DYNAMIC ASSESSMENT OF OBESITY STIGMATIZATION Jason D. Seacat, Ph.D. - PowerPoint PPT Presentation

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 research findings  Laboratory 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 (1999- 2011)  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 cross- sectional 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 log  Pedometer

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