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Malik Z, Williams K, Cockrell D, Collins CE. Stigmatizing attitudes and beliefs about obesity among dental team members. Obes Sci Pract 2024; 10:e70004. [PMID: 39219746 PMCID: PMC11360840 DOI: 10.1002/osp4.70004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 08/06/2024] [Accepted: 08/07/2024] [Indexed: 09/04/2024] Open
Abstract
Background Weight stigma is prevalent within healthcare settings and is an aspect of the lived experience of people living with obesity. There is international evidence of weight stigma in the dental setting, where currently there is also evidence indicating limited training amongst dental professionals regarding obesity or obesity-related stigma. There has been Australian research and none have included dental support staff. Aims This cross-sectional survey aimed to assess stigmatizing attitudes and beliefs of dental professionals (registered general dentists, oral health therapists) and support staff (dental assistants, dental receptionists) working in private and public regional practices in New South Wales and specialists in Special Needs Dentistry across Australia toward people living with obesity. Methods An anonymous electronic validated survey was administered through REDCap™ to assess stigmatizing attitudes and beliefs held amongst respondents in relation to people living with obesity. Results Fifty-three participants completed the survey (n = 33 clinicians, n = 20 support staff). The majority 47/53 (88.7%) held positive attitudes toward people living with obesity. Of the clinicians, 15/33 (45.5%) reported 1 hour or less and 14/33 (42.4%) reported two to 5 hours of obesity-related education. 14/20 (70%) of the support staff reported no prior education or training about obesity. Of responses reflecting weight stigma, only three clinicians reported negative reactions toward the appearance, or discomfort during examination, of a patient with obesity, or a perception of laziness, compared with normal weight individuals. A higher proportion 4/20 (20%) of support staff reported responses indicating negative attitudes for people with obesity compared with normal weight individuals. Conclusion Survey responses reflected evidence of weight stigma in both dental professionals and support staff. Professional development targeting weight stigma reduction in the dental setting is needed for both clinicians and support staff.
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Affiliation(s)
- Zanab Malik
- School of Health Sciences (Oral Health)College of Health, Medicine and WellbeingThe University of NewcastleOurimbahNew South WalesAustralia
- Oral Health ServicesCentral Coast Local Health DistrictGosfordNew South WalesAustralia
| | - Kathryn Williams
- Nepean Blue Mountains Family Metabolic Health ServiceNepean HospitalNepean Blue Mountains Local Health DistrictKingswoodNew South WalesAustralia
- Charles Perkins Centre‐NepeanThe University of SydneySydneyNew South WalesAustralia
| | - Deborah Cockrell
- School of Health Sciences (Oral Health)College of Health, Medicine and WellbeingThe University of NewcastleOurimbahNew South WalesAustralia
| | - Clare E. Collins
- School of Health Sciences (Nutrition and Dietetics)College of Health, Medicine and WellbeingThe University of NewcastleOurimbahNew South WalesAustralia
- Food and Nutrition Research ProgramHunter Medical Research InstituteNew Lambton HeightsNew South WalesAustralia
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Gerend MA, Wilkinson LJ, Sutin AR, Rosado JI, Ehrlich KB, Smith DW, Maner JK. Sociodemographic predictors of perceived weight discrimination. Int J Obes (Lond) 2024; 48:1231-1237. [PMID: 38740855 DOI: 10.1038/s41366-024-01535-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 04/26/2024] [Accepted: 04/30/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Perceived weight discrimination is associated with increased risk for chronic diseases and reduced life expectancy. Nevertheless, little is known about perceived weight discrimination in racial, ethnic, and sexual minority groups or in individuals at the intersections of those groups. The goal of this study was to identify sociodemographic predictors of perceived weight discrimination. SUBJECTS/METHODS A diverse sample of adults (37% Black/African American, 36% Latino, 29% sexual minority) with a body mass index (BMI) ≥ 18.5 kg/m2 were recruited from a national US panel to complete an online survey (N = 2454). Perceived weight discrimination was assessed with the Stigmatizing Situations Survey-Brief (SSI-B). Using hierarchical linear regression analysis, SSI-B scores were predicted from the four sociodemographic characteristics of interest (gender, race, ethnicity, and sexual orientation) while controlling for BMI, age, education, and income (Step 1). At Step 2, all two-way interactions between the four sociodemographic characteristics were added to the model. RESULTS At Step 1, higher SSI-B scores were observed for Latino (vs. non-Latino) adults, sexual minority (vs. heterosexual) adults, younger (vs. older) adults, adults with higher (vs. lower) levels of education, and adults with higher (vs. lower) BMI. At Step 2, race interacted with gender, ethnicity, and sexual orientation to predict SSI-B scores such that relatively higher scores were observed for non-Black women, Black men, adults who identified as Black and Latino, and non-Black sexual minority adults. CONCLUSIONS Perceived weight discrimination varied across sociodemographic groups, with some subgroups reporting relatively high frequency. Black race appeared to be protective for some subgroups (e.g., Black women), but risk-enhancing for others (e.g., Black men, individuals who identified as Black and Latino). Additional research is needed to identify specific factors that cause certain sociodemographic groups -and indeed, certain individuals-to perceive higher levels of weight discrimination than others.
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Affiliation(s)
- Mary A Gerend
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, FL, USA.
| | | | - Angelina R Sutin
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, FL, USA
| | - Javier I Rosado
- College of Medicine, Florida State University, Immokalee Regional Campus, Immokalee, FL, USA
| | | | - David W Smith
- Cardiology, Southern Medical Group, Tallahassee, FL, USA
| | - Jon K Maner
- Department of Psychology, College of Arts and Sciences, Florida State University, Tallahassee, FL, USA
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Putra IGNE, Daly M, Sutin A, Steptoe A, Scholes S, Robinson E. Obesity, psychological well-being related measures, and risk of seven non-communicable diseases: evidence from longitudinal studies of UK and US older adults. Int J Obes (Lond) 2024; 48:1283-1291. [PMID: 38824226 PMCID: PMC11347379 DOI: 10.1038/s41366-024-01551-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 05/14/2024] [Accepted: 05/21/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND We examined the role of psychological well-being related measures in explaining the associations between obesity and increased risk of non-communicable diseases (NCDs: hypertension, heart disease, stroke, diabetes, arthritis, cancer, and memory-related disease) in older adults. METHODS Data were from the English Longitudinal Study of Ageing (ELSA), UK (baseline: Wave 4-2008/2009; n = 8127) and the Health and Retirement Study (HRS), US (baseline: Waves 9 and 10-2008/2010; n = 12,477). Objective body mass index was used to define obesity. A range of psychological well-being related measures (e.g., depressive symptoms, life satisfaction) was available in ELSA (n = 7) and HRS (n = 15), and an index of overall psychological well-being was developed separately in each study. NCDs were from a self-reported doctor diagnosis and/or other assessments (e.g., biomarker data) in both studies; and in ELSA, NCDs from linked hospital admissions data were examined. Longitudinal associations between obesity status, psychological well-being measures, and NCDs were examined using Cox proportional hazard models (individual NCDs) and Poisson regression (a cumulative number of NCDs). Mediation by psychological well-being related measures was assessed using causal mediation analysis. RESULTS Obesity was consistently associated with an increased prospective risk of hypertension, heart disease, diabetes, arthritis, and a cumulative number of NCDs in both ELSA and HRS. Worse overall psychological well-being (index measure) and some individual psychological well-being related measures were associated with an increased prospective risk of heart disease, stroke, arthritis, memory-related disease, and a cumulative number of NCDs across studies. Findings from mediation analyses showed that neither the index of overall psychological well-being nor any individual psychological well-being related measures explained (mediated) why obesity increased the risk of developing NCDs in both studies. CONCLUSION Obesity and psychological well-being may independently and additively increase the risk of developing NCDs.
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Affiliation(s)
- I Gusti Ngurah Edi Putra
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, UK.
| | - Michael Daly
- Department of Psychology, Maynooth University, Maynooth, Ireland
| | - Angelina Sutin
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, FL, USA
| | - Andrew Steptoe
- Department of Epidemiology and Health, Institute of Epidemiology and Health Care, Faculty of Population Health Sciences, University College London, London, UK
| | - Shaun Scholes
- Department of Epidemiology and Health, Institute of Epidemiology and Health Care, Faculty of Population Health Sciences, University College London, London, UK
| | - Eric Robinson
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, UK
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Görres C, Hoßbach J, Pabst A, Luppa M, Stein J, Welzel FD, Jung FU, Hussenoeder FS, Engel C, Kirsten T, Reyes N, Wirkner K, Riedel-Heller SG, Löbner M. [The relationship between obesity, social isolation, and mental health-results from the LIFE adult study]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024:10.1007/s00103-024-03940-3. [PMID: 39190150 DOI: 10.1007/s00103-024-03940-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 07/17/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND Population-based studies on the relationship between social isolation and obesity, which also include younger adults, are still lacking in Germany. The aim of this study is to investigate the prevalence of social isolation in people with and without obesity. In addition, socially isolated people with and without obesity are examined with regard to socio-demographic and socio-economic factors as well as with regard to depressive symptoms. METHODS This study was based on baseline data from the LIFE Adult Study (18-79 years) from the 2011-2014 study period. The sample comprised n = 8350 participants. In addition to socio-demographic characteristics and socio-economic status (SES), data on social isolation (LSNS-6), depression (ADS), and body mass index (BMI) were collected. Evaluations were carried out using inferential statistical analyses. RESULTS Overall, 13.1% of the total sample were affected by social isolation. Participants with obesity (20.4%) had a significantly (p < 0.001) higher prevalence compared to those without obesity (11.4%). A better social integration was significantly associated with younger age (p < 0.001), female sex (p < 0.001), being married (and cohabiting) (p < 0.001), higher socioeconomic status (p < 0.001), and lower depressive symptoms (p < 0.001). DISCUSSION A higher BMI was not associated per se with poorer social integration. However, the present study showed that socially isolated people with obesity represent a special risk group for impaired mental health and had twice the prevalence of social isolation compared to those without obesity.
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Affiliation(s)
- Charlyn Görres
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Medizinische Fakultät, Universität Leipzig, Leipzig, Deutschland
| | - Jana Hoßbach
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Medizinische Fakultät, Universität Leipzig, Leipzig, Deutschland
| | - Alexander Pabst
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Medizinische Fakultät, Universität Leipzig, Leipzig, Deutschland
| | - Melanie Luppa
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Medizinische Fakultät, Universität Leipzig, Leipzig, Deutschland
| | - Janine Stein
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Medizinische Fakultät, Universität Leipzig, Leipzig, Deutschland
| | - Franziska D Welzel
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Medizinische Fakultät, Universität Leipzig, Leipzig, Deutschland
| | - Franziska U Jung
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Medizinische Fakultät, Universität Leipzig, Leipzig, Deutschland
| | - Felix S Hussenoeder
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Medizinische Fakultät, Universität Leipzig, Leipzig, Deutschland
| | - Christoph Engel
- Institut für Medizinische Informatik, Statistik und Epidemiologie, Universität Leipzig, Leipzig, Deutschland
- LIFE - Leipziger Forschungszentrum für Zivilisationserkrankungen, Universität Leipzig, Leipzig, Deutschland
| | - Toralf Kirsten
- Institut für Medizinische Informatik, Statistik und Epidemiologie, Universität Leipzig, Leipzig, Deutschland
- Medizininformatikzentrum - Abteilung Medical Data Science, Universitätsklinikum Leipzig AöR, Leipzig, Deutschland
- LIFE - Leipziger Forschungszentrum für Zivilisationserkrankungen, Universität Leipzig, Leipzig, Deutschland
| | - Nigar Reyes
- Institut für Medizinische Informatik, Statistik und Epidemiologie, Universität Leipzig, Leipzig, Deutschland
| | - Kerstin Wirkner
- LIFE - Leipziger Forschungszentrum für Zivilisationserkrankungen, Universität Leipzig, Leipzig, Deutschland
| | - Steffi G Riedel-Heller
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Medizinische Fakultät, Universität Leipzig, Leipzig, Deutschland
- LIFE - Leipziger Forschungszentrum für Zivilisationserkrankungen, Universität Leipzig, Leipzig, Deutschland
| | - Margrit Löbner
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Medizinische Fakultät, Universität Leipzig, Leipzig, Deutschland.
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Sandsaeter HL, Eik-Nes TT, Getz LO, Magnussen EB, Rich-Edwards JW, Horn J. Navigating weight, risk and lifestyle conversations in maternity care: a qualitative study among pregnant women with obesity. BMC Pregnancy Childbirth 2024; 24:552. [PMID: 39179964 PMCID: PMC11344406 DOI: 10.1186/s12884-024-06751-1] [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: 04/30/2024] [Accepted: 08/09/2024] [Indexed: 08/26/2024] Open
Abstract
BACKGROUND Pregnant women with obesity face heightened focus on weight during pregnancy due to greater risk of medical complications. Closer follow-up in maternety care may contribute to reduce risk and promote health in these women. The aim of this study was to gain a deeper insight in how pregnant women with obesity experience encounters with healthcare providers in maternity care. How is the received maternity care affected by their weight, and how do they describe the way healthcare providers express attitudes towards obesity in pregnancy? METHODS We conducted in-depth interviews with 14 women in Trøndelag county in Norway with pre-pregnancy BMI of ≥ 30 kg/m2, between 3 and 12 months postpartum. The study sample was strategic regarding age, relationship status, education level, obesity class, and parity. Themes were developed using reflexive thematic analysis. The analysis was informed by contextual information from a prior study, describing the same participants' weight history from childhood to motherhood along with their perceptions of childhood quality. RESULTS This study comprised of an overarching theme supported by three main themes. The overarching theme, Being pregnant with a high BMI: a vulnerable condition, reflected the challenge of entering maternity care with obesity, especially for women unprepared to be seen as "outside the norm". Women who had grown up with body criticism and childhood bullying were more prepared to have their weight addressed in maternity care. The first theme, Loaded conversations: a balancing act, emphasizes how pregnant women with a history of body criticism or obesity-related otherness proactively protect their integrity against weight bias, stigma and shame. The women also described how some healthcare providers balance or avoid weight and risk conversations for the same reasons. Dehumanization: an unintended drawback of standardized care makes apparent the pitfalls of prioritizing standardization over person-centered care. Finally, the third theme, The ambivalence of discussing weight and lifestyle, represent women's underlying ambivalence towards current weight practices in maternity care. CONCLUSIONS Our findings indicate that standardized weight and risk monitoring, along with lifestyle guidance in maternity care, can place the pregnant women with obesity in a vulnerable position, contrasting with the emotionally supportive care that women with obesity report needing. Learning from these women's experiences and their urge for an unloaded communication to protect their integrity highlights the importance of focusing on patient-centered practices instead of standardized care to create a safe space for health promotion.
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Affiliation(s)
- Heidi L Sandsaeter
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.
- Department of Obstetrics and Gynecology, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.
| | - Trine Tetlie Eik-Nes
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- Stjørdal Community Mental Health Centre, Levanger Hospital, Levanger, Norway
| | - Linn Okkenhaug Getz
- Research Unit for General Practice, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Elisabeth Balstad Magnussen
- Department of Obstetrics and Gynecology, St. Olav's University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Janet W Rich-Edwards
- Division of Women's Health and Connors Center for Women's Health and Gender Biology, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Julie Horn
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Obstetrics and Gynecology, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
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Sutin AR, Gerend MA, Stephan Y, Terracciano A. Perceived Weight Discrimination and General Coping Strategies. Int J Behav Med 2024:10.1007/s12529-024-10314-1. [PMID: 39143431 DOI: 10.1007/s12529-024-10314-1] [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] [Accepted: 07/31/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND Perceived weight discrimination is associated consistently with worse health outcomes. Coping strategies may be one mechanism of this association. The present research examined the association between perceived weight discrimination and strategies used to cope with general stress (not weight-specific) and whether these strategies accounted for part of the association with markers of health. METHOD Participants (N = 1882) completed a cross-sectional survey with a comprehensive measure of coping strategies and reported on their perceived experience of weight discrimination and markers of physical, mental, and social health. RESULTS Perceived weight discrimination was associated with greater use of disengaged coping strategies (β = .19, p < .01) and was unrelated to active and support coping strategies. Disengaged coping mediated the association between weight discrimination and worse physical, mental, and social health (proportion of mediation ranged from 14 to 47%). This pathway was independent of body mass index (BMI). Individuals in the obesity weight category (BMI ≥ 30 kg/m2) were less likely to use active (β = - .11, p < .01) and support (β = - .09, p < .01) coping strategies, which did not consistently mediate the association with health. CONCLUSION Perceived experiences of weight discrimination are associated with disengaged coping strategies to manage stressful experiences, and these strategies are one mechanism that may contribute to the worse health associated with unfair treatment due to weight.
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Affiliation(s)
- Angelina R Sutin
- Florida State University College of Medicine, 1115 W. Call Street, Tallahassee, FL, 32306, USA.
| | - Mary A Gerend
- Florida State University College of Medicine, 1115 W. Call Street, Tallahassee, FL, 32306, USA
| | | | - Antonio Terracciano
- Florida State University College of Medicine, 1115 W. Call Street, Tallahassee, FL, 32306, USA
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Mihalache L, Popa AD, Gherasim A, Nita O, Graur M, Rosu OM, Arhire LI. Assessing Weight Stigma: Validating Attitudes and Beliefs Questionnaires Among Future Healthcare Professionals. Cureus 2024; 16:e66345. [PMID: 39113816 PMCID: PMC11304508 DOI: 10.7759/cureus.66345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2024] [Indexed: 08/10/2024] Open
Abstract
Background This study aimed to establish the reliability and validity of the Anti-Fat Attitudes (AFA) questionnaire and the Beliefs About Obese Persons (BAOP) scale. Methodology A convenience sample of 257 students from three distinct sections of the University of Medicine and Pharmacy "Grigore T. Popa" Iasi (Medical Faculty, Nutrition and Dietetics, and Nursing) participated in an observational study. Construction validity was tested with exploratory factor analysis. The students completed a form containing sociodemographic data, the AFA questionnaire, and the BAOP scale. Weight and height were self-reported and used to determine the body mass index. Results The value of the Cronbach alpha coefficient for the AFA questionnaire indicated adequate internal consistency (0.862). The exploratory factor analysis identified the following three factors corresponding to the original questionnaire: Dislike, Fear of Fat, and Willpower. We validated a single-factor structure of the BAOP scale, which had adequate internal consistency (0.781). There were statistically significant differences (AFA: p = 0.02; BAOP: p = 0.03) between the scores of the students from Nutrition and Dietetics, Nursing, and General Medicine. Conclusions This study demonstrated that the AFA questionnaire and the BAOP scale could be used to evaluate weight stigma in healthcare students, providing a useful tool to assess the effects of weight stigma awareness interventions in this population.
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Affiliation(s)
- Laura Mihalache
- Internal Medicine II, University of Medicine and Pharmacy "Grigore T. Popa" Iasi, Iasi, ROU
| | - Alina Delia Popa
- Internal Medicine II/Nursing, University of Medicine and Pharmacy "Grigore T. Popa" Iasi, Iasi, ROU
| | - Andreea Gherasim
- Internal Medicine II, University of Medicine and Pharmacy "Grigore T. Popa" Iasi, Iasi, ROU
| | - Otilia Nita
- Internal Medicine II, University of Medicine and Pharmacy "Grigore T. Popa" Iasi, Iasi, ROU
| | - Mariana Graur
- Internal Medicine, University "Ștefan cel Mare" of Suceava, Suceava, ROU
| | - Oana Madalina Rosu
- Internal Medicine II, University of Medicine and Pharmacy "Grigore T. Popa" Iasi, Iasi, ROU
| | - Lidia Iuliana Arhire
- Internal Medicine II, University of Medicine and Pharmacy "Grigore T. Popa" Iasi, Iasi, ROU
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8
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Bennett BL, Puhl RM. Physicians' stigmatizing attitudes about individuals with type 2 diabetes: Associations with communication practices and perceived barriers to care. Prim Care Diabetes 2024:S1751-9918(24)00127-X. [PMID: 39048399 DOI: 10.1016/j.pcd.2024.07.001] [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: 09/25/2023] [Revised: 07/05/2024] [Accepted: 07/07/2024] [Indexed: 07/27/2024]
Abstract
AIMS The stigma of type 2 diabetes (T2D) has received growing attention in the healthcare setting. However, there has been almost no research examining how healthcare professional biases about diabetes relate to patient care. This cross-sectional study examined how physicians' self-reported biases, stereotypes, and attributions about diabetes and obesity were related to their patient care practices. METHODS Physicians treating T2D, specializing in internal medicine or endocrinology (n=205), completed a battery of online questionnaires. RESULTS Physicians who attributed poor patient compliance as the primary barrier to provision of diabetes care had worse perceptions of individuals with T2D and were less likely to use person-centered approaches with their patients. Physicians' stigmatizing attitudes about T2D were associated with less use of person-first language, while more positive perceptions of individuals with T2D were associated with greater use of motivational interviewing. Weight-related stigma was associated with less use of person-centered approaches to care and less confidence in their ability to provide care. CONCLUSIONS Findings reiterate the associations between weight stigma and poorer physician communication and suggest that similar patterns occur in the provision of care for individuals with T2D. Physicians who treat T2D may benefit from stigma reduction interventions for both diabetes and weight-related stigmas.
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Affiliation(s)
- Brooke L Bennett
- Department of Psychology, Clemson University, 321 Calhoun Dr, Brackett Hall 418, Clemson, SC 29634, USA; Rudd Center for Food Policy & Health, University of Connecticut, 1 Constitution Plaza, Suite 600, Hartford, CT 06103, USA.
| | - Rebecca M Puhl
- Rudd Center for Food Policy & Health, University of Connecticut, 1 Constitution Plaza, Suite 600, Hartford, CT 06103, USA; Department of Human Development and Family Sciences, University of Connecticut, 348 Mansfield Road, U-1058, Storrs, CT 06269-1058, USA.
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Konttinen H, Sjöholm K, Carlsson LMS, Peltonen M, Svensson PA. Fifteen-year changes in health-related quality of life after bariatric surgery and non-surgical obesity treatment. Int J Obes (Lond) 2024:10.1038/s41366-024-01572-w. [PMID: 38902388 DOI: 10.1038/s41366-024-01572-w] [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] [Received: 06/27/2023] [Revised: 05/28/2024] [Accepted: 06/13/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Evidence on the long-term (≥10 years) development of health-related quality of life (HRQoL) following bariatric surgery is still limited and mainly based on small-scale studies. This study aimed to investigate (1) 15-year changes in mental, physical, social, and obesity-related HRQoL after bariatric surgery and non-surgical obesity treatment; and (2) whether sociodemographic factors and pre-operative health status are associated with 15-year HRQoL changes in the surgery group. METHODS Participants were from the non-randomized, prospective, controlled Swedish Obese Subjects study. The surgery group (N = 2007, per-protocol) underwent gastric bypass, banding or vertical banded gastroplasty, and matched controls (N = 2040) received usual obesity care. Recruitment took place in 1987-2001 and measurements (including six HRQoL scales) were administered before treatment and after 0.5, 1, 2, 3, 4, 6, 8, 10 and 15 years. Multilevel mixed-effect regression models using all observations for estimation were conducted. RESULTS Surgical patients experienced greater 15-year improvements in perceived health and overall mood, and greater reductions in depression, obesity-related problems, and social interaction limitations than controls (all p < 0.001, adjusted for baseline differences). Effect size (ES) was classified as large only for obesity-related problems (ES = 0.82). At the 15-year follow-up, surgical patients reported better perceived health (p < 0.001) and less obesity-related problems (p = 0.020) than controls. In the surgery group, patients with baseline diabetes had smaller 15-year reductions in social interaction limitations (p < 0.001) and depression (p = 0.049) compared to those without baseline diabetes. Although surgical patients with a history of psychiatric disorder reported lower HRQoL than those without such history over the 15-year follow-up, there were no significant differences in the long-term improvements between the two groups (p = 0.211-0.902). CONCLUSIONS Over 15 years, surgical patients experienced more positive development of HRQoL compared to those receiving usual care. This difference was large for obesity-related problems, but otherwise the differences were small. Patients with pre-operative diabetes might be at increased risk for smaller long-term HRQoL improvements.
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Affiliation(s)
- Hanna Konttinen
- Social Psychology, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland.
| | - Kajsa Sjöholm
- Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Lena M S Carlsson
- Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | | | - Per-Arne Svensson
- Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Standen EC, Ward A, Mann T. The role of social norms, intergroup contact, and ingroup favoritism in weight stigma. PLoS One 2024; 19:e0305080. [PMID: 38900716 PMCID: PMC11189193 DOI: 10.1371/journal.pone.0305080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 05/22/2024] [Indexed: 06/22/2024] Open
Abstract
Although average body size in the U.S. has increased in recent decades, stigma directed at individuals with higher weight has not diminished. In this study, we explored this phenomenon by investigating the relationship between people's perceived social norms regarding higher weight and their reported levels of weight bias (i.e., anti-fat attitudes). Our predictions for perceived social norms drew on the concepts of intergroup contact and ingroup favoritism, which were also probed in this study. We hypothesized that both greater descriptive norms and more favorable injunctive norms regarding higher weight would be associated with lower reported weight bias. Individuals' quantity and quality of social contact with people with higher weight were also predicted to be associated with lower weight bias. Finally, we predicted that individuals who perceived themselves as heavier would display ingroup favoritism (i.e., report less weight bias). Participants (N = 272) from the United States completed a set of online questionnaires about their perceived social norms, social contact with people with higher weight, and explicit weight bias. We found support for each of these pre-registered predictions (ps < 0.03), and post hoc analyses revealed that quality, but not quantity, of social contact with individuals with higher weight was an important predictor of lower weight bias. Together, these findings provide insight into the social psychology of weight bias and help to lay a theoretical foundation for future efforts to reduce weight stigma.
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Affiliation(s)
- Erin C. Standen
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Andrew Ward
- Department of Psychology, Swarthmore College, Swarthmore, Pennsylvania, United States of America
| | - Traci Mann
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota, United States of America
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11
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Mohammedsaeed W, El Shikieri AB. Cardiometabolic Risk Factors among Women with Eating Disorders in Saudi Arabia. J Nutr Metab 2024; 2024:5953893. [PMID: 38867850 PMCID: PMC11168801 DOI: 10.1155/2024/5953893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 04/16/2024] [Accepted: 04/22/2024] [Indexed: 06/14/2024] Open
Abstract
Objective To assess selected cardiometabolic risk factors among Saudi women with eating disorders. Methods An epidemiological, cross-sectional study included women aged between 18 and 50 years with eating disorders (EDs). Women with chronic diseases, pregnant, or lactating were excluded. The weight and height were measured for the calculation of the body mass index (BMI). Fasting blood samples were drawn for the analysis of blood sugar, glycated haemoglobin, lipid profile, albumin, haemoglobin, and C-reactive levels. The atherogenic dyslipidemia index (AIP) was also calculated. Results Patients (n = 100) were enrolled. Fasting blood glucose levels were critically low among women with anorexia nervosa (AN) and bulimia nervosa (BN) but normal among those with binge eating disorders (BEDs). All women with ED suffered from anaemia based on their haemoglobin levels as well as dyslipidemia, hypoalbuminaemia, and high C-reactive protein levels. Women with AN had low cardiovascular (CV) risks based on their normal AIP values. However, women with BN and BED had intermediate CV risks. On average, women with AN suffered from severe thinness and those with BN had normal BMIs, whereas those with BED were overweight. Women (90%) with BN and BED were overweight and/or obese. Conclusion Women with ED had a high risk of cardiovascular diseases defined by their hypoalbuminaemia, dyslipidemia, anaemia, and high AIP levels. Dietitians and psychiatrists are advised to collaborate in assessing the potential risk of having eating disorders to provide counselling sessions to women on healthy balanced diets and their effect on health.
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Affiliation(s)
- Walaa Mohammedsaeed
- Department of Clinical Laboratory Sciences, Faculty of Applied Medical Science at Taibah University, Madinah, Saudi Arabia
| | - Ahlam B. El Shikieri
- Department of Clinical Nutrition, College of Applied Medical Sciences, Taibah University, Medina, Saudi Arabia
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12
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Jiretorn L, Engström M, Laursen C, Ramos Salas X, Järvholm K. 'My goal was to become normal'-A qualitative investigation of coping with stigma, body image and self-esteem long-term after bariatric surgery. Clin Obes 2024; 14:e12657. [PMID: 38549516 DOI: 10.1111/cob.12657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 03/15/2024] [Accepted: 03/16/2024] [Indexed: 05/14/2024]
Abstract
Improved self-esteem and body image, as well as reduced experiences of weight stigma are important patient-reported obesity treatment outcomes. However, more knowledge is needed about how individuals who have undergone metabolic and bariatric surgery (MBS) perceive themselves and their bodies and use different coping strategies in relation to body image and self-esteem long-term after MBS. In this qualitative study body image, self-esteem, weight stigma and coping strategies were explored among 18 individuals who underwent MBS more than 10 years ago when interviewed. Using reflexive thematic analysis, two primary themes were identified: 'Experiences of living with a stigmatised body' and 'Coping with weight stigma, body image and self-esteem', and eight sub-themes. Findings capture frequent experiences of weight stigma before bariatric surgery, the need for coping with stigma and body dissatisfaction before and after MBS, and how different coping strategies are related to participants' perceptions of their bodies and self-concepts. More adaptive coping strategies, such as confrontation and cognitive restructuring may facilitate more positive body image outcomes, than more ruminative and avoidant strategies. Understanding adaptive coping strategies can be useful to develop interventions to reduce negative consequences of weight stigma on body image and self-esteem.
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Affiliation(s)
- Linda Jiretorn
- Department of Psychology, Lund University, Lund, Sweden
- Department of Child and Adolescent Psychiatry, Region Östergötland, Linköping, Sweden
| | - My Engström
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | | | - Kajsa Järvholm
- Department of Psychology, Lund University, Lund, Sweden
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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13
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Hunger JM, Montoya AK, Edrosolan K, Tan J, Hubbard AS, Tomiyama AJ. Ecological Momentary Assessment of Weight Stigma and Eating Behavior in Everyday Life. Ann Behav Med 2024; 58:457-462. [PMID: 38591715 DOI: 10.1093/abm/kaae012] [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] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Weight stigma is widespread, but the existing literature on its harmful consequences remains largely limited to lab-based experiments and large-scale longitudinal designs. PURPOSE The purpose of this study was to understand how weight stigma unfolds in everyday life, and whether it predicts increased eating behavior. METHODS In this event-contingent ecological momentary assessment study, 91 participants reported every time they experienced weight stigma and documented whether they ate, how much they ate, and what they ate. These reports were compared against a timepoint when they did not experience stigma. RESULTS Participants reported a wide variety of stigmatizing events from a variety of sources, with the most common ones being the self, strangers, the media, and family. Multilevel models showed that participants were no more likely to eat post-stigma (vs. the comparison point), but if they did eat, they ate more servings of food (on average consuming 1.45 more servings, or 45% more). Moderation analyses indicated that this effect was amplified for men versus women. CONCLUSION Experiencing weight stigma appears to beget behavioral changes, potentially driving future weight gain, placing individuals at ever more risk for further stigmatization.
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Affiliation(s)
| | - Amanda K Montoya
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Kristienne Edrosolan
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Juanyi Tan
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Anne S Hubbard
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - A Janet Tomiyama
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
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14
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Ye Q, Turner MM, Jang Y. Examining the Psychological Mechanisms Underlying Nostalgia Appeals: A Comparative Experiment of Nostalgia and Regret. HEALTH COMMUNICATION 2024:1-13. [PMID: 38767138 DOI: 10.1080/10410236.2024.2355441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Obesity rates remain high among U.S. adults, especially rural residents. Research has shown that nostalgia appeals effectively promote several healthy behaviors. However, the psychological mechanisms underlying nostalgia appeals remain unclear. This study examined the effects of nostalgia appeals on intention to increase exercise and shed light on how nostalgia affected persuasive outcomes. We anticipated that nostalgia appeals would persuade people by enhancing self-esteem and reducing anger and counterarguing. To illuminate the mechanisms underlying the effects of nostalgia, a between-subject experiment (nostalgia appeal vs. regret appeal vs. irrelevant message vs. neutral persuasive message) was conducted among overweight or obese rural Michiganders (N = 507). Results showed that relative to the regret appeal, the nostalgia appeal led to higher state self-esteem, less anger, and less counterarguing. There was no significant difference in attitude or behavioral intention between the nostalgia appeal, regret appeal, and neutral persuasive message. We demonstrated that enhancing self-esteem was the key mechanism by which the nostalgia appeal persuaded the target audience.
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Affiliation(s)
- Qijia Ye
- Annenberg School for Communication, University of Pennsylvania
| | | | - Youjin Jang
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
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15
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Bradford HM, Puhl RM, Phillippi JC, Dietrich MS, Neal JL. Weight Bias Among Certified Nurse-Midwives and Certified Midwives: Findings From a National Sample. J Midwifery Womens Health 2024; 69:333-341. [PMID: 38459813 DOI: 10.1111/jmwh.13608] [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] [Revised: 12/01/2023] [Indexed: 03/10/2024]
Abstract
INTRODUCTION Weight bias toward individuals with higher body weights permeates health care settings in the United States and has been associated with poor weight-related communication and quality of care as well as adverse health outcomes. However, there has been limited quantitative investigation into weight bias among perinatal care providers. Certified nurse-midwives (CNMs)/certified midwives (CMs) attend approximately 11% of all births in the United States. The aims of this study were to measure the direction and extent of weight bias among CNMs/CMs and compare their levels of weight bias to the US public and other health professionals. METHODS Through direct postcard distribution, social media accounts, professional networks, and email listservs, American Midwifery Certification Board (AMCB)-certified midwives were solicited to complete an online survey of their implicit weight bias using the Implicit Association Test and their explicit weight bias using the Antifat Attitudes Questionnaire, Fat Phobia Scale, and Preference for Thin People measure. RESULTS A total of 2257 midwives participated in the survey, yielding a completion rate of 17.7%. Participants were mostly White and female, with a median age of 46 years and 11 years since AMCB certification. More than 70% of midwives have some level of implicit weight bias, although to a lesser extent compared with previously published findings among the US public (P < .01) and other health professionals (P < .01). In a subsample comparison of female midwives to female physicians, implicit weight bias levels were similar (P > .05). Midwives also express explicit weight bias, but at lower levels than the US public and other health professionals (P < .05). DISCUSSION This study provides the first quantitative research documenting weight bias among a national US sample of perinatal care providers. Findings can inform educational efforts to mitigate weight bias in the perinatal care setting and decrease harm.
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Affiliation(s)
- Heather M Bradford
- Georgetown University, School of Nursing, Washington, District of Columbia
- Vanderbilt University, School of Nursing, Nashville, Tennessee
| | - Rebecca M Puhl
- Department of Human Development & Family Sciences, University of Connecticut, Storrs, Connecticut
| | | | - Mary S Dietrich
- Vanderbilt University, School of Nursing, Nashville, Tennessee
- Vanderbilt University, School of Medicine, Nashville, Tennessee
| | - Jeremy L Neal
- Vanderbilt University, School of Nursing, Nashville, Tennessee
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16
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Hughes AM, Flint SW, Clare K, Kousoulis AA, Rothwell ER, Bould H, Howe LD. Demographic, socioeconomic and life-course risk factors for internalized weight stigma in adulthood: evidence from an English birth cohort study. THE LANCET REGIONAL HEALTH. EUROPE 2024; 40:100895. [PMID: 38745988 PMCID: PMC11092882 DOI: 10.1016/j.lanepe.2024.100895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/15/2024] [Accepted: 03/19/2024] [Indexed: 05/16/2024]
Abstract
Background Obesity is highly stigmatized, with negative obesity-related stereotypes widespread across society. Internalized weight stigma (IWS) is linked to negative outcomes including poor mental health and disordered eating. Previous evidence examining population groups at higher risk of experiencing IWS comes from small, nonrepresentative samples. Here, we re-assess previously reported associations of IWS with demographic, socioeconomic, and wider social factors in a large general population birth cohort study for the first time. Methods In the Avon Longitudinal Study of Parents and Children (ALSPAC), we explored differences in IWS at age 31 years by sex, ethnicity, socioeconomic factors, sexual orientation, and family and wider social influences, using confounder-adjusted multivariable regression. Findings In models adjusted for potential confounders and BMI in childhood, adolescence, and adulthood (N = 4060), IWS was higher for females (standardized beta: 0.56, 95% CI: 0.50, 0.61), sexual minorities (0.17 S.D. higher, 95% CI: 0.09, 0.24), and less socioeconomically advantaged individuals (e.g., 0.16 S.D. higher (95% CI: 0.08, 0.24) for participants whose mothers had minimum or no qualifications, compared to a university degree). The social environment during adolescence and young adulthood was important: IWS was higher for people who at age 13 years felt pressure to lose weight from family (by 0.13 S.D., 95% CI: 0.03, 0.23), and the media (by 0.17, 95% CI: 0.10, 0.25), or had experienced bullying (e.g., 0.25 S.D., 95% CI: 0.17, 0.33 for bullying at age 23 years). Interpretation Internalized weight stigma differs substantially between demographic groups. Risk is elevated for females, sexual minorities, and socioeconomically disadvantaged adults, and this is not explained by differences in BMI. Pressure to lose weight from family and the media in adolescence may have long-lasting effects on IWS. Funding The ESRC, MRC, NIHR, and Wellcome Trust.
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Affiliation(s)
- Amanda M. Hughes
- MRC Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Stuart W. Flint
- School of Psychology, University of Leeds, Leeds, UK
- Scaled Insights, Nexus, University of Leeds, Leeds, UK
| | - Ken Clare
- Leeds Beckett University, Leeds, UK
- Obesity UK, Halifax, UK
- European Coalition for People Living with Obesity, Dublin, Ireland
| | | | - Emily R. Rothwell
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Helen Bould
- MRC Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Gloucestershire Health and Care NHS Foundation Trust, Gloucestershire, UK
| | - Laura D. Howe
- MRC Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
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17
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Hailu H, Skouteris H, Incollingo Rodriguez AC, Galvin E, Hill B. Drivers and facilitators of weight stigma among preconception, pregnant, and postpartum women: A systematic review. Obes Rev 2024; 25:e13710. [PMID: 38343332 DOI: 10.1111/obr.13710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 01/09/2024] [Accepted: 01/13/2024] [Indexed: 04/18/2024]
Abstract
Women in the preconception, pregnant, or postpartum period are susceptible to weight stigma, particularly due to the risk of excess weight gain during the reproductive life period and the negative effects of stigma on the health of both the mother and the child. Identifying the drivers and facilitators of weight stigma will help guide focused weight stigma prevention interventions. This systematic review aimed to identify the drivers and facilitators of weight stigma among preconception, pregnant, and postpartum women. In May 2022, Medline, Embase, PsycINFO, and the Maternity and Infant Care Database were searched for peer-reviewed articles published since 2010 using search terms weight AND stigma AND preconception, OR pregnant, OR postpartum. Of the 1724 articles identified, 34 fulfilled the inclusion criteria and were included in a narrative synthesis. Women reported facing insensitive language, misconceptions about obesity across all settings, and inappropriate media representation. The unavailability of appropriate equipment at facilities was reported by both women and health professionals. Our findings indicate that a rigorous effort by all stakeholders is necessary to promote regulatory, legal, and educational initiatives designed to reduce weight stigma and discrimination against women in the reproductive period.
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Affiliation(s)
- Haimanot Hailu
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Warwick Business School, The University of Warwick, Coventry, UK
| | - Angela C Incollingo Rodriguez
- Psychological and Cognitive Sciences, Department of Social Science and Policy Studies, Worcester Polytechnic Institute, Worcester, Massachusetts, USA
| | - Emma Galvin
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Briony Hill
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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18
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Rachele JN, Mavoa S, Sugiyama T, Kavanagh A, Giles-Corti B, Brown WJ, Inoue S, Amagasa S, Turrell G. Changes in neighbourhood walkability and body mass index: An analysis of residential mobility from a longitudinal multilevel study in Brisbane, Australia. Health Place 2024; 87:103245. [PMID: 38631216 DOI: 10.1016/j.healthplace.2024.103245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 04/02/2024] [Accepted: 04/02/2024] [Indexed: 04/19/2024]
Abstract
This study examined associations between changes in neighbourhood walkability and body mass index (BMI) among 1041 residents who relocated within Brisbane, Australia between 2007 and 2016 over five waves of the HABITAT study. Measures included spatially-derived neighbourhood walkability (dwelling density, street connectivity, and land use mix) and self-reported height and weight. No associations were found between any neighbourhood walkability characteristics and BMI. Examining these associations over the life course, and the impact of residential relocation in the younger years, remains a priority for future research.
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Affiliation(s)
- Jerome N Rachele
- College of Sport, Health and Engineering, Victoria University, Melbourne, Australia; Institute for Health and Sport, Victoria University, Melbourne, Australia.
| | - Suzanne Mavoa
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
| | - Takemi Sugiyama
- Centre for Urban Transitions, Swinburne University of Technology, Melbourne, Australia.
| | - Anne Kavanagh
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
| | | | - Wendy J Brown
- School of Human Movement and Nutrition Studies, University of Queensland, St Lucia, Australia.
| | - Shigeru Inoue
- Department of Preventive Medicine and Public Health, Tokyo Medical University, Tokyo, Japan.
| | - Shiho Amagasa
- Department of Preventive Medicine and Public Health, Tokyo Medical University, Tokyo, Japan; Graduate School of Public Health, Teikyo University, Tokyo, Japan.
| | - Gavin Turrell
- Centre for Urban Research, RMIT University, Melbourne, Australia.
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19
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Bradford HM, Puhl RM, Phillippi JC, Dietrich MS, Neal JL. Implicit and Explicit Weight Bias among Midwives: Variations Across Demographic Characteristics. J Midwifery Womens Health 2024; 69:342-352. [PMID: 38487947 DOI: 10.1111/jmwh.13616] [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] [Revised: 01/10/2024] [Indexed: 06/05/2024]
Abstract
INTRODUCTION Weight bias toward individuals with higher body weights is present in health care settings. However, there has been limited quantitative exploration into weight bias among perinatal care providers and its potential variations based on demographic characteristics. The aim of this study was to examine if the direction and extent of weight bias among midwives certified by the American Midwifery Certification Board (AMCB) varied across age, years since certification, body mass index (BMI), race, ethnicity, and US geographic region. METHODS Through direct email listservs, postcard distribution, social media accounts, and professional networks, midwives were invited to complete an online survey of their implicit weight bias (using the Implicit Association Test) and their explicit weight bias using the Anti-Fat Attitudes Questionnaire (AFA), Fat Phobia Scale (FPS), and Preference for Thin People (PTP) measure. RESULTS A total of 2106 midwives who identified as Black or White and resided in one of 4 US geographic regions participated in the survey. Midwives with a lower BMI expressed higher levels of implicit (P <.01) and explicit (P ≤.01) weight bias across all 4 measures except for the AFA Fear of Fat Subscale. Implicit weight bias levels also varied by age (P <.001) and years since certification (P <.001), with lower levels among younger midwives (vs older) and those with fewer years (vs more) since certification. Only age and BMI remained significant (P <.001) after adjusting for other demographic characteristics. Lower explicit weight bias levels were found among midwives who identified as Black (vs White) on 2 measures (FPS: adjusted β = -0.07, P = .004; PTP: P = .01). DISCUSSION This was the first quantitative study of how weight bias varies across demographic characteristics among a national sample of midwives. Further exploration is needed in more diverse samples. In addition, research to determine whether weight bias influences clinical decision-making and quality of care is warranted.
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Affiliation(s)
- Heather M Bradford
- Georgetown University School of Nursing, Washington, District of Columbia
- Vanderbilt University School of Nursing, Nashville, Tennessee
| | | | | | - Mary S Dietrich
- Vanderbilt University School of Nursing, Nashville, Tennessee
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Jeremy L Neal
- Vanderbilt University School of Nursing, Nashville, Tennessee
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20
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Lamont A, Speed D. Food insecurity and body dissatisfaction in a sample of Canadian adults. J Health Psychol 2024:13591053241242342. [PMID: 38566401 DOI: 10.1177/13591053241242342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Food insecurity may predict poorer body image, which is associated with increased risk of mental health problems. However, minimal attention has been given to the food insecurity-body image link and to factors that may influence this link, such as assigned sex; importantly, females are more likely to experience both food insecurity and body dissatisfaction. The present study used data from the 2017 to 2018 Canadian Community Health Survey (N = 32,017) to investigate the effects of food insecurity and sex on body satisfaction via generalized ordered logistic regression. Results indicated: (1) Food insecurity predicted lower odds of body satisfaction, (2) Males were more likely than females to be satisfied with their bodies, and (3) Food insecurity no longer predicted body satisfaction following the inclusion of sex. Findings suggest the association between food insecurity and body satisfaction may largely be driven by the link between food insecurity and sex. Further investigation is warranted.
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Affiliation(s)
| | - David Speed
- University of New Brunswick - Saint John, Canada
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21
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Edmonds MC, Bickell NA, Gallagher EJ, LeRoith D, Lin JJ. Racial differences in weight perception among Black and White women diagnosed with breast cancer. J Cancer Surviv 2024; 18:531-540. [PMID: 36169797 PMCID: PMC10166002 DOI: 10.1007/s11764-022-01255-3] [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: 05/09/2022] [Accepted: 08/24/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Black women are more likely than White women to have obesity, and obesity is associated with worse breast cancer prognosis. Weight perception, however, has not been studied as a potential mediator of obesity disparities in women with breast cancer. In this study, we sought to describe racial differences and the association of lifestyle factors with weight perception. METHODS In this cross-sectional study design, Black and White women with a new primary breast cancer were surveyed about socio-demographics, weight perception, diet, and exercise habits. Height and weight were measured at enrollment. We classified women with a BMI ≥ 25 kg/m2 or waist circumference ≥ 88 cm who reported that they were "about the right weight" as under-perceivers. Chi-square and t tests were used to assess study variables (e.g., race, physical activity) associated with under-perception of weight. Logistic regression models were fit to evaluate for racial differences in under-perception while controlling for other covariates. RESULTS Of 1,197 women with newly diagnosed breast cancer, the average age was 58 years, and 909 (75.9%) were White. Nine hundred eighteen (77%) had stage I cancer, 1,035 (87%) had estrogen receptor positive cancer, and 795 (66%) were privately insured at time of diagnosis. Seven hundred eighty-nine (66%) women had abdominal obesity (waist circumference ≥ 88 cm), while 366 (31%) women had a BMI ≥ 25 kg/m2. Overall, 24% of women were under-perceivers. Compared to White women, Black women with WC ≥ 88 cm more frequently under-perceived their weight (24% vs. 14% p < 0.0001) were more obese with BMI > 30 kg/m2 (51% vs. 23%, p < 0.0001) and had lower physical activity (22% vs. 77%, p < 0.0001). After controlling for age, education, and stage, Black women remained more likely to under-perceive their weight relative to White women for those with BMI ≥ 25 kg/m2 (OR: 2.64; 95% CI: 1.4-4.6) or waist circumference ≥ 88 cm (OR: 2.89; 95% CI: 1.8-4.5). With respect to lifestyle factors, among women with BMI ≥ 25 kg/m2, those who met physical activity guidelines were less likely to under-perceive their weight compared to those who did not meet physical activity guidelines (OR: 0.37; 95% CI: 0.2-0.6), regardless of race. CONCLUSIONS We found racial differences in weight perception and identified social determinants and lifestyle factors such as lower education and physical inactivity that influenced under-perception of weight among newly diagnosed breast cancer patients. IMPLICATIONS FOR CANCER SURVIVORS Since obesity is associated with worse breast cancer outcomes, identifying optimal modifiable factors to intervene upon to support weight management among breast cancer survivors is clinically important. Breast cancer patients' perceptions about their weight provide insight that may inform lifestyle behavior interventions to reduce obesity during survivorship care.
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Affiliation(s)
- Megan C Edmonds
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Nina A Bickell
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Emily J Gallagher
- Division of Endocrinology, Diabetes and Bone Disease, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Derek LeRoith
- Division of Endocrinology, Diabetes and Bone Disease, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jenny J Lin
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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22
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Wu HX, Chen TT, Ching BHH, Li XY, Li YH. Weight stigma from romantic partners: Its relations with maladaptive and adaptive coping and depressive symptoms. Scand J Psychol 2024; 65:157-167. [PMID: 37675937 DOI: 10.1111/sjop.12965] [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: 02/09/2022] [Revised: 08/03/2023] [Accepted: 08/20/2023] [Indexed: 09/08/2023]
Abstract
Social devaluation of being overweight is common in daily life, but little is known about the weight stigma in romantic relationships. The present study investigated the roles of maladaptive and adaptive coping strategies in the relation between the experience of weight stigma in romantic relationships and depressive symptoms in men and women, respectively. Analyses of gender differences and structural equation modeling yielded several findings. First, while men and women experienced similar levels of weight stigma from their romantic partners, women were more likely to use exercise avoidance, disengagement coping, and reappraisal coping strategies, and to exhibit more depressive symptoms than men. Second, men who experienced weight stigma tended to cope with it through exercise avoidance and disengagement coping, which were related to greater depressive symptoms. Men also coped with weight stigma adaptively via reappraisal coping, which was additionally associated with more positive affect. Third, the relation between the experience of weight stigma and depressive symptoms in women was only explained by using disengagement coping. These findings extend the understanding of weight stigma to a specific context and provide some insight that future interventions to reduce the impacts of weight stigma should be tailored accordingly for men and women.
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Affiliation(s)
- Hannah X Wu
- Faculty of Education, University of Macau, Avenida da Universidade, Taipa, Macau, China
| | - Tiffany T Chen
- Faculty of Education, University of Macau, Avenida da Universidade, Taipa, Macau, China
| | - Boby H-H Ching
- Faculty of Education, University of Macau, Avenida da Universidade, Taipa, Macau, China
| | - Xiang Y Li
- Faculty of Education, University of Macau, Avenida da Universidade, Taipa, Macau, China
| | - Yuan H Li
- Faculty of Education, University of Macau, Avenida da Universidade, Taipa, Macau, China
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23
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Chae K, German J, Kendrick K, Tackett S, O’Rourke P, Gudzune KA, Laudenslager M. What are Internal medicine residents' attitudes toward obesity as a disease, people living with obesity, and obesity treatment? Obes Sci Pract 2024; 10:e748. [PMID: 38562401 PMCID: PMC10984423 DOI: 10.1002/osp4.748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 03/01/2024] [Accepted: 03/17/2024] [Indexed: 04/04/2024] Open
Abstract
Objective Despite the rising prevalence of people living with obesity, physicians are providing suboptimal care to these individuals, which may be a consequence of inadequate education in weight management and negative attitudes toward people living with obesity. Internal Medicine (IM) residency is an ideal setting to address physicians' attitudes toward people living with obesity. However, there is a paucity of recent literature on this topic. This study sought to assess the current attitudes of IM residents toward obesity as a disease, people living with obesity, and obesity treatment. Methods A cross-sectional survey was conducted in 2020 across two IM programs assessing residents' attitudes toward obesity as a disease, people living with obesity, and obesity treatment. RESULTS Among 42 residents who participated in the survey, 64% were women; 31 percent were Post Graduate Year 1, 31% PGY-2, and 38% PGY-3. Mean attitude scores were high on statements regarding obesity as a chronic disease [4.7 (SD 0.4)] and its association with serious medical conditions [4.9 (SD 0.3)]. Residents had overall positive attitudes toward people living with obesity. In contrast, residents felt negatively regarding their level of success in helping patients lose weight [2.0 (SD 0.7)]. CONCLUSIONS While residents recognized obesity as a chronic disease and had positive attitudes toward people living with obesity, their low ratings regarding weight management success suggest that targeted educational efforts are needed to increase obesity treatment self-efficacy.
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Affiliation(s)
- Kacey Chae
- Division of General Internal MedicineDepartment of MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Jashalynn German
- Division of Endocrinology, Diabetes, & MetabolismDepartment of MedicineDuke UniversityDurhamNorth CarolinaUSA
| | - Karla Kendrick
- Winchester Hospital Weight Management CenterBeth Israel Lahey HealthWoburnMassachusettsUSA
| | - Sean Tackett
- Division of General Internal MedicineDepartment of MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Biostatistics, Epidemiology, and Data Management CoreJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Paul O’Rourke
- Division of General Internal MedicineDepartment of MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Kimberly A. Gudzune
- Division of General Internal MedicineDepartment of MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Marci Laudenslager
- Division of General Internal MedicineDepartment of MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
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24
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Yetsenga R, Banerjee R, Streatfeild J, McGregor K, Austin SB, Lim BWX, Diedrichs PC, Greaves K, Mattei J, Puhl RM, Slaughter-Acey JC, Solanke I, Sonneville KR, Velasquez K, Cheung S. The economic and social costs of body dissatisfaction and appearance-based discrimination in the United States. Eat Disord 2024:1-31. [PMID: 38520696 DOI: 10.1080/10640266.2024.2328461] [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] [Indexed: 03/25/2024]
Abstract
This study estimated the social and economic costs of body dissatisfaction and appearance-based discrimination (specifically, weight and skin-shade discrimination) in the United States (USA) in the 2019 calendar year. We used a prevalence-based approach and a cost-of-illness method to estimate the annual cost of harmful appearance ideals for cases of body dissatisfaction and discrimination based on weight and skin shade. Impacts on conditions/illnesses such as eating disorders that are attributable to body dissatisfaction, weight discrimination and skin-shade discrimination were identified through a quasi-systematic literature review, which captured financial, economic, and non-financial costs. For each impact attributable to body dissatisfaction or appearance-based discrimination, annual health system and productivity costs (or labor market costs) were primarily estimated by using a population attributable fraction methodology. Only direct costs that resulted from body dissatisfaction and appearance-based discrimination were included (for example, costs associated with conditions such as depression attributable to body dissatisfaction or appearance-based discrimination). In contrast, indirect costs (e.g. costs associated with a health condition developed following skin bleaching, which was undertaken as a result of body dissatisfaction) were not included. In 2019 body dissatisfaction incurred $84 billion in financial and economic costs and $221 billion through reduced well-being. Financial costs of weight discrimination and skin-shade discrimination were estimated to be $200 billion and $63 billion, respectively, and reduced well-being was estimated to be $206.7 billion due to weight discrimination and $8.4 billion due to skin-shade discrimination. Sensitivity testing revealed the costs likely range between $226 billion and $507 billion for body dissatisfaction, between $175 billion and $537 billion for skin-shade discrimination, and between $126 billion and $265 billion for weight discrimination. This study demonstrates that the prevalence and economic costs of body dissatisfaction and weight and skin-shade discrimination are substantial, which underscores the urgency of identifying policy actions designed to promote prevention.
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Affiliation(s)
- Rhiannon Yetsenga
- Health and Social Policy, Deloitte Access Economics, Sydney, Australia
| | - Rhea Banerjee
- Health and Social Policy, Deloitte Access Economics, Sydney, Australia
| | - Jared Streatfeild
- Health and Social Policy, Deloitte Access Economics, Sydney, Australia
| | | | - S Bryn Austin
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Belle W X Lim
- Health and Social Policy, Deloitte Access Economics, Sydney, Australia
| | | | - Kayla Greaves
- The Centre for Appearance Research is cross-departmental, University of the West of England, Bristol, UK
| | - Josiemer Mattei
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Rebecca M Puhl
- Department of Human Development & Family Sciences, Rudd Center for Food Policy and Health, University of Connecticut, Storrs, Connecticut, USA
| | - Jaime C Slaughter-Acey
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Iyiola Solanke
- Faculty of Law, University of Oxford/Somerville College, Oxford, UK
| | - Kendrin R Sonneville
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | | | - Simone Cheung
- Health and Social Policy, Deloitte Access Economics, Sydney, Australia
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25
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Calais-Ferreira L, Armstrong G, Hahn E, Newton-Howes G, Foulds J, Hopper JL, Spinath FM, Kurdyak P, Young JT. Mental disorders and discrimination: A prospective cohort study of young twin pairs in Germany. SSM Popul Health 2024; 25:101622. [PMID: 38380053 PMCID: PMC10877176 DOI: 10.1016/j.ssmph.2024.101622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/23/2024] [Accepted: 02/06/2024] [Indexed: 02/22/2024] Open
Abstract
Background Mental disorders and perceived discrimination share common risk factors. The association between having a mental disorder and experiencing discrimination is well-known, but the extent to which familial factors, such as genetic and shared environmental factors, might confound this association, including sex differences in familial confounding, remains unexplored. Aims We investigated potential unmeasured familial confounding in the association between mental disorders and perceived discrimination using a matched twin study design. Method We examined data from 2044 same-sex twin pairs (n = 4088) aged 16-25 years from the German population-based study 'TwinLife'. We applied random-effects logistic regression to within-individual and within-and-between pair models of the association between mental disorder and perceived discrimination, and used likelihood ratio tests (LRTs) to compare these models. Multivariable models were adjusted for body mass index, educational attainment, and life satisfaction. Results There were 322 (8.1%) participants with a diagnosed mental disorder, and 15% (n = 604) of the cohort reported having experienced discrimination in the previous 12 months. Mental disorder and discrimination were associated in the adjusted within-individual model (adjusted odds ratio = 2.19, 95% confidence interval: 1.42-3.39, P<0.001). However, the within-and-between pair model showed that this association was explained by the within-pair mean (aOR = 4.24, 95% CI: 2.17-8.29, P<0.001) and not the within-pair difference (aOR = 1.26, 95% CI: 0.70-2.28, P = 0.4) of mental disorder. Therefore, this association was mostly explained by familial confounding, which is also supported by the LRTs for the unadjusted and adjusted models (P<0.001 and P = 0.03, respectively). This familial confounding was more prominent for males than females. Conclusions Our findings show that the association between mental disorder and discrimination is at least partially explained by unmeasured familial factors. Designing family-based healthcare models and incorporating family members in interventions targeted at ameliorating mental ill-health and experiences of discrimination among adolescents may improve efficacy.
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Affiliation(s)
- Lucas Calais-Ferreira
- Centre for Mental Health and Community Wellbeing, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute and Royal Children's Hospital, Melbourne, Victoria, Australia
- Justice Health Group, School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Gregory Armstrong
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Elisabeth Hahn
- Department of Psychology, Saarland University, Saarbruecken, Germany
| | - Giles Newton-Howes
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - James Foulds
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - John L. Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Frank M. Spinath
- Department of Psychology, Saarland University, Saarbruecken, Germany
| | - Paul Kurdyak
- ICES, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Jesse T. Young
- Centre for Adolescent Health, Murdoch Children's Research Institute and Royal Children's Hospital, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
- National Drug Research Institute, Curtin University, Perth, Western Australia, Australia
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26
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Hawley N, Green J, Ahlich E, Hauff C, Hermer J, Skiba MB, James DL, Nash SH. Patient perspectives of weight stigma across the cancer continuum: A scoping review. Cancer Med 2024; 13:e6882. [PMID: 38205894 PMCID: PMC10905240 DOI: 10.1002/cam4.6882] [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: 08/25/2023] [Revised: 11/22/2023] [Accepted: 12/16/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Weight stigma has been defined as the social devaluation and denigration of individuals because of their weight. The purpose of this scoping systematic review was to assess and understand patient experiences with weight stigma in the cancer care setting. METHODS We conducted a systematic scoping review of studies examining shame, prejudice, bias, and stigma in relation to weight and cancer-related care using five databases: PubMed, CINAHL Plus Full Text (ProQuest), Cochrane Library, PsycINFO (EBSCO), and Scopus. Articles were uploaded into Covidence for de-duplication and screening. Included studies were peer reviewed, reported adult patient experiences in cancer-related care, and were published in English between October 2012 and February 2023. Study characteristics and key findings were abstracted and qualitatively synthesized. RESULTS Publications meeting inclusion criteria yielded five studies (n = 113 participants). Most focused on the experiences of women (n = 4) and cancers which predominantly impact women (i.e., breast, cervical, endometrial; n = 4). All stages of the cancer continuum were included with studies examining screening (n = 2), treatment (n = 1), and post-treatment survivorship (n = 2). Weight discrimination was discussed in four studies and weight-biased stereotypes were discussed in three studies. Experiences of weight bias internalization were reported in four studies. One study described an instance of implicit weight bias. CONCLUSIONS Limited studies examine patient experiences of weight stigma in cancer care; however, current evidence suggests that patients do experience weight stigma in cancer-related care. This review highlights critical gaps and a need for more research on the prevalence and impact of weight stigma in cancer screening and care.
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Affiliation(s)
- Nanako Hawley
- Department of Psychology, University of South Alabama, Mobile, Alabama, USA
| | - Jennifer Green
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, California, USA
| | - Erica Ahlich
- Department of Psychology, University of South Alabama, Mobile, Alabama, USA
| | - Caitlyn Hauff
- Department of Health, Kinesiology, and Sport, University of South Alabama, Mobile, Alabama, USA
| | - Janice Hermer
- Arizona State University Library, Arizona State University, Tempe, Arizona, USA
| | - Meghan B Skiba
- College of Nursing, University of Arizona, Tucson, Arizona, USA
| | - Dara L James
- College of Nursing, University of South Alabama, Mobile, Alabama, USA
- Edson College of Nursing and Health Innovation, Arizona State University, Tempe, Arizona, USA
| | - Sarah H Nash
- Department of Epidemiology, University of Iowa, Iowa, Iowa, USA
- Holden Comprehensive Cancer Center, University of Iowa, Iowa, Iowa, USA
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27
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Crompvoets PI, Nieboer AP, van Rossum EFC, Cramm JM. Perceived weight stigma in healthcare settings among adults living with obesity: A cross-sectional investigation of the relationship with patient characteristics and person-centred care. Health Expect 2024; 27:e13954. [PMID: 39102661 PMCID: PMC10790109 DOI: 10.1111/hex.13954] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 12/05/2023] [Accepted: 12/14/2023] [Indexed: 08/07/2024] Open
Abstract
INTRODUCTION Patients living with obesity often experience weight stigma in healthcare settings, which has worrying consequences for their healthcare experiences. This cross-sectional study aimed to: (1) provide an overview of stigmatising experiences in healthcare settings reported by adults living with varying classes of obesity, (2) identify associations among patient characteristics and perceived weight stigma and (3) investigate the association between perceived weight stigma and person-centred care (PCC). METHODS Dutch adults living with obesity classes I (body mass index [BMI]: 30 to <35 kg/m2; n = 426), II (BMI: 35 to <40 kg/m2; n = 124) and III (BMI: ≥40 kg/m2; n = 40) completed measures of perceived weight stigma in healthcare settings and PCC. Descriptive, correlational and multivariate analyses were conducted. RESULTS Of patients living with classes I, II and III obesity, 41%, 59% and 80%, respectively reported experiences of weight stigma in healthcare settings. Younger age, greater obesity severity and the presence of chronic illnesses were associated with greater perceived weight stigma. Greater perceived weight stigma was associated with lower PCC. CONCLUSION The results of this study emphasise the significant role of weight stigma in the healthcare experiences of patients living with obesity. Reducing weight stigma is expected to improve PCC and the overall quality of care for these patients. Minimising weight stigma will require efforts across various healthcare domains, including increasing awareness among healthcare professionals about sensitive communication in weight-related discussions. PATIENT CONTRIBUTION Our sample consisted of patients living with obesity. Additionally, patients were involved in the pilot testing and refinement of the PCC instrument.
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Affiliation(s)
- Paige I. Crompvoets
- Department of Socio‐Medical SciencesErasmus School of Health Policy & Management, Erasmus University RotterdamRotterdamThe Netherlands
| | - Anna P. Nieboer
- Department of Socio‐Medical SciencesErasmus School of Health Policy & Management, Erasmus University RotterdamRotterdamThe Netherlands
| | - Elisabeth F. C. van Rossum
- Department of Internal MedicineDivision of Endocrinology, Erasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
- Obesity Center CGGErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
| | - Jane M. Cramm
- Department of Socio‐Medical SciencesErasmus School of Health Policy & Management, Erasmus University RotterdamRotterdamThe Netherlands
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28
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Rao A, Puhl R, Farrar K. Weight Stigma in Online News Images: A Visual Content Analysis of Stigma Communication in the Depictions of Individuals with Obesity in U.S. and U.K. News. JOURNAL OF HEALTH COMMUNICATION 2024; 29:95-106. [PMID: 38037345 DOI: 10.1080/10810730.2023.2286512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Weight stigma is a pervasive form of discrimination worldwide. News media, and news images in particular, can reinforce weight stigma by portraying persons with obesity in a negative, stereotypical manner. Informed by the model of stigma communication, this study conducted a content analysis of images accompanying obesity-related news articles from the U.S. and U.K. to determine and compare the prevalence of stigmatizing images. Images (N = 445) in obesity-focused news articles obtained from the top four most viewed online news in the U.S. (n = 244) and U.K. (n = 201) during August 2018-August 2019 were systematically coded. These 445 images featured 228 individuals. Of these 228 individuals, 35% were identified as higher weight and 44% as lower weight. Overall, 70% of persons of higher weight in these news images were depicted in a stigmatizing manner. Further, 46% of individuals with higher weight were depicted with their head partially or fully removed from the image, compared to 25% of individuals with lower weight. Additionally, U.K. news were 2.5 times more likely to contain stigmatizing images than U.S. news. These findings highlight the prevalence of weight stigma in news images and suggest that broader systemic efforts are needed by the news media industry to eliminate the use of negative imagery that marginalizes persons of higher weight.
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Affiliation(s)
- Aditi Rao
- Department of Communication, University of Connecticut, Storrs, Connecticut, USA
| | - Rebecca Puhl
- Rudd Center for Food Policy & Health, University of Connecticut, Hartford, Connecticut, USA
- Department of Human Development & Family Sciences, University of Connecticut, Hartford, Connecticut, USA
| | - Kirstie Farrar
- Department of Communication, University of Connecticut, Storrs, Connecticut, USA
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29
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Sun H, Huang J, Tang H, Wei B. Association between weight-adjusted-waist index and urge urinary incontinence: a cross-sectional study from NHANES 2013 to 2018. Sci Rep 2024; 14:478. [PMID: 38177657 PMCID: PMC10767076 DOI: 10.1038/s41598-024-51216-2] [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: 11/22/2023] [Accepted: 01/02/2024] [Indexed: 01/06/2024] Open
Abstract
This study aimed to investigate the association between urge urinary incontinence (UUI) and weight-adjusted waist circumference index (WWI), a newly developed measure of obesity. Data from the 2013-2018 National Health and Nutrition Examination Survey (NHANES) were included in the present cross-sectional study. Urge urinary incontinence was identified by self-reported urine leakage before reaching the toilet. Weighted multivariate logistic regression and generalized additive models were used to investigate the connection between WWI and UUI and its nonlinearity. The nonlinear relationship was explored using smoothed curve fitting. Additionally, further analyses were performed on subgroups and interaction tests were conducted. In the study, a total of 14,118 individuals were enrolled, with a UUI prevalence rate of 21.18%. Overall UUI was more prevalent with elevated WWI (OR 1.20, 95% CI 1.13-12.8, P < 0.0001), which similar results were observed in weekly (OR 1.32, 95% CI 1.18-1.48, P < 0.0001) and daily (OR 1.27, 95% CI 1.06-1.53, P = 0.0091) UUI. And this connection remained steady among all subgroups (P > 0.05 for all interactions). Smoothed curve fitting showed no nonlinear relationship between WWI and UUI. In addition, a stronger correlation was found between WWI and UUI risk than other obesity indicators such as waist circumference (WC) and body mass index (BMI). Among US adults, weight-adjusted waist circumference index values are positively associated with elevated odds of UUI and show stronger associations than WC and BMI. Further studies are required to elucidate the causal relationship between WWI and UUI.
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Affiliation(s)
- Haohao Sun
- Department of Urology, Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, 214023, China
| | - Jingxi Huang
- Department of Urology, Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, 214023, China
| | - Hao Tang
- Department of Urology, Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, 214023, China
| | - Bingbing Wei
- Department of Urology, Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, 214023, China.
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30
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Zahra-Zeitoun Y, Elran-Barak R, Salameh-Dakwar R, Froylich D, Sroka G, Assalia A, Latzer Y. Weight stigma in healthcare settings: the experience of Arab and Jewish bariatric surgery candidates in Israel. Isr J Health Policy Res 2024; 13:1. [PMID: 38167112 PMCID: PMC10759645 DOI: 10.1186/s13584-023-00587-4] [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: 02/16/2023] [Accepted: 12/09/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Weight-related stigma and discrimination are prevalent in our society with adverse biopsychosocial outcomes to people with obesity and morbid obesity. Studies suggest that weight bias in healthcare settings are quite prevalent, but there have been, as far as we know, lack of studies examining prevalence and correlates of weight bias experiences among bariatric surgery candidates in Israel. We aim to understand the nature and prevalence of weight stigma among bariatric surgery candidates. To identify differences between Jewish and Arab candidates. To examine the impact of weight stigma experiences on weight bias internalization (WBI). METHODS A cross-sectional study was performed among 117 adult bariatric surgery candidates from three hospitals in northern Israel (47.8% Jews, 82.4% females, average BMI 42.4 ± 5.2 Kg/meter2). Patients who agreed to participate completed a structured questionnaire on the same day that the bariatric surgery committee met. WBI was measured using a validated 10-item scale. Experiences of weight stigma were measured using items adapted from prior international studies. RESULTS About two thirds of the participants had at least one experience of weight stigma (teased, treated unfairly, or discriminated against because of their weight). As many as 75% of participants reported that weight served as a barrier to getting appropriate health care and as many as half of participants felt in the last year that a doctor judged them because of their weight. No significant differences were found between Arabs and Jews in the prevalence of weight stigma experiences and WBI. However, a trend towards more stigma experiences among Jews was noted. WBI was predicted by female gender and experiences of weight stigma, both in general and within healthcare settings. CONCLUSIONS Weight stigma towards bariatric surgery candidates in Israel is quite prevalent, and specifically in healthcare settings. It is important to adopt policy actions and intervention programs to improve awareness to this phenomenon among the general public and specifically among healthcare providers, as many healthcare providers may be unaware of the adverse effect of weight stigma and of ways in which they are contributing to the problem. Future studies may validate our findings using larger sample size and longitudinal design.
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Affiliation(s)
| | | | | | | | | | | | - Yael Latzer
- School of Public Health, University of Haifa, Haifa, Israel
- Rambam Medical Center, Haifa, Israel
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31
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Magallares A, Recio P, Jáuregui-Lobera I, Benito de Valle P, Irles JA, Hymowitz G. Factor structure and measurement invariance of the Weight-Related Abuse Questionnaire (WRAQ). Eat Behav 2024; 52:101827. [PMID: 38007887 DOI: 10.1016/j.eatbeh.2023.101827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/26/2023] [Accepted: 11/16/2023] [Indexed: 11/28/2023]
Abstract
Weight-related abuse is defined as verbal or physical maltreatment specific to one's weight. The Weight-Related Abuse Questionnaire (WRAQ) is an instrument specifically designed to measure weight-related abuse. The main goal of this research was to study the factor structure and measurement invariance of the Spanish version of the WRAQ in a non-clinical and a clinical sample. The clinical sample included 150 participants with obesity (60 % women) from the Hospital de Valme (Sevilla, Spain). The non-clinical sample included 301 students (79 % women) from the Spanish Open University (UNED). Scales to measure weight self-stigma and fear of gaining weight were used to analyze the convergent validity of the WRAQ. A confirmatory factor analysis showed that a two-factor model (verbal and physical abuse) was an acceptable fit for the data in both the clinical and non-clinical samples. Multigroup Confirmatory Factor Analysis revealed scalar measurement invariance by sample and gender. Cronbach's alpha coefficients and composite reliability for both samples were found to be good, with values ranging from 0.83 to 0.96. Fear of gaining weight was correlated to verbal (r = 0.36, p < .01) and physical (r = 0.12, p < .05) abuse, and weight self-stigma was also related to physical (r = 0.21, p < .01) and verbal (r = 0.41, p < .01) abuse. These results suggest that the WRAQ can be used in clinical and non-clinical samples to assess verbal and physical abuse in both men and women.
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Affiliation(s)
- Alejandro Magallares
- School of Psychology, Social Psychology Department, Spanish Open University (UNED), Madrid, Spain
| | - Patricia Recio
- School of Psychology, Methodology Department, Spanish Open University (UNED), Madrid, Spain.
| | - Ignacio Jáuregui-Lobera
- School of Experimental Sciences, Nutrition and Bromatology, Universidad Pablo de Olavide, Sevilla, Spain
| | | | | | - Genna Hymowitz
- Bariatric and Weight Loss Psychology, Psychiatry and Behavioral Health, Stony Brook University, New York, United States
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32
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Graham CE, Frisco ML. The Mental "Weight" of Discrimination: The Relationship between Perceived Interpersonal Weight Discrimination and Suicidality in the United States. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2023; 64:610-625. [PMID: 37776190 PMCID: PMC10683344 DOI: 10.1177/00221465231200634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Abstract
Extant research has investigated the relationship between body weight and suicidality because obesity is highly stigmatized, leading to social marginalization and discrimination, yet has produced mixed results. Scholars have speculated that factors associated with body weight, such as weight discrimination, may better predict suicidality than body weight itself. We consider this possibility among a sample of 12,057 adult participants ages 33 to 43 in Wave V of the National Longitudinal Study of Adolescent to Adult Health through investigation of the relationships between weight discrimination and two dimensions of suicidality-suicide ideation and attempts. We also examine gender as a moderator of these relationships. We find that weight discrimination is positively associated with both suicide ideation and attempts, and this relationship is similar among men and women. Our findings underscore the need to address issues of weight discrimination in our society to better promote mental well-being.
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Yunus NA, Russell G, Muhamad R, Chai TL, Ahmad Zawawi MAF, Sturgiss E. The experience of living with obesity for adults in Asian countries: A scoping review of qualitative studies. Obes Rev 2023; 24:e13619. [PMID: 37558504 DOI: 10.1111/obr.13619] [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: 07/28/2022] [Revised: 01/24/2023] [Accepted: 07/19/2023] [Indexed: 08/11/2023]
Abstract
Sociocultural and biological backgrounds significantly influence people's experience of obesity. Yet the experience within the Asian sociocultural context is underexplored. This scoping review aims to summarize the qualitative evidence that explores the lived experience of adults with obesity in Asian countries. Guided by the Joanna Briggs Institute (JBI) approach, we systematically searched five databases (MEDLINE, EMBASE, PsychINFO, CINAHL, and Scopus) for studies exploring the lived experience of adults with obesity in Asian countries. Eligible studies with English full text were screened by two reviewers and analyzed using a descriptive qualitative content analysis. Of the 16,764 articles retrieved, 11 were included. The qualitative data can be summarized into three categories: (1) cultural norms shaped the lived experience with obesity, (2) the influence of obesity on social relationships, and (3) coping with life challenges. Despite the small number of studies, a strong influence of the sociocultural environment on the lived experience of obesity was evident, particularly on social roles and expectations, social relationships, the stigma of obesity, and life challenges. The extent and significance of this sociocultural influence on the Asian population warrant further exploration. Future research should fully report the qualitative methods to provide contextual information about the study.
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Affiliation(s)
- Nor Akma Yunus
- School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Grant Russell
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rosediani Muhamad
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Tze Lin Chai
- School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia
| | | | - Elizabeth Sturgiss
- School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia
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Telaak SH, Howe LC, Persky S. Physician weight influences responses to a public health message about the genetics of obesity. PATIENT EDUCATION AND COUNSELING 2023; 115:107853. [PMID: 37542821 DOI: 10.1016/j.pec.2023.107853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 06/01/2023] [Accepted: 06/12/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVE Many patients prefer lean physicians to physicians with obesity and place higher credence in their weight management advice. Because genetic information about weight can be viewed as self-serving for individuals with overweight or obesity, physicians with obesity may be discounted when sharing such information. As provision of genetic information regarding weight becomes increasingly common in public health messaging, could a physician's own weight influence how these messages are received by the public? METHODS In an online survey, 967 participants were randomly assigned a physician profile (lean v. has obesity) with a media interview transcript discussing genetic factors of a common health condition (obesity v. osteoporosis). RESULTS Participants perceived the physician with obesity who discussed genetic factors in obesity as less trustworthy and less credible. Participants were also less likely to anticipate following her advice on weight-related issues. Participants with higher BMI had less negative perceptions of this physician. CONCLUSION Physicians with obesity, when providing public health messaging regarding genetic information about obesity, may be met with distrust and negative attitudes toward the physician. PRACTICAL IMPLICATIONS Future research should investigate health communication strategies that address this form of weight stigma while accurately conveying genetic factors that contribute to weight.
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Affiliation(s)
- Sydney H Telaak
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, USA
| | - Lauren C Howe
- Department of Business Administration, University of Zurich, Switzerland
| | - Susan Persky
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, USA.
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Gordon AR, Egan KA, Wang ML, Ziyadeh NJ, Kenney EL, Rosario M, Austin SB. Weight-based discrimination and disordered eating behaviors in a cohort of U.S. sexual minority young adults. Int J Eat Disord 2023; 56:1983-1990. [PMID: 37345224 PMCID: PMC10592576 DOI: 10.1002/eat.24015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 06/08/2023] [Accepted: 06/08/2023] [Indexed: 06/23/2023]
Abstract
OBJECTIVE Though prevalent, weight-based discrimination is understudied and has been linked to disordered eating behaviors (DEB) among adolescents and adults. Sexual minority populations experience elevated risk of DEB, but little is known about the role of weight discrimination in this elevated risk. METHODS Participants were 1257 sexual minority women and men (ages 18-31 years) in the US Growing Up Today Study cohort. We examined cross-sectional associations between weight discrimination victimization and three DEB in the past year: unhealthy weight control behaviors, overeating, and binge eating. Generalized estimating equations, adjusted for potential confounders, were used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs). RESULTS Three in 10 participants (31%) reported weight-based discrimination victimization. Sexual minority young adults who reported weight-based discrimination had greater relative prevalence of unhealthy weight control behaviors (PR [95% CI]: 1.92 [1.35, 2.74]), overeating (3.15 [2.24, 4.44]), and binge eating (3.92 [2.51, 6.13]), compared with those who reported no weight-based discrimination. Associations with overeating and binge eating remained significant after adjusting for BMI. DISCUSSION The role of weight-based discrimination, and its intersections with other forms of stressors for sexual minority young adults, must be included in efforts to advance eating disorder prevention for this underserved population. PUBLIC SIGNIFICANCE Three in 10 sexual minority young adults in this study had experienced weight-based discrimination, a common but understudied form of discrimination. Sexual minority young adults who experienced weight-based discrimination were at greater risk of disordered eating behaviors than those who had not experienced weight-based discrimination. These findings suggest that weight-based discrimination may be an important-and preventable-risk factor for disordered eating behaviors among sexual minority young adults.
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Affiliation(s)
- Allegra R. Gordon
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Kelsey A. Egan
- Division of General Academic Pediatrics, Department of Pediatrics, Boston Medical Center, Boston University School of Medicine
| | - Monica L. Wang
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
- Office of Narrative, Boston University Center for Antiracist Research, Boston, MA, USA
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Najat J. Ziyadeh
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
| | - Erica L. Kenney
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Margaret Rosario
- Department of Psychology, City University of New York—City College and Graduate Center, New York, NY, USA
| | - S. Bryn Austin
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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de Macêdo PFC, Brito E, de Magalhães Cunha C, da Purificação Nazaré Araújo M, Martins PC, de Santana MLP. Weight stigma and disordered eating behaviors during the COVID-19 pandemic: the mediating role of weight gain concern and psychological distress. Eat Weight Disord 2023; 28:78. [PMID: 37759035 PMCID: PMC10533574 DOI: 10.1007/s40519-023-01608-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
OBJECTIVES The purpose of this study is to investigate whether the relationship between weight stigma experiences and disordered eating behaviors during the COVID-19 pandemic is mediated by weight gain concern and psychological distress among university students with and without overweight. METHODS A cross-sectional study was conducted with university students from five regions of Brazil who participated in the baseline assessment of the Online Cohort on Eating Behavior and Health (July/August 2020). Information on the frequency of binge eating episodes, food restriction, and purging, as well as experienced weight stigma, weight gain concern, and psychological distress, were recorded in an online questionnaire. Stratified structural equation modeling (SEM) analyses were performed to address the research questions of interest. RESULTS Out of the total sample (n = 2511), 33.5% of participants reported experiencing weight stigma. The prevalence of binge eating episodes, food restriction, and purging was 43.7%, 24.1%, and 5.4%, respectively. These behaviors were more prevalent in individuals with overweight than in those without this condition. Furthermore, it was observed that weight gain concern and psychological distress mediated the relationship between weight stigma and disordered eating behaviors regardless of body weight status. CONCLUSIONS Experiences of weight stigma and disordered eating behaviors were prevalent among Brazilian university students, especially among those with overweight. Weight gain concern and psychological distress appear to be important factors underlying the relationship between these constructs during the pandemic, and they can contribute to the development of targeted strategies for the prevention and management of disordered eating. LEVEL OF EVIDENCE Level V, cross-sectional study.
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Affiliation(s)
| | - Edleide Brito
- Department of Statistics, Federal University of Bahia, Salvador, Brazil
| | - Carla de Magalhães Cunha
- School of Nutrition, Federal University of Bahia, Campus Canela, Rua Basílio da Gama, Salvador, BA, 40110-907, Brazil
| | | | - Poliana Cardoso Martins
- School of Nutrition, Federal University of Bahia, Campus Canela, Rua Basílio da Gama, Salvador, BA, 40110-907, Brazil
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Sánchez E, Ciudin A, Sánchez A, Gutiérrez-Medina S, Valdés N, Flores L, Marí-Sanchis A, Goñi F, Sánchez M, Nicolau J, Muñoz C, Díaz-Trastoy O, Cuatrecasas G, Cañizares S, Comas M, López-Cano C, Lecube A. Assessment of obesity stigma and discrimination among Spanish subjects with a wide weight range: the OBESTIGMA study. Front Psychol 2023; 14:1209245. [PMID: 37799531 PMCID: PMC10548879 DOI: 10.3389/fpsyg.2023.1209245] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/04/2023] [Indexed: 10/07/2023] Open
Abstract
Introduction This study aims to assess the extent of rejection and instances of stigmatization linked to obesity within the Spanish population, encompassing a diverse spectrum of weights ranging from normal weight to morbid obesity. Additionally, the study seeks to identify the primary factors influencing these experiences and further examines the impact of bariatric surgery on such dynamics. Materials and methods Multicenter observational study with involving a total of 1,018 participants who were recruited from various Obesity Units. Negatives attitudes towards people with obesity were assessed through three questionnaires: (i) Antifat Attitudes Scale (AFA), (ii) Stigmatizing Situations Inventory (SSI) and (iii) Weight Bias Internalization Scale (WBIS). Subjects were categorized into four groups based on their BMI and history of prior bariatric surgery. Results The cumulative score across all questionnaires (AFA, SSI and WBIS) exhibited a progressive increase, from participants with normal weight to those with obesity (p < 0.001 for all). Within the AFA questionnaire, males showed more rejection towards people with obesity than women, also perceiving obesity as a disease linked to a lack of willpower (p = 0.004 and p = 0.030, respectively). The overall SSI score was negatively associated with age (r = -0.080, p = 0.011), with young participants encountering more stigmatizing experiences than their adult counterparts. Neither employment status nor educational demonstrated a significant association with any of the questionnaires. Interestingly, patients who underwent lost weight following bariatric surgery did not exhibit improved outcomes. Conclusion Individuals with obesity demonstrate a heightened level of aversion towards the disease compared to those with normal weight. Concurrently, the incidence of stigmatizing encounters displays a concerning escalation among younger individuals.
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Affiliation(s)
- Enric Sánchez
- Obesity Unit, Endocrinology and Nutrition Department, University Hospital Arnau de Vilanova de Lleida, Obesity, Diabetes and Metabolism (ODIM) Research Group, IRBLleida, University of Lleida, Lleida, Spain
| | - Andreea Ciudin
- Obesity Unit, Endocrinology and Nutrition Department, Hospital Universitari Vall d’Hebrón, Vall d’Hebron Research Institute, Autonomous University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Ana Sánchez
- Obesity Unit, Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain
| | - Sonsoles Gutiérrez-Medina
- Obesity Unit, Endocrinology and Nutrition Department, Hospital Universitario Rey Juan Carlos, Madrid, Spain
| | - Nuria Valdés
- Obesity Unit, Endocrinology and Nutrition Department, Hospital Universitario de Cabueñes, Gijón, Spain
| | - Lilliam Flores
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Obesity Unit, Endocrinology and Nutrition Department, Hospital Clínic Barcelona, Barcelona, Spain
| | - Amelia Marí-Sanchis
- Obesity Unit, Endocrinology and Nutrition Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - Fernando Goñi
- Obesity Unit, Endocrinology and Nutrition Department, Hospital Universitario de Basurto, Bilbao, Spain
| | - Marta Sánchez
- Obesity Unit, Endocrinology and Nutrition Department, Hospital Universitario Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Joana Nicolau
- Obesity Unit, Endocrinology and Nutrition Department, Hospital Universitario Son Llàtzer, Palma, Spain
| | - Concepción Muñoz
- Obesity Unit, Endocrinology and Nutrition Department, Hospital Universitario Reina Sofia de Córdoba, Córdoba, Spain
| | - Olaia Díaz-Trastoy
- Obesity Unit, Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - Guillem Cuatrecasas
- Obesity Unit, Endocrinology and Nutrition Department, Clínica Sagrada Familia-CPEN Barcelona, Health Science Department, UOC University, Barcelona, Spain
| | - Silvia Cañizares
- Obesity Unit, Psychiatry and Psycology Department, Hospital Clínic Barcelona, Barcelona, Spain
- Clinical Psycology and Psycobiology Department, Universitat de Barcelona, Barcelona, Spain
| | - Marta Comas
- Obesity Unit, Endocrinology and Nutrition Department, Hospital Universitari Vall d’Hebrón, Vall d’Hebron Research Institute, Autonomous University of Barcelona, Barcelona, Spain
| | - Carolina López-Cano
- Obesity Unit, Endocrinology and Nutrition Department, University Hospital Arnau de Vilanova de Lleida, Obesity, Diabetes and Metabolism (ODIM) Research Group, IRBLleida, University of Lleida, Lleida, Spain
| | - Albert Lecube
- Obesity Unit, Endocrinology and Nutrition Department, University Hospital Arnau de Vilanova de Lleida, Obesity, Diabetes and Metabolism (ODIM) Research Group, IRBLleida, University of Lleida, Lleida, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
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Dickinson JK, Bialonczyk D, Reece J, Kyle TK, Close KL, Nadglowski J, Johnson K, Garza M, Pash E, Chiquette E. Person-first language in diabetes and obesity scientific publications. Diabet Med 2023; 40:e15067. [PMID: 36786059 DOI: 10.1111/dme.15067] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 02/15/2023]
Abstract
AIMS We aimed to quantify the use of person-first language (PFL) among scholarly articles focusing on diabetes or obesity. METHODS PFL and condition-first language (CFL) terms for diabetes and obesity (e.g. diabetic, obese) were identified from existing guidelines and a review of the literature. Exact phrase literature searches were conducted between 2011 and 2020 and results were categorised as PFL, CFL or both. RESULTS Among diabetes articles, 43% used PFL, 40% used CFL and 17% contained both. Among obesity articles, 0.5% used PFL, 99% used CFL and 0.2% used both. The use of PFL increased by 3% per year for diabetes articles, compared to 117% for obesity articles. The rate of adoption of PFL in diabetes articles was unchanged in 2018-2020 compared to the 3 years prior. CONCLUSIONS While the use of person-first language in diabetes articles had increased over the review period, its rate of adoption has started to slow. Conversely, the use of PFL in obesity articles is nascent and increasing.
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Affiliation(s)
| | | | - Jessica Reece
- North Carolina Biotechnology Center, Durham, North Carolina, USA
| | | | | | | | | | - Matthew Garza
- The diaTribe Foundation, San Francisco, California, USA
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Keast R, Withnell S, Bodell LP. Longitudinal associations between weight stigma and disordered eating across the weight spectrum. Eat Behav 2023; 50:101788. [PMID: 37572490 DOI: 10.1016/j.eatbeh.2023.101788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 07/05/2023] [Accepted: 07/21/2023] [Indexed: 08/14/2023]
Abstract
Weight stigma reflects discrimination or stereotyping based on weight, and this construct is associated with body dissatisfaction, low self-esteem, and eating pathology. Recent research suggests that internalizing weight stigma (i.e., endorsing negative stereotypes about one's weight) mediates associations between experienced weight stigma and disordered eating. However, much of this research has been cross-sectional and limited data exist on associations between weight stigma constructs and eating pathology across the weight spectrum. The current study explored whether internalized weight stigma differentially mediates the relationship between experiencing weight stigma and disordered eating symptoms over time in higher-weight versus non-higher-weight individuals. Undergraduate students (N = 661, 80 % Female, 28.5 % higher weight) completed surveys at three time points over six months. Multigroup path analyses tested whether the effects of experienced weight stigma and internalized weight stigma on binge eating, food restriction, and body dissatisfaction differed between the higher-weight and non-higher-weight groups. All models showed improved fit when path estimates were allowed to vary between groups. Mediation analyses indicated a significant indirect effect of experienced weight stigma on binge eating via internalized weight stigma among the higher-weight group but not the non-higher-weight group. Only internalized weight stigma was directly associated with body dissatisfaction across weight status. A direct effect of experienced weight stigma on restriction was found in the non-higher-weight group. Findings suggest that, in general, weight stigma negatively affects body image and eating behavior, although specific effects may vary depending on one's weight.
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Affiliation(s)
- Riley Keast
- Department of Psychology, University of Western Ontario, London, ON, Canada
| | - Samantha Withnell
- Department of Psychology, University of Western Ontario, London, ON, Canada
| | - Lindsay P Bodell
- Department of Psychology, University of Western Ontario, London, ON, Canada.
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Macho S, Andrés A, Saldaña C. Weight discrimination, BMI, or weight bias internalization? Testing the best predictor of psychological distress and body dissatisfaction. Obesity (Silver Spring) 2023; 31:2178-2188. [PMID: 37424155 DOI: 10.1002/oby.23802] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/23/2023] [Accepted: 04/24/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVE This study aimed: (1) to compare psychological distress (PD) and body dissatisfaction (BD) in terms of BMI, weight bias internalization (WBI), and weight discrimination (current and past); (2) to assess the best predictor of PD and BD and assess the relationships with weight discrimination, BD, and WBI. METHODS The sample consisted of 1283 participants across all BMI categories, recruited through the internet voluntarily. People with obesity were the most predominant (26.1%). Experiences of weight-based discrimination were reported by participants across all BMI categories, and they were more prevalent in people with obesity. RESULTS People with obesity, those with WBI, and those who faced current and past weight discrimination reported higher PD and higher BD. However, WBI was the best predictor after controlling for BMI, WBI, and current and past weight discrimination. Mediation analyses revealed that the relationship between weight discrimination and BD through WBI was significant, as was the relationship between weight discrimination and WBI through BD. CONCLUSIONS These results stressed the importance of WBI in PD and the role of weight discrimination in WBI and BD. Hence, there is a need to better understand how WBI is formed and to design effective interventions to reduce it.
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Affiliation(s)
- Sergio Macho
- Departament de Psicologia Clínica i Psicobiologia, Universitat de Barcelona, Barcelona, Spain
| | - Ana Andrés
- Faculty of Psychology, Education and Sport Sciences, Blanquerna, Ramon Llull University, Barcelona, Spain
| | - Carmina Saldaña
- Departament de Psicologia Clínica i Psicobiologia, Universitat de Barcelona, Barcelona, Spain
- Institut de Neurociències. Universitat de Barcelona, Barcelona, Spain
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Bauer S, Eglseer D, Großschädl F. Obesity in Nursing Home Patients: Association with Common Care Problems. Nutrients 2023; 15:3188. [PMID: 37513604 PMCID: PMC10385003 DOI: 10.3390/nu15143188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
(1) Background: There is not much research about obesity in nursing homes although knowledge will help us to develop customized treatment plans and prevention strategies, which may help to decrease the burden for all persons involved. The objective of conducting this study was to describe the prevalence of obesity and the association between obesity and care problems in nursing home patients. (2) Methods: This study is a secondary data analysis of data collected in an annually performed cross-sectional study called "Nursing Quality Measurement 2.0". A standardized and tested questionnaire was used to collect data. (3) Results: In total, 1236 nursing home patients took part, and 16.7% of them were obese. The multivariate logistic regression analysis results show that urinary incontinence is significantly associated with the presence of obesity (OR 2.111). The other care problems of pressure injuries, fecal and double incontinence, physical restraints, falls, and pain were not associated with obesity. (4) Conclusions: The results indicate that, in the nursing home setting, healthcare staff should pay special attention to the patients' nutritional status and help patients to maintain a healthy weight and prevent a loss of muscle mass and function. Conducting more studies with larger sample sizes is recommended, as this will allow for differentiation among different obesity classes.
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Affiliation(s)
- Silvia Bauer
- Institute of Nursing Science, Medical University of Graz, Neue Stiftingtalstraße 6/P06-WEST, 8010 Graz, Austria
| | - Doris Eglseer
- Institute of Nursing Science, Medical University of Graz, Neue Stiftingtalstraße 6/P06-WEST, 8010 Graz, Austria
| | - Franziska Großschädl
- Institute of Nursing Science, Medical University of Graz, Neue Stiftingtalstraße 6/P06-WEST, 8010 Graz, Austria
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Bennett BL, Puhl RM. Diabetes stigma and weight stigma among physicians treating type 2 diabetes: Overlapping patterns of bias. Diabetes Res Clin Pract 2023; 202:110827. [PMID: 37451627 DOI: 10.1016/j.diabres.2023.110827] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/29/2023] [Accepted: 07/12/2023] [Indexed: 07/18/2023]
Abstract
AIMS Adults with type 2 diabetes (T2D) report experiencing stigma across multiple settings, including stigmatizing interactions with their healthcare providers. However, research examining physician biases toward patients with T2D is scarce. Identifying stigma-related barriers in diabetes care is essential to prevent providers' biases from impairing health care delivery. This study assessed attitudes towards individuals with T2D and obesity among physicians who treat T2D. METHODS Physicians specializing in internal medicine or endocrinology (n=205) completed a series of online questionnaires assessing their attitudes towards patients with T2D and obesity, and their attributions of controllability and blame of individuals with T2D and obesity. RESULTS While 85% of physicians felt professionally prepared and confident to treat patients with T2D, 1/3 reported being repulsed by patients with T2D and view them as lazy (39%), lacking motivation (44%), and non-compliant with treatment (44%). Many witnessed professionals in their field making negative comments about patients with T2D (44%). Physicians endorsed worse levels of bias towards patients with obesity than T2D, but differences were small. CONCLUSIONS Findings highlight the need for stigma reduction interventions for physicians addressing both T2D and obesity. Research assessing the effects of T2D stigma on quality of patient care and health outcomes is needed.
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Affiliation(s)
- Brooke L Bennett
- Rudd Center for Food Policy & Health, University of Connecticut, 1 Constitution Plaza, Suite 600, Hartford, CT 06103, USA.
| | - Rebecca M Puhl
- Rudd Center for Food Policy & Health, University of Connecticut, 1 Constitution Plaza, Suite 600, Hartford, CT 06103, USA; Department of Human Development and Family Sciences, University of Connecticut, 348 Mansfield Road, U-1058, Storrs, CT 06269-1058, USA.
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Jokela M, Laakasuo M. Obesity as a causal risk factor for depression: Systematic review and meta-analysis of Mendelian Randomization studies and implications for population mental health. J Psychiatr Res 2023; 163:86-92. [PMID: 37207436 DOI: 10.1016/j.jpsychires.2023.05.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 03/17/2023] [Accepted: 05/03/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND/OBJECTIVES Obesity has been associated with elevated risk of depression. If this association is causal, the increasing obesity prevalence might lead to worsening population mental health, but the strength of the causal effect has not been systematically evaluated. SUBJECTS/METHODS The current study provides a systematic review and meta-analysis of studies examining associations between body mass index and depression using Mendelian randomization with multiple genetic variants as instruments for body mass index. We used this estimate to calculate the expected changes in prevalence of population psychological distress from the 1990s-2010s, which were compared with the empirically observed trends in psychological distress in the Health Survey for England (HSE) and U.S. National Health Interview Surveys (NHIS). RESULTS Meta-analysis of 8 Mendelian randomization studies indicated an OR = 1.33 higher depression risk associated with obesity (95% confidence interval 1.19, 1.48). Between 15% and 20% of the participants of HSE and NHIS reported at least moderate psychological distress. The increase of obesity prevalence from the 1990s-2010s in HSE and NHIS would have led to a 0.6 percentage-point increase in population psychological distress. CONCLUSIONS Mendelian randomization studies suggest that obesity is a causal risk factor for elevated risk of depression. The increasing obesity rates may have modestly increased the prevalence of depressive symptoms in the general population. Mendelian randomization relies on methodological assumptions that may not always hold, so other quasi-experimental methods are needed to confirm the current conclusions.
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Affiliation(s)
- Markus Jokela
- Department of Psychology and Logopedics, Medicum, University of Helsinki, Finland.
| | - Michael Laakasuo
- Department of Psychology and Logopedics, Medicum, University of Helsinki, Finland
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Zagaria A, Cerolini S, Mocini E, Lombardo C. The relationship between internalized weight stigma and physical and mental health-related quality of life in a large sample of women: a structural equation modeling analysis. Eat Weight Disord 2023; 28:52. [PMID: 37341775 DOI: 10.1007/s40519-023-01582-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 06/15/2023] [Indexed: 06/22/2023] Open
Abstract
PURPOSE Health-related quality of life (HRQOL) refers to an individual's perception of their physical and mental health status over time. Although emerging evidence has documented a negative association between weight stigma (i.e., negative weight-related attitudes and beliefs towards individuals with overweight or obesity) and mental HRQOL, its influence on physical HRQOL still needs to be fully clarified. This study aims to investigate the impact of internalized weight stigma on mental and physical HRQOL by employing a structural equation modeling (SEM) approach. METHODS The Short Form Health Survey 36 (SF-36) and the Weight Bias Internalization Scale (WBIS) were administered to a sample of 4450 women aged 18-71 (Mage = 33.91 years, SD = 9.56) who self-identified in a condition of overweight or obesity (MBMI = 28.54 kg/m2; SD = 5.86). Confirmatory factor analysis (CFA) was conducted to assess the dimensionality of the scales before testing the proposed structural model. RESULTS After establishing the adequacy of the measurement model, SEM results revealed that internalized weight stigma was significantly and negatively associated with both mental (β = - 0.617; p < 0.001) and physical (β = - 0.355, p < 0.001) HRQOL. CONCLUSION These findings offer additional support to prior research by confirming the association between weight stigma and mental HRQOL. Moreover, this study contributes to the existing literature by strengthening and extending these associations to the physical HRQOL domain. Although this study is cross-sectional in nature, it benefits from a large sample of women and the use of SEM, which offers advantages over traditional multivariate techniques, e.g., by explicitly accounting for measurement error. LEVEL OF EVIDENCE Level V, descriptive cross-sectional study.
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Affiliation(s)
- Andrea Zagaria
- Department of Psychology, Sapienza University of Rome, Rome, Italy.
| | - Silvia Cerolini
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Edoardo Mocini
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
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45
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Stroebe W. Is the energy balance explanation of the obesity epidemic wrong? Appetite 2023:106614. [PMID: 37271254 DOI: 10.1016/j.appet.2023.106614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/06/2023]
Abstract
There is a striking discrepancy in both U.S and the U.K data between obesity rates, which are increasing, and self-reported food consumption rates, which are decreasing. There are two possible explanations for this discrepancy, namely that the widely accepted energy balance interpretation of obesity is wrong or that food consumption data are somehow biased. In a comment entitled "Obesity-an unexplained epidemic", Mozzafarian (2022) challenged the Energy Balance Model (EBM) and argued for a need to replace it with a novel biological theory. This challenge is premature, because there are psychological explanations for this discrepancy, namely that individuals with overweight and obesity underreport their food consumption and that this tendency has increased in recent years. To support these hypotheses, U.S and U.K data are reviewed that used the Doubly Labeled Water method (DLW), which is the gold standard for estimating energy expenditure. Such studies find not only consistent evidence of underreporting, but also that the discrepancy between measured energy expenditure and reported calorie consumption increased over time. Two psychological explanations for this pattern are discussed.
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46
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Pearl RL, Bach C, Wadden TA. Development of a cognitive-behavioral intervention for internalized weight stigma. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2023; 53:165-172. [PMID: 37483684 PMCID: PMC10361685 DOI: 10.1007/s10879-022-09543-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2022] [Indexed: 02/05/2023]
Abstract
Individuals with a higher body weight are the targets of pervasive social stigma. This stigma can become self-directed or internalized, leading to self-devaluation due to weight. Internalized weight stigma is associated with adverse outcomes for mental and physical health, yet little is known about how to prevent or diminish this internalization. This article introduces a novel, group-based, psychological intervention designed to reduce internalized weight stigma and its ill effects on health. Rationale is provided for the therapeutic approach and for the intervention's proposed utility in behavioral weight management settings. Intervention content is described in detail, along with preliminary evidence of its potential effects on psychological and behavioral outcomes.
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Affiliation(s)
- Rebecca L. Pearl
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Caroline Bach
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Psychology, Georgia Southern University, Statesboro, GA, USA
| | - Thomas A. Wadden
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Abstract
Weight stigma is prevalent with negative consequences for health and well-being. This problem is present in health care; stigmatizing attitudes toward patients with obesity are expressed by medical professionals across diverse specialties and patient care settings. This article summarizes the ways in which weight stigma creates barriers to effective care, including poor patient-provider communication, reduced quality of care, and healthcare avoidance. Priorities for stigma reduction in healthcare are discussed, with a clear need for multifaceted approaches and inclusion of people with obesity whose perspectives can inform strategies to effectively remove bias-related barriers to patient care.
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Affiliation(s)
- Rebecca M Puhl
- Rudd Center for Food Policy & Health, University of Connecticut, One Constitution Plaza, Suite 600, Hartford, CT 06103, USA; Department of Human Development & Family Sciences, University of Connecticut, Storrs, CT, USA.
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48
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Leutner M, Dervic E, Bellach L, Klimek P, Thurner S, Kautzky A. Obesity as pleiotropic risk state for metabolic and mental health throughout life. Transl Psychiatry 2023; 13:175. [PMID: 37248222 DOI: 10.1038/s41398-023-02447-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 04/12/2023] [Accepted: 04/24/2023] [Indexed: 05/31/2023] Open
Abstract
Obesity, a highly prevalent disorder and central diagnosis of the metabolic syndrome, is linked to mental health by clinical observations and biological pathways. Patients with a diagnosis of obesity may show long-lasting increases in risk for receiving psychiatric co-diagnoses. Austrian national registry data of inpatient services from 1997 to 2014 were analyzed to detect associations between a hospital diagnosis of obesity (ICD-10: E66) and disorders grouped by level-3 ICD-10 codes. Data were stratified by age decades and associations between each pair of diagnoses were computed with the Cochran-Mantel-Haenszel method, providing odds ratios (OR) and p values corrected for multiple testing. Further, directions of the associations were assessed by calculating time-order-ratios. Receiving a diagnosis of obesity significantly increased the odds for a large spectrum of psychiatric disorders across all age groups, including depression, psychosis-spectrum, anxiety, eating and personality disorders (all pcorr < 0.01, all OR > 1.5). For all co-diagnoses except for psychosis-spectrum, obesity was significantly more often the diagnosis received first. Further, significant sex differences were found for most disorders, with women showing increased risk for all disorders except schizophrenia and nicotine addiction. In addition to the well-recognized role in promoting disorders related to the metabolic syndrome and severe cardiometabolic sequalae, obesity commonly precedes severe mental health disorders. Risk is most pronounced in young age groups and particularly increased in female patients. Consequently, thorough screening for mental health problems in patients with obesity is urgently called for to allow prevention and facilitate adequate treatment.
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Affiliation(s)
- Michael Leutner
- Department of Internal Medicine III, Clinical Division of Endocrinology and Metabolism, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Elma Dervic
- Section for Science of Complex Systems, CeMSIIS, Medical University of Vienna, Spitalgasse 23, A-1090, Vienna, Austria
- Complexity Science Hub Vienna, Josefstaedter Straße 39, 1080, Vienna, Austria
| | - Luise Bellach
- Department of Internal Medicine III, Clinical Division of Endocrinology and Metabolism, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Peter Klimek
- Section for Science of Complex Systems, CeMSIIS, Medical University of Vienna, Spitalgasse 23, A-1090, Vienna, Austria
- Complexity Science Hub Vienna, Josefstaedter Straße 39, 1080, Vienna, Austria
| | - Stefan Thurner
- Section for Science of Complex Systems, CeMSIIS, Medical University of Vienna, Spitalgasse 23, A-1090, Vienna, Austria
- Complexity Science Hub Vienna, Josefstaedter Straße 39, 1080, Vienna, Austria
| | - Alexander Kautzky
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria.
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49
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Lawrence SE, Puhl RM, Watson RJ, Schwartz MB, Lessard LM, Foster GD. Family-based weight stigma and psychosocial health: A multinational comparison. Obesity (Silver Spring) 2023; 31:1666-1677. [PMID: 37171908 DOI: 10.1002/oby.23748] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 01/10/2023] [Accepted: 01/24/2023] [Indexed: 05/14/2023]
Abstract
OBJECTIVE Family-based weight stigma can be expressed as criticism, judgment, teasing, and mistreatment by family members because of an individual's body weight. The current study compared the prevalence and psychosocial correlates of family-based weight stigma among adult members of a weight-management program living in Australia, Canada, France, Germany, the UK, and the US. METHODS Participants (N = 8100 adults who reported having ever experienced weight stigma; 95% female; 94% White) completed an identical online survey in their country's dominant language that assessed their experiences of weight stigma from 16 different family member sources, as well as internalized weight bias, body image, eating behaviors, perceived stress, and self-rated health. RESULTS Family-based weight stigma, especially from mothers (49%-62%), spouses/romantic partners (40%-57%), and fathers (35%-48%), was highly prevalent across countries. Weight stigma from one's immediate family members was associated with indices of poorer psychosocial health across the six countries (β coefficients = |0.08-0.13|). CONCLUSIONS Findings highlight the need for weight stigma-reduction efforts to help family members distinguish between supportive, encouraging discourse and potentially weight-stigmatizing communication. Future research should examine the prevalence and correlates of family-based weight stigma in more diverse community samples, including among racially/ethnically and gender diverse adults, and in non-Western countries.
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Affiliation(s)
- Samantha E Lawrence
- Department of Pediatrics, Division of General Pediatrics and Adolescent Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Rebecca M Puhl
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
- Rudd Center for Food Policy & Health, University of Connecticut, Hartford, Connecticut, USA
| | - Ryan J Watson
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Marlene B Schwartz
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
- Rudd Center for Food Policy & Health, University of Connecticut, Hartford, Connecticut, USA
| | - Leah M Lessard
- Rudd Center for Food Policy & Health, University of Connecticut, Hartford, Connecticut, USA
| | - Gary D Foster
- WW International, Inc., New York, New York, USA
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Pearlman AT, Murphy MA, Raiciulescu S, Gray JC, Klein DA, Schvey NA. The prospective relationship between weight-based discrimination and eating pathology among youth. Eat Behav 2023; 49:101746. [PMID: 37196505 DOI: 10.1016/j.eatbeh.2023.101746] [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: 12/01/2022] [Revised: 04/25/2023] [Accepted: 05/05/2023] [Indexed: 05/19/2023]
Abstract
Among adults and adolescents, weight-based discrimination is associated with disordered eating. However, these relationships remain understudied in children. Given that weight-based discrimination is commonly reported among youth, and that childhood is a crucial developmental period for the onset of disordered eating, the current study assessed prospective associations between weight-based discrimination and eating pathology among participants in the Adolescent Brain Cognitive Development Study. At the one-year visit, children indicated whether they had experienced discrimination due to their weight within the past year. Parents completed a computerized clinical interview to determine the presence of sub-or-full threshold eating disorders (AN, BN, and BED) among their children. At the two-year visit, children completed the same assessment. Height and fasting weight were obtained. Logistic regressions, adjusting for age, sex, race/ethnicity, family income, BMI%ile, and parent-reported presence of the respective eating disorder at one-year, were conducted to assess the associations between weight-based discrimination and eating pathology. Participants were 10,299 children who completed measures at both the one- and two-year visits (Mage at one-year: 10.92 ± 0.64, 47.6 % female, 45.9 % racial/ethnic minority). The presence of weight-based discrimination, reported by 5.6 % (n = 574) of children, was significantly associated with a greater likelihood of reporting AN, BN, and BED one-year later (ORs: 1.94-4.91). Findings suggest that weight-based discrimination may confer additional risk for the onset of disordered eating, above and beyond the contribution of body weight. Intersectional research is needed to examine the role of multiple forms of discrimination in relation to the development of eating pathology.
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Affiliation(s)
- Arielle T Pearlman
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), Bethesda, MD, United States of America.
| | - Mikela A Murphy
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), Bethesda, MD, United States of America; The Henry M. Jackson Foundation for the Advancement of Military Medicine (HJF), Bethesda, MD, United States of America
| | - Sorana Raiciulescu
- Department of Preventive Medicine and Biostatistics, USU, Bethesda, MD, United States of America
| | - Joshua C Gray
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), Bethesda, MD, United States of America
| | - David A Klein
- Department of Pediatrics, USU, Bethesda, MD, United States of America; Department of Family Medicine, USU, Bethesda, MD, United States of America
| | - Natasha A Schvey
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), Bethesda, MD, United States of America
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