Weight stigmatization and bias reduction: perspectives of overweight and obese adults

HEALTH EDUCATION RESEARCH Vol.23 no.2 2008 Pages 347–358 Advance Access publication 19 September 2007 Weight stigmatization and bias reduction: perspectives of overweight and obese adults Rebecca M. Puhl*, Corinne A. Moss-Racusin, Marlene B. Schwartz and Kelly D. Brownell Abstract This study employed qualitative methods with a sample of overweight and obese adults to identify and describe their subjective experiences of weight bias. Participants (274 females and 44 males) completed an online battery of selfreport questionnaires, including several openended questions about weight stigmatization. These questions asked them to describe their worst experiences of weight stigmatization, their perceptions of common weight-based stereotypes, their feelings about being overweight and their suggestions for strategies to reduce weight stigma in our culture. Participants reported experiencing weight stigma across a range of contexts and involving a variety of interpersonal sources. Close relationship partners (such as friends, parents and spouses) were the most common source of their worst stigmatizing encounters. Participants challenged common weight-based stereotypes (notably, that obese individuals are ‘lazy’) and reported that they would like the public to gain a better understanding of the difficulties of weight loss, the causes of obesity and the emotional consequences of being stigmatized. Education was reported as the most promising avenue for future stigmareduction efforts. The experiences and opinions expressed were not significantly different for men versus women or overweight versus obese Rudd Center for Food Policy and Obesity, Yale University, 309 Edwards Street, New Haven, CT 06518, USA *Correspondence to: Rebecca M. Puhl. E-mail: individuals. A minority of participants expressed beliefs suggestive of self-blame and internalization of weight-based stereotypes. These results indicate that while obese individuals experience weight bias across many domains, more stigma-reduction efforts should target stigmatizing encounters in close relationships, including parents, spouses and friends of obese persons. Obesity is associated with significant social consequences, and overweight and obese individuals are often the targets of weight-related stigmatization [1]. A person who is stigmatized possesses an attribute that is linked to a devalued social identity [2, 3] and is ascribed stereotypes or other deviant labels that can lead to unfair treatment, prejudice and even discrimination [4]. Multiple negative characteristics have been attributed to obese individuals, ranging from views that they are lazy and lacking in willpower to perceptions that they are incompetent, unclean and undisciplined [5–9]. Weight-related stigmatization takes multiple forms, including repeated teasing, bullying, harassment and hostility [10, 11]. Emerging evidence suggests that weight stigma is intensifying [12], even as obesity rates have increased, which has important implications for the well-being of overweight and obese individuals. Weight bias has been documented across a range of life domains. When referring to weight stigma or bias in this article, we are referring to negative weight-related attitudes and beliefs that are manifested by stereotypes, rejection and prejudice towards individuals because they are overweight or obese. Weight stigma has been documented in Ó The Author 2007. Published by Oxford University Press. All rights reserved. For permissions, please email: doi:10.1093/her/cym052 R. M. Puhl et al. educational settings toward obese students by peers, classmates, teachers and school administrators [13, 14]; in healthcare environments, where overweight and obese patients may be vulnerable to bias by healthcare professionals [15–22], and in workplace settings, where heavyweight employees are judged negatively by co-workers, supervisors and employers [23, 24]. Weight stigma creates adverse psychosocial consequences for victims, including increased vulnerability to depression, body image distress, psychiatric symptoms [25, 26] and decreased self-acceptance [27]. In addition, weight bias has negative implications for physical health including unhealthy eating patterns [28–31] and avoidance of physical activity [31–33]. Taken together, the amassing literature suggests that being the target of weight-related stigmatization is a common and detrimental experience for obese individuals. Despite increasing attention to this topic in the scientific and medical community, few studies have identified and described weight bias from the perspective of overweight and obese individuals themselves. Qualitative research methods provide a unique opportunity to document the perceptions of stereotyping processes in recipients’ own words and to evaluate the more subjective and personal elements of stigmatization experiences which may be missed in quantitative work [34]. For example, some research has suggested that obese individuals may internalize the stereotypes held against their group and demonstrate bias toward other overweight individuals [35–37]. Qualitative questions can be used to assess the extent to which overweight individuals engage in these internalization processes. As another example, a small number of studies have tested various methods for reducing weight stigma and improving attitudes [38–43]. However, no work to our knowledge has asked overweight and obese individuals for their suggestions of specific strategies that could be helpful in stigma-reduction efforts. Gathering this information from targets of weight stigma may inform educational interventions to reduce this form of bias. The few qualitative studies that have addressed weight stigmatization provide some unique insights on perceptions of bias among adolescents and adults [10, 11, 35]. The limitations in the literature to date are the use of small samples and restricted populations, as well as the reliance on face-to-face methods of data collection, such as interviews and focus groups [10, 11]. The lack of anonymity inherent in in-person methods may influence participants’ willingness to disclose the more painful or personal details of their stigmatizing experiences. Existing qualitative work has primarily focused on one gender and narrow weight ranges [11, 44], precluding examination of the potential influence gender and weight status on the experience of weight bias. The findings on gender effects in the quantitative research have been mixed, with some studies detecting gender differences [45–48] and others not [25, 27]. Only one study has tested whether weight stigmatization worsens as a function of body weight [46] and the findings were suggestive of a positive effect. The objective of the present study was to employ qualitative methods to address the literature limitations described above. We sought to examine the subjective experience of weight stigmatization in a large sample of overweight and obese men (...truncated)