Learning Outcomes
1. Explain the concept of cognitive dissonance and how it influences our beliefs
* 2. Define the terms related to weight stigma and explain each of their impacts
* 3. Explain the link between weight and health
4, List 4 health behaviours found to decrease mortality rate
* 5, Identify the the contexts in which weight stigma is experienced and how it appears in those
contexts
* 6 Identify the consequences of weight stigma on health and the four mechanisms through which
weight stigma impacts health
* 7. Identify the recommendations for decreasing weight stigma
* 8 Compare and contrast the weight-normative approach to the weight-inclusive approach to health
* 9 Identify the harms of the weight-normative approach and explain how the weight-inclusive
approach addresses those harms.
* 10. Explain what the weight inclusive approach looks like in practice and public health policy
* 41 Describe the evidence supporting the weight-inclusive approach to healthcareCognitive Dissonance
* People seek out information that is consistent with
what they already know
* Information that is inconsistent causes discomfort
* To reduce this
Reject our old belief
Deny new evidence
Rationalize our belief in light of new evidenceWhat is weight stigma?Weight Stigma (Brochu et al., 2018)
Weight
Prejudice
Weight Weight
Stigma Stereotypes
Weight
DiscriminationWeight Stigma
Weight Stereotypes
Beliefs about personal
attributes and traits of
people in larger
bodies
Weight Prejudice
Negative attitudes and
unfavourable
evaluations of people
in larger bodies
Weight Discrimination
Negative, unfair, or
unequal behaviour or
treatment of people in
larger bodies because of
their weight or sizeDo adults hold weight-
biased beliefs?Weight Bias in Adults
= Tiggemann & Rothblum, 1988
= Male and female students from Australia and
Vermont asked about
Weight related stereotypes
Personal weight
Dieting
Body imageWeight Bias in Adults
™ Tiggemann & Rothblum, 1988
Findings
™ Vermont students had more
negative body image than Australian
students
= Vermont students more likely to be
dieting
= Women overall more negative body
image and more likely to be dieting .
"And that their weight interfered
with activities
People with overweight BMIs viewed as
= Warmer, friendlier, more unhappy,
self-indulgent, and lazy
"Less self-disciplined, self-confident,
and attractive
Weight stigma more pronounced
= When judging a female individual
= When the participant was female
Weight stigma not impacted by weight of
participantWeight Bias in Adults
= Tiggemann & Rothblum, 1988
= Takeaways
Women had lower body dissatisfaction and
greater dieting behaviours
Women are judged more harshly for weight
Women judge others more harshly for their
weight
Judgements not influenced by participant
weightWeight Bias in Adults
Judged as less
Active
Intelligent
Hardworking
Successful
Athletic
PopularWhy does weight stigma
exist?Why does weight stigma exist?
Causal Attribution Theory
Belief that weight within one's control
Report more negative attitudes
towards people in larger bodies
Perceived violation of values (hard
work and self-control
Less likely to be stigmatized when
weight seen as out of their control
“What is beautiful is good”
Our tendency to assign more
positive characteristics and life
outcomes to people we think
are attractiveWeight Stigma Turned Inward
Higher-body-weight people Weight stigma perpetuates
* Often internalize stigma societal fear of fat
* Report negative attitudes and * 60% of lower-body weight
beliefs about larger bodies, people would rather give up
including their own 1year than be heavy
* 19% would give up 10 years
or moreMatheson et al. 2012
+ Followed 11,761 adults for an average of 14 years
+» Nationally representative survey sample =~
PSN
+ Physical exam
\
Extensive lifestyle, diet, and medical hx questionnaire pSay Matheson et al. 2012
+ Life style behaviours
Not smoking
vat more servings of fruits and vegetables rN
Ei =
Exercising greater than 12 times a month aa)
Moderate alcoholeu iy
Healthy Lifestyle
Habits and Mortality
in Overweight and
Obese Individuals
Wace k mere)
Cox Proportional Hazards Models for Risk of
All-Cause Mortality for All Individuals Ages 21 and
Older by Adherence to 0, 1, 2, 3, or 4 Healthy Habits
Sample size = 11,761 unweighted (133,700,
weighted)
Number of
Healthy Habits
1
3
4
and not smoking.Healthy Lifestyle Habits and Mortality in Overz
Obese Individuals (vtatheson et al., 2012)
Figure 1. Hazard ratio for all-cause mortality by body mass index (kg/m2) and numberof healthy habits
(Ge, fruits and vegetable intake, tobacco, exercise, alcohol). Data from Table 3.Where and when is
weight stigma
experienced?Weight Stigma in Childhood
Prefer not to play with overweight peers
Assign negative characteristics to images
of overweight people
Commonly associated with teasing or
being bullied
Teased during physical activities
Excluded from physical activities
Verbally threatened
Physically harassedWeight Stigma in Healthcare
Physicians report preference for lower-
body-weight people
74% of 15t year med students demonstrate
implicit prejudice
67% also report explicit prejudice
Physicians are less interested in treating
higher-body weight patients
Report beliefs that they are unattractive,
noncompliant, and weak willedWeight Stigma in Healthcare
* Physicians spend less time educating
higher-body-weight patients
Report less respect, prescribe different
treatment
* Half of higher-body-weight women report
multiple occasions of stigma from
physicians
* Lower trust in healthcare providersWeight Stigma in Healthcare
* Psychologists report lower expectations for patients with
higher body weights
Prognosis, effort, and functioning
* More likely to set weight-related treatment goals
“even when the patients did not report any weight
concernsWeight Stigma in Employment
* Higher-weight-body candidates are
Ascribed more negative attributes
More likely to be perceived as a poor fit
Assigned lower started salaries
(compared to thinner candidates with identical credentials)
* Earn go cents for every dollar earned by lower-body-weight peopleWeight Stigma in Education
* School teachers associate higher-
body-weights with untidiness,
decreased likelihood of success,
and lack of willpower
* Higher-weight-body adults receive
fewer post-interview admission
offers to graduate school
* Same rate of interview offersWeight Stigma in Interpersonal Relationships
* Family members
72% of higher-body-weight women reported weight stigma from
family members
* Friends
60% reported weight stigma from friends
* Spouses
47% reported weight stigma from spouses
Lower qualitied relationships and greater dissatisfaction with their
relationshipsWeight Stigma
in the Media
Higher-body-weight people
underrepresented on TV and
depicted in stereotypical ways
Media perpetuates weight
stereotypes and reinforce negative
attitudes
After watching stigmatizing
media, people report
increased negative attitudes
and increased desire for
distance from larger bodiesWhat are the
implications of weight
stigma?Implications of weight stigma
Behaviour
changeImplications of weight stigma
Health
Perceived weight discrimination independently associated
with increased mortality risk of 60%
Weight stigma shortens life expectancy
Weight stigma associated with depression, body
dissatisfaction, and binge eating
Weight based teasing is a significant risk factor for mental
health disordersImplications of weight stigma
Health
Weight stigma associated with weight gain / weight maintenance at
higher weight
2.5 x more likely to be a higher body weight 4 years later
Or 3 x more likely to remain at one
Weight teasing in childhood linked to weight gain in Longitudinal
studies
Independent of original BMI
Being labeled “too fat" for girls at 14 predicted disordered eating at 19
More so if label came from family unger & Tomiyama, 2028)Internalized weight bias predicts weight
regain, not weight loss maintenance.> (ch) \ Vf) i
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