Intersectionality: An Understudied Framework for Addressing Weight Stigma

Weight-related discrimination, perceived stress and psychological and physical well-being of persons with type 2 diabetes: A mediation analysis

AIMS

The aim of the study was to examine perceived stress as a mediator of the association between weight-related discrimination and physical and psychological well-being among persons with type 2 diabetes (T2D).

METHODS

Data were obtained from 5104 persons with self-reported T2D participating in the All of Us research programme in the United States. The Everyday Discrimination Scale, Cohen's Perceived Stress Scale (PSS) and PROMIS Global Health Scale were used to measure weight-related discrimination, perceived stress and health outcomes (physical and psychological), respectively. Mediation effects of PSS were tested by bootstrapping with 5000 random samples.

RESULTS

Participants were, on average, 63.62 (SD 11.38) years old. Majority of them were female (55.53%), non-Hispanic White (72.61%), married or living with a partner (56.92%), had a household income of <$35,000 (31.99%) and had some college education (33.54%). We found that approximately 18% of study participants reported having experienced weight-related discrimination. We also found that weight-related discrimination was independently associated with poor physical and psychological well-being. These associations were partially mediated by perceived stress such that weight-related discrimination was associated with greater perceived stress, which was in turn associated with poorer physical and psychological well-being.

CONCLUSIONS

Given that weight-related discrimination is associated with poor outcomes through elevated stress, interventions that target stress may disrupt this pathway thereby helping to reduce the health impact of weight-related discrimination. This assertion should, however, be tested in future studies.

Breaking Academic Silos: Pedagogical Recommendations for Equitable Obesity Prevention Training and Research During an Age of Nutrition Polarization

Introduction

Obesity is a preventable chronic condition and a risk factor for poor health and early mortality. Weight stigma and weight-neutral medicine are popular topics in social media that are often at odds with current medical guidelines on obesity treatment and prevention. This conflict may erode the public's trust in science, impede research progress on preventing obesity in marginalized groups, and uphold the ongoing and historical lack of diversity among nutrition trainees.

Methods

The authors conducted a series of student-led dialogue sessions with nutrition graduate students in Boston, Massachusetts, from March to May 2023 to understand perceptions of obesity research, health equity, and racism and discrimination. This article summarizes the lessons learned and provides pedagogical recommendations for jointly addressing obesity at the population level and the recruitment, training, and retention of diverse scholars, clinicians, and public health practitioners.

Results

Dialogue sessions revealed that students perceive a disproportionate focus on the harms of obesity as a chronic disease, highlighting that inadequate attention is given to weight stigma and discrimination. Some participants believed that weight-based discrimination is equally detrimental to individual health and wellbeing as having obesity. Discussions also emphasized the need to pinpoint the multidimensional and cultural manifestations of weight stigma, which necessitates collaboration across social sectors and academic disciplines. Students recognized the urgent need to apply an equity lens to obesity research and teaching but felt limited in their access to experts within nutrition science who specialize in racism, discrimination, eating disorders, and weight stigma.

Conclusions

This study identified concrete opportunities for urgently needed new training and research in population-level obesity prevention, emphasizing antiracism, harm reduction, and elimination of stigma and bias across multiple levels of science and society. Overall, the decision to use the BMI within pedagogy and training must be explicitly stated-research, population surveillance, decision-making, or treatment pedagogy and training-while acknowledging its strengths and limitations across diverse settings. Finally, the social determinants of obesity should incorporate not only weight stigma but also racism and multiple forms of discrimination.

Preliminary evaluation of a brief worksite intervention to reduce weight stigma and weight bias internalization

Weight-based discrimination (WBD) is common and associated with reduced physical and emotional functioning. WBD is common in the workplace, yet no studies have evaluated a WBD intervention delivered in a worksite setting. This study evaluated the feasibility, acceptability, and preliminary effectiveness of a 3-hour, remote-delivered WBD intervention at a large public university. Six workshops including 94 participants (41.76 ± 9.37 y; 92.8% women) were delivered December 2020 through May 2021; 88.3% of participants enrolled in the study and 88.8% of enrolled participants completed pre- and post-intervention surveys. Participants strongly agreed the workshop contributed to a more inclusive work environment (M=4.98 ± 0.2; 1 =Strongly Disagree to 5 =Strongly Agree); and was highly needed (4.9 ± 0.3) and liked (4.8 ± 0.5). Qualitative feedback cited benefits of remote delivery in providing body size anonymity and wanting access to intervention materials and more time for discussion and action steps to reduce WBD. Participants experienced significant, medium reductions in explicit weight bias (ps < .001), significant, small reductions in weight bias internalization (p < .001), and statistically non-significant (p = .08), small-to-medium reductions in implicit bias. Targeting worksites as a delivery mechanism has the potential to reduce WBD, thereby improving the health and well-being of diverse employees and creating a more inclusive workspace.

Sociodemographic predictors of perceived weight discrimination

BACKGROUND

Perceived weight discrimination is associated with increased risk for chronic diseases and reduced life expectancy. Nevertheless, little is known about perceived weight discrimination in racial, ethnic, and sexual minority groups or in individuals at the intersections of those groups. The goal of this study was to identify sociodemographic predictors of perceived weight discrimination.

SUBJECTS/METHODS

A diverse sample of adults (37% Black/African American, 36% Latino, 29% sexual minority) with a body mass index (BMI) ≥ 18.5 kg/m2 were recruited from a national US panel to complete an online survey (N = 2454). Perceived weight discrimination was assessed with the Stigmatizing Situations Survey-Brief (SSI-B). Using hierarchical linear regression analysis, SSI-B scores were predicted from the four sociodemographic characteristics of interest (gender, race, ethnicity, and sexual orientation) while controlling for BMI, age, education, and income (Step 1). At Step 2, all two-way interactions between the four sociodemographic characteristics were added to the model.

RESULTS

At Step 1, higher SSI-B scores were observed for Latino (vs. non-Latino) adults, sexual minority (vs. heterosexual) adults, younger (vs. older) adults, adults with higher (vs. lower) levels of education, and adults with higher (vs. lower) BMI. At Step 2, race interacted with gender, ethnicity, and sexual orientation to predict SSI-B scores such that relatively higher scores were observed for non-Black women, Black men, adults who identified as Black and Latino, and non-Black sexual minority adults.

CONCLUSIONS

Perceived weight discrimination varied across sociodemographic groups, with some subgroups reporting relatively high frequency. Black race appeared to be protective for some subgroups (e.g., Black women), but risk-enhancing for others (e.g., Black men, individuals who identified as Black and Latino). Additional research is needed to identify specific factors that cause certain sociodemographic groups -and indeed, certain individuals-to perceive higher levels of weight discrimination than others.

Female obesity: clinical and psychological assessment toward the best treatment

Obesity is a heterogeneous condition which results from complex interactions among sex/gender, sociocultural, environmental, and biological factors. Obesity is more prevalent in women in most developed countries, and several clinical and psychological obesity complications show sex-specific patterns. Females differ regarding fat distribution, with males tending to store more visceral fat, which is highly correlated to increased cardiovascular risk. Although women are more likely to be diagnosed with obesity and appear more motivated to lose weight, as confirmed by their greater representation in clinical trials, males show better outcomes in terms of body weight and intra-abdominal fat loss and improvements in the metabolic risk profile. However, only a few relatively recent studies have investigated gender differences in obesity, and sex/gender is rarely considered in the assessment and management of the disease. This review summarizes the evidence of gender differences in obesity prevalence, contributing factors, clinical complications, and psychological challenges. In addition, we explored gender differences in response to obesity treatments in the specific context of new anti-obesity drugs.

Negative familial weight talk and weight bias internalization in a US sample of children and adolescents

BACKGROUND

Negative familial weight talk may contribute to higher weight bias internalization in pre- and early adolescents (hereafter referred to as children) and may differ by gender, weight status, and race and ethnicity.

OBJECTIVE

Examine the relationship between negative familial weight talk and weight bias internalization and examine differences by gender, weight status, and race and ethnicity.

METHODS

We cross-sectionally analysed 5th-7th graders (10-15 years old) living in Massachusetts (n = 375, 52.3% girls, 21.3% BMI ≥85th percentile, 54.8% non-Hispanic White). Negative familial weight talk frequency during the past 3 months was self-reported and discretized as 'never,' 'occasionally' (1-9 times) and 'often' (>9 times); the Modified Weight Bias Internalization Scale assessed weight bias internalization. Generalized linear models estimated the relationship between negative familial weight talk and weight bias internalization and sub-analyses estimated the relationship across gender, weight status, and race and ethnicity. Results are summarized as ratios of means (RoM).

RESULTS

Children experiencing negative familial weight talk occasionally (RoM = 1.12, p = 0.024) and often (RoM = 1.48, p < 0.001) had significantly higher weight bias internalization than children who never experienced it. In sub-analyses, experiencing negative familial weight talk often was associated with higher weight bias internalization among girls (RoM = 1.66, p < 0.001), boys (RoM = 1.32, p = 0.007), children with BMI <85th percentile (RoM = 1.44, p = 0.007) and BMI ≥85th percentile (RoM = 1.39, p = 0.001), and non-Hispanic White children (RoM = 1.78, p < 0.001), but not Hispanic (RoM = 1.25, p = 0.085) or non-Hispanic Black children (RoM = 1.20; p = 0.31).

CONCLUSIONS

Frequent negative familial weight talk was associated with higher weight bias internalization across gender and weight status and in non-Hispanic White children only.

Consequences of receiving weight-related advice from a healthcare provider: Understanding the varied experiences of people with higher weight

Healthcare providers regularly give weight-related advice (e.g., behavioral weight loss counseling) to patients with higher weight (BMI ≥30 kg/m2). The U.S. Preventive Services Task Force recommends this practice on the basis that behavioral weight-related advice can motivate patients to attempt weight loss; however, it is also possible that this advice has adverse consequences (e.g., negative psychological reactions). In this study, we examined people's reported reactions to a recent experience of receiving weight-related advice from a healthcare provider. U.S. adults (N = 189) with higher weight who reported having received weight-related advice completed an online survey via Prolific. They answered questions about their most recent experience of receiving weight-related advice, including the purpose of the visit, characteristics of their provider, and characteristics of the advice itself. They also provided demographic information and indicated their trust in healthcare providers and the healthcare system. 90.5% of participants (n = 171) reported having one of three types of reactions to their provider's weight-related advice. Participants (1) felt motivated to change their behaviors and weight; (2) felt bad or guilty about their behaviors and weight; or (3) felt both motivated to change and bad or guilty. Using chi-square tests of independence and one-way ANOVAs, we examined how various participant characteristics and characteristics of the visit, provider, and advice itself differed across these three groups. We found significant demographic differences across the groups and found that a disproportionate amount of people in the "motivated" group reported having requested the weight-related advice and having had a two-way discussion about weight with their provider. Whereas some people feel motivated after receiving weight-related advice from a healthcare provider, others are left feeling bad about themselves or ambivalent. Understanding these varied reactions may provide insights into how healthcare providers can deliver advice that is motivating without eliciting negative psychological reactions.

Weight stigma from romantic partners: Its relations with maladaptive and adaptive coping and depressive symptoms

Social devaluation of being overweight is common in daily life, but little is known about the weight stigma in romantic relationships. The present study investigated the roles of maladaptive and adaptive coping strategies in the relation between the experience of weight stigma in romantic relationships and depressive symptoms in men and women, respectively. Analyses of gender differences and structural equation modeling yielded several findings. First, while men and women experienced similar levels of weight stigma from their romantic partners, women were more likely to use exercise avoidance, disengagement coping, and reappraisal coping strategies, and to exhibit more depressive symptoms than men. Second, men who experienced weight stigma tended to cope with it through exercise avoidance and disengagement coping, which were related to greater depressive symptoms. Men also coped with weight stigma adaptively via reappraisal coping, which was additionally associated with more positive affect. Third, the relation between the experience of weight stigma and depressive symptoms in women was only explained by using disengagement coping. These findings extend the understanding of weight stigma to a specific context and provide some insight that future interventions to reduce the impacts of weight stigma should be tailored accordingly for men and women.

The effect of GLP-1 receptor agonist use on negative evaluations of women with higher and lower body weight

BACKGROUND

GLP-1 receptor agonists (GLP-1 RAs) have dramatically altered obesity treatment. Media reports suggest that GLP-1 RAs users often report feeling judged for taking a "shortcut" to lose weight, which may be related to negative stereotypes toward people with larger bodies. Media reports also describe negative attitudes about lean people who take GLP-1 RAs to enhance their appearance. The present research used a 2 × 2 experimental design to test the effects of GLP-1 RA use and body size on attitudes and egocentric impressions.

SUBJECTS/METHODS

A sample of 357 U.S. adults (Mage = 37.8, SD = 13) were randomly assigned to read about a woman, who either was lean or had obesity, and who lost 15% of her body weight either with diet/exercise or a GLP-1 RA. Participants answered questions measuring endorsement of negative weight-related stereotypes and egocentric attitudes toward the woman, as well as beliefs that she took a shortcut to lose weight and beliefs that biogenetic factors caused her baseline weight.

RESULTS

Negative evaluations and egocentric impressions were stronger toward a woman who lost weight with a GLP-1 RA compared to diet/exercise. Losing weight with a GLP-1 RA led to stronger negative evaluations through higher weight loss shortcut beliefs irrespective of body size. Losing weight with a GLP-1 RA also led to higher egocentric impressions through higher shortcut beliefs, and this effect was stronger for a lean woman. Finally, losing weight with a GLP-1 RA led to more negative evaluations through stronger endorsement of biogenetic causal beliefs for a lean woman only.

CONCLUSIONS

This timely study provides evidence that people with larger and smaller bodies alike are at-risk for being judged for using GLP-1 RAs due to beliefs that these medications are a shortcut. Findings also demonstrate novel reactions related to egotism when weight loss is achieved with pharmacological interventions. PRE-REGISTRATION AND DATA: osf.io/xme4w.

Bright-siding stigma: Older adults' experiences at a higher weight in Atlantic Canada

The lived experiences of higher-weight people vary; homogenous samples may fail to capture this diversity. This study develops an in-depth understanding of the lived experiences of higher-weight (Body Mass Index ⩾ 30) older adults (⩾60 years of age) in a Canadian Atlantic province. Participants (n = 11) were interviewed face-to-face using a semi-structured interview guide twice at 2-to-3-month intervals regarding their perceived treatment in social and health situations; how positive and negative healthcare experiences affected their health, lifestyles and healthcare seeking-behaviour; and recommendations in terms of patient experiences, access and inclusion. Participants infrequently reported negative experiences; however, participants' experiences were informed by uptake of moralistic, neoliberal discourses. Thematic content analysis identified two major themes: active citizenship (participants demonstrated internalisation of the imperative for weight loss, healthy lifestyles and active ageing) and bright-siding (participants expressed that a positive attitude could prevent/help cope with stigma). Results suggest that individualistic, rather than collective, political solutions to health and stigma have been taken up by higher-weight older adults in a Canadian Atlantic province, which may hinder attempts at structural reforms addressing stigma.

A systematic review of weight stigma and disordered eating cognitions and behaviors

Weight stigma is persistent across contexts and is associated with disordered eating cognitions and behaviors. This systematic review aimed to examine the existing literature that has explored the relationship between weight stigma and disordered eating cognitions and behaviors. We specifically examined three dimensions of weight stigma - experienced, anticipated, and internalized - and adopted an inclusive conceptualization of outcomes related to disordered eating (including constructs such as binge eating, body dissatisfaction, and other cognitions and behaviors such as dietary restraint, unhealthy weight control behaviors, and drive for thinness). We searched PubMed, Embase, CINAHL, Web of Science, Sociological Abstracts, and PsycINFO for English-language, peer-reviewed articles and dissertations with quantitative methodology published through October 2023. The search resulted in 242 articles meeting inclusion criteria. A narrative review found a consistent relationship between greater weight stigma and more disordered eating cognitions and behaviors. Methodological and theoretical limitations are discussed, as are critical avenues for future research and potential clinical implications stemming from this body of research. Given the widespread nature and impact of weight stigma on disordered eating, it is imperative that we intervene to address weight stigma at all levels, from the structural to the intrapersonal.

An examination of the unique contributions of body image and internalized weight bias to psychological well-being outcomes

High correlations between measures of internalized weight bias (IWB) and body image (BI) have resulted in concerns that IWB is conceptually redundant with BI. This investigation examined the contribution of the unique variance of BI and IWB on three important, weight-related factors: self-esteem, depressive symptoms, and body shame. The study included 403 participants recruited through a Qualtrics research panel. Participants were required to be aged 18 + and have a BMI > 25. The sample contained three equally represented, self-identified racial/ethnic groups: Black non-Hispanic (N = 140), Hispanic (N = 133), and White non-Hispanic (N = 130). When BI was entered in the first step of the regression model, it accounted for 14-40% of the variance in various models; the addition of IWB in step two contributed 11-18% of unique variance. By contrast, when IWB was entered in the first step, it accounted for 25-56% of the variance in various models, with the addition of BI contributing between 0% and 2% unique variance. Therefore, even with a high correlation among the constructs of IWB and BI, IWB was able to contribute unique variance in predicting depressive symptoms, self-esteem, and body shame, and is not redundant with the construct of BI.

Facilitators and barriers for implementing screening brief intervention and referral for health promotion in a rural hospital in Alberta: using consolidated framework for implementation research

BACKGROUND

Screening, brief intervention, and referral (SBIR) is an evidence-based, comprehensive health promotion approach commonly implemented to reduce alcohol and substance use. Implementation research on SBIR demonstrate that patients find it acceptable, reduces hospital costs, and it is effective. However, SBIR implementation in hospital settings for multiple risk factors (fruit and vegetable consumption, physical activity, alcohol and tobacco use) is still emergent. More evidence is needed to guide SBIR implementation for multiple risk factors in hospital settings.

OBJECTIVE

To explore the facilitators and barriers of SBIR implementation in a rural hospital using the Consolidated Framework for Implementation Research (CFIR).

METHODS

We conducted a descriptive qualitative investigation consisting of both inductive and deductive analyses. We conducted virtual, semi-structured interviews, guided by the CFIR framework. All interviews were audio-recorded, and transcribed verbatim. NVivo 12 Pro was used to organize and code the raw data.

RESULTS

A total of six key informant semi-structured interviews, ranging from 45 to 60 min, were carried out with members of the implementation support team and clinical implementers. Implementation support members reported that collaborating with health departments facilitated SBIR implementation by helping (a) align health promotion risk factors with existing guidelines; (b) develop training and educational resources for clinicians and patients; and (c) foster leadership buy-in. Conversely, clinical implementers reported several barriers to SBIR implementation including, increased and disrupted workflow due to SBIR-related documentation, a lack of knowledge on patients' readiness and motivation to change, as well as perceived patient stigma in relation to SBIR risk factors.

CONCLUSION

The CFIR provided a comprehensive framework to gauge facilitators and barriers relating to SBIR implementation. Our pilot investigation revealed that future SBIR implementation must address organizational, clinical implementer, and patient readiness to implement SBIR at all phases of the implementation process in a hospital.

Weight Stigma in Online News Images: A Visual Content Analysis of Stigma Communication in the Depictions of Individuals with Obesity in U.S. and U.K. News

Weight stigma is a pervasive form of discrimination worldwide. News media, and news images in particular, can reinforce weight stigma by portraying persons with obesity in a negative, stereotypical manner. Informed by the model of stigma communication, this study conducted a content analysis of images accompanying obesity-related news articles from the U.S. and U.K. to determine and compare the prevalence of stigmatizing images. Images (N = 445) in obesity-focused news articles obtained from the top four most viewed online news in the U.S. (n = 244) and U.K. (n = 201) during August 2018-August 2019 were systematically coded. These 445 images featured 228 individuals. Of these 228 individuals, 35% were identified as higher weight and 44% as lower weight. Overall, 70% of persons of higher weight in these news images were depicted in a stigmatizing manner. Further, 46% of individuals with higher weight were depicted with their head partially or fully removed from the image, compared to 25% of individuals with lower weight. Additionally, U.K. news were 2.5 times more likely to contain stigmatizing images than U.S. news. These findings highlight the prevalence of weight stigma in news images and suggest that broader systemic efforts are needed by the news media industry to eliminate the use of negative imagery that marginalizes persons of higher weight.

Weight Stigma Associated With Mental Health Concerns Among College Students

INTRODUCTION

Weight stigma is widespread and exists across numerous domains including health care, educational institutions, workplaces, mass media, and interpersonal relationships. Weight stigma experienced during the college years may be particularly consequential because the college years are a period of increased vulnerability for the development of mental health concerns. The purpose of the present study was to examine how experiences of weight stigma relate to mental health concerns, including symptoms of eating disorders, anxiety, and depression, among college students.

METHODS

Prevalence of interpersonal and anticipated weight stigma was examined among 2,707 students participating in the 2018-2019 and 2019-2020 Healthy Minds Study and tested for differences in prevalence across student characteristics. Logistic regression was used to explore relationships between measures of weight stigma and student mental health. Analyses were conducted in 2021-2023.

RESULTS

Interpersonal and anticipated weight stigma were reported by 12.3% and 15.3% of students, respectively. Experiences of interpersonal and anticipated weight stigma were generally lowest among cisgender male students, heterosexual students, those with the fewest financial concerns, and those who did not perceive themselves to be "overweight." Both interpersonal and anticipated weight stigma were associated with elevated odds of high weight concerns, past-month binge eating, past-month purging, high eating disorder risk, moderate/severe anxiety symptoms, and moderate/severe depressive symptoms.

CONCLUSIONS

Findings implicate interpersonal and anticipated weight stigma as potential risk factors for a range of mental health concerns. Weight stigma is an under-recognized and under-funded public health problem.

Raising awareness of anti-fat stigma in healthcare through lived experience education: a continuing professional development pilot study

BACKGROUND

Anti-fat attitudes and weight-based discrimination are prevalent in healthcare settings and among healthcare practitioners and clinical trainees, and can result in immense harm to patients. There is increasing recognition that anti-fat bias in healthcare is a critical issue that must be addressed, but there is a dearth of evidence demonstrating sustained attitude and behavioural change among clinicians, illustrating a need for more innovative educational approaches and rigorous evaluation. We describe the co-design and delivery of a narrative-based continuing professional development curriculum aimed at raising awareness of weight-based bias and stigma.

METHODS

Our research team of lived experience educators, clinicians and researchers collaboratively developed a series of seven podcast episodes comprised of narrative descriptions of lived experiences with and impacts of weight bias, stigma and discrimination in healthcare settings, as well as a post-podcast workshop to facilitate reflection and discussion between participants. The curriculum was piloted among 20 clinicians practicing at a large urban hospital in Mississauga, Canada. We explored feasibility, acceptability and learning impact by analyzing responses to questionnaires completed following each podcast episode and responses shared during the workshops and follow-up feedback sessions.

RESULTS

We observed high acceptability and feasibility of the curriculum. Participants experienced the podcast as a practical and convenient learning format and the workshop as a valuable opportunity to collectively debrief and reflect. The learning impact of the curriculum was strong; participants described a range of emotions elicited by the podcasts, engaged in self-reflection, and expressed a desire to modify clinical approaches. Barriers to the application of learnings identified by participants include pervasiveness of the use of body mass index (BMI) as an indicator of risk and a criterion for referral; discomfort with difficult conversations; prevalent biomedical understandings about the association between weight and health; and clinicians' defensiveness.

CONCLUSION

This pilot study yielded promising findings and demonstrated potential impact on weight bias and stigma among healthcare providers. Necessary next steps include conducting larger scale, rigorous evaluations of the curriculum among broader populations, both health professions trainees and current healthcare providers.

An Examination of Parental Weight Stigma and Weight Talk Among Socioeconomically and Racially/Ethnically Diverse Parents

Parental communication about body weight can influence children's emotional well-being and eating behaviors. However, little is known about the role of parental self-stigma concerning weight and social position variables (ie, race/ethnicity, income, and gender) in weight communication. This study examined how parents' self-stigmatization for their own weight (ie, weight bias internalization) and self-stigmatization for their child's weight (ie, affiliate stigma) relates to weight talk frequency with their children, and whether these associations vary across parental race/ethnicity, income, and gender. Parents (n = 408) completed a cross-sectional, online survey about their weight communication and self-stigmatization. Linear regression was used to examine the relationships among these variables, including interactions between the stigma variables and social position variables in predicting weight talk. Higher levels of weight bias internalization and affiliate stigma were strongly associated with increased parental weight talk frequency; parents who endorsed higher levels of internalized bias about their own weight expressed greater affiliate stigma for their child's weight, regardless of demographic characteristics or weight status. Associations between the stigma variables and weight talk outcomes were stronger among fathers and parents of higher income. Findings highlight the importance of considering weight stigma variables in parental weight communication research.

The Mental "Weight" of Discrimination: The Relationship between Perceived Interpersonal Weight Discrimination and Suicidality in the United States

Extant research has investigated the relationship between body weight and suicidality because obesity is highly stigmatized, leading to social marginalization and discrimination, yet has produced mixed results. Scholars have speculated that factors associated with body weight, such as weight discrimination, may better predict suicidality than body weight itself. We consider this possibility among a sample of 12,057 adult participants ages 33 to 43 in Wave V of the National Longitudinal Study of Adolescent to Adult Health through investigation of the relationships between weight discrimination and two dimensions of suicidality-suicide ideation and attempts. We also examine gender as a moderator of these relationships. We find that weight discrimination is positively associated with both suicide ideation and attempts, and this relationship is similar among men and women. Our findings underscore the need to address issues of weight discrimination in our society to better promote mental well-being.

Weight Stigma and Mental and Emotional Health Among Sexual and Gender Minority Individuals: A Scoping Review

Purpose: Weight stigma is associated with poor mental and emotional health and may be especially harmful to sexual and gender minority (SGM) individuals due to co-occurring minority stress. The literature on this topic has not been synthesized. We conducted a scoping review of the literature on weight stigma and mental and emotional health among SGM individuals to synthesize findings, highlight gaps, and identify clinical and research implications. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews, we searched PubMed, CINAHL, PsycINFO, and Scopus in April 2022. Included studies examined the relationship between weight stigma and mental and emotional health among SGM people of any age. We did not restrict study design or publication date. Results: Of 513 records identified, 23 met inclusion criteria. Most focused on sexual minority individuals; one focused specifically on gender minority individuals. Weight stigma was associated with poorer mental and emotional health in nearly all studies. The most common outcomes examined were self-esteem, maladaptive eating, and depressive symptoms. Five studies, all using the same dataset, focused on adolescents; none focused on older adults. Conclusions: Weight stigma is associated with poorer mental and emotional health among SGM individuals and, through its intersections with minority stress, might impact SGM individuals differently than their cisgender and heterosexual counterparts. There are important gaps regarding weight stigma's effect on SGM adolescents and gender minority individuals and its relationship with a broader range of mental and emotional health outcomes.

Rural African American Women With Severe Obesity: A Cross-Sectional Analysis of Lifestyle Behaviors and Psychosocial Characteristics

PURPOSE

To examine differences in lifestyle behavioral and psychosocial factors between rural African American women with Class 3 obesity and those with overweight, and Class 1-2 obesity.

DESIGN

Cross-sectional study.

SETTING

Rural Southeastern United States.

SUBJECTS

Participants included 289 African American women with a mean age of 56 years, 66% with a high school education or less, and a mean body mass index (BMI) of 38.6 kg/m2; 35% (n = 102) were classified with Class 3 obesity.

MEASURES

We objectively measured height, weight, and physical activity steps/day. Self-reported dietary and physical activity behaviors, general health-related quality of life, mental health, and social support were measured with validated surveys.

ANALYSIS

Chi-Square analysis for categorical variables and analysis of variance (ANOVA) - via multiple linear regression - for continuous variables.

RESULTS

There were no significant demographic differences between BMI groups, except for age, where women with Class 3 obesity were on average younger (51 vs 58 y, P < .001). Although dietary behaviors did not differ significantly between groups, we observed significant group differences in self-reported and objective measures of physical activity. The age-adjusted difference in means for self-reported total physical activity minutes/wk. was 91 minutes, with women categorized with Class 3 obesity reporting significantly fewer weekly minutes than those with overweight/Class 1-2 obesity (64.3 vs 156.4 min/wk. respectively, P < .01). Among psychosocial variables, only in the physical component scores of health-related quality of life did we find significant group differences - lower physical well-being among women with Class 3 obesity compared to those with overweight/Class 1-2 obesity (P = .02).

CONCLUSION

For African American women with Class 3 obesity living in rural setting, these findings suggest behavioral weight loss interventions may need to target physical activity strategies that address physical, psychosocial, and environmental barriers.

Associations between weight discrimination and the use of potentially harmful dietary supplements during the COVID-19 pandemic in the United States

The dietary supplements industry disproportionately markets potentially harmful products promising weight loss, cleansing/detoxing, and boosted energy and immunity to women. The COVID-19 pandemic heightened consumer concerns around health and body weight, which may have increased women's risks of using supplements, particularly if they had a higher weight and experienced weight discrimination. This study aimed to estimate inequities in prevalence and change in use of weight-loss, cleanse/detox, immunity, and energy supplements in the first year of the pandemic and to assess the extent to which the relationship between weight and supplement use differs across discrimination experiences. We drew upon longitudinal data from cisgender women in the U.S. COVID-19 Pandemic Substudy of the Nurses' Health Study II and 3 and Growing Up Today Study cohorts, collected over 5 waves from April/May 2020 to April 2021 (N = 51,814). Modified Poisson generalized estimating equation models, adjusted for age, cohort, race/ethnicity, wave, and Census region, estimated the relative excess risk due to interaction (RERI) between weight status and weight discrimination on prevalence of supplement use. Weight status categories were derived from body mass index (BMI), and weight discrimination was assessed using the attributions item of the Everyday Discrimination Scale. Baseline prevalence of supplement use was 2.7% for weight-loss, 3.3% for cleanse/detox, 4.2% for energy, and 22.6% for immune. Respondents with BMIs of 25-29.9 kg/m2 and 30-34.9 kg/m2 who experienced weight discrimination had RERI values of 0.89 (95% CI 0.14, 1.65) and 1.00 (95% CI 0.25, 1.75) for weight-loss and 0.57 (95% CI 0.13, 1.02) and 0.60 (95% CI 0.19, 1.01) for energy supplements, respectively, indicating this group had excess risk of use compared to lower BMI respondents who experienced no weight discrimination. The findings demonstrate the disproportionate impact of weight discrimination on use of potentially harmful supplements among cisgender women with higher weights during the pandemic.

Weight stigma, welfare stigma, and political values: Evidence from a representative British survey

Obesity-related stigma is increasingly recognised as a public health issue, with serious implications for mental and physical health. However, very little is known about what drives inter-individual differences in obesity-stigmatizing views, and how they are distributed in the population. If views about obesity are not independent of a person's wider beliefs and values, this must be understood so that obesity stigma can be effectively tackled. In a representative sample of British adults aged 18-97 (N = 2186), we explore predictors of weight-stigmatizing attitudes. We consider demographics, socioeconomic position, factors related to one's own weight and health, and beliefs about the causes and consequences of obesity. We explore the role of core political values which predict views about other stigmatized groups, and views about welfare recipients, who are frequently linked with obesity in public and political discourse. Finally, we assess to what extent demographic differences in weight-stigmatizing attitudes are explained by individual body mass index (BMI), attitudes, and beliefs. Consistent with previous studies, women were less weight-stigmatizing than men. People in late middle-age were less weight-stigmatizing than younger or older adults. Adjusted for age and gender, an index of weight-stigmatizing views was positively associated with income, and highest in intermediate categories of education and occupational social class. Weight-stigmatizing attitudes were associated with more right-wing values, more authoritarian values, and more stigmatizing views about welfare recipients. Factors including own BMI, beliefs about causes of obesity, welfare-stigmatizing attitudes and authoritarian values contributed to socioeconomic differences. Weight-stigmatizing attitudes show clear differences between demographic groups, but also vary according to wider social attitudes, beliefs, and a person's core political values. Efforts to reduce weight stigma, and other kinds of stigma, may be more effective if they recognise these links.

The Influence of Contested Racial Identity and Perceived Everyday Discrimination Exposure on Body Mass Index in US Adults

Contested racial identity-the discrepancy between one's self-identified race and socially assigned race-is a social determinant of health and may contribute to overweight and obesity. Obesity is associated with a host of short- and long-term health conditions, including cardiovascular disease, a leading cause of death. Individuals racialized as Black, Hispanic, and Latino are at the greatest risk of obesity. Previous research indicates that experiencing interpersonal discrimination is associated with higher body mass index (BMI) in adults, and individuals with a contested racial identity are disproportionately exposed to interpersonal discrimination. However, the association between BMI and contested racial identity is unknown. This cross-sectional study measured the relationship between contested racial identity and perceived everyday discrimination on BMI in a nationally representative sample of US adults. Contested racial identity was measured with a binary variable indicating agreement between participants' self-identified race and socially assigned race. Weighted unadjusted and adjusted multiple linear regression models quantified the associations between BMI and contested racial identity with and without the mean discrimination score. Covariates included nativity status, income, education, racial identity salience, gender, and age. Among 1689 participants, 18.3% had a contested racial identity. Contested identity was associated with significantly higher BMI (β = 1.01, 95% CI = 0.06, 1.92), but the relationship was attenuated when adjusting for interpersonal discrimination, suggesting that individuals with contested identity may face a greater risk of obesity due to their disproportionately high exposure to interpersonal racial discrimination. Further research is needed to elucidate the impact of racism on BMI and obesity risk.

Profiles of experienced and internalized weight-based stigma in college students across the weight spectrum: Associations with eating disorder, depression, and anxiety symptoms

OBJECTIVE

Weight stigma comprises negative attitudes and weight-related stereotypes that result in rejection, discrimination, and prejudice against individuals in larger bodies. Both internalized and experienced weight stigma are associated with negative mental health outcomes, yet it remains unknown how types of stigmatizing experiences (e.g., systemic vs. intraindividual), internalized stigma, and weight status relate, or how profiles of weight stigma differentially impact mental health.

METHOD

The current study (N = 1001 undergraduates) used latent profile analysis to identify weight stigma risk profiles and test whether profiles were cross-sectionally associated with eating disorder symptoms, depression, and social appearance anxiety.

RESULTS

The best-fitting solution indicated a class high on all facets of weight stigma, a class low on all facets of weight stigma, and three groups with intermediate levels of weight, weight bias internalization, and experienced weight stigma. Gender, but not ethnicity, was associated with class membership. Classes with higher experienced and internalized stigma had higher eating disorder symptoms, depression, and social appearance anxiety.

CONCLUSION

Findings support the utility of weight stigma profiles in identifying risk for negative mental health outcomes. These findings can inform initiatives to reduce weight stigma among college students, especially among high-risk groups.

Trends in Obesity-Related Mortality and Racial Disparities

BACKGROUND

Across the globe, obesity stands as a prominent public health concern, linked to a heightened susceptibility to a range of metabolic and cardiovascular disorders. This study reveals a disproportionate impact of obesity on African American (AA) communities, irrespective of socioeconomic status. Structural racism plays a critical role in perpetuating healthcare disparities between AA and other racial/ethnic groups in the United States. These disparities are reflected in limited access to nutritious food, safe exercise spaces, health insurance, and medical care, all of which significantly influence healthcare outcomes and obesity prevalence. Additionally, both conscious and unconscious interpersonal racism adversely affect obesity care, outcomes, and patient-healthcare provider interactions among Blacks.

STUDY OBJECTIVE

This study aims to analyze and compare obesity-related mortality rates among AAs, Whites, and other racial groups.

METHODOLOGY

We queried the CDC WONDER dataset, incorporating all US death certificates. During data extraction, various ICD 10 codes were used to denote different obesity categories: E66.1 (drug-induced obesity), E66.2 (severe obesity with alveolar hypoventilation), E66.3 (overweight), E66.8 (other forms of obesity), E66.9 (unspecified obesity), E66.0 (obesity due to excess calorie intake), E66.01 (severe obesity due to excess calories), and E66.09 (other forms of obesity caused by excess calorie intake). Our study encompassed decedents aged ≥15 years, with obesity-related diseases as the underlying cause of death from 2018 to 2021. Sex- and race-specific obesity-related mortality rates were examined for AAs, Whites, and other races. Resultant mortality trends were computed and presented as ratios comparing AA and White populations.

RESULTS

This study reveals lower obesity-related mortality rates in AAs compared to Whites. Furthermore, women exhibited higher rates than men. In the 15 to 24 age bracket, males comprised 60.11% of the 361 deaths, whereas females made up 39.89%. In this demographic, 35.46% of deaths were among Blacks, with 64.54% among Whites. Within the 25 to 34 age group, females constituted 37.26% of the 1943 deaths, and males 62.74%. Whites made up 62.94% of the fatalities, Blacks 33.40%, with other racial groups accounting for the remainder. These trends extended through the 35-44, 45-54, 55-64, 65-74, and 75+ age categories, with variations in death proportions among genders and races. Whites consistently accounted for the highest death percentages across all age groups, followed by Blacks. Our data indicate that obesity-related mortality tends to occur earlier in life.

CONCLUSION

Our results corroborate previous studies linking elevated mortality risk to obesity and overweight conditions. The uniformity of our findings across age groups, as well as genders, supports the proposal for applying a single range of body weight throughout life. Given the ongoing rise in obesity and overweight conditions across the United States, excess mortality rates are projected to accelerate, potentially leading to decreased life expectancy. This highlights the urgency for developing and implementing effective strategies to control and prevent obesity nationwide.

Weight Discrimination and Health Risk Behavior in Racial, Ethnic, and Sexual Minority Adults

BACKGROUND

People with obesity face significant discrimination due to their weight. Exposure to such discrimination is associated with poor health outcomes. Little is known about pathways that explain that association, and even less is known about those pathways in racial, ethnic, and sexual minorities. Health risk behaviors may serve as one such pathway.

PURPOSE

We examined associations between weight discrimination and health risk behaviors and assessed whether associations are moderated by gender, race, ethnicity, or sexual orientation.

METHODS

Quota sampling was used to oversample Black (36%), Latino (36%), and sexual minority (29%) adults (n = 2,632) who completed an online survey. Using regression analysis, health risk behaviors (maladaptive eating behaviors, physical inactivity, sitting, smoking, alcohol use, and sleep disturbance) were predicted from previous experience with weight discrimination while controlling for demographic characteristics, BMI, and depressive symptoms. Additional analyses tested for interactions between weight discrimination and key demographic variables (i.e., gender, race, ethnicity, and sexual minority status).

RESULTS

Weight discrimination was associated with greater emotional eating, binge eating, unhealthy weight control behaviors, cigarette smoking, problematic alcohol use, and sleep disturbance. Gender moderated the association between weight discrimination and binge eating, alcohol use, and physical activity, with stronger effects observed in men than women. Exploratory analyses provided limited evidence for differential effects of weight discrimination across specific combinations of intersecting identities.

CONCLUSIONS

Weight discrimination was associated with engagement in unhealthy behaviors and relationships were largely similar across diverse demographic groups. Health risk behaviors may represent a key pathway through which weight discrimination harms health.

Effect of Weight Self-Stigma on Quality of Life and Dietary Habits among Adult Students in Riyadh, Saudi Arabia

Weight self-stigma (WSS) is a personal experience of negative self-evaluations, perceived discrimination, and shame about body weight. Studies suggested that WSS could negatively affect quality of life, eating behavior, and psychological outcomes. WSS has been linked with a number of obesogenic health outcomes that complicate weight loss interventions. Thus, this study aimed to examine the effect of WSS on the quality of life and dietary habits among adult students. A sample of 385 students from Riyadh universities participated in this cross-sectional study and completed three online questionnaires: the WSS questionnaire, the WHO quality of life questionnaire, and a dietary habit questionnaire. The average age of participants was 24 ± 6.74, and the majority were female (78.4%). Results demonstrated a negative association between all QOL domains and WSS (p < 0.001). Moreover, higher BMI is associated with increased self-devaluation and fear of enacted stigma (p < 0.001). There was also a negative link between both quality and quantity of food with WSS (p < 0.01). No significant difference was seen in study outcomes concerning gender. The findings of this study suggest the importance of increasing awareness about the negative impact of WSS and developing social policies to prevent or decrease it. Additionally, multidisciplinary teams, especially dietitians, should be more aware of WSS when dealing with overweight and obese individuals.

Developing and validating a Japanese version of the Weight Self-Stigma Questionnaire

PURPOSE

Weight bias internalization (WBI) is significantly associated with negative physiological and psychological consequences. Given its negative effects, appropriate measurement of WBI is required for weight management and mental and physical health in people with weight problems. One of the most reliable and frequently used questionnaires to assess WBI is the Weight Self-Stigma Questionnaire (WSSQ). However, a Japanese version of the WSSQ has not yet been developed. Thus, the current study aimed to develop a Japanese version of the WSSQ (WSSQ-J) and validate its psychometric properties in the Japanese context.

METHODS

A total of 1454 Japanese participants (age 34.44 ± 6.92; male = 498) with diverse weight statuses (Body mass index: 21.44 ± 3.52, 13.79-41.40 kg/m²) completed an online survey for the WSSQ-J. The internal consistency of the WSSQ-J was estimated by calculating Cronbach's α. Confirmatory factor analysis (CFA) was then carried out to confirm that the factor structure of the WSSQ-J was the same as that of the subscales of the original WSSQ.

RESULTS

The WSSQ-J had a Cronbach's α of 0.917, indicating good internal consistency. In CFA, the comparative fit index was 0.945, the root mean square error of approximation was 0.085, and the standardized root mean square residual was 0.040, indicating that the two-factor model showed satisfactory goodness-of-fit.

CONCLUSION

This study replicated the original findings related to the WSSQ, showing that the WSSQ-J is a reliable WBI questionnaire consisting of two factors. Therefore, the WSSQ-J would be a reliable tool for assessing WBI among Japanese.

LEVEL OF EVIDENCE

Level V, descriptive cross-sectional study.

Biological normalcy and body fat: Obesity prevalence, fat stigma, and allostatic load among late adolescents and young adults

OBJECTIVES

Biological normalcy provides a framework to assess tensions between clinical definitions of "normal," statistical norms, and normative beliefs. A prevailing cultural belief is obesity directly causes poor health, but research has demonstrated consequences of fat stigma. Previous research linked fat stigma and allostatic load (AL) in adults, but this has not been demonstrated in youth, and the role of obesity prevalence is unknown. This study assesses the relationship between fat stigma and AL among youth from counties varying by obesity prevalence.

MATERIALS AND METHODS

Undergraduates from 38 counties across the US state of Indiana (n = 175) were recruited. Fat stigma was measured using the brief stigmatizing situations inventory (SSI). AL was calculated using eight biomarkers representing cardiovascular, metabolic, and immune function. Poisson regression assessed relationships of interest and adjusted for potential confounding. An interaction term and stratified analyses were used to assess moderation.

RESULTS

SSI was not statistically associated with obesity prevalence (RR = 0.96, p = 0.173) but did statistically significantly predict AL (RR = 1.019, p = 0.045) when adjusting for confounders. Obesity prevalence moderated the relationship between SSI and AL (RR = 0.993, p = 0.001).

DISCUSSION

Results suggest that fat stigma, regardless of body fat percentage, is associated with physiologic wear and tear on the late adolescent body, and that exposure to obesity during earlier adolescence moderates this relationship. Those most at risk for high AL reported high fat stigma and lived in counties with relatively low obesity prevalence during earlier adolescence, suggesting vulnerability to fat stigma may be heightened where obesity is less common.

Beyond Binge Eating: The Impact of Implicit Biases in Healthcare on Youth with Disordered Eating and Obesity

(1) Background: Obesity and eating disorders (ED) can coexist resulting in worse health outcomes. Youth with ED are more likely to have obesity relative to peers with a healthy weight. Pediatric providers deliver first-line care to children and youth of all sizes and body shapes from infancy to adolescents. As healthcare providers (HCPs), we bring biases into our practice. Learning to recognize and address these biases is needed to provide the best care for youth with obesity. (2) Purpose: This paper aims to summarize the literature regarding the prevalence of ED beyond binge eating in youth with obesity and discuss how the intersection of weight, gender, and racial biases impact the assessment, diagnosis, and treatment of ED. We provide recommendations for practice and considerations for research and policy. (3) Conclusions: The assessment and treatment of ED and disordered eating behaviors (DEBs) in youth with obesity is complex and requires a holistic approach. This approach begins with identifying and understanding how one's implicit biases impact care. Providing care from a patient-centers lens, which considers how the intersection of multiple stigmatized identities increases the risk for DEBs in youth with obesity may improve long-term health outcomes.

Person-First Treatment Strategies: Weight Bias and Impact on Mental Health of People Living with Obesity

Stigma and bias surrounding body weight is both explicit and implicit, but the most concerning impact on individuals is internalized stigma which is correlated with poor physical and mental health. Strategies to combat this public health concern include increasing awareness, education around the complex disease of obesity, proper use of communication and language surrounding weight, health, and treatment approaches, addressing equipment and practices in the clinical environment, and larger, systemic approaches to policy. Addressing stigma for a condition impacting the majority of our population is critical for the best health and well-being of our patients and ourselves.

Refining the conceptualization and assessment of internalized weight stigma: A mixed methods approach

Internalized weight stigma has gained increasing attention in empirical studies, though questions remain about the adequacy of existing measures. The current study utilized a mixed methods approach, including a novel semi-structured interview, to revisit the conceptualization of internalized weight stigma and explore in more depth the stereotypes and impacts of weight reported by individuals with high scores on the widely-used Weight Bias Internalization Scale. All participants were interviewed as part of the screening procedures for two clinical trials (Study 1 n = 84, mean age=47.8 years, 83.3% women, 67.9% Black, mean BMI=39.2 kg/m2; Study 2 n = 129, mean age=50.0 years, 88.4% women, 65.1% white, mean BMI=37.8 kg/m2). The most common weight stereotypes identified were being lazy, lacking willpower or self-control, and having poor eating habits. Up to 66% of participants reported that they did not endorse negative weight stereotypes or apply them to themselves. The most highly identified impacts of weight were on self-image (>70%) and emotions (68-83%), followed by social (37-62%) and health concerns (20-25%). Approximately 60% of participants indicated that weight affected their self-directed thoughts and feelings "very much" to "extremely." Findings have implications for understanding and assessing internalized weight stigma in research and in clinical settings where interventions are needed.

Obesity among African American people in the United States: A review

Obesity is a growing public health crisis in the United States and is associated with a substantial disease burden due to an increased risk for multiple complications, including cardiovascular and metabolic diseases. As highlighted in this review, obesity disproportionately affects the African American population, women in particular, regardless of socioeconomic status. Structural racism remains a major contributor to health disparities between African American people and the general population, and it limits access to healthy foods, safe spaces to exercise, adequate health insurance, and medication, all of which impact obesity prevalence and outcomes. Conscious and unconscious interpersonal racism also impacts obesity care and outcomes in African American people and may adversely affect interactions between health care practitioners and patients. To reduce health disparities, structural racism and racial bias must be addressed. Culturally relevant interventions for obesity management have been successfully implemented that have shown benefits in weight management and risk-factor reduction. Strategies to improve health care practitioner-patient engagement should also be implemented to improve health outcomes in African American people with obesity. When managing obesity in African American people, it is critical to take a holistic approach and to consider an individual's social and cultural context in order to implement a successful treatment strategy.

The effects of an acute weight stigma exposure on cardiovascular reactivity among women with obesity and hypertension: A randomized trial

OBJECTIVE

Weight stigma induces cardiovascular health consequences for people with obesity. How stigma affects cardiovascular reactivity in individuals with both obesity and hypertension is not known.

METHODS

In a randomized experiment, we assessed the influence of two video exposures, depicting either weight stigmatizing (STIGMA) or non-stigmatizing (NEUTRAL) scenes, on cardiovascular reactivity [resting blood pressure (BP), heart rate (HR), ambulatory BP (ABP), and ambulatory HR (AHR)], among women with obesity and high BP (HBP; n=24) or normal BP (NBP; n=25). Systolic ABP reactivity was the primary outcome. Laboratory BP and HR were measured before/during/following the videos, and ABP and AHR were measured over 19 hours (10 awake hours, 9 sleep hours) upon leaving the laboratory. A repeated measures ANCOVA tested differences in BP and HR changes from baseline in the laboratory and over ambulatory conditions between the two groups after each video, controlling for body mass index, baseline BP and HR.

RESULTS

Laboratory SBP/DBP increased 5.5+7.3/2.4+8.8mmHg more in women with HBP than NBP following the STIGMA versus NEUTRAL video (Ps<0.05). For the primary outcome, ABP increased more in HBP than NBP over sleep (SBP/DBP=4.2+20.6/4.7+14.2mmHg; Ps<0.05) following the STIGMA versus NEUTRAL video, as did HR during sleep (7.5+15.7bpm more in HBP than NBP; P<0.05).

CONCLUSIONS

Weight stigma increases cardiovascular reactivity among women with obesity and HBP in the laboratory and under ambulatory conditions.

CLINICAL TRIAL REGISTRATION

Registered at ClinicalTrials.gov (Identifier: NCT04161638).

Relationships between experiencing anti-fat microaggressions, body appreciation, and perceived physical and mental health

This study examined whether body appreciation mediates the relationships between anti-fat microaggression experiences and perceived physical and mental health. Using a cross-sectional survey design, our study included 384 adult cisgender women in the United States. We found that anti-fat microaggression experiences had a negative association with body appreciation, and perceived physical and mental health. Body appreciation had a positive relationship to perceived physical and mental health. Our study further suggests that body appreciation is an important modifiable factor that mediates the relationships between anti-fat microaggression experiences and perceived mental and physical health. Implications for practice and research are discussed.

Associations among enacted weight stigma, weight self-stigma, and multiple physical health outcomes, healthcare utilization, and selected health behaviors

BACKGROUND

This study examined the relationship among enacted weight stigma, weight self-stigma, and multiple health outcomes. Weight stigma, a stressor experienced across all body sizes, may contribute to poorer physical health outcomes by activating the nervous and endocrine system or by triggering counterproductive health behaviors like lower physical activity, maladaptive eating patterns, and delayed health care, as well as provider bias that may cause a medical concern to be discounted. While associations of weight stigma with mental health issues are well documented, less is known about its association with physical health.

METHODS

We enrolled 3821 adults who completed an online survey assessing enacted weight stigma, weight self-stigma, multiple self-reported physical health outcomes, healthcare utilization, and selected health behaviors.

RESULTS

After controlling for BMI, health care delay or avoidance, sedentary behavior, and selected demographic characteristics, enacted weight stigma, significantly increased the odds of six physical health problems including hypertension (OR 1.36; CI 1.08, 1.72), hyperglycemia (OR 1.73; CI 1.29, 2.31), thyroid disorder, (OR 1.65; CI 1.27, 2.13), any arthritis (OR 1.70; CI 1.27, 2.26), non-arthritic chronic pain (OR 1.76; CI 1.4, 2.29), and infertility (OR 1.53; CI 1.14, 2.05). Weight self-stigma significantly increased the odds for three physical health problems including hypertension (OR 1.43; CI 1.16, 1.76), hyperglycemia (OR 1.37; CI 1.03, 1.81), and non-arthritic chronic pain (OR 1.5; CI 1.2,1.87). Enacted stigma was associated with more than a four-fold increase in odds of believing that a medical concern was disregarded by a health care provider.

CONCLUSIONS

In this study, enacted stigma and weight self-stigma were independently associated with heightened risk for multiple physical health problems, as well as, believing health concerns were discounted by providers. Reducing weight stigma may be an important component of managing multiple physical health conditions.

Racial and Ethnic Disparities in Weight Loss Behaviors Among US College Students

Purpose

Weight loss behaviors are prevalent among college students and are associated with adverse physical and psychological outcomes, such as an elevated risk of developing an eating disorder. While cross-ethnic differences have been reported, no consistent pattern has emerged. The purpose of this study was to examine racial and ethnic differences in weight loss behaviors among female and male college students.

Patients and Methods

The American College Health Association-National College Health Assessment (ACHA-NCHA) II-C survey data from the collection periods from 2015 to 2019 was used. A total of 426,425 students participated in the survey. Most participants were White (60%) and female (68.5%). Information on students' age, body mass index (BMI), and self-rated health was also collected. Logistic regression analyses were performed to determine cross-ethnic differences in weight loss methods among female and male students.

Results

Students' weight loss behaviors were assessed and included dieting, exercising, vomiting or taking laxatives, and the use of diet pills in the past 30 days. More than half of the participants attempted to lose weight through exercise (53.5%), and 40.3% of students dieted to lose weight in the past month. Purging and the use of diet pills were endorsed by 2.9% and 2.8% of the participants, respectively. With few exceptions, male students from racial and ethnic minority backgrounds were more likely to engage in extreme weight control practices (ie, vomiting or taking laxatives, taking diet pills) than White male students, while female students from racial and ethnic minority backgrounds were less likely to use diet and exercise as weight loss methods than White female students. For all outcomes, Biracial/Multiracial and Hispanic/Latino male students were more likely to attempt weight loss than White male students. Biracial/Multiracial female students more frequently endorsed extreme weight control behaviors than White female students.

Conclusion

The results of the present study add to the growing body of literature on the relationship between race and ethnicity and weight loss behaviors. The findings indicate the need for tailored educational and intervention programs on college campuses.

Dismantling weight stigma in eating disorder treatment: Next steps for the field

The authors posit current guidelines and treatment for eating disorders (EDs) fail to adequately address, and often perpetuate, weight stigma. The social devaluation and denigration of higher-weight individuals cuts across nearly every life domain and is associated with negative physiological and psychosocial outcomes, mirroring the harms attributed to weight itself. Maintaining focus on weight in ED treatment can intensify weight stigma among patients and providers, leading to increased internalization, shame, and poorer health outcomes. Stigma has been recognized as a fundamental cause of health inequities. With no clear evidence that the proposed mechanisms of ED treatment effectively address internalized weight bias and its association with disordered eating behavior, it is not hard to imagine that providers' perpetuation of weight bias, however unintentional, may be a key contributor to the suboptimal response to ED treatment. Several reported examples of weight stigma in ED treatment are discussed to illustrate the pervasiveness and insidiousness of this problem. The authors contend weight management inherently perpetuates weight stigma and outline steps for researchers and providers to promote weight-inclusive care (targeting health behavior change rather than weight itself) as an alternative approach capable of addressing some of the many social injustices in the history of this field.

20-55 Yaş Arası Kadınların Beden Algılarının Değerlendirilmesi

Amaç: Beden algısı, algılanan ile sahip olunan vücut ağırlığı arasındaki uyum olup beden algısındaki bozulmalar duygu durum bozukluğu, depresyon, yeme bozuklukları, obezite, aşırı artmış fiziksel aktivite gibi olumsuz durumlara zemin oluşturmaktadır. Çalışmanın amacı 20-55 yaş arası kadınların beden algısının ve beden memnuniyetinin değerlendirilmesidir.Yöntem: Çalışmaya 20-55 yaşları arasında 236 kadın katılmıştır. Çalışmada katılımcılardan antropometrik ölçümler, sosyodemografik özellikler ve obeziteye dair bilgi düzeyinin belirlenmesine yönelik bilgiler alınmıştır. Beden algılarının saptanması için belirli Beden Kütle İndeksi (BKİ) değerlerine sahip 1’den 6’ya kadar sıralanmış kimliksiz silüetler katılımcılar tarafından kişilik, sağlık, sosyal özelliklerine göre değerlendirilmiştir.Bulgular: Araştırmaya katılan kadınların %65,3’ünde beden ağırlığı memnuniyetsizliği olduğu; memnun olmayanların %92,2’sinin ise ağırlık kaybetmek istedikleri gözlemlenmiştir. Katılımcılar düşük BKİ’ye sahip silüetleri kişilik, sosyal, sağlık yönünden daha olumlu özellikler ile eşleştirmiştir. Beden memnuniyetsizliğinin ve bozuk beden ağırlığı algısının artan BKİ, yaş, kronik hastalık durumu ile anlamlı bir biçimde ilişkili olduğu; eğitim düzeyi, meslek grubu, fiziksel aktivite düzeyi, obeziteye dair bilgi düzeyi ile anlamlı bir ilişkisi olmadığı saptanmıştır.Sonuç: Kadınların çoğunda bozuk beden algısı olduğu daha ince bir vücut görünümünü idealleştirdikleri, hafif şişman silüetleri obez olarak niteledikleri tespit edilmiştir. 

Vulnerability and resilience to the harmful health consequences of weight discrimination in Black, Latina, and sexual minority women

BACKGROUND AND OBJECTIVE

Because they deviate from societal expectations regarding thinness, women with high body weight or large body size frequently experience social devaluation and discrimination and such experiences can negatively affect health. Yet relatively little is known about experiences of weight discrimination among people impacted by overlapping forms of oppression such as racism, sexism, and heterosexism or how high body weight may intersect with other marginalized identities to contribute to health disparities. Guided by an intersectional lens, the purpose of the current study was to assess Black, Latina, and sexual minority women's experiences with weight discrimination and to identify factors associated with vulnerability or resilience to the harmful health consequences of weight discrimination in these women.

METHODS

Semi-structured interviews were conducted with thirty-two cisgender women from the United States who identified as Black, Latina, and/or a sexual minority (e.g., lesbian, bisexual) to assess their experiences with and responses to weight discrimination. All participants had a body mass index ≥30 kg/m² and had previously experienced weight discrimination. Data collection took place from June to August of 2020.

RESULTS

Five factors associated with vulnerability or resilience to experiencing or being negatively affected by weight discrimination were identified: 1) sociocultural norms about weight and perceived acceptance of high body weight, 2) perceived links among weight, perceived femininity, and attractiveness, 3) childhood experiences, 4) internalized weight stigma, and 5) coping strategies. The intersectional nature of women's experiences with weight discrimination was apparent in each theme.

CONCLUSIONS

This study identified key factors that may amplify or mitigate the negative health consequences of weight discrimination in socially marginalized women with high body weight. Findings highlight novel research questions to be explored in future research. Such research will be critical for guiding future interventions aimed at reducing the harmful health consequences of weight discrimination.

Who is trying to lose weight? Trends and prevalence in past-year weight loss attempts among US adults 1999-2018 at the intersection of race/ethnicity, gender, and weight status

Common stereotypes of those who desire or attempt to lose weight often center on the experience of White, thin women. However, prior studies have neglected how systems of oppression at intersection of race/ethnicity, gender, and weight status may interact to place certain subpopulations at elevated risk. Repeated cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) 1999-2018 (n = 53,528), a population-representative sample of US adults, were used to 1) assess trends in past-year weight loss attempts using the Kendall-Mann trend test stratifying by race/ethnicity, gender, and weight status, and 2) estimate the adjusted prevalence of weight loss attempts over the combined 20-year period for combinations of race/ethnicity, gender, and weight status using logistic regression. There were significant monotonic trends from 1999 to 2018 for non-Hispanic Black men (43.8% to 67.8%, FDR adjusted p = .022) with an obese BMI, but not for any other groups. After adjusting for covariates, weight loss attempt prevalence was positively associated with BMI category for all race/ethnicity-gender combinations, although the degree of association differed. These findings underscore the need to use an intersectional lens in weight-related research. Despite limited long-term beneficial health impact, certain population subgroups, particularly Black men with an obese BMI, are increasingly trying to lose weight.

"It's Not the Stereotypical 80s Movie Bullying": A Qualitative Study on the High School Environment, Body Image, and Weight Stigma

BACKGROUND

Schools are crucial for preventing negative health outcomes in youth and are an ideal setting to address weight stigma and poor body image. The current study sought to examine and describe the nature of weight stigma and body image in adolescents, ascertain aspects of the school environment that affect body image, and identify recommendations for schools.

METHODS

We conducted 24 semi-structured interviews with students at 2 high schools in 2020. Qualitative data were analyzed using inductive coding and an immersion/crystallization approach.

RESULTS

Students did not report weight discrimination or harmful body image messaging from teachers or administrators. Physical education (PE) class and dress codes were 2 instances where covert weight stigma appeared. The most common forms of peer weight stigma reported were weight-based teasing and self-directed appearance critiques. Students recommended that schools eliminate dress codes, diversify PE activities, address body image issues in school, and be cognizant of teasing within friend groups.

CONCLUSIONS

Weight stigma presents itself in unique ways in high school settings. Schools can play a role in reducing experiences of weight stigma and negative body image. Weight-related teasing within friend groups was common and may not be captured in traditional assessments of bullying. More nuanced survey instruments may be needed.

Internalized weight stigma in women with class III obesity: A randomized controlled trial of a virtual lifestyle modification intervention followed by a mindful self-compassion intervention

Background

Internalized weight stigma (Internalized-WS) is prevalent among individuals with severe obesity, particularly women, and is associated with shame, disordered eating, and weight gain. Effective, accessible interventions that address both severe (Class-III) obesity and Internalized-WS are needed. This randomized pilot trial evaluated the feasibility, acceptability, and preliminary efficacy of a fully-remote lifestyle modification intervention (LM) followed by mindful self-compassion training (MSC) or control.

Methods

Twenty-eight women with Class-III obesity (46.6 ± 3.7 kg/m2) and elevated Internalized-WS were randomized to a virtually-delivered 4-month LM followed by a 2-month MSC or cooking/dietary education (CON). Psychosocial measures/weight were assessed at baseline, 4-(post-LM), 6-(post-MSC/CON), and 9-month (follow-up).

Results

Improvements in Internalized-WS, shame, and self-compassion were observed with LM. Mean 4-month weight loss was 6.3 ± 3.7%. MSC had lower attendance and usefulness ratings versus CON. Post-MSC/CON, MSC yielded significant and/or meaningful improvements in Internalized-WS, self-compassion, and intuitive eating relative to CON. Weight loss did not differ by group at 6-month, and at 9-month trended lower in MSC versus CON.

Conclusion

Virtual LM is feasible, acceptable, and leads to significant weight loss among women with severe obesity; MSC led to further improved Internalized-WS, self-compassion, and intuitive eating. Continued work is needed to elucidate effects of self-compassion training on Internalized-WS, its mechanisms, and linkages to cardiometabolic health and long-term weight loss.

The coping strategies of individuals in multiple jeopardy settings: the case of unemployed older women

This research investigates the harmful consequences of discrimination on self-esteem and examines the coping options of individuals belonging to several stigmatized groups (i.e., unemployed older women) within the multiple jeopardy perspective. Our sample comprised 420 individuals selected by age, gender and professional status. We tested whether the positive and negative links between discrimination and psychological distress induced by discrimination, would vary according to the number of disadvantaged categories individuals belong to. An analysis of the mediating role of some coping options was also conducted. Overall, the results support most of our hypotheses and suggest that the assumed impact of perceived discrimination on psychological outcome increase with the cumulation of discriminations. We also found that, among the various coping options used by individuals in our sample, commitment, but not age-group identification, mediated the links between the cumulated discrimination and self-esteem. The discussion addresses issues related to workplace discrimination in light of the multiple jeopardy perspective.

Update on the epidemiology and treatment of eating disorders among Hispanic/Latinx Americans in the United States

PURPOSE OF REVIEW

This review provides a 6-year update on the prevalence and treatment of eating disorders among Hispanic/Latinx Americans in the United States.

RECENT FINDINGS

Prevalence of eating disorders tends to be lower in Hispanic/Latinx American adolescents and adults relative to non-Hispanic White peers. Numerous risk factors for disordered eating symptoms have been identified, including negative body image, depression, sexual assault and culturally specific risk factors, including ethnic discrimination and acculturative stress. Hispanic/Latinx individuals seek treatment less often with the most influential barriers being cost of treatment, eating disorder stigma, eating disorder shame and mental health shame in general. Limited research on the treatment for eating disorders continue to persist. Culturally adapted cognitive behavioural therapy yielded similar outcomes to traditional cognitive behaviour therapy and had better treatment adherence and retention rates.

SUMMARY

The medical and sociopolitical climate of the United States has changed significantly since our previous review. The need for research on the effectiveness of eating disorder treatments for Hispanic/Latinx Americans remains important for one of the fastest growing populations in the U.S.

Barriers to obesity health care from GP and client perspectives in New Zealand general practice: A meta-ethnography review

Obesity is a complex international health concern affecting individual quality of life and contributing to an unsustainable strain on national health systems. General practice is positioned as best suited to deliver weight management health care, yet, obesity rates remain high suggesting barriers are experienced within this space. The aim of this review is to synthesize general practitioner and client perspectives of weight management to identify barriers experienced in New Zealand general practice. Six databases were searched resulting in eight articles being included in this review. This interpretive synthesis was guided by principles of meta-ethnography and grounded theory. Four overarching themes were identified from client and general practitioner perspectives: stigma, communication, inadequate health care (system limitations for general practitioners and lack of tailored advice for clients), and sociocultural influences. These four barriers were found to be interdependent, influencing each other outside the general practice context, highlighting the intersectionality of weight management health-care barriers and further complicating effective weight management within general practice. Clients reported wanting tailored, non-stigmatized, effective weight management health care, yet, general practitioners reported being ill-equipped to provide this due to barriers both within and outside the limits of their practice. General practice requires more systemic support to deliver effective weight management including public health campaigns and indigenous health information to reduce health inequities. An appraisal of general practice being "best suited" to deliver effective weight management health care that is culturally appropriate is urgently required to improve obesity related health outcomes in New Zealand.

Social consequences and genetics for the child with overweight and obesity: An obesity medicine association (OMA) clinical practice statement 2022

Background

This Obesity Medicine Association (OMA) clinical practice statement (CPS) covers two topics: 1) genetics and 2) social consequences for the child with overweight and obesity. This CPS is intended to provide clinicians with an overview of clinical practices applicable to children and adolescents with body mass indices greater than or equal to the 85th percentile for their ages, particularly those with adverse consequences resulting from increased body mass. The information in this CPS is based on scientific evidence, supported by the medical literature, and derived from the clinical experiences of members of the OMA.

Methods

The scientific information and clinical guidance in this CPS is based upon referenced evidence and derived from the clinical perspectives of the authors.

Results

This OMA clinical practice statement details two topics: 1) genetics and 2) social consequences for the child with overweight and obesity.

Conclusions

This OMA clinical practice statement on genetics and social consequences for the child with overweight and obesity is an overview of current literature. The literature provides a roadmap to the improvement of the health of children and adolescents with obesity, especially those with metabolic, physiological, and psychological complications.

The Influence of Memorable Message Receipt on Dietary and Exercise Behavior among Self-Identified Black Women

Guided by Control Theory and the memorable messages framework, the current investigation examined the relationship between receipt of a health-related memorable message and self-reported diet and exercise behavior. A cross-sectional survey methodology was utilized to evaluate the relationship between receipt of a memorable message and dietary and exercise behaviors in a sample of Black women. Over 80% of the research sample (N = 121) reported receiving a memorable health message regarding diet and/or exercise. Women receiving a memorable message reported a significantly higher number of days engaging in healthy eating and exercise behaviors each week. Messages from medical professionals had the greatest impact on healthy dietary practices, while media-based messages were most influential on the enactment of exercise behavior. Additional research is warranted to determine how the utilization and reinforcement of memorable messages impacts health outcomes among Black women.

Weight stigma and posttraumatic stress disorder symptoms in individuals seeking bariatric surgery

BACKGROUND

After bariatric surgery, some patients experience adverse psychiatric outcomes, including substance use, suicidality, and self-harm. These factors are commonly associated with posttraumatic stress disorder (PTSD) and related symptoms (PTSD-S) that develop following adverse childhood experiences (ACEs) and traumatic events. However, emerging evidence suggests that chronic discrimination also may contribute to PTSD-S. Weight-based discrimination is salient for people with obesity but has received little attention in relation to PTSD-S.

OBJECTIVE

Our study examined factors that may contribute to the link between experienced weight stigma (WS), which is common in individuals seeking bariatric surgery, and PTSD-S.

SETTING

Teaching hospital and surgical weight loss center in the United States.

METHODS

A total of 217 participants completed self-report surveys of experienced and internalized WS, ACEs, and PTSD-S. Demographics and trauma history were obtained from patient medical records. A stepwise multiple regression examined associations between experienced WS and internalized WS with PTSD-S, co-varying demographics, ACEs, and trauma, followed by examination of whether findings held co-varying anxiety/depressive symptoms in a participant subset (n = 189).

RESULTS

After accounting for covariates in step 1 and ACEs and trauma in step 2 (ΔR² = .14), experienced WS and internalized WS accounted for substantial PTSD-S variance in steps 2 and 3 (ΔR² = .12 and .13, respectively; overall model R² =.44; P < .001). Findings held after co-varying anxiety/depressive symptoms.

CONCLUSIONS

Over and above ACEs and trauma, experienced WS and internalized WS may contribute to PTSD-S. Longitudinal research is needed to better elucidate the pathways underlying these associations.