Rudd Center Publications
In an effort to understand, document, and identify ways to reduce weight bias, we are conducting multiple research studies on these topics at the Rudd Center. Our studies aim to:
- Challenge stereotypes and misperceptions associated with obesity
- Document the negative impact of bias on emotional and physical health
- Document the prevalence of weight discrimination
- Identify effective ways to reduce weight bias
Below is a list of peer-reviewed publications on these research topics conducted by Rudd Center Faculty. To view our current research initiatives, click here.
Another useful resource is a book authored by Drs. Brownell, Puhl,and Schwartz of the Rudd Center, called Weight Bias: Nature, Consequences, and Remedies. This volume explores the nature, causes, and consequences of weight bias and presents a range of approaches to combat it. Leading psychologists, health professionals, attorneys, and advocates cover such critical topics as the barriers facing obese adults and children in health care, work, and school settings; how to conceptualize and measure weight-related stigma; theories on how stigma develops; the impact on emotional and physical health, and strategies for reducing prejudice and bringing about systemic change. The full citation for this publication is: Brownell KD, Puhl R, Schwartz MB, Rudd L, eds. Weight Bias: Nature, Consequences, and Remedies. New York: Guilford Publications; 2005.
Peer-Reviewed Publications on Weight Bias by Rudd Faculty
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. Download this article. (.pdf)
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. Download this article. (.pdf)
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 C, Schwartz MB, Brownell KD. Weight Stigmatization and Bias Reduction: Perspectives of Overweight and Obese Adults. Health Ed Res. 2008. Download this article. (.pdf)
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 self-report questionnaires, including several open-ended 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 stigma reduction efforts. The experiences and opinions expressed were not significantly different for men versus women or overweight versus obese 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.
Puhl RM, Latner JD. Stigma, obesity, and the health of the nation's children. Psych Bull. 2007; 133:557-80. Download this article. (.pdf)
Preventing childhood obesity has become a top priority in efforts to improve our nation’s public health. While 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 youth 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 youth and the primary sources of stigma in their lives, including peers, educators, and parents. We 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. We then review stigma-reduction efforts that have been tested to improve attitudes toward obese children, and 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 youth, with an emphasis on the importance of studying the effect of weight stigma on physical health outcomes and identifying effective interventions to improve attitudes.
Puhl R., Moss-Racusin C, Schwartz MB. Internalization of Weight Bias: Implications for Binge Eating and Emotional Wellbeing. Obesity. 2007;15(1);19-23. Download this article. (.pdf)
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 females. Research Method and Procedures: The sample was comprised of 1013 adult females who belonged to a national, non-profit weight loss organization. Participants completed an online battery of self-report questionnaires measuring frequency of weight stigmatization and coping responses to deal with bias, as well as 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. Results: Participants who believed that weight-based stereotypes were true reported more frequent binge eating and refusal to diet in response to stigma experiences compared to 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. Conclusion: 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 challenges 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 R, Brownell KD. Confronting and Coping with Weight Stigma: An Investigation of Overweight and Obese Adults. Obesity. 2006;14:1802-1815. Download this article. (.pdf)
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. Method and Procedures: The total sample was partitioned into two sub-samples for investigation: Sample I was comprised of 2449 adult women, and Sample II was a matched sample of adult males and females (N = 222) which was disaggregated to investigate gender differences. Both samples 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 and self-esteem, attitudes about weight and obesity, and binge-eating behaviors. Results: Experiences of weight stigmatization, in many forms and across multiple occasions, were common in both samples. A variety of coping strategies were used in response to stigma, including 79% of participants who reported eating more food in response to weight stigma, and 75% who reported refusing to diet in response to stigma. More frequent exposure to stigma was related to more attempts to cope and higher body mass index. 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. Discussion: These findings have important implications for obesity treatment and stigma-reduction efforts, and suggest that family members and health care providers are important targets for stigma reduction interventions.
Schwartz MB, Vartanian LR, Nosek BA, Brownell KD. The Influence of One's Own Body Weight on Implicit and Explicit Anti-Fat Bias. Obesity. 2006;14:440-8. Download this article. (.pdf)
This study assessed implicit and explicit anti-fat attitudes and obesity stereotypes among a large online sample of 4,283 participants that included representation froma cross the weight spectrum (from underweight to extremely obese). Respondents also indicated their willingness to make a range of personal sacrifices in exchange for not being obese. All weight groups exhibited significant anti-fat bias, but there was an inverse relation between one’s own weight and the level of observed bias. Thinner people were more likely to automatically associate negative attributes (bad, lazy) with fat people, to prefer thin people to fat people, and to explicitly rate fat people as lazier and less motivated than thin people. A substantial proportion of respondents also indicated a willingness to endure aversive life events to avoid being obese. For example, 46% of the total sample indicated that they would rather give up 1 year of life than be obese, and 30% reported that they would rather be divorced than obese. In each case, thinner people were more willing to sacrifice aspects of their health life.
Puhl R, Schwartz MB, Brownell KD. Impact of Perceived Consensus on Stereotypes about Obese People: A New Approach for Reducing Bias. Health Psychol. 2005; 24: 517-525. Download this article. (.pdf)
In three experiments, the authors tested the effect of perceived social consensus on attitudes toward obese people. Participants completed self-report measures of attitudes toward obese people prior to and following manipulated consensus feedback depicting attitudes of others. In Study 1 (N = 60), participants decreased negative and increased positive stereotypes after learning that others held more favorable attitudes toward obese people. In Study 2 (N = 55), participants improved attitudes when they learned about favorable attitudes of obese people from an in-group versus an out-group source. Study 3 (N = 200) compared a consensus approach to other stigma reduction methods. Social consensus feedback influenced participants’ attitudes and beliefs about causes of obesity. Providing information about the uncontrollable causes of obesity and supposed scientific prevalence of traits also improved attitudes.
Wang SS, Brownell KD, Wadden TA. The influence of the stigma of obesity on overweight individuals. Int J Obes Relat Metab Disord. 2004;28:1333-1337. Download this article. (.pdf)
Objectives: To investigate the internalization of anti-fat bias among overweight individuals across a variety of attitudes and stereotypes.
Design: Two studies were conducted using the Implicit Association Test (IAT), a performance-based measure of bias, to examine beliefs among overweight individuals about 'fat people' vs 'thin people'. Study two also contained explicit measures of attitudes about obese people.
Subjects: Study 1 participants were 68 overweight patients at a treatment research clinic (60 women, 8 men; mean Body Mass Index (BMI) of 37.1+/-3.9 kg/m(2)). Study 2 involved 48 overweight participants (33 women, 15 men) with a BMI of 34.5+/-4.0 kg/m(2).
Results: Participants exhibited significant anti-fat bias on the IAT across several attributes and stereotypes. They also endorsed the explicit belief that fat people are lazier than thin people.
Conclusion: Unlike other minority group members, overweight individuals do not appear to hold more favorable attitudes toward ingroup members. This ingroup devaluation has implications for changing the stigma of obesity and for understanding the psychosocial and even medical impact of obesity on those affected.
Puhl R, Brownell KD. Psychosocial origins of obesity stigma: Toward changing a powerful and pervasive bias. Obes Rev. 2003;4:213-227. Download this article. (.pdf)
Widespread bias and discrimination based on weight have been documented in key areas of living, including education, employment, and health care. This paper examines the social and psychological origins of this bias through a review and critique of theoretical and empirical literatures, and proposes how the field might best advance in the area of reducing stigma. Explanations for the development and reduction of weight stigma are examined with different theoretical approaches, including attribution theory and a social consensus model. Individual and sociocultural contributors to bias suggested by these approaches are highlighted. New directions are discussed in both the understanding and prevention of weight bias.
Puhl R, Brownell K. Ways of coping with obesity stigma: Conceptual review and analysis. Eat Behav. 2003; 4: 53-78. Download this article. (.pdf)
There is clear documentation of bias and discrimination aimed at overweight persons, but less is known about methods individuals use to cope with weight stigma. This paper provides an analysis of such methods, integrating work on weight stigma with what is known from other relevant areas (e.g., race and gender bias). Multiple means of coping have been studied, ranging from attempts to change the stigmatizing condition (losing weight) to taking pride in the condition and mobilizing social action to prevent discrimination. The most promising areas for future research, methodological challenges, and the importance of individual difference and situational factors as moderating variables are discussed.
Schwartz MB, O’Neal H, Brownell KD, Blair S, Billington C. Weight Bias among health professionals specializing in obesity. Obes Res. 2003;11:1033-1039. Download this article. (.pdf)
Purpose: To determine the level of anti-fat bias in health professionals specializing in obesity and identify personal characteristics that correlate with both implicit and explicit bias.
Research Methods and Procedures: The Implicit Associations Test (IAT) and a self-report questionnaire assessing explicit attitudes, personal experiences with obesity, and demographic characteristics was administered to clinicians and researchers attending the opening session of an inter-national obesity conference (N = 389). The IAT was used to assess overall implicit weight bias (associating “obese people” and “thin people” with “good” vs. “bad”) and three ranges of stereotypes: lazy-motivated, smart-stupid, and valuable-worthless. The questionnaire assessed explicit bias on the same dimensions, along with personal and professional experiences with obesity.
Results: Health professionals exhibited a significant pro-thin, anti-fat implicit bias on the IAT. In addition, the subjects significantly endorsed the implicit stereotypes of lazy, stupid, and worthless using the IAT. Level of bias was associated with several personal characteristics. Characteristics significantly predictive of lower levels of implicit anti-fat bias include being male, older, having a positive emotional outlook on life, weighing more, having friends experience of obesity.
Discussion: Even professionals whose careers emphasize research or the clinical management of obesity show very strong weight bias, indicating pervasive and powerful stigma. Understanding the extent of anti-fat bias and the personal characteristics associated with it will aid in developing intervention strategies to ameliorate these damaging attitudes.
Greenberg BS, Eastin M, Hofschire L, Lachlan K, Brownell KD. Portrayals of overweight and obese individuals on commercial television. Am J Pub Health. 2003;93:1342-1348. Download this article.(.pdf)
Objectives: This study examined the distribution and individual characteristics of body types on prime-time television. Methods: Five episodes of each of the 10 top-rated prime-time fictional programs on 6 broadcast networks during the 1999-2000 season were quantitatively analyzed. Results: Of 1018 major television characters, 14% of females and 24% of males were overweight or obese, less than half their percentages in the general population. Overweight and obese females were less likely to be considered attractive, to interact with romantic partners, or to display physical affection. Overweight and obese males were less likely to interact with romantic partners and friends or to talk about dating and were more likely to be shown eating. Conclusions: Overweight and obese television characters are associated with specific negative characteristics.
Schwartz MB, Puhl R. Childhood obesity: a societal problem to solve. Obes Rev. 2003;4:57-71. Download this article.(.pdf)
In contrast to other threats to American children's health, the treatment and prevention of childhood obesity are considered the responsibility of individual children and their parents. This pressure exists in the context of the societal stigmatization of overweight children and the powerful environmental inducements aimed directly at children to eat nutritionally poor foods. Parents of overweight children are left in the difficult position of fearing the social and health consequences of their child's obesity, and fighting a losing battle against the omnipotent presence of the media and constant exposure to unhealthy foods. This paper brings together several literatures to provide a comprehensive examination of the major challenges facing obese children and their families. In particular, this paper documents the extent of stigmatization towards overweight children and reviews evidence of the conflicting advice given to parents about how to help children develop healthful eating in the face of biological and learned food preferences. We conclude with a call for a shift in thinking about the role of our society in the aetiology, treatment and prevention of childhood obesity.
Teachman BA, Gapinski KD, Brownell KD, Rawlins M, Jeyaram S. Demonstrations of implicit anti-fat bias: the impact of providing causal information and evoking empathy. Health Psychol. 2003;22:68-78. Download this article. (.pdf)
Three studies investigated implicit biases, and their modifiability, against overweight persons. In Study 1 (N = 144), the authors demonstrated strong implicit anti-fat attitudes and stereotypes using the Implicit Association Test, despite no explicit anti-fat bias. When participants were informed that obesity is caused predominantly by overeating and lack of exercise, higher implicit bias relative to controls was produced; informing participants that obesity is mainly due to genetic factors did not result in lower bias. In Studies 2A (N = 90) and 2B (N = 63), participants read stories of discrimination against obese persons to evoke empathy. This did not lead to lower bias compared with controls but did produce diminished implicit bias among overweight participants, suggesting an in-group bias.
Geier AB, Schwartz MB, Brownell KD. “Before and after” diet advertisements escalate weight stigma. Eat Weight Disord. 2003;8:282-8. Download this article. (.pdf)
The stigma-producing effects of "before and after" diet advertisements on a healthy weight sample were examined. Subjects (n = 59) were exposed to a presentation containing either a "before and after" diet ad, or solely the "before" or "after" picture embedded in a different ad. Subjects were then given measures to assess negative attitudes and endorsement of stereotypes about overweight people. Across all subjects, strong implicit anti-fat bias was present. Subjects in the Before and After condition indicated that weight is more easily controllable than did subjects in either the Before Picture Only or the After Picture Only conditions. There were two moderating variables for this effect. Subjects who reported greater life satisfaction endorsed fewer anti-fat stereotypes, and those who enjoyed an emotionally close relationship with an overweight person were less biased. These results suggest that "before and after" diet ads enhance weight stigma and perpetuate damaging stereotypes.
Puhl R, Brownell KD. Bias, discrimination, and obesity. Obes Res. 2001;9:788-805. Download this article.(.pdf)
This article reviews information on discriminatory attitudes and behaviors against obese individuals, integrates this to show whether systematic discrimination occurs and why, and discusses needed work in the field. Clear and consistent stigmatization, and in some cases discrimination, can be documented in three important areas of living: employment, education and health care. Among the findings are that 28% of teachers in one study said that becoming obese is the worst thing that can happen to a person; 24% of nurses said that they are "repulsed" by obese persons; and, controlling for income and grades, parents provide less college support for their overweight than for their thin children. There are also suggestions but not yet documentation of discrimination occurring in adoption proceedings, jury selection, housing, and other areas. Given the vast numbers of people potentially affected, it is important to consider the research-related, educational, and social policy implications of these findings.
Teachman BA, Brownell KD. Implicit anti-fat bias among health professionals: is anyone immune? Int J Obes Relat Metab Disord. 2001;25:1525-31. Download this article. (.pdf)
Objective: To investigate whether negative implicit attitudes and beliefs toward overweight persons exist among health professionals who specialize in obesity treatment, and to compare these findings to the implicit anti-fat bias evident in the general population.
Design: Health care professionals completed a series of implicit and explicit attitude and belief measures. Results were compared to measures obtained from a general population sample. Subjects: A total of 84 health professionals who treat obesity (71% male, mean age 48 y, mean body mass index (BMI) 25.39).
Measurements: Participants completed an attitude- and a belief-based Implicit Association Test. This reaction time measure of automatic memory-based associations asked participants to classify words into the following target category pair. 'fat people' vs 'thin people'.
Simultaneously, the tasks required categorization of words into one of the following descriptor category pairs: good vs bad (attitude measure) or motivated vs lazy (stereotype measure). Participants also reported explicit attitudes and beliefs about fat and thin persons.
Results: Clear evidence for implicit anti-fat bias was found for both the attitude and stereotype measures. As expected, this bias was strong but was lower than bias in the general population. Also as predicted, only minimal evidence for an explicit anti-fat bias was found. Implicit and explicit measures of the lazy stereotype were positively related although the attitude measures were not.
Conclusion: Even health care specialists have strong negative associations toward obese persons, indicating the pervasiveness of the stigma toward obesity. Notwithstanding, there appears to be a buffering factor, perhaps related to their experience in caring for obese patients, which reduces the bias.
Books:
Brownell KD, Puhl RM, Schwartz MB, Rudd L. Weight Bias: Nature, Consequences, and Remedies. New York: The Guilford Press. 2005.
Research Papers:
Gapinski KD, Schwartz MB, Brownell KD. Can television change anti-fat attitudes and behavior? Journal of Applied Biobehavioral Research. 2006; 11: 1-28.
Grilo CM, Wilfley DE, Brownell KD, Rodin J. Teasing, body image, and self-esteem in a clinical sample of obese women. Addict Behav. 1994; 19: 443-450.
Henderson KE, Schwartz MB. (in press). Treatment of overweight children: practical strategies for parents. In J. D. Latner, & G. T. Wilson (eds.) Self-help Approaches for Obesity and Eating Disorders: Research and Practice. New York, NY: Guilford Press.
Latner JD, Schwartz MB. Weight bias in a child’s world. In K.D. Brownell, R.M. Puhl, M.B. Schwartz, & L. Rudd (Eds.), Weight Bias: Nature, consequences and remedies (pp. 54-67). 2005 New York, NY: Guilford Press.
Neumark-Sztainer D, Eisenberg M. Weight bias in a teen’s world. In Brownell KD, Puhl R, Schwartz MB, Rudd L, (Eds.), Weight Bias: Nature,Consequences, and Remedies (pp. 68-79). 2005 New York, NY: Guilford Publications.
Puhl R, Brownell KD. Bias, discrimination, and obesity. Obes Res. 2001; 9:788-805.
Puhl RM, Brownell KD. Confronting and coping with weight stigma: An investigation of overweight and obese adults. Obesity. 2006; 14: 1802-1815.
Puhl R, Brownell KD. Psychosocial origins of obesity stigma: Toward changing a powerful and pervasive bias. Obes Res. 2003; 4: 213-227.
Schwartz MB, Brownell KD. Obesity and body image. Body Image. 2004; 1: 43-56.
Schwartz MB, Chambliss HO, Brownell KD, Blair SN, Billington C. Weight bias among health professionals specializing in obesity.Obes Res. 2003; 11: 1033-1039.
Schwartz MB, Vartanian L, Nosek B, Brownell KD. The influence of one's own body weight on implicit and explicit anti-fat bias. Obes Res. 2006; 14: 440-447.
Wang SS, Brownell KD, Wadden TA. The influence of the stigma of obesity on overweight individuals. Int J Obes. 2004; 28: 1333-1337.
Yach D, Stuckler D, Brownell KD. Epidemiologic and economic consequences of the global epidemics of obesity and diabetes. Nat Med. 2006; 12: 62-66.
Young-Hyman D, Schlundt DG, Herman-Wenderoth L, Bozylinski K. Obesity, appearance, and psychosocial adaptation in young African-American children. J Pediatr Psychol. 2003; 28: 463-472.
Brownell K. Personal responsibility and control over our bodies: When expectations exceed reality. Health Psychol. 1991; 10: 303-310.