Weight loss remains one of the most common health concerns for patients seeking alternative healthcare and one of the most difficult to successfully address. Losing weight should be simple, even without the added benefits that natural treatment can offer, and yet this is rarely the case in practice, especially with female patients. Many women seem well-aware that losing weight is harder for them than it is for the men in their lives. It is a common experience for a couple to embark on a weight loss journey together, doing the exact same things, and for the male partner to experience faster, and what seems comparatively effortless, results. There are many speculated causes for this, most of them having to do with the role of female hormones. There are entire weight loss plans tailored specifically for women’s bodies and women’s hormones, and while balancing hormones can certainly help with weight loss in some cases, in other cases female patients find they continue to struggle. There may be yet another nuance to the hormonal equation that is needing to be addressed, and surprisingly it may involve not physical or even strictly mental, but social determinants of health. Remarkably, research is finding that a woman’s self-reported social status is a powerful determinant of her body weight. Even more interestingly, this phenomenon seems to affect women much more than men.
A study found that middle-aged women who identified as “working class” gained significantly more weight over a two-year period than women who identified as “middle” or “upper” class1. In itself, this study does seem remarkable, because there are many barriers to weight loss which might affect working class people disproportionately. Anyone skeptical that social class itself can make you gain weight, as opposed to something correlated therewith, might suggest that socioeconomically disadvantaged people simply have less access to healthy food (i.e. more likely to live in food deserts), less money to purchase healthier foods, less free time to exercise, are more likely to live in dangerous neighborhoods which can discourage exercising outdoors, may have less education to make healthy choices, be less served by healthcare systems, etc. Poverty in general increases one’s risk of obesity, a phenomenon which has been noted worldwide, and all these reasons above have been explored, cited, and in some cases proven to explain why poorer people struggle with obesity more than wealthier people. There does, however, seem to be an additional factor related specifically to one’s social class, and not any factors correlated with it. Furthermore, it seems to affect women disproportionately.
If all the above-cited reasons could explain why low social status seems to complicate weight loss efforts, or lead to weight gain, we would expect obesity rates in economically disadvantaged women to be exactly the same as the rates in economically disadvantaged men, since both men and women in these situations would be faced with the exact same barriers. Both men and women would face the same cortisol-raising stresses associated with poverty, dietary issues, etc. However, a remarkable study found that this is not the case, and that socioeconomic status affects the body weight of men and women in completely different ways2. Specifically, men are more likely to be overweight as adults if they face socioeconomic challenges as adults. This makes perfect sense, for all the reasons cited above, but interestingly this was found to be less true for women. What most accurately predicted women’s body weight as adults was not their current socioeconomic status, but the social status of the family they were raised in as children. Amazingly, the study found that women who were raised in poor families had higher BMIs independent of whatever status they were able to achieve as adults, meaning a middle-class woman who was raised poor is more likely to be obese than a poor woman who was raised middle-class. Astoundingly, the same finding does not apply to men.
Whatever causes women who were raised in deprived backgrounds to gain weight more easily must have little or nothing to do with money, because it continues to affect these women into adulthood even if they ascend the socioeconomic ladder. Our experiences in childhood can be very powerful when it comes to determining our self-image and self-worth, and it seems possible that feelings of low self-worth are tied directly to an inability to lose weight in women. When weight gain is explored as a psychological issue, something not merely physical or diet-related, deeper emotional issues can sometimes surface. This can go beyond simply eating as a way to cope with anxiety or depression: research has found that experiencing childhood abuse increases one’s risk of becoming an obese adult, even when controlling for socioeconomic status, and again that this effect is more pronounced in women3. Women with internalized feelings of shame or a lowered sense of self-worth, whether due to family background, past trauma, or any other cause, may self-sabotage until their appearance comes to reflect how they feel inside. Women who are uncomfortable receiving attention from the opposite sex may gain weight as a way to “hide” themselves from men. The mind exerts a very powerful effect on the body, and patients who are doing everything right and still struggling to lose weight may need to explore whether they feel they truly deserve the body they want, and if low self-worth from whatever cause is posing an obstacle to the confidence, belief, and motivation that typically accompanies any successful endeavor. Although research suggests this may impact women more, such feelings should also be considered in male patients as well.
While you cannot change a patient’s socioeconomic status, it seems likely that the self-worth we derive from the way we are treated by our society, and not our actual income or choice of career, is what truly matters. There are of course many people who seem perfectly happy with less, and some who remain miserable no matter how much they have, so the important thing would seem to be instilling a sense of value and confidence in patients. Most people fundamentally know how to lose weight, and while there is obviously a place for dietary counseling and holistic treatment approaches to support healthy insulin, cortisol, and thyroid hormone levels, one of the most valuable things we can offer to patients is simply motivation. Conventional medicine often frightens patients, with ominous forebodings of premature heart disease and missing time with grandchildren, and this does often succeed in motivating patients to make health changes, though often too late. A more effective approach might be to inspire hope instead of resorting to fear, and this may involve exploring and healing past trauma.
1 Williams L, Germov J, Young A. The effect of social class on mid-age women's weight control practices and weight gain. Appetite. 2011 Jun;56(3):719-25. doi: 10.1016/j.appet.2011.02.009. Epub 2011 Feb 17. PMID: 21333702.
2 Giskes K, van Lenthe FJ, Turrell G, Kamphuis CB, Brug J, Mackenbach JP. Socioeconomic position at different stages of the life course and its influence on body weight and weight gain in adulthood: a longitudinal study with 13-year follow-up. Obesity (Silver Spring). 2008 Jun;16(6):1377-81. doi: 10.1038/oby.2008.54. Epub 2008 Mar 20. PMID: 18356832.
3 Danese A, Tan M. Childhood maltreatment and obesity: systematic review and meta-analysis. Mol Psychiatry. 2014 May;19(5):544-54. doi: 10.1038/mp.2013.54. Epub 2013 May 21. PMID: 23689533.