Body Image 10 (2013) 619–623
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Body Image
journal homepage: www.elsevier.com/locate/bodyimage
Brief research report
The relationship between physical appearance concerns, disgust, and
anti-fat prejudice
Kerry S. O’Brien a,b,∗ , Sigrún Daníelsdóttir c,∗∗ , Ragnar P. Ólafsson d,e , Ingunn Hansdóttir e ,
Thorarna G. Fridjónsdóttir e , Halla Jónsdóttir e
a
Behavioural Studies, Monash University, Australia
School of Psychological Sciences, University of Manchester, UK
c
Division of Health Determinants, Directorate of Health, Reykjavík, Iceland
d
Division of Psychiatry, Landspitali-University Hospital, Reykjavik, Iceland
e
Department of Psychology, University of Iceland, Reykjavik, Iceland
b
a r t i c l e
i n f o
a b s t r a c t
Article history:
Received 10 October 2012
Received in revised form 27 July 2013
Accepted 28 July 2013
Keywords:
Anti-fat prejudice
Physical appearance concerns
Disgust
Obesity
Weight bias
This study examined relationships between physical appearance concerns (fear of fat, body image
disturbance; BIDQ), disgust, and anti-fat prejudice (dislike, blame), and tested whether disgust mediates relationships between physical appearance concerns and anti-fat prejudice. Participants (N = 1649;
age = 28 years) provided demographic data and completed measures of anti-fat prejudice, tendency to
feel disgust, and physical appearance concerns. Univariate, multivariate, and mediation analyses were
conducted. Univariate and multivariate associations were found between fear of fat, BIDQ, disgust, and
anti-fat prejudice for women. For women only, mediation analyses showed that disgust partially mediated relationships between physical appearance concerns and dislike of fat people. For men, univariate
and multivariate relationships were found between fear of fat, and dislike and blame of fat people, but disgust was not related to anti-fat prejudice. Newer constructs centering on physical appearance concerns
and disgust appear promising candidates for understanding anti-fat prejudice.
© 2013 Elsevier Ltd. All rights reserved.
Introduction
As global rates of obesity continue to rise, there is an increasing
acknowledgment that anti-fat prejudice is a significant social problem (weight bias, obesity stigma; (Andreyeva, Puhl, & Brownell,
2008; Puhl & Heuer, 2009; Puhl, Andreyeva, & Brownell, 2008).
Indeed, US research suggests that weight-based prejudice has
increased 66% over the past decade, placing it at a comparable
level to race-based discrimination (Puhl et al., 2008). Similarly,
Latner and Stunkard (2003) found an increase in anti-fat prejudice
amongst children over the last 40 years.
Research seeking to explicate the reasons for anti-fat prejudice has largely focused on attributions regarding the causes of
obesity (e.g., lack of personal control, laziness), and stereotypical
characteristics of fat people (e.g., smelly, stupid; Puhl & Heuer,
2009). This line of theoretical and empirical research, although
∗ Corresponding author at: Behavioural Studies, Monash University, Melbourne,
Australia. Tel.: +61 03 99032377.
∗∗ Corresponding author at: Division of Health Determinants, Directorate of Health,
Reykjavík, Iceland.
E-mail addresses: [email protected] (K.S. O’Brien), [email protected]
(S. Daníelsdóttir).
1740-1445/$ – see front matter © 2013 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.bodyim.2013.07.012
useful, has limitations that are becoming evident. Notably, studies
that have sought to reduce anti-fat prejudice through modification
of attributions, beliefs, and stereotypes have been shown to
be largely unsuccessful in reducing prejudice (Daníelsdóttir,
O’Brien, & Ciao, 2010). Theorists have argued that attributions
and beliefs about targets (e.g., fat people) represent post hoc
reasoning for underlying (automatic) emotional reactions or feelings toward those targets (Haidt, 2001). Others have gone further
in suggesting that attributions may function as justifications for
prejudice toward a target rather than being the primary drivers
of prejudice (Crandall & Eshleman, 2003). Clearly, it is important to better understand the mechanisms underlying anti-fat
prejudice in order to improve anti-fat prejudice reduction interventions.
Recent work suggests that constructs such as disgust
(Vartanian, 2010), physical appearance concerns (O’Brien, Hunter,
& Banks, 2007; O’Brien, Hunter, Halberstadt, & Anderson, 2007),
and pathogen/illness avoidance mechanisms (Park, Faulkner, &
Schaller, 2003; Park, Schaller, & Crandall, 2007) may underpin
anti-fat prejudice. For example, Vartanian (2010) found that disgust was related to dislike of fat people compared to thin people.
Moreover, because disgust is associated with morality and fat people have been viewed as immoral (e.g., gluttonous, sloth, greedy;
Crandall, 1994; Townend, 2009), the disgust-obesity link may also
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K.S. O’Brien et al. / Body Image 10 (2013) 619–623
be explained by socio-cultural factors rather than by innate disgust
mechanisms.
Other researchers have found that people’s own physical
appearance concerns and level of investment in physical appearance are associated with anti-fat prejudice (O’Brien et al., 2009).
Unsurprisingly, measures assessing body image concerns frequently include items directly related to being fat (e.g., ‘I constantly
worry about being or becoming fat’). Similarly, research has
shown that fat people are perceived to be physically unattractive (Crandall, 1994) and ugly (Maddox & Liederman, 1969).
What is not known is whether there is an interrelationship
between physical appearance concerns, disgust, and anti-fat
prejudice.
The link between physical appearance concerns, disgust, and
anti-fat prejudice may arise from negative cognitions regarding the
physical appearance of fat or obese people. Simply put, the physical
appearance of a fat person may evoke disgust because it contravenes personal/societal attitudes toward physical appearance,
slimness, and beauty (O’Brien et al., 2009), and/or unconscious
drives related to evolutionary fitness (Oaten, Stevenson, & Case,
2009). Any felt disgust arising from this contravention of appearance ideals may then result in negative thoughts about fat people in
order to justify or allow expression of negative emotions (i.e., prejudice and discrimination). Explanations for the dislike/avoidance
of certain targets (e.g., obese, disabled) do suggest an interplay
between the physical appearance of targets and disgust (Oaten
et al., 2009; Oaten, Stevenson, & Case, 2011).
Although research has shown a link between physical appearance concerns (body image) and anti-fat prejudice, and between
disgust and anti-fat prejudice, there has been no research
examining the interrelationships between these constructs. This
exploratory study addresses this gap. Based on previous research,
we propose that individuals who have greater physical appearance
concerns/investment will be more likely to view fat/obese people as
physically unattractive because it contravenes personal and societal values regarding physical appearance. These cognitions will
in turn evoke feelings of disgust, which may manifest in anti-fat
prejudice. Thus, we hypothesized that anti-fat prejudice would be
related to both physical appearance concerns and disgust; and that
the relationship between physical appearance concerns and antifat prejudice would be mediated by disgust.
subscale henceforth. The fear of fat subscale assesses personal concerns about gaining weight and becoming fat rather than antipathy
toward fat people (e.g., ‘I feel disgusted with myself when I gain
weight’) and is, thus, a measure of physical appearance concerns
(Crandall, 1994; O’Brien, Hunter, & Banks, 2007; O’Brien, Hunter,
Halberstadt, & Anderson, 2007). Accordingly, we use the fear of
fat subscale alongside a measure of body image disturbance as
measures of physical appearance concerns (see below). The dislike and blame scale items were scored on a Likert scale ranging
from 1 = very strongly disagree to 9 = very strongly agree where higher
scores indicate greater anti-fat prejudice. Cronbach’s alphas for
dislike and blame subscales were acceptable (˛ = .88 and ˛ = .70,
respectively).
Physical appearance concerns. We used the body image disturbance questionnaire (BIDQ; Cash, Phillips, Santos, & Hrabosky,
2004) and AFA’s fear of fat scale (Crandall, 1994) to assess physical
appearance concerns. The 12 item BIDQ measures dissatisfaction
and distress with one’s body and physical appearance, and is
comprised of both quantitative and qualitative components. We
only used the seven item quantitative scale from the BIDQ which
assesses concerns about the appearance of one’s body (e.g., ‘Are
you concerned about the appearance of some part(s) of your body,
which you consider especially unattractive?’). The items are scored
on a 1 to 5 Likert scale with higher scores indicating greater
body image disturbance. Cronbach’s alpha for the scale in the
present study was good (˛ = .91). The three item fear of fat scale
assesses concerns about personal weight and aversion to weight
gain (e.g., ‘I worry about becoming fat’). The word ‘weight’ was
removed from the end of one of the items in the fear of fat scale
and replaced with the word ‘fat’, the modified statement reading ‘One of the worst things that could happen to me would be
if I gained 25 lbs of fat.’ This modification avoids confusion over
whether the weight gained is ‘fat’ or ‘muscle’, the latter being a
potentially desirable outcome for men. The fear of fat scale items
were scored on a Likert scale ranging from 1 = very strongly disagree to 9 = very strongly agree where higher scores indicate physical
concerns regarding weight gain and weight status (Cronbach’s
˛ = .80).
Participants were 1649 university students at the University
of Iceland (N = 1171, 71% female). Mean (M) age was 28 years
(SD = 8.9; range 18–76), and mean BMI was 25.2 (SD = 4.83; range
16.23–50.15). Participants came from a diverse range of university
faculties including; School of Social Sciences (34%), School of Health
Sciences (20%), School of Engineering and Natural Sciences (17%),
School of Education (14%) and School of Humanities (13%).
Disgust. The Disgust Propensity and Sensitivity Scale-Revised
(DPSS-R: van Overveld, de Jong, Peters, Cavanagh, & Davey, 2006)
contains 16 items with two purported subscales. The disgust
propensity scale (8 items) assesses the degree to which participants
experience disgust in different settings (e.g., ‘Disgusting things
make my stomach turn’). The disgust sensitivity scale (8 items)
assesses how distressing certain disgust evoking stimuli or settings
are to participants (e.g., ‘I think disgusting items could cause me
illness/infection’). Items are scored on a Likert scale ranging from
1 = never to 5 = always. The two disgust subscales were highly correlated (r = .78), so we combined the scales to form a single disgust
measure (Cronbach’s alpha was .88).
Materials
Procedure
Anti-fat prejudice. The anti-fat attitudes (AFA) measure is a
13 item questionnaire that assesses participants’ attitudes toward
fat people (Crandall, 1994). The AFA contains three subscales (Dislike, Willpower, and Fear of Fat). The dislike subscale (7 items)
assesses antipathy toward fat people (e.g., ‘I really don’t like fat
people much’). The willpower subscale has three items assessing
belief in personal responsibility for being fat (e.g., ‘Some people are fat because they have no willpower’), and functions as
a measure of blame for being fat. We refer to it as the ‘blame’
Invitations to participate in the study (and study website link)
were sent to all students who had, at time of enrollment, given
permission to be contacted via email by university staff for administrative and research purposes (N = 9109). Follow-up e-mails were
sent two and four days after the initial invitation. Participants
were provided with brief instructions at the beginning of the survey and informed that individual data would be anonymous with
no identifying details required, and that completion of the survey
would be interpreted as tacit consent for participation. Participants
Method
Participants
K.S. O’Brien et al. / Body Image 10 (2013) 619–623
completed the survey online. Ethical approval was granted by the
University and the Icelandic Data Protection Authority.
Statistical Analyses
Gender differences in anti-fat prejudice and explanatory
variables were assessed using ANOVAs. Pearson’s correlation
coefficients were calculated for all variables. Variables with significant correlations with anti-fat prejudice were simultaneously
entered in multivariate regression models to test for significant
associations after accounting for all variables. Confidence intervals
(95% CI) are reported for significant betas. To test for mediation of
relationships between physical appearance concerns and anti-fat
prejudice by disgust, we adopted a bootstrapping method with bias
corrected 95% confidence intervals (Preacher & Hayes, 2008). Mediation is said to be present when a significant relationship between
the independent and dependent variable is either reduced (partial mediation), or becomes non-significant (full mediation) after
controlling for the mediator. We used 5000 bootstrap resamples
to produce 95% CIs. Betas (B) for the direct paths between measures of physical appearance concerns and anti-fat prejudice, and
confidence intervals for indirect path effects, are reported.
Results
Women had lower BMIs, dislike, and blame scores, than men
(see Table 1). Men had lower body image disturbance (BIDQ), fear
of fat, and disgust scores (all ps < .05). The overall mean anti-fat
prejudice scores for this study were M = 2.95, SD = 1.42 for dislike,
and M = 6.13, SD = 1.51 for blame, which is comparable to previous
work (Lieberman, Tyber, & Latner, 2012).
Table 2 displays correlations between variables for men and
women. For women, significant correlations were found between
most variables. Of note, statistically significant positive correlations were found between dislike, disgust, and measures of physical
appearance concerns (BIDQ, fear of fat). That is, the higher the
disgust and physical appearance concerns the greater the anti-fat
dislike. Higher BMI was associated with greater BIDQ, fear of fat, but
lower disgust scores. In men, higher BMI and age were associated
with lower dislike and blame, but higher body image disturbance
and fear of fat. Contrary to expectations, disgust was not associated
with anti-fat attitudes in men; however, disgust was associated
with physical appearance concerns in men.
As significant differences between men and women were found
for several variables, and the patterns of correlations differed
between genders, we conducted separate multivariate regression
analyses for women and men.
Multivariate Regressions for Women
As hypothesized, greater dislike of fat people in women was significantly associated (adjusted R2 = .13, F(5, 801) = 23.26, p < .0001)
with lower BMI (B = −.04, SE B = .009, ˇ = −.016, 95% CI: −.06 to
−.02), higher fear of fat (B = .16, SE B = .026, ˇ = .25, 95% CI: .11 to
.20), and higher disgust (B = .24, SE B = .09, ˇ = .09, 95% CI: .06–.41).
However, contrary to expectations BIDQ was not associated with
dislike of fat people after accounting for all variables. Lower age
(B = −.01, SE B = .01, ˇ = −.08, 95% CI: −.03 to −.002), BMI (B = −.05,
SE B = .01, ˇ = −.16, 95% CI: −.07 to −.03), and greater fear of fat
(B = .18, SE B = .03, ˇ = .24, 95% CI: .13 to .23) were related to higher
anti-fat blame scores (adjusted R2 = .09, F(4, 896) = 23.16, p < .0001).
Multivariate Regressions for Men
Contrary to the hypothesis disgust was not related to either dislike of fat people or blame of fat people. However, multivariate
621
regression models for men found that only lower BMI (B = −.08, SE
B = .02, ˇ = −.23, 95% CI: −.12 to −.04) and higher fear of fat (B = .21,
SE B = .05, ˇ = .25, 95% CI: .11 to .31) were associated with greater
dislike after accounting for variables with univariate relationships
(adjusted R2 = .12, F(3, 346) = 16.58, p < .0001). And, being younger
(age; B = −.03, SE B = .009, ˇ = −.18, 95% CI: −.05 to −.01), having a
lower BMI (B = −.05, SE B = .02, ˇ = −.14, 95% CI: −.08 to −.01), and
having a greater fear of fat (B = .14, SE B = .04, ˇ = 18, 95% CI: .06 to
.22) was associated with greater blame scores (adjusted R2 = .08,
F(3, 347) = 10.96, p < .0001).
Mediation
Consistent with expectations, mediation analyses for women
showed that the relationship between BIDQ and dislike (B = .20,
t(832) 3.52, p = .0005) was partially mediated (B = .12, t(832) 2.14,
p = .03) by disgust (B = .07, CI: .04, .12). Similarly, the relationship
between fear of fat and dislike (B = .17, t(930) 8.81, p < .0001) was
partially mediated (B = .14, t(930) 27.42, p < .005) by disgust (B = .02,
CI: .01, .03). Mediation analysis was not conducted for men as there
were not statistically significant interrelationships between the all
variables of interest, a necessary justification for conducting mediation analysis.
Discussion
The present study explored relationships between anti-fat prejudice, physical appearance concerns, and disgust. As hypothesized,
there were statistically significant univariate and multivariate
relationships between anti-fat prejudice, physical appearance concerns, and disgust, with relationships stronger in women than men.
For women only, disgust partially mediated relationships between
BIDQ and dislike of fat people, and between fear of fat and dislike
of fat people.
The finding that disgust partially mediates relationships
between physical appearance concerns and dislike of fat people is
new, but fits with existing theories (e.g., disgust, evolutionary fitness, pathogen avoidance: Park et al., 2007; Vartanian, 2010) which
propose that specific targets of prejudice activate disgust and/or
drive to avoid illness (Oaten et al., 2009, 2011). Feelings of disgust and illness aversion may then result in social distancing and/or
derogation of targets with physical characteristics that signal poor
evolutionary fitness and illness (e.g., obesity, disability; Park et al.,
2007; Vartanian, 2010). Whether disgust is linked to anti-fat sentiment via evolutionary mechanisms is unclear as research suggests
that disgust can also be acquired via breaches of socio-culturally
derived morality (Lieberman, Tyber, & Latner, 2012). For example,
obesity is often seen as a breach of morality (e.g., greed, gluttony,
sloth: Townend, 2009), with disgust and obesity perhaps linked
via moralistic reasoning, rather than evolutionary fitness/illness
avoidance mechanisms (Oaten et al., 2011).
Multivariate regression models found that for women, fear of
fat and disgust were associated with dislike of fat people, but BIDQ
was not. We additionally found that women with lower BMIs, and
higher fear of fat scores, blamed fat people more for their condition. Disgust was not a significant variable in either dislike or blame
models for men; however, lower BMIs, and greater fear of fat, were
associated with both dislike and blame. The absence of an association in multivariate models between BIDQ and anti-fat prejudice
may be due to BIDQ being subsumed by the fear of fat measure.
The fear of fat measure is more strongly associated with anti-fat
prejudice than the BIDQ, and is better aligned, conceptually, with
the issue of fat/obesity. Whereas the BIDQ is a measure of dissatisfaction with general appearance, rather than concerns regarding
fat/obesity per se. Similarly, we did not find that disgust mediated
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K.S. O’Brien et al. / Body Image 10 (2013) 619–623
Table 1
Means (SDs) participant ratings for women and men on each of the variables along with F-values, significance levels, and effect sizes for gender differences.
Rating criteria
Women (N = 1171)
Men (N = 353)
F value
p Value
Effect sizea d
Age
BMI
Dislike
Blame
Fear of fat
BIDQ
Disgust
28.49 (8.70)
24.87 (4.90)
2.76 (1.28)
5.97 (1.47)
5.45 (2.02)
2.02 (.79)
2.07 (.51)
28.13 (8.96)
25.90 (4.46)
3.58 (1.65)
6.64 (1.51)
4.61 (1.94)
1.64 (.69)
1.90 (.44)
.466
12.18
94.45
54.87
47.71
51.67
24.22
.50
.0001
.00001
.00001
.00001
.00001
.00001
.04
.22
.56
.45
.42
.59
.36
a
Cohen’s d, small effect ≈ .2 moderate effect ≈ .5, large effect ≈ .8+.
Table 2
Pearson’s product moment correlations between the anti-fat attitude subscales (i.e., dislike, blame) and the explanatory variables. Correlations for men are displayed above
the diagonal, and women below the diagonal.
Variable
Age
Age
BMI
Dislike
Blame
Fear of fat
BIDQ
Disgust
–
.15***
−.18***
−.16***
−.23***
−.13***
−.27***
*
**
***
BMI
.23***
–
−.15***
−.14***
.10**
.26***
−.09**
Dislike
Blame
Fear of Fat
BIDQ
Disgust
−.17***
−.22***
–
.39***
.30***
.11**
.20***
−.22***
−.14*
.49***
–
.16**
.04
.10**
−.02
.21***
.22***
.24***
–
.52***
.28***
−.05
.25***
.03
.01
.45***
–
26***
−.05
−.11
.12
−.01
.13*
.26***
–
p < .05.
p < .01.
p < .001.
relationships between appearance concerns and blame. This may
be because disgust is more closely related to emotional antipathy
toward targets (e.g., fat, obese, disabled), which is better captured
by the dislike of fat people subscale. Whereas the blame subscale,
which assesses perceived personal responsibility for obesity, has a
much weaker relationship with disgust (see Table 2).
Although the primary focus of the present study was the interrelationships between anti-fat prejudice, disgust, and physical
appearance concerns, the associations between age, BMI and antifat prejudice, along with gender differences in these relationships,
also merits mention. Here we found that as age and BMI increased
anti-fat prejudice decreased. This finding has been reported by others (O’Brien, Hunter, & Banks, 2007; O’Brien, Hunter, Halberstadt,
& Anderson, 2007); however, the relationships between these variables and anti-fat prejudice is complex. For example, higher BMI is
also associated with greater body dissatisfaction, and greater body
dissatisfaction is associated with anti-fat prejudice in women. Further, age, which is associated with lower anti-fat prejudice, is also
associated with less body dissatisfaction. Thus, the relationships
between age and BMI, and prejudice, may be explained by their cooccurrence with other appearance-related mechanisms. Given that
the size of the associations of these variables are of a similar magnitude to more prominent psychosocial predictors (e.g., personality,
attitudes), more research on their links with anti-fat prejudice is
warranted.
There are limitations to the study. First, the correlational design
of the study prevents us from making causal inferences regarding
the direction of relationships between disgust, physical appearance
concerns, and anti-fat prejudice. Second, the relationship between
one of the measures of physical appearance concerns and the antifat prejudice found here is smaller than found in previous research
(O’Brien, Hunter, & Banks, 2007; O’Brien, Hunter, Halberstadt, &
Anderson, 2007); this is likely due to the use of different measures. Third, we examined prejudicial attitudes rather than actual
discriminatory behavior. Finally, the present study, used a convenience sample with a response rate of 18%, and as such our results
may not generalize to other populations. That said, the present
sample is older (mean age = 28 years) and more diverse (different
university majors) than typical university samples.
Notwithstanding these limitations, our research addresses a gap
in the literature and provides support for recent research exploring novel predictors (i.e., disgust, physical appearance concerns) of
anti-fat prejudice. The study contributes new findings to the field
by showing that disgust partially mediates relationships between
physical appearance concerns and dislike of fat people in women. It
is important that the present findings be replicated in other populations, and examined experimentally. Similarly, we need to consider
how we might moderate physical appearance concerns and disgust
regarding obesity in order to reduce anti-fat prejudice.
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