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Meadows A, Higgs S. Challenging oppression: A social identity model of stigma resistance in higher-weight individuals. Body Image 2022; 42:237-245. [PMID: 35816967 DOI: 10.1016/j.bodyim.2022.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 06/07/2022] [Accepted: 06/07/2022] [Indexed: 11/15/2022]
Abstract
Many higher-weight individuals have internalised societal weight stigma, devaluing themselves because of their weight. Rejecting and challenging societal devaluation is generally associated with superior outcomes compared with stigma internalisation or inaction; however, stigma resistance has not been studied in higher-weight individuals, despite ubiquitous weight stigma in daily life. Applying a social identity framework, we utilised decision tree analysis to explore predictors of responses to weight stigma in 931 self-classified higher-weight individuals. While ingroup identification with the group 'Fat' was the major predictor of stigma resistance (versus internalisation), perceived illegitimacy of societal weight stigma defined a subgroup of resisters even in the absence of group identity. Interventions focusing on the illegitimacy of unequal social status and treatment may be effective at reducing internalisation and fostering resistance in a population with characteristically low ingroup identity.
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Affiliation(s)
- Angela Meadows
- Department of Psychology, University of Essex, Colchester CO4 3SQ, UK.
| | - Suzanne Higgs
- School of Psychology, University of Birmingham, Birmingham B15 2TT, UK
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52
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Bennett BL, Wagner AF, Latner JD. Body Checking and Body Image Avoidance as Partial Mediators of the Relationship between Internalized Weight Bias and Body Dissatisfaction. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9785. [PMID: 36011420 PMCID: PMC9408144 DOI: 10.3390/ijerph19169785] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/06/2022] [Accepted: 08/08/2022] [Indexed: 06/15/2023]
Abstract
Internalized weight bias is associated with body image disturbances and the development of disordered eating. The association between weight bias internalization and body dissatisfaction has proven difficult to disrupt. In order to develop more effective interventions, we must identify the behavioral targets which account for this robust association. The present study sought to examine whether body checking and body image avoidance mediate the relationship between weight bias internalization and body dissatisfaction. In total, 279 female undergraduates (Mage = 20.13, SD = 4.10) were administered a battery of survey measures. Results demonstrated that body checking partially mediates the relationship between weight bias internalization and body dissatisfaction, Z = 7.42, p < 0.001. Body image avoidance was also found to partially mediate the relationship between weight bias internalization and body dissatisfaction, Z = 70.03, p < 0.001. These findings suggest that body checking and body image avoidance may both partially account for the association between weight bias internalization and body dissatisfaction. These findings extend the existing literature on weight bias internalization by highlighting two behavioral targets for prevention and intervention efforts. Understanding these relationships has important implications for both reducing weight bias internalization and improving body dissatisfaction.
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Affiliation(s)
- Brooke L. Bennett
- Rudd Center for Food Policy & Health, University of Connecticut, Hartford, CT 06103, USA
| | - Allison F. Wagner
- Counseling and Psychological Services, University of California San Diego, La Jolla, CA 92093, USA
| | - Janet D. Latner
- Department of Psychology, University of Hawai‘i at Mānoa, Honolulu, HI 96822-2294, USA
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53
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Jiwanmall SA, Kattula D, Nandyal MB, Parvathareddy S, Kirubakaran R, Jebasingh F, Paul TV, Thomas NJ, Kapoor N. Weight Stigma in Patients With Obesity and Its Clinical Correlates: A Perspective From an Indian Bariatric Clinic. Cureus 2022; 14:e26837. [PMID: 35974866 PMCID: PMC9375229 DOI: 10.7759/cureus.26837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2022] [Indexed: 11/11/2022] Open
Abstract
Introduction Obesity being a global epidemic, currently has several adverse health outcomes. Weight stigma is a significant barrier to delivering quality services and also impairs clinical progress. We intended to study the association of stigma with demographic and clinical variables in obese patients to identify the obstacles in treatment-seeking, so stigma could be adequately addressed to improve clinical outcomes. Methods This study was a retrospective chart review in a Bariatric clinic in a tertiary care hospital. The weight self-stigma questionnaire (WSSQ) was routinely used in the clinic. Demographic and clinical data were collected for 146 obese patients. Results Female patients (73%) had higher stigma scores. The mean total stigma score was 41.6(SD 3.83), the total self-devaluation score was 21.88(SD 2.10), total fear of enacted stigma was 21.26(SD 2.33). Multivariate analysis revealed an association between stigma with multiple dysfunctional eating patterns like bingeing, overeating, and grazing (Adjusted aOR 3.86, 95% CI- 1.66-8.96) and psychiatric diagnosis (adjusted aOR 3.00, CI- 1.25-7.17). Conclusion This study found an association between stigma and certain clinical variables that maintain and worsen obesity and comorbid psychiatric diagnoses. This highlights the importance of an assessment of mental health and stigma in general practice when dealing with patients with obesity. Treating the underlying psychiatric comorbidities and addressing unhealthy eating behaviors can help reduce self-stigma. Stigma is a barrier to treatment-seeking that needs to be addressed in the community.
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54
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Atchison A, Zickgraf HF. Orthorexia nervosa and eating disorder behaviors: A systematic review of the literature. Appetite 2022; 177:106134. [PMID: 35750289 DOI: 10.1016/j.appet.2022.106134] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 05/13/2022] [Accepted: 06/08/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Orthorexia nervosa (ON) involves obsessive thoughts about healthy eating and distress related to this obsession. There is still dispute over whether ON should be considered on the obsessive-compulsive spectrum, the eating disorder (ED) spectrum, or as its own disorder. Based on current research, orthorexic behaviors seem to be closely related to eating disorder behaviors. However, given the range of instruments used to measure ED and ON, and the lack of consistency in the specific ED domains explored, a review of the current literature is warranted. OBJECTIVE The objective of this study was to review the literature relating ON and ED symptoms in an effort to understand the nature of their relationship, and to identify ED symptom domains most closely related to ON. METHODS A search was conducted on PubMed, Science Direct, and Web of Science using the term "orthorexia" and at least one of the following: "anorexia nervosa," "bulimia nervosa," "eating disorder," "arfid," "restrictive," "body image," "weight concern," "shape concern." After exclusion criteria were applied, 42 articles were included in the review. RESULTS The results indicated that ON is consistently related to both trait and disordered restrictive eating symptoms of anorexia nervosa, and weight control motivations for food choice. However, ON was less consistently related to binge-spectrum eating disorder symptoms, emotional eating, uncontrolled eating, or body dissatisfaction/shape and weight concerns. CONCLUSION The finding that ON symptoms are related to restraint and weight loss efforts, but not to body dissatisfaction or dysregulated eating suggests that ON may represent a distinct ED.
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Affiliation(s)
- Anna Atchison
- University of South Alabama, Department of Psychology, Mobile, AL, 36688, USA.
| | - Hana F Zickgraf
- University of South Alabama, Department of Psychology, Mobile, AL, 36688, USA
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55
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Rathbone JA, Jetten J, Cruwys T. Perceived legitimacy of weight-based discrimination: Consequences for group identity, collective action, body satisfaction, and self-esteem. Body Image 2022; 41:156-162. [PMID: 35259654 DOI: 10.1016/j.bodyim.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 02/07/2022] [Indexed: 10/18/2022]
Abstract
The present research applied the social identity approach to examine how the perceived legitimacy of weight-based discrimination among ingroup members influences their experience of their higher-weight identity and their well-being, and the conditions under which this occurs. Specifically, we investigated whether portraying weight-based discrimination as legitimate, as opposed to illegitimate, influenced higher-weight individuals' group identification, intentions to engage in collective action on behalf of their group, and their body satisfaction and self-esteem. The moderating role of group boundary permeability and the mediating role of group identification were also examined. North American adults with a self-reported BMI of or above 30 (N = 327) were randomly assigned to one of two experimental conditions: weight-based discrimination that was portrayed as legitimate or illegitimate by other ingroup members. Results revealed that portraying weight-based discrimination as being perceived as legitimate (versus illegitimate) among ingroup members significantly reduced group identification, but only among those who perceived their group's boundaries to be more permeable. For this particular group, reduced identification predicted, in turn, lower collective action intentions, body satisfaction, and self-esteem. This study highlights the damaging effect of legitimized discrimination for ingroup identification and the downstream consequences for collective action and well-being.
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Affiliation(s)
- Joanne A Rathbone
- Research School of Psychology, The Australian National University, Canberra, ACT 2601, Australia.
| | - Jolanda Jetten
- School of Psychology, The University of Queensland, St Lucia, Brisbane, QLD 4072, Australia
| | - Tegan Cruwys
- Research School of Psychology, The Australian National University, Canberra, ACT 2601, Australia
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56
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Levy M, Kakinami L, Alberga AS. The relationship between weight bias internalization and healthy and unhealthy weight control behaviours. Eat Weight Disord 2022; 27:1621-1632. [PMID: 35201546 DOI: 10.1007/s40519-021-01291-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/23/2021] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Weight bias internalization (WBI) is associated with disordered eating symptomology and motivation to control weight. The relationship between WBI and specific weight control behaviours and how these behaviours differ between men and women is not well understood. The objectives of this study are to determine (1) the relationship between WBI and weight control behaviours, (2) whether weight perception is independently associated with weight control behaviours, and (3) whether these relationships differ between men and women. METHODS Canadian adults (N = 161; 52.8% women; body mass index [BMI] = 26.5 ± 4.99 kg/m2) completed questionnaires pertaining to WBI, weight control behaviours (healthy, unhealthy, extreme) and weight perception (accurate, under-, or over-estimation compared with objectively measured BMI). The cross-sectional relationship between (1) WBI or (2) weight perception with the total number of healthy and unhealthy or extreme weight control behaviours, and likelihood of performing specific weight control behaviours were assessed with linear, and logistic regression models, respectively. All analyses were conducted adjusting for age, gender, and race. Subsequent analyses were stratified by sex. RESULTS WBI was associated with an increased likelihood of performing exercise for weight loss (OR 2.28, p < 0.05); increased likelihood of skipping meals in women (OR 2.57, p < 0.01), and consuming little amounts of food and food substitutes in men (OR 2.28, p < 0.01 and OR 2.17, p < 0.05, respectively). Weight perception was not associated with weight control behaviours. CONCLUSIONS WBI was associated with various weight control behaviours. This study highlights the importance of assessing WBI in clinical practice with patients seeking to manage their weight. Future longitudinal research should be conducted to further understand the behavioural and health effects from WBI. LEVEL V Cross-sectional descriptive study.
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Affiliation(s)
- Matthew Levy
- Department of Health, Kinesiology and Applied Physiology, Concordia University, 7141 Sherbrooke St West, SP 165.31, Montreal, QC, H4B 1R6, Canada
| | - Lisa Kakinami
- Department of Mathematics and Statistics, Concordia University, 1455 Boulevard de Maisonneuve West, Montreal, QC, H3G 1M8, Canada.,PERFORM Centre, Concordia University, 7200 Sherbrooke St West, Montreal, QC, H4B 1R6, Canada
| | - Angela S Alberga
- Department of Health, Kinesiology and Applied Physiology, Concordia University, 7141 Sherbrooke St West, SP 165.31, Montreal, QC, H4B 1R6, Canada. .,PERFORM Centre, Concordia University, 7200 Sherbrooke St West, Montreal, QC, H4B 1R6, Canada.
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57
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Cardel MI, Newsome FA, Pearl RL, Ross KM, Dillard JR, Miller DR, Hayes JF, Wilfley D, Keel PK, Dhurandhar EJ, Balantekin KN. Patient-Centered Care for Obesity: How Health Care Providers Can Treat Obesity While Actively Addressing Weight Stigma and Eating Disorder Risk. J Acad Nutr Diet 2022; 122:1089-1098. [PMID: 35033698 PMCID: PMC10056599 DOI: 10.1016/j.jand.2022.01.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 11/10/2021] [Accepted: 01/11/2022] [Indexed: 02/01/2023]
Affiliation(s)
- Michelle I Cardel
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL; WW International, Inc., New York, NY.
| | - Faith A Newsome
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL
| | - Rebecca L Pearl
- Department of Clinical and Health Psychology, University of Florida College of Public Health and Health Professions, Gainesville, FL
| | - Kathryn M Ross
- Department of Clinical and Health Psychology, University of Florida College of Public Health and Health Professions, Gainesville, FL
| | - Julia R Dillard
- University of Toledo, College of Medicine and Life Sciences, Toledo, OH
| | - Darci R Miller
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL
| | - Jacqueline F Hayes
- Weight Control and Diabetes Research Center at the Miriam Hospital and Department of Psychiatry and Human Behavior, Brown University, Providence, RI
| | - Denise Wilfley
- Washington University in St Louis, College of Medicine, St Louis, MO
| | - Pamela K Keel
- Department of Psychology, Florida State University, Tallahassee, FL
| | | | - Katherine N Balantekin
- Department of Exercise and Nutrition Sciences, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY
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58
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Sturgess CMB, Stinson DA. Fat embodiment for resistance and healing from weight stigma. Body Image 2022; 41:52-57. [PMID: 35228103 DOI: 10.1016/j.bodyim.2022.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 02/07/2022] [Indexed: 10/19/2022]
Abstract
Western culture is a decidedly anti-fat culture. Thus fat people are subjected to weight stigma and confront discrimination in virtually every facet of their lives. As a result, fat people often develop a self-concept that includes the stigmatized social identity. Weight stigma is also a traumatic experience that disrupts fat people's embodiment by diminishing feelings of attunement to and appreciation for their bodies. Therefore, healing from the trauma of weight stigma may involve developing a more positive fat identity through a process of fat embodiment. Fat embodiment may improve fat people's well-being by bolstering the integrity of the self, supporting efforts to resist public stigma and heal internalized stigma. In our analysis of embodied approaches to resistance and healing, we draw on social and clinical psychology and the works of public fat scholars and activists. We describe methods of fat embodiment like embracing bodily needs, engaging with fat-positive perspectives, connecting with fat community, and embracing desire and sensual pleasure. Ultimately, we conclude that transforming a negative fat identity into a positive identity through fat embodiment can support the pursuit of justice for fat bodies, connect fat people to their bodily needs and sensations, and support increased self-care and bodily fulfillment.
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59
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Brown A, Flint SW, Batterham RL. Pervasiveness, impact and implications of weight stigma. EClinicalMedicine 2022; 47:101408. [PMID: 35497065 PMCID: PMC9046114 DOI: 10.1016/j.eclinm.2022.101408] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/21/2022] [Accepted: 04/01/2022] [Indexed: 12/14/2022] Open
Abstract
UNLABELLED Evidence has accumulated to demonstrate the pervasiveness, impact and implications of weight stigma. As such, there is a need for concerted efforts to address weight stigma and discrimination that is evident within, policy, healthcare, media, workplaces, and education. The continuation of weight stigma, which is known to have a negative impact on mental and physical health, threatens the societal values of equality, diversity, and inclusion. This health policy review provides an analysis of the research evidence highlighting the widespread nature of weight stigma, its impact on health policy and the need for action at a policy level. We propose short- and medium-term recommendations to address weight stigma and in doing so, highlight the need change across society to be part of efforts to end weight stigma and discrimination. FUNDING None.
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Affiliation(s)
- Adrian Brown
- UCL Centre for Obesity Research, University College London, London, Greater London, United Kingdom
- Bariatric Centre for Weight Management and Metabolic Surgery, University College London Hospital NHS Trust, London, Greater London, United Kingdom
- National Institute of Health Research, UCLH Biomedical Research Centre, London, Greater London, United Kingdom
| | - Stuart W. Flint
- School of Psychology, University of Leeds, Leeds, West Yorkshire LS2 9JU, United Kingdom
- Scaled Insights, Nexus, University of Leeds, Leeds, West Yorkshire United Kingdom
- Corresponding author at: School of Psychology, University of Leeds, Leeds, West Yorkshire LS2 9JU, United Kingdom.
| | - Rachel L. Batterham
- UCL Centre for Obesity Research, University College London, London, Greater London, United Kingdom
- Bariatric Centre for Weight Management and Metabolic Surgery, University College London Hospital NHS Trust, London, Greater London, United Kingdom
- National Institute of Health Research, UCLH Biomedical Research Centre, London, Greater London, United Kingdom
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60
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Argyrides M, Charalambous Z, Anastasiades E, Michael K. Translation and validation of the Greek version of the Modified Weight Bias Internalization Scale in an adult population. Clin Obes 2022; 12:e12503. [PMID: 34964553 DOI: 10.1111/cob.12503] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/14/2021] [Accepted: 12/06/2021] [Indexed: 02/02/2023]
Abstract
Weight bias internalization (WBI) has been identified as a global public health concern, which is associated with significant psychological and physical consequences. Despite increased interest in WBI worldwide, cross-cultural research is limited by the lack of availability of validated measures. The aim of the current study was therefore to translate into Greek and validate the Modified Weight Bias Internalization Scale (WBIS-M), the most widely used instrument in the measurement of WBI. An online convenience sample of 642 participants (364 women and 278 men) completed the Greek translation of the WBIS-M and validated the measures of satisfaction with appearance, investment in appearance, weight/appearance anxiety, body appreciation, dysfunctional eating habits and global self-esteem to assess convergent validity. Principal factor and confirmatory analyses revealed that the WBIS-M upheld its one-factor structure. The WBIS-M showed adequate internal consistency, convergent validity and 3-week test-retest reliability. These findings provide support for the cross-cultural equivalence of the WBIS-M and for the utility of this measure in Greek-speaking populations.
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Affiliation(s)
- Marios Argyrides
- Department of Psychology, Neapolis University Pafos, Pafos, Cyprus
| | - Zoe Charalambous
- Department of Psychology, Neapolis University Pafos, Pafos, Cyprus
| | | | - Katerina Michael
- Department of Psychology, Neapolis University Pafos, Pafos, Cyprus
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61
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Myre M, Glenn NM, Berry TR. Experiences of Size Inclusive Physical Activity Settings Among Women With Larger Bodies. RESEARCH QUARTERLY FOR EXERCISE AND SPORT 2022:1-10. [PMID: 35344473 DOI: 10.1080/02701367.2021.1983515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 09/17/2021] [Indexed: 06/14/2023]
Abstract
Purpose: Size inclusive physical activity settings may help mitigate the impact of physical activity-related weight stigma. In this interpretive description study, we aimed to understand how women with larger bodies experienced size inclusive physical activity settings. The study was informed by a settings-based approach to health promotion. Method: We interviewed nine women with larger bodies who participated in size inclusive physical activity and used an inductive approach to analyze the data. Findings: At the individual level, size inclusion was experienced as an enhancement of well-being, self-worth, and belonging. This was closely tied to the interpersonal level, whereby weight-neutral practices used by fitness instructors and lack of judgment from other exercisers contributed to experiences of size inclusion. At the organizational level, the organization's culture, marketing, programs, and physical spaces could enhance or limit inclusion and participation. However, weight stigma was prevalent in women's experiences outside the physical activity setting. Conclusion: We provide recommendations to improve size inclusion in physical activity settings.
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62
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Puhl RM. Weight stigma, policy initiatives, and harnessing social media to elevate activism. Body Image 2022; 40:131-137. [PMID: 34953387 DOI: 10.1016/j.bodyim.2021.12.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 12/16/2021] [Indexed: 01/27/2023]
Abstract
Efforts to promote positive body image and body acceptance confront considerable challenges in the face of pervasive societal stigma against people who have a high body weight or large body size. Despite decades of evidence documenting the prevalence and harmful consequences of weight stigma and discrimination, policies to address this social injustice are lacking and primarily absent. This article summarizes the current status of policies to address societal weight-based mistreatment and highlights evidence documenting public support for different types of policies and laws that could be implemented to reduce weight-based bullying and discrimination. While considerable public policy support is present, efforts to scale up activism are needed to help curtail societal weight stigma. Social media has been an underutilized approach that could provide a powerful platform to elevate public awareness and promote policy change to help eliminate weight stigma.
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Affiliation(s)
- Rebecca M Puhl
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA; Rudd Center for Food Policy and Health, University of Connecticut, One Constitution Plaza, Suite 600, Hartford, CT 06103, USA.
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63
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Romano KA, Heron KE, Sandoval CM, Howard LM, MacIntyre RI, Mason TB. A meta-analysis of associations between weight bias internalization and conceptually-related correlates: A step towards improving construct validity. Clin Psychol Rev 2022; 92:102127. [PMID: 35074712 PMCID: PMC8858873 DOI: 10.1016/j.cpr.2022.102127] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 11/15/2021] [Accepted: 01/09/2022] [Indexed: 12/13/2022]
Abstract
Weight bias internalization (WBI), a process of weight-based self-devaluation, has been associated with adverse mental and physical health. However, there are limitations with the existing conceptualization and operationalization of WBI that raise questions about the implications of this evidence-base. To address these limitations, the present study investigated the construct validity of WBI by conducting a meta-analysis of associations between WBI (as currently operationalized) and conceptually-related correlates. Studies identified through October 2021 that provided zero-order correlations for associations between WBI and conceptually-related constructs were examined. Meta-regression determined whether these associations differed across WBI measures and demographic (age, sex/gender, race, BMI) and study-level (publication status, sample type, study quality) moderators. Data for 128 (sub)samples were identified (Msample size = 477.83, SD = 1679.90; Mage = 34.46, SD = 12.17; range = 10.21-56.60). Greater WBI exhibited large to very large associations with factors suggested to have considerable overlap with this construct (negative and positive body image, self-devaluation), general and weight-specific experiential avoidance, and individuals' anticipation of future weight stigma. Associations varied for other constructs that have been differentially included in conceptualizations of WBI (endorsing weight bias, weight stigma stereotype awareness, weight stigma experiences), and via measurement-related, demographic, and study-level factors. These findings provide important information that can advance WBI conceptualization and measure-refinement.
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Affiliation(s)
- Kelly A. Romano
- The Virginia Consortium Program in Clinical Psychology, Norfolk, VA, USA
| | - Kristin E. Heron
- The Virginia Consortium Program in Clinical Psychology, Norfolk, VA, USA,Department of Psychology, Old Dominion University, Norfolk, VA, USA
| | | | - Lindsay M. Howard
- Department of Psychology, Augustana University, Sioux Falls, SD, USA
| | | | - Tyler B. Mason
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
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64
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Busetto L, Sbraccia P, Vettor R. Obesity management: at the forefront against disease stigma and therapeutic inertia. Eat Weight Disord 2022; 27:761-768. [PMID: 34052990 PMCID: PMC8933346 DOI: 10.1007/s40519-021-01217-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 05/17/2021] [Indexed: 12/12/2022] Open
Abstract
Obesity is a complex chronic relapsing disease, resulting from the interaction between multiple environmental, genetic and epigenetic causes, and supported by changes in the neuroendocrine mechanisms regulating energy balance and body weight. Adipose tissue dysfunction contributes to obesity-related complications. However, the prevalent narrative about the causes and mechanisms of obesity remains a much more simplistic one, based on the false assumption that individuals can fully control their body weight through appropriate behavioural choices. According to this narrative, obesity is simply reversible "persuading" the patient to follow healthier and more virtuous individual behaviours (moral judgement). This persistent narrative forms the deep root of the stigmatisation of people with obesity at the individual level and creates a clear discrepancy on how obesity prevention and cure are designed in comparison with the case of other non-communicable chronic diseases (clinical stigma). The promotion of systemic preventive measures against obesity is not supported at a political and social level by the persistence of a narrative of obesity as the simple consequence of individual failures and lack of willpower. The simplistic narrative of obesity as a self-imposed condition with an easy way-out ("eat less and move more") creates a clear discrepancy on how obesity is managed by health care systems in comparison with other NCDs. The over-estimation of the efficacy of therapeutic intervention solely based on patients education and lifestyle modification is responsible of therapeutic inertia in health care professionals and in clinical guidelines, limiting or delaying the adoption of more effective therapeutic strategies, like anti-obesity medications and bariatric surgery. In conclusion, the persistence of a narrative describing obesity as a self-induced easily reversible condition has profound consequences on how obesity prevention and management are build, including the design and implementation of obesity management guidelines and a tendency to therapeutic inertia.Level of evidence: No level of evidence.
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Affiliation(s)
- Luca Busetto
- Department of Medicine, University of Padova, Padua, Italy.
- Clinica Medica 3, Azienda Ospedale-Università di Padova, Via Giustiniani 2, 35128, Padua, Italy.
| | - Paolo Sbraccia
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Roberto Vettor
- Department of Medicine, University of Padova, Padua, Italy
- Clinica Medica 3, Azienda Ospedale-Università di Padova, Via Giustiniani 2, 35128, Padua, Italy
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65
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Panza E, Lillis J, Olson K, van den Berg JJ, Tashima K, Wing RR. HIV Status, Obesity, and Risk for Weight Stigma: Comparing Weight Stigma Experiences and Internalization Among Adults with Obesity with and Without HIV. AIDS Behav 2022; 26:686-697. [PMID: 34396464 PMCID: PMC8840952 DOI: 10.1007/s10461-021-03428-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2021] [Indexed: 10/20/2022]
Abstract
Little is known about weight stigma among people living with HIV (PLWH). This study examined whether levels of perceived weight stigma experiences and internalization, assessed retrospectively and naturalistically, differed among adults with obesity based on HIV status. 50 PLWH (BMI = 35 kg/m2) and 51 adults without HIV (BMI = 36 kg/m2) completed retrospective assessments of lifetime perceived weight stigma experiences/internalization. Next, participants were invited to complete an optional 2-week Ecological Momentary Assessment study. 28 PLWH and 39 adults without HIV completed five momentary assessments of perceived weight stigma experiences/internalization daily. In covariate-adjusted models, PLWH reported 1.2-2.8 times lower frequency of lifetime and momentary perceived weight stigma experiences than adults without HIV, but levels of retrospectively- and naturalistically-assessed internalized weight stigma did not differ between groups. Findings suggest that HIV status may buffer against perceptions of weight stigma events, but not internalized weight stigma, highlighting weight stigma as an important area for future research in PLWH.
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Affiliation(s)
- Emily Panza
- Weight Control and Diabetes Research Center, The Miriam Hospital, 196 Richmond Street, Providence, RI, 02903, USA.
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | - Jason Lillis
- Weight Control and Diabetes Research Center, The Miriam Hospital, 196 Richmond Street, Providence, RI, 02903, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - KayLoni Olson
- Weight Control and Diabetes Research Center, The Miriam Hospital, 196 Richmond Street, Providence, RI, 02903, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Jacob J van den Berg
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- The Providence/Boston Center for AIDS Research (CFAR), Providence, RI, USA
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Karen Tashima
- The Providence/Boston Center for AIDS Research (CFAR), Providence, RI, USA
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
- The Miriam Hospital Immunology Center, The Miriam Hospital, Providence, RI, USA
| | - Rena R Wing
- Weight Control and Diabetes Research Center, The Miriam Hospital, 196 Richmond Street, Providence, RI, 02903, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
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66
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Verhaak AMS, Ferrand J, Puhl RM, Tishler DS, Papasavas PK, Umashanker D. Experienced weight stigma, internalized weight bias, and clinical attrition in a medical weight loss patient sample. Int J Obes (Lond) 2022; 46:1241-1243. [PMID: 35173281 PMCID: PMC8852855 DOI: 10.1038/s41366-022-01087-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 01/21/2022] [Accepted: 02/01/2022] [Indexed: 11/09/2022]
Abstract
Background Limited research has explored the relationship between weight bias and clinical attrition, despite weight bias being associated with negative health outcomes. Participants/method Experienced weight stigma (EWS), internalized weight bias (IWB), and clinical attrition were studied in a Medical Weight Loss clinic, which combines pharmacological and behavioral weight loss. Patient sociodemographic, medical, and psychological (depression) variables were measured at consultation, and clinic follow-ups were monitored for 6 months. IWB was assessed with the Weight Bias Internalization Scale Modified (WBIS-M). Results Two-thirds (66%) of study participants returned for follow-up appointments during the 6-month period (“continuers”), while 34% did not return after the initial consultation (“dropouts”). Clinic “dropouts” had higher WBIS-M scores at initial consultation than “continuers,” (χ2(1) = 4.56; p < 0.05). No other variables were related to clinical attrition. Average WBIS-M scores (4.57) were similar to other bariatric patient studies, and were associated with younger age (t = −2.27, p < 0.05), higher depression (t = 2.65, p < 0.01), and history of EWS (t = 2.14, p < 0.05). Conclusion Study findings indicate that IWB has significant associations with clinical attrition. Additional research is warranted to further explore the relationships between EWS, IWB, and medical clinic engagement.
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Affiliation(s)
- Allison M S Verhaak
- Division of Health Psychology, The Institute of Living/Hartford Hospital, Hartford, CT, USA. .,Hartford HealthCare Headache Center, Ayer Neuroscience Institute, Hartford, CT, USA.
| | - Jennifer Ferrand
- Division of Health Psychology, The Institute of Living/Hartford Hospital, Hartford, CT, USA.,Wellness Department/Medical Affairs, Hartford HealthCare, Hartford, CT, USA
| | - Rebecca M Puhl
- University of Connecticut Rudd Center for Food Policy & Health; Department of Human Development and Family Sciences, University of Connecticut, Hartford, CT, USA
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67
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Braun TD, Unick JL, Abrantes AM, Dalrymple K, Conboy LA, Schifano E, Park CL, Lazar S. Intuitive eating buffers the link between internalized weight stigma and body mass index in stressed adults. Appetite 2022; 169:105810. [PMID: 34813916 PMCID: PMC9434977 DOI: 10.1016/j.appet.2021.105810] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 11/05/2021] [Accepted: 11/14/2021] [Indexed: 02/03/2023]
Abstract
Internalized weight stigma (IWS) is independently associated with less intuitive eating (i.e., eating based on endogenous hunger/satiety cues) and higher Body Mass Index (BMI), and intuitive eating training is commonly conceptualized as protective against the effects of IWS on poor behavioral health. The 3-way relationship between IWS, intuitive eating, and BMI has yet to be examined, and it is unclear whether the link between IWS and BMI is buffered by high intuitive eating. This secondary preliminary analysis examined baseline data of stressed adults with poor diet (N = 75, 70% female, 64.1% White, 42.7% with overweight/obesity) in a parent clinical trial that tested the effects of yoga on diet and stress. Validated self-report surveys of IWS and intuitive eating were analyzed with objectively-assessed BMI. Moderated regression analyses using the SPSS PROCESS macro tested whether intuitive eating moderated the IWS-BMI link. The analysis revealed IWS was positively associated with BMI except among people with high intuitive eating. Results extend observational findings linking intuitive eating to lower BMI, and offer preliminary support for the hypothesis that this link may hold even among those with greater IWS. It's possible that individuals with lower BMI and greater IWS may gravitate more towards intuitive eating than those with greater BMI, and/or intuitive eating may be an important target for ameliorating the adverse association of IWS with behavioral and physical health indicators linked to BMI. Continued work is warranted in larger, more generalizable samples using causal and prospective designs.
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Affiliation(s)
- Tosca D. Braun
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Storrs, CT 06269-1020,Department of Psychiatry and Human Behavior, Alpert Medical School of Medicine at Brown University,Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 196 Richmond St., Providence, RI, 02903
| | - Jessica L. Unick
- Department of Psychiatry and Human Behavior, Alpert Medical School of Medicine at Brown University,Weight Control and Diabetes Research Center, The Miriam Hospital, 196 Richmond St., Providence, RI, 02903
| | - Ana M. Abrantes
- Department of Psychiatry and Human Behavior, Alpert Medical School of Medicine at Brown University,Behavioral Medicine and Addictions Research, Butler Hospital
| | - Kristy Dalrymple
- Department of Psychiatry and Human Behavior, Alpert Medical School of Medicine at Brown University,Lifespan Physician’s Group, 146 West River Street, Suite 11B, Providence, RI 02904
| | - Lisa A. Conboy
- Department of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston MA 02215,New England School of Acupuncture, Massachusetts College of Pharmacy and Health Sciences
| | - Elizabeth Schifano
- Department of Statistics, University of Connecticut, 215 Glenbrook Road U4120, Storrs, CT 06269
| | - Crystal L. Park
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Storrs, CT 06269-1020
| | - Sara Lazar
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit St., Boston, MA,Department of Psychology, Harvard Medical School
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68
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Simply too much: the extent to which weight bias internalization results in a higher risk of eating disorders and psychosocial problems. Eat Weight Disord 2022; 27:317-324. [PMID: 33826118 PMCID: PMC8860958 DOI: 10.1007/s40519-021-01170-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/12/2021] [Indexed: 10/25/2022] Open
Abstract
PURPOSE Weight bias internalization (WBI) is associated with negative health consequences such as eating disorders and psychosocial problems in children. To date, it is unknown to what extent WBI considerably raises the risk of negative outcomes. METHODS Analyses are based on cross-sectional data of 1,061 children (9-13 years, M = 11, SD = 0.9; 52.1% female) who filled in the WBI scale (WBIS-C). First, ROC analyses were run to identify critical cut-off values of WBI (WBIS-C score) that identify those who are at higher risk for psychosocial problems or eating disorder symptoms (as reported by parents). Second, it was examined whether WBI is more sensitive than the relative weight status in that respect. Third, to confirm that the cut-off value is also accompanied by higher psychological strain, high- and low-risk groups were compared in terms of their self-reported depressive symptoms, anxious symptoms, body dissatisfaction, and self-esteem. RESULTS WBIS-C scores ≥ 1.55 were associated with a higher risk of disturbed eating behavior; for psychosocial problems, no cut-off score reached adequate sensitivity and specificity. Compared to relative weight status, WBI was better suited to detect disturbed eating behavior. Children with a WBIS-C score ≥ 1.55 also reported higher scores for both depressive and anxious symptoms, higher body dissatisfaction, and lower self-esteem. CONCLUSION The WBIS-C is suitable for identifying risk groups, and even low levels of WBI are accompanied by adverse mental health. Therefore, WBI is, beyond weight status, an important risk factor that should be considered in prevention and intervention. LEVEL OF EVIDENCE Level III, cross-sectional analyses based on data taken from a well-designed, prospective cohort study.
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69
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Bograd S, Chen B, Kavuluru R. Tracking sentiments toward fat acceptance over a decade on Twitter. Health Informatics J 2022; 28:14604582211065702. [PMID: 34986689 DOI: 10.1177/14604582211065702] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The fat acceptance (FA) movement aims to counteract weight stigma and discrimination against individuals who are overweight/obese. We developed a supervised neural network model to classify sentiment toward the FA movement in tweets and identify links between FA sentiment and various Twitter user characteristics. We collected any tweet containing either "fat acceptance" or "#fatacceptance" from 2010-2019 and obtained 48,974 unique tweets. We independently labeled 2000 of them and implemented/trained an Average stochastic gradient descent Weight-Dropped Long Short-Term Memory (AWD-LSTM) neural network that incorporates transfer learning from language modeling to automatically identify each tweet's stance toward the FA movement. Our model achieved nearly 80% average precision and recall in classifying "supporting" and "opposing" tweets. Applying this model to the complete dataset, we observed that the majority of tweets at the beginning of the last decade supported FA, but sentiment trended downward until 2016, when support was at its lowest. Overall, public sentiment is negative across Twitter. Users who tweet more about FA or use FA-related hashtags are more supportive than general users. Our findings reveal both challenges to and strengths of the modern FA movement, with implications for those who wish to reduce societal weight stigma.
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Affiliation(s)
- Sadie Bograd
- 326741Paul Laurence Dunbar High School, Lexington, KY USA
| | - Benjamin Chen
- 326741Paul Laurence Dunbar High School, Lexington, KY, USA
| | - Ramakanth Kavuluru
- Department of Internal Medicine, 4530University of Kentucky, Lexington, KY, USA
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70
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Jalaba S, Trudeau H, Carlson S. Obesity Prevention. PHYSICIAN ASSISTANT CLINICS 2022. [DOI: 10.1016/j.cpha.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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71
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Lemmon G, Jensen JM, Kuljanin G. A primer with purpose: Research implications of the objectification of weight in the workplace. JOURNAL OF OCCUPATIONAL AND ORGANIZATIONAL PSYCHOLOGY 2021. [DOI: 10.1111/joop.12378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Grace Lemmon
- Department of Management & Entrepreneurship DePaul University Chicago Illinois USA
| | - Jaclyn M. Jensen
- Department of Management & Entrepreneurship DePaul University Chicago Illinois USA
| | - Goran Kuljanin
- Department of Management & Entrepreneurship DePaul University Chicago Illinois USA
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72
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Incollingo Rodriguez AC, Nagpal TS. The WOMBS Framework: A review and new theoretical model for investigating pregnancy-related weight stigma and its intergenerational implications. Obes Rev 2021; 22:e13322. [PMID: 34288364 DOI: 10.1111/obr.13322] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/30/2021] [Indexed: 11/30/2022]
Abstract
As the growing weight stigma literature has developed, one critically relevant and vulnerable population has received little consideration-pregnant and postpartum women. Because weight fluctuations are inherent to this life phase, and rates of prepregnancy overweight and obesity are already high, this gap is problematic. More recently, however, there has been a rising interest in pregnancy-related weight stigma and its consequences. This paper therefore sought to (a) review the emerging research on pregnancy-related weight stigma phenomenology and (b) integrate this existing evidence to present a novel theoretical framework for studying pregnancy-related weight stigma. The Weight gain, Obesity, Maternal-child Biobehavioral pathways, and Stigma (WOMBS) Framework proposes psychophysiological mechanisms linking pregnancy-related weight stigmatization to increased risk of weight gain and, in turn, downstream childhood obesity risk. This WOMBS Framework highlights pregnant and postpartum women as a theoretically unique at-risk population for whom this social stigma engages maternal physiology and transfers obesity risk to the child via social and physiological mechanisms. The WOMBS Framework provides a novel and useful tool to guide the emerging pregnancy-related weight stigma research and, ultimately, support stigma-reduction efforts in this critical context.
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Affiliation(s)
- Angela C Incollingo Rodriguez
- Psychological & Cognitive Sciences, Department of Social Science & Policy Studies, Worcester Polytechnic Institute, Worcester, Massachusetts, USA
| | - Taniya S Nagpal
- Department of Kinesiology, Faculty of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada
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73
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Hopkins CM, Miller HN, Brooks TL, Mo-Hunter L, Steinberg DM, Bennett GG. Designing Ruby: Protocol for a 2-Arm, Brief, Digital Randomized Controlled Trial for Internalized Weight Bias. JMIR Res Protoc 2021; 10:e31307. [PMID: 34842549 PMCID: PMC8663559 DOI: 10.2196/31307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/26/2021] [Accepted: 08/28/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Weight bias internalization, also known as weight self-stigma, is a serious health concern for individuals with higher body weight. Weight bias internalization is associated with the greater avoidance of health care and health-promoting activities, disordered eating, social isolation, and weight gain. Elevated weight bias internalization has been associated with low self-compassion, yet few investigations have explored self-compassion as a potential mechanism for reducing internalized weight bias. OBJECTIVE Ruby is a 2-arm randomized controlled trial that was designed to test the efficacy of a 4-week digital self-compassion intervention to reduce internalized weight bias compared with a wait-list control. METHODS Adults with elevated internalized weight bias and a BMI of >30 kg/m2 (N=80) were recruited. Ruby is a standalone digital trial that will be delivered entirely via a smartphone and will involve web-based data collection and text messages. The intervention content will include psychoeducation and daily mindfulness practices with a focus on self-compassion and body concerns. We will use intent-to-treat analyses to examine changes in weight bias internalization throughout time by treatment arm. The analyses will be conducted by using one-way analysis of covariance models and linear mixed models. RESULTS The protocol was designed in May 2020 and approved in December 2020. Data collection is currently underway. CONCLUSIONS Ruby will be the first digital standalone, self-compassion-based intervention designed to reduce internalized weight bias. Owing to its standalone digital delivery, Ruby may be a highly scalable treatment for internalized weight bias that can be delivered on its own or combined with other treatments. We expect Ruby to be accessible to many, as participants can access the digital intervention at times of the day that are the most convenient in their schedule and are not burdened by in-person time commitments, which can be a barrier for participants with competing demands on their time and resources. If efficacious, Ruby will be poised to expand a burgeoning body of literature related to psychological intervention in this area. TRIAL REGISTRATION ClinicalTrials.gov NCT04678973; https://clinicaltrials.gov/ct2/show/NCT04678973. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/31307.
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Affiliation(s)
- Christina M Hopkins
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States
| | - Hailey N Miller
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States.,School of Nursing, Duke University, Durham, NC, United States
| | - Taylor L Brooks
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States
| | - Lihua Mo-Hunter
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States
| | - Dori M Steinberg
- School of Nursing, Duke University, Durham, NC, United States.,Equip Health, San Diego, CA, United States
| | - Gary G Bennett
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States
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74
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Almutairi BF, Alsaygh KW, Altamimi MM, Alshammari AS, Alsomali AM, Alanazi SM, Alzahrani SM, Alsaad AS, Zacharakis G. Internalized Weight Stigma: Prevalence and Association With Psychiatric Disorder Among Overweight and Obese Individuals. Cureus 2021; 13:e18577. [PMID: 34760420 PMCID: PMC8572015 DOI: 10.7759/cureus.18577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2021] [Indexed: 01/31/2023] Open
Abstract
Background and objective Unlike weight stigma, internalized weight stigma (IWS) may be a common but still underreported problem. With the recent emergence of studies investigating its various aspects in Arab-speaking countries, there is still scant data on its incidence and severity in the literature. In light of this, the aim of this study was to evaluate the prevalence of IWS and its association with psychiatric disorders and sociodemographic factors among overweight and obese individuals in a sample from a Saudi population. Methods A cross-sectional study was conducted among a Saudi population using a convenience sample technique and 868 individuals were enrolled to participate in this study. They were asked to fill out an electronic questionnaire about IWS, demographics, and other parameters such as Patient Health Questionnaire (PHQ)-9 and General Anxiety Disorder (GAD)-7. The association was tested using an independent t-test and chi-square test. Results The overall prevalence of internalized stigma in this study was 57%. Higher levels of internalization were more prevalent among younger respondents. We found that females were more prone to internalize weight stigma, at a slightly higher rate than males (59.26% vs. 53.66%), but this difference was not statistically significant. The other sociodemographic factors associated with higher internalization were as follows: being widowed, married, retired, or housewife. Those with higher IWS levels were individuals with higher BMI and with previous experiences of weight stigma. In addition, higher internalization was associated with the development of severe depression and anxiety (p<0.001). Conclusion The prevalence of IWS among overweight and obese individuals was found to be high, and it is highly associated with the development of severe depression and anxiety. There is a need to raise awareness about obesity stigma to help tackle IWS in overweight and obese individuals and to promote their quality of life.
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Affiliation(s)
| | - Khaled W Alsaygh
- Psychiatry, Prince Sattam Bin Abdulaziz University, Al Kharj, SAU
| | - Mazen M Altamimi
- Psychiatry, Prince Sattam Bin Abdulaziz University, Al Kharj, SAU
| | | | - Ahmed M Alsomali
- Psychiatry, Prince Sattam Bin Abdulaziz University, Al Kharj, SAU
| | - Sultan M Alanazi
- Psychiatry, Prince Sattam Bin Abdulaziz University, Al Kharj, SAU
| | - Saud M Alzahrani
- Psychiatry, Prince Sattam Bin Abdulaziz University, Al Kharj, SAU
| | - Ameer S Alsaad
- Psychiatry, Prince Sattam Bin Abdulaziz University, Al Kharj, SAU
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75
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Abstract
Weight bias and stigma exist in a variety of realms in our society (media, education, employment, and health care), and unfortunately many view it as a socially acceptable form of discrimination. Patients with obesity often avoid scheduling appointments for health promotion visits and routine care due to perceived weight bias and stigma from their health care provider. Within the health care setting, it is important that health care providers strategically focus on reducing obesity bias and provide high-quality obesity management. People-first language should be used and waiting rooms and examination rooms should be accommodating to people of all sizes.
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76
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Lawson JL, LeCates A, Ivezaj V, Lydecker J, Grilo CM. Internalized weight bias and loss-of-control eating following bariatric surgery. Eat Disord 2021; 29:630-643. [PMID: 32182194 PMCID: PMC7494529 DOI: 10.1080/10640266.2020.1731920] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Internalized weight bias (IWB), or negative weight related self-evaluation, is associated with eating-disorder psychopathology and common among patients seeking bariatric surgery, but little is known about the clinical presentation of IWB post-operatively. This study examined IWB and clinical correlates among adult patients with loss-of-control (LOC) eating post-sleeve gastrectomy surgery. METHODS Participants (N = 145) were sleeve gastrectomy patients seeking treatment for eating/weight concerns and experiencing regular LOC eating approximately 6 months following surgery. Eating-disorder features were assessed with the Eating Disorder Examination-Bariatric Surgery Version interview (EDE-BSV) and participants completed established measures assessing IWB, depression, and mental and physical components of quality of life. RESULTS IWB was not associated significantly with percent excess weight loss, age, or gender, but White participants reported significantly greater IWB than Non-White participants. IWB was significantly associated with greater eating-disorder psychopathology, depression, and lower perceived mental quality of life. Hierarchical regression analysis revealed that IWB significantly predicted variance in eating-disorder psychopathology above and beyond other related variables. CONCLUSIONS Findings suggest that IWB is common and associated with a range of heightened eating-disorder and psychosocial difficulties among patients experiencing LOC eating following bariatric surgery. Future research exploring the longitudinal post-operative prognostic significance of IWB is recommended.
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Affiliation(s)
- Jessica L Lawson
- Psychology Service, VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Psychiatry Department, Yale School of Medicine, New Haven, Connecticut, USA
| | - Abigail LeCates
- Psychology Department, Amherst College, Amherst, Massachusetts, USA
| | - Valentina Ivezaj
- Psychiatry Department, Yale School of Medicine, New Haven, Connecticut, USA
| | - Janet Lydecker
- Psychiatry Department, Yale School of Medicine, New Haven, Connecticut, USA
| | - Carlos M Grilo
- Psychiatry Department, Yale School of Medicine, New Haven, Connecticut, USA.,Psychiatry Department, Yale University, New Haven, Connecticut, USA
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77
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Mooney SJ, Song L, Drewnowski A, Buskiewicz J, Mooney SD, Saelens BE, Arterburn DE. From the clinic to the community: Can health system data accurately estimate population obesity prevalence? Obesity (Silver Spring) 2021; 29:1961-1968. [PMID: 34605194 PMCID: PMC8571026 DOI: 10.1002/oby.23273] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 07/28/2021] [Accepted: 08/02/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Health system data were assessed for how well they can estimate obesity prevalence in census tracts. METHODS Clinical visit data were available from two large health systems (Kaiser Permanente Washington and University of Washington Medicine) in King County, Washington, as were census tract-level obesity prevalence estimates from the Behavioral Risk Factor Surveillance System (BRFSS). The health system data were geocoded to identify each patient's tract of residence, and the cross-sectional concordance between census tract-level obesity prevalence estimates computed from the two health systems in 2005 to 2006 and the concordance between University of Washington Medicine and BRFSS from 2012 to 2016 were assessed. RESULTS The spatial distribution of obesity was similar between the health systems (Spearman r = 0.63). The University of Washington Medicine estimates of rank order correlated well with BRFSS estimates (Spearman r = 0.85), though prevalence estimates from BRFSS were lower (mean obesity prevalence = 26% for University of Washington Medicine versus 20% for BRFSS, Wilcoxon rank sum test p < 0.001). Across all data sources, obesity was more prevalent in tracts with less educational attainment. CONCLUSIONS Health system clinical weight data can reliably replicate census tract-level spatial patterns in the ranking of obesity prevalence. Health system data may be an efficient resource for geographic obesity surveillance.
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Affiliation(s)
- Stephen J Mooney
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Lin Song
- Seattle-King County Public Health, Seattle, Washington, USA
| | - Adam Drewnowski
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Center for Public Health Nutrition, School of Public Health, University of Washington, Seattle, Washington, USA
| | - James Buskiewicz
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Sean D Mooney
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, USA
| | - Brian E Saelens
- Seattle Children's Research Institute, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - David E Arterburn
- Kaiser Permanente Washington Research Institute, Seattle, Washington, USA
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78
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Schulte EM, Bach C, Berkowitz RI, Latner JD, Pearl RL. Adverse Childhood Experiences and Weight Stigma: Co-Occurrence and Associations with Psychological Well-Being. STIGMA AND HEALTH 2021; 6:408-418. [PMID: 34926807 PMCID: PMC8675894 DOI: 10.1037/sah0000341] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Prior research has demonstrated that individuals with a higher body weight (i.e., obesity) have a relatively high incidence of adverse childhood experiences (ACEs) (e.g., abuse, neglect). Individuals with obesity are also susceptible to experiencing and internalizing weight stigma. Negative physical and mental health consequences have been associated with both ACEs and weight stigma, yet the interplay between these factors has not been explored. The current study examined ACEs in a sample of 105 treatment-seeking adults with obesity who all reported having experienced and internalized weight stigma (90.5% women, 70.5% non-Hispanic White, mean age=49.1 years). The study aimed to 1) provide a descriptive overview of rates of ACEs in this unique sample of adults with potentially high psychological vulnerability and 2) assess associations between ACEs, weight stigma, and psychological well-being. Over three-fourths of participants (76.2%) reported experiencing at least one ACE. The total number of ACEs was significantly associated with more frequent experiences of and greater distress about weight stigma during childhood, as well as higher current perceived stress. Experiencing weight stigma for the first time in childhood was also associated with more reported ACEs. ACEs of abuse were associated with more lifetime reported experiences of weight stigma and greater internalization, use of eating as a strategy to cope with weight stigma, and higher perceived stress. These findings have implications for early identification of and tailored interventions for individuals who have experienced adverse events and weight stigma at a young age.
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Affiliation(s)
- Erica M. Schulte
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA USA
| | - Caroline Bach
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA USA
| | - Robert I. Berkowitz
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA USA
- Department of Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Janet D. Latner
- Department of Psychology, University of Hawaii at Manoa, Honolulu, HI USA
| | - Rebecca L. Pearl
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA USA
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL USA
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79
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Stewart SJF, Ogden J. Motivating or stigmatising? The public health and media messaging surrounding COVID-19 and obesity: a qualitative think aloud study. HEALTH EDUCATION 2021. [DOI: 10.1108/he-04-2021-0067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Purpose
The purpose of this study is to explore how individuals with overweight and obesity living in the UK respond to the public health and media messaging surrounding COVID-19 and obesity.
Design/methodology/approach
Qualitative interview study with a think aloud protocol. A total of 10 participants self-reported to have overweight, obesity or as actively trying to lose weight were recruited through social media and were asked to think aloud whilst exposed to four sets of public health and media materials describing the link between COVID-19 and obesity. Interviews were conducted over zoom, recorded and transcribed verbatim.
Findings
Three primary themes were identified through thematic analysis: “flawed messaging”, “COVID-19 as a teachable moment” and “barriers to change”. Transcending these themes was the notion of balance. Whilst the messaging around COVID-19 and obesity was deemed problematic; for some, it was a teachable moment to facilitate change when their future self and physical health was prioritised. Yet, when focussing on their mental health in the present participants felt more overwhelmed by the barriers and were less likely to take the opportunity to change.
Practical implications
Findings hold implications for public health messaging, highlighting the need for balance between being educational and informative but also supportive, so as to achieve maximum efficacy.
Originality/value
This study offers a novel and useful insight into how the public health and media messaging concerning COVID-19 risk and obesity is perceived by those with overweight and obesity.
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80
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Pearl RL, Puhl RM, Himmelstein MS, Pinto AM, Foster GD. Weight Stigma and Weight-Related Health: Associations of Self-Report Measures Among Adults in Weight Management. Ann Behav Med 2021; 54:904-914. [PMID: 32333673 DOI: 10.1093/abm/kaaa026] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Weight stigma impairs health. Few studies have disentangled the associations of experienced versus internalized stigma with weight-related outcomes. PURPOSE To examine weight and health variables associated with weight stigma experiences and internalization in the largest-to-date sample of adults in weight management. METHODS WW (formerly Weight Watchers) members (N = 18,769, 94.6% female, 91.1% white) completed an online survey from 2017 to 2018. Participants reported whether they had experienced weight stigma and, if so, the onset, past-year frequency and distress, and interpersonal sources of stigma. Participants completed the Modified Weight Bias Internalization Scale (WBIS-M) and self-reported: past-year weight and lifetime weight cycles; current self-monitoring behaviors; eating self-efficacy; physical activity; perceived stress; eating to cope; body image; and mental and physical health-related quality-of-life (HRQOL). Participants reported their demographic characteristics, including height and weight to compute body mass index. RESULTS In logistic and linear regression analyses (controlling for participant characteristics), WBIS-M scores were negatively associated with weight loss, self-monitoring, eating self-efficacy, body image, and mental HRQOL and positively associated with weight gain, weight cycling, perceived stress, and eating to cope (p < .001). Experiencing weight stigma was associated with greater weight loss and less weight gain, although associations with other variables had small effect sizes (absolute β values < 0.10). WBIS-M scores remained significantly associated with all variables when including stigma onset, frequency/distress, and sources. CONCLUSIONS Internalized, but not experienced, weight stigma was consistently associated with adverse weight and health factors. Developing and testing interventions targeting internalized stigma in the context of weight management should be a research priority.
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Affiliation(s)
- Rebecca L Pearl
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Rebecca M Puhl
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA.,Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT, USA
| | - Mary S Himmelstein
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT, USA.,Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - Angela M Pinto
- Science Department, WW (formerly Weight Watchers) International, Inc., New York, NY, USA.,Department of Psychology, Baruch College, City University of New York, New York, NY, USA
| | - Gary D Foster
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Science Department, WW (formerly Weight Watchers) International, Inc., New York, NY, USA
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81
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Petersen JM, Durward C, Levin M. Weight-related psychological inflexibility as a mediator between weight self-stigma and health-related outcomes. Bull Menninger Clin 2021; 85:316-330. [PMID: 34468211 DOI: 10.1521/bumc.2021.85.3.316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Weight self-stigma, the internalization of negative societal stereotypes, is a problem among populations with high weight. Weight self-stigma is associated with psychological inflexibility and maladaptive health-related behaviors. In this study, the authors explore how weight-related psychological inflexibility may influence weight self-stigma and health-related outcomes in 79 adults with high weight. Participants were primarily White (92.4%) and female (82.3%), with an average age of 39.56 years and average body mass index of 33.78. The study uses baseline, self-report data from a larger trial. Results indicate that weight self-stigma was negatively correlated with maladaptive eating behaviors, weight, and mental health. Weight-related psychological inflexibility was found as a significant mediator for the relationship between weight self-stigma and emotional eating, sedentary behavior, and mental health. Weight-related psychological inflexibility did not mediate the relationships between weight self-stigma and other eating measures and physical activity. These results support targeting weight-related psychological inflexibility and weight self-stigma in interventions.
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Affiliation(s)
- Julie M Petersen
- Doctoral student, Department of Psychology at Utah State University, Logan, Utah
| | - Carrie Durward
- Associate professor, Department of Psychology at Utah State University, Logan, Utah
| | - Michael Levin
- Associate professor, Department of Psychology at Utah State University, Logan, Utah
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82
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Puhl RM, Lessard LM, Pearl RL, Himmelstein MS, Foster GD. International comparisons of weight stigma: addressing a void in the field. Int J Obes (Lond) 2021; 45:1976-1985. [PMID: 34059785 DOI: 10.1038/s41366-021-00860-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 04/22/2021] [Accepted: 05/06/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND/OBJECTIVES Despite substantial evidence documenting weight stigma toward people with higher body weight, international comparative studies are lacking in this field. The few studies that have compared weight stigma across different countries focus on explicit weight-biased attitudes rather than people's experiences of weight stigma. The present study conducted a multinational systematic comparison of weight stigma in six countries to assess experiences and interpersonal sources of weight stigma. SUBJECTS/METHODS Adults (N = 13,996) enrolled in WW International (formerly Weight Watchers), residing in Australia, Canada, France, Germany, the UK, and the US completed identical online anonymous surveys in the dominant language for their country. Surveys assessed their history of experiencing weight stigma, the onset of stigmatizing experiences and associated distress from stigma in different time periods, and interpersonal sources of weight stigma. RESULTS More than half of participants (55.6-61.3%) across countries reported experiencing weight stigma. Participants with higher BMI were significantly more likely to report weight-stigmatizing experiences than individuals with lower BMI. In all countries, weight stigma experiences were most frequent in childhood and adolescence, with associated distress highest during these time periods. Participants in Germany reported a higher frequency of weight stigma across their whole life, but lower distress associated with stigmatizing experiences, compared to participants in the other five countries. High percentages of participants in each country experienced weight stigma from family members (76.0-87.8%), classmates (72.0-80.9%), doctors (62.6-73.5%), co-workers (54.1-61.7%), and friends (48.8-66.2%). CONCLUSIONS Weight stigma is prevalent for adults actively engaged in weight management across different Western countries. There were more similarities than differences in the nature, frequency, and interpersonal sources of people's experiences of weight stigma across the six countries in this study. Findings underscore the need for multinational initiatives to address weight stigma and interventions to support individuals engaged in weight management who experience weight mistreatment.
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Affiliation(s)
- Rebecca M Puhl
- Department of Human Development & Family Sciences, University of Connecticut, Storrs, CT, USA. .,Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT, USA.
| | - Leah M Lessard
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT, USA
| | - Rebecca L Pearl
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Mary S Himmelstein
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - Gary D Foster
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,WW International, Inc., New York, NY, USA
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83
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Althumiri NA, Basyouni MH, AlMousa N, AlJuwaysim MF, Alhamdan AA, Al-Qahtani FS, BinDhim NF, Alqahtani SA. Exploring Weight Stigma in Saudi Arabia: A Nationwide Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9141. [PMID: 34501731 PMCID: PMC8430631 DOI: 10.3390/ijerph18179141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 08/09/2021] [Accepted: 08/26/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Weight stigma (WS) in the Middle East, especially in Saudi Arabia, is widely ignored. People with obesity are blamed for their weight, and there is a common perception that weight stigmatization is justifiable and may motivate individuals to adopt healthier behaviors. The authors of this study aimed to explore WS prevalence and factors associated with WS in a large nationwide study of Saudi Arabian adults. METHODS This study was a nationwide cross-sectional survey conducted via phone interviews in June 2020. A proportional quota-sampling technique was adopted to obtain equal distributions of participants by age and sex across the 13 regions of Saudi Arabia. In total, 6239 people were contacted, and 4709 (75.48%) responded and completed the interview. The authors of the study collected data about WS using the Arabic Weight Self-Stigma Questionnaire (WSSQ), BMI, smoking, nutritional knowledge, bariatric surgery, risk of depression, and demographic variables. RESULTS Participants had a mean age of 36.4 ± 13.5 (18-90), and 50.1% were female. The prevalence of higher WS was 46.4%. Among other risk factors, there was a significant association between WS and obesity (odds ratio (OR): 3.93; 95% CI: 2.83-5.44; p < 0.001), waterpipe smoking (OR: 1.80; 95% CI: 1.20-2.69; p < 0.001), bariatric surgery (OR: 2.07; 95% CI: 1.53-2.81; p < 0.001), and risk of depression (OR: 1.68; 95% CI: 1.36-2.09; p < 0.001). CONCLUSION This was the first study to explore WS and its associated factors among adults in a community setting in Saudi Arabia. This study revealed some risk factors associated with WS that may help to identify people at risk of WS and to develop interventions to reduce WS, such as improving nutritional knowledge, correcting the ideas about bariatric surgery and obesity in general, and ceasing waterpipe smoking.
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Affiliation(s)
- Nora A. Althumiri
- Sharik Association for Health Research, Riyadh 13326, Saudi Arabia; (M.H.B.); (N.A.); (M.F.A.); (N.F.B.)
| | - Mada H. Basyouni
- Sharik Association for Health Research, Riyadh 13326, Saudi Arabia; (M.H.B.); (N.A.); (M.F.A.); (N.F.B.)
- Ministry of Health, Riyadh 11176, Saudi Arabia
| | - Norah AlMousa
- Sharik Association for Health Research, Riyadh 13326, Saudi Arabia; (M.H.B.); (N.A.); (M.F.A.); (N.F.B.)
- Public Health College, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Mohammed F. AlJuwaysim
- Sharik Association for Health Research, Riyadh 13326, Saudi Arabia; (M.H.B.); (N.A.); (M.F.A.); (N.F.B.)
- Pharmacy College, King Faisal University, AlAhsa 31982, Saudi Arabia
| | - Adel A. Alhamdan
- Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11362, Saudi Arabia;
| | - Faisal Saeed Al-Qahtani
- Department of Family & Community Medicine, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia;
| | - Nasser F. BinDhim
- Sharik Association for Health Research, Riyadh 13326, Saudi Arabia; (M.H.B.); (N.A.); (M.F.A.); (N.F.B.)
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
- Saudi Food and Drug Authority, Riyadh 13513, Saudi Arabia
| | - Saleh A. Alqahtani
- Liver Transplant Unit, King Faisal Specialist Hospital & Research Centre, Riyadh 11211, Saudi Arabia;
- Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, MD 21218, USA
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84
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Macho S, Andrés A, Saldaña C. Validation of the modified weight bias internalization scale in a Spanish adult population. Clin Obes 2021; 11:e12454. [PMID: 33821573 DOI: 10.1111/cob.12454] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 03/08/2021] [Accepted: 03/18/2021] [Indexed: 01/29/2023]
Abstract
Weight bias internalization has received considerable attention in recent years and has been associated with serious psychological and physical consequences in Westernized societies. The modified weight bias internalization scale (WBIS-M) is one of the most frequently used instruments for assessing internalized weight stigma across different body weight categories. The aim of this study was to adapt the WBIS-M for use in Spanish adult populations. The sample consisted of 678 participants from the Spanish general population recruited through the internet, 79.6% of whom were women. The scale was translated into Spanish and then backtranslated. To study the internal structure, a cross-validation analysis was carried out including both exploratory and confirmatory factor analyses to assess the scale's psychometric properties. Internal consistency was evaluated using Cronbach's alpha and McDonald's omega and a test-retest was conducted to assess one-month stability. Results confirmed that the Spanish adaptation of the WBIS-M is an 11-item unidimensional scale, like the original version and shows excellent psychometric properties. In conclusion, the Spanish WBIS-M version seems to be a robust psychometric tool for use in clinical and research settings.
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Affiliation(s)
- Sergio Macho
- Department of Clinical Psychology and Psychobiology. Faculty of Psychology, University of Barcelona, Barcelona, Spain
| | - Ana Andrés
- Faculty of Psychology, Education and Sport Sciences, Ramon Llull University, Blanquerna, Barcelona, Spain
| | - Carmina Saldaña
- Department of Clinical Psychology and Psychobiology. Faculty of Psychology, University of Barcelona, Barcelona, Spain
- Neuroscience Institute, University of Barcelona, Barcelona, Spain
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85
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Rostanzo E, Aloisi AM. Food addiction assessment in a nonclinical sample of the Italian population. Eur J Clin Nutr 2021; 76:477-481. [PMID: 34211122 DOI: 10.1038/s41430-021-00974-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/10/2021] [Accepted: 06/22/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Discussion about the potential addictive role of certain types of food and their link with obesity has recently increased. Researchers have developed instruments to specifically assess food addiction (FA). The aim of this pilot study was to investigate the prevalence of food addiction in a nonclinical sample of the Italian population. METHODS All participants (n = 148: 46 males, 102 females) completed the Yale Food Addiction Scale 2.0 (YFAS 2.0) and provided self-reported measures and demographic information. They were divided into three age groups. RESULTS The prevalence of FA was 15.5% of our sample (82.6% of the subjects diagnosed with FA were female). The FA symptoms mean was 1.90 (SD = 2.87). In both sexes, participants aged 18-30 had the highest diagnosis of FA, with 52.1% of all FA subjects being females aged 18-30. According to the Body Mass Index (BMI), all the males diagnosed with FA were overweight or obese, as were most (63.2%) of the FA females. CONCLUSIONS Future food education policies could consider FA assessment together with that of other eating disorders, even among nonclinical subjects in order to anticipate diagnosis and improve treatment.
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Affiliation(s)
- Elvira Rostanzo
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Anna Maria Aloisi
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy.
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86
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Internalized weight bias and cortisol reactivity to social stress. COGNITIVE AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2021; 20:49-58. [PMID: 31654234 DOI: 10.3758/s13415-019-00750-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Weight-associated stigmatization and discrimination may induce chronic stress in individuals with obesity. As a consequence, this stressor may cause an imbalance of HPA stress axis leading to increased eating behavior, and ultimately, weight gain. However, the direct link between internalized weight bias and stress response to acute stressors via cortisol secretion has not been investigated so far. Therefore, the purpose of this study was to investigate the interaction between internalized weight stigma as a stressor and cortisol reactivity in an acute psychosocial stress situation induced by the Trier Socials Stress Test for groups (TSST-G). Participants with BMI >30 kg/m2 (n = 79) were included in the study. Results reveal that while individuals with low internalized stigma reacted as predicted with an increase in cortisol secretion to acute psychosocial stress, individuals with medium or high internalized stigma did not show a typical cortisol response. However, these findings depend on the several factors, for instance on gender. In sum, acute stress in individuals with internalized weight bias seems to blunt HPA axis reactions to acute psychosocial stress. The study contributes to the understanding of the psychological and endocrinological consequences of internalized weight bias and underlines the importance of interventions to reduce stigmatization.
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87
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Examining associations among weight stigma, weight bias internalization, body dissatisfaction, and eating disorder symptoms: Does weight status matter? Body Image 2021; 37:38-49. [PMID: 33556915 PMCID: PMC8187267 DOI: 10.1016/j.bodyim.2021.01.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 01/20/2021] [Accepted: 01/20/2021] [Indexed: 02/07/2023]
Abstract
The present study aimed to expand weight stigma theoretical models by accounting for central tenets of prominent eating disorder (ED) theories and increasing the generalizability of existing models for individuals across the weight spectrum. College students (Sample 1: N = 1228; Sample 2: N = 1368) completed online surveys assessing stigma and ED symptoms. In each sample, separately, multi-group path analyses tested whether body mass index (BMI) classification (underweight/average weight, overweight, obese) moderated a model wherein weight stigma experiences were sequentially associated with weight bias internalization, body dissatisfaction, and five ED symptoms: binge eating, purging, restricting, excessive exercise, muscle building behaviors. Results supported the assessed model overall and for individuals in each BMI class, separately. Although patterns of associations differed for individuals with different BMIs, these variations were limited. The present findings suggest that the adverse impact of weight stigma on distinct ED symptoms is not limited to individuals with elevated BMIs and that these associations are generally explained by the same mechanisms. Weight stigma interventions that focus on decreasing weight bias internalization and body dissatisfaction are recommended for individuals across the weight spectrum. Further examination of associations between weight stigma and multiple ED symptoms, beyond disinhibited eating, is supported.
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88
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Becker CB, Middlemas K, Gomez F, Kilpela LS. An exploratory examination of internalized weight stigma in a sample living with food insecurity. Body Image 2021; 37:238-245. [PMID: 33770554 PMCID: PMC8991369 DOI: 10.1016/j.bodyim.2021.03.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 02/25/2021] [Accepted: 03/06/2021] [Indexed: 11/19/2022]
Abstract
Internalized weight stigma (IWS) is associated with various health concerns, regardless of body size. One weakness of existing IWS research is that it largely lacks diverse study populations. One recent exception, however, found increasing IWS was associated with higher levels of food insecurity (FI) in a low-income, majority Latinx sample. Using the same sample (N = 530), the present study further explored levels of IWS as compared to documented (mostly White/European) samples; we also investigated IWS in relation to three dichotomous eating disorder (ED) outcomes (e.g., any/no vomiting). Finally, based on previous qualitative findings regarding dietary restraint in the most severe level of FI, we explored the independent contribution of dietary restraint and IWS to cross-sectional risk of ED pathology. Results indicated that individuals living with FI experience IWS at concerning levels. Additionally, IWS played a small yet significant role in cross-sectional risk for ED pathology regardless of FI severity, while dietary restraint contributed to independent risk only in those with the most severe FI. Findings suggest that IWS is prevalent in this marginalized population, associated with ED pathology, and that the effect of dietary restraint on risk for ED pathology appears to uniquely impact those living with severe FI.
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Affiliation(s)
| | - Keesha Middlemas
- Department of Political Science, Howard University, United States
| | | | - Lisa Smith Kilpela
- Barshop Institute for Longevity and Aging Studies, Research to Advance Community Health Center, Department of Psychiatry and Behavioral Sciences, UT Health San Antonio, United States
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89
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Keirns NG, Tsotsoros CE, Addante S, Layman HM, Krems JA, Pearl RL, Janet Tomiyama A, Hawkins MA. Adverse Childhood Experiences Associated with Greater Internalization of Weight Stigma in Women with Excess Weight. OBESITIES 2021; 1:49-57. [PMID: 35463808 PMCID: PMC9033161 DOI: 10.3390/obesities1010005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Adverse childhood experiences (ACEs) may be an early life factor associated with adult weight stigma via biological (e.g., stress response), cognitive (e.g., self-criticism/deprecation), and/or emotional (e.g., shame) mechanisms. This pilot study investigated relationships between ACEs and internalized and experienced weight stigma in adult women with overweight/obesity and explored differential relationships between weight stigma and ACE subtypes (i.e., abuse, neglect, household dysfunction). Adult women (68% white, M age = 33 ± 10 years, M BMI = 33.7 ± 7.2 kg/m2) completed measures of ACEs (ACE Questionnaire), internalized weight stigma (IWS; Weight Bias Internalization Scale-Modified; WBIS-M), and lifetime experiences of weight stigma (yes/no). Data were analyzed with linear and logistic regression (n = 46), adjusting for age, race, and body mass index (BMI). Linear regressions revealed a positive association between ACE and WBIS-M scores (β = 0.40, p = 0.006), which was driven by Abuse-type ACEs (β = 0.48, p = 0.009). Relationships between WBIS-M scores and Neglect- and Household-Dysfunction-type ACEs did not reach significance (β = 0.20, p = 0.173; β = -0.16, p = 0.273). Though descriptive statistics revealed greater rates of experienced weight stigma endorsement by those with high-3+ ACEs (81%) vs. medium-1-2 ACEs (67%) or low/no-0 ACEs (60%), ACE scores were not significantly associated with experienced weight stigma in logistic regression (Wald = 1.36, p = 0.244, OR = 1.324, 95%, CI = 0.825-2.125). ACEs may be an early life factor that increase the risk for internalizing weight stigma in adulthood. Larger studies should confirm this relationship and follow-up on descriptive findings suggesting a potential association between ACEs and experienced weight stigma.
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Affiliation(s)
- Natalie G. Keirns
- Department of Psychology, Oklahoma State University, 116 Psychology Building, Stillwater, OK 74078, USA
| | - Cindy E. Tsotsoros
- Department of Psychology, Oklahoma State University, 116 Psychology Building, Stillwater, OK 74078, USA
| | - Samantha Addante
- Department of Psychology, Oklahoma State University, 116 Psychology Building, Stillwater, OK 74078, USA
| | - Harley M. Layman
- Department of Psychology, Oklahoma State University, 116 Psychology Building, Stillwater, OK 74078, USA
| | - Jaimie Arona Krems
- Department of Psychology, Oklahoma State University, 116 Psychology Building, Stillwater, OK 74078, USA
| | - Rebecca L. Pearl
- Department of Clinical and Health Psychology, University of Florida, 1225 Center Drive, Gainesville, FL 32610, USA
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 3108, Philadelphia, PA 19104, USA
| | - A. Janet Tomiyama
- Department of Psychology, University of California, A623 Franz Hall, 501 Portola Plaza, Los Angeles, CA 90095, USA
| | - Misty A.W. Hawkins
- Department of Psychology, Oklahoma State University, 116 Psychology Building, Stillwater, OK 74078, USA
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90
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Lessard LM, Puhl RM, Himmelstein MS, Pearl RL, Foster GD. Eating and Exercise-Related Correlates of Weight Stigma: A Multinational Investigation. Obesity (Silver Spring) 2021; 29:966-970. [PMID: 34029444 DOI: 10.1002/oby.23168] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/11/2021] [Accepted: 03/03/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Weight stigma is prevalent across the world. However, little is known about whether and how the harmful health consequences of weight stigma may vary across countries. The current study examined the association between experiences of weight stigma and multiple eating and exercise-related indicators among a large, multinational sample of adults. METHODS Adults enrolled in an international weight management program residing in Australia, Canada, France, Germany, the United Kingdom, and the United States completed identical Web-based surveys in the dominant language for their country. Participants (N = 13,996) reported on their personal experiences of weight stigma and health, including eating behaviors, attitudes toward exercise, and perceived stress. RESULTS More than half of all participants in each country reported experiencing weight stigma. Participants who had experienced weight stigma reported engaging in more eating to cope, gym avoidance, and self-monitoring behaviors, as well as higher levels of stress and reduced eating self-efficacy. These associations were documented over and above sociodemographic characteristics and BMI and did not vary across countries. CONCLUSIONS Study findings document uniform health-related correlates of weight stigma within a multinational context and underscore the need for global initiatives to curtail weight stigma in order to support population health.
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Affiliation(s)
- Leah M Lessard
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, Connecticut, USA
| | - Rebecca M Puhl
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, Connecticut, USA
- Department of Human Development & Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Mary S Himmelstein
- Department of Psychological Sciences, Kent State University, Kent, Ohio, USA
| | - Rebecca L Pearl
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gary D Foster
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- WW International, Inc, New York, New York, USA
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91
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Beach body ready? Shredding for summer? A first look at "seasonal body image". Body Image 2021; 37:269-281. [PMID: 33756298 DOI: 10.1016/j.bodyim.2021.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 02/25/2021] [Accepted: 03/03/2021] [Indexed: 01/25/2023]
Abstract
We introduce the term "seasonal body image" to refer to within-person variation in body image that occurs across the Gregorian seasons of Spring, Summer, Autumn, and Winter. Herein, we (i) quantified and visualised seasonal body image and its mechanisms, and (ii) identified individual predictors of seasonal body image. Sexual minority men (N = 823) residing in the Northern Hemisphere (n = 659) and Southern Hemisphere (n = 164) provided cross-sectional data about their experiences of body image phenomena in Spring, Summer, Autumn, and Winter. Most reported seasonal body image (∼70 %). As hypothesised, in Summer we observed peaks for body dissatisfaction alongside peaks in four proposed seasonal body image mechanisms: pressure from media advertisements, pressure from peers on social media, the feeling that one's body is on public display, and appearance comparisons. In Winter, these phenomena were weakest. Effect sizes ranged from small to large (rs = .07-.50) with an average effect size of medium (.38). Seasonal body image was stronger for individuals with greater muscularity dissatisfaction and body fat dissatisfaction, and for higher body-weight and younger individuals. Future research will visualise seasonal body image using a multi-country Twitter database containing several billion tweets spanning multiple calendar years.
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92
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Stewart SJF, Ogden J. The role of social exposure in predicting weight bias and weight bias internalisation: an international study. Int J Obes (Lond) 2021; 45:1259-1270. [PMID: 33658685 PMCID: PMC8159729 DOI: 10.1038/s41366-021-00791-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/21/2021] [Accepted: 02/05/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Whilst the consequences of weight bias and weight bias internalisation (WBI) have been explored, less is known about the factors contributing to their development. Some research has explored the role of social exposure in weight bias and WBI but has been limited in its definition of exposure and focused solely on western countries. The present study therefore aimed to assess the role of social exposure defined in terms of both population and personal exposure in predicting weight bias and WBI, in an international sample. METHODS Participants (N = 1041) from 33 countries, aged 18-85 years completed online measures of demographics, weight bias, WBI, and population and personal social exposure. Population exposure was defined using national obesity prevalence data from the World Health Organisation to classify countries as low (obesity rates ≤19.9%; n = 162), medium (20.0-29.9%; n = 672) or high prevalence (≥30%; n = 192). Personal exposure was defined in terms of personal contact and health and attractiveness normalisation. RESULTS Using regression analysis, greater weight bias was significantly predicted by being younger, male, less educated, and personal exposure in terms of normalisation beliefs that thinner body types are healthier and more attractive, greater daily exposure and overall exposure to thinner friends. The strongest predictors of weight bias (adj R2 = 13%) were gender (β = -0.24, p < .001), and personal exposure in terms of normalisation beliefs that thinner body types are more attractive (β = -0.13, p = .001). The strongest predictors of WBI (adj R2 = 6%) were attractiveness normalisation (β = -0.23, p < 0.001) and participants' perceived body shape (β = -0.27, p < 0.001). Population exposure did not predict either weight bias or WBI. CONCLUSIONS Personal exposure is more important than population exposure in predicting both weight bias and WBI. Findings hold implications for improving the wellbeing and lived experiences of those living with overweight and obesity.
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Affiliation(s)
| | - Jane Ogden
- Department of Psychology, University of Surrey, Guildford, GU2 7XH, UK
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93
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Lawson JL, Schuh LM, Creel DB, Blackinton RM, Giambrone SA, Grilo CM, Ivezaj V. Examining Weight Bias and Loss-of-Control Eating among Individuals Seeking Bariatric Surgery. Obes Surg 2021; 31:3498-3505. [PMID: 33866532 DOI: 10.1007/s11695-021-05418-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 04/01/2021] [Accepted: 04/07/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Externalized weight bias (EWB), directed towards others, and internalized weight bias (IWB), directed towards the self, are thought to exacerbate obesity and disordered eating and may be important factors to assess and understand among individuals seeking bariatric surgery. This study examined clinical correlates (pre-surgical BMI, depressive symptoms, weight self-efficacy, and shape/weight overvaluation) of both EWB and IWB among individuals presenting for bariatric surgery with and without regular loss-of-control eating (LOC eating). METHODS A total of 316 adults presenting for bariatric surgery completed established self-report measures to assess EWB, IWB, depressive symptoms, weight self-efficacy, and core symptoms of disordered eating including LOC eating and overvaluation of shape/weight. RESULTS IWB and EWB were not associated with pre-surgical BMI, age, or sex, but were both significantly higher among White than non-White participants. Adjusting for race, IWB and EWB were significantly associated with greater eating disorder psychopathology and depressive symptoms and with less weight-related self-efficacy. Participants who endorsed regular LOC eating (53.5% of the sample) endorsed significantly lower weight self-efficacy and higher IWB, EWB, depressive symptoms, and overvaluation of shape/weight. CONCLUSIONS Findings suggest that regular LOC eating is common among individuals seeking bariatric surgery and associated with a range of heightened eating disorder and psychosocial concerns including both IWB and EWB. Future research exploring the longitudinal significance of the relationship between these two forms of weight bias and LOC eating is indicated.
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Affiliation(s)
- Jessica L Lawson
- Psychiatry Department, Yale School of Medicine, New Haven, CT, 06511, USA.,VA Connecticut Healthcare System, West Haven, CT, 06516, USA
| | - Leslie M Schuh
- St. Vincent Bariatric Center, Ascension St. Vincent Carmel Hospital, Carmel, IN, 46032, USA
| | - David B Creel
- St. Vincent Bariatric Center, Ascension St. Vincent Carmel Hospital, Carmel, IN, 46032, USA.,Bariatric & Metabolic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | | | | | - Carlos M Grilo
- Psychiatry Department, Yale School of Medicine, New Haven, CT, 06511, USA
| | - Valentina Ivezaj
- Psychiatry Department, Yale School of Medicine, New Haven, CT, 06511, USA.
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94
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Reinka MA, Quinn DM, Puhl RM. Examining the relationship between weight controllability beliefs and eating behaviors: The role of internalized weight stigma and BMI. Appetite 2021; 164:105257. [PMID: 33864861 DOI: 10.1016/j.appet.2021.105257] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/18/2021] [Accepted: 04/06/2021] [Indexed: 01/31/2023]
Abstract
Body weight is often viewed as personally controllable. This belief, however, ignores the complex etiology of body weight. While such attributions of personal willpower may help some individuals regulate their eating patterns, they have also been associated with increased internalized weight stigma which, itself, is associated with more disinhibited eating. The current investigation aimed to examine how internalized weight stigma, along with BMI, may explain the effect of weight controllability beliefs on disparate dietary behaviors. A community sample of 2702 U.S. adults completed an online survey about their weight controllability beliefs, eating behaviors, and internalized weight stigma, as well as demographic items and self-reported BMI. Results showed that greater weight controllability beliefs were positively related to both more restricted eating, β = 0.135, p < .001, and more disinhibited eating, β = 0.123, p < .001. This ironic effect was partially explained by increased internalized weight stigma. Moreover, BMI moderated the relationship, such that individuals with lower weights demonstrated stronger effects for two of the three eating outcomes than those with higher weights. These findings advance our understanding of the relationship between attributions of personal control for body weight and subsequent health behaviors, and further underscore the need to target internalized weight stigma in dietary interventions.
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Affiliation(s)
- Mora A Reinka
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Rd., Unit 1020, Storrs, CT, 06269-1020, USA; Department of Psychology, Ursinus College, 601 E. Main St., P.O. Box 1000, Collegeville, PA, 19426-1000, USA.
| | - Diane M Quinn
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Rd., Unit 1020, Storrs, CT, 06269-1020, USA
| | - Rebecca M Puhl
- University of Connecticut Rudd Center for Food Policy & Obesity; Department of Human Development and Family Sciences, University of Connecticut, One Constitution Plaza, Suite 600, Hartford, CT, 06103, USA
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95
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Olson KL, Goldstein SP, Lillis J, Panza E. Weight stigma is overlooked in commercial-grade mobile applications for weight loss and weight-related behaviors. Obes Sci Pract 2021; 7:244-248. [PMID: 33841895 PMCID: PMC8019276 DOI: 10.1002/osp4.457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/17/2020] [Accepted: 09/20/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
- KayLoni L Olson
- The Department of Psychiatry and Human Behavior Warren Alpert Medical School of Brown University Providence Rhode Island USA.,The Weight Control and Diabetes Research Center The Miriam Hospital Providence Rhode Island USA
| | - Stephanie P Goldstein
- The Department of Psychiatry and Human Behavior Warren Alpert Medical School of Brown University Providence Rhode Island USA.,The Weight Control and Diabetes Research Center The Miriam Hospital Providence Rhode Island USA
| | - Jason Lillis
- The Department of Psychiatry and Human Behavior Warren Alpert Medical School of Brown University Providence Rhode Island USA.,The Weight Control and Diabetes Research Center The Miriam Hospital Providence Rhode Island USA
| | - Emily Panza
- The Department of Psychiatry and Human Behavior Warren Alpert Medical School of Brown University Providence Rhode Island USA.,The Weight Control and Diabetes Research Center The Miriam Hospital Providence Rhode Island USA
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96
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Patients' views of long-term results of bariatric surgery for super-obesity: sustained effects, but continuing struggles. Surg Obes Relat Dis 2021; 17:1152-1164. [PMID: 33785271 DOI: 10.1016/j.soard.2021.02.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 01/29/2021] [Accepted: 02/20/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Bariatric surgery is a standard treatment for severe obesity, but little is known about patients' perceptions about the long-term impact of such surgery. OBJECTIVE The aim of this study was to explore patients' experiences of living with a bariatric procedure for more than a decade. SETTING University hospital. METHODS At the 10-year follow-up after undergoing Roux-en-Y gastric bypass (RYGB) or biliopancreatic diversion with duodenal switch (BPD/DS), 18 consecutive patients from a previous randomized controlled trial were assessed with a semi-structured interview. Data were analyzed using thematic analysis. RESULTS When asked to reflect broadly on their experiences of living with bariatric surgery for over a decade, the participants rarely mentioned procedure-specific issues and complications. Instead, their accounts revealed 2 broad themes: sustained effects after surgery, incorporating subthemes of better health, brighter futures, and better eating and weight regulation, and continuing struggles, including difficulties with physical activity, finding support, helping their children with overweight, and self-criticism. Many positive changes were sustained, but continuing personal struggles were similar to those presurgery. CONCLUSIONS Participants expressed overall satisfaction with their bariatric surgery and related outcomes. Most participants acknowledged a continued effect on their appetite, which could be important information for patients who worry about a diminished effect after the first year postsurgery. Participants were prone to self-blame when things did not turn out the way they wanted. Therefore, healthcare providers must build a trustful relationship with their patients, so they will not hesitate to return when they face problems such as weight gain.
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97
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Pearl RL, Puhl RM, Lessard LM, Himmelstein MS, Foster GD. Prevalence and correlates of weight bias internalization in weight management: A multinational study. SSM Popul Health 2021; 13:100755. [PMID: 33718581 PMCID: PMC7920853 DOI: 10.1016/j.ssmph.2021.100755] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/08/2021] [Accepted: 02/07/2021] [Indexed: 12/24/2022] Open
Abstract
Weight bias internalization (WBI) is an understudied form of internalized stigma, particularly among treatment-seeking adults with overweight/obesity. The current study surveyed 13,996 adults currently engaged in weight management in the first multinational study of WBI. From May to July 2020, participants in six Western countries completed the Modified Weight Bias Internalization Scale (WBIS-M) and measures of weight change, health behaviors, psychosocial well-being, and health-related quality of life (HRQOL). Participants were majority white, female, middle-aged, and categorized as having overweight or obesity based on body mass index. Results showed higher mean WBIS-M scores among participants in the UK, Australia, and France than in Germany, the US, and Canada. Across all countries, and controlling for participant characteristics and experiences of weight stigma, WBIS-M scores were associated with greater weight gain in the past year. Participants with higher WBIS-M scores also reported poorer mental and physical HRQOL, less eating and physical activity self-efficacy, greater engagement in eating as a coping strategy, more avoidance of going to the gym, poorer body image, and greater perceived stress. Few interaction effects were found between experiences and internalization of weight stigma. Overall, the current findings support WBI as a robust correlate of adverse weight-related health indices across six Western countries. Prospective and experimental studies are needed to determine directionality and causality in the relationship between WBI and poor health outcomes.
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Affiliation(s)
- Rebecca L. Pearl
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Rebecca M. Puhl
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT, USA
- Department of Human Development & Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Leah M. Lessard
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT, USA
| | | | - Gary D. Foster
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- WW International, Inc., New York, NY, USA
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98
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Inconsistencies in the conceptualisation and operationalisation of internalized weight stigma: A potential way forward. Body Image 2021; 36:iii-v. [PMID: 33358360 PMCID: PMC8500548 DOI: 10.1016/j.bodyim.2020.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 11/21/2022]
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99
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Fields LC, Brown C, Skelton JA, Cain KS, Cohen GM. Internalized Weight Bias, Teasing, and Self-Esteem in Children with Overweight or Obesity. Child Obes 2021; 17:43-50. [PMID: 33351706 PMCID: PMC7815063 DOI: 10.1089/chi.2020.0150] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: Although 2/3 of US adults and nearly 1/3 of US children have overweight or obesity, weight stigma is common. Many with overweight or obesity ascribe negative ideas to themselves, resulting in internalized weight bias (IWB). In adults, IWB has been associated with psychosocial problems; however, this relationship has been studied little in children. This study aims to describe IWB in children with overweight and obesity and to study the association of children's IWB with experienced weight bias, self-esteem, and their parents' IWB. Methods: Children ages 9-18 with overweight or obesity completed the Weight Bias Internalization Scale (WBIS), Rosenberg Self-Esteem Scale, and Perception of Teasing Scale; parents completed the Weight Bias Internalization Scale-Modified and the Perceived Weight Discrimination Scale. Descriptive statistics were used to assess IWB, self-esteem, and experienced weight stigma. Chi-square and t-tests were used to examine associations between categorical and continuous variables, respectively. Multivariate linear regression was used to identify correlates of IWB in children. Results: Of 111 child participants, the median WBIS score was 2.8 out of 7. Higher IWB was associated with more peer teasing (p < 0.001) and lower self-esteem (p < 0.001). IWB in children was not associated with child BMI z-score (p = 0.590) or higher parent IWB (p = 0.287). Conclusions: Children with overweight and obesity who have experienced more teasing by peers or who have lower self-esteem are more likely to have a higher IWB. However, increasing child BMI z-score and parent IWB are not associated with higher child IWB.
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Affiliation(s)
- Lauren C. Fields
- Bowman Gray Center, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Callie Brown
- Department of Pediatrics, and Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Brenner FIT (Families in Training) Program, Brenner Children's Hospital, Winston-Salem, NC, USA
- Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Joseph A. Skelton
- Department of Pediatrics, and Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Brenner FIT (Families in Training) Program, Brenner Children's Hospital, Winston-Salem, NC, USA
- Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Kathryn S. Cain
- Bowman Gray Center, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Gail M. Cohen
- Department of Pediatrics, and Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Brenner FIT (Families in Training) Program, Brenner Children's Hospital, Winston-Salem, NC, USA
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100
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Himmelstein MS, Puhl RM. At multiple fronts: Diabetes stigma and weight stigma in adults with type 2 diabetes. Diabet Med 2021; 38:e14387. [PMID: 32799378 DOI: 10.1111/dme.14387] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/25/2020] [Accepted: 08/12/2020] [Indexed: 12/24/2022]
Abstract
AIM The diabetes and obesity fields have called for attention to the harmful role of stigma in obesity and diabetes, especially given that little is known about the extent and nature of diabetes stigma facing adults with type 2 diabetes, or the experience of weight stigma in this population. This study addresses this research gap by examining the prevalence and demographic correlates of weight stigma and diabetes stigma in individuals with type 2 diabetes. METHODS Adults (N = 1212, Mage = 52) with type 2 diabetes living in the USA were recruited by a healthcare-oriented market research firm, and completed online questionnaires to assess their experiences with weight stigma and diabetes stigma, as well as their internalization of both forms of stigma. Rates of stigma and sociodemographic correlates (years with type 2 diabetes, age, education, income, gender, race and BMI) were examined. RESULTS More than half of participants reported prior experiences of weight stigma, and 40-60% reported experiencing weight stigma in a healthcare context. Participants reported frequent experiences with diabetes-related stigma including blame and judgement, self-stigma and differential treatment. Women reported more weight stigma than men, and White women appeared particularly at risk for experiencing weight and diabetes related stigma relative to Black women. CONCLUSIONS Individuals with type 2 diabetes reported higher rates of weight stigma than the general population, experienced high rates of diabetes-related stigma, and many internalized these forms of stigma. Increased attention to stigma reduction is essential to ensuring equitable care for individuals with type 2 diabetes.
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Affiliation(s)
- M S Himmelstein
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - R M Puhl
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT, USA
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