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After years of near total neglect, the problem of childhood obesity is now in the limelight. Terms like “epidemic,” “crisis,” and “emergency” are used frequently when describing the trend. Progress is defined with strong language (e.g., the need for a “war” on obesity) and fueled by statistics such as the observation that this generation of children will be the first to live shorter lives than their parents. Multi-disciplinary journals such as the Journal of Law, Medicine & Ethics have dedicated symposiums to the issue, and conferences have been convened not only by health professionals but by government agencies, the food industry, and even professionals who market to children. The seriousness of childhood obesity is no longer in doubt, and finally attention has turned to the more complex question – what must be done?

Full citation: Schwartz MB, Brownell KD. Actions necessary to prevent childhood obesity: creating the climate for change. J Law Med Ethics. 2007;35(1):78-89. https://doi.org/10.1111/j.1748-720X.2007.00114.x

In a meta-analysis of 88 studies, we examined the association between soft drink consumption and nutrition and health outcomes. We found clear associations of soft drink intake with increased energy intake and body weight. Soft drink intake also was associated with lower intakes of milk, calcium, and other nutrients and with an increased risk of several medical problems (e.g., diabetes).

Full citation: Vartanian LR, Schwartz MB, Brownell KD. Effects of soft drink consumption on nutrition and health: a systematic review and meta-analysis. Am J Public Health. 2007;97(4):667-675. https://doi.org/10.2105/AJPH.2005.083782

This study evaluated an environmental intervention intended to increase consumption of the fruit serving among elementary school children participating in the National School Lunch Program (NSLP). A simple verbal prompt appears to have a significant impact on the likelihood that children will take, and subsequently consume, a fruit serving as part of their purchased school lunch. If these findings are replicated, policymakers may consider adding verbal prompts to the serving policy of the NSLP in an effort to increase fruit consumption among school children.

Full citation: Schwartz MB. The influence of a verbal prompt on school lunch fruit consumption: a pilot study. Int J Behav Nutr Phys Act. 2007;4:6. Published 2007 Mar 5. https://doi.org/10.1186/1479-5868-4-6

Cross-country differences in the prevalence of obesity in older Europeans are substantial and exceed socio-demographic differentials in excessive body weight. Obesity is associated with significantly poorer health outcomes among Europeans aged 50 years and over, with effects similar across countries. Large heterogeneity in obesity throughout Europe should be investigated further to identify areas for effective public policy.

Full citation: Andreyeva T, Michaud PC, van Soest A. Obesity and health in Europeans aged 50 years and older. Public Health. 2007;121(7):497-509. https://doi.org/10.1016/j.puhe.2006.11.016

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.

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.

Full citation: Puhl RM, Moss-Racusin CA, Schwartz MB. Internalization of weight bias: Implications for binge eating and emotional well-being. Obesity (Silver Spring). 2007;15(1):19-23. https://doi.org/10.1038/oby.2007.521

This study examined experiences of weight stigmatization, sources of stigma, coping strategies, psychological functioning, and eating behaviors in a sample of 2671 overweight and obese adults.

Experiences of weight stigmatization, in many forms and across multiple occasions, was common. A variety of coping strategies were used in response. More frequent exposure to stigma was related to more attempts to cope and higher BMI. Physicians and family members were the most frequent sources of weight bias reported. No gender differences were observed in types or frequency of stigmatization. Frequency of stigmatization was not related to current psychological functioning, although coping responses were associated with emotional well-being. These findings raise questions about the relationship between stigma and psychological functioning and have important implications for obesity treatment and stigma reduction intervention efforts, both of which are discussed.

Full citation: Puhl RM, Brownell KD. Confronting and coping with weight stigma: an investigation of overweight and obese adults. Obesity (Silver Spring). 2006;14(10):1802-1815. https://doi.org/10.1038/oby.2006.208

This measure was created in collaboration with the Connecticut State Department of Education in 2006. The survey was designed to be completed by school principals, and sections include:

• Nutrition Education
• School Food Practices
• Physical Education and Physical Activity
• Communication and Promotion
• Coordinated School Health
• Barriers to Promoting a Healthy School Environment

This material is now archived. For more information about measuring school wellness activity, please visit wellsat.org.

In 3 experiments, the authors tested the effect of perceived social consensus on attitudes toward obese people. Participants completed self-report measures of attitudes toward obese people prior to and after manipulated consensus feedback depicting attitudes of others. In Study 1 (N 60), participants decreased negative and increased positive stereotypes after learning that others held more favorable attitudes toward obese people. In Study 2 (N 55), participants improved attitudes when they learned about favorable attitudes of obese people from an in-group versus an out-group source. In Study 3 (N 200), a consensus approach was compared with other stigma reduction methods. Social consensus feedback influenced participants’ attitudes and beliefs about causes of obesity. Providing information about the uncontrollable causes of obesity and supposed scientific prevalence of traits also improved attitudes.

Full citation: Puhl RM, Schwartz MB, Brownell KD. Impact of perceived consensus on stereotypes about obese people: a new approach for reducing bias. Health Psychol. 2005;24(5):517-525. https://doi.org/10.1037/0278-6133.24.5.517

The aim of this study was to determine whether memories of parental rules about food during childhood are linked to adult eating behaviors. An adult community sample (N=122) (56% female, 44% male) with a mean age of 44.6 years completed self-report measures of weight and dieting history, current eating patterns, and recollection of different types of rules about food from their parents. Three types of food rules were assessed: (a) rules which restrict intake of certain foods, (b) rules which encourage food intake, and (c) rules where food is used to reward or punish behavior.

Binge eating and dietary restraint in adulthood are significantly related to participants’ recollection of their parents using food to control their behavior in childhood. These results held true regardless of body mass index (BMI), ethnicity, age, or childhood weight status. This study suggests that some childhood food rules may have a long-lasting impact on eating behaviors. Further research on the impact of using food to reward and punish children’s behavior is needed to inform recommendations to parents regarding the use of food for behavioral control.

Full citation: Puhl RM, Schwartz MB. If you are good you can have a cookie: How memories of childhood food rules link to adult eating behaviors. Eat Behav. 2003;4(3):283-293. https://doi.org/10.1016/S1471-0153(03)00024-2

Widespread bias and discrimination based on weight have been documented in key areas of living, including education, employment, and health care. This paper examines the social and psychological origins of this bias through a review and critique of theoretical and empirical literatures, and proposes how the field might best advance in the area of reducing stigma. Explanations for the development and reduction of weight stigma are examined with different theoretical approaches, including attribution theory and a social consensus model. Individual and sociocultural contributors to bias suggested by these approaches are high-lighted. New directions are discussed in both the understanding and prevention of weight bias.

Full citation: Puhl RM, Brownell KD. Psychosocial origins of obesity stigma: toward changing a powerful and pervasive bias. Obes Rev. 2003;4(4):213-227. https://doi.org/10.1046/j.1467-789x.2003.00122.x