Body Size Stigmatization in Preschool Children:
The Role of Control Attributions
Dara R. Musher-Eizenman, PHD, Shayla C. Holub, MA, Amy Barnhart Miller, MA,
Sara E. Goldstein, PHD, and Laura Edwards-Leeper, MA
Bowling Green State University
Objective 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. Methods 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. Results 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. Conclusion Results suggest that the relationship between body size
stigmatization and control attributions are consistent with attribution theory for
young children. Practical implications of these results and possible interventions
are discussed.
Key words
obesity (attitudes toward); attribution theory; body size; preschoolers.
There is a great deal of evidence that our society holds a
negative attitude toward overweight individuals (e.g.,
Neumark-Sztainer, Story, & Faibisch, 1998; Rothblum,
1992; Yuker & Allison, 1994). Although there are legitimate health concerns associated with obesity, body size
stigmatization has clear negative consequences for the
social interactions of overweight people (Cossrow,
Jeffery, & McGuire, 2001). Also, these attitudes have
implications for the self-perceptions of many individuals. For example, individuals who believe that a thin
body is ideal are more dissatisfied with their own bodies
(Sands & Wardle, 2003), which may lead to more disordered eating (Stice, 1994).
It is important to understand the factors that lead to
individual differences in anti-fat beliefs. A possible source
of individual differences in body size stigmatization is
suggested by attribution theory (Weiner, 1995). This
theory posits that when negative attributes of a person
are seen as controllable, the individual will be more stigmatized than when the attribute is viewed as uncontrollable. Therefore, the current study had several goals. First,
this study replicated prior work demonstrating that very
young children held negative attitudes toward overweight
children (Cramer & Steinwert, 1998). Second, because
little is known about how these attitudes in children
might manifest behaviorally, we explored the degree to
which children used body size to make friendship selections. Finally, we extended this work by examining how
children’s perceptions of the controllability of weight
might be related to body size stigmatization and friendship selections based on body size.
Anti-Fat Attitudes in Young Children
Negative attitudes about obesity are present in children
as young as 3 years of age (Cramer & Steinwert, 1998).
All correspondence should be addressed to Dara R. Musher-Eizenman, Department of Psychology, Bowling Green State
University, Bowling Green, OH 43403. E-mail: mushere@bgnet.bgsu.edu.
Journal of Pediatric Psychology () pp. –, 
doi:./jpepsy/jsh
Journal of Pediatric Psychology vol.  no.  © Society of Pediatric Psychology ; all rights reserved.

Musher-Eizenman, Holub, Barnhart Miller, Goldstein, and Edwards-Leeper
Preschool children believe that children who are overweight possess more negative personality and behavioral
characteristics than do other children (e.g., Sigelman, Miller,
& Whitworth, 1986). Even children who are overweight
themselves hold negative attitudes toward overweight
individuals (Lerner & Korn, 1972; Staffieri, 1967).
A standard technique for assessing anti-fat attitudes
is to elicit reactions to figures of various body sizes
(from very thin to very fat). Some research has found
that children hold negative attitudes toward the thinnest
figures, who may be seen as socially submissive or less
healthy (Brylinsky & Moore, 1994; Staffieri, 1967)—but
by far children hold the most negative attitudes toward
overweight figures, and these attitudes become more
extreme as children get older (Brylinsky & Moore, 1994;
Cramer & Steinwert, 1998).
Furthermore, children’s attitudes toward overweight
individuals are more negative than those toward individuals with other types of stigma. Sigelman, Miller, and
Whitworth (1986) showed preschoolers through second
graders pictures of children with various stigmatizing
attributes. The obese target was the least liked. Also,
those targets with other types of stigma (e.g., a child with
glasses or a physical handicap) were evaluated more
positively with increasing age, whereas this was not true
for overweight targets.
Friendship Selection
One way in which children’s anti-fat attitudes manifest
behaviorally is in peer interactions. Research shows
that overweight children are at risk for peer rejection
(Strauss, Smith, Frame, & Forehand, 1985), victimization (Lagerspetz, Bjorkqvist, Berts, & King, 1982),
and teasing (Neumark-Sztainer et al., 2002). Moreover,
children like overweight peers less and wish to interact
with them less compared with average-weight peers (Bell
& Morgan, 2000; Sigelman, 1991; Young & Avdzej, 1979).
However, it is not completely clear at what age children begin to demonstrate these peer-directed behaviors.
In the Cramer and Steinwert (1998) study, preschool
children chose a figure (thin, average, or chubby) as a
potential playmate. Participants most often chose the
thin or average figure. However, for this task children
could select only one friend from two choices and could
not choose to play with all the figures. In addition, the
dimensions of the figures in this study may have affected
the results. The difference in width between the thin and
average figures was only 1 cm, whereas the difference
between the average and chubby figures was over 3 cm.
Thus, a goal of the current study was to clarify whether
preschoolers considered body size as a salient attribute
in peer selection.
Attribution Theory
It is possible that one reason children characterize overweight individuals more negatively than those with
other physical attributes is that they see this condition as
the fault of the overweight person. Attribution theory
posits that individuals search for a causal understanding
of events (Heider, 1944, 1958), especially when those
events are negative (Clary & Tesser, 1983). According
to Weiner (1995), individuals make a distinction between
controllable and noncontrollable causes of events. If a
controllable attribution (e.g., lack of willpower) is made,
anger and social distancing may result. If the condition
is attributed to an uncontrollable source (e.g., biology),
sympathy and help may follow. Thus, Weiner (1995)
proposes that “others are judged as responsible or as not
responsible for their plights, that is, they are sinners or
sick” (141).
Empirical evidence supports the predictions of
attribution theory for adults’ attitudes about overweight individuals. Adults who hold controllable attributions for weight are more likely to hold anti-fat
attitudes. For example, in contrast to individuals presented with a biogenetic explanation, those presented
with a behavioral explanation for overweight (e.g., overeating, lack of exercise) show greater blame, implicit
bias, and negative stereotyping of individuals who are
fat (DeJong, 1980, 1993; Lewis, Cash, Jacobi, & BubbLewis, 1997; Teachman, Gapinski, Brownell, Rawlins,
& Jeyaram, 2003).
Furthermore, there is evidence that attribution
theory applies to school-age children’s beliefs about
overweight individuals. For example, Tiggemann and
Anesbury (2000) found that 8–12-year-old children on
average believed that obesity was controllable. The more
strongly children held this belief, the more strongly they
held negative stereotypes about overweight individuals.
Moreover, Sigelman and Begley (1987) found that when
kindergarten and first-grade children heard an obese
target described as being responsible for his condition
(i.e., ate too much without dieting), they liked the target
child less than when he was deemed not responsible
(i.e., had a glandular disorder) or when no cause was
given. Still, there has been very little attribution-theory
research with younger children. Some researchers suggest
that preschool children are biased toward using external
attributions (Perry & Bussey, 1984). Other research, however, indicates that young children may discriminate
Body Size Stigmatization
external from internal causes and that this distinction may
be made for some target conditions earlier than others
(Miller & Aloise, 1989).
Thus, the current study explored whether attribution theory applied to preschool children’s evaluation
of overweight individuals. We predicted that children
who believed that overweight was controllable, as compared with those who made external attributions for
weight, would hold stronger anti-fat prejudices and
select fewer overweight children as friends.
Methods
Participants
Letters were sent home to parents of all 4- to 6-year-old
children at seven local preschools and day-care centers
(N = 168) describing the study and asking for consent
for their child to participate. The centers were comparable in the types of families that attended and in the program that they provided. Consent forms were returned for
42 children—18 girls and 24 boys. The mean age of the
children was 5.2 years (range, 4.0–6.2). All of the children
were white and primarily from middle-class homes.
Children’s body mass index (BMI), measured at the time
of testing, ranged from 12.8 to 18.4 (M = 15.4, SD = 1.3),
suggesting that the sample’s weight was consistent with
national norms for this age group (Centers for Disease
Control and Prevention, 2003) (bivariate correlations
indicated no relationship between child’s BMI and any of
the attitude variables of interest in this study [all p > .10].
Thus, child’s BMI is not included in the present analyses).
Materials
Anti-Fat Prejudice
Children’s anti-fat prejudice was measured using an
adjective rating scale similar to the semantic differential
technique used by Stager and Burke (1982). Children
saw a scale with a positive adjective on one end and a
negative adjective on the other. These adjective pairs were
read to the children, who then placed each figure (thin,
average, and chubby, matched to the participant’s gender) at the point on the scale between the two polar
adjectives where they thought it belonged. The figures
were the first, last, and middle figures from the Collins
(1991) figure array for children. The figures were 2 inches
tall with the same-colored clothing. An arrow pointing
down was used to help the children place the figures on
the scale. The figures were presented one at a time in
random order, giving the children the option to rate each
figure the same way. The children repeated this task for
six adjective pairs presented in random order: nice/mean,
smart/stupid, has friends/has no friends, neat/sloppy, cute/
ugly, and quiet/loud.
The children placed the figure in one of seven boxes
along the top of the scale. Two of these boxes were
above the adjectives themselves, and the rest were at
equal intervals representing different points along the
scale. After the children placed the figure, trained coders
recorded the box closest to the center of the figure, for a
possible score of 1 (above the negative adjective) to 7
(above the positive adjective). This was completed using
each figure for each adjective pair. A score of 4 indicated
that the child placed the figure exactly halfway between
the two adjectives in the pair.
Children began with a practice item using the adjective pair of hard/soft and pictures of a rock, a ball, and a
teddy bear. If a child did not complete the practice item
successfully, the instructions were clarified and the item
was repeated by that child. After a child completed the
practice item, the experimenter positioned the rock, ball,
and teddy bear back on the scale where the child had
placed them. The experimenter then asked questions
about the position of the items (e.g., “So, you think that
the rock is harder than the teddy bear, is that right?”). Similar questions were also asked on the child’s first trial using
the figures to ensure that the child understood the task.
This task yielded three scores. The first was the
average rating of the chubby figure, with lower scores
indicating more negative attitudes toward overweight
individuals. The second score was the average rating of
the thin figure, with higher scores indicating a more positive perception of thinness. The third score was the difference between ratings of the average figure and the chubby
figure, with greater discrepancies suggesting greater
prejudice. If the child described the chubby figure more
positively than the average figure, this score was a negative number. The alpha across the six adjectives for the
chubby figure was .63.
Friendship Selection
This measure was developed for the current study to
assess the degree to which children use body size to select
friends. Children saw an 8.5″ × 11″ sheet of beige paper
with 18 randomly arranged figures. The figures were those
used in the adjective task. There were 3 chubby, 3 averagesize, and 3 thin girls, and 3 chubby, 3 average-size, and 3
thin boys. Children circled the 3 children with whom
they would most like to play. Thus, they could select 3
friends of the same gender and same body size. They
then selected from all 18 figures the 1 figure they would
want to have for a best friend.


Musher-Eizenman, Holub, Barnhart Miller, Goldstein, and Edwards-Leeper
Attributions of Control
This scale (based on Anesbury and Tiggemann, 2000)
measures perceived causes of and solutions to overweight
and included five items appropriate for preschool-age
children. The items were: (1) Do children have control
over their weight? (2) If a child is fat, is that his or her
fault? (3) Are children fat because they eat too much?
(4) Are children fat because they don’t exercise? and (5)
Can fat children become thin if they really try?
Children first responded yes or no to an item. A
child who answered yes was prompted to follow up with
definitely or maybe, completing a 3-point scale (0 = no, 1 =
maybe, and 2 = definitely). Regardless of the child’s reading
ability, the experimenter first pointed to two boxes labeled
yes and no, and then, if the child responded yes, the experimenter pointed to a large and small circle to represent definitely and maybe, respectively. Children were allowed to
respond verbally or by pointing to their response. For the
first item, the experimenter checked the child’s understanding (e.g., “So, you think that children definitely have control
over their weight?”). If the child agreed, the experimenter
continued with the remaining questions; otherwise, she
explained the procedure again. If at any point the child was
confused by a question, the experimenter repeated the item
slowly for the child (this occurred for less than 5% of the
questions across all children). An average score was derived
across all five items, with higher scores indicating a more
internal attribution of control for weight (α = .56)
(although this internal consistency is somewhat lower than
ideal, it is consistent with that found in some past research
with this construct, even with adults [e.g., Holt, Clark, &
Kreuter, 2001; Saltzer, 1982]).
Procedure
Children with consent to participate were tested individually in a separate room at the child care center.
Trained female experimenters conducted all testing. In
most cases, a second experimenter observed the testing session to ensure that the protocol was followed closely. The
child measures included here were embedded within a
longer testing protocol. The order of the attitudes and
friendship selection tasks was randomized, and the controllability scale was done last, to avoid affecting the other
tasks. Means for the attitudes and friendship selection tasks
did not differ depending on order of presentation (p > .10).
Table I. Mean (SD) Ratings for Thin, Average, and Chubby Figures for
Each Adjective Pair
Adjective Pair
Thin Figure
Average Figure Chubby Figure
Nice/mean
5.2 (2.4)
5.3 (2.6)
3.0 (2.6)
Smart/stupid
5.2 (2.4)
5.5 (2.2)
2.9 (2.6)
Has friends/has no friends
5.1 (2.4)
5.1 (2.6)
3.2 (2.7)
Neat/sloppy
5.6 (2.1)
5.6 (2.3)
2.3 (2.2)
Cute/ugly
5.5 (2.5)
5.4 (2.1)
2.6 (2.3)
Quiet/loud
5.0 (2.5)
4.8 (2.7)
3.4 (2.8)
the thin figure, 5.2 (SD = 1.3) for the average figure, and 2.9
(SD = 1.5) for the chubby figure. In a repeated-measures
analysis of variance, these were significantly different from
one another, F(2, 82) = 41.5, p < .05. The adjective ratings for the chubby figure were significantly lower than
those for both the thin figure, t(41) = 8.1 (p < .01), and
the average figure, t(41) = 7.3 (p < .01) (see Table I).
Child Friendship Selection
Across three trials, children chose thin figures as friends
39% of the time. Average figures were chosen as friends 45%
of the time. Chubby figures were chosen as friends 16%
of the time. Children selected significantly fewer chubby
figures as friends than either thin figures, t(41) = 3.7
(p < .01), or average figures, t(41) = 4.1 (p < .01). In the
selection of a best friend, a thin figure was chosen by 55%
of the children, an average figure was chosen by 38% of
the children, and a chubby figure was chosen by 7% of
the children.
Attributions of Control
With higher scores indicating a more internal attribution
of control for overweight, attribution of control scores
averaged 0.7 out of a possible 2.0 (actual range, 0–1.8;
SD = 0.49). This suggests that the children, on average,
attributed a low-to-moderate amount of control to overweight children. Bivariate correlations were examined
between attribution scores and adjective rating and friendship selection scores for the chubby figure. Attribution
scores were negatively correlated with the total adjective
rating score for the chubby figure (r = –.34, p < .05) such
that more internal attributions of control were related to
less positive adjective ratings for the chubby figure. Attribution scores were not correlated with the number of
chubby friends selected (r = .17, p > .10) or the figure
selected as a best friend (r = –.18, p > .10).
Results
Child Anti-Fat Prejudice
Discussion
On a scale from 1 to 7 (with 7 being the most positive rating), children’s adjective ratings averaged 5.3 (SD = 1.1) for
Although some concern about overweight is appropriate for physical and psychological health reasons, the
Body Size Stigmatization
consequences of negative stereotyping for obese individuals can also be detrimental. The current study suggests
that not only do preschool children hold anti-fat
attitudes, but the strength of these attitudes is related to
children’s beliefs that overweight is a controllable
attribute. By contrast, attributions of internal control
were not related to preschoolers’ selection of overweight
friends.
Consistent with previous research, preschoolers in
this study assigned more negative characteristics to chubby
figures than to thin or average figures. Although some
research (Brylinsky & Moore, 1994; Cramer & Steinwert,
1998; Staffieri, 1967) has found that preschoolers prefer
average-size figures to both overweight and thin figures,
the participants in this study rated thin and average figures similarly to one another and discriminated against
only chubby figures.
The negative attitudes that preschoolers had toward
children who were overweight were further demonstrated in their selections of potential friends. Chubby
figures were chosen as desirable playmates less often
than thin figures or average-size figures, and this was
true even though children were not forced to choose one
friend from a selection of two, as in previous research,
but were given the more open-ended, and perhaps more
realistic, option of choosing several friends from a larger
sample. Chubby figures were almost never (n = 3) chosen as the best friend. It is possible that the current
study underestimated the bias that preschool children
demonstrate with regard to overweight peers. Juvonen
(1991) found that children reported more positive reactions (e.g., sympathy, liking) to hypothetical deviant
peers (including overweight peers) than they did to
actual classmates. Thus, in addition to the medical risks
associated with being overweight, overweight children
are also potentially subject to the psychological risks
associated with peer rejection. However, based on a
review of research, Harper (1999) suggests that how a
child chooses playmates depends on several factors. For
example, Harper suggests that children’s preferences
will depend on whether they believe that the child being
judged will be able to perform the desired activity. Perhaps in some play contexts this discrimination against
overweight peers would be less apparent. However, it
should be noted that despite strong face validity, prior
research has not provided evidence about the reliability
and validity of this friendship selection measure. Future
research should examine the consistency with which
children respond to this scale over repeated testing occasions or compare children’s responses on this scale with
their actual friendship selections.
In considering these results, it is important to note
that the present sample was entirely White. Because different attitudes about weight have been documented in
individuals from different cultural and racial backgrounds
(e.g., Lawrence & Thelen, 1995; Thompson, Corwin, &
Sargent, 1997), additional research with larger and more
diverse samples is needed to determine the generalizability of these findings.
Of great interest in this study was the novel finding
that preschoolers’ attributions for individuals’ weight were
related to their negative stereotyping of overweight individuals. Children who believed that weight was within
an individual’s control showed stronger prejudice toward
overweight figures. This is the first time that the predictions of attribution theory for anti-fat attitudes have been
demonstrated with preschool children.
In contrast, control attributions did not relate to the
number of chubby friends that children selected or to the
friend that each child chose as his or her best friend. Some
previous research from an attribution-theory perspective
suggests that adults do show consistency between attributions and behavioral intentions. For example, Crandall
and Moriarty (1995) found that participants in their study
reported more social distancing for illnesses presented as
behaviorally caused than those presented as outside of
behavioral control.
On the other hand, there is an empirical precedent for
a lack of correspondence between the attitudes and behavioral intentions measured here. For example, Fishbein
and Ajzen (1974) found in 26 out of 27 studies that
general attitudes did not correlate with specific behaviors;
however, situation-specific attitudes did match behaviors.
Therefore, asking children about their attitudes toward
obese and nonobese friends might have been more predictive of their behavioral intentions for friendship selection.
Similarly, the lack of relation between the children’s
attributions and friendship selections is consistent with
findings from interventions designed to improve peers’
treatment of overweight children. These efforts appear
to be effective in changing attitudes, but improvements
in behavior toward overweight children do not follow
(Bell & Morgan, 2000; Sigelman, 1991). It might be that
such interventions impact only the reporting of attitudes
and do not change deeply held beliefs. Consistent with
this, Bessenoff and Sherman (2000) found with college
students that automatic (i.e., implicit) attitudes about
overweight individuals predicted behavior (i.e., how far
they sat from an overweight woman), whereas controlled
(i.e., explicit) attitudes did not.
The relation of attributions about weight to anti-fat
attitudes at such a young age has implications for the


Musher-Eizenman, Holub, Barnhart Miller, Goldstein, and Edwards-Leeper
messages that parents, teachers, and the media convey to
children about the reasons for individuals being overweight. This is an extremely complex issue, as most agree
that overweight in children is caused by a number of
factors, some of which are controllable and others not
(e.g., see Birch & Fisher, 1998, and Weinsier, 1999, for
reviews). However, these findings argue that adults have
a responsibility to educate children about openness to
diversity of body size, just as we teach acceptance and
encourage diversity of other kinds. Several programs
already exist to meet this goal (e.g., Irving, 2000). Further, an effective intervention may be to emphasize an
obese child’s positive attributes (e.g., he is good at an
activity) rather than weight (La Greca & Bearman, 2000).
Supplementing these existing programs with information
about factors contributing to obesity that are not behaviorally controlled (e.g., genetic or hormonal) may lead
to a change in attributions, which in turn may reduce
stereotyping of overweight individuals. The results of
the current study suggest that targeting such programs
toward preschool children, before these attitudes become
too firmly engrained, might be beneficial.
Despite these practical implications, encouraging body
size acceptance in preschool children will be challenging.
First, because no relationship was found between attributions and behavioral intentions, teaching that overweight
individuals are not entirely responsible for this condition
may not reduce poor treatment of overweight children.
Second, internal attributions for weight may be very difficult to change (e.g., Teachman et al., 2003). Indeed, Lewis
et al. (1997) reported that information on the controllability of weight led to stronger blame of overweight people, whereas information on uncontrollability of weight
did not lead to less blame. Third, previous research
suggests that it may be difficult for young children to
understand and believe low-responsibility conditions
(i.e., glandular and genetic disorders) (Sigelman &
Begley, 1987). Future research should address the best
way to present these explanations to preschool-age
children. Fourth, the distinction that it is healthy to be
of average size but acceptable to be otherwise is a very
subtle concept to teach. Teaching children empathy for
those who are overweight while at the same time teaching them about the risks associated with unhealthy eating and inactivity will take tremendous sensitivity on
the part of parents and teachers.
Given the current state of this field and the growing
awareness of the impact of being overweight, it seems
that the messages conveyed to children should focus on
health-promoting lifestyle choices while simultaneously
educating them about the many factors that determine
body size and acceptance of diversity in body size.
Research is needed, however, to understand the sources
and correlates of young children’s ideas about body size
and to develop and evaluate programs that promote the
most positive attitudes and behaviors.
Received August 14, 2003; revisions received November 26,
2003; accepted March 20, 2004
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