Atitudes de nutricionistas em relação a indivíduos obesos – um estudo exploratório

Under the 'weight' of norms: Social representations of overweight and obesity among Brazilian, French and Spanish dietitians and laywomen

Most contemporary Western cultures are characterized by fatphobia. The fat body is seen as morally incorrect, a sign of disease, loss of control and weakness. People with obesity and overweight, especially women, are discriminated against and stigmatized for their body size, including by health professionals like dietitians. This study sought to understand and compare social representations of obesity and overweight among dietitians and laywomen from three nationalities: Brazilian, French and Spanish. A qualitative and comparative methodology was established based on 131 semi-structured individual interviews. The analysis revealed that the categories of overweight and obesity were negatively perceived by laywomen and dietitians from all three nationalities. Moral discourses linking these conditions with lack of discipline and a lack of emotional control were frequently used. Fatness was associated with irrationality, putting individuals who were overweight and obese in a position of social and moral inferiority. In the case of obesity, these ideas were more discriminatory and stigmatizing. Although environmental, genetic, hereditary or metabolic causes were mentioned as factors causing obesity, behavioural aspects occupied a central place in the discourses. Differences were also observed among the three nationalities. Cultural factors related to the relationship with body and food seemed to influence the interviewees' social representations. Brazilian laywomen and dietitians put more emphasis on moral and individual aspects. Spanish, French and informants who were overweight were more likely to cite physiological and environmental determinants. French informants also mentioned the role of food education given by parents. In conclusion, the discourses of professionals and laywomen had more similarities than differences, were based on moral and normative judgements and influenced by sociocultural norms. Fatphobic attitudes may impact dietitians' perception of patients with obesity and the eating education process.

Do Registered Dietitians, Nutrition Students, and Laypeople Perceive Individuals with Obesity Differently?

(1) Background: Obesity is associated with significant social consequences, and individuals with obesity are regularly affected by weight-related stigmatization experiences. This study compares antifat attitudes among registered dietitians (RD), nutrition students, and laypeople and assesses which factors related to the perceived causes of obesity influence these attitudes. (2) Methods: An online survey was conducted in Brazil with RD (n = 336), nutrition students (n = 300), and laypeople (n = 403) with questionnaires assessing antifat attitudes and perceived causes of obesity. (3) Results: All groups presented low antifat attitudes. Minor differences in antifat attitudes were found among the three groups. Compared to RDs and nutrition students, laypeople presented higher Weight Control/Blame scores, but with a small effect size (η² = 0.01). Weight bias was predicted by age, sex, and body mass index. External, social, and financial factors were not perceived to be very important in the development of obesity by RD and students. (4) Conclusions: Since slight differences were seen among RD and students compared to laypeople, and some perceptions of the causes of obesity indicate a stigmatized view. It is essential to place a greater focus on educating and updating these health professionals and students about weight stigma and its consequences for the mental and physical health of individuals.

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

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

Nutritionists and the comprehensive care of overweight individuals in primary care

ABSTRACT Objective This study sought to highlight the different types of challenges for the integral care of overweight individuals in primary care based on the perception of nutritionists. Methods This is a qualitative study with primary care professionals from the Federal District, Brazil. Semi-structured interviews were conducted to understand the perceptions regarding the organization of integral care. The analysis of the data was based on the theoretical framework Theoretical Domains Framework. Results Challenges related to 10 of the 12 different domains proposed by the theoretical framework were identifi ed. These challenges are related to the capability, opportunity and motivation of workers to act to offer moreeffective care. Conclusion The different nature of the barriers identifi ed were overlapped, which reveal the need for professional qualifi cation along with the consolidation of an appropriate care model for chronic noncommunicable diseases such as obesity.

Weight bias among exercise and nutrition professionals: a systematic review

Obesity affects approximately one-third of American adults. Recent evidence suggests that weight bias may be pervasive among both exercise and nutrition professionals working with adults who have obesity. However, the published literature on this topic is limited. This review aimed to (i) systematically review existing literature examining weight bias among exercise and nutrition professionals; (ii) discuss the implications of this evidence for exercise and nutrition professionals and their clients; (iii) address gaps and limitations of this literature; and (iv) identify future research directions. Of the 31 studies that met the criteria for this review, 20 examined weight bias among exercise professionals, of which 17 (85%) found evidence of weight bias among professionals practicing physical therapy (n = 4), physical education (n = 8) and personal/group fitness training (n = 5). Of 11 studies examining weight bias among nutrition professionals, eight (73%) found evidence of weight bias. These findings demonstrate fairly consistent evidence of weight bias among exercise and nutrition professionals. However, the majority of studies were cross-sectional (90%). Given that weight bias may compromise quality of care and potentially reinforce weight gain and associated negative health consequences in patients with obesity, it is imperative for future work to examine the causes and consequences of weight bias within exercise and nutrition professions using more rigorous study designs.