Weight Bias Research Articles

Acceptance, knowledge, and attitude of family physicians towards obesity as a chronic disease: a multinational cross-sectional study.

Obesity was previously perceived to be a lifestyle issue; however, it was declared a chronic disease by the American Medical Association (AMA) in 2013. However, family physician's views and actions toward managing obesity remain ambiguous and occasionally conflicting. This cross-sectional study explores the acceptance and knowledge of 171 family medicine physicians regarding obesity as a chronic disease. Family physicians were recruited through different channels, including members of professional scientific societies of family medicine that belong to the World Organization of Family Doctors (WONCA) Eastern Mediterranean Regional Office EMRO, a publicly available list of United States (US) family physicians, and authors' personal Facebook and LinkedIn connections. Data was collected across various countries through an anonymous online survey. While most participants acknowledged obesity as a chronic condition with multifactorial origins, there was a notable discrepancy in treatment practices compared to other chronic diseases. A dual perspective emerged, as family physicians often emphasized self-responsibility and behavioral change over medical interventions, potentially hindering effective management. Lower initiation rates for obesity management was exhibited compared to other chronic diseases. There is a gap between recognition and effective management of obesity as a chronic disease within family practice. The findings underscore the need for comprehensive obesity education in medical training to bridge knowledge gaps and reduce weight stigma, enabling physicians to provide optimal care for patients with obesity.

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. 2024;114(12):1354-1364. https://doi.org/10.2105/AJPH.2024.307853).

International PCOS guideline clinical research priorities roadmap: a co-designed approach aligned with end-user priorities in a neglected women’s health condition

Polycystic ovary syndrome (PCOS) is a common endocrinopathy with significant reproductive, metabolic, and psychological complications. Consensus on PCOS clinical research priorities across end-users is fundamental and necessitates a robust co-development of a clinical research roadmap to guide international research efforts. A multistage process included: i) international surveys of women and healthcare providers to identify research priorities and unmet needs; ii) interrogation of systematic reviews conducted for the International PCOS Guideline to identify research gaps; iii) International PCOS Guideline Network consensus generated clinical research roadmap; and iv) international peer review for external validation. A codesigned survey engaging 1278 women with PCOS and 1474 healthcare providers found general concordance on research priorities. International PCOS Guideline development processes identified gaps in the literature and coproduced over 150 research priorities throughout the women's life course, affirmed in international peer review. Key themes included: 1) Optimizing PCOS diagnosis; understanding natural history across diverse populations and life stages; detecting and preventing complications, and integrating and interrogating large data assets; 2) developing evidence-based resources, exploring optimal modes for information provision and models of care; 3) exploring effective lifestyle and weight management strategies; minimising weight stigma; 4) exploring intervention effects (including treatment efficacy, safety, cost-effectiveness, and long-term follow-up) on diverse features of PCOS across subgroups; and 5) optimising preconception care and fertility treatments in PCOS. This rigorously coproduced International PCOS Guideline clinical research roadmap addresses stakeholder priorities to guide future clinical research in this common yet neglected condition. The roadmap complements the established PCOS Core Outcome Set to enhance research quality, and tackles evidence-practice gaps to improve health outcomes for women with PCOS throughout their life course. The survey, International PCOS Guideline Network and 2018 and 2023 International PCOS Guidelines were funded by the Australian National Health and Medical Research Council (NHMRC) Centres of Research excellence in PCOS (APP1078444) and in Women's Health in Reproductive life (APP1171592). Guideline partners, American Society for Reproductive Medicine (ASRM), Endocrine Society, European Society of Human Reproduction and Embryology (ESHRE), and European Society of Endocrinology (ESE), provided additional funding and assisted in guideline development. HT and AM are NHMRC Research Fellows. LM was funded by a Heart Foundation Future Leader and Veski Fellowship and CTT by the NHMRC Centres of Research excellence in Women's Health in Reproductive life. All disclosures of interest were declared before commencing GDG involvement and updated before all major milestones and are available alongside the PCOS Guideline (https://www.monash.edu/__data/assets/pdf_file/0009/3371292/Register-of-disclosures-of-interest.pdf).

Developing a Weight-Neutral Health Intervention in Denmark: Protocol for a Co-Design Process.

Lifestyle interventions for weight loss are generally ineffective in achieving clinically meaningful long-term reductions in body weight and may contribute to negative behavior such as weight cycling or disordered eating. Negative focus on high weight may also contribute to weight stigma. Weight stigma includes negative attitudes and discriminatory behavior toward people with big bodies and can result in psychological stress and unfavorable health outcomes. Taken together, it is possible that the potential harms of lifestyle-based weight loss interventions may exceed the potential benefits. Weight-neutral health (WNH) has emerged as an alternative strategy advocating for size diversity, intuitive eating, and joyful physical movement, all without placing emphasis on weight reduction. This protocol outlines the study design for the co-design process of developing a WNH complex intervention, engaging relevant stakeholders in Denmark. We base our understanding of WNH on the principles from Health at Every Size: body acceptance, joyful movement, intuitive eating, and weight stigma reduction. The co-design development process is based on the Medical Research Council's framework for complex interventions and applies methods from human-centered design through 4 iterative design phases of engaging stakeholders-discover: search existing literature, and conduct interviews with Danish municipal stakeholders working with WNH and other expert stakeholders; define: coproduction of seminars with health professionals (HPs) with knowledge of WNH, and semistructured interviews with people with BMI≥30 kg/m2 who have participated in existing WNH interventions; design: content-creating workshops with HPs and people with BMI≥30 kg/m2; and validate: evaluate seminars, plan feasibility, and produce materials. The data will be analyzed thematically to build a scaffold for the intervention activities and components. In further analysis, we will explore how health is performed, meaning the actions and dialogues that arise when dealing with health guidelines, the societal body, weight, and health expectations, in the context of the intervention. The project is fully funded. As of August 2024, the co-design process was in the closing phase. In total, 15 HPs were included, some of whom have larger body sizes. This provides a dual perspective, combining their personal experiences of living with a high BMI with their professional expertise. In total, 16 people with BMI≥30 kg/m2 have generously shared their experiences with WNH programs, including the difficulties of moving away from external demands and personal wishes for weight loss. Their contributions have nuanced and unfolded our understanding of the principles of WNH in a Danish setting. The intervention designed in and from the co-design process will be tested for feasibility in 2025. The findings from the feasibility study will inform a future randomized controlled trial and present novel findings in the field of health management. The long-term goal is to implement the intervention in a Danish municipal setting free of charge.

“We go hunting …”: Understanding experiences of people living with obesity and food insecurity when shopping for food in the supermarket to meet their weight related goals

The high prevalence of food insecurity in the United Kingdom has been exacerbated by the cost-of-living crisis. In high-income countries, those experiencing food insecurity struggle to buy and consume foods that meet Government healthy eating recommendations, and are at increased risk of obesity, linked to poor diet quality. Individuals in high-income countries purchase most of their food to consume at home from supermarkets, making this an important context within which healthier and environmentally sustainable food purchasing should be supported. However, the lived experience of supermarket food purchasing in people living with obesity and food insecurity has not been explored in depth. Adults, living in England and Scotland, who self-identified as living with obesity and food insecurity and looking to reduce their weight, were recruited to take part in semi-structured interviews (n = 25) or focus groups (n = 8) to explore their experience of shopping for food in the supermarket. Using thematic analysis, four main themes were generated: 1) the Restricted Consumer; restrictions around the type of food purchased, where food can be purchased and the resulting emotional toll, 2) the Conscious Consumer; decision making and effortful practices both in preparation of and during the shopping trip, 3) Mitigating the Rising Cost of Food; agency and actions taken to mitigate high food prices, 4) Stigma; instances of perceived and/or experienced weight and poverty-related stigma and the physical actions and cognitive social comparisons used to minimise stigma. Findings provide insights for evidence-based policy on the need for upstream changes within the wider food system to address the social determinants of health and support people living with obesity and food insecurity to eat healthier and more sustainable diets.

Growing up in a larger body: youth- and parent-reported triggers for illness and barriers to recovery from anorexia nervosa

BackgroundA significant portion of youth with anorexia nervosa (AN) or atypical anorexia nervosa (AAN) have history of ‘overweight/obesity’ (i.e., body mass index ≥ 85th percentile for age-and-sex) prior to the onset of the eating disorder (ED) diagnosis, but research on this population remains limited. The present study used semi-structured interviews to explore themes related to triggers of weight loss, treatment, and recovery among youth with AN/AAN and history of ‘overweight/obesity,’ and their parents.MethodThe sample included eleven youth and parent dyads (Median [IQR] age of youth = 16.0 (1.5) years, 90.9% female, 90.9% White, 27.3% Hispanic) who were evaluated for an ED in a multidisciplinary ED program at a pediatric hospital between November 2020 and April 2021. Nine youth and separately, nine parents of these 11 dyads completed semi-structured interviews with the research team. Seven matched pairs of patients and parents completed demographic surveys and study interviews. Interviews were recorded, transcribed, and coded by four research team members using a reflexive thematic approach.ResultsWeight stigma was the most frequently reported theme for a trigger for weight loss that led to the onset for developing AN/AAN by both youth and parents. Regarding barriers to recovery, themes from more than a half of youth included uncertainty of weight goals in treatment and feeling they are “not sick enough.” Notable themes for attitudes towards treatment from most parents included general agreement with clinician recommendations, but also an uncertainty of weight restoration goals and a belief that their child need to have a “normal” weight.ConclusionThese results highlighted how the majority of interviewed youth with history of ‘overweight/obesity’ reported weight stigma as both a trigger for the development of AN/AAN as well as a barrier to recovering. Internalized weight stigma among parents may influence their attitudes towards weight restoration as a treatment goal where these youth and parents may experience uncertainty of weight goals in treatment. This study demonstrated triggers and barriers to treatment that may be unique to youth with ED and history of ‘overweight/obesity’ and more research is needed to address weight stigma in multidisciplinary ED treatment for this understudied population.

The impact of Perspective-Taking on weight stigma among Chinese University students: The mediating role of Common ingroup identity

Background/Objective Weight stigma has significant psychological and social implications, yet studies on perspective-taking as an intervention strategy remain scarce. This study aimed to investigate the effect of perspective-taking on weight stigma among Chinese university students and examine the potential mediating role of common ingroup identity. Methods A randomized controlled experiment with 202 Chinese university students (experimental group, perspective-taking group: n = 102; control group: n = 100) was conducted. Weight stigma was measured pre- and post-intervention using the Anti-Fat Attitudes Test. The study employed a 2 × 2 mixed design with ANCOVA and mediation analysis. Results The experimental group showed significantly lower post-test weight stigma when controlling for pre-test scores (F(1, 199) = 25.69, p &lt; .001). Perspective-taking engagement was significantly higher in the experimental group (t = 3.13, p = .002). Common ingroup identity negatively correlated with post-test weight stigma (r = -.28, p &lt; .001) but did not significantly mediate the perspective-taking and weight stigma reduction relationship. Conclusion Perspective-taking effectively reduces weight stigma among Chinese university students, contributing to stigma reduction strategies in university settings. Further research on underlying mechanisms is warranted.

Associations among negative weight-related experiences, weight bias internalization, and body-related self-conscious emotions in adolescents: A daily diary study.

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. 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. 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. 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-based disparities in perinatal care: quantitative findings of respect, autonomy, mistreatment, and body mass index in a national Canadian survey

BackgroundQualitative studies document episodes of weight-related disrespectful care, particularly for people with high body mass index (BMI ≥ 30) and reveal implicit and explicit biases in health care providers. No large quantitative studies document the pervasiveness of weight stigma or if experiences change with increasing BMI.MethodsThe multi-stakeholder RESPCCT study team designed and distributed a cross-sectional survey on the experiences of perinatal services in all provinces and territories in Canada. From July 2020 to August 2021, participants who had a pregnancy within ten years responded to closed and open-ended questions. Chi square analysis assessed differences in mean scores derived from three patient-reported experience measures of autonomy (MADM), respect (MOR), and mistreatment (MIST). Controlling for socio-demographic factors, multivariate logistic regression analysis explored relationships between different BMI categories and respectful care.ResultsOf 4,815 Canadians who participated, 3,280 with a BMI of ≥ 18.5 completed all the questions. Pre-pregnancy BMI was significantly associated with race/ethnicity, income sufficiency, and education but not with age. Individuals with higher BMIs were more likely to experience income insufficiency, have lower levels of education, and more frequently self-identified as Indigenous or White. Those with BMI ≥ 35 exhibited notably higher odds of reduced autonomy (MADM) scores, with an unadjusted odds ratio of 1.62 and an adjusted odds ratio of 1.45 compared to individuals with a normal weight. Individuals with BMIs of 25–25.9, 30–34.9, and ≥ 35 exhibited odds of falling into the lower tercile of respect (MOR) scores of 1.34, 1.51, and 2.04, respectively (p < .01). The odds of reporting higher rates of mistreatment (top 33% MIST scores) increased as BMI increased.ConclusionsWhile socio-demographic factors like race and income play significant roles in influencing perinatal care experiences, BMI remains a critical determinant even after accounting for these variables. This study reveals pronounced disparities in the provision of respectful perinatal care to pregnant individuals with higher BMIs in Canada. Data suggest that those with higher BMIs face disrespect, discrimination, and mistreatment. Identification of implicit and explicit weight bias may give providers insight enabling them to provide more respectful care.

Body Positivity, Physical Health, and Emotional Well-Being Discourse on Social Media: Content Analysis of Lizzo's Instagram.

Weight stigma is a fundamental cause of health inequality. Body positivity may be a counterbalance to weight stigma. Social media is replete with weight-stigmatizing content and is a driver of poor mental health outcomes; however, there remains a gap in understanding its potential to mitigate the prevalence and impact of harmful messaging and to promote positive effects on a large scale. We selected musical artist Lizzo, whose brand emphasizes body positivity and empowerment, for an instrumental case study on the discourse on social media and specifically Instagram. We focused on 3 domains, including body positivity, physical health, and emotional well-being. These domains challenge social norms around weight and body size and have the potential to positively affect the physical and psychological health of people with diverse body sizes. We evaluated posts by Lizzo, comments from Instagram users, and replies to comments over a 2-month period (October 11 to December 12, 2019). Two coders rated Lizzo's posts and Instagram users' comments for their sentiments on the 3 domains. Replies to Instagram users' comments were assessed for their reactions to comments (ie, did they oppose or argue against the comment or did they support or bolster the comment). Engagement metrics, including the number of "likes," were also collected. The final sample included 50 original posts by Lizzo, 250 comments from Instagram users, and 1099 replies to comments. A proportion of Lizzo's content included body positive sentiments (34%) and emotional well-being (18%); no posts dealt explicitly with physical health. A substantial amount Instagram users' comments and replies contained stigmatizing content including the use of nauseated and vomiting emojis, implications that Lizzo's body was shameful and should be hidden away, accusations that she was promoting obesity, and impeachments of Lizzo's health. In spite of the stigmatizing content, we also discovered content highlighting the beneficial nature of having positive representation of a Black woman living in a larger body who is thriving. Moreover, analysis of the discourse between users illustrated that stigmatizing expressions are being combated online, at least to some degree. This study demonstrates that Lizzo has exposed millions of social media users to messages about body positivity and provided more visibility for conversations about weight and shape. Future research should examine the extent to which body positive messages can lead to greater acceptance of individuals living in larger bodies. Instagram and other social media platforms should consider ways to reduce body-shaming content while finding ways to promote content that features diverse bodies. Shifting the landscape of social media could decrease stereotypes about weight and shape while increasing dialog about the need for greater acceptance and inclusion of people with diverse bodies.

The Perceived Weight Stigma Scale and Weight Self-Stigma Questionnaire: Rasch analysis, confirmatory factor analysis, and network analysis among Chinese adolescents

ObjectivesThe objectives of the present study were to (i) re-evaluate and expand the psychometric properties of two weight stigma instruments—the Perceived Weight Stigma Scale (PWSS) and the Weight Self-Stigma Questionnaire (WSSQ) among a large sample of adolescents using advanced psychometric methods and (ii) examine how the different types of weight stigma (i.e., PWSS and WSSQ) are associated with psychological distress. Study designCross-sectional study. MethodsIn September 2023, a cross-sectional survey utilising convenience sampling was used to recruit 9995 adolescents (mean age = 16.36 years [standard deviation = 0.78]; 57.8% males). They completed the PWSS, WSSQ, and a measure on psychological distress. The data were analysed using Rasch analysis, confirmatory factor analysis (CFA), structural equation modelling (SEM), and network analysis. ResultsThe CFA and Rasch model results showed acceptable psychometric properties regarding factor structure, factor loading, difficulty, and infit and outfit mean squares (except Items 4 and 7 of the PWSS). There was no substantial differential item functioning for any tested items across the sex and weight categories. The CFA and SEM results showed promising validity indices with significant associations between both weight stigma scales and psychological distress (i.e., depression, anxiety, and stress). Network analysis showed inter-variable connectivity between nodes PWSS3 (“People act as if they are afraid of you”) and WSSQF7 (“I feel insecure about others’ opinions of me”). ConclusionsBoth weight stigma scales had acceptable psychometric properties and were significantly associated with psychological distress, although each assessed different types of weight stigma. This suggests that researchers and clinicians can use these scales to reliably and validly assess weight stigmas among adolescents.

Weight Stigma in the Development, Maintenance, and Treatment of Eating Disorders: A Case Series Informing Implications for Research and Practice.

Weight-centric health practices are based on the principle that excess weight predicts chronic disease, informing a growing sociopolitical movement to address an "obesity epidemic." This hyper-focus on preventing obesity may contribute to weight stigma (i.e., the devaluation and discrimination of individuals based on body size) and other iatrogenic outcomes for youth, including the development and maintenance of eating disorders (EDs). Current evidence-based treatments for EDs include language and practices that may reinforce fears of fatness, body shame, and unhealthy dietary restriction without guidance on addressing weight stigma. Here, we present case examples from three adolescent patients across ED presentations and body sizes to (1) elucidate the role of weight stigma in ED development, (2) highlight the ubiquity and harms of weight stigma within ED treatments, and (3) outline thoughtful protocol adaptations to avoid further harm and facilitate recovery. We conclude with a call for immediate action to advance research characterizing the harms of weight-centric approaches in existing ED interventions to reduce the risk of iatrogenic effects on youth with EDs and advance weight-inclusive approaches to ED treatment.

Using stereotype violation to shift causal understanding and attitudes about weight

ObjectiveWe evaluated an approach to weight stigma reduction involving the provision of an exemplar inconsistent with belief systems underlying weight bias. Specifically, that people with higher weight eat unhealthy, high-calorie diets, and people with lower weight eat healthy, low-calorie diets. Providing exemplars that violate the stereotype's assumptions may lead to a change in beliefs, stereotypes, and ultimately, stigma. MethodsIn an experimental, web-based study, 682 US-based participants were randomized to read narrative vignettes about a fictional middle-aged woman portrayed as either having stable, high body weight, or stable, low body weight, and as eating a long-term diet that was either high- or low- in calorie-dense foods. Two stereotype violation conditions involved a woman with higher weight who maintains a low-calorie diet (HWLC) and a woman with lower weight who maintains a high-calorie diet (LWHC). ResultsFor the HWLC exemplar, results were consistent with stereotype change processes including heightened genetic causal attributions, reduced lifestyle attributions, and more positive attitudes toward the exemplar and “women with obesity” in general. Response to the LWHC exemplar was more uneven. ConclusionsFindings have implications in the understanding of judgments that people make about individuals based on their body size, and dietary habits suggest a new route for interventions that address weight stigma reduction.

The Virtual Patient: a training tool for healthcare staff to have helpful conversations about healthy weight using a Making Every Contact Count (MECC) approach

BackgroundWeight stigma is a key focus within the NHS Healthy Weight Declaration. Conversations around healthy weight can often be stigmatising and unsupportive, creating barriers to accessing healthcare, contributing to health inequalities for people living with obesity. The Virtual Patient (VP) aims to support Northumbria Healthcare NHS staff to have helpful conversations about weight with patients. MethodsThe VP training tool was developed using a Making Every Contact Count (MECC) approach, in collaboration with Keele University. The tool was developed using the weight stigma evidence-base and stakeholder input from dietetics, psychology and public health. Thematic analysis from a lived experience focus group (n=5) informed tool development. The tool was launched to Northumbria Healthcare staff between January-March 2024. Evaluation was through a questionnaire using validated COM-B (Capability, Opportunity, Motivation and Behaviour) principles and considering behaviour change components of MECC (motivation, capability, knowledge). FindingsThe VP platform was accessed by 226 respondents. 18 participants completed some elements of the questionnaire. A technological issue contributed to this low response rate. 88% (n=15) of respondents felt the VP had improved their knowledge, 76% (n=13) felt more motivated to have helpful conversations around healthy weight and 76% (n=13) felt more confident to initiate conversations. Aside from one respondent (6%) reporting reduced confidence, remaining respondents reported no change to knowledge 12% (n=2), motivation 24% (n=4) and confidence 18% (n=3). 100% (n=16) of respondents were clear on how the VP would improve their conversations with patients about healthy weight. InterpretationOverall, respondents viewed the VP positively, and met its aim to improve their conversations with patients. Most respondents felt the tool was easy-to-use and improved their knowledge, confidence and motivation to have helpful conversations about weight. The low response rate may introduce selection bias. Provision of an incentive could have improved response rates. A regional evaluation will further support an understanding of the impact of the tool. FundingNo external funding received. Keele University were provided with funding from Northumbria Healthcare Foundation trust to create the Virtual Patient tool and for the license for the use of the tool (see conflict of interest form for author Thomas Pardoe).

Associations among self-compassion, weight bias internalization, and self-reported psychological and physical health.

Associations among self-compassion, weight bias internalization, and self-reported psychological and physical health.

The role of weight stigma and internalized weight bias in health care avoidance and mistrust.

The role of weight stigma and internalized weight bias in health care avoidance and mistrust.

Addressing weight bias among pediatric healthcare clinical staff

BackgroundChildren with obesity may experience weight-based discrimination as a result of weight bias and stigma, which can have deleterious effects on their health and wellbeing, including increased risk of dysregulated, maladaptive, and disordered eating such as restriction, purging, and binging. Prior work has shown that weight bias occurs from healthcare workers caring for adults, but less is known about the prevalence of weight bias in the pediatric healthcare setting.MethodsWe aimed to determine what proportion of pediatric healthcare professionals had attitudes of weight bias at our own institution by constructing a survey with questions from validated weight bias survey tools. Results revealed nearly half of all respondents had witnessed another healthcare professional make negative remarks about a patient with obesity, and many shared that they lacked the proper education/training and equipment to properly care for patients with obesity. Based on survey results, we created an electronic-based training module to educate healthcare professionals on weight bias and discrimination and how they may negatively affect care provided to children and families with obesity at our institution. Engagement with hospital leadership was a key strategy to ensure participation from medical and nursing/allied health staff in the survey, although only nursing/allied health leadership required the online training module resulting in limited physician engagement.ResultsFeedback received regarding the training module was overwhelmingly positive.ConclusionsOur efforts illustrate that weight bias and discrimination exist in pediatric institutions, and that participation in a tailored electronic-based training module may be viewed as a helpful tool to raise awareness of how weight-based discrimination and bias can negatively affect patient care.

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.