Changes in perceived weight discrimination among Americans, 1995-1996 through 2004-2006

The importance of language in engagement between health-care professionals and people living with obesity: a joint consensus statement

Obesity is a chronic condition that requires long-term management and is associated with unprecedented stigma in different settings, including during interactions with the health-care system. This stigma has a negative effect on the mental and physical health of people with obesity and can lead to avoidance of health care and disruption of the doctor-patient relationship. Considerable evidence exists to suggest that simply having a conversation about obesity can lead to weight loss, which translates into health benefits. However, both health-care practitioners and people living with obesity report apprehension in initiating this conversation. We have collaborated with stakeholders from Obesity UK, physicians, dieticians, clinical psychologists, obesity researchers, conversation analysts, nurses, and representatives from National Health Service England Diabetes and Obesity. This group has contributed to the production of this consensus statement, which addresses how people living with obesity wish to have their condition referred to and provides practical guidance for health-care professionals to facilitate collaborative and supportive discussions about obesity. Expert stakeholders consider that changes to language used at the point of care can alleviate the stigma of obesity within the health-care system and support improved outcomes for both people living with obesity and for the health-care system.

Joint international consensus statement for ending stigma of obesity

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.

Community-level obesity prevention is not associated with dieting behaviours and weight dissatisfaction in children: The Healthy Communities Study

BACKGROUND

Within the context of high childhood obesity prevalence, there is a concern that community efforts intended to reduce childhood obesity may lead to unintended adverse outcomes.

OBJECTIVE

This analysis examined relationships between community programs, policies, and environmental changes (CPPs) for obesity prevention with unhealthy dieting behaviours and body weight satisfaction in children.

METHODS

Using the Healthy Communities Study 2013 to 2015 survey sample of 5138 US children aged 4 to 15 years old, multilevel models examined associations between standardized CPP intensity scores and child dieting behaviours and weight satisfaction, adjusting for community and child-level covariates and clustered study design.

RESULTS

In fully adjusted models, higher total, physical activity, and nutrition CPP intensity scores were associated with lower odds of dissatisfaction with weight (1 year total CPP odds ratio [OR]: 0.41, 95% confidence interval [CI], 0.22-0.73; 6 year total CPP OR: 0.48, 0.29-0.80). Higher physical activity CPP intensity over the past year was associated with greater odds of weight satisfaction (OR: 1.77, 95% CI, 1.10-2.84). No associations were observed with dieting behaviours.

CONCLUSIONS

Results suggest that community efforts focusing on nutrition and physical activity to prevent childhood obesity may be associated with weight satisfaction and not with unhealthy dieting behaviours.

Relationships among weight stigma, eating behaviors and stress in adolescents in Wuhan, China

Background

The purpose of this study was to examine the relationships among weight stigma, eating behaviors, and stress, as well as to analyze the effect of stress in mediating the association between weight stigma and eating behaviors.

Methods

The study involved 1818 adolescents between 14 to 19 years of age and was conducted in Wuhan, China in 2019. Weight stigma, eating behaviors (cognitive restraint, uncontrolled eating, and emotional eating), and stress were assessed by self-report questionnaires. Hierarchical linear regression analyses were used to examine the predictors of cognitive restraint, uncontrolled eating, and emotional eating; the serial mediation models analyses were conducted to analyze the effect of stress in mediating the association between weight stigma and eating behaviors for the whole non-overweight (normal and underweight) and overweight or obese participants, respectively.

Results

Hierarchical linear regression analyses showed that experiences of weight stigma significantly predicted uncontrolled eating and emotional eating regardless of body mass index (BMI) (non-overweight adolescents: uncontrolled eating: β [SE] = 0.161 [0.017]; emotional eating: β [SE] = 0.199 [0.008], p < 0.05; overweight or obese adolescents: uncontrolled eating: β [SE] = 0.286 [0.030]; emotional eating: β [SE] = 0.267 [0.014], p < 0.05); experiences of weight stigma significantly predicted cognitive restraint among non-overweight adolescents (β [SE] = 0.204 [0.013], p < 0.05). Mediation analyses showed that stress mediated the associations between weight stigma and uncontrolled eating and emotional eating among non-overweight adolescents (uncontrolled eating: indirect effect coefficient = 0.0352, 95% CI = 0.0241, 0.0478; emotional eating: indirect effect coefficient = 0.0133, 95% CI = 0.0085, 0.0186).

Conclusions

These findings suggest that non-overweight individuals can still experience weight stigma and its associated negative consequences; the relationship between weight stigma and eating behaviors is modulated by weight status; stress mediated the associations between weight stigma and uncontrolled and emotional eating among non-overweight adolescents.

Gender discrimination and depressive symptoms among child-bearing women: ELSPAC-CZ cohort study

BACKGROUND

Depression is approximately two-fold more prevalent among women than men. Social theories suggest that discrimination is a pathway through which gender inequalities affect women's lives, but data are lacking. This cohort study evaluates whether perceived gender discrimination is linked to depressive symptoms among child-bearing women.

METHODS

Data were obtained from 4,688 participants enrolled in pregnancy in 1991-92 in the European Longitudinal Cohort Study of Pregnancy and Childhood, Czech Republic. Perceived gender discrimination was assessed in mid-pregnancy, year seven, and year eleven. Depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale at eight time-points between mid-pregnancy and year eleven post-delivery. Linear mixed error-component models of depressive symptoms were estimated.

FINDINGS

Perceived gender discrimination, reported by 10.7% of women, was related to higher depressive symptoms, both in the unadjusted analysis (b = 0.15 [95% confidence interval (CI): 0.12, 0.19], p < 0.001) and in the fully adjusted model (b = 0.12 [95% CI: 0.09, 0.16], p < 0.001). Covariates linked to higher depressive symptoms included financial hardship (b = 0.12 [95% CI: 0.10, 0.14], p < 0.001), childhood emotional/physical neglect (b = 0.18 [95% CI: 0.14, 0.22], p < 0.001), and childhood sexual abuse (b = 0.04 [95% CI: 0.03, 0.06], p < 0.001); an inverse relationship was evident for social support (-0.05 [95% CI: -0.07, -0.04], p < 0.001) and having a partner who performs female-stereotypical household tasks (b=-0.03 [95% CI: -0.05, -0.01], p = 0.001).

INTERPRETATION

The findings provide the first evidence that perceived gender discrimination is associated with depressive symptoms among child-bearing women. Social intervention programs aimed at reducing gender discrimination can potentially contribute to better mental health of women.

FUNDING

Bill and Melinda Gates Foundation.

The Effect of a Food Addiction Explanation Model for Weight Control and Obesity on Weight Stigma

There is increasing scientific and public support for the notion that some foods may be addictive, and that poor weight control and obesity may, for some people, stem from having a food addiction. However, it remains unclear how a food addiction model (FAM) explanation for obesity and weight control will affect weight stigma. In two experiments (N = 530 and N = 690), we tested the effect of a food addiction explanation for obesity and weight control on weight stigma. In Experiment 1, participants who received a FAM explanation for weight control and obesity reported lower weight stigma scores (e.g., less dislike of ‘fat people’, and lower personal willpower blame) than those receiving an explanation emphasizing diet and exercise (F_(4,525) = 7.675, p = 0.006; and F_(4,525) = 5.393, p = 0.021, respectively). In Experiment 2, there was a significant group difference for the dislike of ‘fat people’ stigma measure (F_(5,684) = 5.157, p = 0.006), but not for personal willpower weight stigma (F_(5,684) = 0.217, p = 0.81). Participants receiving the diet and exercise explanation had greater dislike of ‘fat people’ than those in the FAM explanation and control group (p values < 0.05), with no difference between the FAM and control groups (p > 0.05). The FAM explanation for weight control and obesity did not increase weight stigma and resulted in lower stigma than the diet and exercise explanation that attributes obesity to personal control. The results highlight the importance of health messaging about the causes of obesity and the need for communications that do not exacerbate weight stigma.

On body economics and fitting in: upward mobility and obesity stigma in Jamaica

Introduction: Jamaican culture is considered 'fat-loving,' and thus less likely to foster obesity stigma. However, the importance of tourism to Jamaica's economy, global trends toward a thinness aesthetic and extant ethos' of both bodily self-acceptance and status-based bodily critique suggest that obesity stigma may exist in Jamaica - particularly in the context of class status aspiration.Objective: This pilot study examined the relationship between upward mobility and fat stigma in Kingston, Jamaica in two samples.Design: The first sample - nineteen college-enrolled 18-25 year olds - completed an online survey. Responses were grouped by perceived wealth status.Results: No relationship was found between wealth status and obesity stigma. There was no association between wealth group and body ideal - whether slender or curvaceous. However, responses to questions concerning the value of having an ideal body differed by wealth grouping. Those with lower perceived wealth tended to cite 'fitting in to society' as a benefit of having an ideal body. Half (5 of 10) the lower wealth group ranked having an ideal body 'very important;' one person in the higher wealth group did so. Findings from twenty ethnographic interviews conducted in Kingston's public spaces with 18-25 year olds confirmed the obesity stigma/social aspiration relationship. Having an ideal body was associated with greater economic and social opportunity and a sense of 'fitting in.'Conclusion: These findings suggest that though (1) there seems to be no singular, size-related aesthetic in Jamaica; (2) obesity stigma does exist; and (3) experience of stigma may be affected by socio-economic status and socio-economic aspiration.

“It is over there, next to that fat lady”: a qualitative study of fat women’s own body perceptions and weight-related discriminations

Abstract We investigated fat women’s perceptions of their own bodies and their experiences with weight-related discriminations, and how these situations affected their well-being. Thirty-nine obese women were interviewed, and three axes of analysis were identified: (1) repercussions of being fat, (2) living with a fat body, and (3) am I a person or just a fat body? These axes were composed of eight themes which had similar meaning or complemented each other. The results showed our participants had mechanisms to diminish the magnitude of their stigmatized bodies (e.g., attempting to lose weight and changing their current food choices). Participants also reported being fat had physical and psychological consequences for them. Most notably, their larger bodies influenced their self-evaluation, making them feel devalued, unlovable, incapable, and incomplete. They reported stigmatizing experiences in familiar situations, at the workplace and in public spaces, and reported being stigmatized by both close and unknown individuals, including healthcare professionals. These professionals were reported to treat patients disrespectfully, which urges attention to health care inequalities for obese people. Our results stress stigmatizing attitudes towards fat people and their own considerations about themselves have negative consequences in their physical and mental well-being.

Adult obesity complications: challenges and clinical impact

The complications associated with adult obesity are overwhelming national healthcare systems. No country has yet implemented a successful population-level strategy to reverse the rising trends of obesity. This article presents epidemiological data on the complications of adult obesity and discusses some of the challenges associated with managing this disease at a population and individual level.

Association of bullying victimization with overweight and obesity among adolescents from 41 low- and middle-income countries

BACKGROUND

Data on the association between overweight/obesity and bullying victimization among adolescents are scarce from low- and middle-income countries.

OBJECTIVES

We assessed the associations between overweight/obesity and bullying victimization in 41 low- and middle-income countries.

METHODS

Cross-sectional data from the Global School-based Student Health Survey were analysed. Data on past 30-day bullying victimization (including type) and body mass index based on measured weight and height were collected. The 2007 WHO Child Growth reference was used to define overweight and obesity. Multivariable logistic regression (multinomial and binary) and meta-analyses based on country-wise estimates were conducted. Data on 114 240 adolescents aged 12 to 15 years were analysed (mean age [SD], 13.8 [1.0] y; 48.8% girls).

RESULTS

Among girls, compared with normal weight, overweight (OR = 1.08; 95% CI, 1.02-1.16; between-country heterogeneity I²  = 0.0%) and obesity (OR = 1.20; 95% CI, 1.07-1.34; I²  = 0.0%) were associated with significantly higher odds for any bullying victimization, but no significant association was observed among boys. However, overweight and obesity were both associated with significantly increased odds for bullying by being made fun of because of physical appearance among both sexes-obesity (vs normal weight): girls OR = 3.42 (95% CI, 2.49-4.71); boys OR = 2.38 (95% CI, 1.67-3.37).

CONCLUSIONS

Effective strategies to reduce bullying of children with overweight/obesity are needed in low- and middle-income countries.

Does weight-related stigmatisation and discrimination depend on educational attainment and level of income? A systematic review

OBJECTIVES

Obesity is considered a global health issue, because of its health-related consequences and also because of its impact on social status as a result of stigma. This study aims to review the quantitative state of research regarding socioeconomic characteristics' influence on weight-related stigmatisation and discrimination. Based on Bourdieu's Theory of Class and his concept of 'habitus', it is assumed that people with a higher level of education and income show stronger negative attitudes towards people with obesity.

METHOD

A narrative systematic literature review was conducted in 2017 using PubMed, PsychINFO, Web of Science and the Cochrane Library. Seventeen studies that measured weight bias and either educational attainment or level of income were included in the analysis.

RESULTS

The results of the studies included were inconsistent: six of these studies were found to support the hypothesis, whereas two of the studies contradicted it. The remaining seven studies did not show any significant correlation between weight bias and either education or income.

CONCLUSION

In light of the inconsistent and heterogeneous results of the studies that report a significant association between weight bias and socioeconomic variables, the findings must be discussed concerning their cultural context, that is, cultural and governmental differences. Furthermore, educational attainment seems to be more likely to predict weight bias than income. The review revealed a lack of research when it came to examining the impact of socioeconomic capital on weight bias.

Intensive care nurses' implicit and explicit attitudes and their behavioural intentions towards obese intensive care patients

AIMS

To examine qualified intensive care nurses' implicit and explicit attitudes towards obese intensive care patients and whether their attitudes are associated with their behavioural intentions towards these patients.

BACKGROUND

Obese intensive care patients may experience more stress than do normal-weight patients. Intensive care nurses' attitudes and the way they address their care are thus vital. Despite a range of studies revealing that health professionals hold anti-fat attitudes towards obese patients, there is a lack of knowledge about intensive care nurses' implicit and explicit attitudes and if such attitudes are associated with behavioural intention.

DESIGN

A cross-sectional survey.

METHODS

From November 2017 - January 2018, a web-based survey was conducted with 159 qualified intensive care nurses (84.3% women, mean age 45.52 years) recruited through 16 intensive care units and Facebook. The survey consisted of implicit attitude tests, explicit bias scales, the Anti-fat Attitude questionnaire, vignettes measuring behavioural intention, and demographic questions.

RESULTS

Intensive care nurses reported implicit preferences for thin over thick people and found obese individuals slightly 'worse' and 'lazy', comprising less willpower than thin individuals. Attitudes were not associated with behavioural intention.

CONCLUSION

This study provides new knowledge about qualified intensive care nurses' anti-fat attitudes and behavioural intention towards obese intensive care patients. These findings should be acknowledged by policymakers, clinical healthcare providers and educators to secure optimal care for these patients.

IMPACT STATEMENT

These results should be used in nursing attitude change programmes, in intensive care units, and among nursing educators, focusing on increasing nurses' knowledge of the complexities of obesity. Further research on obese intensive care patients' healthcare experiences and the impact that healthcare providers' anti-fat attitudes and behaviours has on patients' perceived care quality is needed.

The Effect of Body Mass Index on Functional Outcome of Patients With Knee Replacement

Objective

To investigate the effects of body mass index (BMI) on the rehabilitation process in patients with a recent knee replacement.

Design

This retrospective cohort study included all patients admitted to a rehabilitation hospital, with a recent diagnosis of knee replacement and available hospital admission data including height and weight, between 2014 and 2017.

Setting

Rehabilitation hospital.

Participants

Study participants included patients who had undergone knee replacement surgery (N=742), with available BMI data.

Interventions

None.

Main Outcome Measures

FIM scores, including FIM change per day (FIM efficiency) by BMI category.

Results

The chart review identified 742 patients who had undergone knee replacement surgery, with available BMI data. The identified patients ranged in age from 58 to 85 years, with a mean age of 70 years. Of the patients included in the study, 24 were male, 49 were female, 73 were within the normal weight class, 180 in the overweight class, 189 in the obese class I, 143 in the obese class II, and 157 patients were classified as obese class III. The mean FIM efficiency was highest in the obese class II category (3.96). In a multivariate analysis after controlling for age, obese classes II and III had significantly better FIM efficiency.

Conclusion

This study did not demonstrate that obesity adversely affects the rate of recovery during hospitalization after knee replacement surgery.

Women With Obesity Are Not as Curvy as They Think: Consequences on Their Everyday Life Behavior

Two studies explore the impact of body size on daily life activities of women with obesity. In the first study, ethnographic techniques (first-person perspective video recordings) and subsequent interviews based on the video recordings were used. Results showed atypical behavior of women with obesity and ex-obese women related to memories of embarrassing experiences regarding personal body size (sitting, passing doors sideways, over-careful navigation in public space, and choosing clothes sizes too large.) Women with obesity seem to behave as if they thought they had a larger body than it actually was. These atypical behaviors are related to memories of embarrassing experiences regarding personal body size and stigma. Overweight women exhibit the same behavior but to a lesser and less systematic degree. In the second study, the represented (imagined) body size was compared to the perceived (in a mirror) body size with digital morphing techniques. In the mirror condition, the perceived image is accurate, while in the absence of a mirror women with obesity overestimate their body size by about 30%. Moreover, overestimation of imagined body size increased according to the weight status. Finally, women who had bariatric surgery had poorer estimates than women who had not. This would result of being continuously reminded of obesity and its stigma by daily embarrassing experiences, by being confronted with an environment designed for normal weight (e.g., narrow seats, turnstiles etc.) that makes obesity salient. We suggest that body size overestimation is a case of accentuation where things that matter are perceived bigger. These results could also been explained by the allocentric lock theory.

Impact of exposure to counterstereotypic causality of obesity on beliefs about weight controllability and obesity bias

Individuals with obesity often report experiencing prejudice and discrimination due to their weight. Past research on obesity bias reduction strategies have yielded mixed results. The present study investigated the effectiveness of manipulating information about weight controllability in reducing obesity bias. Participants (N = 350) were randomly assigned into one of three conditions: counterstereotypic, stereotypic, or control. Each condition consisted of four short vignettes. The counterstereotypic condition provided an uncontrollable explanation of obesity (e.g., genetics) in each vignette describing a person with obesity, while the stereotypic condition emphasized lifestyle choices as the main cause of obesity. The control condition included a vignette in which weight was not addressed. Participants completed questionnaires about weight controllability and obesity bias pre- and post-exposure. There was a significant interaction between time and condition on beliefs about weight controllability and obesity bias. Participants in the counterstereotypic condition increased in belief about the uncontrollability of weight and decreased in obesity bias, while participants in the stereotypic condition decreased in belief about the uncontrollability of weight and increased in obesity bias. Obesity bias reduction strategies that utilize information about weight controllability can be effective. However, perpetuating stereotypic causes of obesity can worsen the problem.

Addressing weight bias and stigma of obesity amongst physiotherapists

Backgound: Physiotherapists, as with all other healthcare professionals, report attitudes toward patients with obesity and beliefs about obesity that contribute to weight bias and stigma. Objectives: Determine if physiotherapists' attitudes and/or beliefs changed after attending an educational seminar that included content about the challenges faced by patients with obesity undergoing joint replacement and strategies on how to work effectively and sensitively with this population.Methods: Physiotherapists completed a survey before and after attending a one day seminar to evaluate attitudes (The Attitude Towards Obese Persons, ATOP) and beliefs (Beliefs About Obese Persons, BAOP) towards obesity. To provide a reference, the seminar group's attitudes and beliefs were compared to a provincial cohort of 383 physiotherapists who completed the online version of the survey.Results: The pre-seminar mean ATOP score (71.3 ± 19.3) was similar to the online mean score (72.6 ± 15.3) (p = .66). The post-seminar ATOP score decreased (63.6 ± 15.9) (p = .02) indicating greater negative attitudes. The mean difference of the seminar BAOP showed a modest increase (mean difference 4.6, p = .001) indicating that participants believed obesity was less in control of the individual.Conclusions: Seminar information presented by respected and trusted leaders did not challenge participants' implicit attitudes and beliefs towards obesity. Further evaluation of theory-driven approaches specifically targeting physiotherapists is needed to address stigmatization within the profession.

Body image in relation to nutritional status in adults from the Basque Country, Spain

The aim of this research was to analyse variation in body image perception and satisfaction by age, sex and nutritional status in an adult sample from the Basque Country, Spain. A case-control study was performed for 227 women and 178 men aged 18-70 years. Stunkard's silhouettes were used to evaluate Current Body Image (CBI) and Ideal Body Image (IBI), as well as dissatisfaction and inconsistency scores. Nutritional status was assessed following the WHO criteria for BMI in an adult population. The sample was divided into four groups based on sex and age (early adulthood <45 years, and middle/older adulthood ≥45 years). The Mann-Whitney U test was employed to evaluate sex and age differences, and the Gamma coefficient to assess the association between body image variables and nutritional status. Significant age differences in CBI (p<0.05) and sex differences in IBI (p<0.001) were detected. Both variables showed a positive association with BMI (p<0.01), which indicates that BMI is a biological characteristic related to body image satisfaction and influences participants' perception of themselves. Dissatisfaction scores showed that both sex and age differences (p<0.05) were negatively associated with BMI (p<0.001). Only participants ≥45 years presented sex differences in inconsistency scores (p<0.05); this variable was associated with BMI in women (p<0.01). Preferences in body image showed sexual dimorphism, with women preferring thinner bodies than men - a pattern observed in many Western populations - linked in part to sociocultural pressures. Women were more dissatisfied with their bodies than men; a higher dissatisfaction was observed in older relative to younger participants. The results confirm the association between nutritional status and body size perception and satisfaction, but also the relationship between nutritional status and the reliability with which women can classify themselves; in men, this relationship was not as clear.

Weight bias and health care utilization: a scoping review

Aim:

The purpose of this scoping review was to explore the evidence on how perceptions and/or experiences of weight bias in primary health care influence engagement with and utilization of health care services by individuals with obesity.

Background:

Prior studies have found discrepancies in the use of health care services by individuals living with obesity; a greater body mass index has been associated with decreased health care utilization, and weight bias has been identified as a major barrier to engagement with health services.

Methods:

PubMed was searched from January 2000 to July 2017. Four reviewers independently selected 21 studies examining perceptions of weight bias and its impact on engagement with primary health care services.

Findings:

A thematic analysis was conducted on the 21 studies that were included in this scoping review. The following 10 themes were identified: contemptuous, patronizing, and disrespectful treatment, lack of training, ambivalence, attribution of all health issues to excess weight, assumptions about weight gain, barriers to health care utilization, expectation of differential health care treatment, low trust and poor communication, avoidance or delay of health services, and ‘doctor shopping’. Overall, our scoping review reveals how perceptions and/or experiences of weight bias from primary care health professionals negatively influence patient engagement with primary health care services.

Addressing Internalized Weight Bias and Changing Damaged Social Identities for People Living With Obesity

Obesity is a stigmatized disease due to pervasive personal, professional, institutional, and cultural weight bias. Individuals with obesity experience weight bias across their lifespan and settings, which can affect their life chances and significantly impact health and social outcomes. The objectives of this study were to: (a) explore weight bias and stigma experiences of people living with obesity; (b) develop counterstories that can reduce weight bias and stigma; and (c) reflect on current obesity master narratives and identify opportunities for personal, professional, and social change. Methods: Using purposive sampling, we lived alongside and engaged persons with obesity (n = 10) in a narrative inquiry on weight bias and obesity stigma. We co-developed interim narrative accounts while applying the three-dimensional narrative inquiry space: (a) temporality; (b) sociality; and (c) place, to find meaning in participants' experiences. We also applied the narrative repair model to co-create counterstories to resist oppressive master narratives for participants and for people living with obesity in general. Results: We present 10 counterstories, which provide a window into the personal, familial, professional, and social contexts in which weight bias and obesity stigma take place. Discussion: A fundamental driver of participants' experiences with weight bias is a lack of understanding of obesity, which can lead to internalized weight bias and stigma. Weight bias internalization impacted participants' emotional responses and triggered feelings of shame, blame, vulnerability, stress, depression, and even suicidal thoughts and acts. Participants' stories revealed behavioral responses such as avoidance of health promoting behaviors and social isolation. Weight bias internalization also hindered participants' obesity management process as well as their rehabilitation and recovery strategies. Participants embraced recovery from internalized weight bias by developing self-compassion and self-acceptance and by actively engaging in efforts to resist damaged social identities and demanding respect, dignity, and fair treatment. Conclusion: Narrative inquiry combined with the narrative repair model can be a transformative way to address internalized weight bias and to resist damaged social identities for people living with obesity. By examining experiences, beliefs, values, practices, and relationships that contribute to dominant obesity narratives, we can begin to address some of the socially and institutionally generated negative views of individuals with obesity.

Links between discrimination and cardiovascular health among socially stigmatized groups: A systematic review

BACKGROUND

There is a high prevalence of cardiovascular disease across diverse groups in the U.S. population, and increasing research has identified stigma as a potential barrier to cardiovascular disease prevention and treatment. This systematic review examines evidence linking discrimination and cardiovascular health among socially stigmatized groups.

STUDY DESIGN

Six databases were systematically reviewed from inception through February 2018 for studies with adult subjects, focusing on cardiovascular health indicators among social groups stigmatized because of their gender, race/ethnicity, age, body weight/obesity, or sexual orientation. The Newcastle-Ottawa Scale was used to evaluate the methodological quality and risk of bias for nonrandomized studies, and the Cochrane Collaboration 7-item domain for randomized controlled and experimental trials.

RESULTS

The search identified 84 eligible studies published between 1984 and 2017. Studies retrieved were categorized according to demonstrated links between stigma and cardiovascular disease risk factors including blood pressure (n = 45), heart rate variability (n = 6), blood/saliva cardiovascular biomarkers (n = 18), as well as other indicators of cardiovascular health (n = 15). Based on the findings from included studies, 86% concluded that there was a significant relationship among stigma or discrimination and cardiovascular health indicators among socially stigmatized groups. However, there were varying degrees of evidence supporting these relationships, depending on the type of discrimination and cardiovascular health indicator. The current evidence implies an association between perceived discrimination and cardiovascular health. However, a majority of these studies are cross-sectional (73%) and focus on racial discrimination (79%), while using a wide variety of measurements to assess social discrimination and cardiovascular health.

CONCLUSIONS

Future research should include longitudinal and randomized controlled trial designs, with larger and more diverse samples of individuals with stigmatized identities, using consistent measurement approaches to assess social discrimination and its relationship with cardiovascular health.

Perceived Weight Discrimination Mediates the Prospective Association Between Obesity and Physiological Dysregulation: Evidence From a Population-Based Cohort

Obesity is thought to cause ill health because of the biological strain that excess fat has on physiological function. We tested an alternative explanation in a population-based sample of 3,609 older English adults-that the pervasive discrimination experienced by individuals with excess weight may in part explain why obesity is associated with subsequent multisystem physiological dysregulation, measured via clinical indicators of cardiovascular, metabolic, and immune function. We found that both obesity and perceived weight discrimination predicted an increase in physiological dysregulation from baseline to follow-up 4 years later. Perceived discrimination because of body weight experienced by individuals with obesity explained more than one quarter of the prospective association between obesity and a deterioration in biomarkers of health status. These findings highlight the possibility that the stigma experienced by individuals with obesity may play an important role in explaining the obesity-related disease burden.

Blatant Dehumanization of People with Obesity

OBJECTIVE

Stigmatization of obesity is common, but whether this stigma extends to people with obesity also being considered less human than individuals without obesity has not been examined. This study investigated whether people with obesity are blatantly dehumanized (i.e., explicitly considered to be less human and more animallike) and whether this predicts obesity discrimination.

METHODS

In four online studies (total N = 1,506) with American, British, and Indian participants, evidence for blatant dehumanization of people with obesity was examined. Whether blatant dehumanization of people with obesity was moderated by BMI and to what extent blatant dehumanization predicted support for weight discrimination were also investigated.

RESULTS

In all studies, participants believed that people with obesity were less evolved and less human than people without obesity. Although blatant dehumanization of people with obesity was most pronounced among thinner participants, the belief that people with obesity were less human was also observed among participants with class I obesity. Finally, dehumanization was predictive of support for policies that discriminate against people living with obesity.

CONCLUSIONS

This study provides the first evidence that people with obesity are blatantly dehumanized. This tendency to consider people with obesity as less human reveals the level of obesity stigma and may facilitate and/or justify weight discrimination.

Meanings and Misunderstandings: A Social Determinants of Health Lexicon for Health Care Systems

Policy Points Health care systems and policymakers in the United States increasingly use language related to social determinants of health in their strategies to improve health and control costs, but the terms used are often misunderstood, conflated, and confused. Greater clarity on key terms and the concepts underlying them could advance policies and practices related to social determinants of health-including by defining appropriate roles and limits of the health care sector in this multisector field.

Internalized weight bias and psychological wellbeing: An exploratory investigation of a preliminary model

Although a growing body of literature demonstrates negative effects of internalized weight bias (IWB), the relationships between IWB and relevant social, psychological, and behavioral variables have not yet been evaluated systematically. The purpose of the present study was to create and assess a model of hypothesized risks and outcomes of IWB. In an online survey, 650 adult males and females completed self-report measures of IWB, self-esteem, weight-related stigma experiences, body-related shame, body satisfaction, societal influence on body image, appearance comparisons, binge eating, distress, and weight-related quality of life. The originally hypothesized model did not provide an adequate fit to the data. Iterative modifications were undertaken, and the resulting model, in which social factors were associated with IWB and body image-related constructs which were in turn associated with psychological and behavioral outcomes, provided excellent fit to the data (CFI > .99, SRMR = .02, and RMSEA = .03). Most model paths were similar for underweight or normal weight participants versus participants with overweight or obesity. This study represents an initial effort at constructing a comprehensive model of IWB that can be further refined in future research and used to help guide the development of related interventions.

Inequalities in health-related quality of life according to age, gender, educational level, social class, body mass index and chronic diseases using the Spanish value set for Euroquol 5D-5L questionnaire

BACKGROUND

Reducing health inequalities on the basis of social factors has been a key driver in the development of Public Health policies. Health-related quality of life is a global indicator useful to assess health inequalities within a society. The objective of this study was to identify inequalities on health by analysing the interactive effects of gender, age, educational level, social class, body mass index and chronic diseases on health-related quality of life in a Spanish population sample.

METHODS

We used data from the Spanish National Health Survey 2011-2012. Health-related quality of life was measured by the EQ-5D-5L instrument applying the Spanish value set. Probability of being in perfect health was ascertained by logistic regression models including gender, age, educational level, body mass index and social class and the corresponding terms of interaction. A two-part model combining logistic regression analysis and generalized linear models was applied to calculate the adjusted utility loss associated with chronic conditions (disutility values).

RESULTS

The sample used for analysis contained 18,450 individuals. The mean age was 50 years, 51.3% were women, 55% were overweight or obese and 46.7% had low social status. The mean utility was 0.94 in men and 0.89 in women. Elderly women, obese people, those of low social class and those with chronic conditions had significant lower utility values. Within the regression analysis, interaction assessment revealed that the detrimental effect of obesity disappeared in higher social classes. Utility values for all chronic conditions considered were lower in women than in men and were on a gradient within social class, the lowest for individuals declaring stroke. The greatest decrease on health-related quality of life was determined by declaration of stroke (17.6%) or mental diseases (18.6%).

CONCLUSIONS

The interactive effects of gender, age, educational level, social class, body mass index and chronic diseases on health-related quality of life in the Spanish population revealed important inequalities in health. Social class acted as a modulator of the stigma associated with obesity. Chronic conditions producing loss of autonomy had the greatest impact on reduction of health-related quality of life. This is the first study using the Spanish EQ-5D-5L value set to estimate utilities.

Shaping the Body Politic: Mass Media Fat-Shaming Affects Implicit Anti-Fat Attitudes

The human psyche is profoundly shaped by its cultural milieu; however, few studies have examined the dynamics of cultural influence in everyday life, especially when it comes to shaping people's automatic, implicit attitudes. In this quasi-experimental field study, we investigated the effect of transient, but salient, cultural messages-the pop-cultural phenomenon of celebrity "fat-shaming"-on implicit anti-fat attitudes in the population. Adopting the "copycat suicide" methodology, we identified 20 fat-shaming events in the media; next, we obtained data from Project Implicit of participants who had completed the Weight Implicit Association Test from 2004 to 2015. As predicted, fat-shaming led to a spike in women's (N=93,239) implicit anti-fat attitudes, with events of greater notoriety producing greater spikes. We also observed a general increase in implicit anti-fat attitudes over time. Although these passing comments may appear harmless, we show that feedback at the cultural level can be registered by the "body politic."

Is Weight Discrimination Associated With Physical Activity Among Middle Aged and Older Adults?

Older adults (> 65) are less physically active than all other adult age groups. Although experiences of weight discrimination have been inversely associated with physical activity in several studies of middle-aged and older adults, the role of weight discrimination in this relationship has not been sufficiently explicated. Using data from the Health and Retirement Study (a longitudinal panel study of U.S. adults aged 50 and older), we hypothesized that, among middle aged and older adults, weight discrimination would (a) be inversely related to respondents' reported level of physical activity; and (b) partially mediate the relationship between BMI and physical activity. Using multiple logistic regression analysis, we found an inverse relationship between weight discrimination and vigorous physical activity (OR = 0.79; 95% CI [0.66, 0.94]), as well as between weight discrimination and moderate physical activity (OR = 0.76; 95% CI [0.62, 0.92]). Weight discrimination mediated 13% of the relationship between BMI and vigorous physical activity, as well as 9% of the relationship between BMI and moderate physical activity. Weight discrimination may thus pose a barrier to regular physical activity among middle aged and older adults. Future research and interventions should identify effective ways of mitigating barriers experienced because of weight discrimination in the promotion of physical activity among these age groups, as well as how we may effectively reduce the perpetration of weight discrimination in various settings.

Analysis of the Influence of Age, BMI, and WHtR on Body Mass Acceptance, Attitudes, and Motivation towards Body Mass Reduction in Overweight and Obese Caucasian Women

The emotional consequences of excessive body mass, associated with body image and acceptance, have become a global public health challenge as they may decrease the general well-being and hinder weight loss in overweight and obese individuals. Therefore, this study aimed to analyze the influence of age, body mass index (BMI), and waist-to-height ratio (WHtR) on body mass acceptance, attitudes, and motivation toward body mass reduction in overweight and obese Caucasian women with excessive abdominal fat. The previously validated BodyMass–DRama (Body Mass–Dietary Restrictions: Acceptance, Motivation, Attitudes) questionnaire was applied in this study. The declared acceptance, attitudes and motivation towards body mass reduction were compared between subgroups based on age (20–40, 40–50, and 50–60 years), BMI (25.0–30.0, 30.0–35.0, and ≥35.0 kg/m²), and quartiles of WHtR. The age, BMI and WHtR were stated to be associated with declared acceptance, attitudes, and motivation towards body mass reduction. The different age groups indicated the following as the reasons for excessive body mass: young respondents—low physical activity and consumption of sweets; middle-aged ones—large/irregular meals; aging ones—large/irregular meals and low physical activity (p = 0.0161). While describing motivation toward body mass reduction, young respondents indicated the role of a physician or dietitian (p = 0.0012) or someone who can control them (p = 0.0044), as well as their expectation to be more successful at work after body mass reduction (p = 0.0045), while the aging ones indicated appreciation and plaudits from others (p = 0.0264) as a motivating factor. Respondents with the highest BMI declared having spending free time actively constricted (p = 0.0007); they declared more often than others of feeling exhausted (p = 0.0395) or tired all the time (p = 0.0445), but less often of feeling full of joy (p = 0.0457) or full of energy (p <0.0001). Respondents with moderate WHtR declared less often than others that they expect to enjoy socializing (p = 0.0376), but more often to be able to have a better vacation after body mass reduction (p = 0.0128), while those with the lowest WHtR expected to be more physically active (p = 0.0487). Women with the highest WHtR most commonly indicated external pressure from relatives or co-workers as a motivating factor for body mass reduction (p = 0.0435). Due to these differences between Caucasian women with excessive body mass, the approach of physicians and dietitians, as well as methods applied to motivate patients, need to be customized.

The relationship between weight stigma, weight bias internalization, and physical health in military personnel with or at high-risk of overweight/obesity

Perceived weight stigma is associated with adverse health indices, such as elevated cortisol, lipid/glucose dysregulation, and poorer self-rated health. This relationship may be particularly relevant for military personnel, given the cultural emphasis on fitness and weight/shape. Therefore, we investigated the relationship between weight stigma and physical health in 117 active duty personnel (66.7% male; 56.4% non-Hispanic White; age: 30.8 ± 7.4 years; BMI: 29.5 ± 2.5 kg/m²). Participants reported weight stigma (general and military-specific), weight bias internalization, and the presence (≥1; n = 55) or absence (n = 62) of medical conditions. Logistic regressions were conducted examining the ability of weight stigma (general or military-specific) and weight bias internalization to predict the presence or absence of medical conditions. General weight stigma was not significantly associated with the presence of a medical condition (p > .05). However, individuals with military-specific weight stigma scores twice that of their peers were over three times more likely (p =  .04) to report a medical condition. Weight bias internalization was not significant in any model (ps > .20). Longitudinal studies should prospectively examine the relationship between weight stigma in the military setting and health among service members.

Factors influencing medical student self-competence to provide weight management services

This study aimed to identify factors associated with high obesity care self-competence among US medical students. The authors performed a cross-sectional analysis of 2014 survey data on fourth year medical students collected online as part of the Medical Student Cognitive Habits and Growth Evaluation Study (CHANGES). Independent variables included quality and quantity of interaction with patients and peers with obesity; hours of communication and partnership skills training; negative remarks against patients with obesity by supervising physicians, and witnessed discrimination against patients with obesity. The dependent variable was self-competence in providing obesity care. Of 5823 students invited to participate, 3689 (63%) responded and were included in our analyses. Most students were white (65%), half were women and 42% had high self-competence in caring for patients with obesity. Factors associated with high self-competence included increased interaction with peers with obesity (39% vs. 49%, P < 0.001) and increased partnership skills training (32% vs. 61%, P < 0.001). Increased partnership skills training and quantity of interactions with peers with obesity were associated with high student self-competence in providing obesity-related care to patients. Medical schools might consider increasing partnership skills training to improve students' preparedness and skill in performing obesity-related care.

Weigh More, Pay More? Public Opinion on Varying Health Insurance Contributions among Divergent Weight Groups

BACKGROUND

The prevalence of obesity and its related costs has increased over the past decades. In Germany, obesity-related costs are merely covered by statuary health insurance. Within the statutory health care system, the health insurance contributions do not differ between people with and without health issues, such as being obese. This study aims to investigate the public's opinion about whether people with obesity should pay a higher proportional health care contribution than people of normal weight.

METHODS

We conducted a pilot study and collected thereof data of a convenience sample. In total, 179 participants who perceived themselves to be of normal weight (51.40% female; mean age = 32.46, SD = 5.74) were surveyed using a questionnaire. Within this questionnaire, the participants had to rate how high the proportional health care contribution for people with and without obesity should be. Moreover, we assessed participants' antifat attitudes by applying the Fat Phobia Scale and the Implicit Association Test.

RESULTS

A paired t test revealed that participants suggest a significantly higher proportional contribution for health insurance for people with obesity compared to people with normal weight (t(178) = 4.51, p < 0.001). Logistic regression analysis indicates that people with stronger explicit (OR = 8.77, p < 0.001) and implicit stigma (OR = 1.06, p = 0.018), and higher BMI (OR = 1.27, p = 0.04) are more likely to suggest an increased contribution rate for people with obesity.

CONCLUSION

Although we found that participants suggested higher contribution rates for people with obesity, overall only one-quarter of the participants suggested higher contribution rates for people with obesity, whereas almost three-quarters of the participants did not distinguish the contribution rate for people with and without obesity. Moreover, we found that the participants called for higher insurance premiums for people with and without obesity. Therefore, future studies should consider giving more information about the statutory health care system or the health care contribution rate before asking participants about their opinion.

The weight of weight self-stigma in unhealthy eating behaviours: the mediator role of weight-related experiential avoidance

Weight stigma plays a damaging role in the life of the individuals with overweight and obesity who may internalise the widespread stigmatisation messages. Weight self-stigma is defined as personal experiences of shame, negative self-evaluations as well as perceived discrimination. It has been found to be related to experiential avoidance patterns and poorer outcomes. The current study aims to conduct a confirmatory factor analysis (CFA) on the Weight Self-Stigma Questionnaire (WSSQ) and explore its psychometric properties. Furthermore, the mediator role of weight-related experiential avoidance on the relationship between weight self-stigma and unhealthy eating behaviour was analysed. Concerning the CFA, the sample comprised 331 women with overweight and obesity seeking nutritional treatment. A second independent sample of 58 overweight and obese women was used to assess WSSQ's temporal validity and internal responsiveness. Results supported the WSSQ two-factor structure and good psychometric properties and responsiveness to change. Also, evidence was found for the mediator role of weight-related experiential avoidance on the relationship between BMI, weight self-stigma and unhealthy eating patterns in women with overweight and obesity. Overall, the current study showed that WSSQ is a reliable measure and highlights the important role of weight self-stigma and weight-related experiential avoidance in women with overweight and obesity. Level of evidence: Level V, descriptive studies.

Obesity, perceived weight discrimination, and hair cortisol: a population-based study

BACKGROUND AND PURPOSE

Stigmatization of individuals with obesity is pervasive and may act as a psychological stressor. The present study examined whether perceived weight discrimination mediated the relationship between obesity and cortisol, an objective marker of chronic stress, in a population-based sample.

METHODS

Data were from the English Longitudinal Study of Ageing (n = 1872). Height and weight were objectively measured in 2008/09. Experiences of weight-related discrimination were reported via questionnaire in 2010/11. Hair cortisol concentrations were determined from the scalp-nearest 2 cm hair segment in 2012/13. Mediation analyses tested the role of perceived weight discrimination in the associations between obesity and BMI and hair cortisol concentration, adjusting for age, sex, ethnicity, socio-economic status, smoking status, depression and hair-related factors.

RESULTS

Obesity, BMI and perceived weight discrimination were positively related to hair cortisol (all p <  .01). Perceived weight discrimination significantly mediated associations between obesity and hair cortisol (β = 0.021, SE = 0.007, 95% CI 0.007-0.036) and BMI and hair cortisol (β = 0.001, SE = 0.0004, 95% CI 0.0004-0.002), accounting for 19% of the total effect of obesity and 23% of the total effect of BMI on hair cortisol.

CONCLUSIONS

Perceived weight discrimination is an important mediator of the association between obesity and cortisol. Interventions combating weight stigma and discrimination or promoting strategies for coping with stress could help to lessen the psychological and physiological burden of obesity.

Experiences of weightism among sexual minority men: Relationships with Body Mass Index, body dissatisfaction, and psychological quality of life

RATIONALE

Experiences of weightism are associated with reduced psychological quality of life among heterosexual men and women. However, despite noted vulnerability to body image pressures, weightism has not been quantitatively examined among sexual minority men. We tested two hypotheses: first, that Body Mass Index (BMI) and weightism would evidence a curvilinear relationship, such that underweight and overweight men would report experiencing more weightism than men in the "normal" weight range; and second, that a negative association between BMI and quality of life would be explained by experiences of weightism and body dissatisfaction.

METHOD

Sexual minority men living in Australia and New Zealand (N = 2733) completed an online survey and provided data on their height, weight, experiences of weightism, body dissatisfaction, and psychological quality of life.

RESULTS

Participants' BMIs ranged from 14.15 to 68.12 with 3.0% classified as underweight, 50.5% as "normal" weight, 28.0% as overweight, and 17.4% as obese. Weightism was experienced by 38.9% of participants. As predicted, weightism evidenced a curvilinear relationship with BMI, such that underweight and overweight participants reported experiencing more weightism relative to "normal" weight participants. Yet, this curvilinear relationship evidenced a dominant linear component: Overall, weightism markedly increased as BMI increased, and obese participants reported experiencing the most weightism. In addition, we found evidence supporting our hypothesis that men with higher BMIs would report experiencing more weightism and higher body dissatisfaction, and through these variables, reduced quality of life. Adjusted for body dissatisfaction and weightism, the formerly negative association of BMI with psychological quality of life became (weakly) positive.

CONCLUSIONS

Weightism is a salient phenomenon experienced by sexual minority men in smaller and larger bodies with potential direct and indirect adverse effects on psychological quality of life. Whilst BMI and weightism evidenced a curvilinear relationship, the burden of weightism is disproportionately borne by sexual minority men with higher BMIs.

Weight bias in nutritional practice: a study with nutrition students

Obesity is associated with psychosocial problems like stigma, discrimination, and bias. Studies have found that nutritionists and nutrition students display negative attitudes and biases toward obese individuals. This study examined the existence of nutrition students' bias toward obese individuals. The students answered questionnaires by completing on-line forms with demographic data and self-reported weight and height and were assigned to one of four randomly selected hypothetical cases of patients referred to a nutritionist after receiving a diagnosis of lactose intolerance (normal weight man; normal weight woman; obese man; and obese woman). Except for weight, body mass index (BMI), and daily energy intake, all information on diet, habits, and health conditions were identical for profiles of the same sex. The questionnaire included questions on the indication of procedures and approaches during the consultation, consultation time, counseling strategies, dietary and health evaluation, and students' affective and behavioral reactions. Three hundred and thirty-five students participated, mostly women, with mean BMI of 23kg/m². Patient's weight influenced consultation time and students' perceptions and treatment approaches and strategies. The study revealed biases and negative attitudes mainly involving the students' perceptions and reactions to obese patients, and obese women generally received the worse evaluations.

How and why weight stigma drives the obesity 'epidemic' and harms health

BACKGROUND

In an era when obesity prevalence is high throughout much of the world, there is a correspondingly pervasive and strong culture of weight stigma. For example, representative studies show that some forms of weight discrimination are more prevalent even than discrimination based on race or ethnicity.

DISCUSSION

In this Opinion article, we review compelling evidence that weight stigma is harmful to health, over and above objective body mass index. Weight stigma is prospectively related to heightened mortality and other chronic diseases and conditions. Most ironically, it actually begets heightened risk of obesity through multiple obesogenic pathways. Weight stigma is particularly prevalent and detrimental in healthcare settings, with documented high levels of 'anti-fat' bias in healthcare providers, patients with obesity receiving poorer care and having worse outcomes, and medical students with obesity reporting high levels of alcohol and substance use to cope with internalized weight stigma. In terms of solutions, the most effective and ethical approaches should be aimed at changing the behaviors and attitudes of those who stigmatize, rather than towards the targets of weight stigma. Medical training must address weight bias, training healthcare professionals about how it is perpetuated and on its potentially harmful effects on their patients.

CONCLUSION

Weight stigma is likely to drive weight gain and poor health and thus should be eradicated. This effort can begin by training compassionate and knowledgeable healthcare providers who will deliver better care and ultimately lessen the negative effects of weight stigma.

Weight Perception, Weight Stigma Concerns, and Overeating

OBJECTIVE

Perceiving one's own weight status as being overweight is a likely motivation for weight loss. However, self-perceived overweight status has also been found to be associated with overeating and weight gain. This study examined whether weight stigma concerns explain why individuals who perceive their weight status as overweight are at increased risk of overeating.

METHODS

We conducted two survey studies of United States adults (N = 1,236) in which we assessed whether weight stigma concerns explain the cross-sectional relationship between perceived overweight and overeating tendencies.

RESULTS

Across two studies, the cross-sectional relationship between perceived overweight and overeating tendencies was in part explained by weight stigma concerns. Participants who perceived their weight as "overweight" reported greater weight stigma concerns than participants who perceived their weight as "about right," and this explained 23.3% (Study 1) to 58.6% (Study 2) of the variance in the relationship between perceived overweight and overeating tendencies.

CONCLUSIONS

Weight stigma concerns may explain why perceiving one's own weight status as overweight is associated with an increased tendency to overeat.

Considering Weight Loss Programs and Public Health Partnerships in American Evangelical Protestant Churches

The obesity epidemic is a critical public health threat facing the USA. With the advent of American Evangelical Protestant (AEP) weight loss guides and narratives, AEP churches could potentially aid public health agencies in combatting obesity, and some scholars have called for investment in partnerships between public health agencies and religious institutions. This paper examines the theological and social underpinnings of AEP weight loss programs and considers the potential benefits and risks of public health partnerships with AEP churches to combat obesity. While AEP churches may be successful at empowering people to lose weight, AEP weight loss also carries several risks. These risks include reinforcing gendered bodily norms, stigmatizing both overweight bodies and unhealthy behaviors deemed to be sinful (for example, overeating), and failing to acknowledge social factors that promote obesity. These risks must be assessed and minimized to create appropriate public health weight loss partnerships with AEP communities.

An attitude of gratitude: The effects of body-focused gratitude on weight bias internalization and body image

Internalized weight bias and body dissatisfaction are associated with a number of negative psychological and physical health outcomes. The current study examined the effectiveness of body-focused gratitude, through a short writing exercise, as a strategy to reduce internalized weight bias and improve body image. Young adults (M_age = 22.71, SD = 2.08, 51.2% female) were randomly assigned to either a body gratitude condition (n = 185) or a control condition (n = 184). Results indicated that participants in the gratitude condition reported significantly lower weight bias internalization and significantly more favorable appearance evaluation and greater body satisfaction when compared to the control condition. These effects were in the small range (ds = 0.27-0.33), and neither gender nor BMI moderated these effects. These findings provide preliminary support for body-focused gratitude writing exercises as an effective individual-level strategy for both reducing internalized weight bias and improving body image.

[Transcultural adaptation of the Antifat Attitudes Test to Brazilian Portuguese]

Obese individuals are often blamed for their own condition and the targets of discrimination and prejudice. The scope of this study is to describe the cross-cultural adaptation to Brazilian Portuguese and the validation of the Antifat Attitudes Test - specifically developed for evaluation of negative attitudes toward the obese individual. The scale has 34 statements distributed in three subscales - Social/Character Disparagement (15 items), Physical/Romantic Unattractiveness (10 items) and Weight Control/Blame (9 items). The method involved the translation of the scale; evaluation of the conceptual, operational and item equivalence; evaluation of the semantic equivalence using the paired t test, the Pearson correlation coefficient and the intraclass correlation coefficient (ICC); internal consistency evaluation (Cronbach's alpha) and test-retest reliability (ICC) and Confirmatory Factor Analysis - after application in 340 college students in the area of health. The results showed good global internal consistency and reliability (α 0.85; CCI 0.83), and factor analysis showed that the original subscales can be kept in the adaptation, and therefore the scale adapted to the Brazilian-Portuguese version is valid and useful in studies to explore negative attitudes toward obese individuals.

Knowledge, attitudes, representations and declared practices of nurses and physicians about obesity in a university hospital: training is essential

In the context of a worldwide obesity epidemic, healthcare providers play a key role in obesity management. Knowledge of current guidelines and attitudes to prevent stigmatization are especially important. This study aimed to assess knowledge, attitudes, beliefs, perception of opportunity for intervention, declared practices and need for training and material of nurses and physicians about obesity in a Swiss University Hospital. A total of 834 physicians and nurses filled an online survey. The questionnaire was based on literature, exploratory interviews and expert committee review. It was pre-tested with 15 physicians and nurses. Participants declared a low level of negative attitudes towards individuals living with obesity. However, the results highlighted a lack of knowledge to diagnose obesity in adults and children, as well as confidence and training to care of patients with obesity. One-third of providers did not know how to calculate body mass index. Half of providers felt it was part of their role to take care of patients with obesity, even if 55% of them had the feeling that they did not have adequate training. Nurses and physicians working in a university hospital showed a low level of negative attitudes but a lack of knowledge and skills on obesity management. Training should be improved in this population to insure adequate and coherent messages and equal access to evidence-based treatment for patients living with obesity.

Implicit and explicit anti-fat bias: The role of weight-related attitudes and beliefs

INTRODUCTION

The increasing prevalence of anti-fat bias in American society comes at a great cost to the health and well-being of people who are overweight or obese. A better understanding of the correlates of anti-fat bias would inform development of interventions for reducing anti-fat bias. Based on three theoretical perspectives, this study tested the relation between attitudes and beliefs about weight and anti-fat bias (implicit and explicit): (1) The belief that one is like people who are fat (social identity theory). (2) The belief that one can control her/his weight (attribution theory). And (3) the beliefs that most people prefer thin people and that weight is important (socio-cultural theory).

METHODS

Participants were 66,799 volunteers (47,265 women, mean age of 27.88 ± 11.9 years) who completed the Thin-Fat Implicit Association Test on the Project Implicit website (https://implicit.harvard.edu/) during 2016. Explicit anti-fat bias and weight-related attitudes and beliefs were assessed by self-report. Correlation and regression analyses were conducted to examine links between weight-related attitudes and beliefs and anti-fat bias.

RESULTS

All tested weight-related attitudes and beliefs were significantly (p < .001) correlated with explicit and implicit anti-fat bias, but some of the correlations were very weak. An examination of the relative contribution of the tested weight-related attitudes and beliefs to a model explaining anti-fat bias suggested that the strongest correlates of explicit anti-fat bias were the beliefs that weight was important (β = 0.194, p < .001), that most people prefer thin people (β = 0.177, p < .001), and that the respondent was like people who are fat (β = -0.180, p < .001).

DISCUSSION

The social-identity and socio-cultural theories may provide a stronger explanation for anti-fat bias relative to attribution theory. Future research could use longitudinal designs with more reliable measures in order to verify these cross-sectional findings.

Body size reference norms and subjective weight status: A gender and life course approach

This paper uses data from The National Longitudinal Study of Adolescent to Adult Health (Add Health) to describe county-level variation in norms regarding physical weight among adolescents in the United States. We demonstrate that regardless of one's physical size, those residing in counties with a heavier weight norm are significantly less likely to see themselves as overweight than those residing in counties with a light weight norm. We further show that the local weight norm during adolescence (Wave 1) is associated with individuals' weight perceptions through adolescence and into young adulthood (Wave 4), though these associations attenuate in strength as respondents age. Our results suggest that weight norms have a stronger influence on weight perceptions among women compared to men and that the role of gender is particularly important during adolescence. We encourage life course researchers to consider the normative health environment during adolescence as an important context for understanding disparities in health and health lifestyles as people age.