New studies: The waiting is (almost) the worst part

Much has been learned in recent years about the negative physical and psychological effects of experiencing weight stigma. Tomiyama and colleagues have shown that experienced weight stigma is associated with increased cortisol (the stress hormone) and oxidative stress independent of abdominal fat levels, and Wester et al found higher levels of cortisol in the hair of ‘obese’ subjects compared with ‘overweight’ and ‘normal weight’ individuals, indicative of long-term exposure. These effects may well contribute to increased cardiovascular risk in higher-weight individuals.

However, less has been written about how expectations of prejudice impact on higher-weight individuals. High levels of anti-fat attitudes in the population mean that even in the absence of overt discrimination, even minor daily tasks such as going to the supermarket or catching the bus are fraught with stressful anticipation of negative treatment.

We know from the wider stigma literature that expectation of rejection or ill-treatment due to race, gender, sexuality, and so on, causes all kinds of responses in the target, none of them good. And in the last few years, researchers have started to look at this phenomenon in the context of weight stigma.

Two papers just published add to this literature. The first study was an experimental manipulation using a dating paradigm.

Title: Unpacking the psychological weight of weight stigma: A rejection-expectation pathway

Authors: Blodorn, Major, Hunger, Miller

Source: Journal of Experimental Social Psychology (2016) vol 63, pp 69–76. Link to article

What they did: In a study of 160 young men and women (age range 18–29), all participants were asked to record a short speech about why they would be a good dating prospect. Approximately half of the participants fell into the BMI category ‘normal weight’, about a quarter were in the ‘overweight’ category and a quarter in the ‘obese’ category. A handful fell in the ‘underweight’ category. After completing a series of online questionnaires about themselves, including a measure of their self-esteem levels. They then attended the lab where half were told that their talk would be recorded on tape and evaluated by a member of the opposite sex, and the other half were told that their speech would be recorded on video. They were also shown a picture of an attractive member of the opposite sex who would supposedly be the one rating them. Along with the picture, they read a description of the ‘evaluator’ who described him or herself as fit and fun-loving.

Before the recording, the participants filled in questionnaires assessing their expectations of being either liked or rejected. After the recording, they also answered questions testing their current self-esteem, self-consciousness, stress, and anxiety levels. They also completed a popular test of cognitive function – the Stroop test. When all this was over, they were told the true purpose of the study and that nobody was really evaluating them as potential dating partners.

What they found

Heavier women but not men suffered more anxiety, stress, and self-consciousness and reduced self-esteem when they thought they were going to be evaluated on video by a member of the opposite sex, compared with when they thought they were going to be evaluated on audio tape. This was after controlling for the participants’ usual self-esteem. They also expected to be socially rejected rather than liked. The effect was opposite in thinner women, who expected to be liked more in the video condition than in the audio version. And the impact of rejection expectations was not limited to psychological effects. Heavier women performed worse on the test of cognitive processing in the video compared with the audio condition whereas thinner women performed better. Again, the interaction effect wasn’t observed in the male participants.

Most of the negative psychological outcomes were mediated by rejection expectations. What this means is that higher-weight women in the video condition expected more social rejection, and it was this that increased their stress and self-consciousness levels and reduced their self-esteem, at least in part. The positive psychological response in lower-BMI women was caused in part via their expectation of being liked and accepted. The increases in anxiety and reductions in cognitive function didn’t operate via rejection expectations, and further studies would be needed to identify the mechanism at work here.

What it means

I think this one is pretty self-explanatory, and yet again shows that the burden of society’s body surveillance and judgment falls predominantly on women. Either that or men are a bit oblivious, which is also possible. The effect on cognitive function is also of note. The literature abounds with studies suggesting fatter people are not as intelligent and/or have worse cognitive abilities and impaired brain function – a fact that is usually attributed to their fatness. Well, that is may be, but none of these studies, to my knowledge, account for experienced or expected weight stigma. The concept of stereotype threat, whereby members of a stigmatised group fear that their performance on a task may reinforce negative stereotypes held about their group, is widely recognised in the stigma literature.* That many individuals consider fat people to be stupid as well as weak-willed, greedy, and lazy, it is not inconceivable that this phenomenon may be at play here. Yet the researchers in the ‘obesity’ versus cognition studies usually recommend weight loss as a solution to these apparent deficits. Few have considered the possibility that the environment, and not the individual, might be the problem.

*For a more detailed review of stereotype threat, see this paper: full text.

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The second publication involved the development of a new questionnaire designed to evaluate weight-related rejection sensitivity (W-RS).

Title: Weight-based rejection sensitivity: Scale development and implications for well-being

Authors: McClure Brenchley, Quinn

Source: Body Image (2016) vol 16, pp 79–92. Link to article

Super-quick summary: Development of a new questionnaire to assess weight-related rejection sensitivity – expectations of and anxiety about being discriminated against or experiencing microaggressions in a range of social situations.

In more detail:

What they did

A series of studies were conducted in large samples of college students to develop and test the psychometric properties of this new 16-item scale. This included a longitudinal study where measures were taken at the start and the end of the students’ first semester at college to look at long-term consequences of W-RS on physical and psychological health, overall health and wellbeing, and adjustment to college.

What they found

1. Relationship with related variables: The scale was highly correlated with other constructs that you would expect it to be related to, including perceived, experienced, and internalised discrimination, body dissatisfaction, and self-esteem. Interestingly, the highest correlation was with internalised weight stigma (r = .76), far more than for perceived (r = .47) or experienced (r = .44) stigma. They also showed that despite high correlations between the W-RS measure and scores on body dissatisfaction, the two were not the same thing (they loaded onto different factors with PCA).
2. Reliability in different groups: The scale was reliable across people of different weight and in both genders, and provided fairly stable results over time (test-retest reliability r = .75 and .82 in two separate studies).
3. W-RS measured at the start of the first semester of college significantly predicted greater psychological distress and physical ill health at the end of the semester, after controlling for levels of these variables at the start. A negative relationship with health-related quality of life did not meet statistical significance. W-RS also significantly predicted worse college adjustment. In contrast, body dissatisfaction and appearance-based self-worth didn’t predict any of these negative outcomes, again suggesting that this new W-RS scale is measuring something different from existing body image-related measures. Contrary to expectations, W-RS didn’t significantly predict disordered eating patterns or bulimic symptoms, although there were small effects in the expected direction.

What it means

Well, first, obviously, it shows again that anticipation and anxiety of being rejected due to weight is not good for you. The finding that adjustment to the college environment suffers could provide an additional mechanism whereby higher-weight students underperform in education. One interesting question that arises from these findings is that W-RS is very strongly correlated with internalised weight stigma. This raises the question of directionality. Perhaps individuals who already devalue themselves because of their weight are more likely to anticipate being rejected by others. Internalised weight stigma may be more malleable to intervention than are anticipated stigma. While the ideal solution to the negative impacts of societal stigma would be to reduce the stigma, we don’t have a very good track record there (full text). In the meantime, improving the resilience of the victims may be a useful strategy, protecting us against at least some of the harms associated with societal weight stigma.

While the samples used in these studies were large, all were comprised of undergraduate students. The scale needs to be tested in other samples before we can be sure these results generalise to the wider population, although there is no immediately apparent reason that it would not. In the meantime, this new scale looks like a useful addition to the stigma researcher’s arsenal.