Weight Stigma And Eating Behaviour

Question 1

What is weight stigma?

Answer 1

The negative attitudes held towards people who are overweight or obese and any subsequent prejudice and discrimination

Question 2

Obesity in the UK in 2015

Answer 2

2/3 UK adults OW or OB
1 in 5 children in reception are OW or OB
1 in 3 children in year 6 are OW or OB

Question 3

Puhl & Heuer (2009)

Answer 3

Strong negative attitudes towards people who are OW/OB
They are lazy, unintelligent, lack willpower and motivation
Prevalent in relationships, education, workplace, health services and media

Question 4

Puhl, Andreyeva & Brownell (2008)

Answer 4

Weight stigma is second most common form of discrimination reported in women

Question 5

Harrison et al (2016) weight stigma in children friends

Answer 5

Children in year 1
Read one of three books about Alfie and Thomas - Alfie is either OW/disabled or normal weight
Asked who they would rather be friends with
And give them attributes such as who has the most friends

Question 6

Harrison et al (2016) weight stigma in children friends -results

Answer 6

When Alfie was normal weight, ratings between Alfie and Thomas did not differ and were equally chosen to be friends with
When Alfie was OW, he was rated as being less likely to win a race and as having fewer friends than Thomas and 42/43 chose to be friends with Thomas over Alfie

Question 7

Cramer & Steinweight (1998) when do children start to discriminate?

Answer 7

Children of 3, 4 and 5 read a story
Jenny and Susan were building a sandcastle, Jenny said she likes Susan’s castle, Susan replies that she thinks Jenny’s castle is ugly
Asked which character was the mean one out of thin/OW/average, and asked to pair positive and negative attributes to the characters

Question 8

Cramer & Steinweight (1998) when do children start to discriminate? - Results

Answer 8

OW character selected more than average and thin character as the mean person
As age increased from 3 - 4, there were more negative attributes and fewer positive attributes paired with the OW character
3 is the youngest that this weight stigma has been detected

Question 9

Impact of weight stigma on children - teasing and bullying (Puhl, Peterson & Luedicke, 2013)

Answer 9

71% boys enrolled in weight loss programme reported being bullied

Question 10

Impact of weight stigma on children - psychological health

Answer 10

Weight related teasing predicted lower self-esteem, lower body image and higher depressive symptoms, independent of BMI (Eisenberg et al, 2006)

Those weight-teased were 2 x more likely to think about a suicide attempt compared to those who were not (Eaton et al, 2005)

Question 11

Impact of weight stigma on children - academic performance

Answer 11

Avoid school more (Puhl et al 2011)

Teachers rated heavier children’s academic performance to be worse than their results showed (Zavodny, 2013)

Question 12

Giel et al (2010) - People who are OW or OB are…

Answer 12

Less likely to be offered jobs
Less likely to have managerial or professional roles
Less well paid (when controlling for education)
Are less likely to be promoted
Women are more affected than men

Question 13

Nickson et al (2016) - workplace bias

Answer 13

Asked to assume they are a recruiter and need to hire someone for a customer or non-customer facing role
Told that all candidates hold the same skills and experience
Morphed faces to have non-OW or OW faces

Question 14

Nickson et al (2016) - workplace bias - results

Answer 14

Non-customer facing roles, no differences in the hire ability of OW/non-OW

Customer-facing roles - ppts more likely to choose the non-OW person
Effect greater for females

Small changes in BMI affect hireability in customer facing roles

Question 15

Phelan et al (2015) - health care environment

Answer 15

Blood pressure cuffs might be too small
Weighing scales and waiting room chairs may be too small
Can lead to unintended humiliation of ppts

Question 16

Davis-Coelho et al (2000) - bias in psychologists

Answer 16

Psychologists rated OW patients as less likely to be compliant, expected to have more severe psychological problems and predicted a worse prognosis

Question 17

Sabin, Marini & Nosek (2012) - health care bias

Answer 17

Strong implicit and explicit anti-fat bias in health care professionals even in HCPs who themselves are obese

Question 18

Schwartz et al (2003) - explicit or implicit attitudes in health care

Answer 18

389 professionals who worked in obesity research or worked with OB people
Explicit attitudes and beliefs measured
Implicit association task used to measure implicit attitudes

Question 19

Schwartz et al (2003) - explicit or implicit attitudes in health care - results

Answer 19

Explicit attitudes - OB rated as more lazy, stupid and worthless

Implicit attitudes - Significant implicit anti-fat bias
More likely to pair OW with negative attributes

Question 20

Impact of weight stigma on health

Answer 20

Increased cortisol and BP (Puhl & Suh, 2015)

Avoid and delay using health care services (Mitchell et al, 2008)
Was due to negative weight-related experiences (Amy et al (2006)

Less likely to recall advice and follow instructions (Gudzune et al, 2013)

OW/OB patients are less likely to see weight loss support if they perceive judgement (Gudzune et al (2014)

Question 21

People tend to believe that if they fat shame people….

Answer 21

It will motivate them to lose weight

Question 22

Weight stigma can negatively impact

Answer 22

Food intake
Physical activity
Engagement in weight loss attempts

Question 23

Schvey et al (2011) - stigmatising video

Answer 23

OW/ non-OW participants
Watched stigmatising or neutral video
Then provided with snacks and food intake was measured

Question 24

Schvey et al (2011) - stigmatising video - results

Answer 24

Intake was 3x greater in the OW women in stigma condition compared to neutral

Question 25

Gudzine et al (2014) - weight stigma on weight loss attempts

Answer 25

Online survey with 600 participants Rated extent to which they believed their GP negatively judged their weight Asked them how many times they have engaged in a weight loss attempt in the past year

Question 26

Gudzine et al (2014) - weight stigma on weight loss attempts - results

Answer 26

Less weight loss attempts in ppts who perceived GP to negatively judge them No differences in the actual weight loss observed

Question 27

Causes of obesity

Answer 27

``` Social influences Individual psychology Food production Food consumption Biology Individual activity Activity environment ``` Complex interaction of a multitude of factors

Question 28

Puhl & Brownwell, 2009 - attribution of blame to individual

Answer 28

Weight stigma occurs because blame is attributed to the individual People who are OW or OB are perceived to be lazy and undisciplined Belief persists despite the fact that the majority of the UK are OW or OB

Question 29

DeJong (1993) - shifting of attributions

Answer 29

Watched video of woman who was overweight or normal weight Half told she was overweight due to glandular disorder, others told nothing Rated the woman on attributes

Question 30

DeJong (1993) - shifting of attributions - results

Answer 30

Internal attribution - OW woman rated as more self-indulgent and less disciplined External attribution - ratings did not differ between OW and normal weight woman

Question 31

Pont, Puhl, Cook & Slusser (2017) - education and training

Answer 31

Educate health care professionals about causes of obesity Make people aware of biases (IAT) Used patient-centred, empathetic behaviour change approaches Create safe and non-stigmatising environments in education and health care settings

Question 32

Kushner et al (2014) - medical students

Answer 32

First year medical students Explicit attitudes assessed before training Training involved role playing with overweight patients and feedback Practiced 4-6 times Assessed explicit attitudes again

Question 33

Kushner et al (2014) - medical students -results

Answer 33

Negative stereotypes significantly reduced from baseline to post-training At 1 year follow up these had diminished Regular training required

Question 34

Crossman et al (2018) - dog study

Answer 34

Ppts viewed photo of overweight person with a dog, plant or nothing Rated attitudes towards people who were overweight

Question 35

Why use a dog in the study?

Answer 35

Dogs seen as positive so may lead to halo effect | Counter perceptions that OW people are lazy as they need to take the dog for a walk

Question 36

Crossman et al (2018) - dog study results

Answer 36

No effect of dog on attitudes

Question 37

Kyle & Puhl, 2014 - people first language

Answer 37

Avoids discrimination to people who are OW and OB People with obesity rather than obese people Avoids labelling people by their disease which can reinforce stigma Google Scholar search - majority of studies use disease first language not people first (opposite to other health conditions)

Question 38

Social facilitation of eating

Answer 38

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

Question 39

de Castro & de Castro (1989) - social facilitation

Answer 39

Asked participants to record a food diary of what types of food, how much and who they're with As the number of people increased, food intake increased Meals eaten with others were 44% greater than when eating alone

Question 40

Social correlation

Answer 40

As the number of people increased, food intake increased

Question 41

Limitations with de Castro and de Castro (1989)

Answer 41

Self-report, may not be true Alcohol intake could be causing the extra eating Tend to eat with friends and family

Question 42

Clendenen, Herman & Polivy (1994) - social facilitation experimental evidence

Answer 42

Students allocated to either solo eating, eating in pairs or eating in groups of 4 Also had some groups with people they knew and some with people they didn't know Provided with savoury and sweet snacks

Question 43

Clendenen, Herman & Polivy (1994) - social facilitation experimental evidence results

Answer 43

When eating in pairs or a group compared to solo eating, significantly greater food intake No difference between pairs or 4s Doesn't support social correlation Intake does increase in the friend group from pairs to 4s Effect was greater with friends than with strangers

Question 44

Time extension theory - de Castro (1995)

Answer 44

Meals take longer in groups More food cue exposure Greater intake

Question 45

Arousal theory - Zajonc (1965)

Answer 45

Groups leads to physiological arousal Activate hunger? Unlikely as arousal can also suppress appetite

Question 46

Distraction theory - Bellisle (2001)

Answer 46

Not monitoring intake due to being distracted | Reduced awareness of being full

Question 47

Modelling social others

Answer 47

The amount that social others are eating impacts the amount of food that we eat

Question 48

Nisbett & Storms (1974)

Answer 48

When confederate eats large amounts, participants eat more

Question 49

Conger et al (1980)

Answer 49

When a confederate eats small amounts, participants eat less

Question 50

Attractive confederate affect intake - Pliner & Chaiken (1990)

Answer 50

Participants ate crackers with a male or female confederate Women increased their intake when with unattractive male compared to attractive Male there is no significant difference Males and females ate less food when with opposite sex

Question 51

Self-presentation/impression formation

Answer 51

Want to behave in a way that goes with our identity (small amounts of food to look feminine)

Question 52

Descriptive social norms

Answer 52

Perceptions about what other people tend to do

Question 53

Injunctive social norm

Answer 53

Perception of what others approve of

Question 54

Perceived social norms

Answer 54

Refer to what we believe most other people do or approve of

Question 55

Robinson, Fleming & Higgs (2014) - descriptive norms and vegetable intake

Answer 55

77 UG students Allocated to descriptive norm or health message Looked at vegetable intake at lunch

Question 56

Robinson, Fleming & Higgs (2014) - descriptive norms and vegetable intake resulting

Answer 56

Descriptive norms increased vegetable intake for low vegetable consumers Did not affect already high vegetable consumers

Question 57

Thomas et al (2017) - restaurant study

Answer 57

Placed descriptive norm in 3 restaurants for 2 weeks 'Most people here choose to eat vegetables with their lunch' Outcomes = meals with vs without vegetables, pre-, during and post- intervention

Question 58

Thomas et al (2017) - restaurant study - results

Answer 58

Significant increase in purchase of vegetables pre- and post- intervention

Question 59

Thomas et al (2017) - restaurant study limitations

Answer 59

Not intake based but sales based Wastage was not recorded Don't know what their vegetable intake was before

Question 60

Stok et al (2014) - injunctive norms and eating behaviour

Answer 60

Highschoolers were allocated to descriptive, injunctive or control message Self-report of fruit intake over 2 days

Question 61

Stok et al (2014) - injunctive norms and eating behaviour results

Answer 61

Injunctive norm had no effect on fruit intake compared to control

Question 62

Dynamic social norms

Answer 62

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

Question 63

Sparkman & Walton (2017) - dynamic social norms

Answer 63

Online survey Static norm Dynamic norm 'in recent years...' Asked how interested they are in decreasing their most intake

Question 64

Sparkman & Walton (2017) - dynamic social norms - results

Answer 64

Greater interest to reduce meat intake in the dynamic vs static condition Remained significant when controlling for gender Does interest translate into behaviour?

Question 65

Explanation of why social norms work

Answer 65

Inform people about appropriate portion size (Robinson et al, 2015)

Question 66

Limitations of social norms

Answer 66

Durability | Largely lab based - sets up uncertain situation, demand characteristics

Question 67

Vartanian et al (2015) - limitation of social norms

Answer 67

Samples mostly young females | Males may be less influenced

Question 68

High need for social acceptance (Robinson et al, 2011)

Answer 68

Low self-esteem and high empathy associated with modelling

Question 69

Body weight on social norm

Answer 69

Greater modelling if the social other is the same weight as the participant

Question 70

In vs out group

Answer 70

Undesirable outgroup norm = eating in unhealthy way = greater healthy eating in in group (Cruwys et al, 2015)

Question 71

Obesity and SES

Answer 71

UK adults and children from lower-SES are 2x more likely to become obese than those from higher-SES groups

Question 72

Darmon & Drewnowski (2008) - vegetables

Answer 72

Low-SES is associated with lower fruit and vegetable intake

Question 73

Greater intake of high fat foods in ____ SES

Answer 73

Low

Question 74

Greater screen time watching in ___ SES

Answer 74

Low

Question 75

Wardle & Griffith (2001) - SES and weight loss attempts

Answer 75

Compared to high SES groups, low SES groups... Reported lower weight loss attempts Engage in less body monitoring Engage in few restrictive dietary habits Have greater body weight misperceptions - less likely to describe themselves as overweight

Question 76

Relton et al (2014) - weight control strategies and SES

Answer 76

Survey in South Yorkshire Higher SES group more likely to use a slimming club Lower SES more likely to use medication

Question 77

Buckland et al (2015)

Answer 77

Per calorie, nutrient-rich foods are more expensive compared to less nutrient-rich foods Qualitative data - high-SES didn't mention cost at all

Question 78

Parementer et al (2000) - nutrition knowledge

Answer 78

UK women | SES impacted nutritional knowledge independent of education level

Question 79

Maguire et al (2015) - proximal environment

Answer 79

More fast food outlets in deprived areas | Exposure mean people are more likely to eat them as it is what is in their environment

Question 80

Food scarcity theory and energy regulation

Answer 80

Life-history theory (adapt to deprived environments) Low-SES eat food when it is available Do they eat more in the absence of hunger?

Question 81

Hill et al (2016) - food scarcity and energy regulation

Answer 81

``` Arrived at the lab fasted Allocated to sprite or water 10 minute gap Given opportunity to eat as many cookies as they want Then assessed on their childhood SES ```

Question 82

Hill et al (2016) - food scarcity and energy regulation results

Answer 82

High-SES = In sprite condition they consumed significantly less calories than in water condition Low-SES = No difference in cookie intake regardless of whether they had had the sprite or water Replicated results across 3 separate findings

Question 83

Cardel et al (2016) - SES and stress

Answer 83

40 minute game of Monopoly High social status = banker, start with $2000, $200 when passing go, roll twice per go Low social status = start with $1000, $100 when passing go, roll once per go Measured self-reported stress, heart rate via monitor Outcome = lunch intake

Question 84

Cardel et al (2016) - SES and stress - results

Answer 84

In high SES condition - ppts felt more pride and powerfulness Had lower heart rate Consumed 130kcal less than low SES condition (approached but not actually significant) Suggests low-SES experience more stress and consume more food, could be reason low-SES eat more food

Question 85

Social comparison theory

Answer 85

Compare and evaluate ourselves to others Downward comparisons - boost self esteem, compare to those less fortunate Upward comparisons - can be inspiring, can lead to increased drive to seek resources

Question 86

Perceived relative deprivation

Answer 86

Perceptions of SES relative to social others (upward social comparisons)

Question 87

Sim et al (2017) - PRD and portion sizes

Answer 87

Manipulated perceived wealth Your bonus will be $850, colleagues bonus = $1500 Control = everyone gets $850 Measured desire for portion size at next meal

Question 88

Sim et al (2017) - PRD and portion sizes - results

Answer 88

Greater selected portions in relatively deprived participants compared to control, even when controlling for negative mood

Question 89

Cheon et al (2017) - PRD and food intake

Answer 89

Asked to compare themselves to either people lower than them or higher Measured kcal consumed after this task

Question 90

Cheon et al (2017) - PRD and food intake - results

Answer 90

Those in deprived situation consumed more kcal than those in the high situation and the control

Question 91

Ego depletion theory

Answer 91

Self-regulation requires energy Difficult decisions = energy Less likely to make self-controlled decisions when resources have been depleted (bad day) Low-SES have more difficult decisions throughout the day which means their resources are more depleted and therefore they have less self control Prompts in the environment therefore take over their decisions

Question 92

Crockett et al (2014) - SES and food labels

Answer 92

Least deprived vs most deprived ppts Weight concern - high vs low Labels low fat vs high fat vs no label How is popcorn consumption affected?

Question 93

Crockett et al (2014) - SES and food labels results

Answer 93

Higher-SES = calorie intake does not differ in any condition Low-SES = those concerned about their weight, when there is no label they consume more food compared to when there is a high or low fat label

Question 94

Issues researchers have with SES research

Answer 94

Participants are hard to recruit

Question 95

Ahern et al (2014) - recruitment issues

Answer 95

Invitations sent by GPs in UK to patients with BMI > 28 Asked to take part in a weight loss programme (Weight Watchers) SES assessed using postcodes Patients in least deprived areas are more likely to enrol (8.5% vs 4.9%)

Question 96

Chinn et al (2006) - drop outs

Answer 96

Low-SES are more likely to drop out of interventions

Question 97

Future of SES research

Answer 97

Very early days | Need to use innovative approaches to recruit and retain ppts from low SES backgrounds