Anti-obesity public health advertisements increase risk factors for the development of eating disorders

Effects of exposure to plus-size fashion models on weight-related attitudes in bulimia nervosa: Findings from an exploratory study

BACKGROUND AND OBJECTIVES

Eating disorders are often linked to the internalization of the thin-ideal and weight stigma. The present exploratory study investigates the effects of plus-sized fashion media on weight-related attitudes in bulimia nervosa (BN).

METHODS

Women with BN (n=27) and without an eating disorder (n=28) were exposed to 17 pictures of plus-size fashion models. Participants rated the attractiveness of the models. Before and after the exposure task, participants completed questionnaires on their attitudes towards people with higher weight as well as thin-ideal media.

RESULTS

The BN group rated the bodies of the plus-size fashion models as less attractive than controls, whereas no group differences were found in attractiveness ratings for the models' faces or full images. In both groups, negative attitudes about people with higher weight significantly decreased after viewing plus-size model pictures. Attitudes toward thin-ideal media remained unchanged, with scores higher for BN than controls.

LIMITATIONS

This exploratory study has several limitations, such as the lack of a control condition, small sample size, and reliance on only self-report data.

CONCLUSIONS

These exploratory results imply that the positive effects of plus-sized model images on reducing negative assumptions about people with high weight may not be limited to healthy individuals but also seem to extend to women with BN. Further controlled studies with larger samples and long-term assessments are needed to confirm these findings.

Growing up in a larger body: youth- and parent-reported triggers for illness and barriers to recovery from anorexia nervosa

BACKGROUND

A significant portion of youth with anorexia nervosa (AN) or atypical anorexia nervosa (AAN) have history of 'overweight/obesity' (i.e., body mass index ≥ 85th percentile for age-and-sex) prior to the onset of the eating disorder (ED) diagnosis, but research on this population remains limited. The present study used semi-structured interviews to explore themes related to triggers of weight loss, treatment, and recovery among youth with AN/AAN and history of 'overweight/obesity,' and their parents.

METHOD

The sample included eleven youth and parent dyads (Median [IQR] age of youth = 16.0 (1.5) years, 90.9% female, 90.9% White, 27.3% Hispanic) who were evaluated for an ED in a multidisciplinary ED program at a pediatric hospital between November 2020 and April 2021. Nine youth and separately, nine parents of these 11 dyads completed semi-structured interviews with the research team. Seven matched pairs of patients and parents completed demographic surveys and study interviews. Interviews were recorded, transcribed, and coded by four research team members using a reflexive thematic approach.

RESULTS

Weight stigma was the most frequently reported theme for a trigger for weight loss that led to the onset for developing AN/AAN by both youth and parents. Regarding barriers to recovery, themes from more than a half of youth included uncertainty of weight goals in treatment and feeling they are "not sick enough." Notable themes for attitudes towards treatment from most parents included general agreement with clinician recommendations, but also an uncertainty of weight restoration goals and a belief that their child need to have a "normal" weight.

CONCLUSION

These results highlighted how the majority of interviewed youth with history of 'overweight/obesity' reported weight stigma as both a trigger for the development of AN/AAN as well as a barrier to recovering. Internalized weight stigma among parents may influence their attitudes towards weight restoration as a treatment goal where these youth and parents may experience uncertainty of weight goals in treatment. This study demonstrated triggers and barriers to treatment that may be unique to youth with ED and history of 'overweight/obesity' and more research is needed to address weight stigma in multidisciplinary ED treatment for this understudied population.

Dismantling the myth of "all foods fit" in eating disorder treatment

We call for a reevaluation of the long-standing dogmatic nutritional principle that "all foods fit" for all cases of eating disorders (EDs) and its corollary, "there are no bad foods" (for anyone ever) during ED treatment. Based on accumulated scientific research, we challenge these ideologies as outdated, confusing, and potentially harmful to many patients. We review the evidence that indicates the folly of these assumptions and show there are a variety of exceptions to these rules, including (1) food allergies, sensitivities, and intolerances, (2) religious and spiritual preferences or doctrines, and (3) the ubiquitous emergence and widespread availability of ultra-processed foods leading to the potential development of addiction-like eating and a higher prevalence of various medical and psychiatric comorbidities, as well as higher mortality. This evidence supports a nutritional psychiatry approach that should be integrated into (rather than dissociated from) ED treatment research and practice.

Triggers for eating disorder onset in youth with anorexia nervosa across the weight spectrum

To aid in more targeted eating disorder (ED) prevention efforts, we sought to identify sociodemographic and weight-related risk factors for identified triggers for the onset of anorexia nervosa (AN) in youth. We conducted a retrospective chart review of youth admitted for medical treatment of AN between January 2015 and February 2020. From multidisciplinary admission notes, we extracted patient-reported reasons for diet/exercise changes. We used qualitative thematic analysis to identify ED triggers, then categorized each trigger as binary variables (presence/absence) for logistic regression analysis of risks associated with each trigger. Of 150 patients, mean (SD) age was 14.1(2.3) years. A total of 129 (86%) were female and 120 (80%) were Non-Hispanic White. Triggers included environmental stressors (reported by 30%), external pressures of the thin/fit ideal (29%), internalized thin/fit ideal (29%), weight-related teasing (19%), and receiving health education (14%). Younger age was associated with higher odds of weight-related teasing (p = .04) and health education (p = .03). Males had greater odds of internalized thin/fit ideal than females (p = .04). Those with premorbid body mass indices ≥85th percentile for age and sex had greater odds of reporting positive reinforcement (p = .03) and weight-related teasing (p = .04) than those with weights <85th percentile. We use these findings to detail potential targets for advancing ED prevention efforts.

Individuals with restrictive eating disorders' experience of the introduction of calories on menus in England: An interpretative phenomenological analysis study

OBJECTIVE

In April 2022 the Calorie Labelling (Out of Home) Regulations came into effect in England where cafés, restaurants, and takeaways with over 250 employees were required to provide calorie labelling on menus. Concerns have been raised regarding the potential negative impact this could have on individuals with eating disorders (EDs), yet this has not been explored using qualitative methodology.

METHOD

Eleven participants with a current or previously diagnosed restrictive ED were interviewed in September 2022. Interpretative Phenomenological Analysis (IPA) was used to explore their experience of the introduction of calories on menus.

RESULTS

Using IPA we established six themes and seven subordinate themes. These included the introduction of calories on menus as an 'attack' on individuals with EDs; the prominent visual display of calories as an attentional pull; normalising of calories counting; the impact on behaviour; and associated strategies for managing.

CONCLUSION

This contributes to research surrounding the implications for public health policies on individuals with EDs, especially their ability to reinforce and amplify disordered thoughts and behaviours, and the need for greater consideration of how to minimise impact and potential harm of large public health campaigns.

Mediating effects of a weight-inclusive health promotion program on maladaptive eating in women with high body mass index

Research shows that individuals with a body mass index (BMI) over 30 have experienced an 11-fold increase in restrictive eating and a 7-fold increase in binge eating since the 1990s. Most health promotion programs for higher-weight individuals have not been developed with the high eating disorder risk for this population in mind. The purpose of current study was to test two hypothesized mechanisms underlying improvement in maladaptive eating patterns shown in a weight-inclusive health promotion program designed for women with BMIs at or above 30. Participants (N = 40) were primarily White (93 %), 30-45 years old (M = 39.83, SD = 4.34) with BMIs ranging from 30 to 45 kg/m² (M = 37.42, SD = 3.58). Using the MEMORE macro, we tested a parallel mediation model hypothesizing that internalized weight stigma and intuitive eating would explain improvements on two subscales from the Three-Factor Eating Questionnaire-R18 after a 6-month program. Total effects of the program on uncontrolled (b = -3.76, SE = 0.64, p < .0001) and emotional eating (b = -1.79, SE = 0.34, p < .0001) were significant. The indirect effects (IE) of internalized weight stigma on uncontrolled eating (IE = 1.59, SE = 0.79, 95 % CI = 0.46, 3.49) and emotional eating (IE = 0.67, SE = 0.40, 95 % CI = 0.11, 1.68) were also significant. Likewise, the IEs of intuitive eating on uncontrolled eating (IE = 2.09, SE = 0.70, 95 % CI = 0.60, 3.38) and emotional eating (IE = 1.03, SE = 0.43, 95 % CI = 0.08, 1.82) were significant. These findings indicate that weight-inclusive health promotion programs that directly address weight bias and eating according to cues from the body may help higher-weight individuals improve maladaptive eating patterns via reductions in internalized weight stigma and increases in intuitive eating.

'It makes you not want to eat': Perceptions of anti-obesity public health campaigns in individuals diagnosed with an eating disorder

OBJECTIVE

Recent research has highlighted the potentially deleterious effects of anti-obesity public health campaigns on vulnerable audiences such as those at risk of, or diagnosed with, eating disorders (ED). The qualitative experiences of campaigns in this population group have been little explored.

METHODS

Twelve interviews were conducted with participants either currently or previously diagnosed with an ED using the Interpretative Phenomenological Analysis approach. Participants were shown a series of real-world public health campaigns and, using a semi-structured interview guide, asked about their responses to the images used.

RESULTS

Several themes emerged from the data, including the effect of campaigns on participants, perceived effect on others, and general campaign attributes. It was evident that participants felt that anti-obesity campaigns had the potential to confirm ED thoughts and behaviours, and could act as potential triggers. Participants also felt that they could impact vulnerable groups (e.g., young audiences) and stigmatise those living in larger bodies.

CONCLUSION

Campaigns addressing overweight and obesity should consider reframing these conditions and care must be taken to avoid causing potential harm to vulnerable audiences.

Weight self-stigma and engagement among obese students in a physical education class

BACKGROUND

This is a cross-sectional in design. It involves the mediating effects of basic psychological need satisfaction in relation to the moderating effects of teacher autonomy support regarding weight self-stigma's effect on engagement among obese students in physical education classes.

METHODS

This study includes 165 Chinese high school obese students [mean age, 16.84 (±0.147) years], comprising 93 males (56.63%) and 72 females (43.63%), with a mean body mass index (BMI) of 30.453 (SD = 2.426). Participants completed the weight self-stigma questionnaire, basic psychological need satisfaction questionnaire, teacher autonomy support questionnaire, and student engagement questionnaire.

RESULTS

Weight self-stigma and engagement among obese students were mediated by basic psychological need satisfaction. Moreover, the mediated effect of basic psychological need satisfaction was moderated by teacher autonomy support.

CONCLUSION

Weight self-stigma and basic psychological need satisfaction are the antecedents influencing the engagement of obese students. Notably, weight self-stigma not only directly blocks the engagement of obese students but also their engagement by hindering the acquisition of basic psychological need satisfaction. Teacher autonomy support can significantly reduce the negative impact of weight self-stigma on basic psychological need satisfaction and significantly promote engagement. Therefore, by promoting their physical education engagement, physical education teachers should strengthen the application of their supportive autonomous teaching strategies to help obese students meet their basic psychological needs.