Translating obesity: Navigating the front lines of the “war on fat”: Translating Obesity

Psychosocial and Diet-Related Lifestyle Clusters in Overweight and Obesity

This study explored intraindividual multidimensional profiles integrating psychosocial factors, namely, body image and satisfaction, weight-related self-stigma, positivity, and happiness, and behavioural-lifestyle factors, namely, adherence to a healthy diet, among Spanish adults with overweight or obesity. We further aimed to investigate the association of excess weight (i.e., measured body mass index, BMI) with the abovementioned multidimensional configurations. A convenience sample of 100 adult individuals (60% females) with excessive weight (69% overweight; 31% obesity) was recruited. They completed self-reports regarding the study variables, and their weight and height were measured. With a perspective centered on the individual, a cluster analysis was performed. Three distinct intraindividual psychosocial and diet-related profiles were identified: a group of healthy individuals with excess weight (46%); a group of individuals who were negatively affected by their excessive weight and showed the most distressed profile (18%); and a group of dysfunctional individuals who seemed to be excessively unrealistic and optimistic regarding their excessive weight and unhealthy lifestyles, but were troubled by their weight (36%). Furthermore, individuals in the affected cluster had higher obesity (mean BMI ± SD = 32.1 ± 3.7) than those in the clusters of healthy (28.0 ± 3.0) and dysfunctional individuals (28.1 ± 3.3) (p < 0.05). The results showed that there are specific psychosocial and lifestyle profiles in the adult population with excess weight and that there are relationships among psychological, behavioural, and body-composition factors. For clinical application purposes, it is important to account for the heterogeneity within individuals who are obese and to individualize the interventions, with a focus from weight change to the individual's overall well-being.

Identifying research priorities for the study of atypical anorexia nervosa: A Delphi study

OBJECTIVE

Individuals meeting all criteria for anorexia nervosa (AN) except that weight falls within or above the normal range despite significant weight loss are categorized as having atypical AN (AAN). Existing research has provided mixed evidence concerning the diagnostic demarcation of AN and AAN. The aim of the present study was to identify research priorities for furthering the understanding of AN and AAN as diagnostic entities.

METHOD

Employing the Delphi methodology, experts in the field were invited to suggest research questions that need to be explored in the demarcation of AN from AAN. This yielded 24 research areas, that were presented in subsequent rounds where panelists were asked to prioritize areas of primary interest.

RESULTS

Fifty-three panelists completed all three Delphi rounds. Consensus was only reached on three items considered to be of primary interest: medical, neurobiological, and neurological factors; epidemiology and natural course; and treatment response in AAN compared to AN. In contrast, questions of premorbid weight and determining the need for and nature of a body mass index cutoff differentiating between AAN and AN were seen as being of low priority.

DISCUSSION

These findings reveal a relatively low degree of consensus on the demarcation of AN from AAN in the field of eating disorders. A reason could be that the definition and use of the AAN category vary in research and clinical practice. In order to achieve further diagnostic clarity, research on the demarcation of AAN and AN should focus on the identified prioritized research areas.

Designing, implementing and evaluating an educational intervention targeting weight bias and fat stereotyping

Weight bias directed at individuals at a higher weight leaves them feeling victimised and judged. When possessed by health professionals, stigmatising attitudes may compromise professionalism and quality of care or education provided. An intervention study was conducted in the higher education setting (n = 124), through tailored course design and delivery. The intervention was embedded into a health elective that pre-service health professionals were enrolled in. Attitudes to weight and knowledge of nutrition were targeted simultaneously. Surveys conducted pre- and post-intervention revealed moderate success in achieving study aims of improving nutrition knowledge and decreasing bias. Focus group analyses supported the quantitative findings.

The role of biocultural approaches in assessing interventions for maternal weight and gestational weight gain

Public health and other researchers express growing concern for the role of maternal adiposity and gestational weight gain in driving the obesity epidemic and health disparities based on race and class. Biocultural scholars must continue to contribute to conversations on how best to address issues of population health including the developmental context of obesity, drawing from both evolutionary and social theory. I discuss a number of intervention studies designed to address gestational weight gain in low-income and minority women and consider the degree to which they address the social, political, and economic context, and developmental history of mothers. I further examine the potential for these interventions, focused on the individual behavior of mothers, to contribute to stigma based on socially defined race, class, and body shape and size, and to draw attention away from the powerful economic interests that contribute to and benefit from the obesity epidemic. I end with a discussion of the value of developmental systems theory for thinking critically about obesity and other health interventions.

Stigma: A biocultural proposal for integrating evolutionary and political-economic approaches

OBJECTIVES

Stigma-the process by which people become socially discredited because they hold a characteristic that is classified as unacceptable or undesirable-has barely been considered in biocultural analyses. Yet, it provides an acute point of articulation for evolutionary and political-economic perspectives on human variation, including the biocultural production of health disparities. To explain the theoretical integration of the two perspectives to stigma, we first lay out some operationalizable definitions of stigma, and review feasible methods to capture them in the field. We then test the roles of predictors suggested from evolutionary (respondent's level of disgust, fear of contagion) and political-economic (respondent's perceived social standing and negative social labeling of those who violate hygiene norms) theories of stigma.

METHODS

We used survey, interview, and behavioral report data from a study of hygiene behaviors at four local community sites in Guatemala, Fiji, New Zealand, and the United States (N = 300). We applied a hierarchical GLMM design that treats site as a random effect.

RESULTS

The independent influences of both variable sets are evident in publicly visible forms of reported hygiene behaviors, specifically the exhibition of clean bodies, clothes, and homes.

CONCLUSION

We propose that the study of stigma provides a productive operationalizable space to engage the promise of the biocultural synthesis to integrate evolutionary and political-economic models of health and human variation.

Moral discourse in general practitioners' accounts of obesity communication

Obesity is not addressed with a large proportion of patients presenting in general practice. An increasing body of evidence suggests that health professionals view body weight as a sensitive topic to include in routine consultations and face barriers in initiating weight loss discussions. This study examined the discursive power relations that shape how general practitioners (GPs) understand and talk about obesity using a novel methodology to elicit responses from GPs about raising the topic of weight. Twenty GPs from the South West of England reflected upon novel trigger films simulating doctor-patient interactions, in which a doctor either acknowledged or ignored their patient's body weight. Underpinned by a discourse analytic approach, our findings suggest that GPs both reproduce and resist moral discourse surrounding body weight. They construct obesity as an individual behavioural problem whilst simultaneously drawing on socio-cultural discourse which positions body weight as central to social identity, situating obesity within a context of stigma and positioning patients as powerless to lose weight. Our findings highlight a need for increased reflexivity about competing discursive frameworks at play during medical consultations about obesity, which we suggest, contribute to increased tension and powerlessness for GPs. Trigger films are an innovative method to elicit information and discuss competing discourses.

The Weight of Things: Understanding African American Women's Perceptions of Health, Body Image, and Attractiveness

Negative attitudes toward being overweight or obese are widespread, and these notions perpetuate into conceptions about one's health. Clinically, being overweight is associated with health problems such as diabetes, hypertension, heart disease, and many other illnesses. African American women, who are generally larger in body size, are a particular target for health interventions. However, these women have resisted the "obesity" label, arguing that dominant measures of health are White norms and oppressive. Through the use of in-depth interviews, this study investigates how African American women understand and experience healthfulness, body image, and barriers to each. Findings show that African American women are ambivalent in their acceptance of dominant markers of health and expressed an almost universal disdain for the thin ideal as a marker of "good" health and a positive body image. Moreover, participants articulated a suspicion of formal medical measurements of obesity.

Body Image Models among Low-income African American Mothers and Daughters in the Southeast United States

Obesity among low-income African American women has been studied using the concepts of both satisfaction and acceptance. The satisfaction frame suggests greater satisfaction with their bodies than their white counterparts, irrespective of size. The acceptance frame suggests that alternative aesthetics serve as resistance against intersectional marginalization. Yet, while these women accept their body size in defiance of thinness ideals, they may not be satisfied. We describe cultural models of body image among mothers and daughters in Alabama. We found that respectability, material consumption, and parental support were important factors determining positive body image, exceeding descriptions of physical features. We further found that those expressing greater body dissatisfaction emphasized respectability, whereas those with less dissatisfaction assigned importance to consumerism and physical form. These findings suggest divergences between biomedical messaging and lived experience. They also challenge uncritical or universalist applications of these frames when interpreting African American women's perceptions of their own bodies.

Weight stigma and eating behaviors on a college campus: Are students immune to stigma's effects?

College populations are groups of emerging adults undergoing significant transitions in eating and diet, being exposed to new social influences; many experience weight gain. Theoretically, college campuses should be places where weight stigma is evident and matters for dietary decision-making. We present the findings from two studies conducted within the same college population at a large public university, including anthropometric measures of body mass. Study 1 included two different measures of weight stigma (implicit and explicit) and measures of weight-control eating behaviors and fruit and vegetable consumption in a randomized representative sample of 204 students. Study 2 included a measure of weight responsibility and multiple measures of eating (food frequency, alcohol intake, and 24-hour dietary recalls), among freshman students (n = 202, n = 157 with 24-hour dietary recalls). Study 1 showed that the three types of stigmas were prevalent. Study 2 had a high prevalence of weight stigma attitudes and demonstrated the occurrence of unhealthful eating and binge drinking behaviors. Both studies found no relationship between weight stigma/responsibility and eating behaviors regardless of weight status. Beyond considering limitations of the study design, we propose two possible reasons for college students' relative immunity to the effects of weight stigma. Those with very high levels of stigma could be suppressing stigmatizing attitudes based on what they think others think is acceptable in a liberal college setting, or the chaotic form of "normal" eating in this population hides the effects of weight stigma.

Publically Misfitting: Extreme Weight and the Everyday Production and Reinforcement of Felt Stigma

Living with extreme weight in the United States is associated with discrimination and self‐stigma, creating structural exclusions, embodied stress, and undermining health and wellbeing. Here we combine ethnographic interviews and surveys from those with experiences of living with extreme weight to better explain how this vulnerability is created and reinforced by public cues, both physical (e.g., seatbelts) and social (the reactions of strangers). “Misfitting” is a major theme in interviews, as is the need to plan and scan constantly while navigating too‐small public spaces. The most distressing events combine physical misfitting with unsympathetic reactions from strangers. Sensitivity to stigmatizing public cues reduces with weight loss, but does not disappear. This study explains one basic mechanism that underlies the creation of felt stigma related to weight even after weight loss: the lack of accommodation for size and the lack of empathy from others that characterize modern urban spaces.