Development and Validation of a Brief Form of the Weight Control/Blame Subscale of the Antifat Attitudes Test.

Development and Validation of a Brief Form of the Weight Control/Blame Subscale of the Antifat Attitudes Test - PMC Skip to main content An official website of the United States government Here's how you know Here's how you know Search Log in Primary site navigation Search Log in Search PMC Full-Text Archive Search in PMC Journal List User Guide As a library, NLM provides access to scientific literature. Inclusion in an NLM database does not imply endorsement of, or agreement with, the contents by NLM or the National Institutes of Health. Learn more: PMC Disclaimer | PMC Copyright Notice Obes Facts . 2025 Mar 26;18(4):364–374. doi: 10.1159/000545380 Development and Validation of a Brief Form of the Weight Control/Blame Subscale of the Antifat Attitudes Test Julia Petersen a, b, ✉ , Bjarne Schmalbach c , Elmar Brähler b, d , Oliver Decker e, f , Anja Hilbert a Author information Article notes Copyright and License information a Integrated Research and Treatment Center Adiposity Diseases, Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Leipzig, Leipzig, Germany b Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany c Department of Medical Psychology and Medical Sociology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany d Department of Medical Psychology and Medical Sociology, Medical Faculty, University of Leipzig, Leipzig, Germany e Else-Frenkel-Brunswik Insitute for Democracy Research in Saxony, University of Leipzig, Leipzig, Germany f Sigmund-Freud University Berlin, Berlin, Germany ✉ Correspondence to: Julia Petersen, julia.petersen@unimedizin-mainz.de Oliver Decker and Anja Hilbert: shared senior authorship. ✉ Corresponding author. Received 2024 Nov 4; Accepted 2025 Mar 18; Collection date 2025 Oct. © 2025 The Author(s). Published by S. Karger AG, Basel This article is licensed under the Creative Commons Attribution 4.0 International License (CC BY) ( http://www.karger.com/Services/OpenAccessLicense ). Usage, derivative works and distribution are permitted provided that proper credit is given to the author and the original publisher. PMC Copyright notice PMCID: PMC12052364  PMID: 40139181 Abstract Introduction The Weight Control/Blame (WCB) subscale of the Antifat Attitudes Test (AFAT) measures weight stigma, particularly beliefs linking obesity to personal responsibility, which contributes to discrimination and negative psychological, often reinforced by political ideologies and authoritarian attitudes. This study sought to (1) develop and validate an economic version of the WCB subscale and (2) evaluate associations between weight stigmatizing attitudes, authoritarian beliefs, sexist attitudes, and conspiracy mentality. Methods A four-item short form of the WCB subscale (WCB-4) was developed using a representative sample of the German population ( N = 1,000) and validated on a second sample ( N = 2,524). We assessed psychometric properties, convergent, and divergent validity. Results The four-item solution demonstrated good internal consistency (ω = 0.807) and favorable confirmatory factor analysis results. Weight stigma positively correlated with authoritarian and sexist beliefs, and negatively with depression, anxiety, and body mass index. Conclusion The WCB-4 is a reliable and valid tool for assessing weight stigma in epidemiological research. It highlighted positive associations with authoritarian beliefs and sexist attitudes, reflecting an interconnected system of biases against marginalized groups. Though a minor correlation was found between conspiracy mentality and authoritarian beliefs, no significant link emerged between conspiracy mentality and weight stigma. Keywords: Weight stigma, Antifat attitudes test, Brief measure, Large-scale surveys, Authoritarianism, Conspiracy mentality, Sexism Introduction Weight stigmatization is pervasive, affects many domains of life, and bears significant adverse consequences for individuals’ psychological and physical well-being, as well as social participation [ 1 – 8 ]. This stigmatization, often rooted in the belief that obesity results solely from personal choices, fosters discrimination of individuals with higher body weight [ 3 , 7 , 9 – 13 ]. These stereotypes are frequently influenced by social and political ideologies [ 2 , 9 ]; however, research on this association is still rather rare. Previous research, for example, has explored how authoritarian attitudes contribute to weight stigma, revealing that individuals with authoritarian tendencies often hold negative stereotypes about people with higher body weight [ 14 , 15 ]. Prescott and Logan [ 16 ] theorized that the rise of authoritarianism, particularly in the USA and Europe, could adversely affect public healthcare due to prevalent authoritarian prejudices toward lifestyle-related diseases. This connection between political and institutional authoritarianism and healthcare has been extensively discussed in medical sociology literature [ 17 – 19 ]. Additionally, weight stigma has been closely linked to sexist attitudes, with women often being judged more harshly than men based on their weight, both in the work place and in healthcare settings [ 20 , 21 ]. Klein et al. [ 22 ] further emphasized this intersectionality in their group-related misanthropy framework, noting that hostility toward one group often coincides with hostility toward others, highlighting the interconnectedness of weight stigma. Furthermore, as conspiracy beliefs gain prominence in today’s political and healthcare landscapes [ 23 – 25 ], they may become relevant for understanding weight stigmatization. Obesity is frequently attributed to personal responsibility, which can lead to scapegoating and the oversimplification of complex public health issues. This tendency to blame specific (often minority) groups for societal problems is a common feature of conspiracy beliefs [ 26 – 28 ]. Given this context, it is clear that the connections between weight stigmatization and other sociopolitical constructs require further investigation, particularly since most existing research has been qualitative and/or based on small samples. As noted, two key elements of weight stigmatization are the attribution of obesity to personal responsibility and the tendency to blame individuals for their weight, both of which play significant roles in perpetuating weight stigma [ 29 ]. These beliefs fuel public stigma, which Corrigan et al. [ 30 ] describe as society’s endorsement of stereotypes that lead to prejudice and discrimination against people with obesity. This stigma is often assessed using self-report scales that measure the extent to which these biased attitudes are internalized and influence behavior. One such tool is the Antifat Attitudes Test (AFAT), developed by Lewis et al. [ 31 ]. The AFAT includes the “Weight Control/Blame” (WCB) subscale, which contains nine items related to beliefs about personal responsibility for weight, such as the notion that fat people could lose weight if they wanted to or that there is no excuse for being fat. This subscale has been employed in epidemiological research to explore how beliefs about personal responsibility for weight contribute to societal discrimination and its detrimental effects on individuals’ psychological and physical health [ 11 , 32 ]. The WCB subscale consistently demonstrates good internal consistency and convergent validity [ 31 , 33 , 34 ]. However, comprehensive measures of weight stigma like the AFAT and its subscales (see [ 35 ] for an overview) are often too lengthy for large-scale epidemiological studies, which require more economical instruments. Currently, no weight stigma instrument with fewer than eight items exists – the shortest being the Beliefs About Obese People (BAOP) scale [ 36 ]. Epidemiological studies often demand shorter instruments to balance the need for robust data with the practical challenges posed by large participant samples. Additionally, it is worth noting that many existing self-report weight stigmatization instruments have not undergone rigorous psychometric testing [ 35 ]. In response to these needs, this study aims to (1) develop and validate a shortened form of the AFAT’s “Weight Control/Blame” subscale using two representative samples of the German population. This abbreviated scale is set out to maintain focus on the core issues of obesity stigmatization while offering a more practical solution for extensive epidemiological research. Furthermore, we aim to (2) evaluate the associations between weight stigmatizing attitudes and authoritarian beliefs, sexist attitudes, and conspiracy beliefs – areas where research is still limited, particularly in representative samples. Methods Participants We utilized two nationwide representative (in terms of age, sex, and educational level) samples from the German population. The first sample was drawn in August 2005, while the second was collected in March 2016. For the first sample, participants were selected using the ADM telephone sampling framework ( ADM-Telefonstichproben-Ziehungsgrundlage ) and the Gabler-Häder method, which allowed us to reach households not listed in telephone directories. This survey was conducted through computer-assisted telephone interviews. The second sample employed a random route procedure combined with Kish selection [ 37 ]. Data were collected through self-administered questionnaires in face-to-face settings. Participants in both samples had to be at least 14 years old and have a sufficient understanding of the German language to be included in the study. For the surveys, 1,836 and 4,830 noninstitutionalized civilians, respectively, were contacted. 1,000 and 2,524 of these completed the survey, resulting in response rates of 54.5% and 52.3%, respectively. In total, there were 63 (0.7%) and 221 (0.9%) missing values in the WCB scale, respectively. The missing values in these samples, however, were not deleted but were instead imputed during the development and validation of the shortened instrument. Participants received comprehensive information about the study’s procedures, data collection methods, and the anonymization of personal data before the analysis. Verbal informed consent was obtained from participants and documented by the interviewers. In the case of minors, consent was obtained from their parents or legal guardian. The Ethics Commission of the Medical Faculty at the University of Leipzig approved the study’s content and procedures, including the consent process (452‐15‐21122015). In addition to following ICH-GCP guidelines, both surveys adhered to the ICC/ESOMAR International Code of Marketing and Social Research Practice and the Declaration of Helsinki. Measures Weight Control/Blame Subscale This study utilized the “Weight Control/Blame” (WCB) subscale of the Antifat Attitudes Test (AFAT) developed by Lewis et al. [ 31 ]. As mentioned before, the nine-item WCB subscale assesses the degree to which individuals believe that weight is controllable and that people with overweight or obesity are responsible for their weight and could easily lose weight if they exerted more self-discipline or effort. The response categories ranged from 1 (“strongly disagree”) to 5 (“strongly agree”), with an overall higher mean score indicating stronger beliefs that weight is controllable and that individuals with overweight or obesity are to blame for their condition. The internal consistency of the WCB that was originally reported in the validation study by Lewis et al. [ 31 ] ranged from 0.77 for men to 0.85 for women. We used the translated German version of the WCB scale which was verified using a retranslation process by a certified translator and was tested in a separate population-based sample in a previous study [ 11 ]. The internal consistency of the German version was found to be similar compared to those of the English version with a Cronbach’s α of 0.81 [ 11 , 32 ]. Convergent Validation: Sociopolitical Instruments and Body Mass Index To test the associations between authoritarianism, sexist attitudes, and conspiracy beliefs, we chose the following instruments: authoritarianism was assessed using the Authoritarianism – Ultra Short Scale (A-US; [ 38 ]) a shortened version of the nine-item version of Short Scale for Authoritarianism [ 39 ]. It contains three items that each corresponds to one of the three core dimensions of the original scale: aggression, submission, and conventionalism. The participants were asked to rate their agreement on a five-point scale from 1 (“do not agree at all”) to 5 (“agree fully”), resulting in a sum score from 3 to 15 with higher scores indicating higher agreement on authoritarian world views. The A-US yielded a good internal consistency in the past with McDonald’s omega ranging from 0.68 to 0.71 [ 38 ]. Internal consistency in our sample was comparable to the one reported (ω = 0.69). Next, in order to assess sexist attitudes, we utilized a shortened version of the sexist attitudes scale introduced by Endrikat [ 40 ]. The scale examines the agreement to the two dimensions of sexist attitudes: classic sexism (using statements concerning the role of the woman as wife and mother and the prioritization of the husband’s career before her own) as well as modern sexism (using statements concerning the overall discrimination against women and the disadvantage put on women in the work place), with the two latter items being recoded prior to analysis. The agreement with sexist attitudes was rated on a four-point scale from 1 (“not true at all”) to 4 (“completely true”). Internal consistency in our sample was relatively low with ω = 0.61. Additionally, we surveyed conspiracy mentality using a shortened version of the scale introduced by Imhof and Decker [ 41 ]. The five items of this scale assessed respondents’ levels of agreement with various conspiracy-related statements, including ideas about the hidden influences on people’s lives and the notion that politicians and leaders are merely puppets controlled by more powerful entities. The respondents were asked to rate their agreement on a scale from 1 (“do not agree at all”) to 7 (“agree fully”), resulting in a sum score of 5–35, with higher scores indicating higher levels of conspiracy mentality. Internal consistency in our sample was good with ω = 0.81. Lastly, we calculated the body mass index (BMI, kg/m 2 ) of each respondent using their self-reported height and weight. Based on the literature outlined in the introduction, we expect authoritarian beliefs, sexist attitudes, and conspiracy mentality to be positively associated with weight stigma. In regard to BMI, research found both negative [ 32 ] as well as no relation at all [ 11 , 31 ] to the WCB. Divergent Validation: General Psychopathology In order to test divergent validity, we used the two-item Patient Health Questionnaire (PHQ-2) to assess depressive symptoms. This instrument measures the two core depressive symptoms: depressed mood and anhedonia [ 42 , 43 ]. Both of the items are scored on a 4-point scale ranging from 0 (“not at all”) to 3 (“nearly every day”). Subsequently, the items were summed up into a sum score ranging from 0 to 6 with higher scores demonstrating higher levels of depressiveness. Internal consistency in our sample was high with ω = 0.85. Furthermore, we assessed symptoms of generalized anxiety using the two-item Generalized Anxiety Disorder Screener (GAD-2; [ 42 , 43 ]). Similar to the PHQ-2, participants estimated how much they were affected by nervosity and the inability to stop or control their worrying over the past 2 weeks on a scale ranging from 0 (“not at all”) to 3 (“nearly every day”). The two items were collated into a sum score (0–6) where higher scores indicated a higher symptom load of generalized anxiety. Internal consistency in our sample was high with ω = 0.85. Because of the stigma associated with depression and anxiety [ 44 – 46 ], it might be possible that individuals that suffer from these diseases may have more empathy for other stigmatized groups, including individuals with overweight or obesity. Therefore, we expect both depressiveness as well as generalized anxiety to be negatively associated with weight stigma. Additional Sociodemographic Information In order to describe our samples, we inquired about sex, age, marital status, school education, and net household income. Statistical Procedure Analyses for the present study were conducted using the program R with the packages lavaan , semTools , and stuart [ 47 – 50 ]. In order to describe the two samples, we used absolute and relative frequencies for categorical variables and means with standard deviations for continuous variables. Next, we calculated means, standard deviation, kurtosis, skewness, and loadings for each item of the WCB scale, separate for each sample. For the scale shortening procedure, we first ascertained the dimensionality of WCB scale using parallel analysis [ 51 ], which compares the empirical eigenvalue distribution versus randomly generated ones based on the same covariance matrices. We then utilized item descriptive statistics to examine and eliminate items. The remaining items were then put into stuart ’s bruteforce algorithm in order to find the optimal 4-item solution. Specifically, stuart aims to maximize an underlying objective function consisting of composite reliability and model fit measures. To test validity, we calculated a correlation matrix between the long WCB scale and the newly formed WCB subscale, as well as the measures PHQ-2, GAD-2, A-US, sexism scale, BMI, and conspiracy mentality using Pearson correlations. We then ran a confirmatory factor analysis (CFA) using robust full-information maximum likelihood estimation (FIML-MLR in lavaan ). For the evaluation of model fit, we calculated χ 2 in addition to the commonly recommended fit indices: Comparative Fit Index (CFI), Tucker-Lewis Index (TLI), Root Mean Square Error of Approximation (RMSEA), and Standardized Root Mean Square Residual (SRMR). As per the recommendations by Schermelleh-Engel et al. [ 52 ], CFI and TLI should be greater than 0.95 (better yet, 0.97), whereas RMSEA and SRMR should be smaller than 0.08 and 0.10, respectively (better yet, 0.05). In addition, we estimated internal consistency based on McDonald’s ω [ 53 ]. For the testing of measurement invariance, we used the step-wise procedure explained by Putnick and Bornstein [ 54 ]: (1) unconstrained model, (2) equal factor loadings across groups (3) equal item intercepts across groups, and (4) equal item residuals across groups. Between each of these nested models, we ran a χ 2 -test and in addition examined the change in CFI and RMSEA . The latter two should not fall off by more than 0.010 and 0.015, respectively [ 55 , 56 ]. After checking the measurement model in this fashion, we then tested for the equality of the latent mean between groups. In addition to the significance test mentioned above, we calculated a standardized effect size measure for the mean difference: In the case of sex, we used Cohen’s d . In the case of age groups, we used an R 2 equivalent. Lastly, we reported norm values of the shortened, four-item subscale according to sex and age-group. Results Sample Characteristics Both samples were comparable in sex (57% vs. 55% female), age (M = 44.55, SD = 18.22 vs. M = 48.84, SD = 18.18), and monthly household income. The educational background of the samples differed slightly with respondents from sample 1 having more years of education. More information can be found in Table 1 . Table 1. Sample characteristics Variable Sample 1 ( n = 1,000) Sample 2 ( n = 2,524) n (%) n (%) Sex Female 569 (57) 1,379 (55) Male 431 (43) 1,145 (45) Age, M (SD) 44.55 (18.22) 48.84 (18.18) <30 years 251 (25) 453 (18) 30–39.99 years 169 (17) 372 (15) 40–49.99 years 191 (19) 444 (18) 50–59.99 years 135 (14) 496 (20) 60–69.99 years 150 (15) 395 (16) ≥70 years 104 (10) 364 (14) Marital status Married n/a 1,040 (41) Separated n/a 54 (2) Single n/a 776 (31) Divorced n/a 391 (15) Widowed n/a 256 (10) School education <10 years 257 (26) 824 (33) 10 years 333 (33) 1,087 (43) >10 years 346 (35) 538 (21) Currently student 57 (6) 75 (3) Net household income per month <1,500 EUR 284 (32) 711 (29) 1,500–2,499 EUR 303 (34) 816 (33) ≥2,500 EUR 292 (33) 913 (37) Open in a new tab Initial Evaluation and Scale Shortening Fit statistics for the unifactorial model were mixed in both sample 1 (χ 2 (27) = 98.41, p < 0.001, CFI = 0.927, TLI = 0.903, RMSEA = 0.057, SRMR = 0.036) and in sample 2 (χ 2 (27) = 363.53, p < 0.001, CFI = 0.948, TLI = 0.930, RMSEA = 0.079, SRMR = 0.033). While SRMR and RMSEA were good and acceptable, CFI and TLI were unacceptable, along with the significant χ 2 -test. Reliability as measured by ω was low in sample 1 at 0.675 and good in sample 2 at 0.837. The initial WCB scale consists of the nine items which are displayed in Table 2 . All items fit the normal distribution relatively well according to the skewness and kurtosis values. The parallel analyses in both samples presented unequivocal evidence for the presence of a single factor in the nine original WCB items (see Table 3 ). Judging from these descriptive statistics, merely Item 3 was removed from consideration because of its very low factor loading. Table 2. Item descriptive statistics Item Item description M SD Skewness Kurtosis λ Sample 1 M SD Skewness Kurtosis λ Sample 2 1 No excuse to be fat 3.0 1.3 0.08 1.8 0.444 3 1.1 0.00 2.3 0.644 2 S Could lose weight if they wanted 3.9 1.2 −0.78 2.6 0.551 3.5 1.0 −0.43 2.7 0.646 3 Don’t eat more than others 3.3 1.4 −0.28 1.8 −0.206 3.2 1.1 −0.19 2.3 −0.237 4 Too much unhealthy food 3.9 1.1 −0.88 2.9 0.454 3.6 1.0 −0.52 2.9 0.625 5 S No willpower 2.6 1.2 0.35 2.1 0.549 2.8 1.1 0.08 2.3 0.751 6 Genetically predisposed 2.8 1.3 0.21 1.9 0.512 2.8 1.1 0.03 2.4 0.670 7 S Would lose weight if they knew how they looked 2.6 1.4 0.46 2 0.521 2.9 1.1 0.01 2.4 0.717 8 S Make all kinds of excuses for their weight 3.5 1.2 −0.44 2.2 0.607 3.3 1.1 −0.28 2.5 0.762 9 Lazy 2.2 1.2 0.78 2.6 0.428 2.3 1.1 0.38 2.4 0.627 Open in a new tab S Included in short version. M, mean; SD, standard deviation; λ, loading in the confirmatory factor analysis. Table 3. Results of the parallel analysis Number of factors Sample 1 Sample 2 empirical eigenvalues 95th percentile of random eigenvalues empirical eigenvalues 95th percentile of random eigenvalues 1 2.87 1.14 4.31 1.10 2 1.02 1.08 0.98 1.06 3 0.96 1.06 0.75 1.04 4 0.85 1.03 0.64 1.02 … … … … … Open in a new tab Based on these initial findings, we then put the remaining eight items into the stuart algorithm in search of the optimal unifactorial solution with 4 indicators. In addition, we constrained the search to avoid solutions that include both items 6 and 8, as these items are phrased nearly identically. We ran this analysis on the larger sample 2, yielding the subset of items 2, 5, 7, and 8. Factorial, Convergent, and Divergent Validity We tested the novel short version in both samples using a unifactorial CFA. As was to be expected since this sample was used for its construction, this version yielded virtually perfect fit results in sample 2 (χ 2 (2) = 1.56, p = 0.459, CFI = 1.000, TLI = 1.001, RMSEA = 0.000, SRMR = 0.004). However, its fit was almost identically good in sample 1(χ 2 (2) = 2.64, p = 0.267, CFI = 0.998, TLI = 0.995, RMSEA = 0.019, SRMR = 0.010). Standardized factor loadings in sample 1 ranged between 0.489 and 0.614, yielding an ω of 0.641. In sample 2, loadings were between 0.632 and 0.766, and accordingly ω was also higher at 0.807. We then calculated correlations between the novel WCB-4 short scale, its original 9-item version, a scale consisting of the removed 5 items, as well as several scales of convergent and divergent constructs discussed in the introduction. As was to be expected, we found highly significant correlations between the WCB-4 and the WCB-9 ( r Sample 1 = 0.884, r Sample 2 = 0.935) and the sum score of the removed 5 items ( r Sample 1 = 0.613, r Sample 2 = 0.782). This indicates that the majority of the characteristics that were captured by the original 9-item scale are still retained in the shorter 4-item version. In addition, we calculated correlations with several convergent and divergent constructs (see Table 4 ). Many of the explored correlations were significant, but their magnitude was for the most part small. However, authoritarian and sexist beliefs showed significant positive associations with the WCB scale, while depressiveness, generalized anxiety, and BMI were significantly negative associated. The only factor that was not found to be associated with weight stigma was conspiracy mentality. Table 4. Correlation matrix of convergent and divergent constructs 1 2 3 4 5 6 7 8 1 – WCB-4 1 2 – WCB-9 0.94 1 3 – PHQ-2 −0.10 −0.10 1 4 – GAD-2 −0.10 −0.10 0.76 1 5 – A-US 0.19 0.16 −0.05 −0.06 1 6 – Sexism 0.06 0.08 0.03 0.00 0.12 1 7 – BMI −0.19 −0.23 0.17 0.12 0.03 0.01 1 8 – Conspiracy mentality 0.03 0.00 0.12 0.11 0.11 0.02 0.13 1 Open in a new tab Underscored values represent significant correlations at p < 0.05. WCB, Weight Control/Blame subscale; PHQ-2, Patient Health Questionnaire; GAD-2, Generalized Anxiety Disorder Screener; A-US, Authoritarianism – Ultra Short Scale. Measurement Invariance, Group Differences, and Normative Values Initially, we tested the measurement model of the newly shortened scale for equivalence across age-groups and sex (see Table 5 ). Here, we found evidence for metric invariance, partial scalar invariance, and strict invariance. That means, for both grouping variables loadings and residuals are comparable, but item intercepts may not be. When further constraining latent means to be equal between groups fit decreased significantly. The associated standardized effect sizes were comparatively small d = 0.24 for sex, and R 2 = 0.023 for age, respectively. Finally, we calculated normative percentile ranks by age-groups and sex as reported in Table 6 . Table 5. Measurement invariance test results Sex (male, female) χ 2 df Δχ 2 Δ df p value CFI Δ CFI RMSEA Δ RMSEA Configural model 3.93 4 1.000 0.000 Metric model 7.82 7 3.89 3 0.273 1.000 0.000 0.011 0.011 Scalar model 18.26 10 10.44 3 0.015 0.997 0.003 0.027 0.017 Partial scalar model a 13.14 9 5.32 2 0.070 0.998 0.001 0.020 0.010 Strict model a 19.10 13 5.96 4 0.203 0.998 0.001 0.021 0.000 Equal latent means a 43.01 14 23.91 1 <0.001 0.989 0.009 0.043 0.023 Age-groups (<30, 30–39, 40–49, 50–59, 60–69, >70) χ 2 df Δχ 2 Δ df p value CFI Δ CFI RMSEA Δ RMSEA Configural model 7.55 12 1.000 0.000 Metric model 28.99 27 21.44 15 0.123 0.999 0.001 0.015 0.015 Scalar model 78.15 42 49.16 15 <0.001 0.987 0.012 0.047 0.032 Partial scalar model b 30.58 27 1.59 5 0.902 1.000 0.001 0.000 0.015 Strict model b 46.92 52 16.34 20 0.695 1.000 0.000 0.000 0.000 Equal latent means b 68.54 57 21.62 5 <0.001 0.996 0.004 0.024 0.024 Open in a new tab a The intercept of item 7 was freed to vary between groups. b The intercepts of items 2 and 5 were freed to vary between groups. Table 6. Normative percentile ranks by age groups and sex Total score Male Female <30 30–39 40–49 50–59 60–69 >70 <30 30–39 40–49 50–59 60–69 >70 4 2 2 1 1 1 1 2 2 2 2 2 2 5 4 2 3 3 3 2 2 4 4 4 4 3 6 5 5 4 5 6 4 5 6 7 6 6 9 7 10 6 6 8 12 6 9 10 10 9 8 11 8 14 7 9 13 15 9 16 21 15 13 16 16 9 21 13 16 21 19 14 20 26 22 18 24 20 10 31 25 23 31 26 21 32 36 33 27 32 25 11 40 34 31 49 43 29 41 46 45 38 46 35 12 56 50 46 64 54 43 61 61 60 59 59 48 13 65 61 60 73 67 55 72 71 70 70 70 60 14 74 71 69 82 81 62 79 78 82 75 79 69 15 82 78 77 90 92 70 86 86 86 83 88 76 16 90 88 86 96 96 79 92 92 92 89 92 86 17 93 92 90 97 97 84 96 95 96 92 96 91 18 96 96 95 99 99 89 98 97 99 94 97 95 19 97 98 97 100 100 92 100 98 99 97 100 97 20 100 100 100 100 100 100 100 100 100 Open in a new tab Discussion A shortened, four-item version of the “Weight Control/Blame” subscale of the Antifat Attitudes Test (AFAT) [ 31 ], the WCB-4, was developed and subsequently validated on two large scale representative German population samples. We found a very good internal consistency in sample 2 (ω = 0.807). This result is in line with the findings on the AFAT (men α = 0.77, women α = 0.85; [ 31 ]) as well as the values of a German translation of the WCB subscale (α = 0.81; [ 11 , 32 ]). Additionally, strong measurement invariance across sex and age was found, indicating that unbiased comparisons can be made among these groups. Furthermore, a CFA yielded perfect fits for the WCB-4. The high correlation of the shortened version with its long form indicates that the majority of characteristics that were originally captured were preserved in the shortened version. Additionally, we assessed the convergent and divergent validity of the scale. The WCB-4 showed a positive correlation with authoritarian and sexist beliefs, contributing to the limited literature on these relationships [ 14 , 15 , 20 , 21 ]. These findings suggest that the devaluation of individuals based on weight is intertwined with the devaluation of other marginalized groups, such as women. This reflects an interconnected system of biases, as described by Klein et al. [ 22 ] in their framework of group-related misanthropy, where hostility toward one group often aligns with broader authoritarian attitudes. Although we found significant correlation coefficients, they are quite small – authoritarianism ( r = 0.19) and sexist beliefs ( r = 0.06) – thus, these relationships should be interpreted with caution. Previous research indicates a link between conspiracy mentality and authoritarian beliefs [ 57 ], and our sample revealed a small positive association between the two ( r = 0.11), suggesting some shared attributes, though the relationship remains weak. Notably, conspiracy mentality showed no significant association with weight stigma. This pattern of small and partly insignificant associations implies that factors influencing weight stigma may operate independently from both authoritarianism and conspiracy mentality. Consequently, stigmatizing views toward individuals with overweight and obesity may not align as closely with conspiratorial or authoritarian beliefs as one might expect. Furthermore, the lack of a significant association between conspiracy mentality and weight stigma suggests that obesity stigma may stem more from deeper authoritarian beliefs rather than conspiratorial thinking. Lastly, while previous studies by Lewis et al. [ 31 ] and Hilbert et al. [ 11 ] reported no significant association between BMI and the weight stigma subscale, our findings revealed a negative association, indicating that higher BMI is linked to lower weight stigma. It’s possible that the rise in fat acceptance since the earlier surveys, which can be attributed to various social movements advocating for body positivity and inclusivity, might have led to a shift in public perceptions about people with overweight and obesity. This shift could have helped promote the idea that all body types deserve respect and acceptance, which may have contributed to decreased weight stigma over time. Hilbert et al. [ 32 ] also observed a negative association, reinforcing this notion that societal attitudes toward weight might be evolving. We also observed significant negative associations with depression and anxiety. In these cases, personal experiences with mental health stigma [ 44 – 46 ] may also foster empathy toward individuals with overweight or obesity, rather than leading to judgment. Limitations A key strength of our study is the use of two large, representative surveys from the German population, which enhances the robustness of our findings. However, these results are primarily generalizable to countries with similar cultural backgrounds (e.g., Western societies). Therefore, replication in samples from other cultural settings is strongly recommended. Additionally, these findings may not be relevant for other populations, such as clinical groups. Furthermore, it is important to note that no other similar instruments related to weight stigma, were used to validate the WCB-4. This absence limits the depth of our results, as we cannot fully establish how the WCB-4 compares with other established measures of weight stigma. Lastly, the WCB as well as height and weight were assessed by self-report and could therefore possibly be affected by social desirability bias. Conclusion In summary, the newly developed WCB-4 demonstrates excellent psychometric properties, making it a reliable and valid tool for assessing weight stigma in large-scale surveys, where economical assessment is crucial. Its high correlation with the longer 9-item version suggests that the shorter form appropriately covers the WCB’s concept. Moreover, we demonstrated associations with sociopolitical instruments measuring authoritarian and sexist beliefs, contributing valuable insights to the limited existing literature on these associations. Statement of Ethics The Ethics Commission of the Medical Faculty at the University of Leipzig approved the study’s content and procedures (452‐15‐21122015). Verbal informed consent was obtained in accordance with national guidelines. Furthermore, ICH-GCP guidelines were followed. Conflict of Interest Statement A.H. reports receiving research grants from the German Federal Ministry of Education and Research, German Research Foundation, Innovation Fund, and Roland Ernst Foundation for Health Care; royalties for books on the treatment of eating disorders and obesity with Hogrefe and Kohlhammer; honoraria for workshops and lectures on eating disorders and obesity and their treatment; honoraria as editor of the International Journal of Eating Disorders and the journal Psychotherapeut ; honoraria as a reviewer from Oxford University Press and the German Society for Nutrition; and honoraria as a consultant for WeightWatchers, Zweites Deutsches Fernsehen, Takeda, and Lilly. No other conflicts of interest were reported. The authors declare no further conflict of interest. Funding Sources This research was supported by internal funds of Research Unit Behavioral Medicine at Leipzig University Medical Center. Author Contributions J.P.: conceptualization, writing – original draft, and writing – review and editing. B.S.: formal analysis and writing – original draft. E.B.: supervision and writing – review and editing. O.D.: writing – review and editing. A.H. – conceptualization, supervision, and writing – review and editing. Funding Statement This research was supported by internal funds of Research Unit Behavioral Medicine at Leipzig University Medical Center. Data Availability Statement The data that support the findings of this study are not publicly available due to them containing information that could compromise the privacy of research participants. However, the AFAT assessments supporting the findings of this study are available upon reasonable request from A.H. All other assessments are available upon reasonable request from E.B. References 1. Brewis A, SturtzSreetharan C, Wutich A. Obesity stigma as a globalizing health challenge. Glob Health. 2018;14(1):20. 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