International Journal of Pediatric Obesity.

2010; 5: 2533

ORIGINAL ARTICLE

Predictors of 10-year-olds obesity stereotypes: A population-based study

LENA M. HANSSON & FINN RASMUSSEN

Child and Adolescent Public Health Epidemiology Group, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden

Abstract Introduction. Limited research has been conducted on factors that may increase childrens likelihood of developing negative attitudes or stereotypes about obesity. The aim of this study was to investigate predictors of childrens obesity stereotypes. Methods and procedures. A nationally representative sample of 10-year-old children (N03 000), and their parents were requested to respond to a questionnaire in 2005. Obesity stereotypes were assessed by asking children to attribute positive and negative adjectives to boy and girl silhouette figures with average, thin and obese body sizes. Childrens body esteem was also assessed, as well as parents belief in the controllability of body weight. Additional data were collected on parents and childrens current body size and socio-demographic variables. Results. The study included 1 383 parent and child pairs. Children assigned on average 3.9 (standard deviation, SD03.5) more stereotypes to a boy figure with obesity and 3.7 (SD 03.4) more stereotypes to a girl figure with obesity than to thin and average figures. Predictors of obesity stereotypes were parental body size and parents beliefs concerning controllability of weight. Childrens body esteem was inversely associated with boy obesity stereotypes, while only boys body esteem showed an inverse association with girl obesity stereotypes. Discussion. Obesity stereotyping was a more salient feature among 10-year-olds having leaner parents and/or parents holding stronger beliefs about personal control over body weight. Childrens perception of own body size rather than actual body size seem to be important in forming obesity stereotypes.

Key words: Child, obesity (attitudes towards), parents, stereotyping, prejudice

Introduction There is overwhelming evidence that children hold negative attitudes towards peers with obesity (1). Elementary school children evaluate children with obesity more negatively than thinner children. For example, individuals with obesity are more likely to be characterized as lazy, sloppy and lonely than children of average weight (24). Such widespread weight prejudice is most likely to affect individuals with obesity in terms of psychosocial well-being (5), bullying or victimization (6), and poor academic performance (7,8). However, to date, knowledge is scarce about the determinants of negative attitudes to or of the stereotyping of obese children (1). Childrens responses to others are likely to be due to a combination of many factors, including their social-cognitive

development, experiences of individuals with obesity, exposure to the values of peers, parents, and educators, and cultural transmission. The media, for example, may transmit obesity stereotypes by strongly asserting the importance of the thin ideal, promoting dieting, and portraying individuals with obesity in a biased manner (9). Social interactions in the arena of food and eating are other possible sources of children learning to hold negative attitudes towards obesity. Foods that are associated with dieting or healthy eating may symbolize a need to control weight, an ability that obese individuals are presumed to lack (10). Research has shown that 9year-old girls who frequently interact with their parents with regard to weight loss, and have parents that value thinness, are more likely to hold obesity stereotypes (11). Dieting and a preoccupation with food and weight also predicted stereotypes in these

Correspondence: Finn Rasmussen, Child and Adolescent Public Health Epidemiology Group, Department of Public Health Sciences, Karolinska Institutet, Norrbacka, S-171 76 Stockholm, Sweden. Fax: 46 8 30 80 08. E-mail: finn.rasmussen@ki.se

(Received 15 October 2008; accepted 10 March 2009)

ISSN Print 1747-7166 ISSN Online 1747-7174 # 2010 Informa UK Ltd DOI: 10.3109/17477160902957141

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L. M. Hansson & F. Rasmussen who express prejudice. Given the paucity of studies in this arena, we chose to examining predictors of childrens obesity stereotypes. We tested the hypothesis that childrens obesity stereotypes are positively associated with parents beliefs concerning controllability of weight, and negatively associated with parental body size and childrens own concerns regarding body weight.

girls regardless of their own weight. Two recent studies have shown that college students with higher levels of eating concern and body dissatisfaction report higher levels of anti-fat attitudes (12,13). These findings indicate that perception of ones own body size rather than actual body size may be important in the formation of obesity stereotypes. According to attribution theory, attributing individual responsibility to obesity leads to a negative evaluation of the obese individual, which gives rise to prejudice and concomitant discrimination (10). The theory suggests that the generation of stereotypes does not require contact with the group being stigmatized. Simply conveying the message that obesity is caused by peoples inability to control their weight is enough to form negative affective responses. It has also been shown that belief in controllability is strongly associated with obesity stereotypes in both children and adults (1416). However, we are not aware of any study that has examined the association between parents beliefs concerning the controllability of weight and childrens obesity stereotypes. Parents who believe that the development of obesity is due to lack of willpower and effort may communicate these attitudes to their children and others. This is likely to arouse disgust and feelings of antipathy towards obese individuals, rather than the sympathy that might be expected if people believe that obesity is due to uncontrollable factors (17). Children may explicitly hear their parents not only expressing distaste for obese people, but also blaming them for not controlling their weight. As a consequence, children may react more negatively to an individual with obesity. The experimental studies that have provided information about obese individuals difficulties in controlling their weight have not been able to affect childrens obesity stereotypes (18,19). Therefore, it has been questioned whether obesity stereotypes among children can be fully understood from the perspective of attribution theory. Children raised by parents with obesity may show less negative attitudes because they frequently interact with obese individuals and become familiar with the health problem. To our knowledge, this has not been previously investigated. Research into childrens attitudes towards stigmatized groups has shown that direct contact may result in more positive inter-group attitudes (20). Frequent social interactions with individuals with obesity may therefore result in more positive views about obese people in general. In order to reduce prejudice and the stigmatization of individuals with obesity, we need to understand both who is more likely to be subjected to prejudice and also what characterizes the children

Methods Population In August 2005, a random and nationwide sample of all children, with Swedish citizenship, born in 1995, was drawn from the Swedish Register of the Total Population (RTP). All individuals recorded as permanently living in Sweden are included in this register. Children with parents, who had died or emigrated three years previously, according to the RTP, were excluded before sampling. The sample size was set as a fixed proportion of the RTP, that is, 1 500 boys and 1 500 girls.

Procedure Questionnaires were mailed to the parents or guardians of the children. There was one questionnaire to be filled in by the child, and one to be answered by one of the parents (free parental choice). Consent to participate was indicated by the child and at least one parent answering their respective questionnaires. In an accompanying letter, children and parents were informed that the questionnaire focussed on aspects like bullying behaviour or experience. Parents were additionally informed that the questions dealt with childrens attitudes toward obesity and that the child, as far as possible, should fill in the questionnaire on his/her own. The parents were asked to not interfere with the childs way of responding, but were informed that they could answer any questions that the child might have. The Regional Ethical Review Board, Karolinska Institutet, Stockholm, Sweden, approved the study. Measures Socio-demographics. Parental education (self-reported) was used as a proxy for socioeconomic status. High education was defined as completing at least 15 years of education (corresponding to at least 3 years of university studies). Place of residence (urban or rural) was gathered from the RTP. Urban area referred to the three largest cities in Sweden with their suburbs, and other larger cities (with 50 000200 000 inhabitants).

Predictors of childrens obesity stereotypes Body size. The childs height and weight were reported by the responding parent. This information was obtained from 90% of responders. Data were retrieved from school health services for the remaining children where parents gave their consent (7%). Body mass index (BMI, kg/m2) was calculated and children were classified as thin following the cut-offs recently proposed by Cole et al. (21), and overweight or obese according to the International Obesity Task Force criteria (22). Parents were asked to circle one out of nine figure silhouettes ranging from thin to obese (23), which they thought best resembled their body size. Body silhouettes are simple and useful indicators of BMI; the correlation between body silhouette and BMI in women has been shown to be linear (r 00.77) (24).

27

with obesity. Internal consistency in the sample was a 00.77 for the girl figure and a 00.76 for the boy figure. Body esteem. Childrens body concerns were measured on the Body Esteem Scale for Adolescents and Adults (BESAA) (25). The BESAA has been translated into Swedish and used in a previous study involving 10-year-olds (26). The scale includes three subscales measuring general feelings about ones body (BE Appearance), satisfaction with ones weight (BE Weight), and evaluations attributed to others about ones body and appearance (BE-Attribution). Participants indicate their responses to the statements on a 5-point Likert-scale ranging from never (0) to always (4). Lower scores indicate lower body esteem. Internal consistencies in the present sample were a 00.86 for BE Appearance, a 00.69 for BE Attribution, and a 00.90 for BE Weight. Beliefs about the controllability of weight. Parents responded on a four-item measure designed to assess beliefs about the controllability of weight. This included three statements from the Willpower subscale of Crandalls (15) Anti-fat Attitude Scale (Fat people tend to be fat pretty much through their own fault, Some people are fat because they have no willpower, People who weigh too much could lose at least some part of their weight through a little exercise). The scale showed to have quite low internal consistency (a 00.52) in this sample, accordingly, an additional item was included, Fat people are lacking in character, which increased reliability to 0.64. Each item was rated on a 5-point Likert scale. Response alternatives were: never (1), seldom (2), sometimes (3), often (4) and always (5). The data points clustered around the mean, with only 5% of the parents reporting often or always. We therefore used the 75th percentile to define parents as having a high or a low belief concerning controllability. Statistical analysis We used multiple linear regression analysis to identify predictors of childrens obesity stereotypes. The outcome variables, girl obesity stereotypes and boy obesity stereotypes, both proved to be normally distributed, with moderate right-skewness. Given the large sample size, this is of minor importance. The residuals were also examined graphically, and the histograms and Normal Q-Q plots showed minor right-skewness for the two dependent variables. The residual variance across observations was checked to establish that confidence intervals and precision

Obesity stereotypes. The measure for assessing obesity stereotypes in children was developed specifically for the study. Essentially, there are no validated questionnaires on obesity stereotypes. A list of positive (clean, fast, good, good-looking, happy, hard-working, healthy, honest, joyful, kind, loved, popular, satisfied) and negative (cowardly, different, lazy, lonely, sloppy, slow, strange, stupid) adjectives was used to measure stereotypes concerning child figures of different body sizes. The figures presented for the children have been used previously and represent approximately ages 610 (23). Out of a set of 9 figures, ranging from thin to obese: body size no. 2 represents thinness, body size no. 4 average weight, and body size no. 9 obesity. Each child was asked to judge illustrations of both boys and girls. An obesity stereotype score for each boy and girl figure was produced. This was effected by giving a score of (1 if a positive adjective was assigned to the figure with obesity but not to either of the other figures (thin or average weight), thus indicating positive stereotyping. If a negative adjective was assigned to both the thin and the average weight figure, but not to the obese figure, this also resulted in a score of (1. However, if a positive adjective was assigned to the figure with thinness and average weight but not to the figure with obesity, the score became '1, indicating negative stereotyping. Further, if a negative adjective was attributed to the figure with obesity, but not to either of the other figures, the score was '1. All other combinations were scored 0, such as when a positive adjective was assigned to both the figure with obesity and the figure with average weight, which indicated stereotyping of the thin. The scores for all the adjectives were then summed, giving a total score that could range between (21 to '21. Higher total scores indicated a higher level of stereotyping of the boy or girl figure

28

L. M. Hansson & F. Rasmussen children assigned 15 stereotypes, while 25% reported 6 stereotypes or more. Approximately 80 percent of the responding parents were mothers. Parents body size ranged from size no. 2 to no. 9 with a mean of 4.5. Of the fathers, 39% had a high education, and of the mothers 31%. Of those included in the study, fathers were more likely than mothers to have a high belief in controllability (34% compared with 25%).

were not affected. We used the PROC REG in SAS to estimate predictors of obesity stereotypes with their 95% confidence intervals (CI).

Results Sample characteristics The response rate was 46% (n 0697) for boys and 53% (n 0800) for girls. The response rate was lower for children with foreign background (43%) than for those with Swedish background (51%), and a higher response rate was found for children with high parental education (59%) than for those with low parental education (47%). There was no difference in study participation with regard to urban/rural residence. In total, 1 383 parent and child pairs were complete on all variables used for the analyses. The children analyzed did not deviate from the children that had been excluded due to missing internal data on the investigated characteristics. Childrens means and standard deviations and frequencies of the included variables are presented in Table I. The overall means of 3.71 for the obese girl figure and 3.90 for the obese boy figure confirm a high degree of stereotyping. On average, roughly four negative stereotypes were assigned to the obese figure, which were not assigned to the thin or average figure. About 15% of the children were neutral or performed positive stereotyping. Sixty percent of the

Predictors of childrens obesity stereotypes Spearman and Pearson correlation analyses were used to investigate associations between childrens obesity stereotypes and predictors (Table II). Child BMI was used both as a predictor of obesity stereotypes and as a potential confounder of any association between body esteem and obesity stereotypes. Parental education and place of residence were controlled for, as they are strongly associated with BMI. Predictors that had a p-value lower than 0.10 were considered for inclusion in multiple regression analyses.

Girl obesity stereotypes Table III present predictors of girl obesity stereotypes. Model I shows that child BMI was not associated with obesity stereotypes. Boys were found to report higher obesity stereotypes than girls (Model II). The correlation coefficients showed

Table I. Childrens characteristics. All children (N01 383) Mean (SD) range Age BMI Body esteem Appearance Body esteem Attribution Body esteem Weight Obesity stereotypes Boy figure Obesity stereotypes Girl figure 10.3 17.6 3.30 2.63 3.28 3.90 3.71 (0.3) 9.711.0 (2.6) 11.636.0 (0.59) 1.14.0 (0.62) 1.04.0 (0.74) 1.04.0 (3.49) (519 (3.37)* (1418 % 32 60 7.7 13.2 2.4 82 Boys (n 0634) Mean (SD) range 10.3 17.7 3.31 2.62 3.32 3.96 3.93 (0.3) 9.811.0 (2.6) 12.836.0 (0.57) 1.14.0 (0.64) 1.04.0 (0.70) 1.04.0 (3.46) (418 (3.56) (1418 % 33 62 6.6 13.7 2.4 80 Girls (n 0749) Mean (SD) range 10.3 17.4 3.29 2.64 3.25 3.85 3.53 (0.3)9.710.9 (2.5) 11.630.3 (0.60) 1.24.0 (0.62) 1.04.0 (0.76) 1.04.0 (3.51) (519 (3.18) (418 % 32 58 8.7 12.8 2.4 83

High parental education Urban place of living Thinnessa Overweightb Obesityb Mother responding
a b

Age-specific BMI B18.5 according to Cole, Flegal, Nicholls and Jackson (21). Age-specific BMI cut-offs according to International Obesity Task Force criteria (22). *Independent-samples t-test between boys and girls (t([ 381]02.24, p 00.025).

Predictors of childrens obesity stereotypes

13

29

Table II. Correlation coefcients.

1. Obesity Stereotypes Boy 2. Obesity Stereotypes Girl 3. Child sex (boy 01) 4. BMI 5. BMI-collection type (objective 01) 6. Body esteem Appearance 7. Body esteem Weight 8. Body esteem Attribution 9. Parental education (high01) 10. Place of residence (urban01) 11. Parental sex (father 01) 12. Parental body size 13. Parental controllability belief

*p B0.10; $pB0.05; %p B0.01. BMI: Body mass index.

that BE Appearance and BE Weight, but not BE Attribution, were associated with girl obesity stereotypes (Table II). As BE Appearance and BE Weight were found to be so highly correlated, they were examined separately (using the same analytic steps) to avoid multi-collinearity. Table III shows the results for the models where BE Appearance was used. BE Appearance showed an inverse association with obesity stereotypes, indicating that the lower the body esteem, the higher is obesity stereotyping (Model III). It turned out that BE Weight had a lower regression coefficient (B 0(0.34: 95% CI: (0.61, (0.07) than BE Appearance, but the estimates of the other variables remained almost unchanged regardless of the body esteem subscale employed. Parents belief in controllability, adjusted for parental sex, was entered as a next step (Model IV). A high belief in controllability on the part of parents predicted higher obesity stereotypes in their children. The association was found to be significant at a trend level (p00.05). Parental body size was entered into Model V. Parental body size showed an inverse association with obesity stereotyping; thus, the larger the parental body size, the more tolerant is the child. The addition of parental body size slightly attenuated the estimate for controllability belief. This was attributed to the high correlation between parental body size and controllability belief, that is, the leaner the parent, the higher is the probability of a high belief in controllability being reported (Table II). We tested for possible interaction between child sex and body esteem, and found that girls body esteem did not show an association with girl obesity stereotypes. It was only for boys that obesity stereotyping increased with decreasing body esteem. Due to the borderline significant association between parental controllability belief and childrens obesity stereotypes we ran the regression models separately for mothers and fathers. Maternal controllability belief was found to be significantly and positively associated with childrens girl obesity stereotypes (B 00.60; 95% CI: 0.15, 1.05), while the relationship seemed to be inverse for fathers (B0(0.51; 95% CI: (1.36, 0.36); however, not significant. Boy obesity stereotypes Predictors of boy obesity stereotypes showed a somewhat different pattern (Table IV). For example, child sex showed no association with boy obesity stereotypes (Model II). BE appearance had a slightly higher regression coefficient when regressed on the boy obesity stereotypes than on the girl obesity stereotypes, but the relationship was still in the same direction. There was no interaction between

(0.60% 0.02 0.04 0.01 (0.08% (0.04 (0.02 0.02 (0.02 0.02 (0.05* 0.05$

0.06$ 0.03 (0.01 (0.07% (0.06$ (0.03 0.03 0.02 (0.02 (0.06$ 0.05$

0.06$ 0.02 0.00 0.03 (0.02 0.01 0.04 0.03 0.00 (0.01

0.05$ (0.16% (0.32% (0.10% (0.06$ (0.06$ (0.04 0.17% (0.02

(0.01 (0.03 (0.04 (0.02 0.01 0.02 0.04 0.00

0.68% 0.53% (0.04 0.04 0.00 (0.04* (0.01

0.46% (0.01 0.00 0.02 (0.10% 0.00

(0.06$ 0.00 (0.04 (0.06$ 0.02

0.14% 0.07% (0.10% 0.00

0.03 (0.04 0.02

10

0.00 0.08%

11

(0.06$

12

30

L. M. Hansson & F. Rasmussen

Table III. Linear regression predicting girl obesity stereotypes. Un-standardized regression coefcients B (95% condence interval). All models are adjusted for parental education and place of residence. (0.26 ((0.44; (0.07) (0.60 ((1.21; 0.00)

(0.16 ((0.80; 0.48)

(0.26 ((0.45;(0.08)

0.01 0.42 (0.40 (0.32 0.36

5.7 (1.0)

body esteem and child sex. Both boys and girls showed an increase in obesity stereotyping with decreasing body esteem (Model III). Just as with childrens girl obesity stereotypes, parental body size showed an inverse association with childrens boy obesity stereotypes. Parental controllability belief showed a positive association with childrens obesity stereotypes, also here at a trend level. Maternal controllability belief was significantly associated with childrens boy obesity stereotypes (B00.50; 95% CI: 0.03, 0.97), but paternal controllability belief showed no association (B 00.02; 95% CI: (0.82, 0.85). Discussion

(0.13 ((0.77; 0.51)

Model VI

((0.06; 0.09) (0.38; 4.45) ((0.55; 0.27) ((0.77; 0.15) ((0.05; 0.74)

Model V

((0.08; 0.07) (0.08; 0.78) ((0.70; (0.08) ((0.78; 0.14) (0.00; 0.80)

((0.06; 0.09) (0.07; 0.78) ((0.72; (0.09) ((0.78; 0.14) ((0.04; 0.77)

0.02 2.41 (0.14 (0.31 0.34

4.8 (1.1)

To our knowledge, this is the first study to examine the association between parents beliefs on the controllability of weight and childrens obesity stereotypes, and also the association between parents body size and childrens obesity stereotypes. Parents who emphasized individual responsibility for weight had children who were more likely to express stereotypical views about obesity. The association was found to be borderline significant and must therefore be interpreted cautiously. But we did find that the association became stronger when only mothers controllability belief was used in the regression models suggesting perhaps that parents exert different influence. The sample size of fathers was, in comparison with the sample size of mothers, rather low (n 0252). Therefore, if fathers controllability beliefs are relevant or not for childrens obesity stereotypes needs to be further investigated in a larger sample of fathers. Our result is; however, in line with previous research, which has established that there is a link between beliefs with regard to controllability and obesity stereotypes in both adults and children (14,15,27). However, earlier studies have not directly measured parents belief in controllability and its link to their childrens obesity stereotypes. Parents with a belief in controllability may convey the idea of personal responsibility for obesity, which indirectly promotes stereotypes about obesity in their children. Parents with a high controllability belief may also control their childrens food intake to a greater extent (28), something that children might interpret as fear of fatness and the undesirability of being obese. Further, as controllability beliefs are so highly correlated with obesity stereotypes, the association found may actually reflect an association between parents obesity stereotypes and their childrens obesity stereotypes. Unfortunately, we did not assess parents obesity stereotypes, and therefore cannot ascertain whether parents stereotypes are directly

(0.19 ((0.83; 0.45)

Model IV

(0.19 ((0.84; 0.45)

0.00 ((0.08; 0.07) 0.42 (0.06; 0.78) (0.40 ((0.71; (0.08)

Model III

0.00 0.43 (0.39 (0.32 0.40

(0.18 ((0.82; 0.46)

0.02 ((0.05; 0.09) 0.40 (0.05; 0.76)

Model II

(0.16 ((0.81; 0.48)

0.02 ((0.04; 0.09)

Model I

BMI collection type (objective 01) BMI Sex (boy 01) Body esteem Appearance Parent (father 01) Parental controllability belief (high01) Parental body size Body esteem Appearance ) Sex Intercept

3.3 (0.6) BMI: Body mass index.

Variable

3.2 (0.6)

4.9 (0.9)

4.8 (1.0)

Predictors of childrens obesity stereotypes

Table IV. Linear regression predicting boy obesity stereotypes. Un-standardized regression coefcients B (95% condence interval). All models are adjusted for parental education and place of residence. 0.73) 0.08) 0.51) 0.18) 0.15) 0.80) 0.04)

31

BMI collection type (objective 01) BMI Sex (boy 01) Body esteem Appearance Parent (father 01) Parental controllability belief (high01) Parental body size Intercept

BMI: Body mass index.

transferred to their children. In a previous study, parents obesity stereotypes were not found to be related to their 9-year-old daughters stereotypes (11), but it has been found in another sample that mothers obesity prejudice is related to their adolescent daughters obesity prejudice (29). Children showed stronger obesity stereotypes with decreasing parental body size. That parental body size influences childrens obesity stereotyping is interesting, as earlier studies have not been able to establish a link between negative attitudes towards obesity and own body size (1). Previous studies may have lacked statistical power, and have therefore been unable to detect any association between BMI and obesity stereotypes, but nor did we find any indication that childrens own body size is important in judgements of others body appearance. According to the contact hypothesis, frequent contact with out-group members may result in more positive attitudes, not only to the out-group member one interacts with, but also to the out-group as a whole (30). Further, a study of students indicates that availability of personality information may make for a lesser focus on peoples weight during personal evaluation (31). A possible explanation for our result is that children with larger parents realize that body size has little or nothing to do with certain behaviours or characteristics, and are therefore less disposed to stereotype. Childrens body concerns were found to be related to boy obesity stereotypes, but only boys body esteem was related to girl obesity stereotypes. Why girls body esteem did not seem to matter in judgements of the obese girl silhouette is difficult to interpret. Some earlier research has acknowledged that body concern is a normative discontent among young women (32), most likely prevalent among prepubertal girls, which might entail little variation in the stereotyping of obesity. Associations between body concerns and obesity stereotypes have been reported previously. Studies of young adults (predominantly women) have found significant associations between body-image issues and anti-fat attitudes (12,13). Davison (11) found that weight concerns predicted obesity stereotypes in 9-year-old girls. Another study, of 712-year-olds, found that boys body dissatisfaction was correlated with obesity stereotypes, but that this was not the case for girls (33). All this indicates that feelings about ones body, rather than current weight status, are important in evaluating others appearance.

Model V Model IV

(0.62; 0.71) (0.09; 0.06) (0.23; 0.51) (0.82; 0.16) (0.81; 0.15) (0.00; 0.83) (0.64; (0.09; (0.25; (0.83; 0.69) 0.06) 0.49) 0.18) 0.04 0.01 0.14 0.49 0.33 0.41 0.05 (0.62; 0.71) 0.02 (0.05; 0.09) 0.10 (0.27; 0.47) 0.03 0.01 0.12 0.50 0.05 (0.62; 0.72) 0.02 (0.05; 0.09)

Model III

Model II

Model I

3.5 (0.6)

3.5 (0.6)

5.7 (1.0)

5.7 (1.0)

0.07 (0.59; 0.00 (0.07; 0.14 (0.23; 0.50 (0.83; 0.32 (0.80; 0.38 (0.04; 0.23 (0.42; 6.6 (1.1)

Variable

Strengths and limitations The main strengths of this study lie in its nationwide coverage and large sample size. It is also a strength

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L. M. Hansson & F. Rasmussen suggested that intolerance is a concept that shapes an individuals different types of prejudice, including the prejudice against obesity (29). It seems to be commonplace for people to be general in their prejudice (37), which lends support to the suggestion that people who are racist, sexist, and prejudiced against homosexuals and the disabled also show obesity prejudice. Interestingly, research has demonstrated that obesity prejudice might be greater than prejudice against other socially disadvantaged groups (29,35,38). This call for a need to increase awareness in society about the negative effect such prejudice might have for a substantial number of people, and especially for children. To our knowledge, no research interventions have attempted to affect obesity prejudice in parents. However, there are a few intervention studies that have been performed to reduce obesity stereotyping in elementary school children (18,19,39). Although peers and educators are influential in forming a childs values and beliefs, omitting the family from interventions that have the aim of reducing obesity stereotypes means that they will have only a limited effect. Given the link between body esteem and obesity stereotypes found in the present as well as in other research, interventions that aim to improve body-image might be fruitful in reducing obesity stereotyping. Extended contact with obese individuals, or with children who are the friends of obese individuals, may also provide an opportunity to improve attitudes.

that we have included both boys and girls. Further, the use of an unforced response format for the reporting of stereotypes and the use of three bodysize figures probably decreased the risk of the obese silhouette being consistently disparaged, because negative attributes could also be ascribed to the thin and even to the average weight figure (11,34). However, slow, lazy and sloppy were attributed to the obese figure by a majority of the children; it might be more socially acceptable to attach attributes, such as lazy, to obesity than to make an overall negative evaluation. This brings us to some weaknesses of this study. First, there is the limitation that no validated and internationally accepted measure of obesity stereotyping is currently available for research purposes. We created a composite measure to achieve an overall evaluation of prejudice against obesity. Unfortunately, the use of an overall obesity-stereotype score is a barrier to illuminating which attributes are more associated with the predictors than others. Second, we only had data on one parent in each case. Fathers and mothers might not concord in their prejudices, and may have different influences on their child according to the domain of prejudice being investigated (29). Even though we have no knowledge of parents different patterns of influence, mothers may well be especially concerned with health, eating and body image, and the most relevant parent to include in a study of this kind. Third, we did not apply any measurement of social desirability, although recent research has shown that questionnaire items used to measure anti-fat attitudes might be subject to response bias (35). Further, the assessment of belief in controllability was found to have low internal consistency; this field of research is in urgent need of better developed psychometric instruments. Fourth, the data for this study were correlational. It cannot be concluded that the predictors investigated are the causes of obesity stereotyping. Given the early emergence of obesity stereotypes in children (36), low body esteem, for example, may develop from obesity stereotypes as a fear of becoming overweight, as this condition is so strongly related to others negative evaluations.

Acknowledgements We thank Nina Karnehed for her work regarding study design, construction of questionnaire items and collection of data, and Per Tynelius for sampling and creation of the database. The study was supported by a grant to Finn Rasmussen from the Swedish Foundation for Health Care Sciences and Allergy Research (the Vardal Foundation), Stock holm, Sweden (Project B2005011). Declaration of interest: The authors report no conicts of interest. The authors alone are responsible for the content and writing of the paper.

Implications Obesity stereotypes seem to be a very strong societal phenomena and parental belief of the controllability of weight, parental body size and childrens body esteem only slightly affected the number of stereotypes assigned to the obese silhouette figure. This indicates that other factors are also of importance in forming strong obesity stereotypes. It has been References
1. Puhl RM, Latner JD. Stigma, obesity, and the health of the nations children. Psychol Bull. 2007;133:55780. 2. Staferi JR. Body build and behavioral expectancies in young females. Dev Psychol. 1972;6:1257. 3. Wardle J, Volz C, Golding C. Social variation in attitudes to obesity in children. Int J Obes Relat Metab Disord. 1995;19: 5629.
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Predictors of childrens obesity stereotypes

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