Development and validation of a brief version of the Stigmatizing Situations Inventory

A Core set of patient-reported outcome measures to measure quality of life in obesity treatment research

The lack of standardization in patient-reported outcome measures (PROMs) has made measurement and comparison of quality of life (QoL) outcomes in research focused on obesity treatment challenging. This study reports on the results of the second and third global multidisciplinary Standardizing Quality of life measures in Obesity Treatment (S.Q.O.T.) consensus meetings, where a core set of PROMs to measure nine previously selected patient-reported outcomes (PROs) in obesity treatment research was established. The S.Q.O.T. II online and S.Q.O.T. III face-to-face hybrid consensus meetings were held in October 2021 and May 2022. The meetings were led by an independent moderator specializing in PRO measurement. Nominal group techniques, Delphi exercises, and anonymous voting were used to select the most suitable PROMs by consensus. The meetings were attended by 28 and 27 participants, respectively, including a geographically diverse selection of people living with obesity (PLWO) and experts from various disciplines. Out of 24 PROs and 16 PROMs identified in the first S.Q.O.T. consensus meeting, the following nine PROs and three PROMs were selected via consensus: BODY-Q (physical function, physical symptoms, psychological function, social function, eating behavior, and body image), IWQOL-Lite (self-esteem), and QOLOS (excess skin). No PROM was selected to measure stigma as existing PROMs deemed to be inadequate. A core set of PROMs to measure QoL in research focused on obesity treatment has been selected incorporating patients' and experts' opinions. This core set should serve as a minimum to use in obesity research studies and can be combined with clinical parameters.

Parental Weight Stigma Associated with Self-Directed Weight Talk and Use of Health-Related Restrictive Feeding Practices

BACKGROUND

Parents are important conduits of weight- and health-related messaging. Weight-related communication and approaches to child feeding used by parents may reflect their past experiences with weight stigma and are understudied pathways through which intergenerational weight stigma may be transmitted.

OBJECTIVE

The aim of this study was to examine how experienced and internalized weight stigma among parents of children with higher weights are associated with weight-related communication and the feeding practices they use.

DESIGN

The Listening to Parents study is a cross-sectional study of 103 parent-child dyads who completed in-person study visits at the University of Michigan in Ann Arbor between November 2022 through June 2023.

PARTICIPANTS/SETTING

Participants were parents of children (ages 6 through 14 years, identified by parents as "heavier or overweight") who completed the Stigmatizing Situations Inventory Brief and Weight Bias Internalization Scale-Modified, as well as questions about weight-related communication and the Comprehensive Feeding Practices Questionnaire.

MAIN OUTCOME MEASURES

Outcomes included 5 items corresponding to parental weight-related communication (ie, self-directed, other-directed, and child-directed weight talk, child-directed weight teasing, and child-directed encouragement to lose weight) and 3 Comprehensive Feeding Practices Questionnaire subscales (ie, Monitoring, Restriction for Health, and Restriction for Weight Control).

STATISTICAL ANALYSES PERFORMED

Linear regression models were used to examine associations between mean scored parent-experienced and parent-internalized weight stigma and weight-related communication and feeding practices. Models were adjusted for child gender, parent-perceived child weight status, parental race and ethnicity, parental body mass index, and household income-to-needs ratio.

RESULTS

In covariate-adjusted models, parent-internalized weight stigma was positively associated with self-directed weight talk (β = .20, SE = .078; P = .01) and greater use of health-related restrictive child feeding practices (β = .16, SE = .070; P = .02). No other significant associations in covariate-adjusted models were observed.

CONCLUSIONS

Although parents with greater internalized weight stigma may engage in more self-directed weight talk, they may also be more attuned to the harms of weight stigma and seek to minimize child-directed weight talk and weight teasing.

Effect of a patient education program focused on weight stigma on quality of life and self-efficacy in patients living with obesity: study protocol for a randomized controlled trial

BACKGROUND

After a literature review and interviews with patients living with obesity, key psychosocial determinants such as coping strategies, weight bias internalization, body dissatisfaction and self-efficacy were identified as critical to address obesity-related stigma. The intervention was tailored using evidence-based techniques and input from health professionals to ensure relevance and avoid redundancy. This randomized controlled trial (RCT) aims to evaluate the effect of an intervention specifically designed to address weight stigma among individuals living with obesity.

METHODS

The study compares two parallel arms following different interventions: Patient Education as Usual (PEU) program and the newly developed Patient Education STEREOBES (PES) program, which integrates additional components to counteract weight stigma. The PES program, crafted using the Intervention Mapping process, addresses key psychosocial determinants such as self-efficacy, body image, and coping strategies. It incorporates workshops focused on psychoeducation, physical activity, and emotional regulation through innovative techniques like mindfulness, assertiveness training, and Acceptance and Commitment Therapy (ACT). The program emphasizes group activities and patient interaction to foster resilience against stigmatizing experiences and promote healthier lifestyle choices. This comprehensive intervention is designed to improve psychological, behavioral, and physical outcomes, particularly by reducing the internalization of weight bias and enhancing coping mechanisms.

DISCUSSION

Patients in the PES arm should demonstrate significant improvements in quality of life and self-efficacy compared to the PEU arm. Psychosocial factors should mediate the effect of the intervention on the outcomes involving quality of life and behaviors. This study will provide valuable insights into the role of weight stigma in obesity treatment and the effectiveness of targeted interventions.

TRIAL REGISTRATION

This research protocol has been approved by the Individual Protection Committee Northwest IV (National n°2023-A00327-38) and registered on Clinicaltrial.gov (NCT05906238) on June 7, 2023.

Weight stigma and physical activity avoidance among college-aged students

This study explored cross-sectional associations between prior weight stigma experiences, physical activity (PA) intentions, behaviors, and the acute effects of a weight stigma exposure on PA intentions and behaviors among undergraduate students. Weight-stigma experiences and behavioral intentions were self-reported. Moderate-to-vigorous PA and total PA were assessed using accelerometry. Participants were randomized into two experimental conditions (a weight stigma or control condition) to assess the acute effects of a weight stigma exposure. Forty-nine students (81.6% female; 59.2% Non-Hispanic White; 19.6 ± 1.1 years of age; body mass index: 23.9 ± 4.0 kg/m2) completed the study. Prior weight stigma experiences were positively associated with PA avoidance (β = 12.1 ± 2.7; p < .001) but were not associated with positive PA intentions or behaviors (ps > .05). There were no differences in positive PA intentions, PA avoidance, or PA behaviors across conditions (all ps > .05). Future studies should examine the long-term effects of weight stigma on PA avoidance and objectively measured PA in young college students.

Stigma, Self-Care, and Intuitive Eating in Black Americans with Type 2 Diabetes

Type 2 diabetes is prevalent among Black Americans. Stigma associated with type 2 diabetes, both in general and specific to weight, is damaging to self-care, which is crucial for the effective management of diabetes. Family relationships may buffer the negative impact of stress, especially among Black Americans who have historically relied on informal support networks. Our goal was to investigate how type 2 diabetes stigma (H1) and weight stigma (H2) were related to self-care and intuitive eating - a non-restrictive approach to nutrition; H3 predicted that family relationship satisfaction would moderate the relationships predicted in H1 and H2. Black Americans diagnosed with type 2 diabetes (N = 225) were recruited via Qualtrics panels to complete an online survey of self-report measures. We used multiple linear regression to test our hypotheses. Both chronic illness and weight stigma were related as predicted to one subscale of intuitive eating (eating for physical hunger). Our moderation analyses revealed that family relationship satisfaction was protective against the harms of stigma at moderate to high levels. Intuitive eating is a promising non-restrictive treatment option for type 2 diabetes.

The role of food reward in the associations between weight-based discrimination and feeding practices among caregivers of young children

Certain caregiver feeding practices, including restrictive feeding for weight control, restrictive feeding for health, emotion regulation feeding, and reward feeding, are known to negatively influence short- and long-term child eating and health outcomes. Beyond body size, the precise psychosocial characteristics of caregivers more likely to engage in such feeding practices are unknown. In particular, caregivers who have experienced discrimination based on their weight, who have internalized those biased beliefs, or who find food to be very rewarding may be more likely to use restrictive or controlling feeding practices. The present study investigated the associations among experiences of weight-based discrimination, internalized weight bias, and food reward (i.e., reward-based eating drive) with use of restriction for weight control, restriction for health, emotion regulation feeding, and reward feeding in an online US sample of caregivers (M = 35.27 ± 9.08 y/o) of 2-5 year-old children (N = 305). About half (50.8%) of respondents self-identified as women and most as non-Hispanic (88.5%) and White (75.1%). There were significant positive correlations among caregivers' experience of weight-based discrimination, internalized weight bias, and use of all four feeding practices. Regression results showed that caregivers' food reward moderated the main effect of weight-based discrimination on restrictive feeding for weight control and emotion regulation feeding, such that caregivers who were high in food reward and who experienced discrimination were most likely to engage in these feeding practices. These results can inform interventions aimed at improving child food environments and health.

Sociodemographic predictors of perceived weight discrimination

BACKGROUND

Perceived weight discrimination is associated with increased risk for chronic diseases and reduced life expectancy. Nevertheless, little is known about perceived weight discrimination in racial, ethnic, and sexual minority groups or in individuals at the intersections of those groups. The goal of this study was to identify sociodemographic predictors of perceived weight discrimination.

SUBJECTS/METHODS

A diverse sample of adults (37% Black/African American, 36% Latino, 29% sexual minority) with a body mass index (BMI) ≥ 18.5 kg/m2 were recruited from a national US panel to complete an online survey (N = 2454). Perceived weight discrimination was assessed with the Stigmatizing Situations Survey-Brief (SSI-B). Using hierarchical linear regression analysis, SSI-B scores were predicted from the four sociodemographic characteristics of interest (gender, race, ethnicity, and sexual orientation) while controlling for BMI, age, education, and income (Step 1). At Step 2, all two-way interactions between the four sociodemographic characteristics were added to the model.

RESULTS

At Step 1, higher SSI-B scores were observed for Latino (vs. non-Latino) adults, sexual minority (vs. heterosexual) adults, younger (vs. older) adults, adults with higher (vs. lower) levels of education, and adults with higher (vs. lower) BMI. At Step 2, race interacted with gender, ethnicity, and sexual orientation to predict SSI-B scores such that relatively higher scores were observed for non-Black women, Black men, adults who identified as Black and Latino, and non-Black sexual minority adults.

CONCLUSIONS

Perceived weight discrimination varied across sociodemographic groups, with some subgroups reporting relatively high frequency. Black race appeared to be protective for some subgroups (e.g., Black women), but risk-enhancing for others (e.g., Black men, individuals who identified as Black and Latino). Additional research is needed to identify specific factors that cause certain sociodemographic groups -and indeed, certain individuals-to perceive higher levels of weight discrimination than others.

Discrimination and Stigma Associated with Obesity: A Comparative Study between Spain and Egypt - Data from the OBESTIGMA study

INTRODUCTION

This study explores the under-investigated area of obesity-related discrimination and stigmatization across different countries, specifically comparing Spain (Europe) and Egypt (Middle East).

METHODS

We conducted a cross-sectional observational study involving 2,090 participants from both countries. Participants completed three well-validated questionnaires to assess their attitudes toward obesity, experiences of weight-related stigma, and internalization of weight bias: Antifat Attitudes Scale (AFA), Stigmatizing Situations Inventory (SSI), and Weight Bias Internalization Scale (WBIS). Participants were categorized into four groups based on body mass index (BMI) and history bariatric surgery.

RESULTS

Egyptian participants (BMI = 30.2 ± 6.7 kg/m2 [range: 18.5-69.0 kg/m2]) showed significantly higher aversion toward obesity, as indicated by higher AFA score, compared to their Spanish counterparts (BMI = 35.4 ± 10.1 kg/m2 [18.5-71.9 kg/m2]). In contrast, Spanish participants reported higher levels of weight bias internalization with increasing BMI, while in Egypt, this association was negative. The association of bariatric surgery on stigma reduction also differed between the countries. Multivariate analysis revealed that residing in Egypt was an independent risk factor for higher scores in AFA and WBIS (odds ratio 8.20 [95% confidence interval: 6.78-9.62], p < 0.001 and odds ratio (OR) 6.28 [95% CI: 4.78-7.78], p < 0.001, respectively). In contrast, Spaniards experienced more stigmatizing situations than Egyptians (OR -2.54 [95% CI: 6.78-9.62], p < 0.001).

CONCLUSION

Our study underscores the complex and diverse nature of obesity-related attitudes across cultures. Understanding these cultural differences is crucial for developing effective, culturally sensitive strategies to tackle weight stigma. This research opens avenues for further studies and interventions tailored to cultural contexts.

Weight stigma from romantic partners: Its relations with maladaptive and adaptive coping and depressive symptoms

Social devaluation of being overweight is common in daily life, but little is known about the weight stigma in romantic relationships. The present study investigated the roles of maladaptive and adaptive coping strategies in the relation between the experience of weight stigma in romantic relationships and depressive symptoms in men and women, respectively. Analyses of gender differences and structural equation modeling yielded several findings. First, while men and women experienced similar levels of weight stigma from their romantic partners, women were more likely to use exercise avoidance, disengagement coping, and reappraisal coping strategies, and to exhibit more depressive symptoms than men. Second, men who experienced weight stigma tended to cope with it through exercise avoidance and disengagement coping, which were related to greater depressive symptoms. Men also coped with weight stigma adaptively via reappraisal coping, which was additionally associated with more positive affect. Third, the relation between the experience of weight stigma and depressive symptoms in women was only explained by using disengagement coping. These findings extend the understanding of weight stigma to a specific context and provide some insight that future interventions to reduce the impacts of weight stigma should be tailored accordingly for men and women.

Perceived Health Concerns and Barriers to Care in Persons With Overweight and Obesity: A Patient Survey

OBJECTIVES

To identify patient characteristics, health concerns, and barriers to care based on overweight or obesity.

METHODS

A 50-question anonymous survey was administered to patients. Data were compared by body mass index (BMI).

RESULTS

Among 3976 distributed surveys, 899 were returned and 682 were analyzed. Most respondents were women (60%), White (94%), and married/partnered (65%) and had some college education (80%). Younger and unmarried persons had higher BMI (P < .001). Concern for quality of life (P < .001) and importance of lifestyle changes (P = .006) increased with BMI, but confidence in making changes decreased as BMI increased (P < .001). Perceived good health decreased with increasing BMI (P < .001), whereas depression and other comorbid conditions increased. Self-esteem decreased and stigma increased with higher BMI (both P < .001). Weight discussions with clinicians (P < .001) and belief that clinicians should be involved in weight management (P = .002) increased with BMI, yet self-perception of being judged by clinicians also increased (P < .001). As BMI increased, delays in seeking health care increased (P < .001).

CONCLUSIONS

This survey study highlights perceived health concerns and barriers to care among persons with overweight and obesity. With higher BMI, self-esteem decreased, and stigma, self-perception of poor health, perception of being judged by clinicians, and delay in seeking medical care increased.

Exposure to written content eliciting weight stigmatization: Neural responses in appetitive and food reward regions

OBJECTIVE

Neural activity in food reward- and appetite-related regions was examined in response to high-calorie (HC), low-calorie, and non-food pictures after exposure to written weight stigma (WS) content. Relationships with eating behavior (by Three-Factor Eating Questionnaire [TFEQ]), blood glucose, and subjective appetite were also explored.

METHODS

Adults with overweight and obesity were randomized to read either a WS (n = 20) or control (n = 20) article and subsequently underwent brain scans while they rated pleasantness of food pictures. Fasting glucose, TFEQ, stigma experiences, and appetite were measured before reading the article, appetite after reading, and glucose and appetite again after the scan.

RESULTS

A priori region of interest analyses revealed significant group differences in activation to HC > low-calorie food cues in the caudate and thalamus whereas exploratory whole-brain analyses suggested significant differences in regions including left insula, left thalamus, left inferior temporal gyrus, right lingual gyrus, and bilateral middle occipital gyrus and superior parietal lobule (p < 0.005 uncorrected, k ≥ 200 m3 ). No significant relationships were observed between the pattern of activation and TFEQ, glucose, or subjective appetite in the WS group.

CONCLUSIONS

Exposure to WS was associated with increased responsiveness to HC food content in the dorsal striatum and thalamus in individuals with overweight and obesity.

Distribution of perceived weight stigma and its psychological impact on obese people in Saudi Arabia

Background

Worldwide, obesity prevalence has nearly tripled since 1975, with about 13% of adults being obese and about 39% overweight. Overweight and obese persons are vulnerable to frequent stigmatization and discrimination because of their weight, an issue that is barely discussed in the medical literature. In Saudi Arabia, the prevalence of obesity is 36%. However, there is no available data on the prevalence of perceived weight stigma among obese people. Therefore, this study aims to (a) determine the Distribution of perceived weight stigma among obese people, (b) identify the major sources of stigma, and (c) determine the psychological impact of perceived weight-based stigma on obese people in Saudi Arabia.

Methods

This is a cross-sectional study conducted in Saudi Arabia using an online questionnaire that includes Stigmatizing Situations Inventory Scale (SSI) and Perceived Stress Scale (PSS).

Results

1341 people participated in the study, of which 819 (61%) were females and 522 (39%) were male. Of all, 62 (5%) were underweight, 357 (27%) were normal weight, and 922 (69%) were overweight or obese. Participants in the overweight/obese category scored higher on average in every SSI item than did their counterparts in the underweight and normal weight categories, indicating higher levels of stigma among overweight and obese participants. The major sources of stigma for overweight and obese participants were identified based on the mean of participant responses to each item. These were: assumption about overeating or binge eating (mean response ± SD 2.80 ± 3.01), children's comments (2.22 ± 2.58), being stared at in public (2.18 ± 2.83) and being singled out as a child (2.05 ± 2.67).

Conclusion

Parallel with the literature, our findings indicate a high prevalence of weight stigma in Saudi Arabia which can have negative psychological implications on obese people.

Assessment of obesity stigma and discrimination among Spanish subjects with a wide weight range: the OBESTIGMA study

Introduction

This study aims to assess the extent of rejection and instances of stigmatization linked to obesity within the Spanish population, encompassing a diverse spectrum of weights ranging from normal weight to morbid obesity. Additionally, the study seeks to identify the primary factors influencing these experiences and further examines the impact of bariatric surgery on such dynamics.

Materials and methods

Multicenter observational study with involving a total of 1,018 participants who were recruited from various Obesity Units. Negatives attitudes towards people with obesity were assessed through three questionnaires: (i) Antifat Attitudes Scale (AFA), (ii) Stigmatizing Situations Inventory (SSI) and (iii) Weight Bias Internalization Scale (WBIS). Subjects were categorized into four groups based on their BMI and history of prior bariatric surgery.

Results

The cumulative score across all questionnaires (AFA, SSI and WBIS) exhibited a progressive increase, from participants with normal weight to those with obesity (p < 0.001 for all). Within the AFA questionnaire, males showed more rejection towards people with obesity than women, also perceiving obesity as a disease linked to a lack of willpower (p = 0.004 and p = 0.030, respectively). The overall SSI score was negatively associated with age (r = -0.080, p = 0.011), with young participants encountering more stigmatizing experiences than their adult counterparts. Neither employment status nor educational demonstrated a significant association with any of the questionnaires. Interestingly, patients who underwent lost weight following bariatric surgery did not exhibit improved outcomes.

Conclusion

Individuals with obesity demonstrate a heightened level of aversion towards the disease compared to those with normal weight. Concurrently, the incidence of stigmatizing encounters displays a concerning escalation among younger individuals.

Profiles of experienced and internalized weight-based stigma in college students across the weight spectrum: Associations with eating disorder, depression, and anxiety symptoms

OBJECTIVE

Weight stigma comprises negative attitudes and weight-related stereotypes that result in rejection, discrimination, and prejudice against individuals in larger bodies. Both internalized and experienced weight stigma are associated with negative mental health outcomes, yet it remains unknown how types of stigmatizing experiences (e.g., systemic vs. intraindividual), internalized stigma, and weight status relate, or how profiles of weight stigma differentially impact mental health.

METHOD

The current study (N = 1001 undergraduates) used latent profile analysis to identify weight stigma risk profiles and test whether profiles were cross-sectionally associated with eating disorder symptoms, depression, and social appearance anxiety.

RESULTS

The best-fitting solution indicated a class high on all facets of weight stigma, a class low on all facets of weight stigma, and three groups with intermediate levels of weight, weight bias internalization, and experienced weight stigma. Gender, but not ethnicity, was associated with class membership. Classes with higher experienced and internalized stigma had higher eating disorder symptoms, depression, and social appearance anxiety.

CONCLUSION

Findings support the utility of weight stigma profiles in identifying risk for negative mental health outcomes. These findings can inform initiatives to reduce weight stigma among college students, especially among high-risk groups.

[Obesity, weight-related stigma and its association with the perception of quality of life in Chilean university students]

INTRODUCTION

little attention has been paid to the effect of exposure to weight-related stigma on the quality of life of young Chileans with little obesity.

OBJECTIVE

to identify the prevalence of weight-related stigma and to analyze its association with obesity and the perception of quality of life in university students from Valparaíso, Chile.

METHODS

correlational type study and cross-sectional design. Two hundred and sixty-two university students participated, from 18 to 29 years old, matriculated in the Faculty of Health Sciences of a public university in Valparaíso, Chile. Quality of life was assessed with the WHOQOL-BREF scale, weight-related stigma with the Brief Stigmatizing Situations Inventory (SSI), and nutritional status with body mass index (BMI) classification. The application of the questionnaires was on-line and the answers were anonymous. Multiple logistic regression models were used to evaluate the association between the variables, adjusted for gender and age.

RESULTS

the prevalence of stigma related to weight was 13,2 % in eutrophic, 24,4 % in overweight and 68,0 % in obese. Weight-related stigma, rather than obesity itself, is associated with poorer perceived physical health (OR: 4.30; 95 % CI: 2.10-8.80), psychological health (OR: 4.51; 95 % CI: 2.20-9.26), social relationships (OR: 3.21; 95 % CI: 1.56-6.60) and environment (OR: 2.86; 95 % CI: 1.33-6.14).

CONCLUSION

students exposed to stigmatizing situations related to weight had a worse perception of their quality of life compared to those not stigmatized.

Experienced weight stigma, internalized weight bias, and maladaptive eating patterns among heterosexual and sexual minority individuals

PURPOSE

The current study examined experienced weight stigma (EWS), internalized weight bias (IWB), and maladaptive eating patterns (ME) among sexual minority (SM) and heterosexual individuals.

METHODS

The sample consisted of cisgender heterosexual and SM men and women. Participants were drawn from introductory psychology classes and a variety of supplemental recruitment methods (Facebook, Instagram, MTURK, etc.).

RESULTS

SM individuals reported higher levels of EWS, IWB, and maladaptive eating patterns than heterosexual individuals. Heterosexual men reported the lowest levels of EWS, IWB, and ME compared to all other groups. Additionally, there was a significant association between greater EWS and IWB and greater ME. Gender identity and sexual orientation impacted the strength of the relationship between IWB and ME and, to a lesser extent, EWS and ME.

CONCLUSION

This investigation contributes to knowledge of the impact of gender identity and sexual orientation on EWS and IWB, and demonstrates that IWB and EWS are significant concerns for the SM community, especially in relation to ME.

LEVEL OF EVIDENCE

Level IV, cross-sectional study.

Magnitude and determinants of suicide among overweight reproductive-age women, Chacha and Debre Berhan Town, Ethiopia: community based cross-sectional study

Background

The magnitude and impact of women's suicidal behaviors, like suicidal ideation and suicidal attempts, are an important public health problem in low and middle-income countries, including Ethiopia. Suicidal behavior and being overweight are typical complications of reproductive age with many undesired consequences. Despite both having a serious impact on women of reproductive age, they are neglected in Ethiopia. Accordingly, this study aimed to examine the magnitude and determinants of suicide among overweight reproductive-age women in Chacha and Debre Berhan towns, Ethiopia.

Methods

A community-based cross-sectional study design was once employed from April 1, 2020 to June 1, 2020. The Composite International Diagnostic Interview was used to measure suicidal attempts and ideation, and the data was collected by direct interview. All collected data were entered into Epi Data version 4.6 and analyzed with SPSS version 25. Bivariate and multivariable regression models were used to determine the factors associated with a suicidal attempt and ideation. A p-value of less than 0.05 was considered statistically significant.

Result

Of the total participants, 523 were included, with a response rate of 93.7%. The prevalence of suicidal ideation was 13.0% (95% CI 10.1–15.9), whereas suicidal attempt was 2.3% (95% CI 1.1–3.6). Based on multivariable regression analysis, the odds of suicidal ideation have been higher among overweight women with stressful life events, depression, and younger age groups.

Conclusion

Suicidal ideation was frequent in overweight reproductive-age women. Preventing, treating, and using coping mechanisms regarding identified factors is a good way to minimize the burden of suicide.

Weight stigma and posttraumatic stress disorder symptoms in individuals seeking bariatric surgery

BACKGROUND

After bariatric surgery, some patients experience adverse psychiatric outcomes, including substance use, suicidality, and self-harm. These factors are commonly associated with posttraumatic stress disorder (PTSD) and related symptoms (PTSD-S) that develop following adverse childhood experiences (ACEs) and traumatic events. However, emerging evidence suggests that chronic discrimination also may contribute to PTSD-S. Weight-based discrimination is salient for people with obesity but has received little attention in relation to PTSD-S.

OBJECTIVE

Our study examined factors that may contribute to the link between experienced weight stigma (WS), which is common in individuals seeking bariatric surgery, and PTSD-S.

SETTING

Teaching hospital and surgical weight loss center in the United States.

METHODS

A total of 217 participants completed self-report surveys of experienced and internalized WS, ACEs, and PTSD-S. Demographics and trauma history were obtained from patient medical records. A stepwise multiple regression examined associations between experienced WS and internalized WS with PTSD-S, co-varying demographics, ACEs, and trauma, followed by examination of whether findings held co-varying anxiety/depressive symptoms in a participant subset (n = 189).

RESULTS

After accounting for covariates in step 1 and ACEs and trauma in step 2 (ΔR² = .14), experienced WS and internalized WS accounted for substantial PTSD-S variance in steps 2 and 3 (ΔR² = .12 and .13, respectively; overall model R² =.44; P < .001). Findings held after co-varying anxiety/depressive symptoms.

CONCLUSIONS

Over and above ACEs and trauma, experienced WS and internalized WS may contribute to PTSD-S. Longitudinal research is needed to better elucidate the pathways underlying these associations.

Internalized Stigma as a Transdiagnostic Factor for Women with Eating Disorders

This study aimed to examine how internalized weight bias (IWB), body surveillance, and body shame relate to eating pathology in women with diagnosed eating disorders (EDs) across the weight spectrum. Previous research has examined these variables in primarily non-clinical populations, binge eating disorder, and higher weight populations. In a sample of 98 women with diagnosed EDs, the association of IWB, body surveillance, and body shame on the severity of ED symptoms was examined with hierarchical multiple regression analyses. Results indicate that IWB, body surveillance, and body shame significantly predicted global eating pathology, F (4, 93) = 40.74, p < .001. IWB, body surveillance, and body shame related to global eating pathology, even after controlling for previous weight bias experiences. Analyses with specific symptom clusters found that only body surveillance predicted dietary restraint, only IWB and body shame predicted overvaluation of shape/weight, and only IWB predicted body dissatisfaction. The findings in this study provide initial support for internalized stigma variables (IWB, body surveillance, and body shame) related to ED pathology in a transdiagnostic clinical eating disorder sample across the weight spectrum. Results suggest that further examination of internalized stigma is needed within ED treatment.

Association of Weight-Related Stigmas With Daily Pain Symptoms Among Individuals With Obesity

BACKGROUND

Individuals with obesity are disproportionately impacted by pain-related symptoms.

PURPOSE

This study evaluated experienced weight stigma and internalized weight bias (IWB) as predictors of pain symptoms in daily life among individuals with obesity.

METHODS

Adults with obesity (n = 39; 51% female, 67% White, 43.8 ± 11.6 years old, BMI = 36.8 ± 6.7 kg/m2) completed a baseline assessment (demographics, experienced weight stigma, IWB) and a 14-day Ecological Momentary Assessment (EMA) period involving five daily prompts of pain/aches/joint pain, muscle soreness, experienced weight stigma, and IWB. Generalized linear models were used to assess experienced weight stigma and IWB at baseline as prospective predictors of EMA pain/soreness symptoms. Multi-level models were used to test the association of momentary weight stigma experiences and IWB with pain/soreness at the same and subsequent EMA prompts.

RESULTS

IWB at baseline, but not experienced weight stigma, was associated with more frequent pain symptoms (p < .05) and muscle soreness (p < .01) during EMA. Momentary IWB (but not experienced stigma) was associated with more pain/aches/joint pain and muscle soreness at the same and subsequent prompt.

CONCLUSIONS

Internalized (but not experienced) weight bias was prospectively associated with pain symptoms in daily life among individuals with obesity. Results are consistent with growing evidence that weight-related stigmas represent psychosocial factors that contribute to weight-related morbidity typically attributed to body size.

HIV Status, Obesity, and Risk for Weight Stigma: Comparing Weight Stigma Experiences and Internalization Among Adults with Obesity with and Without HIV

Little is known about weight stigma among people living with HIV (PLWH). This study examined whether levels of perceived weight stigma experiences and internalization, assessed retrospectively and naturalistically, differed among adults with obesity based on HIV status. 50 PLWH (BMI = 35 kg/m2) and 51 adults without HIV (BMI = 36 kg/m2) completed retrospective assessments of lifetime perceived weight stigma experiences/internalization. Next, participants were invited to complete an optional 2-week Ecological Momentary Assessment study. 28 PLWH and 39 adults without HIV completed five momentary assessments of perceived weight stigma experiences/internalization daily. In covariate-adjusted models, PLWH reported 1.2-2.8 times lower frequency of lifetime and momentary perceived weight stigma experiences than adults without HIV, but levels of retrospectively- and naturalistically-assessed internalized weight stigma did not differ between groups. Findings suggest that HIV status may buffer against perceptions of weight stigma events, but not internalized weight stigma, highlighting weight stigma as an important area for future research in PLWH.

Understanding weight stigma in eating disorder treatment: Development and initial validation of a treatment-based stigma scale

Weight stigma is a well-established risk factor for eating disorder pathology, and it is prevalent among healthcare professionals. The current investigation developed and psychometrically validated the Scale for Treatment-based Experiences of Weight Stigma (STEWS) for patient-centered assessment of weight-stigmatizing experiences in eating disorder treatment. Former eating disorder patients (N = 142) with a body-mass-index greater than 25.0 were recruited via Amazon Mechanical Turk. The STEWS demonstrated good internal consistency, convergent validity with widely used weight stigma scales, and incremental validity in predicting eating disorder symptomatology. The STEWS is the first psychometrically sound instrument for treatment-based weight stigma in eating disorder recovery.

Intimate partner violence and COVID-19 among reproductive age women: A community-based cross-sectional survey, Ethiopia

INTRODUCTION

Intimate partner violence is one of the most common psychological, physical, and sexual assaults toward women which suit the entire life of women, and nowadays, the magnitude accelerates due to coronavirus pandemic. Hence, this study was aimed to examine the prevalence of intimate partner violence and predictors during coronavirus among childbearing-age residents in Debre Berhan.

METHODS

A community-based cross-sectional survey was employed from 1 May to 1 July 2020. Eight items of women abuse screening tool were used to estimate intimate partner violence. Trained data collectors directly interview randomly selected participants. The data were entered using Epi-info V. 7 and analyzed using SPSS V. 23. Descriptive statistics were used to determine the prevalence of intimate partner violence and the frequency distribution of other variables. During bivariate analysis, predictor variables with a p-value less than 0.25 were nominated to further analysis. An adjusted odds ratio with a 95% confidence interval was used and a p-value less than 0.05 was considered statistically significant.

RESULT

A total of 700 participants were included with a response rate of 95.1%. The prevalence of intimate partner violence in the past single year was 19% with 95% confidence interval = 16.1-21.9. Besides, the prevalence of emotional (19.9%, 95% confidence interval = 16.9-22.8), sexual (10.9%, 95% confidence interval = 8.6-13.2) and physical (9.4%, 95% confidence interval = 7.3-11.6) violence was reported. Women with depressive symptoms, overweight, suicidal ideation, and body image disturbance were significantly associated with intimate partner violence, but not educational status, employment, income, stressful life events, lifetime alcohol use, suicidal attempt, and abortion.

CONCLUSION AND RECOMMENDATION

Nearly one out of five interviewed participants had intimate partner violence. Being overweight, having poor body image, and having depression increase intimate partner violence. Special preventive measures and treatment, and other legal services should be taken to alleviate the predictor variables and intimate partner violence.

Weight Stigma and Social Media: Evidence and Public Health Solutions

Weight stigma is a pressing issue that affects individuals across the weight distribution. The role of social media in both alleviating and exacerbating weight bias has received growing attention. On one hand, biased algorithms on social media platforms may filter out posts from individuals in stigmatized groups and concentrate exposure to content that perpetuates problematic norms about weight. Individuals may also be more likely to engage in attacks due to increased anonymity and lack of substantive consequences online. The critical influence of social media in shaping beliefs may also lead to the internalization of weight stigma. However, social media could also be used as a positive agent of change. Movements such as Body Positivity, the Fatosphere, and Health at Every Size have helped counter negative stereotypes and provide more inclusive spaces. To support these efforts, governments should continue to explore legislative solutions to enact anti-weight discrimination policies, and platforms should invest in diverse content moderation teams with dedicated weight bias training while interrogating bias in existing algorithms. Public health practitioners and clinicians should leverage social media as a tool in weight management interventions and increase awareness of stigmatizing online content among their patients. Finally, researchers must explore how experiences of stigma differ across in-person and virtual settings and critically evaluate existing research methodologies and terminology. Addressing weight stigma on social media will take a concerted effort across an expansive set of stakeholders, but the benefits to population health are consequential and well-worth our collective attention.

Evaluation of the psychometric properties of self-reported weight stigma measures: A systematic literature review

OBJECTIVE

Conceptualisation and measurement of weight stigma varies across available studies assessing those affected. This paper aims to systematically review the psychometric properties of available self-reported measures of weight stigma.

METHOD

Studies exploring the development and/or validation of weight stigma measures were identified through systematically searching Medline, CINAHL, PsycINFO, Embase, Web of Science, and Scopus databases. The Consensus-based Standards of Health Measurement Instruments (COSMIN) checklist was used to assess the psychometric properties of measures.

RESULTS

Thirty-six articles, reporting 18 different weight stigma measures, were included. For most included measures, measure development and content validity have not been assessed/reported. Structural validity, internal consistency, and hypothesis testing were the most commonly assessed/reported psychometric properties. High-quality ratings were given only for these properties. Most measures were rated as "indeterminate" and received an overall quality rating of "Very Low" as results were based on limited evidence.

CONCLUSIONS

Psychometric properties for published weight stigma measures have rarely been assessed/reported. The observed poor methodological quality for measure development, and limited content validity evidence, negatively impact the quality of evidence for the measures. There is a need for studies assessing the psychometric properties of existing weight stigma measures using COSMIN guidelines, and for a well-designed weight stigma measure informed by both theory and research.

Examining associations among weight stigma, weight bias internalization, body dissatisfaction, and eating disorder symptoms: Does weight status matter?

The present study aimed to expand weight stigma theoretical models by accounting for central tenets of prominent eating disorder (ED) theories and increasing the generalizability of existing models for individuals across the weight spectrum. College students (Sample 1: N = 1228; Sample 2: N = 1368) completed online surveys assessing stigma and ED symptoms. In each sample, separately, multi-group path analyses tested whether body mass index (BMI) classification (underweight/average weight, overweight, obese) moderated a model wherein weight stigma experiences were sequentially associated with weight bias internalization, body dissatisfaction, and five ED symptoms: binge eating, purging, restricting, excessive exercise, muscle building behaviors. Results supported the assessed model overall and for individuals in each BMI class, separately. Although patterns of associations differed for individuals with different BMIs, these variations were limited. The present findings suggest that the adverse impact of weight stigma on distinct ED symptoms is not limited to individuals with elevated BMIs and that these associations are generally explained by the same mechanisms. Weight stigma interventions that focus on decreasing weight bias internalization and body dissatisfaction are recommended for individuals across the weight spectrum. Further examination of associations between weight stigma and multiple ED symptoms, beyond disinhibited eating, is supported.

Shame and Self-compassion as Risk and Protective Mechanisms of the Internalized Weight Bias and Emotional Eating Link in Individuals Seeking Bariatric Surgery

BACKGROUND

Emotional eating in bariatric surgery patients is inconsistently linked with poor post-operative weight loss and eating behaviors, and much research to date is atheoretical. To examine theory-informed correlates of pre-operative emotional eating, the present cross-sectional analysis examined paths through which experienced weight bias and internalized weight bias (IWB) may associate with emotional eating among individuals seeking bariatric surgery.

METHODS

We examined associations of experienced weight bias, IWB, shame, self-compassion, and emotional eating in patients from a surgical weight loss clinic (N = 229, 82.1% female, M. BMI: 48 ± 9). Participants completed a survey of validated self-report measures that were linked to BMI from the patient medical record. Multiple regression models tested associations between study constructs while PROCESS bootstrapping estimates tested the following hypothesized mediation model: IWB ➔ internalized shame ➔ self-compassion ➔ emotional eating. Primary analyses controlled for adverse childhood experiences (ACE), a common confound in weight bias research. Secondary analyses controlled for depressive/anxiety symptoms from the patient medical record (n = 196).

RESULTS

After covariates and ACE, each construct accounted for significant unique variance in emotional eating. However, experienced weight bias was no longer significant and internalized shame marginal, after controlling for depressive/anxiety symptoms. In a mediation model, IWB was linked to greater emotional eating through heightened internalized shame and low self-compassion, including after controlling for depressive/anxiety symptoms.

CONCLUSIONS

Pre-bariatric surgery, IWB may signal risk of emotional eating, with potential implications for post-operative trajectories. Self-compassion may be a useful treatment target to reduce IWB, internalized shame, and related emotional eating in bariatric surgery patients. Further longitudinal research is needed.

Prevalence of Depression and Associated Factors Among Normal and Overweight Reproductive Age Women, Ethiopia: Community-Based Comparative Cross-Sectional Study

Background

Depression and overweight are serious public health problems and the most common complications of childbearing age with many negative consequences on the mental health of women and their children in the world. Even though both have a serious impact, no study has been done in Ethiopia. Therefore, this study aimed to assess and compare the prevalence of depression and associated factors among normal and overweight reproductive-age women in Debre Berhan town.

Methods

A community-based comparative cross-sectional study was conducted from April– June 2020. Patient health questionnaire-9 was used to measure the level of depression and list of threatening experience for stressful life events. Body mass index values of 18.5–24.9 and 25–29.9 kg/m² were used to classify as normal, and overweight, respectively. The data were entered into Epi Data V. 4.6 and were analyzed using SPSS V. 25. A statistically significant association was declared at a p-value < 0.05.

Results

From 1530 participants the response rate were 96.1% and 100% for normal and overweight women, respectively. The prevalence of depression among normal weight women was 26.02% (95% CI: 23.3%, 28.73%) whereas among overweight was 32.89% (95% CI: 28.85%, 36.93%). For women who have normal weight; being exposed to stressful life events, having poor social support, and body image disturbance were statistically significant factors. For women who have overweight, stressful life events, body image disturbance, and experienced weight stigma were significantly associated.

Conclusion and Recommendation

Depression among overweight women was high compared to normal weight in Debre Berhan town. Promoting social support at any aspect of health care services are very important to minimize depression. Especially for overweight women, encouraging management of medical illness, coping mechanisms for different stressful life events and potentiating self-confidence towards body image are a vital means to prevent depression. Health promotion program targeting reproductive age women with significant associated factors are important to overcome overweight and depression in Debre Berhan town.

Associations Between Experience of Early Childhood Trauma and Impact on Obesity Status, Health, as Well as Perceptions of Obesity-Related Health Care

OBJECTIVE

To evaluate the association between obesity and history of childhood trauma in an effort to define implications for the provider-patient relationship and possible causes of failure of obesity treatment.

METHODS

Multisite survey developed by the Patient-Centered Outcomes Research Institute Learning Health Systems Obesity Cohort Workgroup consisting of 49 questions with 2 questions focusing on history of being a victim of childhood physical and/or sexual abuse was mailed to 19,964 overweight or obese patients. Data collection for this survey occurred from October 27, 2017, through March 1, 2018.

RESULTS

Among the 2211 surveys included in analysis, respondents reporting being a victim of childhood abuse increased significantly with obesity (23.6%, 26.0%, 29.1%, and 36.8% for overweight, class I, class II, and class III obesity, respectively; P<.001). A higher percentage of those who reported being a victim of childhood abuse noted that their weight issues began at an earlier age (P=.002) and were more likely to have weight-related comorbidities (P<.001), even after controlling for body mass index. Impacting physician counseling on weight loss, patients who were childhood victims of abuse reported lower self-esteem (P<.001), were more likely to feel judged by their health care providers (P=.009), and less likely to feel being treated with respect (P=.045).

CONCLUSION

Overall, being a victim of childhood abuse was significantly associated with obesity, lower self-esteem and negative experiences interacting with health care providers. Health care providers should receive training to ensure open and nonjudgmental visits with obese patients and consider the role of trauma survivorship issues in patients' development of obesity and health care experiences.

"I Feel Like Less of a Mom": Experiences of Weight Stigma by Association among Mothers of Children with Overweight and Obesity

Background: Parents of children with higher weight are blamed and shamed for their children's weight. However, parents' experiences of this form of stigma, termed weight stigma by association, are poorly understood. The objective of this study was to investigate the sources, forms, and impacts of weight stigma by association among mothers of children with overweight or obesity. Methods: In this qualitative study, mothers who reported concern about their children's weight participated in semistructured interviews administered by the research team. A coding scheme was developed and reliably applied to interview transcripts. Mothers' self-reported sociodemographic information, and height and weight were measured. Results: Thirty-four mothers (Mage: 43.4 years; 26.5% non-Hispanic Black or African American, 70.6% with obesity) participated in the study. Mothers reported that family members were a common source of negative comments about their children's weight; these comments were often critical of mothers' parenting and in some cases contributed to negative affect among mothers. Many mothers also reported negative experiences during children's physicians' visits as a result of their children's weight. Almost all mothers expressed guilt and sadness for their perceived role in their children's weight status, expressing regret that they did not parent differently. Conclusions: Mothers of children with overweight and obesity are frequently the target of weight stigma by association and experience negative cognitions and emotions regarding their perceived role in their children's weight. Continued research is needed to elucidate the impacts of stigma by association due to child weight on parents' health, the parent/child relationship, and children's health.

Unburdening the Weight of Stigma: Findings From a Compassion-Focused Group Program for Women With Overweight and Obesity

OBJECTIVE

The aim of this study was to develop a 2-day intensive-format, Compassion-Focused Therapy (CFT) based group program targeting weight stigma in women with overweight and obesity, and to conduct a pilot study to determine the feasibility and acceptability of the intervention.

METHOD

Participants were 15 females aged 18-62 years (mean [M] = 43.60, standard deviation [SD] = 12.38), who participated in the program and completed measures of self-compassion, internalized weight stigma, psychological distress, life-satisfaction, loneliness, eating self-efficacy, body dissatisfaction, and body shame, at pre-treatment, post-treatment, and 3-month follow-up.

RESULTS

Significant improvements were found from pre-treatment to post-treatment for self-compassion and internalized weight stigma, with gains maintained at 3-month follow-up. Significant improvements were also found on measures of psychological distress, life satisfaction, loneliness, eating self-efficacy, and body dissatisfaction at the post-treatment assessment. Credibility ratings of the program were high.

CONCLUSIONS

This study has contributed to existing stigma research, being the first proof-of-concept study to demonstrate support for an intensive, CFT based group approach targeting the effects of weight stigma for women with overweight and obesity. The findings are discussed in terms of the potential of CFT to assist women develop resilience to the harmful effects of weight stigma, and possible future research directions to further develop and evaluate this approach.

Weight Bias, Shame, and Self-Compassion: Risk/Protective Mechanisms of Depression and Anxiety in Prebariatic Surgery Patients

OBJECTIVE

Psychopathology in bariatric surgery patients may contribute to adverse postoperative sequelae, including weight regain, substance use, and self-harm. This cross-sectional study aimed to advance the understanding of the risk and protective paths through which weight bias associates with depressive and anxiety symptoms in bariatric surgery candidates (BSC).

METHODS

BSC recruited from a surgical clinic (N = 213, 82.2% women, 43  [SD 12] years, mean BMI: 49  [SD 9] kg/m² ) completed measures of experienced weight bias (EWB), internalized weight bias (IWB), body and internalized shame, and self-compassion; anxiety and depression screeners were accessed from medical charts. Multiple regression and PROCESS bootstrapping estimates tested our hypothesized mediation model as follows: EWB→IWB→body shame→shame→self-compassion→symptoms.

RESULTS

After accounting for EWB and IWB, internalized shame accounted for greater variance in both end points than body shame. EWB was associated with greater anxiety through risk paths implicating IWB, body shame, and/or internalized shame. Protective paths associated EWB with fewer depressive and anxiety symptoms among those with higher self-compassion.

CONCLUSIONS

The findings suggest a potentially important role for weight bias and shame in psychological health among BSC and implicate self-compassion, a trainable affect-regulation strategy, as a protective factor that may confer some resiliency. Future research using longitudinal and causal designs is warranted.

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.

A bifactor analysis of the Weight Bias Internalization Scale: What are we really measuring?

Internalized weight stigma (IWS) has been linked with disordered eating behavior, both directly, and as a mediator of the relationship between experienced weight stigma and maladaptive coping. However, the construct of IWS is highly correlated with the related constructs of body image and global self-esteem, and the three constructs may better be represented by underlying trait self-judgment. This overlap is not generally accounted for in existing studies. The present study investigated the shared variance between self-esteem, body image, and IWS in an international sample of higher-weight individuals. Bifactor analysis confirmed that the intermediary role of IWS in the relationship between experienced stigma and self-reported eating behavior was largely accounted for by aspects of body image and global self-esteem. Greater conceptual clarity in the study of IWS is needed to understand the mechanisms via which societal weight stigma impacts on individuals' self-directed judgments and downstream health-related behaviors.

Weight discrimination, anticipated weight stigma, and disordered eating

Weight discrimination is a well-established risk factor for disordered eating cognitions and behaviors. However, little is known about what may account for this association. Recent research suggests that anticipated weight stigma may explain the relationship between weight discrimination and non-eating disorder related health outcomes; the present study seeks to replicate this premise and extend it to the disordered eating realm. In a non-clinical sample of adults in the United States (N = 297) we test the hypothesis that weight discrimination has an indirect association with eating disorder symptomatology through anticipated stigma. At a single timepoint, participants recruited from the online data collection platform SocialSci completed self-report, online surveys of weight discrimination in day-to-day life, anticipated weight stigma, eating disorder symptoms, and demographic information. As hypothesized, weight discrimination was indirectly associated with greater disordered eating symptoms via its association with anticipated weight stigma. This pattern of results held when controlling for gender, body mass index, and self-perceived weight status. These findings suggest that anticipated stigma is relevant in the association between weight discrimination and greater disordered eating. This premise deserves additional attention using methodological approaches that can facilitate stronger causal claims. We discuss the potential for this line of research to inform clinical interventions.

Mediated effects of eating disturbances in the association of perceived weight stigma and emotional distress

PURPOSE

This study aimed to examine the relationships between perceived weight stigma, eating disturbances, and emotional distress across individuals with different self-perceived weight status.

METHODS

University students from Hong Kong (n = 400) and Taiwan (n = 307) participated in this study and completed several questionnaires: Perceived Weight Stigma questionnaire; Three-factor Eating Questionnaire; Hospital Anxiety and Depression Scale. Each participant self-reported their height, weight, and self-perceived weight status.

RESULTS

After controlling for demographics, perceived weight stigma was associated with eating disturbances (β = 0.223, p < 0.001), depression (β = 0.143, p < 0.001), and anxiety (β = 0.193, p < 0.001); and eating disturbances was associated with depression (β = 0.147, p < 0.001) and anxiety (β = 0.300, p < 0.001) in the whole sample. Additionally, eating disturbances mediated the association between perceived weight stigma and emotional distress. Similar findings were shown in the subsamples who perceived themselves as higher weight or normal weight and in the male and female subsamples. However, in the subsamples who perceived themselves as lower weight, only the links between eating disturbances and emotional distress were significant.

CONCLUSION

Perceived weight stigma was associated with eating disturbances and emotional distress in young adults with both higher and normal weight. Eating disturbances were associated with emotional distress regardless of participants' weight status.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Investigating the relationship between parental weight stigma and feeding practices

Promoting a healthy diet in children remains a prominent public health priority. Parents have been shown to be a major influence on their children's eating behaviors, but limited research has been devoted to exploring the factors that lead parents to select certain feeding practices over others. Past research has demonstrated a link between weight stigma (i.e., prejudicial attitudes or discriminatory behavior targeted at individuals who carry excess weight) and an individual's own weight-related behaviors and outcomes, but no study has examined how parental levels of weight stigma maybe associated with a parent's preferred feeding practices. The primary objective of this study was to examine the cross-sectional associations between parental levels of weight-based stigmatization with parental feeding practices. Responses were collected on Amazon's Mechanical Turk website for n = 406 parents who 1) had at least one child aged 5-10 and 2) perceived themselves to be overweight or obese. After adjusting for relevant covariates, parental weight stigma was shown to be significantly associated with restrictive feeding practices, and verbal modeling of eating behaviors (all ps < .05). A priori exploratory mediation analysis identified concern about child weight as a significant mediator between weight stigma and parental feeding practices. A discussion of the potential limitations of this study, future directions of research, and implications of these findings are included.

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.

Motivated, Fit, and Strong-Using Counter-Stereotypical Images to Reduce Weight Stigma Internalisation in Women with Obesity

BACKGROUND

This study aimed to use implicit retraining to change automatic associations between body size and physical activity (PA) in women with obesity to reduce weight bias internalisation (WBI).

METHODS

A Solomon-square experimental design was used to determine the effect of a four-week online implicit retraining intervention on WBI (primary measure) and PA attitudes, self-efficacy, and self-reported behaviour (secondary measures). The intervention was a visual probe task pairing counter-stereotypical images of active individuals with obesity with positive PA-related words. In qualitative telephone interviews, a sub-sample of participants provided feedback and recommendations for using counter-stereotypical images in PA promotion.

RESULTS

Women completed the intervention (n = 48) or a control task (n = 55). Results of a RM-ANOVA showed no interaction or main effect of group on WBI. A main effect of time demonstrated that both groups had reduced WBI between pre-test and post-test, through to one-week follow-up. There were no differences between groups or over time for PA attitudes, self-efficacy, or behaviour. Women who completed interviews (n = 16) discussed several benefits and drawbacks of using counter-stereotypical images.

CONCLUSION

Implicit retraining did not reduce WBI but qualitative findings support the use of counter-stereotypical PA images.

Overlooked and Understudied: Health Consequences of Weight Stigma in Men

OBJECTIVE

A substantial amount of literature has suggested that weight stigma impairs health. Evidence on gender differences in weight stigma has been mixed, but studies of weight stigma within men have been primarily absent from the literature.

METHODS

In two samples of men recruited nationally from across the United States (N = 1,753), participants completed self-report measures assessing their height, weight, demographics, weight stigma (experienced and internalized), psychological well-being (depression), health behaviors (sleep, alcohol, smoking, binge eating, dieting, physical activity), and self-rated health.

RESULTS

Regression analyses showed that, independent of race, socioeconomic status, and BMI, experienced weight stigma and weight bias internalization among men were associated with poor health, including greater depressive symptoms, increased dieting, lower self-reported health, and increased odds of binge eating. Neither internalized nor experienced weight stigma was consistently associated with physical activity, smoking, drinking, or trouble sleeping.

CONCLUSIONS

These findings suggest that both experienced and internalized weight stigma are associated with several indices of poor health in men. It may be informative for future work to examine how men cope with weight stigma, particularly if certain coping responses to stigma involve behaviors that contribute to poorer health.

Weight-related stigma mediates the relationship between weight status and bodily pain: A conceptual model and call for further research

Women are disproportionately impacted by pain compared to men, highlighting the need to better understand factors that contribute to this gender disparity. Previous findings suggest weight-related stigma may be associated with pain among women attempting to lose weight. The goal of this study is to determine if experienced and/or internalized weight bias mediate the relationship between body mass index (BMI) and pain-related impairment in a large, community-based sample of women across the weight spectrum (N = 309; M_Age = 56.5, SD = 14.5; M_BMI = 28.5, SD = 7.1), and to evaluate whether this relationship differs for women with a pain condition. Analyses were performed using the Conditional-PROCESS Macro to examine the relationships between BMI, pain-related impairment, internalized and experienced weight-stigma, and the potentially moderating effect of pain-related conditions on these relationships. After adjusting for covariates, both experienced stigma and internalized weight stigma statistically mediated the BMI and pain-related impairment relationship; however, in the tests of moderated mediation, the indirect effect of internalized weight bias only held true for those without pain conditions. These findings offer a preliminary conceptual model and highlight the importance of pain research to include weight-related stigma.

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.

Mechanisms underlying weight status and healthcare avoidance in women: A study of weight stigma, body-related shame and guilt, and healthcare stress

Studies show that women with high BMI are less likely than thinner women to seek healthcare. We aimed to determine the mechanisms linking women's weight status to their healthcare avoidance. Women (N = 313) were surveyed from a U.S. health-panel database. We tested a theory-driven model containing multiple stigma and body-related constructs linking BMI to healthcare avoidance. The model had a good fit to the data. Higher BMI was related to greater experienced and internalized weight stigma, which were linked to greater body-related shame. Internalized weight stigma was also related to greater body-related guilt, which was associated with higher body-related shame. Body-related shame was associated with healthcare stress which ultimately contributed to healthcare avoidance. We discuss recommendations for a Weight Inclusive Approach to healthcare and the importance of enhancing education for health professionals in weight bias in order to increase appropriate use of preventive healthcare in higher weight women.

Body Image-Acceptance and Action Questionnaire-5: An Abbreviation Using Genetic Algorithms

Body image concerns are typically linked with negative outcomes such as disordered eating and diminished well-being, but some people can exhibit psychological flexibility and remain committed to their valued goals despite being dissatisfied about their bodies. Such flexibility is most frequently measured by the Body Image-Acceptance and Action Questionnaire (BI-AAQ). This study used a recently validated, fully automated method based on genetic algorithms (GAs) on data from an American community sample (N₁=538, 71.5% female, Age: M = 40.87, SD = 13.5) to abbreviate the 12-item BI-AAQ to a 5-item short form, BI-AAQ-5. Validation tests were conducted on data from an independent community sample (N₂₌ 762, 44.6% female, Age: M = 40.65, SD = 13.06). The short form performed comparably to the long form in terms of its factor structure and correlations with theoretically relevant constructs, including body image dissatisfaction, stigma, internalization of societal norms of appearance, self-compassion, and poor mental health. Further, preliminary analyses using structural equation modeling showed that body image flexibility, as measured by either the long or short form, was associated with almost all the criterion variables, even while controlling for a highly related construct of body image dissatisfaction. These results demonstrate the potential discriminant validity of both the long and short form of the BI-AAQ, and show that the BI-AAQ-5 is a suitable alternative to its long form. We discuss how psychological flexibility with respect to body image dissatisfaction can be conducive to positive functioning.

Weight Stigma Predicts Poorer Psychological Well-Being Through Internalized Weight Bias and Maladaptive Coping Responses

OBJECTIVE

Weight-based stigmatization is associated with negative psychological and behavioral consequences, but individuals respond to stigma in different ways. The present study aimed to understand some of the factors that predict how one will cope with weight stigma and how different coping responses predict psychological well-being.

METHODS

Across four samples, 1,391 individuals who identified as having overweight or obesity completed surveys assessing the frequency of weight stigma experiences, internalized weight bias, coping responses to weight stigma, and psychological distress.

RESULTS

Frequency of weight stigma predicted greater internalized weight bias, which predicted more frequent use of maladaptive coping responses ("disengagement coping") and less frequent use of adaptive coping responses ("reappraisal coping"), in turn predicting more depression, anxiety, and stress symptoms.

CONCLUSIONS

The more that individuals with overweight or obesity experience weight stigma and internalize weight bias, the more they report using maladaptive coping and the less they report using adaptive coping when dealing with weight stigma. Maladaptive coping is strongly associated with poorer psychological well-being. Thus, those who experience more frequent weight stigma may be more vulnerable to psychological distress because they appear to be at greater risk of employing maladaptive coping strategies.

Gender differences in the relationship of weight-based stigmatisation with motivation to exercise and physical activity in overweight individuals

Weight stigma is related to lower levels of motivation to exercise in overweight and obesity. This study explored the nature of the relationship between stigma, motivation to exercise and physical activity while accounting for gender differences. Participants were 439 adults with overweight and obesity (mean body mass index = 32.18 kg/m2, standard deviation = 4.09 kg/m2). Females reported significantly more frequent stigma experiences than males. Mediation models found a conditional direct effect of weight stigma for males, with higher frequency of stigma experiences related to higher levels of walking and vigorous physical activity. A conditional indirect effect was found for females for walking, moderate and vigorous levels of physical activity, with higher weight stigma related to lower autonomous motivation, and lower levels of physical activity. Findings suggest that males and females are affected differently by weight-stigma experiences.

The role of weight teasing and weight bias internalization in psychological functioning: a prospective study among school-aged children

Weight-related teasing is a widespread phenomenon in childhood, and might foster the internalization of weight bias. The goal of this study was to examine the role of weight teasing and weight bias internalization as mediators between weight status and negative psychological sequelae, such as restrained eating and emotional and conduct problems in childhood. Participants included 546 female (52%) and 501 (48%) male children aged 7-11 and their parents, who completed surveys assessing weight teasing, weight bias internalization, restrained eating behaviors, and emotional and conduct problems at two points of measurement, approximately 2 years apart. To examine the hypothesized mediation, a prospective design using structural equation modeling was applied. As expected, the experience of weight teasing and the internalization of weight bias were mediators in the relationship between weight status and psychosocial problems. This pattern was observed independently of gender or weight status. Our findings suggest that the experience of weight teasing and internalization of weight bias is more important than weight status in explaining psychological functioning among children and indicate a need for appropriate prevention and intervention approaches.