Implicit Anti-fat Bias Research Articles

'My words would have more weight': exploring weight stigma in UK dietetic practice and dietitian's lived experiences of weight stigma.

Weight stigma is pervasive within healthcare and negatively impacts both access to care and the patient-practitioner relationship. There is limited evidence on weight stigma among registered dietitians, particularly in the United Kingdom, though data show weight-related prejudice towards people living with obesity. The aim of this study was to examine both explicit and implicit weight stigma in practicing dietitians in the United Kingdom, as well as the lived experience of weight stigma among dietitians, both towards themselves and towards others. An online cross-sectional survey was disseminated between February and May 2022 using snowball sampling. Inclusion criteria were that participants were UK registered dietitians aged 20-70 years. Four hundred and two dietitians responded to the survey (female [94.1%], mean age 40.2 years [standard deviation (SD) 10.7]; White ethnicity [90%]; median 12 years [interquartile range (IQR) 6, 22] within dietetic practice). Mean self-reported body mass index was 25.1 kg/m² (SD 8.7). Most dietitians reported experiencing weight stigma prior to (51%) and postregistration (59.7%), whereas nearly a quarter (21.1%) felt that weight influenced their ability as a dietitian. Weight stigma was experienced across the weight spectrum. Overall participants reported explicit weight bias attitudes, moderate beliefs that obesity is controllable and implicit antifat bias. Within open-ended responses, dietitians reported three key themes related to their personal experiences of weight stigma: (1) experiences of stigma in dietetic practice, (2) impact of weight stigma and (3) perception of weight, appearance and job. This study shows that UK dietitians exhibit both explicit and implicit weight bias towards people living with obesity. Dietitians reported experiencing weight stigma, which impacted their career-related decisions and their perception of their own ability to perform as dietitians. The study highlights the need to address weight stigma and its implications within the dietetic profession.

Fat Liberation in the Singing Voice Studio

ABSTRACT In recent years, creating a sense of belonging for marginalized identities within singing voice pedagogy has increased in both visibility and cultural importance. Support and resources on the practice of cultural humility have bolstered the role of social justice in singing voice studios and called attention to the link between affirming students’ identities and their ability to access their fullest artistic expression. However, body size is still often left out of conversations about social justice. If teachers wish to be considered progressive and inclusive, there is a duty to lead the charge for fat liberation within singing voice pedagogy. Through the voices of 66 singers who identify as fat, this article details how anti-fat bias can manifest in the voice studio and identifies common pedagogical practices that have historically failed to serve fat singers. Underpinned by data from 66 interviews, recommendations for dismantling implicit anti-fat bias, working inclusively within the studio and beyond, and advocating for systemic change will be made. The article concludes with specific guidance on how to become a fat liberationist so that students of every body size may find a true sense of belonging in the singing voice studio.

A brief induction of loving kindness meditation to reduce anti-fat bias.

Weight stigma is highly prevalent. However, existing weight stigma interventions are only modestly effective at reducing anti-fat attitudes. The current research proposes a novel approach using a loving kindness meditation (LKM). Experiment 1 tests whether random assignment to the LKM intervention reduces explicit and implicit anti-fat bias and increases empathy based on the LKM recipient with higher weight (close other vs. stranger). Experiment 2 tests whether LKM outperforms an empathy intervention or control to increase empathy or reduce stigmatizing behavior. Results revealed that the LKM increased empathic care but did not reduce anti-fat bias compared to control; the LKM intervention, but not the empathy intervention, reported greater empathy compared to control in unadjusted analyses; and participants in the LKM and empathy interventions (vs. control) were more likely to engage in stigmatizing behavior. These findings suggest that the LKM may not be effective at reducing weight stigma despite increasing empathy.

Variability across time in implicit weight-related bias: Random noise or meaningful fluctuations?

Social psychologists have struggled with the vexing problem of variability over time in implicit bias. While many treat such variability as unexplainable error, we posit that some temporal variability, whether within persons or across society at large, reflects meaningful and predictable fluctuation based on shifts in the social-cultural context. We first examined fluctuations at the group-level in a Project Implicit data set of female participants who completed the Weight Implicit Association Test between 2004 and 2018 (N = 259,613). Extending our prior work showing that mass media celebrity fat-shaming increased women's implicit antifat bias, we show that celebrity body positivity events reduced such bias (Study 1a). We then focused on a specific form of body positivity-that is, celebrity "push-back" in response to fat-shaming. Whereas fat-shaming without antibias push-back was associated with spikes in negative weight attitudes, fat-shaming with push-back showed no change in such bias (Study 1b). Critically, however, closer analysis revealed that this apparent stability was due to the canceling out of opposing negative (fat-shaming) and subsequent positive (body positivity) influences-an effect that was obscured when the window of observation was expanded. Finally, in Study 2, we examined parallel effects at the individual level in a daily diary study. Consistent with the group-level, between-subjects data, women's intraindividual fluctuations in implicit attitudes were reliably predicted based on prior-day exposure to fat-shaming and/or body positivity influences. Taken together, our work highlights how both group- and individual-level variability across time can be meaningfully explained rather than treated as unexplainable or left as unexplained. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Anti-Fat Bias in the Singing Voice Studio, Part One: Culture and Context

Singing voice teachers are working hard to be inclusive and progressive in the 21st century. We are aware of our power to create inclusive learning spaces that embrace our students’ identity traits, including race, gender, sexual orientation, ability, neurodivergence, and more. However, body size is almost always left out of the discussion of inclusive actions in the voice studio. Fatness is a social justice issue and singing voice teachers can either affirm or further marginalize fat students in the 1:1 training setting of the voice studio. In part one, the authors offer background information on the prevalence of fatness, the history of anti-fat bias, and the experiences of fat persons in healthcare, employment, and educational settings. This context encourages voice teachers to examine implicit anti-fat bias, one of the few remaining yet still widely tolerated cultural biases. Many believe that anti-fat bias can be justified by medical facts, but this belief requires an examination of the influence of money and the media. The authors utilize a fat liberationist framework, rejecting the long-held idea that fat bodies are problematic in the performing arts, and affirming that the performing arts industry must provide opportunities for talented and well-trained performers of every body size to work and tell stories that reflect our diverse world. In part two, the authors explore tangible pedagogical modifications to foster a sense of belonging for all voice students, including fat students. Micro-activism in the voice studio is a huge step toward systemic change, and it can have a profoundly positive impact on our students.

Antifat Bias of OT and Physical Therapy Assistants

Abstract Date Presented 04/01/2022 Health care professionals’ antifat bias results in substandard quality of care that contributes to health disparities. OT and physical therapy assistants are key stakeholders in rehabilitation; however, little research examines these clinicians’ antifat bias. This study examined OT assistant and physical therapy assistants’ explicit and implicit antifat bias and find that the majority hold antifat bias with demographics and beliefs correlating with the findings. Primary Author and Speaker: Laura Vanpuymbrouck Contributing Authors: Carli Friedman, Heather Feldner

Anti-Fat Bias in the Singing Voice Studio, Part Two: How to Make a Size Inclusive Voice Studio

Singing voice teachers are working hard to be inclusive and progressive in the 21st century. We are aware of our power to create inclusive learning spaces that embrace our students’ identity traits including race, gender, sexual orientation, ability, neurodivergence, and more. However, body size is almost always left out of the discussion of inclusive actions in the voice studio. Fatness is a social justice issue and singing voice teachers can either affirm or further marginalize fat students in the 1:1 training setting of the voice studio. In part one, the authors offer background information on the prevalence of fatness, the history of anti-fat bias, and the experiences of fat persons in healthcare, employment, and educational settings. This context encourages voice teachers to examine implicit anti-fat bias, one of the few remaining yet still widely tolerated cultural biases. Many believe that anti-fat bias can be justified by medical facts, but this belief requires an examination of the influence of money and the media. The authors utilize a fat liberationist framework, rejecting the long-held idea that fat bodies are problematic in the performing arts, and affirming that the performing arts industry must provide opportunities for talented and well-trained performers in bodies of every size to work and tell stories that reflect our diverse world. In part two, the authors explore tangible pedagogical modifications to foster a sense of belonging for all voice students, including fat students. Micro-activism in the voice studio is a huge step toward systemic change, and it can have a profoundly positive impact on our students.

Implicit visual sensitivity towards slim versus overweight bodies modulates motor resonance in the primary motor cortex: A tDCS study

Motor resonance (MR) can be influenced by individual differences and similarity in the physical appearance between the actor and observer. Recently, we reported that action simulation is modulated by an implicit visual sensitivity towards normal-weight compared with overweight bodies. Furthermore, recent research has suggested the existence of an action observation network responsible for MR, with limited evidence whether the primary motor cortex (M1) is part of this. We expanded our previous findings with regards to the role of an implicit normal-weight-body preference in the MR mechanism. At the same time, we tested the functional relevance of M1 to MR, by using a transcranial direct current stimulation (tDCS) protocol. Seventeen normal-weight and 17 overweight participants were asked to observe normal-weight or overweight actors reaching and grasping a light or heavy cube, and then, at the end of each video-clip to indicate the correct cube weight. Before the task, all participants received 15 min of sham or cathodal tDCS over the left M1. Measures of anti-fat attitudes were also collected. During sham tDCS, all participants were better in simulating the actions performed by normal-weight compared with overweight models. Surprisingly, cathodal tDCS selectively improved the ability in the overweight group to simulate actions performed by the overweight models. This effect was not associated with scores of fat phobic attitudes or implicit anti-fat bias. Our findings are discussed in the context of relevance of M1 to MR and its social modulation by anti-fat attitudes.

Implicit and explicit anti-fat bias: The role of weight-related attitudes and beliefs

IntroductionThe increasing prevalence of anti-fat bias in American society comes at a great cost to the health and well-being of people who are overweight or obese. A better understanding of the correlates of anti-fat bias would inform development of interventions for reducing anti-fat bias. Based on three theoretical perspectives, this study tested the relation between attitudes and beliefs about weight and anti-fat bias (implicit and explicit): (1) The belief that one is like people who are fat (social identity theory). (2) The belief that one can control her/his weight (attribution theory). And (3) the beliefs that most people prefer thin people and that weight is important (socio-cultural theory). MethodsParticipants were 66,799 volunteers (47,265 women, mean age of 27.88 ± 11.9 years) who completed the Thin-Fat Implicit Association Test on the Project Implicit website (https://implicit.harvard.edu/) during 2016. Explicit anti-fat bias and weight-related attitudes and beliefs were assessed by self-report. Correlation and regression analyses were conducted to examine links between weight-related attitudes and beliefs and anti-fat bias. ResultsAll tested weight-related attitudes and beliefs were significantly (p < .001) correlated with explicit and implicit anti-fat bias, but some of the correlations were very weak. An examination of the relative contribution of the tested weight-related attitudes and beliefs to a model explaining anti-fat bias suggested that the strongest correlates of explicit anti-fat bias were the beliefs that weight was important (β = 0.194, p < .001), that most people prefer thin people (β = 0.177, p < .001), and that the respondent was like people who are fat (β = −0.180, p < .001). DiscussionThe social-identity and socio-cultural theories may provide a stronger explanation for anti-fat bias relative to attribution theory. Future research could use longitudinal designs with more reliable measures in order to verify these cross-sectional findings.

Do physical education teachers and general teachers differ in their implicit anti-fat bias?

Do physical education teachers and general teachers differ in their implicit anti-fat bias?

A Study of Anti-Fat Bias among Danish General Practitioners and Whether This Bias and General Practitioners’ Lifestyle Can Affect Treatment of Tension Headache in Patients with Obesity

Objectives: The study investigated whether treatment options for episodic tension-type headache vary among general practitioners (GPs) in Denmark depending on the patients’ weight status and gender, and whether these decisions can be explained by the GPs’ own anti-fat bias and lifestyle. Methods: A cross-sectional questionnaire study with responses from 240 GPs on measures of anti-fat bias, healthiness of GPs’ lifestyles, and reported patient treatment decisions. Results: GPs tended to exhibit negative explicit and implicit anti-fat bias. There were no differences in choice of medical treatment for patients with obesity and those of a normal weight. GPs were more likely to advise a general health check to a patient with obesity (p < 0.001). GPs treating a male patient with obesity were less likely to believe that their patient would comply with the advised treatment compared to those with a male patient of normal weight. Compared with other patient types (4.4–7.7%), GPs who treated a male patient with obesity (27.9%) were more likely to advise a general health check only and no diary-keeping or follow-up consultation (p < 0.001). This was explained by the healthiness of the GPs’ lifestyles (Spearman’s ρ = 0.367; p < 0.01). Conclusion: Despite the presence of clear anti-fat bias, there were no differences in medical treatment, and GPs managed the general health of patients with obesity proactively. The fact that the GPs’ own lifestyle influenced the likelihood that they would recommend diary-keeping and follow-up consultations for male patients with obesity is remarkable and requires further investigation.

Cathodal transcranial direct current stimulation of the extrastriate visual cortex modulates implicit anti-fat bias in male, but not female, participants

Explicit negative attitudes toward obese individuals are well documented and seem to modulate the activity of perceptual areas, such as the Extrastriate Body Area (EBA) in the lateral occipito-temporal cortex, which is critical for body-shape perception. Nevertheless, it is still unclear whether EBA serves a role in implicit weight-stereotypical bias, thus reflecting stereotypical trait attribution on the basis of perceptual cues. Here, we used an Implicit Association Test (IAT) to investigate whether applying transcranial direct current stimulation (tDCS) over bilateral extrastriate visual cortex reduces pre-existing implicit weight stereotypical associations (i.e. “Bad” with Fat and “Good” with Slim, valence-IAT). Furthermore, an esthetic-IAT, which focused on body-concepts related to esthetic dimensions (i.e. “Ugly” and “Beauty”), was developed as a control condition. Anodal, cathodal, or sham tDCS (2mA, 10min) over the right and left lateral occipito-temporal (extrastriate visual) cortex was administered to 13 female and 12male participants, before performing the IATs. Results showed that cathodal stimulation over the left extrastriate visual cortex reduced weight-bias for the evaluative dimensions (Bad vs. Good) as compared to sham stimulation over the same hemisphere. Furthermore, the effect was specific for the polarity and hemisphere of stimulation. Importantly, tDCS affected the responses only in male participants, who presented a reliable weight-bias during sham condition, but not in female participants, who did not show reliable weight-bias at sham condition. The present results suggest that negative attitudes toward obese individuals may reflect neural signals from the extrastriate visual cortex.

Implicit and explicit anti-fat bias among Asian females.

Obesity is not only associated with an increased risk of numerous health problems, but also with high rates of stigmatization and weight-related bias. Anti-fat attitudes have been shown to be prevalent in Western samples; however, there is a lack of studies investigating both implicit and explicitanti-fat bias in Asian populations. There is also limited research investigating the relationship between anti-fat attitudes and weight-related behavioral intentions. Thus, this study aimed to examine anti-fat bias and its effect on behavioral intentions using three types of measures-implicit, explicit, and a revised behavioral intention measure-in a sample of 104 Asian females in Singapore. Significant differences were found between implicit and explicit bias: on average, participants exhibited strong implicit but no explicit anti-fat bias (p<0.001). Furthermore, only implicit anti-fat bias was found to be a significant predictor of behavioral intentions (p<0.05), after accounting for body mass index, and sociodemographic variables. In conclusion, the present study revealed that implicit anti-fat bias is present among Asian females and is a valid predictor of weight-related behavioral intentions. However, anti-fat bias is often not expressed explicitly, possibly influenced by collectivistic beliefs. More studies are needed to better understand similarities and differences between Asian and Western populations regarding attitudes toward overweight and obese individuals.

Ethnic Identity and Implicit Anti-fat Bias: Similarities and Differences between African American and Caucasian Women.

Research using self-report or explicit measures of body image suggests African American women have a more accepting view of larger figures than non-Hispanic White (NHW) women. However, increasing research indicates that explicit views may vary from those held at a deeper, implicit level. Our study examined whether African American women held an implicit negative bias toward overweight/fat individuals, despite a greater explicit acceptance of larger body size. Additionally, ethnic identity was measured to assess if strength of identity related to bias. Anti-fat bias was compared within and between ethnic groups using an Implicit Association Test (IAT), which measures the strength of automatic associations between two concepts. This online IAT measured spontaneous thoughts about figures of various body weights (underweight, overweight, obese) and positive and negative terms (eg, attractive and unattractive or healthy and unhealthy). A pervasive anti-fat bias was found in African American as well as NHW women. For both groups, this bias was related to ethnic identity when thinking about figure size and health. Specifically, African American women with lower ethnic identity were more negatively biased and NHW women with higher ethnic identity were more negatively biased. Findings from this study indicate that implicitly there are few differences in the way these two ethnicities classify heavy figures, and therefore African Americans may not be immune to weight stigma. Given the prevalence of obesity and the lack of research on weight stigma among African American women, there is need to address this issue and its impact on well-being.

洗手对内隐肥胖偏见的影响

研究显示，对过度肥胖者的偏见与行为免疫系统的激活有关。以内隐联想测验为基础，考察洗手这一疾病预防措施对内隐肥胖偏见的影响。结果显示，与控制组相比，洗手显著减少了被试的内隐肥胖偏见，且这一效应没有受到被试自身体重的影响。结果还显示，洗手所带来的这一效应由洗手对肥胖—疾病内隐联结的影响所中介。这些结果提示，通过提供公共卫生干预措施的方式，或可有效减少人们对肥胖者的偏见。 Previous studies have shown that the obesity sigma is linked with the activation of the behavioral immune system. Based on the IAT tests, we tested whether the experience of a modern form of dis-ease protection (hand washing) can reduce the implicit anti-fat bias. Results showed that, compared with the control group, participants significantly reduced their implicit anti-fat bias after hand washing, and such effect was irrelevant to participants’ own body weight. The results also revealed that the hand washing effect was fully mediated by the implicit obesity-disease associations. These results suggest that it may be an effective approach to reduce the obesity sigma by providing public health interventions.

Fat Studies 101: Learning to Have Your Cake and Eat It Too

Fat Studies 101: Learning to Have Your Cake and Eat It Too

Are Medical Students Aware of Their Anti-obesity Bias?

Anti-obesity prejudices affect the quality of care obese individuals receive. The authors sought to determine the prevalence of weight-related biases among medical students and whether they were aware of their biases. Between 2008 and 2011, the authors asked all third-year medical students at Wake Forest School of Medicine to complete the Weight Implicit Association Test (IAT), a validated measure of implicit preferences for "fat" or "thin" individuals. Students also answered a semantic differential item assessing their explicit weight-related preferences. The authors determined students' awareness of their biases by examining the correlation between students' explicit preferences and their IAT scores. Of 354 medical students, 310 (88%) completed valid surveys and consented to participate. Overall, 33% (101/310) self-reported a significant ("moderate" or "strong") explicit anti-fat bias. No students self-reported a significant explicit anti-thin bias. According to the IAT scores, over half of students had a significant implicit weight bias: 39% (121/310) had an anti-fat bias and 17% (52/310) an anti-thin bias. Two-thirds of students (67%, 81/121) were unaware of their implicit anti-fat bias. Only male gender predicted an explicit anti-fat bias (odds ratio 3.0, 95% confidence interval 1.8-5.3). No demographic factors were associated with an implicit anti-fat bias. Students' explicit and implicit biases were not correlated (Pearson r = 0.03, P = .58). Over one-third of medical students had a significant implicit anti-fat bias; few were aware of that bias. Accordingly, medical schools' obesity curricula should address weight-related biases and their potential impact on care.

Are Anti-Stigma Films a Useful Strategy for Reducing Weight Bias Among Trainee Healthcare Professionals? Results of a Pilot Randomized Control Trial

Background: 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. Methods: A pre-post experimental design with a 6-week follow-up, which consisted of an intervention group (n = 22) and a control group (n = 21), was conducted to assess the efficacy of brief anti-stigma films in reducing weight bias, and to test whether future, larger-scale studies among trainee healthcare professionals are feasible. Results: Participants at baseline demonstrated weight bias, on both implicit and explicit attitude measures, as well as strong beliefs that obesity is under a person's control. The intervention films significantly improved explicit attitudes and beliefs toward obese people, and participant evaluation was very positive. The intervention did not significantly improve implicit anti-fat bias. 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.

Implicit and explicit anti-fat bias among a large sample of medical doctors by BMI, race/ethnicity and gender.

Overweight patients report weight discrimination in health care settings and subsequent avoidance of routine preventive health care. The purpose of this study was to examine implicit and explicit attitudes about weight among a large group of medical doctors (MDs) to determine the pervasiveness of negative attitudes about weight among MDs. Test-takers voluntarily accessed a public Web site, known as Project Implicit®, and opted to complete the Weight Implicit Association Test (IAT) (N = 359,261). A sub-sample identified their highest level of education as MD (N = 2,284). Among the MDs, 55% were female, 78% reported their race as white, and 62% had a normal range BMI. This large sample of test-takers showed strong implicit anti-fat bias (Cohen’s d = 1.0). MDs, on average, also showed strong implicit anti-fat bias (Cohen’s d = 0.93). All test-takers and the MD sub-sample reported a strong preference for thin people rather than fat people or a strong explicit anti-fat bias. We conclude that strong implicit and explicit anti-fat bias is as pervasive among MDs as it is among the general public. An important area for future research is to investigate the association between providers’ implicit and explicit attitudes about weight, patient reports of weight discrimination in health care, and quality of care delivered to overweight patients.

The Nature and Implications of Implicit Weight Bias

Although overweight is undesirable from both public and personal health perspectives, the focus of this paper is on exploring the nature of fat prejudice within a social cognition framework. Fat prejudice refers to the tendency to form judgments about people on the basis of excessive body weight. Body size has been described as one of the few per- sonal attributes considered an acceptable target of prejudice, despite the fact that targets of fat prejudice experience sig- nificant psychological distress. Fat prejudice is likely to become an increasingly common psychosocial problem in light of the obesity epidemic that is currently affecting many countries. The current paper reviews findings from nineteen experi- mental studies of implicit anti-fat attitudes; these studies have used either the implicit association test or the affective priming task. The empirical data highlight that implicit anti-fat attitudes are widely held and relatively universal. Robust implicit anti-fat bias is evident among many groups including university students, members of the general public, health professionals, and among those who are themselves overweight or obese. The current data suggest that, similar to findings with other attitudinal objects, the relationship between implicit and explicit measures of anti-fat attitudes is complex. The possibility of changing implicit anti-fat attitudes, either by modifying the underlying associative structures or by altering the pattern of activation, is discussed. Avenues for future research are offered, keeping in mind the challenge of formulat- ing appropriate public health messages whilst also challenging weight bias, and promoting acceptance of diversity in body size.