Diffusing obesity myths

An Educational Session for Medical Students Exploring Weight Bias in Clinical Care Through the Lens of Body Diversity

Introduction

Weight bias is pervasive in health care and can lead to inadequate care for people with higher weight. However, few medical schools offer training on mitigating weight bias and incorporating body diversity into clinical care.

Methods

As part of a course for second-year medical students, we developed and implemented a 3-hour multimodal educational session on mitigating weight bias. Didactics included content on body diversity and addressing weight bias, followed by a facilitated case discussion in small groups focused on debunking common myths related to weight. Assessment consisted of an open-content quiz and evaluation of a postsession survey. We performed a thematic analysis of the essay quiz responses and evaluation survey results.

Results

Three hundred fifty-three students participated in academic years 2020-2021 and 2021-2022. In the postsession quiz, students described several learning points, including understanding environmental influences on body size, improving communication by reducing weight bias, and strengthening the patient-provider relationship. In the postsession evaluation, students reported that their knowledge and skills had improved with respect to the learning objectives, with means of 4.0-4.1 on a 5-point Likert scale. Areas for suggested improvement included more time for discussion and more guidance on weight-inclusive care.

Discussion

This multimodal educational session on weight bias was successful in meeting the stated learning objectives. Future work will consist of building on this content and extending future iterations to residents and attendings, with the goal of disrupting harmful assumptions and improving access to holistic, evidence-based care for all people, regardless of size.

"Myths and Facts" Education Is Comparable to "Facts Only" for Recall of Back Pain Information but May Improve Fear-Avoidance Beliefs: An Embedded Randomized Trial

OBJECTIVE

To assess the effectiveness of patient education with "myths and facts" versus "facts only" on recall of back pain information and fear-avoidance beliefs in patients with chronic low back pain (LBP).

DESIGN

Randomized Study Within A Trial.

METHODS

One hundred fifty-two participants with chronic LBP were included. Participants allocated to the "facts only" group received an information sheet with 6 LBP facts, whereas those allocated to the "myths and facts" group received the same information sheet, with each myth refuted by its respective fact. The primary outcome was a correct recall of back pain facts, and the secondary outcome was the physical activity component of the Fear-Avoidance Beliefs Questionnaire (FABQ-PA), 2 weeks after the provision of the information sheet.

RESULTS

There was no evidence of a difference in the proportion of participants with a correct recall between the "myths and facts" and "facts only" groups (odds ratio = 0.98; 95% confidence interval [CI]: 0.48, 1.99) and no significant difference in FABQ-PA mean scores between groups (-1.58; 95% CI: -3.77, 0.61). Sensitivity analyses adjusted for prognostic factors showed no difference in information recall but a larger difference in FABQ-PA scores (-2.3; 95% CI: -4.56, -0.04).

CONCLUSION

We found no overall difference in the recall of back pain information for patients provided with "myths and facts" compared with that for patients provided with "facts only" and a slight reduction in fear-avoidance beliefs for physical activity using "myths and facts" compared with that using "facts only," but the meaningfulness of this result is uncertain. J Orthop Sports Phys Ther 2022;52(9):586-594. Epub: 9 July 2022. doi:10.2519/jospt.2022.10989.

Influence and effects of weight stigmatisation in media: A systematic

BACKGROUND

The lack of a comprehensive understanding of the role of mass media in perpetuating weight stigma hinders policy formulation. We reviewed the influence of mass media on weight stigmatisation and the effectiveness of media-based interventions designed to prevent or reduce stigma.

METHODS

We conducted a systematic review across seven databases from inception to December 2021. Included studies assessed exposure to or impact of weight stigma in mass media or examined interventions to reduce stigma through media in populations 12+ years. We synthesised data narratively, categorising studies based on similarity in focus to produce a set of integrated findings. The systematic review is registered in PROSPERO (No. CRD42020176306).

FINDINGS

One-hundred-and-thirteen records were eligible for inclusion from 2402 identified; 95 examined the prevalence of stigmatising content in mass media and its impact on stigma. Weight stigma was prevalent across media types, with the dominant discourse viewing overweight and obesity as an individual responsibility and overlooking systemic factors. Exposure to stigmatising content was found to negatively influence attitudes towards people with overweight or obesity. Few studies considered methods of reducing stigma in the media, with only two testing media-based interventions; their results were promising but limited.

INTERPRETATION

Weight stigma in media content is prevalent and harmful, but there is little guidance on reducing it. Future research focus needs to shift from assessing prevalence and impacts to weight stigma interventions.

FUNDING

None.

Weight stigma and prenatal physical activity: Exploring the perspectives of pregnant women living with obesity

OBJECTIVE

To identify sources of weight stigma in physical activity (PA)-related milieus reported by pregnant women living with obesity. We also report person-informed strategies to improve the delivery of PA promotions and prescriptions to prevent weight stigma and improve maternal PA.

DESIGN

This is a qualitative descriptive study and semi-structured interviews were conducted.

SETTING AND PARTICIPANTS

Purposive sampling including pregnant women living with obesity, with a body mass index ≥35.0 kg/m², ≥18 years of age, and receiving specialized prenatal care were recruited from an obstetrics clinic in Kingston, Canada.

MEASUREMENT AND FINDINGS

Data were assessed by a content analysis, whereby coded themes represented sources of weight stigma related to prenatal PA. Demographic characteristics (pre-pregnancy body mass index, age, gestational age) were summarized and presented as means and standard deviations. In-depth interview data were collected from eight women. Average pre-pregnancy BMI, age, and gestational age were 44.6±4.8 kg/m², 32.0±4.1 years, 31.1±5.8 weeks, respectively. Two sources of weight stigma related to prenatal PA were identified: 1. Lack of visual representation - online images and images found in exercise promotional material do not include women who have obesity; 2. Lack of individualized recommendations - currently available prenatal PA guidelines and/or recommendations from healthcare providers do not always consider individual physical barriers or health goals women may have.

KEY CONCLUSION AND IMPLICATIONS FOR PRACTICE

By increasing body positive representation of pregnant women exercising and offering person-centered prenatal PA recommendations, maternal PA may improve including women living with obesity. Findings from this work can inform future PA interventions, health promotion programming, and prescriptions from prenatal care providers to implement person-oriented strategies to prevent weight stigma and improve the delivery of care for pregnant women living with obesity.

Edmonton Obesity Staging System (EOSS) and Work Ability in the Evaluation of Workers Affected by Obesity: A Preliminary Report

OBJECTIVE

Obesity and work-ability may be influenced by reduced performance, associated diseases, and obesogenic environment.

METHODS

Two hundred seventy-six male (46.7 ± 10.6 years; BMI 33.3 ± 4.4 kg/m) and 658 female (48.4 ± 9.7 years; BMI 33.6 ± 5.4 kg/m) were enrolled. They were classified by Edmonton Obesity Staging System (EOSS) and interviewed for "perceived" work-ability.

RESULTS

Total work ability score was 1.3 ± 2.1 in EOSS 0, 1.2 ± 1.5 in EOSS 1, 1.8 ± 2 in EOSS 2, 2.0 ± 2.2 in EOSS 3. Work-ability, in relation to EOSS adjusted for sex, age, work categories referred to EOSS 0, was highest in EOSS stage 3 (P < 0.001 for trend) and with reference to Administration; Industries showed the worst score (P < 0.001) followed by Health (P = 0.001) and Service (P = 0.01).

CONCLUSION

The relation between EOSS and work-ability empowers clinical decision-making and helps to assess the impact of overweight on health and fitness for work.

Perceptions of barriers to effective obesity management in Canada: Results from the ACTION study

Obesity is a chronic disease with a significant and growing impact on Canadians. The "Awareness, Care and Treatment In Obesity MaNagement" (ACTION) Study investigated perceptions, attitudes and perceived barriers to obesity management among Canadian people with obesity (PwO), healthcare providers (HCPs) and employers. In this study adult PwO (body mass index ≥30 kg/m² , based on self-reported height/weight), HCPs (physicians and allied HCPs managing PwO) and employers (≥20 employees; offering health insurance), completed online surveys between 3 August and 11 October 2017 in a cross-sectional design. Survey respondents (N = 2545) included 2000 PwO, 395 HCPs and 150 employers. Obesity was viewed as a "chronic medical condition" by most PwO (60%), HCPs (94%) and employers (71%) and deemed to have a large impact on overall health (74%, 78%, 81%, respectively). Many PwO (74%) believed weight management was their own responsibility. While PwO (55%) reportedly knew how to manage their weight, only 10% reported maintaining ≥10% weight reduction for >1 year. Despite low success rates, the most commonly reported effective long-term weight loss methods tried and/or recommended were "improvements in eating habits" (PwO 38%; HCP 63%) and "being more active" (PwO 39%; HCP 54%). PwO and HCPs reported very different perceptions of the quality and content of their interaction during obesity management discussions. These findings highlight the communication gaps and misunderstanding between PwO, HCPs and employers. This underscores the importance of, and need for, evidence-based management of obesity and a collaborative approach and understanding of the complex nature of this chronic disease.

Obesity Prevention and Management Strategies in Canada: Shifting Paradigms and Putting People First

PURPOSE OF REVIEW

The purpose of this study was to review public and private sector obesity policies in Canada and to make recommendations for future evidence-based obesity prevention and management strategies.

RECENT FINDINGS

Synthesis of obesity prevention and management policies and research studies are presented in three primary themes: (1) Increased awareness about the impact of weight bias and obesity stigma in Canada; (2) Inadequate government obesity prevention and management policies and strategies; and (3) Lack of comprehensive private sector obesity prevention and management policies. Findings suggest that in Canada, obesity continues to be treated as a self-inflicted risk factor, which affects the type of interventions and approaches that are implemented by governments or covered by private health plans. The lack of recognition of obesity as a chronic disease by Canadian public and private payers, health systems, employers, and the public, has a trickle-down effect on access to evidence-based prevention and treatment. Although there is increasing recognition and awareness about the impact of weight bias and obesity stigma on the health and social well-being of Canadians, interventions are urgently needed in education, healthcare, and public policy sectors. We conclude by making recommendations for the advancement of evidence-based obesity prevention and management policies that can improve the lives of Canadians affected by obesity.

Myths about HIV and AIDS among serodiscordant couples in Malawi

Purpose

The purpose of this paper is to report on research that uncovered myths about HIV and AIDS held by serodiscordant couples in Malawi, and the sources of these myths. The paper reflects on how the myths affect serodiscordant couples’ engagement with HIV and AIDS information.

Design/methodology/approach

Van Manen’s (1997) approach to analysis of phenomenological data was used to analyse data from in-depth interviews conducted in Malawi with 21 serodiscordant couples and three individuals who had separated from their partners because of serodiscordance.

Findings

Serodiscordant couples in Malawi believe and hold on to some inaccurate HIV and AIDS information that can be seen as “myths”. Some of these myths are perpetuated by official HIV and AIDS information when it is translated into the local languages. Other myths derive from social norms of the societies where the couples live.

Practical implications

The findings of this paper have practical implications for how HIV and AIDS information providers should engage with target audiences to understand the origins of the myths they hold. The findings also imply that some myths have technical, religious, moral and cultural bases which need to be addressed before challenging the myth itself.

Originality/value

Using real-life descriptions of experiences of HIV and AIDS information provided by serodiscordant couples, the authors reveal how myths can affect engagement with the information. The authors make recommendations on how to address myths in ways that contribute to a positive experience of HIV and AIDS information by serodiscordant couples.

How calorie-focused thinking about obesity and related diseases may mislead and harm public health. An alternative

Prevailing thinking about obesity and related diseases holds that quantifying calories should be a principal concern and target for intervention. Part of this thinking is that consumed calories – regardless of their sources – are equivalent; i.e. ‘a calorie is a calorie’. The present commentary discusses various problems with the idea that ‘a calorie is a calorie’ and with a primarily quantitative focus on food calories. Instead, the authors argue for a greater qualitative focus on the sources of calories consumed (i.e. a greater focus on types of foods) and on the metabolic changes that result from consuming foods of different types. In particular, the authors consider how calorie-focused thinking is inherently biased against high-fat foods, many of which may be protective against obesity and related diseases, and supportive of starchy and sugary replacements, which are likely detrimental. Shifting the focus to qualitative food distinctions, a central argument of the paper is that obesity and related diseases are problems due largely to food-induced physiology (e.g. neurohormonal pathways) not addressable through arithmetic dieting (i.e. calorie counting). The paper considers potential harms of public health initiatives framed around calorie balance sheets – targeting ‘calories in’ and/or ‘calories out’ – that reinforce messages of overeating and inactivity as underlying causes, rather than intermediate effects, of obesity. Finally, the paper concludes that public health should work primarily to support the consumption of whole foods that help protect against obesity-promoting energy imbalance and metabolic dysfunction and not continue to promote calorie-directed messages that may create and blame victims and possibly exacerbate epidemics of obesity and related diseases.