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Hailu H, Skouteris H, Incollingo Rodriguez AC, Galvin E, Hill B. Drivers and facilitators of weight stigma among preconception, pregnant, and postpartum women: A systematic review. Obes Rev 2024; 25:e13710. [PMID: 38343332 DOI: 10.1111/obr.13710] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 01/09/2024] [Accepted: 01/13/2024] [Indexed: 04/18/2024]
Abstract
Women in the preconception, pregnant, or postpartum period are susceptible to weight stigma, particularly due to the risk of excess weight gain during the reproductive life period and the negative effects of stigma on the health of both the mother and the child. Identifying the drivers and facilitators of weight stigma will help guide focused weight stigma prevention interventions. This systematic review aimed to identify the drivers and facilitators of weight stigma among preconception, pregnant, and postpartum women. In May 2022, Medline, Embase, PsycINFO, and the Maternity and Infant Care Database were searched for peer-reviewed articles published since 2010 using search terms weight AND stigma AND preconception, OR pregnant, OR postpartum. Of the 1724 articles identified, 34 fulfilled the inclusion criteria and were included in a narrative synthesis. Women reported facing insensitive language, misconceptions about obesity across all settings, and inappropriate media representation. The unavailability of appropriate equipment at facilities was reported by both women and health professionals. Our findings indicate that a rigorous effort by all stakeholders is necessary to promote regulatory, legal, and educational initiatives designed to reduce weight stigma and discrimination against women in the reproductive period.
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Affiliation(s)
- Haimanot Hailu
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Warwick Business School, The University of Warwick, Coventry, UK
| | - Angela C Incollingo Rodriguez
- Psychological and Cognitive Sciences, Department of Social Science and Policy Studies, Worcester Polytechnic Institute, Worcester, Massachusetts, USA
| | - Emma Galvin
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Briony Hill
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Martin-Wagar CA, Melcher KA, Attaway SE, Bennett BL, Thompson CJ, Kronenberger O, Penwell TE. Does Terminology Matter When Measuring Stigmatizing Attitudes About Weight? Validation of a Modified Attitudes Toward Obese Persons Scale. Res Sq 2024:rs.3.rs-4208912. [PMID: 38645186 PMCID: PMC11030502 DOI: 10.21203/rs.3.rs-4208912/v1] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Commonly used medical terms like "obesity" and "overweight" have been identified as stigmatizing. Thus, this study sought to revise a commonly used measure of weight stigmatizing attitudes, the Attitudes Toward Obese Persons (ATOP) scale. We compared the original terminology in the ATOP (e.g., "obese")to a Modified version using neutral terms (e.g., "higher weight"). We randomized participants (N = 599) to either receive the original or Modified ATOP and compared their scores. There was no significant difference between the scores of participants who received the original ATOP and the Modified ATOP, t(597) = -2.46, p = .550. Through principal component analysis, we found the Modified ATOP is best used as a 13-item unidimensional measure. Findings suggest a Modified version of the ATOP with neutral language is suitable for assessing negative attitudes about higher-weight people without sacrificing psychometric properties. Further examination of the terminology used in weight stigma measures is needed to determine how to best assess weight stigma without reinforcing stigmatizing attitudes. The findings of the present study suggest that the use of neutral terms in measures of anti-fat bias is a promising solution that warrants further investigation.
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Telo GH, Friedrich Fontoura L, Avila GO, Gheno V, Bertuzzo Brum MA, Teixeira JB, Erthal IN, Alessi J, Telo GH. Obesity bias: How can this underestimated problem affect medical decisions in healthcare? A systematic review. Obes Rev 2024; 25:e13696. [PMID: 38272850 DOI: 10.1111/obr.13696] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/24/2023] [Accepted: 12/06/2023] [Indexed: 01/27/2024]
Abstract
INTRODUCTION Obesity is often labeled as a physical characteristic of a patient rather than a disease and it is subject to obesity bias by health providers, which harms the equality of healthcare in this population. OBJECTIVE Identifying whether obesity bias interferes in clinical decision-making in the treatment of patients with obesity. METHODS A systematic review of observational studies published between 1993 and 2023 in MEDLINE, Embase, and Cochrane Library on obesity bias and therapeutic decisions was carried out. The last search was conducted on June 30, 2023. The main outcome was the difference between clinical decisions in the treatment of individuals with and without obesity. The Newcastle-Ottawa scale for observational studies was used to assess for quality. After the selection process, articles were presented in narrative and thematic synthesis categories to better organize the descriptive analysis. RESULTS Of the 2546 records identified, 13 were included. The findings showed fewer screening exams for cancer in patients with obesity, who were also susceptible to less frequent pharmacological treatment intensification in the management of diabetes. Women with obesity received fewer pelvic exams and evidence of diminished visual contact and physician confidence in treatment adherence was reported. Some studies found no disparities in treatment for abdominal pain and tension headaches between patients presented with and without obesity. CONCLUSION The presence of obesity bias has negative effects on medical decision-making and on the quality of care provided to patients with obesity. These findings reveal the urgent necessity for reflection and development of strategies to mitigate its adverse impacts. (The protocol was registered with the international prospective register of systematic reviews, PROSPERO, under the number CRD42022307567).
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Affiliation(s)
- Guilherme Heiden Telo
- Medicine and Health Sciences Graduate Program, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
- Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Lucas Friedrich Fontoura
- Medicine and Health Sciences Graduate Program, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Georgia Oliveira Avila
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Vicenzo Gheno
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Julia Belato Teixeira
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Isadora Nunes Erthal
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Janine Alessi
- Medicine and Health Sciences Graduate Program, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
- Endocrinology Division, Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
- General Internal Medicine Division, Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Gabriela Heiden Telo
- Medicine and Health Sciences Graduate Program, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
- General Internal Medicine Division, Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
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Willer F. The Weight Stigma Heat Map: A tool to identify weight stigma in public health and health promotion materials. Health Promot J Austr 2024; 35:293-302. [PMID: 37198740 DOI: 10.1002/hpja.745] [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: 01/13/2023] [Revised: 04/03/2023] [Accepted: 05/09/2023] [Indexed: 05/19/2023] Open
Abstract
ISSUES ADDRESSED Public health campaigns and health promotion endeavours have been criticised for perpetuating weight stigma by reinforcing misinformation and using deficits-based narratives about larger-bodied people. The aim of this project was to develop a 'heat map' tool to appraise existing health policy and resources for elements that promote weight stigma. METHODS Ten themes were identified from literature using inductive analytic review methodology including pictorial/photographic representation, weight-health beliefs, body weight modifiability and financial concerns. Each theme was divided into four appraisal categories: the demonstration of weight stigma (via negative stereotyping, prejudice or discrimination that limits access to opportunities or services), weight bias (via presenting smaller bodies as normal/natural/healthy/good/desirable), bias-neutral (via representation of people of all shapes and sizes and accurate and nuanced health information about larger-bodied and smaller-bodied people) and finally an anti-stigma approach (via use of strengths-based narratives and overtly positive representation of and leadership by larger-bodied people). RESULTS A colour coding schema (the 'heat map') to visualise stigmatising elements across materials and a scoring system was devised for future quantitative evaluation. To demonstrate the use of the Weight Stigma Heat Map (WSHM), the Australian National Obesity Strategy 2022-2032 was appraised. CONCLUSIONS It is likely that weight stigmatisation is an important but under-recognised factor influencing the effectiveness of campaigns and interventions promoting behaviour change. SO WHAT?: Public health and health promotion professionals should consider using the WSHM as a framework for the development of less stigmatising policies, campaigns and resources and to direct reviews of existing materials.
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Affiliation(s)
- Fiona Willer
- Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
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Mosier-Mills A, Vagwala M, Potter J, Elisseou S. Respecting Body-Size Diversity in Patients: A Trauma-Informed Approach for Clinicians. Perm J 2024; 28:206-211. [PMID: 37981843 PMCID: PMC10940234 DOI: 10.7812/tpp/23.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
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Bradford HM, Puhl RM, Phillippi JC, Dietrich MS, Neal JL. Weight Bias Among Certified Nurse-Midwives and Certified Midwives: Findings From a National Sample. J Midwifery Womens Health 2024. [PMID: 38459813 DOI: 10.1111/jmwh.13608] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/01/2023] [Indexed: 03/10/2024]
Abstract
INTRODUCTION Weight bias toward individuals with higher body weights permeates health care settings in the United States and has been associated with poor weight-related communication and quality of care as well as adverse health outcomes. However, there has been limited quantitative investigation into weight bias among perinatal care providers. Certified nurse-midwives (CNMs)/certified midwives (CMs) attend approximately 11% of all births in the United States. The aims of this study were to measure the direction and extent of weight bias among CNMs/CMs and compare their levels of weight bias to the US public and other health professionals. METHODS Through direct postcard distribution, social media accounts, professional networks, and email listservs, American Midwifery Certification Board (AMCB)-certified midwives were solicited to complete an online survey of their implicit weight bias using the Implicit Association Test and their explicit weight bias using the Antifat Attitudes Questionnaire, Fat Phobia Scale, and Preference for Thin People measure. RESULTS A total of 2257 midwives participated in the survey, yielding a completion rate of 17.7%. Participants were mostly White and female, with a median age of 46 years and 11 years since AMCB certification. More than 70% of midwives have some level of implicit weight bias, although to a lesser extent compared with previously published findings among the US public (P < .01) and other health professionals (P < .01). In a subsample comparison of female midwives to female physicians, implicit weight bias levels were similar (P > .05). Midwives also express explicit weight bias, but at lower levels than the US public and other health professionals (P < .05). DISCUSSION This study provides the first quantitative research documenting weight bias among a national US sample of perinatal care providers. Findings can inform educational efforts to mitigate weight bias in the perinatal care setting and decrease harm.
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Affiliation(s)
- Heather M Bradford
- Georgetown University, School of Nursing, Washington, District of Columbia
- Vanderbilt University, School of Nursing, Nashville, Tennessee
| | - Rebecca M Puhl
- Department of Human Development & Family Sciences, University of Connecticut, Storrs, Connecticut
| | | | - Mary S Dietrich
- Vanderbilt University, School of Nursing, Nashville, Tennessee
- Vanderbilt University, School of Medicine, Nashville, Tennessee
| | - Jeremy L Neal
- Vanderbilt University, School of Nursing, Nashville, Tennessee
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Philip SR, Fields SA, Van Ryn M, Phelan SM. Comparisons of Explicit Weight Bias Across Common Clinical Specialties of US Resident Physicians. J Gen Intern Med 2024; 39:511-518. [PMID: 37794262 PMCID: PMC10973280 DOI: 10.1007/s11606-023-08433-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 09/14/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Patients with high body weight are persistently stigmatized in medical settings, with studies demonstrating that providers endorse negative stereotypes of, and have lower regard for, higher-weight patients. Very little is known about how this weight bias varies across specialties. OBJECTIVE The purpose of this study is to examine how explicit weight bias varies between resident providers among sixteen of the largest residency specialties in the USA. The identification of these differences will guide the prioritization and targeting of interventions. DESIGN The current study utilized cross-sectional, observational data. PARTICIPANTS Forty-nine allopathic medical schools were recruited to participate in this national, longitudinal study. The current study utilized data from 3267 trainees in Year 2 of Residency among those who specialized in one of the most common sixteen residency programs in 2016. MAIN MEASURES Participants reported demographic information and residency specialties and completed three sets of measures pertaining to explicit weight bias. KEY RESULTS A significant minority (13-48%) of residents reported slight-to-strong agreement with each anti-fat statement. There was a significant relationship between residency specialty and anti-fat blame (F(15, 3189 = 12.87, p < .001), η2 = .06), anti-fat dislike (F(15, 3189 = 7.01, p < .001), η2 = .03), and attitudes towards obese patients (F(15, 3208 = 17.78, p < .001), η2 = .08). Primary care residents (e.g., family medicine, pediatrics) consistently reported lower levels of weight bias than those in specialty programs (e.g., orthopedic surgery, anesthesiology). CONCLUSIONS This study is the first to report on weight bias in a large, heterogeneous sample of US resident physicians. Problematic levels of weight bias were found in all specialties, with residents in specialty programs generally reporting more bias than those in primary care residencies. Future research should examine which factors contribute to these differences to guide intervention.
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Affiliation(s)
- Samantha R Philip
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, USA.
| | - Sherecce A Fields
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, USA
| | | | - Sean M Phelan
- Division of Health Care Delivery Research, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, NY, USA
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Bidstrup H, Brennan L, Kaufmann L, Meadows A, de la Piedad Garcia X. A systematic review of ecological momentary assessment studies on weight stigma and a call for a large-scale collaboration. Obes Rev 2024; 25:e13676. [PMID: 38115555 DOI: 10.1111/obr.13676] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 09/21/2023] [Accepted: 11/13/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Weight stigma is associated with poor mental health correlates in cross-sectional research. Researchers are increasingly using Ecological Momentary Assessment (EMA) methods, collecting comprehensive within-person data to understand the temporal nature of weight stigma and its biopsychosocial correlates. AIM To systematically review EMA studies on the effect of weight stigma on biopsychosocial correlates and integrate the findings. METHOD PsycINFO, CINAHL, Embase, Medline Complete, and Web of Science were searched and studies were doubled screened (H.B. and X.P.G.). RESULTS Twelve studies (N = 615) met our inclusion criteria. For both between- and within-subject effects, experienced and internalized weight stigmas were associated with negative correlates/outcomes (e.g., higher disordered eating and lower positive mood). However, studies differed in the correlate measures assessed, EMA methods used, and participant instructions provided. Given these inconsistencies, comparison across studies was difficult, and findings could not be reliably integrated. CONCLUSIONS Consistent with previous research, studies from this review suggest weight stigma leads to adverse outcomes. EMA has the potential to overcome many of the limitations present in cross-sectional research on weight stigma and provide more ecologically valid and reliable results. We argue for a collaborative data-sharing consortium with standardized EMA methodologies, so researchers worldwide can contribute to and make use of a large, collective dataset on weight stigma and health correlates (see osf.io/s5ru6/).
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Affiliation(s)
- Hugh Bidstrup
- School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, Victoria, Australia
- School of Psychology and Public Health, La Trobe University, Albury/Wodonga, Victoria, Australia
| | - Leah Brennan
- School of Psychology and Public Health, La Trobe University, Albury/Wodonga, Victoria, Australia
- Centre for Eating, Weight, and Body Image, East Melbourne, Victoria, Australia
| | - Leah Kaufmann
- School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, Victoria, Australia
| | - Angela Meadows
- Department of Psychology, University of Essex, Colchester, UK
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Jolin JR, Kwon M, Brock E, Chen J, Kokan A, Murdock R, Stanford FC. Policy Interventions to Enhance Medical Care for People With Obesity in the United States-Challenges, Opportunities, and Future Directions. Milbank Q 2024. [PMID: 38332667 DOI: 10.1111/1468-0009.12693] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/08/2023] [Accepted: 01/24/2024] [Indexed: 02/10/2024] Open
Abstract
Policy Points Health policymakers have insufficiently addressed care for people with obesity (body mass index ≥ 30 kg/m2 ) in the United States. Current federal policies targeting obesity medications reflect this unfortunate reality. We argue for a novel policy framework to increase access to effective obesity therapeutics and care, recognizing that, though prevention is critical, the epidemic proportions of obesity in the United States warrant immediate interventions to augment care. Reducing barriers to and improving the quality of existing anti-obesity medications, intensive behavioral therapy, weight management nutrition and dietary counseling, and bariatric surgery are critical. Moreover, to ensure continuity of care and patient-clinician trust, combating physician and broader weight stigma must represent a central component of any viable obesity care agenda.
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Affiliation(s)
| | | | | | | | - Aisha Kokan
- Harvard University
- Global Health and Health Policy, Harvard University
| | | | - Fatima Cody Stanford
- MGH Weight Center, Massachusetts General Hospital, Nutrition Obesity Research Center at Harvard, Harvard Medical School
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Cerolini S, Vacca M, Zegretti A, Zagaria A, Lombardo C. Body shaming and internalized weight bias as potential precursors of eating disorders in adolescents. Front Psychol 2024; 15:1356647. [PMID: 38379620 PMCID: PMC10877040 DOI: 10.3389/fpsyg.2024.1356647] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 01/23/2024] [Indexed: 02/22/2024] Open
Abstract
Introduction Body shaming (BS) is a growing phenomenon within the school context, especially among adolescents. Recently, it has been described as an unrepeated act in which a person expresses unsolicited, mostly negative comments about an individual's body. The targeted person perceives these comments as negative, offensive or body shame-inducing. Empirical evidence also suggests that body weight is the most common reason that youths are teased and bullied. Indeed, weight stigma, described as bias or discriminatory behaviors, attitudes, feelings, and thinking about individuals, because of their weight, can lead to weight-based discrimination and victimization. Preliminary evidence suggests that BS and weight stigma have negative effects on psychological health both in the short and long term. In the delicate stage of adolescence development and pubertal maturation, BS experiences can be highly prevalent and it can lead to adverse outcomes such as eating disorders (ED). However, prevalence data in the Italian context are still lacking. Methods The study aims to estimate weight-related BS perceived by different sources (i.e., peers and family members) and their associations with public and internalized weight bias, body mass index (BMI), body dissatisfaction, and ED symptoms. A sample of 919 high school students (Mage = 15.97, SD = 1.58; 57.1% boys) completed a battery of self-report questionnaires assessing these variables. Results One in four students reported experiences of weight-related BS by peers or family members. A total of 37% reported having at least one BS experience in a lifetime. Higher scores of ED symptoms, body dissatisfaction, and weight bias were reported by adolescents who experienced BS, especially females. Among overweight participants, results showed that internalized weight bias partially mediated the relationship between BS by family members and ED symptoms and fully mediated the relationship between BS by peers and ED symptoms, after controlling for age, sex and BMI. Discussion These findings, despite their cross-sectional nature, add an important contribution to the creation of quantitative empirical evidence on the phenomenon of BS. Its role in explaining eating disorders, both alone and with the mediation of internalized weight stigma has been first proved and needs to be confirmed by longitudinal results.
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Affiliation(s)
- Silvia Cerolini
- Department of Psychology, Sapienza University of Rome, Rome, Italy
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Hawley N, Green J, Ahlich E, Hauff C, Hermer J, Skiba MB, James DL, Nash SH. Patient perspectives of weight stigma across the cancer continuum: A scoping review. Cancer Med 2024; 13:e6882. [PMID: 38205894 PMCID: PMC10905240 DOI: 10.1002/cam4.6882] [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: 08/25/2023] [Revised: 11/22/2023] [Accepted: 12/16/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Weight stigma has been defined as the social devaluation and denigration of individuals because of their weight. The purpose of this scoping systematic review was to assess and understand patient experiences with weight stigma in the cancer care setting. METHODS We conducted a systematic scoping review of studies examining shame, prejudice, bias, and stigma in relation to weight and cancer-related care using five databases: PubMed, CINAHL Plus Full Text (ProQuest), Cochrane Library, PsycINFO (EBSCO), and Scopus. Articles were uploaded into Covidence for de-duplication and screening. Included studies were peer reviewed, reported adult patient experiences in cancer-related care, and were published in English between October 2012 and February 2023. Study characteristics and key findings were abstracted and qualitatively synthesized. RESULTS Publications meeting inclusion criteria yielded five studies (n = 113 participants). Most focused on the experiences of women (n = 4) and cancers which predominantly impact women (i.e., breast, cervical, endometrial; n = 4). All stages of the cancer continuum were included with studies examining screening (n = 2), treatment (n = 1), and post-treatment survivorship (n = 2). Weight discrimination was discussed in four studies and weight-biased stereotypes were discussed in three studies. Experiences of weight bias internalization were reported in four studies. One study described an instance of implicit weight bias. CONCLUSIONS Limited studies examine patient experiences of weight stigma in cancer care; however, current evidence suggests that patients do experience weight stigma in cancer-related care. This review highlights critical gaps and a need for more research on the prevalence and impact of weight stigma in cancer screening and care.
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Affiliation(s)
- Nanako Hawley
- Department of Psychology, University of South Alabama, Mobile, Alabama, USA
| | - Jennifer Green
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, California, USA
| | - Erica Ahlich
- Department of Psychology, University of South Alabama, Mobile, Alabama, USA
| | - Caitlyn Hauff
- Department of Health, Kinesiology, and Sport, University of South Alabama, Mobile, Alabama, USA
| | - Janice Hermer
- Arizona State University Library, Arizona State University, Tempe, Arizona, USA
| | - Meghan B Skiba
- College of Nursing, University of Arizona, Tucson, Arizona, USA
| | - Dara L James
- College of Nursing, University of South Alabama, Mobile, Alabama, USA
- Edson College of Nursing and Health Innovation, Arizona State University, Tempe, Arizona, USA
| | - Sarah H Nash
- Department of Epidemiology, University of Iowa, Iowa, Iowa, USA
- Holden Comprehensive Cancer Center, University of Iowa, Iowa, Iowa, USA
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Howes EM, Parker MK, Misyak SA, DiFeliceantonio AG, Davy BM, Brown LEC, Hedrick VE. The Impact of Weight Bias and Stigma on the 24 h Dietary Recall Process in Adults with Overweight and Obesity: A Pilot Study. Nutrients 2024; 16:191. [PMID: 38257084 PMCID: PMC10818297 DOI: 10.3390/nu16020191] [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: 10/30/2023] [Revised: 12/07/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
People with overweight and obesity tend to both underreport dietary energy intake and experience weight stigma. This exploratory pilot study aimed to determine the relationship between weight bias and weight stigma and energy intake reporting accuracy. Thirty-nine weight-stable adults with BMI ≥ 25 completed three 24 h dietary recalls; indirect calorimetry to measure resting metabolic rate; a survey measuring weight stigma, psychosocial constructs, and physical activity; and a semi-structured qualitative interview. Multiple linear regression was used to determine if weight bias internalization, weight bias toward others, and experiences of weight stigma were predictive of the accuracy of energy reporting. A thematic analysis was conducted for the qualitative interviews. Weight stigma was reported by 64.1% of the sample. Weight stigma constructs did not predict the accuracy of energy intake reporting. People with obesity underreported by a mean of 477 kcals (p = 0.02). People classified as overweight overreported by a mean of 144 kcals, but this was not significant (p = 0.18). Participants reported a desire to report accurate data despite concerns about reporting socially undesirable foods. Future research should quantify the impact of weight stigma on energy reporting in 24 h recalls using a larger, more diverse sample size and objective measures like doubly labeled water for validation.
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Affiliation(s)
- Erica M. Howes
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA 24061, USA; (M.K.P.); (S.A.M.); (A.G.D.); (B.M.D.); (V.E.H.)
| | - Molly K. Parker
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA 24061, USA; (M.K.P.); (S.A.M.); (A.G.D.); (B.M.D.); (V.E.H.)
| | - Sarah A. Misyak
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA 24061, USA; (M.K.P.); (S.A.M.); (A.G.D.); (B.M.D.); (V.E.H.)
| | - Alexandra G. DiFeliceantonio
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA 24061, USA; (M.K.P.); (S.A.M.); (A.G.D.); (B.M.D.); (V.E.H.)
- Fralin Biomedical Research Institute at VTC, Virginia Tech, Roanoke, VA 24016, USA
| | - Brenda M. Davy
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA 24061, USA; (M.K.P.); (S.A.M.); (A.G.D.); (B.M.D.); (V.E.H.)
| | | | - Valisa E. Hedrick
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA 24061, USA; (M.K.P.); (S.A.M.); (A.G.D.); (B.M.D.); (V.E.H.)
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Nutter S, Eggerichs LA, Nagpal TS, Ramos Salas X, Chin Chea C, Saiful S, Ralston J, Barata-Cavalcanti O, Batz C, Baur LA, Birney S, Bryant S, Buse K, Cardel MI, Chugh A, Cuevas A, Farmer M, Ibrahim A, Kataria I, Kotz C, Kyle T, le Brocq S, Mooney V, Mullen C, Nadglowski J, Neveux M, Papapietro K, Powis J, Puhl RM, Rea Ruanova B, Saunders JF, Stanford FC, Stephen O, Tham KW, Urudinachi A, Vejar-Renteria L, Walwyn D, Wilding J, Yusop S. Changing the global obesity narrative to recognize and reduce weight stigma: A position statement from the World Obesity Federation. Obes Rev 2024; 25:e13642. [PMID: 37846179 DOI: 10.1111/obr.13642] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 02/12/2023] [Revised: 08/02/2023] [Accepted: 09/09/2023] [Indexed: 10/18/2023]
Abstract
Weight stigma, defined as pervasive misconceptions and stereotypes associated with higher body weight, is both a social determinant of health and a human rights issue. It is imperative to consider how weight stigma may be impeding health promotion efforts on a global scale. The World Obesity Federation (WOF) convened a global working group of practitioners, researchers, policymakers, youth advocates, and individuals with lived experience of obesity to consider the ways that global obesity narratives may contribute to weight stigma. Specifically, the working group focused on how overall obesity narratives, food and physical activity narratives, and scientific and public-facing language may contribute to weight stigma. The impact of weight stigma across the lifespan was also considered. Taking a global perspective, nine recommendations resulted from this work for global health research and health promotion efforts that can help to reduce harmful obesity narratives, both inside and outside health contexts.
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Affiliation(s)
- Sarah Nutter
- Educational Psychology and Leadership Studies, University of Victoria, Victoria, British Columbia, Canada
| | - Laura A Eggerichs
- Department of Public Health and Community Medicine, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Taniya S Nagpal
- Department of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Canada
| | - Ximena Ramos Salas
- Replica Communications, Kristianstad, Sweden
- Obesity Canada, Edmonton, Canada
- European Association for the Study of Obesity, Teddington, UK
| | - Christine Chin Chea
- Internal and Obesity Medicine, University of the West Indies School of Clinical Medicine and Research, Nassau, Bahamas
| | | | | | | | - Claudia Batz
- George Institute for Global Health, Sydney, Australia
| | - Louise A Baur
- Children's Hospital Westmead Clinical School, University of Sydney, Sydney, Australia
| | - Susie Birney
- Irish Coalition for People Living with Obesity, Dublin, Ireland
| | - Sheree Bryant
- European Association for the Study of Obesity, Teddington, UK
| | - Kent Buse
- George Institute for Global Health, Imperial College London, London, UK
| | - Michelle I Cardel
- WW International, Inc., Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA
| | | | - Ada Cuevas
- Advanced Center for Metabolic Medicine and Nutrition (CAMMYN), Santiago, Chile
| | | | - Allison Ibrahim
- Educational Consultant and Patient Advocate, Kuwait City, Kuwait
| | - Ishu Kataria
- Center for Global Noncommunicable Diseases, RTI International, Research Triangle Park, North Carolina, USA
| | - Catherine Kotz
- Department of Integrative Biology and Physiology, University of Minnesota, and the Minneapolis VA Health Care System, Geriatric Research, Education and Clinical Care, Minneapolis, Minnesota, USA
| | - Ted Kyle
- ConscienHealth, Pittsburgh, Pennsylvania, USA
| | - Sara le Brocq
- National Institute for Health and Care Excellence, London, UK
| | - Vicki Mooney
- European Coalition for People Living with Obesity, Dublin, Ireland
| | - Clare Mullen
- Health Consumers' Council WA, Mount Lawley, Australia
| | | | | | - Karin Papapietro
- Nutrition Unit, Hospital Clínico de La Universidad de Chile, Santiago, Chile
| | | | - Rebecca M Puhl
- Rudd Center for Food Policy and Obesity, University of Connecticut, Storrs, Connecticut, USA
| | | | - Jessica F Saunders
- Psychology Convening Group, Ramapo College of New Jersey, Mahwah, New Jersey, USA
| | - Fatima Cody Stanford
- Neuroendocrine Unit, Pediatric Endocrinology, Nutrition Obesity Research Center at Harvard, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Ogweno Stephen
- Global Health Medicine And Health, Faculty of Biology, University Of Manchester, Manchester, UK
| | - Kwang Wei Tham
- Singapore Association for the Study of Obesity, Singapore
| | | | - Lesly Vejar-Renteria
- Nutrition and Health Research Center, National Institute of Public Health Mexico, Cuernavaca, Mexico
| | | | - John Wilding
- World Obesity Federation, London, UK
- University of Liverpool, Liverpool, UK
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14
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Phillips J. Weight bias and stigma in healthcare: What are we doing about it? Work 2024; 77:731-733. [PMID: 38393880 DOI: 10.3233/wor-246004] [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] [Indexed: 02/25/2024] Open
Abstract
Weight bias and weight stigma is present in healthcare settings negatively affecting people with obesity. Healthcare professionals should be aware of how their potential bias and stigma may be impacting clients with obesity. With obesity projected to rise among the world, the healthcare environment needs to be more accepting and accommodating.
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15
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Madsen M, Michaelsen L, DeCosta P, Grabowski D. Stigma-Generating Mechanisms in Families Enrolled in a Pediatric Weight Management Program: A Qualitative Study of Health Identities and Healthcare Authenticity. Children (Basel) 2023; 11:46. [PMID: 38255360 PMCID: PMC10813986 DOI: 10.3390/children11010046] [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] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/20/2023] [Accepted: 12/25/2023] [Indexed: 01/24/2024]
Abstract
In recent years, there has been increased awareness of obesity as a condition that carries a high level of stigma, as well as growing recognition of its prevalence and harm. Despite the increasing body of research on this topic, there is a gap in the literature regarding mechanisms that generate or exacerbate perceptions of weight stigma, especially within families and pediatric healthcare settings. The present study aims to identify potential stigma-generating mechanisms by focusing on inter-relational dynamics within these contexts. We conducted in-depth, semi-structured interviews with 11 families and analyzed the data by applying sociological theories on health identities and authenticity. Our study found four themes that represent potential stigma-generating mechanisms by being explicitly related to familial health identities and healthcare authenticity: (1) negotiating and reconstruction familial self-understanding, (2) between guilt, shame and conflicts, (3) navigating weight perceptions, and (4) the necessity of positivity and relevance. Our study shows the complexities of weight stigma within family and pediatric healthcare settings, emphasizing the need for sensitive and tailored support, as well as the value of working authentically as crucial aspects in preventing and/or reducing stigma.
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Affiliation(s)
- Mie Madsen
- Department of Prevention, Health Promotion and Community Care, Copenhagen University Hospital—Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark; (P.D.); (D.G.)
| | - Lene Michaelsen
- The Centre for Children and Youths Health, Mimersgade 47A, 2nd Floor, 2200 Copenhagen, Denmark;
| | - Patricia DeCosta
- Department of Prevention, Health Promotion and Community Care, Copenhagen University Hospital—Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark; (P.D.); (D.G.)
| | - Dan Grabowski
- Department of Prevention, Health Promotion and Community Care, Copenhagen University Hospital—Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark; (P.D.); (D.G.)
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16
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Wilson OWA, Nutter S, Russell-Mayhew S, Ellard JH, Alberga AS, MacInnis CC. Weighty words: exploring terminology about weight among samples of physicians, obesity specialists, and the general public. J Commun Healthc 2023:1-7. [PMID: 38131299 DOI: 10.1080/17538068.2023.2297122] [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] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
BACKGROUND The words used to refer to weight and individuals with large bodies can be used to reinforce weight stigma. Given that most previous research has examined preferred terminology within homogenous groups, this research sought to examine terminology preferences across populations. METHODS This paper reports on data gathered with the general public, family physicians, and obesity researchers/practitioners. Participants were asked about the words they commonly: (1) used to refer to people with large bodies (general public); (2) heard in their professional contexts (physicians and obesity specialists); and (3) perceived to be the most socially or professionally acceptable (all samples). RESULTS Similarities and differences were evident between samples, especially related to weight-related clinical terms, the word fat, and behavioral stereotypes. CONCLUSION The results provide some clarity into the differences between populations and highlight the need to incorporate use of strategies that may move beyond person-first language to humanize research and clinical practice with people with large bodies.
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Affiliation(s)
- Oliver W A Wilson
- Werklund School of Education, University of Calgary, Calgary, Canada
- Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Sarah Nutter
- Educational Psychology and Leadership Studies, University of Victoria, Victoria, Canada
| | | | - John H Ellard
- Department of Psychology, University of Calgary, Calgary, Canada
| | - Angela S Alberga
- Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, Canada
| | - Cara C MacInnis
- Department of Psychology, Acadia University, Wolfville, Canada
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17
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Pearl RL, Hernandez M, Bach C, Groshon L, Wadden TA. Prevalence of diagnosed psychiatric disorders among adults who have experienced and internalized weight stigma. Obes Sci Pract 2023; 9:681-687. [PMID: 38090681 PMCID: PMC10712401 DOI: 10.1002/osp4.700] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/11/2023] [Accepted: 07/16/2023] [Indexed: 01/30/2024] Open
Abstract
Objective Experiences and internalization of weight stigma are associated with greater self-reported psychological distress and symptoms of psychiatric disorders such as depression and anxiety. However, little is known about the extent to which individuals who have experienced and internalized weight stigma are diagnosed with or provided treatment for psychiatric conditions. The current study aimed to characterize the prevalence of diagnosed psychiatric disorders among adults with obesity who had experienced and internalized weight stigma. Methods Weight-loss treatment-seeking adults with a history of experiencing weight stigma and high levels of internalized weight stigma were recruited for two clinical trials. Results In Study 1 (n = 84, 83.3% women, 67.9% Black), 25% of participants reported a lifetime history of a mood disorder. Few participants (<10%) reported current psychiatric diagnoses or use of psychiatric medications. In Study 2 (n = 129, 88.4% women, 65.1% white), one-third of participants reported a mood disorder history, and 21.7% reported an anxiety disorder history, with approximately 16%-18% reporting current diagnoses. In both studies, few participants reported a history of a diagnosed eating disorder despite high rates of current full- or subthreshold symptoms. Based on Beck Depression Inventory-II scores, approximately 54%-64% of participants reported mild or greater symptoms of depression. Conclusions Overall, lifetime history of diagnosed psychiatric disorders and current symptoms of depression and eating disorders were relatively high across two samples. More research is needed to determine the impact of weight stigma on the diagnosis and treatment of eating disorders and other psychiatric concerns.
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Affiliation(s)
- Rebecca L. Pearl
- Department of Clinical and Health PsychologyCollege of Public Health and Health ProfessionsUniversity of FloridaGainesvilleFloridaUSA
- Department of PsychiatryCenter for Weight and Eating DisordersPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Marian Hernandez
- Department of Clinical and Health PsychologyCollege of Public Health and Health ProfessionsUniversity of FloridaGainesvilleFloridaUSA
| | - Caroline Bach
- Department of PsychologyGeorgia Southern UniversityStatesboroGeorgiaUSA
| | - Laurie Groshon
- Department of Clinical and Health PsychologyCollege of Public Health and Health ProfessionsUniversity of FloridaGainesvilleFloridaUSA
| | - Thomas A. Wadden
- Department of PsychiatryCenter for Weight and Eating DisordersPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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18
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Leonard SI, Sharma Y, Hughes TL, Jackman KB, Bruzzese JM. Weight Stigma and Mental and Emotional Health Among Sexual and Gender Minority Individuals: A Scoping Review. LGBT Health 2023. [PMID: 37948558 DOI: 10.1089/lgbt.2023.0025] [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] [Indexed: 11/12/2023] Open
Abstract
Purpose: Weight stigma is associated with poor mental and emotional health and may be especially harmful to sexual and gender minority (SGM) individuals due to co-occurring minority stress. The literature on this topic has not been synthesized. We conducted a scoping review of the literature on weight stigma and mental and emotional health among SGM individuals to synthesize findings, highlight gaps, and identify clinical and research implications. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews, we searched PubMed, CINAHL, PsycINFO, and Scopus in April 2022. Included studies examined the relationship between weight stigma and mental and emotional health among SGM people of any age. We did not restrict study design or publication date. Results: Of 513 records identified, 23 met inclusion criteria. Most focused on sexual minority individuals; one focused specifically on gender minority individuals. Weight stigma was associated with poorer mental and emotional health in nearly all studies. The most common outcomes examined were self-esteem, maladaptive eating, and depressive symptoms. Five studies, all using the same dataset, focused on adolescents; none focused on older adults. Conclusions: Weight stigma is associated with poorer mental and emotional health among SGM individuals and, through its intersections with minority stress, might impact SGM individuals differently than their cisgender and heterosexual counterparts. There are important gaps regarding weight stigma's effect on SGM adolescents and gender minority individuals and its relationship with a broader range of mental and emotional health outcomes.
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Affiliation(s)
- Sarah I Leonard
- Center for Sexual and Gender Minority Health Research, Columbia University School of Nursing, New York, New York, USA
| | - Yashika Sharma
- Center for Sexual and Gender Minority Health Research, Columbia University School of Nursing, New York, New York, USA
| | - Tonda L Hughes
- Center for Sexual and Gender Minority Health Research, Columbia University School of Nursing, New York, New York, USA
| | - Kasey B Jackman
- Center for Sexual and Gender Minority Health Research, Columbia University School of Nursing, New York, New York, USA
- NewYork-Presbyterian Hospital, New York, New York, USA
| | - Jean-Marie Bruzzese
- Center for Sexual and Gender Minority Health Research, Columbia University School of Nursing, New York, New York, USA
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19
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Hill B, Azzari Wynn-Jones A, Botting KJ, Cassinelli EH, Daly MP, Gardiner CV, Hanley SJ, Heslehurst N, Steegers-Theunissen R, Verbiest S, Skouteris H. The Challenge of Weight Stigma for Women in the Preconception Period: Workshop Recommendations for Action from the 5th European Conference on Preconception Health and Care. Int J Environ Res Public Health 2023; 20:7034. [PMID: 37998265 PMCID: PMC10671694 DOI: 10.3390/ijerph20227034] [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] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 11/25/2023]
Abstract
Weight stigma is a well-recognised public health issue affecting many members of society including women during the preconception period. The impacts of preconception weight stigma on women are significant and may result in decreased access to and uptake of healthcare, and mental health concerns. The consequences of this weight stigma may translate to negative maternal outcomes and even intergenerational effects on the child. Eliminating weight stigma is therefore imperative. The aim of this paper is to report recommendations to reduce weight stigma for preconception women produced at a workshop with clinical and academic experts on preconception health and weight stigma at the 5th European Conference on Preconception Health and Care. The recommendations are related to two key areas: general societal recommendations prompting all people to acknowledge and adjust our attitudes towards larger-bodied people; and healthcare-specific recommendations imploring clinicians to upskill themselves to reduce weight stigma in practice. We therefore call for urgent approaches to address societal weight-stigmatising attitudes and norms related to both the general population and preconception women, while providing professional development opportunities for healthcare professionals relating to weight stigma. Eliminating weight stigma for preconception women may have positive impacts on the outcomes for mothers and children during pregnancy and beyond.
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Affiliation(s)
- Briony Hill
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne 3004, Australia
| | | | - Kimberley J. Botting
- Department of Maternal and Fetal Medicine, Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London WC1E 6HX, UK;
| | - Emma H. Cassinelli
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast BT12 6BA, UK;
| | - Michael P. Daly
- Centre for Public Health, Bristol Medical School, University of Bristol, Canynge Hall, Whatley Road, Bristol BS8 2PN, UK;
| | - Caitlin Victoria Gardiner
- Department of Global Health and Social Medicine, Bush House, Strand Campus, King’s College London, 40 Aldwych, London WC2B 4BG, UK;
- Developmental Pathways for Health Research Unit, University of the Witwatersrand Faculty of Health Sciences, Johannesburg 2000, Gauteng, South Africa
| | - Stephanie J. Hanley
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK;
| | - Nicola Heslehurst
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4AX, UK;
| | - Regine Steegers-Theunissen
- Department of Obstetrics and Gynaecology, and Department of and Pediatrics, Erasmus MC, University Medical Center, 3015 GD Rotterdam, The Netherlands;
| | - Sarah Verbiest
- School of Social Work, University of North Carolina at Chapel Hill, Pittsboro Road, Chapel Hill, NC 27599-3550, USA;
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne 3004, Australia
- Warwick Business School, University of Warwick, Scarman Rd, Coventry CV4 7AL, UK
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20
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Hamilton A, Smith SR, Lydecker JA. The Relationship of Self-identified Weight Status With Perceived Mental and Physical Health. J Psychiatr Pract 2023; 29:430-438. [PMID: 37948168 PMCID: PMC10653675 DOI: 10.1097/pra.0000000000000744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
OBJECTIVE This study examined whether individuals with higher weight (body mass index in the overweight or obesity range) self-identified as having overweight or obesity (Ow/Ob). The study also examined whether self-identifying as having Ow/Ob was associated with perceived mental health, perceived physical health, depression, and eating disorder psychopathology. METHODS Four study groups were created: those with Ow/Ob who self-identified as having Ow/Ob (Ow/Ob+), those with Ow/Ob who did not self-identify as having Ow/Ob (Ow/Ob-), those with core features of binge-eating disorder (BED) and Ow/Ob, and those with bulimia nervosa (BN) and Ow/Ob. Analyses of variance compared study groups on perceived health, depression, and eating disorder psychopathology. RESULTS The BED and BN groups were more likely to self-identify as having overweight/obesity compared with Ow/Ob groups without eating disorders. The Ow/Ob- group had the best-perceived health and the lowest levels of eating disorder psychopathology and depression compared with the other groups. The Ow/Ob+ group had better perceived mental health than the BED and BN groups but did not differ significantly from the Ow/Ob- group in perceived mental health. Perceived physical health in the Ow/Ob+ group was better than in the BED group and worse than in the Ow/Ob- group. The Ow/Ob+ group had higher levels of eating disorder psychopathology than the Ow/Ob- group. CONCLUSIONS Self-identifying as having obesity is associated with eating disorder psychopathology as well as poorer perceived mental and physical health. Providers should engage patients in discussions about their weight with the understanding that self-identifying as having overweight or obesity might indicate the presence of eating disorder psychopathology. Future clinical research should investigate the directionality or possible bidirectionality of this relationship.
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21
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Lydecker JA, Winschel J, Gilbert K, Cotter EW. School absenteeism and impairment associated with weight bullying. J Adolesc 2023; 95:1478-1487. [PMID: 37487590 PMCID: PMC10731314 DOI: 10.1002/jad.12220] [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: 10/03/2022] [Revised: 07/07/2023] [Accepted: 07/10/2023] [Indexed: 07/26/2023]
Abstract
INTRODUCTION Many children experience weight-based bullying (WB), when individuals are treated poorly or demeaned because of weight. WB has negative mental and physical health consequences. The current study examined how children's experiences of different forms of WB (verbal, social, physical, cyber) were associated with impaired functioning in school, social life, and family life. METHODS Data were collected in Spring 2021. Participants (N = 224) were parents of a school-aged child and lived in the United States. Sixty percent of parents were mothers and 72% of parents self-identified as White. They completed surveys regarding weight, eating, and bullying. RESULTS Social and cyber WB were associated with clinically significant impairment for both children and parents. Children who experienced social and physical WB were more likely to skip school, whereas physical and cyber WB were associated with skipping a particular class. All forms of bullying were associated with skipping gym class. Social and cyber WB were associated with isolating. Cyber WB was associated with all disordered eating behaviors. In addition, physical WB was associated with binge eating, social WB was associated with purging, and verbal WB was associated with secretive eating. DISCUSSION Victims of WB experience impairment in school, social life, and family life, absenteeism, and disordered eating. It is essential to develop approaches to address WB in its various forms to identify strategies for reducing and preventing WB across various levels of influence, including peer groups, schools, and families.
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Affiliation(s)
- Janet A. Lydecker
- Department of Psychiatry, Yale University School of
Medicine, New Haven, CT, USA
| | - Julia Winschel
- Department of Psychiatry, Yale University School of
Medicine, New Haven, CT, USA
- School of Public Health, Yale University, New Haven, CT,
USA
| | - Kelsey Gilbert
- Department of Psychiatry, Yale University School of
Medicine, New Haven, CT, USA
- Department of Psychology, University of Hartford, Hartford,
CT, USA
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22
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Gordon AR, Egan KA, Wang ML, Ziyadeh NJ, Kenney EL, Rosario M, Austin SB. Weight-based discrimination and disordered eating behaviors in a cohort of U.S. sexual minority young adults. Int J Eat Disord 2023; 56:1983-1990. [PMID: 37345224 PMCID: PMC10592576 DOI: 10.1002/eat.24015] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 06/08/2023] [Accepted: 06/08/2023] [Indexed: 06/23/2023]
Abstract
OBJECTIVE Though prevalent, weight-based discrimination is understudied and has been linked to disordered eating behaviors (DEB) among adolescents and adults. Sexual minority populations experience elevated risk of DEB, but little is known about the role of weight discrimination in this elevated risk. METHODS Participants were 1257 sexual minority women and men (ages 18-31 years) in the US Growing Up Today Study cohort. We examined cross-sectional associations between weight discrimination victimization and three DEB in the past year: unhealthy weight control behaviors, overeating, and binge eating. Generalized estimating equations, adjusted for potential confounders, were used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs). RESULTS Three in 10 participants (31%) reported weight-based discrimination victimization. Sexual minority young adults who reported weight-based discrimination had greater relative prevalence of unhealthy weight control behaviors (PR [95% CI]: 1.92 [1.35, 2.74]), overeating (3.15 [2.24, 4.44]), and binge eating (3.92 [2.51, 6.13]), compared with those who reported no weight-based discrimination. Associations with overeating and binge eating remained significant after adjusting for BMI. DISCUSSION The role of weight-based discrimination, and its intersections with other forms of stressors for sexual minority young adults, must be included in efforts to advance eating disorder prevention for this underserved population. PUBLIC SIGNIFICANCE Three in 10 sexual minority young adults in this study had experienced weight-based discrimination, a common but understudied form of discrimination. Sexual minority young adults who experienced weight-based discrimination were at greater risk of disordered eating behaviors than those who had not experienced weight-based discrimination. These findings suggest that weight-based discrimination may be an important-and preventable-risk factor for disordered eating behaviors among sexual minority young adults.
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Affiliation(s)
- Allegra R. Gordon
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Kelsey A. Egan
- Division of General Academic Pediatrics, Department of Pediatrics, Boston Medical Center, Boston University School of Medicine
| | - Monica L. Wang
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
- Office of Narrative, Boston University Center for Antiracist Research, Boston, MA, USA
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Najat J. Ziyadeh
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
| | - Erica L. Kenney
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Margaret Rosario
- Department of Psychology, City University of New York—City College and Graduate Center, New York, NY, USA
| | - S. Bryn Austin
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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23
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Saffari M, Chen IH, Huang PC, O’Brien KS, Hsieh YP, Chen JK, Chang YH, Jiang X, Bevan N, Chang YL, Chen JS, Tsai CC, Griffiths MD, Lin CY. Measurement Invariance and Psychometric Evaluation of the Tendency to Avoid Physical Activity and Sport Scale (TAPAS) Among Mainland Chinese University Students. Psychol Res Behav Manag 2023; 16:3821-3836. [PMID: 37724136 PMCID: PMC10505390 DOI: 10.2147/prbm.s425804] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/29/2023] [Indexed: 09/20/2023] Open
Abstract
Introduction Preventative factors in young people's physical inactivity require further understanding, including related psychosocial factors (eg, body image and weight stigma). The Tendency to Avoid Physical Activity and Sport Scale (TAPAS) is a recently developed instrument to address this issue and the present study examined its psychometric properties among Chinese university students particularly in relation to patterns across sex, physical activity (PA) level, and weight status. Methods Using a convenience sample of 3142 students (mean age = 19.8 years; 56% female) in mainland China, data were collected using an online survey between August and October 2022. Psychometric instruments including the Weight Bias Internalization Scale, 21-item Depression, Anxiety and Stress Scale, and International Physical Activity Questionnaire Short Form were administered along with the TAPAS to assess convergent and discriminant validity. Multi-group confirmatory factor analysis (CFA) assessed the measurement invariance across specific groups. Results The unidimensional structure of the scale was confirmed through CFA (CFI=0.995; RMSEA=0.046). All configural, metric and scalar models of invariance indicated that the scale was invariant across sex, PA level, and weight status. Acceptable convergent and discriminant validity for the scale were found. Conclusion The TAPAS is a suitable instrument to assess body image and weight stigma concerns for avoiding physical activity and sport among Chinese university students.
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Affiliation(s)
- Mohsen Saffari
- Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Health Education Department, Faculty of Health, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - I-Hua Chen
- Chinese Academy of Education Big Data, Qufu Normal University, Qufu, People’s Republic of China
| | - Po-Ching Huang
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kerry S O’Brien
- School of Social Sciences, Monash University, Melbourne, Australia
| | - Yi-Ping Hsieh
- Department of Social Work, College of Nursing and Professional Disciplines, University of North Dakota, Grand Forks, ND, USA
| | - Ji-Kang Chen
- Department of Social Work, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Yun-Hsuan Chang
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Psychology, National Cheng Kung University, Tainan, Taiwan
- Institute of Genomics and Bioinformatics, College of Life Sciences, National Chung Hsing University, Taichung, Taiwan
| | - Xingyong Jiang
- Yangan Primary School of Qionglai City, Qionglai, People’s Republic of China
| | - Nadia Bevan
- School of Social Sciences, Monash University, Melbourne, Australia
| | - Yen-Ling Chang
- Department of Family Medicine, Cardinal Tien Hospital, New Taipei, Taiwan
| | - Jung-Sheng Chen
- Department of Medical Research, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Ching-Chung Tsai
- Department of Pediatrics, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
- School of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Mark D Griffiths
- International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK
| | - Chung-Ying Lin
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Dickinson JK, Bialonczyk D, Reece J, Kyle TK, Close KL, Nadglowski J, Johnson K, Garza M, Pash E, Chiquette E. Person-first language in diabetes and obesity scientific publications. Diabet Med 2023; 40:e15067. [PMID: 36786059 DOI: 10.1111/dme.15067] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 11/08/2022] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 02/15/2023]
Abstract
AIMS We aimed to quantify the use of person-first language (PFL) among scholarly articles focusing on diabetes or obesity. METHODS PFL and condition-first language (CFL) terms for diabetes and obesity (e.g. diabetic, obese) were identified from existing guidelines and a review of the literature. Exact phrase literature searches were conducted between 2011 and 2020 and results were categorised as PFL, CFL or both. RESULTS Among diabetes articles, 43% used PFL, 40% used CFL and 17% contained both. Among obesity articles, 0.5% used PFL, 99% used CFL and 0.2% used both. The use of PFL increased by 3% per year for diabetes articles, compared to 117% for obesity articles. The rate of adoption of PFL in diabetes articles was unchanged in 2018-2020 compared to the 3 years prior. CONCLUSIONS While the use of person-first language in diabetes articles had increased over the review period, its rate of adoption has started to slow. Conversely, the use of PFL in obesity articles is nascent and increasing.
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Affiliation(s)
| | | | - Jessica Reece
- North Carolina Biotechnology Center, Durham, North Carolina, USA
| | | | | | | | | | - Matthew Garza
- The diaTribe Foundation, San Francisco, California, USA
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Lessard LM, Puhl RM, Foster GD, Cardel MI. Parental Communication About Body Weight and Adolescent Health: The Role of Positive and Negative Weight-Related Comments. J Pediatr Psychol 2023; 48:700-706. [PMID: 37377019 DOI: 10.1093/jpepsy/jsad040] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 10/25/2022] [Revised: 06/02/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVE Research has consistently documented adverse effects of parent weight-related comments on adolescent health. However, little empirical attention has focused on isolating the impact of weight-related comments from mothers versus fathers, and the valence of their comments. The present study examined the extent to which positive and negative weight-related comments from mothers and fathers are related to adolescent health and wellbeing, and whether these associations differ according to adolescent sociodemographic characteristics. METHODS Data were collected from a diverse sample of 2032 U.S.-based adolescents aged 10-17 years (59% female; 40% White, 25% Black or African American, 23% Latinx). Online questionnaires assessed perceived frequency of negative and positive weight-related comments from mothers and fathers, as well as four indicators of adolescent health and wellbeing: depression, unhealthy weight control behaviors, weight bias internalization (WBI), and body appreciation. RESULTS More frequent negative weight-related comments from parents were associated with poorer adolescent health and wellbeing, while positive comments contributed to lower levels of WBI and body appreciation; these associations were documented regardless of whether mothers or fathers were the source of such comments, and considerable consistency was demonstrated across adolescent sociodemographic characteristics. CONCLUSION Findings highlight differences in adolescent health based on how parents discuss their body weight (i.e., negatively or positively), and similarity in associations regardless of whether mothers or fathers are the source of weight communication. These findings reiterate the importance of efforts to educate parents on ways to engage in supportive communication about weight-related health with their children.
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Affiliation(s)
- Leah M Lessard
- Rudd Center for Food Policy and Health, University of Connecticut, USA
| | - Rebecca M Puhl
- Rudd Center for Food Policy and Health, University of Connecticut, USA
- Department of Human Development and Family Sciences, University of Connecticut, USA
| | - Gary D Foster
- WW International, Inc, USA
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, USA
| | - Michelle I Cardel
- WW International, Inc, USA
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, USA
- Center for Integrative Cardiovascular and Metabolic Disease, University of Florida, USA
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26
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Shah M, Almandoz JP, Shukla AP. Editorial: Approaches to the management of weight regain after bariatric surgery. Front Endocrinol (Lausanne) 2023; 14:1267014. [PMID: 37645422 PMCID: PMC10461561 DOI: 10.3389/fendo.2023.1267014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 07/31/2023] [Indexed: 08/31/2023] Open
Affiliation(s)
- Meera Shah
- Division of Endocrinology, Diabetes, & Metabolism, Mayo Clinic College of Medicine, Rochester, MN, United States
| | - Jaime P. Almandoz
- Department of Internal Medicine, Division of Endocrinology, UT Southwestern Medical Center, Dallas, United States
| | - Alpana P. Shukla
- Comprehensive Weight Control Center, Division of Endocrinology, Diabetes, & Metabolism, Weill Cornell Medicine, New York, NY, United States
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27
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Whelan AR, Polnaszek BE, Recabo O, Clark MA, Lewkowtiz AK, Ayala NK. Body Mass Index and Perceived Labor Control: Could weight stigma explain differences in birth experience? Res Sq 2023:rs.3.rs-3142767. [PMID: 37502868 PMCID: PMC10371127 DOI: 10.21203/rs.3.rs-3142767/v1] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Background Individuals with a body mass index (BMI) of ≥ 30 kg/m2 experience weight stigma when interacting with the healthcare system. There is limited data on how weight stigma impacts patient's experience of obstetric care. This study aims to assess perceived control over the birth process and compare patients with BMI ≥ 30 to those with BMI < 30. Methods We performed a secondary analysis of a cross-sectional study of term patients. Postpartum, participants completed the Labour Agentry Scale (LAS), a validated tool to assess perceived control over labor/birth. Continuous LAS scores were compared between patients with BMI < 30 and BMI ≥ 30. Results There was no difference in LAS between those with BMI ≥ 30 and BMI < 30. When stratified by World Health Organization (WHO) class of BMI, those with BMI ≥ 40 had a significantly lower LAS scores than those with BMI < 30 (147 vs. 163, p = 0.02), however, this finding was no longer significant after controlling for length of labor and cesarean birth. Conclusion Only participants with the highest BMI experienced decreased control over labor, and this finding was no longer significant after controlling for mode of delivery and length of labor. Further research is necessary into how weight stigma influences birthing people's experience.
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Affiliation(s)
- Anna R Whelan
- Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University
| | - Brock E Polnaszek
- Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University
| | | | - Melissa A Clark
- Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University
| | - Adam K Lewkowtiz
- Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University
| | - Nina K Ayala
- Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University
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28
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Walker DC, Claudat K, Scognamiglio P. Editorial: Clinical guidelines in eating disorders: applications and evaluation. Front Psychiatry 2023; 14:1245908. [PMID: 37520241 PMCID: PMC10382681 DOI: 10.3389/fpsyt.2023.1245908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 06/29/2023] [Indexed: 08/01/2023] Open
Affiliation(s)
| | - Kimberly Claudat
- UC San Diego Health, University of California, San Diego, San Diego, CA, United States
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29
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Schumacher LM, Ard J, Sarwer DB. Promise and unrealized potential: 10 years of the American Medical Association classifying obesity as a disease. Front Public Health 2023; 11:1205880. [PMID: 37521999 PMCID: PMC10375286 DOI: 10.3389/fpubh.2023.1205880] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/30/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction In June 2013, the American Medical Association (AMA), one of the most influential healthcare organizations in the United States, voted to recognize obesity as a disease. Many who supported this change believed that recognition by AMA of obesity as a disease would serve as a tipping point that would increase access to care, accelerate training and research on the prevention and treatment of obesity, and reduce weight stigma. On the 10-year anniversary of this vote, this perspective piece outlines key advances made, as well as unrealized potential, in improving the obesity public health landscape since the AMA's classification of obesity as a disease. Methods We draw on the empirical literature, as well as our experiences as clinical psychologists, a physician, and public health researchers specializing in obesity, to provide an overview of major advances and continued challenges in improving access to obesity treatment, accelerating prevention and training, and reducing weight stigma. We also outline important next steps to advance these goals. Results While several notable advancements have occurred, significant work remains to create equitable access to evidence-based treatments, bring research and training on obesity on par with its prevalence, and reduce the pervasiveness and harm of weight stigma. Conclusion The past decade has witnessed some advances with respect to access to care and attention, yet there is unrealized potential that awaits attention. Truly conceptualizing and treating obesity as a chronic disease requires a major paradigm shift.
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Affiliation(s)
- Leah M. Schumacher
- Department of Kinesiology, College of Public Health, Temple University, Philadelphia, PA, United States
- Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, PA, United States
| | - Jamy Ard
- Department of General Surgery, Atrium Health Wake Forest Baptist, Weight Management Center, Winston-Salem, NC, United States
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - David B. Sarwer
- Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, PA, United States
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, United States
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30
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Scotto di Luzio S, Martinent G, Popa-Roch M, Ballereau M, Chahdi S, Escudero L, Guillet-Descas E. Obesity in Childhood and Adolescence: The Role of Motivation for Physical Activity, Self-Esteem, Implicit and Explicit Attitudes toward Obesity and Physical Activity. Children (Basel) 2023; 10:1177. [PMID: 37508674 PMCID: PMC10378282 DOI: 10.3390/children10071177] [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] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023]
Abstract
The purpose of the present study was to compare attitudes toward body weight and physical activity in both regular-weight and overweight/obese children and adolescents, and assessing relations between attitudes and self-esteem, motivation for physical activity, life satisfaction and level of physical activity. A total of 126 children (Mage = 12.2, SD = 3.4), divided into two subsamples (i.e., overweight/obese, N = 44, and regular-weight), voluntarily participated in the study. A series of univariate analyses of variance was conducted to examine the differences in the study variables across the subsamples. Correlational analyses were conducted to examine the relationships among the variables. The results indicated that obese/overweight participants expressed a more positive implicit attitude toward the thin category than regular-weight participants. Furthermore, among overweight/obese participants, implicit attitude toward physical activity was significantly negatively correlated with explicit attitude toward physical activity and general self-esteem. Significant differences between obese/overweight and regular-weight participants indicated that the status in terms of weight played a key role in attitudes toward the explored constructs.
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Affiliation(s)
- Silvia Scotto di Luzio
- Laboratoire Développement, Individu, Processus, Handicap, Éducation (DIPHE), Université Lyon 2, 69676 Bron, France
| | - Guillaume Martinent
- Laboratoire sur les Vulnérabilités et L'innovation dans Le Sport (L-VIS), Université Claude Bernard Lyon 1, 69100 Villeurbanne, France
| | - Maria Popa-Roch
- Maître de Conférences HDR, Université de Strasbourg, LISEC, 67000 Strasbourg, France
| | - Mathilde Ballereau
- Laboratoire sur les Vulnérabilités et L'innovation dans Le Sport (L-VIS), Université Claude Bernard Lyon 1, 69100 Villeurbanne, France
| | - Soufyane Chahdi
- Laboratoire sur les Vulnérabilités et L'innovation dans Le Sport (L-VIS), Université Claude Bernard Lyon 1, 69100 Villeurbanne, France
| | - Lucie Escudero
- Laboratoire sur les Vulnérabilités et L'innovation dans Le Sport (L-VIS), Université Claude Bernard Lyon 1, 69100 Villeurbanne, France
| | - Emma Guillet-Descas
- Laboratoire sur les Vulnérabilités et L'innovation dans Le Sport (L-VIS), Université Claude Bernard Lyon 1, 69100 Villeurbanne, France
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31
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Sheikh J, Khalil H, Shaikh S, Hebbar M, Zia N, Wicks S, Jayaprakash S, Narendran A, Subramanian A, Malhotra K, Chapman R, Gillett C, Gleeson HK, Robinson L, Chu JJ, Lathia T, Selvan C, O'Reilly MW, Manolopoulos KN, Arlt W, Kempegowda P. Emotional and psychosexual well-being is influenced by ethnicity and birthplace in women and individuals with polycystic ovary syndrome in the UK and India. BJOG 2023; 130:978-986. [PMID: 36807756 PMCID: PMC10952802 DOI: 10.1111/1471-0528.17428] [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: 06/27/2022] [Revised: 02/04/2023] [Accepted: 02/11/2023] [Indexed: 02/20/2023]
Abstract
OBJECTIVE To assess the association of ethnicity and birthplace on emotional and psychosexual well-being in women with polycystic ovary syndrome (PCOS). DESIGN Cross-sectional study. SETTING Community recruitment via social media campaigns. POPULATION Women with PCOS completing an online questionnaire in September-October 2020 (UK) and May-June 2021 (India). METHODS The survey has five components, with a baseline information and sociodemographic section followed by four validated questionnaires: Hospital Anxiety and Depression Scale (HADS); Body Image Concern Inventory (BICI); Beliefs About Obese Persons Scale (BAOP); and Female Sexual Function Index (FSFI). MAIN OUTCOME MEASURES We used adjusted linear and logistic regression models, adjusting for age, education, marital status and parity, to evaluate the impact of ethnicity and birthplace on questionnaire scores and outcomes (anxiety and/or depression, HADS ≥ 11; body dysmorphic disorder (BDD), BICI ≥ 72). RESULTS A total of 1008 women with PCOS were included. Women of non-white ethnicity (613/1008) reported higher rates of depression (OR 1.96, 95% CI 1.41-2.73) and lower BDD (OR 0.57, 95% CI 0.41-0.79) than white women (395/1008). Women born in India (453/1008) had higher anxiety (OR 1.57, 95% CI 1.00-2.46) and depression (OR 2.20, 95% CI 1.52-3.18) but lower BDD rates (OR 0.42, 95% CI 0.29-0.61) than women born in the UK (437/1008). All sexual domains, excluding desire, scored lower for non-white women and women born in India. CONCLUSIONS Non-white women and women born in India reported higher emotional and sexual dysfunction, whereas white women and women born in the UK reported higher body image concerns and weight stigma. Ethnicity and birthplace need to be considered for tailored, multidisciplinary care.
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Affiliation(s)
- Jameela Sheikh
- College of Medical and Dental SciencesUniversity of BirminghamBirminghamUK
| | - Halimah Khalil
- College of Medical and Dental SciencesUniversity of BirminghamBirminghamUK
| | - Salomi Shaikh
- DY Patil University School of MedicineNavi MumbaiIndia
| | - Meghnaa Hebbar
- College of Medical and Dental SciencesUniversity of BirminghamBirminghamUK
| | - Nawal Zia
- College of Medical and Dental SciencesUniversity of BirminghamBirminghamUK
| | | | | | | | | | | | - Rachel Chapman
- University Hospitals Coventry and Warwickshire NHS TrustCoventryUK
| | - Caroline Gillett
- Institute of Metabolism and Systems ResearchUniversity of BirminghamBirminghamUK
| | - Helena K. Gleeson
- Department of Endocrinology, Queen Elizabeth HospitalUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - Lynne Robinson
- Birmingham Women's HospitalBirmingham Women's and Children's NHS Foundation TrustBirminghamUK
| | - Justin J. Chu
- Birmingham Women's HospitalBirmingham Women's and Children's NHS Foundation TrustBirminghamUK
| | | | - Chitra Selvan
- Department of EndocrinologyMS Ramaiah Medical CollegeBengaluruIndia
| | - Michael W. O'Reilly
- Institute of Metabolism and Systems ResearchUniversity of BirminghamBirminghamUK
- Department of MedicineRoyal College of Surgeons in Ireland (RCSI) University of Medicine and Health SciencesDublinIreland
| | | | - Wiebke Arlt
- Institute of Metabolism and Systems ResearchUniversity of BirminghamBirminghamUK
- Department of Endocrinology, Queen Elizabeth HospitalUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
- NIHR Birmingham Biomedical Research Centre at the University Hospitals Birmingham NHS Foundation TrustUniversity of BirminghamBirminghamUK
| | - Punith Kempegowda
- Institute of Metabolism and Systems ResearchUniversity of BirminghamBirminghamUK
- Department of Endocrinology, Queen Elizabeth HospitalUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
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Abstract
Obesity is a chronic, progressive and relapsing disease, characterised by the presence of abnormal or excess adiposity that impairs health and social wellbeing. It is associated with obesity-related disease complications, health inequalities and premature death. Clinical evaluation of obesity requires a thorough history and examination. Assessment should focus not only on anthropometric measurements, but also on the mental, metabolic, mechanical and monetary impact of adiposity, including multiple health conditions. Increased awareness and knowledge will help reduce weight stigma and biases. A focused non-judgemental assessment will help guide further investigations, timely referral and management.
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Affiliation(s)
| | - Judith Carpenter
- Young Adult Services, University Hospitals of Derby and Burton NHS Trust, Derby, UK
| | - Anjali Zalin
- Barts Health NHS Trust, London UK; Bedfordshire Hospitals NHS Foundation Trust, Luton, UK
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Peterson K, Savoie Roskos M. Weight Bias: A Narrative Review of the Evidence, Assumptions, Assessment, and Recommendations for Weight Bias in Health Care. Health Educ Behav 2023:10901981231178697. [PMID: 37350255 DOI: 10.1177/10901981231178697] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
BACKGROUND Weight bias is common in health care and needs to be addressed to provide equal and equitable care for people of all body sizes. AIMS This review aims to (a) describe the impact of weight bias on providers and patients, (b) identify the limitations of body mass index and suggest alternative screenings to determine health risk, (c) provide a review of self-assessment of weight bias, and (d) present evidence of an alternative weight-inclusive approach to health care. METHOD EBSCO Host, Google Scholar, and Pubmed were used to find peer reviewed articles. Keywords included the following: weight bias, weight stigma, weight inclusive, and weight discrimination. RESULTS Projected weight bias is prevalent among health care providers and affects patient visit times, care provided, and communication given. Patients who experience weight bias are more likely to experience stress and depression, which impact chronic disease risk. Body mass index was also found to have numerous limitations as a metric for identifying accurately an individual's cardiometabolic risks, whereas, waist-to-height ratio is a more accurate indicator. There are also numerous screening tools that are available to self-assess for weight bias although more studies are needed to standardize results. An alternative approach to combat weight bias is a behavior-focused approach on health as opposed to weight-focused. CONCLUSION Weight bias is a critical topic that health professionals need to consider to be aware of and begin to change as it has a strong impact on the public's health.
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Walsh EG, Rogalski K, Hibbler L. Weight Bias and Healthism: An Integrative Health Perspective. J Integr Complement Med 2023; 29:271-275. [PMID: 37196164 DOI: 10.1089/jicm.2023.0157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Affiliation(s)
- Elizabeth G Walsh
- The Osher Center for Integrative Health at Vanderbilt, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Physical Medicine and Rehabilitation and Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kayleigh Rogalski
- The Osher Center for Integrative Health at Vanderbilt, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - LeChey Hibbler
- The Osher Center for Integrative Health at Vanderbilt, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Physical Medicine and Rehabilitation and Vanderbilt University Medical Center, Nashville, TN, USA
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35
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Forrest LN, Ivezaj V, Grilo CM. Machine learning v. traditional regression models predicting treatment outcomes for binge-eating disorder from a randomized controlled trial. Psychol Med 2023; 53:2777-2788. [PMID: 34819195 PMCID: PMC9130342 DOI: 10.1017/s0033291721004748] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 10/13/2021] [Accepted: 11/01/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND While effective treatments exist for binge-eating disorder (BED), prediction of treatment outcomes has proven difficult, and few reliable predictors have been identified. Machine learning is a promising method for improving the accuracy of difficult-to-predict outcomes. We compared the accuracy of traditional and machine-learning approaches for predicting BED treatment outcomes. METHODS Participants were 191 adults with BED in a randomized controlled trial testing 6-month behavioral and stepped-care treatments. Outcomes, determined by independent assessors, were binge-eating (% reduction, abstinence), eating-disorder psychopathology, and weight loss (% loss, ⩾5% loss). Predictors included treatment condition, demographic information, and baseline clinical characteristics. Traditional models were logistic/linear regressions. Machine-learning models were elastic net regressions and random forests. Predictive accuracy was indicated by the area under receiver operator characteristic curve (AUC), root mean square error (RMSE), and R2. Confidence intervals were used to compare accuracy across models. RESULTS Across outcomes, AUC ranged from very poor to fair (0.49-0.73) for logistic regressions, elastic nets, and random forests, with few significant differences across model types. RMSE was significantly lower for elastic nets and random forests v. linear regressions but R2 values were low (0.01-0.23). CONCLUSIONS Different analytic approaches revealed some predictors of key treatment outcomes, but accuracy was limited. Machine-learning models with unbiased resampling methods provided a minimal advantage over traditional models in predictive accuracy for treatment outcomes.
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Affiliation(s)
- Lauren N. Forrest
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Psychiatry, Penn State College of Medicine, 700 HMC Crescent Road, Hershey, PA 17033, USA
| | - Valentina Ivezaj
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Carlos M. Grilo
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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Berge JM, Trofholz A, Danner C, Brandenburg D, Pusalavidyasagar S, Loth K. Weight- and Health-focused Conversations in Racially/Ethnically Diverse Households With and Without a Child with Overweight/Obesity. Stigma Health 2023; 8:139-149. [PMID: 37274810 PMCID: PMC10234617 DOI: 10.1037/sah0000268] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Studies indicate parent conversations focused on child weight, shape, or size are associated with unhealthy child weight and weight-related behaviors, whereas health-focused conversations are not. Little research has examined what these types of conversations sound like, how parents respond to them, and whether households with or without a child with overweight/obesity approach these conversations differently. This study used qualitative data to identify the weight- and health-focused conversations occurring in racially/ethnically diverse households. Children ages 5-7 and their families (n=150) from six racial/ethnic groups (i.e., African American, Hispanic, Hmong, Native American, Somali, White) participated in this mixed-methods study. Results showed that parents from households with and without a child with overweight/obesity engaged in similar weight- and health-focused conversations (qualitative themes = focus on growth; health consequences of having overweight/obesity; focus on dietary intake and physical activity; being direct about weight, shape or size; mixing weight- and health-focused conversations). In addition, findings showed that parents also engaged in different types of weight- and health focused conversations depending on whether the household had a child with overweight/obesity (qualitative themes = weight-based teasing; critiquing own weight) or without overweight/obesity (qualitative themes = differences in body shape and size are the norm; focus on modeling rather than talking). Results may be useful for informing public health interventions and for health care providers working with parents regarding weight- and health-focused conversations occurring in home environments of diverse children.
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Affiliation(s)
- Jerica M. Berge
- University of Minnesota Medical School, Department of Family Medicine and Community Health, Minneapolis, MN
| | - Amanda Trofholz
- University of Minnesota Medical School, Department of Family Medicine and Community Health, Minneapolis, MN
| | - Christine Danner
- University of Minnesota Medical School, Department of Family Medicine and Community Health, Minneapolis, MN
| | - Dana Brandenburg
- University of Minnesota Medical School, Department of Family Medicine and Community Health, Minneapolis, MN
| | - Snigdhasmrithi Pusalavidyasagar
- University of Minnesota Medical School, Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Minneapolis, MN
| | - Katie Loth
- University of Minnesota Medical School, Department of Family Medicine and Community Health, Minneapolis, MN
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Romano KA, Heron KE. Daily weight stigma experiences, and disordered and intuitive eating behaviors among young adults with body dissatisfaction. Int J Eat Disord 2023; 56:538-550. [PMID: 36408855 DOI: 10.1002/eat.23859] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 11/09/2022] [Accepted: 11/11/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The present study aimed to extend naturalistic weight stigma research by examining the following aims among young adults with body dissatisfaction and varied body mass indices (BMIs): (1) characterize the frequency of individuals' daily weight stigma experiences, and contextual variations, over a 14-day period; (2) examine whether BMI moderated daily associations between weight stigma experiences relative to eating disorder symptoms and intuitive eating behaviors. METHOD Women (n = 174) and men (n = 24) completed a 14-day daily diary protocol. Concurrent and time-lagged multilevel models examined associations between daily weight stigma, and eating disorder and intuitive eating behaviors among women only due to the small subsample of men. RESULTS Over the 14-day assessment, 43.94% (n = 87) of participants experienced weight stigma. Weight stigma rates varied based on how, where, and by whom weight stigma was expressed, and via BMI. Further, among women, multiple concurrent within-person associations were identified between women's daily weight stigma experiences and daily eating disorder symptoms (skipping meals, binge eating, and body dissatisfaction). Time-lagged associations also showed that women's weight stigma experiences on a given day were associated with a greater likelihood that they would limit the amount of food they consumed the next day. These associations did not differ via women's BMIs. DISCUSSION Collectively, these findings provide important information on how weight stigma experiences unfold in daily life among individuals with body dissatisfaction and varied BMIs, and the proximal and more enduring impact of women's daily weight stigma experiences on their use of multiple adverse eating behaviors that can promote poor health. PUBLIC SIGNIFICANCE The present findings provide important information on how, where, and by whom weight stigma experiences unfold in daily life among young adults with body dissatisfaction and varied body weights, as well as the proximal and more enduring impact of women's daily weight stigma experiences on their use of a variety of adverse eating behaviors that can promote poor health.
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Affiliation(s)
- Kelly A Romano
- Virginia Consortium Program in Clinical Psychology, Norfolk, Virginia, USA
| | - Kristin E Heron
- Virginia Consortium Program in Clinical Psychology, Norfolk, Virginia, USA
- Old Dominion University, Norfolk, Virginia, USA
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Ellen C. Joseph, Trisha L. Raque. Feasibility of a Loving Kindness Intervention for Mitigating Weight Stigma in Nursing Students: A Focus on Self-Compassion. Mindfulness (N Y) 2023. [PMID: 37090853 PMCID: PMC9975442 DOI: 10.1007/s12671-023-02094-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/14/2023] [Indexed: 03/05/2023]
Abstract
Objectives Preliminary research on self-compassion as a target for reducing forms of bias is promising, yet healthcare provider self-compassion has not yet been explored in relationship to weight bias. Healthcare providers commonly endorse weight stigma and bias, contributing to health disparities for patients with “obesity.” The current study explores the feasibility of the self-compassion loving kindness meditation (LKM) as a brief intervention that reduces weight bias in nursing students. Method Participants (189 nursing students) were randomly assigned to the LKM condition or body scan control condition before engaging in an implicit bias task and answering self-report measures of internalization of the thin ideal, weight bias, positive attitudes towards people with “obesity,” positive emotions, self-compassion, cognitive flexibility, and compassionate care. Results Statistically significant differences in self-compassion, cognitive flexibility, weight bias, and compassionate care failed to be found between the groups. Participants in the LKM condition endorsed significantly higher levels of positive emotionality compared to the control condition. Higher levels of self-compassion were related to lower levels of weight bias for participants in both conditions. Multiple linear regression analyses revealed that internalization of the thin ideal and self-compassion accounted for 19.2% of the variance in positive attitudes towards people with “obesity.” Conclusions This study suggests the importance of examining self- and other-compassion in the context of weight stigma. Its findings exemplify the complexity of weight stigma and the need to further explore the mechanisms to be targeted to effectively reduce healthcare professionals’ bias. Pre-registration This study is not preregistered.
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Jongenelis M, Dixon H, Scully M, Morley B. Exploring Intended and Unintended Reactions to Healthy Weight and Lifestyle Advertisements: An Online Experiment. Health Educ Behav 2023; 50:58-69. [PMID: 35758183 DOI: 10.1177/10901981221104727] [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] [Indexed: 01/26/2023]
Abstract
BACKGROUND To address concerns that healthy weight and lifestyle campaigns (HWLCs) could have unintended psychological or behavioral consequences, this study tested reactions to TV advertisements from two HWLCs: LiveLighter® (employs graphic health effects messaging) and Swap It Don't Stop It (employs animation and light-hearted messaging). METHODS An online between-subjects experiment tested reactions to one of five advertisements: "Toxic Fat"; "Sugary Drinks" (both from LiveLighter); "Become a Swapper"; "How to Swap It" (both from Swap It); and "HSBC Bank" (control) among 2,208 adults from Western Australia and Victoria, Australia. Responses assessed were cognitive and emotional reactions, behavioral intentions, internalized weight bias, antifat attitudes, self-esteem and body dissatisfaction. RESULTS The HWLC advertisements prompted favorable cognitive reactions and weak to neutral positive and negative emotional responses. HWLC advertisements promoted stronger intentions to engage in adaptive lifestyle behaviors compared with the control advertisement. Intention to engage in maladaptive behaviors (e.g., skipping meals) was low overall and did not differ by condition. Compared with the control condition, participants who saw LiveLighter "Sugary Drinks" showed weaker disagreement with antifat attitudes; however, mean antifat attitude scores were still at the low end of the scale. HWLC advertisements did not promote internalized weight bias, reduced self-esteem or body dissatisfaction compared with the control advertisement. CONCLUSIONS Overall, HWLC advertisements performed favorably compared with the control advertisement and showed no clear evidence of adverse impacts. Findings suggest HWLC advertisements may not promote negative psychological and behavioral consequences and can continue to be used in obesity prevention efforts.
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Affiliation(s)
| | - Helen Dixon
- The University of Melbourne, Parkville, Victoria, Australia.,Curtin University, Bentley, Western Australia, Australia.,Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Maree Scully
- Cancer Council Victoria, Melbourne, Victoria, Australia
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40
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Brenton-Peters JM, Vallis M, Grant S, Consedine NS, Kirk SFL, Roy R, Serlachius A. Rethinking weight: Finding self-compassion for 'weight management'. Clin Obes 2023; 13:e12562. [PMID: 36285631 DOI: 10.1111/cob.12562] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/03/2022] [Indexed: 01/19/2023]
Abstract
Conventional weight management approaches emphasize engaging in health behaviours, such as healthy eating and physical activity, to control body weight and promote favourable health outcomes (e.g., lower blood pressure). However, weight management is a multi-faceted, complex process influenced by numerous factors that limit the impact of behaviour change on weight. Self-compassion, treating oneself kindly in times of increased distress or difficulty, may offer a way for individuals to cope with the challenges of managing weight. The objectives of this perspective paper are threefold: (1) to conceptualize weight management, (2) to describe the problem that arises when focusing solely on weight loss, and (3) to explore the theoretical rationale for integrating self-compassion into weight management interventions. To support individual health and well-being, there is a need to reframe measures of success and provide innovative ways to cope with the challenges of managing body weight. Continued research is needed to investigate whether self-compassion can support health outcomes for those with weight management goals. This manuscript provides a proposed research agenda and implications for future practice.
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Affiliation(s)
| | - Michael Vallis
- Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Shannan Grant
- Department of Applied Human Nutrition, Faculty of Professional Studies, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Nathan S Consedine
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Sara F L Kirk
- School of Health and Human Performance, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Rajshri Roy
- Discipline of Nutrition and Dietetics, University of Auckland, Auckland, New Zealand
| | - Anna Serlachius
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
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41
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Hagan S, Nelson K. Are Current Guidelines Perpetuating Weight Stigma? A Weight-Skeptical Approach to the Care of Patients with Obesity. J Gen Intern Med 2023; 38:793-798. [PMID: 36138274 PMCID: PMC9971382 DOI: 10.1007/s11606-022-07821-w] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/15/2022] [Indexed: 11/25/2022]
Abstract
Significant controversy exists regarding the evidence to support the clinical benefits and risks of weight loss interventions for individuals with obesity. United States Preventative Task Force (USPSTF) guidelines recommend weight loss for all individuals with obesity while weight-neutral models such as Health at Every Size promote weight inclusivity, focusing on body acceptance rather than weight loss. We discuss how lifestyle-based weight-centric paradigms, such as the USPSTF Guidelines, may increase weight stigma and weight cycling, and many of their purported clinical benefits are not supported by existing evidence. However, we also acknowledge the clear benefits of metabolic surgery in high-risk individuals, and the potential benefits for pharmacotherapy for obesity in selected patients. Herein we describe a weight-skeptical approach to the care of patients with obesity that aims to use available evidence to support patient-centered care.
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Affiliation(s)
- Scott Hagan
- VA Puget Sound Health Care System, Seattle, WA, USA.
- Division of General Internal Medicine, University of Washington, Seattle, WA, USA.
| | - Karin Nelson
- VA Puget Sound Health Care System, Seattle, WA, USA
- Division of General Internal Medicine, University of Washington, Seattle, WA, USA
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
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42
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Roy R, Kaufononga A, Yovich F, Diversi T. The prevalence and practice impact of weight bias among New Zealand registered dietitians. Nutr Diet 2023. [PMID: 36646939 DOI: 10.1111/1747-0080.12791] [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: 06/15/2022] [Revised: 11/27/2022] [Accepted: 12/05/2022] [Indexed: 01/18/2023]
Abstract
AIM This study explored demographics and three characteristics of registered dietitians-optimism, perfectionism, and weight bias and whether they affect three components of dietetics practice-dietetics assessment, dietetics recommendations, and dietitian's perception of the client's success. METHODS A self-administered questionnaire was completed by 92 registered dietitians and student dietitians in New Zealand to assess explicit weight bias. [Correction added on 27 January 2023, after first online publication: in the preceding sentence, '109 registered dietitians' has been updated to '92 registered dietitians'.] Participants were randomised to receive a case study for a condition unrelated to weight accompanied by a photo of a woman with either a smaller or a larger body. Participants then assessed the client based on data provided, provided recommendations, and rated their perception of the client. RESULTS Mean (±SD) scores indicated mild fatphobia (2.63±0.39) in participating dietitians. Dietitians presented with the photo of a larger client assessed the client to have lower health and were more likely to provide unsolicited weight management recommendations. Additionally, dietitians rated the larger client as less receptive and motivated, and less likely to understand the recommendations adequately, with a lower ability to comply with and maintain these recommendations. CONCLUSIONS Dietitians and student dietitians in New Zealand may practise in a manner that could be perceived as influenced by negative implicit weight bias, despite the explicit fatphobia scale scores assessing only mild fatphobia. Further research examining the extent of the problem in New Zealand, how it impacts client outcomes, and possible solutions are required.
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Affiliation(s)
- Rajshri Roy
- Nutrition and Dietetics, Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Ana Kaufononga
- Nutrition and Dietetics, Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Franica Yovich
- Dietetics Department, Northland District Health Board, Whangarei, New Zealand
| | - Tara Diversi
- Nutrition and Dietetics, Dietitians Australia, Canberra, Australia
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43
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McEntee ML, Philip SR, Phelan SM. Dismantling weight stigma in eating disorder treatment: Next steps for the field. Front Psychiatry 2023; 14:1157594. [PMID: 37113547 PMCID: PMC10126256 DOI: 10.3389/fpsyt.2023.1157594] [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: 02/02/2023] [Accepted: 03/20/2023] [Indexed: 04/29/2023] Open
Abstract
The authors posit current guidelines and treatment for eating disorders (EDs) fail to adequately address, and often perpetuate, weight stigma. The social devaluation and denigration of higher-weight individuals cuts across nearly every life domain and is associated with negative physiological and psychosocial outcomes, mirroring the harms attributed to weight itself. Maintaining focus on weight in ED treatment can intensify weight stigma among patients and providers, leading to increased internalization, shame, and poorer health outcomes. Stigma has been recognized as a fundamental cause of health inequities. With no clear evidence that the proposed mechanisms of ED treatment effectively address internalized weight bias and its association with disordered eating behavior, it is not hard to imagine that providers' perpetuation of weight bias, however unintentional, may be a key contributor to the suboptimal response to ED treatment. Several reported examples of weight stigma in ED treatment are discussed to illustrate the pervasiveness and insidiousness of this problem. The authors contend weight management inherently perpetuates weight stigma and outline steps for researchers and providers to promote weight-inclusive care (targeting health behavior change rather than weight itself) as an alternative approach capable of addressing some of the many social injustices in the history of this field.
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Affiliation(s)
- Mindy L. McEntee
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
- *Correspondence: Mindy L. McEntee,
| | - Samantha R. Philip
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, United States
| | - Sean M. Phelan
- Division of Health Care Delivery Research, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
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44
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Hemmingsson E, Nowicka P, Ulijaszek S, Sørensen TIA. The social origins of obesity within and across generations. Obes Rev 2023; 24:e13514. [PMID: 36321346 PMCID: PMC10077989 DOI: 10.1111/obr.13514] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [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: 06/24/2022] [Revised: 09/10/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022]
Abstract
We propose a model for obesity development that traces a considerable part of its origins to the social domain (mainly different forms of prolonged social adversity), both within and across generations, working in tandem with a genetic predisposition. To facilitate overview of social pathways, we place particular focus on three areas that form a cascading sequence: (A) social adversity within the family (parents having a low education, a low social position, poverty and financial insecurity; offspring being exposed to gestational stress, unmet social and emotional needs, abuse, maltreatment and other negative life events, social deprivation and relationship discord); (B) increasing levels of insecurity, negative emotions, chronic stress, and a disruption of energy homeostasis; and (C) weight gain and obesity, eliciting further social stress and weight stigma in both generations. Social adversity, when combined with genetic predisposition, thereby substantially contributes to highly effective transmission of obesity from parents to offspring, as well as to obesity development within current generations. Prevention efforts may benefit from mitigating multiple types of social adversity in individuals, families, and communities, notably poverty and financial strain, and by improving education levels.
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Affiliation(s)
- Erik Hemmingsson
- Department of Physical Activity and Health, The Swedish School of Sport and Health Sciences, Stockholm, Sweden
| | - Paulina Nowicka
- Department of Food Studies, Nutrition, and Dietetics, Uppsala University, Uppsala, Sweden
| | - Stanley Ulijaszek
- Unit for Biocultural Variation and Obesity, School of Anthropology and Museum Ethnography, University of Oxford, Oxford, UK
| | - Thorkild I A Sørensen
- Department of Public Health and Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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45
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Martingano AJ, Telaak SH, Schopp EM, Fortney C, Dolwick AP, Carnell S, Batheja S, Persky S. Using Educational Videos and Perspective-Taking to Communicate Gene-By-Environment Interaction Concepts about Eating Behavior: Effects on Empathy and Weight Stigma. J Nutr Educ Behav 2023; 55:55-67. [PMID: 36621267 PMCID: PMC9833839 DOI: 10.1016/j.jneb.2022.09.005] [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] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE This study investigated whether education about gene-by-environment interaction (G × E) concepts could improve G × E knowledge and positively affect empathy and weight stigma. DESIGN We conducted a randomized trial using a 2 × 2 between-subjects design. SETTING Online. PARTICIPANTS Five hundred eighty-two American participants from the Prolific platform. INTERVENTION Participants were randomly assigned to watch an educational or a control video. Participants then watched a set of vignette scenarios that depicted what it is like to have a predisposition toward obesogenic eating behaviors from either a first-person or third-person perspective. MAIN OUTCOME MEASURE(S) Participants completed questionnaires measuring G × E knowledge, causal attributions, weight stigma, and empathy postintervention. ANALYSIS Two-by-two between-subjects ANOVAs and exploratory mediation analyses were conducted. RESULTS Participants who watched the educational video demonstrated greater G × E knowledge, reported higher empathy toward the characters in the vignette scenarios and held fewer stigmatizing attitudes (notably blame) toward individuals with higher weight. Exploratory mediation analyses indicated that the educational video led to these positive downstream effects by increasing the extent to which participants attributed genetic causes to eating behaviors. CONCLUSIONS AND IMPLICATIONS Education about G × E causes of eating behaviors can have beneficial downstream effects on attitudes toward people with higher weight.
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Affiliation(s)
- Alison Jane Martingano
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
| | - Sydney H Telaak
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
| | - Emma M Schopp
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
| | - Christopher Fortney
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
| | - Alexander P Dolwick
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
| | - Susan Carnell
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD
| | - Sapna Batheja
- Department of Food and Nutrition Studies, College of Health and Human Services, George Mason University, Fairfax, VA
| | - Susan Persky
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD.
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46
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Levy M, Forouhar V, Edache IY, Alberga AS. Predictors of support for anti-weight discrimination policies among Canadian adults. Front Public Health 2023; 11:1060794. [PMID: 37139379 PMCID: PMC10149811 DOI: 10.3389/fpubh.2023.1060794] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 01/09/2023] [Indexed: 05/05/2023] Open
Abstract
Introduction Weight discrimination of individuals with overweight or obesity is associated with adverse mental and physical health. Weight discrimination is prevalent in many sectors such as within workplaces, where individuals with overweight and obesity are denied the same opportunities as individuals with lower weight status, regardless of performance or experience. The purpose of this study was to understand the Canadian public's support or opposition of anti-weight discrimination policies and predictors of support. It was hypothesized that Canadians will show support of anti-weight discrimination policies to some extent. Methods A secondary analysis was conducted on a previous cross-sectional sample of Canadian adults (N = 923, 50.76% women, 74.4% White) who responded to an online survey assessing weight bias and support of twelve anti-weight discrimination policies related to societal policies (e.g., implementing laws preventing weight discrimination) and employment-related policies (e.g., making it illegal to not hire someone due to their weight). Participants completed the Causes of Obesity Questionnaire (COB), the Anti-Fat Attitudes Questionnaire (AFA) and the Modified Weight Bias Internalization Scale (WBIS-M). Multiple logistic regressions were used to determine predictors of policy support. Results Support for policies ranged from 31.3% to 76.9%, with employment anti-discrimination policies obtaining greater support than societal policies. Identifying as White and a woman, being over the age of 45 and having a higher BMI were associated with an increased likelihood of supporting anti-weight discrimination policies. There were no differences between the level of support associated with attributing obesity to behavioral or non-behavioral causes. Explicit weight bias was associated with a reduced likelihood of supporting 8/12 policies. Weight Bias Internalization was associated with an increased likelihood of supporting all societal policies but none of the employment policies. Conclusions Support for anti-weight discrimination policies exists among Canadian adults, and explicit weight bias is associated with a lower likelihood of supporting these policies. These results highlight the need for education on the prevalence and perils of weight discrimination which may urge policy makers to consider weight bias as a form of discrimination that must be addressed. More research on potential implementation of anti-weight discrimination policies in Canada is warranted.
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Affiliation(s)
- Matthew Levy
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC, Canada
| | - Vida Forouhar
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC, Canada
| | - Iyoma Y. Edache
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Angela S. Alberga
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC, Canada
- *Correspondence: Angela S. Alberga
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47
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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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48
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Patel D, Krems JA, Stout ME, Byrd-Craven J, Hawkins MAW. Parents of Children With High Weight Are Viewed as Responsible for Child Weight and Thus Stigmatized. Psychol Sci 2023; 34:35-46. [PMID: 36318753 DOI: 10.1177/09567976221124951] [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] [Indexed: 11/06/2022] Open
Abstract
Courts in seven U.S. states have removed children with "obesity" from parental custody until children could maintain "healthy weights." These rulings-alongside qualitative reports from parents of children with high weight (PoCHs)-suggest that PoCHs are judged as bad parents. Yet little work has tested whether people genuinely stigmatize PoCHs or what drives this phenomenon. In three experiments with U.S. online community participants (N = 1,011; two preregistered), we tested an attribution theory model: Social perceivers attribute children's weights to parents and thus stigmatize those parents. Experiments 1 and 2 support this model (across parent and child gender). Experiment 3 manipulated attributions of parental responsibility for child weight, revealing attenuated stigma with low attributions of responsibility. Findings are among the first to describe and explain stigma toward a large demographic (parents of children with obesity)-with real-world implications (e.g., for family separation, health care)-and may additionally illuminate the psychology underlying stigma toward parents of children with other potentially stigma-evoking identities.
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Affiliation(s)
- Devanshi Patel
- The Oklahoma Center for Evolutionary Analysis, Department of Psychology, Oklahoma State University.,Department of Psychology, Oklahoma State University
| | - Jaimie Arona Krems
- The Oklahoma Center for Evolutionary Analysis, Department of Psychology, Oklahoma State University.,Department of Psychology, Oklahoma State University
| | | | - Jennifer Byrd-Craven
- The Oklahoma Center for Evolutionary Analysis, Department of Psychology, Oklahoma State University.,Department of Psychology, Oklahoma State University
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49
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Bevan N, O’Brien KS, Latner JD, Lin CY, Vandenberg B, Jeanes R, Fung XCC. Weight Stigma and Avoidance of Physical Activity and Sport: Development of a Scale and Establishment of Correlates. Int J Environ Res Public Health 2022; 19:16370. [PMID: 36498442 PMCID: PMC9737786 DOI: 10.3390/ijerph192316370] [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] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/30/2022] [Accepted: 12/04/2022] [Indexed: 06/17/2023]
Abstract
Participation in sport and physical activity (PA) is declining, and the psychosocial factors underpinning avoidance of these activities are not understood. This study developed and tested a new measure assessing the tendency to avoid PA and sport because of weight stigma and appearance-related concerns. University students (n = 581, mean age = 19.8 years) completed an online survey at two time points. Demographic details and measures of weight stigmatization, appearance evaluations, and enjoyment and participation in PA or sport were taken. In addition, we developed and tested a new measure of the tendency to avoid physical activity and sport (TAPAS). Psychometric testing of the scale was conducted, and correlates of TAPAS were examined. The ten-item TAPAS provided a single factor solution, and the final scale score was predictive of lower levels of enjoyment of, and participation in, physical activity and sport (p < 0.001). The scale also displayed good internal and test-retest reliability. This study provides a new measure for assessing people’s tendency to avoid PA and sport because of weight stigma or appearance-related concerns. The results suggest that initiatives seeking to increase participation in PA and sport may need to address weight stigma and associated appearance related concerns.
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Affiliation(s)
- Nadia Bevan
- School of Social Sciences, Faculty of Arts, Monash University, Melbourne 3800, Australia
| | - Kerry S. O’Brien
- School of Social Sciences, Faculty of Arts, Monash University, Melbourne 3800, Australia
| | - Janet D. Latner
- Department of Psychology, University of Hawaii, Honolulu, HI 96822, USA
| | - Chung-Ying Lin
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan 701401, Taiwan
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, No. 1, University Rd., East Dist., Tainan 701401, Taiwan
- Department of Public Health, College of Medicine, National Cheng Kung University, No. 1, University Rd., East Dist., Tainan 701401, Taiwan
- Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 1, University Rd., East Dist., Tainan 701401, Taiwan
| | - Brian Vandenberg
- School of Social Sciences, Faculty of Arts, Monash University, Melbourne 3800, Australia
| | - Ruth Jeanes
- Faculty of Education, Monash University, Melbourne 3199, Australia
| | - Xavier C. C. Fung
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
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50
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Plummer RS, Alter Z, Lee RM, Gordon AR, Cory H, Brion-Meisels G, Reiner J, Topping K, Kenney EL. "It's Not the Stereotypical 80s Movie Bullying": A Qualitative Study on the High School Environment, Body Image, and Weight Stigma. J Sch Health 2022; 92:1165-1176. [PMID: 35702896 PMCID: PMC10137145 DOI: 10.1111/josh.13203] [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] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/09/2022] [Accepted: 04/07/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Schools are crucial for preventing negative health outcomes in youth and are an ideal setting to address weight stigma and poor body image. The current study sought to examine and describe the nature of weight stigma and body image in adolescents, ascertain aspects of the school environment that affect body image, and identify recommendations for schools. METHODS We conducted 24 semi-structured interviews with students at 2 high schools in 2020. Qualitative data were analyzed using inductive coding and an immersion/crystallization approach. RESULTS Students did not report weight discrimination or harmful body image messaging from teachers or administrators. Physical education (PE) class and dress codes were 2 instances where covert weight stigma appeared. The most common forms of peer weight stigma reported were weight-based teasing and self-directed appearance critiques. Students recommended that schools eliminate dress codes, diversify PE activities, address body image issues in school, and be cognizant of teasing within friend groups. CONCLUSIONS Weight stigma presents itself in unique ways in high school settings. Schools can play a role in reducing experiences of weight stigma and negative body image. Weight-related teasing within friend groups was common and may not be captured in traditional assessments of bullying. More nuanced survey instruments may be needed.
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Affiliation(s)
- Rachel S. Plummer
- Department of Nutrition, Harvard T. H. Chan School of Public Health, 665 Huntington Ave, Boston, MA, 02115
| | - Zanny Alter
- Harvard Graduate School of Education, 13 Appian Way, Cambridge, MA, 02138
| | - Rebekka M. Lee
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115
| | - Allegra R. Gordon
- Department of Community Health Sciences, Boston University School of Public Health, 715AlbanySt, Boston, MA, 02118; Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115
| | - Hannah Cory
- Department of Nutrition, Harvard T. H. Chan School of Public Health, 665 Huntington Ave, Boston, MA, 02115
| | | | - Jennifer Reiner
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115
| | - Kimm Topping
- Harvard Graduate School of Education, 13 AppianWay, Cambridge, MA, 02138
| | - Erica L. Kenney
- Department of Nutrition, Harvard T. H. Chan School of Public Health, 665 Huntington Ave, Boston, MA, 02115; Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115
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