Skip to main content
SpringerLink
Log in

Attributing discrimination to weight: associations with well-being, self-care, and disease status in patients with type 2 diabetes mellitus

  • Published:
Journal of Behavioral Medicine Aims and scope Submit manuscript

Abstract

This study examined the association between attributing self-reported discrimination to weight and diabetes outcomes (glycemic control, diabetes-related distress, and diabetes self-care). A community dwelling sample of 185 adults (mean age 55.4; 80 % White/Caucasian 65 % female) with poorly controlled type 2 diabetes (HbA1c level ≥7.5 %) provided demographic and several self-report measures (including diabetes-related distress, diabetes self-care activities, discrimination, and attributions of discrimination), and had height, weight, and glycated hemoglobin (HbA1c) assessed by trained research staff as part of a larger research study. Individuals who attributed self-reported discrimination to weight had significantly higher HbA1c levels, higher levels of diabetes-related distress, and worse diabetes-related self-care behaviors (general diet, exercise, and glucose testing). These relationships persisted even when controlling for BMI, overall discrimination, depressive symptoms, and demographic characteristics. Results indicate that the perception of weight stigma among individuals with type 2 diabetes is strongly associated with a range of poor diabetes outcomes. Efforts to reduce exposure to and/or teach adaptive coping for weight stigma may benefit patients with type 2 diabetes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Andreyeva, T., Puhl, R. M., & Brownell, K. D. (2008). Changes in perceived weight discrimination among Americans, 1995–1996 through 2004–2006. Obesity, 16, 1129–1134.

    Article  PubMed  Google Scholar 

  • Bell, J. A., Kivimaki, M., & Hamer, M. (2014). Metabolically healthy obesity and risk of incident type 2 diabetes: A meta-analysis of prospective cohort studies. Obesity Reviews, 15, 504–515.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Berg, A. O., Melle, I., Rossberg, J. I., Romm, K. L., Larsson, S., Lagerberg, T. V., et al. (2011). Perceived discrimination is associated with severity of positive and depression/anxiety symptoms in immigrants with psychosis: A cross-sectional study. BMC Psychiatry, 11, 77–85. doi:10.1186/1471-244X-11-77

    Article  PubMed Central  PubMed  Google Scholar 

  • Berry, J. D., Dyer, A., Cai, X., Garside, D. B., Ning, H., Thomas, A., et al. (2012). Lifetime risks of cardiovascular disease. New England Journal of Medicine, 366, 321–329.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Bhattacharya, G. (2012). Self-management of type 2 diabetes among African Americans in the Arkansas Delta: A strengths perspective in social-cultural context. Journal of Health Care for the Poor and Underserved, 23, 161–178.

    Article  PubMed  Google Scholar 

  • Brooks, R. J., & Roxburgh, S. (1999). Gender differences in the effect of the subjective experience of diabetes and sense of control on distress. Health, 3, 399–420.

    Google Scholar 

  • Browne, J. L., Ventura, A., Mosely, K., & Speight, J. (2013). ‘I call it the blame and shame disease’: A qualitative study about perceptions of social stigma surrounding type 2 diabetes. BMJ Open, 3, e003384.

    Article  PubMed Central  PubMed  Google Scholar 

  • Budd, G. M., Mariotti, M., Graff, D., & Falkenstein, K. (2011). Health care professionals’ attitudes about obesity: An integrative review. Applied Nursing Research, 24, 127–137.

    Article  PubMed  Google Scholar 

  • Centers for Disease Control and Prevention. (2014). Defining overweight and obesity. Retrieved from http://www.cdc.gov/obesity/adult/defining.html

  • Ciechanowski, P. S., Katon, W. J., Russo, J. E., & Hirsch, I. B. (2003). The relationship of depressive symptoms to symptom reporting, self-care and glucose control in diabetes. General Hospital Psychiatry, 25, 246–252.

    Article  PubMed  Google Scholar 

  • Cosansu, G., & Erdogan, S. (2014). Influence of psychosocial factors on self-care behaviors and glycemic control in Turkish patients with type 2 diabetes mellitus. Journal of Transcultural Nursing, 25, 51–59.

    Article  PubMed  Google Scholar 

  • Durso, L. E., & Latner, J. D. (2008). Understanding self-directed stigma: Development of the Weight Bias Internalization Scale. Obesity, 16, S80–S86.

    Article  PubMed  Google Scholar 

  • Essed, P. (1991). Understanding everyday racism: An interdisciplinary theory. Newbury Park, CA: SAGE Publications.

    Google Scholar 

  • Finch, B. K., Kolody, B., & Vega, W. A. (2000). Perceived discrimination and depression among Mexican-Origin adults in California. Journal of Health and Social Behavior, 41, 295–313.

    Article  CAS  PubMed  Google Scholar 

  • Foster, M. D. (2009). Perceiving pervasive discrimination over time: Implications for coping. Psychology of Women Quarterly, 33, 172–182. doi:10.1111/j.1471-6402.2009.01487.x

    Article  Google Scholar 

  • Foster, G. D., Wadden, T. A., Makris, A. P., Davidson, D., Sanderson, R. S., Allison, D. B., & Kessler, A. (2003). Primary care physicians’ attitudes about obesity and its treatment. Obesity Research, 11, 1168–1177.

    Article  PubMed  Google Scholar 

  • Friedman, M. A., & Brownell, K. D. (1995). Psychological correlates of obesity: Moving to the next research generation. Psychological Bulletin, 117, 3–20.

    Article  CAS  PubMed  Google Scholar 

  • Furukawa, S., Fujita, T., Shimabukuro, M., Iwaki, M., Yamada, Y., Nakajima, Y., et al. (2004). Increased oxidative stress in obesity and its impact on metabolic syndrome. Journal of Clinical Investigation, 114, 1752–1761.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Gaede, R., Vedel, P., Larsen, N., Jensen, G. V. H., Parving, H. H., & Pedersen, O. (2003). Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. New England Journal of Medicine, 348, 383–393.

    Article  PubMed  Google Scholar 

  • Garber, A. J. (2012). Obesity and type 2 diabetes: Which patients are at risk? Diabetes, Obesity & Metabolism, 14, 399–408.

    Article  CAS  Google Scholar 

  • Grabe, S., & Hyde, J. S. (2006). Ethnicity and body dissatisfaction among women in the United States: A meta-analysis. Psychological Bulletin, 132, 622–640. doi:10.1037/0033-2909.132.4.622

    Article  PubMed  Google Scholar 

  • Greene, M. L., Way, N., & Pahl, K. (2006). Trajectories of perceived adult and peer discrimination among Black, Latino, and Asian American adolescents: Patterns and psychological correlates. Developmental Psychology, 42, 218–236.

    Article  PubMed  Google Scholar 

  • Grollman, E. A. (2014). Multiple disadvantaged statuses and health the role of multiple forms of discrimination. Journal of Health and Social Behavior, 55, 3–19. doi:10.1177/0022146514521215

    Article  PubMed  Google Scholar 

  • Grover, S. A., Kaouache, M., Rempel, P., Joseph, L., Dawes, M., Lau, D. C. W., & Lowensteyn, I. (2014). Years of life lost and healthy life-years lost from diabetes and cardiovascular disease in overweight and obese people: A modeling study. Lancet Diabetes Endocrinology,. doi:10.1016/S2213-8587(14)70229-3. Advanced online publication.

    PubMed  Google Scholar 

  • Hebl, M. R., Xu, J., & Mason, M. F. (2003). Weighing the care: Patients’ perceptions of physician care as a function of gender and weight. International Journal of Obesity, 27, 269–275.

    Article  CAS  PubMed  Google Scholar 

  • Henderson, J., Wilson, C., Roberts, L., Munt, R., & Crotty, M. (2014). Social barriers to type 2 diabetes self-management: The role of social capital. Nursing Inquiry, 21, 336–345.

    Article  PubMed  Google Scholar 

  • Hernandez, R., Ruggiero, L., Riley, B. B., Wang, Y. M., Chavez, N., Quinn, L. T., et al. (2014). Correlates of self-care in low-income African American and Latino patients with diabetes. Health Psychology, 33, 597–607.

    Article  PubMed Central  PubMed  Google Scholar 

  • Huynh, Q.-L., Devos, T., & Dunbar, C. M. (2012). The psychological costs of painless but recurring experiences of racial discrimination. Cultural Diversity and Ethnic Minority Psychology, 18, 26–34.

    Article  PubMed Central  PubMed  Google Scholar 

  • Inzucchi, S. E., Bergenstal, R. M., Buse, J. B., Diamant, M., Ferrannini, E., Nauck, M., et al. (2012). Management of hyperglycemia in type 2 diabetes: A patient-centered approach. Diabetes Care, 35, 1364–1379.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Kessler, R. C., Mickelson, K. D., & Williams, D. R. (1999). The prevalence, distribution, and mental health correlates of perceived discrimination in the United States. Journal of Health and Social Behavior, 40, 208.

    Article  CAS  PubMed  Google Scholar 

  • LeBron, A. M. W., Valerio, M. A., Kieffer, E., Sinco, B., Roseland, A. M., Hawkins, J., et al. (2014). Everyday discrimination, diabetes-related distress, and depressive symptoms among African American and Latinos with diabetes. Journal of Immigrant and Minority Health, 16(6), 1208–1216.

    Article  PubMed  Google Scholar 

  • Lewis, T. T., Yang, F. M., Jacobs, E. A., & Fitchett, G. (2012). Racial/ethnic differences in responses to the Everyday Discrimination Scale: A differential item functioning analysis. American Journal of Epidemiology, 175, 391–401.

    Article  PubMed Central  PubMed  Google Scholar 

  • Lopez, J. M. S., Bailey, R. A., Rupnow, M. F. T., & Annunziata, K. (2014). Characterization of type 2 diabetes mellitus burden by age and ethnic groups based on a nationwide survey. Clinical Therapeutics, 36, 494–506.

    Article  PubMed  Google Scholar 

  • Minichiello, V., Browne, J., & Kendig, H. (2000). Perceptions and consequences of ageism: Views of older people. Ageing and Society, 20, 253–278.

    Article  Google Scholar 

  • Ostbye, T., Taylor, D. H., Yancy, W. S., & Krause, K. M. (2005). Associations between obesity and receipt of screening mammography, papanicolaou tests, and influence vaccination: Results from the Health and Retirement Study (HRS) and the Asset and Health Dynamics Among the Oldest Old (AHEAD) Study. American Journal of Public Health, 95, 1623–1630.

    Article  PubMed Central  PubMed  Google Scholar 

  • Pandit, A. U., Bailey, S. C., Curtis, L. M., Seligman, H. K., Davis, T. C., Parker, R. M., et al. (2014). Disease-related distress, self-care and clinical outcomes among low-income patients with diabetes. Journal of Epidemiology and Community Health, 68, 557–564.

    Article  PubMed  Google Scholar 

  • Pascoe, E., & Smart Richman, L. (2009). Perceived discrimination and health: A meta-analytic review. Psychological Bulletin, 135, 531–554.

    Article  PubMed Central  PubMed  Google Scholar 

  • Patel, A., MacMahon, S., Chalmers, J., Neal, B., Billot, L., Woodward, M., et al. (2008). Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. New England Journal of Medicine, 358, 2560–2572.

    Article  CAS  PubMed  Google Scholar 

  • Pearl, R. L., & Dovidio, J. F. (2014). Experiencing weight bias in an unjust world: Impact on exercise and internalization. Health Psychology,. doi:10.1037/hea0000178. Advance online publication.

    Google Scholar 

  • Peek, M. E., Wagner, J., Tang, H., Baker, D. C., & Chin, M. H. (2011). Self-reported racial discrimination in health care and diabetes outcomes. Medical Care, 49, 618–625.

    Article  PubMed Central  PubMed  Google Scholar 

  • Polonsky, W. H., Anderson, B. J., Lohrer, P. A., Welch, G., Jacobson, A. M., Aponte, J. E., & Schwartz, C. E. (1995). Assessment of diabetes-related distress. Diabetes Care, 18, 755–760.

    Article  Google Scholar 

  • Powell, A. D., & Kahn, A. S. (1995). Racial differences in women’s desires to be thin. International Journal of Eating Disorders, 17, 191–195.

    Article  CAS  PubMed  Google Scholar 

  • Puhl, R. M., & Brownell, K. D. (2001). Bias, discrimination, and obesity. Obesity Research, 9, 788–805.

    Article  CAS  PubMed  Google Scholar 

  • Puhl, R. M., & Heuer, C. A. (2009). The stigma of obesity: A review and update. Obesity, 17, 941–964.

    Article  PubMed  Google Scholar 

  • Radloff, L. S. (1977). The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401.

    Article  Google Scholar 

  • Schmitt, M. T., Branscombe, N. R., Postmes, T., & Garcia, A. (2014). The consequences of perceived discrimination for psychological well-being: A meta-analytic review. Psychological Bulletin, 140, 921–948.

    Article  PubMed  Google Scholar 

  • Stojek, M. M. K., & Fischer, S. (2013). Thinness expectancies and restraint in Black and White college women: A prospective study. Eating Behaviors, 14, 269–273. doi:10.1016/j.eatbeh.2013.03.005

    Article  PubMed  Google Scholar 

  • Strutz, K. L., Herring, A. H., & Halpern, C. A. (2015). Health disparities among young adult sexual minorities in the U.S. (2015). American Journal of Preventive Medicine, 48, 76–88.

    Article  PubMed  Google Scholar 

  • Taylor, T. R., Williams, C. D., Makambi, K. H., Mouton, C., Harrell, J. P., Cozier, Y., et al. (2007). Racial discrimination and breast cancer incidence in U.S. black women. American Journal of Epidemiology, 166, 46–54.

    Article  PubMed  Google Scholar 

  • Teixeira, M. E., & Budd, G. M. (2010). Obesity stigma: A newly recognized barrier to comprehensive and effective type 2 diabetes management. Journal of the American Academy of Nurse Practitioners, 22, 527–533.

    Article  PubMed  Google Scholar 

  • Thorand, M., Baumert, J., Kolb, H., Meisinger, C., Chambless, L., Koekig, W., & Herder, C. (2007). Sex differences in the prediction of type 2 diabetes by inflammatory markers—Results from the MONICA/KORA Augsburg case-cohort study, 1984–2002. Diabetes Care, 30, 854–860.

    Article  CAS  PubMed  Google Scholar 

  • Toobert, D. J., Hampson, S. E., & Glascow, R. E. (2000). The summary of diabetes-self-care activities measure—Results from 7 studies and a revised scale. Diabetes Care, 23, 943–950.

    Article  CAS  PubMed  Google Scholar 

  • Vartanian, L. R., Pinkus, R. T., & Smyth, J. M. (2014). The phenomenology of weight stigma in everyday life. Journal of Contextual Behavioral Science, 3, 196–202.

    Article  Google Scholar 

  • Vartanian, L. R., & Smyth, J. M. (2013). Primum non nocere: Obesity stigma and public health. Bioethical Inquiry, 10, 49–57.

    Article  PubMed  Google Scholar 

  • Wagner, J. A., Tennen, H., Feinn, R., & Finan, P. H. (2013). Racial discrimination and metabolic control in women with type 2 diabetes. Ethnicity and Disease, 23, 421–427.

    PubMed  Google Scholar 

  • Wagner, J. A., Tennen, H., Feinn, R., & Osborn, C. Y. (2015). Self-reported discrimination, diabetes distress, and continuous blood glucose in women with type 2 diabetes. Journal of Immigrant and Minority Health, 17, 566–573.

    Article  PubMed Central  PubMed  Google Scholar 

  • Wardian, J., & Sun, F. (2014). Factors associated with diabetes-related distress: Implications for diabetes self-management. Social Work in Health Care, 53, 364–381.

    Article  PubMed Central  PubMed  Google Scholar 

  • Watson, D., & Pennebaker, J. W. (1989). Health complaints, stress, and distress: Exploring the central role of negative affectivity. Psychological Review, 96, 234–254.

    Article  CAS  PubMed  Google Scholar 

  • Welch, G. W., Jacobson, A. M., & Polonsky, W. H. (1997). The problem areas in diabetes scale. Diabetes Care, 20, 760–766.

    Article  CAS  PubMed  Google Scholar 

  • Wilding, J. P. H. (2014). The importance of weight management in type 2 diabetes mellitus. International Journal of Clinical Practice, 68, 682–691.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Williams, D. R., & Mohammed, S. A. (2009). Discrimination and racial disparities in health: Evidence and needed research. Journal of Behavioral Medicine, 32, 20–47.

    Article  PubMed Central  PubMed  Google Scholar 

  • Williams, D. R., Neighbors, H. W., & Jackson, J. S. (2003). Racial/ethnic discrimination and health: Findings from community studies. American Journal of Public Health, 93, 200–208.

    Article  PubMed Central  PubMed  Google Scholar 

  • Wyatt, S. B., Winters, K. P., & Dubbert, P. M. (2006). Overweight and obesity: Prevalence, consequences, and causes of a growing public health problem. American Journal of Medical Science, 331, 166–174.

    Article  Google Scholar 

Download references

Acknowledgments

This work was supported by NIH Grant NCCAM AT-247701.

Author information

Authors and Affiliations

  1. Department of Biobehavioral Health, The Pennsylvania State University, State College, PA, 16802, USA

    Lindsey Potter, Jan Ulbrecht, Vanessa Juth & Joshua Smyth

  2. Vanderbilt University, Nashville, TN, USA

    Kenneth Wallston

  3. SUNY Upstate Medical University, Syracuse, NY, USA

    Paula Trief

  4. Mount Nittany Health, State College, PA, USA

    Jan Ulbrecht

Authors
  1. Lindsey Potter
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kenneth Wallston
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Paula Trief
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jan Ulbrecht
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Vanessa Juth
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Joshua Smyth
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joshua Smyth.

Ethics declarations

Conflict of interest

Lindsey Potter, Kenneth Wallston, Paula Trief, Jan Ulbrecht, Vanessa Juth and Joshua Smyth declare that they have no conflict of interest.

Human and animal rights and Informed Consent

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all patients for being included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Potter, L., Wallston, K., Trief, P. et al. Attributing discrimination to weight: associations with well-being, self-care, and disease status in patients with type 2 diabetes mellitus. J Behav Med 38, 863–875 (2015). https://doi.org/10.1007/s10865-015-9655-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10865-015-9655-0

Keywords

Search

Navigation