1
|
Panza E, Olson K, Sall K, Norris A, Lillis J, Thomas JG, Dunsiger S, Fowler H, Parent H, Wing RR. Sexual Minority Women Report Higher Weight Stigma Levels Than Heterosexual Women in the National Weight Control Registry. Ann Behav Med 2024:kaae042. [PMID: 38990532 DOI: 10.1093/abm/kaae042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND Little is known about weight stigma in sexual minority women, and even less is known about weight stigma in those who have attained substantial weight loss and maintenance. PURPOSE This study examined weight stigma experiences and internalization in sexual minority women from the National Weight Control Registry (NWCR) who had lost ≥30 pounds and maintained this weight loss for ≥1 year, and compared weight stigma levels between sexual minority women versus heterosexual women in the NWCR. METHODS NWCR participants completed an electronic survey. Women who identified as a sexual minority (n = 64; 98% White; MBMI = 29 ± 8; Mage = 47 ± 13) and heterosexual women matched on body mass index (BMI), age, and race (n = 64; 98% White; MBMI = 28 ± 7; Mage = 51 ± 13) were included. Participants completed assessments of experienced and internalized weight stigma. RESULTS Generalized linear models showed that a significantly larger proportion of sexual minority women in the NWCR reported experiencing weight stigma in the past year (24.2%) compared with heterosexual women (4.7%; p < .05). Furthermore, sexual minority (vs. heterosexual) women reported significantly higher levels of internalized weight stigma (p < .001), and a greater proportion of sexual minority women (35%) reported clinically significant internalized weight stigma relative to heterosexual women (2%; p < .001). CONCLUSIONS Sexual minority women are at greater risk for experienced and internalized weight stigma than their heterosexual counterparts among women who have attained significant long-term weight loss. It is critical to expand research on weight stigma in sexual minority women.
Collapse
Affiliation(s)
- Emily Panza
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - KayLoni Olson
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Kayla Sall
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Alyssa Norris
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Center for Preventive and Behavioral Medicine, The Miriam Hospital, Providence, RI, USA
| | - Jason Lillis
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- College of Psychology, California Northstate University, Rancho Cordova, CA, USA
| | - John Graham Thomas
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Shira Dunsiger
- Center for Health Promotion and Health Equity, Brown School of Public Health, Providence, RI, USA
| | - Halle Fowler
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA
- Department of Psychology, Brown University, Providence, RI, USA
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
| | - Hannah Parent
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA
- Department of Psychology, Brown University, Providence, RI, USA
- Infectious Diseases and Immunology, The Miriam Hospital, Providence, RI, USA
| | - Rena R Wing
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| |
Collapse
|
2
|
Mathew D. Combating weight bias. J Hosp Med 2024; 19:639-641. [PMID: 37916759 DOI: 10.1002/jhm.13232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/15/2023] [Accepted: 10/19/2023] [Indexed: 11/03/2023]
Affiliation(s)
- Don Mathew
- Department of Internal Medicine, University of Pittsburgh Medical Center, Monroeville, Pennsylvania, USA
| |
Collapse
|
3
|
Hung P, Miciak M, Godziuk K, Gross DP, Forhan M. Reducing weight bias and stigma in qualitative research interviews: Considerations for researchers. Obes Rev 2024; 25:e13750. [PMID: 38685680 DOI: 10.1111/obr.13750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 05/02/2024]
Abstract
Perceptions and biases influence how we interact with and experience the world, including in professional roles as researchers. Weight bias, defined as negative attitudes or perceptions towards people that have large bodies, can contribute to weight stigma and discrimination leading to negative health and social consequences. Weight bias is experienced by people living with obesity in media, health care, education, employment and social settings. In research settings, there is potential for weight bias to impact various aspects of qualitative research including the participant-researcher dynamic in interviews. However, evidence-based strategies to reduce weight bias in qualitative research interviews have yet to be identified. We discuss how weight bias may influence research interviews and identify several considerations and strategies for researchers to minimize the impact of weight bias. Strategies include practicing reflexivity, planning and conducting interviews in ways that support rapport building, using inclusive language, and considering participatory methods.
Collapse
Affiliation(s)
- Pam Hung
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Maxi Miciak
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Kristine Godziuk
- Department of Agriculture, Food and Nutritional Science, Faculty of Agricultural, Life and Environmental Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Douglas P Gross
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Mary Forhan
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
4
|
Standen EC, Ward A, Mann T. The role of social norms, intergroup contact, and ingroup favoritism in weight stigma. PLoS One 2024; 19:e0305080. [PMID: 38900716 PMCID: PMC11189193 DOI: 10.1371/journal.pone.0305080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 05/22/2024] [Indexed: 06/22/2024] Open
Abstract
Although average body size in the U.S. has increased in recent decades, stigma directed at individuals with higher weight has not diminished. In this study, we explored this phenomenon by investigating the relationship between people's perceived social norms regarding higher weight and their reported levels of weight bias (i.e., anti-fat attitudes). Our predictions for perceived social norms drew on the concepts of intergroup contact and ingroup favoritism, which were also probed in this study. We hypothesized that both greater descriptive norms and more favorable injunctive norms regarding higher weight would be associated with lower reported weight bias. Individuals' quantity and quality of social contact with people with higher weight were also predicted to be associated with lower weight bias. Finally, we predicted that individuals who perceived themselves as heavier would display ingroup favoritism (i.e., report less weight bias). Participants (N = 272) from the United States completed a set of online questionnaires about their perceived social norms, social contact with people with higher weight, and explicit weight bias. We found support for each of these pre-registered predictions (ps < 0.03), and post hoc analyses revealed that quality, but not quantity, of social contact with individuals with higher weight was an important predictor of lower weight bias. Together, these findings provide insight into the social psychology of weight bias and help to lay a theoretical foundation for future efforts to reduce weight stigma.
Collapse
Affiliation(s)
- Erin C. Standen
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Andrew Ward
- Department of Psychology, Swarthmore College, Swarthmore, Pennsylvania, United States of America
| | - Traci Mann
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota, United States of America
| |
Collapse
|
5
|
Borgatti A, Morgan C, Stager L, Dutton GR. Associations between weight bias internalization, weight status, and health among a diverse cohort of freshman college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024:1-10. [PMID: 38875131 DOI: 10.1080/07448481.2024.2346351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 04/09/2024] [Indexed: 06/16/2024]
Abstract
Mental health concerns are common among college students, especially students with higher body mass index (BMI). Weight bias internalization (WBI) is thought to contribute to these mental health disparities. However, little is known about how WBI differs among more diverse students, and to what extent WBI may explain associations between BMI and health in college populations. This study compared rates of WBI in Freshman college students (N = 1289) across gender, race/ethnicity, and sexual orientation, and assessed whether WBI mediated associations between BMI and mental health (depression, self-esteem, stress, loneliness) and behavioral health (disordered eating, physical activity, gym use). Black students and men demonstrated reduced WBI while bisexual women showed increased WBI. Further, WBI mediated the association of BMI with mental health and disordered eating, but not physical activity. These findings suggest that stigma may account for mental health disparities among higher-BMI students, and that minoritized groups are disproportionately impacted.
Collapse
Affiliation(s)
- Alena Borgatti
- Division of Preventive Medicine, School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Psychology, College of Arts and Sciences, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Casie Morgan
- Department of Psychology, College of Arts and Sciences, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lindsay Stager
- Department of Psychology, College of Arts and Sciences, The University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Psychiatry, School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gareth R Dutton
- Division of Preventive Medicine, School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
6
|
Luah XW, Holst-Hansen T, Lübker C. The association between body mass index and health-related quality of life in the 2017 and 2018 health survey of England data: A cross-sectional observational analysis. Diabetes Obes Metab 2024; 26:2318-2328. [PMID: 38499493 DOI: 10.1111/dom.15546] [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: 12/06/2023] [Revised: 02/16/2024] [Accepted: 02/26/2024] [Indexed: 03/20/2024]
Abstract
AIM To provide an updated estimate of the association between body mass index (BMI) and health-related quality of life (HRQoL) among the general population in England and to identify population subgroups with the highest potential utility gains from obesity interventions. MATERIALS AND METHODS The sample included 12 158 adults with valid HRQoL and BMI data from the 2017 and 2018 Health Survey for England. Robust standard error linear regression, controlling for demographic and socioeconomic characteristics, lifestyle behaviours and obesity-related comorbidities, was used for the baseline analysis. Robustness checks assessed the impact of (a) estimator selection; (b) model specifications; (c) statistical outliers at high BMI; (d) potential BMI measurement error; and (e) data pooling. RESULTS The study found a significant association between HRQoL and BMI, which exhibited an inverted U-shaped relationship. The mean HRQoL peaked at 25.7 kg/m2 in men and 22.6 kg/m2 in women and was reduced in the underweight, overweight and obesity BMI ranges. Sensitivity analyses reported similar coefficients, suggesting a robust model specification. CONCLUSIONS Reduced HRQoL beyond optimal BMI underlines the importance of maintaining a normal BMI range for overall health. The rising prevalence of class III obesity is a major public health concern given its disproportionate impact on health, health care utilization and costs. Obesity management is key to preventing the reduction in HRQoL associated with obesity-related comorbidities, and this analysis supports the development of targeted policies and population health initiatives for people with class III obesity.
Collapse
Affiliation(s)
- Xiao Wen Luah
- Department of Economics and Related Studies, University of York, York, UK
- Novo Nordisk A/S, Søborg, Denmark
| | | | - Christopher Lübker
- Novo Nordisk A/S, Søborg, Denmark
- Department of Health Sciences, University of York, York, UK
| |
Collapse
|
7
|
Reel SM, Siegel RM, Pillay Smiley N. Pediatric Oncology and Obesity: An Introduction for General Pediatricians. Clin Pediatr (Phila) 2024; 63:589-593. [PMID: 37542412 DOI: 10.1177/00099228231191957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/07/2023]
Abstract
For pediatric patients with cancer, a healthy lifestyle is important for treatment outcomes and beyond. General pediatricians play a major role in the care of these patients, particularly given the improved rates of survival. Pediatric obesity has many negative consequences, but it is an area where primary care providers can make an impact and provide support to childhood cancer survivors. To provide the best quality of care for this population, there must be collaboration between primary care and oncology providers. Additionally, general practioners should feel empowered to offer standard nutrition and physical activity recommendations to all childhood cancer survivors. For pediatric patients who carry a cancer diagnosis, cure is no longer the only goal. Pediatric providers across specialties need to work as a team to improve long-term quality of life for these patients, starting with modifiable healthy habits.
Collapse
Affiliation(s)
| | - Robert M Siegel
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Center for Better Health and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Natasha Pillay Smiley
- Cancer and Blood Diseases Institute, The Cure Starts Now Foundation Brain Tumor Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| |
Collapse
|
8
|
Kelly NR, Osa ML, Luther G, Guidinger C, Folger A, Williamson G, Esquivel J, Budd EL. Preliminary evaluation of a brief worksite intervention to reduce weight stigma and weight bias internalization. EVALUATION AND PROGRAM PLANNING 2024; 104:102434. [PMID: 38615372 DOI: 10.1016/j.evalprogplan.2024.102434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/20/2024] [Accepted: 04/01/2024] [Indexed: 04/16/2024]
Abstract
Weight-based discrimination (WBD) is common and associated with reduced physical and emotional functioning. WBD is common in the workplace, yet no studies have evaluated a WBD intervention delivered in a worksite setting. This study evaluated the feasibility, acceptability, and preliminary effectiveness of a 3-hour, remote-delivered WBD intervention at a large public university. Six workshops including 94 participants (41.76 ± 9.37 y; 92.8% women) were delivered December 2020 through May 2021; 88.3% of participants enrolled in the study and 88.8% of enrolled participants completed pre- and post-intervention surveys. Participants strongly agreed the workshop contributed to a more inclusive work environment (M=4.98 ± 0.2; 1 =Strongly Disagree to 5 =Strongly Agree); and was highly needed (4.9 ± 0.3) and liked (4.8 ± 0.5). Qualitative feedback cited benefits of remote delivery in providing body size anonymity and wanting access to intervention materials and more time for discussion and action steps to reduce WBD. Participants experienced significant, medium reductions in explicit weight bias (ps < .001), significant, small reductions in weight bias internalization (p < .001), and statistically non-significant (p = .08), small-to-medium reductions in implicit bias. Targeting worksites as a delivery mechanism has the potential to reduce WBD, thereby improving the health and well-being of diverse employees and creating a more inclusive workspace.
Collapse
Affiliation(s)
- Nichole R Kelly
- Counseling Psychology and Human Services, University of Oregon, USA; The Prevention Science Institute, University of Oregon, USA.
| | - Maggie L Osa
- Counseling Psychology and Human Services, University of Oregon, USA; The Prevention Science Institute, University of Oregon, USA
| | - Gabriella Luther
- Counseling Psychology and Human Services, University of Oregon, USA; The Prevention Science Institute, University of Oregon, USA
| | - Claire Guidinger
- Counseling Psychology and Human Services, University of Oregon, USA; The Prevention Science Institute, University of Oregon, USA
| | - Austin Folger
- Counseling Psychology and Human Services, University of Oregon, USA; The Prevention Science Institute, University of Oregon, USA
| | - Gina Williamson
- Counseling Psychology and Human Services, University of Oregon, USA; The Prevention Science Institute, University of Oregon, USA
| | - Juliana Esquivel
- Counseling Psychology and Human Services, University of Oregon, USA; The Prevention Science Institute, University of Oregon, USA
| | - Elizabeth L Budd
- Counseling Psychology and Human Services, University of Oregon, USA; The Prevention Science Institute, University of Oregon, USA
| |
Collapse
|
9
|
Gueltzow M, Groeniger JO, Bijlsma MJ, Jansen PW, Houweling TAJ, van Lenthe FJ. Childhood obesity's influence on socioeconomic disparities in young adolescents' mental health. Ann Epidemiol 2024; 94:19-26. [PMID: 38615897 DOI: 10.1016/j.annepidem.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 03/14/2024] [Accepted: 04/08/2024] [Indexed: 04/16/2024]
Abstract
PURPOSE We investigated whether socioeconomic inequalities in young adolescents' mental health are partially due to the unequal distribution of childhood obesity across socioeconomic positions (SEP), i.e. differential exposure, or due to the effect of obesity on mental health being more detrimental among certain SEPs, i.e. differential impact. METHODS We studied 4660 participants of the Generation R study, a population-based study in the Netherlands. SEP was estimated by mother's education and household income at age five of the child. We estimated the contribution of the mediating and moderating effects of high body fat percentage to the disparity in mental health. This was done through a four-way decomposition using marginal structural models with inverse probability of treatment weighting. RESULTS Comparing children with the least to most educated mothers and the lowest to highest household income, the total disparity in emotional problems was 0.98 points (95%CI:0.35-1.63) and 1.68 points (95%CI:1.13-2.19), respectively. Of these total disparities in emotional problems, 0.50 points (95%CI:0.15-0.85) and 0.24 points (95%CI:0.09-0.46) were due to the differential exposure to obesity. Obesity did not contribute to disparities in behavioural problems. CONCLUSION Addressing the heightened obesity prevalence among children in low SEP families may reduce inequalities in emotional problems in early adolescence.
Collapse
Affiliation(s)
- Maria Gueltzow
- Max Planck Institute for Demographic Research, Rostock, Germany; Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Joost Oude Groeniger
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Public Administration and Sociology, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Maarten J Bijlsma
- Max Planck Institute for Demographic Research, Rostock, Germany; Unit PharmacoTherapy, -Epidemiology, and -Economics (PTEE), Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands
| | - Pauline W Jansen
- Department of Child & Adolescent Psychiatry/Psychology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Generation R Study, Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Department of Psychology, Education & Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Tanja A J Houweling
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Frank J van Lenthe
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| |
Collapse
|
10
|
Gerend MA, Wilkinson LJ, Sutin AR, Rosado JI, Ehrlich KB, Smith DW, Maner JK. Sociodemographic predictors of perceived weight discrimination. Int J Obes (Lond) 2024:10.1038/s41366-024-01535-1. [PMID: 38740855 DOI: 10.1038/s41366-024-01535-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 04/26/2024] [Accepted: 04/30/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Perceived weight discrimination is associated with increased risk for chronic diseases and reduced life expectancy. Nevertheless, little is known about perceived weight discrimination in racial, ethnic, and sexual minority groups or in individuals at the intersections of those groups. The goal of this study was to identify sociodemographic predictors of perceived weight discrimination. SUBJECTS/METHODS A diverse sample of adults (37% Black/African American, 36% Latino, 29% sexual minority) with a body mass index (BMI) ≥ 18.5 kg/m2 were recruited from a national US panel to complete an online survey (N = 2454). Perceived weight discrimination was assessed with the Stigmatizing Situations Survey-Brief (SSI-B). Using hierarchical linear regression analysis, SSI-B scores were predicted from the four sociodemographic characteristics of interest (gender, race, ethnicity, and sexual orientation) while controlling for BMI, age, education, and income (Step 1). At Step 2, all two-way interactions between the four sociodemographic characteristics were added to the model. RESULTS At Step 1, higher SSI-B scores were observed for Latino (vs. non-Latino) adults, sexual minority (vs. heterosexual) adults, younger (vs. older) adults, adults with higher (vs. lower) levels of education, and adults with higher (vs. lower) BMI. At Step 2, race interacted with gender, ethnicity, and sexual orientation to predict SSI-B scores such that relatively higher scores were observed for non-Black women, Black men, adults who identified as Black and Latino, and non-Black sexual minority adults. CONCLUSIONS Perceived weight discrimination varied across sociodemographic groups, with some subgroups reporting relatively high frequency. Black race appeared to be protective for some subgroups (e.g., Black women), but risk-enhancing for others (e.g., Black men, individuals who identified as Black and Latino). Additional research is needed to identify specific factors that cause certain sociodemographic groups -and indeed, certain individuals-to perceive higher levels of weight discrimination than others.
Collapse
Affiliation(s)
- Mary A Gerend
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, FL, USA.
| | | | - Angelina R Sutin
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, FL, USA
| | - Javier I Rosado
- College of Medicine, Florida State University, Immokalee Regional Campus, Immokalee, FL, USA
| | | | - David W Smith
- Cardiology, Southern Medical Group, Tallahassee, FL, USA
| | - Jon K Maner
- Department of Psychology, College of Arts and Sciences, Florida State University, Tallahassee, FL, USA
| |
Collapse
|
11
|
Rosenbaum DL. A randomized controlled trial of a reading-based weight bias intervention. Int J Eat Disord 2024. [PMID: 38738962 DOI: 10.1002/eat.24228] [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: 01/09/2024] [Revised: 04/30/2024] [Accepted: 05/01/2024] [Indexed: 05/14/2024]
Abstract
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.
Collapse
Affiliation(s)
- Diane L Rosenbaum
- Psychological and Social Sciences Program, Pennsylvania State University, Abington College, Abington, Pennsylvania, USA
| |
Collapse
|
12
|
Guglielmi V, Dalle Grave R, Leonetti F, Solini A. Female obesity: clinical and psychological assessment toward the best treatment. Front Endocrinol (Lausanne) 2024; 15:1349794. [PMID: 38765954 PMCID: PMC11099266 DOI: 10.3389/fendo.2024.1349794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/19/2024] [Indexed: 05/22/2024] Open
Abstract
Obesity is a heterogeneous condition which results from complex interactions among sex/gender, sociocultural, environmental, and biological factors. Obesity is more prevalent in women in most developed countries, and several clinical and psychological obesity complications show sex-specific patterns. Females differ regarding fat distribution, with males tending to store more visceral fat, which is highly correlated to increased cardiovascular risk. Although women are more likely to be diagnosed with obesity and appear more motivated to lose weight, as confirmed by their greater representation in clinical trials, males show better outcomes in terms of body weight and intra-abdominal fat loss and improvements in the metabolic risk profile. However, only a few relatively recent studies have investigated gender differences in obesity, and sex/gender is rarely considered in the assessment and management of the disease. This review summarizes the evidence of gender differences in obesity prevalence, contributing factors, clinical complications, and psychological challenges. In addition, we explored gender differences in response to obesity treatments in the specific context of new anti-obesity drugs.
Collapse
Affiliation(s)
- Valeria Guglielmi
- Unit of Internal Medicine and Obesity Center, Department of Systems Medicine, Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - Riccardo Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, VR, Italy
| | - Frida Leonetti
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Anna Solini
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy
| |
Collapse
|
13
|
Bradford HM, Puhl RM, Phillippi JC, Dietrich MS, Neal JL. Weight Bias Among Certified Nurse-Midwives and Certified Midwives: Findings From a National Sample. J Midwifery Womens Health 2024; 69:333-341. [PMID: 38459813 DOI: 10.1111/jmwh.13608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/01/2023] [Indexed: 03/10/2024]
Abstract
INTRODUCTION Weight bias toward individuals with higher body weights permeates health care settings in the United States and has been associated with poor weight-related communication and quality of care as well as adverse health outcomes. However, there has been limited quantitative investigation into weight bias among perinatal care providers. Certified nurse-midwives (CNMs)/certified midwives (CMs) attend approximately 11% of all births in the United States. The aims of this study were to measure the direction and extent of weight bias among CNMs/CMs and compare their levels of weight bias to the US public and other health professionals. METHODS Through direct postcard distribution, social media accounts, professional networks, and email listservs, American Midwifery Certification Board (AMCB)-certified midwives were solicited to complete an online survey of their implicit weight bias using the Implicit Association Test and their explicit weight bias using the Antifat Attitudes Questionnaire, Fat Phobia Scale, and Preference for Thin People measure. RESULTS A total of 2257 midwives participated in the survey, yielding a completion rate of 17.7%. Participants were mostly White and female, with a median age of 46 years and 11 years since AMCB certification. More than 70% of midwives have some level of implicit weight bias, although to a lesser extent compared with previously published findings among the US public (P < .01) and other health professionals (P < .01). In a subsample comparison of female midwives to female physicians, implicit weight bias levels were similar (P > .05). Midwives also express explicit weight bias, but at lower levels than the US public and other health professionals (P < .05). DISCUSSION This study provides the first quantitative research documenting weight bias among a national US sample of perinatal care providers. Findings can inform educational efforts to mitigate weight bias in the perinatal care setting and decrease harm.
Collapse
Affiliation(s)
- Heather M Bradford
- Georgetown University, School of Nursing, Washington, District of Columbia
- Vanderbilt University, School of Nursing, Nashville, Tennessee
| | - Rebecca M Puhl
- Department of Human Development & Family Sciences, University of Connecticut, Storrs, Connecticut
| | | | - Mary S Dietrich
- Vanderbilt University, School of Nursing, Nashville, Tennessee
- Vanderbilt University, School of Medicine, Nashville, Tennessee
| | - Jeremy L Neal
- Vanderbilt University, School of Nursing, Nashville, Tennessee
| |
Collapse
|
14
|
Hailu H, Skouteris H, Incollingo Rodriguez AC, Hill B. SWIPE: a conceptual, multi-perspective model for understanding and informing interventions for weight stigma in preconception, pregnancy, and postpartum. Health Psychol Rev 2024:1-17. [PMID: 38560922 DOI: 10.1080/17437199.2024.2333801] [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: 09/12/2023] [Accepted: 03/18/2024] [Indexed: 04/04/2024]
Abstract
Weight stigma is salient across the preconception, pregnancy, and postpartum (PPP) periods because of prevailing prescriptive norms and expectations about weight and weight gain during the reproductive period. Weight stigma is associated with negative physical and psychological health outcomes for mother and child. A clearly defined, multi-level conceptual model for interventions, research, and policy is critical to mitigating the adverse effects of weight stigma in PPP populations. Conceptual models of weight stigma towards PPP women have advanced our understanding of this issue and guided evidence accumulation but there remains a gap in informing the translation of evidence into action. Guided by evidence-based paradigms for conceptual model development, this paper has two primary objectives. First, we review and summarise theories, frameworks, and models from the PPP population and general literature to inform our understanding of the development and perpetuation of weight stigma for PPP women. Second, we propose a novel comprehensive intervention-guiding conceptual model that draws from and synthesises across multiple disciplines - the SWIPE (Stigma of Weight In the PPP Experience) model. This conceptual model will help to plan coordinated, multi-layered, and effective strategies to reduce and ultimately eliminate weight stigma for PPP women.
Collapse
Affiliation(s)
- Haimanot Hailu
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Helen Skouteris
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Warwick Business School, The University of Warwick, Coventry, UK
| | - Angela C Incollingo Rodriguez
- Psychological & Cognitive Sciences, Department of Social Science & Policy Studies, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Briony Hill
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| |
Collapse
|
15
|
Wu HX, Chen TT, Ching BHH, Li XY, Li YH. Weight stigma from romantic partners: Its relations with maladaptive and adaptive coping and depressive symptoms. Scand J Psychol 2024; 65:157-167. [PMID: 37675937 DOI: 10.1111/sjop.12965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 08/03/2023] [Accepted: 08/20/2023] [Indexed: 09/08/2023]
Abstract
Social devaluation of being overweight is common in daily life, but little is known about the weight stigma in romantic relationships. The present study investigated the roles of maladaptive and adaptive coping strategies in the relation between the experience of weight stigma in romantic relationships and depressive symptoms in men and women, respectively. Analyses of gender differences and structural equation modeling yielded several findings. First, while men and women experienced similar levels of weight stigma from their romantic partners, women were more likely to use exercise avoidance, disengagement coping, and reappraisal coping strategies, and to exhibit more depressive symptoms than men. Second, men who experienced weight stigma tended to cope with it through exercise avoidance and disengagement coping, which were related to greater depressive symptoms. Men also coped with weight stigma adaptively via reappraisal coping, which was additionally associated with more positive affect. Third, the relation between the experience of weight stigma and depressive symptoms in women was only explained by using disengagement coping. These findings extend the understanding of weight stigma to a specific context and provide some insight that future interventions to reduce the impacts of weight stigma should be tailored accordingly for men and women.
Collapse
Affiliation(s)
- Hannah X Wu
- Faculty of Education, University of Macau, Avenida da Universidade, Taipa, Macau, China
| | - Tiffany T Chen
- Faculty of Education, University of Macau, Avenida da Universidade, Taipa, Macau, China
| | - Boby H-H Ching
- Faculty of Education, University of Macau, Avenida da Universidade, Taipa, Macau, China
| | - Xiang Y Li
- Faculty of Education, University of Macau, Avenida da Universidade, Taipa, Macau, China
| | - Yuan H Li
- Faculty of Education, University of Macau, Avenida da Universidade, Taipa, Macau, China
| |
Collapse
|
16
|
Telo GH, Friedrich Fontoura L, Avila GO, Gheno V, Bertuzzo Brum MA, Teixeira JB, Erthal IN, Alessi J, Telo GH. Obesity bias: How can this underestimated problem affect medical decisions in healthcare? A systematic review. Obes Rev 2024; 25:e13696. [PMID: 38272850 DOI: 10.1111/obr.13696] [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: 09/04/2023] [Revised: 11/24/2023] [Accepted: 12/06/2023] [Indexed: 01/27/2024]
Abstract
INTRODUCTION Obesity is often labeled as a physical characteristic of a patient rather than a disease and it is subject to obesity bias by health providers, which harms the equality of healthcare in this population. OBJECTIVE Identifying whether obesity bias interferes in clinical decision-making in the treatment of patients with obesity. METHODS A systematic review of observational studies published between 1993 and 2023 in MEDLINE, Embase, and Cochrane Library on obesity bias and therapeutic decisions was carried out. The last search was conducted on June 30, 2023. The main outcome was the difference between clinical decisions in the treatment of individuals with and without obesity. The Newcastle-Ottawa scale for observational studies was used to assess for quality. After the selection process, articles were presented in narrative and thematic synthesis categories to better organize the descriptive analysis. RESULTS Of the 2546 records identified, 13 were included. The findings showed fewer screening exams for cancer in patients with obesity, who were also susceptible to less frequent pharmacological treatment intensification in the management of diabetes. Women with obesity received fewer pelvic exams and evidence of diminished visual contact and physician confidence in treatment adherence was reported. Some studies found no disparities in treatment for abdominal pain and tension headaches between patients presented with and without obesity. CONCLUSION The presence of obesity bias has negative effects on medical decision-making and on the quality of care provided to patients with obesity. These findings reveal the urgent necessity for reflection and development of strategies to mitigate its adverse impacts. (The protocol was registered with the international prospective register of systematic reviews, PROSPERO, under the number CRD42022307567).
Collapse
Affiliation(s)
- Guilherme Heiden Telo
- Medicine and Health Sciences Graduate Program, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
- Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Lucas Friedrich Fontoura
- Medicine and Health Sciences Graduate Program, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Georgia Oliveira Avila
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Vicenzo Gheno
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Julia Belato Teixeira
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Isadora Nunes Erthal
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Janine Alessi
- Medicine and Health Sciences Graduate Program, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
- Endocrinology Division, Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
- General Internal Medicine Division, Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Gabriela Heiden Telo
- Medicine and Health Sciences Graduate Program, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
- General Internal Medicine Division, Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| |
Collapse
|
17
|
Finch LE, Hawkley LC, Schumm LP, Iveniuk J, McClintock MK, Huang ES. Moderation of associations between weight discrimination and diabetes status by psychosocial factors. J Behav Med 2024; 47:244-254. [PMID: 37946026 PMCID: PMC11017919 DOI: 10.1007/s10865-023-00454-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/09/2023] [Indexed: 11/12/2023]
Abstract
Weight discrimination has adverse effects on health that include increasing the risk factors for developing type 2 diabetes. Preliminary evidence suggests a positive association between weight discrimination and diagnosed diabetes; however, it is unknown whether psychosocial resources may buffer this association. In logistic regressions stratified by gender, we examined links between weight discrimination and diabetes among a nationally representative sample of U.S. adults (the National Social Life, Health, and Aging Project; N = 2,794 adults age 50 and older in 2015-16). We also tested the extent to which trait-resilience and social support from a spouse/partner, family, and friends buffered any observed association. We adjusted for known predictors of diabetes (age, race/ethnicity, Body Mass Index) and conducted sensitivity analyses restricted to men and women with obesity. Net of covariates, in the overall sample, weight discrimination was associated with significantly greater odds of having ever had diabetes among women (OR = 2.00, 95% CI [1.15, 3.47]), but not men. Among women with obesity, weight discrimination was only significantly associated with greater odds of diabetes for those with low resilience (OR = 1.84, 95% CI [1.01, 3.35]). Among men overall, weight discrimination was associated with lower odds of diabetes for those with high family support (OR = 0.03, 95% CI [0.003, 0.25]) as well as those with high friend support (OR = 0.34, 95% CI [0.13, 0.91]); similar effects were observed in men with obesity. These novel findings evince a role for psychosocial resources in buffering associations between weight discrimination and diabetes.
Collapse
Affiliation(s)
- Laura E Finch
- Academic Research Centers, NORC at the University of Chicago, 1155 E 60th St, Chicago, IL, 60637, USA.
| | - Louise C Hawkley
- Academic Research Centers, NORC at the University of Chicago, 1155 E 60th St, Chicago, IL, 60637, USA
| | - L Philip Schumm
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - James Iveniuk
- Academic Research Centers, NORC at the University of Chicago, 1155 E 60th St, Chicago, IL, 60637, USA
| | - Martha K McClintock
- Departments of Psychology and Human Development, University of Chicago, Chicago, IL, USA
| | - Elbert S Huang
- Section of General Internal Medicine, University of Chicago, Chicago, IL, USA
| |
Collapse
|
18
|
Bombak AE, Chinho N, Thomson L, Burk C, Akhter S, O'Keefe K, Turner L. Bright-siding stigma: Older adults' experiences at a higher weight in Atlantic Canada. Health (London) 2024:13634593241238869. [PMID: 38501283 DOI: 10.1177/13634593241238869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
The lived experiences of higher-weight people vary; homogenous samples may fail to capture this diversity. This study develops an in-depth understanding of the lived experiences of higher-weight (Body Mass Index ⩾ 30) older adults (⩾60 years of age) in a Canadian Atlantic province. Participants (n = 11) were interviewed face-to-face using a semi-structured interview guide twice at 2-to-3-month intervals regarding their perceived treatment in social and health situations; how positive and negative healthcare experiences affected their health, lifestyles and healthcare seeking-behaviour; and recommendations in terms of patient experiences, access and inclusion. Participants infrequently reported negative experiences; however, participants' experiences were informed by uptake of moralistic, neoliberal discourses. Thematic content analysis identified two major themes: active citizenship (participants demonstrated internalisation of the imperative for weight loss, healthy lifestyles and active ageing) and bright-siding (participants expressed that a positive attitude could prevent/help cope with stigma). Results suggest that individualistic, rather than collective, political solutions to health and stigma have been taken up by higher-weight older adults in a Canadian Atlantic province, which may hinder attempts at structural reforms addressing stigma.
Collapse
|
19
|
Cassiani-Miranda CA, Díaz Rincón M, Arroyo-Gamero LA, Giraldo-Barrios LG, Carmona-Meza Z. Weight stigma and allostatic load in adults: protocol for a scoping review. BMJ Open 2024; 14:e076629. [PMID: 38367970 PMCID: PMC10875553 DOI: 10.1136/bmjopen-2023-076629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 12/19/2023] [Indexed: 02/19/2024] Open
Abstract
INTRODUCTION Weight-related stigma (WS) has been associated with adverse psychosocial and physical health effects. Despite the relationship between WS and allostatic load, there are no integrative reviews of this association. This scoping review aims to provide a comprehensive overview of the relationship between allostatic load biomarkers associated with WS by identifying gaps in this topic and proposing recommendations for future research. METHODS AND ANALYSIS This protocol was guided by the methodological framework of Arksey and O'Malley and the Joanna Briggs Institute (JBI). The research questions were based on the population-concept-context framework. Studies in adults diagnosed as overweight or obese, exposed to WS and assessing the association between WS and biomarkers of allostatic load will be included. A search will be conducted in Medline (Ovid), PsycINFO (Ovid), Scopus (Elsevier), Cochrane Library (Wiley) and Google Scholar. The search strategy will be conducted in three stages, based on the JBI recommendation with the MESH terms "Social Stigma," "Weight Prejudice," "Biomarkers," "Allostasis," "Adults" and related terms. Data extraction will be done with a template adapted from JBI. The search strategy and selection process results will be presented in a flow chart and summarised in the text. The main results will be presented in a descriptive synthesis. ETHICS AND DISSEMINATION Ethics review and approval are not required. The results will be disseminated through peer-reviewed publications, conferences, congresses or symposia.
Collapse
Affiliation(s)
| | | | | | | | - Zenen Carmona-Meza
- Universidad de Cartagena Facultad de Medicina, Cartagena de Indias, Bolívar, Colombia
| |
Collapse
|
20
|
Sonneville KR, Thurston IB, Gordon AR, Richmond TK, Weeks HM, Lipson SK. Weight Stigma Associated With Mental Health Concerns Among College Students. Am J Prev Med 2024; 66:260-268. [PMID: 37758003 DOI: 10.1016/j.amepre.2023.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/21/2023] [Accepted: 09/21/2023] [Indexed: 09/29/2023]
Abstract
INTRODUCTION Weight stigma is widespread and exists across numerous domains including health care, educational institutions, workplaces, mass media, and interpersonal relationships. Weight stigma experienced during the college years may be particularly consequential because the college years are a period of increased vulnerability for the development of mental health concerns. The purpose of the present study was to examine how experiences of weight stigma relate to mental health concerns, including symptoms of eating disorders, anxiety, and depression, among college students. METHODS Prevalence of interpersonal and anticipated weight stigma was examined among 2,707 students participating in the 2018-2019 and 2019-2020 Healthy Minds Study and tested for differences in prevalence across student characteristics. Logistic regression was used to explore relationships between measures of weight stigma and student mental health. Analyses were conducted in 2021-2023. RESULTS Interpersonal and anticipated weight stigma were reported by 12.3% and 15.3% of students, respectively. Experiences of interpersonal and anticipated weight stigma were generally lowest among cisgender male students, heterosexual students, those with the fewest financial concerns, and those who did not perceive themselves to be "overweight." Both interpersonal and anticipated weight stigma were associated with elevated odds of high weight concerns, past-month binge eating, past-month purging, high eating disorder risk, moderate/severe anxiety symptoms, and moderate/severe depressive symptoms. CONCLUSIONS Findings implicate interpersonal and anticipated weight stigma as potential risk factors for a range of mental health concerns. Weight stigma is an under-recognized and under-funded public health problem.
Collapse
Affiliation(s)
- Kendrin R Sonneville
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan.
| | - Idia B Thurston
- Departments of Health Sciences and Applied Psychology, Institute for Health Equity and Social Justice Research, Northeastern University, Boston, Massachusetts
| | - Allegra R Gordon
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| | - Tracy K Richmond
- Division of Adolescent/Young Adult Medicine, Department of Pediatrics, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts
| | - Heidi M Weeks
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Sarah K Lipson
- Department of Health Law Policy and Management, Boston University School of Public Health, Boston, Massachusetts
| |
Collapse
|
21
|
Rao A, Puhl R, Farrar K. Weight Stigma in Online News Images: A Visual Content Analysis of Stigma Communication in the Depictions of Individuals with Obesity in U.S. and U.K. News. JOURNAL OF HEALTH COMMUNICATION 2024; 29:95-106. [PMID: 38037345 DOI: 10.1080/10810730.2023.2286512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Weight stigma is a pervasive form of discrimination worldwide. News media, and news images in particular, can reinforce weight stigma by portraying persons with obesity in a negative, stereotypical manner. Informed by the model of stigma communication, this study conducted a content analysis of images accompanying obesity-related news articles from the U.S. and U.K. to determine and compare the prevalence of stigmatizing images. Images (N = 445) in obesity-focused news articles obtained from the top four most viewed online news in the U.S. (n = 244) and U.K. (n = 201) during August 2018-August 2019 were systematically coded. These 445 images featured 228 individuals. Of these 228 individuals, 35% were identified as higher weight and 44% as lower weight. Overall, 70% of persons of higher weight in these news images were depicted in a stigmatizing manner. Further, 46% of individuals with higher weight were depicted with their head partially or fully removed from the image, compared to 25% of individuals with lower weight. Additionally, U.K. news were 2.5 times more likely to contain stigmatizing images than U.S. news. These findings highlight the prevalence of weight stigma in news images and suggest that broader systemic efforts are needed by the news media industry to eliminate the use of negative imagery that marginalizes persons of higher weight.
Collapse
Affiliation(s)
- Aditi Rao
- Department of Communication, University of Connecticut, Storrs, Connecticut, USA
| | - Rebecca Puhl
- Rudd Center for Food Policy & Health, University of Connecticut, Hartford, Connecticut, USA
- Department of Human Development & Family Sciences, University of Connecticut, Hartford, Connecticut, USA
| | - Kirstie Farrar
- Department of Communication, University of Connecticut, Storrs, Connecticut, USA
| |
Collapse
|
22
|
Howes EM, Parker MK, Misyak SA, DiFeliceantonio AG, Davy BM, Brown LEC, Hedrick VE. The Impact of Weight Bias and Stigma on the 24 h Dietary Recall Process in Adults with Overweight and Obesity: A Pilot Study. Nutrients 2024; 16:191. [PMID: 38257084 PMCID: PMC10818297 DOI: 10.3390/nu16020191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/07/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
People with overweight and obesity tend to both underreport dietary energy intake and experience weight stigma. This exploratory pilot study aimed to determine the relationship between weight bias and weight stigma and energy intake reporting accuracy. Thirty-nine weight-stable adults with BMI ≥ 25 completed three 24 h dietary recalls; indirect calorimetry to measure resting metabolic rate; a survey measuring weight stigma, psychosocial constructs, and physical activity; and a semi-structured qualitative interview. Multiple linear regression was used to determine if weight bias internalization, weight bias toward others, and experiences of weight stigma were predictive of the accuracy of energy reporting. A thematic analysis was conducted for the qualitative interviews. Weight stigma was reported by 64.1% of the sample. Weight stigma constructs did not predict the accuracy of energy intake reporting. People with obesity underreported by a mean of 477 kcals (p = 0.02). People classified as overweight overreported by a mean of 144 kcals, but this was not significant (p = 0.18). Participants reported a desire to report accurate data despite concerns about reporting socially undesirable foods. Future research should quantify the impact of weight stigma on energy reporting in 24 h recalls using a larger, more diverse sample size and objective measures like doubly labeled water for validation.
Collapse
Affiliation(s)
- Erica M. Howes
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA 24061, USA; (M.K.P.); (S.A.M.); (A.G.D.); (B.M.D.); (V.E.H.)
| | - Molly K. Parker
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA 24061, USA; (M.K.P.); (S.A.M.); (A.G.D.); (B.M.D.); (V.E.H.)
| | - Sarah A. Misyak
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA 24061, USA; (M.K.P.); (S.A.M.); (A.G.D.); (B.M.D.); (V.E.H.)
| | - Alexandra G. DiFeliceantonio
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA 24061, USA; (M.K.P.); (S.A.M.); (A.G.D.); (B.M.D.); (V.E.H.)
- Fralin Biomedical Research Institute at VTC, Virginia Tech, Roanoke, VA 24016, USA
| | - Brenda M. Davy
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA 24061, USA; (M.K.P.); (S.A.M.); (A.G.D.); (B.M.D.); (V.E.H.)
| | | | - Valisa E. Hedrick
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA 24061, USA; (M.K.P.); (S.A.M.); (A.G.D.); (B.M.D.); (V.E.H.)
| |
Collapse
|
23
|
Cuauro SE, Santos N, Andrade E, Dani AW, Sanchious SN, Hooper SC, Becker CB. Internalized Weight Stigma and Weight Discrimination: Associations with Quality of Life and Psychosocial Impairment in a Sample Living with Food Insecurity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7147. [PMID: 38131699 PMCID: PMC10742389 DOI: 10.3390/ijerph20247147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/26/2023] [Accepted: 12/02/2023] [Indexed: 12/23/2023]
Abstract
Research suggests that experiencing weight discrimination is associated with a lower quality of life and poor psychological and physical health. However, much of the existing weight discrimination literature has neglected under-represented groups. Little is known about how the experience of weight discrimination affects quality of life and eating/weight-related psychosocial impairment in those living with food insecurity. The present study investigated the associations of weight discrimination and eating/weight-related psychosocial impairment and quality of life. We examined internalized weight stigma and several psychological indicators as potential mediators. Participants (N = 1085) who were recruited from a local food bank completed a questionnaire assessing food insecurity, weight discrimination, internalized weight stigma, eating disorder pathology, anxiety, depression, eating/weight-related psychosocial impairment, and quality of life. Overall, almost one in four participants reported experiencing weight discrimination. Our serial mediation models indicated that increased experiences of weight discrimination were associated with greater internalized weight stigma and psychopathology, which were in turn associated with lower quality of life and greater eating/weight-related psychosocial impairment. Thus, experiencing weight discrimination may negatively impact quality of life and eating/weight-related psychosocial impairment through its effect on mental health. It is imperative to address the negative effects of the widespread discrimination of people based on their weight.
Collapse
Affiliation(s)
- Sabrina E. Cuauro
- Department of Psychology, Trinity University, San Antonio, TX 78212, USA; (N.S.); (E.A.); (A.W.D.); (S.N.S.); (C.B.B.)
- Department of Psychological Sciences, Rice University, Houston, TX 77005, USA
| | - Natalia Santos
- Department of Psychology, Trinity University, San Antonio, TX 78212, USA; (N.S.); (E.A.); (A.W.D.); (S.N.S.); (C.B.B.)
| | - Estefania Andrade
- Department of Psychology, Trinity University, San Antonio, TX 78212, USA; (N.S.); (E.A.); (A.W.D.); (S.N.S.); (C.B.B.)
| | - Anoushka W. Dani
- Department of Psychology, Trinity University, San Antonio, TX 78212, USA; (N.S.); (E.A.); (A.W.D.); (S.N.S.); (C.B.B.)
| | - Saivone N. Sanchious
- Department of Psychology, Trinity University, San Antonio, TX 78212, USA; (N.S.); (E.A.); (A.W.D.); (S.N.S.); (C.B.B.)
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI 02912, USA
| | - Savannah C. Hooper
- Department of Psychological and Brain Science, University of Louisville, Louisville, KY 40292, USA;
| | - Carolyn Black Becker
- Department of Psychology, Trinity University, San Antonio, TX 78212, USA; (N.S.); (E.A.); (A.W.D.); (S.N.S.); (C.B.B.)
| |
Collapse
|
24
|
Graham CE, Frisco ML. The Mental "Weight" of Discrimination: The Relationship between Perceived Interpersonal Weight Discrimination and Suicidality in the United States. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2023; 64:610-625. [PMID: 37776190 PMCID: PMC10683344 DOI: 10.1177/00221465231200634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Abstract
Extant research has investigated the relationship between body weight and suicidality because obesity is highly stigmatized, leading to social marginalization and discrimination, yet has produced mixed results. Scholars have speculated that factors associated with body weight, such as weight discrimination, may better predict suicidality than body weight itself. We consider this possibility among a sample of 12,057 adult participants ages 33 to 43 in Wave V of the National Longitudinal Study of Adolescent to Adult Health through investigation of the relationships between weight discrimination and two dimensions of suicidality-suicide ideation and attempts. We also examine gender as a moderator of these relationships. We find that weight discrimination is positively associated with both suicide ideation and attempts, and this relationship is similar among men and women. Our findings underscore the need to address issues of weight discrimination in our society to better promote mental well-being.
Collapse
|
25
|
Lewis-Smith H, Pegram G, White P, Ward LM, Diedrichs PC. A short-form drama series created for the digital media environment: A randomised controlled trial exploring effects on girls' body satisfaction, acceptance of appearance diversity, and appearance-related internalised racism. Body Image 2023; 47:101610. [PMID: 37659248 DOI: 10.1016/j.bodyim.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 08/10/2023] [Accepted: 08/13/2023] [Indexed: 09/04/2023]
Abstract
'Edutainment' micro-interventions are a scalable public health strategy that can challenge media-related body image pressures and race- and weight- based stigma. This study evaluated the impact of viewing a brief, theoretically-informed, short-form drama episode on Black and non-Black adolescent girls' body image, acceptance of diversity of appearance (assessed by acceptance of an individual in a larger body and a Black individual), and appearance-related internalised racism (among Black girls only). The fictional drama depicted characters of diverse body sizes and race/ethnicities, with each episode focusing on a risk or protective factor for body image concerns among adolescent girls (e.g., appearance-related teasing and conversations). Participants (N = 686; 50.4 % Black, 49.6 % non-Black) aged 13-18 (Mage = 15.72 years) were randomly allocated to view either the first episode of this series (focused on social media's unrealistic appearance ideals and strategies to resist pressures) or a non-body-image-related control video. Findings revealed no significant differences in body satisfaction between conditions but significant improvements in the acceptance of appearance diversity among all girls who viewed the body image episode. Black girls who viewed this episode experienced significant improvements to appearance-related internalised racism. Edutainment micro-interventions constitute a promising avenue for promoting acceptance of appearance diversity and reducing appearance-related internalised racism.
Collapse
Affiliation(s)
| | - Georgina Pegram
- Centre for Appearance Research, University of the West of England, UK
| | - Paul White
- Applied Statistics Group, University of the West of England, UK
| | | | | |
Collapse
|
26
|
Stickley A, Shirama A, Sumiyoshi T. Perceived discrimination and mental health in the Japanese general population. Int J Soc Psychiatry 2023; 69:1790-1800. [PMID: 37300412 DOI: 10.1177/00207640231175248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Research has shown that discrimination is prevalent in many countries and associated with poorer mental health. However, little is known about discrimination and its effects in Japan. AIMS To address this deficit this study examined the association between perceived discrimination and mental health outcomes in the Japanese general population and the role of general stress in these associations. METHOD Data were analyzed from 1,245 individuals (age 18-89) that were collected in an online survey in 2021. Perceived discrimination was assessed with a single-item measure as was lifetime suicidal ideation. Depressive and anxiety symptoms were respectively measured with the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scale. General stress was assessed with the Perceived Stress Scale (PSS-14). Logistic regression was used to assess associations. RESULTS Perceived discrimination was prevalent (31.6%) in the study sample. In fully adjusted analyses discrimination was associated with all of the mental health outcomes/general stress with odds ratios (ORs) ranging from 2.78 (suicidal ideation) to 6.09 (general stress) among individuals with a high level of discrimination. When the analyses were adjusted for general stress (as a continuous score) there was a large reduction in the ORs although high discrimination continued to be significantly associated with anxiety (OR: 2.21), while a mid level of discrimination was related to depressive symptoms (OR: 1.87) and had a borderline association with suicidal ideation. CONCLUSION Perceived discrimination is common in the Japanese general population and associated with worse mental health, with stress possibly playing a role in this association.
Collapse
Affiliation(s)
- Andrew Stickley
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Aya Shirama
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Tomiki Sumiyoshi
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| |
Collapse
|
27
|
Steptoe A, Frank P. Obesity and psychological distress. Philos Trans R Soc Lond B Biol Sci 2023; 378:20220225. [PMID: 37661745 PMCID: PMC10475872 DOI: 10.1098/rstb.2022.0225] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/16/2023] [Indexed: 09/05/2023] Open
Abstract
The relationship between high body weight and mental health has been studied for several decades. Improvements in the quality of epidemiological, mechanistic and psychological research have brought greater consistency to our understanding of the links. Large-scale population-based epidemiological research has established that high body weight is associated with poorer mental health, particularly depression and subclinical depressive symptoms. There is some evidence for bidirectional relationships, but the most convincing findings are that greater body weight leads to psychological distress rather than the reverse. Particular symptoms of depression and distress may be specifically related to greater body weight. The psychological stress induced by weight stigma and discrimination contributes to psychological distress, and may in turn handicap efforts at weight control. Heightened systemic inflammation and dysregulation of the hypothalamic-pituitary-adrenal axis are biological mechanisms that mediate in part the relationship of greater body weight with poorer mental health. Changing negative societal attitudes to high body weights would improve the wellbeing of people living with obesity, and promote more effective weight-inclusive attitudes and behaviours in society at large, particularly in healthcare settings. This article is part of a discussion meeting issue 'Causes of obesity: theories, conjectures and evidence (Part II)'.
Collapse
Affiliation(s)
- Andrew Steptoe
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London WC1E BT, UK
| | - Philipp Frank
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E BT, UK
| |
Collapse
|
28
|
Oliver TL, Burrell SA, Furman GE, Diewald LK, Mariani B, Starck MR, Shenkman R. Weight bias reduction intervention among nurse practitioner students using simulation-based experiences. J Am Assoc Nurse Pract 2023:01741002-990000000-00173. [PMID: 37788361 DOI: 10.1097/jxx.0000000000000956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 09/01/2023] [Indexed: 10/05/2023]
Abstract
ABSTRACT Few nurse practitioner (NP) programs include obesity and weight bias education in their curriculum. However, NPs will likely provide care for people living with obesity, many of whom have been discriminated against based on their weight by previous providers, and many NP students may feel unprepared to navigate weight management competently. This pilot study included a weight bias reduction (WBR) intervention, which included a simulation-based experience (SBE) with a standardized participant (SP) and educational activities embedded within the NP curriculum. Nineteen NP students participated in this pilot study, but only seven students had matching data for preintervention to postintervention scores. There were no statistically significant differences in preintervention and postintervention Attitudes Toward Obese Persons (ATOP) or Beliefs About Obese Persons (BAOP) scores. Despite this small sample size and not achieving statistical significance, SBE-SP holds promise to depict realistic patient encounters to improve NPs' attitudes and beliefs toward persons with obesity and to reduce weight bias. Therefore, incorporating SBE-SP may be a feasible component of the NP curriculum.
Collapse
Affiliation(s)
- Tracy L Oliver
- Villanova University M. Louise Fitzpatrick College of Nursing, Villanova, Pennsylvania
| | - Sherry A Burrell
- Oncology Nursing Fellowship Program, Villanova University M. Louise Fitzpatrick College of Nursing, Villanova, Pennsylvania
| | - Gail E Furman
- Simulation and Learning Resource Center, Villanova University M. Louise Fitzpatrick College of Nursing, Villanova, Pennsylvania
| | - Lisa K Diewald
- MacDonald Center for Obesity Prevention and Education, Villanova University M. Louise Fitzpatrick College of Nursing, Villanova, Pennsylvania
| | - Bette Mariani
- Villanova University M. Louise Fitzpatrick College of Nursing, Villanova, Pennsylvania
| | - Megan R Starck
- Villanova University M. Louise Fitzpatrick College of Nursing, Villanova, Pennsylvania
| | - Rebecca Shenkman
- MacDonald Center for Obesity Prevention and Education, Villanova University M. Louise Fitzpatrick College of Nursing, Villanova, Pennsylvania
| |
Collapse
|
29
|
Raffoul A, Beccia AL, Jackson DA, Sarda V, Hart JE, Chavarro JE, Austin SB. Associations between weight discrimination and the use of potentially harmful dietary supplements during the COVID-19 pandemic in the United States. Soc Sci Med 2023; 335:116232. [PMID: 37708694 PMCID: PMC10567056 DOI: 10.1016/j.socscimed.2023.116232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/06/2023] [Accepted: 09/08/2023] [Indexed: 09/16/2023]
Abstract
The dietary supplements industry disproportionately markets potentially harmful products promising weight loss, cleansing/detoxing, and boosted energy and immunity to women. The COVID-19 pandemic heightened consumer concerns around health and body weight, which may have increased women's risks of using supplements, particularly if they had a higher weight and experienced weight discrimination. This study aimed to estimate inequities in prevalence and change in use of weight-loss, cleanse/detox, immunity, and energy supplements in the first year of the pandemic and to assess the extent to which the relationship between weight and supplement use differs across discrimination experiences. We drew upon longitudinal data from cisgender women in the U.S. COVID-19 Pandemic Substudy of the Nurses' Health Study II and 3 and Growing Up Today Study cohorts, collected over 5 waves from April/May 2020 to April 2021 (N = 51,814). Modified Poisson generalized estimating equation models, adjusted for age, cohort, race/ethnicity, wave, and Census region, estimated the relative excess risk due to interaction (RERI) between weight status and weight discrimination on prevalence of supplement use. Weight status categories were derived from body mass index (BMI), and weight discrimination was assessed using the attributions item of the Everyday Discrimination Scale. Baseline prevalence of supplement use was 2.7% for weight-loss, 3.3% for cleanse/detox, 4.2% for energy, and 22.6% for immune. Respondents with BMIs of 25-29.9 kg/m2 and 30-34.9 kg/m2 who experienced weight discrimination had RERI values of 0.89 (95% CI 0.14, 1.65) and 1.00 (95% CI 0.25, 1.75) for weight-loss and 0.57 (95% CI 0.13, 1.02) and 0.60 (95% CI 0.19, 1.01) for energy supplements, respectively, indicating this group had excess risk of use compared to lower BMI respondents who experienced no weight discrimination. The findings demonstrate the disproportionate impact of weight discrimination on use of potentially harmful supplements among cisgender women with higher weights during the pandemic.
Collapse
Affiliation(s)
- Amanda Raffoul
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
| | - Ariel L Beccia
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA.
| | - Destiny A Jackson
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Vishnudas Sarda
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA.
| | - Jaime E Hart
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Jorge E Chavarro
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - S Bryn Austin
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| |
Collapse
|
30
|
Ibele AR, Nau PN, Galvani C, Roth JS, Goldberg RF, Kurian MS, Khaitan L, Gould J, Pandya YK. Surgeon experience with insurance barriers to offering gastric bypass as an evidence-based operation for pathologic GERD. Surg Endosc 2023; 37:7642-7648. [PMID: 37491660 DOI: 10.1007/s00464-023-10212-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/11/2023] [Indexed: 07/27/2023]
Abstract
INTRODUCTION Obesity is an increasingly prevalent public health problem often associated with poorly controlled gastroesophageal reflux disease. Fundoplication has been shown to have limited long-term efficacy in patients with morbid obesity and does not address additional weight-related co-morbidities. Roux-en-Y gastric bypass (RYGB) is the gold standard operation for durable resolution of GERD in patients with obesity, and is also used as a salvage operation for GERD after prior foregut surgery. Surgeons report access to RYGB as surgical treatment for GERD is often limited by RYGB-specific benefit exclusions embedded within insurance policies, but the magnitude and scope of this problem is unknown. METHODS A 9-item survey evaluating surgeon practice and experience with insurance coverage for RYGB for GERD was developed and piloted by a SAGES Foregut Taskforce working group. This survey was then administered to surgeon members of the SAGES Foregut Taskforce and to surgeons participating in the SAGES Bariatrics and/or Foregut Facebook groups. RESULTS 187 surgeons completed the survey. 89% reported using the RYGB as an anti-reflux procedure. 44% and 26% used a BMI of 35 kg/m2 and 30 kg/m2 respectively as cutoff for the RYGB. 89% viewed RYGB as the procedure of choice for GERD after bariatric surgery. 69% reported using RYGB to address recurrent reflux secondary to failed fundoplication. 74% of responders experienced trouble with insurance coverage at least half the time RYGB was offered for GERD, and 8% reported they were never able to get approval for RYGB for GERD indications in their patient populations. CONCLUSION For many patients, GERD and obesity are related diseases that are best addressed with RYGB. However, insurance coverage for RYGB for GERD is often limited by policies which run contrary to evidence-based medicine. Advocacy is critical to improve access to appropriate surgical care for GERD in patients with obesity.
Collapse
Affiliation(s)
- Anna R Ibele
- Department of Surgery, University of Utah School of Medicine, 30 North 1900 East, Salt Lake City Utah, 84132, USA.
| | - Peter N Nau
- University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Carlos Galvani
- Tulane University School of Medicine, New Orleans, LA, USA
| | - J Scott Roth
- University of Kentucky College of Medicine, Lexington, KY, USA
| | | | | | - Leena Khaitan
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jon Gould
- Medical College of Wisconsin, Milwaukee, WI, USA
| | | |
Collapse
|
31
|
Albalawi WF, Albaraki J, Alharbi S, Ababtain N, Aloteibi RE, Alsudais AS, Jamjoom J, Alaqeel M. Distribution of perceived weight stigma and its psychological impact on obese people in Saudi Arabia. Saudi Pharm J 2023; 31:101763. [PMID: 37791034 PMCID: PMC10542636 DOI: 10.1016/j.jsps.2023.101763] [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: 06/16/2023] [Accepted: 08/21/2023] [Indexed: 10/05/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Wafi F Albalawi
- Department of Community Health Sciences, College of Applied Medical Sciences - King Saud University, Saudi Arabia
| | - Joud Albaraki
- College of Medicine - King Saud bin Abdul-Aziz University for Health Sciences, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Sereen Alharbi
- College of Medicine - King Saud bin Abdul-Aziz University for Health Sciences, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Nouf Ababtain
- College of Medicine - King Saud bin Abdul-Aziz University for Health Sciences, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Reema Enad Aloteibi
- College of Medicine - King Saud bin Abdul-Aziz University for Health Sciences, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Ali Saleh Alsudais
- College of Medicine - King Saud bin Abdul-Aziz University for Health Sciences, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Jafar Jamjoom
- College of Medicine - King Saud bin Abdul-Aziz University for Health Sciences, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Meshal Alaqeel
- College of Medicine - King Saud bin Abdul-Aziz University for Health Sciences, Saudi Arabia
- Department of Mental Health, Ministry of The National Guard - Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| |
Collapse
|
32
|
Gordon AR, Egan KA, Wang ML, Ziyadeh NJ, Kenney EL, Rosario M, Austin SB. Weight-based discrimination and disordered eating behaviors in a cohort of U.S. sexual minority young adults. Int J Eat Disord 2023; 56:1983-1990. [PMID: 37345224 PMCID: PMC10592576 DOI: 10.1002/eat.24015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 06/08/2023] [Accepted: 06/08/2023] [Indexed: 06/23/2023]
Abstract
OBJECTIVE Though prevalent, weight-based discrimination is understudied and has been linked to disordered eating behaviors (DEB) among adolescents and adults. Sexual minority populations experience elevated risk of DEB, but little is known about the role of weight discrimination in this elevated risk. METHODS Participants were 1257 sexual minority women and men (ages 18-31 years) in the US Growing Up Today Study cohort. We examined cross-sectional associations between weight discrimination victimization and three DEB in the past year: unhealthy weight control behaviors, overeating, and binge eating. Generalized estimating equations, adjusted for potential confounders, were used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs). RESULTS Three in 10 participants (31%) reported weight-based discrimination victimization. Sexual minority young adults who reported weight-based discrimination had greater relative prevalence of unhealthy weight control behaviors (PR [95% CI]: 1.92 [1.35, 2.74]), overeating (3.15 [2.24, 4.44]), and binge eating (3.92 [2.51, 6.13]), compared with those who reported no weight-based discrimination. Associations with overeating and binge eating remained significant after adjusting for BMI. DISCUSSION The role of weight-based discrimination, and its intersections with other forms of stressors for sexual minority young adults, must be included in efforts to advance eating disorder prevention for this underserved population. PUBLIC SIGNIFICANCE Three in 10 sexual minority young adults in this study had experienced weight-based discrimination, a common but understudied form of discrimination. Sexual minority young adults who experienced weight-based discrimination were at greater risk of disordered eating behaviors than those who had not experienced weight-based discrimination. These findings suggest that weight-based discrimination may be an important-and preventable-risk factor for disordered eating behaviors among sexual minority young adults.
Collapse
Affiliation(s)
- Allegra R. Gordon
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Kelsey A. Egan
- Division of General Academic Pediatrics, Department of Pediatrics, Boston Medical Center, Boston University School of Medicine
| | - Monica L. Wang
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
- Office of Narrative, Boston University Center for Antiracist Research, Boston, MA, USA
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Najat J. Ziyadeh
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
| | - Erica L. Kenney
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Margaret Rosario
- Department of Psychology, City University of New York—City College and Graduate Center, New York, NY, USA
| | - S. Bryn Austin
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| |
Collapse
|
33
|
Hackett RA, Jackson SE, Corker E, Steptoe A. The role of stress and health behaviour in linking weight discrimination and health: a secondary data analysis in England. BMJ Open 2023; 13:e072043. [PMID: 37709322 PMCID: PMC10503332 DOI: 10.1136/bmjopen-2023-072043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 08/29/2023] [Indexed: 09/16/2023] Open
Abstract
OBJECTIVE To examine the role of stress and health-risk behaviours in relationships between weight discrimination and health and well-being. DESIGN Secondary data analysis of an observational cohort study. SETTING The English Longitudinal Study of Ageing. PARTICIPANTS Data were from 4341 adults (≥50 years) with overweight/obesity. PRIMARY OUTCOME MEASURES We tested associations between perceived weight discrimination at baseline (2010/2011) and self-rated health, limiting long-standing illness, depressive symptoms, quality of life and life satisfaction over 4-year follow-up (2010/2011; 2014/2015). Potential mediation by stress exposure (hair cortisol) and health-risk behaviours (smoking, physical inactivity, alcohol consumption) was assessed. RESULTS Cross-sectionally, perceived weight discrimination was associated with higher odds of fair/poor self-rated health (OR=2.05 (95% CI 1.49 to 2.82)), limiting long-standing illness (OR=1.76 (95% CI 1.29 to 2.41)) and depressive symptoms (OR=2.01 (95% CI 1.41 to 2.85)) and lower quality of life (B=-5.82 (95% CI -7.01 to -4.62)) and life satisfaction (B=-2.36 (95% CI -3.25 to -1.47)). Prospectively, weight discrimination was associated with higher odds of fair/poor self-rated health (OR=1.63 (95% CI 1.10 to 2.40)) and depressive symptoms (OR=2.37 (95% CI 1.57 to 3.60)) adjusting for baseline status. Those who reported discrimination had higher hair cortisol concentrations (B=0.14 (95% CI 0.03 to 0.25)) and higher odds of physical inactivity (OR=1.90 (95% CI 1.18 to 3.05)). These variables did not significantly mediate associations between discrimination and health outcomes. CONCLUSIONS Weight discrimination is associated with poor health and well-being. While this discrimination is associated with stress exposure and physical inactivity, these variables explain little of the association between discrimination and poorer outcomes.
Collapse
Affiliation(s)
- Ruth A Hackett
- Health Psychology Section, Department of Psychology, King's College London, London, UK
| | - Sarah E Jackson
- Department of Behavioural Science and Health, University College London, London, UK
| | - Elizabeth Corker
- Clinical, Educational and Health Psychology, University College London, London, UK
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Andrew Steptoe
- Department of Behavioural Science and Health, University College London, London, UK
| |
Collapse
|
34
|
Gallagher C, Waidyatillake N, Pirkis J, Lambert K, Cassim R, Dharmage S, Erbas B. The long-term effects of childhood adiposity on depression and anxiety in adulthood: A systematic review. Obesity (Silver Spring) 2023; 31:2218-2228. [PMID: 37555243 DOI: 10.1002/oby.23813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 04/12/2023] [Accepted: 04/14/2023] [Indexed: 08/10/2023]
Abstract
OBJECTIVE This review aimed to evaluate the association between childhood adiposity and depression and anxiety risk in adulthood. METHODS MEDLINE, PsychInfo, Embase, CINAHL, and Scopus were searched on June 6, 2022, to identify studies that investigated the association between childhood weight status (age ≤18 years) and outcomes of depression and/or anxiety in adulthood (age ≥19 years). Study quality was assessed using the Newcastle-Ottawa Scale and results were narratively synthesized. RESULTS Sixteen studies were eligible for inclusion, with heterogeneity in methods and follow-up durations complicating comparisons. Six out of eight studies found a statistically significant association between childhood adiposity and increased likelihood of depression in adulthood, particularly in females. However, overall evidence was of moderate quality and study limitations prevented causal conclusions. In contrast, limited evidence and mixed findings were reported for the associations between childhood adiposity and depressive symptom severity or anxiety outcomes in adulthood. CONCLUSIONS Evidence suggests that childhood adiposity is associated with greater vulnerability to depression in adulthood, particularly in females. However, further research is warranted to address the limitations discussed. Future research should also explore how changes in weight status from childhood to adulthood might differentially influence the likelihood of depression.
Collapse
Affiliation(s)
- Claire Gallagher
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Nilakshi Waidyatillake
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Department of Medical Education, University of Melbourne, Melbourne, Victoria, Australia
| | - Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Katrina Lambert
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Raisa Cassim
- Department of Health, Tasmanian Government, Hobart, Tasmania, Australia
| | - Shyamali Dharmage
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Bircan Erbas
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
- Violet Vines Marshman Centre for Rural Health Research, La Trobe University, Bendigo, Victoria, Australia
| |
Collapse
|
35
|
Liu J, Ma Q, Wang X, Chen M, Ma T, Cui M, Jiang J, Li Y, Gao D, Ma Y, Yuan W, Chen L, Zhang Y, Guo T, Ma J, Dong Y. Weight self-misperception and obesity-related knowledge, attitudes, lifestyle behaviours and cardio-metabolic markers among Chinese school-aged children and adolescents. Public Health Nutr 2023; 26:1549-1561. [PMID: 37092759 PMCID: PMC10410384 DOI: 10.1017/s1368980023000630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/09/2023] [Accepted: 03/22/2023] [Indexed: 04/25/2023]
Abstract
OBJECTIVE The relationships between childhood weight self-misperception and obesity-related factors particularly health markers have not been extensively discussed. This study aims to examine the associations between weight self-misperception and obesity-related knowledge, attitudes, lifestyles and cardio-metabolic markers among Chinese paediatric population. DESIGN Cross-sectional study. SETTING Data sourced from a national survey in Chinese seven provinces in 2013. PARTICIPANTS Children and adolescents aged 5-19 years. RESULTS Of the total 14 079 participants, there were 14·5 % and 2·2 % participants over-estimated and under-perceived their weight, respectively. Multi-variable logistic regression was applied to calculate OR and 95 % CI (95 % Cl) of obesity-related behaviours and cardio-metabolic markers by actual and perceived weight status. Individuals who perceived themselves as overweight/obese were more likely to have prolonged screen time, insufficient dairy intake and over sugar-sweetened beverages consumption (all P < 0·05), regardless of their weight. Furthermore, actual overweight/obese individuals had higher odds of abnormal cardio-metabolic markers, but a smaller magnitude of association was found among weight under-estimators. Among non-overweight/obese individuals, weight over-estimation was positively associated with abdominal obesity (OR: 10·49, 95 % CI: 7·45, 14·76), elevated blood pressure (OR: 1·30, 95 % CI: 1·12, 1·51) and dyslipidemia (OR: 1·43, 95 % CI: 1·29, 1·58). CONCLUSIONS Weight over-perception was more prevalent than under-estimation, particularly in girls. Weight over-estimators tended to master better knowledge but behave more unhealthily; both weight over-perception and actual overweight/obesity status were associated with poorer cardio-metabolic markers. Future obesity intervention programmes should additionally pay attention to the population with inaccurate estimation of weight who were easily overlooked.
Collapse
Affiliation(s)
- Jieyu Liu
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, 100191, China
| | - Qi Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, 100191, China
| | - Xinxin Wang
- School of Public Health and Management, Ningxia Medical University, Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan, China
| | - Manman Chen
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, 100191, China
| | - Tao Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, 100191, China
| | - Mengjie Cui
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, 100191, China
| | - Jun Jiang
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, 100191, China
| | - Yanhui Li
- School of Nursing, Peking University, Beijing, China
| | - Di Gao
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Ying Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, 100191, China
| | - Wen Yuan
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, 100191, China
| | - Li Chen
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, 100191, China
| | - Yi Zhang
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, 100191, China
| | - Tongjun Guo
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, 100191, China
| | - Jun Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, 100191, China
| | - Yanhui Dong
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, 100191, China
| |
Collapse
|
36
|
Macho S, Andrés A, Saldaña C. Weight discrimination, BMI, or weight bias internalization? Testing the best predictor of psychological distress and body dissatisfaction. Obesity (Silver Spring) 2023; 31:2178-2188. [PMID: 37424155 DOI: 10.1002/oby.23802] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/23/2023] [Accepted: 04/24/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVE This study aimed: (1) to compare psychological distress (PD) and body dissatisfaction (BD) in terms of BMI, weight bias internalization (WBI), and weight discrimination (current and past); (2) to assess the best predictor of PD and BD and assess the relationships with weight discrimination, BD, and WBI. METHODS The sample consisted of 1283 participants across all BMI categories, recruited through the internet voluntarily. People with obesity were the most predominant (26.1%). Experiences of weight-based discrimination were reported by participants across all BMI categories, and they were more prevalent in people with obesity. RESULTS People with obesity, those with WBI, and those who faced current and past weight discrimination reported higher PD and higher BD. However, WBI was the best predictor after controlling for BMI, WBI, and current and past weight discrimination. Mediation analyses revealed that the relationship between weight discrimination and BD through WBI was significant, as was the relationship between weight discrimination and WBI through BD. CONCLUSIONS These results stressed the importance of WBI in PD and the role of weight discrimination in WBI and BD. Hence, there is a need to better understand how WBI is formed and to design effective interventions to reduce it.
Collapse
Affiliation(s)
- Sergio Macho
- Departament de Psicologia Clínica i Psicobiologia, Universitat de Barcelona, Barcelona, Spain
| | - Ana Andrés
- Faculty of Psychology, Education and Sport Sciences, Blanquerna, Ramon Llull University, Barcelona, Spain
| | - Carmina Saldaña
- Departament de Psicologia Clínica i Psicobiologia, Universitat de Barcelona, Barcelona, Spain
- Institut de Neurociències. Universitat de Barcelona, Barcelona, Spain
| |
Collapse
|
37
|
Evans AT, Vitek WS. Weight Bias in Reproductive Medicine: A Curiously Unexplored Frontier. Semin Reprod Med 2023; 41:63-69. [PMID: 37992727 DOI: 10.1055/s-0043-1777016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
Obesity has been associated with a multitude of medical comorbidities, infertility, and adverse obstetric outcomes. Weight stigma and weight bias pervade not only the medical field but also education, employment, and activities of daily living. The experience of weight stigma has been shown to adversely impact not only the mental health of individuals with overweight or obesity but also worsen obesogenic behaviors, and medical comorbidities. This review frames the rise of weight stigma and weight bias within the context of the "obesity epidemic" and explores its associations with infertility and decreased access to health care and its subsequent impact on the lives of individuals. Furthermore, it explores the concepts of intrinsic and extrinsic weight stigma/bias and highlights the need for further examination and research into the impact of these factors on access to reproductive medicine and subsequent outcomes.
Collapse
Affiliation(s)
- Adam T Evans
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York
| | - Wendy S Vitek
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York
| |
Collapse
|
38
|
Jolin JR, Stanford FC. More to obesity than what meets the eye: a comprehensive approach to counteracting obesity stigma. Postgrad Med J 2023; 99:367-369. [PMID: 37294713 PMCID: PMC9938081 DOI: 10.1136/pmj-2022-142082] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 08/07/2022] [Indexed: 01/05/2023]
Affiliation(s)
- James René Jolin
- Department of Government, Harvard College, Cambridge, Massachusetts, USA
- Harvard University Global Health and Health Policy, Cambridge, Massachusetts, USA
| | - Fatima Cody Stanford
- Department of Medicine-Neuroendocrine Unit, Pediatric Endocrinology, Nutrition Obesity Research Center at Harvard, Massachusetts General Hospital, Boston, Massachusetts, USA
- Departments of Medicine and Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
39
|
Nadolsky K, Addison B, Agarwal M, Almandoz JP, Bird MD, DeGeeter Chaplin M, Garvey WT, Kyle TK. American Association of Clinical Endocrinology Consensus Statement: Addressing Stigma and Bias in the Diagnosis and Management of Patients with Obesity/Adiposity-Based Chronic Disease and Assessing Bias and Stigmatization as Determinants of Disease Severity. Endocr Pract 2023; 29:417-427. [PMID: 37140524 DOI: 10.1016/j.eprac.2023.03.272] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/17/2023] [Accepted: 03/18/2023] [Indexed: 05/05/2023]
Abstract
OBJECTIVE To focus on the intersection of perception, diagnosis, stigma, and weight bias in the management of obesity and obtain consensus on actionable steps to improve care provided for persons with obesity. METHODS The American Association of Clinical Endocrinology (AACE) convened a consensus conference of interdisciplinary health care professionals to discuss the interplay between the diagnosis of obesity using adiposity-based chronic disease (ABCD) nomenclature and staging, weight stigma, and internalized weight bias (IWB) with development of actionable guidance to aid clinicians in mitigating IWB and stigma in that context. RESULTS The following affirmed and emergent concepts were proposed: (1) obesity is ABCD, and these terms can be used in differing ways to communicate; (2) classification categories of obesity should have improved nomenclature across the spectrum of body mass index (BMI) using ethnic-specific BMI ranges and waist circumference (WC); (3) staging the clinical severity of obesity based on the presence and severity of ABCD complications may reduce weight-centric contribution to weight stigma and IWB; (4) weight stigma and internalized bias are both drivers and complications of ABCD and can impair quality of life, predispose to psychological disorders, and compromise the effectiveness of therapeutic interventions; (5) the presence and of stigmatization and IWB should be assessed in all patients and be incorporated into the staging of ABCD severity; and (6) optimal care will necessitate increased awareness and the development of educational and interventional tools for health care professionals that address IWB and stigma. CONCLUSIONS The consensus panel has proposed an approach for integrating bias and stigmatization, psychological health, and social determinants of health in a staging system for ABCD severity as an aid to patient management. To effectively address stigma and IWB within a chronic care model for patients with obesity, there is a need for health care systems that are prepared to provide evidence-based, person-centered treatments; patients who understand that obesity is a chronic disease and are empowered to seek care and participate in behavioral therapy; and societies that promote policies and infrastructure for bias-free compassionate care, access to evidence-based interventions, and disease prevention.
Collapse
Affiliation(s)
- Karl Nadolsky
- Michigan State University College of Human Medicine, Grand Rapids, Michigan
| | - Brandi Addison
- South Texas Endocrinology and Metabolism Center, Corpus Christi, Texas
| | - Monica Agarwal
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Melanie D Bird
- American Association of Clinical Endocrinology, Jacksonville, Florida
| | | | | | | |
Collapse
|
40
|
Koran-Scholl J, Geske J, Khandalavala KR, Khandalavala B. Teaching module for obesity bias education: incorporating comprehensive competencies and innovative techniques. BMC MEDICAL EDUCATION 2023; 23:340. [PMID: 37193997 DOI: 10.1186/s12909-023-04310-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 04/30/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND The majority of the United States population is overweight or obese, and obesity bias is frequently reported by patients. Obesity bias is associated with adverse health outcomes, even independent of body weight. Primary care residents are often sources of obesity bias towards patients with weight, yet education regarding obesity bias is significantly lacking in most family medicine residency teaching curricula. The aim of this study is to describe an innovative web-based module on obesity bias and discuss its impact in family medicine residents. METHODS The e-module was developed by an interprofessional team of health care students and faculty. It consisted of a 15-minute video containing five clinical vignettes that depicted instances of explicit and implicit obesity bias in a patient-centered medical home (PCMH) model. Family medicine residents viewed the e-module as part of a dedicated one-hour didactic on obesity bias. Surveys were administered prior to and following the viewing of the e-module. They assessed previous education on obesity care, comfort in working with patients with obesity, residents' understanding of their own biases in working with this population, and the anticipated impact of the module on future patient care. RESULTS A total of 83 residents from three family medicine residency programs viewed the e-module and 56 completed both the pre and post survey. There was a significant improvement in residents' comfort in working with patients with obesity as well as their understanding of their own biases. CONCLUSION This teaching e-module is a short, interactive, web-based educational intervention that is free and open-sourced. The first-person patient perspective allows learners to better understand the patient's point of view and its PCMH setting illustrates interactions with a variety of healthcare professionals. It was engaging and well received by family medicine residents. This module can begin the conversation around obesity bias, leading to improved patient care.
Collapse
Affiliation(s)
- Jessica Koran-Scholl
- Department of Family Medicine, University of Nebraska Medical Center, 983075 Nebraska Medical Center, Omaha, NE, 68198-3075, USA.
| | - Jenenne Geske
- Department of Family Medicine, University of Nebraska Medical Center, 983075 Nebraska Medical Center, Omaha, NE, 68198-3075, USA
| | - Karl R Khandalavala
- Mayo Clinic College of Medicine and Science, 200 First ST SW, 55905, Rochester, MN, USA
| | - Birgit Khandalavala
- Department of Family Medicine, University of Nebraska Medical Center, 983075 Nebraska Medical Center, Omaha, NE, 68198-3075, USA
| |
Collapse
|
41
|
Cullin JM. Biological normalcy and body fat: Obesity prevalence, fat stigma, and allostatic load among late adolescents and young adults. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2023. [PMID: 37096804 DOI: 10.1002/ajpa.24752] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 03/17/2023] [Accepted: 04/16/2023] [Indexed: 04/26/2023]
Abstract
OBJECTIVES Biological normalcy provides a framework to assess tensions between clinical definitions of "normal," statistical norms, and normative beliefs. A prevailing cultural belief is obesity directly causes poor health, but research has demonstrated consequences of fat stigma. Previous research linked fat stigma and allostatic load (AL) in adults, but this has not been demonstrated in youth, and the role of obesity prevalence is unknown. This study assesses the relationship between fat stigma and AL among youth from counties varying by obesity prevalence. MATERIALS AND METHODS Undergraduates from 38 counties across the US state of Indiana (n = 175) were recruited. Fat stigma was measured using the brief stigmatizing situations inventory (SSI). AL was calculated using eight biomarkers representing cardiovascular, metabolic, and immune function. Poisson regression assessed relationships of interest and adjusted for potential confounding. An interaction term and stratified analyses were used to assess moderation. RESULTS SSI was not statistically associated with obesity prevalence (RR = 0.96, p = 0.173) but did statistically significantly predict AL (RR = 1.019, p = 0.045) when adjusting for confounders. Obesity prevalence moderated the relationship between SSI and AL (RR = 0.993, p = 0.001). DISCUSSION Results suggest that fat stigma, regardless of body fat percentage, is associated with physiologic wear and tear on the late adolescent body, and that exposure to obesity during earlier adolescence moderates this relationship. Those most at risk for high AL reported high fat stigma and lived in counties with relatively low obesity prevalence during earlier adolescence, suggesting vulnerability to fat stigma may be heightened where obesity is less common.
Collapse
Affiliation(s)
- Jennifer M Cullin
- Department of Anthropology, Indiana University, Bloomington, Indiana, USA
| |
Collapse
|
42
|
Winter VR, Hood A, Sorensen BL, Trout KE. Sexual and reproductive health cancer screening avoidance: The role of body image. Body Image 2023; 45:362-368. [PMID: 37084701 DOI: 10.1016/j.bodyim.2023.04.001] [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: 09/29/2022] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 04/23/2023]
Abstract
The current study examines the relationship of female genital self-image, weight-related cancer screening avoidance, and internalized weight stigma among cisgender women that can provide knowledge about avoidance of life-saving preventative healthcare. This cross-sectional survey included a convenience sample of 384 U.S. cisgender women who were 18+. The sample was primarily white (n = 260, 67.7 %) with a mean age of 33.18 years. 28.4 % reported avoiding a pap smear, 27.1 % avoided a clinical breast exam, and 29.4 % avoided a mammogram. Using multivariate logistic regressions, our results show high internalized weight stigma moderates the relationship of positive genital self-image on weight-related genital and breast cancer screening avoidance. Thus, the odds of avoiding screenings are positive, where the odds of avoidance slightly decreases from the interaction term as female genital body image increases. Interventions to improve female genital body image among cisgender women may lessen the effects of internalized weight stigma on avoiding reproductive cancer screenings. BMI was only a predictor for avoiding pap tests. Further examination is warranted because BMI and sexual health behaviors are not usually associated in body image research. Clinical workforce training is needed to educate providers about the harm of weight stigma and its relationship with healthcare avoidance.
Collapse
Affiliation(s)
- Virginia Ramseyer Winter
- University of Missouri, School of Social Work, Center for Body Image Research & Policy, 705 Clark Hall, Columbia, MO 65211, United States.
| | - Amanda Hood
- University of Missouri School of Social Work, United States
| | | | - Kate E Trout
- University of Missouri, School of Health Professions, Department of Health Sciences, United States
| |
Collapse
|
43
|
Gallagher C, Waidyatillake N, Pirkis J, Lambert K, Cassim R, Dharmage S, Erbas B. The effects of weight change from childhood to adulthood on depression and anxiety risk in adulthood: A systematic review. Obes Rev 2023:e13566. [PMID: 37062534 DOI: 10.1111/obr.13566] [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: 07/24/2022] [Revised: 03/08/2023] [Accepted: 03/16/2023] [Indexed: 04/18/2023]
Abstract
This review aimed to evaluate the effects of weight change from childhood to adulthood on depression and/or anxiety risk in adulthood. We systematically searched MEDLINE, PsychINFO, Embase, Cumulative Index to Nursing and Allied Health Literature, and Scopus for longitudinal studies assessing changes in weight status between childhood (≤18 years) and adulthood (≥19 years) in association with outcomes of depression and/or anxiety in adulthood. Study quality was assessed using a modified version of the Newcastle-Ottawa Scale, and data were narratively synthesized. Seventeen articles met our inclusion criteria: 13 evaluated outcomes of depression, one evaluated outcomes of anxiety, and five evaluated composite measures of depression and anxiety. Evidence was most consistent regarding outcomes of depression, with most finding that persistent and/or increasing adiposity from childhood to adulthood is associated with an increased risk of depression, particularly in women. However, heterogeneity and limitations in the evidence preclude definitive conclusions and inconsistent findings were reported in the few studies that assessed anxiety and composite outcomes. Overall, it appears that early intervention to both prevent or resolve excess weight may aid in reducing the burden of depression, along with mental health support targeting adolescents with persistent and/or increasing adiposity. However, further high-quality research is needed to address the methodological limitations discussed.
Collapse
Affiliation(s)
- Claire Gallagher
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Nilakshi Waidyatillake
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Department of Medical Education, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Katrina Lambert
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Raisa Cassim
- Department of Health, Tasmanian Government, Hobart, Tasmania, Australia
| | - Shyamali Dharmage
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Bircan Erbas
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| |
Collapse
|
44
|
Colombo GE, Pirotta S, Sabag A. Diet and Exercise in the Management of Polycystic Ovary Syndrome: Practical Considerations for Person-Centered Care. Semin Reprod Med 2023; 41:26-36. [PMID: 38040023 DOI: 10.1055/s-0043-1777116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
Polycystic ovary syndrome (PCOS) is a complex multisystem condition associated with life-long reproductive, metabolic, and psychological symptoms. Individuals with PCOS are at an increased risk of cardiovascular disease and type 2 diabetes, with approximately 70% of all PCOS cases presenting with insulin resistance. Lifestyle interventions have historically been recommended as first-line therapies for the management of PCOS-related cardiometabolic disorders. The term "lifestyle management" incorporates a multifaceted approach to dietary, exercise, and behavioral strategies, aiming to promote a healthy lifestyle. This approach has been commonly employed in practice, in particular through exercise and dietary modulation, due to its effect on cardiometabolic outcomes as well as its tolerability. Furthermore, there is evidence to suggest that combining dietary change with exercise may yield the greatest improvements in clinical outcomes. However, such practices require careful consideration and coordination, as there are instances where certain exercise and/or dietary prescriptions may compromise the effectiveness of the respective interventions. Thus, this review aims to provide practical guidance on diet and exercise planning in the routine care of PCOS. Such recommendations include emphasizing realistic and achievable goals, as well as minimizing barriers to lifestyle changes in order to increase the long-term sustainability of this treatment strategy.
Collapse
Affiliation(s)
- Giorgia E Colombo
- Department of Obstetrics and Gynecology, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Stephanie Pirotta
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Angelo Sabag
- Discipline of Exercise and Sport Science, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
45
|
Westbury S, Oyebode O, van Rens T, Barber TM. Obesity Stigma: Causes, Consequences, and Potential Solutions. Curr Obes Rep 2023; 12:10-23. [PMID: 36781624 PMCID: PMC9985585 DOI: 10.1007/s13679-023-00495-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/20/2022] [Indexed: 02/15/2023]
Abstract
PURPOSE OF REVIEW This review aims to examine (i) the aetiology of obesity; (ii) how and why a perception of personal responsibility for obesity so dominantly frames this condition and how this mindset leads to stigma; (iii) the consequences of obesity stigma for people living with obesity, and for the public support for interventions to prevent and manage this condition; and (iv) potential strategies to diminish our focus on personal responsibility for the development of obesity, to enable a reduction of obesity stigma, and to move towards effective interventions to prevent and manage obesity within the population. RECENT FINDINGS We summarise literature which shows that obesity stems from a complex interplay of genetic and environment factors most of which are outside an individual's control. Despite this, evidence of obesity stigmatisation remains abundant throughout areas of media, entertainment, social media and the internet, advertising, news outlets, and the political and public health landscape. This has damaging consequences including psychological, physical, and socioeconomic harm. Obesity stigma does not prevent obesity. A combined, concerted, and sustained effort from multiple stakeholders and key decision-makers within society is required to dispel myths around personal responsibility for body weight, and to foster more empathy for people living in larger bodies. This also sets the scene for more effective policies and interventions, targeting the social and environmental drivers of health, to ultimately improve population health.
Collapse
Affiliation(s)
- Susannah Westbury
- School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia.
| | - Oyinlola Oyebode
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Thijs van Rens
- Department of Economics, University of Warwick, Coventry, UK
| | | |
Collapse
|
46
|
Piran N, Counsell A, Teall TL, Komes J, Evans EH. The developmental theory of embodiment: Quantitative measurement of facilitative and adverse experiences in the social environment. Body Image 2023; 44:227-245. [PMID: 36610894 DOI: 10.1016/j.bodyim.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 01/07/2023]
Abstract
The present program of research involved developing and evaluating three fully structured measures of facilitative and adverse social experiences during adulthood described by the developmental theory of embodiment (DTE) as shaping the quality of the experiences of living in the body. The Physical Freedom Scale - adulthood (PFSa) addresses physical experiences, the Mental Freedom Scale - adulthood (MFSa) assesses exposure to social environments that either facilitate or constrict freedom from constraining social discourses, and the Social Power and Relational Connections Scale - adulthood (SPRCSa) covers experiences of accessing, or being barred from, social power and empowering relational connections. The pilot study ( N = 92) involved item revision and deletion. Study 1 (N = 412) involved factor analyses of the three scales, leading to the emergence of six, three, and four factors in the PFSa, MFSa, and SPRCSa, respectively. The study also provided initial support for the internal consistency of the scales and subscales, as well as their convergent validity. Study 2 (N = 373) confirmed the factor structure of the scales from study 2. Study 3 (N = 64) demonstrated that the scales and their factors were stable over a 3-week period. The scales can be used to study integrated sociocultural models of embodiment.
Collapse
Affiliation(s)
- Niva Piran
- Department of Applied Psychology and Human Development, OISE/University of Toronto, 252 Bloor St. West, Toronto, ON M5S 1V6, Canada.
| | - Alyssa Counsell
- Department of Psychology (JOR 926), Toronto Metropolitan University, 350 Victoria St., Toronto, ON M5B 2K3, Canada.
| | - Tanya Luanne Teall
- Department of Applied Psychology and Human Development, OISE/University of Toronto, 252 Bloor St. West, Toronto, ON M5S 1V6, Canada.
| | - Jessica Komes
- Foundations in Clinical Psychology, School of Psychology, Newcastle University, Dame Margaret Barbour Building, Wallace Street, Newcastle upon Tyne NE2 4DR, United Kingdom.
| | - Elizabeth H Evans
- Behavioral Science Psychology Department, Durham University, Mountjoy Research Park, South Road, Durham DH1 3LE, United Kingdom.
| |
Collapse
|
47
|
Fields ND, VanKim NA, Whitcomb BW, Bertone-Johnson ER, Martínez AD, Chae DH. Racism-Related Experiences and Adiposity: Findings From the Black Women's Experiences Living With Lupus (BeWELL) Study. Womens Health Issues 2023; 33:153-159. [PMID: 36319516 PMCID: PMC10010936 DOI: 10.1016/j.whi.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 09/01/2022] [Accepted: 09/22/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Studies suggest that higher rates of excess adiposity in Black women may in part be driven by experiences of racism. Racial microaggressions, which include unintentional and subtle slights and insults, and responses to racism such as racism-related vigilance, may contribute to adiposity in this population. This study examined these understudied racism-related facets as well as interpersonal racial discrimination in relation to adiposity in a cohort of Black women with systemic lupus erythematosus. METHODS Data are from the Black Women's Experiences Living with Lupus (BeWELL) Study (2015-2017; n = 432). Linear regression was used to examine adiposity measures (body mass index [BMI], percent body fat, and waist-to-hip ratio), measured during a physical examination, in relation to self-reported measures of racial microaggressions, racism-related vigilance, and interpersonal racial discrimination. RESULTS Compared with infrequent microaggressions, very frequent experiences of microaggressions were associated with 2.9 kg/m2 higher BMI (95% confidence [CI], 0.63-5.21) and 2.6% higher body fat (95% CI, 0.32-4.80) after adjusting for covariates. Racism-related vigilance, measured continuously, was positively associated with BMI (b = 0.84; 95% CI-0.08, 1.61) and percent body fat (b = 0.89; 95% CI, 0.14-1.64). Very frequent experiences of everyday discrimination were associated with a higher BMI (b = 2.70; 95% CI, 0.58-4.83) and waist-to-hip ratio (b = 0.32; 95% CI, 0.09-0.55) compared with less frequent everyday discrimination. CONCLUSIONS Our results suggest that various dimensions of racism are associated with excess adiposity. Efforts to address obesity among Black women with systemic lupus erythematosus should consider these multiple aspects to decrease racial inequities in adiposity.
Collapse
Affiliation(s)
- Nicole D Fields
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts.
| | - Nicole A VanKim
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Brian W Whitcomb
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Elizabeth R Bertone-Johnson
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts; Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Airín D Martínez
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts
| | - David H Chae
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| |
Collapse
|
48
|
Piran N, Teall TL, Counsell A. Expanding the social lens: A quantitative study of the developmental theory of embodiment. Body Image 2023; 44:246-261. [PMID: 36566166 DOI: 10.1016/j.bodyim.2022.11.009] [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: 07/20/2021] [Revised: 11/07/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022]
Abstract
The developmental theory of embodiment (DTE) is a research-based theory of social factors that shape the experience of embodiment, a construct that is strongly correlated with body esteem and body appreciation. The DTE is anchored in prospective and retrospective qualitative research studies with cisgender girls and women of diverse backgrounds. This paper describes the first comprehensive quantitative study of factors in the social environment the DTE delineates as shaping the experience of embodiment involving a cross-sectional design, among 412 cisgender women. The 13 quantitative social factors correlated positively with the Experience of Embodiment Scale and accounted together for over 60% of its score variance. The findings of significant positive correlations between all social factors and of a large shared variance amongst these factors in a simultaneous multiple regression predicting the experience of embodiment are in line with the DTE and with a multi-level model of causality central to public health perspectives, whereby social structures and positions, such as those related to gender, shape multiple lower-level protective and risk factors. Future studies of the theory should include prospective designs with samples of varied backgrounds along different dimensions of social location.
Collapse
Affiliation(s)
- Niva Piran
- Department of Applied Psychology and Human Development, OISE/University of Toronto, 252 Bloor St. West, Toronto, ON M5S 1V6, Canada.
| | - Tanya Luanne Teall
- Clinical Psychologist, Department of Applied Psychology and Human Development, OISE/University of Toronto, 252 Bloor St. West, Toronto, ON M5S 1V6, Canada.
| | - Alyssa Counsell
- Department of Psychology (JOR 926), Toronto Metropolitan University, 350 Victoria St., Toronto, ON M5B 2K3, Canada.
| |
Collapse
|
49
|
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.
Collapse
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
| |
Collapse
|
50
|
The effects of an acute weight stigma exposure on cardiovascular reactivity among women with obesity and hypertension: A randomized trial. J Psychosom Res 2023; 165:111124. [PMID: 36571973 DOI: 10.1016/j.jpsychores.2022.111124] [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: 06/03/2022] [Revised: 12/16/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Weight stigma induces cardiovascular health consequences for people with obesity. How stigma affects cardiovascular reactivity in individuals with both obesity and hypertension is not known. METHODS In a randomized experiment, we assessed the influence of two video exposures, depicting either weight stigmatizing (STIGMA) or non-stigmatizing (NEUTRAL) scenes, on cardiovascular reactivity [resting blood pressure (BP), heart rate (HR), ambulatory BP (ABP), and ambulatory HR (AHR)], among women with obesity and high BP (HBP; n=24) or normal BP (NBP; n=25). Systolic ABP reactivity was the primary outcome. Laboratory BP and HR were measured before/during/following the videos, and ABP and AHR were measured over 19 hours (10 awake hours, 9 sleep hours) upon leaving the laboratory. A repeated measures ANCOVA tested differences in BP and HR changes from baseline in the laboratory and over ambulatory conditions between the two groups after each video, controlling for body mass index, baseline BP and HR. RESULTS Laboratory SBP/DBP increased 5.5+7.3/2.4+8.8mmHg more in women with HBP than NBP following the STIGMA versus NEUTRAL video (Ps<0.05). For the primary outcome, ABP increased more in HBP than NBP over sleep (SBP/DBP=4.2+20.6/4.7+14.2mmHg; Ps<0.05) following the STIGMA versus NEUTRAL video, as did HR during sleep (7.5+15.7bpm more in HBP than NBP; P<0.05). CONCLUSIONS Weight stigma increases cardiovascular reactivity among women with obesity and HBP in the laboratory and under ambulatory conditions. CLINICAL TRIAL REGISTRATION Registered at ClinicalTrials.gov (Identifier: NCT04161638).
Collapse
|