL120951), and an NIH Ruth L Kirschstein Postdoctoral Fellowship (M.V., grant number 5 T32 DK 7703-19). NIH had no role in the design, analysis, or writing of this article.
Compliance with Ethical Standards
Authors’ Statement of Conflict of Interest and Adherence to Ethical Standards Authors
Maya Vadiveloo and Josiemer Mattei declare that they have no conflict of interest. All procedures, including the informed consent process, were conducted in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000.
- 1.Forouzanfar MH, Alexander L, Anderson HR, et al.: Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015.Google Scholar
- 6.Goffman E.: Stigma: notes on the Management of Spoiled Identity. Englewood Cliffs: Prentice-Hall, 1963.Google Scholar
- 7.Allport GW.: The nature of prejudice. Cambridge, MA: Addison-Wesley, 1954.Google Scholar
- 11.Potter L, Wallston K, Trief P, et al.: Attributing discrimination to weight: associations with well-being, self-care, and disease status in patients with type 2 diabetes mellitus. J Behav Med. 2015.Google Scholar
- 20.Sikorski C, Luppa M, Luck T, Riedel-Heller SG: Weight stigma "gets under the skin"-evidence for an adapted psychological mediation framework: A systematic review. Obesity (Silver Spring). 2015, 23:266–276.Google Scholar
- 24.Tsenkova VK, Carr D, Schoeller DA, Ryff CD: Perceived weight discrimination amplifies the link between central adiposity and nondiabetic glycemic control (HbA1c). Ann Behav Med. 2011, 41:243–251.Google Scholar
- 26.Upchurch DM, Stein J, Greendale GA, et al.: A longitudinal investigation of race, socioeconomic status, and psychosocial mediators of allostatic load in midlife women: findings from the study of women's health across the nation. Psychosom Med. 2015, 77:402–412.CrossRefPubMedPubMedCentralGoogle Scholar
- 34.Almeida DM: National Survey of Midlife Development in the United States (MIDUS I) National Study of Daily Experiences (NSDE), 1996–1997. Inter-university Consortium for Political and Social Research (ICPSR) [distributor], 2015.Google Scholar
- 37.Ryff CD, Seeman T, Weinstein M: National Survey of Midlife Development in the United States (MIDUS II): Biomarker Project, 2004–2009. Inter-university Consortium for Political and Social Research (ICPSR) [distributor], 2013.Google Scholar
- 38.Mattei J, Bhupathiraju S, Tucker KL: Higher adherence to a diet score based on American Heart Association recommendations is associated with lower odds of Allostatic load and metabolic syndrome in Puerto Rican adults. The Journal of Nutrition. 2013, 143:1753–1759.CrossRefPubMedPubMedCentralGoogle Scholar
- 41.Fang J: Using SAS Procedures FREQ, GENMOD, LOGISTIC, and PHREG to Estimate Adjusted Relative Risks - A Case Study. SAS Global Forum 2011 Statistics and Data Analysis. 2011.Google Scholar
- 45.Barboza Solis C, Kelly-Irving M, Fantin R, et al.: Adverse childhood experiences and physiological wear-and-tear in midlife: findings from the 1958 British birth cohort. Proc Natl Acad Sci. 2015, 112:E738–746.Google Scholar