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Wu R, Puhl RM, Lessard LM, Foster GD, Cardel MI. Exploring the interplay of weight-based teasing and sociodemographic factors in adolescent weight bias internalization. J Pediatr Psychol 2024:jsae042. [PMID: 38853703 DOI: 10.1093/jpepsy/jsae042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 05/21/2024] [Accepted: 05/24/2024] [Indexed: 06/11/2024] Open
Abstract
OBJECTIVE Research has highlighted the potential adverse effects of weight bias internalization (WBI) on adolescents, but there has been little examination of WBI and sources of weight teasing (family, peers, or both) or across racial/ethnic diversity of adolescents. We aimed to examine the relationship between WBI and sources of weight teasing across sociodemographic characteristics and weight status in a diverse community sample of adolescents. METHODS Data were collected from a U.S. sample of 1859 adolescents aged 10-17 years (59% female; 43% White, 27% Black or African American, and 25% Latino). An online questionnaire was used to assess participants' experiences of weight teasing from family members, peers, or both, and their weight status, weight-related goals, WBI, and sociodemographic characteristics. RESULTS Adolescents experiencing weight teasing from both family and peers reported the highest levels of WBI, while those reporting no teasing exhibited the lowest levels. These patterns were observed across sex, race/ethnicity, weight status, and weight goals, and persisted after controlling for depressive symptoms. Notably, family influences played a salient role, with adolescents reporting higher WBI if teased by family only compared to teasing from peers only. Sex and racial differences were also observed in adolescents' experiences with weight-based teasing. CONCLUSION Our study reveals associations between adolescent weight-based teasing, WBI, and sociodemographic factors. Weight-based teasing, whether from family and peers or from family only, was associated with increased WBI. Interventions targeting weight stigma in youth should not be limited to peer-focused efforts, but should also emphasize supportive family communication.
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Affiliation(s)
- Rui Wu
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, United States
| | - Rebecca M Puhl
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, United States
- Rudd Center for Food Policy and Health, University of Connecticut, Hartford, CT, United States
| | - Leah M Lessard
- Rudd Center for Food Policy and Health, University of Connecticut, Hartford, CT, United States
| | - Gary D Foster
- WW International, Inc, New York, NY, United States
- Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Michelle I Cardel
- Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, United States
- Center for Integrative Cardiovascular and Metabolic Disease, University of Florida, Gainesville, FL, United States
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2
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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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3
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Cosimini M, Shah P, Jung C, Bennett A, Fang K, Solomon O, Espinoza J. Cute Kid? Patient Obesity Status and the Use of Nonmedical Descriptors in Presentations by Pediatric Residents. Child Obes 2023; 19:565-569. [PMID: 36350335 DOI: 10.1089/chi.2022.0157] [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: 11/11/2022]
Abstract
Nonmedical descriptors, adjectives that are not related to a medical condition, such as "cute," are often used in presentations in pediatrics. We hypothesize that patterns of their use may reflect obesity bias. Descriptors used by pediatric residents presenting cases of children <9 years in an outpatient clinic during the 2018-2019 and 2019-2020 academic years were recorded. The primary outcome was the association of the use of positive nonmedical descriptors with children's obesity status using logistic regression. Positive descriptors were used in 14% of 994 presentations. Most addressed the appearance of the child with variations of "cute" and "adorable." There was no variation in use of positive descriptors by obesity status. On multivariate logistic regression, the odds of using positive descriptors were higher among female residents, and positive descriptor use declined with patient age. Negative descriptors were rare and often focused on weight.
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Affiliation(s)
- Michael Cosimini
- Division of General Pediatrics, Oregon Health and Science University, Portland, OR, USA
| | - Payal Shah
- Division of General Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Christina Jung
- Division of General Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Ashely Bennett
- Division of General Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Kevin Fang
- Division of General Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Olga Solomon
- Division of General Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Juan Espinoza
- Division of General Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA
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4
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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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5
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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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6
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Roberts KJ, Chaves E. Beyond Binge Eating: The Impact of Implicit Biases in Healthcare on Youth with Disordered Eating and Obesity. Nutrients 2023; 15:nu15081861. [PMID: 37111080 PMCID: PMC10146797 DOI: 10.3390/nu15081861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/30/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
(1) Background: Obesity and eating disorders (ED) can coexist resulting in worse health outcomes. Youth with ED are more likely to have obesity relative to peers with a healthy weight. Pediatric providers deliver first-line care to children and youth of all sizes and body shapes from infancy to adolescents. As healthcare providers (HCPs), we bring biases into our practice. Learning to recognize and address these biases is needed to provide the best care for youth with obesity. (2) Purpose: This paper aims to summarize the literature regarding the prevalence of ED beyond binge eating in youth with obesity and discuss how the intersection of weight, gender, and racial biases impact the assessment, diagnosis, and treatment of ED. We provide recommendations for practice and considerations for research and policy. (3) Conclusions: The assessment and treatment of ED and disordered eating behaviors (DEBs) in youth with obesity is complex and requires a holistic approach. This approach begins with identifying and understanding how one's implicit biases impact care. Providing care from a patient-centers lens, which considers how the intersection of multiple stigmatized identities increases the risk for DEBs in youth with obesity may improve long-term health outcomes.
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Affiliation(s)
- Karyn J Roberts
- College of Nursing, University of Wisconsin-Milwaukee, 1921 E Hartford Avenue, Milwaukee, WI 53211, USA
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Eileen Chaves
- Nationwide Children's Hospital, The Ohio State University, 700 Children's Drive, Jwest 3rd Floor Columbus, Columbus, OH 43205, USA
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7
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Williams DR, Chaves E, Karp SM, Browne NT. Clinical review: Implementation of trauma informed care to optimally impact the treatment of childhood obesity. OBESITY PILLARS (ONLINE) 2023; 5:100052. [PMID: 37990746 PMCID: PMC10662032 DOI: 10.1016/j.obpill.2022.100052] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 12/15/2022] [Indexed: 11/23/2023]
Abstract
Background Traumatic events that occur in infancy, childhood, and adolescence can be impactful over the course of a lifespan. Adverse childhood experiences (ACEs) are associated with chronic health problems and mental illness, and can negatively impact educational and job opportunities. There is a growing body of evidence about the relationship between ACEs and the risk of childhood obesity. Trauma informed care (TIC) is an approach to patient care both at the clinical and organizational level that is responsive to the impact past trauma can have on an individual. Methods This clinical review will focus on the impact of toxic stress from trauma on the child through threats to normal physiology, including the manifestation of obesity through energy regulation pathophysiology, followed by a discussion of TIC principles. Available resources and how trauma informed principles can be used in practice are discussed using case study methodology. Results TIC programs recognize the impact of trauma on both patients and clinicians. TIC implementation includes application of TIC four assumptions and six key principles out-lined by Substance Abuse and Mental Health Services Administration's guidance. Clinicians supported by well-designed systems recognize that disclosure is not the goal of TIC; instead, broad trauma inquiry, proceeding to risk and safety assessment if indicated, and connection to interventions is the focus. Best practice communication allows clinicians to access information without retraumatizing the patient with ongoing repetition of their trauma experience. Conclusion Combining the pillars of obesity treatment (i.e., nutrition, physical activity, behavior therapy, medical management) with the tenets of TIC (realize, recognize, respond, resist re-traumatization) affords patients holistic, intentional care and family support. The desired outcomes of TIC align with goals of obesity treatment in children, namely improvement of health and quality of life, sense of self (e.g., body image and self-esteem), and prevention of negative health outcomes.
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Affiliation(s)
- Dominique R. Williams
- The Ohio State University College of Medicine, Center for Healthy Weight and Nutrition, Nationwide Children's Hospital, 700 Children's Drive LAC, Suite 5F, Columbus, OH, 43215, USA
| | - Eileen Chaves
- Neuropsychology & Pediatric Psychology, The Ohio State University, College of Medicine, Center for Healthy Weight and Nutrition, Nationwide Children's Hospital, 700 Children's Drive LAC, Suite 5F, Columbus, OH, 43215, USA
| | - Sharon M. Karp
- Vanderbilt University School of Nursing, 461 21st Ave South, Nashville, TN, 37240, USA
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8
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Puhl RM, Lessard LM, Foster GD, Cardel MI. Patient and Family Perspectives on Terms for Obesity. Pediatrics 2022; 150:190093. [PMID: 36404759 DOI: 10.1542/peds.2022-058204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/15/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Parent communication about body weight is a sensitive topic, but limited research has studied youth preferences for words used to talk about their weight with parents. We assessed perspectives of weight-based terminology in 2 racially/ethnically diverse samples of youth and parents. METHODS We collected online survey data from 2 panel survey samples between September and December 2021: youth aged 10 to 17 years (n = 2032) and parents of youth aged 10 to 17 years (n = 1936). Participants rated 27 different terms and phrases to describe body weight; parents reported on their usage of this terminology and youth reported their preferences for and emotional responses to terminology. Patterns were examined across sex, race/ethnicity, sexual orientation, and weight status. RESULTS Youth reported preferences for words such as "healthy weight" and dislike of terms such as "obese," "fat," and "large," which induced feelings of sadness, shame, and embarrassment. Differences in youth preferences and emotional reactions were present across sex, sexual orientation, race/ethnicity, and weight status. This included a general pattern of lower preference ratings among girls (versus boys) and sexual minority (versus heterosexual) youth, and stronger preferences for words such as "thick" or "curvy" among racial/ethnic minority, sexual minority, and higher-weight youth. Use of most weight terms was higher among fathers compared with mothers, and by Hispanic/Latinx parents compared with white and Black/African American parents. CONCLUSIONS Our findings underscore diversity of youth preferences and the need for individualized approaches that support effective parent and youth communication by using their preferred terms when discussing weight-related health.
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Affiliation(s)
- Rebecca M Puhl
- Rudd Center for Food Policy & Health, University of Connecticut, Hartford, Connecticut.,Department of Human Development & Family Sciences, University of Connecticut, Storrs, Connecticut
| | - Leah M Lessard
- Department of Human Development & Family Sciences, University of Connecticut, Storrs, Connecticut
| | - Gary D Foster
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,WW International, Inc, New York, New York
| | - Michelle I Cardel
- WW International, Inc, New York, New York.,Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida
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9
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Müssener U, Örn M, Olbers T, Löf M, Sjögren L. Adolescents' and professionals' experiences of metabolic and bariatric surgery and requirements for preoperative and postoperative support through mHealth: a qualitative study. BMJ Open 2022; 12:e064893. [PMID: 36332966 PMCID: PMC9639096 DOI: 10.1136/bmjopen-2022-064893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES This study aimed to explore adolescents' and professionals' incentives and experiences of metabolic and bariatric surgery (MBS) and to explore perceived needs and requirements for preoperative and postoperative support through an mHealth intervention to improve long-term healthy lifestyle behaviour and health outcomes. DESIGN An inductive qualitative study using in-depth semistructured interviews. SETTING Three hospital-based specialist paediatric obesity treatment units in Sweden. PARTICIPANTS A total of 18 participants (14 women and 4 men). Nine adolescents aged between 17 and 22 years who had undergone or were about to undergo surgery, and nine professionals, including researchers and clinicians working in various professional roles such as physiotherapist, dietician, nurse, psychologist, physician and pedagogue. RESULTS Both informant groups of participants highlighted that undergoing MBS is a complex process, and hence actions are required on several levels to optimise the positive, long-term effects of surgery. Efficient communication between the healthcare professionals and adolescents was considered crucial and a key success factor. Informants acknowledged the need for additional support that relates to psychosocial well-being and mental health in order to understand, form and accept new behaviours and identity. An mHealth intervention should be seen as complementary to physical appointments, and informants acknowledged that an app could be a way of improving access to healthcare, and a useful tool to allow for individually tailored and easily available support. CONCLUSIONS The findings address the importance of a personal encounter and a need for additional support that relates to psychosocial well-being, mental health and healthy lifestyle behaviour. These findings should be incorporated into future research concerning mHealth interventions in MBS during adolescence.
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Affiliation(s)
- Ulrika Müssener
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Malin Örn
- Region Västra Götaland, Pediatric Obesity Center, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Torsten Olbers
- Department of Biomedical and Clinical Medicine, Linköping University, Linkoping, Sweden
| | - Marie Löf
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
- Department of Biosciences and Nutrition, Karolinska Institute, Huddinge, Sweden
| | - Lovisa Sjögren
- Region Västra Götaland, Pediatric Obesity Center, Sahlgrenska University Hospital, Goteborg, Sweden
- Department of Biosciences and Nutrition, Karolinska Institute, Huddinge, Sweden
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
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10
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Woo S, Song HJ, Kim Y, Lim H, Park KH. Factors associated with the perception of parents and children regarding obesity-related terminology used by healthcare professionals in a sample of Korean children and adolescents with obesity. Obes Res Clin Pract 2022; 16:421-428. [PMID: 35989180 DOI: 10.1016/j.orcp.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 07/17/2022] [Accepted: 08/05/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVE This study aimed to compare how children with overweight or obesity and their parents perceive the obesity-related terms used by healthcare professionals and investigate the factors associated with these perceptions. METHODS Children and adolescents aged 8-16 years with overweight or obesity (n = 192) and their parents participated in the cross-sectional study by responding to a 5-point Likert-scale questionnaire on 10 obesity-related terms, including "chubby," "weight problem," "weight," "overweight," "BMI," "obese," "heavy," "fleshy," "fat," and "severely obese." RESULTS For both children and parents, "chubby" was the most desirable term (mean ± standard deviation: 3.50 ± 1.12 and 2.95 ± 0.83, respectively), and "severely obese" was the least acceptable term (2.83 ± 1.17 and 2.02 ± 1.02, respectively). Although the parents preferred all the terms less than the children did (p < 0.001), "weight problem" was considered most motivating for a child to lose weight (3.93 ± 0.94). Among children, older age and a larger self-perceived body size were associated with a more positive response towards obesity-related terms, whereas having internalized or externalized problems were negatively associated with these terms. Parents with a history of cardiovascular disease considered "severely obese" (β = -0.419, [95% CI: -0.739, -0.099]) and "fat" (β = -0.457, [95% CI: -0.750, -0.164]) less desirable. CONCLUSIONS Children and adolescents had a higher preference for obesity-related terms than their parents and preferred that healthcare professionals use euphemistic terms such as "chubby," or neutral terms such as "weight problem." Children with larger self-perceived body sizes or older age had a higher preference for obesity-related words. The terms used by healthcare professionals to describe excess weight must be motivating and respectful for all family members participating in the treatment.
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Affiliation(s)
- Sarah Woo
- Department of Medical Sciences, College of Medicine, Hallym University, Chuncheon-si, Gangwon-do 24252, Republic of Korea.
| | - Hong Ji Song
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Hallym University, Anyang-si, Gyeonggi-do 14068, Republic of Korea.
| | - YoonMyung Kim
- University College, Yonsei University International Campus, Incheon 21983, Republic of Korea.
| | - Hyunjung Lim
- Department of Medical Nutrition, Kyung Hee University, Yongin-si, Gyeonggi-do 17104, Republic of Korea.
| | - Kyung Hee Park
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Hallym University, Anyang-si, Gyeonggi-do 14068, Republic of Korea.
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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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12
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Fisch C, Whelan J, Evans S, Whitaker LA, Gajjar S, Ali L, Fugate C, Puhl R, Hartwell M. Use of person-centred language among scientific research focused on childhood obesity. Pediatr Obes 2022; 17:e12879. [PMID: 34928545 DOI: 10.1111/ijpo.12879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/23/2021] [Accepted: 12/03/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Stigma towards children with obesity can begin as early as 3 years old, leading to increased risk for poorer mental health outcomes and lower quality of life. This includes discriminatory language used by peers and adults, which may be compounded by use within the medical community and in published research. OBJECTIVES Our primary objective was to investigate adherence to person-centred language (PCL) in childhood obesity-related medical publications. METHODS We searched PubMed for childhood obesity-related articles from 2018 through 2020, from journals frequently publishing childhood-obesity-related research. Articles were randomized and searched for a list of predetermined, stigmatizing terms. RESULTS Of the sample of 300 articles, only 21.7% were adherent to PCL guidelines. The most frequent labels found were 'obese' appearing in 70.33% of articles and 'overweight' in 63.7%. Labels such as 'chubby', 'large', and 'fat' were less common, but still appeared in the medical literature. CONCLUSIONS A majority of childhood obesity-related articles did not adhere to PCL guidelines. Given the negative effects of stigma among children with obesity, it is imperative to advocate for PCL use within the medical community. Increased stringency by journal editors and publishers may be the next step in this process.
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Affiliation(s)
- Claudia Fisch
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - John Whelan
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Sheridan Evans
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Liza-Ann Whitaker
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences at Cherokee Nation, Tulsa, Oklahoma, USA
| | - Swapnil Gajjar
- Department of Industrial Engineering & Management, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Lamiaa Ali
- Department of Pediatrics, University of Oklahoma School of Community Medicine, Tulsa, Oklahoma, USA
| | - Colony Fugate
- Department of Pediatrics, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Rebecca Puhl
- Department of Human Development & Family Sciences, Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, Connecticut, USA
| | - Micah Hartwell
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA.,Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
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13
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Kirk S, Ogata B, Wichert E, Handu D, Rozga M. Treatment of Pediatric Overweight and Obesity: Position of the Academy of Nutrition and Dietetics Based on an Umbrella Review of Systematic Reviews. J Acad Nutr Diet 2022; 122:848-861. [DOI: 10.1016/j.jand.2022.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 01/13/2022] [Indexed: 10/19/2022]
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14
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van Maarschalkerweerd PEA, Camfferman R, Seidell JC, Halberstadt J. Children's, Parents' and Healthcare Professionals' Preferences for Weight-Based Terminology in Health Care. HEALTH COMMUNICATION 2021; 36:1805-1809. [PMID: 32722954 DOI: 10.1080/10410236.2020.1796282] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The current study explored the preferences for and knowledge of weight-based terminology used in healthcare-related conversations, and descriptively compared the preferences of children, parents and healthcare professionals. In total, 86 children with overweight or obesity, 90 parents of children with overweight or obesity and 572 healthcare professionals indicated their preferences for 22 terms. When applicable, children and parents could indicate unfamiliarity with a term. Many children were unfamiliar with terms such as "adiposity"adipositas"" (93%), "BMI" (60%) and "morbid obesity" (53%). Children, parents and healthcare professionals disliked "fatadjective". All groups liked the terms "healthier weight" and "above a healthy weight". To conclude, children's, parents' and healthcare professionals' preferences for weight-based terminology are predominately congruent, except for "BMI". "BMI" is a popular term among healthcare professionals. It is recommended that healthcare professionals use terms that can be perceived as neutral or positive, such as "healthier weight", as this may contribute to a positive conversation which may lead to better compliance, and to avoid terms that can be perceived as judgmental, such as "fatadjective", as this may worsen the dialogue and relationship between families and healthcare professionals, and increase weight-based stigma. Healthcare professionals should be aware that children may be unfamiliar with some terms.
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Affiliation(s)
| | - Roxanna Camfferman
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute
| | - Jacob C Seidell
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute
| | - Jutka Halberstadt
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute
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15
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Confroy K, Miles C, Kaplan S, Skelton JA. Pediatric Obesity and Sports Medicine: A Narrative Review and Clinical Recommendations. Clin J Sport Med 2021; 31:e484-e498. [PMID: 32852300 DOI: 10.1097/jsm.0000000000000839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 02/11/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To review what is known about sports medicine and pediatric obesity, with a focus on injuries and MSK concerns. DATA SOURCES Systematically searched MEDLINE (PubMed) for all years, using search combinations to best identify potential publications. Manuscripts were reviewed, summarized, and discussed in detail. Experienced clinicians in sports medicine and pediatric obesity reviewed the final searches for substantive content. Inclusion criteria include English language publications, children ≤18 years old, related to the practice of sports medicine and pediatric obesity. Publications excluded that dealt with non-sports medicine aspects of pediatric obesity, such as increasing physical activity or exercise, or the prevention or treatment of obesity. MAIN RESULTS Twenty-eight publications were included for review. Papers fell into 5 groupings: (1) MSK-increased incidence of MSK injury in children with obesity, hypothesized to be a result of changes in biomechanics; (2) weight management-gradual loss while maintaining proper hydration and nutrition for sports performance; (3) fitness/conditioning-children with overweight/obese showed decreased fitness measures and cardiopulmonary conditioning; (4) exertional heat illness-a concern for adolescent athletes with obesity, specifically in football; and (5) differential diagnoses-3 key differential diagnoses were identified for increased awareness: slipped capital femoral epiphysis, Blount's disease, and pes planus. Clinical topics pertinent to sports medicine and pediatric obesity were discussed. CONCLUSIONS Sports medicine clinicians should be aware of the common MSK and sports-related conditions in children with obesity. Few studies have focused investigations on issues related to children with obesity participating in sports and other physical activities.
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Affiliation(s)
- Kristen Confroy
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | - Sebastian Kaplan
- Departments of Family and Community Medicine
- Psychiatry and Behavioral Medicine; and
| | - Joseph A Skelton
- Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina; and
- Brenner FIT (Families In Training) Program, Brenner Children's Hospital, Wake Forest Baptist Health, Winston-Salem, North Carolina
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16
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Auckburally S, Davies E, Logue J. The Use of Effective Language and Communication in the Management of Obesity: the Challenge for Healthcare Professionals. Curr Obes Rep 2021; 10:274-281. [PMID: 34003446 PMCID: PMC8408082 DOI: 10.1007/s13679-021-00441-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Initial conversations about weight with patients are important to set the tone for future dialogue and management of obesity. There is often reluctance in raising the topic of overweight or obesity in consultations. We aimed to evaluate literature to discover the perceived barriers to optimal discussion about weight status and preferred weight-based terminology for adults, adolescents and parents of younger children. RECENT FINDINGS Fear of offending patients, insufficient training and lack of knowledge of referral pathways were identified as factors hindering healthcare professionals' ability to discuss weight with patients. Neutral terms, such as 'weight', were preferred by patients, with 'fat' and 'obese' viewed as undesirable and stigmatising words. There is a need for greater support and provision of specific training, including education on communicating weight status, for those involved in the management of obesity. More research is necessary to assess the impact of interventions to improve initial discussions with patients about weight.
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Affiliation(s)
- Sameera Auckburally
- Faculty of Health and Medicine, Health Innovation One, Sir John Fisher Drive, Lancaster University, Lancaster, LA1 4AT, UK.
- Department of Paediatrics, Blackpool Victoria Hospital, Whinney Heys Rd, Blackpool, FY3 8NR, UK.
| | - Elena Davies
- Faculty of Health and Medicine, Health Innovation One, Sir John Fisher Drive, Lancaster University, Lancaster, LA1 4AT, UK
| | - Jennifer Logue
- Faculty of Health and Medicine, Health Innovation One, Sir John Fisher Drive, Lancaster University, Lancaster, LA1 4AT, UK
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17
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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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18
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Yerges AL, Snethen JA, Carrel AL. Female adolescents with overweight and obesity share their perspectives on the clinical setting and weight management. Clin Obes 2021; 11:e12415. [PMID: 32945141 DOI: 10.1111/cob.12415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/25/2020] [Accepted: 08/28/2020] [Indexed: 12/16/2022]
Abstract
The clinical setting remains a strategic environment for early assessment, identification and treatment of adolescents with obesity. Yet, healthcare providers' (HCPs) efforts have been unsuccessful in improving physical activity, nutritional intake or body mass index in adolescents with obesity. Obesity is a chronic condition that influences how patients interact with HCPs and experience ambulatory healthcare appointments. However, it is unknown how female adolescents with obesity perceive the clinical setting, especially regarding weight management. The purpose of this study was to explore the perceptions of female adolescents with obesity regarding health and weight management in the clinical setting. Using a qualitative design, 28 English-speaking female adolescents, 13 to 19 years of age, with a body mass index ≥85th percentile for height and weight participated in individual interviews. Results demonstrate that adolescents with obesity desire to be recognized as unique individuals and to be involved in their own health conversations. The participants reported that their health care was inadequate when they received impersonal and vague advice from HCPs on weight loss. Weight-related communication was best received in a kind and empathetic manner, with a focus on improving one's health (instead of losing weight). Adolescents in this study articulated the components of healthy eating and physical exercise, yet were unable to synthesize this knowledge into specific dietary practices and daily physical activities. The insights derived from female adolescents with obesity provide guidance on how HCPs can improve their relationship and engage the adolescent in weight-based discussions. Concrete, actionable recommendations are provided for providers who work with female adolescents who are overweight or obese.
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Affiliation(s)
- April L Yerges
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Julia A Snethen
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Aaron L Carrel
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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19
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Moorman EL, Warnick JL, Acharya R, Janicke DM. The use of internet sources for nutritional information is linked to weight perception and disordered eating in young adolescents. Appetite 2020; 154:104782. [PMID: 32544467 DOI: 10.1016/j.appet.2020.104782] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 06/01/2020] [Accepted: 06/11/2020] [Indexed: 12/18/2022]
Abstract
The internet serves as an accessible and confidential resource for young adolescents seeking nutritional information. However, the quality of information retrieved online is mixed and could have serious implications for users. Young adolescents who perceive themselves as overweight may be disproportionately affected as they are at greater risk for disordered eating. The current study aimed to (1) assess whether the frequency of use of different internet sources to obtain nutritional information differs between healthy weight young adolescents and those with overweight/obesity based on both objective and perceived weight status and (2) evaluate the relationships between different internet sources utilized for nutritional information and disordered eating. Young adolescents (n = 167; 10-15 years) completed the Children's Eating Attitudes Test (ChEAT; total disordered eating), indicated their perceived weight status, and reported how often they obtained nutritional information from the following internet sources: professional websites, personal websites, social media, commercial weight loss websites, and forums. Objective height and weight measurements were obtained. Young adolescents that perceived themselves to be a little overweight or overweight reported greater use of personal websites (p = .012), commercial weight loss websites (p = .011), and social media (p = .019) for nutritional information than those that did not perceive themselves to be a little overweight or overweight. The frequency of use of internet sources for nutritional information did not differ based on objective weight status. Greater use of each of the internet sources for nutritional information was related to greater disordered eating (p's < 0.05). While longitudinal research is needed to further examine these relationships, healthcare providers and teachers should provide young adolescents with guidance for interpreting and using online nutritional information to encourage valid and reliable health recommendations.
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Affiliation(s)
- Erin L Moorman
- Department of Clinical and Health Psychology, University of Florida, United States.
| | - Jennifer L Warnick
- Department of Clinical and Health Psychology, University of Florida, United States
| | - Ratna Acharya
- Department of Pediatrics, University of Florida, United States
| | - David M Janicke
- Department of Clinical and Health Psychology, University of Florida, United States
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20
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Sonneville KR, Mulpuri L, Khreizat I, Nichols LP, Plegue MA, Chang T. Youth Preferences for Weight-Related Conversations. HEALTH COMMUNICATION 2020; 35:1328-1333. [PMID: 31290341 DOI: 10.1080/10410236.2019.1631566] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Little guidance is available to clinicians on how to talk about weight with their patients. The aim of this study is to explore youth preferences for weight-related conversations. Participants came from the National MyVoice Text Message Cohort. Between 7/2017 and 01/2018, 952 MyVoice participants provided open-ended responses via text message to three questions about weight-related conversations ("Has your doctor ever talked to you about weight?", "What did he or she say?", and "What should a doctor NOT say when talking about weight?"). The presence of themes was coded using standard qualitative methods. Of the 952 respondents, 568 (60%) reported that their doctor had talked with them about weight. Of these, 85% indicated that their doctor had notified them of their weight, BMI, or weight status and/or the need to change their body weight and 16% had doctors who provided advice about weight control. Eight themes emerged from the analysis of responses to the question "What should a doctor NOT say when talking about weight?". The two most common themes were: (1): Avoid stigmatizing terms/language (32%); and (2) Do not shame patient for their weight (25%). Findings suggest that weight-related conversations do not reflect the preferences of the youth they are designed to benefit. Youth recommended that clinicians focus on health and sustainable behavioral solutions, avoid stigmatizing language and comparing them to others, and be aware of the potential harm associated with making assumptions that conflate weight with health behaviors, morality, or appearance.
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Affiliation(s)
- Kendrin R Sonneville
- Department of Nutritional Sciences, University of Michigan School of Public Health
| | - Lakshman Mulpuri
- Department of Family Medicine, University of Michigan Medical School
| | - Ivana Khreizat
- Department of Nutritional Sciences, University of Michigan School of Public Health
| | - Lauren P Nichols
- Department of Family Medicine, University of Michigan Medical School
| | - Melissa A Plegue
- Department of Family Medicine, University of Michigan Medical School
| | - Tammy Chang
- Department of Family Medicine, University of Michigan Medical School
- Institute for Healthcare Policy and Innovation
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21
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Cardel MI, Atkinson MA, Taveras EM, Holm JC, Kelly AS. Obesity Treatment Among Adolescents: A Review of Current Evidence and Future Directions. JAMA Pediatr 2020; 174:609-617. [PMID: 32202626 PMCID: PMC7483247 DOI: 10.1001/jamapediatrics.2020.0085] [Citation(s) in RCA: 106] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
IMPORTANCE Obesity in adolescence has reached epidemic proportions around the world, with the prevalence of severe obesity increasing at least 4-fold over the last 35 years. Most youths with obesity carry their excess adiposity into adulthood, which places them at increased risk for developing obesity-driven complications, such as type 2 diabetes and cardiovascular disease, and negatively affects social and emotional health. Given that adolescence is a unique transition period marked by significant physiologic and developmental changes, obesity-related complications can also negatively affect adolescent growth and developmental trajectories. OBSERVATIONS Provision of evidence-based treatment options that are tailored and appropriate for the adolescent population is paramount, yet complex. The multifactorial etiology of obesity along with the significant changes that occur during the adolescent period increasingly complicate the treatment approach for adolescent obesity. Treatment practices discussed in this review include an overview of evidence supporting currently available behavioral, pharmacologic, surgical, and device interventions for obesity. However, it is important to note that these practices have not been effective at reducing adolescent obesity at the population level. CONCLUSIONS AND RELEVANCE Because adolescent obesity requires lifelong treatment, effectively addressing this disease will require significant resources, scientific rigor, and the provision of access to quality care similar to other chronic health conditions. Effective and less invasive therapies, effective adjuncts, and comprehensive centers that offer specialized treatment are critical. This considerable need for increased attention to obesity care calls for dedicated resources in both education and research for treatment of obesity in youths.
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Affiliation(s)
- Michelle I. Cardel
- Department of Health Outcomes and Biomedical Informatics and Pediatrics, University of Florida College of Medicine, Gainesville
| | - Mark A. Atkinson
- Diabetes Institute, Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville
| | - Elsie M. Taveras
- Massachusetts General Hospital, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Jens-Christian Holm
- The Children’s Obesity Clinic, Holbaek Hospital, University of Copenhagen, Copenhagen, the Netherlands
| | - Aaron S. Kelly
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota
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22
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Puhl RM. What words should we use to talk about weight? A systematic review of quantitative and qualitative studies examining preferences for weight-related terminology. Obes Rev 2020; 21:e13008. [PMID: 32048465 DOI: 10.1111/obr.13008] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/06/2020] [Accepted: 01/27/2020] [Indexed: 12/18/2022]
Abstract
Evidence of weight stigma and its harmful consequences have led to increased attention to the words that are used to talk about obesity and body weight, including calls for efforts to carefully consider weight-related terminology and promote respectful language in the obesity and medical fields. Despite increased research studies examining people's preferences for specific words that describe body weight, there has been no systematic review to synthesize existing evidence on perceptions of and preferences for weight-related terminology. To address this gap, the current systematic review identified 33 studies (23 quantitative, 10 qualitative) that examined people's preferences for weight-related terminology in the current research literature (from 1999 to 2019). Across studies, findings generally suggest that neutral terminology (eg, "weight" or "unhealthy weight") is preferred and that words like "obese" and "fat" are least acceptable, particularly in provider-patient conversations about weight. However, individual variation in language preferences is evident across demographic characteristics like race/ethnicity, gender, and weight status. Of priority is future research that can improve upon the limited diversity of the existing literature, both with respect to sample diversity and the use of culturally relevant weight-related terminology, which is currently lacking in measurement. Implications for patient-provider communication and public health communication are discussed.
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Affiliation(s)
- Rebecca M Puhl
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT.,Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT
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23
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Stuij M, van Maarschalkerweerd PEA, Seidell JC, Halberstadt J, Dedding C. Youth perspectives on weight-related words used by healthcare professionals: A qualitative study. Child Care Health Dev 2020; 46:369-380. [PMID: 32037594 DOI: 10.1111/cch.12760] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 01/28/2020] [Accepted: 02/03/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Although healthcare professionals often consider body weight a sensitive and difficult topic to discuss with children, a contextualized and comprehensive understanding of youth perspectives on weight-related words used in healthcare has yet to be established. This qualitative study aims to explore perspectives of Dutch children on the terminology healthcare professionals use when discussing weight. METHODS Fourteen interviews and one focus group discussion were held with children (age 8-16) who were in care because of their weight. A toolkit with customizable interview techniques was used in order to facilitate reflection and tailor the interview to each respondent. A narrative content analysis was conducted. RESULTS Respondents attached both clear and subtle differences in meanings to (certain) weight-related words. Their perspectives were not unanimous for any single word. Moreover, at times, respondents framed certain words in positive or negative ways or used a word they disliked to describe themselves. This illustrates that meanings of weight-related words are not fixed but context and situation specific. CONCLUSION This study revealed that meanings children assign to weight-related words are shaped by their experiences in the broader social context, especially at school, as well as with (previous) healthcare professionals. It pointed towards the importance of bedside manner, acquaintanceship, and support. Healthcare professionals treating children because of their body weight are advised to invest in a good patient-caregiver relationship, pay attention to children's previous (negative) social weight-related experiences, and reflect critically on their own preconceptions about body weight and the impact these preconceptions might have on their patient-caregiver relationships.
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Affiliation(s)
- Mirjam Stuij
- Department of Medical Humanities, Amsterdam Public Health Research Institute, Amsterdam UMC (location VUmc), Amsterdam, The Netherlands.,Mulier Institute, Utrecht, The Netherlands
| | - Pomme E A van Maarschalkerweerd
- Faculty of Science, Department of Health Sciences, Section Youth and Lifestyle, VU University Amsterdam, Amsterdam, The Netherlands
| | - Jaap C Seidell
- Faculty of Science, Department of Health Sciences, Section Youth and Lifestyle, VU University Amsterdam, Amsterdam, The Netherlands
| | - Jutka Halberstadt
- Faculty of Science, Department of Health Sciences, Section Youth and Lifestyle, VU University Amsterdam, Amsterdam, The Netherlands
| | - Christine Dedding
- Department of Medical Humanities, Amsterdam Public Health Research Institute, Amsterdam UMC (location VUmc), Amsterdam, The Netherlands
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24
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Plimier CC, Hewawitharana SC, Webb KL, Au LE, Neumark-Sztainer D, Ritchie LD. Community-level obesity prevention is not associated with dieting behaviours and weight dissatisfaction in children: The Healthy Communities Study. Pediatr Obes 2020; 15:e12594. [PMID: 31867897 PMCID: PMC7939126 DOI: 10.1111/ijpo.12594] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 08/12/2019] [Accepted: 10/08/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Within the context of high childhood obesity prevalence, there is a concern that community efforts intended to reduce childhood obesity may lead to unintended adverse outcomes. OBJECTIVE This analysis examined relationships between community programs, policies, and environmental changes (CPPs) for obesity prevention with unhealthy dieting behaviours and body weight satisfaction in children. METHODS Using the Healthy Communities Study 2013 to 2015 survey sample of 5138 US children aged 4 to 15 years old, multilevel models examined associations between standardized CPP intensity scores and child dieting behaviours and weight satisfaction, adjusting for community and child-level covariates and clustered study design. RESULTS In fully adjusted models, higher total, physical activity, and nutrition CPP intensity scores were associated with lower odds of dissatisfaction with weight (1 year total CPP odds ratio [OR]: 0.41, 95% confidence interval [CI], 0.22-0.73; 6 year total CPP OR: 0.48, 0.29-0.80). Higher physical activity CPP intensity over the past year was associated with greater odds of weight satisfaction (OR: 1.77, 95% CI, 1.10-2.84). No associations were observed with dieting behaviours. CONCLUSIONS Results suggest that community efforts focusing on nutrition and physical activity to prevent childhood obesity may be associated with weight satisfaction and not with unhealthy dieting behaviours.
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Affiliation(s)
- Colleen C. Plimier
- School of Public Health; University of California, Berkeley, California; UC Berkeley School of Public Health, 50 University Ave Hall #7360, Berkeley, CA 94720, USA
| | - Sridharshi C. Hewawitharana
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, 2115 Milvia Street, Suite 301, Berkeley, CA 94704, USA
| | - Karen L. Webb
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, 2115 Milvia Street, Suite 301, Berkeley, CA 94704, USA
| | - Lauren E. Au
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, 2115 Milvia Street, Suite 301, Berkeley, CA 94704, USA
| | - Dianne Neumark-Sztainer
- Division of Epidemiology, School of Public Health, University of Minnesota, 1300 Sound Second Street, Suite 300, Minneapolis, MN 55454, USA
| | - Lorrene D. Ritchie
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, 2115 Milvia Street, Suite 301, Berkeley, CA 94704, USA
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25
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Albright CA, Pratt KJ, Martin SB, Hulshult H, Brown CL, Lewis KH, Skelton JA. Family members' experiences with adult participation in weight management programs: Triadic perspectives from patients, partners and children. Clin Obes 2020; 10:e12354. [PMID: 31965733 PMCID: PMC9107074 DOI: 10.1111/cob.12354] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 11/25/2019] [Accepted: 01/03/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Spouses are known to influence the outcomes of an individual's attempt at weight loss, but little is known about the broader influence of, and on, the family. The objectives were to explore: (a) the effects of an adult weight management program on the family and (b) family factors that help or hinder patient weight loss. METHODS A qualitative design was employed to explore triadic family members' experiences of patient participation in a weight management program. Semi-structured interviews were conducted with patients, partners and children (ages 7-18). Questions included support for patient participation and weight loss, dietary choices, meal preparation, physical activity routines, the home-food environment, communication about health and family dynamics. Thematic analysis was used, where codes and categories of codes were then grouped together to create themes and subthemes. RESULTS Nineteen triadic interviews were conducted (57 total). Seven themes emerged, including four related to Outcomes (objective 1): (a) shift in family dynamics, (b) family behaviour change, (c) child observations of family change, (d) indirect benefit to partner; and three related to Process (objective 2): (e) level of accountability, (f) patient perception of support and (g) support is essential and flexible. CONCLUSIONS Future research and clinical applications from these themes should seek to determine the positive behaviour change that was evident in the families that were interviewed, where the culmination of family interactions, expectations and concurrent partner weight loss indicates the potential longevity of weight management programs beyond patients' own participation.
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Affiliation(s)
| | - Keeley J. Pratt
- Department of Human Sciences, Human Development and Family Science Program, College of Education and Human Ecology, The Ohio State University, Columbus, Ohio
| | - Sarah B. Martin
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | - Callie L. Brown
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Kristina H. Lewis
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Joseph A. Skelton
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina
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"…or else I close my ears" How women with obesity want to be approached and treated regarding gestational weight management: A qualitative interview study. PLoS One 2019; 14:e0222543. [PMID: 31536545 PMCID: PMC6752788 DOI: 10.1371/journal.pone.0222543] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 09/01/2019] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION The importance of helping pregnant women maintain a healthy lifestyle and prevent excessive gestational weight gain is well recognized, but pregnant women do not always perceive communication about body weight as respectful or helpful. Furthermore, fear of inducing shame or guilt can prohibit some midwives from talking about body weight, especially if the woman has obesity. We aimed to explore what women of reproductive age with obesity regard to be the most important and relevant aspects when discussing gestational weight management. METHODS Qualitative interview study using focus groups and individual semi-structured interviews with 17 women of reproductive age (19-39 y) with obesity. Thematic analysis was used to analyze the data. RESULTS We identified three themes: 1) Importance of obtaining vital medical information; 2) A wish to feel understood and treated with respect; 3) Midwives' approach is crucial in sensitive key situations, which include bringing up the subject of body weight, weighing, providing weight-related information, coaching lifestyle modification, dealing with emotional reactions and ending a conversation. CONCLUSIONS A majority of the interviewed women wished to receive information about risks about obesity and gestational weight gain, and recommendations on weight management. However, the risk of midwives offending someone by raising the topic may be increased if the pregnant woman believe that gestational weight gain is uncontrollable by the individual. Also, several situations during maternity care meetings can be stigmatizing and make women less receptive to advice or support. Women suggest that a good working alliance is likely to be achieved if midwives have knowledge about the causes of obesity, take interest in the patients' background, have a non-judgmental approach and refrain from giving unsolicited advice.
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Abstract
PURPOSE OF REVIEW This review aims to evaluate current research findings relevant to weight stigmatization, to acknowledge the deleterious impact it has on the health of the paediatric population and to provide insight to optimize future guidelines for the treatment of individuals with overweight and obesity. RECENT FINDINGS Obesity prevalence continues to rise in the USA with estimates in children from ages 2-19 years of 18.5%, an all-time high. With the increase in obesity, there has been a concomitant increase in weight stigma, which affects both youth and general population across varied levels of socioeconomic status and body sizes. SUMMARY Weight stigma is a contributing phenomenon to the current obesity epidemic, as individuals with stigmatized experiences (weight-based teasing, bullying, victimization) have increased risks for acquiring adverse health outcomes that encompass the physical, behavioural and psychological. Weight stigma can also lead affected individuals to internalize such experiences which decrease their overall quality of life. Sources of stigma may come from peers, family, educators, media, as well as healthcare professionals, as highlighted in this review. Efforts to establish prevention and treatment strategies for weight stigma may generate further traction to help improve global obesity rates. VIDEO ABSTRACT.
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Affiliation(s)
- Carl J. Palad
- New York Medical College, Valhalla, New York, Massachusetts, USA
| | | | - Fatima Cody Stanford
- Massachusetts General Hospital, MGH Weight Center, Department of Medicine-Division of Endocrinology- Neuroendocrine, Department of Pediatrics-Division of Endocrinology, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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The mediating role of internalized weight stigma on weight perception and depression among emerging adults: Exploring moderation by weight and race. Body Image 2018; 27:202-210. [PMID: 30384173 DOI: 10.1016/j.bodyim.2018.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 10/16/2018] [Accepted: 10/16/2018] [Indexed: 11/22/2022]
Abstract
The current study examined internalized weight stigma as a mediator of the association between self-perceived weight and depressive symptoms. University students (N = 317) aged 18-25 years completed measures of self-perceived weight, internalized stigma, and depressive symptoms. Multigroup path analyses were used to examine the indirect effect of self-perceived weight on depression through self-stigma. Findings revealed that among persons of size, internalized stigma mediated the effect of higher self-perceived weight on higher depressive symptoms. Among lean persons, this indirect effect was only significant for Black participants. Among all groups, the direct effect of self-perceived weight on internalized stigma was significant. While the present results warrant future replication, the findings expand our understanding of the association between self-perceived weight and depression. These results also illuminate potential future opportunities for rich, culturally informed research and clinical advances that take into account the detrimental role of weight stigma.
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29
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Puhl RM, Himmelstein MS. Weight Bias Internalization Among Adolescents Seeking Weight Loss: Implications for Eating Behaviors and Parental Communication. Front Psychol 2018; 9:2271. [PMID: 30519207 PMCID: PMC6258789 DOI: 10.3389/fpsyg.2018.02271] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 11/01/2018] [Indexed: 12/21/2022] Open
Abstract
Background: Emerging evidence has demonstrated a high prevalence of weight bias internalization (WBI) among adults, as well as consistent links between internalization and adverse psychological and physical health. However, research examining WBI in youth and its impact on their health is scarce, especially among youth seeking weight loss treatment who may be particularly vulnerable to weight stigma from peers and parents. To address this research gap, the present study assessed WBI in a weight loss treatment-seeking sample of adolescents, examining associations between internalization and adolescents' eating behaviors and parental weight-related communication. Methods: Adolescents (N = 148, M age = 15.97 years), completed online self-report measures to assess WBI (using the modified version of the WBI Scale), body weight, binge eating, eating as a coping strategy, and weight teasing from peers and family members. Adolescents also reported on the frequency of parental comments about body weight, parental dieting, and parental encouragement of adolescent dieting. Results: Adolescents expressed a high mean level of internalized weight bias (M = 5.45, SD = 0.88). Higher levels of internalization were observed across increasing body weight categories; no differences were observed for gender or history of weight teasing. WBI was significantly higher among adolescents who reported binge eating and eating to cope with distress. Regression analyses showed that weight-related comments from mothers (but not fathers) significantly predicted adolescents' WBI (including frequency of mothers' comments about adolescents' body weight, comments about their own body weight, and encouragement of their adolescent to diet), as did increased dieting frequency among mothers. Conclusion: The present study provides novel insights to the scant literature on WBI in youth. Findings indicate that WBI is high in both girls and boys engaged in weight loss, and is associated with maladaptive eating behaviors, higher frequency of maternal dieting, and mothers' comments about body weight. These findings have important clinical implications for youth and families engaged in weight loss treatment, and underscore the need for research to clarify adverse effects of internalization on weight-related health in youth and to better understand the role that parental weight communication may have on adolescents' internalization.
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Affiliation(s)
- Rebecca M Puhl
- Department of Human Development and Family Studies, Rudd Center for Food Policy and Obesity, Hartford, CT, United States
| | - Mary S Himmelstein
- Mary Himmelstein, Rudd Center for Food Policy and Obesity, Hartford, CT, United States
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30
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Abstract
BACKGROUND With high rates of adolescent obesity, many parents are talking to adolescents about their body weight. Parental "weight talk" is linked with adverse health behaviors in youth, but we know little about what parents say in these conversations. Using a weight loss treatment-seeking sample of adolescents, the present study assessed adolescents' emotional reactions to words their parents use to describe their weight and preferred language for these interactions. METHODS Adolescents enrolled in a national weight loss camp (N = 148) completed a questionnaire assessing their preferences for, and emotional reactions to, parental use of 18 words to describe their body weight. RESULTS Findings showed a diverse range of weight language used by parents, with many words inducing negative emotional reactions of embarrassment, shame, and sadness in adolescents. Emotional responses to weight language varied according to adolescents' gender, BMI, and experience of weight-teasing from family members. CONCLUSIONS Findings underscore the need to carefully consider language; parents should avoid making assumptions about what language to use in conversations with adolescents about their weight. Educating parents how to identify negative weight talk may help promote more supportive parental communication about weight-related health.
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Affiliation(s)
- Rebecca M Puhl
- 1 Department of Human Development and Family Studies, University of Connecticut , Storrs, CT.,2 Rudd Center for Food Policy and Obesity, University of Connecticut , Hartford, CT
| | - Mary S Himmelstein
- 2 Rudd Center for Food Policy and Obesity, University of Connecticut , Hartford, CT
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31
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Partridge SR, Redfern J. Strategies to Engage Adolescents in Digital Health Interventions for Obesity Prevention and Management. Healthcare (Basel) 2018; 6:E70. [PMID: 29933550 PMCID: PMC6163226 DOI: 10.3390/healthcare6030070] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 06/18/2018] [Accepted: 06/19/2018] [Indexed: 12/20/2022] Open
Abstract
Obesity is one of the greatest health challenges facing today’s adolescents. Dietary interventions are the foundation of obesity prevention and management. As adolescents are digital frontrunners and early adopters of technology, digital health interventions appear the most practical modality for dietary behavior change interventions. Despite the rapid growth in digital health interventions, effective engagement with adolescents remains a pertinent issue. Key strategies for effective engagement include co-designing interventions with adolescents, personalization of interventions, and just-in-time adaptation using data from wearable devices. The aim of this paper is to appraise these strategies, which may be used to improve effective engagement and thereby improve the dietary behaviors of adolescents now and in the future.
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Affiliation(s)
- Stephanie R Partridge
- Faculty of Medicine and Health, Westmead Applied Research Centre, The University of Sydney, Westmead, NSW 2145, Australia.
- Faculty of Medicine and Health, Sydney School of Public Health, Prevention Research Collaboration, Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2006, Australia.
| | - Julie Redfern
- Faculty of Medicine and Health, Westmead Applied Research Centre, The University of Sydney, Westmead, NSW 2145, Australia.
- The George Institute for Global Health, The University of New South Wales, Camperdown, NSW 2006, Australia.
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