Psychobiology and Behavioral Strategies

Attitudes toward Obese Individuals among

Exercise Science Students
HEATHER 0. CHAMBLISS, CARRIE E. FINLEY, and STEVEN N. BLAIR
Centersfor 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 obese
individuals 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 of
questionnaires to assess attitudes toward obese individuals. Instruments included the Implicit Association Test (IAT), a timed self-report
assessment 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 toward
obese individuals. Participants also completed a general demographic questionnaire. Results: A strong bias was found for implicit
measures including good versus bad attitude (P < 0.0001) and motivated versus lazy stereotype (P < 0.0001). Characteristics
associated with greater bad bias included being female, Caucasian, and growing up in a less populated area (P < 0.05). Belief in greater
personal responsibility for obesity was associated with stronger lazy bias (P < 0.01). On the AFAT self-report measure, belief in less
personal 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 and
bias 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 obese
individuals who are at high risk for chronic disease. Key Words: STIGMA, BIAS, DISCRIMINATION, WEIGHT, OBESITY,
HEALTH PROMOTION

T he increasing prevalence of obesity and associated

health risks have brought the issue of obesity pre-
T vention and treatment to the forefront of the public
health agenda (19,20). Exercise has the important potential
to assist in weight management as well as alleviate many of
the comorbidities associated with obesity (18). Because
physical inactivity and overweight are predominant among
American adults, these problems are primary objectives of
current public health initiatives (19,20).
Individuals report diverse barriers to physical activity.
Common barriers include environmental factors such as
safety and proximity to facilities as well as personal factors
such 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 Cooper
Institute, 12330 Preston Road. Dallas, TX 75230: E-mail: hchambliss@
cooperinst.org.
Submitted for publication January 2003.
Accepted for publication October 2003.
0195-9131/04/3603-0468
MEDICINE & SCIENCE IN SPORTS & EXERCISE,
Copyright © 2004 by the American College of Sports Medicine
DOI: 10.1249/01.MSS.0000117115.94062.E4
468
nance of physical activity behaviors including embarrass-
ment, health concerns, disproportionate focus on weight
loss, and previous negative experiences with exercise (1.9).
Additionally, an often-overlooked barrier to exercise for
obese 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 employment
practices, reduced education and housing opportunities, and
negative portrayals in popular media (14). Bias is defined as
"an inclination of temperament or outlook, especially a
personal and sometimes unreasoned judgment" (11). Thus,
antifat bias is an obesity prejudice in which the attribute of
being obese influences expectations about the individual,
often in terms of negative character assessments such as
laziness, lack of self-discipline, and incompetence (14).
Many obese individuals give accounts of disparaging
remarks by health professionals and report discrimination
in facility and equipment access. Negative attitudes and
stereotypes have been documented among various groups
of health professionals including dietitians (1 3), medical
students (22), physicians (6,8), nurses (10), and obesity
specialists (15,16). Because antifat biases have been doc-
umented among other groups of health professionals, it is
TABLE 1. Demographic characteristics.
Undergraduate Graduate
Men Women Men Women
Variable (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(%)N
Single 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- attributes were chosen because they represent common an-
uals also exist among students and professionals within tifat stereotypes and have been examined in prior studies
the exercise and fitness fields. Therefore, the purpose of using the IAT (15-17). Participants complete the IAT by
the present study was to evaluate attitudes toward obesity classifying words into superordinate categories. Check
among students majoring in exercise science and to ex- marks are used to classify the words into the categories
amine individual characteristics associated with antifat indicated at the top of each page (Fig. 1). Participants have
bias. We hypothesized that students would demonstrate 20 s to complete each of the IAT tasks, and each measure is
strong implicit antifat biases but would not explicitly repeated with the superordinate pairings reversed. The IAT
endorse negative attitudes and stereotypes. is then scored by subtracting the number of words correctly
classified when the term fat people is paired with the neg-
ative attributes (i.e., bad and lazy) from the number of words
METHODS
correctly classified when the term fat people is paired with
Participants. Participants were 136 undergraduate and the positive attributes (i.e., good and motivated).
110 graduate students majoring in exercise science repre- People generally find the IAT tasks easier when the
senting three colleges and universities in Texas and Ala- category pairing matches their attitude (fat people paired
bama. Approximately 55% of participants were male. The with bad or lazy vs good or motivated) and are able to
sample was predominantly Caucasian (77%) with a mean correctly classify more words within the 20-s time. Thus, a
age of 23.2 yr. Written informed consent was obtained from positive difference score indicates a stronger automatic pref-
each participant, and The Cooper Institute Institutional Re- erence for the pairing of fat people with negative attributes,
view Board approved the study. Table I presents demo- or implicit antifat bias. Unlike traditional self-report ques-
graphic information for study participants. tionnaires, the IAT measures associations and automatic
Implicit Association Test (IAT). The IAT is a timed
assessment that measures automatic associations of a target TABLE 2. Categories and associated subordinate word stimuli for Implicit
construct with particular attributes. It has been used primar- Association Test (IAT) tasks.
ily to examine social prejudice against different groups (e.g., Stimuli to Be Classified
racial stereotypes) (5). The IAT has also been used to assess Target category labels
implicit antifat bias in various populations including stu- Fat people Fat Obese Large
Thin people Slim Thin Skinny
dents and community members (17) as well as health pro- Attribute category labels (Task 1)
fessionals (15,16). In the present study, all participants were Bad Terrible Nasty Horrible
Good Wonderful Joyful Excellent
given two IAT measures to assess the attributes of bad Attribute category labels (Task 2)
versus good and lazy versus motivated with the target cat- Lazy Slow Lazy Sluggish
egories of fat people and thin people (Table 2). These Motivated Determined Motivated Eager

ATTITUDES TOWARD OBESE INDIVIDUALS Medicine & Science in Sports & Exercise® 469
 Pairing A Pairing B of the lecture time. Students were informed that they were
Thin People Fat People Fat People Thin People volunteering to participate in a study to examine the rela-
Motivated Lazy Motivated Lazy
tionships between individual characteristics and attitudes
/
obese obese and to examine the psychometric properties of question-
sluggish V sluggish /
V naires used in prior research. Questionnaires were coded
V slim slim /
before administration and linked by unique numbers so that
I/ eager eager no identifying information was provided on any of the
large I/ / large
questionnaires. Research packets were distributed to stu-
lazy / lazy I
dents who were instructed to complete the demographic and
fat v / fat AFAT questionnaires and then to stop and wait for direc-
V motivated / motivated tions. The IAT was then administered to the class as a whole
/ thin thin I/
using standardized instructions and timing. After complet-
/ determined determined ing the IAT, participants were asked to provide explicit
I/ skinny skinny I/
ratings for the attributes assessed in the IAT. The order of
instrument administration was selected to avoid contaminat-
FIGURE I-Sample portions of two completed IAT tasks measuring
implicit associations among fat and thin people with lazy and motivated
ing the AFAT self-report questionnaire with the experience
descriptors. Pairing A is more congruent for people who have implicit of completing the IAT. Because the IAT is a task-oriented
antifat bias compared with pairing B. Antifat bias is indicated by a measure, it is unlikely that knowledge regarding the purpose
higher number of correct responses on part A relative to part B.
of the study or completing the AFAT would unduly influ-
ence IAT responding. After the assessments were completed
preferences that exist beyond conscious evaluation, thereby and collected, students were debriefed on the purpose of the
providing a measure of bias of which people may be un- study, and the problem of antifat bias within health promo-
aware or unwilling to report (5). tion settings was discussed.
Explicit ratings. Explicit attitudes representing com- Statistical analysis. Questionnaire data were entered
mon obesity stereotypes were measured using a 7-point by machine scanning and verified. The IAT data were ex-
semantic differential scale. Participants rated their beliefs amined to identify outliers. Participants who completed
about fat people and thin people for the scale very stupid to fewer than four items per page or who had an error rate
very smart and very lazy to very motivated to yield four above 35% (i.e., incorrectly classified or missing items)
explicit ratings. Explicit scores were then calculated by were excluded. This guideline identifies people who did not
subtracting the value on the 7-point measure forfat people understand the task or were not paying attention and ensures
from the value on the scale for thin people. Thus, a score the quality of the data in a group administration. Using this
greater than zero indicated antifat bias for the measured guideline resulted in deleting 14% (35 subjects) from the
attribute (stupid, lazy). In contrast to the IAT, which mea- good/bad analysis and 6% (15 subjects) from the lazy/
sures unconscious associations, the purpose of the explicit motivated analysis. This strategy and percentage of dele-
scale is to measure attitudes directly, allowing a comparison tions is based on previous research using similar methods
between automatic or unconscious attitudes and conscious (16). Scoring of the AFAT measure followed the procedures
attitudes that people are willing to report. This explicit published by Lewis and colleagues (7) in the development
rating scale has been used as a comparison for implicit and validation of the questionnaire.
scores in other studies using the IAT (15,16). Descriptive statistics were calculated for implicit and
Antifat Attitudes Test (AFAT). The AFAT is a ques- explicit IAT scores and AFAT composite and subscale
tionnaire that measures negative attitudes toward obese in- scores. One-sample t-tests were conducted to test whether
dividuals using a traditional self-report format. The instru- the implicit and explicit IAT scores were significantly dif-
ment consists of 47 statements about fat people, and items ferent from zero, which indicates an antifat bias. Analysis of
are rated using a 5-point Likert scale ranging from strongly variance was used to assess differences in IAT and AFAT
disagree, 1, to strongly agree, 5, with some items reverse scores by several demographic characteristics including sex,
scored so that higher scores reflect greater antifat bias. The race, and education as well as social and environmental
questionnaire yields scores for three subscales including influences. Pearson correlations were used to determine the
social/character disparagement, physical/romantic unattrac- associations between implicit and explicit IAT scores and
tiveness, and weight control/blame as well as a total com- AFAT scores. All data analyses were performed using SAS
posite score (7). software, Version 8. All reported P values are two-tailed.
Demographic questionnaire. The demographic Sample size provided a statistical power of 0.80 for detect-
questionnaire documented individual characteristics includ- ing moderate effect sizes at an alpha of P < 0.05 for
ing age, sex, race, and education, as well as social and academic level, gender, and collapsed race for IAT analyses.
environmental influences such as personal experience with
obesity, family history of obesity, and beliefs about personal
RESULTS
responsibility for obesity.
Procedure. The instruments were administered to Implicit attitudes and beliefs. There was a signifi-
groups of exercise science students in the classroom as part 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 attribute
35 l negative attribute
30
t 25
00 20
0
. 15
E higher scores on the composite score and all subscales than
Z 10
5 = 0.02; weight control/blame: F(,, 2 42 ) = 7.2, P = 0.008;
o - I
PC .0001
Good Bad Motivated Lazy
FIGURE 2-Number of IAT items correctly classiried when the fat
people target category was paired with positive and negative attributes.
(mean = 11.8, SD = 6.5, t(2 1 0 ) 26.28, P < 0.0001) and
- attitudes (P > 0.11).
laz)y¼lnotivated(mean = 9.2, SD 6.1, t(230), P < 0.0001).
-
The numbers of items correctly classified in each IAT
condition are presented in Figure 2. This illustrates the
discrepancy between the numbers of items correctly classi-
fied when fat people was combined with each adjective,
with higher scores indicating a stronger antifat bias. A
moderate positive correlation was observed between the two
implicit attribute categories (r = 0.52, P < 0.001). When the
influence 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/motivated
measure when compared with men. Being Caucasian or
growing up in a more rural environment was also associated
with 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 obesity
was 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/bad
attribute 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 attitude
scale (t(2 3 6 ) = -1.3; P = 0.19). A significant correlation
was found between the lazy1¼notivatedimplicit measure and
the very motivated to very lazy explicit scale (r = -0.20, P
= 0.003), but other relationships to implicit measures were
not significant (P > 0.44). Explicit attitudes for the lazy
attribute 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 were
observed between explicit scores for the stupid attribute and
AFAT composite or subscale AFAT scores (P > 0.07).
Antifat attitudes test. Mean item scores for AFAT
subscales 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 composite
scores 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 had
individuals reporting having obese friends (social/character:
F( 242) = 5.9, P = 0.02; physical/romantic: F(L2 42 ) = 5.7 P
total score: F(,, 24 2 ) = 7.8, P = 0.0064). Being an ethnic
minority 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 at
least one comparison group, indicating antifat bias (Table
4). No statistically significant relationships were observed
between AFAT scores and BMI (P > 0.29) or implicit
DISCUSSION
The exercise science students surveyed in the present
study exhibited strong implicit antifat bias, an effect that has
been 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/bad
measure when compared with non-Caucasian participants.
However, one limitation of the study is that the sample is
predominately Caucasian, and we combined minority
groups for analyses. Therefore, we are unable to determine
how antifat bias differs across various ethnic groups within
the population of exercise science students. Women and
individuals 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 personal
control of obesity exhibited greater bias on the lazy stereo-
type. The reasons for these findings are unknown, but it may
be that implicit biases are susceptible to specific repeated
associations over time. As defined by Greenwald and Banaji
(4), an implicit attitude is the unconscious trace of past
experience or prior exposure that influences responses.
Thus, individuals may hold stronger implicit biases for
particular attributes based on personal experience.
As expected, participants did not exhibit high overall bias
scores on the explicit measure or traditional self-report
questionnaire (AFAT). However, certain antifat beliefs and
stereotypes 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 are
the negative attitudes that relate to lifestyle behaviors in-
cluding assumptions regarding junk food, control of weight
loss, and physical coordination. Participants were also more
willing to endorse a lazy stereotype in the explicit ratings.
These types of prejudicial attitudes have potential to inhibit
the effectiveness of lifestyle counseling and wellness activ-
ities provided by health and exercise science professionals.
Medicine & Science in Sports &Exercises 471
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 0.10
SD (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 0.08
SD (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 0.04
SD (0.52) (0.58) (0.68) (0.46)
UG, undergraduate; G, graduate.

Belief in greater personal control of obesity and being a
male undergraduate student were associated with higher
AFAT scores. In addition, individuals without family his-
tory of obesity or reporting no obese friends had higher
antifat scores. Thus, personal experience with friends and
family who are obese may lessen negative attitudes, and it
may be that efforts to enhance sensitivity and understanding
among health and fitness professionals may help reduce bias
toward obese individuals.
Our results are consistent with previous research that has
demonstrated negative attitudes toward obese individuals
among health professionals. Two recent studies adminis-
tered the IAT to groups of health professionals who treat
obesity and found strong implicit negative attitudes (good!
bad) and stereotypes (motivated/lazy) associated with obese
persons (15,16). Similarly, a survey of family practice phy-
sicians found that a significant number of physicians held
negative beliefs toward obese persons and described obese
patients as lazy, sad, and lacking self-control (8).
Stigmatization and discrimination toward obese persons
within the health community may negatively affect quality
of life for many obese individuals in terms of psychosocial
effects, reduced quality of care, and decreased utilization of
services including wellness activities. It is unknown whether
the 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-client
relationship. For example, a study examining physician at-
titudes toward case reports of patients differing only in
weight found that physicians reported that they would feel
more negatively toward overweight "patients," would spend
less time with them, but would order more tests (6). Facility
and equipment access is another area in which obese pa-
tients face discrimination in general health care, as standard
blood pressure cuffs, hospital gowns, and wheelchairs are
often too small to accommodate larger individuals.
Antifat bias and weight discrimination by health profes-
sionals may, in turn, result in a decrease in utilization of
health and weliness services. For example, obese women
have been found to be less likely to seek breast and gyne-
cological screening and exams relative to normal weight
women (3,21), and part of this effect may be due to attitudes
projected by health care professionals. It is likely that the
wellness field parallels other segments of healthcare. How-
ever, further research is needed to determine the extent to
which implicit antifat biases held by fitness professionals
may influence adoption and maintenance of physical activ-
ity. For example, a recent study examined weight criticism
during physical activity among schoolchildren and found
that children who reported greater weight criticism also
reported less sports enjoyment compared with peers (2). To
our knowledge, no studies have examined the impact of
antifat bias and weight discrimination on exercise percep-

TABLE 4. Antifat Attitudes Test (AFAT) items with a mean rating indicating antifat bias.
Overall Undergraduate Graduate
Sample 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 isa 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 initiatives
on obesity prevention and treatment, the problem of antifat
bias and weight discrimination within health promotion
settings warrants focused attention. Individuals who work in
health and fitness fields are exposed to the same cultural
messages as the rest of society, but additional factors may
also contribute to negative perceptions and stereotypes. Stu-
dents pursuing an exercise science degree are often drawn to
the field because of an interest in athleticism, health, and
physical function, which may contribute to a view of obesity
as unacceptable. In addition, some of the academic curricula
in the field of exercise science with an emphasis on health
and ideal body weight may contribute to automatic negative
associations with obesity, thereby extending to obese people
in general. Health and fitness professionals are keenly aware
of the health risks associated with obesity, and it is unknown
how that knowledge and the observance of medical comor-
bidities influence personal attitudes and beliefs toward in-
dividuals who are overweight or obese. Furthermore, little
formal instruction in degree or continuing education pro-
grams is available to provide training in physical activity
promotion and exercise prescription for obese individuals.
Consciousness raising has been suggested as a strategy
for avoiding discrimination and reducing implicit bias (4).
Thus, bringing attention to the existence of antifat bias and
weight discrimination in the area of exercise and wellness
may help improve access to physical activity and quality of
services provided by fitness professionals. For example, the
International Council on Active Aging recently issued a
checklist to rate fitness facilities on "age-friendliness,"
which addresses both the emotional and physical needs of
older individuals participating in physical activity (http:H/
www.icaa.cc/Facilitylayouts/ICAA%2OFacility%2OTest.pdf).
Similar methods initiated by professional organizations could
be used to identify the needs of obese individuals and create
healthy and friendly environments to promote physical activity
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ATTITUDES TOWARD OBESE INDIVIDUALS
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 unconscious
stereotypes exist can help professionals become aware of their
own predispositions toward obese individuals. These effects
may be most pronounced among students, where professional
inexperience 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 students
majoring 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 exercise
settings. Finally, we did not conduct follow-up assessments
to determine whether consciousness raising by research
participation attenuated antifat bias.
It is important that fitness and wellness services are
available, accessible, and acceptable to obese persons.
However, antifat bias and weight discrimination among
exercise professionals may serve as barriers for physical
activity participation for some obese individuals. Therefore,
programs involved in the training of health and fitness
professionals should consider raising awareness of antifat
bias and weight discrimination in health and wellness set-
tings to promote empathy among professionals and better
care for all individuals.
We thank the Rudd Institute for funding this research and Melba
Morrow for her assistance in preparing the manuscript. We also
appreciate the time and participation of the students and instructors
at the participating institutions.
Dr. Blair is a consultant for Jenny Craig International.
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TITLE: Attitudes toward Obese Individuals among Exercise

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SOURCE: Medicine and Science in Sports and Exercise 36 no3 Mr
2004
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