Skip to main content

Perceived Weight Discrimination Amplifies the Link Between Central Adiposity and Nondiabetic Glycemic Control (HbA1c)

Abstract

Background

While the preclinical development of type 2 diabetes is partly explained by obesity and central adiposity, psychosocial research has shown that chronic stressors such as discrimination have health consequences as well.

Purpose

We investigated the extent to which the well-established effects of obesity and central adiposity on nondiabetic glycemic control (indexed by HbA1c) were moderated by a targeted psychosocial stressor linked to weight: perceived weight discrimination.

Methods

The data came from the nondiabetic subsample (n = 938) of the Midlife in the United States (MIDUS II) survey.

Results

Body mass index (BMI), waist-to-hip ratio, and waist circumference were linked to significantly higher HbA1c (p < 0.001). Multivariate-adjusted models showed that weight discrimination exacerbated the effects of waist-to-hip ratio on HbA1c ( p < 0.05), such that people who had higher waist-to-hip ratios and reported weight discrimination had the highest HbA1c levels.

Conclusion

Understanding how biological and psychosocial factors interact at nondiabetic levels to increase vulnerability could have important implications for public health and education strategies. Effective strategies may include targeting sources of discrimination rather than solely targeting the health behaviors and practices of overweight and obese persons.

This is a preview of subscription content, access via your institution.

Fig. 1

References

  1. 1.

    National Diabetes Surveillance System. Center for Disease Control and Prevention.

  2. 2.

    Narayan KM, Boyle JP, Thompson TJ, Sorensen SW, Williamson DF. Lifetime risk for diabetes mellitus in the United States. JAMA. 2003, 290: 1884–1890.

    PubMed  CAS  Article  Google Scholar 

  3. 3.

    National Diabetes Statistics, 2007 fact sheet. In N. I. o. D. a. D. a. K. Diseases (ed). Bethesda, MD: US Department of Health and Human Services, National Institutes of Health, 2008.

  4. 4.

    Attie AD. Genetic and genomic studies of type 2 diabetes in mice. Int Congr Ser. 2004, 1262: 220–223.

    Article  Google Scholar 

  5. 5.

    Glasgow RE, Wagner EH, Kaplan RM, et al. If diabetes is a public health problem, why not treat it as one? A population-based approach to chronic illness. Ann Behav Med. 1999, 21: 159–170.

    PubMed  CAS  Article  Google Scholar 

  6. 6.

    Netterstrom B, Danborg L, Olesen H. Glycated hemoglobin as a measure of physiological stress. Behav Med. 1988, 14: 13–16.

    PubMed  CAS  Article  Google Scholar 

  7. 7.

    Kawakami N, Araki S, Hayashi T, Masumoto T. Relationship between perceived job-stress and glycosylated hemoglobin in white-collar workers. Ind Health. 1989, 27: 149–154.

    PubMed  CAS  Article  Google Scholar 

  8. 8.

    Norberg M, Stenlund H, Lindahl B, et al.: Work stress and low emotional support is associated with increased risk of future type 2 diabetes in women. Diabetes Res Clin Pract. 2007, 76: 368–377.

    CAS  Article  Google Scholar 

  9. 9.

    Dedert EA, Calhoun PS, Watkins LL, Sherwood A, Beckham JC. Posttraumatic stress disorder, cardiovascular, and metabolic disease: A review of the evidence. Ann Behav Med.

  10. 10.

    Dovidio JF, Major, B., Crocker, J. Stigma: Introduction and overview. In T. F. Heatherton, Neck, R. E., Hebl, M. R., Hill, J. G. (ed). The social psychology of stigma. Guilford, 2000, pp. 1–28.

  11. 11.

    Crandall CS. Ideology and lay theories of stigma: The justification of stigmatization. In T. F. Heatherton, Neck, R. E., Hebl, M. R., Hill, J. G. (ed). The social psychology of stigma. Guilford, 2000.

  12. 12.

    Pearlin LI, Schieman S, Fazio EM, Meersman SC. Stress, health, and the life course: Some conceptual perspectives. J Health Soc Behav. 2005, 46: 205–219.

    PubMed  Article  Google Scholar 

  13. 13.

    Williams DR, Mohammed SA. Discrimination and racial disparities in health: Evidence and needed research. J Behav Med. 2009, 32: 20–47.

    PubMed  Article  Google Scholar 

  14. 14.

    Pascoe EA, Smart Richman L. Perceived discrimination and health: A meta-analytic review. Psychol Bull. 2009, 135: 531–554.

    PubMed  Article  Google Scholar 

  15. 15.

    Barnes LL, de Leon CF, Lewis TT, et al. Perceived discrimination and mortality in a population-based study of older adults. Am J Public Health. 2008, 98: 1241–1247.

    PubMed  Article  Google Scholar 

  16. 16.

    Brondolo E, Rieppi R, Kelly KP, Gerin W. Perceived racism and blood pressure: A review of the literature and conceptual and methodological critique. Ann Behav Med. 2003, 25: 55–65.

    PubMed  Article  Google Scholar 

  17. 17.

    Clark R. Self-reported racism and social support predict blood pressure reactivity in Blacks. Ann Behav Med. 2003, 25: 127–136.

    PubMed  Article  Google Scholar 

  18. 18.

    Matthews KA, Salomon K, Kenyon K, Zhou F. Unfair treatment, discrimination, and ambulatory blood pressure in Black and White adolescents. Health Psychol. 2005, 24: 258–265.

    PubMed  Article  Google Scholar 

  19. 19.

    Kessler RC, Mickelson KD, Williams DR: The prevalence, distribution, and mental health correlates of perceived discrimination in the United States. J Health Soc Behav. 1999, 40: 208–230.

    PubMed  CAS  Article  Google Scholar 

  20. 20.

    Hatzenbuehler ML, Keyes KM, Hasin DS. Associations between perceived weight discrimination and the prevalence of psychiatric disorders in the general population. Obesity (Silver Spring), 2009.

  21. 21.

    Williams DR, Neighbors HW, Jackson JS. Racial/ethnic discrimination and health: Findings from community studies. Am J Public Health. 2008, 98: S29–37.

    PubMed  Google Scholar 

  22. 22.

    Rodin M, Price J, Sanchez F, McElliot S. Derogation, exclusion, and unfair treatment of persons with social flaws: Controllability of stigma and the attribution of prejudice. Pers Soc Psychol Bull. 1989, 15: 439–451.

    Article  Google Scholar 

  23. 23.

    Crandall CS, Martinez, R. Culture, ideology, and antifat attitudes. Pers Soc Psychol Bull. 1997, 22: 1165–1176.

    Article  Google Scholar 

  24. 24.

    Puhl RM, Andreyeva T, Brownell KD. Perceptions of weight discrimination: Prevalence and comparison to race and gender discrimination in America. Int J Obes (Lond). 2008, 32: 992–1000.

    PubMed  CAS  Article  Google Scholar 

  25. 25.

    Puhl RM, Heuer CA. The stigma of obesity: A review and update. Obesity (Silver Spring). 2009, 17: 941–964.

    Article  Google Scholar 

  26. 26.

    Puhl R, Brownell KD. Bias, discrimination, and obesity. Obes Res. 2001, 9: 788–805.

    PubMed  CAS  Article  Google Scholar 

  27. 27.

    Bray GA, Jablonski KA, Fujimoto WY, et al. Relation of central adiposity and body mass index to the development of diabetes in the Diabetes Prevention Program. Am J Clin Nutr. 2008, 87: 1212–1218.

    PubMed  CAS  Google Scholar 

  28. 28.

    Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA. 2003, 289: 76–79.

    PubMed  Article  Google Scholar 

  29. 29.

    Surwit RS, Feinglos MN, Livingston EG, Kuhn CM, McCubbin JA. Behavioral manipulation of the diabetic phenotype in ob/ob mice. Diabetes. 1984, 33: 616–618.

    PubMed  CAS  Article  Google Scholar 

  30. 30.

    Alam T, Weintraub N, Weinreb J. What is the proper use of hemoglobin A1c monitoring in the elderly? J Am Med Dir Assoc. 2005, 6: 200–204.

    PubMed  Article  Google Scholar 

  31. 31.

    Edelman D, Olsen MK, Dudley TK, Harris AC, Oddone EZ. Utility of hemoglobin A1c in predicting diabetes risk. J Gen Intern Med. 2004, 19: 1175–1180.

    PubMed  Article  Google Scholar 

  32. 32.

    Muntner P, Wildman RP, Reynolds K, et al. Relationship between HbA1c level and peripheral arterial disease. Diabetes Care. 2005, 28: 1981–1987.

    Article  Google Scholar 

  33. 33.

    Vitelli LL, Shahar E, Heiss G, et al. Glycosylated hemoglobin level and carotid intimal–medial thickening in nondiabetic individuals. The Atherosclerosis Risk in Communities Study. Diabetes Care. 1997, 20:1454–1458.

    CAS  Article  Google Scholar 

  34. 34.

    Diagnosis and classification of diabetes mellitus, Diabetes Care, 2010 Jan;33 Suppl 1:S62-69.

  35. 35.

    Fried LP, Kronmal RA, Newman AB, et al. Risk factors for 5-year mortality in older adults: The Cardiovascular Health Study. JAMA. 1998, 279: 585–592.

    PubMed  CAS  Article  Google Scholar 

  36. 36.

    Love GD, Seeman TE, Weinstein M, Ryff CD. Bioindicators in the MIDUS National Study: Protocol, measures, sample, and comparative context. J Aging Health. 2010, 22(8):1059–1080.

    Google Scholar 

  37. 37.

    Zander R, Lang W, Wolf HU. Alkaline haematin D-575, a new tool for the determination of haemoglobin as an alternative to the cyanhaemiglobin method. I. Description of the method. Clin Chim Acta. 1984, 136: 83–93.

    PubMed  CAS  Article  Google Scholar 

  38. 38.

    Wolf HU, Lang W, Zander R. Alkaline haematin D-575, a new tool for the determination of haemoglobin as an alternative to the cyanhaemiglobin method. II. Standardisation of the method using pure chlorohaemin. Clin Chim Acta. 1984, 136: 95–104.

    PubMed  CAS  Article  Google Scholar 

  39. 39.

    National Heart, Lung and Blood Institute: Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in adults: The Evidence Report. Bethesda (MD): NIH Publication: National Institute of Health, 1998.

    Google Scholar 

  40. 40.

    Williams DR, Yu Y, Jackson JS, Anderson NB. Racial differences in physical and mental health: Socioeconomic status, stress and discrimination. J Health Psychol. 1997, 2: 335–351.

    Article  Google Scholar 

  41. 41.

    Ridgeway C. Interaction and the conservation of gender inequality: Considering employment. Am Sociol Rev. 1997, 62.

  42. 42.

    Boltri JM, Okosun IS, Davis-Smith M, Vogel RL. Hemoglobin A1c levels in diagnosed and undiagnosed Black, Hispanic, and White persons with diabetes: Results from NHANES 1999–2000. Ethn Dis. 2005, 15: 562–567.

    PubMed  Google Scholar 

  43. 43.

    Nuttall FQ. Effect of age on the percentage of hemoglobin A1c and the percentage of total glycohemoglobin in non-diabetic persons. J Lab Clin Med. 1999, 134: 451–453.

    PubMed  CAS  Article  Google Scholar 

  44. 44.

    Carey VJ, Walters EE, Colditz GA et al. Body fat distribution and risk of non-insulin-dependent diabetes mellitus in women. The Nurses’ Health Study. Am J Epidemiol. 1997, 145: 614–619.

    PubMed  CAS  Google Scholar 

  45. 45.

    Sattar N, Preiss D, Murray HM, et al. Statins and risk of incident diabetes: A collaborative meta-analysis of randomised statin trials. Lancet. 375: 735–742.

  46. 46.

    Ivy JL. Role of exercise training in the prevention and treatment of insulin resistance and non-insulin-dependent diabetes mellitus. Sports Med. 1997, 24: 321–336.

    PubMed  CAS  Article  Google Scholar 

  47. 47.

    Pereira MA, Kartashov AI, Ebbeling CB, et al. Fast-food habits, weight gain, and insulin resistance (the CARDIA study): 15-year prospective analysis. Lancet. 2005, 365: 36–42.

    PubMed  Article  Google Scholar 

  48. 48.

    Haire-Joshu D, Glasgow RE, Tibbs TL. Smoking and diabetes. Diabetes Care. 1999, 22: 1887–1898.

    CAS  Article  Google Scholar 

  49. 49.

    Cappuccio FP, D'Elia L, Strazzullo P, Miller MA. Quantity and quality of sleep and incidence of type 2 diabetes: A systematic review and meta-analysis. Diabetes Care. 2009.

  50. 50.

    Andreyeva T, Puhl RM, Brownell KD. Changes in perceived weight discrimination among Americans, 1995–1996 through 2004–2006. Obesity (Silver Spring). 2008, 16: 1129–1134.

    Article  Google Scholar 

  51. 51.

    Amy NK, Aalborg A, Lyons P, Keranen L. Barriers to routine gynecological cancer screening for White and African–American obese women. Int J Obes (Lond). 2006, 30: 147–155.

    PubMed  CAS  Article  Google Scholar 

  52. 52.

    Prentice AM, Jebb SA. Beyond body mass index. Obes Rev. 2001, 2: 141–147.

    PubMed  CAS  Article  Google Scholar 

  53. 53.

    Relationship of body size and shape to the development of diabetes in the diabetes prevention program. Obesity (Silver Spring). 2006, 14: 2107–2117.

  54. 54.

    Snijder MB, Visser M, Dekker JM, Seidell JC: Re: “Changes in body weight and body fat distribution as risk factors for clinical diabetes in US men”. Am J Epidemiol. 2004, 160:1133–1134; author reply 1134–1135.

    PubMed  Article  Google Scholar 

  55. 55.

    Seidell JC, Han TS, Feskens EJ, Lean ME. Narrow hips and broad waist circumferences independently contribute to increased risk of non-insulin-dependent diabetes mellitus. J Intern Med. 1997, 242: 401–406.

    PubMed  CAS  Article  Google Scholar 

  56. 56.

    Frayn KN. Adipose tissue as a buffer for daily lipid flux. Diabetologia. 2002, 45: 1201–1210.

    PubMed  CAS  Article  Google Scholar 

  57. 57.

    Black PH. The inflammatory consequences of psychologic stress: Relationship to insulin resistance, obesity, atherosclerosis and diabetes mellitus, type II. Med Hypotheses. 2006, 67: 879–891.

    PubMed  CAS  Article  Google Scholar 

  58. 58.

    McGarry JD. Banting lecture 2001: Dysregulation of fatty acid metabolism in the etiology of type 2 diabetes. Diabetes. 2002, 51: 7–18.

    PubMed  CAS  Article  Google Scholar 

  59. 59.

    Puhl RM, Brownell KD. Confronting and coping with weight stigma: An investigation of overweight and obese adults. Obesity (Silver Spring). 2006, 14: 1802–1815.

    Article  Google Scholar 

  60. 60.

    Schwartz MB, Chambliss HO, Brownell KD, Blair SN, Billington C. Weight bias among health professionals specializing in obesity. Obes Res. 2003, 11: 1033–1039.

    PubMed  Article  Google Scholar 

  61. 61.

    Foster GD, Wadden TA, Makris AP, et al. Primary care physicians’ attitudes about obesity and its treatment. Obes Res. 2003, 11: 1168–1177.

    PubMed  Article  Google Scholar 

  62. 62.

    Link B, Phelan J. Conceptualizing stigma. Ann Rev Sociol. 2001, 27.

Download references

Acknowledgements

This research was supported by a grant from the National Institute on Aging (P01-AG020166; Carol D. Ryff, Principal Investigator) to conduct a longitudinal follow-up of the MIDUS (Midlife in the US) investigation. The original study was supported by the John D. and Catherine T. MacArthur Foundation Research Network on Successful Midlife Development. We thank the staff of the Clinical Research Center at the University of Wisconsin—Madison, at the University of California—Los Angeles, and at Georgetown University for their support in conducting this study. Data collection was supported by the following grants M01-RR023942 (Georgetown), M01-RR00865 (UCLA) from the General Clinical Research Centers Program, and 1UL1RR025011 (UW) from the Clinical and Translational Science Award (CTSA) program of the National Center for Research Resources, National Institutes of Health. The first author of this study was also supported, in part, by award number T32HD049302 from the Eunice Kennedy Shriver National Institute of Child Health And Human Development. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Eunice Kennedy Shriver National Institute of Child Health and Human Development or the National Institutes of Health.

Conflicts of interest

The authors have no financial disclosures related to products or corporate holdings mentioned in this manuscript.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Vera K. Tsenkova Ph.D..

About this article

Cite this article

Tsenkova, V.K., Carr, D., Schoeller, D.A. et al. Perceived Weight Discrimination Amplifies the Link Between Central Adiposity and Nondiabetic Glycemic Control (HbA1c). ann. behav. med. 41, 243–251 (2011). https://doi.org/10.1007/s12160-010-9238-9

Download citation

Keywords

  • Diabetes
  • Weight discrimination
  • Obesity
  • Individual differences