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King KM, Wyche B, Umstead L. Broaching body size and sizeism: Input from specialized clinicians. Body Image 2024; 51:101775. [PMID: 39116580 DOI: 10.1016/j.bodyim.2024.101775] [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: 01/30/2024] [Revised: 07/15/2024] [Accepted: 07/24/2024] [Indexed: 08/10/2024]
Abstract
Broaching issues of identity and power with clients in the context of their mental health care is affirmed as an effective multicultural and social justice counseling skill by a growing evidence base. Considerations for broaching body size, including size difference and sizeism, with clients has not yet been studied, thus clinicians lack guidelines for facilitating these conversations. In this consensual qualitative research study, we present themes involved in broaching body topics based on our interviews with nine clinicians specialized in treating clients with eating disorders and body-related counseling concerns. Themes addressed counselor development, conceptualization of broaching, clinical-decision-making, practice, and impact of broaching body topics in session. Clinicians identified professional and personal developments they pursued and would advocate for training future clinicians to better serve clients. Descriptions of unique and shared aspects of broaching clients' intersectionality and body-size specifically depict avenues for tailoring broaching conversations. Specific examples of effective and ineffective broaching conversations, including language used and psychoeducational components, provide recommendations for practice and connect to observed impacts on the client, counselor, and counseling process.
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Affiliation(s)
- Kelly M King
- Counselor Education Program, California State University, Sacramento, CA, United States.
| | - Brittany Wyche
- Wake Forest University, Winston Salem, NC, United States
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Wang K, Brownstone L, Kivlighan M. Examining within- and between-member cohesion and working alliance effects on group members' motivation: a preliminary actor-partner interdependence study. Psychother Res 2024:1-14. [PMID: 39102809 DOI: 10.1080/10503307.2024.2385399] [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: 03/20/2024] [Revised: 07/11/2024] [Accepted: 07/22/2024] [Indexed: 08/07/2024] Open
Abstract
OBJECTIVE Informed by the person-environment fit theory, this preliminary study examined if a fit between a group member's treatment experience and their working therapy context (other group members' aggregated treatment experiences) were related to their level of motivation within a group treatment for healing from internalized weight stigma. METHOD We examined the relationship between two types of within-member and between-member's group cohesion, working alliance, and motivation. Specifically, we utilized the Actor-Partner Interdependence Model to operationalize the impact of actor's within-member cohesion and alliance (personal changes over time) and between-member cohesion and alliance (individual differences) as well as partner's within-member cohesion and alliance (contextual changes over time) and between-member cohesion and alliance (contextual differences) on group members' motivation. This study utilized self-report data from 26 group members who participated in three online weight stigma psychotherapy groups. RESULTS For cohesion, results suggested that the relationship between partner within-member cohesion and motivation was larger for members who reported low cohesion across all the sessions compared to the other members of their group. Additionally, an individual group member who perceived a group session more cohesive than they did on average, reported increased motivation in that session, and this relationship was stronger for members who on average perceived their group less cohesive than other group members. Lastly, session-level alliance was more strongly associated with an individual member's motivation in that session when the other group members reported higher group alliance on average. CONCLUSIONS These findings underscore the significance of member-group fit in group therapy and the reciprocal impact of individual members and the group on each other's therapy outcomes.
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Affiliation(s)
- Kun Wang
- Department of Psychological and Quantitative Foundations, University of Iowa, Iowa City, USA
| | - Lisa Brownstone
- Department of Counseling Psychology, Morgridge College of Education, University of Denver, Denver, CO, USA
| | - Martin Kivlighan
- Department of Psychological and Quantitative Foundations, University of Iowa, Iowa City, USA
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Prohaska A. Student opinions of body appreciation week: Openness to alternatives to a weight-centric model of health. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024:1-6. [PMID: 38592942 DOI: 10.1080/07448481.2024.2338413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/22/2024] [Indexed: 04/11/2024]
Abstract
Objective: Body image issues are common among young adult women on college campuses and are correlated with several negative outcomes. Only recently have universities begun to deliver Health at Every Size (HAES) education to university students to promote holistic health. Method: A sample of students who attended events for Body Appreciation Week (BAW) 2022 (N = 42) completed a Qualtrics survey collected by a student health promotion department at a large, southeastern university. I used this data to assess student openness to HAES and other alternatives to weight-centric approaches to health. Results: Overall, students who responded to the survey were pleased with programming that challenged diet culture and introduced the HAES model of health. Conclusion: Student feedback, along with previous research on college student programming interventions, suggests organizing similar events for future BAW and more frequent programming during the academic year to properly assess of the impact of these events on student health.
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Affiliation(s)
- Ariane Prohaska
- Department of Gender and Race Studies, The University of Alabama, Tuscaloosa, AL, USA
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Madsen M, Michaelsen L, DeCosta P, Grabowski D. Stigma-Generating Mechanisms in Families Enrolled in a Pediatric Weight Management Program: A Qualitative Study of Health Identities and Healthcare Authenticity. CHILDREN (BASEL, SWITZERLAND) 2023; 11:46. [PMID: 38255360 PMCID: PMC10813986 DOI: 10.3390/children11010046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/20/2023] [Accepted: 12/25/2023] [Indexed: 01/24/2024]
Abstract
In recent years, there has been increased awareness of obesity as a condition that carries a high level of stigma, as well as growing recognition of its prevalence and harm. Despite the increasing body of research on this topic, there is a gap in the literature regarding mechanisms that generate or exacerbate perceptions of weight stigma, especially within families and pediatric healthcare settings. The present study aims to identify potential stigma-generating mechanisms by focusing on inter-relational dynamics within these contexts. We conducted in-depth, semi-structured interviews with 11 families and analyzed the data by applying sociological theories on health identities and authenticity. Our study found four themes that represent potential stigma-generating mechanisms by being explicitly related to familial health identities and healthcare authenticity: (1) negotiating and reconstruction familial self-understanding, (2) between guilt, shame and conflicts, (3) navigating weight perceptions, and (4) the necessity of positivity and relevance. Our study shows the complexities of weight stigma within family and pediatric healthcare settings, emphasizing the need for sensitive and tailored support, as well as the value of working authentically as crucial aspects in preventing and/or reducing stigma.
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Affiliation(s)
- Mie Madsen
- Department of Prevention, Health Promotion and Community Care, Copenhagen University Hospital—Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark; (P.D.); (D.G.)
| | - Lene Michaelsen
- The Centre for Children and Youths Health, Mimersgade 47A, 2nd Floor, 2200 Copenhagen, Denmark;
| | - Patricia DeCosta
- Department of Prevention, Health Promotion and Community Care, Copenhagen University Hospital—Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark; (P.D.); (D.G.)
| | - Dan Grabowski
- Department of Prevention, Health Promotion and Community Care, Copenhagen University Hospital—Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark; (P.D.); (D.G.)
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Griffiths A, Kingsley S, Mason Z, Tome R, Tomkinson M, Jenkinson B. Listening to larger bodied women: Time for a new approach to maternity care. Women Birth 2023; 36:397-400. [PMID: 37468374 DOI: 10.1016/j.wombi.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/09/2023] [Accepted: 07/10/2023] [Indexed: 07/21/2023]
Affiliation(s)
- Ahlia Griffiths
- Consumer Representative, Australia; Body Positive Birth Alliance, Australia
| | - Sara Kingsley
- Consumer Representative, Australia; Body Positive Birth Alliance, Australia
| | - Zena Mason
- Consumer Representative, Australia; Body Positive Birth Alliance, Australia
| | - Renee Tome
- Consumer Representative, Australia; Body Positive Birth Alliance, Australia
| | - Malyssa Tomkinson
- Consumer Representative, Australia; Body Positive Birth Alliance, Australia
| | - Bec Jenkinson
- Body Positive Birth Alliance, Australia; Australian Women and Girls Health Research Centre, School of Public Health, The University of Queensland, Australia.
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Mensinger JL, Shepherd BF, Schapiro S, Aware Y, Brochu PM, Calogero RM, Tylka TL. Mediating effects of a weight-inclusive health promotion program on maladaptive eating in women with high body mass index. Eat Behav 2023; 49:101730. [PMID: 37121132 DOI: 10.1016/j.eatbeh.2023.101730] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 02/14/2023] [Accepted: 04/17/2023] [Indexed: 05/02/2023]
Abstract
Research shows that individuals with a body mass index (BMI) over 30 have experienced an 11-fold increase in restrictive eating and a 7-fold increase in binge eating since the 1990s. Most health promotion programs for higher-weight individuals have not been developed with the high eating disorder risk for this population in mind. The purpose of current study was to test two hypothesized mechanisms underlying improvement in maladaptive eating patterns shown in a weight-inclusive health promotion program designed for women with BMIs at or above 30. Participants (N = 40) were primarily White (93 %), 30-45 years old (M = 39.83, SD = 4.34) with BMIs ranging from 30 to 45 kg/m2 (M = 37.42, SD = 3.58). Using the MEMORE macro, we tested a parallel mediation model hypothesizing that internalized weight stigma and intuitive eating would explain improvements on two subscales from the Three-Factor Eating Questionnaire-R18 after a 6-month program. Total effects of the program on uncontrolled (b = -3.76, SE = 0.64, p < .0001) and emotional eating (b = -1.79, SE = 0.34, p < .0001) were significant. The indirect effects (IE) of internalized weight stigma on uncontrolled eating (IE = 1.59, SE = 0.79, 95 % CI = 0.46, 3.49) and emotional eating (IE = 0.67, SE = 0.40, 95 % CI = 0.11, 1.68) were also significant. Likewise, the IEs of intuitive eating on uncontrolled eating (IE = 2.09, SE = 0.70, 95 % CI = 0.60, 3.38) and emotional eating (IE = 1.03, SE = 0.43, 95 % CI = 0.08, 1.82) were significant. These findings indicate that weight-inclusive health promotion programs that directly address weight bias and eating according to cues from the body may help higher-weight individuals improve maladaptive eating patterns via reductions in internalized weight stigma and increases in intuitive eating.
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Affiliation(s)
- Janell L Mensinger
- Department of Clinical and School Psychology, Nova Southeastern University, 3301 College Ave, 1073 Maltz, Fort Lauderdale, FL 33314, United States of America.
| | - Benjamin F Shepherd
- Department of Clinical and School Psychology, Nova Southeastern University, 3301 College Ave, 1073 Maltz, Fort Lauderdale, FL 33314, United States of America.
| | - Stevie Schapiro
- Department of Clinical and School Psychology, Nova Southeastern University, 3301 College Ave, 1073 Maltz, Fort Lauderdale, FL 33314, United States of America.
| | - Yashvi Aware
- Department of Clinical and School Psychology, Nova Southeastern University, 3301 College Ave, 1073 Maltz, Fort Lauderdale, FL 33314, United States of America.
| | - Paula M Brochu
- Department of Clinical and School Psychology, Nova Southeastern University, 3301 College Ave, 1073 Maltz, Fort Lauderdale, FL 33314, United States of America.
| | - Rachel M Calogero
- Department of Psychology, Western University, Westminster Hall, Office 321, London, ON N6K 5C2, Canada.
| | - Tracy L Tylka
- Department of Psychology, The Ohio State University, 170F Morrill Hall, 1465 Mt. Vernon Avenue, Marion, OH 43302, United States of America.
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O'Hara L, Taylor J. QATCHEPP: A quality assessment tool for critical health promotion practice. Front Public Health 2023; 11:1121932. [PMID: 37026119 PMCID: PMC10070830 DOI: 10.3389/fpubh.2023.1121932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/01/2023] [Indexed: 04/08/2023] Open
Abstract
Background The origins of health promotion are based in critical practice; however, health promotion practice is still dominated by selective biomedical and behavioral approaches, which are insufficient to reduce health inequities resulting from the inequitable distribution of structural and systemic privilege and power. The Red Lotus Critical Health Promotion Model (RLCHPM), developed to enhance critical practice, includes values and principles that practitioners can use to critically reflect on health promotion practice. Existing quality assessment tools focus primarily on technical aspects of practice rather than the underpinning values and principles. The aim of this project was to develop a quality assessment tool to support critical reflection using the values and principles of critical health promotion. The purpose of the tool is to support the reorientation of health promotion practice toward a more critical approach. Research design We used Critical Systems Heuristics as the theoretical framework to develop the quality assessment tool. First, we refined the values and principles in the RLCHPM, then created critical reflective questions, refined the response categories, and added a scoring system. Results The Quality Assessment Tool for Critical Health Promotion Practice (QATCHEPP) includes 10 values and associated principles. Each value is a critical health promotion concept, and its associated principle provides a description of how the value is enacted in professional practice. QATCHEPP includes a set of three reflective questions for each value and associated principle. For each question, users score the practice as strongly, somewhat, or minimally/not at all reflective of critical health promotion practice. A percentage summary score is generated with 85% or above indicative of strongly critical practice, 50% ≤ 84% is somewhat critical practice, and < 50% minimally or does not reflect critical practice. Conclusion QATCHEPP provides theory-based heuristic support for practitioners to use critical reflection to assess the extent to which practice aligns with critical health promotion. QATCHEPP can be used as part of the Red Lotus Critical Promotion Model or as an independent quality assessment tool to support the orientation of health promotion toward critical practice. This is essential to ensure that health promotion practice contributes to enhancing health equity.
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Affiliation(s)
- Lily O'Hara
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
- *Correspondence: Lily O'Hara
| | - Jane Taylor
- School of Health, University of the Sunshine Coast, Maroochydore, QLD, Australia
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Kvardova N, Machackova H, Smahel D. A moderated mediation model for body-positive online content and body image among adolescents. Body Image 2022; 42:370-374. [PMID: 35930872 DOI: 10.1016/j.bodyim.2022.07.002] [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: 08/31/2021] [Revised: 07/01/2022] [Accepted: 07/05/2022] [Indexed: 10/16/2022]
Abstract
Body-positive online content (BPOC) has recently become widespread, yet the factors that explain its association with body satisfaction have scarcely been studied. The current study investigates the indirect association between the self-reported frequency of viewing BPOC and body satisfaction through body appreciation and the moderating roles of body-ideal internalization, self-esteem, intentional searching, and gender. Utilizing survey data from 1530 Czech adolescents aged 13-18 (M=15.4, SD=1.7, 50 % girls), the present study found limited support for an indirect connection between the frequency of viewing BPOC and body satisfaction through body appreciation. Nonetheless, an indirect association appeared among adolescents with average and above-average frequencies for intentional searching for BPOC. Other investigated moderating factors were not significant. The present findings suggest that BPOC may be positively associated with body image, but only for those who deliberately search for it. The study highlights the importance of individual moderating factors in the context of BPOC and the remaining research gaps, such as the examination of its various types and aspects and their relationship with body image.
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Affiliation(s)
- Nikol Kvardova
- Interdisciplinary Research Team on Internet and Society, Faculty of Social Studies, Masaryk University, Jostova 10, Brno.
| | - Hana Machackova
- Interdisciplinary Research Team on Internet and Society, Faculty of Social Studies, Masaryk University, Jostova 10, Brno.
| | - David Smahel
- Interdisciplinary Research Team on Internet and Society, Faculty of Social Studies, Masaryk University, Jostova 10, Brno.
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O’Hara L, Taylor J. Impact of the use of Red Lotus Critical Health Promotion Model as a pedagogical framework on health promotion graduates’ professional practice: a mixed methods study. Health Promot J Austr 2022; 33 Suppl 1:76-86. [DOI: 10.1002/hpja.642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 07/15/2022] [Accepted: 07/18/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Lily O’Hara
- Department of Public Health College of Health Sciences, QU Health, Qatar University
| | - Jane Taylor
- School of Health and Behavioural Sciences University of the Sunshine Coast
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Coakley KE, Lardier DT. Self-reported Alcohol Misuse Is Associated with Disordered Eating and Binge Eating Disorder in Adults. ALCOHOLISM TREATMENT QUARTERLY 2022. [DOI: 10.1080/07347324.2022.2101409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Kathryn E Coakley
- Department of Individual, Family and Community Education, University of New Mexico, Albuquerque, New Mexico, USA
| | - David T Lardier
- Department of Psychiatry & Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
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Levine MP. Prevention of eating disorders: 2021 in review. Eat Disord 2022; 30:121-143. [PMID: 35167430 DOI: 10.1080/10640266.2022.2030882] [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] [Indexed: 11/03/2022]
Abstract
This review of 19 prevention-related publications in Eating Disorders during 2021 is framed by four models: (1) Mental Health Intervention Spectrum: health promotion → types of prevention → case identification/referral → treatment; (2) the prevention cycle: rationale and theory, shaped by critical reviews → clarifying risk and protective factors → program innovation and feasibility studies → efficacy and effectiveness research → program dissemination; (3) links between disordered eating (DE) and eating disorders (EDs); and (4) Kraemer and Jacobi's criteria for variable, causal risk factors (RFs). Twelve articles demonstrated the strengths and limitations of cross-sectional investigations of RFs for DE and EDs: five explored the role of trauma in activating genetic and psychological RFs (e.g., anxiety and experiential avoidance), while five suggest other variables meriting further evaluation: ergogenic supplement use, "feeling fat," internalized weight bias, food insecurity, and compulsive exercising. One article presents a pilot program that reduced risk factors in a high-risk group: professional ballerinas. Implications of the absence of efficacy, effectiveness, dissemination, and advocacy studies, along with the need to develop tailored programs for various high-risk groups, are discussed.
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Affiliation(s)
- Michael P Levine
- Department of Psychology (emeritus), Kenyon College, Gambier, Ohio, USA
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Obesity, Body Image Dissatisfaction, and Sexual Dysfunction: A Narrative Review. SEXES 2022. [DOI: 10.3390/sexes3010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
With approximately two-thirds of the United States adult population classified as overweight or obese, obesity remains a critical public health concern. Obesity not only contributes to several health complications including type 2 diabetes mellitus and cardiovascular disease, but the condition is also associated with sexual dysfunction in both women and men. Despite evidence linking obesity and its concomitant pathophysiology to sexual problems, the potential roles of psychosocial factors such as body image are understudied. This narrative review evaluates the research linkages between obesity and sexual dysfunction, with particular attention to the potential effects of body image dissatisfaction. A literature search of biomedical and psychological databases was used to identify research pertaining to obesity, sexual function, and/or body image constructs. The pathophysiological effects of obesity on sexual function are well-documented in mechanistic studies and animal trials, often with corroboration in human clinical samples. However, very few studies examine obesity, body image, and sexual function in tandem. Body image dissatisfaction appears to independently impinge upon the sexual response cycle and mental health outcomes, irrespective of body weight. While obesity is often associated with negative body image appraisal, it is unclear whether these constructs exert additive, synergistic, or antagonistic effects on sexual responsivity. Additionally, overweight/obese individuals who exhibit higher levels of body image satisfaction or self-confidence appear to be protected from the deleterious effects of obesity on sexual satisfaction, at least to some extent. Greater reliance upon conceptual/theoretical models from the body image literature may better clarify the relationships between these constructs.
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Demystifying ‘diet culture’: Exploring the meaning of diet culture in online ‘anti-diet’ feminist, fat activist, and health professional communities. WOMENS STUDIES INTERNATIONAL FORUM 2022. [DOI: 10.1016/j.wsif.2021.102558] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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