1.2.1 Social Pressures Regarding Body Size
1.2.1.1 Negative perceptions of obese people
In addition to the health problems associated with obesity, there is strong evidence for a social bias against overweight and obese individuals. It has been demonstrated that negative evaluations of overweight individuals develop in early childhood. (Staff!eri 1967; Caskey and Felker 1971). A study o f 9-year- old British girls found that the negative characteristics attributed to an image of an obese child included lower social competence and lower academic performance as well as poor health and fitness (Hill and Silver 1995). These attitudes persist into adulthood, and experimental studies using young adults have reported that the obese individuals are perceived to be more dependent, less attractive and sexually responsive, less intelligent, more socially isolated and lazier than those of normal weight (Dibiase and Hjelle 1968; Regan 1996; De Jong and Kleck 1986). The perception that obese people are themselves responsible for their overweight is widely held amongst health professionals (Harvey and Hill 2001; Ogden et al 2001), and ‘victim blaming’ attributions are likely to further fuel negative perceptions o f obese individuals.
1.2.1.2 Social and economic consequences of obesitv
Studies examining the social and economic consequences o f obesity have found that overweight in adolescence predicts poorer educational attainment and a lower income in adulthood (Gortmaker et al 1993; Frieze et al 1990). Overweight individuals may also have greater difficulty forming sexual relationships, as they have fewer partners and are less likely to marry than their normal weight peers (Stake and Lauer 1987; Gortmaker et al 1993; Averett and Korenman 1999). Negative social attitudes towards obesity and overweight are matched at the other end of the spectrum by positive attitudes towards thinness. Thinness is one of the most fundamental characteristics of the contemporary image of female beauty (Tovee et al 1998), and individuals who are rated more
Chapter 1 ; The case for and against weight control
highly attractive are also perceived to rate more highly on a range of positive personality and social attributes such as social and intellectual competence and psychological adjustment (Eagly et al 1991). In addition to the attempt to acheive the perceived or real benefits that a slim, attractive body can bring it has also been suggested that thinness might represent desirable qualities to some girls and women independently o f its relationship to attractiveness. Some studies have found that adolescent girls and young women wish to be thinner than the size that they perceive to be optimally attractive to men (Fallon and Rozin 1985; Cohn et al 1987). Since weight is an aspect o f physical appearance that is believed to be subject to a high degree of personal control (Brownell 1991), thinness may also be perceived to demonstrate achievement or personal competence. Similarly, failure to control weight might be perceived as a sign of weakness and failure. (Rodin 1993; Brownell 1991).
1.2.2 Comparing Health and Sociocultural Pressures for Thinness
It is not inconceivable that sociocultural pressures and health pressures could combine beneficially towards reducing the number o f individuals in society who are overweight. One important distinction between pressure for socially desirable body weight and pressure for a healthy weight is that whilst health concerns postulate a ‘U shaped’ relationship between weight and desirability, such that there is an increased health risk pertaining to both overweight and underweight (Katzmarzyk et al 2001), cultural perceptions o f attractiveness are generally believed to characterise all but the thinnest figures at the lower end o f the spectrum as desirable. However, very little research has addressed the question of the extent to which a very thin body shape is desired or accepted amongst young women and girls. Similarly it is not knovm how lay perceptions o f fatness relate to the health recommendations for body weight.
Studies which make use of figure rating scales in which participants have to select from a range of figure drawings ranging from very thin to very fat have generally reported that the ideal for most women and girls is towards the thin
Chapter 1 : The case for and against weight control
end of the spectrum and thinner than their current body size (e.g. Fallon and Rozin 1985; Stevens and Tiggeman 1998), but these studies have generally been more concerned with examining aspects of the discrepancy between women’s ideal and perceived body size than in objectively quantifying body size preferences. Without any objective measure of the body size o f the figures, it is difficult to assess from these studies whether aspirations for thinness are unhealthy. One study which has tried to quantify women’s ideal body size (Tovee et al 2000) made use of photographs of women’s bodies varying by BMI and examined body size estimations and attractiveness ratings. This study reported that women with no history of eating disorders rated a BMI of around 20 as optimally attractive, which represents a body size at the lower end of the healthy range, but far fi'om emaciated. Participants made systematic errors in estimation of their own body size according to their weight, such that thinner participants overestimate their BMI and fatter participants underestimate. This may reflect either systematic distortions in fat and thin participants’ body size perceptions or simply indicate that photographic images do not convey enough information to be perceptually equivalent to naturalistic observations of real people. Nonetheless this study provides a valuable new approach to the objective examination of body ideals.
A small number of other studies have examined the actual BMI identified by women as their ideal, by asking them what they would like to weigh, and adjusting the figure for their height in order to get an estimate o f their ideal BMI. A study by Wardle and Johnson (in press) reported that the ideal weight within a representative sample of normal weight British women was equivalent to a BMI of 21.2 kg/m^. Similarly, Crawford and Campbell (1999) reported that Australian women had an ideal BMI o f 22.7 kg/m^ although amongst the youngest women (aged 18-29) the ideal was just over 21kg/m^. Ideal weight was also strongly affected by current weight, such that fatter women choose a fatter ideal. It may be that the question format in this study, which requires women to consider a preferred weight for themselves, leads them to interpret the ‘ideal’ to mean a desirable but realistic weight to aspire to, rather than the most objectively
Chapter 1 ; The case for and against weight control
attractive female body weight. The concept o f the 'ideal' weight may be inadequately defined, since none o f the papers which have used it have tried to establish whether women interpret it as an realistic aspiration or as an aesthetic judgement.
Simply asking about the preferred body size does not give an indication of the extent to which individuals are tolerant o f figures deviating from their ideal. One study used a figure rating scale to examine the range of body sizes perceived to be socially acceptable as well as the size identified as ideal (Rand and Resnick 2000). The results showed that whilst many women and girls felt that they differed from their ideal body size, they nonetheless had a wide range of tolerance for fatter and thinner body sizes that they would identify as ‘good enough’, or ‘socially acceptable’. Most women and girls perceived their own weight to be within the acceptable range. The focus on ideal versus current perceived body weight in much of the research on body dissatisfaction, may have maximised estimates of the number o f women and girls who are dissatisfied with their weight, whilst ignoring the degree to which people consider as acceptable a range o f body sizes. There have not been any studies which have examined the weight at which women or girls view a body to be underweight, but overweight thresholds have been examined in women. Wardle and Johnson (in press) found that perception o f overweight became normative for women (i.e. affecting over 50% of participants) at a BMI o f around 24kg/m^, whilst Crawford and Campbell (1999) found that the average weight at which women would perceive themselves to be overweight was equivalent to a BMI of 23.7kg/m^. This suggests that women’s perceptions o f overweight may be slightly lower than the WHO recommendations, but also that they are not wildly inappropriate.
The extent to which lay perceptions o f overweight and underweight are compatible with health recommendations, is an area which has not been fully examined within the literature. There is a particular lack o f information on perceptions of underweight and the perspectives of adolescents. The papers
Chapter 1 : The case for and against weight control
discussed here also suggest that the concept of an ideal weight may be at once too narrow and too ill-defined to be the most useful way of addressing lay perceptions of appropriate weight.