Stigmatisation of a formerly obese young female

Associations between marital status and weight loss trajectories entering into early adulthood: a Teen-LABS study

BACKGROUND

Among adolescents who underwent metabolic and bariatric surgery (MBS), it is unclear how relationships and specifically marital status (MS) may be associated with long-term weight loss.

OBJECTIVE

In this analysis, we tested for associations between the MS of adolescents who underwent MBS and the MS of their primary caregiver and weight loss trajectory over 8 years.

SETTING

Teen-LABS participating sites.

METHODS

This sample included 231 participants (75.3% female, 71.4% White, 68.0% Roux-en-Y gastric bypass, 27.7% vertical sleeve gastrectomy, 4.3% laparoscopic adjustable gastric band). A linear mixed model was conducted with the dependent variable percent body mass index (BMI) change from preoperatively through 8 years with between-participant factors (1) participant MS, (2) caregiver MS, and (3) interaction between caregiver and participant MS.

RESULTS

One third of participants and 87% of caregivers were ever married (EM). Compared with never-married (NM) participants and caregivers (-14.6%), EM participants and caregivers (-20.6%), EM participants and NM caregivers (-25.9%), and NM participants and EM caregivers (-19.8%), each had significantly greater BMI loss at 8 years (each P < .05). No other group comparisons achieved statistical significance.

CONCLUSIONS

NM participants with NM caregivers had less favorable long-term BMI. Additional research is needed to better understand how relationships affect behavior change and weight loss after MBS.

The psychological legacy of past obesity and early mortality: evidence from two longitudinal studies

BACKGROUND

We test a novel 'weight scarring' hypothesis which suggests that past obesity is associated with impairments in current psychological well-being and this increases risk of negative physical health outcomes associated with obesity. Across two nationally representative studies, we tested whether past obesity is associated with current psychological outcomes and whether these psychological outcomes explain the association between past obesity and subsequent early mortality.

METHODS

Data were from the National Health and Nutrition Examination Survey (NHANES) (n = 29,047) and the Health and Retirement Study (HRS) (n = 11,998). Past obesity was defined based on maximum lifetime weight in NHANES and the highest weight from past study waves in the HRS. Across both studies, current depressive symptoms were analysed. A set of 10 additional well-being measures were combined to produce an 'index of impaired well-being' in HRS. Subsequent all-cause mortality was examined using National Deaths Index records in NHANES and household interviews in HRS. Linear or logistic regression, Cox proportional hazard regression, and causal mediation models were used.

RESULTS

We found that past obesity was associated with greater current depressive symptoms after controlling for current weight status and in analyses limited to those who were no longer classified as having obesity in NHANES (β = 0.17; 95% CI: 0.13, 0.22) and HRS (β = 0.20; 95% CI: 0.08, 0.31). In HRS, past obesity was also associated with a range of current negative psychological outcomes, including an index of impaired psychological well-being (β = 0.16; 95% CI: 0.05, 0.27). Past obesity was associated with a higher risk of early mortality in both NHANES and HRS (HR = 1.31; 95% CI: 1.16, 1.48 and HR = 1.34; 95% CI: 1.20, 1.50, respectively). Depressive symptoms explained 6% (95% CI: 0.01, 0.10) and 5% (95% CI: 0.01, 0.09) of the association between past obesity and premature mortality in NHANES and HRS, respectively. Impaired psychological well-being partly mediated the association between past obesity and premature mortality by 10% (95% CI: 0.04, 0.16) in HRS.

CONCLUSIONS

Our findings suggest that there may be a psychological legacy of past obesity that is associated with raised mortality risk. Ensuring people with obesity receive psychological support even after experiencing weight loss may be important.

Weight stigma after bariatric surgery: A qualitative study with Brazilian women

Prior studies suggest that one anticipated benefit of bariatric surgery is the achievement of a thinner body, one that is less subject to perceived negative judgment and condemnation by others. However, additional analyses also indicate that stigma may persist even with significant post-surgery weight loss. To investigate the stigma-related perceptions and experiences of women who have undergone bariatric surgery and the resulting body transformations, we conducted individual, semi-structured interviews with thirty Brazilian women (15 aged 33-59 and 15 aged 63-72). The resulting text was then analyzed using thematic analysis. We found that some form of weight stigma persisted for our participants, regardless of weight loss. Ongoing experiences of stigma were also evidenced by the constant internal and external vigilance reported by the women, as well as their articulated efforts to distance themselves from their previous bodies. Additionally, participants reported being judged for choosing an "easy way out" to lose weight. Those in the older group reported that weight stigma was entangled with ageism: older participants received mixed messages underscoring the ways that weight and age may interact in doubly stigmatizing ways. Family and close peers were especially powerful sources of stigma experiences. Collectively, these results show that weight stigma persists even when people undergo a procedure to lose substantive weight and that the degree and types of stigma experiences are influenced by gender and age. Our study suggest future research should explore whether a targeted approach might be more effective, for example, an approach that would emphasize the importance of developing coping strategies with respect to experiences of stigma and discrimination after surgery.

Weight Bias Among Nutrition and Dietetics Students in a Ghanaian Public University

OBJECTIVES

To measure the internal consistency reliability of 3 weight bias scales among nutrition and dietetics students enrolled at a public university in Ghana and to use the Fat Phobia Scale (FPS) to determine the prevalence of weight bias and the differences in gender and body mass index.

DESIGN

Online survey gathered self-reported height, weight, and demographic data. Explicit weight bias was assessed using validated FPS, Beliefs About Obese People, and Attitudes Toward Obese Persons scales.

PARTICIPANTS

Sample of 172 students.

MAIN OUTCOME MEASURES

Prevalence of weight bias.

ANALYSIS

Cronbach α reliability test was used to measure the internal consistency of scales. The prevalence of weight bias was expressed as a percentage. Independent t tests and analysis of variance were used to explore differences in gender and weight categories.

RESULTS

The reliability scores for FPS, Beliefs About Obese People, and Attitudes Toward Obese Persons scales were 0.92, 0.51, and 0.38, respectively. About 53% of participants expressed weight bias. A significant difference was observed for weight bias between overweight and obese participants, with participants with obesity showing greater weight bias (P = 0.03).

CONCLUSION AND IMPLICATIONS

Fat Phobia Scale (most reliable) identified more than half of the students had a negative attitude toward obesity. Weight bias training within this population may improve attitudes toward obesity.

Elective surgery to save my life: rethinking the "choice" in bariatric surgery

AIMS

The aim of this study was to explicate the processes by which a patient's choice to undergo bariatric surgery is made to feel like a medical necessity, to explore the ways widespread societal stigmatization of weight and bariatric surgery shapes patient and provider discourse about surgery and to discuss patient rationalizations of the choice to have surgery.

BACKGROUND

Severe obesity is currently highly stigmatized. Bariatric surgery has become an increasingly used option for individuals seeking to lose drastic amounts of weight. The surgery itself, however, remains stigmatized across many diverse settings.

DESIGN

This research design is centred on an ethnographic study of bariatric surgery patients who undergo surgery at a particular bariatric clinic in the American Southwest.

METHODS

Data collection included repeated ethnographic interviews with 35 individuals enrolled in the bariatric programme over the past 5 years. The interviews were supplemented by extensive participant observation, starting in 2014 to date. Thematic analysis of fieldnotes and transcribed interviews followed.

RESULTS

People who have bariatric surgery for weight-loss may trade one type of stigma for another. Thus, individuals who qualify for bariatric surgery based on weight alone may be reluctant to explore the surgery as a viable option. This research also shows that younger women are more likely to face the effects of weight-related stigma, which has an impact on their motivations for undergoing bariatric surgery.

CONCLUSION

Stigma - both weight-related and surgery-related - needs to be addressed at a larger level, in terms of policy and in clinical bariatric programmes.

How Formerly Overweight and Obese Individuals Negotiate Disclosure of Their Weight Loss

Overweight and obese individuals frequently experience weight-based stigma, and reducing stigma is one reason people want to lose weight. However, research suggests even after individuals become a normal weight, knowledge of their old body size can result in stigma. Through interviews of 30 formerly overweight or obese individuals and the framework of Communication Privacy Management theory, this study found the vast majority of participants perceived more benefits from disclosing their larger identity than risks, regardless of weight-loss method. Participants revealed their weight loss in order to inspire others, build relationships, or hold themselves accountable. Conversely, a few participants concealed to protect their thinner identity (i.e., they feared stigma) or to avoid coming across as boastful. In contrast to previous studies, this investigation suggests most participants were not dissuaded from revealing their former body size due to a threat of residual stigma. Participants' disclosure was overwhelmingly met with encouraging and supportive responses.