The association of BMI and social distance towards obese individuals is mediated by sympathy and understanding.

The desire for social distance towards individuals with obesity as part of the stigmatization process has not been investigated. The aims of this study include: (a) determining the prevalence of social distance and its domains in a population-based sample; (b) reporting levels of emotional response; and (c) investigating the association of BMI, emotional response and social distance. The data were derived from a large population based telephone survey in Germany (total n = 3,003, this sub-sample n = 1008). Emotional response to individuals with obesity was assessed for the emotions discomfort, pity, insecurity, amusement, sympathy, help and incomprehension (5-point Likert scale). Social distance was measured on a 5-point Likert scale covering different areas of social interaction. This served as the dependent variable for a linear regression model and mediation models that included BMI and emotional response. Social distance was highest for job recommendation, introduction to a friend, someone with obesity marrying into the family and renting out a room. Means of emotional responses were highest for pity (Mean = 2.58), sympathy (Mean = 2.87) and wanting to help (M = 2.76). In regression analyses, incomprehension (b = 1.095, p < 0.001) and sympathy (b = -0.833, p < 0.001) and the respondents' own BMI (b = -0.145, p < 0.001) were significantly associated to the overall amount of social distance. Mediation models revealed a significant mediation effect of BMI through sympathy (b = -0.229, % of total effect through mediation = 10.3%) and through incomprehension (b = -0.057, % of total effect through mediation = 27.5%) on social distance. Social distance towards individuals with obesity is prevalent in the general public in Germany and it is associated with emotional responses. Altering the emotional responses may, therefore, be a starting point in anti-stigma interventions. Evoking sympathy and lowering incomprehension may result in lower overall social distance.

[1]  Bruce G. Link,et al.  Public conceptions of mental illness: labels, causes, dangerousness, and social distance. , 1999, American journal of public health.

[2]  A. Hayes.  Beyond Baron and Kenny: Statistical Mediation Analysis in the New Millennium , 2009 .

[3]  Anja Hilbert,et al.  Obesity in Print: An Analysis of Daily Newspapers , 2009, Obesity Facts.

[4]  K. O’Brien,et al.  Obesity discrimination: the role of physical appearance, personal ideology, and anti-fat prejudice , 2013, International Journal of Obesity.

[5]  H. Grabe,et al.  Evolution of public attitudes about mental illness: a systematic review and meta‐analysis , 2012, Acta psychiatrica Scandinavica.

[6]  Chelsea A. Heuer,et al.  The Stigma of Obesity: A Review and Update , 2009, Obesity.

[7]  E. Brähler,et al.  Attitudes towards and Perception of Overweight and Obesity in the Public Opinion: a systematic review , 2011 .

[8]  M. Angermeyer,et al.  Continuum beliefs and stigmatizing attitudes towards persons with schizophrenia, depression and alcohol dependence , 2013, Psychiatry Research.

[9]  K. Brownell,et al.  Changes in Perceived Weight Discrimination Among Americans, 1995–1996 Through 2004–2006 , 2008, Obesity.

[10]  P. Corrigan,et al.  Familiarity with mental illness and social distance from people with schizophrenia and major depression: testing a model using data from a representative population survey , 2004, Schizophrenia Research.

[11]  T. Becker,et al.  Veränderung der Einstellung zur Schizophrenie durch das Psychiatriepraktikum im Medizinstudium , 2013, Psychiatrische Praxis.

[12]  Xavier Pi-Sunyer,et al.  The Medical Risks of Obesity , 2009, Postgraduate medicine.

[13]  James Frank,et al.  The Social Rejection of Former Mental Patients: Understanding Why Labels Matter , 1987, American Journal of Sociology.

[14]  Sander Greenland,et al.  A Procedure to Tabulate and Plot Results after Flexible Modeling of a Quantitative Covariate , 2011 .

[15]  A. Baumann.  Stigmatization, social distance and exclusion because of mental illness: The individual with mental illness as a ‘stranger’ , 2007, International review of psychiatry.

[16]  Arya M. Sharma,et al.  Obesity is a sign – over‐eating is a symptom: an aetiological framework for the assessment and management of obesity , 2010, Obesity reviews : an official journal of the International Association for the Study of Obesity.

[17]  K. Malterud,et al.  "Norwegians fear fatness more than anything else"--a qualitative study of normative newspaper messages on obesity and health. , 2010, Patient education and counseling.

[18]  Herbert Matschinger,et al.  Attitudes towards psychiatric treatment and people with mental illness: changes over two decades , 2013, British Journal of Psychiatry.

[19]  K. O’Brien,et al.  Anti-Fat Prejudice Reduction: A Review of Published Studies , 2010, Obesity Facts.

[20]  Dustin Tingley,et al.  Causal Mediation Analysis , 2011 .

[21]  A. Tolvanen,et al.  Attitudes towards people with mental disorders in a general population in Finland , 2011 .

[22]  K. Brownell,et al.  Positive media portrayals of obese persons: impact on attitudes and image preferences. , 2012, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[23]  S. Riedel-Heller,et al.  Obese Children, Adults and Senior Citizens in the Eyes of the General Public: Results of a Representative Study on Stigma and Causation of Obesity , 2012, PloS one.

[24]  Anthony F Jorm,et al.  Desire for Social Distance from People with Mental Disorders , 2009, The Australian and New Zealand journal of psychiatry.

[25]  H. König,et al.  Obese children, adults and senior citizens in the eyes of the general public: Results of a representative study , 2012 .

[26]  Chelsea A. Heuer,et al.  Obesity stigma: important considerations for public health. , 2010, American journal of public health.

[27]  D. A. Kenny,et al.  The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. , 1986, Journal of personality and social psychology.

[28]  Heide Glaesmer,et al.  The stigma of obesity in the general public and its implications for public health - a systematic review , 2011, BMC public health.

[29]  M. Angermeyer,et al.  Social distance towards the mentally ill: results of representative surveys in the Federal Republic of Germany , 1997, Psychological Medicine.

[30]  E. Bogardus,et al.  Measurement of personal-group relations. , 1947 .

[31]  M. Angermeyer,et al.  Emotional reactions to people with mental illness , 2010, Epidemiologia e Psichiatria Sociale.

[32]  P W Corrigan,et al.  Familiarity with and social distance from people who have serious mental illness. , 2001, Psychiatric services.

[33]  Amy J. C. Cuddy,et al.  A model of (often mixed) stereotype content: competence and warmth respectively follow from perceived status and competition. , 2002, Journal of personality and social psychology.