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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.
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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
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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.
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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
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Maletta RM, Daly M, Goodwin L, Noonan R, Putra IGNE, Robinson E. Changes in the prevalence of perceived discrimination and associations with probable mental health problems in the UK from 2015 to 2020: A repeated cross-sectional analysis of the UK Household Longitudinal Study. SSM Popul Health 2024; 26:101667. [PMID: 38737142 PMCID: PMC11081791 DOI: 10.1016/j.ssmph.2024.101667] [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: 11/23/2023] [Revised: 03/28/2024] [Accepted: 04/01/2024] [Indexed: 05/14/2024] Open
Abstract
Background Significant social and political changes occurred in the UK between 2015 and 2020. Few studies have examined population level trends in experiencing discrimination and mental health problems during this period. Aims To determine prevalence trends in perceived discrimination and probable mental health problems amongst UK adults during 2015-2020. Method Repeated cross-sectional data from the UK Household Longitudinal Study was used to estimate nationally representative trends in perceived discrimination and probable mental health problems (GHQ-12; 4+ threshold) among adults between 2015/2016-2019/2020 (25,756 observations). Weighted logistic regression models with post-estimation margins commands determined changes between survey waves controlling for sociodemographic characteristics. Mediation models explored whether changes in perceived discrimination prevalence trends explained trends in probable mental health problems. Results From 2015/2016 to 2019/2020 perceived discrimination and probable mental health problems increased significantly by 6·1% (95% CI: 3·4-8·8, p <·001) and 4·5% (95% CI: 1·3-7·7, p = ·006), respectively. These changes did not tend to reliably differ by sociodemographic grouping. Increased prevalence of probable mental health problems from 2015/2016 to 2019/2020 was partially explained (15·2% of association mediated) by the increase in perceived discrimination observed during the same time period. Conclusions Amongst UK adults, the prevalence of perceived discrimination and probable mental health problems increased between 2015/2016 to 2019/2020. Increases in perceived discrimination partially explained increases in probable mental health problems. National measures designed to reduce both discrimination and mental health problems have potential to make substantial improvements to public health and should be prioritised in the UK.
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Affiliation(s)
| | - Michael Daly
- Department of Psychology, Maynooth University, Co. Kildare, Ireland
| | - Laura Goodwin
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Lancaster, UK
| | - Rob Noonan
- Faculty of Health and Wellbeing, University of Bolton, Bolton, UK
| | | | - Eric Robinson
- Department of Psychology, University of Liverpool, Liverpool, UK
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Zhang X, Wang Y, Yang X, Li Y, Gui J, Mei Y, Liu H, Guo LL, Li J, Lei Y, Li X, Sun L, Yang L, Yuan T, Wang C, Zhang D, Li J, Liu M, Hua Y, Zhang L. Obesity and lipid indices as predictors of depressive symptoms in middle-aged and elderly Chinese: insights from a nationwide cohort study. BMC Psychiatry 2024; 24:351. [PMID: 38730360 PMCID: PMC11088055 DOI: 10.1186/s12888-024-05806-z] [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: 01/30/2023] [Accepted: 05/02/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Depressive symptoms are one of the most common psychiatric disorders, with a high lifetime prevalence rate among middle-aged and elderly Chinese. Obesity may be one of the risk factors for depressive symptoms, but there is currently no consensus on this view. Therefore, we investigate the relationship and predictive ability of 13 obesity- and lipid-related indices with depressive symptoms among middle-aged and elderly Chinese. METHODS The data were obtained from The China Health and Retirement Longitudinal Study (CHARLS). Our analysis includes individuals who did not have depressive symptoms at the baseline of the CHARLS Wave 2011 study and were successfully follow-up in 2013 and 2015. Finally, 3790 participants were included in the short-term (from 2011 to 2013), and 3660 participants were included in the long-term (from 2011 to 2015). The average age of participants in short-term and long-term was 58.47 years and 57.88 years. The anthropometric indicators used in this analysis included non-invasive [e.g. waist circumference (WC), body mass index (BMI), and a body mass index (ABSI)], and invasive anthropometric indicators [e.g. lipid accumulation product (LAP), triglyceride glucose index (TyG index), and its-related indices (e.g. TyG-BMI, and TyG-WC)]. Receiver operating characteristic (ROC) analysis was used to examine the predictive ability of various indicators for depressive symptoms. The association of depressive symptoms with various indicators was calculated using binary logistic regression. RESULTS The overall incidence of depressive symptoms was 20.79% in the short-term and 27.43% in the long-term. In males, WC [AUC = 0.452], LAP [AUC = 0.450], and TyG-WC [AUC = 0.451] were weak predictors of depressive symptoms during the short-term (P < 0.05). In females, BMI [AUC = 0.468], LAP [AUC = 0.468], and TyG index [AUC = 0.466] were weak predictors of depressive symptoms during the long-term (P < 0.05). However, ABSI cannot predict depressive symptoms in males and females during both periods (P > 0.05). CONCLUSION The research indicates that in the middle-aged and elderly Chinese, most obesity- and lipid-related indices have statistical significance in predicting depressive symptoms, but the accuracy of these indicators in prediction is relatively low and may not be practical predictors.
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Affiliation(s)
- Xiaoyun Zhang
- Department of Graduate School, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, An Hui Province, People's Republic of China
| | - Ying Wang
- Department of Graduate School, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, An Hui Province, People's Republic of China
| | - Xue Yang
- Department of Graduate School, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, An Hui Province, People's Republic of China
| | - Yuqing Li
- Department of Graduate School, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, An Hui Province, People's Republic of China
| | - Jiaofeng Gui
- Department of Graduate School, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, An Hui Province, People's Republic of China
| | - Yujin Mei
- Department of Graduate School, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, An Hui Province, People's Republic of China
| | - Haiyang Liu
- Student Health Center, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, An Hui Province, People's Republic of China
| | - Lei-Lei Guo
- Department of Surgical Nursing, School of Nursing, Jinzhou Medical University, No.40, Section 3, Songpo Road, Linghe District, Jinzhou City, Liaoning Province, People's Republic of China
| | - Jinlong Li
- Department of Occupational and Environmental Health, Key Laboratory of Occupational Health and Safety for Coal Industry in Hebei Province, School of Public Health, North China University of Science and Technology, Tangshan, Hebei Province, People's Republic of China
| | - Yunxiao Lei
- Obstetrics and Gynecology Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, An Hui Province, People's Republic of China
| | - Xiaoping Li
- Department of Emergency and Critical Care Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, An Hui Province, People's Republic of China
| | - Lu Sun
- Department of Emergency and Critical Care Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, An Hui Province, People's Republic of China
| | - Liu Yang
- Department of Internal Medicine Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, An Hui Province, People's Republic of China
| | - Ting Yuan
- Obstetrics and Gynecology Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, An Hui Province, People's Republic of China
| | - Congzhi Wang
- Department of Internal Medicine Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, An Hui Province, People's Republic of China
| | - Dongmei Zhang
- Department of Pediatric Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, An Hui Province, People's Republic of China
| | - Jing Li
- Department of Surgical Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, An Hui Province, People's Republic of China
| | - Mingming Liu
- Department of Surgical Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, An Hui Province, People's Republic of China
| | - Ying Hua
- Rehabilitation Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, An Hui Province, People's Republic of China
| | - Lin Zhang
- Department of Internal Medicine Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, An Hui Province, People's Republic of China.
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Miller M, Swartz TT. "Getting Moving" and Being "Active Fit": Class Differences and Similarities in Health-promoting Parenting through Children's Organized Athletic Activities. Soc Sci Med 2024; 347:116776. [PMID: 38513560 DOI: 10.1016/j.socscimed.2024.116776] [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: 07/06/2023] [Revised: 02/11/2024] [Accepted: 03/08/2024] [Indexed: 03/23/2024]
Abstract
Parents are held increasingly responsible for acting intensively to protect their children's health through everyday decisions and practices. We add to this scholarship by considering how organized athletic activities, an important part of the lives of many children, help parents fulfill their responsibility to protect their children's health. Through qualitative analysis of 92 in-depth interviews with parents, we attend to how parents' class shapes their articulation of the relationship between their children's health and their extracurricular involvement, considering literature on the ubiquity of intensive parenting expectations and the possibility that health behaviors and understandings constitute health-related cultural capital. Contrary to previous research, overall, we find similarities across class in parents' understandings of the health benefits of organized athletic activities. We find that parents believe organized athletic activities protect their children's health from inactivity, excess technology usage, and fatness. We do find some class distinctions. Middle-class parents, and not working-class parents, believe that their children's athletic activities will instill a passion for exercise and staying in shape and give children the experience and knowledge to control their body size and promote their well-being through their lives. This may signal a transformation in the relationship between health-related parenting and class that could maintain middle-class children's advantage if it contributes to differences in health beliefs, narratives, or practices that are differentially rewarded by important institutions such as schools, the workplace, or the medical system.
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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.
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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
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Robstad N, Fegran L. The lived experiences of patients with severe obesity during hospital admissions in Norway: A phenomenological hermeneutic study. J Adv Nurs 2024. [PMID: 38389328 DOI: 10.1111/jan.16109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/26/2024] [Accepted: 02/06/2024] [Indexed: 02/24/2024]
Abstract
AIM To explore the lived experiences of patients with severe obesity during hospital admissions. DESIGN Qualitative study design. METHODS Semi-structured individual interviews with 14 participants with severe obesity from Norway were conducted between May and October 2021. A qualitative phenomenological hermeneutical approach inspired by Paul Riceour was used to analyse the data. RESULTS The following three themes were identified through the analysis of the lived experiences of patients with severe obesity during hospital admissions: blaming my weight, being prejudged and feeling different. The participants shared various emotional experiences of encounters with healthcare professionals at hospitals. They struggled to be recognized and welcomed like everyone else and found it difficult to be judged by someone who did not know them. The various experiences resulted in a vicious circle, ultimately leading to a fear of future hospitalization. CONCLUSION Being a patient with obesity in a hospital setting can present various challenges, leading to feelings of shame and guilt. Experiences of stigma may not necessarily be related to the overall hospital context but rather to encounters with healthcare professionals who may be unfamiliar with the patient's history, which can lead to stigmatizing behaviours. IMPACT Understanding how patients with severe obesity experience their hospital admissions and the importance of familiarizing themselves with the individual patients to avoid stigmatizing behaviours is important for healthcare professionals caring for obese patients. REPORTING METHOD Consolidated Criteria for Reporting Qualitative Research. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution. IMPACT STATEMENT Patients with obesity often encounter stigmatization and negative attitudes from healthcare professionals, particularly in primary care settings. Patients with severe obesity experienced various challenging encounters with healthcare professionals during hospital admissions, resulting in a vicious circle, ultimately leading to a fear of future hospitalization. It is crucial for healthcare professionals involved in the care of patients with obesity to acquaint themselves with individual patients to prevent stigmatizing behaviours.
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Affiliation(s)
- Nastasja Robstad
- Department of Health and Nursing Science, University of Agder, Kristiansand, Norway
| | - Liv Fegran
- Department of Health and Nursing Science, University of Agder, Kristiansand, Norway
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Anguah KOB, Christ SE. Exposure to written content eliciting weight stigmatization: Neural responses in appetitive and food reward regions. Obesity (Silver Spring) 2024; 32:80-90. [PMID: 37861062 DOI: 10.1002/oby.23917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/28/2023] [Accepted: 08/19/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE Neural activity in food reward- and appetite-related regions was examined in response to high-calorie (HC), low-calorie, and non-food pictures after exposure to written weight stigma (WS) content. Relationships with eating behavior (by Three-Factor Eating Questionnaire [TFEQ]), blood glucose, and subjective appetite were also explored. METHODS Adults with overweight and obesity were randomized to read either a WS (n = 20) or control (n = 20) article and subsequently underwent brain scans while they rated pleasantness of food pictures. Fasting glucose, TFEQ, stigma experiences, and appetite were measured before reading the article, appetite after reading, and glucose and appetite again after the scan. RESULTS A priori region of interest analyses revealed significant group differences in activation to HC > low-calorie food cues in the caudate and thalamus whereas exploratory whole-brain analyses suggested significant differences in regions including left insula, left thalamus, left inferior temporal gyrus, right lingual gyrus, and bilateral middle occipital gyrus and superior parietal lobule (p < 0.005 uncorrected, k ≥ 200 m3 ). No significant relationships were observed between the pattern of activation and TFEQ, glucose, or subjective appetite in the WS group. CONCLUSIONS Exposure to WS was associated with increased responsiveness to HC food content in the dorsal striatum and thalamus in individuals with overweight and obesity.
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Affiliation(s)
- Katherene O B Anguah
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, Missouri, USA
| | - Shawn E Christ
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri, USA
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Fortes Cavalcanti de Macêdo P, Brito E, de Magalhães Cunha C, Ribas de Farias Costa P, da Purificação Nazaré Araújo M, Cardoso Martins P, Leila Portela de Santana M. Weight stigma is a predictor of disordered eating in Brazilian college students during the COVID-19 pandemic: A 16-month cohort follow-up. Appetite 2024; 192:107084. [PMID: 37875240 DOI: 10.1016/j.appet.2023.107084] [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: 07/13/2023] [Revised: 10/07/2023] [Accepted: 10/09/2023] [Indexed: 10/26/2023]
Abstract
This study examined the relationship between weight stigma and disordered eating behaviors in university students during the COVID-19 pandemic, considering individuals with and without overweight. A national sample of 738 college students completed an online questionnaire at three time points between July 2020 and December 2021, reporting their experiences of weight stigma, perceived increase in weight stigma during the pandemic, internalized weight stigma, and disordered eating behaviors. The findings showed that the trajectories of disordered eating behaviors varied depending on participants' anthropometric status. Among those with overweight, there was a decrease over time in binge eating, food restriction, and purging. Conversely, the non-overweight group experienced a slight increase in binge eating from T2 to T3. Using the Generalized Estimating Equations model, the study revealed that weight stigma predicted disordered eating behaviors in both weight spectrums during the pandemic. Experiences of weight stigma and the perceived increase in weight stigma significantly increased the likelihood of engaging in binge eating, food restriction, and purging among individuals with overweight. Furthermore, the internalization of weight stigma was longitudinally associated with all examined eating behaviors, regardless of anthropometric status. These findings highlight the importance of addressing weight stigma to prevent disordered eating in college students.
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Affiliation(s)
| | - Edleide Brito
- Statistics Department, Federal University of Bahia, Salvador, Brazil.
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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.
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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.)
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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.
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Hughes AM, McArthur D. Weight stigma, welfare stigma, and political values: Evidence from a representative British survey. Soc Sci Med 2023; 334:116172. [PMID: 37696238 PMCID: PMC7615479 DOI: 10.1016/j.socscimed.2023.116172] [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: 06/13/2023] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 09/13/2023]
Abstract
Obesity-related stigma is increasingly recognised as a public health issue, with serious implications for mental and physical health. However, very little is known about what drives inter-individual differences in obesity-stigmatizing views, and how they are distributed in the population. If views about obesity are not independent of a person's wider beliefs and values, this must be understood so that obesity stigma can be effectively tackled. In a representative sample of British adults aged 18-97 (N = 2186), we explore predictors of weight-stigmatizing attitudes. We consider demographics, socioeconomic position, factors related to one's own weight and health, and beliefs about the causes and consequences of obesity. We explore the role of core political values which predict views about other stigmatized groups, and views about welfare recipients, who are frequently linked with obesity in public and political discourse. Finally, we assess to what extent demographic differences in weight-stigmatizing attitudes are explained by individual body mass index (BMI), attitudes, and beliefs. Consistent with previous studies, women were less weight-stigmatizing than men. People in late middle-age were less weight-stigmatizing than younger or older adults. Adjusted for age and gender, an index of weight-stigmatizing views was positively associated with income, and highest in intermediate categories of education and occupational social class. Weight-stigmatizing attitudes were associated with more right-wing values, more authoritarian values, and more stigmatizing views about welfare recipients. Factors including own BMI, beliefs about causes of obesity, welfare-stigmatizing attitudes and authoritarian values contributed to socioeconomic differences. Weight-stigmatizing attitudes show clear differences between demographic groups, but also vary according to wider social attitudes, beliefs, and a person's core political values. Efforts to reduce weight stigma, and other kinds of stigma, may be more effective if they recognise these links.
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Affiliation(s)
- Amanda M Hughes
- MRC Integrative Epidemiology Unit, Department of Population Health Sciences, University of Bristol, UK.
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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.
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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
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de Macêdo PFC, Brito E, de Magalhães Cunha C, da Purificação Nazaré Araújo M, Martins PC, de Santana MLP. Weight stigma and disordered eating behaviors during the COVID-19 pandemic: the mediating role of weight gain concern and psychological distress. Eat Weight Disord 2023; 28:78. [PMID: 37759035 PMCID: PMC10533574 DOI: 10.1007/s40519-023-01608-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
OBJECTIVES The purpose of this study is to investigate whether the relationship between weight stigma experiences and disordered eating behaviors during the COVID-19 pandemic is mediated by weight gain concern and psychological distress among university students with and without overweight. METHODS A cross-sectional study was conducted with university students from five regions of Brazil who participated in the baseline assessment of the Online Cohort on Eating Behavior and Health (July/August 2020). Information on the frequency of binge eating episodes, food restriction, and purging, as well as experienced weight stigma, weight gain concern, and psychological distress, were recorded in an online questionnaire. Stratified structural equation modeling (SEM) analyses were performed to address the research questions of interest. RESULTS Out of the total sample (n = 2511), 33.5% of participants reported experiencing weight stigma. The prevalence of binge eating episodes, food restriction, and purging was 43.7%, 24.1%, and 5.4%, respectively. These behaviors were more prevalent in individuals with overweight than in those without this condition. Furthermore, it was observed that weight gain concern and psychological distress mediated the relationship between weight stigma and disordered eating behaviors regardless of body weight status. CONCLUSIONS Experiences of weight stigma and disordered eating behaviors were prevalent among Brazilian university students, especially among those with overweight. Weight gain concern and psychological distress appear to be important factors underlying the relationship between these constructs during the pandemic, and they can contribute to the development of targeted strategies for the prevention and management of disordered eating. LEVEL OF EVIDENCE Level V, cross-sectional study.
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Affiliation(s)
| | - Edleide Brito
- Department of Statistics, Federal University of Bahia, Salvador, Brazil
| | - Carla de Magalhães Cunha
- School of Nutrition, Federal University of Bahia, Campus Canela, Rua Basílio da Gama, Salvador, BA, 40110-907, Brazil
| | | | - Poliana Cardoso Martins
- School of Nutrition, Federal University of Bahia, Campus Canela, Rua Basílio da Gama, Salvador, BA, 40110-907, Brazil
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Martin-Wagar CA, Attaway SE, Melcher KA. Differences among feminist and non-feminist women on weight bias internalization, body image, and disordered eating. J Eat Disord 2023; 11:129. [PMID: 37537638 PMCID: PMC10399034 DOI: 10.1186/s40337-023-00851-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/26/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Research yields mixed results on whether feminist beliefs or self-identification are protective against body image disturbance and eating pathology in non-clinical populations. Further, no studies have examined feminism among those with diagnosed eating disorders. Additionally, previous studies have not examined the relationship between feminist identity and weight stigma. This study investigated these relationships and if there are differences in body image, eating pathology, and weight stigma among feminist identity types in women with eating disorders and college women using ANCOVAs. METHODS Participants completed self-report measures and were women with eating disorders (N = 100) and college women (N = 240). RESULTS Sixty-four percent of the women with eating disorders and 75.8% of the college women identified as a feminist. An independent samples t-test found a significantly higher weight bias internalization in the clinical eating disorder sample than in the college women sample. No significant interactions were found between sample type and feminist identity for body image or weight bias internalization. Results were consistent when using a dichotomous feminist identity item and a seven-item continuous feminist identity item. CONCLUSIONS Despite the clear impacts of the intersection of weight status and gender, results from this study suggest that identifying as a feminist is not sufficient to combate weight stigma. Findings highlight the need for further research investigating weight bias internalization within eating disorder prevention efforts and interventions.
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Affiliation(s)
| | - Sarah E Attaway
- Department of Psychology, University of Montana, 32 Campus Dr., Missoula, MT, USA
| | - Katelyn A Melcher
- Department of Psychology, University of Montana, 32 Campus Dr., Missoula, MT, USA
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16
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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.
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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
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Liang S, Liu X, Li D, Zhang J, Zhao G, Yu H, Zhao X, Sha S. Development and validation of a nomogram to predict suicidal behavior in female patients with mood disorder. Front Psychiatry 2023; 14:1212579. [PMID: 37484676 PMCID: PMC10360170 DOI: 10.3389/fpsyt.2023.1212579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 06/21/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction This study aims to explore the risk factors associated with suicidal behavior and establish predictive models in female patients with mood disorders, specifically using a nomogram of the least absolute shrinkage and selection operator (LASSO) regression. Methods A cross-sectional survey was conducted among 396 female individuals diagnosed with mood disorders (F30-F39) according to the International Classification of Diseases and Related Health Problems 10th Revision (ICD-10). The study utilized the Chi-Squared Test, t-test, and the Wilcoxon Rank-Sum Test to assess differences in demographic information and clinical characteristics between the two groups. Logistic LASSO Regression Analyses were utilized to identify the risk factors associated with suicidal behavior. A nomogram was constructed to develop a prediction model. The accuracy of the prediction model was evaluated using a Receiver Operating Characteristic (ROC) curve. Result The LASSO regression analysis showed that psychotic symptoms at first-episode (β = 0.27), social dysfunction (β = 1.82), and somatic disease (β = 1.03) increased the risk of suicidal behavior. Conversely, BMI (β = -0.03), age of onset (β = -0.02), polarity at onset (β = -1.21), and number of hospitalizations (β = -0.18) decreased the risk of suicidal behavior. The area under ROC curve (AUC) of the nomogram predicting SB was 0.778 (95%CI: 0.730-0.827, p < 0.001). Conclusion The nomogram based on demographic and clinical characteristics can predict suicidal behavior risk in Chinese female patients with mood disorders.
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Affiliation(s)
- Sixiang Liang
- National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Xinyu Liu
- National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Dan Li
- National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Jinhe Zhang
- National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Guangwei Zhao
- National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Hongye Yu
- National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Xixi Zhao
- National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Sha Sha
- National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
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Lintang Kusuma MTP, Al-Bashabsheh Z, Albashabsheh NT, Parker M, Muturi N. Examining weight stigmatization toward obese individuals among nutrition and dietetic students using the attribution theory. Indian J Public Health 2023; 67:415-421. [PMID: 37929384 DOI: 10.4103/ijph.ijph_1615_22] [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] [Indexed: 11/07/2023] Open
Abstract
Background Despite the increasing prevalence of obesity in the United States, negative attitudes toward obese individuals are widespread. Health-care providers, including dietetics and nutritionists, are not exempt from showing bias toward obese individuals, which may lead to subsequent psychological and health problems. Objectives The purpose of this study was to measure the extent of weight bias among dietetics and nutrition students and investigate its determinants. Materials and Methods A cross-sectional survey (316) was conducted among undergraduate dietetics and nutrition students at a large Midwestern University to assess weight bias using the Fat Phobia Scale. Eating competence was measured using the ecSI 2.0 and body dissatisfaction using the Stunkard Figure Rating Scale. Other variables included experience with obesity, media exposure to health and nutrition information, and demographic characteristics. Results About 36% of the participants had weight bias, 64% were unsatisfied with their body image and none of the participants had eating competence. Media exposure to health information, body dissatisfaction, and eating competence was related to fat phobia (P < 0.05). Conclusion These findings highlight that weight bias is an apparent issue among students enrolling in health-related programs. Considering their future role in clinical and community settings, this issue should be addressed properly.
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Affiliation(s)
| | - Zaher Al-Bashabsheh
- Doctor, Department of Clinical Nutrition and Dietetics, Faculty of Allied Medical Sciences, Philadelphia University, Amman, Jordan
| | - Nibal T Albashabsheh
- Doctor, Department of Industrial Engineering, The University of Jordan, Amman, Jordan
| | - Michael Parker
- Mr., A.Q. Miller School of Media and Communications, Kansas State University, Manhattan, Kansas, USA
| | - Nancy Muturi
- Professor, A.Q. Miller School of Media and Communications, Kansas State University, Manhattan, Kansas, USA
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Qi R, Sheng B, Zhou L, Chen Y, Sun L, Zhang X. Association of Plant-Based Diet Indices and Abdominal Obesity with Mental Disorders among Older Chinese Adults. Nutrients 2023; 15:2721. [PMID: 37375625 DOI: 10.3390/nu15122721] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/30/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
We aimed to explore the correlation between plant-based diet indices and abdominal obesity with depression and anxiety among older Chinese adults. This study used a cross-sectional design using data from the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS). We used a simplified food frequency questionnaire to evaluate the overall plant-based diet index (PDI), the healthful plant-based diet index (hPDI), and the unhealthful plant-based diet index (uPDI) separately, based on the potential health effects of the foods. Waist circumference (WC) was used to define abdominal obesity. The 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10) and the 7-item Generalized Anxiety Disorder Scale (GAD-7) were applied to estimate depression symptoms and anxiety symptoms, respectively. Multi-adjusted binary logistic regression models were conducted to explore the effects of the three plant-based diet indices, abdominal obesity status, and their interaction on depression and anxiety. We enrolled a total of 11,623 participants aged 83.21 ± 10.98 years, of which 3140 (27.0%) participants had depression and 1361 (11.7%) had anxiety. The trend in the prevalence of depression/anxiety across increasing quartiles of the plant-based diet indices was statistically significant after controlling for potential confounders (p-trend < 0.05). Abdominal obesity was related to a lower prevalence of depression (OR = 0.86, 95% CI: 0.77-0.95) and anxiety (OR = 0.79, 95% CI: 0.69-0.90) compared with non-abdominal obesity. The protective effects of the PDI and hPDI against depression (OR = 0.52, 95% CI: 0.41-0.64; OR = 0.59, 95% CI: 0.48-0.73, respectively) and anxiety (OR = 0.75, 95% CI: 0.57-1.00; OR = 0.52, 95% CI: 0.39-0.70, respectively) were more pronounced in non-abdominally obese participants. The harmful effects of the uPDI against depression (OR = 1.78, 95% CI: 1.42-2.23) and anxiety (OR = 1.56, 95% CI: 1.16-2.10) were more pronounced in non-abdominally obese participants. In addition, a significant interaction between the plant-based diet indices and abdominal obesity was observed in terms of causing the prevalence of depression and anxiety. Consuming more of a healthful plant-based diet and less of an animal-based diet is related to a lower prevalence of depression and anxiety. A healthful plant-based diet plays a vital role in non-abdominally obese individuals.
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Affiliation(s)
- Ran Qi
- School of Public Health, Tianjin Medical University, Tianjin 300070, China
| | - Baihe Sheng
- School of Public Health, Tianjin Medical University, Tianjin 300070, China
| | - Lihui Zhou
- School of Public Health, Tianjin Medical University, Tianjin 300070, China
| | - Yanchun Chen
- School of Public Health, Tianjin Medical University, Tianjin 300070, China
| | - Li Sun
- School of Nursing, Tianjin Medical University, Tianjin 300070, China
| | - Xinyu Zhang
- School of Public Health, Tianjin Medical University, Tianjin 300070, China
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20
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Stroebe W. Is the energy balance explanation of the obesity epidemic wrong? Appetite 2023:106614. [PMID: 37271254 DOI: 10.1016/j.appet.2023.106614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/06/2023]
Abstract
There is a striking discrepancy in both U.S and the U.K data between obesity rates, which are increasing, and self-reported food consumption rates, which are decreasing. There are two possible explanations for this discrepancy, namely that the widely accepted energy balance interpretation of obesity is wrong or that food consumption data are somehow biased. In a comment entitled "Obesity-an unexplained epidemic", Mozzafarian (2022) challenged the Energy Balance Model (EBM) and argued for a need to replace it with a novel biological theory. This challenge is premature, because there are psychological explanations for this discrepancy, namely that individuals with overweight and obesity underreport their food consumption and that this tendency has increased in recent years. To support these hypotheses, U.S and U.K data are reviewed that used the Doubly Labeled Water method (DLW), which is the gold standard for estimating energy expenditure. Such studies find not only consistent evidence of underreporting, but also that the discrepancy between measured energy expenditure and reported calorie consumption increased over time. Two psychological explanations for this pattern are discussed.
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Weghuber D, Khandpur N, Boyland E, Mazur A, Frelut ML, Forslund A, Vlachopapadopoulou E, Erhardt É, Vania A, Molnar D, Ring-Dimitriou S, Caroli M, Mooney V, Forhan M, Ramos-Salas X, Pulungan A, Holms JC, O'Malley G, Baker JL, Jastreboff AM, Baur L, Thivel D. Championing the use of people-first language in childhood overweight and obesity to address weight bias and stigma: A joint statement from the European-Childhood-Obesity-Group (ECOG), the European-Coalition-for-People-Living-with-Obesity (ECPO), the International-Paediatric-Association (IPA), Obesity-Canada, the European-Association-for-the-Study-of-Obesity Childhood-Obesity-Task-Force (EASO-COTF), Obesity Action Coalition (OAC), The Obesity Society (TOS) and the World-Obesity-Federation (WOF). Pediatr Obes 2023; 18:e13024. [PMID: 37002830 DOI: 10.1111/ijpo.13024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 02/06/2023] [Accepted: 02/20/2023] [Indexed: 05/04/2023]
Affiliation(s)
- D Weghuber
- European Childhood Obesity Group (ECOG), Brussels, Belgium
- Department of Pediatrics, Obesity Research Unit, Paracelsus Medical University, Salzburg, Austria
| | - N Khandpur
- Division of Human Nutrition and Health, Wageningen Universiteit, Wageningen, The Netherlands
- Department of Nutrition, Faculty of Public Health, University of São Paulo, São Paulo, Brazil
| | - E Boyland
- European Childhood Obesity Group (ECOG), Brussels, Belgium
- Appetite & Obesity Research Group, Department of Psychology, University of Liverpool, Liverpool, UK
| | - A Mazur
- European Childhood Obesity Group (ECOG), Brussels, Belgium
- Department Pediatrics Pediatric Endocrinology and Diabetes, Medical College of Rzeszow University, Rzeszów, Poland
| | - M L Frelut
- European Childhood Obesity Group (ECOG), Brussels, Belgium
- Pediatric Practice, Albi, France
| | - A Forslund
- European Childhood Obesity Group (ECOG), Brussels, Belgium
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - E Vlachopapadopoulou
- European Childhood Obesity Group (ECOG), Brussels, Belgium
- Department of Endocrinology, Children's Hospital P. & A. Kyriakou, Athens, Greece
| | - É Erhardt
- European Childhood Obesity Group (ECOG), Brussels, Belgium
- Department of Paediatrics, University of Pécs, Pécs, Hungary
| | - A Vania
- European Childhood Obesity Group (ECOG), Brussels, Belgium
- Clinical Researcher, Sapienza University, Rome, Italy
| | - D Molnar
- European Childhood Obesity Group (ECOG), Brussels, Belgium
- Department of Paediatrics, University of Pécs, Pécs, Hungary
| | - S Ring-Dimitriou
- European Childhood Obesity Group (ECOG), Brussels, Belgium
- Department of Sport Science and Kinesiology, Paris Lodron-University, Salzburg, Austria
| | - M Caroli
- European Childhood Obesity Group (ECOG), Brussels, Belgium
- Paediatrician - Nutritionist, Brindisi, Italy
| | - V Mooney
- European Coalition for People Living with Obesity (ECPO), London, UK
| | | | | | - A Pulungan
- Intnerational Pediatric Association, Marengo, Illinois, USA
| | - J C Holms
- The Children's Obesity Clinic, European Centre of Obesity Management and The HOLBAEK Study, Department of Paediatrics, Holbaek University Hospital, Holbaek, Denmark
| | - G O'Malley
- School of Physiotherapy, Division of Population Health Sciences, RCSI University of Medicine and Health Sciences, Child and Adolescent Weight Management Service, Children's Health Ireland at Temple Street, Dublin, Ireland
| | - J L Baker
- Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - A M Jastreboff
- Department of Medicine (Endocrinology and Metabolism) and Department of Pediatrics (Pediatric Endocrinology), Yale University School of Medicine, New Haven, Connecticut, USA
| | - L Baur
- Specialty of Child and Adolescent Health, Sydney Medical School, The University of Sydney, World Obesity Federation, New South Wales, Australia
| | - D Thivel
- European Childhood Obesity Group (ECOG), Brussels, Belgium
- Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions, Auvergne Regional Center for Human Nutrition, International Research Chair Health in Motion, Clermont University Auvergne Foundation, Clermont Auvergne University, Clermont-Ferrand, France
- Specialized Obesity Center Caloris, Clermont-Ferrand, France
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22
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Nakamura Y, Asano M. Developing and validating a Japanese version of the Weight Self-Stigma Questionnaire. Eat Weight Disord 2023; 28:44. [PMID: 37195385 DOI: 10.1007/s40519-023-01573-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 05/11/2023] [Indexed: 05/18/2023] Open
Abstract
PURPOSE Weight bias internalization (WBI) is significantly associated with negative physiological and psychological consequences. Given its negative effects, appropriate measurement of WBI is required for weight management and mental and physical health in people with weight problems. One of the most reliable and frequently used questionnaires to assess WBI is the Weight Self-Stigma Questionnaire (WSSQ). However, a Japanese version of the WSSQ has not yet been developed. Thus, the current study aimed to develop a Japanese version of the WSSQ (WSSQ-J) and validate its psychometric properties in the Japanese context. METHODS A total of 1454 Japanese participants (age 34.44 ± 6.92; male = 498) with diverse weight statuses (Body mass index: 21.44 ± 3.52, 13.79-41.40 kg/m2) completed an online survey for the WSSQ-J. The internal consistency of the WSSQ-J was estimated by calculating Cronbach's α. Confirmatory factor analysis (CFA) was then carried out to confirm that the factor structure of the WSSQ-J was the same as that of the subscales of the original WSSQ. RESULTS The WSSQ-J had a Cronbach's α of 0.917, indicating good internal consistency. In CFA, the comparative fit index was 0.945, the root mean square error of approximation was 0.085, and the standardized root mean square residual was 0.040, indicating that the two-factor model showed satisfactory goodness-of-fit. CONCLUSION This study replicated the original findings related to the WSSQ, showing that the WSSQ-J is a reliable WBI questionnaire consisting of two factors. Therefore, the WSSQ-J would be a reliable tool for assessing WBI among Japanese. LEVEL OF EVIDENCE Level V, descriptive cross-sectional study.
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Affiliation(s)
- Yuko Nakamura
- Center for Evolutionary Cognitive Sciences, Graduate School of Art and Sciences, The University of Tokyo, 3-8-1, Komaba, Meguro-Ku, Tokyo, 153-8902, Japan.
- University of Tokyo Institute for Diversity & Adaptation of Human Mind (UTIDAHM), Meguro-Ku, Tokyo, 153-8902, Japan.
| | - Michiko Asano
- Center for Evolutionary Cognitive Sciences, Graduate School of Art and Sciences, The University of Tokyo, 3-8-1, Komaba, Meguro-Ku, Tokyo, 153-8902, Japan
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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.
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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
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Mensinger JL, Shepherd BF, Schapiro S, Aware Y, Brochu PM, Calogero RM, Tylka TL. Mediating effects of a weight-inclusive health promotion program on maladaptive eating in women with high body mass index. Eat Behav 2023; 49:101730. [PMID: 37121132 DOI: 10.1016/j.eatbeh.2023.101730] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 02/14/2023] [Accepted: 04/17/2023] [Indexed: 05/02/2023]
Abstract
Research shows that individuals with a body mass index (BMI) over 30 have experienced an 11-fold increase in restrictive eating and a 7-fold increase in binge eating since the 1990s. Most health promotion programs for higher-weight individuals have not been developed with the high eating disorder risk for this population in mind. The purpose of current study was to test two hypothesized mechanisms underlying improvement in maladaptive eating patterns shown in a weight-inclusive health promotion program designed for women with BMIs at or above 30. Participants (N = 40) were primarily White (93 %), 30-45 years old (M = 39.83, SD = 4.34) with BMIs ranging from 30 to 45 kg/m2 (M = 37.42, SD = 3.58). Using the MEMORE macro, we tested a parallel mediation model hypothesizing that internalized weight stigma and intuitive eating would explain improvements on two subscales from the Three-Factor Eating Questionnaire-R18 after a 6-month program. Total effects of the program on uncontrolled (b = -3.76, SE = 0.64, p < .0001) and emotional eating (b = -1.79, SE = 0.34, p < .0001) were significant. The indirect effects (IE) of internalized weight stigma on uncontrolled eating (IE = 1.59, SE = 0.79, 95 % CI = 0.46, 3.49) and emotional eating (IE = 0.67, SE = 0.40, 95 % CI = 0.11, 1.68) were also significant. Likewise, the IEs of intuitive eating on uncontrolled eating (IE = 2.09, SE = 0.70, 95 % CI = 0.60, 3.38) and emotional eating (IE = 1.03, SE = 0.43, 95 % CI = 0.08, 1.82) were significant. These findings indicate that weight-inclusive health promotion programs that directly address weight bias and eating according to cues from the body may help higher-weight individuals improve maladaptive eating patterns via reductions in internalized weight stigma and increases in intuitive eating.
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Affiliation(s)
- Janell L Mensinger
- Department of Clinical and School Psychology, Nova Southeastern University, 3301 College Ave, 1073 Maltz, Fort Lauderdale, FL 33314, United States of America.
| | - Benjamin F Shepherd
- Department of Clinical and School Psychology, Nova Southeastern University, 3301 College Ave, 1073 Maltz, Fort Lauderdale, FL 33314, United States of America.
| | - Stevie Schapiro
- Department of Clinical and School Psychology, Nova Southeastern University, 3301 College Ave, 1073 Maltz, Fort Lauderdale, FL 33314, United States of America.
| | - Yashvi Aware
- Department of Clinical and School Psychology, Nova Southeastern University, 3301 College Ave, 1073 Maltz, Fort Lauderdale, FL 33314, United States of America.
| | - Paula M Brochu
- Department of Clinical and School Psychology, Nova Southeastern University, 3301 College Ave, 1073 Maltz, Fort Lauderdale, FL 33314, United States of America.
| | - Rachel M Calogero
- Department of Psychology, Western University, Westminster Hall, Office 321, London, ON N6K 5C2, Canada.
| | - Tracy L Tylka
- Department of Psychology, The Ohio State University, 170F Morrill Hall, 1465 Mt. Vernon Avenue, Marion, OH 43302, United States of America.
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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.
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Affiliation(s)
- Jennifer M Cullin
- Department of Anthropology, Indiana University, Bloomington, Indiana, USA
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26
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Nicolau J, Tofé S, Bonet A, Sanchís P, Pujol A, Ayala L, Gil A, Masmiquel L. Effects of weight stigma on BMI and inflammatory markers among people living with obesity. Physiol Behav 2023; 262:114088. [PMID: 36657653 DOI: 10.1016/j.physbeh.2023.114088] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/19/2022] [Accepted: 01/13/2023] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Weight stigma (WS) and prejudice are one of the most prevalent ways of discrimination among adults, comparable with rates of racial discrimination. Exposure to WS among patients with obesity (PWO) may make the adoption of healthy dietary patterns and regular physical activity even more challenging and, therefore, the achievement of weight loss. Additionally, WS could also induce physiological responses such as increased levels of inflammatory markers, due to stress exposure. METHOD Subjects attending two obesity clinics were evaluated at baseline and after a minimum follow-up of six months. The weight Bias Internalization Scale (WBIS) and the Stigmatizing Situations Inventory (SSI) were administered to evaluate WS. Also, anthropometric and inflammatory markers, including cortisol, ferritin and C-reactive protein (CRP), were recorded at baseline. RESULTS 79 PWO (87.3%♀, 45.5 ± 1.3 years, 35.9 ± 6.3 kg/m2) were included. At baseline, 72.2% started liraglutide as anti-obesity drug. Baseline body mass index (BMI) correlated positively with both WBIS (r = 0.23; p = 0.03) and SSI (r = 0.25; p = 0.02) scores. Mean percentual weight loss after a mean follow-up of six months was -7.28%. However, there was a negative, but not statistically significant, correlation between weight loss and both WBIS (r=-0.14; p = 0.2) and SSI (r=-0.19; p = 0.08). Regarding inflammatory markers, plasma cortisol levels at baseline correlated positively with WBIS (p = 0.005) and SSI (p = 0.02). CRP at baseline also presented a positive correlation with SSI (p = 0.03). No significant correlations were found for stigma tests and ferritin levels. DISCUSSION As weight increases among PWO, so does stigma. Despite we did not find a significant negative association between the presence of WS and weight loss outcomes, there was an increase in inflammatory markers among PWO who experienced higher levels of WS.
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Affiliation(s)
- Joana Nicolau
- Endocrinology and Nutrition Department, Hospital Universitario Son Llàtzer. Health Research Institute of the Balearic Islands (IdISBa). Ctra Manacor km 4, Palma de Mallorca, Baleares, 07198, Spain; Clínica Rotger (Grupo Quirón). Via Roma, 3., Palma de Mallorca, Baleares, 07012, Spain.
| | - Santiago Tofé
- Clínica Juaneda (Grupo Juaneda), Palma de Mallorca, Spain; Servicio de Endocrinología y Nutrición, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Aina Bonet
- Clínica Rotger (Grupo Quirón). Via Roma, 3., Palma de Mallorca, Baleares, 07012, Spain
| | - Pilar Sanchís
- Endocrinology and Nutrition Department, Hospital Universitario Son Llàtzer. Health Research Institute of the Balearic Islands (IdISBa). Ctra Manacor km 4, Palma de Mallorca, Baleares, 07198, Spain
| | - Antelm Pujol
- Endocrinology and Nutrition Department, Hospital Universitario Son Llàtzer. Health Research Institute of the Balearic Islands (IdISBa). Ctra Manacor km 4, Palma de Mallorca, Baleares, 07198, Spain
| | - Luisa Ayala
- Endocrinology and Nutrition Department, Hospital Universitario Son Llàtzer. Health Research Institute of the Balearic Islands (IdISBa). Ctra Manacor km 4, Palma de Mallorca, Baleares, 07198, Spain
| | - Apolonia Gil
- Clínica Rotger (Grupo Quirón). Via Roma, 3., Palma de Mallorca, Baleares, 07012, Spain
| | - Lluís Masmiquel
- Endocrinology and Nutrition Department, Hospital Universitario Son Llàtzer. Health Research Institute of the Balearic Islands (IdISBa). Ctra Manacor km 4, Palma de Mallorca, Baleares, 07198, Spain
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Shepherd BF, Denning DM, Elbe CI, Maki JL, Brochu PM. Status, sexual capital, and intraminority body stigma in a size-diverse sample of gay men. Body Image 2023; 45:219-228. [PMID: 36963337 DOI: 10.1016/j.bodyim.2023.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 02/15/2023] [Accepted: 03/08/2023] [Indexed: 03/26/2023]
Abstract
Gay men are more likely than heterosexual men to experience social pressure based on body weight, shape, and muscularity, which may drive disparities in body image concerns and eating disorders. Utilizing a sample of 1723 gay men living in the United States, the present study examined whether sociodemographic factors (used as proxies for status and sexual capital) and frequency of attending gay-specific establishments or gatherings (community involvement) were associated with gay men's experiences of negative or discriminatory pressures based on body size and shape specifically from other gay men (intraminority body stigma). Experiences of intraminority body stigma were significantly more common among gay men who identified as higher-weight (r = 0.28), less masculine (r = -0.21), less wealthy (r = -0.21), younger (r = -0.21), or people of color (ds = 0.25-0.28). Furthermore, indicators of low status and sexual capital were indirectly associated with less frequent community involvement via more frequent experiences of intraminority body stigma. In addition to frequency, the valence of interactions between gay men should be considered when assessing body image and eating disorder risk in this population. Future research is encouraged to examine intraminority body stigma as an intersectional source of intraminority stress to inform prevention and treatment efforts for gay men.
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Affiliation(s)
- Benjamin F Shepherd
- Department of Clinical and School Psychology, Nova Southeastern University, United States.
| | - Dominic M Denning
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, United States
| | - Connor I Elbe
- Department of Psychology, San Diego State University, United States
| | - Justin L Maki
- Department of Clinical and School Psychology, Nova Southeastern University, United States
| | - Paula M Brochu
- Department of Clinical and School Psychology, Nova Southeastern University, United States
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28
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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.
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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
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Carr D. Ageism and late-life mortality: How community matters. Soc Sci Med 2023; 320:115501. [PMID: 36424283 PMCID: PMC9678335 DOI: 10.1016/j.socscimed.2022.115501] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 10/30/2022] [Indexed: 11/23/2022]
Abstract
AGEISM: the deeply entrenched biases that people hold about old age-is a persistent social problem that intensified during the COVID-19 pandemic. The harmful physical, emotional, and cognitive health consequences of individual-level age bias are well-documented, with most studies operationalizing ageism as an older adult's personal encounters with age discrimination, self-perceptions of their own aging, and internalized negative beliefs about old age. However, the impacts of community-level age bias on older adults' well-being have received less attention. This commentary reviews recent evidence (Kellogg et al.,) showing that county-level explicit age bias is associated with lower mortality rates among older adults, with effects limited to older adults residing in counties with relatively younger populations. Effects were not detected in counties with relatively older populations, or for implicit age bias. These counterintuitive findings require further exploration, including the use of more fine-grained measures of community-level ageism, attention to the role of gentrification in communities, and the development of new measures of structural ageism, drawing on approaches used to study the impacts of structural racism. Data science approaches, including the use of social media data in tandem with mortality data, may reveal how age bias affects older adults. Communities are especially important to older adults, who spend much of their time in areas immediately proximate to their homes. As more individuals age in place, and as federal funding for home-based and community services (HCBS) increases, researchers should identify which community-level characteristics, including age bias, undermine or enhance late-life well-being.
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Affiliation(s)
- Deborah Carr
- Department of Sociology and Center for Innovation in Social Science, Boston University, 704 Commonwealth Ave, Boston, MA, 02215, USA.
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Campoverde Reyes KJ, Sabharwal S, Stanford FC. Legal Evolution of a Law Against Weight Discrimination in the United States: A Focus on Massachusetts. Am J Health Promot 2023; 37:164-167. [PMID: 35974466 PMCID: PMC9909246 DOI: 10.1177/08901171221119795] [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] [Indexed: 01/24/2023]
Abstract
Weight discrimination heightens health inequalities, particularly among racial and ethnically diverse populations. We aim to research the legal evolution of the law against weight discrimination (S.2495) and raise awareness among lawmakers in the Commonwealth of Massachusetts. We invited officials (n = 199) to attend a legislative briefing, and 25.6% completed a 14-question anonymous survey upon arrival. Contrary to our hypothesis, this first-of-its-kind study found that most policymakers are aware of weight biases. While S.2495 did not pass, the current bill S.2669, prohibiting body size discrimination, has recently been reported favorably by the Joint Committee on the Judiciary and referred to the committee on Senate Ways and Means.
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Affiliation(s)
- Karen J. Campoverde Reyes
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Liver Research Center, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Fatima Cody Stanford
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Nutrition Obesity Research Center at Harvard, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Associations among enacted weight stigma, weight self-stigma, and multiple physical health outcomes, healthcare utilization, and selected health behaviors. Int J Obes (Lond) 2023; 47:33-38. [PMID: 36333585 DOI: 10.1038/s41366-022-01233-w] [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: 03/23/2022] [Revised: 10/19/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND This study examined the relationship among enacted weight stigma, weight self-stigma, and multiple health outcomes. Weight stigma, a stressor experienced across all body sizes, may contribute to poorer physical health outcomes by activating the nervous and endocrine system or by triggering counterproductive health behaviors like lower physical activity, maladaptive eating patterns, and delayed health care, as well as provider bias that may cause a medical concern to be discounted. While associations of weight stigma with mental health issues are well documented, less is known about its association with physical health. METHODS We enrolled 3821 adults who completed an online survey assessing enacted weight stigma, weight self-stigma, multiple self-reported physical health outcomes, healthcare utilization, and selected health behaviors. RESULTS After controlling for BMI, health care delay or avoidance, sedentary behavior, and selected demographic characteristics, enacted weight stigma, significantly increased the odds of six physical health problems including hypertension (OR 1.36; CI 1.08, 1.72), hyperglycemia (OR 1.73; CI 1.29, 2.31), thyroid disorder, (OR 1.65; CI 1.27, 2.13), any arthritis (OR 1.70; CI 1.27, 2.26), non-arthritic chronic pain (OR 1.76; CI 1.4, 2.29), and infertility (OR 1.53; CI 1.14, 2.05). Weight self-stigma significantly increased the odds for three physical health problems including hypertension (OR 1.43; CI 1.16, 1.76), hyperglycemia (OR 1.37; CI 1.03, 1.81), and non-arthritic chronic pain (OR 1.5; CI 1.2,1.87). Enacted stigma was associated with more than a four-fold increase in odds of believing that a medical concern was disregarded by a health care provider. CONCLUSIONS In this study, enacted stigma and weight self-stigma were independently associated with heightened risk for multiple physical health problems, as well as, believing health concerns were discounted by providers. Reducing weight stigma may be an important component of managing multiple physical health conditions.
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Magallares A, de Valle PB, Irles JA, Recio P, Jáuregui-Lobera I. Psychometric properties of the Spanish version of the Weight Self-Stigma Questionnaire (S-WSSQ) in a sample of participants with obesity seeking weight loss treatment. Eat Weight Disord 2022; 27:3685-3693. [PMID: 36434471 PMCID: PMC9803612 DOI: 10.1007/s40519-022-01511-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/10/2022] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Weight self-stigma may be defined as a self-devaluation due to one's identification with the group of people with obesity. The Weight Self-Stigma Questionnaire (WSSQ) is an instrument specifically designed to measure weight self-stigma in populations with overweight or obesity. The objective of this study was to adapt the WSSQ to the Spanish population (S-WSSQ) following the guidelines for cross-cultural adaptations. METHODS The sample comprised 165 participants with obesity seeking weight loss treatment (65% women) at the "Hospital de Valme" (Seville, Spain). Scales to measure life satisfaction, self-esteem, positive and negative affect, and antifat attitudes were used to analyze the convergent and divergent validity of the S-WSSQ. RESULTS A confirmatory factor analysis showed adequate values of the goodness of fit indexes of a two-factor model (χ2/df = 2.01 CFI = 0.92, IFI = 0.92, SRMR = 0.08, RMSEA = 0.078), replicating the structure found by the original authors. Cronbach's alphas of the two factors were 0.76 (self-devaluation) and 0.77 (fear of enacted stigma). Composite Reliability values were 0.72 (self-devaluation) and 0.76 (fear of enacted stigma). Self-devaluation and fear of enacted stigma were negatively related to self-esteem, and positive affect, and positively related to negative affect and antifat attitudes. Finally, life satisfaction was negatively correlated to fear of enacted stigma. CONCLUSIONS Based on these results, it is concluded that the S-WSSQ has good psychometric properties and might be used by the Spanish-speaking scientific community to measure weight self-stigma. LEVEL OF EVIDENCE Level V, descriptive study.
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Affiliation(s)
- Alejandro Magallares
- School of Psychology, Social Psychology Department, Spanish Open University (UNED), Madrid, Spain.
- Departamento de Psicología Social y de las Organizaciones, Facultad de Psicología UNED, C/ Juan del Rosal, 10, 28040, Madrid, Spain.
| | | | | | - Patricia Recio
- School of Psychology, Methodology Department, Spanish Open University (UNED), Madrid, Spain
| | - Ignacio Jáuregui-Lobera
- School of Experimental Sciences, Nutrition and Bromatology, Universidad Pablo de Olavide, Seville, Spain
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Body weight changes and bipolar disorder: a molecular pathway analysis. Pharmacogenet Genomics 2022; 32:308-320. [DOI: 10.1097/fpc.0000000000000484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Women carry the weight of deprivation on physical inactivity: Moderated mediation analyses in a European sample of adults over 50 Years of age. SSM Popul Health 2022; 20:101272. [PMID: 36387017 PMCID: PMC9641026 DOI: 10.1016/j.ssmph.2022.101272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022] Open
Abstract
Deprived people are less physically active than privileged individuals. However, pathways underlying the association between deprivation and physical activity remain overlooked. We examined whether the association between deprivation and physical activity was mediated by body mass index (BMI). Consistent with an intersectional perspective (how the combination of belongingness to vulnerable social categories widens inequalities), we tested whether gender moderated this mediating pathway and hypothesized that the mediating effect of BMI would be stronger among women (vs men). Large-scale longitudinal data from 20,961 adults 50 years of age or older (57% women) from the Survey of Health, Ageing and Retirement in Europe were used. Social and material deprivation were measured by questionnaire, BMI and physical activity were reported from two to six years later. Simple mediation models showed that BMI partly mediated the association of material (total effect c = -0.14, proportion of mediated effect = 8%) and of social deprivation (c = -0.24, proportion of mediated effect = 4%) with physical activity. Moderated mediation models revealed that this mediating pathway was moderated by gender. The effect of deprivation on BMI was stronger among women (vs men), with BMI mediating 18% and 7% of the association of material and social deprivation with physical activity among women (vs 4% and 2% among men). Lower levels of physical activity observed among deprived older adults could be partly attributed to a higher BMI. Critically, this mechanism was exacerbated among women, reinforcing the need to understand how deprivation and gender interact to predict health behaviors. Body mass index mediates the association of material and social deprivation with physical activity. This mediating pattern is more pronounced among women, relative to men. The association between deprivation and a higher body mass index is exacerbated among women, compared to men.
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Sun M, Peng J, Lommel L. Prevalence and Correlates of Weight Stigma among Postpartum Women in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14692. [PMID: 36429415 PMCID: PMC9690326 DOI: 10.3390/ijerph192214692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/05/2022] [Accepted: 11/07/2022] [Indexed: 06/16/2023]
Abstract
Weight stigma is linked to a variety of psychological and health problems. In the postpartum period, women may be more likely to experience weight-based discrimination because of their changing social roles, weight, and the new functions their bodies fulfill. However, few studies have explored the issue of postpartum women's weight stigma. Thus, to investigate the prevalence and correlates of weight stigma for postpartum women in China, we conducted a cross-sectional study of 507 postpartum women. Results showed that almost one quarter (21.1%) of postpartum women claimed to have experienced perceived weight stigma (PWS). Two thirds (66.1%) scored at the mean and 14.8% at the highest levels of weight bias internalization (WBI). During the postnatal period, the conditions of those most likely to report experiences of weight-based discrimination included low income [b = -0.203, p = 0.004], occupation as a worker [b = 0.921, p = 0.017] or farmer [b = 0.826, p = 0.033], stress [b = 0.044, p = 0.035], depression [b = 0.057, p = 0.021], and higher WBIS [b = 0.018, p = 0.002]. In addition, postpartum women who lived alone [b = 7.511, p = 0.048], were overweight or obese [b = 5.443, p = 0.000], and had higher PWS [b = 0.897, p = 0.004] and anxiety symptoms [b = 0.219, p = 0.011] had higher levels of internalized weight stigma. Findings from this study provide a foundation to better understand characteristics of postpartum women in China who are at risk for weight stigma.
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Affiliation(s)
- Mei Sun
- Xiangya School of Nursing, Central South University, Changsha 410017, China
- Xiangya Center for Evidence-Based Practice & Healthcare Innovation: A Joanna Briggs Institute Affiliated Group, Central South University, Changsha 410083, China
| | - Jiayuan Peng
- Xiangya School of Nursing, Central South University, Changsha 410017, China
| | - Lisa Lommel
- School of Nursing, University of California San Francisco, San Francisco, CA 94115, USA
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Stepanikova I, Acharya S, Colón-López A, Abdalla S, Klanova J, Darmstadt GL. Maternal gender discrimination and child emotional and behavioural problems: A population-based, longitudinal cohort study in the Czech Republic. EClinicalMedicine 2022; 53:101627. [PMID: 36060515 PMCID: PMC9433606 DOI: 10.1016/j.eclinm.2022.101627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 07/18/2022] [Accepted: 08/05/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Gender discrimination may be a novel mechanism through which gender inequality negatively affects the health of women and girls. We investigated whether children's mental health varied with maternal exposure to perceived gender discrimination. METHODS Complete longitudinal data was available on 2,567 mother-child dyads who were enrolled between March 1, 1991 and June 30, 1992 in the European Longitudinal Cohort Study of Pregnancy and Childhood-Czech cohort and were surveyed at multiple time points between pregnancy and child age up to 15 years. The Strengths and Difficulties Questionnaire (SDQ) was administered at child age 7, 11, and 15 years to assess child emotional/behavioural difficulties. Perceived gender discrimination was self-reported in mid-pregnancy and child age 7 and 11 years. Multilevel mixed-effects linear regression of SDQ scores were estimated. Mediation was tested using structural equation models. FINDINGS Perceived gender discrimination, reported by 11.2% of mothers in mid-pregnancy, was related to increased emotional/behavioural difficulties among children in bivariate analysis (slope = 0.24 [95% confidence interval (CI): 0.15, 0.32], p<0.0001) and in the fully adjusted model (slope = 0.18 [95% CI: 0.09, 0.27], p<0.0001). Increased difficulties were evident among children of mothers with more depressive symptoms (slope = 0.04 [95% CI: 0.03, 0.05], p<0.0001), boys (slope = 0.26 [95% CI: 0.19, 0.34], p<0.0001), first children (slope = 0.16 [95% CI: 0.09, 0.23], p<0.0001), and families under financial hardship (slope = 0.09 [95% CI: 0.04, 0.14], p<0.0001). Effects were attenuated for married mothers (slope-0.12 [95% CI: -0.22, -0.01], p<0.05]. Maternal depressive symptoms and financial hardship mediated about 37% and 13%, respectively, of the total effect of perceived gender discrimination on SDQ scores. INTERPRETATION Perceived gender discrimination among child-bearing women in family contexts was associated with more mental health problems among their children and adolescents, extending prior research showing associations with maternal mental health problems. Maternal depressive symptoms and, to a lesser extent, financial hardship both partially mediated the positive relationship between perceived gender discrimination and child emotional/behavioural problems. This should be taken into consideration when measuring the societal burden of gender inequality and gender-based discrimination. Moreover, gender-based discrimination affects more than one gender and more than one generation, extending to boys in the household even moreso than girls, highlighting that gender discrimination is everyone's issue. Further research is required on the intergenerational mechanisms whereby gender discrimination may lead to maternal and child mental health consequences. FUNDING Bill and Melinda Gates Foundation; Ministry of Education, Youth and Sports, Czech Republic and European Structural and Investment Funds.
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Affiliation(s)
- Irena Stepanikova
- Department of Sociology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- RECETOX, Faculty of Science, Masaryk University, Brno, Czech Republic
| | - Sanjeev Acharya
- Department of Criminology, Sociology, and Geography, Arkansas State University, Jonesboro, Arkansas, USA
| | - Alejandra Colón-López
- Department of Sociology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Safa Abdalla
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Jana Klanova
- RECETOX, Faculty of Science, Masaryk University, Brno, Czech Republic
| | - Gary L. Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
- Corresponding author at: 1701 Page Mill Road, Palo Alto, CA 94304, USA.
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Le Jemtel TH, Samson R, Oparil S. Integrated Care Model of Adiposity-Related Chronic Diseases. Curr Hypertens Rep 2022; 24:563-570. [PMID: 36083439 DOI: 10.1007/s11906-022-01223-3] [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] [Accepted: 09/02/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE OF REVIEW Although obesity is a disease, most patients with obesity do not undergo effective treatment nor adhere to long-term care. We examine the barriers that patients with obesity confront when searching for effective treatment and propose an integrated care model of adiposity-related chronic diseases in a cardio-renal metabolic unit. RECENT FINDINGS The current care of obesity is fragmented between primary care providers, medical specialists and metabolic bariatric surgeons with little or no coordination of care between these providers. The current care of obesity heavily focuses on weight loss as the primary aim of treatment thereby reenforcing the weight stigma and turning patients away from effective therapy like metabolic bariatric surgery. An interdisciplinary cardio-renal metabolic unit that, besides weight loss, emphasizes prevention/remission of adiposity-related chronic diseases may deliver thorough and rewarding care to most patients with obesity.
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Affiliation(s)
- Thierry H Le Jemtel
- Section of Cardiology, John W. Deming Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA.
| | - Rohan Samson
- Section of Cardiology, John W. Deming Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA
| | - Suzanne Oparil
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Samson R, Ennezat PV, Le Jemtel TH, Oparil S. Cardiovascular Disease Risk Reduction and Body Mass Index. Curr Hypertens Rep 2022; 24:535-546. [PMID: 35788967 DOI: 10.1007/s11906-022-01213-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE OF REVIEW Anti-hypertensive and lipid lowering therapy addresses only half of the cardiovascular disease risk in patients with body mass index > 30 kg/m2, i.e., obesity. We examine newer aspects of obesity pathobiology that underlie the partial effectiveness of anti-hypertensive lipid lowering therapy for the reduction of cardiovascular disease risk in obesity. RECENT FINDINGS Obesity-related insulin resistance, vascular endothelium dysfunction, increased sympathetic nervous system/renin-angiotensin-aldosterone system activity, and glomerulopathy lead to type 2 diabetes, coronary atherosclerosis, and chronic disease kidney disease that besides hypertension and dyslipidemia increase cardiovascular disease risk. Obesity increases cardiovascular disease risk through multiple pathways. Optimal reduction of cardiovascular disease risk in patients with obesity is likely to require therapy targeted at both obesity and obesity-associated conditions.
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Affiliation(s)
- Rohan Samson
- Section of Cardiology, John W. Deming Department of Medicine, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70112, USA
| | | | - Thierry H Le Jemtel
- Section of Cardiology, John W. Deming Department of Medicine, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70112, USA.
| | - Suzanne Oparil
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Talumaa B, Brown A, Batterham RL, Kalea AZ. Effective strategies in ending weight stigma in healthcare. Obes Rev 2022; 23:e13494. [PMID: 35934011 PMCID: PMC9540781 DOI: 10.1111/obr.13494] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 12/11/2022]
Abstract
Weight stigma impacts negatively healthcare quality and hinders public health goals. The aim of this review was to identify strategies for minimizing weight bias among healthcare professionals and explore future research directions. An electronic search was performed in PubMed, PsycINFO and Scopus (until June 2020). Studies on weight stigma reduction in healthcare students, trainees and professionals were assessed based on specific inclusion and exclusion criteria. A narrative synthesis was undertaken to analyze emerging themes. We identified five stigma reduction strategies in healthcare: (i) increased education, (ii) causal information and controllability, (iii) empathy evoking, (iv) weight-inclusive approach, and (v) mixed methodology. Weight stigma needs to be addressed early on and continuously throughout healthcare education and practice, by teaching the genetic and socioenvironmental determinants of weight, and explicitly discussing the sources, impact and implications of stigma. There is a need to move away from a solely weight-centric approach to healthcare to a health-focused weight-inclusive one. Assessing the effects of weight stigma in epidemiological research is equally important. The ethical argument and evidence base for the need to reduce weight stigma in healthcare and beyond is strong. Although evidence on long-term stigma reduction is emerging, precautionary action is needed.
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Affiliation(s)
- Britta Talumaa
- Division of Medicine, University College London, London, UK
| | - Adrian Brown
- Division of Medicine, University College London, London, UK.,Centre for Obesity Research, University College London, London, UK.,Bariatric Centre for Weight Management and Metabolic Surgery, University College London Hospital NHS Trust, London, UK.,UCLH Biomedical Research Centre, National Institute of Health Research, London, UK
| | - Rachel L Batterham
- Division of Medicine, University College London, London, UK.,Centre for Obesity Research, University College London, London, UK.,Bariatric Centre for Weight Management and Metabolic Surgery, University College London Hospital NHS Trust, London, UK.,UCLH Biomedical Research Centre, National Institute of Health Research, London, UK
| | - Anastasia Z Kalea
- Division of Medicine, University College London, London, UK.,Institute of Cardiovascular Science, University College London, London, UK
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Rossi AA, Manzoni GM, Pietrabissa G, Di Pauli D, Mannarini S, Castelnuovo G. Weight stigma in patients with overweight and obesity: validation of the Italian Weight Self-Stigma Questionnaire (WSSQ). Eat Weight Disord 2022; 27:2459-2472. [PMID: 35290623 PMCID: PMC9556395 DOI: 10.1007/s40519-022-01385-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 02/26/2022] [Indexed: 02/06/2023] Open
Abstract
PURPOSE This study aimed to explore the factorial structure of the Italian Weight Self-Stigma Questionnaire (WSSQ) (Study1); and to test structural validity, internal consistency, test-retest reliability, and measurement invariance of the questionnaire across gender, Body Mass Index (BMI), age and occurrence of previous hospitalization for obesity (Study2). METHODS At admission into a hospital-based program for weight reduction and rehabilitation, 150 inpatients with overweight/obesity (68% females) completed the WSSQ (Study1). In Study2, in addition to the WSSQ, 446 inpatients (61.9% females) completed the Weight Bias Internalization Scale (WBIS), the Body Uneasiness Test (BUT), and the Center for Epidemiologic Studies Depression Scale (CES-D). A subsample of 40 patients also re-completed the WSSQ at discharge from the hospital. RESULTS The Italian WSSQ showed good overlap with the original factorial structure (Study1) and results were confirmed in Study2. Test-retest reliability and convergent validity showed adequate values. Measurement invariance revealed that WSSQ was perfectly invariant across both BMI and the occurrence of previous hospitalizations for obesity. In both studies, the internal consistency of the questionnaire was deemed acceptable. CONCLUSIONS The Italian WSSQ is a valid, reliable, and invariant tool for the assessment of weight-related self-stigma among patients with overweight/obesity. Future studies should assess its longitudinal invariance as well as its responsiveness to weight reduction treatments. LEVEL OF EVIDENCE V, descriptive study.
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Affiliation(s)
- Alessandro Alberto Rossi
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padua, Italy. .,Interdepartmental Center for Family Research, Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padua, Italy.
| | - Gian Mauro Manzoni
- Psychology Research Laboratory, Ospedale San Giuseppe, IRCCS, Istituto Auxologico Italiano, Verbania, Italy.,Faculty of Psychology, eCampus University, Novedrate, Como, Italy
| | - Giada Pietrabissa
- Psychology Research Laboratory, Ospedale San Giuseppe, IRCCS, Istituto Auxologico Italiano, Verbania, Italy.,Department of Psychology, Catholic University of Milan, Milan, Italy
| | | | - Stefania Mannarini
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padua, Italy.,Interdepartmental Center for Family Research, Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padua, Italy
| | - Gianluca Castelnuovo
- Psychology Research Laboratory, Ospedale San Giuseppe, IRCCS, Istituto Auxologico Italiano, Verbania, Italy.,Department of Psychology, Catholic University of Milan, Milan, Italy
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Speirs DP, Kuijer RG, Yogeeswaran K. Examining how framing obesity as disease vs. food addiction influences stigma among fitness practitioners. Obes Res Clin Pract 2022; 16:429-433. [PMID: 36058838 DOI: 10.1016/j.orcp.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 07/27/2022] [Accepted: 08/18/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To determine if framing the etiology of obesity as a disease, food addiction, or caloric imbalance would increase or decrease anti-fat attitudes (AFA) and challenge the belief that obesity is caused by a lack of personal responsibility or willpower. METHODS Two hundred and forty-nine fitness practitioners (Mage = 37.49 years) were randomly assigned to one of four experimental conditions and asked to read a short article describing obesity as either: (a) food addiction, (b) disease, or (c) caloric imbalance, while a control group read an unrelated article. All practitioners then completed a measure of AFA. RESULTS Practitioners in the food addiction condition recorded significantly lower AFA than practitioners in the disease condition, specifically on the subscale relating to the belief that obesity is a matter of personal responsibility and willpower, or lack thereof. The differing etiologies of obesity had no impact on fitness practitioners' dislike for people with obesity or their personal fears about gaining weight CONCLUSION: Presenting the etiology of obesity as a food addiction may be more effective than the disease or caloric imbalance etiologies at reducing obesity stigma relating to the belief that obesity results from a lack of willpower. Such an understanding can help reduce obesity stigma and may encourage governments to implement obesity reduction policies as recommended by organisations such as the WHO.
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Affiliation(s)
- Daniel P Speirs
- Department of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand; New Zealand Institute of Health and Fitness, New Zealand.
| | - Roeline G Kuijer
- Department of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Kumar Yogeeswaran
- Department of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
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Sarwer DB, Siminoff LA, Gardiner HM, Spitzer JC. The psychosocial burden of visible disfigurement following traumatic injury. Front Psychol 2022; 13:979574. [PMID: 36110275 PMCID: PMC9468754 DOI: 10.3389/fpsyg.2022.979574] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 07/21/2022] [Indexed: 12/15/2022] Open
Abstract
Hundreds of thousands of individuals experience traumatic injuries each year. Some are mild to moderate in nature and patients experience full functional recovery and little change to their physical appearance. Others result in enduring, if not permanent, changes in physical functioning and appearance. Reconstructive plastic surgical procedures are viable treatments options for many patients who have experienced the spectrum of traumatic injuries. The goal of these procedures is to restore physical functioning and reduce the psychosocial burden of living with an appearance that may be viewed negatively by the patient or by others. Even after receipt of reconstructive procedures, many patients are left with residual disfigurement. In some, disability and disfigurement may be so profound that individuals are candidates for vascularized composite allotransplantation (VCA) procedures, i.e., the transplantation of a vascularized human body part containing multiple tissue types (skin, muscle, bone, nerves, and blood vessels) as an anatomical and/or structural unit. This narrative review paper summarizes the literature on the psychosocial burden experienced by those who have visible disfigurement. While many of these individuals experience stigma and discrimination, relatively few studies have employed a stigma framework to understand the psychosocial sequelea. This paper briefly addresses this framework. Last, particular focus is given to the psychosocial issues of individuals with particularly severe injuries who are potential candidates for VCA procedures.
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Affiliation(s)
- David B. Sarwer
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, United States
- *Correspondence: David B. Sarwer,
| | - Laura A. Siminoff
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, United States
| | - Heather M. Gardiner
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, United States
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Hoffmann K, Paczkowska A, Bryl W, Marzec K, Raakow J, Pross M, Berghaus R, Nowakowska E, Kus K, Michalak M. Comparison of Perceived Weight Discrimination between Polish and German Patients Underwent Bariatric Surgery or Endoscopic Method versus Conservative Treatment for Morbid Obesity: An International Multicenter Study. Nutrients 2022; 14:nu14132775. [PMID: 35807955 PMCID: PMC9268827 DOI: 10.3390/nu14132775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 06/29/2022] [Accepted: 07/02/2022] [Indexed: 02/04/2023] Open
Abstract
Objectives: The aim of this study was to compare the level of discrimination among patients with obesity living in Poland and Germany. Methods: This was a retrospective cross-sectional international multicenter survey study including 564 adult participants treated for morbid obesity at selected healthcare facilities in Germany (210 patients) and in Poland (354 patients). Discrimination was evaluated using a custom-made questionnaire based on the related literature. Results: The level of obesity discrimination did not differ between German and Polish patients (p = 0.4282). The presence of obesity was reported to be associated to a large or a very large extent with the feeling of social exclusion and discrimination by 46.63% of German participants and 42.09% of Polish ones (p = 0.2934). The mean level of discrimination related to the lack of employment was higher in patients who underwent bariatric surgery or endoscopic method than in those who underwent conservative treatment (for Germany: 2.85 ± 1.31 (median, 3) vs. 2.08 ± 1.31 (median, 1), p = 0.002; for Poland: 2.43 ± 1.15 (median, 2) vs. 1.93 ± 1.15 (median, 1), p = 0.005). The level of discrimination was associated with sex, age, the degree of obesity, and treatment-related weight loss (p < 0.05). Conclusions: Our findings confirm that obesity significantly affects the social and economic well-being of patients. There is a great need to reduce weight stigma and to take measures to alleviate the socioeconomic and psychological burden of obesity.
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Affiliation(s)
- Karolina Hoffmann
- Department of Internal Diseases, Metabolic Disorders and Arterial Hypertension, Poznan University of Medical Sciences, 60-806 Poznań, Poland;
- Correspondence: ; Tel.: +48-61-8549-377; Fax: +48-61-8478-529
| | - Anna Paczkowska
- Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, 60-806 Poznań, Poland; (A.P.); (K.M.); (K.K.)
| | - Wiesław Bryl
- Department of Internal Diseases, Metabolic Disorders and Arterial Hypertension, Poznan University of Medical Sciences, 60-806 Poznań, Poland;
| | - Kinga Marzec
- Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, 60-806 Poznań, Poland; (A.P.); (K.M.); (K.K.)
| | - Jonas Raakow
- Department of Surgery, Campus Charité Mitte, Campus Virchow Klinikum, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany;
| | - Matthias Pross
- Department of Surgery, DRK Kliniken Berlin, Köpenick, 12559 Berlin, Germany; (M.P.); (R.B.)
| | - Rafael Berghaus
- Department of Surgery, DRK Kliniken Berlin, Köpenick, 12559 Berlin, Germany; (M.P.); (R.B.)
| | - Elżbieta Nowakowska
- Department of Pharmacology and Toxicology, Institute of Health Sciences, Collegium Medicum, University of Zielona Góra, 65-516 Zielona Góra, Poland;
| | - Krzysztof Kus
- Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, 60-806 Poznań, Poland; (A.P.); (K.M.); (K.K.)
| | - Michał Michalak
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, 60-806 Poznań, Poland;
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Martin-Wagar CA, Weigold IK. Internalized Stigma as a Transdiagnostic Factor for Women with Eating Disorders. Eat Disord 2022; 31:173-190. [PMID: 35770871 DOI: 10.1080/10640266.2022.2095481] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
This study aimed to examine how internalized weight bias (IWB), body surveillance, and body shame relate to eating pathology in women with diagnosed eating disorders (EDs) across the weight spectrum. Previous research has examined these variables in primarily non-clinical populations, binge eating disorder, and higher weight populations. In a sample of 98 women with diagnosed EDs, the association of IWB, body surveillance, and body shame on the severity of ED symptoms was examined with hierarchical multiple regression analyses. Results indicate that IWB, body surveillance, and body shame significantly predicted global eating pathology, F (4, 93) = 40.74, p < .001. IWB, body surveillance, and body shame related to global eating pathology, even after controlling for previous weight bias experiences. Analyses with specific symptom clusters found that only body surveillance predicted dietary restraint, only IWB and body shame predicted overvaluation of shape/weight, and only IWB predicted body dissatisfaction. The findings in this study provide initial support for internalized stigma variables (IWB, body surveillance, and body shame) related to ED pathology in a transdiagnostic clinical eating disorder sample across the weight spectrum. Results suggest that further examination of internalized stigma is needed within ED treatment.
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Using structural equation modeling to understand family and psychological factors of childhood obesity: from socioeconomic disadvantage to loss of control eating. Eat Weight Disord 2022; 27:1809-1819. [PMID: 34731454 DOI: 10.1007/s40519-021-01323-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 06/17/2021] [Indexed: 10/19/2022] Open
Abstract
PURPOSE Current study aimed to empirically test the Hemmingsson's theoretical model of childhood obesity which emphasizing the importance of family environment and the emotional distress of parents as influential variables in the emotional distress of the child and subsequent weight gain. This study also tested the hypothesis that the emotional distress of the child triggers a weight gain-inducing behavior (loss of control eating) to suppress negative emotions. METHODS Families of 220 Spanish children participated in the study (28.2% normal, 35.1% overweight and 32.2% obesity), aged between 8 and 12. The evaluation included a clinical interview and a battery of questionnaires. RESULTS Structural equation models were computed according to the steps proposed by theoretical model. Fit indices were acceptable suggesting that the data adequately fit the hypothesized model. Path coefficients in the final model were statistically significant showing a relationship between socioeconomic status, the emotional distress of parents, family environment, the emotional distress of children, loss of control eating and child's BMI Z-score. CONCLUSION Considering this relation between emotional distress and child weight status, childhood obesity intervention programs may benefit from targeting family environment and the potential role that food is playing in the regulation of children's distress. LEVEL OF EVIDENCE Level III: Cohort analytic study.
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Change in weight-based bias over a decade: A longitudinal nationally representative survey. THE LANCET REGIONAL HEALTH - WESTERN PACIFIC 2022; 23:100450. [PMID: 35465043 PMCID: PMC9018381 DOI: 10.1016/j.lanwpc.2022.100450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Cardel MI, Newsome FA, Pearl RL, Ross KM, Dillard JR, Miller DR, Hayes JF, Wilfley D, Keel PK, Dhurandhar EJ, Balantekin KN. Patient-Centered Care for Obesity: How Health Care Providers Can Treat Obesity While Actively Addressing Weight Stigma and Eating Disorder Risk. J Acad Nutr Diet 2022; 122:1089-1098. [PMID: 35033698 PMCID: PMC10056599 DOI: 10.1016/j.jand.2022.01.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 11/10/2021] [Accepted: 01/11/2022] [Indexed: 02/01/2023]
Affiliation(s)
- Michelle I Cardel
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL; WW International, Inc., New York, NY.
| | - Faith A Newsome
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL
| | - Rebecca L Pearl
- Department of Clinical and Health Psychology, University of Florida College of Public Health and Health Professions, Gainesville, FL
| | - Kathryn M Ross
- Department of Clinical and Health Psychology, University of Florida College of Public Health and Health Professions, Gainesville, FL
| | - Julia R Dillard
- University of Toledo, College of Medicine and Life Sciences, Toledo, OH
| | - Darci R Miller
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL
| | - Jacqueline F Hayes
- Weight Control and Diabetes Research Center at the Miriam Hospital and Department of Psychiatry and Human Behavior, Brown University, Providence, RI
| | - Denise Wilfley
- Washington University in St Louis, College of Medicine, St Louis, MO
| | - Pamela K Keel
- Department of Psychology, Florida State University, Tallahassee, FL
| | | | - Katherine N Balantekin
- Department of Exercise and Nutrition Sciences, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY
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48
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Genetically-predicted trait-BMI, everyday discrimination and life satisfaction among older U.S. adults. ADAPTIVE HUMAN BEHAVIOR AND PHYSIOLOGY 2022. [DOI: 10.1007/s40750-022-00189-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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49
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Rodgers RF, Fischer LE, Laveway K, Laws K, Bui E. Fear of fatness and desire for thinness as distinct experiences: A qualitative exploration. Int J Eat Disord 2022; 55:530-540. [PMID: 35150010 DOI: 10.1002/eat.23689] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 01/27/2022] [Accepted: 01/28/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The pursuit of thinness and fear of gaining weight have been found to play an important role in eating disorder symptomatology. While these dimensions have typically been considered conjointly, emerging evidence suggests they may be distinct dimensions. The aim of this study was to explore the subjective experiences of fear of fatness and drive for thinness in young women with body image concerns. METHOD Young women endorsing weight concerns (N = 29, mean age = 20.86, SD = 2.70 years) were interviewed and asked to describe an experience of fear of fat and drive for thinness, respectively. RESULTS Qualitative analysis was conducted and identified four themes: (1) precipitating events; (2) physiological, emotional, cognitive, and proprioceptive experiences; (3) coping strategies; and (4) sociocultural influences. While similarities emerged, the experiences of fear of fatness, and of drive for thinness also evidenced clear differences situating the former in the context of fear-based avoidance patterns, and the latter in approach-based reward models. DISCUSSION These findings provide additional support for the usefulness of considering fear of fat and drive for thinness as distinct constructs. Further research examining the contributions of each of these constructs to eating pathology is warranted.
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Affiliation(s)
- Rachel F Rodgers
- APPEAR, Department of Applied Psychology, Northeastern University, Boston, Massachusetts, USA.,Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, CHRU Montpellier, Montpellier, France
| | - Laura E Fischer
- APPEAR, Department of Applied Psychology, Northeastern University, Boston, Massachusetts, USA
| | - Katherine Laveway
- APPEAR, Department of Applied Psychology, Northeastern University, Boston, Massachusetts, USA
| | - Kristen Laws
- APPEAR, Department of Applied Psychology, Northeastern University, Boston, Massachusetts, USA
| | - Eric Bui
- Department of Psychiatry, Caen University Hospital & Caen University, Caen, France.,Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
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50
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Crockett KB, Borgatti A, Tan F, Tang Z, Dutton G. Weight Discrimination Experienced Prior to Enrolling in a Behavioral Obesity Intervention is Associated with Treatment Response Among Black and White Adults in the Southeastern U.S. Int J Behav Med 2022; 29:152-159. [PMID: 34341957 PMCID: PMC9125874 DOI: 10.1007/s12529-021-10009-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The current study evaluated the associations between history of weight discrimination and race on pre-treatment depressive symptoms, treatment session attendance, and weight loss among Black and White adults enrolled in a 16-week obesity intervention. METHODS Participants (N = 271; mean BMI = 35.7 kg/m2; 59% Black; 92% women) reported prior experiences of weight discrimination and completed the Center for Epidemiological Studies Depression (CES-D) Scale at baseline. Weekly attendance at group sessions was recorded, and weight was measured at baseline and post-treatment. All models adjusted for baseline BMI, age, and sex. RESULTS Participants with a history of weight discrimination scored 2.4 points higher on the CES-D (B = 2.432, p = .012) and lost 2% less weight relative to those without weight discrimination (B = 0.023, p = .002). Race modified the association between weight discrimination and treatment session attendance, such that Black individuals attended fewer sessions if they had prior experience of weight discrimination, but prior weight discrimination was not significantly associated with treatment attendance among White individuals. CONCLUSION Weight discrimination is associated with pre-treatment depressive symptoms and may hinder weight loss regardless of race. Black individuals may attend fewer weight loss treatment sessions if they have prior experience of weight discrimination.
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Affiliation(s)
- Kaylee B Crockett
- Department of Family and Community Medicine, School of Medicine, University of Alabama At Birmingham, Birmingham, AL, USA.
| | - Alena Borgatti
- Division of Preventive Medicine, School of Medicine, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Fei Tan
- Department of Mathematical Sciences, School of Science, Indiana University - Purdue University Indianapolis, IN, Indianapolis, USA
| | - Ziting Tang
- Department of Mathematical Sciences, School of Science, Indiana University - Purdue University Indianapolis, IN, Indianapolis, USA
| | - Gareth Dutton
- Division of Preventive Medicine, School of Medicine, University of Alabama At Birmingham, Birmingham, AL, USA
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