Effect of Sleep Restriction on Adolescent Cognition by Adiposity: A Randomized Crossover Trial

Importance

Pediatric obesity is associated with impaired cognitive function; however, the mechanisms underlying this association demand assessment. Sleep may be a relevant moderator, as poor sleep predicts both increased adiposity and impaired cognitive function.

Objective

To determine the effects of adiposity and sleep on adolescent cognitive function.

Design, Setting, and Participants

This single-blind randomized crossover trial was conducted from September 2020 to October 2022. Parents or caregivers provided demographic information for adolescent participants. Body mass index percentile and bioelectrical impedance analysis assessed adiposity. Adolescents completed 2 actigraphy-confirmed sleep conditions, adequate and restricted, followed by in-person cognitive assessment. No additional follow-up was provided. Data collection for this population-based study took place in a behavioral medicine clinic in Birmingham, Alabama. A total of 323 participants were assessed for eligibility (ages 14-19 years and healthy). Of the 244 eligible adolescents, 157 declined participation. Eighty-seven were randomized and 26 dropped out postenrollment. The final sample included 61 adolescents, 31 with healthy weight and 30 with overweight or obesity. Data were analyzed from April to October 2023.

Interventions

Following a 2-day washout period of adequate sleep, adolescents completed 2 sleep conditions: adequate (mean [SD] duration, 8 hours, 54 minutes [58.0 minutes]) and restricted (mean [SD] duration, 4 hours, 12 minutes [50.7 minutes]).

Main Outcomes and Measures

The National Institutes of Health Cognitive Toolbox assessed global and fluid cognition, cognitive flexibility, working and episodic memory, attention, and processing speed. The Stroop Task assessed inhibition.

Results

The final sample included 61 adolescents (mean [SD] age, 16.3 [1.6] years; 35 [57.4%] female). Restricted sleep predicted poorer global cognition scores (restricted mean [SD], 98.0 [2.8]; adequate mean [SD], 103.2 [2.9]), fluid cognition scores (restricted mean [SD], 94.5 [3.2]; adequate mean [SD], 102.0 [3.6]), and cognitive flexibility scores (restricted mean [SD], 84.8 [3.0]; adequate mean [SD], 92.8 [3.0]) for adolescents with overweight or obesity. No differences emerged for adolescents with healthy weight. Adolescents with overweight or obesity also had poorer attention scores (mean [SD], 80.0 [2.3]) compared to adolescents with healthy weight (mean [SD], 88.4 [SD, 2.3]) following restricted sleep. No differences emerged following adequate sleep. Findings were similar for total body fat percentage (TBF%); however, for adolescents with TBF% above 42, restricted sleep also predicted poorer processing speed, and the association between sleep and attention did not vary based on TBF%.

Conclusions and Relevance

Adolescents with overweight or obesity may be more vulnerable to negative cognitive effects following sleep restriction. Improved sleep hygiene and duration in this group may positively impact their cognitive health.

Trial Registration

ClinicalTrials.gov Identifier: NCT04346433.

Choosing Health: acceptability and feasibility of a theory-based, online-delivered, tailored weight loss, and weight loss maintenance intervention

Few weight loss and weight loss maintenance interventions are tailored to include factors demonstrated to predict the user's behavior. Establishing the feasibility and acceptability of such interventions is crucial. The aim of this study was to assess the acceptability and feasibility of a theory-based, tailored, online-delivered weight loss and weight loss maintenance intervention (Choosing Health). We conducted a mixed methods process evaluation of the Choosing Health tailored intervention, nested in a randomized controlled trial (N = 288) with an embedded N-of-1 study, investigating participants' and implementers' experiences related to intervention context, implementation, and mechanisms of impact. Measures included: (i) surveys, (ii) data-prompted interviews (DPIs) with study participants, (iii) semi-structured interviews with implementers, and (iv) intervention access and engagement data. Five themes described the acceptability of the intervention to participants: (i) monitoring behavior change and personal progress to better understand the weight management process, (ii) working collaboratively with the intervention implementers to achieve participants' goals, (iii) perceived benefits of non-judgmental and problem-solving tone of the intervention, (iv) changes in personal perception of the weight management process due to intervention tailoring, and (v) insufficient intervention content tailoring. The intervention delivery was feasible, however, emails and text messages differed in terms of accessibility and resources required to deliver the content. The use of Ecological Momentary Assessment as a technique to gather personal data for further tailoring was acceptable, and facilitated behavior change monitoring. Personalization of the intervention content above and beyond domain-specific issues, for example, by addressing participants' social roles may better match their needs. Support from the implementers and feedback on body composition changes may increase participants' engagement.

Effects of exposure to plus-size fashion models on weight-related attitudes in bulimia nervosa: Findings from an exploratory study

BACKGROUND AND OBJECTIVES

Eating disorders are often linked to the internalization of the thin-ideal and weight stigma. The present exploratory study investigates the effects of plus-sized fashion media on weight-related attitudes in bulimia nervosa (BN).

METHODS

Women with BN (n=27) and without an eating disorder (n=28) were exposed to 17 pictures of plus-size fashion models. Participants rated the attractiveness of the models. Before and after the exposure task, participants completed questionnaires on their attitudes towards people with higher weight as well as thin-ideal media.

RESULTS

The BN group rated the bodies of the plus-size fashion models as less attractive than controls, whereas no group differences were found in attractiveness ratings for the models' faces or full images. In both groups, negative attitudes about people with higher weight significantly decreased after viewing plus-size model pictures. Attitudes toward thin-ideal media remained unchanged, with scores higher for BN than controls.

LIMITATIONS

This exploratory study has several limitations, such as the lack of a control condition, small sample size, and reliance on only self-report data.

CONCLUSIONS

These exploratory results imply that the positive effects of plus-sized model images on reducing negative assumptions about people with high weight may not be limited to healthy individuals but also seem to extend to women with BN. Further controlled studies with larger samples and long-term assessments are needed to confirm these findings.

Determining Associations Among Health Orientation, Fitness Orientation, and Attitudes Toward Fatness in Physiotherapists and Physiotherapy Students Using Structural Equation Modeling

Purpose

Research suggests physiotherapists hold negative attitudes and beliefs toward fatness and fat people. Physiotherapists are also health-conscious, and invested in healthy lifestyle behaviours including physical activity. Our purpose was to describe relationships between health orientation, fitness orientation, and fat attitudes.

Methods

Physiotherapists (n = 187) and physiotherapy students (n = 34) completed an online survey (Health Orientation Scale, Multidimensional Body-Self Relations Questionnaire, Fat Attitudes Assessment Toolkit). Structural equation modeling estimated associations between fat attitudes (dependent variable) and health and fitness orientation (independent variables).

Results

Participants scored high in orientation toward fitness and health. We found strong positive associations between fitness orientation and health orientation (p < 0.001). Health orientation was not significantly associated with fat attitudes (p = 0.075), whereas increased age was associated with more positive fat attitudes (p < 0.01). Although most participants acknowledged that factors outside an individual's control contribute to body weight, many also agreed with normative negative perspectives.

Conclusions

Physiotherapists are highly oriented toward fitness and health. This may underlie beliefs in the controllability of body weight and contribute to negative attitudes toward fatness and fat people. Further research, with greater sample sizes is necessary to further investigate associations between health orientation and fat attitudes.

Weight stigma from romantic partners: Its relations with maladaptive and adaptive coping and depressive symptoms

Social devaluation of being overweight is common in daily life, but little is known about the weight stigma in romantic relationships. The present study investigated the roles of maladaptive and adaptive coping strategies in the relation between the experience of weight stigma in romantic relationships and depressive symptoms in men and women, respectively. Analyses of gender differences and structural equation modeling yielded several findings. First, while men and women experienced similar levels of weight stigma from their romantic partners, women were more likely to use exercise avoidance, disengagement coping, and reappraisal coping strategies, and to exhibit more depressive symptoms than men. Second, men who experienced weight stigma tended to cope with it through exercise avoidance and disengagement coping, which were related to greater depressive symptoms. Men also coped with weight stigma adaptively via reappraisal coping, which was additionally associated with more positive affect. Third, the relation between the experience of weight stigma and depressive symptoms in women was only explained by using disengagement coping. These findings extend the understanding of weight stigma to a specific context and provide some insight that future interventions to reduce the impacts of weight stigma should be tailored accordingly for men and women.

Moderation of associations between weight discrimination and diabetes status by psychosocial factors

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.

Weight stigma and allostatic load in adults: protocol for a scoping review

INTRODUCTION

Weight-related stigma (WS) has been associated with adverse psychosocial and physical health effects. Despite the relationship between WS and allostatic load, there are no integrative reviews of this association. This scoping review aims to provide a comprehensive overview of the relationship between allostatic load biomarkers associated with WS by identifying gaps in this topic and proposing recommendations for future research.

METHODS AND ANALYSIS

This protocol was guided by the methodological framework of Arksey and O'Malley and the Joanna Briggs Institute (JBI). The research questions were based on the population-concept-context framework. Studies in adults diagnosed as overweight or obese, exposed to WS and assessing the association between WS and biomarkers of allostatic load will be included. A search will be conducted in Medline (Ovid), PsycINFO (Ovid), Scopus (Elsevier), Cochrane Library (Wiley) and Google Scholar. The search strategy will be conducted in three stages, based on the JBI recommendation with the MESH terms "Social Stigma," "Weight Prejudice," "Biomarkers," "Allostasis," "Adults" and related terms. Data extraction will be done with a template adapted from JBI. The search strategy and selection process results will be presented in a flow chart and summarised in the text. The main results will be presented in a descriptive synthesis.

ETHICS AND DISSEMINATION

Ethics review and approval are not required. The results will be disseminated through peer-reviewed publications, conferences, congresses or symposia.

Relationship Between Depression, Anxiety, Stress, and Weight Self-Stigma Among Youths in Saudi Arabia: A Nationwide Study

Background and objectives Many research studies show that self-stigma related to weight can exacerbate mental health issues. There is also evidence suggesting that depression, anxiety, and stress could be predictors of weight stigma. However, these connections have not been thoroughly investigated among young people in Saudi Arabia, where there is a high prevalence of obesity. This study aimed to explore the relationships between depression, anxiety, stress, and weight self-stigma in Saudi Arabian adolescents and young adults. Materials and methods This cross-sectional study was conducted between January and March 2022 and utilized online surveys, including the Weight Self-Stigma Questionnaire (WSSQ) and Depression, Anxiety, and Stress Scale 21 (DASS-21). We conducted descriptive analysis, independent samples t-tests, analysis of variance (ANOVA), and linear regression for the statistical analysis using SPSS version 25 (IBM Corp., Armonk, NY). Results A total of 1624 participants were enrolled in this survey. Most participants (889, 54.7%) were females. The mean age was 20.73 years (SD: 2.63). Males were more likely to report self-stigma compared to females (p = 0.018). Weight self-stigma demonstrated significant positive associations with body mass index (BMI) (p = 0.0001) and depression, anxiety, and stress (p = 0.0001) scores. Further analysis revealed weight self-stigma was positively correlated with psychological distress levels in the study population (p = 0.0001). The results demonstrated a statistically significant difference between different regions of Saudi Arabia with weight self-stigma being more prevalent in the Al-Baha region and least prevalent in the Al-Madinah region. Conclusions The results of this study indicate robust positive correlations between weight self-stigma scores and depression, anxiety, and stress scale scores among adolescents and young adults in Saudi Arabia. Further epidemiological and clinical studies on the national level are warranted.

An overlooked relationship in recovery from substance use disorders: Associations between body mass index and negative emotional states

Recovery from substance use disorders (SUD) is multifactorial. Being overweight could negatively impact physiological and psychological health-related parameters. Using model selection, we examined associations between body mass index (BMI) and negative emotional states (NES; e.g., stress, anxiety, depression) in 54 men with SUD and under treatment in five different therapeutic recovery centers. We found that BMI was positively associated with stress (p < .001), anxiety (p < .001), and depression (p = .002). Therefore, our findings suggest that decreasing the accumulation of body fat might contribute to improving mental health in individuals with SUD during recovery.

The Mental "Weight" of Discrimination: The Relationship between Perceived Interpersonal Weight Discrimination and Suicidality in the United States

Extant research has investigated the relationship between body weight and suicidality because obesity is highly stigmatized, leading to social marginalization and discrimination, yet has produced mixed results. Scholars have speculated that factors associated with body weight, such as weight discrimination, may better predict suicidality than body weight itself. We consider this possibility among a sample of 12,057 adult participants ages 33 to 43 in Wave V of the National Longitudinal Study of Adolescent to Adult Health through investigation of the relationships between weight discrimination and two dimensions of suicidality-suicide ideation and attempts. We also examine gender as a moderator of these relationships. We find that weight discrimination is positively associated with both suicide ideation and attempts, and this relationship is similar among men and women. Our findings underscore the need to address issues of weight discrimination in our society to better promote mental well-being.

Compassion-Focused Therapy to Reduce Body Weight Shame for Individuals With Obesity: A Randomized Controlled Trial

Adults living in larger bodies (Body Mass Index > 30) often experience body weight shame, are highly self-critical, and are at increased risk for anxiety and depression. To date, there have been no RCTs examining the efficacy of Compassion-Focused Therapy (CFT) to help those experiencing body weight shame. The aim of the current study was to investigate the efficacy of CFT as a 12-session group intervention to reduce body weight shame for individuals living in larger bodies. The study used an RCT design with participants randomized to the CFT (n = 28) or waitlist control (n = 27) condition. Participants in both groups were assessed at pre- and postintervention, with the CFT group alone assessed at 3- and 6-month follow-up intervention. Both self-report and a physiological measure of parasympathetic nervous system activity were used (i.e., heart rate variability). Results indicated that CFT had a significant positive impact at postintervention compared to the control group for body weight shame (internal and external), increasing self-compassion, reducing fears of compassion (self, other, and receiving), reducing self-criticism, and reducing external shame. Although there were no significant group effects at postintervention on depression and anxiety, 66% of participants had clinical improvement on depression in the CFT group compared to 8% in the control group at postintervention. CFT did not shift baseline heart rate variability at postintervention. The evidence from this RCT supports CFT as an efficacious intervention to reduce body weight shame for individuals with obesity.

Biological normalcy and body fat: Obesity prevalence, fat stigma, and allostatic load among late adolescents and young adults

OBJECTIVES

Biological normalcy provides a framework to assess tensions between clinical definitions of "normal," statistical norms, and normative beliefs. A prevailing cultural belief is obesity directly causes poor health, but research has demonstrated consequences of fat stigma. Previous research linked fat stigma and allostatic load (AL) in adults, but this has not been demonstrated in youth, and the role of obesity prevalence is unknown. This study assesses the relationship between fat stigma and AL among youth from counties varying by obesity prevalence.

MATERIALS AND METHODS

Undergraduates from 38 counties across the US state of Indiana (n = 175) were recruited. Fat stigma was measured using the brief stigmatizing situations inventory (SSI). AL was calculated using eight biomarkers representing cardiovascular, metabolic, and immune function. Poisson regression assessed relationships of interest and adjusted for potential confounding. An interaction term and stratified analyses were used to assess moderation.

RESULTS

SSI was not statistically associated with obesity prevalence (RR = 0.96, p = 0.173) but did statistically significantly predict AL (RR = 1.019, p = 0.045) when adjusting for confounders. Obesity prevalence moderated the relationship between SSI and AL (RR = 0.993, p = 0.001).

DISCUSSION

Results suggest that fat stigma, regardless of body fat percentage, is associated with physiologic wear and tear on the late adolescent body, and that exposure to obesity during earlier adolescence moderates this relationship. Those most at risk for high AL reported high fat stigma and lived in counties with relatively low obesity prevalence during earlier adolescence, suggesting vulnerability to fat stigma may be heightened where obesity is less common.

Stress-induced eating and drinking and their associations with weight among women and men during 30-year follow-up

BACKGROUND

Stress is associated with obesity through several mechanisms, including coping methods used in stressful situations. However, long-term prospective studies investigating stress-induced eating and drinking in parallel and their relationships with weight are scarce.

PURPOSE

We examined the prevalence of stress-induced eating and drinking and their associations with body mass index (BMI) among women and men during a 30-year follow-up, as well as BMI trajectories from early adulthood to middle age.

METHODS

Participants of a Finnish cohort study were followed by questionnaires at the ages of 22 (N = 1656), 32 (N = 1471), 42 (N = 1334), and 52 (N = 1160). Their coping methods were evaluated by asking how common it was for them to act in certain ways when they encountered stressful situations. We used linear regression analysis to examine the associations between coping methods and BMI, and latent growth models to analyze the BMI trajectories.

RESULTS

The prevalence of stress-induced eating was higher among women than men throughout the follow-up, whereas stress-induced drinking was more common among men at 22 and 32 years of age. Stress-induced eating was associated with higher BMI at all ages among women, and from the age of 32 among men. Eating as a persistent coping method over the life course was associated with a higher and faster growth rate of BMI trajectories. Stress-induced drinking was associated with higher BMI in middle age, and with a faster growth of BMI among men.

CONCLUSIONS

Effective, appropriate stress management may be one essential factor in preventing weight gain in the adult population.

Diet and Exercise in the Management of Polycystic Ovary Syndrome: Practical Considerations for Person-Centered Care

Polycystic ovary syndrome (PCOS) is a complex multisystem condition associated with life-long reproductive, metabolic, and psychological symptoms. Individuals with PCOS are at an increased risk of cardiovascular disease and type 2 diabetes, with approximately 70% of all PCOS cases presenting with insulin resistance. Lifestyle interventions have historically been recommended as first-line therapies for the management of PCOS-related cardiometabolic disorders. The term "lifestyle management" incorporates a multifaceted approach to dietary, exercise, and behavioral strategies, aiming to promote a healthy lifestyle. This approach has been commonly employed in practice, in particular through exercise and dietary modulation, due to its effect on cardiometabolic outcomes as well as its tolerability. Furthermore, there is evidence to suggest that combining dietary change with exercise may yield the greatest improvements in clinical outcomes. However, such practices require careful consideration and coordination, as there are instances where certain exercise and/or dietary prescriptions may compromise the effectiveness of the respective interventions. Thus, this review aims to provide practical guidance on diet and exercise planning in the routine care of PCOS. Such recommendations include emphasizing realistic and achievable goals, as well as minimizing barriers to lifestyle changes in order to increase the long-term sustainability of this treatment strategy.

Psychological Pathways Through Which Social Norms and Social Identity Influence Eating Behavior: Testing a Conceptual Model

BACKGROUND

Although interventions frequently promote healthy eating, failing to consider psychosocial factors, such as social norms, may limit the effectiveness of these efforts. Perceived social norms are a well-documented determinant of eating behavior; however, there is limited understanding of the processes through which, and for whom, this relationship emerges. Using identity-based motivation as a theoretical framework, we present a conceptual model identifying one route through which descriptive social norms-beliefs about how others behave-predict eating behavior, and test whether this process varies across social identities (e.g., self-perceived weight status).

METHOD

Structured telephone interviews were conducted for a national sample of non-diabetic adults who identified as non-Hispanic White, non-Hispanic Black, or Mexican American (n = 990).

RESULTS

Multigroup SEM analysis comparing individuals who self-identified as overweight (versus "about the right weight" and underweight) demonstrated that perceiving descriptive social norms that people do not eat healthy foods predicted greater perceived barriers to eating healthy foods. Perceived barriers, in turn, predicted stronger beliefs that body weight is uncontrollable, and this relationship was stronger for participants who self-identified as overweight (relative to participants who did not identify as overweight). These beliefs subsequently predicted greater self-reported consumption of unhealthy foods (e.g., sweets), but did not predict consumption of fruits or vegetables.

CONCLUSIONS

This study extends our understanding of a psychosocial process that predicts consumption of unhealthy foods and underscores the importance of social identities for shaping responses to perceived norms.

The effects of an acute weight stigma exposure on cardiovascular reactivity among women with obesity and hypertension: A randomized trial

OBJECTIVE

Weight stigma induces cardiovascular health consequences for people with obesity. How stigma affects cardiovascular reactivity in individuals with both obesity and hypertension is not known.

METHODS

In a randomized experiment, we assessed the influence of two video exposures, depicting either weight stigmatizing (STIGMA) or non-stigmatizing (NEUTRAL) scenes, on cardiovascular reactivity [resting blood pressure (BP), heart rate (HR), ambulatory BP (ABP), and ambulatory HR (AHR)], among women with obesity and high BP (HBP; n=24) or normal BP (NBP; n=25). Systolic ABP reactivity was the primary outcome. Laboratory BP and HR were measured before/during/following the videos, and ABP and AHR were measured over 19 hours (10 awake hours, 9 sleep hours) upon leaving the laboratory. A repeated measures ANCOVA tested differences in BP and HR changes from baseline in the laboratory and over ambulatory conditions between the two groups after each video, controlling for body mass index, baseline BP and HR.

RESULTS

Laboratory SBP/DBP increased 5.5+7.3/2.4+8.8mmHg more in women with HBP than NBP following the STIGMA versus NEUTRAL video (Ps<0.05). For the primary outcome, ABP increased more in HBP than NBP over sleep (SBP/DBP=4.2+20.6/4.7+14.2mmHg; Ps<0.05) following the STIGMA versus NEUTRAL video, as did HR during sleep (7.5+15.7bpm more in HBP than NBP; P<0.05).

CONCLUSIONS

Weight stigma increases cardiovascular reactivity among women with obesity and HBP in the laboratory and under ambulatory conditions.

CLINICAL TRIAL REGISTRATION

Registered at ClinicalTrials.gov (Identifier: NCT04161638).

Relationships between experiencing anti-fat microaggressions, body appreciation, and perceived physical and mental health

This study examined whether body appreciation mediates the relationships between anti-fat microaggression experiences and perceived physical and mental health. Using a cross-sectional survey design, our study included 384 adult cisgender women in the United States. We found that anti-fat microaggression experiences had a negative association with body appreciation, and perceived physical and mental health. Body appreciation had a positive relationship to perceived physical and mental health. Our study further suggests that body appreciation is an important modifiable factor that mediates the relationships between anti-fat microaggression experiences and perceived mental and physical health. Implications for practice and research are discussed.

An integrative model of weight stigma, body image, and physical activity in adolescents

Negative weight-related experiences and internalized weight stigma have been associated with poorer body image and reduced physical activity in adolescents. However, exploring body image and physical activity as discrete weight stigma outcomes fails to consider the theoretically- and empirically-supported covariation between the two. The present study tested a novel integrated model of the associations among negative weight-related experiences and internalized weight stigma (via weight-related distress), body image (shame, authentic pride, body appreciation), and physical activity. Canadian adolescents (N = 311, M_age ± SD = 16.00 ± 1.01, 75.5% girls) completed a cross-sectional self-report survey. A structural equation model with maximum likelihood robust estimation was tested. Higher negative weight-related experiences were indirectly associated with poorer body image (i.e., higher shame; lower authentic pride and appreciation) through higher weight-related distress. Authentic pride was associated with moderate-to-vigorous physical activity. Higher negative weight-related experiences were indirectly associated with lower physical activity through higher weight-related distress and lower body-related authentic pride. These findings elucidate targetable individual mechanisms and larger systems that could improve body image and foster physical activity among adolescents who encounter negative weight-related experiences and internalized weight stigma.

A systematic review of compassion-based interventions for individuals struggling with body weight shame

OBJECTIVE

This systematic review investigated compassion-based interventions and the extent to which they can assist with addressing body weight shame.

DESIGN

The systematic review was pre-registered and conducted according to PRISMA guidelines. Seven electronic databases (PsycNET, Pubmed, Web of science, CINAHL, Scopus, ProQuest, Social Science Database) were searched. The methodological quality of studies was also assessed.

MAIN OUTCOME MEASURES

Main outcomes were body weight shame, and compassion. Secondary outcomes assessed were mental health, eating attitudes and behaviours, physical exercise and Body Mass Index and weight.

RESULTS

25 studies (23 papers) met inclusion criteria and results indicated promise for compassion-based interventions for body weight shame, compassion, and health related behaviour. Mixed results were found for BMI and weight. The studies varied considerably in terms of populations targeted, the duration of interventions, and intervention delivery.Conclusion: Overall, compassion-based interventions were found to reduce body weight shame and improve levels of compassion. However, the impact of compassion-based interventions on BMI and weight is less promising. Recommendations for future research are provided.

Depression and Sexual Stigma Are Associated With Cardiometabolic Risk Among Sexual and Gender Minorities Living With HIV in Nigeria

BACKGROUND

People living with HIV are vulnerable to cardiometabolic diseases. We assessed the prevalence of cardiometabolic risk factors (CMRF) and associations with sexual stigma and depression among sexual and gender minorities (SGM) in Abuja and Lagos, Nigeria.

METHODS

The TRUST/RV368 study enrolled SGM between March 2013 and February 2020. Participants were assessed for depression, sexual stigma, and CMRF. Robust multinomial logistic regression was used to estimate adjusted odds ratio (aORs) and 95% confidence intervals (CIs) for associations of depression, sexual stigma, and other factors with increasing numbers of CMRF.

RESULTS

Among 761 SGM, the mean age was 25.0 ± 6.0 years; 580 (76%) identified as cisgender men, 641 (84%) had ≥1 CMRF, 355 (47%) had mild-severe depression, and 405 (53%) reported moderate-high sexual stigma. Compared with individuals without depression, those with mild (aOR 8.28; 95% CI: 4.18 to 16.40) or moderate-severe depression (aOR 41.69; 95% CI: 9.60 to 181.04) were more likely to have 3-5 CMRF. Individuals with medium (aOR 3.17; 95% CI: 1.79 to 5.61) and high sexual stigma (aOR 14.42; 95% CI: 2.88 to 72.29) compared with those with low sexual stigma were more likely to have 3-5 CMRF. Participants age 25-34 years were less likely to have 3-5 CMRF (aOR 0.41; 95% CI: 0.23 to 0.73) compared with participants age younger than 25 years.

CONCLUSION

CMRF increased with severity of depression and sexual stigma, potentially predisposing SGM living with HIV to cardiometabolic diseases. Integrating interventions that address depression and sexual stigma in HIV care programs for SGM may improve cardiometabolic outcomes.

Measuring weight- and shape-based social identity threat vulnerability in young adults

This study assessed the factor structure of a novel self-report measure of weight- and shape-based social identity threat vulnerability, Social Identities and Attitudes Scale-Weight and Body Shape (SIAS-WBS). Weight and race diverse young adults (N = 542; M_age=21.69 +2.32; 69% ciswomen) were recruited from Amazon Mechanical Turk and a university participant pool. Exploratory and confirmatory factor analyses, measurement invariance, internal consistency, convergent validity, and test-retest reliability were conducted. The SIAS-WBS had acceptable factor structure with 15 subscales that were invariant across race, ethnicity, gender, weight perception, and CDC-defined weight groups. The measure demonstrated high internal consistency, convergent validity, and good test-retest reliability. Subscales were Weight & Shape Identification (Influence and Centrality), Weight & Shape Stigma Consciousness, six identification and six negative affect factors across the domains of: Social, Familial, Romantic, Intellectual, Physical Activity, and Physical Attractiveness. Participants in higher weight groups who perceived themselves as lower weight status, reported lower Weight & Shape Identification-Influence (p = 0.02) and lower Stigma Consciousness (p = 0.01), relative to those perceiving themselves as higher weight status. Participants perceiving themselves as higher weight status endorsed lower Physical Activity Identification (p < 0.001) and more negative affect across all domains (p's < 0.02). This suggests that weight misperceivers may be less susceptible to weight-based identity threat.

The associations between relative and absolute body mass index with mortality rate based on predictions from stigma theory

Background

The social consequences of obesity may influence health and mortality rate (MR), given obesity's status as a highly stigmatized condition. Hence, a high absolute body mass index (BMI) in conjunction with the stigmatization of a high BMI may each independently increase the rate of MR.

Objectives

We tested whether relative BMI, defined as ordinal rank within a social reference group jointly defined by age, sex, and race/ethnicity, is associated with MR independent of absolute BMI.

Methods

Data were from three nationally representative datasets: the Health and Retirement Study (n = 31,115), the National Health Interview Survey (NHIS, n = 529,362), and the National Health and Nutrition Examination Survey (n = 31,115). Relative BMI kg/m2 deciles were calculated within twenty-four subgroups jointly defined by age (6 levels), sex (2 levels), and race/ethnicity (4 levels). The association between ordinal rank BMI and MR was assessed using Cox survival generalized additive models in each dataset with adjustments for age, race, sex, smoking, educational attainment, and absolute BMI.

Results

Absolute BMI had a significant non-monotonic association with MR, such that BMI was positively associated with mortality at BMI levels above approximately 25 kg/m2. Contrary to expectations, results from NHIS indicated that individuals in the first decile of relative BMI had the highest MR whereas relative BMI was not associated with MR in the NHANES and HRS.

Conclusion

We hypothesized that the stigmatization of obesity might lead to an increased MR after controlling for absolute BMI. Contrary to expectations, a higher relative BMI was not associated with an increased MR independent of absolute BMI.

Demographic and sociocultural predictors of sexuality-related body image and sexual frequency: The U.S. Body Project I

Body image is a critical component of an individual's sexual experiences. This makes it critical to identify demographic and sociocultural correlates of sexuality-related body image: the subjective feelings, cognitions, and evaluations related to one's body in the context of sexual experience. We examined how sexuality-related body image differed by gender, sexual orientation, race, age, and BMI. Four items assessing sexuality-related body image were completed by 11,620 U.S. adults: self-perceived sex appeal of their body, nude appearance satisfaction, and the extent to which they believed that body image positively or negatively affected their sexual enjoyment and feelings of sexual acceptability as a partner. Men reported slightly less nude appearance dissatisfaction and fewer negative effects of body image on sexual enjoyment and sexual acceptability than women, but did not differ in reported sex appeal. Poorer sexuality-related body image was reported by people with higher BMIs, not in relationships, who had sex less frequently, among White compared to Black women and men, and among gay compared to heterosexual men. Data also revealed a subgroup of respondents who reported that their body image had a positive impact on their sex lives. The findings highlight a need for interventions addressing sexuality-related body image.

Examining the utility of nonlinear machine learning approaches versus linear regression for predicting body image outcomes: The U.S. Body Project I

Most body image studies assess only linear relations between predictors and outcome variables, relying on techniques such as multiple Linear Regression. These predictor variables are often validated multi-item measures that aggregate individual items into a single scale. The advent of machine learning has made it possible to apply Nonlinear Regression algorithms-such as Random Forest and Deep Neural Networks-to identify potentially complex linear and nonlinear connections between a multitude of predictors (e.g., all individual items from a scale) and outcome (output) variables. Using a national dataset, we tested the extent to which these techniques allowed us to explain a greater share of the variance in body-image outcomes (adjusted R²) than possible with Linear Regression. We examined how well the connections between body dissatisfaction and dieting behavior could be predicted from demographic factors and measures derived from objectification theory and the tripartite-influence model. In this particular case, although Random Forest analyses sometimes provided greater predictive power than Linear Regression models, the advantages were small. More generally, however, this paper demonstrates how body image researchers might harness the power of machine learning techniques to identify previously undiscovered relations among body image variables.

Associations between weight discrimination and metabolic health: A cross sectional analysis of middle aged adults

BACKGROUND

Concurrent with the recent rise in overweight and obesity, concerns with weight discrimination have arisen. Individuals who have experienced weight discrimination report a host of deteriorations related to physical and psychological health, which may co-exist with behaviours such as increased food consumption and decreases in physical activity that make weight management difficult. What remains less clear, however, is the extent to which metabolic health may be specifically affected, and how this may vary by setting and perceived intensity of the lifetime history of weight discrimination.

METHOD

To address this, a secondary data analysis was performed on 1365 participants from year 25 of the Coronary Artery Disease in Young Adults (CARDIA) study who were living with overweight and obesity. Descriptive statistics and logistic regression analyses were performed on the presence of metabolic syndrome, diabetes, and abdominal obesity, as well as their experience of the weight discrimination.

RESULTS

Prevalence of the metabolic syndrome, diabetes, and abdominal obesity was higher among those reporting low and high stress weight discrimination compared to those with no history of weight discrimination. In the adjusted analyses, weight discrimination was associated with a 65% greater likelihood for having metabolic syndrome, 85% greater likelihood of diabetes, and between a 2.5- and 3.9-times greater likelihood of abdominal obesity for low and high stress experiences, respectively.

CONCLUSION

Exposure to weight discrimination may worsen metabolic health, as characterized by higher rates of metabolic syndrome and abdominal obesity. These associations may be greater with levels of stress experienced from weight discrimination. Further longitudinal work is necessary to understand the temporal sequence, time lag, and any possible critical periods for weight discrimination on metabolic health.

Understanding weight stigma in eating disorder treatment: Development and initial validation of a treatment-based stigma scale

Weight stigma is a well-established risk factor for eating disorder pathology, and it is prevalent among healthcare professionals. The current investigation developed and psychometrically validated the Scale for Treatment-based Experiences of Weight Stigma (STEWS) for patient-centered assessment of weight-stigmatizing experiences in eating disorder treatment. Former eating disorder patients (N = 142) with a body-mass-index greater than 25.0 were recruited via Amazon Mechanical Turk. The STEWS demonstrated good internal consistency, convergent validity with widely used weight stigma scales, and incremental validity in predicting eating disorder symptomatology. The STEWS is the first psychometrically sound instrument for treatment-based weight stigma in eating disorder recovery.

The mediation effect of perceived weight stigma in association between weight status and eating disturbances among university students: is there any gender difference?

BACKGROUND

The study aimed to examine the association between perceived weight stigma (PWS), weight status, and eating disturbances. We hypothesized that PWS would partially mediate the association between weight status and eating disturbances among university students.

METHODS

The study involved 705 undergraduate students (379 females and 326 males) recruited from Hong Kong and Taiwan Universities (399 Hong Kong; 306 Taiwan participants). Our sample was from one Hong Kong university (located in Kowloon) and five Taiwan universities (three located in Southern Taiwan, one located in Central Taiwan, and one located in North Taiwan). Participants' mean age was 20.27 years (SD = 1.79). All participants completed a demographic information sheet, the Three-Factor Eating Questionnaire-18 (TFEQ-R18), and the PWS questionnaire. PROCESS macro models were used to analyze potential mediations.

RESULTS

We found a significantly higher PWS scores in a high weight group for females and males. There was a significant difference between weight status and eating disturbances. Moreover, PWS partially mediated the association between weight status and eating disturbances for both genders.

CONCLUSIONS

PWS is associated with weight status and eating disturbances, making it an important target for health improvement among young adults. Further studies are needed to corroborate such associations in participants from other societies and cultures.

Weight-based stereotype threat in the workplace: consequences for employees with overweight or obesity

BACKGROUND/OBJECTIVES

Employees with overweight or obesity are often stereotyped as lazy, unmotivated, and less competent than employees with normal weight. As a consequence, employees with overweight or obesity are susceptible to stereotype threat, or the concern about confirming, or being reduced to, a stereotype about their group. This survey study examined whether employees with overweight or obesity experience stereotype threat in the workplace, whether it is associated with their perceived ability to meet their work demands (i.e., work ability), and whether high levels of knowledge about one's self (i.e., authentic self-awareness) can offset a potential negative association.

SUBJECTS/METHODS

Using a correlational study design, survey data were collected from N = 758 full-time employees at three measurement points across 3 months. Employees' average body mass index (BMI) was 26.36 kg/m² (SD = 5.45); 34% of participants were employees with overweight (BMI between 25 and <30), and 18% of participants were employees with obesity (BMI > 30).

RESULTS

Employees with higher weight and higher BMI reported more weight-based stereotype threat (rs between 0.17 and 0.19, p < 0.001). Employees who experienced higher levels of weight-based stereotype threat reported lower work ability, while controlling for weight, height, and subjective weight (β = -0.27, p < 0.001). Authentic self-awareness moderated the relationship between weight-based stereotype threat and work ability (β = 0.14, p < 0.001), such that the relationship between stereotype threat and work ability was negative among employees with low authentic self-awareness (β = -0.25, p < 0.001), and non-significant among employees with high authentic self-awareness (β = 0.08, p = 0.315).

CONCLUSIONS

The findings of this study contribute to the literature by showing that weight-based stereotype threat is negatively associated with employees' perceived ability to meet their work demands, particularly among those employees with low authentic self-awareness.

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.

Examining the associations of sexual minority stressors and past-year depression with overeating and binge eating in a diverse community sample of sexual minority women

Sexual minority stressors (e.g., stigma consciousness, internalized homophobia, discrimination) are posited to contribute to higher prevalence of overeating and binge eating among sexual minority women (SMW) relative to heterosexual women. Few studies have examined psychosocial mediators of the associations of minority stressors with overeating and binge eating in SMW. Using data from a diverse, community-based sample of SMW, we examined these associations, including the potential mediating effects of past-year depression. We also conducted exploratory analyses to determine if the associations of sexual minority stressors with overeating and binge eating differed by sexual identity or by race and ethnicity. The sample included 607 SMW (38.2% White, 37.1% African American, 24.7% Latina) with a mean age of 39.7 years. Approximately 17% and 9% of SMW reported overeating and binge eating, respectively, in the past 3 months. Greater stigma consciousness was associated with higher odds of overeating (AOR 1.31, 95% CI = 1.03-1.66). We found no significant associations between minority stressors and binge eating. Past-year depression did not mediate associations between minority stressors and overeating or binge eating. Although we found no sexual identity differences, stigma consciousness among Latina SMW was associated with higher odds of overeating relative to White SMW (AOR 1.95, 95% CI = 1.21-3.12) and African American SMW (AOR 1.99, 95% CI = 1.19-3.31). Findings highlight the importance of screening SMW for stigma consciousness as a correlate of overeating and considering racial and ethnic differences in overeating and binge eating in this population.

Barriers to losing weight for women attending group visits in primary care: A qualitative exploration using in-depth interviews

Background

Despite the accumulated evidence suggesting the positive aspects of using group visits in obesity, the number of qualitative studies that examine why and how the effects occur at an individual level is limited.

Objectives

This qualitative study aimed to explore the experiences and perspectives of women who participated in group visits and had different weight loss outcomes in the programme.

Method

Purposive maximum variation sampling was performed. Data collection and analysis were performed iteratively, and the data saturation method was used as a guideline for sample size. All participants who completed the group visits were approached, and finally, 20 individuals were included in the study. Semi-structured in-depth interviews were audio-recorded, transcribed verbatim, and analysed thematically using a phenomenological approach.

Results

The mean age of the individuals was 38.5 ± 9.8 years, the education level ranged from incomplete-high school to university degree, and the weight changes were between +4.1% and −17.1%. Two main themes emerged from the thematic analysis revealing barriers: weight stigma (two sub-themes: internal and external stigma) and traumatic life events (three sub-themes: ‘loss of relatives,’ ‘childhood traumas,’ and ‘conflicting intimate partner relationships’).

Conclusion

Considering the barriers to weight loss efforts in this study, these issues need to be explicitly investigated before and during the group visits in addition to weight loss practices and behavioural changes.

Weight-related teasing is associated with body concerns, disordered eating, and health diagnoses in racially and ethnically diverse young men

Research suggests that weight-related teasing is associated with body concerns and disordered eating in male and female adolescents and women. Yet, little is known about these associations for young men with diverse racial and ethnic identities. This study examined the association of weight-related teasing frequency and distress with body concerns, loss of control (LOC) eating, dietary restraint, and history of psychiatric and medical diagnoses in racially and ethnically diverse young men. Racial and ethnic identity was examined as a potential moderator. Participants (N = 1,069; 18-30 years; M_age = 24.1 ± 3.6 years) completed an online survey and reported on general demographics; weight-related teasing; body concerns; LOC eating frequency in the last 28 days; dietary restraint; and history of psychiatric and medical diagnoses. All models adjusted for BMI, income, education, and history of psychiatric diagnoses (when not the dependent variable). Both weight-related teasing frequency and distress were significantly and positively linked with all dependent variables, and these associations did not significantly vary by racial and ethnic identity. These findings suggest that, much like in prior research with adolescents and women, experiences with weight-related teasing are associated with body concerns, disordered eating, and poorer health in racially and ethnically diverse young men, regardless of body size.

Acute Daily Stress, Daily Food Consumption, and the Moderating Effect of Disordered Eating among Adolescents with Overweight/Obesity

Objective: The purpose of this study was to examine the associations between acute daily stress dimensions (frequency, sum) and food intake in adolescents with overweight/obesity, and to explore the potential moderating effect of disordered eating behaviors on these associations. Methods: One hundred eighty-two adolescents with overweight/obesity (65% females; 68.7% non-white; 16.2 ± 1.8 years of age) were included in this analysis. Acute daily stress was measured using the Daily Stress Inventory, and daily caloric intake was measured using a food frequency questionnaire. Disordered eating behavior was assessed using the Eating Attitudes Test (EAT-26). Results: Acute daily stress frequency (B = 0.013 ± 0.003; p < 0.001) and acute daily stress sum (B = 0.003 ± 0.001; p < 0.001) were associated with greater daily caloric intake. Disordered eating behavior moderated the association between acute daily stress frequency and caloric intake (p_interaction = 0.039), with greater daily caloric intake among those with higher levels of disordered eating. Disordered eating behavior did not significantly moderate the association between acute daily stress sum and daily caloric intake (p_interaction = 0.053). Conclusions: These findings suggest that greater exposure to acute daily stressors may increase daily food intake in adolescents with overweight/obesity, with greater susceptibility among those engaging in high levels of disordered eating. Longitudinal research is warranted to elucidate the long-term effect of acute daily stressors and disordered eating on food intake among adolescents with overweight/obesity. The Health and Culture Project is registered at www.clinicaltrials.gov (No. NCT02938663).

A Matter of Justice: "Fat" Is Not Necessarily a Bad Word

This essay argues that the discrimination that fat patients face is an issue of health justice. Insofar as this is the case, bioethicists and health care providers should not only care about it but also work to dismantle the systematic, institutional, social, and individual factors that are contributing to it to ensure that fat patients receive high-quality health care, free of stigma and discrimination. The essay discusses a variety of ways in which fat patients are discriminated against and considers the false assumptions that fuel such discrimination. It concludes by considering the structural and social issues that contribute to fatness and pushes health care providers to abandon the assumption that being fat is an individual moral failing. Ultimately, the paper argues, "fat" is not necessarily a bad word, nor one that health care providers should avoid.

Body weight perception outweighs body weight when predicting shame, criticism, depression and anxiety for lower BMI range and higher BMI range adults

This study examined the relationship between body weight shame, self-criticism and mental health for individuals across body weight ranges. In total 1695 participants completed a series of online measures and we used Structural Equation Modelling, to assess for the relationship between weight, perceived weight, social rank (social comparison, body weight shame, submissiveness) self-criticism (inadequate and self-hatred) and anxious and depressive symptoms. Results indicated that perceived body weight is more important than actual body weight in predicting body weight shame. Importantly, individuals classified in higher BMI ranges rely more on the self-hatred form of self-criticism which significantly predicts anxious and depressive symptoms.

BMI and dissatisfaction with life: contextual factors and socioemotional costs of obesity

Purpose

In this study, we investigate whether individuals’ BMI categories are associated with being dissatisfied with one’s life, how this association is affected by the social comparison that individuals make, and what the role of the overall BMI levels in this process is.

Methods

We use data for 21,577 men and 27,415 women, collected in 2016 by the European Bank for Reconstruction and Development, from 34 countries in Europe, the Middle East, and Central Asia. To understand the moderating effect of contextual environment, we use multilevel mixed effect logistic regression models and data for national, regional, and cohort-specific BMI levels.

Result

We find that the association of BMI and dissatisfaction with life differs by gender, with overweight men being less likely to be dissatisfied with life than men with normal weight and obese women being more likely to be dissatisfied with life compared to women with normal weight. For contextual effects, we find that obese women in regions with low BMI levels are more likely to be dissatisfied with life. The effect of obesity on female life dissatisfaction is not observed in regions with high BMI levels. As for men, regional BMI levels affect the levels of life dissatisfaction but only for underweight men.

Conclusions

Our study adds additional nuance to the quality-of-life research by showing that the association between BMI and decreased life satisfaction is, at least partially, moderated by the contextual environment, and that the character of these effects differs by gender.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11136-021-02912-3.

Ethnic-Racial discrimination experiences predict Latinx adolescents' physiological stress processes across college transition

Consistent with conceptual frameworks of ethnic-race-based stress responses, and empirical evidence for the detrimental effects of ethnic-racial discrimination, the current study hypothesized that experiencing more frequent ethnic-racial discrimination during adolescence would predict differences in physiological responses to psychosocial stress across the college transition. U.S. Latinx adolescents (N = 84; M_age = 18.56; SD = 0.35; 63.1% female; 85.7% Mexican descent) completed survey measures of ethnic-racial discrimination during their final year of high school and first college semester (~5 months later), as well as a standard psychosocial stressor task during their first college semester. Repeated blood pressure and salivary cortisol measures were recorded to assess cardiovascular and neuroendocrine activity at baseline and stress reactivity and recovery. Data were analyzed using multilevel growth models. Experiencing more frequent ethnic-racial discrimination in high school, specifically from adults, predicted higher baseline physiological stress levels and lower reactivity to psychosocial stress during the first college semester, evidenced by both blood pressure and cortisol measures. Experiencing ethnic-racial discrimination from peers in high school also predicted higher baseline blood pressure in college, but not stress reactivity indices. Results were consistent when controlling for concurrent reports of ethnic-racial discrimination, gender, parents' education level, body mass index, oral contraceptive use, time between longitudinal assessments, depressive symptoms, and general perceived stress. Experiencing frequent ethnic-racial discrimination during adolescence may lead to overburdening stress response systems, indexed by lower cardiovascular and neuroendocrine stress reactivity. Multiple physiological stress systems are sensitive to the consequences of ethnic-racial discrimination among Latinx adolescents transitioning to college.

Weight bias and support of public health policies

OBJECTIVES

Public health policies have been proposed to help address prevalent Canadian obesity rates. Along with the increase in obesity prevalence, explicit weight bias is also rampant in Western society. This paper aimed to assess the association between explicit weight bias attitudes and Canadian public support of these policy recommendations.

METHODS

Canadian adults (N = 903; 51% female; BMI = 27.3 ± 7.0 kg/m²) completed an online survey measuring explicit weight bias, using the three subscales of the Anti-Fat Attitudes Questionnaire: Willpower (belief in weight controllability), Fear of fat (fear of gaining weight), and Dislike (antipathy towards people with obesity). Whether these subscales were associated with policy support was assessed with logistic regression. Analyses were adjusted for age, race, gender, and income.

RESULTS

Public support of policy recommendations ranged from 53% to 90%. Explicit weight bias was primarily expressed through a fear of weight gain and the belief that weight gain was within the individual's control based on willpower. Although the Dislike subscale was associated with lower support for several policies that enable or guide individual choice in behaviour change, the Willpower and Fear of fat subscales were associated with greater support for similar policies.

CONCLUSION

This study contributes to evidence-informed public health action by describing public support of public health policies and demonstrating an association between explicit weight bias and public support. A higher total explicit weight bias score increased the odds of supporting primarily less intrusive policies. However, dislike of individuals with obesity was associated with decreased odds of supporting many policies.

The effect of a food addiction explanatory model of eating behaviours on weight-based stigma: An experimental investigation

Weight stigmatization and discrimination are pervasive issues that have numerous adverse consequences for those with excess weight. It has been proposed that some individuals may be addicted to hyperpalatable processed foods, resulting in weight promoting eating behaviours. The current study replicated and extended a study examining the effect of a food addiction explanation for eating behaviours on weight-based stigma and weight-controllability beliefs. Undergraduate students (N = 757) were randomly assigned to one of four conditions where they read a newspaper article accompanied by a photo of a woman 1) who was either of a higher body mass index (BMI) or a lower BMI, and 2) that attributed her eating behaviours to either food addiction or poor dietary and lifestyle choices. Stigma towards the woman and individuals with a higher BMI in general were assessed. Results indicated that the woman with a higher BMI elicited greater weight stigma. Attributing weight to food addiction increased perceptions of psychopathology towards the woman, whereas attributing weight to poor dietary and lifestyle choices elicited judgment towards the woman. Neither explanation about eating behaviours elicited stigma towards individuals with a higher BMI in general. Findings suggest that a food addiction explanation alone may not be sufficient to reduce weight stigma.

Weight stigma and health – Repercussions on the health of adolescents and adults: integrative review of the literature

ABSTRACT Objective To conduct an integrative review in order to understand the repercussions of the social stigma of overweight on the health of adults and adolescents. Methods The international protocol for systematic review and meta-analysis studies PRISMA was adopted to guide the writing of this review. The databases used were PubMed, Psycinfo, SciELO, Medline, Lilacs and Pepsic, considering studies published in the period from 2000 to 2020. Sixty-seven (67) articles were analyzed, and 4 categories emerged: repercussions on physical well-being; repercussions on social well-being; repercussions on mental well-being; and mixed category (physical and psychological impact). Results In the vast majority of studies analyzed, weight stigma had a negative impact on the different spheres that make up the health construct, that is, the physical, social and mental spheres. Conclusions The consequences of weight stigma are a source of intense suffering, with an impact that reduces the quality of life of individuals who experience stigmatization, involving physical, emotional and social aspects.

Unpalatable food for thought: Let marketing research guide effective public obesity interventions

The prevalence of obesity is growing unabatedly despite the considerable efforts directed at the problem. Although abundant research has contributed to our understanding of the multifactorial causes of obesity, there is less attention to research that is relevant for guiding social marketers, public health professionals and policymakers in delivering public health interventions for countering and/or preventing the problem of obesity. This review offers six points for identifying and developing research relevant for guiding community-wide obesity interventions based on the idea that an applied marketing research perspective offers a better model for identifying effective interventions than more theoretical academic research. Specifically, the research guiding public health and social marketing interventions needs to (1) provide information on ultimate outcomes (weight, health and unintended consequences) more than intermediate outcomes (beliefs, attitudes and behaviour), (2) report on observations collected over the longer term, (3) use natural settings (even at a cost of internal validity), (4) endeavour to overcome observer-effects, (5) report effect sizes (rather than statistical significance) and (6) use moderator analyses to capture variation in how a population responds to interventions.

Unburdening the Weight of Stigma: Findings From a Compassion-Focused Group Program for Women With Overweight and Obesity

OBJECTIVE

The aim of this study was to develop a 2-day intensive-format, Compassion-Focused Therapy (CFT) based group program targeting weight stigma in women with overweight and obesity, and to conduct a pilot study to determine the feasibility and acceptability of the intervention.

METHOD

Participants were 15 females aged 18-62 years (mean [M] = 43.60, standard deviation [SD] = 12.38), who participated in the program and completed measures of self-compassion, internalized weight stigma, psychological distress, life-satisfaction, loneliness, eating self-efficacy, body dissatisfaction, and body shame, at pre-treatment, post-treatment, and 3-month follow-up.

RESULTS

Significant improvements were found from pre-treatment to post-treatment for self-compassion and internalized weight stigma, with gains maintained at 3-month follow-up. Significant improvements were also found on measures of psychological distress, life satisfaction, loneliness, eating self-efficacy, and body dissatisfaction at the post-treatment assessment. Credibility ratings of the program were high.

CONCLUSIONS

This study has contributed to existing stigma research, being the first proof-of-concept study to demonstrate support for an intensive, CFT based group approach targeting the effects of weight stigma for women with overweight and obesity. The findings are discussed in terms of the potential of CFT to assist women develop resilience to the harmful effects of weight stigma, and possible future research directions to further develop and evaluate this approach.

Assessing the relationship between weight stigma, stress, depression, and sleep in Chinese adolescents

INTRODUCTION

Weight stigma is defined as the social devaluation of people with overweight or obesity, and its negative effects on the health of adolescents from western countries are well documented, but little is known about the relationships with health behaviors and outcomes in Asian youth. The prevalence of obesity among Chinese adolescents continues to increase, potentially causing negative evaluations of youth with obesity, and potentially reduced quality of life. The health effects of these negative evaluations of Chinese youth with obesity have received little attention.

PURPOSE

The purpose of this study was to examine relationships between weight stigma, stress, depression, and sleep in Chinese adolescents.

METHODS

We utilized a cross-sectional study conducted in Wuhan, China. Sociodemographic, weight stigma, stress, depression, and sleep data were collected through a self-reported questionnaire. Descriptive statistics, t test, correlations, and mediation analyses were performed. A total of 1626 adolescents between 14 and 19 years of age were included in the analysis.

RESULTS

The data showed that adolescents with weight stigma presented significantly higher level of stress and depression, lower global sleep quality, longer sleep latency, and shorter sleep duration than those without weight stigma (p < 0.05). Stress and depression mediated the relationship between weight stigma and global sleep quality (SE = 0.007, 95% CI = 0.053 to 0.081).

CONCLUSION

These findings suggest that adolescents who experience weight stigma may have increased stress and depressive symptoms, which are associated with poorer global sleep quality and more daytime dysfunction.

The role of psychological attribution in responses to weight stigma

Objective

Weight discrimination is associated with numerous negative health consequences. Little is known about early‐stage psychological mechanisms that explain variability in responses to weight discrimination among people with obesity. This study tested the hypothesis that attributing negative social evaluation to one's weight would be associated with stigma‐related stress responses (eg, reduced cognitive functioning and self‐esteem, increased negative affect and cortisol), especially among people who had experienced frequent weight discrimination in the past.

Methods

Adults (N = 109) with obesity were randomly assigned to receive a mildly positive (control) versus negative social evaluation. The extent to which participants attributed the negative evaluation to their physical appearance was assessed, along with negative affect, social and appearance self‐esteem, cognitive functioning and salivary cortisol.

Results

Participants who had experienced frequent weight discrimination in the past were more likely to attribute the negative evaluation to their appearance. Participants who attributed the negative evaluation to their appearance in turn experienced elevated negative affect, lower appearance self‐esteem and worse cognitive functioning.

Conclusions

This study is among the first to identify attribution as an early‐stage process underlying responses to weight stigma. Attribution may be a key psychological factor conferring risk for or protection from the negative effects of weight stigma.

Anticipated and Perceived Stigma Among Patients With Psoriasis

BACKGROUND

Perceived stigma among patients with psoriasis (PWP) is associated with poorer quality of life.

OBJECTIVE

To determine the prevalence and predictors of stigmatizing attitudes that PWP expect and experience from others.

METHODS

We conducted a survey using validated outcome measures to assess the extent to which PWP anticipate and perceive stigma from others. Demographic and clinical characteristics were obtained from electronic medical records.

RESULTS

Patients (n = 106) were 48.11% female, 70.75% white, and had a mean age ± SD of 47.90 ± 16.19 years old. Of all, 25.47% self-reported their psoriasis as severe. Mean physician global assessment score ± SD was 2.98 ± 1.81. Two-thirds (66.98%) of patients reported that, in response to seeing their psoriasis-affected skin, they anticipated others to stereotype them as "contagious." Linear regression analyses demonstrated that patient-reported severe psoriasis, compared to mild psoriasis, was associated with greater anticipation of negative stereotypes, social avoidance, and perceived stigma from others (P values < .05). Physician-measured body surface area and global assessment scores were not significantly associated with any outcome.

CONCLUSION

Prevalence of anticipated and perceived stigma among PWP is high. Our results suggest that objective measures of severity may not identify patients at risk of stigma-related distress. Additional methods, such as directly inquiring about stigmatizing experiences, may be needed.

Experiences of weight stigma in everyday life: An ecological momentary assessment study

Weight stigma and discrimination have been linked to negative health outcomes. Most research on this topic is retrospective, which may not accurately capture day-to-day experiences. The current used ecological momentary assessment to examine weight stigma and discrimination in everyday life. Participants answered ecological momentary assessments about the nature, frequency, and contextual details of weight stigma and discrimination. Over the course of the study, only eight episodes of weight stigma and discrimination were reported. Given that prior ecological momentary assessment studies reported substantially more frequent weight stigma and discrimination, possible explanations for the findings and implications for future research are discussed.

Impacto das Consequências Psicossociais do Estigma do Peso no Tratamento da Obesidade: uma Revisão Integrativa da Literatura

Resumo Trata-se de uma revisão integrativa da literatura, cujo objetivo foi investigar as consequências psicossociais do estigma do peso em adultos e sua influência no tratamento da obesidade. A busca envolveu as bases de dados PubMed, Web of Science e PsycINFO e incluiu artigos em inglês e português publicados nos últimos cinco anos. Foram selecionados quinze artigos, analisados a partir da definição de dois subtemas: “A relação entre estigma, psicopatologias e transtornos do comportamento alimentar” e “A estigmatização entre os profissionais de saúde”. Os resultados apontam para o grande impacto do estigma do peso na saúde psicossocial da pessoa com obesidade e para as atitudes estigmatizantes dos profissionais de saúde no cuidado terapêutico. Observa-se um enfoque patológico do enfrentamento da obesidade com estratégias de cunho comportamental que minimizam a compreensão da problemática. Atualmente, o tratamento da obesidade promovido pelo modelo biomédico não abrange as demandas de caráter psicossocial, o que torna necessário a educação permanente para capacitação dos profissionais de saúde e a implementação de protocolos de intervenção específicos a este grupo populacional. A contribuição de profissionais de diversas áreas, e em especial, daqueles de saúde mental, é essencial em atenção às diferentes particularidades do tratamento, devendo ser baseada em uma perspectiva integral e humanizada, e inserida nos diferentes contextos psicossociais. Devido à perversidade do estigma do peso e suas graves consequências, futuros estudos são necessários para investigação desse problema e das atitudes dos profissionais da saúde, familiares, mídia e da população em geral em relação à pessoa com obesidade.