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Weighed Down by Stigma: How Weight-Based Social Identity Threat Contributes to Weight Gain and Poor Health: Weighed Down by Stigma
Abstract
Weight stigma is pervasive, and a number of scholars argue that this profound stigma contributes to the negative effects of weight on psychological and physical health. Some lay individuals and health professionals assume that stigmatizing weight can actually motivate healthier behaviors and promote weight loss. However, as we review, weight stigma is consistently associated with poorer mental and physical health outcomes. In this article, we propose a social identity threat model elucidating how weight stigma contributes to weight gain and poorer mental and physical health among overweight individuals. We propose that weight-based social identity threat increases physiological stress, undermines self-regulation, compromises psychological health, and increases the motivation to avoid stigmatizing domains (e.g., the gym) and escape the stigma by engaging in unhealthy weight loss behaviors. Given the prevalence of overweight and obesity in the US, weight stigma thus has the potential to undermine the health and wellbeing of millions of Americans.
... The concept of weight stigma refers to negative attitudes, beliefs, and discrimination based on an individual's weight, which can be associated with the way people see themselves and how others see them, impacting one's body image [8]. People with overweight or obesity may experience weight stigma, as it is frequently directed at their physical appearance, particularly their weight and body size [9]. Individuals who are overweight or obese may also be labeled as lazy and unhealthy, which can lead to discrimination against them. ...
... Weight stigma can be encountered in various situations and from different sources, including the workplace, family, health care professionals, and school. Experiencing weight stigma can result in adverse psychological and physical health outcomes, particularly among adolescents [9]. Children and young people with overweight or obesity might face bullying, social exclusion, and discrimination due to weight stigma [10]. ...
... More significantly, weight stigma can induce stress, lower self-esteem, and contribute to a negative body image. Over an extended period, these factors may lead to mental health problems [9]. ...
Background
Psychosomatic complaints have increased among adolescents in recent decades, as have overweight and obesity rates. Both of these trends are regarded as public health concerns. However, the associations between weight status and psychosomatic complaints are not yet clear, necessitating further research. The aim of the present study was to investigate the associations between weight status and psychosomatic complaints in Swedish adolescent boys and girls, as well as to explore the potential buffering effect of family support.
Methods
The data was obtained from the cross-sectional Swedish Health Behaviour in School-aged Children (HBSC) study conducted in 2017/18, which involved 3,135 students aged 11, 13, and 15 years. Weight status was based on self-reported information on weight and height, which allowed for the calculation of body mass index (BMI) and the categorisation of participants into three groups: non-overweight, overweight, and obese. Psychosomatic complaints were assessed based on information regarding the frequency of eight different complaints, which were summed into an index. Family support was measured using three items describing the level of perceived emotional support, and an index was created, which was dichotomised into low and high family support. Gender stratified linear regression models were run to examine the associations between weight status and psychosomatic complaints. Age and family affluence were included as covariates. Interaction terms were included to evaluate whether family support moderated the main association.
Results
Obesity was associated with higher levels of psychosomatic complaints in both boys and girls when compared to being non-overweight (boys: b = 2.56, 95% CI 0.32, 4.79; girls: b = 3.35, 95% CI 0.77, 5.94), while being overweight did not show any statistically significant associations with the outcome (boys: b = 0.21, 95% CI -0.72, 1.15; girls: b = 0.78, 95% CI -0.42, 1.98). In girls, a statistically significant interaction effect between family support and weight status was observed (p = 0.031), indicating that family support buffered against psychosomatic complaints in girls with obesity. No statistically significant interaction was found for boys (p = 0.642).
Conclusions
The findings of this study highlight the importance of public health initiatives aimed at preventing childhood obesity. They also underscore the significant role of family support in reducing psychosomatic complaints among adolescents with obesity. Further research is necessary to gain a deeper understanding of these relationships.
... Social identity threat is linked to the broader societal norms and people's position within social categories, focusing on group memberships rather than personal idiosyncrasies (Ellemers et al., 2002). For example, weight-based discrimination induces social identity threat because it targets people perceived to have a higher body weight and devalues the entire group as inferior compared to other groups (Hunger et al., 2015;Zhu et al., 2022). Social identity threat results in psychological and physical strains, such as lower self-esteem and greater cardiovascular reactivity (Hunger et al., 2015), and it is associated with lower motivations to engage in healthy behaviors (Zhu et al., 2022). ...
... For example, weight-based discrimination induces social identity threat because it targets people perceived to have a higher body weight and devalues the entire group as inferior compared to other groups (Hunger et al., 2015;Zhu et al., 2022). Social identity threat results in psychological and physical strains, such as lower self-esteem and greater cardiovascular reactivity (Hunger et al., 2015), and it is associated with lower motivations to engage in healthy behaviors (Zhu et al., 2022). ...
... Many forms of resistance to persuasion, such as counterarguing or source derogation, require substantial cognitive resources to systematically process the persuasive message and formulate relevant arguments to refute it (Wheeler et al., 2007). Research shows that social identity threat can induce stress that depletes cognitive resources (Hunger et al., 2015). Consequently, people who experience social identity threat may turn to coping strategies that may be least cognitively taxing to enact, such as decreasing attention to message arguments (Derricks & Earl, 2023). ...
Health messages aiming to reduce red meat consumption may threaten multiple social identities because people’s dietary choices are intertwined with personal, social, and cultural aspects of their lives. Leveraging social identity theory and the concept of social identity complexity, this experiment tested how identity-threatening messages affect people’s intention to reduce red meat consumption and how the effect of identity threat may be moderated by messages highlighting the relationships between multiple identities that define a person. Participants (N = 409) read messages that varied identity threat (i.e., the extent to which people feel devalued because of their membership in a social group) and identity complexity (i.e., the extent to which people perceive multiple identities as independent). The study found that identity-threatening messages decreased intentions to reduce red meat consumption when people perceived their dietary identity as overlapping with other identities, but increased the intentions when the dietary identity was seen as independent from other identities. Further, the effects of identity threat and complexity were limited to people with high (vs. low) levels of red meat consumption. We discuss the role of identity complexity in alleviating identity threat and increasing persuasion.
... The theoretical framework of the present study is based on these two fat stigma mechanisms. More specifically, it is proposed that perceived weight stigma (PWS), the external devaluation by individuals who perceive themselves as having a weight issue (Huang, Lee, et al., 2022), could be an initial trigger causing individuals to have psychological distress to avoid PA engagement which subsequently leads to an actual reduction in PA (Hunger et al., 2015). Given that a recent psychometric scale regarding tendency to avoid PA has been developed to link the relationship between PWS and PA (Ajibewa et al., 2022;Bevan et al., 2021Bevan et al., , 2022, the aforementioned theoretical framework can be empirically investigated. ...
... In the aforementioned theoretical framework, PWS is defined as the external devaluation by individuals who perceive themselves as having a weight issue (Huang, Chen, et al., 2022) and has been reported to be a psychosocial factor Nadhiroh et al., 2022) that prevents individuals from participating in PA (Bevan et al., 2021;Vartanian et al., 2018). Speculatively, stigmatized individuals may consider avoidance as a self-protective strategy which helps them escape from psychological stress (Hunger et al., 2015) derived from the harsh comments and judgement of others (Myre et al., 2021), directly resulting in their avoidance of engaging in PA (Brewis, 2014) and the consequential reduction of PA. However, the involvement of tendency to avoid PA in the association between PWS and PA, along with its influences on different levels of PA, remains unclear. ...
... In addition, the effect of psychosocial stress has also been proposed to indirectly magnify the impact of weight stigma (Brewis, 2014). Weight stigma may act as a threat to social identification and result in individuals being in unfriendly social situations (Hunger et al., 2015). Therefore, to reduce perceived stress, a stigmatized individual may choose not to engage in sport and exercise to avoid being publicly devalued, which subsequentially develops to a longer-term avoidance tendency. ...
Background and aims: The World Health Organization recently announced an action plan to increase global physical activity (PA) levels due to individuals' increasingly inactive lifestyle. Perceived weight stigma (PWS) is a psychosocial factor that may reduce individuals' PA, and PA avoidance may be involved in this association. Therefore, the present study conducted a cross-sectional survey to investigate the mediating effect of tendency to avoid PA in the association between PWS and PA among Chinese university physical education (PE) students and non-PE students. Methods: Responses from non-PE (n = 2877) and PE (n = 2286) students were collected via an online survey comprising the Perceived Weight Stigma Scale, Tendency to Avoid Physical Activity and Sport Scale, and International Physical Activity Questionnaire Short Form. Results: Results of moderated atemporal mediation analysis showed a significant association between PWS and PA mediated by tendency to avoid PA among the two groups (B[SE] = 0.94[0.08], p < .001). In addition, compared to non-PE students, PE students were significantly less affected by tendency to avoid PA (B[SE] =-2.61 [0.29], p < .001). However, when affected, PE students showed a larger reduction in moderate PA levels than non-PE students (B[SE] = − 9.14[4.51], p = .043). Conclusion: The present study's findings showed that PWS negatively affected PA via the atemporal mediation of tendency to avoid PA among university PE and non-PE students. Additionally, compared to non-PE students, PE students showed a larger reduction in moderate PA levels when affected by the tendency to avoid PA. Strategies
... While experience sampling studies support the associations between higher negative weight-related experiences, higher weight bias internalization, and less positive and more negative emotions at between and within-person levels Vartanian et al., 2014), they have included adult samples and captured general as opposed to body emotions. Since adolescents experience greater frequency and variability in emotions compared to adults (Bailen et al., 2019), and may be particularly vulnerable to negative psychological responses to social rejection (Harter, 2012;Hunger et al., 2015), investigation into the acute emotional responses to negative weight-related experiences and weight bias internalization specifically within this developmental period is needed. ...
... The present study explored the between-and within-person associations among negative weight-related experiences, weight bias internalization, and body emotions using a daily diary approach. Although negative weight-related experiences, weight bias internalization, and poor body image occur across the weight spectrum (Lucibello et al., 2023;Pearl & Puhl, 2014), anti-fat attitudes and experiences disproportionately affect higher-weight adolescents and can activate unique psychological processes (Hunger et al., 2015); therefore, the moderating role of weight status was tested. The betweenperson hypothesis is that individuals who report more negative weight-related experiences and weight bias internalization on average will experience higher average body shame and embarrassment, and lower body pride, compared to those who report less. ...
Introduction
The present study examined the between‐ and within‐person associations among negative weight‐related experiences, weight bias internalization, and body shame, embarrassment, and pride in adolescents.
Methods
Participants were 93 Canadian students (Mage = 15.54, 59.10% girls, 40.86% white) who completed a 5‐day daily diary study in 2021. Multilevel models were estimated to examine the between‐ and within‐person associations, as well as the cross‐level interactions.
Results
Fifty‐nine negative weight‐related experiences were reported from 22 participants (23.66%) over the 5‐day study period. Adolescents with higher average negative weight‐related experiences (OR = 19.60, 95% CI = 1.90–202.67) and weight bias internalization (OR = 3.66, CI = 2.07–6.46) had greater odds of reporting shame. Similarly, higher average negative weight‐related experiences (OR = 16.29, CI = 3.65–72.75) and weight bias internalization (OR = 2.08, CI = 1.53–2.82) was associated with greater odds of embarrassment. No within‐person effects were noted, such that reporting more negative weight‐related experiences or weight bias internalization than one's own average was not related to body emotions.
Conclusions
This distinction underscores that the persistent, rather than episodic, aspects of negative weight‐related experiences and weight bias internalization are most impactful on adolescents’ body image. These findings have implications for recruitment and screening for individual‐level interventions for internalized weight bias and body image, and highlight the need for system‐level policies and changes that prohibit negative weight‐related experiences and messages to reduce likelihood of internalizing weight bias among adolescents.
... Weight stigma causes physical and psychological consequences. In particular, the weight stigma may be internalized by individuals who then feel to belong to a low-valued social group (Hunger et al., 2015, Ramos Salas et al., 2019. Literature in social and political psychology indicates that when individuals feel to belong to lower-ranked social groups, they tend to compare themselves with and develop negative attitudes toward groups of even lower status (Festinger, 1954, Hogg, 2016, Tajfel and Turner, 2004. ...
... We read our descriptive evidence in light of the literature on social identity theory. Overweight and obese individuals are often stigmatized, and if this stigma is internalized, they feel to belong to a lower-ranked group in society (Hunger et al., 2015, Ramos Salas et al., 2019, Sutin et al., 2015. This mechanism corresponds to a decrease in social status that may trigger out-group conflict, especially toward other low-ranked groups such as immigrants (Festinger, 1954, Hogg, 2016, Schneider, 2008, Tajfel and Turner, 2004. ...
Building on social identity theory, we suggest that natives from stereotyped groups tend to value cultural distance more and think that immigrants are not good for the economy and the fiscal system. We draw upon research showing that overweight and obese individuals suffer from social stigma and discrimination and we investigate the relationship between high body mass and attitudes toward immigrants in Europe. We exploit the appointment of the Belgian Minister of Health to provide causal evidence that stigmatization and stereotyping contribute to negative attitudes toward immigrants. Furthermore, a survey experiment shows that individuals with a higher body mass index prioritize cultural factors over economic ones when facing immigrants.
... 3,17 Experiencing weight stigma ironically leads to healthcare avoidance and behaviors that undermine health, such as sleep disturbance, increased alcohol use, and disordered eating. [18][19][20] The impact of weight bias is not limited to patients. A recent systematic review explored the prevalence of weight bias in educational settings and found that medical students who were in larger bodies and experienced weight stigma reported lower body esteem, greater loneliness, less overall health, and were more likely to use maladaptive coping strategies such as alcohol or illicit drugs. ...
... When asked to indicate why, 29% cited performance-related reasons, which underlines the belief that weight loss or lower body weight will improve athletic performance. Aesthetic reasons were cited by 27.5% of the respondents, and improved self-image by 18.8%. Aesthetic reasons were considered separate from improved self-image when the respondent spoke directly about how they felt about themselves in relation to others as a result of their bodies. ...
Anatomy with human dissection may help to develop respect for the human body and professionalism; however, dissection may worsen students' attitudes about body weight and adiposity. The purpose of this study was to measure weight bias among Doctor of Physical Therapy (DPT) students enrolled in gross anatomy and determine if, and how the experience of dissection impacts weight bias. Ninety‐seven DPT students (70 University of Colorado [CU], 27 Moravian University [MU]) were invited to complete a survey during the first and final weeks of their anatomy course. The survey included demographic items, two measures of weight bias—the Modified Weight Bias Internalized Scale (M‐WBIS) and the Attitudes Towards Obese Persons (ATOP) Scale—and open‐ended questions for the students who participated in dissection (CU students) that explored attitudes about body weight and adiposity. At baseline, there were no significant differences (p > 0.202) in ATOP, M‐WBIS, or BMI between the two universities. The mean scores on both the ATOP and M‐WBIS indicated a moderate degree of both internalized and externalized weight bias. There were no significant changes in ATOP (p = 0.566) or M‐WBIS scores (p = 0.428). BMI had a low correlation with initial M‐WBIS scores (⍴ = 0.294, p = 0.038) and a high correlation with change scores in CU students (⍴ = 0.530, p = 0.011). Future studies should utilize the same measures of weight bias in other healthcare trainees to facilitate comparison and incorporate larger populations of DPT students.
... Next to labelling by others, many people with obesity have the same anti-fat attitudes as slender people (Crandall 1994). This self-stigma is expressed in the form of a negative body image (Harriger and Thompson 2012), feeling guilty or weak (Lillis et al. 2010), distancing from others that have obesity (Durso and Latner 2008), and reduced motivation in weight loss efforts (Corrigan, Larson, and R€ usch 2009;Hunger et al. 2015). ...
... For example, on an intrapersonal level, self-stigma makes people adopt maladaptive coping strategies, such as avoiding stigmatizing situations (Hayward, Vartanian, and Pinkus 2018). This includes avoiding exercising with others (Hunger et al. 2015), which negatively impacts a person's health. In combination with structural stigmatization, such as negative media portrayals, and interpersonal stigmatization, such as colleagues making remarks, this can lead to lower self-esteem and lower self-efficacy and consequently, people may become less motivated to achieve life goals in general (Corrigan, Larson, and R€ usch 2009). ...
In this article we describe how designers can apply storytelling to reduce health-related stigmas. Stigma is a pervasive problem for people with illnesses, such as obesity, and it can persistently hinder coping, treatment, recovery, and prevention. Reducing health-related stigma is complex because it is multi-layered and self-perpetuating, leading to intertwined vicious circles. Interactive storytelling environments can break these vicious circles by delimiting the narrative freedom of stigma actors. We theoretically explain the potential of interactive storytelling environments to reduce stigma through the following seven functions: 1) expose participants to other perspectives, 2) provide a protective frame, 3) intervene in daily conversations, 4) persuade all stigma actors, 5) exchange alternative understandings, 6) elicit understanding and support for stigma victims, and 7) support stigma victims to cope with stigmatization. We elaborate on these functions through a demonstration of an interactive storytelling environment against weight stigma. In conclusion, this article is a call on designers for health and wellbeing, scientists, and practitioners from various disciplines to be sensitive to the pervasiveness of stigma and to collaboratively create destigmatizing storytelling environments.
... Related, it has been found that many patients, particularly heavier individuals, have had stigmatizing interactions in healthcare settings, which can date back to youth [54]. Providers may aim to motivate patients toward weight loss by voicing negative beliefs about weight, yet this approach often increases the likelihood of both poorer physical and mental health [55,56]. However, completely avoiding conversations about weight, body image, and eating disorders is also a disservice to patients who rely on healthcare providers for accurate and helpful information about these issues. ...
Background
Although many people have concerns about their body image, weight, and eating behaviors these issues are not usually discussed in a productive manner with medical providers. Thus, we examined nursing and medical students’ willingness to discuss patients’ weight, body image, and eating disorders and reasons why they may do so.
Method
One hundred and eighty-three nursing and medical students (Mage = 25.06, SD = 5.43) participated in this study. Participants completed open-ended questions pertaining to their willingness to discuss body image, eating, and weight-related issues with future patients. We further queried students’ perspective on body mass index (BMI) as a measure of weight status and sought to determine if participants’ own weight, weight concerns, appearance evaluation, body appreciation, and experiences of stigma were associated with their willingness to discuss weight-related issues with prospective patients.
Results
Coding of qualitative data indicated that nursing and medical students were “sometimes” willing to discuss prospective patients’ weight, body image, and eating disorders, especially if a health concern was evident. Nursing students seemed somewhat more willing to discuss weight issues than medical students and willingness to discuss one of these issues (e.g., body image) was positively associated with willingness discuss the others. Plans for future discussions of body image and weight were marginally associated with personal experiences of weight stigma. The majority of participants indicated that BMI was not a valid measure of health.
Conclusions
Taken together, findings suggest that future providers’ conversations with patients about these sensitive topics are less likely to be associated with their own experiences and more with the relevance of these topics to specific patients.
... However, not all people facing verbal WRA report future BE (Bannon, Salwen, and Hymowtiz 2018), and the underlying factors that might theoretically interfere in the relationship between verbal WRA and BE need further exploration. Hunger et al. (2015) suggest that disturbance in self-regulatory resources and individuals' efforts to avoid weight stigma are related to problematic health behaviors. In line with this finding, the Stigma Control Model of Dysregulated Eating (Mason, Smith, and Lavender 2018) offers a pathway from victimization toward dysregulated eating behaviors through stigma management strategies. ...
Introduction
Previous studies investigated the impact of weight‐related abuse (WRA) on eating pathology. However, the circumstances of such an effect are still unclear. Our study aimed to examine the relationship between verbal WRA and binge eating (BE) behavior via attentional bias (AB) to threat cues and difficulties in emotion regulation.
Method
We conducted a parallel mediation model. On the basis of the purposive sampling method, 183 individuals with obesity and overweight (70.5% female and 28.4% male; Meanage = 32.78), from February to June 2019, were recruited from a nutrition clinic in Tehran. The participants completed the BE scale (BES), the weight‐related abuse questionnaire (WRAQ), the difficulties in emotion regulation scale (DERS), and the dot probe task (DPT).
Results
AB to threat cues had a significantly negative association with verbal WRA and BE. Difficulties in emotion regulation showed a significant positive association with verbal WRA and BE. The parallel mediation model showed a direct effect of verbal WRA on BE. Moreover, the bootstrap analysis revealed that difficulties in emotion regulation could mediate the association between verbal WRA and BE.
Conclusions
Our findings suggest that experiences of verbal WRA can contribute to cognitive bias to negative emotion, maladaptive emotion regulation strategies, and behavioral problems like BE.
... In people who rapidly lose weight, there might be changes in lifestyle (such as increased participation in physical activities and reduced participation in hedonic and food-related activities), possibly resulting in shifts in personal networks (Greaves et al., 2017). On the other hand, body weight is strongly associated with social identity (Hunger et al., 2015) and rapid weight loss could result in identity disturbance, which has been associated with suicide attempts in borderline personality disorder (Yen et al., 2021). Regret and blaming oneself for the previous obesity might lead some people to STB if not properly supported. ...
... However, actively attending to factors that shape shared social identity among intervention recipients can also yield more proximal health benefits. In the context of obesity, research has shown that PWSO often define themselves in relation to their weight (Hunger et al., 2015), may be at a higher risk of loneliness (e.g., Hajek et al., 2021), and are regularly subject to discrimination and prejudice in society: these experiences can become internalized with consequences for subsequent weight-related behaviours (Puhl et al., 2007;Puhl & Suh, 2015;Wang et al., 2004). Group interventions, to the extent that group members develop a sense of shared social identity, may provide a valuable context for individuals to start to address these psychosocial challenges (Branscombe et al., 1999;Farrow & Tarrant, 2009). ...
Introduction
Interventions to support behaviour change in people living with chronic health conditions increasingly use patient groups as the mode of delivery, but these are often designed without consideration of the group processes that can shape intervention outcomes. This article outlines a new approach to designing group‐based behaviour change interventions that prioritizes recipients' shared social identity as group members in facilitating the adoption of established behaviour change techniques (BCTs). The approach is illustrated through an example drawn from research focused on people living with severe obesity.
Methods
A prioritization process was undertaken in collaboration with stakeholders, including behaviour change experts, clinicians, and a former patient to develop an evidence‐based, group intervention informed by the social identity approach to health. Three phases of development are reported: (1) identification of the health problem; (2) delineation of intervention mechanisms and operationalization of BCTs for group delivery and (3) intervention manualization. The fourth phase, intervention testing and optimization, is reported elsewhere.
Results
A group‐based behaviour change intervention was developed, consisting of 12 group sessions and 3 one‐to‐one consultations. The intervention aimed to support the development of shared social identity among recipients, alongside the delivery of evidence‐based BCTs, to improve the likelihood of successful intervention and health outcomes among people living with severe obesity.
Conclusions
A manualized intervention, informed by the social identity approach to health, was systematically designed with input from stakeholders. The development approach employed can inform the design of behavioural interventions in other health contexts where group‐based delivery is planned.
... Considerable research in the past decade has shown that weight stigma is not only widespread (Lee et al., 2021;Prunty et al., 2020), but also induces significant psychological and physiological stress (Hunger et al., 2015;Tomiyama, 2014;Puhl & Heuer, 2009;Sikorski et al., 2015;Tomiyama, 2019). ...
... For example, studies of obesity and executive functioning (EF) rarely include measures of WBI, even though EF and weight stigma share similar relationships to specific predictors of weight gain such as stress, binge eating behavior, and inhibitory control. 57 Similarly, interventions treating comorbid depression and obesity without evaluating WBI neglect a factor known to exacerbate depressive symptoms, reduce weight loss treatment efficacy, and account for the comorbidity prevalence. 58 Finally, individuals who lose weight may subsequently experience reduced WBI and weight discrimination, resulting in mental and physical health benefits distinct from, but attributed to, weight loss. ...
Mental health concerns are common among college students, especially students with higher body mass index (BMI). Weight bias internalization (WBI) is thought to contribute to these mental health disparities. However, little is known about how WBI differs among more diverse students, and to what extent WBI may explain associations between BMI and health in college populations. This study compared rates of WBI in Freshman college students (N = 1289) across gender, race/ethnicity, and sexual orientation, and assessed whether WBI mediated associations between BMI and mental health (depression, self-esteem, stress, loneliness) and behavioral health (disordered eating, physical activity, gym use). Black students and men demonstrated reduced WBI while bisexual women showed increased WBI. Further, WBI mediated the association of BMI with mental health and disordered eating, but not physical activity. These findings suggest that stigma may account for mental health disparities among higher-BMI students, and that minoritized groups are disproportionately impacted
... We also tested dimensions of weight stigma (internalized bias, self-stigma, anticipated stigma) that are theorized to exacerbate the effects of stigma [18], and have been shown to amplify the effects of weight stigma on related outcomes (e.g., maladaptive eating behaviors [19]). Similarly, in line with the social identity threat approach that argues perceiving oneself as a member of the stigmatized group is a component of threat-related effects of weight stigma [20], we examined perceived weight as an exacerbating factor rather than BMI. ...
Background
Weight stigma is widespread, but the existing literature on its harmful consequences remains largely limited to lab-based experiments and large-scale longitudinal designs.
Purpose
The purpose of this study was to understand how weight stigma unfolds in everyday life, and whether it predicts increased eating behavior.
Methods
In this event-contingent ecological momentary assessment study, 91 participants reported every time they experienced weight stigma and documented whether they ate, how much they ate, and what they ate. These reports were compared against a timepoint when they did not experience stigma.
Results
Participants reported a wide variety of stigmatizing events from a variety of sources, with the most common ones being the self, strangers, the media, and family. Multilevel models showed that participants were no more likely to eat post-stigma (vs. the comparison point), but if they did eat, they ate more servings of food (on average consuming 1.45 more servings, or 45% more). Moderation analyses indicated that this effect was amplified for men versus women.
Conclusion
Experiencing weight stigma appears to beget behavioral changes, potentially driving future weight gain, placing individuals at ever more risk for further stigmatization.
... Related, it has been found that many patients, particularly larger-bodied individuals, have had stigmatizing interactions in healthcare settings, which can date back to youth [52]. Providers may aim to motivate patients toward weight loss by voicing negative beliefs about weight, yet this approach often increases the likelihood of both poorer physical and mental health [53,54]. However, completely avoiding conversations about weight, body image, and eating disorders is also a disservice to patients who rely on healthcare providers for accurate and helpful information about these issues. ...
Background: Although many people have concerns about their body image, weight, and eating behaviors these issues are not usually discussed in a productive manner with medical providers. Thus, we examined nursing and medical students’ willingness to discuss patients’ weight, body image, and eating disorders and reasons why they may do so.
Method: One hundred and eighty-three nursing and medical students (Mage=25.06, SD=5.43) participated in this study. Participants completed open-ended questions pertaining to their willingness to discuss body image, eating, and weight-related issues with future patients. We further queried students’ perspective on body mass index (BMI) as a measure of weight status and sought to determine if participants’ own weight, weight concerns, appearance evaluation, body appreciation, and experiences of stigma were associated with their willingness to discuss weight-related issues with prospective patients.
Results: Coding of qualitative data indicated that nursing and medical students were “sometimes” willing to discuss prospective patients’ weight, body image, and eating disorders, especially if a health concern was evident. Nursing students seemed somewhat more willing to discuss weight issues than medical students and willingness to discuss one of these issues (e.g., body image) was positively associated with willingness discuss the others. Plans for future discussions of body image and weight were marginally associated with personal experiences of weight stigma. The majority of participants indicated that BMI was not a valid measure of health.
Conclusions: Taken together, findings suggest that future providers’ conversations with patients about these sensitive topics are less associated with their own experiences and more with the relevance of these topics to specific patients.
... In addition to the food environment in the United Kingdom, systemic barriers predispose migrants to unhealthy dietary patterns and activity patterns, which could contribute to the development of obesity. Though previous studies have investigated barriers and facilitators to successful weight management [15][16][17][18][19], it is important to stress that migrants do not constitute a homogenous group [7,20]. Against this backdrop, the present study explored motivation and barriers against the uptake of weight management efforts and practices among minoritised communities in Medway, England. ...
Background
Migration-related changes in dietary patterns and other structural and individual factors affect weight-related health practices of individuals migrating from low-and-middle-income to high-income countries. Thus, individuals of ethnically diverse backgrounds may be disproportionately affected by poorer health outcomes, including weight-related health issues. Understanding how this community could be supported to adopt weight-related healthy practices such as optimum dietary and exercise behaviour is an important issue for public health research. Against this backdrop, we explored structural and individual factors that facilitate and constrain the uptake of weight management services among members of minority ethnic communities in Medway, England.
Methods
Data were collected from audio-recorded interviews with 12 adult community members from minoritised ethnic communities using a semi-structured interview guide. Participants were recruited through a purposive and convenient sampling technique. Generated data were transcribed, coded into NVivo and analysed using the reflexive thematic analytical technique.
Results
Results showed that social support and health benefits of weight management were the main motivating factors for weight management among the study participants. Conversely, systemic barriers, family commitment and caring responsibilities, changes in dietary patterns post-migration and cultural norms were major factors constraining participants from adopting weight management behaviours.
Conclusion
The results of this study indicate that structural and person-level factors serve as both facilitators and barriers to weight management among ethnically diverse communities in Medway, England. While our study is exploratory and opens doors for more studies among the population, we conclude that these minoritised communities could benefit from more equitable, tailored weight management programmes to support them in adopting weight-related practices.
... Lewis et al., 2011), and reduced participation in physical activity (Meadows & Bombak, 2019;Zhu et al., 2022). The physiological consequences of fat stigma include increased physiological stress, such as increased heart rate, blood pressure, and levels of cortisol (Hunger et al., 2015), metabolic dysregulation and systemic inflammation (Vadiveloo & Mattei, 2017), and an increased risk of diabetes (Wu & Berry, 2018). Tomiyama (2019) proposed a feedback loop whereby fat stigma induces a stress response, activating various cognitive, behavioral, physiological, and biochemical pathways in the body. ...
Fat microaggressions are microlevel social practices in the form of commonplace everyday indignities that insult fat people and have been documented anecdotally and qualitatively. However, no psychometrically validated scale exists for measuring fat microaggressions, despite decades of microaggression research demonstrating their negative health associations. This research describes the development and construct validation of the Fat Microaggressions Scale across four studies. Study 1 focused on item development through a systematic review, qualitative analysis of Tweets using #fatmicroaggressions, and a Delphi review. Study 2 (N = 343) determined that a four-factor structure was appropriate in an online community sample of fat adults. Study 3 (N = 410) confirmed the factor structure in a new online sample of fat adults and provided initial evidence of construct validity. Study 4 (N = 197) found evidence of test–retest reliability and demonstrated additional construct validity. Our findings offer a newly validated quantitative measure of fat microaggressions and an initial framework for naming and categorizing these experiences, which may be used to advance the study of fat microaggressions.
... Moreover, numerous studies have similarly underscored the influence of body weight on individuals' social identities, emphasizing how weight stigma represents a threat to one's social identity [10,76,77]. This implies that individuals have concerns about experiencing devaluation, discrimination, rejection, or negative stereotypes [78]. In our study, we observed how, for an 11-year-old girl, this manifested as a process of identity negotiation. ...
In recent years, there has been increased awareness of obesity as a condition that carries a high level of stigma, as well as growing recognition of its prevalence and harm. Despite the increasing body of research on this topic, there is a gap in the literature regarding mechanisms that generate or exacerbate perceptions of weight stigma, especially within families and pediatric healthcare settings. The present study aims to identify potential stigma-generating mechanisms by focusing on inter-relational dynamics within these contexts. We conducted in-depth, semi-structured interviews with 11 families and analyzed the data by applying sociological theories on health identities and authenticity. Our study found four themes that represent potential stigma-generating mechanisms by being explicitly related to familial health identities and healthcare authenticity: (1) negotiating and reconstruction familial self-understanding, (2) between guilt, shame and conflicts, (3) navigating weight perceptions, and (4) the necessity of positivity and relevance. Our study shows the complexities of weight stigma within family and pediatric healthcare settings, emphasizing the need for sensitive and tailored support, as well as the value of working authentically as crucial aspects in preventing and/or reducing stigma.
... In a study aiming to examine body image perceptions and body image dissatisfaction and their relationship with body mass index (BMI) among medical students in Oman, it was noted that students with obesity were four times more likely to develop body image distortion compared to underweight students [2]. This might be ascribed to the social stigma associated with "being fat" [21]. ...
Background
Body image is mainly determined by biological, social, psychological and cultural factors thus it is a multifaceted vigorous construct. Body image is an essential aspect of girls' self-definition and individual identity. Excessive concern about body image and body image misconceptions leads to dissatisfaction, disturbed eating patterns, affecting the nutritional status and also leading to depression and anxiety disorder.
Methods
This is a descriptive cross-sectional university-based study aiming to investigate body image dissatisfaction and its relation to BMI among female medical students at the University of Khartoum, faculty of medicine. The study was carried out between December 2020 and January 2021. Simple random sampling was applied and a two-sectioned questionnaire was used. The first part consisted of socio-demographic data and the second part contained questions to assess body image the data was. A total of 277 participants were enrolled in the study. Data was analyzed using SPSS version 20.
Results
We enrolled 277 female medical students the majority of participants (53%) were considered of normal weight according to BMI, 7% considered obese, and 18% underweight. Large number of participants thought that they are not in the ideal weight according to their height (62%). (21% to 17%) of participants always feel pressure from people or society to get to a certain weight. With respect to attitude towards weight, (29%) of participants always wear clothes that don't reveal their body shape, (35%) of them always tend to wear clothes that hide their excess weight.
Conclusions
The study concluded that participants who were overweight, obese or underweight have significant increase risk for poor body image perception with odd ratio of 39, 11, and 59 respectively. Thus early and proper interventions are necessary to circumvent the impact and future repercussion of body image distortion.
... As noted, the putative fatality of fatness/ obesity has been compounded in the COVID-19 era, providing further impetus (ammunition) for those seeking to "help" and "advise" (attack) bodies deemed "unfit" and requiring correction (Monaghan, 2021). Medicalized "concern" is implicated in weight-related stigma, exacerbating negative mental health and physiological outcomes (Hunger et al., 2015) that are not necessarily neutralized or filtered out by the Fatosphere. To the contrary, social media may amplify weight-related stigma and the affective economy of hate as evidenced by those detractors who "trolled" Holliday's Instagram page and publicly expressed disdain and incredulity. ...
This article examines how affect, as community connectedness, is strategized by an influencer with her audiences when re-framing weight-related stigma and disordered eating online. An analysis of plus-size model Tess Holliday's Instagram posts (n = 212) identifies four main frames: (1) disclosing experiences of body-shaming/blaming/stigmatization as "our pain," (2) collaborating with fellow influencers in de-stigmatizing disordered eating among (fat) women, (3) engaging audiences in validating body diversity, and (4) defending their community against hate comments. The analysis foregrounds the action of emotion when exploring affective community-building strategies and project stigma in a context depicted as "authentic" and "intimate." The article concludes by noting some limitations with influencer strategies and this study before offering suggestions for future research.
... People with excessive body weight more frequently experience limitations in physical, occupational, and social functioning [6,7]. They are also at risk of stigmatization and social isolation due to their condition [8,9]. Excess body weight also leads to an increased risk of many comorbidities which also affect the quality of life. ...
Introduction and objective:
Body weight can be one of the health effects affecting people’s well-being in its many aspects. The aim of the study was to assess the relationship between body weight and sexual life.
Material and methods:
In June 2020 a survey was conducted online on a nationwide representative group of 3,000 Poles. A year later, in June 2021thje survey was repeated on a nationwide representative group of 2,500 Poles. The data obtained from 4,266 respondents were then analyzed. Four proprietary questions were used to assess sexual life, based on which a 3-point scale was developed (2020 – α = 0.80, homogeneity 61%; 2021 – α = 0.77, homogeneity 64%).
Results:
Excess body weight as measured by BMI was more common in 2021 than in 2020, which confirms the upward trend in body weight in society (55.5% vs. 52.7%). In 2020, more respondents indicated a good assessment of their sexual life than in 2021 (27.3% vs 23.5%, p=0.007). People with excessive body weight rated their sexual life as poorer on the scale (2020 p=0.003; 2021 p=0.009). Multinomial logistic regression showed that people with obesity (BMI>30) had a 1.7 higher increased risk of poor assessment of sexual life than those with normal weight (OR: 1.728; 95% CI: 1.396–2.138; p<0.001). In addition, multinomial logistic regression showed significance for the poor assessment of sexual life for the following factors: age 50–65; female. On the other hand, the following factors were associated with the good assessment of sexual life: age 18–29, being in a relationship, and the year of the study.
Conclusions:
Body weight may be one of the most important aspects affecting the assessment of a person’s sexual life. Educating patients about the correct body weight is extremely important in order to improve their health and sexual life.
Glucagon-like peptide-1 (GLP-1) agonist medications are receiving high levels of attention because of their dramatic efficacy in causing weight loss. This commentary discusses several ways that those in behavioral medicine and health psychology might think about these medications—whether they should be fully in support of them or whether they pose a risk. The positive aspects of GLP-1s include their great promise in improving health independent of weight loss and the perspective that their efficacy frees individuals from the difficulties of behavioral weight maintenance and the associated stigma of “failing” to lose weight. However, GLP-1 agonist medications also risk medicalizing weight and increasing weight stigma (in addition to those on GLP-1 medications being stigmatized for taking the “easy way out”). From a social identity perspective, GLP-1 medications could even be perceived as a tool to eradicate an entire social group—those that identify as higher weight. In terms of clinical care, a patient-centered, weight-inclusive approach will allow for individuals to receive the treatment that fits with their own social and health context. In terms of research, behavioral medicine should shift away from weight loss interventions simply to lower body mass index, and instead intervene on actual health markers, disease endpoints, or healthy behaviors. Doing so will improve health regardless of a person’s weight or whether they are on GLP-1 agonist medications.
Workplace weight discrimination is pervasive and harms both individuals and organizations. However, despite its negative effects on employees and employers, the social and psychological processes linking weight discrimination and workplace outcomes remain unclear. Rooted in evidence that people regularly dehumanize and dismiss the emotions of heavier individuals, the current work tests one socioemotional pathway linking workplace weight discrimination and professional outcomes: social pain minimization (SPM). SPM refers to feelings of emotion invalidation when people share negative social experiences with others and feel their hurts are discounted and dismissed by their colleagues. Across two studies using cross-sectional and prospective designs (Ntotal = 661), the current work provides evidence that workplace weight discrimination increased feelings of SPM, which in turn was associated with greater burnout, lower job satisfaction, and more counterproductive work behaviors. In the wake of workplace weight discrimination, subsequent SPM negatively affects workplace outcomes. For those experiencing workplace weight discrimination, mistreatment and invalidation frequently operate as a one-two punch to critical organizational outcomes.
Person-centred care (PCC) is associated with improved patient well-being and higher levels of satisfaction with care but its impact on individuals living with obesity is not well-established. The main aim of this study was to assess the relationship between PCC and the physical and social well-being of patients living with obesity, as well as their satisfaction with care. This study is based on a cross-sectional, web-based survey administered among a representative panel of Dutch individuals living with obesity. The primary outcomes were physical and social well-being and satisfaction with care. The primary exposure was a rating of overall PCC, encompassing its eight dimensions. In addition, covariates considered in the analyses included sex, age, marital status, education level, body mass index, and chronic illness. The data from a total of 590 participants were analysed using descriptive statistics, correlation analyses, and multiple regression analyses. Among PCC dimensions, participants rated ‘access to care’ the highest (M 4.1, SD 0.6), while ‘coordination of care’ (M 3.5, SD 0.8) was rated lower than all other dimensions. Participants’ overall PCC ratings were positively correlated with their physical (r = 0.255, P < .001) and social well-being (r = 0.289, P < .001) and their satisfaction with care (r = 0.788, P < .001), as were the separate dimension scores. After controlling for sex, age, marital status, education level, body mass index, and chronic illness in the regression analyses, participants’ overall PCC ratings were positively related to their physical (β = 0.24, P < .001) and social well-being (β = 0.26, P < .001), and satisfaction with care (β = 0.79, P < .001). PCC holds promise for improved outcomes among patients living with obesity, both in terms of physical and social well-being, as well as satisfaction with care. This is an important finding, particularly when considering the profound physical, social, and psychological consequences associated with obesity. In addition to highlighting the potential benefits of PCC in the healthcare of individuals living with obesity, the findings offer valuable insights into strategies for further refining the provision of PCC to meet the specific needs of these patients.
Background:
Weight stigma (devaluation due to body weight) in healthcare is common and influences one's engagement in healthcare, health behaviors, and relationship with providers. Positive patient-provider relationships (PPR) are important for one's healthcare engagement and long-term health.
Purpose:
To date, no research has yet investigated whether weight bias internalization (self-stigma due to weight; WBI) moderates the effect of weight stigma on the PPR. We predict that weight stigma in healthcare is negatively associated with (i) trust in physicians, (ii) physician empathy, (iii) autonomy and competence when interacting with physicians, and (iv) perceived physician expertise. We also predict that those with high levels of WBI would have the strongest relationship between experiences of weight stigma and PPR outcomes.
Methods:
We recruited women (N = 1,114) to complete a survey about weight stigma in healthcare, WBI and the previously cited PPR outcomes.
Results:
Weight stigma in healthcare and WBI were associated with each of the PPR outcomes when controlling for age, BMI, education, income, race, and ethnicity. The only exception was that WBI was not associated with trust in physicians. The hypothesis that WBI would moderate the effect of weight stigma in healthcare on PPR outcomes was generally not supported.
Conclusions:
Overall, this research highlights how weight stigma in healthcare as well as one's own internalization negatively impact PPRs, especially how autonomous and competent one feels with their provider which are essential for one to take an active role in their health and healthcare.
Racism is a pervasive threat to health with differential impact based on race and ethnicity. Considering the continued perpetration and visibility of racism online and in the news, vicarious racism, or “secondhand” racism when hearing about or witnessing racism being committed against members of one’s ethnic or racial group, is a particularly urgent threat in the context of such disparities and their subsequent health consequences. The current study examines if frequency of exposure to vicarious racism and the emotional impact of those experiences are linked to psychoactive substance use, and explores the role of ethnic identity in moderating these relationships. In a cross-sectional survey, 504 adult participants aged 18–78 (M age = 30.15, SD = 11.52, 52.6% female) identifying as Black/African American or Latine reported on their experiences with vicarious racism and alcohol, marijuana, and tobacco use over the past 30 days. Logistic regression was utilized to test hypotheses. Primary findings indicate that greater emotional impact of vicarious racism was associated with a 50% increase in odds of alcohol consumption and that ethnic identity moderated the association between vicarious racism and marijuana use. Greater emotional impact of vicarious racism was related to more marijuana use for those lower on ethnic identity, whereas there was no association for those higher on ethnic identity. Vicarious racism was not related to tobacco use. Results suggest that ethnic identity might be protective in the association of vicarious racism on substance use. Further research on this topic is needed as vicarious racism becomes an increasingly common experience among marginalized populations.
In this chapter I consider the larger context in which fat lives are lived. Exploring diet culture and the quest for “cure,” I examine the ways that happiness and disgust are deployed around the specifics of fat. Finally, I take up the ways that fat space, and specifically BBW spaces, functions as a trauma collective.
Bash spaces are as problematic as any other spaces, open to forces such as white supremacy and heterosexism and functioning within objectifying and fetishizing male gazes. In this chapter I blend autoethnographic accounts with data drawn from in-depth interviews to establish some of the problematic discourses which pervade bash spaces. Considering the bigger context of fat life in general, I explore the proliferation of diet culture including a focus on “weight loss” surgeries as well as the hierarchies of normalization which operate in these spaces.
Aims:
The aim of the study was to examine perceived stress as a mediator of the association between weight-related discrimination and physical and psychological well-being among persons with type 2 diabetes (T2D).
Methods:
Data were obtained from 5104 persons with self-reported T2D participating in the All of Us research programme in the United States. The Everyday Discrimination Scale, Cohen's Perceived Stress Scale (PSS) and PROMIS Global Health Scale were used to measure weight-related discrimination, perceived stress and health outcomes (physical and psychological), respectively. Mediation effects of PSS were tested by bootstrapping with 5000 random samples.
Results:
Participants were, on average, 63.62 (SD 11.38) years old. Majority of them were female (55.53%), non-Hispanic White (72.61%), married or living with a partner (56.92%), had a household income of <$35,000 (31.99%) and had some college education (33.54%). We found that approximately 18% of study participants reported having experienced weight-related discrimination. We also found that weight-related discrimination was independently associated with poor physical and psychological well-being. These associations were partially mediated by perceived stress such that weight-related discrimination was associated with greater perceived stress, which was in turn associated with poorer physical and psychological well-being.
Conclusions:
Given that weight-related discrimination is associated with poor outcomes through elevated stress, interventions that target stress may disrupt this pathway thereby helping to reduce the health impact of weight-related discrimination. This assertion should, however, be tested in future studies.
Background
Childhood obesity is considered one of the most prevalent health problems in Saudi Arabia. When attempting to prevent such a problem, parents’ perceptions of their child’s weight status are critical factors to consider.
Objectives
This research aimed to understand parents’ perception and level of readiness to bring change to mitigate childhood obesity and overweight in Riyadh.
Materials and Methods
This is a cross-sectional study conducted in primary schools of National Guard Housing Compounds in Riyadh, Saudi Arabia. In this study, 320 primary school children of both genders and their parents were recruited. Measurements of weight and height and the body mass index (BMI) percentile were done, and the questionnaire was distributed to be filled out by their parents. Items of the questionnaire included demographic information about the parents and their perceptions of the child’s weight status, their beliefs toward obesity, their assessment of dietary and physical activity, and their level of readiness to change the child’s diet and physical activity.
Results
A total of 28% of parents misperceive their children to be overweight or obese. Furthermore, parents with a higher BMI have children with a higher BMI, and the relationship was found to be statistically significant ( p -value of 0.05) for fathers and ( p -value of 0.01) for mothers. Moreover, the parental belief that spending more screen time is the cause of childhood obesity was also found to be significantly associated with the higher BMI status of the child at a P value of 0.02. Furthermore, with a P value of 0.001, parental readiness to change the diet and physical activity of children is significantly associated with an improved lifestyle in children.
Conclusions
The parents included in the current study demonstrated a higher level of readiness to make positive changes in the diet of their children as well as improve their physical activity. These findings provide hope for involving parents in the prevention of childhood obesity in Saudi Arabia.
Aim
Adolescent suicide is a major public health concern, and modifiable risk factors associated with adolescent suicide remain poorly understood. This study aimed to assess the association between screen time and overweight/obesity and self-perceived overweigh and suicidality in adolescents.
Methods
Adolescents from the United States Youth Risk Behavior Surveillance System (YRBSS) between 2013 and 2019 were included in this cross-sectional study. The outcome was suicidality, including considered suicide, made a suicide plan, attempted suicide, and injurious suicide attempt. Multivariable logistic regression model was used to investigate the associations between screen time, overweight/obesity, self-perceived overweight, and suicidality, and expressed as odds ratio (OR) and 95% confidence interval (CI). Mediation analysis was used to explore the role of overweight/obesity and self-perceived overweight on the association between screen time and suicidality.
Results
A total of 30,731 adolescents were included, of which 6,350 (20.65%) had suicidality, including 5,361 (17.45%) with considered suicide, 4,432 (14.42%) with made a suicide plan, 2,300 (7.45%) with attempted suicide, and 677 (2.21%) with injurious suicide attempt. Adolescents with screen time ≥3h were related to higher odds of suicidality (OR=1.35, 95%CI: 1.23-1.46), overweight/obesity (OR=1.27, 95%CI: 1.19-1.38), and self-perceived overweight (OR=1.38, 95%CI: 1.30-1.48) after adjusting confounders. Adolescents with overweight/obesity (OR=1.30, 95%CI: 1.19-1.43) and self-perceived overweight (OR=1.54, 95%CI: 1.39-1.70) were associated with higher odds of suicidality. The association between screen time and suicidality was 4.67% mediated by overweight/obesity and 9.66% mediated by self-perceived overweight. Moreover, the mediating role of overweight/obesity was observed only in females, whereas there were no sex differences in the mediating effect of self-perceived overweight.
Conclusion
Both overweight/obesity and self-perceived overweight mediated the association between screen time and suicidality.
Background:
During the COVID-19 pandemic, digital working methods were increasingly implemented within the setting of German public administrations. Beyond the ostensible risk of infection, a high psychological burden arose for the employees.
Objective:
A subsequent progression of mental strain is to be estimated as a residual effect (approximated by controlling other influencing factors) due to the impossibility of a counterfactual control group.
Methods:
An online survey was conducted in 2020 and repeated in 2021 among a cohort of n = 706 employees of 38 departments of three public administrations in North Rhine-Westphalia, Germany. Mental strain was assessed by the Wuppertal Screening Instrument. Its temporal variation was operationalized as the intercept of a first-difference multiple regression model. Unit of analysis was the department level.
Results:
The prevalence of suboptimal and dysfunctional strain increased from 71% to 73% . The multiple regression model showed a significant increase whilst controlling the influence of socio-demographic changes on the department level. Children, age and educational level were significant predictors. R2 indicated that about 40% of the variance in the temporal variation of mental strain could be explained.
Conclusion:
The observed factors explained a significant proportion of the increase in mental strain in German public administrations. Still, far more than half of the increase stemmed from external influences which were largely determined by pandemic conditions and latency effects remain still to be seen.
People with overweight and obesity tend to both underreport dietary energy intake and experience weight stigma. This exploratory pilot study aimed to determine the relationship between weight bias and weight stigma and energy intake reporting accuracy. Thirty-nine weight-stable adults with BMI ≥ 25 completed three 24 h dietary recalls; indirect calorimetry to measure resting metabolic rate; a survey measuring weight stigma, psychosocial constructs, and physical activity; and a semi-structured qualitative interview. Multiple linear regression was used to determine if weight bias internalization, weight bias toward others, and experiences of weight stigma were predictive of the accuracy of energy reporting. A thematic analysis was conducted for the qualitative interviews. Weight stigma was reported by 64.1% of the sample. Weight stigma constructs did not predict the accuracy of energy intake reporting. People with obesity underreported by a mean of 477 kcals (p = 0.02). People classified as overweight overreported by a mean of 144 kcals, but this was not significant (p = 0.18). Participants reported a desire to report accurate data despite concerns about reporting socially undesirable foods. Future research should quantify the impact of weight stigma on energy reporting in 24 h recalls using a larger, more diverse sample size and objective measures like doubly labeled water for validation.
Introduction
There continues to be an imbalance of research into weight loss and weight loss maintenance (WLM), with a particular lack of research into WLM in young people under 18 years. Failure to coherently understand WLM in young people may be a potential contributor to the underdeveloped guidance surrounding long‐term support. Furthermore, no research has investigated young people's preferences around WLM support following the attendance of a residential intensive weight loss intervention from a qualitative perspective. This study explored the influences of WLM in young people following a residential intensive weight loss intervention, considered how interventions could be improved and sought to develop recommendations for stakeholders responsible for designing WLM interventions.
Methods
The context in which this research is framed was taken from a residential Intensive Weight Loss Intervention for young people aged 8–17 years in England. Six semi‐structured interviews were carried out to understand the lived experience of WLM, including barriers and enablers influencing WLM, adopting an interpretative phenomenological analysis design.
Findings
Three superordinate themes were developed to explain the barriers and enablers to WLM; (1) Behavioural control and the psychosocial skills to self‐regulate WLM; (2) Delivering effective social support; and (3) Conflicting priorities and environmental triggers.
Conclusion
The findings of this research mirror that of other studies of WLM in young people, with the majority of young people struggling to maintain weight loss. However, by exploring the experience of WLM in young people through qualitative means, it was possible to understand the specific motivators and barriers influencing WLM behaviours in this context, providing recommendations to support WLM.
Patient or Public Contribution
The interview guide was developed in consultation with a young person from the intervention, and through discussions with the intervention stakeholders (delivery staff and management staff). The interview guide included topics such as knowledge and skills; experience of weight loss; reflections on weight maintenance, and experiences of daily life postintervention. We piloted the interview schedule with one young person who had consented to take part in the research. This first interview was used to check for understanding of questions and to assess the flow of the interview.
This chapter explores the quotes, opinions, and paraphrased statements from experts, doctors, and scientists used in news articles about obesity. To do this, I followed the keywords researchers, experts, Dr, professor, scientists, doctors, and the reporting verbs which collocate with them. Following, each individual quote, opinion, and statement was read, and categorised based on the topic under discussion. Unsurprisingly, the health ramifications of obesity and weight loss were the two most predominant topics. To supplement the findings and bolster the discussion, I additionally carried out an extensive review of the existing scientific research and literature around weight and obesity. The main purpose is to ascertain whether the messages given in the media are congruent with and representative of the opinions and narratives in the scientific community. That said, I examine the extent to which the media represent the science and scientific opinions surrounding obesity in a balanced accurate manner, and discuss the potential ramifications of misinforming the public about obesity, its associated health risks, and weight loss.
Objective:
Weight stigma is pervasive in the United States. We tested the hypothesis that stigma may be a mechanism through which obesity negatively affects self-reported health. Two studies examined whether perceived weight-based discrimination and concerns over weight stigma mediated the association between BMI and self-reported psychological health (Study 1) and physical health (Study 2).
Method:
In 2 online studies, adult community members completed measures of stigma-relevant mediators (perceived weight discrimination, weight stigma concerns) and provided their height and weight. In Study 1 (N = 171) participants also completed measures of psychological health (depression, self-esteem, quality of life), whereas participants in Study 2 (N = 194) also completed a measure of self-reported physical health. Process modeling was used to simultaneously test for mediation through perceived discrimination and stigma concerns independently as well as for serial mediation through both variables.
Results:
Across both studies, we hypothesized and found support for serial mediation such that BMI was indirectly related to poorer self-reported health through its effect on perceived discrimination and concerns about stigma. Additionally, concerns about stigma mediated the association between BMI and health independent of perceived discrimination.
Conclusions:
Weight stigma is an important mediator of the association between BMI and self-reported health. Furthermore, results indicate that concerns about facing stigma in the future mediate the link between perceived past experiences of discrimination and psychological and physical health.
Objective:
Weight discrimination is associated with increased risk of obesity. The mechanism of this relationship is unknown, but being overweight is a highly stigmatized condition and may be a source of chronic stress that contributes to the development and pathophysiology of obesity. The objective of this study was to test whether weight stigma is associated with physiological risk factors linked to stress and obesity, including hypercortisolism and oxidative stress, independent of adiposity.
Method:
We examined the frequency of experiencing situations involving weight stigma and consciousness of weight stigma in relation to hypothalamic--pituitary--adrenal axis activity and oxidative stress (F₂-isoprostanes) in 45 healthy overweight to obese women.
Results:
Independent of abdominal fat, weight stigma was significantly related to measures of cortisol (including salivary measures of cortisol awakening response and serum morning levels) as well as higher levels of oxidative stress. Perceived stress mediated the relationship between weight stigma consciousness and the cortisol awakening response.
Conclusion:
These preliminary findings show that weight stigma is associated with greater biochemical stress, independent of level of adiposity. It is possible that weight stigma may contribute to poor health underlying some forms of obesity.
Anti-obesity efforts that rely on stigmatizing weight (eg, using harsh language or stereotypical portrayals of overweight individuals) may impede health promotion efforts, as weight stigma is often negatively related to behavior change and thus seems unlikely to result in weight loss.¹ Indeed, considerable research underscores the detrimental effects of weight stigma on the physical health and well-being of children and adolescents,² and nationally representative, longitudinal data show weight-based discrimination is associated with weight gain among older individuals.³ Although the childhood weight stigma literature frequently examines overt and often malicious behaviors (eg, bullying), stigma processes can begin when an individual experiences weight labeling.⁴ By labeling someone as overweight, the negative stereotypes, status loss, and mistreatment associated with this label may now be applicable to the individual. Recent research suggests that the negative psychological effects of weight stigma can begin when one is simply labeled as “too fat” by others.⁵ However, the relationship between weight labeling and weight gain remains unknown. Thus, we examined if weight labeling during childhood was related to the likelihood of having an obese body mass index (BMI) nearly a decade later.
Research focused on assessing weight stigmatization has typically been conducted using cross-sectional, retrospective designs. Such designs may impair the scientific understanding of this stigma by limiting participants' recall of frequencies and/or details about stigmatizing events. To address this, 50 overweight/obese women were recruited from public weight forums to complete week-long daily diaries. A total of 1077 weight-stigmatizing events were reported on the Stigmatizing Situations Inventory. Hierarchical linear modeling was used to investigate potential relationships between participant-level factors and reported stigmatization. Results indicate that body mass index, education, age, daily activities, and interpersonal interactions all may impact individuals' levels of stigmatization.
More than one-third of adults and 17% of youth in the United States are obese, although the prevalence remained stable between 2003-2004 and 2009-2010.
To provide the most recent national estimates of childhood obesity, analyze trends in childhood obesity between 2003 and 2012, and provide detailed obesity trend analyses among adults.
Weight and height or recumbent length were measured in 9120 participants in the 2011-2012 nationally representative National Health and Nutrition Examination Survey.
In infants and toddlers from birth to 2 years, high weight for recumbent length was defined as weight for length at or above the 95th percentile of the sex-specific Centers for Disease Control and Prevention (CDC) growth charts. In children and adolescents aged 2 to 19 years, obesity was defined as a body mass index (BMI) at or above the 95th percentile of the sex-specific CDC BMI-for-age growth charts. In adults, obesity was defined as a BMI greater than or equal to 30. Analyses of trends in high weight for recumbent length or obesity prevalence were conducted overall and separately by age across 5 periods (2003-2004, 2005-2006, 2007-2008, 2009-2010, and 2011-2012).
In 2011-2012, 8.1% (95% CI, 5.8%-11.1%) of infants and toddlers had high weight for recumbent length, and 16.9% (95% CI, 14.9%-19.2%) of 2- to 19-year-olds and 34.9% (95% CI, 32.0%-37.9%) of adults (age-adjusted) aged 20 years or older were obese. Overall, there was no significant change from 2003-2004 through 2011-2012 in high weight for recumbent length among infants and toddlers, obesity in 2- to 19-year-olds, or obesity in adults. Tests for an interaction between survey period and age found an interaction in children (P = .03) and women (P = .02). There was a significant decrease in obesity among 2- to 5-year-old children (from 13.9% to 8.4%; P = .03) and a significant increase in obesity among women aged 60 years and older (from 31.5% to 38.1%; P = .006).
Overall, there have been no significant changes in obesity prevalence in youth or adults between 2003-2004 and 2011-2012. Obesity prevalence remains high and thus it is important to continue surveillance.
Objective
To examine the magnitude of explicit and implicit weight biases compared to biases against other groups; and identify student factors predicting bias in a large national sample of medical students.
Design and Methods
A web-based survey was completed by 4732 1st year medical students from 49 medical schools as part of a longitudinal study of medical education. The survey included a validated measure of implicit weight bias, the implicit association test, and 2 measures of explicit bias: a feeling thermometer and the anti-fat attitudes test.
Results
A majority of students exhibited implicit (74%) and explicit (67%) weight bias. Implicit weight bias scores were comparable to reported bias against racial minorities. Explicit attitudes were more negative toward obese people than toward racial minorities, gays, lesbians, and poor people. In multivariate regression models, implicit and explicit weight bias was predicted by lower BMI, male sex, and non-Black race. Either implicit or explicit bias was also predicted by age, SES, country of birth, and specialty choice.
Conclusions
Implicit and explicit weight bias is common among 1st year medical students, and varies across student factors. Future research should assess implications of biases and test interventions to reduce their impact.
According to the resource model of self-control, overriding one's predominant response tendencies consumes and temporarily depletes a limited inner resource. Over 100 experiments have lent support to this model of ego depletion by observing that acts of self-control at Time 1 reduce performance on subsequent, seemingly unrelated self-control tasks at Time 2. The time is now ripe, therefore, not only to broaden the scope of the model but to start gaining a precise, mechanistic account of it. Accordingly, in the current article, the authors probe the particular cognitive, affective, and motivational mechanics of self-control and its depletion, asking, "What is ego depletion?" This study proposes a process model of depletion, suggesting that exerting self-control at Time 1 causes temporary shifts in both motivation and attention that undermine self-control at Time 2. The article highlights evidence in support of this model but also highlights where evidence is lacking, thus providing a blueprint for future research. Though the process model of depletion may sacrifice the elegance of the resource metaphor, it paints a more precise picture of ego depletion and suggests several nuanced predictions for future research.
© The Author(s) 2012.
Weight discrimination is prevalent in American society. Although associated consistently with psychological and economic outcomes, less is known about whether weight discrimination is associated with longitudinal changes in obesity. The objectives of this research are (1) to test whether weight discrimination is associated with risk of becoming obese (Body Mass Index≥30; BMI) by follow-up among those not obese at baseline, and (2) to test whether weight discrimination is associated with risk of remaining obese at follow-up among those already obese at baseline. Participants were drawn from the Health and Retirement Study, a nationally representative longitudinal survey of community-dwelling US residents. A total of 6,157 participants (58.6% female) completed the discrimination measure and had weight and height available from the 2006 and 2010 assessments. Participants who experienced weight discrimination were approximately 2.5 times more likely to become obese by follow-up (OR = 2.54, 95% CI = 1.58-4.08) and participants who were obese at baseline were three times more likely to remain obese at follow up (OR = 3.20, 95% CI = 2.06-4.97) than those who had not experienced such discrimination. These effects held when controlling for demographic factors (age, sex, ethnicity, education) and when baseline BMI was included as a covariate. These effects were also specific to weight discrimination; other forms of discrimination (e.g., sex, race) were unrelated to risk of obesity at follow-up. The present research demonstrates that, in addition to poorer mental health outcomes, weight discrimination has implications for obesity. Rather than motivating individuals to lose weight, weight discrimination increases risk for obesity.
The hypothesis that obese women compensate for the prejudice of others was tested by having obese and nonobese women converse by telephone with someone who they believed, correctly or incorrectly, could or could not see them. Partners rated obese women's social skills negatively when the women were visible (thus activating the partners' prejudice) but thought they were not. Obese women rated themselves as more likable and socially skilled than nonobese women did when the women thought they were visible to female partners. Judges' ratings of the women's contribution to the conversation indicated that there were no obvious differences in the impressions created by their verbal or nonverbal behaviors. Results support the hypothesis that obese women who were aware of the need to compensate for their partners' reactions to their appearance were able to do so.
Objective:
This article considers how the social psychology of intergroup processes helps to explain the presence and persistence of health disparities between members of socially advantaged and disadvantaged groups.
Method:
Social psychological theory and research on intergroup relations, including prejudice, discrimination, stereotyping, stigma, prejudice concerns, social identity threat, and the dynamics of intergroup interactions, is reviewed and applied to understand group disparities in health and health care. Potential directions for future research are considered.
Results:
Key features of group relations and dynamics, including social categorization, social hierarchy, and the structural positions of groups along dimensions of perceived warmth and competence, influence how members of high status groups perceive, feel about, and behave toward members of low status groups, how members of low status groups construe and cope with their situation, and how members of high and low status groups interact with each other. These intergroup processes, in turn, contribute to health disparities by leading to differential exposure to and experiences of chronic and acute stress, different health behaviors, and different quality of health care experienced by members of advantaged and disadvantaged groups. Within each of these pathways, social psychological theory and research identifies mediating mechanisms, moderating factors, and individual differences that can affect health.
Conclusions:
A social psychological perspective illuminates the intergroup, interpersonal, and intrapersonal processes by which structural circumstances which differ between groups for historical, political, and economic reasons can lead to group differences in health.
Several recent anti-obesity campaigns appear to embrace stigmatization of obese individuals as a public health strategy. These approaches seem to be based on the fundamental assumptions that (1) obesity is largely under an individual's control and (2) stigmatizing obese individuals will motivate them to change their behavior and will also result in successful behavior change. The empirical evidence does not support these assumptions: Although body weight is, to some degree, under individuals' personal control, there are a range of biopsychosocial barriers that make weight regulation difficult. Furthermore, there is accumulating evidence that stigmatizing obese individuals decreases their motivation to diet, exercise, and lose weight. Public health campaigns should focus on facilitating behavioral change, rather than stigmatizing obese people, and should be grounded in the available empirical evidence. Fundamentally, these campaigns should, first, do no harm.
Objective:
The present study examined the relationship between experiences of discrimination and occurrence of binge eating among overweight and obese persons, a population which has previously shown elevated rates of binge eating.
Methods:
Internet-based questionnaires were used to measure frequency and impact of discrimination, binge eating frequency, and emotional eating.
Results:
Pearson correlation analyses demonstrated significant positive relationships between the measures of discrimination and measures of eating behaviors (r = 0.12-0.37). Regression models significantly predicted between 17 and 33% of the variance of emotional eating scores and frequency of binge eating; discrimination measures contributed significantly and independently to the variance in emotional eating and binge eating. Weight bias internalization was found to be a partial mediator of the relationship between discrimination and eating disturbance.
Conclusion:
Results demonstrate the relationship of discrimination to binge eating. Weight bias internalization may be an important mechanism for this relationship and a potential treatment target.
Overweight patients report weight discrimination in health care settings and subsequent avoidance of routine preventive health care. The purpose of this study was to examine implicit and explicit attitudes about weight among a large group of medical doctors (MDs) to determine the pervasiveness of negative attitudes about weight among MDs. Test-takers voluntarily accessed a public Web site, known as Project Implicit®, and opted to complete the Weight Implicit Association Test (IAT) (N = 359,261). A sub-sample identified their highest level of education as MD (N = 2,284). Among the MDs, 55% were female, 78% reported their race as white, and 62% had a normal range BMI. This large sample of test-takers showed strong implicit anti-fat bias (Cohen's d = 1.0). MDs, on average, also showed strong implicit anti-fat bias (Cohen's d = 0.93). All test-takers and the MD sub-sample reported a strong preference for thin people rather than fat people or a strong explicit anti-fat bias. We conclude that strong implicit and explicit anti-fat bias is as pervasive among MDs as it is among the general public. An important area for future research is to investigate the association between providers' implicit and explicit attitudes about weight, patient reports of weight discrimination in health care, and quality of care delivered to overweight patients.
Although research and scholarship on weight-based stigma have increased substantially in recent years, the disproportionate
degree of bias experienced by fat women has received considerably less attention. This paper reviews the literature on the
weight-based stigma experienced by women in North America in multiple domains, including employment, education settings, romantic
relationships, health care and mental health treatment, and portrayals in the media. We also explore the research examining
the intersection of gender and ethnicity related to weight stigma. Across numerous settings, fat women fare worse than thinner
women and worse than men, whether the men are fat or thin. Women experience multiple deleterious outcomes as a result of weight
bias that have a significant impact on health, quality of life, and socioeconomic outcomes. Because of this gender disparity,
we argue that feminist scholars need to devote as much attention to the lived experiences of fat women as they have to the
“fear of fat” experienced by thin women.
KeywordsFat women–Feminism and weight–Weight-based stigma–Weight bias–Women and weight
Self-regulation is a core aspect of adaptive human behavior that has been studied, largely in parallel, through the lenses of social and personality psychology as well as cognitive psychology. Here, we argue for more communication between these disciplines and highlight recent research that speaks to their connection. We outline how basic facets of executive functioning (working memory operations, behavioral inhibition, and task-switching) may subserve successful self-regulation. We also argue that temporary reductions in executive functions underlie many of the situational risk factors identified in the social psychological research on self-regulation and review recent evidence that the training of executive functions holds significant potential for improving poor self-regulation in problem populations.
Background
There are racial health disparities in many conditions for which oxidative stress is hypothesized to be a precursor. These include cardiovascular disease, diabetes, and premature aging. Small clinical studies suggest that psychological stress may increase oxidative stress. However, confirmation of this association in epidemiological studies has been limited by homogenous populations and unmeasured potential confounders.
Purpose
We tested the cross-sectional association between self-reported racial discrimination and red blood cell (RBC) oxidative stress in a biracial, socioeconomically heterogeneous population with well-measured confounders.
Methods
We performed a cross-sectional analysis of a consecutive series of 629 participants enrolled in the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study. Conducted by the National Institute on Aging Intramural Research Program, HANDLS is a prospective epidemiological study of a socioeconomically diverse cohort of 3,721 Whites and African Americans aged 30–64 years. Racial discrimination was based on self-report. RBC oxidative stress was measured by fluorescent heme degradation products. Potential confounders were age, smoking status, obesity, and C-reactive protein.
Results
Participants had a mean age of 49 years (SD = 9.27). In multivariable linear regression models, racial discrimination was significantly associated with RBC oxidative stress (Beta = 0.55, P < 0.05) after adjustment for age, smoking, C-reactive protein level, and obesity. When stratified by race, discrimination was not associated with RBC oxidative stress in Whites but was associated significantly for African Americans (Beta = 0.36, P < 0.05).
Conclusions
These findings suggest that there may be identifiable cellular pathways by which racial discrimination amplifies cardiovascular and other age-related disease risks.
A prior study found that nearly 80% of bariatric surgery patients felt that they were treated disrespectfully by members of the medical profession. This study assessed patient-physician interactions in a group of bariatric surgery patients and in a group of less obese patients who sought weight loss by other means.
A total of 105 bariatric surgery candidates (mean BMI, 54.8 kg/m(2)) and 214 applicants to a randomized controlled trial of the effects of behavior modification and sibutramine (mean BMI, 37.8 kg/m(2)) completed a questionnaire that assessed patient-physician interactions concerning weight.
Only 13% of bariatric surgery patients reported that they were usually or always treated disrespectfully by members of the medical profession, a percentage substantially lower than that found in the previous study. Surprisingly, surgery patients were significantly more satisfied than nonsurgery patients with the care they received for their obesity. Surgery patients also reported significantly more interactions with physicians concerning obesity and weight loss compared with nonsurgery patients. A substantial percentage of both groups, however, reported that their physician did not discuss weight control with them.
These and other findings suggest that doctor-patient interactions concerning weight may have improved in the past decade; however, there is still much room for improvement. Increased efforts are needed to help physicians discuss, assess, and potentially treat obesity in primary care practice.
Current guidelines recommend that "overweight" and "obese" individuals lose weight through engaging in lifestyle modification involving diet, exercise and other behavior change. This approach reliably induces short term weight loss, but the majority of individuals are unable to maintain weight loss over the long term and do not achieve the putative benefits of improved morbidity and mortality. Concern has arisen that this weight focus is not only ineffective at producing thinner, healthier bodies, but may also have unintended consequences, contributing to food and body preoccupation, repeated cycles of weight loss and regain, distraction from other personal health goals and wider health determinants, reduced self-esteem, eating disorders, other health decrement, and weight stigmatization and discrimination. This concern has drawn increased attention to the ethical implications of recommending treatment that may be ineffective or damaging. A growing trans-disciplinary movement called Health at Every Size (HAES) challenges the value of promoting weight loss and dieting behavior and argues for a shift in focus to weight-neutral outcomes. Randomized controlled clinical trials indicate that a HAES approach is associated with statistically and clinically relevant improvements in physiological measures (e.g., blood pressure, blood lipids), health behaviors (e.g., eating and activity habits, dietary quality), and psychosocial outcomes (such as self-esteem and body image), and that HAES achieves these health outcomes more successfully than weight loss treatment and without the contraindications associated with a weight focus. This paper evaluates the evidence and rationale that justifies shifting the health care paradigm from a conventional weight focus to HAES.
Previous research supports a positive association between weight stigmatization experiences and binge eating. However, the extent to which weight stigmatization accounts for binge eating in the context of other risk factors requires further investigation. Using a cumulative risk model, we examine previously studied risk factors (environmental stress, psychological functioning, negative coping, body dissatisfaction) as well as weight stigmatization as predictors of binge eating bariatric patients and undergraduate students. Results show a unique contribution of weight stigmatization. Analyses by sample indicated that this was only the case for the undergraduate student sample. Results support weight stigmatization as a meaningful predictor of binge eating and highlight the need for further work investigating how these experiences work to promote eating pathology.
Stereotype threat spillover is a situational predicament in which coping with the stress of stereotype confirmation leaves one in a depleted volitional state and thus less likely to engage in effortful self-control in a variety of domains. We examined this phenomenon in 4 studies in which we had participants cope with stereotype and social identity threat and then measured their performance in domains in which stereotypes were not "in the air." In Study 1 we examined whether taking a threatening math test could lead women to respond aggressively. In Study 2 we investigated whether coping with a threatening math test could lead women to indulge themselves with unhealthy food later on and examined the moderation of this effect by personal characteristics that contribute to identity-threat appraisals. In Study 3 we investigated whether vividly remembering an experience of social identity threat results in risky decision making. Finally, in Study 4 we asked whether coping with threat could directly influence attentional control and whether the effect was implemented by inefficient performance monitoring, as assessed by electroencephalography. Our results indicate that stereotype threat can spill over and impact self-control in a diverse array of nonstereotyped domains. These results reveal the potency of stereotype threat and that its negative consequences might extend further than was previously thought.
This book presents a thorough overview of a model of human functioning based on the idea that behavior is goal-directed and regulated by feedback control processes. It describes feedback processes and their application to behavior, considers goals and the idea that goals are organized hierarchically, examines affect as deriving from a different kind of feedback process, and analyzes how success expectancies influence whether people keep trying to attain goals or disengage. Later sections consider a series of emerging themes, including dynamic systems as a model for shifting among goals, catastrophe theory as a model for persistence, and the question of whether behavior is controlled or instead 'emerges'. Three chapters consider the implications of these various ideas for understanding maladaptive behavior, and the closing chapter asks whether goals are a necessity of life. Throughout, theory is presented in the context of diverse issues that link the theory to other literatures.
Policies that focus on self-regulation are being implemented to reduce obesity. One policy is menu labeling, the provision of calorie information on restaurant menus, which has evidenced mixed results. To illuminate the role of psychological processes, we examined the effect of weight-based stereotype threat on food choice as a function of body mass index (BMI). In Study 1, participants under stereotype threat ordered food containing more calories from a conventional menu that did not present calorie information as BMI increased, whereas no association between BMI and calories was found in the control (no threat) condition. In Study 2, participants under stereotype threat ordered more calories from a conventional menu as BMI increased, whereas no association between BMI and calories was found among participants who ordered from a calorie menu, demonstrating that menu labeling eliminated the stereotype threat effect. Theoretical and practical implications for stereotype threat and policy interventions are discussed.
Objective
Rates of weight-based stigmatization have steadily increased over the past decade. The psychological and physiological consequences of weight stigma remain understudied.Methods
This study examined the effects of experimentally manipulated weight stigma on the stress-responsive hypothalamic–pituitary–adrenal axis (HPA) in 110 female undergraduate participants (BMI: M = 19.30, SD = 1.55). Objective BMI and self-perceived body weight were examined as moderators of the relationship between stigma and HPA reactivity.ResultsResults indicated participants' perceptions of their own body weight (but not objective BMI) moderated the effect of weight stigma on cortisol reactivity: F(1,102) = 13.48, P < 0.001, η2p = 0.12 (interaction 95% CI range [−2.06 to −1.44, −1.31 to −0.99]). Specifically, participants who perceived themselves as heavy exhibited sustained cortisol elevation post-manipulation compared with individuals who did not experience the weight-related stigma. Cortisol change did not vary by condition for participants who perceived themselves as average weight.Conclusions
In the first study to examine physiological consequences of active interpersonal exposure to weight stigma, experiencing weight stigma was stressful for participants who perceived themselves as heavy, regardless of their BMI. These results are important because stress and cortisol are linked to deleterious health outcomes, stimulate eating, and contribute to abdominal adiposity.
Objective
To examine associations between perceived weight discrimination and changes in weight, waist circumference, and weight status.Methods
Data were from 2944 men and women aged ≥50 years participating in the English Longitudinal Study of Ageing. Experiences of weight discrimination were reported in 2010-2011 and weight and waist circumference were objectively measured in 2008-2009 and 2012-2013. ANCOVAs were used to test associations between perceived weight discrimination and changes in weight and waist circumference. Logistic regression was used to test associations with changes in weight status. All analyses adjusted for baseline BMI, age, sex, and wealth.ResultsPerceived weight discrimination was associated with relative increases in weight (+1.66 kg, P < 0.001) and waist circumference (+1.12 cm, P = 0.046). There was also a significant association with odds of becoming obese over the follow-up period (OR = 6.67, 95% CI 1.85-24.04) but odds of remaining obese did not differ according to experiences of weight discrimination (OR = 1.09, 95% CI 0.46-2.59).Conclusions
Our results indicate that rather than encouraging people to lose weight, weight discrimination promotes weight gain and the onset of obesity. Implementing effective interventions to combat weight stigma and discrimination at the population level could reduce the burden of obesity.
Objective
Perceived weight discrimination has been linked to health outcomes, including risk of obesity. Less is known about how discrimination is associated with intermediate physiological markers of health, such as systemic inflammation. This research examined the association between weight discrimination and C-reactive protein (CRP) and whether it varied by participants' body mass index (BMI).Methods
Cross-sectional design using data from the Health and Retirement Study. Among participants who were overweight or obese (N = 7,394), regression analysis was used to test for an association between weight discrimination and CRP and whether this association was moderated by BMI. Similar associations among seven other attributions for discrimination were tested.ResultsThe association between weight discrimination and CRP varied as a function of BMI: At BMI between the thresholds for overweight and obesity (BMI ∼25–30), weight discrimination was associated with higher circulating levels of CRP; there was no association between weight discrimination and CRP as BMI approached Class 3 obesity (BMI ∼40). A similar pattern emerged for discrimination based on a physical disability, but not for the other attributions for discrimination (e.g., race, age).Conclusions
Weight discrimination is associated with higher circulating CRP, an association that is moderated by BMI.
News reporting on research studies may influence attitudes about health risk, support for public health policies, or attitudes towards people labeled as unhealthy or at risk for disease. Across five experiments (N = 2123) we examined how different news framings of obesity research influence these attitudes. We exposed participants to either a control condition, a news report on a study portraying obesity as a public health crisis, a news report on a study suggesting that obesity may not be as much of a problem as previously thought, or an article discussing weight-based discrimination. Compared to controls, exposure to the public health crisis article did not increase perception of obesity-related health risks but did significantly increase the expression of antifat prejudice in four out of seven comparisons. Across studies, compared to controls, participants who read an article about weight-based discrimination were less likely to agree that overweight constitutes a public health crisis or to support various obesity policies. Effects of exposure to an article questioning the health risks associated with overweight and obesity were mixed. These findings suggest that news reports on the "obesity epidemic" - and, by extension, on public health crises commonly blamed on personal behavior - may unintentionally activate prejudice.
The present study examined the phenomenology of weight stigma in people's everyday lives. Participants were 46 community adults who took part in an ecological momentary assessment study of their experiences with weight stigma. Over a two-week period, participants completed a brief survey following each experience with weight stigma in which they reported on the contextual factors related to the stigma episode, including the source of the stigma and where the stigma episode took place. Participants also reported their positive and negative affect following the stigma episode. On average, participants experienced 11.12 episodes of weight stigma over the two-week period. Stigma was most often expressed by strangers, spouses, friends, parents, and the media. Furthermore, stigma occurred frequently at home as well as in public places. Stigma from strangers was associated with more negative affect compared to stigma from spouses, the media, and (to some degree) friends. These findings provide important information about the phenomenology of weight stigma in daily life, which can have implications for efforts to reduce the occurrence of weight stigma as well as efforts to reduce the negative impact of stigma experiences.
This study investigated the effects of experiences with weight stigma and weight bias internalization on exercise. An online sample of 177 women with overweight and obesity (M age = 35.48 years, M BMI = 32.81) completed questionnaires assessing exercise behavior, self-efficacy, and motivation; experiences of weight stigmatization; weight bias internalization; and weight-stigmatizing attitudes toward others. Weight stigma experiences positively correlated with exercise behavior, but weight bias internalization was negatively associated with all exercise variables. Weight bias internalization was a partial mediator between weight stigma experiences and exercise behavior. The distinct effects of experiencing versus internalizing weight bias carry implications for clinical practice and public health.
Objective
To determine the physiological impact of exposure to weight stigma by examining alterations in salivary cortisol among lean and overweight women.Methods
Participants were 123 lean and overweight adult women (mean body mass index = 26.99 [7.91] kg/m(2)). Participants' salivary cortisol was assessed both before and after either a weight stigmatizing or a neutral video. Participants completed self-report measures of mood and reactions to the video. Height and weight were obtained at the conclusion of the study.ResultsParticipants in the stigmatizing condition exhibited significantly greater cortisol reactivity when compared with those in the neutral condition, irrespective of weight status (Pillai trace = 0.077; F(1,85) = 7.22, p = .009). Lean and overweight women in the stigmatizing condition were equally likely to find the video upsetting and were equally likely to report that they would rather not see obese individuals depicted in a stigmatizing manner in the media.Conclusions
Exposure to weight-stigmatizing stimuli was associated with greater cortisol reactivity among lean and overweight women. These findings highlight the potentially harmful physiological consequences of exposure to weight stigma.
“Success” in dieting interventions has traditionally been defined as weight loss. It is implicit in this definition that losing weight will lead to improved health, and yet, health outcomes are not routinely included in studies of diets. In this article, we evaluate whether weight loss improves health by reviewing health outcomes of long-term randomized controlled diet studies. We examine whether weight-loss diets lead to improved cholesterol, triglycerides, systolic and diastolic blood pressure, and fasting blood glucose and test whether the amount of weight lost is predictive of these health outcomes. Across all studies, there were minimal improvements in these health outcomes, and none of these correlated with weight change. A few positive effects emerged, however, for hypertension and diabetes medication use and diabetes and stroke incidence. We conclude by discussing factors that potentially confound the relationship between weight loss and health outcomes, such as increased exercise, healthier eating, and engagement with the health care system, and we provide suggestions for future research.
America's war on obesity has intensified stigmatization of overweight and obese individuals. This experiment tested the prediction that exposure to weight-stigmatizing messages threatens the social identity of individuals who perceive themselves as overweight, depleting executive resources necessary for exercising self-control when presented with high calorie food. Women were randomly assigned to read a news article about stigma faced by overweight individuals in the job market or a control article. Exposure to weight-stigmatizing news articles caused self-perceived overweight women, but not women who did not perceive themselves as overweight, to consume more calories and feel less capable of controlling their eating than exposure to non-stigmatizing articles. Weight-stigmatizing articles also increased concerns about being a target of stigma among both self-perceived overweight and non-overweight women. Findings suggest that social messages targeted at combating obesity may have paradoxical and undesired effects.
The authors theorized that overweight individuals experience social identity threat in situations that activate concerns about weight stigma, causing them to experience increased stress and reduced self-control. To test these predictions, women who varied in body mass index (BMI) gave a speech on why they would make a good dating partner. Half thought they were videotaped (weight visible); the remainder thought they were audiotaped (weight not visible). As predicted, higher BMI was associated with increased blood pressure and poorer performance on a measure of executive control when weight was visible and concerns about stigma were activated but not when weight was not visible. Compared to average weight women, overweight women also reported more stress-related emotions when videotaped versus audiotaped. Findings suggest that weight stigma can be detrimental to mental and physical health and deplete self-regulatory resources necessary for weight control.
Lesbian, gay, and bisexual (LGB) individuals suffer serious mental health disparities relative to their heterosexual peers, and researchers have linked these disparities to difficult social experiences (e.g., antigay victimization) and internalized biases (e.g., internalized homophobia) that arouse stress. A recent and growing body of evidence suggests that LGB individuals also suffer physical health disparities relative to heterosexuals, ranging from poor general health status to increased risk for cancer and heightened diagnoses of cardiovascular disease, asthma, diabetes, and other chronic conditions. Despite recent advances in this literature, the causes of LGB physical health problems remain relatively opaque. In this article, we review empirical findings related to LGB physical health disparities and argue that such disparities are related to the experience of minority stress-that is, stress caused by experiences with antigay stigma. In light of this minority stress model, we highlight gaps in the current literature and outline five research steps necessary for developing a comprehensive knowledge of the social determinants of LGB physical health.
© The Author(s) 2013.
In the winter of 2012, Children’s Healthcare of Atlanta, Georgia’s largest pediatric health care provider, developed an advertising campaign consisting of television and posters. A central focus of that effort was publishing pictures of obese children. The pictures were accompanied by messages, one of which was “you can stop your child’s obesity.” The targeted audience was not the obese children but their parents, many of whom seem to be in denial of their child’s condition. That strategy backfired.¹ The pictures and messages were received with a torrent of indignation, from parents and others, so much so that the project organizers removed them. Did the organizers of the campaign feel sorry for what they unleashed? Not at all, one spokesperson for the project said, “Our intention was to get people talking about childhood obesity and we did that.” The context for that effort was the fact that 40% of Georgia’s children are overweight or obese, the second highest in the nation, while 50% of Georgians do not consider childhood obesity a problem.
Obesity may be the most difficult and elusive public health problem this country has ever encountered. Unlike the classical infectious diseases and plagues that killed millions in the past, it is not caused by deadly viruses or bacteria of a kind amenable to vaccines for prevention, nor are there many promising medical treatments so far. While diabetes, heart disease, and kidney failure can be caused by obesity, it is easier to treat those conditions than one of their causes. I call obesity elusive partly because of the disturbingly low success rate in treating it, but also because it requires changing the patterns, woven deeply into our social fabric, of food and beverage commerce, personal eating habits, and sedentary lifestyles. It also raises the most basic ethical and policy questions: how far can government and business go in trying to change behavior that harms health, what are the limits of market freedom for industry, and how do we look upon our bodies and judge those of others?.
