Body mass index (BMI) and obesity have a complex relation with risk of dementia that evolves over the lifespan. Research in other domains indicates that the social experience of body weight, not just BMI, is associated with worse health outcomes. The present research uses data from the Health and Retirement Study (N = 12,053) to test whether weight discrimination is associated with increased risk of dementia over an up to 10-year follow-up independent of BMI and other relevant clinical and behavioral risk factors. Participants who reported weight discrimination had a 40% increased risk of incident dementia (Hazard Ratio = 1.40; 95% Confidence Interval = 1.12–1.74), controlling for age, sex, race, ethnicity, and education. The association between weight discrimination and incident dementia held controlling for BMI, diabetes, hypertension, depressive symptoms, smoking, physical activity, and genetic risk status. The present research indicates that the stigma associated with weight is associated with dementia risk independent from obesity. This research highlights that the detrimental effect of obesity on cognitive health in older adulthood may occur through the adverse social experience of body weight in addition to the biological consequences of excess weight.
Subscribe to Journal
Get full journal access for 1 year
only $64.42 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Rent or Buy article
Get time limited or full article access on ReadCube.
All prices are NET prices.
The association remained significant if waist circumference was used instead of BMI (HR = 1.44, 95% CI = 1.12–1.84; n = 11,047 due to missing data on waist circumference).
Kivimäki M, Luukkonen R, Batty GD, Ferrie JE, Pentti J, Nyberg ST. et al. Body mass index and risk of dementia: analysis of individual-level data from 1.3 million individuals. Alzheimers Dement. 2018;14:601–9.
Qizilbash N, Gregson J, Johnson ME, Pearce N, Douglas I, Wing K, et al. BMI and risk of dementia in two million people over two decades: a retrospective cohort study. Lancet Diabetes Endocrinol. 2015;3:431–6.
Wu YK, Berry DC. Impact of weight stigma on physiological and psychological health outcomes for overweight and obese adults: a systematic review. J Adv Nurs. 2018;74:1030–42.
Sutin AR, Stephan Y, Terracciano A. Weight discrimination and risk of mortality. Psychol Sci. 2015;26:1803–11.
Crimmins EM, Kim JK, Langa KM, Weir DR. Assessment of cognition using surveys and neuropsychological assessment: the health and retirement study and the aging, demographics, and memory study. J Gerontol B Psychol Sci Soc Sci. 2011;66(Suppl 1):i162–171.
Kessler RC, Mickelson KD, Williams DR. The prevalence, distribution, and mental health correlates of perceived discrimination in the United States. J Health Soc Behav. 1999;40:208–30.
Langa KM, Larson EB, Crimmins EM, Faul JD, Levine DA, Kabeto MU, et al. A comparison of the prevalence of dementia in the United States in 2000 and 2012. JAMA Intern Med. 2017;177:51–8.
Dutton GR, Lewis TT, Durant N, Halanych J, Kiefe CI, Sidney S, et al. Perceived weight discrimination in the CARDIA study: differences by race, sex, and weight status. Obesity. 2014;22:530–6.
Cheng G, Huang C, Deng H, Wang H. Diabetes as a risk factor for dementia and mild cognitive impairment: a meta-analysis of longitudinal studies. Intern Med J. 2012;42:484–91.
Tsenkova VK, Carr D, Schoeller DA, Ryff CD. Perceived weight discrimination amplifies the link between central adiposity and nondiabetic glycemic control (HbA1c). Ann Behav Med. 2011;41:243–51.
Robinson E, Sutin A, Daly M.Perceived weight discrimination mediates the prospective relation between obesity and depressive symptoms in U.S. and U.K. adults.Health Psychol. 2017;36:112–21.
Norton S, Matthews FE, Barnes DE, Yaffe K, Brayne C. Potential for primary prevention of Alzheimer’s disease: an analysis of population-based data. Lancet Neurol. 2014;13:788–94.
Kuiper JS, Zuidersma M, Oude Voshaar RC, Zuidema SU, van den Heuvel ER, Stolk RP, et al. Social relationships and risk of dementia: a systematic review and meta-analysis of longitudinal cohort studies. Ageing Res Rev. 2015;22:39–57.
Sutin AR, Stephan Y, Carretta H, Terracciano A. Perceived discrimination and physical, cognitive, and emotional health in older adulthood. Am J Geriatr Psychiatry. 2015;23:171–9.
Himmelstein MS, Incollingo Belsky AC, Tomiyama AJ. The weight of stigma: cortisol reactivity to manipulated weight stigma. Obesity. 2015;23:368–74.
Lupien SJ, de Leon M, de Santi S, Convit A, Tarshish C, Nair NP, et al. Cortisol levels during human aging predict hippocampal atrophy and memory deficits. Nat Neurosci. 1998;1:69–73.
Barnes LL, Lewis TT, Begeny CT, Yu L, Bennett DA, Wilson RS. Perceived discrimination and cognition in older African Americans. J Int Neuropsychol Soc. 2012;18:856–65.
Shankar A, Hinds P. Perceived discrimination: associations with physical and cognitive function in older adults. Health Psychol. 2017;36:1126–34.
Terracciano A, Stephan Y, Luchetti M, Albanese E, Sutin AR. Personality traits and risk of cognitive impairment and dementia. J Psychiatr Res. 2017;89:22–27.
Terracciano A, Sutin AR, An Y, O’Brien RJ, Ferrucci L, Zonderman AB, et al. Personality and risk of Alzheimer’s disease: new data and meta-analysis. Alzheimers Dement. 2014;10:179–86.
Research reported in this publication was supported by the National Institute On Aging of the National Institutes of Health under Award Number R01AG053297 and R03AG051960. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The Health and Retirement Study is conducted by the University of Michigan with funding from the National Institute on Aging (U01AG009740).
Conflict of interest
The authors declare that they have no conflict of interest.
About this article
Cite this article
Sutin, A.R., Stephan, Y., Robinson, E. et al. Perceived weight discrimination and risk of incident dementia. Int J Obes 43, 1130–1134 (2019) doi:10.1038/s41366-018-0211-1
Journal of Psychosomatic Research (2019)
Weight Bias Internalization as an Embodied Process: Understanding How Obesity Stigma Gets Under the Skin
Frontiers in Psychology (2019)