Visual Representation of Higher-Weight Individuals in Physical Activity Health Communications: A content analysis of highly visited and trusted health information websites

Objective: Physical activity is recommended to improve a variety of health outcomes. Individuals living in higher-weight bodies are an important target for effective physical activity health communication, yet this population is historically underrepresented in the media and experiences high levels of weight discrimination in the medical and health communities. Imagery is an effective communication strategy that may be particularly impactful because it can elicit especially powerful affective responses and influences on health behavior. The current state of imagery used in physical activity health communications is unknown; thus, the aim of this study is to conduct a content analysis of images depicting people of varying body weights used in online physical activity health communications.Methods: A content analysis was conducted on the five most trafficked websites in 2021 for physical activity information and five highly trusted government websites for health information. Illness representation domains delineated by the common-sense model of health and illness behavior informed which characteristics of the images were coded, including: weight status of the individual, type of physical activity, the rigor and exertion of this activity, affect, clothing, receiving social support, context of weight loss, full versus partial depictions of the body, gender, skin color, and age. One researcher coded all images while a second coded 20% of the sample for interrater reliability. Results: Results indicate that proportions of individuals in higher-weight bodies were significantly lower than expected based upon the US population statistics on bodyweight status. Several stereotypical characteristics of weight representations were present (e.g., higher bodyweight status was associated with more modest clothing), however counter-stereotype patterns were found as well (e.g., rigor of physical activity was not lesser for those of higher bodyweight status). Conclusions: Higher-weight bodies are underrepresented, less likely to be portrayed with social support, more likely to be portrayed in the context of weight loss, and dressed more modestly in physical activity health communications. However, rigor of activity level, and distress and exertion while being active did not differ across bodyweight status. Further reducing stigmatizing images in physical activity health communications may reduce stereotyping and discrimination and allow for more effective health messaging