Punishment for Body Deviance: A multilevel analysis of 26 countries of obesity, social sanction and psychological distress

Obesity has become a major health risk in industrialized and developing countries. Obese people are sometime stigmatized for social and health reasons. This study is aimed to address three issues: 1) whether obese people suffer from psychological distress across 26 countries? 2) whether obese people suffer more psychological distress when their countries have a strong consensus to control oversized body (measured by the acceptance of public funding of programs for obesity prevention) because they may have become a target of social sanction? 3) whether there is gender-specific association between obesity and psychological distress across countries, and whether the effect is stronger in countries with relatively strong social consensus to control oversized body, as compared to those of weak consensus. Data is from 2011 International Social Survey Program (ISSP) on Health Module. A total of 34,531 adults aged 18 to 64 years old in 26 countries across Europe and Asia were included. Multilevel analyses were conducted to examine the association of individual- and country-level variables with psychological distress, with focus on the cross-level interaction between personal obesity and social sanction for oversized body. The results indicated that obese people have a higher level of psychological distress across countries, as compared to non-obese people. However, obese people in countries with high consensus on public funding of programs to prevent obesity presented an elevated risk of psychological distress. This effect is more significant in women than in men.