According to recent statistics, more than one-third of the world’s population is overweight or obesity. In the UK, these rates are even higher, with 64% of adults classed as having overweight or obesity [1
]. Despite its prevalence, people with obesity frequently experience devaluation and discrimination (known as weight-related stigma) within educational, workplace, and healthcare settings [2
]. Evidence also suggests that people may be more likely to face discrimination because of their weight than because of their ethnicity, gender, or sexual orientation [3
]. Weight-related stigma has negative consequences for individuals’ psychological and physical well-being [2
] and may impede weight-loss by prompting maladaptive eating patterns and exercise avoidance [2
Negative attitudes towards people with obesity can be exacerbated by beliefs about the causes
of weight-gain. This is central to attribution theory, which suggests that people make judgements about the cause of a condition; in turn, these judgements determine their attitudes towards an individual [6
]. For example, attributing obesity to factors that are within personal control (e.g., food choices) is thought to perpetuate obesity stigma [8
]. Conversely, stigmatizing attitudes may be attenuated by the belief that weight-gain is caused by uncontrollable factors (e.g., genetics). In support of this, weight-related stigma was found to be most prevalent amongst individuals who believed that obesity was within personal control and caused by a lack of willpower, inactivity, and overeating [9
]. Similar findings have been obtained from studies in which participants’ causal beliefs about obesity were experimentally manipulated. Specifically, participants who read an article that stated that obesity is caused by overeating and a lack of exercise demonstrated more stigmatizing attitudes than participants in a ‘no-prime’ control condition or those who read a neutral article about research into memory skills [11
]. Conversely, participants who were led to believe that obesity is caused by physiological factors (i.e., factors that are beyond personal control) demonstrated less weight-related stigma than those in a control condition [8
One increasingly prevalent etiological theory is that obesity is caused by an addiction to high-calorie foods [14
]. Proponents of this idea suggest that food and drugs have similar effects on the brain and argue that the clinical symptoms of substance abuse coincide with the behaviors and experiences of people who engage in compulsive overeating [15
]. While this idea is widely debated throughout the scientific community (e.g., [17
]), the concept of food addiction has been readily accepted by the general public [20
]. Indeed, research suggests that the majority of people believe that obesity can be caused by food addiction [21
], and up to half of people believe that they are themselves addicted to food [22
]. In light of its popularity, it is important to establish how food addiction models of obesity might affect weight-related stigma.
A small number of studies have examined the effect of the food addiction label on obesity stigma. However, results to date have been inconsistent [25
]. In one study [27
], participants’ attitudes towards a person with ‘food addiction’ were compared with attitudes towards persons with obesity, drug addiction, and disability. The study reported similarly high levels of stigma towards the “obese” and “food addict” labels and, when combined, these labels together elicited greater stigma than either label alone. These findings align with those obtained by Lee et al. [21
] who found that, while the majority (72%) of survey respondents believed that obesity could be caused by a ‘food addiction’, more than half held the view that people with obesity are responsible for their condition (which would be expected to perpetuate obesity stigma). However, in contrast, Latner et al. [28
] found that providing a food addiction explanation for obesity appeared to reduce
weight-stigma. In this study, participants read one of two descriptions of a woman with obesity. In one condition (i.e., the ‘food addiction’ condition), the woman was described as fitting “the typical profile of someone who is addicted to food”. In another condition (i.e., the ‘non-addiction’ condition), the woman was described as “someone who makes unhealthy food choices”. The study found that participants in the food addiction condition displayed lower levels of stigma towards the woman, and towards people with obesity more generally, compared with those in the non-addiction condition.
Inconsistent findings in previous studies may be explained by differences in participants’ causal beliefs about food addiction. Specifically, the effect of the “food addiction” label on obesity stigma may depend on the extent to which food addiction is perceived to be a legitimate medical condition. One qualitative study found that people with overweight and obesity were reluctant to label themselves as a food addict due to concerns that this would be viewed as an ‘excuse’ for overeating [29
]. Indeed, providing excuses for weight gain may exacerbate negative attitudes towards those with obesity [30
]. In contrast, attributing obesity to a medically diagnosed ‘food addiction’ may legitimize the condition and help to reduce weight-related stigma by removing personal responsibility from the individual [31
To test these ideas, across two studies, we examined the effect of medically-diagnosed and self-diagnosed food addiction on weight-related stigma. Using a similar technique to Latner et al. [28
], participants read one of three vignettes which described a woman with obesity. In the ‘medical’ condition, the vignette stated that the woman had been diagnosed with food addiction by her general practitioner (GP). In the ‘self-diagnosed’ condition, the vignette stated that the woman believed herself to be a food addict. There was no reference to food addiction in the control condition. Subsequent attitudes towards the woman (i.e., target-specific stigma) and obesity in general (i.e., general stigma) were then assessed. We hypothesized that weight-related stigma would be significantly lower in the medical condition, and higher in the self-diagnosed condition, relative to in the control condition. Based on previous findings [28
], we predicted that the food addiction label would influence both target-specific and general weight-related stigma.
4. Interim Discussion
Study 1 found that female participants who were exposed to medical and self-diagnosed food addiction vignettes exhibited more target-specific stigma towards a woman with obesity than those in the control condition. This is consistent with previous research in which the food addiction label was found to exacerbate stigmatizing attitudes towards an individual with obesity and ‘food addiction’ [27
One possibility is that ‘food addiction’ stigma may be particularly high amongst those who perceive addiction to be within personal control [7
]. This is supported by previous research in which perceiving addiction as a disease, rather than due to personal choice, was associated with reduced stigma towards people with addictive disorders [40
]. Similarly, biogenetic explanations have been found to reduce stigma towards obesity, problematic eating, and substance abuse, relative to behavior-based explanations [10
]. In Study 2, we examined whether the effect of food addiction condition on stigma would be moderated by the extent that addiction is viewed as a ‘disease’ relative to personal choice.
We also examined whether stigmatizing attitudes towards the target with food-addiction would be moderated by individuals’ scores on a measure of addiction-like eating. Previous research has found that individuals with personal experience of addiction have less negative attitudes towards others with addiction [43
]. Furthermore, social identity theory suggests that individuals view other ‘in-group’ members more favorably than out-group members [44
]. Therefore, we predicted that the effect of condition on target-specific stigma would be attenuated in participants with greater levels of addiction-like eating behavior.
Finally, we examined whether the effect of condition on target-specific and general stigma would differ between males and females. Previous research has found that females demonstrate less obesity-related stigma and stigma towards the ‘food addiction’ label than males [27
]. We, therefore, hypothesized that the exacerbating effect of the food addiction label on stigma would be most pronounced in males.
To summarize, Study 2 examined the following hypotheses: (1) The effect of condition on target-specific and general stigma would be attenuated in those with greater support for the disease model of addiction. (2) The effect of condition on stigma would be attenuated in those who score highly on a measure of addiction-like eating, relative to those who score lower on addiction-like eating. (3) The effect of condition on stigma would be attenuated in females, relative to males.
Across two studies, we examined the effect of the food addiction label on stigmatizing attitudes towards an individual with obesity (i.e., target specific), and towards people with obesity more generally (i.e., general stigma). In Study 1, participants in both the medical and self-diagnosed food addiction conditions demonstrated greater target-specific stigma relative to the control condition. There was no effect of condition on general stigmatizing attitudes towards people with obesity. However, findings from Study 1 were not replicated in Study 2, in which we included both male and female participants. That is, we found no overall differences between the food addiction conditions and the control condition on target-specific stigma. The effect of condition on target-specific or general stigma was also not moderated by addiction disease beliefs (i.e., the extent to which addiction is perceived as a disease) or gender, in Study 2. However, there was a significant condition by addiction-like eating behavior interaction on target-specific stigma; participants who scored low on a measure of addiction-like eating demonstrated greater target-specific stigma in the Medical condition relative to Control and Self-diagnosed conditions. In contrast, target-specific stigma did not differ as a function of condition for those with high levels of addiction-like eating.
Findings from Study 1 are consistent with previous findings in which the food addiction label added to the stigma of obesity [27
]. Higher levels of stigma towards the ‘self-perceived’ food-addicted target in the current study may reflect perceptions of food addiction as an ‘excuse’ for overeating. This is supported by qualitative evidence that individuals with overweight or obesity may be reluctant to label themselves as food addicts due to concerns that this would be perceived as an ‘excuse’ for their weight [29
We predicted that the medical condition might legitimize the concept of food addiction and thereby reduce weight-related stigma (i.e., by removing personal responsibility from the individual). However, contrary to our hypothesis, in Study 1, we found that target-specific stigma was also higher in the medical condition compared to the control condition and did not differ from levels observed in the self-diagnosed condition. This finding is inconsistent with predictions from attribution theory [7
] in which undesirable behaviors that are perceived as beyond personal control are thought to elicit less stigma than those that are perceived as controllable. One possibility is that food addiction explanations increase stigma by inadvertently emphasizing the behavioral aspect of obesity. That is, food addiction may imply a loss of control over eating, and previous studies have found that this may increase stigmatizing attitudes towards obesity [52
]. Another possible explanation is that food addiction, unlike other biological causes of obesity, is believed to be within personal control and that medicalizing the term does not remove perceptions of personal responsibility. Indeed, Lee et al. [21
] reported that almost three-quarters of people supported food addiction as a cause of obesity, and yet obesity was still viewed as a condition that individuals need to take responsibility for. Therefore, it may be the case that stigmatizing attitudes towards ‘food addicted’ individuals are dependent upon the extent that addiction is perceived as being outside of personal control and/or akin to a disease. In relation to this, Study 2 examined whether the effect of food addiction condition on stigma would be attenuated in those with greater support for the disease model of addiction (results discussed below).
Study 1 therefore suggests that the food addiction label exacerbated stigmatizing attitudes towards a woman with obesity, regardless of whether the food addiction was medically diagnosed or self-diagnosed. Notably, findings from Study 1 are inconsistent with those obtained in a previous study in which a ‘food addiction’ explanation for obesity elicited lower
levels of target-specific and general stigma than a control explanation [28
]. This inconsistency may be attributable to the control conditions used in ours and Latner et al.’s [28
] study; in the current study, participants in the control condition were not provided with any explanation for the target’s weight status. In contrast, participants in Latner et al.’s [28
] study read that obesity is caused by repeatedly choosing to consume high-calorie foods. By emphasizing the role of personal choice, it is possible that the control condition used by Latner et al. [28
] may have elicited greater stigma than a ‘food addiction’ explanation for obesity.
In Study 2, we found that greater support for the disease model of addiction was associated with greater target-specific and general stigma towards obesity. This finding was unexpected and is contrary to predictions derived from attribution theory. One possibility is that the perception of addiction as a ‘disease’ encourages the view that addicts are abnormal and perpetuates an ‘us-them’ distinction [53
]. Holding disease views of addiction also suggests that the person’s condition is irrevocable and permanent [54
]. Another possibility is that causal beliefs about food addiction do not coincide with perceptions of other addictions. That is, individuals who support the ‘disease’ model for substance-based addictions may not necessarily attribute food addiction to a disease. Previous research supports this, indicating that addictions vary in the extent to which they are attributed to disease or personal choice. In particular, de Pierre et al. [40
] found that food addiction was perceived as less of a disease and more within personal control compared with other addictions such as alcoholism. The measure of addiction beliefs (i.e., the ABS) used in the current study referred to addiction in general, and thus may not have reflected participants’ beliefs about food addiction per se.
However, the moderating effect of addiction-like eating on target-specific stigma, observed in Study 2, suggest that medically diagnosed food addiction could exacerbate weight-related stigma but only for people with low levels of addiction-like eating tendencies. A possible explanation for this finding is that individuals with personal experience of problematic eating (i.e., high AEBS scores) may have identified more with the target in the vignette and thereby displayed less negative attitudes towards her food addiction (e.g., see [43
]) as opposed to participants with low AEBS scores.
In Study 2, male participants demonstrated significantly higher target-specific stigma, relative to female participants. Males and females did not differ on a measure of general weight-related stigma. However, the lack of interaction between gender and condition is inconsistent with previous research [27
] in which stigmatizing attitudes towards a ‘food addicted’ target were lower in females, relative to males. This null result may be explained by the fact that, in the current study, males had a significantly higher mean BMI than females (see Table S1
). A previous study found that people with higher BMI hold less stigmatizing attitudes towards the ‘food addict’ label, relative to those with lower BMI [27
]. Consistent with this, in Study 1, we found that higher BMI was associated with lower target-specific weight stigma. It is therefore possible that, in the current study, any moderating effect of gender on stigma may have been masked by the higher BMI of male, relative to female, participants. Future research should examine the moderating effect of gender on stigmatizing attitudes towards a food-addicted target in samples of males and females matched for BMI.
The inconsistent findings obtained across Studies 1 and 2 could not be attributable to the inclusion of males in Study 2 as the effect of condition on target-specific stigma was not moderated by gender. The sample tested in Study 2 comprised a larger proportion of older, non-students than the sample tested in Study 1. However, exploratory analyses revealed that the effect of condition on stigma was not moderated by student status or age (see online supplementary material
). Differences between Studies 1 and 2 are, therefore, likely due to another (unknown) variable. Moreover, these findings suggest that the effects of the food addiction label on weight-related stigma may not be generalizable across populations.
There are several limitations to the current study that require consideration. Firstly, we note that the Addiction Belief Scale, used in Study 2, examined beliefs about the causes of addiction in general, and thus may not have captured individual differences in beliefs about the causes of food addiction. Future research could use an adapted version of the ABS (such as that used by de Pierre et al. [40
]) to test whether food addiction stigma is attenuated in individuals who have greater support for a disease model of food addiction. Secondly, we did not examine whether participants believed the food addiction explanation for obesity, nor did we check whether participants had guessed the study aims. It is, therefore, possible that the effect of the food addiction label on stigma, observed in Study 1, could be due to demand characteristics that were not present in Study 2. Thirdly, the use of a female target in the current study precludes the generalizability of our findings to males. Previous research suggests that females are more likely than males to be stigmatized due to their weight [55
], and so attitudes towards the food addiction label may similarly differ as a function of the target’s gender. Finally, it is important to consider that the findings may have been affected by the order in which the questionnaires were presented. In particular, the significant effect of condition on target-specific stigma (M-FPS) (in Study 1), and lack of effect of general stigma (AFA), may be due to the fact that participants completed the M-FPS immediately after reading the vignette, while general stigma (i.e., AFA scores) were assessed later in the study.
Future research should aim to clarify the effect of the food addiction label on weight-related stigma. This may be achieved by considering possible moderating effects of pre-existing beliefs about food addiction (e.g., the extent that it is a legitimate condition, whether it is controllable, etc.). There has been much debate in the scientific literature about whether addiction-like eating should be considered a substance-based ‘food addiction’ or a behavioral ‘eating addiction’ (e.g., [11
]). Therefore, it will also be important to compare attitudes elicited by a ‘food addiction’ label, with attitudes towards an ‘eating addiction’ label. It would also be interesting to compare the effect on the stigma of medically-diagnosed food addiction, with other medical causes of weight gain (e.g., hypothyroidism). Doing so would provide insight into whether the potential exacerbating effect of medicalization on stigma is specific to the food addiction label or whether it extends to the medical model per se. It is also possible that emphasizing the non-behavioral aspect of food addiction (e.g., brain differences to food) may reduce any deleterious effect of a medical diagnosis on stigma. More broadly, the clinical implications of food addiction labels on weight-related stigma must now be considered. In particular, it is important to consider whether the food addiction label may affect people’s approaches to treatment (e.g., seeking pharmacological solutions rather than psychotherapy). It is also possible that, by perpetuating weight-related stigma, the food addiction label could be detrimental to psychological well-being and undermine people’s attempts to lose weight.