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Primary Submission Category: Health equity
Food Embarrassment as a Social Driver of Health: Quantifying Its Independent Impact on Psychological and Cardiometabolic Outcomes
Authors: Brennan Rhodes-Bratton, Melody Goodman, Stephanie Cook, Jonathan Odumegwu, Adolfo Cuevas, Anna-Michelle McSorley, Saba Rouhani, Niyati Parekh,
Presenting Author: Brennan Rhodes-Bratton*
Background: Food embarrassment, the self-consciousness, shame, or anxiety due to perceived or actual judgment of food practices, is an understudied form of internalized stigma. Despite evidence that identity-based stigmas generate psychosocial stress, no study has quantified the independent health burden of food embarrassment among a racially diverse sample.
Methods: Data from the 2023 Survey of Racism and Public Health (N = 4,854) were analyzed using logistic regression to estimate associations between food embarrassment and four health outcomes: general self-rated health (SRH), chronic conditions, cardiometabolic health, and psychological distress. Models adjusted for subjective social status (SSS), food security, cumulative racial discrimination, and sociodemographics. Interaction terms tested for effect modification between race/ethnicity and cumulative discrimination.
Results: After full adjustment, food embarrassment was independently associated with poor SRH (OR=1.38, 95% CI: 1.15–1.64), cardiometabolic conditions (OR=1.33, 95% CI: 1.11–1.59), and psychological distress (OR=2.75, 95% CI: 2.31–3.28). The association with psychological distress was the largest observed and persisted after adjusting for SSS and food security, confirming food-specific embarrassment carries a burden distinct from generalized marginalization. SSS was inversely associated with all outcomes. Cumulative discrimination’s impact on SRH varied by race/ethnicity, while for distress, it showed a significant positive main effect. Very low food security was associated with 3.50 times the odds of psychological distress.
Conclusions: Food embarrassment is an independently consequential psychosocial stressor. Its health burden—most pronounced for psychological distress—is not reducible to social standing or material deprivation, establishing food embarrassment as a distinct contributor to health inequity that warrants dedicated public health attention.