Psychobiology and Behavioral Strategies

Attitudes toward Obese Individuals amongExercise Science StudentsHEATHER 0. CHAMBLISS, CARRIE E. FINLEY, and STEVEN N. BLAIR

Centers for Integrated Health Research, The Cooper Institute, Dallas, TX

ABSTRACT

CHAMBLISS. H. O.. C. E. FINLEY, and S. N. BLAIR. Attitudes toward Obese Individuals among Exercise Science Students. Med.Sci. Sports Exerc., Vol. 36, No. 3, pp. 468-474, 2004. Purpose: The purpose of this research was to evaluate attitudes toward obeseindividuals and to identify personal characteristics associated with antifat bias among students majoring in exercise science. Methods:Undergraduate (N = 136) and graduate (N = 110) students (mean age 23.2 yr, 55% male, 77% Caucasian) completed a series ofquestionnaires to assess attitudes toward obese individuals. Instruments included the Implicit Association Test (IAT), a timed self-reportassessment that measures automatic attitudes and stereotypes toward obese persons through word categorizations (good vs bad;motivated vs lazy), and the Antifat Attitudes Test (AFAT). a self-report instrument that measures negative beliefs and attitudes towardobese individuals. Participants also completed a general demographic questionnaire. Results: A strong bias was found for implicitmeasures including good versus bad attitude (P < 0.0001) and motivated versus lazy stereotype (P < 0.0001). Characteristicsassociated with greater bad bias included being female, Caucasian, and growing up in a less populated area (P < 0.05). Belief in greaterpersonal responsibility for obesity was associated with stronger lazy bias (P < 0.01). On the AFAT self-report measure, belief in lesspersonal responsibility for obesity, positive family history of obesity, and having an obese friend were associated with lower antifat

scores (P < 0.05). Conclusion: These results suggest that students in the field of exercise science possess negative associations andbias toward obese individuals. These findings have important implications for health promotion, as antifat bias and weight discrim-ination among exercise professionals may further contribute to unhealthy lifestyle behaviors and reduced quality of life for many obeseindividuals who are at high risk for chronic disease. Key Words:HEALTH PROMOTION

T he increasing prevalence of obesity and associatedhealth risks have brought the issue of obesity pre-

T vention and treatment to the forefront of the publichealth agenda (19,20). Exercise has the important potentialto assist in weight management as well as alleviate many ofthe comorbidities associated with obesity (18). Becausephysical inactivity and overweight are predominant amongAmerican adults, these problems are primary objectives ofcurrent public health initiatives (19,20).

Individuals report diverse barriers to physical activity.Common barriers include environmental factors such assafety and proximity to facilities as well as personal factorssuch as time, self-efficacy, and enjoyment (12). Obese in-dividuals face additional barriers for adoption and mainte-

Address for correspondence: Heather 0. Chambliss, Ph.D.. The CooperInstitute, 12330 Preston Road. Dallas, TX 75230: E-mail: hchambliss@cooperinst.org.Submitted for publication January 2003.Accepted for publication October 2003.

0195-9131/04/3603-0468MEDICINE & SCIENCE IN SPORTS & EXERCISE,Copyright © 2004 by the American College of Sports Medicine

DOI: 10.1249/01.MSS.0000117115.94062.E4

STIGMA, BIAS, DISCRIMINATION, WEIGHT, OBESITY,

nance of physical activity behaviors including embarrass-ment, health concerns, disproportionate focus on weightloss, and previous negative experiences with exercise (1.9).Additionally, an often-overlooked barrier to exercise forobese children and adults is antifat bias and weight discrim-ination by health professionals and others (2,9).

Obesity has been called the last acceptable form of prej-udice, and discrimination toward obese individuals is prev-alent throughout society including unfavorable employmentpractices, reduced education and housing opportunities, andnegative portrayals in popular media (14). Bias is defined as"an inclination of temperament or outlook, especially apersonal and sometimes unreasoned judgment" (11). Thus,antifat bias is an obesity prejudice in which the attribute ofbeing obese influences expectations about the individual,often in terms of negative character assessments such aslaziness, lack of self-discipline, and incompetence (14).

Many obese individuals give accounts of disparagingremarks by health professionals and report discriminationin facility and equipment access. Negative attitudes andstereotypes have been documented among various groupsof health professionals including dietitians (1 3), medicalstudents (22), physicians (6,8), nurses (10), and obesityspecialists (15,16). Because antifat biases have been doc-umented among other groups of health professionals, it is

468

TABLE 1. Demographic characteristics.

Undergraduate Graduate

Men Women Men WomenVariable (N = 77) (N = 57) (N = 57) (N = 53)

Age (yr)Mean (SD) 22.7 (2.9) 21.4 (2.9) 25.9 (4.8) 23.5 (2.4)Range 18-37 18-33 20-41 20-30

BMI (kg-m 2)

Mean (SD) 26.3 (4.3) 23.3 (3.7) 26.3 (3.7) 23.3 (2.8)Ethnicity [N (%)]

Caucasian 59 (76.6) 50 (87.7) 37 (66.1) 40 (78.4)African-American 7 (9.1) 5 (8.8) 7 (12.5) 3 (5.9)Hispanic 10 (13.0) 2 (3.5) 8 (14.3) 4 (7.8)Other 1 (1.3) 0 (0.0) 4 (7.1) 4 (7.8)Missing 1 2

Marital status (N (%)NSingle 59 (80.8) 49 (92.5) 35 (67.3) 42 (84.0)Married 14 (19.2) 4 (7.6) 16 (30.8) 8 (16.0)Divorced 0 (0.0) 0 (0.0) 1(1.9) 0 (0.0)Missing 4 4 5 3

Childhood environment [N (%)]Rural area-small city 57 (74.0) 41 (71.9) 34 (59.7) 38 (71.7)Mid-sized city-large metropolitan area 20 (26.0) 16 (28.1) 23 (40.4) 15 (28.3)

Family history of obesity [N (%)]Yes 24 (31.2) 17 (29.8) 21(36.8) 27 (50.9)No 53 (68.8) 40 (70.2) 36 (63.2) 26 (49.1)

Personal history of obesity [N (%)]Yes 3 (3.9) 0 (0.0) 1 (1.8) 5 (9.4)No 74 (96.1) 57 (100.0) 56 (98.3) 48 (90.6)

Belief in personal control of obesity [N (%)]Yes 43 (55.8) 34 (59.7) 35 (61.4) 23 (43.4)No 34 (44.2) 23 (40.4) 22 (38.6) 30 (56.6)

possible that prejudicial attitudes toward obese individ-uals also exist among students and professionals withinthe exercise and fitness fields. Therefore, the purpose ofthe present study was to evaluate attitudes toward obesityamong students majoring in exercise science and to ex-amine individual characteristics associated with antifatbias. We hypothesized that students would demonstratestrong implicit antifat biases but would not explicitlyendorse negative attitudes and stereotypes.

METHODS

Participants. Participants were 136 undergraduate and110 graduate students majoring in exercise science repre-senting three colleges and universities in Texas and Ala-bama. Approximately 55% of participants were male. Thesample was predominantly Caucasian (77%) with a meanage of 23.2 yr. Written informed consent was obtained fromeach participant, and The Cooper Institute Institutional Re-view Board approved the study. Table I presents demo-graphic information for study participants.

Implicit Association Test (IAT). The IAT is a timedassessment that measures automatic associations of a targetconstruct with particular attributes. It has been used primar-ily to examine social prejudice against different groups (e.g.,racial stereotypes) (5). The IAT has also been used to assessimplicit antifat bias in various populations including stu-dents and community members (17) as well as health pro-fessionals (15,16). In the present study, all participants weregiven two IAT measures to assess the attributes of badversus good and lazy versus motivated with the target cat-egories of fat people and thin people (Table 2). These

attributes were chosen because they represent common an-tifat stereotypes and have been examined in prior studiesusing the IAT (15-17). Participants complete the IAT byclassifying words into superordinate categories. Checkmarks are used to classify the words into the categoriesindicated at the top of each page (Fig. 1). Participants have20 s to complete each of the IAT tasks, and each measure isrepeated with the superordinate pairings reversed. The IATis then scored by subtracting the number of words correctlyclassified when the term fat people is paired with the neg-ative attributes (i.e., bad and lazy) from the number of wordscorrectly classified when the term fat people is paired withthe positive attributes (i.e., good and motivated).

People generally find the IAT tasks easier when thecategory pairing matches their attitude (fat people pairedwith bad or lazy vs good or motivated) and are able tocorrectly classify more words within the 20-s time. Thus, apositive difference score indicates a stronger automatic pref-erence for the pairing of fat people with negative attributes,or implicit antifat bias. Unlike traditional self-report ques-tionnaires, the IAT measures associations and automatic

TABLE 2. Categories and associated subordinate word stimuli for ImplicitAssociation Test (IAT) tasks.

Stimuli to Be Classified

Target category labelsFat people Fat Obese LargeThin people Slim Thin Skinny

Attribute category labels (Task 1)Bad Terrible Nasty HorribleGood Wonderful Joyful Excellent

Attribute category labels (Task 2)Lazy Slow Lazy SluggishMotivated Determined Motivated Eager

Medicine & Science in Sports & Exercise® 469ATTITUDES TOWARD OBESE INDIVIDUALS

Pairing A

Thin People

Motivated

obese

sluggish

V slim

I/ eager

large

lazy

fat

V motivated

/ thin

/ determined

I/ skinny

Fat People

Lazy

/

V

I/

/

v

Fat People

Motivated

V

/

/

/

Pairing B

obese

sluggish

slim

eager

large

lazy

fat

motivated

thin

determined

skinny

Thin People

Lazy

/

/

I

I/

I/

FIGURE I-Sample portions of two completed IAT tasks measuringimplicit associations among fat and thin people with lazy and motivateddescriptors. Pairing A is more congruent for people who have implicitantifat bias compared with pairing B. Antifat bias is indicated by ahigher number of correct responses on part A relative to part B.

preferences that exist beyond conscious evaluation, therebyproviding a measure of bias of which people may be un-aware or unwilling to report (5).

Explicit ratings. Explicit attitudes representing com-mon obesity stereotypes were measured using a 7-pointsemantic differential scale. Participants rated their beliefsabout fat people and thin people for the scale very stupid tovery smart and very lazy to very motivated to yield fourexplicit ratings. Explicit scores were then calculated bysubtracting the value on the 7-point measure forfat peoplefrom the value on the scale for thin people. Thus, a scoregreater than zero indicated antifat bias for the measuredattribute (stupid, lazy). In contrast to the IAT, which mea-sures unconscious associations, the purpose of the explicitscale is to measure attitudes directly, allowing a comparisonbetween automatic or unconscious attitudes and consciousattitudes that people are willing to report. This explicitrating scale has been used as a comparison for implicitscores in other studies using the IAT (15,16).

Antifat Attitudes Test (AFAT). The AFAT is a ques-tionnaire that measures negative attitudes toward obese in-dividuals using a traditional self-report format. The instru-ment consists of 47 statements about fat people, and itemsare rated using a 5-point Likert scale ranging from stronglydisagree, 1, to strongly agree, 5, with some items reversescored so that higher scores reflect greater antifat bias. Thequestionnaire yields scores for three subscales includingsocial/character disparagement, physical/romantic unattrac-tiveness, and weight control/blame as well as a total com-posite score (7).

Demographic questionnaire. The demographicquestionnaire documented individual characteristics includ-ing age, sex, race, and education, as well as social andenvironmental influences such as personal experience withobesity, family history of obesity, and beliefs about personalresponsibility for obesity.

Procedure. The instruments were administered togroups of exercise science students in the classroom as part

of the lecture time. Students were informed that they werevolunteering to participate in a study to examine the rela-tionships between individual characteristics and attitudesand to examine the psychometric properties of question-naires used in prior research. Questionnaires were codedbefore administration and linked by unique numbers so thatno identifying information was provided on any of thequestionnaires. Research packets were distributed to stu-dents who were instructed to complete the demographic andAFAT questionnaires and then to stop and wait for direc-tions. The IAT was then administered to the class as a wholeusing standardized instructions and timing. After complet-ing the IAT, participants were asked to provide explicitratings for the attributes assessed in the IAT. The order ofinstrument administration was selected to avoid contaminat-ing the AFAT self-report questionnaire with the experienceof completing the IAT. Because the IAT is a task-orientedmeasure, it is unlikely that knowledge regarding the purposeof the study or completing the AFAT would unduly influ-ence IAT responding. After the assessments were completedand collected, students were debriefed on the purpose of thestudy, and the problem of antifat bias within health promo-tion settings was discussed.

Statistical analysis. Questionnaire data were enteredby machine scanning and verified. The IAT data were ex-amined to identify outliers. Participants who completedfewer than four items per page or who had an error rateabove 35% (i.e., incorrectly classified or missing items)were excluded. This guideline identifies people who did notunderstand the task or were not paying attention and ensuresthe quality of the data in a group administration. Using thisguideline resulted in deleting 14% (35 subjects) from thegood/bad analysis and 6% (15 subjects) from the lazy/motivated analysis. This strategy and percentage of dele-tions is based on previous research using similar methods(16). Scoring of the AFAT measure followed the procedurespublished by Lewis and colleagues (7) in the developmentand validation of the questionnaire.

Descriptive statistics were calculated for implicit andexplicit IAT scores and AFAT composite and subscalescores. One-sample t-tests were conducted to test whetherthe implicit and explicit IAT scores were significantly dif-ferent from zero, which indicates an antifat bias. Analysis ofvariance was used to assess differences in IAT and AFATscores by several demographic characteristics including sex,race, and education as well as social and environmentalinfluences. Pearson correlations were used to determine theassociations between implicit and explicit IAT scores andAFAT scores. All data analyses were performed using SASsoftware, Version 8. All reported P values are two-tailed.Sample size provided a statistical power of 0.80 for detect-ing moderate effect sizes at an alpha of P < 0.05 foracademic level, gender, and collapsed race for IAT analyses.

RESULTS

Implicit attitudes and beliefs. There was a signifi-cant antifat bias on both attribute categories, bad/good

470 Official Journal of the American College of Sports Medicine http:Hwww.acsm-msse.org

C positive attributel negative attribute

Bad Motivated Lazy

FIGURE 2-Number of IAT items correctly classiried when the fatpeople target category was paired with positive and negative attributes.

(mean = 11.8, SD = 6.5, t(2 1 0 ) - 26.28, P < 0.0001) andlaz)y¼lnotivated (mean = 9.2, SD - 6.1, t(230), P < 0.0001).

The numbers of items correctly classified in each IATcondition are presented in Figure 2. This illustrates thediscrepancy between the numbers of items correctly classi-fied when fat people was combined with each adjective,with higher scores indicating a stronger antifat bias. Amoderate positive correlation was observed between the twoimplicit attribute categories (r = 0.52, P < 0.001). When theinfluence of individual characteristics was examined,women had stronger implicit bias on the good/bad measure(F (1.207) = 4.8. P = 0.03) but not on the lazy/motivatedmeasure when compared with men. Being Caucasian orgrowing up in a more rural environment was also associatedwith more negative attitudes on the good/bad measure(F(1 203) = 6.5, P = 0.01 and F(, 209) = 7.1, P = 0.008,respectively). Belief in greater personal control of obesitywas associated with antifat bias for the lazy stereotype(F(, 22 9 ) = 7.9, P = 0.006). A small but significant corre-lation was observed between implicit bias on the good/badattribute and BMI, with individuals with a lower BMI hav-ing higher bias scores (r = -0.19, P = 0.006).

Explicit attitudes. Compared with thin people,fatpeo-ple were rated higher on the lazy attribute (mean = 1.30, SD= 1.4, t(2 3 6) = 14.0, P < 0.0001), but there was no signif-icant antifat bias for the very smart to very stupid attitudescale (t(2 3 6 ) = -1.3; P = 0.19). A significant correlationwas found between the lazy1¼notivated implicit measure andthe very motivated to very lazy explicit scale (r = -0.20, P= 0.003), but other relationships to implicit measures werenot significant (P > 0.44). Explicit attitudes for the lazyattribute were positively correlated to composite and sub-scale AFAT scores (composite: r = 0.39; social/character: r- 0.32; physical/romantic: r = 0.36: weight control/blame:

r = 0.42; P < 0.0001 for all). No significant correlations wereobserved between explicit scores for the stupid attribute andAFAT composite or subscale AFAT scores (P > 0.07).

Antifat attitudes test. Mean item scores for AFATsubscales and composite are presented in Table 3. Belief in

ATTITUDES TOWARD OBESE INDIVIDUALS

greater personal control of obesity (F( 1,24 2) = 7.3, P =0.007) and lack of family history of obesity (F(1,2 4 2 ) = 8.7,P = 0.004) were associated with higher antifat compositescores as well as higher scores on the social/character dis-paragement (F(I 242) = 9.5, P = 0.002 and F (1.242) = 7.2, P= 0.008, respectively) and weight control/blame subscales(F(1,242) = 3.8, P = 0.0524 and F(1,242 ) = 5.5, P = 0.002,respectively). Individuals reporting no obese friends hadhigher scores on the composite score and all subscales thanindividuals reporting having obese friends (social/character:F( 242) = 5.9, P = 0.02; physical/romantic: F(L2 42 ) = 5.7 P= 0.02; weight control/blame: F(,,2 42 ) = 7.2, P = 0.008;total score: F(,, 24 2) = 7.8, P = 0.0064). Being an ethnicminority was associated with less antifat bias on the phys-ical/romantic unattractiveness subscale (F (1.212) = 5.2, P =0.02). Eleven AFAT items had a mean score >3.0 for atleast one comparison group, indicating antifat bias (Table4). No statistically significant relationships were observedbetween AFAT scores and BMI (P > 0.29) or implicitattitudes (P > 0.11).

DISCUSSION

The exercise science students surveyed in the presentstudy exhibited strong implicit antifat bias, an effect that hasbeen observed among other groups of health professionals(15,16). In the present study, being Caucasian was associ-ated with more negative attitudes on the implicit good/badmeasure when compared with non-Caucasian participants.However, one limitation of the study is that the sample ispredominately Caucasian, and we combined minoritygroups for analyses. Therefore, we are unable to determinehow antifat bias differs across various ethnic groups withinthe population of exercise science students. Women andindividuals growing up in a more rural environment exhib-ited greater antifat bias for the goodlbad global attribute,whereas people who endorsed a belief in greater personalcontrol of obesity exhibited greater bias on the lazy stereo-type. The reasons for these findings are unknown, but it maybe that implicit biases are susceptible to specific repeatedassociations over time. As defined by Greenwald and Banaji(4), an implicit attitude is the unconscious trace of pastexperience or prior exposure that influences responses.Thus, individuals may hold stronger implicit biases forparticular attributes based on personal experience.

As expected, participants did not exhibit high overall biasscores on the explicit measure or traditional self-reportquestionnaire (AFAT). However, certain antifat beliefs andstereotypes were endorsed, most often in the area of phys-ical unattractiveness and weight blame. Of particular inter-est for this selected group of exercise science students arethe negative attitudes that relate to lifestyle behaviors in-cluding assumptions regarding junk food, control of weightloss, and physical coordination. Participants were also morewilling to endorse a lazy stereotype in the explicit ratings.These types of prejudicial attitudes have potential to inhibitthe effectiveness of lifestyle counseling and wellness activ-ities provided by health and exercise science professionals.

Medicine & Science in Sports & Exercises 471

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TABLE 3. Comparison of Antifat Attitudes Test (AFAT) scores of undergraduate and graduate students by gender.

Undergraduate Sludents Graduate Students PUG vs G PUG vs G PUG vs G

AFAT Scales Men Women P Men Women P (Men) (Women) (All)

I. Social/Character Disparagement (15 items)Mean 1.85 1.69 0.11 1.65 1.59 0.62 0.06 0.31 0.03(SD) (0.59) (0.58) (0.66) (0.43)

II. Physical/Romantic Unattractiveness (10 items)Mean 3.01 2.75 0.02 2.74 2.77 0.80 0.03 0.84 0.10SD (0.61) (0.69) (0.82) (0.57)

Ill. Weight Control/Blame (9 items)Mean 2.91 2.72 0.10 2.72 2.62 0.46 0.13 0.40 0.08SD (0.59) (0.68) (0.82) (0.64)

Composite Score (47 items)Mean 2.40 2.20 0.04 2.19 2.12 0.52 0.05 0.44 0.04SD (0.52) (0.58) (0.68) (0.46)

UG, undergraduate; G, graduate.

Belief in greater personal control of obesity and being amale undergraduate student were associated with higherAFAT scores. In addition, individuals without family his-tory of obesity or reporting no obese friends had higherantifat scores. Thus, personal experience with friends andfamily who are obese may lessen negative attitudes, and itmay be that efforts to enhance sensitivity and understandingamong health and fitness professionals may help reduce biastoward obese individuals.

Our results are consistent with previous research that hasdemonstrated negative attitudes toward obese individualsamong health professionals. Two recent studies adminis-tered the IAT to groups of health professionals who treatobesity and found strong implicit negative attitudes (good!bad) and stereotypes (motivated/lazy) associated with obesepersons (15,16). Similarly, a survey of family practice phy-sicians found that a significant number of physicians heldnegative beliefs toward obese persons and described obesepatients as lazy, sad, and lacking self-control (8).

Stigmatization and discrimination toward obese personswithin the health community may negatively affect qualityof life for many obese individuals in terms of psychosocialeffects, reduced quality of care, and decreased utilization ofservices including wellness activities. It is unknown whetherthe implicit antifat bias observed in the present study trans-lated to discriminatory behavior, as behavior was not mea-sured. However, reports from other health professions indi-cate that antifat bias can result in differential treatment, both

in terms of access to facilities and the professional-clientrelationship. For example, a study examining physician at-titudes toward case reports of patients differing only inweight found that physicians reported that they would feelmore negatively toward overweight "patients," would spendless time with them, but would order more tests (6). Facilityand equipment access is another area in which obese pa-tients face discrimination in general health care, as standardblood pressure cuffs, hospital gowns, and wheelchairs areoften too small to accommodate larger individuals.

Antifat bias and weight discrimination by health profes-sionals may, in turn, result in a decrease in utilization ofhealth and weliness services. For example, obese womenhave been found to be less likely to seek breast and gyne-cological screening and exams relative to normal weightwomen (3,21), and part of this effect may be due to attitudesprojected by health care professionals. It is likely that thewellness field parallels other segments of healthcare. How-ever, further research is needed to determine the extent towhich implicit antifat biases held by fitness professionalsmay influence adoption and maintenance of physical activ-ity. For example, a recent study examined weight criticismduring physical activity among schoolchildren and foundthat children who reported greater weight criticism alsoreported less sports enjoyment compared with peers (2). Toour knowledge, no studies have examined the impact ofantifat bias and weight discrimination on exercise percep-

TABLE 4. Antifat Attitudes Test (AFAT) items with a mean rating indicating antifat bias.

Overall Undergraduate GraduateSample Men Women Men Women

Antifat Attitudes Test Item (N = 244) (N = 77) (N = 57) (N = 57) (N = 53)

There's no excuse for being fat. 3.05 (1.03) 3.10 (0.97) 3.11 (0.90) 3.07 (1.27) 2.89 (0.99)If I were single, I would date a fat person.' 3.83 (1.02) 3.96 (1.06) 3.56 (1.02) 3.93 (1.05) 3.83 (0.91)Jokes about fat people are funny. 2.55 (1.21) 3.06 (1.21) 2.35 (1.09) 2.63 (1.14) 1.94 (1.10)Most fat people buy too much junk food. 3.33 (0.96) 3.55 (0.85) 3.35 (0.94) 3.25 (1.15) 3.09 (0.88)Fat people are physically unattractive. 3.22 (1.16) 3.36 (1.18) 2.91 (1.07) 3.32 (1.15) 3.25 (1.19)Fat people shouldn't wear revealing clothes in public. 4.05 (1.16) 4.09 (1.14) 4.30 (0.93) 3.68 (1.36) 4.11 (1.12)If fat people really wanted to lose weight they could. 3.62 (1.14) 3.81 (1.00) 3.58 (1.24) 3.51 (1.35) 3.53 (0.95)The existence of organizations to lobby for the rights of fat people in our society is a good idea.* 2.97 (1.13) 3.04 (0.95) 3.02 (1.04) 3.02 (1.45) 2.75 (1.07)I don't understand how someone could be sexually attracted to a fat person. 2.77 (1.25) 3.04 (1.14) 2.68 (1.20) 2.44 (1.38) 2.83 (1.25)People who are fat have as much physical coordination as anyone.* 3.25 (1.23) 3.51 (1.14) 3.19 (1.27) 3.21 (1.41) 2.98 (1.03)Fat people should be encouraged to accept themselves the way they are.* 2.75 (1.17) 3.01 (1.06) 2.75 (1.18) 2.58 (1.41) 2.57 (0.97)

Values are means (SD).* Item reverse scored.Item scores > 3.0 indicate antifat bias.

472 Official Journal of the American College of Sports Medicine http://vvvvvv.acsm-msse.org

tions and participation in obese adults, representing an im-portant next step for future research.

Given the prevalence of obesity and the current initiativeson obesity prevention and treatment, the problem of antifatbias and weight discrimination within health promotionsettings warrants focused attention. Individuals who work inhealth and fitness fields are exposed to the same culturalmessages as the rest of society, but additional factors mayalso contribute to negative perceptions and stereotypes. Stu-dents pursuing an exercise science degree are often drawn tothe field because of an interest in athleticism, health, andphysical function, which may contribute to a view of obesityas unacceptable. In addition, some of the academic curriculain the field of exercise science with an emphasis on healthand ideal body weight may contribute to automatic negativeassociations with obesity, thereby extending to obese peoplein general. Health and fitness professionals are keenly awareof the health risks associated with obesity, and it is unknownhow that knowledge and the observance of medical comor-bidities influence personal attitudes and beliefs toward in-dividuals who are overweight or obese. Furthermore, littleformal instruction in degree or continuing education pro-grams is available to provide training in physical activitypromotion and exercise prescription for obese individuals.

Consciousness raising has been suggested as a strategyfor avoiding discrimination and reducing implicit bias (4).Thus, bringing attention to the existence of antifat bias andweight discrimination in the area of exercise and wellnessmay help improve access to physical activity and quality ofservices provided by fitness professionals. For example, theInternational Council on Active Aging recently issued achecklist to rate fitness facilities on "age-friendliness,"which addresses both the emotional and physical needs ofolder individuals participating in physical activity (http:H/www.icaa.cc/Facilitylayouts/ICAA%2OFacility%2OTest.pdf).Similar methods initiated by professional organizations couldbe used to identify the needs of obese individuals and createhealthy and friendly environments to promote physical activity

REFERENCES

I. BALL, K., D. CRAWFORD, and N. OWEN. Too fat to exercise?Obesity as a barrier to physical activity. Aust. N. Z J. PublicHealtli 24:331-333, 2000.

2. FAITH, M. S., M. A. LEONE, T. S. AYERS, M. HEO, and A. PIETRO-

EELLI. Weight criticism during physical activity, coping skills, andreported physical activity in children. Pediatrics I 10:e23, 2002.

3. FONTAINE, K. R., M. S. FAITH, D. B. ALLISON, and L. J. CHESKIN.

Body weight and health care among women in the general popu-lation. Arch. Fam. Med. 7:381-384, 1998.

4. GREENWALD, A. G., and M. R. BANAJI. Implicit social cognition:attitudes, self-esteem, and stereotypes. Psvchol. Rev. 102:4-27,1995.

5. GREENWALD, A. G., D. E. McGHEE, and J. L. SCHWARTZ. Measuringindividual differences in implicit cognition: the implicit associa-tion test. J. Pers. Soc. Psychol. 74:1464-1480, 1998.

6. HEEL. M. R. and J. Xu. Weighing the care: physicians' reactionsto the size of a patient. Int. J. Obes. Relat. Metab. Disord. 25:1246-1252.

7. LEWis, R. J., T. J. CASH, L. JACOBI, and C. BUBB-LEWIS. Prejudicetoward fat people: the development and validation of the AntifatAttitudes Test. Obes. Res. 5:297-307, 1997.

in this population. In terms of education and certification,courses should address both client-centered strategies to pro-mote empathy as well as practical recommendations to accom-modate potential health limitations and physical needs of spe-cial populations, including large individuals. On a basic level,the knowledge that automatic antifat biases and unconsciousstereotypes exist can help professionals become aware of theirown predispositions toward obese individuals. These effectsmay be most pronounced among students, where professionalinexperience may further contribute to misconceptions.

The present study has several limitations. First, the sam-ple included a limited number of students from a few ex-ercise science programs. We cannot determine how repre-sentative this sample is compared with other studentsmajoring in exercise science, and results pertaining to spe-cific sample characteristics should be interpreted with cau-tion given the small sample size in these analyses. Second,we did not measure discriminatory behavior, and it is un-known how implicit antifat bias might influence interper-sonal interactions with obese individuals within exercisesettings. Finally, we did not conduct follow-up assessmentsto determine whether consciousness raising by researchparticipation attenuated antifat bias.

It is important that fitness and wellness services areavailable, accessible, and acceptable to obese persons.However, antifat bias and weight discrimination amongexercise professionals may serve as barriers for physicalactivity participation for some obese individuals. Therefore,programs involved in the training of health and fitnessprofessionals should consider raising awareness of antifatbias and weight discrimination in health and wellness set-tings to promote empathy among professionals and bettercare for all individuals.

We thank the Rudd Institute for funding this research and MelbaMorrow for her assistance in preparing the manuscript. We alsoappreciate the time and participation of the students and instructorsat the participating institutions.

Dr. Blair is a consultant for Jenny Craig International.

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