Janet D. Latner

Stigma, obesity, and the health of the nation's children.

Preventing childhood obesity has become a top priority in efforts to improve our nations public health. Although much research is needed to address this health crisis, it is important to approach childhood obesity with an understanding of the social stigma that obese youths face, which is pervasive and can have serious consequences for emotional and physical health. This report reviews existing research on weight stigma in children and adolescents, with attention to the nature and extent of weight bias toward obese youths and to the primary sources of stigma in their lives, including peers, educators, and parents. The authors also examine the literature on psychosocial and physical health consequences of childhood obesity to illustrate the role that weight stigma may play in mediating negative health outcomes. The authors then review stigma-reduction efforts that have been tested to improve attitudes toward obese children, and they highlight complex questions about the role of weight bias in childhood obesity prevention. With these literatures assembled, areas of research are outlined to guide efforts on weight stigma in youths, with an emphasis on the importance of studying the effect of weight stigma on physical health outcomes and identifying effective interventions to improve attitudes.

The Effects of a High-carbohydrate, High-protein or Balanced Lunch upon Later Food Intake and Hunger Ratings

This study compared the satiating properties of three liquid lunches (450 kcal each), one dominant in protein (71.5% of energy), a second in carbohydrates (99% of energy) and a third containing an equal mixture of the first two formulations, in a within-subjects, repeated measures design. At an ad libitum dinner meal, 12 women consumed 31% more kilocalories in the high-carbohydrate lunch condition than in the high-protein lunch condition and 20% more kilocalories than in the mixture lunch condition. Similar results emerged for the amounts of protein and fat ingested at dinner. Subjects also reported significantly greater pre-dinner hunger and excitement about eating in the carbohydrate lunch condition than in the protein lunch condition. Greater enjoyment of dinner was also found after the carbohydrate lunch than after the mixture and protein lunches.

Understanding Self-directed Stigma: Development of the Weight Bias Internalization Scale

Objective: The present study developed the Weight Bias Internalization Scale (WBIS), an 11‐item measure assessing internalized weight bias among the overweight and obese.

Reducing anti-fat prejudice in preservice health students: a randomized trial.

Anti‐fat sentiment is increasing, is prevalent in health professionals, and has health and social consequences. There is no evidence for effective obesity prejudice reduction techniques in health professionals. The present experiment sought to reduce implicit and explicit anti‐fat prejudice in preservice health students. Health promotion/public health bachelor degree program students (n = 159) were randomized to one of three tutorial conditions. One condition presented an obesity curriculum on the controllable reasons for obesity (i.e., diet/exercise). A prejudice reduction condition presented evidence on the uncontrollable reasons for obesity (i.e., genes/environment); whereas a neutral (control) curriculum focused on alcohol use in young people. Measures of implicit and explicit anti‐fat prejudice, beliefs about obese people, and dieting, were taken at baseline and postintervention. Repeated measures analyses showed decreases in two forms of implicit anti‐fat prejudice (decreases of 27 and 12%) in the genes/environment condition relative to other conditions. The diet/exercise condition showed a 27% increase in one measure of implicit anti‐fat prejudice. Reductions in explicit anti‐fat prejudice were also seen in the genes/environment condition (P = 0.006). No significant changes in beliefs about obese people or dieting control beliefs were found across conditions. The present results show that anti‐fat prejudice can be reduced or exacerbated depending on the causal information provided about obesity. The present results have implications for the training of health professionals, especially given their widespread negativity toward overweight and obesity.

Weighing obesity stigma: the relative strength of different forms of bias.

Objective:To compare the strength of weight bias to other common biases, and to develop a psychometrically sound measure to assess and compare bias against different targets.Subjects:A total of 368 university students (75.4% women, 47.6% white, mean age: 21.53 years, mean body mass index (BMI): 23.01 kg/m2).Measurements:A measure was developed to assess bias against different targets. Three versions of the universal measure of bias (UMB) were developed and validated, each focusing on either ‘fat,’ ‘gay’ or ‘Muslim’ individuals. These were administered to participants, along with two established scales of bias against each target and a measure of socially desirable response style.Results:The UMB demonstrated good internal consistency, appropriate item-total and inter-item correlations, and a clear factor structure suggesting components of Negative Judgment, Distance, Attraction and Equal Rights. Construct validity was indicated by strong correlations between established measures of bias and each corresponding version of the new scale. In contrast to previously established measures of weight bias, the new measure was independent of socially desirable response style. Although homosexual orientation was associated with lower gay bias (P<0.05), greater BMI was not associated with any decrease in weight bias. When comparing the relative strength of bias against different targets, weight bias was significantly greater than bias against both gays and Muslims (P<0.001).Conclusion:Weight bias is significantly stronger than other major targets of bias. This is the first study to develop a universal measure to assess bias against different targets. The excellent psychometric properties of this measure will permit further investigation into the relative severity of different types of prejudice over time and across samples. The present findings suggest that the pervasive discrimination against obese individuals may be more socially acceptable than discrimination against other groups.

Obesity discrimination: the role of physical appearance, personal ideology, and anti-fat prejudice

Objective:Self-report measures of anti-fat prejudice are regularly used by the field, however, there is no research showing a relationship between explicit measures of anti-fat prejudice and the behavioral manifestation of them; obesity discrimination. The present study examined whether a recently developed measure of anti-fat prejudice, the universal measure of bias (UMB), along with other correlates of prejudicial attitudes and beliefs (that is, authoritarianism, social dominance orientation; SDO, physical appearance investment) predict obesity discrimination.Method:Under the guise of a personnel selection task, participants (n=102) gave assessments of obese and non-obese females applying for a managerial position across a number of selection criteria (for example, starting salary, likelihood of selecting). Participants viewed resumes that had attached either a photo of a pre-bariatric surgery obese female (body mass index (BMI)=38–41) or a photo of the same female post-bariatric surgery (BMI=22–24). Participants also completed measures of anti-fat prejudice (UMB) authoritarianism, SDO, physical appearance evaluation and orientation.Results:Obesity discrimination was displayed across all selection criteria. Higher UMB subscale scores (distance and negative judgement), authoritarianism, physical appearance evaluation and orientation were associated with greater obesity discrimination. In regression models, UMB ‘distance’ was a predictor of obesity discrimination for perceived leadership potential, starting salary, and overall employability. UMB ‘negative judgement’ predicted discrimination for starting salary; and authoritarianism predicted likelihood of selecting an obese applicant and candidate ranking. Finally, physical appearance evaluation and appearance orientation predicted obesity discrimination for predicted career success and leadership potential, respectively.Conclusion:Self-report measures of prejudice act as surrogates for discrimination, but there has been no empirical support for the validity of explicit measures of anti-fat prejudice. Here, the UMB, authoritarianism, and physical appearance investment predicted obesity discrimination. The present results provide support for the use of these measures by researchers seeking to assess, understand, and reduce anti-fat prejudice and discrimination.

Effective long-term treatment of obesity: a continuing care model

BACKGROUND: Despite the well-documented success of behavioral techniques in producing temporary weight loss, treatment is typically followed by weight regain. The maintenance of treatment effects may therefore be the greatest challenge in the long-term management of obesity, and continuous care may be necessary to achieve it.OBJECTIVE: To describe the design and evaluate the effectiveness of the Trevose Behavior Modification Program, a potentially widely replicable self-help weight loss program offering continuous care.DESIGN: A description of the course of all subjects (n=171) who entered the Trevose program during 1992 and 1993.SUBJECTS: One hundred and forty-six women aged 44.1±11.7 y with a body mass index (BMI, kg/m2) of 33.2±4.4, and 25 men aged 49.0±19.6 with a BMI of 35.1±5.2 enrolled in the Trevose program during 1992–1993.RESULTS: Mean duration of treatment was 27.1 months, with 47.4% of members still in treatment at 2 y and 21.6% at 5 y. Mean intent-to-treat weight loss was 13.7±0.5% of initial weight, or 12.8±0.5 kg. As long as they remained in treatment, almost all participants lost at least 5% of their initial weight and at least 83% lost more than 10%. Members completing 2 y of treatment lost an average of 19.3% of their initial body weight (17.9 kg); at 5 y the loss was still 17.3% (15.7 kg). After leaving the program, subjects regained weight but remained 4.7% (4.5 kg) below their pretreatment weight.CONCLUSION: A low-cost program offering treatment of indefinite duration produced large long-term weight losses and may be suitable for widespread replication.

Internalized weight bias in obese patients with binge eating disorder: associations with eating disturbances and psychological functioning.

OBJECTIVE Widespread bias against obese individuals may lead to the internalization of weight bias in obese persons. This study examined correlates of internalized weight bias (IWB) in obese patients with binge eating disorder (BED). METHOD One hundred treatment-seeking obese patients with BED were administered with the eating disorders examination interview and questionnaires assessing IWB, fat phobia, depression, and self-esteem. RESULTS The mean IWB score in this group of patients with BED was significantly greater than the mean IWB score observed previously in a community sample of overweight adults. IWB was positively associated with eating disorder psychopathology, fat phobia, and depression, and negatively associated with self-esteem. IWB made significant independent contributions to the variance in eating disorder psychopathology even after accounting for fat phobia, depression, and self-esteem. DISCUSSION Treatment-seeking obese patients with BED demonstrate high levels of IWB. IWB may contribute to the variance in eating disorder psychopathology in BED patients, beyond the contributions of fat phobia, depression, and self-esteem.

Objective and subjective bulimic episodes in the classification of bulimic-type eating disorders: Another nail in the coffin of a problematic distinction

We sought to further explore the validity of the distinction between objective bulimic episodes (OBEs) and subjective bulimic episodes (SBEs) in the study of bulimic-type eating disorders. Drawing on data obtained at the second, interview phase of a large-scale epidemiological study, we identified mutually exclusive subgroups of women with bulimic-type eating disorders who engaged in regular OBEs but not SBEs (n = 37) or regular SBEs but not OBEs (n = 52). These subgroups were compared on a wide range of outcomes, including socio-demographic characteristics, current levels of eating disorder psychopathology, general psychological distress and impairment in role functioning, current and lifetime impairment in quality of life specifically associated with an eating problem, (self)-recognition of an eating problem, health service utilization and use of psychotropic medication. The only difference between groups was that participants who reported regular OBEs were heavier than those who reported regular SBEs. The findings converge with those of previous research in suggesting that bulimic-type eating disorders characterized by regular SBEs, but not OBEs, do not differ in any clinically meaningful way from those characterized by regular OBEs, but not SBEs. Inclusion of bulimic-type eating disorders characterized by regular SBEs as a provisional category requiring further research in DSM-V appears warranted.

Do Antifat Attitudes Predict Antifat Behaviors

Objective: The aim of this study was to investigate discrimination against obese job candidates, and to examine whether widely used measures of implicit and explicit antifat attitudes are related to or predict antifat discrimination.