Dr.

Brewis Slade Research on Globalization, Stigma and Obesity

Slide 1
H, Alexandra Brewis Slade here again. In this lecture I am going to talk about my own research
examining the globalization of what I call “fat stigma.” In this module we have been exploring
how issues of prejudice, discrimination, stigma, and other forms of social exclusion are
damaging to health, especially to those who are less empowered to begin with such as people
in poverty. Perhaps ironically, obesity is fast becoming a global condition associated with
poverty. And it is also a condition associated with social ostracism and shame in our society.

Slide 2
Large bodies are highly stigmatized, and people with large bodies are discriminated against. By
stigmatized, we mean that the characteristic becomes laden with negative moral messages,
such as being lazy and weak, sexless, and dirty. As a result, obese people have a harder time
getting a job or being promoted, they get worse health care, and they have a harder time being
accepted as a person of value based on the idea that fat is a personal failing. It is thus little
surprise that being or feeling fat is associated with higher levels of depression.

Slide 3
In a recent study with ASU students, we found many people said they would rather be blind,
divorced, or alcoholic than obese. This is a good indicator of high levels of explicit stigma. You
can read more about the issues this raises in the Rudd Center pamphlet in your readings for this
module. These findings are pretty similar to those of studies with other groups in the US.

Slide 4
Here is a picture of some of our global health students in London in front of one of my favorite
installations – a compelling visual expression of how obesity is viewed in our society by John
Isaacs called “I can’t help the way I feel”.

When you do studies using Implicit Attitudes Tests, which ask people to very quickly categorize
so they don’t have time to think, many samples from the US show very high rates of deep-
seated or implicit stigma around fat, often much more so than people admit if you interview
them. That is, what people think is arguably worse than what they will admit. Some of the
highest rates of implicit bias against obese people are in health care providers, which is thought
to be one of the reasons health care service tends to discriminate against the largest members
of society. Children and adolescents appear especially vulnerable, even to the point of suicide.
And interestingly, the highest levels of implicit bias are sometimes seen in overweight and
obese people themselves, which suggests why rates of depression may be associated with
weight.

Slide 5
Historically, there is good documentation that many societies, perhaps most, valued plump
bodies, and the slim-idealism so common in the West is something of an historic aberration. In
an oft cited review of the cross-cultural record related to how people valued large bodies,
based on the ethnographically diverse Human Relations Area Files, Brown and Konner (1987)
estimated that 81% of the 325 included human societies preferred plump or fat bodies to thin
ones. This showed how culturally anomalous the American/Western idea of slimness was
viewed within the contexts of the full ethnographic spectrum. The cultural and social contexts
surrounding fat-preferring societies have been detailed in a number of ethnographies since by
cultural anthropologists. This has included the idea that Pacific Islanders (along with people in
many other regions) valued and preferred larger bodies.

Slide 6
I started working on questions about how people globally might be thinking about large bodies
when I was working in Samoa in 1992. This is a beautiful Pacific island in the central Pacific,
where at the time some of the larger people in the world lived. I was there as part of a team
from Brown University trying to understand how adiposity and chronic disease (such as CVD)
were linked. Now, note, this was a time before two-thirds of Americans were overweight, and
the Samoans in this regard were ahead of the trend.

Slide 7
When I was in Samoa we interviewed men and women about their bodies using what are called
body image scales. These help us ask people what size they think they are and what size they
want to be. I followed up with additional work in American Samoa and with Samoans living in
New Zealand. Samoans valued large bodies culturally, seeing them as beautiful, marriageable,
high status, and powerful.
What we found was surprisingly that in all places women identified that they wanted a smaller
body than they had. However at the time said it really didn’t matter (low salience) and did not
have negative views of obesity. Women basically said “would be nice, but who cares”.

Slide 8
In 2010 Amber Wutich and I set out to do a cross cultural study to investigate if these really
negative, stigmatized ideas about fat were globalizing. We chose 11 research sites based on
established field sites to which we had ready access. The study sites include several that have
been glossed as ‘fat-positive’ in the ethnographic record including American Samoa, Puerto
Rico, and Tanzania. A number of our global health majors worked with on this project and
helped us collect the data.
We collected data through in-person survey interviews in American Samoa, Tanzania, Mexico,
Puerto Rico, Paraguay, London, Argentina, United States [Arizona], and from a sample of
university students. We used internet-based surveys in Puerto Rico, New Zealand, and Iceland.
The sites included several that have been glossed as ‘fat-positive’ in the ethnographic record
(American Samoa, Puerto Rico, Tanzania). We intentionally included an eleventh sample of U.S.
undergraduates (from ASU), as the vast majority of the body image studies, including those
done internationally, have been conducted with similar student population.

Slide 9
We found that people in all these different places had a shared cultural model of obesity that
highlighted the ideas of fat-as –bad and fat-as-unhealthy. The most surprising finding was the
very high levels of fat-stigma expressed by people in American Samoa, since the Pacific Island
societies have long been assumed to retain fat-positive values.
You can read the NY Times coverage of the study and see people’s reactions here:
http://well.blogs.nytimes.com/2011/03/30/spreading-fat-stigma-around-the-
globe/?scp=9&sq=global%20obesity&st=cse
The original article, if you wish to read that, can be found in your readings folder for this
module.
Our findings provide clear evidence that negative and especially discrediting ideas about
obesity and ‘fat’ are globalizing.

Slide 10
In our most recent fieldwork, we decided to do further study to understand what these high
rates of obesity stigma might mean, starting with the case of Paraguay since the rates there
were the highest. Here are some of our ASU students in Paraguay on a research internship. We
aren’t so surprised by the findings of high rates of fat stigma in Paraguay, where the front page
of the newspapers are covered in idealized slim (and often large breasted) scantilly clad
women. What we really wanted to understand was how profound and salient those beliefs
about obese people are. So we went and did some more interviews, and did some implicit
attitude tests as well with 200 women in urban Paraguay.

Slide 11
What we found was that even though Paraguayans were as explicitly stigmatzing, even more
so, than people in the US, that when you do cognitive testing to test how biased they are
against obesity, it turns out they have no bias evident. That is, underneath it all they seem to be
on average neutral. Remember that by comparison, in American samples people are much
more likely to associate fat with “bad” than “Good”. It may be that the ideas around fat are
spreading globally, but people havent or havent yet taken them on board as deeply held
implicit beliefs.

Slide 12
These types of cross-cultural research projects are difficult and require a large team to do. I
always have to thank my many collaborators for making this type of research possible.