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“Cheapening the Struggle:” Obese People's Attitudes Towards The Biggest Loser
... Each of the six studies reported findings related to the stereotyping and stigmatization of people with larger bodies as well as weight-related beliefs that reinforce such stigmatization. Participants in these studies described the show as demeaning, humiliating, and exploitative (Holland et al., 2015), shaming (Sender, 2015), invasive, and offensive (Thomas et al., 2007). TBL was also described as presenting people with larger bodies as something to be laughed at, especially during physically challenging activities (Sender & Sullivan, 2008) or "challenges" that require contestants to resist the temptation to eat high-calorie foods (Thomas et al., 2007). ...
... Participants in these studies described the show as demeaning, humiliating, and exploitative (Holland et al., 2015), shaming (Sender, 2015), invasive, and offensive (Thomas et al., 2007). TBL was also described as presenting people with larger bodies as something to be laughed at, especially during physically challenging activities (Sender & Sullivan, 2008) or "challenges" that require contestants to resist the temptation to eat high-calorie foods (Thomas et al., 2007). Participants also stated that TBL reinforces weight-based stereotypes, including people with larger bodies as self-indulgent, gluttonous (Holland et al., 2015), lazy, lacking in willpower (Sender & Sullivan, 2008), and as socially unacceptable (Szto & Gray, 2015). ...
... Szto and Gray (2015) found that, among individuals on Twitter who were actively engaging in weight loss efforts, viewing TBL occurred alongside self-directed negative judgments regarding the amount of body weight that they perceived they still needed to lose. Researchers in three studies also noted that participants viewed shame as a positive motivational strategy for weight loss (Sender, 2015;Szto & Gray, 2015;Thomas et al., 2007). ...
Education-based reality television shows that mix education with entertainment, such as The Biggest Loser (TBL), has been coined “edutainment.” The premise that weight-based edutainment offers potentially positive educational or public health benefits has received little attention. The purpose of this systematic review is to examine if, and the extent to which, TBL serves to improve the health-related knowledge, attitudes, and behaviors of viewers as well as whether or not it contributes to harm, contrary to the purported purpose of edutainment. A systematic review of seven databases was conducted on March 30, 2022, to identify original, peer-reviewed research articles examining perceptions of, and responses to, viewing TBL with regard to health-related knowledge, attitudes, and behaviors of viewers. Two hundred thirty-nine abstracts were screened, and 14 articles were included in the final review. Results were synthesized according to study purpose including: (a) general reactions to viewing TBL (TBL as stigmatizing, unrealistic, potentially unhelpful), (b) mixed responses to viewing the show on self-reported physical activity attitudes and behaviors, and (c) the association between TBL and increased weight-stigmatizing beliefs. Although researchers have identified potential benefits of TBL, the potential harms seem to outweigh any benefits. Weight-based edutainment is fraught with assumptions, stereotypes, and inaccuracies about weight that serve to reinforce stigmatizing discourses in society. We call for researchers and policymakers to advocate for strategies to reduce the harmful consequences of weight-based edutainment, including further investigation of the utility of such programming for viewers of the reality television genre.
... Over its nine seasons TBL has become a key text in obesity discourse, a discourse that has been the subject of sustained critical attention as it has grown to achieve the status of unarguable prescription for not only health but also morality (Donaghue 2014;Rich and Evans 2005). TBL has itself been the subject of critical attention particularly in relation to fat stigma and discrimination (Lupton 2013;Thomas, Hyde, and Komesaroff 2007). ...
... Despite these concerns there is a widespread belief that the "overall" message of the programme is positive because it educates viewers about the importance of diet and exercise (Christenson and Ivancin 2006;Thomas, Hyde, and Komesaroff 2007). But weight-loss and obesity discourse is multi-faceted and complex; beyond the messages of healthy lifestyle choices are values relating to personal responsibility and failure, as well as messages that construct overweight and obese individuals as unable to successfully manage their bodies or their lives (Bordo 1993;Gard and Wright 2005;Throsby 2007). ...
... There is also concern that the effects of TBL go beyond accepted health practices. The ways in which the contestants are treated and portrayedthe revealing clothes, the close ups of flesh, the shots and montages highlighting both physical and emotional weakness and the bullying by trainersare considered by some to be humiliating and exploitative (Holland, Blood, and Thomas 2014;Lupton 2013;Thomas, Hyde, and Komesaroff 2007). There is also concern that the programme strengthens negative stereotypes of overweight and obese people; the notion that fat people are lazy and greedy and lack the ability to manage their lives (Holland, Blood, and Thomas 2014;Thomas, Hyde, and Komesaroff 2007;Waddell 2010), as well as the belief that fat people cannot be happy or successful in their lives, nor can they love themselves or be loved by others (Lupton 2013). ...
The Biggest Loser (TBL) is a reality television weight-loss programme that positions itself as a response to the so-called “obesity crisis”. Research on TBL has thus far focussed on audience responses and its effect on viewers’ beliefs about weight loss. This article focuses instead on how meaning is constructed in TBL. We conducted a multimodal critical discourse analysis of a key episode of TBL (the 2012 Australian season finale) to examine how the textual, visual and auditory elements combine to construct meanings beyond the ostensible health messages. Although the overt message is that all contestants have worked hard, turned their lives around and been “successful”, examination of editing choices, lighting and colour, clothing and time spent on contestants allows us to see that the programme constructs varying degrees of success between contestants and provides accounts for these differences in outcomes. In this way the programme is able to present itself as a putative celebration of all contestants while prescribing narrow limits around what constitutes success. TBL reinforces an ideology in which “success” is a direct result of “the work” of weight loss (both physical and emotional), which can apparently be read straightforwardly off the body. TBL’s “celebration” of weight loss thus reproduces and strengthens the widespread view of fat bodies as physical manifestations of individual (ir)responsibility and psychological dysfunction, and contributes to the ongoing stigmatisation of obesity.
... This might indicate that PSRs are not as impactful as expected in this specific context. Although previous research showed that viewers generally appreciate the underlying concept of the show (i.e., weight loss through healthy eating and physical exercise; Thomas et al., 2007), a recent qualitative study using in-depth interviews found that that audience members perceived the portrayal of excessive exercise in the show to be unrealistic and that they were unsure whether the displayed physical activities would guide and inspire themselves (B. J. Smith & Bonfiglioli, 2019). ...
... Although TBL markets itself as a show promoting a healthy lifestyle by encouraging audience members to lose weight, health professionals and researchers in the fields of public health and health communication raise concern about the message of the reality TV show. For instance, there is criticism that TBL promotes the stigma that being overweight or obese is an individual's fault, that individuals should take personal responsibility for losing weight (Thomas et al., 2007), and that failure has to be taken as personally (Mocarski & Bissell, 2016). Furthermore, Silk and colleagues (2011) criticize that overweight and obese people are portrayed as immoral and irresponsible citizens and as a "problem" that needs to be solved. ...
Overweight is one of the major health-related challenges in industrialized countries and
mostly preventable through a healthy diet and regular engagement in physical activity.
Health communication practitioners and researchers, therefore, started using the
media’s persuasive potential by creating entertainment-education (E-E) programs that
promote healthy nutrition and exercise. By observing the characters in E-E programs,
audience members can learn vicariously and eventually develop personal bonds with
them. The current study investigates the effects of parasocial relationships (PSRs) with
characters of a health-related E-E show, as well as the impact of parasocial breakups
(PSBUs) on health-relevant outcomes. Using the setting of the show The Biggest Loser
(TBL), we conducted a quasi-experimental longitudinal field study. Participants (N =
149) watched shortened episodes of the show once a week for 5 weeks. Results
showed that PSRs with the reality TV characters did not increase over time and after
repeated exposure. Findings furthermore suggest that PSR did not influence self-efficacy perceptions or exercise behavior over time. Parasocial breakup distress intensity was
neither related to self-efficacy nor to exercise behavior. Interpretations of these
findings and implications for better understanding the effects of PSRs and PSBUs are
discussed.
... Within the scholarly literature, some researchers have suggested that the diet and exercise regimen portrayed on "The Biggest Loser" is unhealthy, and that the television show perpetuates negative stereotypes among obese individuals (Christenson & Ivancin, 2006;Hill, 2005;Sender & Sullivan, 2008;Thomas, Hyde, & Komesaroff, 2007;Yoo, 2013). Throughout Christenson and Ivancin's (2006) comparison between reality television shows and their positive and negative effects, the researchers repeatedly discuss the unrealistic and unsafe goals depicted in "The Biggest Loser." ...
... To date, this study is one of the first published research studies specifically addressing individuals who have undergone weight loss utilizing a reality television show as the intervention. While individuals have published scholarly articles regarding the popular television show NBC's "The Biggest Loser" (Thomas, Hyde, & Komesaroff, 2007), this is the first published study that actually included contestants' interviews. Due to the nature of the weight-loss intervention (NBC's "The Biggest Loser") and the need for respondents' anonymity, there were some limitations imposed on the study. ...
Utilizing Qualitative Description influenced by aspects of phenomenology, we conducted fifteen open-ended, semi-structured interviews with former contestants of NBC’s “The Biggest Loser.” The purpose of the study was to explore experiences of significant weight loss. We focused on challenges, emotional well-being, and relational dynamics of contestants transitioning through their weight loss journeys, which included what happened after the show was completed. Further, we analyzed perspectives regarding the utility of Marriage and Family Therapists (MFTs) in working with this population. In the study, three themes emerged which included: (1) Living at the ranch: It’s reality TV, not reality; (2) After the confetti falls: Post-Traumatic Reality TV Syndrome and The Whiplash Effect; and (3) Therapeutic treatment: Much needed but nowhere to be found. The study includes a rich description of the data, as well as a discussion of clinical implications.
... Within the scholarly literature, some researchers have suggested that the diet and exercise regimen portrayed on "The Biggest Loser" is unhealthy, and that the television show perpetuates negative stereotypes among obese individuals (Christenson & Ivancin, 2006;Hill, 2005;Sender & Sullivan, 2008;Thomas, Hyde, & Komesaroff, 2007;Yoo, 2013). Throughout Christenson and Ivancin's (2006) comparison between reality television shows and their positive and negative effects, the researchers repeatedly discuss the unrealistic and unsafe goals depicted in "The Biggest Loser." ...
... To date, this study is one of the first published research studies specifically addressing individuals who have undergone weight loss utilizing a reality television show as the intervention. While individuals have published scholarly articles regarding the popular television show NBC's "The Biggest Loser" (Thomas, Hyde, & Komesaroff, 2007), this is the first published study that actually included contestants' interviews. Due to the nature of the weight-loss intervention (NBC's "The Biggest Loser") and the need for respondents' anonymity, there were some limitations imposed on the study. ...
Utilizing Qualitative Description influenced by aspects of phenomenology, we conducted fifteen open-ended, semi-structured interviews with former contestants of NBC’s “The Biggest Loser.” The purpose of the study was to explore experiences of significant weight loss. We focused on challenges, emotional well-being, and relational dynamics of contestants transitioning through their weight loss journeys, which included what happened after the show was completed. Further, we analyzed perspectives regarding the utility of Marriage and Family Therapists (MFTs) in working with this population. In the study, three themes emerged which included: (1) Living at the ranch: It’s reality TV, not reality; (2) After the confetti falls: Post-Traumatic Reality TV Syndrome and The Whiplash Effect; and (3) Therapeutic treatment: Much needed but nowhere to be found. The study includes a rich description of the data, as well as a discussion of clinical implications.
... Moreover, as other research also points out (e.g. Holland et al. 2015;Lewis et al. 2011;Dickins et al. 2011;Thomas et al. 2007Thomas et al. , 2010, there is often a misunderstanding and misrepresentation of the relationship between health and obesity, which necessitates a paradigm shift in current mainstream approaches. Weight and health are closely interlinked; however, as medical research indicates, it is the extremes on the weight scale that cause significant health implications. ...
... Koh et al. 2012;Seneff et al. 2011;Gillis and Gillis 2005). Therefore, as many rightly argue (see, for example, Gurrieri et al. 2013;Thomas et al. 2007Thomas et al. , 2010, stigmatisation and discrimination against obese people often lead to further health problems, which creates a very complex situation where in an attempt to realise one right (to health), some other standards (e.g. the cross-cutting principle of non-discrimination) are trampled upon. Thus, when addressing the principle of equality and non-discrimination, social marketers should identify the meaning, scope and application of social marketing interventions on the target groups, as well as their broader societal impact. ...
Social marketing has been established with the purpose of effecting change or maintaining people’s behaviour for the welfare of individuals and society (Kotler and Zaltman in J Market 35:3–12, 1971; MacFadyen et al. in The marketing book, Butterworth Heinemann, Oxford, 2003; French et al. in Social marketing and public health: Theory and practice, Oxford University Press, Oxford, UK, 2010), which is also what differentiates it from other types of marketing. However, social marketing scholars have struggled with guiding social marketers in conceptualising the social good and with defining who decides what is socially beneficial in different contexts. In this paper, we suggest that many dilemmas in identifying the social good in social marketing could be addressed by turning to human rights principles, and, in particular, by following a human rights-based approach. We examine a number of cross-cutting human rights principles—namely, transparency and accountability, equality and non-discrimination, and participation and inclusion—that are capable, in a practical way, of guiding the work of social marketers. Through an illustrative case study of the anti-obesity discourse, we present how these principles might help to address some of the challenges facing social marketing, both as a theory and practice, in meeting its definitional characteristic.
... In addition, a team of Australian researchers conducted an indepth, qualitative study with 76 obese people, exploring their perceptions of, "The Biggest Loser," and what, if any, impact it had on their personal lives [124]. The vast majority of study participants felt the show's concept was negative; it made weight loss seem like a "circus sideshow," and oversimplified the complex nature of obesity by narrowing the focus to binge eating and lack of exercise. ...
... While participants believed the basic tenants of healthy eating and exercise were good, they also felt the show's approach was unrealistic, unaffordable, and unsustainable. The participants also felt the show sent the message that obese people could be bullied or shamed into changing, and reinforced a culture of blame toward people who are overweight and obese [124]. ...
Obesity is a major public health concern in the United States. Over the last several decades, the prevalence of obesity among both adults and children has grown at an alarming rate and is now reaching epidemic proportions. The increase in obesity has been associated with rises in a host of other chronic conditions including cardiovascular disease, type 2 diabetes, and some cancers. While the causes of obesity are multifaceted, there is growing evidence that television viewing is a major contributor. Results of numerous studies indicate a direct association between time spent watching television and body weight. Possible explanations for this relationship include: 1) watching television acts as a sedentary replacement for physical activity; 2) food advertisements for nutrient-poor, high-calorie foods stimulate food intake; and 3) television viewing is associated with "mindless" eating. In addition to decreasing physical activity and increasing the consumption of highly palatable foods, television viewing can also promote weight gain in indirect ways, such as through the use of targeted product placements in television shows; by influencing social perceptions of body image; and airing programs that portray cooking, eating and losing weight as entertainment. This paper will provide an interdisciplinary review of the direct and indirect ways in which television influences the obesity epidemic, and conclude with ways in which the negative impact of television on obesity could be reduced.
... These results indicate that anti-fat attitudes increase after brief exposure to weight-loss reality television. articles Behavior and Psychology study viewed the basic concept of the show negatively, believing that it portrayed stereotypical character traits of obesity, promoted individual responsibility for weight (as opposed to genetic or environmental factors), and gave unattainable, unrealistic, and unaffordable weight-loss solutions (16). ...
... Although contestants on The Biggest Loser shared their struggles with weight loss, this did not decrease participants' endorsement of the belief that weight is controllable as well as dislike of obese individuals. These findings are consistent with the contention by obesity researchers and obese individuals that The Biggest Loser inaccurately portrays weight loss and highlights individual responsibility for obesity (6,16). ...
Weight-loss reality shows, a popular form of television programming, portray obese individuals and their struggles to lose weight. While the media is believed to reinforce obesity stereotypes and contribute to weight stigma, it is not yet known whether weight-loss reality shows have any effect on weight bias. The goal of this investigation was to examine how exposure to 40-min of The Biggest Loser impacted participants' levels of weight bias. Fifty-nine participants (majority of whom were white females) were randomly assigned to either an experimental (one episode of The Biggest Loser) or control (one episode of a nature reality show) condition. Levels of weight bias were measured by the Implicit Associations Test (IAT), the Obese Person Trait Survey (OPTS), and the Anti-fat Attitudes scale (AFA) at baseline and following the episode viewing (1 week later). Participants in The Biggest Loser condition had significantly higher levels of dislike of overweight individuals and more strongly believed that weight is controllable after the exposure. No significant condition effects were found for implicit bias or traits associated with obese persons. Exploratory analyses examining moderation of the condition effect by BMI and intention to lose weight indicated that participants who had lower BMIs and were not trying to lose weight had significantly higher levels of dislike of overweight individuals following exposure to The Biggest Loser compared to similar participants in the control condition. These results indicate that anti-fat attitudes increase after brief exposure to weight-loss reality television.
... As has been outlined briefly above, The Biggest Loser has been the object of both scholarly and popular attention, including examinations from sociological, communication, and public-health-related perspectives. As noted previously, these have largely focused on the American version of the show, as well as on the Australian incarnation of the series (for example, see Thomas, Hyde, & Komesaroff, 2007;Monson, Donaghue, & Gill, 2016;Smith & Bonfiglioli, 2019). However, it appears that comparatively little research has examined local versions of The Biggest Loser with regard to the wider European context, especially with a focus on exploring any possible links between the show's popularity and macro level topics such as rates of overweight or obesity in a given country. ...
With rates of overweight and obesity on the rise around the world, there have been numerous reality television shows dedicated to this complex and enduring issue. This exploratory contribution outlines the global epidemiological situation relating to overweight and obesity in the European context, before seeking to discover whether there is any linkage between the rates of overweight in a given European country and the popularity – as demonstrated through the number of seasons broadcast – of the local version of the weight-loss reality show The Biggest Loser. Through the analysis of online sources, preliminary data is gained, providing useful information for further research on the topic at a later date.
... In general terms, some critical qualitative researches have exemplified the potential effects of this kind of TV show in weight stigma processes. This would entail the mocking and trivialising of weight, the restrictive cultural norms of femininity and ethnicity, or the presentation of inaccessible, unrealistic and unhealth weight loss practices, among others (Greenleaf et al., 2019;Thomas et al., 2007) According to Víctor: 'afterwards they give you a diploma saying, "we have lost 200 kilos altogether. The participant with the biggest weight loss is Puri, who has lost 15 kilos"'. ...
Weight stigma is a negative social process that involves discrimination against overweight and obese people. Gyms are important environments to promote exercise where weight stigma can be a hindrance for obese exercise practitioners. This critical-oriented study provides evidence-based answers to this question: How do obese users experience weight stigma in gyms? Six obese gym users (BMI >30) participated in semi-structured interviews and provided visual data for photo-elicitation. A thematic analysis enabled the grouping of their experiences around weight stigma into three forms of discrimination: 1) direct: negative comments about body weight and body size; 2) indirect: internalization of negative stereotypes on weight, ability or appearance; 3) structural: explicit or symbolic rejection related with weight-centric exercise, equipment and recommendations implicit in marketing and advertising. The results provide evidence and interpretations of different forms of discrimination and inequality that operate in gyms, and how they affect obese users’ experiences. Based on these results, we compile a list of measures to prevent weight stigma and recommendations for exercise professionals to relate with obese users.
... The show has also been called out for fat-shaming, as well as for promoting so-called "beach body" aesthetics rather than representing a more inclusive discussion of body types (Silk et al., 2011;Domoff et al., 2012;Gilbert, 2020). In addition, several studies have also argued that aspects of the show increase weight bias and stigma against overweight people (Thomas et al., 2007;Sender, & Sullivan, 2008;Yoo, 2013). ...
First shown in the United States in 2004, The Biggest Loser
is one of the most successful and enduring reality television shows.
The format has been exported internationally, and domestic variants
of the show remain extremely popular in many European countries.
From a translation perspective, however, the title of the show
provides a challenge, as the original English conveys not only the idea
of losing weight, but also the oxymoronic notion of a ‘loser’ ironically
being a winner. This contribution, therefore, provides an overview of
the strategies used to deal with this issue through examination of the
local titles given to The Biggest Loser in thirteen European countries.
An initial analysis aimed to ascertain if the title had actually been
translated into the local language, either fully or partially, taking into
account associated cultural implications regarding English language
proficiency. Subsequently, the titles were examined to see if aspects
of the original were present, such as wordplay and the element
of transformation. Finally, the titles were analysed to see if there
were any common geographical or linguistic similarities between the
various translation strategies.
... Currently there are numerous medias and papers that focusing on the obese and overweight to address the broader social and economic issues that influence people's lives and discusses strategies to remove from a focus on the O-word [18,19]. Thus, I recommend my community to turn point their attitude towards o-words as more detrimental than positives. ...
... Currently there are numerous medias and papers that focusing on the obese and overweight to address the broader social and economic issues that influence people's lives and discusses strategies to remove from a focus on the O-word [18,19]. Thus, I recommend my community to turn point their attitude towards o-words as more detrimental than positives. ...
The attitude of Ethiopian community living in every corner of the country perceiving o-words (overweight and obesity) as symbol of wealth, health, beauty, comfort, honesty, dignity, respect and confidence despite a few literate community dislike for their detrimental effect.
... Currently there are numerous medias and papers that focusing on the obese and overweight to address the broader social and economic issues that influence people's lives and discusses strategies to remove from a focus on the O-word [18,19]. Thus, I recommend my community to turn point their attitude towards o-words as more detrimental than positives. ...
Ethiopian community living in every corner of the country perceive o-words
(overweight and obesity) as symbol of wealth, health, beauty, comfort, honesty, dignity, respect and confidence despite a few literate community dislikes for their detrimental effect.
... Yet, there are criticisms about the presentation of weight loss in the media. Some suggest that the media presents weight loss as simple, generally excludes any references to the common experience of weight re-gain (Bonfiglioli et al., 2007), promotes a quick fix to weight loss (Thomas et al., 2007) and trivialises the complex environmental and genetic influences on body weight and behaviours (Hill, 2005). Media presentations of weight loss have also been criticised as being deceptive, improbable and potentially unsafe (Blaszkiewicz, 2009;Freedhoff and Sharma, 2009) and for adding to obesity stigma (Sandberg, 2007). ...
Obesity is considered a public health concern. In Australia, there are a greater number of overweight or obese men compared with women. The media is an important source of information about body weight and weight management. We undertook a qualitative study to analyse men’s weight loss stories in a popular men’s magazine. Between January 2009 and December 2012, we collected 47 men’s weight loss stories from the Australian edition of Men’s Health magazine. We undertook thematic analysis to examine the stories. Confession, personal responsibility, appearance and transformation were key themes. The stories describe the men’s self-discipline and their monitoring and tracking of their behaviours as activities which supported their weight loss. In this way, the stories promote the importance of such panoptic self-surveillance and self-discipline to the readers. We consider how such stories contribute to the wider synoptic system of media messages about body weight.
... Consider, for example, the popular reality television program "The Biggest Loser," in which morbidly obese contestants compete, through hard work and dedication, to lose the most weight over the course of the season. Although the show has been criticized for a variety of reasons-for promoting an unhealthy and unrealistic approach to weight loss [48] and because contestants have been found to regain lost weight after the show ends [18]-there is some evidence that it increases viewers' sense that they have control over their weight [49]. This suggests that exposing people to personal testimonials in which a protagonist succeeds at achieving a weight-loss goal-through healthy and realistic diet and exercise-may foster an incremental theory of the condition, making them more optimistic about obesity treatment in general [50]. ...
Both the scientific community and the general public have come to recognize the increasing prevalence of obesity as a significant public health crisis. To help address this issue, recent research has begun to explore lay theories of obesity—the mental models that structure how non-experts think about the causes and consequences of the condition. In this chapter, we develop an integrative review of the literature on lay theories of obesity, drawing on research in public health, communications, and psychology to illuminate the factors that shape beliefs and attitudes toward the condition, as well as the consequences of specific lay theories for cognition and behavior. At the individual level, we discuss how certain ways of thinking about obesity facilitate obesity treatment and prevention. At the societal level, we discuss how certain ways of thinking about obesity lead people to support (and oppose) specific types of obesity-related policy interventions. We pay special attention to the role of narrative framing and individual demographics in the etiology of lay beliefs and explore how particular psychological mechanisms (e.g., empathy) can affect attributions and attitudes.
Both the scientific community and the general public have come to recognize the increasing prevalence of obesity as a significant public health crisis. To help address this issue, recent research has begun to explore lay theories of obesity—the mental models that structure how non-experts think about the causes and consequences of the condition. In this chapter, we develop an integrative review of the literature on lay theories of obesity, drawing on research in public health, communications, and psychology to illuminate the factors that shape beliefs and attitudes toward the condition, as well as the consequences of specific lay theories for cognition and behavior. At the individual level, we discuss how certain ways of thinking about obesity facilitate obesity treatment and prevention. At the societal level, we discuss how certain ways of thinking about obesity lead people to support (and oppose) specific types of obesity-related policy interventions. We pay special attention to the role of narrative framing and individual demographics in the etiology of lay beliefs and explore how particular psychological mechanisms (e.g., empathy) can affect attributions and attitudes.
... Reactions to the show have been mixed. Regular viewers report positive feelings about the show, stating the representations were identifiable and relatable, motivational, inspiring, and educational (Anonymous, 2006;Sender & Sullivan, 2008), and the overall concept of the show was positive and encouraging (Thomas, Hyde, & Komesaroff, 2007). Conversely, the show has been criticized for being exploitative, embarrassing, cruel (Sender & Sullivan, 2008), and self-abasing (Rodman, 2004). ...
Through a critical rhetorical analysis using Bandura's social cognitive theory as a lens to view The Biggest Loser (TBL), this article illustrates the contradictions between the show's health promotional aims and its entertainment aims, which show the problems the show creates for health promotion practitioners working on obesity. The social cognitive theory constructs of observational learning, psychological determinants, and environmental determinants emerged from this reading of TBL as central to how the show masquerades as a health promotion tool. This reading reveals that TBL promotes a neoliberal construction of health and obesity that challenges the worldview that many health promotion campaigns take and, therefore, complicates our own efforts to combat obesity. With this revealed, it is suggested that TBL be incorporated into health promotion campaigns only as a foil.
... The majority of news media portrayals of individuals with obesity are negative and stereotypical (e.g., portraying them as sedentary; Puhl, Peterson, DePierre, & Luedicke, 2013), and characters in popular media such as situation comedies, movies, and reality television are frequently targets of weight-based humor and stigmatization (Ata & Thompson, 2010;Fouts & Burggraf, 2000). For example, the reality television weightloss competition The Biggest Loser has been criticized for portraying its contestants in a derogatory manner and perpetuating negative weight-based stereotypes (Thomas, Hyde, & Komesaroff, 2007). Considering the high consumption of media in the United States (Statistical Abstract of the United States, 2007), weight-stigmatizing media content may have the power to affect millions of people at once, highlighting the importance of understanding how media content influences public attitudes and public health. ...
This study aimed to evaluate the impact of exposure to weight-stigmatizing media on exercise intentions, motivation, and behavior, as well as to examine the interaction between this exposure and past experiences with weight stigma. A community sample of 72 women were randomly assigned to view a brief weight-stigmatizing or neutral video. Participants' choice of taking the stairs versus the elevator was observed before they completed measures of exercise intentions, motivation, and behavior; psychological well-being; and experiences with weight stigma. A follow-up survey was sent to participants 1 week later that assessed exercise behavior and intentions. Frequency of past weight stigma correlated with worse psychological well-being and more controlled (versus autonomous) exercise motivation. Significant interactions were found between past weight-stigmatizing experiences and exposure to the weight-stigmatizing video for outcomes of exercise intentions, behavior, and drive for thinness. Participants in the stigma condition with higher frequency of past experiences reported greater exercise intentions and behavior, along with higher drive for thinness. Past experiences of weight stigma interact with exposure to weight-stigmatizing media to increase exercise intentions and behavior, although this effect is accompanied by a heightened drive for thinness that may increase risk for long-term negative health consequences.
... For example, experimental studies have demonstrated that viewing the weight-loss reality television program 'The Biggest Loser' (featuring people with obesity engaging in exercise) increases weight-biased attitudes and more negative attitudes toward exercise [29][30][31]. An important limitation of this prior research, however, is the confounding of stigmatizing portrayals and exercise portrayals of the contestants [30,32]. It is important to consider the behavior exhibited by individuals with obesity, along with whether the depiction arouses stigma, in order to clarify the effects of each on weight-biased attitudes and attitudes toward exercise. ...
Health education campaigns for preventing and reducing obesity often contain weight-stigmatizing visual content, which may have unintended negative health consequences. The goal of the present research was to identify non-stigmatizing visual content for health education materials that can promote exercise among people of diverse weight statuses. An online sample of 483 US women viewed: (i) a woman with obesity portrayed stereotypically; (ii) a woman with obesity exercising; (iii) a woman with obesity portrayed neutrally; or (iv) a lean woman exercising. Race of the models pictured was randomized (White or Black). Participants completed measures of weight bias and exercise behavior and attitudes, and provided information about their weight status. Analysis of covariance revealed that responses to stereotypical and exercise images varied by participant weight status. Across participants, neutral obesity portrayals elicited lower expressions of weight-biased attitudes and higher reports of exercise liking/comfort. Among non-overweight participants, images portraying women with obesity stereotypically or counter-stereotypically produced greater endorsement of negative stereotypes than control, lean images. No effects of model race were found. These findings suggest that the public responds differently to visual portrayals of obesity depending on weight status, and neutral portrayals may be an effective route toward promoting exercise without perpetuating stigma.
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... Notwithstanding these limitations, the results of the present study have implications for people who are dieting (with high levels of dietary restraint) and suggest that watching shows that prime thoughts about weight and appearance (such as The Biggest Loser) may actually be detrimental to their weight loss attempts due to increased food consumption during viewing. Taken together with research that suggests viewing these types of programmes increases weight bias and levels of dislike for overweight individuals (Domoff et al., 2012;Thomas, Hyde, & Komesaroff, 2007), the present research suggests that this type of programme is not useful in overall efforts to reduce obesity or weight-related stigma. In sum, this was the first study to investigate the effects of exposure to a weight loss reality TV show on body satisfaction, mood and snack food consumption. ...
The present study investigated the influence of a weight loss reality TV show on body satisfaction, mood and food consumption. Young Australian women (N=99) first completed baseline measures of state body satisfaction and mood. They were then randomly allocated to either a weight loss or a home renovation program and were provided with snack foods during viewing. Post-measures included state body satisfaction, state mood and trait dietary restraint and snack food consumption. BMI moderated the relationship between condition and body satisfaction and mood. Larger women experienced less body satisfaction and less positive mood in response to the weight loss program. Dietary restraint moderated the relationship between condition and food consumption. A greater percentage of women with lower dietary restraint ate in the control condition; while a greater percentage of women with higher dietary restraint ate food while watching the weight loss program. These findings highlight the potential negative impact of weight-focused reality TV on mood, body satisfaction and snack food consumption among some women.
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... Nearly all the stories indicated that the men's weight loss was fairly slow and steady. This is in contrast with other research examining the presentation of weight loss stories in the media, where weight loss was presented as occurring very quickly and in an unsustainable manner (Boulos, Vikre, Oppenheimer, Chang, & Kanarek, 2012;Thomas, Hyde, & Komesaroff, 2007). Weight loss advertisements in particular have been criticised for their emphasis on rapid weight loss and on omitting reference to the need for diet and exercise (Cleland et al., 2002). ...
We explore weight loss stories from 47 men collected from the Australian edition of Men's Health magazine between January 2009 and December 2012. Our analysis uses a mixed methods approach that combines thematic analysis and descriptive statistics to examine weight loss strategies against clinical practice guidelines for the management of overweight and obesity. All the stories reported the use of physical activity for weight loss and most stories detailed dietary changes for weight loss. Our findings indicate that most of the men reportedly used some form of behavioural strategies to assist them in their behaviour change efforts. The weight loss methods used were consistent with clinical practice guidelines, with the exception of some dietary practices. As narratives may assist with behaviour change, stories like those examined in this study could prove to be very useful in promoting weight loss to men.
... Even in some obesity prevention campaigns, "fat shaming" continues to be a theme [35,36]. 1 These negative media portrayals have reinforcing effects. For instance, competitive weight loss reality programs have been shown to promote individual blame beliefs and contribute to weight stigma [6,44,49], and children exposed to greater amounts of media express greater stigmatization toward overweight individuals [11,21]. These stereotypes are internalized by some overweight individuals and can result in serious health consequences [47]. ...
The escalating obesity rate in the USA has made obesity prevention a top public health priority. Recent interventions have tapped into the social media (SM) landscape. To leverage SM in obesity prevention, we must understand user-generated discourse surrounding the topic. This study was conducted to describe SM interactions about weight through a mixed methods analysis. Data were collected across 60 days through SM monitoring services, yielding 2.2 million posts. Data were cleaned and coded through Natural Language Processing (NLP) techniques, yielding popular themes and the most retweeted content. Qualitative analyses of selected posts add insight into the nature of the public dialogue and motivations for participation. Twitter represented the most common channel. Twitter and Facebook were dominated by derogatory and misogynist sentiment, pointing to weight stigmatization, whereas blogs and forums contained more nuanced comments. Other themes included humor, education, and positive sentiment countering weight-based stereotypes. This study documented weight-related attitudes and perceptions. This knowledge will inform public health/obesity prevention practice.
... Several current reality shows are focused on weight loss and obesity. Some offer information that is potentially useful, although researchers suggest that reality weight loss shows often promote unattainable, unrealistic and unaffordable weight-loss solutions (Thomas et al., 2007). They also focus heavily on the cosmetic rather than the lifestyle transformation of the contestants (Christenson & Ivancin, 2006). ...
Background
Individuals with limited health literacy (LHL) have poorer health outcomes and have difficulty understanding and complying with recommendations to maintain a healthy lifestyle. The present study examined the association between health literacy (HL) and sources of dieting information, the weight-loss methods used and the information needed to manage weight among African American women.Methods
This mixed method study included seven focus groups and a survey of 413 African American women. Binary logistic regression analyses were performed to examine the association between HL category and sources of dieting information, weight-loss methods and information needed to lose weight. Thematic analysis was used to analyse focus group data.ResultsWomen with LHL were significantly more likely to have a higher body mass index (BMI) than those with AHL (P < 0.05). Compared to respondents with LHL, those with adequate health literacy (AHL) are more likely to rely on information obtained from the Internet (P < 0.001), although they are less likely to rely on information obtained from the television (P < 0.05). They also are significantly more likely to participate in physical activity to lose weight (P ≤ 0.002). In addition, women with AHL were significantly less likely to want information on portion control (P = 0.002). Major qualitative themes were the importance of television and the Internet as major sources of health information, the use of healthy and unhealthy weight-loss methods, and being overwhelmed by the plethora of dieting information.ConclusionsHL may affect BMI among AA women, where they access dieting information and the types of information needed to manage their weight.
... Nearly half of Americans believe that television shows like "The Biggest Loser" will have a positive effect on the obesity epidemic (5). Obesity experts generally disagree, arguing that the show perpetuates weight bias, raises false expectations for weight loss, and depicts an intervention that is unrealistic for most people (6)(7)(8). To help address the latter point, I quantified the diet and exercise intervention using a validated computational model to quantitatively integrate the experimental data. ...
Obesity experts have criticized The Biggest Loser television show for its portrayal of an unrealistic intervention that raises false expectations for weight loss. However, the magnitude of the diet and exercise intervention has not been previously quantified.
Using a validated computational model of metabolism, I quantified the diet and exercise intervention by integrating data on energy expenditure, body weight and fat mass collected during The Biggest Loser competition.
Participant body mass index, weight, and percent body fat at baseline were 48.7 ± 10.1 kg/m2, 144.9 ± 39.4 kg, and 49 ± 6% (mean ± SD), respectively. During the first phase of the competition when the contestants were isolated in a boot camp environment, the average rate of weight loss was 0.4 ± 0.1 kg/d and decreased to 0.19 ± 0.1 kg/d after returning home. Total weight loss was 58.2 ± 26 kg with 81.6 ± 8.4% coming from body fat. The computer simulations closely matched these data and calculated that average energy intake decreased by 65% during the first phase to 1300 kcal/d while participating in 3.1 h/d of vigorous exercise. After returning home, energy intake increased to 1900 kcal/d and vigorous exercise decreased to 1.1 h/d. Simulation of diet alone resulted in 34 kg of weight loss with 65% coming from body fat, whereas exercise alone resulted in a loss of 27 kg with 102% from fat.
The intense diet and exercise intervention during The Biggest Loser competition were not sustainable. However, a relatively modest permanent lifestyle intervention of 20% caloric restriction and 20 min/d of vigorous exercise could maintain the massive weight loss.
... Analysis of the literature and outcomes from the consultations also highlighted some distinctive features of obesity prevention not found in generic principles. As noted above, the personal and potentially stigmatizing value of the term 'obesity', which comes from the personal nature and associations of people's appearance and body image (34), has important implications for how community-based programmes and professional groups, such as health professionals and journalists, label programmes and participants, and frame their communications (35,36). It is imperative that health professionals involved in such programmes anticipate the potential stigma and harm, and take action to minimize any harmful consequences, including avoiding 'victim blaming'. ...
Best practice in obesity prevention has generally been defined in terms of 'what' needs to be done while neglecting 'how'. A multifaceted definition of best practice, which combines available evidence on what actions to take, with an established process for interpreting this information in a specific community context, provides a more appropriate basis for defining the principles of best practice in community-based obesity prevention. Based on analysis of a range of literature, a preliminary set of principles was drafted and progressively revised through further analyses of published literature and a series of consultations. The framework for best practice principles comprises: community engagement, programme design and planning, evaluation, implementation and sustainability, and governance. Specific principles were formulated within this framework. While many principles were generic, distinctive features of obesity prevention were also covered. The engagement of end-users influenced the design of the formatting of the outputs, which represent three levels of knowledge transfer: detailed evidence summaries, guiding questions for programme planners and a briefer set of questions for simpler communication purposes. The best practice principles provide a valuable mechanism for the translation of existing evidence and experience into the decision-making processes for planning, implementing and evaluating the complex community-based interventions needed for successful obesity prevention.
... In practice, however, weight-related reality television shows have yet to provide a positive, humanizing portrayal of obesity. In one qualitative study, 76 obese Australians were asked about their attitudes and opinions in regards to the show The Biggest Loser [28]. Results indicated that approximately 71% of the participants had negative views about the show's basic concept. ...
There is ample evidence that overweight and obese individuals are stigmatized in various forms of media. This weight bias is particularly disconcerting when it targets children and adolescents.
The current review surveys the most recent 15 years of research on weight bias and stigmatization in the media and discusses some theoretical models that might help explain the negative effects of such material.
PsycINFO searches were conducted using weight bias- and stigmatization-related terms and phrases. Results were limited to journal articles published in English between 1994 and 2009.
Overall, the data indicate that a wide range of media - from television shows to books, newspapers, and the internet - portray overweight and obese individuals in a stigmatizing manner.
More research on this topic is needed to discern a direct connection between exposure to such material and psychological or physical harm to the viewer. Additionally, virtually all of the research has been conducted in the USA; research in other countries should be a top priority. Efforts to try to educate the media to the deleterious effects of media presentations of weight bias are indicated.
... For example, some studies suggest that weight-related content in magazines fuels both society's drive for thinness and aversion to excess weight (135,136). Others have discussed the implications of weight loss reality television programs for falsely reinforcing notions of the controllability of weight (137,138). Interestingly, for nearly twothirds of the American population, the only format on television where they will see people who have similar bodies to themselves is on shows where the entire cast is trying desperately to become thin. Recent weight loss reality television programs have also been directed toward children. ...
Obese individuals are highly stigmatized and face multiple forms of prejudice and discrimination because of their weight (1,2). The prevalence of weight discrimination in the United States has increased by 66 % over the past decade (3), and is comparable to rates of racial discrimination, especially among women (4). Weight bias translates into inequities in employment settings, health-care facilities, and educational institutions, often due to widespread negative stereotypes that overweight and obese persons are lazy, unmotivated, lacking in self-discipline, less competent, noncompliant
... Whilst some studies have attempted to quantify the different diets that obese people have been on [7,8], and the motivations for weight loss attempts [9], few studies have qualitatively explored the underlying motivating factors of obese people's weight loss attempts, their beliefs and expectations of diets, and the long and short term physical and emotional health effects of weight loss attempts, and what they themselves think are the optimal solutions in helping them manage their weight [10]. The results reported in this paper were part of a larger study looking at the health and social experiences of people living with obesity in the state of Victoria, Australia [11,12]. The aim of this paper was to explore in detail the extent to which people living with obesity have attempted to lose weight, their attitudes towards dieting and weight loss solutions, their opinions about why their weight loss attempts have failed, and suggestions as to what may help them in their struggle with their weight. ...
To explore the extent to which people living with obesity have attempted to lose weight, their attitudes towards dieting, physical exercise and weight loss solutions, why their weight loss attempts have failed, and their opinions about what would be most beneficial to them in their struggle with their weight.
Qualitative study, using open-ended interviews, of 76 people living with obesity in Victoria, Australia in 2006/7. Individuals with a BMI of 30 or over were recruited using articles in local newspapers, convenience sampling, and at a later stage purposive sampling techniques to diversify the sample. Data analysis was conducted by hand using a constant, comparative method to develop and test analytical categories. Data were interpreted both within team meetings and through providing research participants the chance to comment on the study findings.
Whilst participants repeatedly turned to commercial diets in their weight loss attempts, few had used, or were motivated to participate in physical activity. Friends or family members had introduced most individuals to weight loss techniques. Those who took part in interventions with members of their social network were more likely to report feeling accepted and supported. Participants blamed themselves for being unable to maintain their weight loss or 'stick' to diets. Whilst diets did not result in sustained weight loss, two thirds of participants felt that dieting was an effective way to lose weight.
Individuals with obesity receive numerous instructions about what to do to address their weight, but very few are given appropriate long term guidance or support with which to follow through those instructions. Understanding the positive role of social networks may be particularly important in engaging individuals in physical activity. Public health approaches to obesity must engage and consult with those currently living with obesity, if patterns of social change are to occur.
The Cambridge Handbook of the Psychology of Prejudice aims to answer the questions: why is prejudice so persistent? How does it affect people exposed to it? And what can we do about it? Providing a comprehensive examination of prejudice from its evolutionary beginnings and environmental influences through to its manifestations and consequences, this handbook is an essential resource for scholars and students who are passionate about understanding prejudice, social change, collective action, and prejudice reduction. Featuring cutting-edge research from top scholars in the field, the chapters provide an overview of psychological models of prejudice; investigate prejudice in specific domains such as race, religion, gender, and appearance; and develop explicit, evidence-based strategies for disrupting the processes that produce and maintain prejudice. This handbook challenges researchers and readers to move beyond their comfort zone, and sets the agenda for future avenues of research, policy, and intervention.
The discussion on (mis)representations of black women's bodies often focuses on their hyper-corporeality and hyper-sexualisation, with little attention paid to the women thus represented and their views. Reality shows are roundly criticised for objectifying women, being unAfrican and offering little to Africans. This paper contests this perspective by drawing on interviews with 19 contestants in a dance reality show in Ghana. We demonstrate that African participants in this show have a much more affirming view of the show. For them, the show offers benefits including celebrity status, training and employment opportunities. These benefits were not lost on family and friends who supported the candidates in various ways. Given the economic conditions in Ghana, this reality show offers obese women an opportunity to turn their condition into an asset and to do so largely with the backing of friends and family.
Media effects research has documented the prevalence of different ideals in media content, and their effects on media users. We developed a framework for the representation of such ideals, and that may increase our understanding of the effects media have on users' well-being. Drawing on cultural sociology, communication theory, and psychological literature, we introduce the malleability narrative of mediated ideals, described as “a collection of media representations of a variety of ideals that tend to be portrayed as within reach for anyone who is committed to pursuing his/her own self-interest.” The aim of the framework is to foster content analytical research on the occurrence of the malleability narrative in popular media and to stimulate audience research on interactions between media users and the malleability narrative in media, while taking account of different explanatory routes and the heterogeneity of the audience.
The popular reality television show The Biggest Loser Australia (TBL) is a significant source of media content about physical activity. This study examined audience responses to and interpretations of physical activity in TBL. A qualitative study using in-depth interviews was conducted in New South Wales, Australia. A sample of 46 viewers of TBL was recruited, stratified by gender, age group, area of residence, and body mass index. Interview data were thematically analyzed to identify how viewers evaluated TBL. Respondents were most positive about TBL as public health education, premised on personal responsibility, the need for extreme action, and the possibilities of human agency (individually and collectively). Conversely, they were critical about whether the portrayal of physical activity could guide and inspire them personally. They expressed feelings of disgust and fear in response to the exercise challenges, questioned the practicality of the behavior change process in light of their own experience, and were skeptical about the purpose of the program itself. TBL’s representation of physical activity may be limited in its capacity to encourage physical activity. Despite the wide viewership of this program, encouraging physical requires innovation in the development of practical, persuasive and evidence based media messages about physical activity.
Reality makeover shows often focus on weight loss as essential for improved appearance and health. The Biggest Loser (TBL) highlights extreme exercise as the primary mechanism for achieving dramatic weight loss. Using directed content analysis, we explored the stigmatized ways in which contestants were portrayed and treated by personal trainers during the exercise segments of seasons 11–14 of TBL. Analysis involved verbatim transcription of the dialog and noting of contestant depiction during exercise segments of the broadcasts, a preliminary coding process to generate initial ideas and concepts for coding themes, and a final coding process to identify instances of stereotype endorsement, aggression toward contestants, and minimalizing and disregarding contestant experience. The dominant themes were presented as rational and justified methods of motivating behavior change for the good of the contestants. Representing fat bodies as lazy, unattractive, incompetent, and deserving of mistreatment does little to promote health or health behaviors; rather, pervasive weight-related stigma is celebrated and commodified. Efforts to advocate for socially just representations of diverse body shapes and sizes within the health and fitness domain are needed.
Background:
Despite the well-documented benefits of physical activity, North Americans remain sufficiently inactive. Consequently, determining what motivates individuals to engage in physical activity becomes increasingly important. The purpose of this study was to examine whether the frequency of negative appearance-related commentary and positive appearance-related commentary could predict physical activity behaviour.
Methods:
Participants were young adult women (N = 192) who completed a series of questionnaires to assess the frequency of appearance-related commentary they received and their physical activity behaviour.
Results:
A hierarchical regression analysis indicated the overall regression was significant, F (4,187) = 4.73, p < .001, R2adj = .07, ΔR2= .07), with positive weight/shape appearance-related commentary (β = 470.27, p < .001) significantly predicting physical activity behaviour, while controlling for body mass index.
Conclusions:
Providing positive reinforcement via positive weight/shape compliments may be beneficial to motivate physical activity participation.
Open access available from: http://journal.media-culture.org.au/index.php/mcjournal/article/viewArticle/974
Background
In the past twenty years the discourse of the weight-centred health paradigm (WCHP) has attained almost complete dominance in the sphere of public health policy throughout the developed English speaking world. The national governments of Australia and many countries around the world have responded to what is perceived as an ‘epidemic of obesity’ with public health policies and programs explicitly focused on reducing and preventing obesity through so called ‘lifestyle’ behaviour change.
Weight-related public health initiatives have been subjected to extensive critique based on ideological, ethical and empirical grounds (Solovay; Oliver; Gaesser; Gard; Monaghan, Colls and Evans; Wright; Rothblum and Solovay; Saguy; Rich, Monaghan and Aphramor; Bacon and Aphramor; Brown). Many scholars have raised concerns about the stigmatising and harmful effects of the WCHP (Aphramor; Bacon and Aphramor; O'Dea; Tylka et al.), and in particular the inequitable distribution of such negative impacts on women, people who are poor, and people of colour (Campos). Weight-based stigma is now well recognised as a pervasive and insidious form of stigma (Puhl and Heuer). Weight-based discrimination (a direct result of stigma) in the USA has a similar prevalence rate to race-based discrimination, and discrimination for fatter and younger people in particular is even higher (Puhl, Andreyeva and Brownell). Numerous scholars have highlighted the stigmatising discourse evident in obesity prevention programs and policies (O'Reilly and Sixsmith; Pederson et al.; Nuffield Council on Bioethics; ten Have et al.; MacLean et al.; Carter, Klinner, et al.; Fry; O'Dea; Rich, Monaghan and Aphramor). The ‘war on obesity’ can therefore be regarded as a social determinant of poor health (O'Hara and Gregg). Focusing on overweight and obese people is not only damaging to people’s health, but is ineffective in addressing the broader social and economic issues that create health and wellbeing (Cohen, Perales and Steadman; MacLean et al.; Walls et al.).
Analyses of the discourses used in weight-related public health initiatives have highlighted oppressive, stigmatizing and discriminatory discourses that position body weight as pathological (O'Reilly; Pederson et al.), anti-social and a threat to the viable future of society (White). There has been limited analysis of discourses in Australian social marketing campaigns focused on body weight (Lupton; Carter, Rychetnik, et al.).
A number of weight loss-related reality television programs chronicle the weight loss experience of obese individuals in a competitive context. Although highly popular, such shows may misrepresent the behavior change necessary to achieve substantial weight loss. A systematic, quantitative content analysis of Seasons 10-13 (n = 66 episodes) of The Biggest Loser was conducted to determine the amount of time and number of instances that diet, physical activity, or other weight management strategies were presented. The average episode was 78.8 ± 15.7 min in length. Approximately 33.3% of an episode, representing 1,121 segments, portrayed behavioral weight management-related content. Within the episode time devoted to weight management content, 85.2% was related to physical activity, 13.5% to diet, and 1.2% to other. Recent seasons of The Biggest Loser suggest that substantial weight loss is achieved primarily through physical activity, with little emphasis on modifying diet and eating behavior. Although physical activity can impart substantial metabolic health benefits, it may be difficult to create enough of an energy deficit to induce significant weight loss in the real world. Future studies should examine the weight loss attitudes and behaviors of obese individuals and health professionals after exposure to reality television shows focused on weight loss.
Increases in the body weight of people in Australia and other countries around the world have been the subject of intense scientific, political and media attention in recent years. The placement of body weight at the focal point of discourse about health is referred to as the ‘weight-centred health paradigm’. This paradigm has become dominant in public health policy in the developed English speaking world but has been subjected to intense critique on philosophical, ethical and empirical grounds.
Many of the strategies used in weight-related public health initiatives are enacted through the discipline of health promotion. Health promotion is the process of working collaboratively with people to enhance the health of individuals, groups, communities and populations using a broad range of strategies. Health promotion is the spearhead of the new public health, and is explicitly based on a set of values and principles. Health promotion practice that is underpinned by the values and principles of best practice health promotion has been termed modern health promotion. Health promotion underpinned by values and principles not consistent with best practice has been termed traditional health promotion. Despite the major role of health promotion in implementing weight-related public health initiatives, these initiatives have received little critique in relation to the extent to which such initiatives reflect the values and principles of modern or best practice health promotion. This research project addressed that gap.
The research questions for the project were: what are the discourses within weight-related public health initiatives in Australia; and to what extent do weight-related public health initiatives in Australia reflect the values and principles of health promotion? The research epistemology was constructivist, the theoretical perspective was critical theory, and the theoretical framework was Critical Systems Heuristics. Critical discourse analysis was used to examine ten weight-related public health initiatives commissioned or produced by the Australian Government or parliament between 2003 and 2013. The health promotion values and principles continuum provided heuristic support for critical reflection.
From analysis of the claims, values, assumptions, power relationships and ideologies that were explicit, implicit, suppressed or hidden within the initiatives, I identified a broad range of discourses. The hegemonic but lexically questionable discourse of preventative health resulted in the almost complete invisibilisation of the discipline of health promotion. It also provided the foundation for alarmist, biomedical, reductionist discourses about body weight and health, with minimal attention to the social determinants of health, social justice and equity. Individuals were assumed to be naturally ignorant about the behavioural determinants of body weight but nonetheless to have ultimate responsibility for choosing these behaviours and thereby improving their health. Weight-related public health strategies adopted a mixed approach focusing on the whole population as well as the militarist targeting of negative, deficit-based interventions towards specific groups within the community. Discourse related to potential harm was minimal despite the significant potential for harm inherent in the public health initiatives. Discourse regarding evaluation of the initiatives focused on changes in behaviours and disease rates. The documents relied on the power, authority and status of experts to present uncontested discourses around body weight and public health responses to it.
On the basis of these discourses, I determined that the weight-related public health initiatives were reflective of two modern and seven traditional health promotion values and principles related to why the weight-related public health initiatives were needed, and two modern and 11 traditional health promotion values and principles related to what weight-related public health strategies were proposed and implemented in the weight-related public health initiatives. Overall, the weight-related public health initiatives were not consistent with the values and principles of health promotion best practice.
This project will contribute to the greater body of systemic change being implemented by social justice, fat acceptance and Health at Every Size advocates and activists, fat studies and critical weight studies scholars and others who are engaged in the enterprising task of shifting society from the weight-centred to a weight-neutral health paradigm, and thereby improving the health and wellbeing of people of all sizes.
The issue of adiposity is one of the most salient health issues within our society today. As individuals and as a society we are constantly reminded about our weight and encouraged to transform ourselves through the utilisation of methods such as diet, exercise and willpower that are put forth by the health and diet industries. As a result of this constant negative discourse, individuals deemed fat, overweight or obese within our society are constantly faced with judgement that their bodies are unacceptable and are subjected to routine stigma and discrimination based on their weight.
One avenue that has been left largely unexplored is the role that computer-mediated communication (CMC) and the internet can have on the experience and response that corpulent individuals may have to weight-related stigma. This thesis takes the unique approach to the stigma of adiposity in that it aims to examine how individuals utilise the internet in order to mediate, navigate, and ameliorate the stigma and discrimination that they experience within their day-to-day lives. Because the medium of the internet is incredibly vast, however, the field of inquiry relevant to this thesis has been narrowed to that of weblogs (or ‘blogs’).
Utilising a complementary component design, this thesis aims to examine how individuals experience, mediate and change their experiences of weight-related stigma utilising blogs. In order to meet this aim, three qualitative studies have been designed, each utilising distinct methods depending on the study aims and data. The first study, a case study of weight-related stigma, utilises thematic analysis in order to examine the reaction to an episode of weight-related stigma that takes place on a blog. The second, a study of online support, utilises an approach informed by grounded theory to examine a community of bloggers known as the Fatosphere. The third utilises discourse analysis to examine an internet-based campaign called I Stand that attempts to challenge the common perceptions of the corpulent individual.
This research has identified five key findings. The first finding highlights individuals’ use of justification and suppression methods to rationalise their compliance or resistance with the dominant perspectives of adiposity. The second finding highlights individuals’ use of the structural components of CMC to facilitate their engagement within these areas of discourse – namely asynchronicity, anonymity, and disinhibition. The third finding shows that individuals challenge the beliefs, expectations and views of not only themselves but of others within these online environments. The fourth finding illustrates that through challenging these behaviours, individuals also challenge the utilisation of stigma as a method of behaviour change. Finally, the fifth finding demonstrates that individuals emphasise health and wellbeing over weight loss when countering the beliefs of others.
This thesis extends the current body of knowledge regarding weight-related stigma through the novel approach of utilising blogs and the internet. The findings of this study may allow for further new and novel approaches to be taken by any number of stigmatised identities in attempting to mediate, navigate and change the stigma and discrimination that they experience in their day-to-day lives.
The rise of the 'obesity epidemic' in Western societies has led to an increased public gaze on obese individuals. Yet there is limited research that explores through qualitative methods the increased impact it has had on obese individuals' perceptions of self, body image and coping strategies, using their own words. This paper presents the findings of interviews with a community sample of 142 obese adults in Australia. We examined how obese individuals felt about themselves and their bodies, what influenced these feelings, and the subsequent coping strategies employed. While participants were able to identify many positive characteristics about their inner self, the vast majority used negative language to describe their physical appearance. Many participants described feelings of 'guilt', 'shame' and 'blame' associated with their weight. Coping strategies included striving for perfection in other areas of their life, social isolation, maximising aspects of their appearance and 'fat' acceptance. This study shows that, while different groups of obese adults experience, cope with and compensate for the influence of weight-based stereotyping in many different ways, they still feel an unrelenting otherness and difference associated with their weight.
Summary and recommendations for research and practiceIntroductionSelection of communitiesPrinciples of community engagement and capacity buildingPrinciples of program design and planningPrinciples of implementation and sustainabilityPrinciples of evaluationKey challenges in establishing and sustaining community interventionsCase study 1 the EPODE program, FranceCase study 2 Sentinel site for obesity prevention, Victoria, AustraliaReferences
Previous research has largely ignored the question of whether watching reality weight-loss TV shows influences viewers to form a negative obesity stereotype. This study examines antecedents and outcomes of watching The Biggest Loser with the Orientation1-Stimulus-Orientation2-Response (O-S-O-R) model. The study found that individuals who are more concerned with their weight (O(1)) watch more episodes of The Biggest Loser (S). Meanwhile, consumption of The Biggest Loser leads to greater perceived locus of weight control (O(2)), indicating that body weight is under personal control. Perceived locus of weight control, in turn, significantly predicts the attribution of obesity to personal responsibility (R). Ultimately, attributing obesity to personal responsibility leads to the formation of anti-fat attitudes (R). This study offers an integrative theoretical framework to investigate media effects on the formation of an obesity stigma by using the O-S-O-R model. The results imply that certain lifestyle transformation media, such as The Biggest Loser, might reinforce the notion that individuals control their own weight and thus further amplify the obesity stigma.
Obesity has reached epidemic proportions in the United States. Primary care physicians will see increasing numbers of patients with long-term weight management problems.
To examine obese women's perceptions of their physicians' weight management attitudes and practices.
Women who participated in obesity trials at a university clinic completed a questionnaire that assessed their views of weight control provided by their primary care physician.
The patients were 259 women whose age was 44.0 +/- 10.0 years; weight, 96.7 +/- 13.2 kg; and body mass index (calculated as weight in kilograms divided by the square of height in meters), 35.2 +/- 4.5 (all data given as mean +/- SD).
Using 7-point scales (1 indicates low; and 7, high), patients rated their satisfaction with care provided for their general health and that for their obesity. They also identified methods their physician recommended for weight management and the frequency of negative interactions with their physician concerning weight control.
Participants were generally satisfied with the care they received for their general health and with their physicians' medical expertise (mean scores, 6. 1 and 6.2, respectively). They were significantly (P<.001) less satisfied with care for their obesity and with their physicians' expertise in this area (mean scores, 4.1 and 4.3, respectively). Almost 50% reported that their physician had not recommended any of 10 common weight loss methods, and 75% indicated they looked to their physician a "slight amount" or "not at all" for help with weight control. Only a small minority of patients (0.4%-8.0%) reported frequent, negative interactions with physicians concerning their weight.
The last finding helps allay concerns that obese patients are routinely treated disrespectfully by physicians when discussing weight. The challenge, however, for primary care physicians appears to be providing patients better assistance with weight management.
The United States spends considerably more money on health care than the United Kingdom, but whether that translates to better health outcomes is unknown.
To assess the relative heath status of older individuals in England and the United States, especially how their health status varies by important indicators of socioeconomic position.
We analyzed representative samples of residents aged 55 to 64 years from both countries using 2002 data from the US Health and Retirement Survey (n = 4386) and the English Longitudinal Study of Aging (n = 3681), which were designed to have directly comparable measures of health, income, and education. This analysis is supplemented by samples of those aged 40 to 70 years from the 1999-2002 waves of National Health and Nutrition Examination Survey (n = 2097) and the 2003 wave of the Health Survey for England (n = 5526). These surveys contain extensive and comparable biological disease markers on respondents, which are used to determine whether differential propensities to report illness can explain these health differences. To ensure that health differences are not solely due to health issues in the black or Latino populations in the United States, the analysis is limited to non-Hispanic whites in both countries.
Self-reported prevalence rates of several chronic diseases related to diabetes and heart disease, adjusted for age and health behavior risk factors, were compared between the 2 countries and across education and income classes within each country.
The US population in late middle age is less healthy than the equivalent British population for diabetes, hypertension, heart disease, myocardial infarction, stroke, lung disease, and cancer. Within each country, there exists a pronounced negative socioeconomic status (SES) gradient with self-reported disease so that health disparities are largest at the bottom of the education or income variants of the SES hierarchy. This conclusion is generally robust to control for a standard set of behavioral risk factors, including smoking, overweight, obesity, and alcohol drinking, which explain very little of these health differences. These differences between countries or across SES groups within each country are not due to biases in self-reported disease because biological markers of disease exhibit exactly the same patterns. To illustrate, among those aged 55 to 64 years, diabetes prevalence is twice as high in the United States and only one fifth of this difference can be explained by a common set of risk factors. Similarly, among middle-aged adults, mean levels of C-reactive protein are 20% higher in the United States compared with England and mean high-density lipoprotein cholesterol levels are 14% lower. These differences are not solely driven by the bottom of the SES distribution. In many diseases, the top of the SES distribution is less healthy in the United States as well.
Based on self-reported illnesses and biological markers of disease, US residents are much less healthy than their English counterparts and these differences exist at all points of the SES distribution.
Cross-sectional findings have shed considerable light on the relationships between illness stigma and psychological outcomes among persons living with HIV/AIDS in the United States. However, no studies have examined the possible long-term consequences of illness stigma on mental health among Asians and Pacific Islanders living with HIV/AIDS, a group particularly vulnerable to HIV stigma due to ingrained sociocultural norms. This 2-year longitudinal study examined the relationship between five HIV-stigma factors (social rejection, negative self-worth, perceived interpersonal insecurity, financial insecurity, discretionary disclosure) and changes in psychological distress dimensions (self-esteem, hopelessness, dread, confused thinking, sadness, anxiety) among a convenience sample of 44 HIV-seropositive Asians and Pacific Islanders in New York City from 2002 to 2004. Undocumented Asians independently endorsed higher levels of perceived interpersonal insecurity and lower levels of self-esteem than documented participants at both baseline and 2-year follow-up. Results from hierarchical multiple regression analyses indicated that baseline social rejection and perceived interpersonal insecurity were significantly associated with changes in self-esteem at 2-year follow-up, controlling for baseline self-esteem and physical symptoms at follow-up. An interaction effect between baseline financial insecurity and discretionary disclosure was significantly associated with dread at 2-year follow-up. Findings highlight the importance of stigma reduction interventions that: (1) recognize multiple layers of stigma based sexual orientation, gender, and immigration status; and (2) address both individual and structural constraints that perpetuate HIV-stigma among Asians and Pacific Islanders in the United States.
To determine the terms that obese individuals find undesirable or desirable for their doctors to use to describe excess weight of 27.3 kg (i.e., 50 lb) or more.
The study surveyed 167 women and 52 men with a mean BMI of 35.3 and 35.1 kg/m(2), respectively, who participated in one of two randomized trials on the treatment of obesity. An additional sample consisted of 105 extremely obese women (i.e., mean BMI of 52.5 kg/m(2)) who sought bariatric surgery. Patients rated the desirability of 11 terms used to describe excess weight. Ratings were made on five-point scales, ranging from very desirable (+2) to neutral (0) to very undesirable (-2).
Obese women (N = 167) rated as undesirable to very undesirable the terms fatness (mean rating = -1.8), excess fat (-1.4), obesity (-1.4), and large size (-1.3). These four terms were rated as significantly more (all p < or = 0.001) undesirable than the seven remaining descriptors, which included weight, heaviness, BMI, excess weight, unhealthy body weight, weight problem, and unhealthy BMI. The term weight received a mean rating of 1.1, a value significantly more (all p < or = 0.001) desirable than that for all other descriptors. Highly similar ratings of the terms were provided by obese men (N = 52) and extremely obese women (N = 105).
Practitioners may wish to avoid the use of potentially derogatory terms such as fatness and obesity when broaching the topic of weight management with patients.
Community center workers serving children and families in a predominantly Hispanic, low-income neighborhood were interviewed qualitatively, to ascertain their perspectives on obesity and barriers to control and prevention, to design a practical and culturally appropriate intervention for obesity control. All 19 respondents recognized obesity as a problem, identified healthy eating and physical activity as requisites for controlling obesity, and mentioned fast food and cultural influences in Hispanic families as contributory factors. Lack of time emerged as a major barrier to all preventive practices related to eating healthy or being physically active. Safety concerns and lack of safe places for walking and running were mentioned as a barrier to being physically active. Further studies have to be conducted with parents of at-risk children, to understand time constraints. Community health workers should be sensitive to issues of time constraints and incorporate time management recommendations into obesity prevention and education.
To determine if there is a relationship between parental perception of neighborhood safety and overweight at the age of 7 years.
Cross-sectional analysis of the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development.
Ten urban and rural US sites.
A total of 768 children selected via conditional random sampling with complete data at follow-up.
Parents reported demographics and perception of neighborhood safety by standardized questionnaire. Child overweight status was defined as a body mass index greater than or equal to the 95th percentile for age and sex from measured anthropometrics at the age of 7 years. The base model included relationship of the safety reporter to the child, sex, and baseline body mass index z score at the age of 4.5 years. Covariates tested included maternal marital status, education, and depressive symptoms; child race/ethnicity; participation in structured after-school activities; Home Observation for Measurement of the Environment total score; and neighborhood social cohesiveness.
The sample was 85% white, and 10% of the children were overweight. Neighborhood safety ratings in the lowest quartile were independently associated with a higher risk of overweight at the age of 7 years compared with safety ratings in the highest quartile (adjusted odds ratio, 4.43; 95% confidence interval, 2.03-9.65). None of the candidate covariates altered the relationship between perception of neighborhood safety and child overweight status.
Perception of the neighborhood as less safe was independently associated with an increased risk of overweight at the age of 7 years. Public health efforts may benefit from policies directed toward improving both actual and perceived neighborhood safety.
This study examined experiences of weight stigmatization, sources of stigma, coping strategies, psychological functioning, and eating behaviors in a sample of 2671 overweight and obese adults.
The total sample was partitioned into two subsamples for investigation. Sample I was comprised of 2449 adult women, and Sample II was a matched sample of adult men and women (N = 222) that was disaggregated to investigate gender differences. Both samples completed an online battery of self-report questionnaires measuring frequency of weight stigmatization and coping responses to deal with bias, the most common sources of the bias, symptoms of depression, self-esteem, attitudes about weight and obesity, and binge eating behaviors.
Experiences of weight stigmatization, in many forms and across multiple occasions, was common in both samples. A variety of coping strategies were used in response. More frequent exposure to stigma was related to more attempts to cope and higher BMI. Physicians and family members were the most frequent sources of weight bias reported. No gender differences were observed in types or frequency of stigmatization. Frequency of stigmatization was not related to current psychological functioning, although coping responses were associated with emotional well-being.
These findings raise questions about the relationship between stigma and psychological functioning and have important implications for obesity treatment and stigma reduction intervention efforts, both of which are discussed.
Youth adherence to highly active anti-retroviral therapy (HAART) is poor, and little research exists that identifies the reasons youth have difficulty adhering to medications. Given that complete adherence is necessary for favourable health outcomes, it is essential to examine the obstacles youth face in adhering to HAART. The present investigation sought to identify these barriers and to systematically examine the experiences and attitudes youth have towards medications. Twenty-five adolescents and young adults presenting to a public primary care facility for treatment of HIV infection were asked to participate in focus groups which explored their attitudes and experiences around medication adherence. Participants provided richly detailed descriptions of the challenges of managing HIV stigma and their efforts to hide their status from friends, family, doctors, and even themselves. Fifty percent of respondents indicated that they skipped doses because they feared family or friends would discover their status. These results suggest that HIV stigma impacts treatment for youth on several levels, from the accuracy of communication with medical providers to medication adherence, subsequent health outcomes, and the emergence of treatment resistant strains.
Disease and disadvan-tage in the United States and in England
- Banks J M Marmot
- Z Oldfield
- Smith
- Jp
Banks J, Marmot M, Oldfield Z, Smith JP. Disease and disadvan-tage in the United States and in England. JAMA. 2006;3:2037-2045.