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Zancu AS, Diaconu-Gherasim LR. Weight stigma and mental health outcomes in early-adolescents. The mediating role of internalized weight bias and body esteem. Appetite 2024; 196:107276. [PMID: 38367911 DOI: 10.1016/j.appet.2024.107276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 01/28/2024] [Accepted: 02/14/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Weight stigma is increasingly common in early adolescence and may lead to weight bias internalization, with negative consequences for mental health outcomes. This study aimed to: examine the relations of perceived weight stigma and internalized weight bias with early adolescents' internalizing symptoms and disordered eating behavior; explore the mediating role of internalized weight bias on the relations of perceived weight stigma with internalizing symptoms and disordered eating behaviors; examine body esteem as a mediator between internalized weight bias and mental health outcomes. METHODS A sample of 406 early adolescents (59.6% girls) aged between 11 and 13 participated in this cross-sectional study. They completed self-report measures assessing perceived weight stigma, internalized weight bias, body esteem, internalizing symptoms and disordered eating. RESULTS Path analysis indicated that perceived weight stigma was positively related with internalizing symptoms and internalized weight bias. Further, internalized weight bias was negatively related with body esteem and positively related with internalizing symptoms and disordered eating. Internalized weight bias mediated the relations of perceived weight stigma with internalizing symptoms, disordered eating and body esteem. Further, body esteem mediated the relations of internalized weight bias with internalizing symptoms and disordered eating behavior. CONCLUSIONS The findings highlight internalized weight bias as a psychological mechanism potentially explaining negative links of weight stigma with internalizing symptoms and disordered eating in early adolescence. The results emphasize the need for early intervention during this developmental stage, in order to prevent psychological and behavioral outcomes of weight stigma and internalized weight bias.
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Affiliation(s)
- Alexandra Simona Zancu
- Faculty of Psychology and Educational Sciences, Alexandru Ioan Cuza University of Iași, Romania.
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2
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Rancaño KM, Puhl R, Skeer M, Eliasziw M, Must A. Negative familial weight talk and weight bias internalization in a US sample of children and adolescents. Pediatr Obes 2024; 19:e13108. [PMID: 38375755 PMCID: PMC11006571 DOI: 10.1111/ijpo.13108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Negative familial weight talk may contribute to higher weight bias internalization in pre- and early adolescents (hereafter referred to as children) and may differ by gender, weight status, and race and ethnicity. OBJECTIVE Examine the relationship between negative familial weight talk and weight bias internalization and examine differences by gender, weight status, and race and ethnicity. METHODS We cross-sectionally analysed 5th-7th graders (10-15 years old) living in Massachusetts (n = 375, 52.3% girls, 21.3% BMI ≥85th percentile, 54.8% non-Hispanic White). Negative familial weight talk frequency during the past 3 months was self-reported and discretized as 'never,' 'occasionally' (1-9 times) and 'often' (>9 times); the Modified Weight Bias Internalization Scale assessed weight bias internalization. Generalized linear models estimated the relationship between negative familial weight talk and weight bias internalization and sub-analyses estimated the relationship across gender, weight status, and race and ethnicity. Results are summarized as ratios of means (RoM). RESULTS Children experiencing negative familial weight talk occasionally (RoM = 1.12, p = 0.024) and often (RoM = 1.48, p < 0.001) had significantly higher weight bias internalization than children who never experienced it. In sub-analyses, experiencing negative familial weight talk often was associated with higher weight bias internalization among girls (RoM = 1.66, p < 0.001), boys (RoM = 1.32, p = 0.007), children with BMI <85th percentile (RoM = 1.44, p = 0.007) and BMI ≥85th percentile (RoM = 1.39, p = 0.001), and non-Hispanic White children (RoM = 1.78, p < 0.001), but not Hispanic (RoM = 1.25, p = 0.085) or non-Hispanic Black children (RoM = 1.20; p = 0.31). CONCLUSIONS Frequent negative familial weight talk was associated with higher weight bias internalization across gender and weight status and in non-Hispanic White children only.
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Affiliation(s)
- Katherine M. Rancaño
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston MA, Boston, MA
| | - Rebecca Puhl
- Department of Human Development & Family Sciences, University of Connecticut, Storrs, Connecticut
| | - Margie Skeer
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston MA, Boston, MA
| | - Misha Eliasziw
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston MA, Boston, MA
| | - Aviva Must
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston MA, Boston, MA
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3
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Hailu H, Skouteris H, Incollingo Rodriguez AC, Galvin E, Hill B. Drivers and facilitators of weight stigma among preconception, pregnant, and postpartum women: A systematic review. Obes Rev 2024; 25:e13710. [PMID: 38343332 DOI: 10.1111/obr.13710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 01/09/2024] [Accepted: 01/13/2024] [Indexed: 04/18/2024]
Abstract
Women in the preconception, pregnant, or postpartum period are susceptible to weight stigma, particularly due to the risk of excess weight gain during the reproductive life period and the negative effects of stigma on the health of both the mother and the child. Identifying the drivers and facilitators of weight stigma will help guide focused weight stigma prevention interventions. This systematic review aimed to identify the drivers and facilitators of weight stigma among preconception, pregnant, and postpartum women. In May 2022, Medline, Embase, PsycINFO, and the Maternity and Infant Care Database were searched for peer-reviewed articles published since 2010 using search terms weight AND stigma AND preconception, OR pregnant, OR postpartum. Of the 1724 articles identified, 34 fulfilled the inclusion criteria and were included in a narrative synthesis. Women reported facing insensitive language, misconceptions about obesity across all settings, and inappropriate media representation. The unavailability of appropriate equipment at facilities was reported by both women and health professionals. Our findings indicate that a rigorous effort by all stakeholders is necessary to promote regulatory, legal, and educational initiatives designed to reduce weight stigma and discrimination against women in the reproductive period.
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Affiliation(s)
- Haimanot Hailu
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Warwick Business School, The University of Warwick, Coventry, UK
| | - Angela C Incollingo Rodriguez
- Psychological and Cognitive Sciences, Department of Social Science and Policy Studies, Worcester Polytechnic Institute, Worcester, Massachusetts, USA
| | - Emma Galvin
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Briony Hill
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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4
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Wu HX, Chen TT, Ching BHH, Li XY, Li YH. Weight stigma from romantic partners: Its relations with maladaptive and adaptive coping and depressive symptoms. Scand J Psychol 2024; 65:157-167. [PMID: 37675937 DOI: 10.1111/sjop.12965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 08/03/2023] [Accepted: 08/20/2023] [Indexed: 09/08/2023]
Abstract
Social devaluation of being overweight is common in daily life, but little is known about the weight stigma in romantic relationships. The present study investigated the roles of maladaptive and adaptive coping strategies in the relation between the experience of weight stigma in romantic relationships and depressive symptoms in men and women, respectively. Analyses of gender differences and structural equation modeling yielded several findings. First, while men and women experienced similar levels of weight stigma from their romantic partners, women were more likely to use exercise avoidance, disengagement coping, and reappraisal coping strategies, and to exhibit more depressive symptoms than men. Second, men who experienced weight stigma tended to cope with it through exercise avoidance and disengagement coping, which were related to greater depressive symptoms. Men also coped with weight stigma adaptively via reappraisal coping, which was additionally associated with more positive affect. Third, the relation between the experience of weight stigma and depressive symptoms in women was only explained by using disengagement coping. These findings extend the understanding of weight stigma to a specific context and provide some insight that future interventions to reduce the impacts of weight stigma should be tailored accordingly for men and women.
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Affiliation(s)
- Hannah X Wu
- Faculty of Education, University of Macau, Avenida da Universidade, Taipa, Macau, China
| | - Tiffany T Chen
- Faculty of Education, University of Macau, Avenida da Universidade, Taipa, Macau, China
| | - Boby H-H Ching
- Faculty of Education, University of Macau, Avenida da Universidade, Taipa, Macau, China
| | - Xiang Y Li
- Faculty of Education, University of Macau, Avenida da Universidade, Taipa, Macau, China
| | - Yuan H Li
- Faculty of Education, University of Macau, Avenida da Universidade, Taipa, Macau, China
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5
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Telo GH, Friedrich Fontoura L, Avila GO, Gheno V, Bertuzzo Brum MA, Teixeira JB, Erthal IN, Alessi J, Telo GH. Obesity bias: How can this underestimated problem affect medical decisions in healthcare? A systematic review. Obes Rev 2024; 25:e13696. [PMID: 38272850 DOI: 10.1111/obr.13696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/24/2023] [Accepted: 12/06/2023] [Indexed: 01/27/2024]
Abstract
INTRODUCTION Obesity is often labeled as a physical characteristic of a patient rather than a disease and it is subject to obesity bias by health providers, which harms the equality of healthcare in this population. OBJECTIVE Identifying whether obesity bias interferes in clinical decision-making in the treatment of patients with obesity. METHODS A systematic review of observational studies published between 1993 and 2023 in MEDLINE, Embase, and Cochrane Library on obesity bias and therapeutic decisions was carried out. The last search was conducted on June 30, 2023. The main outcome was the difference between clinical decisions in the treatment of individuals with and without obesity. The Newcastle-Ottawa scale for observational studies was used to assess for quality. After the selection process, articles were presented in narrative and thematic synthesis categories to better organize the descriptive analysis. RESULTS Of the 2546 records identified, 13 were included. The findings showed fewer screening exams for cancer in patients with obesity, who were also susceptible to less frequent pharmacological treatment intensification in the management of diabetes. Women with obesity received fewer pelvic exams and evidence of diminished visual contact and physician confidence in treatment adherence was reported. Some studies found no disparities in treatment for abdominal pain and tension headaches between patients presented with and without obesity. CONCLUSION The presence of obesity bias has negative effects on medical decision-making and on the quality of care provided to patients with obesity. These findings reveal the urgent necessity for reflection and development of strategies to mitigate its adverse impacts. (The protocol was registered with the international prospective register of systematic reviews, PROSPERO, under the number CRD42022307567).
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Affiliation(s)
- Guilherme Heiden Telo
- Medicine and Health Sciences Graduate Program, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
- Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Lucas Friedrich Fontoura
- Medicine and Health Sciences Graduate Program, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Georgia Oliveira Avila
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Vicenzo Gheno
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Julia Belato Teixeira
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Isadora Nunes Erthal
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Janine Alessi
- Medicine and Health Sciences Graduate Program, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
- Endocrinology Division, Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
- General Internal Medicine Division, Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Gabriela Heiden Telo
- Medicine and Health Sciences Graduate Program, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
- General Internal Medicine Division, Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
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6
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Willer F. The Weight Stigma Heat Map: A tool to identify weight stigma in public health and health promotion materials. Health Promot J Austr 2024; 35:293-302. [PMID: 37198740 DOI: 10.1002/hpja.745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 04/03/2023] [Accepted: 05/09/2023] [Indexed: 05/19/2023] Open
Abstract
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.
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Affiliation(s)
- Fiona Willer
- Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
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7
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Lin CY, Latner JD, Rozzell-Voss KN, Huang PC, Tsai YC, Pakpour AH, Weng HC. Association of quality of life with internet use and weight stigma across individuals with obesity and those without obesity: Role of self-perception. Acta Psychol (Amst) 2024; 244:104203. [PMID: 38442432 DOI: 10.1016/j.actpsy.2024.104203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 02/12/2024] [Accepted: 02/28/2024] [Indexed: 03/07/2024] Open
Abstract
Weight status, weight stigma, and internet use are important factors impacting quality of life (QoL). However, little is known regarding how these factors interact in their association with QoL, and it is important to understand how self-perceived obesity and body mass index (BMI)-defined obesity may differentially impact QoL. We aimed to assess the associations between weight status (obesity vs. non-obesity, including both self-perceived and BMI-defined), weight stigma, internet use, and QoL. Cross-sectional data from the Taiwan Social Change Survey (N = 1604; mean age = 49.22; 52.93 % women) were used. All participants were classified as having obesity or not having obesity according to both self-perceived (self-perceived as 'too fat') and BMI-defined (≧27 kg/m2 as obesity) weight status. Results showed that the group with obesity (both BMI-defined and self-perceived) had significantly more internet time and lower physical QoL than the group without obesity. Those with self-perceived obesity, but not those with BMI-defined obesity, sought health information via the internet and used social media significantly more than the group without obesity. More internet time was associated with worse physical and mental QoL for the group with obesity regardless of BMI-defined or self-perceived status. Moreover, weight stigma was associated with worse mental QoL for the group with self-perceived obesity, but not for the group with BMI-defined obesity. Accordingly, being a person with obesity (self-defined, or based upon BMI) was associated with more internet time and poorer QoL. People with self-perceived obesity may have increased experience of weight stigma and greater internet use, factors that may contribute to their impaired QoL.
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Affiliation(s)
- Chung-Ying Lin
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Faculty of Health and Life Sciences, INTI International University, Nilai, Malaysia.
| | - Janet D Latner
- Department of Psychology, University of Hawaii, Honolulu, HI, USA.
| | | | - Po-Ching Huang
- School of Physical Therapy, Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Rd., Taoyuan 333323, Taiwan.
| | - Yu-Cheng Tsai
- Department of Pediatrics, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.
| | - Amir H Pakpour
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden.
| | - Hui-Ching Weng
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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8
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Luo X, Zhao D, Gao Y, Yang Z, Wang D, Mei G. Implicit weight bias: shared neural substrates for overweight and angry facial expressions revealed by cross-adaptation. Cereb Cortex 2024; 34:bhae128. [PMID: 38566513 DOI: 10.1093/cercor/bhae128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 03/07/2024] [Accepted: 03/12/2024] [Indexed: 04/04/2024] Open
Abstract
The perception of facial expression plays a crucial role in social communication, and it is known to be influenced by various facial cues. Previous studies have reported both positive and negative biases toward overweight individuals. It is unclear whether facial cues, such as facial weight, bias facial expression perception. Combining psychophysics and event-related potential technology, the current study adopted a cross-adaptation paradigm to examine this issue. The psychophysical results of Experiments 1A and 1B revealed a bidirectional cross-adaptation effect between overweight and angry faces. Adapting to overweight faces decreased the likelihood of perceiving ambiguous emotional expressions as angry compared to adapting to normal-weight faces. Likewise, exposure to angry faces subsequently caused normal-weight faces to appear thinner. These findings were corroborated by bidirectional event-related potential results, showing that adaptation to overweight faces relative to normal-weight faces modulated the event-related potential responses of emotionally ambiguous facial expression (Experiment 2A); vice versa, adaptation to angry faces relative to neutral faces modulated the event-related potential responses of ambiguous faces in facial weight (Experiment 2B). Our study provides direct evidence associating overweight faces with facial expression, suggesting at least partly common neural substrates for the perception of overweight and angry faces.
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Affiliation(s)
- Xu Luo
- School of Psychology, Guizhou Normal University, Huaxi University Town, Guian New District, Guiyang 550025China
| | - Danning Zhao
- School of Psychology, Guizhou Normal University, Huaxi University Town, Guian New District, Guiyang 550025China
| | - Yi Gao
- School of Psychology, Georgia Institute of Technology, 654 Cherry St NW, Atlanta, GA 30332, United States
| | - Zhihao Yang
- School of Psychology, Guizhou Normal University, Huaxi University Town, Guian New District, Guiyang 550025China
| | - Da Wang
- School of Psychology, Guizhou Normal University, Huaxi University Town, Guian New District, Guiyang 550025China
| | - Gaoxing Mei
- School of Psychology, Guizhou Normal University, Huaxi University Town, Guian New District, Guiyang 550025China
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9
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Baska A, Świder K, Zgliczyński WS, Kłoda K, Mastalerz-Migas A, Babicki M. Is Obesity a Cause for Shame? Weight Bias and Stigma among Physicians, Dietitians, and Other Healthcare Professionals in Poland-A Cross-Sectional Study. Nutrients 2024; 16:999. [PMID: 38613032 PMCID: PMC11013468 DOI: 10.3390/nu16070999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 03/04/2024] [Accepted: 03/11/2024] [Indexed: 04/14/2024] Open
Abstract
Weight bias and weight stigma pose significant challenges in healthcare, particularly affecting obesity management practices and patient care quality. Our study evaluates their prevalence and impact among healthcare professionals in Poland. Using the Fat Phobia Scale and custom questions, we surveyed 686 professionals via Computer-Assisted Web Interview (CAWI). Results reveal a moderate level of explicit weight bias (mean score: 3.60 ± 0.57), with significant variations across professional groups: physicians (3.70 ± 0.48), dietitians (3.51 ± 0.48), and others (3.44 ± 0.77). Common feelings towards individuals with obesity include willingness to help (57.0%) and compassion (37.8%), yet 29.9% perceive obesity as shameful. The results also vary depending on the respondent's sex or BMI. These findings underscore the need for evidence-based interventions to mitigate weight stigma and enhance understanding of obesity among healthcare professionals.
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Affiliation(s)
- Alicja Baska
- Department of Lifestyle Medicine, School of Public Health, Centre of Postgraduate Medical Education, 01-813 Warsaw, Poland;
- Polish Society of Lifestyle Medicine, 00-382 Warsaw, Poland
| | | | - Wojciech Stefan Zgliczyński
- Department of Lifestyle Medicine, School of Public Health, Centre of Postgraduate Medical Education, 01-813 Warsaw, Poland;
- Polish Society of Lifestyle Medicine, 00-382 Warsaw, Poland
| | - Karolina Kłoda
- MEDFIT Karolina Kłoda, 70-240 Szczecin, Poland;
- Scientific Section of the Polish Society of Family Medicine, 51-141 Wroclaw, Poland; (A.M.-M.); (M.B.)
| | - Agnieszka Mastalerz-Migas
- Scientific Section of the Polish Society of Family Medicine, 51-141 Wroclaw, Poland; (A.M.-M.); (M.B.)
- Department of Family Medicine, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Mateusz Babicki
- Scientific Section of the Polish Society of Family Medicine, 51-141 Wroclaw, Poland; (A.M.-M.); (M.B.)
- Department of Family Medicine, Wroclaw Medical University, 50-367 Wroclaw, Poland
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10
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Dunford A, Ivezaj V, Grilo CM. Shape discrepancy, weight bias internalization, and eating-disorder psychopathology in patients with loss-of-control eating after bariatric surgery. Surg Obes Relat Dis 2024; 20:291-296. [PMID: 37926627 PMCID: PMC10922050 DOI: 10.1016/j.soard.2023.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 09/12/2023] [Accepted: 09/25/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Postoperative loss-of-control (LOC) eating is associated with eating-disorder psychopathology, poorer weight loss, and mental health outcomes following bariatric surgery. The nature and significance of shape discrepancy has not been examined in patients with LOC eating following bariatric surgery. OBJECTIVES To examine shape discrepancy, WBI (weight bias internalization) and ED (eating-disorder) psychopathology in patients with LOC eating after bariatric surgery. SETTING Yale University School of Medicine, United States. METHODS Participants (N = 148, 84.5% female) seeking treatment for eating and weight concerns and with recurrent LOC eating approximately 6 months after bariatric surgery were assessed with the Eating Disorder Examination-Bariatric Surgery Version Interview and completed questionnaires measuring WBI and depression. Participants selected body shapes representing their current and ideal shapes, and a shape discrepancy score was calculated. RESULTS Most participants (N = 142/148) reported an ideal shape smaller than their current shape; shape discrepancy scores ranged from 0 to 5 (M = 1.89, SD = .82). Greater shape discrepancy was significantly correlated with greater current body mass index (BMI; r = .271, p=<.001) and percent weight loss (%WL) since surgery (r = -.19, p = .023). After adjusting for %WL, shape discrepancy was significantly correlated with greater WBI (r = .37, p < .001), depression (r = .27, p < .001), and ED psychopathology (r = .25, p = .002). CONCLUSIONS Nearly all participants preferred a significantly smaller shape than their current shape. Greater discrepancy between current and ideal shape was associated with higher levels of a range of behavioral (ED psychopathology), cognitive (WBI), and psychological/somatic (depression) concerns. These findings, which persisted after adjusting for %WL, highlight the importance of addressing body image in postoperative interventions.
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Affiliation(s)
- Ashley Dunford
- Department of Psychiatry, Yale University School of Medicine, Program for Obesity, Weight, and Eating Research, New Haven, Connecticut.
| | - Valentina Ivezaj
- Department of Psychiatry, Yale University School of Medicine, Program for Obesity, Weight, and Eating Research, New Haven, Connecticut
| | - Carlos M Grilo
- Department of Psychiatry, Yale University School of Medicine, Program for Obesity, Weight, and Eating Research, New Haven, Connecticut
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11
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Levinson JA, Kinkel-Ram S, Myers B, Hunger JM. A systematic review of weight stigma and disordered eating cognitions and behaviors. Body Image 2024; 48:101678. [PMID: 38278088 DOI: 10.1016/j.bodyim.2023.101678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/23/2023] [Accepted: 12/27/2023] [Indexed: 01/28/2024]
Abstract
Weight stigma is persistent across contexts and is associated with disordered eating cognitions and behaviors. This systematic review aimed to examine the existing literature that has explored the relationship between weight stigma and disordered eating cognitions and behaviors. We specifically examined three dimensions of weight stigma - experienced, anticipated, and internalized - and adopted an inclusive conceptualization of outcomes related to disordered eating (including constructs such as binge eating, body dissatisfaction, and other cognitions and behaviors such as dietary restraint, unhealthy weight control behaviors, and drive for thinness). We searched PubMed, Embase, CINAHL, Web of Science, Sociological Abstracts, and PsycINFO for English-language, peer-reviewed articles and dissertations with quantitative methodology published through October 2023. The search resulted in 242 articles meeting inclusion criteria. A narrative review found a consistent relationship between greater weight stigma and more disordered eating cognitions and behaviors. Methodological and theoretical limitations are discussed, as are critical avenues for future research and potential clinical implications stemming from this body of research. Given the widespread nature and impact of weight stigma on disordered eating, it is imperative that we intervene to address weight stigma at all levels, from the structural to the intrapersonal.
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Affiliation(s)
- Jordan A Levinson
- Department of Psychology, University of California Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA 90095, United States
| | - Shruti Kinkel-Ram
- Department of Psychology, Miami University, 90 N Patterson Avenue, Oxford, OH 45056, United States
| | - Bethany Myers
- University of California Los Angeles, Los Angeles, CA 90095, United States
| | - Jeffrey M Hunger
- Department of Psychology, Miami University, 90 N Patterson Avenue, Oxford, OH 45056, United States.
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12
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Philip SR, Fields SA, Van Ryn M, Phelan SM. Comparisons of Explicit Weight Bias Across Common Clinical Specialties of US Resident Physicians. J Gen Intern Med 2024; 39:511-518. [PMID: 37794262 PMCID: PMC10973280 DOI: 10.1007/s11606-023-08433-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 09/14/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Patients with high body weight are persistently stigmatized in medical settings, with studies demonstrating that providers endorse negative stereotypes of, and have lower regard for, higher-weight patients. Very little is known about how this weight bias varies across specialties. OBJECTIVE The purpose of this study is to examine how explicit weight bias varies between resident providers among sixteen of the largest residency specialties in the USA. The identification of these differences will guide the prioritization and targeting of interventions. DESIGN The current study utilized cross-sectional, observational data. PARTICIPANTS Forty-nine allopathic medical schools were recruited to participate in this national, longitudinal study. The current study utilized data from 3267 trainees in Year 2 of Residency among those who specialized in one of the most common sixteen residency programs in 2016. MAIN MEASURES Participants reported demographic information and residency specialties and completed three sets of measures pertaining to explicit weight bias. KEY RESULTS A significant minority (13-48%) of residents reported slight-to-strong agreement with each anti-fat statement. There was a significant relationship between residency specialty and anti-fat blame (F(15, 3189 = 12.87, p < .001), η2 = .06), anti-fat dislike (F(15, 3189 = 7.01, p < .001), η2 = .03), and attitudes towards obese patients (F(15, 3208 = 17.78, p < .001), η2 = .08). Primary care residents (e.g., family medicine, pediatrics) consistently reported lower levels of weight bias than those in specialty programs (e.g., orthopedic surgery, anesthesiology). CONCLUSIONS This study is the first to report on weight bias in a large, heterogeneous sample of US resident physicians. Problematic levels of weight bias were found in all specialties, with residents in specialty programs generally reporting more bias than those in primary care residencies. Future research should examine which factors contribute to these differences to guide intervention.
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Affiliation(s)
- Samantha R Philip
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, USA.
| | - Sherecce A Fields
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, USA
| | | | - Sean M Phelan
- Division of Health Care Delivery Research, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, NY, USA
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13
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Abstract
Weight bias toward patients in larger bodies is pervasive among health care providers and can negatively influence provider-patient communication, as well as patients' behavior and health outcomes. Weight bias has historical roots that perpetuate thinness and Whiteness as the cultural norm. Although weight bias remains socially acceptable in US culture, contributing factors to an individual's body size are complex and multifactorial. Providers and health care systems also consistently use body mass index (BMI) as an indicator of health status, despite its limitations and harmful effects in the clinical setting. This state of the science review presents 8 evidence-based strategies that demonstrate how to mitigate harm from weight bias and improve quality of care and health outcomes for patients living in larger bodies. Person-centered approaches to care include (1) eliminating clinical recommendations to lose weight; (2) shifting from a focus on weight to health; (3) implementing a size and weight-inclusive approach; (4) engaging in weight bias self-evaluation; (5) creating a welcoming environment for patients of all sizes; (6) seeking permission and learning the patient's story; (7) using weight-inclusive language; and (8) re-evaluating clinical guidelines and policies based on BMI. Midwives and other health care providers may benefit from training that re-imagines the delivery of health care to patients in larger bodies.
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Affiliation(s)
- Signey M Olson
- Georgetown University School of Nursing, Washington, District of Columbia
| | - Elizabeth G Muñoz
- University of Alabama at Birmingham School of Nursing, Birmingham, Alabama
| | - Ellen C Solis
- University of Washington School of Nursing, Seattle, Washington
| | - Heather M Bradford
- Georgetown University School of Nursing, Washington, District of Columbia
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14
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Carels RA, Jansen E, Mansour L, Byrd R, Metzler AL. An examination of the unique contributions of body image and internalized weight bias to psychological well-being outcomes. Body Image 2024; 48:101668. [PMID: 38091859 DOI: 10.1016/j.bodyim.2023.101668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/01/2023] [Accepted: 12/03/2023] [Indexed: 03/05/2024]
Abstract
High correlations between measures of internalized weight bias (IWB) and body image (BI) have resulted in concerns that IWB is conceptually redundant with BI. This investigation examined the contribution of the unique variance of BI and IWB on three important, weight-related factors: self-esteem, depressive symptoms, and body shame. The study included 403 participants recruited through a Qualtrics research panel. Participants were required to be aged 18 + and have a BMI > 25. The sample contained three equally represented, self-identified racial/ethnic groups: Black non-Hispanic (N = 140), Hispanic (N = 133), and White non-Hispanic (N = 130). When BI was entered in the first step of the regression model, it accounted for 14-40% of the variance in various models; the addition of IWB in step two contributed 11-18% of unique variance. By contrast, when IWB was entered in the first step, it accounted for 25-56% of the variance in various models, with the addition of BI contributing between 0% and 2% unique variance. Therefore, even with a high correlation among the constructs of IWB and BI, IWB was able to contribute unique variance in predicting depressive symptoms, self-esteem, and body shame, and is not redundant with the construct of BI.
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Affiliation(s)
- Robert A Carels
- Department of Psychology, East Carolina University, United States.
| | - Emily Jansen
- Department of Psychology, East Carolina University, United States
| | - Lydia Mansour
- Department of Psychology, East Carolina University, United States
| | - Rhonda Byrd
- Department of Psychology, East Carolina University, United States
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15
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Turner SL. Pediatric healthcare professionals' attitudes and beliefs about weight stigma: A descriptive study. J Pediatr Nurs 2024; 75:64-71. [PMID: 38103459 DOI: 10.1016/j.pedn.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 12/08/2023] [Accepted: 12/09/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE Children face weight-based stigma from their healthcare providers at a disconcerting rate, and efforts to mitigate this have been scant. This study aimed to quantify pediatric healthcare professionals' attitudes and beliefs about weight stigma and to determine stigma reduction interventions that are most supported by pediatric healthcare providers. DESIGN AND METHODS Participants completed two validated instruments which measured implicit and explicit weight bias, respectively. They then completed a researcher-designed questionnaire to assess their attitudes and beliefs about weight stigma, and demographic questions. ANOVA models were used to examine associations between bias measures and participant characteristics, chi-square analyses were used to examine associations between questionnaire responses and participant characteristics, and Spearman's rank was used to determine correlations between weight bias and questionnaire responses. RESULTS Participants exhibited moderate-to-high levels of implicit and explicit weight bias (mean Implicit Association Test score = 0.59, mean Crandall Anti-Fat Attitudes Score = 38.95). Associations were noted between implicit bias and years in practice (p < 0.05), and implicit bias and occupation (p < 0.05). There was a significant correlation between explicit bias and multiple questionnaire items, suggesting that healthcare providers with greater weight bias are aware of those biases and are ready to take action to address them. CONCLUSION Though pediatric healthcare exhibit weight-based biases, they are invested in taking steps to mitigate these biases and their impact on patients. PRACTICE IMPLICATIONS The results of this study can inform the design of future interventions that aim to reduce healthcare-based weight bias, thus improving the quality of pediatric healthcare.
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Affiliation(s)
- Samantha L Turner
- UMass Chan Medical School Tan Chingfen Graduate School of Nursing, 55 N Lake Ave, Worcester, MA, United States.
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16
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Bidstrup H, Brennan L, Kaufmann L, Meadows A, de la Piedad Garcia X. A systematic review of ecological momentary assessment studies on weight stigma and a call for a large-scale collaboration. Obes Rev 2024; 25:e13676. [PMID: 38115555 DOI: 10.1111/obr.13676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 09/21/2023] [Accepted: 11/13/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Weight stigma is associated with poor mental health correlates in cross-sectional research. Researchers are increasingly using Ecological Momentary Assessment (EMA) methods, collecting comprehensive within-person data to understand the temporal nature of weight stigma and its biopsychosocial correlates. AIM To systematically review EMA studies on the effect of weight stigma on biopsychosocial correlates and integrate the findings. METHOD PsycINFO, CINAHL, Embase, Medline Complete, and Web of Science were searched and studies were doubled screened (H.B. and X.P.G.). RESULTS Twelve studies (N = 615) met our inclusion criteria. For both between- and within-subject effects, experienced and internalized weight stigmas were associated with negative correlates/outcomes (e.g., higher disordered eating and lower positive mood). However, studies differed in the correlate measures assessed, EMA methods used, and participant instructions provided. Given these inconsistencies, comparison across studies was difficult, and findings could not be reliably integrated. CONCLUSIONS Consistent with previous research, studies from this review suggest weight stigma leads to adverse outcomes. EMA has the potential to overcome many of the limitations present in cross-sectional research on weight stigma and provide more ecologically valid and reliable results. We argue for a collaborative data-sharing consortium with standardized EMA methodologies, so researchers worldwide can contribute to and make use of a large, collective dataset on weight stigma and health correlates (see osf.io/s5ru6/).
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Affiliation(s)
- Hugh Bidstrup
- School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, Victoria, Australia
- School of Psychology and Public Health, La Trobe University, Albury/Wodonga, Victoria, Australia
| | - Leah Brennan
- School of Psychology and Public Health, La Trobe University, Albury/Wodonga, Victoria, Australia
- Centre for Eating, Weight, and Body Image, East Melbourne, Victoria, Australia
| | - Leah Kaufmann
- School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, Victoria, Australia
| | - Angela Meadows
- Department of Psychology, University of Essex, Colchester, UK
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17
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Styk W, Samardakiewicz M, Zmorzynski S. Weight biases, body image and obesity risk knowledge in the groups of nursing students from Poland and Nigeria. Sci Rep 2024; 14:4383. [PMID: 38388835 PMCID: PMC10883915 DOI: 10.1038/s41598-024-54904-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 02/18/2024] [Indexed: 02/24/2024] Open
Abstract
Each population may have its own specific characteristics and cultural differences, which can affect perceptions of one's body, obesity, and the development of weight-related biases. The goal of our study is to (I) examine weight biases among incoming nursing students from two distinct cultures; (II) determine whether the cultural differences may be reflected in the levels of fat phobia, attitudes, and behaviors related to overweight and obesity; (III) adapt the Fat Phobia Scale and translate it into Polish. The study includes 119 Nigerian students and 120 Polish students. The following tools are used-ORK-10, ATOP, BAOP, BES and FPh. The results indicates that Nigerian students have significantly (p < 0.01) less knowledge about the risks associated with overweight and obesity. In contrast, they have a significantly (p < 0.01) more positive body image than the Polish students. Among Nigerian students, men have more positive body image in comparison to women (p = 0.01). An inverse relationship is observed in the group of Polish students, among whom women had a more positive body image than men did (p = 0.01). There are no statistically significant differences in fatphobic attitudes among the studied groups. It has been observed, that culture may be related to weight biases.
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Affiliation(s)
- Wojciech Styk
- Academic Laboratory of Psychological Tests, Medical University of Lublin, Lublin, Poland.
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18
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Cassiani-Miranda CA, Díaz Rincón M, Arroyo-Gamero LA, Giraldo-Barrios LG, Carmona-Meza Z. Weight stigma and allostatic load in adults: protocol for a scoping review. BMJ Open 2024; 14:e076629. [PMID: 38367970 PMCID: PMC10875553 DOI: 10.1136/bmjopen-2023-076629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 12/19/2023] [Indexed: 02/19/2024] Open
Abstract
INTRODUCTION Weight-related stigma (WS) has been associated with adverse psychosocial and physical health effects. Despite the relationship between WS and allostatic load, there are no integrative reviews of this association. This scoping review aims to provide a comprehensive overview of the relationship between allostatic load biomarkers associated with WS by identifying gaps in this topic and proposing recommendations for future research. METHODS AND ANALYSIS This protocol was guided by the methodological framework of Arksey and O'Malley and the Joanna Briggs Institute (JBI). The research questions were based on the population-concept-context framework. Studies in adults diagnosed as overweight or obese, exposed to WS and assessing the association between WS and biomarkers of allostatic load will be included. A search will be conducted in Medline (Ovid), PsycINFO (Ovid), Scopus (Elsevier), Cochrane Library (Wiley) and Google Scholar. The search strategy will be conducted in three stages, based on the JBI recommendation with the MESH terms "Social Stigma," "Weight Prejudice," "Biomarkers," "Allostasis," "Adults" and related terms. Data extraction will be done with a template adapted from JBI. The search strategy and selection process results will be presented in a flow chart and summarised in the text. The main results will be presented in a descriptive synthesis. ETHICS AND DISSEMINATION Ethics review and approval are not required. The results will be disseminated through peer-reviewed publications, conferences, congresses or symposia.
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Affiliation(s)
| | | | | | | | - Zenen Carmona-Meza
- Universidad de Cartagena Facultad de Medicina, Cartagena de Indias, Bolívar, Colombia
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19
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Morse JL, Wooldridge JS, Herbert MS, Tynan M, Dochat C, Afari N. Associations Among Stress, Internalized Weight Stigma, Emotional Eating, and Body Composition in Active-Duty Service Members Enrolling in a Randomized Controlled Trial of a Weight Management Program. Int J Behav Med 2024; 31:145-150. [PMID: 36729285 DOI: 10.1007/s12529-023-10157-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2023] [Indexed: 02/03/2023]
Abstract
BACKGROUND Obesity is a critical public health concern with particular relevance to US military personnel. Stress and internalized weight stigma ("stigma") may contribute to and maintain obesogenic processes and behaviors, including emotional eating. In this secondary cross-sectional analysis, we examined (1) associations among stress and stigma with emotional eating and body fat percentage (BF%), (2) whether stress explains the association between stigma and emotional eating, and (3) whether emotional eating explains associations between stress and stigma with BF%. METHOD Active-duty military service members (N = 178) completed BF% assessment and questionnaires assessing stress, stigma, and emotional eating. RESULTS Structural equation modeling path analyses showed that stress and stigma were both significantly associated with emotional eating (b = 0.35, p < 0.001 and b = 0.23, p < 0.001, respectively) and with BF% (b = 0.38, p < 0.001 and b = 0.29, p < 0.001, respectively) such that individuals who reported higher stress and stigma tended to report more emotional eating and had higher BF%. Stress partially explained the association between internalized weight stigma and emotional eating, and emotional eating partially explained the relationship between stress and BF% but did not significantly mediate the association between stigma and BF%. CONCLUSION Greater stress and internalized weight stigma were associated with more emotional eating and higher BF%; however, emotional eating only partially explained the association between stress and BF%. Results highlight the importance of interventions targeting stress management skills, but additional research is needed to identify mechanisms that explain the association between stigma and BF%.
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Affiliation(s)
- Jessica L Morse
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, La Jolla, San Diego, CA, USA
| | - Jennalee S Wooldridge
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, La Jolla, San Diego, CA, USA
- Center of Excellence for Stress and Mental Health (CESAMH), San Diego, CA, USA
| | - Matthew S Herbert
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, La Jolla, San Diego, CA, USA
- Center of Excellence for Stress and Mental Health (CESAMH), San Diego, CA, USA
| | - Mara Tynan
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, 9500 Gilman Drive, 0737, La Jolla, CA, 92093, USA
| | - Cara Dochat
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, 9500 Gilman Drive, 0737, La Jolla, CA, 92093, USA
| | - Niloofar Afari
- VA San Diego Healthcare System, San Diego, CA, USA.
- Department of Psychiatry, University of California, La Jolla, San Diego, CA, USA.
- Center of Excellence for Stress and Mental Health (CESAMH), San Diego, CA, USA.
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20
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Hawley N, Green J, Ahlich E, Hauff C, Hermer J, Skiba MB, James DL, Nash SH. Patient perspectives of weight stigma across the cancer continuum: A scoping review. Cancer Med 2024; 13:e6882. [PMID: 38205894 PMCID: PMC10905240 DOI: 10.1002/cam4.6882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/22/2023] [Accepted: 12/16/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Weight stigma has been defined as the social devaluation and denigration of individuals because of their weight. The purpose of this scoping systematic review was to assess and understand patient experiences with weight stigma in the cancer care setting. METHODS We conducted a systematic scoping review of studies examining shame, prejudice, bias, and stigma in relation to weight and cancer-related care using five databases: PubMed, CINAHL Plus Full Text (ProQuest), Cochrane Library, PsycINFO (EBSCO), and Scopus. Articles were uploaded into Covidence for de-duplication and screening. Included studies were peer reviewed, reported adult patient experiences in cancer-related care, and were published in English between October 2012 and February 2023. Study characteristics and key findings were abstracted and qualitatively synthesized. RESULTS Publications meeting inclusion criteria yielded five studies (n = 113 participants). Most focused on the experiences of women (n = 4) and cancers which predominantly impact women (i.e., breast, cervical, endometrial; n = 4). All stages of the cancer continuum were included with studies examining screening (n = 2), treatment (n = 1), and post-treatment survivorship (n = 2). Weight discrimination was discussed in four studies and weight-biased stereotypes were discussed in three studies. Experiences of weight bias internalization were reported in four studies. One study described an instance of implicit weight bias. CONCLUSIONS Limited studies examine patient experiences of weight stigma in cancer care; however, current evidence suggests that patients do experience weight stigma in cancer-related care. This review highlights critical gaps and a need for more research on the prevalence and impact of weight stigma in cancer screening and care.
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Affiliation(s)
- Nanako Hawley
- Department of Psychology, University of South Alabama, Mobile, Alabama, USA
| | - Jennifer Green
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, California, USA
| | - Erica Ahlich
- Department of Psychology, University of South Alabama, Mobile, Alabama, USA
| | - Caitlyn Hauff
- Department of Health, Kinesiology, and Sport, University of South Alabama, Mobile, Alabama, USA
| | - Janice Hermer
- Arizona State University Library, Arizona State University, Tempe, Arizona, USA
| | - Meghan B Skiba
- College of Nursing, University of Arizona, Tucson, Arizona, USA
| | - Dara L James
- College of Nursing, University of South Alabama, Mobile, Alabama, USA
- Edson College of Nursing and Health Innovation, Arizona State University, Tempe, Arizona, USA
| | - Sarah H Nash
- Department of Epidemiology, University of Iowa, Iowa, Iowa, USA
- Holden Comprehensive Cancer Center, University of Iowa, Iowa, Iowa, USA
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21
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Waldrop SW, Wang D, Kancherla D, Stanford FC. Current status of weight bias and stigma in pediatrics and the need for greater focus on populations at risk. Curr Opin Pediatr 2024; 36:42-48. [PMID: 37965910 PMCID: PMC10873084 DOI: 10.1097/mop.0000000000001305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
PURPOSE OF REVIEW Obesity is one of the most common pediatric chronic conditions in the United States, affecting approximately 20% of American youth and is more common amongst Black, Latino, and Indigenous and low socioeconomic populations. The condition places children and adolescents at increased risk of physical and mental health conditions partly mediated by the weight bias and stigmatization experienced during the potentially vulnerable periods of childhood and adolescence. RECENT FINDINGS Weight bias and the resulting stigma are pervasive in society. Children have been shown to internalize this bias and its devaluation, which have been shown to contribute to worsening metabolic and mental health outcomes independently. Studies suggest weight stigmatization more adversely affects Black, Latino, and Indigenous children, suggesting the potential for adverse synergistic effects of these historical biases on such youth. SUMMARY Addressing childhood obesity successfully across all racial, ethnic, and socioeconomic lines requires addressing weight bias and stigma. Steps toward this end include collaborative efforts to promote cross-cultural competence and upstander bias education and training for those who care for children, person-centered communication, and a culture of inclusivity across governmental, healthcare, educational, entertainment, and advertising sectors.
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Affiliation(s)
- Stephanie W Waldrop
- Section on Nutrition Department of Pediatrics, University of Colorado (UC), Anschutz Medical Campus, Nutrition Obesity Research Center at UC Anschutz Medical Campus, Aurora, Colorado
| | | | | | - Fatima Cody Stanford
- Massachusetts General Hospital, MGH Weight Center, Department of Medicine-Division of Endocrinology-Neuroendocrine, Department of Pediatrics-Division of Endocrinology, Nutrition Obesity Research Center at Harvard (NORCH), Boston, Massachusetts, USA
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22
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Christensen Pacella KA, Forbush KT. Weight bias internalization is positively associated with insomnia symptom severity in young women with disordered eating. Sleep Health 2024; 10:60-64. [PMID: 38016909 PMCID: PMC10922884 DOI: 10.1016/j.sleh.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 10/04/2023] [Accepted: 10/24/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVE Social stigma has been associated with disparities in sleep heath; however, one type of stigma that has been less evaluated is weight bias internalization. Previous studies have shown inconsistent results linking weight bias internalization and sleep problems and few have examined associations with insomnia. METHODS Women with disordered eating (N = 173, Mage=20.22, SD=1.70, range=18-25) completed questionnaires measuring insomnia symptoms, weight bias internalization, alcohol use, and dysphoria. Linear regression tested associations between weight bias internalization and insomnia symptom severity, after adjusting for demographic variables, alcohol use, and dysphoria. RESULTS Weight bias internalization, alcohol use, and dysphoria were significantly positively associated with insomnia symptom severity above-and-beyond demographic variables. CONCLUSIONS Although effect sizes were small, weight bias internalization was associated with greater insomnia symptom severity. Results add to the growing literature examining the associations of stigma with sleep health.
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Affiliation(s)
| | - Kelsie T Forbush
- Department of Psychology, University of Kansas, Lawrence, Kansas, USA
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23
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Dunham M. Obesity bias awareness decreases nursing students' bias toward patients with obesity. Nursing 2024; 54:56-60. [PMID: 38271133 DOI: 10.1097/01.nurse.0000998024.65699.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
PURPOSE To determine if obesity bias scores among nursing students changed after education was delivered and to what degree body mass index (BMI) was associated with a personal experience of bias during a student's healthcare history. METHODS A quantitative, quasi-experimental design was used to analyze sociodemographic information and Implicit Association Test scores of junior, senior, and full-time accelerated coursework track nursing students. RESULTS Generally, obesity bias declined among the group. However, bias increased regarding increasing BMI. CONCLUSION Obesity bias awareness and obesity education can decrease obesity bias among nursing students.
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Affiliation(s)
- Marguerite Dunham
- Marguerite Dunham is an NP and the program coordinator in Bariatric Surgery for Comprehensive Weight Management at Jefferson Health-Abington
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24
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Rao A, Puhl R, Farrar K. Weight Stigma in Online News Images: A Visual Content Analysis of Stigma Communication in the Depictions of Individuals with Obesity in U.S. and U.K. News. J Health Commun 2024; 29:95-106. [PMID: 38037345 DOI: 10.1080/10810730.2023.2286512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Weight stigma is a pervasive form of discrimination worldwide. News media, and news images in particular, can reinforce weight stigma by portraying persons with obesity in a negative, stereotypical manner. Informed by the model of stigma communication, this study conducted a content analysis of images accompanying obesity-related news articles from the U.S. and U.K. to determine and compare the prevalence of stigmatizing images. Images (N = 445) in obesity-focused news articles obtained from the top four most viewed online news in the U.S. (n = 244) and U.K. (n = 201) during August 2018-August 2019 were systematically coded. These 445 images featured 228 individuals. Of these 228 individuals, 35% were identified as higher weight and 44% as lower weight. Overall, 70% of persons of higher weight in these news images were depicted in a stigmatizing manner. Further, 46% of individuals with higher weight were depicted with their head partially or fully removed from the image, compared to 25% of individuals with lower weight. Additionally, U.K. news were 2.5 times more likely to contain stigmatizing images than U.S. news. These findings highlight the prevalence of weight stigma in news images and suggest that broader systemic efforts are needed by the news media industry to eliminate the use of negative imagery that marginalizes persons of higher weight.
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Affiliation(s)
- Aditi Rao
- Department of Communication, University of Connecticut, Storrs, Connecticut, USA
| | - Rebecca Puhl
- Rudd Center for Food Policy & Health, University of Connecticut, Hartford, Connecticut, USA
- Department of Human Development & Family Sciences, University of Connecticut, Hartford, Connecticut, USA
| | - Kirstie Farrar
- Department of Communication, University of Connecticut, Storrs, Connecticut, USA
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Sonneville KR, Thurston IB, Gordon AR, Richmond TK, Weeks HM, Lipson SK. Weight Stigma Associated With Mental Health Concerns Among College Students. Am J Prev Med 2024; 66:260-268. [PMID: 37758003 DOI: 10.1016/j.amepre.2023.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/21/2023] [Accepted: 09/21/2023] [Indexed: 09/29/2023]
Abstract
INTRODUCTION Weight stigma is widespread and exists across numerous domains including health care, educational institutions, workplaces, mass media, and interpersonal relationships. Weight stigma experienced during the college years may be particularly consequential because the college years are a period of increased vulnerability for the development of mental health concerns. The purpose of the present study was to examine how experiences of weight stigma relate to mental health concerns, including symptoms of eating disorders, anxiety, and depression, among college students. METHODS Prevalence of interpersonal and anticipated weight stigma was examined among 2,707 students participating in the 2018-2019 and 2019-2020 Healthy Minds Study and tested for differences in prevalence across student characteristics. Logistic regression was used to explore relationships between measures of weight stigma and student mental health. Analyses were conducted in 2021-2023. RESULTS Interpersonal and anticipated weight stigma were reported by 12.3% and 15.3% of students, respectively. Experiences of interpersonal and anticipated weight stigma were generally lowest among cisgender male students, heterosexual students, those with the fewest financial concerns, and those who did not perceive themselves to be "overweight." Both interpersonal and anticipated weight stigma were associated with elevated odds of high weight concerns, past-month binge eating, past-month purging, high eating disorder risk, moderate/severe anxiety symptoms, and moderate/severe depressive symptoms. CONCLUSIONS Findings implicate interpersonal and anticipated weight stigma as potential risk factors for a range of mental health concerns. Weight stigma is an under-recognized and under-funded public health problem.
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Affiliation(s)
- Kendrin R Sonneville
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan.
| | - Idia B Thurston
- Departments of Health Sciences and Applied Psychology, Institute for Health Equity and Social Justice Research, Northeastern University, Boston, Massachusetts
| | - Allegra R Gordon
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| | - Tracy K Richmond
- Division of Adolescent/Young Adult Medicine, Department of Pediatrics, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts
| | - Heidi M Weeks
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Sarah K Lipson
- Department of Health Law Policy and Management, Boston University School of Public Health, Boston, Massachusetts
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Adams V. Validation of the Modified Weight Bias Internalization Scale (WBIS-M) among First-Generation Asian Immigrants. Health Soc Work 2024; 49:17-24. [PMID: 38041548 DOI: 10.1093/hsw/hlad033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/20/2023] [Accepted: 04/17/2023] [Indexed: 12/03/2023]
Abstract
Internalized weight bias (i.e., the application of negative weight-based stereotypes to one's self-evaluation) is associated with adverse physical and mental health outcomes. The 10-item version of the Modified Weight Bias Internalization Scale (WBIS-M) is one of the most commonly used measures to assess internalized weight bias. However, studies examining the psychometric properties of the WBIS-M are limited in racially minoritized U.S.-based populations. The current study sought to examine the factor structure of the 10-item version of the WBIS-M in a sample of first-generation Asian immigrants, as both native and foreign-born Asian populations have consistently demonstrated higher rates of weight-related concerns relative to other racially minoritized groups. Confirmatory factor analysis was used to assess the factor structure, and a multiple indicator multiple cause modeling approach was used to assess associations between internalized weight bias and sociodemographic predictors. Results confirm the unidimensionality of the WBIS-M and provide preliminary support for a nine-item version. Identifying as a woman (p = .027) and perceiving oneself as overweight (p < .001) were significantly associated with greater internalized weight bias. When working with Asian and Asian American clients, mental health service providers should be aware of potential weight-related concerns and may consider using the WBIS-M to assess for internalized weight bias.
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Howes EM, Parker MK, Misyak SA, DiFeliceantonio AG, Davy BM, Brown LEC, Hedrick VE. The Impact of Weight Bias and Stigma on the 24 h Dietary Recall Process in Adults with Overweight and Obesity: A Pilot Study. Nutrients 2024; 16:191. [PMID: 38257084 PMCID: PMC10818297 DOI: 10.3390/nu16020191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/07/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
People with overweight and obesity tend to both underreport dietary energy intake and experience weight stigma. This exploratory pilot study aimed to determine the relationship between weight bias and weight stigma and energy intake reporting accuracy. Thirty-nine weight-stable adults with BMI ≥ 25 completed three 24 h dietary recalls; indirect calorimetry to measure resting metabolic rate; a survey measuring weight stigma, psychosocial constructs, and physical activity; and a semi-structured qualitative interview. Multiple linear regression was used to determine if weight bias internalization, weight bias toward others, and experiences of weight stigma were predictive of the accuracy of energy reporting. A thematic analysis was conducted for the qualitative interviews. Weight stigma was reported by 64.1% of the sample. Weight stigma constructs did not predict the accuracy of energy intake reporting. People with obesity underreported by a mean of 477 kcals (p = 0.02). People classified as overweight overreported by a mean of 144 kcals, but this was not significant (p = 0.18). Participants reported a desire to report accurate data despite concerns about reporting socially undesirable foods. Future research should quantify the impact of weight stigma on energy reporting in 24 h recalls using a larger, more diverse sample size and objective measures like doubly labeled water for validation.
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Affiliation(s)
- Erica M. Howes
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA 24061, USA; (M.K.P.); (S.A.M.); (A.G.D.); (B.M.D.); (V.E.H.)
| | - Molly K. Parker
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA 24061, USA; (M.K.P.); (S.A.M.); (A.G.D.); (B.M.D.); (V.E.H.)
| | - Sarah A. Misyak
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA 24061, USA; (M.K.P.); (S.A.M.); (A.G.D.); (B.M.D.); (V.E.H.)
| | - Alexandra G. DiFeliceantonio
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA 24061, USA; (M.K.P.); (S.A.M.); (A.G.D.); (B.M.D.); (V.E.H.)
- Fralin Biomedical Research Institute at VTC, Virginia Tech, Roanoke, VA 24016, USA
| | - Brenda M. Davy
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA 24061, USA; (M.K.P.); (S.A.M.); (A.G.D.); (B.M.D.); (V.E.H.)
| | | | - Valisa E. Hedrick
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA 24061, USA; (M.K.P.); (S.A.M.); (A.G.D.); (B.M.D.); (V.E.H.)
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Zahra-Zeitoun Y, Elran-Barak R, Salameh-Dakwar R, Froylich D, Sroka G, Assalia A, Latzer Y. Weight stigma in healthcare settings: the experience of Arab and Jewish bariatric surgery candidates in Israel. Isr J Health Policy Res 2024; 13:1. [PMID: 38167112 PMCID: PMC10759645 DOI: 10.1186/s13584-023-00587-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 12/09/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Weight-related stigma and discrimination are prevalent in our society with adverse biopsychosocial outcomes to people with obesity and morbid obesity. Studies suggest that weight bias in healthcare settings are quite prevalent, but there have been, as far as we know, lack of studies examining prevalence and correlates of weight bias experiences among bariatric surgery candidates in Israel. We aim to understand the nature and prevalence of weight stigma among bariatric surgery candidates. To identify differences between Jewish and Arab candidates. To examine the impact of weight stigma experiences on weight bias internalization (WBI). METHODS A cross-sectional study was performed among 117 adult bariatric surgery candidates from three hospitals in northern Israel (47.8% Jews, 82.4% females, average BMI 42.4 ± 5.2 Kg/meter2). Patients who agreed to participate completed a structured questionnaire on the same day that the bariatric surgery committee met. WBI was measured using a validated 10-item scale. Experiences of weight stigma were measured using items adapted from prior international studies. RESULTS About two thirds of the participants had at least one experience of weight stigma (teased, treated unfairly, or discriminated against because of their weight). As many as 75% of participants reported that weight served as a barrier to getting appropriate health care and as many as half of participants felt in the last year that a doctor judged them because of their weight. No significant differences were found between Arabs and Jews in the prevalence of weight stigma experiences and WBI. However, a trend towards more stigma experiences among Jews was noted. WBI was predicted by female gender and experiences of weight stigma, both in general and within healthcare settings. CONCLUSIONS Weight stigma towards bariatric surgery candidates in Israel is quite prevalent, and specifically in healthcare settings. It is important to adopt policy actions and intervention programs to improve awareness to this phenomenon among the general public and specifically among healthcare providers, as many healthcare providers may be unaware of the adverse effect of weight stigma and of ways in which they are contributing to the problem. Future studies may validate our findings using larger sample size and longitudinal design.
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Affiliation(s)
| | | | | | | | | | | | - Yael Latzer
- School of Public Health, University of Haifa, Haifa, Israel
- Rambam Medical Center, Haifa, Israel
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Aker S, Şahin MK. Obesity Bias and Stigma, Attitudes, and Beliefs Among Intern Doctors: a Cross-sectional Study from Türkiye. Obes Surg 2024; 34:86-97. [PMID: 37968559 DOI: 10.1007/s11695-023-06919-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/18/2023] [Accepted: 10/18/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND The purpose of this study was to determine intern physicians' attitudes and beliefs toward obesity and individuals with obesity and the frequency at which they encounter discriminatory language in their work environments. METHODS This cross-sectional study was performed with intern physicians at the Ondokuz Mayıs University Medical Faculty in Samsun, Türkiye. A questionnaire was employed for data collection (Appendix). Two hundred eighteen (82.2%) interns took part in the study. The questionnaire consisted of 53 questions in five sections, and included the attitudes toward obese persons (ATOP) and beliefs about obese persons (BAOP) scales. RESULTS The interns most frequently cited genetic factors (98.1%) and endocrine disorder-metabolic disorders (98.1%) as non-behavioral causes of obesity, and overeating (96.2%) and physical immobility (96.2%) as behavioral causes. Lifestyle changes and exercise were most frequently recommended for treatment. The interns' attitudes toward individuals with obesity were very slightly negative, but close to neutral. Analysis showed that 46.8% of the interns reported hearing members of academic staff, intern physicians, or health workers make negative or derogatory comments or jokes about obese patients during their education, while 22.0% reported witnessing an obese patient being subjected to discriminatory treatment in the hospital environment. CONCLUSION Medical faculties must develop curricula aimed at comprehensively addressing obesity-related bias. Such a curriculum should allow students to reflect on their biases, be aimed at reducing the effect of those biases on patient communication, and involve strategies directed toward eliminating those effects from physicians' treatment decisions.
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Affiliation(s)
- Servet Aker
- Department of Medical Education, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey.
| | - Mustafa Kürşat Şahin
- Department of Family Medicine, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
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Schmid J, Linxwiler A, Owen E, Caplan H, Jenkins KR, Bauer KW, Zawistowski M, Weeks HM, Sonneville KR. Weight-inclusive, intuitive eating-based workplace wellness program associated with improvements in intuitive eating, eating disorder symptoms, internalized weight stigma, and diet quality. Eat Behav 2024; 52:101840. [PMID: 38134818 PMCID: PMC11002983 DOI: 10.1016/j.eatbeh.2023.101840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023]
Abstract
INTRODUCTION The use of weight-inclusive programming within a workplace wellness context remains understudied. METHODS The present study is a pilot/feasibility study of a 3-month, virtual, weight-inclusive, intuitive eating-based workplace wellness program. Program participants (n = 114), who were all employees at a large public university in the Midwest, received weekly emails with a link to an instructional video related to intuitive eating and were encouraged to meet virtually with their health coach. Participants provided self-report data on behavioral and psychological outcomes including intuitive eating, internalized weight stigma, eating disorder symptoms, and diet quality at baseline, post-intervention (3 months from baseline), and follow-up (6 months from baseline). Changes in behavioral and psychological outcomes from baseline to post-intervention and follow-up were examined using paired t-tests, with Cohen's d effect sizes reported. Generalized linear models were used to examine whether participant characteristics and program engagement were associated with program outcomes. RESULTS Increases in intuitive eating and decreases in internalized weight stigma and eating disorder symptoms were seen from baseline to post-intervention (Cohen's d = 1.02, -0.47, and -0.63, respectively) and follow-up (Cohen's d = 0.86, -0.31, and -0.60). No changes in dietary quality were seen at post-intervention, but a significant reduction in intake of added sugars, fast food, and sugar sweetened beverages were observed at follow-up (Cohen's d = -0.35, -0.23, -0.25). CONCLUSIONS This study provide preliminary support for the acceptability and potential impact of a weight-inclusive workplace wellness program that should be tested in a rigorous randomized trial.
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Affiliation(s)
- Jane Schmid
- Department of Nutritional Sciences, University of Michigan School of Public Health, United States of America.
| | - Ashley Linxwiler
- Department of Nutritional Sciences, University of Michigan School of Public Health, United States of America.
| | - Erica Owen
- MHealthy, University of Michigan Health and Well-Being Services, United States of America.
| | - Heather Caplan
- Weight Inclusive Nutrition and Dietetics, United States of America.
| | - Kristi Rahrig Jenkins
- MHealthy, University of Michigan Health and Well-Being Services, United States of America.
| | - Katherine W Bauer
- Department of Nutritional Sciences, University of Michigan School of Public Health, United States of America.
| | - Matthew Zawistowski
- Department of Biostatistics, University of Michigan School of Public Health, United States of America.
| | - Heidi M Weeks
- Department of Nutritional Sciences, University of Michigan School of Public Health, United States of America.
| | - Kendrin R Sonneville
- Department of Nutritional Sciences, University of Michigan School of Public Health, United States of America.
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Pudney EV, Puhl RM, Halgunseth LC, Schwartz MB. An Examination of Parental Weight Stigma and Weight Talk Among Socioeconomically and Racially/Ethnically Diverse Parents. Fam Community Health 2024; 47:1-15. [PMID: 37656801 DOI: 10.1097/fch.0000000000000384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
Parental communication about body weight can influence children's emotional well-being and eating behaviors. However, little is known about the role of parental self-stigma concerning weight and social position variables (ie, race/ethnicity, income, and gender) in weight communication. This study examined how parents' self-stigmatization for their own weight (ie, weight bias internalization) and self-stigmatization for their child's weight (ie, affiliate stigma) relates to weight talk frequency with their children, and whether these associations vary across parental race/ethnicity, income, and gender. Parents (n = 408) completed a cross-sectional, online survey about their weight communication and self-stigmatization. Linear regression was used to examine the relationships among these variables, including interactions between the stigma variables and social position variables in predicting weight talk. Higher levels of weight bias internalization and affiliate stigma were strongly associated with increased parental weight talk frequency; parents who endorsed higher levels of internalized bias about their own weight expressed greater affiliate stigma for their child's weight, regardless of demographic characteristics or weight status. Associations between the stigma variables and weight talk outcomes were stronger among fathers and parents of higher income. Findings highlight the importance of considering weight stigma variables in parental weight communication research.
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Affiliation(s)
- Ellen V Pudney
- Department of Pediatrics, Division of Community Health & Research, Eastern Virginia Medical School, Norfolk (Dr Pudney); Department of Human Development & Family Sciences, University of Connecticut, Storrs, and Rudd Center for Food Policy & Health, University of Connecticut, Hartford (Drs Puhl and Schwartz); and Department of Human Development & Family Studies, Michigan State University, East Lansing (Dr Halgunseth)
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Winograd D, Goldschmidt AB, Lydecker J. Associations among parents' internalized weight bias, negative child-focused body talk, and feeding behaviors. Eat Behav 2024; 52:101848. [PMID: 38308903 PMCID: PMC10922654 DOI: 10.1016/j.eatbeh.2024.101848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/05/2024]
Abstract
OBJECTIVE Parents' negative body talk about children (negative weight/shape comments) and internalized weight bias (application of negative weight-based stereotypes to oneself) are associated with children's maladaptive eating behaviors, but mechanisms are poorly understood. Conceptually, parental behaviors and attitudes may translate to implicit and explicit concerns about their child's weight and influence parents' feeding practices. These associations are underexplored in the literature. METHOD 242 parents (59.4% mothers) completed a one-time assessment that included measures of internalized weight bias, negative body talk, and feeding practices. Parents also completed assessments about one of their children, of any weight status (age range 5-15 years; 40% daughters). RESULTS Parents' internalized weight bias was positively associated with concern about their child's weight and restriction of their child's diet. Parents' negative body talk towards their child was positively associated with concern about their child's weight and shape, restriction of their child's diet, and monitoring of their child's diet. Relative to internalized weight-bias, negative body talk had a stronger correlation with parents' concern about child weight and monitoring of child's diet. Correlations did not vary by child gender or weight category. DISCUSSION Parents' internalized weight bias and negative body talk about their child were associated with their feeding practices across child gender and weight categories, with correlations in the small to medium range. Thus, children of all genders and weights may be vulnerable to enacted weight bias. Future studies should examine whether addressing parents' internalized weight bias and communication in family-focused interventions improves feeding practices and child well-being.
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Affiliation(s)
- Dayna Winograd
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Andrea B Goldschmidt
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Janet Lydecker
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
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Sherf-Dagan S, Ofri L, Tayar I, Keisar I, Buch A, Paska-Davis N, Pinus M, Tesler R, Elran-Barak R, Boaz M, Green G. A multifaceted training tool to reduce weight bias among healthcare students: A randomized controlled trial. Obes Res Clin Pract 2024; 18:35-42. [PMID: 38184475 DOI: 10.1016/j.orcp.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/26/2023] [Accepted: 12/22/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Weight bias toward people with obesity (PwO) is common in healthcare settings. Efforts to address weight bias in healthcare settings should begin during university studies. This study aimed to explore the effect of a multifaceted intervention on weight bias among undergraduate healthcare students. METHODS An open label randomized controlled trial. The intervention tool consisted of short video lectures on obesity, vignettes simulating interactions between health professionals and PwO, and open discourse with a PwO. The control group received a short-written document on obesity. Online questionnaires on Anti-Fat Attitudes ('AFA'), short form of the Fat-Phobia Scale ('FPS'), Weight Implicit Association Test ('Weight-IAT'), and knowledge about obesity were administered at baseline, 1-week, and 6-week post-intervention. RESULTS A total of 162, 152, and 146 students participated in the study at baseline, 1-week, and 6-week post-intervention, respectively. Their mean age was 25.8 ± 6.7 years and 88.3% were women. Means of AFA total scores and FPS scores decreased significantly over time only within the intervention group (P Time*Group = 0.002 and 0.014). Both groups showed a similar trend over time in mean scores of Weight-IAT (P Time*Group = 0.868) and knowledge about obesity (P Time*Group = 0.115). CONCLUSIONS A multifaceted intervention resulted in a significant reduction in explicit weight bias but did not yield any additional advantages over the control group in implicit weight bias and knowledge about obesity. CLINICALTRIALS GOV NUMBER NCT05482802.
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Affiliation(s)
- Shiri Sherf-Dagan
- Department of Nutrition Sciences, School of Health Sciences, Ariel University, Ariel, Israel; Department of Nutrition, Assuta Medical Center, Tel Aviv, Israel.
| | - Lani Ofri
- Nursing Department, School of Health Sciences, Ariel University, Ariel, Israel
| | - Inbar Tayar
- Department of Nutrition Sciences, School of Health Sciences, Ariel University, Ariel, Israel
| | - Ido Keisar
- Department of Nutrition Sciences, School of Health Sciences, Ariel University, Ariel, Israel
| | - Assaf Buch
- Department of Nutrition Sciences, School of Health Sciences, Ariel University, Ariel, Israel; Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Naama Paska-Davis
- Spokeswomen and public relations office, Ariel University, Ariel, Israel
| | - Michael Pinus
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel; Harvard Business School, Harvard University, Boston, USA
| | - Riki Tesler
- Health Management Department, School of Health Sciences, Ariel University, Ariel, Israel
| | - Roni Elran-Barak
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Mona Boaz
- Department of Nutrition Sciences, School of Health Sciences, Ariel University, Ariel, Israel
| | - Gizell Green
- Nursing Department, School of Health Sciences, Ariel University, Ariel, Israel
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Tamburrini N, Lockwood P. Obesity bias in diagnostic radiography students: A survey of attitudes, perceptions and technical confidence. Radiography (Lond) 2024; 30:202-208. [PMID: 38035434 DOI: 10.1016/j.radi.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/18/2023] [Accepted: 11/08/2023] [Indexed: 12/02/2023]
Abstract
INTRODUCTION Obesity bias exists in healthcare professionals and students from numerous disciplines and negatively impacts the quality of care, outcomes, engagement, and satisfaction of their patients. With obesity rates continuing to rise in the United Kingdom (UK), more patients will be affected than ever, and it is becoming an increasingly important issue to tackle. This study aims to assess the attitudes to obesity of student diagnostic radiographers and determine if obesity bias exists in this population. METHOD Student radiographers (n = 140) at a single university in the UK were invited to complete an online survey comprising measures designed to assess levels of bias and attitudes towards obesity, including the Attitude Towards Obese Persons (ATOP) scale. Likert-type scales were used to collect quantitative data, and data analysis included descriptive statistics, frequencies, and Spearman's rank correlation coefficient. RESULTS Responses were received from n = 38 students. The mean ATOP score for participants was 70.37 (SD = 19.26). With 26 % (n = 10) scoring below 60, demonstrating strong negative attitudes towards obese individuals. Additionally, students (76.3 %; n = 29) indicated that they observed high levels of obesity bias whilst on clinical placement. There was a statistically significant correlation between levels of weight bias and students' confidence in working with obese patients (r(36) = 0.4, p 0.01). Students who are less confident working with obese patients had higher levels of obesity bias. CONCLUSIONS Obesity bias exists in radiography students at levels comparable to those that have been found previously in other healthcare professionals and students. Furthermore, radiography students lacked confidence in their technical ability to work with obese patients and lower confidence levels were associated with higher levels of obesity bias. IMPLICATIONS FOR PRACTICE The findings of this study provide preliminary knowledge upon which future research can be built.
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Affiliation(s)
- N Tamburrini
- Radiology Department, Maidstone Hospital, Maidstone and Tunbridge Wells NHS Trust, Kent, United Kingdom
| | - P Lockwood
- Department of Radiography, School of Allied Health Professions, Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, Kent, United Kingdom.
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Nutter S, Eggerichs LA, Nagpal TS, Ramos Salas X, Chin Chea C, Saiful S, Ralston J, Barata-Cavalcanti O, Batz C, Baur LA, Birney S, Bryant S, Buse K, Cardel MI, Chugh A, Cuevas A, Farmer M, Ibrahim A, Kataria I, Kotz C, Kyle T, le Brocq S, Mooney V, Mullen C, Nadglowski J, Neveux M, Papapietro K, Powis J, Puhl RM, Rea Ruanova B, Saunders JF, Stanford FC, Stephen O, Tham KW, Urudinachi A, Vejar-Renteria L, Walwyn D, Wilding J, Yusop S. Changing the global obesity narrative to recognize and reduce weight stigma: A position statement from the World Obesity Federation. Obes Rev 2024; 25:e13642. [PMID: 37846179 DOI: 10.1111/obr.13642] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 08/02/2023] [Accepted: 09/09/2023] [Indexed: 10/18/2023]
Abstract
Weight stigma, defined as pervasive misconceptions and stereotypes associated with higher body weight, is both a social determinant of health and a human rights issue. It is imperative to consider how weight stigma may be impeding health promotion efforts on a global scale. The World Obesity Federation (WOF) convened a global working group of practitioners, researchers, policymakers, youth advocates, and individuals with lived experience of obesity to consider the ways that global obesity narratives may contribute to weight stigma. Specifically, the working group focused on how overall obesity narratives, food and physical activity narratives, and scientific and public-facing language may contribute to weight stigma. The impact of weight stigma across the lifespan was also considered. Taking a global perspective, nine recommendations resulted from this work for global health research and health promotion efforts that can help to reduce harmful obesity narratives, both inside and outside health contexts.
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Affiliation(s)
- Sarah Nutter
- Educational Psychology and Leadership Studies, University of Victoria, Victoria, British Columbia, Canada
| | - Laura A Eggerichs
- Department of Public Health and Community Medicine, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Taniya S Nagpal
- Department of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Canada
| | - Ximena Ramos Salas
- Replica Communications, Kristianstad, Sweden
- Obesity Canada, Edmonton, Canada
- European Association for the Study of Obesity, Teddington, UK
| | - Christine Chin Chea
- Internal and Obesity Medicine, University of the West Indies School of Clinical Medicine and Research, Nassau, Bahamas
| | | | | | | | - Claudia Batz
- George Institute for Global Health, Sydney, Australia
| | - Louise A Baur
- Children's Hospital Westmead Clinical School, University of Sydney, Sydney, Australia
| | - Susie Birney
- Irish Coalition for People Living with Obesity, Dublin, Ireland
| | - Sheree Bryant
- European Association for the Study of Obesity, Teddington, UK
| | - Kent Buse
- George Institute for Global Health, Imperial College London, London, UK
| | - Michelle I Cardel
- WW International, Inc., Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA
| | | | - Ada Cuevas
- Advanced Center for Metabolic Medicine and Nutrition (CAMMYN), Santiago, Chile
| | | | - Allison Ibrahim
- Educational Consultant and Patient Advocate, Kuwait City, Kuwait
| | - Ishu Kataria
- Center for Global Noncommunicable Diseases, RTI International, Research Triangle Park, North Carolina, USA
| | - Catherine Kotz
- Department of Integrative Biology and Physiology, University of Minnesota, and the Minneapolis VA Health Care System, Geriatric Research, Education and Clinical Care, Minneapolis, Minnesota, USA
| | - Ted Kyle
- ConscienHealth, Pittsburgh, Pennsylvania, USA
| | - Sara le Brocq
- National Institute for Health and Care Excellence, London, UK
| | - Vicki Mooney
- European Coalition for People Living with Obesity, Dublin, Ireland
| | - Clare Mullen
- Health Consumers' Council WA, Mount Lawley, Australia
| | | | | | - Karin Papapietro
- Nutrition Unit, Hospital Clínico de La Universidad de Chile, Santiago, Chile
| | | | - Rebecca M Puhl
- Rudd Center for Food Policy and Obesity, University of Connecticut, Storrs, Connecticut, USA
| | | | - Jessica F Saunders
- Psychology Convening Group, Ramapo College of New Jersey, Mahwah, New Jersey, USA
| | - Fatima Cody Stanford
- Neuroendocrine Unit, Pediatric Endocrinology, Nutrition Obesity Research Center at Harvard, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Ogweno Stephen
- Global Health Medicine And Health, Faculty of Biology, University Of Manchester, Manchester, UK
| | - Kwang Wei Tham
- Singapore Association for the Study of Obesity, Singapore
| | | | - Lesly Vejar-Renteria
- Nutrition and Health Research Center, National Institute of Public Health Mexico, Cuernavaca, Mexico
| | | | - John Wilding
- World Obesity Federation, London, UK
- University of Liverpool, Liverpool, UK
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Fortes Cavalcanti de Macêdo P, Brito E, de Magalhães Cunha C, Ribas de Farias Costa P, da Purificação Nazaré Araújo M, Cardoso Martins P, Leila Portela de Santana M. Weight stigma is a predictor of disordered eating in Brazilian college students during the COVID-19 pandemic: A 16-month cohort follow-up. Appetite 2024; 192:107084. [PMID: 37875240 DOI: 10.1016/j.appet.2023.107084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/07/2023] [Accepted: 10/09/2023] [Indexed: 10/26/2023]
Abstract
This study examined the relationship between weight stigma and disordered eating behaviors in university students during the COVID-19 pandemic, considering individuals with and without overweight. A national sample of 738 college students completed an online questionnaire at three time points between July 2020 and December 2021, reporting their experiences of weight stigma, perceived increase in weight stigma during the pandemic, internalized weight stigma, and disordered eating behaviors. The findings showed that the trajectories of disordered eating behaviors varied depending on participants' anthropometric status. Among those with overweight, there was a decrease over time in binge eating, food restriction, and purging. Conversely, the non-overweight group experienced a slight increase in binge eating from T2 to T3. Using the Generalized Estimating Equations model, the study revealed that weight stigma predicted disordered eating behaviors in both weight spectrums during the pandemic. Experiences of weight stigma and the perceived increase in weight stigma significantly increased the likelihood of engaging in binge eating, food restriction, and purging among individuals with overweight. Furthermore, the internalization of weight stigma was longitudinally associated with all examined eating behaviors, regardless of anthropometric status. These findings highlight the importance of addressing weight stigma to prevent disordered eating in college students.
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Affiliation(s)
| | - Edleide Brito
- Statistics Department, Federal University of Bahia, Salvador, Brazil.
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Phillips J. Weight bias and stigma in healthcare: What are we doing about it? Work 2024; 77:731-733. [PMID: 38393880 DOI: 10.3233/wor-246004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024] Open
Abstract
Weight bias and weight stigma is present in healthcare settings negatively affecting people with obesity. Healthcare professionals should be aware of how their potential bias and stigma may be impacting clients with obesity. With obesity projected to rise among the world, the healthcare environment needs to be more accepting and accommodating.
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Cuauro SE, Santos N, Andrade E, Dani AW, Sanchious SN, Hooper SC, Becker CB. Internalized Weight Stigma and Weight Discrimination: Associations with Quality of Life and Psychosocial Impairment in a Sample Living with Food Insecurity. Int J Environ Res Public Health 2023; 20:7147. [PMID: 38131699 PMCID: PMC10742389 DOI: 10.3390/ijerph20247147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/26/2023] [Accepted: 12/02/2023] [Indexed: 12/23/2023]
Abstract
Research suggests that experiencing weight discrimination is associated with a lower quality of life and poor psychological and physical health. However, much of the existing weight discrimination literature has neglected under-represented groups. Little is known about how the experience of weight discrimination affects quality of life and eating/weight-related psychosocial impairment in those living with food insecurity. The present study investigated the associations of weight discrimination and eating/weight-related psychosocial impairment and quality of life. We examined internalized weight stigma and several psychological indicators as potential mediators. Participants (N = 1085) who were recruited from a local food bank completed a questionnaire assessing food insecurity, weight discrimination, internalized weight stigma, eating disorder pathology, anxiety, depression, eating/weight-related psychosocial impairment, and quality of life. Overall, almost one in four participants reported experiencing weight discrimination. Our serial mediation models indicated that increased experiences of weight discrimination were associated with greater internalized weight stigma and psychopathology, which were in turn associated with lower quality of life and greater eating/weight-related psychosocial impairment. Thus, experiencing weight discrimination may negatively impact quality of life and eating/weight-related psychosocial impairment through its effect on mental health. It is imperative to address the negative effects of the widespread discrimination of people based on their weight.
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Affiliation(s)
- Sabrina E. Cuauro
- Department of Psychology, Trinity University, San Antonio, TX 78212, USA; (N.S.); (E.A.); (A.W.D.); (S.N.S.); (C.B.B.)
- Department of Psychological Sciences, Rice University, Houston, TX 77005, USA
| | - Natalia Santos
- Department of Psychology, Trinity University, San Antonio, TX 78212, USA; (N.S.); (E.A.); (A.W.D.); (S.N.S.); (C.B.B.)
| | - Estefania Andrade
- Department of Psychology, Trinity University, San Antonio, TX 78212, USA; (N.S.); (E.A.); (A.W.D.); (S.N.S.); (C.B.B.)
| | - Anoushka W. Dani
- Department of Psychology, Trinity University, San Antonio, TX 78212, USA; (N.S.); (E.A.); (A.W.D.); (S.N.S.); (C.B.B.)
| | - Saivone N. Sanchious
- Department of Psychology, Trinity University, San Antonio, TX 78212, USA; (N.S.); (E.A.); (A.W.D.); (S.N.S.); (C.B.B.)
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI 02912, USA
| | - Savannah C. Hooper
- Department of Psychological and Brain Science, University of Louisville, Louisville, KY 40292, USA;
| | - Carolyn Black Becker
- Department of Psychology, Trinity University, San Antonio, TX 78212, USA; (N.S.); (E.A.); (A.W.D.); (S.N.S.); (C.B.B.)
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Brownstone LM, Kelly DA, Harrop EN, Norling HN, Palazzolo LP, Wright O, Tiede E. Healing from weight stigma in community: A thematic analysis of a group intervention for large-bodied individuals. Psychotherapy (Chic) 2023; 60:455-466. [PMID: 37856404 DOI: 10.1037/pst0000509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Discrimination against and negative beliefs about large-bodied individuals, known as weight stigma, is pervasive and harmful. While previous research has focused on the negative consequences of weight stigma, the present study aims to highlight the lived experience of large-bodied individuals while also exploring the process of healing from harmful experiences of weight stigma. Ten adult (9/10 White, 8/10 cisgender women), large-bodied individuals recruited via snowball sampling through a nonprofit, grassroots, eating disorder advocacy organization participated in a 10-week, counselor-facilitated support group with the shared goal of healing from the impact of weight stigma. Researchers used reflexive thematic analysis to analyze video recordings and transcripts of group sessions to answer the following question: how did participants make sense of their weight stigma experiences and engage with the process of healing in community? Four primary themes were generated: (a) Community is Essential, (b) Storying, (c) Deprogramming and Changing Mindset, and (d) Expansive Healing. These results underscore the impact of weight stigma in the lives of large-bodied individuals and provide insight into how clinicians might support such individuals engaging in collective healing from these painful experiences. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Lisa M Brownstone
- Department of Counseling Psychology, Morgridge College of Education, University of Denver
| | - Devin A Kelly
- Department of Counseling Psychology, Morgridge College of Education, University of Denver
| | - Erin N Harrop
- Graduate School of Social Work, University of Denver
| | - Hannah N Norling
- Department of Counseling Psychology, Morgridge College of Education, University of Denver
| | - L P Palazzolo
- Department of Counseling Psychology, Morgridge College of Education, University of Denver
| | - Orphea Wright
- Department of Counseling Psychology, Morgridge College of Education, University of Denver
| | - Emily Tiede
- Department of Counseling Psychology, Morgridge College of Education, University of Denver
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Niela-Vilén H, Murto T. Weight stigma in maternity care. Sex Reprod Healthc 2023; 38:100923. [PMID: 37979456 DOI: 10.1016/j.srhc.2023.100923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Affiliation(s)
| | - Tiina Murto
- Turku University of Applied Sciences, Finland.
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Leget DL, LaCaille LJ, Pearl RL. Comparing measurement of internalized weight stigma and body dissatisfaction. Body Image 2023; 47:101622. [PMID: 37672860 DOI: 10.1016/j.bodyim.2023.101622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 08/21/2023] [Accepted: 08/21/2023] [Indexed: 09/08/2023]
Abstract
Respective conceptualizations of internalized weight stigma and body dissatisfaction are distinct; however, strong relationships between measures of these two constructs prompts consideration about if these are truly unique constructs or whether current measurement tools are not adequately capturing their uniqueness. In this cross-sectional study, 480 U.S. women (78.8% white; MBMI = 25.9) ages 18-40 years, recruited from Amazon's MechanicalTurk and a mid-sized university, completed an online survey with the Modified Weight Bias Internalization Scale (WBIS-M), a modified Body Parts Satisfaction Scale (BPSS), and other validated measures of body image, eating behavior, and mental health. Exploratory factor analysis of the WBIS-M and the BPSS supported a two-factor solution, although two items from the WBIS-M loaded with BPSS items. After removing these items, the 9-item version of the WBIS-M demonstrated stronger relationships with dysfunctional eating and mental health symptoms than did the BPSS (ꞵ range = 0.32-0.62 vs. 0.01-0.18, respectively). Findings from this study provide evidence to support the validity of WBIS-M and BPSS measuring unique constructs, suggesting that internalized weight stigma can be differentiated from body dissatisfaction. This study also highlights the need for further research that examines current measurement tools for internalized weight stigma and body dissatisfaction.
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Affiliation(s)
- Dakota L Leget
- Department of Psychology, University of Minnesota Duluth, 320 BohH 1207 Ordean Court, Duluth, MN, 55812, USA; Department of Clinical and Health Psychology, University of Florida, 1225 Center Drive, Gainesville, FL, 32611, USA.
| | - Lara J LaCaille
- Department of Psychology, University of Minnesota Duluth, 320 BohH 1207 Ordean Court, Duluth, MN, 55812, USA
| | - Rebecca L Pearl
- Department of Clinical and Health Psychology, University of Florida, 1225 Center Drive, Gainesville, FL, 32611, USA
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42
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Barnhart WR, Cui T, Cui S, Ren Y, Ji F, He J. Exploring the prospective relationships between food addiction symptoms, weight bias internalization, and psychological distress in Chinese adolescents. Int J Eat Disord 2023; 56:2304-2314. [PMID: 37772767 DOI: 10.1002/eat.24066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 09/13/2023] [Accepted: 09/13/2023] [Indexed: 09/30/2023]
Abstract
OBJECTIVE Relationships exist between food addiction symptoms, weight bias internalization, and psychological distress, yet previous research is primarily cross-sectional with adults from Western contexts. We examined the prospective relationships between food addiction symptoms, weight bias internalization, and psychological distress in Chinese adolescents. METHODS Over three time points (Time 1, baseline; Time 2, 6-months; Time 3, 12-months) spanning 1 year, we examined cross-sectional and bi-directional relationships between food addiction symptoms, weight bias internalization, and psychological distress in Chinese adolescents (N = 589; aged 14-18 years at baseline). Pearson correlations and cross-lagged models examined the cross-sectional and longitudinal relationships between food addiction symptoms, weight bias internalization, and psychological distress. RESULTS Cross-sectional correlations suggested positive relationships between food addiction symptoms, weight bias internalization, and psychological distress at each time point. Regarding bi-directional relationships, higher psychological distress was associated with both higher weight bias internalization and higher food addiction symptoms at the following time points. However, food addiction symptoms and weight bias internalization were not prospectively associated. Time 2 psychological distress did not significantly mediate the relationship between Time 1 weight bias internalization and Time 3 food addiction symptoms. DISCUSSION Findings suggest no direct longitudinal link between food addiction symptoms and weight bias internalization and vice versa. However, findings do suggest that psychological distress is temporally associated with higher food addiction symptoms and weight bias internalization in Chinese adolescents. Targeting psychological distress may prove useful in treatments of food addiction symptoms and weight bias internalization in Chinese adolescents. PUBLIC SIGNIFICANCE Positive associations exist between food addiction symptoms, weight bias internalization, and psychological distress, but findings are largely cross-sectional and bound to adult populations from Western contexts. Using a longitudinal design in Chinese adolescents, findings suggested that baseline psychological distress was associated with higher food addiction symptoms and higher weight bias internalization at follow-up time points. Treatments targeting psychological distress may be helpful in reducing food addiction symptoms and weight bias internalization in Chinese adolescents.
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Affiliation(s)
- Wesley R Barnhart
- Department of Psychology, Bowling Green State University, Bowling Green, Ohio, USA
| | - Tianxiang Cui
- Department of Psychology, University of Macau, Taipa, Macau, China
| | - Shuqi Cui
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, China
| | - Yaoxiang Ren
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, China
| | - Feng Ji
- Department of Applied Psychology and Human Development, University of Toronto, Toronto, Ontario, Canada
| | - Jinbo He
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, China
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43
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Dennis S, Chatman CJ, Reeder R. Learning the ABCDs of Weight Stigma and Bias. Am Fam Physician 2023; 108:537-538. [PMID: 38215409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Affiliation(s)
| | - Crysta J Chatman
- University of Oklahoma School of Community Medicine, Tulsa, Oklahoma
| | - Raye Reeder
- University of Oklahoma School of Community Medicine, Tulsa, Oklahoma
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44
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Hill B, Azzari Wynn-Jones A, Botting KJ, Cassinelli EH, Daly MP, Gardiner CV, Hanley SJ, Heslehurst N, Steegers-Theunissen R, Verbiest S, Skouteris H. The Challenge of Weight Stigma for Women in the Preconception Period: Workshop Recommendations for Action from the 5th European Conference on Preconception Health and Care. Int J Environ Res Public Health 2023; 20:7034. [PMID: 37998265 PMCID: PMC10671694 DOI: 10.3390/ijerph20227034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 11/25/2023]
Abstract
Weight stigma is a well-recognised public health issue affecting many members of society including women during the preconception period. The impacts of preconception weight stigma on women are significant and may result in decreased access to and uptake of healthcare, and mental health concerns. The consequences of this weight stigma may translate to negative maternal outcomes and even intergenerational effects on the child. Eliminating weight stigma is therefore imperative. The aim of this paper is to report recommendations to reduce weight stigma for preconception women produced at a workshop with clinical and academic experts on preconception health and weight stigma at the 5th European Conference on Preconception Health and Care. The recommendations are related to two key areas: general societal recommendations prompting all people to acknowledge and adjust our attitudes towards larger-bodied people; and healthcare-specific recommendations imploring clinicians to upskill themselves to reduce weight stigma in practice. We therefore call for urgent approaches to address societal weight-stigmatising attitudes and norms related to both the general population and preconception women, while providing professional development opportunities for healthcare professionals relating to weight stigma. Eliminating weight stigma for preconception women may have positive impacts on the outcomes for mothers and children during pregnancy and beyond.
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Affiliation(s)
- Briony Hill
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne 3004, Australia
| | | | - Kimberley J. Botting
- Department of Maternal and Fetal Medicine, Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London WC1E 6HX, UK;
| | - Emma H. Cassinelli
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast BT12 6BA, UK;
| | - Michael P. Daly
- Centre for Public Health, Bristol Medical School, University of Bristol, Canynge Hall, Whatley Road, Bristol BS8 2PN, UK;
| | - Caitlin Victoria Gardiner
- Department of Global Health and Social Medicine, Bush House, Strand Campus, King’s College London, 40 Aldwych, London WC2B 4BG, UK;
- Developmental Pathways for Health Research Unit, University of the Witwatersrand Faculty of Health Sciences, Johannesburg 2000, Gauteng, South Africa
| | - Stephanie J. Hanley
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK;
| | - Nicola Heslehurst
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4AX, UK;
| | - Regine Steegers-Theunissen
- Department of Obstetrics and Gynaecology, and Department of and Pediatrics, Erasmus MC, University Medical Center, 3015 GD Rotterdam, The Netherlands;
| | - Sarah Verbiest
- School of Social Work, University of North Carolina at Chapel Hill, Pittsboro Road, Chapel Hill, NC 27599-3550, USA;
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne 3004, Australia
- Warwick Business School, University of Warwick, Scarman Rd, Coventry CV4 7AL, UK
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45
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Rashid A. Yonder: Ethnic minority maternity experiences, colorectal resection, foreign medical aid, and weight stigma. Br J Gen Pract 2023; 73:511. [PMID: 37884372 PMCID: PMC10617963 DOI: 10.3399/bjgp23x735453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023] Open
Affiliation(s)
- Ahmed Rashid
- GP and Professor of Medical Education, UCL Medical School, UCL, London. @Dr_A_Rashid
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46
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Lin YC, Lin CY, Saffari M, Tsai MC, Chang YH, Strong C, Chen JK, Hsieh YP, Yang YN, Latner JD. Weight stigma is associated with body mass index among college students in Taiwan: the mediated role of internalized weight stigma. BMC Psychol 2023; 11:365. [PMID: 37915074 PMCID: PMC10621093 DOI: 10.1186/s40359-023-01414-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/26/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Weight stigma is an issue often studied in Western countries; however, such information is scarce in Asian studies. METHODS This study aimed to examine the role of internalized weight stigma as a mediator in the relationship between perceived weight stigma and changes in body mass index (BMI). The data were collected through a longitudinal online survey with two phases (n = 974; Phase 1: August and September 2021; Phase 2: November and December 2021). The Perceived Weight Stigma Scale (PWSS), Weight Self-Stigma Questionnaire (WSSQ), and Depression, Anxiety, Stress Scale - 21 (DASS-21) were administered to assess perceived weight stigma, internalized weight stigma, and psychological distress. Hierarchical regressions were used to examine the proposed model, and Hayes' Process Macro was used to test a mediation model. RESULTS The changes in perceived weight stigma and internalized weight stigma were significantly and positively associated with changes in BMI. There were significant and positive associations between perceived weight stigma, internalized weight stigma and psychological distress over time. Change in internalized weight stigma was found to be a significant mediator in the association of change in perceived weight stigma with change in BMI for the entire sample (unstandardized coefficient = 0.04; 95% CI = 0.02, 0.06), female subgroup (unstandardized coefficient = 0.05; 95% CI = 0.02, 0.08), and male subgroup (unstandardized coefficient = 0.03; 95% CI = 0.01, 0.06). Change in perceived weight stigma also had significant effects on change in BMI for the entire sample and the female subgroup, but not for the male subgroup. CONCLUSION Because perceived weight stigma may significantly impact changes in BMI through internalized weight stigma, treatment strategies to ameliorate self-stigma may enhance the results of weight-reduction programs. Such treatment strategies should be considered for inclusion in weight-loss interventions.
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Affiliation(s)
- Yi-Ching Lin
- Department of Early Childhood and Family Education, National Taipei University of Education, Taipei, 106320, Taiwan
| | - Chung-Ying Lin
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, 1 University Rd, Tainan, 701, Taiwan.
- University of Religions and Denominations, Qom, Iran.
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
- Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Mohsen Saffari
- Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Health Education Department, Faculty of Health, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Meng-Che Tsai
- Department of Pediatrics, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
- Department of Medical Humanities and Social Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yun-Hsuan Chang
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Psychology, National Cheng Kung University, Tainan, Taiwan
| | - Carol Strong
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ji-Kang Chen
- Department of Social Work, Chinese University of Hong Kong, New Territories, Hong Kong, China
| | - Yi-Ping Hsieh
- Department of Social Work, College of Nursing and Professional Disciplines, University of North Dakota, Grand Forks, ND, USA
| | - Yung-Ning Yang
- Department of Pediatrics, E-DA Hospital, I-Shou University, Kaohsiung, Taiwan.
- School of Medicine, I-Shou University, Kaohsiung, Taiwan.
| | - Janet D Latner
- Department of Psychology, University of Hawaii at Manoa, Honolulu, HI, USA
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47
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Wetzel KE, Himmelstein MS. Constant vigilance: The impact of weight stigma, vigilance, and internalization on maladaptive eating behaviors. Health Psychol 2023; 42:712-722. [PMID: 37639227 DOI: 10.1037/hea0001324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
OBJECTIVE Weight stigma (social devaluation because of weight) and weight bias internalization (self-stigma due to weight) have been independently implicated in maladaptive eating, which ultimately contributes to poor cardiometabolic health. Additionally, vigilance (being on the lookout for social devaluation) is connected to stress, poor sleep, and depression. Most research considers these factors separately but establishing how these variables interact with one another is essential to understanding their cumulative impact on health behaviors. METHOD Using a diverse national panel of adults in the United States (N = 1,051), this study tested several statistical moderated mediations in which weight stigma was both directly associated with maladaptive eating and indirectly associated with maladaptive eating via vigilance. We simultaneously examined whether the relationship between weight stigma and vigilance was moderated by self-stigma. RESULTS Results indicated that experiencing weight stigma was directly related to each of the maladaptive eating behaviors (eating to cope, restrictive dieting frequency, and binge eating). Weight stigma was also indirectly related to each eating behavior through vigilance; this indirect relationship was stronger among those with high levels of weight bias internalization, compared to those with low levels of weight bias internalization. Race moderated the relationship between weight stigma and vigilance, such that participants identifying as Black had a stronger relationship between them. CONCLUSIONS These results provide support for a theoretical model which explains how weight stigma, self-stigma, and vigilance interact with one another to produce negative health behaviors and highlight the importance of further investigation of vigilance in the context of weight stigma. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Karen E Wetzel
- Department of Psychological Sciences, Kent State University
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48
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Ryan L, Coyne R, Heary C, Birney S, Crotty M, Dunne R, Conlan O, Walsh JC. Weight stigma experienced by patients with obesity in healthcare settings: A qualitative evidence synthesis. Obes Rev 2023; 24:e13606. [PMID: 37533183 DOI: 10.1111/obr.13606] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 06/28/2023] [Accepted: 07/03/2023] [Indexed: 08/04/2023]
Abstract
Weight stigma research is largely focused on quantifiable outcomes with inadequate representation of the perspectives of those that are affected by it. This study offers a comprehensive systematic review and synthesis of weight stigma experienced in healthcare settings, from the perspective of patients living with obesity. A total of 1340 studies was screened, of which 32 were included in the final synthesis. Thematic synthesis generated three overarching analytical themes: (1) verbal and non-verbal communication of stigma, (2) weight stigma impacts the provision of care, and (3) weight stigma and systemic barriers to healthcare. The first theme relates to the communication of weight stigma perceived by patients within patient-provider interactions. The second theme describes the patients' perceptions of how weight stigma impacts upon care provision. The third theme highlighted the perceived systemic barriers faced by patients when negotiating the healthcare system. Patient suggestions to reduce weight stigma in healthcare settings are also presented. Weight stigma experienced within interpersonal interactions migrates to the provision of care, mediates gaining equitable access to services, and perpetuates a poor systemic infrastructure to support the needs of patients with obesity. A non-collaborative approach to practice and treatment renders patients feeling they have no control over their own healthcare requirements.
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Affiliation(s)
- Leona Ryan
- School of Psychology, University of Galway, Galway, Ireland
| | - Rory Coyne
- School of Psychology, University of Galway, Galway, Ireland
| | - Caroline Heary
- School of Psychology, University of Galway, Galway, Ireland
| | - Susie Birney
- Irish Coalition for People Living with Obesity (ICPO), Dublin, Ireland
| | | | - Rosie Dunne
- James Hardiman Library, University of Ireland, Galway, Ireland
| | - Owen Conlan
- School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
| | - Jane C Walsh
- School of Psychology, University of Galway, Galway, Ireland
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Hughes AM, McArthur D. Weight stigma, welfare stigma, and political values: Evidence from a representative British survey. Soc Sci Med 2023; 334:116172. [PMID: 37696238 PMCID: PMC7615479 DOI: 10.1016/j.socscimed.2023.116172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 09/13/2023]
Abstract
Obesity-related stigma is increasingly recognised as a public health issue, with serious implications for mental and physical health. However, very little is known about what drives inter-individual differences in obesity-stigmatizing views, and how they are distributed in the population. If views about obesity are not independent of a person's wider beliefs and values, this must be understood so that obesity stigma can be effectively tackled. In a representative sample of British adults aged 18-97 (N = 2186), we explore predictors of weight-stigmatizing attitudes. We consider demographics, socioeconomic position, factors related to one's own weight and health, and beliefs about the causes and consequences of obesity. We explore the role of core political values which predict views about other stigmatized groups, and views about welfare recipients, who are frequently linked with obesity in public and political discourse. Finally, we assess to what extent demographic differences in weight-stigmatizing attitudes are explained by individual body mass index (BMI), attitudes, and beliefs. Consistent with previous studies, women were less weight-stigmatizing than men. People in late middle-age were less weight-stigmatizing than younger or older adults. Adjusted for age and gender, an index of weight-stigmatizing views was positively associated with income, and highest in intermediate categories of education and occupational social class. Weight-stigmatizing attitudes were associated with more right-wing values, more authoritarian values, and more stigmatizing views about welfare recipients. Factors including own BMI, beliefs about causes of obesity, welfare-stigmatizing attitudes and authoritarian values contributed to socioeconomic differences. Weight-stigmatizing attitudes show clear differences between demographic groups, but also vary according to wider social attitudes, beliefs, and a person's core political values. Efforts to reduce weight stigma, and other kinds of stigma, may be more effective if they recognise these links.
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Affiliation(s)
- Amanda M Hughes
- MRC Integrative Epidemiology Unit, Department of Population Health Sciences, University of Bristol, UK.
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50
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Gordon AR, Egan KA, Wang ML, Ziyadeh NJ, Kenney EL, Rosario M, Austin SB. Weight-based discrimination and disordered eating behaviors in a cohort of U.S. sexual minority young adults. Int J Eat Disord 2023; 56:1983-1990. [PMID: 37345224 PMCID: PMC10592576 DOI: 10.1002/eat.24015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 06/08/2023] [Accepted: 06/08/2023] [Indexed: 06/23/2023]
Abstract
OBJECTIVE Though prevalent, weight-based discrimination is understudied and has been linked to disordered eating behaviors (DEB) among adolescents and adults. Sexual minority populations experience elevated risk of DEB, but little is known about the role of weight discrimination in this elevated risk. METHODS Participants were 1257 sexual minority women and men (ages 18-31 years) in the US Growing Up Today Study cohort. We examined cross-sectional associations between weight discrimination victimization and three DEB in the past year: unhealthy weight control behaviors, overeating, and binge eating. Generalized estimating equations, adjusted for potential confounders, were used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs). RESULTS Three in 10 participants (31%) reported weight-based discrimination victimization. Sexual minority young adults who reported weight-based discrimination had greater relative prevalence of unhealthy weight control behaviors (PR [95% CI]: 1.92 [1.35, 2.74]), overeating (3.15 [2.24, 4.44]), and binge eating (3.92 [2.51, 6.13]), compared with those who reported no weight-based discrimination. Associations with overeating and binge eating remained significant after adjusting for BMI. DISCUSSION The role of weight-based discrimination, and its intersections with other forms of stressors for sexual minority young adults, must be included in efforts to advance eating disorder prevention for this underserved population. PUBLIC SIGNIFICANCE Three in 10 sexual minority young adults in this study had experienced weight-based discrimination, a common but understudied form of discrimination. Sexual minority young adults who experienced weight-based discrimination were at greater risk of disordered eating behaviors than those who had not experienced weight-based discrimination. These findings suggest that weight-based discrimination may be an important-and preventable-risk factor for disordered eating behaviors among sexual minority young adults.
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Affiliation(s)
- Allegra R. Gordon
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Kelsey A. Egan
- Division of General Academic Pediatrics, Department of Pediatrics, Boston Medical Center, Boston University School of Medicine
| | - Monica L. Wang
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
- Office of Narrative, Boston University Center for Antiracist Research, Boston, MA, USA
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Najat J. Ziyadeh
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
| | - Erica L. Kenney
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Margaret Rosario
- Department of Psychology, City University of New York—City College and Graduate Center, New York, NY, USA
| | - S. Bryn Austin
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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