Development and Validation of The Fat Attitudes Assessment Toolkit FAAT A

Received: 1 May 2019 | Revised: 5 May 2022 | Accepted: 9 May 2022
DOI: 10.1111/jasp.12882
ORIGINAL ARTICLE
Development and validation of the Fat Attitudes Assessment

Toolkit (FAAT): A multidimensional nonstigmatizing measure
of contemporary attitudes toward fatness and fat people
Patricia Cain1 | Ngaire Donaghue2 | Graeme Ditchburn3
1
School of Nursing and Midwifery, Edith
Cowan University, Joondalup, Australia Abstract
2
School of Humanities, University of Many instruments recommended for measuring attitudes toward fatness and “obesity”
Tasmania, Hobart, Australia
were developed in the 1990s, a time when the “obesity epidemic” was gaining
3
College of Science, health, Engineering and
Education, Murdoch University, Perth, momentum and anti‐fat rhetoric was normative. Consequently, these instruments have
Australia tended to focus on assessing negative appraisals of fatness and fat people and reinforce
weight stigma. As fat discourse has matured and expanded to incorporate fat positive
Correspondence
Patricia Cain, School of Nursing and Midwifery, attitudes, a nonstigmatizing way of measuring contemporary fat attitudes and beliefs in
Edith Cowan University, 270 Joondalup
quantitative research is required. To address this need, we developed the Fat Attitudes
Dr, Joondalup 6027, Western Australia.
Email: p.cain@ecu.edu.au Assessment Toolkit (FAAT). In this article, we describe the development of the FAAT
and provide initial evidence for the scale's validity and psychometric properties across
three studies. Study 1 included a systematic process for developing the extensive item
pool that was reviewed by subject matter experts and a community panel. We explored
and identified an initial multidimensional structure for the FAAT. Study 2 expanded and
confirmed the factor structure with additional analyses in an independent sample and
provided evidence for the overall reliability of the subscale scores and reliability as a
function of gender and identification as fat. Construct and criterion validity of the
subscale scores were also demonstrated. Study 3 provided evidence for the test‐retest
reliability of the FAAT subscales scores over time. The FAAT includes nine robust scales:
Empathy, Activism Orientation, Size Acceptance, Attractiveness, Critical Health, General
Complexity, Socioeconomic Complexity, Responsibility, and Body Acceptance. Specific
subscales can be combined to form two composite measures: Fat Acceptance and
Attribution Complexity. The scales that comprise the FAAT measure specific elements
of attitudes towards fat people that are frequently targeted in weight stigma reduction
research and activism; the FAAT thus offers a powerful and precise method for
evaluating weight stigma reduction interventions that allows for an assessment of shifts
toward more positive attitudes.
1 | INTRODUCTION including work (Roehling et al., 2007), school (Burmeister et al., 2012),
healthcare settings (Malterud & Ulriksen, 2011; Schwartz et al., 2003;
Fat1 people experience stigmatizing events and discrimination nearly Setchel et al., 2014; Tomiyama et al., 2015), fitness and leisure
every day (Seacat et al., 2014; Vartanian et al., 2014) in virtually every settings (Cardinal et al., 2014; Schvey et al., 2017), interpersonal
domain of daily living (for a review, see Puhl & Heuer, 2009), relationships (Brewis et al., 2011; Collison & Rusbasan, 2016), and the
J Appl Soc Psychol. 2022;52:1121–1145. wileyonlinelibrary.com/journal/jasp © 2022 Wiley Periodicals LLC. | 1121
15591816, 2022, 12, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jasp.12882 by Deakin University Library, Wiley Online Library on [19/07/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
1122 | CAIN ET AL.
military (Schvey et al., 2016). Both experienced and internalized psychometric properties of weight bias measures, see Morrison
forms of weight stigma have been linked to a range of physical, et al. (2009) and Lacroix et al. (2017). We argue that these measures
psychological, and behavioral outcomes. Controlling for BMI and are limited in their utility to assess fat attitudes and are no longer be
other potential confounding factors weight stigma contributes to a fit for purpose when it comes to assessing contemporary and more
higher risk of chronic morbidity and mortality (Puhl & Suh, 2015; nuanced fat attitudes.
Sutin et al., 2015; Tomiyama, 2014), suicidality (Hunger et al., 2020), First, assessing only negative attitudes does not allow for the
depression and anxiety (Greenleaf et al., 2017; Hatzenbuehler possibility that people may hold positive evaluations of fat people.
et al., 2009; Major et al., 2012; Wu & Berry, 2017), and health care This limitation may have implications for the assessment of change
avoidance (Mensinger et al., 2018). in fat attitudes as a result of interventions focused on reducing
There is evidence, however, that anti‐fat attitudes may be weight bias and stigma. Many intervention studies present
shifting. Organizations such as The National Association to Advance participants with information to challenge or complicate negative
Fat Acceptance (NAAFA) in the United States have been working to perceptions of fat people and then assess whether negative
promote the rights of fat people and improve their quality of life since attitudes have changed. For example, some interventions have
the 1960s (Dickins et al., 2016). Fat acceptance and fat activism exposed participants to critical content related to the complex
movements have long challenged anti‐fat ideology and the cultural nature of “obesity” (Diedrichs & Barlow, 2011); first‐person
devaluation of fat people (Cooper, 1998, 2016). Critical public health accounts from fat people of stigmatizing experiences designed to
responses, such as Health At Every Size, and critical “obesity” evoke empathy (Gloor & Puhl, 2016; Teachman et al., 2003);
discourse, have made gains in contesting normative weight‐centric reports that highlight the seriousness of weight discrimination and
assumptions that fatness is an indicator of poor health and disease, punitive consequences (Gujral et al., 2011; McVey et al., 2013);
and that fat people must lose weight to improve their health and messages that support weight‐neutral approaches to health
(Aphramor, 2005; Bacon & Aphramor, 2011; Bacon, 2010; (Fredrick et al., 2015; Humphrey et al., 2015). For a detailed review
Burgard, 2009; Campos et al., 2006; Campos, 2004). Harnessing and critique of weight stigma intervention types and content, see
the burgeoning empirical evidence on the environmental and social Cain et al. (2022). Attitude change research tends to demonstrate
determinants of weight (Colls & Evans, 2014), and the role of weight limited effectiveness using common anti‐fat attitudes measure-
stigma itself in the development and advancement of disease ment scales (Lee et al., 2014). However, anti‐fat scales are not able
(Tomiyama, 2014), these academic, social, and political forces are to capture potential shifts in awareness of weight‐based discrimi-
changing the cultural conservation and dominant discourse around nation and/or increased support for weight‐neutral approaches to
fatness (Cain et al., 2017). We argue that fat attitudes have become health, such changes would reflect more positive fat attitudes that
more nuanced, and notably more positive, in recent decades; yet, to may shift independently of negative attitudes. That is, commonly
our knowledge, a psychometrically sound measure to assess and used anti‐fat attitudes scales may not align with the content of
quantify contemporary fat attitudes does not exist. The purpose of anti‐fat interventions.
the current set of studies was to develop and validate a new measure A second important limitation of commonly used anti‐fat attitude
of fat attitudes that does not perpetuate stigma towards fatness and scales is the stigmatizing language employed. The wording of many
fat people, but rather assesses contemporary and nuanced attitudes items on existing anti‐fat attitudes scales is derogatory and offensive
and beliefs. toward fat people. As most of the adult population in western
countries is now considered “overweight” or “obese” (World Health
Organization, 2014), it is safe to assume that many research
1.1 | Limitations of commonly used antifat attitude participants responding to items on commonly used anti‐fat attitudes
measurement scales scales are themselves fat. If we consider some of these items more
closely through the eyes of a fat participant, the dehumanizing and
Measures of fat attitudes have typically assessed individual‐level devaluing content comes into focus: “Obese people should not
negative attitudes and beliefs toward fat people. Notably, many of expect to live normal lives” (Attitudes Towards Obese Persons Scale;
these measures were developed in the 1990s when the “war on Allison et al., 1991); “It is disgusting when a fat person wears a
obesity” was being waged against fat people to counter the “obesity bathing suit at the beach” (Antifat Attitudes Scale; Morrison &
epidemic” (Lupton, 2013). As such, anti‐fat measures typically focus O'Connor, 1999); “Although some fat people are surely smart, in
on the assessment of disparaging and stereotyped beliefs about fat general, I think they are not quite as bright as normal‐weight people”
people with respect to personal qualities and appearance (e.g., lazy (Anti‐Fat Attitudes Questionnaire; Crandall, 1994). The inclusion of
and unintelligent), views of being fat as a personal weakness and these and other pejorative statements about fat people, even in
failing, fat phobia, and the desire to disassociate from fat people (Cain research that is designed to reduce weight stigma, may have the
et al., 2021). Examples of commonly used measurement scales paradoxical effect of perpetuating and legitimizing negativity toward
include the Anti‐Fat Attitudes Questionnaire (Crandall, 1994), Antifat fat people. People of all sizes can hold positive or negative attitudes
Attitudes Test (Lewis et al., 1995), and Antifat Attitudes Scale toward fat people and people of all sizes participate in research
(Morrison & O'Connor, 1999). For a detailed review of the studies on fat attitudes.
CAIN ET AL. | 1123
Our goal in developing a new measure of anti‐fat attitudes was et al., 2003), and critical health (Fredrick et al., 2015; Humphrey
twofold: to reflect contemporary and nuanced attitudes and beliefs et al., 2015).
towards fat people, and to feature language that does not perpetuate The goal of item development was to capture as much of the
negative stereotypes or denigrate fatness and fat people. Our breadth and depth of contemporary fat discourse as possible,
research was informed by best practices for scale development and including fat positive and critical discourse—that is, discourse that
validation (DeVellis, 2012; Nunnally & Bernstein, 1994; Worthington resists weight centric anti‐fat beliefs (Campos, 2004), challenges
& Whitaker, 2006). In Study 1, we explored the factor structure of systemic stigma (O'Hara & Gregg, 2012), and promotes equality for
the Fat Attitudes Assessment Toolkit (FAAT) and examined the all bodies (Rogge et al., 2004; Rothblum, 2012). As a result, most of
internal reliability. In Study 2, we confirmed the factor structure of the items are positively worded or depict positive representations of
the FAAT and examined the internal reliability, and construct and fat people. However, we did include some items that reflect a
criterion‐related validity. In Study 3, we examined the test‐retest ‘normative’ stance. Negativity towards fatness and fat people remains
reliability of the FAAT. a dominant part of contemporary fat discourse, and any comprehen-
sive measure of attitudes towards fat people needs to be able to
assess these beliefs. In developing these items, we were mindful of
2 | S TU D Y 1 : SC A L E D E V EL O P M E N T AN D using nonjudgmental language and avoiding references to disparaging
E X P L O R A T O R Y FA C T O R AN A L Y S I S character traits. In addition, we included items that were self‐
reflective in nature. Such items will potentially enable comparison
The objective of Study 1 was to develop an extensive item pool, between self‐focused positions in relation to fatness and other
reduce this pool to the most relevant items, and establish the initial focused evaluations.
structure of the measure. Phase one was item development. As we We recognize that labeling our target group in the items is an act
wanted to include items reflecting a range of beliefs and evaluations of othering (Meadows & Danielsdottir, 2016) and we considered the
of fatness and fat people, item development was informed by terms we used carefully. During item development, we used both
discourses around fatness, fat people, and “obesity” with a focus on terms, “fat” and “obese” (without the scare quotes), to reflect
critical discourse. To ensure the item pool was appropriately language used in the broader public discourse. Although fat
representing the construct of interest and accessible to a general acceptance messages have been instrumental in reclaiming the word
audience, we undertook both a subject matter expert review and a “fat” (Saguy & Riley, 2005), and fat is the preferred descriptive term
community review. Following this phase, we investigated the for many people (Thomas et al., 2008), the terms “obese” and
structure of the measure and identified latent constructs through a “overweight” remain in common public use. Therefore, we elected to
series of factor analyses. Exploratory factor analysis (EFA) allows begin with a range of terms, and respond to the advice of subject
items representing a similar construct to be grouped into factors and matter expert reviewers. The initial item pool consisted of 334 items
allows measurement length to be optimized (Worthington & spanning several domains, including: size acceptance, social justice,
Whittaker, 2006). Once the initial structure was established, the empathy for fat people, critical health, discrimination awareness, and
final phase used psychometric tests to reduce item numbers and fat shaming. Items are written as declarative statements with a
establish the internal consistency of the subscales. 7‐point Likert scale response option, ranging from (1) strongly disagree
to (7) strongly agree. A 7‐point Likert scale provides a good balance of
optimal variance and ease of participant response (Mueller, 1986).
2.1 | Item development Seven points also offers a neutral response option so that
participants do not need take an active position on items they deem
We followed the recommendations of Worthington and Whittaker not relevant.
(2006) for the development of items, including attention to the
simplicity of language, brevity, absence of ambiguity, singular focus,
and lack of bias. In generating the items, we studied a variety of 2.2 | Subject matter expert review
popular and academic sources including critical fat literature (e.g.,
Cooper, 1998, 2016; Pausé, 2017; Wann, 1998, 2009) and critical After creating the item pool, subject matter experts were invited to
biomedical literature (e.g., Campos, 2004; Gaesser, 2002). In addition, review. We compiled a list of academics and published researchers
previous work evaluating social media news commentary (Cain working in the field of fat studies and weight stigma scholarship,
et al., 2017), and women's responses to Health At Every Size and together with fat activist authors and bloggers, members of the
fat acceptance messages (Cain & Donaghue, 2018) were evaluated Association for Size Diversity and Health and the National Associa-
for item generation. We also developed items with potential research tion to Advance Fat Acceptance, and dieticians working within a
applications of the scale in mind, and therefore considered items that Health At Every Size framework. In total, 110 subject matter
aligned with constructs targeted for change in anti‐fat attitudes experts were sent details of the objectives of the project and the
research, such as empathy (Burmeister et al., 2017; Cotugna & nature of the review sought. Respondents agreeing to participate
Mallick, 2010), stigma awareness (Hilbert, 2016; Teachman were sent more information on the project and the item pool.
1124 | CAIN ET AL.
Options for review were a “yes/no” response as an indicator that 2.4 | Exploratory analysis of the factor structure
an item was appropriate for inclusion in a measure of attitudes
towards fatness. There was also an opportunity to provide In the final phase of Study 1, we examined the factor structure of the
comments and recommend additional items. As the item pool FAAT using EFA, which identifies a small number of factors or latent
was lengthy, we indicated that partial responses were welcome. constructs within many variables or items (Worthington &
Twelve reviewers provided feedback ranging in depth and volume. Whittaker, 2006). For measure development, EFA demonstrates
Overall response to the project was positive. In responding to the how well items group together to reflect the intended constructs.
expert feedback, we first reviewed and eliminated items that EFA also identifies items that may be a poor representation of a
reviewers deemed inappropriate, including items judged to be too specific construct through cross‐loading items, low loading items, and
vague, not appropriate for a general audience, or too repetitive. highly correlated items (Worthington & Whittaker, 2006). Items can
Following this step, we considered the overall terminology used then be removed from further analysis, reducing the item pool to the
across items. There was consensus that the term fat should replace most relevant items. Given the breadth of the 148 items subjected to
the term “obese,” and we revised several items on this basis. Next, analysis, and the intended purpose of the scale, we anticipated that
we revised items for clarity according to additional feedback. Some the EFA would provide preliminary evidence for the multidimensional
subject matter experts recommended additional items, and we factor structure of the FAAT.
included six new items. After revisions, the item pool included 150
items that spanned five domains: beliefs about fatness (50 items),
positive evaluations of fat people (18 items), awareness of weight 2.5 | Methods
stigma (41 items), attitudes toward size acceptance (34 items), and
personal embodiment/self‐beliefs (7 items). 2.5.1 | Participants and procedure
Obtaining a sample that is both representative of the population of

2.3 | Community review interest and sufficiently sized is important (Springer et al., 2002).
Many current anti‐fat attitude measures were developed with
While the goal of the subject matter expert review was to establish university/college student populations. For our analysis, we sourced
the appropriateness of items, the goal of the community review a sample that was more reflective of the general population. We used
was to determine the accessibility of items; that is, whether Prolific, a crowdsourcing platform established in the United Kingdom,
members of the public found terms confusing, ambiguous, or to recruit all sample participants. We acknowledge that research
unfamiliar, and whether the Likert scale response option was participants recruited in this way may not fully represent the general
considered appropriate. We recruited a convenience sample population. However, platforms such as Prolific are shown to deliver
(n = 22) from contacts of the first author. Thirty‐five adults, who participants who are more honest and higher quality when compared
were not experts on the topic, were approached via social media to those from a university subject pool (Peer et al., 2017). Ethics
with details of the project. Willing participants were provided the approval for data collection was granted by Murdoch University
list of 150 items and asked to provide general feedback on item Human Research Ethics Committee.
clarity, the familiarity of terms, and ease of response. Participants As most existing measures recruited American participants, a
were instructed not to provide responses to items. sample of 751 American adults (at least 18 years old) was recruited.
Overall, respondents did not identify any significant concerns The sample was similar in age (median age 38.2) and education
with item content or the scoring options. Some double‐barreled attainment (Bachelor's degree 36%) to the general American
items were identified and subsequently split, for example, “I think population (United States Census Bureau, 2018). See Table 1 for
it's important to try and achieve body norms and ideals” became sample information. To ensure equal numbers of men and women,
two separate items, one referencing body norms and one participants were pre‐screened according to their gender identifica-
referencing body ideals. In total, we added four items. We tion. There were no other inclusion/exclusion criteria. Participant
eliminated six items based on feedback that it was difficult to numbers for the EFA were determined based on the guideline of five
respond to those items using the Likert scale provided. At the end responses per scale item (Tabachnick & Fidell, 2007), which would be
of this phase, 148 items remained. Items were grouped broadly at a minimum sample size of 740 for our 148 items.
this stage into three categories: items pertaining to attributions for The study was advertised to participants registered with Prolific
weight, beliefs about health, and evaluations of fat people (52 as an investigation of attitudes, beliefs, and evaluations related to
items, e.g., “Healthy bodies come in all shapes and sizes”); items fatness, weight stigma, and size acceptance. Interested participants
relating to evaluations of weight stigma and size acceptance (85 provided consent and then completed the 148‐item survey hosted on
items; e.g., “Fat shaming is unacceptable”); and items relating to the Qualtrics platform. Items were presented in a system‐randomized
personal embodiment/self‐beliefs (11 items; e.g., “My self‐esteem order and the survey was structured so that a response was required
is not impacted by my body weight”). before moving on to the next question. All items were rated using a
CAIN ET AL. | 1125
TABLE 1 Sociodemographic characteristics of participants in Study 1.
Study 1 Study 2 Study 3

n % Age M (SD) n % Age M (SD) n % Age M (SD)
Gender
Women 369 47.8 36.77 (12.57) 191 49 32.68 (11.62) 50 48.5 31.69 (10.71)
Men 378 49.1 34.62 (11.17) 196 50.2 30.84 (8.70) 52 50.5 29.90 (8.72)
Other 4 0.5 26.00 (3.92) 3 0.8 22.67 (2.89) 1 0.01 21
Education
Middle school 10 1.3 4 1.0 1 1.0
High school 77 10 46 11.8 13 12.6
Some college 156 20.2 101 25.9 25 24.3
2‐year degree 71 9.2 40 10.3 9 8.7
4‐year degree 308 39.9 129 33.1 38 36.9
Professional degree 101 13.1 58 14.9 15 14.6
Doctorate 27 3.5 12 3.1 2 1.9
Identifying as Fat
Yes 227 29.4 38.26 (12.33) 87 22.3 34.2 (11.26) 23 22.3 31.69 (10.71)
No 465 60.3 34.50 (11.87) 264 67.7 30.94 (10.06) 70 68.0 29.90 (8.72)
No response 79 10.3 39 10 10 9.7
response scale from 1 (Strongly Disagree) to 7 (Strongly Agree). On axis factoring with oblimin rotation (which allows for factor
completion, participants were asked to indicate their gender, age, and correlation) on the 148 items to examine the factor structure of
highest level of education. Participants were paid the equivalent of the FAAT (Kline, 2000). The initial solution produced a 13‐factor
$9.00 an hour (USD) for their time. Not all participants replied to all structure with eigenvalues greater than 1.00. Given that we wanted
demographic questions (we estimate less than 3% missing data). factors to reflect meaningful distinct constructs of inter‐related
Lastly, participants had the opportunity to respond to the optional content, items loading on more than one factor (Cudeck &
question, “Do you identify as fat?” with a Yes/No option. Approxi- O'Dell, 1994) or demonstrating low factor loadings (<0.30; Aspar-
mately onethird (29.4%) of the sample identified as fat (see Table 1). auhov & Muthén, 2009) are problematic. After excluding 10 cross‐
This item was included to enable us to assess whether a consistent loading and 69 low loading items, 79 items remained across 13
factor structure existed for fat and nonfat participants. factors with eigenvalues greater than 1.00. Inspection of the scree
plot (Carpenter, 2018) showed eigenvalues declining markedly after
six factors, consequently, we conducted another EFA to extract six
2.6 | Results factors. Given the early elimination of so many items due to
loading < 0.30, all 148 items were included. This fixed factor solution
2.6.1 | Data screening presented more meaningful factors. The solution converged in 23
rotations, and after cross‐loading items and low loading items (<0.30)
We cleaned the data and screened for unusual and common response were removed the solution included 121 items (see Table 2). Factor 1
patterns. Completing duplicate surveys from the same IP address was included 61 items that related to empathy, discrimination, and size
not permissible. Due to the forced item response, there were no acceptance. Factor 2 included 21 items that related to the “causes” of
missing responses. fatness. Factor 3 included nine items related to the evaluation of the
injustice faced by fat people. Factor 4 included 15 items related to
health and attractiveness. Factor 5 included nine items related
2.6.2 | Exploratory factor analyses to control and responsibility. Factor 6 included six items related to
self‐reflection on one's own weight and body size.
We first examined the suitability of the 148 items comprising the Scale development is an iterative process (Worthington &
item pool for factor analysis. The Kaiser–Meyer Olkin index of Whittikar, 2006) and we decided to look more closely at the largest
sampling adequacy (0.97) indicated the sample was factorable. All factor. Although the 61 items in Factor 1 were broadly related to
analyses were performed in SPSS 24.0 (IBM, 2016) We used principal each other, we noted different concepts present. To investigate this
1126 | CAIN ET AL.
TABLE 2 Item‐factor loadings for the EFA solution with 121 items in Study 1
Item 1 2 3 4 5 6
We need to take weight‐based discrimination as seriously as other forms of 0.868

discrimination
We should have public health campaigns that focus on the negative impact 0.855
of weight stigma and fat shaming
Discussions and programs recognizing diversity need to include body 0.851

weight
The media should not portray fat people negatively 0.819
The existence of organizations to lobby for the rights of fat people is a 0.783
good thing
Film and television programs should not portray fat people negatively 0.780
Activism is necessary because of the discrimination fat people experience 0.775
Public spaces should accommodate all body sizes 0.758
Size acceptance is an important social movement 0.746
We need more positive images of fat people in the media 0.745
There is a need for Fat Activism because fat shaming is widespread 0.738
As a society, we need to eradicate weight‐based discrimination 0.737
It is important to see fat people represented positively in the media 0.736
Similar to other types of discrimination, it should be illegal to discriminate 0.714

against someone because they are fat
Discrimination due to fatness leads to a denial of human rights 0.710
Rather than fat people changing their bodies; society needs to change the 0.706
way it responds to fat bodies
Size acceptance is a foundation for making healthy lifestyle choices 0.701
We need to stop using the word fat as an insult 0.692
Size acceptance should be encouraged 0.690
We should celebrate all bodies 0.676
Health professionals have a responsibility not to contribute to weight 0.674

stigma
Fat people need acceptance not expressions of contempt 0.650
It makes me angry to hear someone being insulted for being fat 0.621 0.310
All bodies should be considered equally valuable 0.621 0.308
Accepting other people's bodies is important 0.613
As a society, we need to stop trying to change people's bodies 0.594
Fat people are treated badly because of the way society depicts fat bodies 0.592
Health professionals should make fat patients feel comfortable 0.589
Size acceptance does not encourage obesity 0.579
The idea that you can be healthy at any size is a positive message to 0.577 0.369
promote
It is not ok to comment on another person's weight 0.572
I sympathize with fat people who face discrimination 0.572
Weight stigma contributes to poor health 0.549
All bodies are good bodies 0.549

CAIN ET AL. | 1127
TABLE 2 (Continued)
Item 1 2 3 4 5 6
Fat shaming is unacceptable 0.537 0.381
Health professionals should be aware of the negative impact of weight 0.535

stigma
Item 1 2 3 4 5 6
I like the inclusion of larger bodied models in advertising campaigns 0.520
Shaming people for being fat does not encourage them to lose weight 0.511
Weight‐based discrimination can severely limit quality of life 0.501
Weight‐based discrimination negatively impacts on well‐being 0.493 −0.322
Size acceptance promotes an unhealthy lifestyle −0.481 0.315
Self‐esteem shouldn't change just because our bodies do 0.481
Fat people face discrimination in many areas of life 0.476
Bodies of all sizes deserve equal rights 0.469
Fat people face employment based discrimination 0.467
Weight loss advice given to fat people is patronizing 0.455
Having to contend with weight stigma and discrimination would be difficult 0.425 −0.372
Weight‐based discrimination does not motivate people to lose weight 0.425
Accepting your body is important 0.422
Item 1 2 3 4 5 6
Weight focused approaches to health contribute to discrimination against 0.421

fat people
Feeling good about one's weight is difficult in today's society 0.411 −0.355
Public health messages should focus on improving health rather than losing 0.408
weight
If fat people don't like being discriminated against, they should lose weight 0.405 −0.401
Negative beliefs about body weight lead to negative assumptions about fat 0.389
people
It is hard to accept your body if it differs from what the media represents as 0.388
normal
When it comes to other people's weight we should mind our own business 0.384
We should focus less on losing weight and more on achieving health 0.379
Concern for health is used as an excuse to judge fat people 0.363
Fat people are not lazy 0.321
We need to stop promoting weight loss diets as healthy 0.316
The food we eat plays a small role in maintaining our body weight 0.312
Item 1 2 3 4 5 6
Long term weight loss is hard to maintain 0.304
There are medical factors that cause people to be fat −0.626
Sometimes emotional eating leads to fatness −0.578
There are genetic factors that cause people to be fat −0.570
Psychological factors can lead people to become fat −0.563
There are biological factors that result in people being fat −0.550
(Continues)
1128 | CAIN ET AL.
TABLE 2 (Continued)
Item 1 2 3 4 5 6
The availability of high calorie food makes it easy to gain weight −0.538
There are factors outside of personal control that contribute to high body −0.527
weight
Weight gain can be a side effect of taking particular medications −0.511
Lack of knowledge about food and nutrition can lead to fatness −0.502
Weight is influenced by metabolism −0.499
Our environment has contributed to population weight gain −0.480
The low price of ‘fast food' has contributed to population weight gain −0.438
There are many factors that cause people to be fat −0.431
Item 1 2 3 4 5 6
Feeling bad about one's body can be a response to being fat shamed −0.411
The cycle of dieting and regaining weight is detrimental to health −0.358
People today are the descendants of generations who survived famine and −0.347
drought
The media only portrays a few body types as desirable .320 −0.342
Western societies tend to focus negatively on fat people −0.340
The medical costs associated with being fat are considerable 0.325
Busy lifestyles have contributed to population weight gain −0.316
Fat people are discriminated against because they are considered −0.309
responsible for their weight
Being fat does not make a person unworthy of opportunity 0.677
Being fat does not make a person unworthy 0.649
Being fat does not make a person unworthy of inclusion 0.643
All people, regardless of body size deserve respect, equity, and dignity 0.598
Fat people should not need to defend themselves as being worthy of existence 0.514
Item 1 2 3 4 5 6
Fat people do not need to apologize for being fat 0.315 0.505
You can be fat and feel good about yourself 0.494
Fat people should be treated with respect 0.378 0.490
It is wrong to attack people because they are fat 0.406 0.460
Everyone should have the right to make their own choices around food 0.450
Fat people do not need to explain why they are fat 0.442
You can be fat and happy 0.438
Fat people do not need to justify their weight 0.324 0.425
Successful and lasting weight loss is rarely achieved −0.334 0.304
The negative health consequences of high weight are exaggerated 0.668
Fat people are not necessarily unhealthy 0.655
Fat people can be healthy 0.631
Body weight isn't a reliable indicator of health 0.568
Fat people are sexy 0.539
There is nothing wrong with being fat 0.319 0.520

CAIN ET AL. | 1129
Item 1 2 3 4 5 6
Fat people can live longer than thin people 0.507
Fat people can be fit 0.505
Fat people are attractive 0.502
You cannot tell how healthy someone is from their body size 0.498
Bodies come in all sizes, fat bodies are a part of normal human diversity 0.324 0.481
Body Mass Index (BMI) is a poor indicator of health 0.480
Fat people are less likely to die of cancer than thin people 0.477
Obesity should not be considered a disease 0.460
The actual change on average population weight has been exaggerated 0.457
Fat people are sexier than thin people 0.357 0.452
Fat bodies are capable bodies 0.323 0.340 0.435
Fat bodies are not bad bodies 0.327 0.317 0.433
Fat people are happier than thin people 0.417
Healthy bodies come in all shapes and sizes 0.351 0.410
You can be fat and sexy 0.377 0.399
Item 1 2 3 4 5 6
Health is not predicted solely by body weight −0.339 0.362
For any weight, there are people who are healthy and people who are not 0.358
That “obesity” is classified as a disease leads to more negative perceptions 0.347

of obese people
Weight loss advice given to fat people is simplistic 0.311

I think it's important to try and achieve a socially ideal body 0.631
I think it's important to try to achieve recommended body norms −0.596
I feel like I should follow government recommendations around health and −0.564
fitness
I feel like I should follow government dietary recommendations −0.527
People can control their body weight −0.457
Overeating and under exercising are the main reason people are fat −0.433
Fat people are a burden on the health system −0.345
Fatness is the result of lifestyle choices −0.308
Being fat is worse for men 0.305
Item 1 2 3 4 5 6
I feel good about my body 0.795
I feel happy about my weight 0.764
I do not feel defined by my body weight 0.635
My self‐esteem is not impacted by my body weight 0.608
I think I will be judged negatively if I gain weight 0.596
Knowing that society is making negative assumptions because of your −0.324

weight would make it hard to feel good about yourself
Note: N = 751.
1130 | CAIN ET AL.
factor further, an EFA was conducted on these 61 items only, was labeled Size Acceptance and included 16 items that reflect
indicating the presence of two separate factors, for a total of seven acceptance of and support for diverse body weights and shapes
factors overall. Following removal of cross loading and low loading (Cronbach's α = .96).
items, 56 items remained. Of the seven factors, four factors were
deemed meaningful: disapproval of fat‐shaming (13 items), empathy
(12 items), recognition of injustice and discrimination (8 items), and 2.7 | Discussion
fat acceptance (13 items). We decided to retain the items relating to
empathy as Factor 1. The items relating to disapproval of fat shaming Our objective in Study 1 was to develop a representative set of
and recognition of injustice were combined with items from the items and establish a preliminary structure for the measure. We
original Factor 3 above (evaluation of injustice) and the items relating initially developed 334 items to capture the breadth of contempo-
to fat acceptance created a new factor, Factor 7. Following this rary fat discourse and to reflect critical and fat positive attitudes
additional step, we were left with seven meaningful factors and 106 and beliefs. To ensure relevance and accessibility items went
items. through a two‐phase review process which guided our deletion
and addition of items. We subjected 148 items to the initial EFA
with an American sample, which revealed a complex factor
2.6.3 | Refining subfactors and estimating of structure. As scale development is both theory‐driven and data‐
reliability driven (DeVellis, 2012), we worked through different factor
analyses and reliability analyses to arrive at a preliminary solution
A major goal of this stage was to reduce the pool of items down to of 7 factors with 72 items. The aim of Study 2 was to finalize the
those best representing the subscales and the overall construct. content and structure of the measure, perform a confirmatory
Stanton et al. (2002) and others (e.g., Smith et al., 2000; K. F. factor analysis (CFA) to confirm the structural validity of the
Widaman et al., 2011; A. Wieland et al., 2017) note that there are no measure, and examine the measure's construct and criterion‐
agreed standards as to the steps that should be taken to reduce the related validity.
number of items although there is acknowledgment that the process
of item reduction is highly iterative (Worthington & Whittaker, 2006).
Having established the underlying factor structure using the 3 | STU DY 2 : C ONFI RM ATORY FAC T OR
complete pool of items we then conducted additional EFA, somewhat A N A L Y S I S A N D SC A L E V A L I D I T Y
like item parceling (Meade & Kroustalis, 2006). This step served to
identify problematic items while ensuring that sufficient items were Evidence for the structural and content validity of existing measures
retained to represent the construct while balancing the need for of anti‐fat attitudes is limited (Morrison et al., 2009). In Study 2, we
parsimony versus the desire for replicability and generalization (Little sought to demonstrate that the FAAT is structurally robust and
et al., 1999; Velicer & Fava, 1998). During this process items conceptually valid. The objectives of this study were to first replicate
contributing to the internal consistency of each scale were also the exploratory factor structure in a new sample, second to
identified using Cronbach's alpha and alpha if item deleted estimates determine how well the structure fits with the measurement model
(DeVellis, 2012). Items not contributing to internal consistency were through confirmatory factor analysis (CFA), and third to establish the
deleted in an iterative process to optimize scale length. Cronbach's validity of the measure in relation to several theoretically related
alpha of above 0.8 indicates good internal consistency, although constructs. While data gathered for exploratory analysis can be used
levels of above 0.7 are also deemed appropriate (DeVellis, 2012; for confirmatory analysis, a second sample ensures that chance
Kline, 2000). effects do not confound conclusions about the measure
Factor 1 was labeled Empathy and included 12 items that reflect (DeVellis, 2012). Furthermore, CFA is important for measure
empathic responses toward fat people (Cronbach's α = .90). Factor 2 development as it allows for structural relationships between factors
was labeled Attributional Complexity and included 11 items that to be tested, including potential hierarchical relationships among
reflect recognition of causal attributions for fatness (Cronbach's factors (Byrne, 2001). To continue to optimize the length of the scale,
α = .90). Factor 3 was labeled Activism Orientation and included 9 we also use CFA to identify redundant items.
items that reflect recognition of the seriousness and injustice of Before embarking on the CFA, we first looked at the factors and
weight‐based discrimination (Cronbach's α = .95). Factor 4 was items retained from Study 1, making some additions to ensure
labeled Health and Attractiveness and included 15 items that reflect adequate construct representation. Where new items were devel-
perceptions of the health and attractiveness of fat people (Cron- oped, they followed a similar format to existing items. The Health and
bach's α = .92). Factor 5 was labeled Responsibility and included three Attractiveness factor included only two items relating to attractive-
items that reflect neoliberal ideas around control and responsibility ness and to bolster this component we added three more items
for weight (Cronbach's α = .73). Factor 6 was labeled Body Acceptance referring to attractiveness. The Responsibility factor included other‐
and included six items that reflect respondents' own acceptance of focused items, since we were aiming to have both other‐focus and
and satisfaction with their body weight (Cronbach's α = .84). Factor 7 self‐focus represented by this factor, we added three more items that
CAIN ET AL. | 1131
were self‐focused to bolster this component of the factor. This current study. Rather than make broad comparisons we focused on
process resulted in 78 items for the CFA. measures with items that focused on similar constructs to our
Following the data collection for the CFA and validity tests, we subscales. For convergent validity, we examined the association
again reviewed the items and noted an important omission. From the between the Beliefs about Obese Persons Scale (BAOP; Allison
outset we had not included any items relating to economic or et al., 1991) and the Responsibility subscale of the FAAT. The BAOP
socioeconomic factors when assessing complexity. To amend for this, measures the extent to which respondents consider weight to be
four new items were added to the existing items on complexity, and under a person's own control. We expected that scores on the BAOP
another round of data collected. It should be noted that the would be positively correlated with the Responsibility subscale of the
additional items relating to socioeconomic complexity were added FAAT. For discriminant validity, we examined the associations
after validation data and test‐retest reliability data was collected. between two subscales of the Antifat Attitudes Questionnaire (AAQ;
Therefore, the number of factors varies across the different analyses Crandall, 1994) and the FAAT. Specifically, we expected that scores
presented, in some instances we present results for the Complexity on the AAQ's Dislike subscale, which measures a dislike of and desire
subscale and in other instances we present results for both General to dissociate from fat people, would be negatively correlated with the
Complexity and Socioeconomic Complexity. We have noted where Empathy and Size Acceptance subscales of the FAAT; and scores on
this occurs in the presentation of the results. the AAQ's Fear of Fat subscale, which measures personal concerns
To establish the initial psychometric properties of the scale, we around weight and weight gain, would be negatively correlated with
examined mean subscale scores for the total sample, as well as by the Body Acceptance subscale of the FAAT. In addition, we expected
gender and fat identification group. Given that men report higher that scores on the Physical/Romantic Unattractiveness subscale of the
antifat attitudes than women (Crandall, 1994; Ferguson et al., 2009; Anti‐fat Attitudes Test (AFAT; Lewis et al., 1995), which measures
Magallares & Morales, 2013), and women experience higher levels perceptions of fat people as unattractive and undesirable partners,
of weight stigma and discrimination than men (Fikkan & would be negatively correlated with the Attractiveness subscale of
Rothblum, 2012), we expected gender differences on the FAAT. the FAAT.
Also, despite studies showing that fat people internalize weight In the current study, we also examined the association between
stigma and endorse anti‐fat attitudes (Puhl et al., 2007), we the FAAT subscales and social dominance orientation as a test of
expected more nuanced differences to emerge given the nature of construct validity. Social dominance orientation refers to the
the FAAT scale. We also examined the internal reliability of the dispositional tendency to prefer conditions that reinforce and sustain
FAAT subscale scores. unequal social hierarchies with some groups holding more power and
We also examined initial evidence for the validity of the FAAT. resources than other groups (Pratto et al., 1994). Past studies have
DeVellis (2012) identified three types of validity—content validity, demonstrated that negative attitudes toward fatness are linked to
construct validity, and criterion validity—as ways to determine neoliberal ideologies, and notions of individual responsibility, political
adequate scale validation. Content validity is related to the conservatism, anti‐gay prejudice, and tolerance of difference
representativeness of the item pool, and the extent to which items (Crandall & Schiffhauer, 1998; Perez‐Lopez et al., 2001; Pratto
are illustrative of the domains intended (DeVellis, 2012). As described et al., 1994; Quinn & Crocker, 1999). We expected that attitudes
in Study 1, we attended to the issue of content validity in developing toward fat people as assessed by the FAAT would be associated with
our items in several ways: by drawing on multiple sources from the attitudes toward group‐based social hierarchies. Specifically, we
academic literature as well as fat activist writing to inform item expected that scores on the Empathy, Activism Orientation, and
generation as well as soliciting feedback on our item pool from Responsibility subscales would be negatively correlated with total
subject matter experts and community members. For these reasons, scores on the short form of the Social Dominance Orientation scale
it is our judgment that the items have established content validity. In (SDO–SF; Ho et al., 2015). As our measure includes an empathy scale,
Study 2, we focus on tests of construct and criterion‐related validity. to establish validity on the construct of empathy we included a
general measure of empathy, the Toronto Empathy Questionnaire
(TEQ; Spreng et al., 2009). We hypothesized that scores on the TEQ
3.1 | Tests of construct validity would be positively correlated with scores on the Empathy scale.
Construct validity establishes the degree to which a scale accurately

reflects the intended construct (Anastasi, 1986) and measures what it 3.2 | Socially desirable responding
intends to measure (Cronbach & Meehl, 1955). Relationships are
investigated against measures of conceptually similar constructs Knowing whether items elicit socially desirable responses, rather than
(convergent validity; Swank & Mullen, 2017) and theoretically distinct “true” responses, is also important for establishing the validity of a
constructs (discriminant validity; Kline, 1999). Where possible, we measure (Henderson et al., 1987). During the development of
identified scales to test the convergent and discriminant validity of previous scales, the Antifat Attitudes Test (Lewis et al., 1995), the
the FAAT subscales. Due to the novel nature of the FAAT, we were Antifat Attitudes Scale (Morrison & O'Connor, 1999), and the UMB‐
not able to test construct validity for every FAAT subscale in the FS (Latner et al., 2008) all measured social desirability using the
1132 | CAIN ET AL.
Marlowe–Crowne Social Desirability Scale (SDS; Crowne & unattractiveness of fat people (e.g., I can't stand to look at fat people).
Marlowe, 1960). Lewis et al. (1995) and Latner et al. (2008) report Items are scored on a 5‐point Likert scale ranging from 1 (Strongly
their scale development data free of influence form socially desirable disagree) to 5 (Strongly agree). Higher scores indicate more negative
self‐presentation while Morrison and O'Connor found a significant appraisal of the attractiveness of fat people. In this study, Cronbach's α
positive low correlation for women's response but not for men's. As was .88.
there has been critique over the continued relevance of items in the
SDS (Barger, 2002), we use the more recently developed, Social Beliefs About Obese Persons Scale (BAOP). The BAOP (Allison
Desirability Scale‐17 (SDS‐17; Strober, 2001) in this study. We et al., 1991) is an 8‐item scale that assesses beliefs about the causes
hypothesized that the FAAT subscales would be uncorrelated with of obesity and individual accountability (e.g., “Obesity is usually
social desirability. caused by overeating”). Items are scored on a 7‐point Likert scale
ranging from −3 (I strongly disagree) to 3 (I strongly agree). Higher
scores indicate that stronger agreement that weight is controllable,
3.3 | Methods and people are responsible for their weight. In this study, Cronbach's
α was .78.
3.3.1 | Participants
Social Dominance Orientation‐Short Form (SDO–SF). The SDO‐SF (Ho
We recruited participants through Prolific. Individuals who had et al., 2015) is an 8‐item scale that assesses individual differences in
completed Study 1 were excluded from participating. See Table 1 for the preference for group‐based dominance and inequality (e.g.,
demographic information. Participants were similar to Study 1, “Some groups of people are simply inferior to other groups of
although the sample was slightly younger, with somewhat fewer people”). The measure is scored on 7‐point Likert scale, ranging from
participants identifying as fat (22.3%). Participant numbers for the 1 (Strongly oppose) to 7 (Strongly favor). Higher scores indicate a
CFA are determined by the criteria of five responses per scale item stronger preference for systems of group‐based inequality where
(Tabachnick & Fidell, 2007). The FAAT was comprised of 78 items for higher status groups oppress lower‐status groups. In this study,
the CFA (we added the four items measuring socioeconomic Cronbach's α was .87.
complexity after the first round of data was already collected), and
therefore 390 participants were recruited (195 women and 195 men). Toronto Empathy Questionnaire (TEQ). The TEQ (Spreng et al., 2009)
As mentioned, we investigated items relating to socioeconomic consists of 16 items (α = .85) that assess empathy as an emotional
complexity after the initial data had been collected for the CFA and process and comprises of affect oriented items (e.g., “It upsets me to
validation study. We approached the same 390 participants with 258 see someone being treated disrespectfully”). Items are scored on a 5‐
responding, 133 women (Age M = 32.51; SD = 11.53) and 123 men point Likert scale ranging from 0 (Never) to 4 (Always). Higher scores
(Age M = 30.43; SD = 8.68). Being a subset of the original sample, indicate higher levels of general empathy. In this study, Cronbach's
both samples were demographically similar. Ethics approval for data alpha was .89.
collection was granted by Murdoch University Human Research
Ethics Committee. Social Desirability Scale (SDS). The Social Desirability Scale‐17 (SDS‐
17; Strober, 2001) was used to assess whether participant responses
were biased by the desire to respond is socially acceptable ways (e.g.,
3.3.2 | Measures “In traffic I am always polite and considerate of others”). The SDS‐17
includes 16 items (Item 4 was dropped from the final version of the
3.3.2.1 | Construct validity scale) and responses are scored as true (1) or false (0), with higher
scores indicating a stronger tendency to respond in socially desirable
Antifat Attitudes Questionnaire (AAQ). The AAQ is a 13‐item scale ways. In this study, Cronbach's α was .79.
comprising three subscales: Willpower, Dislike, and Fear of Fat
(Crandall, 1994). We included the subscales Dislike (7 items; e.g., “I
really don't like fat people much”) and Fear of Fat (3 items; e.g., “I 3.3.3 | Procedure
worry about becoming fat”). All items are scored on a 10‐point Likert
scale ranging from 0 (Very strongly disagree) to 9 (Very strongly agree). An online survey of 143 items, built using Qualtrics online software,
Higher scores indicate more negative attitudes towards fat people. In was shared through the Prolific website to registered participants,
this study, Cronbach's α was .93 and .83, respectively. and advertised as investigating attitudes, beliefs, and evaluations of
fatness, weight stigma, and size acceptance. After deciding to take
Antifat Attitudes Test (AFAT). The AFAT is a 47‐item scale with three part, participants were given more detail on the nature and
factors: Social/character disparagement, Physical/romantic unattractiveness, requirements of the study and information for informed consent.
and Weight control/blame (Lewis et al., 1995). We included the nine‐item We separated the 78 items from the Fat Attitudes Measure in Study
Physical/romantic unattractiveness factor to assess perceived 1 into three sections and presented these in varied order. After
CAIN ET AL. | 1133
TABLE 3 Factor correlations from EFA in Study 2
Factor 1 2 3 4 5 6 7
1. Empathy
2. Activism orientation .75**
3. Size acceptance .73** .80**
4. Attractiveness .48** .62** .66**
5. Critical health .58** .61** .65** .57**
6. Complexity .50** .47** .48** .30** .45**
7. Responsibility .30** .34** .33** .30** .35** .25**
8. Body acceptance −.09 .01 .03 .04 .09 −.00 −.12*
Note: N = 390. Due to later revision of the Complexity scale correlations for the subscale Complexity are presented instead of Socioeconomic Complexity
and General Complexity.
Abbreviation: EFA, exploratory factor analysis.
**Correlation is significant at the .01 level (two‐tailed).
*Correlation is significant at the .05 level (two‐tailed).
completing the FAAT items, participants completed the 65 items for evaluation of fat bodies. Eight meaningful factors emerged relating to
construct and criterion validity and socially desirable responding. At Empathy (11 items), Weight‐based Discrimination or Injustice (nine
the end of the survey, participants indicated their gender, age, and items), Size Acceptance (eight items), Attractiveness (five items), Critical
highest level of education, though not all participants replied to all Health (eight items), Complexity (seven items), Responsibility (six
demographic questions (we estimate less than 3% missing data). items), and Body Acceptance (four items). As anticipated, the factor
Participants could also respond to the optional question, “Do you structure was like the exploratory structure from the previous study.
identify as fat?” with a Yes or No response. Table 1 presents the EFA was then separately conducted on the Complexity items
sample demographics for Study 2. An addendum to the main survey (KMO = .879). Analysis indicated a two‐factor solution (Oblimin
was also sent to these same participants. This included five four rotation, converging in 7 rotations) and included all items. The first
additional items on socioeconomic complexity (items that were factor included six items relating to general complexity and the
developed in response to the analysis of the data in study two). The second factor included three items relating to socioeconomic
sample completed responses to the remaining eight items from the complexity. This meant that the complexity factor was renamed
Attribution Complexity factor plus the additional four items elating to General Complexity and we added a new ninth factor labeled
socioeconomic complexity. Socioeconomic Complexity.
Correlations between the factors are presented in Table 3. The
Body Acceptance subscale, which is an indicator of the respondent's
3.4 | Results own‐body related attitudes, was not correlated with the other
factors, r (388 = .01–.12; ps > .05 (mean r = .05). Aside from this,
We screened data for unusual and common response patterns. Due Empathy, Discrimination, Size Acceptance, Attractiveness, and Health
to forced item response, there was no missing data. Before analysis, showed moderate to strong associations with each other, r
the Kaiser‐Meyer Olkin measure of sampling adequacy was exam- (388) = .48–.80; ps < .01 (mean r = .65), indicating these factors were
ined, with KMO = .953 (well above the acceptable level of .6), the potentially tapping into a similar latent construct (Cohen, 1988). The
sample was considered factorable. General Complexity and Socioeconomic Complexity subscales were also
strongly associated, r (388) = .60, p < .01.
3.4.1 | Exploratory factor analysis

3.4.2 | CFA
We conducted initial factor analysis using Principal Axis Factoring
and Oblimin rotation on 78 items, which included the additional four We conducted the CFA according to the guidelines by Byrne (2001)
items on socioeconomic complexity, with factor loadings less than .40 and used SPSS Amos Version 24.0. To establish the consistency of
suppressed. The increase in supressed loading value was to ensure the model fit, several indices were reviewed (Schreiber et al., 2006):
that only items making the strongest contribution were included. As a the Root Mean Square Error of Estimation (RMSEA; values < .08
result of this decision, 24 items were eliminated. Most items were indicate reasonable fit and values < .05 indicate good fit); the
eliminated from the larger factors pertaining to size acceptance and Goodness of Fit Index (GFI; values > .90 indicate good fit); and the
1134 | CAIN ET AL.
TABLE 4 Summary of CFA model fit indicators in Study 2
FAAT subscale χ2 p df χ2/df TLI CFI RMSEA
Empathy 26.60 .014 13 2.046 .984 .990 .052
Activism orientation 33.74 .001 12 2.811 .984 .991 .068
Size acceptance 17.40 .026 8 2.175 .991 .995 .055
Attractiveness 1.48 .224 1 1.477 .996 1.00 .035
Critical health 11.83 .037 5 2.367 .979 .990 .059
General complexity* 11.55 .173 8 1.443 .990 .995 .042
Socioeconomic complexity* .44 .510 1 .435 1.003 1.00 .000
Responsibility 12.62 .027 5 2.524 .974 .991 .063
Body acceptance 1.52 .218 1 1.52 .996 .999 .036
Composite scores
Fat acceptance** 83.68 .005 37 2.162 .946 .952 .055
Attribution complexity*** 29.15 .064 19 1.534 .985 .992 .046
Note: N = 390.
Abbreviations: CFA, confirmatory factor analysis; CFI, comparative fit index; FAAT, Fat Attitudes Assessment Toolkit; RMSEA, Root Mean Square Error of
Estimation; TLI, Tucker–Lewis Fit Index.
*n = 258.
**Fat Acceptance reflects mean composite scores comprised of Empathy, Activism Orientation, Size Acceptance, Attractiveness, and Critical Health.
***Attribution Complexity reflects mean composite scores comprised of General Complexity and Socioeconomic Complexity.
Tucker–Lewis Fit Index (TLI; values > .90 indicate good fit). We also Disagree) to 7 (Strongly Agree). Means are included for the total
examined χ as an indicator of model fit. While a nonsignificant χ ,
2 2
sample, men, women, fat‐identified and not fat‐identified. The total
(p > .05) indicates good model fit, χ2 is particularly sensitive to large score mean for the Fat Acceptance composite score was 4.70
sample sizes (Byrne, 2001), and as such, where models produced (SD = 1.13) and for the Attribution Complexity composite score was
significant χ values, we looked to additional indicators to assess
2
5.54 (SD = 0.89).
model fit. At this time, we also reviewed modification indices for Table 6 also presents the reliability coefficients for the subscales
redundant items, that is, items generating highly similar responses. and composite scales for the total sample, men, women, fat identified
For the sake of parsimony, redundant items were deleted until a and not fat identified. Reliability coefficients in the form of
satisfactory model fit was achieved for each factor. In total, nine Cronbach's alpha for all samples were above 0.80 and showed a
items were removed. relatively consistent pattern across sub‐samples (see Table 6),
Table 4 presents the fit indices for each of the nine factors. The CFI, indicating that all scales demonstrated good internal consistency
TFI and RMSEA all indicated good fit of the model to the data. Then, we across the different groups (Kline, 2000). Despite some minor
returned to the highly correlated factors to determine whether these variations in scores, these findings demonstrate the consistency of
factors suited a hierarchical model. The same CFA process was followed the psychometric properties of the scale.
(Byrne, 2001) with a good second‐order model fit indicated for two
higher‐order constructs. The scales Empathy, Activism Orientation, Size
Acceptance, Attractiveness, and Critical Health could be combined to create 3.6 | Construct validity
a composite Fat Acceptance score. The scales General Complexity and
Socioeconomic Complexity could be combined to create a composite We examined the associations between the FAAT subscales and the
Attribution Complexity score. The scales Responsibility and Body measures of construct validity, including Dislike (M = 2.11, SD = 1.89),
Acceptance are standalone scales. Table 5 presents the final item list Fear of Fat (M = 4.47, SD = 2.16), Physical/Romantic Unattractiveness
and factor loadings for the nine factors. (M = 3.15, SD = 1.19), and the Beliefs About Obese Persons scale
(M = 3.20, SD = 0.90). Table 7 presents the full matrix of zero‐order
correlations for these measures. We stated specific hypotheses for
3.5 | FAAT means and reliability some of the FAAT subscales. As expected, the Responsibility subscale
from the FAAT was strongly positively correlated with BAOP, r
Table 6 presents mean and standard deviation scores for each of the (388) = .62, p < .01. Given that the Responsibility subscale is reverse
nine FAAT subscales based on a response scale from 1 (Strongly scored, this indicates that dislike for fat people increases with greater
CAIN ET AL. | 1135
TABLE 5 Factor Loadings for Final Items for the FAAT in Study 2
Item‐level factor loadings from CFA

FAAT subscales 1 2 3 4 5 6 7 8 9
Empathy (7 items)
Negative beliefs about body weight lead to negative 0.743

assumptions about fat people
Fat people face discrimination in many areas of life 0.676
It is hard to accept your body if it differs from what the 0.633

media represents as normal
Weight‐based discrimination negatively impacts on 0.620

well‐being
Fat people are treated badly because of the way society 0.611
depicts fat bodies
Health professionals should be aware of the negative 0.494

impact of weight stigma
Concern for health is used as an excuse to judge fat people 0.446
Activism Orientation (7 items)
We need to take weight‐based discrimination as seriously 0.843

as other forms of discrimination
Activism is necessary because of the discrimination fat 0.705

people experience
Discrimination due to fatness leads to a denial of human 0.697

rights
Discussions and programs recognizing diversity need to 0.576

include body weight
The existence of organizations to lobby for the rights of fat 0.567

people is a good thing
There is a need for Fat Activism because fat shaming is 0.538

widespread
We should have public health campaigns that focus on the 0.416

negative impact of weight stigma and fat shaming
Size Acceptance (6 items)
Size acceptance should be encouraged 0.580
Size acceptance is a foundation for making healthy lifestyle 0.560

choices
We should celebrate all bodies 0.532
Size acceptance is an important social movement 0.529
Rather than fat people changing their bodies; society needs 0.512
to change the way it responds to fat bodies
We need more positive images of fat people in the media 0.447
Attractiveness (5 items)
Fat people are sexy 0.833
Fat people are attractive 0.801
Fat people are sexier than thin people 0.692
If I were single, I would go out with a fat person 0.655
Confident fat people are appealing 0.599
(Continues)
1136 | CAIN ET AL.
TABLE 5 (Continued)
Item‐level factor loadings from CFA

FAAT subscales 1 2 3 4 5 6 7 8 9
Critical Health (5 items)
Body weight isn't a reliable indicator of health 0.632
Health is not predicted solely by body weight 0.610
Fat people are not necessarily unhealthy 0.597
Body Mass Index (BMI) is a poor indicator of health 0.508
Healthy bodies come in all shapes and sizes 0.478
General Complexity (6 items)
There are biological factors that result in people being fat 0.914
There are genetic factors that cause people to be fat 0.840
There are medical factors that cause people to be fat 0.762
There are factors outside of personal control that 0.719

contribute to high body weight
There are many factors that cause people to be fat 0.547
There are environmental factors that contribute to people 0.409

being fat
Socioeconomic Complexity (3 items)
There are factors relating to social disadvantage that result 0.911

in people being fat
There are factors relating to social inequality that cause 0.887

people to be fat
There are economic factors that contribute to people 0.775

being fat
Responsibility (6 items)
Fatness is the result of lifestyle factors* 0.756
Self‐control is important for weight control* 0.730
Overeating and under exercising are the main reason 0.680

people are fat*
Fat people eat too much “junk food”* 0.606
Fat people lack willpower* 0.592
People can control their body weight* 0.571
Body Acceptance (4 items)
I feel good about my body 0.850
I feel happy about my weight 0.836
My self‐esteem is not impacted by my body weight 0.719
I do not feel defined by my body weight 0.641
Note: The final FAAT scale included 9 factors and 49 items. Response scale = 1 (Strongly disagree), 2 (Disagree), 3 (Mildly disagree), 4 (Neither agree or
disagree), 5 (Mildly agree), 6 (Agree), 7 (Strongly Agree).
Abbreviations: CFA, confirmatory factor analysis; FAAT, Fat Attitudes Assessment Toolkit.
*Item is reverse scored. Fat Acceptance Composite Score: Combine scores for Empathy, Activism Orientation, Size Acceptance, Attractiveness and Critical
Health. Attribution Complexity Composite Score: Combines scores for General Complexity and Socioeconomic Complexity.
CAIN
ET AL.
TABLE 6 Reliability coefficients and descriptive statistics for subscales and composite scales by gender and identifying as fat in Study 2
Gender (n = 387) Identifying as fat (n = 351)

Men (n = 196) Women (n = 191) Yes (n = 87) No (n = 264)
Full sample
(n = 390) α M (SD) α M (SD) t d α M (SD) α M (SD) t d
Empathy 5.24 (1.10) .89 5.04 (1.16) .85 5.43 (1.01) −3.49** 0.36 .85 5.56 (0.93) .89 5.17 (1.12) 2.90** 0.38
Activism orientation 4.61 (1.46 .94 4.43 (1.54) .95 4.79 (1.36) −2.41* 0.25 .95 4.91 (1.41) .94 4.52 (1.44) 2.20* 0.27
Size acceptance 4.70 (1.13) .94 4.45 (1.58) .93 4.99 (1.38) −3.62** 0.36 .93 5.11 (1.38) .94 4.62 (1.52) 2.69** 0.34
Attractiveness 3.79 (1.36) .92 3.66 (1.47) .88 3.93 (1.21) −1.99* 0.20 .88 4.23 (1.29) .91 3.59 (1.33) 3.91** 0.49
Critical health 4.93 (1.31) .83 4.80 (1.19) .84 5.05 (1.06) −2.15* 0.22 .84 5.03 (1.19) .82 4.88 (1.13) 1.01 0.13
Fat acceptance (composite) 4.70 (1.13) .96 4.51 (1.20) .96 4.88 (1.20) −3.26** 0.31 .96 5.01 (1.03) .96 4.60 (1.13) 3.01** 0.40
Responsibility 2.82 (0.94) .83 3.02 (0.91) .85 2.62 (0.93) −4.21** 0.43 .82 2.81 (0.91) .83 2.83 (0.95) −0.18 0.02
Body acceptance 4.36 (1.46) .81 3.95 (1.48) .85 3.00 (1.39) 5.68** 0.66 .85 3.00 (1.39) .76 4.79 (1.20) −11.49** 1.38
Men (n = 122) Women (n = 132) Yes (n = 53) No (n = 179)

General complexity 5.68 (0.84) .88 5.72 (0.81) .76 5.64 (0.70) 0.72 0.11 .76 5.64 (0.70) .87 5.65 (0.90) −0.07 0.01
Socioeconomic complexity 5.26 (1.13) .90 5.19 (1.27) .87 5.33 (1.29) −0.80 0.11 .87 5.33 (1.29) .91 5.20 (1.33) 0.60 0.01
Attribution complexity (composite) 5.54 (0.89) .89 5.54 (0.94) .89 5.55 (0.86) 0.12 0.01 .82 5.54 (0.70) .92 5.50 (0.95) 0.25 0.05
Note: Due to later revision of the Complexity scale figures for the subscales Socioeconomic Complexity and General Complexity and the composite scale Attribution complexity are shown separately.
α = Cronbach's alpha.
Abbreviation: SD, standard deviation.
**p < .01 (two‐tailed); *p < .05 (two‐tailed).
| 1137
1138 | CAIN ET AL.
TABLE 7 Summary of correlations among the FAAT subscales and validity measures in Study 3
Activism Size Critical Body

Factor α Empathy orientation acceptance Attractiveness health Complexity Responsibility acceptance
SDO‐SF .87 −.35** −.33** −.33** −.14** −.26** −.26** −.31** .17**
TEQ .89 .40** .32** .36** .23** .22** .31** .30** −.17**
SDS‐17 .79 −.07 .05 .14** .07 −.01 −.09 −.02 .16**
Fear of Fat (AFAS) .83 .01 −.06 −.05 −.03 −.11* .00 −.31 −.33**
Dislike (AFAS) .93 −.28** −.24** −.29** −.23** −.27** −.21** .42** .25**
BAOP .78 −.26** −.39** −.38** −.38** −.40** −.20** .62** .04
Physical/Romantic .88 −.47** −.46** −.56** −.53** −.45** −.34** .47** .19
Unattractiveness
(AAT)
Note: N = 390. Due to later revision of the Complexity scale correlations for the subscale Complexity are presented instead of Socioeconomic Complexity
and General Complexity.
Abbreviations: BAOP, Beliefs about Obese Persons Scale; FAAT, Fat Attitudes Assessment Toolkit; SDO‐SF, Social Dominance Orientation scale;
TEQ, Toronto Empathy Questionnaire.
**Correlation is significant at the 0.01 level (two‐tailed).
attribution of personal responsibility. As expected, the Size Acceptance demonstrated nonsignificant to weak correlations with all the
subscale from the FAAT demonstrated a weak, negative association subscales, r (388) = .01–.16; mean r = .07. As predicted, participants
with the Dislike subscale from the AAQ, r (388) = −.29, p < .01, and the did not respond to the FAAT items in ways that suggest a desire to
Empathy subscale from the FAAT was also weakly, negatively associated reflect favorable or socially acceptable viewpoints.
with Dislike, r (388) = −.28, p < .01. As hypothesized, the Body Acceptance
subscale from the FAAT was moderately negatively correlated with the
Fear of Fat subscale from the AAQ, r (388) = −.33, p < .01. Also, as 4 | D IS CU SS IO N
expected, the Attractiveness subscale form the FAAT was strongly,
negatively correlated with the Physical/Romantic Unattractiveness The objectives of Study 2 consisted of confirming the factor structure
subscale from the FAAT, r (388) = −.53, p < .01. for the FAAT, identifying the final set of items, and validating the
As expected, the Empathy, Activism Orientation, and Responsibility measure against a selection of related constructs. To achieve this,
subscales from the FAAT demonstrated weak to low moderate we recruited a new participant sample with which we replicated
negative correlations with scores on the SDO‐SF (M = 2.51, SD = the exploratory factor structure from Study 1, and incorporated the
1.27), and weak to moderate positive correlations with scores on the additional items developed at the conclusion of Study 1. Following
TEQ (M = 3.82, SD = 0.60). Scores on the SDO‐SF had the largest this, we tested the measurement model through CFA and investi-
negative correlation with the Empathy subscale, r (390) = −.35, gated hierarchical relationships. Throughout this phase, we continued
p < .01, indicating that stronger endorsement of group‐based the iterative process of removing items to optimize scale length. We
inequality was associated with less empathy toward fat people. As also determined reliability coefficients for the subscales and
expected, scores on the TEQ were moderately positively correlated demonstrated the consistent reliability of the subscales across sub‐
with the Empathy subscale, r (390) = .40, p < .01, indicating that these samples with different subscale scores. With the final structure of the
scales are tapping into similar constructs. While we expected a higher FAAT determined, we demonstrated initial validation for the
correlation, this result may point to a difference in general empathy subscales against a range of instruments to establish construct and
and empathy towards fat people. Correlations between the TEQ and criterion validity. We also demonstrated that participants do not
other subscales were also moderate in size, including Activism show evidence of social desirability bias in responding to our scales.
Orientation, r (388) = .32, p < .01, and Size Acceptance, r(388) = .36, The motivation behind the development of the FAAT was to
p < .01), suggesting some underlying association between empathy capture the nuance and complexity of contemporary attitudes
and these constructs. towards fat people. With nine independent psychometrically robust
scales, the final format of the FAAT delivers a flexible approach to
measurement. Researchers can select the scale(s) that best suits a
3.6.1 | Socially desirable responding research question or experimental strategy. As scales range in length
from four to eight items, selecting only the most relevant construct
Mean scores for the SDS‐17 (M = 12.36, SD = 2.67) were correlated for the research question can reduce participant burden. Alterna-
with mean scores on the FAAT subscales (see Table 7). The SDS‐17 tively, for more exploratory studies, all nine scales can be included to
CAIN ET AL. | 1139
investigate relationships between constructs, with a participant take part in the study, participants were given details on the
burden of 49 items. Although the FAAT does not provide a single requirements of the study and information allowing consent to
composite score of fat attitudes, the subscales can be combined to participate. Participants were administered the eight factor 49‐item
form two reliable composite scales for applications in which a finer‐ FAAT scale. As mentioned, the test‐retest data was collected before
grained exploration of attitudes towards fat people is not needed. the revision of the Complexity factor. As such results are shown for
The aim of Study 3 was to examine the test‐reliability of the FAAT the Complexity factor only and not the General Complexity and
over a two‐week time window to further establish the reliability of Socioeconomic Complexity factors. The survey was structured so that
the new scale. a response was required to respond before moving on to the next
question. On completion, participants were asked to indicate their
gender, age, and highest level of education. Not all participants
5 | S TU D Y 3 : TE S T‐ R E T E S T R E L I A B I L I T Y replied to all demographic questions. Lastly, participants had the
opportunity to respond to the optional question, “Do you identify as
In Study 3, our objective was to assess the test‐retest reliability of the fat?” with a Yes/No option. We stopped data collection after 103
final scale, which has not been widely reported for other measures of participants completed the survey, consistent with Kline's (2000)
fat attitudes (Lacroiz et al., 2017). Despite researcher's attempts to recommendation for at least 100 participants to establish test‐retest
change attitudes, they are generally considered to be enduring over reliability. See Table 1 for sample demographics. Ethics approval for
time (Petty & Cacioppo, 1986) and as such, reliable and valid data collection was granted by Murdoch University Human Research
measures should reflect this stability. By measuring the same Ethics Committee.
participants' response across two time periods we aim to demon-
strate test‐retest reliability and consistency of the measurement tool
(DeVon et al., 2007). The length of time between testing is an 5.2 | Results
important consideration. The time frame should be long enough to
reduce the chance of recollection bias and not long enough for actual To establish test‐retest reliability, we used two approaches. We
attitude change to occur (Marx et al., 2003). For this reason, we used examined the correlations across the FAAT subscale scores between
a two‐week assessment window which is considered an appropriate Time 1 and Time 2. Scores at Time 1 and Time 2 demonstrated large
time frame for establishing test‐retest reliability (Marx et al., 2003). positive correlations across the FAAT subscales, r (102) = .64 to .92
(mean r = .82), indicating good test‐retest reliability for all subscales
(see Table 8).
5.1 | Methods We also used a two‐tailed paired samples t‐test with an alpha
level of .05 to test for differences between the Time 1 and Time 2
5.1.1 | Participants, materials, and procedure mean scores across the nine subscales. No significant differences
were observed between Time 1 and Time 2 for Empathy, Activism
Participants from Study 2 were recruited for Study 3 as part of a Orientation, Size Acceptance, Critical Health, Complexity, Responsibility,
follow‐up study. We made the survey available to participants two and Body Acceptance, indicating good test‐retest reliability (see
weeks after they had completed Study 2 (n = 390). Once deciding to Table 8). For the Attractiveness subscale, slightly higher scores at
T A B L E 8 Summary of results for test‐

Time 1 Time 2
retest reliability by subscale in Study 3
Item grouping r M (SD) M (SD) t d
Empathy .841** 5.16 (1.13) 5.05 (1.18) 1.70 0.10
Activism orientation .842** 4.45 (1.55) 4.52 (1.55) −0.83 0.05
Size acceptance .915** 4.51 (1.57) 4.49 (1.52) 0.36 0.01
Attractiveness .791** 3.45 (1.35) 3.67 (1.39) −2.56* 0.16
Critical health .775** 4.67 (1.29) 4.74 (1.20) −0.85 0.06
Complexity .644** 5.49 (1.14) 5.49 (1.15) 0.06 0.00
Responsibility .806** 2.89 (0.90) 2.98 (1.03) −1.46 0.09
Body acceptance .840** 4.34 (1.44) 4.26 (1.46) 1.03 0.06
Note: N = 103. Due to later revision of the Complexity scale scores for the subscale Complexity are
presented instead of Socioeconomic Complexity and General Complexity.
Abbreviation: SD, standard deviation.
**p < .01 (two‐tailed); *p < .05 (two‐tailed).
1140 | CAIN ET AL.
Time 2 were observed, t (100) = −2.56, p = .012, d = −0.16 95% CI perspectives) to assess only fat positive constructs. The nuanced,
[−0.400 to −0.051], indicating more positive views of the attractive- multidimensional assessment of attitudes towards fat people enabled
ness of fat people at Time 2 compared to Time 1. by the FAAT represents an important shift away from more blunt and
stigmatizing approaches to measuring anti‐fat attitudes.
Five of the subscales reflect ideas that align with critical fat
5.3 | Discussion perspectives, and higher scores on these scales indicate more
positive evaluations of fat people. Their scores can also be combined
Study 3 established the reliability of the FAAT subscales over a two‐ to create an overall Fat Acceptance Composite score. Empathy
week time period, with strong associations observed over time for assesses the degree to which respondents recognize and empathize
each of the subscales. In addition, paired sample t‐test results with the negative evaluations that fat people face in everyday life,
demonstrated that scores for all FAAT subscales except the and the impact of these evaluations (e.g., “Fat people are treated
Attractiveness subscale did not significantly different between the badly because of the way society depicts fat bodies”). Activism
two time points. For the Attractiveness subscale, a higher score at Orientation reflects agreement with the idea that the discrimination
Time 2 indicated that participants rated fat people as more attractive faced by fat people is serious and unacceptable, and that such
two weeks later and suggests that this subscale may have some inequality should be eliminated (e.g., “We need to take weight‐based
temporal sensitivity. discrimination as seriously as other forms of discrimination”). Size
Acceptance reflects beliefs about accepting and celebrating bodies of
all sizes (e.g., “We should celebrate all bodies”). Attractiveness reflects
6 | G E N E R A L D IS C U S S IO N beliefs about the attractiveness of fat people (e.g., “Fat people are
sexy”). Critical Health reflects agreement with critiques around health
The FAAT represents a novel and comprehensive measure for and fatness (e.g., “Body weight isn't a reliable indicator of health”).
quantifying contemporary attitudes toward fat people and fatness, Three of the subscales reflect attributions made for fatness and
reflecting the more complex and nuanced public discourse around higher weight that are both within and outside of personal control.
fatness that has emerged since the development of earlier anti‐fat Higher scores on these scales indicate more complex understandings
attitude measures. In developing and validating the FAAT, we of fatness and greater consideration of external factors that influence
followed best practices in measurement design (DeVellis, 2012; body weight. General Complexity assesses attributions for fatness that
Nunnally & Bernstein, 1994; Worthington & Whittaker, 2006), and in reflect factors outside of individual control (e.g., “There are genetic
doing so addressed many limitations of current anti‐fat attitude factors that cause people to be fat”). Socioeconomic Complexity
measures (Lacroix et al., 2017; Morrison et al., 2009). We included assesses attributions for fatness that reflect social and economic
the advice of both subject matter experts and nonexperts to ensure a disparities (e.g., “There are economic factors that contribute to
representative and accessible item pool. Three studies determined people being fat”). These two subscales may be combined to create
the final structure and psychometric properties of the measure. an Attribution Complexity Composite Score and may be useful for
Exploratory and confirmatory factor analyses resulted in nine researchers wanting a broader measure of multiple causes of
subscales able to assess a broad range of attitudes and beliefs. Initial attribution, rather than targeting more specific dimensions. Responsi-
psychometric properties and evidence for construct validity were bility assesses internal attributions for fatness (e.g., “Fatness is the
established to support the reliability and utility of the scale. result of lifestyle factors”).
The nine subscales of the FAAT measure individual differences in Body Acceptance is a self‐reflective scale that allows researchers
attitudes related to fat acceptance (i.e., perceptions of weight‐based a way of capturing how respondents appraise their own bodies within
discrimination; endorsement of size acceptance; empathic responses the broader social context (e.g., “I do not feel defined by my weight”).
to fat people; consideration of the complex relationship between Higher scores reflect more positive and stable evaluations of the self
health and weight; and recognition of the attractiveness of fat that do not focus on weight. When used in combination with an item
people), causes of fatness (i.e., general complexity, socioeconomic assessing self‐identification as fat (or not), this scale allows explora-
complexity, and personal responsibility), and respondents' own body tion of whether attitudes towards fat people in general are associated
acceptance. with people's attitudes towards their own fat or nonfat bodies. This is
important because existing research is grounded in the assumption
that fat people simply internalize negative social attitudes towards
6.1 | Utility of the FAAT fatness, but, as discussed earlier, the increasing visibility of fat
acceptance and other body positivity movements raises interesting
The FAAT is comprised of nine subscales. The format of the FAAT as avenues for research on the relationship between one's own weight
a toolkit allows researchers to choose the “tool” (scale or scales) that status, body acceptance, and broader attitudes towards fatness.
best fits their needs and research questions. The format also allows A major aim guiding our development of the FAAT was to
researchers who do not want to engage with the constructs of develop an assessment tool that may be used to assess the
attribution or responsibility (because they reflect more normative effectiveness of weight‐stigma reduction interventions. For example,
CAIN ET AL. | 1141
interventions involving the presentation of material designed to critical weight researchers have a more palatable option for
evoke empathy for fat people (such as Burmeister et al., 2017; quantitative inquiry. Researchers who are interested solely in fat‐
Cotugna & Mallick, 2010; Falker & Sledge, 2011) will now be able to positive constructs can use scales such as Attractiveness, Size
assess their effectiveness using the Empathy subscale. Critical health Acceptance, Critical Health, and Activism Orientation, for example, to
interventions, such as those presenting material drawn from HAES quantify the endorsement of these critical perspectives on a large
(Humphrey et al., 2015), can directly measure endorsement of critical scale, making an important contribution to scholarship on fat attitude
ideas about the association between health and body size with the measurement.
Critical Health subscale, and examine whether their interventions
promote an understanding of the complex factors relating to fatness
with the Attribution Complexity subscale. Using the FAAT, weight 6.2 | Limitations and future directions
stigma researchers will now also be able to gain a more fine‐grained
understanding of the negative attitudes held towards fat people. For Though we adhered to best practice in measurement design
example, existing research has frequently found that negative (DeVellis, 2012) and addressed many limitations of current fat
attitudes towards fat people are common among health professionals attitude measures, we do not claim that the FAAT is the definitive
(Foster et al., 2003; Malterud & Ulriksen, 2011; Schwartz et al., 2003); solution when it comes to measuring attitudes towards fatness and
understanding the nature of this negativity can help to inform fat people. We propose that the nine subscales do cover the
programs designed to reduce anti‐fat bias in healthcare settings. dominant elements of contemporary fat discourse; however, this
In addition to incorporating key elements of fat‐positive taxonomy is not definitive. For example, there are discourses on
discourse into the assessment of fat attitudes, the FAAT retains the sexuality, intersectionality, and microaggressions that were beyond
ability to assess elements of traditional anti‐fat attitudes that remain the scope of our original item generation. Furthermore, there are
a dominant part of mainstream fat discourse (Cain et al., 2017). The several areas that were represented in the original item pool that did
subscales that measure beliefs about responsibility and attribution for not progress into factors and subscales. These include issues around
fatness not only provide insights into these constructs, but they also healthism, disability, children, and gender. Future scholars may want
enable researchers to assess the associations between these beliefs to extend this study and generate additional instruments for
and other, more fat‐positive attitudes. As mentioned, the notion of quantifying other social responses to fatness and fat people. We
individual responsibility has a long connection to anti‐fat attitudes acknowledge that revision of the Complexity Factor following
(Crandall & Biernat, 1990; Perez‐Lopez et al., 2001). As a result, validation data collection is a limitation. Future studies should
experimental stigma‐reduction research often attempts to shift attempt validation on these scales. Indeed, future factor analysis
negative attitudes by putting forward alternate attributions for and validation in different contexts may result in changes to the
fatness: for example, the role genetics play in weight (Lippa & composition of the scales. Our samples were comprised of American
Sanderson, 2012), that there are multiple determinants of weight participants and recruited through an online participant platform.
(Diedrichs & Barlow, 2011), and that environmental factors contrib- While more representative in terms of age and gender than a
ute to weight (O'Brien et al., 2010). This study has demonstrated university sample, we appreciate that future cross‐cultural valida-
limited effectiveness in reducing negative attitudes (Lee et al., 2014). tion, and validation among different samples, such as health
However, with the FAAT we could investigate whether change professionals, educators, and other sociodemographic groups, will
occurs in uniform ways. For example, do we need to change be important.
perceived attributions for weight to reduce stigma, or can empathy
or activism orientation be increased without shifting beliefs about the
causes of fatness? The FAAT provides scholars with a measurement 7 | CONCLUSION
tool to address new and more nuanced research questions about
contemporary fat attitudes. The FAAT is a new measurement tool designed to assess attitudes
A key feature of the FAAT is that it does not proceed from an towards fat people and fatness in ways that reflect the complexity
assumption that fatness is inherently problematic; items are written and multidimensionality of current social discourse around fatness. It
using fat‐neutral language and with respect for fat people. Existing was developed following best practices in measurement design and
anti‐fat attitude measures present a paradox for many researchers the nine subscales demonstrated robust psychometric properties and
working to reduce weight stigma in that the items in these measures validity in noncollege samples. With the incorporation of fat‐neutral
reproduce many of the toxic elements of anti‐fat culture that language, the FAAT provides a bias‐free and culturally sensitive
researchers are trying to change (Cain et al., 2021). Even though the measure of fat attitudes that demonstrates respect for fat people's
use (or indeed the creation) of anti‐fat measures is not an lived experience and provides a more positive experience for
endorsement of the statements themselves, having them included research participants. We are especially hopeful that the FAAT will
in research materials, often under the imprimatur of prestigious encourage researchers to consider and investigate the multifaceted
research institutions, can be seen as perpetuating and even nature of attitudes towards fat people that will inspire creative ways
legitimating the sentiments expressed in them. With the FAAT, to reduce weight stigma.
1142 | CAIN ET AL.
A C KN O W L E D G M E N T S Cain, P., Donaghue, N., & Ditchburn, G. (2022). Changing attitudes: A

We wish to acknowledge the subject matter experts who provided review and critique of weight stigma intervention research. In M.
Gard, D. Powell, & J. Tenorio (Eds.), Routledge handbook of critical
feedback on the initial item pool. Thanks to Dr Esther Rothblum, Dr
obesity studies. Routledge.
Deb Burgard, Dr Lindo Bacon, Dr Jason Whitesel, Dr Lucy Aphramor, Cain, P., Donaghue, N., & Ditchburn, G. (2021). Quantifying or contribut-
Natalie Ingram, Dr Maureen McHugh, Darliene Howell, Peggy ing to antifat attitudes? In K. Lebesco, & C. Pausé (Eds.), International
Howell, Kerry Beaks, Caitlin O'Reilly, and Olivia Monson. This study handbook of fat studies (pp. 26–36). Routledge.
Cain, P., Donaghue, N., & Ditchburn, G. (2017). Concerns, culprits,
has been funded by an Australian Postgraduate Award.
counsel, and conflict: A thematic analysis of ‘obesity’ and fat
discourse in digital news media. Fat Studies, 6(2), 170–188. https://
ORCID doi.org/10.1080/21604851.2017.1244418
Patricia Cain http://orcid.org/0000-0002-4377-3690 Campos, P. (2004). The obesity myth, New York. Gotham.
Campos, P., Saguy, A., Ernsberger, P., Oliver, E., & Gaesser, G. (2006). The
epidemiology of overweight and obesity: public health crisis or moral
E N D NO T E
panic? International Journal of Epidemiology, 35(1), 55–60. https://
1
In this article, we use the term fat to describe individuals with larger doi.org/10.1093/ije/dyi254
bodies, which is consistent with the Fat Acceptance Movement (Saguy Cardinal, B. J., Whitney, A. R., Narimatsu, M., Herbert, N., & Souza, B. J.
& Riley, 2005), and fat is the preferred descriptive term for many (2014). Obesity bias in the gym: An underrecognized social justice,
people (Thomas et al., 2008). diversity, and inclusivity issue. Journal of Physical Education,
Recreation and Dance, 85(6), 3–6. https://doi.org/10.1080/
07303084.2014.927668
REFERENCES Carpenter, S. (2018). Ten steps in scale development and reporting: A
Allison, D. B., Bastile, V. C., & Yuker, H. E. (1991). The measurement of guide for researchers. Communication Methods and Measures, 12(1),
attitudes toward and beliefs about obese persons. International 25–44. https://doi.org/10.1080/19312458.2017.1396583
Journal of Eating Disorders, 10(5), 599–607. https://doi.org/10. Cohen, J. (1988). Statistical power analysis for the behavioural sciences.
1002/1098-108X Erlbaum Associates.
Anastasi, A. (1986). Evolving concepts of test validation. Annual Reviews of Collison, B., & Rusbasan, D. (2016). Perceived and actual weight stigma
Psychology, 37(1), 1–15. https://doi.org/10.1146/annurev.psych.37. among romantic couples. Interposona, 10(2), 125–135. https://doi.
1.1 org/10.5964/ijpr.v10i2.206
Aphramor, L. (2005). Is a weight‐centered framework salutogenic? Some Cooper, C. (1998). Fat and proud. The Women's Press Ltd.
thoughts on unhinging certain dietary ideologies. Social Theory and Cooper, C. (2016). Fat Activism: A radical social movement. HammerOn
Health, 3(4), 315–340. https://doi.org/10.1057/palgrave.sth.8700059 Press.
Asparouhov, T., & Muthén, B. (2009). Exploratory structural equation Cotugna, N., & Mallick, A. (2010). Following a calorie‐restricted diet may
modelling. Structural Equation Modelling, 16(3), 397–438. https://doi. help in reducing healthcare students' fat‐phobia. Journal of
org/10.1080/10705510903008204 Community Health, 35(3), 321–324. https://doi.org/10.1007/
Bacon, L. (2010). Health at every size: The surprising truth about your weight. s10900-010-9226-9
BenBella Books. Crandall, C. S. (1994). Prejudice against fat people: Ideology and self‐
Bacon, L., & Aphramor, L. (2011). Weight science: Evaluating the evidence interest. Journal of Personality and Social Psychology, 66(5), 882–894.
for a paradigm shift. Nutrition Journal, 10(9), 1–13. https://doi.org/ https://doi.org/10.1037/0022-3514.66.5.882
10.1186/1475-2891-10-9 Crandall, C. S., & Biernat, M. (1990). The ideology of anti‐fat attitudes.
Barger, S. D. (2002). The Marlowe‐Crowne affair: Short forms, psycho- Journal of Applied Social Psychology, 20(3), 227–243. https://doi.org/
metric structure, and social desirability. Journal of Personality 10.1111/j.1559-1816.1990.tb00408.x
Assessment, 79(2), 286–305. https://doi.org/10.1207/ Crandall, C. S., & Schiffhauer, K. L. (1998). Anti‐fat prejudice: Beliefs,
S15327752JPA7902_11 values and American culture. Obesity Research, 6(6), 458–460.
Brewis, A. A., Hruschka, D. J., & Wutich, A. (2011). Vulnerability to fat‐ https://doi.org/10.1002/j.1550-8528.1998.tb00378.x
stigma in women's everyday relationships. Social Science and Cronbach, L., & Meehl, P. (1955). Construct validity in social psychological
Medicine, 73(4), 491–497. https://doi.org/10.1016/j.socscimed. tests. Psychological Bulletin, 52(4), 281–302. https://doi.org/10.
2001.05.048 1037/h0040957
Burgard, D. (2009). What is “Health at Every Size”? In Rothbulm, E. & Crowne, D. P., & Marlowe, D. (1960). A new scale of social desirability
Solovay, S. (Eds.), The fat studies reader (pp. 42–53). New York independent of psychopathology. Journal of Consulting Psychology,
University Press. 24(4), 349–354. https://doi.org/10.1037/h0047358
Burmeister, J. M., Kiefner, A. E., Carels, R. A., & Musher‐Eiznman, D. R. Cudeck, R., & O'Dell, L. L. (1994). Applications of standard error estimates
(2012). Weight bias in graduate school admissions. Obesity, 21(5), in unrestricted factor analysis: Significance tests for factor loadings
918–920. https://doi.org/10.1002/oby.20171 and correlations. Psychological Bulletin, 115(3), 475–487. https://doi.
Burmeister, J. M., Taylor, M. B., Rosi, J., Kiefner‐Burmeister, A., org/10.1037/0033-2909.115.3.475
Borushok, J., & Carels, R. A. (2017). Reducing obesity stigma via a DeVellis, R. (2012). Scale development. Sage.
brief documentary film: A randomized trial. Stigma and Health, 2(1), DeVon, H. A., Block, M. E., Moyle‐Wright, P., Ernst, D. M., Hayden, S. J.,
43–52. https://doi.org/10.1037/sah0000040 Lazzara, D. J., Savoy, S. M., & Kostas‐Polston, E. (2007). A
Byrne, B. M. (2001). Structural equation modelling with AMOS. Lawrence psychometric toolbox for testing validity and reliability use for
Erlbaum Associates. reference of design of study. Journal of Nursing Scholarship, 39(2),
Cain, P., & Donaghue, N. (2018). Political and health messages are 155–164. https://doi.org/10.1111/j.1547-5069.2007.00161.x
differently palatable: A critical discourse analysis of women's Dickins, M., Browning, C., Feldman, S., & Thomas, S. (2016). Social
engagement with Health At Every Size and Fat Acceptance inclusion and the fatosphere: The role of an online weblogging
messages. Fat. Studies, 7(3), 264–277. https://doi.org/10.1080/ community in fostering social inclusion. Sociology of Health and
21604851.2018.144817 Illness, 38(5), 797–811. https://doi.org/10.1111/1467-9566.12397
CAIN ET AL. | 1143
Diedrichs, P. C., & Barlow, F. K. (2011). How to lose weight bias fast! Latner, J. D., O'Brien, K. S., Durso, L. E., Brinkman, L. A., & MacDonald, T.
Evaluating a brief anti‐weight bias intervention. British Journal of (2008). Weighing obesity stigma: The relative strength of different
Health Psychology, 16(4), 846–861. https://doi.org/10.1111/j.2044- forms of bias. International Journal of Obesity, 32(7), 1145–1152.
8287.2011.02022.x https://doi.org/10.1038/ijo.2008.53
Falker, A. J., & Sledge, J. A. (2011). Utilizing a bariatric sensitivity Lee, M., Ata, R. N., & Brannick, M. T. (2014). Malleability of weight‐biased
educational module to decrease bariatric stigmatization by health- attitudes and beliefs: A meta‐analysis of weight bias reduction
care professionals. Bariatric Nursing and Surgical Patient Care, 6(2), interventions. Body Image, 11(3), 251–259. https://doi.org/10.
73–78. https://doi.org/10.1089/bar.2011.9974 1016/j.bodyim.2014.03.003
Ferguson, C., Kornblet, S., & Muldoon, A. (2009). Not all are created equal: Lewis, R. J., Cash, T. F., Jacobi, L., & Bubb‐Lewis, C. (1995). Prejudice
Differences in obesity attitudes between men and women. Women's toward fat people: The development and validation of the Antifat
health Issues, 19(5), 289–291. https://doi.org/10.1016/j.whi.2009. Attitudes Test. Obesity Research, 5(4), 297–307.
07.001 Lippa, N. C., & Sanderson, S. C. (2012). Impact of information about
Fikkan, J. l, & Rothblum, E. D. (2012). Is fat a feminist issue? Exploring the obesity genomics on the stigmatization of overweight individuals: An
gendered nature of weight bias. Sex Roles, 66(9), 575–592. https:// experimental study. Obesity, 20(12), 2367–2376. https://doi.org/10.
doi.org/10.1007/s11199-011-0022-5 1038/oby.2012.144
Foster, G. D., Wadden, T. A., Makris, A. P., Davidson, D., Sanderson, R. S., Little, T. D., Lindenberger, U., & Nesselroade, J. R. (1999). On selecting
& Allison, D. B. (2003). Primary care physicians' attitudes about indicators for multivariate measurement and modeling with latent
obesity and its treatment. Obesity Research, 11(10), 1168–1177. variables: When “good” indicators are bad and “bad” indicators are
https://doi.org/10.1038/oby.2003.161 good. Psychological Methods, 4(2), 192–195.
Fredrick, D. A., Saguy, A. C., & Gruys, K. (2015). Culture, health, and Lupton, D. (2013). Fat. Routledge.
bigotry: How exposure to cultural accounts of fatness shape Magallares, A., & Morales, J. (2013). Gender differences in antifat
attitudes about health risk, health policies, and weight based attitudes. International Journal of Social Psychology, 28(1), 113–119.
prejudice. Social Science and Medicine, 165, 271–279. https://doi. https://doi.org/10.1174/021347413804756014
org/10.1016/j.socscimed.2015.12.031 Major, B., Eliezer, D., & Rieck, H. (2012). The psychological weight of
Gaesser, G. (2002). Big fat lies. Azure Books. weight stigma. Social Psychological and Personality Science, 3(6),
Gloor, J. L., & Puhl, R. M. (2016). Empathy and perspective‐taking: 651–658. https://doi.org/10.1177/1948550611434400
Examination and comparison of strategies to reduce weight Malterud, K., & Ulriksen, K. (2011). Obesity, stigma, and responsibility in
stigma. Stigma and Health, 1(4), 269–279. https://doi.org/10.1037/ health care: A synthesis of qualitative studies. International Journal of
sah0000030 Qualitative Study Health and Well‐being, 6(4), 8404–8414. https://
Greenleaf, C., Petrie, T. A., & Martin, S. B. (2017). Exploring weight‐related doi.org/10,3402/qhw.v6i4.8404
teasing and depression among overweight and obese adolescents. Marx, R. G., Menezes, A., Horovitz, L., Jones, E. C., & Warren, R. F. (2003).
European Review of Applied Psychology, 67(3), 147–153. https://doi. A comparison of two time intervals for test‐retest reliability of
org/10.1016/j.erap.2017.01.004 health status instruments. Journal of Clinical Epidemiology, 56(8),
Gujral, H., Tea, C., & Sheridan, M. (2011). Evaluation of nurse's attitudes 730–735. https://doi.org/10.1016/S)895-4356(03)00084-2
toward adult patients of size. Surgery for Obesity and Related Meade, A. W., & Kroustalis, C. M. (2006). Problems with item parceling for
Diseases, 7(4), 536–540. https://doi.org/10.1016/j.soard.2011. confirmatory factor analytic tests of measurement invariance.
03.008 Organizational Research Methods, 9(3), 369–403.
Hatzenbuehler, M. L., Keyes, K. M., & Hasin, D. S. (2009). Associations Meadows, A., & Danielsdottir, S. (2016). What's in a word? On weight
between perceived weight discrimination and the prevalence of stigma and terminology. Frontiers in Psychology, 7, 1527. https://doi.
psychiatric disorders in the general population. Obesity, 17(11), org/10.3389/fpsyg.2016.01527
2033–2039. https://doi.org/10.1038/oby.2009.131 Mensinger, J. L., Tylka, T. L., & Calamari, M. E. (2018). Mechanisms
Henderson, M. E., Morris, L. L., & Fitz‐Gibbon, C. Y. (1987). How to underlying weight status and healthcare avoidance in women: A
measure attitudes. Sage. study of weight stigma, body‐related shame and guilt, and
Hilbert, A. (2016). Weight stigma reduction and genetic determinism. PLos healthcare stress. Body Image, 25, 139–147.
One, 11(9), 1–14. https://doi.org/10.1371/journal.pone.0162993 McVey, G. L., Walker, K. S., Beyers, J., Harrison, H. I., Simkins, S. W., &
Ho, A. K., Kteily, N., Pratto, F., Foels, R., Sidaniou, J., Sheehy‐Skeffington, Russell‐Mayhew, S. (2013). Integrating weight bias awareness and
J., Henkel, K. E., & Stewart, A. (2015). The nature of Social mental health promotion into obesity prevention delivery: A public
Dominance Orientation: Theorizing and measuring preferences for health pilot study. Preventing chronic disease, 10(4), 1–7. https://doi.
intergroup inequality using the new SDO7 scale. Journal of org/10.5888/pcd10.120185
Personality and Social Psychology, 109(6), 1003–1028. https://doi. Morrison, T., & O'Connor, W. E. (1999). Psychometric properties of a scale
org/10.1037/pspi0000033 measuring negative attitudes toward overweight individuals. The
Humphrey, L., Clifford, D., & Morris, M. N. (2015). Health At Every Size Journal of Psychology, 139(4), 436–445. https://doi.org/10.1080/
college course reduces dieting behaviors and improves intuitive 00224549909840
eating, body esteem and anti‐fat attitudes. Journal of Nutrition and Morrison, T. G., Roddy, S., & Ryan, T. A. (2009). Methods for measuring
Eating Behavior, 47(4), 354–360. https://doi.org/10.1016/j.jneb. attitudes about obese people. In Allison, D. B. & Baskin, M. L. (Eds.),
2015.01.008 Handbook of eating behaviors and weight‐related problems: Measures,
Hunger, J. M., Dodd, D. R., & Smith, A. R. (2020). Weight‐based theory and research (pp. 79–113). Sage Publications.
discrimination, interpersonal needs, and suicidal ideation. Stigma Mueller, D. J. (1986). Measuring social attitudes: A handbook for researchers
and Health, 5(2), 217–224. https://doi.org/10.1037/sah0000188 and practitioners. Teachers College Press.
IBM. (2016). SPSS Statistics for Windows. Version 24.0 IBM Corp. Nunnally, J. C., & Bernstein, I. H. (1994). Psychometric theory (3rd ed.).
Kline, P. (2000). The handbook of psychological testing. Routledge. McGraw Hill.
Lacroix, E., Alberga, A., Russell‐Mathew, S., Mclaren, L., & von Ranson, K. O'Brien, K. S., Puhl, R. M., Latner, J. D., Mir, A. S., & Hunter, J. A. (2010).
(2017). Weight bias: A systematic review of characteristics and Reducing anti‐fat prejudice in preservice health students: A
psychometric properties of self‐report questionnaires. Obsesity randomized control trial. Obesity, 18(11), 2138–2144. https://doi.
Facts, 10(3), 223–237. org/10.1038/oby.2010.79
1144 | CAIN ET AL.
O'Hara, L., & Gregg, J. (2012). Human rights casualties from the “War on Schvey, N. A., Sbrocco, T., Bakalar, J. L., Ress, R., Barmine, M., Gorlick, J.,
Obesity”: Why focusing on body weight is inconsistent with a human Pine, A., Stephens, M., & Tanofsky‐Kraff, M. (2017). The experience
rights approach to health. Fat Studies, 1(1), 32–46. https://doi.org/ of weight stigma among gym members with overweight and obesity.
10.1080/21604851.2012.627790 Stigma and Health, 2(4), 292–306. https://doi.org/10.1037/
Pausé, C. (2017). Borderline: The ethics of fat stigma in public health. The sah0000062
Journal of Law, Medicine & Ethics, 45(4), 510–517. https://doi.org/ Schwartz, M. B., Chambliss, H. O., Brownell, K. D., Blair, S. N., &
10.1177/1073110517750585 Billington, C. (2003). Weight bias among health professionals
Peer, E., Brandimarte, L., Samat, S., & Acquisiti, A. (2017). Beyond the specializing in obesity. Obesity Research, 11(9), 1033–1039.
Turk: Alternative platforms for crowdsourcing behavioral research. https://doi.org/10.1038/oby.2003.142
Journal of Experimental Social Psychology, 70, 153–163. https://doi. Smith, G. T., McCarthy, D. M., & Anderson, K. G. (2000). On the sins of
org/10.1016/j.jesp.2017.01.006 short‐form development. Psychological Assessment, 12(1), 102–111.
Perez‐Lopez, M. S., Lewis, R. J., & Cash, T. F. (2001). The relationship of Springer, D. W., Abell, N., & Hudson, W. W. (2002). Creating and
anti‐fat attitudes to other prejudicial and gender related attitudes. validating rapid assessment instruments for practice and research.
Journal of Applied Social Psychology, 31(4), 683–697. https://doi.org/ Research on Social Work Practice, 12(3), 408–439. https://doi.org/10.
10.1111/j.1559-1816.2001.tb01408 1177/1049731502012003005
Petty, R. E., & Cacioppo, J. T. (1986). Communication and persuasion: Spreng, R. N., McKinnon, M. C., Mar, R. A., & Levine, B. (2009). The
Central and peripheral routes to attitude change. Springer‐Verlag. Toronto Empathy Questionnaire: Scale Development and initial
Pratto, F., Sidanius, J. S., & Malle, B. F. (1994). Social dominance validation of a factor‐analytic solution to multiple empathy
orientation: A personality variable predicting social and political measures. Journal of Personality Assessment, 91(1), 62–71. https://
attitudes. Journal of Personality and Social Psychology, 67(4), doi.org/10.1080/00223890802484381
741–763. https://doi.org/10.1037/0022-3514.67.4.741 Stanton, J. M., Sinar, E. F., Balzer, W. K., & Smith, P. C. (2002). Issues and
Puhl, R. M., & Heuer, C. A. (2009). The stigma of obesity: A review and strategies for reducing the length of self‐report scales. Personnel
Update. Obesity, 17(5), 941–964. https://doi.org/10.1038/oby. Psychology, 55(1), 167–194.
2008.636 Strober, J. (2001). The social desirability scale – 17: Convergent validity,
Puhl, R. M., Moss‐Racusin, C. A., & Schwartz, M. B. (2007). Internalization discriminant validity, and relationship with age. European Journal of
of weight bias: Implications for binge eating and emotional well‐ Psychological Assessment, 17(3), 222–232. https://doi.org/10.1027//
being. Obesity, 15(1), 16–23. https://doi.org/10.1038/oby.2007.521 1015-5759.17.3.222
Puhl, R. M., & Suh, Y. (2015). Health consequences of weight stigma: Sutin, A. R., Stephan, Y., & Terracciano, A. (2015). Weight discrimination
implications for obesity prevention and treatment. Current Obesity and risk of mortality. Psychological Science, 26(11), 1803–1811.
Reports, 4(2), 182–190. https://doi.org/10.1007/s13679-015- https://doi.org/10.1177/0956797615601103
0153-z Swank, J. M., & Mullen, P. R. (2017). Evaluating evidence for conceptually
Quinn, D. M., & Crocker, J. (1999). When ideology hurts: Effects of belief related constructs using bivariate correlations. Measurement and
in the protestant ethic and feeling overweight on the psychological Evaluation on Counselling and Development, 50(4), 270‐274. https://
well‐being of women. Journal of Personality and Social Psychology, doi.org/10.1080/07481756.2017.1339562
77(2), 402–414. https://doi.org/10.1037/0022-3514.77.2.40 Tabachnick, B. G., & Fidell, L. S. (2007). Using multivariate statistics (5th ed.),
Roehling, M. V., Roehling, P. V., & Pichler, S. (2007). The relationship Allyn & Bacon.
between body weight and perceived weight‐related employment Teachman, B. A., Gapinski, K. D., Brownell, K. D., Rawlins, M., &
discrimination: The role of sex and race. Journal of Vocational Behavior, Jeyaram, S. (2003). Demonstrations of implicit anti‐fat bias: The
71(2), 300–318. https://doi.org/10.1016/j.jvb.2007.04.008 impact of providing causal information and evoking empathy. Health
Rogge, M. M., Greenwald, M., & Golden, A. (2004). Obesity, stigma and Psychology, 22(1), 68–78. https://doi.org/10.1037/0278-6133.22.
civilised oppression. Advances in Nursing Science, 27(4), 301–315. 1.68
https://doi.org/10.1097/00012272-200410000-00006 Thomas, S. L., Hyde, J., Karunaretne, A., Herbert, D., & Komesaroff, P. A.
Rothblum, E. (2012). Why a journal on fat studies? Fat Studies, 1(1), 3–5. (2008). Being ‘fat’ in today's world: A qualitative study of the lived
https://doi.org/10.1080/21604851.2012.633469 experience of people with obesity in Australia. Health Expectations,
Saguy, A. C., & Riley, K. W. (2005). Weighing both sides: Morality, 11(4), 321–330. https://doi.org/10.1111/j.1369-7625.2009.
mortality, and framing contests over obesity. Journal of Health 00490.x
Politics, Policy and Law, 30(5), 869–921. https://doi.org/10.1215/ Tomiyama, A. J. (2014). Weight stigma is stressful. A review and evidence
03616878-30-5-869 for the cyclic Obesity/Weight‐based stigma model. Appetite, 82,
Seacat, J. D., Dougal, S. C., & Roy, D. (2014). A daily diary assessment of 8–15. https://doi.org/10.1016/j.appet.2014.06.108
female weight stigmatization. Journal of health psychology, 21(2), Tomiyama, A. J., Finch, L. E., Incollingo Belsky, A. C., Buss, J., Finley, C.,
228–240. https://doi.org/10.1177/1359105314525067 Schwartz, M. B., & Daubenmier, J. (2015). Weigh Bias in 2001 versus
Setchel, J., Watson, B., Jones, L., Guard, M., & Briffa, K. (2014). 2013: Contradictory attitudes among obesity researchers and health
Physiotherapists demonstrate weight stigma: A cross‐sectional professionals. Obesity, 23(1), 46–53. https://doi.org/10.1002/oby.
survey of Australian Physiotherapists. Journal of Physiotherapy, 60(3), 20910
157–162. https://doi.org/10.1016/j.jphys.2014.06.020 United States Census Bureau (2018). Population. Retrieved from https://
Schreiber, J. B., Nora, A., Stage, F. K., Barlow, E. A., & King, J. (2006). www.census.giv/topics/population.html
Reporting structural equation modeling and confirmatory factor Vartanian, L. R., Pinkus, R. T., & Smyth, J. M. (2014). The phenomenology
analysis results: A review. The Journal of Education Research, 99(6), of weight stigma in everyday life. Journal of Contextual Behavioral
323–337. https://doi.org/10.3200/JOER.99.6.323-338 Science, 3(3), 196–202. https://doi.org/10.1016/j.jcbs.2014.01.003
Schvey, N. A., Barmine, M., Bates, D., Oldham, K., Bakalar, J. L., Spieker, E., Velicer, W. F., & Fava, J. L. (1998). Affects of variable and subject sampling
Maurer, D., Stice, E., Stephens, M., Tanofsky‐Kraff, M., & Sbrocco, T. on factor pattern recovery. Psychological Methods, 3(2), 231–251.
(2016). Weight stigma among active duty U.S. military personnel Wann, M. (1998). Fat! So? Ten Speed Press.
with overweight and obesity. Stigma and Health, 2(4), 281–291. Wann, M. (2009). Forward. In Rothbulm, E. & Solovay, S. (Eds.), The fat
https://doi.org/10.1037/sah0000057 studies reader (pp.ix‐xxv). New York University Press.
CAIN ET AL. | 1145
Widaman, K. F., Little, T. D., Preacher, K. J., & Sawalani, G. M. (2011). On A systematic review. Journal of Advanced Nursing, 74(5), 1030–1042.
creating and using short forms of scales in secondary research. https:// https://doi.org/10.1111/jan.13511
doi.org/10.1037/12350-00
Wieland, A., Durach, C. F., Kembro, J., & Treiblmaier, H. (2017). Statistical and
judgmental criteria for scale purification. Supply Chain Managementl,
22(4), 321–328. https://doi.org/10.1108/SCM-07-2016-0230 How to cite this article: Cain, P., Donaghue, N., & Ditchburn,
World Health Organization. (2014). Obesity and overweight (Fact sheet No
311). http://who.int/mediacentre/factsheets/fs311/en G. (2022). Development and validation of the Fat Attitudes
Worthington, R. L., & Whittaker, T. A. (2006). Scale development research: Assessment Toolkit (FAAT): A multidimensional
A content analysis and recommendations for best practice. nonstigmatizing measure of contemporary attitudes toward
Counselling Psychologist, 34(6), 806–838. https://doi.org/10.1177/
fatness and fat people. Journal of Applied Social Psychology, 52,
0011000006288127
Wu, Y., & Berry, D. C. (2017). Impact of weight stigma on physiological 1121–1145. https://doi.org/10.1111/jasp.12882
and psychological health outcomes for overweight and obese adults:

Development and Validation of The Fat Attitudes Assessment Toolkit FAAT A

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Development and Validation of The Fat Attitudes Assessment Toolkit FAAT A

Uploaded by

Copyright:

Available Formats

Received: 1 May 2019 | Revised: 5 May 2022 | Accepted: 9 May 2022

Development and validation of the Fat Attitudes Assessment

Patricia Cain1 | Ngaire Donaghue2 | Graeme Ditchburn3

Obtaining a sample that is both representative of the population of

TABLE 1 Sociodemographic characteristics of participants in Study 1.

Study 1 Study 2 Study 3

Other 4 0.5 26.00 (3.92) 3 0.8 22.67 (2.89) 1 0.01 21

Middle school 10 1.3 4 1.0 1 1.0

High school 77 10 46 11.8 13 12.6

Some college 156 20.2 101 25.9 25 24.3

2‐year degree 71 9.2 40 10.3 9 8.7

4‐year degree 308 39.9 129 33.1 38 36.9

Professional degree 101 13.1 58 14.9 15 14.6

Doctorate 27 3.5 12 3.1 2 1.9

No response 79 10.3 39 10 10 9.7

We need to take weight‐based discrimination as seriously as other forms of 0.868

Discussions and programs recognizing diversity need to include body 0.851

The media should not portray fat people negatively 0.819

Activism is necessary because of the discrimination fat people experience 0.775

Public spaces should accommodate all body sizes 0.758

Size acceptance is an important social movement 0.746

We need more positive images of fat people in the media 0.745

As a society, we need to eradicate weight‐based discrimination 0.737

It is important to see fat people represented positively in the media 0.736

Similar to other types of discrimination, it should be illegal to discriminate 0.714

Discrimination due to fatness leads to a denial of human rights 0.710

Size acceptance is a foundation for making healthy lifestyle choices 0.701

We need to stop using the word fat as an insult 0.692

Size acceptance should be encouraged 0.690

We should celebrate all bodies 0.676

Health professionals have a responsibility not to contribute to weight 0.674

Fat people need acceptance not expressions of contempt 0.650

All bodies should be considered equally valuable 0.621 0.308

Accepting other people's bodies is important 0.613

As a society, we need to stop trying to change people's bodies 0.594

Health professionals should make fat patients feel comfortable 0.589

Size acceptance does not encourage obesity 0.579

It is not ok to comment on another person's weight 0.572

I sympathize with fat people who face discrimination 0.572

Weight stigma contributes to poor health 0.549

All bodies are good bodies 0.549

Fat shaming is unacceptable 0.537 0.381

Health professionals should be aware of the negative impact of weight 0.535

I like the inclusion of larger bodied models in advertising campaigns 0.520

Weight‐based discrimination can severely limit quality of life 0.501

Weight‐based discrimination negatively impacts on well‐being 0.493 −0.322

Size acceptance promotes an unhealthy lifestyle −0.481 0.315

Self‐esteem shouldn't change just because our bodies do 0.481

Fat people face discrimination in many areas of life 0.476

Bodies of all sizes deserve equal rights 0.469

Fat people face employment based discrimination 0.467

Weight loss advice given to fat people is patronizing 0.455

Weight‐based discrimination does not motivate people to lose weight 0.425

Accepting your body is important 0.422

Weight focused approaches to health contribute to discrimination against 0.421

Concern for health is used as an excuse to judge fat people 0.363

Fat people are not lazy 0.321

We need to stop promoting weight loss diets as healthy 0.316

Long term weight loss is hard to maintain 0.304

There are medical factors that cause people to be fat −0.626

Sometimes emotional eating leads to fatness −0.578

There are genetic factors that cause people to be fat −0.570

Psychological factors can lead people to become fat −0.563

3. Size acceptance .73 .80

4. Attractiveness .48 .62 .66**

5. Critical health .58 .61 .65 .57

6. Complexity .50 .47 .48 .30 .45**

7. Responsibility .30 .34 .33 .30 .35 .25