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Gordon K, Matthews A, Zeller MH, Lin J. Practical guidelines for eating disorder risk mitigation in patients undergoing obesity treatment for the pediatric provider. Curr Opin Pediatr 2024; 36:367-374. [PMID: 38655793 DOI: 10.1097/mop.0000000000001356] [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] [Indexed: 04/26/2024]
Abstract
PURPOSE OF REVIEW Pediatric obesity is a growing concern globally. Patients with a history of overweight/obesity often experience stigmatization, especially in the healthcare setting, and are at increased risk of developing psychological comorbidities including eating disorders. This review appraises the most recent studies evaluating eating disorder risk in youth undergoing treatment for obesity, identifies gaps in the literature, and offers practical guidelines to pediatric providers regarding the management of this population. RECENT FINDINGS Recent studies suggest that structured weight management programs may decrease the risk of and/or improve symptoms of certain eating disorders such as binge eating disorder and bulimia nervosa. There is a paucity of research on some components of obesity management such as obesity pharmacotherapeutics and eating disorder risk. SUMMARY Children and adolescents with obesity are a psychologically vulnerable population with increased risk for the development of eating disorders. Further study is needed to evaluate general risk in the setting of specialized and primary care obesity interventions and develop appropriate screening and mitigation tools. Some evidence-based strategies can aid pediatric providers in both weight management and eating disorder prevention and risk assessment.
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Affiliation(s)
- Katelyn Gordon
- Division of Adolescent Medicine, Cincinnati Children's Hospital Medical Center
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Abigail Matthews
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Meg H Zeller
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Department of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jessica Lin
- Division of Adolescent Medicine, Cincinnati Children's Hospital Medical Center
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Sundbom M, Järvholm K, Sjögren L, Nowicka P, Lagerros YT. Obesity treatment in adolescents and adults in the era of personalized medicine. J Intern Med 2024; 296:139-155. [PMID: 39007440 DOI: 10.1111/joim.13816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Abstract
In this multi-professional review, we will provide the in-depth knowledge required to work in the expanding field of obesity treatment. The prevalence of obesity has doubled in adults and quadrupled in children over the last three decades. The most common treatment offered has been lifestyle treatment, which has a modest or little long-term effect. Recently, several new treatment options-leading to improved weight loss-have become available. However, long-term care is not only about weight loss but also aims to improve health and wellbeing overall. In the era of personalized medicine, we have an obligation to tailor the treatment in close dialogue with our patients. The main focus of this review is new pharmacological treatments and modern metabolic surgery, with practical guidance on what to consider when selecting and guiding the patients and what to include in the follow-up care. Furthermore, we discuss common clinical challenges, such as patients with concurrent eating disorder or mental health problems, and treatment in the older adults. We also provide recommendations on how to deal with obesity in a non-stigmatizing way to diminish weight stigma during treatment. Finally, we present six microcases-obesity treatment for persons with neuropsychiatric disorders and/or intellectual disability; obesity treatment in the nonresponsive patient who has "tried everything"; and hypoglycemia, abdominal pain, and weight regain after metabolic surgery-to highlight common problems in weight-loss treatment and provide personalized treatment suggestions.
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Affiliation(s)
- Magnus Sundbom
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Department of Surgery, University Hospital, Uppsala, Sweden
| | - Kajsa Järvholm
- Department of Psychology, Lund University, Lund, Sweden
- Childhood Obesity Unit, Skåne University Hospital, Malmö, Sweden
| | - Lovisa Sjögren
- Department of Pediatrics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Pediatrics, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Paulina Nowicka
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
| | - Ylva Trolle Lagerros
- Department of Medicine (Solna), Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
- Center for Obesity, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden
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Halford JCG, Brown A, Clare K, Ells LJ, Ghosh A, Giri D, Hughes C, Senniappan S. Insights from the ACTION Teens Study: a survey of adolescents living with obesity, their caregivers and healthcare professionals in the UK. BMJ Open 2024; 14:e086391. [PMID: 39043586 PMCID: PMC11268073 DOI: 10.1136/bmjopen-2024-086391] [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: 03/13/2024] [Accepted: 07/01/2024] [Indexed: 07/25/2024] Open
Abstract
OBJECTIVES The Awareness, Care and Treatment In Obesity maNagement (ACTION) Teens study explored attitudes, behaviours, perceptions and barriers regarding effective obesity care among adolescents living with obesity (ALwO), caregivers and healthcare professionals (HCPs). DESIGN Cross-sectional online survey study. SETTING Study across 10 countries; here, we report data from UK respondents. PARTICIPANTS Overall, 416 ALwO (aged 12 to <18 years; body mass index ≥95th percentile for age and sex (WHO charts)), 498 caregivers and 250 HCPs in the UK completed the survey (August-December 2021). PRIMARY AND SECONDARY OUTCOME MEASURES Survey questions addressed key aspects of obesity management for ALwO. RESULTS Overall, 46% of ALwO perceived their weight as normal or below normal and 86% believed their health was at least good; 56% and 93% of caregivers responded similarly for their ALwO. Despite this, most ALwO (57%) had attempted to lose weight in the past year and 34% felt highly motivated to lose weight. YouTube and social media were most often used by ALwO for information about weight management (41% and 39%); few ALwO and caregivers sought information from a doctor (13% and 22%). Among ALwO who had discussed weight with an HCP (n=122), 49% trusted their weight-management advice. Only 10% of ALwO and 8% of caregivers were told by a doctor that they/their child had obesity. For HCPs, obesity-related comorbidities were the most common reason for initiating weight conversations with ALwO (73%), while short appointment times were the most common barrier (46%). Overall, 30% of ALwO and 11% of caregivers did not feel comfortable bringing up weight with an HCP. CONCLUSIONS Improved education and communication are needed among ALwO, caregivers and HCPs in the UK to help improve awareness of obesity, its aetiology and its impact on health, and to support HCPs to proactively initiate weight-related conversations and build trust with ALwO and caregivers. TRIAL REGISTRATION NUMBER NCT05013359.
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Affiliation(s)
| | - Adrian Brown
- Centre for Obesity Research, University College London, London, UK
| | - Kenneth Clare
- Obesity UK and Obesity Institute, School of Health, Leeds Beckett University, Leeds, UK
| | - Louisa J Ells
- Obesity Institute, School of Health, Leeds Beckett University, Leeds, UK
| | | | - Dinesh Giri
- Bristol Royal Hospital for Children, Bristol, UK
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Squires ND, Goode M, Pye A, Papini NM, Lopez NV, Harris C, Dillon JD, Laing EM, Lee S, Clifford D. Weight-Inclusive Podcasts Improved Intuitive Eating, Body Appreciation, and Anti-Fat Attitudes Among Nutrition Students. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2024:S1499-4046(24)00353-1. [PMID: 39046392 DOI: 10.1016/j.jneb.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 06/05/2024] [Accepted: 06/06/2024] [Indexed: 07/25/2024]
Abstract
OBJECTIVE Assess the impact of a weight-inclusive podcast (WIP) intervention on body appreciation, intuitive eating (IE), anti-fat attitudes, and weight and health attitudes in university students enrolled in an upper-division nutrition course. METHODS Quasi-experimental design: Intervention participants listened to 8 weekly WIP episodes (n = 16); the comparison group listened to 8 weekly general nutrition podcasts (n = 29). Intuitive eating, body appreciation, anti-fat attitudes, and general weight and health attitudes were measured preintervention and postintervention. RESULTS Two-way, repeated measures analysis of variance revealed significant interaction effects of time × group, with participants in the WIP group experiencing significantly greater improvements in body appreciation (P = 0.03) and IE (P = 0.02) and greater reductions in anti-fat attitude scores (P = 0.006) than the comparison group. CONCLUSIONS AND IMPLICATIONS Podcasts may be a cost-effective tool to improve body appreciation and IE and reduce anti-fat attitudes in future nutrition professionals. Future research would benefit from recruiting prehealth professionals across different majors.
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Affiliation(s)
- Nikole D Squires
- Department of Health Sciences, Northern Arizona University, Flagstaff, AZ.
| | - Melissa Goode
- Department of Health Sciences, Northern Arizona University, Flagstaff, AZ
| | - Abigail Pye
- Department of Health Sciences, Northern Arizona University, Flagstaff, AZ
| | - Natalie M Papini
- Department of Health Sciences, Northern Arizona University, Flagstaff, AZ
| | - Nanette V Lopez
- Department of Health Sciences, Northern Arizona University, Flagstaff, AZ
| | - Cristen Harris
- Department of Epidemiology, University of Washington, Seattle, WA
| | | | - Emma M Laing
- Department of Nutritional Sciences, University of Georgia, Athens, GA
| | - Saemi Lee
- School of Kinesiology, California State University Los Angeles, Los Angeles, CA
| | - Dawn Clifford
- Department of Health Sciences, Northern Arizona University, Flagstaff, AZ
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Skoko Rodriguez M, Thompson JA, Carter B, Wallace R, Riley K, Johnson R. Improving Weight Bias Awareness Among Providers in the Sexual and Reproductive Health care Setting. Health Equity 2024; 8:461-468. [PMID: 39011072 PMCID: PMC11249127 DOI: 10.1089/heq.2024.0096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2024] [Indexed: 07/17/2024] Open
Abstract
Introduction Provider bias against patients of higher weights can contribute to poor health outcomes and decreased quality of care and patient experience. Addressing weight stigma in sexual and reproductive health settings is important, as these encounters can often be patients' only health care touchpoint. Health care providers must be educated about the harms of weight stigma, ways to recognize and confront their biases, and how to advocate for patients of all sizes. Methods In this quality improvement project, Planned Parenthood health center providers participated in a three-part virtual workshop to improve provider weight bias awareness and understanding using the Health at Every Size framework. Providers completed a pre- and post-survey, as well as a 3-month follow-up survey to assess changes in bias awareness and confidence in applying weight-neutral principles in care interactions. Results Analysis of pre- and post-survey results showed significant improvements in provider awareness of bias as well as changes in implicit bias scores and confidence providing weight-neutral care. Conclusion Educating providers about weight contributes to equity of care for patients of higher weights. Formal education such as workshops have the potential to reduce the harms of weight stigma in health care as changing attitudes and confidence are a precursor to behavior change. Research is needed to assess ideal education modalities and whether receiving care from weight bias-prepared providers affects patient outcomes and experiences.
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Affiliation(s)
- Monica Skoko Rodriguez
- Duke University School of Nursing, Durham, North Carolina, USA
- Planned Parenthood Federation of America, New York, New York, USA
| | | | - Brigit Carter
- Duke University, American Association of Colleges of Nursing, Washington, District of Columbia, USA
| | - Robin Wallace
- Planned Parenthood Federation of America, New York, New York, USA
| | - Katie Riley
- Planned Parenthood of Northern New England, Burlington, Vermont, USA
| | - Ragan Johnson
- Duke University School of Nursing, Durham, North Carolina, USA
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Sjunnestrand M, Neuman N, Järvholm K, Ek A, Nordin K, Salas XR, Eli K, Nowicka P. "A balancing act": parents' longitudinal perspectives of weight-related discussions with their children following obesity treatment. BMC Public Health 2024; 24:1695. [PMID: 38918803 PMCID: PMC11202376 DOI: 10.1186/s12889-024-19195-1] [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: 01/03/2024] [Accepted: 06/19/2024] [Indexed: 06/27/2024] Open
Abstract
Weight-related discussions during childhood may have long-lasting effects on children's body image and well-being. However, little is known about how parents frame these discussions with children who have undergone treatment for obesity. Our study aimed to explore how parents perceive weight-related discussions, several years after their children started obesity treatment. This qualitative study is part of the 4-year follow-up of the More and Less study, a randomized controlled trial examining the effectiveness of a parental support program as part of obesity treatment for preschool-aged children in Stockholm, Sweden. Semi-structured interviews were conducted with 33 parents (79% mothers, 48% with a university degree, 47% with foreign background) of 33 children (mean age 9.3 years (SD 0.7), 46% girls), transcribed and analyzed using realist informed thematic analysis. Three main themes, encompassing three subthemes were developed. Under the first theme, Parental attitudes and concerns, parents emphasized the importance of discussing weight and health behaviors with their children, yet found it challenging due to uncertainties about how to approach it safely and sensitively. A few parents found the conversation manageable, citing their own experiences of having overweight or their style of communication with the child as facilitating the conversation. Under the second theme, The significance of time and context, parents said they engaged in weight-related conversations with their children more frequently as the children matured, driven by their growing self-awareness. Parents also expressed how contextual factors, such as gender and the presence of others, shaped conversations. Parents perceived boys as more resilient, thus exposing them to more negative weight talk. The third theme, Navigating weight stigma, revealed how parents employed strategies such as nurturing their children's self-confidence, downplaying the significance of appearance and emphasizing health when discussing weight to shield their children from weight stigma. Taken together, we found that many parents need support to navigate weight-related discussions. Addressing weight stigma is part of children's obesity management process, as children may be bullied, teased, or experience discrimination in different social settings. More research is needed to explore how young children undergoing obesity treatment experience weight stigma and to understand gendered differences in these experiences.
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Affiliation(s)
- My Sjunnestrand
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden.
| | - Nicklas Neuman
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
| | | | - Anna Ek
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Karin Nordin
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Ximena Ramos Salas
- European Association for the Study of Obesity, United Kingdom and Bias 180, Ottawa, Canada
| | - Karin Eli
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Paulina Nowicka
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
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Ryan L, Quigley F, Birney S, Crotty M, Conlan O, Walsh JC. 'Beyond the Scale': A Qualitative Exploration of the Impact of Weight Stigma Experienced by Patients With Obesity in General Practice. Health Expect 2024; 27:e14098. [PMID: 38859797 PMCID: PMC11165259 DOI: 10.1111/hex.14098] [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: 03/24/2024] [Revised: 05/16/2024] [Accepted: 05/21/2024] [Indexed: 06/12/2024] Open
Abstract
OBJECTIVE Obesity is a complex, chronic, relapsing disease that requires an individualised approach to treatment. However, weight stigma (WS) experienced in healthcare settings poses a significant barrier to achieving person-centred care for obesity. Understanding the experiences of people living with obesity (PwO) can inform interventions to reduce WS and optimise patient outcomes. This study explores how patients with obesity perceive WS in general practice settings; its impact on their psychological well-being and health behaviours, and the patients suggestions for mitigating it. METHODS In-depth semistructured interviews were conducted with 11 PwO who had experienced WS in general practice settings in Ireland. The interviews were conducted online via Zoom between May and August 2023; interviews lasted between 31 and 63 min (M = 34.36 min). Interviews were audio-recorded, transcribed verbatim and analysed using inductive reflexive thematic analysis. RESULTS Three overarching themes specific to participants' experience of WS in general practice were generated: (1) shame, blame and 'failure'; (2) eat less, move more-the go-to treatment; (3) worthiness tied to compliance. A fourth theme: (4) the desire for a considered approach, outlines the participants' suggestions for reducing WS by improving the quality of patient-provider interactions in general practice. CONCLUSION The findings call for a paradigm shift in the management of obesity in general practice: emphasising training for GPs in weight-sensitive communication and promoting respectful, collaborative, and individualised care to reduce WS and improve outcomes for people with obesity. PATIENT OR PUBLIC CONTRIBUTION PPI collaborators played an active and equal role in shaping the research, contributing to the development of the research questions, refining the interview schedule, identifying key themes in the data, and granting final approval to the submitted and published version of the study.
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Affiliation(s)
- Leona Ryan
- School of PsychologyUniversity of GalwayGalwayIreland
| | - Fiona Quigley
- School of Communication and MediaUlster UniversityBelfastNorthern Ireland
| | - Susie Birney
- Irish Coalition for People Living with Obesity (ICPO)DublinIreland
| | | | - Owen Conlan
- School of Computer Science and StatisticsTrinity College DublinDublinIreland
| | - Jane C. Walsh
- School of PsychologyUniversity of GalwayGalwayIreland
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Rodbard HW, Barnard-Kelly K, Pfeiffer AFH, Mauersberger C, Schnell O, Giorgino F. Practical strategies to manage obesity in type 2 diabetes. Diabetes Obes Metab 2024; 26:2029-2045. [PMID: 38514387 DOI: 10.1111/dom.15556] [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: 01/19/2024] [Revised: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 03/23/2024]
Abstract
The rising phenomenon of obesity, a major risk factor for the development and progression of type 2 diabetes, is a complex and multifaceted issue that requires a comprehensive and coordinated approach to be prevented and managed. Although novel pharmacological measures to combat obesity have achieved unprecedented efficacy, a healthy lifestyle remains essential for the long-term success of any therapeutic intervention. However, this requires a high level of intrinsic motivation and continued behavioural changes in the face of multiple metabolic, psychological and environmental factors promoting weight gain, particularly in the context of type 2 diabetes. This review is intended to provide practical recommendations in the context of a holistic, person-centred approach to weight management, including evidence-based and expert recommendations addressing supportive communication, shared decision-making, as well as nutritional and pharmacological therapeutic approaches to achieve sustained weight loss.
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Affiliation(s)
| | - Katharine Barnard-Kelly
- Southern Health NHS Foundation Trust, Southampton, UK
- BHR Limited, Portsmouth, UK
- Spotlight Consultations, Fareham, UK
| | - Andreas F H Pfeiffer
- Department of Endocrinology, Diabetes and Nutrition, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Oliver Schnell
- Sciarc GmbH, Baierbrunn, Germany
- Forschergruppe Diabetes eV at the Helmholtz Centre, Munich-Neuherberg, Germany
| | - Francesco Giorgino
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, Bari, Italy
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Akyirem S, Ekpor E, Namumbejja Abwoye D, Wang K. Weight-related discrimination, perceived stress and psychological and physical well-being of persons with type 2 diabetes: A mediation analysis. Diabet Med 2024; 41:e15322. [PMID: 38561918 PMCID: PMC11088521 DOI: 10.1111/dme.15322] [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: 10/28/2023] [Accepted: 03/19/2024] [Indexed: 04/04/2024]
Abstract
AIMS The aim of the study was to examine perceived stress as a mediator of the association between weight-related discrimination and physical and psychological well-being among persons with type 2 diabetes (T2D). METHODS Data were obtained from 5104 persons with self-reported T2D participating in the All of Us research programme in the United States. The Everyday Discrimination Scale, Cohen's Perceived Stress Scale (PSS) and PROMIS Global Health Scale were used to measure weight-related discrimination, perceived stress and health outcomes (physical and psychological), respectively. Mediation effects of PSS were tested by bootstrapping with 5000 random samples. RESULTS Participants were, on average, 63.62 (SD 11.38) years old. Majority of them were female (55.53%), non-Hispanic White (72.61%), married or living with a partner (56.92%), had a household income of <$35,000 (31.99%) and had some college education (33.54%). We found that approximately 18% of study participants reported having experienced weight-related discrimination. We also found that weight-related discrimination was independently associated with poor physical and psychological well-being. These associations were partially mediated by perceived stress such that weight-related discrimination was associated with greater perceived stress, which was in turn associated with poorer physical and psychological well-being. CONCLUSIONS Given that weight-related discrimination is associated with poor outcomes through elevated stress, interventions that target stress may disrupt this pathway thereby helping to reduce the health impact of weight-related discrimination. This assertion should, however, be tested in future studies.
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Affiliation(s)
- Samuel Akyirem
- Yale School of Nursing, Yale University, West Haven, Connecticut 06519, USA
| | - Emmanuel Ekpor
- School of Nursing and Midwifery, University of Ghana, Accra, Ghana
| | | | - Katie Wang
- Yale School of Public Health, Yale University, New Haven, Connecticut 06511, USA
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10
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Melisse B, van den Berg E, de Beurs E. Effectiveness of web-based guided self-help cognitive behavioral therapy-enhanced for binge-eating disorder: An implementation study. Int J Eat Disord 2024; 57:1379-1389. [PMID: 37876352 DOI: 10.1002/eat.24079] [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: 06/19/2023] [Revised: 10/06/2023] [Accepted: 10/06/2023] [Indexed: 10/26/2023]
Abstract
INTRODUCTION Web-based guided self-help cognitive behavioral therapy-enhanced (CBT-E) is a 12-weeks, 12-sessions, digitalized version of part II of the self-help book Overcoming Binge Eating. This intervention is effective when offered under controlled circumstances in a randomized-controlled-trial. It is unknown how patients with binge-eating disorder (BED) respond to this intervention when offered in real-world clinical-settings. The aim of this study is to examine post-intervention effectiveness of guided self-help CBT-E for BED in real-world settings. METHOD The present study used a cohort-design examining the effectiveness of web-based guided self-help CBT-E according to an intention-to-treat (ITT) analysis. BED patients (n = 278) were assessed pre- and post-intervention. The primary outcome was reduction in binge-eating episodes. Other outcomes were full-recovery (EDE-Q score <2.77 and abstinence from binge-eating episodes), impaired psychosocial functioning, defined as secondary impairment, and general psychopathology post-intervention. RESULTS The number of binge-eating episodes reduced by an average of 16 binge-eating episodes per 4 weeks pre-intervention to five binge-eating episodes during the last 4 weeks of treatment. Abstinence from binge eating was reported by 30%, and 28% reported full recovery. Effect sizes (Cohen's d) were large (d ≥ 1.0) for all outcome measures. There were no differences in outcomes between the ITT and the completers sample. DISCUSSION Guided self-help CBT-E is associated with significant improvements. The effects of guided self-help CBT-E offered in a real-world-setting are comparable to self-help CBT-E offered in a randomized-controlled-trial. However, it should be noted that comparisons with randomized-controlled-trials requires caution. Longer-term follow-up data are necessary to measure persistence of treatment benefits. PUBLIC SIGNIFICANCE Offering CBT-E as a web-based guided self-help intervention has several benefits for patients with BED. Guided self-help CBT-E is associated with significant improvements on the short term when offered in real-world clinical settings.
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Affiliation(s)
- Bernou Melisse
- Novarum Center for Eating Disorders & Obesity, Amstelveen, The Netherlands
- Section Clinical Psychology, Leiden University, Leiden, The Netherlands
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
| | - Elske van den Berg
- Novarum Center for Eating Disorders & Obesity, Amstelveen, The Netherlands
| | - Edwin de Beurs
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
- Research Department, Arkin Mental Health Institute, Amsterdam, The Netherlands
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Rosenbaum DL. A randomized controlled trial of a reading-based weight bias intervention. Int J Eat Disord 2024. [PMID: 38738962 DOI: 10.1002/eat.24228] [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: 01/09/2024] [Revised: 04/30/2024] [Accepted: 05/01/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVE Weight bias, or negative attitudes about larger bodies, is a prevalent issue associated with problems in psychological and physical health, as well as discriminatory behaviors and weight stigma. Literature is mixed regarding the efficacy of weight bias reduction efforts. This study sought to combine three elements that yielded promising results from previous studies (i.e., reductions in beliefs about controllability of weight, reductions in stereotypical beliefs, and promotion of empathy) in a reading-based intervention to reduce weight bias. METHODS Participants (N = 319) were randomized to read a third-person fictional narrative passage about a peer with obesity (intervention) or information on overweight and obesity (control). RESULTS Linear mixed models controlling for body mass index and gender indicated the intervention was effective in producing reductions in overall weight bias and beliefs about controllability of weight from baseline to 1-month follow-up, but significant differences were not found in the domains of bias related to character disparagement or physical unattractiveness. DISCUSSION This combination-approach reading intervention is a promising strategy to reduce weight bias; however, future work is needed to more effectively target negative weight-related attitudes pertaining to character and attractiveness. PUBLIC SIGNIFICANCE STATEMENT A reading-based intervention targeting controllability of weight, stereotypes, and empathy can produce reductions in overall weight bias compared with a control condition. Reductions in beliefs about controllability of weight were shown from the reading-based intervention. These findings may inform the development of programs to reduce negative attitudes about weight, which could help enhance quality of life and reduce risk for several mental health issues.
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Affiliation(s)
- Diane L Rosenbaum
- Psychological and Social Sciences Program, Pennsylvania State University, Abington College, Abington, Pennsylvania, USA
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12
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Charnley M, Newson L, Weeks A, Abayomi J. A qualitative exploration of the experiences of pregnant women living with obesity and accessing antenatal care. PLoS One 2024; 19:e0302599. [PMID: 38701095 PMCID: PMC11068194 DOI: 10.1371/journal.pone.0302599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 04/08/2024] [Indexed: 05/05/2024] Open
Abstract
Women are advised to optimise weight before pregnancy. However, many are either already living with overweight or obesity prior to becoming pregnant, increasing the risks for adverse outcomes. Health care professionals (HCP) are responsible for advising women of risks throughout and following pregnancy. However, midwives often find broaching the conversation around maternal obesity difficult. This study explored the experiences of pregnant women living with obesity in accessing antenatal care. Seventeen women completed a semi-structured interview. Transcripts were analysed thematically. Four themes were developed: 1) antenatal care is inconsistent, 2) additional support is needed, 3) women feel judged about their weight, and 4) weight cycling is highly prevalent. Findings suggest that pregnant women living with obesity often experience weight bias from HCPs, feel judged because of their weight and are left feeling confused and overlooked. Women reported inconsistencies in advice and care offered and acknowledged a lack of continuity of care throughout pregnancy. We call for an urgent need for further multidisciplinary training to address the concerns, experiences and needs of pregnant women living with obesity.
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Affiliation(s)
- Margaret Charnley
- School of Health & Sort Sciences, Liverpool Hope University, Liverpool, United Kingdom
| | - Lisa Newson
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, United Kingdom
| | - Andrew Weeks
- Sanyu Research Unit, Department of Women’s and Children’s Health, University of Liverpool, Liverpool, United Kingdom
| | - Julie Abayomi
- School of Medicine and Nutrition, Health Research Institute, Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, United Kingdom
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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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14
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Maselli DB, Donnangelo LL, Coan B, McGowan CE. How to establish an endoscopic bariatric practice. World J Gastrointest Endosc 2024; 16:178-186. [PMID: 38680199 PMCID: PMC11045351 DOI: 10.4253/wjge.v16.i4.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/28/2024] [Accepted: 03/06/2024] [Indexed: 04/11/2024] Open
Abstract
Obesity is a chronic, progressive, and relapsing disease of excess adiposity that contributes to more than two hundred medical conditions and is projected to affect more than half the adult population of the United States by the year 2030. Given the limited penetrance of traditional bariatric surgery, as well as the cost and adherence barriers to anti-obesity medications, there is growing interest in the rapidly evolving field of endoscopic bariatric therapies (EBTs). EBTs are minimally invasive, same-day, per-oral endoscopic procedures and include endoscopic sleeve gastroplasty, intragastric balloons, and endoscopic bariatric revisional procedures. This field represents an exciting and innovative subspecialty within gastroenterology. However, building a successful endoscopic bariatric practice requires intentional, coordinated, and sustained efforts to overcome the numerous obstacles to entry. Common barriers include acquisition of the technical and cognitive skillset, practice limitations including the availability of nutrition counseling, facility capabilities, direct-to-consumer marketing, and financial pressures such as facility and anesthesia fees. As the highest-volume center for metabolic and bariatric endoscopy in the United States, we provide insights into successfully establishing an endoscopic bariatric program.
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Affiliation(s)
- Daniel B Maselli
- Clinical Research, True You Weight Loss, Atlanta, GA 30342, United States
| | | | - Brian Coan
- Clinical Research, True You Weight Loss, Cary, NC 27513, United States
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15
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Hailu H, Skouteris H, Incollingo Rodriguez AC, Hill B. SWIPE: a conceptual, multi-perspective model for understanding and informing interventions for weight stigma in preconception, pregnancy, and postpartum. Health Psychol Rev 2024:1-17. [PMID: 38560922 DOI: 10.1080/17437199.2024.2333801] [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: 09/12/2023] [Accepted: 03/18/2024] [Indexed: 04/04/2024]
Abstract
Weight stigma is salient across the preconception, pregnancy, and postpartum (PPP) periods because of prevailing prescriptive norms and expectations about weight and weight gain during the reproductive period. Weight stigma is associated with negative physical and psychological health outcomes for mother and child. A clearly defined, multi-level conceptual model for interventions, research, and policy is critical to mitigating the adverse effects of weight stigma in PPP populations. Conceptual models of weight stigma towards PPP women have advanced our understanding of this issue and guided evidence accumulation but there remains a gap in informing the translation of evidence into action. Guided by evidence-based paradigms for conceptual model development, this paper has two primary objectives. First, we review and summarise theories, frameworks, and models from the PPP population and general literature to inform our understanding of the development and perpetuation of weight stigma for PPP women. Second, we propose a novel comprehensive intervention-guiding conceptual model that draws from and synthesises across multiple disciplines - the SWIPE (Stigma of Weight In the PPP Experience) model. This conceptual model will help to plan coordinated, multi-layered, and effective strategies to reduce and ultimately eliminate weight stigma for PPP women.
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Affiliation(s)
- Haimanot Hailu
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Helen Skouteris
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Warwick Business School, The University of Warwick, Coventry, UK
| | - Angela C Incollingo Rodriguez
- Psychological & Cognitive Sciences, Department of Social Science & Policy Studies, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Briony Hill
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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16
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Finch LE, Hawkley LC, Schumm LP, Iveniuk J, McClintock MK, Huang ES. Moderation of associations between weight discrimination and diabetes status by psychosocial factors. J Behav Med 2024; 47:244-254. [PMID: 37946026 PMCID: PMC11017919 DOI: 10.1007/s10865-023-00454-2] [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: 06/20/2023] [Accepted: 10/09/2023] [Indexed: 11/12/2023]
Abstract
Weight discrimination has adverse effects on health that include increasing the risk factors for developing type 2 diabetes. Preliminary evidence suggests a positive association between weight discrimination and diagnosed diabetes; however, it is unknown whether psychosocial resources may buffer this association. In logistic regressions stratified by gender, we examined links between weight discrimination and diabetes among a nationally representative sample of U.S. adults (the National Social Life, Health, and Aging Project; N = 2,794 adults age 50 and older in 2015-16). We also tested the extent to which trait-resilience and social support from a spouse/partner, family, and friends buffered any observed association. We adjusted for known predictors of diabetes (age, race/ethnicity, Body Mass Index) and conducted sensitivity analyses restricted to men and women with obesity. Net of covariates, in the overall sample, weight discrimination was associated with significantly greater odds of having ever had diabetes among women (OR = 2.00, 95% CI [1.15, 3.47]), but not men. Among women with obesity, weight discrimination was only significantly associated with greater odds of diabetes for those with low resilience (OR = 1.84, 95% CI [1.01, 3.35]). Among men overall, weight discrimination was associated with lower odds of diabetes for those with high family support (OR = 0.03, 95% CI [0.003, 0.25]) as well as those with high friend support (OR = 0.34, 95% CI [0.13, 0.91]); similar effects were observed in men with obesity. These novel findings evince a role for psychosocial resources in buffering associations between weight discrimination and diabetes.
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Affiliation(s)
- Laura E Finch
- Academic Research Centers, NORC at the University of Chicago, 1155 E 60th St, Chicago, IL, 60637, USA.
| | - Louise C Hawkley
- Academic Research Centers, NORC at the University of Chicago, 1155 E 60th St, Chicago, IL, 60637, USA
| | - L Philip Schumm
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - James Iveniuk
- Academic Research Centers, NORC at the University of Chicago, 1155 E 60th St, Chicago, IL, 60637, USA
| | - Martha K McClintock
- Departments of Psychology and Human Development, University of Chicago, Chicago, IL, USA
| | - Elbert S Huang
- Section of General Internal Medicine, University of Chicago, Chicago, IL, USA
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Samara MT, Michou N, Lappas AS, Argyrou A, Mathioudaki E, Bakaloudi DR, Tsekitsidi E, Polyzopoulou ZA, Christodoulou N, Papazisis G, Chourdakis M. Is cognitive behavioral therapy more effective than pharmacotherapy for binge spectrum disorders? A systematic review and meta-analysis. Aust N Z J Psychiatry 2024; 58:308-319. [PMID: 38179705 DOI: 10.1177/00048674231219593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
OBJECTIVES Binge spectrum disorders are prevalent worldwide. Psychiatric and medical comorbidities are common, and societal costs are significant. Evidence-based treatment remains underutilized. Cognitive behavioral therapy is the recommended first-line treatment, but pharmacotherapy may be easier to access. INTERVENTIONS Meta-analytic evidence directly comparing cognitive behavioral therapy with pharmacotherapy is lacking. We aimed to compare the effects of cognitive behavioral therapy interventions with any pharmacological treatment for binge spectrum disorders. We searched PubMed, Embase, CENTRAL, ClinicalTrials.gov and reference lists for randomized controlled trials comparing cognitive behavioral therapy with any pharmacotherapy for bulimia nervosa/binge eating disorder and performed pairwise meta-analytic evaluations. PRIMARY OUTCOMES Primary outcomes are remission and frequency of binges. Secondary outcomes are frequency of purges, response, eating disorder psychopathology, weight/body mass index, depression, anxiety, quality of life and dropouts. RESULTS Eleven randomized controlled trials comparing cognitive behavioral therapy with fluoxetine/imipramine/desipramine/methylphenidate/sibutramine were identified (N = 531). Cognitive behavioral therapy was superior to antidepressants in terms of remission, frequency of binges and eating disorder psychopathology. There were no statistically significant differences for any of the individual cognitive behavioral therapy vs drug comparisons in terms of response/depression/anxiety/weight/quality of life/dropouts. Cognitive behavioral therapy was not superior to sibutramine/methylphenidate for the primary outcomes. CONCLUSIONS Data are scarce, comparisons underpowered and, considering the inherent methodological limitations of psychotherapy trials, questions arise regarding the presumed superiority of cognitive behavioral therapy. Further research is needed.
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Affiliation(s)
- Myrto T Samara
- Department of Psychiatry, Faculty of Medicine, University of Thessaly, Larissa, Greece
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Niki Michou
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Andreas S Lappas
- Department of Psychiatry, Faculty of Medicine, University of Thessaly, Larissa, Greece
- Aneurin Bevan University Health Board, Wales, UK
| | - Aikaterini Argyrou
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Elissavet Mathioudaki
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitra Rafailia Bakaloudi
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eirini Tsekitsidi
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Zoi A Polyzopoulou
- Department of Psychology, University of Western Macedonia, Florina, Greece
| | - Nikos Christodoulou
- Department of Psychiatry, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Georgios Papazisis
- Department of Clinical Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Michail Chourdakis
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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18
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Ben Nathan C, Ben Nathan J, Chou YT, Joshi SM, Gallagher C, Chao AM. Benefits managers' attitudes toward obesity treatment coverage. Obes Res Clin Pract 2024; 18:94-100. [PMID: 38637266 DOI: 10.1016/j.orcp.2024.04.001] [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: 04/26/2023] [Revised: 03/09/2024] [Accepted: 04/05/2024] [Indexed: 04/20/2024]
Abstract
Despite the existence of effective treatments, obesity continues to present a severe public health crisis. Limited access to treatments works against efforts to reduce obesity prevalence. A major barrier to treatment access is a lack of insurance coverage. This study focused on an important population of stakeholders: benefits managers. The purpose of this study was to explore the relationships between attitudes about insurance coverage of obesity treatments and obesity stigma. Benefits managers have the ability to advocate for insurance coverage of medical interventions. We assessed whether attitudes toward covering obesity benefits for employees could be modified by receiving targeted information or were associated with particular factors. We recruited participants from Dun & Bradstreet's employer database using emails. Participants were randomized to one of three conditions that provided written information about: (1) prevalence of obesity (control), (2) prevalence + financial implications of obesity, and (3) prevalence + physiology of obesity. Questionnaires were self-administered online. The response rate was 4.8%, with 404 participants meeting eligibility criteria. While attitudes toward coverage of obesity interventions did not differ significantly based on condition (p > 0.05), gender, history of previous obesity treatment, and an individual's likelihood to attribute obesity to biological and environmental factors showed significant associations with supporting coverage of obesity treatment (p < 0.05). Findings suggest that understanding obesity as a condition caused by biological factors as opposed to personal responsibility and behavior is associated with greater support for coverage of all its treatments.
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Affiliation(s)
- Caroline Ben Nathan
- Marketing Department, The Wharton School, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jennifer Ben Nathan
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Yung-Tang Chou
- Department of Computer and Information Science, School of Engineering & Applied Sciences, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Sukanya M Joshi
- Department of Computer and Information Science, School of Engineering & Applied Sciences, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Christine Gallagher
- Milken Institute School of Public Health, The George Washington University, Washington DC 20052, USA
| | - Ariana M Chao
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
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19
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Eggerichs LA, Wilson OWA, Chaplin JE, Ramos Salas X. Weight Stigma in Latin America, Asia, the Middle East, and Africa: A Scoping Review. Obes Facts 2024; 17:217-226. [PMID: 38316119 PMCID: PMC11149978 DOI: 10.1159/000536554] [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: 05/18/2023] [Accepted: 01/22/2024] [Indexed: 02/07/2024] Open
Abstract
INTRODUCTION Being stigmatized because of one's weight can pose physical, mental, and social challenges. While weight stigma and its consequences are established throughout Europe, North America, and Australasia, less is known about weight stigma in other regions. The objective of this study was to identify the extent and focus of weight stigma research in Latin America, Asia, the Middle East, and Africa. METHODS A scoping review of weight stigma research in Latin America, Asia, the Middle East, and Africa was conducted. SCOPUS and PsychINFO databases were searched, and weight stigma experts were contacted to identify relevant literature. Sources were classified based on country/region, population, setting, and category of weight stigma researched. RESULTS A total of 130 sources were identified from 33 countries and territories. Results indicate that weight stigma has been investigated across populations and settings, mainly focusing on manifestations of weight stigma through experiences, practices, drivers, and personal outcomes of these manifestations. CONCLUSIONS Weight stigma is a developing global health concern not restricted to Europe, North America, and Australasia. The extent and focus of weight stigma research in Latin America, Asia, the Middle East, and Africa vary between countries and regions leaving several research gaps that require further investigation.
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Affiliation(s)
- Laura Ann Eggerichs
- Department of Public Health and Community Medicine, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Oliver W A Wilson
- Werklund School of Education, University of Calgary, Calgary, Alberta, Canada
- Te Hau Kori, Te Wāhanga Tātai Hauora Faculty of Health, Te Herenga Waka Victoria University of Wellington, Wellington, New Zealand
| | - John E Chaplin
- Department of Pediatrics, Institute for Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Ximena Ramos Salas
- Research Consultant, Obesity Canada, European Association for the Study of Obesity, Replica Communications, Kristianstad, Sweden,
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20
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Earl S, Burnette JL, Ho AS. Exploring the benefits and costs of a growth mindset in a digital app weight management program. J Health Psychol 2024:13591053241226610. [PMID: 38312005 DOI: 10.1177/13591053241226610] [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: 02/06/2024] Open
Abstract
We explored the potential benefits and costs of believing one can change their weight (i.e. growth mindset) in the context of a digital weight management program. We investigated mechanisms by which growth mindsets relate to weight loss achievement and body shame. Among participants seeking to lose weight (N = 1626; 74.7% female; 77.9% White; Mage = 45.7), stronger growth mindsets indirectly predicted greater weight loss achievement through positive offset expectations and subsequent increased program engagement. Additionally, stronger growth mindsets predicted less body shame through positive offset expectations but predicted more body shame through increased onset responsibility, replicating the double-edged sword model of growth mindsets. We conclude with applications that leverage growth mindsets for optimal behavior change while mitigating costs such as body shame.
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21
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Waldrop SW, Wang D, Kancherla D, Stanford FC. Current status of weight bias and stigma in pediatrics and the need for greater focus on populations at risk. Curr Opin Pediatr 2024; 36:42-48. [PMID: 37965910 PMCID: PMC10873084 DOI: 10.1097/mop.0000000000001305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
PURPOSE OF REVIEW Obesity is one of the most common pediatric chronic conditions in the United States, affecting approximately 20% of American youth and is more common amongst Black, Latino, and Indigenous and low socioeconomic populations. The condition places children and adolescents at increased risk of physical and mental health conditions partly mediated by the weight bias and stigmatization experienced during the potentially vulnerable periods of childhood and adolescence. RECENT FINDINGS Weight bias and the resulting stigma are pervasive in society. Children have been shown to internalize this bias and its devaluation, which have been shown to contribute to worsening metabolic and mental health outcomes independently. Studies suggest weight stigmatization more adversely affects Black, Latino, and Indigenous children, suggesting the potential for adverse synergistic effects of these historical biases on such youth. SUMMARY Addressing childhood obesity successfully across all racial, ethnic, and socioeconomic lines requires addressing weight bias and stigma. Steps toward this end include collaborative efforts to promote cross-cultural competence and upstander bias education and training for those who care for children, person-centered communication, and a culture of inclusivity across governmental, healthcare, educational, entertainment, and advertising sectors.
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Affiliation(s)
- Stephanie W. Waldrop
- Section on Nutrition Department of Pediatrics, University of Colorado School of Medicine, Nutrition Obesity Research Center at the University of Colorado, Aurora, CO, USA
| | - Daisy Wang
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | | | - Fatima Cody Stanford
- Massachusetts General Hospital, MGH Weight Center, Department of Medicine-Division of Endocrinology-Neuroendocrine, Department of Pediatrics-Division of Endocrinology, Nutrition Obesity Research Center at Harvard (NORCH), Boston, MA, USA
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22
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Dunham M. Obesity bias awareness decreases nursing students' bias toward patients with obesity. Nursing 2024; 54:56-60. [PMID: 38271133 DOI: 10.1097/01.nurse.0000998024.65699.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
PURPOSE To determine if obesity bias scores among nursing students changed after education was delivered and to what degree body mass index (BMI) was associated with a personal experience of bias during a student's healthcare history. METHODS A quantitative, quasi-experimental design was used to analyze sociodemographic information and Implicit Association Test scores of junior, senior, and full-time accelerated coursework track nursing students. RESULTS Generally, obesity bias declined among the group. However, bias increased regarding increasing BMI. CONCLUSION Obesity bias awareness and obesity education can decrease obesity bias among nursing students.
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Affiliation(s)
- Marguerite Dunham
- Marguerite Dunham is an NP and the program coordinator in Bariatric Surgery for Comprehensive Weight Management at Jefferson Health-Abington
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23
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Di Fusco SA, Mocini E, Gulizia MM, Gabrielli D, Grimaldi M, Oliva F, Colivicchi F. ANMCO (Italian Association of Hospital Cardiologists) scientific statement: obesity in adults-an approach for cardiologists. Eat Weight Disord 2024; 29:1. [PMID: 38168872 PMCID: PMC10761446 DOI: 10.1007/s40519-023-01630-8] [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: 08/29/2023] [Accepted: 11/27/2023] [Indexed: 01/05/2024] Open
Abstract
Obesity is a complex, chronic disease requiring a multidisciplinary approach to its management. In clinical practice, body mass index and waist-related measurements can be used for obesity screening. The estimated prevalence of obesity among adults worldwide is 12%. With the expected further increase in overall obesity prevalence, clinicians will increasingly be managing patients with obesity. Energy balance is regulated by a complex neurohumoral system that involves the central nervous system and circulating mediators, among which leptin is the most studied. The functioning of these systems is influenced by both genetic and environmental factors. Obesity generally occurs when a genetically predisposed individual lives in an obesogenic environment for a long period. Cardiologists are deeply involved in evaluating patients with obesity. Cardiovascular risk profile is one of the most important items to be quantified to understand the health risk due to obesity and the clinical benefit that a single patient can obtain with weight loss. At the individual level, appropriate patient involvement, the detection of potential obesity causes, and a multidisciplinary approach are tools that can improve clinical outcomes. In the near future, we will probably have new pharmacological tools at our disposal that will facilitate achieving and maintaining weight loss. However, pharmacological treatment alone cannot cure such a complex disease. The aim of this paper is to summarize some key points of this field, such as obesity definition and measurement tools, its epidemiology, the main mechanisms underlying energy homeostasis, health consequences of obesity with a focus on cardiovascular diseases and the obesity paradox.Level of evidence V: report of expert committees.
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Affiliation(s)
- Stefania Angela Di Fusco
- Emergency Department, Clinical and Rehabilitation Cardiology Unit, San Filippo Neri Hospital, ASL Roma 1, Rome, Italy
| | - Edoardo Mocini
- Department of Experimental Medicine, Sapienza University, 00161, Rome, Italy.
| | | | - Domenico Gabrielli
- Cardio-Thoracic-Vascular Department, San Camillo-Forlanini Hospital, Rome, Italy
- Heart Care Foundation, Florence, Italy
| | - Massimo Grimaldi
- Department of Cardiology, General Regional Hospital "F. Miulli", Acquaviva delle Fonti, 70021, Bari, Italy
| | - Fabrizio Oliva
- De Gasperis Cardio Center, Niguarda Hospital, 20162, Milan, Italy
| | - Furio Colivicchi
- Emergency Department, Clinical and Rehabilitation Cardiology Unit, San Filippo Neri Hospital, ASL Roma 1, Rome, Italy
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24
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Sherf-Dagan S, Ofri L, Tayar I, Keisar I, Buch A, Paska-Davis N, Pinus M, Tesler R, Elran-Barak R, Boaz M, Green G. A multifaceted training tool to reduce weight bias among healthcare students: A randomized controlled trial. Obes Res Clin Pract 2024; 18:35-42. [PMID: 38184475 DOI: 10.1016/j.orcp.2023.12.002] [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: 08/18/2023] [Revised: 11/26/2023] [Accepted: 12/22/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Weight bias toward people with obesity (PwO) is common in healthcare settings. Efforts to address weight bias in healthcare settings should begin during university studies. This study aimed to explore the effect of a multifaceted intervention on weight bias among undergraduate healthcare students. METHODS An open label randomized controlled trial. The intervention tool consisted of short video lectures on obesity, vignettes simulating interactions between health professionals and PwO, and open discourse with a PwO. The control group received a short-written document on obesity. Online questionnaires on Anti-Fat Attitudes ('AFA'), short form of the Fat-Phobia Scale ('FPS'), Weight Implicit Association Test ('Weight-IAT'), and knowledge about obesity were administered at baseline, 1-week, and 6-week post-intervention. RESULTS A total of 162, 152, and 146 students participated in the study at baseline, 1-week, and 6-week post-intervention, respectively. Their mean age was 25.8 ± 6.7 years and 88.3% were women. Means of AFA total scores and FPS scores decreased significantly over time only within the intervention group (P Time*Group = 0.002 and 0.014). Both groups showed a similar trend over time in mean scores of Weight-IAT (P Time*Group = 0.868) and knowledge about obesity (P Time*Group = 0.115). CONCLUSIONS A multifaceted intervention resulted in a significant reduction in explicit weight bias but did not yield any additional advantages over the control group in implicit weight bias and knowledge about obesity. CLINICALTRIALS GOV NUMBER NCT05482802.
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Affiliation(s)
- Shiri Sherf-Dagan
- Department of Nutrition Sciences, School of Health Sciences, Ariel University, Ariel, Israel; Department of Nutrition, Assuta Medical Center, Tel Aviv, Israel.
| | - Lani Ofri
- Nursing Department, School of Health Sciences, Ariel University, Ariel, Israel
| | - Inbar Tayar
- Department of Nutrition Sciences, School of Health Sciences, Ariel University, Ariel, Israel
| | - Ido Keisar
- Department of Nutrition Sciences, School of Health Sciences, Ariel University, Ariel, Israel
| | - Assaf Buch
- Department of Nutrition Sciences, School of Health Sciences, Ariel University, Ariel, Israel; Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Naama Paska-Davis
- Spokeswomen and public relations office, Ariel University, Ariel, Israel
| | - Michael Pinus
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel; Harvard Business School, Harvard University, Boston, USA
| | - Riki Tesler
- Health Management Department, School of Health Sciences, Ariel University, Ariel, Israel
| | - Roni Elran-Barak
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Mona Boaz
- Department of Nutrition Sciences, School of Health Sciences, Ariel University, Ariel, Israel
| | - Gizell Green
- Nursing Department, School of Health Sciences, Ariel University, Ariel, Israel
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25
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Phillips J. Weight bias and stigma in healthcare: What are we doing about it? Work 2024; 77:731-733. [PMID: 38393880 DOI: 10.3233/wor-246004] [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] [Indexed: 02/25/2024] Open
Abstract
Weight bias and weight stigma is present in healthcare settings negatively affecting people with obesity. Healthcare professionals should be aware of how their potential bias and stigma may be impacting clients with obesity. With obesity projected to rise among the world, the healthcare environment needs to be more accepting and accommodating.
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Madsen M, Michaelsen L, DeCosta P, Grabowski D. Stigma-Generating Mechanisms in Families Enrolled in a Pediatric Weight Management Program: A Qualitative Study of Health Identities and Healthcare Authenticity. CHILDREN (BASEL, SWITZERLAND) 2023; 11:46. [PMID: 38255360 PMCID: PMC10813986 DOI: 10.3390/children11010046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/20/2023] [Accepted: 12/25/2023] [Indexed: 01/24/2024]
Abstract
In recent years, there has been increased awareness of obesity as a condition that carries a high level of stigma, as well as growing recognition of its prevalence and harm. Despite the increasing body of research on this topic, there is a gap in the literature regarding mechanisms that generate or exacerbate perceptions of weight stigma, especially within families and pediatric healthcare settings. The present study aims to identify potential stigma-generating mechanisms by focusing on inter-relational dynamics within these contexts. We conducted in-depth, semi-structured interviews with 11 families and analyzed the data by applying sociological theories on health identities and authenticity. Our study found four themes that represent potential stigma-generating mechanisms by being explicitly related to familial health identities and healthcare authenticity: (1) negotiating and reconstruction familial self-understanding, (2) between guilt, shame and conflicts, (3) navigating weight perceptions, and (4) the necessity of positivity and relevance. Our study shows the complexities of weight stigma within family and pediatric healthcare settings, emphasizing the need for sensitive and tailored support, as well as the value of working authentically as crucial aspects in preventing and/or reducing stigma.
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Affiliation(s)
- Mie Madsen
- Department of Prevention, Health Promotion and Community Care, Copenhagen University Hospital—Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark; (P.D.); (D.G.)
| | - Lene Michaelsen
- The Centre for Children and Youths Health, Mimersgade 47A, 2nd Floor, 2200 Copenhagen, Denmark;
| | - Patricia DeCosta
- Department of Prevention, Health Promotion and Community Care, Copenhagen University Hospital—Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark; (P.D.); (D.G.)
| | - Dan Grabowski
- Department of Prevention, Health Promotion and Community Care, Copenhagen University Hospital—Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark; (P.D.); (D.G.)
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Berg KH, Natvik E, Eik-Nes TT. Patient experiences of a 10-weeks weight-neutral treatment program for clinical binge eating disorder in a higher weight population. J Eat Disord 2023; 11:228. [PMID: 38111023 PMCID: PMC10729388 DOI: 10.1186/s40337-023-00955-0] [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: 07/27/2023] [Accepted: 12/12/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Weight based stigma might drive the development of both higher weight and binge eating disorder (BED). To improve treatment and outcomes, a deeper understanding of how stigma and shame are correlated in clinical encounters is needed. The current study was designed to gain insight into how participating in a 10-weeks weight-neutral treatment program for patients with binge eating disorder and higher weight was experienced. METHODS Semi-structured interviews were conducted with 10 patients who had completed the BED treatment. The intervention was group based, addressing stigma and shame, using models of attachment and affect regulation in the presentation of BED. Interviews were analyzed guided by van Manen's hermeneutic-phenomenological approach. RESULTS A profound feeling of inferiority due to weight stigma and adverse childhood experiences appeared to have kept the participants stuck in a shame driven carousel of dieting, weight loss, bingeing, and weight regain. Participants and health care professionals' mutual acknowledgement of driving elements of binge eating appeared to support participants feeling more equal. Feeling equal was described as facilitating increased awareness and tolerance of bodily sensations and emotions, and a deeper understanding and self-caring attitude towards themselves. Feeling less shame was described as important for self-disclosure in family relationships, leading to increased understanding and support from others. Simultaneously, unchanged stigmatizing surroundings were described to relate to challenges with eating patterns and weight after end of treatment. CONCLUSION Our findings indicate that relational symmetry, by patients experienced as being met with recognition, compassionate acceptance, and mutual investigation of subjective experience, can contribute to reduction of weight stigma and shame, and the burdensome notion of inferiority experienced by the participants in everyday life, hence improving treatment outcomes. Trail registration The study was approved and registered by the Data Access Committee at Nord-Trøndelag Hospital Trust August 8th, 2019, registration number 2019_2335.
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Affiliation(s)
- Kjersti Hognes Berg
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
- Stjørdal Community Mental Health Centre, Nord-Trøndelag Hospital Trust, Levanger, Norway.
| | - Eli Natvik
- Department of Health and Caring Sciences, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Førde, Norway
- The centre for Health Research, District General Hospital of Førde, Førde, Norway
| | - Trine Tetlie Eik-Nes
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Stjørdal Community Mental Health Centre, Nord-Trøndelag Hospital Trust, Levanger, Norway
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Ravuri SC, Martingano AJ, Persky S. Evaluating eating behavior traits of virtual targets: Attitudes and empathy. Eat Behav 2023; 51:101808. [PMID: 37699308 DOI: 10.1016/j.eatbeh.2023.101808] [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: 04/13/2023] [Revised: 08/25/2023] [Accepted: 08/28/2023] [Indexed: 09/14/2023]
Abstract
There are many common stereotypes related to food consumption and eating behaviors that are considered indicative of one's personal character. Negative evaluations of an individual based on their eating behaviors may lead to stigmatization and other harmful psychosocial outcomes. Using vignette scenarios, we examined 582 participants' attitudes towards two target characters who exhibited bitter food dislike and high reward-based eating drive respectively. In open-ended text responses, participants were more likely to respond negatively and use stigmatizing language when describing the character with high reward-based eating drive versus the character with bitter food dislike. In addition, empathic responses depended on whether participants believed they, themselves, exhibited reward-based eating drive. Participants tended to be more empathetic and more positive towards the target who shared their own reward-based eating behaviors. Interestingly, the same was not true for those who shared bitter food distaste. These results suggest that eating behaviors that are perceived as more controllable and unusual may be more negatively perceived. Targeted education or support to reduce negative attitudes about such traits may be beneficial.
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Affiliation(s)
- Siri C Ravuri
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States
| | - Alison Jane Martingano
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States
| | - Susan Persky
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States.
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Yunus NA, Russell G, Muhamad R, Sturgiss EA. Patients' experience of accessing healthcare for obesity in Peninsular Malaysia: a qualitative descriptive study. BMJ Open 2023; 13:e071087. [PMID: 37989390 PMCID: PMC10668280 DOI: 10.1136/bmjopen-2022-071087] [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: 12/16/2022] [Accepted: 10/30/2023] [Indexed: 11/23/2023] Open
Abstract
OBJECTIVE To explore patients' experiences accessing healthcare for obesity and their perceived behaviour changes following the care. DESIGN Using a descriptive qualitative research approach informed by Levesque's framework of access to healthcare, we conducted phone interviews in the Malaysian language, which were audio-recorded and transcribed verbatim. Data were analysed inductively using a reflexive thematic analysis approach. SETTING Primary care clinics in five states in Peninsular Malaysia. PARTICIPANTS Adult patients with obesity receiving face-to-face care for obesity from healthcare providers in Peninsular Malaysia. RESULTS We interviewed 22 participants aged 24-62, with the majority being female (77%), Malay (95%), married (73%) and with tertiary education (82%). Most participants attended obesity management services at public primary care clinics. We identified five themes: (1) moving from perceiving the need to seeking obesity care is a non-linear process for patients, (2) providers' words can inspire patients to change, (3) patients' needs and preferences are not adequately addressed in current obesity care, (4) over-focusing on weight by patients and healthcare providers can lead to self-blame and loss of hope for patients and (5) obesity healthcare can have consequences beyond weight loss. CONCLUSION Patients lack the self-regulatory skills to continue their lifestyle changes and struggle with self-blame and hopelessness. Over-focusing on weight by patients and obesity healthcare increase patients' self-stigmatisation. While provider-initiated weight discussions and engaging and personalised consultation provide the initial step towards weight management, obesity healthcare could be enhanced by behavioural support and patient education on the complexity of obesity. Further considerations could be given to shifting from a weight-centric to a more holistic health-centred approach in obesity healthcare.
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Affiliation(s)
- Nor Akma Yunus
- School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, 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, Kelantan, Malaysia
| | - Elizabeth Ann Sturgiss
- School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia
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Malik Z, Higgins D, Williams K, Cockrell D, E Collins C. Weight stigma among dental professionals and in the dental setting: a scoping review. Br Dent J 2023:10.1038/s41415-023-6501-6. [PMID: 37978218 DOI: 10.1038/s41415-023-6501-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 06/26/2023] [Accepted: 07/10/2023] [Indexed: 11/19/2023]
Abstract
Background Weight stigma refers to discriminatory acts and ideologies targeted towards individuals because of their body weight and/or size. Weight stigma in healthcare settings generates major health disparities. To date, there have been no previous reviews exploring the issue of weight stigma among dental professionals (DPs) and in the dental setting.Aims To synthesise current evidence on weight stigma among DPs and in dental care settings via a scoping review.Methods A comprehensive search was carried out across four relevant electronic databases (Medline, Scopus, Psychinfo and Cinahl). A total of 25 full-text papers were included in the scoping review.Results Most papers addressed the subject of weight stigma as a secondary finding (20 papers). Both quantitative and qualitative study methods were used to explore weight stigma across the broad categories of attitudes and beliefs about obesity, weight-based discussions, obesity education and training and service implications of obesity. Recommendations regarding weight stigma among DPs and in the dental setting were proposed but have not been formally assessed.Conclusion Further studies addressing weight stigma in dental settings, including causes and consequences among DPs, are required to better inform and address this issue.
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Affiliation(s)
- Zanab Malik
- The University of Newcastle, School of Health Sciences (Oral Health), College of Health, Medicine and Wellbeing, New South Wales, Australia.
| | - Denise Higgins
- The University of Newcastle, School of Health Sciences (Oral Health), College of Health, Medicine and Wellbeing, New South Wales, Australia
| | - Kathryn Williams
- Nepean Blue Mountains Family Metabolic Health Service, Nepean Hospital, Nepean Blue Mountains Local Health District, Kingswood, New South Wales, Australia; Charles Perkins Centre-Nepean, The University of Sydney, Sydney, New South Wales, Australia
| | - Deborah Cockrell
- The University of Newcastle, School of Health Sciences (Oral Health), College of Health, Medicine and Wellbeing, New South Wales, Australia
| | - Clare E Collins
- The University of Newcastle, School of Health Sciences (Nutrition and Dietetics), College of Health, Medicine and Wellbeing, New South Wales, Australia; Food and Nutrition Research Program, Hunter Medical Research Institute, New South Wales, Australia
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Guglielmi V, Capoccia D, Russo B, Lubrano C, Mariani S, Poggiogalle E, Furia G, Alizadeh AH, Patrizi C, Sapienza M, Damiani G, Tarsitano MG, Conte C, Frontoni S. Knowledge, experiences, and perceptions relating to obesity management among primary care physicians in the Lazio Region, Italy. Front Endocrinol (Lausanne) 2023; 14:1249233. [PMID: 38027122 PMCID: PMC10668048 DOI: 10.3389/fendo.2023.1249233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/25/2023] [Indexed: 12/01/2023] Open
Abstract
Background Primary care providers (PCPs) play an essential role in obesity care as they represent the first contact for patients seeking weight loss interventions. Objective This study explored the knowledge, experiences, and perceptions of PCPs in the Lazio Region of Italy in the management of obesity. Design and subjects We conducted an anonymous survey delivered from March to July 2022 via the newsletter of Rome Provincial Order of Physicians and Dentists and at the annual meeting of the regional section of the Italian Obesity Society. Approach The survey consisted of 24 closed-ended questions grouped into 5 sections: sociodemographic and work information; assessment of obesity; management of obesity; connections with regional Centres for Obesity Management; attitudes towards obesity. Key results A total of 92 PCPs accessed the survey. Of those, 2.2% were excluded because they did not see any patients with obesity. A total of 68 PCPs (75.6%) had complete questionnaires and were included in this analysis. All participants reported asking their patients about their eating habits, lifestyle, and clinical complications at the first assessment. Body weight and blood pressure were measured by 98.5% of participants and 82% calculate body mass index (BMI), while a small proportion of PCPs analysed body composition and fat distribution. Over 80% prescribed laboratory tests and ECG. Approximately 40% of PCPs did not refer patients for nutritional counselling, and most prescribed a low-calorie diet. Sixty-three percent referred patients to an endocrinologist, 48.5% to a psychotherapist, and a minority to specialists for obesity complications. Twenty-three percent prescribed anti-obesity medications and 46.5% referred patients for bariatric surgery only in severe cases. Ninety-one percent stated that obesity is "a complex and multifactorial disease" and 7.4% considered obesity to be secondary to other conditions. Conclusions Despite most PCPs adopt a correct approach to manage patients with obesity, many aspects could be improved to ensure optimal and multidisciplinary management.
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Affiliation(s)
- Valeria Guglielmi
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Internal Medicine Unit - Obesity Center, University Hospital Policlinico Tor Vergata, Rome, Italy
- Italian Obesity Society (SIO), Pisa, Italy
| | - Danila Capoccia
- Italian Obesity Society (SIO), Pisa, Italy
- Department of Medical Surgical Sciences and Biotechnologies, Sapienza University of Rome, Santa Maria Goretti Hospital, Latina, Italy
| | - Benedetta Russo
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Italian Obesity Society (SIO), Pisa, Italy
- Unit of Endocrinology, Diabetes and Metabolism, Fatebenefratelli Gemelli Isola Hospital, Rome, Italy
| | - Carla Lubrano
- Italian Obesity Society (SIO), Pisa, Italy
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Stefania Mariani
- Italian Obesity Society (SIO), Pisa, Italy
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Eleonora Poggiogalle
- Italian Obesity Society (SIO), Pisa, Italy
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Furia
- Directive Council of Order of Physicians and Dentists of the Province of Rome, Rome, Italy
- Local Health Authority Roma 1, Hospital Management Area, Rome, Italy
| | - Aurora Heidar Alizadeh
- Directive Council of Order of Physicians and Dentists of the Province of Rome, Rome, Italy
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Cristina Patrizi
- Directive Council of Order of Physicians and Dentists of the Province of Rome, Rome, Italy
| | - Martina Sapienza
- Directive Council of Order of Physicians and Dentists of the Province of Rome, Rome, Italy
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gianfranco Damiani
- Directive Council of Order of Physicians and Dentists of the Province of Rome, Rome, Italy
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario “A. Gemelli” Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Maria Grazia Tarsitano
- Directive Council of Order of Physicians and Dentists of the Province of Rome, Rome, Italy
- Department of Medical and Surgical Science, University Magna Grecia, Catanzaro, Italy
| | - Caterina Conte
- Italian Obesity Society (SIO), Pisa, Italy
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy
- Department of Endocrinology, Nutrition and Metabolic Diseases, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) MultiMedica, Sesto San Giovanni, Italy
| | - Simona Frontoni
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Italian Obesity Society (SIO), Pisa, Italy
- Unit of Endocrinology, Diabetes and Metabolism, Fatebenefratelli Gemelli Isola Hospital, Rome, Italy
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Hill B, Azzari Wynn-Jones A, Botting KJ, Cassinelli EH, Daly MP, Gardiner CV, Hanley SJ, Heslehurst N, Steegers-Theunissen R, Verbiest S, Skouteris H. The Challenge of Weight Stigma for Women in the Preconception Period: Workshop Recommendations for Action from the 5th European Conference on Preconception Health and Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7034. [PMID: 37998265 PMCID: PMC10671694 DOI: 10.3390/ijerph20227034] [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] [Received: 09/01/2023] [Revised: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 11/25/2023]
Abstract
Weight stigma is a well-recognised public health issue affecting many members of society including women during the preconception period. The impacts of preconception weight stigma on women are significant and may result in decreased access to and uptake of healthcare, and mental health concerns. The consequences of this weight stigma may translate to negative maternal outcomes and even intergenerational effects on the child. Eliminating weight stigma is therefore imperative. The aim of this paper is to report recommendations to reduce weight stigma for preconception women produced at a workshop with clinical and academic experts on preconception health and weight stigma at the 5th European Conference on Preconception Health and Care. The recommendations are related to two key areas: general societal recommendations prompting all people to acknowledge and adjust our attitudes towards larger-bodied people; and healthcare-specific recommendations imploring clinicians to upskill themselves to reduce weight stigma in practice. We therefore call for urgent approaches to address societal weight-stigmatising attitudes and norms related to both the general population and preconception women, while providing professional development opportunities for healthcare professionals relating to weight stigma. Eliminating weight stigma for preconception women may have positive impacts on the outcomes for mothers and children during pregnancy and beyond.
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Affiliation(s)
- Briony Hill
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne 3004, Australia
| | | | - Kimberley J. Botting
- Department of Maternal and Fetal Medicine, Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London WC1E 6HX, UK;
| | - Emma H. Cassinelli
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast BT12 6BA, UK;
| | - Michael P. Daly
- Centre for Public Health, Bristol Medical School, University of Bristol, Canynge Hall, Whatley Road, Bristol BS8 2PN, UK;
| | - Caitlin Victoria Gardiner
- Department of Global Health and Social Medicine, Bush House, Strand Campus, King’s College London, 40 Aldwych, London WC2B 4BG, UK;
- Developmental Pathways for Health Research Unit, University of the Witwatersrand Faculty of Health Sciences, Johannesburg 2000, Gauteng, South Africa
| | - Stephanie J. Hanley
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK;
| | - Nicola Heslehurst
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4AX, UK;
| | - Regine Steegers-Theunissen
- Department of Obstetrics and Gynaecology, and Department of and Pediatrics, Erasmus MC, University Medical Center, 3015 GD Rotterdam, The Netherlands;
| | - Sarah Verbiest
- School of Social Work, University of North Carolina at Chapel Hill, Pittsboro Road, Chapel Hill, NC 27599-3550, USA;
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne 3004, Australia
- Warwick Business School, University of Warwick, Scarman Rd, Coventry CV4 7AL, UK
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Steptoe A, Frank P. Obesity and psychological distress. Philos Trans R Soc Lond B Biol Sci 2023; 378:20220225. [PMID: 37661745 PMCID: PMC10475872 DOI: 10.1098/rstb.2022.0225] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/16/2023] [Indexed: 09/05/2023] Open
Abstract
The relationship between high body weight and mental health has been studied for several decades. Improvements in the quality of epidemiological, mechanistic and psychological research have brought greater consistency to our understanding of the links. Large-scale population-based epidemiological research has established that high body weight is associated with poorer mental health, particularly depression and subclinical depressive symptoms. There is some evidence for bidirectional relationships, but the most convincing findings are that greater body weight leads to psychological distress rather than the reverse. Particular symptoms of depression and distress may be specifically related to greater body weight. The psychological stress induced by weight stigma and discrimination contributes to psychological distress, and may in turn handicap efforts at weight control. Heightened systemic inflammation and dysregulation of the hypothalamic-pituitary-adrenal axis are biological mechanisms that mediate in part the relationship of greater body weight with poorer mental health. Changing negative societal attitudes to high body weights would improve the wellbeing of people living with obesity, and promote more effective weight-inclusive attitudes and behaviours in society at large, particularly in healthcare settings. This article is part of a discussion meeting issue 'Causes of obesity: theories, conjectures and evidence (Part II)'.
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Affiliation(s)
- Andrew Steptoe
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London WC1E BT, UK
| | - Philipp Frank
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E BT, UK
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Hughes AM, McArthur D. Weight stigma, welfare stigma, and political values: Evidence from a representative British survey. Soc Sci Med 2023; 334:116172. [PMID: 37696238 PMCID: PMC7615479 DOI: 10.1016/j.socscimed.2023.116172] [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: 06/13/2023] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 09/13/2023]
Abstract
Obesity-related stigma is increasingly recognised as a public health issue, with serious implications for mental and physical health. However, very little is known about what drives inter-individual differences in obesity-stigmatizing views, and how they are distributed in the population. If views about obesity are not independent of a person's wider beliefs and values, this must be understood so that obesity stigma can be effectively tackled. In a representative sample of British adults aged 18-97 (N = 2186), we explore predictors of weight-stigmatizing attitudes. We consider demographics, socioeconomic position, factors related to one's own weight and health, and beliefs about the causes and consequences of obesity. We explore the role of core political values which predict views about other stigmatized groups, and views about welfare recipients, who are frequently linked with obesity in public and political discourse. Finally, we assess to what extent demographic differences in weight-stigmatizing attitudes are explained by individual body mass index (BMI), attitudes, and beliefs. Consistent with previous studies, women were less weight-stigmatizing than men. People in late middle-age were less weight-stigmatizing than younger or older adults. Adjusted for age and gender, an index of weight-stigmatizing views was positively associated with income, and highest in intermediate categories of education and occupational social class. Weight-stigmatizing attitudes were associated with more right-wing values, more authoritarian values, and more stigmatizing views about welfare recipients. Factors including own BMI, beliefs about causes of obesity, welfare-stigmatizing attitudes and authoritarian values contributed to socioeconomic differences. Weight-stigmatizing attitudes show clear differences between demographic groups, but also vary according to wider social attitudes, beliefs, and a person's core political values. Efforts to reduce weight stigma, and other kinds of stigma, may be more effective if they recognise these links.
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Affiliation(s)
- Amanda M Hughes
- MRC Integrative Epidemiology Unit, Department of Population Health Sciences, University of Bristol, UK.
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Snowball JE, Flight WG, Heath L, Koutoukidis DA. A paradigm shift in cystic fibrosis nutritional care: Clinicians' views on the management of patients with overweight and obesity. J Cyst Fibros 2023; 22:836-842. [PMID: 36966039 DOI: 10.1016/j.jcf.2023.03.011] [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: 12/06/2022] [Revised: 03/13/2023] [Accepted: 03/15/2023] [Indexed: 03/27/2023]
Abstract
BACKGROUND Overweight and obesity among people with cystic fibrosis (pwCF) has become more prevalent since the widespread adoption of CF transmembrane conductance regulator (CFTR) modulator therapies and presents a new challenge for nutritional care. We aimed to explore how clinicians working in CF care approach the management of adults with overweight and obesity. METHODS We conducted semi-structured interviews with n = 20 clinicians (n = 6 physiotherapists, n = 6 doctors and n = 8 dietitians) working in 15 adult CF centres in the United Kingdom. The interviews explored their perspectives and current practices caring for people with CF and overweight/obesity. Data were analysed using reflexive thematic analysis. RESULTS Four main themes were identified: 1) challenges of raising the topic of overweight and obesity in the CF clinic (e.g., clinician-patient rapport and concerns around weight stigma); 2) the changing landscape of assessment due to CF-specific causes of weight gain: (e.g., impact of CFTR modulators and CF legacy diet) 3) presence of clinical equipoise for weight management due to the lack of CF-specific evidence on the consequences of obesity and intentional weight loss (e.g., unclear consequences on respiratory outcomes and risk of weight related co-morbidities) and 4) opportunities for a safe, effective, and acceptable weight management treatment for people with CF (e.g., working collaboratively with current multidisciplinary CF care). CONCLUSIONS Approaching weight management in the CF setting is complex. Trials are needed to assess the equipoise of weight management interventions in this group and CF-specific issues should be considered when developing such interventions.
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Affiliation(s)
- Joanna E Snowball
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, United Kingdom; Oxford Adult Cystic Fibrosis Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford, OX3 9DU, United Kingdom; NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom.
| | - William G Flight
- Oxford Adult Cystic Fibrosis Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford, OX3 9DU, United Kingdom
| | - Laura Heath
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, United Kingdom
| | - Dimitrios A Koutoukidis
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, United Kingdom; NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
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36
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Pigsborg K, Kalea AZ, De Dominicis S, Magkos F. Behavioral and Psychological Factors Affecting Weight Loss Success. Curr Obes Rep 2023; 12:223-230. [PMID: 37335395 DOI: 10.1007/s13679-023-00511-6] [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] [Accepted: 05/17/2023] [Indexed: 06/21/2023]
Abstract
PURPOSE OF REVIEW There is a large variability between individuals in the weight loss response to any given diet treatment, which fuels interest into personalized or precision nutrition. Although most efforts are directed toward identifying biological or metabolic factors, several behavioral and psychological factors can also be responsible for some of this interindividual variability. RECENT FINDINGS There are many factors that can influence the response to dietary weight loss interventions, including factors related to eating behavior (emotional eating, disinhibition, restraint, perceived stress), behaviors and societal norms related to age and sex, psychological and personal factors (motivation, self-efficacy, locus of control, self-concept), and major life events. The success of a weight loss intervention can be influenced by many psychological and behavioral constructs and not merely by physiological factors such as biology and genetics. These factors are difficult to capture accurately and are often overlooked. Future weight loss studies should consider assessing such factors to better understand the underlying reasons for the large interindividual variability to weight loss therapy.
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Affiliation(s)
- Kristina Pigsborg
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Rolighedsvej 26, 1958, Frederiksberg, Denmark.
| | - Anastasia Z Kalea
- Division of Medicine, University College London, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Stefano De Dominicis
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Rolighedsvej 26, 1958, Frederiksberg, Denmark
| | - Faidon Magkos
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Rolighedsvej 26, 1958, Frederiksberg, Denmark.
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Aguiar A, Önal F, Hendricks G, Blanchard L, Romanenko E, Fismen AS, Nwosu E, Herstad S, Savona N, Harbron J, Knai C, Samdal O, Rutter H, Lien N, Jalali MS, Kopainsky B. Understanding the dynamics emerging from the interplay among poor mental wellbeing, energy balance-related behaviors, and obesity prevalence in adolescents: A simulation-based study. Obes Rev 2023; 24 Suppl 2:e13628. [PMID: 37753604 DOI: 10.1111/obr.13628] [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: 04/04/2023] [Revised: 06/16/2023] [Accepted: 07/18/2023] [Indexed: 09/28/2023]
Abstract
Both obesity and poor mental wellbeing have a high prevalence in European youth. Adolescents in six countries identified mental wellbeing factors as main drivers of youth obesity through systems mapping. This study sought to (1) explore the dynamics of the interplay between poor mental wellbeing, energy balance-related behaviors, and adolescent overweight and obesity prevalence and (2) test the effect of intervention point scenarios to reduce adolescent obesity. Drawing on the youth-generated systems maps and a literature synthesis, we built a simulation model that represents the links from major feedback pathways for poor mental wellbeing to changes in dietary, physical activity, and sleep behaviors. The model was calibrated using survey data from Norway, expert input, and literature and shows a good fit between simulated behavior and available statistical data. The simulations indicate that adolescent mental wellbeing is harmed by socio-cultural pressures and stressors, which trigger reinforcing feedback mechanisms related to emotional/binge eating, lack of motivation to engage in physical activity, and sleep difficulty. Targeting a combination of intervention points that support a 25% reduction of pressure on body image and psychosocial stress showed potentially favorable effects on mental wellbeing-doubling on average for boys and girls and decreasing obesity prevalence by over 4%.
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Affiliation(s)
- Anaely Aguiar
- System Dynamics Group, Department of Geography, University of Bergen, Bergen, Norway
| | - Furkan Önal
- System Dynamics Group, Department of Geography, University of Bergen, Bergen, Norway
| | | | - Laurence Blanchard
- Faculty of Public Health Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Eduard Romanenko
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Anne-Siri Fismen
- Department of Health and Caring Services, Western Norway University of Applied Science, Bergen, Norway
| | - Emmanuel Nwosu
- Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Sondre Herstad
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Natalie Savona
- Faculty of Public Health Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Janetta Harbron
- Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Cécile Knai
- Faculty of Public Health Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Oddrun Samdal
- Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Harry Rutter
- Department of Social & Policy Sciences, University of Bath, Bath, UK
| | - Nanna Lien
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Mohammad S Jalali
- MGH Institute for Technology Assessment, Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - Birgit Kopainsky
- System Dynamics Group, Department of Geography, University of Bergen, Bergen, Norway
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Jovanovski N, Jaeger T, McDougall R, Keogh L. Gut feelings and lived experiences: a qualitative study of 'anti-diet' dietitians' and psychologists' motivations and experiences regarding the weight-neutral approach. HEALTH SOCIOLOGY REVIEW : THE JOURNAL OF THE HEALTH SECTION OF THE AUSTRALIAN SOCIOLOGICAL ASSOCIATION 2023:1-16. [PMID: 37642433 DOI: 10.1080/14461242.2023.2248080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 08/10/2023] [Indexed: 08/31/2023]
Abstract
This paper examines whether the motivations and experiences of 'anti-diet' dietitians and psychologists represent a paradigm shift in healthcare. We conducted four 2-hour, discipline-specific focus groups with a total of 16 female participants residing in Australia. Our reflexive thematic analysis generated four themes that we consider to be stages of a weight-neutral paradigm shift: (1) a recognition of a mismatch between one's weight-centred training and one's lived experience of diet culture, which subsequently informs (2) gut feelings that influence their decision to reject the weight-centric paradigm, thereby leading to (3) exploring the anti-diet knowledge base and then subsequently (4) promoting or advocating for the weight neutral paradigm. Our findings represent a four-stage paradigm shift in action; emphasising the significance of lived experience in the weight-neutral turn, as well as differences in symbolic power between health professionals. Future research should focus on potential ruptures or conflicts within the weight-neutral paradigm itself, and look more deeply into the experiences of other health professionals who are critical of the weight-centred approach.
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Affiliation(s)
- Natalie Jovanovski
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- School of Health and Biomedical Sciences, Royal Melbourne Institute of Technology, Building, Campus, VIC, Australia
| | - Tess Jaeger
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Rosalind McDougall
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Louise Keogh
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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Moore SG, Kundra A, Ho P, Bissell E, Apekey T. Feasibility of a Community Healthy Eating and Cooking Intervention Featuring Traditional African Caribbean Foods from Participant and Staff Perspectives. Nutrients 2023; 15:3758. [PMID: 37686789 PMCID: PMC10490513 DOI: 10.3390/nu15173758] [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: 07/14/2023] [Revised: 08/12/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
Culturally appropriate healthy eating resources are intended to help people from different ethnic backgrounds consume diets reflecting government dietary recommendations, yet evidence on use in the target groups is lacking. This study evaluated the feasibility of a new brief culturally appropriate community intervention that aimed to introduce food-based healthy eating and recipe resources featuring African Caribbean foods, which were recently co-developed with people from these ethnic backgrounds. Working with a community organization in the UK, a single-arm study was used to collect verbal data from participants and staff on the acceptability of intervention whilst knowledge, skills and behaviours related to healthy eating were evaluated using pre-, post- and follow-up questionnaires. A total of 30 participants were recruited, and 22 completed all three questionnaires; who were mostly female aged 55 years+ (n = 17) and of African Caribbean ethnicity (45%, n = 10), with 32% (n = 7) reporting no educational attainment. At post-intervention and follow-up, most participants reported high satisfaction (n = 21, 95%) with the intervention sessions and high levels of confidence in using the resources at home within budget. The number of participants who were familiar with the healthy eating guidance featuring Caribbean foods increased from pre- (36%, n = 8) to post-intervention/follow-up (n = 22, 100%) (p < 0.05). Findings suggest the intervention is feasible in a community setting and could help increase awareness and use of culturally appropriate healthy eating guidance amongst a diverse group.
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Affiliation(s)
- Sally G. Moore
- School of Food Science and Nutrition, University of Leeds, Leeds LS2 9JT, UK; (A.K.); (P.H.); (E.B.)
| | - Aashna Kundra
- School of Food Science and Nutrition, University of Leeds, Leeds LS2 9JT, UK; (A.K.); (P.H.); (E.B.)
| | - Peter Ho
- School of Food Science and Nutrition, University of Leeds, Leeds LS2 9JT, UK; (A.K.); (P.H.); (E.B.)
| | - Esther Bissell
- School of Food Science and Nutrition, University of Leeds, Leeds LS2 9JT, UK; (A.K.); (P.H.); (E.B.)
| | - Tanefa Apekey
- School of Health and Related Research, Sheffield S1 4DA, UK;
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40
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Dapre E. Are GLP-1 agonists the answer to our obesity epidemic? Br J Gen Pract 2023; 73:365. [PMID: 37500468 PMCID: PMC10405951 DOI: 10.3399/bjgp23x734589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Affiliation(s)
- Elizabeth Dapre
- Elizabeth is an academic GP registrar with an interest in diabetes, working in South Manchester.
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Dobbie LJ, Coelho C, Crane J, McGowan B. Clinical evaluation of patients living with obesity. Intern Emerg Med 2023; 18:1273-1285. [PMID: 37119384 PMCID: PMC10412477 DOI: 10.1007/s11739-023-03263-2] [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: 02/03/2023] [Accepted: 03/11/2023] [Indexed: 05/01/2023]
Abstract
Obesity is a significant public health concern which is implicated in cardiometabolic disease, mechanical complications and psychiatric sequelae. BMI is currently used for diagnosis; however, it has limited sensitivity for adiposity in certain circumstances. This has led to the development of risk stratification tools like the Edmonton Staging criteria and the Kings Obesity Staging Criteria: these facilitate and guide comprehensive obesity-related complication assessment. Healthcare professionals working within obesity clinics should adopt evidence-based communication strategies, including shared decision-making, motivational interviewing, and realistic goal setting. It is also vital to avoid weight-stigmatising terminology in all aspects of care, as this can negatively impact patients. Primary care plays an essential part in obesity care and should work to promptly identify cases, initiate treatment and forward on to specialist services where appropriate. Clinical evaluation of the patient living with obesity should take a holistic approach and involve input from bariatric physicians, dietitians, psychologists, and bariatric surgeons, wider members of the multi-disciplinary team should be involved where needed. Clinicians should take a detailed history, examination and order laboratory tests to investigate for complications. Overall, with appropriate evaluation, these assessments can guide patient management and facilitate long-term improvement in health.
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Affiliation(s)
| | | | - James Crane
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
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Branche O, Buscail C, Péneau S, Baudry J, Poitou C, Oppert JM, Czernichow S, Kesse-Guyot E, Touvier M, Julia C, Bellicha A. Correlates of Weight Bias in Adults From the NutriNet-Santé Study. Am J Prev Med 2023; 65:201-212. [PMID: 37479421 DOI: 10.1016/j.amepre.2023.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 02/03/2023] [Accepted: 02/04/2023] [Indexed: 07/23/2023]
Abstract
INTRODUCTION Explicit weight bias is an underlying cause of weight stigma, but its associations with individual characteristics are not well known. This study aimed to assess explicit weight bias in French adults and to explore the associations with weight status and sociodemographic characteristics. METHODS Adults from the NutriNet-Santé cross-sectional study (France, 2020, n=33,948, 52% women after weighting procedures) completed the Anti-Fat Attitudes Questionnaire assessing three dimensions: Dislike (antipathy toward people with obesity), Fear of fat (concerns about body weight), and Willpower (belief in weight controllability). Associations with weight status and sociodemographic characteristics were examined using multivariable ANCOVA models in 2022. RESULTS Fear of fat and Willpower scores were higher than Dislike scores (mean [SD]=4.0 [2.0], 3.3 [1.7] and 1.9 [1.3], respectively). Fear of fat was higher among women, whereas Dislike and Willpower were higher among men (all p<0.0001). Obesity was associated with greater Fear of fat scores (p<0.0001, mean difference versus normal-weight participants [95% CI]=0.35 [0.24, 0.46] in women, 0.36 [0.17, 0.56] in men), lower Dislike scores (-0.38 [-0.45, -0.32] in women, -0.43 [-0.56, -0.30] in men), and lower Willpower scores (-1.00 [-0.18, -0.90] in women, -0.40 [-0.57, -0.23] in men). In both genders, lower income was associated with lower Dislike, Fear of fat, and Willpower scores (all p<0.0001), and lower education was associated with greater Fear of fat and Willpower scores (all p<0.0001). CONCLUSIONS Explicit weight bias was driven by the fear of gaining weight and the belief in weight controllability. This study provides new insights into which population subgroups should be targeted by interventions aimed at reducing explicit weight bias.
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Affiliation(s)
- Olivia Branche
- Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center - University Paris Cité (CRESS), CNAM, INRAE U1125, Institut National de la Santé et de la Recherche Médicale (INSERM) U1153, Sorbonne Paris Nord University, Bobigny, France
| | - Camille Buscail
- Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center - University Paris Cité (CRESS), CNAM, INRAE U1125, Institut National de la Santé et de la Recherche Médicale (INSERM) U1153, Sorbonne Paris Nord University, Bobigny, France; Public Health Department, GHU Paris Seine-Saint-Denis, Assistance Publique-Hôpitaux de Paris (APHP), Bobigny, France
| | - Sandrine Péneau
- Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center - University Paris Cité (CRESS), CNAM, INRAE U1125, Institut National de la Santé et de la Recherche Médicale (INSERM) U1153, Sorbonne Paris Nord University, Bobigny, France
| | - Julia Baudry
- Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center - University Paris Cité (CRESS), CNAM, INRAE U1125, Institut National de la Santé et de la Recherche Médicale (INSERM) U1153, Sorbonne Paris Nord University, Bobigny, France
| | - Christine Poitou
- Department of Nutrition, Pitié-Salpetrière Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne University, CRNH-Ile de France, Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM), Nutrition and Obesities: Systemic Approaches (NutriOmics) Team, Sorbonne University, Paris, France
| | - Jean-Michel Oppert
- Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center - University Paris Cité (CRESS), CNAM, INRAE U1125, Institut National de la Santé et de la Recherche Médicale (INSERM) U1153, Sorbonne Paris Nord University, Bobigny, France; Department of Nutrition, Pitié-Salpetrière Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne University, CRNH-Ile de France, Paris, France
| | - Sébastien Czernichow
- Department of Nutrition, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris Cité, Paris, France
| | - Emmanuelle Kesse-Guyot
- Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center - University Paris Cité (CRESS), CNAM, INRAE U1125, Institut National de la Santé et de la Recherche Médicale (INSERM) U1153, Sorbonne Paris Nord University, Bobigny, France
| | - Mathilde Touvier
- Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center - University Paris Cité (CRESS), CNAM, INRAE U1125, Institut National de la Santé et de la Recherche Médicale (INSERM) U1153, Sorbonne Paris Nord University, Bobigny, France
| | - Chantal Julia
- Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center - University Paris Cité (CRESS), CNAM, INRAE U1125, Institut National de la Santé et de la Recherche Médicale (INSERM) U1153, Sorbonne Paris Nord University, Bobigny, France; Public Health Department, GHU Paris Seine-Saint-Denis, Assistance Publique-Hôpitaux de Paris (APHP), Bobigny, France
| | - Alice Bellicha
- Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center - University Paris Cité (CRESS), CNAM, INRAE U1125, Institut National de la Santé et de la Recherche Médicale (INSERM) U1153, Sorbonne Paris Nord University, Bobigny, France.
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43
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Schumacher LM, Ard J, Sarwer DB. Promise and unrealized potential: 10 years of the American Medical Association classifying obesity as a disease. Front Public Health 2023; 11:1205880. [PMID: 37521999 PMCID: PMC10375286 DOI: 10.3389/fpubh.2023.1205880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/30/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction In June 2013, the American Medical Association (AMA), one of the most influential healthcare organizations in the United States, voted to recognize obesity as a disease. Many who supported this change believed that recognition by AMA of obesity as a disease would serve as a tipping point that would increase access to care, accelerate training and research on the prevention and treatment of obesity, and reduce weight stigma. On the 10-year anniversary of this vote, this perspective piece outlines key advances made, as well as unrealized potential, in improving the obesity public health landscape since the AMA's classification of obesity as a disease. Methods We draw on the empirical literature, as well as our experiences as clinical psychologists, a physician, and public health researchers specializing in obesity, to provide an overview of major advances and continued challenges in improving access to obesity treatment, accelerating prevention and training, and reducing weight stigma. We also outline important next steps to advance these goals. Results While several notable advancements have occurred, significant work remains to create equitable access to evidence-based treatments, bring research and training on obesity on par with its prevalence, and reduce the pervasiveness and harm of weight stigma. Conclusion The past decade has witnessed some advances with respect to access to care and attention, yet there is unrealized potential that awaits attention. Truly conceptualizing and treating obesity as a chronic disease requires a major paradigm shift.
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Affiliation(s)
- Leah M. Schumacher
- Department of Kinesiology, College of Public Health, Temple University, Philadelphia, PA, United States
- Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, PA, United States
| | - Jamy Ard
- Department of General Surgery, Atrium Health Wake Forest Baptist, Weight Management Center, Winston-Salem, NC, United States
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - David B. Sarwer
- Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, PA, United States
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, United States
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Shepherd CB, Boswell RG, Genet J, Oliver-Pyatt W, Stockert C, Brumm R, Riebl S, Crowe E. Outcomes for binge eating disorder in a remote weight-inclusive treatment program: a case report. J Eat Disord 2023; 11:80. [PMID: 37218018 DOI: 10.1186/s40337-023-00804-0] [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: 02/28/2023] [Accepted: 05/07/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND There are no known published reports on outcomes for medically and psychiatrically compromised patients with binge eating disorder (BED) treated remotely in higher level of care settings. This case report presents outcomes of an intentionally remote weight-inclusive partial hospitalization and intensive outpatient program based on Health at Every Size® and intuitive eating principles. CASE PRESENTATION The patient presented with an extensive trauma background and long history of disturbed eating and body image. She was diagnosed with BED along with several comorbidities, most notably major depressive disorder with suicidality and non-insulin dependent diabetes mellitus. She completed a total of 186 days in the comprehensive, multidisciplinary treatment program encompassing individual and group therapy, as well as other supportive services such as meal support and in vivo exposure sessions. Upon discharge, her BED was in remission, her major depressive disorder was in partial remission, and she no longer exhibited signs of suicidality. Overall, she showed decreases in eating disorder, depressive, and anxiety symptoms as well as increases in quality of life and intuitive eating throughout treatment, which were largely maintained after one year. CONCLUSIONS This case highlights the potential of remote treatment as an option for individuals with BED, especially in cases where access to higher levels of care might be limited. These findings exemplify how a weight-inclusive approach can be effectively applied when working with this population.
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Affiliation(s)
- Caitlin B Shepherd
- Within Health, Coconut Grove, FL, USA.
- Department of Psychology, Smith College, Northampton, MA, USA.
| | - Rebecca G Boswell
- Princeton Center for Eating Disorders, Penn Medicine, Plainsboro, NJ, USA
- Department of Psychology, Princeton University, Princeton, NJ, USA
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Lister NB, Baur LA, Felix JF, Hill AJ, Marcus C, Reinehr T, Summerbell C, Wabitsch M. Child and adolescent obesity. Nat Rev Dis Primers 2023; 9:24. [PMID: 37202378 DOI: 10.1038/s41572-023-00435-4] [Citation(s) in RCA: 59] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/12/2023] [Indexed: 05/20/2023]
Abstract
The prevalence of child and adolescent obesity has plateaued at high levels in most high-income countries and is increasing in many low-income and middle-income countries. Obesity arises when a mix of genetic and epigenetic factors, behavioural risk patterns and broader environmental and sociocultural influences affect the two body weight regulation systems: energy homeostasis, including leptin and gastrointestinal tract signals, operating predominantly at an unconscious level, and cognitive-emotional control that is regulated by higher brain centres, operating at a conscious level. Health-related quality of life is reduced in those with obesity. Comorbidities of obesity, including type 2 diabetes mellitus, fatty liver disease and depression, are more likely in adolescents and in those with severe obesity. Treatment incorporates a respectful, stigma-free and family-based approach involving multiple components, and addresses dietary, physical activity, sedentary and sleep behaviours. In adolescents in particular, adjunctive therapies can be valuable, such as more intensive dietary therapies, pharmacotherapy and bariatric surgery. Prevention of obesity requires a whole-system approach and joined-up policy initiatives across government departments. Development and implementation of interventions to prevent paediatric obesity in children should focus on interventions that are feasible, effective and likely to reduce gaps in health inequalities.
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Affiliation(s)
- Natalie B Lister
- Children's Hospital Westmead Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Louise A Baur
- Children's Hospital Westmead Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
- Weight Management Services, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
| | - Janine F Felix
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Department of Paediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Andrew J Hill
- Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| | - Claude Marcus
- Division of Paediatrics, Department of Clinical Science Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Thomas Reinehr
- Vestische Hospital for Children and Adolescents Datteln, University of Witten/Herdecke, Datteln, Germany
| | - Carolyn Summerbell
- Department of Sport and Exercise Sciences, Durham University, Durham, UK
| | - Martin Wabitsch
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics and Adolescent Medicine, Ulm University Medical Centre, Ulm, Germany
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Winter VR, Hood A, Sorensen BL, Trout KE. Sexual and reproductive health cancer screening avoidance: The role of body image. Body Image 2023; 45:362-368. [PMID: 37084701 DOI: 10.1016/j.bodyim.2023.04.001] [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: 09/29/2022] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 04/23/2023]
Abstract
The current study examines the relationship of female genital self-image, weight-related cancer screening avoidance, and internalized weight stigma among cisgender women that can provide knowledge about avoidance of life-saving preventative healthcare. This cross-sectional survey included a convenience sample of 384 U.S. cisgender women who were 18+. The sample was primarily white (n = 260, 67.7 %) with a mean age of 33.18 years. 28.4 % reported avoiding a pap smear, 27.1 % avoided a clinical breast exam, and 29.4 % avoided a mammogram. Using multivariate logistic regressions, our results show high internalized weight stigma moderates the relationship of positive genital self-image on weight-related genital and breast cancer screening avoidance. Thus, the odds of avoiding screenings are positive, where the odds of avoidance slightly decreases from the interaction term as female genital body image increases. Interventions to improve female genital body image among cisgender women may lessen the effects of internalized weight stigma on avoiding reproductive cancer screenings. BMI was only a predictor for avoiding pap tests. Further examination is warranted because BMI and sexual health behaviors are not usually associated in body image research. Clinical workforce training is needed to educate providers about the harm of weight stigma and its relationship with healthcare avoidance.
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Affiliation(s)
- Virginia Ramseyer Winter
- University of Missouri, School of Social Work, Center for Body Image Research & Policy, 705 Clark Hall, Columbia, MO 65211, United States.
| | - Amanda Hood
- University of Missouri School of Social Work, United States
| | | | - Kate E Trout
- University of Missouri, School of Health Professions, Department of Health Sciences, United States
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47
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Godziuk K, Reeson EA, Harris AHS, Giori NJ. "I Often Feel Conflicted in Denying Surgery": Perspectives of Orthopaedic Surgeons on Body Mass Index Thresholds for Total Joint Arthroplasty: A Qualitative Study. J Bone Joint Surg Am 2023:00004623-990000000-00782. [PMID: 37071729 DOI: 10.2106/jbjs.22.01312] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
BACKGROUND Use of a patient body mass index (BMI) eligibility threshold for total joint arthroplasty (TJA) is controversial. A strict BMI criterion may reduce surgical complication rates, but over-restrict access to effective osteoarthritis (OA) treatment. Factors that influence orthopaedic surgeons' use of BMI thresholds are unknown. We aimed to identify and explore orthopaedic surgeons' perspectives regarding patient BMI eligibility thresholds for TJA. METHODS A cross-sectional, online qualitative survey was distributed to orthopaedic surgeons who conduct hip and/or knee TJA in the United States. Survey questions were open-ended, and responses were collected anonymously. Survey data were coded and analyzed in an iterative, systematic process to identify predominant themes. RESULTS Forty-five surveys were completed. Respondents were 54.3 ± 12.4 years old (range, 34 to 75 years), practiced in 22 states, and had 21.2 ± 13.3 years (range, 2 to 44 years) of surgical experience. Twelve factors influencing BMI threshold use by orthopaedic surgeons were identified: (1) evidence interpretation, (2) personal experiences, (3) difficulty of surgery, (4) professional ramifications, (5) ethics and biases, (6) health-system policies and performance metrics, (7) surgical capacity and resources, (8) patient body fat distribution, (9) patient self-advocacy, (10) control of decision-making in the clinical encounter, (11) expectations for demonstrated weight loss, and (12) research and innovation gaps. CONCLUSIONS Multilevel, complex factors underlie BMI threshold use for TJA eligibility. Addressing identified factors at the patient, surgeon, and health-system levels should be considered to optimally balance complication avoidance with improving access to life-enhancing surgery. CLINICAL RELEVANCE This study may influence how orthopaedic surgeons think about their own practices and how they approach patients and consider surgical eligibility.
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Affiliation(s)
- Kristine Godziuk
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
- Department of Orthopedic Surgery, School of Medicine, Stanford University, Stanford, California
| | | | - Alex H S Harris
- Department of Surgery, School of Medicine, Stanford University, Stanford, California
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California
| | - Nicholas J Giori
- Department of Orthopedic Surgery, School of Medicine, Stanford University, Stanford, California
- VA Palo Alto Health Care System, Palo Alto, California
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Muscogiuri G, Barrea L, Verde L, Docimo A, Savastano S, Di Pauli D, Colao A. Weight stigma speaks Italian, too. J Endocrinol Invest 2023; 46:787-794. [PMID: 36441505 PMCID: PMC10023597 DOI: 10.1007/s40618-022-01971-8] [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: 09/22/2022] [Accepted: 11/17/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Weight stigma is the negative weight related attitudes and beliefs towards individuals because of their overweight or obesity. Subjects with obesity are often victim of weight-related stigma resulting in a significant negative social consequence. As obesity epidemic is growing so fast, there is urgency to act on weight-stigma related social consequences being potentially serious and pervasive. This study investigated experiences, interpersonal sources, and context of weight stigma in Italy in a sample of adult subjects with obesity. METHODS An online questionnaire was distributed to respondents via a snowball sampling method among subjects with obesity belonging to Italian Associations for people living with obesity aged 18 years and above. RESULTS Four hundred and three respondents (47.18 ± 9.44 years; body mass index (BMI) 33.2 ± 8.48 kg/m2) participated to the study. Most respondents were females (94.8%). The age first dieted was 15.82 ± 7.12 years. The mean period of obesity was 27.49 ± 11.41 years. Frequency analyses reported that stigmatizing situations were experienced by 98% of participants: 94.82% during adulthood, 89.88% during adolescence and 75.39% during childhood. Verbal mistreatments (92.43%) was the most reported stigmatizing situation, strangers (92.43%) were the most common interpersonal sources of stigma and public settings (88.08%) were the most common location of stigma. CONCLUSIONS Identifying strategies acting on the identified weight stigma targets could contribute to reduce weight stigma and thus to result in important implications for obesity treatment in Italy.
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Affiliation(s)
- G Muscogiuri
- Dipartimento Di Medicina Clinica E Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, Via Sergio Pansini 5, 80131, Naples, Italy.
- Department of Clinical Medicine and Surgery, Endocrinology Unit, Centro Italiano Per La Cura E Il Benessere del Paziente Con Obesità (C.I.B.O), University Medical School of Naples, Via Sergio Pansini 5, 80131, Naples, Italy.
- Cattedra Unesco "Educazione Alla Salute E Allo Sviluppo Sostenibile", University Federico II, Naples, Italy.
| | - L Barrea
- Department of Clinical Medicine and Surgery, Endocrinology Unit, Centro Italiano Per La Cura E Il Benessere del Paziente Con Obesità (C.I.B.O), University Medical School of Naples, Via Sergio Pansini 5, 80131, Naples, Italy
- Dipartimento Di Scienze Umanistiche, Università Telematica Pegaso, Via Porzio, Centro Direzionale, Isola F2, 80143, Naples, Italy
| | - L Verde
- Department of Clinical Medicine and Surgery, Endocrinology Unit, Centro Italiano Per La Cura E Il Benessere del Paziente Con Obesità (C.I.B.O), University Medical School of Naples, Via Sergio Pansini 5, 80131, Naples, Italy
| | - A Docimo
- Dipartimento Di Medicina Clinica E Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, Via Sergio Pansini 5, 80131, Naples, Italy
| | - S Savastano
- Dipartimento Di Medicina Clinica E Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, Via Sergio Pansini 5, 80131, Naples, Italy
- Department of Clinical Medicine and Surgery, Endocrinology Unit, Centro Italiano Per La Cura E Il Benessere del Paziente Con Obesità (C.I.B.O), University Medical School of Naples, Via Sergio Pansini 5, 80131, Naples, Italy
| | | | - A Colao
- Dipartimento Di Medicina Clinica E Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, Via Sergio Pansini 5, 80131, Naples, Italy
- Department of Clinical Medicine and Surgery, Endocrinology Unit, Centro Italiano Per La Cura E Il Benessere del Paziente Con Obesità (C.I.B.O), University Medical School of Naples, Via Sergio Pansini 5, 80131, Naples, Italy
- Cattedra Unesco "Educazione Alla Salute E Allo Sviluppo Sostenibile", University Federico II, Naples, Italy
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Abstract
Lipoedema is an adipose tissue disorder almost exclusively affecting women. Evidence shows lipoedema is both poorly recognised and misdiagnosed which results in many women struggling to get a diagnosis and to gain access to specialist NHS services. This article aims to raise awareness of lipoedema and highlight the main role that community and primary care nurses can play in identifying this long-term condition earlier. It provides detail on the condition to help signpost, refer for diagnosis and initiate conservative management for those individuals with this challenging condition.
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Affiliation(s)
- Mary Warrilow
- Independent Nursing Consultant and Private Lymphoedema/Lipoedema Therapist; Nurse Consultant at LipoedemaUK; Queen's Nurse
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50
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Abbott S, Shuttlewood E, Flint S, Chesworth P, Parretti H. "Is it time to throw out the weighing scales?" Implicit weight bias among healthcare professionals working in bariatric surgery services and their attitude towards non-weight focused approaches. EClinicalMedicine 2023; 55:101770. [PMID: 36568685 PMCID: PMC9772809 DOI: 10.1016/j.eclinm.2022.101770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND People living with overweight or obesity (PLwO) can be stigmatised by healthcare professionals (HCPs). Reducing focus on weight is a proposed strategy to provide less threatening healthcare experiences. Given the lack of research on weight bias within obesity services, this study aimed to explore implicit bias among obesity specialist HCPs and explore views on non-weight focused approaches. METHODS Obesity specialist HCPs were invited to a webinar, "An exploration of non-weight focused approaches within bariatric services", held in October 2021. Implicit weight bias was examined using the BiasProof mobile device test, based on the Implicit Association Test. Poll data was analysed descriptively, and qualitative data was analysed using framework analysis. FINDINGS 82 of the 113 HCPs who attended the webinar consented to contribute data to the study. Over half (51%) had an implicit weight bias against PLwO. Most (90%) agreed/strongly agreed that obesity services are too weight focused and that patients should not be weighed at every appointment (86%). Perceived benefits of taking a non-weight focused approach included patient-led care, reducing stigma and supporting patient wellbeing, while perceived barriers included loss of objectivity, inducing risk and difficulty demonstrating effectiveness. INTERPRETATION Our findings indicate that half of obesity specialists HCPs in our sample of 82 providers, who are primarily dieticians and psychologists, have an implicit weight bias against PLwO. HCPs feel that a weight-focused approach within services was a barrier to patient care, but that there is a lack of alternative non-weight focused measures. Further research is needed into substitute outcome measures for clinical practice, also seeking the views of PLwO, and into interventions to address implicit weight bias. FUNDING Johnson & Johnson funded the BiasProof licence and publication open access charge.
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Affiliation(s)
- S. Abbott
- Department of Bariatric Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
- Research Centre for Intelligent Healthcare, Coventry University, Richard Crossman Building, Coventry CV1 5RW, UK
- Corresponding author. Research Centre for Intelligent Healthcare, Coventry University, Richard Crossman Building, Coventry CV1 5RW, UK.
| | - E. Shuttlewood
- Department of Bariatric Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - S.W. Flint
- School of Psychology, University of Leeds, Leeds, West Yorkshire, UK
- Scaled Insights, Nexus, University of Leeds, Leeds, West Yorkshire, UK
| | - P. Chesworth
- Patient Advocate, National Bariatric Surgery Register, UK
| | - H.M. Parretti
- Norwich Medical School, University of East Anglia, Norwich, Norfolk NR4 7TJ, UK
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