ORIGINAL RESEARCH article

The impact of perspective taking on obesity stereotypes: the dual mediating effects of self-other overlap and empathy.

\nYunlong Wu

  • School of Psychology, Inner Mongolia Normal University, Hohhot, China

Previous studies have indicated that obese people face many forms of severe prejudice and discrimination in various settings, such as education, employment, and interpersonal relationships. However, research aimed at reducing obesity stereotyping is relatively rare, and prior studies have focused primarily on negative stereotypes. Based on the empathy-altruism hypothesis and self-other overlap hypothesis, this study investigates the impact of perspective taking (PT) on both positive and negative obesity stereotypes and examines the mediating effects of empathy and self-other overlap. A sample of 687 students (191 males and 496 females) at Chinese universities participated by completing self-report questionnaires on trait tendency and evaluation toward obese people. Structural equation modeling and the bootstrap method revealed that self-other overlap (but not empathy) mediated the relationship between PT and negative obesity stereotypes. While self-other overlap and empathy both mediated the relationship between PT and positive obesity stereotypes. These findings address the importance of PT for improving positive and negative obesity stereotypes: specifically, PT promotes psychological merging, and produces empathic concern (EC).

Introduction

Obese people are severely stigmatized because of their weight. An intensive review by Puhl and Heuer (2009) shows that they confront prejudice and discrimination in many forms. In educational settings, obese students are less likely than normal-weight students to obtain a college degree ( Fowler-Brown et al., 2010 ) or be accepted as graduate students after an interview ( Burmeister et al., 2013 ). As regards interpersonal relationships, obese individuals tend to have poor relationships with their peers in school ( Puhl and Latner, 2007 ) and have fewer close friends relative to thinner individuals ( Sarlio-Lähteenkorva, 2001 ). Further, in employment settings, obese applicants are sometimes not hired because of discrimination based on their weight ( Puhl et al., 2008 ). Individuals experiencing the stigma of obesity are vulnerable to psychological disorders such as depression, low self-esteem, and anxiety ( Puhl and King, 2013 ). This stigma derives partly from negative stereotypes ( Tiggemann and Anesbury, 2000 ) that obese people are lazy, unintelligent, and lacking in self-discipline and willpower ( Puhl and Heuer, 2009 ). Although there is a lot of evidence about the adverse consequences of the stigma of obesity, relatively few studies have explored strategies to reduce obesity stereotypes and prejudices ( Gloor and Puhl, 2016 ). It is, therefore, necessary to take measures to improve attitudes toward this group.

Perspective Taking (PT) and Stereotypes

Corrigan and O'Shaughnessy (2007) propose three main avenues to change stereotypes and stigma, namely protest, education, and contact. However, the protest may provoke rebound effects, arouse resistance, and ultimately fail to induce more positive attitudes ( Corrigan et al., 2001 ). Furthermore, the magnitude and duration of education to improve attitudes may be restricted ( Corrigan et al., 2002 ). For contact to be effective, some optimal conditions are required, such as shared goals and cooperation ( Pettigrew and Tropp, 2006 ). Different from these aforementioned approaches (e.g., PT will not cause the rebound effects), PT has become an effective stereotype-improvement strategy ( Galinsky, 2002 ; Todd and Galinsky, 2014 ; Sun et al., 2016 ; Wang et al., 2018 ; Huang et al., 2020 ) because of its unique advantages. Specifically, its positive effect can be generalized from specific individuals to the groups they belong to Shih et al. (2009) for a relatively long time ( Batson et al., 1997 ) at both the explicit and implicit levels ( Todd and Burgmer, 2013 ). The limited existing work applied this strategy to anti-fat bias found that taking the perspective of obese persons who experienced discrimination did produce reduced implicit bias among overweight participants ( Teachman et al., 2003 ). There are two main theoretical hypotheses to explain the mechanisms underlying PT.

PT, Empathy, and Stereotypes

The first is the empathy-altruism hypothesis ( Batson et al., 1997 ), focused on the emotional level, which holds that taking the perspective of a member of a stigmatized group will increase the empathic feelings of an individual, such as sympathy and compassion for that individual. These feelings will evoke altruistic motivation and generalize to the whole stigmatized group, thus increasing the positive evaluation and attitude of an individual toward the group. The theory that PT indirectly reduces stereotyping through the mediating effect of empathy has been tested in many groups, such as people with AIDS ( Li, 2017 ), drug addicts ( Batson et al., 2002 ), African Americans ( Vescio et al., 2003 ), homosexuals ( Wang, 2018 ), and the elderly ( Bian, 2015 ). However, few studies have applied this method to attempt to tackle obesity stereotyping. As far as the author knows, only Cheng and Zhang (2017) have examined the direct impact of PT on implicit obesity stereotypes in China; they found significant attenuation of stereotyping but did not explore the underlying mechanism. To address this deficiency, the present study draws on the empathy-altruism hypothesis to test the mediating role of empathy between PT and obesity stereotypes. Another limitation in the literature is that many studies have shown the role of PT in reducing negative stereotypes ( Galinsky and Moskowitz, 2000 ; Ku et al., 2010 ; Todd et al., 2011 ) but few have considered positive stereotypes ( Wang et al., 2014 ). Obesity stereotypes include not only negative qualities but also positive characteristics, such as warmth and friendliness ( Tiggemann and Rothblum, 1988 ). Does PT weaken or enhance positive obesity stereotypes? The current study will answer this question.

PT, Self-Other Overlap, and Stereotypes

The second explanation mechanism is the self-other overlap hypothesis ( Davis et al., 1996 ; Galinsky and Moskowitz, 2000 ), focused on the cognitive level, which holds that PT can activate self-concept and lead perspective takers to attribute a greater proportion of their self-traits to the other. With perspective takers perceiving that they share more common characteristics with the target, they merge their mental representations of self and others, which changes their evaluation of the target group. Galinsky and Ku (2004) indirectly tested the self-other overlap hypothesis by examining the moderating role of self-esteem on the effect of PT on prejudice toward the elderly. They reasoned that because perspective takers change their attitude by applying the self to the target, the positive self will be activated and applied to the target group when the perspective takers have high self-esteem, thereby improving their attitude toward target group members; conversely, when perspective takers feel negative about themselves, there is no reduction in prejudice against the target group. As expected, Galinsky and Ku (2004) found that perspective takers with high self-esteem evaluated the elderly more positively than did those with low self-esteem. However, the studies of Bian (2015) , Li (2017) , and Wang (2018) , did not produce this result. The three researchers suggested that the inconsistent findings may be caused by a cultural difference in self-esteem between East and West. Todd et al. (2012) found that automatic self–Black associations, measured by IAT, mediated the effect of PT on perceptions of racial discrimination. Additionally, there are multiple measures to assess self–other overlap, such as Adjective Checklist Overlap, Absolute Difference in Attribute Ratings, and the Inclusion of Others in Self Scale (IOS; Aron et al., 1992 ). Myers and Hodges (2012) comprehensively analyzed these measures and identified perceived closeness (e.g., IOS) as the most effective way to measure the quality of the relationship between two people. For the above reasons, the present study does not take the indirect approaches but, instead, uses the IOS to directly measure self-other overlap. The aim is to test whether the influence of PT on obesity stereotypes is realized through the mediating effect of self-other overlap.

In summary, based on the empathy-altruism hypothesis and self-other overlap hypothesis, this study investigates the impact of PT on positive and negative obesity stereotypes and examines the underlying mechanism of this relationship, namely the mediating effects of empathy, and self-other overlap.

Participants

The participants were 687 undergraduates recruited from three universities in Hebei, Shandong, and Jiangxi Province, China, comprising 191 males and 496 females. The average age of participants was 19.91 years (SD = 1.14, age-range = 17~24). Among the participants, 151 students majored in Chinese language and literature, 378 students majored in pharmacy, and 158 students majored in education. Six hundred forty eight students were Han and the rest were ethnic minorities. In terms of self-reported body weight, 141 participants were underweight, 389 participants were moderate, and 157 participants were overweight.

A teacher from each University conducted the questionnaire survey in class. The teachers first explained to the students their rights as participants, including the option to withdraw and assured them that their anonymity and the confidentiality of their responses were guaranteed. Written informed consent was obtained from all participants; for underage participants, consent was obtained from parents. Teachers then distributed the questionnaire to participants, who were seated separately and not permitted to interact with one another while completing the questionnaire. Each participant received a small reward for their contribution to the study.

PT and Empathy

Following Wang et al. (2014) , this study used the PT and empathic concern (EC) subscales of the Chinese version of Zhan (1986) of the Interpersonal Reactivity Index ( Davis, 1980 ) to respectively measure the PT and empathy tendency of students. The PT subscale contains five items, such as “I sometimes try to understand my friends better by imagining how things look from their perspective”; the EC subscale includes six items, such as “I often have tender, concerned feelings for people less fortunate than me.” All items are measured using a 5-point Likert scale of agreement, with response options ranging from 0 (“does not describe me well”) to 4 (“describes me very well”). Cronbach's alphas for each subscale were α PT = 0.84, α EC = 0.52, consistent with the previous study (e.g., Zhang et al., 2010 ).

Self-Other Overlap

Self-other overlap was measured by the IOS. The scale comprises seven pairs of circles with an increasing degree of overlap. One circle represents the self and the other represents obese group members. Participants were asked to select which pair of circles best described their relationship with the obesity group. The scale is scored from 1 (no overlap) to 7 (nearly complete overlap). The higher the overlapping degree of circles, the greater the self-other overlap.

Obesity Stereotypes

Obesity stereotypes were selected from the studies of Vartanian et al. (2015) and Cheng (2017) . Specifically, this study included five negative stereotypes (lazy, sloppy, self-indulgent, lacking in self-discipline, and clumsy) and five positive stereotypes (kind, warm, optimistic, simple and honest, and generous). Participants were asked to rate the extent to which each stereotype fitted the characteristics of obese people. The response options ranged from 1 = strongly disagree to 5 = strongly agree. Cronbach's alphas for the overall scale and each subscale were α overall = 0.77, α positivestereotypes = 0.84, and α negativestereotypes = 0.90.

Analytic Strategy

Descriptive statistics were performed using SPSS 22. The hypothesized relationships were tested through a series of structural equation models and the bootstrap method in AMOS. Studies using structural equation modeling usually set several thresholds for goodness-of-fit indexes, such as root mean square error of approximation (RMSEA) ≤ 0.08 ( Williams et al., 2009 ), CFI ≥ 0.90, and 2 ≤ χ 2 /df ≤ 5 ( Hair et al., 2010 ). Before the data analysis, all variables were standardized. The items of PT, empathy, self-other overlap, and obesity stereotypes were used as analysis indicators. Self-other overlap was considered as a manifest variable, while PT, empathy, and obesity stereotypes were considered as latent variables.

Control for Common Method Bias

Through precautions such as protecting anonymity and using various response formats (5- and 7-point scales), the data collection process was designed to minimize the common method bias of data obtained from the self-report questionnaire. Following data collection, Harman's single-factor test ( Podsakoff et al., 2003 ) was conducted to control for common method bias. The results revealed five factors with eigenvalues >1, of which the first factor accounted for 20.16% of the total variance (below the critical standard of 40%). Therefore, common method bias was not a significant problem in this study.

Descriptive Statistics

The ranges, means, SDs, and correlations of the research variables are reported in Table 1 . All the variables were significantly correlated, except empathy–negative stereotypes and negative–positive stereotypes. In addition, the age and gender of participants were not significantly correlated with either dependent variable [negative ( r age < −0.01, p = 0.95; r gender = 0.05, p = 0.20] and positive ( r age = 0.04, p = 0.25; r gender <0.01, p = 0.99) obesity stereotypes; for simplicity, these results are not presented in the Table. The body weight of participants was significantly correlated with the positive obesity stereotypes ( r = 0.10, p < 0.05), so body weight was controlled for in the subsequent analysis.

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Table 1 . Descriptive statistics of the sample.

Analysis of Mediating Effect

First, the influence of PT on the negative obesity stereotypes and the mediating mechanism of this relationship were examined. Step 1 tested the direct effect of PT on negative obesity stereotypes. The results showed that the direct path was significant (β = −0.15, p < 0.001) but the model fit was poor (RMSEA = 0.10, χ 2 / df = 7.95). Step 2 then assessed the mediating role of empathy between PT and negative obesity stereotypes. As reported above, the correlation between empathy and negative obesity stereotypes was not significant, meaning that PT could not affect the negative obesity stereotypes through the mediating role of empathy. The mediation model analysis also supported this result: Although the indirect path from PT to empathy was significant (β = 0.59, p < 0.001), the indirect path from empathy to negative obesity stereotypes did not reach statistical significance (β = 0.001, p > 0.05). Next, step 3 examined the mediating role of self-other overlap in the effect of PT on negative obesity stereotypes. Model analysis showed that each path reached a significant level (as shown in Figure 1 ) and the model fitted well (RMSEA = 0.07, goodness of fit index (GFI) = 0.96, incremental fit index (IFI) = 0.95, comparative fit index (CFI) = 0.95, tucker-lewis index (TLI) = 0.94, chi-square/degree of freedom (the minimum discrepancy divided by degrees of freedom) χ 2 / df = 4.23). The mediating effect was tested by the bootstrap method. The results showed that the mediating effect of self-other overlap was significant with an indirect effect of 0.03 and a 95% confidence interval (CI) of [−0.06, −0.01]. Then pwrSEM was used to conduct a power analysis ( Wang and Rhemtulla, 2021 ). Results suggested that the study had 0.81 power to detect an indirect effect of 0.03 in the model. The above results indicate that PT has a negative effect on negative obesity stereotypes through the mediating effect of self-other overlap. However, empathy appears not to play a mediating role.

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Figure 1 . The mediating role of self-other overlap between perspective taking and negative obesity stereotypes. * p < 0.05; *** p < 0.001.

Second, the influence of PT on positive obesity stereotypes and the mediating mechanism of this relationship were examined. The body weight of participants was treated as a control variable because it was identified earlier as being significantly correlated with positive obesity stereotypes. Step 1 tested the direct effect of PT on positive obesity stereotypes. The results indicated that the direct path was significant (β = 0.15, p < 0.001) and the model fitted well (RMSEA = 0.07, GFI = 0.95, IFI = 0.96, CFI = 0.96, TLI = 0.95, χ 2 / df = 4.22). Step 2 then assessed the mediating role of empathy between PT and positive obesity stereotypes. The model analysis showed that after adding the mediating variable empathy, the direct path from PT to positive obesity stereotypes became insignificant, while the indirect path from PT to empathy (β = 0.59, p < 0.001) and from empathy to positive obesity stereotypes (β = 0.17, p = 0.01) reached a significant level. The model fit indexes were RMSEA = 0.07, GFI = 0.92, IFI = 0.91, CFI = 0.91, χ 2 / df = 4.49, suggesting that the mediating model acceptably fitted the data. The mediating effect was (0.59 × 0.17)/0.15 = 0.67.

Next, step 3 assessed the mediating role of self-other overlap between PT and positive obesity stereotypes. The results showed that after adding the mediating variable self-other overlap, the direct path from PT to positive obesity stereotypes (β = 0.13, p < 0.01) and the indirect path from PT to self-other overlap (β = 0.26, p < 0.001) and from self-other overlap to positive obesity stereotypes (β = 0.10, p < 0.05) were all significant. The measurement model showed acceptable fit: RMSEA = 0.06, GFI = 0.95, IFI = 0.96, CFI = 0.96, χ 2 / df = 3.80. The mediating effect was (0.26 × 0.10)/0.15 = 0.17. In step 4, the mediating variables empathy and self-other overlap were combined to construct and test an integrated mediating model. The bootstrap method was used to test multiple mediating effects ( Lau and Cheung, 2012 ). Model analysis indicated that the direct path from PT to positive obesity stereotypes became insignificant when the two mediating variables were added simultaneously. The direct effect was 0.03 and the 95% CI (−0.10, 0.16) contained zero. All the other paths were significant: from PT to empathy [CI: (0.51, 0.67)], from empathy to positive obesity stereotypes [CI: (0.02, 0.31)], from PT to self-other overlap [CI: (0.19, 0.35)], from self-other overlap to positive obesity stereotypes [CI: (0.01, 0.310)]. Finally, a dual mediating model was obtained, with an indirect effect of 0.12, a 95% CI of (0.04, 0.22), and good model fit to the data (as shown in Figure 2 , which excludes the control variable for simplicity; RMSEA = 0.07, GFI = 0.92, IFI = 0.91, CFI = 0.91, TLI = 0.90, χ 2 / df = 4.16). Then pwrSEM was used to run a power analysis ( Wang and Rhemtulla, 2021 ). Results suggested that the study had 0.85 power to detect an indirect effect of 0.12 in the model. These results suggest that self–other overlap and empathy both play a mediating role between PT and positive obesity stereotypes.

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Figure 2 . The mediating role of empathy and self-other overlap between perspective taking and positive obesity stereotypes (The dotted line means that the path is not significant). * p < 0.05; *** p < 0.001.

This research aimed to discover the influence of PT on positive and negative obesity stereotypes among University students. Based on the self-other overlap hypothesis (cognitive level) and empathy-altruism hypothesis (emotional level), this study tested the mediating role of self-other overlap and empathy in the relationship between PT and obesity stereotypes. The results will be discussed in detail below.

First, analysis of the mechanism through which PT influences negative obesity stereotypes revealed that self-other overlap, but not empathy, played a mediating role. Although PT can predict empathy, empathy did not significantly affect negative obesity stereotypes. This is consistent with the findings of previous studies that empathy cannot effectively reduce obesity prejudice ( Teachman et al., 2003 ; Gapinski et al., 2006 ). In this regard, studies suggest that empathy inadvertently emphasizes or evokes the negative aspects of obesity ( Daníelsdóttir et al., 2010 ), which may offset the sympathy and compassion that empathy generates for stigmatized groups in negative evaluations. The mean score of the negative obesity stereotypes in this study was 2.61 (median = 3), indicating that the University students did not consider the negative traits to be characteristic of obese people. If this truly reflects the perception of participants about obese people, then they would feel no need to sympathize. However, the responses of participants may have been affected by social desirability bias, such that even in an anonymous context they did not report their true attitudes with respect to negative obesity stereotypes. Future research will benefit from directly measuring social desirability, to quantify and separate its impact. Another consideration is that this study used a trait tendency measurement, rather than taking a specific perspective for the obese group. This may have prevented participants from putting themselves in the position of obese people to feel the challenges they encounter. Future studies could address this limitation by using experimental methods to manipulate participants into taking the perspective of and empathizing with obese people. It would be valuable to discover whether this approach further verifies the hypotheses and results of this research. Additionally, from the perspective of the common ingroup identity model ( Gaertner et al., 1993 ), recategorizing two separate groups as one group could improve negative evaluations toward outgroup members. By promoting self-other overlapping, the attitudes of perspective takers toward former outgroup members (i.e., obese group) become more positive through processes involving pro-ingroup bias.

Second, this study found that self-other overlap and empathy both mediated the relationship between PT and positive obesity stereotypes. Individuals usually view themselves positively ( Taylor and Brown, 1988 ). Through PT that enhances the psychological merging between self and target, individuals apply the positive description of themselves to obese people, thereby enhancing positive evaluation. This is consistent with the findings of Laurent and Myers (2011) but contrary to the result of Wang et al. (2014) , who found that PT reduces the positive stereotypes of doctors through self-other overlap. These different findings may be attributed to the different contents of the stereotype: whereas the traits examined by Laurent and Myers (e.g., attractive, wholesome) and in this study (e.g., kind, warm) mainly focus on the “warmth” dimension, Wang et al. (2014) examined positive characteristics of the “competence” dimension (e.g., analytical, smart).

Although empathy did not mediate the relationship between PT and negative obesity stereotypes, this study supported the empathy-altruism hypothesis by showing that empathy played a mediating role between PT and positive obesity stereotypes. This seems to indicate the positive trait bias of the hypothesis in the obese group. In other words, empathy generates altruistic motivation to help obese people escape unfavorable situations by enlarging their positive traits. However, Gloor and Puhl (2016) found that although PT increases empathy, it also increases fat phobia. This may be related to the attitudes of participants toward obese people. The mean score of the positive obesity stereotypes in this study was 3.62 (median = 3), meaning that participants consider the positive traits to be fairly characteristic of obese people. Skorinko and Sinclair (2013) pointed out that when the characteristics of the target group are consistent with the stereotypes, PT will cause stereotyping to increase.

Finally, the shortcomings of this study must be acknowledged. Obesity stereotypes were measured through a self-report questionnaire. In some prior studies, participants who did not show explicit obesity prejudice were found to have strong implicit negative obesity stereotypes ( Teachman et al., 2003 ). Therefore, future research should use implicit measurement to test whether University students truly hold a neutral attitude toward negative obesity stereotypes. Considering the group specificity of PT, measuring individual tendency through a questionnaire may have weakened the empathy of participants toward the obese group and, consequently, their attitudes toward obesity stereotypes. Future research should, therefore, seek to verify the results of this study by using experimental methods to manipulate PT. Furthermore, the correlational method makes reverse causality an underlying issue. The application of experimental design will help to establish causal links between variables. Despite these limitations, this study makes valuable contributions to the literature by finding that self-other overlap and empathy both mediated the relationship between PT and positive obesity stereotypes among University students. Yet, for negative obesity stereotypes, self-other overlap emerged as the only mediator.

Data Availability Statement

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

Ethics Statement

The studies involving human participants were reviewed and approved by Inner Mongolia Normal University. Written informed consent to participate in this study was provided by the participants and underage participants' parents.

Author Contributions

YW conceived the original idea, organized the data collection, performed the statistical analyses, and drafted the manuscript. YZ critically revised the manuscript. All the authors read and approved the final draft of the manuscript.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's Note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Supplementary Material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpsyg.2021.643708/full#supplementary-material

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Keywords: obesity stereotypes, perspective taking, empathy, self-other overlap, dual mediating effects

Citation: Wu Y and Zhang Y (2021) The Impact of Perspective Taking on Obesity Stereotypes: The Dual Mediating Effects of Self-Other Overlap and Empathy. Front. Psychol. 12:643708. doi: 10.3389/fpsyg.2021.643708

Received: 18 December 2020; Accepted: 12 July 2021; Published: 12 August 2021.

Reviewed by:

Copyright © 2021 Wu and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Yuzhu Zhang, nsdzyz@163.com

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

  • Weight Stigma

What we do Our Policy Priorities Weight Stigma

  • Obesity as a disease
  • Commercial determinants of obesity
  • Childhood Obesity
  • Obesity in Universal Health Coverage
  • The ROOTS of Obesity

Weight stigma refers to the discriminatory acts and ideologies targeted towards individuals because of their weight and size. Weight stigma is a result of weight bias. Weight bias refers to the negative ideologies associated with obesity.

obesity stereotype essay

Changing the global obesity narrative

A position statement on weight stigma from World Obesity

These can include laziness, lack of will power, a lack of moral character, bad hygiene, low level of intelligence and unattractiveness. Stigmatising beliefs and ideologies can lead to stigmatising acts. These acts can manifest themselves in various different ways. People with obesity may experience negative verbal commentaries, teasing, or physical assault.

Additionally, subtle behavioural slights such as eye rolling and tutting frequently occur. The environment also plays a part - for example, seating in cinemas or airlines are not designed to accommodate people with obesity. This is commonly reported in medical settings in particular, where seating, gowns and examination tables are unable to accommodate people with obesity.

The school and education environment is renowned for bullying and weight is one of the primary reasons for victimisation. Weight bias in education settings can come from a variety of different sources - students are not just victimised by their peers. It has been documented that even their teachers (particularly, but not exclusively physical education teachers) can be common perpetrators of stigma.

Weight stigma can prevent students from progressing into higher education. Students with obesity are significantly less likely to be accepted to college or university and those that do are likely to receive less financial support than their healthy-weight peers.

There is consistent evidence of weight discrimination at every stage of employment including; career counselling, interviews and hiring processes, salary disparities, fewer promotions, harsher disciplinary actions and higher contract termination rates. People with obesity are also significantly less likely to be put into a sales or customer-facing position. It has also been shown that people with obesity can be paid less than their healthy-weight counterparts for the same work. This is more pronounced for women with obesity, who can receive up to 6% less for the same work, whilst men with obesity may tend to sort themselves into lower-paying jobs.

Close relationship partners, including spouses/partners, parents, siblings and children, are documented as being the most common source of stigmatising comments, and in some cases, generate the most harmful stigmatising encounters.  

Weight bias persists into healthcare settings. Physicians, nutritionists, dietitians, fitness professionals and exercise science students have all shown a propensity to ascribe stereotypical characteristics such as lazy, weak- willed, and noncompliant. Physicians generally have lower levels of respect for patients with higher BMI and generally spend less time providing consultations to patients with obesity compared to their healthy-weight counterparts. Physicians can also be a direct source of stigmatising comments. In one study by Puhl and Brownell 53% of people with overweight and obesity reported to have received inappropriate comments from their doctor about their weight.

In addition to stigma arising from the physician-patient relationship, many people with obesity report a stigmatising physical environment. This can include gowns, chairs, and examination tables that cannot accommodate people with obesity.

Weight prejudice exists in almost all sections of the media, from children's shows where characters with obesity are stereotyped as clumsy, lazy, and without friends, through to news reports which have apportioned blame for global warming and rising fuel prices to people with obesity.

In terms of representation, underweight characters are significantly over-represented and overweight characters under-represented compared to the general population; something particularly true for women.

Marketing for weight loss products regimes is overwhelmingly focused on personal responsibility for weight, further perpetuating the belief that weight gain or loss is entirely in the hands of the individual. This framing of obesity as a purely personal-level responsibility can also be seen in public-health campaigns that solely focus on behaviour changes in their efforts to lower obesity levels.

Overtly discriminatory language is a predominant aspect of the obesity media narrative and will often be accompanied by equally stigmatising images that perpetuate the many false stereotypes attributed to people with obesity.

obesity stereotype essay

The consequences of stigma

Stigma can result in a variety of adverse emotional responses such as depression, low self-esteem and anxiety. Obesity itself is typically blamed for these potential consequences. However, it is weight stigma, rather than obesity, which has been proven to mediate the greater likelihood of depressive and anxiety disorders in individuals that have or have formally had obesity. Focus tends to be placed on the emotional effects of stigma. However, in addition to emotional health, weight stigma can also have social and physical effects.

Due to the numerous social contexts in which weight stigma can and does occur, the effects it can have on an individual’s social life can be extensive. It has been proven to weaken social relationships. In an effort to evade stigma, individuals have reported engaging in selective social isolation, which refers to avoiding social situations in an effort to remain unnoticed through fear of being stigmatised.

obesity stereotype essay

Stigma and the fear of stigma can affect physical health in a multitude of ways;

  • Fear of stigma can lead to avoidance of seeking medical care which creates barriers to obesity prevention and treatment strategies.
  • Weight stigma has been positively correlated with a variety of disordered eating patterns such as binge eating, emotional eating, restrictive eating, weight cycling and eating anxiety. 
  • There are many scientific studies associating obesity to a variety of serious medical conditions. However, more recently there have been studies with results which indicate that weight stigma plays a fundamental role in the development of some of these medical conditions. For example, it has been found that weight stigma, independent of adiposity positively correlates with increased stress hormone levels. Stress has been found to impact multiple areas of health such as, blood pressure, cardiac health, visceral fat levels and insulin resistance.
  • Finally, in some cases weight stigmatisation is so severe that it has been directly associated with suicidal ideations and acts.

The drivers of stigma

The drivers of stigma are primarily based around a misunderstanding of the complex causes of obesity, with people attributing weight gain to personal responsibility, and failing to grasp the complex mix of genetics, environment, and biological factors that drive it. The focus on personal responsibility results in blaming people with obesity for their condition, and enables the stereotyping of people with obesity as lazy and lacking in willpower.

It is argued by some that stigmatisation of people with obesity will incentivise them to lose weight. However, evidence shows that this is a counterintuitive approach to weight loss motivation. Therefore, in addition to crossing moral boundaries, bias and stigma contribute considerably towards the globally rising obesity levels. Addressing weight stigma is essential in order to meet obesity reduction and prevention targets.

obesity stereotype essay

Tackling stigma

We are working in four distinct areas to tackle the stigma experienced by people with obesity, and encourage others to join us in this.

To tackle stigma in healthcare settings we are calling for better obesity education for healthcare professionals, as well as running our own e-learning platform SCOPE . Many healthcare professionals say they do not feel equipped to treat patients with obesity, and patients with obesity have self-reported their doctors as being a key source of stigmatising remarks. We believe that by providing and advocating for healthcare professional education on obesity we can reduce stigma amongst this group, leading to better treatment for people with obesity, as well as instilling a compassion for people with obesity that will trickle into the rest of our society.

Whilst changing attitudes for healthcare professionals is vital if we're going to reduce stigma, it's not enough to do only that. Wider societal attitudes need to be adjusted too. Our World Obesity Day 2018 Campaign aims to shed light on the ubiquity and seriousness of stigma. Improving awareness about obesity amongst the general public and challenging the assumption that obesity is purely an issue of personal responsibility is paramount to successfully reducing stigma.

Obesity is one of the last diseases where society has failed to implement people first language. People-first language puts the person before their disease, emphasising that an individual is not defined by their condition. For example, it is now very uncommon to see someone referred to as a disabled person ; you'll more likely see reference to a person with a disability . The person comes first, and their disability is a characteristic rather than a defining feature. Unfortunately, this is not yet the norm with obesity, and the language used around the condition remains a major contributor towards stigmatisation. It is still usual to see obese people and a key part of our fight for people-first language is to change this to people with obesity. Language is integral to affording people with obesity the dignity they deserve.

Images used to accompany online or print news stories frequently depict people with obesity from unflattering angles, often inactive or consuming unhealthy food. This portrayal creates an environment where there is a lack of understanding and even a desire to shame individuals who have obesity. They invariably exploit the “shock value” of focusing on abdomens or lower bodies, and excluding heads from the frame of view. We are advocating for a fair portrayal of people with obesity in the media. We maintain a free to use image bank depicting people with obesity in various settings which we are encouraging media outlets to make use of.

Related Resources

World obesity day 2018: toolkit, world obesity day 2018: press releases, world obesity day 2018: mind map, world obesity day 2018: media report, our image bank.

One of the simplest ways to start fighting weight stigma is to use non stigmatising imagery. You can find a whole host of non stigmatising imagery on our image bank, freely available using the link below.

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SCOPE E-Learning

We offer the only internationally recognised course on obesity management. Read more here.

Global Obesity Observatory

We offer various statistics, maps and key data around the topic of obesity. You can find all that and more here.

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Educate medics about weight stigma to reduce UK’s obesity rate

10 August 2022

To help tackle the UK’s obesity crisis, we must better educate medical professionals on weight stigma, according to the conclusions of a large-scale review led by UCL researchers.

Research shows we must better educate medics about weight stigma

It is widely accepted that people living with obesity are negatively affected by weight stigma, often referred to as weight-blaming; this is a form of discrimination, across all settings, based on stereotypes and prejudices about people who are either obese or overweight.

In healthcare, the negative biases associated with weight stigma are known to limit both access to health services and treatments. This has recently been the focus of a joint international consensus statement, published in  Nature *, aiming to end weight stigma in healthcare globally.

Published in  Obesity Reviews , researchers at UCL conducted a review to evaluate weight stigma reduction strategies in healthcare practice and healthcare education, with a view to provide recommendations for interventions, learning, and research.

Lead author, Dr Anastasia Kalea (UCL Division of Medicine) said: “Sadly healthcare, including general practice, is one of the most common settings for weight stigmatisation and we know this acts as a barrier to the services and treatments that can help people manage weight.

“A common misconception among medics and others, is that obesity is caused by factors within a person’s control, focusing on diet and exercise without recognition of, for instance, social and environmental determinants.

“In this review, it was clear more needs to be done to educate healthcare professionals and medical students on the complex range of factors regulating body weight, and to address weight stigma, explicitly emphasising its prevalence, origins, and impact.”

In the largest study of its kind, researchers undertook a systematic review** of 3,773 international research articles. This included 25 weight stigma interventional initiatives, comprising a total of 3,554 participants.

Through this analysis, researchers identified that weight-inclusive approaches to education in healthcare were effective in challenging stereotypes and improving attitudes. Such methods included ethics seminars discussing patient experiences, embedding virtual story-telling of patient case studies, or empathy evoking activities in the curriculum, such as following a calorie restricted diet or participation in clinical encounters with patients living with overweight and obesity. However, other methods such as video presentations and short lectures were not equally effective in improving attitudes in the long term.

Researchers are now calling on medical schools in both the UK and globally to ensure effective and sustained weight-inclusive teaching is embedded in medical doctor training and is added to the continuing professional development of clinicians.

Dr Kalea said: “Weight stigma needs to be addressed early on and continuously throughout healthcare education and practice, by teaching the genetic and socioenvironmental determinants of weight, by discussing the sources, impact and recognising the implications of stigma on treatment. We need to move away from a solely weight-centric approach to healthcare to a health-focussed weight-inclusive one. And it is equally important to assess the effects of weight stigma in epidemiological research.”

Obesity is one of the UK Government’s health priorities. Almost two-thirds (63%) of adults in England are overweight or living with obesity – and one in three children leave primary school overweight or obese, with obesity-related illnesses costing the NHS £6 billion a year***. The urgency of tackling the obesity and overweight has been brought to the fore by evidence of the link to an increased risk from COVID-19.

Dr Kalea added: “Stigma reduction interventions are a current research priority. Improving the ways we educate healthcare professionals early on is a starting point, keeping the focus on our patients; we need to communicate better, listen carefully to our patients needs and let these inform our teaching and research agendas.”

Weight stigma is also known to cause ‘internalised weight bias’ (IWB), which is when a person applies negative societal or cultural beliefs about body weight to themselves. This can lead to psychological distress, depression, anxiety, low self-esteem and often leads to decreased health motivation and maladaptive coping such as avoidance of timely healthcare, social isolation, reduced physical activity and disordered eating behaviours.

Weight stigma has also been shown to increase risk of developing obesity, and healthcare is one of the most common contexts where weight stigmatisation occurs. Physicians have been reported as the second most common source of weight stigma and discrimination.

Senior author, Professor Rachel Batterham OBE (UCL Division of Medicine), who leads the Centre for Obesity Research at UCL and the UCLH Centre for Weight Management said: “Identifying widely applicable ways to effectively reduce healthcare related weight stigma is urgently needed. In addition to improving healthcare provision, and the health and well-being of patients with obesity, healthcare that not only avoids, but actively addresses and reduces internalised weight bias may help patients better cope with and reduce the effects of stigma until it minimised in society. Not surprisingly, whilst stigmatising does the opposite, empathetic, non-stigmatising weight-related communication can increase patients’ health motivation and intention to comply with health professionals’ advice.”

Weight stigma programme launched by UCL

Two years ago the UCL Division of Medicine designed a new MSc Obesity and Clinical Nutrition for healthcare professionals. This applied the evidence in practice to improve obesity management and adopted a weight-inclusive approach.

*  Joint international consensus statement, published in  Nature ,  co-authored by Professor Rachel Batterham OBE at UCL.

**A systematic review carefully identifies all the relevant published and unpublished studies, rates them for quality and bias.

*** UK Government: Tackling Obesity

  • Research paper published in Obesity Reviews
  • Dr Anastasia Kalea's academic profile
  • Professor Rachel Batterham's academic profile
  • UCL Division of Medicine
  • 'Man talking to the doctor at office', credit AnnaStills on iStock

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Culture, Obesity Stereotypes, Self-Esteem, and the “Thin Ideal”: A Social Identity Perspective

  • Published: August 2004
  • Volume 33 , pages 307–317, ( 2004 )

Cite this article

  • Paul A. Klaczynski 1 ,
  • Kristen W. Goold &
  • Jeffrey J. Mudry 2  

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Recent concerns with the increasing prevalence of overweight and obesity among children and adults indicate the need to better understand the psychosocial correlates of weight. We examined the relationships among negative stereotypes of obesity, “thin ideal” beliefs, perceptions of the causes of obesity and of control over weight, body esteem, and global self-esteem. A negative correlation between beliefs in control over one's weight and self-esteem was mediated by both negative attitudes toward obesity and thin idealization. Additionally, body esteem and gender were related but this relationship was mediated by beliefs in control over weight and valuation of the thin ideal. Central to the theoretical foundation of this research, however, was the observed negative correlation between negative attitudes toward obesity and self-esteem. This relationship was mediated primarily by the belief that obesity is caused by personality shortcomings. This last finding is explained from a social identity perspective.

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Klaczynski, P.A., Goold, K.W. & Mudry, J.J. Culture, Obesity Stereotypes, Self-Esteem, and the “Thin Ideal”: A Social Identity Perspective. Journal of Youth and Adolescence 33 , 307–317 (2004). https://doi.org/10.1023/B:JOYO.0000032639.71472.19

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Behavior, Psychology and Sociology

Weight-based stereotype threat in the workplace: consequences for employees with overweight or obesity

  • Hannes Zacher   ORCID: orcid.org/0000-0001-6336-2947 1 &
  • Courtney von Hippel 2  

International Journal of Obesity volume  46 ,  pages 767–773 ( 2022 ) Cite this article

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Background/Objectives

Employees with overweight or obesity are often stereotyped as lazy, unmotivated, and less competent than employees with normal weight. As a consequence, employees with overweight or obesity are susceptible to stereotype threat, or the concern about confirming, or being reduced to, a stereotype about their group. This survey study examined whether employees with overweight or obesity experience stereotype threat in the workplace, whether it is associated with their perceived ability to meet their work demands (i.e., work ability), and whether high levels of knowledge about one’s self (i.e., authentic self-awareness) can offset a potential negative association.

Subjects/Methods

Using a correlational study design, survey data were collected from N  = 758 full-time employees at three measurement points across 3 months. Employees’ average body mass index (BMI) was 26.36 kg/m² (SD = 5.45); 34% of participants were employees with overweight (BMI between 25 and <30), and 18% of participants were employees with obesity (BMI > 30).

Employees with higher weight and higher BMI reported more weight-based stereotype threat ( r s between 0.17 and 0.19, p  < 0.001). Employees who experienced higher levels of weight-based stereotype threat reported lower work ability, while controlling for weight, height, and subjective weight ( β  = −0.27, p  < 0.001). Authentic self-awareness moderated the relationship between weight-based stereotype threat and work ability ( β  = 0.14, p  < 0.001), such that the relationship between stereotype threat and work ability was negative among employees with low authentic self-awareness ( β  = −0.25, p  < 0.001), and non-significant among employees with high authentic self-awareness ( β  = 0.08, p  = 0.315).

Conclusions

The findings of this study contribute to the literature by showing that weight-based stereotype threat is negatively associated with employees’ perceived ability to meet their work demands, particularly among those employees with low authentic self-awareness.

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People with overweight or obesity face prejudice and discrimination in various aspects of their lives, such as healthcare, education, and interpersonal relationships [ 1 ]. Unfortunately, the employment context is no exception. Employees with overweight or obesity are stereotyped to lack self-discipline, self-control, and willpower [ 2 , 3 ], and are seen as less competent and conscientious [ 4 ]. In light of these stereotypes, it is not surprising that cross-sectional surveys, population-based research, and experimental studies demonstrate that people with overweight or obesity experience bias with regard to a variety of workplace outcomes [ 1 ]. For example, compared to people with normal weight, people with overweight or obesity are less likely to be hired [ 5 , 6 ], receive lower pay [ 7 ], and are less likely to receive promotions [ 8 ]. Employees with overweight or obesity also report being the subject of derogatory comments and other uncivil behaviors from their supervisors and co-workers [ 9 ]. In short, employees with overweight or obesity are stigmatized and discriminated against in the workplace [ 1 ], raising the clear possibility that these employees will be susceptible to stereotype threat.

According to stereotype threat theory [ 10 ], concerns about being stereotyped based on one’s group membership can lead people to psychologically distance themselves from domain-relevant activities and performance. That is, stereotype threat can lead to disidentification—or disengagement—from the task domain. Although the majority of stereotype threat research has taken place in a laboratory setting [ 11 ], a growing body of research demonstrates that stereotype threat is also important in the workplace [ 12 , 13 ]. Research in organizational contexts demonstrates that stigmatized groups (e.g., older employees; women in male-dominated fields) disengage from work when they experience stereotype threat [ 12 , 14 ]. Given the growing percentage of people with overweight or obesity worldwide [ 15 ], it is important to examine whether employees with overweight or obesity experience stereotype threat in the workplace, whether it is associated with their perceived ability to meet their work demands, and whether other psychological factors can offset a potential negative association.

Although the stereotypes about employees with overweight or obesity are varied, many focus on the notion that they are less capable [ 4 ]. Over time, people from stereotyped groups can internalize the stigma about their group [ 16 ]. If employees with overweight or obesity internalize the stigma that they are less capable at work than their colleagues with normal weight, then feelings of stereotype threat should lead to lowered perceptions of work ability, or the perceived capacity to continue working in their current job given their perceptions of their physical, cognitive, and interpersonal job demands and their ability to meet these demands [ 17 , 18 ]. In short, employees’ experience of weight-based stereotype threat should lead them to believe they are less capable of meeting the demands of their job.

The moderating role of authentic self-awareness

Scholarly interest in employee authenticity, or “being your true self at work,” has rapidly increased over the past few years [ 19 ]. Authentic self-awareness is the extent of knowledge (and trust in that knowledge) about various aspects of one’s self and the motivation to expand that knowledge [ 20 ]. Employees with high levels of authentic self-awareness consider their self as a whole (e.g., physical appearance, internal states including cognitions and emotions, motives and intentions, social commitments) and are invested in understanding and learning more about their “true self” [ 21 ]. Research has shown that employees’ authentic self-awareness is empirically distinct from, but moderately and positively associated with self-insight (i.e., clarity of understanding various aspects of one’s self), self-acceptance (i.e., positive attitude to one’s self), and self-esteem (i.e., confidence in one’s own worth), and negatively associated with anxiety, cognitive and emotional strain, and ill-health [ 21 ].

We predict that weight-based stereotype threat generally is negatively related to work ability, but that high (vs. low) levels of authentic self-awareness may buffer this negative association. This prediction is based on theorizing that employees who better understand themselves are less likely to comply with unwanted social and situational pressures in their work environment and react less strongly to others’ demands and workplace stressors [ 21 ]. Thus, authentic self-awareness may constitute a coping mechanism that helps employees deal with the stressor of weight-based stereotype threat [ 22 , 23 ]. Consistent with this possibility, experimental work has shown that people who have a more stable sense of self—a trait that is associated with greater self-concept clarity [ 24 ] and greater integration of positive and negative information [ 25 ]—are more likely to treat negative feedback as a challenge rather than a hindrance [ 26 ]. Clarity and stability of the self-concept, as well as integration of positive and negative information into the self-concept, are all important components of authentic self-awareness [ 20 , 27 ].

Additionally, employees who possess a holistic and differentiated understanding of their self and who are motivated to continuously improve their self-understanding should have a broader and more effective set of psychological coping strategies (e.g., positive reframing, reappraisal) at their disposal when they feel stereotyped [ 28 , 29 ]. That is, when faced with weight-based stereotype threat, they should be more capable of restoring a sense of themselves as capable employees through consideration of numerous other aspects of their self-concept. In contrast, employees with low authentic self-awareness do not adopt a broad perspective on their self and are less interested in learning more about its elements. With less self-knowledge at their disposal, these employees should be more susceptible to the negative effects of weight-based stereotype threat. Consistent with this possibility, inauthenticity has been hypothesized to result in employees who are more likely to comply with stereotypes [ 30 ]. Thus, employees’ authentic self-awareness should moderate the negative relationship between weight-based stereotype threat and work ability, such that weight-based stereotype threat is associated with greater deficits in work ability when authentic self-awareness is low than when authentic self-awareness is high.

Participants and procedure

We conducted a correlational survey study with three measurement points over a period of 3 months, incorporating an initial survey with demographic and control variables (Time [T] 1) as well as two subsequent surveys (T2 and T3) that included measures of weight-based stereotype threat, work ability, and authentic self-awareness. We used a time lag of four weeks between measurement points in an effort to ensure that participants could recall their concerns and experiences at work. Data for this study were collected as part of a larger data collection effort, and so far two other studies based on the same dataset, but with completely different research questions and completely different substantive variables, have been published [ 31 , 32 ]. In Germany, correlational studies are exempt from institutional review board approval. The research was conducted in line with the ethical guidelines and requirements of the German Psychological Society. Participation in the study was voluntary and anonymous, and informed consent was obtained from all participants.

We commissioned a professional and ISO 26362 certified panel provider to recruit participants from a nationally representative online panel in Germany. To be eligible for inclusion, participants had to be at least 18 years old and working full-time. Approximately 3500 participants were initially contacted with a request to participate in the first measurement wave (T1). This number of initial participants was determined based on the panel provider’s recommendations to obtain a final sample size of 750 participants or more at T3, which is sufficient to detect small correlational effect sizes (i.e., r  ≥ 0.10) with high (i.e., ≥0.80) statistical power [ 33 ]. Of those 3500 contacted, 1522 responded and were eligible to participate according to our selected inclusion criteria. Of these 1522 who qualified, 758 consented to participate and provided complete data on all three measurement occasions.

The sample was comprised of 438 (57.8%) men and 320 women (42.2%). Participants’ age ranged from 21 to 74 years with a mean age of 43.83 years (SD = 10.70). Most participants held either a lower-secondary school degree (228; 30.1%), a higher-secondary school degree (137; 18.1%), or a college/university degree (241; 31.8%). Participants worked across 21 different industries, with the public administrative sector (12.7%), manufacturing (12.8%), and healthcare (10.3%) most represented.

Overall, body mass index (BMI) values of participants at T1 ranged from 16.71 to 60.22, with an average BMI of 26.36 kg/m² (SD = 5.45). More specifically, only 17 participants (2%) were employees with underweight (BMI < 18.5), whereas 346 participants (46%) were employees with normal weight (BMI between 18.5 to <25), 260 participants (34%) were employees with overweight (BMI between 25 and <30), and 135 participants (18%) were employees with obesity (BMI > 30).

Weight-based stereotype threat

We assessed weight-based stereotype threat by self-report at T2 and T3 using an adapted version of a 5-item stereotype threat scale [ 34 , 35 ], which was itself adapted from a scale to measure stereotype threat in a laboratory context [ 36 ]. We adapted the items by referring to participants’ weight instead of their gender or age as in previous studies. Participants were asked to report on their feelings of weight-based stereotype threat within the last 4 weeks. The items followed the introductory statement “Last month (in the last 4 weeks) I worried that…,” and were: “…some people at my workplace felt I have less ability because of my weight,” “…people at my workplace drew conclusions about my ability based on my weight,” “…some people at my workplace felt that I’m not committed to my work because of my weight,” “…some people at my workplace felt that I have less to contribute at work because of my weight,” “…my behavior caused people in my workplace to think that stereotypes about people of my weight are true.” Responses were provided on a five-point scale from 1 (never) to 5 (always). Reliability for the scale was high at both T2 (Cronbach’s α  = 0.97) and T3 ( α  = 0.98).

Authentic self-awareness

We measured employees’ authentic self-awareness at T2 using a four-item scale [ 21 ]. Specifically, we asked participants to think about the last 4 weeks when responding to the following items on a five-point scale ranging from 1 (not true at all) to 5 (completely true): “I understood why I thought about myself as I did,” “For better or worse, I knew who I really was,” “I understood well why I behaved like I did,” and “I felt like I didn’t know myself particularly well” (reverse coded). Alpha for the scale was 0.71.

Work ability

We measured employees’ perceived work ability at T2 and T3 using a four-item measure [ 17 ], which was based on three items from the work ability index [ 37 ] and one additional item on interpersonal demands adapted from the work ability index [ 38 ]. Participants were asked, “Please evaluate your ability in the last month (the last 4 weeks) to meet the following demands of your work.” The first three items were, “Thinking about the [physical, mental, interpersonal] demands of your work, how do your rate your ability to meet those demands?” and the fourth item was, “How many points would you give your overall ability to work?” Responses were provided on a scale from 0 (was unable to work at all) to 10 (my work ability was at its lifetime best). Reliability for the scale was α  = 0.92 at T2 and α  = 0.92 at T3.

Control variables

At T1, we assessed employees’ age (in years), gender (1 = male, 2 = female), highest level of education (1 = some high school to 7 = college/university degree), weight (in kilograms), height (in cms), and subjective weight. We measured subjective weight with a single item: “How would you describe your weight?” Responses were provided on a scale ranging from 1 (severely underweight) to 5 (severely overweight). We did not control for BMI, as it was highly correlated with objective and subjective weight (see Table 1 ).

Table 1 shows the means, standard deviations (SD), and correlations of all study variables. Weight, subjective weight, and BMI were positively related to weight-based stereotype threat, whereas age, authentic self-awareness, and work ability were negatively associated with weight-based stereotype threat. An exploratory analysis revealed that weight and BMI did not have curvilinear relationships with weight-based stereotype threat, suggesting that stereotype threat was generally lower among employees with lower weight and lower BMI and higher among employees with higher weight and higher BMI.

Table 2 reports the results of the regression analyses. A Kolmogorov–Smirnov test indicated that our main outcome variable, T3 work ability, was not normally distributed, D (758) = 0.108, p  < 0.001. However, given our large sample size, the fact that there were more than 75 observations per predictor variable, and the sizeable SD (SD = 1.82; see Table 1 ), this violation of the normality assumption of regression analysis is not a primary concern for this study [ 39 ]. Consistent with expectations, weight-based stereotype threat was negatively related to work ability. As shown in Table 2 (Model 1), T2 weight-based stereotype threat was negatively associated with T3 work ability above and beyond the T1 control variables ( β  = −0.27, p  < 0.001), suggesting that employees who felt higher levels of stereotype threat subsequently perceived lower work ability. Together, weight-based stereotype threat and the control variables explained 11 percent of the variance in work ability. An additional analysis showed that the interaction between gender and weight-based stereotype threat was not significantly associated with work ability ( β  = −0.03, p  = 0.346), suggesting that the relationship between stereotype threat and work ability is consistent for men and women. The relationship between weight-based stereotype threat and work ability was similar when considering only employees with overweight (i.e., BMI between 25 and <30; β  = −0.20, p  = 0.003), only employees with obesity (i.e., BMI > 30; β  = −0.31, p  < 0.001), or both of these groups combined in the analysis ( β  = −0.25, p  < 0.001).

Next, we tested the prediction that authentic self-awareness moderates the relationship between weight-based stereotype threat and work ability. As shown in Table 2 (Model 2), a significant interaction emerged between weight-based stereotype threat and authentic awareness ( β  = 0.14, p  < 0.001) which, together with the main effect of authentic self-awareness, explained an additional eight percent of the variance in work ability. This interaction is graphically shown in Fig. 1A . Simple slope analyses showed that the relationship between weight-based stereotype threat and work ability was negative and significant at low (−1 SD) levels of authentic self-awareness ( B  = −0.46, SE = 0.08, β  = −0.25, t  = −5.80, p  < 0.001) and weak and non-significant at high (+1 SD) levels of authentic self-awareness ( B  = 0.14, SE = 0.14, β  = 0.08, t  = 1.01, p  = 0.315). An additional analysis showed that a three-way interaction between gender, weight-based stereotype threat, and authentic self-awareness (while controlling for the respective main effects and two-way interaction terms) was not associated with work ability ( β  = −0.03, p  = 0.413). The interaction between weight-based stereotype threat and authentic self-awareness was also significant when only considering employees with overweight in the analysis (i.e., BMI between 25 and <30; β  = 0.15, p  = 0.034), whereas it was not significant when considering only employees with obesity (i.e., BMI > 30; β  = −0.02, p  = 0.843) or both of these groups combined in the analysis ( β  = 0.07, p  = 0.163). Overall, these findings suggest that weight-based stereotype threat was negatively associated with work ability among employees with obesity, as well as among those employees with normal weight or overweight who had low levels of authentic self-awareness. In contrast, weight-based stereotype threat was not significantly associated with work ability among employees with normal weight or overweight who had high levels of authentic self-awareness.

figure 1

Effects of T2 weight-based stereotype threat on ( A ) T3 work ability (without controlling for T2 work ability) and ( B ) T3 work ability (controlling for T2 work ability) moderated by T2 authentic self-awareness.

Supplemental analyses

We conducted a supplemental analysis in which we additionally controlled for baseline (T2) work ability (Model 3, Table 2 ). The patterns of results of this lagged endogenous change model [ 40 , 41 ] did not differ substantially from the results reported above. In particular, results suggest that the interaction between weight-based stereotype threat and authentic self-awareness was associated with change in work ability from T2 to T3 ( β  = 0.07, p  = 0.039). The significant interaction effect is shown in Fig. 1B . Simple slope analyses showed that the relationship between weight-based stereotype threat and change in work ability was negative and significant at low (−1 SD) levels of authentic self-awareness ( B  = −0.23, SE = 0.07, β  = −0.13, t  = −3.22, p  = 0.001) and weak and non-significant at high (+1 SD) levels of authentic self-awareness ( B  = 0.07, SE = 0.12, β  = 0.04, t  = 0.55, p  = 0.585). Again, a three-way interaction between gender, weight-based stereotype threat, and authentic self-awareness was not significantly associated with work ability ( β  = 0.02, p  = 0.659). Additional analyses with only employees with overweight ( β  = 0.05, p  = 0.378), only employees with obesity ( β  = −0.03, p  = 0.729), or both of these groups combined ( β  = 0.01, p  = 0.852) did not yield significant interaction effects. However, T2 weight-based stereotype threat still had a negative main effect when only considering employees with obesity in this analysis ( β  = −0.20, p  = 0.026).

To test whether the temporal order of variables we proposed represents the best fit to the data, we also estimated a reverse temporal order model in which we regressed T3 weight-based stereotype threat on the control variables, baseline (T2) weight-based stereotype threat, work ability, authentic self-awareness, and the interaction of work ability and authentic self-awareness (Model 4, Table 2 ). As shown in Model 4 (Table 2 ), age ( β  = −0.07, p  = 0.004) and authentic self-awareness ( β  = −0.06, p  = 0.044) were weakly and negatively associated with change in weight-based stereotype threat. In contrast, T2 work ability and the interaction between work ability and authentic self-awareness were not significantly associated with change in weight-based stereotype threat. An additional analysis showed that a three-way interaction between gender, work ability, and authentic self-awareness was not significantly associated with change in weight-based stereotype threat ( β  = −0.04, p  = 0.154). The interaction between work ability and authentic self-awareness was also non-significant when considering only employees with overweight ( β  = 0.06, p  = 0.092), only employees with obesity ( β  = −0.08, p  = 0.293), or both of these groups combined ( β  = 0.01, p  = 0.659).

Consistent with expectations, our correlational survey study showed that the experience of weight-based stereotype threat was associated with lower levels of work ability, and this relationship was qualified by authentic self-awareness. Specifically, the relationship between weight-based stereotype threat and work ability was non-significant among employees with higher authentic self-awareness, whereas employees with lower authentic self-awareness reported lower work ability when they experienced weight-based stereotype threat. This interaction effect was weaker, but still significant, when baseline levels of work ability were controlled, suggesting that the interaction between weight-based stereotype threat and authentic self-awareness is associated with mean-level changes in work ability across 1 month.

These findings, albeit correlational and not causal, advance research on stereotype threat, work ability, and authenticity. Most research on stereotype threat has been conducted in the laboratory, and stereotype threat research in a work context has neglected weight-based stereotype threat [ 12 ]. The current results demonstrate that employees with overweight or obesity experience weight-based stereotype threat and this concern, in turn, can diminish their sense of work ability. Work ability is associated with increased absenteeism, disability leave, and early retirement [ 17 ], suggesting that weight-based stereotype threat might be indirectly related to these outcomes. Indeed, this has been shown for other forms of stereotype threat in the workplace [ 42 ]. Additionally, if stereotype threat is negatively associated with work ability it might create a vicious cycle whereby diminished work ability fuels the stereotypes about people with overweight or obesity, thereby making these employees even more susceptible to stereotype threat.

Our findings are consistent with prior research suggesting that high authentic self-awareness constitutes a psychological resource and coping mechanism [ 19 , 20 , 21 ], as it seems to make employees less susceptible to the detrimental consequences of weight-based stereotype threat. It is important to note, however, that authentic self-awareness did not moderate the association between weight-based stereotype threat and work ability when only employees with obesity were considered in the analysis. Due to the fact that these employees are the most overweight and hence the most easily identified as such, it is not surprising that they were also found to be more susceptible to weight-based stereotype threat than employees with overweight or normal weight (i.e., we found positive linear relationships of weight and BMI with weight-based stereotype threat). Thus, it seems likely that authentic self-awareness may only serve a protective function among employees who experience relatively lower levels of stereotype threat (in the current case, employees with overweight, but not those with obesity).

Finally, the bivariate correlations showed that older employees weighed more and had higher BMIs, but nonetheless experienced less weight-based stereotype threat than younger employees. While the former finding is consistent with the literature on work and health [ 43 ], a potential explanation for the latter finding is that older employees have accumulated more work and life experience and may, therefore, be less concerned that other people at work reduce them to weight-based stereotypes. Moreover, the positive relationship between age and authentic self-awareness suggests that older employees possess greater knowledge about various aspects of their selves and, thus, may be less susceptible to experiencing weight-based stereotype threat.

Limitations and future research

This study integrates psychological theorizing on stereotype threat with the literature on obesity and weight stigma to examine the consequences of weight-based stereotype threat in the workplace. Most weight-stigma research focuses on women with overweight [ 44 , 45 ], whereas our sample includes men and women. Additional analyses showed that two- and three-way interactions of gender with weight-based stereotype threat and authentic self-awareness were not significantly associated with work ability. Nevertheless, examining both genders continues to be important in light of the inconsistent associations of weight stigma with potential outcome variables in a workplace context, with some research showing men to be more susceptible and other research showing women to be more susceptible to weight-based prejudice and discrimination (see [ 1 ]). Thus, further research is needed that addresses the issue of intersectionality, or how the combination of gender, weight, and other relevant characteristics may be associated with potential detrimental consequences in the workplace [ 46 , 47 ].

Nonetheless, this study has a number of limitations that should be addressed in future research. First, all of the constructs in our study were assessed using self-report, which may raise concerns about artificially inflated associations due to common method bias. However, following methodological recommendations [ 48 ], we temporally separated measurements of our predictor and outcome variables. Additionally, our predictor, moderator and outcome variables used different response scales, helping to further combat common method variance [ 49 ]. Perhaps most importantly, methodologists have demonstrated that interaction effects are not inflated by common method bias [ 50 ]. Nonetheless, research demonstrates that self- and other-reports of authentic self-awareness are weak and non-significant [ 21 ], suggesting there may be limitations in the accessibility of self-knowledge or that self-presentation biases people’s judgements [ 51 ]. To address this possibility, future research could supplement self-report measures of authentic self-awareness with reports obtained from other people (e.g., co-workers, family members).

Second, although work ability is an important outcome, future studies should examine the associations of weight-based stereotype threat with additional engagement- and disengagement-related work outcomes. Research with employees from other stigmatized groups demonstrates that stereotype threat is associated with more negative job attitudes and increased intentions to quit [ 12 ]. Lower work ability also relates to more negative attitudes and intentions to quit [ 17 ], raising the possibility that work ability may play a mediating role between the experience of stereotype threat and these outcomes.

Previous research has neglected the potential consequences of weight-based stereotype threat in the work context. Consistent with stereotype threat theory, we found a negative relationship between employees’ experiences of weight-based stereotype threat and work ability, which was weaker among those with higher levels of authentic self-awareness. Thus, organizations should identify ways to enhance authentic self-awareness, particularly among employees who may be susceptible to the negative effects of weight-based stereotype threat.

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Zacher, H., von Hippel, C. Weight-based stereotype threat in the workplace: consequences for employees with overweight or obesity. Int J Obes 46 , 767–773 (2022). https://doi.org/10.1038/s41366-021-01052-5

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An attempt to reduce negative stereotyping of obesity in children by changing controllability beliefs

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Tracy Anesbury, Marika Tiggemann, An attempt to reduce negative stereotyping of obesity in children by changing controllability beliefs , Health Education Research , Volume 15, Issue 2, April 2000, Pages 145–152, https://doi.org/10.1093/her/15.2.145

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The purpose of the present study was to investigate whether changing children's beliefs about the controllability of obesity would reduce their negative attitudes toward fat people. The participants were 74 children from Grades 4–6, 42 in the experimental group and 32 in the control group. The experimental group were presented with a brief intervention which focussed on the uncontrollability of weight. The study found that the intervention was successful in reducing the amount of controllability that children assigned to obesity, but was not successful in reducing negative stereotyping of the obese among the experimental group compared to the control group. These results indicate that while children's beliefs about the controllability of obesity can be changed, reducing their negative stereotyping is more difficult.

Obesity is stereotyped in a highly negative manner in Western countries. Many studies have shown that adults characterize obese people by negative attributes such as lazy, unattractive, unhappy, unpopular and sloppy ( Harris et al. , 1982 ; Tiggemann and Rothblum, 1988 ; Ryckman et al. , 1989 ; Cogan et al. , 1996 ). Children also endorse a similar dislike of obesity. The classical study of Richardson et al. ( Richardson et al. , 1961 ) showed that children ranked an obese child last on likeability, behind children with various physical handicaps, such as facial disfigurement and using a wheelchair. Other research has indicated that children as young as the age of 3 describe a fat child as lazier, and less attractive, happy, smart and popular ( Brylinsky and Moore, 1994 ; Hill and Silver, 1995 ; Tiggemann and Wilson-Barrett, 1998 ). These studies also reveal that the gender, age and weight of the child have little effect on the high degree of negative stereotyping.

This negative stereotyping of obesity in children has important implications because of the potential negative ramifications on the peer acceptance and psychological health of overweight children. For example, Strauss et al. ( Strauss et al. , 1985 ) have shown that obese children are liked less as playmates than average-weight children, and that they perceive themselves as more depressed and as having lower self-concept (involving all of behaviour, academic performance, anxiety, popularity, happiness and physical appearance) than do non-obese children. Similarly, Pierce and Wardle ( Pierce and Wardle, 1997 ) have found overweight children to be more vulnerable to low self-esteem. Despite these negative ramifications, as yet no published research has tried to reduce the high degree of stereotyping of obesity by children. Only a few studies have attempted to reduce adults' negative attitudes, some successfully ( Weise et al. , 1992 ; Robinson et al. , 1993 ; Crandall, 1994 ) and some unsuccessfully (Harris et al. , 1991). This is possibly because many people are not aware of the existence of weight stereotyping and discrimination (in adults or in children) since, as Crandall ( Crandall, 1994 ) points out, in contrast to race or gender, there is no strong social pressure against the expression of anti-fat attitudes.

In addition to the strong dislike of obesity, people hold inaccurate beliefs about the causes of obesity. Although there is debate about their relative importance, there is increasing evidence that genetic [for a review, see Price ( Price, 1987 )] and metabolic factors ( Keesey, 1980 ; Rothblum, 1990 ), in addition to sociocultural factors, are important determinants of obesity in adults. Research indicates that the same is true for childhood obesity [e.g. ( Williams and Kimm, 1993 )]. In contrast, popular belief suggests that eating too much and exercising too little are the major causes of obesity. The view that fat is controllable distinguishes stereotyping of obesity from stereotyping of other physical attributes. Whereas race, gender and height are not controlled by the individual, obesity is perceived to be under the individual's direct control. According to attributional accounts of stigma, when a negative outcome such as obesity is attributed to a controllable cause, negative judgements and affective reactions are made about the stigmatized condition ( Weiner et al. , 1988 ). Some studies with adults have confirmed that negative attitudes to fat people are significantly correlated with the perceived control fat people have over their weight ( Allison et al. , 1991 ; Crandall, 1994 ; Crandall and Martinez, 1996 ). Sigelman and Begley ( Sigelman and Begley, 1987 ) also found children evaluated an obese child target more positively when perceived responsibility for the problem was low. Tiggemann and Anesbury (unpublished data) found controllability and negative stereotyping to be positively correlated in children aged 8–12 years.

Given the relationship between controllability and negative attitudes, one way to reduce negative stereotyping of obesity might be to change people's beliefs that obese individuals can control their weight. In the one published study targetting the controllability of obesity, rather than general knowledge about obesity ( Crandall, 1994 ), adult participants heard and read either a persuasive message arguing that fatness is caused by uncontrollable physiological/metabolic and genetic factors (experimental condition) or a message about the role of psychological stress on illness (control condition). Compared to the control group, the experimental group answered significantly more factual questions about weight correctly, and, more importantly, tended to dislike fat people less and were not as likely to attribute obesity to a lack of self-control or willpower. Therefore, by changing beliefs about the controllability of obesity, Crandall ( Crandall, 1994 ) was able to reduce adults' negative attitudes toward fat people.

The purpose of the present study was to attempt to reduce negative stereotyping of obesity in children by introducing an intervention similar to Crandall ( Crandall, 1994 ) that stresses the importance of genetic and metabolic factors as the principal causes of obesity. Like Crandall ( Crandall, 1994 ), the intervention was designed to isolate controllability beliefs as a mediator of negative attitudes to obesity and to attempt to reduce stereotyping in children by directly manipulating those beliefs. A methodological improvement was that change within individuals was also assessed, with the children's perceptions of controllability and their negative stereotyping being measured both before and after the intervention. Based on the results found in adults, it was predicted that, relative to the control group, both controllability beliefs and negative stereotyping would decrease following the intervention for the experimental group.

Participants

The participants were 74 children (39 boys and 35 girls) in Grades 4–6 (age range 9–11 years, M = 10.05, SD = 0.89) in a State primary school located in South Australia. This represents a subset of the children studied by Tiggemann and Anesbury (in preparation).

A questionnaire containing measures of negative stereotyping and the controllability of obesity was administered to the participants in three class groups, in which the instructions and questions were read aloud and explained (Time 1). One week later (Time 2), children were assigned to one of two conditions: the intervention group (19 girls and 23 boys) or the control group (16 girls and 16 boys). Children in the intervention condition were provided with a brief intervention about the uncontrollability of body size, which lasted about 10 min. After the presentation, these children completed a second questionnaire, also measuring negative stereotyping and controllability. During this time, control children were involved in normal activities in another room with the class teacher. Then they too completed the second questionnaire. The instructions to each section were read aloud, after which the children completed the questions on their own.

On completion of the questionnaire, each group was debriefed. The debriefing involved a brief talk about the unrealistic stereotypes of obesity and the uniqueness of a person's size. For the control group, the debriefing also contained a brief version of the intervention.

Questionnaire

There were two versions of the questionnaire, one for girls and one for boys. The first section was designed to elicit the presence of stereotyping of weight, firstly for the respondent's own sex and then the opposite sex. Respondents were presented with Tiggemann and Wilson-Barrett's ( Tiggemann and Wilson-Barrett, 1998 ) silhouette drawings of an obese and normal-weight child side-by-side, and asked to indicate which girl (boy) they thought was friendlier, happier, lazier, more attractive, more confident, works harder, smarter, healthier, like the best, want to play with and be friends with. Respondents were also provided with the option of choosing `same' so that demand characteristics could not totally determine stereotyping. To prevent any systematic bias resulting from the position of the figures, the figures were swapped so that the normal-weight drawing was presented as the left figure in half the questionnaires and as the right figure in the other half. To make the questionnaire more realistic, each of the child figures was given a name, which was different from any of the names of the participating children in Grades 4–6. Each of the names was associated with the normal-weight figure for half of the questionnaires and the obese figure for the other half. In addition, for Time 2, the names and clothing on the figures were modified to encourage generalization.

The 11 items of the stereotyping measure were scored so that a score of 1 was given to each response that indicated negative stereotyping of the obese figure and a score of 0 to each response that indicated no negative stereotyping. These scores were summed to form a scale ranging from 0 to 11. Calculated using the Kuder–Richardson's formula, the resulting internal reliabilities were high, with 0.85 for the female and 0.86 for the male target at Time 1, and 0.90 for the female and 0.86 for the male target at Time 2.

The next section of the questionnaire was concerned with perceptions of controllability or whether children believed weight to be under personal control. Respondents were required to answer nine questions by indicating whether or not they believed the statement to be true (`yes'), false (`no') or they did not know (`don't know'). The questions covered both the initial cause of the condition (e.g. `are many fat children born that way?') and the possible solutions (e.g. `can fat children become thin if they really tried?'). Ideas for the questions came from Crandall's ( Crandall, 1994 ) Antifat Attitudes Questionnaire Willpower subscale, Tiggemann and Rothblum's ( Tiggemann and Rothblum, 1988 ) Perceived Aetiology of Obesity Scale, and Sigelman's ( Sigelman, 1991 ) controllability manipulations and measures. A score of 1 was given for each answer that indicated controllability, 0.5 for each `don't know' answer and 0 for each answer that represented no controllability. The resulting scale ranged from 0 to 9, with a higher score representing a higher degree of controllability assigned to obesity. Calculated using Cronbach's α, the reliability for the nine-item weight measure at Time 1 was 0.64.

At Time 2, these questions were presented first (before the stereotyping measure) so that they could be used as a manipulation check to ensure the children understood the material presented in the intervention. For the second testing, the reliability of the nine-item scale improved substantially to 0.87.

Intervention

The aim of the intervention was to change children's beliefs about the controllability of obesity and thus to highlight that, for the most part, a child cannot control their weight. The intervention was designed especially for children, using evidence for the causes of obesity to address uncontrollability. Metabolism and the storage of fat were chosen as the focus because children were more likely to understand these concepts than they would concepts like natural set-point theory or the procedures involved in adoption and twin studies. To make the intervention interesting and understandable to children, the presentation was given verbally, the language was kept simple, new terms were explained in detail, accompanying pictures were used to illustrate the differences in children's body size and the message about the uncontrollability of body size was repeated many times. Because the intervention was designed as a way to test the effects of controllability on stereotyping, negative stereotyping of obesity itself was not specifically addressed in the presentation.

As an introduction, pictures highlighting differences in the hair, eye and skin colour of adults were presented to explain that people can differ in many types of ways. Then, pictures of children with different body shapes and sizes were shown to illustrate in general the various types of bodies children have. These pictures consisted of boys and girls differing in their height and weight, with each picture being given a name. Differences in children's height were pointed out initially using pictures of tall, average height and short children. The genetic mechanisms underlying height were then discussed, with an explanation that genes carry important information about a child's characteristics that are passed on from the child's parents. Because that information cannot be changed, it was emphasized that a child cannot control their height.

Next, pictures of children with lean, average and large body builds were shown to highlight again that children differ in their body size. Following this, it was explained that genes also play an important role in controlling weight. In particular, it was explained that genes are important in determining a child's ability to break down the fat they eat, so that some children's bodies break down fat fast, whereas others do not. Consequently, children with low metabolism store more fat in their bodies than do those with high metabolism, allowing two children to eat the same amount and type of food but still weigh different amounts. In this context, it was mentioned that diet and exercise do not solely control weight. In conclusion, it was emphasized that, for the most part, a child is not able to control their weight.

Reducing weight controllability

The purpose of the present study was to change children's beliefs about the controllability of obesity and thereby reduce negative stereotyping. To investigate whether the presentation on the uncontrollability of weight reduced weight controllability beliefs, a repeated measures MANOVA was performed with weight controllability as the dependent variable. The repeated measure was time of testing, comprised of the scores from Time 1 and Time 2, and the independent variable was experimental condition. The means, SDs and difference scores for the assessment of weight controllability for Times 1 and 2 are displayed in Table I . The difference score is the difference between the two means, where a negative score indicates that there has been a reduction from Time 1 to Time 2, and a positive score indicates an increase.

The means from Time 1 reveal that the children thought that obesity was controllable to a high degree. From Time 1 to Time 2, the difference column shows that weight controllability beliefs reduced for both groups, but more so in the intervention group than the control group. The repeated measures MANOVA confirmed that the difference between Times 1 and 2 was significant, F (1,70) = 63.45, P < 0.001, and that the means were significantly lower for the intervention group than the control group, F (1,70) = 3.96, P = 0.05. More important, the interaction between time and experimental condition was significant, F (1,70) = 32.16, P < 0.001. This indicates that the reduction in weight controllability was significantly greater for the intervention group than the control group.

Reducing negative stereotyping of obesity

To examine whether negative stereotyping reduced more for those in the intervention group compared to those in the control group, one repeated measures MANOVA was used. The repeated measures consisted of time of testing (scores from Times 1 and 2) and gender of the target (female and male child), and the independent variable was experimental condition. The means, SDs and difference scores for the female and male child targets are presented in Table II . The means for Time 1 indicate that stereotyping was highly negative. For change over time, the difference column shows that negative stereotyping reduced for both groups, although this reduction was greater for those in the intervention group. The repeated measures MANOVA revealed that the difference between the means for Times 1 and 2 was significant, F (1,71) = 22.21, P < 0 . 001. However, contrary to expectation, the interaction between time of testing and experimental condition did not reach statistical significance, F (1,71) = 0.70, P > 0 . 05. In other words, negative stereotyping did not reduce significantly more from the first to the second assessment for the intervention group than for the control group. It needs to be noted, however, that the study was a little underpowered statistically. Although it is difficult to calculate statistical power for interactions and repeated measures ( Howell, 1992 ), an approximation can be obtained for testing between group difference scores. For sample sizes of 32 and 42, as is the case here, the power of detecting a moderate size effect is 0.56, which is reasonable but somewhat below the desirable 0.80 ( Howell, 1992 ).

Although the reduction in scores from Times 1 to 2 was slightly greater for the female than the male child for both the intervention and control groups, the within-subjects effect of gender of the target, F (1,71) = 0.00, P > 0 . 05, and its interaction with experimental condition, F (1,71) = 2.43, P > 0 . 05, were not significant. The interaction between time of testing and gender of the target was also not significant, F (1,71) = 0.96, P > 0 . 05, nor was this interaction significant with experimental condition, F (1,71) = 0.26, P > 0 . 05. Furthermore, the between-subjects main effect of experimental condition was not significant, F (1,71) = 0.02, P > 0 . 05.

Relationship between controllability and stereotyping

The relationship between weight controllability and negative stereotyping of obesity was explored at both times. At Time 1, there was a significant positive correlation between weight controllability and negative stereotyping of obesity for both the female ( r = 0.27, P < 0.05) and male targets ( r = 0.26, P < 0 . 05), showing that negative stereotyping of the obese child increased as weight controllability increased. For Time 2, the correlations were positive but did not reach statistical significance ( r s = 0.16,.20, P s > 0.05). This is consistent with movement over time in the controllability beliefs but not in stereotyping as indicated by the previous MANOVAs.

The purpose of the present study was to attempt to reduce negative stereotyping by teaching children about the uncontrollability of obesity. As expected, the reduction in controllability from the first to the second questionnaire was significantly greater for the intervention group. However, contrary to expectation, negative stereotyping did not reduce from the first to the second questionnaire significantly more for the intervention group than the control group. Rather, both the intervention and control groups reduced their stereotyping of the obese male and female child. In addition, the controllability assigned to obesity was related to the extent of negative stereotyping in the first questionnaire. As children assigned more controllability to obesity, the more negatively they stereotyped the obese male and female child. These results provide support for attribution theory ( Weiner, 1995 ; Weiner et al. , 1988 ), which predicts that assigning controllability to obesity is related to more negative attitudes toward obese people. However, the relationship was not significant in the second questionnaire, showing the correlation was suppressed by the movement in controllability beliefs but not stereotyping.

The results regarding weight controllability show that the intervention was successful in reducing children's beliefs about the controllability of obesity, revealing that the children attended to the message and understood what was being said. This is consistent with Crandall's ( Crandall, 1994 ) finding that adults assign less control to fat after having been presented with information about the genetic and physiological causes of obesity. The present study also extends Crandall's ( Crandall, 1994 ) work by measuring beliefs within individuals over time and by showing that an intervention about the uncontrollability of obesity is capable of reducing controllability beliefs in children. However, as in all studies using intervention techniques, there are demand characteristics from measuring beliefs immediately after an intervention. In this case, the children may have repeated the information they just heard in the talk, rather than changing their actual beliefs about the controllability of obesity. It is also possible that the children understood the items better the second time around, consistent with the improved internal reliability of the controllability measure and accordingly assigned less control to obesity.

Notwithstanding the above limitations, the impact of the intervention shows that there is potential to reduce children's controllability beliefs even further. Although the intervention was relatively short (10 min) and addressed only one aspect of the uncontrollability of obesity (metabolism), children's beliefs still changed in the right direction. Possibly, a longer and more powerful intervention that addresses different aspects of the uncontrollability of obesity would reduce controllability further. In addition, whereas the intervention in the present study was given only once, repeated sessions might be even more beneficial in reducing controllability beliefs.

Although controllability beliefs reduced more in the intervention than in the control group, this was not the case for the extent of negative stereotyping of either the obese male or female child targets. Rather, the results show that both groups reduced their stereotyping from the first to the second questionnaire, suggesting that the intervention was not responsible for the reduction. These results are not in accordance with those of Crandall ( Crandall, 1994 ) who found that teaching adults about the genetic and physiological causes of obesity reduced their negative attitudes towards fat people. However, Crandall's ( Crandall, 1994 ) intervention was able to incorporate more complex information about more sources of uncontrollability of obesity because it was targeted at adults. The intervention employed in the present study may not have been sufficiently powerful or long in duration to elicit a greater reduction in negative stereotyping. Possibly an intervention that incorporates more uncontrollability information and is repeated over time would be more effective in reducing negative stereotyping of obesity in children.

The finding that the control group also reduced their negative stereotyping by the second questionnaire suggests that stereotyping may not be stable over time. It is possible that children's attitudes fluctuate (even if only a little) from week to week. Another possible reason for the reduction in stereotyping by both experimental and control groups, is that the first questionnaire may have acted like an intervention by prompting the children to think about their attitudes and their interactions with overweight children, maybe even to discuss them with their friends, in the time interval before the second questionnaire. In particular, it is likely that children (and their teachers) may never before have considered the issue of controllability of obesity or whether being fat is a child's fault. Consequently, the first questionnaire may have prompted a re-appraisal, resulting in subsequent less negativity towards obese children.

Although addressing the uncontrollability of obesity did not reduce negative stereotyping more for the intervention group than the control group, it is important to remember that the study design was a little underpowered and that this was the first attempt at reducing children's negative stereotyping. Considering that children's stereotyping is so strong and pervasive, and that other factors, such as parental attitudes, children's experience of obesity and school culture may influence stereotyping, it can be expected that successfully reducing stereotyping is a difficult task. However, the present study has taken an important first step by directly addressing the issue of the uncontrollability of obesity as a means of reducing stereotyping in 9- to 11-year-old children. Although not significant as predicted, the study has at least shown that introducing an intervention concerning the uncontrollability of obesity does not make these children's attitudes towards obesity any more negative. Future research might usefully investigate the impact of longer and more powerful interventions targetted at different age groups. In this way the generalizability of the finding could be extended, ultimately leading to a more theoretical account of the development over time of the relationship between controllability and stereotyping.

Overall, the present study has important applied implications. First, the results show that parents and teachers can successfully use messages about the uncontrollability of obesity to change children's beliefs that obesity is controllable. These messages could be incorporated into health and nutrition courses in schools to improve children's understanding of the factors involved in determining weight. Information of this kind would be especially useful for those children who strongly believe that obesity is controlled by the individual and negatively stereotype children based on that belief. Second, it is imperative for parents and teachers to address the problem of negative stereotyping of obesity in children, a problem that often goes unrecognized. Schools should be encouraged to incorporate programs which attack negative stereotyping, as the present study has attempted. This would certainly benefit the overweight and obese children whose self-concept and psychological well-being are otherwise at risk.

Means (SDs) and difference scores for weight controllability for Times 1 and 2

Means (SDs) and difference scores for negative stereotyping of the obese child targets for Times 1 and 2

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Home — Essay Samples — Nursing & Health — Obesity — Obesity As A Stigma Or A Threat To Health

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Obesity as a Stigma Or a Threat to Health

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Published: Jul 17, 2018

Words: 3334 | Pages: 7 | 17 min read

Table of contents

What is weight stigma, interpersonal situations, what are the consequences of weight stigma, physical and mental health consequences, physical health and physiological consequences, mental health and psychological consequences, how are children affected by weight stigma.

  • Consider that patients may have had negative experiences with other health professionals regarding their weight, and approach patients with sensitivity
  •  Recognize the complex etiology of obesity and communicate this to colleagues and patients to avoid stereotypes that obesity is attributable to personal willpower
  •  Explore all causes of presenting problems, not just weight
  • Recognize that many patients have tried to lose weight repeatedly
  • Emphasize behavior changes rather than just the number on the scale
  • Offer concrete advice, e.g., start an exercise program, eat at home, etc., rather than simply saying, “You need to lose weight.”
  • Acknowledge the difficulty of lifestyle changes
  •  Recognize that small weight losses can result in significant health gains
  • Create a supportive health care environment with large, armless chairs in waiting rooms, appropriately-sized medical equipment and patient gowns, and friendly patient reading material.

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obesity stereotype essay

Obesity and How Society Views It Research Paper

Throughout the human history, weight gain and fat storage have been seen the signs of fertility and prosperity. Currently, due to the rise of living standards, excess weight and obesity are posing a growing threat to health in many countries around the world.

Obesity is a chronic disease that prevails in both developed and developing countries and affects children as well as adults. This problem is urgent to the extent that it replaces more traditional public health concerns including infectious disease and malnutrition as negative depositors to person’s health.

In addition, as obesity is the major risk factor for other chronic and non-communicable diseases, it is just a matter of time before the same high mortality rates for such diseases will be viewed in developing countries. The same rates existed in industrialized countries 20 years ago thought having good developed market economies (Takrouni, 2008). Finally, obesity is referred to as abnormal or excessive fat accumulation to an extent that human health may be affected (Takrouri, 2008).

Statement thesis

Obesity is a serious disease that is being heavily discussed in the United States and is contributing to the development of other chronic conditions and dangerous disorders. The weight excess influences the organism and provokes heart diseases and disorders of blood-vascular system.

The weight gain also provides a considerable stress on other organs and, therefore, weakens the immune system of the organism. However, there are cases when excess weight is the outcome of genetic heredity, which is often serves as a viable excuse for obese people. Therefore, there is the necessity to shatter all the myths and to make people lead a healthy life style.

The Epidemic of Obesity

It is undeniable that the epidemic of obesity has no social, economic, technologic, and geographic boundaries. This especially matters as the skyrocketing rates of this disease are closely associated with metabolic syndrome affecting the rate of mortality and morbidity of obesity.

Approximately, two hundred and seventy million (270,000,000) people in the world are considered to be obese and the number is assumed to reach three hundred and fifty million (350,000,000) in coming 2026 (Kushner and Bessesen, 2007, p. 100). The problem of the excess weight has become more urgent in the United States during the last three decades. In particular, one third of adults are obese.

What is more deplorable is that this obesity proliferation has no gender, age, and racial distinctions (Kushner and Bessesen, 2007, p. 100). The more significant concern is connected with the impetuous growth of the childhood obesity. The statistics counts that the United States has each sixth child suffering from obesity (Kushner and Bessesen, 2007, p. 100).

Obesity is considered to cause major impacts on the health care costs, economic costs, and social costs because its swift growth has almost outstripped the HIV/AIDS. To be more precise, 2005 witnessed about 75 % of American people suffering from HIV/AIDS and almost 86 % are the victims of excessive weight (Mooney et al., 2008, p. 42). Therefore, apart from preventive measures of obesity, which are viable solutions for assisting in slowing down the rates of disease, there should be some alternative and effective methods of treatment.

This can be achieved through government research and implementation of scientific projects aimed at facilitating the public education on issues concerning obesity. Proper treatment to those who are already suffering from obesity should be administered and proper care given so as to assist them to overcome the problem of excess weight. Obesity management needs urgent attention, especially in rural areas.

Health care services should be decentralized to local areas for easier access to all people who need them. Therefore, these individuals should be seriously targeted for treatment to prevent obesity proliferation in the United States. There is also the necessity to create awareness of the disease as a major health problem because government and some health care systems pay insufficient attention to it.

Obesity as a Disease

Apart from genetics, most cases of patient’s obesity are the outcome of unhealthy food intake and actual lifestyle. There are few people who think over the reasons of such chronic diseases as heart failure, diabetes, and asthma are excess weigh and careless attitude to the food allowance.

Taking into consideration the weight issues, the above chronic disorders can be considered as symptoms. Therefore, the obesity is the root of all problems that should be eliminated immediately. According to statistics, “even with improved management of comorbidities associated with obesity, the estimated number of excess death in 2000 association with obesity was 111.909” (McKnight, 2005, p.1)

With regard to the above, a healthy life style, culture of food consumption and human behavior are the main pillars of healthy existence.

This is why when buying food and other product, people should stick the appropriate rules. However, the lack of education and proliferation of food culture still leaves much to be desired. In addition, people should stop spending money on weight loss products but spend more on the processes of developing health actions, behavior, and eliminating poor lifestyles (Finkelstein et al., 2003)

Other Chronic Conditions That Make It Hard To Overcome Obesity

The occurrence of chronic disorders is difficult to eliminate for a person who tries to reduce or improve when they have excess weight. Such chronic disorders include the heart disease causing many lethal outcomes, particularly among the American population. Arthrosclerosis is another chronic condition emerging as a result of obesity problems, diabetes, and genetics inheritance. The presented complications aggravate the process of treatment considerably (DeBruyne et al., 2007, p. 372).

In addition to the above-defined chronic conditions, there are some other factors hampering obesity treatment. It should be admitted that obesity prevention and therapy should be carried out with the help of effective strategies and, therefore, common measures are not likely to be implemented. Hence, it is necessary to consider all risk factors, future complications that might occur as well as side effects. Therefore, these chronic diseases are major stumbling blocks for people suffering from obesity.

Types of Illness Relating to Obesity and Consequences of Stigma

Cardiovascular, hypertension, mortality diabetes, and breathing difficulties are related with obesity. Sometimes obesity does not have a negative impact on health. But it might cause stress, anxiety, loss of self-esteem, and depression. This is excess weight affects both the health and the psychological status of a person (Ross, 2003).

Attention to obese people has spread worldwide due to high and shocking rates of obesity and its health problems particularly in the United States of America. Obese people experience stigma and discrimination leading to serious consequences for their emotional and psychological health.

More importantly, obesity stigma is experienced in all aspects of person`s life because such people are poorly treated by their counterparts at work and other social spheres. The state of being obese makes people lazy, passive and indifferent to life; they might even lose the sense of existence. This is especially typical of people with inferiority complex that often develops among people suffering from excess weight.

Before considering the stigma of weight, it is necessary to study the phenomenon of stereotypes that serves as the basic condition for obesity biases. According to Brownell (2005), “the content of all stereotypes varies along two dimension of more and less socially desirable traits: warmth and competence” (p. 111).

Such theoretical model closely relates to stigma of obesity. Hence, the content of stereotypes mentioned above can be applied to obese individuals because such people can commonly react to the presented factors. However, this particular bias is more concerned with the issues of controllability and visibility.

It is proved that the problem of excess weight is a negative stigma because is visible and treated to be controllable (Browneell, 2005, p. 111). Arising from the above, there is an assumption that negative perception of excess weight can create negative reactions and stereotypes which, in their turn, provoke people’s resentment and contempt

Obese adults who experience stigma have developed high rates of social isolation because they feel like they are not accepted by the society. Social reluctance to accept such people cultivates the lack of self esteem and refusal to socialize with people agreed with the stereotype frames. Another consequence of stigma is that it leads to a negative consequence of poor eating behaviors or habits such as overeating by some people in response to stigmatizing encounters (Richards, 2009).

Problems Encountered by Doctors When Treating the Obese Patients

Obesity is an important clinical issue that can not be ignored. Therefore, it needs provision of professional and critical health care services directed at improving the health of the population in the United States. Unfortunately, the health care centers are full of insensitivity and judgment toward the obese people creating difficulties and limits for treatment.

The main problem encountered by the doctors is lack of understanding and appropriate ethical treatment. For instance, the doctor may unintentionally communicate some form of discrimination that may negatively affect the client’s care and hence preventing him/her from visiting the healthcare centers in future. Therefore, irrelevant treatment can prevent doctors from prescribing the right medical and treatment procedure for their patients (Kaplan, 1999).

Obesity, a Global Problem and Its Effect on Children and Women

Obesity has been rated among the increasing epidemics in developed countries and rapid spread in developing countries. In the United States, approximately 125 million grown-ups have problems with weight, 70 million citizens are experiencing obesity and around 10 million have severe obesity problems (Ogden, 2010).

Childhood and women obesity is also on the peak in the United States. This ration of population, hence, has a greater probability of diabetes mellitus development and hypertension rise that increases the risk of acquiring heart diseases and other chronic diseases associated with obesity (Ogden, 2010).

The weight of these children enhances bulling and discrimination by other children who have normal weights thus ruining their self–esteem. Today`s children belong to a generation that is full with computer games and television therefore, they have less time to exercise or even go out to play some outdoor games which encourage physical exercises. A part from watching and playing video games, food is readily available at any time they feel like eating (Coakley, 1999).

Preventive Measures to Overcome Obesity

Parents need to be the role models of their children by insisting on benefits of exercise and well balanced diets. This can be achieved through creating of healthy playing environments by carrying out regular physical exercises like cycling, taking a walk together and swimming activities. Parents need to motivate their children so that they can participate fully in sports and dances and pay attention to physical exercises and even enjoy doing it (Christopher, 2003).

Implementation of food culture will help a great deal in obesity reduction and elimination. This can be achieved by preparing and eating the food together as a family and creating new ways to reward children for work well done like talking them out on shopping trips other than making for them fatty foods.

Health care providers should offer improved services to their patients through the improvement of physical and social environment of health care settings. For example, they should provide bathrooms, which heavier clients can easily accept, have meeting rooms that have large exam tables and blood pressure cuffs with good size and reading materials that do not imply discriminative context (Coakley, 1999).

They should also try to improve their interpersonal interactions with the obese clients through being sensitive in everything they do and communicate to them to avoid embarrassing situation during the treatment process. They should avoid any judgmental comments and instead offer encouragement on the objectives of heath and fitness actions.

The victims of the obese problem should be encouraged to take the stigmatization encounters in a positive manner and use that as their stepping stone to overcome the problem rather than to accept the given situation and doing nothing to rectify the situation at hand. Depression and stress contribute nothing to weight reduction but deprives away a person’s self esteem and happiness.

Thus, these people need to wake up and find solutions to their issues immediately to avoid early deaths (Barry, 2007). The chart presented below provides an explicit, comparative analysis of the actual situation in the United States:

Obesity Share by Nation

Obesity Share by Nation

The given statistics provided by Consumer shows that the United States have on of the highest obesity level.

Prevention of obesity would result into maximized burden of heart problems and, therefore, it will play a big role in reducing the health care budget.

Through the reduction of obesity, other diseases associated with it will also decrease. Therefore, problem of obesity should be given much attention and serious preventive measures should be implemented so that the disease could be treated or prevented. A good obesity prevention program should include balanced diet, exercises, and active involvement of parents and guardians in these programs.

Apart from local measures this problem should be presented at the international level because other countries (developing in particular) should also be engaged in the solution searching process. Hence, the world government should think about effective strategies of economic and social improvement to insure people with a sufficient level of living. Finally, it is necessary to pay attention to ethical and moral aspects when treating obese people.

Reference List

Barry, L. (2007). Heart Care for Life: Developing the Program That Works best for h im/her. Yale: Yale University Press.

Brownell, K. D. (2005). Weight bias: Nature, Consequences, and Remedies . US: Guilford Press.

Christopher, K. (2003). A community-based obesity prevention program for minority Children: rationale and study design for Hip-Hop to Health . US: Harvard University Press.

Coakley, E. (1999). The Disease Burden Associated with Overweight and Obesity. New York: Must and company.

DeBruyne, L. K., Pinna, K., and Whitney, E. N. (2007). Nutrition and Diet Therapy . US: Cengage Learning.

Finkelstein E. A., Fiebelkorn, I. C., and Wang, G. (2003) . National medical spending attributable to overweight and obesity: How much, and who’s paying . Chicago: Finkelstein.

Kaplan, J. (1999 ). Caloric imbalance and public health policy. US: JAMA.

Kushner, R. F, and Bessesen, D. H. (2007). Treatment of the obese patient . US: Springer.

McKnight, L. (2005). Obesity management in family practice . Germany: Birkhäuser.

Mooney, L. A., Knox, D. and Schacht, C. (2008). Understanding Social Problems. US: Cengage Learning.

Ogden, J. (2010). The Experience of Obese and the Many Consequences of Stigma. Journal of Obesity .

Richards, L. (2009). Poor Quality of Obesity Care in the U.S. Nature Reviews Endocrinology , 5(6), p. 291. Web.

Ross, A. (2003). Obesity: etiology, assessment, treatment, and prevention . New York: Human Kinetics.

Takrouri, M. S. (2008). Editorial: Obesity is a Spreading Modern Life Health Problem. The Internet Journal of Health. Web.

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Guest Essay

The Miracle Weight-Loss Drug Is Also a Major Budgetary Threat

obesity stereotype essay

By Brian Deese ,  Jonathan Gruber and Ryan Cummings

Mr. Deese was a director of the National Economic Council. Mr. Gruber is the chairman of the economics department at M.I.T. Mr. Cummings was a staff economist at the Council of Economic Advisers.

The U.S. health care system has struggled for decades with the tension between providing incentives for pharmaceutical innovation and keeping breakthroughs affordable for those who would most benefit from them. Even as countries around the world have stepped in to require lower-priced drugs for their citizens, the United States has been reluctant to do so. As a result, U.S. consumers pay the highest prices in the world for drugs, by a wide margin.

But the impetus for more fundamental reform may come from an unexpected place: America’s obesity epidemic. Many of us are aware that there is a new class of weight-loss drugs that offers enormous promise in addressing obesity. But there is far less awareness of the fact that these drugs also introduce an enormous risk to America’s taxpayers.

The magnitude of potential benefit and potential cost — roughly $15,000 per year per person — posed by these drugs suggests that policymakers may have no alternative but to step in and bring their costs in line with their social benefits. If policymakers succeed in doing so, we could build a model for drug price negotiation that enables an extraordinary medical breakthrough to improve both our health and our fiscal position. Or we could do nothing and create one of the biggest fiscal problems of the decade, with pharma companies profiting at the expense of the taxpayer and of equitable health outcomes.

Produced by the Danish pharmaceutical company Novo Nordisk, Ozempic and Wegovy are part of a new class of GLP-1 receptor agonists that regulate dopamine and help the body process sugar more effectively. Recent studies have shown that the drugs are effective at both reducing weight and preventing diabetes, and their U.S. sales reached more than $13 billion in 2023.

These drugs have the potential to significantly reduce the expenses for obesity-related illnesses and for the condition itself, the cost of which is about $210 billion annually and growing. More than 40 percent of Americans are classified as obese, and that share is projected to reach nearly 50 percent by 2030. In 2021, 38 percent of Americans were estimated to be prediabetic, and in that year, an additional 12 percent were diagnosed as diabetic. We desperately need game-changing weight-loss innovations.

Unfortunately, these drugs are also very expensive, and current evidence suggests that users need to continue to take the drug indefinitely to keep the weight off.

Right now, Medicaid spends a relatively modest amount — roughly $3 billion — on these treatments because federal government health insurance plans generally cover them only for those with Type 2 diabetes. But the government may have a hard time limiting access, given how beneficial they may be for a broader set of people. The savings generated from treating obesity sooner generate a host of health benefits, including reducing the likelihood of someone suffering deadly conditions like heart failure, coronary artery disease and stroke. Restricting the usage of GLP-1s will become extremely difficult to defend because that is not in the public interest.

We have estimated the costs and savings for state public insurance programs, health insurance exchange subsidies and U.S. taxpayers from making this class of drugs more broadly available. Under reasonable assumptions and at current prices, making this class of drugs available to all obese Americans could eventually cost over $1 trillion per year. That exceeds the savings to the government from reduced diabetes incidence and other health care costs from excess weight by $800 billion annually.

This is a staggering sum. It is almost as much as the government spends on the entire Medicare program and almost one-fifth of the entire amount America spends on health care.

We faced problems of highly beneficial but highly expensive drug innovations in the past, but none have come close to the potential scale of this. Recent drug breakthroughs to treat hepatitis C approached $100,000 for a treatment period, but the universe of potential patients is three million to four million , or roughly 2 percent of the overweight population in America.

What can be done? We could simply make patients pay more. But this would be likely to ensure that only richer Americans receive the drugs, compounding existing equity issues surrounding diabetes. Poor Americans are two-thirds more likely to be diabetic than the nonpoor.

It’s becoming clear that the only way to solve the weight-loss drug dilemma is to create a mechanism to bring the costs of these drugs closer in line with their social benefits. These drugs are extremely profitable: Novo Nordisk earned $4.8 billion in sales in the third quarter of 2023 alone. And the U.S. price is unusually high, with Ozempic in the United States costing about 10 times what it does in Britain, Australia or France, where drug prices are negotiated or regulated by the government. In Denmark, the home country of Novo Nordisk, the cost of the drug is under $3,500 a year .

The federal government could use its purchasing authority through Medicare to negotiate lower prices. In 2022, as part of the Inflation Reduction Act, Congress for the first time granted Medicare limited authority to negotiate drug prices. However, the authority under that act is limited to a select set of drugs, starting with 10 in 2026 . The law further requires drugs to have been on the market for several years. This would be relevant for GLP-1s only in the 2030s; waiting this long is letting the proverbial horse out of the barn. Instead, Congress could augment Medicare’s negotiating authority by granting it explicit, immediate authority to negotiate prices for this class of drugs, and states could follow for Medicaid. Bringing the price down to what is paid in Denmark, for example, could save public payers almost $500 billion per year.

Arguments that price declines that would result from such negotiation would kill innovation are misplaced. They ignore the fact that higher government spending of the magnitude necessary to cover Americans in need of this treatment would reduce the government’s ability to invest in basic science, which is a highly effective complement to private research. Starving the federal government would result in less overall innovation in the U.S. economy and less pharmaceutical innovation. We can set a price that provides strong incentives for private innovation without creating a crushing fiscal burden. And we can innovate with new tools to get this balance right, like the government offering research prizes for societally beneficial health innovations alongside utilizing more aggressive price negotiation tools.

Policymakers should address the cost issue now, rather than withhold promising treatments from millions of Americans or just let the costs explode.

Brian Deese is an innovation fellow at the Massachusetts Institute of Technology and was a director the White House National Economic Council in the Biden administration. Jonathan Gruber is the chairman of the economics department at M.I.T. Ryan Cummings is a doctoral economics student at Stanford University and was a staff economist at the White House Council of Economic Advisers.

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An earlier version of this article described incorrectly a statistic about diabetes incidence among Americans. Poor adults are two-thirds more likely to have diabetes than adults with incomes at or higher than 400 percent of the federal poverty level, not than the population as a whole.

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Guest essay: PEIA should cover obesity meds

By mollie mccartney cecil.

On Feb.  28, PEIA announced that it was going to stop coverage of anti-obesity medications effective March 15. This includes both pill and injectable forms of medicines.

Prior to this, PEIA was severely restricting access to these medicines. Only a small group of clinics in the state could prescribe them. If a medication was prescribed by another clinic — even if it was by the patient’s long-time primary care provider or another board-certified obesity medicine specialist — it was denied coverage by PEIA. These medications are powerful tools in obesity treatment. They are also beyond the financial reach of most West Virginians unless they have insurance coverage for them.

All major medical associations recognize obesity as a chronic disease process. These include the American Medical Association, the American Association of Nurse Practitioners and the American Academy of Physician Assistants. It is a disease process that is separate from its complications, such as diabetes, high blood pressure and heart disease.

Despite this accepted medical science, many insurance companies continue to view obesity as a lifestyle choice. Additionally, they do not prioritize the treatment of obesity as a critical aspect of population health improvement. As a result, they deny essential and evidence-based coverage of these medications.

An extensive library of evidence supports the use of a multi-faceted approach to obesity treatment. This includes diet, physical activity, behavioral modification and medical interventions used together. We now have several medications to treat obesity that are proven to be safe and effective and to decrease the long-term complications of obesity. When insurances exclude anti-obesity medications from their coverage, they are depriving patients with obesity of the most effective and appropriate treatment for obesity. Insurers such as PEIA who do this also limit treatment for obesity in a way they do not limit treatment for other chronic disease processes.

West Virginia has the highest rate of obesity in the nation. We have high rates of complications and death as a result. As of 2017, we led the nation in deaths from diabetes. We lead the nation in rates of heart attack and are in the top-five states in the nation for the prevalence of diabetes, stroke and cancer.

In our state, these conditions are usually the result of obesity. We can improve these numbers by using the full toolkit of obesity treatments. This would save countless lives and enable our citizens to live life to the fullest.

PEIA provides coverage for over 200,000 state employees and retirees as well as their dependents. This is a large part of our state’s residents. As a result, PEIA is uniquely positioned to improve health outcomes for a large part of our state’s population. PEIA could finally move the needle on the health problems that we have been fighting for decades. To do this, PEIA needs to cover all obesity treatments.

I have lived in West Virginia my entire life. My ancestors first settled in the Mountain State in the 1790s and my love for this state and my roots run deep. I, and my colleagues who choose to serve our state as health care clinicians, deeply care about West Virginians. We all hear the statistics about how West Virginia is failing to meet health goals. We want our fellow West Virginians to live long, healthy lives free from preventable disease and disability. I sincerely hope PEIA, and other insurers responsible for the health of our citizens, reconsider these policies.

Dr. Mollie McCartney Cecil is a physician double board-certified in Family Medicine and Obesity Medicine. She has lived in Morgantown since starting undergrad at WVU in 2004 and she now practices at United Hospital Center in Bridgeport. She is also a member of the Obesity Medical Association’s national advocacy committee.

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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.

Introduction

Obesity is a major, and growing, public health concern. Globally, obesity affects more than one in ten adults, and prevalence has more than doubled since 1980 [ 1 ]. In 2009, 22% of men and 24% of women [ 2 ] in England were obese (defined as a BMI greater than, or equal to, 30 [ 3 ]), as were 27% of men and 28% of women in Scotland [ 4 ]. Obesity’s rapid growth and links to increased mortality and morbidity [ 5 ] have led the global obesity problem to be described as an epidemic [ 6 ].

Explanations for the causes of obesity have changed over time. Focus has recently shifted somewhat away from viewing obesity as a consequence of negative individual behaviour and towards viewing it as a social and environmental phenomenon [ 7 , 8 ], and one that can be viewed as a natural human response to overwhelming environmental influences [ 5 , 6 ]. In their history of the medicalisation of obesity, Chang and Christakis [ 9 ] observe that: ‘Initially cast as a social parasite, the [obese] patient is later transformed into a societal victim’ (p.155). Underpinning the structurally-driven obesity epidemic is the ‘obesogenic environment’, a combination of features of the post-industrial built, economic, political and sociocultural environments that create barriers to healthy eating and active lifestyles [ 10 , 11 ]. Hill and colleagues [ 6 ] suggest that: ‘in pursuing the good life people have created an environment and a society that unintentionally promote weight gain and obesity, given peoples’ genetic and biological make-up’ (p.20).

The mass media are an important part of the sociocultural environment. Agenda-setting theory illustrates how mass media are instrumental in setting the public agenda, determining the issues to which people are exposed, and what information they receive about those issues [ 12 ]. The mass media reflect, reinforce and shape common culture, including public health-related beliefs and behaviours [ 12 , 13 ]. Media interest in obesity has grown quickly over the past two decades [ 8 , 14 ], coexisting with increases in the incidence of overweight and obesity in the UK and worldwide [ 15 ]. The increasing quantity of reporting about obesity, coupled with ability of mass media to help define public understandings of health issues, means that the media represent an important element of the obesogenic environment.

One way that mass media could influence public understandings and perceptions of obesity is by contributing to its normalisation. Normalisation of obesity is a cyclical process by which shifting public perceptions of weight lead to increases in population adiposity, exacerbating the obesity problem [ 16 – 18 ]. Underpinning this theory is the concept that as average body mass increases within a population, so does that population’s familiarity with, and acceptance of, increased body mass. Increased acceptance may prevent individuals from recognising, and attempting to regulate, unhealthy adiposity in themselves, exacerbating the prevalence of obesity and likely increasing population mortality and morbidity [ 5 ]. Keightley and colleagues [ 18 ] describe how normalisation might condition individuals to rationalise obesity in themselves:

‘It is possible that the increase in the proportion of the population who are overweight or obese may have resulted in a normalising effect on perceptions of weight and as a result, thus changing the social ideology of being fat. That is, the threshold of what has been deemed ‘fat’ in the community may be rising to accommodate increased average weights in the population. It is possible therefore, that through social conditioning, individuals may rationalise the extent and/or risks of obesity based on a perception of physical fitness and social conditioning of body morphology.’ Keightely, Chur-Hansen, Princi & Wittert, P.E342

Moffat [ 19 ] suggests that, despite objections by some researchers that the obesity epidemic is characterised by unhealthy moral panic and alarmism, many health professionals fear that the normalisation of obesity has generated a dangerous apathy about the health risks of obesity. In addition to media representations, potential drivers of normalisation include ‘vanity sizing’, the phenomenon of clothing retailers labelling their garments as smaller than they are [ 20 ], growing food portion sizes [ 21 ] and the increasing medicalisation of obesity [ 17 , 22 ].

A wealth of evidence highlights shifting societal perceptions of weight [ 23 ]. Overweight and obese individuals increasingly underestimate their own weight [ 16 , 24 ] and parents often fail to recognise obesity in their children [ 25 , 26 ]. For example, Johnson and colleagues’ [ 16 ] comparison of two UK household surveys from 1999 and 2007 found that increases in self-reported weight over time were matched by an increase in the body-size threshold at which respondents deemed themselves to be overweight. Overweight and obese respondents to the 2007 survey were less likely to describe their weight status accurately than were their 1999 counterparts. The researchers note that this shift occurred despite of public health campaigns and elevated news reporting on the topic of overweight and obesity. Duncan and colleagues [ 27 ] studied the relationship between weight perceptions and weight-related attitudes in the United States. Their analysis of survey data found that overweight and obese respondents who misperceived their weight were much less likely to want to lose weight, and to have tried to lose weight, than those who perceived their weight accurately. This suggests misperception of weight can act as a barrier to adopting healthy lifestyles.

In addition to a decline in individuals’ ability to accurately assess their own weight, there is evidence that obesity stigma could undermine efforts to tackle the obesity problem [ 28 ]. Stigma is commonly defined in terms of identifying certain characteristics as deviant from widely-accepted societal norms, and therefore marking individuals who embody those characteristics as undesirable outsiders [ 29 ]. Link and Phelan [ 29 ] identify four interrelated components that converge to create stigma: distinguishing and labelling human differences; linking the labelled individuals to negative stereotypes; separating labelled individuals from those without the undesirable characteristics; and finally discrimination and the resulting social disadvantage of the labelled persons. This model can be applied to the process of stigmatisation of obese individuals: humans are be labelled by their BMI category; obese BMI is often associated with negative stereotypes including greed, sloth and lack of discipline [ 30 ]; the obese population is often mentioned as a specific societal group; and obese individuals can be subject to discrimination and disadvantage in various social spheres [ 31 ].

Obesity stigma has consequences for both psychological and physical health. Psychological consequences include depression, self-esteem, body-image dissatisfaction, and unhealthy coping strategies. Crucially, stigma does not appear to provoke the adoption of healthier lifestyles. On the contrary, evidence suggests that stigmatisation increases binge-eating [ 32 , 33 ] and threatens physical health [ 31 ]. As such, it is vital that public health efforts to reduce obesity do not stigmatise it. There is some evidence that media representations might contribute to the stigmatisation of obesity [ 28 , 30 ], but as yet this issue has received relatively little attention.

One aspect of newsprint coverage that content analyses often overlook is the images that illustrate articles. There is evidence that images can significantly influence readers’ interest in, and interpretations of, news articles [ 34 , 35 ], and that news consumers can recall news images long after their memory of the content of the accompanying text has faded [ 36 ]. The power of news images is such that there is value in analysing them in addition to text. Gollust and colleagues [ 37 ] analysed descriptive and demographic features of images of overweight and obese individuals published in American news magazines, and Heuer and colleagues [ 38 ] performed a similar analysis of photographs accompanying American online news stories about obesity. Both of these studies found that image subjects were often depicted engaged in stereotypical behaviours, including eating junk food and watching television. Due to news images’ potential to influence readers’ perceptions, these stereotypical depictions may reinforce damaging stigma. Furthermore, Lewis and colleagues [ 39 ] suggest that the subtle forms of stigma reproduced in banal forms such as newspaper representations tend to be the most harmful in terms of health and social wellbeing. Heuer and colleagues [ 38 ] suggest that the stigmatising depictions may cause blame for obesity to be attributed to obese individuals, which is directly at odds with the goals of public health policy to address obesity as a social and environmental issue.

The normalisation and stigmatisation of obesity are two damaging phenomena in which mass media portrayals may play a role. In this study, we investigate how UK newspapers might contribute to each of those phenomena. We analyse the photographs used to illustrate newspaper articles about obesity with reference to the text that accompanies them to examine how articles represent obesity. Our research questions are, firstly, to what extent might newspaper images of obesity contribute to the normalisation of obesity, and secondly, how might they contribute to the stigmatisation of obesity. To answer the first research question, we analyse the differences between article authors’ written descriptions of image subjects’ body sizes and researchers’ visual estimates of those subjects’ body sizes. Visual estimation of BMI is less accurate than true physical measures, but is used routinely by doctors to diagnose obesity [ 40 ]. Disparities between these descriptions and evaluations may be important because they could cause readers to form an inaccurate impression of what body sizes range is considered to be obese, particularly if these skewed perceptions are reinforced repeatedly over time. In answering the second research question, we analyse the occurrence of a set of potentially stigmatising and stereotyping features in images, and how the appearance of these features relates to the body size represented. To our knowledge, this is the first content analysis of UK newspapers’ coverage of obesity that analyses both images and text, and the first that employs visual estimates of body size.

Sample Selection and Collection

A representative sample of five national daily UK newspapers and their corresponding Sunday counterparts were selected. The selection represented three genres, and consisted of one ‘serious’ newspaper (The Independent & The Independent on Sunday), two ‘mid-market tabloid’ newspapers (The Daily Mail & The Mail on Sunday; The Express & The Sunday Express) and two ‘tabloids’ (The Mirror & The Sunday Mirror; The Sun & The News of the World). This typology has been used in other analyses of print media discourse to select a broad sample of newspapers with various readership profiles and political orientations [ 41 ]. Publications were chosen on the basis of having high circulation figures ( www.nrs.co.uk ) and indicating the inclusion of images in their database entries for articles.

Keyword searches were conducted on the Nexis UK and NewsBank databases to identify articles related to obesity published between 1st January 1996 and 31st December 2010. The time period was chosen to incorporates a short period prior to the WHO’s 1997 warning about the obesity epidemic [ 42 ] and the subsequent rise in newspaper reporting on obesity over the following 15 years [ 8 ]. An initial search was carried out for articles featuring the search terms “obesity”, “obese”, “fat nation”, “fatties” or “lardy” in the headline. To determine relevant search terms, two researchers read a selection of articles about obesity and noted terms that were used commonly.

The initial search retrieved 3,878 articles. The articles were manually sorted based on two initial inclusion criteria: human obesity must be the primary topic of the article, and the article must not be from the letters, television guide or television reviews sections of the publication. Following application of the inclusion criteria, 1,698 relevant articles were retained. The remaining articles were scrutinised for indications that they contained images, either in the form of references to an image in the text, or in the inclusion of image captions. Of the 1,698 relevant articles, 344 indicated that they contained images. As the online newspaper databases used do not store images with articles, original printed copies of the articles were retrieved from the newspaper archives of the National Library of Scotland (NLS). Due to limitations of the archives, 133 of the list of 344 articles with images were retrieved. These 133 images were each examined, and those that were cartoons or did not feature people were excluded. The final sample comprised 119 articles and images ( Table 1 ). In the case of articles that contained more than one image, the largest or most prominent image was used. If more than one person was pictured in the image, the most central or prominent person was used.

The Figure Rating Scale

A figure rating scale was used to assess subjects’ body sizes. Figure rating scales are commonly used in studies of body image disturbance [ 43 ] and generally do not include BMI values. For this study it was necessary to use a scale that attributes a BMI value to each portrait so that body sizes observed by the coders could be assigned to BMI categories. The body image instrument developed by Pulvers and colleagues [ 44 ], which has been tested for content validity, was chosen, and BMI values ranging from 16 to 40 were applied to each portrait in increments of three BMI points based on the authors’ guidance [ 44 , p.1642] ( Fig. 1 ). Coders identified the portrait on the scale that most closely resembled each newspaper image, and assigned each image a rating between one to nine accordingly. To minimise the effect of the pre-existing knowledge of the BMI scale, BMI values and categories were not included in the scale provided to coders. Values and categories based on World Health Organisation [ 3 ] classifications have been included in Fig. (1) for illustrative purposes.

An external file that holds a picture, illustration, etc.
Object name is emss-79954-f001.jpg

The Coding Frame

A coding frame for recording features of the images and articles was developed. Researchers (CP, SH) examined images to create thematic categories capturing information about image subjects and the contexts in which they were photographed. Additional categories were developed to record descriptive details of articles including publication date, publication title and how the subject’s body size is described in the text. While articles did not always specifically describe their image subjects’ body size, such as when a stock image was used to illustrate obesity in general, coders attributed the predominant body size description used in the article to the image used to illustrate it. This approach was chosen to take into account the associations that the reader might perceive, rather than associations that the author may have intended to create.

The initial coding frame was piloted with seven researchers who coded batches of images and suggested further improvements. The final coding frame included two contextual codes and eleven conceptual codes. The contextual codes comprised a unique identification code assigned to each image, and the caption associated with the image, if any. Conceptual codes comprised: body size described in article text; sex; age group; clothing; pose; body parts visible; body angle depicted; photography location; facial expression; the presence of family or others in the image; and obesity-related behaviours depicted.

Coding and Analysis

The thematic content of each image and its accompanying text were coded by CP. The body size depicted in each image was coded by four coders who assigned each image a value between one and nine using the figure rating scale. Using four coders ensured that any systematic coding biases could be identified. Discrepancies between coders’ evaluations of images allowed researchers to identify images that were posed in such a way that parts of the body were obscured, making reasonable estimations of body size difficult to achieve. Those images that produced significant disagreement between coders were not coded. The coded images were assigned BMI categories based on WHO classifications [ 1 ]: a BMI between 18.5 and 24.9 was considered to be ‘normal range’, 25-29.9 ‘overweight’ and 30+ ‘obese’.

Data from completed coding frames were entered into SPSS 15. A key part of the analysis was identifying the degree to which articles’ written descriptions of subjects’ body sizes agreed with coders’ evaluations of those body sizes. Any articles in which the written descriptions of subjects differed from coders’ evaluations could be interpreted as misrepresenting body size, and if a large proportion of articles in the sample were found to be misrepresentative, this might be indicative of a trend of misrepresentation of body size in newsprint coverage of obesity.

Fleiss’ Kappa was used to measure inter-rater agreement between coders’ ratings of image subjects’ BMI categories, and Cohen’s Kappa was used to measure agreement between article authors’ written descriptions and coders’ visual evaluations.

Sample Characteristics

The sample comprised 119 images from articles published between 1998 and 2010 ( Table 1 ). Almost half of subjects were males (n=53) and just over half female (n=64). The sex of two subjects could not be determined. A third (n=39) of subjects were assessed to be young children (≤12 years), a tenth (n=12) teenagers (13-18 years), and half (n=58) adults (≥19 years). The age groups of ten subjects could not be determined. Almost two thirds (n=74) of subjects were pictured alone, and a third (n=45) with others. Two thirds (n=79) of subjects were dressed in casual clothes, 17 were smartly dressed and three were depicted as untidy. Five subjects wore clothing associated with being a medical patient, while a tenth (n=14) of subjects were partially clothed ( Table 2 ).

Subject behaviours

Subjects’ obesity-related behaviours were recorded. Five were pictured watching television, and 28 were pictured with food, often junk food. Subjects’ poses were also coded. A quarter (n=29) were sitting or reclining, six engaged in exercise and the remaining 82 (68.9%) were standing or walking. Of those subjects with visible facial expressions, 37 (45.1%) were happy, 10 unhappy and 35 (42.7%) neutral ( Table 2 ).

Varying Descriptions of Body Size

Eighty-three articles described subjects’ body sizes in the article text. Ten were described as ‘normal’ (including ‘healthy’ and ‘slim’), 13 as overweight and 60 as obese. Coders assessed the body sizes of 105 (88.2%) subjects using the figure rating scale. Fourteen were not coded because they were either too small or awkwardly posed to be evaluated reliably, highlighted by a lack of agreement between coders. Of the subjects coded, seven were judged to be in the ‘normal’ weight range (BMI 18.50-24.99), 13 overweight (BMI 25.00-29.99) and 85 obese (BMI 30.00+). Of the seven images coded as normal weight, four were of individuals who were once obese but had lost weight, two were from articles about exercise classes in schools, and one was from a story about a trend of dieting among girls aged between 11 and 16. A Fleiss’ Kappa test of agreement on BMI category between the four coders returned a Kappa of 0.617, which can be interpreted as substantial agreement [ 45 ].

Articles’ descriptions of body sizes were compared with coders’ estimates of those subjects’ body sizes. A Cohen’s Kappa test of agreement returned a result of 0.361, which can be interpreted as fair agreement [ 45 ]. Table 3 provides an overview of the lack of agreement between descriptions and coders’ estimates. Of the eight subjects estimated by coders to be overweight, two were described as overweight and the remaining six as normal. Of the 64 subjects coded by coders as obese, one was described as normal range, 10 overweight and 53 obese. Table 4 details the distribution of the BMI values of the 53 subjects that were both described in article text as ‘obese’. On the figure rating scale ( Fig. 1 ), the obese category is represented by portraits 6 , 7 , 8 and 9 , representing BMI values 31, 34, 37 and 40 respectively. Table 4 demonstrates that BMI values were not evenly distributed between subjects described by articles as being obese. Subjects tended to represent higher BMI values within the obese range, and the most commonly represented BMI value was 40.

Note: The total number of images represented in this table (100) is less than the whole sample (199) because 19 articles did not describe the body type of the image subject

Relationships Between Body Size and other Characteristics

Researchers recorded the angle from which each subject was photographed and the visibility of each subject’s face. The 10 subjects described as normal weight range were all pictured with their faces visible and facing the camera. Of the 37 subjects shown without their faces visible, five were described as overweight and 28 obese ( Table 2 ).

Subjects described as overweight or obese were depicted as untidy, casually dressed, wearing clothing associated with being a medical patient, or partially clothed more frequently than those described as ‘normal’ weight ( Table 2 ). Subjects described as overweight or obese had unhappy expressions more commonly than did those described as normal weight ( Table 2 ). Only subjects described as obese were pictured engaged in activities associated with sedentary lifestyles (n=5), and they were more commonly photographed eating (n=19) than were those described to be of other body sizes. No subjects described as being of normal weight were untidy, wearing medical clothing, pictured with unhappy or obscured facial expressions, engaged in sedentary activities or eating ( Table 2 ).

The findings help to illustrate two mechanisms by which newspapers may contribute to the normalisation of obesity. Firstly, we identified statistically significant disparity between the articles’ descriptions and coders’ evaluations of subjects’ body sizes. Subjects were frequently of higher BMI categories than they were described in the accompanying text, suggesting that the journalists may have a tendency to underestimate their body sizes. Secondly, we showed that BMI is neither evenly nor normally distributed between subjects described by articles as obese; as nearly three quarters of these subjects represented BMI values of 37 or higher, and nearly one third represented a BMI of 40, often categorised as ‘morbidly obese’ [ 46 ]. This distribution suggests that newspapers tend to use images of relatively extreme obesity to illustrate articles about obesity. In addition, the negatively skewed BMI distribution within obese subjects in the sample differs starkly from the positively skewed distribution of BMI values within the obese population of the UK [ 47 ].

These findings are not, in isolation, evidence of the normalisation of obesity. However, when considered in light of the power of news images to influence readers’ perceptions [ 34 , 35 ], our findings illustrate how newsprint misrepresentations may play a role in reinforcing and exacerbating misconceptions about body size. If the trends identified in this study are extant in wider mass media reporting on obesity, they may play an important role in determining societal perceptions of obesity, and therefore a role in driving the normalisation of obesity. Normalisation is important because it may prevent overweight and obese individuals from adopting healthy lifestyles, and wider society from embracing legislative solutions to obesity [ 17 , 18 ].

In addition to normalisation, signs of stigmatisation were identified. The findings echoed those of previous research [ 37 , 38 ], highlighting a tendency for newspaper photographs of overweight and obese individuals to include negative stereotypes that may reproduce weight stigma. Compared with subjects described as normal weight, subjects illustrating overweight and obesity were more frequently depicted with unhappy or neutral facial expressions, obscured heads or faces, and eating food, often junk food. Unhappy or neutral facial expressions may stigmatise overweight and obese individuals as unhappy or deserving of pity. Excluding subjects’ heads or faces, while likely intended to protect the subject’s privacy, may serve to dehumanise overweight and obese people. Depicting subjects eating food, while not an inherently unhealthy behaviour in itself, may serve to focus readers’ attention on individual overeating as a driver of obesity to the exclusion of other drivers, which could reinforce the stereotype of the obese individual being to blame for a lack of self-control, and undermine the roles of social and environmental drivers of obesity. These trends could be harmful if found in wider mass media coverage of obesity, serving to reproduce negative stereotypes of obesity, leading to further prejudice, discrimination and damage to psychological and physical health [ 28 ].

Certain limitations of the research should be taken into account. Firstly, compromises were unavoidable in choosing the coding instrument. Figure rating scales are predominantly used to study body image perception, not for evaluating BMI. Furthermore, visual estimation is a much less reliable measure BMI than physical measurements. Despite this, visual estimation of BMI is used routinely by doctors, not necessarily with the aids of graphical scales, to diagnose patients’ BMI [ 40 ]. In a blind study of cardiology doctors’ visual estimations of BMI, Husin and colleagues [ 40 ] found that 81% of obese patients were correctly estimated to be obese, with the remaining obese patients were estimated to be overweight. Additionally, the scale used was initially designed for measuring body image perception in African Americans, while the majority of the image subjects in our sample were Caucasian, and body composition is known to vary by ethnicity [ 48 ]. While acknowledging the compromises made in choosing a scale, we are confident that the instrument represented a robust tool for a relatively novel research design. The implementation of a team of coders blind-coding each images allowed individual systematic coding biases to be eliminated. Images that were difficult to code due to their composition or the subject’s pose were identified by substantial disagreement between coders, and removed accordingly, and a Fleiss Kappa test of inter-rater agreement indicated substantial agreement on the remaining images. Any uniform bias among the coders could not be detected. However, if any uniform bias existed, Husin and colleagues’ [ 40 ] findings suggest that coders were likely to underestimate subjects’ BMI values. If this were found to be the so, it would logically follow that the disparities between article text descriptions and image subjects’ true BMI categories were greater than our findings suggest, which would strengthen the conclusion that newsprint representations misrepresent the range of body sizes classed as obese.

The second limitation of the study is its sample size. Inconsistencies in data about images in online newspaper article databases and the incompleteness of the library archive meant that the final sample of 119 articles and images was smaller than we anticipated. As a result, the trends identified in the sample cannot necessarily be generalised to wider newsprint coverage. In addition, the sample size limited our ability to analyze how variables such as publication genre and publication date related to articles’ representations of obesity. Inconsistencies and incompleteness in the database and archive may also have produced the variation in the number of articles published in different publications. For example, the relatively high frequency of illustrated articles about obesity in the Mirror & Sunday Mirror could result from between-publication variations in the way that specific elements of articles are submitted to the database.

However, there is no reason to believe that these articles and images were in any way atypical. In addition, due to the disproportionately powerful influence of news images, compared to that of article text [ 34 , 35 , 36 ], it seems reasonable to suggest that the images analysed may have influenced readers’ perceptions more than would text-only articles.

The third limitation of the study is inherent to content analysis; one can only describe the content of material, and cannot provide insight into its creators’ motives or intentions. This is particularly relevant to newspaper articles as they can be modified by a number of individuals from inception and publication, each of whom may have different motivations. Furthermore, images may have been chosen by a picture editor working independently of the original author of the text. In addition, analysing media content alone cannot tell us what messages the audience will take away, as forming meaning is a collaborative process between the text and the audience, and the context within which the text is consumed plays a role in how it is interpreted [ 49 ]. However, regardless of the intent of publishing decisions, the final article presented to readers is important, due to the role of media portrayals in influencing public understandings of health issues [ 12 ].

Further research in this area might benefit from these limitations being taken into account in their research design. Firstly, a figure rating scale designed specifically for visually estimating BMI, with normative BMI values for each portrait, would be of value. Secondly, taking into account the difficulties inherent to sourcing newspaper articles with images, further research might benefit from focusing instead on online news articles, as did Heuer and colleagues [ 38 ]. In addition, researchers interested in images of obesity may find that images are more numerous in other news media, such as magazine articles or television news, and there may be value in comparing images in articles about obesity with images in unrelated articles. The issue of the complex authorship of newspaper articles may warrant study in itself, which could investigate the roles and motivations of the personnel involved in putting together an article. As Gibson and Zillmann [ 50 ] suggest, journalists should be aware of the potentially harmful power of news images. This study adds to evidence that could lead news media producers with an interest in accuracy and integrity to consider their editorial processes with regard to illustrative images. If editors wish to illustrate obesity to readers in an accurate, informative and socially-responsible manner, they might consider seeking illustrative images that represent the full range of body sizes within the obese category and avoiding images that reinforce negative stereotypes of obesity. Alternatively, if public health campaigners wish to combat misleading and negative images of obesity, they might consider developing informational campaigns aimed specifically at counteracting those images.

Mass media coverage can influence how ideas develop, spread and enter public discourse [ 12 ]. This study suggests that there may be a tendency for newspapers to misrepresent the range of body sizes within the obese category, and disproportionately use images of extreme obesity to illustrate general societal obesity. These trends demonstrate a possible mechanism by which newspapers might contribute to the normalisation of obesity in society. This study also contributes to existing literature on mass media stigmatisation of obesity [ 37 , 38 ], demonstrating how newspapers’ photographic representations of overweight and obesity could serve to reinforce stigmatisation. In conclusion, this study contributes to a growing body of literature on mass media portrayals of obesity. It does so by illustrating two ways in which newspapers’ pictorial depictions of overweight and obesity could harm both public understanding and public healthy: by exacerbating a process of normalisation that distorts public perceptions of healthy weight; and by contributing to the stigmatisation of overweight and obesity that harms the psychological and physical health of overweight and obese individuals [ 28 ].

Acknowledgements

We would like to acknowledge the help provided by the staff of the National Library of Scotland. Thanks are due to Rachel Robertson, Dr. Jenny van Bekkum, Gillian Fergie and Neil Bertram for coding the images, to Candida Fenton for conducting literature searches, and to Dr. Helen Sweeting and Prof. Dame Sally Macintyre for advising on the manuscript.

This project was funded by the Chief Scientist Office of the Scottish Government Health Directorates (MC_A540_5TK70). Data were originally collected by the MRC/CSO Social and Public Health Sciences Unit, University of Glasgow. The authors declare no conflict of interests.

Conflict of Interest

The authors confirm that this article content has no conflicts of interest.

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    The PDG submitted a series of questions which cover two key aspects of obesity and its management: weight bias and stigma and the effectiveness and impact of weight management ... as the negative attitudes or stereotypes people hold against the obese and any subsequent prejudice or discrimination. ... Since this review several more papers have ...

  9. The burden of weight stigma

    Forty-two percent of U.S. adults say they have faced some form of weight stigma, such as being teased about their weight or treated unfairly because of it, with physicians and coworkers listed as some of the most common sources (Lee, K. M., et al., International Journal of Obesity, Vol. 45, 2021; Puhl, R. M., et al., International Journal of ...

  10. Educate medics about weight stigma to reduce UK's obesity rate

    To help tackle the UK's obesity crisis, we must better educate medical professionals on weight stigma, according to the conclusions of a large-scale review led by UCL researchers. ... based on stereotypes and prejudices about people who are either obese or overweight. In healthcare, the negative biases associated with weight stigma are known ...

  11. Culture, Obesity Stereotypes, Self-Esteem, and the "Thin Ideal": A

    Recent concerns with the increasing prevalence of overweight and obesity among children and adults indicate the need to better understand the psychosocial correlates of weight. We examined the relationships among negative stereotypes of obesity, "thin ideal" beliefs, perceptions of the causes of obesity and of control over weight, body esteem, and global self-esteem. A negative correlation ...

  12. Weight-based stereotype threat in the workplace: consequences for

    Authentic self-awareness moderated the relationship between weight-based stereotype threat and work ability (β = 0.14, p < 0.001), such that the relationship between stereotype threat and work ...

  13. Impact of weight bias and stigma on quality of care and outcomes for

    We then performed a narrative review of the existing empirical evidence regarding the impact of obesity stigma and weight bias for healthcare quality and outcomes. Many healthcare providers hold strong negative attitudes and stereotypes about people with obesity. There is considerable evidence that such attitudes influence person-perceptions ...

  14. Impact of weight bias and stigma on quality of care and outcomes for

    Many healthcare providers hold strong negative attitudes and stereotypes about people with obesity. There is considerable evidence that such attitudes influence person-perceptions, judgment, interpersonal behaviour and decision-making. These attitudes may impact the care they provide. Experiences of or expectations for poor treatment may cause ...

  15. attempt to reduce negative stereotyping of obesity in children by

    At Time 1, there was a significant positive correlation between weight controllability and negative stereotyping of obesity for both the female (r = 0.27, P < 0.05) and male targets (r = 0.26, P < 0.05), showing that negative stereotyping of the obese child increased as weight controllability increased.

  16. Obesity as a Stigma Or a Threat to Health

    Obesity is a condition where a person has accumulated so much body fat that it might have a negative effect on their health. If a person's bodyweight is at least 20% higher than it should be, he or she is considered obese. If your Body Mass Index (BMI) is between 25 and 29.9 you are considered overweight.

  17. Obesity and How Society views it

    Cardiovascular, hypertension, mortality diabetes, and breathing difficulties are related with obesity. Sometimes obesity does not have a negative impact on health. But it might cause stress, anxiety, loss of self-esteem, and depression. This is excess weight affects both the health and the psychological status of a person (Ross, 2003).

  18. Obesity, Stigma, and Discrimination

    Obesity, a complex medical condition, has reached epidemic proportions in the United States (US). The National Health and Nutrition Examination Survey (NHANES) conducts height and weight assessments on a representative sample of Americans to gauge its prevalence. A study by Hales et al reported that between 2013 and 2016, the prevalence of obesity stood at 36.5% for men and 40.8% for women.[1]

  19. Stereotypes Of Obesity

    2639 Words 11 Pages. Obesity, or being overweight, is a common problem today. Walk down any street in America and a large majority of people seen will be overweight or obese. Obesity is determined by a measure of body mass index (BMI), which is an indicator of fat content in the body. According to the World Health Organization (WHO, 2015) a BMI ...

  20. Obesity Stereotyping, Impact, and Inclusivity Promotion

    This essay will focus on the obesity stereotype among adults in the United Kingdom. The aspects of obesity stereotype that will be discussed include some background, how the stereotype occurs, the impacts of stereotyping, how to promote inclusiveness, and a personal reflection that focuses on how various aspects of my life have shaped my ...

  21. Stereotyping: Obesity and Race

    Stereotyping: Obesity and Race. Stereotyping is very common among us; every individual is said to fit some sort of stereotype. People tend to judge all the time and even if we hate to admit it or not every single one of us has done it. We categorize people everyday according to race, religion, ethnic background, gender, looks etc.

  22. Stereotypical images and implicit weight bias in overweight/obese

    An initial sample of 42 overweight/obese participants was recruited after they completed an 18-week weight loss intervention (post-treatment sample). They were 71 % female and 81 % Caucasian, with a mean age of 46.9 (SD = 13.0) and a mean BMI of 36.0 (SD = 7.7). While it was not anticipated that weight loss treatment would have any influence on ...

  23. Opinion

    Guest Essay. The Miracle Weight-Loss Drug Is Also a Major Budgetary Threat. March 4, 2024 ... But the impetus for more fundamental reform may come from an unexpected place: America's obesity ...

  24. Guest essay: PEIA should cover obesity meds

    On Feb. 28, PEIA announced that it was going to stop coverage of anti-obesity medications effective March 15. This includes both pill and injectable forms of medicines. Prior to this, PEIA was ...

  25. Normalisation and Stigmatisation of Obesity in UK Newspapers: a Visual

    Introduction. Obesity is a major, and growing, public health concern. Globally, obesity affects more than one in ten adults, and prevalence has more than doubled since 1980 [].In 2009, 22% of men and 24% of women [] in England were obese (defined as a BMI greater than, or equal to, 30 []), as were 27% of men and 28% of women in Scotland [].Obesity's rapid growth and links to increased ...