Weight discrimination and bullying

Bored, afraid, alone: What can we learn from children with paediatric obesity about the impact of the COVID-19 pandemic for future pandemics, care practices and policies?

PURPOSE

The aim of this study was to gain insight into the perspectives of children with paediatric obesity themselves, during the pandemic and afterwards, regarding their wellbeing and health, and to solicit their advice on tailoring obesity care to match their daily realities.

DESIGN AND METHODS

We used a 'draw, write and tell' interview technique, conducted walk-alongs, participant observations and a group session with children with paediatric obesity from seldom-heard communities in Amsterdam, the Netherlands. Data was analysed using reflexive thematic analysis.

RESULTS

Children reported that during lockdowns they were confined to the house, causing them to feel bored and alone. This triggered them to fall into previous unhealthy patterns, such as an increase in sitting on the couch or lying in bed, gaming or watching TV, feeling hungry a lot and eating more. Some children experienced major events, such as mourning the death of a loved one or taking care of other family members, and thus felt they had to grow up fast.

CONCLUSION

Our study adds to our understanding of the mechanisms of the impact of the COVID-19 pandemic from the perspectives of children with paediatric obesity from seldom-heard communities and emphasizes the importance of considering how the pandemic (and related measures) affected the daily - as well as future - lives of children in vulnerable circumstances.

PRACTICAL IMPLICATIONS

The recommendations children gave could be explored as pathways for more child-centred, successful and tailored obesity care practices and policies in order to support their (mental) wellbeing and health.

Presentation of a weight bias internalization tool for use in pregnancy and a call for future research: A commentary

Background

Emerging evidence has shown that weight stigma is a concern during pregnancy, with several studies documenting common sources including healthcare, the media and interpersonal networks. Experiencing weight stigma may lead to weight bias internalization (WBI), whereby individuals accept and self-direct negative weight-related stereotypes, and limited research has assessed this in the context of pregnancy. Pregnancy is unique in terms of weight changes as many individuals will experience gestational weight gain (GWG). Accordingly, a WBI tool that accounts for GWG may be a more population-specific resource to use.

Methods

This commentary presents a pregnancy-specific WBI tool that accounts for GWG. The validated Adult WBI scale was modified to include 'pregnancy weight gain'. This commentary also presents a brief summary of research that has assessed WBI in pregnancy and recommendations for future work.

Results

Recommended future work includes validation of the pregnancy-specific WBI tool and prospective examinations of weight stigma and WBI in pregnancy and implications on maternal and newborn outcomes.

Conclusion

Ultimately this research may inform development of interventions and resources to mitigate weight stigma and WBI in pregnancy and overall may contribute to improving prenatal outcomes and experiences.

A randomized controlled trial of a reading-based weight bias intervention

OBJECTIVE

Weight bias, or negative attitudes about larger bodies, is a prevalent issue associated with problems in psychological and physical health, as well as discriminatory behaviors and weight stigma. Literature is mixed regarding the efficacy of weight bias reduction efforts. This study sought to combine three elements that yielded promising results from previous studies (i.e., reductions in beliefs about controllability of weight, reductions in stereotypical beliefs, and promotion of empathy) in a reading-based intervention to reduce weight bias.

METHODS

Participants (N = 319) were randomized to read a third-person fictional narrative passage about a peer with obesity (intervention) or information on overweight and obesity (control).

RESULTS

Linear mixed models controlling for body mass index and gender indicated the intervention was effective in producing reductions in overall weight bias and beliefs about controllability of weight from baseline to 1-month follow-up, but significant differences were not found in the domains of bias related to character disparagement or physical unattractiveness.

DISCUSSION

This combination-approach reading intervention is a promising strategy to reduce weight bias; however, future work is needed to more effectively target negative weight-related attitudes pertaining to character and attractiveness.

PUBLIC SIGNIFICANCE STATEMENT

A reading-based intervention targeting controllability of weight, stereotypes, and empathy can produce reductions in overall weight bias compared with a control condition. Reductions in beliefs about controllability of weight were shown from the reading-based intervention. These findings may inform the development of programs to reduce negative attitudes about weight, which could help enhance quality of life and reduce risk for several mental health issues.

Weight management practices, views, and experiences of adults living with poor socioeconomic circumstances and obesity: a qualitative systematic review protocol

OBJECTIVE

The objective of this review is to synthesize the best available qualitative evidence on the weight management practices, views, and experiences of adults living with poor socioeconomic circumstances and obesity. Additionally, the review aims to deepen our understanding of the common narratives of obesity according to these people.

INTRODUCTION

People living with poor socioeconomic circumstances are at increased risk of obesity, particularly in high-income countries, and their weight management practices (eg, weight-related behaviors) tend to be less healthy. Since prior research on socioeconomic inequalities in obesity is mostly from quantitative studies, the individual views and experiences related to weight management have been largely ignored. Thus, systematic qualitative evidence is needed on the weight management practices, views, and experiences of adults living with poor socioeconomic circumstances and obesity.

INCLUSION CRITERIA

Qualitative studies examining adults (aged 18 to 74 years) living with poor socioeconomic circumstances and obesity, and conducted in high- and upper-middle-income countries will be considered. The phenomenon of interest is these people's weight management practices, views, and experiences.

METHODS

Searches will be conducted in MEDLINE (Ovid), APA PsycINFO (Ovid), CINAHL (EBSCOhost), Scopus, Web of Science, and the Finnish health sciences database, MEDIC, restricted to the English and Finnish languages. Sources of unpublished studies and gray literature will include Google Scholar and ProQuest Dissertations and Theses. Two independent reviewers will screen the papers, assess methodological quality, and extract data following JBI's procedures. The meta-aggregative approach will be used for data synthesis. Confidence in the findings will be assessed using the ConQual approach.

REVIEW REGISTRATION

PROSPERO CRD42023407938.

Sensitization Lectures for Reducing Weight Bias in Undergraduate Medical Students

INTRODUCTION

Discrimination exists in one form or another in every society, usually against those who are weaker, in fewer numbers, or different from the rest. Most physicians are empathetic towards their patients but can either not keep an eye on their subordinates or lack the power to act against such employees. Persons experiencing discrimination in healthcare centers may try to avoid or postpone future visits, resulting in delayed diagnosis and treatment of ailments. Obesity bias present in society has crept into healthcare centers and intimidates persons with obesity who are seeking medical aid. Implicit and explicit obesity bias has been recorded in healthcare students.

METHODS

Data from 102 undergraduate medical students (23 female) who completed this study was analyzed. Implicit bias (tested online using the Implicit Association Test) and explicit bias (measured using four types of tool kits) were measured before and after conducting an obesity sensitization program (OSP) comprising four lectures on the causes and consequences of obesity and obesity discrimination and its consequences.

RESULTS

The change in implicit bias was not significant. However, a significant reduction was noted in the four different types of tools for explicit bias after conducting the OSP.

CONCLUSION

OSP helped medical students identify obesity bias and reduce explicit bias. Sensitization lectures conducted in medical colleges and schools can help reduce such discrimination in healthcare centers.

A bottom-up approach dramatically increases the predictability of body mass from personality traits

Personality traits consistently relate to and allow predicting body mass index (BMI), but these associations may not be adequately captured with existing inventories' domains or facets. Here, we aimed to test the limits of how accurately BMI can be predicted from and described with personality traits. We used three large datasets (combined N ≈ 100,000) with nearly 700 personality assessment items to (a) empirically identify clusters of personality traits linked to BMI and (b) identify relatively small sets of items that predict BMI as accurately as possible. Factor analysis revealed 14 trait clusters showing well-established personality trait-BMI associations (disorganization, anger) and lesser-known or novel ones (altruism, obedience). Most of items' predictive accuracy (up to r = .24 here but plausibly much higher) was captured by relatively few items. Brief scales that predict BMI have potential clinical applications-for instance, screening for risk of excessive weight gain or related complications.

Weight stigma in healthcare settings: the experience of Arab and Jewish bariatric surgery candidates in Israel

BACKGROUND

Weight-related stigma and discrimination are prevalent in our society with adverse biopsychosocial outcomes to people with obesity and morbid obesity. Studies suggest that weight bias in healthcare settings are quite prevalent, but there have been, as far as we know, lack of studies examining prevalence and correlates of weight bias experiences among bariatric surgery candidates in Israel. We aim to understand the nature and prevalence of weight stigma among bariatric surgery candidates. To identify differences between Jewish and Arab candidates. To examine the impact of weight stigma experiences on weight bias internalization (WBI).

METHODS

A cross-sectional study was performed among 117 adult bariatric surgery candidates from three hospitals in northern Israel (47.8% Jews, 82.4% females, average BMI 42.4 ± 5.2 Kg/meter2). Patients who agreed to participate completed a structured questionnaire on the same day that the bariatric surgery committee met. WBI was measured using a validated 10-item scale. Experiences of weight stigma were measured using items adapted from prior international studies.

RESULTS

About two thirds of the participants had at least one experience of weight stigma (teased, treated unfairly, or discriminated against because of their weight). As many as 75% of participants reported that weight served as a barrier to getting appropriate health care and as many as half of participants felt in the last year that a doctor judged them because of their weight. No significant differences were found between Arabs and Jews in the prevalence of weight stigma experiences and WBI. However, a trend towards more stigma experiences among Jews was noted. WBI was predicted by female gender and experiences of weight stigma, both in general and within healthcare settings.

CONCLUSIONS

Weight stigma towards bariatric surgery candidates in Israel is quite prevalent, and specifically in healthcare settings. It is important to adopt policy actions and intervention programs to improve awareness to this phenomenon among the general public and specifically among healthcare providers, as many healthcare providers may be unaware of the adverse effect of weight stigma and of ways in which they are contributing to the problem. Future studies may validate our findings using larger sample size and longitudinal design.

Outcome of BMI2+: Motivational Interviewing to Reduce BMI Through Primary Care AAP PROS Practices

BACKGROUND

Pediatric obesity rates in the United States remain at an all-time high. Pediatric primary care clinicians and registered dietitians can help treat childhood obesity, and motivational interviewing (MI) has shown promising effects in prior trials.

METHODS

We randomized 18 pediatric primary care practices to receive the Brief Motivational Interviewing to Reduce BMI or BMI2+ intervention or continue with usual care (UC). Practices were recruited through the American Academy of Pediatrics Pediatric Research in Office Settings network. The intervention comprised 4 components1: in-person and telehealth MI counseling by pediatric clinicians; 4 recommended sessions,2 6 telephone MI counseling sessions from a registered dietitian,3 text message reminders and tailored motivational messages, and4 parent educational materials. The main outcome was the change in the percentage of the 95th percentile of BMI. The study was conducted 2017 through 2021.

RESULTS

There was a significant treatment x time interaction (b = 0.017, 95% confidence interval: [0.0066-0.027]) for the main outcome, favoring the UC group, with youth in the intervention arm showing a greater relative increase in their percent of the 95th percentile.

CONCLUSIONS

There was no overall benefit of the intervention and, contrary to expectations, youth in the intervention arm gained more weight, based on percent of the distance from the 95th percentile than matched youth from UC practices. The absolute excess weight gain among intervention relative to UC youth was small, approximately 0.5 BMI units and 1 kg over 2 years. We offer several potential explanations for these unexpected findings.

Bullying Victimization, Real and Perceived Physical Fitness, and Self-Perception Profiles in Middle-School Students with Overweight or Obesity

Bullying victimization has been associated with body weight and physical fitness. In order to compare the prevalence of victimization among adolescents with normal weight or overweight/obesity and to evaluate the association between real or perceived physical fitness and self-perception profiles, a sample of 128 middle-school youths (mean age: 12.2 ± 0.8 years, 61% males) was recruited. The body mass index (BMI) Z score was calculated. Physical fitness was assessed by hand grip strength (HGS), long jump (LJ), and a 3 min step test (3MST). Perceived physical fitness, self-perception profiles (social competence, athletic competence, and physical appearance), and experiences of victimization (teasing about physical appearance, verbal offenses, and exclusion from group activities) were explored using validated questionnaires. Eighty youths (62.5%) showed overweight/obesity. Compared to their counterparts, normal-weight subjects showed lower HGS and perceived muscular strength; higher LJ and 3MST performance; higher perceived overall fitness, speed and flexibility, and physical appearance. Teasing and verbal offences were more frequent among students with overweight/obesity. Being teased about physical aspects was positively related with the BMI Z score. Exclusion from groups was positively associated with LJ performance. All the types of victimization investigated were inversely related to perceived social competence. These findings suggest that self-perception may protect one from victimization, regardless of nutritional status.

Body mass predicts personality development across 18 years in middle to older adulthood

OBJECTIVE

Various personality traits have longitudinal relations with body mass index (BMI), a measure of body weight and a risk factor for numerous health concerns. We tested these associations' compatibility with causality in either direction.

METHOD

Using three waves of the Wisconsin Longitudinal Study (N = 12,235, Mage  = 53.33 at baseline), we tested how accurately the Five-Factor Model personality domains and their items could collectively predict BMI and change in it with elastic net models. With multilevel models, we tested (a) bidirectional and (b) within-person associations between BMI and personality traits.

RESULTS

The five domains were able to predict concurrent (r = 0.08), but not future BMI. Twenty-nine personality items predicted concurrent and future BMI at r = 0.21 and r = 0.16 to 0.25, respectively. Neither the domains nor items could collectively predict change in BMI. Similarly, no individual trait predicted change in BMI, but BMI predicted changes in Conscientiousness, Agreeableness, and several items (|b*| = 0.03 to 0.08). BMI had within-person correlations with these same traits; time-invariant third factors like genetics or childhood environments therefore could not (fully) account for their relations.

CONCLUSIONS

Body weight may contribute to adults' personality development, but the reverse appears less likely.

Role of peer support on the cycle of weight teasing, psychological distress and disordered eating in Taiwanese adolescents: A moderated mediation analysis

BACKGROUND

Several studies have reported the beneficial role of social support on adolescent health. However, few studies have explored the role of peer support on the cycle of weight teasing, psychological distress, and disordered eating.

METHODS

A total of 689 adolescents aged between 13 and 16 years recruited from 37 classes in three middle schools in New Taipei City from March to June 2019 were included for analysis. Path analysis was performed using Hayes' PROCESS module.

RESULTS

The study found that weight teasing is directly and indirectly associated with disordered eating through psychological distress. Peer support plays a role in moderating the relationship between weight teasing and psychological distress; however, it is not significantly associated with decreased risk of disordered eating among adolescents experiencing weight teasing.

CONCLUSION

While peer support can be used against the adverse effects of weight teasing, it is not the absolute solution, and additional interventions are warranted.

Gut microbiota turn up the heat after bariatric surgery

Bariatric surgeries like vertical sleeve gastrectomy (VSG) and Roux-en-Y gastric bypass (RYGB) cause well-established shifts in the gut microbiota, but how this contributes to their unique metabolic benefits is poorly understood. Jin et al and Yadav et al now provide two complementary lines of evidence suggesting that gut microbiota-derived metabolites after VSG and RYGB activate thermogenesis in fat through distinct mechanisms, to in turn promote weight loss and/or improvements in glycemic control.

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

Background

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

Methods

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

Results

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

Conclusion

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

A Cross-Sectional Study Exploring the Relationship Between BMI and Nursing Students' Emotional Well-Being During the COVID-19 Pandemic

Background

Having a weight problem can cause emotional distress, especially in students, who suffer from both issues at a high rate. As a result of the COVID-19 pandemic's negative impact on society, these problems can be significantly impacted. The study aims to investigate the relationship between nursing students' BMI and their mental well-being.

Methods

A cross-sectional study was conducted on 423 students from the second through fourth baccalaureate years of Science of Nursing program - KSA. The instrument for the study was an online questionnaire distributed to the students via Google Forms during the academic year 2021-2022 to collect data on the emotional state of students directly as a result of COVID-19 restrictions and limitations. The statistical analysis was carried out through Chi-square test was used to compare categorical data between groups and the Pearson coefficient is used to determine the correlation between two quantitative variables with normal distribution.

Results

There is a significant correlation between BMI with depression score, anxiety score and stress score. Higher BMI indicated 6.4 times more likeliness to have depression than lower BMI (OR = 6.4). Students who had higher BMI were 2.7 times more likely to have anxiety than those who had lower BMI (OR = 2.7), and 9.4 times more likely to have stress than those who had lower BMI (OR = 9.4).

Conclusion

Study findings indicate that nursing students' BMI increases as depression, anxiety, and stress increase. During the COVID-19 pandemic, participants reported increased weight due to increased stress levels and increased eating. Students in nursing should be aware of the importance of adopting healthy habits and following a healthy lifestyle.

Strengths-Based Factors Related to Post-Traumatic Stress Problems in Black Youth with High Body Weights

OBJECTIVE

Black youth with high body weights [BYHW; Body Mass Index (BMI)≥95th percentile] endure unique stressors (e.g., exposure to discrimination due to race and size) that may contribute to psychopathology. Factors that decrease mental health problems associated with these stressors have been underexamined in BYHW. The current study assessed how multisystemic resilience, weight-related quality of life (QOL), and discrimination were associated with post-traumatic stress problems in BYHW from the perspective of youth and their caregivers.

METHODS

A total of 93 BYHW and one of their primary caregivers were recruited from a Midsouth children's hospital. Youth ranged in age from 11 to 17 years (Mage=13.94, SD = 1.89), were mostly girls (61.3%), and had CDC-defined BMI scores above the 95th percentile. Nearly all caregivers were mothers (91.4%; Mage=41.73 years, SD = 8.08). Youth and their caregivers completed measures of resilience, discrimination, weight-related QOL, and post-traumatic stress problems.

RESULTS

Utilizing linear regression modeling, the youth model was significant [F(3, 89)=31.63, p<.001, Adj. R2=.50], with higher resilience (β=-.23; p=.01) and lower discrimination (β=.52; p<.001) associated with fewer post-traumatic stress problems. The caregiver regression model was also significant [F(2, 90)=10.45, p<.001, Adj. R2=.17], with higher weight-related QOL associated with lower post-traumatic stress problems (β=-.37; p<.001).

CONCLUSIONS

Findings illustrate differences in youth and caregiver perceptions of factors related to post-traumatic stress problems in BYHW. Youth emphasized both internal and external contributors to stress, while caregivers focused on internal variables. Such knowledge could be harnessed to develop strengths-based interventions that address health and well-being among BYHW.

Asthma is associated with bullying victimization in rural adolescents

OBJECTIVE

We characterized bullying among rural adolescents and examined the association between asthma and bullying victimization.

METHODS

Participants (N = 1905; 44.5% Black) were students attending rural high schools who were screened for a randomized trial to address uncontrolled asthma. Screening questions asked students about asthma diagnosis and symptoms, bullying victimization, and demographic characteristics. Logistic regression analyses with school as a fixed effect were employed to examine the extent to which demographic factors, asthma diagnosis, asthma status (i.e. current asthma, no asthma, possible undiagnosed asthma), and among those with current asthma, asthma severity, were associated with bullying victimization. Sensitivity analyses using bullying frequency as the outcome were also conducted.

RESULTS

26.0% reported being bullied. Younger age and self-identifying as White were associated with increased risk of bullying victimization. Compared to those with no asthma, those with current asthma or possible undiagnosed asthma were at increased risk for bullying victimization (adjusted odds ratio [AOR] = 2.46; 95% confidence interval (CI) = 1.76-3.46 and AOR = 2.42; 95% CI = 1.87-3.14, respectively). Among those with current asthma, persistent symptoms increased the risk for bullying victimization (AOR = 2.59; 95% CI = 1.45-4.71). Similar results were obtained with sensitivity analyses.

CONCLUSIONS

In a large rural community cohort, asthma was associated with bullying victimization. Findings suggest that rural students with asthma, with or without diagnosis, could benefit from schools creating inclusive environments that reduce victimization based on this medical condition. School administrators should foster environments that are accepting of all students' abilities and statuses, and healthcare providers can provide proper asthma management education to these adolescents.

Healthy and Equitable Interpersonal Relationships, Health Inequalities and Socio-Educational Interventions: A Conceptual Framework for Action

BACKGROUND

Interpersonal relationships undoubtedly have a bidirectional connection with the health of individuals and communities. Relational models based on equity contribute to well-being, while asymmetrical relationships based on hierarchies and differences of power negatively impact mental, physical, and social health.

METHODS

A conceptual framework for understanding the determinants of interpersonal relational models was developed.

RESULTS

Structural determinants were identified as the combined action of systems of oppression, the socio-historical context that normalizes violence, and social stratification and segregation, consequences which included inequitable access to power, resources, and opportunities. Intermediate determinants include individual, psychosocial, behavioral, and community aspects. Structural and intermediate determinants impact health and health inequalities through multiple relational patterns that are simultaneously established and sustained by individuals and communities. The health impact of inequitable relational patterns includes: Reduced self-esteem; anxiety, stress, and depression; acceptance of violence; physical and sexual harm; suicide; and murder.

CONCLUSIONS

This conceptual framework allows for the modification of relational models by influencing structural and intermediate determinants. Six areas of intervention have been identified: educative policies, school governance, physical and symbolic space, school curriculum, school-community relations, and socio-educative interventions to promote healthy and equitable relationships. Healthy and equitable relationships are associated with improved subjective well-being, health status and protection from violence. Socio-educational interventions that consider the elements of this conceptual framework may be effective in promoting healthy and equitable relational models.

Family-based weight stigma and psychosocial health: A multinational comparison

OBJECTIVE

Family-based weight stigma can be expressed as criticism, judgment, teasing, and mistreatment by family members because of an individual's body weight. The current study compared the prevalence and psychosocial correlates of family-based weight stigma among adult members of a weight-management program living in Australia, Canada, France, Germany, the UK, and the US.

METHODS

Participants (N = 8100 adults who reported having ever experienced weight stigma; 95% female; 94% White) completed an identical online survey in their country's dominant language that assessed their experiences of weight stigma from 16 different family member sources, as well as internalized weight bias, body image, eating behaviors, perceived stress, and self-rated health.

RESULTS

Family-based weight stigma, especially from mothers (49%-62%), spouses/romantic partners (40%-57%), and fathers (35%-48%), was highly prevalent across countries. Weight stigma from one's immediate family members was associated with indices of poorer psychosocial health across the six countries (β coefficients = |0.08-0.13|).

CONCLUSIONS

Findings highlight the need for weight stigma-reduction efforts to help family members distinguish between supportive, encouraging discourse and potentially weight-stigmatizing communication. Future research should examine the prevalence and correlates of family-based weight stigma in more diverse community samples, including among racially/ethnically and gender diverse adults, and in non-Western countries.

The prospective relationship between weight-based discrimination and eating pathology among youth

Among adults and adolescents, weight-based discrimination is associated with disordered eating. However, these relationships remain understudied in children. Given that weight-based discrimination is commonly reported among youth, and that childhood is a crucial developmental period for the onset of disordered eating, the current study assessed prospective associations between weight-based discrimination and eating pathology among participants in the Adolescent Brain Cognitive Development Study. At the one-year visit, children indicated whether they had experienced discrimination due to their weight within the past year. Parents completed a computerized clinical interview to determine the presence of sub-or-full threshold eating disorders (AN, BN, and BED) among their children. At the two-year visit, children completed the same assessment. Height and fasting weight were obtained. Logistic regressions, adjusting for age, sex, race/ethnicity, family income, BMI%ile, and parent-reported presence of the respective eating disorder at one-year, were conducted to assess the associations between weight-based discrimination and eating pathology. Participants were 10,299 children who completed measures at both the one- and two-year visits (M_age at one-year: 10.92 ± 0.64, 47.6 % female, 45.9 % racial/ethnic minority). The presence of weight-based discrimination, reported by 5.6 % (n = 574) of children, was significantly associated with a greater likelihood of reporting AN, BN, and BED one-year later (ORs: 1.94-4.91). Findings suggest that weight-based discrimination may confer additional risk for the onset of disordered eating, above and beyond the contribution of body weight. Intersectional research is needed to examine the role of multiple forms of discrimination in relation to the development of eating pathology.

Formative Development of a Weight Management Intervention for Adolescents with Type 1 Diabetes Mellitus and Obesity

The prevalence of overweight and obesity in youth with type 1 diabetes mellitus (T1D) now exceeds that of youth without T1D. Comorbid T1D and excess adiposity are associated with multiple serious negative health outcomes. Unfortunately, youth with T1D are often excluded from and/or not referred to standard behavioral lifestyle interventions. This is often attributed to the complexities of managing T1D and an effort not to overburden persons who have T1D. Furthermore, standard behavioral weight management intervention recommendations can be perceived as contradicting T1D disease management (e.g., removing sugar-sweetened beverages from diet, energy balance with exercise, and caloric restriction). A weight management intervention specifically designed for youth with T1D is needed to provide treatment to youth with comorbid T1D and overweight/obesity. The current study interviewed adolescents with T1D and overweight/obesity (n = 12), their caregivers (n = 12), and pediatric endocrinologists (n = 9) to understand (a) whether they would be interested in a weight management intervention adapted for youth with T1D and (b) specific adaptations they would want and need. Five central themes emerged following applied thematic analysis: (1) program content, (2) programmatic messaging, (3) program structure, (4) social support, and (5) eating disorder risk. Results provide detailed recommendations for the adaptation of a behavioral weight management intervention for youth with T1D.

Social media-based interventions for adults with obesity and overweight: a meta-analysis and meta-regression

Social isolation and loneliness are growing public health concerns in adults with obesity and overweight. Social media-based interventions may be a promising approach. This systematic review aims to (1) evaluate the effectiveness of social media-based interventions on weight, body mass index, waist circumference, fat, energy intake and physical activity among adults with obesity and overweight and (2) explore potential covariates on treatment effect. Eight databases, namely, PubMed, Cochrane Library, Embase, CINAHL, Web of Science, Scopus PsycINFO and ProQuest, were searched from inception until December 31, 2021. The Cochrane Collaboration Risk of Bias Tool and Grading of Recommendations, Assessment, Development and Evaluation criteria evaluated the evidence quality. Twenty-eight randomised controlled trials were identified. Meta-analyses found that social media-based interventions had small-to-medium significant effects on weight, BMI, waist circumference, body fat mass and daily steps. Subgroup analysis found greater effect in interventions without published protocol or not registered in trial registries than their counterparts. Meta-regression analysis showed that duration of intervention was a significant covariate. The certainty of evidence quality of all outcomes was very low or low. Social media-based interventions can be considered an adjunct intervention for weight management. Future trials with large sample sizes and follow-up assessment are needed.

Person-First Treatment Strategies: Weight Bias and Impact on Mental Health of People Living with Obesity

Stigma and bias surrounding body weight is both explicit and implicit, but the most concerning impact on individuals is internalized stigma which is correlated with poor physical and mental health. Strategies to combat this public health concern include increasing awareness, education around the complex disease of obesity, proper use of communication and language surrounding weight, health, and treatment approaches, addressing equipment and practices in the clinical environment, and larger, systemic approaches to policy. Addressing stigma for a condition impacting the majority of our population is critical for the best health and well-being of our patients and ourselves.

The intangible costs of overweight and obesity in Germany

BACKGROUND

Previous literature documents the direct and indirect economic costs of obesity, yet none has attempted to quantify the intangible costs of obesity. This study focuses on quantifying the intangible costs of one unit body mass index (BMI) increase and being overweight and obese in Germany.

METHODS

By applying a life satisfaction-based compensation value analysis to 2002-2018 German Socio-Economic Panel Survey data for adults aged 18-65, the intangible costs of overweight and obesity are estimated. We apply individual income as a reference for estimating the value of the loss of subjective well-being due to overweight and obesity.

RESULTS

The intangible costs of overweight and obesity in 2018 amount to 42,450 and 13,853 euros, respectively. A one unit increase in BMI induced a 2553 euros annual well-being loss in the overweight and obese relative to those of normal weight. When extrapolated to the entire country, this figure represents approximately 4.3 billion euros, an intangible cost of obesity similar in magnitude to the direct and indirect costs documented in other studies for Germany. These losses, our analysis reveals, have remained remarkably stable since 2002.

CONCLUSIONS

Our results underscore how existing research into obesity's economic toll may underestimate its true costs, and they strongly imply that if obesity interventions took the intangible costs of obesity into account, the economic benefits would be considerably larger.

Perceiving Oneself to Be Integrated into the Peer Group: A Protective Factor against Victimization in Children with Learning Disabilities

Bullying is still a widespread social problem that needs serious attention. To date, research on this topic has shown that understanding the phenomenon requires a psychosocial perspective. The primary goal of the study is to identify the factors that contribute to the victimization of students with learning disabilities. The hypothesis is that the victimization experiences of this group of students can be explained by some socio-relational dynamics. Using a mediation model, this study demonstrates that perceived social integration completely mediates the association between the presence of learning disabilities and victimization experiences. This implies that students with learning disabilities are primarily victimized when they are not socially integrated into their class group. The implications for diagnosis and treatment are discussed.

"Look beyond the weight and accept me": Adolescent perspectives on parental weight communication

Critical weight communication between parents and their adolescent children is prevalent and harmful. However, research on adolescent perspectives about parental weight communication is limited. The present mixed-methods study aimed to address this gap using inductive thematic analysis of 1743 adolescents' (M_age=14.61 years, SD_age=2.48) preferences regarding parental weight communication in response to an open-ended prompt, and quantitative analyses to examine age, gender, race/ethnicity, and weight-related differences in subthemes. In their responses, adolescents articulated 1) whether and 2) how parental weight communication should-or should not-occur, and 3) what these conversations should entail. We identified 15 subthemes across these categories-the endorsement of which often varied by adolescents' demographic and anthropometric characteristics. For example, some adolescents (especially cisgender girls and transgender/gender diverse adolescents) preferred that their parents talk about weight less often (n = 184), while others (especially multiracial/ethnic or Hispanic/Latinx adolescents) hoped that, if parents were to discuss weight with them, they do so in a manner that was compassionate and respectful (n = 150). Across most subthemes, adolescents described adverse responses (e.g., feeling insecure, embarrassed, or hurt) when parents discussed their weight in non-preferred ways. Collectively, findings can inform interventions to promote more supportive health-focused communication in families.

Predictors of support for anti-weight discrimination policies among Canadian adults

Introduction

Weight discrimination of individuals with overweight or obesity is associated with adverse mental and physical health. Weight discrimination is prevalent in many sectors such as within workplaces, where individuals with overweight and obesity are denied the same opportunities as individuals with lower weight status, regardless of performance or experience. The purpose of this study was to understand the Canadian public's support or opposition of anti-weight discrimination policies and predictors of support. It was hypothesized that Canadians will show support of anti-weight discrimination policies to some extent.

Methods

A secondary analysis was conducted on a previous cross-sectional sample of Canadian adults (N = 923, 50.76% women, 74.4% White) who responded to an online survey assessing weight bias and support of twelve anti-weight discrimination policies related to societal policies (e.g., implementing laws preventing weight discrimination) and employment-related policies (e.g., making it illegal to not hire someone due to their weight). Participants completed the Causes of Obesity Questionnaire (COB), the Anti-Fat Attitudes Questionnaire (AFA) and the Modified Weight Bias Internalization Scale (WBIS-M). Multiple logistic regressions were used to determine predictors of policy support.

Results

Support for policies ranged from 31.3% to 76.9%, with employment anti-discrimination policies obtaining greater support than societal policies. Identifying as White and a woman, being over the age of 45 and having a higher BMI were associated with an increased likelihood of supporting anti-weight discrimination policies. There were no differences between the level of support associated with attributing obesity to behavioral or non-behavioral causes. Explicit weight bias was associated with a reduced likelihood of supporting 8/12 policies. Weight Bias Internalization was associated with an increased likelihood of supporting all societal policies but none of the employment policies.

Conclusions

Support for anti-weight discrimination policies exists among Canadian adults, and explicit weight bias is associated with a lower likelihood of supporting these policies. These results highlight the need for education on the prevalence and perils of weight discrimination which may urge policy makers to consider weight bias as a form of discrimination that must be addressed. More research on potential implementation of anti-weight discrimination policies in Canada is warranted.

"I was bullied for being fat in every situation, in every outfit, at every celebration": A qualitative exploratory study on experiences of weight-based oppression in Qatar

Introduction

Weight-based oppression (WBO) has been documented as a widespread phenomenon in Western countries and is associated with a range of psychological, physiological, and behavioral harms. Research on weight-based oppression is largely absent from the Arab region.

Methods

We conducted a qualitative exploratory study using semi-structured in-depth interviews to examine the internalized attitudes, values, and beliefs related to body weight, and experiences of external weight-based oppression of 29 staff, faculty, and students at Qatar University.

Results

Thematic analysis revealed six major themes on the characteristics of internalized WBO, and the nature, timing, source, extent, and impact of external WBO. WBO was regarded as so common in the Arab culture as to be normative, with damaging exposure to WBO beginning in early childhood.

Conclusion

WBO in the Arab region is an important and unrecognized public health issue. Programs to reduce WBO should be developed in all sectors.

Psychometric properties of the Spanish version of the Weight Self-Stigma Questionnaire (S-WSSQ) in a sample of participants with obesity seeking weight loss treatment

PURPOSE

Weight self-stigma may be defined as a self-devaluation due to one's identification with the group of people with obesity. The Weight Self-Stigma Questionnaire (WSSQ) is an instrument specifically designed to measure weight self-stigma in populations with overweight or obesity. The objective of this study was to adapt the WSSQ to the Spanish population (S-WSSQ) following the guidelines for cross-cultural adaptations.

METHODS

The sample comprised 165 participants with obesity seeking weight loss treatment (65% women) at the "Hospital de Valme" (Seville, Spain). Scales to measure life satisfaction, self-esteem, positive and negative affect, and antifat attitudes were used to analyze the convergent and divergent validity of the S-WSSQ.

RESULTS

A confirmatory factor analysis showed adequate values of the goodness of fit indexes of a two-factor model (χ2/df = 2.01 CFI = 0.92, IFI = 0.92, SRMR = 0.08, RMSEA = 0.078), replicating the structure found by the original authors. Cronbach's alphas of the two factors were 0.76 (self-devaluation) and 0.77 (fear of enacted stigma). Composite Reliability values were 0.72 (self-devaluation) and 0.76 (fear of enacted stigma). Self-devaluation and fear of enacted stigma were negatively related to self-esteem, and positive affect, and positively related to negative affect and antifat attitudes. Finally, life satisfaction was negatively correlated to fear of enacted stigma.

CONCLUSIONS

Based on these results, it is concluded that the S-WSSQ has good psychometric properties and might be used by the Spanish-speaking scientific community to measure weight self-stigma.

LEVEL OF EVIDENCE

Level V, descriptive study.

Socioeconomic Status, Overweight, and Obesity in Childhood and Adolescence

BACKGROUND

Overweight and obesity in early life increase the risk of chronic disease and ill health later on. We studied secular trends in the prevalence of overweight and obesity among young people in Germany, with consideration of socioeconomic status (SES).

METHODS

We used repeated cross-sectional data from 3- to 17-year-olds from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Overweight and obesity were defined according to the body mass index, based on measured height and weight from the KiGGS baseline survey (2003-2006) and the KiGGS second wave (2014-2017). SES was assessed with a composite index of parental education, occupation, and income.

RESULTS

In both study periods, the prevalence of overweight and obesity was highest among girls and boys from families of low SES. In the group with lowest SES, the prevalence of overweight rose from 20.0% in 2003-2006 (95% CI [18.0; 22.1]) to 25.5% [20.5; 31.2] in 2014-2017 (p = 0.043). Thus, social differences in the prevalence of overweight increased over time. No such trend was found for the prevalence of obesity.

CONCLUSION

Social differences in the prevalence of overweight among children and adolescents increased from the early 2000s to the mid-2010s. Structural measures are needed to help prevent overweight among young people in socially disadvantaged circumstances.

Obesity in Children

Child obesity is widely prevalent, and general pediatricians play an important role in identifying and caring for patients with obesity. Appropriate evaluation and treatment require an understanding of the complex etiology of child obesity, its intergenerational transmission, and its epidemiologic trends, including racial/ethnic and socioeconomic disparities. The American Academy of Pediatrics has published screening, evaluation, and treatment guidelines based on the best available evidence. However, gaps in evidence remain, and implementation of evidence-based recommendations can be challenging. It is important to review optimal care in both the primary care and multidisciplinary weight management settings. This allows for timely evaluation and appropriate referrals, with the pediatrician playing a key role in advocating for patients at higher risk. There is also a role for larger-scale prevention and policy measures that would not only aid pediatricians in managing obesity but greatly benefit child health on a population scale.

Body mass index and bullying victimization as antecedents for depressive symptoms in a Swedish youth cohort

Aim

The bidirectional association between obesity and depression seen in adults is not clearly established in adolescents. The aim of this study was to investigate the longitudinal association between body mass index (BMI), depressive symptoms and interactions between bullying victimization and BMI, taking gender differences into account.

Subjects and methods

In a Swedish county, self-reported bullying victimization, BMI and depressive symptoms from 1729 adolescents ($$ \overline{y} $$ y ¯ = 14.4, 56% females) were collected in 2012 (wave 1), in 2015 (wave 2) ($$ \overline{y}=17.3 $$ y ¯ = 17.3 ) and in 2018 (wave 3) ($$ \overline{y} $$ y ¯ = 19.9). Longitudinal associations were assessed using binary logistic regression models controlling for confounding factors. Interaction effects between BMI and victimization on depressive symptoms were also assessed.

Results

Wave 1 obese males had approximately six times increased odds ratio compared to normal weight, for wave 2 depressive symptoms. W1 overweight was associated with an odds ratio of 1.5 in all participants for wave 3 depressive symptoms. Victimization was consistently associated with higher odds ratio for future depressive symptoms. We found interaction effects between bullying victimization and BMI for future depressive symptoms with different patterns depending on sex.

Conclusion

Given the present findings, bullying needs to be prevented, and, if it occurs, it needs to be stopped at an early stage to prevent future depressive symptoms.

Evaluation of two weight stigma scales in Malaysian university students: weight self-stigma questionnaire and perceived weight stigma scale

BACKGROUND

This study aimed to examine the psychometric properties of the Weight Self-Stigma Questionnaire (WSSQ) and Perceived Weight Stigma Scale (PWS) among Malaysian university students.

METHODS

University students who were studying in a Malaysia university with a mean age of 24.0 years (n = 380; females 71.6%) were recruited through convenience sampling between 19 August and 30 September 2021. They completed a Google Form consisting of information on sociodemographic background, weight stigma, psychological distress and self-reported body weight and height. Psychometric testing was conducted using the classical test theory (including confirmatory factor analysis) and Rasch models to confirm the two-factor structure of WSSQ and the unidimensional structure of the PWS using the various fit indices. Concurrent validity of the total scores of WSSQ and PWS with psychological distress and body mass index (BMI) was also investigated. Internal consistency using Cronbach's alpha was conducted.

RESULTS

The confirmatory factor analyses and Rasch analyses verified the two-factor structure for the WSSQ and the single-factor structure for the PWS. Both the WSSQ and PWS showed good internal consistency and good concurrent validity as demonstrated by their significant correlations with psychological distress and BMI.

CONCLUSION

The WSSQ and PWS have strong validity and reliability, and they can both be used to assess weight stigma among Malaysian university students.

LEVEL OF EVIDENCE

V: Descriptive study.

Weight stigma in patients with overweight and obesity: validation of the Italian Weight Self-Stigma Questionnaire (WSSQ)

PURPOSE

This study aimed to explore the factorial structure of the Italian Weight Self-Stigma Questionnaire (WSSQ) (Study1); and to test structural validity, internal consistency, test-retest reliability, and measurement invariance of the questionnaire across gender, Body Mass Index (BMI), age and occurrence of previous hospitalization for obesity (Study2).

METHODS

At admission into a hospital-based program for weight reduction and rehabilitation, 150 inpatients with overweight/obesity (68% females) completed the WSSQ (Study1). In Study2, in addition to the WSSQ, 446 inpatients (61.9% females) completed the Weight Bias Internalization Scale (WBIS), the Body Uneasiness Test (BUT), and the Center for Epidemiologic Studies Depression Scale (CES-D). A subsample of 40 patients also re-completed the WSSQ at discharge from the hospital.

RESULTS

The Italian WSSQ showed good overlap with the original factorial structure (Study1) and results were confirmed in Study2. Test-retest reliability and convergent validity showed adequate values. Measurement invariance revealed that WSSQ was perfectly invariant across both BMI and the occurrence of previous hospitalizations for obesity. In both studies, the internal consistency of the questionnaire was deemed acceptable.

CONCLUSIONS

The Italian WSSQ is a valid, reliable, and invariant tool for the assessment of weight-related self-stigma among patients with overweight/obesity. Future studies should assess its longitudinal invariance as well as its responsiveness to weight reduction treatments.

LEVEL OF EVIDENCE

V, descriptive study.

Beyond bariatric surgery and weight loss medicaments. A systematic review of the current practice in obesity rehabilitative inpatient programs in adults and pediatrics

Background

Obesity treatment strategies mainly include outpatient lifestyle modification, drugs and bariatric surgery. Voluntary rehabilitative inpatient programs are gaining relevance as potential alternative settings of care that focus on weight loss and prevention of weight regain through a multidisciplinary approach, but their prevalence is still limited due to the high costs.

Aim

Considering the lack of evidence in this area, the objective of this study is to systematically review the currently available literature on non-pharmacological and non-surgical inpatient programs aimed at weight loss, to clarify the efficacy and the characteristics of these interventions.

Methods

Proper English language articles from 2000 to 2022 were searched on relevant databases. Quality assessment was performed by two different authors using ROB2 and robvis tools. Adult and pediatric studies were reviewed separately and their characteristics were systematically displayed.

Results

36 articles were included (20 on adults, 16 on children, and adolescents) for a total of 5,510 individuals. The multidisciplinary approach was mainly comprehensive of a low-calorie diet, scheduled physical activity, and psychological support based on behavioral treatment. Educational and cooking sessions were present at a lower rate. Globally, inpatient weight loss programs showed a consistent efficacy in reducing body weight and inducing beneficial effects on quality of life, psychological well-being, eating behavior, physical performance, and fatigue. Follow-up data were scarce, but with a high percentage of patients regaining weight after a short period.

Conclusion

Weight loss inpatient rehabilitation is a promising area that has evidence of all-rounded success in the amelioration of several aspects related to obesity. Nevertheless, it appears to be quite inconsistent in preserving these benefits after the intervention. This might slow the innovation process in this area and preclude further investments from national healthcare. Personalized and enriched programs could show greater impact when focusing on the behavioral and educational aspects, which are crucial points, in particular in pediatrics, for setting up a long-lasting lifestyle modification. More studies are therefore necessary to evaluate long-term efficacy based on the different work-up models.

Detecting the research structure and topic trends of social media using static and dynamic probabilistic topic models

Purpose

A huge volume of published research articles is available on social media which evolves because of the rapid scientific advances and this paper aims to investigate the research structure of social media.

Design/methodology/approach

This study employs an integrated topic modeling and text mining-based approach on 30381 Scopus index titles, abstracts, and keywords published between 2006 and 2021. It combines analytical analysis of top-cited reviews with topic modeling as means of semantic validation. The output sequences of the dynamic model are further analyzed using the statistical techniques that facilitate the extraction of topic clusters, communities, and potential inter-topic research directions.

Findings

This paper brings into vision the research structure of social media in terms of topics, temporal topic evolutions, topic trends, emerging, fading, and consistent topics of this domain. It also traces various shifts in topic themes. The hot research topics are the application of the machine or deep learning towards social media in general, alcohol consumption in different regions and its impact, Social engagement and media platforms. Moreover, the consistent topics in both models include food management in disaster, health study of diverse age groups, and emerging topics include drug violence, analysis of social media news for misinformation, and problems of Internet addiction.

Originality/value

This study extends the existing topic modeling-based studies that analyze the social media literature from a specific disciplinary viewpoint. It focuses on semantic validations of topic-modeling output and correlations among the topics and also provides a two-stage cluster analysis of the topics.

Challenging oppression: A social identity model of stigma resistance in higher-weight individuals

Many higher-weight individuals have internalised societal weight stigma, devaluing themselves because of their weight. Rejecting and challenging societal devaluation is generally associated with superior outcomes compared with stigma internalisation or inaction; however, stigma resistance has not been studied in higher-weight individuals, despite ubiquitous weight stigma in daily life. Applying a social identity framework, we utilised decision tree analysis to explore predictors of responses to weight stigma in 931 self-classified higher-weight individuals. While ingroup identification with the group 'Fat' was the major predictor of stigma resistance (versus internalisation), perceived illegitimacy of societal weight stigma defined a subgroup of resisters even in the absence of group identity. Interventions focusing on the illegitimacy of unequal social status and treatment may be effective at reducing internalisation and fostering resistance in a population with characteristically low ingroup identity.

‘Pressure creates diamonds’/‘fire refines gold’: Conceptualizing coping capital

While many consumer behavior studies have investigated consumer coping, few have considered it as a source of positive benefits in addition to being a matter of necessity. In this paper, we draw on Bourdieu’s notion of capital to introduce the concept of coping capital—the intentional or unintentional accumulation of resources, such as emotional and epistemic-competencies and skills resulting from coping with adversity, that may thereafter exist in an embodied state in the form of mental and physical dispositions—dispositions that later provide benefits in life. We suggest that the benefits of coping capital may be determined using either a prospective or a retrospective approach. These benefits may be anticipated or unanticipated when intentionally coping with adversity, while the benefits are predominantly unanticipated when unintentionally coping. By conceptualizing coping capital, our study makes a domain-level conceptual contribution to research on consumer coping. In addition the concept of coping capital may have broader implications outside of the domain of consumption.

Differential Associations between Weight Status (Obesity, Overweight, and Underweight) and Substance Use in Young Adulthood

BACKGROUND

Past evidence suggests obesity co-occurs with tobacco/nicotine, cannabis, and alcohol use in young adulthood, but whether this relationship extends to nicotine or cannabis vaping is unclear. Furthermore, differential relationships between substance use and specific weight status categories (obesity, overweight, and underweight) have not been assessed. This study assessed prevalence of tobacco/nicotine, cannabis, and alcohol use by weight status categories in young adulthood.

METHODS

Of the 1322 young adults (18-29 years; 20.5 ± 2.3 years; 63% female; 42% Hispanic/Latino/a/x, 30% Asian-American/Asian, 18% Caucasian/White, 7% Multiracial, and 2% African-American/Black) from a public, urban university were surveyed on their health-risk behaviors in the spring and fall of 2021.

RESULTS

Multinomial logistic regression models assessed six-month follow-up substance use prevalence (never, lifetime but no past 30-d use, and past 30-d use) by baseline weight status (obese, overweight, underweight; reference: healthy weight). Obesity predicted lower odds of past 30-d nicotine vaping (aOR [95% CI] = 0.27 [0.08-0.92]). Overweight predicted higher odds of lifetime combustible cannabis (aOR [95% CI] = 1.58 [1.08-2.30]) and past 30-d binge drinking (aOR [95% CI] = 1.79 [1.12-2.85]). Underweight was associated with lower odds of lifetime cannabis vaping (aOR [95% CI] = 0.35 [0.12-0.99]) and combustible cannabis (aOR [95% CI] = 0.38 [0.16-0.87]).

CONCLUSIONS

Differential relationships between obesity and overweight on tobacco/nicotine, cannabis, and alcohol use suggest greater specificity is needed when evaluating relationships between higher weight status and substance use. It appears that overweight young adults may be at higher risk of substance use than obese young adults. Greater efforts to consider multiple weight status groups, not just obese, may have significant implications for tobacco/nicotine prevention and intervention efforts targeting vulnerable populations.

The Impact of Teasing and Bullying Victimization on Disordered Eating and Body Image Disturbance Among Adolescents: A Systematic Review

Adolescence is a developmental period in which disordered eating and negative body image are highly prevalent, yet their risk factors are insufficiently understood and targeted. Despite research implicating both teasing and bullying victimization in the development of eating disorders, these strands of research are yet to be integrated. This systematic review hence aimed to identify whether teasing and bullying victimization are associated with greater risk of eating disorders and body image disturbance for adolescents. Systematic searches of PsycINFO and PubMed databases identified 79 papers that included quantitative analyses of the relationship between weight-related or nonspecific teasing or bullying victimization and disordered eating or body image disturbance. Overall, studies indicated that adolescents who are teased or bullied are more likely to experience disordered eating and negative body image compared to nonvictimized adolescents. This was more consistently observed in cross-sectional studies than in longitudinal findings. We identify several methodological limitations of the literature, including the infrequent consideration of potential mediating and moderating variables. Finally, we outline future directions such as temporal sequencing of the complex interrelationships among teasing and bullying, disordered eating, and body image disturbance in adolescents.

Trends of overweight and obesity among preschool children from 2013 to 2018: a cross-sectional study in Rhine-Neckar County and the City of Heidelberg, Germany

BACKGROUND

Early childhood overweight and obesity is a growing public health concern worldwide. Few recent studies have addressed how time trends varied by sociodemographic characteristics at the regional level using large and high-quality data. This study determines how time trends vary in the prevalence of early childhood overweight and obesity by age, gender, and migration background at the regional level.

METHODS

We used a Kernel-density curve to describe the BMI distribution, and evaluated the trends of overweight and obesity by age, gender, and migration background using logistic regression.

RESULTS

Mean BMI and the overall prevalence of overweight and obesity increased among preschool children aged 4-6 years in the Rhine-Neckar County and the City of Heidelberg. After adjusting for age, sex, and migration background, trends of overweight significantly increased only among male children in the age 5 year group with migration background (P < 0.05), and an upward trend of obesity was observed only among male children in the age 5 year group and female children in the age 6 year group with migration background (P < 0.05).

CONCLUSIONS

BMI distribution as well as general prevalence of overweight and obesity are still increasing among preschool children. Children with migration backgrounds, particularly male children in the age 5 year groups and female children in the age 6 year group should be prioritized. Health promotion strategies for children with migration backgrounds will help address this challenge.

Body Size, Fertility, and Reproductive Justice: Examining the Complex Interplay between BMI, Reproductive Health, and Access to Care

The relationship between obesity and reproduction is highly complex. While there are clear obstetrical and fertility risks associated with elevated BMI, it is less clear how weight loss impacts these outcomes. Increasingly, patients considered obese according to BMI are being denied access to fertility care, thus leaving them without treatment options for their disease (infertility). Notably, BMI cutoffs disproportionately affect historically marginalized populations in the United States and people of lower socioeconomic status (SES). This paper uses a reproductive justice framework to discuss access to reproductive healthcare based on BMI. In doing so, we connect obesity to larger systems of structural inequalities. We conclude that rather than strict BMI cutoffs, a more holistically patient-centered approach is appropriate taking into account the overall health of the individual, available scientific data, clinical capabilities, and the patient’s value system. This will ultimately make reproductive medicine more accessible to all patients.

Under the 'weight' of norms: Social representations of overweight and obesity among Brazilian, French and Spanish dietitians and laywomen

Most contemporary Western cultures are characterized by fatphobia. The fat body is seen as morally incorrect, a sign of disease, loss of control and weakness. People with obesity and overweight, especially women, are discriminated against and stigmatized for their body size, including by health professionals like dietitians. This study sought to understand and compare social representations of obesity and overweight among dietitians and laywomen from three nationalities: Brazilian, French and Spanish. A qualitative and comparative methodology was established based on 131 semi-structured individual interviews. The analysis revealed that the categories of overweight and obesity were negatively perceived by laywomen and dietitians from all three nationalities. Moral discourses linking these conditions with lack of discipline and a lack of emotional control were frequently used. Fatness was associated with irrationality, putting individuals who were overweight and obese in a position of social and moral inferiority. In the case of obesity, these ideas were more discriminatory and stigmatizing. Although environmental, genetic, hereditary or metabolic causes were mentioned as factors causing obesity, behavioural aspects occupied a central place in the discourses. Differences were also observed among the three nationalities. Cultural factors related to the relationship with body and food seemed to influence the interviewees' social representations. Brazilian laywomen and dietitians put more emphasis on moral and individual aspects. Spanish, French and informants who were overweight were more likely to cite physiological and environmental determinants. French informants also mentioned the role of food education given by parents. In conclusion, the discourses of professionals and laywomen had more similarities than differences, were based on moral and normative judgements and influenced by sociocultural norms. Fatphobic attitudes may impact dietitians' perception of patients with obesity and the eating education process.

Weight stigma in the COVID-19 pandemic: a scoping review

BACKGROUND

Weight stigma is a phenomenon associated with adverse behavioural and psychological consequences. Although experts suggest that its increase during the COVID-19 pandemic may be associated with worse health outcomes for people with obesity, a thorough analysis of the main findings and gaps is still needed when relating to this subject.

OBJECTIVE

We aim to answer three questions: (1) How does weight stigma manifest in the COVID-19 pandemic? (2) How can weight stigma affect people with overweight or obesity in times of COVID-19? (3) What are the perceptions and experiences of weight stigma during the pandemic in individuals who experience overweight or obesity?

METHODS

We conducted a scoping review of studies addressing weight stigma and the COVID-19 pandemic in electronic databases (Medline/PubMed, CINAHL, Embase, PsycInfo, BVS/Lilacs, Scopus, Web of Science, Google Scholar, and OpenGrey) published until 10th August 2021. All relevant studies were reviewed in full by two researchers. In addition, a narrative synthesis of the data was performed.

RESULTS

The results included 35 studies out of 8,090 records and identified 13 original research publications, 14 text and opinion papers, and 6 narrative reviews. The results revealed the presence of weight stigma in the media, healthcare settings, interpersonal relationships, and public campaigns during the COVID-19 pandemic. The evidence of increasing weight stigma in the COVID-19 outbreak is limited, though. Many weight discrimination consequences were described during this time, such as impairment in accessing healthcare, worst COVID-19 outcomes, and maladaptive eating. However, only maladaptive behaviours and decline in mental health outcomes were demonstrated empirically in all age groups. This effect occurred regardless of body mass index, but people with high body weight were more likely to experience weight stigma. For some people with obesity, weight stigma in the pandemic has made activities of daily routine difficult.

CONCLUSIONS

The results suggest that weight stigma in the COVID-19 pandemic occurs in several settings; moreover, although weight discrimination impacts mental health, whether before or during the pandemic, this influence between the pandemic and pre-pandemic scenario is still unclear. Therefore, more research is required in this field while the pandemic lasts, especially with people with obesity. Overall, people with overweight or obesity are more vulnerable to weight stigma than individuals without overweight. In addition, weight stigma refers to discrimination or prejudice based on a person's weight and relates to several consequences, for instance, poor healthcare treatment and mental health problems. In the COVID-19 outbreak, these weight stigma effects tend to become even more critical because they may be associated with unfavourable COVID-19 outcomes and eating disorder risks. Thus, it is crucial to investigate how weight stigma occurs during the pandemic and its impact on health, mainly for the most affected people. We investigated 35 studies published between 2019 and 2021 to map and explore how weight stigma was manifested and the related consequences for people with overweight or obesity in the COVID-19 pandemic. Only about a third of them were quantitative or qualitative, limiting the evidence of weight stigma in the COVID-19 context. The available evidence suggests that weight stigma manifests in several settings such as media, healthcare, public campaigns, and is more common in people with excess weight. However, weight discrimination experiences before or during the pandemic were associated with adverse psychological and behavioural consequences across all age groups, regardless of body weight. For some people with obesity, for instance, weight stigma made it difficult to accomplish their activities of daily routine. Nevertheless, it remains unclear whether weight stigma has increased in the pandemic, thus, more studies are required, especially about people with overweight or obesity.

Body image, body composition and environment: do they affect adolescents' physical activity?

BACKGROUND

Most adolescents are less physically active than recommended, despite the strong effort of various stakeholders to promote physical activity (PA). Body image and body composition may play an important role not only in directly facilitating adolescents' PA but also in enabling environment-related factors. As evidence is lacking, we aimed to assess the associations of adolescents' PA with body-related and environment-related factors, whether this differs by age and gender, and whether these factors interact.

METHODS

We used data on 888 11- to 15-year-old adolescents (mean age = 13.5, 56% boys) from the Health Behaviour in School-aged Children study conducted in 2018 in Slovakia. We used multinomial logistic regression analysis to assess the association of adolescents' PA with body-related factors (body image, body composition) and environment-related factors (PA-promoting environment, less leisure constraints), taking into account age and gender.

RESULTS

Adolescents who perceived their body as not too fat were more likely to be physically very active rather than inactive [odds ratios (ORs)/95% confidence interval (CI) 2.15/1.44-3.22], and similarly those who were not overweight/obese (3.24/2.09-5.01) and perceived less leisure constraints (1.74/1.44-2.11). In older adolescents and in girls, the association of adolescents' PA with body composition and environment-related factors was stronger. The association of adolescents' PA with perceiving less leisure constraints was stronger among adolescents who did not perceive their body as too fat (OR/95% CI 1.98/1.26-3.14), and for those who were not overweight/obese (OR/95% CI 1.62/1.01-2.57).

CONCLUSION

Adolescents' PA is associated with both body-related and environment-related factors. These associations are stronger in girls and older adolescents, if co-occurring.

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

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

"Negative Things That Kids Should Never Have to Hear": Exploring Women's Histories of Weight Stigma in Physical Activity

Scholars have proposed that cumulative experiences of anti-fat bias and stigma contribute to detrimental physical activity experiences, as well as social and health inequities. The objective of this research was to explore how enacted weight stigma experiences are constructed and impact women's physical activity experiences long term. Eighteen women who identified as having had negative experiences related to their body weight, shape, or size in physical activity contexts participated in semistructured interviews. Using reflexive thematic analysis, four themes were identified: (a) norms of body belonging, (b) distancing from an active identity, (c) at war with the body, and (d) acts of resistance. These findings deepen understandings of how historical experiences of weight stigma can have longstanding consequences on physical activity cognitions, emotions, and behaviors. To equitably promote physical activity, it is imperative that movement spaces (e.g., fitness centers, sport organizations) both target anti-fat stigma and adopt weight-inclusive principles.

Simply too much: the extent to which weight bias internalization results in a higher risk of eating disorders and psychosocial problems

PURPOSE

Weight bias internalization (WBI) is associated with negative health consequences such as eating disorders and psychosocial problems in children. To date, it is unknown to what extent WBI considerably raises the risk of negative outcomes.

METHODS

Analyses are based on cross-sectional data of 1,061 children (9-13 years, M = 11, SD = 0.9; 52.1% female) who filled in the WBI scale (WBIS-C). First, ROC analyses were run to identify critical cut-off values of WBI (WBIS-C score) that identify those who are at higher risk for psychosocial problems or eating disorder symptoms (as reported by parents). Second, it was examined whether WBI is more sensitive than the relative weight status in that respect. Third, to confirm that the cut-off value is also accompanied by higher psychological strain, high- and low-risk groups were compared in terms of their self-reported depressive symptoms, anxious symptoms, body dissatisfaction, and self-esteem.

RESULTS

WBIS-C scores ≥ 1.55 were associated with a higher risk of disturbed eating behavior; for psychosocial problems, no cut-off score reached adequate sensitivity and specificity. Compared to relative weight status, WBI was better suited to detect disturbed eating behavior. Children with a WBIS-C score ≥ 1.55 also reported higher scores for both depressive and anxious symptoms, higher body dissatisfaction, and lower self-esteem.

CONCLUSION

The WBIS-C is suitable for identifying risk groups, and even low levels of WBI are accompanied by adverse mental health. Therefore, WBI is, beyond weight status, an important risk factor that should be considered in prevention and intervention.

LEVEL OF EVIDENCE

Level III, cross-sectional analyses based on data taken from a well-designed, prospective cohort study.

Family Bullying in Childhood: Consequences for Young Adults

This study investigated childhood family bullying and explored any ongoing impacts for young adults. Research has demonstrated that peer bullying leads to contemporaneous poor consequences and some inquiries establish adverse effects of peer bullying lasting into adult life. However, family bullying is much less studied and the effects are not well understood. While there is urgency to intervene in peer bullying, this does not extend to family bullying. The aims of this inquiry were to discover what types of childhood bullying occur in families, any ongoing consequences, and how young adults define bullying. The study was a retrospective qualitative inquiry with a purposive sample. There were 43 participants: the majority were female, mean age 24.3 years, and 27% represented minorities. A qualitative description approach based in naturalistic inquiry was employed for data analysis to understand the lived experiences of young adults. NVivo 11 was used for data storage and analysis. A multi-phase coding process was utilized along with thematic analysis. Types of family bullying and participants' definitions of bullying were generated. Thematic analysis revealed lasting consequences in (a) low self-esteem and shame, (b) eating disorders, and (c) behavioral issues and relationship problems. Outcomes indicate the importance of further research on childhood family bullying as it affects young adult life and the need for researchers as well as practitioners to understand its lifelong impact.