Weight-based Discrimination Research Articles

Racial Discrimination and Perceived Weight Status Are Positively Associated With Depressive Symptoms Among Latina and Hispanic Women in the United States

Holding intersecting marginalized identities in the United States (U.S.)—gender, ethnicity, and perceived weight status (PWS)—may increase Latina and Hispanic women’s risk for depressive symptoms. The purpose of this study was to examine the associations between racial discrimination stress, PWS, and depressive symptoms in Latina and Hispanic women. PWS was also examined as a potential moderator. Participants were an ethnically diverse sample of 467 Latina and Hispanic women ( Mage = 40.79 ± 14.98 years) living in the U.S. After adjusting for age, ethnicity, health insurance status, acculturation, education, income, and body mass index (BMI), racial discrimination stress was positively associated with depressive symptoms ( p < .001). PWS did not moderate this association. However, PWS was significantly associated with depressive symptoms; perceiving oneself as “overweight” was associated with more severe depressive symptoms ( p < .05) compared to perceiving oneself as “skinny” ( p < .05), “average weight” ( p < .05), or “slightly overweight” ( p < .05). These data underscore the influence of both racial discrimination and body size perception, regardless of BMI, on Latina and Hispanic women’s psychological health. Health promotion efforts for Latina and Hispanic women in the U.S. may consider targeting the perpetration of racial and weight-based discrimination, as well as addressing self-perceptions and accompanying beliefs surrounding race and body size.

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 food reward in the associations between weight-based discrimination and feeding practices among caregivers of young children

Certain caregiver feeding practices, including restrictive feeding for weight control, restrictive feeding for health, emotion regulation feeding, and reward feeding, are known to negatively influence short- and long-term child eating and health outcomes. Beyond body size, the precise psychosocial characteristics of caregivers more likely to engage in such feeding practices are unknown. In particular, caregivers who have experienced discrimination based on their weight, who have internalized those biased beliefs, or who find food to be very rewarding may be more likely to use restrictive or controlling feeding practices. The present study investigated the associations among experiences of weight-based discrimination, internalized weight bias, and food reward (i.e., reward-based eating drive) with use of restriction for weight control, restriction for health, emotion regulation feeding, and reward feeding in an online US sample of caregivers (M = 35.27 ± 9.08 y/o) of 2–5 year-old children (N = 305). About half (50.8%) of respondents self-identified as women and most as non-Hispanic (88.5%) and White (75.1%). There were significant positive correlations among caregivers' experience of weight-based discrimination, internalized weight bias, and use of all four feeding practices. Regression results showed that caregivers’ food reward moderated the main effect of weight-based discrimination on restrictive feeding for weight control and emotion regulation feeding, such that caregivers who were high in food reward and who experienced discrimination were most likely to engage in these feeding practices. These results can inform interventions aimed at improving child food environments and health.

“This doctor knows shit about you, but the first thing he says is, ‘you need to lose some weight’”: Anti-fat bias and the contradictory effects of fat medicalization in Czech healthcare

ABSTRACT The anti-fat bias that is built on the premised principle antagonism between a fat and a healthy body remains entrenched in healthcare. Despite evidence that being fat is conditioned by many factors beyond a person’s control, fatness is often seen as a result of irresponsible behavior and moral failure and fat patients report being exposed to mistreatment, discrimination, and shaming in healthcare. Drawing on semi-structured interviews and written testimonies, we examine the experiences of people with fat embodiment in Czech healthcare contexts and explore how they approach their health, biomedicine, and weight management. Although obesity specialists are trying to address the weight stigma and create a respectful environment, an anti-fat bias dominates in the rest of the Czech healthcare system. Moreover, even if the medicalization of fatness contributes to reducing weight stigmatization in some contexts, it also reinforces the perception of fat as a medical pathology, which, in turn, creates an obligation for fat individuals to seek biomedical treatment. We identify three strategies that fat people employ to minimize their exposure to weight-based discrimination: avoiding all healthcare contexts; seeking out younger physicians, whom they find to be generally more supportive; and going to great effort to find a doctor with a non-judgmental approach to obesity. In conclusion, we argue for a more well-being-oriented than weight-centered understanding of human health that will go beyond standardized indicators in favor of more personalized care.

Intersecting Expectations when Expecting: Pregnancy-Related Weight Stigma in Women of Colour.

Weight stigma is a social justice issue that can lead to weight-based discrimination and mistreatment. In pregnancy, emerging evidence has highlighted that weight stigma predominantly affects individuals who have larger bodies and is associated with postpartum depression and avoidance of healthcare. Racial and ethnic background will influence perceptions of, and responses to, weight stigma and therefore it is necessary to ensure diverse voices are represented in our understanding of weight stigma. Semi-structured interviews were conducted with ten women who were within one year postpartum; nine identified as Black or African American and one as Hawaiian. Thematic analysis led to identification of three themes: (1) sources of weight stigma and their response to it, (2) support systems to overcome weight stigma, and (3) intersectional experiences. Women reported that sources of weight stigma included unsolicited comments made about their weight often coming from strangers or healthcare professionals that resulted in emotional distress. Support systems identified were family members and partners who encouraged them to not focus on negative remarks made about weight. Intersectional accounts included comparing their bodies to White women, suggesting that they may carry their weight differently. Women shared that, although they felt immense pressure to lose weight quickly postpartum, motherhood and childcare was their utmost priority. These findings inform further prospective examination of the implications of weight stigma in pregnancy among diverse populations, as well as inform inclusive public health strategies to mitigate weight stigma.

From the side-eye of a fat black girl: using pop culture to tackle fat phobia in education

PurposeThis paper aims to address weight-based bullying as a persistent issue among adolescents. Fat phobia, rooted in societal biases against overweight individuals, leads to social exclusion and discrimination, negatively impacting mental health and equality. Educational settings suffer from the profound effects of fat phobia, creating a toxic atmosphere that distracts from learning and marginalizes students who don't conform to traditional physical norms.Design/methodology/approachThis paper combines historical analysis, literature review and critical discourse analysis. It examines the historical roots of fat phobia, explores the impact of societal influences, analyzes contemporary educational practices and the use of popular culture as a innovative tool.FindingsLeveraging popular culture in anti-fat phobia education effectively challenges stereotypes. Educators empower students to critically analyze media depictions, encouraging empathy and inclusivity. Current events serve as critical teaching tools, sparking discussions on intersecting discrimination forms and equity.Practical implicationsThis paper emphasizes the urgent need to comprehensively address fat phobia in education, advocating for a shift in societal attitudes toward body diversity. Popular culture can serve as an educational tool to create inclusive classrooms where all students are valued and free from weight-based discrimination.Social implicationsThis paper emphasizes the urgent need to comprehensively address fat phobia in education, advocating for a shift in societal attitudes toward body diversity. Popular culture can serve as an educational tool to create inclusive classrooms where all students are valued and free from weight-based discrimination.Originality/valueThe originality and value of this paper lie in its multi-faceted approach to examining weight-based discrimination, its historical context, practical educational strategies, and the innovative use of popular culture as a tool for promoting inclusivity and empathy.

Tweeting about fatphobia and body shaming: A retrospective infodemiological study

BackgroundWe aimed to analyze reactions to tweets that employed weight-based discrimination terms and to compare them to others posted by the same users on X (formerly Twitter). MethodsWe collected tweets featuring weight-based discrimination terms (the study group) and created a control group by randomly selecting up to five tweets from each account that did not mention any such terms. Descriptive statistics, sentiment analysis, and logistic regression modeling were used to compare the numbers of likes and retweets of the study and control groups, and to understand the emotions associated with these tweets. ResultsOur analysis included 22,075 study group tweets and 50,341 control group tweets. Sentiment analysis was conducted on 41,403 (57.2%) tweets, with 65.7% of the study group tweets being found to contain negative sentiments. The study group had a higher median of likes (1 [0–4]) and retweets (0 [0–0]) than the control group (1 [0–2] and 0 [0–0], respectively, with the study group obtaining higher mean ranks in both comparisons, P < 0.001). Multivariable logistic regression analysis revealed that tweets using weight-based discrimination terms gained more likes (OR = 1.22; 95% CI: 1.16–1.28) and retweets (OR = 1.61; 95% CI: 1.49–1.74), independent of, for example, verification status, follower count, year and season of the tweet, and emotional expression of the tweet. ConclusionsTweets concerning fatphobia, body shaming, and similar terms gain more reactions than others posted by the same accounts.

Multiple marginalization, discrimination, and disordered eating among youth aged 10-11.

Although rates of weight discrimination are on-par with racial, ethnic, and gender discrimination, comparatively less work has examined impacts of weight-based discrimination in youth, including on disordered eating. Knowing whether experiences of weight-based discrimination, including in youth with multiply-marginalized identities, are associated with disordered eating could identify vulnerable youth and inform intervention efforts. Youth (N = 11,875) ages 10-11 were recruited through the Adolescent Brain Cognitive Development (ABCD) study. Logistic regressions using cross-sectional data examined discrimination experiences (weight, perceived sexual orientation, race/ethnicity, national origin) and disordered eating (binge-eating, vomiting, weight-gain fear, weight self-worth). Models included race/ethnicity, age, sex, parental income, and degree of elevated weight. Raked poststratification weights were used. Rates of weight-based discrimination (6.2%) were similar to rates of race/ethnicity (4.4%) and sexual orientation discrimination (4.5%). Weight-based discrimination was associated with more disordered eating. Youth reporting multiple experiences of discrimination had significantly increased disordered eating compared to youth who did not report discrimination. Weight-based discrimination is common in youth and associated with disordered eating. Youth with elevated weight are more likely to be multiply marginalized and experience disordered eating. These findings suggest discrimination, including weight-based discrimination, is a critical intervention target to prevent and treat eating disorders. Experiences of discrimination contribute to poorer health; however, weight-based discrimination is relatively understudied. Data from a large sample of youth ages 10-11 showed that youth with elevated weight reported experiencing multiple types of discrimination, and multiply-marginalized youth had increased odds of disordered eating with each additional type of discrimination. Together, this suggests that weight-based discrimination is a critical target to prevent and treat eating disorders, especially in multiply-marginalized youth.

Preliminary evaluation of a brief worksite intervention to reduce weight stigma and weight bias internalization

Weight-based discrimination (WBD) is common and associated with reduced physical and emotional functioning. WBD is common in the workplace, yet no studies have evaluated a WBD intervention delivered in a worksite setting. This study evaluated the feasibility, acceptability, and preliminary effectiveness of a 3-hour, remote-delivered WBD intervention at a large public university. Six workshops including 94 participants (41.76 ± 9.37 y; 92.8% women) were delivered December 2020 through May 2021; 88.3% of participants enrolled in the study and 88.8% of enrolled participants completed pre- and post-intervention surveys. Participants strongly agreed the workshop contributed to a more inclusive work environment (M=4.98 ± 0.2; 1 =Strongly Disagree to 5 =Strongly Agree); and was highly needed (4.9 ± 0.3) and liked (4.8 ± 0.5). Qualitative feedback cited benefits of remote delivery in providing body size anonymity and wanting access to intervention materials and more time for discussion and action steps to reduce WBD. Participants experienced significant, medium reductions in explicit weight bias (ps < .001), significant, small reductions in weight bias internalization (p < .001), and statistically non-significant (p = .08), small-to-medium reductions in implicit bias. Targeting worksites as a delivery mechanism has the potential to reduce WBD, thereby improving the health and well-being of diverse employees and creating a more inclusive workspace.

Early and current experiences of weight-based discrimination are associated with eating psychopathology, depression, and poor general health in adulthood.

Early and current experiences of weight-based discrimination are associated with eating psychopathology, depression, and poor general health in adulthood.

Becoming and acting as an ally against weight-based discrimination

Becoming and acting as an ally against weight-based discrimination

Body shaming and internalized weight bias as potential precursors of eating disorders in adolescents.

Body shaming (BS) is a growing phenomenon within the school context, especially among adolescents. Recently, it has been described as an unrepeated act in which a person expresses unsolicited, mostly negative comments about an individual's body. The targeted person perceives these comments as negative, offensive or body shame-inducing. Empirical evidence also suggests that body weight is the most common reason that youths are teased and bullied. Indeed, weight stigma, described as bias or discriminatory behaviors, attitudes, feelings, and thinking about individuals, because of their weight, can lead to weight-based discrimination and victimization. Preliminary evidence suggests that BS and weight stigma have negative effects on psychological health both in the short and long term. In the delicate stage of adolescence development and pubertal maturation, BS experiences can be highly prevalent and it can lead to adverse outcomes such as eating disorders (ED). However, prevalence data in the Italian context are still lacking. The study aims to estimate weight-related BS perceived by different sources (i.e., peers and family members) and their associations with public and internalized weight bias, body mass index (BMI), body dissatisfaction, and ED symptoms. A sample of 919 high school students (Mage = 15.97, SD = 1.58; 57.1% boys) completed a battery of self-report questionnaires assessing these variables. One in four students reported experiences of weight-related BS by peers or family members. A total of 37% reported having at least one BS experience in a lifetime. Higher scores of ED symptoms, body dissatisfaction, and weight bias were reported by adolescents who experienced BS, especially females. Among overweight participants, results showed that internalized weight bias partially mediated the relationship between BS by family members and ED symptoms and fully mediated the relationship between BS by peers and ED symptoms, after controlling for age, sex and BMI. These findings, despite their cross-sectional nature, add an important contribution to the creation of quantitative empirical evidence on the phenomenon of BS. Its role in explaining eating disorders, both alone and with the mediation of internalized weight stigma has been first proved and needs to be confirmed by longitudinal results.

Nurses' and Nursing Students' Perceptions Toward People Living with Obesity: A Scoping Review Protocol

Introduction: There is significant and pervasive weight bias, weight stigma, and weight-based discrimination everywhere today, even in healthcare settings. Studies have shown that health care professionals (HCPs) hold negative perceptions toward people living with obesity (PLO), which results in heightened health risks for patients. Nurses play a central role in health promotion and the health management of PLO. Thus, identifying nurses' and nursing students' perceptions toward PLO within healthcare practice or educational contexts is paramount to consider further exploratory and intervention studies. Objective: We aim to review and map nurses' and nursing students' perceptions toward PLO from available literature. Method: A search of MEDLINE via PubMed, CINAHL Plus with Full Text (EBSCOhost), and PsycINFO (OVID) will be conducted to identify relevant studies in English, French, Spanish, Portuguese, or Italian on nurses' and nursing students' weight bias. The period covered will be from January 1, 2005, onward, including those available up until our scheduled search in January 2024. Two independent reviewers will conduct screening, study selection, and data extraction. Data will be charted according to the study design, the research setting, years and regions of publication, concepts, and use of theoretical models. The results will be summarized and reported, identifying implications for nursing research and practice. Discussion and Research Spin-offs: This scoping review will inform nursing research and facilitate the development of educational and clinical tools aimed at preventing and reducing weight bias among nurses to promote nursing and interdisciplinary care that upholds principles of equity, diversity, and inclusion.

Raising awareness of anti-fat stigma in healthcare through lived experience education: a continuing professional development pilot study

BackgroundAnti-fat attitudes and weight-based discrimination are prevalent in healthcare settings and among healthcare practitioners and clinical trainees, and can result in immense harm to patients. There is increasing recognition that anti-fat bias in healthcare is a critical issue that must be addressed, but there is a dearth of evidence demonstrating sustained attitude and behavioural change among clinicians, illustrating a need for more innovative educational approaches and rigorous evaluation. We describe the co-design and delivery of a narrative-based continuing professional development curriculum aimed at raising awareness of weight-based bias and stigma.MethodsOur research team of lived experience educators, clinicians and researchers collaboratively developed a series of seven podcast episodes comprised of narrative descriptions of lived experiences with and impacts of weight bias, stigma and discrimination in healthcare settings, as well as a post-podcast workshop to facilitate reflection and discussion between participants. The curriculum was piloted among 20 clinicians practicing at a large urban hospital in Mississauga, Canada. We explored feasibility, acceptability and learning impact by analyzing responses to questionnaires completed following each podcast episode and responses shared during the workshops and follow-up feedback sessions.ResultsWe observed high acceptability and feasibility of the curriculum. Participants experienced the podcast as a practical and convenient learning format and the workshop as a valuable opportunity to collectively debrief and reflect. The learning impact of the curriculum was strong; participants described a range of emotions elicited by the podcasts, engaged in self-reflection, and expressed a desire to modify clinical approaches. Barriers to the application of learnings identified by participants include pervasiveness of the use of body mass index (BMI) as an indicator of risk and a criterion for referral; discomfort with difficult conversations; prevalent biomedical understandings about the association between weight and health; and clinicians’ defensiveness.ConclusionThis pilot study yielded promising findings and demonstrated potential impact on weight bias and stigma among healthcare providers. Necessary next steps include conducting larger scale, rigorous evaluations of the curriculum among broader populations, both health professions trainees and current healthcare providers.

Balancing on the redline: a qualitative study of the experiences purchasing sugar-sweetened beverages among Indigenous adults in a Canadian urban neighbourhood

ObjectiveGrowing evidence suggests that inner-city residents actively navigate their food landscape to meet a wide range of socio-economic needs. Given the increasing focus of health policies on sugar-sweetened beverages (SSB) through price-based strategies, it is critical to understand purchasing habits of populations with higher SSB intake. This study examined urban Indigenous adults’ SSB shopping behaviour and experiences.MethodsWe conducted a community-based participatory research study using semi-structured interviews with a purposive sample of Indigenous adults (≥ 18 years old) from the North End neighbourhood of Winnipeg. Interviews were audio recorded, transcribed verbatim, and thematically analyzed.ResultsAll 20 participants (women = 10; men = 8; two-spirit = 2) consumed SSB on a regular, daily basis either at the time of the interview or at a prior period in their lives. Themes defining residents’ SSB shopping behaviour and experiences of shopping for SSB included balancing on the redline, specifically (1) balancing SSB purchasing constraints and facilitators with savvy shopping approaches and (2) balancing (stereo)typical reactions with resilient coping approaches. Residents procured SSB in various stores within and beyond the boundaries of the North End neighbourhood. SSB is a considerable, reoccurring expense, requiring savvy price-shopping strategies in order to access. Indigenous adults experience judgement and stereotyping when purchasing SSB, including intersecting racial, class, and weight stigma.ConclusionPurchasing SSB is perceived as a source of judgement when outside of inner-city neighbourhoods. Policymakers should consider how policies directed at SSB, which are consumed by Indigenous and food-insecure populations in greater quantities, may magnify existing racial, class, and weight-based discrimination.

Examining health professional perspectives on social media body image movements: A qualitative exploration

There has been a lack of investigation into the understanding of social media body image movements from the healthcare perspective. Health professionals can have a strong influence on how their patients relate to their own bodies, including experiences of weight-based discrimination. This study examined the perspectives of health professionals on body image social media movements and whether they believed they were relevant to their professional practice. This study recruited 30 medical and allied health professionals to participate in semi-structured interviews. Thematic analysis was used to generate common themes across the data. Overall, participants identified benefits associated with body positivity online content, but expressed concerns for the health status of influencers with larger bodies and that overall, the pro-anorexia movement was harmful. Despite having limited understanding and exposure to the body neutrality movement, participants generally preferred it over body positivity. Finally, participants stated that they believed that these movements were relevant to their practice, yet were rarely discussed in consults. These findings suggest there is a lack of body image-based discussions despite the relevance to patient health across multiple domains. This indicates that health professionals may benefit from social media literacy training to support thorough assessment and treatment of their patients.

Weight-based discrimination and disordered eating behaviors in a cohort of U.S. sexual minority young adults.

Though prevalent, weight-based discrimination is understudied and has been linked to disordered eating behaviors (DEB) among adolescents and adults. Sexual minority populations experience elevated risk of DEB, but little is known about the role of weight discrimination in this elevated risk. Participants were 1257 sexual minority women and men (ages 18-31 years) in the US Growing Up Today Study cohort. We examined cross-sectional associations between weight discrimination victimization and three DEB in the past year: unhealthy weight control behaviors, overeating, and binge eating. Generalized estimating equations, adjusted for potential confounders, were used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs). Three in 10 participants (31%) reported weight-based discrimination victimization. Sexual minority young adults who reported weight-based discrimination had greater relative prevalence of unhealthy weight control behaviors (PR [95% CI]: 1.92 [1.35, 2.74]), overeating (3.15 [2.24, 4.44]), and binge eating (3.92 [2.51, 6.13]), compared with those who reported no weight-based discrimination. Associations with overeating and binge eating remained significant after adjusting for BMI. The role of weight-based discrimination, and its intersections with other forms of stressors for sexual minority young adults, must be included in efforts to advance eating disorder prevention for this underserved population. Three in 10 sexual minority young adults in this study had experienced weight-based discrimination, a common but understudied form of discrimination. Sexual minority young adults who experienced weight-based discrimination were at greater risk of disordered eating behaviors than those who had not experienced weight-based discrimination. These findings suggest that weight-based discrimination may be an important-and preventable-risk factor for disordered eating behaviors among sexual minority young adults.

The prospective relationship between weight-based discrimination and eating pathology among youth

Among adults and adolescents, weight-based discrimination is associated with disordered eating. However, these relationships remain understudied in children. Given that weight-based discrimination is commonly reported among youth, and that childhood is a crucial developmental period for the onset of disordered eating, the current study assessed prospective associations between weight-based discrimination and eating pathology among participants in the Adolescent Brain Cognitive Development Study. At the one-year visit, children indicated whether they had experienced discrimination due to their weight within the past year. Parents completed a computerized clinical interview to determine the presence of sub-or-full threshold eating disorders (AN, BN, and BED) among their children. At the two-year visit, children completed the same assessment. Height and fasting weight were obtained. Logistic regressions, adjusting for age, sex, race/ethnicity, family income, BMI%ile, and parent-reported presence of the respective eating disorder at one-year, were conducted to assess the associations between weight-based discrimination and eating pathology. Participants were 10,299 children who completed measures at both the one- and two-year visits (Mage at one-year: 10.92 ± 0.64, 47.6 % female, 45.9 % racial/ethnic minority). The presence of weight-based discrimination, reported by 5.6 % (n = 574) of children, was significantly associated with a greater likelihood of reporting AN, BN, and BED one-year later (ORs: 1.94–4.91). Findings suggest that weight-based discrimination may confer additional risk for the onset of disordered eating, above and beyond the contribution of body weight. Intersectional research is needed to examine the role of multiple forms of discrimination in relation to the development of eating pathology.

Food insecurity, weight-based discrimination, weight self-stigma, and mental health in post-bariatric surgery patients

The United States Department of Agriculture defines food insecurity (FI) as reduced quality and variety of diet or overall reduced food intake. To date, limited research has investigated the relationship between FI, weight stigma, and bariatric surgery. The existing literature suggests that FI in bariatric surgery patients is significantly associated with being a person of color, depression, receiving Medicare or Medicaid, and higher eating disorder (ED) pathology. Research also suggests that weight stigma in bariatric surgery patients is associated with worsened weight loss outcomes. No research to our knowledge has investigated FI, internalized weight stigma, weight-based discrimination, and history of bariatric surgery in one sample. Bariatric surgery patients in this study (N = 266) reported elevated rates of FI relative to the general population, via an online questionnaire. Those with FI also reported higher rates of depression, anxiety, ED pathology, internalized weight stigma, and experiences of weight-based discrimination compared to those who were food secure. Given these findings, bariatric surgical centers should evaluate all potential patients for FI before surgery and, at the bare minimum, provide additional support before and post-surgery. The ethics of conducting bariatric surgery in those with FI who lack significant medical comorbidity also must be considered.

Cancer prevention in females with and without obesity: Does perceived and internalised weight bias determine cancer prevention behaviour?

Women with obesity are not only at higher risk of developing cancer such as gynaecological malignancies but are also less likely to attend cancer prevention screenings (CPS). In this study, we aimed to obtain a better database for Germany and to investigate whether women with obesity are less likely to undergo CPS compared to women without obesity. Moreover, we aimed to identify factors that determine CPS behaviour. A quantitative cross-sectional telephone survey was conducted that assessed data of 1003 females in the general public with obesity (BMI ≥ 30kg/m2; n = 500) and without obesity (BMI < 30kg/m2; n = 503). We assessed participants' utilisation of cervical, breast, and colorectal CPS. Group differences were investigated by using Chi-Square tests, whereas influencing factors that might determine CPS behaviour were examined by multivariate logistic regression analyses. Therefore, logistic regression models for (a) the full sample and (b) the obese sample were conducted. Explanatory factors (i.e., cancer awareness, the internalisation of weight bias (WBIS) and perceived weight-based discrimination) were included. Confounding factors such as sociodemographic variables were included in the multivariate analysis. Women with obesity were less likely to undergo Pap smear (χ2(1) = 13.90, p < 0.001) and clinical breast examination (χ2(4) = 14.41, p < 0.01) compared to women without obesity. In contrast, the utilisation of all other CPS methods did not differ between women with and without obesity. Logistic regression analyses revealed neither an association between CPS behaviour and WBI nor perceived weight bias. Instead, previous cancer diagnoses and knowledge about CPS forms were found to reinforce CPS behaviour. Although data did not suggest that internalised or perceived weight bias deter women with obesity from undergoing CPS, the role of weight bias has not yet been conclusively clarified. Future studies should address potential methodological limitations and evaluate the effectiveness of most recently established cancer prevention programs and in particular how they affect CPS behaviour in women with obesity.