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Psychosocial Aspects of Obesity. Christy Greenleaf, Ph.D. University of North Texas. Obesity Trends* Among U.S. Adults BRFSS, 1990, 1998, 2007. (*BMI  30, or about 30 lbs. overweight for 5’4” person). 1998. 1990. 2007.

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psychosocial aspects of obesity

Psychosocial Aspects of Obesity

Christy Greenleaf, Ph.D.

University of North Texas

slide2

Obesity Trends* Among U.S. AdultsBRFSS,1990, 1998, 2007

(*BMI 30, or about 30 lbs. overweight for 5’4” person)

1998

1990

2007

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Source: CDC Behavioral Risk Factor Surveillance System

cultural importance of the body
Cultural Importance of the Body
  • Lean, thin body
    • self-discipline, achievement of cultural ideal
  • Fat, chubby body
    • ultimate failure publicly displayed for all to see and judge
cultural importance of the body6
Cultural Importance of the Body
  • Heightened social consciousness and awareness of “the body”
    • booming diet industry, estimated to bring in over $40-50 billion dollars each year
    • mass media which idealizes an ultra-lean physique
    • social value placed on having a lean body
diet industry
Diet Industry

Plentiful

Accessible

Affordable

Food Environment

Engineered out of the environment

Physical Activity

Highly profitable “weight loss” industry

diet industry10
Diet Industry
  • Individual responsibility and control
  • If you work hard enough…
  • If you have enough willpower…
  • If you are motivated enough…
mass media
Mass Media

Bulging Brides (We)

Biggest Loser (NBC)

Fat March(ABC)

mass media12
Mass Media
  • Larger individuals rarely shown, often stereotyped (Fouts & Burggraf, 2000; Fouts & Vaughan, 2002; Greenberg et al., 2003)
    • Unattractive, unappealing
    • Target of jokes
    • Shown (over)eating

Friends

Shallow Hal

social value
Social Value
  • Inherent value of thinness?
    • Social capital (thin = good; fat = bad)
weight bias
Weight Bias
  • Negative attitudes affecting interactions
  • Stereotypes leading to:
    • Stigma
    • Rejection
    • Prejudice
    • Discrimination
  • Verbal, physical and relational forms
  • Subtle and overt expressions

Source: obesityonline.org

social realities of weight bias
Social Realities of Weight Bias
  • Overweight people are one of the last socially acceptable targets for bias and discrimination (Puhl & Brownell, 2001)
  • WHY? 
    • Body as controllable, malleable
    • Attributions
    • Perceived social consensus
body as controllable and malleable
Body as Controllable and Malleable
  • Weight loss strengthens weight control beliefs among participants (Blaine, DiBlasi, & Connor, 2002)
attributions
Attributions
    • Internal and Controllable
    • Lack willpower
    • Lack motivation
    • Lazy
    • Don’t care
  • “Ideology of blame” (Crandall, 1994)
    • Deserve psychological, social, and physical consequences
perceived social consensus
Perceived Social Consensus
  • Perceptions of other people’s stereotypical beliefs (Puhl, Schwartz, & Brownell, 2005)
experiences of weight bias and discrimination
Experiences of Weight Bias and Discrimination
  • Negative assumptions from others
  • Comments from children
  • Physical barriers and obstacles
  • Comments from doctors and family members

(Puhl & Brownell, 2006)

prevalence of weight discrimination
Prevalence of Weight Discrimination
  • Reported experiences of weight discrimination among adults = 12% (Andreyeva, Puhl, & Brownell, 2008)
    • 4th most prevalent form of discrimination
    • Rates similar to race (11%) & age (14%) discrimination
where do people experience weight bias
Where do people experience weight bias?
  • Home
  • Work
  • School
  • Health and Fitness settings
home settings
Home settings
  • Family members = #1 source of stigma (72%)
      • Mothers (53%)
      • Spouse (47%)
      • Father (44%)
      • Sister (37%)
      • Brother (36%)
      • Son (20%)
      • Daughter (18%)

(Puhl & Brownell, 2006)

work settings
Work settings
  • Job interviews/hiring practices
  • Wages, promotions, employment termination
  • Overweight/obese employees perceived as…
    • Less conscientious
    • Less agreeable
    • Less emotionally stable
    • Less extroverted

Research contradicts these perceptions

(Puhl & Brownell, 2001; Puhl & Heuer, 2009)

school settings
School settings
  • College admissions
  • Peer teasing
  • Teacher bias

(Puhl & Brownell, 2001; Puhl & Heuer, 2009; Schwartz & Puhl, 2003)

health and fitness settings
Health and Fitness settings
  • Health care providers (#2 source of stigma)
    • Obesity specialists
    • Physicians
    • Nurses
    • Dieticians
  • Medical students
  • Fitness professionals
  • Physical education teachers

(Puhl & Brownell, 2001; Puhl & Heuer, 2009)

health and fitness settings26
Health and Fitness settings
  • Physicians
    • Overweight/Obesity = Behavioral problem
    • Do not feel confident in their treatment of overweight/obesity
    • Treatment of overweight/obesity is useless

(Campbell et al., 2000; Hebl & Xu, 2001; Kristeller & Hoerr, 1997; Puhl & Heuer, 2009)

health and fitness settings27
Health and Fitness settings
  • Dieticians’ perceptions of overweight clients
      • Lack commitment
      • Lack motivation
      • Poor compliance
      • Unrealistic expectations

(Campbell & Crawford, 2000)

health and fitness settings28
Health and Fitness settings
  • Fitness (Pre)Professionals
    • Obese = lazy, unattractive, eat junk food, lack willpower

(Chambliss, Finley, & Blair, 2004)

health and fitness settings29
Health and Fitness settings
  • Fitness Professionals
    • Perceive overweight clients as lazy and unmotivated
    • Should role model healthy weight
    • Feel competent to prescribe exercise for weight loss
    • Find helping clients lose weight gratifying

(Robertson & Vohora, 2008)

(Hare et al., 2000)

health and fitness settings30
Health and Fitness settings
  • Physical Educators
    • Negative attitudes toward overweight students
    • Lower expectations for overweight students

(Greenleaf & Weiller, 2005; O’Brien, Hunter, & Banks, 2007)

why care about weight bias
Why Care about Weight Bias?
  • Fosters blame and intolerance
  • Impacts multiple domains of living
  • Hurts quality of life for adults and children
  • Has serious medical and emotional effects

Source: obesityonline.org

how do people respond to weight bias
How do people respond to weight bias?
  • Poor self-esteem, depression (Puhl & Brownell, 2001; 2003)
  • Avoidance of medical care (Puhl & Heuer, 2009)
  • Overeating / Binge eating (Puhl & Brownell, 2006)
  • Physical inactivity (Storch et al., 2006)
practical implications
Practical Implications
  • Increased health and fitness professionals’ awareness
  • Implicit Associations Test (IAT)
    • https://implicit.harvard.edu/
practical implications36
Practical Implications
  • Empathy suit
    • Professional training/development activity to increase sensitivity
empathy suit focus group
Empathy Suit (focus group)
  • “I just never imagined that it would be that hard to walk and get up out of a chair and stuff”
  • “you would just (avoid doing things)… and people would call you lazy, but the thing is it’s just that hard”
practical implications38
Practical Implications
  • Revised educational training and professional development models
    • Kinesiology students feel no more prepared to work with overweight/obese individuals than other majors (Greenleaf et al., 2008)
practical implications39
Practical Implications
  • Consider physical space of health and fitness environments
weight friendly fitness facility evaluation chambliss patton martin greenleaf 2004
Weight Friendly Fitness Facility Evaluation(Chambliss, Patton, Martin & Greenleaf, 2004)
  • Checklist to evaluate the “weight friendliness” of a facility
    • Facilities and operations
    • Equipment **
    • Programming
    • Staff
practical implications41
Practical Implications
  • Recognize importance of word choice and language
    • Obese - particularly negative social meaning, implying a sense of disgust (Berg, 1998)
    • Overweight - conveys the idea that there is some “correct” weight a person “should” weigh (Berg, 1998)
practical implications42
Practical Implications
  • Desirable and undesirable weight terminology among obese individuals… (Wadden & Didie, 2003)
    • Least preferred: fatness, excess fat, obesity and large size
    • More preferred: weight, heaviness, BMI, excess weight, unhealthy body weight, weight problem, and unhealthy BMI
practical implications resources
Practical Implications - Resources
  • Active at Any Size
  • Rudd Center for Food Policy and Obesity
active at any size
Active at Any Size
  • Information
    • How to get started
    • PA for large individuals
  • Resources
    • DVD/videos
    • Organizations
    • Websites
rudd center for food policy and obesity
Rudd Center for Food Policy and Obesity
  • Leaders in weight bias research and advocacy
  • Resources for teachers, doctors, families, and policy makers

(www.yaleruddcenter.org)

key point
KEY POINT

“…thin people do not have a monopoly on health and fitness. Fit and healthy bodies come in all shapes and sizes” (Blair, 2002)

thank you

Thank You!

Questions or Comments?