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Diabetes Developments - A blog on latest developments in diabetes by David Mendosa

Social Costs of Weight

January 24th, 2009 · No Comments

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Those of us who have diabetes pay a physical cost for it that we know all too well. But many of us aren’t aware of the social cost that we pay for being overweight, which usually accompanies our diabetes.

Fat prejudice is even more subtle than our society’s racial and gender biases and those against and gays and lesbians. Our most recent prejudice, of course, is that against those of the Muslim faith from the Middle East, and that prejudice is anything but subtle. Now, however, social scientists know how to measure fat prejudice.

If being prejudged by others for being fat weren’t bad enough, fat people even dislike themselves for it. Many fat people in the fat acceptance crowd will deny that fact, and we do need to accept ourselves as we are before we can change ourselves for the better.

I had come to accept myself as a fat person, but at some deep level I did not like being fat, and I was a different person then than I am now. No longer a fat person, my personality has changed. I keep surprising myself with my new self-confidence and how I am now able to reach out much more to other individuals and groups of people.

As a journalist for a good part of my long life — even long before I started to specialize in writing about diabetes — I interviewed thousands of people. I preferred to talk with them on the phone to in person. Sure, calling them is more efficient than driving there, although you don’t get any feeling for their milieu, which is important for feature articles.

The advantage for me of telephoning the people I wrote about was that they couldn’t see me. So I didn’t feel self-conscious.

My guess is that most of you structure your life is comparable ways. You may say that diabetes itself has its own social costs, and I agree and have written about those costs. But I think that the social costs of being overweight are even greater.

Diabetes and being overweight are so closely linked that many people believe that one condition causes the other. But in my second book, Losing Weight with Your Diabetes Medication: How Byetta and Other Drugs Can Help You Lose More Weight than You Ever Thought Possible, I devote a whole chapter, “Why Diabetes Doesn’t Make You Fat,” to showing that instead both conditions come from a common cause.

It’s true that almost everyone who has type 2 diabetes is overweight. Our government’s statistics show that 85 percent of all American adults with diabetes are overweight. But those statistics include the 5 to 10 percent of people with diabetes who have type 1, and type 1s are seldom overweight. This means that 90 to 95 percent of all type 2s in this country are overweight.

I know that I experienced fat prejudice not only from myself but also from others. At one point in my life I was a foreign service officer serving in the American Embassy in Blantyre, Malawi, as the head of the American aid program to that country. At that time the foreign service divided its annual personnel evaluations into two parts. The employee saw one part, but the other part went straight to his or her personnel file, where panels used it to make their promotion recommendations.

When the American ambassador to Malawi evaluated me one year, he wrote nothing but nice things about me in the report that he showed me and that I had to sign. But in the report that I couldn’t see he wrote something to the effect that, “Mendosa would be more effective if he lost a few pounds.”

I know this, because a few years later our government became a bit more transparent. It declassified those confidential reports and gave us copies of them.

I experienced fat prejudice. You almost certainly have too.

Now, researchers have figured out clever ways of determining if and where fat prejudice exists. Researchers led by Eugene Caruso, assistant professor of behavioral science at the University of Chicago, have now shown that people can have fat prejudices that they deny having. Their article, “Using conjoint analysis to detect discrimination: Revealing covert preferences from overt choices,” is scheduled to appear in next month’s issue of Social Cognition.

These researchers borrowed the technique of conjoint analysis from the field of marketing research, adapting it to study our prejudices in realistic situations so that we can directly quantify these prejudices. The term “conjoint” refers to evaluating options together, rather than in isolation. This nifty technique can ask the people in their studies to rate products by several important attributes. For example, researchers could ask study participants to rate what they like about TV sets by screen size, brands, and price.

But how important are each of these criteria? By systematically varying these attributes, marketing researchers can do a much better job of measuring how much each attribute is worth. Then, the researchers can figure out how much more people would be willing to pay for one attribute to get what they want.

The experiment that Professor Caruso led asked 101 students to imagine playing a game with with team mates to win money — and to rate for success in the exercise. The profiles of those team mates showed three aspects of their personality that correlated with success — educational level, IQ, and their previous experience with the game. And, oh, yes the profiles just happened to include photos of the potential team mates showing whether they were fat or thin. They manipulated the same face to appear overweight or thin while otherwise making as little change as possible.

When the researchers asked the students which of these factors was least important, they said that it was the weight of the potential team mates. The kicker, however, was that their actual decisions showed otherwise. Weight counted heavily.

“Although participants stated explicitly that weight had little impact on their decisions,” the study says, “weight actually accounted for more than 25 percent of the variance in their revealed preferences.” In fact, the participants were willing to trade off about half of the potential IQ range of team mates to get thin ones on their team.

Were the students lying? Probably not.

Professor Caruso and his associates think that the disparity between stated and revealed preferences in their study “stems in part of people’s inability to have full knowledge of the own minds.” Preferences for thin over fat are so subtle that they are hidden even from ourselves. I wouldn’t be surprised if future studies would show that even obese people prefer those who are thin.

If it were not for The Economist magazine of January 17, I probably would never have heard of this research. That magazine’s article, “The price of prejudice,” brought this important study to my attention.

But yesterday I wrote Professor Caruso, who immediately sent me a PDF of his forthcoming article, which I have now studied as well. I base my discussion above on both the magazine’s cogent summary and the full-text of the research study.

This research may sound like bad news for the vast majority of people with diabetes who are overweight. It isn’t, and if it were I wouldn’t be writing about it.

Race, sex, sexual preferences, and whether a person is from the Middle East are fixed attributes. No one can change them.

Our society must wipe out these aspects of old, tribal thinking. In our lifetimes we have already come farther than humans ever did in all of the countless generations before us. The changes in this country within the past half century have been greater than all of the social changes in recorded human history.

Those changes can and will continue until we overcome all of that outmoded thinking. Those changes may not come in our lifetimes. But we must control our weight now.

Just as our society has changed and will continue to evolve, we as individuals need to change our way of relating to food. Yes, losing weight is awfully difficult. From my many failed attempts before I started using Byetta and then went on a very low-carb diet, I know that all too well.

But we have these two great tools now, so we can go from being obese to slim. This is one aspect of our personality that we can change.

This is a mirror of one of my articles that Health Central published. You can navigate to that site to find my most recent articles.

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Posted in: Psychosocial

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