In or Out? – The power of stigmatization on the body’s fundamental processes

Hidden Figures, a 2016 movie about the “computers” behind the calculations that put rockets and humans into space followed by a man on the moon (Project Mercury and the Apollo Missions) is a tale of racism, sexism, and discrimination.

This movie highlights the lives of three African-American women and the struggles they faced in a white state that failed to integrate as they worked in the male-dominated NASA space program and its associated mathematical and engineering fields.

Watching this movie made me uncomfortable and appreciative of the efforts and difficulties these women went through to create the freedoms I often take for granted. Their efforts allowed me to grow up in an integrated society and pursue my dream of studying science with few obstacles. As a Caucasian woman in science, I have been fortunate and rarely experience stigmatization like these women faced every day of their lives on multiple fronts—race, sex, career choice, discipline of study.

Despite the strides our world has made to be inclusive, social stigmatization occurs daily across societies, leading to intrapersonal and interpersonal conflicts. Religion, sexuality, gender, ethnicity, socio-economic status, even physical attributes such as obesity—are all grounds for exclusion.

According to the CDC (Center for Disease Control), obesity is an epidemic with more than a third of U.S. adults and about 17% of U.S. children meeting the criteria between 2008 and 2014. (If your body weight in kilograms divided by the square of your height in meters exceeds 30, you are considered to be obese. If that number, the Body Mass Index, is between25 and 30, you are overweight.)

Worldwide statistics provided by the World Health Organization (WHO) indicate that the number of people with obesity has more than doubled since 1980; an estimated 1.9 billion adults are considered overweight and 600 million of these individuals are obese as of 2014.

In the U.S. and other Westernized societies, being obese is associated with a number of negative stereotypes, discrimination, stigmatization, frequent social exclusion, and fewer employment opportunities.  Women are affected more strongly than men in all of these arenas, and stigmatized individuals are more sensitive to cues indicative of prejudice.

A recent study in the Psychonomic Society’s journal Cognitive, Affective, & Behavioral Neuroscience examined how social rejection was experienced by people with or without obesity during a collaborative video game. Researcher Anne Schrimpf and her team at the Max Planck Institute for Human Cognitive and Brain Sciences tried to unravel the interaction between physiological responses and mood during social rejection.

Using the computer game Cyberball (see panel B in the image below), 112 healthy adults (29 lean women, 29 women with obesity, 27 lean men, and 27 men with obesity) were assessed for their mood, happiness, feelings of being accepted (affective responses) and their physiological responses (heart rate variability) while playing Cyberball. In Cyberball, players can “throw” a ball back and forth to one another with a stroke of a key or a swipe of a mouse. When free play is allowed, the players can control to whom and how often they throw the ball. However, when used as a social rejection tool, the game can be controlled by the researcher and players can be excluded from the game, as children and adults sometimes do in real life.

Heart rate variability increases when the alerting, excitatory part of the nervous system activates (sympathetic nervous system, SNS) such as when faced with the possibility of social rejection due to body size.  Heart rate variability then decreases when the relaxing, inhibitory nervous system activates to counteract this SNS arousal (parasympathetic nervous system, PNS), such when exclusion is not experienced or a coping mechanism is engaged.

In the study by Schrimpf and colleagues, lean and obese participants were randomly assigned to be included or excluded during a second session of Cyberball after everyone had already played an initial session of Cyberball. Panel A in the image below provides an outline of the procedure. For the participants, a visual representation of their actual weight classification (lean or obese) is used to represent them as a player in Cyberball (Panel B pictures below).

When participants were included, all three players received the ball as often as each other (about 50 throws apiece). The other two players, represented by a typical weight image, were confederates (i.e., computer-generated players that the participant thought were live people). About 50% of the lean and 50% of the obese participants were excluded, which means they did not receive the ball to toss from the other two players as often (down to about a ball per minute after the first three balls).

Using this experimental paradigm, a number of hypotheses were tested. Obese individuals were expected to show stronger and more negative responses to exclusion than inclusion and/or lean individuals, especially when weight status was visible.

The results were generally supportive of the expected predictions.  All participants, except men with obesity, experienced stronger parasympathetic activity during inclusive social situations, and as expected, this response was even stronger for women with obesity. That is, inclusion during a game was associated with greater heart rate variability.

The stronger response by the women with obesity was explained as a compensatory mechanism to the possibility of “to-be-experienced” prejudice.  That is, women with obesity may have paid closer attention to the responses of the other players, sources of potential prejudice, and their bodies adjusted for potentially stigmatizing experiences. If you think you are about to receive an aversive experience, your heart rate will begin to increase because your sympathetic nervous system cranks up, but then your parasympathetic nervous system has to kick in to lower your body’s arousal and return it back to a stable level.  This interaction of the systems appears to produce higher levels of heart rate variability compared to other groups in the study.

Long-term negative feedback for individuals with obesity was expected to affect physiological responses, but this outcome was not observed with these participants. Nonetheless, during Cyberball, individuals with obesity did have increased negative body image and decreased happiness after playing a session of Cyberball relative to their emotional state prior to the Cyberball session. This result is shown in Panel B in the figure below.

Compensatory physiological responses occurred during social inclusion (dashed grey, dashed green lines in the figure below), particularly for individuals with obesity.  The authors argued that this response is elicited because social inclusion may produce greater attentional engagement compared to social exclusion.

Regardless of weight status, being excluded produced similar physiological responses across groups.  Negative internal states induced by social exclusion may produce physiologically-based compensatory responses, similar to the activation of the coping mechanism of psychological disengagement.

In conclusion, this laboratory-based experiment supported the interaction between visibility of weight status, social rejection, and sex for affective and physiological measures. As previous research across a number of contexts has demonstrated, women with obesity are much more affected by social rejection affectively and physiologically than their lean counterparts or men in general.  Women who are obese may be more sensitized to potential stigmatizing experiences and pay attention to them more closely than others.

The story of the three, previously unknown, heroines of Hidden Figures, reminds us that stigmatization is universal, and while it has physical and psychological effects, we need to remember that coping mechanisms are available, whether they are physiologically regulated, emotionally regulated, or both.  If you haven’t had a chance to watch this film and are looking for inspiration, take a couple of hours and watch it. It will not disappoint!

Reference for the article discussed in this post:
Schrimpf, A., Kube, J., Neumann, J., Horstmann, A., Villringer, A., & Gaebler, M. (2017). Parasympathetic cardio-regulation during social interactions in individuals with obesity—The influence of negative body image. Cognitive, Affective, & Behavioral Neuroscience17(2), 330-347. DOI: 10.3758/s13415-016-0482-8.

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