A toxic leader is a person who has responsibility for a group of people or an organization, and who abuses the leader–follower relationship
by leaving the group or organization in a worse condition than it was
in. Good and bad leadership styles can propagate downwards in an
organisation, and there may therefore be little support to be gained by
reporting toxic leadership upwards in the hierarchy.
History
In his 1994 journal article "Petty Tyranny in Organizations" Blake Ashforth discussed potentially destructive sides of leadership and identified what he referred to as "petty tyrants", i.e. leaders who exercise a tyrannicalstyle of management, resulting in a climate of fear in the workplace.
The
basic traits of a toxic leader are generally considered to be either/or
insular, intemperate, glib, operationally rigid, callous, inept, discriminatory, corrupt or aggressive by scholars such as Barbara Kellerman.
Shallow emotional affect (genuine emotion is short-lived and egocentric)
Failure to accept responsibility for own actions
Other traits
The United States Army defines toxic leaders as commanders who put their own needs first, micro-manage subordinates, behave in a mean-spirited manner or display poor decision-making.
A study for the Center for Army Leadership found that toxic leaders in
the army work to promote themselves at the expense of their
subordinates, and usually do so without considering long-term
ramifications to their subordinates, their unit, and the Army
profession.
Ashforth proposed the following six characteristics to define petty tyranny:
Noncontingent use of punishment:
that is, punishment (e.g. displeasure or criticism) allotted without
discernible or consistent principles; not dependent on, or necessarily
associated with, undesirable behaviors.
Corporate control systems: They could use the processes in place to
monitor what is going on. Disciplinary systems could be abused to aid
their power culture.
Organizational structures: They could abuse the hierarchies,
personal relationships and the way that work flows through the business.
Corporate power structures: The toxic leader controls who, if any one makes the decisions and how widely spread power is.
Symbols of personal authority: These may include the right to
parking spaces and executive washrooms or access to supplies and
uniforms. Narcissistic symbols and self-images (i.e. workplace full of self-portraits).
Workplace rituals and routines: Management meetings, board reports,
disciplinary hearing, performance assays and so on may become more
habitual than necessary.
Heavy running costs and a high staff turnover/overtime rate are often also associated with employee related results of a toxic leade
In their book, The Allure of Toxic Leaders: Why We Follow Destructive Bosses and Corrupt Politicians—and How We Can Survive Them,
Jean Lipman-Blumen explained that there was and still is a tendency
among contemporary society to seek authoritative, even dominating
characteristics among our corporate and political leaders because of the
public's own personal psycho-social needs and emotional weaknesses.
Lipman-Blumen noticed "toxic leadership" was not about
run-of-the-mill mismanagement. Rather, it referred to leaders, who, by
virtue of their "dysfunctional personal characteristics" and
"destructive behaviours" "inflict reasonably serious and enduring harm"
not only on their own followers and organizations, but on others outside
of their immediate circle of victims and subordinates, as well. A noted
rule of thumb suggests that toxic leaders leave their followers and others who come within their sphere of influence worse off than they found them either on a personal and/or corporate basis.
Lipman-Blumens' core focus was on investigating why people will
continue to follow and remain loyal to toxic leaders. She also explored
why followers often vigorously resist change and challenges to leaders
who have clearly violated the leader/follower relationship and abused
their power as leaders to the direct detriment of the people they are
leading. Lipman-Blumen suggests there is something of a deeply
psychological nature going on. She argues the need to feel safe, specialness and in a social community all help explain this psychological phenomenon.
In Bad Leadership: What It Is, How It Happens, Why It Matters,
Barbara Kellerman suggests that toxicity in leadership (or simply, "bad
leadership") may be analysed into seven different types:
Incompetent: The leader and at least some followers lack the
will or skill (or both) to sustain effective action. With regard to at
least one important leadership challenge, they do not create positive
change.
Rigid: The leader and at least some followers are stiff and
unyielding. Although they may be competent, they are unable or unwilling
to adapt to new ideas, new information, or changing times.
Intemperate: The leader lacks self-control and is aided and abetted
by followers who are unwilling or unable to effectively intervene.
Callous: The leader and at least some followers are uncaring or
unkind. Ignored and discounted are the needs, wants, and wishes of most
members of the group or organization, especially subordinates.
Corrupt: The leader and at least some followers lie, cheat, or steal. To a degree that exceeds the norm, they put self-interest ahead of the public interest.
Insular: The leader and at least some followers minimize or
disregard the health and welfare of those outside the group or
organization for which they are directly responsible.
Evil: The leader and at least some followers commit atrocities. They
use pain as an instrument of power. The harm can be physical,
psychological or both.
Terry Price
In his book, Understanding Ethical Failures in Leaders, Terry L. Price
argues that the volitional account of moral failures in leaders do not
provide a complete account of this phenomenon. Some have suggested that
the reason leaders misbehave ethically is because they willingly go
against what they know to be wrong. Professor Price however, offers an
alternative analysis of leaders who excuse themselves from normally
applicable moral requirements. He argues that a cognitive account for
ethical failures in leaders provides a better analysis of the issues
involved in all the ethical conundrums under the rubric of "toxic
leadership". Leaders can know that a certain kind of behavior is
generally required by morality but still be mistaken as to whether the
relevant moral requirement applies to them in a particular situation and
whether others are protected by this requirement. Price demonstrates
how leaders make exceptions of themselves, explains how the
justificatory force of leadership gives rise to such exception-making,
and develops normative protocols that leaders should adopt.
Queen bee syndrome is a phenomenon first defined by C. Tavris, G.L. Staines, and T.E. Jayaratne in 1973.
“Queen bee” is a derogatory term applied to women who have achieved
success in traditionally male-dominated fields. These women often take
on “masculine” traits and distance themselves from other women in the
workplace in order to succeed.
They may also view or treat subordinates more critically if they are
female, and refuse to help other women rise up the ranks as a form of
self-preservation.
There are competing arguments as to whether or not queen bee
syndrome is simply a myth. Some believe the term “queen bee” perpetuates
outdated gender stereotypes, especially since there is currently no
male-equivalent term. Tavris herself has expressed regret over coining
such “a catchy name” for “such a complex pattern of behavior”. She
explains that the term has been misinterpreted, providing a false
understanding of female dynamics in the workplace.
The queen bee phenomenon has been documented by several studies. Scientists from the University of Toronto
speculated that queen bee syndrome may be the reason that women find it
more stressful to work for female managers; no difference was found in
stress levels for male workers.
It has been considered that part of the reason “queen bee”
behavior has been untreated, or simply ignored for so long is because in
its intrasexual nature, the discrimination goes virtually unrecognized.
Contrary to men, when women in senior professional positions make
judgements about their female subordinates, often no one will think to
question whether or not it constitutes a form of gender discrimination.
Origin
Gender stereotypes
Queen
bee syndrome could be partially attributed to long-standing societal
gender stereotypes wherein women are perceived to be lacking traditional
leadership and achievement-oriented qualities (i.e., assertiveness,
decisiveness)– often seen as synonymous with masculinity. This brings
upon pressure for professional women to adopt these qualities,
especially in work environments where men are the majority. It's
believed that high-achieving women develop queen bee syndrome due to the
lack of opportunities for women in the professional sector. With few
top spots available to women, especially those of colour, “queen bees”
feel they need to protect their place by exhibiting "masculine" traits
as a form of self-group distancing. As iterated by N. Ellemers
et al., “survival of women in male-dominated work environment entails a
form of individual mobility, in the sense that they have to prove to
themselves and others that they are unlike other women in order to be
successful”. In a 1976 study by Ruble & Higgins,
their research suggested that when females are in the minority of a
group, which in high-level professional sectors is often the case, they
described themselves in more "masculine" terms.
Gender stereotypes plague women in many arenas, notably in the
workplace and in academia. Men have monopolized most positions of power
since time immemorial, therefore their leadership styles have been
predominantly masculine. Women encounter much difficulty in their
attempts to earn these positions, afflicted with the negative “feminine”
stereotypes of emotional instability, low career commitment, and lack
of leadership skills, to name a few. It seems probable that the queen
bee phenomenon arose as a symptom of gender stereotyping, forcing women
to alienate themselves from other women and subsequently their perceived
negative traits.
In childhood, boys are socialized to be leaders and
decision-makers, meanwhile girls are warned that if they're too “bossy”,
they won't be liked. In an experiment by Joyce Benenson, she discovered
that among five-year-old children in a competitive scenario, the
dominant boy was revered by the other boys, however the dominant girl
was disliked by the other girls.
Coming into adolescence and adulthood, moving into leadership positions
already poses a challenge for women who haven’t been afforded the same
opportunities to lead as their male counterparts.
In 1994, V. O’Leary and M. M. Ryan argued that high-achieving
women might be perceived as “queen bees” due to the fact that their
female employees struggle to see them as the boss; seeing their women
bosses as women and their men bosses as bosses. They suggested that
perhaps female employees held their women bosses to a double standard, expecting them to be more understanding, nurturing, and forgiving (traditional “feminine” traits) than men bosses.
Female solidarity or sisterhood
There
is an assumption that women are part of an unspoken sisterhood, and
when some women move up the ranks into more powerful positions, they
must adopt different qualities in order to fit in and gain respect–
qualities that are less than congruent with solidarity or sisterhood. As
J. Wacjman
articulates, “...women's presence in the world of men is conditional on
them being willing to modify their behavior to become more like men or
to be perceived as more male than men". High-achieving women don’t have a
lot of options; in modifying their behavior to be more conducive to
leadership, they alienate themselves from other women and are seen as
traitors, yet by sticking with the unspoken sisterhood, they struggle to
gain traction professionally. When ambitious women choose to do what it
takes to advance their careers, they often get labelled the “queen bee”
due to the skewed perceptions of women in positions of power and
leadership.
Recent research has postulated that queen bee syndrome may be a product of certain cultural influences,especially those related to the modern workplace.
In a study done in the Netherlands by B. Derks, N. Ellemers, C. van
Laar and K. de Groot, it was found that women who displayed the most
“queen bee” tendencies (portrayal of “masculine” traits, distancing from
other women, gender stereotyping) experienced the highest levels of
gender-based discrimination earlier on in their careers.
This supports the theory that the queen bee phenomenon is a consequence
of gender-based discrimination inflicted on women trying to get ahead
in their careers.
"Queen bee" women, aware of their sacrifices made in order to become
successful, see other up-and-coming women and believe they should be
able to figure out how to achieve success without assistance or a whole
movement, just as they did.
These tendencies of women themselves subsequently maintain the barriers
sustained by occupational sexism to shut them out. However, when it
comes to women of similar seniority, “queen bees” are supportive,
believing these women have also worked hard for their success.
It appears that the social dynamics of unbalanced work
environments bring about the most discrimination. In a 1982 study by
Gutek & Morasch, they found that in both female and male-dominated
workplaces, women experienced higher levels of gender-based
discrimination and sexual harassment as opposed to a workplace with
roughly equal numbers of men and women.
Researchers have hypothesized
that queen bee behavior may be developed by women who have achieved
senior positions in their respective fields as a way to defend
themselves against the gender bias experienced in the workplace.
Distancing themselves from female subordinates attempting to advance in
their own careers allows “queen bees” to connect with their male
colleagues while demonstrating stereotypically masculine qualities such
as assertiveness or leadership, which are attributed to success. By
exhibiting these "masculine" traits, “queen bees” further legitimize
their right to be in important professional positions as well as
attaining job security by showing commitment to their careers.
Research has shown that women exhibiting queen bee qualities are
less likely to hire the female when choosing between a highly qualified
male candidate and an equally qualified female candidate due to
‘competition threat’. With a highly qualified female candidate, the
“queen bee” might feel threatened. When asked to choose between a
moderately qualified male candidate and an equally qualified female
candidate, “queen bees” were again less likely to hire the female
candidate, this time due to ‘collective threat’. In this case, the
“queen bee” might worry the female candidate would reflect negatively on
her, as women in male-dominated workplaces are often grouped together
by social categorization.
Social categorization
Social categorization, or self-categorization theory, is a psychological theory closely related to the processes of social perception wherein a person groups themselves and others into categories based on shared characteristics.
This theory is thought to be ingrained since infancy and affects the
way people perceive others– as part of a broader social grouping rather
than as individuals.
By way of social categorization, a subconscious process for the most
part, individuals are assigned pre-designated traits as part of their
larger group or category. For women in the workplace, social
categorization works to their disadvantage as they are assigned
stereotypically feminine traits such as being agreeable, helpful,
sympathetic, and kind– and therefore perceived as less capable in
leadership roles. When high-achieving women present themselves as
anything less than those designated traits, they are often labeled as "bitches"
or more specifically, "queen bees". Men are seen as great leaders for
being ambitious and assertive, whereas women are often viewed as
“unfeminine”, “bossy” or “bitchy” for exhibiting those same traits.
In the professional sector, an in-group
is a (typically exclusive) network of people from any given workplace
who participate in informal get-togethers or events outside of work. It
is at these informal get-togethers where colleagues get to know one
another on a personal level and industry knowledge or workplace gossip
is often shared. Beyond that, being a part of an in-group can lead to
career advantages down the road. More often than not, it seems women and
people of colour
are scarcely included in these exclusive groups due to affinity bias–
the tendency to favour those similar to us– exhibited by their male
superiors. In social psychology, there is another term, similarity attraction, which may contribute to why high-level male executives tend to promote men over equally-qualified women.
With fewer spots left at the top for women and a harder climb to get
there, queen bee syndrome remains as a fighting-mechanism for ambitious
females.
In a 2004 study done in Italy, it was found that the older generation
of female faculty viewed their female doctoral students in a
stereotypical manner and made biased judgements about their commitment.
The older female faculty began to pursue their careers when it was much
rarer for women to do so, and view themselves as more “masculine” as a
result. In contrast, the younger generation of Italian women are
pursuing their careers at a time where it is much more common and widely
accepted, meaning these women have less reason to suppress their
“feminine” traits or perform self-group distancing. This resistance of
gender stereotyping is a freeing evolution for both men and women in
academia.
Emotion politics
Emotion
politics are at play in the maintenance of the queen bee phenomenon,
altering how women treat other women as well as how they carry
themselves in traditionally male-dominated arenas. It has been proven
that when demonstrating the same level of competence that is commended
in men, women are seen as unattractive and cold. When it comes to
certain qualities and emotions, men and women are forcibly segregated
into specific boxes and viewed as opposing, rather than harmonious
forces. In the workplace and in academia notably, when women blur the
lines between the two forces, for example, showing extreme competence or
success in the professional sphere, they become the target for
derogatory terms such as “queen bee”, “ice queen”, and “bitch”. It
appears that when women prove themselves in a traditionally-male role,
they are punished for altering the favourable image of a woman.
Gender discrimination can arise through the beliefs concerning
which emotions are appropriate for people to show. Stereotypically,
women are expected to be kind and nurturing, communal, and modest, while
they are not expected to display anger. Expressing an emotion that
doesn't line up with people's beliefs about gender-appropriate behavior
can lead to being given a lower status at work, and consequently, a
lower wage.
Anger
A 2008
study found that men who expressed anger in the workplace were given a
higher status, while women who expressed anger in the workplace were
given a lower status, regardless of their actual position in the
company. A trainee and a CEO who were female were both given a low
status when displaying anger. Additionally, women who displayed anger in
the workplace were assumed to have something internal influencing their
anger, as opposed to having an external reason to be angry. Men more
often had their anger attributed to an external cause.
The expression of anger is believed to be related to status, as
anger is considered a status emotion. Positive impressions of those who
display anger are reserved for people who are stereotypically conferred a
higher status. A 2007 study found that female employees in a
subordinate position displayed anger toward higher status employees much
less frequently than their male counterparts. This suggests that the
stereotypical norm of men displaying anger carries over into the
workplace, while the norm of women restraining displays of anger also
carries over. It also suggests that, although men in low level positions
in the workplace possess a low status in this context, they may carry
over the higher status that comes with their gender. Women do not
possess this high status; therefore the low status that low-level women
possess in the workplace is the sole status that matters.
Competition
The
queen bee phenomenon still has no male-equivalent term, perhaps because
male competition is seen as normal, healthy behavior, and as children
it’s even encouraged. Female competition however, is looked down upon–
from childhood onward, women in competition are labeled as backstabbing,
conniving, catty “mean girls”. There are countless books and movies
portraying the concept that it has started to become the standard.
Despite the prevalence of material depicting queen bee behavior among
females, studies have shown that men actually participate in similar to
elevated levels of indirect aggression linked to queen bee behavior
(i.e., gossiping, rumour spreading, social exclusion) in comparison to
women.
Admittedly, young boys tend to display physical aggression more than
young girls at any age, but a 1992 study demonstrated that as boys reach
the age of 11, verbal and indirect aggression levels rise. Verbal and
indirect aggression requires a degree of social intelligence and
understanding of interpersonal relationships, skills that girls tend to
develop earlier than boys (around the age of 8). A 2005 study in Britain
asked university students to report how often they either experienced,
or participated in forms of indirect aggression (specifically social
exclusion, use of malicious humour, and guilt induction). The results
presented no differences between the experiences of men and women based
on these self-reported numbers.
Criticisms of the theory
Recent research, that uses a robust causal identification mechanism (i.e., regression discontinuity design), strongly contests the existence of the queen bee phenomenon.
The results of this study suggest that previous research was biased –
either by eliciting confirming cases (as is often done in qualitative
research) or that observational data based on questionnaire measures was
biased because of endogeneity issues.
Some find the queen bee phenomenon to be unknowingly perpetuating gender stereotypes that are sorely outdated.
It is also argued that the term undermines women’s professional
progress and abilities, and tarnishes the reputation of groups of women
in the professional sphere. Another criticism of the theory comes from the belief that it promotes a “blame the woman” narrative.
A study by Credit Suisse
counters the evidence of the queen bee phenomenon. In examining 3,400
of the world’s largest companies, it was revealed that female CEOs were
50% more likely than their male counterparts to have a female CFO; and 55% more likely to have business units run by women. It was also discovered that while typically women are found within human resources
or legal departments, in female-led companies it became less likely due
to the fact that female CEOs were supporting their female executives
branching out into more influential roles within the company.
The 2004 film, Mean Girls (partly based on Queen Bees and Wannabes) depicts examples of both queen bee syndrome as well as social categorization in teenagers.
The sculpture of two women in bronze, Jag tänker på mig själv – Växjö ( 'I am thinking of myself - Växjö') by Marianne Lindberg De Geer, 2005, outside the art museum (Konsthallen) in Växjö, Sweden.
Its display of one thin woman and one fat woman is a demonstration
against modern society's obsession with outwardly appearances. The
sculpture has been a source of controversy in the town, with both
statues being vandalized and repaired in 2006.
The modern fat acceptance movement began in the late 1960s.
Besides its political role, the fat acceptance movement also constitutes
a subculture which acts as a social group for its members.
The fat acceptance movement has been criticized for not adding value to
the debate over human health, with some critics accusing the movement
of "promoting a lifestyle that can have dire health consequences".
History
The
history of the fat acceptance movement can be dated back to 1967 when
500 people met in New York's Central Park to protest against anti-fat bias. Sociologist Charlotte Cooper has argued that the history of the fat activist movement is best understood in waves, similar to the feminist movement,
with which she believes it is closely tied. Cooper believes that fat
activists have suffered similar waves of activism followed by burnout,
with activists in the following wave often unaware of the history of the
movement, resulting in a lack of continuity.
First wave
First wave activities consisted of isolated activists drawing attention to the dominant model of obesity and challenging it as only one of several possible models.
During the early part of the 20th century, obesity was seen as
detrimental to the community, via decreasing human efficiency, and that
obese people interfere with labor productivity in the coastal areas of the United States.
This kind of political climate was the background of the fat acceptance
movement, which originated in the late 1960s. Like other social movements
from this period, the fat acceptance movement, initially known as "Fat
Pride", "Fat Power", or "Fat Liberation", often consisted of people
acting in an impromptu fashion. A "fat-in" was staged in New York's
Central Park in 1967.
Called by radio personality Steve Post, the "Fat-in" consisted of a
group of 500 people eating, carrying signs and photographs of Twiggy (a model famous for her thin figure), and burning diet books.
In 1967, Lew Louderback wrote an article in the Saturday Evening Post
called "More People Should be FAT" in response to discrimination
against his wife. The article led to a meeting between Louderback and
William Fabrey, who went on to found the first organization for fat
people and their supporters, originally named the 'National Association
to Aid Fat Americans' and currently called the National Association to Advance Fat Acceptance
(NAAFA). NAAFA was founded in America, in 1969, by Bill Fabrey in
response to discrimination against his wife. He primarily intended it to
campaign for fat rights, however, a reporter attending the 2001 NAAFA
conference notes that few attendees were active in fat rights politics
and that most women came to shop for fashion, wear it on the conference
catwalk or to meet a potential partner.
Since 1991, Fabrey has worked as a director with the Council on Size
and Weight Discrimination, specializing in the history of the size
acceptance movement.
In 1972 the feminist group The Fat Underground was formed.
It began as a radical chapter of NAAFA and spun off to become
independent when NAAFA expressed concerns about its promotion of a
stronger activist philosophy. The FU were inspired by and, in some cases, members of the Radical Therapy Collective, a feminist
group that believed that many psychological problems were caused by
oppressive social institutions and practices. Founded by Sara Fishman
(then Sara Aldebaran) and Judy Freespirit, the Fat Underground took
issue with what they saw as a growing bias against obesity in the
scientific community. They coined the saying, "a diet is a cure that
doesn't work, for a disease that doesn't exist".
Shortly afterward, Fishman moved to Connecticut, where, along with
Karen Scott-Jones, she founded the New Haven Fat Liberation Front, an
organization similar to the Fat Underground in its scope and focus. In 1983, the two groups collaborated to publish a seminal book in the field of fat activism, Shadow on a Tightrope,
which collected several fat activist position papers initially
distributed by the Fat Underground, as well as poems and essays from
other writers.
In 1979 Carole Shaw coined the term Big Beautiful Woman (BBW) and launched a fashion and lifestyle magazine of the same name aimed at plus-sized women.
The original print magazine ceased publication in May 2003, but
continued in various online formats. The term "BBW" has become widely
used to refer to any fat woman (sometimes in a derogatory way). Several
other periodicals focusing on fashion and lifestyle for
"fuller-figured" women were published in print from the early 1980s to
the mid 2010s - see details within the media section of the wiki article
for Plus-size model. From 1984 - 2000 Radiance: The Magazine for Large Women
was published in print to "support women 'all sizes of large in living
proud, full, active lives, at whatever weight, with self-love and
self-respect."
In the UK The London Fat Women's Group was formed, the first
British fat activist group, and was active between approximately 1985
and 1989.
Other first wave activities included the productions of zines such as Figure 8 and Fat!So? by Marilyn Wann. The latter went on to become a book of the same name.
Second wave
In
the second wave, the fat acceptance movement became more widespread in
the US and started to spread to other countries. Ideas from the movement
began to appear in the mainstream. Publishers became more willing to
publish fat acceptance themed literature.
The 1980s witnessed an increase in activist organizations, publications, and conferences. In 1989 a group of people including actress Anne Zamberlan formed the first French organization for fat acceptance, Allegro fortissimo.
Organizations began holding conferences and conventions, including NAAFA.
By the 1990s, input from the fat acceptance movement began to be
incorporated into research papers by some members of the medical
professions such as new anti-dieting programs and models of obesity management.
Third wave
The
fat acceptance movement has seen a diversification of projects during
the third wave. Activities have addressed issues of both fat and race,
class, sexuality, and other issues. Size discrimination has been
increasingly addressed in the arts, as well.
Campaigning themes
The fat acceptance movement argues that fat people are targets of hatred and discrimination. In particular, advocates suggest obese women are subjected to more social pressure than obese men. The movement argues that these attitudes comprise a fat phobic entrenched societal norm, evident in many social institutions, including the mass media, where fat people are often ridiculed or held up as objects of pity. Discrimination includes a lack of equal access to transportation and employment.
Members of the fat acceptance movement perceive negative societal
attitudes as persistent, and as being based on the presumption that
fatness reflects negatively on a person's character.
Fat activists push for change in societal, personal, and medical
attitudes toward fat people. Fat acceptance organizations engage in public education about what they describe as myths concerning fat people.
Discrimination
Fat people experience many different kinds of discrimination because of their weight. This discrimination appears in healthcare, employment, education, personal relationships, and the media. Fat individuals also argue clothing stores discriminate against them. For example, some women have complained that "one size fits all" stores, which offer a single size for each item, do not cater to those above a certain weight. Public transport
has also been subject to criticism due to lack of inclusivity to fat
people as seats and walkways are often too small to accommodate for
them.
Fat activists argue that anti-fat stigma and aggressive diet
promotion have led to an increase in psychological and physiological
problems among fat people.
Concerns are also raised that modern culture's focus on weight loss
does not have a foundation in scientific research, but instead is an
example of using science as a means to control deviance, as a part of society's attempt to deal with something that it finds disturbing. Diet critics cite the high failure rate of permanent weight-loss attempts, and the dangers of "yo-yo" weight fluctuations and weight-loss surgeries. Fat activists argue that the health issues of obesity and being overweight have been exaggerated or misrepresented, and that the health issues are used as a cover for cultural and aesthetic prejudices against fat.
Proponents of fat acceptance maintain that people of all shapes and sizes can strive for fitness and physical health.
They believe health to be independent of body weight. Informed by this
approach, psychologists who were unhappy with the treatment of fat
people in the medical world initiated the Health at Every Size
movement. It has five basic tenets: 1. Enhancing health, 2. Size and
self-acceptance, 3. The pleasure of eating well, 4. The joy of movement,
and 5. An end to weight bias.
Some medical studies have challenged the 'healthy obesity' concept, though the definitions of metabolically healthy obesity are not standardized across studies.
Documentary filmmaker Kira Nerusskaya released her film The BBW World: Under the Fat! In 2008.
The issues faced by fat women in society have been a central theme of
the fat acceptance movement since its inception. Although the first
organization, National Association to Advance Fat Acceptance, and the
first book, Fat Power (1970), were both created by men, in each
case they were responses to weight discrimination experienced by their
wives. Women soon started campaigning on their behalf with the first
feminist group, 'The Fat Underground', being formed in 1973. Issues
addressed regarding women have included body image, and in particular the thin ideal
and its effect on women. Critics say NAAFA, which opposes dieting and
weight-loss surgery, is an apologist for an unhealthy lifestyle. But
NAAFA says it does no such thing, that some people are just bigger and
no less deserving of the same rights as everyone else.
Fat men
The fat acceptance movement has primarily focused on a feminist model of patriarchal
oppression of fat women, most clearly represented by the encouragement
of women to diet. However, Sander L. Gilman argues that, until the 20th
century, dieting has historically been a man's activity. He continues, "Obesity eats away at the idealized image of the masculine just as surely as it does the idealized image of the feminine." William Banting was the author of an 1863 booklet called Letter On Corpulence which modern diets have used as a model. Men respond to being overweight differently, (i.e., having a Body Mass Index of 25 or more), being half as likely as women to diet, a quarter as likely to undergo weightloss surgery and only a fifth as likely to report feeling shame about their weight.
Irmgard Tischner identifies this behavior as rooted in notions of
masculinity that require disregard for healthcare: "Men do not have to
care about their size or health, as they have women to care about those
things for them".
Some gay men have moved beyond disregard for size to fat acceptance and fat activism with movements like chub culture, which started as Girth & Mirth clubs in San Francisco in 1976 and the bear culture which fetishizes big, hairy men. Ganapati Durgadas argues that fat bisexual and gay men "are reminders of the feminine stigma with which heterosexism still tars queer men". In a comparison of queer fat positive zines, the lesbian-produced Fat Girl was found to have political debate content absent from gay male orientated zines such as Bulk Male and Big Ad.
Joel Barraquiel Tan comments: "If fat is a feminist issue, then fat or
heft is a fetishized one for gay men. Gay men tend to sexualize
difference, where lesbians have historically politicized it."
A fat heterosexual man is known as a "Big Handsome Man", in
counterpart to a Big Beautiful Woman. Like some fat and gay men, BHMs
have sexualized their difference and receive validation of this identity
from BBWs or straight women known as "Female Fat Admirers".
Legislation
In
the 1980s fat people in the United States began seeking legal redress
for discrimination based on weight, primarily in the workplace but also
for being denied access to, or treated differently in regards to,
services or entertainment. The results of these cases have varied
considerably, although in some instances the Americans with Disabilities Act (ADA) has been successfully used to argue cases of discrimination against fat people. Roth and Solovay argue that, as with transgender
people, a major cause for the variation in success is the extent to
which litigants are apologetic for their size (with more apologetic
plaintiffs finding more success):
What is the difference between a million-dollar weight case award and
a losing case? Like the difference between many winning and losing
transgender cases, it's all about the attitude. Does the claimant's
attitude and experience about weight/gender reinforce or challenge
dominant stereotypes? Winning cases generally adopt a legal posture that reinforces social prejudices. Cases that challenge societal prejudices generally lose.
The Americans with Disabilities Act continues to be used as there is
no USA federal law against weight discrimination; however, the state of Michigan has passed a law against weight discrimination. The cities of Washington, D.C., San Francisco (2000), Santa Cruz, Binghamton, Urbana (1990s), New York, and Madison (1970s) have also passed laws prohibiting weight discrimination.
In the cities that have a weight discrimination law, it is rare for
more than one case a year to be brought, except for San Francisco which
may have as many as six. Opinions amongst city enforcement workers vary
as to why the prosecution numbers are so low, although they all
suggested that both overweight people and employers were unaware of the
protective legislation and it was also noted that the cities with
anti-weight discrimination laws tended to be liberal college towns.
However, not all legal changes have protected the rights of fat people. Despite recommendations from the Equal Employment Opportunity Commission to the contrary, the United States Court of Appeals for the Sixth Circuit has decided that fat people will only qualify as disabled
if it can be proved that their weight is caused by an underlying
condition, supporting the concept that being obese is not inherently a
disability.
Other countries besides the United States have considered
legislation to protect the rights of fat people. In the UK an All-Party
Parliamentary Group published a report in 2012 called Reflections on Body Image that found that one in five British people had been victimized because of their weight. The report recommended that Members of Parliament investigated putting "appearance-based discrimination" under the same legal basis as sexual or racial discrimination via the Equality Act 2010
which makes it illegal to harass, victimize or discriminate against
anyone in the workplace based on several named categories, including
size or weight.
The Equality Act came into force on 1 October 2010, it brings together
over 116 separate pieces of legislation into one single Act. The Act
provides a legal framework to protect the rights of individuals and
advance equality of opportunity for all.
Fat studies
There has also been an emerging body of academic studies called Fat Studies. Marilyn Wann argues that fat studies moved beyond being an individual endeavor to being a field of study with the 2004 conference Fat Attitudes: An Examination of an American Subculture and the Representation of the Female Body. The American Popular Culture Association
regularly includes panels on the subject. In many colleges, student
groups with a fat activist agenda have emerged, including Hampshire,
Smith, and Antioch. Fat studies are now available as an interdisciplinary course of study at some colleges, taking a similar approach to other identity studies such as women's studies, queer studies, and African American studies. As of 2011, there were two Australian courses and ten American courses that were primarily focussed on fat studies or Health at Every Size, and numerous other courses that had some fat acceptance content. Taylor & Francis publish an online Fat Studies journal. The first national Fat Studies seminar was held at York in May 2008, leading to the 2009 publication Fat Studies in the UK, edited by Corinna Tomrley and Ann Kalosky Naylor.
Division within the movement
The
fat acceptance movement has been divided in its response to proposed
legislation defining morbidly obese people as disabled. NAAFA
board member Peggy Howell says: "There's a lot of conflict in the size
acceptance community over this. I don't consider myself disabled, and
some people don't like 'fat' being considered a disability."
An example of the positive perspective of obesity being classified as a
disability in wider society is noted by one researcher: "She makes a point to tell me how impressed she is with the way many do make quiet and polite accommodations for her."
Women are particularly active within the fat acceptance movement
and membership of fat acceptance organizations is dominated by
middle-class women in the heaviest 1–2% of the population.
Members have criticized the lack of representation in the movement from
men, people of color, and people of lower socioeconomic status.
Criticism
The
fat acceptance movement has been criticized from several perspectives.
The primary criticism is that fat acceptance ignores studies that have
shown health issues to be linked to obesity and hence, encourages an
unhealthy lifestyle.
In 2008 Lily-Rygh Glen, a writer, musician, and former fat
acceptance activist, interviewed multiple women who claimed to be
rejected by their peers within the movement and labeled "traitors" when
they changed their diets.
Medical criticism
There is a considerable amount of evidence that being obese is connected to increased all-cause mortality and diseases, and significant weight loss (>10%), using a variety of diets, improves or reverses metabolic syndromes and other health outcomes associated with obesity.
Barry Franklin, director of a cardio rehab facility, stated: "I
don't want to take on any specific organization but... A social movement
that would suggest health at any size in many respects can be
misleading."
However, Franklin also agrees that fit people who are obese have
cardiovascular mortality rates that are lower than thin, unfit people,
and proponents of the fat acceptance movement argue that people of all
shapes and sizes can choose behaviors that support their fitness and
physical health.
The fat acceptance movement has been criticized for not adding value to
the debate over human health, with some critics accusing the movement
of "promoting a lifestyle that can have dire health consequences".
The CDC defines an adult (a person aged 20 years or greater) with a body mass index (BMI) of 30 or greater as obese and an adult with a BMI of 25.0 to 29.9 as overweight.
Obesity in adults is divided into three categories. Adults with a BMI
of 30 to 34.9 have class 1 obesity; adults with a BMI of 35 to 39.9 have
class 2 obesity; adults with a BMI of 40 or greater have class 3
obesity, which is also known as extreme or severe obesity (and was
formerly known as morbid obesity).
Children (persons aged 2 to 19 years) with a BMI at or above the 95th
percentile of children of the same age and sex are defined as obese, and
children with a BMI at or above the 85th percentile but less than the
95th percentile are defined as overweight.
Compared to non-obese Americans, between 2001 and 2016, obese
Americans incurred an average of $2,505 more in medical expenses
annually, and in 2016, the aggregate medical cost due to obesity in the
United States of America was $260.6 billion.
However, some evidence suggests the lifetime cost of medical treatment
for obese individuals is lower than for healthy weight individuals. This
is because healthy weight people live longer statistically and tend to
develop chronic diseases that need to be continually treated into old
age, whereas obese people tend to die from metabolic diseases at younger
ages and avoid some of those protracted medical costs.
While lifetime medical costs for obese individuals may be lower than
for healthy weight individuals, obese individuals cause significant
economic productivity loss (ranging from $13.4 billion to $26.8 billion
in 2016).
The obesity rate has steadily increased since 1960–1962, where
approximately 13% of American adults were obese. By 2014, figures from
the CDC found that more than one-third (crude estimate 36.5%) of U.S.
adults and 17% of children were obese. The National Center for Health Statistics
at the CDC showed in their most up to date statistics that 42.4% of
U.S. adults were obese as of 2017–2018 (43% for men and 41.9% for
women).
For the following statistics, "adult" is defined as age 20 and
over. The overweight + obese percentages for the overall US population
are higher reaching 39.4% in 1997, 44.5% in 2004, 56.6% in 2007, 63.8% (adults) and 17% (children) in 2008,in 2010 65.7% of American adults and 17% of American children are
overweight or obese, and 63% of teenage girls become overweight by age
11. In 2013 the Organization for Economic Co-operation and Development
(OECD) found that 57.6% of all American citizens were overweight or
obese. The organization estimated that 3/4 of the American population
would likely be overweight or obese by 2020.
According to research done by the Harvard T.H. Chan School of Public
Health, it is estimated that around 40% of Americans are considered
obese, and 18% are considered severely obese as of 2019. Severe obesity
is defined as a BMI over 35 in the study. Their projections say that
about half of the US population (48.9%) will be considered obese and
nearly 1 in 4 (24.2%) will be considered severely obese by 2030.
According to NHANES data, African American and Mexican American
adolescents between 12 and 19 years old are more likely to be overweight
than non-Hispanic White adolescents. The prevalence is 21%, 23% and 14%
respectively. Also, in a national survey of American Indian children
5–18 years old, 39 percent were found to be overweight or at risk for
being overweight. As per national survey data, these trends indicate that by 2030, 86.3% of adults will be overweight or obese and 51.1% obese.
A 2007 study found that receiving food stamps long term (24 months) was associated with a 50% increased obesity rate among female adults.
Looking at the long-term consequences, overweight adolescents
have a 70 percent chance of becoming overweight or obese adults, which
increases to 80 percent if one or more parent is overweight or obese. In
2000, the total cost of obesity for children and adults in the United
States was estimated to be US$117 billion (US$61 billion in direct
medical costs). Given existing trends, this amount is projected to range
from US$860.7–956.9 billion in healthcare costs by 2030.
Food consumption has increased over time. Annual per capita
consumption of cheese was 4 pounds (1.8 kg) in 1909; 32 pounds (15 kg)
in 2000; the average person consumed 389 grams (13.7 oz) of
carbohydrates daily in 1970; 490 grams (17 oz) in 2000; 41 pounds
(19 kg) of fats and oils in 1909; 79 pounds (36 kg) in 2000. In 1977,
18% of an average person's food was consumed outside the home; in 1996,
this had risen to 32%.
Obesity is a major public health problem in the USA owing to its
rapidly increasing prevalence, substantial mortality and morbidity, and
growing healthcare costs.
Several studies have inquired about the relationship between community
food environment and obesity is significant and inverse among US adults.
The large-scale study demonstrated a substantial and inverse
relationship between the local food environment and adult obesity in the
US using local spatially weighted regression. More importantly, there
were considerable regional differences in the strength and direction of
this connection.
The findings of the study also show the need for geographically
specific public health policies and interventions to address issues with
food environments that are specific to particular regions.
Contributing factors
Obesity rates of adult females, 1960–2015
Numerous studies have attempted to identify contributing factors for
obesity in the United States. Common factors include an overconsumption
of food and an insufficient amount of physical exercise. Eating properly
can lower a person's body weight, but the public often fails to
correctly determine what to eat and what not to eat as well as how much
or how little they should. For example, while dieting, people tend to
consume more low-fat or fat-free products, even though those items can
be just as damaging to the body as the items containing fat. For the
contributing factor of too little exercise, only a small amount (20%) of
jobs require physical activity.
Obesity rates of adult males, 1960–2015
Other factors not directly related to caloric intake and activity
levels that are believed to contribute to obesity include air
conditioning, the ability to delay gratification, and the thickness of the prefrontal cortex of the brain.
Genetics are also believed to be a factor, with a 2018 study stating
that the presence of the human gene APOA2 could result in a higher BMI
in individuals.
Additionally, factors contributing to the probability of obesity can
occur even before birth, including maternal behaviors during gestation
such as smoking or significant weight gain.
The microbiome (population of microbes like bacteria, fungi, and
viruses) of a person's gastrointestinal tractcan additionally contribute
to obesity, and is also modified by it. Lean people and obese people
have been shown to have differences in their gut bacteria which affect
their metabolism.
Causes of obesity
"In
the United States, most people's diets are too high in calories — often
from fast food and high-calorie beverages. People with obesity might
eat more calories before feeling full, feel hungry sooner, or eat more
due to stress or anxiety.”
Effects on life expectancy
The
United States' high obesity rate is a major contributor to its
relatively lower life expectancy in comparison with other high-income
countries. In the US, about 20% of cancer deaths in women and 14% of those in men are due to obesity.
It has been suggested that obesity may lead to a halt in the rise in
life expectancy observed in the United States during the 19th and 20th
centuries.
In the event that obesity continues to grow in newer generations, a
decrease in well-being and life span in the future generations may
continue to degenerate. According to Olshansky, obesity diminishes "the
length of life of people who are severely obese by an estimated 5 to 20
years."
History shows that the number of years lost will continue to grow
because the likelihood of obesity in new generations is higher. Children
and teens are now experiencing obesity at younger ages. They are eating
less healthy and are becoming less active, possibly resulting in less
time lived compared to their parents' . The life expectancy for newer generations can expect to be lower due to obesity and the health risks they can experience at a later age.
There has been an increase in obesity-related medical problems, including type II diabetes, hypertension, cardiovascular disease, and disability. In particular, diabetes has become the seventh leading cause of death in the United States, with the U.S. Department of Health and Human Services estimating in 2008 that fifty-seven million adults aged twenty and older were pre-diabetic, 23.6 million diabetic, with 90–95% of the latter being type 2-diabetic.
Obesity has also been shown to increase the prevalence of
complications during pregnancy and childbirth. Babies born to obese
women are almost three times as likely to die within one month of birth
and almost twice as likely to be stillborn than babies born to women of normal weight.
Prevalence
The National Center for Health Statistics
estimates that, for 2015–2016 in the U.S., 39.8% of adults aged 20 and
over were obese (including 7.6% with severe obesity) and that another
31.8% were overweight.
In the NCHS update for 2018, statistics on severe obesity among U.S.
adults had already climbed to 9.2% while the total obesity prevalence
had reached 42.4%. This also marked the first time in American history
that the obesity rates had reached or exceeded 2/5 people in every adult
age groups.
Obesity rates have increased for all population groups in the United States over the last several decades. Between 1986 and 2000, the prevalence of severe obesity (BMI ≥ 40 kg/m2) quadrupled from one in two hundred Americans to one in fifty. Extreme obesity (BMI ≥ 50 kg/m2) in adults increased by a factor of five, from one in two thousand to one in four hundred.
There have been similar increases seen in children and
adolescents, with the prevalence of overweight in pediatric age groups
nearly tripling over the same period. Approximately nine million
children over six years of age are considered obese. Several recent
studies have shown that the rise in obesity in the US is slowing,
possibly explained by saturation of health-oriented media.
Race
Rates of obesity in US by race based on 2015–2016 data
Obesity is distributed unevenly across racial groups in the United States.
Overall, the prevalence of obesity and severe obesity was highest among
non-Hispanic black adults and lowest among non-Hispanic Asian adults.
The prevalence of obesity among men was not significantly different
between non-Hispanic white, non-Hispanic black, and Hispanic men.
Some of these races tend to populate low socio-economic status
neighborhoods and can lack resources such as health care support, safe
play areas, and grocery stores with affordable fruits and vegetables. Furthermore, minority households can be more prone to obesity because of cultural food preferences and family norms.
White
The obesity rate for White adults 18 years and older (over 30 BMI) in the US in 2015 was 29.7%. For adult White men, the rate of obesity was 30.1% in 2015. For adult White women, the rate of obesity was 26.9% in 2015.
More recent statistics from the NHANES of age adjusted obesity rates
for White adults 20 years and older in the U.S. in 2016 was 37.9%.
The obesity rates of White males and White females from the NHANES 2016
data were relatively equivalent, obesity rates were 37.9% and 38.0%,
respectively.
Black or African American
The obesity rate for Black adults 18 years and older (over 30 BMI) in the US in 2015 was 39.8%. For adult Black men, the rate of obesity was 34.4% in 2015. For adult Black women, the rate of obesity was 44.7% in 2015.
The most recent statistics from the NHANES of age adjusted obesity
rates for Black adults 20 years and older in the U.S. in 2016 was 46.8%.
According to the obesity rates from the NHANES 2016 data, black males
had significantly lower than black females, their rates were 36.9% and
54.8%, respectively.
American Indian or Alaska Native
The obesity rate for American Indian or Alaska Native adults (over 30 BMI) in the US in 2015 was 42.9%. No breakdown by sex was given for American Indian or Alaska Native adults in the CDC figures.
Asian
The obesity rate for Asian adults 18 years and older (over 30 BMI) in the US in 2015 was 10.7%. No breakdown by sex was given for Asian adults in the CDC figures.
In more recent statistics from the NHANES in 2016 of a breakdown by sex
was provided. Asian adults 20 years and older had a total obesity rate
of 12.7%. The rate among Asian males was 10.1% and among Asian females
it was 14.8%. Asian Americans have substantially lower rates of obesity
than any other racial or ethnic group.
Hispanic or Latino
The obesity rate for the Hispanic or Latino adults 18 years and older category (over 30 BMI) in the US in 2015 was 31.8%. For the overall Hispanic or Latino men category, the rate of obesity was 31.6% in 2015. For the overall Hispanic or Latina women category, the rate of obesity was 31.9% in 2015.
According to the most recent statistics from the NHANES in 2016 Latino
adults had the highest overall obesity rates. Latino Adults age 20 and
older had reached an obesity rate of 47.0%.
Adult Latino men's rate was 43.1%, the highest of all males. For adult
Latina women the rate was 50.6%, making them second to African-American
women.
Within the Hispanic or Latino category, obesity statistics for
Mexican or Mexican Americans were provided, with no breakdown by sex. The obesity rate for Mexican or Mexican Americans adults (over 30 BMI) in the US in 2015 was 35.2%.
Native Hawaiian or other Pacific Islander
The obesity rate for Native Hawaiian or other Pacific Islander adults (over 30 BMI) in the US in 2015 was 33.4%. No breakdown by sex was given for Native Hawaiian or other Pacific Islander adults in the CDC figures.
Sex
Over 70 million
adults in U.S. are obese (35 million men and 35 million women).
99 million are overweight (45 million women and 54 million men).
NHANES 2016 statistics showed that about 39.6% of American adults were
obese. Men had an age-adjusted rate of 37.9% and Women had an
age-adjusted rate of 41.1%.
The CDC provided a data update in May 2017 stating that for
adults 20 years and older, the crude obesity rate was 39.8% and the age
adjusted rate was measured to be 39.7%. Including the obese, 71.6% of
all American adults age 20 and above were overweight.
Age
Historically,
obesity primarily affected adults, but childhood obesity has grown
significantly in recent decades. From the mid-1980s to the mid-2010s,
obesity roughly doubled among U.S. children ages 2 to 5 and roughly
tripled among young people over the age of 6.
Overall, obesity in the United States peaks during the middle aged
years. During the period 2015–16, the prevalence of obesity among adults
aged 20–39 was 35.7%, among those aged 40–59, 42.8%, and among those 60
and over, 41.0%.
The rise of overweight among children aged 6–19 in the US
From 1980 to 2008, the prevalence of obesity in children aged 6 to 11
years tripled from 6.5% to 19.6%. The prevalence of obesity in
teenagers more than tripled from 5% to 18.1% in the same time frame. In less than one generation, the average weight of a child has risen by 5 kg in the United States. The CDC has reported that, in 2014, 17.2% of youth aged 2–19 were considered obese and another 16.2% were overweight.
Meaning, over one-third of children and teens in the US were overweight
or obese. Statistics from a 2016–2017 page on the CDC's official
website that 13.9% of toddlers and children age 2–5, 18.4% of children
6–11, and 20.6% of adolescents 12–19 are obese.
The prevalence of child obesity in today's society concerns health
professionals because a number of these children develop health issues
that weren't usually seen until adulthood.
Some of the consequences in childhood and adolescent obesity are
psychosocial. Overweight children and overweight adolescents are
targeted for social discrimination, and thus, they begin to stress-eat.
The psychological stress that a child or adolescent can endure from
social stigma can cause low self-esteem which can hinder a child's after
school social and athletic capability, especially in plump teenage
girls, and could continue into adulthood.
Data from NHANES
surveys (1976–1980 and 2003–2006) show that the prevalence of obesity
has increased: for children aged 2–5 years, prevalence increased from
5.0% to 12.4%; for those aged 6–11 years, prevalence increased from 6.5%
to 19.6%; and for those aged 12–19 years, prevalence increased from
5.0% to 17.6%.
In 2000, approximately 39% of children (ages 6–11) and 17% of
adolescents (ages 12–19) were overweight and an additional 15% of
children and adolescents were at risk of becoming overweight, based on
their BMI.
Analyses of the trends in high BMI for age showed no
statistically significant trend over the four time periods (1999–2000,
2001–2002, 2003–2004, and 2005–2006) for either boys or girls. Overall,
in 2003–2006, 11.3% of children and adolescents aged 2 through 19 years
were at or above the 97th percentile of the 2000 BMI-for-age growth charts, 16.3% were at or above the 95th percentile, and 31.9% were at or above the 85th percentile.
Trend analyses indicate no significant trend between 1999 and
2000 and 2007–2008 except at the highest BMI cut point (BMI for age 97th
percentile) among all 6- through 19-year-old boys. In 2007–2008, 9.5%
of infants and toddlers were at or above the 95th percentile of the
weight-for-recumbent-length growth charts. Among children and
adolescents aged 2 through 19 years, 11.9% were at or above the 97th
percentile of the BMI-for-age growth charts; 16.9% were at or above the
95th percentile; and 31.7% were at or above the 85th percentile of BMI
for age.
In summary, between 2003 and 2006, 11.3% of children and
adolescents were obese and 16.3% were overweight. A slight increase was
observed in 2007 and 2008 when the recorded data shows that 11.9% of the
children between 6 and 19 years old were obese and 16.9% were
overweight. The data recorded in the first survey was obtained by
measuring 8,165 children over four years and the second was obtained by
measuring 3,281 children.
"More than 80 percent of affected children become overweight adults, often with lifelong health problems."
Children are not only highly at risk of diabetes, high cholesterol and
high blood pressure but obesity also takes a toll on the child's
psychological development. Social problems can arise and have a snowball
effect, causing low self-esteem which can later develop into eating disorders.
Adults
There are more obese US adults than those who are just overweight. According to a study in The Journal of the American Medical Association (JAMA),
in 2008, the obesity rate among adult Americans was estimated at 32.2%
for men and 35.5% for women; these rates were roughly confirmed by the
CDC again for 2009–2010. A Gallup survey found 41% of U.S. adults, on
average, from 2017 to 2021, have characterized themselves as overweight,
while the slight majority (53%) have said their weight is about right,
and 5% reported they are underweight.
Though the rate for women has held steady over the previous decade, the
obesity rate for men continued to increase between 1999 and 2008,
according to the JAMA study notes.
Moreover, "The prevalence of obesity for adults aged 20 to 74 years
increased by 7.9 percentage points for men and by 8.9 percentage points
for women between 1976–1980 and 1988–1994, and subsequently by 7.1
percentage points for men and by 8.1 percentage points for women between
1988–1994 and 1999–2000."
According to the CDC, obesity has consistently remained the highest
among middle-age adults since 2011. In the most recent update, 44.8% of
Americans in their forties and fifties qualified as obese; meanwhile 40%
of young adults and 42.4% of older adults were obese.
Elderly
Although
obesity is reported in the elderly, the numbers are still significantly
lower than the levels seen in the young adult population. It is
speculated that socioeconomic factors may play a role in this age group when it comes to developing obesity. Obesity in the elderly increases healthcare costs. Nursing homes are not equipped with the proper equipment needed to maintain a safe environment for the obese residents.
If a heavy bedridden patient is not turned, the chances of a bed sore
increases. If the sore is untreated, the patient will need to be
hospitalized and have a wound vac placed.
Prevalence by state and territory
Adult obesity rates in the U.S. by state (2013)
20.2–24.0%
24.0–25.0%
25.0–26.8%
26.8–28.7%
28.7–30.4%
30.4–32.7%
32.7–34.0%
34.0–35.2%
Obesity rates in the U.S. by state (1985–2010)
The following figures were averaged from 2005 to 2007 adult data compiled by the CDC BRFSS program and 2003–2004 child data[A] from the National Survey of Children's Health. There is also data from a more recent 2016 CDC study of the 50 states plus the District of Columbia, Puerto Rico, the U.S. Virgin Islands and Guam.
Care should be taken in interpreting these numbers, because they
are based on self-report surveys which asked individuals (or, in case of
children and adolescents, their parents) to report their height and
weight. Height is commonly overreported and weight underreported,
sometimes resulting in significantly lower estimates. One study
estimated the difference between actual and self-reported obesity as 7%
among males and 13% among females as of 2002, with the tendency to
increase.
The long-running REGARDS study, published in the journal of Obesity
in 2014, brought in individuals from the nine census regions and
measured their height and weight. The data collected disagreed with the
data in the CDC's phone survey used to create the following chart.
REGARDS found that the West North Central region (North Dakota, South
Dakota, Minnesota, Missouri, Nebraska, and Iowa), and East North Central
region (Illinois, Ohio, Wisconsin, Michigan, and Indiana) were the
worst in obesity numbers, not the East South Central region (Tennessee,
Mississippi, Alabama, Kentucky) as had been previously thought.
Dr. P.H., professor in the Department of Biostatistics in the UAB
School of Public Health George Howard explains that "Asking someone how
much they weigh is probably the second worst question behind how much
money they make," "From past research, we know that women tend to
under-report their weight, and men tend to over-report their height."
Howard said as far as equivalency between the self-reported and measured
data sets, the East South Central region showed the least misreporting.
"This suggests that people from the South come closer to telling the
truth than people from other regions, perhaps because there's not the
social stigma of being obese in the South as there is in other regions."
The area of the United States with the highest obesity rate is American Samoa (75% obese and 95% overweight).
Obesity has been cited as a contributing factor to approximately 100,000–400,000 deaths in the United States per year (including increased morbidity in car accidents) and has increased health care use and expenditures,
costing society an estimated $117 billion in direct (preventive,
diagnostic, and treatment services related to weight) and indirect
(absenteeism, loss of future earnings due to premature death) costs. This exceeds health-care costs associated with smoking or problem drinking and, by one estimate, accounts for 6% to 12% of national health care expenditures in the United States (although another estimate states the figure is between 5% and 10%).
The Medicare and Medicaid programs bear about half of this cost.
Annual hospital costs for treating obesity-related diseases in children
rose threefold, from US$35 million to US$127 million, in the period
from 1979 to 1999, and the inpatient and ambulatory healthcare costs increased drastically by US$395 per person per year.
These trends in healthcare costs associated with pediatric obesity and its comorbidities are staggering, urging the Surgeon General
to predict that preventable morbidity and mortality associated with
obesity may surpass those associated with cigarette smoking.
Furthermore, the probability of childhood obesity persisting into
adulthood is estimated to increase from approximately twenty percent at
four years of age to approximately eighty percent by adolescence, and it is likely that these obesity comorbidities will persist into adulthood.
In the military
An estimated 16% percent of active duty U.S. military personnel were obese in 2004, with the cost of remedial bariatric surgery
for the military reaching US$15 million in 2002. Obesity is currently
the largest single cause for the discharge of uniformed personnel.
A financial analysis published in 2007 further showed that the
treatment of diseases and disorders associated with obesity costs the
military $1.1 billion annually. Moreover, the analysis found that the
increased absenteeism of obese or overweight personnel amounted to a
further 658,000 work days lost per year. This lost productivity is
higher than the productivity loss in the military due to high alcohol
consumption which was found to be 548,000 work days. Problems associated
with obesity further manifested itself in early discharge due to
inability to meet weight standards. Approximately 1200 military
enlistees were discharged due to this reason in 2006.
The rise in obesity has led to fewer citizens able to join the
military and therefore more difficulty in recruitment for the armed
forces. In 2005, 9 million adults aged 17 to 24, or 27%, were too
overweight to be considered for service in the military.
For comparison, just 6% of military aged men in 1960 would have
exceeded the current weight standards of the U.S. military. Excess
weight is the most common reason for medical disqualification and
accounts for the rejection of 23.3% of all recruits to the military. Of
those who failed to meet weight qualifications but still entered the
military, 80% left the military before completing their first term of
enlistment.
In light of these developments, organizations such as Mission:
Readiness, made up of retired generals and admirals, have advocated for
focusing on childhood health education to combat obesity's effect on the
military.
Accommodations
Along with obesity came the accommodations made of American products.
Child-safety seats in 2006 became modified for the 250,000 obese U.S.
children ages six and below.
The obese incur extra costs for themselves and airlines when flying.
Weight is a major component to the formula that goes into the planes
take off and for it to successfully fly to the desired destination. Due
to the weight limits taken in consideration for flight in 2000, airlines
spent $275 million on 350 million additional gallons of fuel for
compensation of additional weight to travel.
Accommodations have also been made in work place environments for
workers, including those such as chairs with no armrests and access to
work outside of the office.
Trends in obesity prevalence show
no increase among youth since 2003–2004, but trends do show increases in
both adults and youth from 1999 to 2000 through 2013–2014. No
significant differences between 2011 and 2012 and 2013–2014 were seen in
either youth or adults.
Under pressure from parents and anti-obesity advocates, many school districts moved to ban sodas, junk foods, and candy from vending machines and cafeterias.
State legislators in California, for example, passed laws banning the
sale of machine-dispensed snacks and drinks in elementary schools in
2003, despite objections by the California-Nevada Soft Drink
Association. The state followed more recently with legislation to
prohibit their soda sales in high schools starting July 1, 2009, with
the shortfall in school revenue to be compensated by an increase in
funding for school lunch programs. A similar law passed by the Connecticut General Assembly in June 2005 was vetoed by governorJodi Rell, who stated the legislation "undermines the control and responsibility of parents with school-aged children."
In mid-2006, the American Beverage Association (including Cadbury, Coca-Cola, and PepsiCo)
agreed to a voluntary ban on the sale of all high-calorie drinks and
all beverages in containers larger than 8, 10 and 12 ounces in
elementary, middle and high schools, respectively.
There have been many strategies to try to control obesity issues.
One cost-effective population-level change is taxes on sugary drinks.
Interventions such as taxes can be a powerful way to improve the
economic landscape of the food environment. According to Circulation,
“Beverages with added sugar are a prime candidate for taxation; they
constitute >10% of caloric intake nationwide and provide little or no
nutritional value.” Weight gain is due to consumption of these sugary
drinks along with other health issues such as diabetes, hypertension,
and more.
A penny-per-ounce tax on sugary drinks would raise the shelf
price of these drinks by around 20%. Many studies have been done and it
has shown that there has been a 14% to 20% reduction in the consumption
of these taxed drinks. People's weight will determine if they choose
healthier options or not to replace these sugary beverages. This
interest of taxes on drinks has been gaining popularity across the U.S.
According to Circulation, “They were considered as a measure at the
federal level to fund healthcare reform in 2009 and were proposed in 11
states and 2 major cities in the 2009 to 2010 legislative cycle.” There
has been some resistance from the beverage industry. Policymakers are
increasingly considering the beverage industry to promote public health.
Non-profit organizations such as HealthCorps work to educate people on healthy eating and advocate for healthy food choices in an effort to combat obesity.
Former American First LadyMichelle Obama led an initiative to combat childhood obesity entitled "Let's Move!". Obama said she aimed to wipe out obesity "in a generation". Let's Move! has partnered with other programs. Walking and bicycling to school helps children increase their physical activity.
In 2008, the state of Pennsylvania enacted a law, the "School
Nutrition Policy Initiative," aimed at the elementary level. These
"interventions included removing all sodas, sweetened drinks, and
unhealthy snack foods from selected schools, 'social marketing' to
encourage the consumption of nutritious foods and outreach to parents."
The results were a "50 percent drop in incidence of obesity and
overweight", as opposed to those individuals who were not part of the
study.
In the past decade, there have been school-based programs that
target the prevention and management of childhood obesity. There is
evidence that long term school-based programs have been effective in
reducing the prevalence of childhood obesity.
For two years, Duke University
psychology and global health professor Gary Bennett and eight
colleagues followed 365 obese patients who had already developed
hypertension. They found that regular medical feedback, self-monitoring,
and a set of personalized goals can help obese patients in a primary
care setting lose weight and keep it off.
Major U.S. manufacturers of processed food,
aware of the possible contribution of their products to the obesity
epidemic, met together and discussed the problem as early as April 8,
1999; however, a proactive strategy was considered and rejected. As a general rule, optimizing the amount of salt, sugar and fat in a product will improve its palatability,
and profitability. Reducing salt, sugar and fat, for the purpose of
public health, had the potential to decrease palatability and
profitability.
Media influence may play an important role in prevention of
obesity as it has the ability to boost many of the main
prevention/intervention methods used nowadays including lifestyle
modification. The media is also highly influential on children and
teenagers as it promotes healthy body image and sets societal goals for
lifestyle improvement. Examples of media influence are support for the
"Let's Move!" campaign and the MyPlate program initiated by Michelle
Obama, and the NFL's Play60 campaign. These campaigns promote physical
activity in an effort to reduce obesity especially for children.
In 2011, the Obama administration
introduced a $400 million Healthy Food Financing Initiative, the goal
of the program is to "create jobs and economic development, and
establish market opportunities for farmers and ranchers," as described
by the secretary of agriculture, Tom Vilsack.
Population-based approaches have been recommended and pursued in
the U.S. Obesity is complex because it affects multiple environments,
involves multiple industries and sectors, and affects both energy intake
and expenditure. Federal level policies include Healthy, Hunger-Free
Kids Act, the Supplemental Nutrition Assistance Program Education
program, and Safe Routes to School funding. (PMC) The Healthy,
Hunger-Free Kids Act of 2010 helped provide nutrition standards for
meals and drinks through a variety of programs affecting 50 million
children daily at 99,000 schools. The risk of obesity declines each year
for children in poverty. The results suggest that the Healthy,
Hunger-Free Kids Act's science-based nutritional standards should be
maintained to support healthy growth, especially among children living
in poverty, according to Health Affairs.
The Supplemental Nutrition Assistance Program Education program
(SNAP-Ed) is an approach that helps people be healthy and active. This
program teaches people how to manage their SNAP dollars, how to shop and
cook for healthy food, and how to stay active. They partner with state
and local organizations to meet people where they are located. Some of
their efforts include nutrition education classes, policy improvement,
social media campaigns, and more. SNAP-Ed directly and sustainably
improves food security either with or without food assistance. Nutrition
education is critical to improving food security in the U.S. low-income
population.
Safe Routes to School is an initiative that makes it safe and
convenient for children to walk and bicycle to and from school. The goal
is to get more children to improve kids’ safety, increase their health
and physical activity, and to get more children walking and bicycling to
school. Studies show that Safe Routes to School programs are effective
at increasing rates of bicycling and walking to school and decreasing
injuries (Safe Routes Partnership).
According to authors from the state of childhood obesity, their
focus was on a few programs and policies regarding children. The Child
and Adult Food Care Program (CACFP) provides federal funding to many
states to reimburse providers for the cost of providing healthy meals to
children and adults in their care. Around 4.3 million children and
130,000 adults partake in this program each year. Providers are required
to meet the minimum nutrition standards to receive reimbursement. Some
of their nutrition requirements are more whole grains, a wider variety
of fruits and vegetables, free added sugars, and less saturated fat. The
goal is to increase children's intake of these healthy foods, reduce
their consumption of grain-based desserts, and improve their overall
health. Research has been done on this program and it has been found
that participation in CACFP moderately increases the consumption of milk
and vegetables among children, and it helps regulate their weight.
Another early childhood education program that helps prepare
children for school by providing education, health, and social services
is Head Start. This program reaches over one million children who have
family economic trouble each year. Early Head Start serves children aged
three and under and pregnant women. Head Start and Early Head Start
programs participate in either CATFP or the federal school meals
programs. Research shows that children who participate in Head Start are
more likely to eat better than children who don't participate in this
program.
Food labeling
Ultimately,
federal and local governments in the U.S. are willing to create
political solutions that will reduce obesity ratings by "recommending
nutrition education, encouraging exercise, and asking the food and
beverage industry to promote healthy practices voluntarily."
In 2008, New York City was the first city to pass a "labeling bill"
that "require[d] restaurants" in several cities and states to "post the
caloric content of all regular menu items, in a prominent place and
using the same font and format as the price."
Furthermore, adding better labels to food and drink products can
help to improve diets. According to a 2021 study, proper labeling on the
front side of products has been proven to reduce the amount of
unhealthy food purchased. On the other hand, there has been an increase
in purchases of healthier products. These labels help consumers to be
more health conscious about the food they are buying.
Many states have started to adopt policies allowing only
healthier drinks such as milk and water. In general, the Affordable Care
Act (ACA) started to require chain restaurants to post calorie
information on their menus, menu boards, and to provide additional
nutrition information such as saturated fat and added sugars to
customers upon request. The Food and Drug Administration's rules that
enforce this provision took effect in 2018. It has applied to
supermarkets, convenience stores, delis, movie theaters, and stadiums.
Retails with fewer than 20 locations don't have to abide by these rules.
It has been shown that benefits of this calorie labeling has increased
awareness of and a reduction in calories purchased. Also, it has shown
to reduce calorie intake and reduce portion sizes. A net savings total
of $8 billion over 20 years will be saved by the menu labeling policy,
according to an FDA regulatory impact analysis.
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