A Big Fat Problem? Public Health Students, Obesity Stigma, and the Law Pubblico

Abstract

Background: Research on the health effects of obesity has largely focused on the negative physical health consequences and medical sequelae associated with the condition. Substantially less research has investigated the medical and social consequences of obesity stigma, though a growing body of research has documented the existence of weight-based stigma in the general population as well as among professionals in the healthcare field. The purpose of this study is to explore public health students' beliefs about obese people and the causes of obesity, to assess their likelihood of support of hypothetical legislation that would provide protections against weight-based discrimination, and to determine whether beliefs about obese people and the causes of obesity would predict students' support for anti-discrimination legislation and/or acceptance of discriminatory practices in various scenarios. Method: Data were collected using an online, self-administered survey of currently-enrolled students at Rollins School of Public Health. Results: 309 participants were eligible and completed the study. Results suggest that public health students surveyed harbored weight bias, even while acknowledging that social causes may play an important role in the development of obesity. Most participants believed that weight-based discrimination in employment scenarios should be illegal, but did not strongly support any of the proposed hypothetical pieces of legislation that would provide legal protections on the basis of weight. Fewer negative attitudes about obesity, a belief that internal causes are to blame for obesity, and female sex were found to be positive predictors of both outcome measures. Liberal political affiliation and multiracial identity were also found to positively predict less support for discrimination in the scenarios presented. Conclusions: This study suggests the need to educate public health students about their own stigmas, and to equip them with tools to ensure that common stereotypes do not negatively influence future research, health education, or policy endeavors. Such efforts may also have the effect of increasing the likelihood that public health students would reject weight-based discrimination and support legislation protecting people against unfair discrimination on the basis of weight status.

Table of Contents

TABLE OF CONTENTS

CHAPTER 1: INTRODUCTION 1

Introduction 1

Significance of Study 3

Theoretical Framework 6

CHAPTER 2: REVIEW OF THE LITERATURE 8

Part I: Weight-Based Stigmatization 8

The Biological and Social Production of Weight-Based Stigma 10

The Prevalence of Weight Bias 12

Weight Bias Among Overweight and Obese People 15

Weight Bias in Health-Related Professions 17

Weight Bias Among Public Health Practitioners 21

Do Anti-Fat Attitudes Translate into Discriminatory Behavior? 22

Part II: Weight-Based Discrimination 24

Obesity and Discrimination 24

Weight-Based Discrimination in Employment 25

Weight-Based Discrimination in Education 26

Weight-Based Discrimination in Interpersonal Interactions and Relationships 27

Weight-Based Discrimination in Healthcare Contexts 27

Part III: The Consequences of Stigmatization and Discrimination 28

Social Consequences 28

Medical Consequences 29

Mental Health Consequences 32

Stigmatization and Discrimination as ‘Motivators' for Weight Loss 35

Part IV: Weight-Based Discrimination: A Human Rights Issue? 36

Background to Discrimination in the Human Rights Regime 36

Nondiscrimination in the Language of Human Rights Instruments 38

Overweight/Obesity as a Human Rights Concern 39

Part V: The Legal Landscape of Weight-Based Discrimination 41

Legal Recourses to Challenge Weight-Based Discrimination 41

Part VI: The Role of Public Health Students in Addressing Weight-Based Discrimination 44

CHAPTER 3: METHODS 47

Study Design 47

Participants and Recruitment 47

Survey Development 48

Demographics 49

Fear of Fatness 49

Causes of Obesity 51

Social Desirability 52

Support for Hypothetical Legislation Preventing Discrimination in Employment Settings 52

Discrimination in Hypothetical Scenarios 53

Open-Ended Response 53

Data Analysis and Statistical Methods 54

CHAPTER 4: RESULTS 56

Fear of Fatness 58

Causes of Obesity 61

Support for Hypothetical Legislation Preventing Discrimination in Employment Settings 66

Discrimination in Hypothetical Scenarios 67

Social Desirability 71

Regression Analysis 71

Open-Ended Response 74

CHAPTER 5: DISCUSSION 76

Discussion 76

Limitations 83

Conclusion 85

REFERENCES 87

APPENDIX A: STUDY APPROVAL LETTER FROM EMORY UNIVERSITY INSTITUTIONAL REVIEW BOARD 96

APPENDIX B: RECRUITMENT EMAIL SENT TO PUBLIC HEALTH STUDENT LISTSERV 97

APPENDIX C: ONLINE, WRITTEN CONSENT FORM 98

APPENDIX D: SURVEY 101

About this Master's Thesis

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School	Rollins School of Public Health
Department	Behavioral Sciences and Health Education
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Parola chiave	fat discrimination bias public health students stigma beliefs cause obesity law stereotypes
Committee Chair / Thesis Advisor	Lang, Delia L, Emory University
Committee Members	Kushner, Howard I, Emory University
Partnering Agencies	Does not apply (no collaborating organization)

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