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Richardson AS, Dubowitz T, Beyer KM, Zhou Y, Kershaw KN, Duck W, Ye F, Beckman R, Gordon-Larsen P, Shikany JM, Kiefe C. Associations of Historical Redlining With BMI and Waist Circumference in Coronary Artery Risk Development in Young Adults. AJPM FOCUS 2024; 3:100209. [PMID: 38590394 PMCID: PMC10999814 DOI: 10.1016/j.focus.2024.100209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
Introduction Historical maps of racialized evaluation of mortgage lending risk (i.e., redlined neighborhoods) have been linked to adverse health outcomes. Little research has examined whether living in historically redlined neighborhoods is associated with obesity, differentially by race or gender. Methods This is a cross-sectional study to examine whether living in historically redlined neighborhoods is associated with BMI and waist circumference among Black and White adults in 1985-1986. Participants' addresses were linked to the 1930s Home Owners' Loan Corporation maps that evaluated mortgage lending risk across neighborhoods. The authors used multilevel linear regression models clustered on Census tract, adjusted for confounders to estimate main effects, and stratified, and interaction models by (1) race, (2) gender, and (3) race by gender with redlining differentially for Black versus White adults and men versus women. To better understand strata differences, they compared Census tract-level median household income across race and gender groups within Home Owners' Loan Corporation grade. Results Black adults (n=2,103) were more likely than White adults (n=1,767) to live in historically rated hazardous areas and to have higher BMI and waist circumference. Redlining and race and redlining and gender interactions for BMI and waist circumference were statistically significant (p<0.10). However, in stratified analyses, the only statistically significant associations were among White participants. White participants living in historically rated hazardous areas had lower BMI (β = - 0.63 [95% CI= -1.11, -0.15]) and lower waist circumference (β = - 1.50 [95% CI= -2.62, -0.38]) than those living in declining areas. Within each Home Owners' Loan Corporation grade, residents in White participants' neighborhoods had higher incomes than those living in Black participants' neighborhoods (p<0.0001). The difference was largest within historically redlined areas. Covariate associations differed for men, women, Black, and White adults, explaining the difference between the interaction and the stratified models. Race by redlining interaction did not vary by gender. Conclusions White adults may have benefitted from historical redlining, which may have reinforced neighborhood processes that generated racial inequality in BMI and waist circumference 50 years later.
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Affiliation(s)
- Andrea S. Richardson
- RAND Corporation, Department of Behavioral and Policy Sciences, Pittsburgh, Pennsylvania
| | - Tamara Dubowitz
- RAND Corporation, Department of Behavioral and Policy Sciences, Pittsburgh, Pennsylvania
| | | | - Yuhong Zhou
- Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kiarri N. Kershaw
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Waverly Duck
- University of California Santa Barbara, Santa Barbara, California
| | - Feifei Ye
- RAND Corporation, Department of Behavioral and Policy Sciences, Pittsburgh, Pennsylvania
| | - Robin Beckman
- RAND Corporation, Department of Behavioral and Policy Sciences, Santa Monica, California
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Webber SC, Thille P, Liu K, Wittmeier K, Cain P. Determining Associations Among Health Orientation, Fitness Orientation, and Attitudes Toward Fatness in Physiotherapists and Physiotherapy Students Using Structural Equation Modeling. Physiother Can 2024; 76:220-229. [PMID: 38725602 PMCID: PMC11078247 DOI: 10.3138/ptc-2022-0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/30/2022] [Accepted: 09/06/2022] [Indexed: 05/12/2024]
Abstract
Purpose Research suggests physiotherapists hold negative attitudes and beliefs toward fatness and fat people. Physiotherapists are also health-conscious, and invested in healthy lifestyle behaviours including physical activity. Our purpose was to describe relationships between health orientation, fitness orientation, and fat attitudes. Methods Physiotherapists (n = 187) and physiotherapy students (n = 34) completed an online survey (Health Orientation Scale, Multidimensional Body-Self Relations Questionnaire, Fat Attitudes Assessment Toolkit). Structural equation modeling estimated associations between fat attitudes (dependent variable) and health and fitness orientation (independent variables). Results Participants scored high in orientation toward fitness and health. We found strong positive associations between fitness orientation and health orientation (p < 0.001). Health orientation was not significantly associated with fat attitudes (p = 0.075), whereas increased age was associated with more positive fat attitudes (p < 0.01). Although most participants acknowledged that factors outside an individual's control contribute to body weight, many also agreed with normative negative perspectives. Conclusions Physiotherapists are highly oriented toward fitness and health. This may underlie beliefs in the controllability of body weight and contribute to negative attitudes toward fatness and fat people. Further research, with greater sample sizes is necessary to further investigate associations between health orientation and fat attitudes.
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Affiliation(s)
- Sandra C. Webber
- From the:
Department of Physiotherapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Patricia Thille
- From the:
Department of Physiotherapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kun Liu
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kristy Wittmeier
- Department of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Patricia Cain
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
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3
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Silbiger K. Mental health providers' perceptions of restrictive eating disorders: Relationship with client body weight. Int J Eat Disord 2024; 57:916-923. [PMID: 38291927 DOI: 10.1002/eat.24154] [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: 10/01/2023] [Revised: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 02/01/2024]
Abstract
OBJECTIVE This study investigated whether mental health providers have different diagnostic impressions and treatment recommendations for patients with restrictive eating disorders, depending on the patient's body weight. METHOD Participants were given one of three versions of a vignette depicting a patient who meets DSM-5 criteria for anorexia nervosa (AN) or atypical AN with the patient's weight described as either below, within, or above the average range for her age and height. Participants were then asked to respond to a series of questions about diagnosis, symptoms, and treatment recommendations. Results were compared between the three weight conditions with the goal of better understanding how a patient's body weight may influence different aspects of participants' clinical impressions. RESULTS Participants given the low weight version of the vignette were more likely to identify the presenting problem as an eating disorder and to agree that the patient experienced dietary restriction and weight loss, weight gain avoidance, and body image concerns. Participants given the low weight description were also more likely to recommend specialized eating disorder treatment and medical follow-up. DISCUSSION Findings suggest that mental health providers were generally more responsive to restrictive eating disorder symptoms when the patient was at a lower body weight. These results are concerning because they suggest patients with atypical AN may be less likely to receive an accurate diagnosis or adequate treatment compared to underweight patients with AN, despite experiencing the same symptoms. PUBLIC SIGNIFICANCE Restrictive eating disorders like AN and atypical AN can cause comparable physical and psychological symptoms in people of any body weight. Despite having the same symptoms, people with a higher body weight are less likely to receive a diagnosis or treatment. This study compared mental health providers' reactions to a description of a patient with an eating disorder at different body weights and found differences in diagnosis, detection of symptoms, and treatment recommendations.
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4
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Kost C, Jamie K, Mohr E. "Whatever I said didn't register with her": medical fatphobia and interactional and relational disconnect in healthcare encounters. FRONTIERS IN SOCIOLOGY 2024; 9:1303919. [PMID: 38586083 PMCID: PMC10996856 DOI: 10.3389/fsoc.2024.1303919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 03/07/2024] [Indexed: 04/09/2024]
Abstract
Introduction This article focuses on medical fatphobia as a specific phenomenon structuring interactions between patients and healthcare practitioners. Throughout the article, we use 'fat' and 'fatphobia' as the preferred terms in the body positivity and fat acceptance communities. It is well documented that 'fat' people frequently experience negative and highly stigmatising healthcare encounters where weight is disproportionately centred and over-attributed as a cause of ill-health. This can compound and worsen disordered eating, trigger mental health problems, and lead to healthcare avoidance. Although the regularity and risks of these weight-focused encounters are well established, there does not yet exist a coherent theoretical framework for understanding such discriminatory practises. Methods In this article, we draw on the experiences of 15 fat women who are members of the Health at Every Size (HAES) online community to explore how they perceive their fatness impacting medical encounters. Results and discussion Through these data and specifically drawing on the framework of 'cultural health capital,' we suggest that given the deep purchase of cultural tropes surrounding it, fatness is perceived to embody and therefore confer on patients' assumptions of low cultural health capital. We argue that ubiquitously characteristic of medical fatphobia is what we call an 'interactional and relational disconnect' between fat patients and healthcare practitioners. We suggest that this disconnect structures fatphobic interactions by over-attributing fatness as the underlying cause of medical problems, which entrenches patient and practitioner ambivalence because of a lack of joint decision-making. We argue that interactional and relational disconnect is produced by, sustained by, and reproduces asymmetric power relations between patients and practitioners. While we demonstrate that patients develop tactics to mitigate and manage fatphobia in healthcare encounters, the persistent interactional asymmetry between doctors and patients means these attempts often fail. We conclude with a plea for sociology to take medical fatphobia seriously as a form of intersectional systemic discrimination. While movements like HAES, fat positivity, and body acceptance create kinship and support fat patients with self-advocacy in healthcare interactions, we suggest that systemic rather than individual change is necessary for effective healthcare inclusion and interaction.
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Affiliation(s)
- Carolin Kost
- University of Cambridge Centre for Gender Studies, University of Cambridge, Cambridge, United Kingdom
| | - Kimberly Jamie
- Department of Sociology, Durham University, Durham, United Kingdom
| | - Elizabeth Mohr
- Berlin School of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
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5
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Morgan S, Mihlar S, Wood E, McKinlay E, Gibbs H, Parker G, Gray L. Sizing Up General Practice Environments for Big-Bodied Patients: An Environmental Assessment of Three Facilities in Aotearoa New Zealand. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2024:19375867241238442. [PMID: 38512992 DOI: 10.1177/19375867241238442] [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: 03/23/2024]
Abstract
OBJECTIVES This research describes the physical environments of and equipment in Aotearoa New Zealand (NZ) general practices in relation to available standards for big-bodied people (BBP) seeking healthcare. BACKGROUND The prevalence of BBP both in NZ and globally has increased over the last 30 years and is expected to increase further. As the first and most utilized point of contact for patients in NZ and many countries, it is essential that general practices provide suitable environments to cater for and meet the needs of big-bodied patients seeking healthcare. METHODS An exploratory study utilizing an environmental investigation was undertaken in three diverse general practices. Data collection consisted of direct observation and physical measurements of practice layout and equipment. Findings were compared to the existing guidelines or standards for the healthcare of BBP. RESULTS The analysis identified most environmental facets and equipment in all three general practices did not meet published guidelines for the care of BBP. CONCLUSIONS In the global context of increasing and sustained prevalence of BBP, this exploratory study highlights it is crucial that general practices and similar community-based facilities review their physical environments and equipment and consider modifications to improve accessibility, inclusivity, and comfort for BBP.
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Affiliation(s)
- Sonya Morgan
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Sheharazade Mihlar
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Emily Wood
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | | | - Helen Gibbs
- Diet Consulting, Gardens Dunedin, New Zealand
| | | | - Lesley Gray
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
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Heidebrecht C, Fierheller D, Martel S, Andrews A, Hollahan A, Griffin L, Meerai S, Lock R, Nabavian H, D'Silva C, Friedman M, Zenlea I. Raising awareness of anti-fat stigma in healthcare through lived experience education: a continuing professional development pilot study. BMC MEDICAL EDUCATION 2024; 24:64. [PMID: 38229086 DOI: 10.1186/s12909-023-04889-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/20/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Anti-fat attitudes and weight-based discrimination are prevalent in healthcare settings and among healthcare practitioners and clinical trainees, and can result in immense harm to patients. There is increasing recognition that anti-fat bias in healthcare is a critical issue that must be addressed, but there is a dearth of evidence demonstrating sustained attitude and behavioural change among clinicians, illustrating a need for more innovative educational approaches and rigorous evaluation. We describe the co-design and delivery of a narrative-based continuing professional development curriculum aimed at raising awareness of weight-based bias and stigma. METHODS Our research team of lived experience educators, clinicians and researchers collaboratively developed a series of seven podcast episodes comprised of narrative descriptions of lived experiences with and impacts of weight bias, stigma and discrimination in healthcare settings, as well as a post-podcast workshop to facilitate reflection and discussion between participants. The curriculum was piloted among 20 clinicians practicing at a large urban hospital in Mississauga, Canada. We explored feasibility, acceptability and learning impact by analyzing responses to questionnaires completed following each podcast episode and responses shared during the workshops and follow-up feedback sessions. RESULTS We observed high acceptability and feasibility of the curriculum. Participants experienced the podcast as a practical and convenient learning format and the workshop as a valuable opportunity to collectively debrief and reflect. The learning impact of the curriculum was strong; participants described a range of emotions elicited by the podcasts, engaged in self-reflection, and expressed a desire to modify clinical approaches. Barriers to the application of learnings identified by participants include pervasiveness of the use of body mass index (BMI) as an indicator of risk and a criterion for referral; discomfort with difficult conversations; prevalent biomedical understandings about the association between weight and health; and clinicians' defensiveness. CONCLUSION This pilot study yielded promising findings and demonstrated potential impact on weight bias and stigma among healthcare providers. Necessary next steps include conducting larger scale, rigorous evaluations of the curriculum among broader populations, both health professions trainees and current healthcare providers.
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Affiliation(s)
| | - Dianne Fierheller
- Institute for Better Health, Trillium Health Partners, Mississauga, Canada
| | | | - Alex Andrews
- School of Social Work, Toronto Metropolitan University, Toronto, Canada
| | - Amanda Hollahan
- School of Social Work, Toronto Metropolitan University, Toronto, Canada
| | - Laura Griffin
- School of Social Work, Toronto Metropolitan University, Toronto, Canada
| | - Sonia Meerai
- Faculty of Social Work, Wilfrid Laurier University, Brantford, Canada
- Program for Health System and Technology Evaluation, Ted Rogers Centre for Heart Research / Peter Munk Cardiac Centre, Toronto General Hospital Research Institute, Toronto, Canada
| | - Raeden Lock
- Social Service Worker Program, Sheridan College, Oakville, Canada
| | - Helia Nabavian
- Postgraduate Medical Education, University of Toronto, Toronto, Canada
| | - Chelsea D'Silva
- Institute for Better Health, Trillium Health Partners, Mississauga, Canada
| | - May Friedman
- School of Social Work, Toronto Metropolitan University, Toronto, Canada
| | - Ian Zenlea
- Institute for Better Health, Trillium Health Partners, Mississauga, Canada.
- Department of Women's and Children's Health Program, Trillium Health Partners, Mississauga, Canada.
- Department of Paediatrics, University of Toronto, Toronto, Canada.
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7
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Harrop EN, Hutcheson R, Harner V, Mensinger JL, Lindhorst T. "You Don't Look Anorexic": Atypical anorexia patient experiences of weight stigma in medical care. Body Image 2023; 46:48-61. [PMID: 37236121 PMCID: PMC10524894 DOI: 10.1016/j.bodyim.2023.04.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 04/23/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023]
Abstract
Eating disorders (ED) and weight stigma pose significant healthcare challenges. Patients at higher weights, like some with atypical anorexia (AAN), may face increased challenges due to weight stigma. This study analyzed patients' lived experiences with weight stigma in healthcare. Thirty-eight adult patients with AAN completed in-depth, semi-structured interviews regarding healthcare experiences. Guided by narrative inquiry approaches, transcripts were thematically coded. Across the illness trajectory (ED development, pre-treatment, treatment, post-treatment), patients reported that weight stigma in healthcare contributed to initiation and persistence of ED behaviors. Themes included "providers pathologizing patient weight," which patients reported triggered ED behaviors and relapse, "provider minimization and denial" of patients' EDs, which contributed to delays in screening and care, and "overt forms of weight discrimination," leading to healthcare avoidance. Participants reported that weight stigma prolonged ED behaviors, delayed care, created suboptimal treatment environments, deterred help-seeking, and lowered healthcare utilization. This suggests that many providers (pediatricians, primary care providers, ED treatment specialists, other healthcare specialists) may inadvertently reinforce patients' EDs. Increasing training, screening for EDs across the weight spectrum, and targeting health behavior promotion rather than universal weight loss, could enhance quality of care and improve healthcare engagement for patients with EDs, particularly those at higher weights.
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Affiliation(s)
- Erin N Harrop
- University of Washington School of Social Work, 4101 15th Ave NE, Seattle, WA 98105, USA; University of Denver Graduate School of Social Work, 2148 South High Street, Denver, CO 80208, USA.
| | - Rebecca Hutcheson
- University of Washington School of Public Health, Hans Rosling Center for Population Health, 3980 15th Ave NE, Seattle, WA 98195, USA
| | - Vern Harner
- University of Washington School of Social Work, 4101 15th Ave NE, Seattle, WA 98105, USA
| | - Janell L Mensinger
- M. Louise Fitzpatrick College of Nursing at Villanova University, 800 E. Lancaster Ave., Villanova, PA 19085, USA; Nova Southeastern University, 3301 College Ave, Fort Lauderdale, FL 33314, USA
| | - Taryn Lindhorst
- University of Washington School of Social Work, 4101 15th Ave NE, Seattle, WA 98105, USA
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8
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Winter VR, Trout K, Harrop E, O'Neill E, Puhl R, Bartlett-Esquilant G. Women's refusal to be weighed during healthcare visits: Links to body image. Body Image 2023; 46:41-47. [PMID: 37209579 DOI: 10.1016/j.bodyim.2023.04.006] [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: 09/08/2022] [Revised: 04/19/2023] [Accepted: 04/23/2023] [Indexed: 05/22/2023]
Abstract
The purpose of this mixed methods study was to assess the relationship between body image and refusal to be weighed by a healthcare provider among women in the United States, including examination of their reasons for refusal. Between January 15 to February 1, 2021, an online mixed-methods cross-sectional survey assessing body image and healthcare behaviors was administered to adult cis-gender women. Of the 384 respondents, 32.3 % reported refusing to be weighed by a healthcare provider. After controlling for SES, race, age, and BMI in multivariate logistical regression, the odds of refusing to be weighed were 40 % lower for every unit increase in body image score (positive body appreciation). The most common reasons for refusing to be weighed were having a negative impact on emotions, self-esteem, or mental health (52.4 %). Higher body appreciation decreased the odds of refusing to be weighed among women. Reasons for refusing to be weighed ranged from shame and embarrassment to lack of provider trust, personal autonomy, and concerns about discrimination. Identifying interventions and alternatives such as telehealth to provide healthcare services that are weight-inclusive may mediate these negative experiences.
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Affiliation(s)
- Virginia Ramseyer Winter
- University of Missouri School of Social Work, Center for Body Image Research & Policy, 705 Clark Hall, Columbia, MO 65211, United States.
| | - Kate Trout
- University of Missouri School of Health Professions, Department of Health Sciences, 329 Clark Hall, Columbia, MO 65211, United States
| | - Erin Harrop
- University of Denver, Graduate School of Social Work, Craig Hall, 2148 South High Street, Denver, CO 80208, United States
| | - Elizabeth O'Neill
- Washburn University Department of Social Work, Benton Hall Room 412B, 1700 SW College Avenue, Topeka, KS 66621, United States
| | - Rebecca Puhl
- University of Connecticut Department of Human Development & Family Sciences and Rudd Center for Food Policy & Health, 348 Mansfield Road, Unit 1058 Storrs, CT 06269-1058, United States
| | - Gillian Bartlett-Esquilant
- University of Missouri School of Medicine, Department of Community and Family Medicine, 7 Hospital Drive Suite MA306N Medical Sciences Building, Columbia, MO 65211, United States
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9
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Lewis CL, Yan A, Williams MY, Apen LV, Crawford CL, Morse L, Valdez AM, Alexander GR, Grant E, Valderama-Wallace C, Beatty D. Health equity: A concept analysis. Nurs Outlook 2023; 71:102032. [PMID: 37683597 DOI: 10.1016/j.outlook.2023.102032] [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: 02/09/2023] [Revised: 07/28/2023] [Accepted: 08/09/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND Although health equity is critically important for healthcare delivery, there are inconsistencies in its definitions or lack of definitions. PURPOSE Develop a comprehensive understanding of health equity to guide nursing practice and healthcare policy. METHOD Walker and Avant's concept analysis method was used to establish defining attributes, antecedents, consequences, and empirical referents of health equity. FINDINGS Health equity defining attributes are grounded in ethical principles, the absence of unfair and avoidable differences, and fair and just opportunities to attain a person's full health potential. Health equity antecedents are categorized into environmental; financial or economic; law, politics, and policy; societal and structural; research; and digital and technology. DISCUSSION Health equity's antecedents are useful to distinguish health disparities from health outcomes resulting from individual preferences. To achieve health equity, organizations need to focus on addressing the antecedents.
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Affiliation(s)
- Chrystal L Lewis
- Department of Research and Health Equity, Stanford Health Care, Menlo Park, CA.
| | - Alice Yan
- Department of Research and Health Equity, Stanford Health Care, Menlo Park, CA
| | - Michelle Y Williams
- Department of Research and Health Equity, Stanford Health Care, Menlo Park, CA; Division of Primary Care and Population Health and Nursing Research Section, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA
| | - Lynette V Apen
- Department of Research and Health Equity, Stanford Health Care, Menlo Park, CA
| | - Cecelia L Crawford
- Department of Research and Health Equity, Stanford Health Care, Menlo Park, CA
| | - Lisa Morse
- Department of Research and Health Equity, Stanford Health Care, Menlo Park, CA
| | - Anna M Valdez
- Department of Nursing, Sonoma State University, Rohnert Park, CA
| | - G Rumay Alexander
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | - Dale Beatty
- Executive Administration, Stanford Health Care, Palo Alto, CA
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10
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Roy R, Kaufononga A, Yovich F, Diversi T. The prevalence and practice impact of weight bias among New Zealand registered dietitians. Nutr Diet 2023. [PMID: 36646939 DOI: 10.1111/1747-0080.12791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 11/27/2022] [Accepted: 12/05/2022] [Indexed: 01/18/2023]
Abstract
AIM This study explored demographics and three characteristics of registered dietitians-optimism, perfectionism, and weight bias and whether they affect three components of dietetics practice-dietetics assessment, dietetics recommendations, and dietitian's perception of the client's success. METHODS A self-administered questionnaire was completed by 92 registered dietitians and student dietitians in New Zealand to assess explicit weight bias. [Correction added on 27 January 2023, after first online publication: in the preceding sentence, '109 registered dietitians' has been updated to '92 registered dietitians'.] Participants were randomised to receive a case study for a condition unrelated to weight accompanied by a photo of a woman with either a smaller or a larger body. Participants then assessed the client based on data provided, provided recommendations, and rated their perception of the client. RESULTS Mean (±SD) scores indicated mild fatphobia (2.63±0.39) in participating dietitians. Dietitians presented with the photo of a larger client assessed the client to have lower health and were more likely to provide unsolicited weight management recommendations. Additionally, dietitians rated the larger client as less receptive and motivated, and less likely to understand the recommendations adequately, with a lower ability to comply with and maintain these recommendations. CONCLUSIONS Dietitians and student dietitians in New Zealand may practise in a manner that could be perceived as influenced by negative implicit weight bias, despite the explicit fatphobia scale scores assessing only mild fatphobia. Further research examining the extent of the problem in New Zealand, how it impacts client outcomes, and possible solutions are required.
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Affiliation(s)
- Rajshri Roy
- Nutrition and Dietetics, Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Ana Kaufononga
- Nutrition and Dietetics, Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Franica Yovich
- Dietetics Department, Northland District Health Board, Whangarei, New Zealand
| | - Tara Diversi
- Nutrition and Dietetics, Dietitians Australia, Canberra, Australia
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11
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Ponjoan A, Jacques-Aviñó C, Medina-Perucha L, Romero V, Martí-Lluch R, Alves-Cabratosa L, Ramos R, Berenguera A, Garcia-Gil MDM. Axes of social inequities in COVID-19 clinical trials: A systematic review. Front Public Health 2023; 11:1069357. [PMID: 36891333 PMCID: PMC9987589 DOI: 10.3389/fpubh.2023.1069357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 01/16/2023] [Indexed: 02/16/2023] Open
Abstract
Objective The representativeness of participants is crucial to ensure external validity of clinical trials. We focused on the randomized clinical trials which assessed COVID-19 vaccines to assess the reporting of age, sex, gender identity, race, ethnicity, obesity, sexual orientation, and socioeconomic status in the results (description of the participants' characteristics, loss of follow-up, stratification of efficacy and safety results). Methods We searched the following databases for randomized clinical trials published before 1st February 2022: PubMed, Scopus, Web of Science, and Excerpta Medica. We included peer-reviewed articles written in English or Spanish. Four researchers used the Rayyan platform to filter citations, first reading the title and abstract, and then accessing the full text. Articles were excluded if both reviewers agreed, or if a third reviewer decided to discard them. Results Sixty three articles were included, which assessed 20 different vaccines, mainly in phase 2 or 3. When describing the participants' characteristics, all the studies reported sex or gender, 73.0% race, ethnicity, 68.9% age groups, and 22.2% obesity. Only one article described the age of participants lost to follow-up. Efficacy results were stratified by age in 61.9%, sex or gender in 26.9%, race and/or, ethnicity in 9.5%, and obesity in 4.8% of the articles. Safety results were stratified by age in 41.0%, and by sex or gender in 7.9% of the analysis. Reporting of gender identity, sexual orientation or socioeconomic status of participants was rare. Parity was reached in 49.2% of the studies, and sex-specific outcomes were mentioned in 22.9% of the analysis, most of the latter were related to females' health. Conclusions Axes of social inequity other than age and sex were hardly reported in randomized clinical trials that assessed COVID-19 vaccines. This undermines their representativeness and external validity and sustains health inequities.
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Affiliation(s)
- Anna Ponjoan
- Grup en Salut Vascular de Girona (ISV-Girona), Institut Universitari d'Investigació en Atenció Primària (IDIAPJGol), Girona, Spain.,Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta (IDIBGI), Girona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Constanza Jacques-Aviñó
- Universitat Autònoma de Barcelona, Bellaterra, Spain.,Institut Universitari d'Investigació en Atenció Primària (IDIAPJGol), Barcelona, Spain
| | - Laura Medina-Perucha
- Universitat Autònoma de Barcelona, Bellaterra, Spain.,Institut Universitari d'Investigació en Atenció Primària (IDIAPJGol), Barcelona, Spain
| | - Victor Romero
- Servicio Canario de la Salud, Santa Cruz de Tenerife, Spain
| | - Ruth Martí-Lluch
- Grup en Salut Vascular de Girona (ISV-Girona), Institut Universitari d'Investigació en Atenció Primària (IDIAPJGol), Girona, Spain.,Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta (IDIBGI), Girona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Lia Alves-Cabratosa
- Grup en Salut Vascular de Girona (ISV-Girona), Institut Universitari d'Investigació en Atenció Primària (IDIAPJGol), Girona, Spain
| | - Rafel Ramos
- Grup en Salut Vascular de Girona (ISV-Girona), Institut Universitari d'Investigació en Atenció Primària (IDIAPJGol), Girona, Spain.,Department of Medical Sciences, School of Medicine, Universitat de Girona, Girona, Spain
| | - Anna Berenguera
- Institut Universitari d'Investigació en Atenció Primària (IDIAPJGol), Barcelona, Spain.,Department of Nursing, Universitat de Girona, Girona, Spain
| | - María Del Mar Garcia-Gil
- Grup en Salut Vascular de Girona (ISV-Girona), Institut Universitari d'Investigació en Atenció Primària (IDIAPJGol), Girona, Spain
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12
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Parker G, Pausé C, Gillon A, Gray L. Self-identified fat people’s understanding of the need for, and use of, long needles when being vaccinated against COVID-19: findings from a international online exploratory survey. CRITICAL PUBLIC HEALTH 2022. [DOI: 10.1080/09581596.2022.2159789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- George Parker
- Te Wāhanga Tātai Hauora Wellington Faculty of Health, Te Herenga Waka Victoria University of Wellington, Wellington, New Zealand
| | - Cat Pausé
- Graduate School of Education, Massey University, Palmerston North, New Zealand
| | - Ashlea Gillon
- School of Psychology, Te Wānanga o Waipapa, Auckland, New Zealand
- Research Fellow, School of Nursing, Waipapa Taumata Rau, University of Auckland, Auckland, New Zealand
- Fulbright Scholar, University of Hawaiʻi at Mānoa, Honolulu, Hawaiʻi
| | - Lesley Gray
- Te Whare Wānanga o Otāgo ki Te Whanga-Nui-a-TaraTel/Waea, University of Otago, Wellington, New Zealand
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13
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Osa ML, Kelly NR, Calogero RM. Disordered eating symptoms as a function of perceived weight status and race: An intersectional examination. Body Image 2022; 43:337-347. [PMID: 36265414 DOI: 10.1016/j.bodyim.2022.09.012] [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: 02/23/2022] [Revised: 09/20/2022] [Accepted: 09/25/2022] [Indexed: 11/16/2022]
Abstract
Disordered eating (DE) exhibited by individuals with intersecting marginalized identities may be less likely to be perceived as pathological compared to DE exhibited by individuals with non-marginalized identities. The present experiment tested the intersectional impact of weight status and race stimuli on responses to DE in a college sample. Undergraduate students (N = 193, Mage = 18.57, SD = 1.88, 71 % female) read a fictional account from a female target with DE who was described as "underweight," "average weight," or "overweight," and "White" or "Black." Participants completed an in-lab survey assessing detection of and responses to DE. Three 2 (race: Black, White) x 3 (weight status: underweight, average weight, overweight) ANCOVAs revealed a main effect of weight status. DE was more likely to be detected in "underweight" than "average" and "overweight" targets (p < .001). Participants encouraged weight loss for "average" and "overweight" targets compared to "underweight" targets (p < .001) and encouraged weight restoration for "underweight" targets compared to "average weight" and "overweight" targets (p < .001). No significant effects for target race or interaction between weight status and race emerged. These findings underscore the salience of weight status in shaping perceptions of DE.
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Affiliation(s)
- Maggie L Osa
- Department of Counseling and Human Services, University of Oregon, Eugene, OR, USA; Prevention Science Institute, University of Oregon, Eugene, OR, USA.
| | - Nichole R Kelly
- Department of Counseling and Human Services, University of Oregon, Eugene, OR, USA; Prevention Science Institute, University of Oregon, Eugene, OR, USA
| | - Rachel M Calogero
- Department of Psychology, Western University, London, Ontario, Canada
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14
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Magallares A, de Valle PB, Irles JA, Recio P, Jáuregui-Lobera I. Psychometric properties of the Spanish version of the Weight Self-Stigma Questionnaire (S-WSSQ) in a sample of participants with obesity seeking weight loss treatment. Eat Weight Disord 2022; 27:3685-3693. [PMID: 36434471 PMCID: PMC9803612 DOI: 10.1007/s40519-022-01511-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/10/2022] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Weight self-stigma may be defined as a self-devaluation due to one's identification with the group of people with obesity. The Weight Self-Stigma Questionnaire (WSSQ) is an instrument specifically designed to measure weight self-stigma in populations with overweight or obesity. The objective of this study was to adapt the WSSQ to the Spanish population (S-WSSQ) following the guidelines for cross-cultural adaptations. METHODS The sample comprised 165 participants with obesity seeking weight loss treatment (65% women) at the "Hospital de Valme" (Seville, Spain). Scales to measure life satisfaction, self-esteem, positive and negative affect, and antifat attitudes were used to analyze the convergent and divergent validity of the S-WSSQ. RESULTS A confirmatory factor analysis showed adequate values of the goodness of fit indexes of a two-factor model (χ2/df = 2.01 CFI = 0.92, IFI = 0.92, SRMR = 0.08, RMSEA = 0.078), replicating the structure found by the original authors. Cronbach's alphas of the two factors were 0.76 (self-devaluation) and 0.77 (fear of enacted stigma). Composite Reliability values were 0.72 (self-devaluation) and 0.76 (fear of enacted stigma). Self-devaluation and fear of enacted stigma were negatively related to self-esteem, and positive affect, and positively related to negative affect and antifat attitudes. Finally, life satisfaction was negatively correlated to fear of enacted stigma. CONCLUSIONS Based on these results, it is concluded that the S-WSSQ has good psychometric properties and might be used by the Spanish-speaking scientific community to measure weight self-stigma. LEVEL OF EVIDENCE Level V, descriptive study.
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Affiliation(s)
- Alejandro Magallares
- School of Psychology, Social Psychology Department, Spanish Open University (UNED), Madrid, Spain.
- Departamento de Psicología Social y de las Organizaciones, Facultad de Psicología UNED, C/ Juan del Rosal, 10, 28040, Madrid, Spain.
| | | | | | - Patricia Recio
- School of Psychology, Methodology Department, Spanish Open University (UNED), Madrid, Spain
| | - Ignacio Jáuregui-Lobera
- School of Experimental Sciences, Nutrition and Bromatology, Universidad Pablo de Olavide, Seville, Spain
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15
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Mensinger JL. Traumatic stress, body shame, and internalized weight stigma as mediators of change in disordered eating: a single-arm pilot study of the Body Trust® framework. Eat Disord 2022; 30:618-646. [PMID: 34634212 DOI: 10.1080/10640266.2021.1985807] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
To enhance access to evidence-based treatment it is increasingly important to evaluate scalable virtual programs that support the needs of those struggling with disordered eating. This study described a scientifically grounded, trauma-informed framework known as Body Trust,® and aimed to pilot test the preliminary effectiveness and mechanisms of change in a Body Trust® program to improve disordered eating. Using quality outcomes data, we examined 70 mostly white (87%) female-identifying (97%) individuals enrolled in a 6-module online program based in the Body Trust® framework (Mage = 45.5 ±10.9; MBMI = 33.7 ±8.0). Putative mediators included traumatic stress, internalized weight stigma, and body shame. Outcomes were objective and subjective binge episodes, overvaluation of weight and shape, and eating concerns. Generalized estimating equations were applied to determine pre-to-post changes. We applied Montoya's MEMORE macro, the joint-significance test, and calculated 95% Monte Carlo confidence intervals to assess mediation. Significant pre-to-post improvements with medium to large effect sizes were detected for all outcomes and mediators (ps<.008). All hypothesized mechanisms supported mediation. Using the Body Trust® framework shows early promise for alleviating disordered eating symptoms through targeting traumatic stress, body shame, and internalized weight stigma. Given the program's use of mindfulness techniques, future research should test target mechanisms like interoception.
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Affiliation(s)
- Janell L Mensinger
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, United States
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16
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Mikhaylova O. Mother blaming and anorexia: How ideological state apparatuses have informed my perception of my mother's role in the formation of my eating disorder. FEMINISM & PSYCHOLOGY 2022. [DOI: 10.1177/09593535221101456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Autoethnographic research has described the tendency to ascribe blame to mothers for their daughters’ disordered eating patterns, but the mechanisms by which these attitudes develop have been insufficiently investigated. The literature on mother-blaming and mothers’ roles in the development of women's eating disorders has provided macro-level theoretical explanations for this attribution of blame but lacks depictions of women who subscribe to these macro narratives and yet subsequently attribute blame to their own mothers on the micro level. In this paper, I address these two gaps by conducting a feminist autoethnographic inquiry into my own history of blaming my mother for my anorexia and other disordered eating patterns. I use classical structuralist and post-structuralist theoretical concepts, as well as Althusser's proposed neo-Marxist idea of ideological state apparatuses (ISAs). Results indicate that my mother-blaming behavior was mainly influenced by apparatuses of medicine, church, education, family, and culture. Legal, political, civic, and media apparatuses were less involved in the construction of my perception in this area. All in all, my findings provide richer insight into mother-blaming internalization on the micro level and enlarge the “palette” of feminist approaches to eating disorder analysis.
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17
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"I'm coming out!": An autoethnographic situation of sel/f/ves within queer fat chronically Ill identity. Body Image 2022; 41:209-215. [PMID: 35276514 DOI: 10.1016/j.bodyim.2022.02.005] [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: 01/24/2022] [Accepted: 02/07/2022] [Indexed: 11/21/2022]
Abstract
In this article, we (two fat, white, queer, nonbinary, chronically ill critical social work scholars) explore the parallel processes of coming out as fat and coming out as other identities (queer, femme, neurodivergent, nonbinary, chronically ill, disabled). We begin by reviewing literature from queer theories, crip theory, and fat studies, addressing concepts of "coming out" and identity. Next, taking an identity-centered autoethnographic and autoarchaeological approach, we explore how the processes in coming out as fat-growing critical consciousness, positive social identity reclamation, community belonging-mirrored other coming out processes, fostering resilience in our lives. We perform this reflection on sense(s) of self within a queer critical intersectional approach, as we individually and collectively examine how our fat identities are situated within our gender, racial, class, ability, health, and sexual orientation contexts. We interrogate how these identities of fatness and beyond, both privileged and oppressed, interplay in our personal, professional, and health-related experiences, and interactions with others. Finally, building off of the theoretical work proposed by Hunger, Major, and Blodorn (2015), we integrate concepts of critical consciousness, positive social identity, and community connectedness into the social identity threat model (as applied to weight stigma), hypothesizing how these potential positive outcomes of "coming out" may moderate the relationship between the psychological stress associated with marginalized identity and the adverse physical and mental health outcomes commonly associated with oppression and minority stress.
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18
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Brown A, Flint SW, Batterham RL. Pervasiveness, impact and implications of weight stigma. EClinicalMedicine 2022; 47:101408. [PMID: 35497065 PMCID: PMC9046114 DOI: 10.1016/j.eclinm.2022.101408] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/21/2022] [Accepted: 04/01/2022] [Indexed: 12/14/2022] Open
Abstract
UNLABELLED Evidence has accumulated to demonstrate the pervasiveness, impact and implications of weight stigma. As such, there is a need for concerted efforts to address weight stigma and discrimination that is evident within, policy, healthcare, media, workplaces, and education. The continuation of weight stigma, which is known to have a negative impact on mental and physical health, threatens the societal values of equality, diversity, and inclusion. This health policy review provides an analysis of the research evidence highlighting the widespread nature of weight stigma, its impact on health policy and the need for action at a policy level. We propose short- and medium-term recommendations to address weight stigma and in doing so, highlight the need change across society to be part of efforts to end weight stigma and discrimination. FUNDING None.
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Affiliation(s)
- Adrian Brown
- UCL Centre for Obesity Research, University College London, London, Greater London, United Kingdom
- Bariatric Centre for Weight Management and Metabolic Surgery, University College London Hospital NHS Trust, London, Greater London, United Kingdom
- National Institute of Health Research, UCLH Biomedical Research Centre, London, Greater London, United Kingdom
| | - Stuart W. Flint
- School of Psychology, University of Leeds, Leeds, West Yorkshire LS2 9JU, United Kingdom
- Scaled Insights, Nexus, University of Leeds, Leeds, West Yorkshire United Kingdom
- Corresponding author at: School of Psychology, University of Leeds, Leeds, West Yorkshire LS2 9JU, United Kingdom.
| | - Rachel L. Batterham
- UCL Centre for Obesity Research, University College London, London, Greater London, United Kingdom
- Bariatric Centre for Weight Management and Metabolic Surgery, University College London Hospital NHS Trust, London, Greater London, United Kingdom
- National Institute of Health Research, UCLH Biomedical Research Centre, London, Greater London, United Kingdom
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19
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Lunt A, Foy M, White C. Working with clients of higher weight in Australia: Findings from a national survey exploring occupational therapy practice. Aust Occup Ther J 2022; 69:403-413. [PMID: 35319102 DOI: 10.1111/1440-1630.12799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 03/02/2022] [Accepted: 03/08/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Occupational therapists are key members of the multidisciplinary team and regularly work with people of higher weight across age groups and practice settings. There is limited existing research regarding the occupational therapy role with this client group. The aim of this study was to explore occupational therapy practice and barriers to service provision for Australian occupational therapists working with clients of higher weight. METHODS A cross-sectional study design using a self-administered online survey was distributed to members of the national occupational therapy professional association. The survey was designed to identify common assessments and interventions used with clients of higher weight and explore occupational therapists' perspectives on their knowledge and confidence and the barriers to service delivery. Descriptive statistics were used to summarise rating scales, and open-ended responses were analysed using thematic analysis. RESULTS Eighty Australian occupational therapists working in a range of settings and with varied experience levels participated in the study. Participants described the most common areas of occupational therapy assessment and intervention when working with clients of higher weight to be self-care, equipment prescription, home modifications and pressure care. Respondents were least confident in interventions related to psychosocial, leisure and employment interventions. Barriers to service delivery included accessibility and cost of equipment, lack of training and weight stigma. CONCLUSION Occupational therapy practice promotes and enables participation in everyday occupations with people of higher weight. This study highlights not only the occupational therapy skills and unique approach to the person, their environment and occupations but also the challenges faced by occupational therapists when working with people of higher weight. Occupational therapists could consider utilising the weight-inclusive paradigm to broaden their contribution from self-care to other important aspects of participation and well-being.
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Affiliation(s)
- Alison Lunt
- Peninsula Health, Frankston, Victoria, Australia
| | - Mikaela Foy
- Peninsula Health, Frankston, Victoria, Australia
| | - Carolynne White
- Inclusion and Participation, Mind Australia, Heidelberg, Victoria, Australia.,Department of Health and Medical Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
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20
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Trainer S, SturtzSreetharan C, Wutich A, Brewis A, Hardin J. Fat Is All My Fault: Globalized Metathemes of Body Self-blame. Med Anthropol Q 2022; 36:5-26. [PMID: 35051296 DOI: 10.1111/maq.12687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/20/2021] [Accepted: 09/24/2021] [Indexed: 11/30/2022]
Abstract
Norms valorizing not-fat bodies appear to have spread around the world, combined with a globalizing belief that thinness is the result of individual management of self and hard work. We examine themes of blame and felt responsibility for weight and "fat" in four distinct geographic and cultural locations: peri-urban Georgia, United States; suburban Osaka, Japan; urban Encarnación, Paraguay; and urban Apia, Samoa. Use of a novel metatheme approach that compares and contrasts these four distinct places characterized by different population-level prevalences of obesity and by specific cultural histories relevant to body norms and ideals provides a flexible toolkit for comparative cross-cultural/multi-sited ethnographic research. We show that self-blame, marked by an articulated sense of individual responsibility for weight and a sense of failing in this responsibility, is present in every field site, but to varying degrees and expressed in different ways. [fat, obesity, metatheme, stigma, self-blame].
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Affiliation(s)
- Sarah Trainer
- SU ADVANCE Program & Research Coordinator, Seattle University
| | | | - Amber Wutich
- School of Human Evolution and Social Change, Arizona State University
| | - Alexandra Brewis
- School of Human Evolution and Social Change, Arizona State University
| | - Jessica Hardin
- Department of Sociology and Anthropology, Rochester Institute of Technology
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21
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Campbell KA, Ford-Gilboe M, Kennedy K, Jackson K, Mantler T, Oudshoorn A. Women’s experiences of navigating chronic pain within the context of living with an episodic disability. WOMEN'S HEALTH 2022; 18:17455057221103994. [PMID: 35726445 PMCID: PMC9218444 DOI: 10.1177/17455057221103994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: Of the 6.2 million Canadians aged 15 years or older who live with disability, 61% have disabilities that are not static or continuous. These dynamic conditions are known as episodic disabilities and many disproportionately experienced by women. Chronic pain is also a common feature associated with many episodic disabilities. The purpose of this article is to explore the experience of chronic pain for women living with episodic disabilities. Methods: This qualitative study draws on the tenets of interpretive description. Thirty women, with one or more episodic disabilities and chronic pain, participated in a semi-structured interview and answered questions about their chronic pain levels, using Von Korff et al.’s graded chronic pain scale. Results: Women experienced gendered treatment within the healthcare system and reported that they were frequently dismissed by their healthcare providers, most often physicians. Healthcare professionals’ practices around pain assessment were another common challenge for women. Women who were able to access financial support from government disability programs were more likely to access allied health professionals. Many of the holistic strategies that women researched and used to treat chronic pain were self-enacted. While diet, exercise, and other self-care activities are general health promotion strategies for all, they were seen as essential aspects of living that helped women have control over chronic pain and modifying the course of their episodic disability. Conclusion: Living with chronic pain and an episodic disability is complex. The findings of this study present the impact that gendered treatment in the healthcare system has on women who live with an episodic disability and experience chronic pain. It is evident that the current system did not meet the needs of the women in our study and system changes could result in better experiences, more disclosure of alternative therapies, and increase women’s agency in their care.
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22
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Teeth are for chewing: a critical review of the conceptualisation and ethics of a controversial intraoral weight-loss device. Br Dent J 2021; 231:675-679. [PMID: 34893725 DOI: 10.1038/s41415-021-3680-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 09/30/2021] [Indexed: 01/10/2023]
Abstract
We are a diverse collective of researchers who are committed to improving the health and wellbeing of marginalised individuals. This article is a response to, and critique of, the DentalSlim Diet Control research. This device revises a controversial 1970s weight-loss technology connected to poor health outcomes, which is indicative of a culture that consistently promotes harm to fat and other marginalised communities.We address the historical context in which unruly bodies, particularly fat, and Indigenous bodies have been the site of unethical investigation conducted under the auspices of medical research. Existence outside the normative white, male, cis physical ideal demands regulation, and disciplinary measures. We demonstrate how Brunton et al.'s research is underpinned by anti-fat attitudes and assumptions which impose this punitive physical intervention onto healthy people in a way that should not be acceptable in medical research.Further, we address a range of harms, giving attention to Māori and to individuals with eating disorders, along with issues of research integrity. We argue that no ethics committee should have approved this research, no academic journal should have published it, and no member of the dental and medical community should promote or prescribe this device.
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23
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Rose Spratt TJ. Understanding ‘fat shaming’ in a neoliberal era: Performativity, healthism and the UK’s ‘obesity epidemic’. FEMINIST THEORY 2021. [DOI: 10.1177/14647001211048300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article explores how ‘fat shaming’ as a practice that encourages open disdain for those living in larger bodies operates as a moralising tool to regulate and manage those who are viewed as ‘bad citizens’. It begins by outlining the problematic use of fat shaming language that is often used as a tool to promote ‘healthy’ lifestyle choices by those who view it as not only an acceptable way of communicating the health risks associated with obesity, but also a productive way of motivating people with overweight and obesity to lose weight. I then go on to discuss how shame as it relates to body image and excess weight is culturally produced through both objective conceptualisations of deviance and subjective judgements about the moral character of those who are living with excess weight. Adopting a feminist theoretical perspective, this article further considers the reciprocal nature of fat shaming by calling attention to how shame as a felt emotion is dependent on understandings of oneself in relation to others, as well as the relationships that one forms with others. In this way, I argue that shame in general, and fat shaming in particular, is performative to the extent that it exists as a relational construct that is iteratively produced through the language and actions that give it meaning.
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24
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Abstract
This essay argues that the discrimination that fat patients face is an issue of health justice. Insofar as this is the case, bioethicists and health care providers should not only care about it but also work to dismantle the systematic, institutional, social, and individual factors that are contributing to it to ensure that fat patients receive high-quality health care, free of stigma and discrimination. The essay discusses a variety of ways in which fat patients are discriminated against and considers the false assumptions that fuel such discrimination. It concludes by considering the structural and social issues that contribute to fatness and pushes health care providers to abandon the assumption that being fat is an individual moral failing. Ultimately, the paper argues, "fat" is not necessarily a bad word, nor one that health care providers should avoid.
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25
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Pausé C, Parker G, Gray L. Resisting the problematisation of fatness in COVID-19: In pursuit of health justice. INTERNATIONAL JOURNAL OF DISASTER RISK REDUCTION : IJDRR 2021; 54:102021. [PMID: 34840940 PMCID: PMC8606246 DOI: 10.1016/j.ijdrr.2020.102021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/14/2020] [Accepted: 12/14/2020] [Indexed: 05/07/2023]
Abstract
The purpose of this paper is to explore the problematisation of fatness in contemporary responses to the COVID-19 pandemic. This paper draws from the catalogue of reports from journalists informed largely by an array of non-peer reviewed scientific literature documenting the relationship between fatness and COVID-19. Our method of enquiry is to examine fatness and COVID-19 through a problematisation lens that enables us to interrogate the scientific, political, and economic processes implicated in the production of fat bodies as problems. Fatness has been problematised in the COVID-19 pandemic. This has diverted responsibility for preparedness and well-being away from health systems and governments and onto the back of fat people and communities. This is unjust and unethical. In juxtaposition, fat activists around the world have challenged the problematisation of fatness and its effects, finding ways for fat people to subvert fat phobic institutions in the midst of the COVID-19 pandemic by collectively organising to support one another. The ways in which fatness is being taken up in current COVID-19 pandemic responses diverts responsibility for health system preparedness and community resiliency to fat individuals. This is both unjust and also obstructs meaningful action to address the health inequities laid bare by COVID-19. This paper is believed to be the first to analyse the problematisation of fatness in COVID-19, highlighting that lessons can be learned about health justice in disasters from the work of fat activists during this COVID-19 pandemic.
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Affiliation(s)
- Cat Pausé
- Massey University, PB 11 222, Palmerston North, 4442, New Zealand
| | | | - Lesley Gray
- University of Otago, Wellington, New Zealand
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26
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Does parental socioeconomic background influence body image and attachment style among university students? Evidence from a European cross-sectional study. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01422-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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27
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Watson D, Hughes K, Robinson E, Billette J, Bombak AE. Patient Recommendations for Providers to Avoid Stigmatizing Weight in Rural-Based Women With Low Income. J Patient Cent Res Rev 2021; 8:20-30. [PMID: 33511250 DOI: 10.17294/2330-0698.1752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose Weight stigma has become widespread within health care and disproportionately affects women, who are under greater appearance-based scrutiny than men. It is also well established that rural-based individuals with low incomes suffer greater health disparities compared with urban, higher-income counterparts, yet studies examining recommendations for nonstigmatizing health care among higher-weight women from low-income rural settings are lacking. This study examined the experiences and recommendations of higher-weight, low-income, rural women, with the aim of improving health care for similar populations. Methods In-depth, semi-structured interviews were conducted in a rural region of the Midwestern United States to explore participants' recommendations for redressing stigma within health care. All participants (n=25) self-identified as higher-weight, low-income, rural women. Results All participants experienced or were aware of weight stigma within health care. Themes identified from responses were understanding patients and their situations, offering options and supplemental information, communicating effectively, taking time, and having a positive attitude. Patient recommendations focused on correcting physician biases, rapport-building, and providing holistic care. Conclusions The findings suggest that weight stigma is prevalent within health care provided to low-income women in rural U.S. Midwest and that there are specific communication and training approaches that may reduce the prevalence of weight stigma in health care.
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Affiliation(s)
- Declan Watson
- Department of Psychology, University of New Brunswick, Fredericton, Canada
| | - Katherine Hughes
- School of Health Sciences, Central Michigan University, Mount Pleasant, MI
| | - Emma Robinson
- Department of Sociology, University of New Brunswick, Fredericton, Canada
| | | | - Andrea E Bombak
- Department of Sociology, University of New Brunswick, Fredericton, Canada
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28
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Franck JE, Ringa V, Rigal L, Sassenou J, Cœuret-Pellicer M, Chauvin P, Menvielle G. Patterns of gynaecological check-up and their association with body mass index within the CONSTANCES cohort. J Med Screen 2020; 28:10-17. [PMID: 32279590 DOI: 10.1177/0969141320914323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To investigate the relationship between patterns of gynaecological check-up and body mass index while accounting for various determinants of health care use. METHODS Sequence analysis and clustering were used to highlight patterns of gynaecological check-up, which included the regularity of breast and cervical cancer screening and visits to the gynaecologist over four years, among 6182 women aged 54-65 included in the CONSTANCES cohort between 2013 and 2015 in France. Multinomial logistic regressions were used to study the association between these patterns and women's body mass index. RESULTS We identified four patterns of gynaecological check-up, from (A) no or inappropriate check-up (20%) to (D) almost one visit to the gynaecologist every year, overscreening for cervical cancer and frequent use of opportunistic breast cancer screening (12%). From patterns A to D, the proportion of obese women decreased and that of women with normal body mass index increased. Obese and overweight women underwent more breast than cervical cancer screening and were less often overscreened than normal weight women. These differences were only partly explained by the lower socioeconomic situation of overweight and obese women. Beyond the financial barrier, the screening modality and the type of exam may play a role. Among women who were screened for cervical cancer, obese and overweight women were less often screened by a gynaecologist. CONCLUSION Further efforts should be made to enhance the take-up of screening among obese women who are deterred by the healthcare system.
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Affiliation(s)
- Jeanna-Eve Franck
- Sorbonne Université, Inserm, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Paris, France
| | - Virginie Ringa
- CESP Centre for Research in Epidemiology and Population Health, Gender, Sexuality and Health team, University of Paris-Saclay, University of Paris-Sud, UVSQ, Villejuif, France. Ined, Paris, France
| | - Laurent Rigal
- CESP Centre for Research in Epidemiology and Population Health, Gender, Sexuality and Health team, University of Paris-Saclay, University of Paris-Sud, UVSQ, Villejuif, France. Ined, Paris, France
| | - Jeanne Sassenou
- CESP Centre for Research in Epidemiology and Population Health, Gender, Sexuality and Health team, University of Paris-Saclay, University of Paris-Sud, UVSQ, Villejuif, France. Ined, Paris, France
| | - Mireille Cœuret-Pellicer
- Inserm-Versailles Saint Quentin en Yvelines University, "Epidemiological Population-Based Cohorts Unit", Villejuif, France
| | - Pierre Chauvin
- Sorbonne Université, Inserm, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Paris, France
| | - Gwenn Menvielle
- Sorbonne Université, Inserm, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Paris, France
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Hollander MAG, Greene MG. A conceptual framework for understanding iatrophobia. PATIENT EDUCATION AND COUNSELING 2019; 102:2091-2096. [PMID: 31230872 DOI: 10.1016/j.pec.2019.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 05/07/2019] [Accepted: 06/09/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Iatrophobia - fear of doctors, medical care, or the medical care system - is common among patients and can negatively impact their health-seeking behaviors and relationships with health care professionals. Despite this, academic literature on iatrophobia often fails to explore its nuanced causes. METHODS We establish a conceptual framework of iatrophobia, categorizing sources of fear that may create barriers to accessing medical care, and recommend a research agenda to address this phenomenon and understand its role in medical care. RESULTS The framework includes three categories of determinants of iatrophobia: patient fear of illness and the medical exam, patient fear of physician reaction, and patient fear related to barriers to care. These categories represent influences from individual to more system-related factors associated with the physician-patient relationship. Research examining iatrophobia should focus on understanding its prevalence, how patients cope with their fear, discussing iatrophobia in the physician-patient encounter, the sociopolitical contribution to iatrophobia, and how iatrophobia can be reduced. CONCLUSIONS Iatrophobia can be categorized into three primary domains, but it remains poorly understood. PRACTICE IMPLICATIONS A more thorough understanding of iatrophobia will help to contextualize its role amid other barriers to care and patient health outcomes.
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Affiliation(s)
- Mara A G Hollander
- Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, PA, United States.
| | - Michele G Greene
- Department of Health and Nutrition Sciences, Brooklyn College, Brooklyn, NY, United States
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Urdapilleta I, Lahlou S, Demarchi S, Catheline JM. Women With Obesity Are Not as Curvy as They Think: Consequences on Their Everyday Life Behavior. Front Psychol 2019; 10:1854. [PMID: 31474907 PMCID: PMC6707138 DOI: 10.3389/fpsyg.2019.01854] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 07/29/2019] [Indexed: 12/26/2022] Open
Abstract
Two studies explore the impact of body size on daily life activities of women with obesity. In the first study, ethnographic techniques (first-person perspective video recordings) and subsequent interviews based on the video recordings were used. Results showed atypical behavior of women with obesity and ex-obese women related to memories of embarrassing experiences regarding personal body size (sitting, passing doors sideways, over-careful navigation in public space, and choosing clothes sizes too large.) Women with obesity seem to behave as if they thought they had a larger body than it actually was. These atypical behaviors are related to memories of embarrassing experiences regarding personal body size and stigma. Overweight women exhibit the same behavior but to a lesser and less systematic degree. In the second study, the represented (imagined) body size was compared to the perceived (in a mirror) body size with digital morphing techniques. In the mirror condition, the perceived image is accurate, while in the absence of a mirror women with obesity overestimate their body size by about 30%. Moreover, overestimation of imagined body size increased according to the weight status. Finally, women who had bariatric surgery had poorer estimates than women who had not. This would result of being continuously reminded of obesity and its stigma by daily embarrassing experiences, by being confronted with an environment designed for normal weight (e.g., narrow seats, turnstiles etc.) that makes obesity salient. We suggest that body size overestimation is a case of accentuation where things that matter are perceived bigger. These results could also been explained by the allocentric lock theory.
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Affiliation(s)
| | - Saadi Lahlou
- Department of Psychological and Behavioural Science, London School of Economics and Political Science, London, United Kingdom
- Paris Institute for Advanced Study, Paris, France
| | - Samuel Demarchi
- Department of Psychology, Paris 8 University, Saint-Denis, France
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Armuand G, Sydsjö G, Skoog Svanberg A, Lampic C. Attitudes towards embryo donation among healthcare professionals working in child healthcare: a survey study. BMC Pediatr 2019; 19:209. [PMID: 31238888 PMCID: PMC6591860 DOI: 10.1186/s12887-019-1578-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 06/06/2019] [Indexed: 01/15/2023] Open
Abstract
Background The aim of this study was to investigate attitudes towards embryo donation and embryo donation families among professionals working in primary child healthcare, and their experiences of these families. Methods A cross-sectional online survey was conducted in Sweden between April and November 2016. A total of 712 primary healthcare physicians, registered nurses and psychologists were approached to participate in this study. The study-specific questionnaire measured attitudes and experiences in the following four domains: legalisation and financing, the family and the child’s health, clinical experience of meeting families following embryo donation, and knowledge of embryo donation. Results Of the 189 women and 18 men who completed the questionnaire (response rate 29%), relatively few (13%) had clinical experience of caring for families following embryo donation. Overall, 69% supported legalisation of embryo donation for infertile couples, and 54% agreed it should be publicly funded. The majority (88%) agreed the child should have the right to know the donors’ identity. Respondents did not believe that children conceived through embryo donation are as healthy as other children (50%), citing the risks of poor mental health (17%) and social stigmatization (18%). Approximately half reported low confidence in their own knowledge of embryo donation (47%) and wanted to know more (58%). Conclusions These results indicate relatively large support among healthcare professionals in Sweden for the legalisation of embryo donation. In order to provide adequate healthcare to families following embryo donation, there is a need to develop educational resources to increase knowledge about the medical and psychosocial consequences of embryo donation among healthcare professionals working in primary healthcare.
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Affiliation(s)
- Gabriela Armuand
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, SE-581 83, Linköping, Sweden.
| | - Gunilla Sydsjö
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, SE-581 83, Linköping, Sweden.,Department of Gynaecology and Obstetrics in Linköping, County Council of Östergötland, Linköping, Sweden
| | - Agneta Skoog Svanberg
- Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, SE-751 85, Uppsala, Sweden
| | - Claudia Lampic
- Department of Women's and Children's Health, Karolinska Institutet, Tomtebodavägen 18A, SE-171 77, Stockholm, Sweden
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Affiliation(s)
- Cat Pausé
- College of Humanities and Social Sciences, Massey University, Palmerston North, New Zealand
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Pausé CJ, Glover M. Exploring the threats to sociable scholarship: An autoethnographic viewing of participatory news making. JOURNAL OF SOCIAL AND POLITICAL PSYCHOLOGY 2018. [DOI: 10.5964/jspp.v6i2.904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Sociable scholarship is the activity of engaging in, and disseminating academic thinking through social media as part of a commitment to be held accountable by the communities a scholar serves. Doing so has both benefits, such as increasing the people impacted by an article, and drawbacks, like ad hominem attacks. In this piece, we use collaborative autoethnography to explore common threats to sociable scholarship. We are activist scholars who are recognised internationally as experts in our field and as committed activists for social change. Marewa is a community psychologist and long-time advocate for reducing the harm caused by smoking tobacco; Cat is a Fat Studies scholar and fat activist who works to ensure fat people have the same rights as non-fat people. We reflect on our own experiences with a specific venue, Facebook Live, to share tips and tools for managing negative encounters, and suggest that universities have a responsibility to protect staff who engage as public intellectuals in digital spaces.
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Veillette LAS, Serrano JM, Brochu PM. What's Weight Got to Do With It? Mental Health Trainees' Perceptions of a Client With Anorexia Nervosa Symptoms. Front Psychol 2018; 9:2574. [PMID: 30618990 PMCID: PMC6304369 DOI: 10.3389/fpsyg.2018.02574] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 11/30/2018] [Indexed: 12/28/2022] Open
Abstract
This study examined the effect of client body mass index (BMI) on diagnostic impressions and perceptions of mental health trainees. Participants read a vignette of a mock female client presenting for treatment with symptoms of anorexia nervosa. Participants were randomly assigned to one of three conditions in which the client was described as “underweight,” “normal weight,” or “overweight.” Results revealed that participants assigned to the “underweight” condition diagnosed the client with anorexia nervosa or atypical anorexia nervosa more frequently than participants assigned to the “overweight” or “normal weight” conditions. There was no difference based on client BMI when the more general diagnosis of other specified feeding or eating disorder (OSFED; previously known as eating disorder not otherwise specified [EDNOS]) was included, however. Participants in the “overweight” and “normal weight” conditions recommended fewer therapy sessions for the client than participants in the “underweight” condition. Furthermore, participants more strongly endorsed weight-based stereotypes to describe the client when she was “overweight” than “normal weight” or “underweight.” Contrary to hypotheses, however, participants reported moderately positive attitudes toward treating the client regardless of BMI. These preliminary findings support initiatives aimed at providing training on weight stigma and eating disorders to mental health professionals.
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Affiliation(s)
- Laurie A S Veillette
- College of Psychology, Nova Southeastern University, Fort Lauderdale, FL, United States
| | - Jose Martinez Serrano
- College of Psychology, Nova Southeastern University, Fort Lauderdale, FL, United States
| | - Paula M Brochu
- College of Psychology, Nova Southeastern University, Fort Lauderdale, FL, United States
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Mechanisms underlying weight status and healthcare avoidance in women: A study of weight stigma, body-related shame and guilt, and healthcare stress. Body Image 2018; 25:139-147. [PMID: 29574257 DOI: 10.1016/j.bodyim.2018.03.001] [Citation(s) in RCA: 112] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 02/28/2018] [Accepted: 03/01/2018] [Indexed: 11/22/2022]
Abstract
Studies show that women with high BMI are less likely than thinner women to seek healthcare. We aimed to determine the mechanisms linking women's weight status to their healthcare avoidance. Women (N = 313) were surveyed from a U.S. health-panel database. We tested a theory-driven model containing multiple stigma and body-related constructs linking BMI to healthcare avoidance. The model had a good fit to the data. Higher BMI was related to greater experienced and internalized weight stigma, which were linked to greater body-related shame. Internalized weight stigma was also related to greater body-related guilt, which was associated with higher body-related shame. Body-related shame was associated with healthcare stress which ultimately contributed to healthcare avoidance. We discuss recommendations for a Weight Inclusive Approach to healthcare and the importance of enhancing education for health professionals in weight bias in order to increase appropriate use of preventive healthcare in higher weight women.
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Armuand G, Lampic C, Skoog-Svanberg A, Wånggren K, Sydsjö G. Survey shows that Swedish healthcare professionals have a positive attitude towards surrogacy but the health of the child is a concern. Acta Paediatr 2018; 107:101-109. [PMID: 28840628 DOI: 10.1111/apa.14041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 06/26/2017] [Accepted: 08/08/2017] [Indexed: 12/22/2022]
Abstract
AIM In February 2016, Sweden upheld its ban on surrogacy following a Government enquiry. This survey investigated attitudes towards surrogacy among primary health professionals working with children and their experiences of working with families following surrogacy abroad. METHODS From April to November 2016, nurses, physicians and psychologist working in primary child health care in four counties in Sweden were invited to participate in a cross-sectional online survey about surrogacy. RESULTS The mean age of the 208 participants was 49.2 years (range 27-68) and nearly 91% were women. Approximately 60% supported legalised surrogacy. Wanting a conscience clause to be introduced in Sweden was associated with not supporting surrogacy for any groups, while personal experiences of infertility and clinical experiences with families following surrogacy were associated with positive attitudes towards surrogacy for heterosexual couples. The majority (64%) disagreed that surrogate children were as healthy as other children, and many believed that they risked worse mental health (21%) and social stigmatisation (21%). CONCLUSION We found that 60% supported legalised surrogacy, but many expressed concerns about the children's health and greater knowledge about the medical and psychosocial consequences of surrogacy is needed.
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Affiliation(s)
- G Armuand
- Department of Clinical and Experimental Medicine; Faculty of Health Sciences; Linköping University; Linköping Sweden
| | - C Lampic
- Department of Neurobiology, Care Sciences and Society; Karolinska Institutet; Huddinge Sweden
| | - A Skoog-Svanberg
- Department of Women's and Children's Health; Uppsala University Uppsala; Uppsala Sweden
| | - K Wånggren
- Department of Clinical Science Intervention and Technology; Karolinska Institutet; Stockholm Sweden
| | - G Sydsjö
- Department of Clinical and Experimental Medicine; Faculty of Health Sciences; Linköping University; Linköping Sweden
- Department of Gynecology and Obstetrics in Linköping; County Council of Östergötland; Linköping Sweden
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Northrop JM. A dirty little secret: stigma, shame and hepatitis C in the health setting. MEDICAL HUMANITIES 2017; 43:218-224. [PMID: 28363990 DOI: 10.1136/medhum-2016-011099] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/02/2017] [Indexed: 05/23/2023]
Abstract
While recent medical innovation shows great promise in treating hepatitis C (HCV), it remains a condition associated with profound stigma. HCV is a bloodborne virus (BBV) most commonly transmitted in high-income countries by injecting drug use, and it is the stigmatising association between the two which is deeply problematic for those with HCV. A qualitative study undertaken in 2002 found that disclosure in health settings places those with HCV in positions of pronounced vulnerability. Disclosure is a primal scene, an interface, where the stigma of HCV, replete with connotations of disease and deviance, potentially transforms those affected into shamed subjects. Standard precautions protect health workers and minimise the transmission of contagion, measures which, in theory, also mitigate the requirement of those with BBVs to unnecessarily disclose their blood status. However, questions on pre-employment health checks, concerns that health treatments might adversely affect the liver and an ethical need to pre-emptively inform healthcare professionals undertaking exposure prone procedures are occasions when those with HCV confront the decision to disclose their blood status. This paper employs Goffman's model of actual and virtual social identities, along with Douglas' notion of dirt and pollution, to examine the dilemmas around disclosure those with HCV negotiate within the health setting. Discriminatory responses by healthcare professionals elucidate the stigmatising potential HCV carries. The subsequent reticence by those with HCV to disclose their blood status risks less than optimum healthcare. Recent studies indicate that stigma occurring in health settings remains a perennial concern for those with HCV.
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Brevers D, Rogiers A, Defontaine A, Cheron G, Clarinval AM, Foucart J, Bouchez A, Bolly V, Tsartsafloudakis L, Jottrand P, Minner P, Bechara A, Kornreich C, Verbanck P. Implementation Intention for Initiating Intuitive Eating and Active Embodiment in Obese Patients Using a Smartphone Application. Front Psychiatry 2017; 8:243. [PMID: 29209236 PMCID: PMC5702316 DOI: 10.3389/fpsyt.2017.00243] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 11/06/2017] [Indexed: 11/13/2022] Open
Abstract
This article describes a study protocol, which aims to explore and describe the feasibility of a mobile-phone application for initiating intuitive eating and intuitive exercising in patients who are following an ambulatory treatment for obesity. Intuitive eating refers to one's ability to make food choices based on one's awareness of his/her body's response. Intuitive exercising encourages people in finding enjoyable ways of being physically active. These two components will be trained using an implementation intention procedure, that is, behavioral plans that aim at creating a strong link between a specified situation and a response. We aim to recruit up to 80 overweight and obese patients over a period of 2 years. The smartphone application will be assessed on the basis of (i) data obtained through a 4-week use period, (ii) self-report measures taken before and after the use of the mobile application, and (iii) feedbacks from participants after the use of the mobile application. This pilot study will allow us to better understand the applicability of the use of mobile application within ambulatory treatment settings, and to adapt the design of the app necessary for building cross-sectional studies investigating its efficacy.
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Affiliation(s)
- Damien Brevers
- Laboratory of Psychological Medicine and Addictology, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium.,Research in Psychology Applied to Motor Learning, Faculty of Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium
| | - Anne Rogiers
- Laboratory of Psychological Medicine and Addictology, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Alexis Defontaine
- Research in Psychology Applied to Motor Learning, Faculty of Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium
| | - Guy Cheron
- Laboratory of Neurophysiology and Movement Biomechanics, Faculty of Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium
| | - Anne-Marie Clarinval
- Laboratory of Neurophysiology and Movement Biomechanics, Faculty of Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium
| | - Jennifer Foucart
- Research in Psychology Applied to Motor Learning, Faculty of Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium
| | - Anne Bouchez
- Laboratory of Psychological Medicine and Addictology, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Véronique Bolly
- Laboratory of Psychological Medicine and Addictology, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Laura Tsartsafloudakis
- Laboratory of Psychological Medicine and Addictology, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Pénélope Jottrand
- Laboratory of Psychological Medicine and Addictology, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Pierre Minner
- Laboratory of Psychological Medicine and Addictology, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Antoine Bechara
- Department of Psychology, Brain and Creativity Institute, University of Southern California, Los Angeles, CA, United States
| | - Charles Kornreich
- Laboratory of Psychological Medicine and Addictology, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Paul Verbanck
- Laboratory of Psychological Medicine and Addictology, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium.,Research in Psychology Applied to Motor Learning, Faculty of Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium
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