Individuals with obesity often encounter challenges in relationships, employment, and health, but a recent study published in Psychological Science has found that the severity of these issues can depend on where they live. The research found that in regions where obesity is more common, the associated social and health difficulties are less pronounced. These findings suggest that societal attitudes and cultural norms surrounding obesity may play a significant role in shaping its consequences.
Obesity is a global health challenge, with prevalence rates doubling worldwide since 1990. Today, over one in four adults in Europe and one in three adults in the United States live with obesity. Alongside well-documented health risks such as cardiovascular disease and mental health struggles, individuals with obesity often face social stigma, discrimination, and economic disadvantages. They are more likely to experience unstable relationships, unemployment, and social exclusion, compounding the health burdens of the condition.
The researchers aimed to explore whether these consequences vary based on the local prevalence of obesity. The underlying theory suggests that societal biases and stigmatization tend to target traits that deviate from the norm. If obesity is more common in a region, it may be viewed as less unusual, potentially reducing the discrimination and negative stereotypes associated with it.
“Obesity affects many people, particularly in the Western world – and it has severe consequences for those affected. Our project originated from the fact that obesity rates greatly vary between and within countries,” said study author Jana Berkessel, a researcher at the Mannheim Centre for European Social Research at the University of Mannheim.
“For example, in the United States, there are some regions where roughly 50% of the population are living with obesity, while in other regions only about 5% of the population are living with obesity. It is quite easily imaginable that persons with obesity in regions with low obesity rates stick out much more and, therefore, will make very different social experiences on an everyday basis.”
The researchers used data from over 3.4 million individuals across the United States and United Kingdom. The study was divided into three parts, examining regional variations in obesity’s consequences and the role of societal attitudes.
Study 1 utilized data from the Behavioral Risk Factor Surveillance System, a large-scale, nationwide survey conducted in the United States. This dataset included responses from 2.8 million participants across more than 2,400 counties. Participants provided self-reported information about their weight, height, relationship status, employment, and general health. By linking these individual responses to regional obesity rates, the researchers could assess how the consequences of obesity differed depending on the local prevalence of the condition.
Study 2 replicated the analysis using data from the BBC Lab in the United Kingdom, a similarly large-scale survey but with notable differences in regional cultural contexts. This dataset included 180,000 participants from 378 districts, offering a cross-national perspective on how regional obesity prevalence impacts personal outcomes.
Study 3 extended the findings by combining U.S. data with insights from Project Implicit, a large-scale initiative measuring explicit weight bias. Explicit weight bias refers to openly expressed stereotypes and prejudices toward individuals with obesity, such as the assumption that they are lazy or undisciplined. This final study aimed to understand whether regional variations in weight bias could explain why the consequences of obesity were less severe in some areas than others.
To measure regional obesity prevalence, the researchers calculated the proportion of individuals with a body mass index (BMI) of 30 or higher within each region. Regional obesity prevalence was then analyzed alongside explicit weight bias scores to determine their influence on the social, economic, and health outcomes reported by participants.
The findings revealed that, across both nations, individuals with obesity generally faced more challenges in relationships, employment, and health compared to their non-obese counterparts. However, the extent of these challenges varied significantly by region.
In regions where obesity prevalence was low, individuals with obesity were more likely to be single compared to those without obesity. For example, in the United States, people with obesity in counties with low obesity prevalence were 1.2 times more likely to be single than their non-obese peers. Conversely, in counties with high obesity prevalence, this disparity disappeared or even reversed, with individuals with obesity slightly less likely to be single than their non-obese counterparts.
Health challenges associated with obesity, such as reporting poor general health, also exhibited regional variation. In low-obesity regions, individuals with obesity were over four times more likely to report poor health compared to their non-obese peers. However, in high-obesity regions, this likelihood was reduced to 1.5 times. While health disparities were still present, their reduced severity in high-obesity areas highlights the potential mitigating effect of cultural norms and societal acceptance on perceived or reported health outcomes.
The researchers found that explicit weight bias was lower in regions where obesity was more prevalent. This reduced bias partially explained why the social and health consequences of obesity were less severe in those areas. For instance, in high-obese regions, the likelihood of being single or reporting poor health was mediated by lower levels of weight bias.
“Across the two datasets we found that obesity has adverse consequences – in the social, economic, and health domain – but that these consequences were less severe in some regions,” Berkessel told PsyPost. “For me, this means, that at least some of the adverse consequences of obesity appear socially construed and, thus, can be reduced. Just to give an example, one way to change society’s views of obesity may be through a more true-to-life representation of different body sizes in the media.”
However, employment outcomes for individuals with obesity were less influenced by regional obesity prevalence. In both the United States and the United Kingdom, individuals with obesity were consistently more likely to be unemployed than those without obesity, regardless of local obesity rates and weight bias. This suggests that factors beyond regional attitudes may contribute to these persistent disparities.
The study highlights important regional variations in the consequences of obesity, but it has limitations. First, the data are primarily from Western countries, and the findings may not generalize to non-Western cultures with different attitudes toward obesity. Second, the study’s cross-sectional design does not establish causality. It is unclear whether living in high-obese regions reduces the impact of obesity or whether individuals with obesity are more likely to remain in such areas. Lastly, while weight bias was identified as a mediator, other factors, such as social comparisons or environmental accommodations, may also contribute to regional differences.
“In my research I am generally interested in how the social context we live in affects our physical and psychological well-being,” Berkessel said. “For example, in a recent study (Ebert, Berkessel, & Jonsson, 2023, PsychScience) we examined whether the political climate in a state relates to the longevity of political partisans. In another study (Berkessel et al., 2021, PNAS) I found that money has a stronger effect on our well-being in countries that are less religious.”
The study, “On the Unequal Burden of Obesity: Obesity’s Adverse Consequences Are Contingent on Regional Obesity Prevalence,” was authored by Jana B. Berkessel, Tobias Ebert, Jochen E. Gebauer, and Peter J. Rentfrow.
