Obesity is one of the leading causes of preventable morbidity and mortality in the United States, and it affects over one third of adults. Weight stigma, devaluation on the basis of excess body weight, contributes to the development and exacerbation of obesity via behavioral and stress mechanisms. My work on weight stigma focuses on how identity, stress, and coping processes produce obesogenic (i.e., obesity inducing) and weight-relevant 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 research in this area demonstrates that subjective body perceptions predict greater weight-based stereotyping of the same target when shown as obese relative to thin (Himmelstein & Tomiyama, 2015). My current work considers the role of subjective weight in producing psychological and physical disease processes. Using a large, diverse adult sample approximating US census characteristics (N=2,424), I found (Himmelstein, Puhl, & Quinn, in prep), independent of BMI, stigma experiences, and sociodemographic characteristics, subjective weight perceptions contributed to depression, increased dieting, decreased physical health, decreased psychological health, decreased exercise efficacy, and decreased self-esteem. My future work on identity processes in weight stigma will address the role of overlapping identities (weight, race, gender).
Stress Processes. Only a handful of studies address physiological consequences of weight stigma, an avenue of research necessary for understanding how weight stigma contributes to health. My prior work examined physiological reactivity to weight stigma via salivary cortisol, a stress-responsive hormone implicated in weight gain and abdominal adiposity (belly fat). I found (Himmelstein, Incollingo Belsky, & Tomiyama, 2015) that individuals who perceived themselves as overweight, independent of BMI, experienced reactivity as reflected by higher concentrations of salivary cortisol after stigma, but individuals who perceived themselves as average weight did not. I am currently working on a project to examine physiological challenge versus physiological threat reactions using cardiovascular markers markers of stress. Further, I am currently writing a K01 proposal to examine weight stigma and stress processes as barriers to effective obesity treatment.
Coping Processes. Very few studies have examined how people cope with obesity stigma.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 at Rutgers (Himmelstein, Sanchez, & Stavrakis, under review), which found negative coping style at age 13 moderated the relationship between experiencing weight stigma in adolescence and likelihood of obesity in early adulthood, independent of BMI in adolescence. My current work in this area examines intersectionality (race, gender) in coping with stigma (Himmelstein, Puhl, & Quinn, in press 2017). Using a diverse national sample of 2,378 I found 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. Further Hispanic women (relative to White women) are at a greater risk for obesity because they are more likely (in some cases equally likely) to engage in obesogenic coping relative to White women. 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 coping also examines the stigma experiences and coping mechanism in obese men. I am currently working on a paper (Himmelstein & Puhl, in prep) comparing stigma experiences and coping strategies among obese men and women, which finds obese men experience equal rates of stigma relative obese women, but are less likely to engage in maladaptive and obesogenic coping strategies.
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. I expect to remain an active masculinity researcher within the larger field of health psychology.
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 reinforcements 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 (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 strongly endorsing 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 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.
Stress Processes. Masculinity 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. My work in the HEART lab examined cardiovascular and endocrine reactivity to masculinity threats during a Trier Social Stress Test. We found (Kramer, Himmelstein, & Springer, 2017) 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. Further, we found (Himmelstein, Kramer, & Springer, under review) heightened 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). In 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 Processes. My 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.