DYNAMIC ASSESSMENT OF OBESITY STIGMATIZATION Jason D. Seacat, Ph.D. - - PowerPoint PPT Presentation

DYNAMIC ASSESSMENT OF OBESITY STIGMATIZATION

Jason D. Seacat, Ph.D. Department of Psychology, Western New England University

Overview

 Part 1: Obesity Overview

 Define and discuss obesity and trends in US  Obesity stigmatization  Consequences of obesity stigmatization

 Part 2: Assessment of Stigmatization

 Daily diary assessment of stigmatization

 Preliminary research findings

 Laboratory assessment of stigmatization effects  Triangulating assessment strategies

Part I: Operational Definitions

 Operational Definitions (CDC Body Mass Index)

 Overweight ≥ 25  Obesity ≥ 30  Morbid Obesity ≥ 40-44.9  Super Morbid Obesity ≥ 45

 Assessment of Obesity Status

 BMI  Body Fat % Scales (e.g., Tanita)  Skin fold thickness  Bioelectric impedance assay

Obesity Trends-Adults

 Prevalence of Overweight/Obese in the United

States

 Despite increasing awareness, education and

intervention the obesity epidemic continues to intensify

 36% of adults are overweight  34% of adults are obese (Flegal et al., 2008)

U.S. Trends and Projections

National Health and Nutrition Survey

U.S. Disparities

 Racial/Ethnic Disparity of Obesity

 Non-Hispanic Black- 44%  Mexican American- 39.3%  All Hispanic- 37.9%  Caucasian- 32.6%

 Geographic Disparity

 South- 29.4%  Midwest- 28.7%  Northeast- 24.9%  West- 24.1% CDC, 2011

Consequences of Obesity

 Physical Health Consequences

 Coronary Heart Disease/Stroke  Type II Diabetes  Hypertension  Certain Cancers (e.g., endometrial,

colorectal)

 Osteoarthritis

 Economic Consequences

 Medical costs alone associated with obesity $147

Billion (Finkelstein, 2009)

Consequences of Obesity

 Social Consequences

 Obesity stigmatization

 According to Puhl and Heuer (2009), obesity

“remains one of the last acceptable targets of stigma/discrimination”

 Despite increasing rates of

• besity, obesity stigmatization is

also increasing

Obesity Stigmatization

 Rates of obesity stigmatization have increased by

66% since 1995 (Schvey, Puhl & Brownell, 2011)

 More than 70% of overweight/obese individuals

now report frequent stigmatization

 Obesity stigmatization occurs in ALL life domains  While both sexes encounter weight stigma, women

are more frequently targeted than men

 Women may also be more susceptible to negative

consequences of stigma due to gender-based attractiveness norms

Types of Obesity Stigma

 Direct- (Institutional & Interpersonal) (e.g., bullying,

denial of housing, workplace harassment, relationship abuse, ostracizing of obese individuals)

 Indirect- (Perceived) Individual perceptions of

stigma and/or internalization of stigma

 Indirect stigma may actually be more potent than direct

as it operates independently of actual occurrences

 Researchers need to assess both direct and indirect

forms of stigmatization

Consequences of Obesity Stigma

 Though consequences of stigma are individualized there

are several commonly reported outcomes, including:

 Lack of access/opportunity  Psychological/emotional trauma  Social isolation  Delay/avoidance of medical treatment  Avoidance of healthy behaviors (e.g., exercise,

compensatory eating) (Seacat & Mickelson, 2009; Vartanian & Colleagues, 2011)

 Perpetuation and exacerbation of obesity status**

Assessing Obesity Stigmatization

 Existing stigma studies indicate that experiences

with obesity stigma range from a low of 1 time per month to a high of 1-2 times per week (1999- 2011)

 Most commonly experienced stigmatizing situations

include (Sarwer et al., 2008)

 Nasty comments from children  Nasty comments from family members  Inappropriate comments from

health care personnel

 Encountering physical barriers

Limitations

 Existing stigma studies have widely employed cross-

sectional and retrospective assessments spanning up to 30 years or more in lifetime

 Memory erosion  “Repression” of traumatic or painful events  Underestimation of event frequency

 Limited ability to capture relationships between obesity

stigma and actual health behavior (exercise/diet)

 Focus on “clinical” populations

Hypotheses

 H1) Rates of obesity stigma will be higher than

previous retrospective reports

 H2) BMI status will be positively correlated with

• besity stigma

 H3) Levels of obesity stigma will be inversely

related to participants’ average amount of exercise (in minutes)

 H4) Levels of obesity stigma will be inversely

correlated with participants’ perceptions of the “healthfulness” of their daily diet

Daily Diary Assessment of Stigma

 Seacat & Dougal (2011; In Prep) sought to test

hypotheses and address limitations with a daily diary assessment study of obesity stigmatization

 Participants

 50 overweight-obese women  Aged 19-61 (M = 37.90)  BMI 25.00-77.90 (M = 42.56)  42% Married  90% Caucasian  60% college educated (2yr-Completion of Grad Sch.)

Daily Diary Assessment

 Procedure

 Approved by IRB, WNE  Study was advertised on weight-related websites and

blogs (e.g., Obesity Forum, Biggest Loser, My Big Fat Blog)

 Participants completed a baseline demographic survey

and a daily diary assessment for a period of 7 days

 All participants were eligible for a raffle drawing for

• ne of five $50 Visa check cards

Daily Diary Assessment

 Measures

 Stigmatizing Situations Questionnaire (Myers and Rosen,

1999) (modified) 50 items/11 sub-scales

 Comments from children  Comments from family  Isolation, feeling ignored  Barriers in environment

 Daily exercise/dietary habits  Daily activities/places visited  Daily interpersonal interactions  Daily media consumption habits

Preliminary Findings

 Hypothesis 1:

 Previous accounts using SSQ: 1x month to 2 x week  Current participants reported a range of 2.74-5.24

stigmatizing events per day

 We also added open-ended stigma questions for

participants to respond to. Many novel events emerged, that were not captured by the SSQ

 “I walked outdoors today and felt embarrassed to walk for

a short time on the highway, where people who knew me might see me. I thought they would assume my car broke down, and not that I was exercising.”

Preliminary Findings- Open Ended

 “[ I was ] with friends at a baby shower today so I

went to McDonalds first so people wouldn't look at me eating more than I should”

 “The dentist was worried I might break his chair”  “An old friend saw me and yelled "I didn't know you

were pregnant”

 “While outside, some of the people that drove by

seemed to do the "heavy-person double take look" as they passed by”

Preliminary Findings-Open Ended

 “I was told that I was a bad mother because I can't

set limits as to what my son or his friends eat during sleepovers, because I can't even control myself”

 “My ex-boss looked at me several times in a

restaurant but acted like he didn't know me. I worked for him for 5 years but he always hated fat people”

Preliminary Findings

 Hypothesis 2:  Consistent with existing research and our current

hypothesis, there was a significant and positive correlation between BMI and levels of reported

• besity stigma (r = .58; p < .001)

Preliminary Findings

 Hypothesis 3:

 Supporting our hypothesis, levels of obesity stigma

were inversely correlated with participants’ average duration of daily exercise (in minutes) ( r = -.323; p =.008)

 Hypothesis 4:

 Contrary to our predictions, levels of obesity stigma

were not significantly correlated with participants’ perceptions of daily dietary habits ( r = -.03; p = .84)

Limitations

 Participant attrition  Reliance upon self-report data  Daily assessment may have “sensitized” participants

to perceive events they typically would not have

 Lack of additional assessment methods to

corroborate exercise/dietary data

 Pedometers  Diet log

Discussion

 Obesity stigma likely occurring at significantly

higher rates than previously demonstrated

 Stigma increases in frequency as obesity status

increases

 Stigma is significantly and negatively correlated

with duration of physical activity in daily life

 Stigma was not significantly correlated with

perceptions of diet

Additional Work

 Dataset also contains detailed accounts of

participants’ daily interpersonal interactions, activities, places visited and media consumption habits

 Next steps will be to analyze these data in conjunction

with 11 subscales of SSQ to determine whether significant relationships exist

 Develop briefer version of SSQ for repeated use on

the basis of current participant response patterns

Future Directions

 Inclusion of direct measures of physiological

reactivity and exercise/diet into daily diary assessment

 Reactivity-

 Ambulatory BP monitors  Momentary data capture devices

 Exercise-

 Exercise/diet log  Pedometer

Laboratory Assessment of Obesity Stigmatization

 Researchers are now beginning to focus more

intently on direct, physiological assessment of responses to obesity stigmatization

 R. Puhl et al. Yale University  B. Major et al. UC Santa Barbara  J. Seacat et al. Western New England Univ.

 Hypothesized that encounters with stigma should

produce detectable CNS and cardiovascular reactivity

Laboratory Assessment of Stigma

 Though proposed, empirical relationship between

• besity stigma and reactivity is yet to be

established

 Majority of obesity stigma is subtle thus reactivity is

likely variable and may be limited

 May produce frequent, low level activation of CNS and

cardiovascular system

 Over time, repeated arousal may contribute to

cumulative stress effects

Micro-Stressor Effects

 Short-term effects- unknown  Cumulative effects- theoretical

 Cardiovascular reactivity

 Exacerbated cardiac response  Increased recovery time from stressors

 Potential CNS Effects-

 Excess cortisol production  Adiposity

Current Work

 Pilot testing a time series trial to assess

cardiovascular and HPA activation to subtle stigma- based stressors

 40 minute protocol  Sex-based academic stigma in Math (St Threat

Paradigm)

 2x2x2 experimental design

 Prime-Negative-Male/Female  Prime-Boost-Male/Female  Neutral-Male/Female

Current Work

 Intra-individual assessment

 BP

, heart rate recorded at baseline and every four minutes

 Salivary cortisol recorded at baseline and in 8 minute

increments thereafter

 Self-report at conclusion of assessment

 Restrictions: No caffeine, no nicotine, no exercise w/in

24hrs

 No food/tooth brushing within 6 hours

 Control for: Time of day, Med use (BP elevating, saliva

diminishing, cortisol modulating)

Conclusion

 Obesity and obesity stigmatization are increasingly

prevalent in society

 Obesity stigma may contribute to perpetuation of

• besity epidemic and to morbidity with other health

conditions

 Assessment of experiences with and consequences

• f obesity stigmatization is in very early stages

 Methods to triangulate data are most widely

accepted (and funded)

Acknowledgements

 Western New England University, Faculty

Development Grants 2010, 2011

 Dr. Sheri Tershner, Director, Neuroscience Program  Dr. Judy Cezeaux, Chair, Biomedical Engineering  WNE Students: Sarah Dougal, Cory Saucier, Aaron

Krause, Christina Barbarisi and others…