Objective

Rates of weight-based stigmatization have steadily increased over the past decade. The psychological and physiological consequences of weight stigma remain understudied.

Methods

This study examined the effects of experimentally manipulated weight stigma on the stress-responsive hypothalamic-pituitary-adrenal axis (HPA) in 110 female undergraduate participants (BMI: M=19.30, SD=1.55). Objective BMI and self-perceived body weight were examined as moderators of the relationship between stigma and HPA reactivity.

Results

Results indicated participants' perceptions of their own body weight (but not objective BMI) moderated the effect of weight stigma on cortisol reactivity: F(1,102)=13.48, P<0.001, η(2) p =0.12 (interaction 95% CI range [-2.06 to -1.44, -1.31 to -0.99]). Specifically, participants who perceived themselves as heavy exhibited sustained cortisol elevation post-manipulation compared with individuals who did not experience the weight-related stigma. Cortisol change did not vary by condition for participants who perceived themselves as average weight.

Conclusions

In the first study to examine physiological consequences of active interpersonal exposure to weight stigma, experiencing weight stigma was stressful for participants who perceived themselves as heavy, regardless of their BMI. These results are important because stress and cortisol are linked to deleterious health outcomes, stimulate eating, and contribute to abdominal adiposity.

To combat the obesity epidemic, interventions and treatments often recommend low-calorie dieting. Calorie restriction (CR) as a weight intervention, however, is often unsuccessful, as most people cannot sustain the behavior. Yet one small group has maintained extreme CR over years - members of the CR Society and followers of The CR Way. This study examined stable psychosocial characteristics of these individuals to identify traits that may promote success at long-term CR. In 65 participants, we measured diet, eating behaviors, and personality traits comparing calorie restrictors with two age-, gender-, ethnicity-, and education-matched comparison groups (normal weight and overweight/obese). We first tested whether the CR group restricted calories without indications of eating disorder pathology, and second, what crystallized psychosocial characteristics set them apart from their nonrestricting comparisons. Results indicated the CR group averaged 10 years of CR but scored lower than comparison groups on measures of disordered eating (p < .001) and psychopathology (p < .001). Particularly against overweight/obese participants, CR participants scored lower on neuroticism (p < .04) and hostility (p < .01), and were stronger in future time orientation (p < .05). Overall, CR profiles reflected high self-control and well being, except for having few close relationships. This study suggests a potential predisposition for successful long-term CR without disordered eating. Since modifying trait factors may be unrealistic, there may be psychosocial boundaries to the capacity for sustaining CR. Paralleling a movement toward personalized medicine, this study points toward a personalized behavioral medicine model in behavioral nutrition and treatment of overweight/obesity.

Objectives

To assess levels of two types of anti-fat bias in obesity specialists, explicit bias, or consciously accessible anti-fat attitudes, and implicit bias, or attitudes that are activated outside of conscious awareness, were examined. This study also assessed changes over time by comparing levels of bias in 2013 to published data from 2001.

Methods

In 232 attendees at the ObesityWeek 2013 conference, we measured explicit anti-fat bias and conducted the Implicit Association Test. These data were compared to those from a study conducted at the 2001 meeting of this group.

Results

Participants exhibited significant implicit and explicit anti-fat/pro-thin bias. Positivity of professional experience with obesity, but not type of professional experience, was correlated with lower explicit anti-fat bias. Compared to 2001, the 2013 sample had lower levels of implicit bias and higher levels of explicit bias.

Conclusions

Although implicit anti-fat attitudes appeared to decrease from 2001 to 2013, explicit anti-fat attitudes increased. Future research should examine whether increasing positive experiences with obese patients reduces anti-fat bias among health professionals. Together, these results suggest that despite the current climate of widespread anti-fat bias, there are pathways toward understanding and ameliorating this bias.