1. Psychosocial Aspects of Obesity Christy Greenleaf, Ph.D. University of North Texas

2. 1998 Obesity Trends* Among U.S. Adults BRFSS, 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

3. In the past…

4. Today…

5. Cultural Importance of the Body Lean, thin body ◦ self-discipline, achievement of cultural ideal Fat, chubby body ◦ ultimate failure publicly displayed for all to see and judge

6. 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

7. Diet Industry Food Environment Plentiful Accessible Affordable Physical Activity Engineered out of the environment Highly profitable “weight loss” industry

8. Toxic Environment

9. Diet Industry

10. Individual responsibility and control If you work hard enough… If you have enough willpower… If you are motivated enough…

11. Mass Media Biggest Loser (NBC) Bulging Brides (We) Fat March(ABC)

12. Mass Media Larger individuals rarely shown, often stereotyped (Fouts & Burggraf, 2000; Fouts & Vaughan, 2002; Greenberg et al., 2003) Unattractive, unappealing Target of jokes Shown (over)eating FriendsShallow Hal

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

14. Weight Bias Negative attitudes affecting interactions Stereotypes leading to: ◦ Stigma ◦ Rejection ◦ Prejudice ◦ Discrimination Verbal, physical and relational forms Subtle and overt expressions Source: obesityonline.org

15. Social Realities of Weight Bias Overweight 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

16. Body as Controllable and Malleable Weight loss strengthens weight control beliefs among participants (Blaine, DiBlasi, & Connor, 2002)

17. Attributions Internal and Controllable Lack willpower Lack motivation Lazy Don’t care “Ideology of blame” (Crandall, 1994) Deserve psychological, social, and physical consequences

18. Perceived Social Consensus Perceptions of other people’s stereotypical beliefs (Puhl, Schwartz, & Brownell, 2005)

19. Experiences of Weight Bias and Discrimination Negative assumptions from others Comments from children Physical barriers and obstacles Comments from doctors and family members (Puhl & Brownell, 2006)

20. Prevalence of Weight Discrimination Reported experiences of weight discrimination among adults = 12% (Andreyeva, Puhl, & Brownell, 2008) 4 th most prevalent form of discrimination Rates similar to race (11%) & age (14%) discrimination

21. Where do people experience weight bias? Home Work School Health and Fitness settings

22. 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)

23. Work settings Job interviews/hiring practices Wages, 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)

24. School settings College admissions Peer teasing Teacher bias (Puhl & Brownell, 2001; Puhl & Heuer, 2009; Schwartz & Puhl, 2003)

25. Health and Fitness settings Health care providers (#2 source of stigma) Obesity specialists Physicians Nurses Dieticians Medical students Fitness professionals Physical education teachers (Puhl & Brownell, 2001; Puhl & Heuer, 2009)

26. 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)

27. Health and Fitness settings Dieticians’ perceptions of overweight clients Lack commitment Lack motivation Poor compliance Unrealistic expectations (Campbell & Crawford, 2000)

28. Health and Fitness settings Fitness (Pre)Professionals Obese = lazy, unattractive, eat junk food, lack willpower (Chambliss, Finley, & Blair, 2004)

29. Health and Fitness settings Fitness 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)

30. Health and Fitness settings Physical Educators Negative attitudes toward overweight students Lower expectations for overweight students (Greenleaf & Weiller, 2005; O’Brien, Hunter, & Banks, 2007)

31. Why Care about Weight Bias? Fosters blame and intolerance Impacts multiple domains of living Hurts quality of life for adults and children Has serious medical and emotional effects Source: obesityonline.org

32. 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)

33. Practical Implications Increased health and fitness professionals’ awareness Implicit Associations Test (IAT) https://implicit.harvard.edu/

36. Practical Implications Empathy suit Professional training/development activity to increase sensitivity

37. 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”

38. Practical Implications Revised 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)

39. Practical Implications Consider physical space of health and fitness environments

40. 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

41. 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)

42. Practical Implications Desirable 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

43. Practical Implications - Resources  Active at Any Size  Rudd Center for Food Policy and Obesity

44. Active at Any Size Information How to get started PA for large individuals Resources DVD/videos Organizations Websites

45. 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)

46. 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)

47. Thank You! Questions or Comments?