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Ali AA, Aqeel AA, Shami MO, Khodari BH, Alqassim AY, Alessa AM, Alhazm FI, Alhazmi YA, Sumayli AY, Arishi FH, Muaddi MA, Alharbi AA, Almaghrabi HA, Alhazmi AH. Relationship Between Depression, Anxiety, Stress, and Weight Self-Stigma Among Youths in Saudi Arabia: A Nationwide Study. Cureus 2024; 16:e54125. [PMID: 38487156 PMCID: PMC10939164 DOI: 10.7759/cureus.54125] [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] [Accepted: 02/13/2024] [Indexed: 03/17/2024] Open
Abstract
Background and objectives Many research studies show that self-stigma related to weight can exacerbate mental health issues. There is also evidence suggesting that depression, anxiety, and stress could be predictors of weight stigma. However, these connections have not been thoroughly investigated among young people in Saudi Arabia, where there is a high prevalence of obesity. This study aimed to explore the relationships between depression, anxiety, stress, and weight self-stigma in Saudi Arabian adolescents and young adults. Materials and methods This cross-sectional study was conducted between January and March 2022 and utilized online surveys, including the Weight Self-Stigma Questionnaire (WSSQ) and Depression, Anxiety, and Stress Scale 21 (DASS-21). We conducted descriptive analysis, independent samples t-tests, analysis of variance (ANOVA), and linear regression for the statistical analysis using SPSS version 25 (IBM Corp., Armonk, NY). Results A total of 1624 participants were enrolled in this survey. Most participants (889, 54.7%) were females. The mean age was 20.73 years (SD: 2.63). Males were more likely to report self-stigma compared to females (p = 0.018). Weight self-stigma demonstrated significant positive associations with body mass index (BMI) (p = 0.0001) and depression, anxiety, and stress (p = 0.0001) scores. Further analysis revealed weight self-stigma was positively correlated with psychological distress levels in the study population (p = 0.0001). The results demonstrated a statistically significant difference between different regions of Saudi Arabia with weight self-stigma being more prevalent in the Al-Baha region and least prevalent in the Al-Madinah region. Conclusions The results of this study indicate robust positive correlations between weight self-stigma scores and depression, anxiety, and stress scale scores among adolescents and young adults in Saudi Arabia. Further epidemiological and clinical studies on the national level are warranted.
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Affiliation(s)
- Abdullah A Ali
- Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan, SAU
| | - Abdulrahman A Aqeel
- Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan, SAU
| | - Mohammed O Shami
- Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan, SAU
| | | | - Ahmad Y Alqassim
- Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan, SAU
| | - Abdulrahman M Alessa
- Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan, SAU
| | - Feras I Alhazm
- Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan, SAU
| | - Yahya Alhasan Alhazmi
- Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan, SAU
| | - Abdulrrahman Y Sumayli
- Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan, SAU
| | - Fatimah H Arishi
- Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan, SAU
| | - Mohammed A Muaddi
- Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan, SAU
| | - Abdullah A Alharbi
- Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan, SAU
| | - Hatim A Almaghrabi
- Department of Medicine and Surgery, College of Medicine, Umm Al-Qura University, Makkah, SAU
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Crane N, Hagerman C, Horgan O, Butryn M. Patterns and Predictors of Engagement With Digital Self-Monitoring During the Maintenance Phase of a Behavioral Weight Loss Program: Quantitative Study. JMIR Mhealth Uhealth 2023; 11:e45057. [PMID: 37463017 PMCID: PMC10394603 DOI: 10.2196/45057] [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: 01/08/2023] [Revised: 04/17/2023] [Accepted: 05/18/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Long-term self-monitoring (SM) of weight, diet, and exercise is commonly recommended by behavioral weight loss (BWL) treatments. However, sustained SM engagement is notoriously challenging; therefore, more must be learned about patterns of engagement with digital SM tools during weight loss maintenance (WLM). In addition, insight into characteristics that may influence SM engagement could inform tailored approaches for participants at risk for poor adherence. OBJECTIVE This study explored patterns of digital SM of weight, diet, and exercise during WLM (aim 1) and examined timing, patterns, and rates of disengagement and reengagement (aim 2). This study also assessed relationships between individual-level factors (weight-related information avoidance and weight bias internalization) and SM engagement (aim 3). METHODS Participants were 72 adults enrolled in a BWL program consisting of a 3-month period of weekly treatment designed to induce weight loss (phase I), followed by a 9-month period of less frequent contact to promote WLM (phase II). Participants were prescribed daily digital SM of weight, diet, and exercise. At baseline, self-report measures assessed weight-related information avoidance and weight bias internalization. SM adherence was objectively measured with the days per month that participants tracked weight, diet, and exercise. Repeated-measures ANOVA examined differences in adherence across SM targets. Multilevel modeling examined changes in adherence across phase II. Relationships between individual-level variables and SM adherence were assessed with Pearson correlations, 2-tailed independent samples t tests, and multilevel modeling. RESULTS During WLM, consistently high rates of SM (≥50% of the days in each month) were observed for 61% (44/72) of the participants for exercise, 40% (29/72) of the participants for weight, and 21% (15/72) of the participants for diet. Adherence for SM of exercise was higher than that for weight or diet (P<.001). Adherence decreased over time for all SM targets throughout phase II (P<.001), but SM of exercise dropped off later in WLM (mean 10.07, SD 2.83 months) than SM of weight (mean 7.92, SD 3.23 months) or diet (mean 7.58, SD 2.92 months; P<.001). Among participants with a period of low SM adherence (ie, <50% of the days in a month), only 33% (17/51 for weight, 19/57 for diet) to 46% (13/28 for exercise) subsequently had ≥1 months with high adherence. High weight-related information avoidance predicted a faster rate of decrease in dietary SM (P<.001). Participants with high weight bias internalization had the highest rates of weight SM (P=.03). CONCLUSIONS Participants in BWL programs have low adherence to the recommendation to sustain daily SM during WLM, particularly for SM of diet and weight. Weight-related information avoidance and weight bias internalization may be relevant indicators for SM engagement. Interventions may benefit from innovative strategies that target participants at key moments of risk for disengagement.
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Affiliation(s)
- Nicole Crane
- Center for Weight, Eating, and Lifestyle Science, Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, United States
| | - Charlotte Hagerman
- Center for Weight, Eating, and Lifestyle Science, Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, United States
| | - Olivia Horgan
- Center for Weight, Eating, and Lifestyle Science, Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, United States
| | - Meghan Butryn
- Center for Weight, Eating, and Lifestyle Science, Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, United States
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Park S, Seo K. Validity and Reliability of the Korean Version of the Weight Self-Stigma Questionnaire (WSSQ-K). NURSING REPORTS 2023; 13:835-843. [PMID: 37368340 DOI: 10.3390/nursrep13020073] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/19/2023] [Accepted: 05/23/2023] [Indexed: 06/28/2023] Open
Abstract
Weight self-stigma refers to negative self-prejudice due to the internalization of negative social messages about one's weight. People with high self-stigma may have low self-esteem and decreased social activity. Weight-related self-stigma can create diet-related disorders since it is highly related to the recognition of body types. However, there are no tools available to measure the weight-related stigma of the general public in Korea. This study evaluated the validity and reliability of the Korean version of the Weight Self-Stigma Questionnaire (WSSQ-K). A methodological study was conducted with 150 Korean university students. Construct validity was evaluated using exploratory factor analysis. The WSSQ-K was correlated with body mass index and measures of self-esteem and weight concern to evaluate concurrent validity. Internal consistency reliability was evaluated with Cronbach's alpha. In the exploratory factor analysis, two factors were proposed: "self-devaluation" (Cronbach's α = 79) and "fear of enacted stigma" (Cronbach's α = 82). Factor loadings for the 12 items on two factors ranged from 0.539 to 0.811, which explained 53.3% of the total variance. The WSSQ-K correlated with body mass index, self-esteem, and weight concern. The findings showed that the WSSQ-K was a reliable and valid measure that could be used for evaluating weight self-stigma in normal-weight adults in Korea.
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Affiliation(s)
- Seyoen Park
- College of Nursing, Chungnam National University, Daejeon 35015, Republic of Korea
| | - Kawoun Seo
- Department of Nursing, Joongbu University, Chungnam 32713, Republic of Korea
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Ziser K, Junne F, Herschbach A, Martus P, Jacoby J, Stuber F, Rahmani Azad Z, Mack I, Weiland A, Krauß I, Greule C, Sudeck G, Kastner L, Zurstiege G, Hoell A, Bethge W, Sammet T, Schliesing O, Zipfel S, Ehehalt S, Giel KE. Supporting families to achieve a healthy weight development for their child with overweight/obesity using the STARKIDS intervention: study protocol for a cluster-randomized controlled trial. Trials 2022; 23:590. [PMID: 35871013 PMCID: PMC9308115 DOI: 10.1186/s13063-022-06525-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 07/06/2022] [Indexed: 11/16/2022] Open
Abstract
Background Childhood and adolescent overweight and obesity are among the most serious health challenges today. Structured weight reduction programs can be helpful to reduce severe health consequences but evidence is partly scarce. The STARKIDS program aims to improve on some of these limitations and is designed to be a structured, stepwise, digitally supported intervention program for the whole family. It is divided into two intervention steps spanning over 1.5 years and aims at promoting a healthy weight development of children/adolescents with overweight/obesity and an increase in quality of life. Methods The STARKIDS intervention is evaluated in a cluster-randomized study design by comparing it with a control group receiving a one-time structured counselling in the pediatric practice. The study aims to include 1000 families with children/adolescents with overweight/obesity from 100 pediatric practices. The main outcomes are reduction in body mass index percentiles and improvements in children’s/adolescent’s quality of life, secondary outcomes refer to the contents of the intervention such as diet, physical activity, stress, and media habits. All outcomes are measured on three measurement time points: (T0) at baseline/inclusion in the study, (T1) baseline + 12 months which is the end of step 1 of the STARKIDS intervention, and (T2) baseline + 18 months which is the end of step 2 of the STARKIDS intervention. Discussion The stepwise, e-health-supported STARKIDS program is a low-threshold intervention program for families with children/adolescents with overweight/obesity. With the proof of concept, STARKIDS provides the potential to be implemented as a standard care tool for the prevention and intervention of childhood/adolescence obesity in the German health system. Trial registration German Clinical Trials Register (DRKS) DRKS00022813 (acknowledged primary register of the World Health Organization). Registered on 27 November 2020 (Universal Trial Number U1111-1254-9536).
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5
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Magallares A, de Valle PB, Irles JA, Recio P, Jáuregui-Lobera I. Psychometric properties of the Spanish version of the Weight Self-Stigma Questionnaire (S-WSSQ) in a sample of participants with obesity seeking weight loss treatment. Eat Weight Disord 2022; 27:3685-3693. [PMID: 36434471 PMCID: PMC9803612 DOI: 10.1007/s40519-022-01511-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/10/2022] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Weight self-stigma may be defined as a self-devaluation due to one's identification with the group of people with obesity. The Weight Self-Stigma Questionnaire (WSSQ) is an instrument specifically designed to measure weight self-stigma in populations with overweight or obesity. The objective of this study was to adapt the WSSQ to the Spanish population (S-WSSQ) following the guidelines for cross-cultural adaptations. METHODS The sample comprised 165 participants with obesity seeking weight loss treatment (65% women) at the "Hospital de Valme" (Seville, Spain). Scales to measure life satisfaction, self-esteem, positive and negative affect, and antifat attitudes were used to analyze the convergent and divergent validity of the S-WSSQ. RESULTS A confirmatory factor analysis showed adequate values of the goodness of fit indexes of a two-factor model (χ2/df = 2.01 CFI = 0.92, IFI = 0.92, SRMR = 0.08, RMSEA = 0.078), replicating the structure found by the original authors. Cronbach's alphas of the two factors were 0.76 (self-devaluation) and 0.77 (fear of enacted stigma). Composite Reliability values were 0.72 (self-devaluation) and 0.76 (fear of enacted stigma). Self-devaluation and fear of enacted stigma were negatively related to self-esteem, and positive affect, and positively related to negative affect and antifat attitudes. Finally, life satisfaction was negatively correlated to fear of enacted stigma. CONCLUSIONS Based on these results, it is concluded that the S-WSSQ has good psychometric properties and might be used by the Spanish-speaking scientific community to measure weight self-stigma. LEVEL OF EVIDENCE Level V, descriptive study.
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Affiliation(s)
- Alejandro Magallares
- School of Psychology, Social Psychology Department, Spanish Open University (UNED), Madrid, Spain.
- Departamento de Psicología Social y de las Organizaciones, Facultad de Psicología UNED, C/ Juan del Rosal, 10, 28040, Madrid, Spain.
| | | | | | - Patricia Recio
- School of Psychology, Methodology Department, Spanish Open University (UNED), Madrid, Spain
| | - Ignacio Jáuregui-Lobera
- School of Experimental Sciences, Nutrition and Bromatology, Universidad Pablo de Olavide, Seville, Spain
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Rossi AA, Manzoni GM, Pietrabissa G, Di Pauli D, Mannarini S, Castelnuovo G. Weight stigma in patients with overweight and obesity: validation of the Italian Weight Self-Stigma Questionnaire (WSSQ). Eat Weight Disord 2022; 27:2459-2472. [PMID: 35290623 PMCID: PMC9556395 DOI: 10.1007/s40519-022-01385-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 02/26/2022] [Indexed: 02/06/2023] Open
Abstract
PURPOSE This study aimed to explore the factorial structure of the Italian Weight Self-Stigma Questionnaire (WSSQ) (Study1); and to test structural validity, internal consistency, test-retest reliability, and measurement invariance of the questionnaire across gender, Body Mass Index (BMI), age and occurrence of previous hospitalization for obesity (Study2). METHODS At admission into a hospital-based program for weight reduction and rehabilitation, 150 inpatients with overweight/obesity (68% females) completed the WSSQ (Study1). In Study2, in addition to the WSSQ, 446 inpatients (61.9% females) completed the Weight Bias Internalization Scale (WBIS), the Body Uneasiness Test (BUT), and the Center for Epidemiologic Studies Depression Scale (CES-D). A subsample of 40 patients also re-completed the WSSQ at discharge from the hospital. RESULTS The Italian WSSQ showed good overlap with the original factorial structure (Study1) and results were confirmed in Study2. Test-retest reliability and convergent validity showed adequate values. Measurement invariance revealed that WSSQ was perfectly invariant across both BMI and the occurrence of previous hospitalizations for obesity. In both studies, the internal consistency of the questionnaire was deemed acceptable. CONCLUSIONS The Italian WSSQ is a valid, reliable, and invariant tool for the assessment of weight-related self-stigma among patients with overweight/obesity. Future studies should assess its longitudinal invariance as well as its responsiveness to weight reduction treatments. LEVEL OF EVIDENCE V, descriptive study.
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Affiliation(s)
- Alessandro Alberto Rossi
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padua, Italy. .,Interdepartmental Center for Family Research, Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padua, Italy.
| | - Gian Mauro Manzoni
- Psychology Research Laboratory, Ospedale San Giuseppe, IRCCS, Istituto Auxologico Italiano, Verbania, Italy.,Faculty of Psychology, eCampus University, Novedrate, Como, Italy
| | - Giada Pietrabissa
- Psychology Research Laboratory, Ospedale San Giuseppe, IRCCS, Istituto Auxologico Italiano, Verbania, Italy.,Department of Psychology, Catholic University of Milan, Milan, Italy
| | | | - Stefania Mannarini
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padua, Italy.,Interdepartmental Center for Family Research, Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padua, Italy
| | - Gianluca Castelnuovo
- Psychology Research Laboratory, Ospedale San Giuseppe, IRCCS, Istituto Auxologico Italiano, Verbania, Italy.,Department of Psychology, Catholic University of Milan, Milan, Italy
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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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Khodari BH, Shami MO, Shajry RM, Shami JA, Names AA, Alamer AA, Moafa AM, Hakami RO, Almuhaysin GS, Alqassim AY. The Relationship Between Weight Self-Stigma and Quality of Life Among Youth in the Jazan Region, Saudi Arabia. Cureus 2021; 13:e18158. [PMID: 34703692 PMCID: PMC8530152 DOI: 10.7759/cureus.18158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Studies on the role of weight self-stigma on the quality of life of young adults are limited. Therefore, the present study aimed to examine the relationship between different forms of weight self-stigma (self-devaluation and fear of enacted stigma) and the quality of life among Saudi youth in the Jazan region. METHODS A cross-sectional study was performed using a sample of 399 participants who were invited through social media platforms. We used Arabic, validated versions of the weight self-stigma questionnaire (WSSQ) and the World Health Organization quality of life questionnaire. Data analysis was performed by independent samples t-test and analysis of variance with Tukey's post hoc test. RESULTS The study sample consisted of 399 participants aged 21.12 years ± 2.91 years. A total of 264 (66.2%) were female. The overall weight self-stigma score of the study population was 34.81 ± 10.73 on the WSSQ. The analysis showed a significant association between weight self-stigma and quality of life and body mass index (BMI; p < 0.01). In addition, participants who were overweight and obese had more self-devaluation and fear of enacted stigma than did participants with normal weight. Participants with high weight self-stigma had lower quality of life than did those with less weight self-stigma. CONCLUSIONS The results of this study show that weight self-stigma is negatively correlated with the individual's quality of life. Weight self-stigma was positively associated with BMI.
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Affiliation(s)
| | | | - Reem M Shajry
- Family Medicine, Ministry of Health Holdings, Jazan, SAU
| | | | - Abdellh A Names
- College of Medicine, Jazan University, Jazan, SAU
- Cardiology, Jazan University, Jazan, SAU
| | | | | | | | | | - Ahmad Y Alqassim
- Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan, SAU
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Papadopoulos S, de la Piedad Garcia X, Brennan L. Evaluation of the psychometric properties of self-reported weight stigma measures: A systematic literature review. Obes Rev 2021; 22:e13267. [PMID: 34105229 DOI: 10.1111/obr.13267] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Conceptualisation and measurement of weight stigma varies across available studies assessing those affected. This paper aims to systematically review the psychometric properties of available self-reported measures of weight stigma. METHOD Studies exploring the development and/or validation of weight stigma measures were identified through systematically searching Medline, CINAHL, PsycINFO, Embase, Web of Science, and Scopus databases. The Consensus-based Standards of Health Measurement Instruments (COSMIN) checklist was used to assess the psychometric properties of measures. RESULTS Thirty-six articles, reporting 18 different weight stigma measures, were included. For most included measures, measure development and content validity have not been assessed/reported. Structural validity, internal consistency, and hypothesis testing were the most commonly assessed/reported psychometric properties. High-quality ratings were given only for these properties. Most measures were rated as "indeterminate" and received an overall quality rating of "Very Low" as results were based on limited evidence. CONCLUSIONS Psychometric properties for published weight stigma measures have rarely been assessed/reported. The observed poor methodological quality for measure development, and limited content validity evidence, negatively impact the quality of evidence for the measures. There is a need for studies assessing the psychometric properties of existing weight stigma measures using COSMIN guidelines, and for a well-designed weight stigma measure informed by both theory and research.
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Affiliation(s)
- Stephanie Papadopoulos
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Victoria, Australia
| | | | - Leah Brennan
- School of Psychology and Public Health, La Trobe University, Albury-Wodonga, New South Wales, Australia
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Lucibello KM, Nesbitt AE, Solomon-Krakus S, Sabiston CM. Internalized weight stigma and the relationship between weight perception and negative body-related self-conscious emotions. Body Image 2021; 37:84-88. [PMID: 33596497 DOI: 10.1016/j.bodyim.2021.01.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 01/21/2021] [Accepted: 01/24/2021] [Indexed: 01/27/2023]
Abstract
Individuals who perceive themselves as "overweight" experience higher negative body-related self-conscious emotions than those who do not. Theoretical and empirical evidence suggests internalized weight stigma may be an important mediator of the relationship between weight perception and self-conscious emotions. Overcoming common measurement limitations and sampling limitations, the present study investigated whether gender moderates the associations among weight perceptions, internalized weight stigma, and negative body-related self-conscious emotions in 104 young adults (64 % women). Individuals who perceived themselves as too heavy (52 %) experienced higher body-related shame and guilt compared to those who perceived themselves as about right. Internalized weight stigma mediated these associations in women but not men, such that perceiving oneself as too heavy was associated with higher internalized weight stigma, which was associated with higher body-related shame and guilt in women. Results underscore the importance of internalized weight stigma as a potential target for intervention among women of diverse weight statuses who are prone to experiencing body-related shame and guilt.
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Affiliation(s)
- Kristen M Lucibello
- Department of Kinesiology, University of Toronto, 55 Harbord Street, Toronto, Ontario, M5S 2W6, Canada
| | - Amy E Nesbitt
- Department of Occupational Science and Occupational Therapy, University of Toronto, 500 University Avenue, Toronto, Ontario, M5G 1V7, Canada
| | - Shauna Solomon-Krakus
- Department of Psychological Clinical Science, University of Toronto Scarborough, 1265 Military Trail, Toronto, Ontario, M1C 1A4, Canada
| | - Catherine M Sabiston
- Department of Kinesiology, University of Toronto, 55 Harbord Street, Toronto, Ontario, M5S 2W6, Canada.
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BinDhim NF, Althumiri NA, Basyouni MH, Sims OT, Alhusseini N, Alqahtani SA. Arabic Translation of the Weight Self-Stigma Questionnaire: Instrument Validation Study of Factor Structure and Reliability. JMIR Form Res 2020; 4:e24169. [PMID: 33185558 PMCID: PMC7695527 DOI: 10.2196/24169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/28/2020] [Accepted: 10/28/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND While it is most often associated with its effects on physical health, obesity is also associated with serious self-stigmatization. The lack of a suitable, validated tool to measure weight-related self-stigma in Arabic countries may be partly responsible for the scarcity of literature about this problem. OBJECTIVE This study investigated the reliability and validity of an Arabic version of the Weight Self-Stigma Questionnaire (WSSQ). METHODS Data on the Arabic-translated version of the 12-item WSSQ were collected using two cross-sectional electronic questionnaires distributed among Saudi nationals through the Sharik Association for Health Research's database in June 2020. Internal consistency, test-retest reliability, and exploratory factor analysis of the Arabic WSSQ were assessed and compared with the original English version and other translations. RESULTS For reliability analysis, 43 participants completed the Arabic WSSQ during two time periods. Internal consistency was α=.898 for the overall survey, α=.819 for the fear of enacted stigma subscale (factor 1), and α=.847 for the self-devaluation subscale (factor 2). The test-retest reliability of the intraclass correlation coefficient was α=.982. In the factor structure analysis, 295 participants completed the questionnaire. The Arabic WSSQ loading of the items was consistent with the original WSSQ, except for the loading of item 9, which was stronger in factor 2 than in factor 1. The two factors accounted for the observed variances of 47.7% and 10.6%. CONCLUSIONS The Arabic version of the WSSQ has good internal consistency and reliability, and the factorial structure is similar to that of the original WSSQ. The Arabic WSSQ is adaptable for clinicians seeking to assess weight-related self-stigma in Arabic-speaking people.
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Affiliation(s)
- Nasser F BinDhim
- Sharik Association for Health Research, Riyadh, Saudi Arabia.,Alfaisal University, College of Medicine, Riyadh, Saudi Arabia
| | | | - Mada H Basyouni
- Sharik Association for Health Research, Riyadh, Saudi Arabia
| | - Omar T Sims
- School of Public Health, Integrative Center for Healthy Aging, University of Alabama at Birmingham, Birmingham, AL, United States
| | | | - Saleh A Alqahtani
- Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, MD, United States.,Liver Transplant Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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12
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Lin CY, Imani V, Cheung P, Pakpour AH. Psychometric testing on two weight stigma instruments in Iran: Weight Self-Stigma Questionnaire and Weight Bias Internalized Scale. Eat Weight Disord 2020; 25:889-901. [PMID: 31055783 DOI: 10.1007/s40519-019-00699-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 04/20/2019] [Indexed: 10/26/2022] Open
Abstract
PURPOSE This study aimed to comprehensively and thoroughly examine the psychometric properties of two commonly used weight-related self-stigma instruments on Iranian adolescents with overweight or obesity: Weight Self-Stigma Questionnaire [WSSQ] and Weight Bias Internalization Scale [WBIS]. METHODS After ensuring the linguistic validity of both the WSSQ and WBIS in their Persian versions, 737 Iranian adolescents with overweight or obesity (male = 354; mean age = 15.8 ± 1.3 years; body mass index = 30.0 ± 4.8 kg/m2) completed both questionnaires and other relevant measures regarding their depression, anxiety, stress, dietary self-efficacy, weight efficacy lifestyle, quality of life, body fat, self-esteem, body shape preoccupation, and sleepiness. RESULTS In the scale level, the confirmatory factory analysis verified the two-factor structure for the WSSQ and the single-factor structure for the WBIS. The factorial structures were further found to be invariant across gender (male vs. female) and across weight status (overweight vs. obesity). Additionally, both the WSSQ and WBIS had promising properties in internal consistency, test-retest reliability, separation reliability, and separation index. In the item level, all items but WBIS item 1 (infit mean square = 1.68; outfit mean square = 1.60) had satisfactory properties in factor loadings, corrected item-total correlation, test-retest reliability, and infit and outfit mean square. Moreover, all the items did not display substantial differential item functioning (DIF) across gender and across weight status. CONCLUSION Both the WSSQ and WBIS were valid instruments to assess the internalization of weight bias for Iranian adolescents with overweight or obesity. LEVEL OF EVIDENCE Level V, cross-sectional descriptive study.
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Affiliation(s)
- Chung-Ying Lin
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Vida Imani
- Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Pauline Cheung
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Amir H Pakpour
- Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Shahid Bahonar Blvd, Qazvin, 3419759811, Iran. .,Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden.
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13
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Weight-related stigma and psychological distress: A systematic review and meta-analysis. Clin Nutr 2019; 39:2001-2013. [PMID: 31732288 DOI: 10.1016/j.clnu.2019.10.016] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 10/09/2019] [Accepted: 10/14/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND & AIMS Individuals who are overweight or who have obesity are likely to perceive or experience unfriendly treatment (i.e., weight-related perceived stigma) from different sources such as work colleagues because of the stigma towards excess weight. People who are overweight may accept such stigma and devalue themselves (i.e., weight-related self-stigma). METHODS A systematic review and meta-analysis was conducted to examine the relationship between weight stigma (including weight-related self-stigma and weight-related perceived stigma) and psychological distress (including depression and anxiety) using random-effects meta-analyses. Utilizing five academic databases (PubMed, Scopus, WOS, Embase and ProQuest) and keywords related to weight stigma and psychological distress, empirical studies focusing on the association between weight stigma and psychological distress were selected. The timeline for the searched papers was from the inception of each database to the end of August 2019. RESULTS Eligible studies (N = 30; 25 on weight-related self-stigma and eight on weight-related perceived stigma) were analyzed with a total of 9345 participants experiencing weight-related self-stigma, and 15,496 experiencing weight-related perceived stigma. The pooled associations were moderate between weight-related self-stigma and psychological distress (corrected Fisher's Z = 0.40 for depression; 0.36 for anxiety) and between perceived stigma and depression (Fisher's Z = 0.44). CONCLUSIONS Results of the meta-analysis demonstrated that weight stigma is associated with psychological distress. The comprehensive search of the literature and rigorous methodology employed are the two major strengths in the present study. Because self-stigma and perceived stigma are different concepts, their associations with psychological distress should not be merged together.
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Pearl RL, Himmelstein MS, Puhl RM, Wadden TA, Wojtanowski AC, Foster GD. Weight bias internalization in a commercial weight management sample: prevalence and correlates. Obes Sci Pract 2019; 5:342-353. [PMID: 31452919 PMCID: PMC6700514 DOI: 10.1002/osp4.354] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/14/2019] [Accepted: 06/14/2019] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Weight bias internalization (WBI) is associated with poor weight-related health. The purpose of this study was to identify the prevalence and correlates of WBI in a large sample of adults in a commercial weight management programme. METHODS WW (the new Weight Watchers) members participated in an online survey. Participants (N = 18,769) completed the 10-item Weight Bias Internalization Scale - Modified (WBIS-M) and the Weight Self-Stigma Questionnaire (WSSQ). Participants reported details about weight-stigmatizing experiences, including the onset, frequency and distress, and interpersonal sources of weight stigma. Participants self-reported their demographics, weight history, and height and weight (to compute body mass index [BMI]). RESULTS Weight bias internalization was relatively high compared with the general population (mean WBIS-M score = 4.3 ± 1.4; mean WSSQ total score = 35.2 ± 9.7). WBI was higher among participants who were female, younger and had higher BMIs (p < 0.001) and lower among those who were Black and were widowed or had a romantic partner (p < 0.001). Onset of weight stigma in childhood and young adulthood, and recent distress due to weight stigma, predicted higher WBI. Extended family and school sources of weight stigma had weaker associations with WBI than did other interpersonal sources. CONCLUSIONS Weight bias was internalized by a significant proportion of adults enrolled in a commercial weight management programme. A phenotype of WBI includes demographic characteristics and the timing and sources of weight stigma.
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Affiliation(s)
- R. L. Pearl
- Center for Weight and Eating Disorders, Department of PsychiatryPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPAUSA
| | - M. S. Himmelstein
- Rudd Center for Food Policy and ObesityUniversity of ConnecticutHartfordCTUSA
- Department of Psychological SciencesKent State UniversityKentOHUSA
| | - R. M. Puhl
- Rudd Center for Food Policy and ObesityUniversity of ConnecticutHartfordCTUSA
- Department of Human Development and Family SciencesUniversity of Connecticut, StorrsStorrsCTUSA
| | - T. A. Wadden
- Center for Weight and Eating Disorders, Department of PsychiatryPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPAUSA
| | | | - G. D. Foster
- Center for Weight and Eating Disorders, Department of PsychiatryPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPAUSA
- WWNew YorkNYUSA
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15
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Maïano C, Aimé A, Lepage G, Morin AJS. Psychometric properties of the Weight Self-Stigma Questionnaire (WSSQ) among a sample of overweight/obese French-speaking adolescents. Eat Weight Disord 2019; 24:575-583. [PMID: 28390006 DOI: 10.1007/s40519-017-0382-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 03/14/2017] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The Weight Self-Stigma Questionnaire (WSSQ) was recently developed to assess the internalization of weight stigma among English-speaking overweight and obese adults. The objective of the present study was to develop and examine the psychometric properties of a French version of the WSSQ, as well as its applicability to adolescents. METHODS The sample comprised 156 overweight and obese adolescents (81 boys, 75 girls, Mage = 16.31). The factor validity and the convergent validity of the French version of the WSSQ were examined using a confirmatory factor analysis and a structural equation model, respectively. RESULTS The a priori two-factor structure of the WSSQ and the composite reliability of its subscales (self-devaluation and fear of enacted stigma) were supported. Convergent validity analyses revealed that both WSSQ subscales were significantly and (a) negatively correlated with measures of self-esteem and physical appearance, and (b) positively correlated with measures of anxiety, depression, fear of negative appearance evaluation, and eating-related pathology (fear of getting fat, eating-related control, food preoccupation, vomiting-purging behaviors, and eating-related guilt subscales). However, no significant relation was found between the WSSQ subscales and body mass index. CONCLUSION These results suggest that the French version of the WSSQ has acceptable psychometric properties and can be used to assess weight self-stigma among overweight and obese adolescents.
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Affiliation(s)
- Christophe Maïano
- Cyberpsychology Laboratory, Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais (UQO), Gatineau, Canada. .,Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais (UQO), Saint-Jérôme, Canada.
| | - Annie Aimé
- Cyberpsychology Laboratory, Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais (UQO), Gatineau, Canada.,Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais (UQO), Saint-Jérôme, Canada
| | - Geneviève Lepage
- Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais (UQO), Saint-Jérôme, Canada
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Psychometric properties and measurement invariance of the Weight Self-Stigma Questionnaire and Weight Bias Internalization Scale in children and adolescents. Int J Clin Health Psychol 2019; 19:150-159. [PMID: 31193103 PMCID: PMC6517648 DOI: 10.1016/j.ijchp.2019.03.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 03/13/2019] [Indexed: 02/05/2023] Open
Abstract
Given the negative consequences of weight bias, including internalized weight stigma, on health outcomes, two instruments—the Weight Self-Stigma Questionnaire (WSSQ) and Weight Bias Internalization Scale (WBIS)—have been developed. However, their psychometric properties are yet to be tested for Asian pediatric populations. Method:Participants aged 8 to 12 years (N = 287; 153 boys) completed the WSSQ and the WBIS, and they were classified into either a group with overweight or a group without overweight based on self-reported weight and height. Results:Both WSSQ and WBIS had their factor structures supported by confirmatory factor analyses (CFAs). The measurement invariance of two-factor structure was further supported for WSSQ across gender and weight status. The measurement invariance of single-factor structure was supported for WBIS across gender but not across weight status. Conclusions:WSSQ and WBIS were both valid to assess the internalization of weight bias. However, the two instruments demonstrated different properties and should be applied in different situations.
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17
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Seo K, Song Y. Self-stigma among Korean patients with diabetes: A concept analysis. J Clin Nurs 2019; 28:1794-1807. [PMID: 30667129 DOI: 10.1111/jocn.14789] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 12/01/2018] [Accepted: 01/14/2019] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To conduct a concept analysis of self-stigma among patients with diabetes and introduce an operational definition of self-stigma. BACKGROUND Due to fears of being monitored, patients with diabetes often conceal their disease and/or withdraw from social relationships. These behaviours negatively affect patients' self-care and socialisation. DESIGN A concept analysis was conducted using a three-phase (theoretical phase, fieldwork phase and final analysis phase) hybrid method by Schwartz-Barcott and Kim (Nursing research methodology: Issues and implementations, 1986, Rockville, MD: Aspen). METHODS During the theoretical phase, a literature search was conducted using PubMed and CINAHL. Using COREQ guidelines, in the fieldwork phase, in-depth interviews were conducted with nine participants with diabetes. The recorded data were analysed using a grounded theory approach. Results from both were included in the analytic phase. RESULTS In the fieldwork phase, nine patients with diabetes (four men and five women; mean age = 57.00 ± 21.93 years) participated in the interview. The mean duration of diabetes was 21.44 ± 12.39 years. The self-stigma concept included three categories with nine attributes: affective (negative feelings and feeling sorry for others who have concerns about me), cognitive (low self-esteem and self-efficacy, perceived weakness, low expectations for the future, worry for children and disease burden) and behavioural factors (social withdrawal and avoiding disease disclosure). The nine attributes included 23 indicators. CONCLUSIONS Self-stigma among patients with diabetes is defined as a state in which patients develop negative self-feelings as they deal with the disease. This can cause diminished self-esteem and self-efficacy, as well as a tendency to avoid disclosing the illness along with social withdrawal. RELEVANCE TO CLINICAL PRACTICE Based on this self-stigma concept analysis, we clarified the attributes of diabetes self-stigma and distinguished it from social stigma in nurse professionals during patient education and clinical assessment.
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Affiliation(s)
- Kawoun Seo
- College of Nursing, Chungnam National University, Daejeon, South Korea.,Department of Nursing, Joongbu University, Chungnam, Republic of Korea
| | - Youngshin Song
- College of Nursing, Chungnam National University, Daejeon, South Korea
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18
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Palmeira L, Cunha M, Pinto-Gouveia J. The weight of weight self-stigma in unhealthy eating behaviours: the mediator role of weight-related experiential avoidance. Eat Weight Disord 2018; 23:785-796. [PMID: 30019257 DOI: 10.1007/s40519-018-0540-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 07/06/2018] [Indexed: 11/29/2022] Open
Abstract
Weight stigma plays a damaging role in the life of the individuals with overweight and obesity who may internalise the widespread stigmatisation messages. Weight self-stigma is defined as personal experiences of shame, negative self-evaluations as well as perceived discrimination. It has been found to be related to experiential avoidance patterns and poorer outcomes. The current study aims to conduct a confirmatory factor analysis (CFA) on the Weight Self-Stigma Questionnaire (WSSQ) and explore its psychometric properties. Furthermore, the mediator role of weight-related experiential avoidance on the relationship between weight self-stigma and unhealthy eating behaviour was analysed. Concerning the CFA, the sample comprised 331 women with overweight and obesity seeking nutritional treatment. A second independent sample of 58 overweight and obese women was used to assess WSSQ's temporal validity and internal responsiveness. Results supported the WSSQ two-factor structure and good psychometric properties and responsiveness to change. Also, evidence was found for the mediator role of weight-related experiential avoidance on the relationship between BMI, weight self-stigma and unhealthy eating patterns in women with overweight and obesity. Overall, the current study showed that WSSQ is a reliable measure and highlights the important role of weight self-stigma and weight-related experiential avoidance in women with overweight and obesity. Level of evidence: Level V, descriptive studies.
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Affiliation(s)
- Lara Palmeira
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), University of Coimbra, Coimbra, Portugal.
| | - Marina Cunha
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), University of Coimbra, Coimbra, Portugal.,Miguel Torga Superior Institute (ISMT), Coimbra, Portugal
| | - José Pinto-Gouveia
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), University of Coimbra, Coimbra, Portugal
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19
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Pearl RL, Puhl RM. Weight bias internalization and health: a systematic review. Obes Rev 2018; 19:1141-1163. [PMID: 29788533 PMCID: PMC6103811 DOI: 10.1111/obr.12701] [Citation(s) in RCA: 269] [Impact Index Per Article: 44.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 03/23/2018] [Accepted: 03/29/2018] [Indexed: 01/31/2023]
Abstract
A robust literature has documented the negative health effects of being the target of weight bias. Weight bias internalization (WBI) occurs when individuals apply negative weight stereotypes to themselves and self-derogate because of their body weight. Compared with experiences of weight bias, less is known about the relationship between WBI and mental and physical health, although more literature on this topic has emerged in recent years. The current systematic review identified 74 studies assessing the relationship between WBI and health and interventions designed to reduce WBI and improve health. Over half of identified studies were published from 2016 to 2017. Results showed strong, negative relationships between WBI and mental health outcomes. Fewer studies have examined the relationship between WBI and physical health, and results were less consistent. Key directions for future research are highlighted, including the need for prospective and experimental studies with greater sample diversity.
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Affiliation(s)
- R L Pearl
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - R M Puhl
- Rudd Center for Food Policy and Obesity, Department of Human Development & Family Studies, University of Connecticut, Hartford, CT, USA
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20
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Sevincer GM, Kaya A, Bozkurt S, Akin E, Kose S. Reliability, validity, and factorial structure of the Turkish version of the Weight Self-Stigma Questionnaire (Turkish WSSQ). PSYCHIAT CLIN PSYCH 2017. [DOI: 10.1080/24750573.2017.1379717] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Guzin M. Sevincer
- Department of Psychology, Istanbul Gelisim University, Istanbul, Turkey
| | - Aysenur Kaya
- Department of Psychology, Istanbul Gelisim University, Istanbul, Turkey
| | - Suleyman Bozkurt
- Department of Bariatric and Metabolic Surgery, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Ercan Akin
- Department of Psychology, Hasan Kalyoncu University, Gaziantep, Turkey
| | - Samet Kose
- Department of Psychology, Hasan Kalyoncu University, Gaziantep, Turkey
- University of Texas Medical School at Houston, Houston, TX, USA
- Center for Neurobehavioral Research on Addictions, Houston, TX, USA
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21
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Hübner C, Schmidt R, Selle J, Köhler H, Müller A, de Zwaan M, Hilbert A. Comparing Self-Report Measures of Internalized Weight Stigma: The Weight Self-Stigma Questionnaire versus the Weight Bias Internalization Scale. PLoS One 2016; 11:e0165566. [PMID: 27792772 PMCID: PMC5085051 DOI: 10.1371/journal.pone.0165566] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 10/13/2016] [Indexed: 12/15/2022] Open
Abstract
Background Internalized weight stigma has gained growing interest due to its association with multiple health impairments in individuals with obesity. Especially high internalized weight stigma is reported by individuals undergoing bariatric surgery. For assessing this concept, two different self-report questionnaires are available, but have never been compared: the Weight Self-Stigma Questionnaire (WSSQ) and the Weight Bias Internalization Scale (WBIS). The purpose of the present study was to provide and to compare reliability, convergent validity with and predictive values for psychosocial health outcomes for the WSSQ and WBIS. Methods The WSSQ and the WBIS were used to assess internalized weight stigma in N = 78 prebariatric surgery patients. Further, body mass index (BMI) was assessed and body image, quality of life, self-esteem, depression, and anxiety were measured by well-established self-report questionnaires. Reliability, correlation, and regression analyses were conducted. Results Internal consistency of the WSSQ was acceptable, while good internal consistency was found for the WBIS. Both measures were significantly correlated with each other and body image. While only the WSSQ was correlated with overweight preoccupation, only the WBIS was correlated with appearance evaluation. Both measures were not associated with BMI. However, correlation coefficients did not differ between the WSSQ and the WBIS for all associations with validity measures. Further, both measures significantly predicted quality of life, self-esteem, depression, and anxiety, while the WBIS explained significantly more variance than the WSSQ total score for self-esteem. Conclusions Findings indicate the WSSQ and the WBIS to be reliable and valid assessments of internalized weight stigma in prebariatric surgery patients, although the WBIS showed marginally more favorable results than the WSSQ. For both measures, longitudinal studies on stability and predictive validity are warranted, for example, for weight-related and psychosocial outcomes.
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Affiliation(s)
- Claudia Hübner
- Leipzig University Medical Center, Integrated Research and Treatment Center AdiposityDiseases, Medical Psychology and Medical Sociology, Department of Psychosomatic Medicine and Psychotherapy, Leipzig, Germany
- * E-mail:
| | - Ricarda Schmidt
- Leipzig University Medical Center, Integrated Research and Treatment Center AdiposityDiseases, Medical Psychology and Medical Sociology, Department of Psychosomatic Medicine and Psychotherapy, Leipzig, Germany
| | - Janine Selle
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Hinrich Köhler
- Department of Surgery, Herzogin Elisabeth Hospital, Braunschweig, Germany
| | - Astrid Müller
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Anja Hilbert
- Leipzig University Medical Center, Integrated Research and Treatment Center AdiposityDiseases, Medical Psychology and Medical Sociology, Department of Psychosomatic Medicine and Psychotherapy, Leipzig, Germany
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Wild B, Hünnemeyer K, Sauer H, Hain B, Mack I, Schellberg D, Müller-Stich BP, Weiner R, Meile T, Rudofsky G, Königsrainer A, Zipfel S, Herzog W, Teufel M. A 1-year videoconferencing-based psychoeducational group intervention following bariatric surgery: results of a randomized controlled study. Surg Obes Relat Dis 2015; 11:1349-60. [PMID: 26421929 DOI: 10.1016/j.soard.2015.05.018] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 04/30/2015] [Accepted: 05/28/2015] [Indexed: 01/21/2023]
Abstract
BACKGROUND For severely obese patients, bariatric surgery has been recommended as an effective therapy. OBJECTIVES The Bariataric Surgery and Education (BaSE) study aimed to assess the efficacy of a videoconferencing-based psychoeducational group intervention in patients after bariatric surgery. SETTING The BaSE study is a randomized, controlled multicenter clinical trial involving 117 patients undergoing bariatric surgery (mean preoperative body mass index [BMI] 49.9 kg/m(2), SD 6.4). Patients were enrolled between May 2009 and November 2012 and were randomly assigned to receive either conventional postsurgical visits or, in addition, a videoconferencing-based 1-year group program. METHODS Primary outcome measures were weight in kilograms, health-related quality of life (HRQOL), and general self-efficacy (GSE). Secondary outcome measures were depression symptoms and eating behavior. RESULTS 94% of the patients completed the study. Mean weight loss for all patients was 45.9 kg (SD 16.4) 1 year after surgery (mean excess weight loss [EWL] 63%). Intention-to-treat analyses revealed no differences in weight loss, EWL, HRQOL, or self-efficacy between study groups at 1 year after surgery. However, patients with clinically significant depression symptoms (CSD) at baseline assigned to the intervention group (n = 29) had a significantly better HRQOL (P = .03), lower depression scores (P = .02), and a trend for a better EWL (.06) 1 year after surgery compared with the control group (n = 20). CONCLUSION We could not prove the efficacy of the group program for the whole study sample. However, results indicate that the intervention is effective for the important subgroup of patients with CSD.
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Affiliation(s)
- Beate Wild
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany.
| | - Katharina Hünnemeyer
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany
| | - Helene Sauer
- Department of Psychosomatic Medicine and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Bernhard Hain
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany
| | - Isabelle Mack
- Department of Psychosomatic Medicine and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Dieter Schellberg
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany
| | - Beat Peter Müller-Stich
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Rudolf Weiner
- Department of Surgery, Hospital Sachsenhausen, Heidelberg, Frankfurt
| | - Tobias Meile
- Department of General, Visceral and Transplant Surgery, University of Tübingen, Tübingen, Germany
| | - Gottfried Rudofsky
- Department of Medicine I and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany
| | - Alfred Königsrainer
- Department of General, Visceral and Transplant Surgery, University of Tübingen, Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Wolfgang Herzog
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany
| | - Martin Teufel
- Department of Psychosomatic Medicine and Psychotherapy, University of Tübingen, Tübingen, Germany
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