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Flashcards in Weight Stigma Deck (85):

What impact does feeling weight stigma have on patients? Phelan et al (2015)

Risk of depression, low self-esteem and lower quality of life.


What is the term from behaviours that emanate from negative attitudes of a stigmatized group?

It is known as enacted stigma - Patient detects this in healthcare provider may affect compliance with provider recommendation


What is explicit negative attitude about obesity perceived as more acceptable than?



What does evidence suggest about communication with stigmatised groups?

It is less patient centred.


If patients detect explicit or implicit negative attitudes they are less likely to...

adhere to weight loss recovery and mental health outcomes.


What are some of the issues with physicians when dealing with obese/stigmatised patients?

less respect for the patients- less positive communication and information giving.
Physicians may over-attribute symptoms and problems to obesity and fail to refer the patient for diagnostic testing or consider treatment options beyond advising patients to lose weight. Oversimplify causes of obesity suggest cut back on takeaway eating.
Feel judged patient may feel embarrassed to ask for help.


What are issues with health equipment?

Arm cuffs, chairs and scales don't cater for larger individuals.


What strategies can be used to improve clinical experiences?

- Increase provider empathy through perspective taking exercises to improve communication.
- Alter perceived norms regarding negative attitudes and stereotypes.
-Use emotion regulation techniques that foster positive effect.
-Address implicit views through implicit association test
- Educate providers on all factors involved in obesity genetic, environmental, biological, psychological and social.
- Focus on disease and conditions rather than weight itself
-Adopt patient centred communication
-Convey a sense of diversity


Kyle & Puhl, 2014 What does weight bias effect?

emotional functioning
personal relationships
educational attainment


What needs to be adopted by health care professionals that is used for people with diabetes but not those with obesity?

People first language


What has research shown about negative attitudes to obesity?

The negative attitudes that individuals hold they are unaware of them.


What does weight stigma refer to?

The negative attitudes held towards people who are OW?OB and any subsequent prejudice and discrimination.


How are OW/OB portrayed in the media?

They are portrayed as unattractive, masculine, no friends, and lack of social skills that embeds these thoughts into society.


1 in 5 children in reception...
1 in 3 children in year 6...

were OW/OB.


Puhl et al 2008 - Weight stigma is the second most common form of discrimination reported by..



Briefly describe Harrison et al (2016) study

Different forms of Alfie in different conditions. When Alfie was healthy weight equally as likely to be friends with him. Alfie overweight less willing to be friends with him and assumed he had negative traits.


What age does weight stigma begin? (Cramer & Steinweight, 1998)

Tested 3,4 and 5year old judgements on ow and normal weight characters and asked to attribute traits to them. 3 year olds youngest detection of weight stigma. All ages rated the OW negatively. As age increased so did the negative attributes.


Puhl et al 2013 found 71% of boys enrolled in a weight loss programme reported being..



Eisenberg at al 2006 found that weight related teasing predicted

lower self-esteem, lower body image and higher depressive symptoms independent of BMI.


What is the likelihood of someone to think about suicide if weight teased? (Eaton et al,2005)

Two times more likely.


Academic performance of OW/OB (Puhl et al 2011) teachers..

rate heavier children academic performance to be warse than their test results showed (zovodry, 2013)
Avoid school (Puhl et al, 2011)


What problems do those that are OB face in the workplace?

Women are more affected than men (Giel et al, 2010)
Less likely to be offered jobs
Less likely to have managerial + professional roles
Less well paid
Less likely to be promoted


Briefly describe Nickson et al 2016 study

Assigning OB and healthweight faces to customer and non customer facing jobs all candidates hold same skills and experience. In non customer facing jobs they were both OB and healthy weight was no difference however in customer facing role the healthy weight face was favoured. Greater effects for female candidates than male.


Public perception that if judged this can motivate..

people to lose weight (Callahan, 2013) according to Puhl & Sun (2015) its not true!


What pro health behaviours can be affected due to weight stigma?

- Food intake
- Physical activity
- Engagement in weight loss attempts


Scheley et al, 2011 found that

after watching stigmatising video versus neutral video and were then provided with snacks intake was three times greater for OW women in stigma condition compared to those in neutral.


Gudzine et al 2014 found that

If OB felt they were being negatively stigmatized by GP less likely to engage in weight loss efforts.


What factors can obesity be attributed to?

Complex interaction of a multitude of factors from:
- Food production
- Social Influences
-Food Consumption
- Individual Psychology
- Activity environment


Weight stigma occurs because weight is attributed to the indivudal, OW are perceived as

lazy/ undisciplined. The belief is persistent eventhough the majority of the UK is obese (Puhl & Brownell, 2009)


Dejong, 1993 manipulated the cause of a women who was shown as OW in a video. The conditions were...

Fat due (internal) to bad diet OR fat due to glandular disorder (external). In internal condition rated as more lazy than the other condition.


Reduce Weight stigma by...

Educate health care professionals and educators about the causes of obesity.


Kushner et al 2014 conducted a study designed to reduce weight stigma...

After training negative stereotypes that medics had greatly reduced. But the effect diminished after a one year follow up.


What is the halo effect? (Crossman et al, 2018)

Positive attitude of stimulus which causes you to think positively of what's associated with it.


(Crossman et al, 2018) what did his study test?

If the halo effect was present when OB/OW were walking with a dog. p's viewed a pic of someone who was OW with or without a dog there was no difference between the conditions.


Robinson et al (2014) What was the main experimental manipulation?

Compare the effect on food selection of a message containing health related information about fruit and vegetable consumption with a message containing social normative information about consumption of fruit and vegetables


Robinson et al, 2014 - What were the findings?

There was no effect of exposure to the injustice norm message. Significant differences between the social norm and health message conditions were observed in low but not high usual consumers of fruit and veg.


What is social facilitation of eating

When people eat in groups they tend to eat more than they do when alone.


What were the main finding? - Stock et al (2014)

Intended fruit intake: Participants had lower intentions to eat fruit in the injunctive condition compared to control and descriptive norm condition. Intentions to eat fruit did not differ between the descriptive and control conditions.
2-day fruit intake: Participants reported greater 2-day fruit intake in the descriptive compared to injunctive and control conditions. Reported 2-day fruit intake did not significantly differ between the injunctive and control conditions.
Problem - Self report data


Outline Castro 1989

Food diary - as number of people in company increased food intake increased. (Correlational data)


State some explanations for increased food intake

Alcohol intake
Eating with family and friends who share the same habits


Outline Clenenden et al 1994

p's Assigned to eating solo, with stranger and with four friends. Greater intake in pairs or fours but no difference between pairs or fours. This means that it contradicts Castro predictions that people eat more in the presence of more people. However does increase more with friend over stranger.


Explain the Time Extension Theory briefly...

Meals take longer in groups, more cues to encourage food intake


Why is arousal not deemed as a plausible explanation for increased food intake?

Arousal could also supress one's appetite


What are some of the sub factors of distraction when social facilitation of eating occurs?

Not monitoring intake ( Belisle, 2001)
Reduced awareness of fullness.


Define modelling

The amount social others eat impacts the amount eaten.


Briefly explain Nisbett & Storms, 1974
Longer et al 1980

When a confederate eats large amounts so does the p's
When confederate eats less so do p's .


Briefly describe Chaiken (1990)

P's either put with attractive or unattractive confederate and were given option to eat. Both male and female are less food with the opposite sex compared to when they were with the same sex.


What is the term used to explain the results of Chaiken (1990)

Self-presentation (Impression formation) behave in a particular way to uphold self-identity,


What is a perceived social norm?

What we think other people do or approve of.


What is a Descriptive norm?

A descriptive norm is perceptions about what other people tend to do.


Injunctive norm is...

Perceptions of what other people approve of


Describe the study of descriptive norms by Robinson, Felming and Higgs (2014)

Descriptive norm vs health message
Descriptive norm increased veg intake over health message. However intake of high vegetable consumers was not effected.


Name the study by Thomas et al (2017)

Social norms in a real world setting measured veg intake before and after presence of descriptive norm sign. Intake increased after.


What are issues with Thomas et al (2017)

Sales data - not intake
Wastage not recorded
Whose intake increased - may people already ate a lot of veg.


define dynamic norm

Info about how other people's behaviour is changing over time


Describe Sparkman and Walton (2017) study

Online survey
Control vs Dynamic
Less meat norm
Greater intent to stop eating meat in the dynamic than the norm- remained significant when controlling for gender.
However :-( Self report and unlikely they will act on intention.


Explanations of social norms

Inform about appropriate portion size
Apply to public health interventions


Limitation of social norms

Durability- short-term effect?
Mainly lab studies
Uncertain situations - norms guide behaviour here
Demand characteristics- behave in a way researcher wants
Young female sample - Vartanian et al (2015) - females more easily influenced
Used in national programs - not sure need more research


Social influences and individual differences

1) High need for social acceptance --> Low self -esteem and high empathy associated with greater modelling (Robinson et al, 2011)
2) Body weight --> greater modelling if the social other is the same weight
3) In group vs Outgroup
Undesireable outgroup norm = unhealthy eating = healthy eating (Cruwys et al, 2015)


Relton et al 2014

Obesity more common in the least deprived areas. Healthy eating controlling portion size and increasing exercise were the most commonly reported weight management strategies. Less common were attending slimming clubs, meal replacement and weight loss medication. Adjusting for BMI, age, deprivation and long standing health conditions women were significantly more likely to report ever using over the counter weight loss medication in least deprived areas. Less likely to report attending slimming clubs and more likely to use weight loss medications.
:-( Self report
:-( Only applicable to South Yorkshire


Is more money spent on obesity treatment or fire and judicial system?



State the stats of OW/OB in deprived area and high ses area for reception and year 6

Reception: Year 6:
Low SES - 13% Low SES - 26%
High SES - 5% High SES - 12%


NHS digital 2017 stats show that

UK adults and children from lower socioeconomic status groups are two times more likely to become obese than those from high ses groups.


SES and diet quality confirms that

Low SES is associated with: - lower fruit and veg intake (Denon & Drewnoski, 2008)
- Greater intake of high fat foods In low SES
- Greater screen time watching in low SES


Compared to high SES groups, Low SES groups:

Report lower weight loss attempts
Engage in less body weight monitoring
Engage in fewer restrictive dietry habits
Greater body weight misperceptions (Wardle & Griffith, 2001)


Outline Relton et al (2014)

High SES more likely to use slimming club- better weight loss outcomes than losing weight yourself.
Low SES more likely to use medications


Why area there SES differences in diet?

Per calorie nutrient rich foods are more expensive compared to less nutrient rich food (Buckland et al, 2013) In date high ses don't mention cost but low ses do.


SES impacted _____________ inspite of educational levels

nutritional knowledge (Parameter et al, 2000)


What are concerns in terms of proximal environment for those from low ses?

More fast food outlets in deprived areas (Maguire et al, 2015)
Exposed to them more frequently tempting to opt for over healthy food.
Easy and accessible
A lot of takeaway around use that could be social norms.


Under the circumstances that individuals are subjected to little food (food scarcity) which is often the case in low SES, how do they behave when offered food?

Eat more even when not hungry.


Define life-history theory

adapt to deprived environment.


Hill et al 2016

Ps arrived after 4/5 hour fast then allocated to sprite or water to make them fuller (sprite meant to be more filling) after 10 min gap they were given the opportunity to eat as many cookies as they want then asked about SES as a child up to the age of 12. High SES sprite condition consumed fewer cookies than water condition therefore responsive to appetite signals. Whereas low SES there was no difference in cookie intake between the sprite and water conditions.


The SES and stress experiment

Manipulate SES by designating some ps with more money and resources. Monitor stress via heart rate and self report and measured lunch intake. High SES felt more pride and power and consumed less lunch than that of low SES. More stress for low SES may explain greater food intake.


Social Comparison Theory
Downward Comparison
Upward Comparison

SCT - compare and evaluate ourselves to others
DC - comparing ourselves to those less fortunate or successful
UC - Comparing ourselves to those higher than us


State the advantages of upward comparison

Can be inspiring
Can lead to increased drive to seek resources.


Festinger , 1954 and Will, 1981 found...

Perceived relative deprivation - perceptions of SES relative to social other (upward social comparison) discomfort feeling if you are low SES and compare yourself with high SES --> can lead to increased food intake.


Percieved relative deprivation and portion sizes (Sim, Lim et al, 2017)

ps see your bonus $850 everyone else $1500 and control condition everyone receives same bonus.
Then select portion size for next meal. Those in the deprived condition even when controlling for negative mood selected greater portions.


Cheon et al 2017 found

Showed ps a ladder and asked them to show where they were financially and compare where they were to others in society. Other condition compared themselves to those receiving more. In low group consumed more energy when provided with food water compared to those in high or control. PDR can therefor impact food intake.



Self -regulation requires energy.
Exert self-control over food intake need to have cognitive resources. if cognitive resources are low cant self regulate.
Difficult decisions = energy (stressful day may opt for more energy foods)


What is the effect for Low SES having to make difficult decisions consistently?

Use up more cognitive resources, more financial decisions- less able to self-control food intake


How does the environment play a role for them with low SES?

Prompts may support self-control.


Outline Crocket et al 2014

Popcorn low SES and high SES and weight concern low vs high
High fat
low fat
no label
High ses no difference in the conditions if concerned about weight or not.
Low SES those concerned about weight ate more of the no label than high or low fat --> perhaps because not many resources to self-regulate so eat more when no label.


Issues with experiments on high and low SES

p recruitment is hard - low SES usually don't want to.


Ahern et al, 2014

Invitations for trial sent by GPs in UK to low and high SES.
OB patients given opportunity take part in weight watchers for free --> high ses more likely to enrol
Low SES more likely to drop out of interventions (Chinn et al, 2006)


Future for SES research

Early days
Need innovative ways to recruit and retain ps from low SES backgrounds
SES is a hot research topic.