Implicit and explicit fat bias among adolescents from two US populations varying by obesity prevalence

Abstract

Summary Background Research shows that explicit (reported) and implicit (unconscious) bias are distinct constructs varying by socioecological context. Implicit bias better predicts poor health outcomes related to chronic psychosocial stress. Objectives Variation in fat bias was identified in two populations of adolescents in Indiana counties with relatively high (Lawrence) and low (Monroe) obesity prevalence. Methods Adolescents (n = 185) aged 14‐18 years were recruited October 2017‐2018. Explicit fat bias was measured using the Attitudes Towards Obese Persons (ATOP) scale. Implicit fat bias was measured using the obesity attitude implicit association test (IAT). Results Both samples scored high on the ATOP, indicating more positive reported attitudes towards persons with obesity, and scores did not differ between counties (P > .05) after adjusting for age, sex, ethnicity, and BMI‐for‐age percentile. Both samples demonstrated unconscious anti‐fat bias, with Monroe exhibiting significantly higher IAT scores (ie, greater anti‐fat bias) than Lawrence after controlling for confounders (P = .039). Conclusion Differences between explicit and implicit fat‐bias were observed. Both samples reported positive attitudes towards obesity but also demonstrated unconscious anti‐fat bias. Unconscious anti‐fat bias was significantly higher in the county with lower prevalence of obesity, suggesting epidemiological context may influence implicit fat bias. Higher obesity prevalence may reduce unconscious anti‐fat bias in a population or, alternatively, lower obesity prevalence may increase such bias.

What is normal body weight? Perceptions around “average” and “healthy” body weight among adolescents in Indiana

“…As these results suggest, perceived body weight norms were associated with normative perceptions of healthy bodies; however, the direction of this relationship was surprising given recent findings that implicit anti‐fat bias among Indiana adolescents was significantly lower in populations with higher obesity prevalence (Cullin, 2020). Thus, one might expect that as perceived average body weight increases, larger bodies would be less likely to be perceived as abnormal (i.e., unhealthy), but this was not the case.…”

Biological normalcy and body fat: Obesity prevalence, fat stigma, and allostatic load among late adolescents and young adults

“…Results from testing P 1 indicated that perceived fat stigma and degree of exposure to obesity during adolescence were not statistically related, thus, statistical norms around body fat did not predict normative views in regards to these variables for this sample. It is possible there is no relationship between obesity prevalence and fat stigma, but this does not seem likely given that implicit anti‐fat bias has been shown to vary by obesity prevalence among adolescents in Indiana (Cullin, 2021) and higher exposure to obesity has been show to increase acceptance of higher proportions of body fat (Robinson & Christiansen, 2014). One possible reason no association was found in this sample is the limited range of variation in obesity levels (24%–34%) between counties.…”

“…Anthropological work has previously demonstrated that normative ideas about body fat around the globe vary depending on changes in obesity prevalence (Brewis et al, 2011) as well as ecological context (Brewis & Wutich, 2012). Furthermore, the threshold for acceptable weight status is thought to be sensitive to the distribution of modal body types within a population (Robinson, 2017), and, in the US state of Indiana where the present study took place, unconscious anti‐fat bias was recently found to be higher among adolescents living where obesity prevalence is relatively low (Cullin, 2021), which is important given that such implicit bias is thought to be a strong driver of discrimination and prejudice (Brewis & Wutich, 2012). These findings suggest that variation in body sizes people observe around them may inform normative ideas and beliefs about weight or body size, which could subsequently drive stigmatizing thoughts and behaviors as well as discriminatory policy and treatment.…”

“…The first objective was to determine if perceived fat stigma was related to exposure to obesity prevalence during adolescence. A study by Cullin (2021) demonstrated that implicit anti‐fat bias among Indiana adolescents varied by obesity prevalence whereby adolescents living in a county with a relatively low prevalence of obesity exhibited higher unconscious anti‐fat bias compared to their peers living in a region of the state where obesity was more common. Given the results from this recent study in Indiana as well as Robinson's (2017) visual normalization hypothesis, it was predicted that perceived fat stigma would be higher for those who grew up in Indiana counties in the US where obesity was relatively less common.…”

The cortisol stress response in youth with overweight and obesity: Influence of psychosocial variables

“…To date, childhood obesity has reached epidemic levels and represents a major public health concern 1 . Besides experiencing short‐and long‐term physical health problems, youth with obesity are at increased risk for many different psychosocial stressors (e.g., weight stigma, parent–child attachment difficulties, …) 2–6 on top of the normative challenges they face. These age‐related vulnerabilities include emotional instability, an increase in risk‐taking behaviour, family difficulties and academic pressure 7,8 .…”