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Tahrani AA, Panova-Noeva M, Schloot NC, Hennige AM, Soderberg J, Nadglowski J, Tarasenko L, Ahmad NN, Sleypen BS, Bravo R, Al-Najim W, le Roux CW. Stratification of obesity phenotypes to optimize future therapy (SOPHIA). Expert Rev Gastroenterol Hepatol 2023; 17:1031-1039. [PMID: 37791820 DOI: 10.1080/17474124.2023.2264783] [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: 03/20/2023] [Accepted: 09/26/2023] [Indexed: 10/05/2023]
Abstract
INTRODUCTION Obesity is considered a poor lifestyle choice. 'Obesity' is not a sufficient definition for patients, any more than 'cancer' or 'arthritis' would be. A major obstacle is the lack of understanding of pathogenesis. The disease of obesity is considered homogenous, while response to treatment is thought of as heterogeneous. This can change if pathogenesis, risk profiles for complications, and treatment responses are viewed within the context of obesity consisting of several subsets of disease. AREAS COVERED The European Union-funded Innovative Medicine Initiative project Stratification of Obesity Phenotypes to Optimize Future Obesity Therapy is part of a momentum shift. Operational variables are being used to develop tests and therapies which may allow the prediction of risk of obesities and the prediction of response to obesity treatments. However, changing stakeholder perspectives on obesity may require more than high-quality data and analysis. EXPERT OPINION For patients to benefit, clinicians need to integrate evidence-based treatments and payers need to reimburse the management of the disease of obesity. This will generate commercial opportunities for industry. We need to involve stakeholders (patients, clinicians, regulators, payer, patient organisations) to create a shared value for mutual gain.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Werd Al-Najim
- Diabetes Complications Research Centre, University College Dublin, Dublin, Ireland
| | - Carel W le Roux
- Diabetes Complications Research Centre, University College Dublin, Dublin, Ireland
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2
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Abstract
Weight stigma impacts negatively healthcare quality and hinders public health goals. The aim of this review was to identify strategies for minimizing weight bias among healthcare professionals and explore future research directions. An electronic search was performed in PubMed, PsycINFO and Scopus (until June 2020). Studies on weight stigma reduction in healthcare students, trainees and professionals were assessed based on specific inclusion and exclusion criteria. A narrative synthesis was undertaken to analyze emerging themes. We identified five stigma reduction strategies in healthcare: (i) increased education, (ii) causal information and controllability, (iii) empathy evoking, (iv) weight-inclusive approach, and (v) mixed methodology. Weight stigma needs to be addressed early on and continuously throughout healthcare education and practice, by teaching the genetic and socioenvironmental determinants of weight, and explicitly discussing the sources, impact and implications of stigma. There is a need to move away from a solely weight-centric approach to healthcare to a health-focused weight-inclusive one. Assessing the effects of weight stigma in epidemiological research is equally important. The ethical argument and evidence base for the need to reduce weight stigma in healthcare and beyond is strong. Although evidence on long-term stigma reduction is emerging, precautionary action is needed.
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Affiliation(s)
- Britta Talumaa
- Division of Medicine, University College London, London, UK
| | - Adrian Brown
- Division of Medicine, University College London, London, UK.,Centre for Obesity Research, University College London, London, UK.,Bariatric Centre for Weight Management and Metabolic Surgery, University College London Hospital NHS Trust, London, UK.,UCLH Biomedical Research Centre, National Institute of Health Research, London, UK
| | - Rachel L Batterham
- Division of Medicine, University College London, London, UK.,Centre for Obesity Research, University College London, London, UK.,Bariatric Centre for Weight Management and Metabolic Surgery, University College London Hospital NHS Trust, London, UK.,UCLH Biomedical Research Centre, National Institute of Health Research, London, UK
| | - Anastasia Z Kalea
- Division of Medicine, University College London, London, UK.,Institute of Cardiovascular Science, University College London, London, UK
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3
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Hoffmann K, Paczkowska A, Bryl W, Marzec K, Raakow J, Pross M, Berghaus R, Nowakowska E, Kus K, Michalak M. Comparison of Perceived Weight Discrimination between Polish and German Patients Underwent Bariatric Surgery or Endoscopic Method versus Conservative Treatment for Morbid Obesity: An International Multicenter Study. Nutrients 2022; 14:nu14132775. [PMID: 35807955 PMCID: PMC9268827 DOI: 10.3390/nu14132775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 06/29/2022] [Accepted: 07/02/2022] [Indexed: 02/04/2023] Open
Abstract
Objectives: The aim of this study was to compare the level of discrimination among patients with obesity living in Poland and Germany. Methods: This was a retrospective cross-sectional international multicenter survey study including 564 adult participants treated for morbid obesity at selected healthcare facilities in Germany (210 patients) and in Poland (354 patients). Discrimination was evaluated using a custom-made questionnaire based on the related literature. Results: The level of obesity discrimination did not differ between German and Polish patients (p = 0.4282). The presence of obesity was reported to be associated to a large or a very large extent with the feeling of social exclusion and discrimination by 46.63% of German participants and 42.09% of Polish ones (p = 0.2934). The mean level of discrimination related to the lack of employment was higher in patients who underwent bariatric surgery or endoscopic method than in those who underwent conservative treatment (for Germany: 2.85 ± 1.31 (median, 3) vs. 2.08 ± 1.31 (median, 1), p = 0.002; for Poland: 2.43 ± 1.15 (median, 2) vs. 1.93 ± 1.15 (median, 1), p = 0.005). The level of discrimination was associated with sex, age, the degree of obesity, and treatment-related weight loss (p < 0.05). Conclusions: Our findings confirm that obesity significantly affects the social and economic well-being of patients. There is a great need to reduce weight stigma and to take measures to alleviate the socioeconomic and psychological burden of obesity.
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Affiliation(s)
- Karolina Hoffmann
- Department of Internal Diseases, Metabolic Disorders and Arterial Hypertension, Poznan University of Medical Sciences, 60-806 Poznań, Poland;
- Correspondence: ; Tel.: +48-61-8549-377; Fax: +48-61-8478-529
| | - Anna Paczkowska
- Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, 60-806 Poznań, Poland; (A.P.); (K.M.); (K.K.)
| | - Wiesław Bryl
- Department of Internal Diseases, Metabolic Disorders and Arterial Hypertension, Poznan University of Medical Sciences, 60-806 Poznań, Poland;
| | - Kinga Marzec
- Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, 60-806 Poznań, Poland; (A.P.); (K.M.); (K.K.)
| | - Jonas Raakow
- Department of Surgery, Campus Charité Mitte, Campus Virchow Klinikum, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany;
| | - Matthias Pross
- Department of Surgery, DRK Kliniken Berlin, Köpenick, 12559 Berlin, Germany; (M.P.); (R.B.)
| | - Rafael Berghaus
- Department of Surgery, DRK Kliniken Berlin, Köpenick, 12559 Berlin, Germany; (M.P.); (R.B.)
| | - Elżbieta Nowakowska
- Department of Pharmacology and Toxicology, Institute of Health Sciences, Collegium Medicum, University of Zielona Góra, 65-516 Zielona Góra, Poland;
| | - Krzysztof Kus
- Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, 60-806 Poznań, Poland; (A.P.); (K.M.); (K.K.)
| | - Michał Michalak
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, 60-806 Poznań, Poland;
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4
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Kirk SF, Forhan M, Yusuf J, Chance A, Burke K, Blinn N, Quirke S, Salas XR, Alberga A, Russell-Mayhew S. Mapping changes in the obesity stigma discourse through Obesity Canada: a content analysis. AIMS Public Health 2022; 9:41-52. [PMID: 35071667 PMCID: PMC8755959 DOI: 10.3934/publichealth.2022004] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/25/2021] [Indexed: 11/18/2022] Open
Abstract
Background Stigmatization of persons living with obesity is an important public health issue. In 2015, Obesity Canada adopted person-first language in all internal documentation produced by the organization, and, from 2017, required all authors to use person-first language in abstract submissions to Obesity Canada hosted conferences. The impact of this intentional shift in strategic focus is not known. Therefore, the aim of this study was to conduct a content analysis of proceedings at conferences hosted by Obesity Canada to identify whether or how constructs related to weight bias and obesity stigma have changed over time. Methods Of 1790 abstracts accepted to conferences between 2008–2019, we excluded 353 abstracts that featured animal or cellular models, leaving 1437 abstracts that were reviewed for the presence of five constructs of interest and if they changed over time: 1) use of person-first versus use of disease-first terminology, 2) incorporation of lived experience of obesity, 3) weight bias and stigma, 4) aggressive or alarmist framing and 5) obesity framed as a modifiable risk factor versus as a disease. We calculated and analyzed through linear regression: 1) the overall frequency of use of each construct over time as a proportion of the total number of abstracts reviewed, and 2) the ratio of abstracts where the construct appeared at least once based on the total number of abstracts. Results We found a significant positive correlation between use of person-first language in abstracts and time (R2 = 0.51, p < 0.01 for frequency, R2 = 0.65, p < 0.05 for ratio) and a corresponding negative correlation for the use of disease-first terminology (R2 = 0.48, p = 0.01 for frequency, R2 = 0.75, p < 0.001 for ratio). There was a significant positive correlation between mentions of weight bias and time (R2 = 0.53 and 0.57, p < 0.01 for frequency and ratio respectively). Conclusion Use of person-first language and attention to weight bias increased, while disease-first terminology decreased in accepted abstracts over the past 11 years since Obesity Canada began hosting conferences and particularly since more explicit actions for expectations to use person-first language were put in place in 2015 and 2017.
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Affiliation(s)
- Sara Fl Kirk
- Healthy Populations Institute, Dalhousie University, PO Box 150000, Halifax, B3H 4R2, Canada.,School of Health and Human Performance, Faculty of Health, Dalhousie University, PO Box 150000, Halifax, NS, B3H 4R2, Canada
| | - Mary Forhan
- Faculty of Rehabilitation Medicine, Department of Occupational Therapy, Corbett Hall, University of Alberta, 11405 87 Avenue NW, Edmonton, AB, T6H 2G4, Canada
| | - Joshua Yusuf
- Healthy Populations Institute, Dalhousie University, PO Box 150000, Halifax, B3H 4R2, Canada.,School of Health and Human Performance, Faculty of Health, Dalhousie University, PO Box 150000, Halifax, NS, B3H 4R2, Canada
| | - Ashly Chance
- Faculty of Rehabilitation Medicine, Department of Occupational Therapy, Corbett Hall, University of Alberta, 11405 87 Avenue NW, Edmonton, AB, T6H 2G4, Canada
| | - Kathleen Burke
- Healthy Populations Institute, Dalhousie University, PO Box 150000, Halifax, B3H 4R2, Canada.,School of Health and Human Performance, Faculty of Health, Dalhousie University, PO Box 150000, Halifax, NS, B3H 4R2, Canada
| | - Nicole Blinn
- Healthy Populations Institute, Dalhousie University, PO Box 150000, Halifax, B3H 4R2, Canada.,School of Health and Human Performance, Faculty of Health, Dalhousie University, PO Box 150000, Halifax, NS, B3H 4R2, Canada
| | - Stephanie Quirke
- Healthy Populations Institute, Dalhousie University, PO Box 150000, Halifax, B3H 4R2, Canada.,School of Health and Human Performance, Faculty of Health, Dalhousie University, PO Box 150000, Halifax, NS, B3H 4R2, Canada
| | - Ximena Ramos Salas
- Research and Policy Consultant, Rönnebergsvägen 116, 29891 Tollarp, Sweden
| | - Angela Alberga
- Department of Health, Kinesiology and Applied Physiology, Concordia University, 7141 Sherbrooke Street West, Montreal, Quebec, H4B1R6 Canada
| | - Shelly Russell-Mayhew
- Werklund School of Education, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
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Sobczak K, Leoniuk K. Attitudes of Medical Professionals Towards Discrimination of Patients with Obesity. Risk Manag Healthc Policy 2021; 14:4169-4175. [PMID: 34675711 PMCID: PMC8504468 DOI: 10.2147/rmhp.s317808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 09/16/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Many studies show that discriminatory practices are common in healthcare institutions, also in the form of medical staff’s inappropriate behaviour. Weight stigma may not only become a source of unpleasant experience for the patients but also cause them to withdraw from the treatment, which may further exacerbate their condition. Patients and Methods In a nationwide study, we asked 184 medical professionals, about their experiences and opinions on the discrimination of patients with obesity. The study was conducted in 2020, with the use of CAWI method, based on an original survey created for this study. Results Most of the medical professionals (68.5%) estimated that the problem of worse attitudes towards patients suffering from obesity is a common phenomenon. About 48.4% witnessed medical staff’s discriminatory behaviours. The most frequent forms of inappropriate behaviours pertained to interpersonal relations – mocking the appearance (96.6%), looks of disgust and repulsion (96.2%), lack of reaction to offensive remarks (92.0%) or scaring a patient with the necessity to lose weight (57.7%). The participants of the study pointed to limited access to dedicated medical equipment (62.4%) as a discriminatory systemic limitation. Conclusion Discrimination of patients with obesity is a social issue, which also occurs within the health care system. Limited access to medical resources, gaps in knowledge of obesity and an insufficient level of soft skills in health care professionals are the key deficiencies, which hinder effective treatment.
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Affiliation(s)
- Krzysztof Sobczak
- Department of Sociology of Medicine and Social Pathology, Medical University of Gdansk, Gdansk, Poland
| | - Katarzyna Leoniuk
- Department of Sociology of Medicine and Social Pathology, Medical University of Gdansk, Gdansk, Poland
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Abstract
Weight stigma is rooted in a fundamental misunderstanding of the origins of obesity, wherein the interplay of behavioral, environmental, genetic, and metabolic factors is deemphasized. Instead, the widespread societal and cultural presence of weight stigma fosters misconceptions of obesity being solely a result of unhealthy personal choices. Weight stigma is pervasive in childhood and adolescence and can affect individuals throughout their life. Although the prevalence of pediatric obesity remains high throughout the world, it becomes increasingly important to understand how weight stigma affects weight and health outcomes in children and adolescents with overweight or obesity, including in those with rare genetic diseases of obesity. We identified and reviewed recent literature (primarily published since 2000) on weight stigma in the pediatric setting. Articles were identified with search terms including pediatric obesity, weight bias, weight stigma, weight-based teasing and bullying, and weight bias in health care. In this narrative review, we discuss the stigma of pediatric obesity as it relates to the complex etiology of obesity as well as describe best practices for avoiding bias and perpetuating stigma in the health care setting.
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Affiliation(s)
- Andrea M. Haqq
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Alberta, Edmonton, Alberta, Canada.,Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada.,Address correspondence to: Andrea M. Haqq, MD, MHS, FRCP(C), FAAP, Department of Pediatrics, Division of Pediatric Endocrinology, University of Alberta, 1C4 Walter C. Mackenzie Health Sciences Center, 8440 112 Street NW, Edmonton, Alberta T6G 2B7, Canada
| | - Maryam Kebbe
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Qiming Tan
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Alberta, Edmonton, Alberta, Canada
| | - Melania Manco
- Unit for Multifactorial Diseases and Complex Phenotypes, Bambino Gesù Children's Hospital, Rome, Italy
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7
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Abstract
Pain is prevalent among individuals with overweight or obesity but few studies have examined the mechanism linking pain with excess body weight. Because there is evidence that social and physical pain may be processed through similar physiological mechanisms, weight-stigma may potentiate the experience of physical pain through shared neuroanatomical pathways. This study evaluated the relationship between perceived weight stigma and self-reported bodily pain in a sample of overweight and obese adult women. Sixty-one women with a body mass index (BMI) between 25-35 completed self-report questionnaires assessing perceived stigma, internalized weight stigma, and self-reported pain. Height and weight were measured and participants completed a demographic and health history questionnaire. Hierarchical regression analyses were utilized to predict self-reported pain from perceived stigma, adjusting for demographic variables associated with self-reported pain as well as pain-related conditions. Perceived stigma was associated with pain F(6, 54)=6.10, p<.001) as was internalized stigma. Perceived stigma mediated the relationship between BMI and bodily pain among individuals with a BMI in the overweight range but not among individuals with a BMI in the obese range. Weight-related stigma among women with overweight or obesity appears to be associated with greater experience of physical pain. These results underscore the need to evaluate multiple mechanisms that might explain the relationship between bodily pain and body weight and to determine how the relationship may vary across different subgroups of individuals.
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8
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Ramos Salas X, Forhan M, Caulfield T, Sharma AM, Raine KD. Addressing Internalized Weight Bias and Changing Damaged Social Identities for People Living With Obesity. Front Psychol 2019; 10:1409. [PMID: 31293476 PMCID: PMC6606721 DOI: 10.3389/fpsyg.2019.01409] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 05/31/2019] [Indexed: 11/13/2022] Open
Abstract
Obesity is a stigmatized disease due to pervasive personal, professional, institutional, and cultural weight bias. Individuals with obesity experience weight bias across their lifespan and settings, which can affect their life chances and significantly impact health and social outcomes. The objectives of this study were to: (a) explore weight bias and stigma experiences of people living with obesity; (b) develop counterstories that can reduce weight bias and stigma; and (c) reflect on current obesity master narratives and identify opportunities for personal, professional, and social change. Methods: Using purposive sampling, we lived alongside and engaged persons with obesity (n = 10) in a narrative inquiry on weight bias and obesity stigma. We co-developed interim narrative accounts while applying the three-dimensional narrative inquiry space: (a) temporality; (b) sociality; and (c) place, to find meaning in participants’ experiences. We also applied the narrative repair model to co-create counterstories to resist oppressive master narratives for participants and for people living with obesity in general. Results: We present 10 counterstories, which provide a window into the personal, familial, professional, and social contexts in which weight bias and obesity stigma take place. Discussion: A fundamental driver of participants’ experiences with weight bias is a lack of understanding of obesity, which can lead to internalized weight bias and stigma. Weight bias internalization impacted participants’ emotional responses and triggered feelings of shame, blame, vulnerability, stress, depression, and even suicidal thoughts and acts. Participants’ stories revealed behavioral responses such as avoidance of health promoting behaviors and social isolation. Weight bias internalization also hindered participants’ obesity management process as well as their rehabilitation and recovery strategies. Participants embraced recovery from internalized weight bias by developing self-compassion and self-acceptance and by actively engaging in efforts to resist damaged social identities and demanding respect, dignity, and fair treatment. Conclusion: Narrative inquiry combined with the narrative repair model can be a transformative way to address internalized weight bias and to resist damaged social identities for people living with obesity. By examining experiences, beliefs, values, practices, and relationships that contribute to dominant obesity narratives, we can begin to address some of the socially and institutionally generated negative views of individuals with obesity.
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Affiliation(s)
| | - Mary Forhan
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Timothy Caulfield
- Faculty of Law and School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Arya M Sharma
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Kim D Raine
- Obesity Canada, University of Alberta, Edmonton, AB, Canada
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9
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Daly M, Sutin AR, Robinson E. Perceived Weight Discrimination Mediates the Prospective Association Between Obesity and Physiological Dysregulation: Evidence From a Population-Based Cohort. Psychol Sci 2019; 30:1030-1039. [PMID: 31158067 DOI: 10.1177/0956797619849440] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Obesity is thought to cause ill health because of the biological strain that excess fat has on physiological function. We tested an alternative explanation in a population-based sample of 3,609 older English adults-that the pervasive discrimination experienced by individuals with excess weight may in part explain why obesity is associated with subsequent multisystem physiological dysregulation, measured via clinical indicators of cardiovascular, metabolic, and immune function. We found that both obesity and perceived weight discrimination predicted an increase in physiological dysregulation from baseline to follow-up 4 years later. Perceived discrimination because of body weight experienced by individuals with obesity explained more than one quarter of the prospective association between obesity and a deterioration in biomarkers of health status. These findings highlight the possibility that the stigma experienced by individuals with obesity may play an important role in explaining the obesity-related disease burden.
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Affiliation(s)
- Michael Daly
- 1 Department of Psychology, Maynooth University.,2 UCD Geary Institute for Public Policy, University College Dublin
| | - Angelina R Sutin
- 3 Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine
| | - Eric Robinson
- 4 Department of Psychological Sciences, Institute of Population Health Sciences, University of Liverpool
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10
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Di Battista EM, Bracken RM, Stephens JW, Rice S, Williams SP, Thomas M, Mellalieu SD. Cardiovascular risk assessments at occupational health services: employee experiences. Occup Med (Lond) 2019; 69:106-112. [PMID: 30476220 DOI: 10.1093/occmed/kqy156] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Across England in the UK, population screening for cardiovascular disease (CVD) primarily takes place within general practice in the form of the National Health Service Health Check. Additional screening sites such as occupational health are advocated to improve the population impact. AIMS To investigate participant experiences with cardiovascular and type 2 diabetes risk assessment (RA) at occupational health and subsequent support-seeking at general practice. METHODS Face-to-face interviews were conducted for this qualitative study. Participants were recruited at three workplaces; a steel works and two hospital sites. Using interpretive phenomenological analyses, themes were drawn from salient narratives and categorically organized. RESULTS There were 29 participants. Themes (n = 16) were organized into two domains; factors that facilitated (n = 9) or thwarted (n = 7) participant engagement with the RA and general practice. All participants described the RA as worthwhile and strongly valued RA at occupational health. Those with obesity and high CVD risk highlighted their difficulties in making lifestyle changes. Participants reported confusion and anxiety when GP advice about medication appeared to contradict what participants had interpreted during RA at occupational health. CONCLUSIONS This study highlights factors that facilitate or thwart engagement in cardiovascular RA at occupational health services and general practice follow-up. Stakeholders can integrate these factors into standard operating procedures to enhance participant engagement and enable safeguards that minimize potential harm to participants.
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Affiliation(s)
- E M Di Battista
- Aneurin Bevan University Health Board, Adult Weight Management Service, Saint Cadoc's Hospital, Caerleon, Newport, UK.,University of South Wales, Faculty of Life Sciences and Education, Pontypridd, UK
| | - R M Bracken
- Applied Sports Technology Exercise and Medicine (A-STEM) Research Centre, College of Engineering, Swansea University, Swansea University Bay Campus, Swansea, UK.,Diabetes Research Group, Swansea University Medical School, Swansea University, Singleton Park, Swansea, UK
| | - J W Stephens
- Diabetes Research Group, Swansea University Medical School, Swansea University, Singleton Park, Swansea, UK
| | - S Rice
- Hywel Dda Health Board, Diabetes Centre, Prince Philip Hospital, Llanelli, Carmarthenshire, UK
| | - S P Williams
- TATA Steel Packaging Recycling, Trostre, Llanelli, Carmarthenshire, UK
| | - M Thomas
- Public Health Wales, Carmarthen, Carmarthenshire, UK
| | - S D Mellalieu
- Cardiff Metropolitan University, Cardiff School of Sport and Health Sciences, Cyncoed Campus, Cardiff, UK
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11
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Robinson E, Sutin A, Daly M. Perceived weight discrimination mediates the prospective relation between obesity and depressive symptoms in U.S. and U.K. adults. Health Psychol 2017; 36:112-121. [PMID: 27748611 PMCID: PMC5267562 DOI: 10.1037/hea0000426] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 07/25/2016] [Accepted: 07/27/2016] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Obesity has been shown to increase risk of depression. Persons with obesity experience discrimination because of their body weight. Across 3 studies, we tested for the first time whether experiencing (perceived) weight-based discrimination explains why obesity is prospectively associated with increases in depressive symptoms. METHOD Data from 3 studies, including the English Longitudinal Study of Ageing (2008/2009-2012/2013), the Health and Retirement Study (2006/2008-2010/2012), and Midlife in the United States (1995/1996-2004/2005), were used to examine associations between obesity, perceived weight discrimination, and depressive symptoms among 20,286 U.S. and U.K. adults. RESULTS Across all 3 studies, Class II and III obesity were reliably associated with increases in depressive symptoms from baseline to follow-up. Perceived weight-based discrimination predicted increases in depressive symptoms over time and mediated the prospective association between obesity and depressive symptoms in all 3 studies. Persons with Class II and III obesity were more likely to report experiencing weight-based discrimination, and this explained approximately 31% of the obesity-related increase in depressive symptoms on average across the 3 studies. CONCLUSION In U.S. and U.K. samples, the prospective association between obesity (defined using body mass index) and increases in depressive symptoms in adulthood may in part be explained by perceived weight discrimination. (PsycINFO Database Record
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Affiliation(s)
- Eric Robinson
- Department of Psychological Sciences, Institute of Psychology, Health & Society, University of Liverpool
| | | | - Michael Daly
- Behavioural Science Centre, Stirling Management School, University of Stirling
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12
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Tanneberger A, Ciupitu-Plath C. Nurses' Weight Bias in Caring for Obese Patients: Do Weight Controllability Beliefs Influence the Provision of Care to Obese Patients? Clin Nurs Res 2017; 27:414-432. [PMID: 28052689 DOI: 10.1177/1054773816687443] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Given the pervasive stigma faced by obese individuals in family, work, and health care settings, the present study aimed to explore whether nurses' weight controllability beliefs influence their perception of how care is provided to obese patients. To this end, 73 nurses from an acute care hospital completed the Weight Control/Blame Subscale of the Antifat Attitudes Test and reported on their perception of discrimination in, and available resources for, the provision of care to obese patients. Nurses endorsing stronger beliefs that weight lies under individual control were more likely to report discrimination of obese patients in clinical practice. Weight bias, higher care intensity, and lack of necessary resources were the main reasons reported for perceived weight discrimination. Our results support theories placing internal attribution of overweight and conflict over resources at the origin of weight stigma and call for appropriate interventions to improve nurses' work environment and reduce their weight bias.
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Abstract
In this paper, we explore barriers to health for fat people. By shifting the focus from what fat people do or do not do, neoliberal principles are replaced by a focus instead on structural and institutional policies, attitudes, and practices. This includes the impact of stigma on the health treatment and health-seeking behavior of fat people. For example, we consider the role that provider anti-fat attitudes and confirmation bias play in the failure to provide evidenced-based healthcare to fat patients. This is an autoethnographic paper, which provides the opportunity to read research from the perspective of fat scholars, framed by questions such as: can fat people have health? Is health itself a state of being, a set of behaviors, a commodity, a performance; perhaps the new social contract? As a co-written autoethnographic paper, one aspect of the evidence provided is the recorded experiences of the two fat authors. This includes writing from notes, journals, compiled and repeated experiences with medical professionals, family, and the community. Framed by feminist standpoint and supported by literature drawn from Fat Studies, Public Health, Obesity Research, and other interdisciplinary fields, this is a valuable opportunity to present an extended account of fat discrimination and the impact of the stigma fat people face through the medical profession and other sectors of the community, written by fat individuals. The paper concludes by considering the health pathways available to fat people. Special attention is paid to whether Bacon and Aphramor's Health at Every Size paradigm provides a path to health for fat individuals.
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Affiliation(s)
- Jennifer A Lee
- College of Arts, Victoria University Melbourne, VIC, Australia
| | - Cat J Pausé
- College of Humanities and Social Sciences, Institute of Education, Massey University Palmerston North, New Zealand
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Rankin J, Matthews L, Cobley S, Han A, Sanders R, Wiltshire HD, Baker JS. Psychological consequences of childhood obesity: psychiatric comorbidity and prevention. Adolesc Health Med Ther 2016; 7:125-146. [PMID: 27881930 PMCID: PMC5115694 DOI: 10.2147/ahmt.s101631] [Citation(s) in RCA: 291] [Impact Index Per Article: 36.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Childhood obesity is one of the most serious public health challenges of the 21st century with far-reaching and enduring adverse consequences for health outcomes. Over 42 million children <5 years worldwide are estimated to be overweight (OW) or obese (OB), and if current trends continue, then an estimated 70 million children will be OW or OB by 2025. The purpose of this review was to focus on psychiatric, psychological, and psychosocial consequences of childhood obesity (OBy) to include a broad range of international studies. The aim was to establish what has recently changed in relation to the common psychological consequences associated with childhood OBy. A systematic search was conducted in MEDLINE, Web of Science, and the Cochrane Library for articles presenting information on the identification or prevention of psychiatric morbidity in childhood obesity. Relevant data were extracted and narratively reviewed. Findings established childhood OW/OBy was negatively associated with psychological comorbidities, such as depression, poorer perceived lower scores on health-related quality of life, emotional and behavioral disorders, and self-esteem during childhood. Evidence related to the association between attention-deficit/hyperactivity disorder (ADHD) and OBy remains unconvincing because of various findings from studies. OW children were more likely to experience multiple associated psychosocial problems than their healthy-weight peers, which may be adversely influenced by OBy stigma, teasing, and bullying. OBy stigma, teasing, and bullying are pervasive and can have serious consequences for emotional and physical health and performance. It remains unclear as to whether psychiatric disorders and psychological problems are a cause or a consequence of childhood obesity or whether common factors promote both obesity and psychiatric disturbances in susceptible children and adolescents. A cohesive and strategic approach to tackle this current obesity epidemic is necessary to combat this increasing trend which is compromising the health and well-being of the young generation and seriously impinging on resources and economic costs.
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Affiliation(s)
- Jean Rankin
- Department of Maternal and Child Health, University of the West of Scotland, Paisley
| | - Lynsay Matthews
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Stephen Cobley
- Department of Exercise and Sport Science, University of Sydney, Sydney, Australia
| | - Ahreum Han
- Department of Exercise and Sport Science, University of Sydney, Sydney, Australia
| | - Ross Sanders
- Department of Exercise and Sport Science, University of Sydney, Sydney, Australia
| | - Huw D Wiltshire
- Cardiff School of Sport/Ysgol Chwaraeon Caerdydd, Cardiff Metropolitan University, Cardiff, UK
| | - Julien S Baker
- School of Science and Sport, Institute of Clinical Exercise and Health Science, University of the West of Scotland, Hamilton, Scotland
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Abstract
Overweight and obesity are escalating in epidemic proportions in the United States. Individuals with overweight and obesity are often reluctant to seek medical help, not only for weight reduction but also for any health issue because of perceived provider discrimination. Providers who are biased against individuals with obesity can hinder our nation's effort to effectively fight the obesity epidemic. By addressing weight bias in the provider setting, individuals affected by obesity may be more likely to engage in a meaningful and productive discussion of weight. Providers need to be the go-to source for obesity-focused information on new and emerging treatments.
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Affiliation(s)
- Sharon M Fruh
- Professor at the University of South Alabama in Mobile
| | | | - Heather R Hall
- Professor and Associate Dean for Academic Affairs at the University of South Alabama
| | - Sara L Davis
- Instructor at the Division of Nursing at Springhill College in Mobile, AL
| | - Errol D Crook
- Abraham A. Mitchell Professor and Chair at the Department of Internal Medicine at the University of South Alabama
| | - Kimberly Zlomke
- Assistant Professor at the Department of Psychology at the University of South Alabama
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van Leeuwen F, Hunt DF, Park JH. Is Obesity Stigma Based on Perceptions of Appearance or Character? Theory, Evidence, and Directions for Further Study. Evol Psychol 2015; 13:1474704915600565. [PMID: 37924183 PMCID: PMC10480947 DOI: 10.1177/1474704915600565] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 07/22/2015] [Indexed: 11/06/2023] Open
Abstract
Theoretical approaches to stigmatization have highlighted distinct psychological mechanisms underlying distinct instances of stigmatization. Some stigmas are based on inferences of substandard psychological character (e.g., individuals deemed untrustworthy), whereas others are based on perceptions of substandard physical appearance (e.g., individuals with physical deformities). These inferences and perceptions are associated with specific cognitive and motivational processes, which have implications for understanding specific instances of stigmatization. Recent theoretical approaches and empirical findings suggest that obesity stigma involves both inferences of substandard psychological character and perceptions of substandard physical appearance. We provide a review of the relevant evidence and discuss directions for future research.
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Affiliation(s)
| | - David Francis Hunt
- School of Experimental Psychology, University of Bristol, Bristol, United Kingdom
| | - Justin H. Park
- School of Experimental Psychology, University of Bristol, Bristol, United Kingdom
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Neil JA, Roberson DW. Enhancing nursing care by understanding the bariatric patient's journey. AORN J 2015; 102:132-40. [PMID: 26227517 DOI: 10.1016/j.aorn.2015.05.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 01/16/2015] [Accepted: 05/18/2015] [Indexed: 01/06/2023]
Abstract
Patients who undergo obesity-related bariatric surgery seek a lasting solution to weight loss and a desire for a healthier lifestyle. Perioperative nurses should be prepared to provide sensitive, high-quality care to this population. Effective assessment and management of bariatric patients involves understanding the motivating factors for seeking bariatric surgery, such as to address the stigma and health problems associated with obesity. Nurses should be knowledgeable about expected outcomes of bariatric care, including long-term processes and lifestyle changes that patients must participate in to sustain weight loss. The informed perioperative nurse is essential to the successful treatment of bariatric patients in their journey to healthier living.
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Abstract
This study examined weight bias against women in a hypothetical university acceptance scenario. One-hundred-and-ninety-eight volunteers from the community in Britain completed a weight bias measure in which they were asked to select the woman they were most and least likely to select for a place at university from an array of figures varying in body size. Participants also completed the Anti-Fat Attitudes Survey, the Short-Form of the Fat Phobia Scale, the Attitudes Toward Obese Persons Scale, and the Beliefs About Obese Persons Scale. Results showed that participants were biased against both obese (> 30 kg/m(2)) and emaciated (<15 kg/m(2)) women. Further analyses showed that weight bias was only significantly predicted by greater antipathy toward fat persons and more negative attitudes toward obese persons. These results provide evidence that the general public hold biased beliefs about access to higher educational opportunities as a function of the body size of applicants.
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Affiliation(s)
- Viren Swami
- a University of Westminster, HELP University College
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Huizinga MM, Cooper LA, Bleich SN, Clark JM, Beach MC. Physician respect for patients with obesity. J Gen Intern Med 2009; 24:1236-9. [PMID: 19763700 PMCID: PMC2771236 DOI: 10.1007/s11606-009-1104-8] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2009] [Revised: 07/28/2009] [Accepted: 08/18/2009] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Obesity stigma is common in our society, and a general stigma towards obesity has also been documented in physicians. We hypothesized that physician respect for patients would be lower in patients with higher body mass index (BMI). METHODS We analyzed data from the baseline visit of 40 physicians and 238 patients enrolled in a randomized controlled trial of patient-physician communication. The independent variable was BMI, and the outcome was physician respect for the patient. We performed Poisson regression analyses with robust variance estimates, accounting for clustering of patients within physicians, to examine the association between BMI and physician ratings of respect for particular patients. RESULTS The mean (SD) BMI of the patients was 32.9(8.1) kg/m(2). Physicians had low respect for 39% of the participants. Higher BMI was significantly and negatively associated with respect [prevalence ratio (PrR) 0.83, 95% CI: 0.73-0.95; p = 0.006; per 10 kg/m(2) increase in BMI]. BMI remained significantly associated with respect after adjustment for patient age and gender (PrR 0.86, 95%CI: 0.74-1.00; p = 0.049). CONCLUSION We found that higher patient BMI was associated with lower physician respect. Further research is needed to understand if lower physician respect for patients with higher BMI adversely affects the quality of care.
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Affiliation(s)
- Mary Margaret Huizinga
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, 2024 East Monument Street, Baltimore, MD 21205, USA.
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