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Pudney EV, Puhl RM, Schwartz MB, Halgunseth LC. The Effect of Parent-Targeted Obesity Messaging on Parental Weight Talk Intention: A Randomized Controlled Experiment. HEALTH COMMUNICATION 2024:1-12. [PMID: 39169856 DOI: 10.1080/10410236.2024.2386212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
It is unknown if parent-targeted health messages about childhood obesity affect parental weight communication with children (e.g., encouraging a child to diet). This randomized, controlled, online experiment assessed the effects of exposure to different message frames on parental intentions to 1) engage in weight communication with their child and, 2) follow the health advice in the message. A diverse sample of U.S. parents (N = 452) were randomly assigned to one of three conditions: 1) a mock news article emphasizing childhood obesity (weight-framed message) with health behavior advice for parents; 2) an article with identical health behavior advice for parents, but framed within the context of improving children's school performance (school-framed message); and 3) a no-treatment control group. Following message exposure, parents completed online surveys assessing their intention to engage in weight communication and the recommended health behaviors. Hierarchical linear regression was used to assess the relationship between experimental condition and the outcome variables. Parents in the weight-frame condition were significantly more likely to report intention to engage in weight communication with their child than parents in the control group, while there was no difference between the school-frame condition and the control group. Parents in both message conditions were equally likely to report intention to adopt the health advice, but parental weight-based self-stigma moderated the relationships. Parent-targeted health advice that features childhood obesity may encourage parents to engage in weight communication with their children. Our findings can inform the development of health messages targeting parents about children's weight-related health.
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Affiliation(s)
| | - Rebecca M Puhl
- Department of Human Development & Family Sciences, University of Connecticut
- Rudd Center for Food Policy & Health, University of Connecticut
| | - Marlene B Schwartz
- Department of Human Development & Family Sciences, University of Connecticut
- Rudd Center for Food Policy & Health, University of Connecticut
| | - Linda C Halgunseth
- Department of Human Development & Family Studies, Michigan State University
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2
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Heley K, Vanderpool RC, Vedham V. Global cancer stigma research: a U.S. National Cancer Institute workshop report. J Natl Cancer Inst Monogr 2024; 2024:4-10. [PMID: 38836530 DOI: 10.1093/jncimonographs/lgad038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/06/2023] [Accepted: 12/22/2023] [Indexed: 06/06/2024] Open
Abstract
Stigma is a social process characterized by negative beliefs, attitudes, and stereotypes associated with a specific attribute or characteristic that leads to discrimination and social exclusion. Stigma manifests across the cancer control continuum and remains a key challenge for cancer prevention and control worldwide. In this commentary, we provide an overview of the U.S. National Cancer Institute's (NCI) Global Cancer Stigma Research Workshop, a multi-disciplinary international conference held virtually in September 2022, which focused on the intersection of cancer and stigma. The meeting was unique in its convening of researchers, advocates, clinicians, and non-governmental and governmental organizations, who-as a collective-provided overarching topics, cross-cutting considerations, and future directions for the cancer stigma research community to consider, which we describe herein. In summary, studying cancer stigma comprehensively requires a holistic, adaptive, and multifaceted approach-and should consider interrelated factors and their intersection within diverse cultural and social contexts worldwide. Collectively, there was a call for: an inclusive approach, encouraging researchers and practitioners to identify and measure cancer stigma as a driver for cancer health inequities globally; an expansion of existing research methodology to include diversity of experiences, contexts, and perspectives; and collaborations among diverse stakeholders to develop more effective strategies for reducing stigma and improving cancer outcomes. Such efforts are essential to cultivating effective and equitable approaches to preventing and treating cancer worldwide.
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Affiliation(s)
- Kathryn Heley
- Health Communication and Informatics Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Robin C Vanderpool
- Health Communication and Informatics Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Vidya Vedham
- Center for Global Health, Office of the Director, National Cancer Institute, Rockville, MD, USA
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Shoemaker A. Bardet-Biedl syndrome: A clinical overview focusing on diagnosis, outcomes and best-practice management. Diabetes Obes Metab 2024; 26 Suppl 2:25-33. [PMID: 38383825 DOI: 10.1111/dom.15494] [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: 12/08/2023] [Revised: 01/16/2024] [Accepted: 01/27/2024] [Indexed: 02/23/2024]
Abstract
Bardet-Biedl syndrome (BBS) is a genetic disorder characterized by early-onset obesity, polydactyly, genital and kidney anomalies, developmental delay and vision loss due to rod-cone dystrophy. BBS is an autosomal recessive disorder with >20 implicated genes. The genotype-phenotype relationship in BBS is not clear, and there may be additional modifying factors. The underlying mechanism is dysfunction of primary cilia. In BBS, receptor trafficking in and out of the cilia is compromised, affecting multiple organ systems. Along with early-onset obesity, hyperphagia is a prominent symptom and contributes significantly to clinical morbidity and caregiver burden. While there is no cure for BBS, setmelanotide is a new pharmacotherapy approved for treatment of obesity in BBS. The differential diagnosis for BBS includes other ciliopathies, such as Alstrom syndrome, and other genetic obesity syndromes, such as Prader-Willi syndrome. Careful clinical history and genetic testing can help determine the diagnosis and a multidisciplinary team is necessary to guide clinical management.
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Affiliation(s)
- Ashley Shoemaker
- Division of Pediatric Endocrinology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Pudney EV, Puhl RM, Halgunseth LC, Schwartz MB. An Examination of Parental Weight Stigma and Weight Talk Among Socioeconomically and Racially/Ethnically Diverse Parents. FAMILY & COMMUNITY HEALTH 2024; 47:1-15. [PMID: 37656801 DOI: 10.1097/fch.0000000000000384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
Parental communication about body weight can influence children's emotional well-being and eating behaviors. However, little is known about the role of parental self-stigma concerning weight and social position variables (ie, race/ethnicity, income, and gender) in weight communication. This study examined how parents' self-stigmatization for their own weight (ie, weight bias internalization) and self-stigmatization for their child's weight (ie, affiliate stigma) relates to weight talk frequency with their children, and whether these associations vary across parental race/ethnicity, income, and gender. Parents (n = 408) completed a cross-sectional, online survey about their weight communication and self-stigmatization. Linear regression was used to examine the relationships among these variables, including interactions between the stigma variables and social position variables in predicting weight talk. Higher levels of weight bias internalization and affiliate stigma were strongly associated with increased parental weight talk frequency; parents who endorsed higher levels of internalized bias about their own weight expressed greater affiliate stigma for their child's weight, regardless of demographic characteristics or weight status. Associations between the stigma variables and weight talk outcomes were stronger among fathers and parents of higher income. Findings highlight the importance of considering weight stigma variables in parental weight communication research.
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Affiliation(s)
- Ellen V Pudney
- Department of Pediatrics, Division of Community Health & Research, Eastern Virginia Medical School, Norfolk (Dr Pudney); Department of Human Development & Family Sciences, University of Connecticut, Storrs, and Rudd Center for Food Policy & Health, University of Connecticut, Hartford (Drs Puhl and Schwartz); and Department of Human Development & Family Studies, Michigan State University, East Lansing (Dr Halgunseth)
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Lv M, Feng-Fang Y, Wang Y, Zhen-Xu H. Factors contributing to emotional distress when caring for children with imperforate anus: a multisite cross-sectional study in China. Front Med (Lausanne) 2023; 10:1088672. [PMID: 38143436 PMCID: PMC10740165 DOI: 10.3389/fmed.2023.1088672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 10/23/2023] [Indexed: 12/26/2023] Open
Abstract
Background Imperforate anus (IA) has a life-long impact on patients and their families. The caregivers of children with IA (CoCIA) might experience distress, which could be detrimental to them physically and mentally. However, there are limitations in the related studies. This study aimed to investigate the prevalence of IA and the associated factors contributing to the distress experienced by CoCIA. Methods A cross-sectional study was conducted in three tertiary children's hospitals from November 2018 to February 2019. Distress was assessed using the Chinese version of the Kessler Psychological Distress Scale, and possible determinants were assessed by the Caregiver Reaction Assessment, the Parent Stigma Scale, the Parent Perception of Uncertainty Scale, and the Social Support Scale. Demographic and clinical information was also collected. Multiple regression analysis was performed to explore the association between variables. Results Out of 229 CoCIA, 52.9% reported experiencing a high level of distress or above. The data analysis revealed that health problems associated with caregiving, stigma, uncertainty, social support, and children who underwent anal reconstruction surgery 1 year before or earlier could significantly predicate caregivers' distress, and these factors could explain 50.1% of the variance. Conclusions The majority of the caregivers of children with IA experience high levels of distress, particularly when their children undergo anal reconstruction surgery 1 year before or earlier. Additionally, health problems related to caregiving, stigma, uncertainty, and low social support could significantly predicate caregivers' distress. It is important for clinical staff to be aware of the prevalent situation of caregivers' distress and to make targeted interventions focused on addressing modifiable factors that should be carried out in family-based care.
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Affiliation(s)
| | | | | | - Hong Zhen-Xu
- Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Forsythe E, Mallya UG, Yang M, Huber C, Cala ML, Greatsinger A, Hagopian E, Pomeroy J, Haqq AM. Caregiver burden in Bardet-Biedl syndrome: findings from the CARE-BBS study. Orphanet J Rare Dis 2023; 18:181. [PMID: 37415214 DOI: 10.1186/s13023-023-02692-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/02/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Bardet-Biedl syndrome (BBS) is a rare, genetically heterogeneous obesity syndrome associated with hyperphagia. Given the early onset of BBS symptoms in childhood and multifaceted complications, this study aimed to quantify the caregiver burden associated with BBS. METHODS A cross-sectional, multi-country survey of caregivers from the United States (US), United Kingdom (UK), Canada, and Germany was designed to quantify the extent of caregiver burden associated with obesity and hyperphagia symptoms (i.e., uncontrollable hunger) among patients with BBS. RESULTS A total of 242 caregivers across the four countries met the inclusion criteria and completed the survey. The mean (standard deviation [SD]) age of the caregivers was 41.9 (6.7) years, and the mean (SD) age of individuals with BBS in their care was 12.0 (3.7) years. Hyperphagia contributed to a BBS diagnosis in 230 of 242 individuals (95.0%). On average, caregivers used eight different weight management approaches for those in their care and expressed a strong desire for more effective weight management methods. Based on the Impacts of Hyperphagia: Caregiver version, patients' hyperphagia had a moderate-to-severe impact on caregiver mood (56.6%), sleep (46.6%), and relationships (48.0%). Caregivers reported experiencing a high level of personal strain (mean [SD], 17.1 [2.9]) and family impact (mean [SD] score, 26.0 [3.8]) due to BBS, as measured by the Revised Impact on Family Scale. Among caregivers in the workforce, there also was high impairment in total work productivity (mean [SD], 60.9% [21.4%]) due to caring for patients with BBS according to the Work Productivity and Activity Impairment. More than half (53%) of the caregivers reported spending over 5,000 out-of-pocket in local currency for medical expenses for the patient with BBS in their care. CONCLUSIONS Obesity and hyperphagia have negative impacts on the lives of caregivers of patients with BBS. The burden is demonstrated to be multifaceted, with various components that may interact with and confound each other, including intensive weight management efforts, productivity loses, impaired family dynamics and out-of-pocket medical expenses.
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Affiliation(s)
- Elizabeth Forsythe
- University College London Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK.
| | | | - Min Yang
- Analysis Group, Inc., Boston, MA, USA
| | | | | | | | | | - Jeremy Pomeroy
- Marshfield Clinic Research Institute, Marshfield, WI, USA
| | - Andrea M Haqq
- Division of Pediatric Endocrinology, University of Alberta, Edmonton, AB, Canada
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Forsythe E, Mallya UG, Yang M, Huber C, Cala ML, Greatsinger A, Hagopian E, Pomeroy J, Haqq AM. Burden of hyperphagia and obesity in Bardet-Biedl syndrome: a multicountry survey. Orphanet J Rare Dis 2023; 18:182. [PMID: 37415189 DOI: 10.1186/s13023-023-02723-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 05/11/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Signs and symptoms of Bardet-Biedl syndrome (BBS) occur during early childhood, progress over time, and place substantial, multifaceted burden on patients and their caregivers. Hyperphagia may be a contributing factor to early-onset obesity in BBS; however, there are limited insights into its impacts on patients and caregivers. We quantified disease burden as it relates to the physical and emotional impacts of hyperphagia in BBS. METHODS The CAREgiver Burden in BBS (CARE-BBS) study was a multicountry, cross-sectional survey of adult caregivers of patients with BBS who have had hyperphagia and obesity. The survey consisted of questionnaires including Symptoms of Hyperphagia, Impacts of Hyperphagia, Impact of Weight on Quality of Life (IWQOL)-Kids Parent Proxy, and Patient-Reported Outcome Measurement Information System (PROMIS) v1.0-Global Health 7. In addition, clinical characteristics, medical history, and weight management questions were included. Outcomes were scored and summarized descriptively in aggregate and by country, age, and obesity severity according to weight class. RESULTS There were 242 caregivers of patients with BBS who completed the survey. Caregivers observed hyperphagic behaviors throughout the day, with negotiating for food (90%) and waking up and asking or looking for food during the night (88%) being the most frequent. Hyperphagia had at least a moderate negative impact on most patients' mood/emotions (56%), sleep (54%), school (57%), leisure (62%), and familial relationships (51%). Hyperphagia affected concentration at school (78%), and symptoms of BBS contributed to patients missing ≥ 1 day of school a week (82%). Responses from the IWQOL-Kids Parent Proxy suggested obesity most greatly negatively affected physical comfort (mean [standard deviation (SD)], 41.7 [17.2]), body esteem (41.0 [17.8]), and social life (41.7 [18.0]). On the PROMIS questionnaire, mean (SD) global health score for pediatric patients with BBS and overweight or obesity (36.8 [10.6]) was lower than the general population (mean, 50). CONCLUSIONS Evidence from this study suggests that hyperphagia and obesity may have broad negative impacts on the lives of patients with BBS, including physical health, emotional well-being, school performance, and personal relationships. Therapies that target hyperphagia may alleviate the extensive clinical and nonclinical impacts experienced by patients with BBS and their caregivers.
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Affiliation(s)
- Elizabeth Forsythe
- Clinical Genetics Department, Guy's Hospital, and National Bardet-Biedl Syndrome Clinics, Great Ormond Street and St Thomas' Hospitals, London, UK
| | | | | | | | | | | | | | - Jeremy Pomeroy
- Marshfield Clinic Research Institute, Marshfield, WI, USA
| | - Andrea M Haqq
- Department of Pediatrics, University of Alberta, 8440 - 112 St NW, Edmonton, AB, T6G 2B7, Canada.
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Ervin C, Norcross L, Mallya UG, Fehnel S, Mittleman RS, Webster M, Haqq AM, Haws RM. Interview-Based Patient- and Caregiver-Reported Experiences of Hunger and Improved Quality of Life with Setmelanotide Treatment in Bardet-Biedl Syndrome. Adv Ther 2023; 40:2394-2411. [PMID: 36961653 PMCID: PMC10036981 DOI: 10.1007/s12325-023-02443-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 01/25/2023] [Indexed: 03/25/2023]
Abstract
INTRODUCTION Bardet-Biedl syndrome (BBS) is a rare genetic disease associated with hyperphagia, a pathologic insatiable hunger, due to impaired signaling in the melanocortin-4 receptor (MC4R) pathway. The impact of hyperphagia on the lives of patients with BBS and their families has not been fully characterized. METHODS Patients with BBS or their caregivers who participated in clinical trials of the MC4R agonist setmelanotide (NCT03013543 and NCT03746522) were included in this qualitative study. Telephone interviews were conducted using a semistructured interview guide to explore patient experience and caregiver observations of hyperphagia before and during setmelanotide treatment. RESULTS Nineteen interviews (8 patients, 11 caregivers) were conducted. The term "hunger" (rather than "hyperphagia") was used in interviews to ensure common terminology. Before setmelanotide treatment, all participants described their (or their child's) hunger as all-consuming, leading to an obsessive focus on food. Nine participants recalled intense, continuous hunger, and most participants (5 patients, 10 caregivers) reported lack of control with eating. Negative impacts on patients' lives included difficulties with concentration, emotional and physical manifestations, and impaired relationships. All participants experienced or observed improvements in hunger and health outcomes during treatment, the most meaningful of which included weight loss and decrease in obsessive focus on food and food-seeking behaviors. All participants reported improvements in either physical and/or emotional well-being and being satisfied with setmelanotide. CONCLUSIONS Hyperphagia and resulting food-seeking behaviors have notable negative impacts on quality of life in patients with BBS and caregivers. Setmelanotide improved hyperphagia, reduced body weight and obsessive focus on food, and facilitated improvements in physical and emotional well-being for both patients and caregivers. TRIAL REGISTRATION NCT03013543 and NCT03746522.
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Affiliation(s)
- Claire Ervin
- RTI Health Solutions, 3040 E Cornwallis Rd, PO Box 12194, Research Triangle Park, NC 27709-2194 USA
| | - Lindsey Norcross
- RTI Health Solutions, 3040 E Cornwallis Rd, PO Box 12194, Research Triangle Park, NC 27709-2194 USA
| | - Usha G. Mallya
- Rhythm Pharmaceuticals, Inc., 222 Berkeley Street, 12th Floor, Boston, MA 02116 USA
| | - Sheri Fehnel
- RTI Health Solutions, 3040 E Cornwallis Rd, PO Box 12194, Research Triangle Park, NC 27709-2194 USA
| | - Robert S. Mittleman
- Rhythm Pharmaceuticals, Inc., 222 Berkeley Street, 12th Floor, Boston, MA 02116 USA
| | - Matthew Webster
- Rhythm Pharmaceuticals, Inc., 222 Berkeley Street, 12th Floor, Boston, MA 02116 USA
| | - Andrea M. Haqq
- University of Alberta, 6-002E Li Ka Shing Centre for Health Research Innovation, Edmonton, AB T6G 2E1 Canada
| | - Robert M. Haws
- Marshfield Clinic Research Institute, 1000 North Oak Avenue, Marshfield, WI 54449 USA
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Abstract
PURPOSE OF REVIEW Bardet Biedl syndrome (BBS) is a rare disease characterized by obesity and hyperphagia. Despite the very high prevalence of paediatric and adult obesity in this population, the prevalence of diabetes mellitus is not well described. RECENT FINDINGS Studies in small and moderately large cohorts suggest a high prevalence of traditional risk factors for diabetes mellitus in people with BBS. People with BBS appear to have a high prevalence of insulin resistance and metabolic syndrome. Small cohort studies have identified high rates of sleep disordered breathing, including sleep apnoea syndrome. Recent research has characterized traditional behavioural risk factors such as sleep hygiene and physical inactivity in people with BBS. High rates of insufficient sleep and prolonged sedentary time suggest behavioural targets of interventions to treat or prevent diabetes mellitus. Hyperphagia, likely caused by defects in the hypothalamic melanocortin-4 receptor (MC4R) neuronal pathway, pose additional challenges to behavioural interventions to prevent diabetes mellitus. SUMMARY Understanding the prevalence of diabetes mellitus and other metabolic disorders in people with BBS and the impact of traditional risk factors on glucose regulation are important to developing effective treatments in this population.
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Affiliation(s)
- Jeremy Pomeroy
- Center of Excellence for Bardet Biedl Syndrome, Marshfield Clinic Research Institute
| | - Kelsi-Marie Offenwanger
- Center of Excellence for Bardet Biedl Syndrome, Department of Psychiatry & Behavioral Health
| | - Tammi Timmler
- Center of Excellence for Bardet Biedl Syndrome, Dietetics, Marshfield Clinic Health System, Marshfield, Wisconsin, USA
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Melluso A, Secondulfo F, Capolongo G, Capasso G, Zacchia M. Bardet-Biedl Syndrome: Current Perspectives and Clinical Outlook. Ther Clin Risk Manag 2023; 19:115-132. [PMID: 36741589 PMCID: PMC9896974 DOI: 10.2147/tcrm.s338653] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/20/2023] [Indexed: 02/04/2023] Open
Abstract
The Bardet Biedl syndrome (BBS) is a rare inherited disorder considered a model of non-motile ciliopathy. It is in fact caused by mutations of genes encoding for proteins mainly localized to the base of the cilium. Clinical features of BBS patients are widely shared with patients suffering from other ciliopathies, especially autosomal recessive syndromic disorders; moreover, mutations in cilia-related genes can cause different clinical ciliopathy entities. Besides the best-known clinical features, as retinal degeneration, learning disabilities, polydactyly, obesity and renal defects, several additional clinical signs have been reported in BBS, expanding our understanding of the complexity of its clinical spectrum. The present review aims to describe the current knowledge of BBS i) pathophysiology, ii) clinical manifestations, highlighting both the most common and the less described features, iii) current and future perspective for treatment.
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Affiliation(s)
- Andrea Melluso
- Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Floriana Secondulfo
- Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Giovanna Capolongo
- Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Giovambattista Capasso
- Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy,Biogem Scarl, Ariano Irpino, AV, 83031, Italy
| | - Miriam Zacchia
- Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy,Correspondence: Miriam Zacchia, Via Pansini 5, Naples, 80131, Italy, Tel +39 081 566 6650, Fax +39 081 566 6671, Email
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Forsythe E, Haws RM, Argente J, Beales P, Martos-Moreno GÁ, Dollfus H, Chirila C, Gnanasakthy A, Buckley BC, Mallya UG, Clément K, Haqq AM. Quality of life improvements following one year of setmelanotide in children and adult patients with Bardet-Biedl syndrome: phase 3 trial results. Orphanet J Rare Dis 2023; 18:12. [PMID: 36647077 PMCID: PMC9841937 DOI: 10.1186/s13023-022-02602-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 12/19/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Bardet-Biedl syndrome is a rare genetic disease associated with hyperphagia and early-onset, severe obesity. There is limited evidence on how hyperphagia and obesity affect health-related quality of life in patients with Bardet-Biedl syndrome, and on how management of these symptoms may influence disease burden. This analysis evaluated changes in health-related quality of life in adults and children with Bardet-Biedl syndrome in a Phase 3 trial following 1 year of setmelanotide treatment (ClinicalTrials.gov identifier: NCT03746522). METHODS Patients with Bardet-Biedl syndrome and obesity received 52 weeks of treatment with setmelanotide and completed various self-reported health-related quality of life measures. Patients aged < 18 years or their caregiver completed the Pediatric Quality of Life Inventory (PedsQL; meaningful improvement, 4.4-point change); adults aged ≥ 18 years completed the Impact of Weight on Quality of Life Questionnaire-Lite (IWQOL-Lite; meaningful improvement range, 7.7-12-point change). Descriptive outcomes were reported in patients with data both at active treatment baseline and after 52 weeks of treatment. RESULTS Twenty patients (< 18 years, n = 9; ≥ 18 years, n = 11) reported health-related quality of life at baseline and 52 weeks. For children and adolescents, PedsQL score mean change from baseline after 52 weeks was + 11.2; all patients with PedsQL impairment at baseline (n = 4) experienced clinically meaningful improvement. In adults, IWQOL-Lite score mean change from baseline was + 12.0. Of adults with IWQOL-Lite impairment at baseline (n = 8), 62.5% experienced clinically meaningful improvement. In adults, IWQOL-Lite score was significantly correlated with changes in percent body weight (P = 0.0037) and body mass index (P = 0.0098). CONCLUSIONS After 1 year of setmelanotide, patients reported clinically meaningful improvements across multiple health-related quality of life measures. This study highlights the need to address the impaired health-related quality of life in Bardet-Biedl syndrome, and supports utility of setmelanotide for reducing this burden. Trial Registration NCT03746522. Registered November 19, 2018, https://clinicaltrials.gov/ct2/show/NCT03746522 .
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Affiliation(s)
- Elizabeth Forsythe
- grid.83440.3b0000000121901201Genetics and Genomics Medicine Programme, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Robert M. Haws
- grid.280718.40000 0000 9274 7048Marshfield Clinic Research Institute, Marshfield, WI USA
| | - Jesús Argente
- grid.5515.40000000119578126Department of Pediatrics and Pediatric Endocrinology, Universidad Autónoma de Madrid, University Hospital Niño Jesús, Madrid, Spain ,grid.413448.e0000 0000 9314 1427CIBER “Fisiopatología de la Obesidad y Nutrición” (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain ,grid.482878.90000 0004 0500 5302IMDEA Food Institute, Madrid, Spain
| | - Philip Beales
- grid.83440.3b0000000121901201Genetics and Genomics Medicine Programme, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Gabriel Á. Martos-Moreno
- grid.5515.40000000119578126Department of Pediatrics and Pediatric Endocrinology, Universidad Autónoma de Madrid, University Hospital Niño Jesús, Madrid, Spain ,grid.413448.e0000 0000 9314 1427CIBER “Fisiopatología de la Obesidad y Nutrición” (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Hélène Dollfus
- grid.412220.70000 0001 2177 138XHôpitaux Universitaires de Strasbourg, CARGO and Department of Medical Genetics, Strasbourg, France
| | - Costel Chirila
- grid.62562.350000000100301493RTI Health Solutions, Research Triangle Park, NC USA
| | - Ari Gnanasakthy
- grid.62562.350000000100301493RTI Health Solutions, Research Triangle Park, NC USA
| | | | - Usha G. Mallya
- grid.476681.aRhythm Pharmaceuticals, Inc., Boston, MA USA
| | - Karine Clément
- grid.411439.a0000 0001 2150 9058Assistance Publique-Hôpitaux de Paris, Nutrition Department, Pitié-Salpêtrière Hospital, Paris, France ,Sorbonne Université, INSERM, NutriOmics Research Unit, Paris, France
| | - Andrea M. Haqq
- grid.17089.370000 0001 2190 316XDivision of Pediatric Endocrinology, University of Alberta, 6-002E Li Ka Shing Centre for Health Research Innovation, Edmonton, AB T6G 2E1 Canada
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Patel D, Krems JA, Stout ME, Byrd-Craven J, Hawkins MAW. Parents of Children With High Weight Are Viewed as Responsible for Child Weight and Thus Stigmatized. Psychol Sci 2023; 34:35-46. [PMID: 36318753 DOI: 10.1177/09567976221124951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Courts in seven U.S. states have removed children with "obesity" from parental custody until children could maintain "healthy weights." These rulings-alongside qualitative reports from parents of children with high weight (PoCHs)-suggest that PoCHs are judged as bad parents. Yet little work has tested whether people genuinely stigmatize PoCHs or what drives this phenomenon. In three experiments with U.S. online community participants (N = 1,011; two preregistered), we tested an attribution theory model: Social perceivers attribute children's weights to parents and thus stigmatize those parents. Experiments 1 and 2 support this model (across parent and child gender). Experiment 3 manipulated attributions of parental responsibility for child weight, revealing attenuated stigma with low attributions of responsibility. Findings are among the first to describe and explain stigma toward a large demographic (parents of children with obesity)-with real-world implications (e.g., for family separation, health care)-and may additionally illuminate the psychology underlying stigma toward parents of children with other potentially stigma-evoking identities.
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Affiliation(s)
- Devanshi Patel
- The Oklahoma Center for Evolutionary Analysis, Department of Psychology, Oklahoma State University.,Department of Psychology, Oklahoma State University
| | - Jaimie Arona Krems
- The Oklahoma Center for Evolutionary Analysis, Department of Psychology, Oklahoma State University.,Department of Psychology, Oklahoma State University
| | | | - Jennifer Byrd-Craven
- The Oklahoma Center for Evolutionary Analysis, Department of Psychology, Oklahoma State University.,Department of Psychology, Oklahoma State University
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13
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Caba L, Florea L, Braha EE, Lupu VV, Gorduza EV. Monitoring and Management of Bardet-Biedl Syndrome: What the Multi-Disciplinary Team Can Do. J Multidiscip Healthc 2022; 15:2153-2167. [PMID: 36193191 PMCID: PMC9526427 DOI: 10.2147/jmdh.s274739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 09/16/2022] [Indexed: 11/23/2022] Open
Abstract
Bardet – Biedl syndrome is a rare autosomal recessive multisystem non-motile ciliopathy. It has heterogeneous clinical manifestations. It is caused by mutations in 26 genes encoding BBSome proteins, chaperonines, and IFT complex. The main clinical features are: retinal cone-rod dystrophy, central obesity, postaxial polydactyly, cognitive impairment, hypogonadism and genitourinary anomalies, and kidney disease. The onset of clinical manifestations is variable which makes the diagnosis difficult in some patients. Because of the multiple system involvement, a multidisciplinary approach is necessary. The purpose of this review is to provide monitoring and management directions for a better approach to these patients.
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Affiliation(s)
- Lavinia Caba
- Department of Mother and Child Medicine – Medical Genetics, “Grigore T. Popa” University of Medicine and Pharmacy, Iaşi, Romania
- Correspondence: Lavinia Caba, Department of Medical Genetics, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, Iasi, 700115, Romania, Email
| | - Laura Florea
- Department of Nephrology - Internal Medicine, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | | | - Valeriu Vasile Lupu
- Department of Mother and Child Medicine – Pediatrics, “Grigore T. Popa” University of Medicine and Pharmacy, Iaşi, Romania
| | - Eusebiu Vlad Gorduza
- Department of Mother and Child Medicine – Medical Genetics, “Grigore T. Popa” University of Medicine and Pharmacy, Iaşi, Romania
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14
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Lee KM, Arriola-Sanchez L, Lumeng JC, Gearhardt A, Tomiyama AJ. Weight Stigma by Association Among Parents of Children With Obesity: A Randomized Trial. Acad Pediatr 2022; 22:754-760. [PMID: 34610460 DOI: 10.1016/j.acap.2021.09.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 09/22/2021] [Accepted: 09/25/2021] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To experimentally test weight stigma and weight stigma by association in a parent-child relationship using a large, community-based sample. METHODS We conducted a randomized experiment on Amazon Mechanical Turk using an online survey. Participants were randomly assigned to view a picture of a parent-child dyad, for which the parent and child's gender (male vs. female) and weight status (with obesity vs. without obesity) were manipulated. Participants read identical parenting descriptions that adhered to the American Academy of Pediatrics' parenting recommendations, then rated the parent's perceived effectiveness, helpfulness, and level of caring using a parenting questionnaire based on Barnhart et al (2013). RESULTS Participants (N = 1862; Mage = 36.8 [11.2] years) rated parents of children with obesity as less effective compared to parents of children without obesity (P = .010) and parents with obesity as less effective compared to parents without obesity (P = .033). Participants also rated parents with obesity as less helpful compared to parents without obesity (P = .021). No differences emerged in perceived caring. Parenting evaluations did not differ across daughters versus sons or mothers versus fathers. CONCLUSIONS Parents of children with obesity may experience weight stigma by association, which could have direct consequences for the parents, the children, and the parent-child relationship.
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Affiliation(s)
- Kristen M Lee
- Department of Psychology, University of California, Los Angeles (KM Lee, L Arriola-Sanchez, and AJ Tomiyama)
| | - Lauren Arriola-Sanchez
- Department of Psychology, University of California, Los Angeles (KM Lee, L Arriola-Sanchez, and AJ Tomiyama)
| | - Julie C Lumeng
- Department of Pediatrics, Medical School, and Department of Nutritional Sciences, School of Public Health, University of Michigan (JC Lumeng), Ann Arbor, Mich
| | - Ashley Gearhardt
- Department of Psychology, University of Michigan (A Gearhardt), Ann Arbor, Mich
| | - A Janet Tomiyama
- Department of Psychology, University of California, Los Angeles (KM Lee, L Arriola-Sanchez, and AJ Tomiyama).
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15
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Watanabe M, Kibe C, Sugawara M, Miyake H. Courtesy stigma of parents of children with Down syndrome: Adaptation process and transcendent stage. J Genet Couns 2021; 31:746-757. [PMID: 34951509 PMCID: PMC9415099 DOI: 10.1002/jgc4.1541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/06/2021] [Accepted: 07/18/2021] [Indexed: 11/10/2022]
Abstract
Courtesy stigma, which arises from close connections to people with stigmatized characteristics, negatively affects interpersonal relations. This study aimed to evaluate courtesy stigma and the adaptation process of parents of children with Down syndrome based on semi-structured interviews with 23 Japanese parents. The interview themes were (a) negatively perceived interpersonal experiences and coping strategies; (b) information disclosure and others' responses; and (c) positively perceived interpersonal experiences. The interview data were transcribed and analyzed based on a grounded theory approach. The results suggested that parents perceived and experienced multidimensional courtesy stigma, and they used various coping strategies categorized in combinations of passive-active and internal-external. All parents disclosed information about their child's diagnosis to others, and reverse disclosure (i.e., revealing own relations with people with disabilities) was characteristically observed thereafter. Through active interaction and reflection, the parents cultivated social relationships, compassion, world views, and community involvement, which led to the transcendent stage. However, internal conflict as a mediator between people with and without Down syndrome re-emerged even after achieving the transcendent stage. These findings could help to develop interventions in genetic counseling for parents to deal with interpersonal relationship difficulties.
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Affiliation(s)
- Motoko Watanabe
- Department of Clinical Genetics, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Institute for Human Life Innovation, Ochanomizu University, Tokyo, Japan
| | - Chieko Kibe
- Center for Institutional Research, Educational Development, and Learning Support, Ochanomizu University, Tokyo, Japan
| | - Masumi Sugawara
- Department of Developmental Psychology, Faculty of Human Studies, Shirayuri University, Tokyo, Japan
| | - Hidehiko Miyake
- Institute for Human Life Innovation, Ochanomizu University, Tokyo, Japan.,Department of Genetic Counseling, Graduate School of Humanities and Sciences, Ochanomizu University, Tokyo, Japan
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16
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Čolić M. Clarification of stigma concepts in research with families of individuals with neurodevelopmental disabilities. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2021; 69:621-627. [PMID: 37346251 PMCID: PMC10281341 DOI: 10.1080/20473869.2021.1989978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/28/2021] [Accepted: 09/28/2021] [Indexed: 06/23/2023]
Abstract
Stigma concepts among families of individuals with neurodevelopmental disabilities have received increased attention from researchers in the past decade. With a growing number of studies published, there are also notable discrepancies in conceptualizations and uses of stigma terms among scholars. These variations may result in inadequate comparisons of findings across studies and a failure to generalize the results. Therefore, I have compared various stigma concepts and offered key features of each term as well as suggested methodology for facilitating stigma research.
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Affiliation(s)
- Marija Čolić
- Department of Special Education, University of Hawaiʻi at Mānoa, Honolulu, HI, USA
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17
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Roberts KJ, Polfuss ML, Marston EC, Davis RL. Experiences of weight stigma in adolescents with severe obesity and their families. J Adv Nurs 2021; 77:4184-4194. [PMID: 34435701 DOI: 10.1111/jan.15012] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/05/2021] [Accepted: 07/29/2021] [Indexed: 01/25/2023]
Abstract
AIM To describe the experiences of weight stigma in adolescents with severe obesity and their parents. DESIGN Qualitative descriptive secondary analysis. METHODS A secondary analysis on 31 transcripts from a larger study of 46 transcripts conducted between February 2019 and June 2020. Semi-structured interviews were conducted with 19 parents (n = 17 mothers, n = 2 fathers) and 12 adolescents (n = 7 male, n = 5 female). Interviews were digitally audio recorded, transcribed and analysed using conventional content analysis. RESULTS Four common themes were identified reflecting experiences of weight stigma: weight-based teasing and bullying, interactions with healthcare providers (HCPs), family interactions and blame. Subthemes were fairness and impact on mental health. CONCLUSION This secondary analysis adds to the sparse literature documenting the experiences of weight stigma from adolescents with severe obesity and their families. It is important to understand the experiences of weight stigma from the adolescent and parent perspective as it can inform healthcare, education and policies across communities and facilitate holistic health for this vulnerable population. IMPACT The need for research to better understand how experiences of weight stigma correlate with physiological and psychological outcomes and inform innovative interventions are critical to improve treatment of severe obesity. Healthcare providers across disciplines are in a strategic position to change the paradigm through which we provide care to youth with severe obesity and guide families in supporting their children's weight management efforts without contributing to weight stigma.
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Affiliation(s)
- Karyn J Roberts
- University of Wisconsin-Milwaukee College of Nursing, Milwaukee, Wisconsin, USA
| | - Michele L Polfuss
- University of Wisconsin-Milwaukee College of Nursing, Milwaukee, Wisconsin, USA
| | - Emma C Marston
- University of Wisconsin-Milwaukee College of Nursing, Milwaukee, Wisconsin, USA
| | - Renée L Davis
- Saint Louis University Trudy Busch Valentine School of Nursing, Saint Louis, Missouri, USA
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18
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Pomeroy J, VanWormer JJ, Meilahn JR, Maki T, Murali HR, Haws RM. Sleep and physical activity patterns in adults and children with Bardet-Biedl syndrome. Orphanet J Rare Dis 2021; 16:276. [PMID: 34127036 PMCID: PMC8201861 DOI: 10.1186/s13023-021-01911-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/07/2021] [Indexed: 12/27/2022] Open
Abstract
Background Overweight and obesity are common features of the rare disease Bardet–Biedl syndrome (BBS). Sleep and physical activity are behaviors that might impact overweight and obesity and thus may play a key role in the health and well-being of people with BBS. Objectively-measured sleep and physical activity patterns in people with BBS are not well known. We evaluated objectively-measured sleep and physical activity patterns in the largest cohort to date of people with BBS. Results Short sleep duration, assessed using wrist-worn accelerometers, was common in both children and adults with BBS. Only 7 (10%) of adults and 6 (8%) of children met age-specific sleep duration recommendations. Most adults 64 (90%) achieved recommended sleep efficiency. The majority of children 26 (67%) age 6–12 years achieved recommended sleep efficiency, but among children age 13–18, only 18 (47%). In both adults and children, sleep duration was significantly negatively correlated with duration of prolonged sedentary time. In children age 6–12 sleep duration was also significantly related to total activity score, children with lower sleep duration had lower total activity scores. Conclusions Insufficient sleep duration is very common in people with BBS. Prolonged sedentary time and short sleep duration are both potentially important health-related behaviors to target for intervention in people with BBS. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-021-01911-4.
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Affiliation(s)
- Jeremy Pomeroy
- Department of Clinical Research, Marshfield Clinic Research Institute, 1000 North Oak Ave, Marshfield, WI, 54449, USA.
| | - Jeffrey J VanWormer
- Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, Marshfield, WI, USA
| | - Jill R Meilahn
- Department of Physical Medicine, Marshfield Clinic Health System, Marshfield, WI, USA
| | - Tara Maki
- Physical Therapy Department, Marshfield Clinic Health System, Marshfield, WI, USA
| | - Hema R Murali
- Department of Pediatrics, Marshfield Clinic Health System, Marshfield, WI, USA
| | - Robert M Haws
- Department of Pediatrics, Marshfield Clinic Health System, Marshfield, WI, USA
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19
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Pomeroy J, Krentz AD, Richardson JG, Berg RL, VanWormer JJ, Haws RM. Bardet-Biedl syndrome: Weight patterns and genetics in a rare obesity syndrome. Pediatr Obes 2021; 16:e12703. [PMID: 32700463 PMCID: PMC7816264 DOI: 10.1111/ijpo.12703] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 06/30/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Bardet-Biedl syndrome (BBS) is a rare genetic disorder that severely inhibits primary cilia function. BBS is typified by obesity in adulthood, but pediatric weight patterns, and thus optimal periods of intervention, are poorly understood. OBJECTIVES To examine body mass differences by age, gender, and genotype in children and adolescents with BBS. METHODS We utilized the largest international registry of BBS phenotypes. Anthropometric and genetic data were obtained from medical records or participant/family interviews. Participants were stratified by age and sex categories. Genotype and obesity phenotype were investigated in a subset of participants with available data. RESULTS Height and weight measurements were available for 552 unique individuals with BBS. The majority of birth weights were in the normal range, but rates of overweight or obesity rapidly increased in early childhood, exceeding 90% after age 5. Weight z-scores in groups >2 years were above 2.0, while height z-scores approached 1.0, but were close to 0.0 in adolescents. Relative to those with the BBS10 genotype, the BBS1 cohort had a lower BMI z-score in the 2-5 and 6-11 age groups, with similar BMI z-scores thereafter. Children with biallelic loss of function (LOF) genetic variants had significantly higher BMI z-scores compared to missense variants. CONCLUSION Despite normal birth weight, most individuals with BBS experience rapid weight gain in early childhood, with high rates of overweight/obesity sustained through adolescence. Children with LOF variants are disproportionally affected. Our findings support the need for earlier recognition and initiation of weight management therapies in BBS.
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Affiliation(s)
- Jeremy Pomeroy
- Clinical Research CenterMarshfield Clinic Research InstituteMarshfieldWisconsinUSA
| | | | - Jesse G. Richardson
- Clinical Research CenterMarshfield Clinic Research InstituteMarshfieldWisconsinUSA
| | - Richard L. Berg
- Clinical Research CenterMarshfield Clinic Research InstituteMarshfieldWisconsinUSA
| | - Jeffrey J. VanWormer
- Clinical Research CenterMarshfield Clinic Research InstituteMarshfieldWisconsinUSA
| | - Robert M. Haws
- Clinical Research CenterMarshfield Clinic Research InstituteMarshfieldWisconsinUSA,Department of PediatricsMarshfield Clinic Health SystemMarshfieldWisconsinUSA
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20
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Gorlick JC, Gorman CV, Weeks HM, Pearlman AT, Schvey NA, Bauer KW. "I Feel Like Less of a Mom": Experiences of Weight Stigma by Association among Mothers of Children with Overweight and Obesity. Child Obes 2021; 17:68-75. [PMID: 33373542 PMCID: PMC7815062 DOI: 10.1089/chi.2020.0199] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background: Parents of children with higher weight are blamed and shamed for their children's weight. However, parents' experiences of this form of stigma, termed weight stigma by association, are poorly understood. The objective of this study was to investigate the sources, forms, and impacts of weight stigma by association among mothers of children with overweight or obesity. Methods: In this qualitative study, mothers who reported concern about their children's weight participated in semistructured interviews administered by the research team. A coding scheme was developed and reliably applied to interview transcripts. Mothers' self-reported sociodemographic information, and height and weight were measured. Results: Thirty-four mothers (Mage: 43.4 years; 26.5% non-Hispanic Black or African American, 70.6% with obesity) participated in the study. Mothers reported that family members were a common source of negative comments about their children's weight; these comments were often critical of mothers' parenting and in some cases contributed to negative affect among mothers. Many mothers also reported negative experiences during children's physicians' visits as a result of their children's weight. Almost all mothers expressed guilt and sadness for their perceived role in their children's weight status, expressing regret that they did not parent differently. Conclusions: Mothers of children with overweight and obesity are frequently the target of weight stigma by association and experience negative cognitions and emotions regarding their perceived role in their children's weight. Continued research is needed to elucidate the impacts of stigma by association due to child weight on parents' health, the parent/child relationship, and children's health.
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Affiliation(s)
- Jenna C. Gorlick
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Claire V. Gorman
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Heidi M. Weeks
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Arielle T. Pearlman
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Natasha A. Schvey
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Katherine W. Bauer
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
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21
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D'Amanda CS, Nolen R, Huryn LA, Turriff A. Psychosocial impacts of Mendelian eye conditions: A systematic literature review. Surv Ophthalmol 2020; 65:562-580. [DOI: 10.1016/j.survophthal.2020.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 01/30/2020] [Accepted: 02/03/2020] [Indexed: 01/07/2023]
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22
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Who's a good boy? Effects of dog and owner body weight on veterinarian perceptions and treatment recommendations. Int J Obes (Lond) 2020; 44:2455-2464. [PMID: 32523035 PMCID: PMC7686094 DOI: 10.1038/s41366-020-0622-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 05/03/2020] [Accepted: 05/22/2020] [Indexed: 12/12/2022]
Abstract
Background: Weight bias against persons with obesity impairs health care delivery
and utilization and contributes to poorer health outcomes. Despite rising
rates of pet obesity (including among dogs), the potential for weight bias
in veterinary settings has not been examined. Subjects/Methods: In two online, 2×2 experimental studies, the effects of dog
and owner body weight on perceptions and treatment recommendations were
investigated in 205 practicing veterinarians (Study 1) and 103 veterinary students (Study 2). In both studies, participants were
randomly assigned to view one of four vignettes of a dog and owners with
varying weight statuses (lean vs. obesity). Dependent measures included
emotion/liking ratings toward the dog and owners; perceived causes of the
dog’s weight; and treatment recommendations and compliance
expectations. Other clinical practices, such as terms to describe excess
weight in dogs, were also assessed. Results: Veterinarians and students both reported feeling more blame,
frustration, and disgust toward dogs with obesity and their owners than
toward lean dogs and their owners (p values<0.001).
Interactions between dog and owner body weight emerged for perceived causes
of obesity, such that owners with obesity were perceived as causing the dog
with obesity’s weight, while lean owners were perceived as causing
the lean dog’s weight. Participants were pessimistic about treatment
compliance from owners of the dog with obesity, and weight loss treatment
was recommended for the dog with obesity when presenting with a medical
condition ambiguous in its relationship to weight. Veterinarians and
students also reported use of stigmatizing terms to describe excess weight
in dogs. Conclusions: Findings from this investigation, with replication, have implications
for training and practice guidelines in veterinary medicine.
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23
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Zelihić D, Hjardemaal FR, Lippe CVD. Caring for a child with Bardet-Biedl syndrome: A qualitative study of the parental experiences of daily coping and support. Eur J Med Genet 2020; 63:103856. [PMID: 31972368 DOI: 10.1016/j.ejmg.2020.103856] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/12/2019] [Accepted: 01/17/2020] [Indexed: 10/25/2022]
Abstract
This study aimed to explore the parental experiences of having a child with Bardet-Biedl syndrome (BBS) and how parents managed to cope with this situation. Five parents of children with BBS (0-18 years old) participated in semistructured in-depth interviews. Inductive thematic analysis was used to identify themes. The parents experienced distress due to a lack of knowledge on BBS in their support system (e.g., school staff, clinicians, and family members), and they found it stressful to coordinate with multiple support services. Socialization at work, support from family members, and communicating with other parents who are in a similar situation promoted better coping and adaptations to daily life. Results highlight the importance of parents receiving adequate support while they face daily challenges. An increased knowledge on how rare disorders impact family life is needed in the support system.
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Affiliation(s)
- Deniz Zelihić
- Centre for Rare Disorders, Rikshospitalet, Oslo University Hospital HF, Norway
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24
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Wang D, Jia Y, Gao W, Chen S, Li M, Hu Y, Luo F, Chen X, Xu H. Relationships between Stigma, Social Support, and Distress in Caregivers of Chinese Children with Imperforate Anus: A Multicenter Cross-Sectional Study. J Pediatr Nurs 2019; 49:e15-e20. [PMID: 31378408 DOI: 10.1016/j.pedn.2019.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 07/13/2019] [Accepted: 07/15/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE This study was conducted to explore the relationships between stigma, social support, and distress in caregivers of children with imperforate anus (IA) and determine whether social support mediates the relationship between stigma and distress. DESIGN AND METHODS This cross-sectional study was conducted in three tertiary children's hospitals in Eastern China. Primary caregivers completed the Social Support Scale and the Chinese versions of the Parent Stigma Scale and Kessler Psychological Distress Scale, and provided their demographic information. The children's demographic and clinical data were also collected. The hypothesized relations were explored using structural equation modeling via the bootstrap method. RESULTS A total of 229 caregivers were enrolled. Distress was positively associated with stigma (r = 0.396, P < 0.01) and negatively associated with social support (r = -0.413, P < 0.01) in all dimensions (r = 0.314-0.346, P < 0.01). Stigma was also negatively correlated with social support (r = 0.280, P < 0.01). Furthermore, social support could partially mediate the relationship between stigma and distress (b = 0.135; 95% confidence interval: 0.072, 0.233). CONCLUSIONS Stigma can increase caregivers' distress, while social support can reduce it. Stigma can also negatively influence caregivers' social support. Therefore, stigma should be mitigated to enhance caregivers' social support and decrease their distress. PRACTICE IMPLICATIONS The study findings may aid in the identification of the psychological status of caregivers of children with IA, and also inform targeted intervention programs.
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Affiliation(s)
- Dan Wang
- Nursing Department, the Children's Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Yushuang Jia
- Nursing Department, the 2nd Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang, China
| | - Wei Gao
- Department of Pediatric Surgery, Anhui Provincial Children's Hospital, Anhui, China
| | - Shuohui Chen
- Nursing Department, the Children's Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Mengting Li
- Nursing Department, the Children's Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Yan Hu
- Nursing Department, the Children's Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Feixiang Luo
- Nursing Department, the Children's Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Xiaofei Chen
- Nursing Department, the Children's Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Hongzhen Xu
- Nursing Department, the Children's Hospital, Zhejiang University School of Medicine, Zhejiang, China.
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25
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Brewis A, Wutich A. Stigma: A biocultural proposal for integrating evolutionary and political-economic approaches. Am J Hum Biol 2019; 32:e23290. [PMID: 31282087 DOI: 10.1002/ajhb.23290] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/08/2019] [Accepted: 06/10/2019] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Stigma-the process by which people become socially discredited because they hold a characteristic that is classified as unacceptable or undesirable-has barely been considered in biocultural analyses. Yet, it provides an acute point of articulation for evolutionary and political-economic perspectives on human variation, including the biocultural production of health disparities. To explain the theoretical integration of the two perspectives to stigma, we first lay out some operationalizable definitions of stigma, and review feasible methods to capture them in the field. We then test the roles of predictors suggested from evolutionary (respondent's level of disgust, fear of contagion) and political-economic (respondent's perceived social standing and negative social labeling of those who violate hygiene norms) theories of stigma. METHODS We used survey, interview, and behavioral report data from a study of hygiene behaviors at four local community sites in Guatemala, Fiji, New Zealand, and the United States (N = 300). We applied a hierarchical GLMM design that treats site as a random effect. RESULTS The independent influences of both variable sets are evident in publicly visible forms of reported hygiene behaviors, specifically the exhibition of clean bodies, clothes, and homes. CONCLUSION We propose that the study of stigma provides a productive operationalizable space to engage the promise of the biocultural synthesis to integrate evolutionary and political-economic models of health and human variation.
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Affiliation(s)
- Alexandra Brewis
- School of Human Evolution and Social Change, Arizona State University, Tempe, Arizona
| | - Amber Wutich
- School of Human Evolution and Social Change, Arizona State University, Tempe, Arizona
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26
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Fenton AT. Abandoning Medical Authority: When Medical Professionals Confront Stigmatized Adolescent Sex and the Human Papillomavirus (HPV) Vaccine. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2019; 60:240-256. [PMID: 31113247 DOI: 10.1177/0022146519849895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Despite authority's centrality to the medical profession, providers routinely forgo their medical authority during clinical encounters. Research focuses on patients challenging medical authority but indicates these confrontations are uncommon and providers seldom relinquish their authority in response. Using rare data of 75 audio recordings of adolescent vaccine discussions during clinical encounters and interviews with and observations of medical staff, I examine how staff leverage or abandon their medical authority to convince parents to vaccinate. I find medical professionals use less authority when at risk of stigmatizing patients: Medical professionals are less authoritative when recommending human papillomavirus (HPV) vaccination versus other adolescent vaccines, particularly when addressing the need to vaccinate before sexual onset due to concerns of labeling the child as sexually active. Medical staff defer to parents in ways that potentially discourage HPV vaccine uptake: They encourage HPV vaccination less than other vaccines and infrequently challenge parents' sex-related reasons for vaccine refusal.
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Affiliation(s)
- Anny T Fenton
- 1 Harvard University, Cambridge, MA, USA
- 2 Maine Medical Center Research Institute, Portland, ME
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Li M, Fu R, Xue H, Wang Y. Intergenerational Association of Maternal Obesity and Child Peer Victimization in the United States. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2019; 60:69-83. [PMID: 30694074 DOI: 10.1177/0022146518824566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Drawing on the intergenerational stress proliferation theory, the courtesy stigma thesis, and the buffering ethnic culture thesis, this study examines the association between maternal obesity and child's peer victimization and whether this association varies for white and black children. Based on longitudinal data from a nationally representative sample of mother-child pairs in the U.S. Panel Study of Income Dynamics Child Development Supplement, negative binomial models show that maternal obesity is associated with increased frequency of peer victimization, even after controlling for family socioeconomic status, child weight status, health status, self-esteem, and demographic characteristics. The association was significant only for white children. Given the developmental significance of child peer relations and the social disparities in obesity, future studies need to explicitly test causal mechanisms underlying the association to decide whether obesity may function as a family stressor (versus an individual stressor) that contributes to the intergenerational reproduction of inequality.
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Affiliation(s)
- Miao Li
- 1 Clemson University, Clemson, SC, USA
| | - Rong Fu
- 2 Siena College, Loudonville, NY, USA
| | - Hong Xue
- 3 Virginia Commonwealth University, Richmond, VA, USA
| | - Youfa Wang
- 4 Ball State University, Muncie, IN, USA
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Vale PRLFD, Cerqueira S, Santos HP, Black BP, Carvalho ESDS. Bad news: Families' experiences and feelings surrounding the diagnosis of Zika-related microcephaly. Nurs Inq 2018; 26:e12274. [PMID: 30450789 DOI: 10.1111/nin.12274] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 09/27/2018] [Accepted: 10/12/2018] [Indexed: 12/24/2022]
Abstract
The rapidly increasing number of cases of Zika virus and limited understanding of its congenital sequelae (e.g., microcephaly) led to stories of fear and uncertainty across social media and other mass communication networks. In this study, we used techniques generic to netnography, a form of ethnography, using Internet-based computer-mediated communications as a source of data to understand the experience and perceptions of families with infants diagnosed with Zika-related microcephaly. We screened 27 YouTube™ videos published online between October 2015 and July 2016, during which the Zika epidemic started, peaked, and declined. We identified three themes: (a) experiencing the news of a diagnosis of Zika-associated microcephaly; (b) experiencing feelings and expectations of the 'imperfect' child; and (c) seeking to understand microcephaly to care for the child. We found that families experienced distressing feelings of shock, sadness, hopelessness, and pain, while dealing with emerging and sometimes conflicting information being transmitted by news outlets, uncertainty about the child's health, and healthcare providers' lack of clarity to guide the family members. The 'unknown' factor of ZIKA was an additional stressful factor in the experience of the families.
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Affiliation(s)
| | - Sheila Cerqueira
- Department of Health, Universidade Estadual de Feira de Santana, Bahia, Brazil
| | - Hudson P Santos
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Beth P Black
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Forsythe E, Kenny J, Bacchelli C, Beales PL. Managing Bardet-Biedl Syndrome-Now and in the Future. Front Pediatr 2018; 6:23. [PMID: 29487844 PMCID: PMC5816783 DOI: 10.3389/fped.2018.00023] [Citation(s) in RCA: 112] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 01/25/2018] [Indexed: 11/13/2022] Open
Abstract
Bardet-Biedl syndrome is a rare autosomal recessive multisystem disorder caused by defects in genes encoding for proteins that localize to the primary cilium/basal body complex. Twenty-one disease-causing genes have been identified to date. It is one of the most well-studied conditions in the family of diseases caused by defective cilia collectively known as ciliopathies. In this review, we provide an update on diagnostic developments, clinical features, and progress in the management of Bardet-Biedl syndrome. Advances in diagnostic technologies including exome and whole genome sequencing are expanding the spectrum of patients who are diagnosed with Bardet-Biedl syndrome and increasing the number of cases with diagnostic uncertainty. As a result of the diagnostic developments, a small number of patients with only one or two clinical features of Bardet-Biedl syndrome are being diagnosed. Our understanding of the syndrome-associated renal disease has evolved and is reviewed here. Novel interventions are developing at a rapid pace and are explored in this review including genetic therapeutics such as gene therapy, exon skipping therapy, nonsense suppression therapy, and gene editing. Other non-genetic therapies such as gene repurposing, targeted therapies, and non-pharmacological interventions are also discussed.
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Affiliation(s)
- Elizabeth Forsythe
- Genetics and Genomic Medicine Programme, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Joanna Kenny
- Genetics and Genomic Medicine Programme, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Chiara Bacchelli
- Genetics and Genomic Medicine Programme, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Philip L Beales
- Genetics and Genomic Medicine Programme, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
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Dako-Gyeke M. Courtesy stigma: A concealed consternation among caregivers of people affected by leprosy. Soc Sci Med 2017; 196:190-196. [PMID: 29195190 DOI: 10.1016/j.socscimed.2017.11.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 10/21/2017] [Accepted: 11/16/2017] [Indexed: 01/14/2023]
Abstract
This study explored experiences of courtesy stigma among caregivers of people affected by leprosy. Using a qualitative research approach, twenty participants were purposively selected and in-depth interviews conducted. The interviews were audio-recorded, transcribed, and analyzed to identify emerging themes that addressed objectives of the study. The findings indicated that caregivers of people affected by leprosy experienced courtesy stigma. Evidence showed that fear of contagion underpinned caregivers' experiences, especially in employment and romantic relationships. In addition, participants adopted different strategies (disregarding, concealment, education, faith-based trust) to handle courtesy stigma. The findings demonstrate that psychosocial support and financial assistance to caregivers are necessary considerations for attainment of effective care for people affected by leprosy.
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Affiliation(s)
- Mavis Dako-Gyeke
- Department of Social Work, School of Social Sciences, University of Ghana, Legon, Accra, Ghana.
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Zenlea IS, Thompson B, Fierheller D, Green J, Ulloa C, Wills A, Mansfield E. Walking in the shoes of caregivers of children with obesity: supporting caregivers in paediatric weight management. Clin Obes 2017; 7:300-306. [PMID: 28703480 DOI: 10.1111/cob.12202] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 05/08/2017] [Accepted: 05/31/2017] [Indexed: 10/19/2022]
Abstract
To incorporate the perspectives and experiences of family caregivers of children with obesity, the KidFit Health and Wellness Clinic, a paediatric weight management programme, embedded feedback opportunities into various stages of programme development. Caregivers were eligible to participate if their children had completed initial 4-week group-based pilot programming or were currently receiving treatment in 10 or 12 week group-based programming. Data were collected through feedback session discussions, audio-recorded, transcribed verbatim and analysed thematically. In total, 6 caregivers participated in the pilot group feedback session and 32 caregivers participated in the structured group feedback sessions. Caregivers reported that healthy lifestyle strategies first communicated by clinic staff to children during group sessions provided expert validation and reinforcement when discussing similar messages at home. Caregivers reported feeling isolated and blamed for causing their children's obesity and appreciated the supportive forum that group-based programming provided for sharing experiences. Since experiences of blame and isolation can burden caregivers of children with obesity, paediatric weight management programmes might consider including peer support opportunities and discussion forums for ongoing social support in addition to education about lifestyle change.
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Affiliation(s)
- I S Zenlea
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Children's Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - B Thompson
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - D Fierheller
- Division of Children's Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - J Green
- Division of Children's Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - C Ulloa
- Division of Children's Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - A Wills
- Division of Children's Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - E Mansfield
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
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Wong MS, Showell NN, Bleich SN, Gudzune KA, Chan KS. The association between parent-reported provider communication quality and child obesity status: Variation by parent obesity and child race/ethnicity. PATIENT EDUCATION AND COUNSELING 2017; 100:1588-1597. [PMID: 28318844 PMCID: PMC5478425 DOI: 10.1016/j.pec.2017.03.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 03/02/2017] [Accepted: 03/08/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To examine the association between healthcare provider communication quality and child obesity status, and the role of parent obesity and child race/ethnicity regarding this association. METHODS We conducted a cross-sectional secondary data analysis with the 2011-2013 Medical Expenditures Panel Survey of parents with children ages 6-12 (n=5390). We used multivariable logistic regression to examine the association of parent-reported healthcare provider communication quality (explaining well, listening carefully, showing respect, and spending enough time) with child obesity status, and effect modification by parent obesity and child race/ethnicity. RESULTS Parents of obese children were more likely to report that their child's healthcare provider listened carefully (OR=1.41, p=0.002) and spent enough time (OR=1.33, p=0.022) than parents of non-obese children. Non-obese parents of obese children experienced better communication in the domains of listening carefully (p<0.001) and spending enough time (p=0.007). Parents of obese non-Hispanic Asian children and non-Hispanic Black children were more likely to report that providers explained things well (p=0.043) and listened carefully (p=0.012), respectively. CONCLUSION Parents of obese children experienced better communication if parents were non-obese or children were non-Hispanic Black or Asian. PRACTICE IMPLICATIONS Healthcare providers should ensure effective communication with obese parents of obese children.
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Affiliation(s)
- Michelle S Wong
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, USA.
| | - Nakiya N Showell
- Division of General Pediatrics & Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Sara N Bleich
- Harvard T.H. Chan School of Public Health, Boston, USA
| | - Kimberly A Gudzune
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University School of Medicine, Baltimore, USA; Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Kitty S Chan
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, USA
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Clarke A. Anticipated stigma and blameless guilt: Mothers' evaluation of life with the sex-linked disorder, hypohidrotic ectodermal dysplasia (XHED). Soc Sci Med 2016; 158:141-8. [PMID: 27140840 PMCID: PMC4884667 DOI: 10.1016/j.socscimed.2016.04.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 04/20/2016] [Accepted: 04/22/2016] [Indexed: 11/29/2022]
Abstract
Practical experience of a genetic disorder may influence how parents approach reproduction, if they know their child may be affected by an inherited condition. One important aspect of this practical experience is the stigmatisation which family members may experience or witness. We outline the concept of stigma and how it affects those in families with a condition that impacts upon physical appearance. We then consider the accounts given by females in families affected by the rare sex-linked disorder, X-linked hypohidrotic ectodermal dysplasia (XHED), which principally affects males but can be passed through female carriers to affect their sons. The stigmatisation of affected males is as important in the accounts given by their womenfolk as the physical effects of the condition; this impacts on their talk about transmission of the disorder to the next generation. Perspectives may also change over time. The mothers of affected sons differ from their daughters, who do not yet have children, and from their mothers, who may express more strongly their sense of guilt at having transmitted the condition, despite there being no question of moral culpability. We conclude with suggestions about other contexts where the possibility of stigma may influence reproductive decisions.
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Affiliation(s)
- Angus Clarke
- Medical Genetics, Cancer & Genetics, School of Medicine, Cardiff University, Wales UK.
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