Potential Policies and Laws to Prohibit Weight Discrimination: Public Views from 4 Countries.

CONTEXT: People viewed as "overweight" or "obese" are vulnerable to weight-based discrimination, creating inequities and adverse health outcomes. Given the high rates of obesity recorded globally, studies documenting weight discrimination in multiple countries, and an absence of legislation to address this form of discrimination, research examining policy remedies across different countries is needed. Our study provides the first multinational examination of public support for policies and legislation to prohibit weight discrimination. METHODS: Identical online surveys were completed by 2,866 adults in the United States, Canada, Australia, and Iceland. We assessed public support for potential laws to prohibit weight-based discrimination, such as adding body weight to existing civil rights statutes, extending disability protections to persons with obesity, and instituting legal measures to prohibit employers from discriminating against employees because of body weight. We examined sociodemographic and weight-related characteristics predicting support for antidiscrimination policies, and the differences in these patterns across countries. FINDINGS: The majority of participants in the United States, Canada, and Australia agreed that their government should have specific laws in place to prohibit weight discrimination. At least two-thirds of the participants in all 4 countries expressed support for policies that would make it illegal for employers to refuse to hire, assign lower wages, deny promotions, or terminate qualified employees because of body weight. Women and participants with higher body weight expressed more support for antidiscrimination measures. Beliefs about the causes of obesity were also related to support for these laws. CONCLUSIONS: Public support for legal measures to prohibit weight discrimination can be found in the United States, Canada, Australia, and Iceland, especially for laws to remedy this discrimination in employment. Our findings provide important information for policymakers and interest groups both nationally and internationally and can help guide discussions about policy priorities to reduce inequities resulting from weight discrimination.

Incentivizing fruit and vegetable purchases among participants in the Special Supplemental Nutrition Program for Women, Infants, and Children.

OBJECTIVE: In 2009, the US Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) began to provide participants with cash-value vouchers to purchase fruits and vegetables ($US 10 for women and $US 6 for children per month). The present paper assesses the potential effects of the new WIC incentives on fruit and vegetable purchases among WIC households in two New England states. DESIGN: A pre-post assessment of changes in fruit and vegetable purchases after the WIC revisions in generalized estimating equation models. SETTING: Scanner data on grocery purchases from a regional supermarket chain in New England, USA. SUBJECTS: WIC-participating households (n 2137) that regularly shopped at the chain during January-September 2009 and January-September 2010. RESULTS: After the WIC revisions, purchases of fresh and frozen vegetables increased in volume by 17·5 % and 27·8 %, respectively. The biggest improvements were observed for fresh fruit, an increase of 28·6 %, adding almost a kilogram of fresh fruits per household per month. WIC households spent three times more of their WIC vouchers on purchasing fresh fruits than fresh vegetables. The magnitudes of substitution effects were relatively small: between 4 % (fresh fruit) and 13 % (canned vegetables) of the amounts purchased in 2009 with non-WIC funds were replaced by purchases made using WIC vouchers in 2010. CONCLUSIONS: The provision of fruit and vegetable benefits in the revised WIC food packages increased overall purchases of fruits and vegetables among WIC-participating households in New England. Efforts to encourage consumption of fruits and vegetables by people receiving federal food assistance are paying off.

Weight bias among professionals treating eating disorders: attitudes about treatment and perceived patient outcomes.

OBJECTIVE: This study aimed to assess weight bias among professionals who specialize in treating eating disorders and identify to what extent their weight biases are associated with attitudes about treating obese patients. METHOD: Participants were 329 professionals treating eating disorders, recruited through professional organizations that specialize in eating disorders. Participants completed anonymous, online self-report questionnaires, assessing their explicit weight bias, perceived causes of obesity, attitudes toward treating obese patients, perceptions of treatment compliance and success of obese patients, and perceptions of weight bias among other practitioners. RESULTS: Negative weight stereotypes were present among some professionals treating eating disorders. Although professionals felt confident (289; 88%) and prepared (276; 84%) to provide treatment to obese patients, the majority (184; 56%) had observed other professionals in their field making negative comments about obese patients, 42% (138) believed that practitioners who treat eating disorders often have negative stereotypes about obese patients, 35% (115) indicated that practitioners feel uncomfortable caring for obese patients, and 29% (95) reported that their colleagues have negative attitudes toward obese patients. Compared to professionals with less weight bias, professionals with stronger weight bias were more likely to attribute obesity to behavioral causes, expressed more negative attitudes and frustrations about treating obese patients, and perceived poorer treatment outcomes for these patients. DISCUSSION: Similar to other health disciplines, professionals treating eating disorders are not immune to weight bias. This has important implications for provision of clinical treatment with obese individuals and efforts to reduce weight bias in the eating disorders field.

Setting policy priorities to address eating disorders and weight stigma: views from the field of eating disorders and the US general public.

BACKGROUND: The prevalence and health consequences of eating disorders and weight stigmatization have prompted increasing discussion of potential policy actions to address these public health issues. The present study aimed to assess support for policy strategies to address eating disorders and weight stigmatization among the general public and relevant health professionals. METHODS: An Internet survey was fielded to a national sample of 944 US adults and 1,420 members of professional organizations specializing in eating disorders to examine their support for 23 potential policy strategies to address eating disorders and weight stigma. Participants also rated policy actions according to their potential for positive impact and feasible implementation. RESULTS: Support for the majority of health and social policies was high in both samples. For example, strategies to 1) improve school-based health curriculum to include content aimed at preventing eating disorders, 2) require training for educators and health providers on the prevention and early identification of eating disorders, and 3) implement school-based anti-bullying policies that that protect students from being bullied about their weight, were supported by over two-thirds of participants. CONCLUSIONS: Our findings suggest that both health and social policy actions will be important in broader policy initiatives to address eating disorders and weight stigma.

Impact of Connecticut legislation incentivizing elimination of unhealthy competitive foods on National School Lunch Program participation.

OBJECTIVES: We analyzed the impact of Connecticut legislation incentivizing voluntary school district-level elimination of unhealthy competitive foods on National School Lunch Program (NSLP) participation. METHODS: We analyzed data on free, reduced, and paid participation in the NSLP from 904 schools within 154 Connecticut school districts from the 2004-2005 to the 2009-2010 school year, resulting in 5064 observations of annual school-level meal participation. We used multilevel regression modeling techniques to estimate the impact of the state competitive food legislation on the count of NSLP lunches served per student in each school. RESULTS: Overall, the state statute was associated with an increase in school lunch participation. We observed increases between 7% and 23% for middle- and high-school meal programs, and a slight decrease of 2.5% for the elementary school free meal eligibility category, leading to an estimated revenue increase of roughly $30 000 for an average school district per school year. CONCLUSIONS: This study provides support for national implementation of proposed rigorous competitive food standards that can improve the health of students while supporting local school district finances.

The stigmatizing effect of visual media portrayals of obese persons on public attitudes: does race or gender matter?

Overweight and obese persons are frequently stigmatized in news media. The present study is the first to systematically compare public reactions to positive and negative images of obese persons accompanying news reports on obesity (while manipulating gender and race of the target)and their effects on generalized attitudes and social distance toward obese persons. The authors conducted 3 randomized experimental studies using online surveys to assess public perceptions of positive versus stereotypical images of obese adults (who varied by gender and race) accompanying a neutral news report about obesity. The sample included 1,251 adults, who were recruited through a national survey panel during May of 2010. Participants who viewed negative, stereotypical images of obese targets increased social distance, antifat attitudes, and ratings of laziness and dislike toward obese persons, whereas positive, nonstereotypical images induced more positive attitudes. These findings remained consistent when accounting for sociodemographic variables. African American female obese targets portrayed in images evoked higher ratings of dislike and social distance compared with Caucasian targets, but ratings were similar for male and female targets. This study provides evidence that images of obese person accompanying written media influence public attitudes toward obese people, and may reinforce weight stigmatization if images contain stereotypical portrayals of obese persons. Implications for efforts to report about obesity in the news media are discussed.

Headless, hungry, and unhealthy: a video content analysis of obese persons portrayed in online news.

The news media has substantial influence on public perceptions of social and health issues. This study conducted a video content analysis to examine portrayals of obese persons in online news reports about obesity. The authors downloaded online news videos about obesity (N = 371) from 5 major news websites and systematically coded visual portrayals of obese and nonobese adults and youth in these videos. The authors found that 65% of overweight/obese adults and 77% of overweight/obese youth were portrayed in a negative, stigmatizing manner across multiple obesity-related topics covered in online news videos. In particular, overweight/obese individuals were significantly more likely than were nonoverweight individuals to be portrayed as headless, with an unflattering emphasis on isolated body parts, from an unflattering rear view of their excess weight, eating unhealthy foods, engaging in sedentary behavior, and dressed in inappropriately fitting clothing. Nonoverweight individuals were significantly more likely to be portrayed positively. In conclusion, obese children and adults are frequently stigmatized in online news videos about obesity. These findings have important implications for public perceptions of obesity and obese persons and may reinforce negative societal weight bias.

Strategies to address weight-based victimization: youths' preferred support interventions from classmates, teachers, and parents.

Weight-Based Victimization is a frequent experience for adolescents who are overweight or obese, and is associated with numerous psychosocial and physical consequences for those who are targets of victimization. Assessing targets` preferences for different types of support and intervention has been absent in the context of weight-based victimization, but is needed to help inform potential interventions, motivate action, and identify strategies to help adolescents cope with experiences of weight-related teasing or bullying. Adolescents (14-18 years, N = 361, 40 % female, 71 % Caucasian) enrolled in national weight-loss camps completed an on-line survey. Participants who reported previous experiences of weight-based victimization were surveyed about their preferred interventions from peers, friends, teachers, Physical Education (PE) teachers/coaches, and parents. Participants indicated their preferences for specific strategies pertaining to target support, bullying intervention and prevention (e.g., inclusion in peer activities, confronting the bully, telling an adult, and improving anti-bullying policies). Friends (66 %) and peers (58 %) were the most highly preferred intervention agents followed by teachers (55 %), PE teachers/coaches (44 %), and parents (43 %). Participants who experienced more weight-based victimization expressed increased desire for intervention. The frequency of victimization, social support from friends and family, and perceived likelihood and helpfulness of intervention significantly influenced participant preferences for certain types of intervention, although preferences were generally consistent across participants' characteristics. The current study is the first to document youth's preferences for interventions in response to weight-based victimization. The findings have important implications for encouraging appropriate intervention and informing bystanders, which may help to reduce the prevalence, recurrence, and consequences for youth who are targets of weight-based teasing or bullying.

Weight-based victimization among adolescents in the school setting: emotional reactions and coping behaviors.

Weight-based victimization is a frequent experience for adolescents, but little is known about their emotional reactions and coping strategies in response to weight-based teasing and bullying. The present study examined the ways that adolescents cope with experiences of weight-based victimization at school. An initial sample of 1,555 students from two high schools in central Connecticut completed a comprehensive battery of self-report measures to assess their experiences of weight-based teasing and bullying at school, affective responses to these experiences, and coping strategies used to deal with incidents of weight-based victimization. Only those students who reported experiencing weight-based victimization (N = 394) were included for the purposes of the present study. Of this sub-sample, 56% were females, 84% were Caucasian, and the mean age was 16.4 years. Weight-based victimization resulted in 40-50% of adolescents feeling sad and depressed, worse about themselves, bad about their body, angry, and some feeling afraid. Gender differences emerged with respect to how boys and girls react to experiences of weight-based victimization. However, structural equation model estimates demonstrated that both boys and girls who reported negative affect in response to weight-based victimization were more likely to use coping strategies of avoidance (e.g., avoiding gym class), increased food consumption, and binge eating. Binary logistic regressions showed that the odds of students skipping school or reporting that their grades were harmed because of weight-based teasing increased by 5% per teasing incident, even after controlling for gender, age, race, grades, and weight status. To our knowledge, this study is the first systematic examination of affective reactions and coping strategies among overweight adolescents in response to weight-based victimization. These findings can inform efforts to assist overweight youth to cope adaptively with weight-based victimization.

Food retailer practices, attitudes and beliefs about the supply of healthy foods.

OBJECTIVE: Non-supermarket food retailers can be a promising channel for increasing the availability of healthy foods in underserved communities. The present paper reports on retailer practices, attitudes and beliefs about the supply of healthy foods before and after the introduction of new subsidies for healthy foods by the US Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in October 2009. DESIGN: We designed and conducted in-person standardized interviews with store owners and managers to assess perceptions of demand and profits for different foods, supply networks, barriers to stocking healthy foods and their changes following implementation of the new WIC packages. SETTING: Non-supermarket retailers in five towns of Connecticut, USA (n 68 in 2009 and n 58 in 2010). SUBJECTS: Owners and managers of WIC-authorized and non-WIC convenience stores and non-chain grocery stores. RESULTS: Retailers identified customer demand as the primary factor in stocking decisions. They reported observing a significantly weaker demand for healthy foods compared with unhealthy foods, although it improved for certain foods with the new WIC subsidies. Less healthy foods were also perceived as more profitable. Supplier networks varied by product from convenient manufacturer delivery for salty snacks to self-supply for produce. WIC retailers were able to quickly adapt and supply healthy foods required under the new WIC programme guidelines. CONCLUSIONS: Retailers other than supermarkets currently perceive little demand for healthy foods, but new WIC subsidies have the power to change these perceptions. Supply barriers seem secondary in the limited offerings of healthy foods by stores and could be overcome when policy changes generate new demand for healthy foods.

Plasma oxytocin and vasopressin levels in young and older men and women: Functional relationships with attachment and cognition.

A growing literature associates the neuropeptides oxytocin (OT) and arginine vasopressin (AVP) with affiliative and cognitive outcomes. The majority of this work in humans, however, considers these neuropeptides separately. Also, despite evidence that OT and AVP interact with gonadal hormones, still warranted is an examination of sex and age variations in endogenous neuropeptide levels, their interrelations, and their functional relationships with attachment and cognition in humans. This study measured endogenous plasma OT and AVP levels in generally healthy young (18-31 years) and older (63-81 years) men and women to (i) determine levels of and interrelations between OT and AVP; (ii) explore functional relationships with self-reported attachment (attachment anxiety and avoidance) and performance-based cognition (processing speed, verbal memory); and (iii) identify variations in these effects by sex and age. We observed sex- and age-differential patterns of results: Women had higher plasma OT levels than men and older adults had higher plasma AVP levels than young adults. The two neuropeptides were highly negatively intercorrelated across all groups. Functionally, higher AVP levels were associated with greater attachment anxiety and higher OT and lower AVP levels were associated with faster sensorimotor processing speed, with sex and age moderating these effects. This integrated approach identifies variations in endogenous peripheral neuropeptide levels in humans, supporting their sex- and age-specific role as "difference makers" in attachment and cognition.

An Adult Developmental Approach to Perceived Facial Attractiveness and Distinctiveness.

Attractiveness and distinctiveness constitute facial features with high biological and social relevance. Bringing a developmental perspective to research on social-cognitive face perception, we used a large set of faces taken from the FACES Lifespan Database to examine effects of face and perceiver characteristics on subjective evaluations of attractiveness and distinctiveness in young (20-31 years), middle-aged (44-55 years), and older (70-81 years) men and women. We report novel findings supporting variations by face and perceiver age, in interaction with gender and emotion: although older and middle-aged compared to young perceivers generally rated faces of all ages as more attractive, young perceivers gave relatively higher attractiveness ratings to young compared to middle-aged and older faces. Controlling for variations in attractiveness, older compared to young faces were viewed as more distinctive by young and middle-aged perceivers. Age affected attractiveness more negatively for female than male faces. Furthermore, happy faces were rated as most attractive, while disgusted faces were rated as least attractive, particularly so by middle-aged and older perceivers and for young and female faces. Perceivers largely agreed on distinctiveness ratings for neutral and happy emotions, but older and middle-aged compared to young perceivers rated faces displaying negative emotions as more distinctive. These findings underscore the importance of a lifespan perspective on perception of facial characteristics and suggest possible effects of age on goal-directed perception, social motivation, and in-group bias. This publication makes available picture-specific normative data for experimental stimulus selection.

Public attitudes about different types of anti-bullying laws: results from a national survey.

State anti-bullying laws have been enacted across the United States to address bullying both by and of youths. Although these statutes can provide critical protection to youth, there is debate about whether such laws should enumerate protected classes of youth. Weight-based bullying is an increasingly prevalent form of harassment and it has been overlooked in policy initiatives. Enumeration in existing laws might help protect overweight victims. As no research has examined this issue, we conducted a national survey of American adults (N=1155) to assess public opinion about enactment of anti-bullying laws that vary according to whether or not they enumerate distinguishing characteristics. Our results demonstrated substantial public agreement (ranging from 2/3 to 3/4 of participants) with enactment of state and federal anti-bullying laws that enumerate distinguishing characteristics, including physical appearance and weight, which are currently absent in most statutes. Our evidence can inform policy and legal approaches to protect youth effectively from bullying.

Combating weight-based bullying in schools: is there public support for the use of litigation?

BACKGROUND: Bullying litigation is an emerging area of law that has increased in response to serious cases of bullying at school. Weight-based bullying is prevalent at school, but no research has examined the use of litigation to address this problem. We assessed public support for litigation approaches to address weight-based bullying at school, and whether support for litigation varies according to the reason why a student is bullied. METHODS: A national sample of 994 adults (49% parents) completed an online questionnaire assessing their support for litigation approaches in response to hypothetical incidents of youth bullying. RESULTS: As many as two thirds of participants supported litigation against schools for failing to intervene and protect students from weight-based bullying. Litigation remedies received slightly higher support in response to bullying due to race or sexual orientation compared to body weight. Participants favored litigation approaches that target schools for inadequate intervention or a bully's parents on behalf of their child's actions. CONCLUSIONS: Our study offers novel findings about public and parental views of litigation as a potential approach to address weight-based (and other forms of) bullying, and introduces considerations about the potential role of litigation as part of broader remedies to address youth bullying.

The Relationship between Parental Behaviors and Children's Sugary Drink Consumption Is Moderated by a Television in the Child's Bedroom.

BACKGROUND: The aim of this longitudinal study was to examine the link between perceived authoritative parenting behaviors and sugary drink consumption among children from low-income families who do or do not have televisions (TVs) in their bedrooms. METHODS: Middle school students (N = 480) completed a baseline survey in sixth grade and a follow-up survey in seventh grade. The students were recruited from 12 schools in a low-income, predominantly black (33%) and Latino (48%), urban school district. The survey assessed the children's perception of their parents' controlling and nurturing behaviors, the presence of a TV in their bedrooms, and their level of sugary drink consumption on the previous school day. Children's report of specific controlling and nurturing parental behaviors were used to create an "authoritative parenting" score. Regression analyses were used to test the main and interactive effects of authoritative parenting behaviors and having a TV in the bedroom with sugary drink consumption in seventh grade, controlling for age, race/ethnicity, gender, BMI, and sugary drink consumption in sixth grade. RESULTS: A significant interaction emerged: The authoritative parenting score predicted lower levels of sugary drink consumption in seventh grade, but this relationship was moderated by whether or not there was a TV in the child's bedroom. CONCLUSION: A TV in the child's bedroom may weaken the positive influence of authoritative parenting behaviors on limiting sugary drink consumption among middle school children from low-income families. Stronger initiatives are recommended to educate parents and help them refrain from placing TVs in their children's bedrooms.

Obesity bias in training: attitudes, beliefs, and observations among advanced trainees in professional health disciplines.

OBJECTIVE: This study examined weight bias among students training in health disciplines and its associations with their perceptions about treating patients with obesity, causes of obesity, and observations of weight bias by instructors and peers. METHODS: Students (N = 107) enrolled in a post-graduate health discipline (Physician Associate, Clinical Psychology, Psychiatric Residency) completed anonymous questionnaires to assess the above variables. RESULTS: Students reported that patients with obesity are a common target of negative attitudes and derogatory humor by peers (63%), health-care providers (65%), and instructors (40%). Although 80% of students felt confident to treat obesity, many reported that patients with obesity lack motivation to make changes (33%), lead to feelings of frustration (36%), and are non-compliant with treatment (36%). Students with higher weight bias expressed greater frustration in these areas. The effect of students' weight bias on expectations for treatment compliance of patients with obesity was partially mediated by beliefs that obesity is caused by behavioral factors. CONCLUSIONS: Weight bias is commonly observed by students in health disciplines, who themselves report frustrations and stereotypes about treating patients with obesity. These findings contribute new knowledge about weight bias among students and provide several targets for medical training and education.

State-level estimates of obesity-attributable costs of absenteeism.

OBJECTIVE: To provide state-level estimates of obesity-attributable costs of absenteeism among working adults in the United States. METHODS: Nationally representative data from the National Health and Nutrition Examination Survey for 1998 to 2008 and from the Behavioral Risk Factor Surveillance System for 2012 are examined. The outcome is obesity-attributable workdays missed in the previous year because of health and their costs to states. RESULTS: Obesity, but not overweight, is associated with a significant increase in workdays absent, from 1.1 to 1.7 extra days missed annually compared with normal-weight employees. Obesity-attributable absenteeism among American workers costs the nation an estimated $8.65 billion per year. CONCLUSIONS: Obesity imposes a considerable financial burden on states, accounting for 6.5% to 12.6% of total absenteeism costs in the workplace. State legislatures and employers should seek effective ways to reduce these costs.

The positive effects of the revised milk and cheese allowances in the special supplemental nutrition program for women, infants, and children.

In 2009, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) implemented revisions to the WIC food packages. Milk and cheese allowances were reduced, and whole milk was disallowed for participants older than 23 months. Using a pre-post research design and scanner data from a New England supermarket chain on purchases of WIC households, this article assesses how the new WIC packages affected milk and cheese purchases and saturated fat intake among WIC households in Connecticut and Massachusetts. Milk and cheese volume purchased by 515 WIC households in Connecticut was compared before and after the WIC revisions (2009-2010) using generalized estimating equation models. Analysis for Massachusetts was descriptive. After implementation of the new WIC packages in Connecticut, whole-milk share declined from about 60% to 25% in WIC milk purchases, but remained flat at about 50% for purchases with non-WIC funds. Total milk volume fell by 14.2% (P<0.001), whole milk by half (P<0.001), and WIC-eligible cheese by 37.2% (P<0.001). Restrictions on whole milk shifted WIC purchases to reduced-fat milk in Connecticut and low-fat milk in Massachusetts, where reduced-fat milk is not permitted by WIC. The amounts of saturated fat from purchased milk and cheese declined by 85 g/month per WIC household in Connecticut and 107 g/month in Massachusetts. The 2009 WIC revisions led to a substantial decrease in purchases of whole milk and cheese among WIC families in New England. The related reduction in saturated fat intake could have important public health implications.

Federal food package revisions: effects on purchases of whole-grain products.

BACKGROUND: In 2009, the U.S. Department of Agriculture's Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) implemented revisions to the composition and quantities of WIC-provided foods. New whole-grain products such as whole-wheat bread and allowable substitutes were added to encourage increased intake of whole grains and fiber among WIC participants. PURPOSE: This paper assesses how the WIC revisions affected purchases of bread and rice among WIC-participating households in Connecticut and Massachusetts. METHODS: Scanner data from a regional supermarket chain were used to examine bread and rice purchases of 2137 WIC households. Purchased volume of bread and rice was compared before and after implementation of the WIC revisions (2009-2010) using generalized estimating equation models. Data were analyzed in 2013. RESULTS: Before the WIC revisions, when no bread or rice was provided through WIC, white bread dominated bread purchases among WIC households (78% of volume), and almost all rice purchased was white (94%). As a result of the WIC revisions, the share of 100% whole-grain bread in total bread purchases tripled (from 8% to 24%), replacing purchases of white bread; the share of brown rice rose to 30% of rice purchases. WIC households used WIC benefits to change some of their bread purchases, rather than to buy more bread overall, whereas total rice purchases increased. CONCLUSIONS: The 2009 WIC revisions significantly increased purchases of whole-grain bread and rice among WIC-participating families. The likely increase in whole-grain and fiber intake among low-income communities could have important public health implications.

Public reactions to obesity-related health campaigns: a randomized controlled trial.

BACKGROUND: Despite numerous obesity-related health campaigns throughout the U.S., public perceptions of these campaigns have not been formally assessed. In addition, several recent publicized campaigns have come under criticism in the popular media for reinforcing stigmatization of obese people. Thus, research in this area is warranted. PURPOSE: To systematically assess public perceptions of recent obesity-related public health campaigns in the U.S. DESIGN: RCT. SETTING/PARTICIPANTS: The data were collected online in summer 2012 from a nationally representative sample of American adults (N=1085). INTERVENTION: Participants were randomly assigned to view 10 obesity-related health campaigns that were pretested and publicly criticized as being stigmatizing of obese people, or 10 campaigns that contained more-neutral content. MAIN OUTCOME MEASURES: Participants provided evaluations of each of the campaigns regarding the extent to which campaigns were rated to be stigmatizing of obese people, motivating for improving lifestyle behaviors, and promoting of self-efficacy for healthy behavior change. Participants additionally evaluated the appropriateness of the visual content depicted in each campaign. Analysis was completed in 2012. RESULTS: Stigmatizing campaigns were no more likely to instill motivation for improving lifestyle behaviors among participants than campaigns that were more neutral (OR=1.095, 95% CI=0.736, 1.630). Stigmatizing campaigns were also rated as inducing less self-efficacy (adjusted mean difference = -0.171 SD, 95% CI= -0.266, -0.076) and having less-appropriate visual content compared to less stigmatizing campaigns (adjusted difference in probability = -0.092, 95% CI= -0.124, -0.059). These findings remained consistent regardless of participants' body weight, and were generally consistent across sociodemographic predictors. CONCLUSIONS: This study highlights the need for careful selection of language and visual content used in obesity-related health campaigns, and provides support for efforts to portray obese people in a nonstigmatizing manner.