Perceived weight discrimination and chronic biochemical stress: A population-based study using cortisol in scalp hair.

Sarah E Jackson,Andrew Steptoe,Clemens Kirschbaum

doi:10.1002/oby.21657

Abstract

ObjectiveThere is increasing evidence for weight‐based discrimination against persons with obesity. This study aimed to examine the physiological impact of perceived weight discrimination on cortisol in hair, an indicator of chronic stress exposure.MethodsData were from 563 nonsmoking individuals with obesity (body mass index, BMI ≥30 kg/m2) participating in the English Longitudinal Study of Ageing. Experiences of discrimination were reported via questionnaire, and hair cortisol concentrations were determined from the scalp‐nearest 2‐cm hair segment. Height and weight were objectively measured. ANCOVAs tested associations between perceived weight discrimination and hair cortisol concentration overall and by degree of obesity. All analyses were adjusted for age, sex, ethnicity, socioeconomic status, and BMI.ResultsMean hair cortisol concentrations were 33% higher in those who had experienced weight discrimination than those who had not (mean log pg/mg 1.241 vs. 0.933, F = 12.01, P = 0.001). The association between weight discrimination and hair cortisol was particularly pronounced in individuals with severe (class II/III) obesity (1.402 vs. 0.972, F = 11.58, P = 0.001).ConclusionsWeight discrimination is associated with the experience of stress at a biological level. Chronic exposure to elevated levels of cortisol may play a role in generating a vicious circle of weight gain and discrimination and contribute to obesity‐associated health conditions.

Highlights

The rising prevalence of obesity over recent decades has been paralleled by growing evidence of weight-based stigma and discrimination [1]
This study examined the relationship between weight discrimination and hair cortisol concentration, a biomarker for chronic stress exposure
Using assays of cortisol from scalp hair, we found that people with obesity who believed they had been treated unfairly because of their weight had significantly greater exposure to cortisol over a period of approximately 2 months than those who had not experienced weight-related discrimination

Summary

Introduction

The rising prevalence of obesity over recent decades has been paralleled by growing evidence of weight-based stigma and discrimination [1]. The experience of weight discrimination may be interpreted by the body as a social stressor, causing activation of the hypothalamicpituitary-adrenal (HPA) axis and resultant release of the hormone cortisol. Weight discrimination is associated with a host of adverse psychological consequences, including depression and anxiety disorders [4], low self-esteem [5], and poor quality of life [6], which are known to be related to stress (e.g., Ref. 7). Weight discrimination has been shown to be related to increased blood pressure [10], chronic inflammation [11], poorer self-rated health [12], greater disease burden [12], and a decline in physical health over time [12]

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Results

Conclusion