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Puhl R, Brownell KD. Bias, discrimination, and obesity
Abstract
This article reviews information on discriminatory attitudes and behaviors against obese individuals, integrates this to show whether systematic discrimination occurs and why, and discusses needed work in the field. Clear and consistent stigmatization, and in some cases discrimination, can be documented in three important areas of living: employment, education, and health care. Among the findings are that 28% of teachers in one study said that becoming obese is the worst thing that can happen to a person; 24% of nurses said that they are "repulsed" by obese persons; and, controlling for income and grades, parents provide less college support for their overweight than for their thin children. There are also suggestions but not yet documentation of discrimination occurring in adoption proceedings, jury selection, housing, and other areas. Given the vast numbers of people potentially affected, it is important to consider the research-related, educational, and social policy implications of these findings.
... Positive Items (2, 4, 7, 10, 11, 11, 14, 15, 17, 20, 22, 25, 27): Scored from 5 to 1 starting from "Strongly agree". Negative Items (1,3,5,6,8,9,9,12,13,16,18,19,21,23,24,26): Scored from 1 to 5 starting from "strongly agree". The scores that can be obtained from the Obesity Prejudice Scale (OPS) vary between 27 and 135. ...
... This leads to the progression of the diseases of the obese patient group and the increase in health expenses spent on this group. [16][17][18][19] The limited research on prejudice against obesity in many professions, including health care, has shown that this prejudice exists to a significant extent. Among healthcare professionals, the idea that patients with obesity are noncompliant with treatment, weak-willed, unsuccessful, lazy, unintelligent and dishonest is quite high. ...
... The reason why obesity prejudice is high among healthcare professionals with low BMI, both in our study and in other studies, may be due to insufficient empathy. 16,22 In the study conducted by Koç 29 in which he examined the empathic tendency level according to demographic data, he examined the empathic tendency level according to different professional groups, and no statistically significant difference was found between age and empathic tendency level. On the contrary, in our study, a statistically significant difference was found between empathic tendency level and age. ...
Aims: The aim of this study was to measure the obesity prejudice and empathic tendency of health personnel working in public hospitals in Gaziantep. Methods: 458 healthcare professionals working in Gaziantep province participated in the study. Data were collected using “GAMS-27 Obesity Bias Scale (OBS)” and “Empathic Tendency Scale (ETS)”. Results: It was determined that 17.5% of the healthcare professionals were unprejudiced, 53.9% were prone to prejudice and 28.6% were prejudiced. However, 9.8% of them stated that their attitudes towards obese individuals were prejudiced and 90.2% were not prejudiced. Single people were found to be more prejudiced against obesity than married people. It was found that emergency department were more prejudiced against obese individuals and had lower empathic tendencies compared to other units. Obesity prejudice scores and empathic tendency scores of those who were satisfied with their physical appearance were significantly higher than those who were not satisfied. There was a weak positive relationship between obesity prejudice score and empathic tendency score, and a weak negative relationship between age and number of children. There was a weak positive correlation between empathic tendency score and obesity prejudice score, and a weak positive correlation between age and number of children and empathic tendency score. The mean score of the Empathic Tendency Scale (ETS) of the healthcare professionals was 69.42. Conclusion: It was determined that healthcare professionals, especially those who considered themselves as thin, young and single, were prejudiced against obesity.
... Weight stigma, the social devaluation and denigration of individuals perceived as carrying excess weight, have profound negative consequences on physical and mental health [17,18]. Research indicates that individuals who face weight discrimination are 2.5 times more likely to report symptoms of major depression than those who do not experience stigma [19]. ...
... Moreover, it creates barriers to healthcare access and quality, as weight bias among healthcare providers may result in suboptimal care for overweight people [23]. The pervasive nature of weight stigma also impacts social relationships and economic opportunities, with overweight individuals facing discrimination in employment and education settings [17,18,24].These multifaceted effects of weight stigma set the stage for understanding the broader concept of "fat phobia" and its societal implications [16,21,22,25]. ...
... Fat phobia and stigma can have devastating effects on people's physical and mental health [56], leading to depression, anxiety and eating disorders [51,57]. Furthermore, research has shown that fat stigma often leads to poorer selfesteem, body image issues, and a lack of access to healthcare [17,18,25,27]. People of larger body sizes often suffer discrimination in employment and social interactions, which can lead to further feelings of isolation and worthlessness [17,22,27]. ...
Background
Weight bias, often known as fat phobia or weight stigma, refers to unfavorable attitudes and stereotypes that are associated with, and applied to, larger bodies. Fat phobia can include an unreasonable and abnormal dread of being overweight or being associated with obese people. Currently, there is no validated tool available to measure fat phobia in Arabic. Measuring fat phobia in Arabic-speaking populations is crucial, because cultural attitudes toward body weight can be quite negative and discriminatory; these negative attitudes can negatively impact mental health. The current study aimed to adapt, translate, and assess the structural validity of the Fat Phobia Scale—Short Form (F-Scale 14) in Arabic.
Methods
The gold standard approach to translation was used. Forward translation involved translation from the English language to the Arabic language by independent translators. Subsequently, a back-translation review was performed on the translated Arabic version for comparison with the original language. A cross-sectional study was conducted online that included 1246 participants from 22 Arabic countries, of whom 74% were female, 66% single, 83% university graduates, with a mean age of 35 ± 6 years.
Results
The F-Scale 14 demonstrated good reliability in the Arabic language, with a Cronbach’s α of 0.82 (95% CI 0.80–0.83), comparable to the original scale. The test–retest reliability of the scale was 0.92 (95% CI 0.90–0.94). According to the fit indices, the F-Scale 14 demonstrated a satisfactory level of structural validity in Arab cultures. Fit indices are statistical measures used in confirmatory factor analysis (CFA) to assess how well a proposed model fits the observed data. The scale showed a small improvement in factorial structure after the removal of some items. The two items removed were self-indulgent versus self-sacrificing and disliking food versus likes food. The correlation between F-Scale 14 and the figure rating scale was r = 0.76 (p < 0.001), suggesting adequate convergent validity.
Conclusions
The F-Scale 14 is a crucial indicator of attitudes and opinions concerning obese or overweight individuals. Based on increased internal consistency reliability and the problematic cultural relevance of two items, we recommend adopting a 12-item version of the scale for better cultural relevance in Arabic populations. It is anticipated that the Arabic F-Scale-12 will be highly useful for research and clinical purposes. Future research should test and adapt the Fat Phobia Scale for diverse Arabic populations to ensure its cultural relevance. Exploring its application in clinical settings will enhance our understanding of weight stigma and inform targeted interventions that promote body positivity. By addressing these areas, we can develop effective strategies to foster healthier attitudes toward body image in Arabic communities.
Level V: Evidence obtained from a cross-sectional descriptive study.
... For item 19, "no" is rated 1 and not 0. Light grey indicates a moderate risk of bias, while dark grey indicates a high risk of bias. is speculative, this association might be related to stigmatization and social isolation. Indeed, evidence suggests that obesity is associated with the frequent occurrence of discriminatory experiences related to weight stigma [86,87], social exclusion, or ostracism [88]. Although this requires further in-depth studies, stigmatization may increase the risk of social isolation or loneliness [53], which is known to be associated with low (selfreported) empathy or even a deteriorated ability to accurately recognize others' mental states (e.g., threat bias) [54,55], possibly because of reduced opportunities to develop empathy abilities. ...
Background and Objectives:
Obesity is associated with various interpersonal difficulties. Previous research on empathy has indicated that weight is negatively correlated with empathic skills in children and adolescents. However, few studies have examined this question in adults, and the existing studies have provided inconsistent results.
Methods:
This systematic review and meta-analysis aimed to examine empathic skills among people with overweight and obesity. Six databases were searched to find studies based on performance measures and self-report questionnaires investigating cognitive and affective empathy in adults with overweight and obesity (BMI>25 kg/m2) compared with normal-weight individuals.
Results:
Ten studies involving 2648 individuals were included after screening the 6779 references that were initially retrieved from the database. Analyses revealed a significant difference between individuals with overweight/obesity and normal-weight individuals (k=11, Hedge’s g=-0.52 [-0.97, -0.07], Z=-2.26, p=0.024). Subgroup analyses revealed no significant difference between people with overweight and people with obesity (Q=0.36, p=0.546). However, the effect size for cognitive empathy was higher than that for affective empathy (Q=7.30, p=0.007), and the effect size for performances measures was higher than that for self-report questionnaires (Q=6.61, p=0.010).
Conclusion:
Adults with overweight or obesity present lower scores of empathy, particularly for cognitive empathy. These results emphasize the need to better understand which specific components of cognitive empathy might be affected and to conduct studies to evaluate affective empathy beyond self-report questionnaires. Future research should also determine the underlying mechanisms and longitudinally test the role of empathy in the onset and maintenance of obesity.
... While the exact mechanism behind the association between VAI and SI remains uncertain, we may examine and provide some insight into it by considering the reciprocal mechanism of the relationship between obesity and SI. From a psychosocial perspective, this association can be elucidated by weight stigma, which encompasses adverse attitudes and beliefs associated with body weight [35]. Individuals with obesity often face significant stigma, and encounters with weight stigma are strongly linked to symptoms of depression, diminished self-esteem, and inclinations toward suicidal thoughts [36]. ...
Background and objective
Suicidal ideation (SI) poses a significant public health challenge, and understanding its predictors, especially modifiable factors like visceral obesity, is essential for prevention. The purpose of this study is to investigate the association between the visceral adiposity index (VAI) and suicidal ideation (SI) among adults in the United States.
Methods
A cross-sectional study using NHANES data from 2005–2018 included adults aged 18 and above with complete SI and VAI data. Suicidal thoughts were evaluated using item 9 from the Patient Health Questionnaire-9 (PHQ-9), while VAI was calculated using gender-specific formulas based on waist circumference, body mass index (BMI), total triglycerides (TG), and high-density lipoproteins (HDL-C). Multivariate logistic regression analysis was implemented after adjusting for several factors to assess the relationship between VAI and SI. Additionally, subgroup analysis and interaction testing were employed to investigate the consistency of this relationship with other demographic parameters.
Result
Our study included a cohort of 15,830 participants, of whom 3.59% exhibited signs of suicidal ideation. Following multivariate logistic regression analysis, we observed a significant positive association between VAI and SI (odds ratio [OR] = 1.03; 95% CI 1.01, 1.04; P = 0.0057), which remained significant after adjusting for various confounding factors. Moreover, utilizing a two-segment linear regression approach, we uncovered a nonlinear relationship between VAI and SI, demonstrating a U-shaped pattern with a critical point at 5.28.
Conclusion
Elevated levels of VAI were consistently associated with an increased probability of SI, and this association remained consistent across various demographic variables.
Level of evidence Level V—cross-sectional observational study.
... A systematic review of published literature from January 2000 and May 2008 provides scientific evidence on weight bias towards overweight and obese individuals within these domains ). Within employment, fat bodies are often the target of daily harassment, disrespectful treatment including derogatory humor, pejorative comments, and decreased job opportunities (Puhl & Brownell, 2001;. Within a variety of healthcare professions, fat, larger-bodied, and higher-weight individuals experience barriers to accessing care due to the prevalence of anti-fatness and beliefs about fatness carried by medical providers (Gudzune et al., 2014b;. ...
This study explored the experiences of fat, larger-bodied, and higher-weight clients who have encountered anti-fatness or anti-fat biases from their counselors or mental health clinicians. The research uncovered how these biases manifest in counseling settings and their effects on clients' mental health and treatment outcomes. Utilizing qualitative methods including semi-structured interviews and photo elicitation, the research aimed to gather rich insights using an Interpretative Phenomenological Analysis (IPA) approach to make sense of how clients interpret their experiences with anti-fatness. The study sought to inform future counseling practices to adopt an intersectional, weight-inclusive approach to treat all body sizes. Key research questions focused on clients' experiences, perceptions, and needs regarding anti-fatness. Findings showed how harmful societal norms unfold in counseling leading to emotional turmoil, censorship of disclosure, and premature termination of services. The study underscored the need for greater awareness and training among counselors regarding body size diversity and anti-fat bias, ultimately advocating for a weight-inclusive approach within the mental health profession.
... [14][15][16]19,[61][62][63][64][65] The definition of OOB was guided by the seminal work of Rebecca M. Puhl on weight stigma and was operationalized as the negative attitudes toward being overweight or obese, encompassing both stigmatizing views and fear of associated health risks. [14][15][16]19,[66][67][68][69] To check and confirm the content and language validity of the OOB items, a panel of experts in pharmacy reviewed the construct in English, confirming the suitability of its content. Following this, the items were translated into Arabic by two bilingual authors (Mohammed Sallam and Malik Sallam). ...
Introduction
Glucagon-like peptide-1 (GLP-1) receptor agonists including Mounjaro and Ozempic, are increasingly used for weight management. Assessing the attitudes and beliefs of current and future healthcare professionals is important considering their roles in recommending and prescribing these drugs. This study aimed to investigate the attitudes toward Mounjaro and Ozempic and its correlation with obesity/overweight bias among healthcare professionals and students in medicine and pharmacy in Arab countries.
Methods
This cross-sectional study was based on a self-administered online questionnaire with participants recruited via a convenient snowball sampling approach. Attitudes towards Mounjaro and Ozempic were evaluated using a newly developed construct termed Mini Health Beliefs and Attitudes toward GLP-1 Drugs Scale (mini-HBAGS), alongside a novel scale to assess obesity/overweight bias (OOB). The new constructs’ validity was assessed via content validity, principal component analysis (PCA), and Cronbach’s α.
Results
The study included 413 participants predominantly from Kuwait (32.8%), Egypt (20.9%), Saudi Arabia (18.8%), and Jordan (15.4%). Familiarity with Mounjaro and Ozempic was high (83.6%), with 17.2% recommending them. Weight management drug use was 14.0%, including 5.9% for Mounjaro and Ozempic. Among participants familiar with Mounjaro and Ozempic, the mean OOB score was 3.83±0.62 (range: 1.00–5.00), indicating agreement, while the mean score for the mini-H-BAGS was 2.70±0.716 (range: 1.00–5.00), indicating a slightly unfavorable attitude. PCA identified perceived benefits and barriers, and subjective norms and attitudes, as key determinants of attitudes toward Mounjaro and Ozempic.
Conclusion
This study revealed slightly negative attitudes toward Mounjaro and Ozempic among healthcare professionals and students in Arab countries. The negative attitudes observed likely reflect concerns about side effects, cost, and accessibility of these medications. The findings highlighted the need for targeted education in Arab countries to address obesity bias and encourage a balanced evaluation of the benefits and risks of GLP-1 drugs for weight management.
... Physicians with biased attitudes are more likely to prejudge patients with higher weight as being not self-controlled, will-weak, and unmotivated to improve health and less adherent to medication (Ferrante et al., 2006;Glauser et al., 2015;Huizinga et al., 2009;Ruelaz et al., 2007). Further, studies demonstrate that weight stigma in physicians has a negative impact on interpersonal and technical quality of their health care work (Puhl and Heuer, 2009;Phelan et al., 2022;Puhl and Brownell, 2013). Physicians use patientcentered communication less frequently, spend less contact time and provide less educational information to patients with higher weight (Pantenburg et al., 2012;Phelan et al., 2015;Huizinga et al., 2009;Hebl and Xu, 2001). ...
Background
Weight bias and stigma are prevalent problems in health care professionals and medical students. They have consequences on care quality and, thus, on health of patients with overweight and obesity. We implemented a new course unit “Prevention and Counseling for Weight Management” thematizing the etiology of weight gain and weight stigma. The purpose of this study was to evaluate changes in students' weight-related attitudes after a structured educational intervention.
Methods
We used an inverted classroom design: a theoretical module for self-study followed by a practical module in presence. This evaluation study investigated the weight bias and causal attribution of 213 medical students (73.7% female) in the 6th semester. Students completed a questionnaire before and after the course, including the Fat Phobia Scale (FPS) and ratings of causal attribution. Questionnaires were generated with EvaSys©. We used t-tests, ANOVAs and Pearson correlations for analysis.
Results
About 96% of the students showed negative attitudes. We found an averaged weight bias in students (FPS = 3.63) and a small decrease in weight bias after the course (FPS = 3.44). The students categorized internal factors as the most important cause of weight gain. After the course, internal factors decreased while external factors increased in relevance. As not intended, biological factors of weight attribution decreased in relevance.
Conclusions
The majority of our students showed weight bias. Medical education like our course can help to reduce negative weight-related attitudes. Curricula and clinical trainings should address weight bias to raise awareness and improve health care for patients with higher weight.
... Plausible explanation for less utilization of CAM therapies in obese doctors in the present study may be their unwillingness to adhere to healthy lifestyle. Exercising and yoga are not easy to execute by obese individuals, and therefore, such individuals are indulged in self-doubt, discomfort, and embarrassment [22]. ...
Objectives: To study appraisal of complementary and alternative medicines (CAM) utilization among doctors for their weight reduction. Methods: This present cross-sectional, questionnaire-based observational study was conducted in Department of Pharmacology of a tertiary care teaching hospital of Rajasthan, India. All the doctors of various specialties were included in the study. The validated questionnaire had three separate segments consisting of items regarding demographic profile, items regarding knowledge of CAM and items regarding CAM utilization by the medical professionals. Results: Out of total 222 respondents, 63(28%) doctors used CAM for their weight reduction. 19(8.6%) male and 44(19.8%) female doctors used CAM for weight reduction. CAM practice among the postgraduate doctors was highly significant in comparison to other qualifications (p<0.001). Association between clinical years of practice and use of CAM was found to be significant (p<0.05). CAM use with respect to body mass index (BMI) of doctors was found statistically significant (p<0.001). 183(82%) doctors were aware of the term CAM and 144 (65%) believed in CAM. Conclusion: This study concluded that 28% doctors had used CAM for themselves for weight reduction. A substantial number of doctors are using CAM themselves and also recommending to others in spite of being trained in modern medicine.
... This social movement is designed to influence various components of the attitude towards the body, including cognitive aspects (body-related beliefs and thoughts-i.e., my body is unattractive/too fat), emotional aspects (body-related feelings and emotions-i.e., shame, fear, blame) and behavioral aspects (body-related actions and behaviors-e.g., physical activity, body grooming) [11]. #BodyPostivity also encourages us to be aware of the commonly existing pressure to change the figure and/or shape of one's body according to the applicable "standard", referring mainly to the phenomena of fat shaming or fatphobia (anti-fat bias which is related to prejudicial assumptions concerning people with overweight or obesity, and the mechanism of shaming this group) [12]. Earlier research in this area shows that there is a negative relationship between body appreciation and various dimensions related to attitudes towards the body (e.g., subscales of Sociocultural Attitudes Towards Appearance Questionnaire 4R [13]). ...
Objectives: The main aim of this study was to investigate the hypothesis that men with high body appreciation and healthy (normal) weight would have significantly lower levels of muscle dysmorphia and the non-adaptive (negative) multiple dimensions of body attitudes, as well as higher levels of the selected pro-health and adaptive exercise motives, than those men with low body appreciation and excess body weight. Methods: A total of 374 Polish men (Mage = 28.96 ± 8.52) completed the following questionnaires: (a) the Body Appreciation Scale-2, (b) the Muscle Dysmorphic Disorder Inventory, (c) the Male Body Attitude Scale, and (d) the Exercise Motivations Inventory-2. Results: By analyzing the most important findings, it was discovered, as hypothesized, that significant differences (in terms of most of the assessed scale/subscales) were found between men who had high body appreciation and healthy weight (Cluster 4), and men with low body appreciation and excess body weight (Cluster 3). Cluster 4 (vs. Cluster 3) was characterized as follows: (a) considering muscle dysmorphia, these participants had lower levels in terms of the total score and subscale of appearance intolerance; (b) they had fewer non-adaptive (negative) body attitudes, with lower total scores and lower scores on two subscales (body fat and height); (c) for the selected pro-health and adaptive exercise motives, Cluster 4 had higher levels on all subscales. Conclusions: Our results show that holding views in line with positive body image is also beneficial for the functioning of adult men. However, further research needs to be conducted in this area to determine whether the content in the interventions and prevention activities for both sexes should be the same and what factors should be taken into account in order to influence excessive fixation on a muscularity.
... Weight stigmatization is pervasive, affects many domains of life, and bears significant adverse consequences for individuals' psychological and physical wellbeing, as well as social participation [1][2][3][4][5][6][7][8]. This stigmatization, often rooted in the belief that obesity results solely from personal choices, fosters discrimination of individuals with higher body weight [3,7,[9][10][11][12][13]. These stereotypes are frequently influenced by social and political ideologies [2,9]; however, research on this association is still rather rare. ...
Background: The Weight Control/Blame (WCB) subscale of the Antifat Attitudes Test (AFAT) measures weight stigma, particularly beliefs linking obesity to personal responsibility, which contributes to discrimination and negative psychological, often reinforced by political ideologies and authoritarian attitudes. Objective: This study sought to (1) develop and validate an economic version of the WCB subscale, and (2) evaluate associations between weight stigmatizing attitudes, authoritarian beliefs, sexist attitudes, and conspiracy mentality. Method: A four-item short form of the WCB subscale (WCB-4) was developed using a representative sample of the German population (N = 1,000) and validated on a second sample (N = 2,524). We assessed psychometric properties, convergent and divergent validity. Results: The four-item solution demonstrated good internal consistency (ω = .807) and favorable confirmatory factor analysis results. Weight stigma positively correlated with authoritarian and sexist beliefs, and negatively with depression, anxiety, and body mass index. Discussion: The WCB-4 is a reliable and valid tool for assessing weight stigma in epidemiological research. It highlighted positive associations with authoritarian beliefs and sexist attitudes, reflecting an interconnected system of biases against marginalized groups. Though a minor correlation was found between conspiracy mentality and authoritarian beliefs, no significant link emerged between conspiracy mentality and weight stigma.
... Moreover, while weight loss achieved through lifestyle changes positively alters people's evaluations of an overweight individual's character, weight loss through bariatric surgery does not. A series of studies by Vartanian and Fardouly consistently demonstrated that individuals who lost weight through surgery were rated as being just as "lazy"-a trait commonly regarded as a vice or moral failing-after their weight loss as they were before (Fardouly & Vartanian, 2012;Vartanian & Fardouly, 2013, 2014. 2 This is consistent with a body of research showing that a person's weight-related attributes, such as body size, food choices, or weight management methods are often moralized in laypeople's social judgments (e.g., Ringel & Ditto, 2019;Ambwani et al., 2019;Hayran et al., 2013;Sikorski et al., 2011;Puhl & Brownell, 2001). In other words, there is evidence that both being overweight and attempting to lose weight through means that are judged to be relatively "low effort" may result in negative judgments about a person's moral character. ...
The injectable medication Ozempic (semaglutide) has demonstrated unprecedented effectiveness in promoting significant weight loss. However, its use has sparked moral debates, with critics dismissing it as a mere "shortcut" compared to traditional methods like diet and exercise. This study investigates how weight loss method—Ozempic, diet/exercise, or a combination of both—impacts moral judgments and perceptions of effort, praiseworthiness, and identity/value change. We used a contrastive vignette technique in two experiments (combined N = 1041, nationally representative for age, sex, and ethnicity) to study the attitudes of US participants toward a fictional character who lost 50 pounds through one of the three described methods. Weight loss through diet/exercise was deemed most effortful and most praiseworthy, whereas Ozempic use, even when combined with diet/exercise, was rated as both less effortful and less praiseworthy than diet/exercise alone. Ozempic use with no mention of diet/exercise was rated as least effortful and least praiseworthy. Compared to diet and exercise alone, Ozempic use also decreased perceptions that the individual had really changed as a person, or experienced a change in their underlying values. We discuss potential implications, address study limitations, and provide suggestions for further work.
... Negative attitudes toward individuals with obesity are also confirmed in other contexts. In 2001, Puhl and Brownell [65] published the first review after several decades of research, revealing the stigma faced by individuals with obesity across various domains, including the workplace, healthcare, and education, highlighting the unjust treatment these individuals endure. Furthermore, false perceptions and beliefs about individuals with obesity promote discrimination and stigma through media, schools, and workplaces, including healthcare settings [1,66], as well as within families and society at large [66,67]. ...
Citation: Arvelo-Rodríguez, Y.-M.; Marrero-González, C.-M.; García-Hernández, A.-M. Attitudes and Behaviors of Nurses and Nursing Students Toward Patients with Obesity: A Systematized Review. Nurs. Rep. 2025, 15, 66. https:// Abstract: Background: The prevalence of people with obesity is increasing worldwide, facing challenges in terms of discrimination and prejudice across all settings, including healthcare. Objective: The objective of this review is to compare and synthesize recent scientific literature regarding nurses' behaviors and attitudes toward patients with obesity. Methods: A systematized methodology was employed, conducting a literature search of studies published in the bibliographic resources (Academic Search Complete, CINAHL Complete, Web of Science, and Scopus from 2018 to 2023); using specific terms combined with the Boolean operators, AND and OR. Inclusion criteria: Quantitative, qualitative, or mixed research conducted on nurses and/or nursing students in a context focused on the care of adult patients with obesity. Critical appraisal tools from the Joanna Briggs Institute (JBI) were used to evaluate the included studies, and their level of evidence was also determined. Results: Initially, the search yielded 166 articles, of which 14 were included in this review. The results found focused on the use of scales and tools heterogeneous to each other. The findings can be categorized into two main areas: studies investigating interventions aimed at reducing negative behaviors related to weight bias and prejudice, and studies focusing on assessing these attitudes. The evidence points in a consistent direction: nurses exhibit negative attitudes toward patients with obesity. Conclusions: The need for multilevel strategies, from clinical to academic training, to address this challenge is highlighted, alongside the development of research that complements the current evidence with a deeper and more detailed understanding of this phenomenon.
... Research has shown that individuals living with obesity are perceived as lazy, unintelligent, lacking selfdiscipline, and poorly motivated compared to those with normal weight [10]. This widespread stigmatization can underpin various forms of psychopathology [11,12]. Exposure to obesity stigma can impair HRQoL [13] and negatively affect body image and increase symptoms of depression and anxiety [14,15]. ...
Introduction
Health-related quality of life (HRQoL) may be impaired in individuals living with obesity, possibly due to exposure to obesity-related stigma which may in turn activate shame. Few studies have been conducted on shame in relation to obesity and its potential association with other constructs such as HRQoL, self-esteem, and body image. In this study, internalized shame and the potential association with HRQoL, self-esteem, and body image were investigated in treatment-seeking patients with obesity class II-III.
Methods
In total, 228 patients referred for obesity treatment at a tertiary clinic in Sweden participated in the study. The cohort was stratified into two groups using a clinical cutoff (≥50) indicating pathological levels of shame as reported on the Internalized Shame Scale (ISS): a high shame group (HSG) and low shame group (LSG).
Results
The mean ISS score for the overall cohort was 41.6, with a mean of 28.1 for the LSG and 66.5 for the HSG. Compared to the LSG, the HSG reported a lower quality of life in seven of eight HRQoL domains as well as a lower obesity-specific health-related quality of life. Furthermore, a higher shame score was associated with poorer body image and lower self-esteem.
Conclusion
Taken together, these findings indicate that a substantial number of patients with obesity report high internalized shame and that these individuals could benefit from extra support in treatment settings.
... made worse by the widespread acceptance of anti-fat discrimination (Puhl & Brownell, 2001). Often, people attempt to justify blatant expressions of weight stigma as important for motivating others to lose weight (Hunger et al., 2020;Logel et al., 2015). ...
The severity and pervasiveness of anti-fat prejudice and discrimination have led to calls for interventions to address them. However, intervention studies to combat anti-fat prejudice have often been stymied by ineffective approaches, small sample sizes, and the lack of standardization in measurement. To that end, we conducted two mega-experiments totaling 28,240 participants and 50 conditions where we tested five intervention approaches to reduce implicit anti-fat prejudice across five implicit measures. We found that interventions were most effective at reducing implicit weight biases when they instructed people to practice an explicit rule linking fat people with good things and thin people with bad things. Interventions that were more indirect or relied on associative learning tended to be ineffective. We also found that change in implicit bias on one implicit measure often generalized to other implicit measures. However, the Evaluative Priming Task and single-target measures of implicit bias like the Single-Target Implicit Association Test were much less sensitive to change. These findings illuminate promising approaches to combating implicit anti-fat prejudice and advance understanding of how implicit bias change generalizes across measures.
... Weight bias is partially driven by aesthetic ideals, because modern Western cultures (and many Eastern cultures) equate thinness with beauty and view larger bodies as undesirable (Swami, 2015). Beyond appearance, negative weight attitudes are rooted in stereotypes about the behaviors and internal characteristics of individuals with high weight, including unfair assumptions that they are lazy, undisciplined, lacking self-control, unintelligent, unattractive, unmotivated, sedentary, gluttonous, and unhealthy (Puhl & Brownell, 2001). Alongside these negative stereotypes is the common, misguided belief that weight is entirely controllable through diet and exercise, leading to blame and scorn of individuals who are viewed as unable to control their weight (Crandall & Reser, 2005). ...
Weight bias and stigma are widespread, unjust, and harmful to health. Increased empirical attention to the internalization of weight bias and stigma (or weight self-stigma) has revealed significant health implications that require further study and intervention. This review summarizes current knowledge on the conceptualization, measurement, prevalence, and correlates of internalized weight stigma. Associations with mental and physical health outcomes and evidence from emerging interventions are discussed, along with scientific challenges, knowledge gaps, and opportunities to advance the understanding and reduction of this and other forms of internalized health-related stigma.
... Negative weightbased assumptions, such as laziness, lack of willpower, low intelligence, and poor self-discipline, contribute to discrimination, prejudice, and stigma against individuals with obesity across different spheres of life. [443][444][445] The relationship between obesity and depression is controversial and complex. While some articles concluded that there is no significant relationship between obesity and depression, 446 Friedman suggested that the uncertainty in the results reflects the diverse experiences individuals have with obesity's impacts. ...
Objectives: To review the current literature on obesity risk factors, epidemiology, and trends, providing insights for effective prevention and intervention strategies. Design: Review article. Setting(s): Global. Outcome Measures: A systematic search was performed using MEDLINE (via PubMed), Scopus, Web of Science, and Google Scholar up to January 2024. Studies on obesity’s history, epidemiology, risk factors, health impacts, and preventive or therapeutic approaches were included. Both primary and secondary studies were considered, excluding those in languages other than English, in vitro studies, and animal studies. No restrictions were applied regarding publication date or article type. Results: The overweight- and obesity-attributable burden of diseases has significantly increased, particularly among adults aged 60 and older, with the most severe effects observed in women aged≥75, highlighting a growing public health challenge and a markedly greater rate of increase in older adults compared to those under 60. The causes of obesity were found to be multifaceted, predominantly influenced by behavioral and environmental factors, with an imbalance between calorie intake and expenditure being the primary issue. The adverse health consequences of obesity have been well documented, with associations noted in various non-communicable diseases, including diabetes, cardiovascular diseases (CVDs), and musculoskeletal disorders. Conclusions: Understanding obesity-comorbidity links is vital to identifying high-risk individuals and prioritizing interventions. Limited access to effective weight management treatments remains a key barrier to improving health outcomes for those affected by obesity.
... 3,4 Weight bias or stigma is the negative attitudes and beliefs held toward individuals due to their weight or body size. 3 Although the recognition of the negative effects associated with weight stigma has existed for decades, [4][5][6] it is noteworthy that a broader acknowledgment of these impacts has only emerged relatively recently. 7,8 Counter to intuition, healthcare workers, including physicians and nurses, have been found to harbor implicit and explicit obesity stigmas, a phenomenon observed not only in Saudi Arabia but also in various countries, where studies indicate that weight stigma in medical settings can lead to differences in healthcare delivery, exacerbating obesity-related health outcomes and reducing patient-provider trust. ...
Background
Obesity is a significant public health issue in Saudi Arabia. Rising obesity rates increase the risk of weight bias and stigma, even among healthcare workers.
Objectives
This study assesses weight stigma in healthcare workers, with findings intended to inform strategies for creating a more supportive healthcare environment for patients with obesity.
Methods
This cross-sectional study was conducted in a university hospital in the Eastern Province of Saudi Arabia. Healthcare workers completed self-administered questionnaires, including the Attitudes toward Obese Persons Scale (ATOP) and the Beliefs about Obese Persons Scale (BAOP), which assess levels of positive attitudes and beliefs about obesity, respectively. Data were analyzed using SPSS.
Results
The study included 266 healthcare workers (HCWs), mean age 33.21 years, with 54.5% female. The ATOP mean score was 64.4, and BAOP mean score was 18.3, indicating moderate negative attitudes and beliefs toward obesity. Significant differences in ATOP scores were found based on age, patient interactions, and years of experience.
Discussion
Our study aligns with international findings, revealing significant weight stigma among healthcare workers in Saudi Arabia. Such stigma can negatively impact patient care, leading to biased treatment and poorer health outcomes. Societal norms and personal biases contribute to this stigma, despite misconceptions regarding its supposed motivational effects. Addressing this requires comprehensive training and education for healthcare providers. Policymakers should include weight bias education into medical curricula and establish anti-discrimination policies to promote inclusivity and respect.
Conclusions
Our study highlights obesity stigma among Saudi healthcare workers and the need for targeted interventions. Creating a supportive, nonjudgmental environment can enhance patient-provider relationships and improve healthcare outcomes for individuals with obesity.
Importance
Children with overweight or obesity experience greater prevalence, severity, and perioperative risk of obstructive sleep-disordered breathing and persistent sleep apnea after tonsillectomy. Yet, little is known about how weight status influences communication between surgeons and families in presurgical consultations.
Objectives
To evaluate the association between patient weight status with (1) clinician-parent communication and (2) parent ratings of care experience during tonsillectomy consultations.
Design, Setting, and Participants
This cross-sectional study examined encounters occurring between April 2016 and September 2023 at outpatient otolaryngology clinics among English-speaking parents of children aged 2 to 17 years undergoing initial evaluation for tonsillectomy and clinicians (surgeons and advanced practice medical professionals) evaluating patients for tonsillectomy. Data were analyzed from September 2023 to May 2024.
Main Outcomes and Measures
Consultations were audio recorded and coded using the Roter Interaction Analysis System to identify verbal and nonverbal communication behaviors. After consultations, clinicians rated child weight status and parents rated care experiences using items modified from the Consumer Assessment of Healthcare Providers & Systems.
Results
Of 231 encounters in this study, 50 (22%) were with children with overweight. Most children were male (n = 130 [57%]). Children and adolescents were aged 2 to 17 years (hereafter referred to as children; mean [SD] age: no overweight, 5.0 [2.6] years; overweight or obesity, 8.1 [3.3] years). There were no differences between the groups with and without overweight in verbal dominance, patient centeredness, clinician facilitation or activation statements, clinician chit-chat statements, or clinician emotional statements. After adjusting for child’s race, parents’ education level, and annual household income, the child overweight status was associated with a decrease in cumulative clinician positive global affect levels by standardized β = −0.18 SDs (95% CI, −0.65 to 0.00 SDs). The small effect size observed may have limited the strength of this association. Furthermore, parents of children with overweight were less likely to report that their clinician definitively demonstrated respect relative to parents of children without overweight (odds ratio, 4.56 [95% CI, 1.06-19.99]).
Conclusion and Relevance
These findings suggest that child weight status was not associated with measured verbal communication behaviors but was associated with lower parent ratings and observer ratings of clinician respectfulness. The small effect size and potential bias from clinician race and ethnicity and sex may have limited this association. These results indicate the need to elucidate and mitigate multilevel determinants that negatively affect quality of care and communication for children with overweight.
Background: Weight stigma describes the negative attitudes held toward people with obesity. Weight bias stereotypes have been previously reported in physicians, physician assistants, nurses, registered dieticians, psychologists, and students enrolled in healthcare professional education programs. Physical and occupational therapists (PTs and OTs) are healthcare providers who evaluate and treat individuals across their lifespan. A PT or an OT who harbors weight bias may create an environment where the patient may fail to optimize their rehabilitation recovery. The first purpose of this scoping review was to identify the prevalence of weight bias in PT and OT clinicians and students. The second purpose was to evaluate the effectiveness of interventions at reducing weight bias in these populations. Methods: The CINAHL, PubMed, and Google Scholar databases were searched, and 15 articles met the inclusion criteria. Results: In each study, PT and/or OT clinicians and/or students demonstrated weight bias. A minimum of approximately twenty percent of surveyed participants had weight bias, with one study reporting over eighty percent of subjects expressing negative attitudes. Three of the studies reported mixed results (i.e., improvement or worsening) regarding weight bias scores after intervention. Conclusions: PT and OT clinicians and students demonstrate weight bias similar to other healthcare professionals. Future research is warranted to identify educational interventions that reduce bias within these populations.
Obesity is linked to notable psychological risks, particularly in social interactions where individuals with high body mass index (BMI) often encounter stigmatization and difficulties in forming and maintaining social connections. Although awareness of these issues is growing, there is a lack of research on real-time, dynamic interactions involving dyads with various BMI levels. To address this gap, our study employed a joint finger-tapping task, where participant dyads engaged in coordinated activity while their brain activity was monitored using functional near-infrared spectroscopy (fNIRS). Our findings showed that both Bidirectional and Unidirectional Interaction conditions exhibited higher levels of behavioral and interbrain synchrony compared to the No Interaction condition. Notably, only in the Bidirectional Interaction condition, higher dyadic BMI was significantly correlated with poorer behavioral coordination and reduced interbrain synchrony. This finding suggests that the ability to maintain social coordination, particularly in scenarios requiring continuous mutual prediction and adjustment, is modulated by dyads' BMI.
Introduction
Weight is reported to be the most common target for bullying at school - far more common than other targets such as ethnicity, religion or sexual orientation. Research suggests weight bias and stigma - including negative beliefs, attitudes and discriminatory behaviours related to a person’s weight - is prevalent in educational settings among both pupils and staff. Most schools have anti-bullying policies. Best practice recommendations advise policies should explicitly identify forms of unacceptable behaviour, such as racism or homophobia. We conducted an audit of secondary schools in southwest England to determine if/how they mention weight-related bullying in their policies, and whether this differs by school-level factors.
Methods
We obtained lists of all secondary mainstream state, private, and special schools in seven local authorities and downloaded anti-bullying policies from their websites. Policies were searched for key words related to weight and size. We also recorded whether policies mentioned appearance or other key targets for bullying, such as race, religion, sexuality etc. We obtained school level data including size, gender mix, academic performance and quality ratings.
Results
From 255 schools with an available bullying or behaviour policy, only 6.7% specifically mentioned weight-related bullying. Just under half (48.6%) mentioned bullying in relation to appearance. Bullying was most often mentioned in relation to race/ethnicity (94.5%), sexual orientation (93.3%), gender (85.9%), religion (84.9%) or gender identity (67.5%). Private schools (N = 40) were more likely to mention weight-related bullying (17.5%) than mainstream state schools (N = 148, 6.1%). No special schools, whether state (N = 41) or private (N = 26), mentioned weight-related bullying in their policies. There was no strong evidence that other school characteristics made a difference, but small numbers limited statistical power of these comparisons.
Conclusion
There is a significant mismatch between the prevalence of weight-related bullying in schools and its representation within school anti-bullying policies. Some types of school are more likely than others to mention weight-related bullying in their policies. We recommend that schools explicitly recognise weight-related bullying in their anti-bullying policies and explore how to support staff and pupils to take action.
The majority of Canadian adults are not meeting the recommended physical activity and sedentary behaviour guidelines. Previous studies have highlighted experiences of weight bias as a potential barrier to physical activity and an enabler of sedentary behaviours. Few studies have examined whether endorsing or internalizing weight bias is associated with these health behaviours. A secondary analysis was conducted on a sample of Canadian adults (N = 891, 52% female, mean age group = 45–54 years; mean body mass index [BMI] = 27.04 ± 6 kg/m²). Participants completed the International Physical Activity Questionnaire, the Sedentary Behaviour Questionnaire, the Modified Weight Bias Internalization Scale, and the Anti-Fat Attitudes Questionnaire (explicit weight bias). Linear regressions were conducted to determine the relationships between weight bias internalization (WBI), explicit weight bias, physical activity and sedentary behaviours. WBI predicted more weekly hours spent engaging in sedentary behaviours (F(6,897) = 14.73, p <.001, R² = 0.09) and anti-fat attitudes (AFA) predicted more weekly minutes of vigorous physical activity (F(6,891) = 5.42, p <.001, adj. R² = 0.03). WBI was not significantly associated with physical activity at any intensity. AFA was not significantly associated with sedentary behaviour, or moderate and mild physical activity. Findings suggest that some elements of weight bias may be related to certain health behaviours like sedentary behaviours and physical activity. Our results warrant further study on other factors that may play a role in the relationships between weight bias and health behaviours. Future research should include longitudinal studies and interventions that investigate the impact of weight bias on health behaviours.
While photovoice, a visual methodology, is widely known for helping to deepen the understanding of participant experiences and informing institutional change, it has rarely centered Black imagery from our unique cultural, historical, and political standpoints. Drawing on insights from a photovoice project titled #FatOnCampus, the authors focus on the compelling imagery and narratives of Serena Moon, a self-identified fat Black graduate student. Through Serena’s contributions, analyzed with assumptions from endarkened feminist epistemology (Dillard, 2006), this article examines how Black cultural perspectives around bodies and fatphobia can manifest in photovoice projects, particularly with Black collaborators and researchers. This endarkened photovoice approach seeks to harness photovoice’s transformative potential, emphasizing self-liberation and self-healing for Black folx. The article ends by inviting scholars to consider how endarkened photovoice can advance research methodologies and deepen our understanding of Black communities and individuals in and across higher education.
The aim of this research was to examine the role of body self‐esteem, Body Mass Index (BMI), and the tendency toward social desirability as predictors of anti‐fat stereotypes and prejudices, and gender, ‘fat’ status, and social status as moderators of this relationship, as well as eye movements of subjects when observing ‘fat’ individuals. Three studies examined the research aims. In the first study ( N = 311; 60.8% female), body self‐esteem, self‐reported BMI, and social desirability were assessed as predictors of anti‐fat stereotypes and prejudice, with ‘fat’ status as a moderating variable. The second study ( N = 311; 60.8% female) replicated this approach, adding perceived social status as a moderator. The third study ( N = 191; 61.5% female) assessed body self‐esteem and collected precise body‐related measurements (weight, body fat, visceral fat, muscle percentage, metabolism, and BMI) using the OMRON body composition monitor. Additionally, it measured anti‐fat stereotypes, prejudice, and eye movements in response to ‘fat’ and ‘non‐fat’ stimuli. The results of the first study suggest that body self‐esteem, BMI, and the tendency toward social desirability can predict anti‐fat stereotypes and prejudices. ‘Fat’ women were evaluated most negatively. The second study indicates that the social status of stimulus individuals is also a significant moderator of the relationships described above. ‘Fat’ women of low social status are evaluated most negatively. In the third study, we obtained information on the following eye movement parameters: (1) First view, (2) Duration of fixations, (3) Fixations and (4) Revisits. Eye movement parameters can be predicted by body self‐esteem and body condition parameters, while gender and ‘fat’ status of stimuli are significant moderators in this relationship. The study explains the role of BMI and body self‐esteem in anti‐fat bias, highlights the importance of gender and social status in perceiving ‘fat’ individuals, as well as the importance of considering nuanced body composition measures, such as visceral fat and muscle percentage, in understanding individual differences in perceptual bias. Differences in viewing patterns between genders underscore the interplay of stereotypes.
With suicide ranking as a leading cause of death globally, identifying modifiable risk factors is crucial. Suicidal ideation (SI) is a significant precursor to suicide, and there is a growing interest in the role of cardiometabolic factors, particularly the cardiometabolic index (CMI), multiplying the triglyceride-to-high-density lipoprotein cholesterol ratio by the waist-to-height ratio, in mental health outcomes. Previous studies have shown a notable relationship among lipid abnormalities, elevated triglyceride levels, and depressive symptom severity, including SI. This research investigated the correlation between the CMI levels of adult Americans and SI, utilizing data from the National Health and Nutrition Examination Survey (NHANES) ranging from the years 2005 to 2018. After collecting data on demographics, physical examinations, and laboratory testing, multivariate logistic regression analysis was conducted to assess the relationship between CMI and SI while adjusting for relevant factors. The study, which enrolled 15,849 individuals exhibiting symptoms of SI, constituting 3.47% of the total, revealed a significant association between CMI levels and SI. A significant positive association was found between CMI and SI (adjusted OR = 1.07, 95% CI: 1.02–1.13, P = .0029). Moreover, a nonlinear relationship was identified between CMI and SI, characterized by an atypical inverted U-shaped curve with a breakpoint at approximately CMI = 2.08. Subgroup analysis revealed consistent findings across various demographic and clinical subpopulations. The findings of this study demonstrate a substantial correlation between elevated CMI levels and an increased incidence of SI within the US population. Early interventions targeted at individuals with elevated CMI levels, such as psychological support or lifestyle adjustments, may mitigate the risk of SI.
Introduction
Most healthcare providers exhibit weight bias (i.e., negative assumptions, beliefs, or discriminatory acts toward someone based on their weight/body size) in their interactions with patients with obesity. Such bias can be exacerbated in medical training and may lead to reduced healthcare utilization and worsened patient outcomes. This study explored reflections of pre-clinical medical students on formative experiences they perceived to be related to their newly identified implicit weight bias.
Method
Seven hundred and sixteen second-year medical students completed the Weight Implicit Association Test (IAT) between April 2019-April 2022 and were instructed to write a reflective response based on their results. Of this sample, 212 students described experiences from childhood in their reflections, and these participant quotes were pulled for analysis. Inductive coding techniques were used to identify themes that were generated from medical students’ reflections on formative experiences using the software program Dedoose Version 8.3.35.
Results
The identified themes highlighted medical students’ own struggles with weight management and body dissatisfaction in childhood, a fear of having obesity, the prioritization of a “healthy” (i.e., thin) body and the stigmatization of larger bodies, and the influence of culture of origin on thin-ideal internalization. Results recognize the manifold experiences that these medical students have before entering their formalized medical training.
Discussion
Despite the proven negative impact on patient care caused by clinician weight bias there is a paucity of medical training programs that address weight bias. This research highlights the need for a more intentional educational curriculum to counteract the deeply rooted implicit weight bias existent in some future healthcare providers.
ACTION Switzerland (NCT05232786) examined obesity‐related perceptions, attitudes, behaviours and potential barriers to treatment among people with obesity (PwO) and healthcare professionals (HCPs). In March/April 2022, adult PwO (body mass index ≥30 kg/m ² , per self‐reported height/weight) and physicians/certified dietitians who manage PwO in Switzerland completed online surveys in a cross‐sectional design. Overall, 1002 PwO, 125 physicians and 25 dietitians completed the survey. Most physicians (97%) and dietitians (100%), but only 57% of PwO, recognized obesity as a chronic disease. Only 42% of PwO considered themselves to have obesity/extreme obesity, while 61% who had discussed weight with an HCP reported receiving an obesity diagnosis. Many PwO (76%) believed weight loss was entirely their responsibility; physicians were less likely than dietitians to agree it was completely their patients' responsibility (28% vs. 68%). Physicians and dietitians report primarily initiating conversations about weight when patients have obesity‐related comorbidities (85% and 64%); their top reasons for not discussing obesity were patients' perceived lack of motivation (76% and 60%) or interest (72% and 64%) in losing weight. In conclusion, some PwO are not aware that obesity is a chronic disease and incorrectly assume complete responsibility for weight loss. Improved communication between PwO and HCPs is required.
Objective: Weight stigma is present in employment, health care, and education institutions and can have detrimental consequences. This study, guided by the Health at Every Size® (HAES®) framework, examined the influence of weight stigma on college students' academic choices, extracurricular participation, overall well-being, and their university experience. Participants and Methods: Undergraduate and graduate students (N = 875) responded to a comprehensive online survey, including a 14 item University Environment Scale (UES). Results: Results revealed a small but significant effect on academic major choice for some students and a substantial impact on participation in extracurricular activities, particularly for students in larger bodies. Additionally, experienced weight stigma was significantly correlated with decreased self-esteem, decreased comfort in the body, and a less favorable university experience for students. Conclusions: There is a need for interventions to address weight stigma on college campuses to improve the overall experiences of students while emphasizing the importance of diverse body representation in both academic and extracurricular settings.
Introduction: Obesity is a chronic, multifactorial disease, dependent on over a hundred exogenous and endogenous variables. However, in our society, the collective unconscious considers that patients suffering from obesity are solely responsible for their condition. This is why they have to face repetitive stigmatising events in every environment even from health professionals. Discussion : In many situations, this leads to an internalisation of the stigma. Patients feel completely responsible for their condition and stigmatise themselves. The consequences can be severe. The patient will not invest in treatment, or the condition may even lead to treatment failure. It is therefore important to address internalised stigma at the start of a multidisciplinary approach to obesity to increase the chances of therapeutic success. Therapeutic patient education is essential in the treatment of obesity in general, but also in the treatment of internalised stigma. A patient-centered approach, focusing on all the psychological aspects seriously affected by this condition, has been shown to be effective in reducing or even eliminating it. Conclusion : Therapeutic patient education is the cornerstone of obesity management, guaranteeing improvements in both physical and psychological health and quality of life.
Aim
To map both direct and comparative research on weight stigma amongst nurses and nursing students by identifying the extent, range and nature of studies and identify the gaps in this area.
Design
Scoping review, following the Joanna Briggs Institute (JBI) guidelines.
Data Sources
Seven databases including MEDLINE, Web of Science, CINAHL, Embase, Scopus, PsycINFO and Cochrane Library, in addition to Google Scholar and Open Access Theses and Dissertations were systematically searched in August 2023.
Methods
Inclusion criteria comprised nurses or nursing students as participants, weight stigma as the concept and any context. After uploading all search results into EndNote and removing duplicates, titles and abstracts/full‐texts were screened. One reviewer extracted data, which were checked and confirmed by other authors. Data were analysed using frequency counts, numerical range and inductive open coding and then reported through diagrams, tables and a narrative summary.
Results
From 2213 initial search results, 80 studies were included. The range of studies regarding their characteristics was described. Studies were mapped in terms of objectives and findings and eight descriptors were identified; including description, comparing different groups of nurses, exploring associations, intervention assessment, comparing nurses with other health professionals, exploring consequences or causes, psychometrics and finding solutions.
Conclusion
The majority of included studies were conducted in the United States, had a cross‐sectional design, and included a high percentage of female participants. Future research with more diversity in terms of participants' gender and country, qualitative designs and a focus on practical strategies to reduce weight stigma will improve the understanding of weight stigma in nursing care.
Impact
The identified gaps in this study can guide future research to develop more practical strategies to reduce weight stigma amongst nurses, modify nursing education and provide relevant healthcare policies. Consequently, the quality of care for higher weight individuals may be improved.
Reporting Method
The EQUATOR guidelines for PRISMA have been utilised.
Patient or Public Contribution
None.
This study examined how patient weight influences mental health providers' diagnosis of bulimia nervosa (BN). US mental health providers (N = 200) from PsychologyToday.com and professional listservs participated in an online experiment, reading vignettes about patients with major depressive disorder (MDD) and BN with the compensatory behavior of excessive exercise. For the BN vignette, participants were randomized to read about a patient whose weight status was described as "healthy weight" or "obesity." Participants reported their diagnoses, confidence, treatment recommendations, and perceived symptom severity. Only 27% of participants accurately diagnosed BN, with 38% of participants instead diagnosing binge eating disorder. There were no significant differences between weight conditions in diagnostic accuracy, confidence, or treatment recommendations for the BN vignette (ps > .05). However, symptoms within the BN vignette were perceived as more severe in the "obesity" condition compared to the "healthy weight" condition (M = 5.08 ± 0.80 vs. M = 4.72 ± 0.99 on a 1-7 scale, p = .005). Within-subjects analyses revealed that participants were more accurate and confident in diagnosing MDD than BN (ps < .01). These findings suggest poor detection of BN among mental health providers when patients present with healthy or higher weights. Providers may benefit from improved training for detecting BN when excessive exercise is used as the primary compensatory behavior.
Conversations about weight have emerged within society as a prevalent topic between social influencers, professionals, and families. Researchers have identified a connection between parental insecure attachment behaviors, emotional feeding, and overeating with their children. However, examining weight talk and body weight perception through the lens of attachment theory has yet to be conceptualized within the field of marriage and family therapy. This article explores attachment theory as a framework to conceptualize weight talk and body weight perception within parent–child relationships. The connections between attachment theory, insecure attachment, and various forms of weight talk and body weight perception within the family system are reviewed. This literature review aims to provide clinicians with a framework for understanding weight-related conversations and body weight perception from an attachment perspective to support and strengthen parent–child relationships in clinical settings. Recommendations are made for future research directions within weight talk and body weight perception literature.
Limited literature addresses the association between pollution, stress, and obesity, and knowledge synthesis on the associations between these three topics has yet to be made. Two reviewers independently conducted a systematic review of MEDLINE, Embase, and Web of Science Core Collection databases to identify studies dealing with the effects of semi‐volatile organic compounds, pesticides, conservatives, and heavy metals on the psychosocial stress response and adiposity in humans, animals, and cells. The quality of papers and risk assessment were evaluated with ToxRTool, BEES‐C instrument score, SYRCLE's risk of bias tool, and CAMARADES checklist. A protocol for the systematic review was registered on PROSPERO. Of 1869 identified references, 63 were eligible after title and abstract screening, 42 after full‐text reading, and risk of bias and quality assessment. An important body of evidence shows a positive association between pollution, stress response, and obesity. Pollution stimulates the hypothalamic–pituitary–adrenal axis by activating the glucocorticoid receptor signaling and transcriptional factors responsible for adipocyte differentiation, hyperphagia, and obesity. Endocrine‐disrupting chemicals also alter the Peroxisome Proliferator‐activated Receptor gamma pathway to promote adipocyte hyperplasia and hypertrophy. However, these associations depend on sex, age, and pollutant type. Our findings evidence that pollution promotes stress, leading to obesity.
Background
Despite being the most prevalent eating disorder, Binge eating disorder (BED) remains largely unrecognized and lacks awareness among the general public, where it is also highly stigmatized. Common stigma surrounding BED includes the belief that individuals with this disorder are responsible for their condition and lack willpower and self-control. Research on BED recognition and stigma among lay adults is scarce. Enhancing public recognition of BED and reducing the stigma associated with it is crucial, as this could significantly improve access to treatment. The aim of the present study was to examine BED recognition and stigma within an adult community sample, and to identify associated respondent characteristics, including sociodemographic and psychosocial factors.
Methods
A sample of 894 adults (88.6% women; Mage = 35.20 ± 14.52) completed an online survey. Participants were presented with a vignette depicting a woman with BED and obesity, followed by questionnaires assessing BED recognition, stigma, and other respondent characteristics. Independent samples t-tests were performed to compare participants who recognized BED in the vignette with those who did not, based on sociodemographic characteristics (i.e., gender, age, income, education) and psychosocial variables (i.e., explicit and internalized weight bias, familiarity with BED). A multiple linear regression analysis was performed to identify the sociodemographic and psychosocial variables that were the most important in explaining the variance in stigma towards BED.
Results
Results indicated that 33% of participants identified BED as the main problem in the vignette. Those who recognized BED were younger, more educated, more familiar with BED, and exhibited lower levels of stigma towards BED. The most significant factor in explaining stigma towards BED was explicit weight bias, particularly attributing obesity to a lack of willpower and disliking people with obesity. Identifying as a man and older age were also associated with greater stigma towards BED.
Conclusion
The findings of the current study highlight the importance of comprehensive public awareness campaigns to improve recognition of BED and to reduce associated stigma.
Our study explored the link between body mass index (BMI) and symptoms of depression, anxiety, and suicidality among university students in China. We conducted a cross-sectional study involving 11 251 undergraduates from seven provinces. Body mass index, physical health status, economic status, depression and anxiety symptoms, and suicidality were self-reported using validated questionnaires. Multiple logistic regression models were fitted for males and females. Results showed that of 11 251 participants (mean age = 20.7 ± 1.3), 22.6% were with underweight, 6.1% with overweight, and 2.7% with obesity. Females with class III obesity had higher suicide risk (adjusted odds ratio [aOR] = 2.05) and suicide attempt history (aOR = 3.55). Males with overweight and class I obesity had lower odds of depressive symptoms. Suicide attempt history was associated with higher odds of overweight for males (aOR = 2.58). Clinicians and public health authorities should take into consideration the implications of overweight and obesity levels on suicidality.
Stigma and discrimination against people higher in weight is common in the U.S. and understanding weight stigma’s consequences for different individuals is important. In this study, Black ( N = 290) and White ( N = 449) men and women who perceived themselves to be “overweight” completed self-report measures of perceived weight discrimination, emotion regulation, psychological distress, and eating behavior. Results showed gender differences among White but not Black participants, weight discrimination and the outcomes of interest were stronger for White men, compared to White women. Furthermore, difficulties in emotion regulation significantly mediated the associations of perceived weight discrimination with anxiety, depression, and emotional eating, with this association stronger for White men relative to White women. These results illuminate difficulties with emotion regulation as an important variable to consider in how perceived weight discrimination impacts psychological distress and eating behavior. These findings point to the possibility that White men may be differentially affected by weight discrimination.
For several decades, the U.S. media have publicized state rankings based on the percentages of each state’s population who are obese. Because Southern states in the United States consistently topped the lists, many people might assume that something about the Southern diet or lifestyle contributed to the high obesity rates. This thought process, linking diet or lifestyle with being overweight, leads people to believe personal actions and inactions are major obesity causes. To check whether the South had more obesity, a survey of U.S. adults (N=1399) provided data that were analyzed with regressions. Other factors (e.g., income, age, and impulsiveness) were related to body mass indexes (BMIs) and geography was not. Therefore, the state rankings did not provide useful information about where obesity was most severe. A significant portion of respondents, however, believed obesity was more serious in the South and that diet and lifestyle were contributors. These attitudes can lead people to discount medical, genetic, and environmental causes of excess weight, focus on personal responsibility as a cause, and boost weight discrimination. In addition, these attitudes could also lower support for programs designed to help people lose weight. Therefore, complex issues like obesity should not be examined with single variables.
Introduction
Obesity, affecting 38% of adults globally, carries economic burdens and health risks like cardiovascular disease and diabetes. Weight-loss programs often face challenges due to stigma and poor body image, impacting individuals’ quality of life. Research on interventions targeting weight stigma is lacking, emphasizing the need for comprehensive approaches addressing psychological and behavioral aspects for effective care.
Methods
A systematic literature review was conducted according to PRISMA guidelines. We searched into three databases (PubMed, APA PsycArticles/PsycInfo, and Web of Science) articles published between 1975 and 2024. Studies were eligible if they involved people living with overweight or obesity who participate in a psychological program targeting, or not, weight stigma and if at least one outcome was related to weight stigma.
Results
We selected 24 studies published between 2009 and 2022, the majority concerning English-speaking countries. Reduction in weight stigma was observed in 23/24 studies, particularly through cognitive-behavioral techniques (18/24 studies), while others studies emphasized individual predispositions and the need for longer, and denser interventions.
Conclusion
Three relevant characteristics emerged from the studies analysed: content, duration and tools. Cognitive-behavioral techniques were central, aiding participants in managing their condition and coping with stigma. Interventions reducing Weight Bias Internalization (WBI) led to improved psychosocial determinants, yet the mechanisms remain unclear. Future research should address intervention duration, participant involvement, and the association between WBI and psychosocial factors to enhance outcomes and understanding.
In contemporary society, socioeconomic status (SES) combines economic standing, social positioning, and resource access, profoundly shaping individual identity and influencing various life domains. Lower SES is closely linked to increased mental health risks, often due to limited resources and social marginalisation. This study investigates the intersection of SES and gaslighting, a psychological manipulation tactic increasingly recognized in sports environments, where it poses significant threats to athletes’ psychological well-being. Phase 1 of the research examines how SES influences exposure to gaslighting in both urban and rural settings, where athletes encounter distinct socioeconomic and mental health challenges. This research addresses a significant gap in the existing literature. While gaslighting has been studied in the contexts of intimate partner violence and politics, its role in sports and its cognitive effects on athletes have received minimal attention. A key focus of this study is the further impact of gaslighting on athletes’ mental energy and vitality—psychological resources essential for sustaining high levels of cognitive functioning, emotional regulation, and resilience in sports. Mental energy, characterised by sustained focus, psychological stamina, and vitality, reflecting overall well-being, is pivotal in maintaining athletic performance. Wherein, the negative effects of gaslighting, particularly through cognitive interference, can deplete these resources, reducing athletes’ vigor, confidence, motivation, and calm, and impairing their concentration and performance levels. Therefore, in Phase 2, this study explores how gaslighting disrupts cognitive processes and emotional regulation by introducing cognitive interference, further exacerbating athletes’ challenges. By filling this research gap and analyzing the direct and indirect pathways through which gaslighting impacts mental energy and vitality, this research emphasizes the critical need for tailored interventions that address cognitive processes to mitigate gaslighting’s harmful effects on athletes’ well-being. These insights offer new avenues for supporting athletes’ mental health and resilience across diverse SES contexts, providing a foundation for further study and targeted interventions in sports psychology.
Internalized weight stigma arises when a person, applying negative societal weight stereotypes to themselves, develops negative beliefs about themselves and other reactions due to their higher weight. When internalized weight stigma coexists with binge-eating disorder (BED), it must be addressed as it hinders the change because the nature of patients’ negative view of themselves and other reactions results in their seeing little or no prospect of being able to control their eating and weight. Furthermore, some patients with internalized weight stigma intermittently strive especially hard to control their eating in pursuit of unrealistic weight goals with a view to reducing their sense of worthlessness. Cognitive behavior therapy (CBT) for BED addresses internalized weight stigma using education and specific cognitive behavioural procedures. When the internalized weight stigma coexists with the overvaluation of shape and weight, the two constructs should be addressed together.
¿Puede una simple acción no verbal cambiar las percepciones que el cliente tiene acerca del vendedor en un encuentro de servicio? En esta tesis hemos examinado, por primera vez en una muestra española y a través de tres estudios, cómo un leve toque del vendedor en el hombro o en el brazo del cliente y/o una sonrisa “Duchenne” del vendedor al cliente influyen en las evaluaciones que el cliente hace de la calidez y de la competencia del vendedor, utilizando para ello el Modelo de Contenido de Estereotipos (Fiske et al., 2002). En el primer estudio (con datos de 2018), estudiamos el efecto del leve toque y de la sonrisa del vendedor sobre las evaluaciones que el cliente hace de su calidez y su competencia, así como la interacción de la sonrisa sobre los efectos del leve toque del vendedor en las evaluaciones del cliente (estudiada por primera vez en un encuentro de servicio). En el segundo estudio, replicamos el primero, pero con datos tomados en 2022, para analizar el efecto pandemia. Y en el tercer estudio, con datos de 2023, estudiamos si el sexo del vendedor y del comprador modula el efecto del leve toque del vendedor en las evaluaciones que el cliente hace de su competencia y su calidez. Además, introducimos la extraversión de cliente (estudios 1 y 2) y el Confort con el Tacto Interpersonal del cliente (estudio 3) como variables moduladoras. Los resultados encontrados muestran que, tanto la sonrisa como el leve toque del vendedor tienen un efecto positivo sobre la evaluación que el cliente hace de su calidez, a lo largo de los 3 estudios. Cuando el vendedor, además, de tocar al cliente, le sonríe, el efecto positivo del tacto sobre la evaluación de la calidez del vendedor es menos intenso, tanto antes como después de la pandemia. En cuanto a la percepción de la competencia, la sonrisa “Duchenne” del vendedor también provoca un efecto positivo sobre el efecto que el tacto del vendedor en las percepciones del cliente, sin efecto pandemia. Sin embargo, el leve toque del vendedor sufre una evolución a lo largo de nuestros tres estudios en cuanto a su efecto sobre la evaluación de su competencia, pasando de ser positivo en 2018, a no ser significativo en 2022 y a tener un efecto negativo en 2023. Así mismo, la interacción de la sonrisa sobre el efecto que el tacto del vendedor tiene sobre la evaluación que el cliente hace de su calidez no es significativa, ni antes ni después de la pandemia. En cuanto a la modulación del sexo del vendedor y del comprador sobre el efecto del leve toque del vendedor en las evaluaciones de los clientes, encontramos que las evaluaciones de los clientes no están influidas por el sexo de los vendedores, sean hombres o mujeres; mientras que el sexo del comprador sí influye, siendo los compradores hombres los que mejor evalúan a los vendedores, en comparación con las clientes mujeres. Se discuten los resultados encontrados y se exponen las implicaciones gerenciales.
Background
This study investigates the potential relationship between obesity and self-ranking of poverty, as a proxy for self-awareness and happiness. To the best of our knowledge, this issue has not been previously explored based on self-ranking of poverty when income is controlled.
Method
Ordered Probit Regressions. We propose a new measure for the influence of western social values and norms associated with discrimination against obese women.
Results
Based on a follow-up survey after two years, findings demonstrate a drop in the projected probability of self-ranking as “not poor” with the BMI from 0.73 to 0.37 (females) – 0.48 (males) when the level of income is controlled. Similar outcomes are obtained when the independent variables are lagged and thus avoid endogeneity concerns. Finally, additional outcomes support the conclusion that the lagged BMI Granger-cause self-ranking of poverty for women, but not for men. Findings support the awareness of more obese women to lower prospects of finding a job.
Conclusion
Since according to twin studies, approximately 80% of obesity emanates from genetic factors, research findings stress the need to educate the public against prejudices on the grounds of obesity. In particular, our study seeks to evoke awareness among potential employers, which, in turn, might motivate avoidance of, or at least reduction in, an implicit wage penalty against obese women.
Individuals who are higher-weight and low-income may disproportionately experience weight and income stigmas in healthcare experiences compared to lower-weight, higher-income individuals. The ways that weight and income stigmas interact in healthcare should be better understood in order to provide better, less stigmatizing care to higher-weight, low-income patients. This study assesses how patients manage stigmatizing experiences in both healthcare and everyday experiences and how that impacts health seeking and stigma management behaviors through semistructured interviews with 11 higher-weight (Body Mass Index ≥30), low-income adults (≥18 years of age) in an Atlantic Canadian province. Participants took part in two interviews that focused on healthcare experiences and both positive and negative places/spaces. The two face-to-face interviews for each participant (total 21 interviews) were audio-recorded and professionally transcribed verbatim. The transcripts were analyzed using thematic analysis to identify recurring concepts and patterns within the data. Two major themes emerged from the data, uptake of stigmatizing, neoliberal health messaging and coping with stigma. Coping with stigma included subthemes control over stigmatizing experiences and stoicism in the face of stigma. The findings suggest that individuals understand their health and wellness through a neoliberal lens and that they deploy strategies of control and stoicism to cope with the stigmas they face.
Background
Individuals with overweight or obesity often endure significant weight‐based prejudice and discrimination in various settings. Experiencing weight‐related stigma is linked to many adverse psychosocial outcomes. Weight self‐stigma is when an individual internalizes and identifies with negative attributes ascribed to people with larger bodies and has self‐devaluing thoughts because of their weight and is associated with poorer health outcomes.
Aims
This study explored how weight self‐stigma may impact weight management efforts and outcomes for adults participating in an onlight weight‐loss intervention.
Materials and Methods
508 adults (86.2% female, 84.6% White) with overweight or obesity participated in an asynchronous 12‐week online weight‐loss intervention with computer‐generated feedback. Weight and weight self‐stigma were measured at baseline and 3 months later.
Results
Thirty‐one point five percent of the sample reported high levels of stigma, which was associated with greater program dropout than those who did not report high stigma (32.5% vs. 21.6%). Program completers reporting high self‐stigma showed better treatment engagement (77.0% vs. 69.7% lessons viewed) and weight loss (M = −6.31% vs. −5.08%); these differences were not observed when using intent‐to‐treat assumptions. When analyzed as a continuous variable, weight self‐stigma showed no association with treatment engagement and outcome.
Discussion
These findings highlight the complexity of understanding how self‐stigma affects treatment engagement and outcome in behavioral weight loss and the need for more targeted research in this understudied area.
Conclusion
Results suggest that weight self‐stigma plays a role in weight management during an online weight‐loss intervention, affecting engagement and outcomes.
The purpose of this phenomenological study was to capture the lived experiences of sizeism, or size discrimination, for fat and big men. The intention of this study was to identify the essence of fat and big men’s experience of sizeism to more adequately understand how sizeism may impact the lives of these men to assist with the creation of more culturally competent psychological services and interventions for this population. A total of 10 participants were included in this study. Participants self-identified as fat or big, cisgender, and varied in race/ethnic identity and age (from 25 to 44 years). Data analysis of their experiences revealed five emergent themes: (a) accessing masculinity, (b) navigating thin privilege, (c) psychological consequences of living in fat male bodies, (d) sexual capital, (e) and fat/big as identity.
Prejudice against fat people was compared with symbolic racism. An anti-fat attitudes questionnaire was developed and used in several studies testing the notion that antipathy toward fat people is part of an “ideology of blame.” Three commonalities between antifat attitudes and racism were explored: (a) the association between values, beliefs, and the rejection of a stigmatized group, (b) the old-fashioned antipathy toward deviance of many sorts, and (c) the lack of self-interest in out-group antipathy. Parallels were found on all 3 dimensions. No in-group bias was shown by fat people. Fatism appears to behave much like symbolic racism, but with less of the negative social desirability of racism.
This experimental study was designed to examine social perceptions and attitudes about nonobese and obese salespeople. Specifically, it focused on subjects' desire to work with nonobese and obese salespeople, and it also investigated subjects' evaluations of the effectiveness of these salespersons' job performance. The data indicate that subjects' evaluations of obese salespeople were influenced by negative stereotypes of obese people and that these unfavorable perceptions diminished their desire to work with them and led to a belief that these persons would be less effective in their jobs than nonobese salespersons. Sex differences in subjects' responses are noted, and implications regarding consumers' decision making are discussed.
This experiment was conducted(1) to examine stereotypes about obese and non- obese female job applicants, and (2) to isolate the effects of obesity from the effects of physical attractiveness in these judgments. College students (n = 104) rated applicants for two different positions. The applicants' resumes either were accom- panied by pictures of obese and nonobese targets who were matched in attractive- ness or by written descriptions of obses and nonobese targets whose attractiveness was not described.A pretest confirmed that students who read these descriptions perceived nonobese targets as significantly more attractive than obese targets. Re- sults showedthat when attractiveness was controlled (i.e., the students saw pic- tures), students exhibited little negative stereotyping of obese applicants. In contrast, students who hadto infer the target's attractiveness from a written descrip- tion rated obsese applicants more negatively than nonobese applicants. These re- sults, which occurred on one of the two resumes used, suggest that obese individualssometimes are evaluated negatively, and that this is due to the physical unattractiveness associated with increased weight.
Twenty-five years ago, the under representation of the obese at high-prestige colleges was demonstrated. This article looks at the problem of who pays for the higher education of heavy-weight adolescents. Three studies (total N = 833) demonstrate that heavy-weight college students rely more on jobs, savings, or financial aid than do normal-weight students, who rely primarily on family support. This effect appears in two different universities and is more reliable for women than for men. The effect remains even when parents' educational level, parents' income, race, family size, and number of children attending college are factored out. Several possible explanations for this effect, including parents' attitudes toward their children, are discussed.
Studies comparing obese and nonobese persons have generally failed to find differences in global aspects of psychological functioning (e.g., depression, anxiety). The resulting conclusion, that obesity does not carry risk for psychological problems, is inimical to clinical impression, reports from overweight individuals, and a consistent literature showing strong cultural bias and negative attitudes toward obese persons. The often-cited notion that obesity has no psychological consequences may be an inevitable byproduct of the manner in which the first generation of studies in the field has been conducted. The authors propose a second generation of studies that begins with a risk factor model to identify the individuals who will suffer from their obesity and the areas of functioning most affected. Recommendations are also made for a third generation of studies that will establish causal pathways linking obesity to specific areas of distress.
In a 1991 study, the author found that females were less likely to receive support from their parents for college education if they were fatter than average. This effect is replicated for female undergraduates (n = 576); no effect emerged for males (n = 450). Controlling for income, ethnicity, family size, and number of children attending college did not change the results. The selection bias against fat women was strongest for daughters of political conservatives, a group previously found to endorse antifat attitudes. This suggests that parents' attitudes may lead to discrimination within families. To demonstrate that this may be due to parents' bias, data from a representative sample of high school seniors (n = 3,386) showed no association between politics, weight, and predictors of college attendance, including grade point average, self-rated intelligence and ability, college aspirations, and health. The evidence accumulates that parents are discriminating against their own heavyweight daughters.
This article reviews the literature on weight and social stigma. It argues that obese women are both held accountable for their weight and rejected on account of their weight. Secondly, it presents evidence that obese women become downwardly socially mobile because of their weight. Finally, it points to some directions that are necessary for western society to cease its obsession with body weight and consequently improve the life satisfaction and mental health of millions of women.
This study examined whether obese persons report more types of employment discrimination and employment-related victimization than do nonobese persons. This question has never been answered directly using obese and nonobese persons in naturalistic settings. The subjects were recruited through the National Association to Advance Fat Acceptance (NAAFA). They were assigned to one of three weight level groups: average (no more than 19% above ideal weight as defined by 1983 Metropolitan Life Height and Weight Tables), obese (20 to 49% above ideal weight), or very obese (50% or more above ideal average weight). Very obese subjects reported more types of employment discrimination, school victimization, attempts to conceal weight, and lower self-confidence than did nonobese subjects. Women reported more attempts to conceal their weight and lower self-confidence because of their weight than did men. Since permanent weight loss is not possible for most obese persons, the results of this study suggest that societal attitudes toward obese persons, particularly toward women, need to change in order to eliminate the employment-related discrimination and victimization experienced by the obese.
This study investigated attitudes about body weight and appearance in a group of young adults. Undergraduate psychology students at the Flinders University of South Australia and at the University of Vermont were asked about their weight and dieting, consciousness about their body, the degree to which their weight had interfered with social activities, their perceptions about the causes of obseity, and their stereotypes about fat and thin men and women. Although 20% of the sample was overweight, 50% of subjects perceived themselves to be overweight to some degree. As expected, weight was a much greater issue for women, who felt more overweight, dieted more, expressed more body consciousness, and reported that weight had interfered more with social activities than did men. Also as expected, Vermont students reported greater frequency of dieting, more concern about weight, and more body consciousness than did students in Australia. Finally, men and women in both cultures stereotyped obese targets significantly more negatively than they did nonobese targets. The results indicate excessive and maladaptive concerns with weight in general, and among women and U.S. students in particular.
The consideration of appearance in employment decisionmaking context is prevalent and widely accepted. Nonetheless, statutory protection against such discrimination remains limited. Federal protection applies only to claims related to already-protected categories of discrimination, including disability, race, color, religion, sex, national origin, and age. Only one state and a small number of cities and counties explicitly prohibit appearance discrimination in employment. This Comment argues that consideration of appearance in employment decisions is not justified, rational, or beneficial to society unless a bona fide occupational qualification or reasonable business purpose exists. States should adopt statutory protection for appearance to protect otherwise qualified applicants and employees from arbitrary and harmful discrimination. This protection will promote the practice of hiring and retaining employees based solely on relevant qualifications and criteria. It also will assist in repairing the inequities that result from the legitimizing of appearance discrimination in employment, as well as in society as a whole.
This study examined whether preschool children differed on measures of psychosocial functioning both cross-sectionally and longitudinally. One hundred and thirty-two children who varied in levels of body fat participated in the study along with their natural parents. Results indicated that the children did not differ in levels of self-esteem and family functioning as a function of their body fat. Prospectively, physical self-esteem weakly (but significantly) correlated with body fat at 1 and 2 years, and father's perception of family functioning predicted body fat at 1 year only. Results suggested that childhood obesity may not develop as a result of psychosocial factors.
Attributions based on written accounts of self-presentations by hypothetical managers were studied. Contrary to prior research, college students did not rate managers sharing credit with subordinates less favorably than managers merely disclosing personal obstacles overcome. A critical difference between this study and the prior one seemed to be that performance was portrayed as strictly a team effort, whereas in the prior study the manager made a significant individual contribution. Credit-sharing, male managers, who were average in weight, were rated more favorably than other men or any women. The present and prior research seem to have confounded information disclosed and degree of modesty.
This paper reports a consistent preferential order when children are asked to rank pictures of children with various physical disabilities. This cultural uniformity, which is not explicitly taught, persists when comparisons of subgroups are made. Rankings are not affected by characteristics of the rater, such as sex; presence of a physical handicap; socioeconomic status; race; urban-rural differences; or setting of the interview. Despite the identity of rankings, girls more than boys show a tendency to emphasize social handicaps more than functional handicaps. Various explanations of the basic uniformity are considered.
The results of this study which used sales managers in the United States as subjects indicate that obese salespeople are considered less fit for challenging sales territories and may be discriminated against in assignment decisions. Interestingly, a job which included little face-to-face contact with customers (inside telephone sales) did offset the effects of obesity. Obese salespeople are also disciplined more harshly for breaches of ethical conduct.
Forty-six medical students were administered the Opinion About Mental Illness (OMI) questionnaire and Derogatis' Symptom Checklist (SCL-90-R) before and after an eight-week academic and clinical course in psychiatry. Significant changes were found after the course on dimensions of Benevolence and Interpersonal Etiology, and mean scores on the community portion of the OMI scale revealed movement in a positive direction. Using multiple regression analysis the pre-test attitude scores accounted for most of the variance on post-test attitudes. Stereotyping, a very important dimension of the OMI scale, was not rejected on either the pre-course or post-course measures. The students' own psychological distress did not have an effect on attitude change.
In the past 20 to 25 years, a significant amount of research has been directed toward diabetes and eating disorders. Evidence from the literature suggests that subclinical eating disorders and bulimia nervosa are prevalent in patients with type 1 diabetes, while subclinical and clinical binge eating disorders are more common in patients with type 2 diabetes. Although the determination of specific interrelations between eating disorders and diabetes requires further investigation, it is evident that healthcare professionals who work with these patients face several issues. Challenges include accurate diagnosis, priority of clinical problems in the development of treatment plans, and the integration of various medical, psychological and social interventions. The intent of this article is to provide a review of the literature about eating disorders and diabetes by describing the different types of eating disorders, examining prevalence estimates, exploring proposed associations, reviewing preventive and treatment approaches, and identifying further resources.
The question of whom our society truly wants to protect from adverse discrimination based on bodily difference is ultimately a question for the body politic. The aim of this article, by contrast, is to use the analytical tools provided by scholars in the field of disability studies to scrutinize how lawmakers to date have understood the concept of impairment as one form of bodily difference. By viewing administrative and judicial treatments of impairment through a disability studies lens, I have sought to give the disability kaleidoscope a turn and thus to provide the reader with an altered view of impairment and, by extension, disability. The purpose of presenting this changed view is primarily to educate, rather than to persuade. In other words, it is less my aim to convince the reader that the social model or minority group model of disability is “right,” than to dispel the reader’s conviction that the medical model understanding is the only shape that the disability picture can take. Ultimately, the article’s goal is modest: to begin an examination, and hopefully a discourse, on how the legal community understands disability — specifically disability as an illegitimate basis for discriminatory treatment.
Two studies explored reactions to the overweight by isolating the effects of weight from other characteristics of the job applicant. The first study, which established the existence of a stereotype, shows that the overweight are viewed consistently more negatively than others on variables considered important for successful job performance. The second study experimentally investigated occupational discrimination in a simulated hiring setting. Overweight applicants were less highly recommended than average-weight persons despite objectively identical performances. The findings are discussed m the context of current research on cognitive processes.
This experimental study was designed to examine social perceptions and attitudes about nonobese and obese salespeople. Specifically, it focused on subjects' desire to work with nonobese and obese salespeople, and it also investigated subjects' evaluations of the effectiveness of these salespersons' job performance. The data indicate that subjects' evaluations of obese salespeople were influenced by negative stereotypes of obese people and that these unfavorable perceptions diminished their desire to work with them and led to a belief that these persons would be less effective in their jobs than nonobese salespersons. Sex differences in subjects' responses are noted, and implications regarding consumers' decision making are discussed.
A puppet program for elementary school children was implemented through early childhood education to promote size acceptance. School children (N = 152) completed an evaluation of the program and 45 fifth grade girls completed the Figure Rating Scale either before or after the program. To students, the program's most important message was “not to tease others” and “be a good friend.” Figure Rating Scale data suggest that the program reduces negative stereotypes about large body shapes. This preliminary report suggests that the puppet program achieves its goal of promoting greater acceptance of diverse body shapes by discouraging teasing and encourag-ing students to treat everybody well.
Objective. This study contributes to the study of the relationship between obesity, occupational attainment, and earnings. Methods. Using data from the National Longitudinal Survey of Youth (NLSY), we utilize a multinomial logit specification to investigate the occupational selection of obese individuals. We then estimate earnings functions that account for the occupational attainment of the overweight. Results. We find that women pay a penalty for being obese, but overweight males, via occupational mobility, sort themselves into jobs to offset this penalty. Conclusions. Weight-related occupational sorting of males may be the outcome of the low barriers they face when moving across occupations. The occupational segregation found for obese women, however, may be mostly rooted in labor market discrimination.
CASUAL observation had suggested to us that obesity was less prevalent in high-ranking, so called "prestige" colleges than in public high schools. We therefore decided to investigate whether or not obesity affected college acceptance. If it did, it would have important implications for public-health programs directed at obesity. We chose for our investigation an outstanding high-school system and an Ivy League and a Seven Sister college.§ Our results did, indeed, indicate that there was less obesity in the colleges than in the high schools. No differences were found in academic criteria and application rates between obese and nonobese high-school students. . . .
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TWENTY years ago, I changed course in my internal medicine practice and decided, rather deliberately, to work on the problem of obesity. My friends, my colleagues, and my family thought I was crazy. The warnings were clear. "Don't risk your credibility and your career." "Don't venture into a part of medicine that no one takes seriously." "Don't move into the world of quacks and charlatans." My brother, a thoughtful, professorial cardiologist, assessed the situation in most negative terms. "The guys who deal with obesity are the sleaziest guys in medicine. Pills and shots!" he shouted. Another friend, also comfortably cloistered in academia, could not imagine how I could possibly want to spend my time working with fat, middle-aged ladies: "What on earth is there to talk about?"Taking the Plunge
Even in my naive youth I was not oblivious to the risks involved in dealing with obesity. Although my credentials
The promotion potential and perceived value of employees with disabilities was experimentally explored. Supervisors and midlevel managers (n= 168) made promotion recommendations for employees of an hypothetical manufacturing company. The candidates for promotion were presented as having 1 of 8 different types of disability or health problem. Results demonstrate that the candidates with either depression or obesity are evaluated more negatively than their equally qualified nondisabled peer. Perceived personal blame for the disability/health problem correlated negatively with promotion recommendations.
Investigated whether being a good model of physical activity and fitness would influence employability within the physical education (PE) profession. Surveys of individuals who hired PE teachers indicated that being 10-20 pounds overweight was detrimental when seeking employment as a public school PE teacher during both initial screening and final phases of hiring. (SM)
Examined whether preschool children differed on measures of psychosocial functioning both cross-sectionally and longitudinally. 132 children who varied in levels of body fat participated in the study along with their natural parents. Results indicated that the children did not differ in levels of self-esteem and family functioning as a function of their body fat. Prospectively, physical self-esteem weakly (but significantly) correlated with body fat at ages 1 and 2 yrs, and father's perception of family functioning predicted body fat at age 1 yr only. Results suggested that childhood obesity may not develop as a result of psychosocial factors. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Tested the hypothesis that landlords are prejudiced against prospective tenants who are obese. Ss were 6 male college seniors: 1 was obese, and 5 were of normal weight. The obese S and one of the normals went (separately) to look at 11 apartments; each was followed in a car by 2 of the other normal-weight Ss, who remained in the car and rated the appearance of the landlords, including their weight. Five of the 11 landlords would not rent to the obese S, but all would rent to the normal S. Of the 5 not renting, 3 had increased the rent, and 2 said that the apartment was pratically rented already. Results suggest discrimination against the obese. The landlord's weight did not appear to be influential in rejecting renters. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
One hundred third year medical students completed a questionnaire which elicited their reactions to obesity, including morbid obesity. The students' reactions toward the moderately obese were neutral or negative; while their reactions to the morbidly obese were almost uniformly negative. This is in contrast to their reactions to persons of average weight, which were neutral or positive. The negative prejudices expressed toward the morbidly obese extended beyond characteristics attributed to weight. Their negative feelings towards the obese did not change after direct contact with morbidly obese patients. Further research is needed to assess how prejudicial views toward obese people affect their medical care.
A person's weight may be perceived as an important aspect of his or her sexuality and a significant determinant of his or her interpersonal sexual experiences. However, researchers interested in body weight and sexuality have focused exclusively on sexual disorders found in individuals with eating disorders; consequently, little is known about people's beliefs about weight and sexuality, despite the individual and interpersonal significance of such beliefs. Undergraduates received information about a male or female, obese or normal-weight stimulus person and then evaluated that person along several dimensions related to sexuality. Participants believed that an obese man's sexual experiences would be highly similar to those of a normal-weight man. However, participants viewed an obese woman as less sexually attractive, skilled, warm, and responsive, and perceived her as less likely to experience desire and various sexual behaviors than a normal-weight woman. In addition, participants believed that an obese woman was less sexually attractive, skilled, warm, and responsive than an obese man.
Objective
The purpose of this study was to assess racial and gender differences in perceptions of ideal body size among White and Black fourth-grade children. Method: A random sample of 817 children (51.4% female, 51.8% White, and mean age 9 years) participated in a body image and weight concern survey. Results: Using socioeconomic status (SES), race, and gender as independent variables, Black children selected significantly heavier ideal sizes than White children for self, male child, female child, adult male, and adult female. Although almost one half (46%) of Black females wanted to be thinner than their current size, their body size selections were significantly larger than those of White females. Black and White males differed only in the selections of ideal female child and adult sizes. Cross-gender comparisons indicated females and Whites experience more body dissatisfaction and weight concern than males and Blacks. Discussion: Our study indicates that early in the sociocultural development of children, gender, race, and SES are influential factors in selecting ideal body size and determining body satisfaction. © 1997 by John Wiley & Sons, Inc. Int J Eat Disord 21: 279–284, 1997.
Gonadal steroids are known to affect astroglial morphology in developing and adult animals. Earlier studies of mixed neuronal-glial cultures from fetal rat hypothalamus showed that glial fibrillary acidic protein (GFAP)-immunoreactive cells with a polygonal shape were transformed into process-bearing cells upon exposure to the ovarian hormone estradiol. This effect was dependent on a direct contact of astroglia with living hypothalamic neurons. The present study shows that somata and processes of neurons in such cultures were immunoreactive for polysialic acid (PSA); astroglia were immunonegative. PSA appears to participate in the estradiol-induced shape changes since treatment with endoneuraminidase, an enzyme that specifically removes PSA from the cell surface, abolished PSA immunostaining and prevented the 17ß-estradiol-induced morphological changes of astroglia. In contrast, treatment with endoneuraminidase did not affect astroglial shape changes induced by basic fibroblast growth factor (bFGF), nor those induced by the addition of neurons to glial cultures. These results suggest that PSA on neuronal membranes, probably linked to the highly sialylated isoform of the neural cell adhesion molecule, is necessary for the expression of certain hormonally-regulated neuro-glial interactions. © 1995 Wiley-Liss, Inc.
This article takes an interdisciplinary approach to the issue of weight-based discrimination in employment, drawing on diverse literatures (psychology, law, sociology, economics), and integrating a review of empirical research and a traditional legal analysis. First, empirical research that focuses on the extent of bias against overweight individuals in employment contexts is reviewed and evaluated. Second, current legal requirements relevant to weight-based discrimination in employment are identified and discussed, and those requirements are applied to the research findings to assess the extent to which the weight-based bias identified in the reviewed studies involves illegal discrimination. Third, based on the results of the review of the research and legal literatures, future research directions are offered and practical implications for employers and policy makers are identified.
This study investigated the extent of negative stereotyping of obesity (compared to negative stereotyping of height) in children and its relationship with the perception of obesity as controllable. Questionnaires measuring negative stereotyping and controllability beliefs about weight (and height) were completed by 96 children from Grades 4 to 6. Consistent negative stereotyping of obesity was found for both child and adult targets, regardless of the child's own gender, age, or weight, Likewise, children uniformly believed obesity to be largely under volitional control. The degree of controllability assigned to obesity was positively correlated with the extent of negative stereotyping. It was concluded that control beliefs may provide a vehicle for changing the strong negative attitudes displayed toward fat people.
Increasing health care insurance costs have focused employer attention on health-related factors in employee recruitment and
retention. One such factor is weight. Employers have argued that overweight employees are absent more often, are more susceptible
to on-the-job injuries and illnesses, and are less productive than others. They have also contended that overweight employees
present poor role models and may cause “negative reactions” by others. Although no federal law addresses employee obesity
specifically, a number of laws prohibiting other forms of discrimination present potentially litigious situations. This article
reviews the background and legal framework of discrimination against the overweight and offers some guidelines for avoiding
such charges.
This study was designed to examine stereotypical beliefs about the physical appearance of employees and the effects of these beliefs on decision-making. Current stereotypes about obese and very thin people were assessed, and the effect of beliefs about obese and very thin people on subjects' evaluations of employee performance was measured. The findings indicated that subjects used information about employees' weight and body build differently, depending on whether they were responding to questions about discipline, the likelihood of recurrence of behavior, or their desire to work with certain employees. Overall, the results suggest that subjects exclude nondiagnostic aspects of employees (e.g., weight and body build) in some types of work decisions.
The aim of the present study was to assess and describe obesity-related beliefs and attitudes among school staff. Mailed surveys were completed by 115 science, health, home economics, and physical education teachers, school nurses, and school social workers from all junior and senior high schools (n = 17) within a large urban school district (response rate = 66%). Over half of the respondents expressed the belief that obesity was largely caused by individual behaviors, such as overeating, poor eating, and lack of physical activity, yet also believed that biological factors contribute to obesity. Between 20% to 25% perceived obese persons as more emotional, less tidy, less likely to succeed at work, having “different personalities,” or having more family problems than nonobese persons. Beliefs and attitudes regarding overweight persons did not differ in accordance with personal weight variables of school staff such as Body Mass Index, body dissatisfaction, and weight loss practices. School staff holding stronger beliefs that obesity is under personal control were somewhat more likely to support school–based activities aimed at decreasing obesity. Since school staff have ongoing contact with many youth, they are in a unique position to help with obesity prevention efforts and to help overweight students feel better about themselves in a thin-oriented society. Staff training can be an important part of school–based programs aimed at the prevention of obesity and its psychosocial consequences. Effective staff training in this area needs to address issues of obesity prevention/treatment and issues related to weight stigmatization.
This study examined the relationship of physical-appearance-related teasing history to body image and self-esteem in a clinical sample of adult obese females. The frequency of being teased about weight and size while growing up was negatively correlated with evaluation of one's appearance and positively correlated with body dissatisfaction during adulthood. Self-esteem was unrelated to teasing history but covaried significantly with body image measures. Subjects with early-onset obesity reported greater body dissatisfaction than did subjects with adult-onset obesity. The findings suggest that being teased about weight/size while growing up may represent a risk factor for the development of negative body image and that self-esteem and body image covary.