Perceptions of weight discrimination: prevalence and comparison to race and gender discrimination in America

General Public's Information-Seeking Patterns of Topics Related to Obesity: Google Trends Analysis

BACKGROUND

Obesity is a major public health challenge, and recent literature sheds light on the concept of "normalization" of obesity.

OBJECTIVE

We aimed to study the worldwide pattern of web-based information seeking by public on obesity and on its related terms and topics using Google Trends.

METHODS

We compared the relative frequency of obesity-related search terms and topics between 2004 and 2019 on Google Trends. The mean relative interest scores for these terms over the 4-year quartiles were compared.

RESULTS

The mean relative interest score of the search term "obesity" consistently decreased with time in all four quartiles (2004-2019), whereas the relative interest scores of the search topics "weight loss" and "abdominal obesity" increased. The topic "weight loss" was popular during the month of January, and its median relative interest score for January was higher than that for other months for the entire study period (P<.001). The relative interest score for the search term "obese" decreased over time, whereas those scores for the terms "body positivity" and "self-love" increased after 2013.

CONCLUSIONS

Despite a worldwide increase in the prevalence of obesity, its popularity as an internet search term diminished over time. The reason for peaks in months should be explored and applied to the awareness campaigns for better effectiveness. These patterns suggest normalization of obesity in society and a rise of public curiosity about image-related obesity rather than its medical implications and harm.

Weight bias internalization and its association with health behaviour adherence after bariatric surgery

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.

Effects of body mass index on relationship status, social contact and socio-economic position: Mendelian randomization and within-sibling study in UK Biobank

BACKGROUND

We assessed whether body mass index (BMI) affects social and socio-economic outcomes.

METHODS

We used Mendelian randomization (MR), non-linear MR and non-genetic and MR within-sibling analyses, to estimate relationships of BMI with six socio-economic and four social outcomes in 378 244 people of European ancestry in UK Biobank.

RESULTS

In MR of minimally related individuals, higher BMI was related to higher deprivation, lower income, fewer years of education, lower odds of degree-level education and skilled employment. Non-linear MR suggested both low (bottom decile, <22 kg/m2) and high (top seven deciles, >24.6 kg/m2) BMI, increased deprivation and reduced income. Non-genetic within-sibling analysis supported an effect of BMI on socio-economic position (SEP); precision in within-sibling MR was too low to draw inference about effects of BMI on SEP. There was some evidence of pleiotropy, with MR Egger suggesting limited effects of BMI on deprivation, although precision of these estimates is also low. Non-linear MR suggested that low BMI (bottom three deciles, <23.5 kg/m2) reduces the odds of cohabiting with a partner or spouse in men, whereas high BMI (top two deciles, >30.7 kg/m2) reduces the odds of cohabitation in women. Both non-genetic and MR within-sibling analyses supported this sex-specific effect of BMI on cohabitation. In men only, higher BMI was related to lower participation in leisure and social activities. There was little evidence that BMI affects visits from friends and family or having someone to confide in.

CONCLUSIONS

BMI may affect social and socio-economic outcomes, with both high and low BMI being detrimental for SEP, although larger within-family MR studies may help to test the robustness of MR results in unrelated individuals. Triangulation of evidence across MR and within-family analyses supports evidence of a sex-specific effect of BMI on cohabitation.

Characterizing Lifetime and Daily Experiences of Weight Stigma among Sexual Minority Women with Overweight and Obesity: A Descriptive Study

Sexual minority women are disproportionately impacted by obesity yet are underrepresented in weight stigma research. This Ecological Momentary Assessment (EMA) study is a secondary analysis that aimed to elucidate the frequency and contextual characteristics of perceived experiences of lifetime and momentary weight stigma among sexual minority women with overweight/obesity. Participants were 55 sexual minority women ages 18-60 with a body mass index ≥25 kg/m2. Perceived lifetime weight stigma events were assessed at baseline. For the subsequent five days, participants used a smartphone to complete five daily, random EMA prompts assessing the frequency/characteristics of perceived weight stigma events in daily life. All participants reported at least one lifetime weight stigma event. During the EMA period, participants reported 44 momentary weight stigma events (M = 0.80), with 24% of participants reporting at least one event. During most instances of weight stigma, women perceived the stigma's cause to be their weight and another minority identity (e.g., sexual orientation). Findings showing high rates of perceived lifetime weight stigma in this sample and frequent co-occurrence of perceived weight stigma with stigma due to other marginalized identities in daily life underscore the need for future, larger studies investigating weight stigma through an intersectional lens in sexual minority women with overweight/obesity.

Experiences of weight stigma in everyday life: An ecological momentary assessment study

Weight stigma and discrimination have been linked to negative health outcomes. Most research on this topic is retrospective, which may not accurately capture day-to-day experiences. The current used ecological momentary assessment to examine weight stigma and discrimination in everyday life. Participants answered ecological momentary assessments about the nature, frequency, and contextual details of weight stigma and discrimination. Over the course of the study, only eight episodes of weight stigma and discrimination were reported. Given that prior ecological momentary assessment studies reported substantially more frequent weight stigma and discrimination, possible explanations for the findings and implications for future research are discussed.

Effects of Gender and Body Weight on Children's Peer Choice During Physical Activities

The present study investigated possible effects of gender and body weight on children's peer choices during physical activities. Twenty-four school-aged children (12 overweight and 12 non-overweight) were observed during 2 play sessions: the 1st session consisted of 2 tests that required agility (A) and 1 that required strength (S) in an A-S-A design; the 2nd session consisted of 2 strength tests and 1 agility in an S-A-S design. Before each session, 2 participants were asked to choose members for their teams. Results suggest that peer gender is a stronger predictor of children's playmate choices than their body weight. More specifically, children preferred to choose a peer of the same gender who was overweight rather than a peer of the opposite gender who was not overweight. However, when there was a choice between an overweight peer and a non-overweight peer of the same gender, the non-overweight child was favored.

Appearance-focused media use as a moderator of the relationship between fear of fat and weight bias: an exploratory study

PURPOSE

Previous research has found that fear of fat, or the fear of gaining weight, is fairly common within both normative and clinical populations. Similarly, weight bias, or biased attitudes directed at obese individuals, has been found across multiple segments of society. A common link shared between fear of fat and weight bias is the inherent emphasis on anti-fat feelings. Previous research has demonstrated an anti-fat bias within media content. Therefore, the purpose of the current research is to examine exposure to appearance-focused media as a moderator of the relationship between fear of fat and weight bias.

METHODS

One hundred and eighty-seven female participants (M_age = 21.05, M_BMI = 22.60) were administered a battery of assessments, including the Goldfarb Fear of Fat Scale and the Universal Measure of Bias of Fat Scale. Participants were also asked to report their frequency of exposure to appearance-focused media (TV and magazines).

RESULTS

Results of this study suggest that appearance-focused media partially moderated the relationship between fear of fat and weight bias.

CONCLUSIONS

This suggests the messages portrayed by the media may be strengthening the relationship between fear of gaining weight and discrimination directed at obese individuals. Understanding this relationship has important implications for reducing weight stigma.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Reducing Health-Related Stigma Through Narrative Messages

Public stigma characterizes three leading health issues: prescription opioid addiction, obesity, and cigarette smoking. Attributions of individual responsibility are often embedded in negative public attitudes around these issues and can be important to stigma's development and reduction. Research suggests that narrative messages may hold promise for influencing attributions and stigma in these health contexts. Using a national sample of American adults from an online panel (N = 5,007), we conducted a survey-embedded randomized experiment, assigning participants to read one of six messages about one of three health issues. All participants read a statement detailing the magnitude of their assigned health problem, after which some respondents received a short inoculation message (serving as a comparison group) or a narrative message emphasizing external factors while acknowledging personal responsibility for the issue. Some participants also read a counter message emphasizing personal responsibility for the health issue to replicate competitive messaging environments surrounding these issues. Relative to those who received only the magnitude of problem message (comparison group 1) or the magnitude of problem and inoculation messages (comparison group 2), the narrative message reduced prescription opioid addiction stigma and increased attributions of responsibility to groups beyond the individual. Narrative effects were mixed for obesity, had no effect on attributions or stigma around cigarette smoking, and were generally consistent whether or not respondents received a counter message. Narrative messages may be a promising approach for shifting responsibility attributions and reducing public stigma around prescription opioid addiction, and may have some relevance for obesity stigma-reduction efforts.

Fast food outlets, physical activity facilities, and obesity among adults: a nationwide longitudinal study from Sweden

BACKGROUND

While neighborhood deprivation is a well-known predictor of obesity, the mechanisms behind this association are unclear and these are important to clarify before designing interventions focusing on modifiable neighborhood environmental factors in order to reduce obesity risk.

OBJECTIVES

This study examined the longitudinal association between availability of fast-food outlets and physical activity facilities and the risk of obesity among adults.

METHODS

This study used multiple national register data from Sweden. During the 11-year follow-up period between 2005 and 2015, data from 1,167,449 men and 542,606 women, aged 20-55 years, were accessible for inclusion in this analysis. Incidence of obesity was identified based on a diagnosis of obesity during the follow-up period derived from clinical register data. Neighborhood availability of fast-food outlets and physical activity facilities were assessed in 2005 and Cox regression was used in the statistical analysis. Individual socio-demographic factors and neighborhood deprivation were used as covariates.

RESULTS

There were no meaningful associations between neighborhood fast-food outlets or physical activity facilities and obesity in men or women. Neighborhood deprivation was, however, consistently and strongly associated with incidence of obesity in both men and women.

CONCLUSIONS

Availability of fast-food outlets and lack of physical activity facilities appear unlikely to cause obesity in Swedish adults. Other potentially modifiable environmental factors within specific social and cultural settings that may influence obesity risk should be examined in future studies.

Body-related discrimination and dieting and substance use behaviors in adolescence

Unfair treatment on the basis of a physical characteristic, such as body weight, is associated with unhealthy dieting behaviors in adolescence and adulthood and has also been implicated in substance use. Peer victimization is likewise associated with these health-risk behaviors. It is unclear, however, whether body discrimination is associated with these behaviors independent of peer victimization. The present research uses data from the Longitudinal Study of Australian Children (LSAC) to test the relation between body discrimination and dieting and substance use behaviors in adolescence and test whether the associations are independent of peer victimization, as well as depressive symptoms which are associated with both forms of victimization and health-risk behaviors. Participants (N = 2955) reported on body discrimination, dieting behaviors, and substance use at ages 14-15. Participants who experienced body discrimination were more likely to report fear of gaining weight, losing control over eating, going without eating, using medicine or vomiting to control their weight, engaging in restrained eating, and exercising to control their weight. They also had tried nicotine, alcohol, and marijuana. The associations with eating and alcohol use were independent of peer victimization, whereas the associations with smoking and marijuana were reduced when peer victimization was included in the model. All associations were also independent of depressive symptoms. Overall, the findings suggest that body discrimination is associated with harmful health behaviors at least as early as age 14.

Examining the contribution of weight-bias internalization to the associations between weight suppression and disordered eating in undergraduates

Weight suppression (WS) is consistently, positively associated with eating disorder (ED) symptoms, but variables that contribute to these associations remain understudied. The current study examined weight-bias internalization as a potential contributor to the link between weight suppression (WS) and disordered eating in an undergraduate sample. Men (n = 285) and women (n = 610) completed assessments of weight history, weight-bias internalization, and ED symptoms. Absolute (difference in highest and current BMI) and relative WS (%BMI change) were calculated. Hierarchical linear and count regression models examined whether WS contributed to ED symptoms (restraint, objective binge episodes [OBEs], loss-of-control [LOC] eating, and compensatory exercise) above and beyond weight-bias internalization. Analyses were conducted by gender. After accounting for weight-bias internalization, WS demonstrated unique associations with restraint in men (p = .01) and women (p < .001), and LOC eating frequency in men (p = .02), though effects were weaker relative to weight-bias internalization. Although WS was positively correlated with frequency of OBEs in men and LOC eating in women, these associations were no longer significant when accounting for weight-bias internalization. Weight-bias internalization was positively associated with all measured ED symptoms. Consistent with previous work, gender differences in the relations of WS and ED symptoms emerged. Results suggest weight-bias internalization might contribute to links between WS and ED symptoms, particularly binge behaviors, in non-clinical samples. Future research should explore whether decreasing weight-bias internalization could weaken the association between WS and ED symptoms.

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.

Perceived weight discrimination and performance in five domains of cognitive function

OBJECTIVE

Individuals who perceive unfair treatment because of their body weight have been found to be at increased risk of poor health outcomes, including risk of dementia. The present research examines the relation between weight discrimination and performance in five cognitive domains (episodic memory, speed-attention, visuospatial ability, language, numeric reasoning) and whether the associations extend to other common attributions for discrimination (age, gender, race).

METHOD

Participants (n = 2593) were from the Harmonized Cognitive Assessment Protocol (HCAP) sub-study of the Health and Retirement Study (HRS). HCAP participants completed a battery of cognitive tasks that measured the five focal cognitive domains. Participants reported on their perceived experiences with discrimination at the previous regular HRS assessment.

RESULTS

In models that accounted for demographic covariates and BMI, weight discrimination (reported by 6% of participants) was associated with a two-fold increased risk of poor performance on tasks of episodic memory, speed-attention, visuospatial ability, and numeric reasoning. Body mass index was largely unrelated to performance in the five cognitive domains. The other attributions for discrimination were generally unrelated to cognition, but there were sex- and race-specific associations for gender and race discrimination, respectively.

CONCLUSIONS

The present study identified attribution- and domain-specific associations between discrimination and cognitive performance in older adulthood.

The Association of Parental Genetic, Lifestyle, and Social Determinants of Health with Offspring Overweight

INTRODUCTION

In the UK, the number of comorbidities seen in children has increased along with the worsening obesity rate. These comorbidities worsen into adulthood. Genome-wide association studies have highlighted single nucleotide polymorphisms associated with the weight status of adults and offspring individually. To date, in the UK, parental genetic, lifestyle, and social determinants of health have not been investigated alongside one another as influencers of offspring weight status. A comprehensive obesity prevention scheme would commence prior to conception and involve parental intervention including all known risk factors. This current study aims to identify the proportion of overweight that can be explained by known parental risk factors, including genetic, lifestyle, and social determinants of health with offspring weight status in the UK.

METHODS

A cross-sectional study was carried out on 123 parents. Parental and offspring anthropometric data and parental lifestyle and social determinants of health data were self-reported. Parental genetic data were collected by use of GeneFiX saliva collection vials and genotype were assessed for brain-derived neurotrophic factor (BDNF) gene rs6265, melanocortin 4 receptor (MC4R) gene rs17782313, transmembrane protein 18 (TMEM18) gene rs2867125, and serine/threonine-protein kinase (TNN13K) gene rs1514175. Associations were assessed between parental data and the weight status of offspring.

RESULTS

Maternal body mass index modestly predicted child weight status (p < 0.015; R2 = 0.15). More mothers of overweight children carried the MC4R rs17782313 risk allele (77.8%; p = 0.007) compared to mothers of normal-weight children. Additionally, fathers who were not Caucasian and parents who slept for <7 h/night had a larger percentage of overweight children when compared to their counterparts (p = 0.039; p = 0.014, respectively).

CONCLUSION

Associations exist between the weight status of offspring based solely on parental genetic, lifestyle, and social determinants of health data. Further research is required to appropriately address future interventions based on genetic and lifestyle risk groups on a pre-parent cohort.

Men with impaired glucose tolerance have lower self-rated health than men with impaired fasting glucose

AIM

Previous studies have shown that individuals with impaired glucose tolerance (IGT) have lower self-rated health than normoglycaemic individuals. The aim of this study was to examine differences in self-rated health between individuals with IGT and those with impaired fasting glucose (IFG) and to consider the potentially mediating effect of physical activity.

METHODS

In 2002-2005, a total of 2816 individuals were randomly selected for a population-based study in Sweden. All participants performed an oral glucose tolerance test (OGTT). Fasting venous blood samples were drawn, and questionnaires concerning lifestyles were completed. Self-rated health (SRH) and leisure time physical activity (LTPA) were reported on a five-graded and four-graded scale, respectively. A total of 213 individuals with IGT and 129 with IFG were detected.

RESULTS

IGT, but not IFG, was associated with low self-rated health. The difference in self-rated health was seen particularly in men when adjusted for age and BMI (OR = 2.13, CI: 1.13-4.02, p = 0.020). The results became insignificant when including physical activity in the model (OR = 1.8, CI: 0.91-3.58, p = 0.094).

CONCLUSION

The low self-rated health adds further weight to the risk profile in men with IGT and stresses the importance of early detection and lifestyle interventions.

Perceived racial discrimination and risk of insomnia among middle-aged and elderly Black women

STUDY OBJECTIVE

To assess whether perceived racial discrimination is associated with insomnia among Black women.

METHODS

Data on everyday and lifetime racism and insomnia symptoms were collected from questionnaires administered in the Black Women's Health Study, an ongoing prospective cohort of Black women recruited in 1995 from across the United States. In 2009, participants completed five questions on the frequency of discriminatory practices in daily life (everyday racism) and six questions on ever experiencing unfair treatment in key institutional contexts (lifetime racism). In 2015, the Insomnia Severity Index was used to assess insomnia symptoms. We estimated odds ratios and 95% confidence intervals for associations of racism with insomnia, using multivariable logistic regression models adjusted for potential confounders.

RESULTS

The 26 139 participants in the analytic sample were 40-90 years old (median = 57 years, SD = 9.6 years). Higher levels of everyday racism and lifetime racism were positively associated with subthreshold (ptrend < .01) and clinical insomnia (ptrend < .01). Results remained unchanged after further adjustment for sleep duration and shift work.

CONCLUSIONS

Higher levels of perceived racism were associated with increased odds of insomnia among middle-aged and elderly Black women. Thus, perceived racism may contribute to multiple racial health disparities resulting from insomnia. Helping minority populations cope with their experiences of discrimination may decrease the significant public health impact of sleep disruption and subsequent diagnoses.

“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.

Experience of Polish Patients with Obesity in Contacts with Medical Professionals

PURPOSE

Discrimination and stigmatization of patients with obesity are a commonly occurring social problem. The purpose of our research was to analyze the scale of the experience including medical staff's improper behaviours towards patients with obesity in Poland.

PATIENTS AND METHODS

In a completed national study, we studied the statements of 621 adult patients who suffer from obesity. An original closed question survey was used as a tool to collect the data. Patients were informed about the possibility to participate in the study through social media, medical institutions and patient foundations.

RESULTS

As many as 82.6% have experienced improper behaviours. Usually, it came from doctors (90%), nurses and midwives (51%), people who operated medical equipment (24%), nutritionists (14%) and paramedics (9%). Exactly 81% of the respondents pointed to unpleasant and judgmental comments as the most frequent form of improper behaviour which they have encountered mainly during diagnostic tests, palpation or procedures.

CONCLUSION

There is an urgent need for developing national strategies connected with care for individuals with higher body weight. Introducing dedicated solutions in this field may contribute to increasing the quality of health care and reducing stigmatizing behaviours.

Análise das diretrizes brasileiras de obesidade: patologização do corpo gordo, abordagem focada na perda de peso e gordofobia

Resumo Atualmente a obesidade é considerada um dos maiores desafios da saúde pública. Ela vem sendo enfrentada a partir do incentivo de mudanças comportamentais individuais, exaltando a perda de peso como forma inquestionável de garantir saúde. Tendo em vista este contexto e a importância das Diretrizes brasileiras de obesidade sobre o campo da obesidade, sua influência sobre a prática profissional, o tipo de tratamento incentivado e o processo decisório em relação aos corpos gordos, foi realizada uma análise deste documento, associada à emergente discussão de como o discurso da saúde justifica e reproduz a gordofobia da sociedade. A análise se deu primeiramente em relação à patologização do corpo gordo e como isto é acompanhado de uma valorização do corpo magro. Em seguida, discute-se a abordagem normativa do peso, que propõe intervenções individuais sempre focadas na perda de peso. Pode-se notar que o discurso presente nas Diretrizes reforça a saúde inerente dos corpos magros, reproduz estereótipos relacionados ao corpo gordo e relaciona diretamente quilos perdidos com melhor nível de saúde.

Social anxiety symptoms moderate the link between obesity and metabolic function

BACKGROUND

Obesity is a well-known risk factor for elevated inflammation and insulin resistance. Social anxiety may moderate this relationship, such that individuals who areboth obese and socially anxious may have an even greater risk for elevated inflammation and insulin resistance than those who are obese but not socially anxious; the combination of obesity and social anxiety is markedly stressful.

METHODS

The current paper reports secondary analyses from the Biomarker wave of the Mid-Life in the United States (MIDUS) study (N = 1255), a publicly available dataset of American adults. Participants completed a standard scale measuring social anxiety symptoms and had their waist circumference, height, and weight measured by a staff member. They also provided a fasting blood sample that was assayed for CRP, IL-6, HOMA-IR, glucose, and insulin.

RESULTS

The interaction between obesity and social anxiety symptoms was significant. People with a larger waist circumference and more social anxiety symptoms had greater inflammation and insulin resistance relative to those with a larger waist circumference but less social anxiety symptoms. These results were similar for both measures of inflammation and were robust across both the unadjusted and adjusted models. The results were also largely replicated in models using body mass index (BMI) rather than waist circumference as the measure of obesity.

CONCLUSIONS

The current findings build on existing work about the health risks of obesity, extending it in an important new direction by demonstrating that these health risks are stronger among those who are also socially anxious. In fact, the magnitude of the relationship between obesity and metabolic function is 1.5 times stronger among those with more social anxiety symptoms. Thus, knowing whether a person is obese only provides one piece of the puzzle; knowing information about both obesity and social anxiety symptoms is critical for understanding who is most at risk for obesity-related health problems. Thus, a critical next step is for intervention scientists to examine health programs tailored to people who are both obese and socially anxious.

Effects of weight stigma in news media on physical activity, dietary and weight loss intentions and behaviour

OBJECTIVES

To investigate the effect of weight stigma in news media on (a) intentions to increase physical activity (PA), improve diet quality and lose weight, and (b) changes in PA, diet quality and body mass index (BMI) over one month, in (i) women of all weight categories and (ii) a subsample of women living with obesity.

METHODS

UK-based women (N=172; subgroup with obesity N=81) were assigned to read an experimental (weight stigma; N=75) or control (smoking stigma; N=97) news article. Questionnaires were administered immediately after, and one month subsequently to collect information on BMI, PA, diet quality, intentions, past stigma, and diet and PA self-efficacy. Logistic and linear regression analyses were used to assess the effect of weight stigma on all outcome variables.

RESULTS

In the whole sample, there was no significant effect of weight stigma on any primary or secondary outcome. In women with obesity, there was no significant effect of weight stigma on diet quality (0.26 units, 95% CI: -0.36 to 0.87) or PA (-1.83 units, 95% CI: -11.11 to 7.44) at follow up, but exposure to weight stigma was associated with a significant increase in BMI at 1-month follow-up (1.15kg/m², 95% CI: 0.38 to 1.92) compared with the control group.

CONCLUSIONS

In people with obesity, exposure to weight-stigmatising media may contribute to increased BMI over time. Larger trials with longer follow-up are needed to confirm these findings.

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.

Perceived discrimination and psychotic experiences in the English general population

BACKGROUND

Perceived discrimination has been linked to psychotic experiences (PEs). However, as yet, information is lacking on the relationship between different forms of discrimination and PEs. This study examined this association in the English general population.

METHODS

Nationally representative, cross-sectional data were analyzed from 7363 adults aged 16 and above that came from the Adult Psychiatric Morbidity Survey, 2007. Self-reported information was obtained on six forms of discrimination (ethnicity, sex, religious beliefs, age, physical health problems/disability, sexual orientation), while PEs were assessed with the Psychosis Screening Questionnaire (PSQ). Multivariable logistic regression analysis was used to assess associations.

RESULTS

In a fully adjusted logistic regression analysis, any discrimination was significantly associated with PEs (odds ratio [OR]: 2.47, 95% confidence interval [CI]: 1.75-3.48). All individual forms of discrimination were significantly associated with PEs except sexual orientation. Multiple forms of discrimination were associated with higher odds for PEs in a monotonic fashion with those experiencing ≥ 3 forms of discrimination having over 5 times higher odds for any PE. In addition, experiencing any discrimination was associated with significantly increased odds for all individual forms of PE with ORs ranging from 2.16 (95%CI: 1.40-3.35) for strange experience to 3.36 (95%CI: 1.47-7.76) for auditory hallucination.

CONCLUSION

Different forms of discrimination are associated with PEs in the general population. As discrimination is common at the societal level, this highlights the importance of public policy and evidence-based interventions to reduce discrimination and improve population mental health.

Unconscious Weight Bias Among Nursing Students: A Descriptive Study

There has been both an increase in obesity and anti-obesity bias in the United States. The Harvard Weight Implicit Association Test (IAT) is a reliable, valid test that can measure unconscious weight bias. First semester Bachelor of Science in Nursing (BSN) students were surveyed anonymously mid-semester and at the end of the semester after completing the Harvard Weight IAT. Sixty-nine out of 77 students completed pre- and post-surveys. Weight preference towards others was not shown to be related to the respondent’s own self-reported body mass index (BMI). The majority of respondents exhibited more weight-related bias on the IAT than they realized. The three qualitative themes that emerged included Awareness of Personal Beliefs and Stereotypes, Reminder to be Impartial, and Skepticism about the IAT. It is important for undergraduate nursing students to be aware of possible unconscious weight bias in order to provide high-quality care to patients.

Obesity Stigma: Is the 'Food Addiction' Label Feeding the Problem?

Obesity is often attributed to an addiction to high-calorie foods. However, the effect of "food addiction" explanations on weight-related stigma remains unclear. In two online studies, participants (n = 439, n = 523, respectively, recruited from separate samples) read a vignette about a target female who was described as 'very overweight'. Participants were randomly allocated to one of three conditions which differed in the information provided in the vignette: (1) in the "medical condition", the target had been diagnosed with food addiction by her doctor; (2) in the "self-diagnosed condition", the target believed herself to be a food addict; (3) in the control condition, there was no reference to food addiction. Participants then completed questionnaires measuring target-specific stigma (i.e., stigma towards the female described in the vignette), general stigma towards obesity (both studies), addiction-like eating behavior and causal beliefs about addiction (Study 2 only). In Study 1, participants in the medical and self-diagnosed food addiction conditions demonstrated greater target-specific stigma relative to the control condition. In Study 2, participants in the medical condition had greater target-specific stigma than the control condition but only those with low levels of addiction-like eating behavior. There was no effect of condition on general weight-based stigma in either study. These findings suggest that the food addiction label may increase stigmatizing attitudes towards a person with obesity, particularly within individuals with low levels of addiction-like eating behavior.

Food cue reactivity in food addiction: A functional magnetic resonance imaging study

BACKGROUND

While neuroimaging studies have revealed that reward dysfunction may similarly contribute to obesity and addiction, no prior studies have examined neural responses in individuals who meet the "clinical" food addiction phenotype.

METHODS

Women (n = 44) with overweight and obesity, nearly half of whom (n = 20) met criteria for moderate-to-severe Yale Food Addiction Scale 2.0 (YFAS 2.0) food addiction, participated in a functional magnetic resonance imaging cue reactivity task. Participants viewed images of highly processed foods, minimally processed foods, and household objects while thinking about how much they wanted each item. Differences in neural responses by YFAS 2.0 food addiction to highly processed and minimally processed food cues were investigated.

RESULTS

There was a significant interaction between participant group and neural response in the right superior frontal gyrus to highly versus minimally processed food cues (r = 0.57). Individuals with YFAS 2.0 food addiction exhibited modest, elevated responses in the superior frontal gyrus for highly processed food images and more robust, decreased activations for minimally processed food cues, whereas participants in the control group showed the opposite responses in this region. Across all participants, the household items elicited greater activation than the food cues in regions associated with interoceptive awareness and visuospatial attention (e.g., insula, inferior frontal gyrus, inferior parietal lobe).

CONCLUSIONS

Women with overweight or obesity and YFAS 2.0 food addiction, compared to those with only overweight or obesity, exhibited differential responses to highly and minimally processed food cues in a region previously associated with cue-induced craving in persons with a substance-use disorder. Overall, the present work provides further support for the utility of the food addiction phenotype within overweight and obesity.

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.

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.

The association between self-rated health and underlying biomarker levels is modified by age, gender, and household income: Evidence from Understanding Society - The UK Household Longitudinal Study

The goal of this study was to evaluate how self-rated health (SRH) and objective measures of health (biomarkers) are associated, and if this association varies by gender, age, and socioeconomic position (measured by household income). Data come from the UK Household Longitudinal Study nurse visit (2010–2012), including a representative sample of adults in Great Britain (N = 15 687 maximum sample). SRH was assessed by the question “In general, would you say your health is excellent, very good, good, fair, or poor?” and dichotomized into good or poor. Indices were created for four biomarker categories based on the aspects of health they are likely to reflect, including visible weigh-related, fitness, fatigue, and disease risk biomarkers. Logistic regression models were run with SRH as the outcome and each biomarker index as a predictor, adjusting by gender, age, and income. Further, interaction terms between each biomarker index and gender, age, and income (independently) were added to test for effect modification. All biomarker indices were associated with SRH in expected directions, with the fitness index most strongly predicting SRH. Gender, age, or income modified the associations between SRH and all biomarker indices to different extents. The association between the visible weight-related biomarker index (including body mass/fat variables) and SRH was stronger for women than men and for those in higher income groups than lower income groups. Income also modified the association between SRH and the fitness biomarker index, whereas age modified the association between SRH and the fatigue biomarker index. When using SRH to investigate health inequalities, researchers and policy makers should be clear that different social groups may systematically consider different dimensions of health when reporting their SRH.

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The association between self-rated global health and underlying objective health as measured by biomarkers varies by type of biomarker, age, sex and socioeconomic status.

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Biomarkers that measure different aspects of fitness most strongly predicting self-rated health.

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The association between the visible biomarkers (including body mass/fat variables) and self-rated health was stronger for women than men and for those in higher income groups than lower income groups.

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Income also modified the association between self-rated health and biomarkers of disease, with a stronger association for higher income groups.

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When rating own health individuals from different social groups may systematically consider different dimensions of health.

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.

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.

Obesity, chronic job discrimination and social support

Purpose

The purpose of this paper is to investigate the relationship between body mass index (BMI) and chronic job discrimination. Additionally, the authors explore the contribution of various forms of social support to that relationship.

Design/methodology/approach

The data for this study were obtained from the National Survey of Midlife Development in the USA (MIDUS). Only those who reported being employed participated in the study (n = 1,150). The variables of interest included BMI, supervisor support, coworker support, family support, friend support, religious support and chronic job discrimination. Analysis included correlations, ANOVA’s and hierarchical linear regression.

Findings

BMI was positively associated with chronic job discrimination. Respondents in the obese and morbidly obese categories reported higher job discrimination compared to normal weight respondents. Family support, supervisor support and coworker support were associated with less reported chronic job discrimination.

Practical implications

Organizational leaders should acknowledge that obesity is associated with discrimination. Organizations should thus create anti-discrimination policies covering weight-based discrimination, conduct sensitivity training for all employees and train and coach supervisors on effective ways of offering support to employees.

Originality/value

This study contributes to the understanding of the role various forms of social support can play in reducing perceptions of chronic job discrimination. The paper is unique in that it considers several sources from which people draw support in managing for stressors.

Advocating for Fat Activism in a Therapeutic Context

Sizeism has a negative impact on women and perpetuates fat shaming. Conventional therapeutic suggestions for addressing weight concerns focuses on self-discipline rather than on the larger social, cultural, or political contexts of weight stigma. Feminist scholars, therapists, and activists have encouraged social activism to promote psychological well-being and challenge systemic weight prejudice. Results of research on health prevention and promotion efforts have begun to shift thinking away from weight loss and toward deconstructing and changing anti-fat attitudes. We highlight some individual and community-based fat activists to illustrate how their strategies and ideas challenge sizeism in a variety of areas including: the rhetoric of fat; body positivity; photography/art; nutrition/exercise; and diversity/intersectionality. Fat activism has utility within a therapeutic context especially for those who have been recipients of sizeism. We strongly encourage therapists to work closely with clients on finding sources and types of fat activism that represent their unique identities which may be more difficult for those with marginalized identities.