Obesity

Question 1

1: Weight Stigma

Learning Outcomes

Answer 1

1. Define weight stigma and where weight stigma is found
2. Describe empirical examples of weight stigma in children and the impact it has on real world outcomes
3. Describe empirical examples of weight stigma in the workplace and health settings
4. Describe the impact weight stigma has on pro-health behaviours
5. Critically evaluate research on weight stigma
6. Identify the main explanation for weight stigma
7. Identify strategies to reduce weight stigma

Question 2

1: Weight Stigma

What is weight stigma?

Answer 2

Definition: weight stigma refers to the negative attitudes held towards people who are overweight or obese and any subsequent prejudice and discrimination

For example: characters in films who are overweight are often portrayed as, in the case of female characters, masculine, non-sexual, the “side-kick”, the “funny one“ and in general just as negative characters – Miss Trunchbull, Marge Dursley, “Shallow Hal”, Megan in Bridesmaids. These negative portrayals can also be seen for male characters – Norbit, Jurassic Park

Question 3

1: Weight Stigma

Obesity in the UK

Answer 3

In the UK in 2015:
• 2/3rds of UK adults were overweight or obese
• In children:
1 in 5 children in reception were overweight or obese
1 in 3 children in year 6 were overweight or obese
• Obesity can lead to a number of chronic diseases including Type II diabetes, coronary heart disease and cancer
• Affects quality of life and wellbeing

Question 4

1: Weight Stigma

What kind of stigmatised views do people hold?

Where are they found?

Answer 4

There are strong negative attitudes towards people with obesity e.g. unintelligent, lazy, undisciplined, lack willpower and motivation

Weight stigma is the second most common form of discrimination reported by women

Found in personal relationships, education, the workplace, health care and the popular media

Question 5

1: Weight Stigma

Weight stigma in children: Study

Answer 5

Harrison et al. (2016)

Participants:
- 126 school children (50% females; mean age: 5.3 years) from 4 UK schools

Methods:

• Read one of three story books about Alfie and Thomas
• Gave ratings of Alfie and Thomas on attributes (e.g. who is more friendly) and who they would choose to be friends with (Alfie or Thomas)
• Alfie’s weight fluctuated and thomas’ remained thin and constant

Findings:

• When Alfie was a healthy weight, ratings between Alfie and Thomas did not differ (p = ns).
• When Alfie was a healthy weight, Alfie and Thomas were equally chosen to be friends with.
• When Alfie was overweight, he was rated as being less likely to win a race and as having fewer friends compared to healthy weight Thomas (p < .01).
• When Alfie was overweight, 42 out of 43 children chose to be friends with Thomas.

Conclusion:
- When forced to choose, children preferred to be friends with a healthy weight child compared to a peer who was overweight

Question 6

1: Weight Stigma

Impact of weight stigma on children

Answer 6

Teasing and bullying:
- 71% of boys enrolled in a weight loss programme reported weight-based teasing and bullying

Psychological health - Weight-based teasing:

• Predicted lower self-esteem, lower body image and higher depressive symptoms
• victims 2 times more likely to think about a suicide attempt compared to those not weight-teased

Academic performance:

• Avoid school
• Teachers rated heavier children’s academic performance to be worse than their test results showed

Future weight status:
- Project EAT-IV
Longitudinal 15-year study (n = 1830, M: 15 years).
- Weight-based teasing predicted binge eating, weight gain and obesity 15 years later (even after controlling for starting BMI)

Question 7

1: Weight Stigma

Weight stigma in adults

The workplace

Answer 7

Weight status is a source of discrimination and prejudice in the workplace, especially for women

Nickson et al. 2016

Study:
- “Assume you are a recruiter and need to hire someone for a customer facing and non-customer facing role. All candidates hold the same skills and experience.
Who would you pick?”
- Pick of thin person and same person morphed to be a higher BMI
- Laboratory study with 120 participants (50% female)

Results:

• For non-customer facing jobs, weight status did not significantly affect hiring.
• For customer facing jobs, participants were more likely to hire non-overweight Vs overweight candidates – this effect was stronger for the female faces than female

Means:
- even slight changes in weight can affect job selection, even if in a healthy BMI, effect is worse for women

Question 8

1: Weight Stigma

Healthcase

Answer 8

Weight stigma in health care environments:
- Blood pressure cuffs, weighing scales and waiting rooms chairs can be too small

Weight stigma in health care practitioners

• Health care practitioners perceive patients with obesity to be “weak-willed, sloppy and lazy” and “awkward, unattractive, ugly and non-compliant”
• Strong implicit and explicit anti-fat bias in health care practitioners

Schwartz et al (2003)

Study:

• 389 obesity professionals
• Looked at:
  1) Explicit attitudes and beliefs (7-point scales)
  2) Implicit Association Task (reaction times to stimuli, faster with congruent stimuli with regards to own views)

Found:

1) Explicit Attitudes
- Rated as more lazy, stupid (both ps

Question 9

1: Weight Stigma

Impact of weight stigma on patients

Answer 9

• Increased cortisol and blood pressure
• Avoid and delay using health care services:
  Less likely to attend cancer screenings
• Less effective communication - less likely to recall advice and follow instructions

Question 10

1: Weight Stigma

Impact of weight stigma on pro-health behaviours

Answer 10

Weight Stigma and Food Intake

Methods:
Women (n = 74; overweight Vs non-overweight) watched stigmatising video Vs neutral video and were then provided with snacks

Results: Intake was 3x greater for overweight women in stigma condition compared to those in the neutral condition

Question 11

1: Weight Stigma

Explanations for weight stigma - attributing blame to the individual

Answer 11

Attribution of Causality - weight stigma occurs because blame is attributed to the individual

People with obesity are perceived to be lazy and undisciplined. This belief persists despite the majority of the UK having a BMI that is overweight or obese.

Question 12

1: Weight Stigma

What happens if external attributions are made?

Answer 12

DeJong, 1993

Methods:
- 168 high-schoolers rated healthy Vs overweight woman.
• Said the people being rated were overweight due to either an internal Vs external cause.

Results:
• Internal attribution - Woman who was overweight was rated as more self-indulgent and less disciplined
• External attribution - Ratings did not differ between the overweight and healthy-weight woman.

Question 13

1: Weight Stigma

How can weight stigma be reduced?

Education and training

Answer 13

Training for health care professionals

• educate health care professionals and educators about the causes of obesity
• make people aware of the anti-fat biases they hold (IAT test)
• use patient-centred, empathetic behaviour change approaches
• create safe and non-stigmatising environments in education and health care settings

Kushner et al. (2014) – Impact of education

Study:

• First year medical students (n = 127; 47% females). Rated explicit attitudes pre- and post-training.
• Training: Patient training role playing scenarios with overweight patients –> received feedback –> Practised 4-6 times

Found:

• Negative stereotypes significantly reduced from baseline (2.31±0.55) to post-training (2.18±0.57), p=0.002
• However, the effect diminished at 1 year follow up

Study limitations:
- Based on explicit attitude measures – would all attitudes be expressed openly/ salient? More research is needed.

Question 14

1: Weight Stigma

How can weight stigma be reduced?

People-first language

Answer 14

• Avoids discrimination to people with obesity
• ‘People with obesity’ rather than ‘obese people’
• Avoids labelling people by their disease which can reinforce stigma
• Disease first language is more common for obesity than other diseases.

Google scholar search – more hits for disease-first language compared to people first language – opposite for autism asthma and diabetes.

Question 15

1: Weight Stigma

Summary

Answer 15

• Weight stigma is wide spread and is found in multiple settings (personal, media, education workplace and health)
• In children, weight stigma leads to bullying and impacts socialising and academic performance
• In adults, weight stigma affects employment and health (physical, care seeking, communication, pro-health behaviours)
• Attributing blame to the individual is one of the main reasons for weight stigma
• Education and respectful language are needed to move away from weight stigma but there is still a lot to be done!

Question 16

2: Social Influences and Eating Behaviour

Learning outcomes

Answer 16

1. Define social facilitation (SF), modelling and social norms (dynamic, descriptive and injunctive) related to eating behaviour
2. Critically evaluate different methods used to investigate social influences on eating behaviour
3. Describe and evaluate studies that have investigated the impact of social influences on eating behaviour
4. Recognise that the impact of social influences on eating can be affected by individual differences
5. Identify explanations for the impact of social influences on eating behaviour (SF, modelling and social norms)

Question 17

2: Social Influences and Eating Behaviour

Social facilitation of eating

Definition

Answer 17

Social Facilitation - “When people eat in groups, they tend to eat more than they do when alone” Hermans et al 2003

Question 18

2: Social Influences and Eating Behaviour

Social facilitation of eating

Study 1: De Castro & De Castro (1989)

Answer 18

STUDY: De Castro & De Castro (1989)

Correlational study

Study:
Asked ppts to record food intake for 7 days whilst also recording social setting

Found:

• “social correlation” – as the number of people increased, food intake increased (r=.4)
• Meals eaten with others were 44% greater (weighed on a scale) compared to eating alone.

This conclusion is supported by multiple studies

Limitations:

• Self-reported eating behaviour
• Correlational data – another factor/ non-social explanation at play?
• Alcohol intake increased food intake
• Tend to eat with family & friends – might choose to eat with people who have similar tastes and eating habits rather than the other person influencing one’s own eating habits to be similar to theirs

Question 19

2: Social Influences and Eating Behaviour

Social facilitation of eating

Study 2: Clendenen et al 1994

Answer 19

Experimental evidence

Remember: Experimental studies allow for the random allocation of participants to either solo or social conditions.

Key Questions to Consider…

a) Is social facilitation found under controlled laboratory procedures?
b) Do the effects extend when eating with strangers?

Clendenen et al 1994

Study:
120 students allocated to one of three conditions:
i. Solo eating
ii. Eating in pairs
iii. Eating in groups of 4
(With friends vs strangers)
- Provided with both savoury and sweet snacks

Found:
> IV 1: Social Environment (Solo vs Social)
- Greater intake in the pairs and 4s compared to solo eaters (90%more), no significant difference between pairs and 4s
> IV 2: Familiarity with Others (Strangers vs Friends)
- Greater oreo intake amongst friends (in both pairs and 4s) compared to strangers in pairs and 4s

Limitations:

• Baseline hunger levels? Were some people just hungrier than others?
• Levels of friendship?
• Snack fondness? – what if they didn’t like oreos?
• What about the findings with savoury snacks?

Question 20

2: Social Influences and Eating Behaviour

Explanations for social facilitation (4)

Answer 20

1) Time Extension Theory (De Castro 1995)
- Meals take longer in groups -> more food cue exposure -> greater intake

2) Arousal (Zajonc, 1965)
- Increasing physiological reaction, activate appetite? (unlikely as arousal tends to suppress appetite)

3) Distraction
- Not monitoring intake (Bellisle, 2001)
- Reduced awareness of fullness

4) Modelling *** (separate card)

Question 21

2: Social Influences and Eating Behaviour

Explanations for social facilitation - Modelling

Answer 21

The amount social others eat impact the amount eaten, studies use confederates that either eat a small or large amount.

• When a confederate eats large amounts, participants eat more (Nisbett & Storms, 1974)
• When a confederate eats small amounts, participants eat less (Conger et al., 1980)

Question 22

2: Social Influences and Eating Behaviour

Does it matter who the confederate is?

Does an attractive peer influence intake?

Pliner & Chaiken (1990)

Answer 22

Does an attractive peer influence intake?

Pliner & Chaiken (1990)

Study:
- Ppts ate crackers with a confederate (m/f; attractive/unattractive). - Confederate ate 15 crackers.

Found:
- Female participants ate less in the company of an attractive male

Means:
- Self-presentation –
“Eat less to display a feminine social identity”

Limitations:

• Were all female ppts straight? They might have expressed explicitly that they found the male attractive but didn’t share the same implicit view.
• Attractiveness is a really subjective quality
• Why did male ppts eat more in the company of an attractive confederate? NS – retest?

Question 23

2: Social Influences and Eating Behaviour

Recap: Difference between social facilitation of eating behaviour and modelling of eating behaviour

Answer 23

Recap: Remember the difference

Social facilitation of eating behaviour – it is easier to eat more when not eating by oneself

Social modelling of eating behaviour – the impact one person’s eating has on another, namely one person modelling the others eating behaviour

Question 24

2: Social Influences and Eating Behaviour

Perceived Social Norms: Descriptive Vs Injunctive

Answer 24

Perceived social norms: refer to what we believe most other people do or approve of

Descriptive perceived social norm – perceptions about what other people tend to DO

Injunctive perceived social norms – perceptions about what other people tend to APPROVE OF

Question 25

2: Social Influences and Eating Behaviour

Do descriptive social norms influence eating behaviour?

Reading paper: Robinson, Flemming and Higgs (2014)

Answer 25

Robinson, Flemming and Higgs (2014): Descriptive Norms and Vegetable Intake

Study:

• 77 UG students allocated to one of two conditions: descriptive norm vs health message
• DN: “Most students eat more vegetables than you’d expect. The typical student eats over three servings of vegetables each day (according to a 2011 study).”
• HM: “A lot of people aren’t aware that heart health and cancer risk can be improved by eating over three servings of vegetables each day”
• Outcome measured by vegetable intake at lunch.

Found:

• Compared to the health message, the descriptive norms message increased vegetable intake for low vegetable consumers.
• No difference for high vegetable consumers.

Limitations:

• No control group to compare effect of health message
• Long term effects on food intake unknown
• Ppts likely of higher SES than UK average (uni students) – low SES correlates with low fruit and veg consumption, so would be ideal target group
• Ppts on diets? Differences in responsiveness to messages
• Little variability in ppt BMI, majority of the UK is overweight – generalisability?
• Mainly female sample – females more susceptible to social norms regarding eating behaviour (see above)
• Norm reference group – ppts exposed to messages on other students habits, changing the norm reference to habits of the UK overall/all young people etc could be informative of the scale these norm messages can be used on

Question 26

2: Social Influences and Eating Behaviour

Do descriptive social norms influence eating behaviour?

Thomas et al (2017) - Real world settings

Answer 26

Thomas et al (2017) - Descriptive Norms and Vegetable Intake IRL

Study:

• UK workplace restaurants put out flyers with a DN message for two weeks:
• “Most people here choose to eat vegetables with their lunch”
• Measured meals with vs without vegetables, pre-during and post- intervention.

Found:
- Significant increase (7%) in purchase of vegetable meals pre- to post-intervention

Limitations:

• Based on the purchase of meals with vegetables, not the amount actually eaten
• Whose intake increased? –> Demographic information not available, high consumers or low consumers?

Question 27

2: Social Influences and Eating Behaviour

Do injunctive social norms influence eating behaviour?

Stok, de Ridder, de Vet & Wit (2014) - Injunctive Norms and Fruit intake

Answer 27

Stok, de Ridder, de Vet & Wit (2014) Injunctive Norms and Fruit intake

Study:

• 96 high school students allocated to one of three conditions:
  i) Descriptive norm (do)
• “A majority of high school students try to eat sufficient fruit”
  ii) Injunctive norm (approve of)
• “A majority of high school students thing other high school students should eat sufficient fruit”
  iii) Control message
• “Healthy eating style reduces the risk of developing several serious diseases like diabetes and coronary diseases”

Measured self-reported fruit intake over 2 days

Found:
- The injunctive norm message had no effect on fruit intake compared to control. Descriptive norm had an effect.

Question 28

2: Social Influences and Eating Behaviour

Dynamic social norms

Answer 28

Dynamic social norms: Information about how other people’s behaviour is changing over time

Question 29

2: Social Influences and Eating Behaviour

Do dynamic social norms influence eating behaviour?

Sparkman and Walton (2017)

Answer 29

Sparkman & Walton (2017) - Meat consumption

Study:
- Online survey of 118 participants (75 men)
> Messages:
- Static Norm (Control): “3 in 10 people eat less meat than they otherwise should”
- Dynamic Norm: “In recent years, 3 in 10 people have changed their behaviour and begun to eat less meat than they otherwise would”
- Outcome:
How interested are you in eating less meat?

Found:
- More reported interest in reducing meat intake for dynamic norm condition

Limitations:

• Do interests translate to intentions/ behaviour?
• More research needed

Question 30

2: Social Influences and Eating Behaviour

Explanations and Limitations of Social Norms in explaining eating behaviour

Answer 30

Explanations for the effects of social norms:
• Inform people about appropriate portion size (Robinson et al. 2015)

Can we apply findings to public health interventions? Can we use social norms to solve r.w.i?

Limitations:

• Durability? Unsure how long the effects of social norm messages last, studies investigate the short term – are the changes long lasting?
• Largely laboratory studies
• Uncertain situations – can make social norms more salient, maybe would use social influence so much in normal situations
• Demand characteristics – suspicious about what the researchers are looking at, could affect eating behavior in the studies
• Sample – young females – males less influenced? (Vartanian et al., 2015) – need to run more studies with diverse samples to account for gender differences

Question 31

2: Social Influences and Eating Behaviour

Social Influences and Individual Differences on Eating Behaviour

Answer 31

Is everyone’s eating behaviour affected by social influences? Not everyone responds to social influences in the same way

The effect of social influences can vary depending on:

1. High need for social acceptance
   • Low self-esteem and high empathy associated with greater modelling (Robinson et al., 2011)
2. Body weight
   • Greater modelling if the social other is the same weight as the participant, more likely to model a social other that is similar in weight to ourselves
3. In- Vs out-group
   • Undesirable outgroup norm = unhealthy eating = greater healthy eating
   • Outgroup norm = healthy eating = less likely to eat healthily
   More influenced by members of our own ingroup

Question 32

2: Social Influences and Eating Behaviour

SUMMARY

Answer 32

• Critically reviewed evidence for the effect of social facilitation, modelling, and norms on eating behaviour
• Considered methods – correlational, experimental (including use of confederates, normative information) and intervention
• Considered explanations for each type of social influence
• The effect of social norms can depend on the type used (descriptive more effective than injunctive)
• The impact of social influences on eating behaviour can vary depending on a number of individual differences

Question 33

3: Social Inequalities and Obesity

Learning objectives

Answer 33

1. Recognise that there are social inequalities in obesity
2. Consider explanations and empirical evidence that has investigated different types of socioeconomic status (SES; actual and perceived) and obesity
3. Consider how weight management strategies differ between low and high SES groups
4. Identify methodological barriers in SES research

Question 34

3: Social Inequalities and Obesity

Inequalities in Health and Obesity

Answer 34

The main determinants of health (Dahlgren & Whitehead, 1992) – covered in Dr Jilly Martin’s lectures

DIAGRAM

Question 35

3: Social Inequalities and Obesity

Socioeconomic Status and Obesity

Answer 35

Definition: ‘Socioeconomic status is the social standing or class of an individual or group. It is often measured as a combination of education, income and occupation.’ – APA

UK adults and children from lower socioeconomic status groups (SES) are 2 times more likely to become obese than those from higher SES groups. There are social gradients in obesity.

Question 36

3: Social Inequalities and Obesity

Explanations for the Inequalities in Health and Obesity

Diet Quality

Answer 36

Low SES is associated with

• lower fruit and vegetable intake
• greater intake of fat foods
• greater screen time watching (sedentary behaviour/ low physical inactivity)

Question 37

3: Social Inequalities and Obesity

Weight control attempts

Wardle and Griffith (2001)

Answer 37

Wardle and Griffith (2001)

Study:
- Aim: To assess SES and attitudes to weight control
Surveyed 1790 UK adults (SES determined by occupation).
- Measured:
i) Weight control behaviours (e.g. ‘trying to lose weight’, ‘not bothered about my weight’, ‘limit fat intake’).
ii) Self-reported height and weight
iii) Perceived weight status (‘very underweight’ to ‘very overweight’)

Found:
Compared to high SES groups, low SES groups:
- Less likely to be trying to lose weight
- Less engaged in less weight control behaviours (e.g. self-weighing)
- Less engaged in restrictive dietary habits
- More likely to have greater body weight misperceptions - less likely to describe themselves overweight – social norms for people in low SES areas, more overweight people in the area creates a skewed norm

Limitations:

• Self-reported height and weight – might under or overestimate, classifications of weight status were based on this
• Weight status was unreliable – in order to try and lose weight, unhealthy weight statuses must be salient to the individual

Question 38

3: Social Inequalities and Obesity

Weight control strategies

Relton et al (2014)

Answer 38

Relton et al (2014)

Study:

• Investigated the use of commercial weight management programmed by high and low SES groups
• Survey of almost 28,000 adults in South Yorkshire.

Found:
- Higher SES group more likely to use a slimming club e.g. weight watchers. Lower SES more likely to use medication.

Question 39

3: Social Inequalities and Obesity

Why are there SES differences in diet?

Answer 39

1. Per calorie, nutrient-research foods are more expensive compared to less nutrient-rich foods (Buckland et al. 2015)
   - Pricing of foods. People from low SES groups may not have the money to buy nutrient rich food that high SES groups do.

Evidence:
Qualitative data: Interviews “What are the barriers to eating healthily?”
High SES – cost was not mentioned
Low SES: “Sometimes vegetables can be really expensive… ”
“Yeah, mostly greasy food. It’s more cheap and easy. Chips, sometimes pizza slices.”

2. Nutrition knowledge
   - Differences in knowledge of nutrition between SES groups.

Evidence: 
UK women (n = 1040) Quiz on nutritional knowledge 
SES impacted nutritional knowledge independent of education levels (Parementer, Waller & Wardle, 2000) – lower SES = lower knowledge 

3. Proximal environment
   - Availability of health food outlets/ shops - constant exposure to unhealthy food cues
   - More fast food outlets in deprived areas (e.g. Maguire, Burgoine & Monsivais, 2015)

Question 40

3: Social Inequalities and Obesity

Food Scarcity, SES and Intake

Food Scarcity and Energy Regulation

Life History Theory

Answer 40

Food Scarcity and Energy Regulation

Life-history theory (bodies gradually adapt to deprived environment) – no longer regulated by internal appetite system, override sensations of hunger and fullness, eating driven by the food available – eat as much as possible when food is available, so it lasts when not available. More likely to eat when not hungry.

Low SES
- eat when food is available.
(If a kid grows up in an environment where food isn’t readily available, they adapt to the environment so that when food becomes available they eat large volumes and opt for high-fat foods)
• Impact appetite control later in life in food rich environments?
• Are low SES more likely to eat in the absence of hunger?

Question 41

3: Social Inequalities and Obesity

Food Scarcity, SES and Intake

Food Scarcity and Energy Regulation

Life History Theory - STUDY

Hill et al (2016)

Answer 41

Hill et al (2016) - Food scarcity and energy regulation with regards to SES

Study:

• Ppts turned up to lab study in a fasted state – controlled for pre-existing hunger levels.
• Randomly allocated to receive a sprite (calorie containing drink) or water (calorie deficient drink).
• Assessed childhood SES (up to 12 y/o).
• Participants: 60 women with body mass indices of <30kg/m2

Would expect that those who had sprite would consume fewer cookies. May differ between the low and high childhood SES groups.

Found:

• High SES: After the sprite, they consumed fewer cookies than those who had water – responsive to appetite signals
• Low SES: Consumed the same number of calories in the sprite and water conditions – unresponsive to internal appetite signals

Limitations:
• Sprite is sweet – maybe low SES ppts aren’t as responsive to the sweetness of the drink, compared to the high SES group

Question 42

3: Social Inequalities and Obesity

Socioeconomic Status and Stress

Cardel et al (2016)

Answer 42

SES, Stress and Food Intake

Those of low SES likely experience higher general levels of stress in day to day life (e.g. how to manage the resources available to them) and this may go on to effect their coping mechanisms, health choices and eating habits

Cardel et al (2016) - SES, Stress and Food Intake in a Monopoly Pilot Study

Study: 
- Forty-minute game of Monopoly (9 participants):
- High social status:
	Start with $2000
	$200 passing Go
	Roll twice per go
	Banker
- Outcome: Measured calorie intake a lunch 

Found:
- High SES –
• Ppts felt more pride and powerfulness (p

Question 43

3: Social Inequalities and Obesity

Social Comparison Theory

Answer 43

How we compare and evaluate ourselves, our opinions and behaviours against others. A regular thought process everyone engages in.

Upward social comparisons
- Can be inspiring
- Can create discomfort if that comparison feels unreachable – can lead to increased drive to seek resources, maybe material or food, may lead to weight gain
…Can go either way

Question 44

3: Social Inequalities and Obesity

Social Comparison Theory

SES and Upward Social Comparisons

Answer 44

Possible that those in low SES situations have salient perceived relative deprivation
- Perceptions of socioeconomic status relative to social others (upward social comparisons)

They are aware of their position economically, and that others have a lot more than them
- Compensate with increased food intake?

This is measured in research via perceived relative deprivation rather than actual SES differences e.g. in games or made-up scenarios.

Question 45

3: Social Inequalities and Obesity

Social Comparison Theory

SES and Upward Social Comparisons

Sim, Lim, Forde and Cheon (2017)

CORE READING

Answer 45

Sim, Lim, Forde & Cheon, (2017) Perceived Relative Depravation and Portions CORE READING

Study:
- Method: Based in Singapore, manipulated perceived relative wealth:
- Had to read a scenario about a bonus at work -
• Your bonus = $850; Colleagues’ bonus = $1500
• Control: everyone received $850
- Outcome measure: Asked to select portion size for next meal

Found:
- Greater selected portions in deprived participants compared to control, even when controlling for negative mood, p=.04, possibly to compensate for the feeling of being deprived.

Another study (Cheon et al 2017) reported similar
findings on overall food intake
- Presented ppts with a (social) ladder, imagine you’re at top or bottom of ladder. Given snacks. Low SES consumed more calories.

Question 46

3: Social Inequalities and Obesity

Ego Depletion

Answer 46

The idea that those from low SES groups have fewer cognitive resources compared to those from high SES groups.

• Self-regulation requires energy
• Difficult decisions = energy
• Poverty – more difficult decisions
• For low SES, external cues may prompt self-regulation when resources are low (more likely to pick foods that you wouldn’t usually/ when self-regulation is at it’s highest – higher calorie, fattier foods).

Question 47

3: Social Inequalities and Obesity

Ego Depletion

SES and Food Labels - External Cues

Crockett, Jebb, Hankins and Marteau (2014)

Answer 47

SES and Food Labels – External Cues

Crockett, Jebb, Hankins & Marteau (2014) - SES and popcorn consumption in a cinema

Study:
• 287 participants (35% males)
• Recruited ppts from the least deprived Vs most deprived areas of London
• Asked about weight concern of ppts - high Vs low
• Measured popcorn intake in the cinema (label: low Vs high fat, Vs no label)

Found:
- High SES group –
no difference in popcorn intake between conditions (label vs no label)
- Low SES group –
> No label group: ppts who were concerned about weight consumed sig. more popcorn compared to those who had a label on their popcorn

So perhaps for low SES individuals, without the label/ external cues there is little self-regualtion, so eat more than others. When provided with a label, able to self-regulate popcorn intake.

Question 48

3: Social Inequalities and Obesity

Methodological Barriers in SES Research

Answer 48

This area is really under-researched as it’s difficult to recruit and retain participants from low SES backgrounds

1. Recruitment Issues

Ahern et al., (2014)
Study:
- GPs sent out invitations for trial in the UK to patients with BMI> 28 kg/m2 for a coommercial weight loss programme (Weight Watchers). SES assessed using postcodes:

Found:
- Patients in least deprived areas more likely to enrol
High SES: 8.5% enrolled
Low SES: 4.9% enrolled

Low SES are also more likely to drop out of interventions (Chinn et al., 2006)

2. Future SES Research

• Very early days of research in this area
• Need to use innovative approaches to recruit and retain participants from low SES backgrounds
• SES is a growing research topic

Question 49

3: Social Inequalities and Obesity

SUMMARY

Answer 49

• Children and adults from low SES are twice as likely to obese compared to those from high SES
• Nutritional knowledge, sedentary behaviours, the food environment, cost and attitudes to weight control behaviours may partly explain social inequalities in obesity
• More broadly, inequalities may also be explained by appetite control (life-history theory), stress, cognitive resources (ego depletion) and social comparisons
Under researched area that is challenging to conduct.