Raising awareness of anti-fat stigma in healthcare through lived experience education: a continuing professional development pilot study.

BACKGROUND: Anti-fat attitudes and weight-based discrimination are prevalent in healthcare settings and among healthcare practitioners and clinical trainees, and can result in immense harm to patients. There is increasing recognition that anti-fat bias in healthcare is a critical issue that must be addressed, but there is a dearth of evidence demonstrating sustained attitude and behavioural change among clinicians, illustrating a need for more innovative educational approaches and rigorous evaluation. We describe the co-design and delivery of a narrative-based continuing professional development curriculum aimed at raising awareness of weight-based bias and stigma. METHODS: Our research team of lived experience educators, clinicians and researchers collaboratively developed a series of seven podcast episodes comprised of narrative descriptions of lived experiences with and impacts of weight bias, stigma and discrimination in healthcare settings, as well as a post-podcast workshop to facilitate reflection and discussion between participants. The curriculum was piloted among 20 clinicians practicing at a large urban hospital in Mississauga, Canada. We explored feasibility, acceptability and learning impact by analyzing responses to questionnaires completed following each podcast episode and responses shared during the workshops and follow-up feedback sessions. RESULTS: We observed high acceptability and feasibility of the curriculum. Participants experienced the podcast as a practical and convenient learning format and the workshop as a valuable opportunity to collectively debrief and reflect. The learning impact of the curriculum was strong; participants described a range of emotions elicited by the podcasts, engaged in self-reflection, and expressed a desire to modify clinical approaches. Barriers to the application of learnings identified by participants include pervasiveness of the use of body mass index (BMI) as an indicator of risk and a criterion for referral; discomfort with difficult conversations; prevalent biomedical understandings about the association between weight and health; and clinicians' defensiveness. CONCLUSION: This pilot study yielded promising findings and demonstrated potential impact on weight bias and stigma among healthcare providers. Necessary next steps include conducting larger scale, rigorous evaluations of the curriculum among broader populations, both health professions trainees and current healthcare providers.

Exploring the association between parental anti-fat attitudes and restrictive feeding practices in a British and Irish sample.

Parental restriction of food intake has been associated with heightened eating disorder psychopathology in some longitudinal research. Yet, relatively little is known about the determinants of restrictive feeding practices. This cross-sectional study explored the association between parents' anti-fat attitudes and their use of restrictive feeding practices in a mixed British (41.10% England, 39.90% Scotland, 4.20% Other) and Irish (14.80%) sample. Parents and caregivers (N = 472; 94.10% female; 70.90% university level education) of children between the ages of 4-8 (48.20% female; 91.10% rated as "normal weight" by their parents) completed self-report questionnaires assessing their anti-fat attitudes (dislike, fear, and blame subscales), use of restrictive feeding practices (for weight control, health purposes, and covert restriction), and how influential their child's body-weight and -shape is for their perception of themselves as parents. Overall, our hypothesis that parental anti-fat attitudes would be significantly associated with restrictive feeding practices was supported. Anti-fat attitudes related to disliking higher body-weight people and blaming parents for their child's weight were significant predictors of all forms of restrictive feeding (all ps < .05). However, anti-fat attitudes related to fearing being a higher body-weight were not significant predictors of restrictive feeding for the purposes of health nor for covert restriction (ps > .05). Additionally, our hypothesis that the associations between anti-fat attitudes and restrictive feeding practices would be stronger for parents for whom their child's body-weight and -shape more strongly influenced how they judged themselves as parents was not supported (the interaction term was not significant in two out of three analyses). Future research is needed to investigate these associations across time and in samples of higher body-weight children.

Implicit visual sensitivity towards slim versus overweight bodies modulates motor resonance in the primary motor cortex: A tDCS study.

Motor resonance (MR) can be influenced by individual differences and similarity in the physical appearance between the actor and observer. Recently, we reported that action simulation is modulated by an implicit visual sensitivity towards normal-weight compared with overweight bodies. Furthermore, recent research has suggested the existence of an action observation network responsible for MR, with limited evidence whether the primary motor cortex (M1) is part of this. We expanded our previous findings with regards to the role of an implicit normal-weight-body preference in the MR mechanism. At the same time, we tested the functional relevance of M1 to MR, by using a transcranial direct current stimulation (tDCS) protocol. Seventeen normal-weight and 17 overweight participants were asked to observe normal-weight or overweight actors reaching and grasping a light or heavy cube, and then, at the end of each video-clip to indicate the correct cube weight. Before the task, all participants received 15 min of sham or cathodal tDCS over the left M1. Measures of anti-fat attitudes were also collected. During sham tDCS, all participants were better in simulating the actions performed by normal-weight compared with overweight models. Surprisingly, cathodal tDCS selectively improved the ability in the overweight group to simulate actions performed by the overweight models. This effect was not associated with scores of fat phobic attitudes or implicit anti-fat bias. Our findings are discussed in the context of relevance of M1 to MR and its social modulation by anti-fat attitudes.

Anti-fat attitudes and dietary restraint within mother-daughter dyads: an Actor-Partner Interdependence Model (APIM) analysis.

PURPOSE: This study examined the association between anti-fat attitudes (fear of fat, dislike of fat, willpower) and dietary restraint within the mother-daughter relationship. METHODS: Mother-adolescent daughter dyads (Npairs = 100) were recruited from a Midwestern community to participate in a study together. They completed self-report measures of anti-fat attitudes and eating behavior. Data were analyzed with an Actor-Partner Interdependence Model (APIM). RESULTS: Significant actor effects for mothers include fear of fat (b = 0.270, B = 0.319, p < 0.05) and willpower (b = 0.228, B = 0.280, p < 0.05) predicting her own dietary restraint. For daughters, fear of fat (b = 0.554, B = 0.612, p < 0.05) and dislike (b = 0.202, B = 0.214, p < 0.05) predict her own dietary restraint. Regarding partner effects, mothers' fear of fat was related to daughters' dietary restraint (b = 0.126, B = 0.138, p < 0.05), and daughters' dislike was related to mothers' restraint (b = 0.257, B = 0.294, p < 0.05). Regarding dyad-level interaction effects, mother and daughter fear of fat interacted to predict daughter dietary restraint (b = 0.184, B = 0.201, p < 0.05), such that when both mother and daughter fear of fat is high, daughters appear to engage in more dietary restraint. CONCLUSIONS: Given the role of mothers' fear of fat in daughter eating behavior, parent-focused or parent-involved interventions may improve family culture around weight and eating, contributing to better adolescent outcomes. LEVEL OF EVIDENCE: V, cross-sectional descriptive study.

Brief non-dieting intervention increases intuitive eating and reduces dieting intention, body image dissatisfaction, and anti-fat attitudes: A randomized controlled trial.

This study developed and examined a brief dissonance-based non-dieting intervention designed to help college women reject unhealthy dieting behaviors, accept their bodies, and increase healthy eating. Participants included 94 female university students (mean age = 20.6 years; mean BMI = 23.8 kg/m2), randomly assigned either to the non-dieting intervention condition or a brochure control condition. The intervention consisted of two 90-120 min interactive group sessions designed to engender the rejection of dieting, increase body acceptance, and develop healthy eating skills. Assessment measures were collected at baseline, post-treatment, and one-month follow-up. The group sessions produced significant improvements in the intervention group compared to the control group on measures of dieting intention, intuitive eating, body image dissatisfaction, eating concerns, and anti-fat attitudes. These effects were sustained at one-month follow-up. There were also overall improvements over time in dietary intake and mental health-related quality of life across conditions. This study extends the research on non-dieting approaches by using a brief, dissonance-based structure and by applying the intervention to a young adult sample that included participants of normal weight. The findings here indicate that a non-dieting approach is acceptable and feasible, and can result in improvements in eating and weight-related behaviors, in young adult women.

How and why weight stigma drives the obesity 'epidemic' and harms health.

BACKGROUND: In an era when obesity prevalence is high throughout much of the world, there is a correspondingly pervasive and strong culture of weight stigma. For example, representative studies show that some forms of weight discrimination are more prevalent even than discrimination based on race or ethnicity. DISCUSSION: In this Opinion article, we review compelling evidence that weight stigma is harmful to health, over and above objective body mass index. Weight stigma is prospectively related to heightened mortality and other chronic diseases and conditions. Most ironically, it actually begets heightened risk of obesity through multiple obesogenic pathways. Weight stigma is particularly prevalent and detrimental in healthcare settings, with documented high levels of 'anti-fat' bias in healthcare providers, patients with obesity receiving poorer care and having worse outcomes, and medical students with obesity reporting high levels of alcohol and substance use to cope with internalized weight stigma. In terms of solutions, the most effective and ethical approaches should be aimed at changing the behaviors and attitudes of those who stigmatize, rather than towards the targets of weight stigma. Medical training must address weight bias, training healthcare professionals about how it is perpetuated and on its potentially harmful effects on their patients. CONCLUSION: Weight stigma is likely to drive weight gain and poor health and thus should be eradicated. This effort can begin by training compassionate and knowledgeable healthcare providers who will deliver better care and ultimately lessen the negative effects of weight stigma.

Toddlers' bias to look at average versus obese figures relates to maternal anti-fat prejudice.

Anti-fat prejudice (weight bias, obesity stigma) is strong, prevalent, and increasing in adults and is associated with negative outcomes for those with obesity. However, it is unknown how early in life this prejudice forms and the reasons for its development. We examined whether infants and toddlers might display an anti-fat bias and, if so, whether it was influenced by maternal anti-fat attitudes through a process of social learning. Mother-child dyads (N=70) split into four age groups participated in a preferential looking paradigm whereby children were presented with 10 pairs of average and obese human figures in random order, and their viewing times (preferential looking) for the figures were measured. Mothers' anti-fat prejudice and education were measured along with mothers' and fathers' body mass index (BMI) and children's television viewing time. We found that older infants (M=11months) had a bias for looking at the obese figures, whereas older toddlers (M=32months) instead preferred looking at the average-sized figures. Furthermore, older toddlers' preferential looking was correlated significantly with maternal anti-fat attitudes. Parental BMI, education, and children's television viewing time were unrelated to preferential looking. Looking times might signal a precursor to explicit fat prejudice socialized via maternal anti-fat attitudes.

Longitudinal relationships between anti-fat attitudes and muscle dysmorphia symptoms.

Weight stigma, and more specifically, anti-fat attitudes, is associated with disordered eating. Furthermore, these anti-fat attitudes influence various appearance ideals. Muscle dysmorphia (MD) is characterized by preoccupation with the muscular ideal and is a potential form of disordered eating commonly experienced by men. Despite theory suggesting that anti-fat attitudes may contribute to MD, research has yet to examine associations between anti-fat attitudes and MD symptoms. Therefore, the current study investigated longitudinal relationships between anti-fat attitudes and MD symptoms. Participants were 269 U.S. men recruited from Prolific who completed three self-report surveys each separated by one month. Primary analyses examined longitudinal relationships between specific anti-fat attitudes and MD symptoms using an adapted three-wave cross-lagged panel model. Results demonstrated that believing that fat people do not have willpower was longitudinally associated with desires to increase muscle size at multiple time points. Furthermore, MD-specific functional impairment predicted fears of becoming fat longitudinally. Practically, men may desire to increase their muscularity to demonstrate their own willpower and distance themselves from anti-fat stereotypes. Thus, clinicians may consider targeting weight stigmatizing attitudes to reduce MD symptom severity among their male clients.

A dyadic analysis of anti-fat attitudes and partners' diet-related influence among gay married men.

OBJECTIVES: The focus on physical appearance among gay men has potential implications for anti-fat attitudes, including those directed toward romantic partners. Partners often influence each other's behaviors including those linked to weight, but most research has examined the consequences of these influence strategies versus their antecedents. To address this research gap, we examined how men's own and their partners' anti-fat attitudes were related to both health-promoting (control) and health-compromising (undermining) types of diet-related influence and whether these associations differed by weight status. METHODS AND RESULTS: Analyzing data from a cross-sectional online survey of 450 U.S. adult gay married men (225 couples), Actor-Partner Interdependence Models revealed that individuals' own anti-fat attitudes (all types) were positively associated with more frequent receipt of spousal control and undermining. Additionally, partner's fears about gaining weight were positively associated with more frequent receipt of spousal control and dislike of higher weight people and fear of gaining weight (among those of higher weight status) were positively associated with more frequent receipt of spousal undermining. CONCLUSION: Our findings add to the literature on diet-related interactions among gay married men, highlight the value of examining these processes dyadically, and suggest the importance of including both members of couples in health promotion and intervention efforts.

Weight bias among Canadians: Associations with sociodemographics, BMI and body image constructs.

This cross-sectional study examined the associations between sociodemographic characteristics, BMI, and body image constructs (body satisfaction and weight bias internalization; WBI) and explicit weight bias. A near-representative sample of 995 English-speaking Canadian adults (52% Female) completed a survey which assessed explicit weight bias (Anti-Fat Attitudes questionnaire), body satisfaction (Body Shape Satisfaction Scale), WBI (Modified Weight Bias Internalization Scale), and self-reported height and weight. Multiple linear regression analyses were run. Results showed that the variable that explained the most variance in explicit weight bias was WBI, followed by BMI. Higher levels of WBI and a lower BMI were both significantly associated with greater explicit weight bias. Male sex was associated with both disliking people with obesity and thinking obesity is attributable to lack of willpower, whereas female sex was associated with worrying about weight gain. The current findings emphasize the importance of future research efforts aimed at preventing or mitigating WBI to reduce negative attitudes about people with obesity.

Automatic pro-thin/anti-fat biases can develop without previous visual exposure to body shapes.

Endorsement of the thin beauty ideal increases risk for future body dissatisfaction and eating disorders among women. Visual-based media is theorized to be a central pathway through which the thin ideal is internalized. This internalization process results in formation of automatic pro-thin and anti-fat attitudes. However, it is often difficult to separate the contribution of visual-based media and other forms of communication in the creation of such attitudes. Using a novel auditory implicit association test, we show that women with congenital blindness with no previous exposure to body shapes develop automatic pro-thin and anti-fat attitudes to the same extent as sighted women. This result was replicated in studies conducted in two countries involving a combined total of 62 women with blindness and 80 sighted women. Results suggest that internalization of the thin ideal can occur without visual exposure to images of the thin beauty ideal or visual exposure to one's own body.

Validation of a Greek adaptation of the Anti-Fat Attitudes Questionnaire.

The Anti-Fat Attitudes Questionnaire (AFA) measures prejudicial attitudes that are held about individuals with overweight BMI or obesity. Despite increased interest in research on anti-fat attitudes worldwide, the psychometric properties of the AFA have rarely been examined in non-English speaking populations. The present study aimed to address this gap in the literature by translating and validating the AFA in the Greek language. An online, community-based sample of 642 individuals (364 women) responded to the Greek translation of the AFA and measures of appearance satisfaction and appreciation, disordered eating, self-esteem and depression. Results indicated that the original three-factor solution of the AFA was maintained in both the Principal and Confirmatory Factor Analyses. Additionally, internal consistency, test-retest reliability and convergent validity all showed adequate results. These findings provide support for the use of the AFA in Greek-speaking populations. The availability of the Greek AFA adds to the toolbox of body image scholars working in the Greek context.

Buffering anti-fat attitudes using contact: The roles of contact quantity, duration, favorability, and intergroup anxiety.

Decades of intergroup contact research have found that contact with outgroups reduces negative attitudes. Yet, few studies have examined the association between contact and anti-fat attitudes. Furthermore, testing different facets of contact, namely contact quantity versus contact duration, provides more precise theoretical predictions for their effectiveness in this under-tested context. This study examined whether intergroup anxiety was indirectly related to and contact favorability moderated the relationship between contact and anti-fat attitudes, tested through the constructs of contact quantity (i.e., how many individuals interacted with) and contact duration (i.e., how often time was spent). Undergraduates (N = 343; 260 women) based in the United States completed an online survey assessing intergroup contact, contact favorability, intergroup anxiety, and anti-fat attitudes. Analyses of conditional indirect effects showed that longer contact but not more contact reduced intergroup anxiety, which lowered anti-fat attitudes. The indirect paths for both contact types were not conditional upon contact favorability. Contact favorability moderated the association between contact duration and anti-fat attitudes such that longer and more favorable contact lowered anti-fat attitudes. Findings are discussed within the contact hypothesis, and future research should explore the distinct elements of the hypothesis as applicable to anti-fat prejudice in in-person and online contexts.

What's Mom and Dad Got to Do With It? Factors Related Between Mothers', Fathers', and Young Children's Weight Bias.

Our aim was to examine the role of parents in the transmission of weight bias to young children. Specifically, we assessed mothers' and fathers' weight bias and beliefs about the controllability of weight, and fear of fat in relation to their children's weight bias. Eighty-three mothers, 57 fathers, and their children (4- to 7-year-olds) participated. We failed to find any significant associations between children's weight bias, maternal responses, and most paternal responses. Only fathers' dislike of adults with overweight had daughters with more positive views of overweight figures. These results suggest that parents do not appear to contribute to the weight bias of preschoolers and their influence may only emerge in middle childhood. The present study also suggests that more work on the psychometric properties of weight bias scales and tasks to measure weight bias in children is vital to accurately evaluate interventions to decrease weight bias.

The Multifaceted Nature of Weight-Related Self-Stigma: Validation of the Two-Factor Weight Bias Internalization Scale (WBIS-2F).

BACKGROUND: Internalized weight stigma (IWS) is generally operationalized as self-devaluation due to weight in higher-weight individuals. The most commonly used measure of IWS, the Weight Bias Internalization Scale (WBIS), was developed from an original pool of 19 items. Item selection was guided by statistical techniques based upon an a priori hypothesized unidimensional factor structure. The resulting 11-item scale mostly assesses appearance-related attitudes, fear of stigma, affect, and desire for change, all of which may be a natural response to societal weight stigma, even in the absence of self-devaluation. Items pertaining to self-blame, stigma awareness, perceived legitimacy of weight stigma, and most items pertaining to self-worth, were excluded from the final scale. It is unclear whether an a priori assumption of multi-dimensionality would have produced different results. METHODS: Exploratory and confirmatory factor analysis of the original 19-item questionnaire was conducted in 931 higher-weight individuals. RESULTS: A 13-item two-factor structure was identified. Factor 1 comprised seven items that could be loosely conceived as weight-related distress. Factor 2 comprised six items, all of which pertained to weight-related self-worth. Tested individually, the six items making up the self-devaluation factor were an excellent fit for the data on all fit indices. CONCLUSION: IWS is a multi-dimensional construct. The two-factor WBIS (WBIS-2F) provides options to explore the relationships between different aspects of IWS and upstream and downstream variables. The Self-Devaluation subscale is suitable for standalone use when weight-related self-devaluation per se is the construct of interest.

Social Dominance Orientation, Dispositional Empathy, and Need for Cognitive Closure Moderate the Impact of Empathy-Skills Training, but Not Patient Contact, on Medical Students' Negative Attitudes toward Higher-Weight Patients.

Anti-fat bias in healthcare providers and medical students has serious implications for quality of care of higher-weight patients. Studies of interventions aimed at reducing anti-fat attitudes in medical students have generally been disappointing, with little enduring effect. It is possible that some students may be more receptive to prejudice-reducing influences than others, due to underlying differences in their personal characteristics. It is also possible that attitudes toward patients, specifically, may differ from anti-fat attitudes in general, and prejudice-reduction effectiveness on patient-specific attitudes has not yet been evaluated. The present study explored the effect on general and patient-specific anti-fat attitudes of (1) contact with higher-weight individuals prior to and during medical school; and (2) training designed to increase medical students' empathy toward patients by encouraging them to take the patient's perspective during clinical encounters. The moderating role of individual difference factors on effectiveness of contact and student-reported hours of empathy training on patient-specific attitudes was assessed. A total of 3,576 students enrolled across 49 US medical schools completed an online survey at the start of their first year of medical school and at the end of their fourth year. Favorable contact experience with higher-weight patients predicted improved attitudes toward heavier patients after 4 years of medical school, and appeared sufficient to partially offset the effects of dislike of higher-weight individuals at baseline. The impact of favorable contact on general anti-fat attitudes was less strong, highlighting the importance of using target-specific outcome measures. The positive effects of favorable contact on attitudes toward higher-weight patients did not differ based on students' baseline levels of social dominance orientation, dispositional empathy, or need for cognitive closure. In contrast, the effectiveness of training did vary by student characteristics, generally being more effective in students who were more egalitarian and empathic at baseline, with little effect, or even adverse effects in students low in these traits. Overall, however, perspective-taking training produced only small improvements in attitudes toward higher-weight patients.

Culture, health, and bigotry: How exposure to cultural accounts of fatness shape attitudes about health risk, health policies, and weight-based prejudice.

RATIONALE: We conducted three experiments to examine how cultural frames shape attitudes about health, focusing on obesity, which is considered a public health crisis and is imbued with symbolic meaning. METHODS: College students (Ns = 99, 114, and 293) read news articles that presented high body weight according to one or more of the following frames: 1) public health crisis; 2) personal responsibility; 3) health at every size (HAES); or 4) fat rights. RESULTS: Compared to people who read the HAES and Fat Rights articles, those who read the Public Health Crisis and Personal Responsibility articles expressed more belief in the health risks of being fat (ds = 1.28 to 1.79), belief that fat people should pay more for insurance (ds = 0.53 to 0.71), anti-fat prejudice (ds = 0.61 to 0.69), willingness to discriminate against fat people (ds = 0.41 to 0.59), and less willingness to celebrate body-size diversity (ds = 0.77 to 1.07). They were less willing to say women at the lower end of the obese range could be healthy. Exposure to these articles increased support for price-raising policies to curb obesity but not support for redistributive or compensatory policies. In Experiment 3, in comparison to a control condition, exposure to HAES or Fat Rights frames significantly reduced beliefs in the risks of obesity and support for charging fat people more for insurance. However, only people exposed to the Fat Rights frame expressed fewer anti-fat attitudes and more willingness to celebrate body-size diversity. CONCLUSIONS: Our findings suggest that simply disseminating information that people can be both fat and healthy will not suffice to reduce prejudice. Given that anti-fat stigma is a health risk and barrier to collective solidarity, fat rights viewpoints can buffer against the negative consequences of anti-fat stigma and promote a culture of health by fostering empathy and social justice.

"No fat friend of mine": Young children's responses to overweight and disability.

Two studies investigated 4- to 6-year-old children's weight bias. In Study 1, 126 children read illustrated books where a main character ('Alfie') was healthy weight, in a wheelchair, or overweight. In Study 2, 150 children read the same stories where the character was female ('Alfina'), or stories where her friends were fat. Children rated 'Alfie'/'Alfina' and a comparison character on nine attributes/behaviours, and chose one that best represented each attribute. Fat and wheelchair 'Alfie'/'Alfina' were rated less likely to win a race, and fat 'Alfie'/'Alfina' as having fewer friends. When forced to choose between characters, fat 'Alfie'/'Alfina' was rejected on most constructs. Children's gender, self-perceived shape, and character's friends' size had no effect on judgements. These findings show children's preferences away from fatness rather than outright rejection, and mostly clearly in friendship choices. Understanding young children's weight bias is important given their increasing involvement in obesity surveillance, prevention, and management.

"You better not leave me shaming!": Conditional indirect effect analyses of anti-fat attitudes, body shame, and fat talk as a function of self-compassion in college women.

The present investigation provided a theoretically-driven analysis testing whether body shame helped account for the predicted positive associations between explicit weight bias in the form of possessing anti-fat attitudes (i.e., dislike, fear of fat, and willpower beliefs) and engaging in fat talk among 309 weight-diverse college women. We also evaluated whether self-compassion served as a protective factor in these relationships. Robust non-parametric bootstrap resampling procedures adjusted for body mass index (BMI) revealed stronger indirect and conditional indirect effects for dislike and fear of fat attitudes and weaker, marginal effects for the models inclusive of willpower beliefs. In general, the indirect effect of anti-fat attitudes on fat talk via body shame declined with increasing levels of self-compassion. Our preliminary findings may point to useful process variables to target in mitigating the impact of endorsing anti-fat prejudice on fat talk in college women and may help clarify who is at higher risk.

UK adults' implicit and explicit attitudes towards obesity: a cross-sectional study.

BACKGROUND: Anti-fat attitudes may lead to stigmatisation of and lowered self-esteem in obese people. Examining anti-fat attitudes is warranted given that there is an association with anti-fat behaviours. Previous studies, mainly outside the UK, have demonstrated that anti-fat attitudes are increasing over time. METHODS: The study was cross-sectional with a sample of 2380 participants (74.2 % female; aged 18-65 years). In an online survey participants reported demographic characteristics and completed a range of implicit and explicit measures of obesity related attitudes. RESULTS: Perceptions of obesity were more negative than reported in previously. Main effects indicated more negative perceptions in males, younger respondents and more frequent exercisers. Attitudes about obesity differed in relation to weight category, and in general were more positive in obese than non-obese respondents. CONCLUSIONS: This is the first study to demonstrate anti-fat attitudes across different sections of the UK population. As such, this study provides the first indication of the prevalence of anti-fat attitudes in UK adults. Interventions to modify these attitudes could target specific groups of individuals with more negative perceptions as identified here. Future work would be useful that increases understanding of both implicit and explicit attitudes towards obesity.