While human beings have been persistent throughout history in creating divisions based on perceived difference, these barriers can be broken down in thinking about the shared possession of implicit biases. Spawning from one’s primary socialization and early experiences, implicit biases are automatic attitudes and beliefs that can occur without intent or consciousness about another individual or group. (Rudman, 2004). While the types of implicit biases held by individuals vary, the perpetuation of implicit weight bias specifically may in fact spawn from societal institutionalization of perceived health in relation to weight. It’s from this societal perpetuation of assumptions that people are in complete control of their weight, and of the negative associations towards certain body sizes that have become ingrained in the population via social media, that it has become more important than ever before to find ways to reduce implicit biases regarding weight. In this particular study we have chosen to focus on how the level of exposure to determinants of health effect implicit bias.
Hypothesis: Increasing exposure to determinants of health will reduce implicit weight bias.
Predictors of Implicit Bias
In order to construct an effective means for reducing implicit weight bias, we must first gain an understanding for how such biases arise. One contributing factor to the development of implicit weight bias is that of early experiences. Throughout childhood and adolescence, individuals are unknowingly constructing their worldview and perceptions of others based, in large part, on the primary and secondary socialization they are exposed to. Therefore, one’s upbringing is important in determining what explicit and implicit biases they will carry throughout adulthood. Lydecker, O’Brian, & Grilo (2018), proposed that parents of children aged between five and fifteen years old would show implicit bias towards overweight children, yet parents who were overweight themselves or had children who were overweight would present less implicit weight bias due to increased positive exposure to obesity. As children often seek validation from parental and authority figures, the implicit attitudes held by such individuals are likely to inadvertently influence the malleable mindsets of those in adolescence. With this underlying assumption in mind, the Lydecker, O’Brian, & Grilo (2018) study had parents complete a survey about both their personal and their child’s weight, take the IAT for child obesity and the “Attitudes Towards Obese Person” scale to showcase both implicit and explicit weight biases held by participants. The study ultimately found that despite demographic features of both adult participants and children, parents showcased implicit bias against overweight children. Though overweight parents showed reduced explicit bias towards overweight children, such reductions weren’t found in relation to their implicit weight bias (Lydecker). Essentially, exposure to stigmatized weights may help in reducing explicit weight bias, however, it is not enough to prevent or even reduce implicit weight bias. This further elucidates just how ingrained weight bias is in our societal mindset, yet it also showcases that parents do hold implicit weight biases that are likely to surface in the upbringing of their children. Influencing future generations to hold similar conscious or unconscious attitudes about weight.
While early experiences and one’s upbringing are important predictors of the development of implicit biases, exposure to societal norms and idealism throughout adolescence is another influential factor. Though weight biases seem to defy borders, emerging in even the most remote areas around the world, the specific sociocultural context in which one grows up can be a critical influence in the implicit associations individuals develop in relation to different weights. Latner and Colleagues (2007) approached the development of weight based discrimination in adolescents by focusing on the effects exposure to media, such as television, has on children. Ultimately, this study asked 171 children, aged ten to thirteen, to look at twelve pictures showcasing children with and without obesity and disabilities. Participants ordered the pictures based on “liking”, rated how they felt towards the obese individuals pictured, and then distinguished their total media usage on a weekly basis (including television, video games, and magazines). Findings of this study established a correlation between increased media exposure and higher rates of dislike and stigma towards obese children (Latner). With American media outlets focusing on the promotion of thinness as a direct indicator of health and positivity, while advertising obesity in a much more negative light, the surface level interpretation weight elicited across such mediums becomes increasingly internalized by today’s youth (Eisenberg). Eisenberg and colleagues (2015) further elucidated such points in their study looking at prevalence of weight-stigmatizing incidents on popular television shows. Ultimately, they found that such portrayals of weight stigmatization aided in normalizing such weight biases amongst adolescents as behavior and attitudes that are accepted and expected (Eisenberg). It is with this over exposure to the normalization of weight bias, based on surface level attributions of appearance, that implicit weight biases form with disregard to the actual underlying determinants of health.
Consequences of Implicit Bias
The development of implicit weight biases ultimately lead to the emergence of stigmatization, which is the action of regarding others with disapproval. Cheng et al. (2018) performed a study utilizing questionnaires to determine the association of weight bias and perceived weight stigma with that of eating behavior and psychological distress amongst undergraduate students in Hong Kong. Ultimately, researchers in the study found that weight bias was related to increase perceptions of weight stigma and inappropriate eating behavior. However, results also showed that weight bias and perceived weight stigma were related to increased levels of anxiety and depression (Cheng). This is particularly important because it distinguishes that weight bias and perceived weight stigma have real physiological and psychological effects on individuals. In another study conducted by Juvonen, Lessard, Schacter, & Suchilt (2017), the emotional consequences of weight stigmatization were looked at by way of weight-based discrimination experienced by middle schoolers. Researchers found that perceived experiences of weight-based discrimination from peers were highly correlated with what was noted as “body dissatisfaction, social anxiety, and loneliness.” Results also showed that overweight students faced higher incidences of weight stigmatization from peers and experienced increased social exclusion and degradation as a result (Juvonen). With the development of implicit weight biases and the stigmatization that follows, individuals targeted by such attitudes and behaviors become increasingly vulnerable to demeaning treatment, social exclusion, distress, anxiety, depression, and inappropriate eating behaviors.
In addition to the physiological and psychological consequences of weight-related stigmatization, stereotypes and prejudice spawning from implicit biases can often be detrimental to individuals occupational and social aspirations. Giel and Colleagues (2012) evidenced such consequences in their study looking at weight stigmatization amongst human resources professionals. Participants in this study were asked to evaluate photographs of individuals of varying BMI (Body Mass Index) based on presumed prestige and achievements. Though participants were experienced hiring professionals trained to make decisions without employing personal biases, results showed that occupational prestige was underestimated for overweight individuals. Researchers performing this study also found that professionals disqualified overweight individuals more often than others from gaining employment and promotions (Giel). In distinguishing the detrimental consequences weight-related stigmatization has on occupational opportunities for those in prejudiced weight classes, we also highlight the growing need for educational interventions to reduce such implicit biases.
With such a goal in mind, Diedrichs & Barlow (2011) conducted a study focused on the effects of an educational intervention on weight biases held by pre-service health students. Students assigned to the intervention group attended lectures on obesity, weight bias, and weight determinants. The results from this group were compared to those from a control condition (no lecture) and from a comparison condition (lectured on obesity and behavioral determinants of weight). Ultimately, researchers found that educational intervention reduced both negative attitudes towards obesity and controllability beliefs about weight held by students (Diedrichs). As such results were only found in the intervention group, it can be deduced that educational exposure to weight bias and determinants of weight are more effective in reducing bias than exposure to behavioral determinants of weight. Ultimately, this study exemplifies just how pervasive the consequences of implicit biases are by addressing the weight-related stigmatization present amongst health professionals. With underlying beliefs about the controllability of weight, health professionals are more likely to approach overweight patients with less empathy and assistance overtime (Cossrow). While Diedrichs et al. elicits hope in the capacity of educational exposure as an effective means for reducing implicit biases, pointed research on different types of educational exposure in relation to weight is needed to determine the most effectual intervention design. Even so, the breadth and pervasiveness of the consequences posed to individuals who are negatively categorized based on their weight establishes a possible need for a study focused on general exposure to determinants of health as an intervention for reducing weight bias.
Conclusion
With this introduction and review of past research, we gain a deeper understanding of how implicit biases arise and become imbedded in everyday situations. Though implicit bias is subtle and often goes unregistered by individuals, the pervasiveness of its consequences reaffirm the need for an intervention that effectively reduces implicit bias. While prior research has shown surface level exposure to weight-based attributions of health only aid in generating stigma, it has also established educational exposure as a possible means for reducing implicit biases and its consequences by extension. Given this research, we have constructed the hypothesis that increasing exposure to determinants of health will reduce implicit weight bias.
