Effects of anti-obesity messages on women's body image and eating behaviour

    Effects of Anti-Obesity Messages on Women’s Body Image and Eating Behaviour Rachel Shentow-Bewsh, Leah Keating, Jennifer S. Mills PII: DOI: Reference:

S1471-0153(15)30026-X doi: 10.1016/j.eatbeh.2015.11.012 EATBEH 998

To appear in:

Eating Behaviors

Received date: Revised date: Accepted date:

13 December 2013 12 November 2015 12 November 2015

Please cite this article as: Shentow-Bewsh, R., Keating, L. & Mills, J.S., Effects of Anti-Obesity Messages on Women’s Body Image and Eating Behaviour, Eating Behaviors (2015), doi: 10.1016/j.eatbeh.2015.11.012

This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

ACCEPTED MANUSCRIPT 1

SC

RI

PT

Running head: EFFECTS OF ANTI-OBESITY NARRATIVES

NU

Effects of Anti-Obesity Messages on Women‟s Body Image

MA

and Eating Behaviour

Rachel Shentow-Bewsh

AC CE P

TE

D

Leah Keating

Jennifer S. Mills

York University

Corresponding Author: Prof. Jennifer Mills, Department of Psychology, York University, 4700 Keele St., Toronto, Ontario M3J 1P3, Canada; Tel: 416-736-2100 ext 33153; Fax: 416-7365814; Email: [email protected].

ACCEPTED MANUSCRIPT Running head: EFFECTS OF ANTI-OBESITY NARRATIVES

2

Abstract Objectives: It has been suggested that obesity stigmatization contributes to negative mental

PT

health outcomes, particularly among overweight individuals. This study examined the effects of

RI

exposure to media-portrayed anti-obesity messages on women‟s state self-esteem, body esteem,

SC

and food intake. It was hypothesized that exposure to anti-obesity messages would result in decreased state self-esteem and body esteem and in increased food intake, and that these effects

NU

would be more pronounced in individuals with either higher BMI or stronger perceived pressure

MA

to be thin. Method: Participants were randomly assigned to one of three experimental conditions in which they either: read a fictitious media article containing either anti-obesity messages or

D

non-obesity-related health messages, or completed a neutral control task (word search). State

TE

self-esteem and body esteem were measured before and after the manipulation. Participants also

AC CE P

completed a candy taste rating task and ad lib consumption was surreptitiously measured. Results: There was no main effect of condition on either psychological outcome variable or on grams consumed. Higher perceived sociocultural pressure to be thin was associated with a decrease in body esteem after reading the anti-obesity article only. Having a higher BMI was associated with greater candy intake in the word search condition. This trend was also apparent in the sun exposure condition, but not in the anti-obesity condition. Discussion: Exposure to anti-obesity messages appears to decrease weight-related body esteem in women who already feel strong pressure to be thin, and may lead heavier women to suppress their food intake.

Keywords: anti-obesity narratives, obesity stigmatization, body image, self-esteem, eating behaviours

ACCEPTED MANUSCRIPT Running head: EFFECTS OF ANTI-OBESITY NARRATIVES

3

PT

Effects of Anti-Obesity Messages on Women‟s Psychological Functioning

1. Introduction

RI

and Eating Behaviour

SC

Weight stigmatization refers to implicit or explicit messages surrounding the

NU

undesirability of being overweight or obese (Brown, 2012). Messages perpetuating negative stereotypes of obese individuals have become increasingly prevalent in the mass media in recent

MA

years. Research has indicated that estimates of audience size for anti-obesity campaigns have increased since 2001 (Emery, Szczypka, Powell, & Chaloupka, 2007). News media articles also

D

tend to dramatize the issue of obesity, often referring to the “obesity epidemic” (Saguy &

TE

Almeling, 2008, p. 59). In a review of Swedish newspaper articles, Sandberg (2007) found that

AC CE P

articles on obesity became increasingly alarmist between 1997 and 2001. Additionally, the articles often implied personal responsibility for overweight or obese status. Various other forms of media also tend to portray obese individuals unfavourably, depicting them as “ugly,” “stupid,” “lazy,” and “greedy” (Sandberg, 2007). In obese individuals, exposure to stigmatization has been associated with lower self-esteem, higher body dissatisfaction, and poorer psychological functioning (Annis, Cash, & Hrabrosky, 2004; Myers & Rosen, 1999; Puhl & Brownell, 2006). Somewhat paradoxically, weight stigmatization may make it more difficult for individuals to regulate their eating behaviours by increasing their levels of distress. According to Heatherton and Baumeister‟s (1991) escape theory, overeating can result from a desire to escape from an unpleasant self-image. Specifically, escape theory states that individuals who are prone to binge eating tend to perceive others to hold high standards for them. These standards or

ACCEPTED MANUSCRIPT Running head: EFFECTS OF ANTI-OBESITY NARRATIVES

4

expectations may be specifically related to body thinness or, more generally, to the belief that they should be successful or popular. When these individuals are unable to meet the high

PT

standards, they become prone to increased negative affect, and become vigilant to others‟ potential negative evaluations of them. To escape from this aversive self-awareness, they restrict

RI

their attention away from an aversive self-image and onto “forbidden” food, since it is something

SC

that they can focus on instead. Subsequently, any dietary inhibitions dissolve and individuals

NU

become likely to overeat (Heatherton & Baumeister, 1991). As such, escape theory may explain how obesity stigmatization and its psychological effects could actually result in the increased

MA

consumption of high calorie, palatable foods.

Consistent with this theory, emerging research has indicated that weight stigmatization,

TE

D

which can make some people feel negatively evaluated, predicts psychological distress and overeating (Thomas, Hyde, Karunaratne, Herbert, & Komesaroff, 2008; Ashmore et al., 2008).

AC CE P

Moreover, the effect of weight stigmatization on increased eating has been found to be stronger for overweight women than for normal-weight women (Schvey, Puhl, & Brownell, 2011) who, presumably, perceive heightened negative self-evaluation when exposed to weight stigmatization.

In addition to objective weight status, some trait variables may predispose some individuals to being particularly vulnerable to negative psychological outcomes following weight stigmatization. Specifically, perceived pressure to be thin may exacerbate the influence of weight stigmatization on an individual‟s thoughts, feelings, and behaviour by leading to a heightened awareness of how one‟s body does not conform with sociocultural body ideals. Indeed, research suggests that pressure to be thin and related constructs, including endorsement of the thin ideal and mass-media consumption, predict body dissatisfaction and lower self-esteem in girls and

ACCEPTED MANUSCRIPT Running head: EFFECTS OF ANTI-OBESITY NARRATIVES

5

women (Botta, 1999; Harrison & Cantor, 1997; Cafri, Brannick, & Thompson, 2005; LòpezGuimèra et al., 2010; Stice, Maxfield, & Wells, 2003; Stice, Spangler, & Agras,

PT

2001).Moreover, the media seem to inform and reinforce individuals‟ perceptions of the thin ideal (see Lòpez-Guimèra, Levine, Carracedo, & Fauquet, 2010). It may be that high perceived

RI

pressure to be thin increases individuals‟ vulnerability to adverse effects following exposure to

SC

weight stigmatizing messages, since these messages explicitly reinforce the undesirability of

NU

being heavy. 1.1 The Current Study

MA

In sum, previous research has suggested that exposure to weight stigmatizing messages negatively impacts individuals‟ psychological well-being (e.g., Myers & Rosen, 1999). There is

TE

D

indirect evidence that such messages may have an effect on eating behaviours (Ashmore et al., 2008) in the form of increased food consumption. The current study examined the effects of

AC CE P

exposure to a fictitious media article featuring obesity-stigmatizing content on participants‟ selfesteem, body image, and in situ eating behaviour. We did not measure “binge eating” per se as a construct with clinical significance. However, we examined women‟s ad lib consumption of a high calorie, low nutrient food (candy) as a function of exposure to weight stigmatizing messages, since many individuals try to avoid this type of food when losing weight. To maximize the impact of the manipulation, we presented a multidimensional weight-stigmatizing article, including a narrative regarding the apparent negative effects of obesity on physical health, social status, and appearance. As comparison conditions, we included both a non-obesity health message control condition (reading about the effects of sun exposure) and a neutral control task (a word search). We were specifically interested in the effects of anti-obesity messages on body image, self-esteem, and eating over and above the effects of reading about the

ACCEPTED MANUSCRIPT Running head: EFFECTS OF ANTI-OBESITY NARRATIVES

6

risk of any health condition. Thus, the sun exposure control condition was intended to control for the potential effects of reading about the negative consequences of any dangerous health

PT

condition on these outcomes. To our knowledge, no previous studies on the effects of anti-

RI

obesity messages have included both a non-obesity-related health message control condition and a neutral, unrelated control condition.

SC

We hypothesized that: (1) consistent with Thomas et al. (2008) , participants who read an

NU

anti-obesity article would report lower self-esteem and lower body esteem than those who read a non-obesity-related health article or who complete a neutral task; (2) consistent with Stice et al.

MA

(2001) and Friedman et al. (2005), the relationships predicted in (1) would be stronger for those higher in perceived pressure to be thin than for those lower on that trait, and for those with a

TE

D

higher BMI than for those with lower a BMI; and (3) in line with hypothesis (1) and consistent with Schvey et al. (2011) among participants who read the anti-obesity narrative, those with a

AC CE P

higher BMI would consume more candy during an ostensible taste rating task than would those with a lower BMI.

2. Method

2.1 Participants

One hundred twenty female undergraduate students enrolled in Introductory Psychology at York University participated in the current study. Only women were included because research has shown that levels of body dissatisfaction and weight concern are significantly higher in women than in men (e.g., Mills, Polivy, McFarlane, & Crosby, 2012; Schwartz & Brownell, 2004) and because the negative relationship between BMI and psychological wellbeing is particularly strong for women (Bookwala & Boyar, 2008). The age range of the sample was 17 to 57 (M = 20.35, SD = 4.70). The BMI range was 16.21-38.65, with a mean of 24.05

ACCEPTED MANUSCRIPT Running head: EFFECTS OF ANTI-OBESITY NARRATIVES

7

(SD = 4.58) and a median of 22.79 (IQR = 5.25), indicating that our sample tended to fall in the “normal” range (World Health Organization [WHO], 2013). Thirty-seven participants (30.8%)

PT

were overweight or obese, or had a BMI of at least 25.0 (WHO, 2013). The weight

RI

characteristics of the sample were consistent with previous samples of female undergraduate students at that university (Mills, Jadd, & Key, 2012). The self-identified ethnic distribution of

SC

the sample was 25.8% White/Caucasian, 16.7% Black/African American, 25.0% Asian, 1.7%

NU

Hispanic/Latino, 4.2% Biracial, and 25.8% Other ethnic identification; one participant did not report her ethnicity.

MA

2.2 Measures

Mood. To measure baseline negative mood, the Negative Affect subscale of the Positive

TE

D

and Negative Affect Scale- Expanded (PANAS-X; Watson & Clark, 1994) was used. The PANAS-X contains 60 items that measure different emotional states. The Negative Affect

AC CE P

subscale contains 10 items and assesses markers of negative affect. Response options range from 1 (very slightly or not at all) to 5 (extremely). Higher scores indicate greater negative affect. The PANAS-X has shown evidence of validity and internal consistency (Watson & Clark, 1994). In the current sample, Cronbach‟s alpha was .79. Hunger. To assess whether participants experienced equivalent levels of premanipulation hunger and to control for potential group differences in hunger or fullness, we included two items at the end of the PANAS-X: one assessed hunger, and the other assessed fullness. Response options ranged from 1 (very slightly or not at all) to 5 (extremely). Fullness was reverse coded and the hunger and fullness ratings were then summed to create an overall hunger index. Self-esteem. To measure state self-esteem, we used the Current Thoughts Scale

ACCEPTED MANUSCRIPT Running head: EFFECTS OF ANTI-OBESITY NARRATIVES

8

(Heatherton & Polivy, 1991). This scale is comprised of 20 items assessing how the individual views him- or herself. Response options range from 1 (not at all) to 5 (extremely). Total scores

PT

can range from 20 to 100; higher scores represent higher state self-esteem. This scale has shown evidence of validity and internal consistency (Heatherton & Polivy, 1991). In the current sample,

RI

Cronbach‟s alpha was .90.

SC

Body image. The Body Esteem Scale (Franzoi & Shields, 1984) was used to measure

NU

state body dissatisfaction. This scale is comprised of 32 items that measure respondents‟ feelings about their bodies and appearance. Respondents rate how they feel about different parts and

MA

functions of their bodies on a scale of 1 (have strong negative feelings) to 5 (have strong positive feelings). Higher scores represent higher body esteem. There are three body esteem factors for

D

each gender. For women, these factors are sexual attractiveness, weight concern, and physical

TE

condition. The mean of these subscale scores indicates participants‟ overall level of body

AC CE P

dissatisfaction. The Body Esteem Scale has demonstrated evidence of validity and internal consistency (Franzoi, 1994; Franzoi & Shields, 1984). In the current sample, for overall body esteem scores, Cronbach‟s alpha was .93; Cronbach‟s alpha was .93 for sexual attractiveness, .90 for weight concern, and .86 for physical condition. To assess participants‟ perceptions of their body size, the Contour Drawing Scale (Thompson & Gray, 1995) was used. This scale presents nine drawings of female silhouettes, which increase in size from left to right. As is commonly done, participants selected the silhouette they felt best resembled first their current and then their ideal body size (Thomson & Gray, 1995; Wertheim, Paxton, & Tilgner, 2004). Subtracting ideal figure ratings from current figure ratings provided an index of body dissatisfaction, with higher scores representing greater dissatisfaction. The Contour Drawing Scale has been found have a test-retest reliability of r = .78

ACCEPTED MANUSCRIPT Running head: EFFECTS OF ANTI-OBESITY NARRATIVES

9

(Thompson & Gray, 1995). It has also demonstrated evidence of concurrent validity, as contour drawing selection was found to be correlated with self-reported weight at r = .71 and BMI at .59

PT

(Thompson & Gray, 1995).

RI

Perceived Sociocultural Pressure (PSP). The Perceived Sociocultural Pressure Scale (Stice & Bearman, 2001) was used to measure the extent to which participants feel pressure from

SC

the media, family, and friends to be thin. This scale has eight items with response options

NU

ranging from 1 (none) to 5 (a lot); higher scores indicate greater perceived pressure to be thin (Stice & Whitenton, 2002). The Perceived Sociocultural Pressure Scale has shown evidence of

MA

validity and internal consistency (Stice & Whitenton, 2002). In the current study, Cronbach‟s alpha was .83.

TE

D

Representativeness of media articles. To assess participants‟ reactions to the fictitious media articles, they were asked to complete a questionnaire measuring the extent to which they

AC CE P

found the articles effective, persuasive, personally relevant, and similar to other articles they had read. Response options ranged from 1 (Not at all relevant) to 10 (Extremely relevant). 2.3 Procedure

Participants signed up for a study on “how personality affects one‟s perception of media messages.” The experiment was run by two normal-weight female researchers who wore lab coats to minimize any potential social comparison on body size from participants. Each participant was tested individually in a single testing session lasting approximately 1 hour. Participants read and signed an informed consent form. They then completed the PANAS-X, the Current Thoughts Scale, and the Body Esteem Scale. Prior to their arrival, a random number generator was used to randomize participants to one of three experimental conditions. Participants assigned to the anti-obesity condition read an article that described the health and

ACCEPTED MANUSCRIPT Running head: EFFECTS OF ANTI-OBESITY NARRATIVES

10

economic costs of obesity (Appendix A), and those assigned to the sun exposure condition read an article that described the effects of excessive sun exposure (Appendix B). Participants

PT

assigned to the second control condition completed a word search. As mentioned earlier, the

RI

inclusion of two control groups was to more precisely isolate the experimental manipulation to anti-obesity messages, and not just any health warning message. Both health articles were

SC

written by the authors and piloted by a group of female undergraduate and graduate students to

NU

ensure that they were perceived as being stigmatizing and relevant to young women. Both articles contained narratives, which can be defined as “...emotionally interesting and image-

MA

evoking cohesive and coherent stories” (Lemal & Van den Bulck, 2010, p.178). Narratives were included because previous research has found that that health messages may be more effective

TE

D

when expressed through narrative messages than through more fact-based approaches (Lemal & Van den Bulck, 2010). A thumbnail image was embedded in each article, as a review of obesity-

AC CE P

related news articles indicated that such articles frequently include images (Heuer et al., 2011). Consistent with this review‟s finding that these images often obscure obese individuals‟ faces (Heuer et al.), heads were omitted from the images included in the current study. The experimenter recorded the length of time that participants took to read the articles. The word search task was intended to be a neutral condition that would control for time. We considered using an alternative control task whereby participants would have read a neutral article, but we ascertained that no text of the same length would be completely neutral for all participants. Since the word search also required some reading and was deemed by the team of researchers in our lab to be easy, moderately engaging, and not related to health risk we determined it to be a suitable neutral control task. The word search was a 23 word-squared grid and the task was to find the names of 20 male and female “classic stars” of television and movies

ACCEPTED MANUSCRIPT Running head: EFFECTS OF ANTI-OBESITY NARRATIVES

11

(e.g., Gregory Peck, Linda Darnell). No names on the list were readily associated with either thinness or obesity. Participants in the word search control condition were given 7 minutes to

PT

work on the task in order to match for the average length of time that pilot participants took to

RI

read the article. To avoid evoking feelings of anxiety or frustration in participants, we did not provide instructions or encouragement to perform well on the word search. Next, participants

SC

who read an article completed their ratings of the article. To maintain the study‟s cover story,

NU

participants in the word search condition completed a questionnaire on their general media

MA

usage.

All participants then completed the measures of state self-esteem and body image.

D

Following their completion, the experimenter carried two medium-sized bowls into the room.

TE

One bowl was filled with M&Ms and the other was filled with Skittles. The experimenter gave participants a taste rating questionnaire, which included questions about how enjoyable the

AC CE P

candy was, as well as about how often they have seen the candy advertised in the past year. Participants were told to taste and rate the candies and to feel free to eat as much candy as they wanted because the lab had “tons of extra candy.” The experimenter left participants to complete the taste rating task for 10 minutes. Unbeknownst to the participants, both bowls were weighed to the nearest hundredth of a gram before and after the taste-rating task in order to surreptitiously calculate amount eaten. A similar taste-rating situation (i.e., paradigm) has been used in previous eating research (e.g., Mills & Palandra, 2008). Following the taste task, all participants completed the trait measures, including the measure of perceived sociocultural pressure and the demographics questionnaire. They were then debriefed about the true nature of the study. No participant correctly guessed the study‟s actual purpose. Next, the experimenter measured participants‟ objective height and weight using a

ACCEPTED MANUSCRIPT Running head: EFFECTS OF ANTI-OBESITY NARRATIVES

12

traditional scale that was calibrated prior to use. This information was used to calculate BMI. The study was approved by the university‟s research ethics review committee.

PT

2.4 Statistical Analyses

RI

To examine the effects of condition on change in the psychological outcome variables,

SC

we ran mixed design analyses of variance (ANOVAs) with condition as the between-subjects factor and time as the within-subjects factor. To examine the effects of condition on perception

NU

of body size using the Contour Drawing Scale, which was assessed only at post-manipulation,

MA

we conducted a one-way ANOVA.

To examine whether BMI and perceived pressure to be thin moderated the relationships

D

among condition and changes in self-esteem and body esteem, we used hierarchical multiple

TE

regression with residual change scores as the outcome variables. Residual change scores were

AC CE P

used because unlike simple change scores, they are not dependent on the initial levels of the prescores (Cohen, Cohen, West, & Aiken, 2003).Condition and either mean-centered BMI or meancentered perceived pressure to be thin scores were entered in the first step of the model, and the condition x BMI or condition x perceived pressure to be thin interaction was entered in the second step. Condition was dummy-coded with the anti-obesity condition as the reference group. To examine the effects of condition on grams consumed, a one-way ANOVA was conducted. To examine whether BMI moderated the relationship between condition and food intake, we used hierarchical multiple regression with condition and mean-centered BMI in the first step of the model and their interaction in the second step. 3. Results 3.1 Data Screening and Preliminary Analyses

ACCEPTED MANUSCRIPT Running head: EFFECTS OF ANTI-OBESITY NARRATIVES

13

All analyses were conducted using SPSS 20.0. All variables were assessed for missing data and multivariate normality. Little‟s (1988) Missing Completely at Random test was not

PT

significant, χ2(18) = 16.87, p =.532, indicating that the data were missing at random. Among the

RI

pre- and post-manipulation variables, three univariate outliers were identified and adjusted to within 3.29 standard deviations of the mean (Tabachnick & Fidell, 2007). There were also two

SC

univariate outliers on age. Unless noted below, statistical conclusions did not change once these

NU

cases were excluded. BMI and number of grams consumed were significantly positively skewed. The distributions of these variables improved after square root transformation; the transformed

MA

variables were used in all subsequent analyses.

Among the residual change score variables (described below), there were seven

TE

D

univariate outliers. Two of these cases were also multivariate outliers (χ2 < .001). Analyses were run with and without adjusting the outliers. With the exception of two analyses (discussed

AC CE P

below), results did not change once the outliers were adjusted. Additionally, residual change scores in body esteem, in the physical condition subscale of the Body Esteem Scale, were significantly leptokurtic (p < .001). The original distributions were retained because: the outliers were determined to represent valid scores, the pre- and post-treatment variables were normally distributed, the outliers and kurtosis were not severe (z < 4.25), and inspection of histograms suggested that the variables were normally distributed. All other statistical and regression assumptions were deemed to be met. Next, we ran independent samples t-tests to assess for potential differences between the experimenters and conditions on the study variables. We then ran independent samples t-tests to assess for between-condition differences in the extent to which participants found the articles representative. There were no between-experimenter differences in participants‟ scores for any

ACCEPTED MANUSCRIPT Running head: EFFECTS OF ANTI-OBESITY NARRATIVES

14

study variable. Furthermore, the conditions did not differ significantly on BMI, age, hunger, time taken to read the articles, or on any pre-manipulation study variable. Table 1 shows the

PT

descriptive statistics for these variables. There were no significant differences between the anti-

RI

obesity and sun exposure conditions in the extent to which participants found the articles relevant, effective, persuasive, and similar to other articles. Participants found the articles

SC

effective (M = 7.34, SD = 1.81), persuasive (M = 7.54, SD = 1.88), similar to other articles they

NU

had read (M = 8.09, SD = 1.69), and moderately relevant to them (M = 5.46, SD = 2.65). Table 1

MA

Means (and Standard Deviations) for All Variables of Interest

AC CE P

TE

D

Anti-Obesity Sun Exposure Word Search Variable Condition Condition Condition Total Sample (n = 40) (n = 40) (n = 40) (n = 120) BMI 24.39 23.78 23.96 24.04 (5.13) (4.76) (3.84) (4.58) Age in years 20.48 19.90 20.68 20.35 (6.34) (2.40) (4.53) (4.70) Level of hunger 5.90 6.70 5.98 6.19 (1.55) (1.70) (1.89) (1.74) Time taken to read article in 274.58 264.30 __ 269.44 seconds (72.15) (85.75) (78.91) PANAS-X Negative Affect 2.12 2.01 2.19 2.11 (0.60) (0.63) (0.74) (0.65) Current Thoughts Scale (Pre) 70.35 69.83 67.68 69.28 (12.23) (13.54) (14.08) (13.25) Current Thoughts Scale (Post) 72.27 69.82 67.36 69.81 (13.18) (14.31) (13.89) (13.83) Body Esteem Scale (Pre) 3.36 3.51 3.29 3.39 (0.60) (0.70) (0.64) (0.65) Body Esteem Scale (Post) 3.33 3.49 3.26 3.36 (0.66) (.75) (0.65) (0.69) Contour Drawing Scale 1.26 1.06 1.55 1.29 (1.57) (1.35) (1.39) (1.44) Food Intake 31.08 28.33 27.89 29.10 (23.07) (22.72) (24.66) (23.34) 2 Note. BMI = body mass index (kg/m ). PANAS-X = Positive and Negative Affect ScaleExpanded. With the exception of the analyses that examined BMI as a moderator, all analyses in this

ACCEPTED MANUSCRIPT Running head: EFFECTS OF ANTI-OBESITY NARRATIVES

15

study were conducted with and without controlling for BMI. With one exception, statistical conclusions did not change controlling for BMI. Unless otherwise specified, results are reported

PT

without BMI as a covariate.

RI

We also ran a multivariate analysis of variance to compare identification with the different ethnic groups on BMI, on perceived sociocultural pressure to be thin, on residual

SC

change in body esteem and in the body esteem subscales, on residual change in self-esteem, on

NU

contour drawing scale scores, and on grams consumed. Due to the small number of participants who self-identified as Hispanic and Biracial, these individuals were classified as “Other” for the

MA

purpose of this analysis. Using Wilk‟s lambda, there was no significant multivariate effect of ethnicity on this combination of variables, F(24, 327) = 1.15, p = .290, partial η2 = .08.

TE

D

Moreover, ethnicity had no main effect on any of the dependent variables (all ps > .05). 3.2 Effects of Condition on Psychological Outcomes

AC CE P

State self-esteem was not significantly affected by condition, F(2, 117) = 0.82, p = .444, ηp2 = .01, by time, F(1, 117) = 1.58, p = .211, ηp2 = .01,or by condition x time interaction, F(2, 117) = 2.75, p = .068, ηp2 = .05.

Similarly, body esteem was not significantly affected by condition, F(2, 117) = 1.21, p = .301, ηp2 = .02, by time, F(1, 117) = 2.20, p = .141, ηp2 = .02, or by condition x time interaction, F (2, 117) = 0.07, p = .929, ηp2 = .001. The effect of condition on each subscale of the Body Esteem Scale was also analyzed. Sexual attractiveness scores were not affected by condition, F(2, 117) = 1.18, p = .31, ηp2 = .02, by time, F(1, 117) = 1.45, p = .231, ηp2 = .01, or by condition x time interaction, F(2, 117) = 0.16, p = .849, ηp2 = .003. Likewise, weight concern was not affected by condition, F(2, 117) = 0.67, p = .521, ηp2 = .01, by time, F(1, 117) = 0.68, p = .412, ηp2 = .01, or by condition x time interaction,

ACCEPTED MANUSCRIPT Running head: EFFECTS OF ANTI-OBESITY NARRATIVES

16

F(2, 117) = 0.24, p = .786, ηp2 = .004. Additionally, physical condition was not affected by condition, F(2, 117) = 1.28), p = .283, ηp2 = .02, by time F(1, 117) = 1.67, p = .199, ηp2 = .01, or

PT

by condition x time interaction, F(2, 117) = 0.01, p = .990, ηp2 = .0002. Condition did not significantly affect scores on the Contour Drawing Scale, F (2, 117) =

RI

1.15, p = .320, ηp2 = .019. Thus, contrary to the first hypothesis, condition alone did not have a

SC

significant effect on any of the psychological variables measured.

NU

3.4 Moderating Effect of BMI

Table 2 shows the results of each step of the regression analyses predicting the regressed

MA

change scores from condition, BMI, and their interaction. Adding condition, BMI, and their interaction did not significantly improve any of the models predicting change in the self-esteem

TE

D

or body esteem variables. Therefore, contrary to the second hypothesis, BMI did not moderate

Table 2

AC CE P

the relationship between condition and the psychological outcomes.

Predicting Change in Psychological Variables from Condition, BMI, and their Interaction Regressed Change Outcome Variable F p ΔR2 Self-Esteem Step 1: Condition and BMI 1.97 .122 .05 Step 2: Condition x BMI 0.70 .514 .01 Total Body Esteem Step 1: Condition and BMI 0.23 .879 .01 Step 2: Condition x BMI 1.21 .302 .02 Body Esteem: Sexual Attractiveness Step 1: Condition and BMI 0.17 .916 .004 Step 2: Condition x BMI 0.62 .538 .01 Body Esteem: Weight Concern Step 1: Condition and BMI 0.81 .493 .02 Step 2: Condition x BMI 1.41 .249 .02 Body Esteem: Physical Condition Step 1: Condition and BMI 0.04 .991 .001 Step 2: Condition x BMI 1.16 .318 .02 Note. For the first step of the models, F(2, 116). For the second step, F(2, 114).

R2

.06

.03

.02

.04

.02

ACCEPTED MANUSCRIPT Running head: EFFECTS OF ANTI-OBESITY NARRATIVES

17

3.5 Moderating Effect of Perceived Sociocultural Pressure Table 3 shows the results of each step of the regression analyses predicting the residual

PT

change scores from condition, perceived sociocultural pressure to be thin, and their interaction.

RI

Condition, perceived pressure to be thin scores, and their interaction did not significantly predict change in self-esteem, or in the sexual attractiveness or physical condition components of body

SC

esteem.

NU

Table 3

Predicting Change in Psychological Variables from Condition, Perceived Sociocultural

MA

Pressure, and their Interaction

AC CE P

TE

D

Regressed Change Outcome Variable F p ΔR2 R2 Self-Esteem Step 1: Condition and PSP 1.86 .140 .05 Step 2: Condition x PSP 0.63 .536 .01 .06 Total Body Esteem Step 1: Condition and PSP 0.77 .516 .02 Step 2: Condition x PSP 2.43 .093 .04 .06 Body Esteem: Sexual Attractiveness Step 1: Condition and PSP 0.20 .899 .01 Step 2: Condition x PSP 0.17 .844 .003 .01 Body Esteem: Weight Concern Step 1: Condition and PSP 0.89 .451 .02 Step 2: Condition x PSP 2.47 .089 .04 .06 Body Esteem: Physical Condition Step 1: Condition and PSP 0.21 .888 .01 Step 2: Condition x PSP 0.57 .570 .01 .02 Note. PSP = Perceived sociocultural pressure. For the first step of the models, F(2, 115). For the second step, F(2, 113). Entering condition and perceived pressure to be thin scores into the model also did not significantly predict change in overall body esteem. Adding the condition x perceived pressure to be thin interaction did not significantly improve the model. Similarly, the condition x perceived pressure to be thin interaction was not significant using the anti-obesity vs. sun exposure condition variable, B = 0.24, SE = 0.06, β = 0.05, t(113) = 0.43, p = .670, pr2 = .002. However,

ACCEPTED MANUSCRIPT Running head: EFFECTS OF ANTI-OBESITY NARRATIVES

18

the interaction was significant using the anti-obesity vs. word search condition variable, B = 0.11, SE = 0.05, β = 0.28, t(113) = 2.11, p = .037, pr2 = .04. For participants in the anti-obesity

PT

condition, perceived pressure to be thin was marginally significantly related to change in body

RI

esteem, B = -0.08, SE = 0.04, β = -0.31, t(113) = -1.97, p = .056, pr2 = .09. That is, participants higher in perceived pressure to be thin tended to experience greater reductions in body esteem.

SC

This relationship was not significant in the word search condition, B = 0.03, SE = 0.04, β = 0.14,

NU

t(113) = 0.85, p = .400, pr2 = .14. The condition x PSP interaction was no longer significant once BMI was controlled for (p = .056). However, because BMI was not significantly associated with

MA

change in body esteem, the final model did not include BMI as a predictor. The interaction

TE

trend was in the same direction.

D

became only marginally significant (p = .082) once an outlier was adjusted (z < 3.29), though the

Condition, perceived pressure to be thin, and their interaction accounted for 6.4% of the

AC CE P

variance in change in weight concern (i.e., in weight-related body esteem). Entering condition and perceived pressure to be thin scores into the model did not significantly predict change in weight concern, F(3, 115) = 0.89, p = .451, R2 = .02. Adding the condition x perceived pressure to be thin interaction did not significantly predict change in weight concern, Fchange(2, 113) = 2.47, p = .089, R2change = .04. Similarly, there was no significant condition x perceived pressure to be thin interaction using the anti-obesity vs. sun exposure condition variable, B = 0.14, SE = 0.08, β = 0.22, t(113) = 1.81, p = .073, pr2 = .03. However, there was a significant condition x perceived pressure to be thin interaction using the anti-obesity vs. word search condition variable, B = 0.14, SE = 0.07, β = 0.26, t(113) = 1.99, p = .049, pr2 = .03. As a reminder, greater weight concern scores represent more positive body esteem (Franzoi & Shields, 1984), and therefore lower regressed change scores reflect greater reductions in those scores. In the anti-

ACCEPTED MANUSCRIPT Running head: EFFECTS OF ANTI-OBESITY NARRATIVES

19

obesity condition, higher perceived pressure to be thin tended to experience greater reductions in weight-related body esteem, B = -0.13, SE = 0.05, β = -0.41, t(113) = -2.70, p = .010, pr2 = .16.

PT

This relationship was not significant in the word search condition, B = 0.01, SE = 0.05, β = 0.02,

RI

t(113) = 0.11, p = .912, pr2 = .0003 (Figure 1). The interaction became only marginally significant (p = .084) once the outlier was adjusted, though the trend was in the same direction.

SC

This interaction also became marginally significant (p = .052) once the outliers on age were

AC CE P

TE

D

MA

NU

excluded.

Figure 1. Relationship between perceived sociocultural pressure (PSP) and change in weight concern for each study condition. Low PSP = 1 SD below the mean; High PSP = 1 SD above the mean. Therefore, the second part of the second hypothesis was partially supported; perceived pressure to be thin moderated the relationship between condition and body esteem, as well as weight concern. However, perceived pressure to be thin did not moderate the relationships between condition and the other psychological variables measured.

ACCEPTED MANUSCRIPT Running head: EFFECTS OF ANTI-OBESITY NARRATIVES

20

3.6 Effects of Condition on Food Intake Condition was not related to total grams consumed, F(2, 117) = 0.37, p = .695, ηp2 = .01.

PT

8

RI

6

SC

5

NU

4 3

1 0

Anti-Obesity Condition

Sun Exposure Condition

MA

2

Word Search Condition Low BMI

D

Number of Grams Consumed (Square Root Transformed)

7

High BMI

TE

Body Mass Index (Square Root Transformed)

AC CE P

Figure 2. Relationship between body mass index (BMI; square root transformed) and number of grams consumed (square root transformed) for each study condition. Low BMI = 1 SD below the mean; High BMI = 1 SD above the mean. Concerning the moderating effect of BMI on the relationship between condition and food intake, BMI, condition, and their interaction accounted for 8.4% of the variance in grams consumed. Entering condition and BMI into the model did not significantly predict grams consumed, F(3, 116) = 1.80, p = .150, R2 = .05. Adding the condition x BMI did not significantly improve model fit, Fchange(2, 114) = 2.46, p = .090, R2change = .04. Using the dummy-coded variable representing the anti-obesity vs. sun exposure condition, there was no significant condition x BMI interaction, B = 1.24, SE = 0.98, β = 0.16, t(114) = 1.27, p = .207, pr2 = .01. Using the variable representing the anti-obesity vs. word search condition, there was a significant condition x BMI interaction, B = 2.42, SE = 1.11, β = 0.25, t(114) = 2.18, p = .031, pr2 = .04. In

ACCEPTED MANUSCRIPT Running head: EFFECTS OF ANTI-OBESITY NARRATIVES

21

the anti-obesity condition, BMI was not significantly related to grams consumed, B = -0.09, SE = 0.67, β = - 0.02, t(38) = 0.13, p = .899, pr2 = .0004. In the word search condition, BMI was

PT

significantly positively related to grams consumed, B = 2.34, SE = 0.87, β = 0.40, t(38) = 2.68, p = .011, pr2 = .15 (Figure 2). Of note, this relationship was not significant in the sun exposure

SC

in the same direction as in the word search condition.

RI

condition, B = 1.15, SE = 3.49, β = 0.25, t(38) = 1.61, p = .115, pr2 = .06; however, the trend was

NU

Therefore, the third hypothesis was not supported, as the effect of the anti-obesity condition was not particularly strong for participants with higher BMIs. That is, participants with

MA

higher BMIs who read obesity-related messages did not consume more than participants with lower BMIs who read the same messages.

D

4. Discussion

TE

This study experimentally tested the impact of reading anti-obesity messages on women‟s

AC CE P

self-esteem, body image, and eating behaviour. The study‟s first hypothesis was that women who read an article containing anti-obesity messages would experience greater decreases in selfesteem and body esteem, compared to participants who read either a non-obesity-related health article or who completed a word search. The results did not support this hypothesis; condition had no effect on any changes in these variables. This finding is inconsistent with previous research indicating that exposure to obesity stigmatization is associated with poorer mental health (Myers & Rosen, 1999). However, other research has indicated that exposure to obesity stigmatization may be less important to psychological functioning than an individual‟s ability to cope with feelings resulting from stigmatization (Puhl & Brownell, 2006). We did not include any measure of coping that could be used as a potential moderator in this regard, such as defensiveness or avoidance. Since it is possible that some individuals minimize or otherwise

ACCEPTED MANUSCRIPT Running head: EFFECTS OF ANTI-OBESITY NARRATIVES

22

avoid negative psychological states resulting from stigmatization, future research could examine whether coping strategies moderate the impact of obesity-related media messages on

PT

psychological functioning.

RI

This study‟s second hypothesis was that the effects of exposure to anti-obesity messages on body image would be particularly negative for participants with a higher BMI and those who

SC

perceive greater sociocultural pressure to be thin. Results partially supported this hypothesis.

NU

BMI did not interact with condition in predicting change on any measure of body image. However, perceived pressure to be thin did interact with condition in predicting changes

MA

in both body esteem and in weight concern (i.e., weight-related body esteem). There was a tendency for those who perceived greater pressure to be thin to experience decreases in body

TE

D

esteem after reading the anti-obesity article. This relation between perceived pressure to be thin and body esteem was not present in those who read either a non-weight related health message,

AC CE P

or who completed a more neutral control task. Further analyses suggested that this interaction was attributable to the interaction between perceived pressure and condition in predicting change in weight concern. In the anti-obesity condition only, higher perceived pressure was associated with decreases in weight-related body esteem. This pattern of results indicates that in women who normally feel strong social pressure to be thin, reading anti-obesity messages may further increase their concerns about their weight. This finding is consistent with previous research indicating that media exposure reinforces individuals‟ perceptions of the thin ideal and increases body dissatisfaction (Lòpez-Guimèra et al., 2010). This study‟s third hypothesis was that exposure to anti-obesity messages would affect food intake and that any effect would be stronger for heavier individuals. This prediction was based on Heatherton and Baumeister‟s (1991) escape theory, which states that the feeling of

ACCEPTED MANUSCRIPT Running head: EFFECTS OF ANTI-OBESITY NARRATIVES

23

being negatively evaluated may lead to overeating among individuals prone to this behaviour, as well as on previous research indicating that exposure to weight-related stigmatizing material

PT

predicts increased food intake in obese adults (Ashmore et al., 2008; Schvey et al., 2011).

RI

Unexpectedly, BMI was statistically significantly related to amount of candy consumed in the word search condition, but not in the anti-obesity or sun exposure conditions. However, a visual

SC

inspection of this relationship (Figure 2) suggested that in both control conditions, heavier

NU

participants showed a tendency to eat more candy than the thinner participants. Conversely, in the anti-obesity message condition, heavier women appeared to eat less than they would have in

MA

the other conditions. This finding suggests that reading about the negative effects of obesity may lead heavier women to suppress their food intake more than they otherwise would have. While

TE

D

BMI was not statistically significantly related to food consumption in the sun exposure condition, the pattern of results in the sun exposure group suggested a trend that was more

AC CE P

similar to the word search condition than to the anti-obesity message condition. However, we may have had insufficient power to detect this relationship. Given previous research indicating that many obese individuals are unhappy with their weight (Greener, Douglas, & van Teijlingen, 2010), it is possible that exposure to messages about the dangers of obesity may have reminded these women of the health risks of overeating. Furthermore, research has shown that many obese individuals feel personally responsible for their weight (Greener et al., 2010). Thus, reading anti-obesity messages may lead these women to want to do something about it. This possibility is consistent with other research showing that dietary restraint is often motivated by a desire to lose weight (Fairburn et al., 2008). Future research may explore possible mechanisms that may explain why heavier participants may be more inclined to restrict their food intake upon reading anti-obesity narratives.

ACCEPTED MANUSCRIPT Running head: EFFECTS OF ANTI-OBESITY NARRATIVES

24

It is also possible that exposure to a weight-related emotionally-salient and personal story led heavier participants to feel motivated to decrease their food intake, rather than feel

PT

stigmatized; previous research has found that narrative health messages are more likely to

RI

motivate individuals to engage in health-promoting behaviours than non-narrative messages (Lemal & Van den Bulck, 2010). In our study, the anti-obesity messages were most relevant to

SC

heavier participants; therefore, it may have been particularly salient and motivating for them.

NU

Future research should study the effects of reading obesity-related messages on body dissatisfaction and eating behaviour, and how body size may influence those relations.

MA

This study had several limitations. First, only written articles were used in the current study. Kim and Willis (2007) found that compared to newspaper articles, television places more

TE

D

emphasis on individual-level causes of obesity. Additionally, research utilizing stigmatizing videos has found that weight stigmatization predicts increased food consumption (Schvey et al.,

AC CE P

2001). Future research may examine whether personalized videos differentially impact women‟s psychological functioning and eating behaviours. Second, although measures of negative mood, self-esteem, and body esteem were assessed at baseline, measures of psychological distress (such as depressive symptoms or anxiety) were not; it is possible that there were significant differences between the conditions on these variables that affected the results. Third, the reference to wearing bikinis in the sun-exposure message condition may have brought to mind the thin ideal for some participants, which may have affected their post-manipulation self-esteem or body esteem. Fourth, only low-nutrient, high-calorie food options were provided in the taste rating task. Future research should provide a variety of food options (e.g., healthy versus unhealthy food) in their paradigm to better understand how exposure to obesity-related messages can affect eating behaviours. Finally, it is unclear whether results from the current study generalize to

ACCEPTED MANUSCRIPT Running head: EFFECTS OF ANTI-OBESITY NARRATIVES

25

women‟s day-to-day experiences of anti-obesity media messages. However, participants rated the anti-obesity articles as similar to other articles that they had read, suggesting that the articles

PT

used in this study were representative of those that individuals might typically encounter in the media. Additionally, the inclusion of a taste-rating paradigm provided a behavioural measure of

RI

participants‟ reactions to anti-obesity messages. Nevertheless, future research should examine

SC

the effects of anti-obesity messages on women‟s psychological functioning and eating

NU

behaviours in a more naturalistic setting, as well as measure the effects of other potential moderating variables, such as coping style or level of internalization of the thin ideal.

MA

The current study‟s results indicate that exposure to anti-obesity messages may lead to body dissatisfaction among those who already feel strong sociocultural pressure to be thin.

TE

D

Furthermore, exposure to obesity-related messages may motivate heavier women to reduce their food consumption. Therefore, although the types of obesity-related messages currently found in

AC CE P

the news may suppress food intake among heavier women, they may not be the most appropriate way to simultaneously promote healthy living and body acceptance. These findings suggest that researchers, policy analysts, and advertisers should collaborate to develop media campaigns that promote both of these causes.

ACCEPTED MANUSCRIPT 26

PT

Running head: EFFECTS OF ANTI-OBESITY NARRATIVES

RI

References

SC

Annis, N. M., Cash, T. F., & Hrabosky, J. I. (2004). Body image and psychosocial differences among stable average weight, currently overweight, and formerly overweight women: the

doi:10.1016/j.bodyim.2003.12.001

NU

role of stigmatizing experiences. Body Image, 1, 155-167.

MA

Ashmore, J. A., Friedman, K. E., Reichmann, S. K., & Musante, G. J. (2008). Weight-based stigmatization, psychological distress, & binge eating behavior among obese treatment-

TE

D

seeking adults. Eating Behaviors, 9, 203–209. doi: 10.1016/j.eatbeh.2007.09.006 Blanchard, F. A., & Frost, R. O. (1983). Two factors of restraint: Concern for dieting and weight

AC CE P

fluctuation. Behaviour Research and Therapy, 21(3), 259-267. Bookwala, J., & Boyar, J. (2008). Gender, excessive body weight, and psychological well-being in adulthood. Psychology of Women Psychology Quarterly, 32, 188-195. doi:10.1111/j.1471-6402.2008.00423.x Botta, R. A. (1999). Television images and adolescent girls‟ body image disturbance. Journal of Communication, 49, 22-41. doi:10.1111/j.1460-2466.1999.tb02791.x Browne, N. T. (2012). Weight bias, stigmatization, and bullying of obese youth. Bariatric Nursing and Surgical Patient Care, 7(3), 107-115. doi: http://dx.doi.org/10.1089/bar.2012.9972 Cafri, G., Yamamiya, Y., Brannick, M., & Thompson, J. K. (2005). The influence of sociocultural factors on body image: A meta-analysis. Clinical Psychology: Science and

ACCEPTED MANUSCRIPT Running head: EFFECTS OF ANTI-OBESITY NARRATIVES

27

Practice, 12, 421-433. doi:10.1093/clipsy.bpi053 Clark, L. A., & Watson, D. (1995). Constructing validity: Basic issues in objective scale

PT

development. Psychological Assessment, 7, 309-319. doi:10.1037/1040-3590.7.3.309

RI

Cohen, J., Cohen, P., West, S. G., & Aiken, L. S. (2003). Applied multiple regression/correlation analysis for the behavioral sciences. Mahwah, NJ: Erlbaum.

SC

Cools, J., Schotte, D. E., & McNally, R. J. (1992). Emotional arousal and overeating in

NU

restrained eaters. Journal of Abnormal Psychology, 101, 348-351. doi:10.1037/0021843X.101.2.348

MA

Emery, S. L., Szczypka, G., Powell, L. M., & Chaloupka, F. J. (2007). Public health obesityrelated TV advertising: Lessons learned from tobacco. American Journal of Preventative

TE

D

Medicine, 33, S257-S263. doi:10.1016/j.amepre.2007.07.003 Fairburn, C. G., Cooper, Z., Shafran, R., Bohn, K., Hawker, D. M., Murphy, R., & Straebler, S.

AC CE P

(2008). Dietary restraint, dietary rules and controlling eating. (pp. 124-135) Guilford Press, New York, NY. Retrieved from http://search.proquest.com.ezproxy.library.yorku.ca/docview/622016153?accountid=151 82

Franzoi, S. L. (1994). Further evidence of the reliability and validity of the body esteem scale. Journal of Clinical Psychology, 50, 237-239. doi:10.1002/1097-4679(199403)50:2 Franzoi, S. L., & Shields, S. A. (1984). The Body-Esteem Scale: Multidimensional structure and sex differences in a college population. Journal of Personality Assessment, 48, 173-178. doi:10.1207/s15327752jpa4802_12 Friedman, K. E., Reichmann, S. K., Costanzo, P. R., Zelli, A., Ashmore, J. A., & Musante, G. M. (2005). Weight stigmatization and ideological beliefs: Relation to psychological

ACCEPTED MANUSCRIPT Running head: EFFECTS OF ANTI-OBESITY NARRATIVES

28

functioning in obese adults. Obesity Research, 13(5), 907-916. http://dx.doi.org.ezproxy.library.yorku.ca/10.1038/oby.2005.105

PT

Greener, J., Douglas, F., & van Teijlingen, E. (2010). More of the same? Conflicting

RI

perspectives of obesity causation and intervention amongst overweight people, health professionals and policy makers. Social Science & Medicine, 70, 1042-1049.

SC

doi:10.1016/j.socscimed.2009.11.017

464. doi:10.1037/0033-2909.115.3.444

NU

Greeno, C. G., & Wing, R. R. (1994). Stress-induced eating. Psychological Bulletin, 115, 444-

MA

Harrison, K., & Cantor, J. (1997). The relationship between media consumption and eating disorders. Journal of Communication, 47, 40-67. doi:10.1111/j.1460-

TE

D

2466.1997.tb02692.x

Heatherton, T. E., & Baumeister, R. F. (1991). Binge eating as escape from self-awareness.

AC CE P

Psychological Bulletin, 110, 86-108. doi:10.1037/0033-2909.110.1.86 Heatherton, T. F., & Polivy, J. (1991). Development and validation of a scale for measuring state self-esteem. Journal of Personality and Social Psychology, 60, 895-910. doi:10.1037/0022-3514.60.6.895 Herman, C. P., & Mack, D. (1975). Restrained and unrestrained eating. Journal of Personality, 43, 647-660. doi:10.1111/j.1467-6494.1975.tb00727.x Herman, C. P., & Polivy, J. (1983). A boundary model for the regulation of eating. Psychiatric Annals, 13, 918-927. http://www.psychiatricannalsonline.com/cmeInfo.asp Heuer, C. A., McClure, K. J., & Puhl, R. M. (2011). Obesity stigma in online news: A visual content analysis. Journal of Health Communication, 16(9), 976-987. doi: http://dx.doi.org/10.1080/10810730.2011.561915

ACCEPTED MANUSCRIPT Running head: EFFECTS OF ANTI-OBESITY NARRATIVES

29

Krantz, D. S. (1978). The social context of obesity research: Another perspective on its place in the field of social psychology. Personality and Social Psychology Bulletin, 4(1), 177-184.

PT

Lemal, M., & Van den Bulck, J. (2010). Testing the effectiveness of a skin cancer narrative in

RI

promoting positive health behavior: A pilot study. Preventive Medicine, 51, 178–181. doi:10.1016/j.ypmed.2010.04.019

SC

Lewis, S., Thomas, S. K., Blood, R. W., Castle, D. J., Hyde, J., & Komesaroff, P. A. (2011).

NU

How do obese individuals perceive and respond to the different types of obesity stigma that they encounter in their daily lives? A qualitative study. Social Science & Medicine,

MA

73, 1349-1356. doi:10.1016/j.socscimed.2011.08.021 Little, R. J. A. (1988). A test of missing completely at random for multivariate data with

TE

D

missing values. Journal of the American Statistical Association, 83, 1198-1202. http://www.tandfonline.com/toc/uasa20/current#.Ud9Vj_lqnO0

AC CE P

Lòpez-Guimèra, G., Levine, M. P., Sànchez-Carracedo, D., & Fauquet, J. (2010). Influence of mass media on body image and eating disordered attitudes and behaviors in females: A review of effects and processes. Media Psychology, 13, 387-416. doi:10.1080/15213269.2010.525737 Mills, J. S., & Palandra, A. (2008). Perceived caloric content of a preload and disinhibition among restrained eaters. Appetite, 50, 240-245. doi:10.1016/j.appet.2007.07.007 Myers, A., & Rosen, J. C. (1999). Obesity stigmatization and coping: Relation to mental health symptoms, body image, and self-esteem. International Journal of Obesity, 23, 221-230. doi:10.1038/sj.ijo.0800765 Puhl, R. M., & Brownell, K. D. (2006). Confronting and coping with weight stigma: An investigation of overweight and obese adults. Obesity, 14, 1802-1815.

ACCEPTED MANUSCRIPT Running head: EFFECTS OF ANTI-OBESITY NARRATIVES

30

doi:10.1038/oby.2006.208 Saguy, A. C., & Almeling, R. (2008). Fat in the fire? Science, the news media, and the „„obesity

PT

epidemic.” Sociological Forum, 23, 53-83. doi:10.1111/j.1573-7861.2007.00046.x

RI

Sandberg, H. (2007). A matter of looks: The framing of obesity in four Swedish daily newspapers. Communications, 32, 447-472. doi:10.1515/COMMUN.2007.018

SC

Schvey, N. A., Puhl, R. M., & Brownell, K. D. (2011). The impact of weight stigma on caloric

NU

consumption. Obesity, 19, 1957-1962. doi:10.1038/oby.2011.204 Schwartz, M. B., & Brownell, K. D. (2004). Obesity and body image. Body Image, 1, 43-56.

MA

doi:10.1016/S1740-1445(03)00007-X

Sin, N. L. Y., & Vartanian, L. R. (2012). Is counter-regulation among restrained eaters a result of

TE

D

motivated overeating? Appetite, 59, 588-493. doi: 10.1016/j.appet.2012.06.014 Soper, D.S. (2011) A-priori sample size calculator for hierarchical multiple regression (Version

AC CE P

3.0) [Online Software]. Retrieved from http://www.danielsoper.com/statcalc3. Stice, E., & Agras, W. S. (1998). Predicting onset and cessation bulimic behaviors during adolescence: A longitudinal grouping analysis. Behavior Therapy, 29(2), 257-276. doi:10.1016/S0005-7894(98)80006-3 Stice, E., & Bearman, S. K. (2001). Body-image and eating disturbances prospectively predict increases in depressive symptoms in adolescent girls: A growth curve analysis. Developmental Psychology, 37, 597-607. doi:10.1037//0012-1649.37.5.597 Stice, E., Maxfield, J., & Wells, T. (2003). Adverse effects of social pressure to be thin on young women: An experimental investigation of the effects of „„fat talk.‟‟ International Journal of Eating Disorders, 34, 108-117. doi:10.1002/eat.10171 Stice, E., Spangler, D., & Agras, W. S. (2001). Exposure to media-portrayed thin-ideal images

ACCEPTED MANUSCRIPT Running head: EFFECTS OF ANTI-OBESITY NARRATIVES

31

adversely affects vulnerable girls: A longitudinal experiment. Journal of Social and Clinical Psychology, 20(3), 270-288. doi :http://dx.doi.org/10.1521/jscp.20.3.270.22309

PT

Stice, E., & Whitenton, K. (2002). Risk factors for body dissatisfaction in adolescent girls: A

RI

longitudinal investigation. Developmental Psychology, 38, 669-678. doi:10.1037//0012-

SC

1649.38.5.669

Tabachnick, B. G., & Fidell, L. S. (2007). Using Multivariate Statistics (5th ed.). Boston, MA:

NU

Pearson Education Inc.

MA

Thomas, S. L., Hyde, J., Karunaratne, A., Herbert, D., & Komesaroff, P. A. (2008). Being fat in today‟s world: A qualitative study of the lived experience of people with obesity in

D

Australia. Health Expectations, 11, 321-330. doi:10.1111/j.1369-7625.2008.00490.x

TE

Thompson, M. A., & Gray, J. J. (1995). Development and validation of a new body-image

AC CE P

assessment scale. Journal of Personality Assessment, 64(2), 258-269. doi:10.1207/s15327752jpa6402_6 Watson, D., & Clark, L. A. (1994). The PANAS-X: Manual for the positive and negative affect schedule-Expanded Form. Iowa City, IA: University of Iowa. Wertheim, E. H., Paxton, S. J., & Tilgner, L. (2004). Test–retest reliability and construct validity of Contour Drawing Rating Scale scores in a sample of early adolescent girls. Body Image, 1, 199-205. doi:10.1016/S1740-1445(03)00024-X Womble, L. G., Williamson, D. A., Martin, C. K., Zucker, N. L., Thaw, J. M., Netemeyer, R., …Greenway, F. L. (2001). Psychosocial variables associated with binge eating in obese males and females. International Journal of Eating Disorders, 30, 217-221. doi:10.1002/eat.1076 World Health Organization. (2013, March). Obesity and overweight. Retrieved from

ACCEPTED MANUSCRIPT Running head: EFFECTS OF ANTI-OBESITY NARRATIVES

32

AC CE P

TE

D

MA

NU

SC

RI

PT

http://www.who.int/mediacentre/factsheets/fs311/en/.

ACCEPTED MANUSCRIPT Running head: EFFECTS OF ANTI-OBESITY NARRATIVES

33

Appendix A Article Presented in Anti-Obesity Condition

PT

The Obesity Epidemic

RI

CARLY WEEKS Globe and Mail Blog Posted on Tuesday, November 20, 2011

AC CE P

TE

D

MA

NU

SC

Obesity is on the rise and is becoming increasingly costly, according to a new report by the Canadian Institution for Health Research (CIHR). In the past 30 years the percentage of obese adults in the population has doubled. Many experts have labeled the obesity problem in Canada a health epidemic. The stigma that accompanies this health problem has also become widespread. Stacy Evans weighed 225 pounds at her heaviest and vividly remembers the painful comments she endured throughout her adolescence. “My friends all through middle school would call me „thunder thighs,‟ and although I tried to laugh it off and pretend it didn‟t bother me, the comments just kept coming. I remember one time I was at a farmer‟s market, and one of the fruit stand vendors said to me, „Yeah, you should really consider eating some more fruit, and laying off the fried chicken.‟” Miss Evans was not only subjected to cruel remarks from family, friends, and strangers, but she also encountered various health problems. “I would often wake up more tired than when I went to sleep, and found that I had to gasp for air a few times during the night. During the day, my heart would suddenly start to race really fast, and I would get a lot of chest pain. I would also have a lot of trouble walking, since my knees would start to kill soon after I would leave my house.” It was not until Miss Evans was diagnosed with type 2 diabetes that she realized how dangerous her extra weight truly was. “I was told that being obese was a risk factor for a whole slew of health problems, like hypertension, high blood pressure, and high cholesterol. But it was when my doctor looked at me and told me that I had diabetes that I knew that losing weight was not just something I wanted to do, but something that I desperately had to do for my health.” The health costs of obesity are staggering. Obesity significantly increases the risk of no fewer than 18 chronic illnesses, including diabetes, cardiovascular and heart disease, osteoarthritis, some forms of cancer, and metabolic syndrome. Metabolic syndrome is diagnosed when a person has a combination of certain risk factors, such as excessive stomach fat, abnormal cholesterol levels and elevated blood pressure or insulin levels. The more metabolic risk factors people have, the greater their chances of developing heart disease or diabetes, or suffering from a stroke, according to the U.S. National Heart, Lung and Blood Institute. Shockingly, about 50% of all deaths in Canada can be attributed to obesity! In addition to enormous health costs, there are also significant financial costs to obesity. Obesity costs the Canadian economy somewhere between $4.6-billion and $7.1-billion a year. However, economic costs are not nearly as high as the personal costs obese individuals have to pay. Not only are they dealing with “spare tires” and “muffin tops”, but they also have to deal with finding a place to sit on a bus, paying more for a seat on an aircraft, and not finding clothes that fit (you can forget about squeezing into those skinny jeans…). Social problems are also

ACCEPTED MANUSCRIPT Running head: EFFECTS OF ANTI-OBESITY NARRATIVES

34

AC CE P

TE

D

MA

NU

SC

RI

PT

common in obese individuals. People tend to make less eye contact with obese individuals and be less friendly to them. People often make assumptions about obese individuals, thinking they are lazy and slow, that they have no self-control, and that they are foolish, which often makes it more difficult for them to find a job. There are a number of risk factors that increase a person‟s likelihood of being obese. Eating fewer than five serving of fruits and vegetables a day (the minimum daily recommendation from Health Canada) greatly increases your risk of becoming obese. Physical inactivity, meaning a person is active less than 15 minutes a day, is perhaps the greatest predictor of obesity. “Not surprisingly, this report shows that improving lifestyle behaviors, such as healthy eating and physical activity, can have a significant impact on reducing the waistlines and improving the health of Canadians,” said Jeremy Veillard, vice-president of research and analysis at CIHR. “The report‟s findings highlight the critical need for programs and strategies to address the very serious problem of obesity”, said Vincent Bowman, director of research at the Heart and Stroke Foundation. “We can imagine how serious an issue this can be over the long term,” he said. “It is very concerning and I think it highlights the need for prevention and for Canadians to consider what lifestyle changes may improve their health. There are a lot of things that Canadians can do to reduce their risk of obesity, and it is quite unfortunate that so few Canadians are aware of the power they have over this health problem. Public-health initiatives to improve dietary habits and physical activity are needed to address these health issues”.

ACCEPTED MANUSCRIPT Running head: EFFECTS OF ANTI-OBESITY NARRATIVES

35

Appendix B Article Presented in Anti-Obesity Condition

PT

Health Canada reviewing sunscreen rules

RI

CARLY WEEKS Globe and Mail Blog Posted on Tuesday, November 20, 2011

AC CE P

TE

D

MA

NU

SC

The skin is the body‟s largest organ. As a dermatologist and president of the Canadian Dermatology Association, Dr. Wexler emphasizes the important role of skin in the body‟s overall health. We often associate a glowing complexion with good health, but skin color obtained from being in the sun actually accelerates the effects of aging and increases your risk for developing skin cancer. Stacy Evans, recently diagnosed with malignant melanoma, vividly remembers thinking that her sun tanning was harmless when she would sit out on her back porch with friends throughout her teenage years. “My friends and I loved spending our Saturday afternoons in our bikinis, lying on the porch and hoping all the tanning oil we slathered on did something. We never thought anything negative would come out of it. We just wanted to get some colour, and this was the best way to do it.” Melanoma, a cancer that typically starts in the skin and is often found in moles, is thought by experts to be related to how much time one spends in the sun. “I noticed a small mole just above my knee that I knew had never been there before. I asked my GP to check it out, and she made an appointment for me to see a dermatologist to have the mole removed. I thought that would be the end of it, but it turns out I have more cancerous cells that need to be removed.” It was not until Miss Evans was diagnosed with malignant melanoma that she realized how dangerous excessive sun exposure could be. “My mother always told me that I would get skin cancer if I sat out in the sun too much, but I just brushed her comments aside. It was only when my doctor looked at me and told me that I had cancer that I realized just how true my mother‟s words were. If I could turn back the clock and spend less time in the sun, I definitely would.” Sun exposure also causes most of the skin changes that we think of as a normal part of aging. Over time, the sun's ultraviolet (UV) light damages the fibers in the skin called elastin. When these fibers breakdown, the skin begins to sag, stretch, and lose its ability to go back into place after stretching. The skin also bruises and tears more easily -- taking longer to heal. So while sun damage to the skin may not be apparent when you're young, it will definitely show later in life. “There are a few ways we can protect our skin”, Dr. Wexler advises. First and foremost, we must wear sunscreen with a SPF of at least 15. “The „sun protection factor‟ in sunscreens measures how long it takes to produce a burn on protected skin relative to unprotected skin”, Dr. Wexler explains. “It is complicated because time of day, a person‟s skin type, and the amount applied can impact how well the SPF works”. But in general, dermatologists recommend

ACCEPTED MANUSCRIPT Running head: EFFECTS OF ANTI-OBESITY NARRATIVES

36

AC CE P

TE

D

MA

NU

SC

RI

PT

people choose products with at least SPF 15, although many argue it‟s better to start with an SPF of 30. The problem with this is that most young women don‟t use any sunscreen when tanning and a lot of them use tanning oils that can cause a lot of harm to one‟s skin. “A lot of people think that tanning oils are safe to use because they have an SPF of 5 or 10, but this is simply not enough to protect one from the sun. People have no idea how much damage they are doing to their skin by sun tanning, and if they realized how much they are increasing their chances of developing melanoma, their behaviour may change drastically,” Dr. Wexler comments. How would you know how much sunscreen you should apply? As a guideline, use half a teaspoon for the face and neck area and six teaspoons for the whole body. How do you know whether you have applied enough sunscreen? Apply a thin white coat covering your whole body, and then rub it in – this is the recommended minimum. Just because you have slathered on a layer of sunscreen does not mean you can go out and bake, however. Another smart way to protect your skin is by staying out of the sun and off tanning beds, even if you are wearing sunscreen. This means avoiding sun exposure in many ways: avoid outdoor activities between 11 a.m. and 4 p.m., wear protective clothing, put on a hat with a wide brim and stay in the shade. Ultraviolet radiation provides us with vitamin D, which is important for proper functioning of our immune system, but for most people, 15 minutes of exposure to the sun two-to-three times a week, is enough.

ACCEPTED MANUSCRIPT Running head: EFFECTS OF ANTI-OBESITY NARRATIVES

37

Author Disclosure Form

PT

Role of Funding Sources Financial support for the research was provided by a York University Faculty of Health grant to JM and the W.B. Templeton Honours Thesis Award to RS. The funding sources had no involvement in the research.

AC CE P

TE

D

MA

NU

Conflict of Interest There are no conflicts of interest for the authors to declare.

SC

RI

Contributors All authors designed the study and wrote the protocol. RS conducted literature searches and provided summaries of previous research studies. RS and LK conducted the statistical analysis. RS wrote the first draft of the manuscript with assistance from JM. All authors contributed to the revisions and have approved the final manuscript.

ACCEPTED MANUSCRIPT Running head: EFFECTS OF ANTI-OBESITY NARRATIVES

38

Highlights Experimental effects of exposure to anti-obesity messages were tested among women.



Perceived pressure to be thin moderated effects of anti-obesity messages.



Anti-obesity messages may lead heavier women to suppress their food intake.

AC CE P

TE

D

MA

NU

SC

RI

PT

