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Wu R, Puhl RM, Lessard LM, Foster GD, Cardel MI. Exploring the interplay of weight-based teasing and sociodemographic factors in adolescent weight bias internalization. J Pediatr Psychol 2024:jsae042. [PMID: 38853703 DOI: 10.1093/jpepsy/jsae042] [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: 02/23/2024] [Revised: 05/21/2024] [Accepted: 05/24/2024] [Indexed: 06/11/2024] Open
Abstract
OBJECTIVE Research has highlighted the potential adverse effects of weight bias internalization (WBI) on adolescents, but there has been little examination of WBI and sources of weight teasing (family, peers, or both) or across racial/ethnic diversity of adolescents. We aimed to examine the relationship between WBI and sources of weight teasing across sociodemographic characteristics and weight status in a diverse community sample of adolescents. METHODS Data were collected from a U.S. sample of 1859 adolescents aged 10-17 years (59% female; 43% White, 27% Black or African American, and 25% Latino). An online questionnaire was used to assess participants' experiences of weight teasing from family members, peers, or both, and their weight status, weight-related goals, WBI, and sociodemographic characteristics. RESULTS Adolescents experiencing weight teasing from both family and peers reported the highest levels of WBI, while those reporting no teasing exhibited the lowest levels. These patterns were observed across sex, race/ethnicity, weight status, and weight goals, and persisted after controlling for depressive symptoms. Notably, family influences played a salient role, with adolescents reporting higher WBI if teased by family only compared to teasing from peers only. Sex and racial differences were also observed in adolescents' experiences with weight-based teasing. CONCLUSION Our study reveals associations between adolescent weight-based teasing, WBI, and sociodemographic factors. Weight-based teasing, whether from family and peers or from family only, was associated with increased WBI. Interventions targeting weight stigma in youth should not be limited to peer-focused efforts, but should also emphasize supportive family communication.
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Affiliation(s)
- Rui Wu
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, United States
| | - Rebecca M Puhl
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, United States
- Rudd Center for Food Policy and Health, University of Connecticut, Hartford, CT, United States
| | - Leah M Lessard
- Rudd Center for Food Policy and Health, University of Connecticut, Hartford, CT, United States
| | - Gary D Foster
- WW International, Inc, New York, NY, United States
- Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Michelle I Cardel
- Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, United States
- Center for Integrative Cardiovascular and Metabolic Disease, University of Florida, Gainesville, FL, United States
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Nabors L, Fiser-Gregory K, Olaniyan A, Stanton-Chapman T, Merianos A. College students' attitudes about ways family, friends, significant others and media affect their eating and exercise behaviors and weight perceptions. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024; 72:1296-1308. [PMID: 35623042 DOI: 10.1080/07448481.2022.2076101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 04/06/2022] [Accepted: 05/06/2022] [Indexed: 06/15/2023]
Abstract
Objective: This study examined college students' perceptions of how parents, family, friends, significant others, and the media influenced eating and exercise behaviors and weight perceptions. Participants: Forty-one college students, mostly female, participated in interviews. Methods: A Grounded Theory approach, using open coding and memoing, was used to uncover key themes. Results: Healthy cooking and exercise role models at home were viewed as positive, encouraging healthy eating and exercise. Criticism was perceived as negative for healthy habits and weight perceptions. Friends and significant others who practiced positive health habits and were body accepting were uplifting. Cultural transmission of the thin ideal could occur through the media. Some noted that media messages were becoming more positive. Conclusions: Using peers, especially friends, as collaborators in interventions, and discussing parental influences on eating, exercise, and weight perceptions may positively impact obesity prevention programs and interventions for college students.
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Affiliation(s)
- L Nabors
- Health Promotion and Education, School of Human Services, College of Education, Criminal Justice and Human Services, University of Cincinnati, Cincinnati, Ohio, USA
| | - K Fiser-Gregory
- Health Promotion and Education, School of Human Services, College of Education, Criminal Justice and Human Services, University of Cincinnati, Cincinnati, Ohio, USA
| | - A Olaniyan
- Health Promotion and Education, School of Human Services, College of Education, Criminal Justice and Human Services, University of Cincinnati, Cincinnati, Ohio, USA
| | - T Stanton-Chapman
- Early Childhood Education and Human Development, School of Education, College of Education, Criminal Justice and Human Services, University of Cincinnati, Cincinnati, Ohio, USA
| | - A Merianos
- Health Promotion and Education, School of Human Services, College of Education, Criminal Justice and Human Services, University of Cincinnati, Cincinnati, Ohio, USA
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3
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Winograd D, Goldschmidt AB, Lydecker J. Associations among parents' internalized weight bias, negative child-focused body talk, and feeding behaviors. Eat Behav 2024; 52:101848. [PMID: 38308903 PMCID: PMC10922654 DOI: 10.1016/j.eatbeh.2024.101848] [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: 10/12/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/05/2024]
Abstract
OBJECTIVE Parents' negative body talk about children (negative weight/shape comments) and internalized weight bias (application of negative weight-based stereotypes to oneself) are associated with children's maladaptive eating behaviors, but mechanisms are poorly understood. Conceptually, parental behaviors and attitudes may translate to implicit and explicit concerns about their child's weight and influence parents' feeding practices. These associations are underexplored in the literature. METHOD 242 parents (59.4% mothers) completed a one-time assessment that included measures of internalized weight bias, negative body talk, and feeding practices. Parents also completed assessments about one of their children, of any weight status (age range 5-15 years; 40% daughters). RESULTS Parents' internalized weight bias was positively associated with concern about their child's weight and restriction of their child's diet. Parents' negative body talk towards their child was positively associated with concern about their child's weight and shape, restriction of their child's diet, and monitoring of their child's diet. Relative to internalized weight-bias, negative body talk had a stronger correlation with parents' concern about child weight and monitoring of child's diet. Correlations did not vary by child gender or weight category. DISCUSSION Parents' internalized weight bias and negative body talk about their child were associated with their feeding practices across child gender and weight categories, with correlations in the small to medium range. Thus, children of all genders and weights may be vulnerable to enacted weight bias. Future studies should examine whether addressing parents' internalized weight bias and communication in family-focused interventions improves feeding practices and child well-being.
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Affiliation(s)
- Dayna Winograd
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Andrea B Goldschmidt
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Janet Lydecker
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
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4
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Madsen M, Michaelsen L, DeCosta P, Grabowski D. Stigma-Generating Mechanisms in Families Enrolled in a Pediatric Weight Management Program: A Qualitative Study of Health Identities and Healthcare Authenticity. CHILDREN (BASEL, SWITZERLAND) 2023; 11:46. [PMID: 38255360 PMCID: PMC10813986 DOI: 10.3390/children11010046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/20/2023] [Accepted: 12/25/2023] [Indexed: 01/24/2024]
Abstract
In recent years, there has been increased awareness of obesity as a condition that carries a high level of stigma, as well as growing recognition of its prevalence and harm. Despite the increasing body of research on this topic, there is a gap in the literature regarding mechanisms that generate or exacerbate perceptions of weight stigma, especially within families and pediatric healthcare settings. The present study aims to identify potential stigma-generating mechanisms by focusing on inter-relational dynamics within these contexts. We conducted in-depth, semi-structured interviews with 11 families and analyzed the data by applying sociological theories on health identities and authenticity. Our study found four themes that represent potential stigma-generating mechanisms by being explicitly related to familial health identities and healthcare authenticity: (1) negotiating and reconstruction familial self-understanding, (2) between guilt, shame and conflicts, (3) navigating weight perceptions, and (4) the necessity of positivity and relevance. Our study shows the complexities of weight stigma within family and pediatric healthcare settings, emphasizing the need for sensitive and tailored support, as well as the value of working authentically as crucial aspects in preventing and/or reducing stigma.
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Affiliation(s)
- Mie Madsen
- Department of Prevention, Health Promotion and Community Care, Copenhagen University Hospital—Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark; (P.D.); (D.G.)
| | - Lene Michaelsen
- The Centre for Children and Youths Health, Mimersgade 47A, 2nd Floor, 2200 Copenhagen, Denmark;
| | - Patricia DeCosta
- Department of Prevention, Health Promotion and Community Care, Copenhagen University Hospital—Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark; (P.D.); (D.G.)
| | - Dan Grabowski
- Department of Prevention, Health Promotion and Community Care, Copenhagen University Hospital—Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark; (P.D.); (D.G.)
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5
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Świder K, Baska A, Babicki M, Mastalerz-Migas A, Kłoda K. Weight stigma and fat phobia in Poland - attitudes towards people living with obesity and the level of knowledge about obesity among the social media internet respondents and medical professionals. Front Nutr 2023; 10:1287783. [PMID: 37876616 PMCID: PMC10593449 DOI: 10.3389/fnut.2023.1287783] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 09/27/2023] [Indexed: 10/26/2023] Open
Abstract
Introduction Obesity often subjects individuals to stigmatization, impacting self-esteem, contributing to depression, social isolation, and even exacerbating weight gain. Our research aimed to evaluate weight stigma, fat phobia, their expressions, and obesity-related knowledge among social media internet respondents and medical practitioners in Poland. Methods Conducted through Computer-Assisted Web Interview (CAWI), our study employed the Fat Phobia Scale (FPS) and tailored questions, analyzing 1705 questionnaires. Results The respondents averaged a score of 3.60 ± 0.62 on the FPS. Interestingly, men exhibited higher stigma levels than women. Variables like BMI, residency, and interactions with people having obesity did not significantly impact stigma levels. Approximately 74.0% of respondents found individuals with obesity less attractive than those with normal weight, while 32.2% identified obesity as a cause of shame. Only 69.1% were aware of the BMI-based obesity diagnosis criterion. Conclusion Given limited knowledge of Poland's weight stigma landscape, our research yields crucial insights for shaping social campaigns and enhancing educational initiatives in obesity management for healthcare professionals. Further studies will be instrumental in addressing patient and practitioner needs effectively.
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Affiliation(s)
| | - Alicja Baska
- Department of Lifestyle Medicine, School of Public Health, Centre of Postgraduate Medical Education, Warsaw, Poland
- Polish Society of Lifestyle Medicine, Warsaw, Poland
| | - Mateusz Babicki
- Department of Family Medicine, Wroclaw Medical University, Wroclaw, Poland
- Head of the Scientific Section of the Polish Society of Family Medicine, Wroclaw, Poland
| | | | - Karolina Kłoda
- Head of the Scientific Section of the Polish Society of Family Medicine, Wroclaw, Poland
- MEDFIT Karolina Kłoda, Szczecin, Poland
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Bensley J, Riley HO, Bauer KW, Miller AL. Weight bias among children and parents during very early childhood: A scoping review of the literature. Appetite 2023; 183:106461. [PMID: 36642116 DOI: 10.1016/j.appet.2023.106461] [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: 07/28/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Exposure to and endorsement of weight bias attitudes are risk factors for poor mental health and weight-related outcomes among children and youth. Better understanding early-emerging weight bias, and how parents of young children may influence development of weight bias, may help reduce its occurrence. Although early childhood (under 5 years) is a developmental period characterized by increasing social-cognitive abilities to categorize others based on external features such as weight, little is known about the emergence or socialization of very early weight bias. The aim of this review was therefore to investigate weight bias and its correlates among very young children and parents of very young children as potential socialization agents. METHODS A comprehensive search strategy was used to search electronic databases for studies that examined weight bias attitudes among children and parents. The review included studies that assessed weight bias in children and/or parents of children ages 1-3 years old (some including 3-5 year-olds), and that were published in English between 2011 and 2021. RESULTS Thirteen of the 1748 identified studies met inclusion criteria. Only two studies used a longitudinal design. Seven of eight studies of children used behavioral tasks to assess child weight bias; among the 10 studies including parents, 4 used interviews and 6 used questionnaires to assess parent weight bias. Children were found to display anti-fat and pro-thin bias, with bias more prevalent among older children. Positive associations between parent and child weight bias were found in four studies. CONCLUSIONS Child weight bias emerges prior to age 3 years and shows some association with parent weight bias. Future research should employ longitudinal designs to characterize influences on emerging weight bias among very young children.
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Affiliation(s)
- Jackson Bensley
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Hurley O Riley
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Katherine W Bauer
- Department of Nutritional Sciences, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Alison L Miller
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.
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7
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Förster LJ, Vogel M, Stein R, Hilbert A, Breinker JL, Böttcher M, Kiess W, Poulain T. Mental health in children and adolescents with overweight or obesity. BMC Public Health 2023; 23:135. [PMID: 36658514 PMCID: PMC9849834 DOI: 10.1186/s12889-023-15032-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 01/11/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Overweight and obesity represent huge concerns for children's physical and mental well-being. This study examined the relationship between body mass index (BMI) and health-related quality of life (HRQoL), somatoform complaints, and behavioral problems in children and adolescents. Additionally, the influence of sex, age, and socioeconomic status (SES) on these associations was considered. METHODS In total, we studied 2350 participants between the ages of 4 and 18 years (1213 4- to 10-years-old (child sample) and 1137 11-to 18-year-olds (adolescent sample)). To assess HRQoL, somatoform complaints, and behavioral difficulties, we applied the KIDSCREEN-27, a short form of the Giessen Complaints Questionnaire, and the Strengths and Difficulties Questionnaire (SDQ). The BMI was transformed to BMI standard deviation scores (BMI-SDS), according to German gender- and age-specific reference data. Associations were investigated using linear regression analyses. Each association was checked for interaction with sex, age, and SES. RESULTS Regarding HRQoL, we found worsening scores in physical well-being and psychological well-being with increasing BMI-SDS. Somatoform complaints were not significantly associated with BMI-SDS. Conduct problems, peer relationship problems, and emotional problems (the latter only in the adolescent sample) were positively associated with BMI-SDS. While we did not observe any significant interactions with sex, we found some significant interactions with age and/or SES. CONCLUSION Our findings highlight the importance of mental difficulties in children and adolescents with higher BMI and, consequently, underline the relevance of including psychological interventions in the treatment of overweight or obesity.
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Affiliation(s)
- Lucas-Johann Förster
- LIFE Leipzig Research Center for Civilization Diseases, Leipzig University, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany. .,Department of Women and Child Health, University Hospital for Children and Adolescents and Center for Pediatric Research, Leipzig University, Liebigstrasse 20a, 04103, Leipzig, Germany.
| | - Mandy Vogel
- grid.9647.c0000 0004 7669 9786LIFE Leipzig Research Center for Civilization Diseases, Leipzig University, Philipp-Rosenthal-Strasse 27, 04103 Leipzig, Germany ,grid.9647.c0000 0004 7669 9786Department of Women and Child Health, University Hospital for Children and Adolescents and Center for Pediatric Research, Leipzig University, Liebigstrasse 20a, 04103 Leipzig, Germany
| | - Robert Stein
- grid.9647.c0000 0004 7669 9786Department of Women and Child Health, University Hospital for Children and Adolescents and Center for Pediatric Research, Leipzig University, Liebigstrasse 20a, 04103 Leipzig, Germany ,grid.411339.d0000 0000 8517 9062Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Zentrum München at the University of Leipzig and University Hospital Leipzig, Leipzig, Germany
| | - Anja Hilbert
- grid.9647.c0000 0004 7669 9786Department of Psychosomatic Medicine and Psychotherapy, Behavioral Medicine Research Unit, Integrated Research and Treatment Center Adiposity Diseases, University of Leipzig Medical Center, Stephanstrasse 9a, 04103 Leipzig, Germany
| | - Julius Lars Breinker
- grid.9647.c0000 0004 7669 9786Department of Psychosomatic Medicine and Psychotherapy, Behavioral Medicine Research Unit, Integrated Research and Treatment Center Adiposity Diseases, University of Leipzig Medical Center, Stephanstrasse 9a, 04103 Leipzig, Germany
| | - Marleen Böttcher
- grid.9647.c0000 0004 7669 9786Department of Women and Child Health, University Hospital for Children and Adolescents and Center for Pediatric Research, Leipzig University, Liebigstrasse 20a, 04103 Leipzig, Germany
| | - Wieland Kiess
- grid.9647.c0000 0004 7669 9786LIFE Leipzig Research Center for Civilization Diseases, Leipzig University, Philipp-Rosenthal-Strasse 27, 04103 Leipzig, Germany ,grid.9647.c0000 0004 7669 9786Department of Women and Child Health, University Hospital for Children and Adolescents and Center for Pediatric Research, Leipzig University, Liebigstrasse 20a, 04103 Leipzig, Germany
| | - Tanja Poulain
- grid.9647.c0000 0004 7669 9786LIFE Leipzig Research Center for Civilization Diseases, Leipzig University, Philipp-Rosenthal-Strasse 27, 04103 Leipzig, Germany ,grid.9647.c0000 0004 7669 9786Department of Women and Child Health, University Hospital for Children and Adolescents and Center for Pediatric Research, Leipzig University, Liebigstrasse 20a, 04103 Leipzig, Germany
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8
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Puhl RM, Lessard LM, Foster GD, Cardel MI. Patient and Family Perspectives on Terms for Obesity. Pediatrics 2022; 150:190093. [PMID: 36404759 DOI: 10.1542/peds.2022-058204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/15/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Parent communication about body weight is a sensitive topic, but limited research has studied youth preferences for words used to talk about their weight with parents. We assessed perspectives of weight-based terminology in 2 racially/ethnically diverse samples of youth and parents. METHODS We collected online survey data from 2 panel survey samples between September and December 2021: youth aged 10 to 17 years (n = 2032) and parents of youth aged 10 to 17 years (n = 1936). Participants rated 27 different terms and phrases to describe body weight; parents reported on their usage of this terminology and youth reported their preferences for and emotional responses to terminology. Patterns were examined across sex, race/ethnicity, sexual orientation, and weight status. RESULTS Youth reported preferences for words such as "healthy weight" and dislike of terms such as "obese," "fat," and "large," which induced feelings of sadness, shame, and embarrassment. Differences in youth preferences and emotional reactions were present across sex, sexual orientation, race/ethnicity, and weight status. This included a general pattern of lower preference ratings among girls (versus boys) and sexual minority (versus heterosexual) youth, and stronger preferences for words such as "thick" or "curvy" among racial/ethnic minority, sexual minority, and higher-weight youth. Use of most weight terms was higher among fathers compared with mothers, and by Hispanic/Latinx parents compared with white and Black/African American parents. CONCLUSIONS Our findings underscore diversity of youth preferences and the need for individualized approaches that support effective parent and youth communication by using their preferred terms when discussing weight-related health.
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Affiliation(s)
- Rebecca M Puhl
- Rudd Center for Food Policy & Health, University of Connecticut, Hartford, Connecticut.,Department of Human Development & Family Sciences, University of Connecticut, Storrs, Connecticut
| | - Leah M Lessard
- Department of Human Development & Family Sciences, University of Connecticut, Storrs, Connecticut
| | - Gary D Foster
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,WW International, Inc, New York, New York
| | - Michelle I Cardel
- WW International, Inc, New York, New York.,Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida
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9
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Decker KM, Philip SR, Thurston IB. Measuring weight- and shape-based social identity threat vulnerability in young adults. Body Image 2022; 42:136-144. [PMID: 35714420 DOI: 10.1016/j.bodyim.2022.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 06/03/2022] [Accepted: 06/04/2022] [Indexed: 11/26/2022]
Abstract
This study assessed the factor structure of a novel self-report measure of weight- and shape-based social identity threat vulnerability, Social Identities and Attitudes Scale-Weight and Body Shape (SIAS-WBS). Weight and race diverse young adults (N = 542; Mage=21.69 +2.32; 69% ciswomen) were recruited from Amazon Mechanical Turk and a university participant pool. Exploratory and confirmatory factor analyses, measurement invariance, internal consistency, convergent validity, and test-retest reliability were conducted. The SIAS-WBS had acceptable factor structure with 15 subscales that were invariant across race, ethnicity, gender, weight perception, and CDC-defined weight groups. The measure demonstrated high internal consistency, convergent validity, and good test-retest reliability. Subscales were Weight & Shape Identification (Influence and Centrality), Weight & Shape Stigma Consciousness, six identification and six negative affect factors across the domains of: Social, Familial, Romantic, Intellectual, Physical Activity, and Physical Attractiveness. Participants in higher weight groups who perceived themselves as lower weight status, reported lower Weight & Shape Identification-Influence (p = 0.02) and lower Stigma Consciousness (p = 0.01), relative to those perceiving themselves as higher weight status. Participants perceiving themselves as higher weight status endorsed lower Physical Activity Identification (p < 0.001) and more negative affect across all domains (p's < 0.02). This suggests that weight misperceivers may be less susceptible to weight-based identity threat.
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Affiliation(s)
- Kristina M Decker
- Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Samantha R Philip
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, USA
| | - Idia B Thurston
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, USA; Department of Health Promotion and Community Health Sciences, Texas A&M Health, College Station, TX, USA; Department of Psychology, The University of Memphis, Memphis, TN, USA
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10
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Baile JI, González-Calderón MJ, Rabito-Alcón MF. Obesity Bias in the School Setting: A Brief Report. CHILDREN 2022; 9:children9071067. [PMID: 35884051 PMCID: PMC9322516 DOI: 10.3390/children9071067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/11/2022] [Accepted: 07/15/2022] [Indexed: 12/05/2022]
Abstract
Obesity bias is one of the main psychosocial consequences experienced by people who are overweight and people with obesity. Therefore, its study, especially during childhood, has become an emerging objective. The aim of this study is to examine obesity bias in children in the school setting. In total, 171 primary school students (Mean age: 10.68; SD: 0.63) from a school in Madrid (Spain) filled out a survey in which they indicated whether they would choose a classmate with obesity with whom they would carry out academic, social, and leisure activities. The rejection ratios of peers with obesity and other personal characteristics such as gender, nationality, or ethnicity were compared. The results indicate that more than half of the participants would not choose a partner with obesity to carry out any of the three activities suggested, and that obesity was the personal characteristic that elicited the highest rate of rejection, especially among females. The possible explanations for these findings are discussed, as well as why the school setting should be a nonaggressive but protective environment for children with obesity.
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Abstract
ABSTRACT Weight stigma is the devaluation of a person because of excess body weight. Individuals who experience stigmatization are at increased risk for adverse physical and psychological health outcomes. This article provides an overview of weight stigma and the implications for nursing practice and policy.
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Affiliation(s)
- Karyn J Roberts
- Karyn J. Roberts is an adjunct assistant professor at Northwestern University Feinberg School of Medicine-Department of Pediatrics in Chicago, Ill. and a clinical assistant professor at the University of Wisconsin-Milwaukee (UW-Milwaukee) College of Nursing in Milwaukee, Wis., where Michele L. Polfuss is an associate professor. She's also the Joint Research Chair in the Nursing of Children at UW-Milwaukee and Children's Hospital of Wisconsin
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12
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Busetto L, Sbraccia P, Vettor R. Obesity management: at the forefront against disease stigma and therapeutic inertia. Eat Weight Disord 2022; 27:761-768. [PMID: 34052990 PMCID: PMC8933346 DOI: 10.1007/s40519-021-01217-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 05/17/2021] [Indexed: 12/12/2022] Open
Abstract
Obesity is a complex chronic relapsing disease, resulting from the interaction between multiple environmental, genetic and epigenetic causes, and supported by changes in the neuroendocrine mechanisms regulating energy balance and body weight. Adipose tissue dysfunction contributes to obesity-related complications. However, the prevalent narrative about the causes and mechanisms of obesity remains a much more simplistic one, based on the false assumption that individuals can fully control their body weight through appropriate behavioural choices. According to this narrative, obesity is simply reversible "persuading" the patient to follow healthier and more virtuous individual behaviours (moral judgement). This persistent narrative forms the deep root of the stigmatisation of people with obesity at the individual level and creates a clear discrepancy on how obesity prevention and cure are designed in comparison with the case of other non-communicable chronic diseases (clinical stigma). The promotion of systemic preventive measures against obesity is not supported at a political and social level by the persistence of a narrative of obesity as the simple consequence of individual failures and lack of willpower. The simplistic narrative of obesity as a self-imposed condition with an easy way-out ("eat less and move more") creates a clear discrepancy on how obesity is managed by health care systems in comparison with other NCDs. The over-estimation of the efficacy of therapeutic intervention solely based on patients education and lifestyle modification is responsible of therapeutic inertia in health care professionals and in clinical guidelines, limiting or delaying the adoption of more effective therapeutic strategies, like anti-obesity medications and bariatric surgery. In conclusion, the persistence of a narrative describing obesity as a self-induced easily reversible condition has profound consequences on how obesity prevention and management are build, including the design and implementation of obesity management guidelines and a tendency to therapeutic inertia.Level of evidence: No level of evidence.
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Affiliation(s)
- Luca Busetto
- Department of Medicine, University of Padova, Padua, Italy.
- Clinica Medica 3, Azienda Ospedale-Università di Padova, Via Giustiniani 2, 35128, Padua, Italy.
| | - Paolo Sbraccia
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Roberto Vettor
- Department of Medicine, University of Padova, Padua, Italy
- Clinica Medica 3, Azienda Ospedale-Università di Padova, Via Giustiniani 2, 35128, Padua, Italy
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13
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Robertson MDA, Dempster S, Doherty L, Sharpe H. Exploring the association between parental anti-fat attitudes and restrictive feeding practices in a British and Irish sample. Appetite 2021; 168:105755. [PMID: 34648909 DOI: 10.1016/j.appet.2021.105755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 09/30/2021] [Accepted: 10/09/2021] [Indexed: 12/22/2022]
Abstract
Parental restriction of food intake has been associated with heightened eating disorder psychopathology in some longitudinal research. Yet, relatively little is known about the determinants of restrictive feeding practices. This cross-sectional study explored the association between parents' anti-fat attitudes and their use of restrictive feeding practices in a mixed British (41.10% England, 39.90% Scotland, 4.20% Other) and Irish (14.80%) sample. Parents and caregivers (N = 472; 94.10% female; 70.90% university level education) of children between the ages of 4-8 (48.20% female; 91.10% rated as "normal weight" by their parents) completed self-report questionnaires assessing their anti-fat attitudes (dislike, fear, and blame subscales), use of restrictive feeding practices (for weight control, health purposes, and covert restriction), and how influential their child's body-weight and -shape is for their perception of themselves as parents. Overall, our hypothesis that parental anti-fat attitudes would be significantly associated with restrictive feeding practices was supported. Anti-fat attitudes related to disliking higher body-weight people and blaming parents for their child's weight were significant predictors of all forms of restrictive feeding (all ps < .05). However, anti-fat attitudes related to fearing being a higher body-weight were not significant predictors of restrictive feeding for the purposes of health nor for covert restriction (ps > .05). Additionally, our hypothesis that the associations between anti-fat attitudes and restrictive feeding practices would be stronger for parents for whom their child's body-weight and -shape more strongly influenced how they judged themselves as parents was not supported (the interaction term was not significant in two out of three analyses). Future research is needed to investigate these associations across time and in samples of higher body-weight children.
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Affiliation(s)
- MacKenzie D A Robertson
- School of Health in Social Science, University of Edinburgh, Teviot Place, EH8 9AG, Edinburgh, UK.
| | - Sarah Dempster
- School of Health in Social Science, University of Edinburgh, Teviot Place, EH8 9AG, Edinburgh, UK
| | - Lauren Doherty
- School of Health in Social Science, University of Edinburgh, Teviot Place, EH8 9AG, Edinburgh, UK
| | - Helen Sharpe
- School of Health in Social Science, University of Edinburgh, Teviot Place, EH8 9AG, Edinburgh, UK
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14
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Roberts KJ, Polfuss ML, Marston EC, Davis RL. Experiences of weight stigma in adolescents with severe obesity and their families. J Adv Nurs 2021; 77:4184-4194. [PMID: 34435701 DOI: 10.1111/jan.15012] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/05/2021] [Accepted: 07/29/2021] [Indexed: 01/25/2023]
Abstract
AIM To describe the experiences of weight stigma in adolescents with severe obesity and their parents. DESIGN Qualitative descriptive secondary analysis. METHODS A secondary analysis on 31 transcripts from a larger study of 46 transcripts conducted between February 2019 and June 2020. Semi-structured interviews were conducted with 19 parents (n = 17 mothers, n = 2 fathers) and 12 adolescents (n = 7 male, n = 5 female). Interviews were digitally audio recorded, transcribed and analysed using conventional content analysis. RESULTS Four common themes were identified reflecting experiences of weight stigma: weight-based teasing and bullying, interactions with healthcare providers (HCPs), family interactions and blame. Subthemes were fairness and impact on mental health. CONCLUSION This secondary analysis adds to the sparse literature documenting the experiences of weight stigma from adolescents with severe obesity and their families. It is important to understand the experiences of weight stigma from the adolescent and parent perspective as it can inform healthcare, education and policies across communities and facilitate holistic health for this vulnerable population. IMPACT The need for research to better understand how experiences of weight stigma correlate with physiological and psychological outcomes and inform innovative interventions are critical to improve treatment of severe obesity. Healthcare providers across disciplines are in a strategic position to change the paradigm through which we provide care to youth with severe obesity and guide families in supporting their children's weight management efforts without contributing to weight stigma.
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Affiliation(s)
- Karyn J Roberts
- University of Wisconsin-Milwaukee College of Nursing, Milwaukee, Wisconsin, USA
| | - Michele L Polfuss
- University of Wisconsin-Milwaukee College of Nursing, Milwaukee, Wisconsin, USA
| | - Emma C Marston
- University of Wisconsin-Milwaukee College of Nursing, Milwaukee, Wisconsin, USA
| | - Renée L Davis
- Saint Louis University Trudy Busch Valentine School of Nursing, Saint Louis, Missouri, USA
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15
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Hart E, Tan CC, Chow CM. Anti-fat attitudes and dietary restraint within mother-daughter dyads: an Actor-Partner Interdependence Model (APIM) analysis. Eat Weight Disord 2021; 26:1417-1426. [PMID: 32596761 DOI: 10.1007/s40519-020-00949-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 06/20/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE This study examined the association between anti-fat attitudes (fear of fat, dislike of fat, willpower) and dietary restraint within the mother-daughter relationship. METHODS Mother-adolescent daughter dyads (Npairs = 100) were recruited from a Midwestern community to participate in a study together. They completed self-report measures of anti-fat attitudes and eating behavior. Data were analyzed with an Actor-Partner Interdependence Model (APIM). RESULTS Significant actor effects for mothers include fear of fat (b = 0.270, B = 0.319, p < 0.05) and willpower (b = 0.228, B = 0.280, p < 0.05) predicting her own dietary restraint. For daughters, fear of fat (b = 0.554, B = 0.612, p < 0.05) and dislike (b = 0.202, B = 0.214, p < 0.05) predict her own dietary restraint. Regarding partner effects, mothers' fear of fat was related to daughters' dietary restraint (b = 0.126, B = 0.138, p < 0.05), and daughters' dislike was related to mothers' restraint (b = 0.257, B = 0.294, p < 0.05). Regarding dyad-level interaction effects, mother and daughter fear of fat interacted to predict daughter dietary restraint (b = 0.184, B = 0.201, p < 0.05), such that when both mother and daughter fear of fat is high, daughters appear to engage in more dietary restraint. CONCLUSIONS Given the role of mothers' fear of fat in daughter eating behavior, parent-focused or parent-involved interventions may improve family culture around weight and eating, contributing to better adolescent outcomes. LEVEL OF EVIDENCE V, cross-sectional descriptive study.
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Affiliation(s)
- Ellen Hart
- Eastern Michigan University, Ypsilanti, MI, USA.
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16
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Fan CW, Liu CH, Huang HH, Lin CY, Pakpour AH. Weight Stigma Model on Quality of Life Among Children in Hong Kong: A Cross-Sectional Modeling Study. Front Psychol 2021; 12:629786. [PMID: 33967895 PMCID: PMC8100454 DOI: 10.3389/fpsyg.2021.629786] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/12/2021] [Indexed: 11/14/2022] Open
Abstract
We proposed a model to examine the relationship among different types of weight-related stigmas and their relationship to quality of life (QoL). We recruited 430 dyads of elementary school children [mean age = 10.07 years; nboy = 241 (56.0%); noverweight = 138 (32.1%)] and their parents. Parents completed QoL instruments about their children assessing generic QoL and weight-related QoL. Children completed QoL instruments assessing generic QoL and weight-related QoL and stigma scales assessing experienced weight stigma, weight-related self-stigma, and perceived weight stigma. Experienced weight stigma was significantly associated with perceived weight stigma, and in turn, perceived weight stigma was significantly associated with weight-related self-stigma. However, experienced weight stigma was not directly associated with weight-related self-stigma. In addition, experienced stigma was negatively associated with both child-rated and parent-rated QoL. Perceived weight stigma was associated only with parent-rated weight-related QoL but not child-rated QoL. Self-stigma was associated with child-rated QoL but not parent-rated QoL. Moreover, perceived weight stigma and weight-related self-stigma were significant mediators in the association between body weight and children's QoL; experienced weight stigma was not a significant mediator. The study findings can be used to inform healthcare providers about the relationship among different types of stigmas and their influence on child-rated and parent-rated QoL and help them develop interventions to address the global trend of overweight/obesity in youth and pediatric populations.
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Affiliation(s)
- Chia-Wei Fan
- Department of Occupational Therapy, AdventHealth University, Orlando, FL, United States
| | - Chieh-Hsiu Liu
- National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hsin-Hsiung Huang
- Department of Statistics and Data Science, University of Central Florida, Orlando, FL, United States
| | - Chung-Ying Lin
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Public Health, National Cheng Kung University Hospital, College of Medicien, National Cheng Kung University, Tainan, Taiwan.,Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Amir H Pakpour
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.,Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
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17
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Siegel JA, Ramseyer Winter V, Cook M. "It really presents a struggle for females, especially my little girl": Exploring fathers' experiences discussing body image with their young daughters. Body Image 2021; 36:84-94. [PMID: 33217716 DOI: 10.1016/j.bodyim.2020.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 11/02/2020] [Accepted: 11/02/2020] [Indexed: 10/22/2022]
Abstract
Body dissatisfaction in children, particularly young girls, is a growing concern around the world. The home environment can have a strong influence on children's well-being, and parents may contribute to their children's positive or negative body image development. Nearly all research on parent influence on body image has focused on mothers, leaving fathers' attitudes and experiences poorly-understood. To address this gap in the literature, we interviewed 30 fathers (Mage = 40.30; SD = 7.48) of girls between the ages of 5 and 10 about the conversations they have with their daughters regarding body image. Through thematic analysis, we identified three primary themes: barriers to effective communication, combatting negative influences, and strategies for discussing body image. Fathers recognized the importance of talking about body image with their daughters, yet many did not feel confident or competent to do so effectively. They engaged in a variety of strategies to combat adverse cultural influences and encourage self-expression, character development, and mental and physical health in their daughters. However, messages about health were sometimes conflated with messages about thinness or food restriction. Implications for families and future research are discussed.
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Affiliation(s)
- Jaclyn A Siegel
- Western University, Department of Psychology, 1151 Richmond Street, London, Ontario, Canada, N6A 3K7.
| | - Virginia Ramseyer Winter
- University of Missouri, School of Social Work, Clark Hall 729, Columbia, MO, 65211, United States.
| | - Mackenzie Cook
- University of Missouri, School of Social Work, Clark Hall 729, Columbia, MO, 65211, United States.
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18
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Skelton JA, Woolford SJ, Skinner A, Barlow SE, Hampl SE, Lazorick S, Armstrong S. Weight Management without Stigma or Harm: A Roundtable Discussion with Childhood Obesity Experts. Child Obes 2021; 17:79-85. [PMID: 33728995 DOI: 10.1089/chi.2021.29010.roundtable] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Joseph A Skelton
- Professor, Department of Pediatrics, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Brenner FIT® (Families in Training), Brenner Children's Hospital, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Susan J Woolford
- Associate Professor, Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Asheley Skinner
- Professor, Duke University Population Health Sciences, Durham, NC, USA
| | - Sarah E Barlow
- Professor of Pediatrics, Division of Gastroenterology, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Director of Children's Health Integrated Program in Childhood Obesity, Dallas, TX, USA
| | - Sarah E Hampl
- General Academic Pediatrics and Weight Management, Center for Children's Healthy Lifestyles & Nutrition, Children's Mercy Kansas City, Kansas City, MO, USA.,Professor of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Suzanne Lazorick
- Professor, Departments of Pediatrics and Public Health, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Sarah Armstrong
- Professor of Pediatrics and Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
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19
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Fields LC, Brown C, Skelton JA, Cain KS, Cohen GM. Internalized Weight Bias, Teasing, and Self-Esteem in Children with Overweight or Obesity. Child Obes 2021; 17:43-50. [PMID: 33351706 PMCID: PMC7815063 DOI: 10.1089/chi.2020.0150] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: Although 2/3 of US adults and nearly 1/3 of US children have overweight or obesity, weight stigma is common. Many with overweight or obesity ascribe negative ideas to themselves, resulting in internalized weight bias (IWB). In adults, IWB has been associated with psychosocial problems; however, this relationship has been studied little in children. This study aims to describe IWB in children with overweight and obesity and to study the association of children's IWB with experienced weight bias, self-esteem, and their parents' IWB. Methods: Children ages 9-18 with overweight or obesity completed the Weight Bias Internalization Scale (WBIS), Rosenberg Self-Esteem Scale, and Perception of Teasing Scale; parents completed the Weight Bias Internalization Scale-Modified and the Perceived Weight Discrimination Scale. Descriptive statistics were used to assess IWB, self-esteem, and experienced weight stigma. Chi-square and t-tests were used to examine associations between categorical and continuous variables, respectively. Multivariate linear regression was used to identify correlates of IWB in children. Results: Of 111 child participants, the median WBIS score was 2.8 out of 7. Higher IWB was associated with more peer teasing (p < 0.001) and lower self-esteem (p < 0.001). IWB in children was not associated with child BMI z-score (p = 0.590) or higher parent IWB (p = 0.287). Conclusions: Children with overweight and obesity who have experienced more teasing by peers or who have lower self-esteem are more likely to have a higher IWB. However, increasing child BMI z-score and parent IWB are not associated with higher child IWB.
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Affiliation(s)
- Lauren C. Fields
- Bowman Gray Center, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Callie Brown
- Department of Pediatrics, and Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Brenner FIT (Families in Training) Program, Brenner Children's Hospital, Winston-Salem, NC, USA
- Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Joseph A. Skelton
- Department of Pediatrics, and Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Brenner FIT (Families in Training) Program, Brenner Children's Hospital, Winston-Salem, NC, USA
- Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Kathryn S. Cain
- Bowman Gray Center, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Gail M. Cohen
- Department of Pediatrics, and Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Brenner FIT (Families in Training) Program, Brenner Children's Hospital, Winston-Salem, NC, USA
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20
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Puhl RM, Lessard LM. Weight Stigma in Youth: Prevalence, Consequences, and Considerations for Clinical Practice. Curr Obes Rep 2020; 9:402-411. [PMID: 33079337 DOI: 10.1007/s13679-020-00408-8] [Citation(s) in RCA: 112] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2020] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW This review summarizes recent evidence on weight stigma experienced by youth with overweight or obesity. We examine the prevalence and sources of weight-based victimization targeting youth, consequences of these stigmatizing experiences for their psychological and physical health, and considerations for addressing weight stigma in clinical practice and pediatric care. RECENT FINDINGS Weight stigma is highly prevalent among youth with high body weight, who are targets of weight-based victimization from peers, parents, and teachers. These experiences place youth at risk for psychological distress (primarily depressive symptoms, low self-esteem, and suicidal ideation), worse social and academic outcomes, and adverse physical health consequences including maladaptive eating behaviors, lower physical activity, substance use, and weight gain. Healthcare professionals and clinicians have important roles to play in efforts to help reduce weight stigma and support youth with obesity. Fundamental to these efforts is the use of supportive, compassionate, and non-stigmatizing communication with youth and their families.
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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, One Constitution Plaza, Suite 600, Hartford, CT, 0610, USA.
| | - Leah M Lessard
- Rudd Center for Food Policy and Obesity, University of Connecticut, One Constitution Plaza, Suite 600, Hartford, CT, 0610, USA
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21
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Gallucci A, Del Mauro L, Pisoni A, Lauro LJR, Mattavelli G. A Systematic Review Of Implicit Attitudes And Their Neural Correlates In Eating Behaviour. Soc Cogn Affect Neurosci 2020; 18:nsaa156. [PMID: 33219691 PMCID: PMC10074774 DOI: 10.1093/scan/nsaa156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 09/17/2020] [Accepted: 11/20/2020] [Indexed: 12/15/2022] Open
Abstract
An increasing number of studies suggests that implicit attitudes toward food and body shape predict eating behaviour and characterize patients with eating disorders (EDs). However, literature has not been previously analysed, thus differences between patients with EDs and healthy controls and the level of automaticity of the processes involved in implicit attitudes are still matters of debate. The present systematic review aimed to synthetize current evidence from papers investigating implicit attitudes towards food and body in healthy and EDs populations. PubMed, EMBASE (Ovid), PsycINFO, Web of Science and Scopus were systematically screened and 183 studies using different indirect paradigms were included in the qualitative analysis. The majority of studies reported negative attitudes towards overweight/obese body images in healthy and EDs samples and weight bias as a diffuse stereotypical evaluation. Implicit food attitudes are consistently reported as valid predictors of eating behaviour. Few studies on the neurobiological correlates showed neurostimulation effects on implicit attitudes, but the automaticity at brain level of implicit evaluations remains an open area of research. In conclusion, implicit attitudes are relevant measures of eating behaviour in healthy and clinical settings, although evidence about their neural correlates is limited.
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Affiliation(s)
- Alessia Gallucci
- Ph.D. Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Via Cadore, 48--20900, Monza, Italy
- NeuroMi (Neuroscience Center), University of Milano-Bicocca, Piazza dell'Ateneo Nuovo, 1--20126, Milan, Italy
| | - Lilia Del Mauro
- Department of Psychology, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo, 1--20126, Milan, Italy
| | - Alberto Pisoni
- NeuroMi (Neuroscience Center), University of Milano-Bicocca, Piazza dell'Ateneo Nuovo, 1--20126, Milan, Italy
- Department of Psychology, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo, 1--20126, Milan, Italy
| | - Leonor J Romero Lauro
- NeuroMi (Neuroscience Center), University of Milano-Bicocca, Piazza dell'Ateneo Nuovo, 1--20126, Milan, Italy
- Department of Psychology, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo, 1--20126, Milan, Italy
| | - Giulia Mattavelli
- NETS, School of Advanced Studies, IUSS, Piazza della Vittoria n.15, 27100, Pavia, Italy
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22
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Hutchison SM, Müller U. What's Mom and Dad Got to Do With It? Factors Related Between Mothers', Fathers', and Young Children's Weight Bias. The Journal of Genetic Psychology 2020; 181:506-512. [PMID: 32811348 DOI: 10.1080/00221325.2020.1808566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Our aim was to examine the role of parents in the transmission of weight bias to young children. Specifically, we assessed mothers' and fathers' weight bias and beliefs about the controllability of weight, and fear of fat in relation to their children's weight bias. Eighty-three mothers, 57 fathers, and their children (4- to 7-year-olds) participated. We failed to find any significant associations between children's weight bias, maternal responses, and most paternal responses. Only fathers' dislike of adults with overweight had daughters with more positive views of overweight figures. These results suggest that parents do not appear to contribute to the weight bias of preschoolers and their influence may only emerge in middle childhood. The present study also suggests that more work on the psychometric properties of weight bias scales and tasks to measure weight bias in children is vital to accurately evaluate interventions to decrease weight bias.
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Affiliation(s)
- Sarah M Hutchison
- Department of Psychology, University of Victoria, Victoria, BC, Canada
| | - Ulrich Müller
- Department of Psychology, University of Victoria, Victoria, BC, Canada
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23
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Tas D, Tüzün Z, Düzçeker Y, Akgül S, Kanbur N. The effects of parental and peer factors on psychiatric symptoms in adolescents with obesity. Eat Weight Disord 2020; 25:617-625. [PMID: 30806924 DOI: 10.1007/s40519-019-00660-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 02/19/2019] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The aim of this study was to examine the relationships among psychiatric symptoms, effect of beliefs and attitudes of parents about obese people and victimization or bullying in obese adolescents. METHODS The study group included 110 obese or overweight adolescents and 55 adolescents of normal weight as the control group. All adolescents completed the Brief Symptom Inventory (BSI) and Traditional Bullying Scale. The parents completed the Attitudes Toward Obese Persons (ATOP) Scale and Beliefs About Obese Persons (BAOP) Scale. RESULTS The BSI subscale scores for depression were significantly higher in the study group. There was no significant relationship found between psychiatric symptoms of obese or overweight adolescents and the ATOP and BAOP scores of parents. When victims, bullies/victims, bullies and those not included in any group among obese or overweight adolescents were examined, psychiatric symptoms of victims and bullies/victims were significantly higher. CONCLUSIONS The results of this study suggest that the clinical treatment of obesity is not just a matter of diet and exercise but additionally dealing with issues of depression and anxiety. A very satisfactory result of the study was that parents of obese or overweight adolescents did not show an increased weight bias. This study has also shown the association between negative social and psychological ramifications, as the study group was more likely to be the victims and perpetrators of bullying behaviors than their normal-weight peers. LEVEL OF EVIDENCE Level III, case-control analytic study.
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Affiliation(s)
- Demet Tas
- Department of Pediatrics, University of Health Sciences Child Health and Diseases Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Zeynep Tüzün
- Division of Adolescent Medicine, Department of Pediatrics, Hacettepe University Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Yasemin Düzçeker
- Division of Adolescent Medicine, Department of Pediatrics, Hacettepe University Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Sinem Akgül
- Division of Adolescent Medicine, Department of Pediatrics, Hacettepe University Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Nuray Kanbur
- Division of Adolescent Medicine, Department of Pediatrics, Hacettepe University Ihsan Dogramaci Children's Hospital, Ankara, Turkey.
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24
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Smith JD, Fu E, Kobayashi MA. Prevention and Management of Childhood Obesity and Its Psychological and Health Comorbidities. Annu Rev Clin Psychol 2020; 16:351-378. [PMID: 32097572 PMCID: PMC7259820 DOI: 10.1146/annurev-clinpsy-100219-060201] [Citation(s) in RCA: 122] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Childhood obesity has become a global pandemic in developed countries, leading to a host of medical conditions that contribute to increased morbidity and premature death. The causes of obesity in childhood and adolescence are complex and multifaceted, presenting researchers and clinicians with myriad challenges in preventing and managing the problem. This article reviews the state of the science for understanding the etiology of childhood obesity, the preventive interventions and treatment options for overweight and obesity, and the medical complications and co-occurring psychological conditions that result from excess adiposity, such as hypertension, nonalcoholic fatty liver disease, and depression. Interventions across the developmental span, varying risk levels, and service contexts (e.g.,community, school, home, health care systems) are reviewed. Future directions for research are offered with an emphasis on translational issues for taking evidence-based interventions to scale in a manner that will reduce the public health burden of the childhood obesity pandemic.
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Affiliation(s)
- Justin D Smith
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA; ,
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA
| | - Emily Fu
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA; ,
| | - Marissa A Kobayashi
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida 33136, USA;
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25
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Rubino F, Puhl RM, Cummings DE, Eckel RH, Ryan DH, Mechanick JI, Nadglowski J, Ramos Salas X, Schauer PR, Twenefour D, Apovian CM, Aronne LJ, Batterham RL, Berthoud HR, Boza C, Busetto L, Dicker D, De Groot M, Eisenberg D, Flint SW, Huang TT, Kaplan LM, Kirwan JP, Korner J, Kyle TK, Laferrère B, le Roux CW, McIver L, Mingrone G, Nece P, Reid TJ, Rogers AM, Rosenbaum M, Seeley RJ, Torres AJ, Dixon JB. Joint international consensus statement for ending stigma of obesity. Nat Med 2020; 26:485-497. [PMID: 32127716 PMCID: PMC7154011 DOI: 10.1038/s41591-020-0803-x] [Citation(s) in RCA: 406] [Impact Index Per Article: 101.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 02/14/2020] [Indexed: 12/11/2022]
Abstract
People with obesity commonly face a pervasive, resilient form of social stigma. They are often subject to discrimination in the workplace as well as in educational and healthcare settings. Research indicates that weight stigma can cause physical and psychological harm, and that affected individuals are less likely to receive adequate care. For these reasons, weight stigma damages health, undermines human and social rights, and is unacceptable in modern societies. To inform healthcare professionals, policymakers, and the public about this issue, a multidisciplinary group of international experts, including representatives of scientific organizations, reviewed available evidence on the causes and harms of weight stigma and, using a modified Delphi process, developed a joint consensus statement with recommendations to eliminate weight bias. Academic institutions, professional organizations, media, public-health authorities, and governments should encourage education about weight stigma to facilitate a new public narrative about obesity, coherent with modern scientific knowledge.
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Affiliation(s)
- Francesco Rubino
- King's College London, Department of Diabetes, School of Life Course Science, London, UK.
- King's College Hospital, Bariatric and Metabolic Surgery, London, UK.
| | - Rebecca M Puhl
- Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford, CT, USA
| | - David E Cummings
- UW Medicine Diabetes Institute, University of Washington, Seattle, WA, USA
- Weight Management Program, Virginia Puget Sound Health Care System, University of Washington, Seattle, WA, USA
| | - Robert H Eckel
- Division of Endocrinology, Metabolism & Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Donna H Ryan
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA
| | - Jeffrey I Mechanick
- The Marie-Josee and Henry R. Kravis Center for Clinical Cardiovascular Health at Mount Sinai Heart, New York, NY, USA
- Divisions of Cardiology and Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Ximena Ramos Salas
- Obesity Canada, Edmonton, Canada
- European Association for the Study of Obesity, Teddington, UK
| | - Phillip R Schauer
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA
| | | | - Caroline M Apovian
- Boston University School of Medicine, Boston, MA, USA
- Center for Nutrition and Weight Management, Boston Medical Center, Boston, MA, USA
| | - Louis J Aronne
- Comprehensive Weight Control Center, Division of Endocrinology, Diabetes and Metabolism, Weill Cornell Medicine, New York, NY, USA
| | - Rachel L Batterham
- National Institute of Health Research, University College London Hospitals Biomedical Research Centre, London, UK
- University College London Hospital Foundation Trust, London, UK
- Centre for Obesity Research, Department of Medicine, University College London, London, UK
| | - Hans-Rudolph Berthoud
- Neurobiology of Nutrition and Metabolism Department, Pennington Biomedical Research Centre, Louisiana State University System, Baton Rouge, LA, USA
| | - Camilo Boza
- Centro de Innovación Clinica Las Condes Universidad Adolfo Ibañez, Santiago, Chile
| | - Luca Busetto
- Department of Internal Medicine, University of Padova, Padua, Italy
| | - Dror Dicker
- Hasharon Hospital-Rabin Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Obesity Management Task Force, European Association for the Study of Obesity, Teddington, UK
| | - Mary De Groot
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Daniel Eisenberg
- Department of Surgery, Stanford School of Medicine and Palo Alto Virginia Health Care System, Stanford, CA, USA
| | - Stuart W Flint
- School of Psychology, University of Leeds, Leeds, UK
- Scaled Insights, Nexus, University of Leeds, Leeds, UK
| | - Terry T Huang
- Department of Health Policy & Management, Center for Systems & Community Design, New York, NY, USA
- NYU-CUNY Prevention Research Center, Graduate School of Public Health & Health Policy, City University of New York, New York, NY, USA
| | - Lee M Kaplan
- Obesity, Metabolism and Nutrition Institute, Massachusetts General Hospital, Boston, MA, USA
| | - John P Kirwan
- Integrated Physiology and Molecular Medicine, Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Judith Korner
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | | | | | - Carel W le Roux
- Diabetes Complications Research Centre, University College Dublin, Dublin, Ireland
| | - LaShawn McIver
- Government Affairs & Advocacy, American Diabetes Association, Arlington, VA, USA
| | - Geltrude Mingrone
- King's College London, Department of Diabetes, School of Life Course Science, London, UK
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Catholic University, Rome, Italy
| | | | - Tirissa J Reid
- Division of Endocrinology, Diabetes & Metabolism, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Ann M Rogers
- Pennsylvania State Hershey Medical Center, Hershey, PA, USA
| | | | - Randy J Seeley
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Antonio J Torres
- Hospital Clinico San Carlos. Universidad Complutense de Madrid, Madrid, Spain
| | - John B Dixon
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
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26
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Singh UD, Chernoguz A. Parental attitudes toward bariatric surgery in adolescents with obesity. Surg Obes Relat Dis 2019; 16:406-413. [PMID: 31917199 DOI: 10.1016/j.soard.2019.12.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 10/06/2019] [Accepted: 12/04/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Parental underestimation of the severity and risks of their child's obesity and parents' potential implicit weight bias contribute to the reluctance to consider bariatric surgery for their adolescent children with obesity. Despite evidence for safety and efficacy of bariatric surgery in adolescents, pediatric providers may be hesitant or uncomfortable to discuss the benefits and refer patients for surgical evaluation. Understanding these barriers is an essential step toward effective long-term care in this patient population. OBJECTIVES We hypothesized that parental views on bariatric surgery are primarily influenced by personal experiences with bariatric surgery, their implicit bias, understanding of health risks of obesity, and counseling by pediatric providers. SETTING Data were collected and analyzed at an academic medical center in the United States. METHODS After a retrospective chart review of 192 adolescents with obesity, a telephone survey of patients' parents was conducted. RESULTS Parents of 71.4% of patients who received outpatient weight loss counseling had accurate recollection of that event. Only 12.8% of parents who were referred to lifestyle programs successfully enrolled. Neither prior personal exposure to bariatric surgery nor enrollment of the child in a lifestyle program increased parents' likelihood to consider bariatric surgery for their child (P = .10 and .70, respectively). Most parents (84.6%) who were counseled by their pediatric provider about bariatric surgery would consider it, compared with only 34.5% of the parents who did not receive counseling (P < .001). CONCLUSIONS Counseling by pediatric providers, not involvement in lifestyle programs or exposure to bariatric surgery, increased parents' willingness to consider bariatric surgery for their child. Given the current recommendations to incorporate bariatric surgery as a treatment modality in severe adolescent obesity, earlier counseling about the role of surgery by pediatric providers is essential. More detailed provider education on the current state of bariatric surgery in the treatment of severe adolescent obesity is also necessary.
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Affiliation(s)
| | - Artur Chernoguz
- Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts.
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