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The Last Bastion for Unbridled Antipathy? Stigmatization of Obese People in Germany

What has Chancellor Angela Merkel in common with her fellow Germans? She is overweight – just like more than half of Germany’s population. About 23 percent of males and females are even obese (adipose).

As in countries with comparable rates the growing number of adipose people has, however, not led to a growing acceptance. In Germany there has been a lack of data on this issue. Recent scientific surveys of the Integrated Research and Treatment Center (IFB) AdiposityDiseases in Leipzig have shown, that obesity might be Germany’s last bastion for prejudices, refusal, and stigmatization.

Especially for the USA diverse studies show negative attitudes toward obese people as well as stigmatization, and discrimination. In Germany the same proved to be true, whereas for other diseases like AIDS or disabilities public discourse and campaigns seem to have led to fewer stigmatizing attitudes.

Scientists of the IFB and the Institute of Social Medicine, Occupational and Public Health (ISAP) have investigated how medical students, hospital staff and the public think about obese people and the causes of overweight. In a Germany-wide representative survey participants attributed adjectives like "lazy" versus "industrious” or "active" versus "inactive" to obese children, adults, and senior citizens as well as to normal weight persons shown in pictures (vignettes with weight data). These attributions were analyzed via the so-called Fat-Phobia-Scale (FPS, Bacon et al).

Prejudices, Stigmatization, and Assignment of Guilt for Obesity
99 percent of the survey participants rated obese people of all ages more negatively than normal weight individuals. Over 20 percent attributed unfavourable features like ”inactive”, “shapeless”, “slow” or “has no willpower” to obese persons. Quite impressively, there is not a single adjective pair that is rated equally over the two vignettes. The age of the participants was not associated with higher stigmatization. Higher education and being overweight led to lower FPS scores. Claudia Sikorski, head of the study underlines that “especially obese children were rated amazingly negative. Although the participants held them less responsible for their overweight, they are subject to more negative attribution than obese adults or senior citizens.” This strong stigmatization can well start a vicious circle of stress-induced and psychological disorders, unhealthy eating and activity behaviours and finally more overweight.

As to the causes of obesity, participants could choose internal ones like overeating or lack of activity versus genetic causes and external reasons such as an obesogenic environment. The more obese people were considered to be responsible for their overweight the more stigmatizing was the attribution of features.

Are Attitudes of Medical Students and Health Care Professionals different? A similar survey with 671 medical students revealed that the percentage of aspiring doctors with negative attitudes is just as high as in the general public. Despite a bigger medical knowledge most students hold obese individuals accountable for excess weight. Birte Pantenburg, who conducted the survey, explains that, “however, 44 percent of the participants stated that fighting the overweight epidemic is equally the individuals’ and the society’s responsibility. A majority would furthermore appreciate a stronger focus on obesity in the medical curriculum.” Today, a broad majority of students and citizens deem obesity to be one of the most important health problems in Germany. In the early 2000s only 2 to 3 percent of the population agreed to that.

Nearly 700 health care professionals of the University Hospital of Leipzig participated in a comparable survey. As observed with psychiatric patients, respondents who have more experience with obese patients displayed less negative views. So did women and overweight health care workers. The questionnaire also contained questions on the work-related impact of adiposity.

Health Care System is not Fit for Obese Patients
A majority of nurses, doctors and therapists underlined that providing health care to obese patients is more difficult and over 60 percent stated that the resources and equipments are insufficient. Public health scientist Claudia Sikorski assumes that “the insufficient hospital equipment and the fear of medical complications lead to a higher reluctance to treat obese patients and to more stigmatizing attitudes.” As with medical students the deeper medical knowledge of hospital staff does not reduce negative attributions and the assignment of responsibility predominantly to the patient. After all, 30 percent see genetic causes as strongly relevant for developing obesity. There is evidence that the quality of health care for obese people has decreased due to stigmatizing and depreciative behaviours toward this group of patients.

The phenomenon of stigmatizing obese people is paradox in many ways: Although the rates of obesity are rising, stigmatization does not decline. Furthermore, stigmatization does not change anything to the good, it does not help us to assess people correctly, and it does not motivate obese individuals to lose weight. Prof. Steffi Riedel-Heller, director of ISAP, therefore, stresses the "importance of integrating the scientific findings in the development of anti-stigma-campaigns and of more appropriate obesity-programs."

The Integrated Research and Treatment Center (IFB) AdiposityDiseases is one of eight IFBs in Germany funded by the Federal Ministry of Education and Research. It is a joint center of the Universität Leipzig and the University Hospital Leipzig. Aim of the IFB’s federal funding is to link research and treatment inter-disciplinarily under one roof, so that the treatment of adipose (obese) patients benefits from scientific findings earlier than usually. Presently, the IFB has about 40 research projects, and for patient care there are two outpatient clinics for obese children and adolescents as well as for adults. The IFB will extend adiposity research and treatment continually in the coming years, it is the national reference center for adiposity.

More information:
Doris Gabel M.A.
Integrated Research and Treatment Center (IFB)
Media and Public Relations
Philipp-Rosenthal-Str. 27
04103 Leipzig, Germany
Phone: + 49 (0)341 / 97-13361
Fax: + 49 (0)341 / 97-15949

Susann Huster | Universität Leipzig
Further information:

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