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Gooey M, Hailu H, Sturgiss E, Advocat J, Bergmeier H, Skouteris H. Preventing childhood obesity in general practice: a qualitative study of GPs, practice nurses, and practice managers. Fam Pract 2024; 41:770-780. [PMID: 38489826 DOI: 10.1093/fampra/cmae013] [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] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND General practitioners (GPs) in Australia have an important role to play in preventing childhood obesity. Activities such as growth monitoring and promotion of healthy behaviours can contribute to obesity prevention efforts; however, the practicalities of how this is done are poorly documented. OBJECTIVES Objectives were to understand current attitudes and practices regarding promoting healthy childhood growth and development and preventing childhood obesity in general practice, and identify practical barriers and enablers to routinely incorporating this into general practice based on the observations and personal experiences of general practice staff. METHODS A descriptive qualitative study was undertaken with Australian general practice staff. Barriers and enablers underwent thematic analysis and mapped to the ecological model. RESULTS Interviews were conducted with 9 GPs, 4 nurses, and 2 practice managers. Participants agreed that growth monitoring and healthy behaviour promotion should be done for children with a healthy weight. However, the thematic analysis indicated that obesity prevention in clinics is not supported well by the broader general practice system, there are complexities associated with obesity prevention discussions, and the COVID-19 pandemic has intensified challenges in general practice. Two themes for obesity prevention enablers were identified; these related to bridging the implementation gap and the need for changes outside the clinic to support behaviour within the clinic. Ecological model mapping implicated multiple ecological levels for each theme. CONCLUSION Childhood obesity prevention through growth monitoring and healthy behaviour promotion is relevant to general practice; however, more support is needed to enable implementation and embed these practices day-to-day.
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Affiliation(s)
- Michelle Gooey
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Haimanot Hailu
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Elizabeth Sturgiss
- School of Primary and Allied Health Care, Monash University, Frankston, Australia
| | - Jenny Advocat
- School of Primary and Allied Health Care, Monash University, Frankston, Australia
| | - Heidi Bergmeier
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Warwick Business School, University of Warwick, Coventry, United Kingdom
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2
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Wagner BE, Cook S. Weight Bias and Stigma in Pediatric Obesity. Pediatr Clin North Am 2024; 71:819-830. [PMID: 39343495 DOI: 10.1016/j.pcl.2024.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/01/2024]
Abstract
Weight stigma is pervasive during childhood and adolescent years. Well-established physical and psychosocial health consequences of weight stigma, like disordered eating behaviors, low self-esteem, and higher depressive symptoms, make it especially harmful during a critical period of development for youth. Lasting negative health impacts of these experiences highlight the importance of addressing weight stigma early on. The pediatric health care setting, both physical and social components, can be one of many sources of weight-stigmatizing experiences for youth. This observation has prompted calls for action in the health care setting to reduce weight biases and stigmatizing behavior among pediatric providers.
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Affiliation(s)
- Brooke E Wagner
- Department of Population Health Sciences, Duke Center for Childhood Obesity Research, Duke University School of Medicine, 215 Morris Street, Durham, NC, USA
| | - Stephen Cook
- Nationwide Children's Hospital, 700 Children's Drive, LA 5F, Columbus, OH, USA.
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3
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Levinson JA, Clifford D, Laing EM, Harris CL, Slagel N, Squires ND, Hunger JM. Weight-Inclusive Approaches to Nutrition and Dietetics: A Needed Paradigm Shift. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2024:S1499-4046(24)00397-X. [PMID: 39217533 DOI: 10.1016/j.jneb.2024.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/12/2024] [Accepted: 07/13/2024] [Indexed: 09/04/2024]
Abstract
This Perspective article encourages the field of nutrition and dietetics to move away from a weight-centric paradigm that emphasizes weight loss and weight management as primary health outcomes. This approach can perpetuate weight stigma, which is associated with poorer health behaviors, poorer mental health, disordered eating, and even increased mortality risk. We propose an alternative approach-adopting a weight-inclusive paradigm-that focuses on providing care across the weight spectrum by centering health behaviors rather than weight. This approach allows individuals of all sizes to have equitable access to high-quality nutrition and dietetics care.
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Affiliation(s)
- Jordan A Levinson
- Department of Psychology, University of California Los Angeles, Los Angeles, CA
| | - Dawn Clifford
- Department of Health Sciences, Northern Arizona University, Flagstaff, AZ
| | - Emma M Laing
- Department of Nutritional Sciences, University of Georgia, Athens, GA
| | - Cristen L Harris
- Department of Epidemiology, University of Washington, Seattle, WA
| | - Nicholas Slagel
- Department of Kinesiology, Nutrition, and Dietetics, University of Northern Colorado, Greeley, CO
| | - Nikole D Squires
- Department of Health Sciences, Northern Arizona University, Flagstaff, AZ
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4
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Obita G, Burns M, Nnyanzi LA, Kuo CH, Barengo NC, Alkhatib A. Childhood obesity and comorbidities-related perspective and experience of parents from Black and Asian minority ethnicities in England: a qualitative study. Front Public Health 2024; 12:1399276. [PMID: 39175897 PMCID: PMC11340680 DOI: 10.3389/fpubh.2024.1399276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 07/23/2024] [Indexed: 08/24/2024] Open
Abstract
Background Preventing childhood obesity and associated comorbidities is often hampered by disproportionate disparity in healthcare provision in minority ethnic populations. This study contextualized factors influencing childhood obesity and related comorbidity from the perspectives and experiences of parents of ethnic minority populations. Methods Following ethical approval, families (n = 180) from ethnic minority populations in the Northeast of England were contacted through flyers, community social groups and online forum. Of the 180 families contacted, 22 expressed interests, of whom 12 parents were eligible to participate in the study, and one family dropped out due to time constraints. Therefore 11 parents from ethnic minority communities living with at least one child with obesity were interviewed. Each family was separately visited at home and took part in a semi-structured interview based on the study's qualitative, descriptive phenomenological design. Nine of the families had one child who was diagnosed with an obesity-related comorbidity (non-alcoholic fatty liver disease, musculoskeletal problems or respiratory disorder). Semi-structured interviews were standardized around parents' perspective and experience on how their children were impacted by obesity and comorbidities, healthcare preventative interventions including lifestyle physical activity and nutrition, and views on tackling obesity impact on their lives. All interviews were analyzed using qualitative thematic analysis. Results Parents' perspectives revealed 11 themes centered around experience of living with a child with obesity, risks, and impact of obesity related Non-Communicable Diseases; and access to support, and barriers unique to minority ethnic groups. Parents revealed social disadvantages, fear of victimization by social services, perceptions on their cultural and religious traditions, and racial stigmatization related to their child's weight. Parents reported closer bonding with their children to protect them from the untoward consequences of overweight, and little awareness of healthcare obesity prevention programs. Work pressure, lack of time, absence of guidance from professionals were seen as barriers to healthy lifestyle, while support from friends and closer family bond in adopting healthy lifestyle behaviors were facilitators. However, there was little awareness or access to current healthcare obesity preventive offerings. Conclusion Minority ethnic communities' perspective on childhood obesity prevention does not match the healthcare system preventative offerings. Community and family-oriented obesity preventative approaches, especially lifestyle interventions are needed beyond those administered by the primary healthcare system.
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Affiliation(s)
- George Obita
- School of Health and Life Sciences, Teesside University, Middlesbrough, United Kingdom
| | - Mark Burns
- James Cook University Hospital, South Tees Hospital Trusts, Middlesbrough, United Kingdom
| | | | - Chia-Hua Kuo
- Institute of Sport Science, University of Taipei, Taipei, Taiwan
| | - Noël C. Barengo
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, United States
- Escuela Superior de Medicina, Universidad Nacional de Mar del Plata, Mar del Plata, Argentina
| | - Ahmad Alkhatib
- School of Health and Life Sciences, Teesside University, Middlesbrough, United Kingdom
- Institute of Sport Science, University of Taipei, Taipei, Taiwan
- College of Life Sciences, Birmingham City University, Birmingham, United Kingdom
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5
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Bodepudi S, Hinds M, Northam K, Reilly-Harrington NA, Stanford FC. Barriers to Care for Pediatric Patients with Obesity. Life (Basel) 2024; 14:884. [PMID: 39063637 PMCID: PMC11277597 DOI: 10.3390/life14070884] [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: 05/11/2024] [Revised: 06/21/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
This review article emphasizes the challenges pediatric patients face during obesity treatment. Prior research has been compartmentalized, acknowledging that stigma, the ability to implement lifestyle changes, social health determinants, and healthcare accessibility are considerable impediments for obese children. These issues emerge at various levels, including the individual or family, the community and school, and even national policy. This suggests the need for a more comprehensive, team-based approach to tackle pediatric obesity. Understanding these barriers is the first step toward creating effective strategies and solutions to overcome these challenges.
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Affiliation(s)
- Sreevidya Bodepudi
- MGH Weight Center, Massachusetts General Hospital, Boston, MA 02114, USA; (K.N.); (N.A.R.-H.)
- Harvard Medical School, Boston, MA 02115, USA
| | | | - Kayla Northam
- MGH Weight Center, Massachusetts General Hospital, Boston, MA 02114, USA; (K.N.); (N.A.R.-H.)
| | - Noreen A. Reilly-Harrington
- MGH Weight Center, Massachusetts General Hospital, Boston, MA 02114, USA; (K.N.); (N.A.R.-H.)
- Harvard Medical School, Boston, MA 02115, USA
| | - Fatima Cody Stanford
- Harvard Medical School, Boston, MA 02115, USA
- MGH Weight Center, Massachusetts General Hospital, Department of Medicine-Division of Endocrinology-Neuroendocrine, Department of Pediatrics-Division of Endocrinology, Nutrition Obesity Research Center at Harvard (NORCH), Boston, MA 02114, USA
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6
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O'Connor EA, Evans CV, Henninger M, Redmond N, Senger CA. Interventions for Weight Management in Children and Adolescents: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2024; 332:233-248. [PMID: 38888913 DOI: 10.1001/jama.2024.6739] [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] [Indexed: 06/20/2024]
Abstract
Importance Body mass index (BMI) of the 95th or greater percentile for age and sex is common among young people, and its prevalence has increased in recent decades. Objective To examine the benefits and harms of weight management interventions initiated in health care settings among children and adolescents with high BMI. Data Sources MEDLINE via Ovid, PsycINFO via Ovid, and the Cochrane Central Registry of Controlled Trials through January 12, 2023; ongoing surveillance through January 26, 2024. Study Selection English-language studies of weight management interventions (behavioral and pharmacologic, including liraglutide, semaglutide, orlistat, and phentermine/topiramate) among children aged 2 to 18 years with high BMI (eg, ≥85th or ≥95th percentile for age and sex) conducted in or recruited from health care settings. Data Extraction and Synthesis One investigator abstracted data; a second checked for accuracy. Outcomes with sufficient evidence for meta-analysis were pooled using random-effects models. Main Outcomes and Measures BMI and other weight-related outcomes, cardiometabolic measures, quality of life, physical activity, dietary pattern scores, and harms. Results Fifty-eight randomized clinical trials (RCTs) were included (N = 10 143). Behavioral interventions were associated with small reductions in BMI and other weight outcomes after 6 to 12 months (28 RCTs [n = 4494]; mean difference in change between groups, -0.7 [95% CI, -1.0 to -0.3]). Larger effects were seen in interventions with higher contact hours and that offered physical activity sessions. Reporting was sparse for outcomes other than BMI, with few significant findings. Semaglutide and phentermine/topiramate had the largest effects on BMI (eg, 1 RCT [n = 201] for semaglutide; mean difference, -6.0 [95% CI, -7.3 to -4.6]). The very few studies that evaluated outcomes after medication discontinuation showed immediate weight regain. Gastrointestinal adverse effects were common with liraglutide, semaglutide, and orlistat. Serious adverse effects were rare, but no studies had follow-up longer than 17 months. Conclusions and Relevance In the short term, weight management interventions led to lower BMI in children and adolescents, with no evidence of serious harm. Evidence is lacking about how weight management interventions affect BMI beyond 1 year and after medication discontinuation and about longer-term effects on other outcomes.
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Affiliation(s)
- Elizabeth A O'Connor
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Corinne V Evans
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Michelle Henninger
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Nadia Redmond
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Caitlyn A Senger
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
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Papademetriou M, Riehl M, Schulman AR. Stigma, Bias, and the Shortfalls of Body Mass Index: A Reflection on the State of Weight Management. Am J Gastroenterol 2024; 119:1023-1027. [PMID: 38501657 DOI: 10.14309/ajg.0000000000002769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/07/2024] [Indexed: 03/20/2024]
Abstract
Obesity is a complex, multifactorial chronic disease. With the development of novel endoscopic techniques and devices for the treatment of obesity, combined with expanding indications for medications, gastroenterologists are more involved in weight management than ever before. Despite the modern definition of obesity as a disease, weight bias and stigma are pervasive in the medical community and beyond. These sentiments contribute to worse outcomes for patients. Furthermore, body mass index (BMI), which is the primary metric to define obesity, does not always approximate visceral adiposity in all populations. A weight-centric model of health, which relies on BMI, misclassifies individuals who may be metabolically healthy at elevated weights. This review will summarize the history of BMI, highlight the problems that arise with a weight-centric model of health, and propose alternative weight-inclusive frameworks for assessment and intervention.
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Affiliation(s)
- Marianna Papademetriou
- Division of Gastroenterology and Hepatology, Washington DC VA Medical Center, Washington, District of Columbia, USA
| | - Megan Riehl
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA ; and
| | - Allison R Schulman
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA ; and
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
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8
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Lucibello KM, Goldfield GS, Alberga AS, Leatherdale ST, Patte KA. Exploring the association between internalized weight bias and mental health among Canadian adolescents. Pediatr Obes 2024:e13118. [PMID: 38676448 DOI: 10.1111/ijpo.13118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 02/15/2024] [Accepted: 03/03/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Internalized weight bias (IWB) has been identified as a correlate of higher depressive and anxiety symptoms in adolescents with higher weights. However, there has been limited investigation into how IWB relates to positive mental health and whether these associations differ across genders. OBJECTIVES To examine the associations between IWB and mental health (depression, anxiety, flourishing) in adolescents with higher weights, and to test the potential moderating role of gender. METHODS Canadian adolescents with higher weights (N = 7538, 60% boys, 36% girls, 4% gender diverse, ages 12-19) from the COMPASS study completed a survey during the 2021-2022 school year. Data were analysed using generalized linear models. RESULTS Highest IWB and poorest mental health were noted within gender diverse adolescents, followed by girls then boys. Gender moderated the relationship between higher IWB and higher depression, higher anxiety and lower flourishing, with the strongest relationships noted among girls. CONCLUSION IWB interventions should be tailored to gender subgroups that may be particularly vulnerable to maladaptive mental health outcomes associated with IWB. System-level changes that mitigate perpetuation of weight bias and discrimination which lead to IWB are also essential, particularly for girls.
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Affiliation(s)
| | - Gary S Goldfield
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | - Angela S Alberga
- Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, QC, Canada
| | - Scott T Leatherdale
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Karen A Patte
- Department of Health Sciences, Brock University, St. Catharines, ON, Canada
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9
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Newson L, Sides N, Rashidi A. The psychosocial beliefs, experiences and expectations of children living with obesity. Health Expect 2024; 27:e13973. [PMID: 39102658 PMCID: PMC10795089 DOI: 10.1111/hex.13973] [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] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 12/23/2023] [Accepted: 01/03/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND Childhood obesity has been shown to impair psychological health. However, psychological factors are often overlooked in both research evaluations and treatment interventions, and children's perspectives on managing obesity are underexplored. Neglecting psychosocial factors might undermine interventions. This research explored the psychological beliefs, expectations and experiences of children living with obesity (range 7-13) and attending a weight management programme (WMP). METHODS Thirty-four participants (19 females, 15 males, average age 9.5 years) completed a semistructured interview. Recorded interviews were transcribed verbatim and analysed using thematic analysis. RESULTS Four overarching themes were developed: (1) defining health and self-recognition; (2) external influence; feedback, stigma and comparison; (3) recognising emotions and (4) future expectations: obesity is a reality. These themes interact to influence the children's psychosocial status. CONCLUSIONS This study highlights a range of psychosocial and emotional difficulties that children living with obesity experience and suggests that these remain regardless of their attendance at a WMP. Interventions for children living with obesity should address psychosocial factors, including stress management, peer victimisation and handling feedback from others. PATIENT OR PUBLIC CONTRIBUTION As proposed by the two young people acting as patient and public involvement and engagement representatives, the utilisation of scrapbooks as a preinterview tool was particularly helpful in aiding discussion during the interviews. This innovative approach could be considered a valuable methodological technique for investigating sensitive topics with children in future research.
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Affiliation(s)
- Lisa Newson
- School of Psychology, Faculty of HealthLiverpool John Moores UniversityLiverpoolUK
| | | | - Amineh Rashidi
- School of Nursing and MidwiferyEdith Cowan UniversityJoondalupAustralia
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10
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Waldrop SW, Wang D, Kancherla D, Stanford FC. Current status of weight bias and stigma in pediatrics and the need for greater focus on populations at risk. Curr Opin Pediatr 2024; 36:42-48. [PMID: 37965910 PMCID: PMC10873084 DOI: 10.1097/mop.0000000000001305] [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] [Indexed: 11/16/2023]
Abstract
PURPOSE OF REVIEW Obesity is one of the most common pediatric chronic conditions in the United States, affecting approximately 20% of American youth and is more common amongst Black, Latino, and Indigenous and low socioeconomic populations. The condition places children and adolescents at increased risk of physical and mental health conditions partly mediated by the weight bias and stigmatization experienced during the potentially vulnerable periods of childhood and adolescence. RECENT FINDINGS Weight bias and the resulting stigma are pervasive in society. Children have been shown to internalize this bias and its devaluation, which have been shown to contribute to worsening metabolic and mental health outcomes independently. Studies suggest weight stigmatization more adversely affects Black, Latino, and Indigenous children, suggesting the potential for adverse synergistic effects of these historical biases on such youth. SUMMARY Addressing childhood obesity successfully across all racial, ethnic, and socioeconomic lines requires addressing weight bias and stigma. Steps toward this end include collaborative efforts to promote cross-cultural competence and upstander bias education and training for those who care for children, person-centered communication, and a culture of inclusivity across governmental, healthcare, educational, entertainment, and advertising sectors.
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Affiliation(s)
- Stephanie W. Waldrop
- Section on Nutrition Department of Pediatrics, University of Colorado School of Medicine, Nutrition Obesity Research Center at the University of Colorado, Aurora, CO, USA
| | - Daisy Wang
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | | | - Fatima Cody Stanford
- Massachusetts General Hospital, MGH Weight Center, Department of Medicine-Division of Endocrinology-Neuroendocrine, Department of Pediatrics-Division of Endocrinology, Nutrition Obesity Research Center at Harvard (NORCH), Boston, MA, USA
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11
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Dunham M. Obesity bias awareness decreases nursing students' bias toward patients with obesity. Nursing 2024; 54:56-60. [PMID: 38271133 DOI: 10.1097/01.nurse.0000998024.65699.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
PURPOSE To determine if obesity bias scores among nursing students changed after education was delivered and to what degree body mass index (BMI) was associated with a personal experience of bias during a student's healthcare history. METHODS A quantitative, quasi-experimental design was used to analyze sociodemographic information and Implicit Association Test scores of junior, senior, and full-time accelerated coursework track nursing students. RESULTS Generally, obesity bias declined among the group. However, bias increased regarding increasing BMI. CONCLUSION Obesity bias awareness and obesity education can decrease obesity bias among nursing students.
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Affiliation(s)
- Marguerite Dunham
- Marguerite Dunham is an NP and the program coordinator in Bariatric Surgery for Comprehensive Weight Management at Jefferson Health-Abington
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12
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Kotanidou EP, Tsinopoulou VR, Karasogiannidou V, Stabouli S, Sapountzi E, Serbis A, Galli-Tsinopoulou A. Evaluation of Health-Related Quality of Life in Adolescents With Obesity: A Randomized Qualitative Study Among Healthcare Professionals. Cureus 2024; 16:e51928. [PMID: 38333507 PMCID: PMC10851325 DOI: 10.7759/cureus.51928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 02/10/2024] Open
Abstract
Adolescent obesity constitutes a disorder with physical and psychosocial implications. Childhood and adolescent obesity rates are constantly increasing worldwide. Since adolescent obesity is a chronic disease, which is part of noncommunicative degenerative diseases, its holistic approach decisively includes the assessment of its impact on quality of life. The use of the tools Pediatric Quality of Life Inventory 4.0 (PedsQL4.0) and The Impact of Weight on Quality of Life for Kids (IWQOL-Kids), the familiarity of health professionals with them, their applicability, and relevance in clinical practice, are a cornerstone in the promotion of health services in adolescent obesity. The present randomized qualitative study aimed to highlight the attitudes and preferences of pediatricians on the assessment of health-related quality of life (HRQoL), among obese adolescents. The sample consists of 120 pediatricians, randomly selected from the totality of municipality-registered pediatricians (Municipality of Thessaloniki, Greece) who were interviewed in a semi-structured way, regarding their attitudes in the assessment of health-related quality of life, as measured by the PedsQL4.0 and IWQOL-Kids tools. The interviews revealed that most participants gained insight into the HRQoL assessment process during the present study interview with the researchers. Only eight (n=8/120) participants were familiar with the explored tools, PedsQL4.0 and IWQOL-KIDS. The remaining sample (n=112/120) was unfamiliar with both the two questionnaires and their content as well. Among the referred barriers to the usage of the tools, lack of time was stated as the pivotal factor hindering the implementation of the tools in clinical practice. There was no consensus on the preferred questionnaire among the participating healthcare professionals. All participants stated that the use of one or both questionnaires would have added significant value to the support and care of adolescents with obesity. Tools assessing HRQoL present low familiarity among pediatricians in real-world data. Focus on the engagement of the healthcare providers in the evaluation of obesity-related quality of life is unequivocal, in order to improve health care status in adolescents with obesity.
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Affiliation(s)
- Eleni P Kotanidou
- Program of Postgraduate Studies Adolescent Medicine and Adolescent Health Care, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
- 2nd Department of Pediatrics, AHEPA University General Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Vasiliki Rengina Tsinopoulou
- Program of Postgraduate Studies Adolescent Medicine and Adolescent Health Care, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
- 2nd Department of Pediatrics, AHEPA University General Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Vasileia Karasogiannidou
- Program of Postgraduate Studies Adolescent Medicine and Adolescent Health Care, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Styliani Stabouli
- Program of Postgraduate Studies Adolescent Medicine and Adolescent Health Care, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
- 1st Department of Pediatrics, General Hospital Hippokratio, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Evdoxia Sapountzi
- 2nd Department of Pediatrics, AHEPA University General Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Anastasios Serbis
- Department of Pediatrics, University Hospital of Ioannina, School of Medicine, University of Ioannina, Ioannina, GRC
| | - Assimina Galli-Tsinopoulou
- Program of Postgraduate Studies Adolescent Medicine and Adolescent Health Care, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
- 2nd Department of Pediatrics, AHEPA University General Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
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13
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Madsen M, Michaelsen L, DeCosta P, Grabowski D. Stigma-Generating Mechanisms in Families Enrolled in a Pediatric Weight Management Program: A Qualitative Study of Health Identities and Healthcare Authenticity. CHILDREN (BASEL, SWITZERLAND) 2023; 11:46. [PMID: 38255360 PMCID: PMC10813986 DOI: 10.3390/children11010046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/20/2023] [Accepted: 12/25/2023] [Indexed: 01/24/2024]
Abstract
In recent years, there has been increased awareness of obesity as a condition that carries a high level of stigma, as well as growing recognition of its prevalence and harm. Despite the increasing body of research on this topic, there is a gap in the literature regarding mechanisms that generate or exacerbate perceptions of weight stigma, especially within families and pediatric healthcare settings. The present study aims to identify potential stigma-generating mechanisms by focusing on inter-relational dynamics within these contexts. We conducted in-depth, semi-structured interviews with 11 families and analyzed the data by applying sociological theories on health identities and authenticity. Our study found four themes that represent potential stigma-generating mechanisms by being explicitly related to familial health identities and healthcare authenticity: (1) negotiating and reconstruction familial self-understanding, (2) between guilt, shame and conflicts, (3) navigating weight perceptions, and (4) the necessity of positivity and relevance. Our study shows the complexities of weight stigma within family and pediatric healthcare settings, emphasizing the need for sensitive and tailored support, as well as the value of working authentically as crucial aspects in preventing and/or reducing stigma.
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Affiliation(s)
- Mie Madsen
- Department of Prevention, Health Promotion and Community Care, Copenhagen University Hospital—Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark; (P.D.); (D.G.)
| | - Lene Michaelsen
- The Centre for Children and Youths Health, Mimersgade 47A, 2nd Floor, 2200 Copenhagen, Denmark;
| | - Patricia DeCosta
- Department of Prevention, Health Promotion and Community Care, Copenhagen University Hospital—Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark; (P.D.); (D.G.)
| | - Dan Grabowski
- Department of Prevention, Health Promotion and Community Care, Copenhagen University Hospital—Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark; (P.D.); (D.G.)
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14
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Rancaño KM, Lawrence SE. Health Consequences of Familial Negative Weight Talk Across the Spectrum of Gender Diversity. Curr Nutr Rep 2023; 12:581-593. [PMID: 37837600 DOI: 10.1007/s13668-023-00501-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2023] [Indexed: 10/16/2023]
Abstract
PURPOSE OF REVIEW To synthesize differences in familial negative weight talk and health-related correlates across gender identities and to highlight gaps relevant to the unique experiences and health correlates of boys and transgender and gender diverse youth. RECENT FINDINGS Most of the studies included in this review observed no difference by gender in familial negative weight talk health correlates. Gender biases in existing measures, however, may have contributed to underreporting of health correlates in boys. Moreover, transgender and gender diverse youth are severely underrepresented in this research. Future research should consistently examine effect modification across gender identities and include measures that are specific to the weight-based concerns and experiences of boys and transgender and gender diverse youth.
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Affiliation(s)
- Katherine M Rancaño
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Ave, Boston, MA, 02111, USA.
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15
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Darling KE, Warnick J, Guthrie KM, Santos M, Jelalian E. Referral to Adolescent Weight Management Interventions: Qualitative Perspectives From Providers. J Pediatr Psychol 2023; 48:815-824. [PMID: 37776204 PMCID: PMC11009491 DOI: 10.1093/jpepsy/jsad068] [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: 04/25/2023] [Revised: 09/12/2023] [Accepted: 09/19/2023] [Indexed: 10/02/2023] Open
Abstract
OBJECTIVE Current guidelines for treatment of obesity in adolescence include screening and referring youth with obesity to appropriate weight management (WM) care. However, prior work has not explored the referral process to adolescent WM programs, especially for youth from lower-income backgrounds, who are at increased risk of obesity and related negative health outcomes. This qualitative study sought to understand pediatricians' current practices regarding referrals to adolescent WM interventions with a focus on adolescents from lower-income backgrounds. METHODS Individual interviews were conducted with 11 medical providers that had referred at least 5 adolescents from low-income backgrounds to WM interventions. Applied thematic analysis was used for data analysis. RESULTS Identified themes included weight-related discussions with adolescents as potentially fraught, as providers want to address weight-related health concerns while being thoughtful about potential harm. Providers also noted varied factors affecting their decision to refer to WM programs, including health implications, perceived motivation of the patient and family, and availability of programs. Providers identified that many families experience shame or guilt around referral to WM. Few themes were identified regarding impact of income on weight-related conversations with adolescents. CONCLUSION Findings were novel in regard to discussions of weight in adolescents with obesity leading to WM referral. Despite being a primary focus of the present study, few themes were identified regarding specific considerations for adolescents from low-income backgrounds. Future clinical research should focus on provider-focused interventions to increase sensitivity regarding weight-related discussions and attention to diversity, equity, and inclusion.
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Affiliation(s)
- Katherine E Darling
- Weight Control and Diabetes Research Center, The Miriam Hospital, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, USA
| | - Jennifer Warnick
- Weight Control and Diabetes Research Center, The Miriam Hospital, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, USA
| | - Kate M Guthrie
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, USA
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, USA
| | - Melissa Santos
- Division of Pediatric Psychology, Connecticut Children’s Medical Center, USA
| | - Elissa Jelalian
- Weight Control and Diabetes Research Center, The Miriam Hospital, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, USA
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16
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Foster BA, Latour E, Lim JY, Weinstein K. Weight trajectories and obesity remission among school-aged children. PLoS One 2023; 18:e0290565. [PMID: 37729125 PMCID: PMC10511102 DOI: 10.1371/journal.pone.0290565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/10/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Many studies examining weight trajectories have used adiposity measures shown to be problematic for trajectory analysis in children with obesity, and remission of obesity remains poorly understood. OBJECTIVES To describe weight trajectories for school-aged children, the rate of obesity remission and factors associated. METHODS Children between 6 and 11 years of age with ≥3 valid height and weight measurements from an Oregon hospital-system over a minimum six-month period were included. Percent distance from the median body mass index (BMI) was used for modeling. Latent class analysis and linear mixed models were used to classify children based on their weight trajectory. RESULTS We included 11,247 subjects with a median of 2.1 years of follow-up, with 1,614 (14.4%) classified as overweight and 1,794 (16.0%) classified as obese. Of subjects with obesity, 1% experienced remission during follow-up, whereas 23% of those with overweight moved to within a healthy weight range. Latent class analysis identified three classes within each weight-based stratum over time. The majority of children with overweight or obesity had a flat trajectory over time. Lower socioeconomic status was associated with a worsening trajectory. Latent class models using alternate measures (BMI, BMI z-scores, tri-ponderal mass index (TMI)) differed substantially from each other. CONCLUSIONS Obesity remission was uncommon using the adiposity metric of distance from the median though transition from overweight to healthy weight was more common. Children with low socioeconomic status have worse trajectories overall. The choice of adiposity metric may have a substantial effect on the outcomes.
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Affiliation(s)
- Byron A. Foster
- Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, United States of America
- School of Public Health, Oregon Health & Science University and Portland State University, Portland, Oregon, United States of America
| | - Emile Latour
- Biostatistics Shared Resource, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Jeong Youn Lim
- Biostatistics Shared Resource, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Kelsey Weinstein
- Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, United States of America
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17
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Kumar MM. Eating Disorders in Youth with Chronic Health Conditions: Clinical Strategies for Early Recognition and Prevention. Nutrients 2023; 15:3672. [PMID: 37686703 PMCID: PMC10490114 DOI: 10.3390/nu15173672] [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: 07/26/2023] [Revised: 08/16/2023] [Accepted: 08/16/2023] [Indexed: 09/10/2023] Open
Abstract
Youth with chronic health conditions face an elevated risk of eating disorders and disordered eating behaviors. Contributors to this phenomenon may include the unique threats faced by this vulnerable population to their body image, their relationships with food and eating, and their mental health and self-esteem. However, youth with chronic health conditions may also experience more severe medical complications and mortality from eating disorder behaviors because of the additional risks conveyed by their underlying conditions. In this review, clinical strategies are provided to support youth with chronic health conditions through early recognition of eating disorder behaviors and prompt referral to treatment, which is important for a better prognosis. Suggestions are also given to mitigate their risk of developing eating disorders by proactively addressing risk factors and offering thoughtful anticipatory guidance that promotes a positive relationship with food and eating.
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Affiliation(s)
- Maya Michelle Kumar
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California San Diego, San Diego, CA 92123, USA
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18
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Jolin JR, Stanford FC. More to obesity than what meets the eye: a comprehensive approach to counteracting obesity stigma. Postgrad Med J 2023; 99:367-369. [PMID: 37294713 PMCID: PMC9938081 DOI: 10.1136/pmj-2022-142082] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 08/07/2022] [Indexed: 01/05/2023]
Affiliation(s)
- James René Jolin
- Department of Government, Harvard College, Cambridge, Massachusetts, USA
- Harvard University Global Health and Health Policy, Cambridge, Massachusetts, USA
| | - Fatima Cody Stanford
- Department of Medicine-Neuroendocrine Unit, Pediatric Endocrinology, Nutrition Obesity Research Center at Harvard, Massachusetts General Hospital, Boston, Massachusetts, USA
- Departments of Medicine and Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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19
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Braddock A, Browne NT, Houser M, Blair G, Williams DR. Weight stigma and bias: A guide for pediatric clinicians. OBESITY PILLARS 2023; 6:100058. [PMID: 37990653 PMCID: PMC10661884 DOI: 10.1016/j.obpill.2023.100058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/10/2023] [Accepted: 02/18/2023] [Indexed: 11/23/2023]
Abstract
Introduction Many children and adolescents with obesity experience weight stigma and bias, which can have detrimental mental health, medical, and social consequences. Weight stigma in the healthcare setting threatens the therapeutic relationship between health care providers and their pediatric patients and families. Methods Data supporting this guidance were derived from cited references. Results Based upon referenced citations, this review offers 7 best practices for pediatric providers to work to reduce weight stigma including: assess for personal weight bias, improve communication, provide a welcoming clinic environment, seek out additional training and informative experiences, evaluate the messaging and culture of the organization, screen for trauma and bullying, and enlist the help of board-certified obesity medicine specialists. Conclusions Providers have an important role in mitigating the harmful effects of weight stigma. It is our hope these recommendations, as well as the other resources provided, will help providers to begin to address their own individual weight biases, as well as the institutional weight biases where we care for patients.
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Affiliation(s)
- Amy Braddock
- University of Missouri, 1 Hospital Drive, Columbia, MO, 65212, USA
| | - Nancy T. Browne
- LSUHSC School of Medicine, Department of Pediatrics, 200 Henry Clay Ave., New Orleans, LA, 70118, USA
| | - Marcella Houser
- LSUHSC School of Medicine, Department of Pediatrics, 200 Henry Clay Ave., New Orleans, LA, 70118, USA
| | | | - Dominique R. Williams
- The Ohio State University College of Medicine Center for Healthy Weight and Nutrition, Nationwide Children's Hospital, 700 Children's Drive LA, Suite 5F, Columbus, OH, 43215, USA
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20
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van der Voorn B, Camfferman R, Seidell JC, Puhl RM, Halberstadt J. Weight-biased attitudes about pediatric patients with obesity in Dutch healthcare professionals from seven different professions. J Child Health Care 2023:13674935221133953. [PMID: 36861392 DOI: 10.1177/13674935221133953] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Little is known about the prevalence of negative weight-biased attitudes among Dutch healthcare professionals (HCPs) when treating children and adolescents with obesity and whether interdisciplinary differences are present. Accordingly, we asked Dutch HCPs that treat pediatric patients with obesity to complete a validated 22-item self-report questionnaire about their weight-biased attitudes. In total, 555 HCPs participated from seven different disciplines: 41 general practitioners (GPs), 40 pediatricians, 132 youth healthcare physicians, 223 youth healthcare nurses, 40 physiotherapists, 40 dieticians, and 39 mental health professionals. HCPs from all disciplines reported to experience negative weight-biased attitudes among themselves. Pediatricians and GPs scored highest on negative weight-biased attitudes, including frustrations in treating children with obesity, and feeling less confident and prepared to treat children with obesity. Dieticians scored the least negative weight-biased attitudes. Participants from all groups perceived weight bias expressed by their colleagues, toward children with obesity. These findings are comparable to results reported by adult HCPs from other countries. Interdisciplinary differences were found and underscore the need for more research on contributing factors that impact explicit weight bias among pediatric HCPs.
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Affiliation(s)
- Bibian van der Voorn
- Department of Health Science, 1190Vrije Universiteit, Amsterdam, The Netherlands
| | - Roxanna Camfferman
- Department of Health Science, 1190Vrije Universiteit, Amsterdam, The Netherlands
| | - Jacob C Seidell
- Department of Health Science, 1190Vrije Universiteit, Amsterdam, The Netherlands
| | - Rebecca M Puhl
- Rudd Center for Food Policy & Health, Department of Human Development & Family Sciences, University of Connecticut, Hartfort, CT, USA
| | - Jutka Halberstadt
- Department of Health Science, 1190Vrije Universiteit, Amsterdam, The Netherlands
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21
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Hampl SE, Hassink SG, Skinner AC, Armstrong SC, Barlow SE, Bolling CF, Avila Edwards KC, Eneli I, Hamre R, Joseph MM, Lunsford D, Mendonca E, Michalsky MP, Mirza N, Ochoa ER, Sharifi M, Staiano AE, Weedn AE, Flinn SK, Lindros J, Okechukwu K. Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. Pediatrics 2023; 151:e2022060640. [PMID: 36622115 DOI: 10.1542/peds.2022-060640] [Citation(s) in RCA: 292] [Impact Index Per Article: 292.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 01/10/2023] Open
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22
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Lucibello KM, Sabiston CM, Pila E, Arbour-Nicitopoulos K. An integrative model of weight stigma, body image, and physical activity in adolescents. Body Image 2023; 45:1-10. [PMID: 36731346 DOI: 10.1016/j.bodyim.2023.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 01/12/2023] [Accepted: 01/12/2023] [Indexed: 02/03/2023]
Abstract
Negative weight-related experiences and internalized weight stigma have been associated with poorer body image and reduced physical activity in adolescents. However, exploring body image and physical activity as discrete weight stigma outcomes fails to consider the theoretically- and empirically-supported covariation between the two. The present study tested a novel integrated model of the associations among negative weight-related experiences and internalized weight stigma (via weight-related distress), body image (shame, authentic pride, body appreciation), and physical activity. Canadian adolescents (N = 311, Mage ± SD = 16.00 ± 1.01, 75.5% girls) completed a cross-sectional self-report survey. A structural equation model with maximum likelihood robust estimation was tested. Higher negative weight-related experiences were indirectly associated with poorer body image (i.e., higher shame; lower authentic pride and appreciation) through higher weight-related distress. Authentic pride was associated with moderate-to-vigorous physical activity. Higher negative weight-related experiences were indirectly associated with lower physical activity through higher weight-related distress and lower body-related authentic pride. These findings elucidate targetable individual mechanisms and larger systems that could improve body image and foster physical activity among adolescents who encounter negative weight-related experiences and internalized weight stigma.
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Affiliation(s)
| | | | - Eva Pila
- School of Kinesiology, Western University, London, Ontario, Canada
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23
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Kataria I, Jackson-Morris A, Jewell J, Williams D, Bhandari P, Sharma D, Lai J, Jain T, Colozza D. Weight stigma among adolescents in three low- and middle-income countries. J Glob Health 2022; 12:04098. [PMID: 36520445 PMCID: PMC9754065 DOI: 10.7189/jogh.12.04098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Overweight (OW) and obesity affect millions of adolescents worldwide. Evidence from high-income countries indicates widespread weight stigma that adversely affects young people's mental and physical health. However, evidence relating to low- and middle-income countries (LMICs) is sparse. We aimed to generate insight into weight stigma prevalence and experience among adolescents in three LMICs. Methods We identified adolescents aged 15-19 from Brazil, South Africa, and Indonesia from families within market research databases. We adopted a mixed-methods design. The sample included equal numbers by country, sex, and age, and included urban and rural dwellers. Self-reported weight was recorded but was not a selection criterion. Consent (age >18) and assent/parental consent (<age 18) were obtained. In-depth interviews (n = 18) informed the survey design. We used a computer-assisted telephonic interviewing survey (n = 1200) to assess weight stigma prevalence and experience. We conducted a qualitative thematic data analysis and used SPSS-23 for quantitative data. Results Many adolescents affected by OW and some affected by underweight (UW) had experienced weight stigma and expressed negative perceptions of their weight. Negative perceptions were expressed the most by those affected by OW, followed by those affected by UW, and then those of healthy weight (HW). Weight stigma and weight dissatisfaction were highest in Brazil and South Africa, and lower in Indonesia. More young women experienced weight stigma, yet this was also common among young men. One in five of all participants reported negative impacts, predominantly on mental health, and regarding weight management and healthy behaviours. Young people recommended measures to address weight stigma, promote an inclusive model of health and body image, and better support to achieve and maintain a HW. Conclusions Weight stigma adversely affects sizeable numbers of adolescents in LMICs, particularly those affected by OW. Addressing this is essential to protect adolescent (and future adult) mental and physical health.
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Affiliation(s)
- Ishu Kataria
- Center for Global Noncommunicable Diseases, RTI International, North Carolina, USA
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24
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Sánchez-Carracedo D. Obesity stigma and its impact on health: A narrative review. ENDOCRINOL DIAB NUTR 2022; 69:868-877. [PMID: 36446710 DOI: 10.1016/j.endien.2021.12.007] [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: 10/24/2021] [Accepted: 12/29/2021] [Indexed: 06/16/2023]
Abstract
Weight stigma and weight bias are pervasive in our society and are based on wrong assumption that obesity derives basically from a lack self-discipline and personal responsibility, obviating recent evidence showing that obesity is a prevalent, complex, progressive, and relapsing chronic disease that results from the interaction between behavioural, environmental, genetic, and metabolic factors. This narrative review provides an overview of recent research on this problem, mainly focused on the negative impact of weigh stigma on health. Overall, recent evidence shows that weight stigma can contribute to worsening obesity-related problems and creating additional barriers to effective obesity care and prevention. In addition, a brief description of some of the most important international initiatives to address the weight stigma is provided.
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Affiliation(s)
- David Sánchez-Carracedo
- Unidad de Conductas Relacionadas con la Alimentación y el Peso, Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona Campus de la UAB, Bellaterra, Barcelona, Spain.
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25
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Hoebel J, Waldhauer J, Blume M, Schienkiewitz A. Socioeconomic Status, Overweight, and Obesity in Childhood and Adolescence. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:839-845. [PMID: 36345700 PMCID: PMC9981977 DOI: 10.3238/arztebl.m2022.0326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 05/06/2022] [Accepted: 09/19/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Overweight and obesity in early life increase the risk of chronic disease and ill health later on. We studied secular trends in the prevalence of overweight and obesity among young people in Germany, with consideration of socioeconomic status (SES). METHODS We used repeated cross-sectional data from 3- to 17-year-olds from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Overweight and obesity were defined according to the body mass index, based on measured height and weight from the KiGGS baseline survey (2003-2006) and the KiGGS second wave (2014-2017). SES was assessed with a composite index of parental education, occupation, and income. RESULTS In both study periods, the prevalence of overweight and obesity was highest among girls and boys from families of low SES. In the group with lowest SES, the prevalence of overweight rose from 20.0% in 2003-2006 (95% CI [18.0; 22.1]) to 25.5% [20.5; 31.2] in 2014-2017 (p = 0.043). Thus, social differences in the prevalence of overweight increased over time. No such trend was found for the prevalence of obesity. CONCLUSION Social differences in the prevalence of overweight among children and adolescents increased from the early 2000s to the mid-2010s. Structural measures are needed to help prevent overweight among young people in socially disadvantaged circumstances.
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Affiliation(s)
- Jens Hoebel
- Department of Epidemiology and Health Monitoring of the Robert Koch Institute, Berlin,*Fachgebiet Soziale Determinanten der Gesundheit Abteilung für Epidemiologie und Gesundheitsmonitoring Robert Koch-Institut General-Pape-Str. 62–66, 12101 Berlin, Germany
| | - Julia Waldhauer
- Department of Epidemiology and Health Monitoring of the Robert Koch Institute, Berlin
| | - Miriam Blume
- Department of Epidemiology and Health Monitoring of the Robert Koch Institute, Berlin
| | - Anja Schienkiewitz
- Department of Epidemiology and Health Monitoring of the Robert Koch Institute, Berlin
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26
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Vale D, Lyra CDO, Dantas NM, Andrade MEDC, Oliveira AGRDC. Dietary and Nutritional Profiles among Brazilian Adolescents. Nutrients 2022; 14:nu14204233. [PMID: 36296917 PMCID: PMC9608776 DOI: 10.3390/nu14204233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/30/2022] [Accepted: 10/01/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: The present study analyzed the prevalence of dietary and nutritional profiles among Brazilian adolescents and their associations with social determinants of health. (2) Methods: A population-based survey was administered to 16,409 adolescents assessed by the 2015 National School Health Survey. A multivariate model of dietary and nutritional profiles was estimated from correspondence analysis. (3) Results: The dietary and nutritional profiles more prevalent among Brazilian adolescents were “lower nutritional risk dietary pattern and eutrophic” (42.6%), “lower nutritional risk dietary pattern and overweight” (6.8%), and “higher nutritional risk dietary pattern and overweight” (6.0%). Healthier profiles were associated with less urbanized territories, health-promoting behaviors, and families with worse material circumstances. The less healthy profiles were associated with more urbanized environments, health risk behaviors, and families with better material circumstances. (4) Brazilian adolescents have different dietary and nutritional profiles that are characterized by sociopolitical and economic contexts, family material and school circumstances, and the behavioral and psychosocial health factors of the individuals. All of this points to the social determination of these health problems among adolescents in Brazil.
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Affiliation(s)
- Diôgo Vale
- Postgraduate Program in Collective Health, Federal University of Rio Grande do Norte, Natal 59056-000, RN, Brazil
- Federal Institute of Education, Science and Technology of Rio Grande do Norte, Natal 59015-300, RN, Brazil
- Correspondence: ; Tel.: +55-84-998625453
| | - Clélia de Oliveira Lyra
- Postgraduate Program in Collective Health, Federal University of Rio Grande do Norte, Natal 59056-000, RN, Brazil
| | - Natalie Marinho Dantas
- Postgraduate Program in Nutrition in Public Health, School of Public Health, University of São Paulo, São Paulo 05508-000, SP, Brazil
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Gremillion ML, Lang AC, Everhart SA, Davies WH, Stolzman SC, Weisman SJ, Hainsworth KR. Effects of Weight and Pain on Physical Activity: Insights from the Lived Experiences of Youth with Co-Occurring Chronic Pain and Obesity. Child Obes 2022; 18:301-308. [PMID: 34890258 DOI: 10.1089/chi.2021.0208] [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] [Indexed: 11/13/2022]
Abstract
Objective: Pediatric obesity and chronic pain are each associated with an increased risk for numerous poor physical and mental health outcomes. Co-occurring chronic pain and obesity (CPO) result in greater functional disability compared with either condition alone. The aim of the present study was to use qualitative methods to better understand the challenges experienced by adolescents with CPO, with a specific focus on physical activity. Methods: Semistructured interviews were conducted with 13 youth with CPO. Participants were questioned about pain, physical activity, coping strategies, and the perceived relationship between weight and pain. Interviews were audiorecorded, transcribed, and analyzed according to Interpretative Phenomenological Analysis. Results: Superordinate themes expressed by youth included: Impact of Chronic Pain on Relationships, Impact of Pain on Self-Perception, Using Food to Cope with Pain, Perceived Relationship between Pain and Weight after Onset of Pain, Attitudes toward Physical Activity, Barriers to Physical Activity, and Supports to Physical Activity. Conclusions: Participants identified challenges associated with CPO. Notably, participants identified pain as a greater barrier to exercise than weight, implicating the salience of chronic pain in the lives of youth with CPO. Furthermore, participants identified a desire to be more physically active, yet discussed struggles and concerns about attempts to increase their physical activity and indicated a desire for guidance about being more active. This study highlights the complexities of the relationship between CPO and underscores the importance of providers collaboratively working with patients to develop a practical plan to resume movement and physical activity.
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Affiliation(s)
- Monica L Gremillion
- Department of Anesthesiology, Medical College of Wisconsin/Children's Wisconsin, Milwaukee, WI, USA
| | - Amy C Lang
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Samantha A Everhart
- Department of Psychology, Children's Hospital of Orange County, Orange, CA, USA
| | - W Hobart Davies
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Stacy C Stolzman
- Department of Physical Therapy, Concordia University Wisconsin, Mequon, WI, USA
| | - Steven J Weisman
- Department of Anesthesiology, Medical College of Wisconsin/Children's Wisconsin, Milwaukee, WI, USA
| | - Keri R Hainsworth
- Department of Anesthesiology, Medical College of Wisconsin/Children's Wisconsin, Milwaukee, WI, USA
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Abstract
ABSTRACT Weight stigma is the devaluation of a person because of excess body weight. Individuals who experience stigmatization are at increased risk for adverse physical and psychological health outcomes. This article provides an overview of weight stigma and the implications for nursing practice and policy.
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Affiliation(s)
- Karyn J Roberts
- Karyn J. Roberts is an adjunct assistant professor at Northwestern University Feinberg School of Medicine-Department of Pediatrics in Chicago, Ill. and a clinical assistant professor at the University of Wisconsin-Milwaukee (UW-Milwaukee) College of Nursing in Milwaukee, Wis., where Michele L. Polfuss is an associate professor. She's also the Joint Research Chair in the Nursing of Children at UW-Milwaukee and Children's Hospital of Wisconsin
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29
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Canfell OJ, Littlewood R, Wright ORL, Walker JL. "We'd be really motivated to do something about it": a qualitative study of parent and clinician attitudes towards predicting childhood obesity in practice. Health Promot J Austr 2022; 34:398-409. [PMID: 35504851 DOI: 10.1002/hpja.611] [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: 06/09/2021] [Revised: 01/25/2022] [Accepted: 04/27/2022] [Indexed: 11/06/2022] Open
Abstract
ISSUE ADDRESSED In Australia, one-in-four (24.9%) children live with overweight or obesity (OW/OB). Identifying infants at-risk of developing childhood OW/OB is a potential preventive pathway but its acceptability is yet to be investigated in Australia. This study aimed to (1) investigate acceptability of predicting childhood OW/OB with parents of infants (aged 0-2 years) and clinicians and (2) explore key language to address stigma and maximise the acceptability of predicting childhood OW/OB in practice. METHODS Cross-sectional and qualitative design, comprising individual semi-structured interviews. Participants were multidisciplinary paediatric clinicians (n=18) and parents (n=13) recruited across public hospitals and health services in Queensland, Australia. Data were analysed under the Framework Method using an inductive, thematic approach. RESULTS Five main themes were identified: (1) Optimism for prevention and childhood obesity prediction (2) Parent dedication to child's health (3) Adverse parent response to risk for childhood obesity (4) Language and phrasing for discussing weight and risk (5) Clinical delivery. Most participants were supportive of using a childhood OW/OB prediction tool in practice. Parents expressed dedication to their child's health that superseded potential feelings of judgment or blame. When discussing weight in a clinical setting, the use of sensitive (i.e. 'overweight', 'above average', 'growth' versus 'obesity') and positive, health-focused language was mostly supported. CONCLUSIONS Multidisciplinary paediatric clinicians and parents generally accept the concept of predicting childhood OW/OB in practice in Queensland, Australia. SO WHAT?: Clinicians, public health and health promotion professionals and policymakers can act now to implement sensitive communication strategies concerning weight and obesity risk.
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Affiliation(s)
- Oliver J Canfell
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD, Australia.,Children's Health Queensland Hospital and Health Service, Department of Health, Queensland Government, South Brisbane, QLD, Australia.,Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Herston, QLD, Australia.,UQ Business School, Faculty of Business, Economics and Law, The University of Queensland, St Lucia, QLD, Australia.,Health and Wellbeing Queensland, Queensland Government, The State of Queensland, Milton QLD, Australia
| | - Robyn Littlewood
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD, Australia.,Children's Health Queensland Hospital and Health Service, Department of Health, Queensland Government, South Brisbane, QLD, Australia.,Health and Wellbeing Queensland, Queensland Government, The State of Queensland, Milton QLD, Australia
| | - Olivia R L Wright
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD, Australia
| | - Jacqueline L Walker
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD, Australia.,Health and Wellbeing Queensland, Queensland Government, The State of Queensland, Milton QLD, Australia
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Browne NT, Hodges EA, Small L, Snethen JA, Frenn M, Irving SY, Gance-Cleveland B, Greenberg CS. Childhood obesity within the lens of racism. Pediatr Obes 2022; 17:e12878. [PMID: 34927392 DOI: 10.1111/ijpo.12878] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 11/28/2021] [Accepted: 12/03/2021] [Indexed: 11/30/2022]
Abstract
Despite decades of research and a multitude of prevention and treatment efforts, childhood obesity in the United States continues to affect nearly 1 in 5 (19.3%) children, with significantly higher rates among Black, Indigenous, and People of Colour communities. This narrative review presents social foundations of structural racism that exacerbate inequity and disparity in the context of childhood obesity. The National Institute of Minority Health and Health Disparities' Research Framework guides the explication of structurally racist mechanisms that influence health disparities and contribute to childhood obesity: biologic and genetic, health behaviours, chronic toxic stress, the built environment, race and cultural identity, and the health care system. Strategies and interventions to combat structural racism and its effects on children and their families are reviewed along with strategies for research and implications for policy change. From our critical review and reflection, the subtle and overt effects of societal structures sustained from years of racism and the impact on the development and resistant nature of childhood obesity compel concerted action.
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Affiliation(s)
| | - Eric A Hodges
- UNC-Chapel Hill School of Nursing, Chapel Hill, North Carolina, USA
| | - Leigh Small
- Michigan State University College of Nursing, East Lansing, Michigan, USA
| | - Julia A Snethen
- University of Wisconsin-Milwaukee, College of Nursing, Milwaukee, Wisconsin, USA
| | - Marilyn Frenn
- Marquette University College of Nursing, Milwaukee, Wisconsin, USA
| | - Sharon Y Irving
- Pediatric Nursing, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA.,Pediatric Critical Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Cindy Smith Greenberg
- College of Health and Human Development, California State University, Fullerton, California, USA
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31
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Sánchez-Carracedo D. El estigma de la obesidad y su impacto en la salud: una revisión narrativa. ENDOCRINOL DIAB NUTR 2022. [DOI: 10.1016/j.endinu.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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32
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Harris CL, Goldman BM, Gurkas P, Butler C, Bookman P. Superwoman's kryptonite: The superwoman schema and perceived barriers to weight management among U.S. Black women. J Health Psychol 2022; 27:2887-2897. [PMID: 35086379 DOI: 10.1177/13591053211068974] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The role that the superwoman schema (SWS) plays in U.S. Black women's perceptions of barriers (biological, psychological, and sociological) to healthy weight management is unknown. This exploratory study examined whether 122 women classified as normal weight, overweight or obese differed in their perceptions of types of barriers and if the SWS predicted perceived barriers to weight management. Women classified as obese reported more barriers than those classified as normal weight. The SWS uniquely positively predicted perceived psychological and sociological barriers. Our findings suggest that the SWS may play a vital role in the self-management of weight in U.S. Black women.
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Abstract
Weight bias and stigma exist in a variety of realms in our society (media, education, employment, and health care), and unfortunately many view it as a socially acceptable form of discrimination. Patients with obesity often avoid scheduling appointments for health promotion visits and routine care due to perceived weight bias and stigma from their health care provider. Within the health care setting, it is important that health care providers strategically focus on reducing obesity bias and provide high-quality obesity management. People-first language should be used and waiting rooms and examination rooms should be accommodating to people of all sizes.
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Affiliation(s)
- Sharon M Fruh
- College of Nursing, University of South Alabama, 5721 USA Drive North, Mobile, AL 36688, USA.
| | - Rebecca J Graves
- College of Nursing, University of South Alabama, 5721 USA Drive North, HAHN 2037 F, Mobile, AL 36688, USA
| | - Caitlyn Hauff
- Department of Health, Kinesiology, and Sport, College of Education and Professional Studies, University of South Alabama, HKS 1020, 171 Student Services Drive, Mobile, AL 36688, USA
| | - Susan G Williams
- College of Nursing, University of South Alabama, 161 North Section Street Suite C, Fairhope, AL 36532, USA
| | - Heather R Hall
- College of Nursing, University of South Alabama, 5721 USA Drive North, Room 3068, Mobile, AL 36688, USA
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Abstract
Pediatric obesity is a heterogeneous, chronic, relapsing disease associated with metabolic and psychosocial complications. Weight-based victimization, including unrelenting microaggressions, negatively impacts child mental and physical health. Evidence-based guidelines offer individualized, stepwise approaches to obesity treatment. Pediatric nurses positively impact children with obesity by providing affirmation, clinical management, and psychosocial support. Pediatric nurses are respected and positioned to present evidence-based obesity education, correct common obesity myths, sensitively address obesity-related bias and discrimination, and model person-first language and actions. This article shares how nurses in multiple practice areas can make a meaningful impact on the lives of children and adolescents with obesity.
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35
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Eilander MMA, van Mil MMA, Koetsier LW, Seidell JC, Halberstadt J. Preferences on how to measure and discuss health related quality of life within integrated care for children with obesity. J Patient Rep Outcomes 2021; 5:106. [PMID: 34648095 PMCID: PMC8517052 DOI: 10.1186/s41687-021-00381-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/26/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Childhood obesity can affect physical as well as psychosocial wellbeing. Therefore, childhood obesity care aims to improve all dimensions of health related quality of life (HRQoL). HRQoL can be measured with the generic questionnaire PedsQL4.0 and the weight-specific IWQOL-Kids. In the Netherlands, HRQoL assessment is conducted by the coordinating professional (CP). The aim of this qualitative study was to examine how and when to implement the measurement and discussion of HRQoL using the PedsQL4.0 and IWQOL-Kids within the integrated care for children with obesity in the Netherlands. Semi-structured interviews were conducted with fourteen CPs, in which the following was discussed: a) familiarity and attributions with regard to the assessment of HRQoL; b) wishes and needs with regard to the usage of the questionnaires; c) its practical incorporation. RESULTS Interviews revealed that most CPs gained insight into the HRQoL by talking with families. One CP used the PedsQL4.0, the remaining CPs were unfamiliar with the two questionnaires. Even though some barriers, for instance a lack of time, might hinder the implementation of the PedsQL4.0 and IWQOL-Kids, all participants think the usage of either one or both questionnaires would have additional value to the support and care for children with obesity. There was no consensus about the questionnaire of preference. CONCLUSIONS When the right preconditions are met, HRQoL questionnaires have the potential to support CPs in improving the care for children with obesity, tailored to each individual child.
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Affiliation(s)
- Minke M A Eilander
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
| | - Marieke M A van Mil
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Leandra W Koetsier
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Jacob C Seidell
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Jutka Halberstadt
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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36
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Kamolthip R, Fung XCC, Lin CY, Latner JD, O'Brien KS. Relationships among Physical Activity, Health-Related Quality of Life, and Weight Stigma in Children in Hong Kong. Am J Health Behav 2021; 45:828-842. [PMID: 34702430 DOI: 10.5993/ajhb.45.5.3] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objectives: Our objective in this study was to establish the relationships among active and inactive physical activity, HRQoL, and weight stigma in children. Additionally, we investigated weight stigma as a mediator of the relationship between physical activity and HRQoL.Methods: This cross-sectional study was conducted in Hong Kong (June 2017-July 2018). Participants were 437 children in elementary school (2 primary schools and 2 non-governmental organizations) and their parents (dyads). Participants completed questionnaires containing items assessing demographic characteristics, physical activity level, and several HRQoL measures.Results: We found a statistically significant difference between a higher physically activity group (exercise > 2 hours/week) in all measures of HRQoL. Weight stigma had a significant mediating effect on the relationship between physical activity and child-rated HRQoL (Coefficient = -0.37; SE=0.05; t = 8.21; p < .001), parent-rated HRQoL (Coefficient = -0.16; SE = 0.04; t = 4.21; p < .001), and child-rated weight-related QoL (Coefficient = -0.56; SE = 0.04; t = 14.92; p < .001). Conclusions: Physical activity was associated with better HRQoL and lower weight stigma. Weight stigma appears to affect how physical activity is related to better HRQoL, but the association is somewhat weak.
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Affiliation(s)
- Ruckwongpatr Kamolthip
- Ruckwongpatr Kamolthip, Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Xavier C. C. Fung
- Xavier C. C. Fung, Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Chung-Ying Lin
- Chung-Ying Lin, Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan, and Department
of Public Health, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan;,
| | - Janet D. Latner
- Janet D. Latner, Department of Psychology, University of Hawaii at Manoa, Honolulu, HI, United States
| | - Kerry S. O'Brien
- Kerry S. O'Brien, School of Social Sciences, Faculty of Arts, Monash University, Melbourne, VIC, Australia
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Loth KA, Lebow J, Uy MJA, Ngaw SM, Neumark-Sztainer D, Berge JM. First, Do No Harm: Understanding Primary Care Providers' Perception of Risks Associated With Discussing Weight With Pediatric Patients. Glob Pediatr Health 2021; 8:2333794X211040979. [PMID: 34514059 PMCID: PMC8427925 DOI: 10.1177/2333794x211040979] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 08/02/2021] [Indexed: 11/17/2022] Open
Abstract
Many health care providers struggle with if- and how-to discuss weight with their pediatric patients. This study used one-on-one interviews with primary care providers (n = 20) to better understand their: (1) perception of risks associated with talking about weight with pediatric patients, (2) commitment to adhering to best practices of pediatric weight management, and (3) approaches to mitigate perceived risks. Providers felt concerned that discussing weight with children during clinic visits may have unintended negative impacts. Despite perceived risks, providers continued regular BMI screening and weight-focused conversations, but took care with regard to language and approach with the goal of mitigating perceived risks. Findings suggest that pediatric primary care providers perceive that engaging in weight-related discussions with their patients has the potential to lead to negative, unintended consequences. Future research is needed to understand if weight-focused conversations should be avoided altogether or if there are approaches that can effectively mitigate risks.
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Affiliation(s)
- Katie A. Loth
- University of Minnesota Medical School, Minneapolis, MN, USA
| | | | | | | | | | - Jerica M. Berge
- University of Minnesota Medical School, Minneapolis, MN, USA
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Serban CL, Putnoky S, Ek A, Eli K, Nowicka P, Chirita-Emandi A. Making Childhood Obesity a Priority: A Qualitative Study of Healthcare Professionals' Perspectives on Facilitating Communication and Improving Treatment. Front Public Health 2021; 9:652491. [PMID: 34336760 PMCID: PMC8321411 DOI: 10.3389/fpubh.2021.652491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 06/21/2021] [Indexed: 01/02/2023] Open
Abstract
In Romania, one in four children has excess weight. Because childhood obesity is a sensitive topic, many healthcare professionals find it difficult to discuss children's excess weight with parents. This study aims to identify barriers and facilitators in childhood obesity-related communication, as perceived by healthcare professionals in Romania. As part of the STOP project, healthcare professionals (family physicians, pediatricians, and dieticians) who treat children with excess weight were invited to a telephone interview. The semi-structured questions were translated from a questionnaire previously used at the Swedish study site of the STOP project. Interviews were transcribed and then used for thematic analysis. Fifteen doctors and three dieticians (16 females and 2 males), with average 18.2 ± 10.1 years of experience, were interviewed. Four main themes were identified. Professionals reported that when children began experiencing obesity-related stigma or comorbidities, this became the tipping point of weight excess, where parents felt motivated to begin treatment. Barriers in communication were part of several layers of distrust, recognized as tension between professionals and caregivers due to conflicting beliefs about excess weight, as well as lack of trust in medical studies. Most respondents felt confident using models of good practice, consisting of a gentle approach and patient-centered care. Nonetheless, professionals noted systemic barriers due to a referral system and allocation of clinical time that hinder obesity treatment. They suggested that lack of specialized centers and inadequate education of healthcare professional conveys the system does not prioritize obesity treatment and prevention. The interviewed Romanian doctors and dieticians identified patient-centered care as key to treating children with obesity and building trust with their caregivers. However their efforts are hindered by healthcare system barriers, including the lack of specialized centers, training, and a referral system. The findings therefore suggest that, to improve childhood obesity prevention and treatment, systemic barriers should be addressed. Trial Registration:ClinicalTrials.gov, NCT03800823; 11 Jan 2019.
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Affiliation(s)
- Costela Lacrimioara Serban
- Functional Sciences Department, "Victor Babes" University of Medicine and Pharmacy Timişoara, Timişoara, Romania
| | - Salomeia Putnoky
- Microbiology Department, Centre for Studies in Preventive Medicine, "Victor Babes" University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Anna Ek
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Karin Eli
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom.,School of Anthropology and Museum Ethnography, University of Oxford, Oxford, United Kingdom
| | - Paulina Nowicka
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Department of Food Studies, Nutrition, and Dietetics, Uppsala University, Uppsala, Sweden
| | - Adela Chirita-Emandi
- Department of Microscopic Morphology Genetics Discipline, Center of Genomic Medicine, Regional Center of Medical Genetics Timis, "Victor Babes" University of Medicine and Pharmacy Timisoara, Timisoara, Romania.,Regional Center of Medical Genetics, "Louis Turcanu" Clinical Emergency Hospital for Children, Timişoara, Romania
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Thompson N, Adams EL, Tkacz Browne N, Bean MK. Pediatric Surgery and School Nurse Attitudes Regarding Children with Obesity. J Pediatr Nurs 2021; 59:75-80. [PMID: 33497956 PMCID: PMC8292152 DOI: 10.1016/j.pedn.2021.01.007] [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: 08/20/2020] [Revised: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Weight bias towards individuals with obesity exists among medical professionals; yet, there is less evidence of the extent to which weight biases exist in different types of nursing professions. This study aimed to describe pediatric surgery and school nurses' weight biases towards children with obesity and examine factors associated with weight biases. DESIGN AND METHODS Pediatric surgery (n = 108) and school nurses (n = 177) completed a single online survey that assessed their attitudes towards weight regarding children with obesity. Responses were categorized as % agreement (responded "agree" or "strongly agree" to a given statement). Nurses also reported % time spent working with children who had obesity. RESULTS Almost all nurses (>93%) agreed it was important to treat patients with obesity with compassion and respect. However, many nurses endorsed statements stating that patients with obesity are often non-compliant with treatment recommendations (47%) and can be difficult to deal with (35%). Only about half of school nurses (53%) and surgical nurses (56%) felt professionally prepared to effectively treat patients with obesity. Nurses commonly reported hearing/witnessing other professionals in their field make negative comments (69%) or convey negative stereotypes (55%) about patients with obesity. School nurses who spent a greater % of time working with children with overweight had more positive weight attitudes (p = 0.04). CONCLUSIONS Negative attitudes towards patients with obesity were relatively prevalent in this population of pediatric surgery and school nurses. PRACTICE IMPLICATIONS There is a need for more educational opportunities, professional trainings, and policy initiatives to reduce weight bias among nurses.
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Affiliation(s)
- Nancy Thompson
- Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA, USA.
| | - Elizabeth L Adams
- Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA, USA.
| | - Nancy Tkacz Browne
- Northern Light Health, Eastern Maine Medical Center, Department of Pediatrics, WOW Pediatric & Adolescent Weight & Cardiometabolic Clinic, Bangor, ME, USA
| | - Melanie K Bean
- Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA, USA.
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Association between patients' body mass index and emergency department wait times: A multicenter observational cohort investigation by the reducing disparities increasing equity in emergency medicine (REDEEM) study group. Am J Emerg Med 2021; 49:178-184. [PMID: 34119812 DOI: 10.1016/j.ajem.2021.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/31/2021] [Accepted: 06/03/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Numerous studies have demonstrated evidence of obesity bias in healthcare settings, however, little is known about obesity bias in the Emergency Department (ED). The objective of this study was to investigate obesity bias in an ED setting by assessing the association between body mass index (BMI) and door-to-room (DTR) or door-to-provider (DTP) times among ED patients. METHODS We conducted an observational cohort study of all adult patient (age ≥ 18 years of age) visits to 21 Mayo Clinic and Mayo Clinic Health System EDs between November 1, 2018 and March 31, 2020. We compared DTR and DTP times based on BMI category. RESULTS We found that median DTR and DTP times for adults with class 3 obesity are significantly shorter than patients in the normal weight category. For men with class 3 obesity, median DTR and DTP times were 7.5% and 5.4% shorter than men in the normal weight category. Relative to women in the normal weight category, the median DTR and DTP times were 4.6% and 3.8% faster for women in obesity class 1, 4.9% and 5.1% faster for women in obesity class 2, and DTR was 4.4% faster for women in obesity class 3. These percentage differences translated to slightly shorter wait times of 0.4-1.2 min compared to median wait times for patients with normal BMI. CONCLUSION We did not find evidence of longer wait times experienced by people with obesity. Rather, patients with obesity often experienced wait times that were shorter than patients of normal weight.
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41
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Ma L, Chu M, Li Y, Wu Y, Yan AF, Johnson B, Wang Y. Bidirectional relationships between weight stigma and pediatric obesity: A systematic review and meta-analysis. Obes Rev 2021; 22:e13178. [PMID: 33533189 DOI: 10.1111/obr.13178] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 01/04/2023]
Abstract
This study for the first time quantified concurrent and bidirectional relationships between weight stigma and weight status in children, with age and gender as moderators. A literature search was conducted in PubMed, Web of Science, and PsycINFO for studies examined associations between weight stigma and weight status among children aged 6-18 years. Twenty-five studies (20 cross-sectional studies and five longitudinal studies) from six countries with 101,036 participants were included in review, and 18 were included in meta-analysis. Weight and height were self-reported in nine studies, otherwise objectively measured. With data from 17 cross-sectional studies and baseline portions of four longitudinal studies, meta-analysis showed weight stigma and overweight/obesity were associated (pooled OR = 3.12, 95% CI: 2.71, 3.60), they were also associated across age and gender. Body mass index (BMI) was associated with greater weight stigma (pooled r = 0.38, 95% CI: 0.32, 0.43). Age modified such association. Weight stigma predicted increased BMI from three longitudinal studies (pooled β = 1.12, 95% CI: 0.78, 1.45); another two longitudinal studies reported BMI predicted greater weight stigma. Data were inadequate for age- or gender-stratified analyses. Findings supported positive concurrent and bidirectional relationships between weight stigma and weight status. Timely obesity and weight stigma interventions to protect children well-being are needed.
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Affiliation(s)
- Lu Ma
- Global Health Institute, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Meng Chu
- Global Health Institute, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Yixuan Li
- Global Health Institute, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Yang Wu
- Department of Sociology, Center for Asian & Pacific Economic & Social Development, Research Institute for Female Culture, Jiangxi University of Finance and Economics, Nanchang, China
| | - Alice Fang Yan
- Division of General Internal Medicine, Department of Medicine, Center of Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Blair Johnson
- Department of Psychological Sciences and Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, Connecticut, USA
| | - Youfa Wang
- Global Health Institute, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China.,Fisher Institute of Health and Well-Being, Department of Nutrition and Health Science, College of Health, Ball State University, Muncie, Indiana, USA
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Abstract
Weight stigma is rooted in a fundamental misunderstanding of the origins of obesity, wherein the interplay of behavioral, environmental, genetic, and metabolic factors is deemphasized. Instead, the widespread societal and cultural presence of weight stigma fosters misconceptions of obesity being solely a result of unhealthy personal choices. Weight stigma is pervasive in childhood and adolescence and can affect individuals throughout their life. Although the prevalence of pediatric obesity remains high throughout the world, it becomes increasingly important to understand how weight stigma affects weight and health outcomes in children and adolescents with overweight or obesity, including in those with rare genetic diseases of obesity. We identified and reviewed recent literature (primarily published since 2000) on weight stigma in the pediatric setting. Articles were identified with search terms including pediatric obesity, weight bias, weight stigma, weight-based teasing and bullying, and weight bias in health care. In this narrative review, we discuss the stigma of pediatric obesity as it relates to the complex etiology of obesity as well as describe best practices for avoiding bias and perpetuating stigma in the health care setting.
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Affiliation(s)
- Andrea M. Haqq
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Alberta, Edmonton, Alberta, Canada.,Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada.,Address correspondence to: Andrea M. Haqq, MD, MHS, FRCP(C), FAAP, Department of Pediatrics, Division of Pediatric Endocrinology, University of Alberta, 1C4 Walter C. Mackenzie Health Sciences Center, 8440 112 Street NW, Edmonton, Alberta T6G 2B7, Canada
| | - Maryam Kebbe
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Qiming Tan
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Alberta, Edmonton, Alberta, Canada
| | - Melania Manco
- Unit for Multifactorial Diseases and Complex Phenotypes, Bambino Gesù Children's Hospital, Rome, Italy
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43
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Fan CW, Liu CH, Huang HH, Lin CY, Pakpour AH. Weight Stigma Model on Quality of Life Among Children in Hong Kong: A Cross-Sectional Modeling Study. Front Psychol 2021; 12:629786. [PMID: 33967895 PMCID: PMC8100454 DOI: 10.3389/fpsyg.2021.629786] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/12/2021] [Indexed: 11/14/2022] Open
Abstract
We proposed a model to examine the relationship among different types of weight-related stigmas and their relationship to quality of life (QoL). We recruited 430 dyads of elementary school children [mean age = 10.07 years; nboy = 241 (56.0%); noverweight = 138 (32.1%)] and their parents. Parents completed QoL instruments about their children assessing generic QoL and weight-related QoL. Children completed QoL instruments assessing generic QoL and weight-related QoL and stigma scales assessing experienced weight stigma, weight-related self-stigma, and perceived weight stigma. Experienced weight stigma was significantly associated with perceived weight stigma, and in turn, perceived weight stigma was significantly associated with weight-related self-stigma. However, experienced weight stigma was not directly associated with weight-related self-stigma. In addition, experienced stigma was negatively associated with both child-rated and parent-rated QoL. Perceived weight stigma was associated only with parent-rated weight-related QoL but not child-rated QoL. Self-stigma was associated with child-rated QoL but not parent-rated QoL. Moreover, perceived weight stigma and weight-related self-stigma were significant mediators in the association between body weight and children's QoL; experienced weight stigma was not a significant mediator. The study findings can be used to inform healthcare providers about the relationship among different types of stigmas and their influence on child-rated and parent-rated QoL and help them develop interventions to address the global trend of overweight/obesity in youth and pediatric populations.
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Affiliation(s)
- Chia-Wei Fan
- Department of Occupational Therapy, AdventHealth University, Orlando, FL, United States
| | - Chieh-Hsiu Liu
- National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hsin-Hsiung Huang
- Department of Statistics and Data Science, University of Central Florida, Orlando, FL, United States
| | - Chung-Ying Lin
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Public Health, National Cheng Kung University Hospital, College of Medicien, National Cheng Kung University, Tainan, Taiwan.,Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Amir H Pakpour
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.,Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
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Krause L, Vogelgesang F, Thamm R, Schienkiewitz A, Damerow S, Schlack R, Junker S, Mauz E. Individual trajectories of asthma, obesity and ADHD during the transition from childhood and adolescence to young adulthood. JOURNAL OF HEALTH MONITORING 2021; 6:2-15. [PMID: 35586784 PMCID: PMC8832367 DOI: 10.25646/7913] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 01/21/2021] [Indexed: 11/05/2022]
Abstract
The German Health Interview and Examination Survey for Children and Adolescents (KiGGS) provides comprehensive and reliable data on the health situation of the upcoming generation. The KiGGS cohort accompanies participants from the KiGGS baseline study (2003-2006) into adulthood. Until now, two follow-up surveys of the cohort have been implemented with KiGGS Wave 1 (2009-2012) and KiGGS Wave 2 (2014-2017). In KiGGS Wave 2, the cohort was supplemented by the in-depth study 'Family and care-specific factors influencing the development, trajectories and effects of mental disorders (especially ADHD), obesity and allergic diseases (especially asthma)'. One aim of the study was to identify individual trajectories of these health disorders. For this purpose, probabilities for typical transitions from the KiGGS baseline study to KiGGS Wave 2 were calculated. An important result is that many participants who had asthma, obesity or ADHD at KiGGS baseline still had the disease more than ten years later: Over a third still had asthma (35%) or ADHD (37%), and almost half were still affected by obesity (47%). The results point to the need for early preventive measures to stop these potentially chronic diseases from developing in childhood and adolescence.
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Affiliation(s)
- Laura Krause
- Corresponding author Dr Laura Krause, Robert Koch Institute, Department of Epidemiology and Health Monitoring, General-Pape-Str. 62–66, 12101 Berlin, Germany, E-mail:
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45
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Krause L, Vogelgesang F, Thamm R, Schienkiewitz A, Damerow S, Schlack R, Junker S, Mauz E. Individual trajectories of asthma, obesity and ADHD during the transition from childhood and adolescence to young adulthood. JOURNAL OF HEALTH MONITORING 2021. [PMID: 35586784 DOI: 10.25646/9178:1-65] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
The German Health Interview and Examination Survey for Children and Adolescents (KiGGS) provides comprehensive and reliable data on the health situation of the upcoming generation. The KiGGS cohort accompanies participants from the KiGGS baseline study (2003-2006) into adulthood. Until now, two follow-up surveys of the cohort have been implemented with KiGGS Wave 1 (2009-2012) and KiGGS Wave 2 (2014-2017). In KiGGS Wave 2, the cohort was supplemented by the in-depth study 'Family and care-specific factors influencing the development, trajectories and effects of mental disorders (especially ADHD), obesity and allergic diseases (especially asthma)'. One aim of the study was to identify individual trajectories of these health disorders. For this purpose, probabilities for typical transitions from the KiGGS baseline study to KiGGS Wave 2 were calculated. An important result is that many participants who had asthma, obesity or ADHD at KiGGS baseline still had the disease more than ten years later: Over a third still had asthma (35%) or ADHD (37%), and almost half were still affected by obesity (47%). The results point to the need for early preventive measures to stop these potentially chronic diseases from developing in childhood and adolescence.
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Affiliation(s)
- Laura Krause
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | | | - Roma Thamm
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Anja Schienkiewitz
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Stefan Damerow
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Robert Schlack
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Stephan Junker
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Elvira Mauz
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
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46
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Kalarchian MA, Hammer J, Kapuścińska A. Fostering Innovation in Prevention and Treatment of Obesity in Youth: Digitally Mediated Physical Play as an Exemplar. Obesity (Silver Spring) 2021; 29:475-477. [PMID: 33538095 DOI: 10.1002/oby.23113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/11/2020] [Accepted: 12/14/2020] [Indexed: 11/12/2022]
Abstract
Novel approaches to obesity prevention among youth are needed. Accordingly, the Office of Women's Health, Department of Health and Human Services, sponsored a challenge to create an interactive video game for obesity prevention. Our team took a theory-based, evidence-informed approach to increasing physical activity in girls. Our approach-digitally mediated physical play-allowed us to include computing-based strategies that promote activity without keeping players in front of a screen. Our prize-winning prototype app, Frolic, helps girls choose the perfect game to play in any context, engaging parents for support. The app is used to highlight some opportunities and challenges for interdisciplinary collaboration. However, much work remains to be done to deploy innovative digital obesity interventions and fully capture the contributions of these tools. In order to accelerate advances, funding is needed for projects that combine engineering design principles with traditional obesity research paradigms.
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Affiliation(s)
| | - Jessica Hammer
- Human Computer Interaction Institute, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
- Entertainment Technology Center, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Adela Kapuścińska
- Human Computer Interaction Institute, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
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47
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Redsell SA, Bains K, Le Brocq S, Bucks R, Byrne‐Davis L, Gray L, Hotham S, Hennessy M, Kyle TK, McPherson A, Quigley F, Vicari M, Zinn S. Concerns regarding “Association between intelligence quotient and obesity in England” and unjustifiable harm to people in bigger bodies. LIFESTYLE MEDICINE 2021. [DOI: 10.1002/lim2.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Sarah A. Redsell
- School of Health Sciences University of Nottingham B302, Medical School Building, Queens Medical Centre Nottingham NG7 2HA UK
| | - Kiran Bains
- School of Health Sciences University of Nottingham B302, Medical School Building, Queens Medical Centre Nottingham NG7 2HA UK
| | - Sarah Le Brocq
- School of Health Sciences University of Nottingham B302, Medical School Building, Queens Medical Centre Nottingham NG7 2HA UK
| | - Romola Bucks
- School of Health Sciences University of Nottingham B302, Medical School Building, Queens Medical Centre Nottingham NG7 2HA UK
| | - Lucie Byrne‐Davis
- School of Health Sciences University of Nottingham B302, Medical School Building, Queens Medical Centre Nottingham NG7 2HA UK
| | - Lesley Gray
- School of Health Sciences University of Nottingham B302, Medical School Building, Queens Medical Centre Nottingham NG7 2HA UK
| | - Sarah Hotham
- School of Health Sciences University of Nottingham B302, Medical School Building, Queens Medical Centre Nottingham NG7 2HA UK
| | - Marita Hennessy
- School of Health Sciences University of Nottingham B302, Medical School Building, Queens Medical Centre Nottingham NG7 2HA UK
| | - Theodore K. Kyle
- School of Health Sciences University of Nottingham B302, Medical School Building, Queens Medical Centre Nottingham NG7 2HA UK
| | - Amy McPherson
- School of Health Sciences University of Nottingham B302, Medical School Building, Queens Medical Centre Nottingham NG7 2HA UK
| | - Fiona Quigley
- School of Health Sciences University of Nottingham B302, Medical School Building, Queens Medical Centre Nottingham NG7 2HA UK
| | - Michelle Vicari
- School of Health Sciences University of Nottingham B302, Medical School Building, Queens Medical Centre Nottingham NG7 2HA UK
| | - Sarah Zinn
- School of Health Sciences University of Nottingham B302, Medical School Building, Queens Medical Centre Nottingham NG7 2HA UK
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48
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Luck-Sikorski C, Bernard M. Stigmatisierung und Diskriminierung von Patient*innen mit Adipositas. PSYCHOTHERAPEUT 2020. [DOI: 10.1007/s00278-020-00475-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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McMaster CM, Cohen J, Alexander S, Neal R, Gow ML, Calleja E, Signorelli C, Tan EJ, Williams K, Sim K, Leong G, Baur LA. Satisfaction and acceptability of paediatric weight management services amongst parents and carers: A mixed-methods study. Clin Obes 2020; 10:e12391. [PMID: 32830905 DOI: 10.1111/cob.12391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/15/2020] [Accepted: 06/20/2020] [Indexed: 01/17/2023]
Abstract
To optimize treatment for children and adolescents with obesity and minimize attrition, consideration of parents' engagement and satisfaction with paediatric weight management services is crucial. The aim of this study was to conduct a mixed-methods evaluation of parental acceptability and satisfaction of available paediatric weight management services in New South Wale, Australia's most populous state. Parents/carers referred to one of six weight management services between March 2018 and July 2019 were invited to participate. The study involved: (a) surveys and one-on-one phone interviews to assess overall satisfaction, acceptability of service design and delivery, treatment expectations, and service accessibility, strengths, weaknesses and areas of improvement; (b) a survey to determine costs to families of attending the service; and (c) a survey assessing families' reasons for treatment non-attendance. N = 146 participants completed the survey to assess service satisfaction and acceptability and 37 of these also participated in phone interviews. Ninety-three per cent were satisfied with the overall care they received and patient weight loss/cessation of weight gain and improvement in the family's overall health were rated as the most valued changes. Content analysis of interviews highlighted participants' recognition of positive changes achieved during treatment and appreciation of the resources provided, and the encouraging/empathetic nature of staff. The most common reasons for treatment attrition were difficulty in accessing the weight management service and flexibility of appointment times. Findings from this study can be utilized in future planning and development of paediatric weight management services to facilitate integrated, responsive and effective care of children and adolescents with obesity.
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Affiliation(s)
- Caitlin M McMaster
- Weight Management Services, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
- Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Sydney, New South Wales, Australia
| | - Jennifer Cohen
- Weight Management Services, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
- Discipline of Paediatrics, School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Shirley Alexander
- Weight Management Services, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Renee Neal
- Weight Management Services, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Megan L Gow
- University of Sydney Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
| | - Elizabeth Calleja
- Weight Management Services, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Christina Signorelli
- Kids Cancer Centre, School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Eng Joo Tan
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Kathryn Williams
- Nepean Family Metabolic Health Service, Nepean Hospital, New South Wales, Australia
- Nepean Clinical School, School of Dentistry and Health, University of Sydney, New South Wales, Australia
| | - Kyra Sim
- Sydney Local Health District, Sydney, New South Wales, Australia
| | - Gary Leong
- Nepean Family Metabolic Health Service, Nepean Hospital, New South Wales, Australia
| | - Louise A Baur
- Weight Management Services, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
- University of Sydney Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
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Stewart L, Easter S. British Dietetic Association's Obesity Specialist Group dietetic obesity management interventions in children and young people: review & clinical application. J Hum Nutr Diet 2020; 34:224-232. [PMID: 33170552 DOI: 10.1111/jhn.12834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/05/2020] [Accepted: 10/12/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Dietitians play a vital role in the management of childhood obesity. To support that role the Obesity Specialist Group of the British Dietetic Association commissioned a review and clinical application paper. This current paper is a summary of that review document, which is available on the BDA's website. METHODS The initial sources of evidence were guidelines, published reviews and government guidance. Best practice advice was sought from networks including the BDA's Obesity and Paediatric Specialists groups. The original document was reviewed by a review group and members of the Obesity and Paediatric Specialist group's committees. RESULTS The overall aim of dietetic interventions in childhood weight management should be to deliver evidence based dietetic weight management care, which helps maintain positive lifestyle changes. To support this aim the review recommends the UK BMI cut off points in setting service referral and triaging criteria. Ensuring the whole child's world is taken into account when undertaking assessment and throughout the programme process is essential. Dietitians working in this field require behavioural change skills, motivational techniques and the ability to communicate to children of differing ages and their parents. Knowledge of local child safe guarding procedures are necessary for all working in this field. Recommendations on basic and advanced skills required are specified. CONCLUSIONS This paper was written to compliment a full review document. The complexities around case management, child protection issues and competing family motivations require dietitians trained at undergraduate and postgraduate level to deliver high quality weight management and behavioural change.
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Affiliation(s)
- L Stewart
- AppleTree Healthy Lifestyle Consultancy, Perth, UK
| | - S Easter
- Bristol Royal Hospital for Children, Bristol, UK
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