The role of the fatosphere in fat adults' responses to obesity stigma: a model of empowerment without a focus on weight loss

Bio-citizens online: A content analysis of pro-ana and weight loss blogs

Current neoliberal ideology in Western society encourages individuals to self-monitor their body to control population health. The resulting self-surveillance includes weight management, promoted as a marker of health. Disordered eating, like anorexia, is framed as a health disorder. However, weight loss is framed as a health initiative; we argue that these framings are engaging with the same body project, encouraging thinness as a marker of health and good bio-citizenry. Using content analysis to compare online blog context created by individuals engaged in weight loss and individuals who identify as pro-anorexia, we argue and evidence that both groups are engaged in body projects with shared parameters. Findings suggest each group is striving to embody a thin ideal through weight management. Specifically, weight loss bloggers and pro-ana bloggers demonstrate similar diet and exercise behaviours in online diaries detailing their weight loss experiences. Thus, weight loss and anorexia exist on the same spectrum of responsible bio-citizenry.

Obesity Stigma: Causes, Consequences, and Potential Solutions

PURPOSE OF REVIEW

This review aims to examine (i) the aetiology of obesity; (ii) how and why a perception of personal responsibility for obesity so dominantly frames this condition and how this mindset leads to stigma; (iii) the consequences of obesity stigma for people living with obesity, and for the public support for interventions to prevent and manage this condition; and (iv) potential strategies to diminish our focus on personal responsibility for the development of obesity, to enable a reduction of obesity stigma, and to move towards effective interventions to prevent and manage obesity within the population.

RECENT FINDINGS

We summarise literature which shows that obesity stems from a complex interplay of genetic and environment factors most of which are outside an individual's control. Despite this, evidence of obesity stigmatisation remains abundant throughout areas of media, entertainment, social media and the internet, advertising, news outlets, and the political and public health landscape. This has damaging consequences including psychological, physical, and socioeconomic harm. Obesity stigma does not prevent obesity. A combined, concerted, and sustained effort from multiple stakeholders and key decision-makers within society is required to dispel myths around personal responsibility for body weight, and to foster more empathy for people living in larger bodies. This also sets the scene for more effective policies and interventions, targeting the social and environmental drivers of health, to ultimately improve population health.

Multi-level gains of fat activism and their impact on sustained activism for fat justice

Previous research has indicated that outcomes of collective action can occur at the individual, group, and societal levels. Taken together, we argue that multi-level outcomes can influence sustained involvement in social movements. We aimed to examine the multi-level outcomes of fat activism across two studies. In our first study, we conducted semi-structured interviews with fat activists (N = 20) to learn what they believe are the multi-level outcomes of fat activism. At the individual level, activists reported greater health, well-being, and self-esteem; at the group level, they reported a sense of community and increased clothing options; and at the societal level, they reported change in toxic cultures around dieting. By building on the findings of Study 1, Study 2 (N = 464) aimed to understand how fat individuals' past collective action participation may predict their future collective action participation through individual-, group-, and societal-level gains. Results indicate that greater collective action participation in the past predicts greater willingness to engage in collective action through the pathway of higher beliefs in individual and societal gains of fat activism, but not through group-level gains, even after we control for identification with fat and fat activist identities. We discuss these findings in relation to the importance of multi-level outcomes in collective action and sustained involvement in social movements.

Fat embodiment for resistance and healing from weight stigma

Western culture is a decidedly anti-fat culture. Thus fat people are subjected to weight stigma and confront discrimination in virtually every facet of their lives. As a result, fat people often develop a self-concept that includes the stigmatized social identity. Weight stigma is also a traumatic experience that disrupts fat people's embodiment by diminishing feelings of attunement to and appreciation for their bodies. Therefore, healing from the trauma of weight stigma may involve developing a more positive fat identity through a process of fat embodiment. Fat embodiment may improve fat people's well-being by bolstering the integrity of the self, supporting efforts to resist public stigma and heal internalized stigma. In our analysis of embodied approaches to resistance and healing, we draw on social and clinical psychology and the works of public fat scholars and activists. We describe methods of fat embodiment like embracing bodily needs, engaging with fat-positive perspectives, connecting with fat community, and embracing desire and sensual pleasure. Ultimately, we conclude that transforming a negative fat identity into a positive identity through fat embodiment can support the pursuit of justice for fat bodies, connect fat people to their bodily needs and sensations, and support increased self-care and bodily fulfillment.

"Negative Things That Kids Should Never Have to Hear": Exploring Women's Histories of Weight Stigma in Physical Activity

Scholars have proposed that cumulative experiences of anti-fat bias and stigma contribute to detrimental physical activity experiences, as well as social and health inequities. The objective of this research was to explore how enacted weight stigma experiences are constructed and impact women's physical activity experiences long term. Eighteen women who identified as having had negative experiences related to their body weight, shape, or size in physical activity contexts participated in semistructured interviews. Using reflexive thematic analysis, four themes were identified: (a) norms of body belonging, (b) distancing from an active identity, (c) at war with the body, and (d) acts of resistance. These findings deepen understandings of how historical experiences of weight stigma can have longstanding consequences on physical activity cognitions, emotions, and behaviors. To equitably promote physical activity, it is imperative that movement spaces (e.g., fitness centers, sport organizations) both target anti-fat stigma and adopt weight-inclusive principles.

Tracking sentiments toward fat acceptance over a decade on Twitter

The fat acceptance (FA) movement aims to counteract weight stigma and discrimination against individuals who are overweight/obese. We developed a supervised neural network model to classify sentiment toward the FA movement in tweets and identify links between FA sentiment and various Twitter user characteristics. We collected any tweet containing either "fat acceptance" or "#fatacceptance" from 2010-2019 and obtained 48,974 unique tweets. We independently labeled 2000 of them and implemented/trained an Average stochastic gradient descent Weight-Dropped Long Short-Term Memory (AWD-LSTM) neural network that incorporates transfer learning from language modeling to automatically identify each tweet's stance toward the FA movement. Our model achieved nearly 80% average precision and recall in classifying "supporting" and "opposing" tweets. Applying this model to the complete dataset, we observed that the majority of tweets at the beginning of the last decade supported FA, but sentiment trended downward until 2016, when support was at its lowest. Overall, public sentiment is negative across Twitter. Users who tweet more about FA or use FA-related hashtags are more supportive than general users. Our findings reveal both challenges to and strengths of the modern FA movement, with implications for those who wish to reduce societal weight stigma.

Obesity, Body Image Dissatisfaction, and Sexual Dysfunction: A Narrative Review

With approximately two-thirds of the United States adult population classified as overweight or obese, obesity remains a critical public health concern. Obesity not only contributes to several health complications including type 2 diabetes mellitus and cardiovascular disease, but the condition is also associated with sexual dysfunction in both women and men. Despite evidence linking obesity and its concomitant pathophysiology to sexual problems, the potential roles of psychosocial factors such as body image are understudied. This narrative review evaluates the research linkages between obesity and sexual dysfunction, with particular attention to the potential effects of body image dissatisfaction. A literature search of biomedical and psychological databases was used to identify research pertaining to obesity, sexual function, and/or body image constructs. The pathophysiological effects of obesity on sexual function are well-documented in mechanistic studies and animal trials, often with corroboration in human clinical samples. However, very few studies examine obesity, body image, and sexual function in tandem. Body image dissatisfaction appears to independently impinge upon the sexual response cycle and mental health outcomes, irrespective of body weight. While obesity is often associated with negative body image appraisal, it is unclear whether these constructs exert additive, synergistic, or antagonistic effects on sexual responsivity. Additionally, overweight/obese individuals who exhibit higher levels of body image satisfaction or self-confidence appear to be protected from the deleterious effects of obesity on sexual satisfaction, at least to some extent. Greater reliance upon conceptual/theoretical models from the body image literature may better clarify the relationships between these constructs.

Weight Stigma and Social Media: Evidence and Public Health Solutions

Weight stigma is a pressing issue that affects individuals across the weight distribution. The role of social media in both alleviating and exacerbating weight bias has received growing attention. On one hand, biased algorithms on social media platforms may filter out posts from individuals in stigmatized groups and concentrate exposure to content that perpetuates problematic norms about weight. Individuals may also be more likely to engage in attacks due to increased anonymity and lack of substantive consequences online. The critical influence of social media in shaping beliefs may also lead to the internalization of weight stigma. However, social media could also be used as a positive agent of change. Movements such as Body Positivity, the Fatosphere, and Health at Every Size have helped counter negative stereotypes and provide more inclusive spaces. To support these efforts, governments should continue to explore legislative solutions to enact anti-weight discrimination policies, and platforms should invest in diverse content moderation teams with dedicated weight bias training while interrogating bias in existing algorithms. Public health practitioners and clinicians should leverage social media as a tool in weight management interventions and increase awareness of stigmatizing online content among their patients. Finally, researchers must explore how experiences of stigma differ across in-person and virtual settings and critically evaluate existing research methodologies and terminology. Addressing weight stigma on social media will take a concerted effort across an expansive set of stakeholders, but the benefits to population health are consequential and well-worth our collective attention.

#quarantine15: A content analysis of Instagram posts during COVID-19

There has been a surge in "quarantine15" social media posts during the self-isolation and lockdowns associated with the COVID-19 global pandemic. Given the influence of other body and weight-centered social media content (e.g., Fitspiration, Fatspiration) on body image and weight stigmatizing thoughts and attitudes, characterizing the features of quarantine15 content is an imperative first step towards understanding its impact on those who view it. Therefore, the present study is a content analysis of quarantine15 content on Instagram. A total of 668 posts were sampled using the hashtag quarantine15, and systematically analyzed for features related to positive and negative body image, as well as weight stigma. The results showed that the posts containing human figures (57.5 %) showcased individuals who were perceived as lower-weight (88.8 %), White (70.3 %), and women (87 %). Approximately one-third (34.4 %) of the images containing individuals were considered objectifying. Posts also perpetuated the controllability of weight through diet (51.5 %) and physical activity (27.5 %), while 46.9 % expressed dislike towards higher-weight bodies. Future experimental research in this area will be important for understanding both the acute and long-term effects of viewing quarantine15 content on body image, weight stigmatizing attitudes and thoughts, and internalized weight stigma.

Toward a Compassionate Intersectional Neuroscience: Increasing Diversity and Equity in Contemplative Neuroscience

Mindfulness and compassion meditation are thought to cultivate prosocial behavior. However, the lack of diverse representation within both scientific and participant populations in contemplative neuroscience may limit generalizability and translation of prior findings. To address these issues, we propose a research framework called Intersectional Neuroscience which adapts research procedures to be more inclusive of under-represented groups. Intersectional Neuroscience builds inclusive processes into research design using two main approaches: 1) community engagement with diverse participants, and 2) individualized multivariate neuroscience methods to accommodate neural diversity. We tested the feasibility of this framework in partnership with a diverse U.S. meditation center (East Bay Meditation Center, Oakland, CA). Using focus group and community feedback, we adapted functional magnetic resonance imaging (fMRI) screening and recruitment procedures to be inclusive of participants from various under-represented groups, including racial and ethnic minorities, gender and sexual minorities, people with disabilities, neuropsychiatric disorders, and/or lower income. Using person-centered screening and study materials, we recruited and scanned 15 diverse meditators (80% racial/ethnic minorities, 53% gender and sexual minorities). The participants completed the EMBODY task - which applies individualized machine learning algorithms to fMRI data - to identify mental states during breath-focused meditation, a basic skill that stabilizes attention to support interoception and compassion. All 15 meditators' unique brain patterns were recognized by machine learning algorithms significantly above chance levels. These individualized brain patterns were used to decode the internal focus of attention throughout a 10-min breath-focused meditation period, specific to each meditator. These data were used to compile individual-level attention profiles during meditation, such as the percentage time attending to the breath, mind wandering, or engaging in self-referential processing. This study provides feasibility of employing an intersectional neuroscience approach to include diverse participants and develop individualized neural metrics of meditation practice. Through inclusion of more under-represented groups while developing reciprocal partnerships, intersectional neuroscience turns the research process into an embodied form of social action.

Becoming active: more to exercise than weight loss for indigenous men

Objective: To understand what motivates sedentary indigenous and ethnic minority men to become more physically active. Design: We use thematic analysis to present data from a qualitative study exploring 23 sedentary indigenous Māori (New Zealand) men's experiences of completing a 12-week exercise intervention to improve their metabolic health. Results: Four themes emerged: The Bros - having fellowship and mutual motivation; Being better informed about exercise; Impacting overall wellbeing; and Disseminating the findings beyond the study Exercise interventions informed by indigenous Māori cultural values and knowledge increased its relevance to their daily lives. The motivation for these indigenous men was more culturally-based external factors than an inherent desire to lose weight. Conclusion: Indigenous and minority men in many developed countries have high morbidity and premature mortality related to sedentary lifestyles. The low uptake of physical activities possibly relates to focusing more on outcomes such as weight loss which lacks cultural relevance. When offering health promotion interventions for marginalized populations these findings highlight the importance of culturally tailoring interventions to the unique sources of motivation for each group to increase activity to improve their efficacy.

Transforming Health Experience and Action through Shifting the Narrative on Obesity in Primary Care Encounters

We sought to understand the impact of primary care conversations about obesity on people's everyday life health experience and practices. Using a dialogic narrative perspective, we examined key moments in three very different clinical encounters, the patients' journals, and follow-up interviews over several weeks. We trace how people living with obesity negotiate narrative alternatives that are offered during clinical dialogue to transform their own narrative and experience of obesity and self. Findings provide pragmatic insights into how providers can play a significant role in shifting narratives about obesity and self and how such co-constructed narratives translate into change and tangible health outcomes in people's lives.

#Teeth&Tweets: the reach and reaction of an online social media oral health promotion campaign

Aim The aim of the study was to investigate: i) the geographical reach and reaction of the online participants engaging in an oral health campaign 'National Smile Month' UK 2016 (NSM); and ii) whether dental practices during NSM were using Twitter to help address regional oral health inequalities.Methods Twitter posts, that is 'tweets', were collected using the application programming interface (API) software Mozdeh, for one month. Tweets were classified into high, medium or low engagement. Participants' postcode data of the organisation/practice were obtained via an internet search using Google. The geolocation of tweets was then linked by organisations' postcode to the 2015 Index of Multiple Deprivation and the oral health survey of five-year-olds 2014/15, and subsequently mapped using Google Fusion Tables.Results A total of 23,100 tweets were captured with a final total of 2,968 usable tweets from 763 separate accounts. Two hundred and twelve tweets were from dental practices, with 107 classified as low engagement, 99 medium, and 45 high engagement (39 of those tweets were from organisations allied to oral health). Interactive maps were created to give a visual representation of the relationship between those participants producing 'high' impact tweets and the level of dental decay in five-year-olds and deprivation levels.Conclusion The majority of tweets did not promote any specific preventative behaviour. Dental practices in England were not contributing to National Smile Month via Twitter in a way that would improve regional oral health inequalities. In areas of high-need there is evidence of proactive engagement with NSM via Twitter by local authorities and their healthcare partners.

Experiences of Self-Monitoring in Self-Directed Weight Loss and Weight Loss Maintenance: Systematic Review of Qualitative Studies

The experience and role of self-monitoring in self-directed weight loss attempts may be distinctly different from that within formal interventions, and has yet to be fully explored. We systematically reviewed qualitative studies to examine experiences of self-monitoring as an aid to self-directed weight loss. Thematic synthesis was used to construct descriptive and analytical themes from the available data. In all, 22 studies (681 participants) were included, in which the uses of self-monitoring ranged from an aid to increase adherence to a tool for facilitating analysis. Self-monitoring also influenced and was influenced by self-perception and emotions. Feelings of shame were linked with abandonment of efforts. Findings highlight the centrality of interpretation of self-monitored data, the implications this interpretation has on sense of self, and the impact of broader discourses. Explicitly framing self-monitoring as a positive tool with which to aid analysis may encourage helpful use of this technique.

Weight loss support seeking on twitter: the impact of weight on follow back rates and interactions

People seek weight loss support on online social networks, but little is known about how to build a supportive community. We created four Twitter accounts portraying women interested in weight loss (two obese, two normal weight/overweight) and followed health care professional and peer accounts for 2-5 weeks. We examined follow back rates, interactions, and organic follows from professionals and peers by weight status. Follow back rates did not differ by weight status when following professionals (6.8 % normal weight/overweight vs 11.0 % for obese; p = 0.4167) or peers (6.7 % for normal weight/overweight vs 10.8 % for obese; p = 0.1548). Number of interactions and organic followers also did not differ by weight status. Peers interacted with study accounts significantly more than professionals (p = 0.0138), but interactions were infrequent. Women seeking weight loss support on Twitter may need to be present for more than 5 weeks to build an interactive weight loss community.

Fat is fashionable and fit: A comparative content analysis of Fatspiration and Health at Every Size® Instagram images

In step with the proliferation of Thinspiration and Fitspiration content disseminated in popular web-based media, the fat acceptance movement has garnered heightened visibility within mainstream culture via the burgeoning Fatosphere weblog community. The present study extended previous Fatosphere research by comparing the shared and distinct strategies used to represent and motivate a fat-accepting lifestyle among 400 images sourced from Fatspiration- and Health at Every Size^®-themed hashtags on Instagram. Images were systematically analyzed for the socio-demographic and body size attributes of the individuals portrayed alongside content reflecting dimensions of general fat acceptance, physical appearance pride, physical activity and health, fat shaming, and eating and weight loss-related themes. #fatspiration/#fatspo-tagged images more frequently promoted fat acceptance through fashion and beauty-related activism; #healthateverysize/#haes posts more often featured physically-active portrayals, holistic well-being, and weight stigma. Findings provide insight into the common and unique motivational factors and contradictory messages encountered in these fat-accepting social media communities.

Men's weight loss stories: How personal confession, responsibility and transformation work as social control

Obesity is considered a public health concern. In Australia, there are a greater number of overweight or obese men compared with women. The media is an important source of information about body weight and weight management. We undertook a qualitative study to analyse men's weight loss stories in a popular men's magazine. Between January 2009 and December 2012, we collected 47 men's weight loss stories from the Australian edition of Men's Health magazine. We undertook thematic analysis to examine the stories. Confession, personal responsibility, appearance and transformation were key themes. The stories describe the men's self-discipline and their monitoring and tracking of their behaviours as activities which supported their weight loss. In this way, the stories promote the importance of such panoptic self-surveillance and self-discipline to the readers. We consider how such stories contribute to the wider synoptic system of media messages about body weight.

Development of an Evidence-Informed Blog to Promote Healthy Eating Among Mothers: Use of the Intervention Mapping Protocol

BACKGROUND

Low adherence to dietary guidelines and a concurrent rise of obesity-related chronic diseases emphasize the need for effective interventions to promote healthy eating. There is growing recognition that behavior change interventions should draw on theories of behavior change. Online interventions grounded in theory lead to increased effectiveness for health behavior change; however, few theory-driven social media-based health promotion interventions have been described in the literature.

OBJECTIVE

The objective of this study was to describe the application of the Intervention Mapping (IM) protocol to develop an evidence-informed blog to promote healthy eating among French-Canadian mothers of preschool and school-aged children.

METHODS

The following six steps of the IM protocol were performed. In Step 1, a preliminary needs assessment included a literature search on theoretical domains predicting Vegetables and Fruits intakes and Milk and Alternatives intakes in adults (ie, knowledge, beliefs about capabilities, beliefs about consequences, intention/goals) and a qualitative study including focus groups to identify female Internet users' perceptions of their use of healthy eating blogs. In Step 2, two behavioral outcomes were selected (ie, increase daily intakes of Vegetables and Fruits and Milk and Alternatives of mothers to reach Canadian dietary recommendations) and subsequently divided into six performance objectives inspired by national and international dietary recommendations such as planning for healthy meals. A matrix of change objectives was then created by crossing performance objectives with theoretical domains predicting Vegetables and Fruits intakes and Milk and Alternatives intakes in adults. Step 3 consisted of selecting theory-based intervention methods (eg, modeling and goal setting) and translating them into practical applications for the context of a dietary intervention delivered through a blog. A 6-month intervention was developed in Step 4 in which we aimed to address one performance objective per month in weekly blog publications written by a registered dietitian. For Step 5, we sought to include engagement-promoting methods (eg, peer and counselor support) to promote mothers' use of the blog and adherence to the intervention. Finally in Step 6, a randomized controlled trial has been launched to evaluate the effects of the blog on dietary behaviors of French-Canadian mothers.

RESULTS

The intervention study is expected to be completed in March 2018.

CONCLUSIONS

An intervention mapping protocol allowed for effective decision making in the development of a novel knowledge translation tool to increase adherence to dietary recommendations among mothers of preschool and school-aged children.

Predictors of dieting and non-dieting approaches among adults living in Australia

BACKGROUND

There is a dearth of research comparing why dieting and non-dieting approaches are adopted. A greater understanding of reasons underlying dieting and non-dieting attempts will help to identify target beliefs for interventions to support and motivate adults to attempt whatever approach they are willing and/or able to pursue. We investigated the predictors of dieting and non-dieting approaches in Australian adults using predictors that were identified in a previous qualitative study.

METHODS

We conducted a prospective study, with two waves of data collection occurring 4 weeks apart. At baseline, participants completed a questionnaire assessing constructs drawn from the theory of planned behaviour (attitude, subjective norm, and self-efficacy), past behaviour, non-planning, attributions for dieting failure, weight control beliefs, and dieting and non-dieting intentions. We used path modelling to analyse responses.

RESULTS

At baseline, 719 adults (52.2% male) aged between 18 and 76 completed the questionnaire. Four weeks later, 64% of participants (n = 461) reported on their dieting and non-dieting behaviour in the past month. Past behaviour, attitude, subjective norm, and self-identity significantly predicted dieting intentions. Dieting intentions and past behaviour significantly predicted dieting behaviour, while non-planning and self-efficacy did not. The model explained 74.8% of the variance in intention and 52.9% of the variance in behaviour. While most findings were similar for the non-dieting model, subjective norms and self-identity did not predict intention, while self-efficacy and self-identity both predicted non-dieting behaviour directly. The non-dieting model explained 58.2% of the variance in intention and 37.5% of the variance in behaviour.

CONCLUSIONS

The findings from this study provide support for the application of TPB and identity theory constructs in the context of both dieting and non-dieting behaviour. Self-efficacy and self-identity appear more relevant to non-dieting behaviour than dieting behaviour, while subjective norms was more influential in predicting dieting. Practitioners wishing to encourage either approach in their clients should attempt to modify the constructs that influence each approach.

Missing the target: including perspectives of women with overweight and obesity to inform stigma-reduction strategies

OBJECTIVE

Pervasive weight stigma and discrimination have led to ongoing calls for efforts to reduce this bias. Despite increasing research on stigma-reduction strategies, perspectives of individuals who have experienced weight stigma have rarely been included to inform this research. The present study conducted a systematic examination of women with high body weight to assess their perspectives about a broad range of strategies to reduce weight-based stigma.

METHODS

Women with overweight or obesity (N = 461) completed an online survey in which they evaluated the importance, feasibility and potential impact of 35 stigma-reduction strategies in diverse settings. Participants (91.5% who reported experiencing weight stigma) also completed self-report measures assessing experienced and internalized weight stigma.

RESULTS

Most participants assigned high importance to all stigma-reduction strategies, with school-based and healthcare approaches accruing the highest ratings. Adding weight stigma to existing anti-harassment workplace training was rated as the most impactful and feasible strategy. The family environment was viewed as an important intervention target, regardless of participants' experienced or internalized stigma.

CONCLUSION

These findings underscore the importance of including people with stigmatized identities in stigma-reduction research; their insights provide a necessary and valuable contribution that can inform ways to reduce weight-based inequities and prioritize such efforts.

Sustainable Lifestyle Change-Participatory Design of Support Together with Persons with Obesity in the Third Age

Sustainable lifestyle changes due to obesity are difficult to achieve regardless methods used. We need to know more about the lived experience of obesity and older persons' needs for support to make a sustainable change. This paper focuses on the need-finding process in designing support for a sustainable lifestyle change. Multistage focus group interviews were conducted with persons aged 61-72 living in Northern Sweden. A participatory and appreciative reflection and action (PAAR) approach was used in the group-sessions. Probes were used to increase reflections and achieve a deeper knowledge about the participants' needs of support. Data were analysed using qualitative thematic content analysis. Our findings revealed that to be able to succeed with a lifestyle change a focus has to be on a converted way of thinking, managing vulnerability, and achieving an emotional balance. To achieve a sustainable lifestyle change due to obesity in the third age the focus has to be on a health identity instead of a weight identity. Personalised support with enjoyable physical activities should be designed and developed. Strategies for emotional balance based on autonomy and self-empowerment must be included. This knowledge is important when designing support for sustainable change.

Social inclusion and the Fatosphere: the role of an online weblogging community in fostering social inclusion

Overweight and obesity are one of the most salient issues within society today, and the stigmatisation of overweight individuals is prevalent and widespread. Utilising interviews with 44 individuals who blog within an online fat acceptance community known as the Fatosphere, participants' perceptions of inclusion and exclusion were examined within their offline and online environments. Additionally, the effect this had on their offline lives was examined. Participants described a profound sense of exclusion within their offline lives through three agencies: the medicalisation of 'fatness', the weight loss industry and the media, which echoed descriptions of moral judgement. Furthermore, a sense of inclusion was described within the Fatosphere through the protection and support that they found within this 'safe space'. The effects of the Fatosphere influenced their lives in both negative and positive ways, allowing them to better deal with stigma and discrimination, but sometimes effecting their offline relationships in a negative manner. The Fatosphere provides a unique opportunity for corpulent individuals to engage in a community that is removed from the prominent weight-related discourse within modern society.

Obesity frames and counter-frames in British and German online newspapers

By featuring news articles highlighting certain aspects of obesity and backgrounding others, the media can frame these aspects as especially applicable to how obesity should be understood and addressed. Despite the highest rates in Europe, news reports from Britain and Germany have come under little scholarly scrutiny. In this article, we explore frames and their frequency of use in British and German online newspapers. Our findings reveal a dominant cross-national framing of obesity in terms of ‘self-control’, which places a more pronounced emphasis on individual responsibility than demonstrated by earlier studies and may contribute to a culture of weight bias and stigma. The results also reveal evidence for cross-national efforts to challenge this individualising framing with counter-frames of ‘acceptance’ and ‘coming out’. We argue that this is a positive development, which demonstrates the potential of media frames to function not only as possible contributors to weight bias and stigma but also as mechanisms for countering entrenched social conceptions of obesity.

Use of an Experiential Learning Assignment to Prepare Future Health Professionals to Utilize Social Media for Nutrition Communications

Social media has become a popular platform for reputable health organizations to disseminate health information to the public. However, future health professionals may receive little training in social media communication. To train future dietetic professionals, we incorporated a social media assignment into a Communications course curriculum to facilitate effective use of social media for the profession. For the assignment, students were instructed to make 2 posts on Facebook. The posts were due 3 weeks apart so that students received feedback on their first post before making their second post. To demonstrate the type of social media communication commonly used by reputable health organizations, the first post raised awareness or provided nutrition education. The second post used Facebook’s “comment” feature, to respond to another student’s first post, demonstrating the use of social media for community engagement. Both posts included a hyperlink that the user could click to get more information. Students were evaluated on the hook, main points, professionalism, credibility, and effectiveness of inviting the reader to the hyperlinked website and its ease of navigation. Dietetics educators should be encouraged to incorporate social media education into their curriculums for the benefit of future dietitians and their clients.

Social Media Use in Chronic Disease: A Systematic Review and Novel Taxonomy

PURPOSE

The purpose of this study is to evaluate clinical outcomes from applications of contemporary social media in chronic disease; to develop a conceptual taxonomy to categorize, summarize, and then analyze the current evidence base; and to suggest a framework for future studies on this topic.

METHODS

We performed a systematic review of MEDLINE via PubMed (January 2000 to January 2015) of studies reporting clinical outcomes on leading contemporary social media (ie, Facebook, Twitter, Wikipedia, YouTube) use in 10 chronic diseases. Two reviewers independently performed data extraction and quality assessment; characterization of study outcomes as positive, negative, neutral, or undefined impact; and inductive, thematic analysis to develop our taxonomy.

RESULTS

Of 378 citations identified, 42 studies examining the use of Facebook (n = 16), blogs (n = 13), Twitter (n = 8), wikis (n = 5), and YouTube (n = 4) on outcomes in cancer (n = 14), depression (n = 13), obesity (n = 9), diabetes (n = 4), heart disease (n = 3), stroke (n = 2), and chronic lower respiratory tract infection (n = 1) were included. Studies were classified as support (n = 16), patient education (n = 10), disease modification (n = 6), disease management (n = 5), and diagnosis (n = 5) within our taxonomy. The overall impact of social media on chronic disease was variable, with 48% of studies indicating benefit, 45% neutral or undefined, and 7% suggesting harm. Among studies that showed benefit, 85% used either Facebook or blogs, and 40% were based within the domain of support.

CONCLUSIONS

Using social media to provide social, emotional, or experiential support in chronic disease, especially with Facebook and blogs, appears most likely to improve patient care.

Obese people's perceptions of the thin ideal

The media play a key role in promoting the thin ideal. A qualitative study, in which we used in depth interviews and thematic analysis, was undertaken to explore the attitudes of 142 obese individuals toward media portrayals of the thin ideal. Participants discussed the thin ideal as a social norm that is also supported through the exclusion of positive media portrayals of obese people. They perceived the thin ideal as an 'unhealthy' mode of social control, reflecting on their personal experiences and their concerns for others. Participants' perceptions highlighted the intersections between the thin ideal and gender, grooming and consumerism. Participants' personal responses to the thin ideal were nuanced--some were in support of the thin ideal and some were able to critically reflect and reject the thin ideal. We consider how the thin ideal may act as a form of synoptical social control, working in tandem with wider public health panoptical surveillance of body weight.

Obesity in social media: a mixed methods analysis

The escalating obesity rate in the USA has made obesity prevention a top public health priority. Recent interventions have tapped into the social media (SM) landscape. To leverage SM in obesity prevention, we must understand user-generated discourse surrounding the topic. This study was conducted to describe SM interactions about weight through a mixed methods analysis. Data were collected across 60 days through SM monitoring services, yielding 2.2 million posts. Data were cleaned and coded through Natural Language Processing (NLP) techniques, yielding popular themes and the most retweeted content. Qualitative analyses of selected posts add insight into the nature of the public dialogue and motivations for participation. Twitter represented the most common channel. Twitter and Facebook were dominated by derogatory and misogynist sentiment, pointing to weight stigmatization, whereas blogs and forums contained more nuanced comments. Other themes included humor, education, and positive sentiment countering weight-based stereotypes. This study documented weight-related attitudes and perceptions. This knowledge will inform public health/obesity prevention practice.

The contribution of applied social sciences to obesity stigma-related public health approaches

Obesity is viewed as a major public health concern, and obesity stigma is pervasive. Such marginalization renders obese persons a "special population." Weight bias arises in part due to popular sources' attribution of obesity causation to individual lifestyle factors. This may not accurately reflect the experiences of obese individuals or their perspectives on health and quality of life. A powerful role may exist for applied social scientists, such as anthropologists or sociologists, in exploring the lived and embodied experiences of this largely discredited population. This novel research may aid in public health intervention planning. Through these studies, applied social scientists could help develop a nonstigmatizing, salutogenic approach to public health that accurately reflects the health priorities of all individuals. Such an approach would call upon applied social science's strengths in investigating the mundane, problematizing the "taken for granted" and developing emic (insiders') understandings of marginalized populations.

Information needs of people with low back pain for an online resource: a qualitative study of consumer views

PURPOSE

To identify the information needs of people with low back pain (LBP) in Australia, and the preferred methods to present this information online, as a basis for development of a patient-centred website. Available online LBP resources are limited in quality and content and it is not clear if they are meeting the needs of sufferers.

METHOD

Focus groups and semi-structured telephone interviews, involving 28 people with LBP.

RESULTS

Seven categories of information were identified: reasons for LBP, treatment and management options, self-help information, psychological and social dimensions, lay stories, quality assurance of information and roles of different healthcare professionals and locally available services. Identified preferences for online presentation included: multimodality, emphasis on visual media, readability and interactivity. Participants had been unable to obtain desired LBP information using existing resources.

CONCLUSIONS

This study provides important guidance for development of a patient-centred website grounded in the expressed needs and preferences of people with LBP. Understanding the breadth of patients' questions and concerns is essential for provision of patient-centred information and interventions. Incorporating these with the current evidence base would provide an accessible and relevant LBP patient education referral point, which is currently lacking. Implications for Rehabilitation Use of the internet to obtain health information is increasing, although there is little evidence that existing low back pain websites are meeting the expressed needs of health consumers. Our research suggests that people with low back pain have difficulty finding relevant and trustworthy information about the condition on the internet. Taking patient information needs and presentation preferences into account when designing online information material will provide people with low back pain an accessible and relevant educational resource that is currently lacking.

'Talk to us like we're people, not an X-ray': the experience of receiving care for chronic pain

Chronic pain is a commonly reported problem in primary care, and is Australia’s third most costly health problem. Despite advances in the understanding and treatment of pain, many people with chronic pain do not receive the best available care. This paper examines the health care experiences of people with chronic pain and focuses discussion on the impact that institutional and cultural factors can have on individual experience. Unstructured narrative interviews were conducted with a convenience sample of 20 people with chronic pain. Participants’ experiences pointed to several factors that can affect the outcome of the health care they receive, including: the belief that all pain is due to identifiable injury or disease; a commitment to finding a diagnosis and cure; problematic patient−provider communication; and poor integration of health services. Comprehensively addressing these factors cannot be achieved by focusing interventions at the individual level. A multifaceted response, which includes public health and systemic initiatives, is required.

Empowerment and bariatric surgery: negotiations of credibility and control

Today obesity is understood as a chronic illness. Programs developed to deal with obesity often build on an explicit aim to "empower" patients to take increased responsibility for their health, in line with contemporary neoliberal discourses. There is little empirically based knowledge about this so-called empowering process. In this article we focus on how an empowering program for patients diagnosed as morbidly obese worked on individuals' identity. The program encompassed a course in lifestyle change, bariatric surgery, and aftercare. We conducted qualitative interviews with 9 individuals at different stages of their treatment process and applied discourse analysis to interpret their constructions and negotiations as they progressed through the program. We found that dimensions of control and credibility framed the respondents' identity work. Based on the findings we suggest that contemporary discourses of empowerment as practice might leave the participants "trapped" within the ambivalence of freedom and control.

A qualitative study of the determinants of dieting and non-dieting approaches in overweight/obese Australian adults

Background

Dieting has historically been the main behavioural treatment paradigm for overweight/obesity, although a non-dieting paradigm has more recently emerged based on the criticisms of the original dieting approach. There is a dearth of research contrasting why these approaches are adopted. To address this, we conducted a qualitative investigation into the determinants of dieting and non-dieting approaches based on the perspectives and experiences of overweight/obese Australian adults.

Methods

Grounded theory was used inductively to generate a model of themes contrasting the determinants of dieting and non-dieting approaches based on the perspectives of 21 overweight/obese adults. Data was collected using semi-structured interviews to elicit in-depth individual experiences and perspectives.

Results

Several categories emerged which distinguished between the adoption of a dieting or non-dieting approach. These categories included the focus of each approach (weight/image or lifestyle/health behaviours); internal or external attributions about dieting failure; attitudes towards established diets, and personal autonomy. Personal autonomy was also influenced by another category; the perceived knowledge and self-efficacy about each approach, with adults more likely to choose an approach they knew more about and were confident in implementing. The time perspective of change (short or long-term) and the perceived identity of the person (fat/dieter or healthy person) also emerged as determinants of dieting or non-dieting approaches respectively.

Conclusions

The model of determinants elicited from this study assists in understanding why dieting and non-dieting approaches are adopted, from the perspectives and experiences of overweight/obese adults. Understanding this decision-making process can assist clinicians and public health researchers to design and tailor dieting and non-dieting interventions to population subgroups that have preferences and characteristics suitable for each approach.