By Kayla Harris, Sarah Putney, and Jenna Thompson

Over the past several decades, obesity rates have risen throughout the world. Despite this fact, or perhaps even because of it, fat stigma (discrimination or prejudice against someone on the basis of their weight) is still prevalent in the United States and in other countries; this stigma is expressed in both an explicit (outwardly spoken or acted upon) and implicit (internalized) manner. The current dominant global thought on obesity worsens explicit fat stigma by blaming overweight individuals for a perceived lack of self-control or lack of morality, and for promoting thin bodies as ideal. Yet despite the globalization of explicit fat stigma, there are still variations from culture to culture on how obese individuals are treated. The level of prejudice present in a society is thus dependent upon the level of implicit stigma the society’s members possess, which can be impacted by several factors such as media exposure, community involvement, and socioeconomic status.

In a 2014 study published in Annals of Anthropological Study, “A World of Suffering? Biocultural Approaches to Fat Stigma in The Global Contexts of The Obesity Epidemic,” anthropologists and Arizona State professors Brewis and Wutich examine how these factors (media exposure, poverty, etc.) affect both implicit and explicit fat stigma, and use this data to compare fat stigma beliefs in the United States to those present in other cultures. This study is one of many by Brewis and Wutich discussing the impacts of stigma on health cross-culturally, and both women emphasize the importance of the cultural context of stigma, noting that understanding fat stigma in different societies helps to inform its impacts on both individuals and entire populations.

In their paper, Brewis and Wutich criticize the dominant cultural equation of “fat equals bad,” pointing out that weight-blaming and associating fatness with laziness undermines individual weight loss efforts. Furthermore, discrimination and stigmatization of weight negatively impacts almost every aspect of an overweight individual’s life, from childhood bullying to fewer academic, romantic, and career opportunities in adulthood; this emotional suffering can trump all other aspects of self and identity. Fat stigma may also prevent upward economic mobility, and therefore make it more likely for people to live in environments lacking healthy food options or opportunities for exercise, resulting in obesity often being associated with poverty and income inequality. These are examples of how fat stigma can layer with the effects of other stigmas (such as poverty, geographic location, or immigrant status) to prevent treatment for obesity health problems. Anthropologists label this compounding stigmatization ‘embodiment’, a phenomenon in which a stigma against an individual is accepted and internalized as a valid characteristic of the person, impacting the stigmas they may face in other aspects of their life. In places where there is fat stigmatization, there is often also a stigma against low socioeconomic status, and embodiment of these stigmas may prevent people from finding treatment or getting healthier. Brewis and Wutich reference the concept of embodiment as one that plays a role in exacerbating the growing global stigmatization of weight.

Globally, stigmatizing ideas about fat appear to be growing in developing countries where poverty is more common. This contrasts with the traditional view of low-income countries such as American Samoa as fat-positive, which have, in reality, recorded some of the highest levels of fat stigma. Brewis and Wutich entered their study with questions about how the current obesity “epidemic” intersects with changing norms about bodies, and how this might shape people’s emotional suffering related to weight. Some of the questions they asked included:

•    How do changing anti-fat norms intersect with changing body sizes?
•    Why would fat stigma become more profound if more people are obese?
•    Do some cultural contexts amplify vulnerability to fat stigma?

Brewis and Wutich referenced evidence from several ethnographic studies linking biological weight and cultural weight related norms to assist in hypothesizing answers to these questions about why certain cultures possess differing levels of fat stigma. First, media (especially television) appeared to be driving the new pro-slim norms among younger women in Fiji. Second, in both Fiji and Jamaica, anchoring identity in community was linked with protecting against weight distress. Finally, concerns about upward socioeconomic mobility may drive fat-fear and pathological eating. For example, in Brazil, the desire for success in a growing transnational economy has increased awareness of body size, resulting in the growing popularity of plastic surgery amongst Brazilian women: because beauty provides a mechanism for economic mobility, being labeled fat essentially destroys a woman’s upward mobility.

Considering the suggestions from these studies and their own hypotheses, Brewis and Wutich developed a biocultural theory relating weight and weight stigma across diverse regions. Their initial model proposed that internalized fat stigma would be related to the interaction between external fat norms and the embodiment of an individual’s weight, socioeconomic status, sense of community, and media exposure.  They placed an emphasis on distinguishing between explicit and implicit stigmas, and focused the study on women, as they are currently at a higher risk for obesity globally and historically have had greater concerns around weight.

To test this model, Brewis and Wutich collected 5 samples: 48 US female college students, 201 urban women in Paraguay, 101 women in urban Bolivia, 41 women from India and 23 Muslim women living in the United States. Each woman’s BMI was estimated from height and weight measurements and their level of media exposure was measured as the number of hours spent reading newspapers or magazines or watching television. The women’s sense of community was measured using a scale in which participants chose between 7 Venn diagrams describing the relationship between themselves and their community and socioeconomic status was rudimentarily measured using years of formal schooling. To capture each participant’s explicit fat stigma beliefs, they used the Attitudes to Obese People (ATOP) scale and the Beliefs About Obese People (BAOP) scale, which captured social and environmental norms by asking participants to agree or disagree with statements such as “Most non-obese people would not want to marry anyone who is obese” or “Most obese people are dissatisfied with themselves”. Alternatively, the implicit attitude tests given captured the levels of internalization of social norms as personal beliefs and of prejudice that may lie outside of explicit awareness, or that people may be uncomfortable to reveal. To get a better understanding on how the implicit test works, you can take the test for yourself by clicking on the link below.

https://implicit.harvard.edu/implicit/takeatest.html

In the implicit test used in Brewis and Wutich’s study, participants were presented with the categories of ‘fat versus slim’ and ‘good versus bad’, and asked to classify synonyms for these words as quickly as possible. The implicit tests are based on the idea that if someone is accustomed to make an association, they will be able to do so more quickly. Thus, if an individual makes more fat negative associations than fat positive in a 20 second time limit, they possess some level of anti-fat bias.

The purpose of these methods was to summarize how women in different cultures recognize, understand, and internalize fat stigma in relation to their own body size, and Brewis and Wutich found, after implementing their study, that women of all five cultures possessed some level of negative explicit stigma towards fatness. They also discovered, when examining all cases, that there was a greater variation in implicit stigma than explicit stigma- so great, in fact, that some cultures had a net positive implicit bias towards overweight individuals.

US university students had the highest levels of both explicit and implicit fat stigma, scoring the most fat negative on the IAT tests. Indian women were also fat negative on the IAT tests, while Paraguayan women were net neutral, and Bolivian and US Muslim women were mostly fat positive. Even after considering variations in BMI, socioeconomic status, and media exposure in the 5 different cultures, US college students were still significantly more likely to possess fat stigma than the fat positive Bolivian and US Muslim women, suggesting that the community in which one lives proves to be one of the highest factors in developing a fat stigma. The revised model Brewis and Wutich suggest to explain their results maintains that low levels of community inclusion, media consumption, and education can contribute to a higher internal fat stigma (and conversely, body size, age, and community inclusion are the factors correlated to a high external fat stigma).

Brewis and Wutich explain their model through a cultural analysis of implicit, rather than explicit, bias. Though explicit anti-fat norms are widely expressed across an array of social contexts at a consistently high level, the variation in the IAT (implicit stigma) results suggest that the emotional costs of “being fat” may be very different from place to place- that is, one might face more discrimination for their weight in certain cultures rather than others. In fact, because it is often negative implicit ideas that correlate with higher levels of discrimination, rather than explicit stigmas (a concept proved by prior studies on racism and sexism), the notion that explicit and implicit stigmas are not correlated to one another is unsurprising, and therefore an analysis of the factors contributing to implicit fat stigma was far more relevant in determining why cultures perceive weight differently.

Surprisingly, Brewis and Wutich determined that lower levels of media consumption contributed to higher levels of internalized fat stigma, though they qualify this assertion by noting that they did not take into account in this measurement the consumption of social media, the media outlet women in areas with the highest levels of internal fat stigma are most likely to use. They assert that the media consumption they tracked, television and newspapers, actually represents a departure from pop culture, and that high levels of media consumption in their study instead correlate with a lower level of dependency on popular culture’s thin ideals and a lower level of negative fat stigma. Less surprisingly, higher levels of community involvement predicted decreasing levels of negative stigma. Brewis and Wutich suggest this is because people that are less involved in their community are more focused on themselves, and more focused on self-image, ultimately causing them to value a thin appearance as a part of their self-worth. They also claim that individuals who are highly involved in their community are more sheltered from internalizing any negativity that might be expressed outwardly towards overweight individuals. Finally, in an analysis of education levels (which was how the study measured wealth and socioeconomic status), Brewis and Wutich determined that education levels were only minor, unreliable predictors of fat stigma, suggesting that this stigma depends upon large, generalized cultures, rather than local ones.

Ultimately, all 5 culture samples presented fat-negative external views, correlating with an increasingly fat-negative global norm perpetuated by globalization, but not all of the cultures expressed fat-negative internal views, indicating that fat-stigmatizing norms are not always internalized, even as explicit fat stigma seems to be spreading across the globe. Therefore, the results of Brewis and Wutich’s study suggest that it may be easier to prevent the painful effects of fat stigma (such as the ones found at Duke in the introductory video) from being implemented in places such as Bolivia and Paraguay where the explicit anti-fat norms have not (yet) become implicit beliefs. That is, in these developing societies that have not always perceived obesity to be bad (for example, many revered overweight individuals for being wealthy enough to afford hearty meals), individuals might not yet have internalized what the global fat-shaming phenomenon is telling them to believe.

This study is instrumental in developing a culture-based fat stigma theory that may improve the lives of the obese, because a basic knowledge of fat stigma is fundamental for health care providers that seek to tackle the growing challenge of obesity. Additionally, this study may encourage governments to prevent the implementation of infrastructural changes that make life unduly difficult for overweight individuals, an anthropological phenomenon known as structural violence (social bodies such as governments discriminating against certain individuals by exacting policies that work directly against such individuals). Knowledge of the fat stigma and its origins is useful in preventing this structural violence by indicating what aspects of society are problematically stigmatic towards overweight individuals, and thereby, is useful in creating a society that is more equal for its overweight members.