The Stress of Advancement: A Nurse Practitioner's Exploration in Providing Culturally Competent Obesity Prevention Counseling in Black Women

BACKGROUND

Black women are diagnosed, disabled, and die from obesity and associated chronic diseases at higher rates than any other sex or race. Advanced practice registered nurses (APRN) can potentially improve culturally relevant health education and counseling by using health literacy communication tools.

OBJECTIVE

Explore individualized barriers and APRNs' role in providing obesity prevention education and counseling by assessing the efficacy of the Teach-Back Method (TBM) to understand health habits and attitudes.

METHODS

Black women aged 18-45, previously diagnosed as overweight or obese, and identified with perceived barriers were recruited from a predominantly Black church in Atlanta. They engaged in weekly, 1-hour educational sessions via Zoom, addressing four common barriers identified in the literature. Sessions ended with a 5-10 minute Teach-Back session. Pre- and post-intervention Readiness to Change Questionnaire (RCQ) were completed. Descriptive statistics and quantitative data from surveys and pre- and post-RCQ were analyzed.

RESULTS

Twenty women completed the intervention. Paired sample t-test revealed no statistical significance or correlation between pre- and post-RCQ scores after using TBM in educational sessions. However, Pearson's correlation showed positive associations between elevated body mass index levels as one advances their education and annual income, with a p-value of 0.05.

DISCUSSION

Increased rates of obesity are experienced despite higher educational attainment or pay. Stress and high-coping mechanisms contributed to disordered eating, decreased physical activity engagement, and decreased motivation toward habit change. Clinicians should be held accountable for delivering culturally sensitive care using the TBM, addressing social determinants of health, performing routine stress assessments, and checking their implicit biases.

The need for more inclusive measurement to advance equity in eating disorders prevention

Eating disorder (ED) research and practice have been shaped by prevailing stereotypes about who EDs are most likely to affect. Subsequently, the field has prioritized the needs and concerns of affluent, cisgender, heterosexual, white girls and women to the exclusion of others, especially people marginalized based on their race, ethnicity, sexual orientation, and/or gender identity. However, EDs exist across diverse groups and actually occur with elevated prevalence in several marginalized groups. Growing research points to differences in the drivers of EDs in such groups (e.g. desire to attain the curvy rather than thin ideal; dietary restraint due to food insecurity rather than weight/shape concerns), yet tools typically used for screening and intervention evaluation do not capture eating pathology driven by such factors. In this commentary, we describe gaps in existing ED assessment tools and argue these gaps likely underestimate EDs among marginalized groups, bias who is invited, participates in, and benefits from ED prevention programs, and obscure potential group differences in the efficacy of such programs. We also discuss the potential of these ramifications to exacerbate inequities in EDs. Finally, we outline recommendations to overcome existing gaps in measurement and, consequently, advance equity in the realm of ED prevention.

"Whatever I said didn't register with her": medical fatphobia and interactional and relational disconnect in healthcare encounters

Introduction

This article focuses on medical fatphobia as a specific phenomenon structuring interactions between patients and healthcare practitioners. Throughout the article, we use 'fat' and 'fatphobia' as the preferred terms in the body positivity and fat acceptance communities. It is well documented that 'fat' people frequently experience negative and highly stigmatising healthcare encounters where weight is disproportionately centred and over-attributed as a cause of ill-health. This can compound and worsen disordered eating, trigger mental health problems, and lead to healthcare avoidance. Although the regularity and risks of these weight-focused encounters are well established, there does not yet exist a coherent theoretical framework for understanding such discriminatory practises.

Methods

In this article, we draw on the experiences of 15 fat women who are members of the Health at Every Size (HAES) online community to explore how they perceive their fatness impacting medical encounters.

Results and discussion

Through these data and specifically drawing on the framework of 'cultural health capital,' we suggest that given the deep purchase of cultural tropes surrounding it, fatness is perceived to embody and therefore confer on patients' assumptions of low cultural health capital. We argue that ubiquitously characteristic of medical fatphobia is what we call an 'interactional and relational disconnect' between fat patients and healthcare practitioners. We suggest that this disconnect structures fatphobic interactions by over-attributing fatness as the underlying cause of medical problems, which entrenches patient and practitioner ambivalence because of a lack of joint decision-making. We argue that interactional and relational disconnect is produced by, sustained by, and reproduces asymmetric power relations between patients and practitioners. While we demonstrate that patients develop tactics to mitigate and manage fatphobia in healthcare encounters, the persistent interactional asymmetry between doctors and patients means these attempts often fail. We conclude with a plea for sociology to take medical fatphobia seriously as a form of intersectional systemic discrimination. While movements like HAES, fat positivity, and body acceptance create kinship and support fat patients with self-advocacy in healthcare interactions, we suggest that systemic rather than individual change is necessary for effective healthcare inclusion and interaction.

Racializing Motherhood and Maternity Care in News Representations of Breastfeeding

Racial inequalities in breastfeeding have been a U.S. national concern, prompting health science research and public discourse. Social science research reveals structural causes, including racism in labor conditions, maternity care practices, and lactation support. Yet research shows that popular and health science discourses disproportionately focus on individual and community factors, blaming Black women and communities for unequal breastfeeding rates. This study examines how scientific reports are communicated to the public through a critical analysis of 104 U.S. news articles reporting research on racial disparities in breastfeeding. Findings show that articles acknowledge unequal treatment within maternity care but justify it by presenting Black patients as overburdening the maternity care systems they use due to low socioeconomic status, welfare dependency, poor family support, and poor health. Through these representations, articles co-construct racialized motherhood and maternity care systems in ways that hide manifestations of obstetric racism and combat social support for systemic change.

Racial and Ethnic Disparities in Weight Loss Behaviors Among US College Students

Purpose

Weight loss behaviors are prevalent among college students and are associated with adverse physical and psychological outcomes, such as an elevated risk of developing an eating disorder. While cross-ethnic differences have been reported, no consistent pattern has emerged. The purpose of this study was to examine racial and ethnic differences in weight loss behaviors among female and male college students.

Patients and Methods

The American College Health Association-National College Health Assessment (ACHA-NCHA) II-C survey data from the collection periods from 2015 to 2019 was used. A total of 426,425 students participated in the survey. Most participants were White (60%) and female (68.5%). Information on students' age, body mass index (BMI), and self-rated health was also collected. Logistic regression analyses were performed to determine cross-ethnic differences in weight loss methods among female and male students.

Results

Students' weight loss behaviors were assessed and included dieting, exercising, vomiting or taking laxatives, and the use of diet pills in the past 30 days. More than half of the participants attempted to lose weight through exercise (53.5%), and 40.3% of students dieted to lose weight in the past month. Purging and the use of diet pills were endorsed by 2.9% and 2.8% of the participants, respectively. With few exceptions, male students from racial and ethnic minority backgrounds were more likely to engage in extreme weight control practices (ie, vomiting or taking laxatives, taking diet pills) than White male students, while female students from racial and ethnic minority backgrounds were less likely to use diet and exercise as weight loss methods than White female students. For all outcomes, Biracial/Multiracial and Hispanic/Latino male students were more likely to attempt weight loss than White male students. Biracial/Multiracial female students more frequently endorsed extreme weight control behaviors than White female students.

Conclusion

The results of the present study add to the growing body of literature on the relationship between race and ethnicity and weight loss behaviors. The findings indicate the need for tailored educational and intervention programs on college campuses.

Dress codes written for dietetics education programs: A Foucauldian discourse analysis

Organized in the US in 1917, dietetics emerged from the discipline of home economics as an “acceptable” area of study for women. Since its inception, dietetics has lacked diversity; most dietetics professionals identify as white, cisgender, heterosexual, middle to upper-middle-class women. In the supervised practice setting, interns are expected to dress “professionally” and follow health/safety protocols. Given the field’s history, it is reasonable to suspect that dress codes—rules/expectations regarding what employees/participants can/cannot wear—for dietetics programs may be problematic. To explore this, we conducted a discourse analysis using a Foucauldian feminist approach, drawing on the notion of governmentality. Eighty-five dietetics dress codes, supplemented with survey questions, from US-based accredited dietetics education programs were analyzed. Three primary discursive effects were identified: “Invisibilizing” informs dietetics students/interns how to be professional and modest. “Protecting” highlights dress to promote health and safety. “Normalizing” privileges conforming to thin, cisgender, white European women of higher SES. These findings show how the dress codes reify a “model” dietitian and privilege/oppress/discipline some bodies over others, supporting criticisms of dietetics dress codes as discriminatory and oppressing/privileging select societal groups. Recommendations are provided to address biases and prevent dress codes from negatively impacting diversity/inclusion in the profession.

Truer Facts Through Stronger Values: Confronting Science's Sociopolitical Realities

Assaults on science have led scientists to demand "politics-free/values-free" science that safeguards science against error by grounding it in "politically neutral" evidence. Considering racial disparities in lead poisoning, HIV/AIDS, and COVID-19, we show the solution is doomed. Politically charged beliefs are essential for assessing public-health research; thus, the beliefs' truth affects the research's accuracy. However, science's sociopolitical uses systematically distort politically charged beliefs. Since errors assimilate into our scientific corpus and inform new hypotheses, scientists need accurate sociopolitical theories of distorting forces to identify errors. Analyzing Black-Panther opposition to violence research, we argue since racial disparities structure society and science has been distorted to buttress racial inequities, knowledgeable anti-racist scientists exert corrective forces on research. They hold accurate politically charged beliefs about sociopolitical forces shaping science and health, and are committed to eradicating distortions. Thus, rather than quarantining politically charged beliefs, scientists should sharpen their sociopolitical theories and normative commitments.

Body image and internalization of appearance ideals in Black women: An update and call for culturally-sensitive research

Extant research on body image supports sociocultural theories emphasizing the internalization of societal pressures to attain the thin-ideal, as well as other White or Eurocentric ideals that are predominant in mainstream media. While earlier research suggests that Black women are less likely to report body dissatisfaction and thin-ideal internalization compared to women of other racial backgrounds, recent studies argue that most measures of body image and appearance ideals may not be accurate assessments of body dissatisfaction for this population. In this paper, we summarize the literature over the past two decades on body image and appearance ideals among cisgender Black girls and women and discuss the applications of well-established sociocultural theories of body dissatisfaction. We additionally highlight existing gaps in culturally-sensitive theory and assessment tools and consider the benefits of applying intersectionality-informed research. We lastly propose future directions in research, assessment, and intervention to develop more culturally-sensitive approaches to identifying, assessing, and addressing body dissatisfaction among Black girls and women. This paper encourages researchers to apply culturally-sensitive and intersectionality-informed theory to improve efforts in assessing early warning signs of body dissatisfaction and developing effective interventions for this population.

"That chart ain't for us": How Black women understand "obesity," health, and physical activity

In this article, we use qualitative methodology to explore how eight physically active Black women, who self-identify as "obese," understand and experience health and physical activity, as well as how they position themselves in relation to discourses pertaining to "obesity" and Black femininity. Drawing on Foucauldian-informed critical obesity scholarship and Black feminist thought, we explore the ways in which physically active Black women concurrently resist, reproduce, and navigate racialized and gendered obesity discourse. Our findings advance critical obesity scholarship as we indicate that participants simultaneously adapt to, negotiate, and resist obesity discourse by re-defining health, questioning the BMI, and centering their desire for corporeal "thickness" as critical to their identity as Black women.

‘Mind Your Business and Leave My Rolls Alone’: A Case Study of Fat Black Women Runners’ Decolonial Resistance

The Black female body has been vilified, surveilled, and viewed as ‘obese’ and irresponsible for centuries in Western societies. For just as long, some Black women have resisted their mischaracterizations. Instead they have embraced a ‘fat’ identity. But little research has demonstrated how Black fat women participate in sport. The purpose of this study is to show how Black fat women who run use social media to unapologetically celebrate Blackness and fatness. This research uses a case-study approach to illuminate a broader phenomenon of decolonial resistance through running. In addition to analysis of websites, blogs, and news articles devoted to Black women’s running, we discuss the (social) media content of two specific runners: Mirna Valerio and Latoya Shauntay Snell. We performed a critical discourse analysis on 14 media offerings from the two runners, including websites, Twitter pages, and blogs collected over a five-month period from September 2020–January 2021. The analysis examined how they represent themselves and their communities and how they comment on issues of anti-fat bias, neoliberal capitalism, ableist sexism, and white supremacy, some of the pillars of colonialism. Whereas running is often positioned as a weight-loss-focused and white-dominated colonial project, through their very presence and use of strategic communication to amplify their experiences and build community, these runners show how being a Black fat female athlete is an act of decolonial resistance. This study offers a unique sporting example of how fat women challenge obesity discourses and cultural invisibility and how Black athletes communicate anti-racist, decolonial principles.

Embodied Resistance: Multiracial Identity, Gender, and the Body

This article explores the importance of the physical body in the development of gendered racial and ethnic identities through in-depth semi-structured interviews with 11 multiracial/multiethnic women. From a critical mixed race and critical feminist perspective, I argue that the development of an embodied and gendered multiracial and multiethnic identity is a path to questioning and resisting the dominant monoracial order in the United States. Interviews reveal that respondents develop these embodied identities both through understandings of themselves as gendered and raced subjects and through relationships with monoracial individuals. The process by which these women understand their physical bodies as multiracial subjects illustrates a critical embodied component of the social construction of race and ethnicity in the United States.

Determinants of support for government involvement in obesity control among American adults

Obesity takes a substantial toll on society as a whole. Obesity and its health-related complications contribute significantly to healthcare costs and negatively affects almost every aspect of human life. It is therefore reasonable for the government to be involved in finding solutions to control the epidemic. This article examined factors that influence support for government intervention in the obesity epidemic in the United States. We used data from Obesity in the United States: Public Perceptions, a survey of a nationally representative sample of American adults. We conducted OLS regression analysis, to understand how three main covariates that described beliefs about causes of obesity and a series of controls impact support for government intervention in obesity control. There was a significant negative relationship between support for government intervention and beliefs about causes of obesity. Also, political ideology and party affiliation significantly influenced support for government intervention. For instance, while Democrats were more supportive of government interventions to control obesity, Republicans were not supportive of such intervention. Additionally, race and environmental characteristics of place of residence significantly influenced support for government intervention. Further, there were significant joint effects of political affiliation, race, and weight status on support for government intervention. Unlike previous studies, we find that one of the important factors that drive people to either support or abhor government intervention is the perception of what causes obesity. It is important that public health officials and other stakeholders understand the intricacies of public support for obesity control.

The Supplemental Nutrition Assistance Program and Child Weight Status: A Review

CONTEXT

The Supplemental Nutrition Assistance Program (SNAP) is a food assistance program that helps Americans afford a healthy diet. However, its influence on children's weight status is unclear. This review examined the evidence of the relationship between SNAP participation and child weight.

EVIDENCE ACQUISITION

The following databases were searched: PubMed, EconLit, Web of Science, and the U.S. Department of Agriculture Economic Research Service. The last search was performed in October 2018. This systematic review gives a narrative synthesis of included studies.

EVIDENCE SYNTHESIS

Twenty-three studies that examined the weight outcomes of children aged 2-18 years and SNAP participation were included. Eleven studies found no significant relationship between SNAP and child weight outcomes. Nine found that SNAP participation was associated with increased weight outcomes in certain subpopulations, and four found that SNAP was linked to a predicted decrease in weight outcomes in some subpopulations. However, many of these studies did not address a key methodologic challenge: self-selection. Of those that did, five found that SNAP participation was associated with an increased risk of being overweight and elevated weight in certain subpopulations.

CONCLUSIONS

SNAP participation may help boys maintain a healthy body weight but can be a contributing factor in being overweight or obese in girls who are long-term participants, or who are already overweight. Food security and participation in multiple food assistance programs may be important modifiers. These findings are relevant to policymakers who are considering reducing SNAP funding or restructuring the program. Further research that utilizes strong designs is needed.

Microaggressions, Discrimination, and Phenotype among African Americans: A Latent Class Analysis of the Impact of Skin Tone and BMI

Data from the 2001-2003National Survey of American Life are used to investigate the effects of phenotype on everyday experiences with discrimination among African Americans (N=3343). Latent class analysis is used to identify four classes of discriminatory treatment: 1) low levels of discrimination, 2) disrespect and condescension, 3) character-based discrimination, and 4) high levels of discrimination. We then employ latent class multinomial logistic regression to evaluate the association between skin tone and body weight and these four classes of discrimination. Designating the low level discrimination class as the reference group, findings revealed that respondents with darker skin were more likely to be classified into the disrespect/condescension and the high level microaggression types. BMI was unrelated to the discrimination type, although there was a significant interaction effect between gender and BMI. BMI was strongly and positively associated with membership in the disrespect and condescension type among men but not among women. These findings indicate that skin tone and body weight are two phenotypic characteristics that influence the type and frequency of discrimination experienced by African Americans.