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Stigmatisation and
obesity: literature
Stigmatisation and obesity: Literature update
February 2015
Published February 2015 by the UK Health Forum for the Obesity Learning Centre
UK Health Forum,
Fleetbank House,
2-6 Salisbury Square,
London, EC4Y 8JX
The Obesity Learning Centre (OLC) is the nationwide centre for quality assured information for
everyone working in obesity. The OLC sets out to strengthen and support local capacity
and capabilities to treat overweight in children and adults.
The OLC is maintained by the Research Information Services team at the UK Health Forum and
works closely with Public Health England.
The Obesity Learning Centre is maintained and provided by the UK Health Forum.
The UK Health Forum is a charitable alliance of professional and public interest organisations
working to reduce the risk of avoidable non-communicable diseases (NCDs) by developing
evidence-based public health policy and supporting its implementation through advocacy and
information provision.
Obesity Learning Centre Literature Update: Stigmatisation and obesity. February 2015
Inside this literature update
Stigmatisation and obesity: Literature update .................................................................................... 1
February 2015 ............................................................................................................................................... 1
Inside this literature update ............................................................................................................................ 2
About this literature update ....................................................................................................................... 3
........................................................................................................................................................................ 4
Attitudes towards and perceptions of obesity affecting children and young people ..................... 4
Obesity and stigmatisation in health and care settings ......................................................................... 9
Public perceptions of and attitudes towards obesity........................................................................... 13
Stigmatization of and discrimination against obese individuals in the workplace .......................... 17
Portrayals of obesity in the media ........................................................................................................... 18
Effect of stigmatization.............................................................................................................................. 19
Measuring stigmatization .......................................................................................................................... 22
Self-perception and self-stigmatization in obese individuals............................................................... 23
Obesity stigmatization and public health planning.............................................................................. 27
Further reading ........................................................................................................................................... 28
Appendix: Search strategy ....................................................................................................................... 38
PubMed & Cochrane Library MeSH search strategy ........................................................................ 38
Google Scholar search strategy .......................................................................................................... 38
Search record ......................................................................................................................................... 38
Obesity Learning Centre Literature Update: Stigmatisation and obesity. February 2015
About this literature update
This literature update has been designed and carried out by qualified information professionals
at the UK Health Forum in order to provide an update on published literature on the topic of
stigmatization issues relating to obesity. This topic has been selected for the final update in this
series in order to highlight the importance of understanding the impact of stigma on people
who are obese, not just in terms of their own mental health and well-being, but also their
access to services and experience of discrimination, and the influence of public perceptions
on policy making.
The search carried out to prepare this update was not a systematic literature search, and was
carried out purely for the purposes of delivering a brief update on the named topic. The aim of
this update is to highlight open access research on the named topic. The body of the
document contains links to open access research, while the ‘Further reading’ section contains
details of content accessible by subscription only. If you require a comprehensive update on
the named topic you are advised to carry out a systematic search using a full range of
appropriate databases.
Readers should note that absence of evidence does not indicate absence of effect. The area
covered by this update is an area where the amount and level of available evidence is still
developing. This update focuses on peer reviewed and commercially published research, with
some unpublished or ‘grey’ non-commercially produced literature such as government
reports, policy documents, or publications produced by organisations such as charities and
NGOs. If you require a comprehensive update on grey literature for the named topic you are
advised to include grey literature sources in your search.
The UK Health Forum produces a weekly news and grey literature update service and eLibrary
called Prevention Information and Evidence. This eLibrary contains obesity and nutrition grey
literature and is available from the Obesity Learning Centre website:
To assist the reader the results of the search have been presented in themes as follows:
Attitudes towards and perceptions of obesity effecting children and young people
Obesity and stigmatisation in health and care settings
Public perceptions of and attitudes towards obesity
Stigmatization of and discrimination against the obese in the workplace
Portrayals of obesity in the media
Effect of stigmatization
Measuring stigmatization
Self-perception and self-stigmatization in obese individuals
Obesity stigmatization and public health planning
Obesity Learning Centre Literature Update: Stigmatisation and obesity. February 2015
The articles included in this update are open
access. Follow links provided in PubMed to
access full text.
Attitudes towards and perceptions of obesity
affecting children and young people
ANESBURY, T. & TIGGEMANN, M. 2000. An attempt to reduce negative stereotyping of obesity in
children by changing controllability beliefs. Health Educ Res, 15, 145-52.
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Aim: The purpose of the present study was to investigate whether changing children's beliefs
about the controllability of obesity would reduce their negative attitudes toward fat people.
The participants were 74 children from Grades 4-6, 42 in the experimental group and 32 in the
control group. The experimental group were presented with a brief intervention which
focussed on the uncontrollability of weight.
Conclusion: The study found that the intervention was successful in reducing the amount of
controllability that children assigned to obesity, but was not successful in reducing negative
stereotyping of the obese among the experimental group compared to the control group.
These results indicate that while children's beliefs about the controllability of obesity can be
changed, reducing their negative stereotyping is more difficult.
BELL, S. K. & MORGAN, S. B. 2000. Children's attitudes and behavioral intentions toward a peer
presented as obese: does a medical explanation for the obesity make a difference? J Pediatr
Psychol, 25, 137-45.
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Aim: To examine the effect of information on children's attitudes and behavioral intentions
toward a peer presented as obese.
Conclusion: Ratings were generally more favorable for the average-weight than for the obese
condition. However, provision of medical information had a positive effect on attitudes toward
the obese peer only for younger children and a negative effect on willingness of older children
to share academic activities with the peer. Boys and girls showed more positive behavioral
intentions toward the same-sex target child regardless of obesity condition. Information
explaining obesity has a minimal positive effect on children's attitudes and behavioral
intentions toward a peer presented as obese.
BURMEISTER, J. M., KIEFNER, A. E., CARELS, R. A. & MUSHER-EIZENMAN, D. R. 2013. Weight bias in
graduate school admissions. Obesity (Silver Spring), 21, 918-20.
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Aim: Whether weight bias occurs in the graduate school admissions process is explored here.
Specifically, we examined whether body mass index (BMI) was related to letter of
recommendation quality and the number of admissions offers applicants received after
attending in-person interviews.
Conclusion: Higher BMI significantly predicted fewer post-interview offers of admission into
Obesity Learning Centre Literature Update: Stigmatisation and obesity. February 2015
psychology graduate programs. Results also suggest this relationship is stronger for female
applicants. BMI was not related to overall quality or the number of stereotypically weightrelated adjectives in letters of recommendation. Surprisingly, higher BMI was related to more
positive adjectives in letters. The first evidence that individuals interviewing applicants to
graduate programs may systematically favor thinner applicants is provided here. A conscious
or unconscious bias against applicants with extra body weight is a plausible explanation.
Stereotype threat and social identity threat are also discussed as explanations for the
relationship between BMI and interview success.
DAVISON, K. K. & BIRCH, L. L. 2004. Predictors of fat stereotypes among 9-year-old girls and
their parents. Obes Res, 12, 86-94.
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Aim: To assess familial links in fat stereotypes and predictors of stereotypes among girls and
their parents.
Conclusion: Girls and parents exhibited fat stereotypes. Fathers who were more educated and
had a higher family income were more likely to endorse fat stereotypes, as were mothers and
fathers with a high investment in their physical appearance. Although no associations were
found between girls' and parents' fat stereotypes, girls were more likely to endorse fat
stereotypes when interactions with parents and peers focused on body shape and weight loss.
Girls were also more likely to endorse fat stereotypes when they reported higher levels of
maladaptive eating attitudes. No associations were found between weight status and fat
EDMUNDS, L. D. 2005. Parents' perceptions of health professionals' responses when seeking
help for their overweight children. Fam Pract, 22, 287-92.
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Aim: The aim was to explore parents' perceptions of help-seeking experiences with health
Conclusion: Parents went through a complex process of monitoring and self-help approaches
before seeking professional help. The responses they received from GPs included: being
sympathetic, offering tests and further referrals, general advice which parents were already
following, mothers were blamed, or dismissed as "making a fuss", and many showed a lack of
interest. Health visitors offered practical advice and paediatric dietitians were very supportive.
Experiences with community dietitians were less constructive.
GREENLEAF, C., MARTIN, S. B. & RHEA, D. 2008. Fighting fat: how do fat stereotypes influence
beliefs about physical education? Obesity (Silver Spring), 16 Suppl 2, S53-9.
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Aim: The purpose of this study was to examine college students' beliefs about youth obesity,
the roles of schools and physical education in addressing obesity, and the training they
receive to work with overweight youth.
Conclusion: The importance of youth being normal weight was rated most highly among
participants in physical education-related majors and among those who endorsed fat
stereotypes. Participants who endorsed fat stereotypes, compared to those who did not, were
more likely to believe that all school professionals should be involved in treating childhood
obesity. Participants who endorsed fat stereotypes, compared to those who did not, more
Obesity Learning Centre Literature Update: Stigmatisation and obesity. February 2015
strongly agreed that physical educators should be role models by maintaining normal weight
and educating parents on childhood obesity, and PE classes should focus on lifelong fitness.
No group differences in perceived competencies to develop exercise, weight loss, nutritional,
and educational programs for overweight youth were found.
GRIFFITHS, L. J. & PAGE, A. S. 2008. The impact of weight-related victimization on peer
relationships: the female adolescent perspective. Obesity (Silver Spring), 16 Suppl 2, S39-45.
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Aim: Obesity is associated with undesirable psychological and social consequences. This
qualitative study examined the relationship between obesity and victimization, and the impact
this has on peer relationships.
Conclusion: Weight-related victimization experiences were common and their impact on peer
relationships was complex. Low self-confidence, isolation, and peer anxiety were all identified
as resulting from victimization and were all barriers to developing peer relationships.
Participants sought protection from victimization by seeking the "ideal" nonjudgmental
empathetic best friend(s) and supportive family members to shield them from negative
experiences. However there was also evidence that, while they were guarded with their own
feelings, the experience of victimization increased empathy in these obese female
KRAIG, K. A. & KEEL, P. K. 2001. Weight-based stigmatization in children. Int J Obes Relat Metab
Disord, 25, 1661-6.
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Aim: To examine sex differences in children's weight-based stigmatization. DESIGN: Schoolbased sample of children evaluating qualities of children of varying weights. SUBJECTS: Thirtyfour children (age, 7-9 y; body mass index (BMI) 12.1-31.2 kg/m2).
Conclusion: Children evaluated drawings of thin children most favorably and drawings of
chubby children least favorably. Thin girls were rated more favorably than average or chubby
girls, for whom ratings did not differ significantly. Conversely, chubby boys were rated less
favorably than average or thin boys for whom ratings did not differ significantly. CONCLUSION:
These patterns may further explain gender differences in motivation to lose weight.
LATNER, J. D., SIMMONDS, M., ROSEWALL, J. K. & STUNKARD, A. J. 2007. Assessment of obesity
stigmatization in children and adolescents: modernizing a standard measure. Obesity (Silver
Spring), 15, 3078-85.
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Aim: Stigmatization of overweight children is highly prevalent. However, the measurement of
stigma has varied widely across studies. An up-to-date version of a commonly used measure of
weight-related stigma is needed. scales (VASs).
Conclusion: Rankings of liking of the new figures were highly correlated with rankings of
corresponding old figures, especially for overweight figures [boys: rho (77) = 0.72, p < 0.001;
girls: rho (153) = 0.68, p < 0.001]. Rankings of overweight and other figures were also highly
correlated with VAS assessment of liking and with a composite, internally consistent VAS
measure of liking and stereotypical attributes. Only negative stereotypes about the
intelligence of overweight boys and girls contributed significantly to the variance in liking.
Obesity Learning Centre Literature Update: Stigmatisation and obesity. February 2015
LATNER, J. D. & STUNKARD, A. J. 2003. Getting worse: the stigmatization of obese children. Obes
Res, 11, 452-6.
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Aim: The prevalence of childhood obesity more than doubled in the period from 1961 to 2001.
We replicated a 1961 study of stigma in childhood obesity to see what effect this increased
prevalence has had on this stigma.
Conclusion: Children in both the present and the 1961 study liked the drawing of the obese
child least. The obese child was liked significantly less in the present study than in 1961 [KruskalWallis H(1) = 130.53, p < 0.001]. Girls liked the obese child less than boys did [H(1) = 5.23, p <
0.02]. Children ranked the healthy child highest and significantly higher than in 1961 [H(1) =
245.40, p < 0.001]. The difference in liking between the healthy and obese child was currently
40.8% greater than in 1961.
LATNER, J. D., STUNKARD, A. J. & WILSON, G. T. 2005. Stigmatized students: age, sex, and
ethnicity effects in the stigmatization of obesity. Obes Res, 13, 1226-31.
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Aim: To assess the stigmatization of obesity relative to the stigmatization of various disabilities
among young men and women. Attitudes across ethnic groups were compared. In addition,
these findings were compared with data showing severe stigmatization of obesity among
Conclusion: Obesity was highly stigmatized relative to physical disabilities. African-American
women liked obese peers more than did African-American men, white men, or white women
[F(1,216) = 4.02, p < 0.05]. Overweight and obese participants were no less stigmatizing of
obesity than normal weight participants. Adults were more accepting than children of their
obese peers [t(761) = 9.16, p < 0.001].
2004. Body size stigmatization in preschool children: the role of control attributions. J Pediatr
Psychol, 29, 613-20.
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Aim: The current study assessed preschool-age children's control attributions for weight and
the relationship of these attributions to attitudes and behavioral intentions toward children of
different body sizes. Forty-two children (mean age = 5.2 years) were interviewed about the
adjectives they attributed to figures of different sizes, their preference for size in playmates,
and their beliefs about children's ability to control their own weight.
Conclusion: Adjective ratings for obese figures were the most negative, with no differences
found for thin and average figures; the heaviest figure was also chosen less often than other
figures to be a playmate. Internal attributions of control for weight were related to less positive
adjective ratings for the heavier figure but not to children's friendship selections.
Obesity Learning Centre Literature Update: Stigmatisation and obesity. February 2015
TUCCI, S. A., BOYLAND, E. J., HALFORD, J. C. & HARROLD, J. A. 2013. Stigmatisation of a formerly
obese young female. Obes Facts, 6, 433-42.
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Aim: Weight loss does not necessarily decrease the negative appraisal of a formerly
overweight individual. Since past weight history tends to be disclosed in several contexts, this
study aims to investigate whether negative appraisals are gender-specific and if they are
modulated by the evaluators' own BMI.
Conclusion: Female evaluators rated the target with the OW statement more negatively than
the target with the NW statement. In contrast, males exposed to the OW statement rated the
target as having fewer emotional/psychological problems and being less stupid/uncreative.
BMI only influenced ratings in males, where those with higher BMI ascribed more negative
attributes to the target with the NW statement than the OW statement.
ZELLER, M. H., INGERSKI, L. M., WILSON, L. & MODI, A. C. 2010. Factors contributing to weight
misperception in obese children presenting for intervention. Clin Pediatr (Phila), 49, 330-6.
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Aim: To assess weight stigma, self-perception of weight status, and factors contributing to
accurate self-perception of weight status in obese youth presenting for treatment at a
hospital-based multidisciplinary weight management program.
Conclusion: The majority endorsed negative/stereotypical attributes toward an obese body
type, chose an average or underweight figure as their ideal, and 39% misperceived their
weight status. Older child age and greater HRQOL impairment were significant predictors (P <
.01) of correct self-perception. Pediatricians may find that talking with the elementary schoolaged patient and family about whether weight/size affects their day-to-day life will prove to
be a salient and neutral opening to discussing the child's obesity and need for intervention.
differences in weight-related teasing in adolescents. Obesity (Silver Spring), 16 Suppl 2, S3-10.
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Aim: The current study examined general, peer, and family weight teasing across
race/ethnicity and weight status (average weight, overweight, obese) in adolescents. For
those participants who reported peer or family weight teasing, the extent to which this teasing
bothered them was also reported.
Conclusions: Prevalences of general weight teasing were similar across race/ethnicity. AsianAmerican boys, black boys, and Asian-American girls reported lower prevalences of peer
teasing than whites. Hispanic, Asian-American, and mixed/other girls reported higher
prevalences of family weight teasing than did white girls. In nearly all racial/ethnic groups for
all three teasing variables, obese adolescents were significantly more likely to report having
been teased, compared to average-weight adolescents. In some racial/ethnic groups
overweight adolescents were also significantly more likely than average-weight adolescents to
report having been teased. Among girls who were teased, fewer black and mixed/other girls
were bothered by peer teasing, compared to white girls. Similarly, fewer girls from most
racial/ethnic groups were bothered by family weight teasing, compared to white girls.
Obesity Learning Centre Literature Update: Stigmatisation and obesity. February 2015
Obesity and stigmatisation in health and care
BLEICH, S. N., GUDZUNE, K. A., BENNETT, W. L., JARLENSKI, M. P. & COOPER, L. A. 2013. How does
physician BMI impact patient trust and perceived stigma? Prev Med, 57, 120-4.
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Aim: The objective is to evaluate whether physician body mass index (BMI) impacts their
patients' trust or perceptions of weight-related stigma.
Conclusion Patients reported high levels of trust in their PCPs, regardless of the PCPs body
weight (normal BMI=8.6; overweight=8.3; obese=8.2; where 10 is the highest). Trust in diet
advice was significantly higher among patients seeing overweight PCPs as compared to
normal BMI PCPs (87% vs. 77%, p=0.04). Reports of feeling judged by their PCP were significantly
higher among patients seeing obese PCPs (32%; 95% confidence interval (CI): 23-41) as
compared to patients seeing normal BMI PCPs (14%; 95% CI: 7-20). Overweight and obese
patients generally trust their PCP, but they more strongly trust diet advice from overweight
PCPs as compared to normal BMI PCPs.
COHEN, L. P., DANIEL, P.; STEADMANN, CATHERINE 2005. The O Word: Why the focus on obesity
is harmful to community health. Californian Journal of Health Promotion, 33
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Focusing on the obese and overweight individual alone and is not helping us address the
broader social and economic issues that influence people’s lives. This paper discusses
strategies to remove us from a focus on the O word and from blaming the individual for their
physicians' practices and attitudes regarding care of extremely obese patients. Obesity (Silver
Spring), 17, 1710-6.
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Aim: Despite the growing epidemic of extreme obesity in the United States, weight
management is not adequately addressed in primary care. This study assessed family
physicians' practices and attitudes regarding care of extremely obese patients and factors
associated with them.
Conclusion: Bariatric surgery and weight loss medications were infrequently recommended,
particularly in physicians with higher volume of extremely obese patients (odds ratio (OR) 0.38;
95% confidence interval (CI) 0.23, 0.62 and OR 0.51; 95% CI 0.31, 0.85 for surgery and
medications, respectively). Higher knowledge was associated with increased frequency of
recommendations of weight loss medications (P < 0.0001) and bariatric surgery (P < 0.0001).
There was a high prevalence of negative attitudes, particularly in younger physicians and
those with lower patient volume. Increased knowledge of weight-loss diets was associated
with less dislike in discussing weight loss (P < 0.0001), less frustration (P = 0.0001), less belief that
treatment is often ineffective (P < 0.0001), and less pessimism about patient success (P =
0.0002). Many providers encountered challenges performing examinations on extremely obese
Obesity Learning Centre Literature Update: Stigmatisation and obesity. February 2015
patients. More education of primary care physicians, particularly on bariatric surgery, specific
examination techniques, and availability of community resources for obese persons is needed.
Further research is needed to determine if interventions to increase knowledge of physicians
will lead to less negative attitudes toward weight loss and extremely obese patients.
FRIEDMAN, K. E., ASHMORE, J. A. & APPLEGATE, K. L. 2008. Recent experiences of weight based
stigmatization in a weight loss surgery population: psychological and behavioral correlates.
Obesity (Silver Spring), 16 Suppl 2, S69-74.
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Aim: This study evaluated the association between experiences of weight-based stigmatization
(e.g., job discrimination, inappropriate comments from physicians) within the past month,
psychological functioning, and binge eating among a sample of individuals seeking weight
loss surgery.
Conclusion: Weight-based stigmatization was a common experience within the past month
among participants. Frequency of stigmatizing experiences was negatively associated with
self-esteem and positively associated with depression, anxiety, body image disturbance, and
emotional eating. Recent experiences of stigmatization were associated with a diagnosis of
binge eating disorder. Weight-based stigmatization is a common experience among obese
individuals seeking weight loss surgery, and these experiences are associated with deleterious
consequences. It appears that environmental barriers (e.g., chairs too small, not being able to
find medical equipment in an appropriate size) and interpersonal attacks are the most
common stigmatizing experiences. These data justify future studies to better understand causal
relationships and efforts to design and test interventions aimed at reducing weight-based
stigmatization and the associated negative consequences.
KUSHNER, R. F., ZEISS, D. M., FEINGLASS, J. M. & YELEN, M. 2014. An obesity educational
intervention for medical students addressing weight bias and communication skills using
standardized patients. BMC Med Educ, 14, 53.
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Aim: In order to manage the increasing worldwide problem of obesity, medical students will
need to acquire the knowledge and skills necessary to assess and counsel patients with
obesity. Few educational intervention studies have been conducted with medical students
addressing stigma and communication skills with patients who are overweight or obese. The
purpose of this study was to evaluate changes in students' attitudes and beliefs about obesity,
and their confidence in communication skills after a structured educational intervention that
included a clinical encounter with an overweight standardized patient (SP).
Conclusion: Three scales emerged from the questionnaire: negative obesity stereotyping (7
items), empathy (3 items), and counseling confidence (3 items). There were small but
significant immediate post-intervention improvements in stereotyping (p = .002) and empathy
(p < .0001) and a very large mean improvement in confidence (p < .0001). Significant
improvement between baseline and immediate follow-up responses were maintained for
empathy and counseling at one year after the encounter but stereotyping reverted to the
baseline mean. Percent of students with improved scale scores immediately and at one year
follow up were as follows: stereotyping 53.1% and 57.8%; empathy 48.4% and 47.7%; and
confidence 86.7% and 85.9%.
Obesity Learning Centre Literature Update: Stigmatisation and obesity. February 2015
MAGLIOCCA, K. R., JABERO, M. F., ALTO, D. L. & MAGLIOCCA, J. F. 2005. Knowledge, beliefs,
and attitudes of dental and dental hygiene students toward obesity. J Dent Educ, 69, 1332-9.
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Aim: Obesity is recognized as a growing public health problem. The authors surveyed dental
hygiene and dental students from one institution regarding education, knowledge, perceived
professional duties, and attitudes toward the overweight and obese population.
Conclusion: Half of the respondents reported no obesity education prior to professional dental
education, and 80 percent received five hours or less while in professional training. While most
students held a generally positive attitude regarding obese and overweight patients, a
number of students demonstrated evidence of negative stereotyping. Obesity education and
training must be integrated into dental education to permit greater understanding of
coexisting medical problems, explore the basis for a negative attitude and work toward its
elimination, and raise public health awareness within dentistry.
stigma in maternity care: women's experiences and care providers' attitudes. BMC Pregnancy
Childbirth, 13, 19.
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Aim: Weight stigma is pervasive in Western society and in healthcare settings, and has a
negative impact on victims' psychological and physical health. In the context of an increasing
focus on the management of overweight and obese women during and after pregnancy in
research and clinical practice, the current studies aimed to examine the presence of weight
stigma in maternity care. Addressing previous limitations in the weight stigma literature, this
paper quantitatively explores the presence of weight stigma from both patient and care
provider perspectives.
Conclusion: Women with a higher BMI were more likely to report negative experiences of care
during pregnancy and after birth, compared to lower weight women. Pre-service maternity
care providers perceived overweight and obese women as having poorer self-management
behaviours, and reported less positive attitudes towards caring for overweight or obese
pregnant women, than normal-weight pregnant women. Even care providers who reported
few weight stigmatising attitudes responded less positively to overweight and obese pregnant
PERSKY, S. & ECCLESTON, C. P. 2011. Medical student bias and care recommendations for an
obese versus non-obese virtual patient. Int J Obes (Lond), 35, 728-35.
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Aim: This study examined the independent effect of a patient's weight on medical students'
attitudes, beliefs and interpersonal behavior toward the patient, in addition to the clinical
recommendations they make for her care.
Conclusion: Analyses revealed more negative stereotyping, less anticipated patient
adherence, worse perceived health, more responsibility attributed for potentially weightrelated presenting complaints and less visual contact directed toward the obese version of a
virtual patient than the non-obese version of the patient. In contrast, there was no clear
evidence of bias in clinical recommendations made for the patient's care.
Obesity Learning Centre Literature Update: Stigmatisation and obesity. February 2015
Self-reported stigmatization among candidates for bariatric surgery. Obesity (Silver Spring), 16
Suppl 2, S75-9.
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Aim: The popularity of bariatric surgery has increased the focus on the psychological aspects
of extreme obesity. Although a growing literature has documented the psychosocial burden
associated with extreme obesity, surprisingly little attention has been paid to the experience of
weight-related stigmatization among extremely obese individuals. The present study
investigated self-reported experiences of weight-related stigmatization, weight-related quality
of life, and depressive symptoms among 117 extremely obese individuals (BMI = 48.2 +/- 7.5
kg/m2) who presented for bariatric surgery at the Hospital of the University of Pennsylvania.
Conclusion: In general, these individuals reported infrequent weight-related stigma, which was
unrelated to BMI. Some specific forms of stigmatization, however, appear to be related to
body size. The occurrence of stigmatization was associated with poorer weight-related quality
of life and greater symptoms of depression.
Weight bias among health professionals specializing in obesity. Obes Res, 11, 1033-9.
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Aim: To determine the level of anti-fat bias in health professionals specializing in obesity and
identify personal characteristics that correlate with both implicit and explicit bias.
Conclusion: Health professionals exhibited a significant pro-thin, anti-fat implicit bias on the IAT.
In addition, the subjects significantly endorsed the implicit stereotypes of lazy, stupid, and
worthless using the IAT. Level of bias was associated with several personal characteristics.
Characteristics significantly predictive of lower levels of implicit anti-fat bias include being
male, older, having a positive emotional outlook on life, weighing more, having friends who
are obese, and indicating an understanding of the experience of obesity.
Attitudes of health care professionals towards female obese patients. Obes Facts, 6, 512-22.
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Aim: The health care setting has been reported to be one main source of weight stigma
repeatedly; however, studies comparing different professions have been lacking.
Conclusion: Only 25% graded current health care of obese patients to be 'good' or 'very
good'. 63% of all HCPs 'somewhat' or 'strongly' agreed that it was often difficult to get the
resources needed in order to care for obese patients. The mean FPS score was comparable to
that in the general public (M = 3.59), while nursing staff showed slightly more positive attitudes
compared to physicians and therapists. Higher age, higher BMI, and ascribing personal
responsibility for obesity to the individual were associated with a higher level of stigmatizing
attitudes. The nursing staff agreed on obesity as an illness to a greater extent while physicians
attributed obesity to the individual.
Obesity Learning Centre Literature Update: Stigmatisation and obesity. February 2015
2013. Are anti-stigma films a useful strategy for reducing weight bias among trainee healthcare
professionals? Results of a pilot randomized control trial. Obes Facts, 6, 91-102.
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Aim: Weight bias is an important clinical issue that the educators of tomorrow's healthcare
professionals cannot afford to ignore. This study, therefore, aimed to pilot a randomized
controlled trial of the effects of educational films designed to reduce weight stigmatization
toward obese patients on trainee dietitians' and doctors' attitudes.
Conclusion: The current study suggests both that it is possible to conduct a substantive trial of
the effects of educational films designed to reduce weight stigma on a larger cohort of
trainee healthcare professionals, and that brief educational interventions may be effective in
reducing stigmatizing attitudes in this population.
TEACHMAN, B. A. & BROWNELL, K. D. 2001. Implicit anti-fat bias among health professionals: is
anyone immune? Int J Obes Relat Metab Disord, 25, 1525-31.
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Aim: To investigate whether negative implicit attitudes and beliefs toward overweight persons
exist among health professionals who specialize in obesity treatment, and to compare these
findings to the implicit anti-fat bias evident in the general population.
Conclusion: Clear evidence for implicit anti-fat bias was found for both the attitude and
stereotype measures. As expected, this bias was strong but was lower than bias in the general
population. Also as predicted, only minimal evidence for an explicit anti-fat bias was found.
Implicit and explicit measures of the lazy stereotype were positively related although the
attitude measures were not.
Public perceptions of and attitudes towards obesity
HAYDEN, M. J., DIXON, M. E., DIXON, J. B., PLAYFAIR, J. & O'BRIEN, P. E. 2010. Perceived
discrimination and stigmatisation against severely obese women: age and weight loss make a
difference. Obes Facts, 3, 7-14.
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Aim: Patients' perceptions about weight-related stigma and discrimination were assessed in 2
groups of patients, obese and laparoscopic adjustable gastric banding (LAGB).
Conclusion: Whilst perceptions of discrimination and stigmatisation were common and
affected many life situations, they were less prevalent than previous reports. It appeared that it
was not the frequency or number of events which affected an individual but the intensity of
the experience. Younger women reported greater discrimination than older women and felt
the social consequences of obesity to a greater extent. Older women were more concerned
about the consequences of being overweight on their health.
Obesity Learning Centre Literature Update: Stigmatisation and obesity. February 2015
HEBL, M. R., RUGGS, E. N., SINGLETARY, S. L. & BEAL, D. J. 2008. Perceptions of obesity across the
lifespan. Obesity (Silver Spring), 16 Suppl 2, S46-52.
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Aim: Previous research on obesity stereotyping has almost extensively involved looking at the
perceptions that 5-21-year-old individuals have toward members of their own age in-group.
Very little research has examined how people perceive obesity across the lifespan. The current
research begins to address this gap by examining the extent to which individuals between 18
and 77 years of age stereotype obesity in 20, 40, and 60-year-old targets.
Conclusion: As predicted, heavier women were rated more negatively than thinner women on
every dimension we examined. In addition, older women were rated more negatively than
younger women on attractiveness, but more positively on every other dimension. Other main
effects revealed that female (relative to male) and older (relative to younger) participants
were more lenient in their ratings. Several two-way interactions revealed that the obesity
stereotype for attractiveness is exaggerated when targets are younger, that males (compared
to females) levy a greater penalty for increasing weight, and that this pattern is exaggerated
more for younger men. DISCUSSION: This research shows a consistency across the lifespan in
the extent to which participants, varying in weight, age, and sex, stereotype obesity. It also
appears that, at least with respect to attractiveness, younger obese individuals are denigrated
to a larger degree than older. In sum, this research shows prevalent and consistent patterns of
obesity stereotyping across the lifespan.
HILBERT, A., RIEF, W. & BRAEHLER, E. 2008. Stigmatizing attitudes toward obesity in a
representative population-based sample. Obesity (Silver Spring), 16, 1529-34.
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Aim: The aim of this study was to determine stigmatizing attitudes toward obesity in the
population, and its related psychological and sociodemographic determinants.
Conclusion: Of the 1,000 participants, 23.5% (n=235) had stigmatizing attitudes toward obesity,
21.5% (n=215) did not have stigmatizing attitudes toward obesity, and 55.0% (n=550) had
attitudes that were undetermined with respect to stigmatization. Predictors of greater
stigmatization were more causal attributions of obesity to individual behavior, less education,
and older age, while causal attributions of obesity to heredity and labeling obesity as an illness
predicted less stigmatization. Stigmatizing attitudes were significantly associated with stronger
overall support of obesity prevention, but less readiness to support prevention financially.
LIEBERMAN, D. L., TYBUR, J. M. & LATNER, J. D. 2012. Disgust sensitivity, obesity stigma, and
gender: contamination psychology predicts weight bias for women, not men. Obesity (Silver
Spring), 20, 1803-14.
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Recent research has established a link between disgust sensitivity and stigmatizing reactions to
various groups, including obese individuals. However, previous research has overlooked
disgust's multiple evolved functions. Here, we investigated whether the link between disgust
sensitivity and obesity stigma is specific to pathogen disgust, or whether sexual disgust and
moral disgust--two separate functional domains--also relate to negative attitudes toward
obese individuals. Additionally, we investigated whether sex differences exist in the manner
disgust sensitivity predicts obesity stigma, whether the sexes differ across the subtypes of
obesity bias independent of disgust sensitivity, and last, the association between participants'
BMI and different subtypes of obesity stigma. In study 1 (N = 92), we established that obesity
elicits pathogen, sexual, and moral disgust. In study 2, we investigated the relationship
Obesity Learning Centre Literature Update: Stigmatisation and obesity. February 2015
between these types of disgust sensitivity and obesity stigma. Participants (N = 387) reported
their level of disgust toward various pathogen, sexual, and moral acts and their attitudes
toward obese individuals. For women, but not men, increased pathogen disgust sensitivity
predicted more negative attitudes toward obese individuals. Men reported more negative
general attitudes toward obese individuals whereas women reported greater fear of
becoming obese. The sexes also differed in how their own BMI related to the subtypes of
obesity stigma. These findings indicate that pathogen disgust sensitivity plays a role in obesity
stigma, specifically for women. Defining the scope of disgust's activation in response to obesity
and its relationship with other variables can help identify possible mechanisms for
understanding and ultimately alleviating prejudice and discrimination.
LIPPA, N. C. & SANDERSON, S. C. 2012. Impact of information about obesity genomics on the
stigmatization of overweight individuals: an experimental study. Obesity (Silver Spring, Md.)
[Online], 20.
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Advances in genomic technologies are rapidly leading to new understandings of the roles that
genetic variations play in obesity. Increasing public dissemination of information regarding the
role of genetics in obesity could have beneficial, harmful, or neutral effects on the
stigmatization of obese individuals. This study used an online survey and experimental design to
examine the impact of genetic versus non-genetic information on obesity stigma among selfperceived non-overweight individuals. Participants (n = 396) were randomly assigned to read
either genetic, non-genetic (environment), or gene-environment interaction obesity causal
information. A total of 48% of participants were female; mean age was 42.7 years (range = 1886 years); 75% were white; 45.2% had an annual household income of less than $40,000; mean
BMI was 23.4 kg/m(2). Obesity stigma was measured using the Fat Phobia Scale - short form
(FPS-S). After reading the experimental information, participants in the genetic and geneenvironment conditions were more likely to believe that genetics increase obesity risk than
participants in the non-genetic condition (both P < 0.05), but did not differ on obesity stigma.
Obesity stigma was higher among whites and Asians than Hispanics and African Americans (P
= 0.029), and associated with low self-esteem (P = 0.036). Obesity stigma was also negatively
associated with holding 'germ or virus' (P = 0.033) and 'overwork' (P = 0.016) causal beliefs
about obesity, and positively associated with 'diet or eating habits' (P = 0.001) and 'lack of
exercise' (P = 0.004) causal beliefs. Dissemination of brief information about the role of genetics
in obesity may have neither a beneficial nor a harmful impact on obesity stigmatization
compared with non-genetic information among self-perceived non-overweight individuals.
antifat attitudes predict antifat behaviors? Obesity (Silver Spring), 16 Suppl 2, S87-92.
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Aim: The aim of this study was to investigate discrimination against obese job candidates, and
to examine whether widely used measures of implicit and explicit antifat attitudes are related
to or predict antifat discrimination.
Conclusion: Participants rated obese job candidates as having less leadership potential, as less
likely to succeed, and as less likely to be employed than normal-weight candidates. Obese
candidates were also given a lower starting salary and ranked as less qualified overall than
candidates portrayed as normal weight. Neither implicit nor explicit antifat attitude measures
were significantly related to antifat discrimination.
Obesity Learning Centre Literature Update: Stigmatisation and obesity. February 2015
SIKORSKI, C., LUPPA, M., BRAHLER, E., KONIG, H. H. & RIEDEL-HELLER, S. G. 2012. Obese children,
adults and senior citizens in the eyes of the general public: results of a representative study on
stigma and causation of obesity. PLoS One, 7, e46924.
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Obese individuals are blamed for their excess weight based on causal attribution to the
individual. It is unclear whether obese individuals of different age groups and gender are
faced with the same amount of stigmatization. This information is important in order to identify
groups of individuals at risk for higher stigmatization and discrimination. A telephone interview
was conducted in a representative sample of 3,003 participants. Experimental manipulation
was realized by vignettes describing obese and normal-weight children, adults and senior
citizens. Stigmatizing attitudes were measured by semantic differential. Causal attribution was
assessed. Internal factors were rated with highest agreement rates as a cause for the vignette's
obesity. Lack of activity behavior and eating too much are the most supported causes.
Importance of causes differed for the different vignettes. For the child, external causes were
considered more important. The overweight vignette was rated consistently more negatively.
Higher educational attainment and personal obesity were associated with lower stigmatizing
attitudes. The vignette of the obese child was rated more negatively compared to that of an
adult or senior citizen. Obesity is seen as a controllable condition, but for children external
factors are seen as well. Despite this finding, they are faced with higher stigmatizing attitudes in
the general public, contradicting attribution theory assumptions. Internal and external
attribution were found to be inter-correlated. Obese children are the population most at risk
for being confronted with stigmatization, making them a target point in stigma-reduction
SIKORSKI, C., LUPPA, M., KAISER, M., GLAESMER, H., SCHOMERUS, G., KONIG, H. H. & RIEDELHELLER, S. G. 2011. The stigma of obesity in the general public and its implications for public
health - a systematic review. BMC Public Health, 11, 661.
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Aim: Up to this date, prevalence rates of obesity are still rising. Aside from co-morbid diseases,
perceived discrimination and stigmatization leads to worsen outcomes in obese individuals.
Higher stigmatizing attitudes towards obese individuals may also result in less support of
preventive and interventive measures. In light of the immense burden of obesity on health
care systems and also on the individuals' quality of life, accepted and subsidized preventive
measures are needed. Policy support might be determined by views of the lay public on
causes of obesity and resulting weight stigma. This study seeks to answer how representative
samples of the lay public perceive people with obesity or overweight status (stigmatizing
attitudes); what these samples attribute obesity to (causal attribution) and what types of
interventions are supported by the lay public and which factors determine that support
(prevention support).
Conclusion: Only 7 articles were found. One study reported prevalence rates of stigmatizing
attitudes. About a quarter of the population in Germany displayed definite stigmatizing
attitudes. Other studies reported causal attributions. While external influences on weight are
considered as well, it seems that internal factors are rated to be of higher importance. Across
the studies found, regulative prevention is supported by about half of the population, while
childhood prevention has highest approval rates. Results on sociodemographic determinants
differ substantially.
Obesity Learning Centre Literature Update: Stigmatisation and obesity. February 2015
VARTANIAN, L. R. 2010. Disgust and perceived control in attitudes toward obese people. Int J
Obes (Lond), 34, 1302-7.
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Aim: Efforts to explain negative attitudes toward obese people have centered on beliefs
about the controllability of body weight, whereas other processes (such as the emotion of
disgust) have been largely ignored. This study examined the role of disgust in evaluations of
obese people, as well as other social groups (for example smokers, drug addicts, women,
homosexuals, politicians).
Conclusion: Disgust was the strongest predictor of negative attitudes toward obese people,
and disgust fully mediated the association between perceptions of control and attitudes
toward obese people. In addition, obese people were rated less favorably, and as more
disgusting, than almost all social groups. Across all social groups, perceived control over group
membership was positively correlated with disgust ratings, and disgust mediated the link
between perceived control and favorability ratings.
Stigmatization of and discrimination against obese
individuals in the workplace
& THIEL, A. 2012. Stigmatization of obese individuals by human resource professionals: an
experimental study. BMC Public Health, 12, 525.
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Aim: Weight-related stigmatization is a public health problem. It impairs the psychological wellbeing of obese individuals and hinders them from adopting weight-loss behaviors. We
conducted an experimental study to investigate weight stigmatization in work settings using a
sample of experienced human resource (HR) professionals from a real-life employment setting.
Conclusion: Participants underestimated the occupational prestige of obese individuals and
overestimated it for normal-weight individuals. Obese people were more often disqualified
from being hired and less often nominated for a supervisory position, while non-ethnic normalweight individuals were favored. Stigmatization was most pronounced in obese females.
GIEL, K. E., THIEL, A., TEUFEL, M., MAYER, J. & ZIPFEL, S. 2010. Weight bias in work settings - a
qualitative review. Obes Facts, 3, 33-40.
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Aim: Studies have repeatedly demonstrated the influence of physical appearance on
behavior and treatment of individuals in work settings. A high proportion of obese individuals in
the USA have reported perceived discrimination in the work place due to their body weight.
The present review examines the specific kind, context and extent of a weight bias in work
Conclusion: There is evidence from self-report data, surveys, and laboratory research for a
weight bias in five aspects of work life. Evidence shows that obesity is a general barrier to
employment, certain professions and professional success. Obese individuals are at higher risk
of encountering stereotypes concerning their work-related qualities and for general unequal
Obesity Learning Centre Literature Update: Stigmatisation and obesity. February 2015
treatment in the work place. Current evidence reveals a weight bias in several areas in the
work place. The ecological validity of results is limited due to the predominant reliance on
laboratory studies with student samples. Field studies are needed to examine weight-based
discrimination in actual work environments as well as to uncover underlying mechanisms.
MILLER, B. J. & LUNDGREN, J. D. 2010. An experimental study of the role of weight bias in
candidate evaluation. Obesity (Silver Spring), 18, 712-8.
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Obese individuals are evaluated negatively and attributed negative trait characteristics in
several contexts including employment, health care, and education. The current experimental
study of college students examined the effect of body mass on the evaluation of political
candidates and examined whether the gender of the candidate moderated the relationship.
A series of ordinary least squares regression analyses found an interactive effect between
candidate obesity and candidate gender for global evaluation and for several trait
characteristics. Specifically, obese female candidates were evaluated more negatively than
nonobese female candidates and nonobese male candidates were evaluated more
negatively than were obese male candidates. This interaction persisted even after controlling
for standard political and demographic characteristics of the evaluator. These findings suggest
that weight bias exists for obese female political candidates, but that larger body size may be
an asset for male candidates. The ability of candidates to be successful may depend less on
their policy positions or even party affiliation and more on their physical attributes than has
been previously assumed.
Portrayals of obesity in the media
GREENBERG, B. S., EASTIN, M., HOFSCHIRE, L., LACHLAN, K. & BROWNELL, K. D. 2003. Portrayals of
overweight and obese individuals on commercial television. Am J Public Health, 93, 1342-8.
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Aim: This study examined the distribution and individual characteristics of body types on primetime television.
Conclusion: Of 1018 major television characters, 14% of females and 24% of males were
overweight or obese, less than half their percentages in the general population. Overweight
and obese females were less likely to be considered attractive, to interact with romantic
partners, or to display physical affection. Overweight and obese males were less likely to
interact with romantic partners and friends or to talk about dating and were more likely to be
shown eating.
HILBERT, A. & RIED, J. 2009. Obesity in print: an analysis of daily newspapers. Obes Facts, 2, 4651.
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Aim: Stigmatizing attitudes towards obese people are common in the public. Based on
findings that portrayals of obesity in entertainment media foster weight-related stigmatization,
the goal of the current study was to analyze media coverage of obesity in daily newspapers.
Conclusion: The national and local newspapers examined offered more comprehensive and
Obesity Learning Centre Literature Update: Stigmatisation and obesity. February 2015
less incorrect information about obesity than the tabloid newspaper. Compared with the other
types of papers, the information about obesity in the local papers was less negative and less
catastrophizing. The national newspapers presented more attributions of obesity to internal,
controllable causes than the other newspaper types, and the tabloid newspaper used more
personalized descriptions of cases with extreme features.
Effect of stigmatization
perceived stereotype threat among overweight/obese adults using a multi-threat framework.
Obes Facts, 6, 258-68.
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Aim: The Multi-Threat Framework accounts for potentially different forms of stereotype threat
that differ in target (i.e., the individual or the group) and source (i.e., the self or others). This
investigation examined how these different forms of perceived stereotype threat were related
to concepts, such as group identity, stereotype endorsement, stigma consciousness, etc.,
among overweight and obese individuals.
Conclusion: Participants reported a history of feeling threatened by stereotypes related to
weight. When reflecting on past experiences of perceived stereotype threat, participants
reported greater levels of self/own stereotype threat compared to group stereotype threat.
Level of stereotype threat was related to a number of personal characteristics (i.e., sex, BMI)
and individual factors (i.e., group identity, stigma consciousness, fear of fat). Individuals who
are overweight report a history of being threatened by negative stereotypes. The findings
support the Multi-Threat Framework for stereotype threat based on body weight. Overweight
individuals' susceptibility to stereotype threat may vary systematically depending on several
factors. Future research should examine weight-related stereotypes' impact on cognitive and
behavioral outcomes.
CARR, D. & JAFFE, K. 2012. The psychological consequences of weight change trajectories:
evidence from quantitative and qualitative data. Econ Hum Biol, 10, 419-30.
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We use quantitative and qualitative data to explore the psychological impact of weight
change among American adults. Using data from the Midlife Development in the United
States (MIDUS) study, a survey of more than 3000 adults ages 25-74 in 1995, we contrast
underweight, normal weight, overweight, obese I, and obese II/III persons along five
psychosocial outcomes: positive mood, negative mood, perceived interpersonal
discrimination, self-acceptance, and self-satisfaction. We further assess whether these
relationships are contingent upon one's body mass index (BMI) at age 21. We find a strong
inverse association between adult BMI and each of the five outcomes, reflecting the stigma
associated with high body weight. However, overweight adults who were also overweight at
age 21 are more likely than persons who were previously slender to say they were "very
satisfied" with themselves. Results from 40 in-depth semi-structured interviews reveal similarly
that persons who were persistently overweight or obese accept their weight as part of their
identity, whereas those who experienced substantial weight increases (or decreases) struggle
between two identities: the weight they actually are, and the weight that they believe
Obesity Learning Centre Literature Update: Stigmatisation and obesity. February 2015
exemplifies who they are. We discuss implications for stigma theory, and the ways that stigma
exits and entries affect psychological well-being.
CARR, D., JAFFE, K. J. & FRIEDMAN, M. A. 2008. Perceived interpersonal mistreatment among
obese Americans: do race, class, and gender matter? Obesity (Silver Spring), 16 Suppl 2, S60-8.
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Aim: We examine the extent to which body weight affects three types of perceived
interpersonal mistreatment, and evaluate whether these patterns vary by race, social class,
and gender in a large sample of American men and women.
Conclusion: In the total sample, obese I and obese II/III persons report significantly higher levels
of all three types of perceived mistreatment (compared to normal weight persons), even when
demographic, socioeconomic status, and health characteristics are controlled. Among black
men, however, obese II/III persons report significantly lower levels of all three types of
perceived mistreatment, compared to their normal weight peers. Among both men and
women, obese professional workers report significantly more perceived interpersonal
mistreatment, compared to obese persons of lower socioeconomic status.
J. 2005. Weight stigmatization and ideological beliefs: relation to psychological functioning in
obese adults. Obes Res, 13, 907-16.
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Aim: This study evaluated the relation among weight-based stigmatization, ideological beliefs
about weight, and psychological functioning in an obese, treatment-seeking sample.
Conclusion: Weight-based stigmatization was a common experience for participants.
Frequency of stigmatizing experiences was positively associated with depression, general
psychiatric symptoms, and body image disturbance, and negatively associated with selfesteem. Further, participants' own negative attitudes about weight problems were associated
with their psychological distress and moderated the relation between the experience of
stigmatization and body image.
OGDEN, J. C., CECELIA 2010. The experience of being obese and the many consequences of
stigma. Journal of Obesity, 9.
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Aim: The present qualitative study aimed to explore how people experience their obesity and
to explore the impact of this on their motivations to lose weight.
Conclusion: Participants (n = 46) were either currently obese or had been obese and were
interviewed about their experiences. Participants described the impact of obesity on aspects
of their self-identity and used language such as “ugly”, “freak”, “hate”, “blob”, and “disgust”
which reflected the pervasively negative impact of their weight. They highlighted a complex
and often contradictory relationship with food and described how such negative experiences
were created out of the dynamic between their obesity and a stigmatising social context.
Some, however, suggested that such stigma could also have positive consequences by
promoting and encouraging behaviour change. Many obese people, therefore, experience
their weight in profoundly negative way as a result of existing within a social context which
stigmatises their condition. The results are discussed in terms of the costs and benefits of stigma
and a balance between support, tolerance, and collusion in promoting weight loss.
Obesity Learning Centre Literature Update: Stigmatisation and obesity. February 2015
PUHL, R. 2009. Obesity stigma - Causes, effects and some practical solutions. Diabetes Voice,
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Obesity has become a pandemic, affecting adults and children around the world.
Considerable medical, scientific and lifestyle-related knowledge and resources are being
channelled into the identification of strategies to combat this major public health problem.
Despite these multidisciplinary efforts, however, little attention has been paid to the damaging
social and psychological consequences of obesity. Many people with overweight and/or
obesity frequently face stigmatization, prejudice and discrimination because of their body size
and shape, with disturbing and potentially harmful implications for their emotional and
physical health and well-being. Given the high rates of type 2 diabetes among people with
obesity, many of those with diabetes are vulnerable to weight stigma and its consequences.
SUTIN, A. R. T., ANTONIO 2013. Perceived weight discrimination and obesity. PLoS One.
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Aim: Weight discrimination is prevalent in American society. Although associated consistently
with psychological and economic outcomes, less is known about whether weight
discrimination is associated with longitudinal changes in obesity. The objectives of this research
are (1) to test whether weight discrimination is associated with risk of becoming obese (Body
Mass Index≥30; BMI) by follow-up among those not obese at baseline, and (2) to test whether
weight discrimination is associated with risk of remaining obese at follow-up among those
already obese at baseline. Participants were drawn from the Health and Retirement Study, a
nationally representative longitudinal survey of community-dwelling US residents. A total of
6,157 participants (58.6% female) completed the discrimination measure and had weight and
height available from the 2006 and 2010 assessments.
Conclusion: Participants who experienced weight discrimination were approximately 2.5 times
more likely to become obese by follow-up (OR = 2.54, 95% CI = 1.58–4.08) and participants
who were obese at baseline were three times more likely to remain obese at follow up (OR =
3.20, 95% CI = 2.06–4.97) than those who had not experienced such discrimination. These
effects held when controlling for demographic factors (age, sex, ethnicity, education) and
when baseline BMI was included as a covariate. These effects were also specific to weight
discrimination; other forms of discrimination (e.g., sex, race) were unrelated to risk of obesity at
follow-up. The present research demonstrates that, in addition to poorer mental health
outcomes, weight discrimination has implications for obesity. Rather than motivating
individuals to lose weight, weight discrimination increases risk for obesity.
STAMAN, J. 2007. Obesity discrimination and the Americans with Disabilities Act. Congressional
Research Service Reports and Issue Briefs.
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The Americans with Disabilities Act (ADA) provides broad nondiscrimination protection for
individuals with disabilities. However, to be covered under the statute, an individual must first
meet the definition of an individual with a disability. Questions have been raised as to whether
and to what extent obesity is a disability under the ADA and whether the ADA protects obese
individuals from discrimination. This report provides background regarding how obesity is
covered under the ADA and its supporting regulations. It also discusses some of the ways in
Obesity Learning Centre Literature Update: Stigmatisation and obesity. February 2015
which courts have applied the ADA to obesity discrimination claims.
WANG, S. S., BROWNELL, K. D. & WADDEN, T. A. 2004. The influence of the stigma of obesity on
overweight individuals. Int J Obes Relat Metab Disord, 28, 1333-7.
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Aim: To investigate the internalization of anti-fat bias among overweight individuals across a
variety of attitudes and stereotypes.
Conclusion: Participants exhibited significant anti-fat bias on the IAT across several attributes
and stereotypes. They also endorsed the explicit belief that fat people are lazier than thin
people. Unlike other minority group members, overweight individuals do not appear to hold
more favorable attitudes toward ingroup members. This ingroup devaluation has implications
for changing the stigma of obesity and for understanding the psychosocial and even medical
impact of obesity on those affected.
Measuring stigmatization
BACON, J. G., SCHELTEMA, K. E. & ROBINSON, B. E. 2001. Fat phobia scale revisited: the short
form. Int J Obes Relat Metab Disord, 25, 252-7.
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Aim: To develop a shortened form of the original 50-item fat phobia scale.
Conclusion: The shortened fat phobia scale is expected to increase the utility of the measure
in a diverse array of research and clinical settings. Future research should focus on developing
scale norms for the general population and conducting research on fat phobia in males and
among different ethnic groups.
DEPIERRE, J. A. & PUHL, R. M. 2012. Experiences of weight stigmatization: a review of self-report
assessment measures. Obes Facts, 5, 897-918.
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Aim: Overweight and obese persons are vulnerable to frequent stigmatization and
discrimination because of their weight. Despite widespread prejudice towards obese persons,
many questions remain regarding the nature, extent, and impact of weight-based
stigmatization experienced by so many people. However, improving our knowledge in this
area will only be as good as the measures we have to study this phenomenon. Our paper is
the first to provide a comprehensive summary of published quantitative self-report measures
available for assessing experiences of weight stigmatization in children and adults.
Conclusion: Existing measures contain a number of limitations and have been assessed in
samples lacking diversity. Improvements in measurement are needed to achieve a clearer
understanding of the nature and extent of self-perceived weight stigmatization and to
develop measures that accurately reflect this type of stigmatization. Specific directions for
future research that will help improve measurement of self-perceived weight stigmatization
and advance this area of study are highlighted.
Obesity Learning Centre Literature Update: Stigmatisation and obesity. February 2015
RUGGS, E. N., KING, E. B., HEBL, M. & FITZSIMMONS, M. 2010. Assessment of weight stigma. Obes
Facts, 3, 60-9.
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The purpose of this review article is to familiarize readers with the common methodologies used
to assess weight stigma. This article explores the most frequent ways weight stigma is assessed,
offers relevant empirical examples of each methodology, examines the strengths and
weaknesses of each approach, and offers recommendations for strengthening research
assessment of weight stigma for the future. Furthermore, this article highlights 4 dimensions that
are important to consider when assessing weight stigma, regardless of the research
methodology used.
Self-perception and self-stigmatization in obese
BARBER, J. A., PALMESE, L., REUTENAUER, E. L., GRILO, C. M. & TEK, C. 2011. Implications of
weight-based stigma and self-bias on quality of life among individuals with schizophrenia. J
Nerv Ment Dis, 199, 431-5.
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Aim: Obesity has been associated with significant stigma and weight-related self-bias in
community and clinical studies, but these issues have not been studied among individuals with
schizophrenia. A consecutive series of 70 obese individuals with schizophrenia or
schizoaffective disorder underwent assessment for perceptions of weight-based stigmatization,
self-directed weight bias, negative affect, medication compliance, and quality of life. The
levels of weight-based stigmatization and self-bias were compared with levels reported for
nonpsychiatric overweight/obese samples. Weight measures were unrelated to stigma, selfbias, affect, and quality of life. Weight-based stigmatization was lower than published levels for
nonpsychiatric samples, whereas levels of weight-based self-bias did not differ. After
controlling for negative affect, weight-based self-bias predicted an additional 11% of the
variance in the quality of life measure. Individuals with schizophrenia and schizoaffective
disorder reported weight-based self-bias to the same extent as nonpsychiatric samples despite
reporting less weight stigma. Weight-based self-bias was associated with poorer quality of life
after controlling for negative affect.
self-protective nature of implicit identity and its relationship to weight bias and short-term
weight loss. Obes Facts, 4, 278-83.
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Aim: Research suggests that making overly positive self-evaluations is the norm rather than the
exception. However, unlike other stigmatized groups, overweight individuals do not exhibit a
positive in-group social identity and instead exhibit significant explicit, implicit, and internalized
weight bias. Therefore, it is not known whether overweight/obese individuals will evidence selfenhancement on general traits (good, attractive), or on traits inconsistent with fat stereotypes
(disciplined, active, healthy eater), on an assessment of implicit attitudes. Similarly, it is not
known whether these ratings will be associated with preexisting levels of weight bias, gender,
Obesity Learning Centre Literature Update: Stigmatisation and obesity. February 2015
or short-term weight loss.
Conclusion: Although participants evidenced significant anti-fat attitudes, they implicitly
identified themselves as significantly thinner, better, more attractive, active, disciplined, and
more likely to eat healthy than 'other' people. Compared to men, women were less likely to
view themselves as thin and attractive relative to others. Greater implicit anti-fat bias and
implicitly seeing the self as thin relative to others was associated with less short-term weight loss.
Despite evidence for explicit, implicit, and internalized weight bias, participants generally
evidenced a positive implicit self-identity, including areas consistent with negative fat
A. M. 2013. Stereotypical images and implicit weight bias in overweight/obese people. Eat
Weight Disord, 18, 441-5.
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Aim: In this brief report, an unanswered question in implicit weight bias research is addressed: Is
weight bias stronger when obese and thin people are pictured engaging in stereotype
consistent behaviors (e.g., obese-watching TV/eating junk food; thin-exercising/eating
healthy) as opposed to the converse?
Conclusion: Implicit weight bias was evident regardless of whether participants viewed
stereotype consistent or inconsistent pictures. However, implicit bias was significantly stronger
for stereotype consistent compared to stereotype inconsistent images.
M. 2009. Internalized weight stigma and its ideological correlates among weight loss treatment
seeking adults. Eat Weight Disord, 14, e92-7.
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There are significant economic and psychological costs associated with the negative weightbased social stigma that exists in American society. This pervasive anti-fat bias has been
strongly internalized among the overweight/obese. While the etiology of weight stigma is
complex, research suggests that it is often greater among individuals who embrace certain
etiological views of obesity or ideological views of the world. This investigation examined 1) the
level of internalized weight stigma among overweight/obese treatment seeking adults, and 2)
the association between internalized weight stigma and perceived weight controllability and
ideological beliefs about the world ('just world beliefs', Protestant work ethic). Forty-six
overweight or obese adults (BMI >or=27 kg/m2) participating in an 18- week behavioral weight
loss program completed implicit (Implicit Associations Test) and explicit (Obese Person's Trait
Survey) measures of weight stigma. Participants also completed two measures of ideological
beliefs about the world ("Just World Beliefs", Protestant Ethic Scale) and one measure of beliefs
about weight controllability (Beliefs about Obese Persons). Significant implicit and explicit
weight bias was observed. Greater weight stigma was consistently associated with greater
endorsement of just world beliefs, Protestant ethic beliefs and beliefs about weight
controllability. Results suggest that the overweight/obese treatment seeking adults have
internalized the negative weight-based social stigma that exists in American society.
Internalized weight stigma may be greater among those holding specific etiological and
ideological beliefs about weight and the world.
Obesity Learning Centre Literature Update: Stigmatisation and obesity. February 2015
& ASHRAFLOUN, L. 2013. Internalized weight bias: ratings of the self, normal weight, and obese
individuals and psychological maladjustment. J Behav Med, 36, 86-94.
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Current measures of internalized weight bias assess factors such as responsibility for weight
status, mistreatment because of weight, etc. A potential complementary approach for
assessing internalized weight bias is to examine the correspondence between individuals'
ratings of obese people, normal weight people, and themselves on personality traits. This
investigation examined the relationships among different measures of internalized weight bias,
as well as the association between those measures and psychosocial maladjustment. Prior to
the beginning of a weight loss intervention, 62 overweight/obese adults completed measures
of explicit and internalized weight bias as well as body image, binge eating, and depression.
Discrepancies between participants' ratings of obese people in general and ratings of
themselves on both positive and negative traits predicted unique variance in measures of
maladjustment above a traditional assessment of internalized weight bias. This novel approach
to measuring internalized weight bias provides information above and beyond traditional
measures of internalized weight bias and begins to provide insights into social comparison
processes involved in weight bias.
DURSO, L. E. & LATNER, J. D. 2008. Understanding self-directed stigma: development of the
weight bias internalization scale. Obesity (Silver Spring), 16 Suppl 2, S80-6.
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Aim: The present study developed the Weight Bias Internalization Scale (WBIS), an 11-item
measure assessing internalized weight bias among the overweight and obese.
Conclusion: Results indicate that the WBIS had high internal consistency (Cronbach's alpha =
0.90) and correlated significantly with antifat attitudes but was not a completely overlapping
construct (r = 0.31). The scale showed strong partial correlations with self-esteem (r = -0.67),
drive for thinness (r = 0.47), and body image concern (r = 0.75), controlling for BMI. Internalized
weight bias was also significantly correlated with measures of mood and eating disturbance.
Multiple regression analyses were conducted using WBIS scores, antifat attitudes, and BMI as
predictor variables of body image, mood, self-esteem, and binge eating. WBIS scores were
found to significantly predict scores on each of these measures.
health beliefs and behaviors differ according to severity of obesity? A qualitative study of
Australian adults. Int J Environ Res Public Health, 7, 443-59.
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Public responses to obesity have focused on providing standardized messages and supports to
all obese individuals, but there is limited understanding of the impact of these messages on
obese adults. This descriptive qualitative study using in-depth interviews and a thematic
method of analysis, compares the health beliefs and behaviors of 141 Australian adults with
mild to moderate (BMI 30-39.9) and severe (BMI > or = 40) obesity. Mildly obese individuals felt
little need to change their health behaviors or to lose weight for health reasons. Most believed
they could "lose weight" if they needed to, distanced themselves from the word obesity, and
stigmatized those "fatter" than themselves. Severely obese individuals felt an urgent need to
change their health behaviors, but felt powerless to do so. They blamed themselves for their
Obesity Learning Centre Literature Update: Stigmatisation and obesity. February 2015
weight, used stereotypical language to describe their health behaviors, and described being
"at war" with their bodies. Further research, particularly about the role of stigma and
stereotyping, is needed to fully understand the impact of obesity messaging on the health
beliefs, behaviors, and wellbeing of obese and severely obese adults.
LILLIS, J., LUOMA, J. B., LEVIN, M. E. & HAYES, S. C. 2010. Measuring weight self-stigma: the
weight self-stigma questionnaire. Obesity (Silver Spring), 18, 971-6.
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Stigma associated with being overweight or obese is widespread. Given that weight loss is
difficult to achieve and maintain, researchers have been calling for interventions that reduce
the impact of weight stigma on life functioning. Sound measures that are sensitive to change
are needed to help guide and inform intervention studies. This study presents the weight selfstigma questionnaire (WSSQ). The WSSQ has 12 items and is designed for use only with
populations of overweight or obese persons. Two samples of participants--one treatment
seeking, one nontreatment seeking--were used for validation (N = 169). Results indicate that
the WSSQ has good reliability and validity, and contains two distinct subscales-self-devaluation
and fear of enacted stigma. The WSSQ could be useful for identifying individuals who may
benefit from a stigma reduction intervention and may also help evaluate programs designed
to reduce stigma.
PUHL, R. M., MOSS-RACUSIN, C. A. & SCHWARTZ, M. B. 2007. Internalization of weight bias:
Implications for binge eating and emotional well-being. Obesity (Silver Spring), 15, 19-23.
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Aim: This study examined the relationship between internalization of negative weight-based
stereotypes and indices of eating behaviors and emotional well-being in a sample of
overweight and obese women.
Conclusion: Participants who believed that weight-based stereotypes were true reported more
frequent binge eating and refusal to diet in response to stigma experiences compared with
those who reported stereotypes to be false. The degree to which participants believed
stereotypes to be true or false was not related to types or amount of stigma experiences
reported, self-esteem, depression, or attitudes toward obese persons. In addition, engaging in
weight loss strategies as a response to bias was not predicted by stereotype beliefs or by
actual stigma experiences, regardless of the amount or types of stigma reported. These
findings suggest that obese individuals who internalize negative weight-based stereotypes
may be particularly vulnerable to the negative impact of stigma on eating behaviors and also
challenge the notion that stigma may motivate obese individuals to engage in efforts to lose
weight. This study highlights a new area of research that warrants attention to better
understand weight stigma and its potential consequences for health.
SCHWARTZ, M. B., VARTANIAN, L. R., NOSEK, B. A. & BROWNELL, K. D. 2006. The influence of
one's own body weight on implicit and explicit anti-fat bias. Obesity (Silver Spring), 14, 440-7.
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Aim: This study examined the influence of one's own body weight on the strength of implicit
and explicit anti-fat bias.
Conclusion: All weight groups exhibited significant anti-fat bias, but there was an inverse
relation between one's own weight and the level of observed bias. Thinner people were more
Obesity Learning Centre Literature Update: Stigmatisation and obesity. February 2015
likely to automatically associate negative attributes (bad, lazy) with fat people, to prefer thin
people to fat people, and to explicitly rate fat people as lazier and less motivated than thin
people. However, when the lazy stereotype was contrasted with another negative attribute
(anxious), obese and non-obese people exhibited equally strong implicit stereotyping. Finally,
a substantial proportion of respondents indicated a willingness to endure aversive life events to
avoid being obese. For example, 46% of the total sample indicated that they would rather
give up 1 year of life than be obese, and 30% reported that they would rather be divorced
than be obese. In each case, thinner people were more willing to sacrifice aspects of their
health or life circumstances than were heavier people.
Obesity stigmatization and public health planning
Obesity, stigma and public health planning. Health Promot Int, 24, 88-93.
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Given the rise in obesity rates in North America, concerns about obesity-related costs to the
health care system are being stressed in both the popular media and the scientific literature.
With such constant calls to action, care must be taken not to increase stigmatization of obese
people, particularly of children. While there is much written about stigma and how it is
exacerbated, there are few guidelines for public health managers and practitioners who are
attempting to design and implement obesity prevention programs that minimize stigma. We
examine stigmatization of obese people and the consequences of this social process, and
discuss how stigma is manifest in health service provision. We give suggestions for designing
non-stigmatizing obesity prevention public health programs. Implications for practice and
policy are discussed.
POMERANZ, J. L. 2008. A historical analysis of public health, the law, and stigmatized social
groups: the need for both obesity and weight bias legislation. Obesity (Silver Spring), 16 Suppl 2,
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History teaches that discrimination against socially undesirable groups leads to societal and
governmental neglect of the stigmatized group's health problem. By placing weight
discrimination in a historical context, this article demonstrates that legislation specifically aimed
at rectifying obesity is less likely while weight bias is socially acceptable. Beyond obesity
legislation, public health professionals may consider advocating for legislation directly
targeting discrimination based on weight. This article reviews the history of discrimination
against distinct groups and provides statutory solutions for discrimination based on weight. In
addition to revising current statutes and regulatory rules, a unique statute targeting weight bias
in the employment context is considered.
PUHL, R. M. & HEUER, C. A. 2010. Obesity stigma: important considerations for public health. Am
J Public Health, 100, 1019-28.
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Stigma and discrimination toward obese persons are pervasive and pose numerous
consequences for their psychological and physical health. Despite decades of science
Obesity Learning Centre Literature Update: Stigmatisation and obesity. February 2015
documenting weight stigma, its public health implications are widely ignored. Instead, obese
persons are blamed for their weight, with common perceptions that weight stigmatization is
justifiable and may motivate individuals to adopt healthier behaviors. We examine evidence
to address these assumptions and discuss their public health implications. On the basis of
current findings, we propose that weight stigma is not a beneficial public health tool for
reducing obesity. Rather, stigmatization of obese individuals threatens health, generates
health disparities, and interferes with effective obesity intervention efforts. These findings
highlight weight stigma as both a social justice issue and a priority for public health.
Further reading
Please note that the articles in this section of the update require subscriptions to access. The
Obesity Learning Centre and the UK Health Forum regret that we are unable to supply Obesity
Learning Centre users with full text articles at the present time.
ANDREYEVA, T., PUHL, R. M. & BROWNELL, K. D. 2008. Changes in Perceived Weight Discrimination
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Appendix: Search strategy
Resource limitations meant that only open access databases could be searched for this literature
update. The following open access databases were searched:
Cochrane Library:
Google Scholar:
PubMed & Cochrane Library MeSH search strategy
"Stereotyping"[Mesh]) AND "Obesity"[Mesh]
English language
Publication dates: 2004 – 2014
Google Scholar search strategy
Obesity and (“stereotyping” or “stereotype” or blame or bias or stigma or discrimination or bully)
Search record
Date of search
9 January 2015
Google Scholar
9 January 2015
9 January 2015
Details and comments
No. records
259,000 results found. Scanned first
200 results and retrieved 82
relevant records.
Obesity Learning Centre Literature Update: Stigmatisation and obesity. February 2015