Journal Watch: Obesity and Weight Stigma/Bias

| April 1, 2017

Missing the target: including perspectives of women with overweight and obesity to inform stigma-reduction strategies.
Puhl RM, Himmelstein MS, Gorin AA, Suh YJ. Obes Sci Pract. 2017;3(1):25–35.
Synopsis: Pervasive weight stigma and discrimination have led to ongoing calls for efforts to reduce this bias. Despite increasing research on stigma-reduction strategies, perspectives of individuals who have experienced weight stigma have rarely been included to inform this research. The present study conducted a systematic examination of women with high body weight to assess their perspectives about a broad range of strategies to reduce weight-based stigma.
Women with overweight or obesity (N = 461) completed an online survey in which they evaluated the importance, feasibility and potential impact of 35 stigma-reduction strategies in diverse settings. Participants (91.5% who reported experiencing weight stigma) also completed self-report measures assessing experienced and internalized weight stigma.

Most participants assigned high importance to all stigma-reduction strategies, with school-based and healthcare approaches accruing the highest ratings. Adding weight stigma to existing anti-harassment workplace training was rated as the most impactful and feasible strategy. The family environment was viewed as an important intervention target, regardless of participants’ experienced or internalized stigma.

These findings underscore the importance of including people with stigmatized identities in stigma-reduction research; their insights provide a necessary and valuable contribution that can inform ways to reduce weight-based inequities and prioritize such efforts.
PMID: 28392929

Can raising awareness about the psychological causes of obesity reduce obesity stigma?
Khan SS, Tarrant M, Weston D, Shah P, Farrow C. Health Commun. 2017 Feb 19:1–8.
Synopsis: Obesity stigma largely remains a socially acceptable bias with harmful outcomes for its victims. While many accounts have been put forward to explain the bias, the role of obesity etiology beliefs has received little scrutiny. The research examined the effect that beliefs about the psychological etiology of obesity have on the expression of obesity stigma and the mechanisms underpinning this effect. Participants (N = 463) were asked to evaluate a target person with obesity after reading one of three possible etiologies: psychological, genetic, or behavioral. The presentation of a psychological etiology of obesity elicited less prejudice compared to behavioral causes but greater prejudice compared to genetic causes; observed differences were found to be a function of the agency ascribed to the target’s obesity and empathy expressed for the target. The findings highlight the impact that communicating obesity in terms of psychological causes can have for the expression of obesity stigma.
PMID: 28278610

The role of stigma in weight loss maintenance among U.S. adults.
Puhl RM, Quinn DM, Weisz BM, Suh YJ. Ann Behav Med. 2017 Mar 1.
Synopsis: The authors examined the role of weight stigma—experienced and internalized—as a contributor to weight-loss maintenance and weight regain in adults.

A diverse, national sample of 2,702 American adults completed an online battery of questionnaires assessing demographics, weight-loss history, subjective weight category, experienced and internalized weight stigma, weight-monitoring behaviors, physical activity, perceived stress, and physical health. Analyses focused exclusively on participants who indicated that their body weight a year ago was at least 10 percent less than their highest weight ever (excluding pregnancy), the weight loss was intentional, and that attempts to lose or maintain weight occurred during the past year (n = 549). Participants were further classified as weight regainers (n = 235) or weight-loss maintainers (n = 314) based on subsequent weight loss/gain. Data were collected in 2015 and analyzed in 2016.

Hierarchical logistic regression models showed that internalized weight stigma and subjective weight category made significant individual contributions to prediction of weight-loss maintenance, even after accounting for demographics, perceived stress, experienced stigma, physical health, and weight-loss behaviors. For every one-unit increase in internalized weight stigma, the odds of maintaining weight loss decreased by 28% (95% CI: 14-40%, p < .001).
Findings provide initial evidence that overlooked psychosocial factors, like weight stigma, may hinder weight-loss maintenance. Implications for addressing stigma in obesity-focused clinical interventions are highlighted.
PMID: 28251579

The effects of obesity-related health messages on explicit and implicit weight bias.
Rudolph A, Hilbert A. Front Psychol. 2017;7:2064.
Synopsis: The pervasiveness of explicit and implicit weight bias (WB) defined as negative stereotypes and prejudice regarding one’s weight has been observed among individuals of all weight categories. As a source of WB, health messages have been discussed due to reinforcing stigmatizing notions. The present study sought to investigate whether health messages (i.e., eat healthy, become physically active) have the potential to increase explicit and implicit WB.

Participants (N = 144) from the community were randomized to either an experimental group (EG) or a control group (CG). While the EG was presented with health messages, the CG was presented with neutral information. Before and after manipulation, participants completed measures of explicit and implicit WB. Paired samples t-test revealed no differences in explicit WB after manipulation, however, a small effect decrease of implicit WB in the EG but not in the CG was found. This study provided evidence that health messages might have differential impact to change WB. According to dual-model approaches, explicit and implicit WB tap into two different information processing systems, and thus were differentially affected by health messages. Brief exposure to health messages might have the potential to contribute to health behavior and to mitigate implicit WB.
PMID:  28123375

Nurses’ weight bias in caring for obese patients.
Tanneberger A, Ciupitu-Plath C. Clin Nurs Res. 2017 Jan 1:1054773816687443.
Synopsis: This study aimed to explore whether nurses’ weight controllability beliefs influence their perception of how care is provided to obese patients. To this end, 73 nurses from an acute care hospital completed the Weight Control/Blame Subscale of the Antifat Attitudes Test and reported on their perception of discrimination in, and available resources for, the provision of care to obese patients. Nurses endorsing stronger beliefs that weight lies under individual control were more likely to report discrimination of obese patients in clinical practice. Weight bias, higher care intensity, and lack of necessary resources were the main reasons reported for perceived weight discrimination. The authors concluded that the results support theories placing internal attribution of overweight and conflict over resources at the origin of weight stigma and call for appropriate interventions to improve nurses’ work environment and reduce their weight bias.
PMID:  28052689

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