Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

A multinational examination of weight bias: predictors of anti-fat attitudes across four countries

Abstract

Background/Objectives:

As rates of obesity have increased throughout much of the world, so too have bias and prejudice toward people with higher body weight (that is, weight bias). Despite considerable evidence of weight bias in the United States, little work has examined its extent and antecedents across different nations. The present study conducted a multinational examination of weight bias in four Western countries with comparable prevalence rates of adult overweight and obesity.

Methods:

Using comprehensive self-report measures with 2866 individuals in Canada, the United States, Iceland and Australia, the authors assessed (1) levels of explicit weight bias (using the Fat Phobia Scale and the Universal Measure of Bias) and multiple sociodemographic predictors (for example, sex, age, race/ethnicity and educational attainment) of weight-biased attitudes and (2) the extent to which weight-related variables, including participants’ own body weight, personal experiences with weight bias and causal attributions of obesity, play a role in expressions of weight bias in different countries.

Results:

The extent of weight bias was consistent across countries, and in each nation attributions of behavioral causes of obesity predicted stronger weight bias, as did beliefs that obesity is attributable to lack of willpower and personal responsibility. In addition, across all countries the magnitude of weight bias was stronger among men and among individuals without family or friends who had experienced this form of bias.

Conclusions:

These findings offer new insights and important implications regarding sociocultural factors that may fuel weight bias across different cultural contexts, and for targets of stigma-reduction efforts in different countries.

This is a preview of subscription content

Access options

Buy article

Get time limited or full article access on ReadCube.

$32.00

All prices are NET prices.

References

  1. Puhl R, Heuer CA . The stigma of obesity: a review and update. Obesity 2009; 17: 941–964.

    Article  Google Scholar 

  2. Puhl RM, Andreyeva T, Brownell KD . Perceptions of weight discrimination: prevalence and comparison to race and gender discrimination in America. Int J Obesity 2008; 32: 992–1000.

    CAS  Article  Google Scholar 

  3. Hatzenbuehler ML, Keyes KM, Hasin DS . Associations between perceived weight discrimination and the prevalence of psychiatric disorders in the general population. Obesity 2009; 17: 2033–2039.

    Article  Google Scholar 

  4. Sutin AR, Terracciano A . Perceived weight discrimination and obesity. PLoS One 2013; 8: e70048.

    CAS  Article  Google Scholar 

  5. Crandall CS . Prejudice against fat people. Ideology and self-interest. J Pers Soc Psychol 1994; 66: 882–894.

    CAS  Article  Google Scholar 

  6. Roehling MV, Roehling PV, Odland M . Investigating the validity of stereotypes about overweight employees: the relationship between body weight and normal personality traits. Grp Organiz Manage 2008; 33: 392–424.

    Article  Google Scholar 

  7. Sabin JA, Marini M, Nosek BA . Implicit and explicit anti-fat bias among a large sample of medical doctors by BMI, race/ethnicity and gender. PLoS One 2012; 7: e48448.

    CAS  Article  Google Scholar 

  8. Schwartz MB, Vartanian LR, Nosek BA, Brownell KD . The influence of one's own body weight on implicit and explicit anti-fat bias. Obesity 2006; 14: 440–447.

    Article  Google Scholar 

  9. Latner JD, Ebneter DS, O’Brien KS . Residual obesity stigma. An experimental investigation of bias against obese and lean targets differing in weight-loss history. Obesity 2012; 20: 2035–2038.

    Article  Google Scholar 

  10. O’Brien KS, Puhl RM, Latner JD, Mir AS, Hunter JA . Reducing anti-fat prejudice in pre-service health students. A randomized trial. Obesity 2010; 18: 2138–2144.

    Article  Google Scholar 

  11. Crandall CS, Martinez R . Culture, ideology, and anti-fat attitudes. Pers Soc Psychol Bul 1996; 22: 1165–1176.

    Article  Google Scholar 

  12. Puhl RM, Schwartz MB, Brownell KD . Impact of perceived consensus on stereotypes about obese people: a new approach for reducing bias. Health Psychol 2005; 24: 517–525.

    Article  Google Scholar 

  13. Brewis AA, Wutich A, Falletta-Cowden A, Rodriguez-Soto I . Body norms and fat stigma in a global perspective. Cur Anthropology 2011; 52: 269–276.

    Article  Google Scholar 

  14. Crandall CS, D'Anello S, Sakalli N, Lazarus E, Nejtardt GW, Feather NT . An attribution-value model of prejudice: anti-fat attitudes in six nations. Pers Soc Psychol Bul 2001; 27: 30–37.

    Article  Google Scholar 

  15. Lewis S, Thomas SL, Blood RW, Castle DJ, Hyde J, Komesaroff PA . How do obese individuals perceive and respond to the different types of obesity stigma thatvthey encounter in their daily lives? A qualitative study. Soc Sci Med 2011; 73: 1349–1356.

    Article  Google Scholar 

  16. Ruggs EN, King EB, Hebl M, Fitzsimmons M . Assessment of weight stigma. Obes Facts 2010; 3: 60–69.

    Article  Google Scholar 

  17. Swinburn BA, Sacks G, Hall KD, McPherson K, Finegood DT, Moodie ML et al. The global obesity pandemic: shaped by global drivers and local environments. Lancet 2011; 378: 804–814.

    Article  Google Scholar 

  18. Janssen I . The public health burden of obesity in Canada. Can J Diabetes 2013; 37: 90–96.

    Article  Google Scholar 

  19. World Health Organization. Global health observatory data repository. 2013; Retrieved from http://apps.who.int/gho/data/view.main.

  20. Australian Bureau of Statistics (2012). Australian Health Survey: first results, 2011–12.

  21. Ogden CL, Carroll MD, Kit BK, Flegal KM . Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA 2014; 311: 806–814.

    CAS  Article  Google Scholar 

  22. Lonner WJ, Berry JW . Field Methods in Cross-Cultural Research. Sage: Beverly Hills, CA, 1986.

    Google Scholar 

  23. United States Census Bureau (2010). Profile of general population and housing characteristics. Catalogue no.4364.0.55.001. Canberra. Retrieved from http://www.census.gov/prod/www/decennial.html.

  24. Davis J, Busch J, Hammatt Z, Novotny R, Harrigan R, Grandinetti A et al. The relationship between ethnicity and obesity in Asian and Pacific Islander populations: a literature review. Ethn Dis 2004; 14: 111–118.

    PubMed  Google Scholar 

  25. Latner JD, Knight T, Illingworth K . Body image and self-esteem among Asian, Pacific Islander, and White college students in Hawaii and Australia. Eating Disorders. J Treat Prevent 2011; 19: 355–361.

    Google Scholar 

  26. Centers for Disease Control. (2012). Defining overweight and obesity. Overweight and Obesity. Retrieved from http://www.cdc.gov/nccdphp/dnpa/obesity/defining.htm.

  27. Bacon JG, Scheltema KE, Robinson BE . Fat Phobia Scale revisited: the short form. Int J Obes Relat Metab Disord 2011; 25: 252–257.

    Article  Google Scholar 

  28. Latner JD, O’Brien KS, Durso LE, Brinkman LA, MacDonald T . Weighing obesity stigma. Relative strength of different targets of bias. Int J Obesity 2008; 32: 1145–1152.

    CAS  Article  Google Scholar 

  29. Puhl RM, Latner JL, King K, Luedicke J . Weight bias among professionals who treat eating disorders: associations with attitudes about treatment and perceptions of patient outcomes. Int J Eating Disord 2014; 47: 65–75.

    Article  Google Scholar 

  30. Foster GD, Wadden TA, Makris AP, Davidson D, Sanderson RS, Allison DB et al. Primary care physicians’ attitudes about obesity and its treatment. Obes Res 2003; 11: 1168–1177.

    Article  Google Scholar 

  31. DePierre JA, Puhl RM, Luedicke J . A new stigmatized identity? Comparisons of a ‘Food Addict’ label with other stigmatized health conditions. Behav Soc Psychol 2013; 35: 10–21.

    Google Scholar 

  32. O'Brien KS, Hunter JA, Halberstadt J, Anderson J . Body image and explicit and implicit anti-fat attitudes: the mediating role of physical appearance comparisons. Body Image 2007; 4: 249–256.

    Article  Google Scholar 

  33. StataCorp Stata Statistical Software: Release 13 College Station, TX: StataCorp LP 2013.

  34. Falkner NH, French SA, Jeffery RW, Neumark-Sztainer D, Sherwood NE, Morton M . Mistreatment due to weight: prevalence and sources of perceived mistreatment in women and men. Obes Res 1999; 7: 572–576.

    CAS  Article  Google Scholar 

  35. Grabe S, Ward ML, Hyde JS, Shibley J . The role of the media in body image concerns among women: a meta-analysis of experimental and correlational studies. Psychol Bull 2008; 134: 460–476.

    Article  Google Scholar 

  36. Durso LE, Latner JD . Understanding self-directed stigma: development of the Weight Bias Internalization Scale. Obesity 2008; 16: S80–S86.

    Article  Google Scholar 

  37. Danielsdottir S, O'Brien KS, Ciao A . Anti-fat prejudice reduction: a review of published studies. Obes Facts 2010; 3: 47–58.

    Article  Google Scholar 

  38. Gross JE . The first amendment and diet industry: how puffery in weight loss advertisements has gone too far. J Law Health 2007; 325–355.

  39. Tsai AG, Wadden TA . Systematic review: an evaluation of major commercial weight loss programs in the United States. Annals Intern Med 2005; 142: 56–66.

    Article  Google Scholar 

Download references

Acknowledgements

We thank the Canadian Obesity Network, the Directorate of Health in Iceland and participating universities for their collaboration on this project. We also thank Ximena Ramos Salas for reading an earlier version of the paper and for her assistance in recruitment of Canadian Obesity Network (CON) participants. This study was funded by a donation from the Rudd Foundation.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to R M Puhl.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Puhl, R., Latner, J., O'Brien, K. et al. A multinational examination of weight bias: predictors of anti-fat attitudes across four countries. Int J Obes 39, 1166–1173 (2015). https://doi.org/10.1038/ijo.2015.32

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ijo.2015.32

Further reading

Search

Quick links