Pervasiveness, impact and implications of weight stigma

Examining the impact of identity-safety cues on inclusion for adults with higher body weights in healthcare settings

OBJECTIVES

Adults with higher body weights experience weight stigma in healthcare, which can heighten concerns about treatment in these settings. This study investigates whether a specific strategy-using an identity-safety cue, or a cue which signals that one's social identity is valued-mitigates these concerns.

METHODS

527 U.S. adults who self-identified as overweight were randomized to read about a hypothetical physician who endorsed a weight-inclusive clinical approach (identity-safety cue condition) or making health information accessible (control condition). Next, participants read a vignette where the physician attributed their persistent knee pain to their age (control diagnosis), lifestyle habits (ambiguous diagnosis), or body weight (stigmatizing diagnosis).

RESULTS

Exposure to the physician who employed the identity-safety (versus control) cue decreased weight stigma concerns, increased perceptions of physician allyship, and promoted identity-safety. While use of the identity-safety cue elicited benefits regardless of the physician's clinical diagnosis, viewing the identity-safety cue alongside the stigmatizing diagnosis increased perceptions that the physician's commitment to diversity was dishonest, which subsequently harmed feelings of safety.

CONCLUSIONS

Use of identity-safety cues in healthcare can effectively promote inclusion for adults with higher body weights. However, perceiving that the physician's pro-diversity efforts are dishonest can undermine inclusion.

PRACTICE IMPLICATIONS

To effectively promote inclusion for adults with higher body weights, physicians should employ cues which explicitly signal that their weight identity is valued.

Youth Perspectives on the Use of Medications for Weight Loss

PURPOSE

Semaglutide (Ozempic, Wegovy) has surged in popularity for its weight loss effects. Its widespread media coverage may have an outsized impact on adolescents and young adults due to their higher engagement in social media and their vulnerability to unintended consequences of weight-related discourse (e.g., body dissatisfaction, disordered eating, weight stigma). This study aimed to determine youth familiarity with and opinions about use of medications such as Ozempic and Wegovy for weight loss.

METHODS

Five open-ended questions were asked to 753 youth participants (14-24 years) in the MyVoice nationwide text message poll in March 2024. Responses were analyzed using content analysis and coding differences resolved by consensus. Differences by demographic characteristics were explored using chi-square tests.

RESULTS

Overall, 547 (73%) youth responded; average age was 20.4 ± 2.5 years, with 50.3% identifying as female. Nearly three-quarters (73.6%) had heard of medications like Ozempic and Wegovy, but the majority (57.5%) stated that these medications should not be used by youth. Three primary concerns arose: (1) safety; (2) inappropriate use; and (3) role of personal responsibility for healthy lifestyle (a belief that was more common among males than females or other gender).

DISCUSSION

Awareness about semaglutide was high, but perceptions of use were generally negative or hesitant, particularly among males, who emphasized the importance of healthy lifestyle behaviors. Hesitancy due to safety concerns and the role of weight stigma should be explored to determine the potential impact on users of such medications when medically indicated.

Assessing Weight Stigma Interventions: A Systematic Review of Randomized Controlled Trials

PURPOSE OF REVIEW

The primary goals of this pre-registered systematic review were to critically evaluate the existing randomized controlled trials targeting weight stigma/bias and identify promising avenues for future research.

RECENT FINDINGS

Prior systematic reviews have highlighted intervention strategies such as shifting causal attributions of obesity, evoking empathy, deploying weight-inclusive approaches, increasing education, and combining these strategies. Here, we provide an updated systematic review of weight stigma interventions. A systematic search was conducted following the PRISMA guidelines and performed in PubMed/Medline, PubMed, PsycINFO, and Google Scholar until October 2024, yielding a final sample of 56 articles. In addition to previously established strategies, we identified several novel strategies, such as cognitive dissonance and connection building. Interventions can largely shift attitudinal outcomes, but future research should extend beyond attitude measures, assess weight bias over a longer term, and across more diverse populations.

'My first thoughts are…': a Framework Method analysis of UK general practice healthcare professionals' internal dialogue and clinical reasoning processes when seeing patients living with obesity in primary care

OBJECTIVES

To use vignettes to facilitate exploration of the internal dialogue and clinical reasoning processes of general practice healthcare professionals (GPHCPs) during interactions with patients living with obesity.

DESIGN

This study used an exploratory qualitative research design. Data were collected using semistructured interviews. Interviews were transcribed verbatim, and data analysed using Framework Method analysis. Five vignettes were presented to participants, showing a patient's photograph, name, age and body mass index. Participants were asked to describe their first impressions of each fictionalised patient.

SETTING

Interviews were conducted remotely via Skype between August and September 2019.

PARTICIPANTS

A convenience sample of UK GPHCPs was recruited via a targeted social media strategy, using virtual snowball sampling. 20 participants were interviewed (11 general practice nurses and 9 general practitioners).

RESULTS

Five themes were generated: visual assessment, assumed internal contributing factors, assumed external contributing factors, potential clinical contributing factors and potential clinical consequences. A pattern-recognition approach was identified, as GPHCPs' assumptions around patients' lifestyles, occupations and eating habits emerged as explanations for their weight, with a mixture of both objective and subjective comments.

CONCLUSIONS

While it is part of the diagnostic skill of a clinician to be able to form a clinical picture based on the information available, it is important to be aware of the potential for assumptions made within this process to contribute to unconscious bias/stereotyping. Healthcare professionals need to work to counteract the potential impact of internal bias on their consultations to provide fair and equitable care for people living with obesity, by exercising reflexivity within their clinical practice.

A Randomized Controlled Trial of a Combined Physical Activity and Attitude Education Intervention on Weight Stigma and Health Outcomes

BACKGROUND

Weight stigma is prevalent among adolescents and can negatively impact physical and mental health. This study examined the effects of a combined physical activity and attitude education intervention on weight stigma and related outcomes among high school students.

METHODS

A randomized controlled trial was conducted with 524 high school students. The intervention group received a 3-month program combining physical activity education and anti-stigma attitude training. Outcomes measured included the use of weight loss medication, physical activity levels, weight loss, and depressive symptoms.

RESULTS

The intervention group showed significant decreases in weight loss medication use and depressive symptoms, and increases in physical activity levels compared to the control group. No significant differences were observed in weight loss between groups. Gender differences were noted, with girls showing greater improvements in physical activity.

IMPLICATIONS

Findings support integrating weight stigma reduction strategies into school health programs. Schools should adopt attitude modification approaches, promote inclusive physical activities, and foster social support to address weight stigma and associated depression symptoms.

CONCLUSIONS

Combining physical activity and attitude education can effectively reduce weight stigma and improve health behaviors among high school students. Future research should explore long-term effects and tailored approaches for different student populations.

The real-life experiences of people living with overweight and obesity: A psychosocial perspective

Understanding the lived experience of obesity, just like any other chronic outcome, is essential to addressing deep routed inequalities and stigma associated with obesity, as well as creating more inclusive and effective policies and healthcare. The psychosocial aspects of obesity are vast and as such the lived experience of obesity differs between individuals and groups. However, there are consistent psychosocial issues identified within empirical studies as well as lived experience accounts that require consideration and potential adaption in the design and delivery of care including weight management and obesity services. Improving perceptions and understanding of the lived experience can also foster empathy which appears to be lacking based on research examining everyday encounters, media portrayal of people living with obesity, and in healthcare settings. Stigma and discrimination are consistent and, in some instances, occur daily in many societal settings leading to mental and physical health concerns, social disengagement and dysfunctional relationships with significant others, as well as avoidance of health promoting activities and settings. Using a narrative review approach, our aim was to examine the empirical evidence generated in countries across the world, reporting on the real-life experiences of people living with obesity. Our search strategy was informed by existing empirical evidence of the psychosocial aspects of obesity and an in-depth interview exploring the lived experience of obesity specifically conducted to inform this article. In doing so, we highlight key psychosocial aspects and provide a voice for a personal account of the challenges experienced in child and adulthood. Recommendations are offered for stakeholders including policymakers and practitioners that aim to address these real-life challenges experienced by people living with obesity. PLAIN LANGUAGE SUMMARY: In this publication, the authors provide a detailed review of the lived experiences of people living with obesity with a focus on the psychological and social factors and experiences across the life course. The paper also uniquely presents real-life experiences from Sarah, who identifies as living with obesity. In doing so, the authors highlight exposure to and experiences of weight management related behaviours and weight stigma from an early age. Experiences of weight stigma and feelings of being excluded from social settings and more generally society are evidenced throughout. Indeed, Sarah's accounts support the research evidence presented, where for instance, she highlights feeling excluded as a younger person when not being able to purchase "trendy" clothing and as an adult when buying clothing for work, experiences of weight stigma in workplaces and issues related to travelling as well as the actions she takes to avoid imposing on other people. The key lived experiences, both from the research evidence and Sarah's accounts, provide insights about the link between obesity and mental health, where for instance, the experiences of weight stigma and feeling excluded from society are associated with mental health outcomes including reduced self-worth and self-esteem, increased depression and increased risk of self-harming. The authors provide a list of ways to address weight stigma in society as well as in healthcare, a setting where weight stigma is often reported by people living with obesity, and calls for greater involvement of people living with obesity in policy, healthcare development and practice, as well as the need to address the widespread weight stigma and discrimination. [Plain language summary added March 2025, after original online publication].

Applying a Weight Stigma Lens to Australian and International Obesity-Related Policies for Women Across the Preconception, Pregnancy and Postpartum Periods: A Mapping Review

ISSUE ADDRESSED

Weight stigma significantly affects preconception, pregnant and postpartum (PPP) women. Existing policies and guidelines do not adequately address weight stigma and may inadvertently contribute to it. This mapping review aimed to identify gaps in addressing weight stigma in current Australian and international obesity-related policies relevant to PPP women.

METHODS

We conducted a mapping review of Australian state-based and national and international obesity-related policies relevant to PPP women through government websites and guideline databases. Policy screening and data extraction followed three frameworks (Attribution Theory; Health Stigma and Discrimination Framework; Framework for Policy Mobilisation). Analyses were stratified by the policy's direct or indirect relevance to PPP women, and Australian and international policies were compared. Strength and gaps in relation to weight stigma were identified.

RESULTS

Forty-one Australian and 18 international policies were included. Ten (24%) Australian policies explicitly mentioned weight stigma and 13 (31%) met criteria for potentially blaming people for their weight or body size. Acknowledgement of drivers and impacts of weight stigma and adequate mobilisation plans were scarce. Findings were consistent across state and national Australian policies, PPP populations and international comparisons. Strengths of policies comprehensively addressing weight stigma were incorporating lived experience consumers' voices and acknowledging obesity's complex and multifactorial nature. Potential improvements included focussing on nonstigmatising language and discourse.

CONCLUSIONS

Weight stigma is rarely recognised or not adequately addressed in obesity-related policies for PPP women. SO WHAT?: Eliminating weight stigma in policies can improve public narratives around obesity, clinical practice and reproductive-aged women's experiences and outcomes.

Assessing weight bias among Turkish dietitians: determinants and impact on professional practice

BACKGROUND

Weight bias, whether explicit or implicit, has a detrimental effect on the physiological and psychological well-being of individuals, thereby complicating obesity management, particularly in healthcare settings. The objective of this study was to examine weight bias among Turkish dietitians. A further aim was to investigate the effect of the patient's weight status on the dietitian's assessment and dietetic practice.

METHODS

This cross-sectional web-based study analyzed data from 411 Turkish dietitians. The participants completed a series of sociodemographic information, anthropometric measurements, and scales, including the Fat Phobia Scale (FPS) and Attitudes Toward Obese Persons Scale (ATOP). After completing the scales, the dietitians were randomly assigned to a case study on lactose intolerance via an online survey platform. All patient information was identical, except for the patient's weight and photography. The objective of the case study was to evaluate how the body weight of a patient who consulted a dietitian for a reason unrelated to the body weight affected professional practices.

RESULTS

A total of 66.9% of dietitians exhibited fat phobia. While men had higher FPS scores than women (p = 0.022), dietitians with a family history of obesity (p = 0.032) had lower FPS scores. BMI was negatively associated with FPS scores (β = -0.036, p = 0.026). However, dietitians with a history of feeling overweight had higher FPS scores (p = 0.024). Dietitians' assessments of cases differed according to the patient's body weight status. Although, there were no statistically significant differences in FPS and ATOP scores between dietitians assigned to cases with higher or lower body weight (p > 0.05 for each), those assessing the case with higher body weight rated patients' nutritional (p = 0.025) and biochemical status (p < 0.001) as worse and were more inclined to recommend weight management strategies.

CONCLUSIONS

The issue of fat phobia and weight bias represents a significant concern among dietitians, with notable impacts on their professional practice. It is therefore of crucial importance to address and resolve these issues within the context of dietetic education.

TRIAL REGISTRATION

ClinicalTrials.gov registration number: NCT06624111 (submitted 01/10/2024).

BMI or not to BMI? debating the value of body mass index as a measure of health in adults

Body mass index (BMI) is used across public health to calculate height to weight ratio and translate into weight status. Whether BMI is appropriate as an individual- or population-level health measure for adults is debated. BMI is a cost-effective and feasible metric to establish health risk. Yet, BMI's historical underpinnings, weight categories, usefulness as clinical diagnostic measure, and application across population subgroups has called the measurement tool into question. At the annual ISBNPA meeting in June 2023, the co-authors engaged in a debate session on the topic. This paper presents the complexity of arguments for or against BMI as a measurement tool and proposes its evolution to support whole-person health.

Assessing the Uses, Benefits, and Limitations of Digital Technologies Used by Health Professionals in Supporting Obesity and Mental Health Communication: Scoping Review

BACKGROUND

Obesity and mental health issues present interconnected public health challenges that impair physical, social, and mental well-being. Digital technologies offer potential for enhancing health care communication between health professionals (HPs) and individuals living with obesity and mental health issues, but their effectiveness is not fully understood.

OBJECTIVE

This scoping review aims to identify and understand the different types of technologies used by HPs in supporting obesity and mental health communication.

METHODS

A comprehensive scoping review, which followed a validated methodology, analyzed studies published between 2013 and 2023 across 8 databases. The data extraction focused on HPs' use of communication technologies, intervention types, biopsychosocial considerations, and perceptions of technology use. The review was guided by the following research question: "What are the uses, benefits, and limitations of digital technologies in supporting communication between HPs and persons living with obesity and mental health issues?"

RESULTS

In total, 8 studies-featuring web-based platforms, social media, synchronous video calls, telephone calls, automated SMS text messaging, and email-met the inclusion criteria. Technologies such as virtual learning collaborative dashboards and videoconferencing, supported by automated SMS text messaging and social media (Facebook and WhatsApp groups), were commonly used. Psychologists, dietitians, social workers, and health coaches used digital tools to facilitate virtual appointments, diet and mental health monitoring, and motivational and educational support through group therapy, 1-on-1 sessions, and hybrid models. Benefits included enhanced access to care and engagement, personalized digital cognitive behavioral therapy, perceived stigma reduction, privacy, and improved physical health outcomes in weight reduction. However, improvements in mental health outcomes were not statistically significant in studies reporting P values (P≥.05). The limitations included engagement difficulties due to conflicting personal family and work commitments; variable communication mode preferences, with some preferring in-person sessions; and misinterpretations of SMS text messaging prompts. Conflicts arose from cultural and individual differences, weight stigma, and confusion over HP roles in obesity and mental health care.

CONCLUSIONS

Digital technologies have diversified the approaches HPs can take in delivering education, counseling, and motivation to individuals with obesity and mental health issues, facilitating private, stigma-reduced environments for personalized care. While the interventions were effective in obesity management, the review revealed a shortfall in addressing mental health needs. This highlights an urgent need for digital tools to serve as media for a deeper engagement with individuals' complex biopsychosocial needs. The integration of data science and technological advancements offers promising avenues for tailored digital solutions. The findings advocate the importance of continued innovation and adaptation in digital health care communication strategies, with clearer HP roles and an interdisciplinary, empathetic approach focused on individual needs.

The Impact of Novel Medications for Obesity on Weight Stigma and Societal Attitudes: A Narrative Review

PURPOSE OF REVIEW

This narrative review examines the potential implications of the expanded use of novel medications for obesity, particularly the GLP-1 receptor agonists, on weight stigma and societal attitudes towards pharmacologically induced weight loss. It analyses how these medications may potentially contribute to both reducing and exacerbating stigma and discusses strategies to reduce weight bias.

RECENT FINDINGS

The introduction of GLP-1 receptor agonists has demonstrated effectiveness in reducing weight and lead to improved health outcomes for individuals living with obesity. However, while these medications may reduce stigma by framing obesity as a medical issue rather than a personal failure, disparities in access and use related to high costs may inflate existing biases against those who cannot afford treatment. Also, a few studies indicate that users of these medications may feel stigmatised for taking what is perceived as an "easy way out" to lose weight, mirroring historical attitudes towards bariatric surgery. The new medications for obesity may have the potential to reduce obesity stigma by reframing it as a medical condition rather than a moral failing. However, taking legal actions to build a more inclusive society including ensuring equitable access to these medications will be essential in mitigating stigma and help fostering a supportive environment for those living with obesity. Lessons from reducing stigma surrounding other medical conditions suggest that supportive health care and educational campaigns that promote the understanding of obesity as a complex health issue are needed to reshape negative perceptions towards individuals with obesity.

Physical Health in Psychosis: a Perspective on the Recovery Paradigm

This paper explores the intersection of physical health and recovery-oriented approaches in psychosis, offering a unique perspective through autoethnography. By combining personal experience with a broader analysis of existing mental health frameworks, the paper highlights the often overlooked importance of physical health in the recovery process for individuals with psychosis. The autoethnographic narrative reveals the complex challenges posed by antipsychotic medications, including weight gain and metabolic complications, and their impact on overall well-being. It emphasizes the dual stigma of mental health challenges and weight gain, highlighting the need for a more integrated, holistic approach to mental health care. Recommendations include enhanced education for healthcare providers, personalized care plans, and a multidisciplinary approach aimed at bridging the gap between physical and mental health in psychosis recovery.

Motivational Interviewing (MI) in Obesity Care: Cultivating Person-Centered and Supportive Clinical Conversations to Reduce Stigma: A Narrative Review

Background

Patients perceive high levels of weight prejudice, stigma, and discrimination within health systems, affecting their ability to manage their obesity and related chronic conditions. Scientific and patient obesity associations worldwide have prioritized the reduction of weight stigma to improve patient experiences in health systems and overall health outcomes. Since a significant proportion of the population is now living with multiple chronic diseases related to obesity, healthcare systems must shift toward multi-disease management frameworks incorporating person-centered and non-stigmatizing clinical conversations. Motivational Interviewing (MI) has the potential to transform clinical interactions by using non-stigmatizing language, communication, and practices. Studies using MI in obesity management have solely focused on weight loss outcomes, while other patient experience related outcomes would also be relevant to evaluate.

Methods

A narrative review was undertaken to critically analyze the potential impact of MI on obesity and chronic disease management practices and experiences.

Findings

An analysis and contextualization of the MI theoretical framework for obesity management, based on the philosophy of motivational spirit, was reviewed, assessing micro skills or strategies.

Conclusion

MI may assist healthcare professionals conduct non-stigmatizing clinical conversations in accordance with basic principles of collaborative therapeutic alliances. A proposal for research considerations that can help illuminate the potential for of MI in obesity management is also outlined.

Reframing Diabetes Prevention: From Body Shaming to Metabolic Reprogramming

This review integrates new developments in psychology with updated physiological insight on the complex relationships among chronic psychological stress (arising from weight stigmatization and body shaming), food composition, physical activity and metabolic health for the example of diabetes. We address how visual measures of health, such as body mass index (BMI) and waist-to-hip ratio, do not adequately capture metabolic health and can instead contribute to weight stigmatization, chronic stress, and system-wide impairment of metabolic health. We also emphasize the importance of food composition over calorie counting. We summarize how chronic stress interacts with nutritional deficiencies and physical inactivity to disrupt the stress response, immune response, gut microbiome, and function of fat depots. We specifically address how interactions among lifestyle factors and the gut microbiome regulate whether fat stored around the waist has a negative or positive effect on metabolic health. We aim to provide a resource and updated framework for diabetes prevention and health promotion by (i) highlighting metabolic imbalances triggered by lifestyle changes during the transition to industrialized society and (ii) detailing the potential to support metabolic health through access to modest, but comprehensive lifestyle adjustments.

Variation in the commissioning of specialist weight management services and bariatric surgery across England: Results of a freedom of information-based mapping exercise across the 42 integrated Care Systems of England

Specialist weight management services including bariatric surgery are commissioned within regions of England called Integrated Care Systems (ICSs) with eligibility and treatment guidelines determined as part of the National Institute for Health and Care Excellence (NICE) guidance. Reported variation in commissioning and bariatric surgery eligibility criteria has not been previously mapped. Freedom of Information (FOI) requests provide a tool, supported by legislation, to ask questions of public authorities including ICSs such that they must respond accurately. FOIs were sent to all 42 ICSs in England asking 4 questions aiming to establish whether there is variation in the commissioning of specialist weight management services and the eligibility criteria for bariatric surgery across England. Responses were presented descriptively and mapped across England. Responses were received from 41 out of 42 ICSs, with 34 reporting that they provide commissioned medical weight management programmes and 38 funding bariatric surgery. Thirteen reported using criteria that were not compliant with NICE guidance. A large area of the country centred around the East of England does not have a bariatric unit reducing access to care. There is significant geographical variation in the availability of both bariatric and specialist medical weight management services across England, with large portions of the country without local access to a service or no service at all. Where services are available, there is significant inconsistency in eligibility for bariatric surgery despite nationally available guidance.

Beyond the Physical: Weight Stigma and the Bariatric Patient Journey

Background: Obesity represents a global epidemic associated with significant health risks, including diabetes, cardiovascular disease, and certain cancers. Management strategies have evolved from focusing solely on weight reduction to emphasizing overall health improvements and mitigating associated risks. Methods: This narrative review analyzed the existing peer-reviewed literature across databases such as PubMed, Scopus, EMBASE, the Cochrane Library, and Google Scholar to examine the outcomes of bariatric surgery and its interplay with weight stigma. The review incorporated data from clinical studies, systematic reviews, and meta-analyses, focusing on bariatric surgery and its psychological impact, as well as approaches to mitigate stigma in bariatric care. Results: Bariatric surgery has emerged as the most effective intervention for sustained weight loss and the resolution of obesity-related comorbidities. However, individuals undergoing surgery frequently encounter weight stigma, both pre- and postoperatively, which manifests through discriminatory healthcare interactions, societal biases, and internalized self-criticism. These factors contribute to anxiety, depression, diminished healthcare engagement, and weight regain, ultimately affecting the long-term surgical outcomes. Conclusions: Addressing weight stigma in bariatric care is critical to optimizing outcomes. Interventions such as preoperative counseling, postoperative psychological support, and multidisciplinary care can mitigate the psychological and societal burdens of stigma. This review explores the intricate relationships between obesity, bariatric surgery outcomes, weight stigma, and the health-related quality of life (HRQOL).

Remote Lifestyle Intervention to Reduce Postpartum Weight Retention: Protocol for a Community-Engaged Hybrid Type I Effectiveness-Implementation Randomized Controlled Trial

BACKGROUND

Maternal obesity is associated with significant racial disparities. People who identify as non-Hispanic Black and Latinx are at the highest risk related adverse short- and long-term health outcomes (eg, hypertension in pregnancy and postpartum weight retention). Remote lifestyle interventions delivered during and after pregnancy hold promise for supporting healthy weight outcomes; however, few are tested in groups of people who self-identify as non-Hispanic Black and Latinx or address the neighborhood-level and psychosocial factors driving maternal health disparities. Implementing remote lifestyle interventions within community-based programs that serve birthing people may optimize trust and engagement, promote scalability and sustainability, and have the broadest public health impact.

OBJECTIVE

The goal of this trial is to test the effectiveness of a culturally adapted remote lifestyle intervention (Healthy for Two-Home Visiting) implemented within home visiting compared to usual home visiting services on postpartum weight retention among pregnant or postpartum individuals, in particular those who identify as non-Hispanic Black and Latinx. Facilitators and barriers to implementation of the intervention within home visiting will be examined.

METHODS

We describe the rationale and protocol for this hybrid type I effectiveness-implementation randomized controlled trial. In this paper, we highlight the community-engaged approach and trial design features that enable the implementation of the intervention within home visiting and demonstrate its applicability to the target population. Participants will be 360 pregnant individuals with overweight or obesity enrolled between 20 and 33 weeks of gestation and randomized 1:1 to Healthy for Two-Home Visiting or usual home visiting services. The primary outcome is weight retention at 6 months post partum, calculated as 6-month postpartum weight minus earliest pregnancy weight (≤18 wk of gestation). The measures of implementation include intervention feasibility, acceptability, reach, adoption, and fidelity. Throughout the paper, we highlight the community input used to improve intervention effectiveness and study implementation and as a strategy to promote maternal health equity.

RESULTS

This study was funded in June 2021, and recruitment began in April 2023. As of November 2024, we enrolled 90 participants. Data collection to assess the intervention's effectiveness is expected to end in June 2026. Implementation evaluation is expected to conclude in December 2026.

CONCLUSIONS

This hybrid type I effectiveness-implementation randomized controlled trial integrates a culturally adapted remote lifestyle intervention into early home visiting services to examine its effectiveness on postpartum weight retention compared to usual home visiting. We anticipate that the study results will enable an understanding of the drivers of successful implementation within a community-based setting to maximize the future sustainability and dissemination of a strategy for reducing long-term obesity and other maternal health disparities.

TRIAL REGISTRATION

Clinicaltrials.gov NCT05619705; https://clinicaltrials.gov/study/NCT05619705.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/62847.

Assessing exposure to weight stigma: development and initial validation of the Weight Stigma Exposure Inventory (WeSEI)

BACKGROUND

Weight stigma is pervasive, and it has a significant impact on the social, physical, and psychological health of an individual. Weight stigma is observed from several different sources. Therefore, the present study developed and validated a new instrument, the Weight Stigma Exposure Inventory (WeSEI), to assess different sources of observed weight stigma across interpersonal and non-interpersonal sources.

METHODS

The participants (n = 15,991) comprised Taiwanese young adults, Chinese adolescents, and Chinese young adults who completed paper-and-pencil and online surveys between September 2023 and December 2023. All participants provided demographic information, and completed the WeSEI, Weight Self-Stigma Questionnaire (WSSQ), and Perceived Weight Stigmatization Scale (PWSS). Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to examine the factor structure of the WeSEI.

RESULTS

EFA and CFA results confirmed a seven-factor structure (television sources, traditional media sources, social media sources, parent sources, stranger sources, significant other sources, and friends sources) across 35 items of the WeSEI. Moreover, the WeSEI was supported by measurement invariance across subgroups (i.e., subsamples, gender, and weight status). Moreover, there were positive correlations between all seven factors of the WeSEI and the WSSQ and PWSS.

CONCLUSION

The WeSEI appears to assess observed weight stigma from different sources, and had good reliability, validity, and invariance across various subsamples. The WeSEI may be useful in clinical practice and research for assessing exposure to weight stigma from different sources.

Weightism in Asia: A Narrative Review and Implications for Practice

Weightism, also known as weight-related discrimination, is pervasive and believed to be one of the socially accepted types of discrimination in Asia. Weightism is pervasive, impactful, and has significant repercussions on individuals grappling with excess weight. Despite being a major risk factor for obesity, excess weight is not well documented in the Asian literature. This narrative review explores compelling evidence indicating that weightism adversely affects both physical and psychological well-being across various aspects of life. Research findings suggest that weightism be deemed socially unacceptable in Asia to mitigate the obesity epidemic and enhance overall well-being. Consequently, several recommendations for reducing weight stigma in Asian culture are proposed to support a healthier future.

Weight stigma and physical activity avoidance among college-aged students

This study explored cross-sectional associations between prior weight stigma experiences, physical activity (PA) intentions, behaviors, and the acute effects of a weight stigma exposure on PA intentions and behaviors among undergraduate students. Weight-stigma experiences and behavioral intentions were self-reported. Moderate-to-vigorous PA and total PA were assessed using accelerometry. Participants were randomized into two experimental conditions (a weight stigma or control condition) to assess the acute effects of a weight stigma exposure. Forty-nine students (81.6% female; 59.2% Non-Hispanic White; 19.6 ± 1.1 years of age; body mass index: 23.9 ± 4.0 kg/m2) completed the study. Prior weight stigma experiences were positively associated with PA avoidance (β = 12.1 ± 2.7; p < .001) but were not associated with positive PA intentions or behaviors (ps > .05). There were no differences in positive PA intentions, PA avoidance, or PA behaviors across conditions (all ps > .05). Future studies should examine the long-term effects of weight stigma on PA avoidance and objectively measured PA in young college students.

The Perceived Weight Stigma Scale and Weight Self-Stigma Questionnaire: Rasch analysis, confirmatory factor analysis, and network analysis among Chinese adolescents

OBJECTIVES

The objectives of the present study were to (i) re-evaluate and expand the psychometric properties of two weight stigma instruments-the Perceived Weight Stigma Scale (PWSS) and the Weight Self-Stigma Questionnaire (WSSQ) among a large sample of adolescents using advanced psychometric methods and (ii) examine how the different types of weight stigma (i.e., PWSS and WSSQ) are associated with psychological distress.

STUDY DESIGN

Cross-sectional study.

METHODS

In September 2023, a cross-sectional survey utilising convenience sampling was used to recruit 9995 adolescents (mean age = 16.36 years [standard deviation = 0.78]; 57.8% males). They completed the PWSS, WSSQ, and a measure on psychological distress. The data were analysed using Rasch analysis, confirmatory factor analysis (CFA), structural equation modelling (SEM), and network analysis.

RESULTS

The CFA and Rasch model results showed acceptable psychometric properties regarding factor structure, factor loading, difficulty, and infit and outfit mean squares (except Items 4 and 7 of the PWSS). There was no substantial differential item functioning for any tested items across the sex and weight categories. The CFA and SEM results showed promising validity indices with significant associations between both weight stigma scales and psychological distress (i.e., depression, anxiety, and stress). Network analysis showed inter-variable connectivity between nodes PWSS3 ("People act as if they are afraid of you") and WSSQF7 ("I feel insecure about others' opinions of me").

CONCLUSIONS

Both weight stigma scales had acceptable psychometric properties and were significantly associated with psychological distress, although each assessed different types of weight stigma. This suggests that researchers and clinicians can use these scales to reliably and validly assess weight stigmas among adolescents.

An exploratory examination of medical and nursing students' intentions to discuss body image, weight, and eating disorders with their patients

BACKGROUND

Although many people have concerns about their body image, weight, and eating behaviors these issues are not usually discussed in a productive manner with medical providers. Thus, we examined nursing and medical students' willingness to discuss patients' weight, body image, and eating disorders and reasons why they may do so.

METHOD

One hundred and eighty-three nursing and medical students (Mage = 25.06, SD = 5.43) participated in this study. Participants completed open-ended questions pertaining to their willingness to discuss body image, eating, and weight-related issues with future patients. We further queried students' perspective on body mass index (BMI) as a measure of weight status and sought to determine if participants' own weight, weight concerns, appearance evaluation, body appreciation, and experiences of stigma were associated with their willingness to discuss weight-related issues with prospective patients.

RESULTS

Coding of qualitative data indicated that nursing and medical students were "sometimes" willing to discuss prospective patients' weight, body image, and eating disorders, especially if a health concern was evident. Nursing students seemed somewhat more willing to discuss weight issues than medical students and willingness to discuss one of these issues (e.g., body image) was positively associated with willingness discuss the others. Plans for future discussions of body image and weight were marginally associated with personal experiences of weight stigma. The majority of participants indicated that BMI was not a valid measure of health.

CONCLUSIONS

Taken together, findings suggest that future providers' conversations with patients about these sensitive topics are less likely to be associated with their own experiences and more with the relevance of these topics to specific patients.

'My words would have more weight': exploring weight stigma in UK dietetic practice and dietitian's lived experiences of weight stigma

BACKGROUND

Weight stigma is pervasive within healthcare and negatively impacts both access to care and the patient-practitioner relationship. There is limited evidence on weight stigma among registered dietitians, particularly in the United Kingdom, though data show weight-related prejudice towards people living with obesity. The aim of this study was to examine both explicit and implicit weight stigma in practicing dietitians in the United Kingdom, as well as the lived experience of weight stigma among dietitians, both towards themselves and towards others.

METHODS

An online cross-sectional survey was disseminated between February and May 2022 using snowball sampling. Inclusion criteria were that participants were UK registered dietitians aged 20-70 years.

RESULTS

Four hundred and two dietitians responded to the survey (female [94.1%], mean age 40.2 years [standard deviation (SD) 10.7]; White ethnicity [90%]; median 12 years [interquartile range (IQR) 6, 22] within dietetic practice). Mean self-reported body mass index was 25.1 kg/m² (SD 8.7). Most dietitians reported experiencing weight stigma prior to (51%) and postregistration (59.7%), whereas nearly a quarter (21.1%) felt that weight influenced their ability as a dietitian. Weight stigma was experienced across the weight spectrum. Overall participants reported explicit weight bias attitudes, moderate beliefs that obesity is controllable and implicit antifat bias. Within open-ended responses, dietitians reported three key themes related to their personal experiences of weight stigma: (1) experiences of stigma in dietetic practice, (2) impact of weight stigma and (3) perception of weight, appearance and job.

CONCLUSION

This study shows that UK dietitians exhibit both explicit and implicit weight bias towards people living with obesity. Dietitians reported experiencing weight stigma, which impacted their career-related decisions and their perception of their own ability to perform as dietitians. The study highlights the need to address weight stigma and its implications within the dietetic profession.

Testing the validity of the Norwegian translation of the modified weight bias internalization scale

BACKGROUND

Individuals with higher weight (overweight or obesity) may experience social stigma due to their weight. Weight stigma can be internalized with adverse health effects. Internalized weight stigma is relevant across different weight categories, but no validated weight-neutral measure of internalized weight bias currently exists in Norway. The current study aimed to examine the validity of a Norwegian translation of the Modified Weight Bias Internalization Scale.

METHODS

A Norwegian translation of the Modified Weight Bias Internalization Scale (WBIS-M) was administered in an adult Norwegian sample (N = 315, of which 251 women) ranging from self-reported "very underweight" to "very overweight".

RESULTS

A confirmatory factor analysis was conducted on 11 of the original 11 items in the WBIS-M. Based on previous factor analyses with this scale, we expected a one-factor model. One of the items related to competence showed poor model fit, and concern was raised around possible item ambiguity partway through the study. Two versions of this item were therefore tested, neither of which yielded an acceptable fit. After exclusion of this item, the results showed high loadings for the remaining 10 items on one factor with a high internal consistency (α = 0.94). Convergent validity was approached by looking at the relationship between answers on the WBIS-M, self-perceived weight, and items on overall health and psychological/emotional state.

CONCLUSION

The 10-item Norwegian version of the WBIS-M shows sound psychometric properties and can be used to measure internalized weight bias in a weight-neutral fashion in a Norwegian-speaking population. Internalized weight bias was correlated with psychological/emotional state and overall health, with those reporting more internalized weight bias also reporting that they felt worse. This relationship was stronger for women than men in our sample and was partially dependent on weight. The women also showed higher internalized weight bias than the men. Future studies should include more male participants and explore alternative versions of the missing item related to competence.

Informing the development of antipsychotic-induced weight gain management guidance: patient experiences and preferences - qualitative descriptive study

BACKGROUND

Antipsychotic-induced weight gain (AIWG) is a substantial contributor to high obesity rates in psychiatry. Limited management guidance exists to inform clinical practice, and individuals with experience of managing AIWG have had no or minimal input into its development. A lack of empirical research outlining patient values and preferences for management also exists. Recommendations addressing weight management in psychiatry may be distinctly susceptible to ideology and sociocultural values regarding intervention appropriateness and expectations of self-management, reinforcing the need for co-produced management guidance. This study is the first to ask: how do individuals conceptualise preferred AIWG management and how can this be realised in practice?

AIMS

1. Explore the management experiences of individuals with unwanted AIWG. 2. Elicit their values and preferences regarding preferred management.

METHOD

Qualitative descriptive methodology informed study design. A total of 17 participants took part in semi-structured interviews. Data analysis was undertaken using reflexive thematic analysis.

RESULTS

Participants reported that clinicians largely overestimated AIWG manageability using dietary and lifestyle changes. They also reported difficulties accessing alternative management interventions, including a change in antipsychotic and/or pharmacological adjuncts. Participants reported current management guidance is oversimplified, lacks the specificity and scope required, and endorses a 'one-size-fits-all' management approach to an extensively heterogenous side-effect. Participants expressed a preference for collaborative AIWG management and guidance that prioritises early intervention using the range of evidence-based management interventions, tailored according to AIWG risk, participant ability and participant preference.

CONCLUSION

Integration of this research into guideline development will help ensure recommendations are relevant and applicable, and that individual preferences are represented.

Patient perceptions of success in obesity treatment: An IMI2 SOPHIA study

Background

It is anticipated that by 2030, 20% of the world's population will live with obesity. Success in the management of obesity is predominately determined in terms of BMI or percentage weight loss, yet the limitations of these have been widely recognized. This study aimed to understand patient definitions of success in obesity treatment.

Methods

A series of in-depth focus groups, carried out with n = 30 adults living with obesity, offered a qualitative insight into patient definitions of success.

Results

A thematic analysis of data yielded four thematic findings: Success as freedom from stigma, bias and the mental burden of obesity; success as being able to participate fully in the world; success as measured by NSVs [non-scale victories]; and success is not a number on a scale.

Conclusions

What this study highlights is (1) how current measures of success do not accurately encompass the priorities of people living with obesity, (2) the importance of addressing the psychological and emotional aspects of living with obesity in any definition of success , and (3) the importance of meaningful co-creation of goals and indicators of success between clinician and patient for the effective management of the disease of obesity.

Exploring the Associations between Media and Instagram Interaction Patterns with Weight Bias among Undergraduate Nutrition Students in the Brazilian Nutritionists' Health Study

This study examined the association between media and Instagram interaction patterns with weight bias among undergraduate nutrition students in the Brazilian Nutritionists' Health Study. We also explored the potential mediating role of students' own body image perception in these relationships. A total of 406 students (78% women) participated in this cross-sectional analysis. Sociodemographic data, media influence, Instagram interaction patterns, body image perception, and weight bias were assessed using semi-structured questionnaires. Findings indicated that exposure to fitness content on Instagram (β = 0.17, p < 0.001) and the pursuit of an ideal athletic body (β = 0.12, p = 0.034) were associated with increased weight bias. In contrast, engagement with body diversity content (β = -0.23, p < 0.001) and perceived pressure from media to conform to appearance ideals (β = -0.24, p < 0.001) had a mitigating effect on weight bias. Notably, body image perception did not mediate these relationships (p > 0.05). In conclusion, this study revealed a link between media exposure and weight bias among undergraduate nutrition students, independent of their body image perception. Developing social media literacy programs that encourage students to critically evaluate media content is imperative to reduce weight bias. Additionally, a deeper examination of the media content that contributes to weight bias and the potential need for targeted regulatory measures is warranted.

Relationships Between Chronic Illness, Body Mass Index, and Patient-Provider Communication

Little is known about how higher-weight patients experience patient-provider communication, particularly among those with chronic illness. This study uses quantitative analytical methods and nationally representative data to determine how patient-provider communication is affected when patients have one or more chronic illnesses, as well as if patient BMI has a moderating effect on this association. Pearson correlation and multivariate logistic regression were both used to determine the significance of these associations. A significant, negative, relationship was found between overall patient-provider communication and patient chronic illness status, but no significant relationship was found between respondent BMI and patient-provider communication. There was no observable moderation effect of respondent BMI on the relationship between their number of chronic illnesses and the perceived quality of the patient-provider communication they experienced. From this study there is evidence that patients with multiple chronic illness experience worse communication with their health care providers which could be due to numerous types of bias. More research is needed to better understand if and how weight and other bias affects outcomes for chronically ill patients. Research implications include improving the comprehensiveness of nation-wide surveys that measure health care quality to include improved measures of perceived bias, including weight bias, and patient-provider communication, as these are complex, multi-factorial concepts.

Choosing Health: acceptability and feasibility of a theory-based, online-delivered, tailored weight loss, and weight loss maintenance intervention

Few weight loss and weight loss maintenance interventions are tailored to include factors demonstrated to predict the user's behavior. Establishing the feasibility and acceptability of such interventions is crucial. The aim of this study was to assess the acceptability and feasibility of a theory-based, tailored, online-delivered weight loss and weight loss maintenance intervention (Choosing Health). We conducted a mixed methods process evaluation of the Choosing Health tailored intervention, nested in a randomized controlled trial (N = 288) with an embedded N-of-1 study, investigating participants' and implementers' experiences related to intervention context, implementation, and mechanisms of impact. Measures included: (i) surveys, (ii) data-prompted interviews (DPIs) with study participants, (iii) semi-structured interviews with implementers, and (iv) intervention access and engagement data. Five themes described the acceptability of the intervention to participants: (i) monitoring behavior change and personal progress to better understand the weight management process, (ii) working collaboratively with the intervention implementers to achieve participants' goals, (iii) perceived benefits of non-judgmental and problem-solving tone of the intervention, (iv) changes in personal perception of the weight management process due to intervention tailoring, and (v) insufficient intervention content tailoring. The intervention delivery was feasible, however, emails and text messages differed in terms of accessibility and resources required to deliver the content. The use of Ecological Momentary Assessment as a technique to gather personal data for further tailoring was acceptable, and facilitated behavior change monitoring. Personalization of the intervention content above and beyond domain-specific issues, for example, by addressing participants' social roles may better match their needs. Support from the implementers and feedback on body composition changes may increase participants' engagement.

'Beyond the Scale': A Qualitative Exploration of the Impact of Weight Stigma Experienced by Patients With Obesity in General Practice

OBJECTIVE

Obesity is a complex, chronic, relapsing disease that requires an individualised approach to treatment. However, weight stigma (WS) experienced in healthcare settings poses a significant barrier to achieving person-centred care for obesity. Understanding the experiences of people living with obesity (PwO) can inform interventions to reduce WS and optimise patient outcomes. This study explores how patients with obesity perceive WS in general practice settings; its impact on their psychological well-being and health behaviours, and the patients suggestions for mitigating it.

METHODS

In-depth semistructured interviews were conducted with 11 PwO who had experienced WS in general practice settings in Ireland. The interviews were conducted online via Zoom between May and August 2023; interviews lasted between 31 and 63 min (M = 34.36 min). Interviews were audio-recorded, transcribed verbatim and analysed using inductive reflexive thematic analysis.

RESULTS

Three overarching themes specific to participants' experience of WS in general practice were generated: (1) shame, blame and 'failure'; (2) eat less, move more-the go-to treatment; (3) worthiness tied to compliance. A fourth theme: (4) the desire for a considered approach, outlines the participants' suggestions for reducing WS by improving the quality of patient-provider interactions in general practice.

CONCLUSION

The findings call for a paradigm shift in the management of obesity in general practice: emphasising training for GPs in weight-sensitive communication and promoting respectful, collaborative, and individualised care to reduce WS and improve outcomes for people with obesity.

PATIENT OR PUBLIC CONTRIBUTION

PPI collaborators played an active and equal role in shaping the research, contributing to the development of the research questions, refining the interview schedule, identifying key themes in the data, and granting final approval to the submitted and published version of the study.

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.

Expected and Desirable Preterm and Small Infant Growth Patterns

Adequate nutrition is necessary for achieving optimal growth and neurodevelopment. Growth is a natural and expected process that happens concomitantly with rapid advancements in neurodevelopment. Serial weight, length, and head circumference growth measures are essential for monitoring development, although identifying pathological deviations from normal growth can pose challenges. Appropriate growth assessments require considerations that a range of sizes for length, head circumference, and weight are expected and appropriate. Because of genetic differences and morbidities, there is a considerable overlap between the growth of healthy infants and those with growth alterations. Parents tend to be over-concerned about children who plot low on growth charts and often need reassurance. Thus, the use of terms such as "poor" growth or growth "failure" are discouraged when growth is approximately parallel to growth chart curves even if their size is smaller than specific percentiles. No specific percentile should be set as a growth goal; individual variability should be expected. An infant's size at birth is important information that goes beyond the common use of prognostic predictions of appropriate compared with small or large for gestational age. The lower the birthweight, the lower the nutrient stores and the more important the need for nutrition support. Compared to term infants, preterm infants at term-equivalent age have a higher percentage of body fat, but this diminishes over the next months. Current research findings support expert recommendations that preterm infants should grow, after early postnatal weight loss, similar to the fetus and then term-born infants, which translates to growth approximately parallel to growth chart curves. There is no need for a trade-off between optimum cognition and optimum future health. Each high-risk infant needs individualized nutrition and growth assessments. This review aims to examine infant growth expectations and messaging for parents of preterm and term-born infants within the broader causal framework.

Policy Interventions to Enhance Medical Care for People With Obesity in the United States-Challenges, Opportunities, and Future Directions

Policy Points Health policymakers have insufficiently addressed care for people with obesity (body mass index ≥ 30 kg/m2) in the United States. Current federal policies targeting obesity medications reflect this unfortunate reality. We argue for a novel policy framework to increase access to effective obesity therapeutics and care, recognizing that, though prevention is critical, the epidemic proportions of obesity in the United States warrant immediate interventions to augment care. Reducing barriers to and improving the quality of existing anti-obesity medications, intensive behavioral therapy, weight management nutrition and dietary counseling, and bariatric surgery are critical. Moreover, to ensure continuity of care and patient-clinician trust, combating physician and broader weight stigma must represent a central component of any viable obesity care agenda.

Familial confounding of internalising symptoms and obesity in adolescents and young adults; a co-twin analysis

BACKGROUND

Obesity and internalising disorders, including depression and anxiety, often co-occur. There is evidence that familial confounding contributes to the co-occurrence of internalising disorders and obesity in adults. However, its impact on this association among young people is unclear. Our study investigated the extent to which familial factors confound the association between internalising disorders and obesity in adolescents and young adults.

SUBJECTS/METHODS

We used a matched co-twin design to investigate the impact of confounding by familial factors on associations between internalising symptoms and obesity in a sample of 4018 twins aged 16 to 27 years.

RESULTS

High levels of internalising symptoms compared to low levels increased the odds of obesity for the whole cohort (adjusted odds ratio [AOR] = 3.1, 95% confidence interval [CI]: 1.5, 6.8), and in females (AOR = 4.1, 95% CI 1.5, 11.1), but not in males (AOR = 2.8 95% CI 0.8, 10.0). We found evidence that internalising symptoms were associated with an increased between-pair odds of obesity (AOR 6.2, 95% CI 1.7, 22.8), using the paired analysis but not using a within-pair association, which controls for familial confounding. Sex-stratified analyses indicated high internalising symptoms were associated with increased between-pair odds of obesity for females (AOR 12.9, 95% CI 2.2, 76.8), but this attenuated to the null using within-pair analysis. We found no evidence of between or within-pair associations for males and weak evidence that sex modified the association between internalising symptoms and obesity (likelihood ratio test p = 0.051).

CONCLUSIONS

Some familial factors shared by twins confound the association between internalising symptoms and obesity in adolescent and young adult females. Internalising symptoms and obesity were not associated for adolescent and young adult males. Therefore, prevention and treatment efforts should especially address familial shared determinants of obesity, particularly targeted at female adolescents and young adults with internalising symptoms and those with a family history of these disorders.

Living with obesity in Ireland: determinants, policy and future perspectives

Globally, the prevalence of those living with obesity (≥30 kg/m2) is rising, with this trend expected to continue if firm and decisive policy interventions are not introduced. Across Europe, despite many consecutive policies aiming to reverse rising trends in weight status over recent decades, no country is currently on track to halt and reverse current trends in the coming years. This is evident in Ireland too, whereby the reporting of nationally representative weight status data show that targets have not been achieved since reporting began. The aim of this review is to critically appraise recent evidence relating to the key determinants of obesity including weight status, diet quality and physical activity with an emphasis on socioeconomic inequalities. And to consider these in the context of respective policy measures and propose future-focused recommendations. Furthermore, as with the complex nature of obesity, multifaceted approaches that shift the focus from the individual and place responsibility at a societal level will be reviewed.

Patient perspectives on personalised medicine for obesity: An IMI2 SOPHIA Study

OBJECTIVE

Personalised medicine is seen as an exciting opportunity to improve the health outcomes of people with obesity. As research on phenotyping and personalised treatment for obesity rapidly advances, this study sought to understand patient preferences and perspectives on personalised medicine for obesity.

METHODS

A participatory world café methodology was used to garner the perspectives of people living with obesity on the potential opportunities and limitations associated with a personalised approach to obesity risk identification and treatment. Data were recorded by participants on tablemats and analysed thematically using thematic analysis.

RESULTS

Patients expressed the hope that personalised medicine for obesity would reduce stigma, support understanding of obesity as a disease, and improve treatment outcomes and acceptance. They also expressed concern about the accuracy of personalised medicine for obesity, its implications for insurance and that further advances in individual, personalised medicine, would detract attention from social, environmental, economic and psychological drivers of obesity.

CONCLUSIONS

This study highlights how patients are generally very optimistic about the potential for personalised obesity medicine but also raise a number of legitimate concerns that will be of interest to clinicians, industry, and policy makers.

Does neuroscience research change behaviour? A scoping review and case study in obesity neuroscience

The language employed by researchers to define and discuss diseases can itself be a determinant of health. Despite this, the framing of diseases in medical research literature is largely unexplored. This scoping review examines a prevalent medical issue with social determinants influenced by the framing of its pathogenesis: obesity. Specifically, we compare the currently dominant framing of obesity as an addiction to food with the emerging frame of obesity developing from neuroinflammation. We triangulate both corpus linguistic and bibliometric analysis of the top 200 most engaging neuroscience journal articles discussing obesity that were published open access in the past 10 years. The constructed Neurobesity Corpus is available for public use. The scoping review analysis confirmed that neuroinflammation is an emerging way for obesity to be framed in medical research. Importantly, the articles analysed that discussed neuroinflammation were less likely to use crisis terminology, such as referring to an obesity "epidemic". We highlight a potential relationship between the adoption of addiction frames and the use of stigmatising language in medical research.

The Weight Stigma Heat Map: A tool to identify weight stigma in public health and health promotion materials

ISSUES ADDRESSED

Public health campaigns and health promotion endeavours have been criticised for perpetuating weight stigma by reinforcing misinformation and using deficits-based narratives about larger-bodied people. The aim of this project was to develop a 'heat map' tool to appraise existing health policy and resources for elements that promote weight stigma.

METHODS

Ten themes were identified from literature using inductive analytic review methodology including pictorial/photographic representation, weight-health beliefs, body weight modifiability and financial concerns. Each theme was divided into four appraisal categories: the demonstration of weight stigma (via negative stereotyping, prejudice or discrimination that limits access to opportunities or services), weight bias (via presenting smaller bodies as normal/natural/healthy/good/desirable), bias-neutral (via representation of people of all shapes and sizes and accurate and nuanced health information about larger-bodied and smaller-bodied people) and finally an anti-stigma approach (via use of strengths-based narratives and overtly positive representation of and leadership by larger-bodied people).

RESULTS

A colour coding schema (the 'heat map') to visualise stigmatising elements across materials and a scoring system was devised for future quantitative evaluation. To demonstrate the use of the Weight Stigma Heat Map (WSHM), the Australian National Obesity Strategy 2022-2032 was appraised.

CONCLUSIONS

It is likely that weight stigmatisation is an important but under-recognised factor influencing the effectiveness of campaigns and interventions promoting behaviour change. SO WHAT?: Public health and health promotion professionals should consider using the WSHM as a framework for the development of less stigmatising policies, campaigns and resources and to direct reviews of existing materials.

Factors associated with progression or non-progression to bariatric surgery in adults: A systematic review

Access to bariatric surgery is limited, and the factors related to undergoing or not undergoing the procedure are poorly understood. To this end, a systematic review of PubMed, Embase, PsycINFO, and CINAHL was conducted to deduce the factors associated with progression or non-progression to bariatric surgery. Quantitative and qualitative English-language articles ranging in date from database conception to September 2023 were included. Eligible studies employed adult participants (18 years of age or above) who had been referred for bariatric surgery. A total of 57 studies were identified. Fifteen key factors were found, alongside six less frequently studied factors: age, sex, BMI, race and ethnicity, distance to clinic, socio-economic status, insurance coverage, physical health, psychological health, eating history and habits, substance use and smoking, social influence and relationships, pre-surgery process and requirements, surgery-related concerns, choice of surgery, and others (emergency room visitation, COVID-19 virus, health literacy, appearance perceptions, time-off work, and stigma related to surgery). No factors were found to be reliably associated with progression or non-progression to bariatric surgery; however, the nature of these findings is tentative considering methodological flaws and limited research. Further studies are required to elucidate potential inequities in bariatric surgery access and educate policymakers and health professionals.

Weight Stigma in Latin America, Asia, the Middle East, and Africa: A Scoping Review

INTRODUCTION

Being stigmatized because of one's weight can pose physical, mental, and social challenges. While weight stigma and its consequences are established throughout Europe, North America, and Australasia, less is known about weight stigma in other regions. The objective of this study was to identify the extent and focus of weight stigma research in Latin America, Asia, the Middle East, and Africa.

METHODS

A scoping review of weight stigma research in Latin America, Asia, the Middle East, and Africa was conducted. SCOPUS and PsychINFO databases were searched, and weight stigma experts were contacted to identify relevant literature. Sources were classified based on country/region, population, setting, and category of weight stigma researched.

RESULTS

A total of 130 sources were identified from 33 countries and territories. Results indicate that weight stigma has been investigated across populations and settings, mainly focusing on manifestations of weight stigma through experiences, practices, drivers, and personal outcomes of these manifestations.

CONCLUSIONS

Weight stigma is a developing global health concern not restricted to Europe, North America, and Australasia. The extent and focus of weight stigma research in Latin America, Asia, the Middle East, and Africa vary between countries and regions leaving several research gaps that require further investigation.

Perceived weight stigma in healthcare settings among adults living with obesity: A cross-sectional investigation of the relationship with patient characteristics and person-centred care

INTRODUCTION

Patients living with obesity often experience weight stigma in healthcare settings, which has worrying consequences for their healthcare experiences. This cross-sectional study aimed to: (1) provide an overview of stigmatising experiences in healthcare settings reported by adults living with varying classes of obesity, (2) identify associations among patient characteristics and perceived weight stigma and (3) investigate the association between perceived weight stigma and person-centred care (PCC).

METHODS

Dutch adults living with obesity classes I (body mass index [BMI]: 30 to <35 kg/m2; n = 426), II (BMI: 35 to <40 kg/m2; n = 124) and III (BMI: ≥40 kg/m2; n = 40) completed measures of perceived weight stigma in healthcare settings and PCC. Descriptive, correlational and multivariate analyses were conducted.

RESULTS

Of patients living with classes I, II and III obesity, 41%, 59% and 80%, respectively reported experiences of weight stigma in healthcare settings. Younger age, greater obesity severity and the presence of chronic illnesses were associated with greater perceived weight stigma. Greater perceived weight stigma was associated with lower PCC.

CONCLUSION

The results of this study emphasise the significant role of weight stigma in the healthcare experiences of patients living with obesity. Reducing weight stigma is expected to improve PCC and the overall quality of care for these patients. Minimising weight stigma will require efforts across various healthcare domains, including increasing awareness among healthcare professionals about sensitive communication in weight-related discussions.

PATIENT CONTRIBUTION

Our sample consisted of patients living with obesity. Additionally, patients were involved in the pilot testing and refinement of the PCC instrument.

Mind the gap! Factors that predict progression to bariatric surgery indicate that more psychological treatment may be required

In the UK, the number of adults living with obesity is increasing. Bariatric surgery is an available treatment for those living with a BMI (kg/m2 ) ≥40 and above, or ≥35 with obesity-related comorbidities. Guidelines highlight the importance of providing psychological support pre- and post-surgery owing to the complex psychopathology present in those living with obesity. There are a lack of studies examining which patients proceed to surgery and the factors that predict progression. Routine patient data were collected within one NHS regional service in the UK, comprising 733 patients between 3 August 2018 and 26 July 2019, aged between 17 and 76 years (M = 43.20, SD = 12.32). The only exclusion criteria were patients still awaiting a final decision for surgical outcome at the point of analysis (N = 29), which resulted in 704 patients included in analysis. Binary Logistic Regression revealed those who were more likely to progress to surgery had a lower-level use of maladaptive external substances; lower level of self-harm and/or suicidality, were older in age; had a lower BMI; and had less comorbidities than those who did not progress. Findings support existing literature in that bariatric patients often present with physical and mental health complexity. Two thirds of patients in this study did not progress to surgery. Service commissioning decisions meant that these patients did not have access to psychology treatment. Consequently, in cases where bariatric surgery is considered, a final treatment option and otherwise clinically appropriate, lack of access to specialist services may result in unmet patient need owing particularly to a lack of psychological treatment provision.

Obesity Stigma Among Healthcare Workers in a Teaching Hospital in Saudi Arabia

BACKGROUND

Obesity is a significant public health issue in Saudi Arabia. Rising obesity rates increase the risk of weight bias and stigma, even among healthcare workers.

OBJECTIVES

This study assesses weight stigma in healthcare workers, with findings intended to inform strategies for creating a more supportive healthcare environment for patients with obesity.

METHODS

This cross-sectional study was conducted in a university hospital in the Eastern Province of Saudi Arabia. Healthcare workers completed self-administered questionnaires, including the Attitudes toward Obese Persons Scale (ATOP) and the Beliefs about Obese Persons Scale (BAOP), which assess levels of positive attitudes and beliefs about obesity, respectively. Data were analyzed using SPSS.

RESULTS

The study included 266 healthcare workers (HCWs), mean age 33.21 years, with 54.5% female. The ATOP mean score was 64.4, and BAOP mean score was 18.3, indicating moderate negative attitudes and beliefs toward obesity. Significant differences in ATOP scores were found based on age, patient interactions, and years of experience.

DISCUSSION

Our study aligns with international findings, revealing significant weight stigma among healthcare workers in Saudi Arabia. Such stigma can negatively impact patient care, leading to biased treatment and poorer health outcomes. Societal norms and personal biases contribute to this stigma, despite misconceptions regarding its supposed motivational effects. Addressing this requires comprehensive training and education for healthcare providers. Policymakers should include weight bias education into medical curricula and establish anti-discrimination policies to promote inclusivity and respect.

CONCLUSIONS

Our study highlights obesity stigma among Saudi healthcare workers and the need for targeted interventions. Creating a supportive, nonjudgmental environment can enhance patient-provider relationships and improve healthcare outcomes for individuals with obesity.

The Challenge of Weight Stigma for Women in the Preconception Period: Workshop Recommendations for Action from the 5th European Conference on Preconception Health and Care

Weight stigma is a well-recognised public health issue affecting many members of society including women during the preconception period. The impacts of preconception weight stigma on women are significant and may result in decreased access to and uptake of healthcare, and mental health concerns. The consequences of this weight stigma may translate to negative maternal outcomes and even intergenerational effects on the child. Eliminating weight stigma is therefore imperative. The aim of this paper is to report recommendations to reduce weight stigma for preconception women produced at a workshop with clinical and academic experts on preconception health and weight stigma at the 5th European Conference on Preconception Health and Care. The recommendations are related to two key areas: general societal recommendations prompting all people to acknowledge and adjust our attitudes towards larger-bodied people; and healthcare-specific recommendations imploring clinicians to upskill themselves to reduce weight stigma in practice. We therefore call for urgent approaches to address societal weight-stigmatising attitudes and norms related to both the general population and preconception women, while providing professional development opportunities for healthcare professionals relating to weight stigma. Eliminating weight stigma for preconception women may have positive impacts on the outcomes for mothers and children during pregnancy and beyond.