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
