A world of suffering? Biocultural approaches to fat stigma in the global contexts of the obesity epidemic

Even as obesity rates rise, weight-related stigma remains widespread in the United States and leads to many documented social, economic, and health disparities. These include lower wages, less academic achievement, social exclusion as early as childhood, psychosocial stress, depression, and additional weight gain. Recent research documents the proliferation of antifat beliefs across the globe, but we know little about how this fat stigma varies across cultures. A clearer empirical and theoretical understanding of fat stigma in cultural context is essential to gauging its likely biocultural impacts across populations. Using data from Paraguay, Bolivia, India, and students and Muslim women in the United States (N = 414 women), we show that psychometric scales suggest high levels of stated or expressed fat stigma in all these samples, capturing globalizing anti-fat norms. However, when we assess what people think implicitly through reaction-time implicit association tests, we find marked variation across sites in the degree to which people are internalizing these stigmatized ideas around obesity. In India and among U.S. university students, women tend to internalize the idea of "fat" negatively. Paraguay women present, on average, fat-neutral internalized views. In Bolivia and among Muslim women in the United States, average assessments suggest fat-positive internalized views. This indicates fat stigmatizing norms are not always internalized, even as explicit fat stigma otherwise appears to be globalizing. Our findings indicate that the proposed biocultural relationships between fat stigma and health disparities may be complex and very context specific.