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NEW YORK (CNN) — Fatness was an unexpected topic at the presidential debate at Hofstra University on Monday — and many obesity experts now say that they are concerned about what was said.
The topic arose when Democratic presidential nominee Hillary Clinton claimed that Republican nominee Donald Trump publicly body-shamed former Miss Universe winner Alicia Machado, who gained weight after winning the title in 1996. Machado said Trump called her "Miss Piggy."
Then, as Trump mused about who may have hacked the Democratic National Committee, he said the cyberattacker could have been someone sitting on their bed who weighs 400 pounds.
"Mr. Trump's comments were highly regrettable and speak not only to weight bias directed at women but also to men," said Kelly Brownell, dean of the Sanford School of Public Policy at Duke University and an expert on obesity.
"People should be judged based on their character and other attributes rather than their body weight. Body weight is not a reflection of intelligence, ability to work hard or any other factor, and it shouldn't be perceived as such," he said. "I can't even imagine there is an association between body weight and creating a cyberattack."
Yet weight bias is a bigger problem than most people may think, experts say — especially for women.
"We know from our research on weight stigma and discrimination that even though both women and men experience unfair treatment because of excess weight, women report these experiences at lower levels of obesity than men," said Rebecca Puhl, a professor at the University of Connecticut and deputy director of the university's Rudd Center for Food Policy & Obesity.
"Weight stigma occurs in many different aspects of daily living," she said. "People who have a higher body weight are vulnerable to stigma in employment, schools and colleges, health care settings, public accommodations, the mass media, and in interpersonal relationships with family and friends."
Women are more likely to face weight discrimination in the workplace than men, even when their body mass index is within the healthy range, according to a study published this month in the journal Plos One.
For the study, an international team of researchers asked 120 participants to rate eight pictures that showed the faces of men and women at various weight levels: Each face was portrayed in one "original" photo and one photo in which the face appeared heavier. The participants were asked to rate the photos based on hireability, but they also were told that the men and women in the photos were all equally qualified for various jobs.
The researchers discovered that there was no significant difference between the ratings of the original and "heavier" photos for male faces. However, there was a statistically significant difference between the ratings of the original and "heavier" photos for female faces, if they were being considered for a job that required a lot of interaction with customers.
In other words, the "heavier" women were evaluated significantly more negatively in customer-facing job roles, the study suggests.
There is a long history of legal battles about weight discrimination among women in various customer-facing job roles, from flight attendants to aerobics instructors to university dance team members.
"A little weight gain for female job applicants is damaging to women's job chances. These findings suggest quite clearly that women are at a distinct disadvantage compared to men" in this area, the researchers wrote in the study.
Discrimination hurts health
If someone perceives that they are experiencing weight discrimination, they are more likely to suffer daily stress and negative emotions than otherwise, which could cause their health to worsen over time, according to a separate study published this month in the journal Obesity.
The study involved 1,153 adults who had a body mass index classified as either overweight or obese. The adults were asked to participate in daily interviews over an eight-day period, in which they were called each night and asked about their everyday experiences.
The participants who reported having faced weight discrimination, compared with those who hadn't faced any weight discrimination, experienced more daily stress, worse emotional health and worse physical health over the subsequent eight days, said Angelina Sutin, assistant professor in the Florida State University College of Medicine and lead author of the study.
"When we did the study, it was what we had expected. We published a paper earlier this year that showed weight discrimination increased risk of mortality, so people who had experienced weight discrimination had died younger than those who hadn't experienced it," Sutin said.
"What has been surprising is how robust and replicable the association between weight discrimination and health has been," she said. "Within the past few years, and up until today, there's really been a lot of new research showing that weight discrimination has very significant associations with health."
The one place that bans weight discrimination
Do laws protect against weight discrimination? Michigan is the only state that prohibits it, Puhl said.
"About half a dozen local laws have been passed in various places in the country, and Massachusetts has been trying to pass a state law to prohibit weight discrimination for some time. But overall, in most places, there is no legal recourse for people who have been discriminated against because of their weight," she said.
Sutin noted that she thinks more Americans are paying closer attention to weight discrimination and deeming it unacceptable, according to the criticism that Trump has received for his comments.
"There has been a big backlash against what has been said recently, and I think that goes to show that it is rising in the public awareness and consciousness that this is not acceptable to do," Sutin said. "One reason why people are reacting so much to what Trump is saying is that there is this growing sense that it is inappropriate to shame people because of their weight."
Still a significant problem
Americans are heavier than ever before, with 35 percent of men and 40 percent of women being considered obese. About 17 percent of children and adolescents are obese, according to the Centers for Disease Control and Prevention. Weight-based bullying is one of the most common forms of bullying in youth in the United States, Puhl said.
And the solution to the problem is basic but not easy. It begins with dialogue about weight, even at an early age.
If a loved one's weight may be putting their health in serious jeopardy, there is a way to speak with them without causing them more stress, said Dianne Neumark-Sztainer, professor and division head of epidemiology and community at the University of Minnesota School of Public Health.
"Place the focus on health rather than on weight," Neumark-Sztainer said, adding that in her book for parents titled "I'm, Like, So Fat!" she makes recommendations for adults on how to talk to their teen children about weight.
"Provide an environment that makes it easy to make healthy choices. Focus less on weight; instead, focus on behavior and overall health. Provide a supportive environment with lots of talking and even more listening," Neumark-Sztainer said. "Fat-shaming does not motivate people but makes them feel terrible about themselves and actually causes them to eat more and gain more weight."
Puhl agreed. "The bottom line is that all people deserve to be treated with respect and dignity, regardless of their body size. Fat-shaming is ineffective, harmful, and fuels the fire of societal prejudice," she said.
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