Recent Publications
Schwartz MB, Vartanian LR, Wharton CM, Brownell KD. Examining the nutritional quality of breakfast cereals marketed to children. J Am Diet Assoc. 2008 Apr.
The purpose of this study was to determine whether
there were identifiable differences in nutritional quality
between cereals that are primarily marketed to children
and cereals that are not marketed to children. Of the 161
cereals identified between January and February 2006,
46% were classified as being marketed to children (eg,
packaging contained a licensed character or contained an
activity directed at children). Compared
to nonchildren’s cereals, children’s cereals were denser in
energy, sugar, and sodium, but were less dense in fiber
and protein. The majority of children’s cereals
(66%) failed to meet national nutrition standards, particularly
with respect to sugar content. Overall, there were important differences
in nutritional quality between children’s cereals
and nonchildren’s cereals. Dietary advice for children to
increase consumption of ready-to-eat breakfast cereals
should identify and recommend those cereals with the
best nutrient profiles.
Wharton CM, Long M, Schwartz MB. Changing nutrition standards in schools: The emerging impact on school revenue. J School Health. 2008 April.
Although great focus has been placed on nutritional and other consequences of changes in food-related policies within schools, few reports exist describing the impact of such changes on school revenue. This systematic review of four peer-reviewed papers and three state-based reports provides an overview of the few revenue-related studies published recently, as well as information from a sampling of state reports on the subject. Thus far, few data exist to substantiate the concern that changes in nutrition standards in schools lead to a loss in total revenue. An interesting phenomenon of increased participation in the National School Lunch Program was noted in a number of reports and might play a role in buffering financial losses.
Puhl RM, Andreyeva T, Brownell KD. Perceptions of weight discrimination: prevalence and comparison to race and gender discrimination in America. Int J Obes. 2008 Mar 4.
Limited data are available on the prevalence and patterns of body weight discrimination from representative samples. This study examined experiences of weight/height discrimination in a nationally representative sample of US adults and compared their prevalence and patterns with discrimination experiences based on race and gender. The prevalence of weight/height discrimination ranged from 5% among men to 10% among women, but these average percentages obscure the much higher risk of weight discrimination among heavier individuals (40% for adults with body mass index (BMI) of 35 and above). Younger individuals with a higher BMI had a particularly high risk of weight/height discrimination regardless of their race, education and weight status.
Andreyeva T, Puhl RM, Brownell KD. Changes in perceived weight discrimination among Americans, 1995-1996 through 2004-2006. Obesity. 2008 Feb 28.
This study examined trends in weight discrimination over 10 years among a nationally representative sample of adults aged 35-74 years from the National Survey of Midlife Development in the United States. Reports of weight discrimination were compared to experiences of discrimination based on race, age and gender. The prevalence of weight discrimination increased from 7% in 1995-1996 to 12% in 2004-2006. During this same time period, race discrimination remained stable, whereas the prevalence of weight discrimination increased to levels comparable with those reported for race and age discrimination. In summary, weight/height discrimination is highly prevalent in American society and increasing at disturbing rates. Its prevalence is relatively close to reported rates of race and age discrimination, but virtually no legal or social sanctions against weight discrimination exist.
Puhl RM, Moss-Racusin CA, Schwartz MB, Brownell KD. Weight stigmatization and bias reduction: perspectives of overweight and obese adults. Health Educ Res. 2007 Sep 19.
This study employed qualitative methods with a sample of overweight and obese adults to identify and describe their subjective experiences of weight bias. Participants completed an online battery of self-report questionnaires, including several open-ended questions about weight stigmatization. Participants reported experiencing weight stigma across a range of contexts and involving a variety of interpersonal sources. The 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.
Puhl RM, Latner JD. Stigma, obesity, and the health of the nation’s children. Psychol Bull. 2007 Jul;133(4):557-80.
Preventing childhood obesity has become a top priority in efforts to improve our nation's 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.
Schwartz MB, Brownell KD. Actions necessary to prevent childhood obesity: creating the climate for change. J Law Med Ethics. 2007 Spring; 35(1):78-89.
Childhood obesity has become a public health epidemic, and currently a battle exists over how to frame and address this problem. This paper explores how public policy approaches can be employed to address obesity. We present the argument that obesity should be viewed as the consequence of a "toxic environment" rather than the result of the population failing to take enough "personal responsibility." In order to make progress in decreasing the prevalence of obesity, we must shift our view of obesity away from the medical model (which focuses on the individual) to a public health model (which focuses on the population). At the same time, we must be sensitive to the problem of weight bias. Potential obstacles to taking a public policy approach are identified, as well as suggestions on how to overcome them.
Schwartz MB. The influence of a verbal prompt on school lunch fruit consumption: a pilot study. Int J Behav Nutr Phys Act. 2007 Mar 5;4:6.
This study evaluated an environmental intervention intended to increase consumption of the fruit serving among elementary school children participating in the National School Lunch Program (NSLP). Children's fruit consumption was measured in two schools by observation. In the intervention school, cafeteria workers provided the verbal prompt, "Would you like fruit or juice with your lunch?" as the children stood in line in front of the fruit serving options. The control school had the same fruit and 100% juice options available, but the cafeteria workers did not provide a verbal prompt to take a fruit serving. Two variables were assessed: (1) Did children leave the lunch line with a fruit serving on their trays? and (2) Did they subsequently eat the fruit serving? RESULTS: The average percentage of children who took a fruit serving was 60% in the control school and 90% in the intervention school. In both schools, approximately 80% of children ate the fruit on their tray. As a result, nearly 70% of the children in the intervention school consumed a fruit serving at lunch, while fewer than 40% did so in the control school. The authors found that a simple verbal prompt appears to have a significant impact on the likelihood that children will take, and subsequently consume, a fruit serving as part of their purchased school lunch. If these findings are replicated, policymakers may consider adding verbal prompts to the serving policy of the NSLP in an effort to increase fruit consumption among school children.
Vartanian LR, Schwartz MB, Brownell KD. Effects of soft drink consumption on nutrition and health: a systematic review and meta-analysis. Am J Public Health. 2007 Apr;97(4):667-75. Epub 2007 Feb 28.
In a meta-analysis of 88 studies, we examined the association between soft drink consumption and nutrition and health outcomes. We found clear associations of soft drink intake with increased energy intake and body weight. Soft drink intake also was associated with lower intakes of milk, calcium, and other nutrients and with an increased risk of several medical problems (e.g., diabetes). Study design significantly influenced results: larger effect sizes were observed in studies with stronger methods (longitudinal and experimental vs cross-sectional studies). Several other factors also moderated effect sizes (e.g., gender, age, beverage type). Finally, studies funded by the food industry reported significantly smaller effects than did non-industry-funded studies. Recommendations to reduce population soft drink consumption are strongly supported by the available science.
Puhl RM, Moss-Racusin CA, Schwartz MB. Internalization of weight bias: Implications for binge eating and emotional well-being. Obesity (Silver Spring). 2007 Jan;15(1):19-23.
This study examined the relationship between internalization of negative weight-based stereotypes and indices of eating behaviors and emotional well-being in a sample of overweight and obese women. Participants completed an on-line battery of self-report questionnaires measuring frequency of weight stigmatization and coping responses to deal with bias and symptoms of depression and self-esteem, attitudes about weight and obesity, and binge eating behaviors. In addition, participants were asked to list the most common weight-based stereotypes and whether they believed them to be true or false. The authors found that participants who believed that weight-based stereotypes were true reported more frequent binge eating and refusal to diet in response to stigma experiences compared with those who reported stereotypes to be false. The degree to which participants believed stereotypes to be true or false was not related to types or amount of stigma experiences reported, self-esteem, depression, or attitudes toward obese persons. In addition, engaging in weight loss strategies as a response to bias was not predicted by stereotype beliefs or by actual stigma experiences, regardless of the amount or types of stigma reported. These findings suggest that obese individuals who internalize negative weight-based stereotypes may be particularly vulnerable to the negative impact of stigma on eating behaviors and also challenge the notion that stigma may motivate obese individuals to engage in efforts to lose weight. This study highlights a new area of research that warrants attention to better understand weight stigma and its potential consequences for health.
Puhl RM, Brownell KD. Confronting and coping with weight stigma: an investigation of overweight and obese adults. Obesity (Silver Spring). 2006 Oct;14(10):1802-15.
This study examined experiences of weight stigmatization, sources of stigma, coping strategies, psychological functioning, and eating behaviors in a sample of 2671 overweight and obese adults. Participants completed an online battery of self-report questionnaires measuring frequency of weight stigmatization and coping responses to deal with bias, the most common sources of the bias, symptoms of depression, self-esteem, attitudes about weight and obesity, and binge eating behaviors. Experiences of weight stigmatization, in many forms and across multiple occasions, was common among participants. A variety of coping strategies were used in response. More frequent exposure to stigma was related to more attempts to cope and higher BMI. Physicians and family members were the most frequent sources of weight bias reported. No gender differences were observed in types or frequency of stigmatization. Frequency of stigmatization was not related to current psychological functioning, although coping responses were associated with emotional well-being. These findings raise questions about the relationship between stigma and psychological functioning and have important implications for obesity treatment and stigma reduction intervention efforts, both of which are discussed.
Brownell KD, Yach D. Lessons from a small country about the global obesity crisis. Global Health. 2006 Sep 12;2:11.
Developed countries had high obesity rates before the problem was taken seriously and hence the genesis must be seen in retrospect. Developing countries offer a clear view of causal factors but also opportunities for prevention, which must focus on both food and physical activity environments.
In Press
Schwartz, M.B., Vartanian, L., Wharton, C. & Brownell, K.D. (in press). Examining the nutritional quality of breakfast cereals marketed to children. Journal of the American Dietetic Association.
Wharton, C., Long, M., & Schwartz, M.B. (in press). Changing nutrition standards in schools: The emerging impact on school revenue. Journal of School Health.