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Sample size: 1387
Field period: 10/11/2013-03/06/2014
This research examines the effect of body size on the assignment of blame and responsibility for illness and explores the social consequences of these causal attributions. In this study I ask whether overweight and obese individuals are seen as more responsible for illness than their thinner counterparts and whether this higher level of blame leads to more negative social outcomes. Drawing on original data from a vignette experiment embedded within a nationally representative study of U.S. adults I find that obese patients are more likely to be seen as responsible for the development of illness than normal weight patients. Study participants are more likely to believe that a disease has lifestyle causes and less likely to believe a disease has biological causes when the patient is obese. Participants also attribute significantly more control, responsibility, and blame to obese patients than non-obese patients for both lifestyle (Type II Diabetes) and non-lifestyle (non-Hodgkin lymphoma) associated diseases. This effect is even larger when the patient is an obese woman, which suggests that obesity stigma may have greater consequences for women. Study participants are less sympathetic towards obese patients, less willing to offer help when the patient is obese, and are more supportive of penalizing obese patients socially and financially. Attributes of blame and responsibility partially mediate these outcomes suggesting that biased attributions for illness contribute to negative social consequences for already stigmatized patients.
H1: Lifestyle factors will be seen as more of a contributor to disease when a patient is obese compared to non-obese, while genetics will be seen as a greater contributor to disease when a patient is non-obese compared to obese.
H2: Observers will be more likely to believe illness was caused by factors under individual control if the patient is obese.
H3: Obese patients will be judged as more responsible and more to blame for the development of a disease than non-obese patients.
H4: Observers will attribute greater controllability, responsibility, and blame for both lifestyle-related and non-lifestyle-related illnesses when the ill patient is overweight or obese.
H5: Women will be seen as even more responsible and more to blame for the development of illness when they are obese relative to when men are obese.
H6: Observers will be less sympathetic, less willing to offer help, and more willing to impose social and financial penalties when a patient is overweight or obese.
H7: Greater assignment of blame and responsibility for illness contributes to more social rejection, more support for imposing penalties, and less social support.
Study participants were randomly assigned to read one of two disease profiles, Type II diabetes or non-Hodgkin lymphoma, and then read the profile of a patient with that disease. Patient profiles varied by gender (man/woman), race (African American/White), and body size (moderately obese/normal weight).
Attributions of causality: lifestyle, environment, genetics, and/or bad luck
Attributions of blame, control, and responsibility
Measures of observer responses to the patient include feelings of sympathy, willingness to help, social distance, and willingness to penalize.
Results from this study indicate that obese people are seen as more responsible and more to blame for illness than non-obese people. When a patient is obese observers are more likely to indicate that a disease is caused by a patient's lifestyle and other factors under the patient's control. When the same patient is described as non-obese observers are more likely to attribute the illness to biology and other factors outside of the patient's control. This biased attribution process allows others to hold the individual patient responsible for the illness and to blame the patient for being ill. Being blamed for a negative outcome, such as developing a life-threatening illness, has harmful psychological, emotional, and social consequences. In addition to experiencing the stigma of blame, individuals who are seen as in control of negative outcomes are also more likely to be socially sanctioned and receive less support. Observers are less sympathetic towards obese patients, less willing to offer help, less willing to live near or work with obese patients, and are more supportive of penalizing obese patients. Greater attribution of fault for illness explains some of this negative response towards obese patients.Finally, this study also provides evidence to suggest that obesity stigma and anti-fat bias affect women more than men. When it comes to assigning responsibility and blame for illness, the penalty that women face for being obese is larger than the penalty men face. Observers are more likely to attribute the cause of type II diabetes to lifestyle factors when a patient is an obese woman and are less likely to attribute the cause of the disease to genetics. This means that when a woman is obese she is seen as more responsible for negative health outcomes than when a man is obese. This finding indicates that the attribution process is biased by both cultural beliefs about obesity and cultural beliefs about gender. This suggests that the stigmatizing of obese bodies is a gendered process that disproportionally disadvantages women.
Presented at Southern Sociological Association March 2015.