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Jennifer Nelson, M.S., R.D. and Katherine Zeratsky, R.D.
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Jennifer Nelson, M.S., R.D. and Katherine Zeratsky, R.D.
Katherine Zeratsky and Jennifer Nelson
Jennifer K. Nelson, M.S., R.D., L.D., C.N.S.D.
Jennifer Nelson is your link to a better diet. As specialty editor of the Food & Nutrition Center, she plays a vital role in bringing you healthy recipes and meal planning."Nutrition is one way people have direct control over the quality of their lives," she says. "I hope to translate the science of nutrition into ways that people can select and prepare great-tasting foods that help maintain health and treat disease."
A St. Paul, Minn., native, she is certified by the National Board of Nutrition Support Certification, has been with Mayo Clinic since 1978, and is director of clinical dietetics and an associate professor of nutrition at Mayo Clinic College of Medicine.
She leads clinical nutrition efforts for a staff of more than 50 clinical dietitians and nine dietetic technicians and oversees staffing, strategic and financial planning, and quality improvement. Nelson was co-editor of the James Beard Foundation Award-winning "The New Mayo Clinic Cookbook." She has been a contributing author to and reviewer of many Mayo Clinic books, including "Mayo Clinic Healthy Weight for EveryBody," "The Mayo Clinic Family Health Book" and "The Mayo Clinic/Williams Sonoma Cookbook." She contributes to the strategic direction of the Food & Nutrition Center, which includes creating recipes and menus, reviewing nutrition content of various articles, and answering nutrition questions posed to Ask a Specialist.
Katherine Zeratsky, R.D., L.D.
As a specialty editor for the Food & Nutrition Center, Katherine Zeratsky helps you sort through the facts and figures, the fads and the hype to learn more about nutrition and diet.A Marinette, Wis., native, she is certified in dietetics by the state of Minnesota and the American Dietetic Association. She has been with Mayo Clinic since 1999.
She is active in nutrition-related curriculum and course development in pediatrics at Mayo Clinic Rochester and nutrition education related to the physiology and recommended intakes for premature infants.
Other areas of interest include breast milk and formula safety, neonatal feeding, and nutrition for breast-feeding mothers.
She graduated from the University of Wisconsin-Madison, served a dietetic internship at the University of Iowa Hospitals and Clinics, and worked as a registered dietitian and health risk counselor at ThedaCare of Appleton, Wis., before joining the Mayo Clinic staff.
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Sept. 6, 2008
Study finds evidence of obesity stigma
By Jennifer Nelson, M.S., R.D. and Katherine Zeratsky, R.D.
Sensitive topic ahead.
I need to state right up front that it is not my intent to offend anyone. Instead, I share my thoughts in the spirit of openness and concern. I also hope that by doing so that each of you who decides to respond will also share your views in a caring and constructive fashion.
There is an interesting study in the July 2008 "International Journal of Obesity" whose objective was to develop a tool that would measure and compare biases that we all have to varying degrees.
A clarification is called for here. "Bias" according to my on-line thesaurus is also known as: prejudice, partiality, unfairness, preconceived notion, foregone conclusion. The study also is up front in stating that they use the terms bias and prejudice interchangeably.
What? We all have prejudice? Sure we do — and to varying degrees. I personally have a strong bias against violence. We all have preconceptions and both tolerance and intolerance for any number of issues. These feelings can be weak or strong.
This study developed a tool that could be used to measure bias, and to also rank biases from being a strong bias relative to others that are weaker. The three targets of bias that were chosen to measure and compare were: obesity, homosexuality, and Muslims. Why did they choose these targets? The authors chose these three because each are widely known minority groups — and like it or not, they are documented targets of discrimination.
What emerged was that that there was strongest prejudice against obesity, followed next by bias against homosexuals, and then against Muslims. (If you wish to see the statistical details and strengths of the rankings you may access the using the link below.)
Laws and other protective policies have been put into place over the years to discourage — even punish — discrimination against race, gender, sexual orientation, and religion. It is pointed out that there is widespread documented evidence of weight bias in employment, educational, interpersonal — and yes — in medical settings. However unlike these other targets, no laws or protective policies are in place to discourage or punish bias against obesity.
The study concludes that weight bias is significantly stronger than bias against homosexuals and Muslims. It also concludes that much more research is needed in the area of prejudice and its causes and solutions.
For now, at the least, don't you think social advocacy is needed to decrease the disproportionate attitude — and acceptance — of bias toward obese individuals? The authors — and I — applaud the efforts and progress made in protecting other minority groups against prejudice and discrimination. And, I also agree with the authors that "it is unacceptable that the obesity stigma is still so pervasive, strong and under recognized."
What are your feelings?
- Jennifer
41 comments posted
November 18, 2009 1:39 a.m.
Watch the DVD "Food.Inc ". It will change the way you see the food you eat every day.
- Paula
November 16, 2009 2:21 p.m.
In all honesty, I can see both sides of this issue. I was a fit child and I never had issues with my weight until I was about 11 years old and moved away from my childhood home and friends. I wasn't accepted at my new school and sat home isolated, eating to feel better. I gained about 40 lbs that year. Once I moved back to my home of origin and reconnected with my friends, off the weight came. Since then I have battled off and on with my weight. In the last year, I have lost over 80 lbs, and while I know I'll never be the size I was at my "thinnest" I know that I had to get honest about the choices I was making in regard to food and why I was eating the way I was eating. Yes, the world treats the obese harshly, and I don't agree with it. On the same token, I don't agree with allowing poor life choices to affect the lives and health of others. I have seen obese parents feed obese children piles of junk food, an increase of children with type 2 diabetes and high blood pressure because of low activity and poor diet. I don't believe in perpetuating an unattainable body size or that "thinner is better", but I do believe that I am personally responsible for my behavior and my choices and what behaviors I model to my children. If I choose to eat the wrong things for the wrong reasons and not take care of myself, I alone am responsible and can blame no one but myself. All people should be treated with respect and dignity, but there needs to be a realistic look at
- Carla
August 13, 2009 2:22 p.m.
I am biased against obese people not because of their physical appearance but because of the behavioral implications of their being obese. The sight of an obese person is physically disgusting. But there are other things that are also disgusting, like picking your nose in public. What are the behavioral implications of being obese? -Obese people do not have self-control -Obese people do not have discipline -Obese people are indulgent I think these behaviours are the reason most people are biased against obese persons. Being obese implies these behaviours.
- charles
August 12, 2009 8:20 a.m.
I firmly believe that obesity is a choice. People choose to watch The Bachelor rather than to exercise everyday. People choose to eat that deliciously wrapped grease filled double cheeseburger rather than a turkey sandwhich with a banana. Everything in your life is a choice. You choose your profession, outfit, car, house and weight. Those who say they exercise everyday and are 300lbs+ are kidding themselves. I am not bias towards those who are obese but I hate hearing that obesity is a disease and they are the victim. Cancer is a disease, obesity is a choice. If obese people were an okay thing, they wouldnt be called obese people...they would be called people. I am 5'1 and 110lbs and I choose everyday to exercise and to eat foods because they are good for my body, not for my taste buds.
- No name given
August 3, 2009 7:02 a.m.
I work in the health care field as a nurse and every day I see the severe consequences of overindulgance. Yes, I admit I am biased against obese people. Why should I have to hurt my back trying to turn a morbidly obese patient who is too fat to turn themselves? I loathe to care for fat patients, in fact, I pity them. Of course I am coridial to them, even respectful. But secretly, I despise them. I have even gotten injured on the job because of an obese patient! I was on disability for awhile. Weight bias is real. And with the ever increasing amount of obese Americans, I'm sure the bias will continue to grow.
- Eve
July 17, 2009 11:16 a.m.
Interesting, and unsurprising. The observation that bias against the obese is stronger than that against other stigmatized groups probably reflects, in addition to cultural norms, the vested interest that taxpayers have in the issue. Because of the health problems/risks associated with obesity, it is not simply an 'alternate lifestyle,' but a public health problem with the potential for a profound effect on healthcare costs if it reaches large enough proportions (no pun intended). The data, and all the talk of an 'obesity epidemic' suggest that it has. While a person's size and shape are influenced by hereditary factors, the recent rapid increase in the prevalence of obesity indicates that the role of these factors in the 'epidemic' is likely modest at best, and perhaps negligible. This doesn't make it right, of course, to treat obese people badly or punish them for their obesity, but it is equally wrong, at least on the level of public health, to simply ignore their problem. Smoking might be considered a relatively comparable issue; no one (except smokers) opposes extra taxes on cigarettes, bans on smoking in certain places, etc., but taxes on fattening food (so-called 'fat taxes') are seen as stigmatizing. Clearly, a balance needs to be struck, and the facts regarding this issue need to be discussed with candor if any progress is to be made.
- No name given
July 1, 2009 11:00 a.m.
I have struggled all of my life to lose weight. I have tried evrything under the sun but the weight doesn't come off. A few years ago I worked a 12 hour shift on my feet all day and on my days off I took care of my infant granson. There was no time for myself, no time to exercise.I WAS FAT AND STILL AM FAT! I developed cellulitus in my left leg. After about 3 days of suffering I went to a clinic. A doctor who came into the examining room to confirm the PA's diagnosis spent the better part of the visit lecturing me on my weight. I had no idea that the cellulitus would blister the next day. Noone bothered to tell me that the cellulitus could develop into something far worse, AND COULD LEAD TO LYMPHOEDEMA, AMPUTATION, OR DEATH if I did not take care of it, They didn't say one word about staying home from work, nor how to care for the condition if it started to blister! I was in tears as I left the clinic,and don't ever want to go back. I felt like a victim of the worst kind of bias, and it could have effected the course of my life. Sadly,many other people across the nation including myself have the same bias. I do not like looking at fat people,and I hate looking in the mirror at myself. This country needs to evaluate the importance of preventive care including making it mandatory that insurance companies cover treatments to stop extreme obesity.
- maryl
June 15, 2009 9:01 p.m.
If people would just open there minds and be realistic, they would see that obese individuals are no different and have the same feelings as any skinny "perfect" person. Fat people have emotions too! I am An obese american.
- Lisa
May 27, 2009 12:21 p.m.
It will be hard to combat the prejudices as long as the medical profession continues to stigmatize weight. More and more evidence comes out every day indicating that: -- research that finds correlation between weight and health do not demonstrate causation; -- when such research controls for other factors that may affect health, the contribution of weight itself diminishes; -- dieting does not work in the long term, because the body has mechanisms to maintain a stable weight; -- because the body interprets reduced calories as starvation and tries to compensate, dieting has been shown to actually increase the amount of weight gained later; -- studies comparing "overweight" people who have dieted versus those who never have, show that dieting is worse than simply maintaining one's natural weight -- weight only makes any serious contribution to problems such as heart disease and diabetes if the person is at the extremes of weight (high or low) Let's remove the glasses of prejudice so we can see clearly.
- sylva
May 12, 2009 1:22 a.m.
I have struggled with my weight my entire life. I was a chubby child, who slimmed down (but not enough for everyone else!) to a size 11. However, my father's side of the family has a strong propensity to weight problems, and since college, even with "fasting" diets, I have never gotten below a size 18. While doing this, I was walking six miles a day, swimming two hours a day, and lifting weights. I hiked, too. I felt great. Then one day my husband and I were at a beach. We were sitting having drink at some tables when some kids who'd been drinking came along and sat next to us, crowding us and making us feel uncomfortable. My husband asked if I wanted to leave. "I guess, since some people don't even ask to share our table," I replied. "Don't talk. It makes you look fat," one of the young guys said. That was it. I was never going to meassure up, even though my blood pressure, etc., all said I was healthy. I'm about to finish graduate school, and I can tell you prejudice is real. A friend with weight issues and I have been repeatedly passed over for positions here. Although I am trying to be healthy again, I feel as though I am fighting a losing battle. Thin people will never understand. They fit society's mold, while I never can without bariatric surgery.
- JA
April 6, 2009 9:10 a.m.
Dear Jennifer It was interesting to read your comments. At present I am completing a dissertation on obeisty stigma and the impact this can have on a persons identity and psychological wellbeing. As you already mentioned each of us has our own prejudices and at times make incorrect or unfair judgement on others. Although our judgements are often made from our experiences, values and beliefs we still have the power to change them. As an obese person myself I am ashamed to admit my own past experience of obesity stigma seemed to have been internalised and I myself have been prejucide against obese people including myself. Ofcourse social hatred and self hate become the same thing, eventually they can leave a person feeling rejected, unloved and socially isolated. Low self worth and unmangeable emotions can often lead to binge eating as a way of coping and in my opinion can become an addictive behaviour. I feel it is extremely important for anyone who experiences stigatization to have someone who can listen and understand. Someone with whom you can talk through your feelings without being judged. Perhaps if people thought and understood why they are prejudice against others and what affect this may have on the individual there perceptions may change. In the future I would like to see this subject researched more and see support groups set up just they are for any other form of addition. I would also like to see more individuals prosecuted for obesity predjudice
- Amanda T
January 24, 2009 12:08 p.m.
I am not obese, in fact I have been acused of being anorexic most my life... I am not. I just have to say that I am being judged everyday. Everyone is. Wether it be your shoes to the shirt you're wearing or your weight. You can't just sit back and assume someone is going to "take control" and fix it for you. You are the the one who has to make the change in yourself! If you're healthy, thats all that matters! Don't let someones elses narrow-mindedness stand in the way of your confidence and well being! I would also like to say that skinny does not always equal healthy. Skinny should not be the goal, healthy and happy should be. Everyones body is different. If we all sang the same note in the choir, we would never have harmony.
- m
January 15, 2009 11:40 p.m.
The government should not be involved in any manner whatsoever in trying to solve this bias. Government action will not change the bias. It will merely force it to change. Not only that, the government has not right to begin to persecute what is going on in your head.
- Grozet
September 16, 2008 11:54 p.m.
I have severe asthma and other health issues, including a blood clotting disorder and have spent seven of tee last fourteen days in an area university medical hospital. When I was released, after having an oxygen saturation level of 88%, my sister, who is a nurse, called to see if they had a diagnosis. I told her, I had a hard time breathing because of neighbor's burning garbage outside and she said, "You have tftb!" I said what is that? She said,"You are too fat to breathe." I am on 40 mgs. of prednisone, along with three corticosteroids and lost almost 100 pounds. Since being on the steroids, I have regained 40 pound and now weigh 347 pounds. I remember being in 7th grade and playing basketball, volleyball, softball and walking a mile to swim at the town pool--and I weighed 200 pounds--in 7th grade. One kid teased me and said "You are fat." I said, I can lose weight, what will you do with your lack of intelligence?" He never teased me again. It is very hard trying to lose weight when on many medications but my current doctors have been very supportive. The nurses at the old office would make comments about trying to lose five pounds. I finally said something about how disheartening it is to her them wine about five pounds when I have been trying to lose over a hundred pounds for most of my life. People in the medical profession need to be our allies in the fight against fat--not the ones belittling us.
- Lisa
September 14, 2008 6:49 p.m.
I am the first to admit that I have an obesity bias, and that it partly applies to myself. When I finished high school eight years ago, I was approximately 40 pounds heavier than I am now, and during the journey of these past eight years, I have sufffered with bulimia, anorexia, and all around low body image because I have this horrible fear of being overweight. I was told by my gym and "health" teachers in high school that I was overweight or even obese, and I am still haunted by those terms. I firmly believe that this so-called health education, and the media coverage of the so-called obesity epidemic, have contributed not only to the cultural bias against the overweight but also to the increase in the prevalence of eating disorders. Young women and men fear not only being overweight but the *rejection* that comes with it because of the societal bias. I am trying hard to get over my bias because I know what this mentality has done to me, what I have put myself through because of it. I am glad that someone has taken the time to study this bias, and I wish that there were more reports of it in the media so others could become aware of it as well.
- Lisa
September 13, 2008 11:17 a.m.
It makes you feel bad about yourself- everything you do is tied up with your excess weight. So- the study is no surprise to me
- Shelley
September 12, 2008 10:27 a.m.
No news flash here. It's very sad that people feel they can insult you in public and feel they are doing their job to make you wake up and stop eating. For many it's a life long painful struggle, disease, call it what you want. No one says when I grow up I want to be obese. Now that I am in my 50's the cracks don't bother me like they did. Someone once told me they say "take your best shot because I can find something wrong with you too, like a big nose, zit, etc." That may be true but we need to have respect for anyone we encounter, no matter how different. Now when someone is publically insistent on bringing my size to everyone's notice I just say "Thanks for noticing" and walk away cuz gee, So many times I am ignored out there. Seriously, It's a problem of intolerance and you will never get everyone to change their views, but I have found it's most important to value yourself. Then those comments are what they are..ignorance. Now when it works itself into hiring practices...that's when we need to stand up and fight.
- Cheryl
September 11, 2008 4:19 p.m.
We keep hearing that our nation is getting larger. If obesity becomes more the norm, then what will happen to this bias? FYI, there are laws against obesity bias in Michigan and(I believe)Santa Cruz,CA.
- Janelle
September 10, 2008 1:24 p.m.
To the previous poster named Eve: I think it was a terrible stereotypical thing of you to type that Southerners sit on the porch too much, insinuating that they are lazy and do not excercise or move enough. YOU are what this article is all about.....people who are biased! Shame on you!
- Caroline S.
September 10, 2008 12:27 p.m.
It is important to have concrete data on the prevalence of somatic prejudice against the adipose. It is also important to bring in other lines of study as well which can bear on this, particularly from researchers I've heard who indicate that cardiovascular and metabolic health are adversely affected by such things as chronic fear and learned helplessness, which no doubt affect every group which is subjected to social otherization. How much heart disease, diabetes, and other maladies found in the adipose population is secondary not to the fat but to the stimga? I feel that given the data emerging on this, it is time for there to be a far more militant stance against those who practice prejudice on the premise of it being for the recipient's "own good". Such people need to have it put to them that the blood of the people they systematically disenfranchise is on their hands.
- Avery Ray Colter
September 10, 2008 11:32 a.m.
Yes, we are discriminated against and I am afraid it will continue. Even the charts that measure obesity are part of the problem. These charts do not take into consideration your health, your body size or age...they just generalize as do people all to often. Recently I went into a so called physician assistant's office for routine blood work as I had several years ago weight loss surgery for my regular follow-up. The person I saw insulted me to my face and told me I was still too "FAT" (her words) and refused to do the blood work until I had my stomach examined (which has never been done). I told her to go to...that I felt wonderful and I just wanted to make sure my vitamin levels were where they were supposed to be. I reported her to her superiors...and she was "written up" but she still is at the clinic. That is what you need to do for any type of discrimination! Let people know you won't tolerate it and report them. I'm am still considered obese - 5'2, from 285 to now 160 and yes I feel wonderful with no complications and am in wonderful health! It saddens me now that my 12 year old granddaughter is now in trouble at 250+ pounds and it tears my heart out when I hear people make comments..thinking her less of a person, etc. Stand up for those who can't and for yourself! If we start to let people know we won't tolerate their discrimination maybe we'd be better off. Why can't people just be nice, they are not any better than we are and they nee
- Mary
September 10, 2008 10:35 a.m.
It is nice to read an article that confirms what most of us that are labeled obese already know. There are many people who seem to act as if being fat is contagious. As an RN, I have worked with many physicians who treat patients poorly if they are heavy. Many obese people are told their symptoms are because they are overweight, and they are not given the same consideration or testing that would be offered a thinner person. My best advice is to stay away from these types of physicians. Find one who doesn't insist on weighing you every time you visit, and who will actually treat you with the same consideration they would a thinner person. Also,find friends who are true to you no matter what size you are. I have friends in all sizes and shapes. Most people that would discriminate aginst someone heavier than themselves are probably just bitter because they need a cookie.
- Laurie
September 10, 2008 9:15 a.m.
I have struggled with my weight all my life. Years ago I joined Weight Watchers and lost 50 pounds. All of a sudden, I was Miss Popularity! How sad that people only liked me when I was thin, because now that I gained the weight back, I'm no longer recognized as a worthy or even sane person. "How could she let herself go again?" I ask myself the same question every single day, but I truly believe that I am a 'body type'. It's like my body wants to be the weight that I am. A lot of those thin model type girls are very miserable because they are absolutely hungry. There are so many hungry people in the third world countries. We, in North America, are rivileged to have sufficient food around us. Every one of my relatives and ancestors is or was overweight, which proves the genetic link to obesity. I go to the gym a few times per week and I know that I am very fit, despite being overweight. I am also perfectly healthy at 5'2 1/2" and 215 lbs, just ask my doctor! I take no medications yet at age 55 and I believe that if I continue to eat healthy food and exercise that I will stay healthy.
- Inge
September 10, 2008 8:31 a.m.
Good Morning; I read your article with interest. I think we all have our own opinions as to why obesity is on the rise, and that looking at heriditary as a major factor is an old concept. It is true to a certain extent. I lived in Europe for three years and my father was from Sicily, My mother from Panama. My whole family was on the thin side. I weighed in at 100 pounds as a corpman in the Navy, only to have them ply me with all kinds of milk shakes and hi caloric foods, all to no avail. I beleive that Italians and Spanish are more prone to obesity than other groups. I beleive that Southerns tend to eat to much greasy foods, to little exercise sitting on the porch etc etc. I started putting on weight after a hysterectomy at age 60. Was on premrinfor 30 years, and still on low dose. I still didn't think 135 pounds for a 5'2" young lady who jogged and ran 10ks, was to much. But then my childhood asthma kicked me, and a DTP findings, thrombi,COPD, led to many many many medicines. I now sit at 160 pounds at age 78. I have tried all sorts of dietary ads, no luck. My doctors do not say a word, and ignore me when I tell them I think I need to lose weight. I still exercise when I can. I know I would feel much better at 15 lbs less. Thanks for listening. ciao Eve
- Eva C. Oldham
September 10, 2008 4:43 a.m.
I feel as I always feel. I grew up almost thin, was voted everything in high school, college, etc. and modeled some. Then, my husband left me with our dying son with cystic fibrosis. I ate constantly, day and night. My son had to have 3000 to 4000 calories to exist. I ate with him, without him. I just ate. I gained about 50 lbs. Now, at my age, if I lose much, I'll look even worse. Ah, but the abuse I take from doctors, groups, even church members. I was even laughed at by a minister when I mentioned dating. I have a high IQ and have held top positions in DC and other places, but that matters not. I'm fat. That colors my whole life and will probably affect whether I get the medical attention I need when the time comes.
- mary ann
41 comments posted