Weight Bias Research Articles

Fat Liberation in the Singing Voice Studio

ABSTRACT In recent years, creating a sense of belonging for marginalized identities within singing voice pedagogy has increased in both visibility and cultural importance. Support and resources on the practice of cultural humility have bolstered the role of social justice in singing voice studios and called attention to the link between affirming students’ identities and their ability to access their fullest artistic expression. However, body size is still often left out of conversations about social justice. If teachers wish to be considered progressive and inclusive, there is a duty to lead the charge for fat liberation within singing voice pedagogy. Through the voices of 66 singers who identify as fat, this article details how anti-fat bias can manifest in the voice studio and identifies common pedagogical practices that have historically failed to serve fat singers. Underpinned by data from 66 interviews, recommendations for dismantling implicit anti-fat bias, working inclusively within the studio and beyond, and advocating for systemic change will be made. The article concludes with specific guidance on how to become a fat liberationist so that students of every body size may find a true sense of belonging in the singing voice studio.

Enhancing Battery Capacity Estimation Accuracy through the Neural Network Algorithm

Accurate estimation of battery metrics, such as state of health (SOH), is crucial for effective battery management systems (BMS) due to capacity degradation over time. This paper proposes a methodology to enhance battery capacity estimation accuracy by addressing uncertainties related to state of charge (SOC) estimation and measurement. The methodology employs the Neural Network Algorithm (NNA), an optimization algorithm inspired by artificial neural networks (ANNs). The NNA generates an initial population of pattern solutions and iteratively updates them using a weight matrix, bias operator, and transfer function operator. By combining the advantages of ANNs and optimization techniques, the NNA aims to find an optimal solution considering interdependent variables and incorporating global and local feedbacks. Leveraging the capabilities of the NNA, our objective is to identify the candidate that minimizes a specified cost function, ensuring up-to-date cell capacity through a memory forgetting factor. The algorithm's precision was validated using NASA's Prognostic Data, demonstrating outstanding performance by surpassing two aggressive algorithms in terms of accuracy. In the most severe case scenario, the algorithm achieved a peak error of less than 0.4%. Furthermore, the algorithm consistently demonstrated predictive performance measures that were superior to those of the compared algorithms.

Emotion in Motion: Weight Bias Internalization, Exercise Avoidance, and Fitness-Related Self-Conscious Emotions.

Weight bias internalization (WBI), the process of internalizing negative attitudes and stereotypes towards overweight individuals, significantly impacts self-worth and health behaviors, such as exercise avoidance. In the current study, we focused on the mediating role of fitness-related self-conscious emotions, particularly shame and guilt. A cross-sectional study involving 150 self-described overweight Dutch women (age M = 49.63 ± 10.72) was conducted online. Participants completed measures assessing weight bias internalization, exercise avoidance, and body/fitness-related self-conscious emotions. Data were analyzed using linear regression and mediation analysis, controlling for age, BMI, and exercise frequency. The results show that weight bias internalization, guilt-free shame, and shame-free guilt uniquely predict exercise avoidance. Guilt-free shame partially mediated the relationship between weight bias internalization and exercise avoidance, indicating that increased internalized weight bias led to higher levels of guilt-free shame, which in turn contributed to exercise avoidance. Shame-free guilt did not act as a unique mediator. These findings underscore the importance of addressing weight bias internalization and fitness-related self-conscious emotions, particularly guilt-free shame, in interventions targeting exercise avoidance among overweight individuals. Strategies promoting self-compassion and reducing shame may prove beneficial in improving exercise behaviors and overall well-being.

Does a person's body size and the application type influence healthcare students' perceptions of technologies to promote physical activity? Findings from a cross-sectional study

BackgroundRecent evidence suggests that weight bias may be pervasive, even among health professionals specialized in obesity, including healthcare students. Technology-based physical activity interventions are promising for people with obesity, specifically when they are theory-driven (e.g., autonomy-supportive as described by self-determination theory). However, perceptions of these technologies have been understudied among healthcare students and professionals. ObjectiveThe purpose of this study was to examine the influence of a person's body size based on body mass index and technology type on healthcare students' perceptions. DesignThis is a cross-sectional, experimental study. Participants and methodsFive hundred and two healthcare students (360 females, 142 males; mean age = 23.3, SD = 5.0) were randomly exposed to one of four scenarios that manipulated a hypothetical person's body mass index (22 kg/m2 vs. 42 kg/m2) and a technology-based physical activity type based on self-determination theory (autonomy-supportive app vs. controlling app). They then completed measures of their perceptions of the person's app acceptability and self-efficacy and of their intention to recommend the app. Multivariate and univariate analyses of covariance were performed. ResultsStudents exposed to the larger-bodied people (42 kg/m2) versus the smaller-bodied people (22 kg/m2) perceived a lower level of person's app acceptability (i.e., higher social influence and less enjoyment in using the app), as well as a lower level of self-efficacy to use the technology. Students exposed to the controlling app were more likely to recommend it compared to those exposed to the autonomy-supportive app. ConclusionsThese results suggest that healthcare students' attitudes may be negatively influenced by explicit weight bias. Also, in contrast to self-determination theory precepts, a controlling app may be more frequently recommended. Further study of healthcare students' implicit attitudes toward technology is needed.

Introducing a Weight-Inclusive Paradigm in Sport and Physical Education

The increased focus on preventing obesity in physical education spaces often leads to weight-centric ideology and anti-fat attitudes that subject fat students to weight stigma and can reduce their enjoyment of and engagement in physical activity. To promote lifelong physical activity and health among students, physical educators must reexamine their beliefs regarding weight as an indicator of both health and capacity for physical activity. This article discusses common misconceptions about the relationship between weight, health, and physical activity and provides examples and resources for educators to create a more weight-inclusive physical education program.

A qualitative exploration of the experiences of pregnant women living with obesity and accessing antenatal care.

Women are advised to optimise weight before pregnancy. However, many are either already living with overweight or obesity prior to becoming pregnant, increasing the risks for adverse outcomes. Health care professionals (HCP) are responsible for advising women of risks throughout and following pregnancy. However, midwives often find broaching the conversation around maternal obesity difficult. This study explored the experiences of pregnant women living with obesity in accessing antenatal care. Seventeen women completed a semi-structured interview. Transcripts were analysed thematically. Four themes were developed: 1) antenatal care is inconsistent, 2) additional support is needed, 3) women feel judged about their weight, and 4) weight cycling is highly prevalent. Findings suggest that pregnant women living with obesity often experience weight bias from HCPs, feel judged because of their weight and are left feeling confused and overlooked. Women reported inconsistencies in advice and care offered and acknowledged a lack of continuity of care throughout pregnancy. We call for an urgent need for further multidisciplinary training to address the concerns, experiences and needs of pregnant women living with obesity.

A Time When Bubbles Burst

An expanding body of work demonstrates that American food writing is extending its reach beyond pleasure and abundance to address systemic problems. It has gradually moved away from the practice of assigning status and value to certain foodways, a task predominantly performed by food authorities who did not reflect diverse backgrounds. Instead, recent food journalism engages in discussions regarding class, race, colonialism, ableism, weight stigma, labor rights, and immigration policies, among other pertinent social and political issues. Self-scrutiny is one of its distinguishing features. Much of this change was accelerated by the COVID-19 pandemic, which created the circumstances in which food writing became more self-reflexive and more likely to take a political stance. The central aim of this article is to center writings on restaurants to explore key insights from chefs and authors who explicitly reorient their work toward social justice. This shift can be identified in the Best American Food Writing series (2020–2021) and is supported by other contemporary works that discuss food and sociopolitical issues with an emphasis on the restaurant critic’s positionality. The article closes with a consideration of the long-term impact of the main reckoning that occurred in 2020.

Improving Weight Bias Awareness Among Providers in the Sexual and Reproductive Health care Setting.

Provider bias against patients of higher weights can contribute to poor health outcomes and decreased quality of care and patient experience. Addressing weight stigma in sexual and reproductive health settings is important, as these encounters can often be patients' only health care touchpoint. Health care providers must be educated about the harms of weight stigma, ways to recognize and confront their biases, and how to advocate for patients of all sizes. In this quality improvement project, Planned Parenthood health center providers participated in a three-part virtual workshop to improve provider weight bias awareness and understanding using the Health at Every Size framework. Providers completed a pre- and post-survey, as well as a 3-month follow-up survey to assess changes in bias awareness and confidence in applying weight-neutral principles in care interactions. Analysis of pre- and post-survey results showed significant improvements in provider awareness of bias as well as changes in implicit bias scores and confidence providing weight-neutral care. Educating providers about weight contributes to equity of care for patients of higher weights. Formal education such as workshops have the potential to reduce the harms of weight stigma in health care as changing attitudes and confidence are a precursor to behavior change. Research is needed to assess ideal education modalities and whether receiving care from weight bias-prepared providers affects patient outcomes and experiences.

Obesity.

Obesity is a common condition and a major cause of morbidity and mortality. Fortunately, weight loss treatment can reduce obesity-related complications. This review summarizes the evidence-based strategies physicians can employ to identify, prevent, and treat obesity, including best practices to diagnose and counsel patients, to assess and address the burden of weight-related disease including weight stigma, to address secondary causes of weight gain, and to help patients set individualized and realistic weight loss goals and an effective treatment plan. Effective treatments include lifestyle modification and adjunctive therapies such as antiobesity medications and metabolic and bariatric surgery.

A Feasible Estimation of a “Corrected” EQ-5D Social Tariff

ObjectivesTo demonstrate the feasibility of estimating a social tariff free of utility curvature and probability weighting biases and to test transferability between riskless and risky contexts. MethodsValuations for a selection of EQ-5D-3L health states were collected from a large and representative sample (N = 1676) of the Spanish general population through computer-assisted personal interviewing. Two elicitation methods were used: the traditional time trade-off (TTO) and a novel risky-TTO procedure. Both methods are equivalent for better than death states, which allowed us to test transferability of utilities across riskless and risky contexts. Corrective procedures applied are based on rank-dependent utility theory, identifying parameter estimates at the individual level. All corrections are health-state specific, which is a unique feature of our corrective approach. ResultsTwo corrected value sets for the EQ-5D-3L system are estimated, highlighting the feasibility of developing national tariffs under nonexpected utility theories, such as rank-dependent utility. Furthermore, transferability was not supported for at least half of the health states valued by our sample. ConclusionsIt is feasible to estimate a social tariff by using interviewing techniques, sample sizes, and sample representativeness equivalent to prior studies designed to generate national value sets for the EQ-5D. Utilities obtained in distinct contexts may not be interchangeable. Our findings caution against routinely taking transferability of utility for granted.

Shortcomings of Current PCOS Care: Provider Bias and Provider–Patient Goal Misalignment [ID 2683466

INTRODUCTION: Polycystic ovary syndrome (PCOS) affects 5–7 million people. Diagnosis is often only achieved after long delays and multiple opinions. We conducted focus groups to elucidate patient experience with diagnosis and treatment in PCOS. METHODS: We conducted semistructured virtual focus groups of individuals with diagnosed or suspected PCOS recruited from a university hospital obstetrics and gynecology clinic. Questions focused on experiences of bias in PCOS care and opportunities to improve care approaches. Rapid qualitative analysis of focus group transcripts was performed. RESULTS: Participants' (n=24) median age was 29 years. Three were non-White, eight Hispanic or Latino ethnicity, and one other than female gender. Provider bias influenced PCOS diagnosis: PCOS testing was delayed in those with smaller bodies, while symptoms of participants with larger bodies were attributed to body weight rather than to medical conditions. Provider recommendations were frequently misaligned with patients' needs and goals: Providers focused on weight loss when other approaches were requested, and fertility was centered, even for patients not desiring childbearing. Providers assumed and mistrusted patient reports of health behaviors: Larger body size was assumed to imply poor dietary habits and sedentary lifestyle. Participants frequently self-advocated to access testing, alternate treatments, and specialists. Conceptualizations of ideal PCOS care included centering patients' goals, access to specialists, and care coordination. Participants desired PCOS education, resources, and support for themselves and their communities. CONCLUSION: Provider bias and misalignment with patients' goals are common experiences in PCOS care. Centering patients’ goals, addressing weight bias, and creating additional PCOS educational and support resources are earnestly needed.

Reducing weight bias and stigma in qualitative research interviews: Considerations for researchers.

Perceptions and biases influence how we interact with and experience the world, including in professional roles as researchers. Weight bias, defined as negative attitudes or perceptions towards people that have large bodies, can contribute to weight stigma and discrimination leading to negative health and social consequences. Weight bias is experienced by people living with obesity in media, health care, education, employment and social settings. In research settings, there is potential for weight bias to impact various aspects of qualitative research including the participant-researcher dynamic in interviews. However, evidence-based strategies to reduce weight bias in qualitative research interviews have yet to be identified. We discuss how weight bias may influence research interviews and identify several considerations and strategies for researchers to minimize the impact of weight bias. Strategies include practicing reflexivity, planning and conducting interviews in ways that support rapport building, using inclusive language, and considering participatory methods.

The relationship between weight stigma, self-esteem, and life satisfaction in individuals seeking bariatric surgery

Objective: Stigma is a mark that defines some people, devalues, and causes them to be distinguished from others in society. Obesity is among the diseases that might cause discrimination and stigmatization. This study aimed to evaluate the relationship between weight stigma, self-esteem, and life satisfaction in people with a bariatric surgery history. Method: This cross-sectional study was evaluated in 250 individuals [147 female (58.8%) and 103 male (41.2%)] with a mean age of 34.35 ± 7.46 years. Descriptive characteristics, the factors leading to bariatric surgery, self-esteem, and life satisfaction scores were collected with a questionnaire. Linear regression models for the life satisfaction scale were analyzed. Statistically, P < 0.05 values were considered significant. Results: The postgraduates had lower life satisfaction than high school and undergraduate students (P=0.001); the non-smokers had higher life satisfaction than smokers or who quit smoking (P=0.036) and also non-alcoholics had higher life satisfaction than the other groups who consume alcohol or quit consuming (P=0.000). The self-esteem of the non-smokers was higher than smokers or who quit smoking (P=0.000). The postoperative body weight loss of the individuals was 93.8 ± 31.3 kg. Accordingly, most of the individuals (98.4%) applied for surgery because of a “fear of health problems”, 98.8% of the individuals were “experiencing exclusion or discrimination at school or work”, 99.2% of the individuals were “feeling insecure about the opinions of others” and “being blamed by people for weight problems”. The self-esteem score of the overweight group was higher than the group with normal BMI values (P=0.012). According to the regression model, weight loss and self-esteem were among the determinants of life satisfaction (P=0.000). Conclusion: The current data suggest that strategies to reduce stigma behavior should be developed in addition to lifestyle interventions, including dietary approaches, in the treatment of obesity. It is necessary to conduct follow-up studies on this subject, which span the time before and after bariatric surgery.

Applying self-determination theory to internalized weight stigma and mental health correlates among young and middle adult women: A structural equation model.

Limited research has explored the relationship between self-determination theory constructs (basic psychological needs, autonomous/controlled regulation) and internalized weight stigma (IWS). This cross-sectional, online study surveyed 480 U.S. women aged 18-40 between 2021 and 2022. We hypothesized that need frustration and controlled weight regulation would relate to higher IWS, which would be associated with dysfunctional eating, distress, and lower life satisfaction. Conversely, we predicted that need satisfaction, autonomous regulation, and body satisfaction would be associated with reduced IWS, dysfunctional eating and distress, and higher life satisfaction. Structural equation modeling demonstrated an acceptable model fit (CMIN/DF = 2.95, CFI = 0.90, RMSEA = 0.06, SRMR = 0.07), accounting for 74% of IWS variance. Findings indicate the relevance of self-determination theory in understanding IWS, supporting a dual-process model whereby adverse and adaptive outcomes follow distinct pathways. Longitudinal studies are warranted to validate psychological needs and regulatory styles as mechanisms for IWS development and to assess generalizability across diverse populations.

Exploring the association between internalized weight bias and mental health among Canadian adolescents.

Internalized weight bias (IWB) has been identified as a correlate of higher depressive and anxiety symptoms in adolescents with higher weights. However, there has been limited investigation into how IWB relates to positive mental health and whether these associations differ across genders. To examine the associations between IWB and mental health (depression, anxiety, flourishing) in adolescents with higher weights, and to test the potential moderating role of gender. Canadian adolescents with higher weights (N = 7538, 60% boys, 36% girls, 4% gender diverse, ages 12-19) from the COMPASS study completed a survey during the 2021-2022 school year. Data were analysed using generalized linear models. Highest IWB and poorest mental health were noted within gender diverse adolescents, followed by girls then boys. Gender moderated the relationship between higher IWB and higher depression, higher anxiety and lower flourishing, with the strongest relationships noted among girls. IWB interventions should be tailored to gender subgroups that may be particularly vulnerable to maladaptive mental health outcomes associated with IWB. System-level changes that mitigate perpetuation of weight bias and discrimination which lead to IWB are also essential, particularly for girls.

Weight Inclusive Thinking for Fitness Spaces (WIT FITS): A Three-Month Follow-Up of a Weight Stigma Intervention for Exercise Professionals

Among the few interventions that exist to decrease weight stigma in exercise settings, none include a long-term follow-up to assess if changes are sustained. The aim of this study was to assess if a weight stigma intervention that showed success in improving fat attitudes among university recreation center professionals had sustained effects after three months, compared to a control group. Participants were 46 university recreation center professionals who took the Fat Attitudes Assessment Toolkit before completing a two-hour self-paced online intervention or control course, after course completion, and at a three-month follow-up. At follow-up, participants in the intervention group showed significant improvement in total fat attitudes, F(2, 88) = 7.94, p < .001, η2p = 0.15 and in fat acceptance, F(2, 88) = 4.25, p = .017, η2p = 0.09. Future studies should further develop interventions and assess results in larger samples and after longer periods of time.

“This isn’t a high-risk body”: Reframing Risk and Reducing Weight Stigma in Midwifery Practice

This article investigates the standards of care for fat recipients of midwifery care through a lens that questions common risk-focused narratives related to fat pregnant bodies. Throughout this article, we use the term "fat" rather than "obese" or "overweight". We avoid the language of obese/overweight because these medicalized terms are used to stigmatize fat people. Working from a fat liberation standpoint involves reclaiming the word “fat” as a morally-neutral descriptive term for larger bodies. Drawing on data from a research project exploring weight stigma during pregnancy care, we present findings from eleven interviews with fat parents including those who identify as women or transmen who accessed midwifery care during their pregnancy and/or childbirth experiences. Participants had both positive and negative experiences with midwives, often within the same care relationship. Related to weight specifically, many participants reported that midwives focused on the risk factors often associated with being fat while pregnant, even when their clients did not display signs of these risks. We discuss how practitioners—particularly midwives—might shift away from an anti-obesity, risk-based narrative. Instead, practitioners might acknowledge the potential risks of fatness during pregnancy while simultaneously honouring fat individuals' embodied realities and treating fat clients with respect to facilitate positive pregnancy and birthing experiences. This article has been peer reviewed.

Reducing anti-fat bias toward the self and others: a randomized controlled trial

Despite strong evidence linking anti-fat bias directed toward others with markers of self-directed anti-fat bias, there is a dearth of theory-based research examining the cognitive pathways underlying this relationship, and existing bias-reduction intervention efforts have thus far been conducted with exclusive focus on one domain or the other. Cognitive dissonance (CD)-based interventions have been identified as viable for reducing anti-fat bias directed toward the self and others. However, no study has yet examined whether the effects of these domain-specific interventions (e.g., anti-fat bias towards the self) extend to anti-fat bias in the non-targeted domain (e.g., anti-fat bias towards others). The present study aimed to address these gaps in the literature by comparing effects of brief CD-based interventions targeting anti-fat bias directed toward either the self or others on measures of anti-fat bias. Participants (N = 197, female-identifying undergraduates) were randomized to a writing activity prompting cognitive dissonance about either self-directed or other-directed anti-fat bias, or a bias-consistent control condition. Results indicated that participants in the CD intervention conditions showed significantly greater reductions in both explicit self- and other-directed anti-fat biases than those in the control condition, but results did not significantly differ across CD conditions. This supports the potential utility of interventions simultaneously targeting anti-fat bias in both domains and provides insight into the cognitive pathways underlying these related forms of bias.

Mitigating Weight Stigma: A Randomized Controlled Trial Addressing Obesity Prejudice through Education among Healthcare Undergraduates

Beyond the challenges presented by obesity itself, a considerable portion of the population encounters prejudice and discriminatory behavior based on their weight and size. This phenomenon, termed weight stigma and weight bias, appears to be perpetuated not only by the broader society but also by healthcare providers, leading to distrust and alienation among individuals with obesity, thereby exacerbating a global issue. Recognizing weight stigma as a violation of human rights and its association with declining health outcomes, there is a pressing need to explore evidence-based strategies for mitigating it within healthcare. This is especially crucial at the early stages of professional development. Methodology: A randomized controlled trial employing a 60 min lecture experimental design was conducted to evaluate changes in conceptions, beliefs, and prejudices toward obesity among healthcare undergraduates (n = 242). Results: Semantic network analysis revealed participants’ conceptualization of obesity as a condition closely linked to diet and sedentary habits. Moreover, three out of four healthcare students considered obesity a disease for which the individual is responsible. While individuals with obesity were described as weak, lazy, and having a high affinity for food, these prejudices decreased following the educational intervention. Conclusion: Following an educational intervention based on the multifactorial nature of obesity and weight stigma, it was possible to modify prejudices and conceptions about obesity among future healthcare professionals.

Target Weight and Gender Moderate Anti-Black Bias in Pain Perception

Perceivers recognize pain less readily on Black (vs. White) faces in the United States. The present work investigated whether this perceptual bias is moderated by target weight and gender across three experiments. Anti-Black bias in pain perception was mitigated within heavier-weight (vs. average-weight) male-appearing targets (Experiment 1) but was independent of female-appearing targets’ weight (Experiment 2). A well-powered, pre-registered Experiment 3 replicated these findings, confirming that target weight and gender interactively shaped anti-Black bias in pain perception: target weight moderated perceptual bias within male-appearing (but not female-appearing) faces. These findings help illuminate factors that interact to shape racial bias in pain perception and demonstrate the importance of intersectionality when studying social perceptual biases.