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The social consequences of obesity are significant, with weight-based stigmatization and prejudiced common outcomes. Research has documented evidence of negative stereotypes, prejudice, and discrimination toward obese individuals in areas of employment, education, health care, the media, and interpersonal relationships (1,2,3). This stigmatization is pervasive and harmful, with serious consequences for psychological (4,5,6) and physical health (7,8). Given the prevalence of overweight and obesity in the United States, the number of children and adults potentially faced with stigmatization is immense. To improve the quality of life for obese individuals, we must understand and prevent the social disadvantages associated with obesity and its stigmatization. This supplement presents a series of articles examining the nature and extent of weight bias, as well as its negative impact on obese adults and youth.

Children and adolescents are especially vulnerable to weight bias and its harmful effects (9). With recent research suggesting that weight bias is worsening among youth (10), there is a clear incentive for additional studies to better understand the nature, extent, and impact of this problem in children. Six articles in this supplement are devoted to weight bias in youth. These studies address important research questions regarding the prevalence of weight bias across race and ethnicity (van den Berg et al.), correlates of body stigmatization endorsed by preschoolers (Rich et al.), and longitudinal patterns of weight-based teasing during adolescence (Haines et al.). Several articles also examine how weight bias affects overweight and obese youth, including the consequences of weight bias for psychological functioning and eating behaviors (Libbey et al.), the negative impact of internalizing weight bias (Davison et al.), and how weight stigmatization influences peer relationships (Griffiths and Page). Each of these studies contributes new knowledge and reinforces the complexity of this problem among youth.

Understanding the nature of antifat attitudes requires examination of weight bias among diverse samples. To date, research has primarily examined weight-based perceptions that young people have toward individuals in their same age group. Studies assessing perceptions of obesity across the lifespan are scarce. An article by Hebl et al. begins to address this gap by examining the extent to which college-aged individuals stigmatize obesity in 20-, 40-, and 60-year-old targets, demonstrating the importance of considering a life span perspective in understanding weight stigmatization. Greenleaf et al. also address this issue, but instead examine perceptions about obese children among young adults training to become physical educators, with specific attention to how weight stereotypes influence their beliefs about physical education. Another article by Carr et al. examines data from a diverse, nationally representative sample of Americans to determine how body weight affects specific types of interpersonal mistreatment, and whether these patterns vary by race, social class, and gender. Their findings provide new insight about the ways that social identities may influence stigmatizing treatment of obese individuals.

It is important to examine weight bias experienced by individuals at extreme levels of obesity, who may be at heightened vulnerability to stigma and its consequences (5,11,12). Two papers in this supplement examine stigmatization experiences among bariatric surgery candidates (Friedman et al. and Sarwer et al.). Both studies demonstrate that experiences of weight bias are associated with deleterious outcomes, but the findings raise questions about how common weight bias is reported among surgery candidates. Both studies used the Stigmatizing Situations Inventory to assess experiences of weight bias, although Sarwer et al. used the original version of this measure and found weight bias to be less common than findings reported by Friedman et al. who used a modified version of the survey. These studies highlight the importance of examining the consequences of weight-based stigmatization among individuals considering weight-loss surgery, as well as the necessity to establish reliable assessment tools to measure stigmatizing experiences.

The pervasiveness of prejudice toward obese youth and adults makes it imperative that scientists have access to valid and reliable measures to assess weight bias. Despite the accumulating science on obesity stigma, methods for measuring attitudes toward obese people and stigmatization experiences among obese individuals have received little research attention. There are few validated measurement instruments, and none so far that reflect best practices in scale development. Two articles in this supplement begin to address some of the methodological gaps in the field. An article by Durso and Latner describes the development of a new self-report measure to assess internalized weight bias among obese individuals, which shows promise for future use as a psychometrically sound instrument. A second article by O'Brien et al. examines the relationship between measures of implicit and explicit attitudes and discriminatory behaviors.

Given the social acceptability and cultural tolerance of weight stigma in North America, major shifts in societal attitudes may be required to reduce this form of bias. There are currently no federal laws in the United States to protect obese individuals from weight discrimination, and legislative efforts may be important, and perhaps necessary, to effectively reduce stigma. In the final article in this supplement, Pomeranz reviews the issue of weight discrimination in a historical analysis, examining legislative and public health strategies to reduce weight bias.

Each of the 14 articles in this supplement was subject to careful and thorough peer-review by external reviewers with relevant expertise. Each manuscript was sent to two external reviewers selected by the guest editors based on the content of the manuscript and the scientific expertise of the reviewers. All reviews were collected by the guest editors, and sent anonymously to the primary author, requesting revisions and written responses to indicate how the reviewers’ comments were addressed in the revised manuscript. Revised manuscripts were then re-reviewed by external reviewers and at least one of the guest editors, resulting in additional revisions if necessary, to improve the quality of the papers. The guest editors determined final acceptance of the papers.

We hope that the articles in this supplement will stimulate important questions and discussion on topics of weight bias. Although research attention to weight bias has increased, many gaps in our knowledge remain. More science is needed to understand the nature, extent, and consequences of weight stigma for overweight and obese individuals of different ages, gender, and ethnic backgrounds. Research is also needed to identify effective methods for reducing bias, and to test interventions that lead to lasting improvements in attitudes and behaviors toward obese individuals.

Vast numbers of people are vulnerable to weight bias, and the consequences of stigma and discrimination on public health could be considerable. We hope this supplement will bring needed attention to this issue among scientists in the obesity field, who have an important role to play in improving the quality of life for so many individuals affected by stigma and prejudice.

Disclosure

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The authors declared no conflict of interest.

References

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