Weight Bias Research Articles

The role of weight stigma and food literacy in eating behaviour

Abstract Background Overweight/obesity is associated with negative health outcomes that may be caused by experience and internalization of weight stigma. Weight stigma seems to diminish weight control efforts and may be associated with unhealthy eating behaviours. Moreover, lack is known about the protective factors against stigmatization. We aimed to assess the role of weight stigma and food literacy in eating behaviour in people with overweight and obesity controlling for sociodemographic and clinical variables. Methods A total of 189 participants with overweight/obesity (52.9% female; mean age 48.8±14.5 years; body-mass index (BMI) 32.6±6.5 kg/m2; waist-to-height ratio (WHtR) 0.6±0.1) completed the Experienced Weight Stigma Questionnaire and the Weight Self-Stigma Questionnaire. To examine eating behaviours including cognitive restraint, uncontrolled eating, and emotional eating we used the Three Factor Eating Questionnaire. Multiple linear regression analyses were performed. Results Higher WHtR and BMI were associated with emotional eating and uncontrolled eating. Experienced weight stigma was associated with emotional eating but was no longer significant when self-stigmatization was added to the regression model. Self-stigmatization was associated with emotional eating and uncontrolled eating. This association attenuated when food literacy was added to the final models. Low food literacy was significantly associated with emotional and uncontrolled eating. No role of weight-related measures, stigma or food literacy in the cognitive restrain was found. The explained variance in the final regression models for emotional eating and uncontrolled eating was 41%, and 32.7%, respectively. Conclusions Emotional eating and uncontrolled eating may represent crucial components to address in health and weight management. Nutrition literacy may have a positive effect on diminishing associations between weight stigma and unhealthy eating patterns. [Funding: VEGA: 1/0748/22]. Key messages • Eating disorder symptoms and their association with obesity should be considered when designing public health interventions. • Interventions targeting weight stigmatization and food literacy may mitigate the negative impact of weight stigma on eating behaviours.

Supplemental Material for The Role of Weight Stigma and Internalized Weight Bias in Health Care Avoidance and Mistrust

Supplemental Material for The Role of Weight Stigma and Internalized Weight Bias in Health Care Avoidance and Mistrust

Demographic, socioeconomic and lifecourse risk-factors for internalized weight stigma

Abstract Background Obesity is highly stigmatized, with negative obesity-related stereotypes widespread across society. Internalized weight stigma (IWS) is linked to negative outcomes including poor mental health and disordered eating. Previous evidence examining population groups at higher risk of experiencing IWS comes from small, nonrepresentative samples. Here, we re-assess previously reported associations of IWS with social factors in a large general population birth cohort study for the first time. Methods In the Avon Longitudinal Study of Parents and Children (ALSPAC), we explored differences in IWS at age 31 years by sex, ethnicity, socioeconomic factors, and sexual orientation using multivariable regression. Using data collected over a 32-year period, we explore the impact of family, peer, and wider social influences in adolescence, and bullying from mid-childhood to adulthood, whilst minimising risk of recall bias. Results In models adjusted for potential confounders and BMI in childhood, adolescence, and adulthood (N = 4060), IWS was higher for females (0.56 S.D. higher, CI:0.50-0.61), sexual minorities (0.17 S.D. higher, CI:0.09-0.24), and less socioeconomically advantaged individuals (0.16 S.D. higher (CI:0.08-0.24) for those whose mothers had minimum or no qualifications, compared to a university degree). The social environment during adolescence and young adulthood was important: IWS was higher for people who at age 13 years felt pressure to lose weight from family (0.13 S.D., CI:0.03-0.23), and the media (S.D. 0.17, CI:0.10-0.25), or had experienced bullying (0.25 S.D., CI:0.17-0.33 for bullying at age 23 years). Conclusions Internalized weight stigma differs substantially between demographic groups, and this is not explained by differences in BMI. The family environment during adolescence, bullying, and pressure to lose weight from the media may have long-lasting impacts on adult IWS. These may be fruitful avenues for intervention to reduce IWS and its consequences. Key messages • Females, sexual minorities, and socioeconomically disadvantaged adults are at greater risk of IWS irrespective of BMI. • To reduce IWS, interventions should improve the family and social environment.

Understanding barriers and facilitators to lifestyle management in people with polycystic ovary syndrome: A mixed method systematic review.

Polycystic ovary syndrome (PCOS) is an endocrine disorder affecting 10-13% of reproductive-aged women. Lifestyle management through diet and physical activity changes can improve reproductive, metabolic, and psychological comorbidities. The aim of this systematic review is to understand the barriers and facilitators to lifestyle changes from the perspective of people with PCOS and health care professionals (HCP) using the theoretical domains framework and capability, opportunity, motivation, and behavior model. Six databases were systematically searched for qualitative, quantitative, and mixed-methods studies to 22nd September 2022. Quantitative outcomes from quantitative and mixed-methods studies were narratively synthesized and all studies were thematically analyzed. Sixty-eight papers met the eligibility criteria. HCP education on lifestyle management in PCOS was viewed by all to be inadequate, impacting the quality of care and health outcomes. Lifestyle advice delivered by a multidisciplinary team, including dietitians, was identified as a key component for change. All agreed that there was a need for individualized and PCOS-specific lifestyle advice. Weight stigma was identified as negatively impacting both those in larger and smaller bodies with PCOS, reducing the quality of care and affecting self-perception and mental health. People with PCOS perceived that lifestyle management was overly focused on weight loss and fertility, independent of their own personal motivations and goals. Systemic changes, including increasing HCP education on lifestyle management and multidisciplinary collaboration, focusing on lifestyle advice that meets individual needs, and reducing the use of weight-centric care are necessary for long-term sustainable changes and improvements in health outcomes in people with PCOS.

Body image is associated with persistence. A study of the role of weight-related stigma

AbstractThe study replicates a preliminary report from 2019 on therelationship between body image and persistence.PurposeThe aim of our study was to analyze the associations between body image, persistence, and body weight stereotypes.Patients and methodsA total of 750 individuals were recruited for the study. The research was carried out in computer labs. The procedure consisted of psychological questionnaires (Persistence Scale, The Body Esteem Scale, Perceived Weight Stigma Questionnaire, Weight Bias Internalization Scale, Hospital Anxiety and Depression Scale, Formal Characteristics of Behavior – Temperament Inventory, and NEO-PI-R) and The Maze Test (a computer tool). After completing the Simple Maze Test, saliva samples were collected. Next, the subjects proceeded to the laboratory where anthropometric and body composition measurements were taken. The hormone levels (cortisol and dehydroepiandrosterone) in the collected saliva samples were analyzed via ELISA to determine stress.ResultsBody image and persistence are related variables. They are associated with the internalization of stereotypes and perceived stigma related to body weight. These associations are differentially shaped according to sex and the regularity of body weight. In women, a stronger association of these variables with body image was observed, while in men, the relationship with body image was weaker, with a stronger association shown by perceived weight-related stigma. In the group of participants with a BMI<18.5, there was no significant association between the internalization of stereotypes and the analyzed variables. This relationship appeared in the group of subjects with a normal body weight and was strongest in the group of participants who were overweight or obese. Perceived weight-related stigma was most strongly associated with body image in the group with BMI<18.5 kg/m2 and with persistence in the group with BMI>25 kg/m2.ConclusionBody-related stigma affects not only overweight and obese individuals and its mechanisms may be shaped differently.

Weight bias and preparedness to treat higher-weight patients: Understanding the role of motivation to respond without weight-based prejudice among resident physicians.

Weight bias and preparedness to treat higher-weight patients: Understanding the role of motivation to respond without weight-based prejudice among resident physicians.

Support for a Weight-Inclusive Curriculum? Exploring Partner Perspectives and Influences on Nutrition Education in Vermont High Schools.

The weight-normative approach to nutrition education dominates health education programming across the United States, despite evidence that this paradigm contributes to negative outcomes including weight cycling, bias and stigma, the development of disordered eating behaviors, and weight-based bullying. This study investigates perspectives of 10 potential partners with interest in and potential to influence nutrition education. Through qualitative interviews and document analysis, researchers explored support for a weight-inclusive curriculum and factors that influence high school nutrition curricular content and implementation. Findings indicate that partners hold both weight-inclusive and weight-normative values, guidance around nutrition curricular content is lacking, and state-level policy is crucial to the valuing and implementation of consistent curricula. Lack of guidance or mandated curricular content contributes to inequities across the state. Weight-inclusive curricular materials are needed. Administration must take an active role in providing access to professional development and state policy support for curricular implementation is essential. Weight-inclusive curriculum could serve to improve health outcomes for adolescents. However, successful implementation of, or changes to, health and nutrition curricula will require support and engagement from partners at all ecological levels.

Alternative Perspectives on Obesity and Hypertension.

It is known that obesity and hypertension have a relationship with one another. Often, obesity is thought to directly cause hypertension, with a list of mechanisms commonly cited. This, however, does not do the relationship justice. Not only can the directionality of the relationship be flipped, but the mechanisms may be misattributed confounders, themselves. Beyond this, some argue that the results of trials using glucagon-like-peptide-1 receptor agonist (GLP1R) medications suggest a causal relationship between obesity and hypertension, but this will be debunked. The relationship is far from linear, and mainstream literature often excludes key confounders that will be discussed in this article including food insecurity, mental health, socioeconomic status (SES), and weight stigma and discrimination. The factors used to measure the risk of hypertension as well as the measurements of hypertension, itself, need to be reexamined. For instance, there may be a high amount of "false positives" among the diagnosed. Finally, current research needs to be critically evaluated for forms of weight centrism and weight bias, deciphering improper assumptions from true, evidence-based science.

Prenatal weight stigma can affect relationship quality and maternal health outcomes

BackgroundWeight stigma is defined as negative misconception and stereotypes associated with weight, and it is commonly experienced during pregnancy. Weight stigma during pregnancy may be sourced from trusted close relationships including family members, partners, and friends. Social support is a necessary psychosocial factor for optimal health and wellbeing throughout pregnancy, and weight stigma sourced from these integral relationships may negatively affect health outcomes. The purpose of this study was to assess the impact of weight stigma from close others on maternal health outcomes.MethodsA survey was administered via Qualtrics to pregnant women (≥ 13 weeks, residence within the United States or Canada, ≥ 18 years old, singleton pregnancy). During pregnancy, participants completed questionnaires identifying whether they had experienced weight stigma from a close relationship (i.e., family, partners, or friends), how often, and relationship quality scales for each source. At three months postpartum, they were surveyed about their pregnancy outcomes including gestational diabetes, gestational hypertension, preeclampsia, chronic pain, anxiety/depression. They also completed the Edinburgh Postpartum Depression Scale (EPDS), and a linear regression was performed with frequency of weight stigma. Logistic regressions were performed between frequency of weight stigma and health outcomes. If significant, relationship quality was tested as a potential mediator. Significance was accepted as p < 0.05.Results463 participants completed both surveys of which 86% had experienced weight stigma from close others. Frequency of weight stigma was significantly associated with chronic pain (β = 0.689, p < 0.001), and anxiety/depression (β = 0.404, p = 0.005). The relationship between frequency of weight stigma in pregnancy and chronic pain was mediated by quality of all relationships. Family relationship quality mediated between frequency of weights stigma and anxiety/depression. Frequency of weight stigma was significantly associated with depression symptom severity measured by the EPDS (β = 0.634, p < 0.001).ConclusionThese findings underscore the issue of weight stigma and show that experiencing this from trusted close others is associated with poor health outcomes like chronic pain. Advocacy efforts to mitigate weight stigma in pregnancy and strengthen close relationships to improve maternal health and wellbeing is warranted.

A Systematic Review of Interventions That Aim to Reduce Implicit and Explicit Weight Biases among Fitness Professionals

Despite the high prevalence of weight bias among fitness professionals, few resources are currently available to educate fitness professionals about weight bias and no systematic review of weight bias interventions has been conducted among this population. This paper therefore reviewed extant weight bias interventions for fitness professionals to inform future weight bias-reduction initiatives. Seven reports comprising six studies were identified from inception until April 2024. Findings showed small to large improvements in explicit weight bias, particularly on the weight control/blame component. No improvements were observed in implicit weight bias. The results show an urgent need to bridge the gap between the resources currently available in the fitness industry and those developed by the scientific community and to develop novel multifaceted interventions that draw from multiple theories of attitude and behavior change to effectively tackle weight bias among fitness professionals.

An exploratory examination of medical and nursing students’ intentions to discuss body image, weight, and eating disorders with their patients

BackgroundAlthough 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.MethodOne 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.ResultsCoding 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.ConclusionsTaken 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.

Efficacy of interventions aimed at reducing explicit and implicit weight bias in healthcare students: A systematic review and meta-analysis.

We conducted a systematic review and meta-analysis to determine the efficacy of interventions aimed at reducing weight bias in healthcare students, and to explore factors that may impact intervention success. A systematic review and random-effects meta-analyses were conducted by including studies that examined the efficacy of weight bias reduction interventions for healthcare students. Of the 3463 journal articles and dissertations screened, 67 studies (within 64 records) met inclusion criteria, with 35 studies included in the meta-analyses (explicit = 35, implicit [and explicit] = 10) and 32 studies included in the narrative synthesis (explicit = 34, implicit [and explicit] = 3). Weight bias interventions had a small but positive impact, g = -0.31 (95% CI = -0.43 to -0.19, p < 0.001), in reducing students' explicit weight bias but there was no intervention effect on implicit weight bias, g = -0.12 (95% CI = -0.26 to 0.02, p = 0.105). There was considerable heterogeneity in the pooled effect for explicit bias (I2 = 74.28, Q = 132.21, df = 34, p < 0.001). All subgroup comparisons were not significant (p > 0.05) and were unable to explain the observed heterogeneity. Narrative synthesis supported meta-analytic findings. The small but significant reduction of explicit weight bias encourages the continued testing of interventions, irrespective of variation in individual intervention components. Contrarily, reductions in implicit weight bias may only be possible from a large societal shift in negative beliefs and attitudes held towards people living in larger bodies.

The Body Advocacy Movement-Health: a pilot randomized trial of a novel intervention targeting weight stigma among health professional students

BackgroundWeight stigma among healthcare professionals is associated with negative health impacts on patients, yet there are few effective strategies to combat weight stigma among health professional learners. The Body Advocacy Movement-Health (BAM-Health) is a novel group-based, peer-led stigma reduction intervention for health professional students that targets weight stigma across intrapersonal, interpersonal, and structural levels. The present study (1) assesses short-term impacts of BAM-Health participation on intrapersonal and interpersonal weight bias compared to an informational brochure control condition and (2) explores the feasibility and acceptability of BAM-Health among a sample of health professional students.MethodsSixty-seven health professional students participated in BAM-Health (n = 34) or received an informational brochure about weight stigma (n = 33). Participants completed validated self-report surveys assessing internalized weight/ appearance concerns and interpersonal weight stigma prior to their assigned intervention (baseline), immediately following intervention (post-intervention), and four weeks after intervention (follow-up). Baseline to post-intervention and baseline to follow-up effect sizes on each measure were calculated. At post-intervention, participants completed feedback surveys for thematic assessment.ResultsBAM-Health participation had a large baseline to post-intervention effect on internalized weight/ appearance concerns that diminished slightly at follow-up (Cohen’s d = -0.88; d = -0.62). Receipt of the informational brochure had a small effect on internalized weight/ appearance concerns (d = -0.27); however, these changes were not sustained at follow-up (d = 0.04). BAM-Health participation resulted in reductions in interpersonal obesity stigma and anti-fatness with small effect sizes (d = -0.32; d = -0.31). The effect on obesity stigma was slightly amplified at follow-up (d = -0.43); however, decreases in anti-fatness were not sustained (d = -0.13). The brochure condition failed to demonstrate effects on anti-fatness (d = 0.13, d = 0.14) or obesity stigma (d = -0.12; d = -0.12) at either time point. Between-session attrition rates of 4.5%, favorable quantitative ratings on post-session acceptability surveys, and free responses demonstrating appreciation of the virtual group environment and session activities reflect feasibility and acceptability of BAM-Health.ConclusionsBAM-Health is a novel peer-led intervention that aims to reduce weight stigma among health professional students. BAM-Health met feasibility benchmarks and received positive feedback from participants, demonstrating acceptability and indicating interest among health professional students in analyzing and reducing weight stigma in their personal lives and careers. The intervention led to promising decreases in internalized and interpersonal weight stigma at post-intervention, some of which were sustained at follow-up. However, lack of effect on internalized weight/ appearance concerns measures may indicate that BAM-Health participants are more likely to reject weight stigma directed toward others following intervention, while maintaining thin ideals for themselves. Further investigation of BAM-Health with a larger sample and continued program development is warranted.

A mixed-methods investigation of weight bias reduction in medical students

ABSTRACT We used a mixed-methods design to test a novel weight bias intervention and understand current attitudes toward people with higher weight and weight-inclusive care among medical students (N = 80). The intervention was embedded in curriculum and uniquely focused on delegitimising the use of weight as a heuristic for health. Almost half of participants (43.8%) responded to both pre- and post-intervention surveys. These participants found the intervention acceptable; and reported significant pre-post reductions in weight bias and endorsement of using weight as a heuristic for health. Less engaged participants reported significantly greater endorsement of using weight as a heuristic for health at pre-intervention. One central theme emerged from pre-intervention qualitative responses, related to how medical students scoped both the problem and the solution. This consisted of three sub-themes: (1) problematizing the system and clinician (and their weight bias), (2) problematizing the patient (who was responsible for their own health), and (3) problematizing the medical condition (weight and health behaviors as problems for the clinician to solve). Participants often showed evidence of several and sometimes contradictory ways of problem-scoping. Problematizing the patient, including weight-stigmatizing assumptions, was particularly pronounced among less engaged participants (i.e. those who did not complete the post-survey). Findings suggest that the intervention may be acceptable and effective in reducing weight bias in medical students who already have lower levels of bias than their peers. Qualitative findings suggest that, even when medical students recognize the harmful impacts of weight stigma and the benefits of weight-inclusive care, approaches to care may remain weight-centric. Together, the findings suggest a key challenge for weight bias reduction among medical students lies in addressing problem-scoping that may encourage weight bias and weight-centric care, and reaching the population most in need of intervention – students with high levels of weight bias.

Potential pathways to the onset and development of eating disorders in people with overweight and obesity: A scoping review.

To describe pathways to eating disorder (ED) development that have been evaluated in people with overweight and obesity. Four databases were searched to identify studies testing ED development models in adolescents (10-19 years) or adults (>19 years) with overweight and obesity. Explanatory variables were thematically grouped into constructs to describe pathways to each ED outcome. Of 2226 studies screened, 46 (10 adolescent; 36 adult) were included. Study samples were predominantly female, ranging from 22 to 2236 participants and mean age 12.3 to 56.0 years. In total, 207 explanatory variables were grouped into 18 constructs to summarize 107 pathways that were identified. The most common ED outcome was binge eating (n= 24 studies), followed by global ED psychopathology (n= 10 studies). Across pathways to ED development, negative affect was the most proposed construct, followed by preoccupation with weight/shape and weight stigma. Pathways to ED development in people with overweight and obesity are complex and may include more than 18 different explanatory factors of which negative affect, preoccupation with weight/shape, and weight stigma are the most common. More research on adolescents, males, and the spectrum of ED in diverse populations is required for early identification and intervention.

Bias related to overweight and obesity among French psychiatrists: Results of a national survey

BackgroundAccording to people with a higher weight, physicians are the second most stigmatizing group related to excess weight. As a result of these weight-related biases, the therapeutic relationship with the patient and the quality of care would be negatively affected. In addition, this stigma could negatively impact the clinical practice related to higher weight and avoidance of care. ObjectivesThe objective of this study was to assess the stigma of overweight and obesity among psychiatric residents and psychiatrists in France. Specifically, the study aimed to assess factors that may influence weight-related bias among psychiatrists, to explore the relevance of visual assessment of body mass index, and to determine how they this feature is integrated into their practice. MethodAn online questionnaire including sociodemographic items, the Fat Phobia Scale, the Beliefs About Obese Persons Scale, the Body Shape Scales, and questions about their clinical practice was distributed via national professional mailing lists and social networks. ResultsThe survey was answered by 271 seniors or residents in psychiatry. The results indicated a moderate level of weight-related bias among psychiatrists as assessed by the Fat Phobia Scale which was higher in residents than in senior psychiatrists. Over a third of the respondents had no material to assess their patient's weight, and two thirds did not systematically assess overweight or obesity. Finally, the results demonstrate that psychiatrists failed to accurately evaluate overweight or obesity based on male or female silhouettes. ConclusionIt appears that measures should be taken to raise awareness among psychiatrists of the stigmatization of individuals living with a higher weight, as well as to enhance the quality of weight gain care in psychiatry.

Countermarketing Versus Health Education Messages About Sugar-Sweetened Beverages: An Online Randomized Controlled Trial of US Adults.

Objectives. To test whether countermarketing messages for sugary drinks lead to lower intentions to consume sugary drinks and less perceived weight stigma than health education messages. Methods. In August 2023, we conducted an online randomized controlled trial with US adults (n = 2169). We assessed the effect of countermarketing messages, health education messages, and neutral control messages on intentions to consume sugary drinks and perceived weight stigma. Results. Both countermarketing messages (Cohen d = -0.20) and health education messages (d = -0.35) led to lower intentions to consume sugary drinks than control messages (Ps < .001). However, both types of messages elicited more perceived weight stigma than control messages (ds = 0.87 and 1.29, respectively; Ps < .001). Countermarketing messages were less effective than health education messages at lowering intentions to consume sugary drinks (d for countermarketing vs health education = 0.14) but also elicited less perceived weight stigma than health education messages (d = -0.39; Ps < .01). Conclusions. Countermarketing messages show promise for reducing sugary drink consumption while eliciting less weight stigma than health education messages, though they may need to be refined further to minimize weight stigma and maximize effectiveness. Clinical Trial Number. ClinicalTrials.gov NCT05953194. (Am J Public Health. Published online ahead of print October 3, 2024:e1-e11. https://doi.org/10.2105/AJPH.2024.307853).

On the Unequal Burden of Obesity: Obesity's Adverse Consequences Are Contingent on Regional Obesity Prevalence.

Obesity has adverse consequences for those affected. We tested whether the association between obesity and its adverse consequences is reduced in regions in which obesity is prevalent and whether lower weight bias in high-obese regions can account for this reduction. Studies 1 and 2 used data from the United States (N = 2,846,132 adults across 2,546 counties) and United Kingdom (N = 180,615 adults across 380 districts) that assessed obesity's adverse consequences in diverse domains: close relationships, economic outcomes, and health. Both studies revealed that the association between obesity and its adverse consequences is reduced (or absent) in high-obese regions. Study 3 used another large-scale data set (N = 409,837 across 2,928 U.S. counties) and revealed that lower weight bias in high-obese regions seems to account for (i.e., mediate) the reduction in obesity's adverse consequences. Overall, our findings suggest that obesity's adverse consequences are partly social and, thus, not inevitable.

Clinical observations of weight stigma among nursing students: A descriptive approach.

Mistreatment of individuals due to their body size or weight stigma has been described as a source of stress and as a deterrent for engagement in the healthcare system. Efforts to reduce weight stigma have included curricular interventions to reduce weight bias among future healthcare professionals. However, few studies have examined students' observations of weight stigma and subsequent socialization to healthcare environmental norms. The purpose of this study is to evaluate observed weight stigma among pre-licensure nursing students and recent graduates during clinical rotations and its effect on the perceived ability to provide respectful care to people in larger bodies. A cross-sectional, descriptive study was conducted from February to March 2023. Participants answered questions related to personal weight bias (Fat Phobia Scale), observations of weight stigma, and perceived ability to provide respectful care. Ninety-one participants completed the survey, of whom half (n = 48) held a high level of weight bias. A quarter of participants (n = 23) reported that they engaged in weight stigma behaviors and a quarter (n = 24) of participants observed weight stigma behaviors from two or more healthcare professional roles. Almost one-third (n = 10) of participants who observed weight stigma behaviors perceived that it impacted their ability to provide respectful care to patients in larger bodies. These findings describe that weight stigma enacted by multiple healthcare professional roles is observed by nursing students during clinical rotations and is perceived to impact their ability to provide respectful care. Efforts to improve healthcare professionals' sensitivity to the effects of weight bias and weight stigma should include addressing the role of socialized norms on weight bias among future healthcare professionals.

Stigmatizing attitudes and beliefs about obesity among dental team members.

Weight stigma is prevalent within healthcare settings and is an aspect of the lived experience of people living with obesity. There is international evidence of weight stigma in the dental setting, where currently there is also evidence indicating limited training amongst dental professionals regarding obesity or obesity-related stigma. There has been Australian research and none have included dental support staff. This cross-sectional survey aimed to assess stigmatizing attitudes and beliefs of dental professionals (registered general dentists, oral health therapists) and support staff (dental assistants, dental receptionists) working in private and public regional practices in New South Wales and specialists in Special Needs Dentistry across Australia toward people living with obesity. An anonymous electronic validated survey was administered through REDCap™ to assess stigmatizing attitudes and beliefs held amongst respondents in relation to people living with obesity. Fifty-three participants completed the survey (n=33 clinicians, n=20 support staff). The majority 47/53 (88.7%) held positive attitudes toward people living with obesity. Of the clinicians, 15/33 (45.5%) reported 1hour or less and 14/33 (42.4%) reported two to 5hours of obesity-related education. 14/20 (70%) of the support staff reported no prior education or training about obesity. Of responses reflecting weight stigma, only three clinicians reported negative reactions toward the appearance, or discomfort during examination, of a patient with obesity, or a perception of laziness, compared with normal weight individuals. A higher proportion 4/20 (20%) of support staff reported responses indicating negative attitudes for people with obesity compared with normal weight individuals. Survey responses reflected evidence of weight stigma in both dental professionals and support staff. Professional development targeting weight stigma reduction in the dental setting is needed for both clinicians and support staff.