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Body weight has a long history of functioning as a symbol of one’s beauty, social status, morality, discipline, and health. It has also been a standard inflicted much more intensely on women than men. While US culture has long idealized thinness for women, even at risky extremes, there is growing evidence that weight standards are broadening. Larger bodies are becoming more visible and accepted, while desire for and approval of a thin ideal has diminished. However, the continued widespread prevalence of anti-fat attitudes and stigma leaves uncertainty about just how much weight standards are changing. This study used an online survey (n = 320) to directly compare evaluations of thin, fat, and average size women through measures of negative stereotypes, prejudicial attitudes, and perceptions about quality of life. Results indicated that, as hypothesized, thin women were perceived less favorably than average weight women. However, fat women were perceived less favorably than both average and thin women. Men were harsher than women in their evaluations of only fat women. Additionally, participants being underweight or overweight did not produce an ingroup bias in their evaluations of underweight and overweight targets, respectively. That is, participants did not rate their own group more favorably, with the exception of overweight participants having lower prejudice toward overweight targets. These findings add to the emerging evidence that women’s weight standards are in transition, marked by an increasingly negative perception of thin women, though not necessarily growing positivity toward fat women. This evidence further points toward the need for more extensive research on attitudes of people across the entire weight spectrum.

Despite the unparalleled importance of value within healthcare, value-based models remain underutilised in the procurement of medical devices. Research is needed to understand what factors incentivise standard, low-priced device purchasing as opposed to value-adding devices with potentially higher overall health outcomes. Framed in agency theory, we examine the conditions under which different actors involved in purchasing decisions select premium-priced, value-adding medical devices over low-priced, standard medical devices.

We conducted 2 × 2 × 2 between-subjects scenario-based vignette experiments on three UK-based online samples of managers (n = 599), medical professionals (n = 279) and purchasing managers (n = 449) with subjects randomly assigned to three treatments: (1) cost-saving incentives, (2) risk-sharing contracts and (3) stronger (versus weaker) clinical evidence.

Our analysis demonstrates the harmful effects of intra-organisational cost-saving incentives on value-based purchasing (VBP) adoption; the positive impact of inter-organisational risk-sharing contracts, especially when medical professionals are involved in decision-making; and the challenge of leveraging clinical evidence to support value claims.

Our results demonstrate the need to align incentives in a context with multiple intra- and inter-organisational agency relationships at play, as well as the difficulty of reducing information asymmetry when information is not easily interpretable to all decision-makers. Overall, the intra-organisational agency factors strongly influenced the choices for the inter-organisational agency relationship.

We contribute to VBP in healthcare by examining the role of intra- and inter-organisational agency relationships and incentives concerning VBP (non-) adoption. We also examine how the impact of such mechanisms differs between medical and purchasing (management) professionals.