Mechanisms Explaining the Link Between Weight Discrimination and Poor Cardiovascular Health
Phase: NA
Conditions: Obesity
Sponsor: Florida State University

PROTOCOL TITLE: Decision Making Study  
 
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PROTOCOL TITLE:  
 
 
Decision Making Study  
 
(Grant title: Mechanisms Explaining the Link Between Weight Discrimination 
and Poor Cardiovascular Health) 
 
PRINCIPAL INVESTIGATOR: 
Mary Gerend, PhD 
Behavioral Sciences and Social Medicine 
FSU College of Medicine  
850-645-1541 
mary.gerend@med.fsu.edu  
VERSION NUMBER/DATE: 
Version 2 / October 13, 2022 
 
REVISION HISTORY 
 
Revision 
# 
Version Date 
Summary of Changes 
Consent 
Change? 
1 
10/13/2022 
The revised protocol addresses all issues raised 
in the initial pre-review including 1) following 
all clinical trial-related requirements and 
modifying sections in the protocol to include 
additional information, 2) asking all study team 
members to update their CAMS and 3) provide 
evidence of GCP training, 4) making requested 
revisions to the consent form, 5) uploading 
additional study documents referenced in the 
protocol, and 6) including information about 
the saliva sample on the debriefing form and 
verbal script.  
 
I am waiting for a few study team members to 
complete their required human subjects 
training (HSR and GCP). All members will 
have completed this training by Oct 21, 2022. 
All COI reports will also be submitted by this 
date.   
yes 
 
 
 
 
 
 
 
 
 
 
 
 

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Table of Contents 
1.0 
Study Summary ........................................................................................................ 3 
2.0 
Objectives ................................................................................................................ 4 
3.0 
Background .............................................................................................................. 4 
4.0 
Study Endpoints ..................................................................................................... 13 
5.0 
Study Intervention/Investigational Agent .............................................................. 15 
6.0 
Procedures Involved............................................................................................... 16 
7.0 
Data and Specimen Banking .................................................................................. 21 
8.0 
Sharing of Results with Subjects ........................................................................... 21 
9.0 
Study Timelines ..................................................................................................... 21 
10.0 Inclusion and Exclusion Criteria ............................................................................ 21 
11.0 Vulnerable Populations .......................................................................................... 22 
12.0 Local Number of Subjects ..................................................................................... 22 
13.0 Recruitment Methods ............................................................................................. 22 
14.0 Withdrawal of Subjects .......................................................................................... 22 
15.0 Risks to Subjects .................................................................................................... 22 
16.0 Potential Benefits to Subjects ................................................................................ 24 
17.0 Data Management and Confidentiality .................................................................. 24 
18.0 Provisions to Monitor the Data to Ensure the Safety of Subjects .......................... 26 
19.0 Provisions to Protect the Privacy Interests of Subjects .......................................... 28 
20.0 Compensation for Research-Related Injury ........................................................... 28 
21.0 Economic Burden to Subjects ................................................................................ 28 
22.0 Consent Process ..................................................................................................... 28 
23.0 Process to Document Consent in Writing .............................................................. 29 
24.0 Setting .................................................................................................................... 29 
25.0 Resources Available............................................................................................... 30 
26.0 Multi-Site Research ............................................................................................... 30 
 
 
 

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1.0 
Study Summary 
 
Study Title 
Decision Making Study   
 
(Grant title: Mechanisms Explaining the Link Between 
Weight Discrimination and Poor Cardiovascular Health)  
Study Design 
Randomized clinical trial  
Primary Objective 
• Identify early-stage cognitive, affective, behavioral, and 
physiological mechanisms activated by experimentally 
manipulated weight discrimination. 
• Identify psychological and demographic variables that 
moderate effects of weight discrimination. 
Secondary 
Objective(s) 
N/A 
Research 
Intervention(s)/ 
Investigational 
Agent(s)  
Experimental (weight discrimination) manipulation vs. 
Control manipulation  
IND/IDE #  
(see section 5) 
N/A 
Study Population 
Adults ≥ aged 18 years recruited from the local community   
Sample Size 
320 
Study Duration for 
individual 
participants 
135-140 minutes total  
Study Specific 
Abbreviations/ 
Definitions  
BMI = body mass index  
 
 

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2.0 
Objectives 
Specific Aims and Hypotheses 
Our long-term goal is to develop interventions to minimize the negative health effects of 
weight discrimination. As a step toward this goal, we propose to conduct an experiment 
to identify mechanisms through which weight discrimination leads to poor cardiovascular 
health. A diverse sample of participants with obesity will be randomly assigned to 
experience weight discrimination vs. a control manipulation to test the following aims:   
Aim 1: Identify early-stage cognitive, affective, behavioral, and physiological 
mechanisms activated by experimentally manipulated weight discrimination. 
We will manipulate exposure to weight discrimination to assess causal effects on 
cognitive (e.g., impaired self-regulation), affective (e.g., negative emotion), 
behavioral (e.g., comfort eating), and physiological (e.g., inflammation) outcomes 
in people with obesity (BMI ≥ 30 kg/m2). We hypothesize that, relative to control 
participants, participants in the weight discrimination condition will display 
elevated responses on early-stage mechanisms that culminate in increased risk for 
poor cardiovascular health (e.g., more impaired self-regulation, higher negative 
emotion, lower positive emotion, more social withdrawal and comfort eating, and 
increased cortisol secretion). 
Aim 2: Identify psychological variables that moderate effects of weight 
discrimination. Our pilot studies suggest that some individuals are more vulnerable to 
the adverse effects of weight discrimination than others. The proposed experiments will 
identify psychological individual differences (e.g., internalized weight bias, self-
compassion) that moderate responses to the weight discrimination manipulation. We 
hypothesize that self-compassion and conscientiousness will be associated with resilience 
to the negative effects of weight discrimination, while internalized weight bias and 
neuroticism will increase risk for poor outcomes.  
Aim 3: Identify demographic characteristics that moderate effects of weight 
discrimination. Given the paucity of studies recruiting diverse samples, coupled with 
methodological limitations of previous research, little is known about whether 
demographic characteristics moderate (amplify or mitigate) effects of weight 
discrimination. We will recruit a diverse sample and conduct exploratory analyses to 
assess whether the negative effects of weight discrimination differ by age, sex/gender, 
race, and ethnicity.  
 
3.0 
Background 
Prior research and gaps in current knowledge. 
Discrimination is a critical social determinant of health that underlies poor health 
outcomes.1-4 One common but understudied form of discrimination is weight 
discrimination. Weight discrimination is the behavioral manifestation of weight stigma—
the social devaluation of people with excess body weight.5,6 Discriminatory actions 
toward people with obesity are perpetuated by widely held negative stereotypes.6 Indeed, 
weight discrimination is a pervasive—sometimes daily—experience for people with 
obesity.5,7-9 Encounters with weight discrimination range from inappropriate comments 

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and bullying to diminished opportunities for education, employment, and healthcare.5-11 
Findings suggest that the stress produced by weight discrimination prompts weight gain, 
creating a vicious cycle between weight discrimination and obesity.12-14 Further, there is 
now well-documented evidence that experiencing weight discrimination is associated 
with cardiovascular health problems that culminate in increased risk of mortality.15-22 
Importantly, associations between weight discrimination and poor health persist when 
controlling for body mass index (BMI),14,16-18 indicating that effects of weight 
discrimination do not merely reflect health risks associated with higher body weight.   
 
This project will address several key gaps in the literature. First, although the association 
between weight discrimination and poor cardiovascular health is well documented,15-22 
far less is known about the mechanisms of this association. Identifying these mechanisms 
is critical because they are potential targets for intervention. Second, previous research 
has relied primarily on correlational data, and thus little is known about the causal effects 
of weight discrimination. We will use rigorous experimental methods to identify early-
stage mechanisms that explain the link between weight discrimination and poor 
cardiovascular health. Third, previous studies have largely ignored the possibility that 
different people respond to weight discrimination in different ways. To address this gap, 
we will identify psychological factors (e.g., self-compassion) and demographic 
characteristics (e.g., race/ethnicity) that moderate the negative health effects of weight 
discrimination.  
 
SIGNIFICANCE 
Obesity is widespread and people with obesity are frequently subjected to 
discrimination. Currently, 42.4% of US adults meet criteria for obesity (BMI ≥ 30 
kg/m2).23 By 2030, nearly 1 in 2 adults is expected to meet criteria for obesity and 1 in 4 
will meet criteria for class II or III obesity (BMI ≥ 35 or 40 kg/m2).24 Obesity 
disproportionately affects minority populations, with the highest prevalence found in 
non-Hispanic Black adults (49.6%), followed by Hispanic adults (44.8%) and non-
Hispanic White adults (42.2%).23,25 Weight discrimination is a pervasive—sometimes 
daily—experience for people with obesity.5,7-9 Encounters with weight discrimination 
range from inappropriate comments and bullying to diminished opportunities for 
education, employment, and healthcare.5-11 A recent meta-analysis on the prevalence of 
weight discrimination found that 19% of individuals with class I obesity (BMI = 30-34.9 
kg/m2) and 42% of individuals with class II (BMI = 35-39.9 kg/m2) or III obesity (BMI ≥ 
40 kg/m2) have experienced weight discrimination.9  
Weight discrimination is a serious public health problem.5,8 Weight stigma stems 
from the perception that body weight is highly controllable and thus people with obesity 
are personally responsible for their weight.6 Although the etiology of obesity is complex 
and involves many factors (e.g., genetics, behavior, environment), the prevailing message 
that weight can be easily controlled through diet and exercise perpetuates negative 
stereotypes and prompts discrimination against people with obesity.6 Such messages also 
contribute to the incorrect yet widely held belief that stigmatizing people for their weight 
will motivate them to lose weight. The reality is quite the opposite: Being stigmatized for 
one’s weight is highly stressful and prompts further weight gain, resulting in a vicious 
cycle between weight discrimination, obesity, and poor health.6,8,14,20,26,27  

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Weight discrimination is associated with increased risk for poor cardiovascular 
health. Epidemiological studies link weight discrimination to increased risk for 
myocardial infarction and other forms of heart disease (e.g., angina pectoris, 
tachycardia),17,18 as well as established risk factors for cardiovascular disease (CVD) 
including arteriosclerosis, diabetes, depression, hyperlipidemia, and obesity.12-14,18,28 
Weight discrimination is also associated with physiological processes underlying CVD 
such as high allostatic load, lipid/metabolic dysregulation, oxidative stress, and 
inflammation.19-22,26 Importantly, many (though not all) of the associations between 
weight discrimination and CVD risk remain after controlling for BMI,14,16-18,22 which 
indicates that harmful effects of weight discrimination are independent of health risks 
from excess body weight.  
There is a critical need for interventions that mitigate the harmful effects of weight 
stigma. Reducing the public health burden of weight stigma requires multi-level 
interventions that address both the perpetrators and the targets of weight 
discrimination.5,8,27 Little research has focused on reducing weight-based prejudice 
among perpetrators and the few interventions that do exist have been largely 
ineffective.29 As weight discrimination continues to be a pervasive societal problem, 
there is a critical need for interventions to better support individuals who are the target of 
weight discrimination. 
To inform such interventions, research is needed to identify early-stage mechanisms 
that underlie the adverse effects of weight discrimination, as well as moderators of 
those effects. Guided by our conceptual model (Figure 1), we propose that repeated 
exposure to weight discrimination results in a cascade of negative cognitive, affective, 
behavioral, and physiological processes that gradually culminate in poor cardiovascular 
health. These effects are expected to be moderated by psychological factors and 
demographic characteristics. Our model draws on the broader literature on interpersonal 
discrimination (e.g., due to race, gender, sexual orientation) and health 3,6,15,30,31 as well as 
Co-I Dr. Tomiyama’s cyclic model of weight stigma,26 which proposes that exposure to 
weight discrimination triggers a stress response that prompts physiological (e.g., cortisol 
secretion), emotional (e.g., feelings of shame), and behavioral (e.g., impaired self-

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regulation, comfort eating) processes that promote weight gain, thus creating a vicious 
cycle between weight stigma and obesity.  
Little is known about mechanisms that explain the link between weight 
discrimination and poor health. Previous studies have suggested mechanisms that may 
underlie the link between weight discrimination and poor cardiovascular health (e.g., 
overeating, cortisol secretion), yet most of this work relies on correlational studies, thus 
limiting the ability to make causal inferences.19-22,32-35 For instance, correlational studies 
have documented an association between self-reported experiences with weight 
discrimination and unhealthy eating behavior (e.g., overeating, binge eating).13,34,35 Our 
project will advance the literature by experimentally manipulating exposure to weight 
discrimination to identify causal mechanisms.  
Identifying moderating variables will guide interventions to reduce the harmful 
effects of weight discrimination. Previous research has largely failed to examine 
variables that moderate effects of weight discrimination on poor health outcomes. To 
address this gap, we will identify both psychological variables (Aim 2) and demographic 
characteristics (Aim 3) that moderate responses to experimentally manipulated weight 
discrimination. Our pilot work identified several promising psychological moderators. 
For example, one candidate is internalized weight bias, or the extent to which people 
devalue and stigmatize themselves for their weight. In our pilot work, participants with 
higher internalized weight bias were more likely to view a negative social interaction as 
reflecting weight discrimination and, in turn, to display more negative affect, poorer self-
esteem, and higher self-regulation failure. Replicating this finding in the current project 
would identify a valuable intervention target for mitigating the harmful effects of weight 
discrimination. Identifying demographic moderators (e.g., race, ethnicity, sex/gender) 
will also be useful for personalizing interventions to those groups with the highest need.     
Using a rigorous experimental approach, we will identify moderators of and 
mechanisms through which weight discrimination undermines cardiovascular 
health. Identifying moderators and mechanisms is a critical first step for intervention 
development.36 By intervening on early-stage mechanisms, we can prevent the cascade of 
downstream processes that contribute to poor cardiovascular health.  
INNOVATION   
We will use an experimental approach to manipulate weight discrimination. 
Previous studies documenting associations between self-report measures of perceived 
weight discrimination and poor health outcomes have relied almost exclusively on 
correlational designs.15-22 Moreover, the few studies that have used experimental methods 
have either primed obesity stereotypes37-39 or manipulated concerns that participants 
could be stigmatized for their weight (i.e., activated weight-based social identity 
threat).40-44 Yet these manipulations lack the core component of weight stigma – personal 
devaluation for having excess body weight -- because the stereotypes primed were not 
personally directed at participants and the social identity threat manipulations never 
involved any actual devaluation of the participant. Reliance on these manipulations may 
underestimate the full impact of weight discrimination. We are aware of only one study 
(by Co-I Dr. Tomiyama) that experimentally manipulated exposure to weight 
discrimination by informing participants in the experimental condition that they could not 
participate in a shopping activity due to their shape and size.45 Thus, to address the dearth 

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of causal evidence, we will manipulate exposure to weight discrimination by randomly 
assigning participants to experience vs. not experience personal devaluation on the basis 
of their body weight in order to test effects on mechanistic variables. Further, our 
manipulations were designed to reflect real-world contexts in which weight 
discrimination commonly occurs (e.g., the workplace).5,7-9 In line with calls for research 
that examines the mechanisms of weight discrimination,13,35 our approach will 
significantly advance the field by determining causal effects of weight discrimination on 
mechanisms hypothesized to underlie poor cardiovascular health. To our knowledge, the 
proposed study will be among the first to identify early-stage mechanisms activated by 
experimentally manipulated weight discrimination. 
We will test whether racial and ethnic minorities are particularly vulnerable to 
weight discrimination. Despite the higher prevalence of obesity among Black and 
Hispanic adults compared to White adults,23,25 most research on weight discrimination 
has been conducted with primarily White samples. Although findings are mixed, the few 
studies that have examined weight stigma in more diverse samples indicate that relative 
to Whites, racial and ethnic minorities experience equivalent rates of weight 
discrimination.7 Whether effects of weight discrimination differ by race/ethnicity, 
however, is largely unknown. We will help fill this important gap by recruiting sufficient 
numbers of racial/ethnic minority participants to directly investigate whether race or 
ethnicity moderates effects of experimentally manipulated weight discrimination on 
early-stage mechanisms.  
Preliminary Studies  
Our preliminary studies provide valuable pilot data and demonstrate our team’s ability to 
(1) conduct rigorous lab-based experiments that manipulate weight discrimination, (2) 
recruit sufficient numbers of adults with obesity, including racial and ethnic minority 
participants, and (3) work together in successful collaborations. 
Pilot Study 1: Qualitative Study on People’s Experiences with and Responses to 
Weight Discrimination. We conducted in-depth qualitative interviews with a diverse 
national sample of 32 adult men and women with obesity (BMI ≥ 30 kg/m2) who had 
experienced mistreatment for their weight.46,47 We identified common forms of weight-
based discrimination (e.g., receiving offensive comments, being stereotyped, 
experiencing social rejection) and typical settings in which such discrimination occurred 
(e.g., health care, employment). For instance, weight discrimination was highly prevalent 
in employment settings. Participants were frequently labeled with derogatory obesity-
related stereotypes (e.g., lazy, incompetent, unintelligent, lacking self-discipline) and 
regularly excluded from job-related opportunities for advancement (e.g., trainings, 
promotions). We also identified common cognitive (e.g., self-regulation deficits, self-
acceptance); emotional (e.g., psychological distress, shame, anger); and behavioral (e.g., 
unhealthy eating behavior, social avoidance or withdrawal, social support seeking) 
responses to weight discrimination. These findings guided Aim 1 of the proposed 
research by suggesting contexts in which to manipulate weight discrimination in our 
experiments, as well as cognitive, affective, and behavioral processes (mechanisms) 
activated in response to weight discrimination. 
Pilot Study 2: Early-Stage Cognitive and Affective Responses to Manipulated Weight 
Discrimination. This lab experiment demonstrated that perceptions of weight 

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discrimination evoke a number of negative responses.48 Adults with obesity (N=109) 
participated in a “first impressions” study in which they received negative (vs. neutral 
control) feedback from a partner (a member of the study team). Participants who viewed 
the negative feedback as weight discrimination showed elevated negative emotions 
(shame, anger) and poorer performance on a self-regulation task (Stroop task).  
Psychological moderators. Further, participants high in internalized weight bias 
(IWB) and neuroticism were more likely to view the negative feedback as reflecting 
weight discrimination and to report more negative emotions, whereas participants high in 
self-compassion and conscientiousness demonstrated the opposite pattern. Findings 
support Aim 1 by demonstrating effects of weight discrimination on negative emotions 
and self-regulation and Aim 2 by identifying psychological moderators.   
Pilot Study 3: Cognitive, Affective, and Behavioral Correlates of Expectations of 
Rejection. This lab study identified individual differences associated with expectations of 
rejection during a novel social interaction and the implications of those expectations for 
psychological and behavioral outcomes. Before completing a task with a partner (a 
member of the study team), adults with obesity (N=111) reported the extent to which they 
thought they would be accepted vs. rejected by their partner. Participants who anticipated 
rejection by their partner reported more distress and anxiety. Expectations of rejection 
were also associated with social withdrawal, indicated by participants choosing to work 
by themselves to avoid further social interaction.  
Psychological moderators. Participants high in internalized weight bias and 
neuroticism reported higher expectations of rejection, more distress and anxiety, and 
greater social withdrawal. In contrast, participants high in self-compassion demonstrated 
the opposite pattern. These findings demonstrate support for Aim 2. 
Pilot Study 4: Experiences with Weight Discrimination in Black, Hispanic, and 
Sexual Minority Women. We recently conducted another qualitative study with 32 Black, 
Hispanic, and sexual minority (e.g., lesbian) women (BMIs ≥ 30 kg/m2) to assess their 
lived experiences with weight discrimination. In addition to replicating several findings 
from Pilot Study 1, we observed additional sample-specific findings. Although higher 
body weight was perceived to be more acceptable within Black and Hispanic 
communities, women from these communities nevertheless reported facing high levels of 
weight stigma, which contributed to cumulative stress produced by discrimination based 
on race/ethnicity. Further, although levels of internalized weight bias varied, most of the 
women interviewed appeared to struggle with at least some degree of internalized weight 
bias. These findings support Aims 2 and 3 by identifying moderating variables.   
Background: Scientific Rationale  
Rationale for experimental manipulations. The proposed study will leverage rigorous 
methods from the extensive experimental social psychology literature on social 
exclusion. This literature has produced well-validated procedures for manipulating social 
rejection and personal devaluation in effective but ethical ways.49,50 These manipulations 
produce immediate behavioral effects but, after thorough debriefing, no lasting distress or 
adverse effects. The proposed study relies on a controlled laboratory manipulation in 
which participants are led to believe that they were excluded from a group of “co-
workers” who hold biased viewed toward people with higher body weight and apply 

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weight-based stereotypes to the participant. This approach simulates a “real-world” 
experience with weight discrimination in a way that is impactful and personally relevant.     
Rationale for outcome measures (Aim 1). Selection of outcome measures (i.e., 
mechanisms) was guided by previous research,6,15,20 theory, 3,6,15,26,30,31 and our pilot 
data.3,30,31 Our central premise is that experiencing weight discrimination elicits a stress 
response that results in a cascade of cognitive, affective, behavioral, and physiological 
responses which, over time and with repeated exposure, lead to poor cardiovascular 
health (Figure 1 and Table 1).6,15,20,26  
Cognitive mechanisms. We will assess self-regulation. We are interested in two 
aspects of self-regulation: executive control and delay discounting. Executive control 
reflects one’s ability to exert 
control over one’s thoughts, 
feelings, and behavior. It 
plays an essential role in the 
downregulation of stress51 
and is associated with a range 
of positive health behaviors 
relevant to cardiovascular 
health.52 Anticipating that 
one may be stigmatized for 
one’s weight has been shown 
to result in poor executive 
functioning.40,42 Delay 
discounting reflects a 
tendency to delay 
gratification and prioritize long-term incentives,53 and underlies behaviors such as 
healthy eating and exercise that bring long-term cardiovascular benefits.54 Deficits in 
executive control and delay discounting can trigger processes (e.g., heightened stress, 
overeating) that contribute to poor cardiovascular health.20 We hypothesize that weight 
discrimination will cause deficits in self-regulation (Aim 1).  
Affective mechanisms. We will assess negative and positive emotion triggered by 
exposure to weight discrimination. Negative, stress-based emotions include shame, anger, 
anxiety, and distress, which together reflect the broader construct of negative affect. 
Exposure to obesity stereotypes, weight-based social identity threat, and rejection have 
all been shown to produce high levels of negative affect among people with 
obesity.15,26,40,42 Moreover, negative affect is a robust risk factor for CVD.55,56 Further, 
specific negative emotional states (e.g., shame, distress) are associated with 
psychological (e.g., depression), behavioral (e.g., comfort eating, social withdrawal, 
sedentary behavior), and physiological stress responses (e.g., cortisol secretion) that can 
harm cardiovascular health.26,57,58 Conversely, exposure to weight discrimination is 
linked with low levels of positive emotion. A recent study that used ecological 
momentary assessment found that more daily episodes of weight stigma were related to 
lower end-of-the-day positive emotions (e.g., happiness, pride), which in turn were 
associated with less motivation to diet, exercise, and lose weight.59 With repeated 
exposure to weight discrimination, these affective mechanisms can become activated 
Table 1. Outcome variables for proposed experiment 
Mechanism 
Outcome measure/task 
Cognitive  
 
Self-regulation 
Stroop task (executive control) 
Delay discounting task 
Affective  
 
 
Negative emotion (e.g., shame, anger) 
Positive emotion (e.g., self-assurance) 
Behavioral  
 
 
Social withdrawal  
Self-efficacy for weight control behavior 
Intentions for weight control behavior  
Comfort eating  
Physiological  
 
 
Cortisol  

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chronically and lead to a pattern of harmful responses that increase CVD risk. We 
hypothesize that exposure to weight discrimination will increase negative emotion and 
decrease positive emotion (Aim 1). 
Behavioral mechanisms. We will assess eating behavior, self-efficacy and intentions 
for weight control behavior, and social withdrawal. Numerous studies link weight 
discrimination to unhealthy eating behavior.35 Exposure to weight discrimination is 
predicted to increase comfort eating as a means of immediate stress 
reduction.13,20,26,35,38,60 If left unregulated, however, comfort eating can promote further 
weight gain and impair cardiovascular health.61-64 Additionally, exposure to weight 
stigma undermines self-efficacy for engaging in effective weight control behavior 
(confidence in one’s ability to resist eating in certain situations).39,43,59,65 As these 
behaviors have important effects on weight,12,14,35 we will assess self-efficacy for weight 
control behavior  and intentions to engage in healthy weight control behavior. 
Discrimination and social rejection also promote social withdrawal, a tendency to avoid 
social interaction in favor of social isolation.66,67 Although such isolation may bring 
temporary feelings of safety or relief, over extended periods, social withdrawal can 
promote loneliness, depression, and anxiety,68-70 which adversely affect cardiovascular 
health.71-73 We hypothesize that exposure to weight discrimination will increase comfort 
eating, reduce self-efficacy and intentions for weight control behavior, and increase 
social withdrawal (Aim 1).   
Physiological mechanisms. We will assess salivary cortisol, a steroid hormone that 
regulates the body’s response to stress. Experimental work has demonstrated sustained 
cortisol reactivity in response to weight stigma (vs. control).44,45,74 Cortisol contributes to 
weight gain directly by promoting abdominal fat deposition and indirectly by promoting 
increased eating, especially hyperpalatable foods.20 Over time, weight gain and obesity 
contribute to poor cardiovascular health.75-77 We hypothesize that exposure to weight 
discrimination will lead to increased cortisol reactivity (Aim 1).    
 
Rationale for moderators (Aims 2 and 3).  
Psychological moderators (Aim 2). We will assess psychological individual 
difference variables as potential moderators of the effect of weight discrimination on 
primary outcomes. Guided by the literature3,13,28 and our pilot work (see below), we 
identified psychological factors expected to moderate the negative effects of weight 
discrimination (Table 2). Internalized weight bias and neuroticism are expected to 
amplify the effects of weight discrimination on mechanisms, that is, effects of weight 
discrimination are expected to be stronger in individuals characterized by these traits. 
People high in internalized weight bias direct weight-based stereotypes at themselves and 
fear stigmatization due to their weight.78-80 They are also more likely to use maladaptive 
strategies to cope with weight stigma (e.g., social isolation, overeating).7,81 Neuroticism is 
a broad personality trait reflecting the tendency to experience negative emotions.82 Thus, 
individuals high in Neuroticism may be more sensitive to and negatively affected by 
weight discrimination. Conversely, self-compassion and conscientiousness are 
hypothesized to be resilience factors, that is, effects of weight discrimination are expected 
to be weaker in individuals characterized by these traits. Self-compassion is the tendency 
to respond to painful and difficult experiences with self-kindness rather than self-
criticism.83 Thus, individuals with high self-compassion, may be less likely to display 

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negative outcomes when exposed to discrimination. Conscientiousness is a broad 
personality trait reflecting the tendency to be organized and disciplined.82 People high in 
conscientiousness tend to interpret ambiguous situations as opportunities rather than 
threats84 and thus may be less likely to view unfair treatment as discriminatory. Further, 
people high in conscientiousness may be less likely to engage in unhealthy behaviors 
following weight discrimination.85  
Demographic moderators (Aim 3). We will examine whether age, sex/gender, race, 
and ethnicity moderate the effects of weight discrimination. Analyses will be exploratory 
given the lack of available data supporting robust predictions; most studies do not 
examine demographic moderators and those that have generally show mixed or null 
effects.7,14,16-19,22,28,34 Further, previous studies have been limited by methodological 
constraints (e.g., correlational designs, use of self-report measures of weight 
discrimination, insufficient representation of racial/ethnic minorities). Thus, definitive 
tests of moderation are needed.  
There are reasons to expect moderating effects. 
For instance, younger people are more likely to 
report experiencing weight discrimination than 
older people,9 yet it is unknown whether 
weight discrimination has differential effects 
on health or putative mechanisms. With respect 
to sex/gender, women are more likely than men 
to report weight discrimination9 and women randomly assigned to anticipate weight 
stigma sometimes display relatively worse outcomes (e.g., poorer self-regulation, more 
shame).40 Nevertheless, weight discrimination is associated with adverse health outcomes 
in both men and women, and the magnitude of moderating effects of gender is 
unclear.16,86,87 We considered competing predictions regarding moderation by 
race/ethnicity: On one hand, effects of weight discrimination could be amplified among 
Black and Hispanic/Latino participants relative to non-Hispanic Whites, based on 
evidence indicating that possessing multiple stigmatized identities places individuals at 
greater risk for more cumulative exposure to discrimination and in turn, worse health due 
to greater stress and reduced coping resources.46,88,89 On the other hand, the effects of 
weight discrimination could be buffered among those minority groups, as some evidence 
suggests greater acceptance of higher body weight and less body dissatisfaction among 
Blacks and Hispanics relative to non-Hispanic Whites.90-95  
To that end, we will test whether age, race (Black/African American vs. non-Black), 
ethnicity (Latino/Hispanic vs. non-Latino/Hispanic), or sex/gender (male/man vs. 
female/woman) moderate the effect of weight discrimination on proposed outcomes to 
determine whether certain demographic subgroups are more vulnerable to the negative 
effects of weight discrimination. Although these analyses will be exploratory, it is critical 
to evaluate whether effects are similar or different across sociodemographic groups 
because any differences would indicate that interventions need to be tailored to 
populations, or conversely, if similar, that interventions may be generalizable. 
In summary, this research will identify novel and highly modifiable targets for 
interventions designed to reduce the adverse health effects of weight discrimination. In 
testing moderator variables, this work will identify individuals who display particular 
vulnerability vs. resilience to the harmful effects of discrimination. Information about 
Table 2. Proposed moderating variables  
Risk  
Factors 
Internalized weight bias  
Neuroticism  
Resilience 
Factors 
Self-compassion  
Conscientiousness 
Exploratory 
Factors 
Demographics (age, 
gender, race, ethnicity) 

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moderators will thus help future intervention efforts target those individuals who are most 
likely to benefit from intervention. Given the high prevalence of obesity and the millions 
of Americans affected by weight discrimination,23 this work will address a critical public 
health issue. At a broader level, this research will also provide crucial insights into 
mechanisms that potentially underlie the adverse health consequences of other common 
forms of social stigma (e.g., discrimination due to race/ethnicity, sexual orientation, 
social class).  
 
4.0 
Study Endpoints 
Outcome measures include cognitive (self-regulation); affective (emotional states); 
behavioral (social withdrawal, comfort eating); and physiological (cortisol secretion) 
responses to experimentally manipulated weight discrimination.  
Measures to assess cognitive mechanisms.  
Delay discounting task.96 Delay discounting involves the subjective depreciation of 
an incentive based on its timing. The measure assesses the ability to delay gratification, 
that is, a tendency to prioritize larger long-term rewards over smaller short-term rewards. 
Participants will complete a well-validated task in which they choose short vs. long-term 
rewards from a set of five dichotomous choices (e.g., to receive $1 immediately or $10 in 
one month).97 The task takes about 1 minute to administer, is highly reliable, and 
correlates well with longer and more extensive measures of delay discounting97 (metric: 
discount rate (k) ranges from 0-1).  
Stroop task. The Stroop task provides a measure of executive control by assessing the 
ability to inhibit an automatic response (reading) in favor of performing a more 
controlled task (color naming). The task is a classic, widely-used and well-validated 
measure of executive control.98 Participants will perform 8 blocks of 20 trials that will 
take approximately 5 minutes to complete. Executive control scores will be calculated as 
a joint function of response accuracy and speed.99  
Measures to assess affective mechanisms. We will use a modified version of the 
Positive and Negative Affect Scale-Expanded Form (PANAS-X)100 to assess emotions in 
response to the experimental manipulation. The scale demonstrates good validity and 
reliability.100 Emotions will be assessed with 46 adjectives (e.g., angry, confident). 
Participants will be asked to indicate the extent to which they feel each emotion at that 
moment (1=very slightly or not at all to 5=extremely). A composite score for positive and 
negative emotion will be created by taking the average of the relevant adjectives.  
Measures to assess behavioral mechanisms. 
Social withdrawal. Social withdrawal will be assessed with a measure from previous 
research,50 in which participants indicate the extent to which they want to work on a task 
either by themselves, with one of their former group members, or with a new partner. 
Choosing to work by oneself reflects a desire to avoid social interaction. The details of 
the task will be tailored for the study to fit the study’s narrative flow.  
Comfort eating. Comfort eating will be assessed via an eating task to objectively 
measure hyperpalatable (high-fat, -sodium, -sugar, and -carbohydrate) food intake.101 To 
avoid floor effects often observed in laboratory eating settings, the eating task will take 
place under the guise of a faux taste test.102 Participants will be asked to rate each of the 

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foods/drinks to ostensibly guide the development of their food marketing campaign later 
during the study. To avoid ceiling effects and to allow participants to eat without fearing 
that the experimenter will negatively judge the amount they have eaten, large quantities 
of each food will be made available. Participants will have 10 minutes to complete the 
task alone in a private room. Bowls will be weighed (unobtrusively) before and after the 
task to compute the difference in grams, which will then be converted to kilocalories 
based on published nutrition information from the food maker.  
Self-efficacy for weight control behavior. Self-efficacy (perceived confidence) in 
one’s ability to engage in weight control behaviors (e.g., dietary restraint, physical 
activity) over the next six months will be assessed with items adapted from previous 
research. Self-efficacy for dietary restraint will be assessed with the short form of the 
Weight Efficacy Lifestyle Questionnaire103 (e.g., I can resist eating … when I am 
depressed or down; 8 items). Self-efficacy for physical activity will be assessed with the 
Exercise Self-efficacy Scale104 (e.g., I am confident I can participate in regular exercise 
when … I am tired; 5 items). To mask the study’s focus, weight control items will be 
interspersed with items assessing self-efficacy for other health behaviors (e.g., flu 
vaccination, sleep, cancer screening). Participants will rate their self-efficacy for each 
behavior on an 8-point scale (0=not at all confident to 7=very confident). Items will be 
averaged to create a composite score.  
Intentions for weight control behavior. Using the same health behaviors assessed for 
self-efficacy, we will also assess intentions for weight control behavior. Participants will 
be asked to rate the extent to which they intend to engage in each behavior over the next 
six months.105 Each item will be rated on an 8-point scale (0=strongly disagree to 
7=strongly agree). Items will be averaged to create a composite score. 
Measures to assess physiological mechanisms. 
Cortisol reactivity. We will measure cortisol secretion via saliva (passive drool) at 
three timepoints during the session: baseline, 20 minutes post-manipulation (to assess 
reactions to the manipulation), and 60 minutes post-manipulation (to assess recovery).106 
As in previous research,106 participants will be asked to swish their mouths with water 2-
3 times before the final sample is collected to avoid altering cortisol levels. Within 2 
hours of collection, saliva samples will be frozen at -20°C. As in our previous work,48 
samples will be analyzed in duplicate with immunoassays. Participants will be instructed 
to refrain from eating, drinking, smoking, or exercising for 1 hour before the session. To 
reduce diurnal cortisol variability, sessions will be conducted between 1:00 and 7:00 p.m. 
During the session, we will assess factors that could potentially affect assay results (e.g., 
consumption of food, alcohol, nicotine within the past 12 hours; presence of oral diseases 
or injury; current medications), so that we can control for them in analyses if needed.  
Measures to assess moderators (Table 2). Moderators will be assessed with an online 
survey completed at least one week before the experimental session. We will use reliable 
and well-validated measures to assess all psychological moderators. Internalized weight 
bias will be assessed with the 11-item Modified Weight Bias Internalization Scale.79 Self-
compassion will be assessed with the 26-item Self-Compassion Scale.83 The 60-item Big 
Five Inventory-282 will be used to assess the five core personality domains (extraversion, 
agreeableness, conscientiousness, neuroticism, and openness). To mask the study’s focus, 
the survey will include other measures unrelated to weight stigma (e.g., emotion 

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regulation),107 plus demographic characteristics (e.g., education, biological sex) and 
health status (e.g., physical and mental health status, past medical history).   
5.0 
Study Intervention/Investigational Agent 
The study intervention does not involve drugs or devices that are regulated by the FDA.  
Participants will be randomly assigned to one of two conditions: experimental (weight 
discrimination) vs. control manipulation. The experimental manipulation will involve 
three components:  
1. Learning that their groupmates are biased against overweight people  
2. Receiving feedback that labels them with negative weight-based stereotypes (e.g., 
lacking self-discipline)  
3. Not being selected as a partner for the remaining lab tasks (social exclusion). 
In contrast, participants in the control condition will: 1) learn that their groupmates are 
very accepting of overweight people (i.e., they have positive attitudes toward people with 
higher body weight), 2) receive positive feedback about their personal attributes that are 
not consistent with negative weight-based stereotypes, and 3) will be told that one of their 
group members had to leave early for an emergency so the pairs cannot be assembled as 
usual (i.e., they will not experience social exclusion). In neither condition is any explicit 
reference to the participant’s body weight, size, or shape included. 
 
All three components of the planned experimental manipulation reflect common 
examples of weight discrimination reported by participants in our pilot data.46,47 
Moreover, all three manipulations have been used in previous IRB-approved 
experimental studies involving weight stigma or social exclusion. Interacting with a 
confederate/partner who is biased against overweight people (component 1) has been 
used in published studies41 and is currently being used at UCLA for an NIH-funded study 
by Co-Investigator, Dr. Janet Tomiyama, in concert with direct interaction with a 
confederate who expresses (veiled) negative stereotypes about the participant (we will 
not use this latter procedure in our study). Giving people bogus feedback about their 
personal attributes has a long history in social psychology (component 2). Classic 
and recent studies, for example, have provided participants with bogus negative feedback 
about their intelligence.108,109 Similarly, studies have given participants bogus negative 
feedback about their level of competence to assess effects on psychological processes.110 
Finally, the group exclusion manipulation (component 3) in which participants interact 
with a group and then learn that nobody chose to work with them has been used in many 
published studies,111 including studies conducted at FSU by Co-Investigator, Dr. Jon 
Maner.50,112  
 
The study team used a combination of the second and third components a few years ago 
in a study in which participants received (bogus) negative feedback from their partner to 
manipulate weight stigma.48 In (bogus) written feedback shared with the participant after 
viewing their video, a confederate (i.e., member of our study team who was pretending to 
be their partner for the study) indicated they were not looking forward to the face-to-face 
interaction with their partner (as indicated by a “2” on a 7-point scale ranging from 1 ‘not 

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at all’ to 7 ‘very much’), and that they had a negative overall impression of their partner 
(as indicated by a “2” on a 7-point scale ranging from 1 ‘very negative’ to 7 ‘very 
positive’). Their feedback also included the following hand-written note: “Her/His video 
was fine, but I guess I’m not that excited about talking face-to-face.” 
 
In summary, all components of the experimental manipulation used in the current study 
have been used in previous studies to produce immediate behavioral effects but, after 
thorough debriefing, no lasting distress or adverse effects have been reported.  
 
Please see section 6.0 (Procedures Involved) for more detail about the experimental 
manipulation.  
 
6.0 
Procedures Involved 
Describe and explain the study design. 
The study uses a between-subjects experimental design. Participants will be randomly 
assigned to one of two conditions: experimental vs. control. 
Research procedures, including procedures being performed to monitor 
subjects for safety or minimize risks. 
The study involves two parts: a pre-session online baseline survey and an experimental 
session that will take place in the lab. Trained research assistants will guide participants 
through study procedures in the lab, including delivery of the intervention 
(manipulation), assessment of study outcomes, and study debriefing. 
As identified in our pilot data and previous research,5,7-9,46,113 employment is a common 
setting for weight discrimination. Negative employment outcomes (e.g., lower wages, 
fewer opportunities for promotion) often stem from negative stereotypes that cast 
employees with obesity as lazy, unintelligent, and incompetent.5,8 To manipulate weight 
discrimination, this study will adapt manipulations widely used in previous experimental 
studies of social exclusion (conducted by Co-I Dr. Maner)50,112 and weight stigma,41 as 
well as our own pilot work.48  
The study will be presented as an investigation of “decision making in the workplace,” 
during which participants (adults with obesity) will “interact with” and receive initial 
impression ratings from three “co-workers” (“confederates,” that is, research assistants 
posing as other participants). Participants will be told that the research team has partnered 
with the FSU marketing department to study how psychological factors affect decision 
making and that during the lab session they will work with their groupmates to develop a 
food product marketing campaign.  
To begin, participants will create a 3-minute introductory “getting to know you” (GTKY) 
video, as in our pilot study.48 To guide the creation of their video, participants will be 
provided with a list of “getting to know you” questions (please see attached video 
introduction questions) they can answer in their video. Participants will also complete a 
“getting to know you” questionnaire in which they will be asked to indicate their personal 
qualities (filler questions that assess self-monitoring practices) and social values where 
they will be asked to rate their attitudes toward elderly adults, overweight people, and 

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racial and ethnic minority individuals. Participants’ videos and “getting to know you” 
questionnaire responses (averaged across the three members) will (ostensibly) be shown 
to their group members, and participants will view three similar videos created 
(ostensibly) by each of their group members. (Please see two sample confederate videos 
that were uploaded to IRB staff member Annette Allman’s NiFTy account). After 
watching the videos, participants will provide impression ratings of each group member.  
Participants will also be informed that, for the next portion of the session, the group will 
be divided into pairs to perform a taste-test task and develop ideas for the marketing 
campaign. Pairs will (ostensibly) be based on each person’s preferences for whom they 
most want to work with based on the initial videos, and participants will be asked to 
indicate their preferences. The experimenter will say the following:  
“For the marketing task we want to partner people with someone they’d like to work 
with. Things work better that way. So please indicate here on this paper (at the 
bottom of the ‘First Impressions Questionnaire’ page 2) which one of your group 
mates (A, B, or C) you would most like to work with so we can try to partner you 
with them.”  
As described in Section 5.0 (Study Intervention), participants will be randomly assigned 
to one of two manipulations. In the experimental (weight discrimination) condition, 
participants will learn that their group members are biased against overweight people but 
not elderly or racial/ethnic minority individuals, as indicated by the GTKY summary 
ratings handout in which the three member’s ratings will be presented in averaged form 
(experimental condition). Participants will also receive negative feedback about their 
personal attributes by being labeled with negative weight-based stereotypes (as indicated 
by the first impressions summary ratings averaged across the three members; 
experimental condition). Although some ratings will be positive (e.g., they will receive 
high ratings on being friendly and kind), participants will be rated poorly on attributes 
viewed as necessary to develop a strong marketing campaign (i.e., motivation to work 
hard, possessing self-discipline to persist at the task, and competence). 
In the control condition, participants will learn that their group members have positive 
attitudes toward people with higher body weight, as well as elderly and racial/ethnic 
minority individuals, as indicated by the GTKY summary ratings handout (control 
condition). Participants will also receive positive feedback about their personal attributes, 
as indicated by the summary ratings averaged across the three members (control 
condition). 
After (ostensibly) assembling the group’s preferences, the experimenter will inform 
participants in the experimental condition that no one selected them to be their partner, 
thus they will perform the next few tasks alone. This manipulation has been shown to 
prompt feelings of social exclusion.50 In contrast, participants in the control condition 
will be told that one of their group members had to leave unexpectedly for a family 
emergency, so pairs cannot be assembled as usual, thus they will perform the next few 
tasks alone. In sum, while participants in both conditions will perform the tasks alone, 
only those in the experimental condition should experience social exclusion. For the 
exact wording of the social exclusion manipulation, please see the attached script (social 
exclusion manipulation).  

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After the manipulation has been delivered, participants will complete a manipulation 
check (see lab survey). Participants will be asked to indicate their overall impressions of 
their groupmates and their perception of their groupmates’ overall impressions of 
themselves. Participants will be also report the extent to which they think the impressions 
their group members formed of them thus far are based on various factors including their 
gender, race or ethnicity, weight, age, personality, and what they said in their video.48  
Next, participants will complete primary outcome measures (Table 1). To assess comfort 
eating, participants will take part in a well-validated faux taste test from previous 
research (described below).102 To provide a measure of social avoidance/withdrawal, we 
will use a previously validated measure50 in which participants indicate the extent to 
which they prefer to complete the final task either by themselves, with a member of their 
previous group, or with a new partner (described below). Anthropometric measures (i.e., 
height, weight, waist and hip circumference) will be assessed at the end of the study 
following standard lab-based procedures. 
To assess cortisol (a steroid hormone that regulates the body’s response to stress), 
participants will be asked to provide three saliva samples during the lab visit. The first 
saliva sample will be collected at baseline (5-10 minutes after they arrive at the lab). The 
second and third saliva samples will be collected 25 and 60 minutes, respectively, after 
delivery of the experimental manipulation. If participants finish all study measures before 
it is time to collect the third saliva sample, they will be asked to watch a video about 
marketing strategies to presumedly help them prepare for the final task. Here’s a link to 
the kind of video that will be shown to participants: 
https://www.youtube.com/watch?v=0Ty64auIk_w  
The experimenter will be instructed to stop the video when it’s time to collect the sample. 
 We will use off-the-shelf foods for the taste test task. The following foods/drinks will be 
offered to participants: Lay’s classic potato chips, Chips Ahoy cookies, milk chocolate 
M&M candies, and Sprite. During the taste test, participants will be provided with 
plentiful quantities of each food item (i.e., 80 grams of chips, 15 cookies, 300 grams of 
M&Ms) and 2 (355 mL) can of Sprite. These quantities were selected to circumvent both 
ceiling effects (i.e., participants eating all of the food available) and floor effects (i.e., 
participants eating no food at all) and are currently being used in a similar study being 
conducted by Co-I, Dr. Tomiyama. All food items will be stored according to package 
instructions (e.g., in airtight containers to preserve freshness). Cans of Sprite will be 
refrigerated. Participants will not be given food items that have become stale or are 
beyond their “best by” date. Any expired foods will be discarded. For sanitary reasons, 
any food or drink that is leftover after the taste test will be discarded as soon as the 
research assistant has logged the post-task weight for each item.   
Participants will be screened for relevant food allergies on the screening survey (see 
attached). Those individuals who report being allergic to one or more of the products on 
the list will be excluded from the study. To take additional precautions, the consent form 
will remind participants of the food tasting and rating task that will take place during the 
lab visit. Participants will be instructed to alert a member of the study team if they have a 
relevant food allergy. If this occurs, the participant will be informed that they do not meet 
the eligibility criteria for the study and thus will not be scheduled for the lab visit (i.e., 
they will be withdrawn from the study for not meeting eligibility criteria). Further, 

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immediately prior to the food tasting exercise, the experimenter will remind participants 
of the ingredients contained in the foods they will be tasting. Participants will again be 
queried as to whether they have any relevant food allergies. If a participant admits to 
having a food allergy, any food items containing the specified ingredient(s) will not be 
offered to the participant during the taste test. In the unlikely event that a participant is 
allergic to all of the items of the food allergy list, the food tasting exercise will not be 
conducted.   
The experimenter will bring the food to the lab room on a tray and will wear gloves while 
handling the food and presenting it to the participant. After setting down the tray, the 
experimenter will open a can of Sprite in front of the participant. To introduce the task 
the experimenter will say the following:  
“Okay, now it’s time for the food tasting and rating task. These are the same foods 
that you’ll be promoting in your food marketing campaign, so we wanted to give you 
a chance to try them. Please have at least a taste of each item so that you can rate 
them. Rate the foods using this form [hand participant food rating form; see attached 
food rating form]. You are welcome to have as much as want. It is important that you 
answer the questions on the form as accurately as you can, so if you need more food 
to answer the questions, please let me know. [Add off-handedly] And if you finish 
early, feel free to eat as much as you want. For sanitation purposes, we have to throw 
it away after you go anyway. You’ll have about 10 minutes for this task. If you finish 
before I return, please feel free to review your ratings to make sure they are accurate.”  
To assess social avoidance/withdrawal, the experimenter will say the following after the 
participant has completed the food tasting task:  
“Next, you’ll be sharing your ideas for the food marketing campaign. There are a 
few ways we can do it and it’s up to you. You can do it by yourself, you can do it 
with one of the remaining people from your previous group—the same people in the 
videos you watched earlier—or there’s someone else who showed up late for the  
study and you could do it with them. You haven’t met them yet, but they’ll be doing 
the marketing task as well so that’s another option. Just so you know, the task will 
take the same amount of time whether you do it by yourself or with another person.  
So again, your options are by yourself, with a former group member, or with the new 
group member who showed up late. Please give it some thought. I’ll be back in a few 
minutes and you can let me know your preference then.”  
Participants will be asked to indicate their response verbally to the experimenter, who 
will record their response.  
Describe procedures performed to lessen the probability or magnitude of risks 
and source records  
Our team is highly committed to the protection of participant welfare. We will work 
closely with our university’s Institutional Review Board to ensure participant wellbeing 
and safety. Further, we will follow best practices for debriefing all study participants.  
We will follow best practices for saliva sample collection. For example, participants will 
receive verbal instructions from the experimenter along with a written handout that 

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repeats the instructions and provides additional tips if they are having difficulty 
producing enough saliva (please see attached). Participants will also be given privacy and 
as much time as needed to provide the sample.   
All participants will undergo a “funneled” debriefing process at the end of the study that 
begins with broad questions that narrow to probe for suspicion. The debriefing process 
will consist of an initial verbal debriefing with the research assistant, followed by receipt 
of a written debriefing form that provides additional information and psychological 
support resources. After receiving this information, participants will have the opportunity 
to discuss the study with the research assistant and ask questions. Here, we provide a 
brief summary of the verbal debriefing process and the information contained in the 
written debriefing form.  
Debriefing Procedure Summary: The research assistant will begin by asking the 
participant a series of questions to assess prior knowledge of any aspects of the study 
(e.g., “Did anyone else tell you anything about what you would be doing in this study 
before your session today?”) and gauge suspicion about study procedures (e.g., What do 
you think today’s study was about? Was there anything we told you during the study that 
you didn’t believe?”). Afterwards, the research assistant will explain the goals of the 
study and the nature of the two experimental conditions. All aspects of the procedure, 
including all elements of deception, will be explained clearly to participants. Participants 
will be assured that any feedback they received during the session from their ostensible 
partners was not real (i.e., the GTKY and first impression ratings from their “co-
workers,” being told that no one wanted to work with them on the partner task) and was 
developed by the research team to elicit particular types of reactions. Research assistants 
will emphasize this point until they are confident participants understand that none of the 
study procedures reflect any actual evaluation of the participant. The research assistant 
will apologize for not initially disclosing the purpose of the study and apologize for any 
discomfort that may have been experienced while completing the study measures or 
tasks.  
Research assistants will be trained on how to assist participants who experience distress. 
Further, participants will be given a list of psychological support resources they can 
utilize (e.g., helplines) if they experience any lingering distress after the study has ended. 
Upon receiving full disclosure of the study goals, participants will be given the 
opportunity to withdraw their data from the study.  
Participants will be thanked for their participation and given the written debriefing form. 
The debriefing form will provide a more detailed version of the verbal debriefing by 
outlining the study purpose and rationale underlying the current study. After receiving the 
verbal and written debriefing, participants will be given an opportunity to discuss the 
study with the research assistant and ask questions about the procedures and study goals. 
Participants will also be provided with several suggested readings if they are interested in 
learning more about weight discrimination and health, efforts that will be taken to protect 
their confidentiality, and a list of psychological support resources. The form will include 
contact information for the PI (Dr. Gerend) and the FSU human subjects committee 
should participants have any additional questions or concerns about the study. 
Participants will be instructed to contact the PI if they would like to receive a copy of the 

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study results.  
Source Records: Please see attached documents for all surveys that will be used to 
collect data about participants (i.e., screening survey, baseline survey, lab survey).  
Describe what data will be collected during the study and how that data will be 
obtained. 
Outcome measures include cognitive (self-regulation); affective (emotional states); 
behavioral (social withdrawal, comfort eating); and physiological (cortisol secretion as 
indicated via saliva) responses to experimentally manipulated weight discrimination. 
Measures will be assessed with experimenter-administered and self-administered survey 
questions, computer-based tasks, a saliva sample, and a faux taste test. Please see 
previous description of outcomes for more detail.  
Proposed psychological and demographic moderating variables will be assessed in the 
screening survey and baseline survey. 
 
7.0 
Data and Specimen Banking 
N/A 
8.0 
Sharing of Results with Subjects 
N/A 
9.0 
Study Timelines 
The duration of an individual subject’s participation in the study is a total of 135-
140 minutes (15-20 minutes for the baseline survey; 120 minutes for the lab-based 
portion of the study).  
We are aiming to recruit approximately 36 participants per month and will be 
recruiting for a 9 to 11-month period. If are not able to meet our recruitment 
goals, we will extend the recruitment window as necessary.  
Our estimated date of completion is 9/30/2023. If we need more time to complete 
the study, we will request a no-cost extension.  
10.0 Inclusion and Exclusion Criteria 
Interested participants will be directed to an online screening survey via a link or 
QR code to assess eligibility criteria. 
Eligibility criteria: (1) BMI ≥ 30 kg/m2 (BMI criteria for obesity), (2) ≥ 18 years of age, 
(3) able to read and understand English, (4) have Internet access (to complete the baseline 
survey), and (5) able to come to FSU’s campus to take part in a lab-based study.  
Exclusion criteria: (1) having participated in any of our pilot studies on weight stigma, 
(2) diagnosed with a current major psychiatric disorder (e.g., major depressive disorder, 
eating disorder), (3) pregnant or nursing, diagnosed with Cushing syndrome, taking 
steroid-based medications, or (4) having allergies to ingredients in the foods being 
offered during the taste test (e.g., gluten, peanuts).   

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We will not be recruiting special populations (adults unable to consent, individuals who 
are not yet adults, pregnant women or prisoners).  
 
11.0 Vulnerable Populations 
N/A 
12.0 Local Number of Subjects 
 
Total number of subjects: 320 
 
13.0 Recruitment Methods 
Participants will be recruited from the local Tallahassee community and the 
surrounding area (e.g., Thomasville, Crawfordville). Following procedures used 
in our pilot work, we will use a variety of recruitment strategies (e.g., flyers, 
online ads, community outreach). Ads for the study will be distributed in the local 
Tallahassee community via flyers, online message boards (e.g., Craig’s List), and 
social media sites (e.g., Facebook).  
To facilitate recruitment of a racially/ethnically diverse sample, we have partnered with 
the FSU Center for Translational Behavioral Science’s (CTBS) Community Engagement 
Core. The Community Engagement Core provides community liaison services, consults 
on engagement methodology, and facilitates the Community Advisory Council. The 
Council is a community advisory group comprised of area health care providers, 
professionals, and community members who have come together to enhance CTBS's 
mission toward effective community engagement in research. The Community 
Engagement Core is facilitated by Dr. Ennis and Dr. Pickett who serve as liaisons 
between investigators and the Council to engage relevant community partnerships needed 
to facilitate participant engagement and recruitment. As leaders of local community-
based organizations, Council members also provide stakeholder input to facilitate 
recruitment. Participants will be recruited via direct outreach to locations such as local 
churches and community-based organizations.  
 
Interested participants will be directed to an online screening survey to assess eligibility 
criteria.  
The ads will provide a brief description of the study and the location where the 
study will take place. The ads will also mention that study participants will be 
compensated. Ads will include a link or QR code for the screening survey. Copies 
of the screening survey and advertisements are attached.  
Participants will receive $75 cash upon completion of the lab-portion of the study.   
14.0 Withdrawal of Subjects 
The PI does not anticipate having to a) withdraw subjects from this research without their 
consent or b) terminate the study early. 46,47 
As described previously, the consent form will remind participants of the food 
tasting and rating task that will take place during the lab visit. Participants will be 

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instructed to alert a member of the study team if they have a relevant food allergy. 
If this occurs, the participant will be informed that they do not meet the eligibility 
criteria for the study and thus will not be scheduled for the lab visit (i.e., they will 
be withdrawn from the study for not meeting eligibility criteria).  
If a participant arrives at the lab and does not appear to meet the minimum BMI 
criteria (BMI = 30 kg/m2), the research assistant will be instructed to re-assess 
eligibility criteria to catch errors that were possibly made on the screening survey 
when reporting height and weight. Participants who may have entered inaccurate 
height or weight information on the screening survey (and thus do not meet the 
required BMI cutoff) will be told they cannot enroll in the study as they do not 
meet eligibility criteria. We do not anticipate having to do this very often, but it 
has happened a few times in our previous work, so we will have a procedure in 
place to address it.  
Participants may decide to withdraw from the study at any time. No additional data will 
be collected after a participant withdraws. If a participant shares their intent to withdraw, 
the investigator will ask if the information that has already collected can be used or 
whether it should be destroyed.  
 
15.0 Risks to Subjects 
Potential Risks: Participants may experience psychological distress in response to the 
experimental manipulation. The manipulation used in this study is like other commonly 
used procedures designed to produce acute short-term distress in a laboratory setting 
49,50,114-119 without affecting long-term mental or physical health.  Distress is expected to 
be no stronger than what participants might experience in response to a single instance of 
day-to-day weight discrimination outside the lab. These risks are considered to be 
minimal as both the probability and magnitude of discomfort are not anticipated to be 
greater than those ordinarily encountered in daily life. It is also important to note that the 
negative effects of weight discrimination on health are presumed to be cumulative over 
the life course and develop only after repeated exposure to the chronic stress of weight 
discrimination experienced over time. Our manipulations simulate a single instance of 
weight-based discrimination and thus should have measurable acute effects in the lab 
without contributing to long-term risk.  
Potential risks also include those associated with providing the three saliva samples (e.g., 
disgust with the procedure, difficulty producing enough saliva). Overall, these risks are 
considered to be minimal as the probability and magnitude of harm or discomfort 
anticipated in this study are not greater than those ordinarily encountered in daily life.  
 
Information about the study’s actual purpose will be withheld from participants until the 
debriefing process, which will take place at the end of the lab-portion of the study. 
During the consent process the experimenter will provide participants with a statement to 
the effect that participants may not be made aware of some features about the study and 
will be provided with additional information about the study at the end of their 
participation or at any time they withdraw. All participants will take part in the funneled 
debriefing process at the end of their participation or at any time they withdraw. Please 

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see attached for the full text of the verbal debriefing script and the written debriefing 
form.  
 
16.0 Potential Benefits to Subjects 
Potential benefits of the research for participants are minimal. Participants will 
learn (via debriefing) about the potential negative effects of weight discrimination 
on health and will be provided with links to several readings if they are interested 
in learning more about it. 
17.0 Data Management and Confidentiality 
 
Statistical Design, Power, and Analysis Plan  
We designed this study to have very high power for the main effects of weight 
discrimination (Aim 1) and to ensure sufficient sensitivity for moderation effects of 
psychological (Aim 2) and demographic variables (Aim 3). 
 Aim 1: Identify early-stage cognitive, affective, behavioral, and physiological 
mechanisms activated by experimentally manipulated weight discrimination. We 
hypothesize that, relative to participants in the control condition(s), participants in the 
weight discrimination (experimental) condition (vs. control) will display more impaired 
self-regulation, higher negative emotion, lower positive emotion, more social withdrawal 
and comfort eating, lower self-efficacy and intentions for engaging in weight control 
behavior, and increased cortisol secretion. 
Aim 1 power and analysis. Nine outcomes are assessed for the study (Table 1), hence 
we adopt a conservative Bonferroni adjustment when evaluating the primary hypothesis 
and use significance level α = 0.005 to maintain familywise Type I error rate of 0.05. We 
assumed conservative effect size estimates, which were among the smallest observed in 
our pilot data.48 We plan to recruit 160 subjects per condition for the study, which yields 
90% power (α = 0.005) to detect the medium Cohen’s d = 0.50 between the control and 
experimental conditions.  
Aim 1 analyses will use unadjusted ANOVA followed by analysis of covariance and 
multiple regression methods that permit adjustment for age and other baseline 
characteristics that may exhibit imbalance across experimental conditions. To analyze 
effects of the manipulation on cortisol secretion (assessed at 3 timepoints), we will 
calculate the area under the curve (AUC) with respect to ground (AUCg).120 For all Aims, 
residual diagnostics will assess model assumptions (e.g., normality, homogeneity) and 
responses will be transformed if necessary. Effect of experimental weight discrimination 
will be reported for both unadjusted and adjusted analyses. 
 Aim 2: Identify psychological variables that moderate effects of weight 
discrimination. We hypothesize that the effect of weight discrimination (vs. control) will 
be stronger for individuals who score higher on certain psychological variables (i.e., 
internalized weight bias, neuroticism) and weaker for individuals who score higher on 
other variables (i.e., self-compassion, conscientiousness; See Table 2). In other words, 
possessing some traits will be protective, while possessing other traits may render 
individuals more vulnerable to the harmful effects of weight discrimination.  
Aim 2 power and analysis. The very high power of these designs for the primary 
hypotheses of Aim 1 ensures sufficient power for Aim 2 and additional analyses. 

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Statistical analysis will use multiple regression with condition assignment, the moderator, 
and their interaction as predictors and focus on interpretation of the coefficient for the 
interaction.121 With a continuous moderator, the coefficient for the interaction is the 
difference in the slope coefficients associated with the moderator in each of the treatment 
groups. Because these slopes are proportional to the correlation between the moderator 
and outcome in each group, respectively, the test of no moderation is equivalent to the 
test of equal correlation between moderator and outcome in all groups. Using Fisher’s z 
transform of the correlations to approximate normality, The study (with 160 subjects in 
each of two conditions) provides 90% [80%] power (2-sided, α = 0.05) to detect the 
change in correlation between moderator and outcome from 0.65 to 0.39 [0.43] 
associated with treatment assignment.122 Additional statistical analyses will adjust for 
baseline characteristics by including these as additional predictors in the model; 
estimated moderation effects will be reported for both unadjusted and adjusted analyses. 
 Aim 3: Identify demographic characteristics that moderate effects of weight 
discrimination. We will conduct exploratory analyses to assess whether the negative 
effects of weight discrimination are moderated by age, sex/gender, race, and ethnicity.  
Aim 3 power and analysis. The power to detect a moderating effect of age is similar 
to continuous moderators described in Aim 2. Defining the effect of a binary moderator 
as the difference in the standardized effects of intervention associated with the two levels 
of the moderator, The study provides 88% power for a moderator effect of 0.70.122 If the 
moderator is unbalanced (e.g., 60% of participants are female), then the power to detect a 
moderator effect of 0.70 is 86%. Power is maintained at 84% when there is a more severe 
imbalance (e.g., 1/3 Hispanic vs. 2/3 non-Hispanic). 
All analyses will use the intent-to-treat data sets, meaning all participants will be included 
and associated with the experimental condition to which they were assigned. Missing 
outcomes will be addressed using multiple imputation or marginalization (i.e., maximum 
likelihood). Based on our pilot work, we anticipate little missing data. If the missingness 
exceeds 10%, however, we will evaluate the potential for nonignorability by including 
indicators for missingness throughout our analyses.  
Participant privacy and data will be carefully protected. Participant information will be 
collected using a secure web-based application. The baseline survey will be as brief as 
possible and will be configured for easy completion on multiple platforms (e.g., cell 
phone, tablet, laptop). Participants will have the option to skip questions that make them 
uncomfortable. The experimental session will take place in a private laboratory on 
campus and will be guided through the study by a research assistant.  
Data Security 
Procedures to eliminate risks related to breach of confidentiality are as follows: Each 
participant will be given a unique identifier in the data set which will be stripped of all 
personal information to protect confidentiality. Data sets used for analysis will contain 
participant identification numbers but neither names nor any other identifying 
information. Identification information will be retained by the PI for the duration of the 
study and stored separately from the responses provided by subjects. Data will be stored 
in password-protected databases on secure servers, accessible only to project staff. 
Collaborators will receive data stripped of personal identifiers (de-identified data). To 
ensure complete confidentiality, access to the “key” linking personal identifiers to 

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participant usernames and passwords will be restricted to the PI. Dr. Gerend will oversee 
the data storage and reporting procedures. The “key” linking personally identifiable 
information to the participant’s ID in the data set will be destroyed at the end of the 
study. Reports will only use aggregated data and will not identify individual participants. 
All study staff will be trained in security and confidentiality procedures before receiving 
access to any participant data.  
Quality Control 
The baseline and lab-based survey will include several data quality checks (e.g., 
attention checks) and a “speeding check” to identify any surveys that may be 
associated with poor quality.  
Data Handling and Storage  
All data will be stored on the PI’s password protected computer in a secure folder 
on the College of Medicine server. Dr. Gerend will oversee data storage and 
handling procedures. Only members of the study team will have access to the 
data. De-identified data will be stored into perpetuity. Collaborators will receive 
data stripped of personal identifiers (de-identified data). Data transmission 
procedures will follow best practices to ensure data safety and security during 
transfer.  
Saliva samples will be handled following standard laboratory procedures to 
ensure participant privacy and specimen protection. Saliva samples will be frozen 
at -20°C within 2 hours of collection and will be stored in a secure area (card-
access only). Saliva samples will be stored until they are ready for analysis. 
Samples will be assayed for cortisol by an outside laboratory in small batches or 
once data collection is complete, depending on how quickly data collection takes 
place. Specimens will be shipped following standard protocols required by the 
processing lab.  
 
18.0 Provisions to Monitor the Data to Ensure the Safety of Subjects 
This research constitutes a clinical trial and, as such, requires a Data Safety and 
Monitoring Plan (DSMP), but not a formal Data Safety and Monitoring Board.  
Data and Safety Monitoring Plan  
Potential Risks: Participants may experience psychological distress in response to the 
experimental manipulation. The manipulation used in this study is like other commonly 
used procedures designed to produce acute short-term distress in a laboratory setting 
49,50,114-119 without affecting long-term mental or physical health.  Distress is expected to 
be no stronger than what participants might experience in response to a single instance of 
day-to-day weight discrimination outside the lab. These risks are considered to be 
minimal as both the probability and magnitude of discomfort are not anticipated to be 
greater than those ordinarily encountered in daily life. It is also important to note that the 
negative effects of weight discrimination on health are presumed to be cumulative over 
the life course and develop only after repeated exposure to the chronic stress of weight 
discrimination experienced over time. Our manipulations simulate a single instance of 
weight-based discrimination and thus should have measurable acute effects in the lab 
without contributing to long-term risk.  

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Potential risks also include those associated with providing the three saliva samples (e.g., 
disgust with the procedure, difficulty producing enough saliva). Overall, these risks are 
considered to be minimal as the probability and magnitude of harm or discomfort 
anticipated in this study are not greater than those ordinarily encountered in daily life.  
Any unexpected or serious adverse events that occur during the course of the study will 
be reported by the PI (Dr. Gerend) to the Florida State University Institutional Review 
Board (IRB) in accordance with current University guidelines for reporting adverse 
events. 
Dr. Gerend will be responsible for monitoring data to ensure the safety of participants. 
The PI will provide close monitoring of each study to ensure steady progress of the trial 
and the safety of its participants. The PI will be in daily contact with study personnel and 
will actively oversee participant recruitment and enrollment, intervention administration, 
and all data collection activities. The research team will have weekly meetings to monitor 
the progress the study. 
At the end of every experimental session, the research assistant will document whether 1) 
any problems that occurred during the lab session (e.g., session started late; computer 
problems; participant could not produce sufficient saliva; participant continued to 
experience psychological distress after the debriefing procedure), 2) whether the 
participant indicated that their data should be kept or discarded (and if so, why), and/or 3) 
if a participant decided to withdraw from the study (and if so, why). The research 
assistant will be instructed to inform Dr. Gerend immediately after the lab session if 
a participant decides to have their data discarded, if a participant continues to 
exhibit psychological distress after the debriefing process, or if a participant decides 
to withdraw from the study.  
In order to assure privacy for participants and to minimize risk, we will be primarily 
using computer-based data collection procedures. This reduces the number of people who 
view the data and increases self-disclosure on sensitive topics. Access to the data will be 
password protected. 
Each participant will be given a random unique identifier in the data set that will be 
stripped of all personal information to protect confidentiality. Data sets used for analysis 
will contain participant identification numbers but neither names nor other identifying 
information such as home address. Identification information will be retained by the PI 
for the duration of the project and stored separately from the responses provided by 
subjects. Collaborators will receive data stripped of personal identifiers (de-identified 
data). To ensure complete confidentiality, access to the “key” linking personally 
identifiable information to the participant’s ID will be restricted to the PI. Reports will 
not identify individual participants. Dr. Gerend will oversee the data storage and 
reporting procedures. De-identified data will be stored into perpetuity. The “key” linking 
personally identifiable information to the participant’s ID in the data set will be destroyed 
at the end of the project. Reports will only use aggregated data. All study staff will be 
trained in security and confidentiality procedures before receiving access to any 
participant data. 
Adverse Events. The PI will review the progress of the project and data being collected to 
ensure that potential adverse effects are identified, if they occur, and reported to the 

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Committees for the Protection of Human Subjects. Any action recommended by these 
boards to the PI will be implemented immediately in order to determine actions to be 
taken to minimize further risk. The adverse event report will further be communicated to 
other entities (e.g., NIH) in a timely manner as appropriate based on their policies. The PI 
will also be responsible for reporting to the program director if the IRB or any other 
entity temporarily or permanently suspends an NIH-funded trial.  
Unanticipated problems involving risks to subjects or others will be promptly reported by 
the PI to the IRB. The PI will also notify the project officer of any study modifications or 
suspension imposed by the IRB (in response to adverse events). All notifications will be 
done via email immediately followed with a certified letter. 
 
19.0 Provisions to Protect the Privacy Interests of Subjects 
Steps will be taken to protect subjects’ privacy interests. During recruitment, 
potential participants will decide for themselves whether they would like to 
answer the questions in the online screening survey and/or provide their contact 
information to be enrolled in the study. Participants who are eligible for the study 
will be contacted by the project coordinator to take the baseline survey and 
schedule their lab-based session. Participants who are no longer interested in 
taking part in the study will be able to decline participation at any time.  
Data collection procedures will take into account privacy interests by using 
computer surveys that will be completed in private and at the participant’s own 
pace. We will follow best practices for survey design and ask sensitive questions 
in a respectful manner. Sensitive questions (e.g., annual income) will include a 
“prefer not to answer” option.  
The research team will not be permitted to access any additional sources of 
information about subjects beyond data provided in their screening survey, 
baseline survey, or during the lab-based study itself.  
20.0 Compensation for Research-Related Injury 
It is not anticipated that participants in this study will experience research-related 
injury. In the event that a participant experiences a research-related injury the 
participant will be instructed to contact the investigator to report the issue and to 
contact their primary care physician for medical care. Generally, this care will be 
billed to the participant, their insurance, or another third party. In the event that a 
participant experiences a research-related injury, Florida State University is not 
able to offer financial compensation nor to absorb the costs of medical treatment.  
21.0 Economic Burden to Subjects 
N/A 
22.0 Consent Process 
Participants interested in taking part in the study will be sent a link to the baseline survey 
by the study coordinator. The baseline survey will begin with the informed consent form. 
Participants will be asked to ‘sign’ the e-consent form by typing their name. Participants 

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will not be allowed to complete any study procedures (including the baseline survey) 
until they have completed the informed consent form.  
At the start of lab visit (which will take place approximately one week later), the 
experimenter will review key information about the study from the consent form and ask 
participants if they have any questions about the study or their rights as a participant. 
After all questions are answered to the participant’s satisfaction, the study will begin.  
The experimenter will follow SOP: Informed Consent Process for Research (HRP-090). 
Alteration of Consent Process 
As this research involves deception, the true purpose of the study will not be disclosed in 
the consent form. The true purpose of the study will be provided during the debriefing. 
The research could not practically be carried out without this alteration. To further mask 
the focus of the study, information that would traditionally be included the informed 
consent form for clinical trials such as circumstances that make a participant eligible 
(e.g., having a BMI ≥ 30) or ineligible for the study (e.g., having participated in one of 
our previous studies on weight stigma) will not be included. Further, the consent form 
will not mention that participants will be randomized to receive the experimental vs. 
control manipulation, however, this information will be revealed and discussed during the 
debriefing process.   
ClinicalTrials.gov Requirements 
The clinical trial proposed in this application will be registered on ClinicalTrials.gov. An 
unsigned copy of the IRB-approved consent form will be posted to the ClinicalTrials.gov 
site as required by NIH.  
23.0 Process to Document Consent in Writing 
As informed consent will be obtained electronically at the beginning of the baseline 
survey, participants will be asked to ‘sign’ the e-consent form by typing their name into 
the survey. Please see attached consent document for details.  
Participants who would like a copy of the consent form will be informed they can print or 
save a copy of the screen. Additionally, participants can request a hard copy of the 
consent form from the experimenter during the lab visit. This information will be 
included at the end of the consent form.    
24.0 Setting 
Participants will be recruited from the local Tallahassee community and the 
surrounding area (e.g., Thomasville, Crawfordville). Following procedures used 
in our pilot work, we will use a variety of recruitment strategies (e.g., flyers, 
online ads, community outreach). Ads for the study will be distributed in the local 
Tallahassee community via flyers, online message boards (e.g., Craig’s List), and 
social media sites (e.g., Facebook).  
To facilitate recruitment of a racially/ethnically diverse sample, we have partnered with 
the FSU Center for Translational Behavioral Science’s (CTBS) Community Engagement 
Core. The Community Engagement Core provides community liaison services, consults 
on engagement methodology, and facilitates the Community Advisory Council. The 

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Council is a community advisory group comprised of area health care providers, 
professionals, and community members who have come together to enhance CTBS's 
mission toward effective community engagement in research. The Community 
Engagement Core is facilitated by Dr. Ennis and Dr. Pickett who serve as liaisons 
between investigators and the Council to engage relevant community partnerships needed 
to facilitate participant engagement and recruitment. As leaders of local community-
based organizations, Council members also provide stakeholder input to facilitate 
recruitment. Participants will be recruited via direct outreach to locations such as local 
churches and community-based organizations.  
Participants will complete the online baseline survey at their own convenience in a 
location of their choosing.  
The lab-based portion of the study will take place on campus at Florida State 
University. Data collection will take place in a private room in the lab of co-
investigator, Dr. Jon Maner, Department of Psychology.  
25.0 Resources Available 
The investigative team has the necessary skills, experience, and resources to 
successfully carry out the proposed project. The team has a successful history of 
collaboration and experience conducting similar studies in a laboratory setting.  
• 
As roughly two thirds of U.S. adults are overweight or obese, the team 
will have access to a large pool of potential participants for the study.  
• 
Dr. Gerend will devote approximately 20% effort to this study to ensure 
timely completion of the project.  
• 
Dr. Gerend will train all study staff and research assistants assisting with 
this research. Further, the PI will meet with the research team weekly to 
discuss study progress and any other important information relevant to 
conducting the study.  
 
The study team consists of six FSU faculty members and one external faculty 
member from UCLA, Dr. A. Janet Tomiyama. Dr. Tomiyama will not be engaged 
with data collection (i.e., obtaining informed consent from participants, running 
participants through the study) and thus the FSU IRB does not need to serve as 
her IRB of record.   
 
26.0 Multi-Site Research 
The study is NOT a multi-site project.  
 
 
 

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References 
1. 
Krieger N. Discrimination and health inequities. Int J Health Serv. 2014;44(4):643-
710. doi:10.2190/HS.44.4.b 
2. 
Mays VM, Cochran SD, Barnes NW. Race, race-based discrimination, and health 
outcomes among African Americans. Annu Rev Psychol. 2007;58:201-25. 
doi:10.1146/annurev.psych.57.102904.190212 
3. 
Pascoe EA, Richman LS. Perceived discrimination and health: A meta-analytic 
review. Psychol Bull. Jul 2009;135(4):531-554. doi:10.1037/a0016059 
4. 
Williams DR, Neighbors HW, Jackson JS. Racial/ethnic discrimination and health: 
findings from community studies. Am J Public Health. Feb 2003;93(2):200-8. 
doi:10.2105/ajph.93.2.200 
5. 
Pearl RL. Weight bias and stigma: Public health implications and structural 
solutions. Soc Iss Policy Rev. Jan 2018;12(1):146-182. doi:10.1111/sipr.12043 
6. 
Puhl RM, Heuer CA. Obesity stigma: Important considerations for public health. 
Am J Public Health. Jun 2010;100(6):1019-1028. doi:10.2105/Ajph.2009.159491 
7. 
Himmelstein MS, Puhl RM, Quinn DM. Intersectionality: An understudied 
framework for addressing weight stigma. American Journal of Preventive Medicine. 
Oct 2017;53(4):421-431. doi:10.1016/j.amepre.2017.04.003 
8. 
Puhl RM, Heuer CA. The stigma of obesity: A review and update. Obesity. May 
2009;17(5):941-64. doi:10.1038/oby.2008.636 
9. 
Spahlholz J, Baer N, Konig HH, Riedel-Heller SG, Luck-Sikorski C. Obesity and 
discrimination - A systematic review and meta-analysis of observational studies. 
Obes Rev. Jan 2016;17(1):43-55. doi:10.1111/obr.12343 
10. Phelan SM, Burgess DJ, Yeazel MW, Hellerstedt WL, Griffin JM, van Ryn M. 
Impact of weight bias and stigma on quality of care and outcomes for patients with 
obesity. Obes Rev. Apr 2015;16(4):319-26. doi:10.1111/obr.12266 
11. Puhl RM, Brownell KD. Confronting and coping with weight stigma: an 
investigation of overweight and obese adults. Obesity Oct 2006;14(10):1802-15. 
doi:10.1038/oby.2006.208 
12. Jackson SE, Beeken RJ, Wardle J. Perceived weight discrimination and changes in 
weight, waist circumference, and weight status. Obesity Dec 2014;22(12):2485-8. 
doi:10.1002/oby.20891 
13. Puhl RM, Himmelstein MS, Pearl RL. Weight stigma as a psychosocial contributor 
to obesity. American Psychologist. Feb-Mar 2020;75(2):274-289. 
doi:10.1037/amp0000538 
14. Sutin AR, Terracciano A. Perceived weight discrimination and obesity. Plos One. 
Jul 24 2013;8(7)doi:10.1371/journal.pone.0070048 
15. Major B, Tomiyama AJ, Hunger J. The negative and bidirectional effects of weight 
stigma on health In: Major B, Dovidio JF, Link BG, eds. The Oxford Handbook of 
Stigma, Discrimination, and Health Oxford University Press; 2018:499-520. 
16. Sutin AR, Stephan Y, Terracciano A. Weight discrimination and risk of mortality. 
Psychol Sci. Nov 2015;26(11):1803-1811. doi:10.1177/0956797615601103 
17. Udo T, Grilo CM. Cardiovascular disease and perceived weight, racial, and gender 
discrimination in U.S. adults. J Psychosom Res. Sep 2017;100:83-88. 
doi:10.1016/j.jpsychores.2017.07.007 

PROTOCOL TITLE: Decision Making Study  
 
Page 32 of 38 
Revised: August 12, 2022 
 
18. Udo T, Purcell K, Grilo CM. Perceived weight discrimination and chronic medical 
conditions in adults with overweight and obesity. International Journal of Clinical 
Practice. Dec 2016;70(12):1003-1011. doi:10.1111/ijcp.12902 
19. Sutin AR, Stephan Y, Luchetti M, Terracciano A. Perceived weight discrimination 
and C-reactive protein. Obesity (Silver Spring). Sep 2014;22(9):1959-61. 
doi:10.1002/oby.20789 
20. Tomiyama AJ. Stress and obesity. Annual Review of Psychology. Jan 4 
2019;70:703-718. doi:10.1146/annurev-psych-010418-102936 
21. Tomiyama AJ, Epel ES, McClatchey TM, et al. Associations of weight stigma with 
cortisol and oxidative stress independent of adiposity. Health Psychol. Aug 
2014;33(8):862-7. doi:10.1037/hea0000107 
22. Vadiveloo M, Mattei J. Perceived weight discrimination and 10-year risk of 
allostatic load among US adults. Ann Behav Med. Feb 2017;51(1):94-104. 
doi:10.1007/s12160-016-9831-7 
23. Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity and severe 
obesity among adults: United States, 2017-2018. NCHS Data Brief. Feb 
2020;(360):1-8.  
24. Ward ZJ, Bleich SN, Cradock AL, et al. Projected U.S. state-level prevalence of 
adult obesity and severe obesity. N Engl J Med. Dec 19 2019;381(25):2440-2450. 
doi:10.1056/NEJMsa1909301 
25. Fryar CD, Carroll MD, Afful J. Prevalence of overweight, obesity, and severe 
obesity among adults aged 20 and over: United States, 1960–1962 through 2017–
2018. 2020.  
26. Tomiyama AJ. Weight stigma is stressful. A review of evidence for the Cyclic 
Obesity/Weight-Based Stigma model. Appetite. Nov 1 2014;82:8-15. 
doi:10.1016/j.appet.2014.06.108 
27. Tomiyama AJ, Carr D, Granberg EM, et al. How and why weight stigma drives the 
obesity 'epidemic' and harms health. BMC Medicine. Aug 15 2018;16(1):123. 
doi:10.1186/s12916-018-1116-5 
28. Hatzenbuehler ML, Keyes KM, Hasin DS. Associations between perceived weight 
discrimination and the prevalence of psychiatric disorders in the general population. 
Obesity Nov 2009;17(11):2033-9. doi:10.1038/oby.2009.131 
29. Danielsdottir S, O'Brien KS, Ciao A. Anti-fat prejudice reduction: a review of 
published studies. Obes Facts. Feb 2010;3(1):47-58. doi:10.1159/000277067 
30. Hatzenbuehler ML. How does sexual minority stigma "get under the skin"? A 
psychological mediation framework. Psychol Bull. Sep 2009;135(5):707-730. 
doi:10.1037/a0016441 
31. Williams DR, Mohammed SA. Discrimination and racial disparities in health: 
Evidence and needed research. J Behav Med. Feb 2009;32(1):20-47. 
doi:10.1007/s10865-008-9185-0 
32. Han S, Agostini G, Brewis AA, Wutich A. Avoiding exercise mediates the effects 
of internalized and experienced weight stigma on physical activity in the years 
following bariatric surgery. BMC Obes. 2018;5:18. doi:10.1186/s40608-018-0195-3 
33. Jackson SE, Steptoe A. Association between perceived weight discrimination and 
physical activity: a population-based study among English middle-aged and older 
adults. BMJ Open. Mar 7 2017;7(3):e014592. doi:10.1136/bmjopen-2016-014592 

PROTOCOL TITLE: Decision Making Study  
 
Page 33 of 38 
Revised: August 12, 2022 
 
34. Sutin A, Robinson E, Daly M, Terracciano A. Weight discrimination and unhealthy 
eating-related behaviors. Appetite. Jul 1 2016;102:83-9. 
doi:10.1016/j.appet.2016.02.016 
35. Vartanian LR, Porter AM. Weight stigma and eating behavior: A review of the 
literature. Appetite. Jul 1 2016;102:3-14. doi:10.1016/j.appet.2016.01.034 
36. Sheeran P, Klein WM, Rothman AJ. Health behavior change: Moving from 
observation to intervention. Annu Rev Psychol. Jan 3 2017;68:573-600. 
doi:10.1146/annurev-psych-010416-044007 
37. Brochu PM, Dovidio JF. Would you like fries (380 calories) with that? Menu 
labeling mitigates the impact of weight-based stereotype threat on food choice 
Social Psychological and Personality Science. 2014;5(4):414-421.  
38. Schvey NA, Puhl RM, Brownell KD. The impact of weight stigma on caloric 
consumption. Obesity (Silver Spring). Oct 2011;19(10):1957-62. 
doi:10.1038/oby.2011.204 
39. Seacat JD, Dougal SC, Roy D. A daily diary assessment of female weight 
stigmatization. J Health Psychol. 2016;21:228-240.  
40. Blodorn A, Major B, Hunger J, Miller C. Unpacking the psychological weight of 
weight stigma: A rejection-expectation pathway. J Exp Soc Psychol. Mar 1 
2016;63:69-76. doi:10.1016/j.jesp.2015.12.003 
41. Hunger JM, Blodorn A, Miller CT, Major B. The psychological and physiological 
effects of interacting with an anti-fat peer. Body Image. Dec 2018;27:148-155. 
doi:10.1016/j.bodyim.2018.09.002 
42. Major B, Eliezer D, Rieck H. The psychological weight of weight stigma. Social 
Psychological and Personality Science. 2012;3(6):651-658.  
43. Major B, Hunger JM, Bunyan DP, Miller CT. The ironic effects of weight stigma. 
Journal of Experimental Social Psychology. 2014;51:74-80.  
44. Schvey NA, Puhl RM, Brownell KD. The stress of stigma: Exploring the effect of 
weight stigma on cortisol reactivity. Psychosom Med. Feb 2014;76(2):156-62. 
doi:10.1097/PSY.0000000000000031 
45. Himmelstein MS, Incollingo Belsky AC, Tomiyama AJ. The weight of stigma: 
Cortisol reactivity to manipulated weight stigma. Obesity. Feb 2015;23(2):368-74. 
doi:10.1002/oby.20959 
46. Gerend MA, Patel S, Ott N, et al. A qualitative analysis of people's experiences 
with weight-based discrimination. Psychology & Health. May 12 2021:1-18. 
doi:10.1080/08870446.2021.1921179 
47. Gerend MA, Patel S, Ott N, et al. Coping with weight discrimination: Findings from 
a qualitative study. Stigma & Health. 2021;6(4):440-449. doi:10.1037/sah0000335 
48. Gerend MA, Sutin AR, Terracciano A, Maner JK. The role of psychological 
attribution in responses to weight stigma. Obesity Science & Practice. Oct 
2020;6(5):473-483. doi:10.1002/osp4.437 
49. Eisenberger NI, Lieberman MD, Williams KD. Does rejection hurt? An FMRI 
study of social exclusion. Science. Oct 10 2003;302(5643):290-2. 
doi:10.1126/science.1089134 
50. Maner JK, DeWall CN, Baumeister RF, Schaller M. Does social exclusion motivate 
interpersonal reconnection? Resolving the "porcupine problem". J Pers Soc 
Psychol. Jan 2007;92(1):42-55. doi:10.1037/0022-3514.92.1.42 

PROTOCOL TITLE: Decision Making Study  
 
Page 34 of 38 
Revised: August 12, 2022 
 
51. Tsai N, Eccles JS, Jaeggi SM. Stress and executive control: mechanisms, 
moderators, and malleability. Brain and Cognition. 2019;13:54-59.  
52. Nelson TD, Mize Nelson J, Alex Mason W, Tomaso CC, Kozikowski CB, Andrews 
Espy K. Executive control and adolescent health: Toward a conceptual framework. 
Adolesc Res Rev. Mar 2019;4(1):31-43. doi:10.1007/s40894-018-0094-3 
53. Snider SE, DeHart WB, Epstein LH, Bickel WK. Does delay discounting predict 
maladaptive health and financial behaviors in smokers? Health Psychol. Jan 
2019;38(1):21-28. doi:10.1037/hea0000695 
54. Daugherty JR, Brase GL. Taking time to be healthy: Predicting health behaviors 
with delay discounting and time perspective. Personality and Individual 
Differences. 2010;48:202-207.  
55. Pedersen SS, von Kanel R, Tully PJ, Denollet J. Psychosocial perspectives in 
cardiovascular disease. Eur J Prev Cardiol. Jun 2017;24(3_suppl):108-115. 
doi:10.1177/2047487317703827 
56. Suls J, Bunde J. Anger, anxiety, and depression as risk factors for cardiovascular 
disease: the problems and implications of overlapping affective dispositions. 
Psychol Bull. Mar 2005;131(2):260-300. doi:10.1037/0033-2909.131.2.260 
57. Cheung MSP, Gilbert P, Irons C. An exploration of shame, social rank and 
rumination in relation to depression. Personality and Individual Differences. 
2004;36:1143-1153.  
58. Dickerson SS, Gruenewald TL, Kemeny ME. When the social self is threatened: 
Shame, physiology, and health. J Pers. Dec 2004;72(6):1191-216. 
doi:10.1111/j.1467-6494.2004.00295.x 
59. Vartanian LR, Pinkus RT, Smyth J. Experiences of weight stigma in everyday life: 
Implications for health motivation. Stigma & Health. 2018;3:85-92.  
60. Finch LE, Tomiyama AJ. Comfort eating, psychological stress, and depressive 
symptoms in young adult women. Appetite. Dec 2015;95:239-44. 
doi:10.1016/j.appet.2015.07.017 
61. Enserro DM, Vasan RS, Xanthakis V. Twenty-year trends in the American Heart 
Association cardiovascular health score and impact on subclinical and clinical 
cardiovascular disease: The Framingham Offspring Study. J Am Heart Assoc. May 
17 2018;7(11)doi:10.1161/JAHA.118.008741 
62. Lloyd-Jones DM, Hong Y, Labarthe D, et al. Defining and setting national goals for 
cardiovascular health promotion and disease reduction: the American Heart 
Association's strategic Impact Goal through 2020 and beyond. Circulation. Feb 2 
2010;121(4):586-613. doi:10.1161/CIRCULATIONAHA.109.192703 
63. Mozaffarian D, Wilson PW, Kannel WB. Beyond established and novel risk 
factors: lifestyle risk factors for cardiovascular disease. Circulation. Jun 10 
2008;117(23):3031-8. doi:10.1161/CIRCULATIONAHA.107.738732 
64. Pencina MJ, D'Agostino RB, Sr., Larson MG, Massaro JM, Vasan RS. Predicting 
the 30-year risk of cardiovascular disease: the framingham heart study. Circulation. 
Jun 23 2009;119(24):3078-84. doi:10.1161/CIRCULATIONAHA.108.816694 
65. Major B, Rathbone JA, Blodorn A, Hunger JM. The countervailing effects of 
weight stigma on weight-loss motivation and perceived capacity for weight control. 
Personality and Social Psychology Bulletin. Sep 2020;46(9):1331-1343. 
doi:10.1177/0146167220903184 

PROTOCOL TITLE: Decision Making Study  
 
Page 35 of 38 
Revised: August 12, 2022 
 
66. Hatzenbuehler ML, Nolen-Hoeksema S, Dovidio J. How does stigma "get under the 
skin"?: The mediating role of emotion regulation. Psychol Sci. Oct 
2009;20(10):1282-9. doi:10.1111/j.1467-9280.2009.02441.x 
67. Simone M, Lockhart G. Two distinct mediated pathways to disordered eating in 
response to weight stigmatization and their application to prevention programs. J 
Am Coll Health. Oct 2016;64(7):520-6. doi:10.1080/07448481.2016.1188106 
68. Cacioppo JT, Hawkley LC. Social isolation and health, with an emphasis on 
underlying mechanisms. Perspect Biol Med. Summer 2003;46(3 Suppl):S39-52.  
69. Cornwell EY, Waite LJ. Social disconnectedness, perceived isolation, and health 
among older adults. J Health Soc Behav. Mar 2009;50(1):31-48. 
doi:10.1177/002214650905000103 
70. Watson J, Nesdale D. Rejection sensitivity, social withdrawal, and loneliness in 
young adults. Journal of Applied Social Psychology 2012;42:1984-2005.  
71. Knox SS, Uvnas-Moberg K. Social isolation and cardiovascular disease: an 
atherosclerotic pathway? Psychoneuroendocrinology. Nov 1998;23(8):877-90. 
doi:10.1016/s0306-4530(98)00061-4 
72. Steptoe A, Kivimaki M. Stress and cardiovascular disease. Nat Rev Cardiol. Apr 3 
2012;9(6):360-70. doi:10.1038/nrcardio.2012.45 
73. Valtorta NK, Kanaan M, Gilbody S, Ronzi S, Hanratty B. Loneliness and social 
isolation as risk factors for coronary heart disease and stroke: systematic review and 
meta-analysis of longitudinal observational studies. Heart. Jul 1 
2016;102(13):1009-16. doi:10.1136/heartjnl-2015-308790 
74. McCleary-Gaddy AT, Miller CT, Grover KW, Hodge JJ, Major B. Weight stigma 
and hypothalamic-pituitary-adrenocortical axis reactivity in individuals who are 
overweight. Ann Behav Med. Mar 20 2019;53(4):392-398. doi:10.1093/abm/kay042 
75. Lavie CJ, Milani RV, Ventura HO. Obesity and cardiovascular disease: risk factor, 
paradox, and impact of weight loss. J Am Coll Cardiol. May 26 2009;53(21):1925-
32. doi:10.1016/j.jacc.2008.12.068 
76. Van Gaal LF, Mertens IL, De Block CE. Mechanisms linking obesity with 
cardiovascular disease. Nature. Dec 14 2006;444(7121):875-80. 
doi:10.1038/nature05487 
77. Zalesin KC, Franklin BA, Miller WM, Peterson ED, McCullough PA. Impact of 
obesity on cardiovascular disease. Endocrinol Metab Clin North Am. Sep 
2008;37(3):663-84, ix. doi:10.1016/j.ecl.2008.06.004 
78. Lillis J, Luoma JB, Levin ME, Hayes SC. Measuring weight self-stigma: The 
weight self-stigma questionnaire. Obesity May 2010;18(5):971-6. 
doi:10.1038/oby.2009.353 
79. Pearl RL, Puhl RM. Measuring internalized weight attitudes across body weight 
categories: validation of the modified weight bias internalization scale. Body Image. 
Jan 2014;11(1):89-92. doi:10.1016/j.bodyim.2013.09.005 
80. Durso LE, Latner JD. Understanding self-directed stigma: development of the 
weight bias internalization scale. Obesity. Nov 2008;16:S80-S86. 
doi:10.1038/oby.2008.448 
81. Hayward LE, Vartanian LR, Pinkus RT. Coping with weight stigma: development 
and validation of a Brief Coping Responses Inventory. Obesity Science & Practice. 
Dec 2017;3(4):373-383. doi:10.1002/osp4.125 

PROTOCOL TITLE: Decision Making Study  
 
Page 36 of 38 
Revised: August 12, 2022 
 
82. Soto CJ, John OP. The next Big Five Inventory (BFI-2): developing and assessing a 
hierarchical model with 15 facets to enhance bandwidth, fidelity, and predictive 
power. J Pers Soc Psychol. Jul 2017;113(1):117-143. doi:10.1037/pspp0000096 
83. Neff KD. The development and validation of a scale to measure self-compassion. 
Self Identity. 2003;2(3):223-250. doi:10.1080/15298860390209035 
84. Serfass DG, Sherman RA. Personality and perceptions of situations from the 
Thematic Apperception Test. Journal of Research in Personality. 2013;47:708-718. 
doi:doi:10.1016/j.jrp.2013.06.007 
85. Bogg T, Roberts BW. Conscientiousness and health-related behaviors: a meta-
analysis of the leading behavioral contributors to mortality. Psychol Bull. Nov 
2004;130(6):887-919. doi:10.1037/0033-2909.130.6.887 
86. Hayward LE, Vartanian LR, Pinkus RT. Weight stigma predicts poorer 
psychological well-being through internalized weight bias and maladaptive coping 
responses. Obesity Apr 2018;26(4):755-761. doi:10.1002/oby.22126 
87. Himmelstein MS, Puhl RM, Quinn DM. Weight stigma and health: The mediating 
role of coping responses. Health Psychology. Feb 2018;37(2):139-147. 
doi:10.1037/hea0000575 
88. Grollman EA. Multiple disadvantaged statuses and health: the role of multiple 
forms of discrimination. Journal of Health and Social Behavior. Mar 2014;55(1):3-
19. doi:10.1177/0022146514521215 
89. Olvera N, Dempsey A, Gonzalez E, Abrahamson C. Weight-related teasing, 
emotional eating, and weight control behaviors in Hispanic and African American 
girls. Eating Behaviors. Dec 2013;14(4):513-7. doi:10.1016/j.eatbeh.2013.06.012 
90. Dorsey RR, Eberhardt MS, Ogden CL. Racial/ethnic differences in weight 
perception. Obesity Apr 2009;17(4):790-5. doi:10.1038/oby.2008.603 
91. Grabe S, Hyde JS. Ethnicity and body dissatisfaction among women in the United 
States: a meta-analysis. Psychol Bull. Jul 2006;132(4):622-40. doi:10.1037/0033-
2909.132.4.622 
92. Hebl MR, King EB, Perkins A. Ethnic differences in the stigma of obesity: 
Identification and engagement with a thin ideal. Journal of Experimental Social 
Psychology. 2009;45:1165-1172.  
93. Pepper AC, Ruiz SY. Acculturation's influence on antifat attitudes, body image and 
eating behaviors. Eat Disord. Oct-Dec 2007;15(5):427-47. 
doi:10.1080/10640260701667912 
94. van den Berg P, Neumark-Sztainer D, Eisenberg ME, Haines J. Racial/ethnic 
differences in weight-related teasing in adolescents. Obesity (Silver Spring). Nov 
2008;16 Suppl 2:S3-10. doi:10.1038/oby.2008.445 
95. Wellman JD, Araiza AM. Examining the impact of perceived weight discrimination 
on reported eating and exercise among White and Latino/a adults. Eat Behav. May 
15 2021;42:101529. doi:10.1016/j.eatbeh.2021.101529 
96. da Matta A, Goncalves FL, Bizarro L. Delay discounting: Concepts and measures. 
Psychology and Neuroscience. 2012;5:135-146.  
97. Koffarnus M, Bickel WK. A 5-trial adjusting delay discounting task: Accurate 
discount rates in less than one minute. Experimental and Clinical 
Psychopharmacology. 2014;22:222-228.  

PROTOCOL TITLE: Decision Making Study  
 
Page 37 of 38 
Revised: August 12, 2022 
 
98. MacLeod CM. Half a century of research on the Stroop effect: An integrative 
review. Psychol Bull. Mar 1991;109(2):163-203. doi:10.1037/0033-2909.109.2.163 
99. Scarpina F, Tagini S. The Stroop color and word test. Front Psychol. 2017;8:557. 
doi:10.3389/fpsyg.2017.00557 
100. Watson D, Clark LA. The PANAS-X: Manual for the positive and negative affect 
schedule - Expanded form. 1994:1-27.  
101. Fazzino TL, Rohde K, Sullivan DK. Hyper-Palatable Foods: Development of a 
Quantitative Definition and Application to the US Food System Database. Obesity 
(Silver Spring). Nov 2019;27(11):1761-1768. doi:10.1002/oby.22639 
102. Robinson E, Haynes A, Hardman CA, Kemps E, Higgs S, Jones A. The bogus taste 
test: Validity as a measure of laboratory food intake. Appetite. Sep 1 2017;116:223-
231. doi:10.1016/j.appet.2017.05.002 
103. Ames GE, Heckman MG, Grothe KB, Clark MM. Eating self-efficacy: 
development of a short-form WEL. Eat Behav. Dec 2012;13(4):375-8. 
doi:10.1016/j.eatbeh.2012.03.013 
104. Marcus BH, Selby VC, Niaura RS, Rossi JS. Self-efficacy and the stages of 
exercise behavior change. Res Q Exerc Sport. Mar 1992;63(1):60-6. 
doi:10.1080/02701367.1992.10607557 
105. Schwarzer R, Renner B. Social-cognitive predictors of health behavior: action self-
efficacy and coping self-efficacy. Health Psychol. Sep 2000;19(5):487-95.  
106. Finch LE, Cummings JR, Tomiyama AJ. Cookie or clementine? 
Psychophysiological stress reactivity and recovery after eating healthy and 
unhealthy comfort foods. Psychoneuroendocrinology. Sep 2019;107:26-36. 
doi:10.1016/j.psyneuen.2019.04.022 
107. Gross JJ, John OP. Individual differences in two emotion regulation processes: 
implications for affect, relationships, and well-being. J Pers Soc Psychol. Aug 
2003;85(2):348-62. doi:10.1037/0022-3514.85.2.348 
108. Ibrahim F, Göddertz D, Herzberg PY. An experimental study of the non-self-
serving attributional bias within the impostor phenomenon and its relation to the 
fixed mindset. Current Psychology. September 21, 2022 2022;doi:10.1007/s12144-
022-03486-0 
109. Rousseau FL, McKelvie SJ. Effects of bogus feedback on intelligence test 
performance. J Psychol. Jan 2000;134(1):5-14. doi:10.1080/00223980009600844 
110. Shin DD, Kim SI, Lee MJ, Jiang Y, Bong M. Role of perceived competence and 
task interest in learning from negative feedback. Front Psychol. 2022;13:830462. 
doi:10.3389/fpsyg.2022.830462 
111. Twenge JM, Baumeister RF, DeWall CN, Ciarocco NJ, Bartels JM. Social 
exclusion decreases prosocial behavior. J Pers Soc Psychol. Jan 2007;92(1):56-66. 
doi:10.1037/0022-3514.92.1.56 
112. DeWall CN, Twenge JM, Koole SL, Baumeister RF, Marquez A, Reid MW. 
Automatic emotion regulation after social exclusion: tuning to positivity. Emotion. 
Jun 2011;11(3):623-36. doi:10.1037/a0023534 
113. Roehling MV, Roehling PV, Pichler S. The relationship between body weight and 
perceived weight-related employment discrimination: The role of sex and race. 
Journal of Vocational Behavior 2007;71:300-318.  

PROTOCOL TITLE: Decision Making Study  
 
Page 38 of 38 
Revised: August 12, 2022 
 
114. Baumeister RF, DeWall CN, Ciarocco NJ, Twenge JM. Social exclusion impairs 
self-regulation. J Pers Soc Psychol. Apr 2005;88(4):589-604. doi:10.1037/0022-
3514.88.4.589 
115. Leary MR, Tambor ES, Terdal SK, Downs DL. Self-esteem as an interpersonal 
monitor: The sociometer hypothesis. J Pers Soc Psychol. 1995;68:518-530.  
116. Nezlek JB, Kowalski RM, Leary MR, Blevins T, Holgate S. Personality moderators 
of reactions to interpersonal rejection: Depression and trait self-esteem. Personality 
and Social Psychology Bulletin. 1997;23:1235-1244.  
117. Oaten M, Williams KD, Jones A, Zadro L. The effects of ostracism on self-
regulation in the socially anxious. Journal of Social and Clinical Psychology. 
2008;27:471-504.  
118. Pickett C, Gardner WL, Knowles ML. Getting a cue: The need to belong influences 
attention to subtle social cues. Personality and Social Psychology Bulletin. 
2004;30:1095-1107.  
119. Salvy SJ, Bowker JC, Nitecki LA, Kluczynski MA, Germeroth LJ, Roemmich JN. 
Impact of simulated ostracism on overweight and normal-weight youths' motivation 
to eat and food intake. Appetite. Feb 2011;56(1):39-45. 
doi:10.1016/j.appet.2010.11.140 
120. Pruessner JC, Kirschbaum C, Meinlschmid G, Hellhammer DH. Two formulas for 
computation of the area under the curve represent measures of total hormone 
concentration versus time-dependent change. Psychoneuroendocrinology. Oct 
2003;28(7):916-31. doi:10.1016/s0306-4530(02)00108-7 
121. Hayes AF. Introduction to mediation, moderation, and conditional process 
analysis: A regression-based approach (3rd edition). The Guilford Press; 2022. 
122. Cohen J. Statistical Power Analysis for the Behavioral Sciences 2nd Edition ed. 
Lawrence Erlbaum Associates; 1988.