101
|
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.
Collapse
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
| |
Collapse
|
102
|
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: 13] [Impact Index Per Article: 4.3] [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]
|
103
|
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.
Collapse
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
| |
Collapse
|
104
|
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.
Collapse
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
| |
Collapse
|
105
|
Unburdening the Weight of Stigma: Findings From a Compassion-Focused Group Program for Women With Overweight and Obesity. J Cogn Psychother 2020; 34:336-357. [PMID: 33372127 DOI: 10.1891/jcpsy-d-20-00015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to develop a 2-day intensive-format, Compassion-Focused Therapy (CFT) based group program targeting weight stigma in women with overweight and obesity, and to conduct a pilot study to determine the feasibility and acceptability of the intervention. METHOD Participants were 15 females aged 18-62 years (mean [M] = 43.60, standard deviation [SD] = 12.38), who participated in the program and completed measures of self-compassion, internalized weight stigma, psychological distress, life-satisfaction, loneliness, eating self-efficacy, body dissatisfaction, and body shame, at pre-treatment, post-treatment, and 3-month follow-up. RESULTS Significant improvements were found from pre-treatment to post-treatment for self-compassion and internalized weight stigma, with gains maintained at 3-month follow-up. Significant improvements were also found on measures of psychological distress, life satisfaction, loneliness, eating self-efficacy, and body dissatisfaction at the post-treatment assessment. Credibility ratings of the program were high. CONCLUSIONS This study has contributed to existing stigma research, being the first proof-of-concept study to demonstrate support for an intensive, CFT based group approach targeting the effects of weight stigma for women with overweight and obesity. The findings are discussed in terms of the potential of CFT to assist women develop resilience to the harmful effects of weight stigma, and possible future research directions to further develop and evaluate this approach.
Collapse
|
106
|
Curll SL, Brown PM. Weight stigma and psychological distress: A moderated mediation model of social identification and internalised bias. Body Image 2020; 35:207-216. [PMID: 33049458 DOI: 10.1016/j.bodyim.2020.09.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/15/2020] [Accepted: 09/15/2020] [Indexed: 01/31/2023]
Abstract
Links between weight stigma and negative health outcomes are well documented, but risk and protective factors remain unclear. In this study, 458 higher-weight Australian adults completed online self-report measures of perceived weight stigma, weight-based social identification (identity centrality), internalised weight bias, and psychological distress. Associations between these variables were investigated in line with the rejection-identification model and the social identity approach to health. Perceived stigma was positively associated with social identification and psychological distress. Simple mediation analysis showed a positive indirect effect of perceived stigma on psychological distress through social identification. However, moderated mediation analysis revealed that this indirect effect was dependent on internalised bias. Among participants who reported low internalised bias, social identification was associated with lower psychological distress; but for those with high internalised bias, this relationship was reversed. Findings suggest that perceived weight stigma, weight-based social identification, and internalised weight bias are key factors that should be considered together in the design and evaluation of interventions to improve the mental health of higher-weight individuals.
Collapse
Affiliation(s)
- Sonia L Curll
- Discipline of Psychology, Faculty of Health, University of Canberra, 11 Kirinari Street, Bruce, ACT, 2617, Australia.
| | - Patricia M Brown
- Discipline of Psychology, Faculty of Health, University of Canberra, 11 Kirinari Street, Bruce, ACT, 2617, Australia.
| |
Collapse
|
107
|
Austen E, Greenaway KH, Griffiths S. Differences in weight stigma between gay, bisexual, and heterosexual men. Body Image 2020; 35:30-40. [PMID: 32829093 DOI: 10.1016/j.bodyim.2020.08.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 08/02/2020] [Accepted: 08/03/2020] [Indexed: 02/05/2023]
Abstract
Gay and bisexual men may experience more weight stigma than heterosexual men; however, research is limited. We examined differences in experienced weight discrimination, weight bias, and internalized weight bias in two studies: the first comprising gay (n = 351), bisexual (n = 357), and heterosexual (n = 408) men, and the second comprising gay (n = 614) and bisexual (n = 123) men. In Study 1, bisexual men reported experiencing more weight discrimination than gay (r = .07) and heterosexual (r = .08) men. Bisexual (Glass' Δ = 0.41) and gay (Δ = 0.37) men reported greater internalized weight bias than heterosexual men. Heterosexual men reported more weight bias than gay (Cohen's d = 0.35) and bisexual (d = 0.46) men. In Study 2, gay men reported more internalized weight bias than bisexual men (d = 0.26). Sexual orientation did not moderate the relationships of weight stigma with either body dissatisfaction or psychological quality of life. Among gay and bisexual men, experiencing weight discrimination predicted diminished psychological quality of life through internalized weight bias and body dissatisfaction. Our research emphasizes the importance of assessing weight stigma among sexual minorities and suggests bisexual men might be particularly vulnerable to weight stigma.
Collapse
Affiliation(s)
- Emma Austen
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia.
| | - Katharine H Greenaway
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Scott Griffiths
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| |
Collapse
|
108
|
Davies A, Burnette CB, Mazzeo SE. Real women have (just the right) curves: investigating anti-thin bias in college women. Eat Weight Disord 2020; 25:1711-1718. [PMID: 31701378 DOI: 10.1007/s40519-019-00812-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 10/28/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Weight stigma is associated with negative mental and physical health outcomes across the body mass index (BMI) continuum. However, few studies have examined discrimination experienced by people with low body weights. OBJECTIVES This study explored the presence of anti-thin bias, defined as the belief that individuals at lower body weights have undesirable personality characteristics, in young adult women. Additionally, we examined perceived etiology of weight for women with underweight. METHOD Participants (N =295 women, age 18.84 ± 2.32) were randomly assigned to read one of the six vignettes about women who differed by race (White and Black) and BMI status (slightly underweight, average weight, and slightly overweight). RESULTS Negative personality characteristics were more likely to be ascribed to vignette characters with under- or overweight BMIs, compared to characters with average weight BMIs. Participants were more likely to attribute underweight characters' body weight to an eating disorder (ED) compared with average or overweight characters. CONCLUSION Results suggest that women with under- or overweight BMIs experience greater stigmatization for their body weight than women with average BMIs, underscoring the need for research to investigate weight discrimination across the weight spectrum. LEVEL OF EVIDENCE Level I, experimental study.
Collapse
Affiliation(s)
- Alexandria Davies
- Department of Psychology, Virginia Commonwealth University, P.O. Box 842018, Richmond, VA, 23284-2018, USA.
| | - C Blair Burnette
- Department of Psychology, Virginia Commonwealth University, P.O. Box 842018, Richmond, VA, 23284-2018, USA
| | - Suzanne E Mazzeo
- Department of Psychology, Virginia Commonwealth University, P.O. Box 842018, Richmond, VA, 23284-2018, USA
| |
Collapse
|
109
|
Abstract
PURPOSE OF REVIEW Despite its rapidly rising global prevalence, obesity is not featured in any of the Sustainable Development Goals (SDGs). This review highlights the multiple points at which obesity is affected by the Goals. RECENT FINDINGS At least 14 out of the 17 thematic SDG targets play a role in driving the obesity epidemic, including health, food, education, water quality, land and ocean quality, urbanisation and employment. Although the SDGs recognise the need to reduce 'malnutrition in all its forms', the Goals underplay the role of urbanisation and unregulated markets on dietary health. Furthermore, adherence to the SDGs may be weak and compromised by conflicted interests. Nonetheless, governments have shown that they can, when pressed, respond to health challenges, and we anticipate how the rise in the numbers of people experiencing excess bodyweight may itself lead to greater demand for collective responsibility to ensure our environments are fully health-creating.
Collapse
Affiliation(s)
- Tim Lobstein
- World Obesity Federation, Suite 406, 107-111 Fleet Street, London, EC4A 2AB, UK.
- Boden Institute, University of Sydney, Camperdown, NSW, 2006, Australia.
| | | |
Collapse
|
110
|
Davies AE, Burnette CB, Mazzeo SE. Black and White women's attributions of women with underweight. Eat Behav 2020; 39:101446. [PMID: 33137598 DOI: 10.1016/j.eatbeh.2020.101446] [Citation(s) in RCA: 4] [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: 04/09/2020] [Revised: 10/01/2020] [Accepted: 10/14/2020] [Indexed: 12/29/2022]
Abstract
Despite the idealization of thin bodies, many people with low body weights report experiencing weight stigma. This stigma might relate to stereotypes about eating disorders (EDs). Specifically, people with lower body weights might be perceived as having EDs, conditions associated with significant stigma. Also, there is considerable pressure for Black women to obtain a curvy ideal, which could lead to anti-thin bias (i.e., the belief that individuals at lower body weights have undesirable characteristics) in this group. The current study evaluated these possibilities via an examination of anti-thin bias in Black and White women. Further, we explored perceived attributions of weight for Black and White women with underweight. Black (n = 96) and White (n = 128) participants read racially concordant vignettes in which characters varied by body mass index (BMI) status (slightly underweight, average weight, and slightly overweight). White women were more likely to ascribe negative personality characteristics to White vignette characters with underweight than to characters with average weight. In contrast, Black women's perceptions of Black vignette characters did not differ according to weight status. Both Black and White participants were more likely to attribute underweight characters' body weight to an ED compared with average weight characters. Results suggest that weight bias literature should incorporate the assessment and impact of weight stigma for individuals across the BMI spectrum.
Collapse
Affiliation(s)
- Alexandria E Davies
- Department of Psychology, Virginia Commonwealth University, P.O. Box 842018, Richmond, VA 23284-2018, USA.
| | - C Blair Burnette
- Department of Psychology, Virginia Commonwealth University, P.O. Box 842018, Richmond, VA 23284-2018, USA
| | - Suzanne E Mazzeo
- Department of Psychology, Virginia Commonwealth University, P.O. Box 842018, Richmond, VA 23284-2018, USA
| |
Collapse
|
111
|
Ellis JM, Essayli JH, Zickgraf HF, Rossi J, Hlavka R, Carels RA, Whited MC. Comparing stigmatizing attitudes toward anorexia nervosa, binge-eating disorder, avoidant-restrictive food intake disorder, and subthreshold eating behaviors in college students. Eat Behav 2020; 39:101443. [PMID: 33142129 DOI: 10.1016/j.eatbeh.2020.101443] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 09/20/2020] [Accepted: 10/07/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The relative stigmatization of various eating disorders (ED) remains understudied, and there is no research examining stigma toward avoidant-restrictive food intake disorder (ARFID) or adult picky eating. The present study examined the relative stigmatization of various EDs and the subthreshold eating behaviors that are risk factors for their development, and the relation of gender differences to stigma. METHOD A sample of 1147 college students was recruited and completed the study online. Participants were randomized and presented with a vignette representing a clinical ED [anorexia nervosa (AN), binge-eating disorder (BED), ARFID] or a subthreshold eating presentation (restrained eating, emotional eating, picky eating). Participants completed measures of stigma and perceived psychopathology. A 6 (target eating behavior) × 2 (target gender) × 2 (participant gender) MANOVA and subsequent ANOVAs were employed. RESULTS Measures of stigma revealed significant main effects for eating presentation and participant gender. There were also significant interactions between eating presentation and participant gender. Men reported more stigmatizing views toward BED and AN compared to women. Overall, restraint was stigmatized less than the other targets, and AN received the greatest amount of stigma. Participants rated BED and AN as more pathological than all other targets, emotional eating and ARFID as more pathological than picky eating and restrained eating, and restrained eating as less pathological than all other targets. CONCLUSIONS Future research should explore how the severity of eating behavior influences perceptions and at what level behaviors such as restriction are recognized as disordered.
Collapse
Affiliation(s)
- Jordan M Ellis
- Department of Psychology, East Carolina University, United States of America; Wilford Hall Ambulatory Medical Center, Joint Base San Antonio - Lackland, United States of America.
| | - Jamal H Essayli
- Department of Pediatrics and Psychiatry & Behavioral Health, Penn State College of Medicine, United States of America
| | - Hana F Zickgraf
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, United States of America
| | - James Rossi
- Department of Psychology, East Carolina University, United States of America
| | - Reid Hlavka
- Department of Psychology, East Carolina University, United States of America
| | - Robert A Carels
- Department of Psychology, East Carolina University, United States of America
| | - Matt C Whited
- Department of Psychology, East Carolina University, United States of America
| |
Collapse
|
112
|
Potts S, Krafft J, Levin ME. A Pilot Randomized Controlled Trial of Acceptance and Commitment Therapy Guided Self-Help for Overweight and Obese Adults High in Weight Self-Stigma. Behav Modif 2020; 46:178-201. [PMID: 33251823 DOI: 10.1177/0145445520975112] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Weight self-stigma, in which individuals internalize stigmatizing messages about weight, is a prevalent problem that contributes to poor quality of life and health. This pilot randomized controlled trial evaluated acceptance and commitment therapy (ACT) guided self-help using The Diet Trap for 55 overweight/obese adults high in weight self-stigma. Participants were randomized to the ACT self-help book plus phone coaching (GSH-P; n = 17), self-help book plus email prompts only (GSH-E; n = 20), or a waitlist condition (n = 18), with online self-report assessments at baseline and posttreatment (8 weeks later). Participants reported high satisfaction ratings and engagement with the ACT self-help book, with no differences between GSH-P and GSH-E. Both GSH-P and GSH-E improved weight self-stigma relative to waitlist with large effect sizes. There were mixed findings for health outcomes. The GSH-P condition improved more on healthy eating behaviors and general physical activity, but neither ACT condition improved more than waitlist on self-reported body mass index, emotional eating, and a second measure of physical activity. Results suggest an ACT self-help book with email prompts can reduce weight self-stigma and potentially improve some health behavior outcomes. Phone coaching may provide additional benefits for generalizing ACT to diet and physical activity.
Collapse
Affiliation(s)
- Sarah Potts
- Partnership Health Center, Missoula, MT, USA
| | | | | |
Collapse
|
113
|
Kliem S, Puls HC, Hinz A, Kersting A, Brähler E, Hilbert A. Validation of a Three-Item Short Form of the Modified Weight Bias Internalization Scale (WBIS-3) in the German Population. Obes Facts 2020; 13:560-571. [PMID: 33238284 PMCID: PMC7802509 DOI: 10.1159/000510923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 08/05/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Individuals suffering from overweight or obesity frequently experience weight-based stigmatization. The widespread belief that weight is a matter of personal will and self-control results in various weight-based stereotypes (e.g., laziness, lack of self-discipline, or neglect). OBJECTIVE Based on the modified version of the Weight Bias Internalization Scale (WBIS-M), a short form for the economic assessment of weight bias internalization in the general population was compiled and validated. METHODS A three-item short form (WBIS-3) was derived based on data from a representative sample of the German population (n = 1,092). This new short form was validated in a second representative population sample (n = 2,513). Item characteristics and internal consistency were obtained. Measurement invariance was tested. Construct validity was established via the correlation with theoretically related constructs (depression, anxiety, eating behavior, discrimination, weight status). To establish scale validity, all analyses were performed for the whole sample as well as for the subsample of individuals with overweight. Age- and gender-specific population norms were provided. RESULTS The WBIS-3 exhibited excellent psychometric properties. Internal consistency was α = 0.92. Strong measurement invariance was confirmed regarding age, gender, discrimination, and weight status in both the whole sample as well as the overweight subsample. CONCLUSIONS The WBIS-3 constitutes a valid and economical tool for the assessment of weight bias internalization in epidemiological contexts. Measurement invariance allows for an unbiased comparison of means, correlation coefficients, and path coefficients within structural equation modeling across groups.
Collapse
Affiliation(s)
- Sören Kliem
- Ernst-Abbe-Hochschule, University of Applied Sciences, Jena, Germany
| | - Hans-Christian Puls
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany,
- Integrated Research and Treatment Center AdiposityDiseases, Behavioral Medicine Research Unit, University of Leipzig Medical Center, Leipzig, Germany,
| | - Andreas Hinz
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Anette Kersting
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Elmar Brähler
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
- Integrated Research and Treatment Center AdiposityDiseases, Behavioral Medicine Research Unit, University of Leipzig Medical Center, Leipzig, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Anja Hilbert
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
- Integrated Research and Treatment Center AdiposityDiseases, Behavioral Medicine Research Unit, University of Leipzig Medical Center, Leipzig, Germany
| |
Collapse
|
114
|
Jolliff AF, Moreno MA, D'Angelo J. The mediating role of depressive and anxiety symptoms in the association between obesity and problematic social media use in young adults. Obes Sci Pract 2020; 6:454-459. [PMID: 33082987 PMCID: PMC7556436 DOI: 10.1002/osp4.434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/28/2020] [Accepted: 05/30/2020] [Indexed: 12/03/2022] Open
Abstract
Background Obesity has been associated with problematic internet use or internet use characterized by impulsivity, dependence, risk taking or impairment. Despite the unique affordances and growing popularity of social media, few studies have investigated obesity in relation to the problematic use of social media in contrast to general internet use. Objective The purpose of this study was to explore the relationship between obesity and problematic social media use and to test symptoms of anxiety and depression as potential mediators of this relationship. Methods A cross‐sectional online survey was administered to young adults between the ages of 18–25 using the Qualtrics platform. Two mediation models were tested using model 4 of the PROCESS Macro in SPSS. Results Participants (n = 4939) were between the ages of 18–25 (M = 21.74, SD = 2.3). Participants were 50.6% female (n = 2496) and 58.1% White (n = 2871). Reporting obesity was positively associated with reporting increased levels of problematic social media use, B = 1.15, SE B = .32, t(1, 4938) = 3.59, p < .001. The indirect effects in each model from obesity to problematic social media use, through both symptoms of anxiety and depression separately, were significant, B = .14, SE B = .05, confidence interval [0.055, .231] and B = .16, SE B = .07, confidence interval [0.018, .317], respectively. Conclusions Young adults who present both with obesity and with symptoms of depression or anxiety are more at risk for problematic social media use. These patients may benefit from education on health‐promoting social media use.
Collapse
Affiliation(s)
- Anna F Jolliff
- Department of Pediatrics University of Wisconsin—Madison Madison Wisconsin USA
| | - Megan A Moreno
- Department of Pediatrics University of Wisconsin—Madison Madison Wisconsin USA
| | - Jonathan D'Angelo
- Department of Pediatrics University of Wisconsin—Madison Madison Wisconsin USA
| |
Collapse
|
115
|
Pearl RL, Wadden TA, Chao AM, Walsh O, Alamuddin N, Berkowitz RI, Tronieri JS. Weight Bias Internalization and Long-Term Weight Loss in Patients With Obesity. Ann Behav Med 2020; 53:782-787. [PMID: 30304382 DOI: 10.1093/abm/kay084] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The relationship between weight bias internalization (WBI) and long-term weight loss is largely unknown. PURPOSE To determine the effects of weight loss on WBI and assess whether WBI impairs long-term weight loss. METHODS One hundred thirty-three adults with obesity completed the Weight Bias Internalization Scale (WBIS) at baseline, after a 14-week lifestyle intervention in which they lost ≥5 per cent of initial weight, and at weeks 24 and 52 of a subsequent randomized controlled trial (RCT) for weight-loss maintenance (66 weeks total). Linear mixed models were used to examine the effects of weight loss on WBIS scores and the effects of baseline WBIS scores on weight change over time. Logistic regression was used to determine the effects of baseline WBIS scores on achieving ≥5 and ≥10 per cent weight loss. RESULTS Changes in weight did not predict changes in WBIS scores. Baseline WBIS scores predicted reduced odds of achieving ≥5 and ≥10 per cent weight loss at week 24 of the RCT (p values < .05). At week 52, the interaction between participant race and WBIS scores predicted weight loss (p = .046) such that nonblack (but not black) participants with higher baseline WBIS scores had lower odds of achieving ≥10 per cent weight loss (OR = 0.38, p = .01). Baseline WBIS scores did not significantly predict rate of weight change over time. CONCLUSIONS Among participants in a weight loss maintenance trial, WBI did not change in relation to changes in weight. More research is needed to clarify the effects of WBI on long-term weight loss and maintenance across race/ethnicity. CLINICAL TRIALS REGISTRATION ClinicalTrials.gov identifier NCT02388568.
Collapse
Affiliation(s)
- Rebecca L Pearl
- Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.,Department of Surgery, Edwin and Fannie Gray Hall Center for Human Appearance, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Thomas A Wadden
- Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Ariana M Chao
- Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.,Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA
| | - Olivia Walsh
- Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Naji Alamuddin
- Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.,Department of Medicine, Institute for Diabetes, Obesity, and Metabolism, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Robert I Berkowitz
- Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.,Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, PA
| | - Jena Shaw Tronieri
- Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
116
|
Prunty A, Clark MK, Hahn A, Edmonds S, O’Shea A. Enacted weight stigma and weight self stigma prevalence among 3821 adults. Obes Res Clin Pract 2020; 14:421-427. [DOI: 10.1016/j.orcp.2020.09.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/11/2020] [Indexed: 11/15/2022]
|
117
|
Gmeiner MS, Warschburger P. Intrapersonal predictors of weight bias internalization among elementary school children: a prospective analysis. BMC Pediatr 2020; 20:408. [PMID: 32859162 PMCID: PMC7456014 DOI: 10.1186/s12887-020-02264-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 07/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Weight-related stigmatization is a widespread problem. Particularly the internalization of weight-related stereotypes and prejudices (weight bias internalization, WBI) is related to mental and physical health impairments. To date, little is known about the risk factors of WBI. Previous studies are mainly cross-sectional and based on adult samples. As childhood is a sensitive period for the development of a healthy self-concept, we examined predictors of WBI in children. METHODS The final sample included 1,463 schoolchildren (6-11 years, 51.7% female) who took part in a prospective study consisting of three measurement waves. The first two waves delivered data on objective weight status and self-reported weight-related teasing, body dissatisfaction, relevance of one's own figure, self-esteem and depressive symptoms; WBI was measured during the third wave. To examine predictors of WBI, we ran hierarchical regression analyses and exploratory mediation analyses. RESULTS Lower parental education level, higher child weight status, female gender, experience of teasing, higher body dissatisfaction, higher figure-relevance, and higher depression scores were found to be predictive for higher WBI scores. Body dissatisfaction (only for girls) and the relevance of one's own figure (both genders) mediated the association between self-esteem and WBI; no weight-related differences were observed. CONCLUSIONS Our study offers longitudinal evidence for variables that enable the identification of children who are at risk for WBI. Thus, the findings deliver starting points for interventions aimed at the prevention of adverse health developments that come along with WBI.
Collapse
Affiliation(s)
- Michaela Silvia Gmeiner
- Department of Psychology, University of Potsdam, Karl-Liebknechtstr. 24-25, 14476, Potsdam, Germany
| | - Petra Warschburger
- Department of Psychology, University of Potsdam, Karl-Liebknechtstr. 24-25, 14476, Potsdam, Germany.
| |
Collapse
|
118
|
Feig EH, Amonoo HL, Onyeaka HK, Romero PM, Kim S, Huffman JC. Weight bias internalization and its association with health behaviour adherence after bariatric surgery. Clin Obes 2020; 10:e12361. [PMID: 32319211 DOI: 10.1111/cob.12361] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 02/13/2020] [Accepted: 04/01/2020] [Indexed: 12/27/2022]
Abstract
This study tested the hypothesis that internalized weight bias (WBI) is negatively associated with health-related quality of life, weight loss and health behaviour adherence (eg, physical activity, diet, vitamin adherence) in patients who had weight loss surgery (WLS). It also tested whether self-efficacy for exercise, barriers to being active and depression were mediators between WBI and moderate-to-vigorous physical activity (MVPA). Participants were recruited from online support forums. They completed an anonymous online survey assessing WBI, physical activity, health behaviour adherence, depression, health-related quality of life, self-efficacy for exercise and barriers to being physically active. Multiple regression analyses and a bootstrapping approach for mediation were used. The sample included 112 primarily white and female adults, who had surgery 1 month to 24 years prior. WBI was negatively associated with weight loss since surgery, MVPA, dietary adherence, vitamin adherence and mental health-related quality of life, and was not associated with walking, physical health-related quality of life or fluid intake adherence. Self-efficacy for exercise, barriers to being active and depression were partial mediators between WBI and physical activity. After WLS, WBI may signal poorer adherence to critical health behaviours. It also is associated with less weight loss. WBI should be assessed and treated by WLS providers.
Collapse
Affiliation(s)
- Emily H Feig
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Hermioni L Amonoo
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Henry K Onyeaka
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Perla M Romero
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Sonia Kim
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jeff C Huffman
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
119
|
Himmelstein MS, Puhl RM, Pearl RL, Pinto AM, Foster GD. Coping with Weight Stigma Among Adults in a Commercial Weight Management Sample. Int J Behav Med 2020; 27:576-590. [PMID: 32430784 DOI: 10.1007/s12529-020-09895-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Coping responses to weight stigma can adversely affect health. Using data from a large commercial weight management sample, this study examined how adults cope with weight stigma, relationships among experienced weight stigma, weight bias internalization, and coping, as well as coping strategies as mediators of the stigma-health relationship. METHOD Participants were adults enrolled in WW (formerly Weight Watchers) who reported at least one lifetime experience of weight stigma (N = 11,924). Participants completed questionnaires about the type and frequency of stigma experiences, weight bias internalization, strategies used to cope with weight stigma, and health-related quality of life. RESULTS Active coping, planning, positive reframing, acceptance, emotional support, and exercise avoidance were the most common coping strategies employed in response to acute weight stigma experiences. Weight bias internalization was more strongly associated with coping strategies likely to exacerbate health (e.g., disordered eating, substance use, self-blame) than positive reframing, acceptance, and emotional support. More types of experienced weight stigma (e.g., teasing, unfair treatment) were associated with more frequent use of all coping strategies. Coping strategies did not mediate the stigma-health relationship, and several strategies were associated with poor mental health. CONCLUSION More types of experiences with weight stigma were associated with more attempts to cope generally, while weight bias internalization was associated with coping strategies which were in turn associated with poor mental health. Developing effective approaches for identifying individuals likely to internalize weight stigma and helping individuals adopt effective coping strategies in response to stigma are important avenues of future research.
Collapse
Affiliation(s)
- Mary S Himmelstein
- Department of Psychological Sciences, Kent State University, PO Box 5190, Kent, OH, 44242-0001, USA.
| | - Rebecca M Puhl
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT, USA.,Department of Human Development and Family Sciences, University of Connecticut, Storrs, 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
| | - Angela M Pinto
- WW, New York, NY, USA.,Psychology Department, 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.,WW, New York, NY, USA
| |
Collapse
|
120
|
Rubino F, Puhl RM, Cummings DE, Eckel RH, Ryan DH, Mechanick JI, Nadglowski J, Ramos Salas X, Schauer PR, Twenefour D, Apovian CM, Aronne LJ, Batterham RL, Berthoud HR, Boza C, Busetto L, Dicker D, De Groot M, Eisenberg D, Flint SW, Huang TT, Kaplan LM, Kirwan JP, Korner J, Kyle TK, Laferrère B, le Roux CW, McIver L, Mingrone G, Nece P, Reid TJ, Rogers AM, Rosenbaum M, Seeley RJ, Torres AJ, Dixon JB. Joint international consensus statement for ending stigma of obesity. Nat Med 2020; 26:485-497. [PMID: 32127716 PMCID: PMC7154011 DOI: 10.1038/s41591-020-0803-x] [Citation(s) in RCA: 415] [Impact Index Per Article: 103.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 02/14/2020] [Indexed: 12/11/2022]
Abstract
People with obesity commonly face a pervasive, resilient form of social stigma. They are often subject to discrimination in the workplace as well as in educational and healthcare settings. Research indicates that weight stigma can cause physical and psychological harm, and that affected individuals are less likely to receive adequate care. For these reasons, weight stigma damages health, undermines human and social rights, and is unacceptable in modern societies. To inform healthcare professionals, policymakers, and the public about this issue, a multidisciplinary group of international experts, including representatives of scientific organizations, reviewed available evidence on the causes and harms of weight stigma and, using a modified Delphi process, developed a joint consensus statement with recommendations to eliminate weight bias. Academic institutions, professional organizations, media, public-health authorities, and governments should encourage education about weight stigma to facilitate a new public narrative about obesity, coherent with modern scientific knowledge.
Collapse
Affiliation(s)
- Francesco Rubino
- King's College London, Department of Diabetes, School of Life Course Science, London, UK.
- King's College Hospital, Bariatric and Metabolic Surgery, London, UK.
| | - Rebecca M Puhl
- Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford, CT, USA
| | - David E Cummings
- UW Medicine Diabetes Institute, University of Washington, Seattle, WA, USA
- Weight Management Program, Virginia Puget Sound Health Care System, University of Washington, Seattle, WA, USA
| | - Robert H Eckel
- Division of Endocrinology, Metabolism & Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Donna H Ryan
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA
| | - Jeffrey I Mechanick
- The Marie-Josee and Henry R. Kravis Center for Clinical Cardiovascular Health at Mount Sinai Heart, New York, NY, USA
- Divisions of Cardiology and Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Ximena Ramos Salas
- Obesity Canada, Edmonton, Canada
- European Association for the Study of Obesity, Teddington, UK
| | - Phillip R Schauer
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA
| | | | - Caroline M Apovian
- Boston University School of Medicine, Boston, MA, USA
- Center for Nutrition and Weight Management, Boston Medical Center, Boston, MA, USA
| | - Louis J Aronne
- Comprehensive Weight Control Center, Division of Endocrinology, Diabetes and Metabolism, Weill Cornell Medicine, New York, NY, USA
| | - Rachel L Batterham
- National Institute of Health Research, University College London Hospitals Biomedical Research Centre, London, UK
- University College London Hospital Foundation Trust, London, UK
- Centre for Obesity Research, Department of Medicine, University College London, London, UK
| | - Hans-Rudolph Berthoud
- Neurobiology of Nutrition and Metabolism Department, Pennington Biomedical Research Centre, Louisiana State University System, Baton Rouge, LA, USA
| | - Camilo Boza
- Centro de Innovación Clinica Las Condes Universidad Adolfo Ibañez, Santiago, Chile
| | - Luca Busetto
- Department of Internal Medicine, University of Padova, Padua, Italy
| | - Dror Dicker
- Hasharon Hospital-Rabin Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Obesity Management Task Force, European Association for the Study of Obesity, Teddington, UK
| | - Mary De Groot
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Daniel Eisenberg
- Department of Surgery, Stanford School of Medicine and Palo Alto Virginia Health Care System, Stanford, CA, USA
| | - Stuart W Flint
- School of Psychology, University of Leeds, Leeds, UK
- Scaled Insights, Nexus, University of Leeds, Leeds, UK
| | - Terry T Huang
- Department of Health Policy & Management, Center for Systems & Community Design, New York, NY, USA
- NYU-CUNY Prevention Research Center, Graduate School of Public Health & Health Policy, City University of New York, New York, NY, USA
| | - Lee M Kaplan
- Obesity, Metabolism and Nutrition Institute, Massachusetts General Hospital, Boston, MA, USA
| | - John P Kirwan
- Integrated Physiology and Molecular Medicine, Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Judith Korner
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | | | | | - Carel W le Roux
- Diabetes Complications Research Centre, University College Dublin, Dublin, Ireland
| | - LaShawn McIver
- Government Affairs & Advocacy, American Diabetes Association, Arlington, VA, USA
| | - Geltrude Mingrone
- King's College London, Department of Diabetes, School of Life Course Science, London, UK
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Catholic University, Rome, Italy
| | | | - Tirissa J Reid
- Division of Endocrinology, Diabetes & Metabolism, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Ann M Rogers
- Pennsylvania State Hershey Medical Center, Hershey, PA, USA
| | | | - Randy J Seeley
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Antonio J Torres
- Hospital Clinico San Carlos. Universidad Complutense de Madrid, Madrid, Spain
| | - John B Dixon
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| |
Collapse
|
121
|
Abstract
The aims of this article are to (1) present a shared definition of weight stigma related to pregnancy and (2) develop a definition to inform valid and reliable nursing research addressing weight stigma in the obstetric setting. Weight stigma is increasingly prevalent in society, especially among women with prepregnancy overweight or obesity. However, a universally accepted definition of weight stigma related to pregnancy has yet to be identified. We followed Walker and Avant's concept analysis methodology using an iterative approach to ensure a robust and conceptually sound definition of weight stigma related to pregnancy.
Collapse
|
122
|
Pudney EV, Himmelstein MS, Puhl RM, Foster GD. Distressed or not distressed? A mixed methods examination of reactions to weight stigma and implications for emotional wellbeing and internalized weight bias. Soc Sci Med 2020; 249:112854. [PMID: 32097842 DOI: 10.1016/j.socscimed.2020.112854] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 02/11/2020] [Accepted: 02/12/2020] [Indexed: 12/22/2022]
Abstract
People react to, and are affected by, stigmatizing experiences in different ways. The current study examined different reactions to weight stigma to identify who may be vulnerable to lasting distress from these experiences. Using a mixed methods approach, this study compared qualitative descriptions of reactions to experiences of weight stigma in conjunction with quantitative measures of weight bias internalization (WBI) and other health indices. Data were collected from September 2017 to August 2018. Participants were U.S. adults enrolled in a commercial weight management program (n = 425, 96% female) who reported previous experiences of weight stigma (on quantitative measures), and who also qualitatively described feeling either no longer distressed (n = 178) or still distressed (n = 247) by those experiences. Qualitative analyses revealed that participants who were no longer distressed engaged in self-acceptance, were not concerned about other's evaluations of them, and prioritized health rather than appearance. Those who were still distressed from previous weight stigma experiences considered their body weight, and being stigmatized for it, as playing a prominent role in shaping their self-perception, they blamed themselves for experiencing the consequences of weight stigma, and ruminated on their memories of stigmatizing experiences. Hierarchical regressions demonstrated that participants who were still distressed reported greater WBI, greater perceived stress, and poorer mental health than participants who were no longer distressed. When adding WBI to the model predicting perceived stress, differences between participants who were no longer distressed versus still distressed attenuated and became statistically insignificant, suggesting that these qualitative reaction patterns to stigma may be related to participants' level of WBI. Given that some people may experience longer term distress from weight stigma than others, this study can inform interventions aimed to prevent or mitigate the negative consequences associated with being stigmatized.
Collapse
Affiliation(s)
- Ellen V Pudney
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA; Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford, CT, USA.
| | - Mary S Himmelstein
- Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford, CT, USA; Department of Psychological Sciences, Kent State University, USA
| | - Rebecca M Puhl
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA; Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford, CT, USA
| | - Gary D Foster
- WW (formerly Weight Watchers), New York, NY, USA; Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
123
|
Pearl RL, Wadden TA, Bach C, Gruber K, Leonard S, Walsh OA, Tronieri JS, Berkowitz RI. Effects of a cognitive-behavioral intervention targeting weight stigma: A randomized controlled trial. J Consult Clin Psychol 2020; 88:470-480. [PMID: 31971410 DOI: 10.1037/ccp0000480] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To test the effects of a cognitive-behavioral intervention for weight bias internalization (WBI; i.e., self-stigma) combined with behavioral weight loss (BWL). METHOD Adults with obesity and elevated WBI were randomly assigned to BWL alone or combined with the Weight Bias Internalization and Stigma Program (BWL + BIAS). Participants attended weekly group meetings for 12 weeks, followed by 2 biweekly and 2 monthly meetings (26 weeks total). Changes at Week 12 on the Weight Bias Internalization Scale (WBIS) and Weight Self-Stigma Questionnaire (WSSQ) were the principal outcomes, with changes at Week 26 assessed as secondary outcomes. Other outcomes included changes in mood, body image, eating behaviors, self-monitoring, and weight. RESULTS Seventy-two participants were randomized (84.7% female, 66.7% Black, mean age = 47.1 ± 11.5 years) Linear mixed models showed no significant differences between the BWL + BIAS and BWL groups in WBIS changes at Week 12 (-1.3 ± 0.2 vs. -1.0 ± 0.2) or week 26 (-1.5 ± 0.2 vs. -1.3 ± 0.2). BWL + BIAS participants had greater reductions in WSSQ total scores at Week 12 (p = .03), with greater changes on the self-devaluation subscale at Weeks 12 and 26 (p ≤ .03). BWL + BIAS participants reported significantly greater benefits on measures of eating and self-monitoring. Percent weight loss at Week 26 did not differ significantly between groups (BWL + BIAS = -4.5 ± 1.0%, BWL = -5.9 ± 1.0%, p = .28). CONCLUSION A psychological intervention for WBI produced short-term reductions in some aspects of weight self-stigma in persons with obesity. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Collapse
Affiliation(s)
- Rebecca L Pearl
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania
| | - Thomas A Wadden
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania
| | - Caroline Bach
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania
| | - Kathryn Gruber
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania
| | - Sharon Leonard
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania
| | - Olivia A Walsh
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania
| | - Jena S Tronieri
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania
| | - Robert I Berkowitz
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania
| |
Collapse
|
124
|
Marshall RD, Latner JD, Masuda A. Internalized Weight Bias and Disordered Eating: The Mediating Role of Body Image Avoidance and Drive for Thinness. Front Psychol 2020; 10:2999. [PMID: 32038383 PMCID: PMC6987958 DOI: 10.3389/fpsyg.2019.02999] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 12/18/2019] [Indexed: 11/22/2022] Open
Abstract
Internalized weight bias has been linked with undesirable physical and psychological health outcomes, including disordered eating. Interventions have targeted internalized weight bias and associated outcomes, but little is known about underlying mechanisms of change. Existing treatment literature suggests that drive for thinness and body image avoidance may sustain the link between internalized weight bias and disordered eating. The present study aimed to determine if drive for thinness and body image avoidance mediated the relationship between internalized weight bias and disordered eating in an ethnically diverse sample. Participants included 225 female college students aged 18–49 years (mean age = 20.4 years, SD = 4.4), with a mean BMI of 23.3 kg/m2 who completed a computer-based survey for partial course credit. As expected, internalized weight bias was positively associated with disordered eating, and results supported the hypothesis of the mediating role of drive for thinness and body image avoidance. These results are important given the shortage of intervention efforts targeting internalized weight bias. Future intervention efforts aimed at reducing internalized weight bias and associated outcomes may benefit from simultaneously targeting drive for thinness and body image avoidance.
Collapse
Affiliation(s)
- Rachel D Marshall
- Department of Psychology, University of Hawai'i at Mānoa, Honolulu, HI, United States
| | - Janet D Latner
- Department of Psychology, University of Hawai'i at Mānoa, Honolulu, HI, United States
| | - Akihiko Masuda
- Department of Psychology, University of Hawai'i at Mānoa, Honolulu, HI, United States
| |
Collapse
|
125
|
Emmer C, Bosnjak M, Mata J. The association between weight stigma and mental health: A meta-analysis. Obes Rev 2020; 21:e12935. [PMID: 31507062 DOI: 10.1111/obr.12935] [Citation(s) in RCA: 143] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 06/26/2019] [Accepted: 07/14/2019] [Indexed: 10/26/2022]
Abstract
In recent years, there has been considerable research on the relation between weight stigma and mental health, but no quantitative synthesis of the empirical evidence is available to date. This meta-analysis (105 studies, 59 172 participants, and 497 effect sizes) fills this gap by quantifying the association between weight stigma and mental health. Age, gender, and factors presumed to exert a protective role (i.e., adaptive coping strategies and perceived social support) were tested as potential moderators. The three-level meta-analytic model estimated under a random effects assumption revealed a medium to large negative association between weight stigma and mental health (r = -0.35). The overall association remained significant when controlling for publication year, education, and body weight. There was substantial heterogeneity in effect sizes between studies (I2 = 43%) and within studies (I2 = 56%). Surprisingly, all moderator hypotheses had to be rejected. Body weight was a significant moderator, indicating a stronger association between weight stigma and diminished mental health with increasing body mass index. Future research might focus on explaining the heterogeneity of findings and on testing causality as well as potential underlying mechanisms.
Collapse
Affiliation(s)
- Christine Emmer
- Health Psychology, University of Mannheim, Mannheim, Germany
| | - Michael Bosnjak
- ZPID-Leibniz Institute for Psychology Information and University of Trier, Trier, Germany
| | - Jutta Mata
- Health Psychology, University of Mannheim, Mannheim, Germany
| |
Collapse
|
126
|
Breland JY, Wong MS, Frayne SM, Hoggatt KJ, Steers WN, Saechao F, Washington DL. Obesity and Health Care Experiences among Women and Men Veterans. Womens Health Issues 2019; 29 Suppl 1:S32-S38. [PMID: 31253240 DOI: 10.1016/j.whi.2019.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 03/29/2019] [Accepted: 04/05/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Obesity is highly stigmatized, especially for women, and therefore may negatively affect health care experiences. Past findings on the relationship between obesity and health care experiences are mixed, perhaps because few studies examine relationships by gender and obesity class. Our objective was to evaluate whether women and men with more severe obesity report worse health care experiences related to Veterans Health Administration (VA) care. METHODS Health care experiences (self-management support, mental health assessments, office staff courtesy, communication with providers) and overall provider ratings were assessed with the 2014 VA Survey of Health Care Experiences of Patients. Using multiple regression analyses (n = 13,462 women, n = 268,180 men), we assessed associations among obesity classes, health care experiences, and overall provider ratings, adjusting for sociodemographic, health, and primary care use characteristics. RESULTS The greatest differences in health care experiences between patients with and without obesity were in self-management support experiences, which were more favorable among women and men of all obesity classes. There were gender differences in associations between obesity and mental health assessments: for men, but not women, those in any obesity class gave higher ratings than those without obesity. For most other health care experiences and provider ratings, men with obesity reported slightly less favorable experiences than those without. There was no consistent pattern for women. CONCLUSIONS It is promising that VA patients with obesity report more self-management support, given the behavior change required for weight management. Lower health care experience and provider ratings among men with obesity suggest a need to further investigate possible obesity-related stigma in VA primary care.
Collapse
Affiliation(s)
- Jessica Y Breland
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, California.
| | - Michelle S Wong
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Susan M Frayne
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, California; Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
| | - Katherine J Hoggatt
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California; Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California
| | - W Neil Steers
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California; Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Fay Saechao
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, California
| | - Donna L Washington
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California; Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| |
Collapse
|
127
|
Myre M, Berry TR, Ball GDC, Hussey B. Motivated, Fit, and Strong-Using Counter-Stereotypical Images to Reduce Weight Stigma Internalisation in Women with Obesity. Appl Psychol Health Well Being 2019; 12:335-356. [PMID: 31714033 DOI: 10.1111/aphw.12187] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 08/30/2019] [Accepted: 10/16/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study aimed to use implicit retraining to change automatic associations between body size and physical activity (PA) in women with obesity to reduce weight bias internalisation (WBI). METHODS A Solomon-square experimental design was used to determine the effect of a four-week online implicit retraining intervention on WBI (primary measure) and PA attitudes, self-efficacy, and self-reported behaviour (secondary measures). The intervention was a visual probe task pairing counter-stereotypical images of active individuals with obesity with positive PA-related words. In qualitative telephone interviews, a sub-sample of participants provided feedback and recommendations for using counter-stereotypical images in PA promotion. RESULTS Women completed the intervention (n = 48) or a control task (n = 55). Results of a RM-ANOVA showed no interaction or main effect of group on WBI. A main effect of time demonstrated that both groups had reduced WBI between pre-test and post-test, through to one-week follow-up. There were no differences between groups or over time for PA attitudes, self-efficacy, or behaviour. Women who completed interviews (n = 16) discussed several benefits and drawbacks of using counter-stereotypical images. CONCLUSION Implicit retraining did not reduce WBI but qualitative findings support the use of counter-stereotypical PA images.
Collapse
|
128
|
Psychological Pathway from Obesity-Related Stigma to Depression via Internalized Stigma and Self-Esteem among Adolescents in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16224410. [PMID: 31718003 PMCID: PMC6887789 DOI: 10.3390/ijerph16224410] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 11/08/2019] [Accepted: 11/08/2019] [Indexed: 01/26/2023]
Abstract
The objective of this research was to examine the pathway from public stigma, to perceived stigma, to depression in adolescents via internalized stigma. Adolescents in grade 7 through 9 from a junior high school in Changhua County in Taiwan completed self-administered surveys from March to July in 2018. Adolescents were asked questions regarding depressive symptoms, obesity-related perceived stigma, and internalized stigma. Structural equation modeling was used to fit the pathway model. The pathway was first analyzed with the full sample and then stratified by actual and perceived weight status. Our final analytic sample consisted of 464 adolescents. The pathway model suggested an acceptable model fit. Perceived weight stigma (PWS) was significantly associated with internalized stigma regardless of actual or self-perceived weight status. Internalized stigma was significantly associated with anxiety for both actual (β = 0.186) and self-perceived nonoverweight (non-OW) participants (β = 0.170) but not for overweight (OW) participants (neither actual nor self-perceived). For OW adolescents, perceived weight stigma was associated with anxiety. However, the internalization process did not exist. It may be that the influence of perceived weight stigma is larger than internalized stigma on anxiety. It may also be that the level of internalization was not yet high enough to result in anxiety.
Collapse
|
129
|
Puhl RM, Himmelstein MS, Pearl RL, Wojtanowski AC, Foster GD. Weight Stigma Among Sexual Minority Adults: Findings from a Matched Sample of Adults Engaged in Weight Management. Obesity (Silver Spring) 2019; 27:1906-1915. [PMID: 31689008 PMCID: PMC6839787 DOI: 10.1002/oby.22633] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 08/06/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Despite elevated rates of obesity among some groups of sexual minority (SM) adults, research examining weight stigma in this population is scarce. METHODS Weight stigma and weight-related health correlates were assessed in SM adults (N = 658) versus heterosexual adults (N = 658) matched on sex, race/ethnicity, age, education, and BMI. Adults enrolled in WW (formerly Weight Watchers) completed digital questionnaires assessing experienced weight stigma, weight bias internalization (WBI), weight cycling, eating self-efficacy, eating to cope, physical activity, and health-related quality of life (HRQOL). RESULTS Survey response rates ranged from 0.8% to 3.5%. There were no differences in experienced weight stigma between SM and heterosexual participants; more than two-thirds experienced weight stigma, and more than 50% reported stigma from family, health care providers, teachers and classmates, and community members. Gay men endorsed higher WBI than heterosexual men (β = 0.22, P < 0.001). Regardless of sexual orientation, WBI was associated with poorer mental HRQOL, lower eating self-efficacy, and increased eating to cope, controlling for demographics and BMI. CONCLUSIONS Experiencing weight stigma is as common for SM adults as heterosexual adults engaged in weight management, and WBI is associated with maladaptive eating behaviors and poor mental HRQOL. Increased attention to weight stigma and its health implications in SM populations is warranted.
Collapse
Affiliation(s)
- Rebecca M Puhl
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, Connecticut, USA
| | - Mary S Himmelstein
- Department of Psychological Sciences, Kent State University, Kent, Ohio, USA
| | - Rebecca L Pearl
- 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, New York, New York, USA
| |
Collapse
|
130
|
Craig H, le Roux C, Keogh F, Finucane FM. How Ethical Is Our Current Delivery of Care to Patients with Severe and Complicated Obesity? Obes Surg 2019; 28:2078-2082. [PMID: 29766353 PMCID: PMC6018590 DOI: 10.1007/s11695-018-3301-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Despite overwhelming evidence that bariatric interventions reduce morbidity and mortality and are cost-effective, access for affected patients is limited. We sought to describe the extent to which health policy makers and publically funded health services have an ethical obligation to provide bariatric care. We conducted a narrative review of the literature pertaining to the efficacy, safety, and cost-effectiveness of bariatric surgical interventions, in the context of the core principles of medical ethics. We found that in relation to autonomy (i.e., the right to self-determination), beneficence, non-maleficence, and justice (i.e., the obligation to provide fair and equitable treatment to all patients), the current provision of bariatric surgical care fell short of meeting internationally recognized medical ethical standards. These findings have important implications for government policy and healthcare resource allocation. Respecting the individual’s right of self-determination, to do good, prevent harm, and provide equity in access to services is paramount, even when that individual is obese.
Collapse
Affiliation(s)
- Hilary Craig
- Department of Surgery, St. James's Hospital, Dublin, Ireland
| | - Carel le Roux
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Dublin, Ireland
| | - Fiona Keogh
- Centre for Economic and Social Research in Dementia, National University of Ireland, Galway, Ireland
| | - Francis M Finucane
- Bariatric Medicine Service and HRB Clinical Research Facility, Galway University Hospital and National University of Ireland, Galway, Ireland.
| |
Collapse
|
131
|
Himmelstein MS, Puhl RM, Quinn DM. Overlooked and Understudied: Health Consequences of Weight Stigma in Men. Obesity (Silver Spring) 2019; 27:1598-1605. [PMID: 31364819 DOI: 10.1002/oby.22599] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 06/25/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVE A substantial amount of literature has suggested that weight stigma impairs health. Evidence on gender differences in weight stigma has been mixed, but studies of weight stigma within men have been primarily absent from the literature. METHODS In two samples of men recruited nationally from across the United States (N = 1,753), participants completed self-report measures assessing their height, weight, demographics, weight stigma (experienced and internalized), psychological well-being (depression), health behaviors (sleep, alcohol, smoking, binge eating, dieting, physical activity), and self-rated health. RESULTS Regression analyses showed that, independent of race, socioeconomic status, and BMI, experienced weight stigma and weight bias internalization among men were associated with poor health, including greater depressive symptoms, increased dieting, lower self-reported health, and increased odds of binge eating. Neither internalized nor experienced weight stigma was consistently associated with physical activity, smoking, drinking, or trouble sleeping. CONCLUSIONS These findings suggest that both experienced and internalized weight stigma are associated with several indices of poor health in men. It may be informative for future work to examine how men cope with weight stigma, particularly if certain coping responses to stigma involve behaviors that contribute to poorer health.
Collapse
Affiliation(s)
- Mary S Himmelstein
- Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford, Connecticut, USA
- Department of Psychological Sciences, Kent State University, Kent, Ohio, USA
| | - Rebecca M Puhl
- Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford, Connecticut, USA
- Department of Human Development & Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Diane M Quinn
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| |
Collapse
|
132
|
Pudney EV, Himmelstein MS, Puhl RM. The role of weight stigma in parental weight talk. Pediatr Obes 2019; 14:e12534. [PMID: 31140759 DOI: 10.1111/ijpo.12534] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 03/13/2019] [Accepted: 03/28/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Many parents engage in "weight talk" with their child, such as encouraging their child to lose weight or making comments about their own weight or others' weight. What parents say to their children about weight can affect children's well-being, yet little is known about parental characteristics that may be at play regarding this common practice. OBJECTIVES This study examined the role of weight stigma in parental weight talk, and whether internalized weight bias mediates the relationship between parents' experiences of weight stigma and weight-based conversations and comments. METHODS A sample of 453 parents (Mage = 35.07) with children 2 to 17 years old (Mage = 8.76) completed surveys measuring parental experiences with weight stigma, weight bias internalization, and frequency of different types of parental weight talk. Mediations were tested via the PROCESS macro. RESULTS Independent of controls (parent BMI, child BMI percentile, parent and child sex, parent and child age, race, income, and education), experienced weight stigma was indirectly associated with greater frequency of weight-based conversations (β = .08) and comments about oneself (β = .08) and others (β = .04) via parents' internalized weight bias. CONCLUSIONS These findings offer novel insights for understanding parental weight talk and can inform pediatric providers working with families on weight-related issues.
Collapse
Affiliation(s)
- Ellen V Pudney
- Department of Human Development and Family Sciences, University of Connecticut, Mansfield, Connecticut.,Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, Connecticut
| | - Mary S Himmelstein
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, Connecticut
| | - Rebecca M Puhl
- Department of Human Development and Family Sciences, University of Connecticut, Mansfield, Connecticut.,Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, Connecticut
| |
Collapse
|
133
|
Pearl RL, Himmelstein MS, Puhl RM, Wadden TA, Wojtanowski AC, Foster GD. Weight bias internalization in a commercial weight management sample: prevalence and correlates. Obes Sci Pract 2019; 5:342-353. [PMID: 31452919 PMCID: PMC6700514 DOI: 10.1002/osp4.354] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/14/2019] [Accepted: 06/14/2019] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Weight bias internalization (WBI) is associated with poor weight-related health. The purpose of this study was to identify the prevalence and correlates of WBI in a large sample of adults in a commercial weight management programme. METHODS WW (the new Weight Watchers) members participated in an online survey. Participants (N = 18,769) completed the 10-item Weight Bias Internalization Scale - Modified (WBIS-M) and the Weight Self-Stigma Questionnaire (WSSQ). Participants reported details about weight-stigmatizing experiences, including the onset, frequency and distress, and interpersonal sources of weight stigma. Participants self-reported their demographics, weight history, and height and weight (to compute body mass index [BMI]). RESULTS Weight bias internalization was relatively high compared with the general population (mean WBIS-M score = 4.3 ± 1.4; mean WSSQ total score = 35.2 ± 9.7). WBI was higher among participants who were female, younger and had higher BMIs (p < 0.001) and lower among those who were Black and were widowed or had a romantic partner (p < 0.001). Onset of weight stigma in childhood and young adulthood, and recent distress due to weight stigma, predicted higher WBI. Extended family and school sources of weight stigma had weaker associations with WBI than did other interpersonal sources. CONCLUSIONS Weight bias was internalized by a significant proportion of adults enrolled in a commercial weight management programme. A phenotype of WBI includes demographic characteristics and the timing and sources of weight stigma.
Collapse
Affiliation(s)
- R. L. Pearl
- Center for Weight and Eating Disorders, Department of PsychiatryPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPAUSA
| | - M. S. Himmelstein
- Rudd Center for Food Policy and ObesityUniversity of ConnecticutHartfordCTUSA
- Department of Psychological SciencesKent State UniversityKentOHUSA
| | - R. M. Puhl
- Rudd Center for Food Policy and ObesityUniversity of ConnecticutHartfordCTUSA
- Department of Human Development and Family SciencesUniversity of Connecticut, StorrsStorrsCTUSA
| | - T. A. Wadden
- Center for Weight and Eating Disorders, Department of PsychiatryPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPAUSA
| | | | - G. D. Foster
- Center for Weight and Eating Disorders, Department of PsychiatryPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPAUSA
- WWNew YorkNYUSA
| |
Collapse
|
134
|
Meadows A, Higgs S. Internalised Weight Stigma Moderates the Impact of a Stigmatising Prime on Eating in the Absence of Hunger in Higher- but Not Lower-Weight Individuals. Front Psychol 2019; 10:1022. [PMID: 31139111 PMCID: PMC6519002 DOI: 10.3389/fpsyg.2019.01022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 04/17/2019] [Indexed: 11/23/2022] Open
Abstract
A considerable body of evidence links internalised weight stigma with higher levels of disordered eating behaviour and cognitions in both normative- and higher-weight populations. However, to date, the impact of internalised weight stigma on objectively measured food intake has not been explored. In the present study, a weight-diverse sample of 158 non-smoking adults (BMI ≥ 25 kg/m2 n = 72, BMI < 25 kg/m2 n = 86) were recruited to a study on "The effects of hunger and satiety on information processing." Participants first completed a series of online questionnaires, then attended a lab visit in a fed state. Participants were randomised to read a sham news article on the negative consequences of either weight (stigma condition) or smoking (control condition) and answer some questions about the article. Then, under the pretence of a non-study-relevant break, participants were exposed to a pre-weighed selection of sweet and savoury snacks for 15 min. Mood and hunger levels were assessed prior to and after reading the vignette, and after the break. In contrast to the relationship with self-report eating behaviour, internalised weight stigma was not a significant independent predictor of total energy intake and did not moderate the relationship between exposure to the stigma prime and calories consumed. However, differences emerged on the basis of participants' weight status. Higher-weight participants with high levels of internalised weight stigma consumed fewer snack calories following exposure to a weight-stigma prime compared with a neutral prime (B = -137, SE = 58, t = -2.35, p = 0.020, 95% CI -252, -22) whereas those with low levels of internalised weight stigma tended to eat more in the weight stigma condition (B = 118, SE = 62, t = 1.91, p = 0.059, 95% CI -4, 241). In normative-weight participants, no differences in energy intake by levels of internalised weight stigma were observed. These findings suggest differences in the relationships between internalised weight stigma and self-reported disordered eating behaviour versus eating in the absence of hunger (EAH) measured under laboratory conditions. Additionally, internalised weight stigma appears to have differential effects on response to stigma in higher-weight and normative-weight individuals.
Collapse
Affiliation(s)
- Angela Meadows
- School of Psychology, University of Exeter, Exeter, United Kingdom
- School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Suzanne Higgs
- School of Psychology, University of Birmingham, Birmingham, United Kingdom
| |
Collapse
|
135
|
Morley B, Niven P, Dixon H, Swanson M, Szybiak M, Shilton T, Pratt IS, Slevin T, Wakefield M. Association of the LiveLighter mass media campaign with consumption of sugar-sweetened beverages: Cohort study. Health Promot J Austr 2019; 30 Suppl 1:34-42. [PMID: 30903631 PMCID: PMC6972651 DOI: 10.1002/hpja.244] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 03/20/2019] [Indexed: 12/30/2022] Open
Abstract
ISSUE ADDRESSED Evaluation of the behavioural impact of Western Australia's LiveLighter healthy weight and lifestyle campaign focussed on decreasing consumption of sugar-sweetened beverages (SSBs) using graphic imagery, as well as monitoring unintended consequences. METHODS A cohort design with pre-campaign telephone survey of Western Australian adults aged 25-49 (Time 1 May/Jun 2013: N = 1504) undertaken and repeated following the campaign (Time 2 Aug/Sep 2013: N = 822). RESULTS Post-campaign awareness was 67% with respondents in low socio-economic areas most likely to report viewing the campaign frequently. There was evidence of reduced SSB intake from baseline to follow-up among frequent (4+/week) SSB consumers (22% cf. 16%; P = 0.003) and some evidence among overweight (BMI 25+) weekly SSB consumers (56% cf. 48%; P = 0.013). There was also some evidence consumption of sweet food decreased (3+/week: 53% cf. 48%; P = 0.035) while fruit, vegetable and fast food consumption remained stable. Knowledge of potential health consequences of SSBs increased (70% cf. 82%; P < 0.001) with no change in knowledge of potential health consequences of overweight generally (86% cf. 89%). Importantly, there was no increase in endorsement of overweight stereotypes. CONCLUSIONS The LiveLighter "Sugary Drinks" campaign positively impacted adults' knowledge and behaviour with regard to SSB consumption in a pattern specific to the campaign messaging and without adverse impact on weight-related stereotypes. SO WHAT?: Findings support the use of mass media for healthy lifestyle change. They suggest the public are receptive to undertaking the campaign's simple concrete lifestyle recommendation and provide an indication of the campaign dose required to achieve positive behaviour change.
Collapse
Affiliation(s)
- Belinda Morley
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Vic., Australia
| | - Philippa Niven
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Vic., Australia
| | - Helen Dixon
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Vic., Australia
| | - Maurice Swanson
- Heart Foundation (Western Australia), Subiaco, WA, Australia
| | - Maria Szybiak
- Heart Foundation (Western Australia), Subiaco, WA, Australia
| | - Trevor Shilton
- Heart Foundation (Western Australia), Subiaco, WA, Australia
| | - Iain S Pratt
- Cancer Council Western Australia, Subiaco, WA, Australia
| | - Terry Slevin
- Cancer Council Western Australia, Subiaco, WA, Australia
| | - Melanie Wakefield
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Vic., Australia
| |
Collapse
|
136
|
Stewart SJF, Ogden J. The Role of BMI Group on the Impact of Weight Bias Versus Body Positivity Terminology on Behavioral Intentions and Beliefs: An Experimental Study. Front Psychol 2019; 10:634. [PMID: 30967821 PMCID: PMC6439336 DOI: 10.3389/fpsyg.2019.00634] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 03/07/2019] [Indexed: 11/13/2022] Open
Abstract
This experimental study investigated the role of BMI on the impact of weight bias vs body positivity terminology on behavioral intentions and beliefs about obesity. Participants (n = 332) were randomly allocated to two conditions to receive a vignette depicting an image of a person with obesity using either weight bias (n = 164) or body positivity (n = 168) terminology. Participants were divided into three groups based upon their BMI category (normal weight n = 173; overweight n = 92; obese n = 64). They then completed measures of behavioral intentions, obesity illness beliefs, and fat phobia. Although there were several differences in beliefs by BMI group, the results showed no differences between weight bias or body positivity terminology on any measures. There were, however, significant BMI group by condition interactions for beliefs about obesity relating to personal control and treatment control. Post hoc tests showed that weight bias resulted in reduced personal control in the obese BMI group compared to other participants. Weight bias also resulted in higher personal control over obesity in normal weight individuals compared to body positivity. People with obesity reported higher treatment control when exposed to weight bias compared to overweight participants, whereas normal weight participants reported greater treatment control when exposed to body positivity compared to both other groups. To conclude, the impact of weight bias and body positivity information is not universal and varies according to the BMI of the audience and the outcome being measured; whereas people of normal weight may benefit from weight bias there is no evidence that obese people benefit from body positivity. Implications for the prevention and treatment of obesity are discussed.
Collapse
Affiliation(s)
| | - Jane Ogden
- School of Psychology, University of Surrey, Guildford, United Kingdom
| |
Collapse
|
137
|
Purton T, Mond J, Cicero D, Wagner A, Stefano E, Rand-Giovannetti D, Latner J. Body dissatisfaction, internalized weight bias and quality of life in young men and women. Qual Life Res 2019; 28:1825-1833. [DOI: 10.1007/s11136-019-02140-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2019] [Indexed: 12/20/2022]
|
138
|
Abstract
PURPOSE OF REVIEW This review aims to evaluate current research findings relevant to weight stigmatization, to acknowledge the deleterious impact it has on the health of the paediatric population and to provide insight to optimize future guidelines for the treatment of individuals with overweight and obesity. RECENT FINDINGS Obesity prevalence continues to rise in the USA with estimates in children from ages 2-19 years of 18.5%, an all-time high. With the increase in obesity, there has been a concomitant increase in weight stigma, which affects both youth and general population across varied levels of socioeconomic status and body sizes. SUMMARY Weight stigma is a contributing phenomenon to the current obesity epidemic, as individuals with stigmatized experiences (weight-based teasing, bullying, victimization) have increased risks for acquiring adverse health outcomes that encompass the physical, behavioural and psychological. Weight stigma can also lead affected individuals to internalize such experiences which decrease their overall quality of life. Sources of stigma may come from peers, family, educators, media, as well as healthcare professionals, as highlighted in this review. Efforts to establish prevention and treatment strategies for weight stigma may generate further traction to help improve global obesity rates. VIDEO ABSTRACT.
Collapse
Affiliation(s)
- Carl J. Palad
- New York Medical College, Valhalla, New York, Massachusetts, USA
| | | | - Fatima Cody Stanford
- Massachusetts General Hospital, MGH Weight Center, Department of Medicine-Division of Endocrinology- Neuroendocrine, Department of Pediatrics-Division of Endocrinology, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
139
|
Lee GC, Platow MJ, Augoustinos M, Van Rooy D, Spears R, Bar‐Tal D. When are anti-fat attitudes understood as prejudice versus truth? An experimental study of social influence effects. Obes Sci Pract 2019; 5:28-35. [PMID: 30820328 PMCID: PMC6381298 DOI: 10.1002/osp4.315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 11/28/2018] [Accepted: 11/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND/OBJECTIVES If people who hold anti-fat attitudes believe these attitudes to be true, then anti-prejudice appeals are likely to be unsuccessful, if only because the targets will not see their attitudes as in need of change. The current study examined processes that may lead people to see their anti-fat attitudes as 'truth' or as 'prejudice'. SUBJECTS/METHODS Participants (N = 482) read anti-fat statements and were then presented with an interpretation of these statements as 'truth' or 'prejudice'. The source of this interpretation was either an (i) in-group or out-group member and (ii) expert or non-expert. Participants' judgements of the statements were expected to vary such that in-group others and experts would exert more influence than would out-group others and non-experts. RESULTS Participants aligned their own interpretations of an anti-fat statement with those of an expert, but not with those of a non-expert, F(1,466) = 8.97, p < 0.05, ηp 2 = 0.02. The group membership variable had no effect on judgements of 'truth' or 'prejudice' of the anti-fat statement. CONCLUSION The expressions that people believe constitute anti-fat prejudice versus truth about people described as overweight are influenced by exposure to expert opinion (in this case, by medical doctors). Implications for the success of weight-based anti-prejudice appeals and for healthcare provision are discussed.
Collapse
Affiliation(s)
- G. C. Lee
- Research School of PsychologyThe Australian National UniversityCanberraAustralia
| | - M. J. Platow
- Research School of PsychologyThe Australian National UniversityCanberraAustralia
| | - M. Augoustinos
- School of PsychologyThe University of AdelaideAdelaideAustralia
| | - D. Van Rooy
- Research School of PsychologyThe Australian National UniversityCanberraAustralia
| | - R. Spears
- Faculty of Behavioural and Social SciencesGroningen UniversityGroningenThe Netherlands
| | - D. Bar‐Tal
- School of EducationTel Aviv UniversityTel AvivIsrael
| |
Collapse
|
140
|
Walsh OA, Wadden TA, Tronieri JS, Chao AM, Pearl RL. Weight Bias Internalization Is Negatively Associated With Weight-Related Quality of Life in Persons Seeking Weight Loss. Front Psychol 2019; 9:2576. [PMID: 30618992 PMCID: PMC6304379 DOI: 10.3389/fpsyg.2018.02576] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 11/30/2018] [Indexed: 11/17/2022] Open
Abstract
Research has shown a negative relationship between weight bias internalization (WBI) and general measures of health-related quality of life (QOL), such as the Short Form–36. Less is known about the impact of WBI on weight-specific domains of QOL. This study examined the relationship between WBI and weight-related QOL, as measured by the Impact of Weight on Quality of Life (IWQOL-Lite) scale. Participants were 178 adults with obesity [71.3% black, 87.6% female, mean body mass index (BMI) = 40.9 ± 5.9 kg/m2] enrolled in a weight loss trial testing the effects of lorcaserin on weight loss maintenance. At baseline, participants completed the Weight Bias Internalization Scale (WBIS), the IWQOL-Lite and the Patient Health Questionnaire (PHQ-9, to assess symptoms of depression). Total scores for the IWQOL-Lite and its five subscales (Physical Function, Self-Esteem, Sexual Life, Public Distress and Work) were calculated. Linear regression analyses showed that WBIS scores were associated with the IWQOL-Lite total score and all subscales above and beyond the effects of demographic variables, BMI, and depressive symptoms (beta values = -0.18 to -0.70, p values < 0.019). The relationship between WBIS and the IWQOL-Lite scales did not differ by gender or race. WBI was associated with mental and physical aspects of weight-related QOL in a predominantly black and female treatment-seeking sample of patients with obesity. Prioritizing the development of interventions to reduce WBI may be important for improving weight-related QOL.
Collapse
Affiliation(s)
- Olivia A Walsh
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Thomas A Wadden
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Jena Shaw Tronieri
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Ariana M Chao
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States.,Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Rebecca L Pearl
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| |
Collapse
|
141
|
Jung FU, Luck-Sikorski C. Overweight and Lonely? A Representative Study on Loneliness in Obese People and Its Determinants. Obes Facts 2019; 12:440-447. [PMID: 31315116 PMCID: PMC6758716 DOI: 10.1159/000500095] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 04/02/2019] [Indexed: 01/03/2023] Open
Abstract
Obesity is associated with physical and medical restrictions and comorbidities, but it also entails psychosocial effects such as social isolation and feelings of rejection. The aim of this study was to investigate the link between loneliness and weight stigma in a large sample of obese individuals. Results were derived from a large representative sample (n = 1,000). The survey included the 3-item version of the UCLA loneliness scale, the Patient Health Questionnaire (PHQ-9) as well as the Weight Bias Internalization scale (WBIS). The mean UCLA score was 1.943 (SD = 0.771). Respondents with higher levels of depression (B = 0.176), higher internalized weight bias (B = 0.435), and the experience of discrimination (B = 0.286) reported higher levels of loneliness. Future studies should investigate the mediation pathways between obesity, loneliness, and its determinants to provide a framework for successful interventions as part of obesity management programs.
Collapse
Affiliation(s)
- Franziska U Jung
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, University Hospital Leipzig, Leipzig, Germany,
- SRH University of Applied Health Sciences, Gera, Germany,
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany,
| | - Claudia Luck-Sikorski
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, University Hospital Leipzig, Leipzig, Germany
- SRH University of Applied Health Sciences, Gera, Germany
| |
Collapse
|
142
|
Zickgraf HF, Ellis JM, Essayli JH. Disentangling orthorexia nervosa from healthy eating and other eating disorder symptoms: Relationships with clinical impairment, comorbidity, and self-reported food choices. Appetite 2018; 134:40-49. [PMID: 30543837 DOI: 10.1016/j.appet.2018.12.006] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 11/30/2018] [Accepted: 12/09/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND Orthorexia nervosa (ON) is characterized by obsessions about eating healthily and rigid adherence to a perceived healthy diet. This study uses the Eating Habits Questionnaire to investigate the relationship of ON symptoms with self-reported food intake, eating-related impairment, obsessive compulsive disorder symptoms (OCD), gender, and BMI while controlling for other eating disordered symptoms. The aim of this study is to provide further evidence for the construct of ON as distinct from other forms of disordered eating. METHODS The sample consisted of 449 adults recruited on Amazon's Mechanical Turk. Self-reported symptoms of currently recognized eating disorders (anorexia and bulimia nervosa, AN/BN, avoidant/restrictive food intake disorder, ARFID) were statistically controlled in correlational analyses and MANCOVA exploring the relationship of ON domains to comorbidity, eating behavior, gender, and weight. RESULTS Confirmatory factor analysis supported a three-factor solution for the EHQ, with factors representing normative healthy eating behaviors ("behaviors"), positive feelings associated with healthy eating ("feelings"), and interference/problems from rigid healthy eating ("problems"). Overall ON symptoms were more strongly related to AN/BN than to ARFID. Of the subscales, only Problems was related to other eating disorder symptomatology. Controlling for other eating disorder symptoms, overall ON symptomatology was not related to clinical impairment from eating or OCD, although it was related to higher self-reported intake of fruits/vegetables and lower intake of discretionary foods. When other eating disordered symptoms and ON domains were statistically controlled, Problems was related to clinical eating impairment, OCD symptoms, and higher intake of both fruits/vegetables and discretionary foods. CONCLUSIONS The Problems scale of the EHQ appears to capture disordered eating symptomatology that is distinct from other eating disorders and from normative healthy eating behaviors, consistent with descriptions of ON.
Collapse
Affiliation(s)
- Hana F Zickgraf
- University of Chicago Pritzker School of Medicine, United States; Penn State College of Medicine, Penn State Health Milton S. Hershey Medical Center, United States.
| | | | - Jamal H Essayli
- Penn State College of Medicine, Penn State Health Milton S. Hershey Medical Center, United States
| |
Collapse
|
143
|
Olson KL, Lillis J, Thomas JG, Wing RR. Prospective Evaluation of Internalized Weight Bias and Weight Change Among Successful Weight-Loss Maintainers. Obesity (Silver Spring) 2018; 26:1888-1892. [PMID: 30421843 PMCID: PMC6249105 DOI: 10.1002/oby.22283] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 07/17/2018] [Accepted: 07/19/2018] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Internalized weight bias (IWB) has been associated with weight regain after intentional weight loss, but reliance on cross-sectional data limits the understanding of this relationship. This study prospectively evaluated IWB as a predictor of weight change in a longitudinal observational study of successful weight-loss maintainers. METHODS National Weight Control Registry participants (maintained 13.6-kg weight loss for ≥ 1 y) were asked to complete an online questionnaire including current weight and Weight Bias Internalization Scale-Modified (WBIS-M) at baseline and 12 months. RESULTS At baseline, 1,250 of 1,643 eligible individuals completed the baseline assessment (71% female; 94% white; mean age ± SD: 52 y ± 13.1; BMI: 27 ± 5.5). The average WBIS-M score was 3.0 (± 1.3). Study completers (n = 862) reported 2.2% (± 7.8%) weight gain. Higher baseline IWB predicted weight gain among men (n = 254; t = -2.28; P = 0.02) but not women (n = 608; t = 1.22; P = 0.22). A one-point reduction in WBIS-M score at follow-up was associated with a 3.0% weight loss. CONCLUSIONS Among weight-loss maintainers, IWB may be a risk factor for weight gain among men. Weight loss at follow-up was associated with reduced IWB in both men and women. Reliance on female-only samples may limit our understanding of IWB and its implications for weight control.
Collapse
Affiliation(s)
- KayLoni L. Olson
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence RI
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University
| | - Jason Lillis
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence RI
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University
| | - J. Graham Thomas
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence RI
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University
| | - Rena R. Wing
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence RI
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University
| |
Collapse
|
144
|
The mediating role of internalized weight stigma on weight perception and depression among emerging adults: Exploring moderation by weight and race. Body Image 2018; 27:202-210. [PMID: 30384173 DOI: 10.1016/j.bodyim.2018.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 10/16/2018] [Accepted: 10/16/2018] [Indexed: 11/22/2022]
Abstract
The current study examined internalized weight stigma as a mediator of the association between self-perceived weight and depressive symptoms. University students (N = 317) aged 18-25 years completed measures of self-perceived weight, internalized stigma, and depressive symptoms. Multigroup path analyses were used to examine the indirect effect of self-perceived weight on depression through self-stigma. Findings revealed that among persons of size, internalized stigma mediated the effect of higher self-perceived weight on higher depressive symptoms. Among lean persons, this indirect effect was only significant for Black participants. Among all groups, the direct effect of self-perceived weight on internalized stigma was significant. While the present results warrant future replication, the findings expand our understanding of the association between self-perceived weight and depression. These results also illuminate potential future opportunities for rich, culturally informed research and clinical advances that take into account the detrimental role of weight stigma.
Collapse
|
145
|
Puhl RM, Himmelstein MS. Weight Bias Internalization Among Adolescents Seeking Weight Loss: Implications for Eating Behaviors and Parental Communication. Front Psychol 2018; 9:2271. [PMID: 30519207 PMCID: PMC6258789 DOI: 10.3389/fpsyg.2018.02271] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 11/01/2018] [Indexed: 12/21/2022] Open
Abstract
Background: Emerging evidence has demonstrated a high prevalence of weight bias internalization (WBI) among adults, as well as consistent links between internalization and adverse psychological and physical health. However, research examining WBI in youth and its impact on their health is scarce, especially among youth seeking weight loss treatment who may be particularly vulnerable to weight stigma from peers and parents. To address this research gap, the present study assessed WBI in a weight loss treatment-seeking sample of adolescents, examining associations between internalization and adolescents' eating behaviors and parental weight-related communication. Methods: Adolescents (N = 148, M age = 15.97 years), completed online self-report measures to assess WBI (using the modified version of the WBI Scale), body weight, binge eating, eating as a coping strategy, and weight teasing from peers and family members. Adolescents also reported on the frequency of parental comments about body weight, parental dieting, and parental encouragement of adolescent dieting. Results: Adolescents expressed a high mean level of internalized weight bias (M = 5.45, SD = 0.88). Higher levels of internalization were observed across increasing body weight categories; no differences were observed for gender or history of weight teasing. WBI was significantly higher among adolescents who reported binge eating and eating to cope with distress. Regression analyses showed that weight-related comments from mothers (but not fathers) significantly predicted adolescents' WBI (including frequency of mothers' comments about adolescents' body weight, comments about their own body weight, and encouragement of their adolescent to diet), as did increased dieting frequency among mothers. Conclusion: The present study provides novel insights to the scant literature on WBI in youth. Findings indicate that WBI is high in both girls and boys engaged in weight loss, and is associated with maladaptive eating behaviors, higher frequency of maternal dieting, and mothers' comments about body weight. These findings have important clinical implications for youth and families engaged in weight loss treatment, and underscore the need for research to clarify adverse effects of internalization on weight-related health in youth and to better understand the role that parental weight communication may have on adolescents' internalization.
Collapse
Affiliation(s)
- Rebecca M Puhl
- Department of Human Development and Family Studies, Rudd Center for Food Policy and Obesity, Hartford, CT, United States
| | - Mary S Himmelstein
- Mary Himmelstein, Rudd Center for Food Policy and Obesity, Hartford, CT, United States
| |
Collapse
|
146
|
Phelan SM. An update on research examining the implications of stigma for access to and utilization of bariatric surgery. Curr Opin Endocrinol Diabetes Obes 2018; 25:321-325. [PMID: 30048259 DOI: 10.1097/med.0000000000000431] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW To summarize recent literature examining the relationship between stigma and utilization of surgical treatments for obesity. RECENT FINDINGS The stigma of obesity and stigma associated with surgical treatments for obesity can affect both healthcare providers' recommendations of these options and patients' likelihood of considering and choosing these treatments. Presurgical requirements of healthcare and insurance organizations and a lack of postsurgical support reflect the stigmatizing attitudes that bariatric/metabolic surgery is an 'easy fix' and 'last resort' for patients too undisciplined to lose weight in other ways. SUMMARY Here we review the literature published in the last year that addresses the implications of stigma for the utilization and outcomes of surgical treatments for obesity.
Collapse
Affiliation(s)
- Sean M Phelan
- Division of Healthcare Policy and Research, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
147
|
Ivezaj V, Wiedemann AA, Lydecker JA, Grilo CM. Food addiction among Spanish-speaking Latino/as residing in the United States. Eat Behav 2018; 30:61-65. [PMID: 29870970 PMCID: PMC6047914 DOI: 10.1016/j.eatbeh.2018.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 05/22/2018] [Accepted: 05/23/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This study examined food addiction, assessed by the Yale Food Addiction Scale (YFAS), and associated features among a participant group of Spanish-speaking Latino/as residing in the United States. METHOD Participants were 140 Spanish-speaking Latino/as (n = 77 female) who participated in an anonymous web-based survey. Mean age and body mass index (BMI) were 31.87 (SD = 9.12) years and 28.34 (SD = 7.14) kg/m2, respectively. Participants completed a battery of established self-report measures assessing food addiction, binge-eating and eating-disorder psychopathology (Eating Disorder Examination-Questionnaire; EDE-Q), depressive symptoms (Patient Health Questionnaire-2; PHQ-2), and mental and physical functioning (MOS Short Form Health Survey; SF-12). RESULTS Of the 140 participants, 25 (17.9%) exceeded the clinical threshold of food addiction; no significant differences were observed between those categorized with versus without food addiction in age, sex, or race. YFAS scores were significantly correlated with EDE-Q overvaluation, EDE-Q dissatisfaction, BMI, SF-12, and the PHQ-2 (all p-values < .01). Categorical analyses revealed similar findings with participants categorized with clinical levels of food addiction being significantly more likely to meet clinical levels of overvaluation of weight/shape, and reporting significantly greater frequency of binge-eating, depressive symptoms, and poorer overall mental health than those not meeting food addiction criteria (all p-values < .05). CONCLUSION Our findings for this Spanish-speaking participant group are generally consistent with those reported in a meta-analysis of English-speaking individuals in suggesting that higher YFAS scores are associated with greater disturbances in eating psychopathology. Future studies should examine whether level of acculturation might contribute to differences in food addiction symptoms and associated psychopathology among Spanish-speaking Latino/as.
Collapse
Affiliation(s)
| | | | | | - Carlos M. Grilo
- Yale School of Medicine, New Haven, CT, 06519,Yale University, New Haven, CT, 06511
| |
Collapse
|
148
|
Pearl RL, Puhl RM. Weight bias internalization and health: a systematic review. Obes Rev 2018; 19:1141-1163. [PMID: 29788533 PMCID: PMC6103811 DOI: 10.1111/obr.12701] [Citation(s) in RCA: 299] [Impact Index Per Article: 49.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 03/23/2018] [Accepted: 03/29/2018] [Indexed: 01/31/2023]
Abstract
A robust literature has documented the negative health effects of being the target of weight bias. Weight bias internalization (WBI) occurs when individuals apply negative weight stereotypes to themselves and self-derogate because of their body weight. Compared with experiences of weight bias, less is known about the relationship between WBI and mental and physical health, although more literature on this topic has emerged in recent years. The current systematic review identified 74 studies assessing the relationship between WBI and health and interventions designed to reduce WBI and improve health. Over half of identified studies were published from 2016 to 2017. Results showed strong, negative relationships between WBI and mental health outcomes. Fewer studies have examined the relationship between WBI and physical health, and results were less consistent. Key directions for future research are highlighted, including the need for prospective and experimental studies with greater sample diversity.
Collapse
Affiliation(s)
- R L Pearl
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - R M Puhl
- Rudd Center for Food Policy and Obesity, Department of Human Development & Family Studies, University of Connecticut, Hartford, CT, USA
| |
Collapse
|
149
|
Pearl RL, Wadden TA, Tronieri JS, Berkowitz RI, Chao AM, Alamuddin N, Leonard SM, Carvajal R, Bakizada ZM, Pinkasavage E, Gruber KA, Walsh OA, Alfaris N. Short- and Long-Term Changes in Health-Related Quality of Life with Weight Loss: Results from a Randomized Controlled Trial. Obesity (Silver Spring) 2018; 26:985-991. [PMID: 29676530 PMCID: PMC5970047 DOI: 10.1002/oby.22187] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 03/12/2018] [Accepted: 03/13/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The objective of this study was to determine the effects of weight loss and weight loss maintenance (WLM) on weight-specific health-related quality of life in a 66-week trial. METHODS Adults with obesity (N = 137, 86.1% female, 68.6% black, mean age = 46.1 years) who had lost ≥ 5% of initial weight in a 14-week intensive lifestyle intervention/low-calorie diet (LCD) program were randomly assigned to lorcaserin or placebo for an additional 52-week WLM program. The Impact of Weight on Quality of Life-Lite (IWQOL-Lite) scale (including five subscales), Patient Health Questionnaire-9 (depression), and Perceived Stress Scale were administered at the start of the 14-week LCD program, randomization, and week 52 of the randomized controlled trial (i.e., 66 weeks total). RESULTS Significant improvements in all outcomes, except weight-related public distress, were found following the 14-week LCD program (P values < 0.05). Improvements were largely maintained during the 52-week randomized controlled trial, despite weight regain of 2.0 to 2.5 kg across treatment groups. Participants who lost ≥ 10% of initial weight achieved greater improvements in physical function, self-esteem, sexual life, and the IWQOL-Lite total score than those who lost < 5% and did not differ from those who lost 5% to 9.9%. CONCLUSIONS Improvements in weight-specific health-related quality of life were achieved with moderate weight loss and were sustained during WLM.
Collapse
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
- Edwin & Fannie Gray Hall Center for Human Appearance, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Thomas A. Wadden
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Jena Shaw Tronieri
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Robert I. Berkowitz
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, PA
| | - Ariana M. Chao
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA
| | - Naji Alamuddin
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Institute for Diabetes, Obesity, and Metabolism, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Sharon M. Leonard
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Ray Carvajal
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Zayna M. Bakizada
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Emilie Pinkasavage
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Kathryn A. Gruber
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Olivia A. Walsh
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | | |
Collapse
|
150
|
Lydecker JA, Riley KE, Grilo CM. Associations of parents' self, child, and other "fat talk" with child eating behaviors and weight. Int J Eat Disord 2018; 51. [PMID: 29542177 PMCID: PMC6002914 DOI: 10.1002/eat.22858] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Fat talk, negative communication about weight, is common in the media, peer groups, and families. Little is known about parental fat talk directed at oneself or others. This study examined associations between different forms of parental fat talk and child disordered eating behaviors and weight, and differences by child sex and age. METHOD Parents of preadolescents or adolescents (n = 581) reported fat talk about themselves (self-fat talk), others (obesity-fat talk), and their child (child-fat talk). RESULTS 76.0% of parents reported regular self-fat talk in front of children, 51.5% reported obesity-fat talk, and 43.6% reported child-fat talk. Fat talk did not differ significantly between parents of preadolescents and adolescents but was more common with sons than daughters. Of the three forms of fat talk, only child-fat talk was associated with all child eating and weight variables (binge eating, overeating, secretive eating, and overweight/obesity); associations were strongest for adolescent girls. Child sex was associated with secretive eating and overweight/obesity. CONCLUSIONS Parents reported using different forms of fat talk frequently. Parent self- and obesity-fat talk were reported more frequently, but child-fat talk was the most strongly associated with children's eating and weight. Because of associations with disordered eating behaviors, intervening to reduce fat talk might contribute to improving pediatric disordered eating and weight-related interventions.
Collapse
Affiliation(s)
- Janet A. Lydecker
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Kristen E. Riley
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA,Amherst College, Amherst, MA, USA
| | - Carlos M. Grilo
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| |
Collapse
|