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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

Introductory psychology students (120 females and 120 males) rated attractiveness and fecundity of one of six computer-altered female figures representing three body-weight categories (underweight, normal weight and overweight) and two levels of waist-to-hip ratio (WHR), one in the ideal range (0.72) and one in the non-ideal range (0.86). Both females and males judged underweight figures to be more attractive than normal or overweight figures, regardless of WHR. The female figure with the high WHR (0.86) was judged to be more attractive than the figure with the low WHR (0.72) across all body-weight conditions. Analyses of fecundity ratings revealed an interaction between weight and WHR such that the models did not differ in the normal weight category, but did differ in the underweight (model with WHR of 0.72 was less fecund) and overweight (model with WHR of 0.86 was more fecund) categories. These findings lend stronger support to sociocultural rather than evolutionary hypotheses.

Full citation: Puhl RM, Boland FJ. Predicting female physical attractiveness: Waist-to-hip ratio versus thinness. Psychology, Evolution & Gender. 2001;3(1):27-46. https://doi.org/10.1080/14616660110049573

There is clear documentation of bias and discrimination aimed at overweight persons, but less is known about methods individuals use to cope with weight stigma. This paper provides an analysis of such methods, integrating work on weight stigma with what is known from other relevant areas (e.g., race and gender bias). Multiple means of coping have been studied, ranging from attempts to change the stigmatizing condition (losing weight) to taking pride in the condition and mobilizing social action to prevent discrimination. The most promising areas for future research, methodological challenges, and the importance of individual difference and situational factors as moderating variables are discussed.

Full citation: Puhl R, Brownell KD. Ways of coping with obesity stigma: review and conceptual analysis. Eat Behav. 2003;4(1):53-78. https://doi.org/10.1016/s1471-0153(02)00096-x

In contrast to other threats to American children’s health, the treatment and prevention of childhood obesity are considered the responsibility of individual children and their parents. This pressure exists in the context of the societal stigmatization of overweight children and the powerful environmental induce-ments aimed directly at children to eat nutritionally poor foods. Parents of overweight children are left in the difficult position of fearing the social and health consequences of their child’s obesity, and fighting a losing battle against the omnipotent presence of the media and constant exposure to unhealthy foods. This paper brings together several literatures to provide a comprehensive examination of the major challenges facing obese children and their families. In particular, this paper documents the extent of stigmatization towards overweight children and reviews evidence of the conflicting advice given to parents about how to help children develop healthful eating in the face of biological and learned food preferences. We conclude with a call for a shift in thinking about the role of our society in the treatment and prevention of childhood obesity.

Full citation: Schwartz MB, Puhl R. Childhood obesity: a societal problem to solve. Obes Rev. 2003;4(1):57-71. https://doi.org/10.1046/j.1467-789x.2003.00093.x