SocialFactorsandObesity1

RunningHead:SOCIALFACTORSANDOBESITY

ExplainingtheSpreadofObesitywithSocialFactors
JacobD.Brady
MiddleburyCollege

SocialFactorsandObesity2

TheobesityrateintheUnitedStatesaswellasmanyotherwealthycountrieshasrisen
significantlyoverthepastseveraldecades;accordingtotheCentersforDiseaseControland
Prevention,currentlymorethanonethirdofadultsarecategorizedasobeseintheUnitedStates
(i.e.havingBMI(bodymassindex)of30orhigher),thehighestofallcountries.Obesityisan
unhealthycondition,andislinkedwithincreasedriskofailmentsbothphysicalandmental
includingheartdisease,diabetes,highbloodpressure,andvariouscancers,aswellasdepression,
lowselfesteem,andsocialisolation(especiallyinyoungerindividuals)(CentersforDisease
ControlandPrevention[CDC],2012);Fletcher,Bonell,&Sorhaindo,2011;Whale,Gillison,&
Smith,2014).Thereisanoticeableeconomicburdencausedbyobesity(CDC,2012).Thecauses
ofthespreadofobesityarealsonotentirelyknown,thoughtherearemanyhypothesizedfactors
(CohenCole&Fletcher,2008).Thispaperexaminestherolethatsocialnormsandothersocial
factorsplayinperpetuatingincreasingobesityrates.ChristakisandFowler(2007)performedan
extensivestudyshowingthatobesityspreads,notunlikeavirus,throughsocialconnections.This
hasprovidedafoundationforseverallaterstudies.Itisapparentthatobesityclustersinsocial
groups,andthereisevidencethattheincreasingprevalenceofobesityraisesthenormweight,
whichinturnalterswhatweightsareconsideredaboutright, furthercontinuingtheobesity
problem.
ChristakisandFowler(2007)suggestedthatpersontopersonspreadofobesity isa
significantcontributingfactorintheobesityincrease;essentially,obesityissociallycontagious.

SocialFactorsandObesity3
Theyanalyzedasocialnetworkof12,067individualsovera32yearperiod(fromthe
FraminghamHeartStudy(FHS)19712003)toexaminetheimpactthatanindividualbecoming
obesewouldhaveonthechanceofhisorherfriendsorfamilymembersbecomingobese
(Christakis&Fowler,2007).Theyfoundthatifanindividualbecameobese,therewasa
significantincreaseinthechancethatsomeonesociallycloseorrelevantinthatindividualslife
wouldbecomeobeseaswell.Ifoneidentifiesapersonashisorherfriend,andthatfriend
becameobese,heorshewas57%morelikelytobecomeobese(171%morelikelyformutual
friends).Ifonessiblingbecameobese,heorshewas40%morelikelytobecomeobese,andif
onesmarriagepartnerbecameobese,theotherpartnerhada37%higherchanceofbecoming
obese(Christakis&Fowler,2007).Thistransmissionofobesitytoclosesocialtiesforms
clusters ofobesepeoplewithinasocialnetwork.Theseclustersappeartobebasedonsocial
closenessratherthanphysicalproximity(Christakis&Fowler,2007).Thuslocalenvironmental
factors areunlikelytobeaspowerfulinexplainingthisobservedspreadofobesitythansocial
factors(Christakis&Fowler,2007).ChristakisandFowlercontrolledforindividualstendency
tobefriendthoseofasimilarweightbyincludingonlythosewhowerefriendsatboththethe
startandendoftheexaminedtimeperiod.Theyspeculatedthatobesityinimportantsocial
contactsmightalteranindividualsnormsregardingwhatweightisacceptable,and/orchangehis
orhertoleranceforbeingobese, howevertheirdatawasonlycapableofshowingthatthereare
socialclustersofobesepersons,sohypothesizingthatsocialnormsaboutbodyweightare
behindthisisuntested(Christakis&Fowler,2007).Giventhatobesityisnegative,andthus
assumingthatanindividualdoesnotchoosepurposefullytobecomeobese,itisprobablethat

SocialFactorsandObesity4
whenonessocialtiesbecomeobese,hisorhernormregardingwhatweightisok changes.An
individualmayfeelthathisorhercurrentweightisntaproblem,sinceitappearstobea
commonornormsize.ThusChristakisandFowlersspeculationseemslikely.
CohenColeandFletcher(2008)usedtheNationalLongitudinalStudyofAdolescent
Health(AddHealth)dataset,ratherthantheFHSdata,totestChristakisandFowlers(2007)
observationofthecontagiousnatureofobesitywithinsocialnetworks.Theyfoundthatthe
spreadofobesityseemstoberelatedtolocalenvironmentalfactorsratherthansocialnetwork
norms,contradictingChristakisandFowler(2007)(CohenCole&Fletcher,2008).
Differentiatingbetweenenvironmentalfactorsandsocialfactorsischallenging,however,so
CohenColeandFletcherdonotclaimthatChristakisandFowlers(2007)findingsare
necessarilyincorrect,onlythattheydidnotcometothesameconclusions.CristakisandFowler
(2008)thenrespondedtoCohenColeandFletchersrejectionoftheirhypothesis,andwere
unabletoreplicateCohenColeandFletchersfindingsusingtheAddHealthdataset.Unlike
CohenColeandFletchers,ChristakisandFowlers(2008)analysisoftheAddHealthdataused
directionalcomparisonstoshowsocialratherthanenvironmentalinfluence.Thatis,ifAclaims
Bisherfriend,butBdoesnotconsiderAtobeafriend,Aislikelytobeinfluencedbyimpacted
byB,butnotvisversa.ChristakisandFowlers(2007)FHSdatasupportedthis,asdidtheir
analysisoftheAddHealthdata(Christakis&Fowler,2008).Environmentalfactorswouldnt
leadtoadifferenceininfluencebydirection,thussupportingthesocialspreadofobesity.
SimilartoCohenColeandFletcher(2008),HallidayandKwak(2007)alsoattemptedto

SocialFactorsandObesity5
replicateChristakisandFowlers(2007)resultsusingAddHealthdata.UnlikeCohenColeand
Fletcher,theyconfirmedthesocialcontagionofobesity.ItappearstheCohenColeandFletcher
mayhavepulledincorrectconclusionsfromtheirdata,asChristakisandFowler(2007)ismore
robustandreplicated.
BurkeandNadler(2010)soughttoexplicitlytestforashiftinbodyweightnormsusing
thetwomostrecentNationalHealthandNutritionExaminationSurveys(NHANES)from1988
1994and19992004respectively.Inthissurvey,individualswereaskedtoclassifythemselves
asoverweight,underweight,oraboutright, asubjectivejudgementthatreflectsunderlying
socialnorms(Burke&Nadler,2010).Theyfoundasignificantdeclineinthepercentof
individualswhoselfclassifiedthemselvesasoverweightbetweenthefirstandsecondsurvey,
despitethefactthatnumberofobeseindividualshadincreased(Burke&Nadler,2010).Burke
andNadlerusedthisasevidenceofchangingweightnorms,attributingthesetopopularmedia,
publichealthmessages,andscholasticcontent (Burke&Nadler,2010).Thisisaself
perpetuatingissue,sinceanincreasingpercentageofobeseadultscreatesaeverenlarging
problemwhichisinturnmorefrequentlyaddressedinthenews(confirmedbyBurkeand
Nadler)andhealthcampaigns,whichreflectsthenormthatmanypeopleareobese,andthat
obesityisthenorm.Amorerelaxedstandardofoverweight emerges(Burke&Nadler,2010).
Whenbeingoverweightisthenorm,manyindividualswhowerepreviouslyconsideredmildly
overweight,orstrugglingtostayatahealthyweightnowfeelasthoughthereislesspressureto
behealthysincetheyarentasoverweightasthoseinthemedia,andmaygainmoreweight,
sustainingthecycle.ThisdatasupportsChirstakisandFowlers(2007)conclusionthatsocial

SocialFactorsandObesity6
normswereresponsibleforthespreadofobesity,especiallysincethosewithinsocialnetworks
havestronginfluencesoneachother.asfoundbyWang,Xue,ChenandIgusa(2014).
Wang,Xue,Chen,andIgusa(2014)expandedonBurkeandNadlers(2010)study,and
soughttoidentifynormswithinsocialnetworks,whichBurkeandNadlersNHANESdatawas
toogeneraltoaddress.Theyexaminedchildrensschoolsasatestsocialnetwork,sinceschools
arewelldefined placesinwhichchildreninteractandinfluenceeachother,anddevisedan
agentbasedmodelfromECLSK(EarlyChildhoodLongitudinalStudy KindergartenCohort)
longitudinaldata(Wang,Xue,Chen,&Igusa,2014).Theirmodelwasdesignedtoshowthe
impactofsocialnormsontheincreasingprevalenceofobesity,orasstated,thefollowthe
averagesocialinteractionrule(Wang,Xue,Chen,&Igusa,2014).Thisrule,whichwasfound
tobeineffectinschoolsexaminedthroughoutthemodel,impliesthatchildrenwillmaintaina
bodyweightsimilartotheaverageintheirsocialnetwork,;studentsBMIwasverysimilar
withinschools,andwhenmeanBMIrose,studentswithlowerBMItendedtocatchup
(Fletcher,Bonell,&Sorhaindo,2011;Wang,Xue,Chen,&Igusa,2014).Generalizingthese
findingstoadultswithinsocialnetworks(whichmaybeapotentiallimitation),Wangetal.
supportbothBurkeandNadlerandChristakisandFowler(2007);theyshowsocialnormchange
anditsinfluenceinincreasingobesityrates,butmoreimportantlyfillinamissingpieceinBurke
andNadlersstudybyshowingthesesocialnormscanbepresentinaspecificsocialnetwork,
whichishelpfulinexplainingtheobesityspreadfoundbyChristakisandFowler.
WoutersandGeenen(2013)observedthestronginfluencepeers,specificallyduring
adolescence,haveononeanother.Thissocialinfluencewasnotableinvariousbehaviors

SocialFactorsandObesity7
includingdruguse,eatingdisorders,foodchoices,andexercisehabits;anindividualtendstodo
whathisorherfriendsaredoing(Wouters&Geenen,2013).Thisisevidencethatsocial
influenceaffectsbehavior,specificallywithinonespeergrouporsocialnetwork,whichsupports
thesocialfactorexplanationfortheclusteringandspreadofobesity.
Hruschka,Brewis,Wutich,andMorin(2011)extendedChristakisandFowler(2007)by
collectingdataspecificallyforthepurposeoftestingsocialnormsaboutobesity,ratherthan
utilizingexistingdatalikeChristakisandFowler.Theycollecteddatafrom101womenand812
oftheirsocialconnections(Hruschka,Brewis,Wutich,&Morin,2001).Duetothedesignof
theirstudy,theycouldtestspecificpathwaysinwhichindividualsinfluencebodyweightnorms
withintheirsocialnetworktofindexactlyhowobesitywasspreadingthroughnorms.Their
findingsarenovel,however,whenexaminingtheimpactnormshaveonthisspread,asthey
foundthatonlythroughonepathway(friends weightchangingone'sownideasofwhatisagood
weight)didsocialnormsshowsignificantrelationtothesocialspreadandclusteringofobesity,
andevensothesenormsonlyexplained20%ofthisspreadandclustering(Hruschka,Brewis,
Wutich,&Morin,2011).Theyfoundsocialnormsthusonlyexplainonefifthofdonothavea
largeimpactonthespreadofobesity,explainingonlyafifthofit(Hruschka,Brewis,Wutich,&
Morin,2011).ThisconclusioncontradictsWang,Xue,Chen,andIgusa(2014)andBurkeand
Nadler(2010).Thus,Hruschkaetal.suggestthepossibilityofshortcomingsintheirstudy;
perhapstheywereunabletodetectanindirectimpactofsocialnorms,ortheydidntmeasure
withsuitablereliability. However,iftheywerecorrectthatsocialclusteringofobesityisnot
fullyexplainedbysocialnorms,andChristakisandFowlercorrectlycontrolledforindividuals

SocialFactorsandObesity8
selectingtointeractwithpeopleofasimilarweightwhenconcludingthatobesityclusters
socially,thentheremustbeadditionalfactors,suchaseatingandexercisehabits,thatare
transmittedsociallyandcouldexplainthesocialspreadandclusteringofobesity.
Severalofthepreviousstudiesconfirmthatobesityspreadsthroughsocialnetworks;this
isnearlycertainlythecase.Ball,Jeffery,Abbott,McNaughton,andCrawford(2010),however,
examinedwhetherhealthrelatedbehavior,suchasexerciseandfoodchoices,werealso
transmittedsocially.Theysurveyed3610womenandaskedabouttheirhabits,andthehabitsof
thosearoundthem(Ball,Jeffery,Abbott,McNaughton,&Crawford,2010).Theyfoundthat
whenexercisingwasthenorm,peopleweremorelikelytoexercise,andthatnormsaboutwhat
kindoffoodspeopleconsumedwereassociatedwithmoreofthatfoodconsumed(e.g.when
eatingfastfoodisthenorm,individualsaremorelikelytoeatfastfood)(Ball,Jeffery,Abbott,
McNaughton,&Crawford,2010).CombingthiswithFletcher,Bonell,andSorhaindos(2011)
findingsthateatingbehaviorsareclusteredwithinsocialnetworksillustrateshowsocialnorms
caninfluencethespreadofhealthrelatedbehavior.Sincethereisastrongconnectionbetween
diet,exercise,andobesity,thiscouldexplaintheinabilityofHruschka,Brewis,Wutich,and
Morin(2011)toexplainthesocialclusteringofobesityusingonlybodyweightnorms.Ifan
individualsclosesocialtiesareobese,theyarelikelytohavepooreatingand/orexercisehabits,
whichthenalterthenormaboutthosebehaviorsforthatindividual,whoisthenlikelytofollow
withalteringhisorherbehaviortomatchthatnorm,increasinghisorherlikelihoodofbecoming
obese.UnlikeChristakisandFowler(2007),Balletal.didnotcontrolforselectiveassociation,
inthiscase,individualschoosingtoassociatewiththosewithsimilarexerciseandeatinghabits
tothem,whichcouldcompromisethestrengthoftheeffectofsocialnormsthattheyfound.

SocialFactorsandObesity9
However,duetothestrengthofthesocialnormeffectandsupportfromotherstudies(e.g.
Whale,Gillison,&Smith,2014),healthrelatedbehaviornormsarelikelyafactorperpetuating
thesocialspreadandclusteringofobesity.
Whale,Gillison,andSmith(2014)notedthatsocialpressurestowardshealthybehavior
areveryapparentinsociety.Modelsandindividualsinadvertisementsarethin;themediain
generalportraysthinasgood.Whaleetal.examinedtheinfluenceofthisoutwardnormon
peoplesbehavior,anditsrelationshiptoincreasingobesityrates.Theyinterviewedwomen
particularly,likelysincethemediaportraysthinwomenmoreprominentlythanitdoesmen.
Theyfoundthatononehand,thereisthemediaidealofthinasgood,whichwasconfirmedby
thewomeninterviewed;everyparticipanttalkedabouthowwomenmustbesliminordertobe
acceptedinsociety,andhowthisprovidedstrongmotivationtoloseweight (Whale,Gillison,&
Smith,2014).However,theattitudethatthisidealisunrealisticandunachievable mayweaken
theeffectivenessofthethinnessnormininfluencingindividualsbehaviorbyreducing
motivationtoloseweight(Whale,Gillison,&Smith,2014).Ontheotherhand,theynotedthe
riseinwhatweightisconsideredacceptable,asfoundbyBurkeandNadler(2010),duetothe
increasedprevalenceofobeseindividuals.Thisoverweightnormmaydirectlyoverpowerthe
thinnessnormduetothelatterbeingunrealistic,butregardless,theconflictingnormscreatea
disjunctionbetweenbeliefs(i.e.cognitivedissonance),andascognitivedissonancetheory
indicates,individualsarelikelytochangeeithertheirbehaviororthoughtstoeliminatethis
dissonance(Whale,Gillison,&Smith,2014).Asistypicallythecase,thischangetendstooccur
inindividualsattitudesratherthantheirbehavior,sincechangingbehaviorisamoresignificant

SocialFactorsandObesity10
changeandrequiresmoreworkthanalteringbeliefsaboutobesity.Thus,thereisatendencyto
believethatbeingoverweightisacceptable,sinceitisthenorm.Thisthinkingisobviously
dangerous,andonlyperpetuatestheobesityproblem.
Itsapparentthatthegrowingproblemofobesityispubliclyrecognized,andthusthere
havebeenincreasinglyfrequenthealthcampaigns(Cooke,Croker,&Wardle,2008).However,
asfoundbyBurkeandNadler(2010),Cook,Croker,andWardle(2008)confirmedthat,coupled
withtheincreasingpercentageofoverweightpersons,thethresholdforwhatindividuals
consideredoverweight tobeisrising.Only75%ofoverweightindividualsconsidered
themselvesoverweightin2007,comparedwith81%in1999(Cooke,Croker,&Wardle,2008).
TheirstudywasperformedinGreatBritainusingBritishnationalsurveys,whichdemonstrates
thatthisissueisnotconfinedtotheUnitedStates.Cooketal.supportedchangingnormsand
socialcomparisonascontributingfactorstothemisidentificationofwhatbeingoverweight
entails.Healthcampaignsinthemediatendtoshowseverelyobesepeople whichcanincrease
overweightindividualsthinkingtheirweightisnotanissuewhencomparingthemselvestothe
fewextremelyobeseindividuals,andthusthathealthcampaignsarenotrelevanttothem(Cooke,
Croker,&Wardle,2008).Thesecampaignscouldthusbecontributingtotheobesityproblem,
ratherthanremedyingit,bycausingoverweightindividualstodownplaytheirproblemandlose
motivationtoloseweight.Similarlyadvertisinghasanimpactoneatinghabits,specificallythe
typesoffoodpreferredandthusconsumed,whichtendtobeenergydenseandleadtoobesity,
perhapssincethesefoodtypesarefrequentinadvertisingandgivethesensethatthosefoodsare
whatpeopleeat(Wouters&Geenen,2013).

SocialFactorsandObesity11
Obesityisanundeniableworldwideissuewhichhasbecomeincreasinglycommonover
thepastfewdecades.Dealingwiththisissuerequiresknowledgeofitssourceandexplanationof
itsincreasingprevalence.Themajorityofthestudiesexaminedinthispaperexplainasignificant
portionofthespreadofobesitybysocialfactorsandnorms.CohenColeandFletcher(2008)and
Hruschka,Brewis,Wutich,andMorin(2011)aretheapparentoutliers;CohenColeandFletcher
specificallyseemstobeincorrect,asitsconclusionsareinconsistentwithfindingsbymanyother
studiesonthistopic,andHruschka,Brewis,Wuitch,andMorinsuggestsocialnormscouldstill
beafactor,justnotsolelynormsaboutweight.Otherresearch(e.g.Fletcher,Bonell,&
Sorhaindo(2011);Whale,Gillison,&Smith(2014);Wouters&Gleenen(2013))showsthat
obesityrelatedbehaviorssuchaseatingandexercisehabitsareinfluencedbyrelatedsocial
normsandcanspreadthroughsocialnetworks.Thisisevidencethatobesitycanalsospread
throughsocialnetworksduetotherelatednatureofthesebehaviorsandobesity.Thereisdirect
supportfornormsaboutwhatbodyweightisacceptableorstandardinfluencingpeoples
attitudes,whichisapparentintherisingnumberofoverweightindividualswhofailtorecognize
themselvesasoverweight(Burke,Heiland,&Nadler,2010;Johnson,Cooke,Croker,&Wardle,
2008).Thesenormsareapparentonalargescale,suchasinthemedia,oratalocallevelwithin
socialgroups,andinbothscalesthesenormshaveaneffectonweightperceptionsandbehavior.
AsfoundbyChristakisandFowler(2007)andconfirmedandsupportedbymanyothers(e.g.
Halliday&Kwak(2007);Hruschka,Brewis,Wutich,&Morin,2001),obesityisspreadingnot
unlikeavirus.Withtheincreasingprevalenceofoverweightness, individualsseebeing
overweightasthenorm,andnotasanegativeeveniftheyareawareitisunhealthy.Thissame
norminfluenceappliestounhealthyeatingandexercisehabitsaswell.Together,theyperpetuate

SocialFactorsandObesity12
thespreadofobesity.Sincenormsexplainincreasingobesityrates,healthcampaignstargeting
theobesemaynotbeeffectiveastheycontributeto,insteadofremedy,thenormthatobesityis
standard.Thusattemptstograduallyandeventuallycuretheobesityepidemicpresentinthe
UnitedStatesandmanyothercountriesshouldtakecaretofocusonchangingpeoples
perceptionsoftheissueandthesocialnormssurroundingit.
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