old and overweight: another kind of double jeopardy?

8/8/2019 Old and Overweight: Another Kind of Double Jeopardy?

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Ageism in the New Millkenium

O ld and Overweight:

Another Kind of Double Jeopardy?

By Emily A. NaPier, Madonna Harrington Meyer,

and Christine L. Himes

The stig,

overweight mau

over the lif,not be consistent acrossthe life course.What aboutpeople who are both old and overweight? Dothey face doubly negative sanctions?

Our reading of the literature suggests thatwhile elders certainly face many negative healthconsequencesfrom being overweight,they maybe less likely than younger overweight peopleto encounter negative economic and social con-sequences. Our culture may be generally moreaccepting of extrapounds in old age. Moreover,because they are less likely to be searching for

new partners or new jobs, older people are lesslikely to be in situations in which people who areoverweight are most likely to face discrimina-tion. However, in the more extreme cases,among those who are both old and obese,stigmatizationmay be quite pronounced. Thosewho are significantly overweight, and particu-larly those who have been so for decades, gen-erally reach old age in poorer health and withfewer resources.

INCREASING BODY SIZE

Americans have been dubbed the fattest peo-

2.003). The proportionthat is overweight and

"na of obese has risen dramati-cally for all ages. Accord-

', notpersist ing to the most widelyused measure, the body-

Scoltrse. mass index (BMI), a BMIof Z5 or higher is over-weight, and a BM I of 30 or

higher is obese (National Center for Health Sta-tistics, 2oo4.). Figure i shows that between 196oand zooo, the proportion of adult men whowere overweight rose from 5o percent to 7o per-cent, while the proportion of women who wereoverweight rose from 4o percent to over 6opercent The percentage of men who were obeserose from io percent to nearly 30 percent, andthe proportion of women who were obese rosefrom 15 percent to about 35 percent in the same

forty-year period.Rates of overweight and obesity generally

increase with age until age 75 , when there is asmall drop (e.g., Ferraro, Thorpe, and Wilkin-son, 2003). Figure 2 shows that during the peakyears of excess weight, ages 55 to 74, more than70 percent of men and women are overweightand more than 35 percent are obese. Afterage 75,the rates drop slightly; just over6o percent of theold-old are overweight, and just over 2o per-cent are classified as obese.

Certain groups are particularly likely to beoverweight. In part because of lower income

B eing overweight orobese has long beenstigmatizing. Overweightpeople face economic andsocial repercussions as wellas negative health conse-quences. But these may


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GENERATIONS

panic women are much morelikely than whitewomen to be overweight and obese (Flegal etal., 1998; NCHS, 2004). According to the NCHS(2004), 78 percentofAfrican American womenare overweight, compared to 71 percent of His-

panic women and 57 percent of white women.Similarly, 50 percent of African American, 39percent of Hispanic, and 31 percent of whitewomen are obese. Fully io percent of middle-aged black women are morbidly obese, withBMIs greater than 40 (Flegal et al., 1998).

HIEALTH-IRELATED CONSEQUENCES

OF OVERWEIGHT

Overweight and obesity are significant riskfactors for developing several chronic condi-tions and may impede proper medical care.Those who are overweight, and particularlythosewho are obese, are significantlymore likelyto have diabetes, high blood pressure, high cho-lesterol, coronary heart disease, and certain typesof cancer (Mokdad et al.,2oo1; Paul and Townsend,1995; Wolf and Colditz, Percentage1998). People who are over-weight also have shorter life

spans, with age at death 8 0decreasing as level of over- 70 o

weight increases. The risk is 6ohighest for those who havebeen overweightfor longer 20 -periods of time and de- 10_creases if one does not 196o-become overweightor obese 1962until after age 50 (Paul andTownsend, 1995;Stevens etal., 1998).While some oftheincreased risk for chronic SouRc: Natonadiseases is a direct physicalresult of overweight and obesity, several authorssuggest that the stigma of overweight is so pro-nounced in the medical field that many peoplewho are overweight avoid going to the doctor(e.g., Puhl andBrownell, 2003; Schwartz et al.,2003). Olsonand colleagues (1994) found thatamong women who delayed or cancelled doc-tor appointments, embarrassmentabout their

weight was the most common reason.In addition to avoiding healthcare settings,overweight and obese people are less likely to

engage in related health-promoting behaviors.Excess weight creates functional limitations,diminishes mobility, and impairs ability to exer-cise at all ages. Those older adults who developchronic illness because of their obesity will expe-

rience functional limitations beyond those cre-ated by the illnesses themselves as a result oftheir weight (Himes, 2ooo). Among peoplewith hypertension, diabetes, arthritis, or a heartcondition, Kington and Smith (1997) foundthat women, African Americans and Hispan-ics, and those in the lowest income stratumhad the worst functional ability.

Becauseof he increasedprevalenceof chronicillness,overweightand obesepeopleaccrue muchhigherhealth costs.For example, the overweightand obese require1.2and1.84 times the numberofpharmacy disbursements, respectively, as peo-ple ofaverageweight. For diabetes medications,in particular,the numbers jump to 1.4. and6.o8times for overweight and obese, respectively

(Thompson et al., 2oo0). Oster and colleagues(1999) suggest that a reduction in body weightofio percent for obese men and women ages 35to 64-would result in a lifetimesavings of from$2,200 to $5,300 per person in medical costs.

Medical professionals encourage people tomaintain a healthy weight to avoid many of thechronic conditions associated with obesity. But

media images and cultural expectations mayplay the largest role in encouraging Americansto spend billions annually trying to become thin-

Figure 1of Adult Population Overweight an d Obese,

by Sex, over Time

* Overweight Males

* Overweight Females

D Obese Males

0 Obese Females

1971- 1976- 1988- 1999-

1974 1980 1994 2,002

Years

I Center for Health Statistics,2004.


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Ageism in the New Millemium

ner. The booming weight-loss industry includesweight-loss centers, diet foods and beverages,supplements and prescription medications, dietbooks, surgery, and other options (Kolata, 2oo4;Sherrid, 2003). Annual revenue estimates range

from $33 billion (Rashadand Grossman, 2oo4)to $4o billion (KIolata, 2004).

ECONOMIC CONSEQUENCES

OF OVERWEIGHT

Several studies have reported economic dis-crimination against overweight people at allstages of employment, with older workers notimmune. Societal attitudesabout being fat shapeemployers' attitudes about the abilities of over-

Figure 2Percentage of Population Oveiweight a

by Sex an d Age

s8o

t 6o

u 40

20

20-34 35-44- 45-5+ 55-64

Age in Years

SouRcE:National Center for Health Statistics, zoo4.

weight employees. For example, employersoften think that overweight employees are slow-moving, have poor attendance, are unattractive,

and are not good role models because ofnega-tive personalitytraits (Roehling, 1999; Paul andTownsend, 1995). People who are overweightare less likely to be hired than are applicants ofaverage weight. Additionally, overweight andobese people are hired for less prestigious jobsthan are their average weight counterparts andhave lower occupational attainment (Pagan andDavila, 1997). Pingitore and colleagues (i994)found that 35 percent of the variance in hiring

rates between applicants of average weight andobese applicants could be attributed to weightand that this bias was more pronounced for

65-7+ 75-Plus

Employers justify discrimination against peo-ple who are overweight and obese by contend-ing that they are more likely to miss workbecause of illness. Obese employees are in factmore likely to have moderate to high levels of

absenteeism from work, defined as three ormore days of absence due to illness in a six-month period, than are their nonobese coun-terparts (Tucker and Friedman, 1998).

Overweight and obese employees are paidless than employees of average weight, but thewage penalty, or differential, varies by gender,race, and age.Women face a greater wage penaltyfor being overweight than men do (Baum andFord, 2oo+). Wages ofwhite women are affected

by weight more than arewages of black and His-panic women (Cawley,2004). Older overweightemployees are penalizedmore than are youngerworkers, and those whogained weight early in lifeface greater wage penaltiesthan do those who gainedweight later in life (Baum

and Ford, zoo4; Averettand Korenman, 1996).

SOCIAL CONSEQUENCES

OF OVERWEIGHT

In the United States,being overweight has

become so widespread in the general popula-tion that stigmatization may be lessening.Evenso, recent studies suggest that social discrimi-

nation continues to occur on the basis of BMI.Common stereotypes of people who are over-weight characterize them as lazy, self-indulgent,impulsive, and incompetent (Paul andTownsend, 1995; Roehling, i999; Rothblum,1992). The perception is that they are responsi-ble for their own condition and lackingwillpower; otherwise, theywould simply reducetheir food intake and thus lose weight (Puhiand Brownell, 2003; Rothblum, 1992). Suchstereotypes persist despite evidence that over-weight people generally do not have highercaloric intakes than do people of average weight

nd Obese,


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GENERATIONS

Rather than thinking of them as "fat and jolly,"many think of overweightpeople as emotionallymaladjustedand disagreeable (Roehling, 1999).Even overweight and obese people themselveshave been found to subscribe to these stereo-

typical antifat attitudes, suggesting that theyhave,intermalized the social stigma againstbeingoverweight (Wang, Brownell, and Wadden,2 0 0 4 ) . Indeed, one survey found that 2 4 per-cent of women and 17 percent of men wouldtrade three or more years of heir lives to be theirdesired weight (Publ and Brownell, 2003) .

The amount of stigma attachedto being over-weight varies by gender and age. At every agethere is more societal pressure for women thanmen to be thin. Additionally, women pay ahigher price for being overweight in the job mar-ket. Finally, being overweight may moreadversely affect the chances of marrying forwomen than for men. Overweight women aresignificantlyless likelyto marry than are womenof average weight, particularly if they are over-weight as young adults (Rissanen,1996; Averettand Korenman, 1996). Being overweightappearsto have somewhat fewer social consequences atolder ages than it does at younger ages.There is

significantlymore pressure on younger adultsto be thin and fit. Moreover, older people aresignificantlyless likely to be in either the mar-riage or job markets, thus they are less likely tobe subjected to sanctions on the basis of bodysize. Overall, being overweight may not be asstigmatizing for older people as for those atyounger ages.

INCREASING AccEPTABiLiTy?

'As the proportion of the adult populationthat is overweight increases--it now approachestwo-thirds- stigmatization may be beginningto wane. We have already begun to accommo-date larger bodies. Chairs at restaurants, on air-planes, and in theaters are getting bigger. Somerestaurants even keep a few oversized chairs onhand for the obese (Crister, 2003). Clothing isavailable in larger cuts with such names as"relaxed fit' so that we can wear larger cloth-ing without changing the size on the tag. Also,

more stores and brands are carrying a broaderrange of sizes, as it is estimated that 30 percentofyoung women wear a size 14 or larger Lycra

spandex serves to make clothes more comfort-able, so people are less aware of their weight(Crister,2003). Fashion models now are oftenconsidered too thin, so models with varyingbody sizes are becoming increasinglyvisible,

though they are usually categorized as "plussize" models (Rand and Wright, 2 0 0 0 ) .

In addition, poor eating habitshave becomemore acceptable. As the quality of food declines,the portions increase, particularly in the fastfood industry and in school cafeterias (Crister,2003; Schlosser,2002). Oversized portions areassociatedwith overeating.Whereas we mighthesitate to order two regular servings of friesfor fear of appearing gluttonous,we may read-ily order one supersized portion.Further, thesheervariety of snack foods offered has encour-aged consumers to snack more frequently andto consume greater quantities (Crister,2003).

Even when they are overweight, most peopleconsider their body size to be within a range ofacceptablebody sizes for their age group, thoughthey maydesire to be thinner.Rand and Resnick(2000) found that 84 percent of adolescents, 81percent of young adults, and 88 percent of mid-dle-aged adults who were overweight consid-

ered their body size acceptable. Similarly, 54percent of adolescents, 60 percent of youngadults, and 45 percent of middle-aged adultswho were obese considered their body sizeacceptable. Generally, elementary and highschool students indicate a narrower range ofbody size acceptability than do middle-agedadults (Rand and Wright, 2000).

Atyounger ages, the message is dear: Thin isin. But with advancing age, the messages aresomewhatmore mixed.Why wouldwe be moreaccepting of overweight among elders thanamong younger ages? It may be because ourageist views of growing old include notions ofgrowing unfit. We tend to see old age as a timeof oss, particularly loss of body strength, speed,endurance, and other factors we associate withfitness. We actually expectpeople to becomeless fit, lessattractive, and lessphysically capablewith age. Indeed, we are surprised when they donot. Within the complexities ofAmericanvalues,

we have always beenmore forgiving of he extrapounds accumulated in middle age. We embracethe notion of the portly grandpa bouncing


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Ageisn in the New Millennium

grandchildren on his knee. We are drawn to theimage of the plump, apron-wearing grandmabaking yet another batch of cookies.

Yet, it is not that simple. As with youngerpeople, olderpeople are bombardedwith media

images of healthy, youthful, and thin peoplewho are living active lifestyles. The April 29,2oo5, issue ofModk Maurity contains manyarticles on how you can "Get Thin N o , ' "Cal-culateyour BMu' and "FollowaReal-lifeBoomerCouple on their Journey to Fitness:'As the pro-portion of the population that is old increases,we tend to postpone the age at which we regardpeople as old. We tend to expect middle-agedpeople to retain youthful figures and lifestyles

later into the life course. So if we are becomingmore accepting of overweight among "theelderly," the age atNwhich it becomes more accept-able to carry extra pounds is most likely rising.

DISCUSSION

Ultimately, the degree ofstigmatization asso-dated with being overweight depends on justhow early in the life course one becomes over-weight and just how overweight one becomes.The most serious health, social, and economicconsequences of being overweightoccur amongthose who became overweight in young adult-hood and those who became obese or even mor-bidly obese. Those who are overweight early inthe life course-and more significantly over-weight-are more likely to develop more serioushealth effects (PaulandTownsend, 1995; Stevenset al., 1998). They are also more likelyto face dis-crimination in the marriage and employmentmarkets (Averett and Korenman, 1996). Those

who become overweightduring middle age haveoften already determined their mates and jobs,thus they are less likely to face discrimination inthese socialand economic arenas. Indeed, beingsettled in a marriage with kids, and in a job, con-tributes to gaining weight (Averett and Koren-

man, 1996). Thus gaining a little extra weightthroughout the middle years appears to lead torelatively few consequences in either health, eco-nomic, or social realms. But gaininga great deal

of extra weight, especiallyearlier in the life course,sets young adults, particularly women, on tra-jectories that lead to fewer economic and social

Even though overweight and obesity havebecome commonplace, people with these char-acteristics continue to be subject to various sortsof health, economic, and social disparities overthe life course. It is certainly true that the com-

bination of discrimination on the basis ofweightduring the earlier stages oflife with discrimina-tion on the basis of age during the middle stagesof ife sets many people on trajectories that resultin fewer economic and social resources in oldage.And perhaps most important, health prob-lems related to being overweight are only exac-erbated in old age. Thus, even if it becomessomewhat more socially acceptable to be over-weight, the negative health consequences stilllead to a less desirable old age. VZ

EmilyA. NaPie; MA., is a doctoral tudent insociology; M&adonnaHarringtonMeyer PhD., isdirector,GerontologyCente, professor of ociology,and senior research associate;and Christine L.Hims, PhD., isprofessorand chair, ociology,andsenior research associate,all at Center or PolicyBesearnk Syracuse Univerity, Syracuse,N.Y.

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old and overweight: another kind of double jeopardy?

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