Body Norms and Fat Stigma in Global Perspective

Body Norms and Fat Stigma in Global Perspective Author(s): Alexandra A. Brewis, Amber Wutich, Ashlan Falletta-Cowden, Isa Rodriguez-Soto Source: Current Anthropology, Vol. 52, No. 2 (April 2011), pp. 269-276 Published by: The University of Chicago Press on behalf of Wenner-Gren Foundation for Anthropological Research Stable URL: http://www.jstor.org/stable/10.1086/659309 . Accessed: 30/03/2011 21:17 Your use of the JSTOR archive indicates your acceptance of JSTOR's Terms and Conditions of Use, available at . http://www.jstor.org/page/info/about/policies/terms.jsp. JSTOR's Terms and Conditions of Use provides, in part, that unless you have obtained prior permission, you may not download an entire issue of a journal or multiple copies of articles, and you may use content in the JSTOR archive only for your personal, non-commercial use. Please contact the publisher regarding any further use of this work. Publisher contact information may be obtained at . http://www.jstor.org/action/showPublisher?publisherCode=ucpress. . Each copy of any part of a JSTOR transmission must contain the same copyright notice that appears on the screen or printed page of such transmission. JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms of scholarship. For more information about JSTOR, please contact support@jstor.org. The University of Chicago Press and Wenner-Gren Foundation for Anthropological Research are collaborating with JSTOR to digitize, preserve and extend access to Current Anthropology. http://www.jstor.org Current Anthropology Volume 52, Number 2, April 2011 Reports Body Norms and Fat Stigma in Global Perspective Alexandra A. Brewis, Amber Wutich, Ashlan Falletta-Cowden, and Isa Rodriguez-Soto School of Human Evolution and Social Change, Arizona State University, Tempe, Arizona 85287-2402, U.S.A. (alex.brewis@asu.edu). 19 IX 10 CA⫹ Online-Only Material: Supplement A While slim-body ideals have spread globally in the last several decades, we know comparatively little of any concurrent proliferation of fat-stigmatizing beliefs. Using cultural surveys and body mass estimates collected from 680 adults from urban areas in 10 countries and territories, we test for cultural variation in how people conceptualize and stigmatize excess weight and obesity. Using consensus analysis of belief statements about obese and fat bodies, we find evidence of a shared model of obesity that transcends populations and includes traditionally fat-positive societies. Elements include the recognition of obesity as a disease, the role of individual responsibility in weight gain and loss, and the social undesirability of fat but also the inappropriateness of open prejudice against fat. Focusing on statements about fat that are explicitly stigmatizing, we find most of these expressed in the middleincome and developing-country samples. Results suggest a profound global diffusion of negative ideas about obesity. Given the moral attributions embedded in these now shared ideas about fat bodies, a globalization of body norms and fat stigma, not just of obesity itself, appears to be well under way, and it has the potential to proliferate associated prejudice and suffering. Big body size and fatness are imbued with cultural meaning in all human societies, often profoundly reflecting and shaping identities and the broader social order (Bordo and Heywood 2003 [1993]; Brown and Konner 1987; Brown and Sweeney 2009; Douglas 1970). In much of the industrialized West, where bodies are dominant and preferred symbols of self (Becker 1995:33; Degher and Hughes 1999; Rubin, Shmilovitz, and Weiss 1993), slimness is associated with health, beauty, intelligence, youth, wealth, attractiveness, grace, self-discipline, and goodness (Caputi 1983; Moreno and Thelen 1993). Fatness and obesity are by contrast associated with ugliness, sexlessness, and undesirability but also with specifically moral 䉷 2011 by The Wenner-Gren Foundation for Anthropological Research. All rights reserved. 0011-3204/2011/5202-0008$10.00 DOI: 10.1086/ 659309 269 failings, such as a lack of self-control, social irresponsibility, ineptitude, and laziness (Becker 1995; Cordell and Ronai 1999; de Garine and Pollock 1995; DeJong 1993; de Vries 2007:61; Grogan and Richards 2002; Martin 2001 [1987]; Stunkard and Sobal 1995; Turner 1984). The social discrediting implicit in these moral judgments, as the key to shaping social stigma (Goffman 1986 [1963]), maps well onto the high rates of enacted and felt prejudice reported by the fatter members of society in places such as the United States (Janssen et al. 2004; Puhl and Heuer 2009; Sjöberg, Nilsson, and Leppert 2005). The technically obese (those with body mass index [BMI] greater than 30) have less career and educational access, lower pay, and worse health care service, and they are significantly more likely to be fired, bullied, teased, and romantically rejected (see Puhl and Heuer 2009 for a recent literature review). Profoundly, many Americans say they would rather die younger or be blind than be obese (Schwartz et al. 2006). In sharp contrast, a number of ethnographic studies conducted in the 1980s and 1990s have detailed social contexts in which fat bodies express beauty, marriageability, attractiveness, and an array of positive moral attributes such as control of selfish desires, closeness to God, generosity, fertility, familial responsibility, and social belonging. Some of the best examples are Popenoe’s (2004) study with Azawagh Arabs in Niger, Sobo’s (1994) study in rural Jamaica, Anderson-Fye’s (2004) work on a Belize caye, Massara’s (1989) research with Philadelphia Puerto Ricans, and Becker’s (1995) study of a Fijian village conducted in the late 1980s. However, there has been substantive globalization of slim-body ideals since at least the 1980s, whereby many of the places where large or fat bodies were reported to be valued or viewed neutrally now increasingly state a preference for slim bodies on standard body image scales (e.g., Brewis et al. 1998). Becker’s (2004) follow-up study in Fiji in the early 2000s provides some of the most detailed ethnographic examination of this implied global shift. Over just one decade, Becker found young women had completely transformed their identities in relation to their bodies; following the introduction of television, young women adopted slimmer-body ideals tied to increased use of individual body presentation as an identity anchor and supplanting an identity tied to community, such as through nurturing others (Becker 2004). Due to an absence of any comparative studies, it is not well understood whether and how fat negativism might be transforming and homogenizing across groups in the same manner as the adoption of slim idealism. Slim idealism in itself need not inevitably lead to fat negativism, raising the possibility that the processes of any spread in these ideas may be connected, or not. For example, in Samoa in the mid-1990s, Brewis et al. (1998) found that most adults expressed a slimbody ideal that was paired with a lack of appreciable negative concern about fatness despite the traditional value afforded to it. This compels us to wonder to what degree antifat ideas 270 might have gained traction in recent years and are now entwined with proslim ones. This question of how widely antifat ideas have spread is especially current given that overweight and obesity rates are rising quickly among adults in all regions except sub-Saharan Africa; many developing countries now identify obesity as a major public health issue and express concerned about both health and economic implications (Popkin 1994, 2004). Little thought at all, however, is being given to its possible social costs. The spread of cultural ideas about the negative moral meanings of fat would, however, anticipate an increase in people vulnerable to fat stigma, adding increased social costs to obesity as well as with the better-documented and anticipated medical and economic ones. Here we report on an empirically oriented cross-cultural study designed as a preliminary effort to identify potential globalizing patterns in people’s cultural models related to obesity and fat bodies in general and their fat stigma in particular. By “cultural models” we refer to the ideas that form a consensus in a specific domain of knowledge (Romney, Weller, and Batchelder 1986). By “fat stigma” we mean specifically negative values placed on fat or large bodies that are socially discrediting, in the manner of Goffman (1986 [1963]). The organizing questions are whether there is evidence of a globalization of ideas regarding obesity and fat bodies, and do local differences in cultural models explain any observed patterns of variation, or is the distribution of cultural knowledge rather tied more to individual factors such as education or body size (thereby suggesting a more globalized, less culturally specific patterning)? Based on existing published ethnographies we would predict considerable across-population variation in ideas about fat stigma, including the very low stigma seen in places like American Samoa that are conventionally understood to be relatively fat neutral or positive, compared to places such as the mainland mainstream United States, where widespread antifat ideas have been documented and dominant for several decades. However, the pace of change in slim-body ideals globally suggests we need to determine whether this assumed distinction between the West and the rest is actually observable. Samples and Methods Given that we framed our study as a pilot study to test for very basic patterns cross-culturally, our selection of sites was based on convenience. We selected nine diverse country and territory research sites where Arizona State University anthropology faculty and students have active research programs, including several that have been glossed as fat-positive in the ethnographic record (American Samoa, Puerto Rico, Tanzania). We also included a sample from the United States, specifically, from predominantly white middle-class neighborhoods, as our basic frame of reference as a known fatstigmatizing context. There is a conventional wisdom that Current Anthropology Volume 52, Number 2, April 2011 U.S. hegemony in a multitude of domains is relevant to how people think about and respond to obesity. There is some evidence to support this idea, such as studies tracing the mass promotion of very slim ideals through such media as television (e.g., Rubinstein and Caballero 2000), a highly medicalized and globalizing model of obesity that emphasizes its status as a sickness and thus the need for medical treatment (e.g., Sobal 1995), in mass production and marketing of obesogenic food (e.g., Kelly 2005), and the über-stigmatization of fat (e.g., Stearns 2007). We also collected an eleventh sample of undergraduates to provide a further frame of reference, since the vast majority of the body image studies, including those done internationally, have been conducted with such student populations (e.g., Akan and Grilo 1995; Crandall et al. 2001). Data were collected between April and September 2009. We collected data through in-person interviews in Pago Pago, American Samoa; Dar Es Salaam and Zanzibar, Tanzania; the border town of Nogales, Mexico; San Jose in Puerto Rico, Asunción in Paraguay; London; Buenos Aires in Argentina, relatively affluent Scottsdale, Arizona, United States; and with undergraduate students at Arizona State University. (We also collected interview data with Quichua speakers in Amazonian Ecuador, but problems with the surveys prevented their being included in the analysis.) Participants were recruited in public places at each of these sites, with the rationale that this approach should be sufficient to identify agreement around cultural knowledge if agreement in fact existed at the local level. We then supplemented these with Internet-based versions of the same surveys conducted through respondent-driven sampling with people living in urban Puerto Rico, New Zealand, and Iceland. The sample sizes and some sample-specific characteristics are given in table 1. Our primary tool was a survey containing cultural statements regarding obesity, body norms, and fat to which each participant responded with agreement or disagreement. The responses to survey questions were used to conduct cultural consensus analysis using UCINET software to identify culturally specific answer keys (i.e., the culturally correct answer to each question; see Hruschka et al. 2008 for a detailed discussion), to test for shared cultural models and assess individual competencies against that model, to compare those models from place to place, and to identify variation in fat stigma specifically. Evidence of a shared cultural model was a single factor and a large ratio between the first and second eigenvalues. Following Weller (2007:353–354), we considered average cultural competency scores above 0.5 to indicate moderate agreement about an underlying cultural model and above 0.66 to indicate strong agreement with an underlying model. In assessing individual competencies against shared models, we considered a score above 0.8 to be very high competency (i.e., a person who knows what others know). In terms of assessing fat stigma in particular, we selected 25 statements from the survey that represent socially discrediting attributions related to body fat and obesity (e.g., 271 Table 1. Sample characteristics Sample size (N) Female (%) Average age (yr) Average BMI Average BMI for men Average BMI for women Percentage overweight (BMI 1 25) Survey format 80 40 86 66 46 44 105 52 62.5 50 66.3 40 34.8 70.5 69.2 63.5 32.3 32.4 32.4 34.5 45.0 51.9 37.2 37.3 34.1 23.4 25.8 23.9 28.3 23.7 25.9 26.9 33.1 24.1 26.4 24.8 28.7 24.9 26.2 27.0 34.7 22.7 25.6 22.5 28.4 23.2 25.8 26.9 86.3 28.2 49.4 40.6 75.6 27.3 53.8 51.9 In person In person Online In person In person Online In person Online 44 77 40 61.4 67.5 57.5 37.2 24.1 46.9 23.6 23.5 25.3 27.9 24.4 23.9 24.6 23.1 26.5 27.3 27.0 48.5 In person Online In person 60 36.3 26.1 26.3 26.0 48.5 American Samoa Argentina Iceland London Mexico New Zealand Paraguay Puerto Rico United States (excluding undergraduates) U.S. undergraduates Tanzania Total 680 Note. BMI p body mass index. “people are overweight because they are lazy”). A high score on the scale (closer to the maximum of 25) indicated more expressed fat stigma. The items used to create this scale are shown in CA⫹ online supplement A. Following Weller (2007:348), the cultural statements themselves were derived inductively and deductively. We extracted statements from interview transcripts and field notes from our teams’ previous qualitative research in Samoa, Mexico, New Zealand, and the United States, and from detailed readings of any relevant ethnographies (especially Anderson-Fye 2004; Becker 1995; Massara 1989; Nichter 2001; Popenoe 2004; Sobo 1994). We also systematically reviewed public health Web sites, such as for the U.S. Centers for Disease Control and the American Medical Association, for recommendation statements. The statements derived from these sources emphasized the role of individual decisions and behaviors in the genesis of obesity, (i.e., overeating, underexercising) but also sometimes noted factors purportedly beyond the control of individuals, such as built environments or genetic predisposition. This process yielded an initial pool of 150 cultural statements. We went through several rounds of translation and back-translation between English and Spanish and piloting in both languages, and after removing items that people did not understand or did not respond well to or that were duplicative, we were left with a final survey containing 83 statements, shown in CA⫹ supplement A. Translation and backtranslation into other languages was done only at the end of the tool development process. In developing the tool we used “true” or “false” as the only response options because we wanted to compel people to make decisions on ostensibly judgmental items (e.g., “obese people should be ashamed of their bodies”), and the formal consensus model assumes that respondents will guess without bias when given dichotomous response choices (Weller 2007:344). Participants’ level of body fatness (i.e., being overweight or obese) was included as a factor of interest in this study because it might help explain both cross-population and interindividual differences in how people respond to the cultural statements. To assess body fat status, we used height and weight measures to estimate BMI using the standard formula of weight (kg) divided by height (m2). Measures were (1) taken using a portable scale and flexible tape in sites where people do not weigh themselves often (e.g., Mexico, American Samoa) or (2) based on self-reports in places where a reasonable correlation between self-reported weight and weighed weight in adults can be expected (e.g., New Zealand, Iceland, United States). The use of self-reported height and weight in some of the samples is a potential limitation of this study, although in countries where people weigh themselves often, self-reports tend to be reasonably accurate (see Engstrom et al. 2003). Regression analyses were conducted using PAWS (SPSS), version 18.0. Oversight for this study was provided by the Arizona State University Office of Research Compliance and Assurance. Results As figure 1 shows, average fat stigma scores ranged from a low of 10.4 for Tanzania to a high of 15.0 for Paraguay, out of a possible total of 25. This suggests fat stigma is apparent in all the samples. To identify to what degree the mean levels of fat stigma are similar or different across samples, we computed a matrix (V) where the ijth element is what proportion of study group i’s single deviation from their mean stigma is overlapped by that of group j. In other words, if V(i, j) is close to 1, then i’s variation in fat stigma is almost completely contained within j’s variation. If V(i, j) # V(j, i) is close to 1, then the two groups can be said to have the same level of fat stigma because j overlaps i considerably and i overlaps j considerably, meaning they cannot be of very different sizes. On this basis we find that U.S. undergraduates, London, and New Zealand samples overlap with all other samples the most (that 272 Current Anthropology Volume 52, Number 2, April 2011 is, V(i, j) # V(j, i) is very close to 1.0), while Paraguay and Tanzania overlap least (i.e., are the more distinctive at both ends of the spectrum). From the cross-cultural body image literature, which suggests women on the whole are much more concerned with body idealism and are earlier adopters of slim ideals than men, we might expect women to also express greater fat stigma than men. Based on a logistic regression model combining all individuals from the different samples, we instead found that higher fat stigma scores (≥16) were predicted by lower education level (a five-level variable based on completed primary, secondary, high school, technical training, or graduate/professional school; 95% confidence interval [CI] p .705–.964, P ! .05), but not gender, age level (three-level variable), or overweight status (two-level variable: BMI 1 25 or not; all P 1 .05, and CI contained 1.0). Similarly, low stigma scores (≤10) were predicted by higher education level (95% CI p 1.052–1.501, P ! .05), but not age level, overweight status, or gender (all P 1 .05, and CI contained 1.0). Given the findings of prior ethnographic surveys (e.g., Brown and Konner 1987), we predicted that shared understandings about the social meanings of big bodies could be Table 2. Average competency scores, by country and territory Each population independently Global model .446 .621 .578 .491 .448 .563 .611 .626 .402 .586 .549 .479 .406 .531 .569 .609 .566 .555 .531 .546 .529 .354 American Samoa Argentina Iceland London Mexico New Zealand Paraguay Puerto Rico United States (excluding undergraduates) U.S. undergraduates Tanzania found within all of these 11 surveyed groups and that the models derived for each sample would vary across groups. When we ran the consensus analysis on each sample independently (table 2), the average competency scores ranged between 0.45 (American Samoa and Mexico) and 0.63 (Puerto Rico), indicating that population samples fall within a range Figure 1. Boxplot showing variation in average stigma scores across the samples. The middle of each box represents the average, the vertical line the median, the boxes the twenty-fifth and seventy-fifth percentiles, and range is represented by the whiskers. 273 that indicates each has shared cultural model about the meanings of fat/obesity. Answer keys for each of the samples are found in CA⫹ supplement A, showing the commonalities and differences across the samples. While some negative ideas about fat/obesity were evident in the answer keys of all our samples, it is important to pair this with the observation that many of the sample-specific culturally correct answers also included statements that did not endorse the most negative statements around meanings applied to fat/obesity. American Samoa, Mexico, and Paraguay were the only samples in which the culturally correct answers associated overweight and obesity with laziness. American Samoa and Mexico had the greatest degree of mix of fat-positive and fat-negative statements. Tanzania had a more fat-neutral cultural model than the other groups, based on a reading of the answer keys. However, in Tanzania as elsewhere, the cultural model recognized obesity as a disease with negative health effects. Following evaluation of the cultural models derived for each of the 11 samples, we combined all 680 participants in a pooled cultural consensus analysis. We termed this our “global” model in the sense that it is not specific to any site and includes the fuller range of cultural diversity captured by our study. The results suggest this global sample also has a shared cultural model in the domain of obesity/fat; average competency score for all participants was 0.51. Elements evident in the answer key for this global model included those expressing slim as desirable, obesity as dangerous and a disease, and the role of both personal responsibility and genetic or biological predisposition in the etiology of obesity. The most stigmatizing statements, however, did not feature in any noticeable way in the shared global answer key, and the reading of the culturally correct statements in this regard speak to the idea that that fat is highly undesirable but that extreme fat stigma and prejudice is not socially acceptable. The answer key for this global model is also given in CA⫹ supplement A. Interestingly, as with the stigma scores, we found little difference by gender in individual competency scores against the global model. Using Student t-tests to compare withinsample competency scores and stigma scores between women and men, only Argentina showed significant gender differences (P p .047). To specify the degree to which other country and territory samples (vs. individuals) showed similarity to the U.S. cultural model, we first pooled all U.S.-born participants (excluding territories) into one further consensus model and compared the answer key for each sample against this additional U.S. answer key and estimated the proportion of items that were in agreement. These are shown in table 3 and range from 62.7% of the culturally correct answers from Tanzania being the same as the U.S to 94% for London being the same. Using logistic regression, we then tested the relationship between individual demographic variables and individual competencies against the U.S. cultural model for those who were born and are still living outside the United States, sum- Table 3. Correlation of answer keys for different samples compared with the United States answer key Overlap of answer keys with the the U.S. model American Samoa Argentina Iceland London Mexico New Zealand Paraguay Puerto Rico United States (excluding undergraduates) U.S. undergraduates Tanzania .867 .867 .928 .94 .771 .867 .807 .867 .988 .976 .627 Note. Agreement scores generated by comparing each sample’s answer key to the United States answer key. marized in Table 4. Predictor variables included age, education, gender, and a binary variable related to being overweight or not (BMI 1 25).The resulting odds ratios and confidence intervals suggest that the likelihood of having higher competency (defined as a score 10.6) against the U.S. model was significantly different (P ! .05 ) and estimated to be 1.56 times increased with each level of education and was two times higher for women. However, higher competency was not associated with age level or overweight status (P 1 .05). There also proved to be no association between a continuous measure of BMI and individual participants’ competency scores against the global cultural model of obesity of individuals (as shown in table 4) in a pooled multipleregression analysis. We also ran a separate analysis to test whether individual BMI predicted variation in individual levels of cultural competency against this U.S. model; the result was also not significant (both P 1 .05). Conclusion Based on this analysis of a limited but reasonably diverse set of cross-cultural samples, globalization of a cultural model about obesity and the globalization of fat stigma are clearly evident. Key ideas in the global model of obesity include the notions that obesity is a disease and that fat reflects personal and social failing. In all our samples, some fat stigma is evident, and the global model suggests that the cultural shared idea that fat or obesity is a basis for judging the social and personal qualities of the individual. However, and critically, the shared cultural model also suggests the culturally correct perspective that expressing those judgments too obviously or forcefully is not acceptable. We do see some evidence of more mixed cultural models balanced between fat neutral/positive and fat negative ideas—which may indicate an ongoing period of cultural transition—in sites like Mexico and American Samoa. Only Tanzania had a cultural model that can be char- 274 Current Anthropology Volume 52, Number 2, April 2011 Table 4. Average proportion of individual’s culturally correct answers against the United States and the global (pooled) shared cultural model answer keys American Samoa Argentina Iceland London Mexico New Zealand Paraguay Puerto Rico United States (excluding undergraduates) U.S. undergraduates Tanzania Proportion correct against the U.S. model Proportion correct against the global model .666 .765 .762 .732 .65 .757 .745 .786 .661 .751 .758 .725 .632 .752 .727 .775 .757 .749 .672 .765 .758 .65 acterized as largely fat neutral, with an absence of fat-stigmatizing beliefs. In this regard, Tanzania appears as an outlier that warrants specific explanation; we are unable to offer one at this juncture except to recognize that sub-Saharan Africa is the one remaining part of the world not affected by rapidly rising obesity rates and where hunger remains a daily challenge for many. One of the most noteworthy findings is that the highest fat stigma scores are not in the United States or London but rather in Mexico, Paraguay, and—perhaps mostly unexpectedly—in American Samoa. These higher scores reflect their agreement with several fat-stigmatizing items on the survey, including those associated with the relationship between overweight and laziness, not agreed with in the other samples. We propose, based on a careful examination of the answer keys and confirmed by our own ethnographic experience in several of the sites, that this is due to differences in the consciousness of these populations about politically correct responses to certain kinds of overtly fat-stigmatizing statements. For example, in Mexico, Paraguay, and American Samoa, there is not a high social value placed on self-censoring stigmatizing statements about fat/obesity. In the other sites, in contrast (and reflected in the shared model), it is understood that it is impolite or otherwise socially inappropriate to express highly stigmatizing opinions about overweight people and obesity—even if one thinks them. The difference is thus not necessarily in the underlying beliefs attached to fat bodies but rather the presence of norms regarding the importance of masking these beliefs. Further support for this interpretation can be found in the association between more education and lower expression of the stigma statements, regardless of sample group, and the fact that some sites (e.g., Iceland) agreed almost universally with slim-idealizing statements yet did not endorse these highly fat-stigmatizing statements. Interestingly, individual fat stigma scores and individual cultural competency scores against the global model were both best predicted by education, not gender nor country of residence. Further, they did not relate within or across groups to respondents’ actual body fat status. Education may emerge as the best predictor of this variation because it provides a proxy measure of respondents’ exposure to antifat ideas via mass media (e.g., television and film) and public health messages. Both of these factors would make it more likely that respondents would be exposed to, adopt, and express stigmatizing ideas. For example, obesity is afforded significant public health attention in the island Pacific, including in American Samoa, and most people living in urban areas in the region would be regularly exposed to fat-as-unhealthy types of messages (e.g., WHO 2000). In summary, these analyses suggest that norms about fatas-bad and fat-as-unhealthy are spreading globally and that cultural diversity in conceptions of ideal or acceptable body size appears to be on the decline. Certainly, negative and especially discrediting ideas about fat/obesity are now seemingly much more widespread than a thorough reading of the available ethnographies would suggest. This process of cultural change appears to be happening very quickly, likely representing homogenization in beliefs in this domain just within the last decade or two. This leans us toward the age-old anthropological challenge of better understanding what drives the cultural diffusion of new ideas and feeds their gaining salience. Our findings hint that newer forms of educational media, including global public health campaigns, may be driving this trend. Whatever their source, it is important to understand the dynamics of fat-stigmatizing cultural models because of their potential influence on both physical and social well-being of individuals in a wide range of socioecological contexts. The findings and limitations of this study both suggest ways forward in researching these problems. The cultural and geographic span represented by the samples included in this study was limited (e.g., nothing from Asia) and sample sizes were modest, but these results certainly suggest that more comprehensive studies examining the global dissemination and impact of fat-stigmatizing ideas are warranted and should prove fruitful. The findings around the role of education sug- 275 gest that more detailed, ethnographically situated studies, in the middle-income developing nations in particular, seem justified, examining in more sophisticated ways how likely related factors as media, migration, and economic changes affect stigma, both as an expressed and an experienced phenomenon. While we did not detect age effects on stigma levels, we also did not collect any data from anyone under 18 years of age. The apparently rapid spread of stigmatized ideas about obesity/fat, however, certainly raises questions about possible intergenerational and cohort effects as well. Almost all our participants are living in urban areas, and our observations might have been very different if we had instead focused on rural contexts or the contrast between the two. Further, Internet versus in-person sampling, the use of measured and self-report height anthropometric data, and the use of cultural statements drawn from a subset of the populations sampled may lead to various biases, and more comprehensive comparative studies should address these. Ultimately, a combination of both comparative and locally focused studies will be required to unravel the details of how and why this process of the globalization of fat stigma is occurring and what it means ultimately for those who represent the enormous global trend toward obesity. What we do observe, however, is that there is a critical process around the globalization of fat stigma that is very much in progress and should be of concern. Acknowledgments We thank Arizona State University President’s Initiative Fund for support for the Late Lessons from Early History projects, Daniel Hruschka, A. Magdalena Hurtado, Benjamin Morin, and the students who helped collect data in the summer of 2009, especially Ashley Archer-Hayes, Lubayna Fawcett, Benjamin Lang, Cristina Ochoa, Stephen Ruffenach, Alissa Ruth, Sveinn Sigurdsson, Martha Wetzel, and Rossana Vega. References Cited Akan, G. E., and C. M. Grilo. 1995. Sociocultural influences on eating attitudes and behaviors, body image, and psychological functioning: a comparison of African-American, Asian-American, and Caucasian college women. International Journal of Eating Disorders 18(2):181–187. Anderson-Fye, E. P. 2004. A “Coca-Cola” shape: cultural change, body image, and eating disorders in San Andrés, Belize. Culture, Medicine and Psychiatry 28(4):561–595. Becker, A. E. 1995. Body, self, and society: the view from Fiji. 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