At multiple fronts: Diabetes stigma and weight stigma in adults with type 2 diabetes

AIM

The diabetes and obesity fields have called for attention to the harmful role of stigma in obesity and diabetes, especially given that little is known about the extent and nature of diabetes stigma facing adults with type 2 diabetes, or the experience of weight stigma in this population. This study addresses this research gap by examining the prevalence and demographic correlates of weight stigma and diabetes stigma in individuals with type 2 diabetes.

METHODS

Adults (N = 1212, M_age  = 52) with type 2 diabetes living in the USA were recruited by a healthcare-oriented market research firm, and completed online questionnaires to assess their experiences with weight stigma and diabetes stigma, as well as their internalization of both forms of stigma. Rates of stigma and sociodemographic correlates (years with type 2 diabetes, age, education, income, gender, race and BMI) were examined.

RESULTS

More than half of participants reported prior experiences of weight stigma, and 40-60% reported experiencing weight stigma in a healthcare context. Participants reported frequent experiences with diabetes-related stigma including blame and judgement, self-stigma and differential treatment. Women reported more weight stigma than men, and White women appeared particularly at risk for experiencing weight and diabetes related stigma relative to Black women.

CONCLUSIONS

Individuals with type 2 diabetes reported higher rates of weight stigma than the general population, experienced high rates of diabetes-related stigma, and many internalized these forms of stigma. Increased attention to stigma reduction is essential to ensuring equitable care for individuals with type 2 diabetes.

Weight bias internalization in a commercial weight management sample: prevalence and correlates

OBJECTIVE

Weight bias internalization (WBI) is associated with poor weight-related health. The purpose of this study was to identify the prevalence and correlates of WBI in a large sample of adults in a commercial weight management programme.

METHODS

WW (the new Weight Watchers) members participated in an online survey. Participants (N = 18,769) completed the 10-item Weight Bias Internalization Scale - Modified (WBIS-M) and the Weight Self-Stigma Questionnaire (WSSQ). Participants reported details about weight-stigmatizing experiences, including the onset, frequency and distress, and interpersonal sources of weight stigma. Participants self-reported their demographics, weight history, and height and weight (to compute body mass index [BMI]).

RESULTS

Weight bias internalization was relatively high compared with the general population (mean WBIS-M score = 4.3 ± 1.4; mean WSSQ total score = 35.2 ± 9.7). WBI was higher among participants who were female, younger and had higher BMIs (p < 0.001) and lower among those who were Black and were widowed or had a romantic partner (p < 0.001). Onset of weight stigma in childhood and young adulthood, and recent distress due to weight stigma, predicted higher WBI. Extended family and school sources of weight stigma had weaker associations with WBI than did other interpersonal sources.

CONCLUSIONS

Weight bias was internalized by a significant proportion of adults enrolled in a commercial weight management programme. A phenotype of WBI includes demographic characteristics and the timing and sources of weight stigma.

Weight-based victimization from friends and family: implications for how adolescents cope with weight stigma

BACKGROUND

Youth with overweight and obesity commonly experience weight-based victimization. The ways that these youth cope with victimization can adversely impact their health. Despite considerable evidence that family members and friends are common perpetrators of weight-based victimization, the relationships among different sources of victimization and coping responses of youth are unknown.

OBJECTIVES

The present study examined the relationships between weight-based victimization from four sources (friends, peers, family members and teachers) and stigma-specific coping responses in adolescents using linear regression.

METHODS

Adolescents (ages 13-18 years; N = 148) enrolled in a national weight loss camp completed questionnaires about demographics, weight bullying, sources of teasing and internalized weight bias.

RESULTS

Teasing sources explained a large proportion of the variance in coping strategies for weight-based victimization. Weight teasing from friends was associated with greater frequency of negative emotions. Weight teasing from peers and friends were associated with greater frequency of coping via avoidance behaviours, while teasing from family was associated with fewer avoidance behaviours. Adolescents reported wanting more support from parents and stronger school policies to address weight-bullying.

CONCLUSIONS

These results suggest associations between weight-teasing sources and coping mechanisms. Interventions should examine the role of coping strategies to protect against adverse health effects of weight-based victimization.

Adolescent preferences for weight terminology used by health care providers

BACKGROUND

In light of high rates of obesity and weight stigma in youth, the American Academy of Paediatrics recommends that paediatric health care professionals use appropriate, sensitive and non-stigmatizing language in communication about weight with youth. For these efforts to be effective, there is a need to identify weight-based language preferences among youth with overweight and obesity, as research in this area is scarce.

OBJECTIVES

The present study provides a systematic assessment of youth perspectives of weight-based language used by providers.

METHODS

Adolescents (ages 13-18 years; N = 148) enrolled in a national weight loss camp were surveyed about their preferences for words that health providers use to refer to their body weight. Adolescents completed an online survey and responded to a list of 16 words describing excess body weight, as well as questions assessing demographics, body mass index, and experienced as well as internalized weight stigma.

RESULTS

Adolescents assigned low ratings to words like 'fat', 'large', 'obese' and 'extremely obese', indicating that they would not want providers to use these words when discussing their body weight. In contrast, words like 'weight problem', 'BMI' and 'plus size' were rated among the most preferred words for providers to use. Word preferences varied across gender, body mass index and extent of internalized weight stigma.

CONCLUSIONS

These findings underscore the importance of acknowledging different word preferences among youth, and to avoid making assumptions about what words youth will feel most comfortable using in discussions about their body weight.

Missing the target: including perspectives of women with overweight and obesity to inform stigma-reduction strategies

OBJECTIVE

Pervasive weight stigma and discrimination have led to ongoing calls for efforts to reduce this bias. Despite increasing research on stigma-reduction strategies, perspectives of individuals who have experienced weight stigma have rarely been included to inform this research. The present study conducted a systematic examination of women with high body weight to assess their perspectives about a broad range of strategies to reduce weight-based stigma.

METHODS

Women with overweight or obesity (N = 461) completed an online survey in which they evaluated the importance, feasibility and potential impact of 35 stigma-reduction strategies in diverse settings. Participants (91.5% who reported experiencing weight stigma) also completed self-report measures assessing experienced and internalized weight stigma.

RESULTS

Most participants assigned high importance to all stigma-reduction strategies, with school-based and healthcare approaches accruing the highest ratings. Adding weight stigma to existing anti-harassment workplace training was rated as the most impactful and feasible strategy. The family environment was viewed as an important intervention target, regardless of participants' experienced or internalized stigma.

CONCLUSION

These findings underscore the importance of including people with stigmatized identities in stigma-reduction research; their insights provide a necessary and valuable contribution that can inform ways to reduce weight-based inequities and prioritize such efforts.