Comparing views on obesity across cultures and stages of health training
| ISRCTN | ISRCTN15931460 |
|---|---|
| DOI | https://doi.org/10.1186/ISRCTN15931460 |
| Sponsor | Universitat Rovira i Virgili |
| Funder | Universitat Rovira i Virgili |
- Submission date
- 21/04/2026
- Registration date
- 27/07/2026
- Last edited
- 27/07/2026
- Recruitment status
- Recruiting
- Overall study status
- Ongoing
- Condition category
- Nutritional, Metabolic, Endocrine
Plain English summary of protocol
Background and study aims
Obesity stigma refers to negative attitudes, beliefs, and stereotypes about people living with obesity. This stigma can affect not only individuals’ well-being but also the quality of healthcare they receive. Research has shown that even healthcare professionals and students may hold biased views.
This study aims to explore attitudes, beliefs, and perceptions about obesity among university students studying health-related degrees (such as Medicine, Nutrition, Nursing, Psychology, Physiotherapy, and Physical Activity). It will also examine whether these attitudes differ depending on the student’s stage of training and across different countries. The goal is to better understand how education and cultural context influence obesity stigma, and to help improve future training for healthcare professionals.
Who can participate?
Students enrolled in undergraduate health-related degree programs (Medicine, Nutrition, Nursing, Psychology, Physiotherapy, and Physical Activity) at participating universities in Spain, Mexico, and Chile.
What does the study involve?
Participants will be asked to complete an anonymous online survey using Microsoft Forms.
What are the possible benefits and risks of participating?
The findings may help improve education and training for future healthcare professionals, promoting more respectful and informed care for people living with obesity.
The possible risks of participating mainly relate to the nature of the questions. Some survey items may touch on sensitive topics around weight, health, or personal experiences with stigma, which could potentially cause emotional discomfort or distress for certain individuals. Because the survey is self-reported, participants may feel uncertain about how their responses will be used, though the study is designed to contribute to a better understanding of obesity stigma and its impact on individuals and society.
Where is the study run from?
University of Rovira i Virgili, Spain.
When is the study starting and how long is it expected to run for?
November 2025 to December 2030.
Who is funding the study?
University of Rovira i Virgili, Spain.
Who is the main contact?
Mrs Mònica Bulló, monica.bullo@urv.cat
Contact information
Scientific, Principal investigator, Public
Facultat de Medicina i Ciències de la Salut, Carrer de Sant Llorenç, 21, Reus, Tarragona
Reus
43201
Spain
 ORCID ID |
0000-0002-0218-7046 |
|---|---|
| Phone | +34 977 759 388 |
| monica.bullo@urv.cat |
Study information
| Primary study design | Observational |
|---|---|
| Observational study design | Cross sectional study |
| Scientific title | Cross-cultural and academic trajectory perspectives on obesity stigma: a comparative study across health science disciplines and training stages |
| Study acronym | CE-STIGMA-O |
| Study objectives | Obesity stigma is a widespread problem that negatively affects not only those people living with obesity but also the quality of care they receive from health professionals. Biased attitudes and misconceptions about people with obesity can sometimes be found even among health professionals. By investigating these attitudes in undergraduate students from Medicine, Nutrition, Nursing, and Physical Activity programs, this study aims to shed light on when and how such biases might develop or change during professional training. Conducting the study across multiple countries and regions further allows us to examine how cultural and regional differences might influence stigma. The ultimate goal is to use this evidence to inform and strengthen educational strategies, so that future health professionals are better prepared to approach obesity with understanding and respect, rather than judgment. |
| Ethics approval(s) |
Approved 30/10/2025, IISPV Research Ethics Committee for Medicines (Comité Ético de Investigación con Medicamentos del IISPV) (Hospital Universitari Sant Joan de Reus, Avda, Josep Laporte, 2, Planta 0 – E1 color taronja (Admissions), Reus, 43204, Spain; (+34) 977 75 93 94; ceim@iispv.cat), ref: 284/2025 |
| Health condition(s) or problem(s) studied | Obesity-related stigma in university students. |
| Methodology | Data will be collected through structured anonymous surveys administered via Microsoft forms. The survey will include sections on general sociodemographic information and a set of validated questionnaires designed to assess multiple dimensions, including knowledge, attitudes, behaviours, and self-perceived competencies relevant to the students’ field of study. The survey will be distributed to participants through email invitations and public announcements, ensuring wide accessibility and voluntary participation. a) Sociodemographic information will be collected from participants including age, gender identity, race, ethnicity, student status, and self-perceived body weight. These variables will be self-reported through a structured questionnaire to ensure consistency in responses. The inclusion of these measures will allow for the characterization of the sample and will facilitate the examination of potential associations between sociodemographic factors and study outcomes. b) Antifat Attitudes (AFA) Spanish validated scale: Prejudice against people with obesity will be assessed using the validated Spanish Antifat Attitudes (AFA) scale, a 13-item, 7-point Likert instrument with three subscales (dislike, fear of being fat, willpower). Subscale and overall scores will be calculated as the mean of corresponding items, with higher scores indicating stronger antifat attitudes. The scale has shown good reliability (α = 0.78–0.87). c) Beliefs About Obese Persons (BAOP) Spanish validated scale: Beliefs about obesity will be assessed using the 8-item BAOP scale, which evaluates the extent to which participants believe obesity is controllable. Items will be rated on a Likert-type scale, and mean scores will be calculated, with higher values indicating stronger beliefs that obesity is uncontrollable. d) Modified Weight Bias Internalization Scale (WBIS-M): Internalized weight bias will be assessed using the 11-item WBIS-M. Participants will rate items on 7-point Likert scale. Items 1 and 9 were reverse scored. Higher scores will indicate stronger endorsement of negative weight-related stereotypes. e) Attitudes Toward Obese Persons (ATOP) English validated scale: Attitudes toward people with obesity will be measured using the 20-item ATOP scale. Items will be rated on a Likerttype scale, and total scores will be calculated as the mean of all items, with higher scores reflecting more positive attitudes. The scale has demonstrated good reliability (α ≈ 0.80) f) Fat Phobia Scale–Short English validated Form (FPS-SF): Negative attitudes toward people with obesity will be assessed using the 14-item FPS-SF. Items will be rated on a 5-point semantic differential scale, and total scores will be calculated as the mean of all items. Higher scores will indicate stronger fat-phobic attitudes. The scale has demonstrated good reliability (α ≈ 0.86). Overall, while all five instruments relate to weight bias, they differ in scope: AFA and FPSSF capture general attitudes, ATOP and BAOP focus on beliefs and cognitive appraisals, and WBIS-M measures internalized stigma. Using these complementary tools provides a comprehensive assessment of both attitudes toward obesity and the personal impact of weight stigma. |
| Intervention type | Behavioural |
| Primary outcome measure(s) |
|
| Key secondary outcome measure(s) | |
| Completion date | 18/12/2030 |
Eligibility
| Participant type(s) | |
|---|---|
| Age group | Mixed |
| Lower age limit | 17 Years |
| Upper age limit | 100 Years |
| Sex | All |
| Target sample size at registration | 2000 |
| Key inclusion criteria | Students who have given informed consent. |
| Key exclusion criteria | Not meeting the key inclusion criteria |
| Date of first enrolment | 18/11/2025 |
| Date of final enrolment | 18/11/2028 |
Locations
Countries of recruitment
- Chile
- Mexico
- Spain
Study participating centres
Results and Publications
| Individual participant data (IPD) Intention to share | No |
|---|
Editorial Notes
21/04/2026: Study’s existence confirmed by the IISPV Research Ethics Committee for Medicines (Comité Ético de Investigación con Medicamentos del IISPV), Spain.
