The influence of a defendant's body weight on perceptions of guilt.

OBJECTIVE: To investigate the influence of a defendant's weight on simulated jurors' perceptions of guilt. DESIGN AND METHODS: Participants were 471 lean and overweight adults (mean body mass index: 25.34±5.91) who read a vignette describing a case of check fraud while viewing one of four images of the alleged defendant (a lean male, a lean female, an obese male or an obese female). Participants rated the defendant's culpability on a 5-point Likert scale and completed measures of anti-fat attitudes. RESULTS: Male respondents endorsed greater overall weight bias than females (F (1470)=23.815, P<0.01, η(2)=0.048). A three-way interaction was detected between participant sex, defendant sex and defendant weight on perceptions of guilt such that when the defendant was female, male participants were significantly more likely to find her guilty if she was obese than if she was lean (guilt ratings=4.05±0.83; 3.31±1.03, respectively; F(1467)=5.935, P=0.015, R(2)=0.060). In addition, lean male participants were significantly more likely to believe that the obese female defendant met criteria for check fraud, and indicated greater belief she would be a repeat offender, compared with the lean female defendant (t(90)=2.081, P=0.040; t(90)=2.395 P=0.019, respectively). There were no differences in perceptions of guilt or responsibility between the obese male and the lean male defendants. CONCLUSION: The results of this novel study indicate that both weight and gender of a defendant may affect juror perceptions of guilt and responsibility.

Perceptions of weight discrimination: prevalence and comparison to race and gender discrimination in America.

OBJECTIVE: Limited data are available on the prevalence and patterns of body weight discrimination from representative samples. This study examined experiences of weight/height discrimination in a nationally representative sample of US adults and compared their prevalence and patterns with discrimination experiences based on race and gender. METHOD AND PROCEDURES: Data were from the National Survey of Midlife Development in the United States, a 1995-1996 community-based survey of English-speaking adults aged 25-74 (N=2290). Reported experiences of weight/height discrimination included a variety of institutional settings and interpersonal relationships. Multivariate regression analyses were used to predict weight/height discrimination controlling for sociodemographic characteristics and body weight status. RESULTS: The prevalence of weight/height discrimination ranged from 5% among men to 10% among women, but these average percentages obscure the much higher risk of weight discrimination among heavier individuals (40% for adults with body mass index (BMI) of 35 and above). Younger individuals with a higher BMI had a particularly high risk of weight/height discrimination regardless of their race, education and weight status. Women were at greater risk for weight/height discrimination than men, especially women with a BMI of 30-35 who were three times more likely to report weight/height discrimination compared to male peers of a similar weight. DISCUSSION: Weight/height discrimination is prevalent in American society and is relatively close to reported rates of racial discrimination, particularly among women. Both institutional forms of weight/height discrimination (for example, in employment settings) and interpersonal mistreatment due to weight/height (for example, being called names) were common, and in some cases were even more prevalent than discrimination due to gender and race.

Couples training, pharmacotherapy, and behavior therapy in the treatment of obesity.

The effects of behavior therapy with and without either pharmacotherapy or couples training were studied in 124 obese adults. In a 16-week behavioral weight-reduction program, patients were assigned to medication (fenfluramine hydrochloride) and no-medication conditions and to three spouse conditions in a 2 x 3 design. Two conditions consisted of patients with "cooperative" spouses; in one, patients were treated with their spouses, and in the other they were treated alone. In the third, patients with "uncooperative" spouses were treated alone. Fenfluramine produced significantly greater weight losses than no medication, but patients in the medication group regained weight much more rapidly during a 12-month maintenance period. The spouse conditions did not differ in weight change during treatment or follow-up. Obese spouses lost as much weight as the patients and were slightly more successful than the patients at maintaining their losses. Patients with obese spouses lost more weight than patients with nonobese spouses. Depression decreased in proportion to decrease in weight.

Medical, metabolic, and psychological effects of weight cycling.

This article reviews studies on the effects of weight cycling and weight variability on metabolism, psychological status, morbidity, and mortality. Repeated bouts of weight loss and regain, known as weight cycling or yo-yo dieting, are highly prevalent, occur in males and females, and are common in both overweight and nonoverweight individuals. While there has been no consistent demonstration that, as was first thought, weight cycling makes subsequent weight loss more difficult or regain more rapid, it is possible that this does occur under some conditions or in particular individuals. There are stronger and more consistent links between body weight variability and negative health outcomes, particularly all-cause mortality and mortality from coronary heart disease. Weight cycling may also have negative psychological and behavioral consequences; studies have reported increased risk for psychopathology, life dissatisfaction, and binge eating. The bulk of epidemiologic research shows an association of weight variability with morbidity and mortality, although the mechanisms are not clear at present. There is a clear need for further research on the effects of weight cycling on behavior, metabolism, and health. Understanding and promoting weight maintenance is an important priority.

Differential changes in plasma high-density lipoprotein-cholesterol levels in obese men and women during weight reduction.

Levels of high-density lipoprotein-cholesterol (HDL-cholesterol) and other lipoproteins of 73 obese men and women were measured before and after a 16-week weight reduction program. There were significant differences between men and women. In men, a 10.7-kg weight loss was associated with a 5% increase in the HDL-cholesterol level, a 15.8% decrease in the low-density lipoprotein-cholesterol (LDL-cholesterol) level, and a 30.1% increase in the HDL-LDL ratio. Women, in contrast, showed an 8.9-kg weight loss, a 3.3% decrease in the HDL-cholesterol level, a 4.7% decrease in the LDL-cholesterol level, and no significant change in the HDL-LDL ratio. These differences suggest that weight raeduction may be an important means of improving plasma lipoprotein patterns in men but may be of more limited value in women.

Psychosocial origins of obesity stigma: toward changing a powerful and pervasive bias.

Widespread bias and discrimination based on weight have been documented in key areas of living, including education, employment, and health care. This paper examines the social and psychological origins of this bias through a review and critique of theoretical and empirical literatures, and proposes how the field might best advance in the area of reducing stigma. Explanations for the development and reduction of weight stigma are examined with different theoretical approaches, including attribution theory and a social consensus model. Individual and sociocultural contributors to bias suggested by these approaches are highlighted. New directions are discussed in both the understanding and prevention of weight bias.

The double-blind in danger: untoward consequences of informed consent.

Patients and physicians correctly identified medication assignments in 70% of the cases in a double-blind trial of an appetite suppressant. The breach of the double-blind design may have had therapeutic consequences; correct identification was associated with favorable outcome. These findings suggest that requirements for describing the side effects of medications to patients before they give informed consent may help them guess which medication they receive and thus may influence the integrity of double-blind studies and the results of controLled trials.

Weight reduction at the work site: a promise partially fulfilled.

Three consecutive studies of weight reduction at the work site were conducted with 172 female union members, who participated in 16-week behavioral group programs. There was no significant difference in weight loss over the three studies, but attrition decreased from 57.5% to 33.8% and weight loss maintenance improved. Groups that met three to four times weekly had less attrition than those which met once a week, but had no more weight loss. These behavioral weight reduction programs were as effective as self-help and commercial groups, and lay leaders produced results equivalent to those produced by professional therapists at one-third the cost.

Evaluation and modification of exercise patterns in the natural environment.

Using a new experimental paradigm to evaluate physical activity in the natural environment, the authors made of 45,694 observations of persons using stairs or an adjacent escalator at a shopping mall, train station, and bus terminal. In study 1, stair use more than doubled for both obese and nonobese persons during two-week periods when a colorful sign encouraging use of the stairs was positioned at the stairs/escalator choice point. In study 2, stair use remained elevated for 15 consecutive days while the sign was present, decreased during a 1-month follow-up period, and returned to baseline by 3 months. These results not only demonstrate the usefulness of this paradigm, but also suggest the strength of simple, inexpensive public health interventions to increase physical activity.

A school-based behavior modification, nutrition education, and physical activity program for obese children.

Sixty-three obese children, ages 5 to 12 yr, participated in a school-based program of behavior modification, nutrition education, and physical activity. The 10-wk program involved educating the children and those in the children's social network (parents, teachers, physical education instructor, food service personnel, school administrators, and the nurse's aide). Two methods were used to evaluate weight loss: the children were compared to a control group of obese children who did not receive the program, and the children in the program were used as their own controls by analyzing weight records for the 3 yr before the program. Sixty (95%) of the 63 children in the program lost weight, compared to only three (21%) of the 14 control children. The program children showed a mean decrease of 15.4% in their percentage overweight, and lost an average of 4.4 kg. These children also reversed the steady weight gain that had occurred before the program. These results suggest that a comprehensive program in the schools can produce significant weight losses, and that children left untreated tend to increase their degree of obesity.

Estimates of food quantity and calories: errors in self-report among obese patients.

We report three studies that examine the accuracy and usefulness of food records among dieting obese patients. In study 1 errors in quantity and calorie estimates for 10 common foods averaged 63.9% (quantity) and 53.4% (calories). The results of study 2 indicate that only 53% of entries in daily food records were specified enough to permit objective estimates of the calories consumed. In study 3, blind raters could not predict weight loss based on subjects' self-recorded behavior changes. Collectively, these results question the utility of food records for estimating energy intake or predicting weight loss.

A comparison of two very-low-calorie diets: protein-sparing-modified fast versus protein-formula-liquid diet.

This study investigated the acceptability of two very-low-calorie diets in 16 moderately overweight persons participating in a weight reduction program. Subjects were prescribed a 1000-1200 kcal balanced diet the first month and asked to complete appetite and mood scales on a weekly basis. They were then randomly assigned to either a protein-sparing-modified fast (PSMF) or a protein-formula-liquid diet, each of which provided about 400 kcal daily. Analysis of the appetite data showed that PSMF subjects reported significantly less hunger and preoccupation with eating than did liquid diet subjects during 2 of the 4 weeks on a very-low-calorie diet. Subjects in both conditions reported significant reductions in anxiety. Results are discussed in terms of possible advantages of PSMF.

Psychological correlates of obesity: moving to the next research generation.

Studies comparing obese and nonobese persons have generally failed to find differences in global aspects of psychological functioning (e.g., depression, anxiety). The resulting conclusion, that obesity does not carry risk for psychological problems, is inimical to clinical impression, reports from overweight individuals, and a consistent literature showing strong cultural bias and negative attitudes toward obese persons. The often-cited notion that obesity has no psychological consequences may be an inevitable byproduct of the manner in which the first generation of studies in the field has been conducted. The authors propose a second generation of studies that begins with a risk factor model to identify the individuals who will suffer from their obesity and the areas of functioning most affected. Recommendations are also made for a third generation of studies that will establish causal pathways linking obesity to specific areas of distress.

Treatment of obese children with and without their mothers: changes in weight and blood pressure.

Weight and blood pressure changes were evaluated in a 16-month controlled trial comparing three methods of involving mothers in the treatment of their obese adolescents (aged 12 to 16 years). The treatments were: (1) Mother-Child Separately--children and mothers attended separate groups; (2) Mother-Child Together--the children and mothers met together in the same group; and (3) Child Alone--the children met in groups and mothers were not involved. The program consisted of behavior modification, social support, nutrition, and exercise. The Mother-Child Separately group lost more weight (8.4 kg) during treatment than did the other two groups (5.3 and 3.3 kg). Differences between the groups increased at the 1-year follow-up: compared to pretreatment weight, the Mother-Child Separately group lost 7.7 kg compared with gains of approximately 3 kg in the other two groups. Blood pressures of children with the highest initial pressures decreased by 16/9 mm Hg at the end of treatment and by 16/5 mm Hg at the 1-year follow-up. These results suggest that a program of behavior modification and parent involvement can lead to significant weight losses in obese children, and that the nature of parent involvement may be important.

Weight reduction diets and health promotion.

Obesity is an important health problem. Despite record rates of dieting and the availability of numerous programs, the problem is not abating. This article discusses the popularity of fad diets, the safety and effectiveness of commonly used approaches to weight loss, and the health effects of weight change. We propose an approach in which the search for a best treatment is secondary to the development of criteria to match patients to different treatments. This approach provides an opportunity for the health professional to take advantage of the multiple weight reduction resources in the community.

Personal responsibility and control over our bodies: when expectation exceeds reality.

Good health has become more than a means to personal goals such as greater attractiveness and increased longevity. It symbolizes self-control, hard work, ambition, and success in life. Inherent in this symbolism is the concept that the individual controls behavior, which in turn controls health. Although control over one's life plays an important role in both physical and mental health, the concept of personal control also infers responsibility. Positive attributes are accorded to people who are healthy, but those who fall ill, or those with less than the perfect body, are blamed and are thought to be self-indulgent, lazy, or even irresponsible and immoral. There is a tendency to overstate the impact of personal behavior on health. However, biological realities shape the degree to which health is under the control of the individual. The positive effects of behavior change must be balanced with the limits imposed by biology.

Whether obesity should be treated.

Antidieting sentiment is strengthened in part by the assumption that all diets fail, which in turn is based on data from university-based treatment programs. A small percentage of overweight people attempt to lose weight in these programs, and they differ in important ways from overweight people in general. They are heavier, more likely to be binge eaters, and have higher levels of psychopathology--all negative prognostic factors for treatment. Generalizing from the treatment of this group to all programs is highly questionable. Hence, little is known about the effectiveness of approaches used by most people. There is a pressing need for research on this topic, and a need for treatments that address the specific needs of those who seek clinical treatments.

Age and sex differences in health habits and beliefs of schoolchildren.

All children in Grades 3 through 12 of one school system completed a survey about health habits and beliefs including smoking and eating habits, perceptions of exercise, weight, and parental involvement in health. The surveys were factor-analyzed within grade and sex, and the overall factors that emerged were Smoking Habits, Family Discussion of Health, Family Thinking About Health, Nutritional Habits, and Health Locus of Control. Analysis of variance of each factor revealed that girls generally reported healthier food habits than did boys. However, girls reported more smoking and less exercise. There are also changes in habits and belief with age; junior high school is a particularly important time for the development of several habits. The findings are discussed in relation to theories of child development and the implications for the content and timing of future health education intervention programs with children.

Studying intergenerational transmission of eating attitudes and behaviors: methodological and conceptual questions.

Associations between parent and child attitudes and behaviors related to eating and weight were examined among college-age men and women and their mothers and fathers (ns = 44, 47, 87, and 66, respectively). Parent attitudes and behaviors were assessed from the perspective of the parent and the student, and 2 pathways of influence were examined: modeling and direct criticism. In general, students' attitudes and behaviors were more strongly related to perceptions of their parents rather than to parents' own self-reports. There was more support for perceived direct criticism as a pathway of influence, particularly for daughters. Perceived criticism about eating and appearance had large associations with student attitudes and behaviors. Weight loss behavior was related to perceived criticism among daughters and to perceived paternal eating attitudes among sons. Results highlight important methodological and conceptual questions for intergenerational research.

Relation of level of exercise, age, and weight-cycling history to weight and eating concerns in male and female runners.

We examined the association between level of exercise and degree of weight preoccupation in a large sample of male and female runners, as well as risk factors posited to influence weight and eating concerns in the general population. Subjects were 2,459 males and 1,786 females who had completed a questionnaire on weight and eating concerns in a national running magazine. Eight percent of the males and 24% of the females had symptomatic scores on the Eating Attitudes Test (EAT). Exercise level, defined as weekly running mileage, was positively associated with excessive weight and eating concerns in males but not in females. Both sexes with a history of weight cycling were more likely to have symptomatic EAT scores than those with no such history. These results highlight the importance of studying these concerns in males as well as females and of examining the role of exercise level and weight-cycling history in the development of serious weight preoccupations.