Support for weight-related anti-discrimination laws and policies: Modelling the role of attitudes toward poverty alongside weight stigma, causal attributions about weight, and prejudice

Highlights

• Attitudes toward poverty directly associated with support for weight-related laws and policies.

• Direct relationship also mediated by weight-related stigma and prejudice.

• Mediational pathways involving attributions of being larger-bodied were not significant.

Abstract

In the present study, we sought to position support for weight-related anti-discrimination laws and policies within a broader political and socioeconomic context. Specifically, we hypothesised that individualistic (rather than structural) anti-poverty attitudes would provide the basis for negative weight-related dispositions. To test this hypothesis, we asked 392 respondents from the United Kingdom to complete measures of support for weight-related anti-discrimination laws and policies, attributions about the causes of being larger-bodied, and weight-related stigma and prejudice. Path analysis with robust maximum likelihood estimation indicated that greater individualistic anti-poverty attitudes were significantly and directly associated with lower support for weight-related anti-discrimination laws and policies. This direct association was also significantly mediated by weight-related stigma and via a serial mediation involving both weight-related stigma and prejudice. Although greater individualistic anti-poverty attitudes were significantly associated with greater personal attributions for being larger-bodied, the latter did not emerge as a significant mediation pathway. The present findings highlight the importance of considering broader political and socioeconomic contextual factors that may provide a basis for the development, maintenance, and manifestation of negative weight-related dispositions.

Introduction

Weight-related stigma (i.e., negative attitudes and blame directed toward higher-weight individuals) and discrimination (i.e., inequitable treatment and disadvantaging of higher-weight individuals) are commonplace among larger-bodied individuals globally (Brewis et al., 2018, Pearl, 2018, Puhl and Heuer, 2009, von Liebenstein, 2023). Such forms of stigma and discrimination are associated with negative consequences for larger-bodied individuals (Brown et al., 2022, Pearl and Hopkins, 2022), including poorer psychological well-being (e.g., Robinson et al., 2017; Sutin et al., 2019; Warnick et al., 2022), fewer educational opportunities (e.g., Kenney et al., 2015; Swami & Monk, 2013), and poorer physical health (Tomiyama et al., 2018). These associations – which have become stronger over the course of the COVID-19 pandemic (Sutin et al., 2021) – may in turn contribute to premature mortality (Sutin et al., 2015) and to increased health and social inequalities at a population level (Puhl & Heuer, 2010). Despite these serious deleterious outcomes, weight-based discrimination remains legal in most parts of the world (Pomeranz & Puhl, 2013).

Traditionally, efforts to mitigate population obesity have focussed on psycho-educational interventions for larger-bodied individuals (Harwood et al., 2022, Hartlev, 2014). However, aside from their low efficaciousness, such methods have also been criticised for ascribing responsibility and blame to larger-bodied individuals (i.e., engaging in victim-blaming) and thus reinforcing weight stigma (Brewis et al., 2018; Ramos Salas et al., 2017). An alternative method is to shift practitioner and policy-maker attention onto “structural solutions” – the enactment of policies and laws that prohibit unfair treatment based on body weight (Pearl, 2018, Solanke, 2021) – that are likely to mitigate harm from weight stigma and discrimination. Such structural solutions include laws that protect employees from workplace discrimination based on weight, the inclusion of body weight as a protected category in civil rights laws, and providing larger-bodied individuals with legal protection from discrimination (e.g., Suh et al., 2014a, Suh et al., 2014b; Puhl et al., 2014, Puhl et al., 2016; von Liebenstein, 2023). Such solutions could benefit individual health by reducing exposure to stressors that contribute to poorer physical and psychological health (Pearl et al., 2017), but could also improve societal attitudes and thereby reduce weight stigma and discrimination at population levels (Huang et al., 2020).

Public support is important for the enactment process of anti-discrimination policies and laws (Bajaj et al., 2022, Puhl et al., 2015, Sikorski et al., 2011); that is, public support often serves as the “driving force” that convinces policy-makers to advocate for protective legislation (Puhl, 2022, p. 133). Although a majority of respondents in studies in some countries (e.g., Canada, Germany, the United States, the United Kingdom) support the enactment of policies and laws to prohibit weight-based discrimination, especially in occupational settings (Puhl, 2022, Puhl et al., 2015, Puhl et al., 2021, von Liebenstein, 2021), much more can be done to better understand the factors that lead to such support (or the lack thereof). Thus, some research has focused on socio-demographic predictors of support for weight-related anti-discrimination laws and policies, with some studies indicating greater support among women (compared with men), larger-bodied individuals, and individuals with lower education (e.g., Hilbert et al., 2017; Puhl et al., 2015). However, associations between socio-demographic factors and support for such laws and policies are often weak and sometimes equivocal (e.g., some studies suggest no significant effects of gender; Puhl, Neumark-Sztainer, et al., 2016; Sikorski et al., 2011).

Instead of focusing on socio-demographic variables, there may be greater value in shifting the focus of research onto attitudinal dispositions and beliefs instead. For instance, in a recent systematic review, Hill et al. (2021) reported that the majority of studies assessing predictors of anti-stigma and discrimination policies were focused on causal attributions (i.e., assigning responsibility for being larger-bodied to individual behaviour). For example, support for weight-based policies was significantly lower when individuals more strongly attributed obesity to personal control (e.g., lack of willpower; Beeken & Wardle, 2013) and responsibility was ascribed to the individual. Conversely, when obesity is attributed to factors beyond personal control (e.g., the environmental availability of unhealthy foods or genetics), there is generally greater support for the enactment of weight-related policies (Joslyn and Haider-Markel, 2019, Mazzocchi et al., 2015). Thus, to the extent that obesity is seen as being under personal control (Puhl & Brownell, 2003), it typically results in lower support for weight-related anti-discrimination policies and laws.

However, the link between causal attributions and support for weight-related anti-discrimination policies and laws is unlikely to be direct. For instance, drawing on attribution theory (Weiner, 2006, Weiner et al., 1988), causal beliefs about the controllability of obesity are thought to lead to stigmatising attitudes (e.g., stereotyping larger-bodies individuals as lazier and unintelligent; Elran-Barak & Bar-Anan, 2018; Evans et al., 2023; Puhl & Brownell, 2001; Swami et al., 2008) that, in turn, influence bias and discrimination (for a review, see Puhl & Brownell, 2003). To the extent that stigmatising attitudes are based on causal attributions of obesity to the individual, respondents may be more likely to adopt a victim-blaming stance and thus demonstrate lower support for weight-related anti-discrimination policies and laws. Systematic reviews of the literature (e.g., Sikorski et al., 2011) and cross-sectional studies (e.g., Chambers & Traill, 2011) have generally supported this model linking attributions, stigmatising attitudes, and support for public health initiatives focused on weight.

Although this research appears fairly conclusive, there are several ways in which this body of work could be extended. First, the role prejudicial attitudes in relation to support for weight-related anti-discrimination policies and laws needs to be investigated more fully. According to both Crandall and Biernat’s (1990) model of anti-fat attitudes and the integrated threat theory of prejudice (Stephan & Rentfro, 2002), prejudice (i.e., antipathy and negative affect directed towards an outgroup) is located as an outcome of stereotypical and stigmatising views of larger-bodied individuals. Narratives of an “obesity epidemic”, for instance, promote sensationalised presentations of obesity as a threat to societal and economic well-being (Rathbone et al., 2022), a form of “symbolic violence” (Bourdieu, 1991, Gailey, 2022) that allows for the emergence of prejudicial attitudes toward larger-bodied individuals (Puhl and Brownell, 2003, Puhl, 2022). In turn, anti-fat prejudice has been shown to be significantly associated with lower support for weight-based anti-discrimination policies and laws, even after controlling for a range of socio-demographic characteristics (Berg et al., 2016).

A second issue that is deserving of attention in relation to support for weight-related anti-discrimination policies and laws is the role of broader political, cultural, and economic structures and beliefs (cf. Link & Phelan, 2014). For instance, contemporary neoliberal health discourse constructs the “fat” body as an unhealthy, failed body (Guthman and DuPuis, 2006, Halse, 2009), while obscuring the social construction of body sizes (Ernsberger, 2009). To the extent that such discourse presents eating and exercise behaviours as largely dependent on individual choice – the biomedical methods of choice for weight reduction and maintenance (Wright and Harwood, 2009, Rathbone et al., 2022) – body size thus becomes a matter of personal responsibility, with larger-bodied individuals marked and blamed for failing to adhere to normative standards of appearance (i.e., slenderness; Solovay & Rothblum, 2009). Thus, larger-bodied individuals come to be constructed not only as a danger to themselves (e.g., in terms of individual health outcomes), but also to the economic productivity of a society or nation (Evans et al., 2008, Farrell, 2011, LeBesco, 2010).

Within this discourse, however, the intersection between body size and social class becomes especially salient (Evans et al., 2008), with larger-bodied working-class people subordinated and regulated as deviant (LeBesco, 2007, van Amsterdam, 2013). For instance, in the United Kingdom, scholars have discussed how a range of television programming uses the neoliberal health discourse and the elicitation of negative affect (e.g., disdain, anger, disgust, fear) to position larger-bodied working-class individuals as a subordinated social category (e.g., Harrison et al., 2021; Mulderrig, 2017; Raisborough et al., 2019, Raisborough et al., 2022; Rich, 2011). More generally, as Hatherley (2015, p. 67) has written, “fatness is used as visual shorthand to signify the working-classes’ supposed bad spending, bad eating habits, and in short ‘bad taste’”. Thus, in contemporary United Kingdom culture, the larger-bodied working-class body has come to symbolise a condition of being socially and physically “unfit”, a visible state of being irresponsible and lacking in self-control (Hatherley, 2015; Jones, 2012; Rich, 2011; Rich et al., 2015). In making these constructions, obesity performs a specific socio-political function: casting doubt on the legitimacy of people’s impairments and on entitlement to support, and thus shifting the blame for economic hardship onto marginalised groups (Raisborough, 2016; Wacquant, 2008).

Extending these perspectives, and drawing on Link and Phelan’s (2014) theorising of the motives of stigma (i.e., stigma as means of keeping people in, away, or down), it might be suggested that weight-related stigma and discrimination are a means for those of high socioeconomic status to maintain their wealth, status, and power (Bernard et al., 2019) and to place a symbolic distance between themselves and those of low(er) socioeconomic status (Boero, 2012, Saguy, 2013). That is, because socioeconomic status is a largely invisible characteristic and to the extent that being larger-bodied is constructed as a metaphor for lower socioeconomic status, individuals or groups of high socioeconomic status may engage in weight-related stigma and discrimination to keep larger-bodied individuals down. However, studies testing this hypothesis have returned mixed results, with studies variously indicating that higher educational attainment and income (proxies of socioeconomic status) are positively, negatively, or not significantly associated with weight-related stigma, discrimination, and support for anti-discrimination laws and policies, respectively (for a review, see Bernard et al., 2019).

One limitation of this body of work, however, lies in the reliance on proxies of socioeconomic status, such as educational attainment and income. Although education and income may provide useful indicators of a person’s socioeconomic status, these indices may not fully reflect relevant attitudinal dimensions – learned and reinforced through sociocultural routes (Ajzen & Cote, 2008) – that shape weight-related beliefs (Bourdieu, 1987). More to the point, there may be greater value in focusing on attitudes toward poverty (Feagin, 1972), which broadly focus on individualistic (i.e., a person’s deficits or inability to pull themselves out of poverty) or structural explanations (i.e., socioeconomic structures in society that limit opportunities of people living in poverty; Weiner et al., 2011; Yun & Weaver, 2010). In this sense, it is likely that individualistic anti-poverty attitudes – rather than education or income – underpin the extent to which weight-related stigma and discrimination are mobilised to keep larger-bodied individuals down. To our knowledge, however, this proposition has not been previously tested vis-à-vis weight-related stigma, discrimination, and support for anti-discrimination laws and policies.

Here, we suggest that – in the United Kingdom at least – weight-related attitudes may be predicated on neoliberal health discourse generally and attitudes toward poverty more specifically. That is, we begin by locating attitudes toward individuals living in poverty as the cognitive and affective basis that allows for the development and maintenance of negative weight-related attitudes and behavioural dispositions. From this point-of-view, and to the extent that being larger-bodied is conflated with living in poverty (Hatherley, 2015), positioning individuals as being responsible for “being poor” – for example, as a result of bad choices and personal failings, and a lack of motivation, work ethic and moral stature (Reutter et al., 2005) – affords a stigmatising worldview that leads to the stigmatisation and discrimination of larger-bodied individuals. Put differently, weight-related attitudes are hypothesised as being predicated upon attitudes toward poverty. As such, our work shifts the ontological focus away from proxies of socioeconomic status (e.g., educational attainment) and onto socioculturally-learned attitudinal dispositions.

More specifically, we firstly hypothesised that attitudes toward poverty (wherein individuals living in poverty are cast as responsible for their condition and discriminated against) would be significantly associated with lower support for weight-related anti-discrimination policies and laws (H₁). Additionally, and based on the review above, we also hypothesised a serial indirect mediation association (i.e., a mediation via two or more mediators that are closely associated due to theoretical underpinnings or empirical findings) linking attitudes toward poverty and support for weight-related anti-discrimination policies and laws via personal attributions for being larger-bodied, stigmatisation of larger-bodied individuals, and prejudice towards larger-bodied individuals (H₂). In this model, we hypothesised that personal attributions for being larger-bodied would precede both stigmatisation and prejudice, which would be consistent with existing research (e.g., Crandall & Biernat, 1990; Puhl & Brownell, 2003). A graphical representation of this hypothesised model is presented in Fig. 1. Finally, given that gender identity is equivocally associated with support weight-related anti-discrimination laws and policies (Hilbert et al., 2017, Puhl et al., 2016), we also tested the invariance of our hypothesised model across gender.