The Weight Stigma Heat Map: A tool to identify weight stigma in public health and health promotion materials

ISSUES ADDRESSED

Public health campaigns and health promotion endeavours have been criticised for perpetuating weight stigma by reinforcing misinformation and using deficits-based narratives about larger-bodied people. The aim of this project was to develop a 'heat map' tool to appraise existing health policy and resources for elements that promote weight stigma.

METHODS

Ten themes were identified from literature using inductive analytic review methodology including pictorial/photographic representation, weight-health beliefs, body weight modifiability and financial concerns. Each theme was divided into four appraisal categories: the demonstration of weight stigma (via negative stereotyping, prejudice or discrimination that limits access to opportunities or services), weight bias (via presenting smaller bodies as normal/natural/healthy/good/desirable), bias-neutral (via representation of people of all shapes and sizes and accurate and nuanced health information about larger-bodied and smaller-bodied people) and finally an anti-stigma approach (via use of strengths-based narratives and overtly positive representation of and leadership by larger-bodied people).

RESULTS

A colour coding schema (the 'heat map') to visualise stigmatising elements across materials and a scoring system was devised for future quantitative evaluation. To demonstrate the use of the Weight Stigma Heat Map (WSHM), the Australian National Obesity Strategy 2022-2032 was appraised.

CONCLUSIONS

It is likely that weight stigmatisation is an important but under-recognised factor influencing the effectiveness of campaigns and interventions promoting behaviour change. SO WHAT?: Public health and health promotion professionals should consider using the WSHM as a framework for the development of less stigmatising policies, campaigns and resources and to direct reviews of existing materials.

Patient aggression towards receptionists in general practice: a systematic review

OBJECTIVE

General practice receptionists provide an essential function in the healthcare system but routinely encounter acts of incivility and aggression from patients, including hostility, abuse and violence. This study was conducted to summarise what is known about patient-initiated aggression towards general practice receptionists, including impacts on reception staff and existing mitigation strategies.

DESIGN

Systematic review with convergent integrated synthesis.

ELIGIBILITY CRITERIA

Studies published at any time in English that examine patient aggression experiences of reception staff in primary care settings.

INFORMATION SOURCES

Searches of five major databases were performed (CINAHL Complete, Scopus, PubMed, Healthcare Administration Database and Google Scholar) to August 2022.

RESULTS

Twenty studies of various designs were included, ranging from the late 1970s to 2022 and originating from five OECD countries. Twelve were assessed as high quality using a validated checklist. Reviewed articles represented 4107 participants; 21.5% were general practice receptionists. All studies reported that displays of aggression towards receptionists by patients were a frequent and routine occurrence in general practice, particularly verbal abuse such as shouting, cursing, accusations of malicious behaviour and use of racist, ablest and sexist insults. Although infrequent, physical violence was widely reported. Inefficient appointment scheduling systems, delayed access to doctors and prescription denial appeared common precipitators. Receptionists adapted their behaviour and demeanour to placate and please patients to avoid escalation of patient frustrations at the cost of their own well-being and clinic productivity. Training in patient aggression management increased receptionist confidence and appeared to decrease negative sequalae. Coordinated support for general practice reception staff who had experienced patient aggression was generally lacking, with a small proportion receiving professional counselling.

CONCLUSIONS

Patient aggression towards reception staff is a serious workplace safety concern for general practices and negatively affects healthcare sector function more broadly. Receptionists in general practice deserve evidence-based measures to improve their working conditions and well-being for their own benefit and that of the community.

REGISTRATION

Pre-registered in Open Science Framework (osf.io/42p85).

Australian dietitians' beliefs and attitudes towards weight loss counselling and health at every size counselling for larger-bodied clients

AIM

Research suggests that dietitians now employ weight-neutral (WN) approaches (Health at Every Size (HAES), Intuitive Eating and non-diet) as well as more traditional weight-centric (WC) approaches (weight loss counselling) to address adult weight concerns. This study aimed to compare the knowledge of and attitudes towards WN practice compared with WC practice in Australian dietitians who work with larger-bodied clients as delineated by practice approach.

METHODS

A cross-sectional web-based knowledge, attitudes and practices survey was conducted with Australian dietitians who counsel adults with a body mass index >25 kg/m² . Based on their responses, dietitians were categorised into WC (preferring weight loss counselling), WN (preferring HAES counselling) or mixed approach (MA). Between-group comparisons were conducted using Pearson's chi^- squared tests for knowledge and practice and independent t-tests for attitudes.

RESULTS

Of the 317 respondents, 18.3% fulfilled the criteria for WN practitioners, 30.3% for WC practitioners and the remainder were classified as providing a MA. Weight-neutral approaches were more positively regarded generally than WC approaches (84.5% vs 53.9%) as well as considered professionally responsible (86% vs 58.7%) and perceived as more helpful for clients (61.2% vs 35%). Knowledge of WN practice goals was poor with only 36.9% (n = 117) of the participants indicating correctly that this mode of treatment is incompatible with a weight loss goal.

CONCLUSIONS

Weight-neutral practice was considered acceptable by Australian dietetics professionals who counsel larger-bodied people regardless of their personal practice preference although many displayed inaccurate knowledge of WN approaches.

Physical Activity Participation and Nutrition and Physical Activity Knowledge in University Dance Students

OBJECTIVE

To assess participation in physical activity and knowledge of general nutrition and current public health messages about the health benefits of physical activity in university dance students, and to investigate differences between first-year and later-year students and between students in dance and dance performance course groups.

METHODS

This cross-sectional study recruited 67 participants from dance undergraduate degrees in a university in Australia. Nutrition knowledge was assessed using the General Nutrition Knowledge Questionnaire. Physical activity participation and awareness of its benefits were assessed using the Active Australia Survey.

RESULTS

Results indicate low nutrition knowledge among dance students, with 47% and 52% of responses correct in dance and dance performance students, respectively. Nutrition knowledge did not vary between students in first or later years. Self-reported participation in moderate and vigorous physical activity varied substantially and met or exceeded recommendations based upon duration and frequency for 98% of participants. However, awareness of physical activity messages varied, with dance students more likely to disagree about the level of activity needed for health benefits.

CONCLUSIONS

Dance students report varying levels of physical activity that usually met or exceeded recommendations; however, knowledge of general nutrition and physical activity benefits was low. Improved knowledge could contribute to changes in behavior that improve health status in this population.

Antiasthmatic effects of onions: inhibition of 5-lipoxygenase and cyclooxygenase in vitro by thiosulfinates and "Cepaenes"

Nine thiosulfinates (TS) and four "Cepaenes" (CS) isolated from onions and/or synthetized by us showed dose dependent (0.25 to 100 microM) marked inhibitory effects on both cyclooxygenase (CA, tested on sheep seminal vesicle microsomes) and 5-lipoxygenase activity (LO, tested on porcine leukocytes). The following rank order of activity was observed: saturated aliphatic TS less than aromatic TS approximately alpha, beta-unsaturated TS less than CS. CS inhibited both CA and LO by more than 75% at 10 and 1 microM concentrations respectively. Most likely, these in vitro effects are responsible for antiinflammatory and antiasthmatic properties of onion extracts observed in vivo, at least in part.