Weight Stigma And Eating Behaviour Flashcards
What is weight stigma?
The negative attitudes held towards people who are overweight or obese and any subsequent prejudice and discrimination
Obesity in the UK in 2015
2/3 UK adults OW or OB
1 in 5 children in reception are OW or OB
1 in 3 children in year 6 are OW or OB
Puhl & Heuer (2009)
Strong negative attitudes towards people who are OW/OB
They are lazy, unintelligent, lack willpower and motivation
Prevalent in relationships, education, workplace, health services and media
Puhl, Andreyeva & Brownell (2008)
Weight stigma is second most common form of discrimination reported in women
Harrison et al (2016) weight stigma in children friends
Children in year 1
Read one of three books about Alfie and Thomas - Alfie is either OW/disabled or normal weight
Asked who they would rather be friends with
And give them attributes such as who has the most friends
Harrison et al (2016) weight stigma in children friends -results
When Alfie was normal weight, ratings between Alfie and Thomas did not differ and were equally chosen to be friends with
When Alfie was OW, he was rated as being less likely to win a race and as having fewer friends than Thomas and 42/43 chose to be friends with Thomas over Alfie
Cramer & Steinweight (1998) when do children start to discriminate?
Children of 3, 4 and 5 read a story
Jenny and Susan were building a sandcastle, Jenny said she likes Susan’s castle, Susan replies that she thinks Jenny’s castle is ugly
Asked which character was the mean one out of thin/OW/average, and asked to pair positive and negative attributes to the characters
Cramer & Steinweight (1998) when do children start to discriminate? - Results
OW character selected more than average and thin character as the mean person
As age increased from 3 - 4, there were more negative attributes and fewer positive attributes paired with the OW character
3 is the youngest that this weight stigma has been detected
Impact of weight stigma on children - teasing and bullying (Puhl, Peterson & Luedicke, 2013)
71% boys enrolled in weight loss programme reported being bullied
Impact of weight stigma on children - psychological health
Weight related teasing predicted lower self-esteem, lower body image and higher depressive symptoms, independent of BMI (Eisenberg et al, 2006)
Those weight-teased were 2 x more likely to think about a suicide attempt compared to those who were not (Eaton et al, 2005)
Impact of weight stigma on children - academic performance
Avoid school more (Puhl et al 2011)
Teachers rated heavier children’s academic performance to be worse than their results showed (Zavodny, 2013)
Giel et al (2010) - People who are OW or OB are…
Less likely to be offered jobs
Less likely to have managerial or professional roles
Less well paid (when controlling for education)
Are less likely to be promoted
Women are more affected than men
Nickson et al (2016) - workplace bias
Asked to assume they are a recruiter and need to hire someone for a customer or non-customer facing role
Told that all candidates hold the same skills and experience
Morphed faces to have non-OW or OW faces
Nickson et al (2016) - workplace bias - results
Non-customer facing roles, no differences in the hire ability of OW/non-OW
Customer-facing roles - ppts more likely to choose the non-OW person
Effect greater for females
Small changes in BMI affect hireability in customer facing roles
Phelan et al (2015) - health care environment
Blood pressure cuffs might be too small
Weighing scales and waiting room chairs may be too small
Can lead to unintended humiliation of ppts
Davis-Coelho et al (2000) - bias in psychologists
Psychologists rated OW patients as less likely to be compliant, expected to have more severe psychological problems and predicted a worse prognosis
Sabin, Marini & Nosek (2012) - health care bias
Strong implicit and explicit anti-fat bias in health care professionals even in HCPs who themselves are obese
Schwartz et al (2003) - explicit or implicit attitudes in health care
389 professionals who worked in obesity research or worked with OB people
Explicit attitudes and beliefs measured
Implicit association task used to measure implicit attitudes
Schwartz et al (2003) - explicit or implicit attitudes in health care - results
Explicit attitudes - OB rated as more lazy, stupid and worthless
Implicit attitudes - Significant implicit anti-fat bias
More likely to pair OW with negative attributes
Impact of weight stigma on health
Increased cortisol and BP (Puhl & Suh, 2015)
Avoid and delay using health care services (Mitchell et al, 2008)
Was due to negative weight-related experiences (Amy et al (2006)
Less likely to recall advice and follow instructions (Gudzune et al, 2013)
OW/OB patients are less likely to see weight loss support if they perceive judgement (Gudzune et al (2014)
People tend to believe that if they fat shame people….
It will motivate them to lose weight
Weight stigma can negatively impact
Food intake
Physical activity
Engagement in weight loss attempts
Schvey et al (2011) - stigmatising video
OW/ non-OW participants
Watched stigmatising or neutral video
Then provided with snacks and food intake was measured
Schvey et al (2011) - stigmatising video - results
Intake was 3x greater in the OW women in stigma condition compared to neutral
Gudzine et al (2014) - weight stigma on weight loss attempts
Online survey with 600 participants
Rated extent to which they believed their GP negatively judged their weight
Asked them how many times they have engaged in a weight loss attempt in the past year
Gudzine et al (2014) - weight stigma on weight loss attempts - results
Less weight loss attempts in ppts who perceived GP to negatively judge them
No differences in the actual weight loss observed
Causes of obesity
Social influences Individual psychology Food production Food consumption Biology Individual activity Activity environment
Complex interaction of a multitude of factors
Puhl & Brownwell, 2009 - attribution of blame to individual
Weight stigma occurs because blame is attributed to the individual
People who are OW or OB are perceived to be lazy and undisciplined
Belief persists despite the fact that the majority of the UK are OW or OB
DeJong (1993) - shifting of attributions
Watched video of woman who was overweight or normal weight
Half told she was overweight due to glandular disorder, others told nothing
Rated the woman on attributes
DeJong (1993) - shifting of attributions - results
Internal attribution - OW woman rated as more self-indulgent and less disciplined
External attribution - ratings did not differ between OW and normal weight woman
Pont, Puhl, Cook & Slusser (2017) - education and training
Educate health care professionals about causes of obesity
Make people aware of biases (IAT)
Used patient-centred, empathetic behaviour change approaches
Create safe and non-stigmatising environments in education and health care settings
Kushner et al (2014) - medical students
First year medical students
Explicit attitudes assessed before training
Training involved role playing with overweight patients and feedback
Practiced 4-6 times
Assessed explicit attitudes again
Kushner et al (2014) - medical students -results
Negative stereotypes significantly reduced from baseline to post-training
At 1 year follow up these had diminished
Regular training required
Crossman et al (2018) - dog study
Ppts viewed photo of overweight person with a dog, plant or nothing
Rated attitudes towards people who were overweight
Why use a dog in the study?
Dogs seen as positive so may lead to halo effect
Counter perceptions that OW people are lazy as they need to take the dog for a walk
Crossman et al (2018) - dog study results
No effect of dog on attitudes
Kyle & Puhl, 2014 - people first language
Avoids discrimination to people who are OW and OB
People with obesity rather than obese people
Avoids labelling people by their disease which can reinforce stigma
Google Scholar search - majority of studies use disease first language not people first (opposite to other health conditions)
Social facilitation of eating
When people eat in groups, they tend to eat more than when they eat alone
de Castro & de Castro (1989) - social facilitation
Asked participants to record a food diary of what types of food, how much and who they’re with
As the number of people increased, food intake increased
Meals eaten with others were 44% greater than when eating alone
Social correlation
As the number of people increased, food intake increased
Limitations with de Castro and de Castro (1989)
Self-report, may not be true
Alcohol intake could be causing the extra eating
Tend to eat with friends and family
Clendenen, Herman & Polivy (1994) - social facilitation experimental evidence
Students allocated to either solo eating, eating in pairs or eating in groups of 4
Also had some groups with people they knew and some with people they didn’t know
Provided with savoury and sweet snacks
Clendenen, Herman & Polivy (1994) - social facilitation experimental evidence results
When eating in pairs or a group compared to solo eating, significantly greater food intake
No difference between pairs or 4s
Doesn’t support social correlation
Intake does increase in the friend group from pairs to 4s
Effect was greater with friends than with strangers
Time extension theory - de Castro (1995)
Meals take longer in groups
More food cue exposure
Greater intake
Arousal theory - Zajonc (1965)
Groups leads to physiological arousal
Activate hunger?
Unlikely as arousal can also suppress appetite
Distraction theory - Bellisle (2001)
Not monitoring intake due to being distracted
Reduced awareness of being full
Modelling social others
The amount that social others are eating impacts the amount of food that we eat
Nisbett & Storms (1974)
When confederate eats large amounts, participants eat more
Conger et al (1980)
When a confederate eats small amounts, participants eat less
Attractive confederate affect intake - Pliner & Chaiken (1990)
Participants ate crackers with a male or female confederate
Women increased their intake when with unattractive male compared to attractive
Male there is no significant difference
Males and females ate less food when with opposite sex
Self-presentation/impression formation
Want to behave in a way that goes with our identity (small amounts of food to look feminine)
Descriptive social norms
Perceptions about what other people tend to do
Injunctive social norm
Perception of what others approve of
Perceived social norms
Refer to what we believe most other people do or approve of
Robinson, Fleming & Higgs (2014) - descriptive norms and vegetable intake
77 UG students
Allocated to descriptive norm or health message
Looked at vegetable intake at lunch
Robinson, Fleming & Higgs (2014) - descriptive norms and vegetable intake resulting
Descriptive norms increased vegetable intake for low vegetable consumers
Did not affect already high vegetable consumers
Thomas et al (2017) - restaurant study
Placed descriptive norm in 3 restaurants for 2 weeks
‘Most people here choose to eat vegetables with their lunch’
Outcomes = meals with vs without vegetables, pre-, during and post- intervention
Thomas et al (2017) - restaurant study - results
Significant increase in purchase of vegetables pre- and post- intervention
Thomas et al (2017) - restaurant study limitations
Not intake based but sales based
Wastage was not recorded
Don’t know what their vegetable intake was before
Stok et al (2014) - injunctive norms and eating behaviour
Highschoolers were allocated to descriptive, injunctive or control message
Self-report of fruit intake over 2 days
Stok et al (2014) - injunctive norms and eating behaviour results
Injunctive norm had no effect on fruit intake compared to control
Dynamic social norms
Information about how other people’s behaviour is changing over time
Sparkman & Walton (2017) - dynamic social norms
Online survey
Static norm
Dynamic norm ‘in recent years…’
Asked how interested they are in decreasing their most intake
Sparkman & Walton (2017) - dynamic social norms - results
Greater interest to reduce meat intake in the dynamic vs static condition
Remained significant when controlling for gender
Does interest translate into behaviour?
Explanation of why social norms work
Inform people about appropriate portion size (Robinson et al, 2015)
Limitations of social norms
Durability
Largely lab based - sets up uncertain situation, demand characteristics
Vartanian et al (2015) - limitation of social norms
Samples mostly young females
Males may be less influenced
High need for social acceptance (Robinson et al, 2011)
Low self-esteem and high empathy associated with modelling
Body weight on social norm
Greater modelling if the social other is the same weight as the participant
In vs out group
Undesirable outgroup norm = eating in unhealthy way = greater healthy eating in in group (Cruwys et al, 2015)
Obesity and SES
UK adults and children from lower-SES are 2x more likely to become obese than those from higher-SES groups
Darmon & Drewnowski (2008) - vegetables
Low-SES is associated with lower fruit and vegetable intake
Greater intake of high fat foods in ____ SES
Low
Greater screen time watching in ___ SES
Low
Wardle & Griffith (2001) - SES and weight loss attempts
Compared to high SES groups, low SES groups…
Reported lower weight loss attempts
Engage in less body monitoring
Engage in few restrictive dietary habits
Have greater body weight misperceptions - less likely to describe themselves as overweight
Relton et al (2014) - weight control strategies and SES
Survey in South Yorkshire
Higher SES group more likely to use a slimming club
Lower SES more likely to use medication
Buckland et al (2015)
Per calorie, nutrient-rich foods are more expensive compared to less nutrient-rich foods
Qualitative data - high-SES didn’t mention cost at all
Parementer et al (2000) - nutrition knowledge
UK women
SES impacted nutritional knowledge independent of education level
Maguire et al (2015) - proximal environment
More fast food outlets in deprived areas
Exposure mean people are more likely to eat them as it is what is in their environment
Food scarcity theory and energy regulation
Life-history theory (adapt to deprived environments)
Low-SES eat food when it is available
Do they eat more in the absence of hunger?
Hill et al (2016) - food scarcity and energy regulation
Arrived at the lab fasted Allocated to sprite or water 10 minute gap Given opportunity to eat as many cookies as they want Then assessed on their childhood SES
Hill et al (2016) - food scarcity and energy regulation results
High-SES = In sprite condition they consumed significantly less calories than in water condition
Low-SES = No difference in cookie intake regardless of whether they had had the sprite or water
Replicated results across 3 separate findings
Cardel et al (2016) - SES and stress
40 minute game of Monopoly
High social status = banker, start with $2000, $200 when passing go, roll twice per go
Low social status = start with $1000, $100 when passing go, roll once per go
Measured self-reported stress, heart rate via monitor
Outcome = lunch intake
Cardel et al (2016) - SES and stress - results
In high SES condition - ppts felt more pride and powerfulness
Had lower heart rate
Consumed 130kcal less than low SES condition (approached but not actually significant)
Suggests low-SES experience more stress and consume more food, could be reason low-SES eat more food
Social comparison theory
Compare and evaluate ourselves to others
Downward comparisons - boost self esteem, compare to those less fortunate
Upward comparisons - can be inspiring, can lead to increased drive to seek resources
Perceived relative deprivation
Perceptions of SES relative to social others (upward social comparisons)
Sim et al (2017) - PRD and portion sizes
Manipulated perceived wealth
Your bonus will be $850, colleagues bonus = $1500
Control = everyone gets $850
Measured desire for portion size at next meal
Sim et al (2017) - PRD and portion sizes - results
Greater selected portions in relatively deprived participants compared to control, even when controlling for negative mood
Cheon et al (2017) - PRD and food intake
Asked to compare themselves to either people lower than them or higher
Measured kcal consumed after this task
Cheon et al (2017) - PRD and food intake - results
Those in deprived situation consumed more kcal than those in the high situation and the control
Ego depletion theory
Self-regulation requires energy
Difficult decisions = energy
Less likely to make self-controlled decisions when resources have been depleted (bad day)
Low-SES have more difficult decisions throughout the day which means their resources are more depleted and therefore they have less self control
Prompts in the environment therefore take over their decisions
Crockett et al (2014) - SES and food labels
Least deprived vs most deprived ppts
Weight concern - high vs low
Labels low fat vs high fat vs no label
How is popcorn consumption affected?
Crockett et al (2014) - SES and food labels results
Higher-SES = calorie intake does not differ in any condition
Low-SES = those concerned about their weight, when there is no label they consume more food compared to when there is a high or low fat label
Issues researchers have with SES research
Participants are hard to recruit
Ahern et al (2014) - recruitment issues
Invitations sent by GPs in UK to patients with BMI > 28
Asked to take part in a weight loss programme (Weight Watchers)
SES assessed using postcodes
Patients in least deprived areas are more likely to enrol (8.5% vs 4.9%)
Chinn et al (2006) - drop outs
Low-SES are more likely to drop out of interventions
Future of SES research
Very early days
Need to use innovative approaches to recruit and retain ppts from low SES backgrounds
