Obesity stigma: important considerations for public health

Coping with Weight-related Discrepancies: Initial Development of the WEIGHTCOPE

PURPOSE

The present research sought to provide the initial development, validation and reliability for a measure (WEIGHTCOPE) to assess the variation in how women, who are currently trying to lose or maintain weight, cope with common, perceived weight-related discrepancies.

METHODS

To this end, two studies were conducted to 1) develop an initial list of coping responses to common weight-related triggers, 2) create an initial measurement model through exploratory factor analysis (study 1; n = 470), and 3) provide initial validation for the measure through confirmatory factor analysis (study 2; n = 310).

FINDINGS

Results support the initial validity and reliability of a 38-item, 10-factor structure: Physical Activity, Healthy Eating, Suppressed Eating, Supplement Use, Self-Regulation, Positive Reframing, Social Support, Disengagement, Camouflage, and Comfort Food. The present findings reiterate individual variation in coping choice in response to a perceived weight-related discrepancy, and its prospective assessment with the WEIGHTCOPE.

CONCLUSIONS

The WEIGHTCOPE can be an integral tool for public health and clinical practice, where triggers are common, and interventions are employed to enhance the use of more positive forms of weight control behaviors and/or avoid negative consequences of weight- and fat-related discrepancies. Future research can use the WEIGHTCOPE to help guide theoretical and pragmatic approaches to various triggering events and potential moderators of coping.

Stigmatizing attitudes and beliefs toward bulimia nervosa: the importance of knowledge and eating disorder symptoms

Widely held stigmatizing attitudes and beliefs toward bulimic eating disorders may lead to self-blame and reduced treatment seeking. Knowledge and familiarity with mental disorders may help decrease associated stigma. However, these relationships are not well understood in bulimia nervosa (BN). A community sample of 1828 adults aged 18 to 70 years completed a survey assessing stigmatizing attitudes and beliefs toward BN, knowledge and familiarity with the disorder, as well as levels of eating disorder symptoms. Knowledge of BN was negatively associated with three dimensions of stigmatization, personal responsibility (ρ = -0.28), unreliability (ρ = -0.19), and advantages of BN (ρ = -0.23). Familiarity revealed no association with stigmatization. Both men and women with high levels of eating disorder symptoms perceived BN as less serious than the participants with low levels of symptoms. Increasing community knowledge about bulimia may help mitigate stigmatization and perceived barriers to treatment.

Impact of non-diet approaches on attitudes, behaviors, and health outcomes: a systematic review

OBJECTIVE

To determine the overall effect of non-diet, weight-neutral interventions on factors such as weight, biochemical measures, food and activity behavior, body image, and mental health.

DESIGN

Systematic review of intervention literature.

SETTING

Group classes in community and worksite settings (14 studies), and individual counseling (1) and online education (1) in college settings.

PARTICIPANTS

Eighteen research articles (representing 16 studies) evaluating non-diet interventions using quasi-experimental and randomized study designs with either a comparison or control group.

MAIN OUTCOME MEASURES

Anthropometric, physiological, psychological, and dietary intake.

ANALYSIS

Systematic search of 168 articles and review of 18 articles meeting inclusionary criteria.

RESULTS

Non-diet interventions resulted in statistically significant improvements in disordered eating patterns, self-esteem, and depression. None of the interventions resulted in significant weight gain or worsening of blood pressure, blood glucose, or cholesterol, and in 2 studies biochemical measures improved significantly compared with the control or diet group. Primary limitations were inconsistent definitions of non-diet approaches and the use of different assessment instruments for measuring outcomes.

CONCLUSIONS AND IMPLICATIONS

Because of the long-term ineffectiveness of weight-focused interventions, the psychological improvements seen in weight-neutral, non-diet interventions warrant further investigation.

The role of parents in public views of strategies to address childhood obesity in the United States

POLICY POINTS: The American public--both men and women and those with and without children in the household--holds parents highly responsible and largely to blame for childhood obesity. High attributions of responsibility to parents for reducing childhood obesity did not universally undermine support for broader policy action. School-based obesity prevention policies were strongly supported, even among those viewing parents as mostly to blame for childhood obesity. Americans who viewed sectors outside the family (such as the food and beverage industry, schools, and the government) as helping address childhood obesity were more willing to support a wider range of population-based obesity prevention policies.

CONTEXT

The public's views of parents' behaviors and choices--and the attitudes held by parents themselves--are likely to influence the success of efforts to reverse obesity rates.

METHODS

We analyzed data from 2 US national public opinion surveys fielded in 2011 and 2012 to examine attributions of blame and responsibility to parents for obesity, both among the general public and parents themselves, and we also explored the relationship between views of parents and support for obesity prevention policies.

FINDINGS

We found that attribution of blame and responsibility to parents was consistently high, regardless of parental status or gender. Support for policies to curb childhood obesity also did not differ notably by parental status or gender. Multivariable analyses revealed consistent patterns in the association between public attitudes toward parents' responsibility and support for policies to curb childhood obesity. High parental responsibility was linked to higher support for school-targeted policies but generally was not associated with policies outside the school setting. Attribution of greater responsibility to entities external to children and their parents (schools, the food and beverage industry, and the government) was associated with greater support for both school-targeted and population-based obesity prevention policies.

CONCLUSIONS

Our findings suggest that the high attribution of responsibility to parents for reducing childhood obesity does not universally undermine support for broader policy action. But appealing to parents to rally support for preventing obesity in the same way as for other parent-initiated social movements (eg, drunk driving) may be challenging outside the school setting.

Translating it into real life: a qualitative study of the cognitions, barriers and supports for key obesogenic behaviors of parents of preschoolers

Background

Little is known about preschool parents’ cognitions, barriers, supports and modeling of key obesogenic behaviors, including breakfast, fruit and vegetable consumption, sugary beverage intake, feeding practices, portion sizes, active playtime, reduced screen-time, sleep and selection of child-care centers with characteristics that promote healthy behaviors.

Methods

Thus, the purpose of this study was to examine these factors via survey and focus groups among 139 parents of 2- to 5-year-old children. Standard content analysis procedures were used to identify trends and themes in the focus group data, and Analysis of Variance was used to test for differences between groups in the survey data.

Results

Results showed 80% of parents ate breakfast daily, consumed sugary beverages 2.7 ± 2.5SD days per week, and had at least two different vegetables and fruits an average of 5.2 ± 1.8SD and 4.6 ± 2.0SD days per week. Older parents and those with greater education drank significantly fewer sugary drinks. Parents played actively a mean 4.2 ± 2.2 hours/week with their preschoolers, who watched television a mean 2.4 ± 1.7 hours/day. Many parents reported having a bedtime routine for their preschooler and choosing childcare centers that replaced screen-time with active play and nutrition education. Common barriers to choosing healthful behaviors included lack of time; neighborhood safety; limited knowledge of portion size, cooking methods, and ways to prepare healthy foods or play active indoor games; the perceived cost of healthy options, and family members who were picky eaters. Supports for performing healthful behaviors included planning ahead, introducing new foods and behaviors often and in tandem with existing preferred foods and behaviors, and learning strategies from other parents.

Conclusions

Future education programs with preschool parents should emphasize supports and encourage parents to share helpful strategies with each other.

Promoting Physical Activity Participation among Adolescents: The Barriers and the Suggestions

Background:

Physical activity is a complex behavior. To designing the effective intervention, qualitative researches may be allowed for greater understanding of the reasons behind the adolescences’ physical activity-related behaviors’.

Methods:

Using the grounded theory approach, including semi-structured focus group discussions (FGDs) and in-depth interviews, we conducted a quantitative study to elicit the adolescents and key informants’ opinion regarding the satiation, needs, social and environmental barriers of adolescents’ physical activity. For FGDs, participants were selected from volunteered adolescent (aged 10–19 years) of the populated western part of Tehran, which was selected as a research field. Key informants were invited from the health professionals and experts in the field of adolescents’ health.

Results:

According to findings, although the majority of participants agreed on the important role of physical activity, the lack of essential motivation and the pressure of educational assignments remove it from the daily program priorities. Lack of a safe environment for girls’ physical activity and high cost of professional sports were two first mentioned barriers. It was also suggested that future interventions should focus on improving more parents’ engagement and their direct participation in physical activities with their adolescents.

Conclusions:

We proposed the participatory strategies for adolescent's physical activity promotion. Through which target groups participation during the designing, development, and implementation of health programs led to more effective interventions.

Prevalence of Overweight and Obesity among Students in the Kumasi Metropolis

The aim was to determine the prevalence of obesity and overweight among students in the Kumasi metropolis. In a descriptive cross-sectional study, 500 students aged 10 to 20 years were examined from two junior high schools selected by multistage sampling technique and three randomly selected senior high schools. Height and weight were measured in all participants and the body mass index (BMI) of each individual was calculated. Body mass index classes were calculated according to the International Obesity Task Force standards. Out of the 500 students, 290 (58.00%) were males and 210 (42.00%) were females. The prevalence of underweight, normal weight, overweight, and obesity was 7.40%, 79.60%, 12.20%, and 0.80%, respectively. Overweight was more prevalent among students than obesity. There is therefore the need to establish effective public health promotion campaigns among students in order to curtail future implications on health.

Perceived discrimination and favourable regard toward underweight, normal weight and obese eating disorder sufferers: implications for obesity and eating disorder population health campaigns

Background

Obesity stigma has been shown to increase binge eating, whilst positive regard for eating disorders (EDs) may increase dietary restriction which can also lead to binge eating and weight gain. In the context of increasing prevalence of both obesity and EDs exploring community attitudes towards these illnesses may uncover new variables worthy of consideration in population health campaigns. The aim of the study was to explore community perceived stigma and conversely favourable regard toward eating disorder (ED) sufferers of varying weight status, and understand how the attitudes of obese individuals may differ from those of non-obese individuals. Data for this purpose were derived from interviews with individuals participating in a general population health survey. Vignettes of an underweight female with Anorexia Nervosa (AN), a normal weight male with an atypical eating disorder (NWED) and an obese female with Binge Eating Disorder (BED) were presented to three randomly selected sub-samples of n = 983, 1033 and 1030 respectively. Questions followed that assessed participants’ attitudes towards and beliefs about the person described in the vignette and their eating behaviours.

Results

Sixty-six per cent of participants who responded to the obese BED vignette believed that there would be discrimination against the person described (primarily because of her weight). Corresponding figures were for the AN and NWED vignettes were 48% and 35%, respectively. A positive regard for weight-loss or body-image-enhancing ED behaviours was reported ‘occasionally’ or more often by 8.8% of respondents to the AN vignette and by 27.5% of respondents to the NWED vignette. Positive regard for ED behaviours was significantly more likely in obese participants (AN: 15%; NWED: 43%).

Conclusion

The findings support integrated ED and obesity prevention programs that address weight stigma and the social desirability of ED behaviours in vulnerable individuals.

Atitudes de nutricionistas em relação a indivíduos obesos – um estudo exploratório

O objetivo foi identificar atitudes de nutricionistas em relação à obesidade; envolvendo crenças sobre características atribuídas às pessoas obesas, fatores de desenvolvimento e a obesidade em si. Os participantes (N = 344; 97,1% mulheres) foram contatados via conselho profissional e responderam a pesquisa online. As questões do estudo foram adaptadas de trabalhos internacionais com as respostas analisadas por frequência de concordância. As respostas indicaram forte estigmatização da obesidade e preconceito contra o obeso, atribuindo características como: guloso (67,4%), não atraente (52,0%), desajeitado (55,1%), sem determinação (43,6%) e preguiçoso (42,3%). E considerando entre os mais importantes fatores causais: alterações emocionais e de humor, vício ou dependência de comida e baixa autoestima. Esta temática deve ser mais pesquisada uma vez que tais atitudes podem impactar a eficácia do tratamento; também para discussão e formação ampla sobre os significados da obesidade, e tratamento mais individualizado e humanizado para pacientes obesos.

Sex, race, and the adverse effects of social stigma vs. other quality of life factors among primary care patients with moderate to severe obesity

BACKGROUND

Patients with obesity face widespread social bias, but the importance of this social stigma to patients relative to other quality of life (QOL) factors is unclear.

OBJECTIVE

Our aim was to examine the importance of obesity-related social stigma relative to other QOL factors on reducing patients' overall well-being.

DESIGN

We used a cross-sectional telephone interview.

SETTING

The study was conducted at four diverse primary care practices in Greater Boston.

PARTICIPANTS

Three hundred and thirty-seven primary care patients aged 18-65 years and with a body mass index (BMI) of 35 kg/m(2) or higher participated in the study.

MAIN MEASURES

Patients' health utility (preference-based QOL measure) was determined via responses to a series of standard gamble scenarios assessing willingness to risk death to lose various amounts of weight or to achieve perfect health. We used the Impact of Weight on Quality of Life-lite instrument to assess QOL domains specific to obesity (physical function, self-esteem, sexual life, public distress or social stigma, and work), and we examined variation in utility explained by these domains.

KEY RESULTS

Depending on patients' race/ethnicity, mean health utilities ranged from 0.92 to 0.99 among men and from 0.89 to 0.93 among women. After adjustment for race, BMI, and education, none of the QOL domains explained much of the variation in utility among men, except for work function among Hispanic men. In contrast, social stigma was the leading QOL contributor to utility for Caucasian women (explaining 6 % of the marginal variation beyond demographics and BMI). In contrast, sexual function was the most important contributor among African American women (3 % marginal variation), and work life was most important among Hispanic women (> 20 % in variation). Lower scores in one domain did not always translate into lower well-being. Moreover, QOL summary scores often explained less of the variation than some individual domains.

CONCLUSION

Obesity-related social stigma had disproportionate adverse effects on Caucasian women patients' well-being, whereas weight-related impairment in work function was particularly important among Hispanic patients and impaired sexual function was important to diminished well-being among African American women although its impact appeared modest.

Weight stigma "gets under the skin"-evidence for an adapted psychological mediation framework: a systematic review

OBJECTIVE

Research consistently shows a negative view of individuals with obesity in the general public and in various other settings. Stigma and discrimination can be considered chronic stressors, as these factors have a profound impact on the psychological well-being of the affected individuals. This article proposes a framework that entails a mediation of the adverse effects of discrimination and stigmatization on mental well-being through elevated psychological risk factors that are not unique to weight but that could affect overweight and normal-weight individuals alike.

METHODS

A systematic review was conducted to assess the prevalence of psychological risk factors, such as self-esteem and coping, in individuals with obesity.

RESULTS

Forty-six articles were assessed and included for detailed analysis. The number of studies on these topics is limited to certain dimensions of psychological processes. The best evaluated association of obesity and psychosocial aspects is seen for self-esteem. Most studies establish a negative association of weight and self-esteem in children and adults. All studies with mediation analysis find a positive mediation through psychological risk factors on mental health outcomes.

CONCLUSIONS

This review shows that elevated psychological risk factors are existent in individuals with obesity and that they may be a mediator between weight discrimination and pathopsychological outcomes.

Stigma and the addiction paradigm for obesity: lessons from 1950s America

AIMS

To discuss an historical episode in which obesity was conceptualized as an addictive disorder and declared to be a major epidemic in the early postwar United States. This history illuminates past consequences of framing obesity as an addiction in ways that may inform constructive policy responses today.

METHODS

Review of secondary and primary sources, including archival documents, relating to obesity in biomedical and popular thought of the 1940s and 1950s.

RESULTS

In the United States in the late 1940s and 1950s, new medical thinking about obesity reinterpreted overweight and obesity as chiefly the consequence of addiction (understood in the then dominant psychodynamic theory as a psychological defect, oral fixation). This new conception was rapidly taken up in popular discourse and clinical practice, with adverse effects through amplification of weight stigma. Further, in the conservative political context, the addiction concept contributed to an ineffective policy response to the alarming new epidemiological evidence about obesity's consequences. Despite a lack of evidence for efficacy of the intervention, public health efforts focused on correcting individual eating behaviour among obese people by encouraging self-help in lay groups modelled, in part, on Alcoholics Anonymous. Population-level intervention was neglected.

CONCLUSIONS

Current public health policy initiatives must be mindful of the risks of reframing obesity as an addiction. These include inadvertently reinforcing stigma, narrowing responses to those aiming to modify individual behaviour and biology and neglecting population policies aiming to reduce the consumption of energy-dense foods, as all occurred in the 1950s United States.

Weighing in: the taste-engineering frame in obesity expert discourse

OBJECTIVES

We sought expert opinion on the problems with 2 dominant obesity-prevention discourse frames-personal responsibility and the environment-and examined alternative frames for understanding and addressing obesity.

METHODS

We conducted 60-minute, semistructured interviews with 15 US-based obesity experts. We manually coded and entered interview transcripts into software, generating themes and subthematic areas that captured the debate's essence.

RESULTS

Although the environmental frame is the dominant model used in communications with the public and policymakers, several experts found that communicating key messages within this frame was difficult because of the enormity of the obesity problem. A subframe of the environmental frame--the taste-engineering frame--identifies food industry strategies to influence the overconsumption of certain foods and beverages. This emerging frame deconstructs the environmental frame so that causal attributes and responsible agents are more easily identifiable and proposed policies and public health interventions more salient.

CONCLUSIONS

Expert interviews are an invaluable resource for understanding how experts use frames in discussing their work and in conversations with the public and policymakers. Future empirical studies testing the effectiveness of the taste-engineering frame on public opinion and support for structural-level health policies are needed.

The Restaurant Food Hot Potato: Stop Passing it on-A Commentary on Mah and Timming's, 'Equity in Public Health Ethics: The Case of Menu Labelling Policy at the Local Level'

In the case discussion, ‘Equity in Public Health Ethics: The Case of Menu Labelling Policy at the Local Level’ (2014), Mah and Timming state that menu labelling would ‘place requirements for information disclosure on private sector food businesses, which, as a policy instrument, is arguably less intrusive than related activities such as requiring changes to the food content’. In this commentary on Mah and Timming’s case study, I focus on discussing how menu-labelling policy permits governments to avoid addressing the heart of the problem, which is high-calorie, high-sodium restaurant food. Menu labelling policy does not address food content in a way that is meaningful for change, instead relying on individuals to change their behaviour given new information. Besides having questionable efficacy, this raises concerns about moralizing food choices.

The association of BMI and social distance towards obese individuals is mediated by sympathy and understanding

The desire for social distance towards individuals with obesity as part of the stigmatization process has not been investigated. The aims of this study include: (a) determining the prevalence of social distance and its domains in a population-based sample; (b) reporting levels of emotional response; and (c) investigating the association of BMI, emotional response and social distance. The data were derived from a large population based telephone survey in Germany (total n = 3,003, this sub-sample n = 1008). Emotional response to individuals with obesity was assessed for the emotions discomfort, pity, insecurity, amusement, sympathy, help and incomprehension (5-point Likert scale). Social distance was measured on a 5-point Likert scale covering different areas of social interaction. This served as the dependent variable for a linear regression model and mediation models that included BMI and emotional response. Social distance was highest for job recommendation, introduction to a friend, someone with obesity marrying into the family and renting out a room. Means of emotional responses were highest for pity (Mean = 2.58), sympathy (Mean = 2.87) and wanting to help (M = 2.76). In regression analyses, incomprehension (b = 1.095, p < 0.001) and sympathy (b = -0.833, p < 0.001) and the respondents' own BMI (b = -0.145, p < 0.001) were significantly associated to the overall amount of social distance. Mediation models revealed a significant mediation effect of BMI through sympathy (b = -0.229, % of total effect through mediation = 10.3%) and through incomprehension (b = -0.057, % of total effect through mediation = 27.5%) on social distance. Social distance towards individuals with obesity is prevalent in the general public in Germany and it is associated with emotional responses. Altering the emotional responses may, therefore, be a starting point in anti-stigma interventions. Evoking sympathy and lowering incomprehension may result in lower overall social distance.

Systematic review of mental health and well-being outcomes following community-based obesity prevention interventions among adolescents

OBJECTIVES

This paper aimed to systematically evaluate the mental health and well-being outcomes observed in previous community-based obesity prevention interventions in adolescent populations.

SETTING

Systematic review of literature from database inception to October 2014. Articles were sourced from CINAHL, Global Health, Health Source: Nursing and Academic Edition, MEDLINE, PsycARTICLES and PsycINFO, all of which were accessed through EBSCOhost. The Cochrane Database was also searched to identify all eligible articles. PRISMA guidelines were followed and search terms and search strategy ensured all possible studies were identified for review.

PARTICIPANTS

Intervention studies were eligible for inclusion if they were: focused on overweight or obesity prevention, community-based, targeted adolescents (aged 10-19 years), reported a mental health or well-being measure, and included a comparison or control group. Studies that focused on specific adolescent groups or were treatment interventions were excluded from review. Quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) guidelines.

PRIMARY AND SECONDARY OUTCOME MEASURES

Primary outcomes were measures of mental health and well-being, including diagnostic and symptomatic measures. Secondary outcomes included adiposity or weight-related measures.

RESULTS

Seven studies met the inclusion criteria; one reported anxiety/depressive outcomes, two reported on self-perception well-being measures such as self-esteem and self-efficacy, and four studies reported outcomes of quality of life. Positive mental health outcomes demonstrated that following obesity prevention, interventions included a decrease in anxiety and improved health-related quality of life. Quality of evidence was graded as very low.

CONCLUSIONS

Although positive outcomes for mental health and well-being do exist, controlled evaluations of community-based obesity prevention interventions have not often included mental health measures (n=7). It is recommended that future interventions incorporate mental health and well-being measures to identify any potential mechanisms influencing adolescent weight-related outcomes, and equally to ensure interventions are not causing harm to adolescent mental health.

Translation of obesity practice guidelines: interprofessional perspectives regarding the impact of public health nurse system-level intervention

OBJECTIVE

The purpose of the study was to investigate the perceptions of administrators and clinicians regarding a public health facilitated collaborative supporting the translation into practice of the Institute for Clinical Systems Improvement (ICSI) Adult Obesity Guideline.

DESIGN AND SAMPLE

This qualitative study was conducted with 10 health care organizations participating in a voluntary, interprofessional obesity management collaborative. A purposive sample of 39 participants included two to three clinicians and an administrator from each organization. Interview analysis focused on how the intervention affected participants and their practices.

RESULTS

Four themes described participant experiences of obesity guideline translation: (1) a shift from powerlessness to positive motivation, (2) heightened awareness coupled with improved capacity to respond, (3) personal ownership and use of creativity, and (4) a sense of the importance of increased interprofessional collaboration.

CONCLUSIONS

The investigation of interprofessional perspectives illuminates the feelings and perceptions of clinician and administrator participants regarding obesity practice guideline translation. These themes suggest that positive motivation, improved capacity, personal creative ownership, and interprofessional collaboration may be conducive to successful evidence-based obesity guideline implementation. Further research is needed to evaluate these findings relative to translating the ICSI obesity guideline and other guidelines into practice in diverse clinical settings.

"A little on the heavy side": a qualitative analysis of parents' and grandparents' perceptions of preschoolers' body weights

OBJECTIVES

Parents' difficulties in perceiving children's weight status accurately pose a barrier for family-based obesity interventions; however, the factors underlying weight misinterpretation still need to be identified. This study's objective was to examine parents and grandparents' perceptions of preschoolers' body sizes. Interview questions also explored perceptions of parental responsibility for childhood obesity and appropriate contexts in which to discuss preschoolers' weights.

DESIGN

Semistructured interviews, which were videotaped, transcribed and analysed qualitatively.

SETTING

Eugene and the Springfield metropolitan area, Oregon, USA PARTICIPANTS: Families of children aged 3-5 years were recruited in February-May 2011 through advertisements about the study, published in the job seekers' sections of a classified website (Craigslist) and in a local newspaper. 49 participants (22 parents and 27 grandparents, 70% women, 60% with overweight/obesity) from 16 low-income families of children aged 3-5 years (50% girls, 56% with overweight/obesity) were interviewed.

RESULTS

There are important gaps between clinical definitions and lay perceptions of childhood obesity. While parents and grandparents were aware of their preschoolers' growth chart percentiles, these measures did not translate into recognition of children's overweight or obesity. The participants spoke of obesity as a problem that may affect the children in the future, but not at present. Participants identified childhood obesity as being transmitted from one generation to the next, and stigmatised it as resulting from 'lazy' parenting. Parents and grandparents avoided discussing the children's weights with each other and with the children themselves.

CONCLUSIONS

The results suggest that clinicians should clearly communicate with parents and grandparents about the meaning and appearance of obesity in early childhood, as well as counteract the social stigma attached to obesity, in order to improve the effectiveness of family-based interventions to manage obesity in early childhood.

Impact of non-physician health professionals' BMI on obesity care and beliefs

OBJECTIVE

Examine the impact of non-physician health professional body mass index (BMI) on obesity care, self-efficacy, and perceptions of patient trust in weight loss advice.

METHODS

A national cross-sectional Internet-based survey of 500 US non-physician health professionals specializing in nutrition, nursing, behavioral/mental health, exercise, and pharmacy collected between January 20 and February 5, 2014 was analyzed.

RESULTS

Normal-BMI professionals were more likely than overweight/obese professionals to report success in helping patients achieve clinically significant weight loss (52% vs. 29%, P = 0.01). No differences by health professional BMI about the appropriate patient body weight for weight-related care (initiate weight loss discussions and success in helping patients lose weight), confidence in ability to help patients lose weight, or in perceived patient trust in their advice were observed. Most health professionals (71%) do not feel successful in helping patients lose weight until they are morbidly obese, regardless of BMI.

CONCLUSIONS

Normal-BMI non-physician health professionals report being more successful than overweight and obese health professionals at helping obese patients lose weight. More research is needed to understand how to improve self-efficacy for delivering obesity care, particularly among overweight and class I obese patients.

Perceived weight discrimination and changes in weight, waist circumference, and weight status

OBJECTIVE

To examine associations between perceived weight discrimination and changes in weight, waist circumference, and weight status.

METHODS

Data were from 2944 men and women aged ≥50 years participating in the English Longitudinal Study of Ageing. Experiences of weight discrimination were reported in 2010-2011 and weight and waist circumference were objectively measured in 2008-2009 and 2012-2013. ANCOVAs were used to test associations between perceived weight discrimination and changes in weight and waist circumference. Logistic regression was used to test associations with changes in weight status. All analyses adjusted for baseline BMI, age, sex, and wealth.

RESULTS

Perceived weight discrimination was associated with relative increases in weight (+1.66 kg, P < 0.001) and waist circumference (+1.12 cm, P = 0.046). There was also a significant association with odds of becoming obese over the follow-up period (OR = 6.67, 95% CI 1.85-24.04) but odds of remaining obese did not differ according to experiences of weight discrimination (OR = 1.09, 95% CI 0.46-2.59).

CONCLUSIONS

Our results indicate that rather than encouraging people to lose weight, weight discrimination promotes weight gain and the onset of obesity. Implementing effective interventions to combat weight stigma and discrimination at the population level could reduce the burden of obesity.

Association between binge eating disorder and changes in cognitive functioning following bariatric surgery

Evidence suggests that both obesity and binge eating disorder (BED) may be associated with deficits in cognitive functioning. The purpose of this study was to examine whether a lifetime history of BED would be associated with changes in several domains of cognitive functioning (attention, executive function, language, and memory) following bariatric surgery. Participants were 68 bariatric surgery patients who completed a computerized battery of cognitive tests within 30 days prior to undergoing surgery and again at a 12-Month postoperative follow-up. Results revealed that on the whole, participants displayed improvements from baseline to follow-up in attention, executive function, and memory, even after controlling for diagnostic history of depression; no changes were observed for language. However, individuals with and without a history of BED did not differ in changes in body mass index or in the degree of improvement in cognitive functioning from baseline to follow-up. Such results suggest that a history of BED does not influence changes in cognitive functioning following bariatric surgery. Future research will be needed to further clarify the role of BED in predicting cognitive function over time.

Weight and health-related quality of life: the moderating role of weight discrimination and internalized weight bias

OBJECTIVES

Obesity is an increasingly prevalent public health concern, with associated medical comorbidities and impairment in health-related quality of life (HRQoL). Obese women are frequently victims of weight-related discrimination. The HRQoL impairments among obese people could be related to this discrimination and to internalized weight bias. Design We examined the potential moderating role of discrimination (from others) and self-directed (internalized) weight-based discrimination in the association between body mass index (BMI) and HRQoL.

METHODS

Eighty-one women (mean age=41.1years; mean BMI=43.40kg/m(2), 97% Caucasian) completed valid and reliable measures of weight bias internalization (weight bias internalization scale), perceived discrimination by others (everyday discrimination scale) and both physical and mental HRQoL (SF-36 Health Survey). Multiple regression analysis was used to test whether internalized weight bias or discrimination moderated the association between BMI and the summary scores for physical and mental HRQoL, controlling for age.

RESULTS

Significant associations were found between BMI and discrimination (r=.36, p=.002), between internalized weight bias and both mental (r=.61, p<.001) and physical HRQoL (r=.45, p<.001), and between discrimination and physical HRQoL (r=.29, p=.014). A statistically significant interaction was found between BMI and internalized weight bias (b=-.21, SE=.10, p<0.05) in accounting for the variance in physical HRQoL.

CONCLUSIONS

The association between higher BMI and poorer physical HRQoL was found only in individuals reporting high levels of internalized weight bias. Self-discrimination among overweight individuals may be a critical factor in their physical health impairment.

Changes in obesity between fifth and tenth grades: a longitudinal study in three metropolitan areas

BACKGROUND

Despite epidemic childhood obesity levels, we know little about how BMI changes from preadolescence to adolescence and what factors influence changes.

METHODS

We studied 3961 randomly selected public school students and 1 parent per student in 3 US metropolitan areas in fifth and again in tenth grades. In each grade, we measured child and parent height/weight and calculated BMI category. We examined whether baseline sociodemographic characteristics, child health-related factors, and parental obesity were significantly associated with exit from and entry into obesity from fifth to tenth grade.

RESULTS

Fifth- and tenth-graders were 1%/2% underweight, 53%/60% normal weight, 19%/18% overweight, and 26%/20% obese, respectively. Among obese tenth-graders, 83% had been obese as fifth-graders and 13% had been overweight. Sixty-five percent of obese fifth-graders remained obese as tenth-graders, and 23% transitioned to overweight. Multivariately, obese fifth-graders who perceived themselves to be much heavier than ideal (P = .01) and those who had lower household education (P = .006) were less likely to exit obesity; by contrast, overweight fifth-graders were more likely to become obese if they had an obese parent (P < .001) or watched more television (P = .02).

CONCLUSIONS

Obese fifth-graders face challenges in reducing obesity, especially when they lack advantages associated with higher socioeconomic status or when they have a negative body image. Clinicians and others should educate parents on the importance of preventing obesity very early in development. Children who are not yet obese by fifth grade but who have an obese parent or who watch considerable television might benefit from monitoring, as might children who have negative body images.

Food addiction and its impact on weight-based stigma and the treatment of obese individuals in the U.S. and Australia

It is argued that food addiction explanations of obesity may reduce the significant stigma levelled at obese and overweight individuals. We surveyed 479 adults to determine the prevalence of food addiction in the U.S. (n = 215) and, for the first time, in Australia (n = 264) using the Yale Food Addiction Scale (YFAS). We also assessed the level of weight-based stigma in this population. The prevalence of food addiction in our Australian sample was 11%, similar to U.S. participants and consistent with previous studies. Those who met criteria for diagnosis had a larger mean BMI (33.8 kg/m²) than those who did not (26.5 kg/m²). Overall, the level of stigma towards others was low and differed significantly based on BMI, predominately among normal weight and obese participants (p = 0.0036). Obese individuals scored higher on certain measures of stigma, possibly reflecting individual experiences of stigma rather than negative attitudes towards other obese individuals (p = 0.0091). Despite significant support for a “food addiction” explanation of obesity, participants still valued personal responsibility in overcoming obesity and did not support coercive approaches to treat their “addiction”.

Social networks and future direction for obesity research: A scoping review

Despite significant efforts to decrease obesity rates, the prevalence of obesity continues to increase in the United States. Obesity risk behaviors including physical inactivity, unhealthy eating, and sleep deprivation are intertwined during daily life and are difficult to improve in the current social environment. Studies show that social networks-the thick webs of social relations and interactions-influence various health outcomes, such as HIV risk behaviors, alcohol consumption, smoking, depression, and cardiovascular mortality; however, there is limited information on the influences of social networks on obesity and obesity risk behaviors. Given the complexities of the biobehavioral pathology of obesity and the lack of clear evidence of effectiveness and sustainability of existing interventions that are usually focused on an individual approach, targeting change in an individual's health behaviors or attitude may not take sociocontextual factors into account; there is a pressing need for a new perspective on this problem. In this review, we evaluate the literature on social networks as a potential approach for obesity prevention and treatment (i.e., how social networks affect various health outcomes), present two major social network data analyses (i.e., egocentric and sociometric analysis), and discuss implications and the future direction for obesity research using social networks.

Altered motivation masks appetitive learning potential of obese mice

Eating depends strongly on learning processes which, in turn, depend on motivation. Conditioned learning, where individuals associate environmental cues with receipt of a reward, forms an important part of hedonic mechanisms; the latter contribute to the development of human overweight and obesity by driving excessive eating in what may become a vicious cycle. Although mice are commonly used to explore the regulation of human appetite, it is not known whether their conditioned learning of food rewards varies as a function of body mass. To address this, groups of adult male mice of differing body weights were tested two appetitive conditioning paradigms (pavlovian and operant) as well as in food retrieval and hedonic preference tests in an attempt to dissect the respective roles of learning/motivation and energy state in the regulation of feeding behavior. We found that (i) the rate of pavlovian conditioning to an appetitive reward develops as an inverse function of body weight; (ii) higher body weight associates with increased latency to collect food reward; and (iii) mice with lower body weights are more motivated to work for a food reward, as compared to animals with higher body weights. Interestingly, as compared to controls, overweight and obese mice consumed smaller amounts of palatable foods (isocaloric milk or sucrose, in either the presence or absence of their respective maintenance diets: standard, low fat-high carbohydrate or high fat-high carbohydrate). Notably, however, all groups adjusted their consumption of the different food types, such that their body weight-corrected daily intake of calories remained constant. Thus, overeating in mice does not reflect a reward deficiency syndrome and, in contrast to humans, mice regulate their caloric intake according to metabolic status rather than to the hedonic properties of a particular food. Together, these observations demonstrate that excess weight masks the capacity for appetitive learning in the mouse.

Changes in health selection of obesity among Mexican immigrants: a binational examination

Health selection is often measured by comparing the health of more recent immigrants to the native born of their new host country. However, this comparison fails to take into account two important factors: (1) that changes in the health profile of sending countries may impact the health of immigrants over time, and (2) that the best comparison group for health selection would be people who remain in the country of origin. Obesity represents an important health outcome that may be best understood by taking into account these two factors. Using nationally-representative datasets from Mexico and the US, we examined differences in obesity-related health selection, by gender, in 2000 and 2012. We calculated prevalence ratios from log-binomial models to compare the risk of obesity among recent immigrants to the US to Mexican nationals with varying likelihood of migration, in order to determine changes in health selection over time. Among men in 2000, we found little difference in obesity status between recent immigrants to the US and Mexican non-migrants. However, in 2012, Mexican men who were the least likely to migrate had higher obesity prevalence than recent immigrants, which may reflect emerging health selection. The trends for women, however, indicated differences in obesity status between recent Mexican immigrants and non-migrants at both time points. In both 2000 and 2012, Mexican national women had significantly higher obesity prevalence than recent immigrant women, with the biggest difference between recent immigrants and Mexican women who were least likely to migrate. There was also indication that selection increased with time for women, as the differences between Mexican nationals and recent immigrants to the US grew from 2000 to 2012. Our study is among the first to use a binational dataset to examine the impact of health selectivity, over time, on obesity.

Childhood obesity-an insight into preventive strategies

Childhood obesity is now a global problem throughout the world. The major factors affecting weight regulation and the development of obesity in children are the result of a large number of biological, behavioral, social, environmental, and economic factors and the complex interactions between them that promote a positive energy balance. The changes in the dietary habits with the adoption of sedentary life style increases manifold obesity-related diseases and their complications. An obese child later on grows up to become an obese adult. Therefore, the role of primary prevention along with methodical diet control, behavioral changes, and physical activity are the important strategies against the battle of childhood obesity.

Obesity in social media: a mixed methods analysis

The escalating obesity rate in the USA has made obesity prevention a top public health priority. Recent interventions have tapped into the social media (SM) landscape. To leverage SM in obesity prevention, we must understand user-generated discourse surrounding the topic. This study was conducted to describe SM interactions about weight through a mixed methods analysis. Data were collected across 60 days through SM monitoring services, yielding 2.2 million posts. Data were cleaned and coded through Natural Language Processing (NLP) techniques, yielding popular themes and the most retweeted content. Qualitative analyses of selected posts add insight into the nature of the public dialogue and motivations for participation. Twitter represented the most common channel. Twitter and Facebook were dominated by derogatory and misogynist sentiment, pointing to weight stigmatization, whereas blogs and forums contained more nuanced comments. Other themes included humor, education, and positive sentiment countering weight-based stereotypes. This study documented weight-related attitudes and perceptions. This knowledge will inform public health/obesity prevention practice.

Re-entering obesity prevention: a qualitative-empirical inquiry into the subjective aetiology of extreme obese adolescents

BACKGROUND

While numerous studies highlight the relevance of socio-cultural factors influencing incidence and prevalence of obesity, only a few address how obese people perceive causes and prevention of or intervention for obesity. This study contributes to a more thorough understanding of subjective aetiologies and framing themes for a mainly understudied but promising field. Thus it may serve for the development of effective public health strategies to combat obesity.

METHODS

Autobiographically based in-depth interviews were conducted with 20 patients (adolescents and young adults) institutionalised in the obesity rehabilitation centre INSULA in Bischofswiesen (Germany). The data were analysed with Atlas.ti with regard to two main perspectives: (1) How the interviewees perceive 'their' obesity from a subjective point of view and (2) which conclusions they draw from their own 'story' concerning prevention/intervention strategies.

RESULTS

The interviewees did not indicate a clear starting point for their overweight. Nevertheless, certain life-events (e.g. divorce or illness of parents) were identified as catalysing weight gain. As a consequence of coping with distress, body weight rises rapidly and not continuously. Obesity was generally framed as a problem primarily located within the family and not in the wider environment. Corresponding to this, the family was identified as the main and most important addressee of preventive measures. The interviewees highlighted the importance of personal responsibility as a prerequisite for self-determined action against obesity, but denied any link between responsibility and guilt.

CONCLUSIONS

This study contributes substantially to a broader perspective on the prevention of obesity. First, more attention has to be paid to the interactions of medical aspects and the social dimension of obesity. Second, prevention efforts should be more aware of the relevance of subjective aetiology when it comes to the definition of reasonable and effective governance strategies in tackling obesity. Third, current assumptions concerning the importance of personal responsibility for obesity prevention might underestimate the relevance of self-determined action of the obese.

Low-income women's conceptualizations of emotional- and stress-eating

Emotional- and stress-eating have been proposed as risk factors for obesity. However, the way that individuals conceptualize these behaviors is not well understood and no studies have employed a qualitative approach. We sought to understand how women conceptualize emotional- and stress-eating. Sixty-one low-income women from South-central Michigan with young children (ages 2-5 years) participated in either a focus group or individual semi-structured interview during which they were asked about their conceptualizations of eating behaviors among adults and children. Responses were transcribed and the constant comparative method was used to identify themes. Identified themes included that emotional- and stress-eating are viewed as uncommon, severe, pitiable behaviors that reflect a lack of self-control and are highly stigmatized; that when these behaviors occurred among children, the behaviors resulted from neglect or even abuse; and that bored-eating is viewed as distinct from emotional- or stress-eating and is a common and humorous behavior with which participants readily self-identified. Future research and interventions should seek to develop more detailed conceptualizations of these behaviors to improve measurement, destigmatize emotional- and stress-eating and potentially capitalize on the strong identification with bored-eating by targeting this behavior for interventions.

Obese subjects involvement in a population-based survey: the use of information and communication technologies (ICT) to avoid stigmatization

BACKGROUND

Epidemiological and health promotion studies in obese subjects are hampered by the difficulty of obtaining a representative sample from the community. The enrollment process can be at high risk of stigmatization. The purpose of this study is to describe an original information and communication technologies (ICT) strategy to get around these ethical and methodological difficulties.

METHODS

A multimedia campaign of communication was organized on the topic of overweight and quality of life (QoL). A specific website was developed to collect via a questionnaire QoL data as well as information related to patient's needs and health perception from participants. To promote the website, multiple information supports were largely diffused. Primary care professionals were solicited to enhance the enrollment. The campaign started with a press conference covered by the main television channels.

RESULTS

The ICT-based approach allowed the participation of 4,155 subjects homogeneously distributed with respect to body mass index, age, gender and socioeconomic level. A high percentage of subjects fully completed the web-based questionnaire. The press conference allowed reaching a quarter of the total sample within 5 days.

CONCLUSIONS

Overweight remains a major public health problem. This survey showed that a holistic approach supported by ICT is a promising way to recruit obese subjects without stigmatizing the disorder.

Beyond BMI: The Next Chapter in Childhood Obesity Management

Pediatric obesity treatment has traditionally focused on body mass index (BMI) and has had limited success. Recent research has suggested new ways to approach this topic that focuses more on holistic measures of health and inclusion of a larger population of children. This paper discusses new evidence in the prevention of chronic disease and treatment of obesity that has a body positive and mental health lens as well as integrating research from several areas of health, including the prevention of chronic disease. Practical medical and mental health assessments tools are suggested for clinical use. Implications for an individualized, positive treatment future are presented.

Physiotherapists demonstrate weight stigma: a cross-sectional survey of Australian physiotherapists

QUESTION

Do physiotherapists demonstrate explicit and implicit weight stigma?

DESIGN

Cross-sectional survey with partial blinding of participants. PARTICIPANTS responded to the Anti-Fat Attitudes questionnaire and physiotherapy case studies with body mass index (BMI) manipulated (normal or overweight/obese). The Anti-Fat Attitudes questionnaire included 13 items scored on a Likert-type scale from 0 to 8. Any score greater than zero indicated explicit weight stigma. Implicit weight stigma was determined by comparing responses to case studies with people of different BMI categories (where responses were quantitative) and by thematic and count analysis for free-text responses.

PARTICIPANTS

Australian physiotherapists (n=265) recruited via industry networks.

RESULTS

The mean item score for the Anti-Fat Attitudes questionnaire was 3.2 (SD 1.1), which indicated explicit weight stigma. The Dislike (2.1, SD 1.2) subscale had a lower mean item score than the Fear (3.9, SD 1.8) and Willpower (4.9, SD 1.5) subscales. There was minimal indication from the case studies that people who are overweight receive different treatment from physiotherapists in clinical parameters such as length of treatment time (p=0.73) or amount of hands-on treatment (p=0.88). However, there were indications of implicit weight stigma in the way participants discussed weight in free-text responses about patient management.

CONCLUSION

Physiotherapists demonstrate weight stigma. This finding is likely to affect the way they communicate with patients about their weight, which may negatively impact their patients. It is recommended that physiotherapists reflect on their own attitudes towards people who are overweight and whether weight stigma influences treatment focus.

Prior doctor shopping resulting from differential treatment correlates with differences in current patient-provider relationships

OBJECTIVE

To determine the prevalence of doctor shopping resulting from differential treatment and to examine associations between this shopping and current primary care relationships.

METHODS

In 2012, a national internet-based survey of 600 adults receiving primary care in the past year with a BMI ≥ 25 kg/m(2) was conducted. Our independent variable was "switching doctors because I felt treated differently because of my weight." Logistic regression models to examine the association of prior doctor shopping with characteristics of current primary care relationships: duration, trust in primary care provider (PCP), and perceived PCP weight-related judgment, adjusted for patient factors were used.

RESULTS

Overall, 13% of adults with overweight/obesity reported previously doctor shopping resulting from differential treatment. Prior shoppers were more likely to report shorter durations of their current relationships [73% vs. 52%; p = 0.01] or perceive that their current PCP judged them because of their weight [74% vs. 11%; p < 0.01] than nonshoppers. No significant differences in reporting high trust in current PCPs were found.

CONCLUSIONS

A subset of patients with overweight/obesity doctor shop resulting from perceived differential treatment. These prior negative experiences have no association with trust in current relationships, but our results suggest that patients may remain sensitive to provider weight bias.

Body mass index (BMI)-for-age and health-related quality of life (HRQOL) among high school students in Tehran

BACKGROUND

The study aimed to determine the association between body mass index (BMI)-for-age and health-related quality of life (HRQOL) among high school students in Tehran.

METHODS

A total of 465 high school students (227 girls and 238 boys) and their parents were participated in this cross-sectional study. Body weight and height of the students were measured. For assessing HRQOL, both adolescent self-report and parent proxy-report of the Persian version of Pediatric Quality of Life Inventory (PedsQL™4.0) questionnaire were completed by adolescents and their parents respectively.

RESULTS

The prevalence of overweight and obesity (38.5%) was higher than severe thinness and thinness (2.8%). Mean of adolescent self-reported and parent proxy-reported HRQOL total score were 80.26 ± 12.07 and 81.30 ± 14.08 respectively. In terms of HRQOL subscale scores, the highest subscale score of HRQOL was reported in social functioning (87.27 ± 14.40) and the lowest score was reported in emotional functioning (69.83 ± 18.69). Based on adolescent self-report, adolescent boys had significantly higher mean score for total and all subscale scores of HRQOL compared with girls (P < 0.05). BMI-for-age was inversely correlated to adolescent self-reported HRQOL total score (r = -0.25, P < 0.05). Based on adolescents self-report, HRQOL total score was significantly different by body weight status (F = 16.16, P < 0.05). Normal weight adolescents had significantly higher HRQOL total score compared with overweight (mean difference: 7.32; P < 0.05) and obese adolescents (mean difference: 9.10, P < 0.05). The HRQOL total score was not significantly different between normal weight and underweight adolescents (mean difference: 1.65, P = 0.96). However, based on parent proxy-reports, HRQOL total score was not significantly different by body weight status (F = 2.64, P = 0.059).

CONCLUSION

More than one-third of adolescents were overweight and obese. BMI-for-age was inversely correlated to adolescent self-reported HRQOL. Based on adolescents' perspective, overweight and obese adolescents had poorer HRQOL compared with normal weight adolescents. Intervention studies are needed to improve the HRQOL of overweight and obese adolescents in Tehran.

Sex differences in adult outcomes by changes in weight status from adolescence to adulthood: results from Add Health

OBJECTIVE

Changes in weight status from adolescence to adulthood may be associated with varying social, vocational, economic, and educational outcomes, which may differ by sex. We studied whether there are differences in adult outcomes by sex for different weight status changes in the transition to adulthood.

METHODS

Using data from the National Longitudinal Study of Adolescent Health, participants were categorized by weight status from adolescence into adulthood. We examined self-reported outcomes in adulthood for living with parents, being married, being a parent, employment, receipt of public assistance, income, and college graduation by weight groupings (healthy-healthy, healthy-overweight/obese, overweight/obese-overweight/obese, overweight/obese-healthy). The effect of changes in weight status on the adult outcomes was modeled, controlling for sex, age, parental education, and race/ethnicity.

RESULTS

There were differences by sex for many of the self-reported outcomes, especially educational and economic outcomes. Female subjects who became overweight/obese between adolescence and adulthood or remained so had worse economic and educational findings as adults compared to male subjects.

CONCLUSIONS

Overall, for female subjects, becoming and remaining overweight/obese was associated with worse outcomes, while for male subjects, adolescent obesity was more important than isolated adult obesity. The relationship between obesity and life situations may be more negative for female subjects in the transition to adulthood. The findings emphasize that adolescent obesity, and not just obesity isolated in adulthood, is important for characteristics achieved in adulthood.

The weight-inclusive versus weight-normative approach to health: evaluating the evidence for prioritizing well-being over weight loss

Using an ethical lens, this review evaluates two methods of working within patient care and public health: the weight-normative approach (emphasis on weight and weight loss when defining health and well-being) and the weight-inclusive approach (emphasis on viewing health and well-being as multifaceted while directing efforts toward improving health access and reducing weight stigma). Data reveal that the weight-normative approach is not effective for most people because of high rates of weight regain and cycling from weight loss interventions, which are linked to adverse health and well-being. Its predominant focus on weight may also foster stigma in health care and society, and data show that weight stigma is also linked to adverse health and well-being. In contrast, data support a weight-inclusive approach, which is included in models such as Health at Every Size for improving physical (e.g., blood pressure), behavioral (e.g., binge eating), and psychological (e.g., depression) indices, as well as acceptability of public health messages. Therefore, the weight-inclusive approach upholds nonmaleficience and beneficience, whereas the weight-normative approach does not. We offer a theoretical framework that organizes the research included in this review and discuss how it can guide research efforts and help health professionals intervene with their patients and community.

'I'm not a druggie, I'm just a diabetic': a qualitative study of stigma from the perspective of adults with type 1 diabetes

OBJECTIVES

While health-related stigma has been the subject of considerable research in other conditions (eg, HIV/AIDS, obesity), it has not received substantial attention in diabetes. Our aim was to explore perceptions and experiences of diabetes-related stigma from the perspective of adults with type 1 diabetes mellitus (T1DM).

DESIGN

A qualitative study using semistructured interviews, which were audio recorded, transcribed and subject to thematic analysis.

SETTING

All interviews were conducted in non-clinical settings in metropolitan areas of Victoria, Australia.

PARTICIPANTS

Adults aged ≥18 years with T1DM living in Victoria were eligible to take part. Participants were recruited primarily through the state consumer organisation representing people with diabetes. A total of 27 adults with T1DM took part: 15 (56%) were women; median IQR age was 42 (23) years and diabetes duration was 15 (20) years).

RESULTS

Australian adults with T1DM perceive and experience T1DM-specific stigma as well as stigma-by-association with type 2 diabetes. Such stigma is characterised by blame, negative social judgement, stereotyping, exclusion, rejection and discrimination. Participants identified the media, family and friends, healthcare professionals and school teachers as sources of stigma. The negative consequences of this stigma span numerous life domains, including impact on relationships and social identity, emotional well-being and behavioural management of T1DM. This stigma also led to reluctance to disclose the condition in various environments. Adults with T1DM can be both the target and the source of diabetes-related stigma.

CONCLUSIONS

Stigmatisation is part of the social experience of living with T1DM for Australian adults. Strategies and interventions to address and mitigate this diabetes-related stigma need to be developed and evaluated.