The body politic: the relationship between stigma and obesity-associated disease

Mendelian randomization analysis separated the independent impact of childhood obesity and adult obesity on socioeconomic status, psychological status, and substance use

Background

Obesity is linked to a variety of psychosocial and behavioral outcomes but the causalities remain unclear yet. Determining the causalities and distinguishing between the separate effects of childhood and adult obesity is critical to develop more targeted strategies to prevent adverse outcomes.

Methods

With single nucleotide polymorphisms (SNPs) used as genetic variables, we employed univariable Mendelian randomization (UVMR) to explore the causalities between childhood and adult body mass index (BMI) and socioeconomic status, psychological status, and substance use. Genetic data for childhood and adult BMI came respectively from 47,541 children aged 10 years and 339,224 adult participants. The outcome data were obtained from corresponding consortia. The direct impact of childhood BMI and adult BMI was then examined using a multivariable MR (MVMR).

Results

UVMR found that higher childhood BMI was linked causally to lower household income (β = -0.06, 95 % CI = -0.08 ∼ -0.03, P = 4.86 × 10-5), decreased subjective well-being (β = -0.07, 95 % CI = -0.12 ∼ -0.03, P = 1.74 × 10-3), and an increased tendency of smoking regularly (OR = 1.12, 95 % CI = 1.04-1.20, P = 1.52 × 10-3). Similar results were observed in adult BMI. MVMR further revealed that after adjusting with adult BMI, childhood BMI remained an isolated impact on household income. The impacts of adult BMI on the outcomes were diminished when adjusting with childhood BMI.

Conclusion

The findings indicate the impacts of childhood obesity on subjective well-being and smoking initiation are a result of higher BMI sustaining into adulthood, whereas the effect on household income is attributed to a lasting impact of obesity in early life. The results would help facilitate more targeted strategies for obesity management to prevent adverse outcomes.

Does Terminology Matter When Measuring Stigmatizing Attitudes About Weight? Validation of a Brief, Modified Attitudes Toward Obese Persons Scale

Objective Commonly used terms like "obese person" have been identified as stigmatizing by those with lived experience. Thus, this study sought to revise a commonly used measure of weight stigmatizing attitudes, the Attitudes Toward Obese Persons (ATOP) scale. Methods The original terminology in the 20-item ATOP (e.g., "obese") was compared to a modified version using neutral terms (e.g., "higher weight"). Participants ( N  = 832) were randomized to either receive the original or modified ATOP. Results There was a statistically significant difference, with a low effect size ( d =-0.26), between the scores of participants who received the original ATOP ( M  = 69.25) and the modified ATOP ( M  = 72.85), t (414) = -2.27, p  = .024. Through principal component analysis, the modified ATOP was found to be best used as a brief, 8-item unidimensional measure. In a second sample, confirmatory factor analysis verified the fit of the brief, 8-item factor structure. Conclusions Findings suggest a modified, brief version of the ATOP (ATOP-Heigher Weight; ATOP-HW) with neutral language is suitable for assessing negative attitudes about higher-weight people. The ATOP-HW may slightly underestimate weight stigma compared to the original ATOP. Further examination of the terminology used in weight stigma measures is needed to determine how to best assess weight stigma without reinforcing stigmatizing attitudes. The findings of the present study suggest that the use of neutral terms in measures of anti-fat bias is a promising solution that warrants further investigation.

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.

"Whatever I said didn't register with her": medical fatphobia and interactional and relational disconnect in healthcare encounters

Introduction

This article focuses on medical fatphobia as a specific phenomenon structuring interactions between patients and healthcare practitioners. Throughout the article, we use 'fat' and 'fatphobia' as the preferred terms in the body positivity and fat acceptance communities. It is well documented that 'fat' people frequently experience negative and highly stigmatising healthcare encounters where weight is disproportionately centred and over-attributed as a cause of ill-health. This can compound and worsen disordered eating, trigger mental health problems, and lead to healthcare avoidance. Although the regularity and risks of these weight-focused encounters are well established, there does not yet exist a coherent theoretical framework for understanding such discriminatory practises.

Methods

In this article, we draw on the experiences of 15 fat women who are members of the Health at Every Size (HAES) online community to explore how they perceive their fatness impacting medical encounters.

Results and discussion

Through these data and specifically drawing on the framework of 'cultural health capital,' we suggest that given the deep purchase of cultural tropes surrounding it, fatness is perceived to embody and therefore confer on patients' assumptions of low cultural health capital. We argue that ubiquitously characteristic of medical fatphobia is what we call an 'interactional and relational disconnect' between fat patients and healthcare practitioners. We suggest that this disconnect structures fatphobic interactions by over-attributing fatness as the underlying cause of medical problems, which entrenches patient and practitioner ambivalence because of a lack of joint decision-making. We argue that interactional and relational disconnect is produced by, sustained by, and reproduces asymmetric power relations between patients and practitioners. While we demonstrate that patients develop tactics to mitigate and manage fatphobia in healthcare encounters, the persistent interactional asymmetry between doctors and patients means these attempts often fail. We conclude with a plea for sociology to take medical fatphobia seriously as a form of intersectional systemic discrimination. While movements like HAES, fat positivity, and body acceptance create kinship and support fat patients with self-advocacy in healthcare interactions, we suggest that systemic rather than individual change is necessary for effective healthcare inclusion and interaction.

Dual burden of infectious and chronic disease in low-resource U.S. communities: examining relationships between infection, adiposity, and inflammation

BACKGROUND

Rising global obesity rates are linked with inflammation and associated morbidities. These negative outcomes are generally more common in low-resource communities within high-income countries; however, it is unclear how frequent infectious disease exposures in these settings may influence the relationship between adiposity and inflammation.

AIM

We test associations between adiposity measures and distinct forms of inflammation among adults (n = 80) living in low-resource U.S. communities experiencing high levels of obesity and pathogen exposure.

SUBJECTS AND METHODS

Adiposity measures included BMI and percent body fat. Inflammation measures included systemic inflammation (C-reactive protein [CRP]) and localised intestinal inflammation (faecal calprotectin [FC]). The relationship between a condition characterised by elevated inflammation (Helicobacter pylori infection) and adiposity was also considered.

RESULTS

Adiposity was not significantly related to FC concentration. However, both adiposity measures were positively related with odds of CRP elevation and H. pylori infection was associated with significantly lower adiposity measures (all p < 0.05).

CONCLUSION

For this disadvantaged U.S. sample, the association between adiposity and inflammation varies by the systemic/localised nature of inflammation and the likely underlying cause of inflammation. Defining these associations will improve understanding of how rising obesity rates shape long-term health inequities, with implications for more effective intervention design.

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.

BMI and perceived weight on suicide attempts in Korean adolescents: findings from the Korea Youth Risk Behavior Survey (KYRBS) 2020 to 2021

BACKGROUND

Suicide is a leading cause of death in South Korea (hereafter 'Korea'), and there is evidence that body weight and perceived weight affecting suicide have a significant effect on suicidal behavior in adolescence. This study investigated the association between body mass index (BMI), perceived weight, and suicide attempts in adolescents.

METHODS

We included nationally representative data for a total of 106,320 students in our final analysis. We calculated and stratified BMI (underweight, normal weight, overweight) to determine the correlation between BMI and suicide attempts. We stratified the participants into three groups (perceived as underweight, normal weight, and overweight) for subjective body weight perception to analyze the relationship between subjective body weight perception and suicide attempts. We further analyzed the combination of BMI and subjective body weight perception to determine the relationship between suicide attempts and distorted subjective weight perception.

RESULTS

Compared with perceiving oneself as having a normal weight, the odds ratios (ORs) for suicide attempts were significantly increased in the group perceiving themselves as overweight. In addition, those who perceived themselves as overweight but were underweight according to their BMI were at significantly increased risk of suicide attempts relative to those who perceived themselves as about the right weight.

CONCLUSIONS

There was a significant association with suicide attempts in the underweight and perceived overweight group. This shows the importance of combining BMI and perceived weight when examining the relationship between weight and suicide attempts in adolescents.

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.

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.

The prevalence and practice impact of weight bias among New Zealand registered dietitians

AIM

This study explored demographics and three characteristics of registered dietitians-optimism, perfectionism, and weight bias and whether they affect three components of dietetics practice-dietetics assessment, dietetics recommendations, and dietitian's perception of the client's success.

METHODS

A self-administered questionnaire was completed by 92 registered dietitians and student dietitians in New Zealand to assess explicit weight bias. [Correction added on 27 January 2023, after first online publication: in the preceding sentence, '109 registered dietitians' has been updated to '92 registered dietitians'.] Participants were randomised to receive a case study for a condition unrelated to weight accompanied by a photo of a woman with either a smaller or a larger body. Participants then assessed the client based on data provided, provided recommendations, and rated their perception of the client.

RESULTS

Mean (±SD) scores indicated mild fatphobia (2.63±0.39) in participating dietitians. Dietitians presented with the photo of a larger client assessed the client to have lower health and were more likely to provide unsolicited weight management recommendations. Additionally, dietitians rated the larger client as less receptive and motivated, and less likely to understand the recommendations adequately, with a lower ability to comply with and maintain these recommendations.

CONCLUSIONS

Dietitians and student dietitians in New Zealand may practise in a manner that could be perceived as influenced by negative implicit weight bias, despite the explicit fatphobia scale scores assessing only mild fatphobia. Further research examining the extent of the problem in New Zealand, how it impacts client outcomes, and possible solutions are required.

Perception, risk factors, and health behaviours in adult obesity in Kolkata, India: a mixed methods approach

BACKGROUND

World Health Organisation has described obesity as one of the most neglected public health issues. Initially, obesity was only a problem in high-income countries; however, at present, it is rising in middle and low-income countries as well, rapidly in India, especially in the urban areas. In the light of the increasing prevalence of obesity in India, it was worthwhile to study perception, risk factors and health behaviours in adult obesity holistically.

METHODS

This study resorted to a concurrent mixed methods approach, collecting and combining quantitative survey (n = 120) and qualitative interview data (n = 18). Female and male aged 25-54 years with a waist circumference of 80 cm and 90 cm or higher, respectively, and a BMI of 25 or higher were selected from Kolkata, India. Kolkata was chosen as the study area since it ranked 7th out of 640 districts, the highest among the five major urban cities in India, with around 41% of the female and 43% of the male population aged 15-49 years with a BMI of 25 or higher.

RESULTS

Participants confirmed that lifestyle was one of the main reasons for obesity. They believed that family history, social relations, behavioural factors, urbanisation, and time-poor were significant risk factors of obesity. Interview participants expanded that technology, lack of health education and self-care, and digital marketing of food influenced the risk of obesity. Participants confirmed that they wanted to lose weight to feel healthier. Most respondents claimed that they engaged in lightly to moderate-intensity physical activity. However, a discrepancy in opinion was observed between survey responses and interview participants' views on dietary behaviours. Participants confirmed that they rarely consulted health professionals and that the family had a minimal role in preventing obesity. Interview participants expanded that people should make better lifestyle choices at an individual level to prevent obesity.

CONCLUSIONS

Health education is fundamental. Making better lifestyle choices is crucial, which would help increase the lifespan and health span and decrease the risk of diseases. In addition, social support and better policies are required to prevent the disease and any related complications.

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.

"I'm coming out!": An autoethnographic situation of sel/f/ves within queer fat chronically Ill identity

In this article, we (two fat, white, queer, nonbinary, chronically ill critical social work scholars) explore the parallel processes of coming out as fat and coming out as other identities (queer, femme, neurodivergent, nonbinary, chronically ill, disabled). We begin by reviewing literature from queer theories, crip theory, and fat studies, addressing concepts of "coming out" and identity. Next, taking an identity-centered autoethnographic and autoarchaeological approach, we explore how the processes in coming out as fat-growing critical consciousness, positive social identity reclamation, community belonging-mirrored other coming out processes, fostering resilience in our lives. We perform this reflection on sense(s) of self within a queer critical intersectional approach, as we individually and collectively examine how our fat identities are situated within our gender, racial, class, ability, health, and sexual orientation contexts. We interrogate how these identities of fatness and beyond, both privileged and oppressed, interplay in our personal, professional, and health-related experiences, and interactions with others. Finally, building off of the theoretical work proposed by Hunger, Major, and Blodorn (2015), we integrate concepts of critical consciousness, positive social identity, and community connectedness into the social identity threat model (as applied to weight stigma), hypothesizing how these potential positive outcomes of "coming out" may moderate the relationship between the psychological stress associated with marginalized identity and the adverse physical and mental health outcomes commonly associated with oppression and minority stress.

The acute effect of a laboratory shame induction protocol on endothelial function in young, healthy adults

NEW FINDINGS

What is the central question of this study? Shame is a form of social stress which involves internalizing social devaluations imposed by others. The aim of this study was to determine, for the first time, how acutely experiencing shame impacts endothelial function. What is the main finding and its importance? Brachial artery flow-mediated dilation, an index of endothelial function, was impaired following an intervention that acutely increased self reported shame. This occurred without increases in cortisol or tumor necrosis factor alpha receptor binding. Frequent or prolonged shame induced endothelial dysfunction could have important cardiovascular consequences.

ABSTRACT

Objective The objective of this study was to examine the impact of a shame induction protocol on endothelial function. Methods Fifteen participants (n = 7 men, n = 8 women) completed both a written shame induction and control protocol on two different experimental days. Pre- and post-protocol we assessed: 1) Endothelial function and arterial shear rate via a standard brachial artery reactive hyperemia flow-mediated dilation (FMD) test across two post-intervention time points (15 and 35-min post); 2) Perceived shame via the Experiential Shame Scale (ESS), and; 3) Cortisol and sTNFαRII (soluble tumor necrosis factor alpha receptor) through oral fluid analysis. Results Shame increased after the shame induction protocol (pre: 2.9±.6 vs. post: 3.7±.5, p<.001) but not the control protocol (pre: 3.0±.5 vs. post: 2.8±.5, p = .15) (protocol by time interaction: p<.001). When all three time points were included in the analysis, %FMD did not change over time. Considering only the lowest point, %FMD significantly decreased in response to the shame protocol (pre: 4.8±1.9 vs. post: 3.2±1.6, p<.001) but not the control protocol (4.2±1.8 vs. post: 3.8±1.5, p = .45) (protocol by time interaction: p = .035). Covariation of the shear rate stimulus for FMD did not alter the FMD results. When including both the control and shame protocol, but not the shame protocol alone, increased shame was significantly associated with decreased FMD (r = -.37, p<.046). There were no significant time by protocol interaction effects for cortisol or sTNFαRII. Conclusions Temporary increases in shame may cause transient endothelial dysfunction which, if chronically repeated, could manifest as reduced vasoprotection against atherosclerosis. This article is protected by copyright. All rights reserved.

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.

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.

Weight-Based Teasing and Metabolic Syndrome Components among Adolescent Military Dependents at Risk for Adult Obesity

Background: Among adults, weight stigma is associated with markers of poor cardiometabolic health. Although weight-based teasing (WBT) is common among youth with high body weight, few studies have examined its associations with cardiometabolic markers. Owing to unique stressors (e.g., parental deployment and frequent moves), military-dependent youth may be at particularly high risk for obesity, WBT, and poor cardiometabolic health. We, therefore, assessed associations between WBT and cardiometabolic health markers among adolescent military dependents presenting for a weight gain prevention trial. Methods: Participants underwent fasting phlebotomy; had fasting weight, height, and waist circumference measured; and completed assessments of WBT, anxiety, and loss-of-control eating. Multivariate analysis of covariance, adjusting for relevant covariates including demographics and body composition, was used to examine differences in metabolic syndrome (MetS) components (waist circumference, systolic and diastolic blood pressure, high-density lipoprotein cholesterol, triglycerides, and glucose) between youth reporting WBT and youth reporting no WBT. Bootstrapped models examined whether WBT mediated the relationship between BMIz and MetS components. Results: Data from 142 youth (57.7% female; 14.4 ± 1.6 years; 51.2% non-Hispanic White, 20.9% non-Hispanic Black; BMIz: 1.9 ± 0.4) were analyzed. WBT was not significantly associated with any MetS component. Relationships were observed between BMIz and all MetS components (except systolic blood pressure and glucose), although WBT did not significantly mediate these relationships (p's > 0.05). Conclusions: This study did not find support for a relationship between WBT and MetS components in adolescent military dependents at risk for adult obesity. Prospective research is needed to determine whether associations between WBT and adverse cardiometabolic outcomes emerge primarily in adulthood.

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.

Socioeconomics of Obesity

PURPOSE OF REVIEW

The purpose of this review is to evaluate and emphasize important findings in the recent literature regarding the socioeconomics of obesity. It is important to evaluate trends of this global epidemic and elucidate its impact on different demographic groups and across socioeconomic strata.

RECENT FINDINGS

Obesity rates continue to increase domestically and globally which is associated with a concomitant rise in medical and economic costs. There are disparities in obesity rates based on race/ethnicity, sex, gender and sexual identity, and socioeconomic status, yet these disparities are not explained fully by health behaviors, socioeconomic position, or cumulative stress alone-community and societal environmental factors have a significant role in the obesity epidemic. Socioeconomic factors contribute to obesity on an individual and community level, and any viable approach to sustainably addressing the obesity epidemic must take these factors into account.

Body Image and the Double Burden of Nutrition among South Africans from Diverse Sociodemographic Backgrounds: SANHANES-1

This study investigated the associations between underweight, obesity and body image (BI) among 15+ year-old South Africans with diverse socio-demographic backgrounds. A cross-sectional survey and the analyses of data for 6411 15+ year-old participants in the first South African National Health and Nutrition Examination Survey was undertaken. Body image was compared to body mass index (BMI) and socio-demography. Data were analyzed using SPSS versions 25. Results are in percentages, means, 95% confidence intervals, p-values, and odds ratios. Overall, participants who were obese of which majority: were females, earned ZAR 9601+, completed grade 6, were non-Black men, were married and resided in urban formal areas, were more likely to underestimate their BMI and desire to be lighter. Participants who were underweight of which majority: were males, had no form of income or education, were black men, were not married, resided in less urban and farm areas, were younger than 25 years, were more likely to overestimate their BMI and desire to be heavier. While underweight and obesity were strong determinants of BI, BI was differentiated by socio-demography. These findings have a public health implication that requires special attention to curb the irrepressible underweight and obesity in South Africa.

Effects of DCM Leaf Extract of Gnidia glauca (Fresen) on Locomotor Activity, Anxiety, and Exploration-Like Behaviors in High-Fat Diet-Induced Obese Rats

Obesity is the main component of metabolic syndromes involving distinct etiologies that target different underlying behavioral and physiological functions within the brain structures and neuronal circuits. An alteration in the neuronal circuitry stemming from abdominal or central obesity stimulates a cascade of changes in neurochemical signaling that directly or indirectly mediate spontaneously emitted behaviors such as locomotor activity patterns, anxiety, and exploration. Pharmacological agents available for the treatment of neurologic disorders have been associated with limited potency and intolerable adverse effects. These have necessitated the upsurge in the utilization of herbal prescriptions due to their affordability and easy accessibility and are firmly embedded within wider belief systems of many people. Gnidia glauca has been used in the management of many ailments including obesity and associated symptomatic complications. However, its upsurge in use has not been accompanied by empirical determination of these folkloric claims. The present study, therefore, is aimed at determining the modulatory effects of dichloromethane leaf extract of Gnidia glauca on locomotor activity, exploration, and anxiety-like behaviors in high-fat diet-induced obese rats in an open-field arena. Obesity was experimentally induced by feeding the rats with prepared high-fat diet and water ad libitum for 6 weeks. The in vivo antiobesity effects were determined by oral administration of G. glauca at dosage levels of 200, 250, and 300 mg/kg body weight in high-fat diet-induced obese rats from the 6^th to 12^th week. Phytochemical analysis was done using gas chromatography linked to mass spectroscopy. Results indicated that Gnidia glauca showed anxiolytic effects and significantly increased spontaneous locomotor activity and exploration-like behaviors in HFD-induced obese rats. The plant extract also contained phytocompounds that have been associated with amelioration of the main neurodegenerative mediators, viz., inflammation and oxidative stress. These findings provide “qualified leads” for the synthesis of new alternative therapeutic agents for the management of neurologic disorders. However, there is a need to conduct toxicity studies of Gnidia glauca to establish its safety profiles.

On Folk Devils, Moral Panics and New Wave Public Health

New wave public health places an emphasis on exhorting individuals to engage in healthy behaviour with good health being a signifier of virtuous moral standing, whereas poor health is often associated with personal moral failings. In effect, the medical is increasingly being collapsed into the moral. This approach is consistent with other aspects of contemporary neoliberal governance, but it fuels moral panics and creates folk devils. We explore the implications and dysfunctional consequences of this new wave of public health policy in the context of the latest moral panic around obesity.

Obesity and Reproduction

OBJECTIVE

To provide a comprehensive review and evidence-based recommendations for the delivery of fertility care to women with obesity.

OUTCOMES

The impact of obesity on fertility, fertility treatments, and both short and long-term maternal fetal outcomes was carefully considered.

EVIDENCE

Published literature was reviewed through searches of MEDLINE and CINAHL using appropriate vocabulary and key words. Results included systematic reviews, clinical trials, observational studies, clinical practice guidelines, and expert opinions.

VALUES

The Canadian Fertility & Andrology Society (CFAS) is a multidisciplinary, national non-profit society that serves as the voice of reproductive specialists, scientists, and allied health professionals working in the field of assisted reproduction in Canada. The evidence obtained for this guideline was reviewed and evaluated by the Clinical Practice Guideline (CPG) Committee of the CFAS under the leadership of the principal authors.

BENEFITS, HARMS, AND COSTS

The implementation of these recommendations should assist clinicians and other health care providers in counselling and providing reproductive care to women with obesity.

VALIDATION

This guideline and its recommendations have been reviewed and approved by the membership, the CPG Committee and the Board of Directors of the CFAS.

SPONSORS

Canadian Fertility & Andrology Society.

RECOMMENDATIONS

Twenty-one evidence based recommendations are provided. These recommendations specifically evaluate the impact of obesity on natural fertility, fertility treatments, and maternal-fetal outcomes. Strategies to lose weight and BMI cut-offs are also addressed.

The relationship between weight stigma, weight bias internalization, and physical health in military personnel with or at high-risk of overweight/obesity

Perceived weight stigma is associated with adverse health indices, such as elevated cortisol, lipid/glucose dysregulation, and poorer self-rated health. This relationship may be particularly relevant for military personnel, given the cultural emphasis on fitness and weight/shape. Therefore, we investigated the relationship between weight stigma and physical health in 117 active duty personnel (66.7% male; 56.4% non-Hispanic White; age: 30.8 ± 7.4 years; BMI: 29.5 ± 2.5 kg/m²). Participants reported weight stigma (general and military-specific), weight bias internalization, and the presence (≥1; n = 55) or absence (n = 62) of medical conditions. Logistic regressions were conducted examining the ability of weight stigma (general or military-specific) and weight bias internalization to predict the presence or absence of medical conditions. General weight stigma was not significantly associated with the presence of a medical condition (p > .05). However, individuals with military-specific weight stigma scores twice that of their peers were over three times more likely (p =  .04) to report a medical condition. Weight bias internalization was not significant in any model (ps > .20). Longitudinal studies should prospectively examine the relationship between weight stigma in the military setting and health among service members.

A dual continuum model of the reasons for use of complementary health approaches among overweight and obese adults: findings from the 2012 NHIS

BACKGROUND

Obese and overweight individuals have greater illness and disease burden, but previous findings from the 2002 National Health Interview Survey (NHIS) suggest that they are no more likely to use complementary health approaches (CHA) than those of normal weight. The current study investigates the relationship between weight status and CHA use, and among CHA users, examines differences in reasons for use by weight status. We propose and test a Dual Continuum Model of Motivations for Use of CHA to examine differences in reasons for use by weight status.

METHOD

Participants were drawn from the 2012 NHIS, a nationally representative sample of civilian, non-institutionalized US adults (N = 34,525). Weight status was operationalized by body mass index. CHA use was measured in the past year and was categorized into alternative providers, products, and practices. Among CHA users (N = 9307) factors associated with use were categorized as health enhancing or health reactive.

RESULTS

Logistic regression showed overweight and obese individuals were less likely to use alternative providers, products, and practices than normal weight. Multinomial logit regression showed some support that overweight and obese adults were less likely than normal weight persons to use CHA for health-enhancing reasons, and more likely to use for health reactive reasons.

CONCLUSIONS

Despite greater health burden, overweight and obese adults are underutilizing CHA, including modalities that can be helpful for health management. The Dual Continuum Model of CHA Motivations shows promise for explicating the diversity of reasons for CHA use among adults at risk for health problems.

Listen… and Speak: A Discussion of Weight Bias, its Intersections with Homophobia, Racism, and Misogyny, and Their Impacts on Health

This article is a version of the Ryley–Jeffs Memorial Lecture, delivered on 8 June 2018. It discusses weight bias and the intersections with homophobia, racism, and misogyny, and how these impact health. While the dominant discourse attests that people can lose weight and keep it off, evidence informs us that maintenance of weight loss is unlikely. Using a flawed epistemological framework, obesity has been declared a disease, and weight bias been perpetuated. Weight bias is pervasive, both in the general public and amongst health professionals, often using inappropriate tools to assess the impact of weight on health. This contributes to overlooking the life circumstances that truly cause morbidity: social determinants of health such as income, social connectedness and isolation, adverse childhood experiences, and cultural erasure. A variety of tools dietitians can use to appropriately assess health risk are provided, along with examples of actions that can be taken to reduce weight bias. Dietitians who are leading the profession in taking action against weight bias and stigma are profiled.

Body Mass Index, Perceived Weight, and Self-Rated Health among South Korean Adults: Conjoint Effect on Health?

The prevalence of overweight and obesity is rising rapidly in many countries, including South Korea. The present study examined the association between weight perception and self-rated health, independent of body weight status, as well as how weight status and perceived weight status intersect and relate to the self-rated health among adults in South Korea. Data were from 722 men and 800 women in 2010 Korean General Social Survey. Results showed that over half of Korean adults perceived their weight incorrectly with a fair agreement (men ƙ = 0.36; women ƙ = 0.31). Multivariate analyses indicated that poor/fair self-rated health had no significant association with body weight status, measured by self-reported weight and height, but it had a significant association with perceived weight status in men. The intersectionality analysis in which weight status and weight perceptions were cross-classified indicated that both measured and perceived weight status should be taken into account for the indicator of self-rated health as well as for better understanding of weight-related health consequences.

Mechanisms underlying weight status and healthcare avoidance in women: A study of weight stigma, body-related shame and guilt, and healthcare stress

Studies show that women with high BMI are less likely than thinner women to seek healthcare. We aimed to determine the mechanisms linking women's weight status to their healthcare avoidance. Women (N = 313) were surveyed from a U.S. health-panel database. We tested a theory-driven model containing multiple stigma and body-related constructs linking BMI to healthcare avoidance. The model had a good fit to the data. Higher BMI was related to greater experienced and internalized weight stigma, which were linked to greater body-related shame. Internalized weight stigma was also related to greater body-related guilt, which was associated with higher body-related shame. Body-related shame was associated with healthcare stress which ultimately contributed to healthcare avoidance. We discuss recommendations for a Weight Inclusive Approach to healthcare and the importance of enhancing education for health professionals in weight bias in order to increase appropriate use of preventive healthcare in higher weight women.

Body weight, perceived weight stigma and mental health among women at the intersection of race/ethnicity and socioeconomic status: insights from the modified labelling approach

With increasing rates of obesity in the United States, attention to life chances and psychological consequences associated with weight stigma and weight-based discrimination has also intensified. While research has demonstrated the negative effects of weight-based discrimination on mental health, little is known about whether different social groups are disproportionately vulnerable to these experiences. Drawing on the modified labelling theory, the focus of this paper is to investigate the psychological correlates of body weight and self-perceived weight-based discrimination among American women at the intersection of race/ethnicity and socioeconomic status (SES). Analyses use data from the National Health Measurement Study (NHMS), a national multi-stage probability sample of non-institutional, English-speaking adults, ages 35 to 89 in 2005-2006. Our findings demonstrate that the effect of weight-based discrimination on psychological well-being is highly contingent on social status. Specifically, the psychological consequences of discrimination on Hispanic women and women in the lowest household income group is significantly greater relative to White women and women with higher household income, controlling for obesity status and self-rated health. These results suggest that higher social status has a buffering effect of weight stigma on psychological well-being.

Cross-sectional and Prospective Examination of Weight Misperception and Depressive Symptoms Among Youth with Overweight and Obesity

This study aims to determine the association between weight misperception (considering oneself average or underweight) and depressive symptoms among youth with overweight/obesity. Linear regression models (adjusted for age, BMI, parental education, percent poverty) were used to examine cross-sectional (wave II, 1996, n = 3898, M _age = 15.9, SD = 0.13) and longitudinal (from wave II to IV, 1996-2008/2009, n = 2738, M _age = 28.5, SD = 0.06) associations between weight misperception and depressive symptoms (Center for Epidemiologic Studies-Depression Scale) in a subsample of White, Black, Asian, Hispanic, and Multi-racial male and female youth with overweight/obesity participating in the National Longitudinal Study of Adolescent Health. Average BMI was 29.0 (0.16) at wave II and 35.7 (0.23) at wave IV. Thirty-two percent misperceived their weight status as average weight (n = 1151, 30 %) or underweight (n = 99, 3 %). In fully adjusted cross-sectional models, White (β = -1.92, 95 % CI = -2.79, -1.06) and Multi-racial (β = -4.43, 95 % CI = -6.90, -1.95) youth who perceived themselves as average weight had significantly lower depressive symptoms compared to accurate weight-perceivers. In fully adjusted longitudinal models, White youth (β = -0.41, 95 % CI = -0.81, -0.004) who perceived themselves as average weight had significantly lower depressive symptoms 12 years later. Findings suggest that weight misperception may be protective against depression among White adolescents and young adults with overweight/obesity. Clinical and population interventions should consider potential harmful effects of correcting weight misperceptions on the mental health of youth with overweight/obesity.

Assessment of body perception, psychological distress, and subjective quality of life among obese and nonobese subjects in Turkey

BACKGROUND

Obesity can lead to psychological, social, and medical problems that may negatively affect the quality of life Aim: In our study, we aimed to evaluate the body perception, psychological distress, and subjective quality of life of obese subjects in comparison with normal weighted ones.

METHODS

A total of 494 subjects, aged between 18 and 64 years, were included to the study. Patients with the body mass index (BMI) of ≥18.5-24.9 kg/m2 were assigned to the control group; BMI ≥ 30 kg/m2 were assigned to the obese patient group. An ethical committee approval with protocol No. of 2011/242 was obtained from the Ethical Committee of Eskişehir Osmangazi University Faculty of Medicine. Interviews were performed two times with obese subjects in the 1st and the 6th month of weight loss program, once with the control group. Data identification form, the form which included the biochemical parameters, Trait Anxiety inventory, State anxiety scale, Quality of Life scale-Short Form [(SF-36)(QOL)], Multidimensional Body-Self Relations Questionnaire (MBSRQ), Zung Depression Rating Scale, and Zung Anxiety Rating Scale were applied to participants.

RESULTS

Obesity is more common in women. Obesity reduces the quality of life, negatively affects body perception, and triggers anxiety. Because of their body structure, obese individuals are exposed to social pressure and unethical attitudes.

CONCLUSIONS

Both health risks and social implications of obesity are important. Further studies are needed to ethically evaluate the psycho-social problems caused by obesity.

Subjective assessments of income and social class on health and survival: An enigma

We examined the association between various measures of subjective social class identification (SSCI) and self-rated health as well as survival using the 2014 General Social Survey-National Death Index dataset (n = 21,108). We used multinomial logistic regression models to assess the association between SSCI and self-rated health and used Cox proportional hazards to assess the association between SSCI and survival. All analyses were adjusted for age, year at interview, race, gender, family income, and educational attainment level. The measures of SSCI that we had available were strongly correlated with self-rated health after controlling for objective measures of social status. For example, those who saw themselves as lower class were nine times as likely to self-report poor rather than excellent health status (odds ratio = 8.69; 95% confidence interval = 5.04-14.98) compared with those saw themselves as upper class. However, no such associations were observed for survival. While our alternative measures of SSCI were important predictors of self-rated health, they were not predictive of survival. This suggests that there may be potential confounding between two perceptions: SSCI and self-rated health.

Stigma in Practice: Barriers to Health for Fat Women

In this paper, we explore barriers to health for fat people. By shifting the focus from what fat people do or do not do, neoliberal principles are replaced by a focus instead on structural and institutional policies, attitudes, and practices. This includes the impact of stigma on the health treatment and health-seeking behavior of fat people. For example, we consider the role that provider anti-fat attitudes and confirmation bias play in the failure to provide evidenced-based healthcare to fat patients. This is an autoethnographic paper, which provides the opportunity to read research from the perspective of fat scholars, framed by questions such as: can fat people have health? Is health itself a state of being, a set of behaviors, a commodity, a performance; perhaps the new social contract? As a co-written autoethnographic paper, one aspect of the evidence provided is the recorded experiences of the two fat authors. This includes writing from notes, journals, compiled and repeated experiences with medical professionals, family, and the community. Framed by feminist standpoint and supported by literature drawn from Fat Studies, Public Health, Obesity Research, and other interdisciplinary fields, this is a valuable opportunity to present an extended account of fat discrimination and the impact of the stigma fat people face through the medical profession and other sectors of the community, written by fat individuals. The paper concludes by considering the health pathways available to fat people. Special attention is paid to whether Bacon and Aphramor's Health at Every Size paradigm provides a path to health for fat individuals.

Perceived weight discrimination and chronic biochemical stress: A population-based study using cortisol in scalp hair

OBJECTIVE

There is increasing evidence for weight-based discrimination against persons with obesity. This study aimed to examine the physiological impact of perceived weight discrimination on cortisol in hair, an indicator of chronic stress exposure.

METHODS

Data were from 563 nonsmoking individuals with obesity (body mass index, BMI ≥30 kg/m² ) participating in the English Longitudinal Study of Ageing. Experiences of discrimination were reported via questionnaire, and hair cortisol concentrations were determined from the scalp-nearest 2-cm hair segment. Height and weight were objectively measured. ANCOVAs tested associations between perceived weight discrimination and hair cortisol concentration overall and by degree of obesity. All analyses were adjusted for age, sex, ethnicity, socioeconomic status, and BMI.

RESULTS

Mean hair cortisol concentrations were 33% higher in those who had experienced weight discrimination than those who had not (mean log pg/mg 1.241 vs. 0.933, F = 12.01, P = 0.001). The association between weight discrimination and hair cortisol was particularly pronounced in individuals with severe (class II/III) obesity (1.402 vs. 0.972, F = 11.58, P = 0.001).

CONCLUSIONS

Weight discrimination is associated with the experience of stress at a biological level. Chronic exposure to elevated levels of cortisol may play a role in generating a vicious circle of weight gain and discrimination and contribute to obesity-associated health conditions.

A scoping review of weight bias by community pharmacists towards people with obesity and mental illness

BACKGROUND

Community pharmacists are accessible health care professionals who are increasingly offering weight management programs. People living with serious mental illness have markedly higher rates of obesity and associated illness outcomes than the general population, providing pharmacists who are interested in offering weight management services with an identifiable patient subgroup with increased health needs. Issues with stigma within obesity and mental illness care are prevalent and can lead to inequities and reduced quality of care.

METHODS

We conducted a scoping review to map and characterize the available information from published and grey literature sources regarding community pharmacists and weight bias towards obese people with lived experience of mental illness. A staged approach to the scoping review was used.

RESULTS

Six articles and 6 websites were abstracted after we removed duplicates and applied our inclusion and exclusion criteria. The published studies that we found indicated that pharmacists and pharmacy students do demonstrate implicit and explicit weight bias.

CONCLUSIONS

Very limited research is available regarding weight bias in pharmacists and stigma towards people with obesity, and we found no information on these phenomena relating to people with lived experience of mental illness. Investigations are needed to characterize the extent and nature of anti-fat bias and attitudes by pharmacists and the consequences of these attitudes for patient care.

Internalized weight stigma moderates eating behavior outcomes in women with high BMI participating in a healthy living program

Weight stigma is a significant socio-structural barrier to reducing health disparities and improving quality of life for higher weight individuals. The aim of this study was to examine the impact of internalized weight stigma on eating behaviors after participating in a randomized controlled trial comparing the health benefits of a weight-neutral program to a conventional weight-management program for 80 community women with high body mass index (BMI > 30, age range: 30-45). Programs involved 6 months of facilitator-guided weekly group meetings using structured manuals. Assessments occurred at baseline, post-intervention (6 months), and 24-months post-randomization. Eating behavior outcome measurements included the Eating Disorder Examination-Questionnaire and the Intuitive Eating Scale. Intention-to-treat linear mixed models were used to test for higher-order interactions between internalized weight stigma, group, and time. Findings revealed significant 3-way and 2-way interactions between internalized weight stigma, group, and time for disordered and adaptive eating behaviors, respectively. Only weight-neutral program participants with low internalized weight stigma improved global disordered eating scores. Participants from both programs with low internalized weight stigma improved adaptive eating at 6 months, but only weight-neutral program participants maintained changes at follow-up. Participants with high internalized weight stigma demonstrated no changes in disordered and adaptive eating, regardless of program. In order to enhance the overall benefit from weight-neutral approaches, these findings underscore the need to incorporate more innovative and direct methods to reduce internalized weight stigma for women with high BMI.

Pressure To Be Thin and Insulin Sensitivity Among Adolescents

PURPOSE

Extant research indicates that some of the comorbidities associated with adult obesity may be adversely affected by the stress resulting from negative body image and weight-related stigma. This study examined the association between weight-related pressure and insulin sensitivity in adolescents, who are vulnerable to both weight-based teasing and the onset of metabolic dysregulation.

METHODS

Participants were 215 adolescent healthy volunteers (55% female; 59% white; 35% overweight/obese; mean ± standard deviation age = 15.4 ± 1.4 year), who completed a self-report measure of pressure to be thin from parents, friends, and romantic partners. Fasting blood samples were obtained to assess serum insulin and glucose, which were used to calculate insulin sensitivity; fat mass (kg) and fat-free mass (%) were measured with air-displacement plethysmography. Pubertal stage was determined by physical examination.

RESULTS

Pressure to be thin was positively associated with fasting insulin (p = .01) and negatively associated with insulin sensitivity (p = .02), after controlling for pubertal stage, sex, race, height, fat-free mass, and adiposity. Pressure to be thin was associated with a greater odds of having hyperinsulinemia (fasting insulin ≥ 15 μIU/mL; odds ratio (95% confidence interval): 1.65 [1.08-2.50], p = .02), adjusting for the same covariates.

CONCLUSIONS

Results indicate that adolescents perceiving more pressure to be thin have greater elevations of fasting insulin and poorer insulin sensitivity above and beyond the effect of fat mass. Future research is warranted to elucidate the mechanisms responsible for this relationship.

Implicit Cognition: Implications for Global Health Disparities

Implicit cognition, or our unconscious thoughts and beliefs, is an important predictor of our behaviors and decisions. It also predicts outcomes related to physical and mental health at the level of the individual and influences the dynamics of the patient-physician relationship. This article outlines specific ways in which implicit measures of cognition predict vulnerabilities to adverse health and contribute to social disparities in health and discusses important future directions for this body of research.

Weight Discrimination and Risk of Mortality

Discrimination based on weight is a stressful social experience linked to declines in physical and mental health. We examined whether this harmful association extends to risk of mortality. Participants in the Health and Retirement Study (HRS; N = 13,692) and the Midlife in the United States Study (MIDUS; N = 5,079) reported on perceived discriminatory experiences and attributed those experiences to a number of personal characteristics, including weight. Weight discrimination was associated with an increase in mortality risk of nearly 60% in both HRS participants (hazard ratio = 1.57, 95% confidence interval = [1.34, 1.84]) and MIDUS participants (hazard ratio = 1.59, 95% confidence interval = [1.09, 2.31]). This increased risk was not accounted for by common physical and psychological risk factors. The association between mortality and weight discrimination was generally stronger than that between mortality and other attributions for discrimination. In addition to its association with poor health outcomes, weight discrimination may shorten life expectancy.

Correlates of weight stigma in adults with overweight and obesity: A systematic literature review

OBJECTIVE

While evidence regarding associations between weight stigma and biopsychosocial outcomes is accumulating, outcomes are considered in isolation. Thus, little is known about their complex relationships. This article extends existing work by systematically reviewing the biopsychosocial consequences of stigma in adults with overweight/obesity.

METHODS

Articles were identified through Medline, CINAHL, PsycINFO, Embase, Web of Science, and Cochrane databases. Independent extraction of articles was conducted using predefined data fields, including data on biopsychosocial correlates in each study.

RESULTS

Twenty-three studies published from 2001 and addressing correlates of stigma in adults with overweight/obesity (body mass index ≥25 kg m(-2); 18-65 years) were identified. Numerous biopsychosocial correlates of weight stigma were studied, particularly in treatment-seeking individuals. Available research shows that weight stigma is consistently associated with medication non-adherence, mental health, anxiety, perceived stress, antisocial behavior, substance use, coping strategies, and social support. Biopsychosocial correlates were not considered in combination in research. Psychological correlates were well documented in comparison to biological and social correlates for each weight stigma type. There were some indications that associations are stronger once stigma is internalized.

CONCLUSIONS

While there is evidence for biopsychosocial correlates of weight stigma, these are not considered in combination in research; thus their inter-relationships are unknown. Conclusions from the review are limited by this and the small number of studies, types of designs, and variables considered.

Associations of weight stigma with cortisol and oxidative stress independent of adiposity

OBJECTIVE

Weight discrimination is associated with increased risk of obesity. The mechanism of this relationship is unknown, but being overweight is a highly stigmatized condition and may be a source of chronic stress that contributes to the development and pathophysiology of obesity. The objective of this study was to test whether weight stigma is associated with physiological risk factors linked to stress and obesity, including hypercortisolism and oxidative stress, independent of adiposity.

METHOD

We examined the frequency of experiencing situations involving weight stigma and consciousness of weight stigma in relation to hypothalamic--pituitary--adrenal axis activity and oxidative stress (F₂-isoprostanes) in 45 healthy overweight to obese women.

RESULTS

Independent of abdominal fat, weight stigma was significantly related to measures of cortisol (including salivary measures of cortisol awakening response and serum morning levels) as well as higher levels of oxidative stress. Perceived stress mediated the relationship between weight stigma consciousness and the cortisol awakening response.

CONCLUSION

These preliminary findings show that weight stigma is associated with greater biochemical stress, independent of level of adiposity. It is possible that weight stigma may contribute to poor health underlying some forms of obesity.

Weighed down by stigma: How weight-based social identity threat contributes to weight gain and poor health

Weight stigma is pervasive, and a number of scholars argue that this profound stigma contributes to the negative effects of weight on psychological and physical health. Some lay individuals and health professionals assume that stigmatizing weight can actually motivate healthier behaviors and promote weight loss. However, as we review, weight stigma is consistently associated with poorer mental and physical health outcomes. In this article we propose a social identity threat model elucidating how weight stigma contributes to weight gain and poorer mental and physical health among overweight individuals. We propose that weight-based social identity threat increases physiological stress, undermines self-regulation, compromises psychological health, and increases the motivation to avoid stigmatizing domains (e.g., the gym) and escape the stigma by engaging in unhealthy weight loss behaviors. Given the prevalence of overweight and obesity in the US, weight stigma thus has the potential to undermine the health and wellbeing of millions of Americans.

The Psychosocial Factors Related to Obesity: A Study Among Overweight, Obese, and Morbidly Obese Women in India

Psychosocial factors among overweight, obese, and morbidly obese women in Delhi, India were examined. A follow-up survey was conducted of 325 ever-married women aged 20-54 years, systematically selected from 1998-99 National Family Health Survey samples, who were re-interviewed after 4 years in 2003. Information on day-to-day problems, body image dissatisfaction, sexual dissatisfaction, and stigma and discrimination were collected and anthropometric measurements were obtained from women to compute their current body mass index. Three out of four overweight women (BMI between 25 and 29.9 kg/m(2)) were not happy with their body image, compared to four out of five obese women (BMI of 30 kg/m(2) or greater), and almost all (95 percent) morbidly obese women (BMI of 35 kg/m(2) or greater) (p < .0001). It was found that morbidly obese and obese women were five times (adjusted odds ratio [aOR] 5.29, 95% confidence interval [CI] 2.02-13.81, p < .001) and two times (aOR 2.30, 95% CI 1.20-4.42, p < .001), respectively, as likely to report day-to-day problems; twelve times (aOR 11.88, 95% CI 2.62-53.87, p < .001) and three times, respectively, as likely (aOR 2.92, 95% CI 1.45-5.88, p = .001) to report dissatisfaction with body image; and nine times (aOR 9.41, 95% CI 2.96-29.94, p < .001) and three times (aOR 2.93, 95% CI 1.03-8.37, p = .001), respectively, as likely to report stigma and discrimination as overweight women.

Impact of weight bias and stigma on quality of care and outcomes for patients with obesity

The objective of this study was to critically review the empirical evidence from all relevant disciplines regarding obesity stigma in order to (i) determine the implications of obesity stigma for healthcare providers and their patients with obesity and (ii) identify strategies to improve care for patients with obesity. We conducted a search of Medline and PsychInfo for all peer-reviewed papers presenting original empirical data relevant to stigma, bias, discrimination, prejudice and medical care. We then performed a narrative review of the existing empirical evidence regarding the impact of obesity stigma and weight bias for healthcare quality and outcomes. Many healthcare providers hold strong negative attitudes and stereotypes about people with obesity. There is considerable evidence that such attitudes influence person-perceptions, judgment, interpersonal behaviour and decision-making. These attitudes may impact the care they provide. Experiences of or expectations for poor treatment may cause stress and avoidance of care, mistrust of doctors and poor adherence among patients with obesity. Stigma can reduce the quality of care for patients with obesity despite the best intentions of healthcare providers to provide high-quality care. There are several potential intervention strategies that may reduce the impact of obesity stigma on quality of care.