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Gerend MA, Wilkinson LJ, Sutin AR, Rosado JI, Ehrlich KB, Smith DW, Maner JK. Sociodemographic predictors of perceived weight discrimination. Int J Obes (Lond) 2024:10.1038/s41366-024-01535-1. [PMID: 38740855 DOI: 10.1038/s41366-024-01535-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 04/26/2024] [Accepted: 04/30/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Perceived weight discrimination is associated with increased risk for chronic diseases and reduced life expectancy. Nevertheless, little is known about perceived weight discrimination in racial, ethnic, and sexual minority groups or in individuals at the intersections of those groups. The goal of this study was to identify sociodemographic predictors of perceived weight discrimination. SUBJECTS/METHODS A diverse sample of adults (37% Black/African American, 36% Latino, 29% sexual minority) with a body mass index (BMI) ≥ 18.5 kg/m2 were recruited from a national US panel to complete an online survey (N = 2454). Perceived weight discrimination was assessed with the Stigmatizing Situations Survey-Brief (SSI-B). Using hierarchical linear regression analysis, SSI-B scores were predicted from the four sociodemographic characteristics of interest (gender, race, ethnicity, and sexual orientation) while controlling for BMI, age, education, and income (Step 1). At Step 2, all two-way interactions between the four sociodemographic characteristics were added to the model. RESULTS At Step 1, higher SSI-B scores were observed for Latino (vs. non-Latino) adults, sexual minority (vs. heterosexual) adults, younger (vs. older) adults, adults with higher (vs. lower) levels of education, and adults with higher (vs. lower) BMI. At Step 2, race interacted with gender, ethnicity, and sexual orientation to predict SSI-B scores such that relatively higher scores were observed for non-Black women, Black men, adults who identified as Black and Latino, and non-Black sexual minority adults. CONCLUSIONS Perceived weight discrimination varied across sociodemographic groups, with some subgroups reporting relatively high frequency. Black race appeared to be protective for some subgroups (e.g., Black women), but risk-enhancing for others (e.g., Black men, individuals who identified as Black and Latino). Additional research is needed to identify specific factors that cause certain sociodemographic groups -and indeed, certain individuals-to perceive higher levels of weight discrimination than others.
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Affiliation(s)
- Mary A Gerend
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, FL, USA.
| | | | - Angelina R Sutin
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, FL, USA
| | - Javier I Rosado
- College of Medicine, Florida State University, Immokalee Regional Campus, Immokalee, FL, USA
| | | | - David W Smith
- Cardiology, Southern Medical Group, Tallahassee, FL, USA
| | - Jon K Maner
- Department of Psychology, College of Arts and Sciences, Florida State University, Tallahassee, FL, USA
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2
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Finch LE, Hawkley LC, Schumm LP, Iveniuk J, McClintock MK, Huang ES. Moderation of associations between weight discrimination and diabetes status by psychosocial factors. J Behav Med 2024; 47:244-254. [PMID: 37946026 PMCID: PMC11017919 DOI: 10.1007/s10865-023-00454-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/09/2023] [Indexed: 11/12/2023]
Abstract
Weight discrimination has adverse effects on health that include increasing the risk factors for developing type 2 diabetes. Preliminary evidence suggests a positive association between weight discrimination and diagnosed diabetes; however, it is unknown whether psychosocial resources may buffer this association. In logistic regressions stratified by gender, we examined links between weight discrimination and diabetes among a nationally representative sample of U.S. adults (the National Social Life, Health, and Aging Project; N = 2,794 adults age 50 and older in 2015-16). We also tested the extent to which trait-resilience and social support from a spouse/partner, family, and friends buffered any observed association. We adjusted for known predictors of diabetes (age, race/ethnicity, Body Mass Index) and conducted sensitivity analyses restricted to men and women with obesity. Net of covariates, in the overall sample, weight discrimination was associated with significantly greater odds of having ever had diabetes among women (OR = 2.00, 95% CI [1.15, 3.47]), but not men. Among women with obesity, weight discrimination was only significantly associated with greater odds of diabetes for those with low resilience (OR = 1.84, 95% CI [1.01, 3.35]). Among men overall, weight discrimination was associated with lower odds of diabetes for those with high family support (OR = 0.03, 95% CI [0.003, 0.25]) as well as those with high friend support (OR = 0.34, 95% CI [0.13, 0.91]); similar effects were observed in men with obesity. These novel findings evince a role for psychosocial resources in buffering associations between weight discrimination and diabetes.
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Affiliation(s)
- Laura E Finch
- Academic Research Centers, NORC at the University of Chicago, 1155 E 60th St, Chicago, IL, 60637, USA.
| | - Louise C Hawkley
- Academic Research Centers, NORC at the University of Chicago, 1155 E 60th St, Chicago, IL, 60637, USA
| | - L Philip Schumm
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - James Iveniuk
- Academic Research Centers, NORC at the University of Chicago, 1155 E 60th St, Chicago, IL, 60637, USA
| | - Martha K McClintock
- Departments of Psychology and Human Development, University of Chicago, Chicago, IL, USA
| | - Elbert S Huang
- Section of General Internal Medicine, University of Chicago, Chicago, IL, USA
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3
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Zahra-Zeitoun Y, Elran-Barak R, Salameh-Dakwar R, Froylich D, Sroka G, Assalia A, Latzer Y. Weight stigma in healthcare settings: the experience of Arab and Jewish bariatric surgery candidates in Israel. Isr J Health Policy Res 2024; 13:1. [PMID: 38167112 PMCID: PMC10759645 DOI: 10.1186/s13584-023-00587-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 12/09/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Weight-related stigma and discrimination are prevalent in our society with adverse biopsychosocial outcomes to people with obesity and morbid obesity. Studies suggest that weight bias in healthcare settings are quite prevalent, but there have been, as far as we know, lack of studies examining prevalence and correlates of weight bias experiences among bariatric surgery candidates in Israel. We aim to understand the nature and prevalence of weight stigma among bariatric surgery candidates. To identify differences between Jewish and Arab candidates. To examine the impact of weight stigma experiences on weight bias internalization (WBI). METHODS A cross-sectional study was performed among 117 adult bariatric surgery candidates from three hospitals in northern Israel (47.8% Jews, 82.4% females, average BMI 42.4 ± 5.2 Kg/meter2). Patients who agreed to participate completed a structured questionnaire on the same day that the bariatric surgery committee met. WBI was measured using a validated 10-item scale. Experiences of weight stigma were measured using items adapted from prior international studies. RESULTS About two thirds of the participants had at least one experience of weight stigma (teased, treated unfairly, or discriminated against because of their weight). As many as 75% of participants reported that weight served as a barrier to getting appropriate health care and as many as half of participants felt in the last year that a doctor judged them because of their weight. No significant differences were found between Arabs and Jews in the prevalence of weight stigma experiences and WBI. However, a trend towards more stigma experiences among Jews was noted. WBI was predicted by female gender and experiences of weight stigma, both in general and within healthcare settings. CONCLUSIONS Weight stigma towards bariatric surgery candidates in Israel is quite prevalent, and specifically in healthcare settings. It is important to adopt policy actions and intervention programs to improve awareness to this phenomenon among the general public and specifically among healthcare providers, as many healthcare providers may be unaware of the adverse effect of weight stigma and of ways in which they are contributing to the problem. Future studies may validate our findings using larger sample size and longitudinal design.
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Affiliation(s)
| | | | | | | | | | | | - Yael Latzer
- School of Public Health, University of Haifa, Haifa, Israel
- Rambam Medical Center, Haifa, Israel
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Zhao Z, Serier KN, Smith BN, Vogt D, Kehle-Forbes S, Mitchell KS. Gender similarities and differences in associations between weight discrimination, shape/weight concerns, and eating disorder symptoms among post-9/11 veterans. Eat Behav 2023; 51:101818. [PMID: 37741082 DOI: 10.1016/j.eatbeh.2023.101818] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 09/13/2023] [Accepted: 09/13/2023] [Indexed: 09/25/2023]
Abstract
OBJECTIVE Weight discrimination, defined as mistreatment of people based on body weight, is associated with body image concerns and eating disorder (ED) symptoms. Military veterans are particularly vulnerable to developing ED symptoms, which may be due to experiences of weight discrimination resulting from the military's strict weight and fitness requirements. However, no previous study has examined these associations among veterans. We investigated relationships between weight discrimination during and after military service and shape/weight concerns and ED symptoms in post-9/11 veterans. Based on evidence for gender differences in weight discrimination, body image, and ED symptoms, we also examined whether gender moderated these associations. METHOD Participants were randomly selected from the population of post-9/11 U.S. veterans who had been discharged from the military within the previous 18 months. A total of 1494 veterans completed the Everyday Discrimination Scale, Eating Disorders Examination-Questionnaire, and the Eating Disorder Diagnostic Scale-5. RESULT Women were more likely to report weight discrimination and had higher levels of ED symptoms and shape/weight concerns than men. Weight discrimination in and after leaving the military were positively associated with shape/weight concerns and ED symptoms in the full sample and among men and women. Gender moderated the association between weight discrimination after leaving the military and shape/weight concerns such that the association was stronger among men. DISCUSSION Both male and female veterans may be vulnerable to developing ED symptoms, in part due to weight discrimination experienced during and after military service. Our findings emphasize the need to address weight discrimination and its consequences in veterans.
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Affiliation(s)
- Ziyu Zhao
- National Center for PTSD at VA Boston Healthcare System, United States of America; Department of Psychological & Brain Science, Boston University, United States of America
| | - Kelsey N Serier
- National Center for PTSD at VA Boston Healthcare System, United States of America; Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, United States of America
| | - Brian N Smith
- National Center for PTSD at VA Boston Healthcare System, United States of America; Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, United States of America
| | - Dawne Vogt
- National Center for PTSD at VA Boston Healthcare System, United States of America; Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, United States of America
| | - Shannon Kehle-Forbes
- National Center for PTSD at VA Boston Healthcare System, United States of America; Minneapolis VA Healthcare System, United States of America; Department of Medicine, University of Minnesota, United States of America
| | - Karen S Mitchell
- National Center for PTSD at VA Boston Healthcare System, United States of America; Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, United States of America.
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5
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Hughes AM, McArthur D. Weight stigma, welfare stigma, and political values: Evidence from a representative British survey. Soc Sci Med 2023; 334:116172. [PMID: 37696238 PMCID: PMC7615479 DOI: 10.1016/j.socscimed.2023.116172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 09/13/2023]
Abstract
Obesity-related stigma is increasingly recognised as a public health issue, with serious implications for mental and physical health. However, very little is known about what drives inter-individual differences in obesity-stigmatizing views, and how they are distributed in the population. If views about obesity are not independent of a person's wider beliefs and values, this must be understood so that obesity stigma can be effectively tackled. In a representative sample of British adults aged 18-97 (N = 2186), we explore predictors of weight-stigmatizing attitudes. We consider demographics, socioeconomic position, factors related to one's own weight and health, and beliefs about the causes and consequences of obesity. We explore the role of core political values which predict views about other stigmatized groups, and views about welfare recipients, who are frequently linked with obesity in public and political discourse. Finally, we assess to what extent demographic differences in weight-stigmatizing attitudes are explained by individual body mass index (BMI), attitudes, and beliefs. Consistent with previous studies, women were less weight-stigmatizing than men. People in late middle-age were less weight-stigmatizing than younger or older adults. Adjusted for age and gender, an index of weight-stigmatizing views was positively associated with income, and highest in intermediate categories of education and occupational social class. Weight-stigmatizing attitudes were associated with more right-wing values, more authoritarian values, and more stigmatizing views about welfare recipients. Factors including own BMI, beliefs about causes of obesity, welfare-stigmatizing attitudes and authoritarian values contributed to socioeconomic differences. Weight-stigmatizing attitudes show clear differences between demographic groups, but also vary according to wider social attitudes, beliefs, and a person's core political values. Efforts to reduce weight stigma, and other kinds of stigma, may be more effective if they recognise these links.
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Affiliation(s)
- Amanda M Hughes
- MRC Integrative Epidemiology Unit, Department of Population Health Sciences, University of Bristol, UK.
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O'Hara L, Alajaimi B, Alshowaikh B. "I was bullied for being fat in every situation, in every outfit, at every celebration": A qualitative exploratory study on experiences of weight-based oppression in Qatar. Front Public Health 2023; 11:1015181. [PMID: 36923042 PMCID: PMC10008867 DOI: 10.3389/fpubh.2023.1015181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 02/08/2023] [Indexed: 02/28/2023] Open
Abstract
Introduction Weight-based oppression (WBO) has been documented as a widespread phenomenon in Western countries and is associated with a range of psychological, physiological, and behavioral harms. Research on weight-based oppression is largely absent from the Arab region. Methods We conducted a qualitative exploratory study using semi-structured in-depth interviews to examine the internalized attitudes, values, and beliefs related to body weight, and experiences of external weight-based oppression of 29 staff, faculty, and students at Qatar University. Results Thematic analysis revealed six major themes on the characteristics of internalized WBO, and the nature, timing, source, extent, and impact of external WBO. WBO was regarded as so common in the Arab culture as to be normative, with damaging exposure to WBO beginning in early childhood. Conclusion WBO in the Arab region is an important and unrecognized public health issue. Programs to reduce WBO should be developed in all sectors.
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Affiliation(s)
- Lily O'Hara
- Department of Public Health, QU Health, Qatar University, Doha, Qatar
| | - Bayan Alajaimi
- Department of Public Health, QU Health, Qatar University, Doha, Qatar
| | - Bayan Alshowaikh
- Department of Public Health, QU Health, Qatar University, Doha, Qatar
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Shonrock AT, Miller JC, Byrd R, Sall KE, Jansen E, Carraway M, Campbell L, Carels RA. Experienced weight stigma, internalized weight bias, and maladaptive eating patterns among heterosexual and sexual minority individuals. Eat Weight Disord 2022; 27:3487-3497. [PMID: 36223058 DOI: 10.1007/s40519-022-01486-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 09/25/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE The current study examined experienced weight stigma (EWS), internalized weight bias (IWB), and maladaptive eating patterns (ME) among sexual minority (SM) and heterosexual individuals. METHODS The sample consisted of cisgender heterosexual and SM men and women. Participants were drawn from introductory psychology classes and a variety of supplemental recruitment methods (Facebook, Instagram, MTURK, etc.). RESULTS SM individuals reported higher levels of EWS, IWB, and maladaptive eating patterns than heterosexual individuals. Heterosexual men reported the lowest levels of EWS, IWB, and ME compared to all other groups. Additionally, there was a significant association between greater EWS and IWB and greater ME. Gender identity and sexual orientation impacted the strength of the relationship between IWB and ME and, to a lesser extent, EWS and ME. CONCLUSION This investigation contributes to knowledge of the impact of gender identity and sexual orientation on EWS and IWB, and demonstrates that IWB and EWS are significant concerns for the SM community, especially in relation to ME. LEVEL OF EVIDENCE Level IV, cross-sectional study.
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Affiliation(s)
| | - J Caroline Miller
- Department of Psychology, East Carolina University, Greenville, NC, USA
| | - Rhonda Byrd
- Department of Psychology, East Carolina University, Greenville, NC, USA
| | - Kayla E Sall
- Department of Psychology, East Carolina University, Greenville, NC, USA
| | - Emily Jansen
- Department of Psychology, East Carolina University, Greenville, NC, USA
| | - Marissa Carraway
- Department of Psychology, East Carolina University, Greenville, NC, USA
| | - Lisa Campbell
- Department of Psychology, East Carolina University, Greenville, NC, USA
| | - Robert A Carels
- Department of Psychology, East Carolina University, Greenville, NC, USA
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Liao B, Xu D, Tan Y, Chen X, Cai S. Association of mental distress with chronic diseases in 1.9 million individuals: A population-based cross-sectional study. J Psychosom Res 2022; 162:111040. [PMID: 36137487 DOI: 10.1016/j.jpsychores.2022.111040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 09/08/2022] [Accepted: 09/11/2022] [Indexed: 10/31/2022]
Abstract
OBJECTIVE Mental distress has a high global prevalence and is associated with poor health outcomes. This study aimed to estimate the relationship between mental distress and the risk of 10 chronic diseases using data from the Behavioral Risk Factor Surveillance System (BRFSS). METHODS Cross-sectional data from the 2013, 2014, 2015, 2016 and 2017 BRFSS were analyzed. The association between mental distress based on the number of days of poor mental health and the risk of 10 chronic diseases, namely obesity, diabetes, asthma, chronic obstructive pulmonary disease (COPD), arthritis, kidney disease, coronary heart disease (CHD), stroke, skin cancer, and other cancers, were assessed by logistic regression models to calculate odds ratios and 95% confidence intervals. Subgroup analyses stratified by age and sex were also conducted. RESULTS Positive associations between mental distress and chronic diseases were observed. We also found a dose-response gradient between mental distress levels and the risk of all chronic diseases except skin cancer. In respondents aged 18-44 years reporting ≥23 days/month of mental distress, there has the largest odds ratio between mental distress levels and each chronic disease. Moreover, mental distress was associated with higher risks of obesity and arthritis in women relative to men. CONCLUSIONS Mental distress was positively associated with chronic diseases. Age and sex are crucial in this relationship. Further studies with longitudinal data are needed to clarify the direction of this association.
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Affiliation(s)
- Bing Liao
- School of Nursing, Guangdong Pharmaceutical University, Haizhu District, Guangzhou, China; Department of Nursing, Central People's Hospital of Zhanjiang, Chikan District, Zhanjiang, China
| | - Dali Xu
- Department of Psychiatry and Neuroimaging Centre, Wenzhou Seventh People's Hospital, Wenzhou, Zhejiang, China.
| | - Yingyao Tan
- School of Nursing, Guangdong Pharmaceutical University, Haizhu District, Guangzhou, China
| | - Xiong Chen
- Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Shu Cai
- School of Nursing, Guangdong Pharmaceutical University, Haizhu District, Guangzhou, China.
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Crockett KB, Borgatti A, Tan F, Tang Z, Dutton G. Weight Discrimination Experienced Prior to Enrolling in a Behavioral Obesity Intervention is Associated with Treatment Response Among Black and White Adults in the Southeastern U.S. Int J Behav Med 2022; 29:152-159. [PMID: 34341957 PMCID: PMC9125874 DOI: 10.1007/s12529-021-10009-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The current study evaluated the associations between history of weight discrimination and race on pre-treatment depressive symptoms, treatment session attendance, and weight loss among Black and White adults enrolled in a 16-week obesity intervention. METHODS Participants (N = 271; mean BMI = 35.7 kg/m2; 59% Black; 92% women) reported prior experiences of weight discrimination and completed the Center for Epidemiological Studies Depression (CES-D) Scale at baseline. Weekly attendance at group sessions was recorded, and weight was measured at baseline and post-treatment. All models adjusted for baseline BMI, age, and sex. RESULTS Participants with a history of weight discrimination scored 2.4 points higher on the CES-D (B = 2.432, p = .012) and lost 2% less weight relative to those without weight discrimination (B = 0.023, p = .002). Race modified the association between weight discrimination and treatment session attendance, such that Black individuals attended fewer sessions if they had prior experience of weight discrimination, but prior weight discrimination was not significantly associated with treatment attendance among White individuals. CONCLUSION Weight discrimination is associated with pre-treatment depressive symptoms and may hinder weight loss regardless of race. Black individuals may attend fewer weight loss treatment sessions if they have prior experience of weight discrimination.
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Affiliation(s)
- Kaylee B Crockett
- Department of Family and Community Medicine, School of Medicine, University of Alabama At Birmingham, Birmingham, AL, USA.
| | - Alena Borgatti
- Division of Preventive Medicine, School of Medicine, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Fei Tan
- Department of Mathematical Sciences, School of Science, Indiana University - Purdue University Indianapolis, IN, Indianapolis, USA
| | - Ziting Tang
- Department of Mathematical Sciences, School of Science, Indiana University - Purdue University Indianapolis, IN, Indianapolis, USA
| | - Gareth Dutton
- Division of Preventive Medicine, School of Medicine, University of Alabama At Birmingham, Birmingham, AL, USA
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10
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Adil O, Kuk JL, Ardern CI. Associations between weight discrimination and metabolic health: A cross sectional analysis of middle aged adults. Obes Res Clin Pract 2022; 16:151-157. [PMID: 35227638 DOI: 10.1016/j.orcp.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 02/08/2022] [Accepted: 02/15/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Concurrent with the recent rise in overweight and obesity, concerns with weight discrimination have arisen. Individuals who have experienced weight discrimination report a host of deteriorations related to physical and psychological health, which may co-exist with behaviours such as increased food consumption and decreases in physical activity that make weight management difficult. What remains less clear, however, is the extent to which metabolic health may be specifically affected, and how this may vary by setting and perceived intensity of the lifetime history of weight discrimination. METHOD To address this, a secondary data analysis was performed on 1365 participants from year 25 of the Coronary Artery Disease in Young Adults (CARDIA) study who were living with overweight and obesity. Descriptive statistics and logistic regression analyses were performed on the presence of metabolic syndrome, diabetes, and abdominal obesity, as well as their experience of the weight discrimination. RESULTS Prevalence of the metabolic syndrome, diabetes, and abdominal obesity was higher among those reporting low and high stress weight discrimination compared to those with no history of weight discrimination. In the adjusted analyses, weight discrimination was associated with a 65% greater likelihood for having metabolic syndrome, 85% greater likelihood of diabetes, and between a 2.5- and 3.9-times greater likelihood of abdominal obesity for low and high stress experiences, respectively. CONCLUSION Exposure to weight discrimination may worsen metabolic health, as characterized by higher rates of metabolic syndrome and abdominal obesity. These associations may be greater with levels of stress experienced from weight discrimination. Further longitudinal work is necessary to understand the temporal sequence, time lag, and any possible critical periods for weight discrimination on metabolic health.
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Affiliation(s)
- Omar Adil
- School of Kinesiology and Health Sciences, York University, 4700 Keele St, Toronto, Ontario M3J 1P3, Canada.
| | - Jennifer L Kuk
- School of Kinesiology and Health Sciences, York University, 4700 Keele St, Toronto, Ontario M3J 1P3, Canada.
| | - Chris I Ardern
- School of Kinesiology and Health Sciences, York University, 4700 Keele St, Toronto, Ontario M3J 1P3, Canada.
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Karlsen TH, Sheron N, Zelber-Sagi S, Carrieri P, Dusheiko G, Bugianesi E, Pryke R, Hutchinson SJ, Sangro B, Martin NK, Cecchini M, Dirac MA, Belloni A, Serra-Burriel M, Ponsioen CY, Sheena B, Lerouge A, Devaux M, Scott N, Hellard M, Verkade HJ, Sturm E, Marchesini G, Yki-Järvinen H, Byrne CD, Targher G, Tur-Sinai A, Barrett D, Ninburg M, Reic T, Taylor A, Rhodes T, Treloar C, Petersen C, Schramm C, Flisiak R, Simonova MY, Pares A, Johnson P, Cucchetti A, Graupera I, Lionis C, Pose E, Fabrellas N, Ma AT, Mendive JM, Mazzaferro V, Rutter H, Cortez-Pinto H, Kelly D, Burton R, Lazarus JV, Ginès P, Buti M, Newsome PN, Burra P, Manns MP. The EASL-Lancet Liver Commission: protecting the next generation of Europeans against liver disease complications and premature mortality. Lancet 2022; 399:61-116. [PMID: 34863359 DOI: 10.1016/s0140-6736(21)01701-3] [Citation(s) in RCA: 66] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 07/10/2021] [Accepted: 07/15/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Tom H Karlsen
- Department of Transplantation Medicine and Research Institute for Internal Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital Rikshospitalet and University of Oslo, Oslo, Norway.
| | - Nick Sheron
- Institute of Hepatology, Foundation for Liver Research, Kings College London, London, UK
| | - Shira Zelber-Sagi
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel; Department of Gastroenterology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Patrizia Carrieri
- Aix-Marseille University, Inserm, Institut de recherche pour le développement, Sciences Economiques et Sociales de la Santé et Traitement de l'Information Médicale (SESSTIM), ISSPAM, Marseille, France
| | - Geoffrey Dusheiko
- School of Medicine, University College London, London, UK; Kings College Hospital, London, UK
| | - Elisabetta Bugianesi
- Department of Medical Sciences, Division of Gastroenterology, University of Torino, Torino, Italy
| | | | - Sharon J Hutchinson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Clinical and Protecting Health Directorate, Public Health Scotland, Glasgow, UK
| | - Bruno Sangro
- Liver Unit, Clinica Universidad de Navarra-IDISNA and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Pamplona, Spain
| | - Natasha K Martin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, USA; Population Health Sciences, University of Bristol, Bristol, UK
| | - Michele Cecchini
- Health Division, Organisation for Economic Co-operation and Development, Paris, France
| | - Mae Ashworth Dirac
- Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA; Department of Family Medicine, University of Washington, Seattle, WA, USA; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Annalisa Belloni
- Health Economics and Modelling Division, Public Health England, London, UK
| | - Miquel Serra-Burriel
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Cyriel Y Ponsioen
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Brittney Sheena
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Alienor Lerouge
- Health Division, Organisation for Economic Co-operation and Development, Paris, France
| | - Marion Devaux
- Health Division, Organisation for Economic Co-operation and Development, Paris, France
| | - Nick Scott
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
| | - Margaret Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia; Department of Infectious Diseases, Alfred Hospital, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Doherty Institute and School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Henkjan J Verkade
- Paediatric Gastroenterology and Hepatology, Department of Paediatrics, University Medical Centre Groningen, University of Groningen, Netherlands; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Ekkehard Sturm
- Division of Paediatric Gastroenterology and Hepatology, University Children's Hospital Tübingen, Tübingen, Germany; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | | | | | - Chris D Byrne
- Department of Nutrition and Metabolism, Faculty of Medicine, University of Southampton, Southampton, UK; Southampton National Institute for Health Research, Biomedical Research Centre, University Hospital Southampton and Southampton General Hospital, Southampton, UK
| | - Giovanni Targher
- Department of Medicine, Section of Endocrinology, Diabetes, and Metabolism, University of Verona, Verona, Italy
| | - Aviad Tur-Sinai
- Department of Health Systems Management, The Max Stern Yezreel Valley College, Yezreel Valley, Israel
| | - Damon Barrett
- School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Tatjana Reic
- European Liver Patients Organization, Brussels, Belgium; Croatian Society for Liver Diseases-Hepatos, Split, Croatia
| | | | - Tim Rhodes
- London School of Hygiene & Tropical Medicine, London, UK
| | - Carla Treloar
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Claus Petersen
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
| | - Christoph Schramm
- Martin Zeitz Center for Rare Diseases, Hamburg Center for Translational Immunology (HCTI), and First Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Robert Flisiak
- Department of Infectious Diseases and Hepatology, Medical University of Białystok, Poland
| | - Marieta Y Simonova
- Department of Gastroenterology, HPB Surgery and Transplantation, Clinic of Gastroentrology, Military Medical Academy, Sofia, Bulgaria
| | - Albert Pares
- Liver Unit, Hospital Clinic of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; CIBEREHD, Madrid, Spain
| | - Philip Johnson
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Alessandro Cucchetti
- Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Isabel Graupera
- Liver Unit, Hospital Clinic of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; CIBEREHD, Madrid, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Spain
| | - Christos Lionis
- Clinic of Social and Family Medicine, Medical School, University of Crete, Heraklion, Greece
| | - Elisa Pose
- Liver Unit, Hospital Clinic of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Spain
| | - Núria Fabrellas
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; CIBEREHD, Madrid, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Spain
| | - Ann T Ma
- Liver Unit, Hospital Clinic of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Juan M Mendive
- Prevention and Health Promotion Research Network (redIAPP), Institute of Health Carlos III, Madrid, Spain; La Mina Health Centre, Catalan Institute of Health (ICS), Barcelona, Spain
| | - Vincenzo Mazzaferro
- HPB Surgery and Liver Transplantation, Istituto Nazionale Tumori IRCCS Foundation (INT), Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Bath, UK
| | - Helena Cortez-Pinto
- Clínica Universitária de Gastrenterologia and Laboratório de Nutrição, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Deirdre Kelly
- Liver Unit, Birmingham Women's and Children's Hospital and University of Birmingham, UK
| | - Robyn Burton
- Alcohol, Drugs, Tobacco and Justice Division, Public Health England, London, UK
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, Barcelona, Spain
| | - Pere Ginès
- Liver Unit, Hospital Clinic of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; CIBEREHD, Madrid, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Spain
| | - Maria Buti
- CIBEREHD del Instituto de Salud Carlos III, Madrid, Spain; Liver Unit, Hospital Universitario Valle Hebron, Barcelona, Spain
| | - Philip N Newsome
- National Institute for Health Research Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, University of Birmingham, Birmingham, UK
| | - Patrizia Burra
- Multivisceral Transplant Unit, Gastroenterology, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
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Merriwether EN, Wittleder S, Cho G, Bogan E, Thomas R, Bostwick N, Wang B, Ravenell J, Jay M. Racial and weight discrimination associations with pain intensity and pain interference in an ethnically diverse sample of adults with obesity: a baseline analysis of the clustered randomized-controlled clinical trial the goals for eating and moving (GEM) study. BMC Public Health 2021; 21:2201. [PMID: 34856961 PMCID: PMC8638106 DOI: 10.1186/s12889-021-12199-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 10/18/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Everyday experiences with racial (RD) and weight discrimination (WD) are risk factors for chronic pain in ethnically diverse adults with obesity. However, the individual or combined effects of RD and WD on pain in adults with obesity is not well understood. There are gender differences and sexual dimorphisms in nociception and pain, but the effect of gender on relationships between RD, WD, and pain outcomes in ethnically diverse adults with obesity is unclear. Thus, the purposes of this study were to: 1) examine whether RD and WD are associated with pain intensity and interference, and 2) explore gender as a moderator of the associations between RD, WD, and pain. METHODS This is a baseline data analysis from a randomized, controlled clinical trial of a lifestyle weight-management intervention. Eligible participants were English or Spanish-speaking (ages 18-69 years) and had either a body mass index of ≥30 kg/m2 or ≥ 25 kg/m2 with weight-related comorbidity. RD and WD were measured using questions derived from the Experiences of Discrimination questionnaire (EOD). Pain interference and intensity were measured using the PROMIS 29 adult profile V2.1. Linear regression models were performed to determine the associations between WD, RD, gender, and pain outcomes. RESULTS Participants (n = 483) reported mild pain interference (T-score: 52.65 ± 10.29) and moderate pain intensity (4.23 ± 3.15). RD was more strongly associated with pain interference in women (b = .47, SE = .08, p < 001), compared to men (b = .14, SE = .07, p = .06). Also, there were no significant interaction effects between RD and gender on pain intensity, or between WD and gender on pain interference or pain intensity. CONCLUSIONS Pain is highly prevalent in adults with obesity, and is impacted by the frequencies of experiences with RD and WD. Further, discrimination against adults with obesity and chronic pain could exacerbate existing racial disparities in pain and weight management. Asking ethnically diverse adults with obesity about their pain and their experiences of RD and WD could help clinicians make culturally informed assessment and intervention decisions that address barriers to pain relief and weight loss. TRIAL REGISTRATION NCT03006328.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Melanie Jay
- NYU Grossman School of Medicine, New York, USA
- New York Harbor VA, New York, USA
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13
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Warnick JL, Darling KE, West CE, Jones L, Jelalian E. Weight Stigma and Mental Health in Youth: A Systematic Review and Meta-Analysis. J Pediatr Psychol 2021; 47:237-255. [PMID: 34791368 DOI: 10.1093/jpepsy/jsab110] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 09/23/2021] [Accepted: 09/29/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Over the past two decades, there has been a steady increase in research focused on the association between weight-based stigma and mental health outcomes in children and adolescents. The present study is a systematic review and meta-analysis of the associations between weight stigma and mental health in youth. METHODS A systematic search of PubMed, PsychInfo, and Embase databases was conducted in January 2020. Inclusion criteria included the following: (a) examined an association between weight stigma and a mental health outcome, (b) mean sample age <18 (+1 standard deviation) years, (c) written in English, and (d) peer reviewed. Forty eligible articles were identified. The moderating effects of age, sex (percent female), weight status (percent with overweight/obesity), and study quality were examined. RESULTS Overall, meta-analytic findings using a random-effects model indicated a statistically significant moderate association between weight stigma and poorer mental health outcomes (r = .32, 95% confidence interval [0.292, 0.347], p < .001). Age and study quality each moderated the association between weight stigma and mental health. Generally, the study quality was fair to poor, with many studies lacking validated measurement of weight stigma. CONCLUSIONS Although there was a significant association between weight stigma and mental health in youth, study quality hinders the current body of literature. Furthermore, findings highlight the lack of consideration of internalized weight stigma in child populations, the importance of using validated measures of weight stigma, and the need for increased awareness of how these associations affect populations of diverse backgrounds.
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Affiliation(s)
- Jennifer L Warnick
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, USA.,Weight Control and Diabetes Research Center, The Miriam Hospital, USA
| | - Katherine E Darling
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, USA.,Weight Control and Diabetes Research Center, The Miriam Hospital, USA
| | - Caroline E West
- Department of Psychological Sciences, Kent State University, USA
| | - Laura Jones
- Department of Clinical and Health Psychology, University of Florida, USA
| | - Elissa Jelalian
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, USA.,Weight Control and Diabetes Research Center, The Miriam Hospital, USA
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14
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Williamson G, Osa ML, Budd E, Kelly NR. Weight-related teasing is associated with body concerns, disordered eating, and health diagnoses in racially and ethnically diverse young men. Body Image 2021; 38:37-48. [PMID: 33831652 DOI: 10.1016/j.bodyim.2021.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/15/2021] [Accepted: 03/15/2021] [Indexed: 12/12/2022]
Abstract
Research suggests that weight-related teasing is associated with body concerns and disordered eating in male and female adolescents and women. Yet, little is known about these associations for young men with diverse racial and ethnic identities. This study examined the association of weight-related teasing frequency and distress with body concerns, loss of control (LOC) eating, dietary restraint, and history of psychiatric and medical diagnoses in racially and ethnically diverse young men. Racial and ethnic identity was examined as a potential moderator. Participants (N = 1,069; 18-30 years; Mage = 24.1 ± 3.6 years) completed an online survey and reported on general demographics; weight-related teasing; body concerns; LOC eating frequency in the last 28 days; dietary restraint; and history of psychiatric and medical diagnoses. All models adjusted for BMI, income, education, and history of psychiatric diagnoses (when not the dependent variable). Both weight-related teasing frequency and distress were significantly and positively linked with all dependent variables, and these associations did not significantly vary by racial and ethnic identity. These findings suggest that, much like in prior research with adolescents and women, experiences with weight-related teasing are associated with body concerns, disordered eating, and poorer health in racially and ethnically diverse young men, regardless of body size.
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Affiliation(s)
- Gina Williamson
- Counseling Psychology and Human Services, University of Oregon, 1215 University of Oregon, Eugene, OR 97403, United States; The Prevention Science Institute, University of Oregon, 1600 Millrace Dr, Eugene, OR 97403, United States
| | - Maggie L Osa
- Counseling Psychology and Human Services, University of Oregon, 1215 University of Oregon, Eugene, OR 97403, United States; The Prevention Science Institute, University of Oregon, 1600 Millrace Dr, Eugene, OR 97403, United States
| | - Elizabeth Budd
- Counseling Psychology and Human Services, University of Oregon, 1215 University of Oregon, Eugene, OR 97403, United States; The Prevention Science Institute, University of Oregon, 1600 Millrace Dr, Eugene, OR 97403, United States
| | - Nichole R Kelly
- Counseling Psychology and Human Services, University of Oregon, 1215 University of Oregon, Eugene, OR 97403, United States; The Prevention Science Institute, University of Oregon, 1600 Millrace Dr, Eugene, OR 97403, United States.
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15
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Puhl RM, Lessard LM, Pearl RL, Himmelstein MS, Foster GD. International comparisons of weight stigma: addressing a void in the field. Int J Obes (Lond) 2021; 45:1976-1985. [PMID: 34059785 DOI: 10.1038/s41366-021-00860-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 04/22/2021] [Accepted: 05/06/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND/OBJECTIVES Despite substantial evidence documenting weight stigma toward people with higher body weight, international comparative studies are lacking in this field. The few studies that have compared weight stigma across different countries focus on explicit weight-biased attitudes rather than people's experiences of weight stigma. The present study conducted a multinational systematic comparison of weight stigma in six countries to assess experiences and interpersonal sources of weight stigma. SUBJECTS/METHODS Adults (N = 13,996) enrolled in WW International (formerly Weight Watchers), residing in Australia, Canada, France, Germany, the UK, and the US completed identical online anonymous surveys in the dominant language for their country. Surveys assessed their history of experiencing weight stigma, the onset of stigmatizing experiences and associated distress from stigma in different time periods, and interpersonal sources of weight stigma. RESULTS More than half of participants (55.6-61.3%) across countries reported experiencing weight stigma. Participants with higher BMI were significantly more likely to report weight-stigmatizing experiences than individuals with lower BMI. In all countries, weight stigma experiences were most frequent in childhood and adolescence, with associated distress highest during these time periods. Participants in Germany reported a higher frequency of weight stigma across their whole life, but lower distress associated with stigmatizing experiences, compared to participants in the other five countries. High percentages of participants in each country experienced weight stigma from family members (76.0-87.8%), classmates (72.0-80.9%), doctors (62.6-73.5%), co-workers (54.1-61.7%), and friends (48.8-66.2%). CONCLUSIONS Weight stigma is prevalent for adults actively engaged in weight management across different Western countries. There were more similarities than differences in the nature, frequency, and interpersonal sources of people's experiences of weight stigma across the six countries in this study. Findings underscore the need for multinational initiatives to address weight stigma and interventions to support individuals engaged in weight management who experience weight mistreatment.
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Affiliation(s)
- Rebecca M Puhl
- Department of Human Development & Family Sciences, University of Connecticut, Storrs, CT, USA. .,Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT, USA.
| | - Leah M Lessard
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT, USA
| | - Rebecca L Pearl
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Mary S Himmelstein
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - Gary D Foster
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,WW International, Inc., New York, NY, USA
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16
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Wellman JD, Araiza AM. Examining the impact of perceived weight discrimination on reported eating and exercise among White and Latino/a adults. Eat Behav 2021; 42:101529. [PMID: 34023666 DOI: 10.1016/j.eatbeh.2021.101529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 03/20/2021] [Accepted: 05/10/2021] [Indexed: 11/20/2022]
Abstract
A large body of research suggests that, among White individuals, perceived weight discrimination has deleterious consequences for eating and exercise outcomes; however, the research literature on perceived weight discrimination among other racial/ethnic groups is limited. The primary goal of the present study was to examine the associations of perceived weight discrimination with eating and exercise thoughts and behaviors among White versus Latino/a participants. A sample of White (N = 50) and Latino/a (N = 281) undergraduate college students with higher body weight (BMI: M = 30.65, SD = 5.42) completed self-report measures assessing perceived weight-based discrimination, frequency of intake of unhealthy and healthy foods, and frequency of both thoughts about exercise and exercise behaviors; we examined relationships among these variables within White versus Latino/a participants. Results showed that perceived weight discrimination was associated with more frequent intake of unhealthy foods, more frequent exercise thoughts, and less frequent exercise behaviors among White participants, and that there were no significant associations between perceived weight discrimination and the eating and exercise measures of interest among Latino/a participants. These findings highlight a number of potential avenues for future research to identify the mechanisms underlying these differential associations of perceived weight discrimination to eating and exercise behaviors across racial/ethnic groups.
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17
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Gerend MA, Patel S, Ott N, Wetzel K, Sutin AR, Terracciano A, Maner JK. A qualitative analysis of people's experiences with weight-based discrimination. Psychol Health 2021; 37:1093-1110. [PMID: 33979254 DOI: 10.1080/08870446.2021.1921179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aim of this study was to describe people's day-to-day experiences with weight-based discrimination and to distill themes that shed new light on this phenomenon. DESIGN A qualitative study was conducted in 2019 using a purposive sampling strategy. A racially and ethnically diverse sample of 32 U.S. adult men and women with a body mass index ≥30 kg/m2 completed a semi-structured interview. RESULTS Primary types of interpersonal weight-based discrimination included offensive comments, negative assumptions, social rejection, and unwanted attention or bullying. Participants also encountered environmental sources of weight bias such as inadequate seating in public venues. Three higher order themes that cut across people's experiences with weight-based discrimination were identified: 1) the often-ambiguous nature of weight-based discrimination; 2) intersections between body weight and other social identities; and 3) the role of social comparison processes. CONCLUSION Findings provide a detailed portrait of people's everyday experiences with weight-based discrimination. These experiences often reflected widely held negative stereotypes about people with higher body weight and conveyed the socially devalued status of higher-weight individuals in society. Findings have important implications for future research and interventions aimed at reducing the harmful effects of weight-based discrimination on health and emotional wellbeing.
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Affiliation(s)
- Mary A Gerend
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, Florida, USA
| | - Shefali Patel
- College of Medicine, Florida State University, Tallahassee, Florida, USA
| | - Nicholas Ott
- College of Medicine, Florida State University, Tallahassee, Florida, USA
| | - Karen Wetzel
- College of Medicine, Florida State University, Tallahassee, Florida, USA
| | - Angelina R Sutin
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, Florida, USA
| | - Antonio Terracciano
- Department of Geriatrics, College of Medicine, Florida State University, Tallahassee, Florida, USA
| | - Jon K Maner
- Department of Psychology, College of Arts and Sciences, Florida State University, Tallahassee, Florida, USA
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18
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Siqueira BB, Assumpção MC, Barroso SM, Japur CC, Penaforte FRDO. Weight stigma and health – Repercussions on the health of adolescents and adults: integrative review of the literature. J bras psiquiatr 2021. [DOI: 10.1590/0047-2085000000324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ABSTRACT Objective To conduct an integrative review in order to understand the repercussions of the social stigma of overweight on the health of adults and adolescents. Methods The international protocol for systematic review and meta-analysis studies PRISMA was adopted to guide the writing of this review. The databases used were PubMed, Psycinfo, SciELO, Medline, Lilacs and Pepsic, considering studies published in the period from 2000 to 2020. Sixty-seven (67) articles were analyzed, and 4 categories emerged: repercussions on physical well-being; repercussions on social well-being; repercussions on mental well-being; and mixed category (physical and psychological impact). Results In the vast majority of studies analyzed, weight stigma had a negative impact on the different spheres that make up the health construct, that is, the physical, social and mental spheres. Conclusions The consequences of weight stigma are a source of intense suffering, with an impact that reduces the quality of life of individuals who experience stigmatization, involving physical, emotional and social aspects.
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19
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Sutin AR, Terracciano A, Li G, Wang L. Frequency and Correlates of Weight-Based Discrimination among Adolescents in China. Int J Behav Med 2021; 28:523-7. [PMID: 33791993 DOI: 10.1007/s12529-021-09982-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Unfair treatment on the basis of body weight is common in the West and associated with lower well-being, starting at least as early as adolescence. We examine whether the frequency and predictors and correlates of weight discrimination seen in the West extend to adolescents in China. METHODS Participants (N = 1539) were adolescents in China who took part in a longitudinal study of mental health and academic burnout in high school. At Wave 1, participants reported on their personality and well-being and completed a school health check that included measured height and weight. At Wave 2 approximately 6 months later, participants reported on experiences with unfair treatment and completed the same measures of well-being. RESULTS Of 10 attributions for unfair treatment, weight was most common at 18%. Female gender and body mass index were associated with greater risk of reporting weight discrimination. Emotional stability, conscientiousness, and state happiness measured at Wave 1 were associated with lower risk of weight discrimination at Wave 2. Concurrently, weight discrimination was associated with lower happiness, less life satisfaction, and more distress. CONCLUSIONS Adolescents in China report weight discrimination, and the patterns of association between weight discrimination and psychological function are similar to what is seen in the West.
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20
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Hill B, Incollingo Rodriguez AC. Weight Stigma across the Preconception, Pregnancy, and Postpartum Periods: A Narrative Review and Conceptual Model. Semin Reprod Med 2021; 38:414-422. [PMID: 33728621 DOI: 10.1055/s-0041-1723775] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Weight stigma is a pervasive issue promoting significant adverse health and psychosocial consequences. Preconception, pregnant, and postpartum women are particularly vulnerable to weight stigma, which can directly impact their health and that of the next generation. Of note, weight stigma affects women living with obesity who are already at risk for developing gestational diabetes and experiencing associated stigmas. This narrative review aimed to examine the literature on weight stigma across the preconception, pregnancy, and postpartum periods, specifically to (1) synthesize the evidence using a socioecological lens; (2) develop a conceptual model of weight stigma tailored to women across this life phase; and (3) provide recommendations for future research. To date, weight stigma research across the preconception, pregnancy, and postpartum periods has focused predominately on pregnancy and antenatal care. The drivers and facilitators of this stigma are pervasive, occurring across various contexts and settings. Manifestations of weight stigma include decreased reproductive healthcare quality, mental health symptoms, poorer health behaviors, and adverse pregnancy outcomes. Future research should further investigate the experiences of women preconception and postpartum, and health/social impacts beyond healthcare. The model herein will guide such research to ultimately identify opportunities for stigma reduction and improve multigenerational health and well-being outcomes.
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Affiliation(s)
- Briony Hill
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Angela C Incollingo Rodriguez
- Psychological and Cognitive Sciences, Department of Social Science and Policy Studies, Worcester Polytechnic Institute, Worcester, Massachusetts
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21
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Sutin AR, Gerend MA, Maner JK, Stephan Y, Terracciano A. Psychological and Social Functioning Are Associated with Reports of Perceived Weight Discrimination Across Eight Years. J Res Pers 2021; 88. [PMID: 33612874 DOI: 10.1016/j.jrp.2020.104002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This research uses the Health and Retirement Study to identify psychological and social factors that prospectively predict new reports of perceived weight discrimination among individuals who measure in the obese weight category. Participants (Mage=66.89, SD=8.33; 58% women) reported on their personality and social isolation, had a body mass index (BMI)≥30, reported no perceived weight discrimination at baseline, and completed at least one assessment over the up to 8-year follow-up (N=3,064). Eleven percent of participants reported new experiences of perceived weight discrimination. Higher Neuroticism and loneliness at baseline were associated with new reports; Conscientiousness was protective. This research adds to models of weight stigma by identifying psychological and social factors that contribute to reporting new instances of perceived weight discrimination.
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22
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Himmelstein MS, Puhl RM. At multiple fronts: Diabetes stigma and weight stigma in adults with type 2 diabetes. Diabet Med 2021; 38:e14387. [PMID: 32799378 DOI: 10.1111/dme.14387] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/25/2020] [Accepted: 08/12/2020] [Indexed: 12/24/2022]
Abstract
AIM The diabetes and obesity fields have called for attention to the harmful role of stigma in obesity and diabetes, especially given that little is known about the extent and nature of diabetes stigma facing adults with type 2 diabetes, or the experience of weight stigma in this population. This study addresses this research gap by examining the prevalence and demographic correlates of weight stigma and diabetes stigma in individuals with type 2 diabetes. METHODS Adults (N = 1212, Mage = 52) with type 2 diabetes living in the USA were recruited by a healthcare-oriented market research firm, and completed online questionnaires to assess their experiences with weight stigma and diabetes stigma, as well as their internalization of both forms of stigma. Rates of stigma and sociodemographic correlates (years with type 2 diabetes, age, education, income, gender, race and BMI) were examined. RESULTS More than half of participants reported prior experiences of weight stigma, and 40-60% reported experiencing weight stigma in a healthcare context. Participants reported frequent experiences with diabetes-related stigma including blame and judgement, self-stigma and differential treatment. Women reported more weight stigma than men, and White women appeared particularly at risk for experiencing weight and diabetes related stigma relative to Black women. CONCLUSIONS Individuals with type 2 diabetes reported higher rates of weight stigma than the general population, experienced high rates of diabetes-related stigma, and many internalized these forms of stigma. Increased attention to stigma reduction is essential to ensuring equitable care for individuals with type 2 diabetes.
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Affiliation(s)
- M S Himmelstein
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - R M Puhl
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT, USA
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Hitch D, Pazsa F, Qvist A. Clinical Leadership and Management Perceptions of Inpatients with Obesity: An Interpretative Phenomenological Analysis. Int J Environ Res Public Health 2020; 17:E8123. [PMID: 33153188 DOI: 10.3390/ijerph17218123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/24/2020] [Accepted: 10/25/2020] [Indexed: 11/17/2022]
Abstract
While obesity is recognized as a key global public health issue, there has been no research to date on the perceptions of care for people with this condition held by individuals in positions of organizational power. The aim of this study was therefore to describe the perceptions and experiences of clinical leaders and managers of providing care to inpatients with obesity at a metropolitan public health service. This study applied an interpretative phenomenological analysis (IPA) approach to qualitative research, conducting interviews with 17 participants. Their perceptions of care for inpatients with obesity encompassed both their personal understanding as an individual, and their observations about the organizational, patient and carer perspectives. Three overall themes were identified: (1) the problem of inpatients with obesity, (2) inpatients with obesity as sources of risk and (3) personal and professional perceptions of inpatients with obesity. While clinical leaders and managers were aware of the potential impact of stigma and weight bias on care given to this cohort, elements of implicit bias, stereotyping, "othering" and ambivalence were frequently present in the data. Ongoing efforts to improve care for patients with obesity must therefore include efforts to address perceptions and attitudes at all organisational levels of the workforce.
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Gerend MA, Sutin AR, Terracciano A, Maner JK. The role of psychological attribution in responses to weight stigma. Obes Sci Pract 2020; 6:473-483. [PMID: 33082989 PMCID: PMC7556435 DOI: 10.1002/osp4.437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/31/2020] [Accepted: 06/07/2020] [Indexed: 11/24/2022] Open
Abstract
Objective Weight discrimination is associated with numerous negative health consequences. Little is known about early‐stage psychological mechanisms that explain variability in responses to weight discrimination among people with obesity. This study tested the hypothesis that attributing negative social evaluation to one's weight would be associated with stigma‐related stress responses (eg, reduced cognitive functioning and self‐esteem, increased negative affect and cortisol), especially among people who had experienced frequent weight discrimination in the past. Methods Adults (N = 109) with obesity were randomly assigned to receive a mildly positive (control) versus negative social evaluation. The extent to which participants attributed the negative evaluation to their physical appearance was assessed, along with negative affect, social and appearance self‐esteem, cognitive functioning and salivary cortisol. Results Participants who had experienced frequent weight discrimination in the past were more likely to attribute the negative evaluation to their appearance. Participants who attributed the negative evaluation to their appearance in turn experienced elevated negative affect, lower appearance self‐esteem and worse cognitive functioning. Conclusions This study is among the first to identify attribution as an early‐stage process underlying responses to weight stigma. Attribution may be a key psychological factor conferring risk for or protection from the negative effects of weight stigma.
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Affiliation(s)
- Mary A Gerend
- Department of Behavioral Sciences and Social Medicine, College of Medicine Florida State University Tallahassee Florida USA
| | - Angelina R Sutin
- Department of Behavioral Sciences and Social Medicine, College of Medicine Florida State University Tallahassee Florida USA
| | - Antonio Terracciano
- Department of Geriatrics, College of Medicine Florida State University Tallahassee Florida USA
| | - Jon K Maner
- Department of Psychology, College of Arts and Sciences Florida State University Tallahassee Florida USA
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Puhl RM, Telke S, Larson N, Eisenberg ME, Neumark-Stzainer D. Experiences of weight stigma and links with self-compassion among a population-based sample of young adults from diverse ethnic/racial and socio-economic backgrounds. J Psychosom Res 2020; 134:110134. [PMID: 32413612 PMCID: PMC7384387 DOI: 10.1016/j.jpsychores.2020.110134] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This study examines weight stigma experiences in a population-based sample of young adults from diverse ethnic/racial and socio-economic backgrounds, and explores cross-sectional associations between weight stigma and self-compassion, including gender differences in this relationship. METHODS Data come from EAT 2018, a population-based study of weight and related behaviors in young adults (N = 1523, mean age = 22 years, 53.5% females). Adjusted models tested associations between different experiences of weight stigma and the Self-Kindness Subscale of the Self-Compassion Scale, controlling for age, body mass index (BMI), ethnicity/race, and SES. RESULTS Over a third (32.3-52.2%) of participants reported experiences of weight teasing, and almost half (39.2-54.8%) indicated that people in their work or school settings are treated differently based on weight. There were few differences across ethnic/racial groups in reports of weight stigma. The prevalence of weight stigma experiences reported by participants in their current school or work environment was similar across gender, and those who had experienced weight stigma had lower levels of self-kindness. Among both females and males, lower self-kindness scores were associated with the experience of weight teasing (females: χ2 = 22.6, df = 1, p < .001, d = 0.32; males χ2 = 7.6, df = 1, p < .001, d = 0.22). For females only, lower self-kindness scores were associated with being treated unfairly due to weight (χ2 = 11.1, df = 1, p < .001, d = 0.23), and having others make comments about your weight (χ2 = 14.6, df = 1, p < .001, d = 0.28). Findings remained after adjusting for race/ethnicity, BMI, and SES. CONCLUSION Associations between self-compassion and experiences of weight stigma found in our diverse sample of young adults offers insights on this understudied relationship.
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Affiliation(s)
- Rebecca M Puhl
- Department of Human Development & Family Sciences, University of Connecticut, Storrs, CT, United States of America; Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT, United States of America.
| | - Susan Telke
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, United States of America
| | - Nicole Larson
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, United States of America
| | - Marla E Eisenberg
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States of America
| | - Dianne Neumark-Stzainer
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, United States of America
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Mijas M, Koziara K, Galbarczyk A, Jasienska G. Chubby, Hairy and Fearless. Subcultural Identities and Predictors of Self-Esteem in a Sample of Polish Members of Bear Community. Int J Environ Res Public Health 2020; 17:E4439. [PMID: 32575744 DOI: 10.3390/ijerph17124439] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/17/2020] [Accepted: 06/17/2020] [Indexed: 11/17/2022]
Abstract
Bear subculture exists within a larger gay community, which has been recognized by public health experts as disproportionately burdened with stigma and related health adversities. Bears are distinguished by a particular body look—body hirsuteness and heavy-set physique. Previous research documented the various health risks, and the exposure to both sexual minority and weight stigma, of this population. In this study we focused on the determinants of self-esteem in Bears. We explored the significance of such predictors as: perceived sexual minority and weight stigma, age, resilience, and physique as reflected by the BMI. Our sample consisted of 60 men from the Polish Bear community (i.e., Bears, Cubs, Otters, Wolves). Linear regression models were performed for the entire sample (N = 60) and for Bear-identified men (N = 31). Perceived sexual minority stigma negatively, and resilience positively, predicted self-esteem. In the case of Bear-identified men, age, perceived exposure to weight discrimination, and BMI were also significant predictors of self-esteem. Higher BMI in the case of Bear-identified men predicted higher self-esteem. Our results suggest that although Bear-identified men are characterized by their similarities to other gay men, subcultural identities create unique social contexts that are important for health and health interventions in this population.
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Ballesta-Castillejos A, Gomez-Salgado J, Rodriguez-Almagro J, Ortiz-Esquinas I, Hernandez-Martinez A. Relationship between maternal body mass index with the onset of breastfeeding and its associated problems: an online survey. Int Breastfeed J 2020; 15:55. [PMID: 32539791 PMCID: PMC7296910 DOI: 10.1186/s13006-020-00298-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 06/02/2020] [Indexed: 12/17/2022] Open
Abstract
Background Obesity is a worldwide public health problem that demands significant attention. Several studies have found that maternal obesity has a negative effect on the duration of breastfeeding and delayed lactogenesis. The World Health Organization has classified Body Max Index (BMI) as normal weight (normoweight) (BMI:18.5–24.9), overweight (BMI:25–29.9), obesity grade I (30.0–34.9), obesity grade II (BMI: 35.0–39.9) and obesity grade III (BMI ≥ 40.0). The objective of this study is to describe the relationship between maternal BMI and breastfeeding rates, as well as breastfeeding-associated problems and discomfort in women assisted by the Spanish Health System. Methods To this end, a cross-sectional observational study aimed at women who have been mothers between 2013 and 2018 in Spain was developed. The data was collected through an online survey of 54 items that was distributed through lactation associations and postpartum support groups between March and June 2019. Five thousand eight hundred seventy one women answered the survey. In the data analysis, Crude Odds Ratios (OR) and Adjusted Odds Ratios (AOR) were calculated through a multivariate analysis through binary and multinomial regression. Results A linear relationship was observed between the highest BMI figures and the reduction of the probability of starting skin-to-skin contact (AOR for obesity type III of 0.51 [95% CI 0.32, 0.83]), breastfeeding in the first hour (AOR for obesity type III of 0.58 [95% CI 0.36, 0.94]), and exclusive breastfeeding to hospital discharge (AOR for obesity type III of 0.57 [95% CI 0.35, 0.94]), as compared to women with normoweight. Conclusions Women with higher BMI are less likely to develop successful breastfeeding than women with normoweight.
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Affiliation(s)
| | - Juan Gomez-Salgado
- Department of Sociology, Social Work and Public Health, University of Huelva, 21071, Huelva, Spain.,Safety and Health Postgraduate Programme, Universidad Espíritu Santo, 091650, Guayaquil, Ecuador
| | - Julian Rodriguez-Almagro
- Department of Nursing, Ciudad Real Nursing School, University of Castilla-La Mancha, 13071, Ciudad Real, Spain.
| | | | - Antonio Hernandez-Martinez
- Department of Nursing, Ciudad Real Nursing School, University of Castilla-La Mancha, 13071, Ciudad Real, Spain.,Department of Obstetrics & Gynaecology, Alcázar de San Juan, 13600, Ciudad Real, Spain
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Meadows A, Higgs S. A bifactor analysis of the Weight Bias Internalization Scale: What are we really measuring? Body Image 2020; 33:137-151. [PMID: 32155463 DOI: 10.1016/j.bodyim.2020.02.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 02/23/2020] [Accepted: 02/23/2020] [Indexed: 12/13/2022]
Abstract
Internalized weight stigma (IWS) has been linked with disordered eating behavior, both directly, and as a mediator of the relationship between experienced weight stigma and maladaptive coping. However, the construct of IWS is highly correlated with the related constructs of body image and global self-esteem, and the three constructs may better be represented by underlying trait self-judgment. This overlap is not generally accounted for in existing studies. The present study investigated the shared variance between self-esteem, body image, and IWS in an international sample of higher-weight individuals. Bifactor analysis confirmed that the intermediary role of IWS in the relationship between experienced stigma and self-reported eating behavior was largely accounted for by aspects of body image and global self-esteem. Greater conceptual clarity in the study of IWS is needed to understand the mechanisms via which societal weight stigma impacts on individuals' self-directed judgments and downstream health-related behaviors.
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Affiliation(s)
- Angela Meadows
- School of Psychology, Western University, London, Ontario, N6A 5C2, Canada.
| | - Suzanne Higgs
- School of Psychology, University of Birmingham, Birmingham, B15 2TT, UK.
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Sutin AR, Stephan Y, Robinson E, Daly M, Terracciano A. Body-related discrimination and dieting and substance use behaviors in adolescence. Appetite 2020; 151:104689. [PMID: 32247897 DOI: 10.1016/j.appet.2020.104689] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/20/2020] [Accepted: 03/26/2020] [Indexed: 11/17/2022]
Abstract
Unfair treatment on the basis of a physical characteristic, such as body weight, is associated with unhealthy dieting behaviors in adolescence and adulthood and has also been implicated in substance use. Peer victimization is likewise associated with these health-risk behaviors. It is unclear, however, whether body discrimination is associated with these behaviors independent of peer victimization. The present research uses data from the Longitudinal Study of Australian Children (LSAC) to test the relation between body discrimination and dieting and substance use behaviors in adolescence and test whether the associations are independent of peer victimization, as well as depressive symptoms which are associated with both forms of victimization and health-risk behaviors. Participants (N = 2955) reported on body discrimination, dieting behaviors, and substance use at ages 14-15. Participants who experienced body discrimination were more likely to report fear of gaining weight, losing control over eating, going without eating, using medicine or vomiting to control their weight, engaging in restrained eating, and exercising to control their weight. They also had tried nicotine, alcohol, and marijuana. The associations with eating and alcohol use were independent of peer victimization, whereas the associations with smoking and marijuana were reduced when peer victimization was included in the model. All associations were also independent of depressive symptoms. Overall, the findings suggest that body discrimination is associated with harmful health behaviors at least as early as age 14.
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30
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Van Dyke ME, Baumhofer NK, Slopen N, Mujahid MS, Clark CR, Williams DR, Lewis TT. Pervasive Discrimination and Allostatic Load in African American and White Adults. Psychosom Med 2020; 82:316-23. [PMID: 32108740 DOI: 10.1097/PSY.0000000000000788] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE This study aimed to examine associations among race, the accumulation of multiple forms of discriminatory experiences (i.e., "pervasive discrimination"), and allostatic load (AL) in African Americans and whites in midlife. METHODS Using data collected in 2004 to 2006 from 226 African American and 978 white adults (57% female; mean [SD] age = 54.7 [0.11] years) in the Midlife in the United States II Biomarker Project, a pervasive discrimination score was created by combining three discrimination scales, and an AL score was created based on 24 biomarkers representing seven physiological systems. Linear regression models were conducted to examine the association between pervasive discrimination and AL, adjusting for demographics and medical, behavioral, and personality covariates. A race by pervasive discrimination interaction was also examined to determine whether associations varied by race. RESULTS African Americans had higher pervasive discrimination and AL scores than did whites. In models adjusted for demographics, socioeconomic status, medications, health behaviors, neuroticism, and negative affect, a pervasive discrimination score of 2 versus 0 was associated with a greater AL score (b = 0.30, SE = 0.07, p < .001). Although associations seemed to be stronger among African Americans as compared with whites, associations did not statistically differ by race. CONCLUSIONS More pervasive discrimination was related to greater multisystemic physiological dysregulation in a cohort of African American and white adults. Measuring discrimination by combining multiple forms of discriminatory experiences may be important for studying the health effects of discrimination.
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31
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Sutin AR, Stephan Y, Gerend MA, Robinson E, Daly M, Terracciano A. Perceived weight discrimination and performance in five domains of cognitive function. J Psychosom Res 2020; 131:109793. [PMID: 31439334 PMCID: PMC7002199 DOI: 10.1016/j.jpsychores.2019.109793] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 08/02/2019] [Accepted: 08/03/2019] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Individuals who perceive unfair treatment because of their body weight have been found to be at increased risk of poor health outcomes, including risk of dementia. The present research examines the relation between weight discrimination and performance in five cognitive domains (episodic memory, speed-attention, visuospatial ability, language, numeric reasoning) and whether the associations extend to other common attributions for discrimination (age, gender, race). METHOD Participants (n = 2593) were from the Harmonized Cognitive Assessment Protocol (HCAP) sub-study of the Health and Retirement Study (HRS). HCAP participants completed a battery of cognitive tasks that measured the five focal cognitive domains. Participants reported on their perceived experiences with discrimination at the previous regular HRS assessment. RESULTS In models that accounted for demographic covariates and BMI, weight discrimination (reported by 6% of participants) was associated with a two-fold increased risk of poor performance on tasks of episodic memory, speed-attention, visuospatial ability, and numeric reasoning. Body mass index was largely unrelated to performance in the five cognitive domains. The other attributions for discrimination were generally unrelated to cognition, but there were sex- and race-specific associations for gender and race discrimination, respectively. CONCLUSIONS The present study identified attribution- and domain-specific associations between discrimination and cognitive performance in older adulthood.
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Affiliation(s)
- Angelina R. Sutin
- Florida State University College of Medicine,Corresponding author at: Angelina R. Sutin, Ph.D., Florida State University College of Medicine, 1115 W. Call Street, Tallahassee.
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32
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McClure‐Brenchley KJ, Pitpitan EV, Quinn DM. Prejudice against higher‐weight health providers: Implications for patients and providers. J Appl Soc Psychol 2020. [DOI: 10.1111/jasp.12655] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
| | | | - Diane M. Quinn
- Department of Psychological Sciences University of Connecticut Storrs CT USA
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Bethea TN, Zhou ES, Schernhammer ES, Castro-Webb N, Cozier YC, Rosenberg L. Perceived racial discrimination and risk of insomnia among middle-aged and elderly Black women. Sleep 2020; 43:zsz208. [PMID: 31555803 PMCID: PMC6955644 DOI: 10.1093/sleep/zsz208] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 06/26/2019] [Indexed: 12/17/2022] Open
Abstract
STUDY OBJECTIVE To assess whether perceived racial discrimination is associated with insomnia among Black women. METHODS Data on everyday and lifetime racism and insomnia symptoms were collected from questionnaires administered in the Black Women's Health Study, an ongoing prospective cohort of Black women recruited in 1995 from across the United States. In 2009, participants completed five questions on the frequency of discriminatory practices in daily life (everyday racism) and six questions on ever experiencing unfair treatment in key institutional contexts (lifetime racism). In 2015, the Insomnia Severity Index was used to assess insomnia symptoms. We estimated odds ratios and 95% confidence intervals for associations of racism with insomnia, using multivariable logistic regression models adjusted for potential confounders. RESULTS The 26 139 participants in the analytic sample were 40-90 years old (median = 57 years, SD = 9.6 years). Higher levels of everyday racism and lifetime racism were positively associated with subthreshold (ptrend < .01) and clinical insomnia (ptrend < .01). Results remained unchanged after further adjustment for sleep duration and shift work. CONCLUSIONS Higher levels of perceived racism were associated with increased odds of insomnia among middle-aged and elderly Black women. Thus, perceived racism may contribute to multiple racial health disparities resulting from insomnia. Helping minority populations cope with their experiences of discrimination may decrease the significant public health impact of sleep disruption and subsequent diagnoses.
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Affiliation(s)
- Traci N Bethea
- Slone Epidemiology Center, Boston University, Boston, MA
- Department of Medicine, Boston University School of Medicine, Boston, MA
| | - Eric S Zhou
- Dana-Farber Cancer Institute, Boston, MA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Eva S Schernhammer
- Department of Medicine, Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Epidemiology, Medical University of Vienna, Vienna, Austria
| | | | - Yvette C Cozier
- Slone Epidemiology Center, Boston University, Boston, MA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Lynn Rosenberg
- Slone Epidemiology Center, Boston University, Boston, MA
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Himmelstein MS, Puhl RM, Quinn DM. Overlooked and Understudied: Health Consequences of Weight Stigma in Men. Obesity (Silver Spring) 2019; 27:1598-1605. [PMID: 31364819 DOI: 10.1002/oby.22599] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 06/25/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVE A substantial amount of literature has suggested that weight stigma impairs health. Evidence on gender differences in weight stigma has been mixed, but studies of weight stigma within men have been primarily absent from the literature. METHODS In two samples of men recruited nationally from across the United States (N = 1,753), participants completed self-report measures assessing their height, weight, demographics, weight stigma (experienced and internalized), psychological well-being (depression), health behaviors (sleep, alcohol, smoking, binge eating, dieting, physical activity), and self-rated health. RESULTS Regression analyses showed that, independent of race, socioeconomic status, and BMI, experienced weight stigma and weight bias internalization among men were associated with poor health, including greater depressive symptoms, increased dieting, lower self-reported health, and increased odds of binge eating. Neither internalized nor experienced weight stigma was consistently associated with physical activity, smoking, drinking, or trouble sleeping. CONCLUSIONS These findings suggest that both experienced and internalized weight stigma are associated with several indices of poor health in men. It may be informative for future work to examine how men cope with weight stigma, particularly if certain coping responses to stigma involve behaviors that contribute to poorer health.
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Affiliation(s)
- Mary S Himmelstein
- Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford, Connecticut, USA
- Department of Psychological Sciences, Kent State University, Kent, Ohio, USA
| | - Rebecca M Puhl
- Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford, Connecticut, USA
- Department of Human Development & Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Diane M Quinn
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
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35
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Pool LR, Carnethon MR, Goff DC Jr, Gordon-Larsen P, Robinson WR, Kershaw KN. Longitudinal Associations of Neighborhood-level Racial Residential Segregation with Obesity Among Blacks. Epidemiology 2018; 29:207-14. [PMID: 29280853 DOI: 10.1097/EDE.0000000000000792] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite 50 years since the passage of the Fair Housing Act of 1968, the majority of black Americans continue to live in highly segregated communities. Differing exposure to obesogenic environments in segregated neighborhoods may contribute to racial disparities in obesity prevalence. METHODS We used prospective data from the Coronary Artery Risk Development in Young Adults (CARDIA) study to examine associations between levels of neighborhood-level racial residential segregation and incident obesity in black men and women. Obesity, determined by measured anthropometry, and residential segregation, measured using the local Gi*statistic, were recorded at baseline and follow-up at years 7, 10, 15, 20, and 25. We used marginal structural survival models to account for time-dependent confounding and for loss to follow-up. RESULTS Black women living in highly segregated neighborhoods at the prior exam were 30% more likely to become obese during the follow-up period as compared with women living in neighborhoods with low levels of segregation after adjustment for sociodemographic and cardiovascular risk covariates (hazard ratio = 1.3 [95% confidence interval = 1.0, 1.7]). Cumulatively high exposure to segregation averaged across time points was associated with 50% higher hazard of obesity (hazard ratio = 1.5 [95% confidence interval = 1.0, 2.3]) among women. We observed few differences in obesity incidence among men by segregation levels. CONCLUSIONS Fewer health-promoting resources, stressful neighborhood context, and social norms that are less stigmatizing of obesity may contribute to these findings, but more research on specific pathways leading from segregation to obesity is needed to understand differing patterns between men and women.
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Affiliation(s)
- Christine A. Smith
- Psychology and Human Development, University of Wisconsin-Green Bay, Green Bay, Wisconsin
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37
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Decker KM, Thurston IB, Kamody RC. The mediating role of internalized weight stigma on weight perception and depression among emerging adults: Exploring moderation by weight and race. Body Image 2018; 27:202-10. [PMID: 30384173 DOI: 10.1016/j.bodyim.2018.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 10/16/2018] [Accepted: 10/16/2018] [Indexed: 11/22/2022]
Abstract
The current study examined internalized weight stigma as a mediator of the association between self-perceived weight and depressive symptoms. University students (N = 317) aged 18-25 years completed measures of self-perceived weight, internalized stigma, and depressive symptoms. Multigroup path analyses were used to examine the indirect effect of self-perceived weight on depression through self-stigma. Findings revealed that among persons of size, internalized stigma mediated the effect of higher self-perceived weight on higher depressive symptoms. Among lean persons, this indirect effect was only significant for Black participants. Among all groups, the direct effect of self-perceived weight on internalized stigma was significant. While the present results warrant future replication, the findings expand our understanding of the association between self-perceived weight and depression. These results also illuminate potential future opportunities for rich, culturally informed research and clinical advances that take into account the detrimental role of weight stigma.
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Panza GA, Armstrong LE, Taylor BA, Puhl RM, Livingston J, Pescatello LS. Weight bias among exercise and nutrition professionals: a systematic review. Obes Rev 2018; 19:1492-1503. [PMID: 30176183 DOI: 10.1111/obr.12743] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 06/20/2018] [Accepted: 06/28/2018] [Indexed: 12/16/2022]
Abstract
Obesity affects approximately one-third of American adults. Recent evidence suggests that weight bias may be pervasive among both exercise and nutrition professionals working with adults who have obesity. However, the published literature on this topic is limited. This review aimed to (i) systematically review existing literature examining weight bias among exercise and nutrition professionals; (ii) discuss the implications of this evidence for exercise and nutrition professionals and their clients; (iii) address gaps and limitations of this literature; and (iv) identify future research directions. Of the 31 studies that met the criteria for this review, 20 examined weight bias among exercise professionals, of which 17 (85%) found evidence of weight bias among professionals practicing physical therapy (n = 4), physical education (n = 8) and personal/group fitness training (n = 5). Of 11 studies examining weight bias among nutrition professionals, eight (73%) found evidence of weight bias. These findings demonstrate fairly consistent evidence of weight bias among exercise and nutrition professionals. However, the majority of studies were cross-sectional (90%). Given that weight bias may compromise quality of care and potentially reinforce weight gain and associated negative health consequences in patients with obesity, it is imperative for future work to examine the causes and consequences of weight bias within exercise and nutrition professions using more rigorous study designs.
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Affiliation(s)
- G A Panza
- Department of Kinesiology, University of Connecticut, Storrs, CT, USA.,Department of Cardiology, Hartford Hospital, Hartford, CT, USA
| | - L E Armstrong
- Department of Kinesiology, University of Connecticut, Storrs, CT, USA
| | - B A Taylor
- Department of Kinesiology, University of Connecticut, Storrs, CT, USA.,Department of Cardiology, Hartford Hospital, Hartford, CT, USA
| | - R M Puhl
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT, USA.,Department of Human Development and Family Studies, University of Connecticut, Storrs, CT, USA
| | - J Livingston
- Department of Research Services, University of Connecticut, Storrs, CT, USA
| | - L S Pescatello
- Department of Kinesiology, University of Connecticut, Storrs, CT, USA
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Sutin AR, Stephan Y, Robinson E, Daly M, Terracciano A. Perceived weight discrimination and risk of incident dementia. Int J Obes (Lond) 2019; 43:1130-4. [PMID: 30250239 DOI: 10.1038/s41366-018-0211-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 07/31/2018] [Accepted: 08/04/2018] [Indexed: 01/29/2023]
Abstract
Body mass index (BMI) and obesity have a complex relation with risk of dementia that evolves over the lifespan. Research in other domains indicates that the social experience of body weight, not just BMI, is associated with worse health outcomes. The present research uses data from the Health and Retirement Study (N = 12,053) to test whether weight discrimination is associated with increased risk of dementia over an up to 10-year follow-up independent of BMI and other relevant clinical and behavioral risk factors. Participants who reported weight discrimination had a 40% increased risk of incident dementia (Hazard Ratio = 1.40; 95% Confidence Interval = 1.12-1.74), controlling for age, sex, race, ethnicity, and education. The association between weight discrimination and incident dementia held controlling for BMI, diabetes, hypertension, depressive symptoms, smoking, physical activity, and genetic risk status. The present research indicates that the stigma associated with weight is associated with dementia risk independent from obesity. This research highlights that the detrimental effect of obesity on cognitive health in older adulthood may occur through the adverse social experience of body weight in addition to the biological consequences of excess weight.
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Abstract
Obesity is a complex medical condition that has psychosocial and physiological implications for those suffering from the disease. Factors contributing to obesity such as depression, childhood experiences, and the physical environment should be recognized and addressed. Weight bias and stigmatization by health care providers and bedside clinicians negatively affect patients with obesity, hindering those patients from receiving appropriate care. To provide optimal care of patients with obesity or adiposity, health care providers must understand the physiological needs and requirements of this population while recognizing and addressing their own biases. The authors describe psychosocial and environmental factors that contribute to obesity, discuss health care providers' weight biases, and highlight implications for acute care of patients suffering from obesity.
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Affiliation(s)
- Rachel Smigelski-Theiss
- Rachel Smigelski-Theiss is Clinical Nurse Specialist, Queen's Medical Center, 1301 Punchbowl Street, Honolulu, HI 96813 . Malisa Gampong is Nurse Manager, Queen's Medical Center, Honolulu, Hawaii. Jill Kurasaki is Nurse Manager, Queen's Medical Center, Honolulu, Hawaii
| | - Malisa Gampong
- Rachel Smigelski-Theiss is Clinical Nurse Specialist, Queen's Medical Center, 1301 Punchbowl Street, Honolulu, HI 96813 . Malisa Gampong is Nurse Manager, Queen's Medical Center, Honolulu, Hawaii. Jill Kurasaki is Nurse Manager, Queen's Medical Center, Honolulu, Hawaii
| | - Jill Kurasaki
- Rachel Smigelski-Theiss is Clinical Nurse Specialist, Queen's Medical Center, 1301 Punchbowl Street, Honolulu, HI 96813 . Malisa Gampong is Nurse Manager, Queen's Medical Center, Honolulu, Hawaii. Jill Kurasaki is Nurse Manager, Queen's Medical Center, Honolulu, Hawaii
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Himmelstein MS, Puhl RM, Quinn DM. Weight Stigma in Men: What, When, and by Whom? Obesity (Silver Spring) 2018; 26:968-976. [PMID: 29687615 DOI: 10.1002/oby.22162] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 01/26/2018] [Accepted: 02/16/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study assessed the weight stigma experiences of men, examining characteristics of men who experienced weight stigma versus men who did not. METHODS Data from three samples of men were examined (N = 1,513). Sample 1 consisted of men with obesity at elevated risk for weight stigma. Sample 2 comprised a convenience online panel. Sample 3 included men from a national online panel of US adults. Men in all samples completed almost identical questionnaires assessing demographics, anthropometrics, weight stigma, and dieting. RESULTS Approximately 40% of men reported experiencing weight stigma. Weight stigma was associated with increased odds of having a BMI consistent with underweight or obesity relative to normal weight. Verbal mistreatment was the most common form of weight stigma experienced across all life stages for men. The most common sources of weight stigma were peers, family members, and strangers. Men reporting weight stigma were younger and less likely to be married, had higher BMIs, and were more likely to have tried to lose weight in the past year relative to men not reporting weight stigma. CONCLUSIONS Understanding differences among men as a function of weight stigma is important for practitioners, as it can identify men who may most benefit from intervention.
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Affiliation(s)
- Mary S Himmelstein
- Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford, Connecticut, USA
| | - Rebecca M Puhl
- Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford, Connecticut, USA
- Department of Human Development & Family Studies, University of Connecticut, Storrs, Connecticut, USA
| | - Diane M Quinn
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
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Elfassy T, Glymour MM, Kershaw KN, Carnethon M, Llabre MM, Lewis CE, Schneiderman N, Zeki Al Hazzouri A. Association Between Sustained Poverty and Changes in Body Mass Index, 1990-2015: The Coronary Artery Risk Development in Young Adults Study. Am J Epidemiol 2018; 187:1240-1249. [PMID: 29244061 PMCID: PMC5982791 DOI: 10.1093/aje/kwx365] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 11/22/2017] [Accepted: 11/22/2017] [Indexed: 12/19/2022] Open
Abstract
We sought to determine whether sustained poverty is associated with change in body mass index (BMI, calculated as weight (kg)/height (m)2) among 4,762 black and white adults from the Coronary Artery Risk Development in Young Adults study. Household income in the prior year and current BMI were measured at 7 visits between 1990 and 2015. Sustained poverty was the proportion of visits during which household income was below 200% of the federal poverty level (range, 0%-100%). Sustained poverty and BMI were time-updated. Mean age in 1990 was 30 years. In adjusted linear mixed-effects models, every 10% increase in sustained poverty was significantly associated with faster BMI growth among white men (0.004/year, 95% CI: 0.001, 0.008) and white women (0.003/year, 95% CI: 0.000, 0.006), and slower BMI growth among black men (-0.008/year, 95% CI: -0.010, -0.005) and black women (-0.003/year, 95% CI: -0.006, 0.000). In other words, being always versus never in poverty from 1990 to 2015 was predicted to result in greater BMI gain by 1.00 unit and 0.75 units among white men and women and less BMI gain by 2.0 units and 0.75 units among black men and women, respectively. Sustained poverty was a predictor of changes in BMI with differential associations according to race.
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Affiliation(s)
- Tali Elfassy
- Division of Epidemiology, Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida
| | - M Maria Glymour
- Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, California
| | - Kiarri N Kershaw
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Evanston, Illinois
| | - Mercedes Carnethon
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Evanston, Illinois
| | - Maria M Llabre
- Department of Psychology, University of Miami, Coral Gables, Florida
| | - Cora E Lewis
- Division of Preventive Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Neil Schneiderman
- Department of Psychology, University of Miami, Coral Gables, Florida
| | - Adina Zeki Al Hazzouri
- Division of Epidemiology, Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida
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Gibson-Smith D, Bot M, Snijder M, Nicolaou M, Derks EM, Stronks K, Brouwer IA, Visser M, Penninx BWJH. The relation between obesity and depressed mood in a multi-ethnic population. The HELIUS study. Soc Psychiatry Psychiatr Epidemiol 2018; 53:629-638. [PMID: 29644388 PMCID: PMC5959973 DOI: 10.1007/s00127-018-1512-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 04/09/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To examine the association between obesity and depressed mood in a large multi-ethnic population and check for consistency in this association across six ethnic groups. METHODS Data of 21,030 persons (18-70 years) were sourced from the HELIUS study. Cross-sectional relationships between obesity measures [body mass index (kg/m2) and waist circumference (cm)] and depressed mood (PHQ-9 score ≥ 10) were analysed. Consistency of associations was investigated across ethnic groups by interaction terms (ethnicity*obesity measures) in basic (age, sex, education) and fully (health behaviours and somatic health) adjusted models. RESULTS Obesity was prevalent in all ethnic groups, but varied substantially. After sociodemographic adjustment, obesity measures were associated with increased odds of depressed mood but this was inconsistent across ethnic groups. Obesity (BMI ≥ 30 or highest waist circumference quartile) was strongly and significantly associated with depressed mood in the Dutch [Odds Ratio (OR) = 1.72; 95% Confidence intervals (CI) 1.24-2.40, and OR = 1.86; 95% CI 1.38-2.50], respectively, and African Surinamese (OR = 1.60; 95% CI 1.29-1.98 and OR = 1.59; 95% CI 1.27-2.00, respectively) but had a weaker, non-significant association in other ethnic groups (South-Asian Surinamese, Ghanaian, Moroccan, Turkish groups). Adjustment for health behaviours and somatic health had limited effect on this pattern. CONCLUSION Obesity was associated with a higher risk of depressed mood. However, ethnic differences were found: the obesity-depressed mood association was strong in the Dutch and African Surinamese populations, but not in other ethnic groups. Future studies should explore whether differential normative values or pathophysiology across ethnic groups explain why the obesity-depression association is inconsistent across ethnic groups.
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Affiliation(s)
- Deborah Gibson-Smith
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, Oudenaller 1, 1081 HJ, Amsterdam, The Netherlands.
| | - Mariska Bot
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, Oudenaller 1, 1081 HJ Amsterdam, The Netherlands
| | - Marieke Snijder
- Department of Public Health, Amsterdam Public Health research institute, Academic Medical Center, Amsterdam, The Netherlands ,Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Public Health research institute, Academic Medical Center, Amsterdam, The Netherlands
| | - Mary Nicolaou
- Department of Public Health, Amsterdam Public Health research institute, Academic Medical Center, Amsterdam, The Netherlands
| | - Eske M. Derks
- Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands ,QIMR Berghofer, Translational Neurogenomics group, Brisbane, Australia
| | - Karien Stronks
- Department of Public Health, Amsterdam Public Health research institute, Academic Medical Center, Amsterdam, The Netherlands
| | - Ingeborg A. Brouwer
- Department of Health Sciences, Faculty of Earth and Life Sciences and Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Earth and Life Sciences and Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands ,Department of Internal Medicine, Nutrition and Dietetics, VU University Medical Center, Amsterdam, The Netherlands
| | - Brenda W. J. H. Penninx
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, Oudenaller 1, 1081 HJ Amsterdam, The Netherlands
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Puhl RM, Himmelstein MS, Quinn DM. Internalizing Weight Stigma: Prevalence and Sociodemographic Considerations in US Adults. Obesity (Silver Spring) 2018; 26:167-175. [PMID: 29082666 DOI: 10.1002/oby.22029] [Citation(s) in RCA: 138] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 08/29/2017] [Accepted: 09/06/2017] [Indexed: 01/02/2023]
Abstract
OBJECTIVE This study aimed to conduct a comprehensive assessment of the presence, severity, and sociodemographic correlates of weight bias internalization (WBI) across three distinct samples of US adults. METHODS Levels of WBI were compared in (1) a sample of adults with obesity and heightened risk of weight stigma (N = 456), (2) an online community sample (N = 519), and (3) a national online panel (N = 2,529). Samples 2 and 3 comprised adults with and without obesity. Participants completed identical self-report measures, including demographic variables and weight-related factors, to determine their relationship with low, mean, and high levels of WBI. RESULTS At least 44% of adults across samples endorsed mean levels of WBI (as determined by sample 3). The highest levels of WBI were endorsed by approximately one in five adults in the general population samples and by 52% in the sample of adults with obesity. Individuals with the highest WBI were white, had less education and income, were currently trying to lose weight, and had higher BMIs, higher self-perceived weight, and previous experiences of weight stigma (especially teasing). CONCLUSIONS Internalized weight bias is prevalent among women and men and across body weight categories. Findings provide a foundation to better understand characteristics of individuals who are at risk for internalizing weight bias.
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Affiliation(s)
- Rebecca M Puhl
- Department of Human Development and Family Studies, University of Connecticut, Storrs, Connecticut, USA
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, Connecticut, USA
| | - Mary S Himmelstein
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, Connecticut, USA
| | - Diane M Quinn
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
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Himmelstein MS, Puhl RM, Quinn DM. Intersectionality: An Understudied Framework for Addressing Weight Stigma. Am J Prev Med 2017; 53:421-431. [PMID: 28579331 DOI: 10.1016/j.amepre.2017.04.003] [Citation(s) in RCA: 129] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 03/22/2017] [Accepted: 04/03/2017] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Obesity is an ongoing public health concern in the U.S. Weight stigma is linked to a number of obesogenic health outcomes, which complicate obesity treatment and prevention. Despite higher rates of obesity in female and minority populations, little research has examined weight stigma in non-white women and men. This study investigated intersectionality in weight stigma and health-related coping responses to stigmatizing experiences across racial groups. METHODS In 2015, a total of 2,378 adults completed questionnaires about weight stigma, weight bias internalization, and coping strategies. Analyses were conducted in 2016. RESULTS No differences in weight stigma emerged as a function of race or gender, but women reported higher weight bias internalization (B=0.19, p=0.004). Further, black men and women reported less weight bias internalization than white men and women (B=-0.43, p=0.009). Compared with white women, black women were less likely to cope with stigma using disordered eating (B=-0.57, p=0.001), whereas Hispanic women were more likely to cope with stigma using disordered eating (B=0.39, p=0.020). Black men were more likely than white men to cope with stigma via eating (B=-0.49, p=0.017). CONCLUSIONS Findings highlight that weight stigma is equally present across racial groups, but that groups internalize and cope with stigma in different ways, which exacerbate health risks. Increased research and policy attention should address stigma as an obstacle in prevention and treatment for obesity to reduce weight-based inequities in underserved populations.
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Affiliation(s)
- Mary S Himmelstein
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, Connecticut.
| | - Rebecca M Puhl
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, Connecticut; Department of Human Development and Family Studies, University of Connecticut, Storrs, Connecticut
| | - Diane M Quinn
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut
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Bernardo CDO, Bastos JL, González-Chica DA, Peres MA, Paradies YC. Interpersonal discrimination and markers of adiposity in longitudinal studies: a systematic review. Obes Rev 2017; 18:1040-1049. [PMID: 28569010 DOI: 10.1111/obr.12564] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 04/16/2017] [Accepted: 04/25/2017] [Indexed: 01/02/2023]
Abstract
While the impact of interpersonal discrimination on mental health is well established, its effects on physical health outcomes have not been fully elucidated. This study systematically reviewed the literature on the prospective association between interpersonal discrimination and markers of adiposity. Medline, Web of Science, Scopus, PsycInfo, SciELO, LILACS, Google Scholar, Capes/Brazil and ProQuest databases were used to retrieve relevant information in November 2016. The results from the 10 studies that met the inclusion criteria support an association between interpersonal self-reported discrimination and the outcomes. In general, the most consistent findings were for weight and body mass index (BMI) among women, i.e. high levels of self-reported discrimination were related to increased weight and BMI. Waist circumference (WC) showed a similar pattern of association with discrimination, in a positive direction, but an inverted U-shaped association was also found. Despite a few inverse associations between discrimination and markers of adiposity, none of the associations were statistically significant. Overall, markers of adiposity were consistently associated with discrimination, mainly through direct and nonlinear associations. This review provides evidence that self-reported discrimination can play an important role in weight, BMI and WC changes.
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Affiliation(s)
- C de O Bernardo
- Post-Graduate Program in Public Health, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - J L Bastos
- Post-Graduate Program in Public Health, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - D A González-Chica
- Discipline of General Practice, School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - M A Peres
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Y C Paradies
- Alfred Deakin Institute for Citizenship and Globalisation, Deakin University, Melbourne, Victoria, Australia
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Baumgarten A, Bastos JL, Toassi RFC, Hilgert JB, Hugo FN, Celeste RK. Discrimination, gender and self-reported aesthetic problems among Brazilian Adults. Community Dent Oral Epidemiol 2017; 46:24-29. [DOI: 10.1111/cdoe.12324] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 06/22/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Alexandre Baumgarten
- Postgraduate Program in Epidemiology; Federal University of Rio Grande do Sul; Porto Alegre Brazil
| | - João Luiz Bastos
- Postgraduate Program in Community Health; Federal University of Santa Catarina; Florianópolis Brazil
| | | | - Juliana Balbinot Hilgert
- Postgraduate Program in Epidemiology; Federal University of Rio Grande do Sul; Porto Alegre Brazil
- Postgraduate Program in Dentistry; Federal University of Rio Grande do Sul; Porto Alegre Brazil
| | - Fernando Neves Hugo
- Postgraduate Program in Dentistry; Federal University of Rio Grande do Sul; Porto Alegre Brazil
- Research Centre in Social Dentistry; Federal University of Rio Grande do Sul; Porto Alegre Brazil
| | - Roger Keller Celeste
- Postgraduate Program in Dentistry; Federal University of Rio Grande do Sul; Porto Alegre Brazil
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Keith VM, Nguyen AW, Taylor RJ, Mouzon DM, Chatters LM. Microaggressions, Discrimination, and Phenotype among African Americans: A Latent Class Analysis of the Impact of Skin Tone and BMI. Sociol Inq 2017; 87:233-255. [PMID: 28603300 PMCID: PMC5464745 DOI: 10.1111/soin.12168] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Data from the 2001-2003National Survey of American Life are used to investigate the effects of phenotype on everyday experiences with discrimination among African Americans (N=3343). Latent class analysis is used to identify four classes of discriminatory treatment: 1) low levels of discrimination, 2) disrespect and condescension, 3) character-based discrimination, and 4) high levels of discrimination. We then employ latent class multinomial logistic regression to evaluate the association between skin tone and body weight and these four classes of discrimination. Designating the low level discrimination class as the reference group, findings revealed that respondents with darker skin were more likely to be classified into the disrespect/condescension and the high level microaggression types. BMI was unrelated to the discrimination type, although there was a significant interaction effect between gender and BMI. BMI was strongly and positively associated with membership in the disrespect and condescension type among men but not among women. These findings indicate that skin tone and body weight are two phenotypic characteristics that influence the type and frequency of discrimination experienced by African Americans.
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Affiliation(s)
- Verna M Keith
- Department of Sociology, Race and Ethnic Studies Institute, 4351 TAMU, Texas A & M University, College Station, TX 77843-4351,
| | - Ann W Nguyen
- Edward R. Roybal Institute on Aging, University of Southern California, Los Angeles, CA 90015,
| | - Robert Joseph Taylor
- School of Social Work, Institute for Social Research, University of Michigan, Ann Arbor, MI 48109,
| | - Dawne M Mouzon
- Edward J. Bloustein School of Planning and Public Policy, Institute for Health, Health Care Policy, and Aging Research Rutgers, The State University of New Jersey, New Brunswick, NJ 08901,
| | - Linda M Chatters
- School of Public Health, School of Social Work, Institute for Social Research, University of Michigan Ann, Arbor MI 48109,
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Robinson E, Sutin A, Daly M. Perceived weight discrimination mediates the prospective relation between obesity and depressive symptoms in U.S. and U.K. adults. Health Psychol 2017; 36:112-121. [PMID: 27748611 PMCID: PMC5267562 DOI: 10.1037/hea0000426] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 07/25/2016] [Accepted: 07/27/2016] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Obesity has been shown to increase risk of depression. Persons with obesity experience discrimination because of their body weight. Across 3 studies, we tested for the first time whether experiencing (perceived) weight-based discrimination explains why obesity is prospectively associated with increases in depressive symptoms. METHOD Data from 3 studies, including the English Longitudinal Study of Ageing (2008/2009-2012/2013), the Health and Retirement Study (2006/2008-2010/2012), and Midlife in the United States (1995/1996-2004/2005), were used to examine associations between obesity, perceived weight discrimination, and depressive symptoms among 20,286 U.S. and U.K. adults. RESULTS Across all 3 studies, Class II and III obesity were reliably associated with increases in depressive symptoms from baseline to follow-up. Perceived weight-based discrimination predicted increases in depressive symptoms over time and mediated the prospective association between obesity and depressive symptoms in all 3 studies. Persons with Class II and III obesity were more likely to report experiencing weight-based discrimination, and this explained approximately 31% of the obesity-related increase in depressive symptoms on average across the 3 studies. CONCLUSION In U.S. and U.K. samples, the prospective association between obesity (defined using body mass index) and increases in depressive symptoms in adulthood may in part be explained by perceived weight discrimination. (PsycINFO Database Record
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Affiliation(s)
- Eric Robinson
- Department of Psychological Sciences, Institute of Psychology, Health & Society, University of Liverpool
| | | | - Michael Daly
- Behavioural Science Centre, Stirling Management School, University of Stirling
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50
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Udo T, Purcell K, Grilo CM. Perceived weight discrimination and chronic medical conditions in adults with overweight and obesity. Int J Clin Pract 2016; 70:1003-1011. [PMID: 28032427 PMCID: PMC5215793 DOI: 10.1111/ijcp.12902] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 10/02/2016] [Indexed: 11/30/2022] Open
Abstract
AIM This study investigated whether perceived weight discrimination is associated with increased risk for major chronic medical conditions and whether the associations persist after adjusting for other stressful life events in addition to BMI, physical activity and sociodemographic variables. METHODS The study included 21 357 overweight/obese adults (52.9% women) from the 2001 to 2002 and 2004 to 2005 National Survey of Alcohol and Related Conditions. RESULTS Perceived weight discrimination was significantly associated with risk for arteriosclerosis, diabetes, high cholesterol, myocardial infarction, minor heart conditions and stomach ulcers. Perceived weight discrimination was associated with reporting more stressful life events. After adjusting additionally for stressful life events in the final multiple logistic regression, associations with arteriosclerosis, diabetes and minor cardiac conditions remained significant. Gender-stratified analyses revealed that perceived weight discrimination was associated with different medical conditions in women than men, and many associations became non-significant when adjusting for stressful life events, particularly for women. CONCLUSIONS Among overweight/obese adults, perceived weight discrimination is associated with significantly increased risk for obesity-related chronic medical conditions even after adjusting for BMI, physical activity and sociodemographic variables. Accounting for other acute stressful life events may also be important in understanding the health effects of perceived weight discrimination. Such added health risk of overweight/obesity posed by perceived weight discrimination warrants public health and policy interventions against weight discrimination to reduce the socioeconomic burden of obesity.
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Affiliation(s)
- Tomoko Udo
- Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, State University of New York, 12144, USA
| | - Katherine Purcell
- Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, State University of New York, 12144, USA
| | - Carlos M. Grilo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510
- National Center on Addiction and Substance Abuse (at Yale), New Haven, CT. 06510
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