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Brewis A, Trainer S. No 'easy' weight loss: don't overlook the social cost of anti-obesity drugs. Nature 2024; 626:258-260. [PMID: 38321134 DOI: 10.1038/d41586-024-00329-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
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Chan JKY, Vartanian LR. Psychological predictors of adherence to lifestyle changes after bariatric surgery: A systematic review. Obes Sci Pract 2024; 10:e741. [PMID: 38404933 PMCID: PMC10893879 DOI: 10.1002/osp4.741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/08/2024] [Accepted: 02/04/2024] [Indexed: 02/27/2024] Open
Abstract
Objective Adherence to lifestyle changes after bariatric surgery is associated with better health outcomes; however, research suggests that patients struggle to follow post-operative recommendations. This systematic review aimed to examine psychological factors associated with adherence after bariatric surgery. Methods PubMed, PsycInfo, and Embase were searched (from earliest searchable to August 2022) to identify studies that reported on clinically modifiable psychological factors related to adherence after bariatric surgery. Retrieved abstracts (n = 891) were screened and coded by two raters. Results A total of 32 studies met the inclusion criteria and were included in the narrative synthesis. Appointment attendance and dietary recommendations were the most frequently studied post-operative instructions. Higher self-efficacy was consistently predictive of better post-operative adherence to diet and physical activity, while pre-operative depressive symptoms were commonly associated with poorer adherence to appointments, diet, and physical activity. Findings were less inconsistent for anxiety and other psychiatric conditions. Conclusions This systematic review identified that psychological factors such as mood disorders and patients' beliefs/attitudes are associated with adherence to lifestyle changes after bariatric surgery. These factors can be addressed with psychological interventions; therefore, they are important to consider in patient care after bariatric surgery. Future research should further examine psychological predictors of adherence with the aim of informing interventions to support recommended lifestyle changes.
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Affiliation(s)
- Jade K. Y. Chan
- School of PsychologyUNSW SydneySydneyNew South WalesAustralia
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Prevalence and short-term change in symptoms of anxiety and depression following bariatric surgery: a prospective cohort study. BMJ Open 2024; 14:e071231. [PMID: 38171620 PMCID: PMC10773381 DOI: 10.1136/bmjopen-2022-071231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 11/23/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVES Bariatric surgery is an effective treatment for severe obesity that leads to significant physical health improvements. Few studies have prospectively described the short-term impact of surgery on mental health using standardised case-finding measures for anxiety or depressive disorders. This study describes the prevalence and short-term course of these conditions following surgery. DESIGN Prospective observational cohort study. SETTING 12 National Health Service centres in England. PARTICIPANTS Participants studied took part in the By-Band-Sleeve study, a multicentre randomised controlled trial evaluating the surgical management of severe obesity. We included participants who had undergone surgery (gastric bypass, gastric band or sleeve gastrectomy) within 6 months of randomisation. PRIMARY AND SECONDARY OUTCOME MEASURES Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS) at baseline and 12 months post-randomisation. Sociodemographic variables collected at prerandomisation included body mass index, age, sex, ethnicity, marital status, tobacco use, employment status and income band. RESULTS In our sample of 758 participants, 94.5% (n 716) and 93.9% (n 712) had completed baseline anxiety (HADS-A) and depression (HADS-D) subscales. At pre-randomisation 46.1% (n 330/716, 95% CI 42.4% to 49.7%) met clinical case criteria for anxiety and 48.2% (n 343/712, 95% CI 44.5% to 51.8%) for depression. Among participants returning completed 12 months post-randomisation questionnaires (HADS-A n 503/716, HADS-D n 498/712), there was a significant reduction in the proportion of clinical cases with anxiety (-9.5%, 95% CI -14.3% to -4.8% p<0.001) and depression (-22.3%, 95% CI -27.0% to -17.6% p<0.001). CONCLUSIONS Almost half of people undergoing bariatric surgery had underlying anxiety or depressive symptoms. In the short term, these symptoms appear to substantially improve. Future work must identify whether these effects are sustained beyond the first post-randomisation year. TRIAL REGISTRATION NUMBER NCT02841527 and ISRCTN00786323.
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Zahra-Zeitoun Y, Elran-Barak R, Salameh-Dakwar R, Froylich D, Sroka G, Assalia A, Latzer Y. Weight stigma in healthcare settings: the experience of Arab and Jewish bariatric surgery candidates in Israel. Isr J Health Policy Res 2024; 13:1. [PMID: 38167112 PMCID: PMC10759645 DOI: 10.1186/s13584-023-00587-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 12/09/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Weight-related stigma and discrimination are prevalent in our society with adverse biopsychosocial outcomes to people with obesity and morbid obesity. Studies suggest that weight bias in healthcare settings are quite prevalent, but there have been, as far as we know, lack of studies examining prevalence and correlates of weight bias experiences among bariatric surgery candidates in Israel. We aim to understand the nature and prevalence of weight stigma among bariatric surgery candidates. To identify differences between Jewish and Arab candidates. To examine the impact of weight stigma experiences on weight bias internalization (WBI). METHODS A cross-sectional study was performed among 117 adult bariatric surgery candidates from three hospitals in northern Israel (47.8% Jews, 82.4% females, average BMI 42.4 ± 5.2 Kg/meter2). Patients who agreed to participate completed a structured questionnaire on the same day that the bariatric surgery committee met. WBI was measured using a validated 10-item scale. Experiences of weight stigma were measured using items adapted from prior international studies. RESULTS About two thirds of the participants had at least one experience of weight stigma (teased, treated unfairly, or discriminated against because of their weight). As many as 75% of participants reported that weight served as a barrier to getting appropriate health care and as many as half of participants felt in the last year that a doctor judged them because of their weight. No significant differences were found between Arabs and Jews in the prevalence of weight stigma experiences and WBI. However, a trend towards more stigma experiences among Jews was noted. WBI was predicted by female gender and experiences of weight stigma, both in general and within healthcare settings. CONCLUSIONS Weight stigma towards bariatric surgery candidates in Israel is quite prevalent, and specifically in healthcare settings. It is important to adopt policy actions and intervention programs to improve awareness to this phenomenon among the general public and specifically among healthcare providers, as many healthcare providers may be unaware of the adverse effect of weight stigma and of ways in which they are contributing to the problem. Future studies may validate our findings using larger sample size and longitudinal design.
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Affiliation(s)
| | | | | | | | | | | | - Yael Latzer
- School of Public Health, University of Haifa, Haifa, Israel
- Rambam Medical Center, Haifa, Israel
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Al-Mushaigah BS, Almesned RA, Alsolai OA, Alfahhad NM, Almesned AA. Knowledge and Attitude of the Public Toward Bariatric Weight Loss Surgery and Its Impact on Candidates and Patients in the Al-Qassim Region, Saudi Arabia. Cureus 2023; 15:e50477. [PMID: 38226076 PMCID: PMC10788245 DOI: 10.7759/cureus.50477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 01/17/2024] Open
Abstract
Background Obesity is defined as abnormal or excessive fat accumulation that presents a serious health risk and is a major public health concern. Obesity prevention and management require evidence-based strategies that emphasize diet and physical activity. Bariatric surgery is also a life-changing procedure that can improve physical and mental health, but the stigma associated with it can prevent people from seeking treatment and affect their lives adversely. Studies have shown that bariatric surgery patients face discrimination from the public and healthcare professionals, which can lead to adverse psychological outcomes and hinder access to quality care. Goals and methods This study intends to explore the stigma related to bariatric surgery in Al-Qassim Region, Saudi Arabia, because it is crucial to understand its prevalence among the public and the influence it has on both those who have undergone the surgery and those who are considering it as an option. The participants had to complete an online questionnaire, comprised a general section and other sections based on whether or not the individual has, has not, or is considering bariatric surgery. Results A total of 988 individuals, 605 of whom were female (61.2%), agreed to participate in the study. The most common body mass index (BMI) category was 18.5-24.9 (43.5%, n=414). The majority of the participants had either agreed or strongly agreed that obesity is a disease (87.8%, n=867) and that genetic factors play a role in causing it (38.8%, n=383). The factors selected most commonly that increase the risk of obesity were "idle and lazy life" (76.5%, n=756) and "eating too much" (75.6%, n=747). Fewer than half of the participants (44.43%, n=439) reported that they had never thought about treating obesity through surgical operations, 9.62% (n=95) had considered it, and 3.74% (n=37) had actually undergone the surgery. Among those who underwent weight loss surgery (n=37), 43.20% (n=16) reported that they received critical comments or poor treatment from the community, 35.10% (n=13) felt ashamed or embarrassed to disclose their surgery, and 37.80% (n=14) avoided social situations or events because of those comments or poor treatment. The comments reported most often were "You have taken the easy way out instead of adopting a healthy lifestyle" (51.40%, n=19) and "Why didn't you try to go on a diet?" (51.40%, n=19). Among those who have intentions to undergo weight loss surgery (n=95), a significant proportion of the participants (43%, n=40) agreed or strongly agreed that concerns about public opinion or community treatment could affect their decision to undergo weight loss surgery. Moreover, 32.6% (n=31) of them agreed or strongly agreed that society has a negative attitude toward individuals who have undergone obesity treatment. When asked whether they had ever avoided telling people that they were considering surgery because of potential adverse reactions, 42.10% (n=40) of the participants responded that they had. Conclusion This study helped bring attention to, and prove, the stigma related to bariatric surgery in Al-Qassim Region. Such stigma has prevented patients from seeking or undergoing a surgical option to manage their weight, even if it is the option recommended for them. As such, public education and awareness campaigns are encouraged to help reduce the stigma, as well as improve access to bariatric surgery for those who need it.
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Affiliation(s)
| | - Rakan A Almesned
- College of Interventional Radiology, Qassim University, Buraydah, SAU
| | | | - Noor M Alfahhad
- College of Family Medicine, Qassim University, Buraydah, SAU
| | - Abdulelah A Almesned
- Unaizah College of Medicine and Medical Sciences, Qassim University, Buraydah, SAU
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Lin YC, Lin CY, Saffari M, Tsai MC, Chang YH, Strong C, Chen JK, Hsieh YP, Yang YN, Latner JD. Weight stigma is associated with body mass index among college students in Taiwan: the mediated role of internalized weight stigma. BMC Psychol 2023; 11:365. [PMID: 37915074 PMCID: PMC10621093 DOI: 10.1186/s40359-023-01414-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/26/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Weight stigma is an issue often studied in Western countries; however, such information is scarce in Asian studies. METHODS This study aimed to examine the role of internalized weight stigma as a mediator in the relationship between perceived weight stigma and changes in body mass index (BMI). The data were collected through a longitudinal online survey with two phases (n = 974; Phase 1: August and September 2021; Phase 2: November and December 2021). The Perceived Weight Stigma Scale (PWSS), Weight Self-Stigma Questionnaire (WSSQ), and Depression, Anxiety, Stress Scale - 21 (DASS-21) were administered to assess perceived weight stigma, internalized weight stigma, and psychological distress. Hierarchical regressions were used to examine the proposed model, and Hayes' Process Macro was used to test a mediation model. RESULTS The changes in perceived weight stigma and internalized weight stigma were significantly and positively associated with changes in BMI. There were significant and positive associations between perceived weight stigma, internalized weight stigma and psychological distress over time. Change in internalized weight stigma was found to be a significant mediator in the association of change in perceived weight stigma with change in BMI for the entire sample (unstandardized coefficient = 0.04; 95% CI = 0.02, 0.06), female subgroup (unstandardized coefficient = 0.05; 95% CI = 0.02, 0.08), and male subgroup (unstandardized coefficient = 0.03; 95% CI = 0.01, 0.06). Change in perceived weight stigma also had significant effects on change in BMI for the entire sample and the female subgroup, but not for the male subgroup. CONCLUSION Because perceived weight stigma may significantly impact changes in BMI through internalized weight stigma, treatment strategies to ameliorate self-stigma may enhance the results of weight-reduction programs. Such treatment strategies should be considered for inclusion in weight-loss interventions.
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Affiliation(s)
- Yi-Ching Lin
- Department of Early Childhood and Family Education, National Taipei University of Education, Taipei, 106320, Taiwan
| | - Chung-Ying Lin
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, 1 University Rd, Tainan, 701, Taiwan.
- University of Religions and Denominations, Qom, Iran.
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
- Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Mohsen Saffari
- Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Health Education Department, Faculty of Health, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Meng-Che Tsai
- Department of Pediatrics, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
- Department of Medical Humanities and Social Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yun-Hsuan Chang
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Psychology, National Cheng Kung University, Tainan, Taiwan
| | - Carol Strong
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ji-Kang Chen
- Department of Social Work, Chinese University of Hong Kong, New Territories, Hong Kong, China
| | - Yi-Ping Hsieh
- Department of Social Work, College of Nursing and Professional Disciplines, University of North Dakota, Grand Forks, ND, USA
| | - Yung-Ning Yang
- Department of Pediatrics, E-DA Hospital, I-Shou University, Kaohsiung, Taiwan.
- School of Medicine, I-Shou University, Kaohsiung, Taiwan.
| | - Janet D Latner
- Department of Psychology, University of Hawaii at Manoa, Honolulu, HI, USA
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Ryan L, Coyne R, Heary C, Birney S, Crotty M, Dunne R, Conlan O, Walsh JC. Weight stigma experienced by patients with obesity in healthcare settings: A qualitative evidence synthesis. Obes Rev 2023; 24:e13606. [PMID: 37533183 DOI: 10.1111/obr.13606] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 06/28/2023] [Accepted: 07/03/2023] [Indexed: 08/04/2023]
Abstract
Weight stigma research is largely focused on quantifiable outcomes with inadequate representation of the perspectives of those that are affected by it. This study offers a comprehensive systematic review and synthesis of weight stigma experienced in healthcare settings, from the perspective of patients living with obesity. A total of 1340 studies was screened, of which 32 were included in the final synthesis. Thematic synthesis generated three overarching analytical themes: (1) verbal and non-verbal communication of stigma, (2) weight stigma impacts the provision of care, and (3) weight stigma and systemic barriers to healthcare. The first theme relates to the communication of weight stigma perceived by patients within patient-provider interactions. The second theme describes the patients' perceptions of how weight stigma impacts upon care provision. The third theme highlighted the perceived systemic barriers faced by patients when negotiating the healthcare system. Patient suggestions to reduce weight stigma in healthcare settings are also presented. Weight stigma experienced within interpersonal interactions migrates to the provision of care, mediates gaining equitable access to services, and perpetuates a poor systemic infrastructure to support the needs of patients with obesity. A non-collaborative approach to practice and treatment renders patients feeling they have no control over their own healthcare requirements.
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Affiliation(s)
- Leona Ryan
- School of Psychology, University of Galway, Galway, Ireland
| | - Rory Coyne
- School of Psychology, University of Galway, Galway, Ireland
| | - Caroline Heary
- School of Psychology, University of Galway, Galway, Ireland
| | - Susie Birney
- Irish Coalition for People Living with Obesity (ICPO), Dublin, Ireland
| | | | - Rosie Dunne
- James Hardiman Library, University of Ireland, Galway, Ireland
| | - Owen Conlan
- School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
| | - Jane C Walsh
- School of Psychology, University of Galway, Galway, Ireland
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Sánchez E, Ciudin A, Sánchez A, Gutiérrez-Medina S, Valdés N, Flores L, Marí-Sanchis A, Goñi F, Sánchez M, Nicolau J, Muñoz C, Díaz-Trastoy O, Cuatrecasas G, Cañizares S, Comas M, López-Cano C, Lecube A. Assessment of obesity stigma and discrimination among Spanish subjects with a wide weight range: the OBESTIGMA study. Front Psychol 2023; 14:1209245. [PMID: 37799531 PMCID: PMC10548879 DOI: 10.3389/fpsyg.2023.1209245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/04/2023] [Indexed: 10/07/2023] Open
Abstract
Introduction This study aims to assess the extent of rejection and instances of stigmatization linked to obesity within the Spanish population, encompassing a diverse spectrum of weights ranging from normal weight to morbid obesity. Additionally, the study seeks to identify the primary factors influencing these experiences and further examines the impact of bariatric surgery on such dynamics. Materials and methods Multicenter observational study with involving a total of 1,018 participants who were recruited from various Obesity Units. Negatives attitudes towards people with obesity were assessed through three questionnaires: (i) Antifat Attitudes Scale (AFA), (ii) Stigmatizing Situations Inventory (SSI) and (iii) Weight Bias Internalization Scale (WBIS). Subjects were categorized into four groups based on their BMI and history of prior bariatric surgery. Results The cumulative score across all questionnaires (AFA, SSI and WBIS) exhibited a progressive increase, from participants with normal weight to those with obesity (p < 0.001 for all). Within the AFA questionnaire, males showed more rejection towards people with obesity than women, also perceiving obesity as a disease linked to a lack of willpower (p = 0.004 and p = 0.030, respectively). The overall SSI score was negatively associated with age (r = -0.080, p = 0.011), with young participants encountering more stigmatizing experiences than their adult counterparts. Neither employment status nor educational demonstrated a significant association with any of the questionnaires. Interestingly, patients who underwent lost weight following bariatric surgery did not exhibit improved outcomes. Conclusion Individuals with obesity demonstrate a heightened level of aversion towards the disease compared to those with normal weight. Concurrently, the incidence of stigmatizing encounters displays a concerning escalation among younger individuals.
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Affiliation(s)
- Enric Sánchez
- Obesity Unit, Endocrinology and Nutrition Department, University Hospital Arnau de Vilanova de Lleida, Obesity, Diabetes and Metabolism (ODIM) Research Group, IRBLleida, University of Lleida, Lleida, Spain
| | - Andreea Ciudin
- Obesity Unit, Endocrinology and Nutrition Department, Hospital Universitari Vall d’Hebrón, Vall d’Hebron Research Institute, Autonomous University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Ana Sánchez
- Obesity Unit, Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain
| | - Sonsoles Gutiérrez-Medina
- Obesity Unit, Endocrinology and Nutrition Department, Hospital Universitario Rey Juan Carlos, Madrid, Spain
| | - Nuria Valdés
- Obesity Unit, Endocrinology and Nutrition Department, Hospital Universitario de Cabueñes, Gijón, Spain
| | - Lilliam Flores
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Obesity Unit, Endocrinology and Nutrition Department, Hospital Clínic Barcelona, Barcelona, Spain
| | - Amelia Marí-Sanchis
- Obesity Unit, Endocrinology and Nutrition Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - Fernando Goñi
- Obesity Unit, Endocrinology and Nutrition Department, Hospital Universitario de Basurto, Bilbao, Spain
| | - Marta Sánchez
- Obesity Unit, Endocrinology and Nutrition Department, Hospital Universitario Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Joana Nicolau
- Obesity Unit, Endocrinology and Nutrition Department, Hospital Universitario Son Llàtzer, Palma, Spain
| | - Concepción Muñoz
- Obesity Unit, Endocrinology and Nutrition Department, Hospital Universitario Reina Sofia de Córdoba, Córdoba, Spain
| | - Olaia Díaz-Trastoy
- Obesity Unit, Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - Guillem Cuatrecasas
- Obesity Unit, Endocrinology and Nutrition Department, Clínica Sagrada Familia-CPEN Barcelona, Health Science Department, UOC University, Barcelona, Spain
| | - Silvia Cañizares
- Obesity Unit, Psychiatry and Psycology Department, Hospital Clínic Barcelona, Barcelona, Spain
- Clinical Psycology and Psycobiology Department, Universitat de Barcelona, Barcelona, Spain
| | - Marta Comas
- Obesity Unit, Endocrinology and Nutrition Department, Hospital Universitari Vall d’Hebrón, Vall d’Hebron Research Institute, Autonomous University of Barcelona, Barcelona, Spain
| | - Carolina López-Cano
- Obesity Unit, Endocrinology and Nutrition Department, University Hospital Arnau de Vilanova de Lleida, Obesity, Diabetes and Metabolism (ODIM) Research Group, IRBLleida, University of Lleida, Lleida, Spain
| | - Albert Lecube
- Obesity Unit, Endocrinology and Nutrition Department, University Hospital Arnau de Vilanova de Lleida, Obesity, Diabetes and Metabolism (ODIM) Research Group, IRBLleida, University of Lleida, Lleida, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
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Robinson KM, Scherer AM, Nishimura TE, Laroche HH. Value of cognitive interviewing in the development of the weight stigma in healthcare inventory. PATIENT EDUCATION AND COUNSELING 2023; 113:107767. [PMID: 37104937 DOI: 10.1016/j.pec.2023.107767] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/16/2023] [Accepted: 04/19/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND Despite the detrimental effects of weight stigma in healthcare, there is no widely validated measure comprehensively examining such experiences. OBJECTIVE We aimed to develop and pilot test an inventory to measure patient experiences of weight stigma in healthcare, and to ensure our items were easily understood. PATIENT INVOLVEMENT During our iterative design process, patients assessed whether our inventory items were easy to understand and we included an open-ended comments question. METHODS We compiled items from pre-existing tools assessing experiences of weight stigma in healthcare, and developed our own novel items. We conducted field pre-testing with a convenience sample of 48 patients at a Midwest academic internal medicine clinic. We utilized an iterative design process whereby respondents provided feedback on our inventory, we analyzed the data and made revisions, and then repeated the cycle. RESULTS Respondents found some of the language in our items confusing; expressed reluctance to speculate on the motivations of healthcare providers; had difficulty with "double-barreled" questions; found some questions vague; and expressed the desire to have weight addressed in clinical encounters neither too much nor too infrequently. We altered items appropriately, and in subsequent rounds of data collection they were easier to understand. DISCUSSION Patients found many common weight stigma survey items and some of our novel items confusing. Our modified inventory reduces patient confusion and enhances data quality. PRACTICAL VALUE Our study demonstrates the value of cognitive interviewing. Furthermore, the WSHCI will be a useful tool for clinicians and research teams seeking to measure weight stigma in healthcare but first needs to be validated in a larger sample. FUNDING This study was supported by the Physician Scientist Training Program, Diabetes Center T32 (DK112751), and the Clinical and Translational Science Award grant funded from the National Institutes of Health (UL1TR002537).
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Affiliation(s)
- Kathleen M Robinson
- Department of Internal Medicine, Division of Endocrinology, University of Iowa, Iowa City, USA.
| | - Aaron M Scherer
- Department of Internal Medicine, Division of General Internal Medicine, University of Iowa, Iowa City, USA
| | - Taryn E Nishimura
- Department of Internal Medicine, Division of General Internal Medicine, University of Iowa, Iowa City, USA; Department of Psychiatry, University of Iowa, Iowa City, USA
| | - Helena H Laroche
- Center for Children's Healthy Lifestyle and Nutrition, Children's Mercy Hospital, Kansas City, USA; University of Missouri-Kansas City School of Medicine, Kansas City, USA
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Dimitrov Ulian M, Fernandez Unsain R, Rocha Franco R, Aurélio Santo M, Brewis A, Trainer S, SturtzSreetharan C, Wutich A, Gualano B, Baeza Scagliusi F. Weight stigma after bariatric surgery: A qualitative study with Brazilian women. PLoS One 2023; 18:e0287822. [PMID: 37498887 PMCID: PMC10374044 DOI: 10.1371/journal.pone.0287822] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 06/13/2023] [Indexed: 07/29/2023] Open
Abstract
Prior studies suggest that one anticipated benefit of bariatric surgery is the achievement of a thinner body, one that is less subject to perceived negative judgment and condemnation by others. However, additional analyses also indicate that stigma may persist even with significant post-surgery weight loss. To investigate the stigma-related perceptions and experiences of women who have undergone bariatric surgery and the resulting body transformations, we conducted individual, semi-structured interviews with thirty Brazilian women (15 aged 33-59 and 15 aged 63-72). The resulting text was then analyzed using thematic analysis. We found that some form of weight stigma persisted for our participants, regardless of weight loss. Ongoing experiences of stigma were also evidenced by the constant internal and external vigilance reported by the women, as well as their articulated efforts to distance themselves from their previous bodies. Additionally, participants reported being judged for choosing an "easy way out" to lose weight. Those in the older group reported that weight stigma was entangled with ageism: older participants received mixed messages underscoring the ways that weight and age may interact in doubly stigmatizing ways. Family and close peers were especially powerful sources of stigma experiences. Collectively, these results show that weight stigma persists even when people undergo a procedure to lose substantive weight and that the degree and types of stigma experiences are influenced by gender and age. Our study suggest future research should explore whether a targeted approach might be more effective, for example, an approach that would emphasize the importance of developing coping strategies with respect to experiences of stigma and discrimination after surgery.
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Affiliation(s)
- Mariana Dimitrov Ulian
- Departamento de Nutrição, Faculdade de Saúde Pública da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Ramiro Fernandez Unsain
- Departamento de Nutrição, Faculdade de Saúde Pública da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Ruth Rocha Franco
- Unidade de Endocrinologia Pediátrica do Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Marco Aurélio Santo
- Divisão de Cirurgia do Aparelho Digestivo, Unidade de Cirurgia Bariátrica e Metabólica, São Paulo, SP, Brasil
| | - Alexandra Brewis
- School of Human Evolution and Social Change, Arizona State University, Tempe, AZ, United States of America
| | - Sarah Trainer
- School of Human Evolution and Social Change, Arizona State University, Tempe, AZ, United States of America
| | - Cindi SturtzSreetharan
- School of Human Evolution and Social Change, Arizona State University, Tempe, AZ, United States of America
| | - Amber Wutich
- School of Human Evolution and Social Change, Arizona State University, Tempe, AZ, United States of America
| | - Bruno Gualano
- Grupo de Pesquisa em Fisiologia Aplicada e Nutrição, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Fernanda Baeza Scagliusi
- Departamento de Nutrição, Faculdade de Saúde Pública da Universidade de São Paulo, São Paulo, SP, Brasil
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11
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Abstract
Weight stigma is prevalent with negative consequences for health and well-being. This problem is present in health care; stigmatizing attitudes toward patients with obesity are expressed by medical professionals across diverse specialties and patient care settings. This article summarizes the ways in which weight stigma creates barriers to effective care, including poor patient-provider communication, reduced quality of care, and healthcare avoidance. Priorities for stigma reduction in healthcare are discussed, with a clear need for multifaceted approaches and inclusion of people with obesity whose perspectives can inform strategies to effectively remove bias-related barriers to patient care.
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Affiliation(s)
- Rebecca M Puhl
- Rudd Center for Food Policy & Health, University of Connecticut, One Constitution Plaza, Suite 600, Hartford, CT 06103, USA; Department of Human Development & Family Sciences, University of Connecticut, Storrs, CT, USA.
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12
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Crowley N. Person-First Treatment Strategies: Weight Bias and Impact on Mental Health of People Living with Obesity. Prim Care 2023; 50:89-101. [PMID: 36822731 DOI: 10.1016/j.pop.2022.10.002] [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: 12/15/2022]
Abstract
Stigma and bias surrounding body weight is both explicit and implicit, but the most concerning impact on individuals is internalized stigma which is correlated with poor physical and mental health. Strategies to combat this public health concern include increasing awareness, education around the complex disease of obesity, proper use of communication and language surrounding weight, health, and treatment approaches, addressing equipment and practices in the clinical environment, and larger, systemic approaches to policy. Addressing stigma for a condition impacting the majority of our population is critical for the best health and well-being of our patients and ourselves.
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13
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Food insecurity, weight-based discrimination, weight self-stigma, and mental health in post-bariatric surgery patients. Body Image 2023; 45:46-53. [PMID: 36773445 DOI: 10.1016/j.bodyim.2023.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 02/12/2023]
Abstract
The United States Department of Agriculture defines food insecurity (FI) as reduced quality and variety of diet or overall reduced food intake. To date, limited research has investigated the relationship between FI, weight stigma, and bariatric surgery. The existing literature suggests that FI in bariatric surgery patients is significantly associated with being a person of color, depression, receiving Medicare or Medicaid, and higher eating disorder (ED) pathology. Research also suggests that weight stigma in bariatric surgery patients is associated with worsened weight loss outcomes. No research to our knowledge has investigated FI, internalized weight stigma, weight-based discrimination, and history of bariatric surgery in one sample. Bariatric surgery patients in this study (N = 266) reported elevated rates of FI relative to the general population, via an online questionnaire. Those with FI also reported higher rates of depression, anxiety, ED pathology, internalized weight stigma, and experiences of weight-based discrimination compared to those who were food secure. Given these findings, bariatric surgical centers should evaluate all potential patients for FI before surgery and, at the bare minimum, provide additional support before and post-surgery. The ethics of conducting bariatric surgery in those with FI who lack significant medical comorbidity also must be considered.
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14
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Bennett BL, Lawson JL, Funaro MC, Ivezaj V. Examining weight bias before and/or after bariatric surgery: A systematic review. Obes Rev 2022; 23:e13500. [PMID: 36053042 DOI: 10.1111/obr.13500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/10/2022] [Accepted: 07/24/2022] [Indexed: 11/29/2022]
Abstract
Research examining weight bias in the bariatric population, who may be at greater risk of weight stigma, is scarce. The present study aimed to systematically review the literature for quantitative evidence that explores the medical, psychosocial, and behavioral sequelae associated with experienced, internalized, and/or externalized weight bias in patients seeking or who have undergone bariatric surgery. Five databases were systematically searched for English peer-reviewed quantitative studies, which examined weight bias in a sample of individuals seeking or who had undergone bariatric surgery. Risk of bias was assessed. Twenty-nine studies were included, of which 13 examined internalized weight bias, 12 examined experienced weight bias, 4 examined both, and 0 examined externalized weight bias. Most studies were cross-sectional, and the results showed high risk of bias. The results suggested that both experienced and internalized weight bias were associated with a host of negative psychosocial, behavioral, and medical sequelae. The findings of this review underscore the need for more rigorous research to better understand the relationship between weight bias and bariatric surgery, particularly longitudinally. Future patients may benefit from research developing interventions for reducing weight bias prior to and following bariatric surgery in order to reduce the associated negative correlates and improve outcomes.
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Affiliation(s)
- Brooke L Bennett
- Rudd Center for Food Policy and Health, University of Connecticut, Hartford, Connecticut, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jessica L Lawson
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA.,VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Melissa C Funaro
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, Connecticut, USA
| | - Valentina Ivezaj
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
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15
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Garcia FK, Verkooijen KT, Veen EJ, Mulder BC, Koelen MA, Hazebroek EJ. Stigma Toward Bariatric Surgery in the Netherlands, France, and the United Kingdom: Protocol for a Cross-cultural Mixed Methods Study. JMIR Res Protoc 2022; 11:e36753. [PMID: 35482364 PMCID: PMC9100527 DOI: 10.2196/36753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/03/2022] [Accepted: 03/07/2022] [Indexed: 11/16/2022] Open
Abstract
Background Bariatric surgery is an effective procedure for the treatment of obesity. Despite this, only 0.1% to 2% of eligible individuals undergo surgery worldwide. The stigma surrounding surgery might be a reason for this. Thus far, no research has systematically studied the nature and implications of bariatric surgery stigma. The limited studies on bariatric surgery stigma are often conducted from the perspective of the public or health care professions and either use small and nonrepresentative samples or fail to capture the full essence and implications of the stigma altogether, including attitudes toward patients and perpetrators of the stigma. In addition, studies from patients’ perspectives are limited and tend to address bariatric surgery stigma superficially or implicitly. Finally, the extent to which cultural factors shape and facilitate this stigma and the experiences of patients have not yet been researched. Objective This study aimed to explore the perceptions, experiences, and consequences of bariatric surgery stigma from the perspective of the public, health care professionals, and patients before and after bariatric surgery. Furthermore, although the concept of stigma is universal, every society has specific cultural norms and values that define acceptable attributes and behaviors for its members. Therefore, this study also aimed to explore the extent to which cultural factors influence bariatric surgery stigma by comparing the Netherlands, France, and the United Kingdom. Methods This paper describes the protocol for a multiphase mixed methods research design. In the first part, we will conduct a scoping review to determine the current knowledge on bariatric surgery stigma and identify knowledge gaps. In the second part, semistructured interviews among patients before and after bariatric surgery will be conducted to explore their experiences and consequences of bariatric surgery stigma. In the third part, surveys will be conducted among both the public and health care professionals to determine the prevalence, nature, and impact of bariatric surgery stigma. Surveys and interviews will be conducted in the Netherlands, France, and the United Kingdom. Finally, data integration will be conducted at the interpretation and reporting levels. Results The study began in September 2020 and will continue through September 2025. With the results of the review, we will create an overview of the current knowledge regarding bariatric surgery stigma from patients’ perspectives. Qualitative data will provide insights into patients’ experiences with bariatric surgery stigma. Quantitative data will provide information related to the prevalence and nature of bariatric surgery stigma from the perspective of the public and health care professionals. Both qualitative and quantitative data will be compared for each country. Conclusions The findings from this study will lead to new insights that can be used to develop strategies to reduce bariatric surgery stigma and improve access, use, and outcomes of bariatric surgery. International Registered Report Identifier (IRRID) PRR1-10.2196/36753
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Affiliation(s)
- Franshelis K Garcia
- Health and Society, Department of Social Sciences, Wageningen University, Wageningen, Netherlands
| | - Kirsten T Verkooijen
- Health and Society, Department of Social Sciences, Wageningen University, Wageningen, Netherlands
| | - Esther J Veen
- Rural Sociology, Department of Social Sciences, Wageningen University, Wageningen, Netherlands.,Almere University of Applied Sciences, Almere, Netherlands
| | - Bob C Mulder
- Strategic Communication, Department of Social Sciences, Wageningen University, Wageningen, Netherlands
| | - Maria A Koelen
- Health and Society, Department of Social Sciences, Wageningen University, Wageningen, Netherlands
| | - Eric J Hazebroek
- Human Nutrition and Health, Department of Agrotechnology and Food Sciences, Wageningen University, Wageningen, Netherlands.,Department of Bariatric Surgery, Vitalys, Rijnstate Hospital, Arnhem, Netherlands
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16
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Li Z, Pan Y, Zhang Y, Qin J, Lei X. Dietary experiences after bariatric surgery in patients with obesity: A qualitative systematic review. Obes Surg 2022; 32:2023-2034. [PMID: 35359201 DOI: 10.1007/s11695-022-06018-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 03/15/2022] [Accepted: 03/16/2022] [Indexed: 12/24/2022]
Abstract
This systematic review evaluated the dietary experience of patients with obesity post-bariatric surgery. Scopus, CINAHL, Medline, Psych INFO, and Embase databases were searched and JBI Critical Appraisal Tool was used for quality assessment. Thomas and Harden's three-stage thematic synthesis was undertaken using the Enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) statement for reporting. Of the 24 studies extracted, we coded and developed 34 descriptive themes into 7 categories, which were then categorized to 3 analytical themes. The number of all the participants in the 24 articles is 383 people. The results revealed most patients can control their diet for a short period post-surgery. However, this was a matter of gradual self-consciousness as patients also required support and dietary management in postoperative recovery. CLINICAL TRIAL REGISTRATION NUMBER: The protocol for this qualitative systematic review has been registered with PROSPERO (registration number CRD42021229083).
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Affiliation(s)
- Zhiwen Li
- The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Yingli Pan
- The Fourth Affiliated Hospital of China Medical University, Shenyang, China.
| | - Yingchun Zhang
- The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Jingjing Qin
- The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Xuejiao Lei
- The Fourth Affiliated Hospital of China Medical University, Shenyang, China
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17
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Verhaak AMS, Ferrand J, Puhl RM, Tishler DS, Papasavas PK, Umashanker D. Experienced weight stigma, internalized weight bias, and clinical attrition in a medical weight loss patient sample. Int J Obes (Lond) 2022; 46:1241-1243. [PMID: 35173281 PMCID: PMC8852855 DOI: 10.1038/s41366-022-01087-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 01/21/2022] [Accepted: 02/01/2022] [Indexed: 11/09/2022]
Abstract
Background Limited research has explored the relationship between weight bias and clinical attrition, despite weight bias being associated with negative health outcomes. Participants/method Experienced weight stigma (EWS), internalized weight bias (IWB), and clinical attrition were studied in a Medical Weight Loss clinic, which combines pharmacological and behavioral weight loss. Patient sociodemographic, medical, and psychological (depression) variables were measured at consultation, and clinic follow-ups were monitored for 6 months. IWB was assessed with the Weight Bias Internalization Scale Modified (WBIS-M). Results Two-thirds (66%) of study participants returned for follow-up appointments during the 6-month period (“continuers”), while 34% did not return after the initial consultation (“dropouts”). Clinic “dropouts” had higher WBIS-M scores at initial consultation than “continuers,” (χ2(1) = 4.56; p < 0.05). No other variables were related to clinical attrition. Average WBIS-M scores (4.57) were similar to other bariatric patient studies, and were associated with younger age (t = −2.27, p < 0.05), higher depression (t = 2.65, p < 0.01), and history of EWS (t = 2.14, p < 0.05). Conclusion Study findings indicate that IWB has significant associations with clinical attrition. Additional research is warranted to further explore the relationships between EWS, IWB, and medical clinic engagement.
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Affiliation(s)
- Allison M S Verhaak
- Division of Health Psychology, The Institute of Living/Hartford Hospital, Hartford, CT, USA. .,Hartford HealthCare Headache Center, Ayer Neuroscience Institute, Hartford, CT, USA.
| | - Jennifer Ferrand
- Division of Health Psychology, The Institute of Living/Hartford Hospital, Hartford, CT, USA.,Wellness Department/Medical Affairs, Hartford HealthCare, Hartford, CT, USA
| | - Rebecca M Puhl
- University of Connecticut Rudd Center for Food Policy & Health; Department of Human Development and Family Sciences, University of Connecticut, Hartford, CT, USA
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18
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Himmelstein MS, Knepp KA, Phelan SM. The role of weight stigma in weight regain in bariatric surgery. Front Endocrinol (Lausanne) 2022; 13:1076696. [PMID: 36561565 PMCID: PMC9763922 DOI: 10.3389/fendo.2022.1076696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022] Open
Abstract
Obesity is highly stigmatized, and individuals who undergo bariatric surgery are subject not only to weight stigma, but also to stigma related to the procedure itself. Patients lost to follow-up after surgery make estimating the amount of regain occurring after surgery difficult, and often patients fail to follow up due the shame of weight regain. Patients report difficulty following the diet necessary to maintain weight loss. Additionally, when they seek support after surgery, they often encounter stigmatizing messaging related to weight. Weight bias internalization, weight stigma, and stigma about having the surgery all contribute to feelings of social isolation, disordered eating, and reduced motivation to engage in physical activity. In this chapter, we present evidence for the impact of stigma on bariatric surgery outcomes and discuss the behavioral, physiological, and emotional processes that contribute to weight regain.
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Affiliation(s)
- Mary S. Himmelstein
- Department of Psychological Sciences, Kent State University, Kent, OH, United States
| | - Kristen A. Knepp
- Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH, United States
| | - Sean M. Phelan
- Division of Health Care Delivery Research, Robert D. & Patricia E. Kern Center for the Science of Healthcare Delivery, & Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, MN, United States
- *Correspondence: Sean M. Phelan,
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19
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Lawson JL, LeCates A, Ivezaj V, Lydecker J, Grilo CM. Internalized weight bias and loss-of-control eating following bariatric surgery. Eat Disord 2021; 29:630-643. [PMID: 32182194 PMCID: PMC7494529 DOI: 10.1080/10640266.2020.1731920] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Internalized weight bias (IWB), or negative weight related self-evaluation, is associated with eating-disorder psychopathology and common among patients seeking bariatric surgery, but little is known about the clinical presentation of IWB post-operatively. This study examined IWB and clinical correlates among adult patients with loss-of-control (LOC) eating post-sleeve gastrectomy surgery. METHODS Participants (N = 145) were sleeve gastrectomy patients seeking treatment for eating/weight concerns and experiencing regular LOC eating approximately 6 months following surgery. Eating-disorder features were assessed with the Eating Disorder Examination-Bariatric Surgery Version interview (EDE-BSV) and participants completed established measures assessing IWB, depression, and mental and physical components of quality of life. RESULTS IWB was not associated significantly with percent excess weight loss, age, or gender, but White participants reported significantly greater IWB than Non-White participants. IWB was significantly associated with greater eating-disorder psychopathology, depression, and lower perceived mental quality of life. Hierarchical regression analysis revealed that IWB significantly predicted variance in eating-disorder psychopathology above and beyond other related variables. CONCLUSIONS Findings suggest that IWB is common and associated with a range of heightened eating-disorder and psychosocial difficulties among patients experiencing LOC eating following bariatric surgery. Future research exploring the longitudinal post-operative prognostic significance of IWB is recommended.
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Affiliation(s)
- Jessica L Lawson
- Psychology Service, VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Psychiatry Department, Yale School of Medicine, New Haven, Connecticut, USA
| | - Abigail LeCates
- Psychology Department, Amherst College, Amherst, Massachusetts, USA
| | - Valentina Ivezaj
- Psychiatry Department, Yale School of Medicine, New Haven, Connecticut, USA
| | - Janet Lydecker
- Psychiatry Department, Yale School of Medicine, New Haven, Connecticut, USA
| | - Carlos M Grilo
- Psychiatry Department, Yale School of Medicine, New Haven, Connecticut, USA.,Psychiatry Department, Yale University, New Haven, Connecticut, USA
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20
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Althumiri NA, Basyouni MH, AlMousa N, AlJuwaysim MF, Alhamdan AA, Al-Qahtani FS, BinDhim NF, Alqahtani SA. Exploring Weight Stigma in Saudi Arabia: A Nationwide Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9141. [PMID: 34501731 PMCID: PMC8430631 DOI: 10.3390/ijerph18179141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 08/09/2021] [Accepted: 08/26/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Weight stigma (WS) in the Middle East, especially in Saudi Arabia, is widely ignored. People with obesity are blamed for their weight, and there is a common perception that weight stigmatization is justifiable and may motivate individuals to adopt healthier behaviors. The authors of this study aimed to explore WS prevalence and factors associated with WS in a large nationwide study of Saudi Arabian adults. METHODS This study was a nationwide cross-sectional survey conducted via phone interviews in June 2020. A proportional quota-sampling technique was adopted to obtain equal distributions of participants by age and sex across the 13 regions of Saudi Arabia. In total, 6239 people were contacted, and 4709 (75.48%) responded and completed the interview. The authors of the study collected data about WS using the Arabic Weight Self-Stigma Questionnaire (WSSQ), BMI, smoking, nutritional knowledge, bariatric surgery, risk of depression, and demographic variables. RESULTS Participants had a mean age of 36.4 ± 13.5 (18-90), and 50.1% were female. The prevalence of higher WS was 46.4%. Among other risk factors, there was a significant association between WS and obesity (odds ratio (OR): 3.93; 95% CI: 2.83-5.44; p < 0.001), waterpipe smoking (OR: 1.80; 95% CI: 1.20-2.69; p < 0.001), bariatric surgery (OR: 2.07; 95% CI: 1.53-2.81; p < 0.001), and risk of depression (OR: 1.68; 95% CI: 1.36-2.09; p < 0.001). CONCLUSION This was the first study to explore WS and its associated factors among adults in a community setting in Saudi Arabia. This study revealed some risk factors associated with WS that may help to identify people at risk of WS and to develop interventions to reduce WS, such as improving nutritional knowledge, correcting the ideas about bariatric surgery and obesity in general, and ceasing waterpipe smoking.
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Affiliation(s)
- Nora A. Althumiri
- Sharik Association for Health Research, Riyadh 13326, Saudi Arabia; (M.H.B.); (N.A.); (M.F.A.); (N.F.B.)
| | - Mada H. Basyouni
- Sharik Association for Health Research, Riyadh 13326, Saudi Arabia; (M.H.B.); (N.A.); (M.F.A.); (N.F.B.)
- Ministry of Health, Riyadh 11176, Saudi Arabia
| | - Norah AlMousa
- Sharik Association for Health Research, Riyadh 13326, Saudi Arabia; (M.H.B.); (N.A.); (M.F.A.); (N.F.B.)
- Public Health College, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Mohammed F. AlJuwaysim
- Sharik Association for Health Research, Riyadh 13326, Saudi Arabia; (M.H.B.); (N.A.); (M.F.A.); (N.F.B.)
- Pharmacy College, King Faisal University, AlAhsa 31982, Saudi Arabia
| | - Adel A. Alhamdan
- Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11362, Saudi Arabia;
| | - Faisal Saeed Al-Qahtani
- Department of Family & Community Medicine, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia;
| | - Nasser F. BinDhim
- Sharik Association for Health Research, Riyadh 13326, Saudi Arabia; (M.H.B.); (N.A.); (M.F.A.); (N.F.B.)
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
- Saudi Food and Drug Authority, Riyadh 13513, Saudi Arabia
| | - Saleh A. Alqahtani
- Liver Transplant Unit, King Faisal Specialist Hospital & Research Centre, Riyadh 11211, Saudi Arabia;
- Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, MD 21218, USA
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21
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Maston G, Franklin J, Hocking S, Swinbourne J, Gibson A, Manson E, Sainsbury A, Markovic T. Dietary adherence and program attrition during a severely energy-restricted diet among people with complex class III obesity: A qualitative exploration. PLoS One 2021; 16:e0253127. [PMID: 34138917 PMCID: PMC8211265 DOI: 10.1371/journal.pone.0253127] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 06/01/2021] [Indexed: 12/27/2022] Open
Abstract
Meal replacement Severely Energy-Restricted Diets (SERDs) produce ≥ 10% loss of body mass when followed for 6 weeks or longer in people with class III obesity (BMI ≥ 40 kg/m2). The efficacy of SERDs continues to be questioned by healthcare professionals, with concerns about poor dietary adherence. This study explored facilitators and barriers to dietary adherence and program attrition among people with class III obesity who had attempted or completed a SERD in a specialised weight loss clinic. Participants who commenced a SERD between January 2016 to May 2018 were invited to participate. Semi-structured in-depth interviews were conducted from September to October 2018 with 20 participants (12 women and 8 men). Weight change and recounted events were validated using the participants' medical records. Data were analysed by thematic analysis using line-by-line inductive coding. The mean age ± SD of participants was 51.2 ± 11.3 years, with mean ± SD BMI at baseline 63.7 ± 12.6 kg/m2. Five themes emerged from participants' recounts that were perceived to facilitate dietary adherence: (1.1) SERD program group counselling and psychoeducation sessions, (1.2) emotionally supportive clinical staff and social networks that accommodated and championed change in dietary behaviours, (1.3) awareness of eating behaviours and the relationship between these and progression of disease, (1.4) a resilient mindset, and (1.5) dietary simplicity, planning and self-monitoring. There were five themes on factors perceived to be barriers to adherence, namely: (2.1) product unpalatability, (2.2) unrealistic weight loss expectations, (2.3) poor program accessibility, (2.4) unforeseeable circumstances and (2.5) externalised weight-related stigma. This study highlights opportunities where SERD programs can be optimised to facilitate dietary adherence and reduce barriers, thus potentially improving weight loss outcomes with such programs. Prior to the commencement of a SERD program, healthcare professionals facilitating such programs could benefit from reviewing participants to identify common barriers. This includes identifying the presence of product palatability issues, unrealistic weight loss expectations, socio-economic disadvantage, and behaviour impacting experiences of externalised weight-related stigma.
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Affiliation(s)
- Gabrielle Maston
- The Boden Collaboration for Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Janet Franklin
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Samantha Hocking
- The Boden Collaboration for Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Sydney School of Medicine (Central Clinical School), Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Jessica Swinbourne
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Alice Gibson
- Menzies Centre for Health Policy, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Elisa Manson
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Amanda Sainsbury
- School of Human Sciences, Faculty of Science, The University of Western Australia, Crawley, WA, Australia
| | - Tania Markovic
- The Boden Collaboration for Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Sydney School of Medicine (Central Clinical School), Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
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22
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Gerend MA, Patel S, Ott N, Wetzel K, Sutin AR, Terracciano A, Maner JK. A qualitative analysis of people's experiences with weight-based discrimination. Psychol Health 2021; 37:1093-1110. [PMID: 33979254 DOI: 10.1080/08870446.2021.1921179] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aim of this study was to describe people's day-to-day experiences with weight-based discrimination and to distill themes that shed new light on this phenomenon. DESIGN A qualitative study was conducted in 2019 using a purposive sampling strategy. A racially and ethnically diverse sample of 32 U.S. adult men and women with a body mass index ≥30 kg/m2 completed a semi-structured interview. RESULTS Primary types of interpersonal weight-based discrimination included offensive comments, negative assumptions, social rejection, and unwanted attention or bullying. Participants also encountered environmental sources of weight bias such as inadequate seating in public venues. Three higher order themes that cut across people's experiences with weight-based discrimination were identified: 1) the often-ambiguous nature of weight-based discrimination; 2) intersections between body weight and other social identities; and 3) the role of social comparison processes. CONCLUSION Findings provide a detailed portrait of people's everyday experiences with weight-based discrimination. These experiences often reflected widely held negative stereotypes about people with higher body weight and conveyed the socially devalued status of higher-weight individuals in society. Findings have important implications for future research and interventions aimed at reducing the harmful effects of weight-based discrimination on health and emotional wellbeing.
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Affiliation(s)
- Mary A Gerend
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, Florida, USA
| | - Shefali Patel
- College of Medicine, Florida State University, Tallahassee, Florida, USA
| | - Nicholas Ott
- College of Medicine, Florida State University, Tallahassee, Florida, USA
| | - Karen Wetzel
- College of Medicine, Florida State University, Tallahassee, Florida, USA
| | - Angelina R Sutin
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, Florida, USA
| | - Antonio Terracciano
- Department of Geriatrics, College of Medicine, Florida State University, Tallahassee, Florida, USA
| | - Jon K Maner
- Department of Psychology, College of Arts and Sciences, Florida State University, Tallahassee, Florida, USA
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23
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Braun TD, Gorin AA, Puhl RM, Stone A, Quinn DM, Ferrand J, Abrantes AM, Unick J, Tishler D, Papasavas P. Shame and Self-compassion as Risk and Protective Mechanisms of the Internalized Weight Bias and Emotional Eating Link in Individuals Seeking Bariatric Surgery. Obes Surg 2021; 31:3177-3187. [PMID: 33905070 DOI: 10.1007/s11695-021-05392-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/19/2021] [Accepted: 03/25/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Emotional eating in bariatric surgery patients is inconsistently linked with poor post-operative weight loss and eating behaviors, and much research to date is atheoretical. To examine theory-informed correlates of pre-operative emotional eating, the present cross-sectional analysis examined paths through which experienced weight bias and internalized weight bias (IWB) may associate with emotional eating among individuals seeking bariatric surgery. METHODS We examined associations of experienced weight bias, IWB, shame, self-compassion, and emotional eating in patients from a surgical weight loss clinic (N = 229, 82.1% female, M. BMI: 48 ± 9). Participants completed a survey of validated self-report measures that were linked to BMI from the patient medical record. Multiple regression models tested associations between study constructs while PROCESS bootstrapping estimates tested the following hypothesized mediation model: IWB ➔ internalized shame ➔ self-compassion ➔ emotional eating. Primary analyses controlled for adverse childhood experiences (ACE), a common confound in weight bias research. Secondary analyses controlled for depressive/anxiety symptoms from the patient medical record (n = 196). RESULTS After covariates and ACE, each construct accounted for significant unique variance in emotional eating. However, experienced weight bias was no longer significant and internalized shame marginal, after controlling for depressive/anxiety symptoms. In a mediation model, IWB was linked to greater emotional eating through heightened internalized shame and low self-compassion, including after controlling for depressive/anxiety symptoms. CONCLUSIONS Pre-bariatric surgery, IWB may signal risk of emotional eating, with potential implications for post-operative trajectories. Self-compassion may be a useful treatment target to reduce IWB, internalized shame, and related emotional eating in bariatric surgery patients. Further longitudinal research is needed.
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Affiliation(s)
- Tosca D Braun
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA. .,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA. .,Department of Psychological Sciences, Institute for Collaboration on Health, Intervention, & Policy, University of Connecticut, Storrs, CT, USA.
| | - Amy A Gorin
- Department of Psychological Sciences, Institute for Collaboration on Health, Intervention, & Policy, University of Connecticut, Storrs, CT, USA
| | - Rebecca M Puhl
- Department of Human Development & Family Sciences, Rudd Center for Food Policy & Obesity, University of Connecticut, Storrs, CT, USA
| | - Andrea Stone
- Surgical Weight Loss Center, Hartford Hospital, Glastonbury, USA
| | - Diane M Quinn
- Department of Psychological Sciences, Institute for Collaboration on Health, Intervention, & Policy, University of Connecticut, Storrs, CT, USA
| | - Jennifer Ferrand
- Institute of Living, Div. of Health Psychology, Hartford Hospital, Hartford, CT, USA
| | - Ana M Abrantes
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,Behavioral Medicine and Addiction Research, Butler Hospital, Providence, RI, USA
| | - Jessica Unick
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA
| | - Darren Tishler
- Surgical Weight Loss Center, Hartford Hospital, Glastonbury, USA
| | - Pavlos Papasavas
- Surgical Weight Loss Center, Hartford Hospital, Glastonbury, USA
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24
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Lawson JL, Schuh LM, Creel DB, Blackinton RM, Giambrone SA, Grilo CM, Ivezaj V. Examining Weight Bias and Loss-of-Control Eating among Individuals Seeking Bariatric Surgery. Obes Surg 2021; 31:3498-3505. [PMID: 33866532 DOI: 10.1007/s11695-021-05418-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 04/01/2021] [Accepted: 04/07/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Externalized weight bias (EWB), directed towards others, and internalized weight bias (IWB), directed towards the self, are thought to exacerbate obesity and disordered eating and may be important factors to assess and understand among individuals seeking bariatric surgery. This study examined clinical correlates (pre-surgical BMI, depressive symptoms, weight self-efficacy, and shape/weight overvaluation) of both EWB and IWB among individuals presenting for bariatric surgery with and without regular loss-of-control eating (LOC eating). METHODS A total of 316 adults presenting for bariatric surgery completed established self-report measures to assess EWB, IWB, depressive symptoms, weight self-efficacy, and core symptoms of disordered eating including LOC eating and overvaluation of shape/weight. RESULTS IWB and EWB were not associated with pre-surgical BMI, age, or sex, but were both significantly higher among White than non-White participants. Adjusting for race, IWB and EWB were significantly associated with greater eating disorder psychopathology and depressive symptoms and with less weight-related self-efficacy. Participants who endorsed regular LOC eating (53.5% of the sample) endorsed significantly lower weight self-efficacy and higher IWB, EWB, depressive symptoms, and overvaluation of shape/weight. CONCLUSIONS Findings suggest that regular LOC eating is common among individuals seeking bariatric surgery and associated with a range of heightened eating disorder and psychosocial concerns including both IWB and EWB. Future research exploring the longitudinal significance of the relationship between these two forms of weight bias and LOC eating is indicated.
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Affiliation(s)
- Jessica L Lawson
- Psychiatry Department, Yale School of Medicine, New Haven, CT, 06511, USA.,VA Connecticut Healthcare System, West Haven, CT, 06516, USA
| | - Leslie M Schuh
- St. Vincent Bariatric Center, Ascension St. Vincent Carmel Hospital, Carmel, IN, 46032, USA
| | - David B Creel
- St. Vincent Bariatric Center, Ascension St. Vincent Carmel Hospital, Carmel, IN, 46032, USA.,Bariatric & Metabolic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | | | | | - Carlos M Grilo
- Psychiatry Department, Yale School of Medicine, New Haven, CT, 06511, USA
| | - Valentina Ivezaj
- Psychiatry Department, Yale School of Medicine, New Haven, CT, 06511, USA.
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25
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Reinka MA, Quinn DM, Puhl RM. Examining the relationship between weight controllability beliefs and eating behaviors: The role of internalized weight stigma and BMI. Appetite 2021; 164:105257. [PMID: 33864861 DOI: 10.1016/j.appet.2021.105257] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/18/2021] [Accepted: 04/06/2021] [Indexed: 01/31/2023]
Abstract
Body weight is often viewed as personally controllable. This belief, however, ignores the complex etiology of body weight. While such attributions of personal willpower may help some individuals regulate their eating patterns, they have also been associated with increased internalized weight stigma which, itself, is associated with more disinhibited eating. The current investigation aimed to examine how internalized weight stigma, along with BMI, may explain the effect of weight controllability beliefs on disparate dietary behaviors. A community sample of 2702 U.S. adults completed an online survey about their weight controllability beliefs, eating behaviors, and internalized weight stigma, as well as demographic items and self-reported BMI. Results showed that greater weight controllability beliefs were positively related to both more restricted eating, β = 0.135, p < .001, and more disinhibited eating, β = 0.123, p < .001. This ironic effect was partially explained by increased internalized weight stigma. Moreover, BMI moderated the relationship, such that individuals with lower weights demonstrated stronger effects for two of the three eating outcomes than those with higher weights. These findings advance our understanding of the relationship between attributions of personal control for body weight and subsequent health behaviors, and further underscore the need to target internalized weight stigma in dietary interventions.
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Affiliation(s)
- Mora A Reinka
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Rd., Unit 1020, Storrs, CT, 06269-1020, USA; Department of Psychology, Ursinus College, 601 E. Main St., P.O. Box 1000, Collegeville, PA, 19426-1000, USA.
| | - Diane M Quinn
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Rd., Unit 1020, Storrs, CT, 06269-1020, USA
| | - Rebecca M Puhl
- University of Connecticut Rudd Center for Food Policy & Obesity; Department of Human Development and Family Sciences, University of Connecticut, One Constitution Plaza, Suite 600, Hartford, CT, 06103, USA
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26
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Meneguzzo P, Behrens SC, Favaro A, Tenconi E, Vindigni V, Teufel M, Skoda EM, Lindner M, Quiros-Ramirez MA, Mohler B, Black M, Zipfel S, Giel KE, Pavan C. Body Image Disturbances and Weight Bias After Obesity Surgery: Semantic and Visual Evaluation in a Controlled Study, Findings from the BodyTalk Project. Obes Surg 2021; 31:1625-1634. [PMID: 33405179 PMCID: PMC8012323 DOI: 10.1007/s11695-020-05166-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 12/01/2020] [Accepted: 12/09/2020] [Indexed: 12/14/2022]
Abstract
Purpose Body image has a significant impact on the outcome of obesity surgery. This study aims to perform a semantic evaluation of body shapes in obesity surgery patients and a group of controls. Materials and Methods Thirty-four obesity surgery (OS) subjects, stable after weight loss (average 48.03 ± 18.60 kg), and 35 overweight/obese controls (MC), were enrolled in this study. Body dissatisfaction, self-esteem, and body perception were evaluated with self-reported tests, and semantic evaluation of body shapes was performed with three specific tasks constructed with realistic human body stimuli. Results The OS showed a more positive body image compared to HC (p < 0.001), higher levels of depression (p < 0.019), and lower self-esteem (p < 0.000). OS patients and HC showed no difference in weight bias, but OS used a higher BMI than HC in the visualization of positive adjectives (p = 0.011). Both groups showed a mental underestimation of their body shapes. Conclusion OS patients are more psychologically burdened and have more difficulties in judging their bodies than overweight/obese peers. Their mental body representations seem not to be linked to their own BMI. Our findings provide helpful insight for the design of specific interventions in body image in obese and overweight people, as well as in OS.
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Affiliation(s)
- Paolo Meneguzzo
- Department of Neuroscience, University of Padova, via Giustiniani 2, 35128, Padova, Italy.
| | - Simone Claire Behrens
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany.,Max Planck Institute for Intelligent Systems, Tübingen, Germany
| | - Angela Favaro
- Department of Neuroscience, University of Padova, via Giustiniani 2, 35128, Padova, Italy.,Padova Neuroscience Center, University of Padova, Padova, Italy
| | - Elena Tenconi
- Department of Neuroscience, University of Padova, via Giustiniani 2, 35128, Padova, Italy.,Padova Neuroscience Center, University of Padova, Padova, Italy
| | - Vincenzo Vindigni
- Department of Neuroscience, University of Padova, via Giustiniani 2, 35128, Padova, Italy
| | - Martin Teufel
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR University-Hospital Essen, Essen, Germany
| | - Eva-Maria Skoda
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR University-Hospital Essen, Essen, Germany
| | - Marion Lindner
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR University-Hospital Essen, Essen, Germany
| | - M Alejandra Quiros-Ramirez
- Max Planck Institute for Intelligent Systems, Tübingen, Germany.,Psychology Department, University of Konstanz, Konstanz, Germany
| | - Betty Mohler
- Max Planck Institute for Intelligent Systems, Tübingen, Germany
| | - Michael Black
- Max Planck Institute for Intelligent Systems, Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany
| | - Katrin E Giel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany
| | - Chiara Pavan
- Department of Medicine, University of Padova, Padova, Italy
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27
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Wagner AF, Butt M, Rigby A. Internalized weight bias in patients presenting for bariatric surgery. Eat Behav 2020; 39:101429. [PMID: 32942239 DOI: 10.1016/j.eatbeh.2020.101429] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 08/13/2020] [Accepted: 08/20/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Internalized weight bias (IWB) is significantly related to poor psychosocial health outcomes in patients with increased body mass index (BMI). The objective of this study was to evaluate the psychometric properties and correlates of the Weight-Bias Internalization Scale in a pre-surgical bariatric population. METHODS Self-report measures were administered to patients prior to surgery. Measures assessed internalized weight bias, body dissatisfaction, depression, anxiety, quality of life, and eating behaviors. Statistical methods included confirmatory factor analysis to examine the factor structure [of the WBIS] in this population, descriptive statistics, correlations, and hierarchical linear regression between continuous variables to determine patterns of associations, and t-tests to compare levels of IWB between the current sample and previously documented samples. RESULTS Confirmatory factor analysis indicated an acceptable fit using a one-factor structure for the WBIS, with one item removed. Mean WBIS in the current sample was comparable to that documented in a community sample of adults with overweight and obesity, as well as a sample of adolescents seeking bariatric surgery. Additionally, IWB was positively associated with body dissatisfaction, restrained, emotional, and external eating, depression, and anxiety, and negatively associated with quality of life. Further, individuals endorsing episodes of loss of control over eating had significantly higher WBIS scores. CONCLUSIONS This study highlights the strong pattern of associations with measures of body image, disordered eating, and quality of life point toward the relevance of IWB to bariatric patients' experiences. Future studies to explore the longitudinal effects of IWB in a post-bariatric population are needed particularly to understand psychosocial and surgical health outcomes.
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Affiliation(s)
- A F Wagner
- Penn State College of Medicine, Department of Minimally Invasive Surgery, Hershey, PA 17033, United States of America.
| | - M Butt
- Penn State College of Medicine, Department of Public Health Sciences, Hershey, PA 17033, United States of America
| | - A Rigby
- Penn State College of Medicine, Department of Minimally Invasive Surgery, Hershey, PA 17033, United States of America
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28
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Snyder M, Haskard-Zolnierek K, Howard K, Hu Y. Weight stigma is associated with provider-patient relationship factors and adherence for individuals with hypothyroidism. J Health Psychol 2020; 27:702-712. [PMID: 33081509 DOI: 10.1177/1359105320963548] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The goal of this study was to examine weight stigma experiences during medical visits as related to provider-patient relationship factors and adherence among individuals with hypothyroidism. A total of 362 participants recruited via social media participated in an online survey. Regression and mediation analyses indicated that weight stigma was negatively associated with adherence; this relationship was mediated by decreased trust in provider, less perceived provider empathy, and lower provider-patient depth-of-relationship. Structural equation modeling with BMI controlled revealed that weight stigma is associated with worsened provider-patient relationship and adherence. Findings suggest the importance of eliminating weight stigma experiences for patients.
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Affiliation(s)
| | | | | | - Yueqin Hu
- Texas State University, San Marcos, TX, USA
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29
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Pearl RL, Wadden TA, Chao AM, Walsh O, Alamuddin N, Berkowitz RI, Tronieri JS. Weight Bias Internalization and Long-Term Weight Loss in Patients With Obesity. Ann Behav Med 2020; 53:782-787. [PMID: 30304382 DOI: 10.1093/abm/kay084] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The relationship between weight bias internalization (WBI) and long-term weight loss is largely unknown. PURPOSE To determine the effects of weight loss on WBI and assess whether WBI impairs long-term weight loss. METHODS One hundred thirty-three adults with obesity completed the Weight Bias Internalization Scale (WBIS) at baseline, after a 14-week lifestyle intervention in which they lost ≥5 per cent of initial weight, and at weeks 24 and 52 of a subsequent randomized controlled trial (RCT) for weight-loss maintenance (66 weeks total). Linear mixed models were used to examine the effects of weight loss on WBIS scores and the effects of baseline WBIS scores on weight change over time. Logistic regression was used to determine the effects of baseline WBIS scores on achieving ≥5 and ≥10 per cent weight loss. RESULTS Changes in weight did not predict changes in WBIS scores. Baseline WBIS scores predicted reduced odds of achieving ≥5 and ≥10 per cent weight loss at week 24 of the RCT (p values < .05). At week 52, the interaction between participant race and WBIS scores predicted weight loss (p = .046) such that nonblack (but not black) participants with higher baseline WBIS scores had lower odds of achieving ≥10 per cent weight loss (OR = 0.38, p = .01). Baseline WBIS scores did not significantly predict rate of weight change over time. CONCLUSIONS Among participants in a weight loss maintenance trial, WBI did not change in relation to changes in weight. More research is needed to clarify the effects of WBI on long-term weight loss and maintenance across race/ethnicity. CLINICAL TRIALS REGISTRATION ClinicalTrials.gov identifier NCT02388568.
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Affiliation(s)
- Rebecca L Pearl
- Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.,Department of Surgery, Edwin and Fannie Gray Hall Center for Human Appearance, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Thomas A Wadden
- Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Ariana M Chao
- Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.,Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA
| | - Olivia Walsh
- Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Naji Alamuddin
- Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.,Department of Medicine, Institute for Diabetes, Obesity, and Metabolism, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Robert I Berkowitz
- Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.,Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, PA
| | - Jena Shaw Tronieri
- Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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30
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Ivezaj V, Lydecker JA, Grilo CM. Language Matters: Patients' Preferred Terms for Discussing Obesity and Disordered Eating with Health Care Providers After Bariatric Surgery. Obesity (Silver Spring) 2020; 28:1412-1418. [PMID: 32662251 PMCID: PMC7501175 DOI: 10.1002/oby.22868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/31/2020] [Accepted: 04/18/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Patients who seek or undergo bariatric surgery are likely to experience pervasive societal biases regarding weight and eating behaviors in the health care system. This cross-sectional study examined patient preferences for desired weight- and eating-related terms for health care providers among individuals with loss-of-control eating after bariatric surgery. METHODS A total of 114 of 140 adults who underwent bariatric surgery approximately 1.5 years prior and were in the follow-up stage of a controlled treatment trial testing behavioral treatments completed language preference measures. RESULTS Of the 11 terms used to describe weight, only 2 were viewed neutrally, weight and BMI. All other terms, including obesity, were rated negatively, and many were rated extremely negatively. Fatness was the least desirable term. Of the 18 terms used to describe loss-of-control eating, one ("ate until uncomfortably full") was rated positively, and several were rated neutrally. On average, none of the weight or loss-of-control eating terms was rated as "desirable" or "very desirable." Analyses revealed few gender and racial differences in language preferences. CONCLUSIONS Many weight-related and loss-of-control eating terms are viewed as undesirable. Health care providers should begin with neutrally rated terms and ask patients about their language preferences when speaking with individuals before/after bariatric surgery to improve patient-centered care and reduce perceived weight bias.
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Affiliation(s)
| | | | - Carlos M. Grilo
- Yale School of Medicine, New Haven, CT, 06519
- Yale University, New Haven, CT, 06511
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31
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Feig EH, Amonoo HL, Onyeaka HK, Romero PM, Kim S, Huffman JC. Weight bias internalization and its association with health behaviour adherence after bariatric surgery. Clin Obes 2020; 10:e12361. [PMID: 32319211 DOI: 10.1111/cob.12361] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 02/13/2020] [Accepted: 04/01/2020] [Indexed: 12/27/2022]
Abstract
This study tested the hypothesis that internalized weight bias (WBI) is negatively associated with health-related quality of life, weight loss and health behaviour adherence (eg, physical activity, diet, vitamin adherence) in patients who had weight loss surgery (WLS). It also tested whether self-efficacy for exercise, barriers to being active and depression were mediators between WBI and moderate-to-vigorous physical activity (MVPA). Participants were recruited from online support forums. They completed an anonymous online survey assessing WBI, physical activity, health behaviour adherence, depression, health-related quality of life, self-efficacy for exercise and barriers to being physically active. Multiple regression analyses and a bootstrapping approach for mediation were used. The sample included 112 primarily white and female adults, who had surgery 1 month to 24 years prior. WBI was negatively associated with weight loss since surgery, MVPA, dietary adherence, vitamin adherence and mental health-related quality of life, and was not associated with walking, physical health-related quality of life or fluid intake adherence. Self-efficacy for exercise, barriers to being active and depression were partial mediators between WBI and physical activity. After WLS, WBI may signal poorer adherence to critical health behaviours. It also is associated with less weight loss. WBI should be assessed and treated by WLS providers.
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Affiliation(s)
- Emily H Feig
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Hermioni L Amonoo
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Henry K Onyeaka
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Perla M Romero
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Sonia Kim
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jeff C Huffman
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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32
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Stevens C. Sick but healthy: bariatric patients and the social construction of illness and disability. SOCIOLOGY OF HEALTH & ILLNESS 2020; 42:907-924. [PMID: 32157704 DOI: 10.1111/1467-9566.13074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Bariatric (weight loss) surgery modifies the digestive system, which produces impairments and symptoms which might be considered illness or disability. Bariatric patients, however, do not view themselves as ill or disabled, but healthier than before surgery. For this study, 35 bariatric patients - from a clinic located in the Midwestern United States - were interviewed to investigate how moral and medical discourses surrounding obesity impact how patients experience their bodies after bariatric surgery. While previous literature on bariatric patients has explored discourses of medicine, stigma and discipline, fewer have analysed how patients interpret physiological symptoms. Patients often reduce or discontinue medications for chronic illness after bariatric surgery, then replace them with a strict regimen of dietary supplements. Even though these supplements are taken to manage an impaired digestive system, they do not carry the same moral weight as medications for chronic illness. Patients also experience painful and humiliating symptoms after bariatric surgery. Bariatric patients interpret symptoms not as illness, but as important disciplinary tools to lose weight. These findings have implications for the social construction and experience of illness and disability in the context of fat stigma, health morality and biomedicalisation.
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Affiliation(s)
- Corey Stevens
- Department of Sociology, Southern Illinois University, Edwardsville, IL, USA
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33
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Feig EH, Golden J, Huffman JC. Emotional Impact on Health Behavior Adherence After Bariatric Surgery: What About Positive Psychological Constructs? Obes Surg 2020; 29:2238-2246. [PMID: 30887307 DOI: 10.1007/s11695-019-03833-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Health behaviors are critical for weight loss maintenance after weight loss surgery (WLS), and emotional factors often play a role in adherence. Positive psychological constructs (e.g., optimism, positive affect) have predicted health outcomes in other medical populations but have been infrequently examined in post-WLS patients. METHODS This study measured optimism and positive affect in post-WLS patients recruited from online support groups. A hierarchical linear regression analysis tested their association with health behavior adherence, physical activity, and weight loss, controlling for demographic and weight-related covariates. It also tested depression and anxiety symptoms as moderators. RESULTS In 95 participants, positive affect was associated with better adherence (b = 0.41, p < 0.01) and greater moderate-to-vigorous physical activity (b = 0.20, p < 0.001) controlling for demographic/weight-related covariates, and independently with more weight loss (b = 0.24, p < 0.05). Optimism was independently associated with better adherence (b = 0.32, p < 0.05) and with greater moderate-to-vigorous physical activity controlling for demographic/weight-related covariates (b = 0.16, p < 0.05). These associations no longer reached statistical significance controlling for depression and anxiety symptoms. Anxiety symptoms moderated the relationship between positive affect and adherence (b = 0.06, p < 0.01), and depression (b = 0.15, p < 0.01) and anxiety (b = 0.02, p < 0.05) symptoms each moderated the relationship between optimism and walking, such that there was a stronger relationship between positive psychological constructs and health behaviors for those with higher anxiety or depression scores. CONCLUSIONS Positive psychological states should be included when assessing emotional factors related to health behaviors in post-WLS patients. Interventions targeting health behaviors may be improved with inclusion of skills to boost positive psychological states.
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Affiliation(s)
- Emily H Feig
- Massachusetts General Hospital Department of Psychiatry, 55 Fruit St., Boston, MA, 02114, USA.
- Harvard Medical School Department of Psychiatry, 25 Shattuck St., Boston, MA, 02115, USA.
| | - Julia Golden
- Massachusetts General Hospital Department of Psychiatry, 55 Fruit St., Boston, MA, 02114, USA
| | - Jeff C Huffman
- Massachusetts General Hospital Department of Psychiatry, 55 Fruit St., Boston, MA, 02114, USA
- Harvard Medical School Department of Psychiatry, 25 Shattuck St., Boston, MA, 02115, USA
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34
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Sobczak K, Leoniuk K, Rudnik A. Experience of Polish Patients with Obesity in Contacts with Medical Professionals. Patient Prefer Adherence 2020; 14:1683-1688. [PMID: 33061311 PMCID: PMC7519823 DOI: 10.2147/ppa.s270704] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 08/22/2020] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Discrimination and stigmatization of patients with obesity are a commonly occurring social problem. The purpose of our research was to analyze the scale of the experience including medical staff's improper behaviours towards patients with obesity in Poland. PATIENTS AND METHODS In a completed national study, we studied the statements of 621 adult patients who suffer from obesity. An original closed question survey was used as a tool to collect the data. Patients were informed about the possibility to participate in the study through social media, medical institutions and patient foundations. RESULTS As many as 82.6% have experienced improper behaviours. Usually, it came from doctors (90%), nurses and midwives (51%), people who operated medical equipment (24%), nutritionists (14%) and paramedics (9%). Exactly 81% of the respondents pointed to unpleasant and judgmental comments as the most frequent form of improper behaviour which they have encountered mainly during diagnostic tests, palpation or procedures. CONCLUSION There is an urgent need for developing national strategies connected with care for individuals with higher body weight. Introducing dedicated solutions in this field may contribute to increasing the quality of health care and reducing stigmatizing behaviours.
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Affiliation(s)
- Krzysztof Sobczak
- Department of Sociology of Medicine & Social Pathology, Medical University of Gdansk, Gdansk, Poland
- Correspondence: Krzysztof Sobczak Email
| | - Katarzyna Leoniuk
- Department of Sociology of Medicine & Social Pathology, Medical University of Gdansk, Gdansk, Poland
| | - Agata Rudnik
- Institute of Psychology, University of Gdansk, Gdansk, Poland
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Bryant EJ, Malik MS, Whitford-Bartle T, Waters GM. The effects of bariatric surgery on psychological aspects of eating behaviour and food intake in humans. Appetite 2019; 150:104575. [PMID: 31875518 DOI: 10.1016/j.appet.2019.104575] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 12/07/2019] [Accepted: 12/20/2019] [Indexed: 12/14/2022]
Abstract
Bariatric surgery has emerged as an increasingly popular weight loss intervention, with larger and more endurable weight loss compared to pharmacological and behavioural interventions. The degree of weight loss patients experience varies, between individuals, surgeries and over time. An explanation as to why differing weight loss trajectories exist post-surgery could be due to the complex interplay of individual differences in relation to eating behaviours and appetite. Thus the aim of this narrative review is to explore literature between 2008 and 2018, to assess the impact of impact of bariatric surgery on food selection and nutrient status, on eating behaviour traits and on disturbed and disordered eating behaviour, to determine their impact of weight loss success and weight loss trajectories. Immediately post-surgery, up until 1-2 years post-surgery, there is a reliance upon the surgery's alteration of the gastrointestinal tract to control food intake and subsequently lose weight. Energy intake is reduced, dietary adherence is higher, supplement intake is higher, appetite ratings are lower, there is a reduction in psychopathology, and an increase in wellbeing. After this point, patients become more susceptible to weight regain, as this is the point where passive observation of the weight reducing action of surgery, moves into more cognitive effort, on the part of the individual, to control energy intake. There are various factors which influence an individual's ability to successfully regulate their energy intake post-surgery, such as their level of Disinhibition, Restraint, Hunger, Emotional Eating, Uncontrolled Eating, psychopathology and wellbeing. The need for continued psychological and nutritional support post-surgery is necessary to reduce weight regain susceptibility.
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Affiliation(s)
- E J Bryant
- Division of Psychology, University of Bradford, West Yorkshire, UK.
| | - M S Malik
- Division of Psychology, University of Bradford, West Yorkshire, UK
| | | | - G M Waters
- Division of Psychology, University of Bradford, West Yorkshire, UK
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Healthism and the experiences of social, healthcare and self-stigma of women with higher-weight. SOCIAL THEORY & HEALTH 2019. [DOI: 10.1057/s41285-019-00118-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Luck-Sikorski C, Jung F, Dietrich A, Stroh C, Riedel-Heller SG. Perceived Barriers in the Decision for Bariatric and Metabolic Surgery: Results from a Representative Study in Germany. Obes Surg 2019; 29:3928-3936. [PMID: 31301032 DOI: 10.1007/s11695-019-04082-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Attitudes of the general public may be an influencing factor for low surgery rates: When skepticism is high, support for individuals wanting or needing to undergo surgery may diminish. This study assesses the relevance of barriers to metabolic surgery. METHODS The study was conducted using a representative sample of the German population (n = 1007). Participants were asked to imagine that they would have to decide for or against metabolic surgery and rate how this decision would be influenced by a number of reasons given to them (Likert scale). Results are presented by weight status. RESULTS The barrier found most irrelevant is that surgery could be considered cheating across all weight groups. About a fourth of the sample state that not knowing enough about surgery (28.5%), being afraid of surgery (28.3%), and potential negative consequences after surgery (24.5%) are reasons against metabolic surgery that were rated extremely relevant. Having obesity was a significant predictor of endorsement in two variables: feeling like cheating (lower probability for relevance, OR = 0.58, p = 0.025) and a lack of knowledge (lower probability for relevance, OR = 0.59, p = 0.031). CONCLUSIONS In summary, the public's view of weight loss surgery lacks information about post-surgical consequences. It is important to address these points in the public and in social networks of patients as they may be pre- or antecedent of surgery stigma.
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Affiliation(s)
- C Luck-Sikorski
- Integrated Research and Treatment Center AdiposityDiseases (IFB), University of Leipzig, Leipzig, Germany. .,SRH University of Applied Health Sciences, Neue Straße 28-30, 07548, Gera, Germany. .,Department of General, Abdominal and Pediatric Surgery, SRH Municipal Hospital Gera, Strasse des Friedens, 122, Gera, Germany.
| | - F Jung
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany
| | - A Dietrich
- Integrated Research and Treatment Center AdiposityDiseases (IFB), Department of Surgery, University of Leipzig, Leipzig, Germany
| | - C Stroh
- Department of General, Abdominal and Pediatric Surgery, SRH Municipal Hospital Gera, Strasse des Friedens, 122, Gera, Germany
| | - S G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany
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Kadar GE, Thompson HG. Obesity bias among preclinical and clinical chiropractic students and faculty at an integrative health care institution: A cross-sectional study. THE JOURNAL OF CHIROPRACTIC EDUCATION 2019; 33:8-15. [PMID: 30044139 PMCID: PMC6417871 DOI: 10.7899/jce-17-15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 01/15/2018] [Accepted: 03/05/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE: The purpose of this study was to assess the prevalence of obesity bias among preclinical and clinical chiropractic students and faculty at an integrative health care academic institution. METHODS: This was a cross-sectional quantitative, single-method survey with group comparison using the Beliefs About Obese Persons scale (BAOP) and the Attitudes Toward Obese Persons scale. Both instruments were administered as a single 28 question survey via email to 450 students and 46 faculty members in a doctor of chiropractic (DC) program. Differences were determined by 2 tailed t tests. RESULTS: The response rate for faculty and students was 31% and 65%, respectively. One hundred forty-three DC students, preclinical ( n = 65) and clinical ( n = 78), and 30 DC faculty, preclinical ( n = 15) and clinical ( n = 15) completed the survey. Both students and faculty harbored antiobesity attitudes and moderate antiobesity beliefs. Students demonstrated slightly more positive attitudes toward obese persons than did preclinical faculty. Although preclinical faculty did not demonstrate more biased attitudes than did preclinical students ( p = .057), they were more biased than clinical students ( p = .26). On the BAOP, preclinical faculty scored significantly lower than both preclinical students and clinical students ( p = .013 and .017, respectively). CONCLUSION: Obesity bias was common among clinical and preclinical chiropractic students and faculty at our institution. A cultural shift that reduces bias may require changes in both the curriculum and cocurriculum.
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Täuber S, Mulder LB, Flint SW. The Impact of Workplace Health Promotion Programs Emphasizing Individual Responsibility on Weight Stigma and Discrimination. Front Psychol 2018; 9:2206. [PMID: 30510529 PMCID: PMC6253158 DOI: 10.3389/fpsyg.2018.02206] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 10/24/2018] [Indexed: 12/18/2022] Open
Abstract
Over time, there has been a steady increase of workplace health promotion programs that aim to promote employees' health and fitness. Previous research has focused on such program's effectiveness, cost-savings, and barriers to engaging in workplace health promotion. The present research focuses on a downside of workplace health promotion programs that to date has not been examined before, namely the possibility that they, due to a focus on individual responsibility for one's health, inadvertently facilitate stigmatization and discrimination of people with overweight in the workplace. Study 1 shows that the presence of workplace health promotion programs is associated with increased attributions of weight controllability. Study 2 experimentally demonstrates that workplace health promotion programs emphasizing individual rather than organizational responsibility elicit weight stigma. Study 3, which was pre-registered, showed that workplace health promotion programs emphasizing individual responsibility induced weight-based discrimination in the context of promotion decisions in the workplace. Moreover, focusing on people with obesity who frequently experience weight stigma and discrimination, Study 3 showed that workplace health promotion programs highlighting individual responsibility induced employees with obesity to feel individually responsible for their health, but at the same time made them perceive weight as less controllable. Together, our research identifies workplace health promotion programs as potent catalysts of weight stigma and weight-based discrimination, especially when they emphasize individual responsibility for health outcomes. As such, we offer valuable insights for organizations who aim to design and implement workplace health promotion programs in an inclusive, non-discriminatory way that benefits all employees.
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Affiliation(s)
- Susanne Täuber
- Department of Human Resource Management and Organizational Behavior, University of Groningen, Groningen, Netherlands
| | - Laetitia B Mulder
- Department of Human Resource Management and Organizational Behavior, University of Groningen, Groningen, Netherlands
| | - Stuart W Flint
- School of Sport, Leeds Beckett University, Leeds, United Kingdom
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Phelan SM. An update on research examining the implications of stigma for access to and utilization of bariatric surgery. Curr Opin Endocrinol Diabetes Obes 2018; 25:321-325. [PMID: 30048259 DOI: 10.1097/med.0000000000000431] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW To summarize recent literature examining the relationship between stigma and utilization of surgical treatments for obesity. RECENT FINDINGS The stigma of obesity and stigma associated with surgical treatments for obesity can affect both healthcare providers' recommendations of these options and patients' likelihood of considering and choosing these treatments. Presurgical requirements of healthcare and insurance organizations and a lack of postsurgical support reflect the stigmatizing attitudes that bariatric/metabolic surgery is an 'easy fix' and 'last resort' for patients too undisciplined to lose weight in other ways. SUMMARY Here we review the literature published in the last year that addresses the implications of stigma for the utilization and outcomes of surgical treatments for obesity.
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Affiliation(s)
- Sean M Phelan
- Division of Healthcare Policy and Research, Mayo Clinic, Rochester, Minnesota, USA
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Pearl RL, Puhl RM. Weight bias internalization and health: a systematic review. Obes Rev 2018; 19:1141-1163. [PMID: 29788533 PMCID: PMC6103811 DOI: 10.1111/obr.12701] [Citation(s) in RCA: 275] [Impact Index Per Article: 45.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 03/23/2018] [Accepted: 03/29/2018] [Indexed: 01/31/2023]
Abstract
A robust literature has documented the negative health effects of being the target of weight bias. Weight bias internalization (WBI) occurs when individuals apply negative weight stereotypes to themselves and self-derogate because of their body weight. Compared with experiences of weight bias, less is known about the relationship between WBI and mental and physical health, although more literature on this topic has emerged in recent years. The current systematic review identified 74 studies assessing the relationship between WBI and health and interventions designed to reduce WBI and improve health. Over half of identified studies were published from 2016 to 2017. Results showed strong, negative relationships between WBI and mental health outcomes. Fewer studies have examined the relationship between WBI and physical health, and results were less consistent. Key directions for future research are highlighted, including the need for prospective and experimental studies with greater sample diversity.
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Affiliation(s)
- R L Pearl
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - R M Puhl
- Rudd Center for Food Policy and Obesity, Department of Human Development & Family Studies, University of Connecticut, Hartford, CT, USA
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Han S, Agostini G, Brewis AA, Wutich A. Avoiding exercise mediates the effects of internalized and experienced weight stigma on physical activity in the years following bariatric surgery. BMC OBESITY 2018; 5:18. [PMID: 29988619 PMCID: PMC6027738 DOI: 10.1186/s40608-018-0195-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 05/02/2018] [Indexed: 11/10/2022]
Abstract
Background People living with severe obesity report high levels of weight-related stigma. Theoretically, this stigma undermines weight loss efforts. The objective of this study is to test one proposed mechanism to explain why weight loss is so difficult once an individual becomes obese: that weight-related stigma inhibits physical activity via demotivation to exercise. Methods The study focused on individuals who had bariatric surgery within the past 5 years (N = 298) and who report a post-surgical body mass index (BMI) ranging from 16 to 70. Exercise avoidance motivation (EAM) and physical activity (PA) were modeled as latent variables using structural equation modeling. Two measures of weight stigma, the Stigmatizing Situations Inventory (SSI) and the Weight Bias Internalization Scale (WBIS) were modified for people with a long history of extreme obesity for use as observed predictors. Results Exercise avoidance motivation (EAM) significantly mediated the association between both experienced (SSI) and internalized (WBIS) weight stigma and physical activity (PA) in this population. Conclusion Exercise avoidance motivation, influenced by weight stigma, may be a significant factor explaining the positive relationship between higher body weights with lower levels of physical activity.
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Affiliation(s)
- SeungYong Han
- Mayo Clinic/Arizona State University Obesity Solutions, 1000 Cady Mall Suite 164, Tempe, AZ 85287 USA
| | - Gina Agostini
- Mayo Clinic/Arizona State University Obesity Solutions, 1000 Cady Mall Suite 164, Tempe, AZ 85287 USA
| | - Alexandra A Brewis
- Mayo Clinic/Arizona State University Obesity Solutions, 1000 Cady Mall Suite 164, Tempe, AZ 85287 USA.,2School of Human Evolution and Social Change, Arizona State University, 900 Cady Mall, Tempe, AZ 85287 USA
| | - Amber Wutich
- 2School of Human Evolution and Social Change, Arizona State University, 900 Cady Mall, Tempe, AZ 85287 USA
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Increasing overweight and obesity erodes engagement in one's neighborhood by women, but not men. Prev Med Rep 2018; 10:144-149. [PMID: 29755933 PMCID: PMC5945908 DOI: 10.1016/j.pmedr.2018.02.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 01/22/2018] [Accepted: 02/26/2018] [Indexed: 01/04/2023] Open
Abstract
Obesity is socially stigmatized in the U.S., especially for women. Significant research has focused on the role that the social and built environments of neighborhoods play in shaping obesity. However, the role of obesity in shaping neighborhood social structure has been largely overlooked. We test the hypothesis that large body size inhibits an individual's engagement in his or her neighborhood. Our study objectives are to assess if (1) body size (body mass index) interacts with gender to predict engagement in one's neighborhood (neighborhood engagement) and (2) if bonding social capital interacts with gender to predict neighborhood engagement independent of body size. We used data collected from the cross-sectional 2011 Phoenix Area Social Survey (PASS), which systematically sampled residents across four neighborhood types (core urban, urban fringe, suburban, retirement) across the Phoenix Metopolitian Area. Survey data was analyzed using logistic regression for 804 participants, including 35% for whom missing data was computed using multiple imputation. We found that as body size increases, women—but not men—have reduced engagement in their neighborhood, independent of bonding social capital and other key covariates (objective 1). We did not observe the interaction between gender and bonding social capital associated with neighborhood engagement (objective 2). Prior scholarship suggests obesity clusters in neighborhoods due to processes of social, economic, and environmental disadvantage. This finding suggests bi-directionality: obesity could, in turn, undermine neighborhood engagement through the mechanism of weight stigma and discrimination.
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Hood MM, Kelly MC, Feig EH, Webb V, Bradley LE, Corsica J. Measurement of adherence in bariatric surgery: a systematic review. Surg Obes Relat Dis 2018; 14:1192-1201. [PMID: 29853195 DOI: 10.1016/j.soard.2018.04.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 04/16/2018] [Accepted: 04/17/2018] [Indexed: 12/22/2022]
Abstract
After bariatric surgery, rates of adherence to behavioral recommendations, including attending regular appointments and following specific dietary, physical activity, and vitamin use recommendations, tend to be highly variable across studies. Lack of consistency in measurement of adherence is a likely contributor to this variability, making it challenging to determine the prevalence and impact of nonadherence in this population. PubMed was searched for articles measuring behavioral adherence or compliance in patients after bariatric surgery, resulting in 85 articles. Articles were reviewed for the definition and measurement of adherence in each area (appointment attendance, as well as dietary, physical activity, and vitamin use adherence), and on the use and reporting of recommended adherence measurement strategies. Over half of the articles measured adherence to appointment attendance. Significant variability was found across adherence definitions and measurement methods, and use of recommended adherence measurement strategies was poor. Adherence was mostly commonly measured via self-report (either verbal or written) using cutoffs for adherent versus nonadherent behavior. Over half of studies assessed adherence up to ≥2 years postsurgery. Recommendations for ways to improve adherence measurement in patients who have had bariatric surgery are outlined.
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Affiliation(s)
- Megan M Hood
- Rush University Medical Center, Chicago, Illinois.
| | | | - Emily H Feig
- Rush University Medical Center, Chicago, Illinois
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Sevincer GM, Kaya A, Bozkurt S, Akin E, Kose S. Reliability, validity, and factorial structure of the Turkish version of the Weight Self-Stigma Questionnaire (Turkish WSSQ). PSYCHIAT CLIN PSYCH 2017. [DOI: 10.1080/24750573.2017.1379717] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Guzin M. Sevincer
- Department of Psychology, Istanbul Gelisim University, Istanbul, Turkey
| | - Aysenur Kaya
- Department of Psychology, Istanbul Gelisim University, Istanbul, Turkey
| | - Suleyman Bozkurt
- Department of Bariatric and Metabolic Surgery, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Ercan Akin
- Department of Psychology, Hasan Kalyoncu University, Gaziantep, Turkey
| | - Samet Kose
- Department of Psychology, Hasan Kalyoncu University, Gaziantep, Turkey
- University of Texas Medical School at Houston, Houston, TX, USA
- Center for Neurobehavioral Research on Addictions, Houston, TX, USA
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Kim MK, Heo Y. Metabolic Surgery in Korea: What to Consider before Surgery. Endocrinol Metab (Seoul) 2017; 32:307-315. [PMID: 28956359 PMCID: PMC5620026 DOI: 10.3803/enm.2017.32.3.307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 07/11/2017] [Accepted: 07/14/2017] [Indexed: 11/11/2022] Open
Abstract
Obesity is increasing globally and represents a significant global health problem because it predisposes towards various diseases, such as type 2 diabetes mellitus, cardiovascular disease, degenerative joint disease, and certain types of cancer. Numerous studies have shown that bariatric surgery reduces body mass and ameliorates obesity-related complications, such as hypertension and hyperglycemia, suggesting that surgery is the most effective therapeutic option for severely obese and obese diabetic patients. Recent international guidelines recommend surgical treatment for diabetic patients with class III obesity (body mass index [BMI] >40 kg/m²), regardless of their level of glycemic control or the complexity of their glucose-lowering regimens, and for patients with class II obesity (BMI 35.0 to 39.9 kg/m²) and hyperglycemia that is poorly controlled despite appropriate lifestyle and pharmacological therapy. The most popular procedures are Roux-en-Y gastric bypass and sleeve gastrectomy, but new procedures with better outcomes have been reported. For optimal surgical outcome, comprehensive management including assessments of a medical condition, nutrition, mental health, and social support is needed before and after surgery. However, there is still a lack of understanding regarding metabolic surgery in Korea. Therefore, this article reviews indications for metabolic surgery in patients with a specific focus on the situation in Korea.
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Affiliation(s)
- Mi Kyung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Yoonseok Heo
- Department of Surgery, Inha University School of Medicine, Incheon, Korea.
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Lobstein T, Brinsden H, Gill T, Kumanyika S, Swinburn B. Comment: obesity as a disease - some implications for the World Obesity Federation's advocacy and public health activities. Obes Rev 2017; 18:724-726. [PMID: 28489340 DOI: 10.1111/obr.12554] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 03/24/2017] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - T Gill
- The Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Sydney, New South Wales, Australia
| | - S Kumanyika
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - B Swinburn
- School of Population Health, University of Auckland, Auckland, New Zealand
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Patel JJ, Mundi MS, Hurt RT, Wolfe B, Martindale RG. Micronutrient Deficiencies After Bariatric Surgery: An Emphasis on Vitamins and Trace Minerals [Formula: see text]. Nutr Clin Pract 2017; 32:471-480. [PMID: 28609642 DOI: 10.1177/0884533617712226] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Obesity has become a worldwide epidemic with a disproportionate increase in grade III obesity. Bariatric surgery offers an attractive option for sustained weight loss compared with traditional methods such as exercise and diet. Micronutrient deficiencies are common and clinically significant after bariatric surgery. These deficiencies are related to a combination of patient and surgical variables. A thorough understanding of specific micronutrient deficiencies is necessary for early recognition and optimal management. The purpose of this review is to describe indications, outcomes, and types of bariatric procedures, risk factors, and mechanisms for micronutrient deficiencies, as well as outline specific vitamin and trace element deficiencies after bariatric surgery.
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Affiliation(s)
- Jayshil J Patel
- 1 Division of Pulmonary & Critical Care Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Manpreet S Mundi
- 2 Division of Endocrinology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Bruce Wolfe
- 4 Division of Bariatric Surgery, Oregon Health Sciences University, Portland, Oregon, USA
| | - Robert G Martindale
- 5 Division of General Surgery, Oregon Health Sciences University, Portland, Oregon, USA
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