Obesity & Mental Health in the Workplace
- Liz Birdie Ong Shi Yun
The Pandemic of Obesity
Obesity is a grave public health concern of pandemic proportions – with global prevalence nearly tripling between 1975 and 2016 (1). A chronic condition on the level of other chronic illnesses such as type 2 diabetes, coronary artery disease (CAD), and a wide variety of cancers, obesity also often occurs in combination with many of these diseases and fuels each other in a vicious cycle. The simplest and most useful population-wide estimate of being overweight or obese is the Body Mass Index (BMI), though that has been long known to be only a crude measure and not an accurate representation of the individual degree of obesity and health (1).
The Impacts of Obesity-Associated Stigma
However, obesity has an additional unique challenge that many other invisible chronic diseases (such as CAD) do not face – stigmatisation from society. Weight stigma has been shown to permeate multiple domains in society: the workplace, healthcare, educational settings, interpersonal relationships, and the media (2). Obesity is a common reason for school bullying, and the media perpetuates misconceptions that people with obesity are either aggressive or unloved (3).
Impacts on mental health
Obesity-associated stigma can adversely impact mental health. Research has shown that there is a higher prevalence of psychiatric disorders such as depression, anxiety, and eating disorders among people with obesity compared to the general population (4). The relationship between obesity and mental health disorders is bidirectional and incredibly complex, driving each other in a vicious cycle directly and indirectly through poor quality of life, medications, chronic pain, and other comorbidities (4, 5). However, it has also been found in an Austrian population-wide study looking at data from 1997 to 2014 that a diagnosis of obesity significantly more often preceded a psychiatric diagnosis in a wide variety of psychiatric conditions in which obesity was also a co-diagnosis, with the exceptions of eating and personality disorders and psychosis-spectrum disorders (4).
Impacts on healthcare provision
Alarmingly, research has also found that even among healthcare professionals and students, bias towards overweight and obesity is very much a problem (3, 6). This causes those individuals to be erroneously perceived as non-compliant, lazy, and undisciplined, and healthcare professionals may overattribute health problems to obesity and increase the risk of misdiagnoses. My observations during my hospital rotations also showed me that healthcare professionals are trained to deliver care to people of size and stature within normal ranges, and many available hospital facilities and equipment are likewise made and calibrated. These all contribute to compromising the healthcare delivered to individuals with obesity.
Furthermore, such biases and discrimination also not only erect a barrier to seeking treatment and care for fear of unpleasant encounters in clinical settings, but they may also inhibit the successful engagement of patients during clinical consultations and their motivation and drive to implement treatment plans and lifestyle changes due to the fear, shame, and skewed perceptions about themselves and weight management that have been perpetuated by societal stigma (6).
Solutions to Destigmatisation
There is an urgent need for obesity to be recognised as a chronic and relapsing disease (5).
There is much for society to be working on in building living and working environments that prevent the development of obesity but also provide obese individuals with all the unbiased care and support that they need to live a healthy and motivated life free from stigma and discrimination.
Who needs to recognise?
Such change must be implemented in all domains of society, including education on the negative implications of obesity-associated stigma for the media, teachers and educators, workplace managers, and healthcare professionals (3). That includes changes in the beliefs on the end of the patient and individuals in society. The family environment, including parental work schedules and eating habits at home, are critical risk factors in the development of obesity, with other factors, such as social and professional requirements among friends and colleagues, further inhibit successful weight management (5). Patients' success in implementing long-term lifestyle changes requires a strong support network from friends and family and wider society.
What needs to be recognised?
Recognition of the complexity of obesity – as well as the biological, genetic, emotional, psychiatric, personal, and other factors that feed into this vicious cycle that make it a chronic relapsing condition – would also help society in empathising with individuals living with obesity and empowering them in their fight to reach a healthy weight (rather than to reach a number on the weighing scale that conforms to unhealthy standards of beauty).
Additionally, simply learning to consciously look beyond the visible and physical and realising that no matter their height or weight, every individual has a unique story and much knowledge, experience, and insight to offer everyone and the world around them. Indeed, simply asking and listening will unearth many conversational and experiential treasures that would otherwise have been missed because of instinctual barriers set up on first impressions.
What else can be done?
Other things could be done besides education on what needs to be recognised. In clinical settings, change can create a weight-friendly space where clinicians are trained to use appropriate “patient-first” languages and have accommodations such as extra-large patient gowns and larger sofas, needles, speculums, and weighing scales (7).
Appropriate education, as well as policies that do not tolerate any form of humour or depiction of misconceptions about obesity as well as language and practices that may be detrimental to the mental health, care, and work of obese individuals, would also be valuable in improving the culture around obesity in both clinical and employment settings (7).
On an interpersonal level, practical implementations such as language changes used among family and friends can also go a long way. Support can also be accountable partners in maintaining healthy eating and hydration habits, sleeping schedules, and physical activity – such as a “date” with a friend for a jog or swim or regular check-ups to chat about successes and disappointments. The education on and recognition of other supports that are available – such as psychiatric and dietetic supports, motivational and support groups, bariatric surgery, medical treatments (e.g. GLP-1 receptor antagonists like liraglutide and semaglutide (8), and naltrexone/bupropion (9)), as well as a plethora of healthy and empowering media content surrounding this area – can also be instrumental in supporting individuals living with obesity and their family and friends as they walk together on this journey to improving their health and the culture surrounding obesity.
References
1. World Health Organisation (WHO). Obesity and overweight 2021 [updated 9 June 2021. Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight.
2. Spahlholz J, Baer N, König HH, Riedel-Heller SG, Luck-Sikorski C. Obesity and discrimination - a systematic review and meta-analysis of observational studies. Obes Rev. 2016;17(1):43-55.
3. Fulton M, Srinivasan VN. Obesity, Stigma And Discrimination. StatPearls. Treasure Island (FL): StatPearls Publishing
Copyright © 2023, StatPearls Publishing LLC.; 2023.
4. Leutner M, Dervic E, Bellach L, Klimek P, Thurner S, Kautzky A. Obesity as pleiotropic risk state for metabolic and mental health throughout life. Translational Psychiatry. 2023;13(1):175.
5. Kim TN. Barriers to Obesity Management: Patient and Physician Factors. J Obes Metab Syndr. 2020;29(4):244-7.
6. Phelan SM, Burgess DJ, Yeazel MW, Hellerstedt WL, Griffin JM, van Ryn M. Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obes Rev. 2015;16(4):319-26.
7. Ginsburg BM, Sheer AJ. Destigmatizing Obesity and Overcoming Inherent Barriers to Obtain Improved Patient Engagement. StatPearls. Treasure Island (FL): StatPearls Publishing
Copyright © 2023, StatPearls Publishing LLC.; 2023.
8. Xie Z, Yang S, Deng W, Li J, Chen J. Efficacy and Safety of Liraglutide and Semaglutide on Weight Loss in People with Obesity or Overweight: A Systematic Review. Clin Epidemiol. 2022;14:1463-76.
9. le Roux CW, Fils-Aimé N, Camacho F, Gould E, Barakat M. The relationship between early weight loss and weight loss maintenance with naltrexone-bupropion therapy. eClinicalMedicine. 2022;49.