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Wu R, Puhl RM, Lessard LM, Foster GD, Cardel MI. Exploring the interplay of weight-based teasing and sociodemographic factors in adolescent weight bias internalization. J Pediatr Psychol 2024; 49:547-558. [PMID: 38853703 DOI: 10.1093/jpepsy/jsae042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 05/21/2024] [Accepted: 05/24/2024] [Indexed: 06/11/2024] Open
Abstract
OBJECTIVE Research has highlighted the potential adverse effects of weight bias internalization (WBI) on adolescents, but there has been little examination of WBI and sources of weight teasing (family, peers, or both) or across racial/ethnic diversity of adolescents. We aimed to examine the relationship between WBI and sources of weight teasing across sociodemographic characteristics and weight status in a diverse community sample of adolescents. METHODS Data were collected from a U.S. sample of 1859 adolescents aged 10-17 years (59% female; 43% White, 27% Black or African American, and 25% Latino). An online questionnaire was used to assess participants' experiences of weight teasing from family members, peers, or both, and their weight status, weight-related goals, WBI, and sociodemographic characteristics. RESULTS Adolescents experiencing weight teasing from both family and peers reported the highest levels of WBI, while those reporting no teasing exhibited the lowest levels. These patterns were observed across sex, race/ethnicity, weight status, and weight goals, and persisted after controlling for depressive symptoms. Notably, family influences played a salient role, with adolescents reporting higher WBI if teased by family only compared to teasing from peers only. Sex and racial differences were also observed in adolescents' experiences with weight-based teasing. CONCLUSION Our study reveals associations between adolescent weight-based teasing, WBI, and sociodemographic factors. Weight-based teasing, whether from family and peers or from family only, was associated with increased WBI. Interventions targeting weight stigma in youth should not be limited to peer-focused efforts, but should also emphasize supportive family communication.
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Affiliation(s)
- Rui Wu
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, United States
| | - Rebecca M Puhl
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, United States
- Rudd Center for Food Policy and Health, University of Connecticut, Hartford, CT, United States
| | - Leah M Lessard
- Rudd Center for Food Policy and Health, University of Connecticut, Hartford, CT, United States
| | - Gary D Foster
- WW International, Inc, New York, NY, United States
- Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Michelle I Cardel
- Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, United States
- Center for Integrative Cardiovascular and Metabolic Disease, University of Florida, Gainesville, FL, United States
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2
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Rancaño KM, Puhl R, Skeer M, Eliasziw M, Must A. Negative familial weight talk and weight bias internalization in a US sample of children and adolescents. Pediatr Obes 2024; 19:e13108. [PMID: 38375755 PMCID: PMC11006571 DOI: 10.1111/ijpo.13108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Negative familial weight talk may contribute to higher weight bias internalization in pre- and early adolescents (hereafter referred to as children) and may differ by gender, weight status, and race and ethnicity. OBJECTIVE Examine the relationship between negative familial weight talk and weight bias internalization and examine differences by gender, weight status, and race and ethnicity. METHODS We cross-sectionally analysed 5th-7th graders (10-15 years old) living in Massachusetts (n = 375, 52.3% girls, 21.3% BMI ≥85th percentile, 54.8% non-Hispanic White). Negative familial weight talk frequency during the past 3 months was self-reported and discretized as 'never,' 'occasionally' (1-9 times) and 'often' (>9 times); the Modified Weight Bias Internalization Scale assessed weight bias internalization. Generalized linear models estimated the relationship between negative familial weight talk and weight bias internalization and sub-analyses estimated the relationship across gender, weight status, and race and ethnicity. Results are summarized as ratios of means (RoM). RESULTS Children experiencing negative familial weight talk occasionally (RoM = 1.12, p = 0.024) and often (RoM = 1.48, p < 0.001) had significantly higher weight bias internalization than children who never experienced it. In sub-analyses, experiencing negative familial weight talk often was associated with higher weight bias internalization among girls (RoM = 1.66, p < 0.001), boys (RoM = 1.32, p = 0.007), children with BMI <85th percentile (RoM = 1.44, p = 0.007) and BMI ≥85th percentile (RoM = 1.39, p = 0.001), and non-Hispanic White children (RoM = 1.78, p < 0.001), but not Hispanic (RoM = 1.25, p = 0.085) or non-Hispanic Black children (RoM = 1.20; p = 0.31). CONCLUSIONS Frequent negative familial weight talk was associated with higher weight bias internalization across gender and weight status and in non-Hispanic White children only.
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Affiliation(s)
- Katherine M. Rancaño
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston MA, Boston, MA
| | - Rebecca Puhl
- Department of Human Development & Family Sciences, University of Connecticut, Storrs, Connecticut
| | - Margie Skeer
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston MA, Boston, MA
| | - Misha Eliasziw
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston MA, Boston, MA
| | - Aviva Must
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston MA, Boston, MA
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3
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Foster T, Eaton M, Probst Y. The relationship between internalised weight bias and biopsychosocial outcomes in children and youth: a systematic review. J Eat Disord 2024; 12:38. [PMID: 38491402 PMCID: PMC10941429 DOI: 10.1186/s40337-023-00959-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 12/20/2023] [Indexed: 03/18/2024] Open
Abstract
OBJECTIVE To synthesise the evidence on the relationships between internalised weight bias (IWB) and biopsychosocial health outcomes in individuals ≤ 25 years. METHODS A systematic review was conducted by searching five scientific databases up to May 2022 to retrieve studies that investigated associations between IWB and biopsychosocial outcomes. Articles with participants ≤ 25 years, at least one validated measure of IWB, one measure of a biopsychosocial outcome, and were observational were included. Excluded articles involved systematic literature reviews, case study reports, intervention studies, meta-analyses, grey literature, pilot, and feasibility studies. Quality assessment was carried out using the American Dietetic Association Quality Criteria Checklist. The protocol was registered with PROSPERO, ID number CRD42022323876. RESULTS Two hundred and sixty-six articles were identified. Nineteen were eligible for inclusion, (15 cross-sectional and 4 prospective). The Weight Bias Internalization Scale and the Weight Self-Stigma Questionnaire were the most used tools to assess IWB with large heterogeneity in tool types used to assess biopsychosocial measures. IWB had positive associations with psychopathology, eating disorder symptomology, higher BMI, being female, and experiences of weight stigma. It was negatively associated with quality of life, body image, physical activity, social ability, self-esteem, and socioeconomic status. DISCUSSION IWB associated with adverse biopsychosocial outcomes in children and youth populations. IWB may be more clinically relevant in assessing at-risk children and youth than physical weight due to its psychosocial aspects and ability to expand beyond the scope of BMI. Research would benefit from better assessment tools designed for children and youth that accurately measure IWB. Future research should focus on increased diversity and longitudinal study designs with children and youth-specific populations.
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Affiliation(s)
- Tiarna Foster
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, NSW, Australia
| | - Melissa Eaton
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, NSW, Australia
| | - Yasmine Probst
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, NSW, Australia.
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4
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Levinson JA, Kinkel-Ram S, Myers B, Hunger JM. A systematic review of weight stigma and disordered eating cognitions and behaviors. Body Image 2024; 48:101678. [PMID: 38278088 PMCID: PMC11180546 DOI: 10.1016/j.bodyim.2023.101678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/23/2023] [Accepted: 12/27/2023] [Indexed: 01/28/2024]
Abstract
Weight stigma is persistent across contexts and is associated with disordered eating cognitions and behaviors. This systematic review aimed to examine the existing literature that has explored the relationship between weight stigma and disordered eating cognitions and behaviors. We specifically examined three dimensions of weight stigma - experienced, anticipated, and internalized - and adopted an inclusive conceptualization of outcomes related to disordered eating (including constructs such as binge eating, body dissatisfaction, and other cognitions and behaviors such as dietary restraint, unhealthy weight control behaviors, and drive for thinness). We searched PubMed, Embase, CINAHL, Web of Science, Sociological Abstracts, and PsycINFO for English-language, peer-reviewed articles and dissertations with quantitative methodology published through October 2023. The search resulted in 242 articles meeting inclusion criteria. A narrative review found a consistent relationship between greater weight stigma and more disordered eating cognitions and behaviors. Methodological and theoretical limitations are discussed, as are critical avenues for future research and potential clinical implications stemming from this body of research. Given the widespread nature and impact of weight stigma on disordered eating, it is imperative that we intervene to address weight stigma at all levels, from the structural to the intrapersonal.
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Affiliation(s)
- Jordan A Levinson
- Department of Psychology, University of California Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA 90095, United States
| | - Shruti Kinkel-Ram
- Department of Psychology, Miami University, 90 N Patterson Avenue, Oxford, OH 45056, United States
| | - Bethany Myers
- University of California Los Angeles, Los Angeles, CA 90095, United States
| | - Jeffrey M Hunger
- Department of Psychology, Miami University, 90 N Patterson Avenue, Oxford, OH 45056, United States.
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5
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Newson L, Sides N, Rashidi A. The psychosocial beliefs, experiences and expectations of children living with obesity. Health Expect 2024; 27:e13973. [PMID: 39102658 PMCID: PMC10795089 DOI: 10.1111/hex.13973] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 12/23/2023] [Accepted: 01/03/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND Childhood obesity has been shown to impair psychological health. However, psychological factors are often overlooked in both research evaluations and treatment interventions, and children's perspectives on managing obesity are underexplored. Neglecting psychosocial factors might undermine interventions. This research explored the psychological beliefs, expectations and experiences of children living with obesity (range 7-13) and attending a weight management programme (WMP). METHODS Thirty-four participants (19 females, 15 males, average age 9.5 years) completed a semistructured interview. Recorded interviews were transcribed verbatim and analysed using thematic analysis. RESULTS Four overarching themes were developed: (1) defining health and self-recognition; (2) external influence; feedback, stigma and comparison; (3) recognising emotions and (4) future expectations: obesity is a reality. These themes interact to influence the children's psychosocial status. CONCLUSIONS This study highlights a range of psychosocial and emotional difficulties that children living with obesity experience and suggests that these remain regardless of their attendance at a WMP. Interventions for children living with obesity should address psychosocial factors, including stress management, peer victimisation and handling feedback from others. PATIENT OR PUBLIC CONTRIBUTION As proposed by the two young people acting as patient and public involvement and engagement representatives, the utilisation of scrapbooks as a preinterview tool was particularly helpful in aiding discussion during the interviews. This innovative approach could be considered a valuable methodological technique for investigating sensitive topics with children in future research.
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Affiliation(s)
- Lisa Newson
- School of Psychology, Faculty of HealthLiverpool John Moores UniversityLiverpoolUK
| | | | - Amineh Rashidi
- School of Nursing and MidwiferyEdith Cowan UniversityJoondalupAustralia
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6
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Waldrop SW, Wang D, Kancherla D, Stanford FC. Current status of weight bias and stigma in pediatrics and the need for greater focus on populations at risk. Curr Opin Pediatr 2024; 36:42-48. [PMID: 37965910 PMCID: PMC10873084 DOI: 10.1097/mop.0000000000001305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
PURPOSE OF REVIEW Obesity is one of the most common pediatric chronic conditions in the United States, affecting approximately 20% of American youth and is more common amongst Black, Latino, and Indigenous and low socioeconomic populations. The condition places children and adolescents at increased risk of physical and mental health conditions partly mediated by the weight bias and stigmatization experienced during the potentially vulnerable periods of childhood and adolescence. RECENT FINDINGS Weight bias and the resulting stigma are pervasive in society. Children have been shown to internalize this bias and its devaluation, which have been shown to contribute to worsening metabolic and mental health outcomes independently. Studies suggest weight stigmatization more adversely affects Black, Latino, and Indigenous children, suggesting the potential for adverse synergistic effects of these historical biases on such youth. SUMMARY Addressing childhood obesity successfully across all racial, ethnic, and socioeconomic lines requires addressing weight bias and stigma. Steps toward this end include collaborative efforts to promote cross-cultural competence and upstander bias education and training for those who care for children, person-centered communication, and a culture of inclusivity across governmental, healthcare, educational, entertainment, and advertising sectors.
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Affiliation(s)
- Stephanie W. Waldrop
- Section on Nutrition Department of Pediatrics, University of Colorado School of Medicine, Nutrition Obesity Research Center at the University of Colorado, Aurora, CO, USA
| | - Daisy Wang
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | | | - Fatima Cody Stanford
- Massachusetts General Hospital, MGH Weight Center, Department of Medicine-Division of Endocrinology-Neuroendocrine, Department of Pediatrics-Division of Endocrinology, Nutrition Obesity Research Center at Harvard (NORCH), Boston, MA, USA
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7
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Slimi O, Marsigliante S, Ciardo V, Bahloul M, Selmi O, Jebabli N, Muscella A. The effects of adapted physical education sessions on the empathy of female students with overweight. Front Psychol 2023; 14:1170446. [PMID: 37325765 PMCID: PMC10264700 DOI: 10.3389/fpsyg.2023.1170446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/04/2023] [Indexed: 06/17/2023] Open
Abstract
The global prevalence of childhood and adolescent overweight and obesity increases rapidly. Physical activity plays a major role in the prevention of obesity. The present study aimed to analyze the effect of adapted basketball sessions according to the empathic capacity of adolescent girls with overweight. Forty-two girls with overweight (age: 16.09 ± 0.85; years; height: 1.64 ± 0.67 m: weight: 73.02 ± 0.61 kg; BMI: 27.15 ± 1.37) volunteered to participate in the study and were randomly assigned to the experimental group (EG, n = 21) and control group (CG, n = 21). EG was submitted to a basketball intervention adapted to students with obesity while the CG performed classic basketball exercises for 7 weeks. Each week girls had 2 basketball teaching-learning sessions, lasting 50 min. The participants' empathy was assessed before and after the intervention using the Favre CEC. The results showed that adaptation intervention was associated with a significant emotional contagion decrease (Δ% = 0.466) and splitting with emotions (Δ% = 0.375), and with an empathy increase (Δ% = 1.387), in EG compared to CG. No significant difference was assessed in the empathy CG, before and after the intervention. This study demonstrated that adapted physical education classes could be an effective strategy to improve empathetic skills and inclusion of overweight girls as well as a means to prevent obesity.
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Affiliation(s)
- Oumayma Slimi
- Higher Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Santo Marsigliante
- Department of Biological and Environmental Sciences and Technologies (Di.S.Te.B.A.), University of Salento, Lecce, Italy
| | - Vito Ciardo
- Department of Biological and Environmental Science and Technologies, University of Salento, Lecce, Italy
| | - Mourad Bahloul
- Higher Institute of Education and Continuing Training, Virtual University of Tunis, Tunis, Tunisia
- Higher Institute of Business Administration of Sfax, University of Sfax, Sfax, Tunisia
| | - Okba Selmi
- Higher Institute of Sports and Physical Education of Kef, University of Jendouba, Kef, Tunisia
| | - Nidhal Jebabli
- Higher Institute of Sports and Physical Education of Kef, University of Jendouba, Kef, Tunisia
| | - Antonella Muscella
- Department of Biological and Environmental Sciences and Technologies (Di.S.Te.B.A.), University of Salento, Lecce, Italy
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8
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He J, Barnhart WR, Zhang Y, Han J, Wang Z, Cui S, Nagata JM. Muscularity teasing and its relations with muscularity bias internalization, muscularity-oriented body dissatisfaction, and muscularity-oriented disordered eating in Chinese adult men. Body Image 2023; 45:382-390. [PMID: 37104997 DOI: 10.1016/j.bodyim.2023.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 03/31/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023]
Abstract
Despite increasing research on weight teasing and other forms of appearance teasing, muscularity teasing, which occurs when an individual is victimized due to low muscularity, has not yet received research attention. Given the solid evidence of positive relations between weight teasing and thinness-oriented body dissatisfaction and disordered eating, we aimed to tap into muscularity teasing and examine its relations with muscularity-oriented body dissatisfaction and muscularity-oriented disordered eating (e.g., rigid dietary rules for enhancing muscularity). A sample of 500 Chinese men, aged 18 - 62 years, were recruited online, and they competed questionnaires assessing muscularity teasing, muscularity bias internalization, muscularity-oriented body dissatisfaction, and muscularity-oriented disordered eating. Correlation analyses showed that muscularity teasing was significantly related to muscularity bias internalization (r = 0.55, p < .001), muscularity-oriented body dissatisfaction (r = 0.50, p < .001), and muscularity-oriented disordered eating (r = 0.38, p < .001). Structural equation modelling indicated that muscularity bias internalization and muscularity-oriented body dissatisfaction, as concurrent mediators, fully mediated the relationships between muscularity teasing and muscularity-oriented disordered eating. Findings extend existing knowledge in appearance teasing research to encompass muscularity teasing in order to better understand the etiology of muscularity-oriented body dissatisfaction and muscularity-oriented disordered eating.
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Affiliation(s)
- Jinbo He
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, China.
| | - Wesley R Barnhart
- Department of Psychology, Bowling Green State University, Bowling Green, OH, USA
| | - Yuchen Zhang
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, China
| | - Jiayi Han
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, China
| | - Ziyue Wang
- School of Humanities and Social Sciences, Beijing Forestry University, Beijing, China
| | - Shuqi Cui
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, China
| | - Jason M Nagata
- Division of Adolescent & Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
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9
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Hampl SE, Hassink SG, Skinner AC, Armstrong SC, Barlow SE, Bolling CF, Avila Edwards KC, Eneli I, Hamre R, Joseph MM, Lunsford D, Mendonca E, Michalsky MP, Mirza N, Ochoa ER, Sharifi M, Staiano AE, Weedn AE, Flinn SK, Lindros J, Okechukwu K. Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. Pediatrics 2023; 151:e2022060640. [PMID: 36622115 DOI: 10.1542/peds.2022-060640] [Citation(s) in RCA: 271] [Impact Index Per Article: 271.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 01/10/2023] Open
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10
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Barnhart WR, Cui S, Cui T, He J. Relationships between weight bias internalization and biopsychosocial health outcomes: A prospective study in Chinese adolescents. Int J Eat Disord 2023; 56:1021-1033. [PMID: 36706116 DOI: 10.1002/eat.23904] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 01/14/2023] [Accepted: 01/15/2023] [Indexed: 01/28/2023]
Abstract
OBJECTIVE An extensive literature has documented the deleterious effects of weight bias internalization (WBI) on biopsychosocial health outcomes. Still, this research is largely confined to the Western context. Furthermore, few studies have explored associations between WBI and biopsychosocial health outcomes, including in non-Western adolescent populations. METHOD The present study explored the longitudinal relationships between WBI and body dissatisfaction, disordered eating, psychosocial impairment related to eating disorder features, and psychological and physical well-being in a sample (N = 1549; aged 11-18 years at baseline) of Chinese adolescents. Relationships between study variables were examined between two waves of data measurement (Time 1, baseline, and Time 2, 6-month). Cross-lagged and multivariate models were used to explore prospective relationships between WBI and biopsychosocial correlates. RESULTS Bidirectional relationships were observed between WBI and biopsychosocial correlates in Chinese adolescents. Adjusting for covariates and other predictor variables, higher body dissatisfaction, disordered eating, psychosocial impairment, and psychological distress at Time 1 predicted higher WBI at Time 2. Furthermore, higher WBI at Time 1 predicted higher body dissatisfaction, disordered eating, psychosocial impairment, and psychological distress at Time 2. DISCUSSION Weight bias internalization and psychosocial correlates were interrelated across time in Chinese adolescents. Improving WBI might be promising in the prevention of eating and body image disturbances and diminished psychosocial well-being. Similarly, reducing eating and body image disturbances and improving psychosocial well-being might be useful prevention targets in reducing WBI in Chinese adolescents. PUBLIC SIGNIFICANCE The present study represents an initial effort to explore bidirectional relationships between WBI and biopsychosocial health outcomes in Chinese adolescents. Findings suggest bidirectional relationships between WBI and psychosocial variables, highlighting the potential utility of incorporating WBI interventions into eating pathology and poor psychosocial well-being prevention designs for Chinese adolescents.
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Affiliation(s)
- Wesley R Barnhart
- Department of Psychology, Bowling Green State University, Bowling Green, Ohio, USA
| | - Shuqi Cui
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, Guangdong, China
| | - Tianxiang Cui
- Department of Psychology, University of Macau, Macau, China
| | - Jinbo He
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, Guangdong, China
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11
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Tanas R, Gil B, Marsella M, Nowicka P, Pezzoli V, Phelan SM, Queirolo S, Stanford FC, Pettoello-Mantovani M, Bernasconi S. Addressing Weight Stigma and Weight-Based Discrimination in Children: Preparing Pediatricians to Meet the Challenge. J Pediatr 2022; 248:135-136.e3. [PMID: 35714964 PMCID: PMC9999724 DOI: 10.1016/j.jpeds.2022.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 06/09/2022] [Indexed: 11/22/2022]
Affiliation(s)
- Rita Tanas
- Department of Pediatrics, Arcispedale S. Anna, Ferrara, Italy
| | - Begoña Gil
- Comprehensive Childhood Obesity Plan of Andalusia, Health Counseling, Andalusian Government, Sevilla, Spain
| | - Maria Marsella
- Department of Pediatrics, San G. Moscati Hospital, Avellino, Italy
| | - Paulina Nowicka
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Solna, Sweden; Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
| | - Valdo Pezzoli
- Pediatric Institute of Southern Switzerland, EOC Lugano, Lugano, Switzerland
| | - Sean M Phelan
- Division of Health Care Delivery Research, Robert D. & Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Sara Queirolo
- Pediatric Institute of Southern Switzerland, EOC Lugano, Lugano, Switzerland
| | - Fatima Cody Stanford
- Departments of Medicine, Neuroendocrine Unit and Pediatrics, Pediatric Endocrinology, Boston, MA; Nutrition Obesity Research Center at Harvard, MGH Weight Center, Massachusetts General Hospital, Boston, MA
| | - Massimo Pettoello-Mantovani
- European Pediatric Association, Union of National Pediatric Societies and Associations, Berlin, Germany; Department of Pediatrics, Scientific Institute "Casa Sollievo," Univeristy of Foggia, Foggia, Italy.
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12
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Saunders JF, Nutter S, Russell-Mayhew S. Examining the Conceptual and Measurement Overlap of Body Dissatisfaction and Internalized Weight Stigma in Predominantly Female Samples: A Meta-Analysis and Measurement Refinement Study. Front Glob Womens Health 2022; 3:877554. [PMID: 35528312 PMCID: PMC9070483 DOI: 10.3389/fgwh.2022.877554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/24/2022] [Indexed: 01/31/2023] Open
Abstract
Both body dissatisfaction and internalized weight stigma have been identified as risk factors for many negative health outcomes for women, including depression and eating disorders. In addition to these contributions, these concepts have been found to overlap to various degrees in existing literature. We conducted a systematic review and meta-analysis on articles published prior to February 2022 to demonstrate the conceptual and measurement overlap between body dissatisfaction and internalized weight stigma as currently quantified. We identified 48 studies examining the interrelation between body dissatisfaction and internalized weight stigma in predominantly female samples. Stronger correlations between these two constructs, some bordering on multicollinearity, were prevalent in community samples compared to clinical samples and with some but not all the commonly used measures in the body image and weight stigma fields. Body mass index (BMI) moderated these relations such that individuals with higher self-reported BMI were more likely to report lower correlations between the constructs. This concept proliferation, stronger for individuals with lower BMIs and community samples, necessitates the need change how we conceptualize and measure body dissatisfaction and internalized weight stigma. To this end, we conducted study two to refine existing measures and lessen the degree of measurement overlap between internalized weight stigma and body dissatisfaction, particularly in community samples of women. We aimed to clarify the boundaries between these two concepts, ensuring measurement error is better accounted for. Female university students completed existing measures of body satisfaction and internalized weight stigma, which were analyzed using an exploratory followed by a confirmatory factor analysis. In our attempts to modify two existing measures of internalized weight stigma and body dissatisfaction, the majority of the internalized weight stigma items were retained. In contrast, most of the body dissatisfaction items either cross-loaded onto both factors or loaded on to the internalized weight stigma factor despite being intended for the body dissatisfaction factor, suggesting that the measurement issues identified in recent prior research may be due not only to the way we conceptualize and quantify weight stigma, but also the ways in which we quantify body dissatisfaction, across the existing corpus of body dissatisfaction scales.
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Affiliation(s)
- Jessica F. Saunders
- Hiatt School of Psychology, Clark University, Worcester, MA, United States
- *Correspondence: Jessica F. Saunders
| | - Sarah Nutter
- Department of Educational Psychology and Leadership Studies, University of Victoria, Victoria, BC, Canada
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13
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Romano KA, Heron KE, Sandoval CM, Howard LM, MacIntyre RI, Mason TB. A meta-analysis of associations between weight bias internalization and conceptually-related correlates: A step towards improving construct validity. Clin Psychol Rev 2022; 92:102127. [PMID: 35074712 PMCID: PMC8858873 DOI: 10.1016/j.cpr.2022.102127] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 11/15/2021] [Accepted: 01/09/2022] [Indexed: 12/13/2022]
Abstract
Weight bias internalization (WBI), a process of weight-based self-devaluation, has been associated with adverse mental and physical health. However, there are limitations with the existing conceptualization and operationalization of WBI that raise questions about the implications of this evidence-base. To address these limitations, the present study investigated the construct validity of WBI by conducting a meta-analysis of associations between WBI (as currently operationalized) and conceptually-related correlates. Studies identified through October 2021 that provided zero-order correlations for associations between WBI and conceptually-related constructs were examined. Meta-regression determined whether these associations differed across WBI measures and demographic (age, sex/gender, race, BMI) and study-level (publication status, sample type, study quality) moderators. Data for 128 (sub)samples were identified (Msample size = 477.83, SD = 1679.90; Mage = 34.46, SD = 12.17; range = 10.21-56.60). Greater WBI exhibited large to very large associations with factors suggested to have considerable overlap with this construct (negative and positive body image, self-devaluation), general and weight-specific experiential avoidance, and individuals' anticipation of future weight stigma. Associations varied for other constructs that have been differentially included in conceptualizations of WBI (endorsing weight bias, weight stigma stereotype awareness, weight stigma experiences), and via measurement-related, demographic, and study-level factors. These findings provide important information that can advance WBI conceptualization and measure-refinement.
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Affiliation(s)
- Kelly A. Romano
- The Virginia Consortium Program in Clinical Psychology, Norfolk, VA, USA
| | - Kristin E. Heron
- The Virginia Consortium Program in Clinical Psychology, Norfolk, VA, USA,Department of Psychology, Old Dominion University, Norfolk, VA, USA
| | | | - Lindsay M. Howard
- Department of Psychology, Augustana University, Sioux Falls, SD, USA
| | | | - Tyler B. Mason
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
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14
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Simply too much: the extent to which weight bias internalization results in a higher risk of eating disorders and psychosocial problems. Eat Weight Disord 2022; 27:317-324. [PMID: 33826118 PMCID: PMC8860958 DOI: 10.1007/s40519-021-01170-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/12/2021] [Indexed: 10/25/2022] Open
Abstract
PURPOSE Weight bias internalization (WBI) is associated with negative health consequences such as eating disorders and psychosocial problems in children. To date, it is unknown to what extent WBI considerably raises the risk of negative outcomes. METHODS Analyses are based on cross-sectional data of 1,061 children (9-13 years, M = 11, SD = 0.9; 52.1% female) who filled in the WBI scale (WBIS-C). First, ROC analyses were run to identify critical cut-off values of WBI (WBIS-C score) that identify those who are at higher risk for psychosocial problems or eating disorder symptoms (as reported by parents). Second, it was examined whether WBI is more sensitive than the relative weight status in that respect. Third, to confirm that the cut-off value is also accompanied by higher psychological strain, high- and low-risk groups were compared in terms of their self-reported depressive symptoms, anxious symptoms, body dissatisfaction, and self-esteem. RESULTS WBIS-C scores ≥ 1.55 were associated with a higher risk of disturbed eating behavior; for psychosocial problems, no cut-off score reached adequate sensitivity and specificity. Compared to relative weight status, WBI was better suited to detect disturbed eating behavior. Children with a WBIS-C score ≥ 1.55 also reported higher scores for both depressive and anxious symptoms, higher body dissatisfaction, and lower self-esteem. CONCLUSION The WBIS-C is suitable for identifying risk groups, and even low levels of WBI are accompanied by adverse mental health. Therefore, WBI is, beyond weight status, an important risk factor that should be considered in prevention and intervention. LEVEL OF EVIDENCE Level III, cross-sectional analyses based on data taken from a well-designed, prospective cohort study.
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15
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Himmelstein MS, Knepp KA, Phelan SM. The role of weight stigma in weight regain in bariatric surgery. Front Endocrinol (Lausanne) 2022; 13:1076696. [PMID: 36561565 PMCID: PMC9763922 DOI: 10.3389/fendo.2022.1076696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022] Open
Abstract
Obesity is highly stigmatized, and individuals who undergo bariatric surgery are subject not only to weight stigma, but also to stigma related to the procedure itself. Patients lost to follow-up after surgery make estimating the amount of regain occurring after surgery difficult, and often patients fail to follow up due the shame of weight regain. Patients report difficulty following the diet necessary to maintain weight loss. Additionally, when they seek support after surgery, they often encounter stigmatizing messaging related to weight. Weight bias internalization, weight stigma, and stigma about having the surgery all contribute to feelings of social isolation, disordered eating, and reduced motivation to engage in physical activity. In this chapter, we present evidence for the impact of stigma on bariatric surgery outcomes and discuss the behavioral, physiological, and emotional processes that contribute to weight regain.
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Affiliation(s)
- Mary S. Himmelstein
- Department of Psychological Sciences, Kent State University, Kent, OH, United States
| | - Kristen A. Knepp
- Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH, United States
| | - Sean M. Phelan
- Division of Health Care Delivery Research, Robert D. & Patricia E. Kern Center for the Science of Healthcare Delivery, & Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, MN, United States
- *Correspondence: Sean M. Phelan,
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16
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Fan CW, Liu CH, Huang HH, Lin CY, Pakpour AH. Weight Stigma Model on Quality of Life Among Children in Hong Kong: A Cross-Sectional Modeling Study. Front Psychol 2021; 12:629786. [PMID: 33967895 PMCID: PMC8100454 DOI: 10.3389/fpsyg.2021.629786] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/12/2021] [Indexed: 11/14/2022] Open
Abstract
We proposed a model to examine the relationship among different types of weight-related stigmas and their relationship to quality of life (QoL). We recruited 430 dyads of elementary school children [mean age = 10.07 years; nboy = 241 (56.0%); noverweight = 138 (32.1%)] and their parents. Parents completed QoL instruments about their children assessing generic QoL and weight-related QoL. Children completed QoL instruments assessing generic QoL and weight-related QoL and stigma scales assessing experienced weight stigma, weight-related self-stigma, and perceived weight stigma. Experienced weight stigma was significantly associated with perceived weight stigma, and in turn, perceived weight stigma was significantly associated with weight-related self-stigma. However, experienced weight stigma was not directly associated with weight-related self-stigma. In addition, experienced stigma was negatively associated with both child-rated and parent-rated QoL. Perceived weight stigma was associated only with parent-rated weight-related QoL but not child-rated QoL. Self-stigma was associated with child-rated QoL but not parent-rated QoL. Moreover, perceived weight stigma and weight-related self-stigma were significant mediators in the association between body weight and children's QoL; experienced weight stigma was not a significant mediator. The study findings can be used to inform healthcare providers about the relationship among different types of stigmas and their influence on child-rated and parent-rated QoL and help them develop interventions to address the global trend of overweight/obesity in youth and pediatric populations.
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Affiliation(s)
- Chia-Wei Fan
- Department of Occupational Therapy, AdventHealth University, Orlando, FL, United States
| | - Chieh-Hsiu Liu
- National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hsin-Hsiung Huang
- Department of Statistics and Data Science, University of Central Florida, Orlando, FL, United States
| | - Chung-Ying Lin
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Public Health, National Cheng Kung University Hospital, College of Medicien, National Cheng Kung University, Tainan, Taiwan.,Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Amir H Pakpour
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.,Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
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17
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Fields LC, Brown C, Skelton JA, Cain KS, Cohen GM. Internalized Weight Bias, Teasing, and Self-Esteem in Children with Overweight or Obesity. Child Obes 2021; 17:43-50. [PMID: 33351706 PMCID: PMC7815063 DOI: 10.1089/chi.2020.0150] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: Although 2/3 of US adults and nearly 1/3 of US children have overweight or obesity, weight stigma is common. Many with overweight or obesity ascribe negative ideas to themselves, resulting in internalized weight bias (IWB). In adults, IWB has been associated with psychosocial problems; however, this relationship has been studied little in children. This study aims to describe IWB in children with overweight and obesity and to study the association of children's IWB with experienced weight bias, self-esteem, and their parents' IWB. Methods: Children ages 9-18 with overweight or obesity completed the Weight Bias Internalization Scale (WBIS), Rosenberg Self-Esteem Scale, and Perception of Teasing Scale; parents completed the Weight Bias Internalization Scale-Modified and the Perceived Weight Discrimination Scale. Descriptive statistics were used to assess IWB, self-esteem, and experienced weight stigma. Chi-square and t-tests were used to examine associations between categorical and continuous variables, respectively. Multivariate linear regression was used to identify correlates of IWB in children. Results: Of 111 child participants, the median WBIS score was 2.8 out of 7. Higher IWB was associated with more peer teasing (p < 0.001) and lower self-esteem (p < 0.001). IWB in children was not associated with child BMI z-score (p = 0.590) or higher parent IWB (p = 0.287). Conclusions: Children with overweight and obesity who have experienced more teasing by peers or who have lower self-esteem are more likely to have a higher IWB. However, increasing child BMI z-score and parent IWB are not associated with higher child IWB.
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Affiliation(s)
- Lauren C. Fields
- Bowman Gray Center, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Callie Brown
- Department of Pediatrics, and Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Brenner FIT (Families in Training) Program, Brenner Children's Hospital, Winston-Salem, NC, USA
- Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Joseph A. Skelton
- Department of Pediatrics, and Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Brenner FIT (Families in Training) Program, Brenner Children's Hospital, Winston-Salem, NC, USA
- Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Kathryn S. Cain
- Bowman Gray Center, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Gail M. Cohen
- Department of Pediatrics, and Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Brenner FIT (Families in Training) Program, Brenner Children's Hospital, Winston-Salem, NC, USA
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