How do obese individuals perceive and respond to the different types of obesity stigma that they encounter in their daily lives? A qualitative study

A daily diary assessment of female weight stigmatization

Research focused on assessing weight stigmatization has typically been conducted using cross-sectional, retrospective designs. Such designs may impair the scientific understanding of this stigma by limiting participants’ recall of frequencies and/or details about stigmatizing events. To address this, 50 overweight/obese women were recruited from public weight forums to complete week-long daily diaries. A total of 1077 weight-stigmatizing events were reported on the Stigmatizing Situations Inventory. Hierarchical linear modeling was used to investigate potential relationships between participant-level factors and reported stigmatization. Results indicate that body mass index, education, age, daily activities, and interpersonal interactions all may impact individuals’ levels of stigmatization.

The influence of plaintiff's body weight on judgments of responsibility: the role of weight bias

PROBLEM

The current study investigated the influence of a plaintiff's weight and the location of an accident on a simulated jury's perceptions of plaintiff's personal responsibility for an accident.

METHODS

Participants were 185 lean and overweight male and female adults (mean self-reported body mass index: 24.87±5.45) who read one of three vignettes describing an accident that occurred while leaving one of three different establishments (fast food burger restaurant; fitness gym; department store) while viewing one of two silhouettes of the alleged plaintiff (a lean female; an obese female).

RESULTS

Participants were significantly more likely to report the plaintiff's weight entered into their perceptions of personal responsibility when they viewed the overweight plaintiff compared to the thin plaintiff. As respondent's self-reported weight bias increased, participants were more likely to hold the plaintiff responsible and more likely to blame plaintiff characteristics for the accident.

CONCLUSION

The weight of a plaintiff may affect juror perceptions of personal responsibility particularly if the juror possesses self-reported weight bias.

Effects of messages emphasizing environmental determinants of obesity on intentions to engage in diet and exercise behaviors

Introduction

Reducing rates of obesity will require interventions that influence both individual decisions and environmental factors through changes in public policy. Previous work indicates that messages emphasizing environmental determinants increases support for public policies, but some suspect this strategy may undermine motivation to engage in diet and exercise.

Methods

Study 1 involved 485 adults recruited from a shopping mall in New York. Study 2 involved 718 adult members of a Web-based national panel of US adults. Respondents in both studies were randomly assigned to read a story that emphasized environmental determinants of health or a control condition. The stories varied in the extent to which they described the story character as taking personal responsibility for weight management. Logistic regression and ordered logit models were used to test for differences in intentions to engage in diet and exercise behaviors based on which story the participant read. Analyses were also performed separately by participants’ weight status.

Results

In both studies, messages that acknowledged personal responsibility while emphasizing environmental causes of obesity increased intentions to engage in healthy behavior for at least 1 weight status group.

Conclusion

Emphasizing factors outside of personal control appears to enhance rather than undermine motivations to engage in healthy diet and exercise behavior.

Normalisation and Stigmatisation of Obesity in UK Newspapers: a Visual Content Analysis

Obesity represents a major and growing global public health concern. The mass media play an important role in shaping public understandings of health, and obesity attracts much media coverage. This study offers the first content analysis of photographs illustrating UK newspaper articles about obesity. The researchers studied 119 articles and images from five major national newspapers. Researchers coded the manifest content of each image and article and used a graphical scale to estimate the body size of each image subject. Data were analysed with regard to the concepts of the normalisation and stigmatisation of obesity. Articles' descriptions of subjects' body sizes were often found to differ from coders' estimates, and subjects described as obese tended to represent the higher values of the obese BMI range, differing from the distribution of BMI values of obese adults in the UK. Researchers identified a tendency for image subjects described as overweight or obese to be depicted in stereotypical ways that could reinforce stigma. These findings are interpreted as illustrations of how newspaper portrayals of obesity may contribute to societal normalisation and the stigmatisation of obesity, two forces that threaten to harm obese individuals and undermine public health efforts to reverse trends in obesity.

What can qualitative studies tell us about the experiences of women who are pregnant that have an eating disorder?

OBJECTIVE

pregnancy is a life-stage during which women undergo significant changes to their body and can feel acute responsibility for the development and well-being of the fetus. A synthesis of qualitative studies was conducted to increase our understanding of pregnancy experiences among women with an eating disorder.

DESIGN

a systematic search of eight electronic databases was carried out to identify relevant investigations. Studies were appraised by two authors. Data were combined using framework analysis. From 459 references, seven papers were included in the review.

FINDINGS

an overriding concept of inner turmoil transpired from the synthesis. This personal conflict related to the fear and guilt expressed by interviewees and stemmed from their association of self-worth with their body, concerns about their child's health and worries about others' response to their eating and weight control practices.

KEY CONCLUSIONS

participants reported vacillating between wanting to do the best for their child, being motivated by social pressures and feeling the need to control their body for self-preservation purposes. This created the inner turmoil they experienced while pregnant.

IMPLICATIONS FOR PRACTICE

midwives should be sensitive to the possibility of an eating disorder among pregnant women. In such cases, practitioners could act as a conduit for any assistance required, guiding these mothers towards appropriate nutritional and psychological support. To do this, professionals must have knowledge of such conditions and be aware of services available for women disclosing disordered eating behaviours.

Medical students' attitudes towards overweight and obesity

OBJECTIVE

Studies from the USA have identified medical students as a major source of stigmatizing attitudes towards overweight and obese individuals. As data from Europe is scarce, medical students' attitudes were investigated at the University of Leipzig in Leipzig, Germany.

DESIGN

Cross-sectional survey containing an experimental manipulation consisting of a pair of vignettes depicting an obese and a normal weight 42-year-old woman, respectively. Vignettes were followed by the Fat Phobia Scale (FPS), a semantic differential assessing weight related attitudes. In case of the overweight vignette a panel of questions on causal attribution for the overweight preceded administration of the FPS.

SUBJECTS

671 medical students were enrolled at the University of Leipzig from May to June 2011.

RESULTS

The overweight vignette was rated significantly more negative than the normal weight vignette (mean FPS score 3.65±0.45 versus 2.54±0.38, p<0.001). A higher proportion of students had negative attitudes towards the overweight as compared to the normal weight individual (98.9% versus 53.7%, p<0.001). A "positive energy balance" was perceived as the most relevant cause for the overweight, followed by "negligent personality trait", "societal and social environment" and "biomedical causes". Attributing a "positive energy balance" or "negligent personality trait" as relevant cause for the overweight was positively associated with negative attitudes.

CONCLUSION

The results of this study confirm and complement findings from other countries, mainly the USA, and indicate that weight bias in the health care setting may be a global issue. Stigmatizing attitudes towards overweight and obesity are prevalent among a sample of medical students at the University of Leipzig. Negative attitudes arise on the basis of holding the individual accountable for the excess weight. They call for bringing the topic of overweight and obesity more into the focus of the medical curriculum and for enhancing medical students' awareness of the complex aetiology of this health condition.

Understanding everyday life of morbidly obese adults-habits and body image

BACKGROUND

Morbid obesity is a progressive, chronic condition associated with failed attempts at change and repeated relapses.

AIM

There seems to be little previous research into the understanding of the everyday life of morbidly obese adults. We wanted to gain more knowledge about characteristics of eating habits and body image as well as motivational forces for change.

METHODS

A qualitative approach was chosen in order to gain insight into how morbidly obese adults experience everyday life. Qualitative interviews are well suited to provide insight into themes from the interviewee's life story from the subjects' own perspectives. To gain insight into such processes, a narrative approach that allowed the informants to give voice to their ways of doing, thinking and feeling in daily life, was adopted. The informants comprised seven women and four men aged of 26-56 years, recruited from a population of obese individuals who had participated in a weight reduction course. A hermeneutic approach was used where the research question was the basis for a reflective interpretation.

RESULTS

The following meaning-units were identified: to be perceived as overweight; and to see oneself as overweight. Ingrained habits: the struggle between knowing and doing; acting without knowing; and eating is soothing.

CONCLUSIONS

Seeing oneself as an obese person is a gradual process that implied experiencing oneself as different from significant others, such as (slim) siblings and friends. To experience a gap between knowing and doing concerning food habits in everyday life indicates that informants value they have a choice. This is an important insight to consider when framing interventions to support this vulnerable group.

Experiences of weight stigmatization: a review of self-report assessment measures

BACKGROUND

Overweight and obese persons are vulnerable to frequent stigmatization and discrimination because of their weight. Despite widespread prejudice towards obese persons, many questions remain regarding the nature, extent, and impact of weight-based stigmatization experienced by so many people. However, improving our knowledge in this area will only be as good as the measures we have to study this phenomenon. Our paper is the first to provide a comprehensive summary of published quantitative self-report measures available for assessing experiences of weight stigmatization in children and adults.

METHODS

This review examined 22 measures of self-reported weight stigmatization and highlights the strengths and limitations of existing assessment.

RESULTS

Existing measures contain a number of limitations and have been assessed in samples lacking diversity. Improvements in measurement are needed to achieve a clearer understanding of the nature and extent of self-perceived weight stigmatization and to develop measures that accurately reflect this type of stigmatization.

CONCLUSIONS

Specific directions for future research that will help improve measurement of self-perceived weight stigmatization and advance this area of study are highlighted.