Weight bias: new science on an significant social problem. Introduction

Anti-fat attitudes of Nutrition undergraduates in Brazil toward individuals with obesity

Abstract Obesity-related prejudice and discrimination may have a source in health professionals and students. The objective was to assess anti-fat attitudes among Brazilian nutrition undergraduates who reported demographic data, weight, height and responded the Antifat Attitudes Test (AFAT) and the Brazilian Silhouette Scales to assess body image satisfaction and perception. Total and subscales of AFAT scores were compared among categories using the Mann-Whitney U test. Associations of participants’ characteristics with the AFAT were analyzed using multiple linear regression. Total AFAT score was positively associated with male sex (ß: .13; p < .001), age (ß: .06; p < .001), educational institution outside capital (ß: .03; p < .05), private institutions (ß: .08; p < .001); and negatively associated with income (ß: -.05; p = .006), participants who perceived themselves with increased BMI (ß: -.15; p < .001) and those at the third year of course (ß: -.05; p = .041). Subscales scores were positively associated with male sex and age; and negatively associated with those who perceived themselves heavier. They have anti-fat attitudes especially if they were man, older, from private institutions, are at the beginning of the course, and have lower household income - and less weight bias if they perceived with increased BMI.

Are skin color and body mass index associated with social network structure? Findings from a male sex market study

Objectives: There is a growing burden of HIV and sex-related diseases in South Asia and India. Sociological research illustrates that key axes of social stratification, such as race and ethnicity, affect social network structure which, in turn, impacts sexual health and wellbeing. Research on networks has increasingly begun to examine the ways in which networks drive or harness sexual behaviors, but has largely neglected the influence of culture and cultural markers in this continuum. Furthermore, much of the existing scholarship has been conducted in the U.S. or in Western contexts.Design: As part of an exploratory effort, we examined how skin color and body mass index (BMI) affected networks among 206 men who have with men (MSM) frequenting sex markets in Hyderabad, India. A novel phone-based network generation method of respondent-driven sampling was used for recruitment. In assessing how skin color and BMI drive these structures, we also compared how these factors contribute to networks relative to two more commonly referenced markers of social difference among Indians, caste and religion.Results: Our findings suggest that skin color and BMI contribute significantly more to network structure than do caste and religion.Conclusions: These findings tentatively illuminate the importance of individual-level heterogeneity in bodily attributes, factors which are seldom considered in conventional approaches to researching how social stratification and health inequalities are animated during the formation of networks.

Designing, implementing and evaluating an educational intervention targeting weight bias and fat stereotyping

Weight bias directed at individuals at a higher weight leaves them feeling victimised and judged. When possessed by health professionals, stigmatising attitudes may compromise professionalism and quality of care or education provided. An intervention study was conducted in the higher education setting (n = 124), through tailored course design and delivery. The intervention was embedded into a health elective that pre-service health professionals were enrolled in. Attitudes to weight and knowledge of nutrition were targeted simultaneously. Surveys conducted pre- and post-intervention revealed moderate success in achieving study aims of improving nutrition knowledge and decreasing bias. Focus group analyses supported the quantitative findings.

Weight bias in nutritional practice: a study with nutrition students

Obesity is associated with psychosocial problems like stigma, discrimination, and bias. Studies have found that nutritionists and nutrition students display negative attitudes and biases toward obese individuals. This study examined the existence of nutrition students' bias toward obese individuals. The students answered questionnaires by completing on-line forms with demographic data and self-reported weight and height and were assigned to one of four randomly selected hypothetical cases of patients referred to a nutritionist after receiving a diagnosis of lactose intolerance (normal weight man; normal weight woman; obese man; and obese woman). Except for weight, body mass index (BMI), and daily energy intake, all information on diet, habits, and health conditions were identical for profiles of the same sex. The questionnaire included questions on the indication of procedures and approaches during the consultation, consultation time, counseling strategies, dietary and health evaluation, and students' affective and behavioral reactions. Three hundred and thirty-five students participated, mostly women, with mean BMI of 23kg/m². Patient's weight influenced consultation time and students' perceptions and treatment approaches and strategies. The study revealed biases and negative attitudes mainly involving the students' perceptions and reactions to obese patients, and obese women generally received the worse evaluations.

Internalized weight stigma moderates eating behavior outcomes in women with high BMI participating in a healthy living program

Weight stigma is a significant socio-structural barrier to reducing health disparities and improving quality of life for higher weight individuals. The aim of this study was to examine the impact of internalized weight stigma on eating behaviors after participating in a randomized controlled trial comparing the health benefits of a weight-neutral program to a conventional weight-management program for 80 community women with high body mass index (BMI > 30, age range: 30-45). Programs involved 6 months of facilitator-guided weekly group meetings using structured manuals. Assessments occurred at baseline, post-intervention (6 months), and 24-months post-randomization. Eating behavior outcome measurements included the Eating Disorder Examination-Questionnaire and the Intuitive Eating Scale. Intention-to-treat linear mixed models were used to test for higher-order interactions between internalized weight stigma, group, and time. Findings revealed significant 3-way and 2-way interactions between internalized weight stigma, group, and time for disordered and adaptive eating behaviors, respectively. Only weight-neutral program participants with low internalized weight stigma improved global disordered eating scores. Participants from both programs with low internalized weight stigma improved adaptive eating at 6 months, but only weight-neutral program participants maintained changes at follow-up. Participants with high internalized weight stigma demonstrated no changes in disordered and adaptive eating, regardless of program. In order to enhance the overall benefit from weight-neutral approaches, these findings underscore the need to incorporate more innovative and direct methods to reduce internalized weight stigma for women with high BMI.

Predicting anti-fat attitudes: individual differences based on actual and perceived body size, weight importance, entity mindset, and ethnicity

The purpose of the current study was to examine the relative impact of actual and perceived weight, weight importance, entity mindset, and ethnicity on anti-fat attitudes as well as to examine whether certain variables play the role of mediator. Participants included a multiethnic U.S. sample of 923 female undergraduates who completed a series of measures online. Lower BMI, higher perceived weight, higher importance of weight, endorsement of an entity mindset, and identification as White as compared to Black, Hispanic, or Asian predicted higher overall anti-fat attitudes. Examination of the individual Antifat Attitudes Questionnaire subscales (i.e. dislike, fear of fat, and willpower) using Relative Weight Analysis suggested that weight importance is an important predictor of multiple aspects of anti-fat attitudes. In addition, weight importance mediated the relationship between perceived weight and fear of fat as well as the relationship between ethnicity and dislike. Implications of findings and future research directions are discussed.

Lifestyle therapy for the treatment of youth with type 2 diabetes

Type 2 diabetes (T2D) in youth is a relatively novel condition facing paediatric health care providers. Few experimental trials exist to guide clinical management in this population. Supporting and prescribing modifiable lifestyle behaviours is cornerstone in the management of T2D in adults. Clinical trials in obese adolescents suggest that intensive lifestyle interventions that include both dietary changes and increased physical activity elicit clinically meaningful reductions in weight and improve cardiovascular risk profiles. Observational studies in youth with T2D suggest that better diet quality and increased physical activity are associated with better metabolic control; however, the limited experimental data available does not support these observations. Trials evaluating lifestyle monotherapy for the treatment of hyperglycaemia in youth with T2D do not exist, and the only study evaluating combined lifestyle and pharmacologic therapy did not show additional benefit over pharmacologic treatment with metformin alone. Physiological and psychosocial differences between youth and adults with T2D likely contribute to the differences in the effectiveness of lifestyle therapy for improving glycaemic control. The current review describes these topics in detail and provides recommendations for paediatric health care providers for the promotion of lifestyle therapy for the management of hyperglycaemia and cardiovascular risk factors for youth with T2DM.

The intersectionality of discrimination attributes and bullying among youth: an applied latent class analysis

Discrimination is commonly experienced among adolescents. However, little is known about the intersection of multiple attributes of discrimination and bullying. We used a latent class analysis (LCA) to illustrate the intersections of discrimination attributes and bullying, and to assess the associations of LCA membership to depressive symptoms, deliberate self harm and suicidal ideation among a sample of ethnically diverse adolescents. The data come from the 2006 Boston Youth Survey where students were asked whether they had experienced discrimination based on four attributes: race/ethnicity, immigration status, perceived sexual orientation and weight. They were also asked whether they had been bullied or assaulted for these attributes. A total of 965 (78%) students contributed to the LCA analytic sample (45% Non-Hispanic Black, 29% Hispanic, 58% Female). The LCA revealed that a 4-class solution had adequate relative and absolute fit. The 4-classes were characterized as: low discrimination (51%); racial discrimination (33%); sexual orientation discrimination (7%); racial and weight discrimination with high bullying (intersectional class) (7%). In multivariate models, compared to the low discrimination class, individuals in the sexual orientation discrimination class and the intersectional class had higher odds of engaging in deliberate self-harm. Students in the intersectional class also had higher odds of suicidal ideation. All three discrimination latent classes had significantly higher depressive symptoms compared to the low discrimination class. Multiple attributes of discrimination and bullying co-occur among adolescents. Research should consider the co-occurrence of bullying and discrimination.

Obesity in the news: do photographic images of obese persons influence antifat attitudes?

News coverage of obesity has increased dramatically in recent years, and research shows that media content may contribute to negative public attitudes toward obese people. However, no work has assessed whether photographic portrayals of obese people that accompany news stories affect attitudes. In the present study, the authors used a randomized experimental design to test whether viewing photographic portrayals of an obese person in a stereotypical or unflattering way (versus a nonstereotypical or flattering portrayal) could increase negative attitudes about obesity, even when the content of an accompanying news story is neutral. The authors randomly assigned 188 adult participants to read a neutral news story about the prevalence of obesity that was paired with 1 of 4 photographic portrayals of an obese adult (or no photograph). The authors subsequently assessed attitudes toward obese people using the Fat Phobia Scale. Participants in all conditions expressed a moderate level of fat phobia (M = 3.83, SD = 0.58). Results indicated that participants who viewed the negative photographs expressed more negative attitudes toward obese people than did those who viewed the positive photographs. Implications of these findings for the media are discussed, with emphasis on increasing awareness of weight bias in health communication and journalistic news reporting.

Parents and vehicle purchases for their children: a surprising source of weight bias

According to current estimates, 68% of the population in United States is considered either overweight or obese. Despite its relative frequency, prejudice and discrimination against overweight and obese Americans is a common occurrence. This study seeks to build on previous findings that overweight individuals are more likely than their skinnier peers to rely on themselves, rather than family, to fund their education. We examined whether this trend continued in car-buying practices. Results suggest that overweight and obese individuals differentially rely on their own sources of income to finance a car, even after controlling for socioeconomic differences. Possible explanations and implications are discussed.

Obesity as a determinant of two forms of bullying in Ontario youth: a short report

OBJECTIVE

Obesity can have negative effects in terms of stigma and discriminatory behavior. Past cross-sectional analyses have shown that overweight and obese youths are more likely to be involved in bullying. Here, we examine such relationships in a longitudinal analysis. Study outcomes were self-reports of: i) physical bullying victimization and perpetration and ii) relational bullying victimization and perpetration.

METHODS

Participants were administered the Health Behaviour in School-Age Children Survey in 2006 and then again in 2007, and included 1,738 youths from 17 Ontario high schools. Relationships between adiposity and each of the four forms of bullying were evaluated using multi-level analyses.

RESULTS

Excess adiposity was shown to precede bullying involvement in this study. Obese and overweight males reported 2-fold increases in both physical and relational victimization, while obese females reported 3-fold increases in perpetration of relational bullying. Among those free of bullying at baseline (2006), significant increases in perpetration of relational bullying were reported by obese females in 2007 relative to normal-weight females (14.8 vs. 3.8% among normal-weight girls; p = 0.02).

CONCLUSIONS

Findings are congruent with previous cross-sectional studies and confirm that obese youths are at increased risk of social consequences attributable to their appearance.

Obesity-related disability: key factors identified by the International Classification of Functioning, Disability and Health

PURPOSE

To identify obese patients' disability features considering the level of body impairments, activity limitations and participation restrictions in relation to environmental factors' effect.

METHOD

Adult obese inpatients (BMI > 35) were enrolled and were administered a set of 166 ICF categories. Count-based indexes were developed for each ICF component: correlations and regression on performance and capacity indexes were performed.

RESULTS

Fifty-one patients (62.7% females, mean age 38.1) entered in the study. Description of ICF-based disability components is reported. Capacity is better correlated with body functions (r = 0.619, P < 0.01) and body structures (r = 0.375, P < 0.01) than performance; on the contrary, environmental barriers are correlated better with performance (r = 0.531, P < 0.01) than with capacity. Impairments in body functions and environmental barriers are the best predictors of limitations both in capacity and in performance.

CONCLUSIONS

Through this multidisciplinary approach, supported by ICFs biopsychosocial model, we described functioning and disability in obese patients, highlighting the strong effect of body functions' impairments and the limited one of environmental factors. This approach can guide rehabilitation programmes, the promotion of positive health outcomes and the modification of patients' lifestyle, not only intended as an issue of barriers' elimination, but as the activation and maintenance of environmental facilitators.