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Dimitrov Ulian M, Fernandez Unsain R, Rocha Franco R, Aurélio Santo M, Brewis A, Trainer S, SturtzSreetharan C, Wutich A, Gualano B, Baeza Scagliusi F. Weight stigma after bariatric surgery: A qualitative study with Brazilian women. PLoS One 2023; 18:e0287822. [PMID: 37498887 PMCID: PMC10374044 DOI: 10.1371/journal.pone.0287822] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 06/13/2023] [Indexed: 07/29/2023] Open
Abstract
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.
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Affiliation(s)
- Mariana Dimitrov Ulian
- Departamento de Nutrição, Faculdade de Saúde Pública da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Ramiro Fernandez Unsain
- Departamento de Nutrição, Faculdade de Saúde Pública da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Ruth Rocha Franco
- Unidade de Endocrinologia Pediátrica do Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Marco Aurélio Santo
- Divisão de Cirurgia do Aparelho Digestivo, Unidade de Cirurgia Bariátrica e Metabólica, São Paulo, SP, Brasil
| | - Alexandra Brewis
- School of Human Evolution and Social Change, Arizona State University, Tempe, AZ, United States of America
| | - Sarah Trainer
- School of Human Evolution and Social Change, Arizona State University, Tempe, AZ, United States of America
| | - Cindi SturtzSreetharan
- School of Human Evolution and Social Change, Arizona State University, Tempe, AZ, United States of America
| | - Amber Wutich
- School of Human Evolution and Social Change, Arizona State University, Tempe, AZ, United States of America
| | - Bruno Gualano
- Grupo de Pesquisa em Fisiologia Aplicada e Nutrição, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Fernanda Baeza Scagliusi
- Departamento de Nutrição, Faculdade de Saúde Pública da Universidade de São Paulo, São Paulo, SP, Brasil
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Sobczak K, Leoniuk K, Rudnik A. Experience of Polish Patients with Obesity in Contacts with Medical Professionals. Patient Prefer Adherence 2020; 14:1683-1688. [PMID: 33061311 PMCID: PMC7519823 DOI: 10.2147/ppa.s270704] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 08/22/2020] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Discrimination and stigmatization of patients with obesity are a commonly occurring social problem. The purpose of our research was to analyze the scale of the experience including medical staff's improper behaviours towards patients with obesity in Poland. PATIENTS AND METHODS In a completed national study, we studied the statements of 621 adult patients who suffer from obesity. An original closed question survey was used as a tool to collect the data. Patients were informed about the possibility to participate in the study through social media, medical institutions and patient foundations. RESULTS As many as 82.6% have experienced improper behaviours. Usually, it came from doctors (90%), nurses and midwives (51%), people who operated medical equipment (24%), nutritionists (14%) and paramedics (9%). Exactly 81% of the respondents pointed to unpleasant and judgmental comments as the most frequent form of improper behaviour which they have encountered mainly during diagnostic tests, palpation or procedures. CONCLUSION There is an urgent need for developing national strategies connected with care for individuals with higher body weight. Introducing dedicated solutions in this field may contribute to increasing the quality of health care and reducing stigmatizing behaviours.
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Affiliation(s)
- Krzysztof Sobczak
- Department of Sociology of Medicine & Social Pathology, Medical University of Gdansk, Gdansk, Poland
- Correspondence: Krzysztof Sobczak Email
| | - Katarzyna Leoniuk
- Department of Sociology of Medicine & Social Pathology, Medical University of Gdansk, Gdansk, Poland
| | - Agata Rudnik
- Institute of Psychology, University of Gdansk, Gdansk, Poland
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Scribani M, Norberg M, Lindvall K, Weinehall L, Sorensen J, Jenkins P. Sex-specific associations between body mass index and death before life expectancy: a comparative study from the USA and Sweden. Glob Health Action 2019; 12:1580973. [PMID: 30947624 PMCID: PMC6461107 DOI: 10.1080/16549716.2019.1580973] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Understanding the impact of obesity on premature mortality is critical, as obesity has become a global health issue. OBJECTIVE To contrast the relationship between body mass index (BMI) and premature death (all-cause; circulatory causes) in New York State (USA) and Northern Sweden. METHODS Baseline data were obtained between 1989 and 1999 via questionnaires (USA) and health exams (Sweden), with mortality data from health departments, public sources (USA) and the Swedish Death Register. Premature death was death before life expectancy based on sex and year of birth. Within country and sex, time to premature death was compared across BMI groups (18.5-24.9 kg/m2 (reference), 25-29.9 kg/m2, 30.0-34.9 kg/m2, ≥35.0 kg/m2) using Proportional Hazards regression. Absolute risk (deaths/100,000 person-years) was compared for the same stratifications among nonsmokers. RESULTS 60,600 Swedish (47.8% male) and 31,198 US subjects (47.7% male) were included. Swedish males with BMI≥30 had increased hazards (HR) of all-cause premature death relative to BMI 18.5-24.9 (BMI 30-34.9, HR = 1.71 (95% CI: 1.44, 2.02); BMI≥35, HR = 2.89 (2.16, 3.88)). BMI≥25 had increased hazards of premature circulatory death (BMI 25-29.9, HR = 1.66 (1.32, 2.08); BMI 30-34.9, HR = 3.02 (2.26, 4.03); BMI≥35, HR = 4.91 (3.05, 7.90)). Among US males, only BMI≥35 had increased hazards of all-cause death (HR = 1.63 (1.25, 2.14)), while BMI 30-34.9 (HR = 1.83 (1.20, 2.79)) and BMI≥35 (HR = 3.18 (1.96, 5.15)) had increased hazards for circulatory death. Swedish females showed elevated hazards with BMI≥30 for all-cause (BMI 30-34.9, HR = 1.42 (1.18, 1.71) and BMI≥35, HR = 1.61 (1.21, 2.15) and with BMI≥35 (HR = 3.11 (1.72, 5.63)) for circulatory death. For US women, increased hazards were observed among BMI≥35 (HR = 2.10 (1.60, 2.76) for all-cause and circulatory HR = 3.04 (1.75, 5.30)). Swedish males with BMI≥35 had the highest absolute risk of premature death (762/100,000 person-years). CONCLUSIONS This study demonstrates a markedly increased risk of premature death associated with increasing BMI among Swedish males, a pattern not duplicated among females.
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Affiliation(s)
- Melissa Scribani
- a Bassett Healthcare Network, Bassett Research Institute , Cooperstown , NY , USA.,b Epidemiology and Global Health, Department of Public Health and Clinical Medicine , Umeå University , Umeå , Sweden
| | - Margareta Norberg
- b Epidemiology and Global Health, Department of Public Health and Clinical Medicine , Umeå University , Umeå , Sweden
| | - Kristina Lindvall
- b Epidemiology and Global Health, Department of Public Health and Clinical Medicine , Umeå University , Umeå , Sweden
| | - Lars Weinehall
- b Epidemiology and Global Health, Department of Public Health and Clinical Medicine , Umeå University , Umeå , Sweden
| | - Julie Sorensen
- a Bassett Healthcare Network, Bassett Research Institute , Cooperstown , NY , USA
| | - Paul Jenkins
- a Bassett Healthcare Network, Bassett Research Institute , Cooperstown , NY , USA
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Abstract
Aim: The purpose of this scoping review was to explore the evidence on how perceptions and/or experiences of weight bias in primary health care influence engagement with and utilization of health care services by individuals with obesity. Background: Prior studies have found discrepancies in the use of health care services by individuals living with obesity; a greater body mass index has been associated with decreased health care utilization, and weight bias has been identified as a major barrier to engagement with health services. Methods: PubMed was searched from January 2000 to July 2017. Four reviewers independently selected 21 studies examining perceptions of weight bias and its impact on engagement with primary health care services. Findings: A thematic analysis was conducted on the 21 studies that were included in this scoping review. The following 10 themes were identified: contemptuous, patronizing, and disrespectful treatment, lack of training, ambivalence, attribution of all health issues to excess weight, assumptions about weight gain, barriers to health care utilization, expectation of differential health care treatment, low trust and poor communication, avoidance or delay of health services, and ‘doctor shopping’. Overall, our scoping review reveals how perceptions and/or experiences of weight bias from primary care health professionals negatively influence patient engagement with primary health care services.
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Fang V, Gillespie C, Crowe R, Popeo D, Jay M. Associations between medical students' beliefs about obesity and clinical counseling proficiency. BMC OBESITY 2019; 6:5. [PMID: 30766687 PMCID: PMC6360739 DOI: 10.1186/s40608-018-0222-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 12/12/2018] [Indexed: 12/19/2022]
Abstract
Background Despite evidence that biological and genetic factors contribute strongly to obesity, many healthcare providers still attribute obesity more to controllable behavioral issues rather than factors outside a person’s control. We evaluated whether medical school students’ beliefs about obesity correlate with ability to effectively counsel patients with obesity. Methods Clerkship-year medical students at NYU School of Medicine completed an Objective Structured Clinical Experience (OSCE) that tests ability to effectively counsel standardized actor-patients with obesity. We surveyed these students to evaluate their beliefs about the causes of obesity and their attitudes towards people with obesity. We analyzed correlations between student beliefs, negative obesity attitudes, and OSCE performance. Results The response rate was 60.7% (n = 71). When asked to rate the importance of individual factors, students rated controllable factors such as unhealthy diet, physical inactivity, and overeating as more important than genetics or biological factors (p < 0.01). Believing obesity is caused by uncontrollable factors was negatively correlated with obesity bias (r = − 0.447; p < 0.0001). Believing that obesity is caused by factors within a person’s control was negatively correlated with counseling skills (r = − 0.235; p < 0.05). Conclusions Attribution of obesity to external factors correlated with greater ability to counsel patients with obesity, suggesting that educating providers on the biological causes of obesity could help reduce bias and improve provider care.
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Affiliation(s)
- Victoria Fang
- 1Department of Medicine, New York University School of Medicine, New York, NY USA
| | - Colleen Gillespie
- 1Department of Medicine, New York University School of Medicine, New York, NY USA
| | - Ruth Crowe
- 1Department of Medicine, New York University School of Medicine, New York, NY USA
| | - Dennis Popeo
- 2Department of Psychiatry, New York University School of Medicine, New York, NY USA
| | - Melanie Jay
- 3Departments of Medicine and Population Health, New York University School of Medicine, New York, NY USA.,New York Harbor Veterans Health Affairs, New York, NY USA
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Bernardo CDO, Bastos JL, González-Chica DA, Peres MA, Paradies YC. Interpersonal discrimination and markers of adiposity in longitudinal studies: a systematic review. Obes Rev 2017; 18:1040-1049. [PMID: 28569010 DOI: 10.1111/obr.12564] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 04/16/2017] [Accepted: 04/25/2017] [Indexed: 01/02/2023]
Abstract
While the impact of interpersonal discrimination on mental health is well established, its effects on physical health outcomes have not been fully elucidated. This study systematically reviewed the literature on the prospective association between interpersonal discrimination and markers of adiposity. Medline, Web of Science, Scopus, PsycInfo, SciELO, LILACS, Google Scholar, Capes/Brazil and ProQuest databases were used to retrieve relevant information in November 2016. The results from the 10 studies that met the inclusion criteria support an association between interpersonal self-reported discrimination and the outcomes. In general, the most consistent findings were for weight and body mass index (BMI) among women, i.e. high levels of self-reported discrimination were related to increased weight and BMI. Waist circumference (WC) showed a similar pattern of association with discrimination, in a positive direction, but an inverted U-shaped association was also found. Despite a few inverse associations between discrimination and markers of adiposity, none of the associations were statistically significant. Overall, markers of adiposity were consistently associated with discrimination, mainly through direct and nonlinear associations. This review provides evidence that self-reported discrimination can play an important role in weight, BMI and WC changes.
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Affiliation(s)
- C de O Bernardo
- Post-Graduate Program in Public Health, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - J L Bastos
- Post-Graduate Program in Public Health, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - D A González-Chica
- Discipline of General Practice, School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - M A Peres
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Y C Paradies
- Alfred Deakin Institute for Citizenship and Globalisation, Deakin University, Melbourne, Victoria, Australia
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Racial and ethnic minority patients report different weight-related care experiences than non-Hispanic Whites. Prev Med Rep 2016; 4:296-302. [PMID: 27486558 PMCID: PMC4960010 DOI: 10.1016/j.pmedr.2016.06.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 06/14/2016] [Accepted: 06/27/2016] [Indexed: 01/25/2023] Open
Abstract
Our objective was to compare patients' health care experiences, related to their weight, across racial and ethnic groups. In Summer 2015, we distributed a written survey with telephone follow-up to a random sample of 5400 racially/ethnically and geographically diverse U.S. adult health plan members with overweight or obesity. The survey assessed members' perceptions of their weight-related healthcare experiences, including their perception of their primary care provider, and the type of weight management services they had been offered, or were interested in. We used multivariable multinomial logistic regression to examine the relationship between race/ethnicity and responses to questions about care experience. Overall, 2811 members (53%) responded to the survey and we included 2725 with complete data in the analysis. Mean age was 52.7 years (SD 15.0), with 61.7% female and 48.3% from minority racial/ethnic groups. Mean BMI was 37.1 kg/m2 (SD 8.0). Most (68.2%) respondents reported having previous discussions of weight with their provider, but interest in such counseling varied by race/ethnicity. Non-Hispanic blacks were significantly less likely to frequently avoid care (for fear of discussing weight/being weighed) than whites (OR 0.49, 95% CI 0.26–0.90). Relative to whites, respondents of other race/ethnicities were more likely to want weight-related discussions with their providers. Race/ethnicity correlates with patients' perception of discussions of weight in healthcare encounters. Clinicians should capitalize on opportunities to discuss weight loss with high-risk minority patients who may desire these conversations. Minority patients may desire more information about weight management. Non-Hispanic whites may be more likely to avoid care due to fear of weight bias. Clinicians could conduct more sensitive weight loss discussions with all patients.
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Ferrante JM, Seaman K, Bator A, Ohman-Strickland P, Gundersen D, Clemow L, Puhl R. Impact of Perceived Weight Stigma among Underserved Women on Doctor-Patient Relationships. Obes Sci Pract 2016; 2:128-135. [PMID: 27293804 PMCID: PMC4902272 DOI: 10.1002/osp4.40] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objective The aim of this study was to evaluate how perception of weight stigma among underserved women with obesity impacts doctor–patient relationships. Methods This study consisted of an interviewer‐administered survey of 149 women with obesity (body mass index (BMI) > 30 kg m−2) immediately after their physician visit at four Federally Qualified Health Centers. Perceptions of weight stigma and physician empathy were measured using the Stigma Situations in Health Care instrument and Consultation and Relational Empathy (CARE) measure, respectively. Associations of CARE and Stigma scores with BMI and patient characteristics were analysed using Mantel–Haenszel chi‐squared test and ordinal logistic regression. Results The mean CARE score was 42.1 (standard deviation 8.4; range 11.0–50.0), and mean stigma score was 4.6 (standard deviation 7.6; range 0–43.0). Each increase in BMI category was associated with almost twofold increased odds of higher perception of stigma (odds ratio, 1.90, 95% confidence interval 1.30–2.78, P = 0.001). BMI was not associated with CARE. However, for each increase in stigma category, the odds of lower CARE score doubled (odds ratio, 0.52, 95% confidence interval 0.36–0.75, P = 0.0005). Conclusions While BMI was not associated with perception of physician empathy, higher frequency of weight stigmatizing situations was negatively associated with perception of physician empathy. Reducing weight stigma in primary care could improve doctor–patient relationships and quality of care in patients with obesity.
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Affiliation(s)
- Jeanne M Ferrante
- Department of Family Medicine and Community Health, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA; Rutgers-Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - KelliAnn Seaman
- Preliminary Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Alicja Bator
- Department of Family Medicine and Community Health, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Pamela Ohman-Strickland
- Department of Family Medicine and Community Health, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA; Rutgers-Cancer Institute of New Jersey, New Brunswick, New Jersey, USA; Department of Biostatistics, Rutgers-School of Public Health, Piscataway, New Jersey, USA
| | - Daniel Gundersen
- Department of Family Medicine and Community Health, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA; Rutgers-Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Lynn Clemow
- Department of Family Medicine and Community Health, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Rebecca Puhl
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, Connecticut, USA
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Rodolpho JRC, Hoga LAK, Reis-Queiroz J, Jamas MT. Experiences and daily life attitudes of women with severe mental disorders: integrative review of associated factors. Arch Psychiatr Nurs 2015; 29:223-35. [PMID: 26165977 DOI: 10.1016/j.apnu.2015.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 03/10/2015] [Accepted: 03/21/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objective is to identify the factors that influence the experiences and daily life attitudes of women with severe mental disorders (SMD). METHOD A search for studies published from 2000 to 2014 was conducted in electronic databases. All relevant primary studies were screened using integrative methods. Findings were synthesized thereafter. RESULTS Fifteen articles were included. A total of 21 factors were identified as being associated with experiences and daily life attitudes of women with SMD. These factors consisted of the following five categories: strengths and limitations regarding self-care behavior and healthcare delivery, unmet healthcare needs, psychosocial vulnerabilities underlying SMD, gains and challenges of motherhood, and adoption of coping strategies. CONCLUSIONS Healthcare providers can greatly contribute to improving the quality of healthcare for women with SMD, but several barriers need to be overcome.
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Affiliation(s)
| | | | - Jéssica Reis-Queiroz
- University of São Paulo, School of Nursing, Cerqueira Cesar, São Paulo, SP, Brazil.
| | - Milena Temer Jamas
- São Paulo State University, Faculty of Medicine of Botucatu, Department of Nursing.
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Abstract
Despite decades of research documenting consistent stigma and discrimination against individuals with obesity, weight stigma is rarely considered in obesity prevention and treatment efforts. In recent years, evidence has examined weight stigmatization as a unique contributor to negative health outcomes and behaviors that can promote and exacerbate obesity. This review summarizes findings from published studies within the past 4 years examining the relationship between weight stigma and maladaptive eating behaviors (binge eating and increased food consumption), physical activity, weight status (weight gain and loss and development of obesity), and physiological stress responses. Research evaluating the effects of weight stigma present in obesity-related public health campaigns is also highlighted. Evidence collectively demonstrates negative implications of stigmatization for weight-related health correlates and behaviors and suggests that addressing weight stigma in obesity prevention and treatment is warranted. Key questions for future research to further delineate the health effects of weight stigmatization are summarized.
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Affiliation(s)
- Rebecca Puhl
- Rudd Center for Food Policy and Obesity, University of Connecticut, One Constitution Plaza, Suite 600, Hartford, CT, 06103, USA.
| | - Young Suh
- Rudd Center for Food Policy and Obesity, University of Connecticut, One Constitution Plaza, Suite 600, Hartford, CT, 06103, USA.
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