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Barnes RD, Lawson JL. Weight stigma and binge eating related to poorer perceptions of healthcare provider interaction quality in a community-based sample. J Eat Disord 2024; 12:128. [PMID: 39223683 PMCID: PMC11370053 DOI: 10.1186/s40337-024-01093-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 08/22/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Weight stigma refers to the social rejection, discrimination, and ideological devaluation of individuals because of body size and is a direct result of weight bias and anti-fat attitudes. Individuals with higher weight may be less likely to seek healthcare due to weight stigma, and if or when they do present for care, medical providers with weight bias may fail to provide high quality care. Little, however, is known about the intersectionality of weight stigma and perceptions of healthcare interactions as experienced by individuals who also binge eat. METHODS Community-based adults completed online self-report questionnaires regarding generalized weight stigma (Attitudes Towards Obese Persons1), healthcare interaction quality (Patient Perceptions of Healthcare Provider Interaction Quality; PPH), and disordered eating (Eating Disorder Examination-Questionnaire) via Amazon's Mechanical Turk platform. For this cross-sectional study, participants were categorized by the presence and absence of regular binge episodes. Pearson's correlations, T-tests, ANOVA/ANCOVA, and a multivariate regression were used to examine relationships among demographic variables, weight stigma, disordered eating, and the PPH. RESULTS Participants (N = 648) primarily identified as female (65.4%) and White, non-Hispanic (72.7%). Participants' average age and body mass index (BMI) were 37.5 (SD = 12.3) years old and 27.3 (SD = 6.9) kg/m2, respectively. Higher healthcare provider interaction quality ratings (PPH) were significantly related to lower BMI (r(648)=-0.098,p = 0.012), less weight stigma (r(648) = 0.149,p < 0.001), and identifying as a woman (t(514) = 2.09, p = 0.037, Cohen's d = 0.165) or White, non-Hispanic (t(646)=-2.73, p = 0.007, Cohen's d=-0.240). Participants reporting regular binge eating endorsed significantly worse perceptions of healthcare provider quality than those who did not, even after accounting for BMI, F(1, 645) = 8.42, p = 0.004, η2 = 0.013. A multivariate linear regression examining the PPH as dependent, and weight stigma and binge eating as independent, variable/s, was significant even after accounting for covariates (sex, race, BMI), F(95, 640) = 7.13,p < 0.001, R2 = 0.053 (small effect). CONCLUSIONS More negative experiences with healthcare providers was associated with worse weight stigma, higher BMI, regular binge eating and overall disordered eating, and for participants identifying as male or a Person of Color. These data have implications for non-clinical community populations and are particularly important as experiencing poorer quality of interactions with healthcare providers may decrease individuals' likelihood of seeking needed care for both disordered eating and health-related concerns. TRIAL REGISTRATION N/A.
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Affiliation(s)
- Rachel D Barnes
- Division of General Internal Medicine, University of Minnesota Medical School, MMC 741, 420 Delaware Street SE, Minneapolis, MN, 55455, USA.
| | - Jessica L Lawson
- VA Connecticut Healthcare System, West Haven, CT, USA
- Yale School of Medicine, Department of Psychiatry, New Haven, CT, USA
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2
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Perelman H, Gilbert K, Grilo CM, Lydecker JA. Loss of control in binge-eating disorder: Fear and resignation. Int J Eat Disord 2023; 56:1199-1206. [PMID: 36920120 PMCID: PMC10247475 DOI: 10.1002/eat.23929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/24/2023] [Accepted: 02/24/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVE Binge-eating disorder involves overeating while feeling a loss of control (LOC). Emotions around LOC appear to vary; some patients fear LOC whereas others feel powerless or "resigned" to LOC. This study examined differences in psychopathology among treatment-seeking patients with binge-eating disorder categorized with fear of LOC, resignation to LOC, and no fear/resignation of LOC. METHOD Doctoral research clinicians administered diagnostic and semistructured interviews to characterize psychopathology and establish a diagnosis of binge-eating disorder in participants (N = 382). The interview assessed fear of LOC in the past month. Further queries assessed whether, in the absence of fear of LOC, patients were resigned to LOC or had no fear/resignation. RESULTS Patients with fear of LOC and resigned to LOC endorsed significantly greater global eating-disorder psychopathology than patients with no fear/resignation. Patients with fear of LOC reported greater distress about binge eating and greater depression than those with no fear/resignation. Patients resigned to LOC reported significantly more frequent binge-eating episodes than those with fear of LOC and no fear/resignation. Black individuals and men were more likely to report no fear/resignation than other demographic groups. DISCUSSION This study describes a novel clinical aspect of binge-eating disorder: resignation to LOC. Findings highlight the importance of including anticipatory cognitive-affective experiences in treatment formulations and planning. Future research should examine co-occurrence of these experiences and their association with impairment. Future research should also examine how fear of LOC and resignation to LOC change during treatment and whether they predict or moderate treatment outcomes. PUBLIC SIGNIFICANCE Adults with binge-eating disorder have anticipatory cognitive-affective experiences about loss of control (LOC) over eating (i.e., fear of LOC, resigned to LOC, no fear nor resignation of LOC). Individuals who experience fear of LOC and those who are resigned to LOC had more severe psychopathology than those without fear/resignation. Binge-eating disorder has the highest prevalence of the eating disorders; thus, findings have high public significance in guiding clinicians' treatment planning.
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Affiliation(s)
- Hayley Perelman
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
- Department of Counseling Psychology and Applied Human Development, Boston University, Boston, Massachusetts, USA
| | - Kelsey Gilbert
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
- Department of Psychology, University of Hartford, Hartford, Connecticut, USA
| | - Carlos M Grilo
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Janet A Lydecker
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
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Herbozo S, Brown KL, Burke NL, LaRose JG. A Call to Reconceptualize Obesity Treatment in Service of Health Equity: Review of Evidence and Future Directions. Curr Obes Rep 2023; 12:24-35. [PMID: 36729299 PMCID: PMC9894524 DOI: 10.1007/s13679-023-00493-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/10/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW Rates of obesity and associated comorbidities are higher among Black and Latino adults compared to white adults. We sought to provide an overview of both structural and individual factors contributing to obesity inequities and synthesize available evidence regarding treatment outcomes in Black and Latino adults, with an eye towards informing future directions. RECENT FINDINGS Obesity disparities are influenced by myriad systemic issues, yet the vast majority of interventions target individual-level factors only, and most behavioral treatments fail to target drivers beyond eating and physical activity. Extant treatments are not equally accessible, affordable, or effective among Black and Latino adults compared with white counterparts. Asset-based, culturally relevant interventions that target the root causes of obesity and address intersectional stress-designed in partnership with intended beneficiaries-are urgently needed. Treatment trials must improve enrollment of Black and Latino adults and report treatment outcomes by race and ethnicity.
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Affiliation(s)
- Sylvia Herbozo
- Department of Surgery, Department of Psychiatry and Behavioral Sciences, College of Medicine, University of Illinois at Chicago, Chicago, USA.
- Department of Psychiatry and Behavioral Sciences and Department of Surgery, Rush University Medical Center, 1725 West Harrison Street, Chicago, IL, 60612, USA.
| | - Kristal Lyn Brown
- Division of General Internal Medicine, School of Medicine, The Johns Hopkins University, Baltimore, USA
| | - Natasha L Burke
- Department of Psychology, Fordham University, The Bronx, USA
| | - Jessica Gokee LaRose
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, USA
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Batsis JA, Zagaria AB, Brooks E, Clark MM, Phelan S, Lopez-Jimenez F, Bartels SJ, Rotenberg S, Carpenter-Song E. The Use and Meaning of the Term Obesity in Rural Older Adults: A Qualitative Study. J Appl Gerontol 2021; 40:423-432. [PMID: 32065013 PMCID: PMC7429325 DOI: 10.1177/0733464820903253] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The term "obesity" is associated with societal stigma and discrimination. Eight individual semi-structured interviews and five focus groups with 29 community-dwelling, rural older adults with obesity, seven primary care clinicians, and four rural community leaders were completed using purposive and snowball sampling. Clinicians perceived that older adults are less affected by obesity stigma than younger adults, yet this was not observed by community leaders; however, older participants with obesity reported that they often felt ashamed and/or stigmatized because of their weight. There was also a disconnect between clinician and older adult understanding of obesity. For older adults with obesity, the word "obesity" was associated with negative connotations. Just as physiological aspects of obesity persist into older adulthood, so do psychological aspects, such as perceptions of stigma. The use of the word "obesity" in medical settings may hinder communication between clinician and older participants. Heightened awareness may change the dialogue around obesity.
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Affiliation(s)
- John A. Batsis
- Geisel School of Medicine and The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH
- Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH
- Dartmouth Centers for Health and Aging, Dartmouth College, Hanover, NH
- Health Promotion Research Center at Dartmouth, Lebanon, NH
| | - Alexandra B. Zagaria
- Geisel School of Medicine and The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH
| | - Emma Brooks
- Dartmouth Centers for Health and Aging, Dartmouth College, Hanover, NH
- Section of Weight & Wellness, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Matthew M. Clark
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Sean Phelan
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN
| | | | | | - Sivan Rotenberg
- Department of Psychiatry, Dartmouth Hitchcock Medical Center, Lebanon, NH
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Ivezaj V, Lydecker JA, Grilo CM. Language Matters: Patients' Preferred Terms for Discussing Obesity and Disordered Eating with Health Care Providers After Bariatric Surgery. Obesity (Silver Spring) 2020; 28:1412-1418. [PMID: 32662251 PMCID: PMC7501175 DOI: 10.1002/oby.22868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/31/2020] [Accepted: 04/18/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Patients who seek or undergo bariatric surgery are likely to experience pervasive societal biases regarding weight and eating behaviors in the health care system. This cross-sectional study examined patient preferences for desired weight- and eating-related terms for health care providers among individuals with loss-of-control eating after bariatric surgery. METHODS A total of 114 of 140 adults who underwent bariatric surgery approximately 1.5 years prior and were in the follow-up stage of a controlled treatment trial testing behavioral treatments completed language preference measures. RESULTS Of the 11 terms used to describe weight, only 2 were viewed neutrally, weight and BMI. All other terms, including obesity, were rated negatively, and many were rated extremely negatively. Fatness was the least desirable term. Of the 18 terms used to describe loss-of-control eating, one ("ate until uncomfortably full") was rated positively, and several were rated neutrally. On average, none of the weight or loss-of-control eating terms was rated as "desirable" or "very desirable." Analyses revealed few gender and racial differences in language preferences. CONCLUSIONS Many weight-related and loss-of-control eating terms are viewed as undesirable. Health care providers should begin with neutrally rated terms and ask patients about their language preferences when speaking with individuals before/after bariatric surgery to improve patient-centered care and reduce perceived weight bias.
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Affiliation(s)
| | | | - Carlos M. Grilo
- Yale School of Medicine, New Haven, CT, 06519
- Yale University, New Haven, CT, 06511
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Puhl RM. What words should we use to talk about weight? A systematic review of quantitative and qualitative studies examining preferences for weight-related terminology. Obes Rev 2020; 21:e13008. [PMID: 32048465 DOI: 10.1111/obr.13008] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/06/2020] [Accepted: 01/27/2020] [Indexed: 12/18/2022]
Abstract
Evidence of weight stigma and its harmful consequences have led to increased attention to the words that are used to talk about obesity and body weight, including calls for efforts to carefully consider weight-related terminology and promote respectful language in the obesity and medical fields. Despite increased research studies examining people's preferences for specific words that describe body weight, there has been no systematic review to synthesize existing evidence on perceptions of and preferences for weight-related terminology. To address this gap, the current systematic review identified 33 studies (23 quantitative, 10 qualitative) that examined people's preferences for weight-related terminology in the current research literature (from 1999 to 2019). Across studies, findings generally suggest that neutral terminology (eg, "weight" or "unhealthy weight") is preferred and that words like "obese" and "fat" are least acceptable, particularly in provider-patient conversations about weight. However, individual variation in language preferences is evident across demographic characteristics like race/ethnicity, gender, and weight status. Of priority is future research that can improve upon the limited diversity of the existing literature, both with respect to sample diversity and the use of culturally relevant weight-related terminology, which is currently lacking in measurement. Implications for patient-provider communication and public health communication are discussed.
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Affiliation(s)
- Rebecca M Puhl
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT.,Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT
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Chevinsky JD, Wadden TA, Chao AM. Binge Eating Disorder in Patients with Type 2 Diabetes: Diagnostic and Management Challenges. Diabetes Metab Syndr Obes 2020; 13:1117-1131. [PMID: 32341661 PMCID: PMC7166070 DOI: 10.2147/dmso.s213379] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 03/26/2020] [Indexed: 12/21/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) is associated with an increased risk of disordered eating behaviors including binge eating disorder (BED). Comorbid BED in patients with T2DM has been associated with adverse clinical outcomes such as higher body mass index (BMI) and depressive symptoms. Identifying and addressing this disorder in patients with T2DM is a significant challenge for health-care providers. The purpose of this narrative review is to discuss current perspectives on BED in the context of T2DM with implications for screening and management of these highly comorbid conditions. BED continues to be underrecognized and underdiagnosed. However, there are established tools that providers can use to screen for BED such as the SCOFF Questionnaire and Questionnaire on Eating and Weight Patterns-5. There are several effective treatments for BED including cognitive behavioral therapy, interpersonal therapy, and lisdexamfetamine dimesylate. However, few studies have examined the effects of these treatments in patients with co-morbid T2DM and BED.
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Affiliation(s)
| | - Thomas A Wadden
- Perelman School of Medicine at the University of Pennsylvania, Department of Psychiatry, Philadelphia, PA, USA
| | - Ariana M Chao
- Perelman School of Medicine at the University of Pennsylvania, Department of Psychiatry, Philadelphia, PA, USA
- University of Pennsylvania School of Nursing, Department of Biobehavioral Health Sciences, Philadelphia, PA, USA
- Correspondence: Ariana M Chao University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA19104, USATel +1215-746-7183Fax +1215-898-2878 Email
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Chao AM, Rajagopalan AV, Tronieri JS, Walsh O, Wadden TA. Identification of Binge Eating Disorder Criteria: Results of a National Survey of Healthcare Providers. J Nurs Scholarsh 2019; 51:399-407. [PMID: 30821428 DOI: 10.1111/jnu.12468] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE To determine whether general healthcare providers and adult psychiatrists recognized binge eating disorder (BED) symptoms and features. The aims were to examine how they delineated the core criteria of BED-eating a large amount of food and sense of loss of control over eating-and how their evaluations compared to ratings by BED experts. DESIGN This is a cross-sectional study of a nationwide U.S. sample of healthcare providers and a convenience sample of BED experts. METHODS Providers were mailed surveys that asked respondents about their perceptions of a large amount of food and whether they thought case vignettes met thresholds for loss of control. Participants were also asked to select BED diagnostic criteria from a symptom list. Results were analyzed using one-way analyses of variance with post-hoc comparisons and chi-squared tests. FINDINGS The survey was completed by 405 healthcare providers (response rate of 28.4%). Ratings of a large amount of food did not differ between BED experts and general healthcare providers (p = .10) or psychiatrists (p = .90). Provider groups did not differ significantly on whether five of the six vignettes met thresholds for loss of control (p > .05). Of the respondents, 93.0% of general healthcare providers and 88.6% of psychiatrists could not correctly identify the diagnostic criteria for BED. CONCLUSIONS Across provider groups, demarcation of a large amount of food and loss of control over eating were relatively consistent. However, general healthcare providers and psychiatrists were not able to correctly identify BED symptoms. CLINICAL RELEVANCE Training and education are greatly needed to improve knowledge of the diagnostic criteria for BED.
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Affiliation(s)
- Ariana M Chao
- University of Pennsylvania School of Nursing, Department of Biobehavioral Health Sciences, Philadelphia, PA, USA.,Perelman School of Medicine at the University of Pennsylvania, Department of Psychiatry, Philadelphia, PA, USA
| | | | - Jena Shaw Tronieri
- Perelman School of Medicine at the University of Pennsylvania, Department of Psychiatry, Philadelphia, PA, USA
| | - Olivia Walsh
- Perelman School of Medicine at the University of Pennsylvania, Department of Psychiatry, Philadelphia, PA, USA
| | - Thomas A Wadden
- Perelman School of Medicine at the University of Pennsylvania, Department of Psychiatry, Philadelphia, PA, USA
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Reas DL. Public and Healthcare Professionals' Knowledge and Attitudes toward Binge Eating Disorder: A Narrative Review. Nutrients 2017; 9:nu9111267. [PMID: 29160843 PMCID: PMC5707739 DOI: 10.3390/nu9111267] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 11/10/2017] [Accepted: 11/18/2017] [Indexed: 12/22/2022] Open
Abstract
Binge eating disorder (BED) is characterized by recurrent binge eating and marked distress in the absence of inappropriate compensatory behaviors for weight control. BED is prevalent in men and women, is associated with elevated psychosocial and functional impairment, and is associated strongly with obesity and related medical comorbidities. The aim is to provide a brief, state-of-the-art review of the major and recent findings to inform educational and awareness campaigns, stigma reduction interventions, as well as current clinical practice and future research. A narrative approach was used to synthesize emerging literature on the public and healthcare professionals’ knowledge and attitudes toward individuals with BED in comparison to other eating disorders (EDs) or mental illness. A total of 13 articles were reviewed. Nine studies investigated community samples and four studies investigated healthcare professionals. The reviewed literature suggested that BED is perceived by the public as less impairing, less severe, and “easier-to-treat” than other EDs. Attitudes and beliefs reflecting perceived blameworthiness and lack of self-discipline were ascribed to vignettes with BED. Community studies indicated a low level of public awareness that BED constitutes a discreet eating disorder. The literature on healthcare professionals’ knowledge and attitudes toward BED remains very limited. The few existing studies suggest encouraging trends in recognition and diagnostic accuracy, yet there remains a need for increased clinical awareness of BED-associated medical complications and knowledge of full BED diagnostic criteria.
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Affiliation(s)
- Deborah Lynn Reas
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, N-0424 Oslo, Norway.
- Institute of Psychology, Faculty of Social Sciences, University of Oslo, N-0317 Oslo, Norway.
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