DYNAMIC ASSESSMENT OF
OBESITY STIGMATIZATION
Jason D. Seacat, Ph.D.
Department of Psychology, Western New England University
Overview

Part 1: Obesity Overview
 Define
and discuss obesity and trends in US
 Obesity stigmatization
 Consequences of obesity stigmatization

Part 2: Assessment of Stigmatization
 Daily
diary assessment of stigmatization
 Preliminary
 Laboratory
research findings
assessment of stigmatization effects
 Triangulating assessment strategies
Part I: Operational Definitions

Operational Definitions (CDC Body Mass Index)
 Overweight
≥ 25
 Obesity ≥ 30
 Morbid Obesity ≥ 40-44.9
 Super Morbid Obesity ≥ 45

Assessment of Obesity Status
 BMI
 Body
Fat % Scales (e.g., Tanita)
 Skin fold thickness
 Bioelectric impedance assay
Obesity Trends-Adults

Prevalence of Overweight/Obese in the United
States
 Despite
increasing awareness, education and
intervention the obesity epidemic continues to intensify
 36% of adults are overweight
 34% of adults are obese (Flegal et al., 2008)
U.S. Trends and Projections
National Health and Nutrition Survey
U.S. Disparities

Racial/Ethnic Disparity of Obesity
 Non-Hispanic
Black- 44%
 Mexican American- 39.3%
 All Hispanic- 37.9%
 Caucasian- 32.6%

Geographic Disparity
 South-
29.4%
 Midwest- 28.7%
 Northeast- 24.9%
 West- 24.1%
CDC, 2011
Consequences of Obesity

Physical Health Consequences
 Coronary
Heart Disease/Stroke
 Type II Diabetes
 Hypertension
 Certain Cancers (e.g., endometrial,
colorectal)
 Osteoarthritis

Economic Consequences
 Medical
costs alone associated with obesity $147
Billion (Finkelstein, 2009)
Consequences of Obesity

Social Consequences
 Obesity


stigmatization
According to Puhl and Heuer (2009), obesity
“remains one of the last acceptable targets of
stigma/discrimination”
Despite increasing rates of
obesity, obesity stigmatization is
also increasing
Obesity Stigmatization




Rates of obesity stigmatization have increased by
66% since 1995 (Schvey, Puhl & Brownell, 2011)
More than 70% of overweight/obese individuals
now report frequent stigmatization
Obesity stigmatization occurs in ALL life domains
While both sexes encounter weight stigma, women
are more frequently targeted than men
 Women
may also be more susceptible to negative
consequences of stigma due to gender-based
attractiveness norms
Types of Obesity Stigma


Direct- (Institutional & Interpersonal) (e.g., bullying,
denial of housing, workplace harassment,
relationship abuse, ostracizing of obese individuals)
Indirect- (Perceived) Individual perceptions of
stigma and/or internalization of stigma
 Indirect
stigma may actually be more potent than direct
as it operates independently of actual occurrences

Researchers need to assess both direct and indirect
forms of stigmatization
Consequences of Obesity Stigma

Though consequences of stigma are individualized there
are several commonly reported outcomes, including:
Lack of access/opportunity
 Psychological/emotional trauma
 Social isolation
 Delay/avoidance of medical treatment
 Avoidance of healthy behaviors (e.g., exercise,
compensatory eating) (Seacat & Mickelson, 2009;
Vartanian & Colleagues, 2011)
 Perpetuation and exacerbation of obesity status**

Assessing Obesity Stigmatization


Existing stigma studies indicate that experiences
with obesity stigma range from a low of 1 time per
month to a high of 1-2 times per week (19992011)
Most commonly experienced stigmatizing situations
include (Sarwer et al., 2008)
 Nasty
comments from children
 Nasty comments from family members
 Inappropriate comments from
health care personnel
 Encountering physical barriers
Limitations

Existing stigma studies have widely employed crosssectional and retrospective assessments spanning up to
30 years or more in lifetime
Memory erosion
 “Repression” of traumatic or painful events
 Underestimation of event frequency



Limited ability to capture relationships between obesity
stigma and actual health behavior (exercise/diet)
Focus on “clinical” populations
Hypotheses




H1) Rates of obesity stigma will be higher than
previous retrospective reports
H2) BMI status will be positively correlated with
obesity stigma
H3) Levels of obesity stigma will be inversely
related to participants’ average amount of exercise
(in minutes)
H4) Levels of obesity stigma will be inversely
correlated with participants’ perceptions of the
“healthfulness” of their daily diet
Daily Diary Assessment of Stigma


Seacat & Dougal (2011; In Prep) sought to test
hypotheses and address limitations with a daily
diary assessment study of obesity stigmatization
Participants
 50
overweight-obese women
 Aged 19-61 (M = 37.90)
 BMI 25.00-77.90 (M = 42.56)
 42% Married
 90% Caucasian
 60% college educated (2yr-Completion of Grad Sch.)
Daily Diary Assessment

Procedure
 Approved
by IRB, WNE
 Study was advertised on weight-related websites and
blogs (e.g., Obesity Forum, Biggest Loser, My Big Fat
Blog)
 Participants completed a baseline demographic survey
and a daily diary assessment for a period of 7 days
 All participants were eligible for a raffle drawing for
one of five $50 Visa check cards
Daily Diary Assessment

Measures

Stigmatizing Situations Questionnaire (Myers and Rosen,
1999) (modified) 50 items/11 sub-scales
Comments from children
 Comments from family
 Isolation, feeling ignored
 Barriers in environment

Daily exercise/dietary habits
 Daily activities/places visited
 Daily interpersonal interactions
 Daily media consumption habits

Preliminary Findings

Hypothesis 1:
Previous accounts using SSQ: 1x month to 2 x week
 Current participants reported a range of 2.74-5.24
stigmatizing events per day


We also added open-ended stigma questions for
participants to respond to. Many novel events emerged,
that were not captured by the SSQ

“I walked outdoors today and felt embarrassed to walk for
a short time on the highway, where people who knew me
might see me. I thought they would assume my car broke
down, and not that I was exercising.”
Preliminary Findings- Open Ended




“[ I was ] with friends at a baby shower today so I
went to McDonalds first so people wouldn't look at
me eating more than I should”
“The dentist was worried I might break his chair”
“An old friend saw me and yelled "I didn't know you
were pregnant”
“While outside, some of the people that drove by
seemed to do the "heavy-person double take look" as
they passed by”
Preliminary Findings-Open Ended


“I was told that I was a bad mother because I can't
set limits as to what my son or his friends eat during
sleepovers, because I can't even control myself”
“My ex-boss looked at me several times in a
restaurant but acted like he didn't know me. I worked
for him for 5 years but he always hated fat people”
Preliminary Findings


Hypothesis 2:
Consistent with existing research and our current
hypothesis, there was a significant and positive
correlation between BMI and levels of reported
obesity stigma (r = .58; p < .001)
Preliminary Findings

Hypothesis 3:
 Supporting
our hypothesis, levels of obesity stigma
were inversely correlated with participants’ average
duration of daily exercise (in minutes)
( r = -.323; p =.008)

Hypothesis 4:
 Contrary
to our predictions, levels of obesity stigma
were not significantly correlated with participants’
perceptions of daily dietary habits ( r = -.03; p = .84)
Limitations




Participant attrition
Reliance upon self-report data
Daily assessment may have “sensitized” participants
to perceive events they typically would not have
Lack of additional assessment methods to
corroborate exercise/dietary data
 Pedometers
 Diet
log
Discussion




Obesity stigma likely occurring at significantly
higher rates than previously demonstrated
Stigma increases in frequency as obesity status
increases
Stigma is significantly and negatively correlated
with duration of physical activity in daily life
Stigma was not significantly correlated with
perceptions of diet
Additional Work

Dataset also contains detailed accounts of
participants’ daily interpersonal interactions,
activities, places visited and media consumption
habits
 Next
steps will be to analyze these data in conjunction
with 11 subscales of SSQ to determine whether
significant relationships exist

Develop briefer version of SSQ for repeated use on
the basis of current participant response patterns
Future Directions

Inclusion of direct measures of physiological
reactivity and exercise/diet into daily diary
assessment
 Reactivity Ambulatory
BP monitors
 Momentary data capture devices
 Exercise Exercise/diet
 Pedometer
log
Laboratory Assessment of Obesity
Stigmatization

Researchers are now beginning to focus more
intently on direct, physiological assessment of
responses to obesity stigmatization
 R.
Puhl et al. Yale University
 B. Major et al. UC Santa Barbara
 J. Seacat et al. Western New England Univ.

Hypothesized that encounters with stigma should
produce detectable CNS and cardiovascular
reactivity
Laboratory Assessment of Stigma


Though proposed, empirical relationship between
obesity stigma and reactivity is yet to be
established
Majority of obesity stigma is subtle thus reactivity is
likely variable and may be limited
 May
produce frequent, low level activation of CNS and
cardiovascular system
 Over time, repeated arousal may contribute to
cumulative stress effects
Micro-Stressor Effects


Short-term effects- unknown
Cumulative effects- theoretical
 Cardiovascular
reactivity
 Exacerbated
cardiac response
 Increased recovery time from stressors
 Potential
 Excess
CNS Effects-
cortisol production
 Adiposity
Current Work




Pilot testing a time series trial to assess
cardiovascular and HPA activation to subtle stigmabased stressors
40 minute protocol
Sex-based academic stigma in Math (St Threat
Paradigm)
2x2x2 experimental design
 Prime-Negative-Male/Female
 Prime-Boost-Male/Female
 Neutral-Male/Female
Current Work

Intra-individual assessment
BP, heart rate recorded at baseline and every four minutes
 Salivary cortisol recorded at baseline and in 8 minute
increments thereafter
 Self-report at conclusion of assessment


Restrictions: No caffeine, no nicotine, no exercise w/in
24hrs


No food/tooth brushing within 6 hours
Control for: Time of day, Med use (BP elevating, saliva
diminishing, cortisol modulating)
Conclusion




Obesity and obesity stigmatization are increasingly
prevalent in society
Obesity stigma may contribute to perpetuation of
obesity epidemic and to morbidity with other health
conditions
Assessment of experiences with and consequences
of obesity stigmatization is in very early stages
Methods to triangulate data are most widely
accepted (and funded)
Acknowledgements




Western New England University, Faculty
Development Grants 2010, 2011
Dr. Sheri Tershner, Director, Neuroscience Program
Dr. Judy Cezeaux, Chair, Biomedical Engineering
WNE Students: Sarah Dougal, Cory Saucier, Aaron
Krause, Christina Barbarisi and others…