The avoidance of obese people is well documented, but its psychological basis is poorly understood; we think obesity triggers equivalent emotional and avoidant‐based responses as a contagious disease

Is obesity treated like a contagious disease? Caley Tapp  Megan Oaten  Richard J. Stevenson  Stefano Occhipinti  Ravjinder Thandi. Journal of Applied Social Psychology, December 27 2019. https://doi.org/10.1111/jasp.12650

Abstract: The behavioral avoidance of people with obesity is well documented, but its psychological basis is poorly understood. Based upon a disease avoidance account of stigmatization, we tested whether a person with obesity triggers equivalent self‐reported emotional and avoidant‐based responses as a contagious disease (i.e., influenza). Two hundred and sixty‐four participants rated images depicting real disease signs (i.e., person with influenza), false alarms (i.e., person with obesity), person with facial bruising (i.e., negative control), and a healthy control for induced emotion and willingness for contact along increasing levels of physical proximity. Consistent with our prediction, as the prospect for contact became more intimate, self‐reported avoidance was equivalent in the influenza and obese target conditions, with both significantly exceeding reactions to the negative and healthy controls. In addition, participants reported greatest levels of disgust toward the obese and influenza target conditions. These results are consistent with an evolved predisposition to avoid individuals with disease signs. Implicit avoidance occurs even when participants know explicitly that such signs—here, obese body form—result from a noncontagious condition. Our findings provide important evidence for a disease avoidance explanation of the stigmatization of people with obesity.


4 | DISCUSSION
We predicted that participant desire for avoidance of a person with
obesity and a person with influenza would significantly exceed
avoidant-based responses toward healthy and negative controls
and that this avoidance desire would increase as the prospect for
contact becomes more intimate and that this effect will be more
pronounced for the obesity and influenza targets. Consistent with
our prediction, when the prospect for contact was intimate (i.e.,
kissing, sexual activity), self-reported avoidance was equivalent in
the influenza and obesity targets, with both significantly exceeding reactions to the negative and healthy controls. By contrast,
participants were significantly more willing to have more intimate
levels of contact with the bruise or healthy target. As the prospect for contact became sexualized (i.e., kiss on the mouth and
sex), both male and female participants reported the greatest,
and equivalent, avoidance toward the obesity and influenza targets, relative to the negative and healthy controls. When the contact involved real physical intimacy participants reacted toward
the obesity target as if they were a contagious disease carrier.
Consistent with previous research examining false disease signs
(e.g., Kouznetsova et al., 2012; Ryan et al., 2012), participants correctly indicate that obesity is not a contagious condition and that
influenza is a contagious condition.
In support of a disease avoidance explanation, our results also
show that participants felt higher levels disgust when exposed to
both a person with obesity and a person with influenza, compared
to the healthy and bruise targets. Although previous research has
found gender differences in trait disgust predicting responses
toward people with obesity (Fisher et al., 2013; Lieberman et al.,
2012), no differences in felt disgust between male and female participants emerged in our study. Gender differences did emerge for
ratings of fear and anger, and this was by in large driven by the
bruise target—female participants felt more fear toward the bruise
target, whereas male participants felt more anger in response to
the bruise target. We suggest that this is due to the differential
subjective meaning of a facial bruise for men and women, in that
a man with a bruised face implies that he has been involved in a
fight, whereas a woman with a bruise is more likely to be viewed
as a victim of violence. While men and women differed in terms of
their anger and fear responses toward the bruise target they did
not significantly differ in terms of their disgust or avoidance responses toward the bruise target, thus the differences in emotion
expressed toward the bruise target is unlikely to be the driver of
participant avoidance responses.
As this study obtained willingness for physical contact via self-reports, future research should examine whether the self-reported
desire to avoid intimate contact with people with obesity demonstrated in the present study is expressed behaviorally. Although it
is clearly not possible to examine intimate levels of physical contact
in an experiment, there are other methods of assessing whether
disgust-driven avoidance behavior occurs. A study conducted by
Ryan et al. (2012) utilized behavioral outcome measure to compare
responses to a person with a facial birthmark and a person with influenza, but this type of method has yet to be extended to other
nonnormative body features, such as obesity.
A limitation of the present research was that we did not gather information about participant's own weight, which meant that we were
unable to examine the effect of participant weight status on the effects of interest. However, there is a growing body of evidence which
suggests that people with obesity themselves hold negative stereotypes about people with obesity (e.g., Papadopoulos & Brennan,
2015; Wang, Brownell, & Wadden,2004). Thus, it is unlikely that
differential effects across levels of weight would exist with regards
to the desire to avoid physical contact with a person with obesity.
Future research should include appropriate measures of participant
weight in order to provide further empirical evidence regarding the
effect of participant weight on stigmatization of people with obesity,
with a particular focus on intimate levels of physical contact.
Future research should also consider the role of relevant individual differences and make use of designs that allow this to be examined. Differences in levels of perceived vulnerability to disease
or trait levels of disgust may moderate the findings of the present
research. It is likely that people with higher levels of perceived vulnerability to disease or higher levels of trait disgust would display
even more of a desire for avoidance, and this effect should exist for
both a person with influenza and a person with obesity. In addition,
it would be valuable for future research to incorporate a measure of
participant disgust at the prospect of each level of physical contact,
rather than just overall levels of disgust felt toward the target. This
would allow for a more fine grained exploration of the role of disgust
in the avoidance processes demonstrated.
In conclusion, the finding of greatest desire to avoid intimate
physical contact with the obese and influenza targets, in combination with the finding that both the obese and influenza targets also
generated the greatest self-reported disgust, suggests the activation of a disease avoidance system. The display of some superficial
form of physical nonnormality, leads observers to respond to them
as though they are contagious disease carriers (Kouznetsova et al.,
2012; Schaller & Duncan, 2007). Our results show that a person
with obesity appears to be treated as though they possess a disease
cue—a false alarm in this case. A likely explanation is that obese body
form was heuristically perceived as a sign of disease that triggered
a disgust and avoidance response as the prospect for disease transmission increased (i.e., as intimacy of physical contact increased).
These findings make an important contribution to our understanding
of the psychological basis underlying the stigmatization of people
with obesity. It would be useful for interventions aimed at reducing
stigma toward people with obesity to take a disease avoidance explanation into account, particularly with regards to the role of disgust.