Psychosocial Psychosocial Aspects of ObesityAspects of Obesity

Christy Greenleaf, Ph.D.

University of North Texas

1998

Obesity Trends* Among U.S. AdultsBRFSS, 1990, 1998, 2007

(*BMI 30, or about 30 lbs. overweight for 5’4” person)

2007

1990

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Source: CDC Behavioral Risk Factor Surveillance System

In the past…

Today…

Cultural Importance of the BodyLean, thin body

◦ self-discipline, achievement of cultural ideal

Fat, chubby body ◦ ultimate failure publicly

displayed for all to see and judge

Cultural Importance of the Body

Heightened social consciousness and awareness of “the body”

• booming diet industry, estimated to bring in over $40-50 billion dollars each year

• mass media which idealizes an ultra-lean physique

• social value placed on having a lean body

Diet Industry

Food Environment PlentifulAccessibl

eAffordabl

ePhysical Activity Engineered out of the environment

Highly profitable “weight loss” industry

Toxic Environment

Diet Industry

Diet IndustryIndividual

responsibility and control

If you work hard enough… If you have enough

willpower… If you are motivated

enough…

Mass Media

Biggest Loser (NBC)

Bulging Brides (We)

Fat March(ABC)

Mass MediaLarger individuals rarely shown,

often stereotyped (Fouts & Burggraf, 2000; Fouts & Vaughan, 2002; Greenberg et al., 2003)

• Unattractive, unappealing• Target of jokes• Shown (over)eating

Friends Shallow Hal

Social Value

Inherent value of thinness?◦Social capital (thin = good; fat = bad)

Weight BiasNegative attitudes affecting

interactions Stereotypes leading to:

◦Stigma◦Rejection◦Prejudice◦Discrimination

Verbal, physical and relational forms

Subtle and overt expressions

Source: obesityonline.org

Social Realities of Weight BiasOverweight people are one of the

last socially acceptable targets for bias and discrimination (Puhl & Brownell, 2001)

WHY? • Body as controllable, malleable• Attributions • Perceived social consensus

Body as Controllable and Malleable

Weight loss strengthens weight control beliefs among participants (Blaine, DiBlasi, & Connor, 2002)

AttributionsInternal and Controllable• Lack willpower• Lack motivation• Lazy• Don’t care

“Ideology of blame” (Crandall, 1994) • Deserve psychological, social, and physical

consequences

Perceived Social ConsensusPerceptions of other people’s

stereotypical beliefs (Puhl, Schwartz, & Brownell, 2005)

Experiences of Weight Bias and DiscriminationNegative assumptions from

othersComments from childrenPhysical barriers and obstaclesComments from doctors and

family members(Puhl & Brownell, 2006)

Prevalence of Weight Discrimination

Reported experiences of weight discrimination among adults = 12% (Andreyeva, Puhl, & Brownell, 2008)

• 4th most prevalent form of discrimination

• Rates similar to race (11%) & age (14%) discrimination

Where do people experience weight bias?

HomeWorkSchoolHealth and Fitness settings

Home settings

Family members = #1 source of stigma (72%)

• Mothers (53%)• Spouse (47%)• Father (44%)• Sister (37%)• Brother (36%)• Son (20%)• Daughter (18%)(Puhl & Brownell, 2006)

Work settings Job interviews/hiring practicesWages, promotions, employment termination

Overweight/obese employees perceived as…• Less conscientious• Less agreeable• Less emotionally stable• Less extroverted

Research contradicts these perceptions

(Puhl & Brownell, 2001; Puhl & Heuer, 2009)

School settings

College admissions

Peer teasingTeacher bias

(Puhl & Brownell, 2001; Puhl & Heuer, 2009; Schwartz & Puhl, 2003)

Health and Fitness settingsHealth and Fitness settings

Health care providers (#2 source of stigma)

Obesity specialistsPhysiciansNursesDieticians

Medical studentsFitness

professionalsPhysical

education teachers

(Puhl & Brownell, 2001; Puhl & Heuer, 2009)

Physicians • Overweight/Obesity = Behavioral

problem

• Do not feel confident in their treatment of overweight/obesity

• Treatment of overweight/obesity is useless

Health and Fitness settings

(Campbell et al., 2000; Hebl & Xu, 2001; Kristeller & Hoerr, 1997; Puhl & Heuer, 2009)

Health and Fitness settingsDieticians’ perceptions of

overweight clients• Lack commitment • Lack motivation• Poor compliance• Unrealistic expectations

(Campbell & Crawford, 2000)

Health and Fitness settingsFitness (Pre)Professionals

• Obese = lazy, unattractive, eat junk food, lack willpower

(Chambliss, Finley, & Blair, 2004)

Health and Fitness settingsFitness Professionals

• Perceive overweight clients as lazy and unmotivated

• Should role model healthy weight• Feel competent to prescribe exercise

for weight loss • Find helping clients lose weight

gratifying(Hare et al., 2000)

(Robertson & Vohora, 2008)

Health and Fitness settingsPhysical Educators

• Negative attitudes toward overweight students

• Lower expectations for overweight students

(Greenleaf & Weiller, 2005; O’Brien, Hunter, & Banks, 2007)

Why Care about Weight Bias?Fosters blame and

intoleranceImpacts multiple domains of

livingHurts quality of life for adults

and childrenHas serious medical and

emotional effects

Source: obesityonline.org

How do people respond to weight bias?

Poor self-esteem, depression (Puhl & Brownell, 2001; 2003)

Avoidance of medical care (Puhl & Heuer, 2009)

Overeating / Binge eating (Puhl & Brownell, 2006)

Physical inactivity (Storch et al., 2006)

Practical ImplicationsIncreased health and fitness

professionals’ awareness

Implicit Associations Test (IAT)https://implicit.harvard.edu/

0

5

10

15

20

Fat People + Lazy Fat People +Motivated

Number ofItems CorrectlyClassified

Practical ImplicationsEmpathy suit

• Professional training/development activity to increase sensitivity

Empathy Suit (focus group)

“I just never imagined that it would be that hard to walk and get up out of a chair and stuff”

“you would just (avoid doing things)… and people would call you lazy, but the thing is it’s just that hard”

Practical ImplicationsRevised educational training and

professional development models

• Kinesiology students feel no more prepared to work with overweight/obese individuals than other majors (Greenleaf et al., 2008)

Practical Implications

Consider physical space of health and fitness environments

Weight Friendly Fitness Facility Evaluation (Chambliss, Patton, Martin & Greenleaf, 2004)

Checklist to evaluate the “weight friendliness” of a facility◦Facilities and operations◦Equipment **◦Programming◦Staff

Practical Implications

Recognize importance of word choice and language

• Obese - particularly negative social meaning, implying a sense of disgust (Berg, 1998)

• Overweight - conveys the idea that there is some “correct” weight a person “should” weigh (Berg, 1998)

Practical ImplicationsDesirable and undesirable weight terminology among obese individuals… (Wadden & Didie, 2003)

• Least preferred: fatness, excess fat, obesity and large size

• More preferred: weight, heaviness, BMI, excess weight, unhealthy body weight, weight problem, and unhealthy BMI

Practical Implications - Resources Active at Any

Size Rudd Center

for Food Policy and Obesity

Active at Any Size

Information• How to get started• PA for large individuals

Resources• DVD/videos• Organizations• Websites

Rudd Center for Food Policy and Obesity

Leaders in weight bias research and advocacy

Resources for teachers, doctors, families, and policy makers

(www.yaleruddcenter.org)

KEY POINT

“…thin people do not have a monopoly on

health and fitness. Fit and healthy bodies come in all shapes and sizes” (Blair,

2002)

Thank You!Thank You!

Questions or Comments?