Higher Weight Individuals Research Articles

Fitspo at Every Size? A comparative content analysis of #curvyfit versus #curvyyoga Instagram images

ABSTRACTContemporary fat studies scholarship seeks to challenge and critique the normative weightist lens through which modern social media for example stereotypically represent the embodiment of higher-weight individuals or the typical underrepresentation of body diversity in the cases of mainstream Fitspiration and yoga lifestyle media. Simultaneously, proponents of the fat acceptance/body positivity movement are currently at odds over the increasingly expansive appropriation of the term curvy for self-identification. In light of these tensions, utilizing body conceptualization theory as a guiding framework, we examined the shared and distinct approaches used to exemplify and motivate fitness and health as reflected in 300 images sourced from #curvyfit and #curvyyoga on Instagram. Images were systematically coded for sociodemographic (e.g., race/ethnicity, gender), body-as-process (e.g., physically active portrayals), and body-as-object (e.g., weight loss, body modification) attributes. Results revealed that #curvyfit images featured a greater representation of physical appearance–oriented aspects of fitness; #curvyyoga images more often conveyed larger body sizes, shapes, and body-as-process characteristics. Preliminary findings have important implications for counteracting weight-biased perceptions equating thinness with physical fitness and promoting yoga as an important health practice among individuals with a range of body sizes. Our initial stage findings also raise areas of future critical inquiry surrounding the complex messaging at the intersection of fat embodiment, curvy identification, and healthism that are particularly ripe for subsequent qualitative investigation with actual digital media users.

Disparities in eating disorder diagnosis and treatment according to weight status, race/ethnicity, socioeconomic background, and sex among college students.

Eating disorders (EDs) present a significant threat to the health of adolescents and young adults, yet remain under-diagnosed and under-treated at a population-level. EDs have historically been thought to afflict "skinny, white, affluent girls" (the SWAG stereotype). As such, higher-weight individuals, racial/ethnic minorities, those from socioeconomically disadvantaged backgrounds, and males may not recognize their need for treatment, may not be properly screened for EDs, and/or may not be referred to treatment. Using large-scale survey data from the healthy bodies study, we examined variations in prevalence of perceived need for ED treatment, ED diagnosis, past-year ED treatment, and treatment barriers according to weight status, race, socioeconomic background, and sex among undergraduate and graduate students with symptoms of an ED (N = 1,747). Among students with symptoms of an ED, 30.7% perceived a need for treatment, 10.5% had received a diagnosis, and 13.6% had received treatment in the past year. Individual characteristics were highly associated with perceived need, diagnosis, and past-year treatment. Females were more likely than males to perceive a need for treatment (OR = 1.97), to be diagnosed (OR = 4.66), and to be treated (OR = 1.64) for their ED symptoms. Socioeconomic background was associated with perceived need for treatment and past-year treatment, with students from affluent backgrounds having higher odds of perceiving need (OR = 1.52) and of receiving treatment (OR = 1.89) compared with their non-affluent peers. At a population-level, the unmet need for ED treatment disproportionately affects certain groups. Stereotypes about who develops EDs could contribute to disparities in ED treatment and outcomes.

Detecting the Undiagnosed: Findings on Sleep Apnea Identification in Veterans With Insomnia Using at-Home Sleep Monitor Technology

Background: Sleep disorders are a serious national health issue. Insomnia and sleep apnea are the most commonly diagnosed, with serious negative impacts including increased mortality, performance problems, accidents, and health-care utilization. Given a high level of apnea in persons with insomnia (29%), the incorporation of objective measures of sleep for at-home sleep monitoring for clinical trials may assist in potential sleep apnea detection and treatment for persons with insomnia. This may be particularly important for military personnel, as a 372% increase in insomnia encounters and a 517% increase in apnea encounters was recently reported for this population. Objective: The primary goal of this pilot trial was to assess usability and feasibility of mobile health information technologies (HITs) designed to reduce insomnia in post-9/11 Veterans. As this pilot focused on insomnia treatment with HITs, veterans with an objective sleep measure indicating moderate to severe sleep apnea were withdrawn. Participants used a home-based sleep monitor (WatchPAT) which has been validated against polysomnography and derives the Apnea-Hypopnea Index (AHI) from arterial tonometry, pulse oximetry and snoring. We report here on the positive screening rate for sleep apnea in our sample of Veterans with insomnia, a secondary but clinically significant finding within this HIT pilot. Methods: Thirty-eight Veterans were enrolled who met criteria for insomnia on the Insomnia Severity Index, with 33 Veterans in total engaging in the first night of sleep monitoring. A WatchPAT device provided screening results based on AHI scores over 1-2 nights of home use. Those with sleep apnea above the mild range, i.e., AHI > 15 (moderate or severe), were withdrawn from the trial and referred for further assessment. Results: Of the 33 veterans who completed the first night of sleep monitoring at home, a total of eighteen (54.5%) were identified as having moderate to severe sleep apnea as indicated through WatchPAT measurement. Demographic predictors of apnea were also explored, as apnea rates increase with age and occur more frequently in higher weight individuals. Results were unexpected given the mean age of the final sample (43.8 years, SD = 11.3), as age did not differ between those with no/mild apnea vs. moderate/severe apnea (t (31) = 0.89, ns). However, those with moderate/severe apnea had a significantly higher body mass index (BMI; 30.7, SD = 4.5 vs. 26.8, SD = 2.9; t (31) = 2.88, P<.01). Conclusions: The pilot demonstrated a higher-than-expected positive screen rate for apnea in post-9/11 Veterans. The high co-occurrence of sleep apnea and insomnia in these Veterans suggests the need to conduct comprehensive clinical sleep assessments for Veterans reporting chronic insomnia since apnea may blunt the effectiveness of insomnia interventions. Sleep apnea is treatable and successful treatment can enhance overall health and quality of life. Given the persistence of insomnia in patients treated for sleep apnea, clinicians should also re-assess for insomnia following apnea treatment to determine whether insomnia has resolved. The use of at-home sleep monitors may thus provide a mobile, wearable, and usable at-home sleep monitors for such assessment and treatment.

Social Dominance Orientation, Dispositional Empathy, and Need for Cognitive Closure Moderate the Impact of Empathy-Skills Training, but Not Patient Contact, on Medical Students' Negative Attitudes toward Higher-Weight Patients.

Anti-fat bias in healthcare providers and medical students has serious implications for quality of care of higher-weight patients. Studies of interventions aimed at reducing anti-fat attitudes in medical students have generally been disappointing, with little enduring effect. It is possible that some students may be more receptive to prejudice-reducing influences than others, due to underlying differences in their personal characteristics. It is also possible that attitudes toward patients, specifically, may differ from anti-fat attitudes in general, and prejudice-reduction effectiveness on patient-specific attitudes has not yet been evaluated. The present study explored the effect on general and patient-specific anti-fat attitudes of (1) contact with higher-weight individuals prior to and during medical school; and (2) training designed to increase medical students' empathy toward patients by encouraging them to take the patient's perspective during clinical encounters. The moderating role of individual difference factors on effectiveness of contact and student-reported hours of empathy training on patient-specific attitudes was assessed. A total of 3,576 students enrolled across 49 US medical schools completed an online survey at the start of their first year of medical school and at the end of their fourth year. Favorable contact experience with higher-weight patients predicted improved attitudes toward heavier patients after 4 years of medical school, and appeared sufficient to partially offset the effects of dislike of higher-weight individuals at baseline. The impact of favorable contact on general anti-fat attitudes was less strong, highlighting the importance of using target-specific outcome measures. The positive effects of favorable contact on attitudes toward higher-weight patients did not differ based on students' baseline levels of social dominance orientation, dispositional empathy, or need for cognitive closure. In contrast, the effectiveness of training did vary by student characteristics, generally being more effective in students who were more egalitarian and empathic at baseline, with little effect, or even adverse effects in students low in these traits. Overall, however, perspective-taking training produced only small improvements in attitudes toward higher-weight patients.

Internalized weight stigma moderates eating behavior outcomes in women with high BMI participating in a healthy living program

Weight stigma is a significant socio-structural barrier to reducing health disparities and improving quality of life for higher weight individuals. The aim of this study was to examine the impact of internalized weight stigma on eating behaviors after participating in a randomized controlled trial comparing the health benefits of a weight-neutral program to a conventional weight-management program for 80 community women with high body mass index (BMI > 30, age range: 30–45). Programs involved 6 months of facilitator-guided weekly group meetings using structured manuals. Assessments occurred at baseline, post-intervention (6 months), and 24-months post-randomization. Eating behavior outcome measurements included the Eating Disorder Examination-Questionnaire and the Intuitive Eating Scale. Intention-to-treat linear mixed models were used to test for higher-order interactions between internalized weight stigma, group, and time. Findings revealed significant 3-way and 2-way interactions between internalized weight stigma, group, and time for disordered and adaptive eating behaviors, respectively. Only weight-neutral program participants with low internalized weight stigma improved global disordered eating scores. Participants from both programs with low internalized weight stigma improved adaptive eating at 6 months, but only weight-neutral program participants maintained changes at follow-up. Participants with high internalized weight stigma demonstrated no changes in disordered and adaptive eating, regardless of program. In order to enhance the overall benefit from weight-neutral approaches, these findings underscore the need to incorporate more innovative and direct methods to reduce internalized weight stigma for women with high BMI.

15. Augmentation of homing of cord blood stem cells

The field of cord blood (CB) transplantation has come quite a way since its inception and the first clinical transplant in October 1988. CB hematopoietic stem (HSC) and progenitor (HPC) cells have been used to treat a wide variety of genetic disorders and malignancies. These transplants were possible because the cells could be cryopreserved for prolonged periods of time and stored in CB banks for future use. The vast majority of CB transplants have been performed in children and low weight recipients. Fewer CB transplants have been done in adults and higher weight individuals because of the limiting numbers of CB cells that are available for collection and storage at the birth of babies. A number of procedures have been and are being investigated to enhance the efficiency of CB transplantation for adults. This includes attempts at ex-vivo expansion of HSC, which has not yet provided a clinical breakthrough because we don’t know enough of the biology regarding stem cell self-renewal and proliferation to truly expand the HSC. Transplantation of multiple CB units is ongoing with early clinical success, but this procedure has apparently not greatly reduced the time to engraftment and only one of the transplanted CB units seems to survive for longer term engraftment. Not all mouse HSC home with absolute efficiency, effects consistent with clinical experience in which limiting numbers of cells result in graft failure. The chemokine stromal cell derived factor-1 (SDF-1)/CXCL12 and its Gα protein–linked seven transmembrane spanning receptor CXCR4 are involved in chemotaxis, mobilization and homing of HSC and HSC. CD26 is a cell surface dipeptidylpeptidase IV, which can truncate SDF-1/CXCL12. We found that inhibition or deletion of CD26 on target populations containing or highly enriched for human CB and human and murine bone marrow HSC/HPC greatly enhanced the chemotactic responsiveness of these cells to SDF-1/CXCL12. Inhibition/deletion of CD26 in mice was associated with greatly decreased ability to mobilize HPC with G-CSF. Based on these finds we hypothesized that enhancement in homing of HSC to the bone marrow niche needed for support of the self-renewal and proliferative capacity of HSC would lead to increased engraftment with limiting numbers of HSC. We tested this hypothesis, first with mouse bone marrow cells transplanted into lethally irradiated congenic mice in the setting of non-competitive and also competitive repopulation, each followed by repopulation in a non-competitive repopulation assay in lethally irradiated secondary congenic mice. Mouse bone marrow donor cells pretreated with CD26 inhibitors Diprotin A (Ile-Pro-Ile) or Val-Pyr or from CD26 gene knock-out (−/−) mice had greatly enhanced capacity to home to the bone marrow of recipients, and this was associated with enhanced engraftment, especially with dose-limiting numbers of donor cells. Recent work from our laboratory has found that in vitro inhibition of CD26 on human CD34+ CB cells enhances engraftment of these cells in sublethally irradiated NOD/SCID mice. These encouraging results with CB cells suggest that targeting CD26, or other means to enhance homing/engraftment may be of practical value in a clinical setting to use limiting numbers of CB HSC for successful transplantation.