Shame and severity of bulimic symptoms

Initial research suggests that self-conscious affect such as shame may perpetuate bulimic symptoms among individuals suffering from bulimia nervosa (BN). This investigation reports findings from two studies that examine the relation of shame to bulimic symptoms. In the first study, the relation of shame to bulimic symptoms was examined among 137 female college undergraduates. Shame accounted for a significant portion of variance in bulimic symptoms after controlling for age, weight status, guilt, and depressed mood. A second study examined the severity of shame in 30 bulimic patients compared to 28 eating-disordered patients with subclinical symptoms. Although patients with more severe bulimic symptoms exhibited higher levels of shame, this relation was not independent of the shared relation with depression and guilt. Findings are discussed in terms of the role of shame in bulimic symptoms.

"Before and after" diet advertisements escalate weight stigma

The stigma-producing effects of "before and after" diet advertisements on a healthy weight sample were examined. Subjects (n = 59) were exposed to a presentation containing either a "before and after" diet ad, or solely the "before" or "after" picture embedded in a different ad. Subjects were then given measures to assess negative attitudes and endorsement of stereotypes about overweight people. Across all subjects, strong implicit anti-fat bias was present. Subjects in the Before and After condition indicated that weight is more easily controllable than did subjects in either the Before Picture Only or the After Picture Only conditions. There were two moderating variables for this effect. Subjects who reported greater life satisfaction endorsed fewer anti-fat stereotypes, and those who enjoyed an emotionally close relationship with an overweight person were less biased. These results suggest that "before and after" diet ads enhance weight stigma and perpetuate damaging stereotypes.

Psychosocial origins of obesity stigma: toward changing a powerful and pervasive bias

Widespread bias and discrimination based on weight have been documented in key areas of living, including education, employment, and health care. This paper examines the social and psychological origins of this bias through a review and critique of theoretical and empirical literatures, and proposes how the field might best advance in the area of reducing stigma. Explanations for the development and reduction of weight stigma are examined with different theoretical approaches, including attribution theory and a social consensus model. Individual and sociocultural contributors to bias suggested by these approaches are highlighted. New directions are discussed in both the understanding and prevention of weight bias.

Weight bias among health professionals specializing in obesity

PURPOSE

To determine the level of anti-fat bias in health professionals specializing in obesity and identify personal characteristics that correlate with both implicit and explicit bias.

RESEARCH METHODS AND PROCEDURES

The Implicit Associations Test (IAT) and a self-report questionnaire assessing explicit attitudes, personal experiences with obesity, and demographic characteristics was administered to clinicians and researchers attending the opening session of an international obesity conference (N = 389). The IAT was used to assess overall implicit weight bias (associating "obese people" and "thin people" with "good" vs. "bad") and three ranges of stereotypes: lazy-motivated, smart-stupid, and valuable-worthless. The questionnaire assessed explicit bias on the same dimensions, along with personal and professional experiences with obesity.

RESULTS

Health professionals exhibited a significant pro-thin, anti-fat implicit bias on the IAT. In addition, the subjects significantly endorsed the implicit stereotypes of lazy, stupid, and worthless using the IAT. Level of bias was associated with several personal characteristics. Characteristics significantly predictive of lower levels of implicit anti-fat bias include being male, older, having a positive emotional outlook on life, weighing more, having friends who are obese, and indicating an understanding of the experience of obesity.

DISCUSSION

Even professionals whose careers emphasize research or the clinical management of obesity show very strong weight bias, indicating pervasive and powerful stigma. Understanding the extent of anti-fat bias and the personal characteristics associated with it will aid in developing intervention strategies to ameliorate these damaging attitudes.

Portrayals of overweight and obese individuals on commercial television

OBJECTIVES

This study examined the distribution and individual characteristics of body types on prime-time television.

METHODS

Five episodes of each of the 10 top-rated prime-time fictional programs on 6 broadcast networks during the 1999-2000 season were quantitatively analyzed.

RESULTS

Of 1018 major television characters, 14% of females and 24% of males were overweight or obese, less than half their percentages in the general population. Overweight and obese females were less likely to be considered attractive, to interact with romantic partners, or to display physical affection. Overweight and obese males were less likely to interact with romantic partners and friends or to talk about dating and were more likely to be shown eating.

CONCLUSIONS

Overweight and obese television characters are associated with specific negative characteristics.

Sociotropy and bulimic symptoms in clinical and nonclinical samples

OBJECTIVE

The purpose of this study is to examine the relation between sociotropy and bulimic symptoms. Studies of interpersonal functioning among individuals with bulimia nervosa consistently reveal issues of social dependency, need for approval, and fear of rejection. These themes are conceptually related to sociotropy, a cognitive-personality factor that has been implicated in the development and maintenance of depression. Individuals high in sociotropy are keenly invested in attaining others' approval and avoiding social rejection.

METHODS

The relationship between sociotropy and bulimic symptoms was examined in two samples of women: undergraduate women and community women seeking treatment at a private eating disorder facility.

RESULTS

In both samples, sociotropy was significantly associated with bulimic symptoms beyond the shared relation with depressed mood.

DISCUSSION

Findings are discussed in terms of the maintenance and treatment of bulimia nervosa.

Trick, treat, or toy: children are just as likely to choose toys as candy on halloween

This study investigated whether children would choose toys over candy when offered both on Halloween. Seven households gave trick-or-treaters a choice between comparably sized toys and candies. The subjects (N = 284) were between 3 and 14 years of age. Children were just as likely to choose toys as candy. There were no gender differences. The implication of this study is that children will not be disappointed by toy treats on Halloween. In practice, nutrition professionals should encourage adults to create holiday traditions that do not rely on unhealthful foods.

Demonstrations of implicit anti-fat bias: the impact of providing causal information and evoking empathy

Three studies investigated implicit biases, and their modifiability, against overweight persons. In Study 1 (N = 144), the authors demonstrated strong implicit anti-fat attitudes and stereotypes using the Implicit Association Test, despite no explicit anti-fat bias. When participants were informed that obesity is caused predominantly by overeating and lack of exercise, higher implicit bias relative to controls was produced; informing participants that obesity is mainly due to genetic factors did not result in lower bias. In Studies 2A (N = 90) and 2B (N = 63), participants read stories of discrimination against obese persons to evoke empathy. This did not lead to lower bias compared with controls but did produce diminished implicit bias among overweight participants, suggesting an in-group bias.

Comparison of price change and health message interventions in promoting healthy food choices

This study examines the feasibility and effectiveness of an environmental intervention for improving diet by comparing the impact of health messages, lowered prices, and their combination on the purchase of healthy food items in a restaurant. Price decreases alone, rather than a combination of price decreases and health messages, were associated with a higher level of increased purchases of some healthy food items as compared with control items over a 4-month period. Price decreases may be a more powerful means than health messages of increasing consumption of healthy foods. Health messages may have paradoxical effects if foods labeled as healthy are assumed to taste bad.

Predicting adolescent eating and activity behaviors: the role of social norms and personal agency

Guided by the theory of planned behavior, this 2-week longitudinal study examined health behaviors in a sample of 279 adolescents. Social norms and perceived behavioral control (PBC) were tested as predictors of self-reported intentions and behaviors in 2 domains, eating and physical activity. Differentiating, as opposed to aggregating, parent and peer norms provided unique information. For PBC, the authors distinguished global causality beliefs from self-related agency beliefs and intraself (effort, ability) from extraself (parents, teachers) means. Intraself agency beliefs strongly predicted healthy intentions, whereas intraself causality beliefs had a negative influence. Patterns differed somewhat across behaviors and gender. Results highlight theoretical issues and provide potential targets for research on health promotion programs for youth.

Ways of coping with obesity stigma: review and conceptual analysis

There is clear documentation of bias and discrimination aimed at overweight persons, but less is known about methods individuals use to cope with weight stigma. This paper provides an analysis of such methods, integrating work on weight stigma with what is known from other relevant areas (e.g., race and gender bias). Multiple means of coping have been studied, ranging from attempts to change the stigmatizing condition (losing weight) to taking pride in the condition and mobilizing social action to prevent discrimination. The most promising areas for future research, methodological challenges, and the importance of individual difference and situational factors as moderating variables are discussed.

Demonstrations of implicit anti-fat bias: the impact of providing causal information and evoking empathy

Three studies investigated implicit biases, and their modifiability, against overweight persons. In Study 1 (N = 144), the authors demonstrated strong implicit anti-fat attitudes and stereotypes using the Implicit Association Test, despite no explicit anti-fat bias. When participants were informed that obesity is caused predominantly by overeating and lack of exercise, higher implicit bias relative to controls was produced; informing participants that obesity is mainly due to genetic factors did not result in lower bias. In Studies 2A (N = 90) and 2B (N = 63), participants read stories of discrimination against obese persons to evoke empathy. This did not lead to lower bias compared with controls but did produce diminished implicit bias among overweight participants, suggesting an in-group bias.

Comparison of price change and health message interventions in promoting healthy food choices

This study examines the feasibility and effectiveness of an environmental intervention for improving diet by comparing the impact of health messages, lowered prices, and their combination on the purchase of healthy food items in a restaurant. Price decreases alone, rather than a combination of price decreases and health messages, were associated with a higher level of increased purchases of some healthy food items as compared with control items over a 4-month period. Price decreases may be a more powerful means than health messages of increasing consumption of healthy foods. Health messages may have paradoxical effects if foods labeled as healthy are assumed to taste bad.

Obesity: responding to the global epidemic

Obesity has reached epidemic proportions in the United States and other developed nations. In the United States, 27% of adults are obese and an additional 34% are overweight. Research in the past decade has shown that genetic influences clearly predispose some individuals to obesity. The marked increase in prevalence, however, appears to be attributable to a toxic environment that implicitly discourages physical activity while explicitly encouraging the consumption of supersized portions of high-fat, high-sugar foods. Management of the obesity epidemic will require a two-pronged approach. First, better treatments, including behavioral, pharmacologic, and surgical interventions, are needed for individuals who are already obese. The second and potentially more promising approach is to prevent the development of obesity by tackling the toxic environment. This will require bold public policy initiatives such as regulating food advertising directed at children. The authors call not for the adoption of a specific policy initiative, but instead propose that policy research, based on viewing obesity as a public health problem, become a central focus of research.

Obesity: responding to the global epidemic

Obesity has reached epidemic proportions in the United States and other developed nations. In the United States, 27% of adults are obese and an additional 34% are overweight. Research in the past decade has shown that genetic influences clearly predispose some individuals to obesity. The marked increase in prevalence, however, appears to be attributable to a toxic environment that implicitly discourages physical activity while explicitly encouraging the consumption of supersized portions of high-fat, high-sugar foods. Management of the obesity epidemic will require a two-pronged approach. First, better treatments, including behavioral, pharmacologic, and surgical interventions, are needed for individuals who are already obese. The second and potentially more promising approach is to prevent the development of obesity by tackling the toxic environment. This will require bold public policy initiatives such as regulating food advertising directed at children. The authors call not for the adoption of a specific policy initiative, but instead propose that policy research, based on viewing obesity as a public health problem, become a central focus of research.

Emotional expression and body dissatisfaction

OBJECTIVE

The purpose of this study was to examine the relation between emotional expression and body dissatisfaction in a sample of young women.

METHOD

Participants were 141 female undergraduates. They were assessed for emotional expression, body dissatisfaction, nonassertiveness, and depressive symptoms. The unique relation between emotional expression and body dissatisfaction was analyzed using hierarchical multiple regression.

RESULTS

Emotional expression was related inversely to body dissatisfaction. This association was significant after controlling for body mass index, nonassertiveness, and depressive symptoms.

DISCUSSION

This is the first study to examine the link between emotional expression and body dissatisfaction. Findings are discussed in terms of possible strategies for modifying shape- and weight-related concerns in women.

Bias, discrimination, and obesity

This article reviews information on discriminatory attitudes and behaviors against obese individuals, integrates this to show whether systematic discrimination occurs and why, and discusses needed work in the field. Clear and consistent stigmatization, and in some cases discrimination, can be documented in three important areas of living: employment, education, and health care. Among the findings are that 28% of teachers in one study said that becoming obese is the worst thing that can happen to a person; 24% of nurses said that they are "repulsed" by obese persons; and, controlling for income and grades, parents provide less college support for their overweight than for their thin children. There are also suggestions but not yet documentation of discrimination occurring in adoption proceedings, jury selection, housing, and other areas. Given the vast numbers of people potentially affected, it is important to consider the research-related, educational, and social policy implications of these findings.

Implicit anti-fat bias among health professionals: is anyone immune?

OBJECTIVE

To investigate whether negative implicit attitudes and beliefs toward overweight persons exist among health professionals who specialize in obesity treatment, and to compare these findings to the implicit anti-fat bias evident in the general population.

DESIGN

Health care professionals completed a series of implicit and explicit attitude and belief measures. Results were compared to measures obtained from a general population sample.

SUBJECTS

A total of 84 health professionals who treat obesity (71% male, mean age 48 y, mean body mass index (BMI) 25.39).

MEASUREMENTS

Participants completed an attitude- and a belief-based lmplicit Association Test. This reaction time measure of automatic memory-based associations asked participants to classify words into the following target category pair. 'fat people' vs 'thin people'. Simultaneously, the tasks required categorization of words into one of the following descriptor category pairs: good vs bad (attitude measure) or motivated vs lazy (stereotype measure). Participants also reported explicit attitudes and beliefs about fat and thin persons.

RESULTS

Clear evidence for implicit anti-fat bias was found for both the attitude and stereotype measures. As expected, this bias was strong but was lower than bias in the general population. Also as predicted, only minimal evidence for an explicit anti-fat bias was found. Implicit and explicit measures of the lazy stereotype were positively related although the attitude measures were not.

CONCLUSION

Even health care specialists have strong negative associations toward obese persons, indicating the pervasiveness of the stigma toward obesity. Notwithstanding, there appears to be a buffering factor, perhaps related to their experience in caring for obese patients, which reduces the bias.

Studying intergenerational transmission of eating attitudes and behaviors: methodological and conceptual questions

Associations between parent and child attitudes and behaviors related to eating and weight were examined among college-age men and women and their mothers and fathers (ns = 44, 47, 87, and 66, respectively). Parent attitudes and behaviors were assessed from the perspective of the parent and the student, and 2 pathways of influence were examined: modeling and direct criticism. In general, students' attitudes and behaviors were more strongly related to perceptions of their parents rather than to parents' own self-reports. There was more support for perceived direct criticism as a pathway of influence, particularly for daughters. Perceived criticism about eating and appearance had large associations with student attitudes and behaviors. Weight loss behavior was related to perceived criticism among daughters and to perceived paternal eating attitudes among sons. Results highlight important methodological and conceptual questions for intergenerational research.

Stress and body shape: stress-induced cortisol secretion is consistently greater among women with central fat

OBJECTIVE

Excessive central fat puts one at greater risk of disease. In animal studies, stress-induced cortisol secretion has been shown to increase central fat. The objective of this study was to assess whether women with central fat distribution (as indicated by a high waist-to-hip ratio [WHR]), across a range of body mass indexes, display consistently heightened cortisol reactivity to repeated laboratory stressors.

METHODS

Fifty-nine healthy premenopausal women, 30 with a high WHR and 29 with a low WHR, were exposed to consecutive laboratory sessions over 4 days (three stress sessions and one rest session). During these sessions, cortisol and psychological responses were assessed.

RESULTS

Women with a high WHR evaluated the laboratory challenges as more threatening, performed more poorly on them, and reported more chronic stress. These women secreted significantly more cortisol during the first stress session than women with a low WHR. Furthermore, lean women with a high WHR lacked habituation to stress in that they continued to secrete significantly more cortisol in response to now familiar challenges (days 2 and 3) than lean women with a low WHR.

CONCLUSIONS

Central fat distribution is related to greater psychological vulnerability to stress and cortisol reactivity. This may be especially true among lean women, who did not habituate to repeated stress. The current cross-sectional findings support the hypothesis that stress-induced cortisol secretion may contribute to central fat and demonstrate a link between psychological stress and risk for disease.

Studying intergenerational transmission of eating attitudes and behaviors: methodological and conceptual questions

Associations between parent and child attitudes and behaviors related to eating and weight were examined among college-age men and women and their mothers and fathers (ns = 44, 47, 87, and 66, respectively). Parent attitudes and behaviors were assessed from the perspective of the parent and the student, and 2 pathways of influence were examined: modeling and direct criticism. In general, students' attitudes and behaviors were more strongly related to perceptions of their parents rather than to parents' own self-reports. There was more support for perceived direct criticism as a pathway of influence, particularly for daughters. Perceived criticism about eating and appearance had large associations with student attitudes and behaviors. Weight loss behavior was related to perceived criticism among daughters and to perceived paternal eating attitudes among sons. Results highlight important methodological and conceptual questions for intergenerational research.

Small taxes on soft drinks and snack foods to promote health

Health officials often wish to sponsor nutrition and other health promotion programs but are hampered by lack of funding. One source of funding is suggested by the fact that 18 states and 1 major city levy special taxes on soft drinks, candy, chewing gum, or snack foods. The tax rates may be too small to affect sales, but in some jurisdictions, the revenues generated are substantial. Nationally, about $1 billion is raised annually from these taxes. The authors propose that state and local governments levy taxes on foods of low nutritional value and use the revenues to fund health promotion programs.