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Title: Attitudes toward and beliefs about obese persons across Hong Kong and Taiwan : wording effects and measurement invariance
Authors: Tsai, MC
Strong, C
Latner, JD
Lin, YC
Pakpour, AH
Lin, CY 
Wang, SM 
Keywords: Cross-culture
Weight bias
Weight stigma
Young adults
Issue Date: 2019
Publisher: BioMed Central
Source: Health and quality of life outcomes, 30 July 2019, v. 17, 134, p. 1-11 How to cite?
Journal: Health and quality of life outcomes 
Abstract: Background The psychosocial consequences of obesity are important but often underrated. The Attitudes Toward Obese Persons (ATOP) and Beliefs About Obese Persons (BAOP) scales used to measure weight-related bias have little psychometric information, especially in East Asian contexts. The objective of this study was to use rigorous statistical methods to demonstrate the psychometric properties of these two instruments in Hong Kong and Taiwanese college students.
Methods A convenience sample of 707 students was recruited from the universities in Hong Kong and Taiwan. Several competing confirmatory factor analyses (CFAs) were conducted to confirm the factorial structure of the ATOP and BAOP. The best fit models for the ATOP and BAOP were chosen for the examination of the measurement invariance across subcultures. We then compared configurable models with or without loading and/or intercept constrained before correlating the latent constructs between the best models for the ATOP and BAOP.
Results The comparison in multiple CFAs found that the model with one factor and two correlated-wording-method factors outperformed the other models for both the ATOP and BOAP. However, the internal consistency was suboptimal (ATOP: alpha=.56 to .80; BTOP: alpha=.57 to .65) and the measurement invariance was somewhat unsupported among the Hong Kong and Taiwan samples. Moreover, after controlling wording effects, the latent construct of the ATOP was moderately associated with that of BAOP (r=.356; p<.001).
Conclusion Chinese versions of the ATOP and BAOP can be treated as a unidimensional factor for use in Hong Kong and Taiwan university students. However, further refinements of both instruments may be needed before using them to capture the social attitudes and beliefs toward obesity individuals, which is expected to advance our understanding of weight-related bias in East Asian contexts.
EISSN: 1477-7525
DOI: 10.1186/s12955-019-1198-6
Rights: © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0International License (, which permits unrestricted use, distribution, andreproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link tothe Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver( applies to the data made available in this article, unless otherwise stated.
The following publication Tsai, M. C., Strong, C., Latner, J. D., Lin, Y. C., Pakpour, A. H., Lin, C. Y., & Wang, S. M. (2019). Attitudes toward and beliefs about obese persons across Hong Kong and Taiwan: wording effects and measurement invariance. Health and Quality of Life Outcomes, 17, 134, 1-11 is available at
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