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O’Hea EL, Edwards-Hampton SA, Beall Brown DL, Sonneville KR, Ziedonis DM, Gearhardt AN. The Food Addiction Clinical Treatment (FACT) Manual: A Harm Reduction Treatment Approach. Behav Sci (Basel) 2024; 14:557. [PMID: 39062380 PMCID: PMC11273413 DOI: 10.3390/bs14070557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 06/18/2024] [Accepted: 06/24/2024] [Indexed: 07/28/2024] Open
Abstract
While the construct of food addiction has been controversial, there is growing evidence that certain foods can activate biobehavioral and neurological mechanisms consistent with addiction to other substances. Despite increased evidence and acceptance of certain foods as addictive substances amongst the scientific community, there is a paucity of interventions available that are uniquely suited for the treatment of this condition. Further, many of the addiction and disordered eating treatment models currently utilized for food addiction are seemingly at odds, with the former often recommending complete abstinence from trigger foods and the latter promoting intake of all foods in moderation. The Food Addiction Clinical Treatment (FACT) manual was created as an alternative using an empirically supported harm-reduction model specifically targeted to treat the addiction and disordered eating features of food addiction. The purpose of the current article is to expose readers to the key tenets of the FACT manual, demonstrate the feasibility of this intervention with a sample of participants with severe food addiction, and discuss future directions for the treatment of food addiction. Positive outcomes from this intervention provide preliminary evidence for the efficacy of FACT for the treatment of food addiction with minimal negative adverse effects. Future research using randomized control trials and longer follow-up is needed to validate the FACT manual as an empirically supported treatment for food addiction.
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Affiliation(s)
- Erin L. O’Hea
- Department of Psychology, Stonehill College, North Easton, MA 02357, USA
| | | | - Dana L. Beall Brown
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO 80045, USA;
| | - Kendrin R. Sonneville
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA;
| | - Douglas M. Ziedonis
- Department of Psychiatry and Behavioral Science, University of New Mexico, Albuquerque, NM 87131, USA;
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Nagpal TS, Pearce N, Adamo KB. Presentation of a weight bias internalization tool for use in pregnancy and a call for future research: A commentary. OBESITY PILLARS 2024; 10:100107. [PMID: 38524875 PMCID: PMC10957497 DOI: 10.1016/j.obpill.2024.100107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/05/2024] [Accepted: 03/06/2024] [Indexed: 03/26/2024]
Abstract
Background Emerging evidence has shown that weight stigma is a concern during pregnancy, with several studies documenting common sources including healthcare, the media and interpersonal networks. Experiencing weight stigma may lead to weight bias internalization (WBI), whereby individuals accept and self-direct negative weight-related stereotypes, and limited research has assessed this in the context of pregnancy. Pregnancy is unique in terms of weight changes as many individuals will experience gestational weight gain (GWG). Accordingly, a WBI tool that accounts for GWG may be a more population-specific resource to use. Methods This commentary presents a pregnancy-specific WBI tool that accounts for GWG. The validated Adult WBI scale was modified to include 'pregnancy weight gain'. This commentary also presents a brief summary of research that has assessed WBI in pregnancy and recommendations for future work. Results Recommended future work includes validation of the pregnancy-specific WBI tool and prospective examinations of weight stigma and WBI in pregnancy and implications on maternal and newborn outcomes. Conclusion Ultimately this research may inform development of interventions and resources to mitigate weight stigma and WBI in pregnancy and overall may contribute to improving prenatal outcomes and experiences.
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Affiliation(s)
- Taniya S. Nagpal
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Canada
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Rancaño KM, Puhl R, Skeer M, Eliasziw M, Must A. Negative familial weight talk and weight bias internalization in a US sample of children and adolescents. Pediatr Obes 2024; 19:e13108. [PMID: 38375755 PMCID: PMC11006571 DOI: 10.1111/ijpo.13108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Negative familial weight talk may contribute to higher weight bias internalization in pre- and early adolescents (hereafter referred to as children) and may differ by gender, weight status, and race and ethnicity. OBJECTIVE Examine the relationship between negative familial weight talk and weight bias internalization and examine differences by gender, weight status, and race and ethnicity. METHODS We cross-sectionally analysed 5th-7th graders (10-15 years old) living in Massachusetts (n = 375, 52.3% girls, 21.3% BMI ≥85th percentile, 54.8% non-Hispanic White). Negative familial weight talk frequency during the past 3 months was self-reported and discretized as 'never,' 'occasionally' (1-9 times) and 'often' (>9 times); the Modified Weight Bias Internalization Scale assessed weight bias internalization. Generalized linear models estimated the relationship between negative familial weight talk and weight bias internalization and sub-analyses estimated the relationship across gender, weight status, and race and ethnicity. Results are summarized as ratios of means (RoM). RESULTS Children experiencing negative familial weight talk occasionally (RoM = 1.12, p = 0.024) and often (RoM = 1.48, p < 0.001) had significantly higher weight bias internalization than children who never experienced it. In sub-analyses, experiencing negative familial weight talk often was associated with higher weight bias internalization among girls (RoM = 1.66, p < 0.001), boys (RoM = 1.32, p = 0.007), children with BMI <85th percentile (RoM = 1.44, p = 0.007) and BMI ≥85th percentile (RoM = 1.39, p = 0.001), and non-Hispanic White children (RoM = 1.78, p < 0.001), but not Hispanic (RoM = 1.25, p = 0.085) or non-Hispanic Black children (RoM = 1.20; p = 0.31). CONCLUSIONS Frequent negative familial weight talk was associated with higher weight bias internalization across gender and weight status and in non-Hispanic White children only.
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Affiliation(s)
- Katherine M. Rancaño
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston MA, Boston, MA
| | - Rebecca Puhl
- Department of Human Development & Family Sciences, University of Connecticut, Storrs, Connecticut
| | - Margie Skeer
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston MA, Boston, MA
| | - Misha Eliasziw
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston MA, Boston, MA
| | - Aviva Must
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston MA, Boston, MA
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Hughes AM, Flint SW, Clare K, Kousoulis AA, Rothwell ER, Bould H, Howe LD. Demographic, socioeconomic and life-course risk factors for internalized weight stigma in adulthood: evidence from an English birth cohort study. THE LANCET REGIONAL HEALTH. EUROPE 2024; 40:100895. [PMID: 38745988 PMCID: PMC11092882 DOI: 10.1016/j.lanepe.2024.100895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/15/2024] [Accepted: 03/19/2024] [Indexed: 05/16/2024]
Abstract
Background Obesity is highly stigmatized, with negative obesity-related stereotypes widespread across society. Internalized weight stigma (IWS) is linked to negative outcomes including poor mental health and disordered eating. Previous evidence examining population groups at higher risk of experiencing IWS comes from small, nonrepresentative samples. Here, we re-assess previously reported associations of IWS with demographic, socioeconomic, and wider social factors in a large general population birth cohort study for the first time. Methods In the Avon Longitudinal Study of Parents and Children (ALSPAC), we explored differences in IWS at age 31 years by sex, ethnicity, socioeconomic factors, sexual orientation, and family and wider social influences, using confounder-adjusted multivariable regression. Findings In models adjusted for potential confounders and BMI in childhood, adolescence, and adulthood (N = 4060), IWS was higher for females (standardized beta: 0.56, 95% CI: 0.50, 0.61), sexual minorities (0.17 S.D. higher, 95% CI: 0.09, 0.24), and less socioeconomically advantaged individuals (e.g., 0.16 S.D. higher (95% CI: 0.08, 0.24) for participants whose mothers had minimum or no qualifications, compared to a university degree). The social environment during adolescence and young adulthood was important: IWS was higher for people who at age 13 years felt pressure to lose weight from family (by 0.13 S.D., 95% CI: 0.03, 0.23), and the media (by 0.17, 95% CI: 0.10, 0.25), or had experienced bullying (e.g., 0.25 S.D., 95% CI: 0.17, 0.33 for bullying at age 23 years). Interpretation Internalized weight stigma differs substantially between demographic groups. Risk is elevated for females, sexual minorities, and socioeconomically disadvantaged adults, and this is not explained by differences in BMI. Pressure to lose weight from family and the media in adolescence may have long-lasting effects on IWS. Funding The ESRC, MRC, NIHR, and Wellcome Trust.
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Affiliation(s)
- Amanda M. Hughes
- MRC Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Stuart W. Flint
- School of Psychology, University of Leeds, Leeds, UK
- Scaled Insights, Nexus, University of Leeds, Leeds, UK
| | - Ken Clare
- Leeds Beckett University, Leeds, UK
- Obesity UK, Halifax, UK
- European Coalition for People Living with Obesity, Dublin, Ireland
| | | | - Emily R. Rothwell
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Helen Bould
- MRC Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Gloucestershire Health and Care NHS Foundation Trust, Gloucestershire, UK
| | - Laura D. Howe
- MRC Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
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Bradford HM, Puhl RM, Phillippi JC, Dietrich MS, Neal JL. Implicit and Explicit Weight Bias among Midwives: Variations Across Demographic Characteristics. J Midwifery Womens Health 2024; 69:342-352. [PMID: 38487947 DOI: 10.1111/jmwh.13616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/10/2024] [Indexed: 06/05/2024]
Abstract
INTRODUCTION Weight bias toward individuals with higher body weights is present in health care settings. However, there has been limited quantitative exploration into weight bias among perinatal care providers and its potential variations based on demographic characteristics. The aim of this study was to examine if the direction and extent of weight bias among midwives certified by the American Midwifery Certification Board (AMCB) varied across age, years since certification, body mass index (BMI), race, ethnicity, and US geographic region. METHODS Through direct email listservs, postcard distribution, social media accounts, and professional networks, midwives were invited to complete an online survey of their implicit weight bias (using the Implicit Association Test) and their explicit weight bias using the Anti-Fat Attitudes Questionnaire (AFA), Fat Phobia Scale (FPS), and Preference for Thin People (PTP) measure. RESULTS A total of 2106 midwives who identified as Black or White and resided in one of 4 US geographic regions participated in the survey. Midwives with a lower BMI expressed higher levels of implicit (P <.01) and explicit (P ≤.01) weight bias across all 4 measures except for the AFA Fear of Fat Subscale. Implicit weight bias levels also varied by age (P <.001) and years since certification (P <.001), with lower levels among younger midwives (vs older) and those with fewer years (vs more) since certification. Only age and BMI remained significant (P <.001) after adjusting for other demographic characteristics. Lower explicit weight bias levels were found among midwives who identified as Black (vs White) on 2 measures (FPS: adjusted β = -0.07, P = .004; PTP: P = .01). DISCUSSION This was the first quantitative study of how weight bias varies across demographic characteristics among a national sample of midwives. Further exploration is needed in more diverse samples. In addition, research to determine whether weight bias influences clinical decision-making and quality of care is warranted.
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Affiliation(s)
- Heather M Bradford
- Georgetown University School of Nursing, Washington, District of Columbia
- Vanderbilt University School of Nursing, Nashville, Tennessee
| | | | | | - Mary S Dietrich
- Vanderbilt University School of Nursing, Nashville, Tennessee
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Jeremy L Neal
- Vanderbilt University School of Nursing, Nashville, Tennessee
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Pearl RL, Hernandez M, Bach C, Groshon L, Wadden TA. Prevalence of diagnosed psychiatric disorders among adults who have experienced and internalized weight stigma. Obes Sci Pract 2023; 9:681-687. [PMID: 38090681 PMCID: PMC10712401 DOI: 10.1002/osp4.700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/11/2023] [Accepted: 07/16/2023] [Indexed: 01/30/2024] Open
Abstract
Objective Experiences and internalization of weight stigma are associated with greater self-reported psychological distress and symptoms of psychiatric disorders such as depression and anxiety. However, little is known about the extent to which individuals who have experienced and internalized weight stigma are diagnosed with or provided treatment for psychiatric conditions. The current study aimed to characterize the prevalence of diagnosed psychiatric disorders among adults with obesity who had experienced and internalized weight stigma. Methods Weight-loss treatment-seeking adults with a history of experiencing weight stigma and high levels of internalized weight stigma were recruited for two clinical trials. Results In Study 1 (n = 84, 83.3% women, 67.9% Black), 25% of participants reported a lifetime history of a mood disorder. Few participants (<10%) reported current psychiatric diagnoses or use of psychiatric medications. In Study 2 (n = 129, 88.4% women, 65.1% white), one-third of participants reported a mood disorder history, and 21.7% reported an anxiety disorder history, with approximately 16%-18% reporting current diagnoses. In both studies, few participants reported a history of a diagnosed eating disorder despite high rates of current full- or subthreshold symptoms. Based on Beck Depression Inventory-II scores, approximately 54%-64% of participants reported mild or greater symptoms of depression. Conclusions Overall, lifetime history of diagnosed psychiatric disorders and current symptoms of depression and eating disorders were relatively high across two samples. More research is needed to determine the impact of weight stigma on the diagnosis and treatment of eating disorders and other psychiatric concerns.
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Affiliation(s)
- Rebecca L. Pearl
- Department of Clinical and Health PsychologyCollege of Public Health and Health ProfessionsUniversity of FloridaGainesvilleFloridaUSA
- Department of PsychiatryCenter for Weight and Eating DisordersPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Marian Hernandez
- Department of Clinical and Health PsychologyCollege of Public Health and Health ProfessionsUniversity of FloridaGainesvilleFloridaUSA
| | - Caroline Bach
- Department of PsychologyGeorgia Southern UniversityStatesboroGeorgiaUSA
| | - Laurie Groshon
- Department of Clinical and Health PsychologyCollege of Public Health and Health ProfessionsUniversity of FloridaGainesvilleFloridaUSA
| | - Thomas A. Wadden
- Department of PsychiatryCenter for Weight and Eating DisordersPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Aladel A, Dakhakhni B, Almuhtadi Y, Alsheweir A, Aljammaz S. Effect of Weight Self-Stigma on Quality of Life and Dietary Habits among Adult Students in Riyadh, Saudi Arabia. Healthcare (Basel) 2023; 11:1754. [PMID: 37372872 DOI: 10.3390/healthcare11121754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
Weight self-stigma (WSS) is a personal experience of negative self-evaluations, perceived discrimination, and shame about body weight. Studies suggested that WSS could negatively affect quality of life, eating behavior, and psychological outcomes. WSS has been linked with a number of obesogenic health outcomes that complicate weight loss interventions. Thus, this study aimed to examine the effect of WSS on the quality of life and dietary habits among adult students. A sample of 385 students from Riyadh universities participated in this cross-sectional study and completed three online questionnaires: the WSS questionnaire, the WHO quality of life questionnaire, and a dietary habit questionnaire. The average age of participants was 24 ± 6.74, and the majority were female (78.4%). Results demonstrated a negative association between all QOL domains and WSS (p < 0.001). Moreover, higher BMI is associated with increased self-devaluation and fear of enacted stigma (p < 0.001). There was also a negative link between both quality and quantity of food with WSS (p < 0.01). No significant difference was seen in study outcomes concerning gender. The findings of this study suggest the importance of increasing awareness about the negative impact of WSS and developing social policies to prevent or decrease it. Additionally, multidisciplinary teams, especially dietitians, should be more aware of WSS when dealing with overweight and obese individuals.
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Affiliation(s)
- Alanoud Aladel
- Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11451, Saudi Arabia
| | - Badeeah Dakhakhni
- Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11451, Saudi Arabia
| | - Yara Almuhtadi
- Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11451, Saudi Arabia
| | - Azzah Alsheweir
- Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11451, Saudi Arabia
| | - Sadeem Aljammaz
- Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11451, Saudi Arabia
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Nakamura Y, Asano M. Developing and validating a Japanese version of the Weight Self-Stigma Questionnaire. Eat Weight Disord 2023; 28:44. [PMID: 37195385 DOI: 10.1007/s40519-023-01573-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 05/11/2023] [Indexed: 05/18/2023] Open
Abstract
PURPOSE Weight bias internalization (WBI) is significantly associated with negative physiological and psychological consequences. Given its negative effects, appropriate measurement of WBI is required for weight management and mental and physical health in people with weight problems. One of the most reliable and frequently used questionnaires to assess WBI is the Weight Self-Stigma Questionnaire (WSSQ). However, a Japanese version of the WSSQ has not yet been developed. Thus, the current study aimed to develop a Japanese version of the WSSQ (WSSQ-J) and validate its psychometric properties in the Japanese context. METHODS A total of 1454 Japanese participants (age 34.44 ± 6.92; male = 498) with diverse weight statuses (Body mass index: 21.44 ± 3.52, 13.79-41.40 kg/m2) completed an online survey for the WSSQ-J. The internal consistency of the WSSQ-J was estimated by calculating Cronbach's α. Confirmatory factor analysis (CFA) was then carried out to confirm that the factor structure of the WSSQ-J was the same as that of the subscales of the original WSSQ. RESULTS The WSSQ-J had a Cronbach's α of 0.917, indicating good internal consistency. In CFA, the comparative fit index was 0.945, the root mean square error of approximation was 0.085, and the standardized root mean square residual was 0.040, indicating that the two-factor model showed satisfactory goodness-of-fit. CONCLUSION This study replicated the original findings related to the WSSQ, showing that the WSSQ-J is a reliable WBI questionnaire consisting of two factors. Therefore, the WSSQ-J would be a reliable tool for assessing WBI among Japanese. LEVEL OF EVIDENCE Level V, descriptive cross-sectional study.
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Affiliation(s)
- Yuko Nakamura
- Center for Evolutionary Cognitive Sciences, Graduate School of Art and Sciences, The University of Tokyo, 3-8-1, Komaba, Meguro-Ku, Tokyo, 153-8902, Japan.
- University of Tokyo Institute for Diversity & Adaptation of Human Mind (UTIDAHM), Meguro-Ku, Tokyo, 153-8902, Japan.
| | - Michiko Asano
- Center for Evolutionary Cognitive Sciences, Graduate School of Art and Sciences, The University of Tokyo, 3-8-1, Komaba, Meguro-Ku, Tokyo, 153-8902, Japan
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Lawrence SE, Puhl RM, Watson RJ, Schwartz MB, Lessard LM, Foster GD. Family-based weight stigma and psychosocial health: A multinational comparison. Obesity (Silver Spring) 2023; 31:1666-1677. [PMID: 37171908 DOI: 10.1002/oby.23748] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 01/10/2023] [Accepted: 01/24/2023] [Indexed: 05/14/2023]
Abstract
OBJECTIVE Family-based weight stigma can be expressed as criticism, judgment, teasing, and mistreatment by family members because of an individual's body weight. The current study compared the prevalence and psychosocial correlates of family-based weight stigma among adult members of a weight-management program living in Australia, Canada, France, Germany, the UK, and the US. METHODS Participants (N = 8100 adults who reported having ever experienced weight stigma; 95% female; 94% White) completed an identical online survey in their country's dominant language that assessed their experiences of weight stigma from 16 different family member sources, as well as internalized weight bias, body image, eating behaviors, perceived stress, and self-rated health. RESULTS Family-based weight stigma, especially from mothers (49%-62%), spouses/romantic partners (40%-57%), and fathers (35%-48%), was highly prevalent across countries. Weight stigma from one's immediate family members was associated with indices of poorer psychosocial health across the six countries (β coefficients = |0.08-0.13|). CONCLUSIONS Findings highlight the need for weight stigma-reduction efforts to help family members distinguish between supportive, encouraging discourse and potentially weight-stigmatizing communication. Future research should examine the prevalence and correlates of family-based weight stigma in more diverse community samples, including among racially/ethnically and gender diverse adults, and in non-Western countries.
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Affiliation(s)
- Samantha E Lawrence
- Department of Pediatrics, Division of General Pediatrics and Adolescent Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Rebecca M Puhl
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
- Rudd Center for Food Policy & Health, University of Connecticut, Hartford, Connecticut, USA
| | - Ryan J Watson
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Marlene B Schwartz
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
- Rudd Center for Food Policy & Health, University of Connecticut, Hartford, Connecticut, USA
| | - Leah M Lessard
- Rudd Center for Food Policy & Health, University of Connecticut, Hartford, Connecticut, USA
| | - Gary D Foster
- WW International, Inc., New York, New York, USA
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Huang PC, Lee CH, Griffiths MD, O’Brien KS, Lin YC, Gan WY, Poon WC, Hung CH, Lee KH, Lin CY. Sequentially mediated effects of weight-related self-stigma and psychological distress in the association between perceived weight stigma and food addiction among Taiwanese university students: A cross-sectional study. J Eat Disord 2022; 10:177. [PMID: 36414956 PMCID: PMC9682751 DOI: 10.1186/s40337-022-00701-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 11/09/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Weight-related stigma has negative physiological and psychological impacts on individuals' quality of life. Stigmatized individuals may experience higher psychological distress and therefore increase the potential risk to develop obesity and/or food addiction. The present study examined the associations and mediated effect between perceived weight stigma, weight-related self-stigma, and psychological distress in explaining food addiction among Taiwanese university students. METHODS All participants (n = 968) completed an online survey which included the Perceived Weight Stigma Questionnaire, Weight Self-Stigma Questionnaire, Depression, Anxiety, Stress Scale-21, and Yale Food Addiction Scale Version 2. RESULTS After controlling for demographic variables, significant associations were found in the paths from (1) perceived weight stigma to weight-related self-stigma ([Formula: see text] = 0.23), psychological distress ([Formula: see text] = 0.35), and food addiction ([Formula: see text] = 0.23); (2) weight-related self-stigma to psychological distress ([Formula: see text] = 0.52) and food addiction ([Formula: see text] = 0.59); and (3) psychological distress to food addiction ([Formula: see text] = 0.59) (all p-values < 0.001). The mediation model showed the sequential mediated effect of weight-related self-stigma and psychological distress in the association between perceived weight stigma and food addiction. CONCLUSIONS The results provide novel insights that weight-related self-stigma and psychological distress sequentially mediated the relationship between perceived weight stigma and food addiction among Taiwanese university students. The findings of the present study could be implemented into interventions that aim to reduce food addiction derived from weight-related stigma. Future studies should consider group analysis to consider confounding factors or other populations to provide more evidence regarding the mechanism of weight-related stigma.
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Affiliation(s)
- Po-Ching Huang
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, No. 1, University Rd., East Dist., Tainan, 701401 Taiwan
| | - Chiu-Hsiang Lee
- Department of Nursing, Chung Shan Medical University, No. 110, Sec. 1, Jianguo N. Rd., South Dist., Taichung, 402306 Taiwan
- Department of Nursing, Chung Shan Medical University Hospital, No. 110, Sec. 1, Jianguo N. Rd., South Dist., Taichung, 402306 Taiwan
| | - Mark D. Griffiths
- International Gaming Research Unit, Psychology Department, Nottingham Trent University, 50 Shakespeare Street, Nottingham, NG1 4FQ UK
| | - Kerry S. O’Brien
- School of Social Sciences, Faculty of Arts, Monash University, 20 Chancellors Walk, Clayton, VIC 3800 Australia
| | - Yi-Ching Lin
- Department of Early Childhood and Family Education, National Taipei University of Education, No. 134, Sec. 2, Heping E. Rd., Da’an Dist., Taipei, 106320 Taiwan
| | - Wan Ying Gan
- Department of Nutrition, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor Malaysia
| | - Wai Chuen Poon
- Sunway University Business School, Sunway University, Selangor Darul Ehsan, No. 5, Jalan Universiti, 47500 Bandar Sunway, Malaysia
| | - Ching-Hsia Hung
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, No. 1, University Rd., East Dist., Tainan, 701401 Taiwan
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, No. 1, Daxue Rd., East Dist., Tainan, 701401 Taiwan
| | - Kuo-Hsin Lee
- Department of Emergency Medicine, E-Da Hospital, I-Shou University, No.1, Yida Rd, Yanchao District, Kaohsiung City, 824 Taiwan
- School of Medicine, I-Shou University, No. 8, Yi-Da Road, Jiao-Su Village, Yan-Chao District, Kaohsiung City, 824 Taiwan
| | - Chung-Ying Lin
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, No. 1, University Rd., East Dist., Tainan, 701401 Taiwan
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, No. 1, University Rd., East Dist., Tainan, 701401 Taiwan
- Department of Public Health, College of Medicine, National Cheng Kung University, No. 1, University Rd., East Dist., Tainan, 701401 Taiwan
- Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 1, University Rd., East Dist., Tainan, 701401 Taiwan
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Talumaa B, Brown A, Batterham RL, Kalea AZ. Effective strategies in ending weight stigma in healthcare. Obes Rev 2022; 23:e13494. [PMID: 35934011 PMCID: PMC9540781 DOI: 10.1111/obr.13494] [Citation(s) in RCA: 58] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 12/11/2022]
Abstract
Weight stigma impacts negatively healthcare quality and hinders public health goals. The aim of this review was to identify strategies for minimizing weight bias among healthcare professionals and explore future research directions. An electronic search was performed in PubMed, PsycINFO and Scopus (until June 2020). Studies on weight stigma reduction in healthcare students, trainees and professionals were assessed based on specific inclusion and exclusion criteria. A narrative synthesis was undertaken to analyze emerging themes. We identified five stigma reduction strategies in healthcare: (i) increased education, (ii) causal information and controllability, (iii) empathy evoking, (iv) weight-inclusive approach, and (v) mixed methodology. Weight stigma needs to be addressed early on and continuously throughout healthcare education and practice, by teaching the genetic and socioenvironmental determinants of weight, and explicitly discussing the sources, impact and implications of stigma. There is a need to move away from a solely weight-centric approach to healthcare to a health-focused weight-inclusive one. Assessing the effects of weight stigma in epidemiological research is equally important. The ethical argument and evidence base for the need to reduce weight stigma in healthcare and beyond is strong. Although evidence on long-term stigma reduction is emerging, precautionary action is needed.
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Affiliation(s)
- Britta Talumaa
- Division of Medicine, University College London, London, UK
| | - Adrian Brown
- Division of Medicine, University College London, London, UK.,Centre for Obesity Research, University College London, London, UK.,Bariatric Centre for Weight Management and Metabolic Surgery, University College London Hospital NHS Trust, London, UK.,UCLH Biomedical Research Centre, National Institute of Health Research, London, UK
| | - Rachel L Batterham
- Division of Medicine, University College London, London, UK.,Centre for Obesity Research, University College London, London, UK.,Bariatric Centre for Weight Management and Metabolic Surgery, University College London Hospital NHS Trust, London, UK.,UCLH Biomedical Research Centre, National Institute of Health Research, London, UK
| | - Anastasia Z Kalea
- Division of Medicine, University College London, London, UK.,Institute of Cardiovascular Science, University College London, London, UK
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12
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Meadows A, Higgs S. Challenging oppression: A social identity model of stigma resistance in higher-weight individuals. Body Image 2022; 42:237-245. [PMID: 35816967 DOI: 10.1016/j.bodyim.2022.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 06/07/2022] [Accepted: 06/07/2022] [Indexed: 11/15/2022]
Abstract
Many higher-weight individuals have internalised societal weight stigma, devaluing themselves because of their weight. Rejecting and challenging societal devaluation is generally associated with superior outcomes compared with stigma internalisation or inaction; however, stigma resistance has not been studied in higher-weight individuals, despite ubiquitous weight stigma in daily life. Applying a social identity framework, we utilised decision tree analysis to explore predictors of responses to weight stigma in 931 self-classified higher-weight individuals. While ingroup identification with the group 'Fat' was the major predictor of stigma resistance (versus internalisation), perceived illegitimacy of societal weight stigma defined a subgroup of resisters even in the absence of group identity. Interventions focusing on the illegitimacy of unequal social status and treatment may be effective at reducing internalisation and fostering resistance in a population with characteristically low ingroup identity.
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Affiliation(s)
- Angela Meadows
- Department of Psychology, University of Essex, Colchester CO4 3SQ, UK.
| | - Suzanne Higgs
- School of Psychology, University of Birmingham, Birmingham B15 2TT, UK
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13
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Cuccolo K, Kramer R, Petros T, Thoennes M. Intermittent fasting implementation and association with eating disorder symptomatology. Eat Disord 2022; 30:471-491. [PMID: 34191688 DOI: 10.1080/10640266.2021.1922145] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Intermittent fasting (IF) is an emerging dietary trend that remains understudied. This study aimed to describe the implementation and eating disorder (ED) symptomatology, relevant to engagement in IF among both men and women. Intermittent fasters (N = 44 women, N = 20 men) recruited from Amazon Mechanical Turk, Reddit, and a Midwestern University were administered a demographic questionnaire, an assessment of ED symptomatology (Eating Disorder Examination Questionnaire; EDE-Q), and asked about their IF use. To assess the level of ED symptomatology among individuals using IF community and clinical norms were used for comparison. We hypothesized a) men and women engaging IF would score higher on the EDE-Q and b) more individuals engaging in IF would endorse ED behaviors (e.g., self-induced vomiting) than community norms. Intermittent fasters reported fasting for approximately 16 hours daily and for weight loss purposes. Men and women engaging in IF scored significantly higher than community norms on all subscales of the EDE-Q, with 31.25% of participants' EDE-Q scores being at or above the clinical EDE-Q cut-off. Men and women engaging in IF reported engaging in ED behaviors. Results suggest that IF is associated with ED symptomatology. Further research on psychological characteristics and temporal order of the association between IF and ED symptomatology is warranted.
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Affiliation(s)
- Kelly Cuccolo
- Department of Psychology, University of North Dakota, Grand Forks, United States
| | - Rachel Kramer
- Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Thomas Petros
- Department of Psychology, University of North Dakota, Grand Forks, United States
| | - McKena Thoennes
- Department of Psychology, University of North Dakota, Grand Forks, United States
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14
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Bograd S, Chen B, Kavuluru R. Tracking sentiments toward fat acceptance over a decade on Twitter. Health Informatics J 2022; 28:14604582211065702. [PMID: 34986689 DOI: 10.1177/14604582211065702] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The fat acceptance (FA) movement aims to counteract weight stigma and discrimination against individuals who are overweight/obese. We developed a supervised neural network model to classify sentiment toward the FA movement in tweets and identify links between FA sentiment and various Twitter user characteristics. We collected any tweet containing either "fat acceptance" or "#fatacceptance" from 2010-2019 and obtained 48,974 unique tweets. We independently labeled 2000 of them and implemented/trained an Average stochastic gradient descent Weight-Dropped Long Short-Term Memory (AWD-LSTM) neural network that incorporates transfer learning from language modeling to automatically identify each tweet's stance toward the FA movement. Our model achieved nearly 80% average precision and recall in classifying "supporting" and "opposing" tweets. Applying this model to the complete dataset, we observed that the majority of tweets at the beginning of the last decade supported FA, but sentiment trended downward until 2016, when support was at its lowest. Overall, public sentiment is negative across Twitter. Users who tweet more about FA or use FA-related hashtags are more supportive than general users. Our findings reveal both challenges to and strengths of the modern FA movement, with implications for those who wish to reduce societal weight stigma.
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Affiliation(s)
- Sadie Bograd
- 326741Paul Laurence Dunbar High School, Lexington, KY USA
| | - Benjamin Chen
- 326741Paul Laurence Dunbar High School, Lexington, KY, USA
| | - Ramakanth Kavuluru
- Department of Internal Medicine, 4530University of Kentucky, Lexington, KY, USA
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15
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Lemmon G, Jensen JM, Kuljanin G. A primer with purpose: Research implications of the objectification of weight in the workplace. JOURNAL OF OCCUPATIONAL AND ORGANIZATIONAL PSYCHOLOGY 2021. [DOI: 10.1111/joop.12378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Grace Lemmon
- Department of Management & Entrepreneurship DePaul University Chicago Illinois USA
| | - Jaclyn M. Jensen
- Department of Management & Entrepreneurship DePaul University Chicago Illinois USA
| | - Goran Kuljanin
- Department of Management & Entrepreneurship DePaul University Chicago Illinois USA
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16
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Pearl RL, Wadden TA, Jakicic JM. Is weight stigma associated with physical activity? A systematic review. Obesity (Silver Spring) 2021; 29:1994-2012. [PMID: 34747131 PMCID: PMC8612947 DOI: 10.1002/oby.23274] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/17/2021] [Accepted: 07/26/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Weight stigma is associated with impaired health, attributed in part to reductions in health-promoting behaviors. This review analyzed evidence of the association between weight stigma and physical activity (PA) in adults and youth. METHODS Three databases were searched for terms related to weight stigma and PA. Eligible studies reported the quantitative association between at least one measure of weight stigma and one behavioral measure of PA. RESULTS A total of 38 studies met eligibility criteria. Of the 29 studies of adults, 3 used objective PA measures, and 79% used an observational, cross-sectional design. Findings of the relationship between weight stigma and PA were mixed. Everyday weight discrimination and internalizing weight stigma were associated with reduced PA in most studies. Several studies found indirect, and not direct, effects of weight stigma on PA when analyses included other individual-level factors. In the nine studies of youth, two used objective PA measures, all were observational, and only one study was longitudinal. Most youth studies found a relationship between weight-based teasing and reduced PA. CONCLUSIONS Weight teasing, everyday discrimination, and internalization were associated with reduced PA. However, associations were inconsistent and often indirect. Future studies should include objective PA measures with larger samples and longitudinal assessments.
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Affiliation(s)
- Rebecca L. Pearl
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Thomas A. Wadden
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - John M. Jakicic
- Healthy Lifestyle Institute and Physical Activity and Weight Management Research Center, University of Pittsburgh, Pittsburgh, PA, USA
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17
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Almutairi BF, Alsaygh KW, Altamimi MM, Alshammari AS, Alsomali AM, Alanazi SM, Alzahrani SM, Alsaad AS, Zacharakis G. Internalized Weight Stigma: Prevalence and Association With Psychiatric Disorder Among Overweight and Obese Individuals. Cureus 2021; 13:e18577. [PMID: 34760420 PMCID: PMC8572015 DOI: 10.7759/cureus.18577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2021] [Indexed: 01/31/2023] Open
Abstract
Background and objective Unlike weight stigma, internalized weight stigma (IWS) may be a common but still underreported problem. With the recent emergence of studies investigating its various aspects in Arab-speaking countries, there is still scant data on its incidence and severity in the literature. In light of this, the aim of this study was to evaluate the prevalence of IWS and its association with psychiatric disorders and sociodemographic factors among overweight and obese individuals in a sample from a Saudi population. Methods A cross-sectional study was conducted among a Saudi population using a convenience sample technique and 868 individuals were enrolled to participate in this study. They were asked to fill out an electronic questionnaire about IWS, demographics, and other parameters such as Patient Health Questionnaire (PHQ)-9 and General Anxiety Disorder (GAD)-7. The association was tested using an independent t-test and chi-square test. Results The overall prevalence of internalized stigma in this study was 57%. Higher levels of internalization were more prevalent among younger respondents. We found that females were more prone to internalize weight stigma, at a slightly higher rate than males (59.26% vs. 53.66%), but this difference was not statistically significant. The other sociodemographic factors associated with higher internalization were as follows: being widowed, married, retired, or housewife. Those with higher IWS levels were individuals with higher BMI and with previous experiences of weight stigma. In addition, higher internalization was associated with the development of severe depression and anxiety (p<0.001). Conclusion The prevalence of IWS among overweight and obese individuals was found to be high, and it is highly associated with the development of severe depression and anxiety. There is a need to raise awareness about obesity stigma to help tackle IWS in overweight and obese individuals and to promote their quality of life.
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Affiliation(s)
| | - Khaled W Alsaygh
- Psychiatry, Prince Sattam Bin Abdulaziz University, Al Kharj, SAU
| | - Mazen M Altamimi
- Psychiatry, Prince Sattam Bin Abdulaziz University, Al Kharj, SAU
| | | | - Ahmed M Alsomali
- Psychiatry, Prince Sattam Bin Abdulaziz University, Al Kharj, SAU
| | - Sultan M Alanazi
- Psychiatry, Prince Sattam Bin Abdulaziz University, Al Kharj, SAU
| | - Saud M Alzahrani
- Psychiatry, Prince Sattam Bin Abdulaziz University, Al Kharj, SAU
| | - Ameer S Alsaad
- Psychiatry, Prince Sattam Bin Abdulaziz University, Al Kharj, SAU
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18
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Puhl RM, Lessard LM, Pearl RL, Grupski A, Foster GD. Policies to address weight discrimination and bullying: Perspectives of adults engaged in weight management from six nations. Obesity (Silver Spring) 2021; 29:1787-1798. [PMID: 34612007 PMCID: PMC8571064 DOI: 10.1002/oby.23275] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/10/2021] [Accepted: 05/12/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Across the world, it remains legal to discriminate against people because of their weight. Although US studies demonstrate public support for laws to prohibit weight discrimination, multinational research is scarce. The present study conducted a multinational comparison of support for legislative measures to address weight discrimination and bullying across six countries. METHODS Participants were adults (n = 13,996) enrolled in an international weight-management program and residing in Australia, Canada, France, Germany, the UK, and the US. Participants completed identical online surveys that assessed support for antidiscrimination laws and policies to address weight bullying, demographic characteristics, and personal experiences of weight stigma. RESULTS Across countries, support was high for laws (90%) and policies (92%) to address weight-based bullying, whereas greater between-country variation emerged in support for legislation to address weight-based discrimination in employment (61%, 79%), as a human rights issue (57%), and through existing disability protections (47%). Findings highlight few and inconsistent links between policy support and sociodemographic correlates or experienced or internalized weight stigma. CONCLUSIONS Support for policies to address weight stigma is present among people engaged in weight management across Westernized countries; findings offer an informative comparison point for future cross-country research and can inform policy discourse to address weight discrimination and bullying.
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Affiliation(s)
- Rebecca M Puhl
- Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford, Connecticut, USA
- Department of Human Development & Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Leah M Lessard
- Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford, Connecticut, USA
| | - Rebecca L Pearl
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Gary D Foster
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- WW International, Inc, New York, New York, USA
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19
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Schulte EM, Bach C, Berkowitz RI, Latner JD, Pearl RL. Adverse Childhood Experiences and Weight Stigma: Co-Occurrence and Associations with Psychological Well-Being. STIGMA AND HEALTH 2021; 6:408-418. [PMID: 34926807 PMCID: PMC8675894 DOI: 10.1037/sah0000341] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Prior research has demonstrated that individuals with a higher body weight (i.e., obesity) have a relatively high incidence of adverse childhood experiences (ACEs) (e.g., abuse, neglect). Individuals with obesity are also susceptible to experiencing and internalizing weight stigma. Negative physical and mental health consequences have been associated with both ACEs and weight stigma, yet the interplay between these factors has not been explored. The current study examined ACEs in a sample of 105 treatment-seeking adults with obesity who all reported having experienced and internalized weight stigma (90.5% women, 70.5% non-Hispanic White, mean age=49.1 years). The study aimed to 1) provide a descriptive overview of rates of ACEs in this unique sample of adults with potentially high psychological vulnerability and 2) assess associations between ACEs, weight stigma, and psychological well-being. Over three-fourths of participants (76.2%) reported experiencing at least one ACE. The total number of ACEs was significantly associated with more frequent experiences of and greater distress about weight stigma during childhood, as well as higher current perceived stress. Experiencing weight stigma for the first time in childhood was also associated with more reported ACEs. ACEs of abuse were associated with more lifetime reported experiences of weight stigma and greater internalization, use of eating as a strategy to cope with weight stigma, and higher perceived stress. These findings have implications for early identification of and tailored interventions for individuals who have experienced adverse events and weight stigma at a young age.
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Affiliation(s)
- Erica M. Schulte
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA USA
| | - Caroline Bach
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA USA
| | - Robert I. Berkowitz
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA USA
- Department of Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Janet D. Latner
- Department of Psychology, University of Hawaii at Manoa, Honolulu, HI USA
| | - Rebecca L. Pearl
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA USA
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL USA
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20
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Pearl RL, Puhl RM, Himmelstein MS, Pinto AM, Foster GD. Weight Stigma and Weight-Related Health: Associations of Self-Report Measures Among Adults in Weight Management. Ann Behav Med 2021; 54:904-914. [PMID: 32333673 DOI: 10.1093/abm/kaaa026] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Weight stigma impairs health. Few studies have disentangled the associations of experienced versus internalized stigma with weight-related outcomes. PURPOSE To examine weight and health variables associated with weight stigma experiences and internalization in the largest-to-date sample of adults in weight management. METHODS WW (formerly Weight Watchers) members (N = 18,769, 94.6% female, 91.1% white) completed an online survey from 2017 to 2018. Participants reported whether they had experienced weight stigma and, if so, the onset, past-year frequency and distress, and interpersonal sources of stigma. Participants completed the Modified Weight Bias Internalization Scale (WBIS-M) and self-reported: past-year weight and lifetime weight cycles; current self-monitoring behaviors; eating self-efficacy; physical activity; perceived stress; eating to cope; body image; and mental and physical health-related quality-of-life (HRQOL). Participants reported their demographic characteristics, including height and weight to compute body mass index. RESULTS In logistic and linear regression analyses (controlling for participant characteristics), WBIS-M scores were negatively associated with weight loss, self-monitoring, eating self-efficacy, body image, and mental HRQOL and positively associated with weight gain, weight cycling, perceived stress, and eating to cope (p < .001). Experiencing weight stigma was associated with greater weight loss and less weight gain, although associations with other variables had small effect sizes (absolute β values < 0.10). WBIS-M scores remained significantly associated with all variables when including stigma onset, frequency/distress, and sources. CONCLUSIONS Internalized, but not experienced, weight stigma was consistently associated with adverse weight and health factors. Developing and testing interventions targeting internalized stigma in the context of weight management should be a research priority.
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Affiliation(s)
- Rebecca L Pearl
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Rebecca M Puhl
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA.,Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT, USA
| | - Mary S Himmelstein
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT, USA.,Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - Angela M Pinto
- Science Department, WW (formerly Weight Watchers) International, Inc., New York, NY, USA.,Department of Psychology, Baruch College, City University of New York, New York, NY, USA
| | - Gary D Foster
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Science Department, WW (formerly Weight Watchers) International, Inc., New York, NY, USA
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21
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Puhl RM, Lessard LM, Pearl RL, Himmelstein MS, Foster GD. International comparisons of weight stigma: addressing a void in the field. Int J Obes (Lond) 2021; 45:1976-1985. [PMID: 34059785 DOI: 10.1038/s41366-021-00860-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 04/22/2021] [Accepted: 05/06/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND/OBJECTIVES Despite substantial evidence documenting weight stigma toward people with higher body weight, international comparative studies are lacking in this field. The few studies that have compared weight stigma across different countries focus on explicit weight-biased attitudes rather than people's experiences of weight stigma. The present study conducted a multinational systematic comparison of weight stigma in six countries to assess experiences and interpersonal sources of weight stigma. SUBJECTS/METHODS Adults (N = 13,996) enrolled in WW International (formerly Weight Watchers), residing in Australia, Canada, France, Germany, the UK, and the US completed identical online anonymous surveys in the dominant language for their country. Surveys assessed their history of experiencing weight stigma, the onset of stigmatizing experiences and associated distress from stigma in different time periods, and interpersonal sources of weight stigma. RESULTS More than half of participants (55.6-61.3%) across countries reported experiencing weight stigma. Participants with higher BMI were significantly more likely to report weight-stigmatizing experiences than individuals with lower BMI. In all countries, weight stigma experiences were most frequent in childhood and adolescence, with associated distress highest during these time periods. Participants in Germany reported a higher frequency of weight stigma across their whole life, but lower distress associated with stigmatizing experiences, compared to participants in the other five countries. High percentages of participants in each country experienced weight stigma from family members (76.0-87.8%), classmates (72.0-80.9%), doctors (62.6-73.5%), co-workers (54.1-61.7%), and friends (48.8-66.2%). CONCLUSIONS Weight stigma is prevalent for adults actively engaged in weight management across different Western countries. There were more similarities than differences in the nature, frequency, and interpersonal sources of people's experiences of weight stigma across the six countries in this study. Findings underscore the need for multinational initiatives to address weight stigma and interventions to support individuals engaged in weight management who experience weight mistreatment.
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Affiliation(s)
- Rebecca M Puhl
- Department of Human Development & Family Sciences, University of Connecticut, Storrs, CT, USA. .,Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT, USA.
| | - Leah M Lessard
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT, USA
| | - Rebecca L Pearl
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Mary S Himmelstein
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - Gary D Foster
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,WW International, Inc., New York, NY, USA
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22
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Althumiri NA, Basyouni MH, AlMousa N, AlJuwaysim MF, Alhamdan AA, Al-Qahtani FS, BinDhim NF, Alqahtani SA. Exploring Weight Stigma in Saudi Arabia: A Nationwide Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9141. [PMID: 34501731 PMCID: PMC8430631 DOI: 10.3390/ijerph18179141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 08/09/2021] [Accepted: 08/26/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Weight stigma (WS) in the Middle East, especially in Saudi Arabia, is widely ignored. People with obesity are blamed for their weight, and there is a common perception that weight stigmatization is justifiable and may motivate individuals to adopt healthier behaviors. The authors of this study aimed to explore WS prevalence and factors associated with WS in a large nationwide study of Saudi Arabian adults. METHODS This study was a nationwide cross-sectional survey conducted via phone interviews in June 2020. A proportional quota-sampling technique was adopted to obtain equal distributions of participants by age and sex across the 13 regions of Saudi Arabia. In total, 6239 people were contacted, and 4709 (75.48%) responded and completed the interview. The authors of the study collected data about WS using the Arabic Weight Self-Stigma Questionnaire (WSSQ), BMI, smoking, nutritional knowledge, bariatric surgery, risk of depression, and demographic variables. RESULTS Participants had a mean age of 36.4 ± 13.5 (18-90), and 50.1% were female. The prevalence of higher WS was 46.4%. Among other risk factors, there was a significant association between WS and obesity (odds ratio (OR): 3.93; 95% CI: 2.83-5.44; p < 0.001), waterpipe smoking (OR: 1.80; 95% CI: 1.20-2.69; p < 0.001), bariatric surgery (OR: 2.07; 95% CI: 1.53-2.81; p < 0.001), and risk of depression (OR: 1.68; 95% CI: 1.36-2.09; p < 0.001). CONCLUSION This was the first study to explore WS and its associated factors among adults in a community setting in Saudi Arabia. This study revealed some risk factors associated with WS that may help to identify people at risk of WS and to develop interventions to reduce WS, such as improving nutritional knowledge, correcting the ideas about bariatric surgery and obesity in general, and ceasing waterpipe smoking.
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Affiliation(s)
- Nora A. Althumiri
- Sharik Association for Health Research, Riyadh 13326, Saudi Arabia; (M.H.B.); (N.A.); (M.F.A.); (N.F.B.)
| | - Mada H. Basyouni
- Sharik Association for Health Research, Riyadh 13326, Saudi Arabia; (M.H.B.); (N.A.); (M.F.A.); (N.F.B.)
- Ministry of Health, Riyadh 11176, Saudi Arabia
| | - Norah AlMousa
- Sharik Association for Health Research, Riyadh 13326, Saudi Arabia; (M.H.B.); (N.A.); (M.F.A.); (N.F.B.)
- Public Health College, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Mohammed F. AlJuwaysim
- Sharik Association for Health Research, Riyadh 13326, Saudi Arabia; (M.H.B.); (N.A.); (M.F.A.); (N.F.B.)
- Pharmacy College, King Faisal University, AlAhsa 31982, Saudi Arabia
| | - Adel A. Alhamdan
- Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11362, Saudi Arabia;
| | - Faisal Saeed Al-Qahtani
- Department of Family & Community Medicine, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia;
| | - Nasser F. BinDhim
- Sharik Association for Health Research, Riyadh 13326, Saudi Arabia; (M.H.B.); (N.A.); (M.F.A.); (N.F.B.)
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
- Saudi Food and Drug Authority, Riyadh 13513, Saudi Arabia
| | - Saleh A. Alqahtani
- Liver Transplant Unit, King Faisal Specialist Hospital & Research Centre, Riyadh 11211, Saudi Arabia;
- Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, MD 21218, USA
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Macho S, Andrés A, Saldaña C. Validation of the modified weight bias internalization scale in a Spanish adult population. Clin Obes 2021; 11:e12454. [PMID: 33821573 DOI: 10.1111/cob.12454] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 03/08/2021] [Accepted: 03/18/2021] [Indexed: 01/29/2023]
Abstract
Weight bias internalization has received considerable attention in recent years and has been associated with serious psychological and physical consequences in Westernized societies. The modified weight bias internalization scale (WBIS-M) is one of the most frequently used instruments for assessing internalized weight stigma across different body weight categories. The aim of this study was to adapt the WBIS-M for use in Spanish adult populations. The sample consisted of 678 participants from the Spanish general population recruited through the internet, 79.6% of whom were women. The scale was translated into Spanish and then backtranslated. To study the internal structure, a cross-validation analysis was carried out including both exploratory and confirmatory factor analyses to assess the scale's psychometric properties. Internal consistency was evaluated using Cronbach's alpha and McDonald's omega and a test-retest was conducted to assess one-month stability. Results confirmed that the Spanish adaptation of the WBIS-M is an 11-item unidimensional scale, like the original version and shows excellent psychometric properties. In conclusion, the Spanish WBIS-M version seems to be a robust psychometric tool for use in clinical and research settings.
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Affiliation(s)
- Sergio Macho
- Department of Clinical Psychology and Psychobiology. Faculty of Psychology, University of Barcelona, Barcelona, Spain
| | - Ana Andrés
- Faculty of Psychology, Education and Sport Sciences, Ramon Llull University, Blanquerna, Barcelona, Spain
| | - Carmina Saldaña
- Department of Clinical Psychology and Psychobiology. Faculty of Psychology, University of Barcelona, Barcelona, Spain
- Neuroscience Institute, University of Barcelona, Barcelona, Spain
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Abstract
PURPOSE OF REVIEW This review explores potential sources of weight bias and stigma during the COVID-19 pandemic, including "quarantine-15" messages and discussion of obesity in media and public health campaigns. We examine evidence of the effects of weight bias on well-being during the pandemic and highlight unanswered questions to be addressed in future research. RECENT FINDINGS Studies that have investigated weight change during stay-at-home orders have yielded mixed findings and relied predominantly on self-reported retrospective recall, thus providing weak evidence of a widespread "quarantine-15" effect. No studies to date have evaluated the effects on weight stigma and health of obesity-focused COVID-19 media and public health messages. Individuals with a history of experiencing weight bias may be more vulnerable to binge eating and psychological distress during the pandemic. Weight bias and stigma during the COVID-19 pandemic, and their effects on health and well-being, warrant greater investigation and consideration in public health efforts.
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Affiliation(s)
- Rebecca L Pearl
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA.
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Erica M Schulte
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Pearl RL, Puhl RM, Lessard LM, Himmelstein MS, Foster GD. Prevalence and correlates of weight bias internalization in weight management: A multinational study. SSM Popul Health 2021; 13:100755. [PMID: 33718581 PMCID: PMC7920853 DOI: 10.1016/j.ssmph.2021.100755] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/08/2021] [Accepted: 02/07/2021] [Indexed: 12/24/2022] Open
Abstract
Weight bias internalization (WBI) is an understudied form of internalized stigma, particularly among treatment-seeking adults with overweight/obesity. The current study surveyed 13,996 adults currently engaged in weight management in the first multinational study of WBI. From May to July 2020, participants in six Western countries completed the Modified Weight Bias Internalization Scale (WBIS-M) and measures of weight change, health behaviors, psychosocial well-being, and health-related quality of life (HRQOL). Participants were majority white, female, middle-aged, and categorized as having overweight or obesity based on body mass index. Results showed higher mean WBIS-M scores among participants in the UK, Australia, and France than in Germany, the US, and Canada. Across all countries, and controlling for participant characteristics and experiences of weight stigma, WBIS-M scores were associated with greater weight gain in the past year. Participants with higher WBIS-M scores also reported poorer mental and physical HRQOL, less eating and physical activity self-efficacy, greater engagement in eating as a coping strategy, more avoidance of going to the gym, poorer body image, and greater perceived stress. Few interaction effects were found between experiences and internalization of weight stigma. Overall, the current findings support WBI as a robust correlate of adverse weight-related health indices across six Western countries. Prospective and experimental studies are needed to determine directionality and causality in the relationship between WBI and poor health outcomes.
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Affiliation(s)
- Rebecca L. Pearl
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Rebecca M. Puhl
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT, USA
- Department of Human Development & Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Leah M. Lessard
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT, USA
| | | | - Gary D. Foster
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- WW International, Inc., New York, NY, USA
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Kliem S, Puls HC, Hinz A, Kersting A, Brähler E, Hilbert A. Validation of a Three-Item Short Form of the Modified Weight Bias Internalization Scale (WBIS-3) in the German Population. Obes Facts 2020; 13:560-571. [PMID: 33238284 PMCID: PMC7802509 DOI: 10.1159/000510923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 08/05/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Individuals suffering from overweight or obesity frequently experience weight-based stigmatization. The widespread belief that weight is a matter of personal will and self-control results in various weight-based stereotypes (e.g., laziness, lack of self-discipline, or neglect). OBJECTIVE Based on the modified version of the Weight Bias Internalization Scale (WBIS-M), a short form for the economic assessment of weight bias internalization in the general population was compiled and validated. METHODS A three-item short form (WBIS-3) was derived based on data from a representative sample of the German population (n = 1,092). This new short form was validated in a second representative population sample (n = 2,513). Item characteristics and internal consistency were obtained. Measurement invariance was tested. Construct validity was established via the correlation with theoretically related constructs (depression, anxiety, eating behavior, discrimination, weight status). To establish scale validity, all analyses were performed for the whole sample as well as for the subsample of individuals with overweight. Age- and gender-specific population norms were provided. RESULTS The WBIS-3 exhibited excellent psychometric properties. Internal consistency was α = 0.92. Strong measurement invariance was confirmed regarding age, gender, discrimination, and weight status in both the whole sample as well as the overweight subsample. CONCLUSIONS The WBIS-3 constitutes a valid and economical tool for the assessment of weight bias internalization in epidemiological contexts. Measurement invariance allows for an unbiased comparison of means, correlation coefficients, and path coefficients within structural equation modeling across groups.
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Affiliation(s)
- Sören Kliem
- Ernst-Abbe-Hochschule, University of Applied Sciences, Jena, Germany
| | - Hans-Christian Puls
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany,
- Integrated Research and Treatment Center AdiposityDiseases, Behavioral Medicine Research Unit, University of Leipzig Medical Center, Leipzig, Germany,
| | - Andreas Hinz
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Anette Kersting
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Elmar Brähler
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
- Integrated Research and Treatment Center AdiposityDiseases, Behavioral Medicine Research Unit, University of Leipzig Medical Center, Leipzig, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Anja Hilbert
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
- Integrated Research and Treatment Center AdiposityDiseases, Behavioral Medicine Research Unit, University of Leipzig Medical Center, Leipzig, Germany
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Prunty A, Clark MK, Hahn A, Edmonds S, O’Shea A. Enacted weight stigma and weight self stigma prevalence among 3821 adults. Obes Res Clin Pract 2020; 14:421-427. [DOI: 10.1016/j.orcp.2020.09.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/11/2020] [Indexed: 11/15/2022]
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Gmeiner MS, Warschburger P. Intrapersonal predictors of weight bias internalization among elementary school children: a prospective analysis. BMC Pediatr 2020; 20:408. [PMID: 32859162 PMCID: PMC7456014 DOI: 10.1186/s12887-020-02264-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 07/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Weight-related stigmatization is a widespread problem. Particularly the internalization of weight-related stereotypes and prejudices (weight bias internalization, WBI) is related to mental and physical health impairments. To date, little is known about the risk factors of WBI. Previous studies are mainly cross-sectional and based on adult samples. As childhood is a sensitive period for the development of a healthy self-concept, we examined predictors of WBI in children. METHODS The final sample included 1,463 schoolchildren (6-11 years, 51.7% female) who took part in a prospective study consisting of three measurement waves. The first two waves delivered data on objective weight status and self-reported weight-related teasing, body dissatisfaction, relevance of one's own figure, self-esteem and depressive symptoms; WBI was measured during the third wave. To examine predictors of WBI, we ran hierarchical regression analyses and exploratory mediation analyses. RESULTS Lower parental education level, higher child weight status, female gender, experience of teasing, higher body dissatisfaction, higher figure-relevance, and higher depression scores were found to be predictive for higher WBI scores. Body dissatisfaction (only for girls) and the relevance of one's own figure (both genders) mediated the association between self-esteem and WBI; no weight-related differences were observed. CONCLUSIONS Our study offers longitudinal evidence for variables that enable the identification of children who are at risk for WBI. Thus, the findings deliver starting points for interventions aimed at the prevention of adverse health developments that come along with WBI.
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Affiliation(s)
- Michaela Silvia Gmeiner
- Department of Psychology, University of Potsdam, Karl-Liebknechtstr. 24-25, 14476, Potsdam, Germany
| | - Petra Warschburger
- Department of Psychology, University of Potsdam, Karl-Liebknechtstr. 24-25, 14476, Potsdam, Germany.
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Bayer S, Drabsch T, Schauberger G, Hauner H, Holzapfel C. Responsibility of Individuals and Stakeholders for Obesity and a Healthy Diet: Results From a German Survey. Front Psychiatry 2020; 11:616. [PMID: 32719623 PMCID: PMC7350775 DOI: 10.3389/fpsyt.2020.00616] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 06/12/2020] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Overweight and obesity are thought to be mainly caused by an energy-rich diet and a sedentary lifestyle. The opinions of those with and without obesity about an individual´s and stakeholder´s responsibility for overweight and obesity as well as a healthy diet is rather unclear. Therefore, a survey was conducted to assess the thoughts of persons with and without obesity about the responsibilities for a high body weight and healthy diet. METHODS This telephone-based survey was conducted in Germany. Landline and mobile phone users older than 17 years were quota sampled to represent the German population (n=1,003). Additionally, 354 adults with a body mass index (BMI) ≥ 30 kg/m2 were included in the survey population. Questions on weight management, eating and drinking and anthropometry were asked. Furthermore, the opinions of participants on the responsibility of individuals and stakeholders for obesity and a healthy diet were collected. Data was statistically weighted by age, gender, education, domicile, and BMI. RESULTS Data of 1,357 persons (51.1% female, age: 50.5 ± 18.5 years, 15.9% with BMI ≥ 30 kg/m2) were analyzed. Participants responded that the general causes of a high body weight were low physical activity (82.7%) and excessive caloric intake (80.5%) followed by a lack of will power (72.1%). Almost 90% of the survey population reported that each individual is responsible for his/her own healthy diet. More than 85% of the survey population agreed that a healthy diet in kindergarten and nutrition education at schools should be the preferred approaches when politics take care of a person´s healthy diet. Sub-analyses revealed that BMI, sex, age, and education are potential confounders. CONCLUSION This German survey showed that the majority of participants indicated that the responsibility for a healthy diet lies with the individual and high body weight is caused by self-controlled attitudes. These results suggest that the survey population underestimates societal and environmental factors that contribute to the development of obesity, which could lead to attitudes that facilitate weight-related stigmatization. Furthermore, survey participants indicated that they would support policy-driven measures that promote a healthy diet.
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Affiliation(s)
- Sandra Bayer
- School of Medicine, Institute for Nutritional Medicine, Technical University of Munich, Munich, Germany
| | - Theresa Drabsch
- School of Medicine, Institute for Nutritional Medicine, Technical University of Munich, Munich, Germany
| | - Gunther Schauberger
- Chair of Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Hans Hauner
- School of Medicine, Institute for Nutritional Medicine, Technical University of Munich, Munich, Germany
- ZIEL - Institute for Food & Health, Technical University of Munich, Freising, Germany
| | - Christina Holzapfel
- School of Medicine, Institute for Nutritional Medicine, Technical University of Munich, Munich, Germany
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Himmelstein MS, Puhl RM, Pearl RL, Pinto AM, Foster GD. Coping with Weight Stigma Among Adults in a Commercial Weight Management Sample. Int J Behav Med 2020; 27:576-590. [PMID: 32430784 DOI: 10.1007/s12529-020-09895-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Coping responses to weight stigma can adversely affect health. Using data from a large commercial weight management sample, this study examined how adults cope with weight stigma, relationships among experienced weight stigma, weight bias internalization, and coping, as well as coping strategies as mediators of the stigma-health relationship. METHOD Participants were adults enrolled in WW (formerly Weight Watchers) who reported at least one lifetime experience of weight stigma (N = 11,924). Participants completed questionnaires about the type and frequency of stigma experiences, weight bias internalization, strategies used to cope with weight stigma, and health-related quality of life. RESULTS Active coping, planning, positive reframing, acceptance, emotional support, and exercise avoidance were the most common coping strategies employed in response to acute weight stigma experiences. Weight bias internalization was more strongly associated with coping strategies likely to exacerbate health (e.g., disordered eating, substance use, self-blame) than positive reframing, acceptance, and emotional support. More types of experienced weight stigma (e.g., teasing, unfair treatment) were associated with more frequent use of all coping strategies. Coping strategies did not mediate the stigma-health relationship, and several strategies were associated with poor mental health. CONCLUSION More types of experiences with weight stigma were associated with more attempts to cope generally, while weight bias internalization was associated with coping strategies which were in turn associated with poor mental health. Developing effective approaches for identifying individuals likely to internalize weight stigma and helping individuals adopt effective coping strategies in response to stigma are important avenues of future research.
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Affiliation(s)
- Mary S Himmelstein
- Department of Psychological Sciences, Kent State University, PO Box 5190, Kent, OH, 44242-0001, USA.
| | - Rebecca M Puhl
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT, USA.,Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Rebecca L Pearl
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Angela M Pinto
- WW, New York, NY, USA.,Psychology Department, Baruch College, City University of New York, New York, NY, USA
| | - Gary D Foster
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,WW, New York, NY, USA
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Tanas R, Bernasconi S, Marsella M, Corsello G. What's the name? Weight stigma and the battle against obesity. Ital J Pediatr 2020; 46:60. [PMID: 32404121 PMCID: PMC7222505 DOI: 10.1186/s13052-020-00821-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 04/24/2020] [Indexed: 12/25/2022] Open
Abstract
Childhood obesity has spread worldwide, it is on the rise, starts earlier and is more severe, despite all treatment attempts. According to recent studies, weight stigma is a factor that can hinder the success of therapies. Healthcare workers, mainly paediatricians, need to feel the urgency of anti-stigma training. The use of non-stigmatizing terminologies and images in various areas (school, sports clubs, healthcare, media, society in general) can improve disease management.
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Affiliation(s)
- Rita Tanas
- Advisor of the Adolescence Study Group, Italian Pediatric Society, Ferrara, Italy.
| | | | - Maria Marsella
- UOC di Pediatria, Azienda Ospedaliera San G. Moscati, Avellino, Italy
| | - Giovanni Corsello
- Dipartimento di Scienze per la Promozione della Salute e Materno Infantile "G. D'Alessandro" Università, Palermo, Italy
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Pudney EV, Himmelstein MS, Puhl RM, Foster GD. Distressed or not distressed? A mixed methods examination of reactions to weight stigma and implications for emotional wellbeing and internalized weight bias. Soc Sci Med 2020; 249:112854. [PMID: 32097842 DOI: 10.1016/j.socscimed.2020.112854] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 02/11/2020] [Accepted: 02/12/2020] [Indexed: 12/22/2022]
Abstract
People react to, and are affected by, stigmatizing experiences in different ways. The current study examined different reactions to weight stigma to identify who may be vulnerable to lasting distress from these experiences. Using a mixed methods approach, this study compared qualitative descriptions of reactions to experiences of weight stigma in conjunction with quantitative measures of weight bias internalization (WBI) and other health indices. Data were collected from September 2017 to August 2018. Participants were U.S. adults enrolled in a commercial weight management program (n = 425, 96% female) who reported previous experiences of weight stigma (on quantitative measures), and who also qualitatively described feeling either no longer distressed (n = 178) or still distressed (n = 247) by those experiences. Qualitative analyses revealed that participants who were no longer distressed engaged in self-acceptance, were not concerned about other's evaluations of them, and prioritized health rather than appearance. Those who were still distressed from previous weight stigma experiences considered their body weight, and being stigmatized for it, as playing a prominent role in shaping their self-perception, they blamed themselves for experiencing the consequences of weight stigma, and ruminated on their memories of stigmatizing experiences. Hierarchical regressions demonstrated that participants who were still distressed reported greater WBI, greater perceived stress, and poorer mental health than participants who were no longer distressed. When adding WBI to the model predicting perceived stress, differences between participants who were no longer distressed versus still distressed attenuated and became statistically insignificant, suggesting that these qualitative reaction patterns to stigma may be related to participants' level of WBI. Given that some people may experience longer term distress from weight stigma than others, this study can inform interventions aimed to prevent or mitigate the negative consequences associated with being stigmatized.
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Affiliation(s)
- Ellen V Pudney
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA; Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford, CT, USA.
| | - Mary S Himmelstein
- Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford, CT, USA; Department of Psychological Sciences, Kent State University, USA
| | - Rebecca M Puhl
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA; Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford, CT, USA
| | - Gary D Foster
- WW (formerly Weight Watchers), New York, NY, USA; Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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