Posts Tagged ‘bias’
How popular beliefs about obesity contribute to the growing problem
Obesity is becoming more common in western cultures. Because the genetic component linked to obesity remains the same as it has in the past, there is an increased concern about the cultural and environmental causes of overeating (Lissner, 1997). Affluent western cultures have higher incidences than cultures that have more limited resources. Western cultures also hold more beliefs about individual control over outcomes and value thinness more than non-western cultures (Klaczynski, Goold, & Mudry, 2004). Both of these observations contribute to the increased problem of weight control and overeating in western cultures. Beliefs about individual control are associated with negative affect toward people with obesity and these beliefs are internalized by people who struggle with overeating themselves (Fabricatore & Wadden, 2004). Additionally, the pressures to be thin in western societies contribute to feelings of failure in people battling overeating. In turn, the prejudice and negative attitudes toward obese individuals negatively impacts body esteem subsequently leading to binge eating (Klaczynski, Goold, & Mudry, 2004).
The influence of prejudice and negative attitudes toward people struggling with overeating is widespread. In 2004, Fabricatore and Wadden stated that in the U.S. “ridicule and disparagement of obese individuals seems to remain a socially acceptable form of prejudice” (332). Unfortunately, this prejudice extends from the medical community to the mental health community to the population of overeaters themselves (Fabricatore & Wadden, 2004; Klaczynski, Goold, & Mudry, 2004; Brownell & Puhl, 2003). The scope of this prejudice is so widespread that it does not leave much of a window of opportunity for individuals who are stigmatized by this stereotype to seek the help that they need to overcome their eating problem. Additionally, it increases the risk for low body image, thus enhancing the likelihood for further binge eating. The relationship becomes almost circular in nature.
Another implication of the prejudices that people hold toward overeating and obesity is that it leaves a much smaller window of opportunity for treatment of overeating. Brownell and Puhl (2003) suggest that “negative attitudes in physicians may lead obese persons to avoid seeking health care” (p.16). Additionally, having the belief that overeating and bingeing is due to internal flaws such as laziness also decreases the likelihood that overweight people will seek help or continue with their treatment programs if they fail to see improvement (Brownell & Puhl, 2004).
A study by Klacynski, Goold, and Mudry (2004) investigated people’s attributions of the causes of obesity and found that after stereotypes of obesity were primed, scores that attributed obesity to internal causes increased whereas scores that attributed physical and social causes for obesity remained the same. That is, being thin is an achievement of will and, therefore, being fat (the antithesis) is likely due to lack of will. They also found a negative correlation between self-esteem and anti-fat attitudes and negative stereotypes of the obese. More crucially, this correlation remained significant among participants who’s BMIs were 25 or higher (with 24 being the upper limit in the “normal” weight category). This suggests that the prejudice is so strong that it permeates into the group at which it is targeted.
Body esteem has been linked to obesity such that people with low body esteem who are also exposed to other risk factors are more likely to engage in binge eating (Klacynski, Goold, & Mudry, 2004). Low body esteem is related to negative attitudes about obesity and overeating and is related to the beliefs people hold about obesity (whether it is due to internal or external causes). More specifically, the negative attitudes people hold about obesity mediate the relationship between beliefs about control and body esteem: people who believe that overeating is due to lack of motivation and control over their own eating habits are more likely to hold negative views toward those who overeat, and consequently, negatively influences body esteem (Klacynski, Goold, & Mudry, 2004). Another explanation is that individuals who suffer from the negative stereotypes adopted from beliefs about control and negative attitudes toward obesity are more likely to experience low body esteem which contributes to binge eating. Both explanations are in accordance with the dual-pathway model which shows that low body esteem is negative affect which is a risk factor for binge eating (Van Strien & Ouwens, 2007).
Due to the rampant prejudice toward individuals with obesity and the unfortunate consequences of that prejudice, it is not surprising that there is a steady increase in weight related disorders, particularly overeating. Additionally concerning is the notion that people generally hold internal causes of obesity as the strongest influence on overeating with lesser consideration for the physical and social causes. Because these beliefs are associated with prejudice, and subsequently low body imagine and binge eating, it is particularly difficult for those who struggle with binge eating to overcome it. The prevalence of prejudice within the mental health and medical realms is overwhelming. Awareness and training of the known risk factors and maintenance of overeating is called for in these fields, and perhaps more thoroughly with the public in general, to help individuals at risk for overeating.
References
Brownell, K., & Puhl, R. (2003). Stigma and Discrimination in Weight Management and Obesity. Health Systems, 16-18.
Fabricatore, A.N., & Wadden, T.A. (2004). Psychological Aspects of Obesity. Clinics in Dermatology (22), 332-337.
Klaczynski, P.A., Goold, K.W., & Mudry, J.J. (2004). Culture, Obesity Stereotypes, Self-Esteem, and the “Thin Ideal”: A Social Identity Perspective. Journal of Youth and Adolescence,33, 307-317.
Lissner, L. (1997). Psychosocial aspects of obesity: Individual and societal perspectives. Scandinavian Journal of Nutrition (41), 75-79.
Polivy, J. & Herman, C.P. (2002). Causes of eating disorders. Annual Review of Psychology (53), 187-213.
Van Strien, T., & Ouwens, M.A. (2007). Effects of distress, alexithymia and impulsivity on eating. Eating Behaviors (8), 251-257.
Why the CBCL’s Inter-rater Reliability is poor at the Item and Syndrome level
There seem to be no obvious methodological or statistical issues that could account for the poor inter-rater reliability. Embregts argues that informants might have a different view on presence and severity of behavioral problems depending on the frequency and quality of interaction they have with the client (“biased” data). Secondly both judges might have different standards of judgment when interpreting the behavioral data (“biased” interpretation). Another reason for poor inter-rater reliability might be different characteristics of the judges. As Albert Einstein already noted, we can not observe a process without influencing it – that notion is valid on a molecular level and (even more so – in my opinion) on a behavioral level. Different behaviors by the judge might lead the client to act differently. Ultimately data collection would be biased if the behaviour of the judge leads to behavior that would not be observed in a “normal situation”. This is a limitation we have to live with when conduction non-experimental studies. Diagnostic overshadowing is another process that could influence assessment of psychopathology and related behaviours: Judges might be inclined to attribute overlap between symptoms of mental retardation and psychopathology to the mental retardation. Finally the author hypothesis that low level of intellectual functioning make it hard for the judge to project oneself in the clients mental level. It might also be that there is just not one perfect treatment and many roads lead to Rome so to speak. If it is found that different treatment are effective and that they have about the same effect, inter-rater reliability should be computed in relation to treatment families and not single specific treatments, otherwise the IR rating might be much too conservative.
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