Weight Stigma

Obesity is one of the leading causes of preventable mortality in the United States and it affects over one third of adults.  Weight stigma involves stereotyping and devaluation of individuals on the basis of excess body weight. Weight stigma contributes to the development and exacerbation of obesity and many other health conditions.  My work on weight stigma focuses on how identity, stress, and coping processes contribute to obesogenic (i.e., obesity inducing) and cardiometabolic health outcomes.  Research on weight stigma is the primary focus in my five-year plan for research

Identity Processes. Research on weight stigma disproportionately focuses on consequences of stigma among objective (i.e., BMI) rather than subjective (perceiving oneself as overweight/ obese) weight classes. I argue that subjective weight is an important factor in understanding how individuals experience weight stigma, interpret weight stigma, as well as how stigma experiences influence health outcomes.  Using a novel, theory driven model of stereotyping and a unique within-subjects manipulation, my prior work demonstrated that people’s perceptions of their own body weight predicted worse stereotyping of others who were depicted as obese relative to thin (Himmelstein & Tomiyama, 2015).  My current work on identity processes in weight stigma has expanded to address the role of overlapping and understudied identities (weight, race, gender) in weight stigma research.  Although rates of obesity are higher among Black and Hispanic populations, most weight stigma research involves samples in which 70-95% of participants identify as White. I have been awarded $6,000 in grant funding and am currently collecting a large national sample of Black, Hispanic, and White men and women to compare stigma experiences, coping mechanisms, and cardiometabolic risk factors as a function of intersectional identities. I expect to publish with these new data in the late summer and early fall. In addition, my current work on identity processes in stigma research has focused on stigma in men.  Although men are not generally considered an understudied group in health research, there is very little research on weight stigma processes in men or health outcomes associated with weight stigma among men.  Using two samples, including a specialized sample of men with obesity, I recently submitted a manuscript describing weight stigma experiences reported by men (Himmelstein & Puhl, under review). About 40% of men in both samples reported experiencing weight stigma; those reporting stigma had higher BMIs, were more likely diet, and scored lower on weight management efficacy relative to men not reporting stigma.  In a second paper, using two national samples, I found that independent of race, SES, and BMI; weight stigma among men was associated with (1) lower physical health scores, (2) greater frequency of restrictive dieting, (3) greater trouble sleeping, (4) higher alcohol intake, (5) greater likelihood of having problems with substance use, and (6) greater likelihood smoking, (7) higher depression scores, (8) lower self-esteem scores, and (9) lower satisfaction in social relationships (Himmelstein, Puhl, & Quinn, in prep). I expect both of these papers in preparation to be under review in August 2017. 

Stress ProcessesVery few studies have addressed physiological consequences of weight stigma, an avenue of research necessary for understanding how weight stigma contributes to health.  In one of the first studies to address this gap, my research examined physiological reactivity to weight stigma via salivary cortisol, a stress-responsive hormone implicated in weight gain and abdominal adiposity (belly fat). I found that individuals who perceived themselves as overweight, independent of BMI, experienced physiological reactivity as reflected by higher concentrations of salivary cortisol after stigma, but individuals who perceived themselves as average weight did not (Himmelstein, Incollingo Belsky, & Tomiyama, 2015). I am currently working on an interdisciplinary project with colleagues at the University of Connecticut and Hartford Hospital to examine physiological reactivity to weight stigma using a within-subjects design with hypertensive and non-hypertensive women. We are assessing physiological challenge versus physiological threat reactions to weight stigma using cardiovascular markers, as well as immune and endocrine markers of stress.  These results will inform a larger R01 proposal. Further, I am currently planning a K01 proposal for NIDDK to examine whether weight stigma experiences interfere with behavioral weight loss outcomes using patients enrolled in a weight loss program.

Coping Processes.  Little is currently known about how people cope with weight stigma. This area is quickly becoming my specialty within the obesity field, as I am one of only a few researchers addressing this issue.  The limited evidence on coping suggests the most common coping strategies reinforce emotional distress and obesogenic behavior (i.e., coping via eating and avoiding exercise). I developed and supervised a project with an honors student as a graduate student (Himmelstein, Sanchez, & Stavrakis, under review), which used existing longitudinal data to examine coping and weight labeling in adolescence and obesity in young adulthood.  Together with my student we found, consistently across multiple points of measurement, that negative coping style in adolescence explained the relationship between weight labeling in adolescence and obesity in young adulthood, independent of BMI at the time of labeling.  My recent work in this area examines intersectionality (race, gender) in coping with stigma (Himmelstein, Puhl, & Quinn, 2017). Using a diverse national sample of 2,378 adults, I found that Black women may be buffered from the negative effects of experiencing weight stigma because they are less likely (relative to White women) to engage in obesogenic coping strategies (e.g., binge eating). Further, Hispanic women (relative to White women) are at a greater risk for obesity related to weight stigma because they are more likely (in some cases equally likely) to engage in obesogenic coping. This study represents the first systematic exploration of weight stigma experiences and coping mechanisms in response to weight stigma in non-White men and women. My current work in this area explores coping strategies that individuals use in response to weight stigma as mediators of the stigma-health relationship.  I found that weight stigma was indirectly associated with lower depression scores, greater dieting frequency, better psychological wellbeing, better self-esteem, and better physical health for individuals who coped with the distress of weight stigma by engaging in healthy lifestyle behaviors (healthy eating, exercise) (Himmelstein, Puhl & Quinn, in press 2017). Conversely, weight stigma was indirectly associated with higher depression scores, lower psychological wellbeing, poorer self-esteem and physical health scores when individuals coped with weight stigma by engaging in negative affect or maladaptive eating behaviors. With colleagues, I am currently collecting data on coping in a large scale national study of 10,000 adults engaged in a popular commercial weight loss program. This will be the first study examining weight stigma and coping strategies among a national sample engaged in weight loss. 


Mortality data suggest men can expect to die approximately five years sooner than women. Masculinity plays a major role in health-related gender disparities via positive associations with risk behavior and negative associations with health promoting behavior. My research on masculinity examines health-related obstacles (e.g., admitting pain and vulnerability) which operate as threats to social identity among men embracing masculinity beliefs, and ultimately contribute to poor health outcomes.  Contrary to most research on masculinity, I also seek to understand health consequences of masculinity among women. My research on masculinity is a secondary focus in my five-year research plan.  

Identity Processes. My work on identity focuses on the ways in which cultural scripts about masculinity become embedded in the identities of men and male relationships within the United States. I first examined how masculinity beliefs influenced attitudes toward healthcare, avoidance of preventative healthcare, and delay of healthcare in acute need (Himmelstein & Sanchez, 2015). I found the more participants embraced masculine traits, like self-reliance and bravery, as part of their identity, the more likely they were to minimize problems, avoid preventative care and delay acute care during illness or injury. Interestingly, these relationships held for both men and women. The major difference between men and women were the societal re-enforcements that encourage men’s identification of masculine traits and women’s inhibition of masculine traits which left men at greater risk of healthcare underutilization. Further, I examined rates of injury reporting and masculinity among male and female athletes. I found higher scores on masculinity were associated with more severe injuries, greater frequency of injuries, and less reporting of injuries in male division 1 athletes but not female division 1 athletes (Bronson, Himmelstein, & Sanchez, in prep). My research suggests that masculinity beliefs, masculine self-construal, and competitive environments put men at risk, perhaps because male dominated environments inhibit men’s expression of pain. To more directly test this hypothesis, I examined whether men’s disclosure of health symptoms varied in a simulated doctor-patient interaction depending on whether the doctor was female or male (Himmelstein & Sanchez, 2016). Men who strongly endorsed masculinity disclosed fewer symptoms to male doctors relative to female. In a separate study, I found that men embracing masculinity sought out male doctors due to sexist beliefs that men make superior doctors. Taken together, my research suggests masculinity influences poor health outcomes in men because it encourages delay of care and impedes symptom reporting.  In my future work, I plan to test whether weight stigma operates as a masculinity threat for men because obesity is associated with being weak and lazy, two stereotypes which also violate masculine proscriptions. I am currently pursuing a small grant from SPSP to examine this theory.

Stress ProcessesMasculinity may contribute to poor health outcomes in men via stress pathways.  Precarious manhood theory suggests that masculinity must be enacted and consistently proven. Further, when masculinity is threatened men experience stress.  My work in this area tests the tenants of precarious manhood theory via physiological reactivity.  At Rutgers, I co-founded and helped to set-up a physiological lab, the HEART (Health, Environment, and Relational Ties) lab.  My work in this lab examined cardiovascular and endocrine reactivity to masculinity threats during a Trier Social Stress Test. In this research, we observed greater heart-rate-variability among men who experienced a masculinity threat during the trier social stress task relative to men who received a neutral threat (Kramer, Himmelstein, & Springer, 2017).  Further, we found heighted cortisol reactivity to masculinity threats relative to neutral threats only among men who strongly endorsed the idea of precarious manhood (i.e., that masculinity is earned, must be enacted and consistently proven) (Himmelstein, Kramer, & Springer, under review). In the future I plan to examine how masculinity attitudes may moderate physiological reactivity, specifically whether masculinity beliefs might differentiate between men who perceive masculinity threats as threatening versus challenging.  

Coping ProcessesMy work on coping and masculinity examined how men cope with pain (social, emotional, physical) as a function of their masculine attitudes.  In my dissertation, I found that men rate male targets seeking psychological help for social pain (relative to medical help for physical pain) as less masculine, which may partially explain (1) men’s reluctance to seek psychological care during times of acute need and (2) higher rates of suicide among men.  I plan to continue this line of work by helping to design interventions which encourage help-seeking behaviors in men, particularly for psychological or social issues.