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RESEARCH Current Research Weight Bias among Dietetics Students: Implications for Treatment Practices

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Background: Several studies have examined attitudes about obesity among food and nutrition professionals, yielding mixed results, and no experimental research has tested the impact of dietitians' attitudes on their treatment practices or health evaluations with obese patients. Objective: This study investigated attitudes of dietetics students toward obese persons and tested whether a patient's body weight influences students' treatment decisions and health evaluations within a randomized experiment. Design: Between the months of September and December 2007, a convenience sample of 182 dietetics undergraduate students (92% women; mean age 23.1+/-5.4 years) from colleges throughout the United States completed online self-report surveys to assess weight bias (using the Fat Phobia Scale). Participants were also randomly assigned to read one of four mock health profiles of patients who varied only by weight-related characteristics (eg, obese or average weight) and sex (male or female), and asked to make judgments about the patient's health status and participation in treatment. Statistical analyses performed: To compare group data, multiple analysis of variance was used to test for an effect of the patient's body mass index on participants' health evaluations and their perceptions of patients in each of the four experimental conditions. Correlations were calculated between mean fat phobia scores and perceptions of patients. Results: Participants in all conditions expressed a moderate amount of fat phobia (mean=3.7), and students rated obese patients as being less likely to comply with treatment recommendations compared with nonobese patients (P<0.05). Results from multivariate analysis of variance tests showed students also evaluated obese patients' diet quality and health status to be poorer than nonobese patients, despite equivalent nutritional and health information across weight categories for each sex in patient profiles. In contrast, obese and nonobese patients were rated to be similarly motivated, receptive, and successful in treatment. Conclusion: Implications of these findings for education and intervention in dietetics training are discussed, with emphasis on increasing awareness of weight bias in existing dietetics curricula.

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... Studies indicated that weight-based stigmatization may occur in multiple areas of daily life and particularly in the inner circle of the individuals, and it also seems quite common among health care professionals, including physicians, nurses, medical students, psychologists, and even dietitians [15][16][17][18]. As dietitians are the only degree-qualified health professionals that assess, diagnose and treat nutrition-related problems, their weight bias attitudes may have devastating consequences [7,13,[19][20][21]. ...
... Similar to the design of other studies [4,20,23,24,30], two hypothetical cases with vignettes were created for this study. In addition to all quantitative properties, the questions were identical with the same order, but vignettes were differentiated only in their weight and BMI. ...
... This study demonstrated that Turkish dietitians working at private hospitals had mild levels of weight bias, which was consistent with previous findings that have been reported among other dietitian populations [23,24]. However, some comparative studies conducted on nutrition and dietetic students and dietitians have identified slightly higher mean FPS scores, indicating moderate levels of weight bias [15,20,32,33]; and a study reported that dietitians tended to be less tolerant of obesity than those among the general population [19]. In addition to these findings, more studies also reported the stigmatizing attitudes of other health professionals or students [21,23,34]. ...
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Objective Since obesity is a multifactorial disease, some health professionals may esteem that weight control is a matter of personal willpower and stigmatize individuals. These weight-based attitudes seem quite common even among dietitians. This study aimed to determine whether the level of weight bias affects the dietary approaches of the dietitians. Methods Two hypothetical cases with obese and normal weight vignettes were created to be evaluated, and the explicit weight bias was assessed by the fat phobia scale among 99 dietitians via an online questionnaire. Results The majority of the dietitians demonstrated mild or moderate levels of weight bias (59.6% and 32.3%, respectively). The obese vignette had the highest agreement for nearly all adjectives and was perceived as having poorer diet quality, general health status, and insufficient physical activity level. Conclusion Overall, as weight bias is a concerning issue among most dietitians, necessary steps are required for the reduction of prejudice and thus protect the patients from stigmatizing attitudes. Keywords Nutritionists; Obesity; Stereotyping; Weight prejudice
... The aim of the study was to compare exercise recommendations, attitudes, and behaviors of personal trainers toward an obese and an average-weight client. Based on the social identity theory and previous evidence (1,15,18,23), it was hypothesized that personal trainers would prescribe biased exercise recommendations, behave differently, and express a more negative attitude toward the obese compared with the average weight client. ...
... Weight bias is widespread across a multitude of social settings. The media portrays obese individuals more negatively (10), children characterize obese peers as stupid, mean, and sloppy (20), and a significant share of health professionals such as dietitians, nurses, and physicians endorse negative portrayals of their obese patients as lazy and noncompliant and hold strong anti-fat bias (7,15,22,23,27). Furthermore, anti-fat bias may have pervasive consequences for overweight individuals. ...
... The Attitude Toward the Client survey (ATC) survey asked the feelings of personal trainers toward working with the client. The survey was adapted from previous research studies (15,23). The survey consisted of four Likert-like items: (a) The amount of patience I would have working with this client; (b) The personal desire I have to help this client; (c) This sort of client would make me like my job; (d) I might enjoy working with this client. ...
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The aim of the study was to compare exercise recommendations, attitudes, and behaviors of personal trainers toward clients of different weight statuses. Fifty-two personal trainers participated in the study. The data collection was organized into two phases. In phase one, trainers read a profile and watched the video displaying an interview of either an obese or an average-weight client. Profiles and video interviews were identical except for weight status. Then, trainers provided exercise recommendations and rated their attitude toward the client. In phase two, trainers personally met an obese or an average-weight mock client. Measures were duration and number of advices provided by the trainer to a question posed by the client and sitting distance between trainer and client. There were no significant differences in exercise intensity (p = .94), duration of first session (p = .65), and total exercise duration of first week (p = .76) prescribed to the obese and average-weight clients. The attitude of the personal trainers toward the obese client were not significantly different from the attitude of personal trainers toward the average-weight client (p = .58). The number of advices provided (p = .49), the duration of the answer (p = .55), and the distance personal trainers sat from the obese client (p = .68) were not significantly different from the behaviors displayed toward the average-weight client. Personal trainers did not discriminate against obese clients in professional settings.
... O termo "weight bias" 6,7,8,9,10,11,12 , traduzido como "preconceito relacionado ao peso", vem sendo atribuído ao preconceito em si (componente atitudinal), aos estereótipos (componentes relacionados às crenças acerca da etiologia e manutenção da obesidade) e à discriminação -manifesta por ações e comportamentos 4,10 . ...
... Nutricionistas estão entre os profissionais citados 20,21 , e mesmo entre aqueles especializados no tratamento da obesidade pode haver altos índices de preconceito 6 . Similarmente, são relatadas atitudes negativas e preconceito com o indivíduo obeso por estudantes de graduação em nutrição 8,20,22 , o que é preocupante considerando-se que irão atuar no tratamento da obesidade nos diversos níveis de atenção à saúde. ...
... Alguns estudos exploraram as atitudes de estudantes de nutrição 8,9,20,22 , incluindo avaliação de atitudes diante de casos ou consultas simuladas com pacientes com obesidade 8,23,24 . No Brasil, há estudos que exploraram a questão do estigma e do preconceito relacionados ao peso sob a ótica do indivíduo com obesidade por meio de metodologias qualitativas 25,26,27 , também há um estudo transversal que investigou a ocorrência de discriminação autorrelatada por adolescentes de um estudo de coorte 29 , uma revisão sistemática sobre as crenças e práticas dos profissionais de saúde face à obesidade (que não inclui nenhum estudo realizado no Brasil) 29 , e apenas um estudo qualitativo que analisou a perspectiva de profissionais de saúde e pacientes para com a obesidade 30 . ...
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Resumo: A obesidade está relacionada a problemas psicossociais como estigma, discriminação e preconceito. Estudos verificaram que nutricionistas e estudantes de nutrição apresentam atitudes negativas e preconceito em relação aos indivíduos com obesidade. O estudo avaliou a existência de preconceito em relação aos indivíduos obesos por parte de estudantes de nutrição. Os estudantes responderam aos questionários por meio de preenchimento de formulários on-line - dados demográficos, peso e altura autorreferidos; em seguida foram direcionados para um de quatro casos hipotéticos - sorteados aleatoriamente - de um paciente referenciado a um nutricionista após receber o diagnóstico de intolerância à lactose (sexo masculino e eutrófico; sexo feminino e eutrófica; sexo masculino e obeso; e sexo feminino e obesa). Com exceção do peso, do índice de massa corporal (IMC) e do consumo energético diário, todas as informações relativas à dieta, hábitos de vida e condições de saúde eram idênticas para os perfis do mesmo sexo. Incluíram-se questões relativas à indicação de procedimentos e condutas durante a consulta, tempo de atendimento, estratégias de aconselhamento, avaliação da dieta e da saúde, e reações afetivas e comportamentais. Participaram 335 estudantes, prioritariamente mulheres, com IMC médio de 23kg/m². O peso do paciente influenciou o tempo de atendimento, percepções, condutas e estratégias de tratamento, com a identificação de preconceitos e atitudes negativas principalmente relacionadas às percepções e reações dos estudantes diante dos pacientes com obesidade, sendo que a mulher com obesidade recebeu piores avaliações no geral.
... Some of these factors have their origin in society, but it is not clear how much health professionals themselves contribute to maintaining prejudice against individuals with obesity 1-5 . Discriminatory attitudes among health professionals -especially dietitians -have already been explored in some populations and less rarely among students [4][5][6][7][8][9][10][11][12] . ...
... Stigma, bias and discrimination contribute to deleterious consequences in the psychological sphere [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] , adding or aggravating preexisting morbidities 15,19,20 and limiting the access to health [21][22][23] . In Brazil, prevalence of obesity has increased considerably in the last decades, from 5.2% in 1975 to 22.1% in 2016 24 , but studies addressing its social consequences are rare 25 . ...
... Although the number of men was small, the finding of more negative attitudes among this population is noteworthy, which suggests the need for clarifying this relation in assessments that include an equivalent number of men in the sample. The influence of sex was not assessed in other studies that were carried out with dietitians and nutrition student 6,7,10,11,43,44 ; except one, but which did not find significance 8 . ...
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Obesity-related prejudice and discrimination may have a source in health professionals and students. The objective was to assess anti-fat attitudes among Brazilian nutrition undergraduates who reported demographic data, weight, height and responded the Antifat Attitudes Test (AFAT) and the Brazilian Silhouette Scales to assess body image satisfaction and perception. Total and subscales of AFAT scores were compared among categories using the Mann-Whitney U test. Associations of participants’ characteristics with the AFAT were analyzed using multiple linear regression. Total AFAT score was positively associated with male sex (ß: .13; p < .001), age (ß: .06; p < .001), educational institution outside capital (ß: .03; p < .05), private institutions (ß: .08; p < .001); and negatively associated with income (ß: -.05; p = .006), participants who perceived themselves with increased BMI (ß: -.15; p < .001) and those at the third year of course (ß: -.05; p = .041). Subscales scores were positively associated with male sex and age; and negatively associated with those who perceived themselves heavier. They have anti-fat attitudes especially if they were man, older, from private institutions, are at the beginning of the course, and have lower household income - and less weight bias if they perceived with increased BMI.
... Besides that, there have been suggestions for interventions to address the weight stigma, but few interventions have been carried out in the workplace (Puhl et al., 2009). Most research in the workplace has focused on the healthcare industry, examining the impact of an intervention made by healthcare providers in the treatment of obese patients (Godfree, 2020). ...
... Because of the stigma attached to being obese, the cause of obesity is assigned to something that the individual can control. When it comes to obesity, there are many clichés, such as a lack of willpower and self-discipline (Puhl et al., 2009). In 2018, a survey was conducted under the name 'British social attitudes towards obesity'. ...
... Research on obesity bias has given inconsistent results. Therefore, additional research is needed to determine the most effective techniques for weight bias reduction (Puhl et al., 2009). A descriptive research design was used to discuss and clearly define the relationship between the different variables and factors of the study. ...
Article
The purpose of the paper is to examine the discrimination and biasness that obese people face during and after hiring in the workplace setting.NBased on literature, a conceptual framework has been developed that analyses the impact of obesity, explicit biasness, and implicit biasness on hiring discrimination and workplace discrimination. Data was collected using a self-administered questionnaire on a sample of 95 respondents from the banking sector. A convenient sampling technique was employed and the analysis was done by using structured equation modelling. The results indicated that people who are overweight or obese are less accepted and discriminated against during hiring, and even if they are hired, the views they receive that they are lazy, lack self-discipline, and incompetent. The stereotypes and negative attitudes towards overweight people have been found at both explicit and implicit levels. The findings of the study have several implications for policy makers in the banking sector, who need to revise recruitment policies, provide equal employment opportunities, and promote a healthy environment in the banks by educating their employees to reduce stereotypes.
... While weight stigma can occur at diverse body weights, the highest rates (~45%) of weight discrimination are often reported among adults with class II to class III obesity (body mass index [BMI] ≥35 kg m À2 ) (3,4). These stigmatizing experiences incur a range of negative consequences for emotional and physical health, including increased risk of depression (5,6), low self-esteem (7), poor body image (7), psychological distress (8)(9)(10), continued obesity and weight gain (11), physiological reactivity (12,13), cardiovascular disease risk factors (14) and exercise avoidance (15). ...
... Seven studies examined weight bias among exercise professionals in an exercise setting including personal/group fitness trainers (n = 4) (21,(45)(46)(47) and exercise professional trainees (n = 3) (48)(49)(50). Eleven studies examined weight bias among nutrition professionals including dietitians/nutritionists (n = 5) (51-55), dietetic/nutrition trainees (n = 5) (15,(56)(57)(58)(59) and a mixed sample of nutrition professionals/trainees (n = 1) (60). ...
... Of the 31 included studies, one study measured only implicit weight bias (54), 21 studies measured only explicit weight bias (15,20,22,(34)(35)(36)(37)39,40,46,48,(50)(51)(52)(53)(55)(56)(57)(58)(59)(60) and nine studies measured both implicit and explicit weight bias (21,38,(41)(42)(43)(44)(45)47,49). Implicit weight bias was assessed among the studies using the Implicit Associations Test (IAT) (61) (n = 10) (21,38,(41)(42)(43)(44)(45)47,49,54). ...
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Obesity affects approximately one‐third of American adults. Recent evidence suggests that weight bias may be pervasive among both exercise and nutrition professionals working with adults who have obesity. However, the published literature on this topic is limited. This review aimed to (i) systematically review existing literature examining weight bias among exercise and nutrition professionals; (ii) discuss the implications of this evidence for exercise and nutrition professionals and their clients; (iii) address gaps and limitations of this literature; and (iv) identify future research directions. Of the 31 studies that met the criteria for this review, 20 examined weight bias among exercise professionals, of which 17 (85%) found evidence of weight bias among professionals practicing physical therapy (n = 4), physical education (n = 8) and personal/group fitness training (n = 5). Of 11 studies examining weight bias among nutrition professionals, eight (73%) found evidence of weight bias. These findings demonstrate fairly consistent evidence of weight bias among exercise and nutrition professionals. However, the majority of studies were cross‐sectional (90%). Given that weight bias may compromise quality of care and potentially reinforce weight gain and associated negative health consequences in patients with obesity, it is imperative for future work to examine the causes and consequences of weight bias within exercise and nutrition professions using more rigorous study designs.
... Diğer taraftan obez hastalar, sağlık hizmeti alırken yaygın olarak önyargı ile karşılaşabilmektedir (3,4). Obez hastalar, sağlık çalışanları tarafından kendilerine önyargılı davranışları ve negatif tutumu hissetmeleri nedeniyle tedaviye devam etmek istemediğini belirtmiştir (5). Bu durum obez hastaların sağlık hizmetlerinden kaçınmalarına, tedavilerini aksatmalarına/geciktirmelerine ve sonuç olarak gittikçe artan sağlık sorunlarına yenilerinin eklenmesine neden olmaktadır (6)(7)(8). ...
... Bu durum obez hastaların sağlık hizmetlerinden kaçınmalarına, tedavilerini aksatmalarına/geciktirmelerine ve sonuç olarak gittikçe artan sağlık sorunlarına yenilerinin eklenmesine neden olmaktadır (6)(7)(8). Sağlık çalışanları da obez hastalara karşı olumsuz tutum ve davranış sergilediklerini kabul etmektedirler (3,5,9). Sağlık çalışanlarının obez hastalara yönelik tutumlarını inceleyen bir araştırmada, hemşirelerin %45'i obez hastaya bakım vermeyi tercih etmeyeceğini (9), %52'sinin obez hastaya bakım vermede isteksiz olduğunu ortaya koymuştur (10,11). ...
Article
INTRODUCTION: This study is planned to determine the biases of nurses caring for obese patients and to improve suggestions for improving care quality of obese patients. METHODS: A total of 370 nurses (95.8%) working in a university hospital who met research criteria constituted sample of this study. Data have been collected between February-May 2017 using data collection form and GAMS-27 Obesity Prejudice Scale (GAMS-27 OPS). Percent, average, standard deviation, student t, ANOVA, and pearson correlation tests have been used in data analysis. RESULTS: Out of 69.2% of nurses caring for obese patients, only 27.6% have stated to have taken an education about obesity. GAMS-27 OPS mean score of nurses is 73.4+-10.2, and 63.2% has been identified as bias inclined and 10.0% as biased. While age, gender, education status and marital status of nurses do not affect scale scores, education taken for obese patient care is determined to decrease the bias incline. It was determined that as the body mass index of the nurses decreased, the obesity bias increased significantly. DISCUSSION AND CONCLUSION: Study results showed most of nurses to be bias inclined, few to have taken education for obese patient care, and education to decrease bias incline against obese patients. Considering impact of training, this issue may be included in existing nursing education and in-service trainings. It may be advisable to conduct new studies in which the factors affecting the bias tendency of nurses are determined and the relationship between the reasons why nurses donot want to give care to obese patients and the bias tendencies.
... There are many studies regarding the prevalence of weight bias among medical students [42][43][44][45] and other health professional students. 16,21,65 However, a literature review did not uncover any studies investigating whether this is prevalent among CIM students and faculty, particularly those studying chiropractic, the largest graduate level CIM profession in the United States. 66,67 The erosion of empathy observed in medical students by Hojat et al 53 and Newton et al 52 has also not been investigated in CIM students. ...
... The precise purpose of the study (determining presence of obesity bias) was not communicated to the participants to prevent the emergence of social desirability bias. This strategy is in keeping with the work on weight bias published by Swift et al 16 and Puhl et al. 65 Participants were also informed that their participation in the survey was strictly voluntary and whether they chose to participate or not had no bearing on their status at the institution or their relationships with any institutional staff, faculty, or administration. Students were informed that their participation would not have any impact on their grades. ...
Article
Objective: The purpose of this study was to assess the prevalence of obesity bias among preclinical and clinical chiropractic students and faculty at an integrative health care academic institution. Methods: This was a cross-sectional quantitative, single-method survey with group comparison using the Beliefs About Obese Persons scale (BAOP) and the Attitudes Toward Obese Persons scale. Both instruments were administered as a single 28 question survey via email to 450 students and 46 faculty members in a doctor of chiropractic (DC) program. Differences were determined by 2 tailed t tests. Results: The response rate for faculty and students was 31% and 65%, respectively. One hundred forty-three DC students, preclinical ( n = 65) and clinical ( n = 78), and 30 DC faculty, preclinical ( n = 15) and clinical ( n = 15) completed the survey. Both students and faculty harbored antiobesity attitudes and moderate antiobesity beliefs. Students demonstrated slightly more positive attitudes toward obese persons than did preclinical faculty. Although preclinical faculty did not demonstrate more biased attitudes than did preclinical students ( p = .057), they were more biased than clinical students ( p = .26). On the BAOP, preclinical faculty scored significantly lower than both preclinical students and clinical students ( p = .013 and .017, respectively). Conclusion: Obesity bias was common among clinical and preclinical chiropractic students and faculty at our institution. A cultural shift that reduces bias may require changes in both the curriculum and cocurriculum.
... In accordance, other studies with nutrition students have shown that they evaluated PWO more negatively and expressed negative judgments regarding this population's self-care, discipline, and diet quality. Also, they imagined that they would need more rigor and patience to "deal" with PWO in their future practices (38,39). ...
... When dietitians and nutrition students realized what they were being evaluated on, they may have been more likely to answer in a way they consider most desired and accepted by society, regardless of whether it is true or not (47). Still, considering the results abovementioned with nutrition students (38,39), it is possible to suggest that the stigmatized views of PWO might perpetuate in their future practice, which should be further investigated. ...
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The aim of this study was to understand how dietitians’ body size influences perceived competence and warmth, based on the Stereotype Content Model (SCM). Online data were collected from 1,039 Brazilians, who were either laypeople, registered dietitians, or nutrition students. Participants rated the competence and warmth dimensions of three dietitians who differed in sex, body weight, and age. Participants also indicated how likelythey would consult or recommend each dietitian for nutritional advice, and indicated their attitudes towards people with obesity [using The Antifat Attitudes Test (AFAT)]. Laypeople attributed less competence and warmth to all profiles compared to dietitians and students (p < 0.001). Three clusters occupied the SCM warmth-by-competence space. However, the clusters were different among groups (laypeople, dietitians, and students). For lay participants, the woman without overweight, the older woman, and the older man were located in the high competence/ medium warmth cluster. Meanwhile, the woman with obesity was located in the medium competence / high warmth cluster. The dietitians and students map found the woman with obesity and the older woman in a high competence and warmth cluster. In general, the woman with obesity, the man without obesity, and the older man can be classified as ambivalent stereotypes, the woman being perceived as more warm than competent and the men more competent than warm. Participants with high AFAT scores were less likely to consult or recommend to a family member a dietitian with obesity. This study contributes to identifying ambivalent stereotypes for dietitians. Dietitians with obesity can be seen as warm but less competent. Also, although less intense than laypeople, dietitians and students exhibited weight stigma. These findings can foster important discussions about weight stigma and emphasize the need to increase population awareness about the causes of obesity.
... The internal consistency of the F-scale was high at baseline, 7-day follow-up, and 30-day follow-up (Cronbach's α=0.854, 0.844, and 0.858, respectively). These relatively high internal consistency outcomes are in accordance with previous studies [32,37,38,42]. The beliefs about the causes of obesity questionnaire According to the mean ranking order of all factors at baseline, the leading factors were overeating, a high-calorie diet, and high consumption of processed food. ...
... Moreover, the results of the current study may have been affected by the tools used to assess outcomes measured. Fat-phobic attitudes toward PwO were assessed by the F-scale, while the mean baseline F-scale scores in the present study were below the accepted average level of fatphobia for both study groups and lower than reported in other studies amongst students and health professionals [24,37,38,[42][43][44]. Similarly, the baseline means AFA 'dislike' and 'willpower' subscales scores in the present study were lower than previous studies in a similar population [37,38]. ...
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Introduction: Weight bias, stigma, and discrimination are common among healthcare professionals. We aimed to evaluate whether an online education module affects weight bias and knowledge about obesity in a private medical center setting. Methods: An open label randomized controlled trial was conducted among all employees of a chain of private medical centers in Israel (n=3,290). Employees who confirmed their consent to participate in the study were randomized into intervention or control (i.e., 'no intervention') arms. The study intervention was an online 15-minute educational module that included obesity, weight bias, stigma, and discrimination information. Questionnaires on Anti-Fat Attitudes ('AFA'), fat-phobia ('F-scale), and beliefs about the causes of obesity were answered at baseline (i.e., right before the intervention), 7-days, and 30-days post-intervention. Results: A total of 506, 230, and 145 employees responded to the baseline, 7-day, and 30-day post-intervention questionnaires, respectively. Mean participant age was 43.3±11.6 years, 84.6% were women, and 67.4% held an academic degree. Mean F-scale scores and percentage of participants with above-average fat-phobic attitudes (≥3.6) significantly decreased only within the intervention group over time (P≤0.042). However, no significant differences between groups over time were observed for AFA scores or factors beliefs to cause obesity. Conclusions: A single exposure to an online education module on weight bias and knowledge about obesity may confer only a modest short-term improvement in medical center employees fat-phobic attitudes toward people with obesity. Future studies should examine if re-exposure to such intervention could impact weight bias, stigma, and discrimination among medical center staff in the long-term. ClinicalTrials.gov number: NCT04741113.
... Given the focus on weight, it is not surprising that dietetics students and dietitians have been found to hold stigmatizing and biased beliefs toward fat people (e.g., Diversi, Hughes, and Burke 2016;Harvey et al. 2002;Puhl, Wharton, and Heuer 2009). How these stigmatizing and biased beliefs manifest within dietetics education has yet to be explored. ...
... The small pool of research on weight stigma among dietitians and dietetics students indicates that it is a serious problem in the profession. Diversi, Hughes, and Burke (2016) and Puhl, Wharton, and Heuer (2009) found that practicing dietitians and dietetics students rate patients in "larger bodies" as less compliant with nutrition recommendations than patients in smaller bodies. Harvey et al. (2002) found that dietitians blame "overweight" and "obese" patients for their excess weight, particularly their poor eating habits. ...
Article
Dietetics education and practice is rooted in a weight-centric paradigm of health. Research demonstrates that dietetic students and practitioners hold stigmatizing beliefs about fat people. Some have sardonically noted that being thin is taken as evidence of dietitians’ expertise within the profession and in the eyes of the public. In this light, fat dietetic students are likely subject to stigma within their educational environments. However, no studies have explored dietetics students’ experiences of weight stigma during their education. This research draws on qualitative interviews to explore the experience of Canadian dietetics students who self-identified as fat, “higher weight,” “overweight,” or “obese.” An interplay of overt, structurally rooted weight stigma and internalized weight stigma were found to pervade the pedagogical environment of dietetics education. Findings suggest that fat students grapple with their seemingly conflicting identities as fat people and dietetics students, and feel pressure to “perform dietitian.” However, participants also resisted weight stigma, and questioned pressures to conform to the thin body and healthy eating ideals.
... Regarding RD, evidence also shows negative attitudes towards PWO, including studies carried out in Brazil [21,22,30,31]. In a systematic review [28], three of four crosssectional studies examining weight bias among dietitians documented the occurrence of weight bias. ...
... They were asked to make judgments about the patient's health status and treatment adherence. The dietetic students rated patients with obesity as being less likely to comply with treatment recommendations and having poorer diet quality and health status than patients without obesity [30]. However, the relationship between weight bias and nutrition students is unclear. ...
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(1) Background: Obesity is associated with significant social consequences, and individuals with obesity are regularly affected by weight-related stigmatization experiences. This study compares antifat attitudes among registered dietitians (RD), nutrition students, and laypeople and assesses which factors related to the perceived causes of obesity influence these attitudes. (2) Methods: An online survey was conducted in Brazil with RD (n = 336), nutrition students (n = 300), and laypeople (n = 403) with questionnaires assessing antifat attitudes and perceived causes of obesity. (3) Results: All groups presented low antifat attitudes. Minor differences in antifat attitudes were found among the three groups. Compared to RDs and nutrition students, laypeople presented higher Weight Control/Blame scores, but with a small effect size (η2 = 0.01). Weight bias was predicted by age, sex, and body mass index. External, social, and financial factors were not perceived to be very important in the development of obesity by RD and students. (4) Conclusions: Since slight differences were seen among RD and students compared to laypeople, and some perceptions of the causes of obesity indicate a stigmatized view. It is essential to place a greater focus on educating and updating these health professionals and students about weight stigma and its consequences for the mental and physical health of individuals.
... Diğer taraftan obez hastalar, sağlık hizmeti alırken yaygın olarak önyargı ile karşılaşabilmektedir (3,4). Obez hastalar, sağlık çalışanları tarafından kendilerine önyargılı davranışları ve negatif tutumu hissetmeleri nedeniyle tedaviye devam etmek istemediğini belirtmiştir (5). Bu durum obez hastaların sağlık hizmetlerinden kaçınmalarına, tedavilerini aksatmalarına/geciktirmelerine ve sonuç olarak gittikçe artan sağlık sorunlarına yenilerinin eklenmesine neden olmaktadır (6)(7)(8). ...
... Bu durum obez hastaların sağlık hizmetlerinden kaçınmalarına, tedavilerini aksatmalarına/geciktirmelerine ve sonuç olarak gittikçe artan sağlık sorunlarına yenilerinin eklenmesine neden olmaktadır (6)(7)(8). Sağlık çalışanları da obez hastalara karşı olumsuz tutum ve davranış sergilediklerini kabul etmektedirler (3,5,9). Sağlık çalışanlarının obez hastalara yönelik tutumlarını inceleyen bir araştırmada, hemşirelerin %45'i obez hastaya bakım vermeyi tercih etmeyeceğini (9), %52'sinin obez hastaya bakım vermede isteksiz olduğunu ortaya koymuştur (10,11). ...
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Amaç: Araştırma, iki ayrı bölgeye uygulanan subkutan enjeksiyonun ağrı ve ekimoz oluşumuna etkisinin belirlenmesi amacıyla yarı deneysel olarak gerçekleştirilmiştir. Gereç ve Yöntem: Araştırma, gerekli izinler alındıktan sonra, İzmir’de bir eğitim ve araştırma hastanesinin palyatif bakım kliniğinde 15 Haziran 2013 - 30 Aralık 2013 tarihleri arasında yürütülmüştür. Araştırma örneklemini yetişkin, bilinci açık, işitme engeli olmayan, gebe olmayan, hematolojik hastalığı bulunmayan, alerji öyküsü olmayan, kol ve abdominal bölge doku bütünlüğü bozulmamış ve ilk kez antikoagülan tedavi uygulanacak olan 70 hasta oluşturmuştur. Verilerin toplanmasında “Hasta Tanıtım Formu”, “Ekimoz Takip Çizelgesi” ve “Vizüel Analog Skala” kullanılmıştır. Kol ve abdominal bölgeye subkutan enjeksiyon uygulanan hastaların enjeksiyon alanı işaretlenmiş, enjeksiyondan 48 saat sonra bölge gözlenmiş, cetvel yardımıyla ekimoz büyüklüğü belirlenip kaydedilmiştir. Bulgular: Hastaların yaş ortalaması 63.62±12.74 yıldır. Hastaların %71.4’ünün kronik hastalığı mevcuttur. Kol bölgesinden yapılan enjeksiyon sonrasında oluşan ortalama ekimoz büyüklüğü 0.82±0.45 cm olarak bulunurken, abdominal bölgeden yapılan subkutan enjeksiyon için ortalama ekimoz büyüklüğü 0.65±0.450.82 cm olarak bulunmuştur. Kol ve abdominal bölgeden yapılan subkutan enjeksiyon sonrası oluşan ekimoz büyüklükleri arasında istatistiksel olarak anlamlı bir fark bulunmuştur. Hastaların işlem sırasında ağrı şiddeti skorları kol bölgesinde ortalama 4.32±1.27, abdominal bölgede ortalama 3.45±1.68 olarak bulunmuştur. Hastaların kol ve abdominal bölgeden yapılan subkutan enjeksiyon sonrası ağrı skorları arasında istatistiksel olarak anlamlı bir fark bulunmuştur. Sonuç: Araştırma sonucunda, hastaların abdominal bölgeden yapılan enjeksiyonda daha az ağrı hissettikleri ve ekimoz büyüklüklerinin daha az olduğu saptanmıştır. Subkutan enjeksiyon uygulamalarında abdominal bölgenin kol bölgesine tercihen kullanımının deride ekimoz oluşumunu ve ağrı düzeyini azaltacağı söylenebilir. Anahtar Kelimeler: Subkutan enjeksiyon, Ekimoz, Ağrı. Abstract Objective: This research was conducted quasi-experimentally to detect the effect of subcutaneous injection, which was applied to two different areas, on formation of pain and ecchymosis. Material and Method: The study was conducted after the research ethical committee approval, in palliative care clinic of a training and research hospital in Izmir between June, 15 and December, 30 in 2013. The study sample was composed of 70 patients who were adults, conscious, not hear-impaired, not pregnant, did not have allergy history and hematologic disease, had undestroyed tissue integrity in leg and abdominal site and would undergo anticoagulant treatment for the first time. During the data collection, “Patient Identification Form”, “Ecchymosis Inspection Form” and “Visual Analogue Scale” were used. The injection area of the patients, whose arms and abdominal areas were subjected to subcutaneous injection, were marked. After 48 hours, these areas were examined and the size of the ecchymosis was determined via a rule and recorded. Findings: The mean age of the patients was 63.62±12.74 years. 71.4% of the patients had chronic diseases. While the ecchymosis size in arm was 0.82±0.45, the ecchymosis size in abdominal region was 0.65±0.450.82. There was a statistically significant difference between ecchymosis size which was formed after subcutaneous injection in arm and abdominal regions. The mean scores of severity in the patients during process were found to be 4.32±1.27 for the arm area and 3.45±1.68 for the abdominal area. There was a statistically significant difference between pain score of patients in arm and abdominal areas during the subcutaneous injection. Conclusion: Consequently, it was found that the patients felt less pain during injection that was applied to abdominal region and the ecchymosis sizes were also smaller. In the applications of subcutaneous injection, the use of abdominal area rather than arm area can be claimed to decrease ecchymosis formation and level of pain. Efforts should be made to inform the families and include the infants in the screening programme who cannot pass the initial screening tests and who are not involved in further control tests. Keywords: Subcutaneous injection, Ecchymosis, Pain.
... Strong negative bias and baseless stereotypes are also prevalent among health professionals from multiple fi elds who are called to play important roles in the prevention and treatment of obesity. Studies demonstrating various forms of anti-obesity bias have been conducted with physicians, pharmacists, and other healthcare professionals (Sabin, Marini, & Nosek, 2012;Teachman & Brownell, 2001), nurses (Poon & Tarrant, 2009), clinicians specializing in obesity (Schwartz, Chambliss, Brownell, Blair, & Billington, 2003), dieticians (Berryman, Dubale, Manchester, & Mittelstaedt, 2006;Puhl, Wharton, & Heuer, 2009), physical educators (Greenleaf & Weiller, 2005;O'Brien, Hunter, & Banks, 2007 ), exercise science students (Chambliss, Finley, & Blair, 2004;Rukavina, Li, Shen, & Sun, 2010), fi tness professionals, and regular exercisers ( Dimmock et al., 2009 ;Hare et al., 2000 ;Robertson & Vohora, 2008). ...
... Despite all patients having the same health and nutritional information, preservice dieticians perceived the health and diet quality of the higher-weight patients to be significantly poorer relative to the average-weight patients. Furthermore, preservice dieticians also believed that higher-weight patients would be significantly less likely to adhere to treatment recommendations, compared with average-weight patients (Puhl, Wharton, & Heuer, 2009). This weight-based rejection does not go unnoticed by higherweight individuals. ...
Article
This research seeks to broaden our understanding of weight stigma and discrimination in healthcare by exploring the influence of social norms on the treatment of higher‐weight individuals. We conducted two experimental studies to investigate: (a) how health professionals' treatment decisions are influenced by patient weight; (b) the effect of norms that endorse weight stigma on health professionals' treatment decisions for patients of different weights; and (c) how these norms may operate differently within healthcare, compared with the general public. Practising health professionals (Study 1; N = 243) and laypeople (Study 2; N = 242) were randomly assigned to view the medical profile of either an average‐weight or higher‐weight patient who was seeking health care for migraines. Study 1 revealed that health professionals tended to treat the higher‐weight patient for both their presenting condition and their weight. Health professionals who perceived weight stigma to be more normative among their colleagues displayed a hyper‐vigilance toward weight, treating weight significantly more among both higher‐weight and average‐weight patients than those who perceived weight stigma to be less normative. Study 2 found that, unlike health professionals, laypeople treated the higher‐weight patient for their weight at the expense of the presenting condition; and such differential treatment was inflated among those who perceived weight stigma to be the norm. The present research found clear evidence of bias in health professionals' treatment decision making—particularly for patients with larger bodies. However, unlike laypeople, this bias did not come at the expense of treating the presenting problem.
... Dietitians who are "overweight" have been found to blame themselves for their weight and have worries about their health [27]. Though an understudied area, several studies suggest that dietitians feel similarly toward patients who are overweight, and hold negative views on weight and towards people of higher weights [28][29][30][31][32][33][34]. Research dating back to 1995 supports the idea that negative attitudes about weight within dietetics have persisted over time, and that little has been done to eradicate these views [35]. ...
Article
Obesity is framed by mainstream media and health care professionals as an "epidemic" contributing to the ill health of the population. This paper reviews literature related to dominant discourses about weight in dietetics, drawing on literature from other health care disciplines, and how these discourses influence patient care. Emerging, competing discourses are also reviewed. Literature highlighted that dietitians and dietetic students are often biased and hold stigmatizing beliefs toward "overweight" and "obese" patients. No research has been conducted in Canada addressing this question, leaving this as an opportunity for future research. Weight stigma and interventions focused on weight have multiple negative implications for individuals, especially those living in larger bodies, including reluctance to seek health care, poor body image, subsequent weight gain, and increased disordered eating. There are alternative discourses emerging, which shift the focus away from weight and toward social justice. The ways in which dietetic students are trained to "manage" weight, and how dominant discourses influence this training, is an important area of future exploration. Dietetic professionals are encouraged to reflect on their weight biases and educate themselves on weight inclusive approaches to health, such as Health at Every Size and Well Now.
... Although questions were nonsuggestive and open ended, participants may still be influenced by bias and stereotypes regarding obesity, race, or gender that are inherent in the society. [35][36][37] Sabin et al. examined implicit attitudes about weight and race in American Indian Health Service primary care providers and found strong implicit bias toward thinner visual depictions of individuals. 38 However, this bias did not seem to influence the provider's weight management treatment approaches for children. ...
Article
Background: Over 2% of children between the ages of 2 and 5 have severe obesity; however, little is known about the characteristics of this population to guide healthcare professionals in providing care. An initial step is to examine observations of practitioners who manage children with severe early onset obesity in the clinical setting. Methods: A total of 72 interdisciplinary healthcare providers with experience providing obesity treatment to children under age 5 with severe obesity completed a semistructured online questionnaire. Participants responded to 10 open-ended questions about provider observations on several topics, including nutrition, eating behavior, activity, family structure and history, medical history, psychological conditions, and household routines. Data analysis was conducted using grounded theory methods. Emerging themes and subthemes were analyzed based on topics and provider discipline (e.g., medical, nursing, and psychology). Results: The most commonly observed and reported characteristic of young children with severe obesity was a parent-described dysfunctional approach to food, including frequent complaints about hunger, food seeking, and lack of satiety. Other characteristics included the presence of externalizing behaviors in the child such as temper tantrums and ADHD, developmental delays, medical comorbidities (e.g., asthma and sleep apnea), and unstructured home environments. Conclusions: Drawing on the experience of an interdisciplinary group of healthcare providers, this is the first study to describe provider observations of the young child with severe early onset obesity. If validated, these observations can serve to illuminate areas for further education and inform potential clinical subtyping, providing an opportunity to identify target areas for intervention.
... positioned as the norm and obese people as deviant (Solovay and Rothblum 2009). Obese people are typically constructed as individuals who have failed to take personal responsibility for shaping their bodies (Wright and Harwood 2009), as risks to their own health, and as societal burdens who increase costs of medical care for others (Puhl et al. 2009). One of the negative consequences of the body size hierarchy is that discrimination against obese individuals is widespread in the US (Puhl and Heuer 2009). ...
Article
We examine separate and combined effects of children’s body size and gender on school bullying victimization in the United States. Second-grade data for the 2012/13 school year from the US Early Childhood Longitudinal Study, Kindergarten Cohort, 2011 were analyzed, hierarchical generalized logistic modeling was used, and three forms of school bullying were studied. Girls were less likely than boys to be verbally or physically bullied, and obese children were more likely to be verbally and relationally bullied than non-obese children. The protective effect of gender extends to obese girls when obesity is not a risk factor (physical bullying). When obesity is a risk factor, gender is not protective (verbal bullying) or is a risk factor (relational bullying) for girls. These findings suggest that an intersectional body size–gender lens is crucial to understanding how inequality is produced through school bullying. Future interventions should incorporate an intersectional understanding of school bullying.
... Both explicit and implicit studies of attitudes have shown that sizeism is common in the United States among the general public (e.g., Crandall, 1994), physicians and nurses (e.g., Foster et al., 2003;Hebl & Xu, 2001), psychotherapists (Agell & Rothblum, 1991;Brown, 1989;Davis-Coelho, Waltz, & Davis-Coelho, 2000;Pratt et al., 2016;Young & Powell, 1985), and even among professionals tasked with assisting people who want to lose weight (e.g., "obesity experts," dieticians, physical education teachers, personal trainers; O 'Brien, Hunter, & Banks, 2007;O'Brien, Puhl, Latner, Mir, & Hunter, 2010;Puhl, Wharton, & Heuer, 2009). Evidence of therapists' sizeism is documented in several articles included in this special issue (see Akoury, Shaffer, & Warren, 2019;Brochu, 2019;Harrop, 2019;Kinavey & Cool, 2019;Meulman, 2019;Scott, 2019), and these are unlikely to be isolated incidents. ...
Article
The importance of addressing weight bias as a social justice issue in psychotherapy and psychology education and training is introduced. The history of the development of fat studies is briefly reviewed. Current coverage of size and sizeism in psychology is critically examined and contrasted with the increasing adoption of the medical model of “obesity.” Fat shaming in the practice of mental health professionals is examined as a barrier to clients’ physical and mental health. Alternatives to medicalized weight management and fat shaming are introduced. Models that emphasize size acceptance and resist negative embodiment are encouraged. The potential for a future that makes space for every body is assessed.
... All rights reserved. Beck, 2016;Burmeister, Kiefner, Carels, & Musher-Eizenman, 2013;Puhl, Wharton, & Heuer, 2009). Weight stigma, also known as weight bias, encompasses negative stereotypes and attitudes, as well as prejudicial behaviors and discrimination, related to an individual's weight (Puhl & Brownell, 2001, 2003. ...
Article
Perceived weight stigma is associated with adverse health indices, such as elevated cortisol, lipid/glucose dysregulation, and poorer self-rated health. This relationship may be particularly relevant for military personnel, given the cultural emphasis on fitness and weight/shape. Therefore, we investigated the relationship between weight stigma and physical health in 117 active duty personnel (66.7% male; 56.4% non-Hispanic White; age: 30.8± 7.4 years; BMI: 29.5 ± 2.5 kg/m 2). Participants reported weight stigma (general and military-specific), weight bias internalization, and the presence (1; ≥ n = 55) or absence (n = 62) of medical conditions. Logistic regressions were conducted examining the ability of weight stigma (general or military-specific) and weight bias internalization to predict the presence or absence of medical conditions. General weight stigma was not significantly associated with the presence of a medical condition (p > .05). However, individuals with military-specific weight stigma scores twice that of their peers were over three times more likely (p= .04) to report a medical condition. Weight bias internaliza-tion was not significant in any model (s p > .20). Longitudinal studies should prospectively examine the relationship between weight stigma in the military setting and health among service members.
... and 3.70 and the students had moderate level off at phobia similar to the present study. [11][12][13][14][15] In this study, the ATOP mean score of the students was also observed to be 59.95 0.63 compared to another study in which ATOP mean score was found to be 57.4 12.9 with 302 students in Turkey 9 and 54.52 15.14 in another study on 93 obese patients abroad, 16 which are similar to the present study. In many studies conducted abroad, ATOP mean scores were found to be higher than the mean score obtained in the present study. ...
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Objective: To evaluate fat phobia levels and attitudes towards obese person among university students to determine their correlation with healthy lifestyle behaviour. Methods: The knowledge, attitude and practice study was conducted at Sakarya University, Turkey, between May and December 2015, and comprised students of either gender. Data was collected by using the socio-demographic form, fat phobia scale, attitudes toward obese persons scale, and health-promoting lifestyle profile II scale. SPSS 16 was used for data analysis. Results: Of the 2100 students, 1056(50.3%) were male and 2067(98.4%) were in the 17-26 years age group. The mean fat phobia scale score was 3.72±0.63and mean attitudes toward obese persons scale score was 59.95±0.63. Relationship between fat phobia scale, attitudes toward obese persons scale, and health-promoting lifestyle profile II scale scores was significant (p<0.05). Conclusions: Fatphobia moderately existed among the students.
... The Fat Phobia Scale-Short Form is strongly correlated with the entire 50-item scale and has demonstrated excellent reliability across two separate samples; Cronbach's α = 0.87 in one sample and Cronbach's α = 0.91 in a second sample (Bacon et al., 2001). The Fat Phobia Scale has been used as a measure of explicit weight bias in several other studies (e.g., Puhl et al., 2015;Puhl, Wharton, & Heuer, 2009,). Cronbach's alpha in the current sample was α = 0.86. ...
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The purpose of the study was to investigate the influence of weight bias and demographic characteristics on the assessment of pediatric chronic pain. Weight status, race, and sex were manipulated in a series of virtual human (VH) digital images of children. Using a web-based platform, 96 undergraduate students with health care-related majors (e.g., Health Science, Nursing, Biology, and Pre-Medicine) read a clinical vignette and provided five ratings targeting the assessment of each VH child’s pain. Students also answered a weight bias questionnaire. Group-based analyses were conducted to determine the influence of the VH child’s weight and demographic cues, as well as greater weight bias on assessment ratings. Male and VH children with obesity were rated as more likely to avoid non-preferred activities due to pain compared to female and healthy weight children, respectively (both p < .001). The pain of VH children with obesity was rated as more likely to be influenced by psychological/behavioral issues compared to the pain of healthy weight VH children (p = .022). African American VH children were rated as experiencing significantly greater pain than Caucasian VH children (p = .037). As child weight increased, low weight bias participants felt more sympathy, while high weight bias participants felt less sympathy (p = .002). Also, low weight bias participants showed increased motivation to help, while high weight bias participants showed less motivation to help, as VH patient weight increased (p = .008). Child weight and evaluator weight bias may be influential in the assessment of pediatric pain. If supported by future research, results highlight the importance of training in evidence-based practice and education on weight bias for students majoring in health-care fields.
... It has been suggested that there is a need to understand whether HCP weight biases affect quality of health care. 5 While it is established that many HCPs have weight biases, 2,[5][6][7][8][9] it is less understood whether this affects quality of health care provided. Studies show that HCPs perceive populations with obesity nonadherent to health recommendations, 10 show less respect, 11 and provide less health education compared with those without obesity. ...
Article
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The purpose of this study was to determine whether weight bias exhibited by health care professionals (HCPs) impacts quality of health care provided to individuals with obesity. HCPs (n = 220; 88% female, 87% nurses) in the Midwest region of the United States were recruited to complete an online survey. In this within-subjects study design, participants completed the Attitudes Towards Obese Persons (ATOP) scale to assess weight bias and responded to 2 (1 person with obesity and 1 person without obesity) hypothetical patient scenarios to evaluate quality of care. A median split was calculated for ATOP scores to divide participants into high or low weight bias groups. Within these groups, thematic analysis was used to uncover themes in quality of care based on participants’ responses to each scenario. The analysis revealed that HCPs in the high weight bias group gave specific diet and exercise recommendations, offered health advice regarding weight loss, and used less teaching discourse when responding to the patient with obesity. In addition, in both weight bias groups, patients with obesity were started on pharmaceutical therapies sooner. The findings of this study suggest a need to educate HCPs on the importance of empathy and compassion when providing treatment to all patients, regardless of weight, to increase quality of care and ultimately improve patient outcomes.
... Amongst the sources of weight stigma, family members and peers were reported as the most common and frequent sources for both adolescents and adults [8][9][10]. Apart from these sources, weight stigma is also common in the areas of education, employment, health care and media [10][11][12] as a study reported that being overweight is a primary reason of victimization at school particularly during physical activities [13]. ...
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PurposeWeight stigma has been described as social devaluation of people on the basis of their weight and it is associated with negative consequences. The present study was designed to investigate weight stigma and its relationship with disordered eating behaviors in overweight adolescents. One of the main objectives of this study is to investigate the mediating role of body esteem between weight stigma and disordered eating behaviors in overweight adolescent girls.Methods Through cross-sectional research design and purposive sampling technique, a sample of 200 overweight adolescent girls was recruited from Lahore, Pakistan. Participants were asked to fill self-report measures related to weight stigma, body esteem, and disordered eating behaviors.ResultsSPSS and AMOS were used to analyze the data. Pearson product moment correlation showed that experiences of weight stigma were negatively related to body esteem and positively related to disordered eating behaviors in overweight adolescent girls. Furthermore, structural equation modeling (SEM) showed that body esteem was significantly mediating the relationship between weight stigma and disordered eating behaviors in adolescent girls.Conclusion It is concluded that weight stigma and body esteem play a significant role in the development and maintenance of disordered eating behaviors in overweight adolescents. Awareness/educational programs could be designed to empower adolescent girls in combating negative consequences of weight stigma. Furthermore, specific programs could be designed at college or university level to boost one’s body esteem and reduce disordered eating behaviors.Level of evidenceLevel V, cross-sectional descriptive study.
... Stereotypes are as common among health care professionals as they are among the general public. Stereotypes of fat people (e.g., lazy, unmotivated, noncompliant, undisciplined, inactive) have been documented among physicians, nutritionists, dieticians, and pharmacists (e.g., Foster et al. 2003;Puhl, Wharton, and Heuer 2009;Sabin, Marini, and Nosek 2012;Teachman and Brownell 2001). Patients may become aware of their health care providers' negative attitudes and stereotypes either explicitly (i.e., medical fat shaming, such as blaming any health complaint on the patient's weight or angrily criticizing the patient for not having lost weight) or implicitly (i.e., microaggressions, such as apparent reluctance to touch the patient, negative facial expression when entering a patient's weight in the chart). ...
Article
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This article suggests ways health psychology instructors can challenge the prevailing discourse of the “obesity epidemic” as a major risk factor for chronic illness. Textbooks generally support messages about the “dangers” of a body mass index above “normal,” and therefore students will only hear countermessages if the instructor provides them. Suggestions include naming and rejecting healthism, explaining why diets do not work, providing evidence that oppression (including sizeism) has negative impacts on health, and connecting sizeism to other topics in the textbook. Practicing size acceptance and adopting the Health At Every Size® philosophy are more likely than diets, pills, or surgeries to support people’s health.
... This reflects a strong anti-fat bias that is evident in the media, institutions such as schools and business, and everyday discourse. This bias results in stigma and discrimination (Puhl & Brownell, 2001).Obese people are thought to be weak willed, lazy, sloppy, incompetent, emotionally unstable, and even defective as people (Puhl et al., 2009). Beyond effects on psychological issues such as mood, self-esteem, and body image, bias can result in outright discrimination. ...
Article
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COVID-19 pandemic has not only caused physical distress but also psychological distress on patients as well as all around the world. The problem majorly faced by post COVID patient are stress, fear, insomnia, depression and anxiety leading to a psychological disorder i.e., post-traumatic stress disorder. The aim of the present study is to assess the effect of CBT on anxiety and post-traumatic stress in post COVID patients. The research design used in this study is within experimental research design. The sample of this study comprises of 60 patients who had been in contact with COVID-19. Out of which 30 patients who were given only pharmacotherapy (Group-A) makes the control group and other 30 patients who were given CBT with pharmacotherapy (Group-B) which is experimental group; consents were taken from all the patients of Geetanjali medical college and hospital. Purposive sampling was used to conduct the research. The result shows that there is positive significant effect of CBT on COVID anxiety and post traumatic stress.
... school. and healthcare settings (12,25,32,(34)(35)(36)(37). A substantial level of obesity prejudice has also been found to exist among healthcare workers as reported by a few studies on obesity prejudice (10,17,35,38,40). ...
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Objective: The aim of this study was to investigate the obesity related prejudices and negative attitudes of university students who study in health and non-health fields. Subjective and Methods: This is a descriptive study conducted to determine the obesity prejudice levels of students studying in health and social fields. A total of 732 students (577 females, 155 males) of different faculties of a university participated in the study voluntarily. The Prejudice was measured with Obesity Prejudice Scale (OPS). Analysis of Variance and Covariance were used to investigate relationships between of OPS scores and factors. Results: A total of 732 students, 577 (78.8%) females and 155 (21.2%) males, participated in this study, which was conducted to determine obesity prejudices of university students. According to their mean OPS scores, 18.4% of the students were found to be unprejudiced, 55.1% prone to be prejudiced, and 26.5% prejudiced. The intragroup comparisons of mean OPS scores of health and social field students indicated that the differences between the prejudiced and the unprejudiced were statistically highly significant (p<0.0001). Conclusions: In order to prevent the development of internalized obesity prejudices emerging as a result of prejudices against obese individuals in the society and their stigmatization, this problem must be solved at an early age, especially during university education. It is necessary that state policies should be established to monitor the attitudes of individuals towards obesity, people should be educated and supervised on this subject, and that further research representing the society on this topic should be conducted.
... This reflects a strong anti-fat bias that is evident in the media, institutions such as schools and business, and everyday discourse. This bias results in stigma and discrimination (Puhl & Brownell, 2001).Obese people are thought to be weak willed, lazy, sloppy, incompetent, emotionally unstable, and even defective as people (Puhl et al., 2009). Beyond effects on psychological issues such as mood, self-esteem, and body image, bias can result in outright discrimination. ...
Article
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Polycystic Ovary syndrome is common endocrine disorder generally found in girls of reproductive age which adversely cause metabolic, endocrine, reproductive and mental health of young girls. It has long-term consequences associated with it like diabetes, hypertension, endometrial cancer and coronary artery disease. The prevalence of PCOS is rising in India, which are undergoing rapid transitions due to westernization. Appearance related issues e.g., hirsutism, acne, and obesity, the body image of PCOS women especially young girls (who are more concern for their body) have become more challenging. Thus the girls with PCOS have greater body dissatisfaction and low self esteem as it is exclusively based on body image. Negative perception of body image among PCOS girls include dissatisfaction with appearance, perceived loss of femininity, feeling less sexually attractive, and self-consciousness about appearance. However, due to limited literature on psychosocial impact for girls diagnosed with PCOS, especially in developing countries like India, its significance is still unfathomed. Keeping in mind the importance of body image and self esteem on physical appearance in young girls in the Indian culture the present review was undertaken.
... Diyetetik öğrencileri ile yapılan bir çalışmada (n=182), öğrencilerin %80'inin obezitesi olan bireyleri güvenilmez olarak değerlendirdiği belirlenmiştir. Buna ilave olarak, katılımcıların çoğunluğu vücut ağırlığı fazla olan bireyleri inaktif (%77), düşük özgüveni olan (%75), dayanıksız (%72), yavaş (%68), öz-kontrolü zayıf (%65), çekici olmayan (%54), iradesiz (%41) ve tembel (%41) olarak tanımlamıştır (32). Bu çalışma da, katılımcıların yarısından fazlası obezitesi olan bireyleri hastalıklara yatkın, çabuk yorulan, hareket yetenekleri kısıtlı, yavaş, hareket etmeyi sevmeyen, yaşam kaliteleri düşük ve iradesiz bireyler olarak değerlendirmiştir. ...
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Aim: This research was planned to determine the obesity prejudice levels of the faculty of health sciences students and to investigate factors related to obesity prejudice in students. Material and Methods: This descriptive and cross-sectional study was carried out with 756 students studying at the faculty of health sciences of a state university. The data were collected using a questionnaire including sociodemographic characteristics, lifestyle habits, anthropometric measurements, GAMS-27 Obesity Prejudice Scale, and Eating Attitude Test-40. SPSS 26.0 statistical software was used to analyze the data and the significance level was accepted as p<0.05. Results: The mean age of the students participating in this research was 20.07±1.36 years. According to the GAMS-27 Obesity Prejudice Scale, 53.6% of students were prejudiced against obesity, 41.1% were inclined to prejudice and 5.3% were unprejudiced. When obesity prejudice was evaluated by departments, obesity prejudice was found higher among nutrition and dietetic students compared to nursing and physiotherapy and rehabilitation students (p<0.001). According to body mass index classification, obesity prejudice scale scores were determined lower in students with obesity compared to other students (p=0.001). Similarly, students who accepted themselves as obese in a period throughout their life had significantly lower prejudice scale scores than those without such a period (p=0.005). ÖZ Amaç: Bu araştırma, sağlık bilimleri fakültesi öğrencilerinin obezite ön yargı düzeylerini belirlemek ve öğrencilerde obezite ön yargısı ile ilişkili etmenleri araştırmak amacıyla planlanmıştır. Gereç ve Yöntemler: Tanımlayıcı ve kesitsel tipteki bu araştırma bir devlet üniversitesinin sağlık bilimleri fakültesinde öğrenim görmekte olan 756 öğrenci ile yürütülmüştür. Veriler sosyo-demografik özelliklerin, yaşam tarzı alışkanlıklarının, antropometrik ölçümlerin, GAMS-27 Obezite ön yargı ölçeği'nin ve Yeme Tutum Testi-40'ın yer aldığı bir anket formu kullanılarak toplanmıştır. Verilerin analizinde SPSS 26.0 istatistik paket programı kullanılmış ve anlamlılık düzeyi p<0,05 olarak kabul edilmiştir. Bulgular: Araştırmaya katılan öğrencilerin yaş ortalaması 20,07±1,36 yıldır. GAMS-27 obezite ön yargı ölçeği puanına göre öğrencilerin %53,6'sı obeziteye karşı ön yargılı, %41,1'i ön yargıya eğilimli ve %5,3'ü ön yargısız bulunmuştur. Obezite ön yargısı bölümlere göre değerlendirildiğinde, beslenme ve diyetetik öğrencilerinin obezite ön yargısı, hemşirelik bölümü ve fizyoterapi ve rehabilitasyon bölümü öğrencilerine göre daha yüksek bulunmuştur (p<0,001). Öğrenciler beden kütle indekslerine göre sınıflandırıldığında, obezitesi olan öğrencilerin diğer öğrencilere kıyasla obezite ön yargı puanlarının daha düşük olduğu belirlenmiştir (p=0,001). Benzer şekilde, yaşamında, kendini şişman bulduğu bir dönemi olan öğrencilerde, böyle bir dönemi olmayanlara göre ön yargı ölçeği puanlarının anlamlı şekilde daha düşük olduğu saptanmıştır (p=0,005). Sonuç: Sağlık bilimlerinde, özellikle beslenme ve diyetetik bölümünde öğrenim görmekte olan öğrencilerin büyük çoğunluğunun obeziteye karşı ön yargılı veya ön yargıya eğilimli olduğu saptanmıştır. Öğrencilerin gelecekte etkin ve ön yargısız bir sağlık hizmeti sunabilmeleri için ders programlarına obezite ön yargılarını azaltmaya yönelik uygulamaların eklenmesi önerilebilir.
... Evidence indicates that physicians spend less time in appointments, provide less education about health, have less respect for people with a higher body weight, and report that caring of people living with obesity is a greater waste of time compared to thinner people. 67 People living with obesity who report weight bias in the healthcare setting have less trust in their providers, 68 are less likely to access healthcare screening 69−71 and services, 72 have poorer outcomes, 73 and are more likely to avoid future healthcare. 74 Indeed, research has reported that due to weight stigma experiences, women living with overweight or obesity delay routine cancer screening, 75 which is compounded by 83% of physicians being reluctant to perform an examination on women living with obesity. ...
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Evidence has accumulated to demonstrate the pervasiveness, impact and implications of weight stigma. As such, there is a need for concerted efforts to address weight stigma and discrimination that is evident within, policy, healthcare, media, workplaces, and education. The continuation of weight stigma, which is known to have a negative impact on mental and physical health, threatens the societal values of equality, diversity, and inclusion. This health policy review provides an analysis of the research evidence highlighting the widespread nature of weight stigma, its impact on health policy and the need for action at a policy level. We propose short- and medium-term recommendations to address weight stigma and in doing so, highlight the need change across society to be part of efforts to end weight stigma and discrimination. Funding None.
... A global increase in explicit and implicit weight bias has occurred that impacts the continuum of care [3]. Weight bias has been documented across health care providers (HCPs), various practice areas and professional levels [4], including among trainee students [5][6][7], and professionals specializing in obesity [8,9]. Globally, registered dietitians (RD) also contribute to weight bias [10][11][12] and maybe less tolerant of people with obesity than individuals in the general population [13]. ...
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Weight bias among registered dietitians (RDs) is a concern and effective interventions to reduce weight bias are sparse. Our objective was to determine if a short, attribution theory-based online video intervention would reduce weight bias in RDs. Dietitians from a nationally representative sample were recruited for a randomized, parallel-arm study with online surveys at pre-, post-intervention and 1-month follow-up. One hundred and forty-seven RDs who watched one of three videos embedded in an online survey from June to August 2019 were considered for the analysis. RDs were randomized to watch either the intervention, positive control, or negative control video. The primary outcome was the change in the “blame” component of the Anti-Fat Attitude Test (AFAT) from pre-to immediate post-intervention. Differences in changes in AFAT and Implicit Association Test (IAT) scores across treatment groups were assessed via linear models; multiple imputation were performed for missing data. Baseline demographics, AFAT and IAT scores of the 147 participants who watched a video were not significantly different between the study groups (p > 0.05). The intervention group’s AFAT-blame score reduced by an average of 0.05 between pre- and immediate post-intervention but was not statistically significant (p = 0.76, confidence intervals (CI) = −0.40, 0.30). Furthermore, there were no significant changes for AFAT-social, AFAT-physical subscores, and IAT within or between groups between pre- and immediate post-intervention (p > 0.05). Due to high attrition rates, the changes at 1-month follow-up are not reported. This study was the first to explore the effectiveness of an online video intervention to reduce weight bias in RDs. This study was unable to detect a significant impact of a short, attribution theory-based video intervention on weight bias in practicing RDs and future larger studies are needed to confirm our findings.
... The literature looking at dimensions of diversity and identity in dietetics is largely focussed on race and culture (Brown & White, 2021;DeBiasse, 2021;Mahajan, 2021;Welling-ton et al., 2021), sex and gender (Gheller et al., 2018;Joy et al., 2019), and body size (Bessey et al., 2020;Kasten, 2018;Puhl et al., 2009) from North American perspectives. This is perhaps unsurprising, as researchers seek to problematise and rebut the thin, white, female-dietitian trope. ...
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Through an exploration of the origins of dietetics in the West, and specifically in Australia, we problematise the lack of diversity within the profession through the lens of intersectionality. Dietetics in Australia continues to be dominated by Australian‐born women, and ideologies about dietitians perpetuate narratives of white, young, slim, women. Intersectional approaches to critiquing diversity in dietetics provides a useful framework to extend critical studies of health disparities into disparities in the dietetics professional workforce, which is advanced through structural, political and representational intersectionality guided critique. Through the analysis, a dialog is prompted in order to chart paths forward to find ‘how differences will find expression’ within the professional group. To do this, dietetics as a profession must reckon with its historical roots and step forward, out of a perceived position of objective neutrality regarding people and diversity, and into a position that can recognise that professional institutions have the power to exclude and marginalise, along with the power to include and transform.
... 15,16 Previous research has suggested that weight bias may be prevalent among dietitians and dietetics students. 17,18 Those who experience weight bias from their health care providers are likely to avoid health screenings, cancel their appointments, experience poorer outcomes from treatment, report consuming more food, and avoid exercise. 6,19 Although there seems to be promising potential for this approach, little is known about the current incorporation of NDWN in accredited US dietetic programs, including the factors that might influence adoption. ...
Article
Objective Determine awareness and prevalence of, and interest in nondiet weight-neutral (NDWN) focused curriculum and factors associated with the presence in accredited dietetic programs throughout the US. Methods Online cross-sectional survey sent to directors of US Coordinated Programs (n = 60) and Didactic Programs in Dietetics (n = 214). Results 116 programs (42%) responded, 95% reported knowledge of NDWN approaches to weight management like Health at Every Size. Most schools (72%) included NDWN in their curriculum, mostly in a single lecture (53%). Most respondents (74%) reported interest in an NDWN curriculum. Common factors for not including NDWN were: lack of trained and knowledgeable staff (35%) and insufficient space in the curriculum to incorporate additional topics (35%). Conclusions and Implications Most knew of NDWN approaches and included in curricula but only as 1 lecture. Faculty training and curriculum flexibility may help support the increased incorporation of NDWN approaches.
... Previous work on weight bias reduction efforts has suggested that beginning with trainees, such as dietetics students, 48 is the most effective way to change the culture of weight stigma within a profession. 45 One way in which the Academy can demonstrate its commitment to decreasing weight bias among dietetics students is to explicitly state a commitment to decreasing weight bias in the core knowledge and competencies distributed by the Accreditation Council for Education in Nutrition and Dietetics. ...
... Many perceive individuals who are overweight or obese as sick and lazy people, without control and motivation. Dietetics students (Puhl et al., 2009;Obara et al., 2018) and dietitians (McArthur and Ross, 1997;Harvey et al., 2002;Cori et al., 2015) also have fatphobic attitudes. However, there is still a lack of studies on weight stigma among dietitians, especially outside Anglo-Saxon countries (Silva and Cantisani, 2018). ...
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Most contemporary Western cultures are characterized by fatphobia. The fat body is seen as morally incorrect, a sign of disease, loss of control and weakness. People with obesity and overweight, especially women, are discriminated against and stigmatized for their body size, including by health professionals like dietitians. This study sought to understand and compare social representations of obesity and overweight among dietitians and laywomen from three nationalities: Brazilian, French and Spanish. A qualitative and comparative methodology was established based on 131 semi-structured individual interviews. The analysis revealed that the categories of overweight and obesity were negatively perceived by laywomen and dietitians from all three nationalities. Moral discourses linking these conditions with lack of discipline and a lack of emotional control were frequently used. Fatness was associated with irrationality, putting individuals who were overweight and obese in a position of social and moral inferiority. In the case of obesity, these ideas were more discriminatory and stigmatizing. Although environmental, genetic, hereditary or metabolic causes were mentioned as factors causing obesity, behavioural aspects occupied a central place in the discourses. Differences were also observed among the three nationalities. Cultural factors related to the relationship with body and food seemed to influence the interviewees' social representations. Brazilian laywomen and dietitians put more emphasis on moral and individual aspects. Spanish, French and informants who were overweight were more likely to cite physiological and environmental determinants. French informants also mentioned the role of food education given by parents. In conclusion, the discourses of professionals and laywomen had more similarities than differences, were based on moral and normative judgements and influenced by sociocultural norms. Fatphobic attitudes may impact dietitians’ perception of patients with obesity and the eating education process.
... Health professionals specialising in "obesity", doctors, nurses, dietitians, nutritionists and physical education students, have all been found to have biases against fat people (O'Brien, Hunter & Banks, 2006;Puhl, Wharton & Heuer 2009;Schwartz et al, 2003;Swift et al, 2012;Tomiyama et al, 2014). The understanding of sports science students' may be influenced by these biased "obesity experts". ...
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Sports science students' may have an exaggerated understanding of the negative health correlates of "overweight" and "obesity" due to what they see in the media. A five question test was administered to 24 sports science students, after watching an obesity related media report. First year (n=10), third year (n=7) and post graduate (n=7) student groups all scored significantly worse than a random number generator (n=100), due to generally overstating the negative health correlates of increased body weight, whilst generally being confident of their answers.
... In the healthcare setting, ample research has documented the expression of negative attitudes toward individuals with overweight and obesity by primary care physicians (Ferrante, Piasecki, Ohman-Strickland, & Crabtree, 2009;Hebl & Xu, 2001), medical students (S. M. Phelan et al., 2014), dietetic students (Puhl, Wharton, & Heuer, 2009), and nurses and clinical support staff (Garcia, Amankwah, & Hernandez, 2016). A systematic review of this literature concluded that although weight stigma remains pervasive within the healthcare setting, attitudes toward individuals with overweight and obesity in this setting had improved (Budd, Mariotti, Graff, & Falkenstein, 2011). ...
Thesis
Selective attention to food and body stimuli have been proposed as vulnerability factors for weight gain leading to overweight and obesity, yet research on attentional biases in this population has produced mixed findings. To assist in clarifying the nature of these attentional biases as a function of weight category, the present research examined attentional subcomponents (i.e., speeded detection and increased distraction) using a novel paradigm in this context, namely, the visual-search task. The final sample included women in the healthy-weight (n = 50), overweight (n = 41), and obese (n = 46) weight ranges according to World Health Organization (2000) guidelines. Parts One and Two of this research assessed attentional biases for low- and high-calorie food stimuli in individuals with overweight and obesity. Part One of this research tested the hypothesis that the overweight and obese groups would display speeded detection for low- and high-calorie food versus non-food images (i.e., plants or animals) when compared with the healthy-weight group. When the target images were foods and plants, and the distractor images were animals, results indicated that all weight groups engaged in speeded detection for food versus non-food images. However, relative to the overweight group, the obese group unexpectedly displayed reduced speeded detection for food images, which could represent a degree of avoidance of food in early attentional processing among women with obesity. These findings were not replicated when the target images were foods and animals, and the distractor images were plants. This latter finding may have been due to the visual and/or thematic similarity between foods and plants, rendering it more difficult to discern food targets among plant distractors relative to food targets among animal distractors. Part Two investigated the hypothesis that the overweight and obese groups would display increased distraction by low- and high-calorie food versus non-food images (i.e., plants or animals) when compared with the healthy-weight group. When the distractor images were foods and plants, and the target images were animals, no weight group differences were observed in increased distraction. In contrast, when the distractor images were food and animals, and the target images were plants, the obese group showed increased distraction by low-calorie food images relative to the healthy-weight group. Moreover, all weight groups showed increased distraction by high-calorie food versus non-food images. However, relative to the healthy-weight group, the overweight group surprisingly displayed reduced distraction by high-calorie food images. Overall, the unexpected pattern of results observed across Parts One and Two raises questions about whether attention toward or away from food stimuli is adaptive or maladaptive. Parts Three and Four of this research assessed attentional biases for body shape and weight stimuli in individuals with overweight and obesity. Part Three examined the hypothesis that the overweight and obese groups would display speeded detection for low- and high-weight body versus non-body images (i.e., shoes and cars) when compared with the healthy-weight group. Regardless of whether the shoe or car images performed the role of the target or distractor, no weight group differences were observed in speeded detection. Finally, Part Four investigated the hypothesis that the overweight and obese groups would display increased distraction by low- and high-weight body versus non-body images (i.e., shoes and cars). Again, regardless of the role performed by the non-body images (i.e., target or distractor), no weight group differences were observed in level of distraction. While it is plausible that biased attention for body stimuli does not form part of the core difficulties that contribute to overweight and obesity, it is also possible that the visual-search tasks used in Parts Three and Four were subject to a floor effect.
... Common stereotypes reported among healthcare workers include attitudes that patients with obesity are lazy, weak-willed, and incompatible and unsuccessful with treatment [9,[11][12][13][14]. ...
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Abstract Background: The biased attitudes and behaviors of healthcare professionals towards individuals with obesity cause these individuals to not be able to benefit from health services adequately. Awareness of factors that limit the quality of treatment will improve obesity treatment outcomes. This study aimed to develop a tool for measuring the obesity bias of health students. Methods: 265 students who voluntarily participated in the study were asked to write 3 positive or negative definitions about individuals with obesity. These sentences were evaluated, the draft scale which consisted of 36 items was redesigned by the experts for the final edition. The scale was administered to 236 health sciences students. After correlation analysis of the items, 8 items were found to break the integrity of the Likert-type scale and reduced its reliability. And 1 item was neither positive nor negative. Results: The Cronbach's alpha coefficient of the scale was found as 0.847, which indicated that the developed scale was highly reliable. The one-dimension construct of the scale was validated by confirmatory factor analysis. Conclusion: This scale, which the researchers call "Obesity Bias Scale", has been found to be a reliable tool that can be used to detect obesity bias. Keywords: Obesity; Obesity Bias; Likert Scale; Validity Analysis; Reliability Analysis
Article
Objectives To measure the internal consistency reliability of 3 weight bias scales among nutrition and dietetics students enrolled at a public university in Ghana and to use the Fat Phobia Scale (FPS) to determine the prevalence of weight bias and the differences in gender and body mass index. Design Online survey gathered self-reported height, weight, and demographic data. Explicit weight bias was assessed using validated FPS, Beliefs About Obese People, and Attitudes Toward Obese Persons scales. Participants Sample of 172 students. Main Outcome Measures Prevalence of weight bias. Analysis Cronbach α reliability test was used to measure the internal consistency of scales. The prevalence of weight bias was expressed as a percentage. Independent t tests and analysis of variance were used to explore differences in gender and weight categories. Results The reliability scores for FPS, Beliefs About Obese People, and Attitudes Toward Obese Persons scales were 0.92, 0.51, and 0.38, respectively. About 53% of participants expressed weight bias. A significant difference was observed for weight bias between overweight and obese participants, with participants with obesity showing greater weight bias (P = 0.03). Conclusion and Implications Fat Phobia Scale (most reliable) identified more than half of the students had a negative attitude toward obesity. Weight bias training within this population may improve attitudes toward obesity.
Article
Objective Weight-biased attitudes and views held by health care professionals can have a negative impact on the patient-provider relationship and the provision of care, but studies have found mixed results about the extent and nature of bias, which warrants a review of the evidence. Methods A systematic review and random-effects meta-analysis were conducted by including studies up to January 12, 2021. Results A total of 41 studies met inclusion criteria, with 17 studies providing sufficient data to be meta-analyzed. A moderate pooled effect (standardized mean difference = 0.66; 95% CI: 0.37-0.96) showed that health care professionals demonstrate implicit weight bias. Health care professionals also report explicit weight bias on the Fat Phobia Scale, Antifat Attitudes Scale, and Attitudes Towards Obese Persons Scale. Findings show that medical doctors, nurses, dietitians, psychologists, physiotherapists, occupational therapists, speech pathologists, podiatrists, and exercise physiologists hold implicit and/or explicit weight-biased attitudes toward people with obesity. A total of 27 different outcomes were used to measure weight bias, and the overall quality of evidence was rated as very low. Conclusions Future research needs to adopt more robust research methods to improve the assessment of weight bias and to inform future interventions to address weight bias among health care professionals.
Article
Being fat is widely recognised as a stigmatised identity which disproportionately impacts women, both personally and professionally. Women are numerically dominant as therapy practitioners, and we use this group to explore the ways a “fat counsellor” is imagined in the context of counselling. A qualitative story completion task, about a woman starting therapy, was presented to 203 British young people ages 15–24. Participants were 75% female, 88% white, 93% heterosexual, and 98% able-bodied. The story stem did not specify the sex of the counsellor, who was identified as fat; the vast majority of stories assumed the counsellor was female. Overall, fatness was perceived as negatively affecting therapy and the counsellor’s professional credibility because fatness was equated with a lack of psychological health, which rendered fat counsellors professionally “unfit.” This finding extends the literature on “weight bias” in professional settings and has implications for counsellors of all body sizes.
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This paper is an integrative review of the literature whose objective was to investigate the psychosocial consequences of weight stigma in adults and its influence on the treatment of obesity. The search involved the PubMed, Web of Science and PsycINFO databases and included articles in English and Portuguese published during the last five years. We selected 15 articles, analyzed according to the definition of two subtopics: “The relationship between stigma, psychopathologies and eating disorders” and “Stigmatization among health professionals”. The results point to the great impact of weight stigma on the psychosocial health of obese individuals and the stigmatizing attitudes of health professionals in therapeutic care. A pathological approach to coping with obesity using behavioral strategies that minimizes the understanding of the problem was observed. Currently, the treatment of obesity promoted by the biomedical model does not include the demands of a psychosocial character, which makes permanent education necessary for training of health professionals and the implementation of specific intervention protocols for this population group. The contribution of professionals from different areas, and especially those of mental health, is essential to pay attention to the various characteristics of the treatment, following an integral and humanized perspective, inserted in different psychosocial contexts. Due to the perversity of weight stigma and its serious consequences, further studies are needed to investigate it as well as the attitudes of health professionals, family members, the media and the general population towards obese individuals.
Chapter
Weight bias, stigmatization, and discrimination are prevalent in society and affect every aspect of a person’s life. These experiences are more than hurtful, they contribute to internalized bias and have a significant negative impact on physical and psychological health. Healthcare environments are a common source of bias, which compromises care and clinician-patient relationships. Clinicians, clinicians-in-training, and educators across numerous disciplines are common sources of bias and stigma. As a result, many people delay or avoid care altogether, leading to worse health outcomes. Weight bias and stigma are major contributors to why obesity is not fully recognized and treated as a disease, why obesity rates are rising, and why the health of people with obesity is worsening rather than improving.
Article
The way that health professionals talk about conditions is crucial to patient-centred care. Hilda Mulrooney explains how obesity is a condition that is often framed in negative language that needs to be changed in order to improve healthcare quality in primary care The language and images used to describe those living with obesity are often stigmatising. They can contribute to the perception that those with obesity are responsible for their own condition. Much of the rhetoric around excess weight emphasises actions that individuals can take. This ignores the complexity of how weight is gained and retained, and the roles of genetics and environmental factors. In the UK, those advocating for obesity to be recognised as a disease suggest that this may reduce levels of weight-related stigma. The use of non-stigmatising images and people-first language are recommended to help change perceptions of blame around obesity.
Chapter
Obesity is one of the health problems that threaten humanity considerably. In our country, considering the right to healthcare of each individual, earned by birth, they have a right to receive an equal and just healthcare. Obese individuals may suffer from negative attitudes of health professionals in providing protective health services and inpatient treatments. In this chapter, the aim was to draw attention to ethical conflicts between obese individuals and health professionals in the process of their healthcare and raise awareness of these problems.
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The conventional approach to chronic disease management in women of color is a dieting-for-weight-loss approach, which has not been proven to be effective. The purpose of this article is to highlight the shortcomings of the dieting-for-weight-loss approach and demonstrate the potential efficacy of the Health at Every Size approach when working with women of color to prevent and address chronic diseases. The article's areas of focus are weight stigma, bias, and size discrimination; the implications of differing weight perceptions and motivations for change; and weight as the primary determinant of health and biological factors affecting weight.
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Everyone has the right to exercise their body, but does everyone have the same opportunity when it comes to exercise apparel? Are women of all shapes and sizes allotted the same shopping and purchasing experiences when it comes to exercise apparel? Are all yoga pants, bras, and tank tops created equal? This chapter aims to explore size inclusiveness in the exercise apparel industry and illuminates a viewpoint that all pants are not in fact created equal.
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The purpose of this study was to examine the impact of weight discrimination on perceived attributions, person-job fit, and hiring recommendations. Three experiments were undertaken to investigate these issues with people applying for positions in fitness organizations (i.e., aerobics instructor and personal trainer). In all three studies qualified people who were overweight, relative to their qualified and sometimes unqualified thin counterparts, were perceived to have less desirable attributes (e.g., lazy), were thought to be a poorer fit for the position, and were less likely to receive a hiring recommendation. These relationships were influenced by applicant expertise and applicant sex in some cases. Implications for the fitness industry are discussed.
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This study was designed to assess physicians' attitudes toward obese patients and the causes and treatment of obesity. A questionnaire assessed attitudes in 2 geographically representative national random samples of 5000 primary care physicians. In one sample (N = 2500), obesity was defined as a BMI of 30 to 40 kg/m(2), and in the other (N = 2500), obesity was defined as a BMI > 40. Six hundred twenty physicians responded. They rated physical inactivity as significantly more important than any other cause of obesity (p < 0.0009). Two other behavioral factors-overeating and a high-fat diet-received the next highest mean ratings. More than 50% of physicians viewed obese patients as awkward, unattractive, ugly, and noncompliant. The treatment of obesity was rated as significantly less effective (p < 0.001) than therapies for 9 of 10 chronic conditions. Most respondents (75%), however, agreed with the consensus recommendations that a 10% reduction in weight is sufficient to improve obesity-related health complications and viewed a 14% weight loss (i.e., 78 +/- 5 kg from an initial weight of 91 kg) as an acceptable treatment outcome. More than one-half (54%) would spend more time working on weight management issues if their time was reimbursed appropriately. Primary care physicians view obesity as largely a behavioral problem and share our broader society's negative stereotypes about the personal attributes of obese persons. Practitioners are realistic about treatment outcomes but view obesity treatment as less effective than treatment of most other chronic conditions.
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The prevalence and correlates of obese individuals who are resistant to the development of the adiposity-associated cardiometabolic abnormalities and normal-weight individuals who display cardiometabolic risk factor clustering are not well known. The prevalence and correlates of combined body mass index (normal weight, < 25.0; overweight, 25.0-29.9; and obese, > or = 30.0 [calculated as weight in kilograms divided by height in meters squared]) and cardiometabolic groups (metabolically healthy, 0 or 1 cardiometabolic abnormalities; and metabolically abnormal, > or = 2 cardiometabolic abnormalities) were assessed in a cross-sectional sample of 5440 participants of the National Health and Nutrition Examination Surveys 1999-2004. Cardiometabolic abnormalities included elevated blood pressure; elevated levels of triglycerides, fasting plasma glucose, and C-reactive protein; elevated homeostasis model assessment of insulin resistance value; and low high-density lipoprotein cholesterol level. Among US adults 20 years and older, 23.5% (approximately 16.3 million adults) of normal-weight adults were metabolically abnormal, whereas 51.3% (approximately 35.9 million adults) of overweight adults and 31.7% (approximately 19.5 million adults) of obese adults were metabolically healthy. The independent correlates of clustering of cardiometabolic abnormalities among normal-weight individuals were older age, lower physical activity levels, and larger waist circumference. The independent correlates of 0 or 1 cardiometabolic abnormalities among overweight and obese individuals were younger age, non-Hispanic black race/ethnicity, higher physical activity levels, and smaller waist circumference. Among US adults, there is a high prevalence of clustering of cardiometabolic abnormalities among normal-weight individuals and a high prevalence of overweight and obese individuals who are metabolically healthy. Further study into the physiologic mechanisms underlying these different phenotypes and their impact on health is needed.
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The purpose of this study was to develop and evaluate an educational intervention designed to modify the stigma held by first-year medical students towards obese patients. The intervention, composed of video, audio and written components, was based on Petty and Cacioppo's elaboration likelihood model. Prior to the course, the medical students held largely accurate beliefs about the causes of obesity, but they still maintained negative stereotypes of the obese as lazy and lacking in self-control. Analysis of students' attitudes toward obese patients five weeks and one year after the course indicates that the intervention was effective. At the five-week assessment, students in the intervention group differed from students in the control group on six of eight measures of attitudes toward the obese. One year after the course, the intervention group was significantly more likely to rate genetic factors as important in obesity and less likely to blame the obese for their condition.
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To document attitudes and current practices of Australian dietitians in the management of overweight and obesity, and to examine their training needs. Cross-sectional postal survey of a randomly selected sample of members of the Dietitians Association of Australia. 400 dietitians (66% of those surveyed). Questionnaire-based measures of dietitian's views of obesity, education and training in weight management, definitions and perceptions of success, professional preparedness, approaches to weight management, strategies recommended for weight management, and problems and frustrations experienced. Dietitians viewed themselves as potential leaders in the field of weight management, and saw this area as an important part of their role. While they considered themselves to be the best-trained professionals in this area, many felt that their training was poor and many were pessimistic about intervention outcomes. Despite this, most dietitians held views that were current, and regularly employed many of the elements of known best practice in management. However, important areas of weakness included: providing opportunities for long-term follow-up; providing a range of management interventions; promoting self-monitoring of diet and exercise; and promoting opportunities for social support. This study suggests that training in and advocacy for the management and prevention of overweight and obesity are priority areas for dietitians, and that formal studies to evaluate dietitians' effectiveness in management should be undertaken.
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To document general practitioners' (GPs) attitudes and practices regarding the prevention and management of overweight and obesity. A cross-sectional survey of a randomly selected sample of 1500 Australian GPs was conducted, of which 752 questionnaires were returned. The measures included views on weight management, definitions of success, views regarding the usefulness of drugs, approaches to and strategies recommended for weight management, and problems and frustrations in managing overweight and obesity. GPs view weight management as important and feel they have an important role to play. Although they consider themselves to be well prepared to treat overweight patients, they believe that they have limited efficacy in weight management and find it professionally unrewarding. GPs view the assessment of a patient's dietary and physical activity habits and the provision of dietary and physical activity advice as very important. The approaches least likely to be considered important and/or least likely to be practiced were those that would support the patient in achieving and maintaining lifestyle change. There remains considerable opportunity to improve the practice of GPs in their management of overweight and obesity. Although education is fundamental, it is important to acknowledge the constraints of the GPs' existing working environment.
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To develop a shortened form of the original 50-item fat phobia scale. The first factor from the original fat phobia scale-undisciplined, inactive and unappealing-was identified as a potential short form of the scale. A new sample of 255 people completed the original 50-item scale. The reliability of a shortened 14-item version of the scale was tested and compared to that of the full scale using both the new sample and the original sample of 1135 study participants. The fat phobia scale-short form demonstrated excellent reliability in both samples and was strongly correlated with the 50-item scale. Mean and 90th percentile scores are given for both the long and short versions of the scale. The shortened fat phobia scale is expected to increase the utility of the measure in a diverse array of research and clinical settings. Future research should focus on developing scale norms for the general population and conducting research on fat phobia in males and among different ethnic groups.
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To examine how the weight of a patient affects both the attitudes that physicians hold as well as the treatments that they intend to prescribe. In a six-cell randomized design, physicians evaluated a medical chart of a male or female patient, depicted as either average weight, overweight or obese, who presented with a migraine headache. A total of 122 physicians affiliated with one of three hospitals located in the Texas Medical Center of Houston completed the experiment. Using a standard medical procedure form, physicians indicated how long they would spend with the patient and which of 41 medical tests and procedures they would conduct. They also indicated their affective and behavioral reactions to the patient. The weight of a patient significantly affected how physicians viewed and treated them. Although physicians prescribed more tests for heavier patients, F(2, 107)=3.65, P<0.03, they simultaneously indicated that they would spend less time with them, F(2, 107)=8.38, P<0.001, and viewed them significantly more negatively on 12 of the 13 indices. This study reveals that physicians continue to play an influential role in lowering the quality of healthcare that overweight and obese patients receive. As the girth of America continues to increase, continued research and improvements in the quality of such healthcare deserve attention.
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Low compliance to prescribed medical interventions is an ever present and complex problem, especially for patients with a chronic illness. With increasing numbers of medications shown to do more good than harm when taken as prescibed, low compliance is a major problem in health care. Relevant studies were retrieved through comprehensive searches of different database systems to enable a thorough assessment of the major issues in compliance to prescribed medical interventions. The term compliance is the main term used in this review because the majority of papers reviewed used this term. Three decades have passed since the first workshop on compliance research. It is timely to pause and to reflect on the accumulated knowledge. The enormous amount of quantitative research undertaken is of variable methodological quality, with no gold standard for the measurement of compliance and it is often not clear which type of non-compliance is being studied. Many authors do not even feel the need to define adherence. Often absent in the research on compliance is the patient, although the concordance model points at the importance of the patient's agreement and harmony in the doctor-patient relationship. The backbone of the concordance model is the patient as a decision maker and a cornerstone is professional empathy. Recently, some qualitative research has identified important issues such as the quality of the doctor-patient relationship and patient health beliefs in this context. Because non-compliance remains a major health problem, more high quality studies are needed to assess these aspects and systematic reviews/meta-analyses are required to study the effects of compliance in enhancing the effects of interventions.
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This study aimed to assess the prevalence of perceived weight-teasing and associations with unhealthy weight-control behaviors and binge eating in a population-based sample of youth. Particular focus was placed on overweight youth, who may be most vulnerable to weight-teasing. The study population included 4746 adolescents from St Paul/Minneapolis public schools who completed surveys and anthropometric measurements as part of Project EAT, a population-based study of eating patterns and weight concerns among teens. There were statistically significant associations between perceived weight-teasing and weight status; both overweight and underweight youth reported higher levels of teasing than average weight youth. Very overweight youth (body mass index (BMI) > or = 95th percentile) were most likely to be teased about their weight; 63% of very overweight girls, and 58% of very overweight boys reported being teased by their peers, while weight-teasing by family members was reported by 47% of these girls and 34% of these boys. Youth who were teased about their weight, particularly overweight girls, reported that it bothered them. Perceived weight-teasing was significantly associated with disordered eating behaviors among overweight and non-overweight girls and boys. For example, among overweight youth, 29% of girls and 18% of boys who experienced frequent weight-teasing reported binge-eating as compared to 16% of girls and 7% of boys who were not teased. Many adolescents, in particular those who are overweight, report being teased about their weight and being bothered by the teasing. Weight-teasing is associated with disordered eating behaviors that may place overweight youth at increased risk for weight gain. Educational interventions and policies are needed to curtail weight-related mistreatment among youth.
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To determine in normal weight, overweight, and obese men the risk of all-cause and cardiovascular disease (CVD) mortality associated with the metabolic syndrome (MetS) and the influence of cardiorespiratory fitness (CRF). This observational cohort study included 19,173 men who underwent a clinical examination, including a maximal exercise test. MetS was defined according to National Cholesterol Education Program guidelines. At baseline 19.5% of the men had MetS. The ORs of the metabolic syndrome at baseline were 4.7 (95% CI 4.2-5.3) in overweight and 30.6 (26.7-35.0) in obese men compared with normal weight men. A total of 477 deaths (160 CVD) occurred in 10.2 years of follow-up. The risks of all-cause mortality were 1.11 (0.75-1.17) in normal weight, 1.09 (0.82-1.47) in overweight, and 1.55 (1.14-2.11) in obese men with MetS compared with normal weight healthy men. The corresponding risks for CVD mortality were 2.06 (0.92-4.63) in normal weight, 1.80 (1.10-2.97) in overweight, and 2.83 (1.70-4.72) in obese men with the MetS compared with normal weight healthy men. After the inclusion of CRF in the model, the risks associated with obesity and MetS were no longer significant. Obesity and MetS are associated with an increased risk of all-cause and CVD mortality; however; these risks were largely explained by CRF.
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To assess whether weight-related teasing predicts the development of binge eating, unhealthy weight control behaviors, and frequent dieting among male and female adolescents. A prospective study was conducted with an ethnically and socioeconomically diverse sample of 2516 adolescents who completed surveys at both time 1 (1998-1999) and time 2 (2003-2004) of the Project EAT (Eating Among Teens) study. In 1998-1999, approximately one fourth of participants reported being teased about their weight at least a few times a year. After adjustment for age, race/ethnicity, socioeconomic status (SES), and BMI, boys who were teased about their weight were more likely than their peers to initiate binge eating with loss of control and unhealthy weight control behaviors 5 years later. The predicted prevalence for incident binge eating behaviors with loss of control among boys who were teased was 4.1% as compared with 1.4% for those who were not teased, after adjustment for age, race/ethnicity, SES, and BMI. For unhealthy weight control behaviors at time 2, the predicted prevalence was 27.5% among boys who were teased and 19.3% for boys who were not teased, after adjustment for age, race/ethnicity, SES, and BMI. Girls who were teased were more likely than their peers to become frequent dieters. The predicted prevalence for incident frequent dieting among girls who were teased was 18.2% as compared with 11.0% for those who were not teased, after adjustment for age, race/ethnicity, SES, and BMI. Weight teasing in adolescence predicts disordered eating behaviors at 5-year follow-up. The patterns of these associations differ by gender. Reducing teasing through educational interventions and policies may reduce the level of disordered eating behaviors among youths.
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To investigate the implicit and explicit prejudice of physical education (PE) students before, and following extensive professional training, and to examine the relationship of anti-fat prejudice to relevant psychosocial predictors. Implicit and explicit anti-fat prejudice of year one and three PE students (cross-sectional sample) were assessed and compared to a similarly matched (age, body mass index (BMI), education) sample of psychology students. Three hundred and forty-four university students, 180 PE students, 164 psychology students (67% female, mean age 20 years, BMI: mean 23.18 kg/m(2)). Measures of implicit and explicit anti-fat prejudice were administered to PE and psychology students in either their second week, or near completion of their third year, of university study. Physical identity, body esteem and social dominance orientation (SDO) were assessed in order to establish their relationship with anti-fat bias. PE students displayed higher levels of implicit anti-fat bias than psychology students, and other health professionals. Additionally, year three PE students displayed higher levels of implicit anti-fat attitudes than year one PE students. The higher implicit anti-fat biases exhibited by year three PE students were associated with SDO, and lower body esteem. Physical educators, and particularly those more socialized in the PE environment, display strong negative prejudice toward obese individuals that is greater than that displayed by other groups. These prejudices appear to be supported by an over-investment in physical attributes, and ideological beliefs.
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Background: Underreporting of energy intake is associated with self-reported diet measures and appears to be selective according to personal characteristics. Doubly labeled water is an unbiased reference biomarker for energy intake that may be used to assess underreporting. Objective: Our objective was to determine which factors are associated with underreporting of energy intake on food-frequency questionnaires (FFQs) and 24-h dietary recalls (24HRs). Design: The study participants were 484 men and women aged 40-69 y who resided in Montgomery County, MD. Using the doubly labeled water method to measure total energy expenditure, we considered numerous psychosocial, lifestyle, and sociodemographic factors in multiple logistic regression models for prediction of the probability of underreporting on the FFQ and 24HR. Results: In the FFQ models, fear of negative evaluation, weight-loss history, and percentage of energy from fat were the best predictors of underreporting in women (R(2) = 0.09); body mass index, comparison of activity level with that of others of the same sex and age, and eating frequency were the best predictors in men (R(2) = 0.10). In the 24HR models, social desirability, fear of negative evaluation, body mass index, percentage of energy from fat, usual activity, and variability in number of meals per day were the best predictors of underreporting in women (R(2) = 0.22); social desirability, dietary restraint, body mass index, eating frequency, dieting history, and education were the best predictors in men (R(2) = 0.25). Conclusion: Although the final models were significantly related to underreporting on both the FFQ and the 24HR, the amount of variation explained by these models was relatively low, especially for the FFQ.
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It has been said that obese persons are the last acceptable targets of discrimination.1-4 Anecdotes abound about overweight individuals being ridiculed by teachers, physicians, and complete strangers in public settings, such as supermarkets, restaurants, and shopping areas. Fat jokes and derogatory portrayals of obese people in popular media are common. Overweight people tell stories of receiving poor grades in school, being denied jobs and promotions, losing the opportunity to adopt children, and more. Some who have written on the topic insist that there is a strong and consistent pattern of discrimination, 5 but no systematic review of the scientific evidence has been done.
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Are the psychotherapeutic experiences of fat clients negatively affected by the cultural bias against fat people? This empirical study demonstrates that clients' weight may negatively affect psychologists' clinical judgments of and treatment planning for fat clients. Strategies to combat fat bias are presented for both training programs and clinicians. Information provided for training programs includes specific guidelines for curriculum development. Strategies presented for clinicians include assessment of one's own bias, self-education, treatment alternatives, and practice recommendations.
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This research examines the effects of obesity, gender, and specialty on the social influence of physicians. Recent research in other areas of social science indicates that the effects of gender are declining, but the effects of the obesity physical appearance dimension linger. For physicians, just the opposite seems to be the case. More significant gender effects than obesity effects were found. Some specialties also interact with gender and obesity. Moreover, the research describes an innovative use of morphing to manipulate and isolate the obesity stimulus.
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Although obese individuals are at high risk of being insulin resistant and developing type 2 diabetes mellitus, as well as having atherosclerosis, it is possible that a phenotype exists with a metabolically benign fat distribution that protects such individuals from type 2 diabetes or cardiovascular disease. In an attempt to identify subjects with metabolically benign obesity, the investigators used magnetic resonance (MR) tomography to measure total body, visceral, and subcutaneous fat, and proton (1H)-MR spectroscopy to determine fat deposition in ectopic tissues (liver and skeletal muscle). The oral glucose tolerance test was used to estimate insulin resistance. The study subjects-314 individuals (121 men and 193 women) with a mean age of 45 (range, 18-69) years-were divided into three groups based on body mass index (BMI) [calculated as weight in kilograms divided by height in meters squared]: normal weight (BMI, ≤25.0), overweight (BMI, 25.0-29.9), and obese (BMI, ≥30.0). The obese group was further divided into 2 subgroups: obese-insulin sensitive (IS)-placement in the upper quartile of insulin sensitivity, and obese-insulin resistant (IR)-placement in the lower three quartiles of insulin sensitivity. The percentage of total body and visceral fat was higher in the overweight and obese groups than the normal-weight group (P < .05), but no statistically significant differences were found between the obese-IS and obese-IR groups. In contrast, compared to the obese-IR group, the obese-IS group had a lower percentage of ectopic fat in skeletal muscle (P < .001) and especially the liver (4.3% ± 0.6% versus 9.5% ± 0.8%), lower intima-media thickness of the common carotid artery (0.54 ± 0.02 versus 0.59 ± 0.01 mm, P < .05), and higher insulin sensitivity (17.4 ± 0.3 versus 7.3 ± 0.3 AU, P < .05). Surprisingly, insulin sensitivity in the normal weight group (18.2 ± 0.9 AU) was almost identical to that in the obese-IS group. Moreover, there was no statistically significantly difference in intima-media thickness between these two groups. These data provide evidence for the existence of a metabolically benign obesity profile that may provide protection against insulin resistance and atherosclerosis.
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One hundred third year medical students completed a questionnaire which elicited their reactions to obesity, including morbid obesity. The students' reactions toward the moderately obese were neutral or negative; while their reactions to the morbidly obese were almost uniformly negative. This is in contrast to their reactions to persons of average weight, which were neutral or positive. The negative prejudices expressed toward the morbidly obese extended beyond characteristics attributed to weight. Their negative feelings towards the obese did not change after direct contact with morbidly obese patients. Further research is needed to assess how prejudicial views toward obese people affect their medical care.
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LR: 20061115; JID: 7501160; 0 (Antilipemic Agents); 0 (Cholesterol, HDL); 0 (Cholesterol, LDL); 57-88-5 (Cholesterol); CIN: JAMA. 2001 Nov 21;286(19):2401; author reply 2401-2. PMID: 11712930; CIN: JAMA. 2001 Nov 21;286(19):2400-1; author reply 2401-2. PMID: 11712929; CIN: JAMA. 2001 Nov 21;286(19):2400; author reply 2401-2. PMID: 11712928; CIN: JAMA. 2001 Nov 21;286(19):2400; author reply 2401-2. PMID: 11712927; CIN: JAMA. 2001 May 16;285(19):2508-9. PMID: 11368705; CIN: JAMA. 2003 Apr 16;289(15):1928; author reply 1929. PMID: 12697793; CIN: JAMA. 2001 Aug 1;286(5):533-5. PMID: 11476650; CIN: JAMA. 2001 Nov 21;286(19):2401-2. PMID: 11712931; ppublish
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Thesis (Ph. D.)--University of Mississippi, 1972. Vita. Includes bibliographical references (leaves 75-78). Microfilm. s
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Obesity represents a risk factor for insulin resistance, type 2 diabetes mellitus, and atherosclerosis. In addition, for any given amount of total body fat, an excess of visceral fat or fat accumulation in the liver and skeletal muscle augments the risk. Conversely, even in obesity, a metabolically benign fat distribution phenotype may exist. In 314 subjects, we measured total body, visceral, and subcutaneous fat with magnetic resonance (MR) tomography and fat in the liver and skeletal muscle with proton MR spectroscopy. Insulin sensitivity was estimated from oral glucose tolerance test results. Subjects were divided into 4 groups: normal weight (body mass index [BMI] [calculated as weight in kilograms divided by height in meters squared], < 25.0), overweight (BMI, 25.0-29.9), obese-insulin sensitive (IS) (BMI, > or = 30.0 and placement in the upper quartile of insulin sensitivity), and obese-insulin resistant (IR) (BMI, > or = 30.0 and placement in the lower 3 quartiles of insulin sensitivity). Total body and visceral fat were higher in the overweight and obese groups compared with the normal-weight group (P < .05); however, no differences were observed between the obese groups. In contrast, ectopic fat in skeletal muscle (P < .001) and particularly the liver (4.3% +/- 0.6% vs 9.5% +/- 0.8%) and the intima-media thickness of the common carotid artery (0.54 +/- 0.02 vs 0.59 +/- 0.01 mm) were lower and insulin sensitivity was higher (17.4 +/- 0.9 vs 7.3 +/- 0.3 arbitrary units) in the obese-IS vs the obese-IR group (P < .05). Unexpectedly, the obese-IS group had almost identical insulin sensitivity and the intima-media thickness was not statistically different compared with the normal-weight group (18.2 +/- 0.9 AU and 0.51 +/- 0.02 mm, respectively). A metabolically benign obesity that is not accompanied by insulin resistance and early atherosclerosis exists in humans. Furthermore, ectopic fat in the liver may be more important than visceral fat in the determination of such a beneficial phenotype in obesity.
Article
To examine practice nurses' beliefs about obesity and their current practices and the role of the weight management context and their own BMI on these factors. Cross sectional questionnaire. Questionnaires concerning beliefs about obesity and current practices were completed by 586 practice nurses. The subjects rated lifestyle as the main cause and cardiovascular problems as the main consequences of obesity, regarded weight loss as beneficial and reported high confidence in their ability to give advice to obese patients. However, their expectations of patient compliance and actual weight loss were low indicating that practice nurses rate their advice giving skills as independent to the outcome of this advice. Further, failed weight loss was explained in terms of patient and not professional factors. In addition, the results indicated variability in their beliefs and behaviour according to the location of this advice and the practice nurse's own BMI. In particular, practice nurses who run weight loss clinics reported giving weight loss advice more frequently, spending longer counselling obese patients, reported greater confidence in giving weight loss advice and more optimism about outcomes. Further, those with low BMIs rated obesity as more preventable, reported being less likely to advise patients to use a calorie controlled diet and more likely to suggest eating less in general. Education programmes for practice nurses should not only include skills training but emphasise both the factors involved in advice giving and self appraisal. Such appraisal should include a role for both the practice nurse's and the patient's behaviour to minimise the 'operation was a success but the patient died' approach to obesity management.
Article
Previous research has documented prejudicial attitudes and discrimination against overweight people. Yet the extent to which overweight people themselves perceive that they have been mistreated because of their weight has not been carefully studied. The purpose of this study was to examine the prevalence of perceived mistreatment due to weight and sources of perceived mistreatment. A non-clinical sample of healthy adults (187 men and 800 women) enrolled in a weight gain prevention program comprised the study population. A self-administered questionnaire was used to measure perceived mistreatment due to weight. Overall, 22% of women and 17% of men reported weight-related mistreatment. The most commonly reported sources of mistreatment among women were strangers (12.5%) and a spouse or loved one (11.9%). Men were most likely to report mistreatment by a spouse or loved one (10.2%) and friends (7.5%). Somewhat surprisingly, sex differences in perceived weight-related mistreatment were significant only for stranger as the source. Perceived weight-related mistreatment was positively associated with body mass index (BMI) (r = 0.39, p<0.0001). Reported mistreatment was nearly ten times as pervalent among individuals in the highest quartile of the BMI distribution (42.5%) than among those in the lowest BMI quartile (5.7%), but was significantly greater than zero in all but the very lean. Perceived mistreatment due to weight is a common experience and is not restricted to the morbidly obese. Results are discussed in light of the sociocultural value for thinness.