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Gerend MA, Wilkinson LJ, Sutin AR, Rosado JI, Ehrlich KB, Smith DW, Maner JK. Sociodemographic predictors of perceived weight discrimination. Int J Obes (Lond) 2024:10.1038/s41366-024-01535-1. [PMID: 38740855 DOI: 10.1038/s41366-024-01535-1] [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] [Received: 12/13/2023] [Revised: 04/26/2024] [Accepted: 04/30/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Perceived weight discrimination is associated with increased risk for chronic diseases and reduced life expectancy. Nevertheless, little is known about perceived weight discrimination in racial, ethnic, and sexual minority groups or in individuals at the intersections of those groups. The goal of this study was to identify sociodemographic predictors of perceived weight discrimination. SUBJECTS/METHODS A diverse sample of adults (37% Black/African American, 36% Latino, 29% sexual minority) with a body mass index (BMI) ≥ 18.5 kg/m2 were recruited from a national US panel to complete an online survey (N = 2454). Perceived weight discrimination was assessed with the Stigmatizing Situations Survey-Brief (SSI-B). Using hierarchical linear regression analysis, SSI-B scores were predicted from the four sociodemographic characteristics of interest (gender, race, ethnicity, and sexual orientation) while controlling for BMI, age, education, and income (Step 1). At Step 2, all two-way interactions between the four sociodemographic characteristics were added to the model. RESULTS At Step 1, higher SSI-B scores were observed for Latino (vs. non-Latino) adults, sexual minority (vs. heterosexual) adults, younger (vs. older) adults, adults with higher (vs. lower) levels of education, and adults with higher (vs. lower) BMI. At Step 2, race interacted with gender, ethnicity, and sexual orientation to predict SSI-B scores such that relatively higher scores were observed for non-Black women, Black men, adults who identified as Black and Latino, and non-Black sexual minority adults. CONCLUSIONS Perceived weight discrimination varied across sociodemographic groups, with some subgroups reporting relatively high frequency. Black race appeared to be protective for some subgroups (e.g., Black women), but risk-enhancing for others (e.g., Black men, individuals who identified as Black and Latino). Additional research is needed to identify specific factors that cause certain sociodemographic groups -and indeed, certain individuals-to perceive higher levels of weight discrimination than others.
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Affiliation(s)
- Mary A Gerend
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, FL, USA.
| | | | - Angelina R Sutin
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, FL, USA
| | - Javier I Rosado
- College of Medicine, Florida State University, Immokalee Regional Campus, Immokalee, FL, USA
| | | | - David W Smith
- Cardiology, Southern Medical Group, Tallahassee, FL, USA
| | - Jon K Maner
- Department of Psychology, College of Arts and Sciences, Florida State University, Tallahassee, FL, USA
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Sánchez E, Ciudin A, Sánchez A, Gutiérrez-Medina S, Valdés N, Flores L, Marí-Sanchis A, Goñi F, Sánchez M, Nicolau J, Muñoz C, Díaz-Trastoy O, Cuatrecasas G, Cañizares S, Comas M, López-Cano C, Lecube A. Assessment of obesity stigma and discrimination among Spanish subjects with a wide weight range: the OBESTIGMA study. Front Psychol 2023; 14:1209245. [PMID: 37799531 PMCID: PMC10548879 DOI: 10.3389/fpsyg.2023.1209245] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/04/2023] [Indexed: 10/07/2023] Open
Abstract
Introduction This study aims to assess the extent of rejection and instances of stigmatization linked to obesity within the Spanish population, encompassing a diverse spectrum of weights ranging from normal weight to morbid obesity. Additionally, the study seeks to identify the primary factors influencing these experiences and further examines the impact of bariatric surgery on such dynamics. Materials and methods Multicenter observational study with involving a total of 1,018 participants who were recruited from various Obesity Units. Negatives attitudes towards people with obesity were assessed through three questionnaires: (i) Antifat Attitudes Scale (AFA), (ii) Stigmatizing Situations Inventory (SSI) and (iii) Weight Bias Internalization Scale (WBIS). Subjects were categorized into four groups based on their BMI and history of prior bariatric surgery. Results The cumulative score across all questionnaires (AFA, SSI and WBIS) exhibited a progressive increase, from participants with normal weight to those with obesity (p < 0.001 for all). Within the AFA questionnaire, males showed more rejection towards people with obesity than women, also perceiving obesity as a disease linked to a lack of willpower (p = 0.004 and p = 0.030, respectively). The overall SSI score was negatively associated with age (r = -0.080, p = 0.011), with young participants encountering more stigmatizing experiences than their adult counterparts. Neither employment status nor educational demonstrated a significant association with any of the questionnaires. Interestingly, patients who underwent lost weight following bariatric surgery did not exhibit improved outcomes. Conclusion Individuals with obesity demonstrate a heightened level of aversion towards the disease compared to those with normal weight. Concurrently, the incidence of stigmatizing encounters displays a concerning escalation among younger individuals.
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Affiliation(s)
- Enric Sánchez
- Obesity Unit, Endocrinology and Nutrition Department, University Hospital Arnau de Vilanova de Lleida, Obesity, Diabetes and Metabolism (ODIM) Research Group, IRBLleida, University of Lleida, Lleida, Spain
| | - Andreea Ciudin
- Obesity Unit, Endocrinology and Nutrition Department, Hospital Universitari Vall d’Hebrón, Vall d’Hebron Research Institute, Autonomous University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Ana Sánchez
- Obesity Unit, Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain
| | - Sonsoles Gutiérrez-Medina
- Obesity Unit, Endocrinology and Nutrition Department, Hospital Universitario Rey Juan Carlos, Madrid, Spain
| | - Nuria Valdés
- Obesity Unit, Endocrinology and Nutrition Department, Hospital Universitario de Cabueñes, Gijón, Spain
| | - Lilliam Flores
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Obesity Unit, Endocrinology and Nutrition Department, Hospital Clínic Barcelona, Barcelona, Spain
| | - Amelia Marí-Sanchis
- Obesity Unit, Endocrinology and Nutrition Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - Fernando Goñi
- Obesity Unit, Endocrinology and Nutrition Department, Hospital Universitario de Basurto, Bilbao, Spain
| | - Marta Sánchez
- Obesity Unit, Endocrinology and Nutrition Department, Hospital Universitario Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Joana Nicolau
- Obesity Unit, Endocrinology and Nutrition Department, Hospital Universitario Son Llàtzer, Palma, Spain
| | - Concepción Muñoz
- Obesity Unit, Endocrinology and Nutrition Department, Hospital Universitario Reina Sofia de Córdoba, Córdoba, Spain
| | - Olaia Díaz-Trastoy
- Obesity Unit, Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - Guillem Cuatrecasas
- Obesity Unit, Endocrinology and Nutrition Department, Clínica Sagrada Familia-CPEN Barcelona, Health Science Department, UOC University, Barcelona, Spain
| | - Silvia Cañizares
- Obesity Unit, Psychiatry and Psycology Department, Hospital Clínic Barcelona, Barcelona, Spain
- Clinical Psycology and Psycobiology Department, Universitat de Barcelona, Barcelona, Spain
| | - Marta Comas
- Obesity Unit, Endocrinology and Nutrition Department, Hospital Universitari Vall d’Hebrón, Vall d’Hebron Research Institute, Autonomous University of Barcelona, Barcelona, Spain
| | - Carolina López-Cano
- Obesity Unit, Endocrinology and Nutrition Department, University Hospital Arnau de Vilanova de Lleida, Obesity, Diabetes and Metabolism (ODIM) Research Group, IRBLleida, University of Lleida, Lleida, Spain
| | - Albert Lecube
- Obesity Unit, Endocrinology and Nutrition Department, University Hospital Arnau de Vilanova de Lleida, Obesity, Diabetes and Metabolism (ODIM) Research Group, IRBLleida, University of Lleida, Lleida, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
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Hackett RA, Jackson SE, Corker E, Steptoe A. The role of stress and health behaviour in linking weight discrimination and health: a secondary data analysis in England. BMJ Open 2023; 13:e072043. [PMID: 37709322 PMCID: PMC10503332 DOI: 10.1136/bmjopen-2023-072043] [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: 01/23/2023] [Accepted: 08/29/2023] [Indexed: 09/16/2023] Open
Abstract
OBJECTIVE To examine the role of stress and health-risk behaviours in relationships between weight discrimination and health and well-being. DESIGN Secondary data analysis of an observational cohort study. SETTING The English Longitudinal Study of Ageing. PARTICIPANTS Data were from 4341 adults (≥50 years) with overweight/obesity. PRIMARY OUTCOME MEASURES We tested associations between perceived weight discrimination at baseline (2010/2011) and self-rated health, limiting long-standing illness, depressive symptoms, quality of life and life satisfaction over 4-year follow-up (2010/2011; 2014/2015). Potential mediation by stress exposure (hair cortisol) and health-risk behaviours (smoking, physical inactivity, alcohol consumption) was assessed. RESULTS Cross-sectionally, perceived weight discrimination was associated with higher odds of fair/poor self-rated health (OR=2.05 (95% CI 1.49 to 2.82)), limiting long-standing illness (OR=1.76 (95% CI 1.29 to 2.41)) and depressive symptoms (OR=2.01 (95% CI 1.41 to 2.85)) and lower quality of life (B=-5.82 (95% CI -7.01 to -4.62)) and life satisfaction (B=-2.36 (95% CI -3.25 to -1.47)). Prospectively, weight discrimination was associated with higher odds of fair/poor self-rated health (OR=1.63 (95% CI 1.10 to 2.40)) and depressive symptoms (OR=2.37 (95% CI 1.57 to 3.60)) adjusting for baseline status. Those who reported discrimination had higher hair cortisol concentrations (B=0.14 (95% CI 0.03 to 0.25)) and higher odds of physical inactivity (OR=1.90 (95% CI 1.18 to 3.05)). These variables did not significantly mediate associations between discrimination and health outcomes. CONCLUSIONS Weight discrimination is associated with poor health and well-being. While this discrimination is associated with stress exposure and physical inactivity, these variables explain little of the association between discrimination and poorer outcomes.
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Affiliation(s)
- Ruth A Hackett
- Health Psychology Section, Department of Psychology, King's College London, London, UK
| | - Sarah E Jackson
- Department of Behavioural Science and Health, University College London, London, UK
| | - Elizabeth Corker
- Clinical, Educational and Health Psychology, University College London, London, UK
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Andrew Steptoe
- Department of Behavioural Science and Health, University College London, London, UK
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Gerend MA, Zetrenne S, Sutin AR, Naar S, Maner JK. Weight Discrimination and Health Risk Behavior in Racial, Ethnic, and Sexual Minority Adults. Ann Behav Med 2023; 57:571-581. [PMID: 37061832 DOI: 10.1093/abm/kaad003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2023] Open
Abstract
BACKGROUND People with obesity face significant discrimination due to their weight. Exposure to such discrimination is associated with poor health outcomes. Little is known about pathways that explain that association, and even less is known about those pathways in racial, ethnic, and sexual minorities. Health risk behaviors may serve as one such pathway. PURPOSE We examined associations between weight discrimination and health risk behaviors and assessed whether associations are moderated by gender, race, ethnicity, or sexual orientation. METHODS Quota sampling was used to oversample Black (36%), Latino (36%), and sexual minority (29%) adults (n = 2,632) who completed an online survey. Using regression analysis, health risk behaviors (maladaptive eating behaviors, physical inactivity, sitting, smoking, alcohol use, and sleep disturbance) were predicted from previous experience with weight discrimination while controlling for demographic characteristics, BMI, and depressive symptoms. Additional analyses tested for interactions between weight discrimination and key demographic variables (i.e., gender, race, ethnicity, and sexual minority status). RESULTS Weight discrimination was associated with greater emotional eating, binge eating, unhealthy weight control behaviors, cigarette smoking, problematic alcohol use, and sleep disturbance. Gender moderated the association between weight discrimination and binge eating, alcohol use, and physical activity, with stronger effects observed in men than women. Exploratory analyses provided limited evidence for differential effects of weight discrimination across specific combinations of intersecting identities. CONCLUSIONS Weight discrimination was associated with engagement in unhealthy behaviors and relationships were largely similar across diverse demographic groups. Health risk behaviors may represent a key pathway through which weight discrimination harms health.
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Affiliation(s)
- Mary A Gerend
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, FL, USA
| | | | - Angelina R Sutin
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, FL, USA
| | - Sylvie Naar
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, FL, USA
| | - Jon K Maner
- Department of Psychology, College of Arts and Sciences, Florida State University, Tallahassee, FL, USA
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Johnson SN, Forbush KT, Swanson TJ. The impact of discrimination on binge eating in a nationally representative sample of Latine individuals. Int J Eat Disord 2022; 55:1120-1129. [PMID: 35796067 DOI: 10.1002/eat.23773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/13/2022] [Accepted: 06/16/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Latines have higher rates of eating disorders characterized by binge eating compared to their non-Latine white counterparts, yet culturally and socially relevant factors related to binge eating in Latines have been largely understudied. The purpose of the current study was to examine how discrimination and acculturative stress were associated with binge eating in a nationally representative sample of Latines. An additional aim was to test the extent to which family cohesion and social support could buffer against the effects of discrimination and acculturative stress on binge eating. METHOD Participants (56% female, N = 2550) were Latines enrolled in the National Latino and Asian American Study. Structural equation modeling using 1000 re-sampled data sets built from machine learning iterative sampling procedures was used to examine the effects of discrimination, acculturative stress, family cohesion, and social support on binge eating. RESULTS Results indicated that only discrimination was significantly associated with binge eating. Neither the direct effect of acculturative stress, interaction of family cohesion and acculturative stress, interaction of social cohesion and acculturative stress, nor the interaction of social support and discrimination were significantly associated with binge eating. DISCUSSION This study highlights the need for mental-health providers to understand and assess discrimination among Latines presenting with concerns of binge eating. Treatments that effectively provide coping strategies to manage discriminatory experiences and reduce binge eating could improve both effectiveness of treatment and retention rates for Latine individuals with binge eating. PUBLIC SIGNIFICANCE This study examined the association of discrimination, acculturative stress, family cohesion, and social support with binge eating in Latines. Only discrimination was significantly associated with binge eating, highlighting the importance for providers to assess discrimination among Latines with binge-eating concerns and to improve equity, inclusion, and belonging at a societal level. Modifying existing treatments to address coping with discrimination could improve the effectiveness for Latines with binge-eating concerns.
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Affiliation(s)
- Sarah N Johnson
- Department of Psychology, University of Kansas, Lawrence, Kansas, USA
| | - Kelsie T Forbush
- Department of Psychology, University of Kansas, Lawrence, Kansas, USA
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Hooper L, Puhl R, Eisenberg ME, Reicks M, Neumark-Sztainer D. How is weight teasing cross-sectionally and longitudinally associated with health behaviors and weight status among ethnically/racially and socioeconomically diverse young people? Int J Behav Nutr Phys Act 2022; 19:71. [PMID: 35739552 PMCID: PMC9219184 DOI: 10.1186/s12966-022-01307-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 05/31/2022] [Indexed: 11/24/2022] Open
Abstract
Background Weight stigma is prevalent among young people and harmful to health. The current study used a health equity lens to examine cross-sectional and longitudinal associations between experiencing weight teasing (a form of weight stigma) with a range of weight-related health behaviors and weight status in an ethnically/racially and socioeconomically diverse sample of young people. We also assessed whether ethnicity/race and adolescent socioeconomic status (SES) operated as effect modifiers in these relationships. Methods Adolescents (n = 1568) were enrolled in EAT 2010–2018 (Eating and Activity over Time) and followed into young adulthood. Weight teasing; screen time; moderate-to-vigorous physical activity (MVPA); sleep duration; breakfast frequency; fruit, vegetable, sugar-sweetened beverage (SSB), and fast-food intake; and body mass index (BMI) were assessed at baseline (mean age = 14.4 years) and eight-year follow-up (mean age = 22.2 years). Multivariate linear regression estimated marginal means and 95% confidence intervals. All analyses adjusted for BMI and sociodemographic characteristics. Results Weight teasing was cross-sectionally associated with longer screen time, shorter sleep duration, and higher BMI during adolescence; and cross-sectionally associated with shorter sleep duration, lower breakfast frequency, higher fast-food intake, higher SSB intake, and higher BMI during young adulthood. In the longitudinal analyses, weight teasing was not associated with health behaviors but did predict higher BMI (teased: 28.2 kg/m2, not teased: 26.4 kg/m2, p < 0.001). White and higher adolescent SES subgroups had higher MVPA, more frequent breakfast intake, lower fast-food intake, and lower BMI than their respective counterparts. The relationships between weight teasing and health behaviors and weight status were largely consistent across ethnic/racial and adolescent SES subgroups. Conclusions Findings add to growing evidence that weight-based mistreatment poses a threat to weight-related health and that young people across ethnic/racial and SES subgroups are vulnerable to the negative effects of weight teasing. Limitations include attrition at follow-up and the self-reported nature of many measures. Results suggest a need for increased attention to existing recommendations to reduce weight stigma in young people from diverse ethnic/racial and socioeconomic backgrounds including training for healthcare providers to better equip them to address the harms of weight teasing and foster more compassionate care to promote health-supporting behaviors in young people. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-022-01307-y.
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Affiliation(s)
- Laura Hooper
- Division of Epidemiology and Community Health, University of Minnesota, Suite 300, 1300 S, 2nd St., Minneapolis, MN, 55454-1015, USA. .,Department of Food Science and Nutrition, University of Minnesota, 225 Food Science and Nutrition, 1334 Eckles Ave, St. Paul, MN, 55108, USA.
| | - Rebecca Puhl
- Department of Human Development & Family Sciences, College of Liberal Arts and Sciences, University of Connecticut, 348 Mansfield Road, U-1058, Storrs, CT, 06269-1058, USA
| | - Marla E Eisenberg
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, 717 Delaware Street SE, 3rd Floor, Minneapolis, MN, 55414, USA
| | - Marla Reicks
- Department of Food Science and Nutrition, University of Minnesota, 225 Food Science and Nutrition, 1334 Eckles Ave, St. Paul, MN, 55108, USA
| | - Dianne Neumark-Sztainer
- Division of Epidemiology and Community Health, University of Minnesota, Suite 300, 1300 S, 2nd St., Minneapolis, MN, 55454-1015, USA
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Bray B, Bray C, Bradley R, Zwickey H. Binge Eating Disorder Is a Social Justice Issue: A Cross-Sectional Mixed-Methods Study of Binge Eating Disorder Experts' Opinions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6243. [PMID: 35627779 PMCID: PMC9141064 DOI: 10.3390/ijerph19106243] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/14/2022] [Accepted: 05/17/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Binge eating disorder is an autonomous DSM-V diagnosis characterized by discrete rapid consumption of objectively large amounts of food without compensation, associated with loss of control and distress. Environmental factors that contribute to binge eating disorder continue to evolve. This mixed-methods cross-sectional study assessed whether there is consensus among experts in the field about environmental factors that influence adult binge eating disorder pathology. METHODS Fourteen expert binge eating disorder researchers, clinicians, and healthcare administrators were identified internationally based on federal funding, PubMed-indexed publications, active practice in the field, leadership in relevant societies, and/or clinical and popular press distinction. Semi-structured interviews were recorded anonymously and analyzed by ≥2 investigators using reflexive thematic analysis and quantification. RESULTS Identified themes included: (1) systemic issues and systems of oppression (100%); (2) marginalized and under-represented populations (100%); (3) economic precarity and food/nutrition insecurity/scarcity (93%); (4) stigmatization and its psychological impacts (93%); (5) trauma and adversity (79%); (6) interpersonal factors (64%); (7) social messaging and social media (50%); (8) predatory food industry practices (29%); and (9) research/clinical gaps and directives (100%). CONCLUSIONS Overall, experts call for policy changes around systemic factors that abet binge eating and for greater public education about who can have binge eating disorder. There is also a call to take and account for the narratives and life experiences of individuals with binge eating disorder to better inform our current understanding of the diagnosis and the environmental factors that impact it.
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Affiliation(s)
- Brenna Bray
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR 97201, USA; (R.B.); (H.Z.)
| | - Chris Bray
- Wilder Research Division, Amherst H. Wilder Foundation, Saint Paul, MN 55104, USA;
| | - Ryan Bradley
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR 97201, USA; (R.B.); (H.Z.)
- Herbert Wertheim School of Public Health, University of California, San Diego, CA 97037, USA
| | - Heather Zwickey
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR 97201, USA; (R.B.); (H.Z.)
- Herbert Wertheim School of Public Health, University of California, San Diego, CA 97037, USA
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Yoon CY, Hazzard VM, Emery RL, Mason SM, Neumark-Sztainer D. Everyday discrimination as a predictor of maladaptive and adaptive eating: Findings from EAT 2018. Appetite 2022; 170:105878. [PMID: 34952131 PMCID: PMC8761174 DOI: 10.1016/j.appet.2021.105878] [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] [Received: 10/22/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 01/25/2023]
Abstract
Various types of stressors are associated with maladaptive eating, but how the stressor of everyday discrimination (e.g., less respect, poorer service) relates to maladaptive eating and adaptive eating remains unclear. We examined everyday discrimination as a predictor of maladaptive and adaptive eating. Data were collected in a population-based study, Eating and Activity over Time (N = 1410, ages 18-30). Everyday discrimination was categorized as none, low, moderate, or high. Outcomes included maladaptive eating (i.e., overeating and binge eating) and adaptive eating (i.e., intuitive eating and mindful eating). Modified Poisson regressions estimated the prevalence ratios (PRs) for overeating and binge eating associated with everyday discrimination. Linear regressions estimated associations between everyday discrimination and intuitive and mindful eating scores. After adjustment for age, ethnicity/race, gender, and socioeconomic status, moderate and high levels of discriminatory experiences were each associated with a significantly greater prevalence of binge eating (PR = 2.2, [95% CI = 1.3-3.7] and PR = 3.1, [95% CI = 2.0-4.7], respectively) and lower intuitive (β = -0.4, [95% CI = -0.7, -0.2] and β = -0.5 [95% CI = -0.8, -0.3], respectively), and mindful eating scores (β = -0.3, [95% CI = -0.6, -0.1] and β = -0.5 [95% CI = -0.8, -0.3], respectively) compared to young adults with no discriminatory experience. Public health efforts to prevent maladaptive eating and encourage the adoption of adaptive eating should consider the potential contribution of everyday discrimination and the need to advocate for equity and inclusion.
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Affiliation(s)
- Cynthia Y. Yoon
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA 55454,University of Houston, Department of Health and Human Performance, Houston, Texas, 77204
| | - Vivienne M. Hazzard
- Sanford Center for Biobehavioral Research, 120 Eight St S, Fargo, ND 58103, USA
| | - Rebecca L. Emery
- University of Minnesota Medical School, Duluth campus, Department of Family Medicine and Biobehavioral Health, Duluth, Minnesota, 55812
| | - Susan M. Mason
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA 55454
| | - Dianne Neumark-Sztainer
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA 55454
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Alvarenga MDS, Obara AA, Takeda GA, Ferreira-Vivolo SRG. Anti-fat attitudes of Nutrition undergraduates in Brazil toward individuals with obesity. CIENCIA & SAUDE COLETIVA 2022; 27:747-760. [DOI: 10.1590/1413-81232022272.02342021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 03/15/2021] [Indexed: 11/22/2022] Open
Abstract
Abstract Obesity-related prejudice and discrimination may have a source in health professionals and students. The objective was to assess anti-fat attitudes among Brazilian nutrition undergraduates who reported demographic data, weight, height and responded the Antifat Attitudes Test (AFAT) and the Brazilian Silhouette Scales to assess body image satisfaction and perception. Total and subscales of AFAT scores were compared among categories using the Mann-Whitney U test. Associations of participants’ characteristics with the AFAT were analyzed using multiple linear regression. Total AFAT score was positively associated with male sex (ß: .13; p < .001), age (ß: .06; p < .001), educational institution outside capital (ß: .03; p < .05), private institutions (ß: .08; p < .001); and negatively associated with income (ß: -.05; p = .006), participants who perceived themselves with increased BMI (ß: -.15; p < .001) and those at the third year of course (ß: -.05; p = .041). Subscales scores were positively associated with male sex and age; and negatively associated with those who perceived themselves heavier. They have anti-fat attitudes especially if they were man, older, from private institutions, are at the beginning of the course, and have lower household income - and less weight bias if they perceived with increased BMI.
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The roles of weight stigma, emotion dysregulation, and eating pathology in suicide risk. Body Image 2021; 38:162-170. [PMID: 33892440 DOI: 10.1016/j.bodyim.2021.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 04/10/2021] [Accepted: 04/11/2021] [Indexed: 11/24/2022]
Abstract
Using an interpersonal theory of suicide and affect regulation framework, we investigated the relationships between perceived burdensomeness, thwarted belongingness, weight stigmatization, emotion dysregulation, eating pathology, and suicide risk. Three main hypotheses were investigated. First, we predicted a positive linear relationship between weight stigmatization and risk. Second, an indirect effect of weight stigmatization on risk via perceived burdensomeness and thwarted belongingness was posited. Third, we hypothesized that weight stigmatization would indirectly affect suicide risk via emotion dysregulation and eating pathology. Undergraduates (N = 156) completed online surveys. Linear regressions and indirect effect analyses were performed. Weight stigmatization was directly, positively associated with increased suicide risk. Weight stigmatization indirectly affected suicide risk via perceived burdensomeness but not thwarted belongingness. Higher stigmatization was associated with higher levels of perceived burdensomeness, which was associated with higher risk. An indirect effect of weight stigmatization on suicide risk through emotional dysregulation emerged. Higher weight stigmatization was associated with higher emotional dysregulation, which was associated with higher suicide risk. When all models were combined, only an indirect effect via perceived burdensomeness remained. Our findings may have clinical and public health implications for suicide prevention among people with weight stigma-related risk factors.
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Examining the impact of perceived weight discrimination on reported eating and exercise among White and Latino/a adults. Eat Behav 2021; 42:101529. [PMID: 34023666 DOI: 10.1016/j.eatbeh.2021.101529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 03/20/2021] [Accepted: 05/10/2021] [Indexed: 11/20/2022]
Abstract
A large body of research suggests that, among White individuals, perceived weight discrimination has deleterious consequences for eating and exercise outcomes; however, the research literature on perceived weight discrimination among other racial/ethnic groups is limited. The primary goal of the present study was to examine the associations of perceived weight discrimination with eating and exercise thoughts and behaviors among White versus Latino/a participants. A sample of White (N = 50) and Latino/a (N = 281) undergraduate college students with higher body weight (BMI: M = 30.65, SD = 5.42) completed self-report measures assessing perceived weight-based discrimination, frequency of intake of unhealthy and healthy foods, and frequency of both thoughts about exercise and exercise behaviors; we examined relationships among these variables within White versus Latino/a participants. Results showed that perceived weight discrimination was associated with more frequent intake of unhealthy foods, more frequent exercise thoughts, and less frequent exercise behaviors among White participants, and that there were no significant associations between perceived weight discrimination and the eating and exercise measures of interest among Latino/a participants. These findings highlight a number of potential avenues for future research to identify the mechanisms underlying these differential associations of perceived weight discrimination to eating and exercise behaviors across racial/ethnic groups.
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12
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Molina K, Baskin ML, Long D, Carson TL. Psychological and behavioral pathways between perceived stress and weight change in a behavioral weight loss intervention. J Behav Med 2021; 44:822-832. [PMID: 34003418 DOI: 10.1007/s10865-021-00231-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 05/07/2021] [Indexed: 11/30/2022]
Abstract
Black women have a higher prevalence of obesity and tend to have suboptimal outcomes in behavioral weight loss programs for reasons that are not fully understood. Studies have shown a potential relationship between perceived psychological stress and weight loss in behavioral interventions. This study sought to assess whether baseline stress was directly or indirectly associated with 6-month weight change among Black women participating in a behavioral weight loss study. Indirect pathways of interest included depressive symptoms and dietary intake. A secondary analysis of data (n = 409) collected from a cluster, randomized behavioral weight loss trial was conducted. Demographics, anthropometry, surveys, and dietary data were collected at baseline and 6 months. Path analysis was used to test for direct and indirect effects of baseline stress on 6-month weight change while controlling for sociodemographic factors and intervention group. Baseline stress was not directly associated with 6-month weight change nor was it indirectly associated via depressive symptoms in the adjusted model. However, each of the direct paths linking baseline stress to weight loss were statistically significant. Stress was not associated with 6-month weight change via dietary intake. Baseline stress was positively associated with 6-month depressive symptoms which in turn was associated with less weight change. Depressive symptoms may offer an additional psychosocial target to consider when designing behavioral weight loss interventions for Black women.
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Affiliation(s)
- Kristine Molina
- Department of Psychological Sciences, University of California Irvine, Irvine, CA, USA
| | - Monica L Baskin
- School of Medicine, Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
- Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Dustin Long
- School of Public Health, Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tiffany L Carson
- Department of Health Outcomes and Behavior, Division of Population Sciences, H. Lee Moffitt Cancer Center & Research Institute, MFC-EDU, 12902 Magnolia Drive, Tampa, FL, 33612, USA.
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
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Donofry SD, Emery RL, Kolko Conlon RP, Germeroth LJ, Wang B, Cheng Y, Levine MD. Documenting the course of loss of control over eating prior to, during and after pregnancy among women with pre-pregnancy overweight and obesity. Int J Eat Disord 2021; 54:633-638. [PMID: 33368433 PMCID: PMC8561745 DOI: 10.1002/eat.23454] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 12/10/2020] [Accepted: 12/12/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Loss of control over eating (LOC) is common among women, particularly those with overweight and obesity (OV/OB), and predicts weight gain. Given the importance of understanding weight and eating behaviors during pregnancy, we sought to characterize LOC across pregnancy and the postpartum period among women with pre-pregnancy OV/OB. METHODS Pregnant women (N = 257; 28.44 ± 5.48 years old) with self-reported OV/OB prior to pregnancy were interviewed using a pregnancy-adapted version of the Eating Disorder Examination (EDE-PV). Pre-pregnancy LOC was retrospectively assessed during the first trimester and then prospectively assessed monthly throughout pregnancy and postpartum over the course of seven assessments. RESULTS Rates of LOC were significantly higher during pregnancy compared to prior to ( χ12 =44.845, p < .01) and after ( χ12 =36.379, p < .01) pregnancy, with 37% (n = 95) of women reporting ≥1 LOC episode during pregnancy. LOC during pregnancy was associated with higher likelihood of LOC postpartum. Higher age (OR = 1.084, p = .04) and identifying as a minority (OR = 0.344, p = .02) was associated with greater likelihood of experiencing LOC during pregnancy only. DISCUSSION LOC during pregnancy is common among women with pre-pregnancy OV/OB, suggesting that screening and intervention for LOC during pregnancy may be warranted. Future research is necessary to examine the relationship between LOC during pregnancy and maternal and infant health outcomes.
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Affiliation(s)
- Shannon D. Donofry
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania,Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Rebecca L. Emery
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Rachel P. Kolko Conlon
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Lisa J. Germeroth
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Bang Wang
- Department of Statistics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Yu Cheng
- Department of Statistics, University of Pittsburgh, Pittsburgh, Pennsylvania,Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michele D. Levine
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania,Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania,Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
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Siqueira BB, Assumpção MC, Barroso SM, Japur CC, Penaforte FRDO. Weight stigma and health – Repercussions on the health of adolescents and adults: integrative review of the literature. JORNAL BRASILEIRO DE PSIQUIATRIA 2021. [DOI: 10.1590/0047-2085000000324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ABSTRACT Objective To conduct an integrative review in order to understand the repercussions of the social stigma of overweight on the health of adults and adolescents. Methods The international protocol for systematic review and meta-analysis studies PRISMA was adopted to guide the writing of this review. The databases used were PubMed, Psycinfo, SciELO, Medline, Lilacs and Pepsic, considering studies published in the period from 2000 to 2020. Sixty-seven (67) articles were analyzed, and 4 categories emerged: repercussions on physical well-being; repercussions on social well-being; repercussions on mental well-being; and mixed category (physical and psychological impact). Results In the vast majority of studies analyzed, weight stigma had a negative impact on the different spheres that make up the health construct, that is, the physical, social and mental spheres. Conclusions The consequences of weight stigma are a source of intense suffering, with an impact that reduces the quality of life of individuals who experience stigmatization, involving physical, emotional and social aspects.
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15
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Davies A, Burnette CB, Mazzeo SE. Real women have (just the right) curves: investigating anti-thin bias in college women. Eat Weight Disord 2020; 25:1711-1718. [PMID: 31701378 DOI: 10.1007/s40519-019-00812-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 10/28/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Weight stigma is associated with negative mental and physical health outcomes across the body mass index (BMI) continuum. However, few studies have examined discrimination experienced by people with low body weights. OBJECTIVES This study explored the presence of anti-thin bias, defined as the belief that individuals at lower body weights have undesirable personality characteristics, in young adult women. Additionally, we examined perceived etiology of weight for women with underweight. METHOD Participants (N =295 women, age 18.84 ± 2.32) were randomly assigned to read one of the six vignettes about women who differed by race (White and Black) and BMI status (slightly underweight, average weight, and slightly overweight). RESULTS Negative personality characteristics were more likely to be ascribed to vignette characters with under- or overweight BMIs, compared to characters with average weight BMIs. Participants were more likely to attribute underweight characters' body weight to an eating disorder (ED) compared with average or overweight characters. CONCLUSION Results suggest that women with under- or overweight BMIs experience greater stigmatization for their body weight than women with average BMIs, underscoring the need for research to investigate weight discrimination across the weight spectrum. LEVEL OF EVIDENCE Level I, experimental study.
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Affiliation(s)
- Alexandria Davies
- Department of Psychology, Virginia Commonwealth University, P.O. Box 842018, Richmond, VA, 23284-2018, USA.
| | - C Blair Burnette
- Department of Psychology, Virginia Commonwealth University, P.O. Box 842018, Richmond, VA, 23284-2018, USA
| | - Suzanne E Mazzeo
- Department of Psychology, Virginia Commonwealth University, P.O. Box 842018, Richmond, VA, 23284-2018, USA
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Wiss DA, Avena N, Gold M. Food Addiction and Psychosocial Adversity: Biological Embedding, Contextual Factors, and Public Health Implications. Nutrients 2020; 12:E3521. [PMID: 33207612 PMCID: PMC7698089 DOI: 10.3390/nu12113521] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/12/2020] [Accepted: 11/13/2020] [Indexed: 12/13/2022] Open
Abstract
The role of stress, trauma, and adversity particularly early in life has been identified as a contributing factor in both drug and food addictions. While links between traumatic stress and substance use disorders are well documented, the pathways to food addiction and obesity are less established. This review focuses on psychosocial and neurobiological factors that may increase risk for addiction-like behaviors and ultimately increase BMI over the lifespan. Early childhood and adolescent adversity can induce long-lasting alterations in the glucocorticoid and dopamine systems that lead to increased addiction vulnerability later in life. Allostatic load, the hypothalamic-pituitary-adrenal axis, and emerging data on epigenetics in the context of biological embedding are highlighted. A conceptual model for food addiction is proposed, which integrates data on the biological embedding of adversity as well as upstream psychological, social, and environmental factors. Dietary restraint as a feature of disordered eating is discussed as an important contextual factor related to food addiction. Discussion of various public health and policy considerations are based on the concept that improved knowledge of biopsychosocial mechanisms contributing to food addiction may decrease stigma associated with obesity and disordered eating behavior.
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Affiliation(s)
- David A. Wiss
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA 90095, USA;
| | - Nicole Avena
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA;
- Department of Psychology, Princeton University, Princeton, NJ 08540, USA
| | - Mark Gold
- School of Medicine, Washington University in St. Louis, St. Louis, MO 63130, USA
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Prediction of the Influential Factors on Eating Behaviors: A Hybrid Model of Structural Equation Modelling-Artificial Neural Networks. ScientificWorldJournal 2020; 2020:4194293. [PMID: 32508538 PMCID: PMC7251460 DOI: 10.1155/2020/4194293] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 03/16/2020] [Accepted: 04/21/2020] [Indexed: 11/18/2022] Open
Abstract
The importance of eating behavior risk factors in the primary prevention of obesity has been established. Researchers mostly use the linear model to determine associations among these risk factors. However, in reality, the presence of nonlinearity among these factors causes a bias in the prediction models. The aim of this study was to explore the potential of a hybrid model to predict the eating behaviors. The hybrid model of structural equation modelling (SEM) and artificial neural networks (ANN) was applied to evaluate the prediction model. The SEM analysis was used to check the relationship of the emotional eating scale (EES), body shape concern (BSC), and body appreciation scale (BAS) and their effect on different categories of eating behavior patterns (EBP). In the second step, the input and output required for ANN analysis were obtained from SEM analysis and were applied in the neural network model. 340 university students participated in this study. The hybrid model (SEM-ANN) was conducted using multilayer perceptron (MLP) with feed-forward network topology. Moreover, Levenberg–Marquardt, which is a supervised learning model, was applied as a learning method for MLP training. The tangent/sigmoid function was used for the input layer, while the linear function was applied for the output layer. The coefficient of determination (R2) and mean square error (MSE) were calculated. Using the hybrid model, the optimal network happened at MLP 3-17-8. It was proved that the hybrid model was superior to SEM methods because the R2 of the model was increased by 27%, while the MSE was decreased by 9.6%. Moreover, it was found that BSC, BAS, and EES significantly affected healthy and unhealthy eating behavior patterns. Thus, a hybrid approach could be suggested as a significant methodological contribution from a machine learning standpoint, and it can be implemented as software to predict models with the highest accuracy.
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18
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Sutin AR, Stephan Y, Robinson E, Daly M, Terracciano A. Body-related discrimination and dieting and substance use behaviors in adolescence. Appetite 2020; 151:104689. [PMID: 32247897 DOI: 10.1016/j.appet.2020.104689] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/20/2020] [Accepted: 03/26/2020] [Indexed: 11/17/2022]
Abstract
Unfair treatment on the basis of a physical characteristic, such as body weight, is associated with unhealthy dieting behaviors in adolescence and adulthood and has also been implicated in substance use. Peer victimization is likewise associated with these health-risk behaviors. It is unclear, however, whether body discrimination is associated with these behaviors independent of peer victimization. The present research uses data from the Longitudinal Study of Australian Children (LSAC) to test the relation between body discrimination and dieting and substance use behaviors in adolescence and test whether the associations are independent of peer victimization, as well as depressive symptoms which are associated with both forms of victimization and health-risk behaviors. Participants (N = 2955) reported on body discrimination, dieting behaviors, and substance use at ages 14-15. Participants who experienced body discrimination were more likely to report fear of gaining weight, losing control over eating, going without eating, using medicine or vomiting to control their weight, engaging in restrained eating, and exercising to control their weight. They also had tried nicotine, alcohol, and marijuana. The associations with eating and alcohol use were independent of peer victimization, whereas the associations with smoking and marijuana were reduced when peer victimization was included in the model. All associations were also independent of depressive symptoms. Overall, the findings suggest that body discrimination is associated with harmful health behaviors at least as early as age 14.
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19
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Hackett RA, Steptoe A, Lang RP, Jackson SE. Disability discrimination and well-being in the United Kingdom: a prospective cohort study. BMJ Open 2020; 10:e035714. [PMID: 32169928 PMCID: PMC7069317 DOI: 10.1136/bmjopen-2019-035714] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Disability discrimination is linked with poorer well-being cross-sectionally. The aim of this study was to explore prospective associations between disability discrimination and well-being. DESIGN Prospective cohort study. SETTING The United Kingdom Household Longitudinal Study. PARTICIPANTS Data were from 871 individuals with a self-reported physical, cognitive or sensory disability. PRIMARY OUTCOME MEASURES Depression was assessed in 2009/10. Psychological distress, mental functioning, life satisfaction and self-rated health were assessed in 2009/10 and 2013/14. RESULTS Data were analysed using linear and logistic regression with adjustment for age, sex, household income, education, ethnicity and impairment category. Perceived disability discrimination was reported by 117 (13.4%) participants. Cross-sectionally, discrimination was associated with depression (OR=5.40, 95% CI 3.25 to 8.97) fair/poor self-rated health (OR=2.05; 95% CI 1.19 to 3.51), greater psychological distress (B=3.28, 95% CI 2.41 to 4.14), poorer mental functioning (B=-7.35; 95% CI -9.70 to -5.02) and life satisfaction (B=-1.27, 95% CI -1.66 to -0.87). Prospectively, discrimination was associated with increased psychological distress (B=2.88, 95% CI 1.39 to 4.36) and poorer mental functioning (B=-5.12; 95% CI -8.91 to -1.34), adjusting for baseline scores. CONCLUSIONS Perceived disability-related discrimination is linked with poorer well-being. These findings underscore the need for interventions to combat disability discrimination.
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Affiliation(s)
- Ruth A Hackett
- Health Psychology Section, King's College London, London, UK
- Behavioural Science and Health, University College London, London, UK
| | - Andrew Steptoe
- Behavioural Science and Health, University College London, London, UK
| | - Raymond P Lang
- Leonard Cheshire Research Centre, Epidemiology and Public Health, University College London, London, UK
| | - Sarah E Jackson
- Behavioural Science and Health, University College London, London, UK
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20
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Tarozo M, Pessa RP. Impacto das Consequências Psicossociais do Estigma do Peso no Tratamento da Obesidade: uma Revisão Integrativa da Literatura. PSICOLOGIA: CIÊNCIA E PROFISSÃO 2020. [DOI: 10.1590/1982-3703003190910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Trata-se de uma revisão integrativa da literatura, cujo objetivo foi investigar as consequências psicossociais do estigma do peso em adultos e sua influência no tratamento da obesidade. A busca envolveu as bases de dados PubMed, Web of Science e PsycINFO e incluiu artigos em inglês e português publicados nos últimos cinco anos. Foram selecionados quinze artigos, analisados a partir da definição de dois subtemas: “A relação entre estigma, psicopatologias e transtornos do comportamento alimentar” e “A estigmatização entre os profissionais de saúde”. Os resultados apontam para o grande impacto do estigma do peso na saúde psicossocial da pessoa com obesidade e para as atitudes estigmatizantes dos profissionais de saúde no cuidado terapêutico. Observa-se um enfoque patológico do enfrentamento da obesidade com estratégias de cunho comportamental que minimizam a compreensão da problemática. Atualmente, o tratamento da obesidade promovido pelo modelo biomédico não abrange as demandas de caráter psicossocial, o que torna necessário a educação permanente para capacitação dos profissionais de saúde e a implementação de protocolos de intervenção específicos a este grupo populacional. A contribuição de profissionais de diversas áreas, e em especial, daqueles de saúde mental, é essencial em atenção às diferentes particularidades do tratamento, devendo ser baseada em uma perspectiva integral e humanizada, e inserida nos diferentes contextos psicossociais. Devido à perversidade do estigma do peso e suas graves consequências, futuros estudos são necessários para investigação desse problema e das atitudes dos profissionais da saúde, familiares, mídia e da população em geral em relação à pessoa com obesidade.
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21
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Health risk behaviours and allostatic load: A systematic review. Neurosci Biobehav Rev 2020; 108:694-711. [DOI: 10.1016/j.neubiorev.2019.12.020] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/05/2019] [Accepted: 12/11/2019] [Indexed: 12/26/2022]
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Özalp Kızılay D, Yalın Sapmaz Ş, Şen S, Özkan Y, Cengiz Özyurt B, Ersoy B. Mental health of both child and parents plays a larger role in the health-related quality of life of obese and overweight children. J Pediatr Endocrinol Metab 2019; 32:1359-1367. [PMID: 31714889 DOI: 10.1515/jpem-2019-0401] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 09/11/2019] [Indexed: 11/15/2022]
Abstract
Aims A decrease in health-related quality of life (HRQOL) measures among obese (OB) and overweight (OW) children has been shown in several studies, but knowledge about the variables affecting HRQOL impairments is missing. The aim of this study was to evaluate the relationship between HRQOL and sociodemographic characteristics, anthropometric measurements, metabolic parameters, mental symptoms and parental attitudes in a sample of OB/OW children. Methods Eighty-six OB/OW children, aged between 9 and 17 years, participated in the study. We performed sociodemographic questioning, anthropometric examinations and laboratory evaluations of the participants. HRQOL was assessed using the Pediatric Quality-of-Life Inventory (PedsQL), and levels of anxiety and depressive symptoms were measured using the Screen for Child Anxiety-Related Disorders (SCARED) questionnaire and the Children's Depression Inventory (CDI), respectively. Parental attitudes were assessed with the Parental Attitude Research Instrument (PARI) questionnaire. Results A statistically significant relationship was found between total scores of CDI and SCARED answered by children and the total and subscale scores of PedsQL. Scores of total quality of life subscale, physical functionality and emotional functionality subscales were significantly lower in children with a family history of mental illness. No relationship was found between PedsQL subscales, anthropometric and metabolic parameters. Conclusions Emotional problems and parental psychological distress are important factors in models of HRQOL in the OB/OW pediatric population.
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Affiliation(s)
- Deniz Özalp Kızılay
- Çiğli State Training Hospital, Department of Pediatrics, Division of Pediatric Endocrinology, Izmir, Turkey
| | - Şermin Yalın Sapmaz
- Department of Child Psychiatry, Celal Bayar University, School of Medicine, Manisa, Turkey
| | - Semra Şen
- Department of Pediatrics, Celal Bayar University, School of Medicine, Manisa, Turkey
| | - Yekta Özkan
- Department of Child Psychiatry, Celal Bayar University, School of Medicine, Manisa, Turkey
| | - Beyhan Cengiz Özyurt
- Department of Public Health, Celal Bayar University, School of Medicine, Manisa, Turkey
| | - Betül Ersoy
- Department of Pediatrics, Division of Pediatric Endocrinology, Celal Bayar University, School of Medicine, Manisa, Turkey
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Borinsky S, Gaughan JP, Feldman-Winter L. Perceived overweight/obesity, low resilience, and body size dissatisfaction among adolescents. Obes Res Clin Pract 2019; 13:448-452. [PMID: 31474380 DOI: 10.1016/j.orcp.2019.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 08/18/2019] [Accepted: 08/18/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The obesity epidemic has been compounded by the stress of weight stigmatization. Resilience helps adolescents achieve positive outcomes during times of stress. This study aimed to determine relationships between overweight/obesity, perceived overweight/obesity, body size dissatisfaction (BSD), and/or resilience using a novel assessment tool among adolescents, and to determine if a modifiable factor such as resilience holds potential for treatments for BSD. METHODS Adolescents, ages 13-21, were recruited from clinics at an academic medical center. Weight, height, demographic characteristics, BSD, and resilience were assessed via questionnaires and health records. A model of predictive variables for BSD was tested, and an adjusted analysis was performed using logistic regression. RESULTS Eighty-five adolescents participated: 48% overweight/obese, 32% BSD, and 53% low resilience (LR). There was no association between actual and perceived overweight/obesity and LR (P=0.386 and P=0.123, respectively). Perceived overweight/obesity was five times (AOR 5.3; 95% CI=1.6-14.5; P=0.004) and LR was six times (AOR 6.4; 95% CI=1.9-22.4; P=0.003) more likely to be associated with BSD. The strongest sub-component of LR associated with BSD, was low confidence (OR 4.7; 95% CI=1.4-15.2; P=0.008). CONCLUSIONS LR and perceived overweight/obesity are independently associated with BSD. This finding is important because resilience can be improved, thus highlighting a need for future studies involving resilience building interventions to decrease BSD.
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Affiliation(s)
- Stephanie Borinsky
- Cooper Medical School of Rowan University, Camden, NJ 08103, United States
| | - John P Gaughan
- Cooper Research Institute, Cooper University Health Care, Camden, NJ 08103, United States
| | - Lori Feldman-Winter
- Cooper Medical School of Rowan University, Camden, NJ 08103, United States; Division of Adolescent Medicine, Department of Pediatrics, The Children's Regional Hospital at Cooper University Hospital, Camden, NJ 08103, United States.
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Daly M, Sutin AR, Robinson E. Perceived Weight Discrimination Mediates the Prospective Association Between Obesity and Physiological Dysregulation: Evidence From a Population-Based Cohort. Psychol Sci 2019; 30:1030-1039. [PMID: 31158067 DOI: 10.1177/0956797619849440] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Obesity is thought to cause ill health because of the biological strain that excess fat has on physiological function. We tested an alternative explanation in a population-based sample of 3,609 older English adults-that the pervasive discrimination experienced by individuals with excess weight may in part explain why obesity is associated with subsequent multisystem physiological dysregulation, measured via clinical indicators of cardiovascular, metabolic, and immune function. We found that both obesity and perceived weight discrimination predicted an increase in physiological dysregulation from baseline to follow-up 4 years later. Perceived discrimination because of body weight experienced by individuals with obesity explained more than one quarter of the prospective association between obesity and a deterioration in biomarkers of health status. These findings highlight the possibility that the stigma experienced by individuals with obesity may play an important role in explaining the obesity-related disease burden.
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Affiliation(s)
- Michael Daly
- 1 Department of Psychology, Maynooth University.,2 UCD Geary Institute for Public Policy, University College Dublin
| | - Angelina R Sutin
- 3 Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine
| | - Eric Robinson
- 4 Department of Psychological Sciences, Institute of Population Health Sciences, University of Liverpool
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25
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Zimmer‐Gembeck MJ, Duffy AL, Stuart J. Let’s get physical: Recent research on relations of adolescent peer victimization with psychosomatic symptoms, sleep, and body weight. ACTA ACUST UNITED AC 2019. [DOI: 10.1111/jabr.12162] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Amanda L. Duffy
- School of Applied Psychology Griffith University Southport Queensland Australia
| | - Jaimee Stuart
- School of Applied Psychology Griffith University Southport Queensland Australia
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26
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Young JM, Conroy DM, Jaeger SR. Self-Control and Weight-Loss Practices: An Exploration of Repertory Grid Constructs. JOURNAL OF CONSTRUCTIVIST PSYCHOLOGY 2019. [DOI: 10.1080/10720537.2018.1547994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | | | - Sara R. Jaeger
- The New Zealand Institute for Plant and Food Research Ltd., Auckland, New Zealand
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Sutin AR, Robinson E, Daly M, Terracciano A. Perceived Body Discrimination and Intentional Self-Harm and Suicidal Behavior in Adolescence. Child Obes 2018; 14:528-536. [PMID: 30226995 PMCID: PMC6249665 DOI: 10.1089/chi.2018.0096] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND This study examines whether discrimination based on the body is associated with intentional self-harm and suicidal behavior in adolescence. METHODS Participants were from the Longitudinal Study of Australian Children (N = 2948; 48% female). Discrimination and items on self-harm and suicidal behavior were measured in the Wave 6 assessment, when study participants were 14-15 years old. BMI, depressive symptoms, peer victimization, and weight self-perception were also assessed. RESULTS Discrimination was associated with increased risk of thoughts of self-harm (OR = 2.41, 95% CI = 1.88-3.10), hurting the self on purpose (OR = 2.27, 95% CI = 1.67-3.08), considering suicide (OR = 2.17, 95% CI = 1.59-2.96), having a suicide plan (OR = 2.50, 95% CI = 1.81-2.47), attempting suicide (OR = 1.96, 95% CI = 1.30-2.96), controlling for sociodemographic factors, BMI, and depressive symptoms. These associations generally held adjusting for peer victimization or weight self-perception. CONCLUSIONS Weight discrimination has been associated consistently with poor outcomes in adulthood. The present research indicates these associations extend to adolescence and an extremely consequential outcome: the social experience of weight increases risk of intentional self-harm and suicidal behavior.
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Affiliation(s)
- Angelina R. Sutin
- Florida State University College of Medicine, Tallahassee, FL.,Address correspondence to: Angelina R. Sutin, PhD, Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, 1115 W. Call Street, Tallahassee, FL 32306
| | - Eric Robinson
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Michael Daly
- Behavioural Science Centre, University of Stirling, Stirling, United Kingdom.,UCD Geary Institute, University College Dublin, Dublin, Ireland.,Department of Psychology, Maynooth University, National University of Ireland, Maynooth, Ireland
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Romano E, Haynes A, Robinson E. Weight Perception, Weight Stigma Concerns, and Overeating. Obesity (Silver Spring) 2018; 26:1365-1371. [PMID: 29956497 PMCID: PMC6221161 DOI: 10.1002/oby.22224] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 05/10/2018] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Perceiving one's own weight status as being overweight is a likely motivation for weight loss. However, self-perceived overweight status has also been found to be associated with overeating and weight gain. This study examined whether weight stigma concerns explain why individuals who perceive their weight status as overweight are at increased risk of overeating. METHODS We conducted two survey studies of United States adults (N = 1,236) in which we assessed whether weight stigma concerns explain the cross-sectional relationship between perceived overweight and overeating tendencies. RESULTS Across two studies, the cross-sectional relationship between perceived overweight and overeating tendencies was in part explained by weight stigma concerns. Participants who perceived their weight as "overweight" reported greater weight stigma concerns than participants who perceived their weight as "about right," and this explained 23.3% (Study 1) to 58.6% (Study 2) of the variance in the relationship between perceived overweight and overeating tendencies. CONCLUSIONS Weight stigma concerns may explain why perceiving one's own weight status as overweight is associated with an increased tendency to overeat.
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Affiliation(s)
- Eugenia Romano
- Institute of Psychology, Health & SocietyUniversity of LiverpoolLiverpoolUK
| | - Ashleigh Haynes
- Institute of Psychology, Health & SocietyUniversity of LiverpoolLiverpoolUK
| | - Eric Robinson
- Institute of Psychology, Health & SocietyUniversity of LiverpoolLiverpoolUK
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Guardabassi V, Mirisola A, Tomasetto C. How is weight stigma related to children's health-related quality of life? A model comparison approach. Qual Life Res 2017; 27:173-183. [PMID: 28884265 DOI: 10.1007/s11136-017-1701-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Obesity is a highly stigmatizing condition for both adults and children, and both obesity and stigma experiences are negatively related with health-related quality of life (HRQoL). However, the relations among these constructs have been modeled in different and sometimes inconsistent terms in past research, and have been the object of surprisingly few studies in pediatric populations. The present study addresses this gap by comparing, in a sample of preadolescent children, four competing models (i.e., additive, mediation, moderation, and moderated mediation models) accounting for the role of stigma experiences in the concurrent relation between body weight and HRQoL. METHODS A community sample of 600 children aged 8-11 years completed the Perception of Teasing Scale to assess weight-based teasing experiences and the PedsQL 4.0 to assess HRQoL. Parent-reported height and weight were used to calculate age- and gender-adjusted zBMI. Log-likelihood test, BIC difference, and Wald test were used for model comparisons. RESULTS The mediation model outperformed both additive and moderation models and was found to be equally informative (but more parsimonious) as compared to the moderated mediation account. The same pattern of results was replicated for both global HRQoL and domain-specific quality of life domains (i.e., physical, emotional, social, and scholastic). CONCLUSIONS The mediation model provided the best fitting and more parsimonious representation of the relations between body weight, stigma experiences, and HRQoL, meaning that an increased likelihood of experiencing weight-based teasing episodes, rather than excess weight per se, is associated with reduced quality of life in middle childhood.
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Affiliation(s)
- Veronica Guardabassi
- Department of Psychology, University of Bologna, Piazza Aldo Moro, 90, 47521, Cesena, FC, Italy.
| | - Alberto Mirisola
- Department of Psychological, Pedagogical and Educational Sciences, University of Palermo, Piazza Marina, 61, 90133, Palermo, Italy
| | - Carlo Tomasetto
- Department of Psychology, University of Bologna, Piazza Aldo Moro, 90, 47521, Cesena, FC, Italy
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Bernardo CDO, Bastos JL, González-Chica DA, Peres MA, Paradies YC. Interpersonal discrimination and markers of adiposity in longitudinal studies: a systematic review. Obes Rev 2017; 18:1040-1049. [PMID: 28569010 DOI: 10.1111/obr.12564] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 04/16/2017] [Accepted: 04/25/2017] [Indexed: 01/02/2023]
Abstract
While the impact of interpersonal discrimination on mental health is well established, its effects on physical health outcomes have not been fully elucidated. This study systematically reviewed the literature on the prospective association between interpersonal discrimination and markers of adiposity. Medline, Web of Science, Scopus, PsycInfo, SciELO, LILACS, Google Scholar, Capes/Brazil and ProQuest databases were used to retrieve relevant information in November 2016. The results from the 10 studies that met the inclusion criteria support an association between interpersonal self-reported discrimination and the outcomes. In general, the most consistent findings were for weight and body mass index (BMI) among women, i.e. high levels of self-reported discrimination were related to increased weight and BMI. Waist circumference (WC) showed a similar pattern of association with discrimination, in a positive direction, but an inverted U-shaped association was also found. Despite a few inverse associations between discrimination and markers of adiposity, none of the associations were statistically significant. Overall, markers of adiposity were consistently associated with discrimination, mainly through direct and nonlinear associations. This review provides evidence that self-reported discrimination can play an important role in weight, BMI and WC changes.
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Affiliation(s)
- C de O Bernardo
- Post-Graduate Program in Public Health, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - J L Bastos
- Post-Graduate Program in Public Health, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - D A González-Chica
- Discipline of General Practice, School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - M A Peres
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Y C Paradies
- Alfred Deakin Institute for Citizenship and Globalisation, Deakin University, Melbourne, Victoria, Australia
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Daly M, Robinson E, Sutin AR. Does Knowing Hurt? Perceiving Oneself as Overweight Predicts Future Physical Health and Well-Being. Psychol Sci 2017; 28:872-881. [PMID: 28504919 DOI: 10.1177/0956797617696311] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Identifying oneself as being overweight may be associated with adverse health outcomes, yet prospective tests of this possibility are lacking. Over 7 years, we examined associations between perceptions of being overweight and subsequent health in a sample of 3,582 U.S. adults. Perceiving oneself as being overweight predicted longitudinal declines in subjective health ( d = -0.22, p < .001), increases in depressive symptoms ( d = 0.09, p < .05), and raised levels of physiological dysregulation ( d = 0.24, p < .001), as gauged by clinical indicators of cardiovascular, inflammatory, and metabolic functioning. These associations remained after controlling for a range of potential confounders and were observed irrespective of whether perceptions of being overweight were accurate or inaccurate. This research highlights the possibility that identifying oneself as overweight may act independently of body mass index to contribute to unhealthy profiles of physiological functioning and impaired health over time. These findings underscore the importance of evaluating whether weight-feedback interventions may have unforeseen adverse consequences.
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Affiliation(s)
- Michael Daly
- 1 Behavioural Science Centre, University of Stirling.,2 UCD Geary Institute, University College Dublin
| | - Eric Robinson
- 3 Institute of Psychology, Health & Society, University of Liverpool
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Vadiveloo M, Mattei J. Perceived Weight Discrimination and 10-Year Risk of Allostatic Load Among US Adults. Ann Behav Med 2017; 51:94-104. [PMID: 27553775 PMCID: PMC5253095 DOI: 10.1007/s12160-016-9831-7] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Discrimination promotes multisystem physiological dysregulation termed allostatic load, which predicts morbidity and mortality. It remains unclear whether weight-related discrimination influences allostatic load. PURPOSE The aim of this study was to prospectively examine 10-year associations between weight discrimination, allostatic load, and its components among adults 25-75 years in the Midlife Development in the US Biomarker Substudy. METHODS Participants with information on weight discrimination were analyzed (n=986). At both timepoints, participants self-reported the frequency of perceived weight discrimination across nine scenarios as "never/rarely" (scored as 0), "sometimes" (1), or "often" (2). The two scores were averaged and then dichotomized as "experienced" versus "not experienced" discrimination. High allostatic load was defined as having ≥3 out of 7 dysregulated systems (cardiovascular, sympathetic/parasympathetic nervous systems, hypothalamic pituitary axis, inflammatory, lipid/metabolic, and glucose metabolism), which collectively included 24 biomarkers. Relative risks (RR) were estimated from multivariate models adjusted for sociodemographic and health characteristics, other forms of discrimination, and BMI. RESULTS Over 41% of the sample had obesity, and 6% reported weight discrimination at follow-up. In multivariable-adjusted analyses, individuals who experienced (versus did not experience) weight discrimination had twice the risk of high allostatic load (RR, 2.07; 95 % CI, 1.21; 3.55 for baseline discrimination; 2.16, 95 % CI, 1.39; 3.36 for long-term discrimination). Weight discrimination was associated with lipid/metabolic dysregulation (1.56; 95 % CI 1.02, 2.40), glucose metabolism (1.99; 95 % CI 1.34, 2.95), and inflammation (1.76; 95 % CI 1.22, 2.54), but no other systems. CONCLUSIONS Perceived weight discrimination doubles the 10-year risk of high allostatic load. Eliminating weight stigma may reduce physiological dysregulation, improving obesity-related morbidity and mortality.
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Affiliation(s)
- Maya Vadiveloo
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI, 02881, USA
| | - Josiemer Mattei
- Department of Nutrition, Harvard T. H. Chan School of Public Health, 665 Huntington Ave, Bldg 2, Boston, MA, 02115, USA.
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Jackson SE, Kirschbaum C, Steptoe A. Perceived weight discrimination and chronic biochemical stress: A population-based study using cortisol in scalp hair. Obesity (Silver Spring) 2016; 24:2515-2521. [PMID: 27740706 PMCID: PMC5132135 DOI: 10.1002/oby.21657] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 07/27/2016] [Accepted: 08/01/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVE There is increasing evidence for weight-based discrimination against persons with obesity. This study aimed to examine the physiological impact of perceived weight discrimination on cortisol in hair, an indicator of chronic stress exposure. METHODS Data were from 563 nonsmoking individuals with obesity (body mass index, BMI ≥30 kg/m2 ) participating in the English Longitudinal Study of Ageing. Experiences of discrimination were reported via questionnaire, and hair cortisol concentrations were determined from the scalp-nearest 2-cm hair segment. Height and weight were objectively measured. ANCOVAs tested associations between perceived weight discrimination and hair cortisol concentration overall and by degree of obesity. All analyses were adjusted for age, sex, ethnicity, socioeconomic status, and BMI. RESULTS Mean hair cortisol concentrations were 33% higher in those who had experienced weight discrimination than those who had not (mean log pg/mg 1.241 vs. 0.933, F = 12.01, P = 0.001). The association between weight discrimination and hair cortisol was particularly pronounced in individuals with severe (class II/III) obesity (1.402 vs. 0.972, F = 11.58, P = 0.001). CONCLUSIONS Weight discrimination is associated with the experience of stress at a biological level. Chronic exposure to elevated levels of cortisol may play a role in generating a vicious circle of weight gain and discrimination and contribute to obesity-associated health conditions.
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Affiliation(s)
- Sarah E. Jackson
- Department of Epidemiology and Public HealthUniversity College LondonLondonUK
| | | | - Andrew Steptoe
- Department of Epidemiology and Public HealthUniversity College LondonLondonUK
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Raves DM, Brewis A, Trainer S, Han SY, Wutich A. Bariatric Surgery Patients' Perceptions of Weight-Related Stigma in Healthcare Settings Impair Post-surgery Dietary Adherence. Front Psychol 2016; 7:1497. [PMID: 27777562 PMCID: PMC5056165 DOI: 10.3389/fpsyg.2016.01497] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 09/20/2016] [Indexed: 01/14/2023] Open
Abstract
Background: Weight-related stigma is reported frequently by higher body-weight patients in healthcare settings. Bariatric surgery triggers profound weight loss. This weight loss may therefore alleviate patients' experiences of weight-related stigma within healthcare settings. In non-clinical settings, weight-related stigma is associated with weight-inducing eating patterns. Dietary adherence is a major challenge after bariatric surgery. Objectives: (1) Evaluate the relationship between weight-related stigma and post-surgical dietary adherence; (2) understand if weight loss reduces weight-related stigma, thereby improving post-surgical dietary adherence; and (3) explore provider and patient perspectives on adherence and stigma in healthcare settings. Design: This mixed methods study contrasts survey responses from 300 postoperative bariatric patients with ethnographic data based on interviews with 35 patients and extensive multi-year participant-observation within a clinic setting. The survey measured experiences of weight-related stigma, including from healthcare professionals, on the Interpersonal Sources of Weight Stigma scale and internalized stigma based on the Weight Bias Internalization Scale. Dietary adherence measures included patient self-reports, non-disordered eating patterns reported on the Disordered Eating after Bariatric Surgery scale, and food frequencies. Regression was used to assess the relationships among post-surgical stigma, dietary adherence, and weight loss. Qualitative analyses consisted of thematic analysis. Results: The quantitative data show that internalized stigma and general experiences of weight-related stigma predict worse dietary adherence, even after weight is lost. The qualitative data show patients did not generally recognize this connection, and health professionals explained it as poor patient compliance. Conclusion: Reducing perceptions of weight-related stigma in healthcare settings and weight bias internalization could enhance dietary adherence, regardless of time since patient's weight-loss surgery.
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Affiliation(s)
- Danielle M Raves
- Mayo Clinic/ASU Obesity Solutions, Arizona State University Tempe, AZ, USA
| | - Alexandra Brewis
- School of Human Evolution and Social Change, Arizona State University Tempe, AZ, USA
| | - Sarah Trainer
- Mayo Clinic/ASU Obesity Solutions, Arizona State University Tempe, AZ, USA
| | - Seung-Yong Han
- Mayo Clinic/ASU Obesity Solutions, Arizona State University Tempe, AZ, USA
| | - Amber Wutich
- School of Human Evolution and Social Change, Arizona State University Tempe, AZ, USA
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Sutin AR, Stephan Y, Grzywacz JG, Robinson E, Daly M, Terracciano A. Perceived weight discrimination, changes in health, and daily stressors. Obesity (Silver Spring) 2016; 24:2202-9. [PMID: 27581053 PMCID: PMC5301307 DOI: 10.1002/oby.21598] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 06/04/2016] [Accepted: 06/07/2016] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To examine whether perceived weight discrimination is associated with change in health markers over time and whether it is associated with daily stressors, physical symptoms, and affect. METHODS Participants were selected from the Midlife in the United States (MIDUS) study if they had data on perceived weight discrimination and health markers at MIDUS II (2004-2006), health markers at MIDUS III (2013-2014), and a body mass index ≥25 kg/m(2) (N = 1,841). A subset of these participants (N = 1,153) reported on their experiences daily for 8 days as part of the second National Study of Daily Experiences. RESULTS Perceived weight discrimination was associated with declines in mental and physical health over time (median β = 0.06). Participants who reported weight discrimination experienced more daily stressors (β = 0.13), physical symptoms (β = 0.13), and negative affect (β = 0.13) and less positive affect (β = -0.12) over the 8 days of the second National Study of Daily Experiences. Weight discrimination was most strongly associated with interpersonal stressors (median β = 0.14), feelings of anger (β = 0.16) and frustration (β = 0.14), lower attention (β = -0.14) and activity (β = -0.16), and more nonspecific physical symptoms (e.g., fatigue; β = 0.10). CONCLUSIONS This research replicates the association between perceived weight discrimination and worse health over time and extends this literature to show that people who experience weight discrimination have more daily stressors, physical symptoms, and negative emotions.
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Affiliation(s)
- Angelina R Sutin
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, Florida, USA.
| | - Yannick Stephan
- Laboratory of Dynamic of Human Abilities and Health Behaviors, University of Montpellier, Montpellier, France
| | - Joseph G Grzywacz
- Department of Family and Child Sciences, Florida State University College of Human Sciences, Tallahassee, Florida, USA
| | - Eric Robinson
- Department of Psychological Sciences, Institute of Psychology, Health & Society, University of Liverpool, Liverpool, Merseyside, UK
| | - Michael Daly
- Behavioural Science Centre, University of Stirling, Scotland, UK
- Behavioural Science Centre, UCD Geary Institute, University College Dublin, Dublin, Ireland
| | - Antonio Terracciano
- Department of Geriatrics, Florida State University College of Medicine, Tallahassee, Florida, USA
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Alfaris N, Kyle TK, Nadai J, Stanford FC. A new era of addiction treatment amplifies the stigma of disease and treatment for individuals with obesity. Int J Obes (Lond) 2016; 40:1335-6. [PMID: 27323868 PMCID: PMC6103629 DOI: 10.1038/ijo.2016.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- N Alfaris
- MGH Weight Center, Department of Medicine- Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine-Gastrointestinal Unit, Obesity, Metabolism and Nutrition Institute, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School Boston, Boston, MA, USA
| | - T K Kyle
- ConscienHealth, Pittsburgh, PA, USA
- Obesity Action Coalition, Tampa, FL, USA
| | - J Nadai
- MGH Weight Center, Department of Medicine- Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School Boston, Boston, MA, USA
| | - F C Stanford
- MGH Weight Center, Department of Medicine- Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School Boston, Boston, MA, USA
- Department of Pediatrics Endocrinology, Massachusetts General Hospital, Boston, MA, USA
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37
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Carels RA, Latner J. Weight stigma and eating behaviors. An introduction to the special issue. Appetite 2016; 102:1-2. [PMID: 26946278 DOI: 10.1016/j.appet.2016.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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