Beyond personal responsibility: Effects of causal attributions for overweight and obesity on weight-related beliefs,stigma, and policy support

Objective: The objective of this research was to compare the effects of different causal attributions for overweight and obesity, among individuals with overweight and obesity, on weight-related beliefs, stigmatising attitudes and policy support.

Design: In Study 1, an online sample of 95 US adults rated the extent to which they believed various factors caused their own weight status. In Study 2, 125 US adults read one of three randomly assigned online passages attributing obesity to personal responsibility, biology, or the ‘food environment.’ All participants in both studies were overweight or obese.

Main outcome measures: All participants reported beliefs about weight loss, weight-stigmatising attitudes, and support for obesity-related policies.

Results: In Study 1, biological attributions were associated with low weight-malleability beliefs and blame, high policy support, but high internalised weight bias. ‘Food environment’ attributions were not associated with any outcomes, while ‘personal responsibility’ attributions were associated with high prejudice and blame. In Study 2, participants who received information about the food environment reported greater support for food-related policies and greater self-efficacy to lose weight.

Conclusion: Emphasising the role of the food environment in causing obesity may promote food policy support and health behaviours without imposing the negative consequences associated with other attributions.     

What do targeting positive views on ageing add to a physical activity intervention in older adults? Results from a randomised controlled trial

Objective: Physical activity is a key factor for healthy ageing, yet many older people lead a sedentary lifestyle. Traditional physical activity interventions do not consider the specific needs and views of older adults. As views on ageing are known to be related to health behaviours, the current study evaluates the effectiveness of prompting positive views on ageing within a physical activity intervention.

Design: Randomised controlled trial with three groups aged 65+: Intervention for physical activity with ‘views-on-ageing’-component (n?=?101; IGVoA), and without ‘views-on-ageing’-component (n?=?30; IG), and active control intervention for volunteering (n?=?103; CG).

Main outcome measures: Attitudes towards older adults and physical activity were assessed five weeks before intervention, two weeks, six weeks and 8.5?months after the intervention.

Results: Compared to the IG and CG, positive attitudes towards older adults increased in the IGVoA after the intervention. For IGVoA, the indirect intervention effect on change in activity via change in attitudes towards older adults was reliable.

Conclusion: A ‘views-on-ageing’-component within a physical activity intervention affects change in physical activity via change in views on ageing. Views on ageing are a promising intervention technique to be incorporated into future physical activity interventions for older adults.     

Making snacking less sinful: (Counter-)moralising obesity in the public discourse differentially affects food choices of individuals with high and low perceived body mass

Objective: As public discourse surrounding obesity highlights the societal costs of obesity and individual’s own responsibility for their weight, being overweight is often framed as immoral. Such ‘moralizing’ messages about being overweight may be a psychological threat for those with high body mass. Attempting to counter-moralise the public discourse (i.e. actively arguing that there is nothing ‘immoral’ about being overweight) may relieve this threat, inducing people, especially those with higher (perceived) weight, to engage in healthier behaviours.

Method: Two experiments were performed among Dutch and US participants. (Counter-)moralisation was manipulated. Body mass and weight-related self-perceptions were measured. The dependent variable was healthy vs. unhealthy snack choice.

Results: (Counter-)moralisation and (perceived) overweight jointly predicted snack choice: counter-moralising messages induced healthy snacking, but only among those who regarded themselves to have a high body mass.

Conclusions: The effects of moralising vs. counter-moralising obesity depended on one’s (perceived) overweight. This suggests that, for people with relatively high weight, the current moralising public discourse on obesity works in counterproductive ways. Campaigns that ‘counter-moralize’ obesity (i.e. that refute moralising messages) are more productive, although they should be tailored to those who see themselves as being overweight.     

The role of centrality to self-concept in moderating the associations between injury perceptions and outcomes

Abstract

Objectives: To test the centrality of injury to self-concept as a moderator of the associations between injury perceptions and outcomes.

Methods: Two concurrent studies on samples of injured individuals.

Measures: The centrality of injury to one’s self concept was measured by the degree of self-injury separation (PRISM); injury perceptions were measured by the injury perception questionnaire; and outcomes by standard scales of self-assessed health, physical, emotional and social functioning, vitality, depression, anxiety and somatisation. Regression analyses examined the significance of adding the interactions between injury centrality and injury perceptions to explained outcome variance, beyond their separate contributions.

Results: Both injury centrality and injury perceptions significantly explained variance in patients’ functioning and well-being. Injury centrality moderated the associations between various injury perceptions and outcomes, especially pronounced for emotional representations of the injury. As hypothesised, the effects of injury perceptions on outcomes were stronger among patients for whom the injury was central to their self-concept compared to patients who perceived the injury as peripheral to their self-concept.

Conclusions: ‘Centrality to the self’ is a moderator of the impact of perceptions on outcomes of injuries. The findings suggest ways to tailor interventions to sub-groups of injured patients based on injury centrality to their self-concept.     

Longevity of attentional bias modification effects for food cues in overweight and obese individuals

Accumulating evidence shows that overweight individuals exhibit an attentional bias for food and that this bias can be modified. This study investigated the longevity of such modification effects. Using a dot probe paradigm, a community sample of overweight and obese women (N = 104) was trained to direct attention towards (‘attend’) or away from (‘avoid’) food pictures. Participants completed five weekly training sessions. Attentional bias was measured before and after training, at 24 h and one-week follow-up. To increase generalisability, at each of the post-training and follow-up assessments, participants were shown a mix of old and new food pictures. They also completed another implicit bias measure, i.e. a word stem task. Attentional bias for food increased in the ‘attend’ group and decreased in the ‘avoid’ group. These retraining effects were maintained at 24 h and one-week follow-up, and extended to new food pictures. Participants in the ‘avoid’ group also produced relatively fewer food words on the word stem task than those in the ‘attend’ group. Results are consistent with predictions of cognitive-motivational models that attentional biases are malleable. They further suggest that attentional bias modification, which targets the implicit processes that underlie the heightened food responsivity in overweight individuals, could help combat pathological (over)eating.     

The adoption of physical activity and eating behaviors among persons with obesity and in the general population: the role of implicit attitudes within the Theory of Planned Behavior

Obesity can be prevented by the combined adoption of a regular physical activity (PA) and healthy eating behaviors (EB). Researchers mainly focused on socio-cognitive models, such as the Theory of Planned Behavior (TPB), to identify the psychological antecedents of these behaviors. However, few studies were interested in testing the potential contribution of automatic processes in the prediction of PA and EB. Thus, the main objective of this study was to explore the specific role of implicit attitudes in the pattern of prediction of self-reported PA and EB in the TPB framework, among persons with obesity and in adults from the general population. One hundred and fifty-three adults participated to this cross-sectional study among which 59 obese persons (74% women, age: 50.6 ± 12.3 years, BMI: 36.8 ± 4.03 kg m^–²) and 94 people from the general population (51% women; age: 34.7 ± 8.9 years). Implicit attitudes toward PA and EB were estimated through two Implicit Association Tests. TPB variables, PA and EB were assessed by questionnaire. Regarding to the prediction of PA, a significant contribution of implicit attitudes emerged in obese people, β = .25; 95%[CI: .01, .50]; P = .044, beyond the TPB variables, contrary to participants from the general population. The present study suggests that implicit attitudes play a specific role among persons with obesity regarding PA. Other studies are needed to examine which kind of psychological processes are specifically associated with PA and EB among obese people.     

Approach bias for food cues in obese individuals

This study aimed to investigate the existence of an approach bias for food cues in obese individuals. A community sample of 56 obese women and 56 normal weight controls completed an approach–avoidance variant of the implicit association task. The obese participants were faster to respond to trials that paired food words with approach words, and trials that paired non-food words with avoid words, than the converse pairings, thus, demonstrating an approach bias for food. This bias was evident for both high caloric and low caloric food words, and was not attributable to a state of deprivation or feelings of hunger. By contrast, the normal weight controls did not show any such bias. The results are consistent with recent neurocognitive perspectives of obesity. At a practical level, approach biases for food may present a potential target for modifying (excessive) food intake.     

The role of risk perception in explaining parental sunscreen use

Objective: This study assessed: (1) whether risk perceptions about skin cancer were related to parent's use of sunscreen on their children; (2) which combination of assessments susceptibility and severity best explain parental sunscreen protection behaviours and (3) whether risk perceptions influence behaviour directly through intentions or through attitudes, subjective norms and self-efficacy.

Design: Two longitudinal studies assessed sunscreen protection behaviours of parents for their toddlers (N?=?391) and young children (N?=?436).

Main outcome measure: Parent's use of sunscreen on their children.

Results: Risk perceptions correlated with future sunscreen protection behaviours of parents but were lower than those of attitude, social influence and self-efficacy. Treating susceptibility and severity as an additive function resulted in the best model fit. Risk perceptions were related with future intention and future sunscreen protection behaviour, but the effects were mediated through attitude, social influence and self-efficacy.

Conclusions: Our path analyses suggest treating susceptibility and severity as an additive function. A multiplicative model without main effects – although often used – had the poorest fit. Risk perceptions influence behaviour by influencing attitudinal and self-efficacy beliefs. Addressing risk perceptions in health communication programs is relevant when the purpose is to increase awareness and to influence attitudes and self-efficacy.     

N-of-1 study of weight loss maintenance assessing predictors of physical activity,adherence to weight loss plan and weight change

Objective: Behaviour change interventions are effective in supporting individuals to achieve clinically significant weight loss, but weight loss maintenance (WLM) is less often attained. This study examined predictive variables associated with WLM.

Design: N-of-1 study with daily ecological momentary assessment combined with objective measurement of weight and physical activity, collected with wireless devices (Fitbit?) for six months. Eight previously obese adults who had lost over 5% of their body weight in the past year took part. Data were analysed using time series methods.

Main outcomes measures: Predictor variables were based on five theoretical themes: maintenance motives, self-regulation, personal resources, habits, and environmental influences. Dependent variables were: objectively estimated step count and weight, and self-reported WLM plan adherence.

Results: For all participants, daily fluctuations in self-reported adherence to their WLM plan were significantly associated with most of the explanatory variables, including maintenance motivation and satisfaction with outcomes, self-regulation, habit, and stable environment. Personal resources were not a consistent predictor of plan adherence.

Conclusion: This is the first study to assess theoretical predictions of WLM within individuals. WLM is a dynamic process including the interplay of motivation, self-regulation, habit, resources, and perceptions of environmental context. Individuals maintaining their weight have unique psychological profiles which could be accounted for in interventions.     

Implicit and explicit memory bias in depressed and non depressed subjects

Abstract

Two experiments were carried out to investigate a possible mood-congruent memory bias in explicit memory (free-recall test) and implicit memory (word-stem completion task) for positive and negative words in depressed and non depressed college students. A comparison of implicit and explicit mood-congruent memory bias should help to reveal cognitive processes involved in this effect. The results of both studies indicated that depressed subjects showed a memory bias not only on the traditional explicit memory task, but on the implicit memory task as well. The theoretical implications of these results are discussed.     

Fitness vs. fatness: Implicit bias towards obesity among fitness professionals and regular exercisers

ObjectivesSuccess of supported exercise programmes to tackle obesity appear to be shaped, in part, by co-exercisers’ beliefs. This study, therefore, aimed to assess implicit attitudes towards obesity among two key groups of people in a public exercise setting: fitness professionals offering exercise advice, and regular exercisers.DesignQuestionnaire survey.MethodsIn all, 57 fitness professionals and 56 regular exercisers were recruited from gyms across Central England. Participants completed a demographic questionnaire, semantic differential measure of explicit beliefs and the implicit associations test (IAT). The IAT reveals unconscious attitudes of participants to implicit associations between target concepts (thin vs. fat) and attributes (good vs. bad). The attribute of motivated vs. lazy was adopted in the current study due to relevance in an exercise setting.ResultsEvidence of a strong anti-fat bias was found (p<.01) for both fitness professionals and regular exercisers on all implicit and explicit measures (good vs. bad; motivated vs. lazy). This bias was more pronounced for fitness professionals who themselves had never been overweight and who believed personal control dictated body weight. For regular exercisers, a higher level of anti-fat bias was found for females, younger participants and those who had never been overweight.ConclusionsThis study suggests that the guidance to support exercise, and combat obesity, may be compromised by the beliefs of those facilitating such programmes.     

A weight‐related growth mindset increases negative attitudes toward obese people

In implicit personality theory, people with entity views or a fixed mindset perceive characteristics (e.g., intelligence) as uncontrollable, whereas people with incremental views or a growth mindset perceive characteristics as controllable. In addition to other benefits, the literature sometimes suggests that having a growth mindset will protect against prejudice, which the current two studies examine in terms of negative attitudes toward obese people. Participants (total N = 501) were randomly assigned to complete a questionnaire assessing attitudes toward an obese or nonobese person and a self‐theory questionnaire also assessed ideas about body weight. People with a growth mindset, and not fixed mindset, were more likely to have negative attitudes toward obese individuals, pointing to a potential downside of growth mindset in the obesity domain.     

Social cognitions measured in 4 to 6 year olds are predictive of objectively measured physical activity

Objective: This study tested whether social cognitions from the reasoned action approach (RAA) can be reliably measured in a sample of primary school children (aged 4–6 years) and whether these RAA measures are predictive of physical activity.

Design: Longitudinal observational study with repeated measures over six months.

Measures: RAA variables were measured using a novel choice paradigm between physically active and sedentary pastimes. Relative reinforcing value, covariates (sex, age, deprivation and BMI) and physical activity by accelerometry (primary outcome) were also measured.

Results: RAA cognitions could be measured with acceptable retest reliability and discriminant validity and social norms regarding parents and teachers (but not friends) were correlated with physical activity and change in physical activity when relative reinforcing value and other covariates were controlled for.

Conclusions: RAA cognitions can be reliably measured in primary school children aged 4–6 and RRA measures appear useful in understanding children’s activity choices and may potentially inform future interventions.     

Trajectories of self-efficacy in persons with chronic illness: An explorative longitudinal study

Background: Self-efficacy is important for changing health behaviour in persons with chronic illness. Longer term trajectories have not been previously explored.

Objective: This study’s objective was to explore the trajectories of self-efficacy in two different groups with chronic illnesses attending a patient education course.

Design: The study design was a longitudinal, comparative cohort study with five time points during a one-year follow-up, using repeated measures analysis of variance.

Setting and participants: Persons with morbid obesity (n = 55) and persons with chronic obstructive pulmonary disease (COPD; n = 56) were recruited at the start of patient education courses in Norway and followed-up four times the following year.

Main outcome measure: The General Self-Efficacy Scale was the main outcome.

Results: Obese persons showed a linear pattern of increasing self-efficacy during the follow-up period, whereas persons with COPD had an initial increase followed by a decrease in self-efficacy. Having paid work was associated with a more positive self-efficacy trajectory.

Conclusion: The results provide support for the currently employed patient education course for morbidly obese persons. In contrast, persons with COPD may need more extensive and/or more frequent support in order to increase and maintain self-efficacy across time.     

“Weak,Sad, and Lazy Fatties”: Adolescents’ Explicit and Implicit Weight Bias Following Exposure to Weight Loss Reality TV Shows

Weight loss reality TV shows, which portray obese individuals and their struggle to lose weight, are highly popular. However, the shows often contain negative and stereotypical portrayals of obese individuals that can contribute to the formation of weight bias among viewers. In particular, adolescents might be highly susceptible to such portrayals, since physical appearance and body image play an important role during adolescence. In our experimental study, we investigated the priming effects of exposure to weight loss reality TV shows on implicit and explicit attitudes toward obese individuals among 353 adolescents. We exposed a treatment group (n = 173) to video clips of a weight loss reality TV show and a control group (n = 180) to video clips of an information-based TV magazine. Results indicated that for individuals who expressed a fear of being obese, exposure to the weight loss reality TV show reinforced negative explicit attitudes toward obese individuals by activating a perception of weight controllability. Exposure to the weight loss reality TV show also enhanced negative implicit attitudes toward obese individuals among all adolescents, irrespective of their fear of being obese. Altogether, our findings underscore the role of media in perpetuating weight bias.     

The role of self-regulation strategies and self-efficacy perceptions in successful weight loss maintenance

Abstract

The purpose of this study was to identify the self-regulatory strategies which people use to lose, maintain, or manage their weight, and to assess their self-efficacy perceptions to implement these strategies. Thirty-three (N = 33) undergraduate college students were divided into three groups based on their past weight loss experience and confirmed by their current Body Mass Index: (a) overweight participants who tried but failed to lose weight, (b) participants who used to be overweight but lost significant weight and kept it off for at least six months, and (c) participants with an optimal weight. All participants were interviewed using a structured questionnaire. Data were analyzed using a one-way ANOVA and correlation analyses. Participants who used self-regulatory strategies such as goal-setting, self-monitoring, self-evaluation, environmental structuring, time management, social assistance and information seeking were better able to maintain or lose weight. Overweight participants reported significantly less strategy use than participants who had lost weight or who had a healthy weight. In addition, overweight participants had lower self-efficacy perceptions about implementing strategies than did healthy weight participants or participants who had successfully lost weight. Finally, a path analysis revealed that participants who reported high self-efficacy perceptions and applied their strategies persistently in the face of difficulties were more likely to successfully manage their weight.     

Teaching Clinical Psychology Trainees about Weight Bias

Abstract

As an assistant professor who teaches clinical psychology trainees about social aspects of behavior, I devote one week to the topic of weight bias. In this class, I rely on the research literature to challenge common myths about “obesity,” demonstrate the pervasiveness and harm of weight bias, and offer recommendations to trainees to apply to their own professional and personal lives. I encourage trainees to shift focus from weight and weight loss to health and well-being and to engage in self-reflection on the role of weight bias in their interactions with others. Here, I describe my weight bias seminar and outline common questions and my responses to them (e.g., Do you actually believe that “obese” people can be healthy?). Weight bias is a neglected topic in most clinical psychology training programs. Weight bias must be addressed in clinical psychology programs to produce culturally competent graduates who are aware of diversity issues.     

Comorbid interpretation and expectancy bias in social anxiety and alcohol use

Background: In two studies, the present research examined whether being high in both social anxiety and alcohol use disorder symptoms is associated with a comorbid interpretation and expectancy bias that reflects their bidirectional relationship.

Design: Cross-sectional, quantitative surveys.

Methods: Measures of social anxiety and alcohol use disorder symptoms, as well as an interpretation and expectancy bias task assessing biases for social anxiety, drinking, and comorbid social anxiety and drinking.

Results: In Study 1 (N?=?447), individuals high (vs. low) in social anxiety had stronger social threat bias and individuals high (vs. low) in alcohol use disorder symptoms had stronger drinking bias. Those high in both social anxiety and alcohol use disorder symptoms endorsed interpretations and expectancies linking social interaction with alcohol use. Comorbid bias predicted membership into the high social anxiety/drinking group, even after taking into account single-disorder biases. In Study 2 (N?=?325), alcohol use disorder symptoms predicted drinking bias and social anxiety symptoms predicted social anxiety bias. Alcohol use disorder symptoms, social anxiety symptoms, and their interaction predicted comorbid interpretation and expectancy bias.

Conclusion: Results indicate unique cognitive vulnerability markers for persons with comorbid social anxiety and alcohol use disorder symptoms, which may improve detection and treatment of this serious comorbidity.     

The effects of scenario-based risk information on perceptions of susceptibility to Chlamydia and HIV

Abstract

Objectives: The Self-Report Habit Index (SRHI) was originally reported as one-dimensional; however, habit has been described as characterised by several features. Moreover, one-dimensional models for the SRHI have demonstrated poor fit. Therefore, we aimed to compare multidimensional models with a one-dimensional model in both snacking and physical activity habits, besides examining further instrument characteristics.

Design: A cross-sectional study was conducted with high school and university students (n?=?555).

Main outcome measure: The SRHI adapted for physical activity and for snaking habits was applied at one time point.

Results: Nested models with one factor, two factors and three factors were compared. Next, a hierarchical second-order model was tested, and further validity issues, as well as invariance between habits, were examined. Three-dimensional models represented a better fit for both habits. However, fit was still inadequate in the snacking version. In addition, discriminant validity concerns emerged for the physical activity SRHI. Moreover, invariance between the snacking and the physical activity versions was not confirmed.

Conclusions: Considering the SRHI as composed by the dimensions of ‘lack of awareness’, ‘lack of control’ and ‘history of behavioural repetition’ seems to be more accurate. Nevertheless, our findings suggest that further research is needed.     

Automatic affective-motivational regulation processes underlying supportive dyadic coping: the role of increased implicit positive attitudes toward communal goals in response to a stressed relationship partner

Background and objectives: We examined the implicit affective mechanisms underlying provision of support in intimate dyads. Specifically, we hypothesized that in individuals with high relationship satisfaction, the perception that one’s partner is stressed leads to increased implicit positive attitudes toward communal goals. In turn, this change in implicit attitudes facilitates supportive behavior.

Design and methods: In two studies, we induced partner stress by instructing participants to either recall a situation where their partner was highly stressed (Study 1; N?=?47 university students) or imagine a specific stressful event (excessive workload; Study 2; N?=?85 university students). Subsequently, implicit attitudes toward communal goals were assessed with an Implicit Association Test.

Results: In both studies, we found that among participants with high relationship satisfaction partner stress increases preferences for communal goals. In addition, implicit preferences for communal goals predicted stronger inclinations to engage in supportive dyadic coping (Study 2).

Conclusions: The current findings provide important insights into the implicit cognitive-affective mechanics of dyadic coping. Moreover, they can explain how people manage to avoid experiencing motivational conflicts between partner-oriented and self-oriented goals in situations characterized by high partner stress.